A pilot investigation of an iOS-based app for toilet training children with autism spectrum disorder.

We developed an iOS-based app with a transmitter/disposable sensor and corresponding manualized intervention for children with autism spectrum disorder. The app signaled the onset of urination, time-stamped accidents for analysis, reminded parents to reinforce intervals of continence, provided a visual outlet for parents to communicate reinforcement, and afforded opportunity for timely feedback from clinicians. We compared this intervention with an intervention that uses standard behavioral treatment in a pilot randomized controlled trial of 33 children with autism spectrum disorder aged 3-6 years with urinary incontinence. Parents in both groups received initial training and four booster consultations over 3 months. Results support the feasibility of parent-mediated toilet training studies (e.g., 84% retention rate, 92% fidelity of parent-implemented intervention). Parents used the app and related technology with few difficulties or malfunctions. There were no statistically significant group differences for rate of urine accidents, toilet usage, or satisfaction at close of intervention or 3-month follow-up; however, the alarm group trended toward greater rate of skill acquisition with significantly less day-to-day intervention. Further development of alarm and related technology and future comparative studies with a greater number of participants are warranted.

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.

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.

Increasing prosocial behavior and academic achievement among adolescent African American males.

African American adolescents disproportionately perform poorly compared to peers in both behavioral and academic aspects of their educational experience. In this study, African American male students participated in an after-school program involving tutoring, group counseling, and various enrichment activities. All students were assessed regarding their behavioral changes using attendance, discipline referrals, suspensions, and expulsions reports. The Kaufman Brief Intelligence Test (KBIT) and the Kaufman Test of Educational Achievement (KTEA) were used to assess the adolescents' improvement in their skills in reading and mathematics. After the end of the two-year program, initial results showed that the adolescents had increased their daily attendance, decreased discipline referrals, and had no suspensions or expulsions. These results also indicated that although the students entered the program at different skill levels, they were assessed to have the ability to function at their appropriate grade level. Their average improvement in basic skills was at least two grade levels. Implications drawn from the findings include: (a) there is a need to emphasize appropriate assessment prior to beginning a skill improvement program; (b) a need to emphasize the use of individualized learning plans and tutors; and (c) a need to further investigate the role of assessment and intervention in after-school programming in order to close the achievement gap.

Use of urine alarms in toilet training children with intellectual and developmental disabilities: A review.

The purpose of this review is to describe and evaluate the existing research on the use of urine alarms in the daytime toilet training of children with intellectual and developmental disabilities (IDD). A systematic literature search yielded 12 studies, many of which were published over a decade ago. The findings suggest that interventions that incorporate the use of urine alarms are promising in the treatment of daytime enuresis for children with IDD; however, more carefully controlled research is needed to confirm these findings and elucidate the precise role urine alarms may play in toileting interventions. Methodological strengths and limitations of the body of research are discussed.

Efficacy of the ADEC in Identifying Autism Spectrum Disorder in Clinically Referred Toddlers in the US.

The Autism Detection in Early Childhood (ADEC) is a brief, play-based screening tool for the assessment of autism spectrum disorder (ASD) in children aged 12-36 months. We examined the psychometric properties of the ADEC in a clinical sample of toddlers (n = 114) referred to a US pediatric hospital for assessment due to concerns of developmental delay or ASD. The ADEC (cutoff = 11) returned good sensitivity (.93-.94) but poorer specificity (.62-.64) for best estimate clinical diagnosis of ASD, and compared favorably with the ADOS-2. Internal consistency was acceptable, α = .80, and inter-rater reliability was high, ICC = .95. Results support the use of the ADEC as a clinical screen for ASD.

Utensil manipulation during initial treatment of pediatric feeding problems.

Children with feeding disorders exhibit a variety of problem behaviors during meals. One method of treating problem mealtime behavior is to implement interventions sequentially after the problem behavior emerges (e.g., Sevin, Gulotta, Sierp, Rosica, & Miller, 2002). Alternatively, interventions could target problem behavior in anticipation of its emergence. In the current study, we implemented nonremoval and re-presentation of bites either on a spoon or on a Nuk for 12 children with feeding problems. The nonremoval and re-presentation treatment improved feeding behavior for 8 of 12 children. Of those 8 children, 5 had lower levels of expulsions, and 4 of the 8 children had higher levels of mouth clean with the Nuk than with the spoon. We describe the subsequent clinical course of treatment and present follow-up data for 7 of the 8 children who responded to the nonremoval and re-presentation treatment with the spoon or Nuk. The data are discussed in terms of potential reasons why the utensil manipulation improved feeding behavior for some children.

