Psychometric assessment of first-degree relatives of 62 autistic probands in Utah.

The Wechsler Intelligence Scales, Wide Range Achievement Test, and the Shipley-Hartford Test were administered to 122 parents and 153 siblings of 62 autistic probands in Utah. Scores were distributed as expected within the published normative ranges for each scale. Parents' scores correlated with those of their nonautistic children, but neither parents' nor siblings' scores correlated with the IQ level of the autistic probands. These results do not confirm prior reports from England and the United States of a high rate of cognitive and learning problems in the siblings of autistic individuals, nor the aggregation of such problems in the siblings of probands with high or low levels of cognitive function.

The UCLA-University of Utah epidemiologic survey of autism: recurrence risk estimates and genetic counseling.

The authors recently reported, in this journal, an epidemiologic survey of autism in Utah. Twenty (9.7%) of the 207 families ascertained had more than one autistic child. Analyses of these data revealed that autism is 215 times more frequent among the siblings of autistic patients than in the general population. The overall recurrence risk estimate (the chance that each sibling born after an autistic child will develop autism) is 8.6%. If the first autistic child is a male the recurrence risk estimate is 7%, and if a female 14.5%. These new recurrence risk estimates should be made available to all individuals who have autistic children and are interested in family planning.

The UCLA-University of Utah epidemiologic survey of autism: prevalence.

The authors conducted an epidemiologic survey in Utah using a four-level ascertainment system, blind current diagnostic assessments, and DSM-III criteria. Of 483 individuals ascertained, 241 were diagnosed as having autism. The best estimate for the prevalence rate was 4 per 10,000 population. Autism was not associated with parental education, occupation, racial origin, or religion. Sixty-six percent of the autistic subjects scored below 70 on standardized IQ tests, and females scored proportionately lower than males. Twenty (9.7%) of 207 families had more than one autistic sibling, which supports the authors' previous finding that there may be a familial subtype of autism.

The UCLA-University of Utah epidemiologic survey of autism: the etiologic role of rare diseases.

Twelve rare diseases known to cause CNS pathology were found in 26 (11%) of 233 autistic probands identified during a recent epidemiologic survey of Utah. These 26 probands had significantly lower mean IQs than the remaining patients (43 versus 60) but similar sex distribution and prevalence of abnormal EEGs and seizures. The rarity and diversity of these 12 diseases make it highly unlikely that they randomly occurred with autism. Their presence in this epidemiologic survey is the most compelling evidence to date to support the hypothesis that different diseases producing different types of CNS pathology can play an etiologic role in autism.

The UCLA-University of Utah epidemiologic survey of autism: prenatal, perinatal, and postnatal factors.

In a recent epidemiologic survey conducted in Utah, 241 autistic patients (DSM-III criteria) were found. Medical records of 233 autistics were surveyed for the presence of 36 potentially pathologic prenatal, perinatal, and postnatal factors. These results were compared with those of an identical survey of 62 of their nonautistic siblings, with the results of four previously published surveys, and with normative data. No potentially pathologic factor or group of factors occurred significantly more frequently among the autistic patients. Also, previous observations of significant differences in the occurrence of certain factors in the histories single vs multiple siblings with autism were not confirmed, with the exception of increased viral-type illness during gestation in single-incidence cases. Thus, the etiology of the brain pathology that characteristically disrupts normal development and produces the syndrome of autism remains obscure. Other data from the epidemiologic survey, however, suggest that the role of genetic factors needs to be explored further.

The UCLA-University of Utah epidemiologic survey of autism: genealogical analysis of familial aggregation.

To assess familial aggregation of autism, 86 autistic subjects were linked to the Utah Genealogical Database. Kinship coefficients were estimated for all possible pairs of autistic subjects and then averaged. Fifty replicate sets of matched control subjects (86 members in each set) were drawn randomly from the database, and the average kinship coefficient was computed for all possible pairs of individuals in each set. The average kinship coefficient for the autistic subjects was approximately 1/1,000, while the average kinship coefficients for the 50 control groups ranged from 4/100,000 to 1.6./10,000. These results indicate a strong tendency for autism to cluster in families. When kinship was analyzed by specific degrees of relationship, it was shown that the familial aggregation of autism is confined exclusively to sib pairs and does not extend to more remote degrees of relationship. This finding indicates that a single-gene model is unlikely to account for most cases of autism.

