Cerebral palsy (CP) is caused by a lesion in the developing infant brain. Recent neuroplasticity literature suggests that intensive, task-specific intervention ought to commence early, during the critical period of neural development. To determine whether GAME (Goals Activity Motor Enrichment), a motor learning, environmental enrichment intervention, is effective for improving motor skills in infants at high risk of CP. Single blind randomised controlled trial of GAME versus standard care. Primary outcome was motor skills on the Peabody Developmental Motor Scales-2 (PDMS-2). Secondary outcomes included Canadian Occupational Performance Measure (COPM), Bayley Scales of Infant and Toddler Development (BSID-III) and Gross Motor Function Measure-66 (GMFM-66). Outcome assessors were masked to group allocation and data analyzed with multiple regression. All n = 30 infants enrolled received the assigned intervention until 16 weeks post enrolment. At 12 months of age, n = 26 completed assessments. Significant between group differences were found in raw scores on the PDMS-2 in favour of GAME (B = 20.71, 95%CI 1.6639.76, p = 0. 03) and at 12 months on the total motor quotient (B = 8.29, 95%CI 0.1316.45,p = 0.05). Significant between group differences favored GAME participants at 12 months on the cognitive scale of the BSID-III and satisfaction scores on the COPM. GAME intervention resulted in advanced motor and cognitive outcomes when compared with standard care.
► MBT-AS is examined in adults with ASD, results are compared to a wait-list group. ► Adults with ASD show reduced anxiety, depression and rumination after MBT-AS. ► Results show an increase in positive affect after MBT-AS. ► Adults with ASD seem to benefit from MBT-AS. Research shows that depression and anxiety disorders are the most common psychiatric concern in autism spectrum disorders (ASD). Mindfulness-based therapy (MBT) has been found effective in reducing anxiety and depression symptoms, however research in autism is limited. Therefore, we examined the effects of a modified MBT protocol (MBT-AS) in high-functioning adults with ASD. 42 participants were randomized into a 9-week MBT-AS training or a wait-list control group. Results showed a significant reduction in depression, anxiety and rumination in the intervention group, as opposed to the control group. Furthermore, positive affect increased in the intervention group, but not in the control group. Concluding, the present study is the first controlled trial to demonstrate that adults with ASD can benefit from MBT-AS.
Multimorbidity may be related to the supposed early aging of people with intellectual disabilities (ID). This group may suffer more often from multimorbidity, because of ID-related physical health conditions, unhealthy lifestyle and metabolic effects of antipsychotic drug use. Multimorbidity has been defined as two or more chronic conditions. Data on chronic conditions have been collected through physical assessment, questionnaires, and medical files. Prevalence, associated factors and clusters of multimorbidity have been studied in 1047 older adults (≥50 years) with ID. Multimorbidity was prevalent in 79.8% and associated with age and severe/profound ID. Four or more conditions were prevalent in 46.8% and associated with age, severe/profound ID and Down syndrome. Factor analyses did not reveal a model for disease-clusters with good fit. Multimorbidity is highly prevalent in older adults with ID. Multimorbidity should receive more attention in research and clinical practice for targeted pro-active prevention and treatment.
Assessing social skills is one of the most complex and challenging areas to study because behavioral repertoires vary depending on an individual's culture and context. However, researchers have conclusively demonstrated that individuals with intellectual disabilities (ID) have impaired social skills as well as those with co-morbid autism spectrum disorders (ASD) and epilepsy. However, it is unknown how these groups differ. Assessment of social skills was made with the Matson Evaluation of Social Skills for Individuals with Severe Retardation. One hundred participants with ID were matched and compared across four equal groups comprising 25 participants with ID, 25 participants with epilepsy, 25 participants with ASD, and 25 participants with combined ASD and epilepsy. When controlling for age, gender, race, level of ID, and hearing and visual impairments, significant differences were found among the four groups on the MESSIER, Wilks's Λ = .58, (18, 257) = 3.05, < .01. The multivariate based on Wilks's Λ was .17. Significant differences were found on the Positive Verbal subscale, (3, 96) = 3.70, < .01, = .10, Positive Non-verbal subscale, (3, 96) = 8.95, < .01, = .22, General Positive subscale, (3, 96) = 7.30, < .01, = .19, Negative Non-verbal subscale, (3, 96) = 5.30, < .01, = .14, and General Negative subscale, (3, 96) = 3.16, < .05, = .09. Based on these results, individuals with ID expressing combined co-morbid ASD and epilepsy had significantly more impaired social skills than the ID only or groups containing only a single co-morbid factor with ID (ASD or epilepsy only). Implications of these findings are discussed.