The validity of the Baby and Infant Screen for Children with aUtIsm Traits: Part 1 (BISCUIT: Part 1).

A top priority in the field of autism spectrum disorders (ASD) is the development of precise early diagnostic tools that can be completed with minimal time and training. We report on the convergent and divergent validity of the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT), specifically the BISCUIT-Part 1. Previous research with this scale has determined its reliability and sensitivity/specificity. In this study, a sample of 1,007 toddlers 17-37 months of age were assessed individually. The BISCUIT-Part 1 demonstrated good convergent validity with the Modified CHecklist for Autism in Toddlers (M-CHAT) and the Personal Social domain from the Battelle Developmental Inventory, Second Edition (BDI-2). Additionally, divergent validity was demonstrated by its small correlation with the Adaptive and Motor domains from the BDI-2.

Chin prompt plus re-presentation as treatment for expulsion in children with feeding disorders.

Expulsion (spitting out food) is a problem behavior observed in many children with feeding disorders. In the current investigation, we identified 4 children diagnosed with a feeding disorder who exhibited high rates of expulsion. Treatment with re-presentation (placing expelled liquids or solids back into the child's mouth) was not effective in reducing expulsion. Therefore, we added a chin-prompt procedure (the feeder applied gentle upward pressure to the child's chin and lower lip) for the initial presentation and the re-presentation. Chin prompt plus re-presentation resulted in low rates of expulsion for all 4 children. The results are discussed in terms of the potential underlying mechanisms behind the effectiveness of the chin-prompt procedure.

Children with autism spectrum disorders: a comparison of those who regress vs. those who do not.

OBJECTIVE: While autism spectrum disorders (ASD) constitute a group of similar conditions, considerable heterogeneity in symptoms of these neurodevelopmental disorders have been noted. One of the most important, yet least studied, of these factors is developmental regression. METHODS: One-hundred and twenty-five children were studied and broken down into the following three groups: ASD children with and without substantial regression and typically developing children. In study one, the three groups were compared on global measures of ASD symptomatology, comorbid psychopathology, challenging behaviour and social skills. In study two, the two ASD groups were compared on each individual item from the dependent measures. RESULTS: Mean age when regression occurred was 27.76 months. The ASD children as a whole differed from the typically developing controls, showing more symptoms of ASD, as would be expected, and poorer social skills, while differences were also noted between the two ASD groups. CONCLUSIONS: It was determined that children with ASD who regress present with a distinct behavioural profile when compared to children with ASD who do not regress, which included greater levels of impairment on global measures of ASD symptomatology, comorbid psychopathology, challenging behaviour and social skills.

Factor structure and diagnostic fidelity of the Baby and Infant Screen for Children with aUtIsm Traits-Part 1 (BISCUIT-part 1).

OBJECTIVE: Due to the effectiveness of early intervention on the outcome of individuals with ASD, there is a race to identify children with ASD at younger ages. The Baby and Infant Screen for Children with aUtIsm Traits-Part 1 (BISCUIT-Part 1) is a new assessment tool designed to assess symptoms of ASD in children between the ages of 17-37 months. The aim of this study was to identify the factor structure of BISCUIT-Part 1 and investigate group differences with regards to these factors. METHODS: Participants (n = 1287) were enrolled in a state-funded early intervention programme for children at-risk for a developmental disability. The BISCUIT was administered to a parent or other significant caregiver along with other developmental measures as part of the assessment protocol for the early intervention programme. RESULTS: The exploratory factor analysis yielded a three-factor solution consistent with symptom clusters characteristic of ASD. Furthermore, participants diagnosed with ASD exhibited significantly higher scores on the factors of the BISCUIT-Part 1, compared to toddlers without a diagnosis of ASD. CONCLUSION: The BISCUIT-Part 1 shows promise in aiding clinicians in the diagnosis of ASD in infants and toddlers.

A comparison of social skills profiles in intellectually disabled adults with and without ASD.

