► We examined the health of US children with 4 distinct developmental disabilities (DDs). ► Mutually exclusive DDs were: autism; intellectual disability; ADHD; learning disability/other delay. ► Each DD was associated with increased prevalence of many medical conditions. ► These included respiratory, gastrointestinal, dermatologic, and neurologic conditions. ► Each DD was associated with increased health service use, delays in care, and unmet needs. Studies document various associated health risks for children with developmental disabilities (DDs). Further study is needed by disability type. Using the 2006–2010 National Health Interview Surveys, we assessed the prevalence of numerous medical conditions (e.g. asthma, frequent diarrhea/colitis, seizures), health care use measures (e.g. seeing a medical specialist and >9 office visits in past year), health impact measures (e.g. needing help with personal care), and selected indicators of unmet health needs (e.g. unable to afford needed prescription medications) among a nationally representative sample of children ages 3–17 years, with and without DDs. Children in four mutually exclusive developmental disability groups: autism ( = 375), intellectual disability (ID) without autism ( = 238); attention-deficit/hyperactivity disorder (ADHD) without autism or ID ( = 2901); and learning disability (LD) or other developmental delay without ADHD, autism, or ID ( = 1955); were compared to children without DDs ( = 35,775) on each condition or health care measure of interest. Adjusted odds ratios (aORs) were calculated from weighted logistic regression models that accounted for the complex sample design. Prevalence estimates for most medical conditions examined were moderately to markedly higher for children in all four DD groups than children without DDs. Most differences were statistically significant after adjustment for child sex, age, race/ethnicity, and maternal education. Children in all DD groups also had significantly higher estimates for health care use, impact, and unmet needs measures than children without DDs. This study provides empirical evidence that children with DDs require increased pediatric and specialist services, both for their core functional deficits and concurrent medical conditions.
► Systematic research review regarding the possible link between ASD and vitamin D. ► Narrative literature review of the role of vitamin D in various biological processes. ► There is some support for vitamin D deficiency's role in the pathogenesis of ASD. ► Vitamin D may, hypothetically, have a role in ASD development via the brain and gene regulation. ► We argue for the recognition of this possibly important role of vitamin D in ASD. Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with multiple genetic and environmental risk factors. The interplay between genetic and environmental factors has become the subject of intensified research in the last several years. Vitamin D deficiency has recently been proposed as a possible environmental risk factor for ASD. The aim of the current paper is to systematically review the research regarding the possible connection between ASD and vitamin D, and to provide a narrative review of the literature regarding the role of vitamin D in various biological processes in order to generate hypotheses for future research. Systematic data obtained by different research groups provide some, albeit very limited, support for the possible role of vitamin D deficiency in the pathogenesis of ASD. There are two main areas of involvement of vitamin D in the human body that could potentially have direct impact on the development of ASD: (1) the brain (its homeostasis, immune system and neurodevelopment) and (2) gene regulation. Vitamin D deficiency – either during pregnancy or early childhood – may be an environmental trigger for ASD in individuals genetically predisposed for the broad phenotype of autism. On the basis of the results of the present review, we argue for the recognition of this possibly important role of vitamin D in ASD, and for urgent research in the field.
► 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.
► 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.
► 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.
► 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.
► Prevalence of substance use appears low among people with intellectual disabilities. ► Rates of legal substance use may be more similar to rates in the general population. ► Risk of substance abuse is comparatively high among substance users. ► Several subgroups in this group have greater exposure to substance use than others. ► Well-designed, theory-driven studies of substance use are needed for this population. Individuals with disabilities are a growing population that confronts multiple disadvantages from social and environmental determinants of health. In particular, the 7–8 million people in the U.S. with an intellectual disability (ID) suffer disproportionately from substance use problems, largely because of a lack of empirical evidence to inform prevention and treatment efforts for them. Although available research could inform future research efforts, studies are scattered across disciplines with the last review synthesizing findings written more than five years ago. To consider more recent findings with earlier works, PubMed, PsychINFO, and Google Scholar were searched and produced 37 peer-reviewed texts across multiple disciplines, 15 from 2006 or later. While the prevalence of alcohol and illicit drug use in this population are low, the risk of having a substance-related problem among ID substance users is comparatively high. Gaps in the research and population subgroups that warrant special attention are identified, such as individuals with borderline and mild ID, individuals with co-occurring mental illness, and individuals who are incarcerated. Compared with substance abusers without ID, ID substance abusers are less likely to receive substance abuse treatment or remain in treatment. Research is needed to better gauge the magnitude of substance use problems, identify prevention strategies, and specify treatment components that meet the unique needs of individuals with ID.