This study assessed the prevalence and type of associated neuropsychiatric problems in children and adults with 22q11 deletion syndrome. One-hundred consecutively referred individuals with 22q11 deletion syndrome were given in-depth neuropsychiatric assessments and questionnaires screens. Autism spectrum disorders (ASDs) and/or attention deficit/hyperactivity disorder (ADHD) were diagnosed in 44 cases. ASD was diagnosed in 23 cases of whom only 5 had autistic disorder. ADHD was diagnosed in 30 individuals. In nine of these cases with ASD or ADHD there was a combination of these diagnoses. Mental retardation (MR) with or without ASD/ADHD was diagnosed in 51 individuals. ASD, ADHD, and/or MR were present in 67 cases. Females had higher IQ than males. The results of this study showed that the vast majority of all individuals with 22q11 deletion syndrome have behavior and/or learning problems and more than 40% meet criteria for either ASD, ADHD or both. Neuropsychiatric and neuropsychological evaluations are indicated as parts of the routine clinical assessment of individuals with 22q11 deletion syndrome.
This study explored whether or not a population-based sample of children with developmental coordination disorder (DCD), with and without comorbid attention deficit/hyperactivity disorder (ADHD), experienced higher levels of psychological distress than their peers. A two-stage procedure was used to identify 244 children: 68 with DCD only, 54 with ADHD only, 31 with comorbid DCD and ADHD, and 91 randomly selected typically developing (TD) children. Symptoms of depression and anxiety were measured by child and parent report. Child sex and caregiver ethnicity differed across groups, with a higher ratio of boys to girls in the ADHD only group and a slightly higher proportion of non-Caucasian caregivers in the TD group. After controlling for age, sex, and caregiver ethnicity, there was significant variation across groups in both anxiety (by parent report, (3,235) = 8.9, < 0.001; by child report, (3,236) = 5.6, = 0.001) and depression (parent report, (3,236) = 23.7, < 0.001; child report, (3,238) = 9.9, < 0.001). In general, children in all three disorder groups had significantly higher levels of symptoms than TD children, but most pairwise differences among those three groups were not significant. The one exception was the higher level of depressive symptoms noted by parent report in the ADHD/DCD group. In conclusion, children identified on the basis of motor coordination problems through a population-based screen showed significantly more symptoms of depression and anxiety than typically developing children. Children who have both DCD and ADHD are particularly at heightened risk of psychological distress.
► Obesity as measured by BMI is more prevalent in older people with intellectual than in the general population. ► Using waist circumference and waist-to-hip ratio more obesity than overweight is found in older people with ID, which indicates cardiovascular morbidity risk. ► Risk groups are women, people with higher age, less severe ID, more independent functioning, Down syndrome, less physical activity and use of atypical antipsychotics. Overweight and obesity are major health problems associated with increased cardiovascular disease risk, which is not sufficiently studied in people with intellectual disability yet. The present study was part of the Healthy Ageing in Intellectual Disability (HA-ID) study. The aim of this study was to establish (1) the prevalence of overweight, obesity and body fat percentage in older people with intellectual disability (ID) through measurement of Body Mass Index (BMI), waist circumference, waist-to-hip ratio (WHR) and skin fold thickness, and compare this with prevalence of overweight and obesity in the general population, and (2) the association of overweight and obesity with participant and treatment characteristics (gender, age, level of ID, Down syndrome, autism, independent living, smoking, (instrumental) activities of daily living ((I)ADL), physical activity and use of atypical antipsychotic medication) using regression analyses. In this cross-sectional study 945 persons, aged 50 and over with borderline to profound ID, living in central settings, in community settings and independently were included. Overweight and obesity were highly prevalent, with more obesity (26%) than in the general Dutch older population (10%) as measured by BMI, and 46–48% obesity as measured by waist circumference and WHR respectively. Women, people with Down syndrome, higher age, less severe ID, autism, people who are able to eat independently, preparing meals and doing groceries independently, people with physical inactivity and use of atypical antipsychotics were significantly more at risk of being overweight or obese. This merits specific actions by policy makers and clinical practice to improve health outcomes.
