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Parenting interventions for children with autism spectrum and disruptive behavior disorders: opportunities for cross-fertilization.

Empirical support exists for parent training/education (PT/PE) interventions for children with disruptive behavior disorders (DBD) and autism spectrum disorders (ASD). While the models share common roots, current approaches have largely developed independently and the research findings have been disseminated in two different literature traditions: mental health and developmental disabilities. Given that these populations often have overlapping clinical needs and are likely to receive services in similar settings, efforts to integrate the knowledge gained in the disparate literature may be beneficial. This article provides a systematic overview of the current (1995-2005) empirical research on PT/PE for children with DBD and ASD; attending to factors for cross-fertilization. Twenty-two ASD and 38 DBD studies were coded for review. Literature was compared in three main areas: (1) research methodology, (2) focus of PT/PE intervention, and (3) PT/PE procedures. There was no overlap in publication outlets between the studies for the two populations. Results indicate that there are opportunities for cross-fertilization in the areas of (1) research methodology, (2) intervention targets, and (3) format of parenting interventions. The practical implications of integrating these two highly related areas of research are identified and discussed.

Autistic Disorder↗

Population and case-control surveillance in the search for environmental causes of birth defects.

An important national health goal is to reduce morbidity attributable to birth defects and developmental disabilities. Population-based surveillance has made notable contributions toward preventing these problems; it is also useful in monitoring changes in their incidence and in helping to identify reproductive hazards in the environment. The Metropolitan Atlanta Congenital Defects Program of the Centers for Disease Control is a model for such surveillance activities. Its register contains data on birth defects of all infants born in the five-county metropolitan area since 1976. Information on all major malformations discernible by physical examination is collected by the register staff. Mothers of babies with selected major malformations are interviewed at length. The register data base permits testing of new hypotheses concerning birth defects. It has speeded an extensive study of the possible effects of military service in Vietnam on the risk of having a baby with a birth defect. In addition, because of their special skills, program staff have made contributions to genetic services and to the development of national policy on maternal serum alpha fetoprotein.

Adult↗

On the relation between object manipulation and stereotypic self-injurious behavior.

Results from a number of studies have shown an inverse relationship between stereotypic behavior and object manipulation. The purposes of this study were to determine whether techniques similar to those used previously (prompting and reinforcement) would be effective in increasing object manipulation under both prompted and unprompted conditions, and to ascertain whether increases in object manipulation would result in decreases in stereotypic self-injurious behavior (SIB). Two individuals with developmental disabilities who engaged in SIB maintained by automatic reinforcement participated. Results showed that object manipulation increased from baseline levels when experimenters prompted participants to manipulate leisure items, but that object manipulation was not maintained under unprompted conditions, and rates of SIB stayed within baseline levels. We then attempted to increase object manipulation further by (a) reinforcing object manipulation, (b) blocking SIB while reinforcing manipulation, and (c) preventing SIB by applying protective equipment while reinforcing object manipulation. Reinforcing object manipulation alone did not affect levels of object manipulation. Blocking effectively reduced attempts to engage in SIB for 1 participant but produced no increase in object manipulation. When the 2nd participant was prevented from engaging in SIB through the use of protective equipment, rates of object manipulation increased dramatically but were not maintained when the equipment was removed. These results suggest that stimulation derived from object manipulation, even when supplemented with arbitrary reinforcement, may not compete with stimulation produced by stereotypic SIB; therefore, direct interventions to reduce SIB are required.

Adult↗

Remote symptomatic epilepsy: does seizure severity increase mortality?

OBJECTIVE: To investigate the excess mortality due to remote symptomatic epilepsy, taking account of frequency and type of seizures. METHODS: The authors compared mortality in persons with (n = 8,156) and without (n = 72,526) history of epilepsy in a 1988 to 1999 California population of persons with mild developmental disabilities. Subjects had traumatic brain injury, cerebral palsy, Down syndrome, autism, or no identifiable condition. There were 506,204 person-years of data, with 1,523 deaths. Excess death rates and standardized mortality ratios were computed for the persons in the study with epilepsy, relative to those in the study without epilepsy. Controlled comparisons were made using logistic regression on person-years. RESULTS: Compared to subjects with no epilepsy, the excess mortality was six (deaths per 1,000 persons per year) for persons with a recent (<12 months) history of status epilepticus, five for a recent history of generalized tonic-clonic seizure, three for a recent history of nonconvulsive seizures, and less than one for a history of epilepsy but no recent events. Proportion in remission and excess mortality showed no change over the 12-year study period. CONCLUSIONS: Persistent seizures are associated with increased mortality in remote symptomatic epilepsy. Mortality is highest among individuals with status epilepticus or generalized convulsions.

