Relationship between serum cortisol levels, stereotypies, and the presence of autism spectrum disorder in patients with severe intellectual disability.

Stereotypies are one of the diagnostic criteria for autism spectrum disorder (ASD) and are common to both ASD and intellectual disability (ID). Previous studies have been inconclusive, with some showing a positive correlation between stereotypies and cortisol, while others have shown a negative correlation. We hypothesised and investigated the presence of ASD as one of the variables involved in this discrepancy. We tested the following hypotheses on serum cortisol in a total of 84 hospitalised patients with severe ID and ASD with severe ID. Hypothesis (1) Higher levels of stereotypies are associated with higher levels of serum cortisol. Hypothesis (2) The presence of ASD will moderate the association between stereotypies and high serum cortisol levels. The results of the analysis supported hypotheses (1) and (2). We also found that in the population with ID, serum cortisol levels were significantly lower in the ASD group compared to the non-ASD group. The present findings that the association between stereotypies and serum cortisol levels in people with severe ID is moderated by the presence of ASD suggest that the stress response system may function differently in people with ID and ASD than in the general population.

The role of task preference in the effectiveness of response interruption and redirection.

Response interruption and redirection (RIRD) is a common treatment for automatically reinforced vocal stereotypy; it involves the contingent presentation of task instructions. Tasks that are included in RIRD are typically selected based on caregiver report, which may affect the efficacy of RIRD. The purpose of the current study was to evaluate the role of task preference in the efficacy of RIRD for four participants who engaged in vocal stereotypy. We conducted task-preference assessments and selected tasks of varying preferences to include in RIRD. For three out of four participants, the results showed that RIRD with higher preference tasks was not effective at reducing vocal stereotypy, whereas RIRD with lower preference tasks was effective for all participants.

Co-morbid tics and stereotypies: a systematic literature review.

BACKGROUND: Tics and stereotypies are childhood-onset repetitive behaviours that can pose significant diagnostic challenges in clinical practice. Both tics and stereotypies are characterised by a complex co-morbidity profile, however little is known about the co-occurrence of these hyperkinetic disorders in the same patient population. OBJECTIVE: This review aimed to assess the relationship between tics and stereotypies when these conditions present in co-morbidity. METHODS: We conducted a systematic literature review of original studies on co-morbid tics and stereotypies, according to the standards outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Our literature search identified six studies of suitable sample size (n ≥ 40) presenting data on the association between tics and stereotypies in otherwise typically developing patients. A considerable proportion (23%) of patients diagnosed with stereotypic movement disorder present with co-morbid tics (range 18-43%). Likewise, the prevalence of primary stereotypies is increased in patients with tic disorders such as Tourette syndrome (8%, range 6-12%). DISCUSSION: Tics and stereotypies can often develop in co-morbidity. The association of tics and stereotypies in the same patient has practical implications, in consideration of the different treatment approaches. Future research should focus on the assessment and management of both conditions, particularly in special populations (e.g. patients with pervasive developmental disorders).

An Honest Joker reveals stereotypical beliefs about the face of deception.

Research on deception detection has mainly focused on Simple Deception, in which false information is presented as true. Relatively few studies have examined Sophisticated Deception, in which true information is presented as false. Because Sophisticated Deception incentivizes the appearance of dishonesty, it provides a window onto stereotypical beliefs about cues to deception. Here, we adapted the popular Joker Game to elicit spontaneous facial expressions under Simple Deception, Sophisticated Deception, and Plain Truth conditions, comparing facial behaviors in static, dynamic nonspeaking, and dynamic speaking presentations. Facial behaviors were analysed via machine learning using the Facial Action Coding System. Facial activations were more intense and longer lasting in the Sophisticated Deception condition than in the Simple Deception and Plain Truth conditions. More facial action units intensified in the static condition than in the dynamic speaking condition. Simple Deception involved leaked facial behaviors of which deceivers were unaware. In contrast, Sophisticated Deception involved deliberately leaked facial cues, including stereotypical cues to lying (e.g., gaze aversion). These stereotypes were inaccurate in the sense that they diverged from cues in the Simple Deception condition-the actual appearance of deception in this task. Our findings show that different modes of deception can be distinguished via facial action analysis. They also show that stereotypical beliefs concerning cues to deception can inform behavior. To facilitate future research on these topics, the multimodal stimuli developed in this study are available free for scientific use.