We developed an Internet survey to identify treatments used by parents of children with autism. The survey listed 111 treatments and was distributed via colleagues and through chapters of the Autism Society of America and Autism Organizations Worldwide. A total of 552 parents submitted usable returns during the 3-month survey period. On average the parents reported using seven different treatments. The number of treatments used varied as a function of the child's age and type/severity of disability within the autism spectrum. Speech therapy was the most commonly reported intervention, followed by visual schedules, sensory integration, and applied behavior analysis. In addition, 52% of parents were currently using at least one medication to treat their child, 27% were implementing special diets, and 43% were using vitamin supplements. Because parents were using a large number of treatments, many of which lack empirical support, future research should focus on understanding the decision-making processes that underlie treatment selection by parents of children with autism.
► Variables across all ICF levels are associated with participation in leisure. ► Child- related variables seem to be the most important for participation. ► Similar variables seem to be associated to participation across diagnostic groups. ► Age is an important factor for participation in leisure activities. ► More research is needed to find variables related to participation for various ages. In 2001 the International Classification of Functioning (ICF) defined participation as ‘someone's involvement in life situations’. Participation in leisure activities contributes to the development of children and their quality of life. Children with physical disabilities are known to be at risk for participation in fewer activities. The group of children with physical disabilities is highly heterogeneous consisting of children with different diagnosis and different ages. This systematic review aims to analyse the literature for the purpose of looking for variables involved in the frequency of participation in leisure activities for children and youth with different diagnoses and ages. Frequency of participation in leisure activities for children and youth with physical disabilities is associated with a variety of variables. Gross motor function, manual ability, cognitive ability, communicative skills, age and gender are the most important variables. The current evidence suggests that similar variables seem to apply to children with different diagnoses. Age is an important variable in participation of children and youth. However evidence about those variables associated with children at different ages is still lacking.
A number of studies have investigated procedural learning in dyslexia using serial reaction time (SRT) tasks. Overall, the results have been mixed, with evidence of both impaired and intact learning reported. We undertook a systematic search of studies that examined procedural learning using SRT tasks, and synthesized the data using meta-analysis. A total of 14 studies were identified, representing data from 314 individuals with dyslexia and 317 typically developing control participants. The results indicate that, on average, individuals with dyslexia have worse procedural learning abilities than controls, as indexed by sequence learning on the SRT task. The average weighted standardized mean difference (the effect size) was found to be 0.449 (CI : .204, .693), and was significant ( < .001). However, moderate levels of heterogeneity were found between study-level effect sizes. Meta-regression analyses indicated that studies with older participants that used SRT tasks with second order conditional sequences, or with older participants that used sequences that were presented a large number of times, were associated with smaller effect sizes. These associations are discussed with respect to compensatory and delayed memory systems in dyslexia.
► This review identified 17 studies examining self stigma in people with intellectual disabilities and 20 studies of courtesy stigma in family carers. ► The studies on self stigma revealed that people are aware of being treated negatively, although stigma was not always internalised. ► Family carers reported negative attitudes from the public and from their family, often resulting in marginalisation. ► Both self stigma and courtesy stigma were associated with lower psychological wellbeing. ► There is a lack of large scale studies and longitudinal studies examining prevalence of self or affiliate stigma, and the effectiveness of interventions to reduce stigma. People with intellectual disability are one of the most stigmatised groups in society. Despite this, research in this area has been limited. This paper provides a review of studies examining self stigma in people with intellectual disability, and courtesy and affiliate stigma in family carers. An electronic search of studies published between 1990 and February 2012, using four databases and hand searching of journals was conducted. Thirty-seven papers were included in the review: 17 studies examined self stigma and 20 studies examined courtesy or affiliate stigma. The findings indicate that both individuals and family carers experience stigma and that it may have a negative impact on psychological wellbeing. Awareness of stigma in people with intellectual disability appears to be related to the extent to which individuals accept and internalise the label of intellectual disability. Most of the studies were qualitative studies or small descriptive studies. There is a lack of large prevalence studies and longitudinal studies examining the impact of stigma, in both individuals with intellectual disability and their carers.