► Hypertension, diabetes and metabolic syndrome are present similarly among older people with intellectual disability as in the general older Dutch population. ► Hypercholesterolemia is present less often in older people with ID as compared to the general population. ► Cardiovascular risk factors are often unnoticed among older people with ID. ► Risk groups are women, older people, people with obesity and people who live and function more independently. Hypertension, diabetes, hypercholesterolemia and the metabolic syndrome are important risk factors for cardiovascular disease (CVD). In older people with intellectual disability (ID), CVD is a substantial morbidity risk. The aims of the present study, which was part of the Healthy Ageing in Intellectual Disability (HA-ID) study, were (1) to determine the prevalence of CVD risk factors in older people with ID and to compare this with the prevalence in the same-aged general population, (2) to determine how many risk factors had not been previously diagnosed, and (3) to identify correlates of CVD risk factors (gender, age, level of ID, Down syndrome, independent living, activities of daily living, mobility, instrumental activities of daily living, physical activity, use of atypical antipsychotics, central obesity), using logistic regression analyses. In this cross-sectional study, 980 people with borderline to profound ID participated. Hypertension (53%), diabetes (14%) and metabolic syndrome (45%) were present similarly as in the general Dutch population. Hypercholesterolemia was present less often (23%). Fifty percent of the people with hypertension had not been previously diagnosed with this condition. Percentages for diabetes, hypercholesterolemia, and the metabolic syndrome were 45, 46 and 94 respectively. People who were more at risk for CVD risk factors were women, older people, people with obesity, people who lived more independently and people who were able to do groceries or prepare a meal independently. Policy on prevention, detection and treatment of CVD risk factors is urgently needed.
► Quality of sleep, especially sleep duration, was related to problems with day-time cognitive and adaptive functioning in children with Autism Spectrum Disorder. ► Our examination of children with ASD's sleep deprivation (i.e., few hours of sleep per night) negatively impacted their intellectual ability and verbal skills. ► Parental report of their children's sleep in a 24 h period predicted adaptive behavior, such as daily living and social skills and motor dexterity for children. ► Children who experienced more night waking (e.g., screaming) and more sensitivity to sleeping environment disturbances (e.g., noise) were less likely to be successful with daily living skills. ► Breathing related sleep problems and fewer hours of sleep related most often to problems with perceptual tasks. Sleep problems associated with autism spectrum disorders (ASD) have been well documented, but less is known about the effects of sleep problems on day-time cognitive and adaptive performance in this population. Children diagnosed with autism or pervasive developmental disorder-not otherwise specified (PDD-NOS) ( = 335) from 1 to 10 years of age ( = 5.5 years) were evaluated for the relationships of Behavioral Evaluation of Disorders of Sleep (BEDS; ) scores to measures of intelligence and adaptive behavior. Results suggested that children who slept fewer hours per night had overall intelligence, verbal skills, overall adaptive functioning, daily living skills, socialization skills, and motor development. Children who slept fewer hours at night with waking during the night had more communication problems. Breathing related sleep problems and fewer hours of sleep related most often to problems with perceptual tasks. The results indicate that quality of sleep – especially sleep duration – may be related to problems with day-time cognitive and adaptive functioning in children with autism and PDD-NOS. However, future research must be conducted to further understand these relationships.
► Four children with developmental disabilities were taught to request preferred snacks or toys using an iPod -based speech-generating device (SGD) and manual signs (MS) ► Preference for using SGD versus MS was assessed during and after acquisition training ► The intervention led to acquisition of SGD and MS use and three participants demonstrated a preference for the SGD. We compared speed of acquisition and preference for using a speech-generating device (SGD) versus manual signing (MS) as augmentative and alternative communication (AAC) options. Four children with developmental disabilities (DD), aged 5–10 years, were taught to request preferred objects using an iPod -based SGD and MS. Intervention was introduced in a multiple-probe across participants design and SGD and MS conditions were compared in an alternating treatments design. A systematic choice-making paradigm was implemented to determine if the children showed a preference for using SGD or MS. All participants showed increased use of SGD when intervention was introduced, but only three learned under the MS condition. Three participants exhibited a preference for the SGD while the remaining participant demonstrated a preference for using MS. Results support previous studies showing that individuals with DD often show a preference for different AAC options and extend previous data by suggesting that acquisition and maintenance was better for the preferred option.