Access to Care Limitations: When Distance and Lack of Evidence Meet.

CASE: Jimmy is a 13-year-old adolescent boy who was diagnosed with Down syndrome (trisomy 21) prenatally. Jimmy is the only individual with Down syndrome in the small, rural community where he lives with his parents. He has mild sleep apnea, and his gross and fine motor developmental milestones were generally consistent with those expected among children with Down syndrome. At age 4, his parents raised concerns about his limited language, strong preference to be alone, and refusal to leave the house. Parents had observed his marked startle response to loud laughter and adult male voices. At age 7, his preferred activities consisted of dangling necklaces or shoelaces in front of his face and rocking his body forward and backward when seated. After limited progress in special education, speech, and occupational therapies, he was referred, at age 8, to a specialty center 3 hours from his home for a multidisciplinary evaluation. There, he received a diagnosis of co-occurring autism spectrum disorder (ASD).Over the last year, his repetitive behaviors have become more intense. He hits the side of his head with his fist and presses his thumbs into his eyes, causing bruising. Any attempts to remove his dangle objects are met with aggressive behaviors, including hitting, kicking, scratching, and elopement. At school, he refuses to complete work and sometimes hits his teacher. Aggression stops in the absence of educational demands. School staff informed parents they are not equipped to handle Jimmy's behaviors.Jimmy recently presented to the specialty center for developmental-behavioral pediatric and psychology support at the request of his primary care clinician. The developmental pediatrician discussed with Jimmy's parents the possibility of a trial of medication to address disruptive/aggressive behavior if there is not improvement with initiation of behavioral strategies. The psychologist began weekly behavioral parent training visits through telehealth, including prevention strategies, reinforcement, and functional communication training. The strategies have helped decrease the frequency of elopement and aggressive behaviors. Self-injurious behaviors and refusal at school have remained constant.Despite some stabilization, limited local resources as well as the lack of evidence-based guidelines for people with both Down syndrome and ASD have impeded improvements in Jimmy's significant behavioral and developmental challenges. His parents have become increasingly isolated from critical family and community support as well. In what ways could the clinicians and community support this child and his family and prevent others from experiencing similar hardships?

Gender stereotypes and motor performance: How explicit and implicit stereotypes influence girls standing long jump and anxiety.

OBJECTIVES: Inducing a negative stereotype toward women usually leads to a decrease in women's motor performance. Given that most studies have focused on explicit stereotype induction among adults, the main aim of this study was to investigate the effects of explicit and implicit gender stereotypes on standing long jump performance in children. The second aim was to investigate the effects of these same manipulations on children's state anxiety. DESIGN: A mixed model design with within-between-subject was used with standing long jump performance and state anxiety as dependent variables. METHOD: Two hundred and four children (Mage = 10.95 years, SDage = 0.85) participated in this study and were randomly assigned, after baseline measurement, into four different groups (i.e., explicit/implicit vs. explicit vs. implicit vs. control). Specifically, participants performed 8 trials of standing long jump (4 trials during the baseline phase and 4 trials during the experimental phase). Children also completed the competitive state Anxiety Inventory at baseline as well as immediately after the trials. RESULTS: For motor performance, children in the explicit/implicit group and in the implicit group were negatively affected by the stereotype manipulation during all trials whereas participants in the explicit group were only negatively impacted during the last two trials. However, regarding state anxiety, children were negatively affected after both explicit only and implicit only manipulations and more significantly after explicit/implicit manipulation. CONCLUSIONS: The present research showed that the explicit and implicit manipulations influenced motor performance differently, but that these two manipulations increased state anxiety in the same way. Moreover, the combination of the explicit and implicit inductions leads to a greater significant negative influence on state anxiety but not motor performance.

