The relations between cognition and autism severity, head size and intervention outcome, were examined. Change in cognitive level with intervention was measured in children with autism and compared to children with developmental disabilities (DD). Eighty-one children (mean age 25.9 months) with autism ( = 44) and DD ( = 37) were assessed at pre- and post 1 year of intervention. Cognitive abilities and autism severity were measured by standardized tests. Three pre-intervention cognitive level groups: normal (IQ > 90), borderline (70 < IQ < 89) and impaired (50 < IQ < 69) were examined. The impaired group had more severe autism symptoms than the borderline and the normal cognitive groups. However, following intervention the groups did not differ in the change in core autism symptoms. IQ scores increased significantly more in the autism group than in the DD group. IQ improvements correlated significantly with reduction in autism symptoms and mostly in stereotyped behaviors. : Cognitive ability in autism is associated with autism severity. Two distinct subtypes based on cognitive level are identified. However, baseline cognitive level cannot predict the progress rate in autism symptoms with intervention. Improvement of social–communicative behaviors and the intensive intervention are related to significant cognitive increments in autism.
Autism spectrum disorders (ASD) are a class of conditions categorized by communication problems, ritualistic behaviors, and inappropriate social behaviors. While there is much evidence to support a genetic link for ASD, an identified genetic marker remains elusive. As such, practitioners place considerable emphasis on traditional measures of intelligence and adaptive behavior to aid in diagnosis. Despite the fact that these measures are commonplace, little research has been conducted to shed light on whether deficits in intellectual functioning affect the range of core symptoms for ASD. This study represents a first attempt to determine whether level of IQ has an effect on the expression of ASD symptoms in adults with intellectual disability (ID). Three hundred and six adults, 151 with both ASD and ID and 155 with ID alone, were evaluated with respect to the nature and extent of their ASD symptoms and intellectual functioning. Individuals with autism displayed a higher number of symptoms than those with pervasive developmental disorder-not otherwise specified (PDD-NOS) on all three domains of impairment (social, communication, repetitive behaviors). As expected, persons with ID alone evinced far fewer symptoms than both these groups. IQ level was found to be a moderator for expression of ASD symptoms for the entire sample but not for the autism group.
The relationship between behavior problems and psychiatric disorders in individuals with intellectual disability is still unresolved. The present study compares the prevalence and pattern of psychiatric disorders in individuals with intellectual disability who were assessed on the ABC to have moderate and severe behavior problems and a matched group of individuals without such problems. Both groups were living in community settings and had their intellectual disability varied from mild to profound degrees. The participants were screened for psychiatric disorders using four different instruments; the Reiss Screen, the Mini PAS-ADD, the DASH-II and the ADD. The group with moderate and severe behavior problems showed significantly more symptoms of psychiatric disorders than the group without such problems when items related to behavior disorders were omitted, and the majority of the participants with behavior problems had symptoms of the main psychiatric disorders. The participants with mild and moderate intellectual disability showed more symptoms of psychosis and depression than the participants with severe and profound intellectual disability. There were no direct associations between individual behavior problems and psychiatric disorders, but the group with mild/moderate intellectual disability showed a somewhat different pattern of associations than the group with severe/profound intellectual disability. Depression was associated with screaming and aggression in the participants with severe and profound intellectual disability, and with self-injury in the participants with mild and moderate intellectual disability. The finding that the majority of the participants with behavior problems showed symptoms of psychiatric disorders suggests that many behavior problems may be (unconventional) symptoms of psychiatric disorders or reflect a difficult life situation caused by a psychiatric disorders, or that a difficult life situation may contribute to both psychiatric disorders and behavior problems in individuals with intellectual disability.
The objective of this study was to examine injury risk in children with autism, ADD/ADHD, learning disability, psychopathology, or other medical conditions. Children aged 3–5 years who participated in the National Survey of Children's Health were included. Six study groups were analyzed in this report: autism ( = 82), ADD/ADHD ( = 191), learning disability ( = 307), psychopathology ( = 210), other medical conditions ( = 1802), and unaffected controls ( = 13,398). The weighted prevalence of injury in each group was 24.2% (autism), 26.5% (ADD/ADHD), 9.3% (learning disability), 20.5% (psychopathology), 14.6% (other medical conditions), and 11.9% (unaffected controls). Compared to unaffected controls, the risk of injury was 2.15 (95% confidence interval (CI): 1.00–4.60), 2.74 (95% CI: 1.63–4.59), 2.06 (95% CI: 1.24–3.42), and 1.26 (95% CI: 1.00–1.58) in children with autism, ADD/ADHD, psychopathology, and other medical conditions, respectively, after adjusting for child sex, child age, number of children in the household, child race, and family poverty level. Children with autism, ADD/ADHD, and other psychopathology were about 2–3 times more likely to experience an injury that needs medical attention than unaffected controls. Future studies need to clarify the extent to which injuries in young children with autism, ADD/ADHD, and psychopathology are related to core symptoms, comorbid conditions, associated behaviors, or unintentional injuries due to lack of additional supervision from caregivers.