► Psychological distress was inversely related to perceived social support. ► Inverse association between physical health complaints and perceived social support. ► More adaptive waking cortisol response in caregivers that reported greater social support. Elevated psychological distress and concomitant dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis has been implicated as one pathway that links the stress of caregiving with adverse health outcomes. This study assessed whether perceived social support might mitigate the psychological, endocrine and health consequences of caregiver stress in parents of children with autism and attention deficit hyperactivity disorder (ADHD). Parental caregivers completed measures of psychological distress, perceived availability of social support and physical health complaints. To capture important parameters of the basal diurnal cortisol pattern, caregivers collected salivary cortisol at waking, 30 min post waking, 1200 h and 2200 h on two consecutive weekdays. Psychological distress and self reported physical health complaints were inversely related to scores on all support subscales: tangible, belonging, self esteem and appraisal. Results further revealed a significant, positive association between magnitude of the cortisol awakening response (CAR) and caregivers’ self esteem. As a buffer between the stress of caregiving and adverse physical health outcomes, social support acts to reduce stress appraisals and mitigate disturbances of the HPA axis. Moving forward, intervention programmes might seek to increase caregivers’ perceived availability of social resources.
► This meta-analysis analyzes PECS relative to targeted and non-targeted outcomes. ► Results supported the judgment that PECS is a promising intervention method. ► Functional communication outcomes associated with PECS were most impacted. ► Preschool children and those with autism showed the strongest effects. ► Students who advanced through the most PECS phases had the best outcomes. The Picture Exchange Communication System (PECS) is a widely used picture/icon aided augmentative communication system designed for learners with autism and other developmental disorders. This meta-analysis analyzes the extant empirical literature for PECS relative to targeted (functional communication) and non-targeted concomitant outcomes (behavior, social skills, and speech) for learners with autism, learners with autism and intellectual disabilities and those with autism and multiple disabilities. Effect size analyses were done using the Improvement Rate Difference method, an advanced metric. Effect sizes were independently analyzed for targeted and non-targeted outcomes, student age, learner disability, and number of phases in the PECS protocol acquired by learners. Results supported the judgment that PECS is a promising intervention method. Analysis also revealed that functional communication outcomes associated with the PECS protocol were most impacted, that preschool children and those with autism generally showed the strongest training effects, and that in general students who advanced through the most PECS protocol phases had the best outcomes.
► Parent treatment inclusion does not increase the parental stress levels. ► High level of staff treatment fidelity reduces the parental stress levels. ► High level of parent treatment fidelity predicts a better child outcome. ► Parent training and constant parent-mediated treatment provision reduces challenging behaviors. Although early intensive behavior interventions have been efficient in producing positive behavior outcome in young children with Autism Spectrum Disorder, there is a considerable variety in the children's progress. Research has suggested that parental and treatment factors are likely to affect children's response to treatment. The purpose of the current study was to examine the interrelating factors that impact children's progress, highlighting the influence of parent inclusion in treatment provision captured by parental stress, how faithfully the parents followed the treatment protocols and the intensity of treatment provided at home. Twenty-four children received cross-setting staff- and parent-mediated EIBI, including continuous parent training and supervision. A comparison group of 20 children received eclectic intervention. Standardized tests were carried out by independent examiners at intake and after six months. The intervention group outperformed the eclectic group in measures of autism severity, developmental and language skills. Parent training and constant parent-mediated treatment provision led to reduced challenging behaviors from the children, increased treatment fidelity and child direct behavior change as measured by performance in correct responding on behavior targets. Variables of treatment progress and potential predictors of child outcome were analyzed in detail and mapped with regard to their relationships drawn from multiple regression analysis. Particularly, the study highlights an association between parental stress and staff treatment fidelity that interferes with decision making in treatment planning and consequently with positive behavior outcome. Such results provide important scientific and clinical information on parental and treatment factors likely to affect a child's response to treatment.