Perceived gender and political persuasion: a social media field experiment during the 2020 US Democratic presidential primary election.

Women have less influence than men in a variety of settings. Does this result from stereotypes that depict women as less capable, or biased interpretations of gender differences in behavior? We present a field experiment that-unbeknownst to the participants-randomized the gender of avatars assigned to Democrats using a social media platform we created to facilitate discussion about the 2020 Primary Election. We find that misrepresenting a man as a woman undermines his influence, but misrepresenting a woman as a man does not increase hers. We demonstrate that men's higher resistance to being influenced-and gendered word use patterns-both contribute to this outcome. These findings challenge prevailing wisdom that women simply need to behave more like men to overcome gender discrimination and suggest that narrowing the gap will require simultaneous attention to the behavior of people who identify as women and as men.

Complex faces and naïve machines A commentary on facial perceptions of age, gender, and leader preferences in the age of AI.

Tasks driven by artificial intelligence (AI), such as evaluating video job interviews, rely on facial recognition systems for decision-making. Therefore, it is extremely important that the science behind this technology is continually advancing. If not, visual stereotypes, such as those associated with facial age and gender, will lead to dangerous misapplications of AI.

Atypical head banging developed in teens persisting into adulthood as sleep-related rhythmic movement disorder.

Head banging is one subtype of sleep-related rhythmic movement disorder, characterized by stereotyped, repetitive rhythmic movements, such as lifting the head or entire upper body, banging the frontal area hard on the pillow, or slamming the occiput against a headboard. An atypical form of head banging with punching or slapping the head with a hand is extremely rare, with only 4 such cases reported so far. Herein, we present a young adult male who, since his early teens, has had atypical head banging, also called head-slapping, and discuss the neuropsychological and polysomnographic findings and review the literature. CITATION: Ji K-H, Kang M-R, Kim SJ. Atypical head banging developed in teens persisting into adulthood as sleep-related rhythmic movement disorder. J Clin Sleep Med. 2023;19(5):999-1001.

Representation of autism in fictional media: A systematic review of media content and its impact on viewer knowledge and understanding of autism.

LAY ABSTRACT: The way autism is represented in fictional media can impact people's views of autistic people. For example, representations may contribute to negative views of autistic people as being unusual or dangerous, or they may challenge stereotypes and instead highlight the strengths of autistic people. This work aimed to review previous research to understand how autistic people have been represented in fictional media (Part A). It also sought to understand whether viewing fictional portrayals of autism has an impact on people's knowledge of autism and attitudes towards autistic people (Part B). Of 14 studies that were included in Part A, several unhelpful and stereotypical portrayals of autism emerged. Positive portrayals were those that highlighted the strengths of autistic people and reflected nuance. There is a need for greater diversity in representation of autism in fictional media. For example, not all autistic people are white heterosexual males. Across the five studies included in Part B, there were no improvements in people's knowledge of autism after watching or reading a short segment from a fictional TV series or novel that depicts an autistic person. Although there was a significant improvement in people's attitudes towards autistic people, these findings do not provide a complete picture given the short length of the media exposure and small number of studies. Future studies should investigate how multiple exposures to the representation of autistic people in both fictional and non-fictional sources can affect people's understanding of autism. There is also a need to develop more accurate and respectful ways of measuring people's knowledge of, and attitudes towards, autism.

Sex-Based Differences in Autism Symptoms in a Large, Clinically-Referred Sample of Preschool-Aged Children with ASD.

