The association between familial ASD diagnosis, autism symptomatology and developmental functioning in young children.

Few studies have directly compared individuals with and without a relative diagnosed with ASD on various domains. The present study aimed to examine the relationship between familial ASD diagnosis and the exhibition of ASD symptoms in young children with and without ASD diagnoses. Participants included 8353 children aged 17-37 months old and their families. They were divided into four groups based on individual and family diagnosis, then compared on autism symptomatology and developmental domains. No differences were found between ASD groups on overall scores and each of the factor domains, indicating no association between family ASD diagnosis and ASD symptomatology or developmental functioning. Disparate results were found for atypically developing groups with and without relatives diagnosed with ASD. Implications of these results are discussed.

Developmental Functioning of Infants and Toddlers with Neurodevelopmental Disorders.

PURPOSE: The current study aimed to investigate developmental functioning in infants and toddlers with autism spectrum disorder (ASD), seizures, cerebral palsy (CP), and atypical development. METHODS: An ANOVA was utilized to investigate the differences between neurodevelopmental group on BDI-2 developmental quotient and a MANOVA was used to investigate the differences between the groups and five developmental domains. RESULTS: The results indicated statistically significant differences in overall developmental functioning and each subdomain of the BDI-2. DISCUSSION: These findings provide the basis for further research to investigate comorbidities of the three neurodevelopmental disorders and parse out the impact of intellectual disability (ID).

Developmental Functioning of Toddlers At-Risk for Autism With and Without Down Syndrome.

PURPOSE: Due to the difficulties in differentiating between impairments associated with intellectual disability and ASD symptomology, DS often leads to delayed or misdiagnoses of ASD. METHOD: An ANOVA was run to investigate the effects of ASD risk and DS on overall developmental functioning across three groups: ASD+, DS-, and DS+ (n = 138). A MANOVA was run to investigate the differences of group on five developmental subdomains. RESULTS: The results revealed significant group differences in the overall developmental functioning and each developmental subdomain. Children in the DS+ group demonstrated significantly lower overall developmental functioning, as well as lower adaptive, cognitive, motor, and communication skills compared to their peers; however, children in the DS- group demonstrated significantly better social skills compared to their peers in the ASD+ group. DISCUSSION: These findings support the need for early screening and identification of ASD among those with DS.

Treatments for the challenging behaviours of adults with intellectual disabilities.

OBJECTIVE: To provide an overview and critical assessment of common problems and best evidence practice in treatments for the challenging behaviours (CBs) of adults with intellectual disabilities (IDs). METHOD: Commonly observed problems that present obstacles to successful treatment plans are discussed, followed by an analysis of available research on the efficacy of behavioural and pharmacological therapies. RESULTS: Behavioural and pharmacological interventions are most commonly used when addressing CBs in people with IDs. However, within each of these techniques, there are methods that have support in the literature for efficacy and those that do not. As clinicians, it is important to follow research so that we are engaging in best practices when developing treatment plans for CBs. CONCLUSIONS: One of the most consuming issues for psychiatrists and other mental health professionals who work with people who evince developmental disabilities, such as IDs, are CBs. These problems are very dangerous and are a major impediment to independent, less restrictive living. However, there is a major gap between what researchers show is effective and much of what occurs in real-world settings.

Development and initial testing of the BABY-BISCUIT in an at-risk population.

PURPOSE: Early identification of autism spectrum disorder (ASD) via screeners for diagnostic measures are a high priority. At present, there is no consensus on one screener due to the need for better sensitivity and specificity. In this study, we report on the development and utility of the BABY-BISCUIT, a six-item screener based on a modified subset of items from the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT). METHODS: A sample of 504 children between 17-3 9months of age, who consisted of toddlers identified as at-risk for neurodevelopmental and other health disorders, were tested during an annual screening through the Louisiana EarlySteps program. RESULTS: An exploratory factor analysis yielded a one-factor solution (X2 = 48.62, df = 9, p = <.001). High sensitivity (i.e., 100.0%) at the cost of reduced specificity (i.e., 33.3%, AUC = 0.957) was found for an optimal screening cutoff score of 1. CONCLUSIONS: Findings from this study suggest that the BABY-BISCUIT has the potential to be a short and easily administered screener for ASD to inform whether further ASD assessment is necessary. Further investigation of convergent validity with established ASD measures is recommended.