Positive practice overcorrection combined with additional procedures to teach signed words to an autistic child.

The present study evaluated the effectiveness of using positive practice overcorrection in combination with other techniques to teach two manual signs ("milk" and "cookie") to an autistic boy. This boy had a great deal of difficulty in forming any type of discrimination and often became confused in learning the most simple simultaneous discrimination. Intervention primarily consisted of positive practice overcorrection in which the subject was physically guided to form a required hand sign 10 times when he responded incorrectly and was positively reinforced when he signed correctly. The study used a changing criterion within a multiple-baseline design across responses. The results indicated that overcorrection plus positive reinforcement was effective in teaching one sign (milk), however, and added contingent exercise (having to stand up and sit down 10 times for an incorrect response) was required to teach the second sign (cookie). Once the two signs were learned to a criterion level, it was a relatively easy task for the subject to respond correctly with the signs in a matching-to-sample task.

Comprehensive treatment of chronic fire setting in a severely disordered boy.

A comprehensive, multidimensional treatment strategy was designed for a severely behaviorally disordered 10-year-old boy with a 7-year history of setting fires. The study replicates a previous study designed to suppress fire setting, teach appropriate substitute behavior and increase awareness of the consequences of fire setting. Three additional components were added to the original treatment program: relaxation training, a response cost for fire setting, and a visit to a hospital burn unit (overt sensitization). Follow-up data 1 year later indicate that treatment was successful in extinguishing all fire-setting behaviors. The additional treatment components presented in this paper may add to the efficacy and sustained durability of treatment gains in difficult, low frequency fire setting behavior.

The use of contingent water misting in the treatment of self-choking.

A 25-year-old, deaf-blind, mentally retarded male was treated for chronic self-choking using water mist treatment and positive reinforcement. During pre-treatment baseline, self-chokes occurred at a rate of 2.09 per minute. During treatment sessions each self-choke was followed by water misting of the subject's face paired with a forceful "No!". Periods of 20 sec absent of self-chokes were positively reinforced with liquids and/or social contacts. Treatment procedures were generalized from the initial therapists, location, and absence of other clients and staff to other locations, and the presence of other clients and staff. Water mist treatment was associated with at least a 10-fold and as much as a 100-fold reduction of self-choking (i.e. to 0.02-0.20 self-chokes per min) across treatment and generalization phases. Eight-month follow-up observations showed that self-choke rates were at zero.

Cyclical self-injurious behavior, contingent water mist treatment, and the possibility of rapid-cycling bipolar disorder.

Cyclical self-injurious behavior (SIB) in the form of self-slapping was treated in a 45-year-old, profoundly retarded woman who had a life-long history of SIB. Her SIB alternated between high (mean = 8.54 responses per min; SD = 6.77 and low (mean = 0.05 responses per min; SD = 0.20) frequencies every 8 weeks on average. Instances of self-slapping produced water mist treatment paired with a verbal command, "No hitting". Absence of self-slapping and/or completion of a work task led to a variety of outcomes, including brief back rubs, sips of water, small edibles, and praise. Water mist treatment reduced the frequency of SIB within treatment days during high frequency periods, but produced no reduction across treatment days. Treatment onset was associated with a slight increase in the frequency of SIB during three of the five low frequency periods. However, water mist treatment suppressed SIB completely in sessions during low frequency periods and the suppression continued across treatment days. Water mist treatment produced no discernible changes in the length of the high and low frequency periods of SIB.

Non-aversive reduction of cigarette smoking in two adult men in a residential setting.

Two middle-aged men with mental retardation, addicted to smoking cigarettes, operated spinners that determined the probability with which they could obtain cigarettes and other items. Absence of several maladaptive behaviors permitted the operation of the spinners hourly (i.e., DRO 60 min), 16 h per day, 7 days per week. The actual frequencies of obtaining cigarettes followed the theoretical probabilities of obtaining cigarettes in all phases of the study. Presumed smoking frequencies were reduced by about 50% with associated medical benefits. Low frequencies of maladaptive behaviors were maintained throughout.

Reduction of self-injurious behavior in an autistic girl using a multifaceted treatment program.