Adolescent↗

Fat intolerance in developmentally impaired children with severe feeding intolerance.

Children with a variety of genetic, metabolic, and neurologic disorders can suffer from severe feeding intolerance that is unresponsive to medical, surgical, and nutritional therapy. Developmentally disabled tube-fed children with severe upper gastrointestinal symptoms that persisted after fundoplication who were unresponsive to all medical, surgical, and nutritional interventions underwent a thorough gastrointestinal evaluation, including gastroscopy, pH-metry, upper gastrointestinal barium series, and gastric emptying studies. They were placed on a low-fat diet, and the symptoms before and after the diet were compared. The patients were then rechallenged with incremental increases in fat until the symptoms recurred or the patients reached their former fat concentration. Six children meeting the study criteria were evaluated. Four of these patients had a significant improvement in symptoms, oral intake and feeding tolerance with a decrease in fat intake, and relapse of symptoms when fat calories were increased. Improvement occurred in children who had been intolerant to duodenal feeding. We were subsequently able to wean two children from tube feeding. Dietary fat can provoke upper gastrointestinal symptoms in children with gastric and intestinal dysmotility. Short-term manipulation of dietary fat intake can improve tolerance to feeding.

Child, Preschool↗

Linguistic abilities in children with Williams-Beuren syndrome.

In recent studies children with Williams-Beuren syndrome (WBS) have been characterized as having a distinct neuropsychological profile with verbal abilities being superior to visuo-spatial and motor skills. An unusual command of language, including excessive use of verbal stereotypes, social phrases, and clichés has been noticed. The aim of this study is to establish whether the quality and quantity of verbal behavior, and the articulation and tonal quality of the voices of children with WBS differ from other children with nonspecific developmental disabilities. A group of 25 children with WBS and a control group of 25 children matched for age (4-10 years), sex (12 girls; 13 boys), and non-verbal reasoning abilities (mean IQ = 79) were investigated. The Heidelberg Language Development Test and a picture story were administered. The mothers were asked to answer a questionnaire to assess the articulation and the vocal characteristics of their children. The results show that children with WB syndrome do not differ in most qualitative and quantitative tasks with regard to verbal competence. They produce significantly more correct plural-singular formations than the control children (t = 2.49, P < 0.01) on a primitive level of grammatical competence. In general, their articulation was reported to be more exact and clear (t = -2.73, P < 0.006). More mothers of children with WBS noticed a production of stereotypes, the use of social phrases, and clichés than did mothers of the control children (Chi square = -6.67 P < 0.005). Children with WBS were less likely to lisp as compared to the control children (Chi square = 2.08, P = 0.074).(ABSTRACT TRUNCATED AT 250 WORDS)

Articulation Disorders↗

Standardized Walking Obstacle Course (SWOC): reliability and validity of a new functional measurement tool for children.

PURPOSE: This study reports reliability of the Standardized Walking Obstacle Course (SWOC) and concurrent validity with the Timed Up and Go (TUG) for use in children with and without developmental disabilities. METHODS: Seventy-three children completed the SWOC and TUG during each of two sessions scheduled one week apart. Two raters took measures of time and number of steps on the SWOC to correlate with the same measures on the TUG. RESULTS: Very high interrater reliabilities for time (intercorrelation coefficient [ICC] 0.99) and number of steps (ICC 0.94-0.99) noted. High intrarater reliabilities recorded for time (ICC 0.83-0.97) and number of steps (ICC 0.84-0.96). Significant correlations (p < 0.05) between the TUG and SWOC were moderate to very high for time (r = 0.72-0.90) and number of steps (r = 0.63-0.92). CONCLUSION: The SWOC demonstrates good reliability within and between raters and concurrent validity with the TUG for use with children to establish their functional ambulation capability. The SWOC could easily be used in any setting for any child who can follow the directions and walk without an assistive device. Further testing is needed of the use of the SWOC to detect change and measure the extent of the environment's influence on activity and participation for different populations of children.

