Hair Cortisol and Self-Injurious Behavior Among Children With Autism Spectrum Disorder.

Elevated salivary cortisol levels have been documented in individuals who engage in self-injurious behavior (SIB), indicating acute physiological stress. Less is known about the chronicity of stress and SIB. We analyzed the relationship between parent ratings of problem behavior and hair cortisol concentrations (an index of chronic adrenocortical activity) in 23 children with autism spectrum disorder (ASD). Parent ratings of problem behavior were not significantly correlated with hair cortisol concentrations. When children were categorized into groups based on the frequency and severity of SIB, participants with the greatest frequency and severity of SIB had higher hair cortisol concentrations compared to children without SIB. Frequent and severe SIB may be associated with altered hypothalamic-pituitary-adrenal (HPA) axis activity in children with ASD.

Scaling Up Behavioral Skills Training: Effectiveness of Large-Scale and Multiskill Trainings.

We used behavioral skills training (BST) to teach multiple skills to 2 cohorts of 18 participants. BST consisted of the standard 4 components: (a) didactic instruction, (b) modeling, (c) role-play, and (d) feedback, modified to be delivered in a large-group format. All components were provided by 1 trainer, simultaneously to all participants, with peers delivering feedback during role-plays. Across 4 targeted skills (e.g., discrete-trial teaching), the average performance of Cohort 1 improved from less than 60% correct implementation in baseline to a performance of between 85% and 100% correct, across participants, following BST. We used social validity data collected from Cohort 1 to modify the length of instruction across skills for Cohort 2. BST was similarly effective for Cohort 2, with a decrease in the additional training required for trainees to demonstrate the skill in a novel role-play scenario or with a client. Implications for effectively scaling up BST are discussed.

Evaluating the Relationship between the Rate and Temporal Distribution of Self-Injurious Behavior.

Self-injurious behavior (SIB) presents unique challenges as researchers have identified that some SIB may be resistant to treatment. The unit of analysis in this research is often the frequency of behavior with relatively little attention devoted to the analysis of inter-response time relations. We assessed whether changes in the rate of SIB were also associated with changes in the temporal distribution of this behavior in the presence and absence of systematically manipulated environmental variables. This study included three participants diagnosed with profound intellectual disabilities who engaged in SIB maintained by both negative and automatic reinforcement. For two of the participants, we used a multiple baseline design across participants to assess the effects of noncontingent access to preferred activities on both the rate and temporal distribution of SIB. For the third participant, we used a reversal design to assess the effects of a change in daily schedule (i.e., attending or not attending work) on the rate and temporal distribution of SIB. For all three participants, antecedent manipulations decreased the rate of SIB; however, operant contingency values (a measure of temporal distribution) did not change in a corresponding fashion. These data suggest that although antecedent manipulations may decrease the overall rate of the behavior, once SIB is emitted, additional instances are likely to occur close together in time.

The Relationship Between Pain, Self-Injury, and Other Problem Behaviors in Young Children With Autism and Other Developmental Disabilities.

Research has suggested that individuals who engage in self-injurious behavior may have enhanced expressions of pain, which contradicts previous assertions of blunted pain sensitivity in this population. The purpose of this study was to measure expressions of pain among young children being evaluated for autism and other neurodevelopmental disabilities. The frequency of pain-related behaviors was assessed during everyday routines using the Non-Communicating Children's Pain Checklist (NCCPC-R) for 51 children. Significant group differences between children with and without self-injury were found for the NCCPC-R total scores. The frequency and severity of self-injury, aggression, and stereotypy were also highly correlated with the total scores on the NCCPC-R. These results continue to support that individuals with self-injury may have enhanced expressions of pain.

Care of children with autism spectrum disorder.

Autism spectrum disorder (ASD) is both common and complicated. Many children with ASD are not identified until school age. The primary care physician (PCP) plays a vital role in recognizing the symptoms of ASD and in making referrals for definitive diagnosis. Most children with ASD also have co-occurring learning, medical, and/or mental health problems that require collaboration across the educational, medical, and mental health systems. This article reviews the symptoms of ASD, screening tools for school-aged children suspected of having ASD, and the PCP's role in identifying ASD and managing co-occurring conditions in the primary care medical home.

Functional Analysis Outcomes and Comparison of Direct Observations and Informant Rating Scales in the Assessment of Severe Behavior Problems of Infants and Toddlers At-Risk for Developmental Delays.