Self-injurious hand biting was reduced in an autistic girl by using fine water mist combined with a loud statement of "No!" following the behavior, and verbal praise for appropriate behavior. The subject was 6 years old when the interventions were implemented, and she had been in arm and head restraints since infancy. A fading procedure that moved from a large to smaller bottles allowed generalization across settings and people. Treatment was effective at a 6-month follow-up in both structured and unstructured settings.

Interventions for students with traumatic brain injury: managing behavioral disturbances.

The present article provides information about the behavioral sequelae that are commonly seen in children and adolescents following a traumatic brain injury (TBI) and ways that educators can begin to address these problems. Because, for the most part, behavioral interventions have not been empirically validated for use with TBI populations, this article focuses on the unique needs of these students and the factors that should be considered in designing intervention strategies. Emphasis is placed on the cognitive sequelae of TBI that can cause further behavioral problems and interfere with interventions (e.g., impaired attention, executive function, reasoning and problem solving, and learning and memory).

Homework and students with learning disabilities and behavior disorders: a practical, parent-based approach.

This article provides a limited review of the effects of homework on students with disabilities, the essentials of effective homework programs, and variables that affect home-school partnerships. The emphasis is on students with learning disabilities and behavior disorders who are at risk for academic failure and poor school adjustment. The authors introduce the University of Utah Homework Partners series, which highlights three homework packages: a cooperative learning teams-based approach for classrooms, a package to train parents to be positive academic tutors for their children, and a systematic program to train parents in effective homework practices. The latter package is the major focus of this article because it emphasizes home-school partnerships for students with disabilities. Sanity Savers for Parents: Tips for Tackling Homework is a training program that teaches parents how to assess, design, and troubleshoot an effective in-home homework program for their child. The overall emphasis of this program is on practical interventions that are positive and motivating and include a home-to-school link to maximize the generalization of effects for students with learning and behavior disabilities.

Using student-managed interventions to increase homework completion and accuracy.

We examined the effectiveness of self-managed individual and group contingency procedures in improving the completion and accuracy rates of daily mathematics homework assignments. A group of sixth-grade students having homework difficulties in mathematics were selected for the study. There was substantial improvement in the amount of homework completed over baseline for a majority of the students, whereas the results for accuracy were mixed. Students who participated in the self-management training made significant gains on standardized measures of academic achievement and curriculum-based measures of classroom performance. Parents also reported significantly fewer problems associated with homework completion following the intervention. Students who were allowed to select their own performance goals made superior improvements in the number of homework assignments returned compared to students who were given a specified goal by the classroom teacher. Parents, subjects, and the classroom teacher responded positively on consumer satisfaction measures following termination of the study.

Use of T scores on the revised child behavior profile with inpatients.

The assignment of T values to raw scores on the behavior problem scales of the Revised Child Behavior Profile (RCBP) was examined. RCBP T scores below 70T are normalized standard scores. Therefore, the T scores below 70T are comparable within each scale and from one scale to another. In contrast, RCBP T scores above 70T are not standard scores. Therefore, they cannot be compared appropriately to other scores. The lack of intrascale and interscale comparability of RCBP T scores above 70 is especially problematic for the study of inpatients whose scores tend to fall in the unscaled region above 70T. Therefore, it is recommended that for studies of inpatients, raw scores on the behavior problem scales should be transformed to standard scores by use of the mean and standard deviation of an appropriate comparison group. Then, for purposes of interpretation, scores that fall in the upper ranges of the inventory can be compared appropriately to other scores on the same scale or to scores on other scales of the RCBP.

Complex segregation analysis of autism.

A complex segregation analysis of autism in 185 Utah families was carried out using the mixed model. The 209 affected individuals in these families represent nearly complete ascertainment of the autistic cases born in Utah between 1965 and 1984. The sibling recurrence risk for autism was 4.5% (95% confidence limits 2.8%-6.2%). Likelihoods were maximized for major-gene models, a polygenic model, a sibling-effect model, and a mixed model consisting of major-gene and shared-sibling effects. The analysis provided no evidence for major-locus inheritance of autism. Subdivision of the sample according to the probands' IQ levels showed that sibling recurrence risk did not vary consistently with IQ level. A segregation analysis of families in which the proband had an IQ less than 50 also failed to provide evidence for a major locus. However, because of the etiologic heterogeneity of this disorder, genetic analysis of other meaningful subsets of families could prove informative.