The purpose of this study was to systematically examine the social-skills profiles among adults with autism spectrum disorders (ASD) and intellectual disability (ID). Using one-way multivariate analysis of variance (MANOVA), three groups (autism, pervasive developmental disorder-not otherwise specified [PDD-NOS], and ID only) were compared on seven global measures of social behavior. There were 72 individuals in each group matched on level of ID, verbal ability, age, and gender. Distinctions were noted in the areas of positive social behaviors and negative nonverbal social behaviors. Those with autism displayed the greatest deficits in these areas, followed by those with PDD-NOS. The results support the notions that social impairment remains a distinct feature of ASD in adults with ID, that autism and PDD-NOS are two conditions on the same spectrum, and that this spectrum is relevant for adults with ID. Implications of the results and directions for future research are discussed.

Psychometric testing methods for children's social skills.

Social skill excesses and deficits have garnered considerable attention from researchers and clinicians over the last three decades. This trend is undoubtedly due to the central role these problems play in psychopathology and the general adjustment of children of all ages. Not surprisingly, these concerns and attention to such problems have also fostered a substantial literature on scaling methods specifically designed to help define and identify social skill deficits as well as track treatment progress. In this paper, for example, we identified 48 scales and related testing methods specifically designed for this purpose. Our goal here was to critically review the psychometric properties and patterns of research with existing social skill tests for children. Current strengths and weaknesses along with future directions for research are considered for this highly researched topic.

Factors associated with the Questions About Behavior Function for functional assessment of low and high rate challenging behaviors in adults with intellectual disability.

The assessment of maintaining variables with the goal of developing prosocial intervention plans has become a driving force in the intellectual disabilities (ID) literature. One particularly crucial variable is whether the behavior is low or high rate and whether the challenging behavior is best characterized by self-injury or aggression. Because low rate behaviors present such a challenge to experimental functional analysis, checklist data in the form of the Questions About Behavior Function (QABF) may therefore be particularly useful. The reliability, frequency, and related characteristics of aggression and self-injury of 95 adults with ID were studied. High rate behaviors were reliable, but reliability of QABF functions varied with respect to the challenging behavior assessed. Individual items had higher interrater reliability for aggression compared to self-injury.

Autism in adults with severe intellectual disability: an empirical study of symptom presentation.

BACKGROUND: Autism is one of the most intriguing and highly studied conditions in the field of mental health. However, most research has been carried out with young children to the exclusion of adults, particularly adults with intellectual disability (ID). The present study represents a first attempt to describe symptom patterns of autism for adults with severe ID. METHOD: Fifty-seven adults with ID who met DSM-IV-TR and ICD-10 diagnostic criteria for autism were compared to 57 matched controls with ID only (no Axis I diagnosis). RESULTS: Marked differences were noted in a range of symptoms, particularly with respect to impairments in social interaction and restricted or repetitive behaviours and interests. These items were able to predict the presence or absence of autism at a high rate of diagnostic accuracy. CONCLUSIONS: Based on these findings, it appears that adults with ID and autism evince a distinct pattern of impairment when compared to controls with ID alone.

The validity of the autism spectrum disorders-diagnosis for intellectually disabled adults (ASD-DA).

Psychologists interviewed direct-care staff using a battery of assessment measures including the autism spectrum disorders-diagnosis for intellectually disabled adults (ASD-DA), the Diagnostic Assessment for the Severely Handicapped-II (DASH-II), the Matson Evaluation of Social Skills for Individuals with Severe Retardation (MESSIER), the Socialization domain of the Vineland Adaptive Behavior Scales (VABS), and a checklist containing criteria for autism and PDD-NOS from the DSM-IV-TR and ICD-10. Three hundred and seven intellectually disabled (ID) adolescents and adults ranging in age from 16 to 88 were assessed. Participants were diagnosed with either ID and ASD (autism or PDD-NOS; n=156) or ID and no Axis I diagnosis (n=151). A modification of the multitrait-multimethod approach was used to establish the convergent and discriminant validity of the ASD-DA. The scale proved to have robust convergent validity when correlated with the DSM-IV-TR/ICD-10 checklist, MESSIER, and Socialization domain of the VABS. Additionally, discriminant validity was demonstrated by comparing the ASD-DA to items from the DASH-II (measure of general psychopathology). The implications of these data are discussed.