► Presents an overview of the family quality of life construct. ► Reviews research pertaining to families with a child with developmental disability. ► Special attention is given to families of children with autism. ► Adapts developmental psychopathology concepts of diverse process and outcome. ► Presents methodological considerations of differentiation and comparison groups. Research on families living with developmental disability generally and autism specifically is dominated by a deficit view that elicits an elaborate representation of problems and risks without the benefit of considering families’ potential for adaptation and resilience. A central tenet of developmental psychopathology is that the study of adaptive and maladaptive development is mutually informative. Specifically, one can examine resilience within the context of adversity and the multiple processes and pathways to adaptive and maladaptive developmental outcomes. We believe these concepts can also be extended to the study of families living with developmental disability as they transition through the family lifecycle. This paper provides an overview of the family quality of life (FQOL) construct, including its conceptualization and measurement, and a review of studies on FQOL among families of children with various developmental disabilities. Special attention is given to families of children with autism, as this is a circumstance characterized by unique adversity. We suggest benefits from adopting a developmental psychopathology perspective, and illustrate how relevant concepts can inform our methodologies as we move forward. We will demonstrate how such an integrated, systemic, and temporal approach will help generate more refined questions on FQOL among families caring for a child with developmental disability in order to provide the specific answers needed to directly inform policy and clinical practice.
► EIBI is an effective, but expensive treatment for children with ASD and ID. ► Estimated costs for EIBI and treatment as usual are applied in a cost-offset model. ► From age 3 to 65 years avoided costs are € 1,103,067 per individual with ASD. Early intensive behavioral intervention (EIBI) may result in improved cognitive, adaptive and social functioning and reductions in autism severity and behavioral problems in children with Autism Spectrum Disorder (ASD). For a subset of children, normal functioning may be the result. However, due to the intensity (20–40 h per week for 3 years with a low child staff ratio) implementation costs are high and can be controversial. Estimated costs for education, (supported) work and (sheltered) living for individuals with ASD in the Netherlands are applied in a cost-offset model. A compelling argument for the provision of EIBI is long term savings which are approximately € 1,103,067 from age 3 to 65 years per individual with ASD. Extending these costs to the whole Dutch ASD population, cost savings of € 109.2–€ 182 billion have been estimated, excluding costs associated with inflation.
► Autism needs to be recognised in the early years. ► The combination of M-CHAT and a new joint-attention observation (JA-OBS) screen is very effective in targeting young children with autism. ► Training up of skilled nurses/child health visitors is needed for good autism screening to be properly implemented. ► Mild cases of autism and Asperger syndrome are likely to be missed under 3 years of age. ► Specificity of the screening procedure cannot be assured until many years of continued surveillance have elapsed. The evidence from early intervention studies of autism has emphasised the need for early diagnosis. Insight into the early presentation of autism is crucial for early recognition, and routine screening can optimise the possibility for early diagnosis. General population screening was conducted for 2.5-year-old children at child health centres in Gothenburg, Sweden, and the efficacy of the screening instruments in predicting a clinical diagnosis of autism was studied. The tools used for autism screening comprised the Modified Checklist for Autism in Children (M-CHAT) and an observation made by trained nurses of the child's joint attention abilities (JA-OBS). From the new screening procedure a “definitive” suspicion of autism spectrum disorder (ASD) was raised in 64 individuals in the study population of 3999 young children. Fifty-four of these were clinically assessed in detail. Forty-eight children had a confirmed diagnosis of ASD, three had severe language disorder, and three (6%) were classified as having typical development. The for the combination of M-CHAT and the JA-OBS was 90%. The combination of instruments used showed promise for early detection of autism as a routine in the developmental programme at child health centres. Trained medical staff is a basic requirement and enables earlier detection and the use of screening tools beyond routine population screening regardless of the age at which a suspicion of autism is raised.