Activities of Daily Living↗

A randomized clinical trial of home intervention for children with failure to thrive.

OBJECTIVE: To evaluate the efficacy of a home-based intervention on the growth and development of children with nonorganic failure to thrive (NOFTT). DESIGN: Randomized clinical trial. PARTICIPANTS: The NOFTT sample included 130 children (mean age, 12.7 months; SD, 6.4) recruited from urban pediatric primary care clinics serving low income families. All children were younger than 25 months with weight for age below the fifth percentile. Eligibility criteria included gestational age of at least 36 weeks, birth weight appropriate for gestational age, and no significant history of perinatal complications, congenital disorders, chronic illnesses, or developmental disabilities. Children were randomized into two groups: clinic plus home intervention (HI) (n = 64) or clinic only (n = 66). There were no group differences in children's age, gender, race, or growth parameters, or on any of the family background variables. Most children were raised by single, African-American mothers who received public assistance. Eighty-nine percent of the families (116 of 130) completed the 1-year evaluation. INTERVENTIONS: All children received services in a multidisciplinary growth and nutrition clinic. A community-based agency provided the home intervention. Families in the HI group were scheduled to receive weekly home visits for 1 year by lay home visitors, supervised by a community health nurse. The intervention provided maternal support and promoted parenting, child development, use of informal and formal resources, and parent advocacy. MEASUREMENTS: Growth was measured by standard procedures and converted to z scores for weight for height and height for age to assess wasting and stunting. Cognitive and motor development were measured with the Bayley Scales of Infant Development, and language development was measured by the Receptive/Expressive Emergent Language Scale. Both scales were administered at recruitment and at the 12-month follow-up. Parent-child interaction was measured by observing mothers and children during feeding at recruitment and at the 12-month follow-up, and the quality of the home was measured by the Home Observation Measure of the Environment 18 months after recruitment. ANALYSES: Repeated-measures multivariate analyses of covariance were used to examine changes in children's growth and development and parent-child interaction. Analyses of covariance were used to examine the quality of the home. Independent variables were intervention status and age at recruitment (1.0 to 12.0 vs 12.1 to 24.9 months). Maternal education was a covariate in all analyses. When changes in developmental status and parent-child interaction were examined, weight for height and height for age at recruitment were included as covariates. RESULTS: Children's weight for age, weight for height, and height for age improved significantly during the 12-month study period, regardless of intervention status. Children in the HI group had better receptive language over time and more child-oriented home environments than children in the clinic-only group. The impact of intervention status on cognitive development varied as a function of children's ages at recruitment, with younger children showing beneficial effects of home intervention. There were no changes in motor development associated with intervention status. During the study period, children gained skills in interactive competence during feeding, and their parents became more controlling during feeding, but differences were not associated with intervention status. CONCLUSIONS: Findings support a cautious optimism regarding home intervention during the first year of life provided by trained lay home visitors. Early home intervention can promote a nurturant home environment effectively and can reduce the developmental delays often experienced by low income, urban infants with NOFTT: Subsequent investigations of home intervention should consider alternative options for toddlers with NOFTT:

Child Development↗

The importance of sustainability in the design of culturally appropriate programmes of early intervention.

The need for early intervention with regard to children with developmental disabilities is of increasingly universal relevance. The means adopted in pursuit of this end will, however, vary appropriately across cultures. All intervention programmes will inevitably share many features in common, but to be truly effective, programmes need to take into account circumstances in the locality in which they operate. This notion is frequently paid 'lip-service', but many programmes across the globe still retain the essential character of services developed in the context of Europe or North America. What is required is a radical appreciation of the importance of service programmes reflecting the structure and functions of indigenous culture. A concept useful in this regard is that of sustainability, which is currently guiding much discussion concerning the nature of economic and agricultural programmes in the developing world. This term emphasizes the need to consider from the outset the mechanisms that will serve to support changes brought about on the formal introduction of intervention programmes. Using a behaviour analytic framework to examine the concept of sustainability, specific prerequisites of a 'sustainable service' within any particular setting are suggested. A resulting checklist of factors that should be considered in advance of service development may be a useful aid to service planners.