Examination of multiple birth as a predictor of autism symptom severity and developmental functioning in an early intervention sample.

Multiple birth is one of several perinatal factors associated with increased risk for autism spectrum disorder (ASD); however, complexity in its relationship to ASD symptoms and developmental functioning remains. The present study investigated perinatal risk factors for ASD, primarily focusing on birth status, within a large early intervention sample. In particular, the relationship between ASD, perinatal factors, and the effect of birth status on developmental functioning and ASD symptom severity were examined in youth with and without ASD classification who were born singly or were the product of a multiple birth. Overall, the presence of other perinatal risk factors, including prematurity, low birth weight, and advanced parental age, was primarily related to birth status and not to ASD classification, while severity of ASD symptoms and developmental impairments were primarily related to ASD classification and not to birth status. Study findings and implications for early screening of children with developmental delays are discussed.

Treating selective mutism using modular CBT for child anxiety: a case study.

Selective mutism is a rare, debilitating condition usually seen in children. Unfortunately, there is little research examining effective treatments for this disorder, and designing an evidence-based treatment plan can be difficult. This case study presents the evidence-based treatment of an 8-year-old Caucasian boy with selective mutism using an established treatment for anxiety--Modular Cognitive-Behavioral Therapy for Childhood Anxiety Disorders (Chorpita, 2007). The treatment consisted of 21 sessions and included modules on psychoeducation, exposure, cognitive restructuring, social skills, and maintenance and relapse prevention. The client's symptoms were greatly improved by the end of treatment based on fear hierarchy ratings, self-report and parent-report questionnaires, and child and parent clinical interviews. In addition, at discharge the client no longer met criteria for selective mutism. Improvements were maintained when the client was reassessed at 1-month and 6-month follow-up appointments.

Factors Associated with Restricted, Repetitive Behaviors and Interests and Diagnostic Severity Level Ratings in Young Children with Autism Spectrum Disorder.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by restricted, repetitive patterns of behavior and interests (RRBIs). With the latest update to the Diagnostic and Statistical Manual of Mental Disorders, a severity level rating is assigned to the two core features of ASD (American Psychiatric Association in Diagnostic and statistical manual of mental disorders 5 American Psychiatric Association Washington, D.C., 2013). Previous studies have identified factors associated with RRBI severity; however, the relationship among RRBIs, adaptive functioning, and diagnostic severity level remains unclear. The present study investigated whether adaptive functioning and parent-reported ASD symptoms predict RRBI severity in young children with ASD. Additionally, a fine-grained analysis was conducted to examine the factors associated with diagnostic severity level ratings. Several significant associations were found. Study findings and implications for assessment and treatment of RRBIs are discussed.

Comparing Rates of Diagnosis Using DSM-IV-TR Versus DSM-5 Criteria for Autism Spectrum Disorder.

With the publication of DSM-5, many changes were introduced regarding how Autism Spectrum Disorder (ASD) would be diagnosed. Changes from DSM-IV-TR were controversial, with many arguing that individuals would lose their diagnosis with the new criteria. The purpose of this study was to examine differences in the application of diagnostic criteria across both recent versions in a sample of infants and toddlers. Fewer individuals met criteria according to DSM-5; however, a larger proportion of individuals met criteria for both. Additionally, individuals with higher levels of symptoms were more likely to meet criteria for both versions as compared to either alone. Overall, results suggest that there are meaningful differences in how DSM criteria may apply to individuals with an ASD.

Parental Age at Conception and the Relationship with Severity of Autism Symptoms.

BACKGROUND: Previous research has examined the relationship between advanced parental age at conception and the incidence of autism, and has noted strong relationships between advanced parental age and other developmental disabilities. AIM: The purpose of this study was to confirm that and extend that knowledge to the association between advanced parental age and severity of autism symptoms as measured by a parental report of ASD symptom severity. METHODS: The current study included 252 participants between the ages of 2-17 years and their parents. RESULTS: Child's gender and paternal age were found to be significant predictors of autism severity with males and children with older fathers at conception showing the highest severity. Interestingly, maternal age was not found to be a significant predictor of autism risk or severity of symptoms in this sample. CONCLUSION: Possible explanations for these findings are discussed, as well as future directions for research in this area.

Gender Differences and Similarities: Autism Symptomatology and Developmental Functioning in Young Children.

