Co-existence of disorders – including attention-deficit/hyperactivity disorder, oppositional defiant disorder, tic disorder, developmental coordination disorder, and autism spectrum disorder – and sharing of symptoms across disorders (sometimes referred to as comorbidity) is the rule rather than the exception in child psychiatry and developmental medicine. The acronym ESSENCE refers to Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations. It is a term I have coined to refer to the reality of children (and their parents) presenting in clinical settings with impairing child symptoms before age 3 (−5) years in the fields of (a) general development, (b) communication and language, (c) social inter-relatedness, (d) motor coordination, (e) attention, (f) activity, (g) behaviour, (h) mood, and/or (i) sleep. Children with major difficulties in one or more (usually several) of these fields, will be referred to and seen by health visitors, nurses, social workers, education specialists, pediatricians, GPs, speech and language therapists, child neurologists, child psychiatrists, psychologists, neurophysiologists, dentists, clinical geneticists, occupational therapists and physiotherapists, but, usually they will be seen only by one of these specialists, when they would have needed the input of two or more of the experts referred to. Major problems in at least one ESSENCE domain before age 5 years often signals major problems in the same or overlapping domains years later. There is no time to wait; something needs to be done, and that something is unlikely to be just in the area of speech and language, just in the area of autism or just in special education.
Behavior problems such as aggression, property destruction, stereotypy, self-injurious behavior, and other disruptive behavior are commonly observed among adults with intellectual disabilities (ID), autism spectrum disorders (ASD), and epilepsy residing at state-run facilities. However, it is unknown how these populations differ on behavior problem indicies. Assessment of behavior problems were made with the ASD–behavior problems-adult version battery. 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, Wilks's = .79, (12, 246) = 1.93, .05, = .03, and stereotypy subscale, (3, 96) = 2.62, > .05, = .08. No significant differences were found on the self-injury subscale and disruptive behavior subscale. Trend analysis demonstrated that individuals with ID expressing combined co-morbid ASD and epilepsy were significantly more impaired than the control group (ID only) or groups containing only a single co-morbid factor with ID (ASD or epilepsy only) on these four subscales. Implications of these findings in the context of known issues in ID, epilepsy, and ASD, current assessment practices among these populations and associated challenges are discussed.
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.
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.
Few studies assess psychiatric disorders in representative samples of individuals with autism and ID. Symptoms of autism and psychiatric disorders have been confounded. PAC, a conceptually analysed and validated screening instrument, was used. Assess prevalence of psychiatric disorders in individuals with intellectual disability only ( ) and with combination of autism and ID ( ). Sixty-two (autism) and 132 (ID-only) participants were screened for psychiatric disorders with the Psychopathology in Autism Checklist (PAC); included general adjustment problems ( ), and severe adjustment problems ( ) in one county in Norway. Psychosis, depression, anxiety, and OCD were addressed. Both SGAP and a high psychiatric disorder score were required to screen a psychiatric disorder. “Diagnostic overlap” was defined as more than one psychiatric disorder concurrent with autism. Psychiatric disorders and SGAP were found to be high both in the autism (53.2%) and ID-only group (17.4%). More than 50% of the autism and approximately 20% of ID-only group had SGAP. The differences were significant. The autism–psychiatric disorder interaction was significant. The largest differences between the prevalence in the autism and the ID-only group were shown in individuals with anxiety. The majority of the individuals in both study groups were afflicted with more than one psychiatric disorder. About 60% were found to have more than one disorder. The individuals with more severe psychiatric symptoms had higher degrees of diagnostic overlap. Having an intellectual disability seem to imply high risk for developing adjustment problems, and it seems especially difficult for individuals with autism to master every-day challenges.