Behavior Therapy↗

Effectiveness of functional communication training with and without extinction and punishment: a summary of 21 inpatient cases.

Functional communication training (FCT) is a frequently used treatment for reducing problem behavior exhibited by individuals with developmental disabilities. Once the operant function of problem behavior is identified by a functional analysis, the client is taught to emit an appropriate communicative response to obtain the reinforcer that is responsible for behavioral maintenance. Studies on FCT have typically used small numbers of participants, have reported primarily on clients for whom FCT was successful, and have varied with respect to their use of other treatment components. The main purposes of the present study were to evaluate the efficacy of FCT for treating severe problem behavior in a relatively large sample of individuals with mental retardation (N = 21) and to determine the contribution of extinction and punishment components to FCT treatment packages. FCT with extinction was effective in reducing problem behavior for the majority of clients and resulted in at least a 90% reduction in problem behavior in nearly half the applications. However, when demand or delay-to-reinforcement fading was added to FCT with extinction, treatment efficacy was reduced in about one half of the applications. FCT with punishment (both with and without fading) resulted in at least a 90% reduction in problem behavior for every case in which it was applied.

Adolescent↗

Comparison of verbal preference assessments in the presence and absence of the actual stimuli.

Stimulus preference assessments for individuals with developmental disabilities typically involve offering choices among stimuli and providing immediate access to the chosen stimuli. Several researchers have explored the utility of presenting choices verbally, thereby obviating the need to present the choices in tangible form and deliver access to those choices immediately. However, studies that have compared verbal selection to selection among tangible stimuli have nonetheless delivered the chosen stimulus following selections, in essence, manipulating the antecedent but not the consequence. It therefore remains unclear whether preference assessments that do and do not include the actual stimuli yield comparable results. The current study compared preference assessment results for three participants in which either (a) the stimuli were presented, selections were made verbally, and selection resulted in no differential consequence, or (b) the stimuli were presented both verbally and in tangible form, and selection produced access to the stimulus. Reinforcer assessments were then conducted to test contradictory predictions of reinforcer efficacy made by the two methods. Comparisons between the two assessments yielded only modest rank-order correlations (M=0.24; range, -0.17 to 0.57) that varied widely across participants. Results of the reinforcer assessments suggested that the verbal-plus-tangible stimulus preference assessment more accurately predicted reinforcer strength.

Acoustic Stimulation↗

Standardization of the Denver developmental screening test for Israeli children.

The Denver Developmental Screening Test (DDST), standardized in the USA, is used for the early detection of developmental disabilities. For use in Israel, the DDST required translation into Hebrew and standardization for Israeli children in view of the test's known cultural bias. The sample included 2,248 children between the ages of 2 wk and 6.5 yr, and was stratified by demographic, ethnic and socioeconomic characteristics to approximate a representative cross-section of the Israeli population. The testers were not psychologists but they received special training. Our results revealed significant differences between the norms of the DDST and its Israeli version, mainly in the personal-social items. For 23 test items there was a difference of greater than 20% between the ages at which they were achieved by 50% of Israeli and Denver children, and for 35 items, there was a difference of greater than 20% in the 90th percentile ages in the two groups. Israeli children showed earlier development in language and personal-social items, while the Denver sample showed earlier development in fine and gross motor skills. The time range between the 25th and 90th percentile in many of the items in the Israeli sample was greater than in the Denver sample. There were sufficient differences between the findings in the two groups to justify using the Israeli version for the local population.

Age Factors↗

Excess mortality in remote symptomatic epilepsy.

BACKGROUND: Published estimates of excess mortality associated with epilepsy vary greatly. How much, if any, of the excess is attributable to the seizures themselves as opposed to an underlying condition causing the epilepsy is not clear from the literature. This article offers evidence that epilepsy per se is associated with excess mortality. The excess varies according to severity and frequency of seizures. MATERIALS AND METHODS: The authors studied mortality rates of developmentally disabled persons in California with and without epilepsy. In order to focus on the effect on mortality risk of epilepsy per se, they included only persons with good motor function (able to walk and climb stairs) and at worst moderate mental retardation (MR). The data were 506,204 person-years and 1523 deaths among 80,682 California subjects of age 5 to 65 years during the 1988-1999 study period. Mortality rates for persons with epilepsy were compared to rates for persons with no history of epilepsy. RESULTS: Mortality rates were higher for persons with epilepsy than for those without. Excess death rates (EDRs) varied according to type and frequency of seizures. Combined EDRs were 6 (deaths per 1000 person-years) for persons with recent (< 12 months) history of status epilepticus, 5 for recent history of generalized tonic-clonic (GTC) seizures, 3 for recent history of seizures but no recent GTC seizures, and less than 1 for a history of seizures but no recent events. CONCLUSIONS: The data presented here are evidence that epilepsy per se is associated with increased mortality. The EDRs reported here may be better measures of excess mortality due to epilepsy than previously published estimates.