A growing body of research suggests that symptoms of autism spectrum disorder (ASD) may present differently in males and females. This study examined gender differences in ASD symptoms and developmental functioning, using the Baby and Infant Screen for Children with aUtism Traits, Part 1 (BISCUIT-Part 1) and the Battelle Developmental Inventory, 2nd Edition (BDI-2), amongst children aged 17-37 months meeting ASD diagnostic criteria (n = 1317). No gender differences were found in regards to overall symptom severity or symptom domains on the BISCUIT-Part 1 when gender groups were matched by cognitive ability. Females with ASD had greater motor deficits and less communication impairment compared to their male counterparts as measured by the BDI-2. Secondary analyses examining item endorsement patterns were also conducted. Implications of the findings are discussed.

Differences in Developmental Concerns of Young Children with Autism Spectrum Disorder Across Racial/Ethnic Groups.

PURPOSE: Parents/caregivers of children with autism spectrum disorder (ASD) have varying types of initial concerns regarding their child's development, which may be culturally bound to parents' perceptions of their child's development. This study investigated differences in the types of initial developmental concerns reported by parents or caregivers of different racial/ethnic groups with children in an early intervention program. METHOD: This study examined the frequency of endorsement of different types of concerns in African American, Caucasian, and Hispanic families. RESULTS: No significant differences between racial/ethnic groups were found in the endorsement of concerns related to communication, language/speech, motor, problem behavior, sensory, feeding, prematurity, attention, adaptive functioning, and medical conditions. Racial/ethnic groups differed significantly in their endorsement for social concerns. CONCLUSION: Racial/ethnic group differences were confirmed regarding initial developmental concerns related to social behavior, which may be due to cultural beliefs. The implications of these findings on early identification are discussed.

PDD-NOS symptoms in adults with intellectual disability: toward an empirically oriented diagnostic model.

PDD-NOS has been an illusive diagnostic category in Autism Spectrum Disorders (ASD). It is a frequently occurring ASD, but it has typically been defined by what it is not-autism. This latter condition has received the bulk of the attention in the development of diagnostic methods, while PDD-NOS has largely been ignored from a diagnostic standpoint. The symptoms that characterize PDD-NOS in adults with intellectual disability (ID), beyond the extrapolation of a few child studies, are largely unknown. This study is an attempt to provide systematic empirical data to describe the condition of PDD-NOS in adults with ID. The implication of these data for diagnosis and future research are discussed.

Rett syndrome in adults with severe intellectual disability: exploration of behavioral characteristics.

Rett syndrome is a genetically linked form of autism spectrum disorder (ASD) accompanied by intellectual disability (ID). The disorder is also characterized by cardiorespiratory dysregulation, disturbance in muscle tone, reduced brain growth and scoliosis. Over 300 studies have been published on the disorder, most of which has focused on identification of causative factors, which appears to be the result of mutations of gene MECP2. Rarely have adults with Rett syndrome been studied, and behavioral characteristics in these individuals are largely unknown. The present study aimed to extend what little is known about behavioral characteristics of Rett syndrome in adults, with particular emphasis on social, communicative, and adaptive behavior. Rett syndrome adults with severe ID were matched to autistic adults with ID and ID only controls. The implications of these data for more fully describing and diagnosing the condition in adults are discussed.

A review of behavioral treatments for self-injurious behaviors of persons with autism spectrum disorders.

Autism spectrum disorders (ASD) are considered to be among the most serious of the mental health conditions. Concomitant with many cases of ASD is intellectual disability. Further compounding the disability is the fact that both conditions are known risk factors for self-injurious behavior (SIB). To date, the most effective intervention methods, based on the available data, appear to be variants of behavior modification. This article provides an overview of the current status of learning-based interventions for SIB in ASD and provides a review of specific studies. Although most studies describe some combination of reinforcement and punishment procedures, efforts are under way to develop more positively oriented strategies, such as functional assessment, to decrease the use of punishment. However, almost all the treatment studies employ single case designs, thus preventing a comparison of treatment efficacy. These issues are discussed along with other strengths, weaknesses, and future directions for clinical practice and treatment.

Cutoff scores for the Matson Evaluation of Social Skills for Individuals With Severe Retardation (MESSIER) for adults with intellectual disability.