The main goals of this study were to determine the prevalence, frequency and severity of challenging behaviour in people with profound intellectual and multiple disabilities (PIMD). Because in the literature several health problems and sensory impairments are associated with the onset and existence of challenging behaviour, this relationship was also examined. This study involved 181 people with PIMD (age: mean: 35; SD: 19, 56% male). The Behaviour Problem Inventory was used to determine prevalence, frequency and severity of self-injurious (SIB), stereotypical and aggressive/destructive behaviour, and an additional questionnaire was used to determine the presence of sensory impairments and health problems among the participants. Results show a prevalence of 82% for SIB and stereotypical behaviour in the sample. Aggressive/destructive behaviour was seen in 45% of the participants. Concerning the frequency, on average SIB occurs on a daily or weekly basis. Stereotypical behaviour is seen on a daily basis and aggressive/destructive behaviour is usually reported once a week. All three types of challenging behaviour also occur on an hourly basis. The severity of challenging behaviour is usually rated by staff as of minor consequence for the person with PIMD. Furthermore, a relationship was found between having visual, tactile or psychiatric problems and the occurrence of challenging behaviour. Participants with visual impairments, tactile impairments or psychiatric problems showed significantly higher mean scores regarding challenging behaviour. Challenging behaviour within the target group of people with PIMD is very common. The prevalence figures are high, but direct support professionals are not inclined to rate such behaviour as of serious consequence.
Descriptive and comparative follow-up studies of young adult males with Asperger syndrome (AS) diagnosed in childhood, using both interview, self- and parent assessment instruments for the study of aspects of emotional well-being, social functioning, and cognitive-practical skills have not been performed in the past. One-hundred males with AS diagnosed in childhood were approached for the assessment using the Asperger Syndrome Diagnostic Interview (ASDI), (personal and parent interview), the Leiter-R-Questionnaires, the Beck Depression Inventory (BDI), and the Dysexecutive Questionnaire (DEX). About 75% of the targeted group participated. The ASDI results came out significantly different at personal vs parent interviews in several key domains. In contrast, the Leiter-R-Questionnaires, showed no significant differences across the individuals with AS and their parents in the scoring of cognitive/social and emotional/adaptive skills. The BDI proved to be an adequate screening instrument for depression in that it correctly identified the vast majority of cases with clinical depression in the AS group. The DEX results suggested an executive function deficit problem profile in males with AS as severe as that reported in groups of individuals with traumatic brain injury and schizophrenia. Interviews (personal and collateral), and self-rating and parent-rating questionnaires all have a role in the comprehensive diagnostic process in AS and other autism spectrum disorders, and could be used as adjuncts when evaluating whether or not individuals meeting diagnostic symptom criteria for the condition have sufficient problems in daily life to warrant a clinical diagnosis of AS.
The aims of this study were to estimate prevalence rates of children with autism spectrum disorder (ASD) diagnoses in a cohort of 6-year-old children with birth year 2002, referred to the Autism Centre for Young Children, serving the whole of Stockholm county and on the basis of the available data discuss clinical aspects of assessment, habilitation and follow-up. Records of 142 of a total of 147 (123 boys and 24 girls) identified children with ASD diagnoses were scrutinised with respect to type of diagnosis, cognitive level, other developmental disorders and medical/neurological disorders. The overall prevalence of such disorders was 6.2/1000 (95% confidence interval 5.2–7.2/1000). The rates of learning disability/mental retardation, developmental delay without a specified cognitive level and normal intelligence constituted about one third, respectively. AS and atypical autism tended to be diagnosed more often at age 5–6 years while AD with learning disability/mental retardation was more often diagnosed at age 3–4 years. The awareness of ASDs has resulted in increasing numbers of children being diagnosed at young ages. We conclude that it is important to take into account these children's broader developmental profiles, need for repeated assessment of cognitive functions and follow-up over time and also the requirement for medical/neurological consideration and work-up.
The purpose of the present study was to assess which types of neuropsychological deficits appear to be most commonly associated with autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorder (ADHD) in adults. The effect of the combination of ASD with ADHD (ASD/ADHD) was also studied. One hundred and sixty-one adult individuals (≥18 years of age) were included in the study. None had full scale IQ less than 71. The neuropsychological investigations included measures of intellectual ability, learning and memory, attention/executive function and theory of mind. The three diagnostic groups showed reduced performance in most cognitive domains. However, within these domains differentiating distinct features could be seen. The dysfunctions of the ASD/ADHD group cannot be seen as a summary of the dysfunctions found in the ASD and ADHD groups. The ADHD seemed to have the most severe neuropsychological impairments of the three groups. No domain-specific deficit typical of any of the diagnostic groups was found.
