Developmental associations between motor and communication outcomes in Fragile X syndrome: Variation in the context of co-occurring autism.

LAY ABSTRACT: Fragile X syndrome (FXS), the leading heritable cause of intellectual disability, has a co-occurrence rate of autism spectrum disorder (ASD) estimated at ~60%. Children with FXS experience delayed achievement and slower development of key motor abilities, which happens to an even greater extent for children with both FXS and ASD. A multitude of studies have demonstrated that motor abilities are foundational skills related to later communication outcomes in neurotypical development, as well as in the context of ASD. However, these associations remain unexamined in FXS, or FXS + ASD. In this study, we aimed to determine the associations between early motor skills and their rate of development on communication outcomes in FXS. Furthermore, we investigated whether these associations varied in the context of co-occurring FXS + ASD. Results revealed within-FXS variation in the context of co-occurring ASD between some aspects of motor development and communication outcomes, yet within-FXS consistency between others. Findings provide evidence for variability in developmental processes and outcomes in FXS in the context of co-occurring ASD and offer implications for intervention.

Expanding School-Based Motivational Interviewing Through Delivery by Paraprofessional Providers: A Preliminary Scoping Review.

The supply of school mental health (SMH) providers and services cannot meet the demand of students in-need, and this gap is expected to widen in coming years. One way to increase the reach of helpful services for youth is to grow the SMH workforce through task-shifting to paraprofessionals. Task-shifting could be especially promising in expanding Motivational Interviewing (MI) interventions, as MI can be molded to target a number of academic and behavioral outcomes important to schools. However, no review of training exclusively paraprofessional samples in MI has yet been conducted. The current paper provides a scoping review of 19 studies of training paraprofessional providers to use MI to evaluate trainee characteristics, training content and format, and outcomes. Of these 19 studies, 15 reported that paraprofessionals improved in using MI following training. Nine studies reported that task-shifting MI was positively received by clients and/or providers. Six studies examined task-shifting MI in youth-serving contexts, and four examined the practice in traditional school contexts, suggesting its potential for use in SMH. Other findings and implications, such as client behavior change and provider fidelity, are shared, along with ideas for advancing research, practice, and policy in this subfield.

Attention/Deficit Hyperactivity Disorder in Adolescent and Young Adult Males With Fragile X Syndrome.

This study characterized the rates of attention-deficit/hyperactivity disorder (ADHD) in adolescent and young adult males with fragile X syndrome (FXS) using a multi-method approach integrating a DSM-based parent interview (Children's Interview for Psychiatric Syndromes; P-ChIPS, Fristad et al., 1998) and a parent rating scale (Child Behavior Checklist; CBCL, Achenbach, 2001). Thirty-one males with FXS, aged 16-24 years, participated. Forty-two percent met DSM-5 criteria for ADHD and 35% exceeded the CBCL cut-offs. Agreement between the two classification methods was fair (κ = 0.38). Autism symptom severity and nonverbal cognitive ability did not predict ADHD diagnoses/symptoms. Results show high rates of ADHD in males with FXS during late adolescence and young adulthood, which are not accounted for by impaired nonverbal cognitive skills or autism symptom severity. DSM-based ADHD-specific scales are recommended over broadband symptom scales to improve accurate identification.

Life satisfaction and maladaptive behaviors in early adolescents.

This study explored the directionality of the relations between global life satisfaction (LS) and internalizing and externalizing behaviors using a sample of regular education students who were initially enrolled in Grade 7 (n = 470). Self-report measures of internalizing and externalizing behaviors and LS were administered on 2 occasions, 6 months apart, to students from a Southeastern U.S. middle school. Short-term longitudinal analyses revealed that neither externalizing behaviors nor internalizing behaviors at Time 1 predicted LS at Time 2. However, LS at Time 1 predicted externalizing behaviors at Time 2. LS at Time 1 also predicted internalizing behaviors at Time 2, but the results were moderated by student gender. At higher levels of LS, boys reported lower levels of internalizing behaviors at Time 2. The overall results suggested that lower levels of LS are an antecedent of increased maladaptive behaviors among early adolescents. Alternatively, higher levels of LS may be a protective factor against subsequent externalizing behaviors among boys and girls and internalizing behaviors among boys. Furthermore, the results provide further support for the discriminant validity of positive and negative measures of mental health and suggest that LS measures may provide useful information for comprehensive adolescent health screening and monitoring systems.

Mechanisms of change in adolescent life satisfaction: a longitudinal analysis.

This study explored the psychosocial mechanisms of change associated with differences in levels and linear change of adolescents' global life satisfaction across a 2-year time period. Based on a theoretical model proposed by Evans (1994), this study tested the relations between selected personality (i.e., extraversion and neuroticism) and environmental (stressful life events) variables and global life satisfaction when mediated by internalizing and externalizing problems. The results suggested support for internalizing problems as a mediator of the relationship of personality and environmental variables with life satisfaction. Pathways mediated by internalizing problems significantly predicted levels and linear change of life satisfaction across a 2-year time span. Furthermore, pathways mediated by externalizing problems significantly predicted the level but not the linear change of life satisfaction. Thus, behavior problems and their antecedents appear to relate significantly to adolescents' perceptions of their quality of life. Implications for adolescent mental health promotion were discussed.

Measuring school-related subjective well-being in adolescents.

The tripartite model of subjective well-being (SWB) incorporates 3 components: frequent positive emotions, infrequent negative emotions, and an overall positive evaluation of life circumstances (Diener, Suh, Lucas, & Smith, 1999). In light of the large amount of time that youth spend in school, this study investigated a tripartite model of school-related SWB among adolescents, based on 3 measures of SWB appropriate for adolescents. The measures included a measure of school satisfaction (SS) and measures of positive and negative emotions experienced specifically during school hours. Confirmatory factor analysis was conducted to analyze the factorial validity of 3- and 4-factor models of school-related SWB in a sample of 921 adolescents. Results indicated that a 4-factor model comprised of positive emotions, negative emotions, fear-related negative emotions, and SS best described the structure of school-related SWB in the current sample. Results also revealed a comparable factor structure for male and female students. The study points to the possible benefits of a contextualized approach to SWB that takes into account the specific environments in which adolescents live.

A dual-factor model of mental health: toward a more comprehensive understanding of youth functioning.

Traditional mental health models focus on psychological problems and distress; accordingly, health is viewed as the absence of illness or disability. In contrast, a dual-factor model of mental health incorporates both indicators of positive subjective well-being (SWB) and measures of psychopathological symptoms to comprehensively determine an individual's psychological adjustment. This study used such a dual-factor model to measure the mental health status of young adolescents. A total of 764 middle school students were classified into one of four distinct groups based on having high or low psychopathology and high or low SWB. Furthermore, group differences in student engagement, academic achievement, and environmental support for learning were investigated. Results demonstrated the existence of a traditionally neglected group of adolescents (low SWB and low psychopathology) who are nonetheless at risk for academic and behavior problems in school and who performed no better than the most troubled group of adolescents. Overall, both the presence of positive well-being and the absence of symptoms were necessary for ensuring the most advantageous school performance. These results highlight the importance of incorporating positive indicators of well-being along with traditional negative factors in more fully understanding relationships between individuals' mental health and educational outcomes.