► Reviewed twelve studies evaluating a parenting program for children with disability. ► Significant moderate effect sizes for reducing reported and observed child problems. ► Significant effect sizes on improving parenting styles, satisfaction/efficacy. ► Significant effect sizes on improving parental adjustment and parental relationship. ► Stepping Stones Triple P is an effective behavioral family intervention. This systematic review and meta-analysis evaluated the treatment effects of a behavioral family intervention, Stepping Stones Triple P (SSTP) for parents of children with disabilities. SSTP is a system of five intervention levels of increasing intensity and narrowing population reach. Twelve studies, including a total of 659 families, met eligibility criteria. Studies needed to have evaluated SSTP, be written in English or German, contribute original data, and have sufficient data for analyses. No restrictions were placed on study design. A series of meta-analyses were performed for seven different outcome categories. Analyses were conducted on the combination of all four levels of SSTP for which evidence exists (Levels 2–5), and were also conducted separately for each level of SSTP. Significant moderate effect sizes were found for all levels of SSTP for reducing child problems, the primary outcome of interest. On secondary outcomes, significant overall effect sizes were found for parenting styles, parenting satisfaction and efficacy, parental adjustment, parental relationship, and observed child behaviors. No significant treatment effects were found for observed parenting behaviors. Moderator analyses showed no significant differences in effect sizes across the levels of SSTP intervention, with the exception of child observations. Risk of bias within and across studies was assessed. Analyses suggested that publication bias and selective reporting bias were not likely to have heavily influenced the findings. The overall evidence base supported the effectiveness of SSTP as an intervention for improving child and parent outcomes in families of children with disabilities. Limitations and future research directions are discussed.
The goal of this study was to systematically examine group differences among adults with intellectual disabilities (ID), comorbid autism spectrum disorders (ASD), and epilepsy through a detailed exploration of the characteristics that these disorders present in the area of psychopathology. Previous studies indicating that individuals with ID have comorbid ASD and epilepsy tend to stop short of addressing these disorders’ impact on the full range of psychosocial issues, particularly in adult samples. Assessment of psychopathology was made with the ASD-comorbidity-adult version (ASD-CA). One hundred participants, with ID held constant, were matched and compared across four equal groups comprising 25 participants with ID, 25 participants with epilepsy, 25 participants with ASD, and 25 participants with combined ASD and epilepsy. When controlling for age, gender, race, level of ID, and hearing and visual impairments, results of the MANOVA revealed significant differences among groups, Wilks's = .76, (15, 254) = 1.82, < .05, = .09. A one-way ANOVA was conducted for each of the five subscales of the ASD-CA as follow-up tests to the MANOVA. Groups differed significantly Anxiety/Repetitive Behavior subscale, (3, 96) = 2.93, < .05, = .08, Irritability/Behavior excess subscale, (3, 96) = 4.74, < .01, = .13, Attention/Hyperactivity subscale, (3, 96) = 5.18, < .01, = .14, and Depressive Symptoms subscale, (3, 96) = 3.73, < .01, = .10. Trend analysis demonstrated that individuals with ID expressing combined comorbid ASD and epilepsy were significantly more impaired than the control group (ID only) or groups containing only a single comorbid factor with ID (ASD or epilepsy only). Implications of these findings elucidate the nature of these disorders and their influence on patient care and management.
This paper evaluates comprehensive psycho-educational research on early intervention for children with autism. Twenty-five outcome studies were identified. Twenty studies evaluated behavioral treatment, 3 studies evaluated TEACCH and 2 studies evaluated the Colorado Health Sciences Project. Outcome studies are graded according to their scientific value, and subsequently graded according to the magnitude of results documented in the studies. Based on the available evidence, treatment recommendations are made and practice parameters are suggested.
▶ Preschool auditory and speech perception impairments precede dyslexia in grade 3. ▶ FM sensitivity and speech-in-noise perception uniquely predict growth in reading. ▶ Longitudinal relations between auditory processing, speech perception and phonology. Developmental dyslexia is characterized by severe reading and spelling difficulties that are persistent and resistant to the usual didactic measures and remedial efforts. It is well established that a major cause of these problems lies in poorly specified phonological representations. Many individuals with dyslexia also present impairments in auditory temporal processing and speech perception, but it remains debated whether these more basic perceptual impairments play a role in causing the reading problem. Longitudinal studies may help clarifying this issue by assessing preschool children before they receive reading instruction and by following them up through literacy development. The current longitudinal study shows impairments in auditory frequency modulation (FM) detection, speech perception and phonological awareness in kindergarten and in grade 1 in children who receive a dyslexia diagnosis in grade 3. FM sensitivity and speech-in-noise perception in kindergarten uniquely contribute to growth in reading ability, even after controlling for letter knowledge and phonological awareness. These findings indicate that impairments in auditory processing and speech perception are not merely an epiphenomenon of reading failure. Although no specific directional relations were observed between auditory processing, speech perception and phonological awareness, the highly significant concurrent and predictive correlations between all these variables suggest a reciprocal association and corroborate the evidence for the auditory deficit theory of dyslexia.