Previous research has identified possible sex-based differences in restricted and repetitive behaviors in autism spectrum disorder (ASD). However, this finding is mixed, particularly among preschool-aged children. We investigated the presence of sex-based differences in parent-rated ASD symptomatology, using the Autism Spectrum Rating Scale (ASRS). Participants consisted of a large (n = 481,100 female), clinically-referred sample of preschoolers (ages 2-5) diagnosed with ASD (NVIQ: M = 67.11, SD = 21.79). Females had less severe symptoms on the Total, Unusual Behaviors, DSM-5, and Stereotypy scales on the ASRS. The effects were small-to-medium, but statistically significant. There was evidence of differential relationships between nonverbal IQ and ASRS scores among males and females. This study provides additional evidence of sex-based differences in ASD symptoms present from an early age.

Motor stereotypies in autism spectrum disorder: Clinical randomized study and classification proposal.

LAY ABSTRACT: Motor stereotypies are one of the most frequent features in children with a diagnosis of autism spectrum disorder. They may disrupt children's functioning and development and be a potential source of stress for families. Several factors, including sex, age, cognitive ability, and severity of autism spectrum disorder, may influence the presence and intensity of stereotypies. The present study aimed to identify the prevalence of motor stereotypies in a group of children with autism spectrum disorder. In addition, it sought to investigate whether sex, age, cognitive ability, verbal language, neurological comorbidities, and severity of autism spectrum disorder were associated with an increased probability and higher number, duration, and variability of stereotypies. A total of 134 participants aged 2.3-17.6 years underwent a clinical protocol with standardized video-recorded sessions. Stereotypies were identified and classified by two independent evaluators. The prevalence of stereotypies was 56.7%, and a total of 1198 motor stereotypies were captured. Children who were younger, nonverbal, and had higher severity of autism spectrum disorder had an increased probability of presenting stereotypies. Being nonverbal or having higher severity of autism spectrum disorder was also associated with presenting a higher number of stereotypies. Children with developmental delay, intellectual disability, or epilepsy displayed longer stereotypies, and children with developmental delay or intellectual disability additionally presented more diverse stereotypies. As part of the study, the authors present a clinical classification model, a glossary, and video samples of motor stereotypies. The findings of this study suggest that children who are younger, nonverbal, have lower cognitive ability, and have higher severity of autism spectrum disorder may have a higher burden of stereotypies. Earlier intervention and monitoring of these children have the potential to improve their long-term outcomes.

Gender stereotypes about intellectual ability in Japanese children.

Japan has a large gender gap; thus, this study examined whether Japanese 4- to 7-year-old children exhibit a "brilliance = males" stereotype and whether parental attitudes toward gender roles were related to children's stereotypes. We also explored whether the children exhibited such stereotypes in response to various stimuli. We showed children photos (Study 1) and stick figures (Study 2) of men, women, boys, and girls, asking them to attribute traits (smart or nice) to each. Study 1 revealed overwhelming in-group positivity in girls, whereas the results for boys were rather mixed. In Study 2, girls generally attributed nice to their own gender compared to boys. However, "brilliance = males" stereotypical responses were observed from 7 years of age, when boys began to be more likely to attribute smartness to their own gender compared to girls. The new data in Study 3 replicated results of Study 1 and parts of the results of Study 2. Moreover, merging the Study 3 data with that of Studies 1 and 2 confirmed their findings. Furthermore, it replicated the "brilliance = males" stereotype among 7-year-olds in the stick figure task. Parental attitudes toward gender roles were unrelated to children's gender stereotypes. The results indicated that Japanese children may acquire "brilliance = males" stereotypes later than American children (6-years-old). Furthermore, the results were clearer when children were presented with stick figure stimuli.

Stereotypical descriptions of computer science career interests are not representative of many computer scientists.

Using responses from a large respondent-initiated online survey, we find that the career interests of many current and aspiring computer scientists in the United States diverge from a popular and official depiction of computer scientists' interests used for career and workforce development worldwide. Distinct profiles of career interests emerged from the data. These profiles suggest that many women in the field value social and artistic expression in a way not currently recognized by established depictions of computer scientists' interests. Better capturing the diversity of interests in computer science might help to boost women's, and men's, engagement in this STEM field.