The study examined the family environment and perceived social support of 33 parents with a child diagnosed with Asperger syndrome and 43 parents with a child with learning disability, which were compared to 45 parents of children without disabilities as a control group. Parents completed the Family Environment Scale and Social Support Scale questionnaires. The comparison revealed significant differences for expressiveness and family system organization and for social support. Parents with an Asperger child perceived their family's expressive feelings as lower and the family organization as higher, and perceived their friendships and other support as lower than the other groups of parent. Parents of the control group reported the highest family support. The study highlighted the need for additional social support for parents with a child with special needs, and accentuated the importance of developing awareness and intervention programs to facilitate parents’ coping abilities and their family interactions.
Participation in leisure activities is a fundamental human right and an important factor of quality of life. Adults with intellectual disabilities (ID) and physical disabilities often experience limited opportunities to participate in leisure activities, virtual reality (VR) technologies may serve to broaden their repertoire of accessible leisure activities. Although the use of VR in rehabilitation has grown over the past decade, few applications have been reported for people with ID. Thirty-three men and women with moderate ID and severe cerebral palsy participated in the study. Each participant in the experimental group ( = 17) took part in VR activity two to three times weekly for 12 weeks. Virtual games were provided via GestureTek's Gesture Xtreme video capture VR system. The VR-based activities were perceived by the participants to be enjoyable and successful. Moreover, participants demonstrated clear preferences, initiation and learning. They performed consistently and maintained a high level of interest throughout the intervention period. VR appears to provide varied and motivating opportunities for leisure activities among young adults with intellectual and physical disabilities. Its ease of use and adaptability make it a feasible option for this population.
A key area of weakness in individuals with fetal alcohol spectrum disorder (FASD) is working memory, thus the goal of this study was to determine whether teaching children (aged 4–11) with FASD verbal rehearsal would increase their memory. Rehearsal training has been effective in other populations with working memory difficulties, so we hypothesized that children with FASD would also benefit from rehearsal training. Children were divided into an Experimental group, who received rehearsal training and a Control group, who did not receive training. All children were tested on digit span tasks over three sessions: a pretest (baseline) and then post-test 1 and post-test 2 (where only the Experimental group received rehearsal training). The Experimental group showed a significant increase in performance across session but the Control group did not. Children in the Experimental group performed significantly higher than the Control group on post-test 2 but not on the pretest or post-test 1. More children in the Experimental group showed behavioral evidence and self-report of rehearsal after training. Rehearsal training was successful at increasing the memory for numbers among children with FASD and may help to ameliorate working memory difficulties in FASD, ultimately supporting academic and developmental growth of children with FASD.
Participants were 101 individuals with self-injurious behavior (SIB) and severe or profound intellectual disability who were matched by gender, age, and level of intellectual disability to controls. Persons with SIB were more likely to exhibit the challenging behaviors of physical aggression, property destruction, sexually inappropriate behaviors and stereotypies when compared to controls, suggestive of co-occurring behaviors. Moreover, the maladaptive behavior of irritability, as assessed by the aberrant behavior checklist (ABC) was able to correctly classify 72.8% of the sample into their respective group memberships. Implications of these findings are discussed.
Psychologists interviewed direct-care staff using a battery of assessment measures including the autism spectrum disorders-diagnosis for intellectually disabled adults (ASD-DA), the Diagnostic Assessment for the Severely Handicapped-II (DASH-II), the Matson Evaluation of Social Skills for Individuals with Severe Retardation (MESSIER), the Socialization domain of the Vineland Adaptive Behavior Scales (VABS), and a checklist containing criteria for autism and PDD-NOS from the DSM-IV-TR and ICD-10. Three hundred and seven intellectually disabled (ID) adolescents and adults ranging in age from 16 to 88 were assessed. Participants were diagnosed with either ID and ASD (autism or PDD-NOS; = 156) or ID and no Axis I diagnosis ( = 151). A modification of the multitrait–multimethod approach was used to establish the convergent and discriminant validity of the ASD-DA. The scale proved to have robust convergent validity when correlated with the DSM-IV-TR/ICD-10 checklist, MESSIER, and Socialization domain of the VABS. Additionally, discriminant validity was demonstrated by comparing the ASD-DA to items from the DASH-II (measure of general psychopathology). The implications of these data are discussed.