► We studied parent–infant interaction in six-month-old infants with a sibling with ASD. ► Play interactions were rated for global parent, infant and dyadic characteristics. ► At-risk sibs were less lively than controls, possibly reflecting a trait difference. ► Parents of at-risk sib infants tended to have a more directive interactive style. ► Research must explore if disrupted interaction may amplify infant social atypicality. Recent models of the early emergence of autism spectrum disorder (ASD) propose an interaction between risk susceptibility and the infant's social environment, resulting in a progressively atypical developmental trajectory. The infant's early social environmental experience consists mostly of interaction with caregivers, yet there has been little systematic study of early parent–infant interaction in infants at risk of ASD. This study examined the global characteristics of parent–infant interaction in 6- to 10-month-old infants with an older sibling diagnosed with ASD (at-risk sibs), in comparison with a group of infants with no family history of ASD (low-risk sibs). As part of the British Autism Study of Infant Siblings (BASIS), 6-min videotaped unstructured play interactions of mother–infant dyads (45 at-risk sibs and 47 low-risk sibs) were rated on global aspects of parent–infant interaction, blind to participant information. Differences in global characteristics of interaction were observed in both infant and parent contributions in the at-risk group compared to low-risk controls. In analyses adjusted for age and developmental level, at-risk sib infants were less lively, and their parents showed higher directiveness, and lower sensitive responding (as a trend after adjustment). Level of infant liveliness was independent of other interactive behaviour. Consistent with reports in previous literature in older children with autism and in other neurodevelopmental disorders, our findings may suggest that infants at genetic risk are exposed to a more directive interactive style relatively early in infancy. We discuss possible explanations for these findings and implications for further developmental study and intervention.
The study of comorbid psychopathology among persons with autism spectrum disorder (ASD) is picking up steam. The purpose of this paper was to review and describe important characteristics of existing studies. Among the current crop of papers, depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) have been frequently evaluated. Groups studied have most frequently been children. Persons with ASD and normal intelligence quotient (IQ) scores have been studied more often than individuals with ASD and intellectual disability. Additional characteristics are discussed, and the implications of these data for future developments in the field are reviewed.
Parents of children with developmental disabilities (DD) are at increased risk of experiencing psychological stress compared to other parents. Children's high levels of internalizing and externalizing problems have been found to contribute to this elevated level of stress. Few studies have considered the reverse direction of effects, however, in families where a child has a DD. The present study investigated transactional relations between child behavior problems and maternal stress within 176 families raising a child with early diagnosed DD. There was evidence of both child-driven and parent-driven effects over the 15-year study period, spanning from early childhood (age 3) to adolescence (age 18), consistent with transactional models of development. Parent–child transactions were found to vary across different life phases and with different domains of behavior problems.
There is an abundance of research investigating Autism Spectrum Disorders (ASD) in children; however, little emphasis has been placed on ASD in adults, especially in regards to comorbid psychopathology. Although scales are available that measure comorbidity in adults with ID, what is needed are scales that measure comorbidity in adults with ID and ASD. One such scale is the newly developed Autism Spectrum Disorders-Comorbidity for Adults (ASD-CA). There are two purposes of this study. The first is to further develop the ASD-CA by calculating cutoff scores for its subscales. The second is to compare the frequency of symptom endorsements on the ASD-CA among three groups: individuals with ID; individuals with ID and ASD; and individuals with ID, ASD, and additional psychopathology.
► 50+ adults with intellectual disabilities have very low physical activity levels. ► Low physical activity levels are seen across the entire 50+ population with ID. ► Only the functionally more able 50+ adults with ID could be measured with pedometers. This study measures physical activity levels in a representative population-based sample of older adults (aged ≥50 years) with intellectual disabilities. For this, the steps/day of all 1050 participants of the Healthy Ageing and Intellectual Disabilities study (HA-ID; a study conducted among three Dutch healthcare providers in 2009–2010), were measured with a pedometer. Largely due to physical limitations ( = 103), walking speed <3.2 km/h ( = 252), limited understanding or non-cooperation ( = 233), only 257 of the group were able to participate in valid measurements with pedometers. Of these 257 participants, only 16.7% (95% CI 12.2–21.3) complied with the guideline of 10,000 steps/day, 36.2% (95% CI 30.3–42.1) took 7500 steps/day or more, and 39% (95% CI 32.6–44.5) was sedentary (<5000 steps/day). Because the measured sample was the more functionally able part of the total sample, this result is likely to be a considerable overestimation of the actual physical activity levels in this population. This realistic study shows that physical activity levels are extremely low in adults aged 50 years and over with intellectual disabilities. Focus on lifetime promotion of physical activity in this specific, but rapidly growing population, is recommended.