Adolescent↗

Amygdala volume and nonverbal social impairment in adolescent and adult males with autism.

BACKGROUND: Autism is a syndrome of unknown cause, marked by abnormal development of social behavior. Attempts to link pathological features of the amygdala, which plays a key role in emotional processing, to autism have shown little consensus. OBJECTIVE: To evaluate amygdala volume in individuals with autism spectrum disorders and its relationship to laboratory measures of social behavior to examine whether variations in amygdala structure relate to symptom severity. DESIGN: We conducted 2 cross-sectional studies of amygdala volume, measured blind to diagnosis on high-resolution, anatomical magnetic resonance images. Participants were 54 males aged 8 to 25 years, including 23 with autism and 5 with Asperger syndrome or pervasive developmental disorder not otherwise specified, recruited and evaluated at an academic center for developmental disabilities and 26 age- and sex-matched community volunteers. The Autism Diagnostic Interview-Revised was used to confirm diagnoses and to validate relationships with laboratory measures of social function. MAIN OUTCOME MEASURES: Amygdala volume, judgment of facial expressions, and eye tracking. RESULTS: In study 1, individuals with autism who had small amygdalae were slowest to distinguish emotional from neutral expressions (P=.02) and showed least fixation of eye regions (P=.04). These same individuals were most socially impaired in early childhood, as reported on the Autism Diagnostic Interview-Revised (P<.04). Study 2 showed smaller amygdalae in individuals with autism than in control subjects (P=.03) and group differences in the relation between amygdala volume and age. Study 2 also replicated findings of more gaze avoidance and childhood impairment in participants with autism with the smallest amygdalae. Across the combined sample, severity of social deficits interacted with age to predict different patterns of amygdala development in autism (P=.047). CONCLUSIONS: These findings best support a model of amygdala hyperactivity that could explain most volumetric findings in autism. Further psychophysiological and histopathological studies are indicated to confirm these findings.

Adolescent↗

The effects of neonatal basal forebrain lesions on cognition: towards understanding the developmental role of the cholinergic basal forebrain.

Abnormal development of the cholinergic basal forebrain has been implicated in numerous developmental disabilities such as Rett Syndrome and Down Syndrome. This review summarizes recent data using two rodent animal models that involve interrupting cholinergic basal forebrain projections on postnatal day 1 and postnatal day 7 when basal forebrain fibers are beginning to innervate their neocortical and hippocampal targets, respectively. In one model, electrolytic lesions in mice aimed at the basal forebrain on postnatal day 1 transiently reduce cholinergic markers in neocortex which induce permanent alterations in neocortical anatomy that correlate with impairments on cognitive tasks. Furthermore, the lesion effects are sex dependent. In another model, 192 IgG saporin lesions in rats on postnatal day 7 permanently reduce cholinergic markers in neocortex and hippocampus, and result in mild impairments in spatial processing, acquisition and exploratory activities. These data suggest that during the first postnatal week of development the cholinergic basal forebrain system is critical for normal neocortical differentiation and, possibly synaptogenesis in neural circuits that will be important for spatial memory and acquisition of spatial data. During the second postnatal week of development, the cholinergic basal forebrain system appears to take on a role largely similar to its adult role in selective attention and processing of new information. These studies also suggest strongly that interrupting cholinergic basal forebrain innervation of neocortex and hippocampus leads to anatomical and neurochemical abnormalities that may serve as neural substrates for some of the cognitive deficits seen in disorders such as Rett Syndrome and Down Syndrome.

Acetylcholine↗

The class specific effects of compliance training with "do" and "don't" requests: analogue analysis and classroom application.