The role of pain in relation to self-injurious behavior (SIB) among individuals with intellectual disabilities is not well understood. Some models of SIB are based on altered endogenous opioid system activity which could result in elevated pain thresholds. In this study, non-verbal behavioral signs indicative of pain as measured by the Non-Communicating Children's Pain Checklist (NCCPC) were compared between matched individuals with ( = 35) and without ( = 35) chronic self-injurious behavior (SIB) and neurodevelopmental disorders. Significant ( Control Group) were found for the NCCPC Total Score, and for the Vocal, Social/Personality, and Eating/Sleeping subscales of the NCCPC. These results are not consistent with models of SIB in which pain sensitivity is assumed to be attenuated because of opioid system activity and are suggestive of intact and possibly amplified pain expression.
A review of the existing literature on the occurrence of challenging behavior among children with prenatal drug exposure was conducted. While a large number of studies were identified that evaluated various outcomes of prenatal drug exposure, only 37 were found that directly evaluated challenging behaviors. Of the 37 studies, 23 focused on prenatal cocaine exposure, and 14 focused on prenatal alcohol exposure; most studies relied on broadband measures such as the CBCL for the assessment of challenging behavior. Among the 37 studies, a clear role for the postnatal environment on developing challenging behaviors was evident; however, prenatal alcohol exposure showed a much clearer independent effect upon challenging behaviors than was noted in the prenatal cocaine studies. Additionally, only 3 of the 37 studies addressed interventions for challenging behaviors, each of which showed an improvement in child behavior or parent–child interactions. As researchers have continued to show the importance of the postnatal environment, it is likely that interventions addressing specific environmental risk factors will be helpful to reduce or prevent challenging behaviors among this population.
The prevalence of co-morbid depression in people with intellectual disability (ID) provides a strong rationale for the early identification and treatment of individuals at risk. The aim of this study was to evaluate a staff-administered group CBT program for the treatment of depression in people with mild ID. A sample of 13 staff employed at two community-based disability agencies were trained to deliver the program to 47 individuals with mild ID and symptoms of depression. A wait list control group comprised of 27 individuals subsequently completed the program. Compared to the control group, individuals who had participated in the treatment program showed lower depression scores, and fewer automatic negative thoughts. Furthermore, these changes were maintained at a 3-month follow-up. The results indicate that staff can be trained to deliver a CBT program within community settings that is effective in the reduction of depression symptomatology in people with mild ID.
This study examined the effects of training and feedback on instructor performance of Discrete Trial Teaching (DTT) and support skills. This included an examination of the generalization and maintenance of instructor skills, and the impact of instructor skills on student performance. Six undergraduate research assistants received an 8-h training in DTT and taught a variety of skills and behaviors to four preschool students who had developmental disabilities. A multiple-baseline design was used to assess instructor performance following training alone, during implementation of oral and written performance feedback, and at 2, 4, 6, and 10 weeks follow-up. Instructors demonstrated correct use of DTT and related skills at a rate of 63–80% following training. When performance feedback was provided, all instructors attained proficiency ratings of 90% by the second session and 97–100% by the fourth session. High levels of instructor proficiency were maintained at follow-up and generalized across students and learning tasks. Student learning and instructional efficiency were superior in the feedback and follow-up conditions compared to baseline. The results highlight the need for training programs that allow school personnel to correctly use DTT to effectively facilitate learning and development in students who have developmental disabilities.
In addition to explaining challenging behaviour by way of behaviour analytic, functional analyses, challenging behaviour is increasingly explained by way of psychiatric symptomatology. According to some researchers, the two approaches complement each other, as psychiatric symptomatology may form a motivational basis for the individual's response to more immediate environmental challenges, like deprivation and aversive conditions. The most common example may be that depressive mood may render task demands aversive. Consequently, the person may show escape-motivated challenging behaviour in the presence of demands. The question becomes whether, or to what extent, relationships between psychiatric symptomatologies and particular functions of challenging behaviour exist. In the present, preliminary study, PAS-ADD checklist, a psychiatric screening instrument, and motivation assessment scale (MAS) were employed in order to investigate this issue. The results show that symptomatologies are largely unrelated to particular behavioural functions. Practical implications are discussed.
