Cognitive shifting and externalising problem behaviour in intellectual disability and autism spectrum disorder.

BACKGROUND: Behavioural problems are frequently reported in residential care for people with an intellectual disability (ID) in particular when they are additionally diagnosed with autism spectrum disorder (ASD). There are indications that impairment in cognitive shifting may be associated with problem behaviour. The objectives of this study were (1) to examine the relationship of cognitive shifting and severity of ASD symptoms with externalising problem behaviour in individuals with ID, with and without ASD, and (2) to examine whether a diagnosis based on shifting impairment is more predictive of externalising problem behaviour than an ASD diagnosis. METHOD: Participants consisted of adolescents and young adults with mild ID, with and without ASD (n = 41). Pearson intercorrelations were computed to explore the relationship between shifting impairment and severity of ASD symptoms on the one hand and ratings of externalising problem behaviour on the other hand. t-Tests were performed to analyse differences in externalising problem behaviour. RESULTS: Unlike ASD symptom severity, shifting scores were found to be associated with externalising problem behaviour, but only if shifting was measured using rating scales and not when using neuropsychological tasks. Externalising problem behaviour scores significantly differed when groups were classified according to shifting impairment (impaired vs. non-impaired) but not when they were classified according to ID and ASD diagnoses. CONCLUSIONS: It is proposed to use a cognition-based approach when analysing problem behaviour, thus concentrating not so much on ID and ASD diagnosis and their corresponding symptoms, but rather placing the focus on cognitive symptoms.

Executive functioning in individuals with intellectual disabilities and autism spectrum disorders.

BACKGROUND: Executive functioning (EF) is important for adequate behavioural functioning and crucial for explaining symptoms of autism spectrum disorders (ASD) in individuals with normal intelligence, but is scarcely studied in individuals with ASD and intellectual disabilities (ID). We therefore study EF in an ID population by comparing performances on three frequently studied executive functions (shifting, inhibition and updating) between individuals with ASD and individuals without ASD. When studying ID populations, one should be aware of Spearman's Law of Diminishing Returns (SLODR), as it questions the possibility of measuring separate cognitive functions in ID populations. METHODS: Six EF tasks were administered to 50 individuals with mild to borderline ID, of which half was diagnosed with ASD. In order to investigate the distinctness of the three executive functions in this ID sample, the results on the six EF tasks were subjected to principal components analysis (PCA). Subsequently, a multivariate analysis of variance (MANOVA) was performed to assess differences between the ASD and non-ASD group on shifting, inhibition and updating. RESULTS: The PCA revealed the hypothesised EF trichotomy. MANOVA analysis showed no significant group differences on EF-performance. CONCLUSIONS: Three separate executive functions were measured in this ID population, but despite much evidence that individuals with ASD display more behavioural problems and the proven relevance of EF in behavioural functioning, no significant group difference was found on shifting, inhibition or updating. After this first effort to achieve more insight into EF of individuals with ASD and ID the relation between behavioural problems and EF will require further study.

A multidimensional weight-management program for women.

Real and imagined overweight and obesity, and resulting weight-reduction efforts, are associated with the development of a variety of health problems and eating disorders. For many years, research and practice in the field of weight management have been based largely on a unidimensional, simplistic, weight-loss paradigm. The long-term success rate for persons using this paradigm has been low. This article presents a multidimensional paradigm that focuses on all aspects of the prevention, treatment, and management of weight-related problems. The goal is to stimulate a shift from the unidimensional to a more multidimensional approach in weight-management interventions. The paradigm presents weight management as a continuum on which 5 prominent points are identified: formulation of reasonable weight goals, prevention of unnecessary weight; gain or loss, weight loss when necessary, prevention of relapse, and acceptance of an overweight/obese physique when necessary. The intrapersonal characteristics and skills associated with this continuum, namely, self-esteem, body image, self-efficacy, locus of control, motivation, stress management, problem solving and decision making, and assertiveness, as well as the role of stage of change and environmental influences on weight management, are examined. Issues concerning the different dimensions of the paradigm are discussed as are challenges and applications for researchers and practitioners in the field of weight management.

Shifting impairment and aggression in intellectual disability and autism spectrum disorder.

Aggressive behaviour is a major problem in individuals with an intellectual disability (ID) as well as in individuals with an Autism Spectrum Disorder (ASD). There are indications that suggest a link between cognitive shifting and aggression. In this study, reports of aggressive incidents of adolescents and young adults with different clinical diagnoses (ID, ID+ASD, ASD) were collected during 1 year, using the Staff Observation Aggression Scale-Revised. Whether they were diagnosed with ID, ASD or both; individuals who displayed aggression were found to face more cognitive shifting difficulties than non-aggressive individuals, while no significant differences were found on severity of ASD symptoms. Study results support the assumption that a cognition-based model for aggression may be more adequate than a diagnose-based model.

Immune response to hepatitis B vaccine in hemodialysis patients.

The impaired immune reactivity of hemodialysis patients has been reported to interfere with adequate antibody responses to standard doses of hepatitis B vaccine. In 22 hemodialysis patients, however, a 92% conversion rate could be obtained by administering multiple doses of plasma-derived MSD-vaccine. As the cost of such an amplified vaccination schedule is still lower than the cost of one dialysis treatment, this active vaccination policy for highly susceptible patients appears financially justified.