We investigated the relationship between challenging behavior and co-morbid psychopathology in adults with intellectual disability (ID) and autism spectrum disorders (ASDs) ( = 124) as compared to adults with ID only ( = 562). All participants were first time referrals to specialist mental health services and were living in community settings. Clinical diagnoses were based on ICD-10 criteria and presence of challenging behavior was assessed with the Disability Assessment Schedule (DAS-B). The analyses showed that ASD diagnosis was significantly associated with male gender, younger age and lower level of ID. Challenging behavior was about four times more likely in adults with ASD as compared to non-ASD adults. In those with challenging behavior, there were significant differences in co-morbid psychopathology between ASD and non-ASD adults. However, after controlling for level of ID, gender and age, there was no association between co-morbid psychopathology and presence of challenging behavior. Overall, the results suggest that presence of challenging behavior is independent from co-morbid psychopathology in adults with ID and ASD.
The latest researches adopted software technology turning the Nintendo Wii Balance Board into a high performance change of standing posture (CSP) detector, and assessed whether two persons with multiple disabilities would be able to control environmental stimulation using body swing (changing standing posture). This study extends Wii Balance Board functionality for standing posture correction (i.e., actively adjust abnormal standing posture) to assessed whether two persons with multiple disabilities would be able to actively correct their standing posture by controlling their favorite stimulation on/off using a Wii Balance Board with a newly developed standing posture correcting program (SPCP). The study was performed according to an ABAB design, in which A represented baseline and B represented intervention phases. Data showed that both participants significantly increased time duration of maintaining correct standing posture (TDMCSP) to activate the control system to produce environmental stimulation during the intervention phases. Practical and developmental implications of the findings were discussed.
Examine the rate, predictors, and effect on daily life skills of developmental coordination disorder (DCD) and other motor control difficulties in school age girls with autism spectrum disorder (ASD) and/or attention-deficit/hyperactivity disorder (ADHD), in preschool age girls with ASD referred to a neuropsychiatric clinic, and in a community sample of school age girls. The girls (131 in total) were examined with standardised test of motor function and parent interviews and questionnaires. The school girls were compared with 57 age-and IQ-matched girls from the community. DCD was diagnosed in 25% of clinic school girls with ASD, in 32% of those with ADHD, and in 80% of the clinic preschool girls with ASD. Parents reported more motor problems in the school age clinic group. Agreement between a brief motor screening test and a full comprehensive motor examination was moderate to good in the clinic group. Young age, autistic symptomatology, and low performance IQ predicted more motor coordination problems. Motor coordination problems were related to lower ability in daily life skills even when the effect of PIQ was controlled for. A large minority of school girls with ASD and/or ADHD, and a majority of preschool girls with ASD meet full diagnostic criteria for DCD. Their motor problems contribute to reduced activity in daily life even when the effects of IQ have been partialled out.
We evaluated the efficacy of a vocational training program including behavioral skills training, and a “performance cue system” (i.e., a proprietary iPhone application adapted for the study) to teach targeted social-vocational skills to six young adults with an Autism Spectrum Disorder. In two separate studies, participants were employed to assist in the delivery of a fire safety education program. Participants were asked to wear an inflatable firefighter WalkAround mascot costume and to perform 63 scripted behaviors in coordination with a fire prevention specialist who was the lead program presenter. In Study 1, three participants were initially exposed to established company training procedures comprised of behavioral skills training components to determine whether they met mastery of the skills. If necessary to reach criteria, participants were then exposed to a performance cue system. In Study 2, three additional participants were provided with the performance cue system alone, and then behavioral skills training if required. A single case, multiple-baseline design across subjects was used to evaluate efficacy of each intervention. Results indicate that 5 of 6 participants reached criterion only after introduction of the cue system while the sixth reached criterion with behavioral skills training alone. The program received high satisfaction ratings from participants, their parents, and consumers. Implications and potential use of the PCS in other employment settings are discussed.
Despite the increased interest in the effects of omega-3 supplementation on childrens’ learning and behaviour, there are a lack of controlled studies of this kind that have utilised a typically developing population. This study investigated the effects of omega-3 supplementation in 450 children aged 8–10 years old from a mainstream school population, using a randomised, double-blind, placebo-controlled design. Participants were supplemented with either active supplements (containing docosahexaenoic acid, DHA and eicosapentaenoic acid, EPA) or a placebo for 16 weeks. Cheek cell fatty acid levels were recorded pre- and post-supplementation and a range of cognitive tests and parent and teacher questionnaires were used as outcome measures. After supplementation, changes in the relationship between omega-6 and omega-3 were significant in the active group. Despite the wide range of cognitive and behavioural outcome measures employed, only three significant differences between groups were found after 16 weeks, one of which was in favour of the placebo condition. Exploring the associations between changes in fatty acid levels and changes in test and questionnaire scores also produced equivocal results. These findings are discussed in relation to previous findings with clinical populations and future implications for research.