Benefits of treatment for obstructive sleep apnea (OSA) in children with cerebral palsy could differ from those in otherwise healthy children. We examined the effects of OSA treatment by comparing a group of children with cerebral palsy treated with adenotonsillectomy or continuous positive airway pressure (CPAP) by nasal mask with controls who had not received treatment. Parents completed a structured questionnaire assessing change in their child's quality of life (QOL) and OSA symptoms after treatment, or between 6 months ago and the present time for controls. Fifty-one children were eligible, of whom 19 (37%) completed questionnaires: treatment group, = 10 (adenotonsillectomy 7, CPAP 3); and controls, = 9. The treatment group showed an improvement in OSA symptoms compared to controls, especially sleep disturbance ( = 0.005), daytime functioning ( = 0.03) and caregiver concern ( = 0.03). Parental QOL score improved by a mean of 18% in the treatment group ( = 0.06 for a difference from controls). Treatment of OSA in children with cerebral palsy leads to significant benefit in some aspects of health and QOL.
The objective of the study was to study differences in aging phenomena among adults with intellectual disability (ID), who live in community residence versus their peers in residential care centers and to determine the contribution of health status, age, gender, etiology and level of ID to the decline in ADL function with age. Our study was based on matched pairs between persons with ID in community residence ( = 101) and their peers living in residential centers ( = 101) by age, gender, etiology and level of ID. Fifty-three percent were aged 40–49 years, 23% were aged 50–59 years and 14% were aged 60–71 years. Ten percent had Down syndrome (DS), 16% had cerebral palsy (CP) and the rest had ID with no specific etiology (NSID). Caregivers were interviewed to ascertain health problems, sensory impairments and activity of daily living (ADL). The type of residence alone could not explain the morbidity and health problems of adults with ID, which were affected by age and etiology. Participants with NSID functioned better than those with Down syndrome or cerebral palsy in all ADL areas. MANOVA and regression analysis indicated that age and health status did not contribute to the explained variance of the ADL function of the participants without specific etiology. The CP group had the most vulnerable etiology exposed to medical problems and decline in ADL function with age. Action should be taken to increase the awareness of the staff to health deterioration that can occur among adult persons with ID, especially among various types of etiologies, such as DS and CP.
This study assessed the combination of two microswitches with a voice output communication aid (VOCA) with two persons (an adolescent and a young adult) with multiple disabilities. The microswitches allowed the participants to obtain direct access to preferred environmental stimuli; the VOCA enabled them to ask for caregiver's attention. Initially, the participants were taught to use each of the two microswitches individually and then together. Next, they were taught to use the VOCA and, eventually, this was available together with the microswitches. Results showed that the participants learned to operate the microswitches and the VOCA and used all three of them consistently when they were simultaneously available. Implications of these findings and the potential role of a VOCA combined with conventional microswitches were discussed.
We examined the behavior-altering effect of the motivating operation on challenging behavior during leisure activities for three individuals with severe disabilities. Prior functional analyses indicated that challenging behavior was maintained by positive reinforcement in the form of attention or tangible items for all participants. During leisure sessions, each participant played preferred games (cards, jigsaws) with two individuals without disabilities. The discriminative stimuli for challenging behavior were present during leisure sessions but challenging behavior was never reinforced. Immediately prior to leisure sessions, the participants received either access to the reinforcers that maintained challenging behavior or no access. Access versus no access to reinforcers for challenging behavior prior to leisure sessions was alternated in a multi-element design. Results demonstrated higher levels of challenging behavior during leisure sessions when the participants did not have access to the reinforcers prior to the sessions. Little challenging behavior occurred during leisure sessions when the participants had prior access to the reinforcers. Arguments for further examining the behavior-altering effects of the motivating operation in future applied research are presented.
Authors examined the effects of information source on peers’ cognitive and behavioral attitudes toward an unfamiliar child with autism. Children ( = 296; age = 10.21 years) received information about an unfamiliar child with autism from one of the following sources: (a) videotape, (b) teacher, (c) hypothetical mother, (d) hypothetical father, or (e) hypothetical “doctor.” Interactive effects between source, and sex and grade were found for cognitive and behavioral attitudes. Fifth-graders reported more favorable cognitive and behavioral attitudes when information was provided by extra-familial sources (i.e., “doctor”) versus parent sources. Mother yielded more persuasive effects on behavioral attitudes for third-graders versus fifth-graders. Attitudes toward autism differ depending on who provides information about the disability. Persuasion theory appears useful to guide evaluation of educational interventions to improve attitudes towards autism. Implications of the findings, study limitations, and recommendations for future research are discussed.