► This study reports meta-analytic findings in very preterm born children. ► Medium to large-sized visual perceptive deficits were found. ► Medium-sized visual-motor integration deficits were observed. ► Visual-motor integration deficits were related to gender, gestational age and IQ. ► An affected dorsal visual stream may account for the deficits observed. A range of neurobehavioral impairments, including impaired visual perception and visual-motor integration, are found in very preterm born children, but reported findings show great variability. We aimed to aggregate the existing literature using meta-analysis, in order to provide robust estimates of the effect of very preterm birth on visual perceptive and visual-motor integration abilities. Very preterm born children showed deficits in visual-spatial abilities (medium to large effect sizes) but not in visual closure perception. Tests reporting broad visual perceptive indices showed inconclusive results. In addition, impaired visual-motor integration was found (medium effect size), particularly in boys compared to girls. The observed visual-spatial and visual-motor integration deficits may arise from affected occipital-parietal-frontal neural circuitries.
► We performed a review on balance and gait in persons with Intellectual Disabilities (ID). ► Balance and gait capacities are affected in persons with ID compared to their age-matched peers. ► We suggest a theoretical model for balance and gait across the lifespan in persons with ID. ► Several voids in the literature are highlighted and directions for further research are given. Limitations in mobility are common in persons with intellectual disabilities (ID). As balance and gait capacities are key aspects of mobility, the prevalence of balance and gait problems is also expected to be high in this population. The objective of this study was to critically review the available literature on balance and gait characteristics in persons with ID. Furthermore, the consequences of balance and gait problems in relation to falls were studied, as well as the trainability of balance and gait in persons with ID. The systematic literature search identified 48 articles to be included in this review. The literature consistently reports that balance and gait capacities are affected in persons with ID compared to their age-matched peers. These problems start at a young age and remain present during the entire lifespan of persons with ID, with a relatively early occurrence of age-related decline. From these results a conceptual model was suggested in which the development of balance and gait capacities in the ID population across the life span are compared to the general population. Regarding the second objective, our review showed that, although the relationship of balance and gait problems with falls has not yet been thoroughly investigated in persons with ID, there is some preliminary evidence that these aspects are also important in the ID population. Finally, this review demonstrates that balance and gait are potentially trainable in persons with ID. These results suggest that falls might be prevented with ID-specific exercise interventions.
Limitations in mobility are common in persons with intellectual disabilities (ID). As balance and gait capacities are key aspects of mobility, the prevalence of balance and gait problems is also expected to be high in this population. The objective of this study was to critically review the available literature on balance and gait characteristics in persons with ID. Furthermore, the consequences of balance and gait problems in relation to falls were studied, as well as the trainability of balance and gait in persons with ID. The systematic literature search identified 48 articles to be included in this review. The literature consistently reports that balance and gait capacities are affected in persons with ID compared to their age-matched peers. These problems start at a young age and remain present during the entire lifespan of persons with ID, with a relatively early occurrence of age-related decline. From these results a conceptual model was suggested in which the development of balance and gait capacities in the ID population across the life span are compared to the general population. Regarding the second objective, our review showed that, although the relationship of balance and gait problems with falls has not yet been thoroughly investigated in persons with ID, there is some preliminary evidence that these aspects are also important in the ID population. Finally, this review demonstrates that balance and gait are potentially trainable in persons with ID. These results suggest that falls might be prevented with ID-specific exercise interventions. (C) 2011 Elsevier Ltd. All rights reserved.
► Behavioral parent training is an effective intervention for children with attention deficit hyperactivity disorder, with an overall moderate effect size at post-treatment and a small effect size at follow-up. ► Sustainability of the effects over time is an important issue that awaits further scrutiny. ► The effect of behavioral parent training decreases in children with attention deficit hyperactivity disorder comorbid with other behavioral problems. This meta-analysis examined the effect of behavioral parent training on child and parental outcomes for children with attention deficit hyperactivity disorder. Meta-analytic procedures were used to estimate the effect of behavioral parent training on children with attention deficit hyperactivity disorder. Variables moderating the intervention effect were examined. Forty studies were included and generated an overall moderate effect size at post-treatment and a small effect size at follow-up. The majority of outcome categories were associated with a moderate effect size at post-treatment that decreased to a small effect size at follow-up. Parenting competence was the only outcome that had a large effect, which decreased to moderate at follow-up. The strength of the effect differed between questionnaire and observation measures. Behavioral parent training is an effective intervention for children with attention deficit hyperactivity disorder. Sustainability of the effects over time is a problem that awaits further scrutiny. Recommendations for further research and clinical practices are provided.