Physical inactivity is a global public health problem, and it has been linked to many of the most serious illnesses facing many industrialized nations. There is little evidence examining the physical activity profile and determinants for the vulnerable population such as people with intellectual disabilities (ID). The present paper aims to describe the regular physical activity prevalence and to examine its determinants among adolescents with intellectual disabilities in Taiwan. Participants were recruited from 3 special education schools in Taiwan, with the entire response participants composed of 351 primary caregivers of adolescents with ID (age 16–18 years). There were 29.9% ID individuals had regular physical activity habits, and the main physical activities were walking, sports, and jogging. There were only 8% individuals with ID met the national physical activity recommendation in Taiwan which suggests at least exercise 3 times per week and 30 min per time. In a stepwise logistic regression analysis of regular physical activity habit, we found that the factors of caregiver's educational level and preference toward physical activity were variables that can significantly predict ID individuals who had regular physical activity habit in their daily livings after controlling other factors. To maximize the positive effect of physical activity on people with ID, the present study suggests that it is needed to initiate appropriate techniques used for motivation to participate in physical activity for this population.
Antipsychotic drugs are the most frequently prescribed of the psychotropic drugs among the intellectually disabled (ID) population. Given their widespread use, efforts to systematically assess and report side effects are warranted. Specific scaling methods such as the ( ), the ( ), and ( ) are reviewed. Symptom patterns and a focus on additional research are discussed. While progress has been made, more and more systematic methods to research these problems are necessary.
Phonological awareness (PA) is the ability to hear and manipulate the smallest units of sound in our language. It is key to learning to read for typically developing children. Some have suggested that this is not true for children with Down syndrome (DS). The purpose of this review was to provide a better understanding of the role PA plays for children with DS as they learn to read and to provide guidance on whether phonics-based reading instruction is likely to benefit these students. Results from a review of 20 studies indicate that children with DS rely on PA skills in learning to read and suggest that phonics-based reading instruction may be beneficial for at least some of these children.
This study described the aerobic capacity [VO (ml/kg/min)] in contemporary children and adolescents with cerebral palsy (CP) using a maximal exercise test protocol. Twenty-four children and adolescents with CP classified at Gross Motor Functional Classification Scale (GMFCS) level I or level II and 336 typically developing children were included. All children performed a progressive exercise test on a treadmill with respiratory gas-exchange analysis. The results are compared with normative values for age and gender-matched controls. Aerobic capacity of children and adolescents with CP, who are classified at GMFCS level I or II was significantly lower than that of typically developing controls. Especially in girls with CP, the aerobic capacity deteriorated with age. The aerobic capacity of contemporary children and adolescents with CP, who are classified at GMFCS level I or II is significantly lower than that of typically developing controls.
This study evaluated the effectiveness of low intensity behavioral treatment (on average 6.5 h per week) supplementing preschool services in 3–6-year-old children with autism spectrum disorder and severe to mild intellectual disability. Treatment was implemented in preschools (i.e., daycare centers) and a discrete trial teaching approach was used. Twelve children in the treatment group were compared to 22 children receiving regular intervention. At pre-treatment, both groups did not differ on chronological age, developmental age, diagnosis and level of adaptive skills. Eight months into treatment, children receiving behavioral treatment displayed significantly higher developmental ages and made more gains in adaptive skills than children from the control group. No significant differences between groups were found on autistic symptom severity and emotional and behavioral problems.
Developmental Co-ordination Disorder (DCD), also known as Dyspraxia in the United Kingdom (U.K.), is a developmental disorder affecting motor co-ordination. In the past this was regarded as a childhood disorder, however there is increasing evidence that a significant number of children will continue to have persistent difficulties into adulthood. Despite this, there remains little information as to how the difficulties might present at this stage, and additionally the impact on every day functioning. As young people move into further and higher education there is a need for screening and assessment tools. Such tools allow for identification of these difficulties, access to support, and clarification of areas where appropriate support needs to be targeted. This paper describes the first adult screening tool for DCD. The development and the results from testing this tool in two countries, Israel and the U.K. are outlined and the implications for its use in further and higher education discussed.