Social skills are defining aspects of intellectual disability (ID). Additionally, their presence or absence can be a major impediment to independent living, and they correlate with other problems in the ID population, such as comorbid psychopathology. To date, little has been done to develop scales to measure these problems, particularly for adults. One exception has been the Matson Evaluation of Social Skills for the Severely Retarded (MESSIER). The scale has well established reliability, however many of its psychometric properties have yet to be explored. This study was designed to establish cutoff scores for the total score and factors and to explore the relationship of individual items to severity of social deficits. Participants are adults with severe or profound ID, assessed on the MESSIER. Specific psychometrics for the test including cutoff scores are established. The implications of these data for theory, research, and practice are discussed.

Cutoff scores, norms and patterns of feeding problems for the Screening Tool of fEeding Problems (STEP) for adults with intellectual disabilities.

Independent living is a goal for everyone, but often persons with intellectual disabilities (ID) have major challenges in this respect. In fact, deficits in daily living skills are a hallmark of the condition. One of the most serious and potentially problematic of the independent living skills is difficulties or irregularities in eating. These problems can not only effect independence but they can result in more restrictive living conditions, poor nutrition, choking, aspiration, or even death. Given the serious nature of the disorder, it points to the need for adequate screening and diagnosis of such problems. The present study reports on the STEP and the development of cutoff scores and norms for the scale. Possible applications of these data for real world problems of person with ID are discussed.

The effects of intellectual functioning on the range of core symptoms of autism spectrum disorders.

Autism spectrum disorders (ASD) are a class of conditions categorized by communication problems, ritualistic behaviors, and inappropriate social behaviors. While there is much evidence to support a genetic link for ASD, an identified genetic marker remains elusive. As such, practitioners place considerable emphasis on traditional measures of intelligence and adaptive behavior to aid in diagnosis. Despite the fact that these measures are commonplace, little research has been conducted to shed light on whether deficits in intellectual functioning affect the range of core symptoms for ASD. This study represents a first attempt to determine whether level of IQ has an effect on the expression of ASD symptoms in adults with intellectual disability (ID). Three hundred and six adults, 151 with both ASD and ID and 155 with ID alone, were evaluated with respect to the nature and extent of their ASD symptoms and intellectual functioning. Individuals with autism displayed a higher number of symptoms than those with pervasive developmental disorder-not otherwise specified (PDD-NOS) on all three domains of impairment (social, communication, repetitive behaviors). As expected, persons with ID alone evinced far fewer symptoms than both these groups. IQ level was found to be a moderator for expression of ASD symptoms for the entire sample but not for the autism group.

The relationship of self-injurious behavior and other maladaptive behaviors among individuals with severe and profound intellectual disability.

Participants were 101 individuals with self-injurious behavior (SIB) and severe or profound intellectual disability who were matched by gender, age, and level of intellectual disability to controls. Persons with SIB were more likely to exhibit the challenging behaviors of physical aggression, property destruction, sexually inappropriate behaviors and stereotypies when compared to controls, suggestive of co-occurring behaviors. Moreover, the maladaptive behavior of irritability, as assessed by the aberrant behavior checklist (ABC) was able to correctly classify 72.8% of the sample into their respective group memberships. Implications of these findings are discussed.

Characteristics of challenging behaviours in adults with autistic disorder, PDD-NOS, and intellectual disability.

BACKGROUND: Challenging behaviours are frequently a problem for people with autism spectrum disorders (ASD) and intellectual disability (ID). A better understanding of which individuals display which behaviours, at what rates, and the relationship of these behaviours to comorbid psychopathology would have important implications. METHOD: A group of 161 adults with ASD (autistic disorder or Pervasive Developmental Disorder--Not Otherwise Specified [PDD-NOS]) and 159 matched controls with ID only residing in two large residential facilities in Southeastern United States, were studied using the Autism Spectrum Disorders--Behavior Problems for Adults (ASD-BPA). RESULTS: In all four categories of challenging behaviour measured by the ASD-BPA (Aggression/Destruction, Stereotypy, Self-Injurious Behavior, and Disruptive Behavior), frequency of challenging behaviours increased with severity of autistic symptoms. The greatest group differences were found for Stereotypy (repeated/unusual vocalisations/body movements and unusual object play), Self-Injurious Behavior (harming self and mouthing/swallowing objects), Aggression/Destruction (banging on objects), and Disruptive Behavior (elopement). CONCLUSIONS: Challenging behaviours in people with ASD and ID are barriers to effective education, training, and social development, and often persist throughout adulthood. Thus, programs designed to remediate such behaviours should continue across the life-span of these individuals.