A comparison of RIRD within chained and multiple schedules in the treatment of vocal stereotypy.

Slaton and Hanley (2016) compared the effects of multiple and chained schedules on stereotypy and item engagement for 2 individuals who exhibited automatically maintained motor stereotypy. Contingent access to motor stereotypy (i.e., chained schedules) was more effective than time-based access (i.e., multiple schedules) at reducing motor stereotypy, increasing item engagement, and establishing stimulus control for both participants. We systematically replicated Slaton and Hanley with 2 participants by a) targeting vocal stereotypy, b) including response interruption and redirection as a treatment component across conditions, c) conducting sessions in the natural environment with teaching assistants as change agents, and d) conducting an analysis of the effective treatment component(s). Chained schedules were more effective for 1 participant, whereas both treatments were effective for the other participant. The component analysis showed that different components were necessary for effective treatment for each participant.

A retrospective analysis of stereotypy: Applicability of the behavioral subtyping model.

Recent research on automatically reinforced self-injurious behavior (ASIB) has identified specific patterns of responding in functional analyses that correlate with intervention efficacy (Hagopian et al., 2015; Hagopian et al., 2017). Whereas research by Hagopian et al. (2015, 2017) points to an important development in the assessment and treatment of ASIB, it is unclear if the applicability extends to automatically reinforced noninjurious behaviors, including stereotypy. Therefore, the current study replicated the methods of Hagopian et al. (2017), extending this research to published cases of stereotypy and related behavior. The behavioral subtype for each case was identified, and where applicable, the subtype was compared to intervention outcome data. The categorization of data sets as either Subtype 1 or Subtype 2 did not correspond with specific treatment outcomes. Unlike the results of Hagopian et al. (2015, 2017), reinforcement-based interventions were not more likely to be effective for Subtype 1 stereotypy than for Subtype 2 stereotypy.

Comparison of the presence and absence of an intervention to reduce hand stereotypies in individuals with Rett syndrome.

BACKGROUND: We investigated how many individuals with Rett syndrome were undergoing interventions to reduce stereotypic hand movements and the factors determining the presence or absence of an intervention. METHOD: A questionnaire was sent to 194 families. Each survey item was compared between the intervention and non-intervention groups according to the presence or absence of interventions to reduce hand stereotypies. RESULTS: Information was acquired from 72 cases; 72.1% of individuals had received an intervention to reduce stereotypies at some point in their lives. An upper limb splint was the most common intervention. Age, locomotor and reaching function, diagnostic age, frequency and type of stereotypy, joint contractures and stereotypy-associated problems separated the presence or absence of a current or past intervention. CONCLUSIONS: Interventions for stereotypy-associated problems are important and there are several variables related to whether an intervention is received.

Descriptive Longitudinal Analysis of Stereotypy and Corresponding Changes in Psychotropic Medication.

INTRODUCTION: Psychotropic medication is often prescribed to individuals with intellectual and developmental disabilities who engage in challenging and other behavior (e.g., aggression and stereotypy, respectively), but there is limited understanding of the effects of these medications on behavior. OBJECTIVE: Within the context of a larger study that evaluated the effects of psychotropic medication regimen changes on the presentation of challenging behavior, this study describes the presentation of stereotypic behavior of three individuals diagnosed with autism spectrum disorder. METHODS: Stereotypy was measured during weekly, one-hour, direct observations and during the control and ignore conditions of functional analyses of challenging behavior (which were conducted following changes in psychotropic medication regimens). RESULTS: Patterns of stereotypy varied over time, but not significantly, and at times seemed to coincide with medication changes. DISCUSSION: Our results suggest stereotypy persists throughout adulthood; however, additional research is needed.