Two experiments are reported in which the relationship between compliance with "do" and "don't" requests was examined with developmentally disabled children. In Experiment 1, a multiple baseline design across subjects with counterbalanced treatment conditions was used to evaluate a compliance training program composed of four phases: (a) baseline, during which no consequences were delivered for compliance, (b) reinforcement for compliance with one targeted "do" request, (c) reinforcement for compliance with one targeted "don't" request, and (d) follow-up with reinforcement on a variable ratio schedule for compliance with any "do" or "don't" request. Results of probes conducted before and after training within each condition indicated that generalized compliance occurred only with requests of the same type as the target exemplar ("do" or "don't"). In Experiment 2, these results were replicated in a classroom setting. Following collection of baseline probe data on student compliance, a teacher training program was successfully implemented to increase reinforcement of compliance first with one "do" and subsequently with one "don't" request of a target student. Results of multiple baseline probes across "do" and "don't" requests indicated that the teacher generalized and maintained reinforcement of compliance with other requests of the same type and to other students, with a resulting increase in student compliance with the type of requests reinforced. The impact of treatment on both teacher and student behavior was socially validated via consumer ratings. Implications of these findings with respect to response class formation and compliance training programs are discussed.

Autistic Disorder↗

The frequency of vestibular disorders in developmentally delayed preschoolers with otitis media.

This study investigated the frequency of vestibular disorders in developmentally disabled preschoolers who did and who did not have a history of otitis media. Fifteen children with a history of otitis media and fifteen children with no history of otitis media were given two tests for vestibular functioning: the Southern California Postrotary Nystagmus Test (SCPNT) and the Lateral Labyrinthine Righting Reaction (LLRR), acting on the head. The scores on these tests were dichotomized, and a correlation between these two tests as measures of vestibular function was obtained. Because this correlation did not reach a satisfactory level, two a satisfactory level, two separate chi-square analyses were performed to examine the frequency of vestibular disorders with otitis media. Both tests showed a statistically significant difference in the incidence of vestibular disorders between the two groups of children; the group having otitis media demonstrated more vestibular disorders. The SCPNT demonstrated more striking results than did LLRR. This finding is related to the two tests measuring different aspects of vestibular functioning; the separate chi-square analyses were performed to examine the frequency of vestibular disorders with otitis media. Both tests showed a statistically significant difference in the incidence of vestibular disorders between the two groups of children; the group having otitis media demonstrated more vestibular disorders. The SCPNT demonstrated more striking results than did LLRR. This finding is related to the two tests measuring different aspects of vestibular functioning; the SCPNT reflects semicircular canal functioning, and the LLRR reflects utricular and saccular functioning. The criteria used for LLRR (four seconds) also may have influenced the results obtained using this test.

Child, Preschool↗

Health-related quality of life of Canadian children and youth prenatally exposed to alcohol.

BACKGROUND: In Canada, the incidence of Fetal Alcohol Spectrum Disorder (FASD) has been estimated to be 1 in 100 live births. Caused by prenatal exposure to alcohol, FASD is the leading cause of neuro-developmental disabilities among Canadian children, and youth. OBJECTIVE: To measure the health-related quality of life (HRQL) of Canadian children and youth diagnosed with FASD. METHODS: A prospective cross-sectional study design was used. One-hundred and twenty-six (126) children and youth diagnosed with FASD, aged 8 to 21 years, living in urban and rural communities throughout Canada participated in the study. Participants completed the Health Utilities Index Mark 3 (HUI3). HUI3 measures eight health attributes: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain. Utilities were used to measure a single cardinal value between 0 and 1.0 (0 = all-worst health state; 1 = perfect health) to reflect the global HRQL for that child. Mean HRQL scores and range of scores of children and youth with FASD were calculated. A one-sample t-test was used to compare mean HRQL scores of children and youth with FASD to those from the Canadian population. RESULTS: Mean HRQL score of children and youth with FASD was 0.47 (95% CI: 0.42 to 0.52) as compared to a mean score of 0.93 (95% CI: 0.92 to 0.94) in those from the general Canadian population (p < 0.001). Children demonstrated moderate to severe dysfunction on the single-attributes of cognition and emotion. CONCLUSION: Children and youth with FASD have significantly lower HRQL than children and youth from the general Canadian population. This finding has significant implications for practice, policy development, and research.

Adolescent↗