Severe problem behaviors, like aggression, self-injury, and repetitive behaviors, in people with intellectual and developmental disabilities often appear during early development and may persist without early intervention. The frequencies of self-injurious behavior, aggression, tantrums, property destruction and stereotyped behavior among 17 infants and toddlers at risk for developmental delays and severe behavior problems were assessed using two methods: 1) direct observation of responses during 10 s partial interval recording during analogue functional analysis and 2) the Behavior Problem Inventory-01 (BPI-01; Rojahn et al, 2001), an informant rating scale. Analogue functional analysis results suggested that the most common function for problem behavior was automatic reinforcement, followed by negative reinforcement in the form of escape from demands. Agreement across the two types of measurement systems as to occurrence of the behaviors reported on the BPI-01 and direct observations during analogue functional analyses was greater than 75% across aggression, self-injury, and stereotyped behavior. Agreement at a more molecular level of the ranking of the most commonly occurring specific behaviors was considerably lower. Results are discussed in terms of future research on identifying conditions that set the occasion for high levels of agreement between indirect and direct measurement systems for severe behavior problems.

Early Prevention of Severe Neurodevelopmental Behavior Disorders: An Integration.

There is a very substantial literature over the past 50 years on the advantages of early detection and intervention on the cognitive, communicative, and social-emotional development of infants and toddlers at risk for developmental delay due to premature birth or social disadvantage. Most of these studies excluded children with severe delays or other predisposing conditions, such as genetic or brain disorders. Many studies of children with biological or socio-developmental risk suggest that behavior disorders appear as early as three years and persist into adulthood if not effectively treated. By contrast, little is known about the infants and toddlers with established risk for severe delays, who make up a significant proportion of the population with dual diagnoses later in life.In the past decade, there has been a growing interest in early detection and intervention with children aged birth to three years, e.g. the P.L.99-457, Part C Birth-Three population, who may have disabilities and severe behavior problems, e.g. aggression, self-injury, and repetitive stereotyped behaviors. The available research is scattered in the behavior analytic literature, in the child development literature, as well as in the child mental health and psychiatry literature, the developmental disability literature, the animal modeling literature, and the genetics literature. The goal of this introductory overview is to integrate these literatures, by cross-referencing members of these various groups who have worked in this field, in order to provide the reader with an integrated picture of what is known and of future directions that need more research.

Observational effects on the preferences of children with autism.

Children with an autism spectrum disorder (ASD) may play with limited objects or toys, making it difficult for teachers to identify reinforcers to use in teaching new skills. The goal of this study was to alter children's preferences from highly preferred toys to toys that were originally less preferred using an observational pairing procedure. Child participants observed a preferred adult playing with toys that were initially less preferred by the child. This intervention resulted in a shift in preference toward the item manipulated by the adult. Maintenance of the changed preference was idiosyncratic across participants. Results suggest a procedure for expanding the range of items that students with ASD will select.

Designs and analyses of psychotropic and behavioral interventions for the treatment of problem behavior among people with intellectual and developmental disabilities.

A combination of behavioral and medication-based interventions has been the most effective form of treatment for reducing problem behavior in individuals with intellectual and developmental disabilities. Evaluating the 2 types of interventions in combination and separately may require that researchers adapt methods traditionally used to evaluate drug interventions for individuals without disabilities. Some methodological difficulties that arise when evaluating drug treatments with this population include the withholding of treatment from control groups, identifying large homogeneous samples of participants, predicting individual clinical responsiveness, and many others. The purpose of this article is to summarize the methodological problems that arise when studying drug-behavior interactions among people with intellectual and developmental disabilities and to suggest alternative methods that may ameliorate these issues.

Repeated adolescent MDMA ("Ecstasy") exposure in rats increases behavioral and neuroendocrine responses to a 5-HT2A/2C agonist.

MDMA (3,4-methylenedioxymethamphetamine) is a popular recreational drug among adolescents. The present study aimed to determine the effects of repeated intermittent administration of 10 mg/kg MDMA during adolescence on behavioral (Experiment 1) and neuroendocrine (Experiment 2) responses of rats to the 5-HT(2A/2C) agonist 1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI) and on [(3)H]ketanserin binding to 5-HT(2A) receptors. In the first experiment, MDMA pretreatment increased the frequency of head twitches and back muscle contractions, but not wet-dog shakes, to a high-dose DOI challenge. In the second experiment, both the prolactin and corticosterone responses to DOI were potentiated in MDMA-pretreated animals. No changes were found in 5-HT(2A) receptor binding in the hypothalamus or other forebrain areas that were examined. These results indicate that intermittent adolescent MDMA exposure enhances sensitivity of 5-HT(2A/2C) receptors in the CNS, possibly through changes in downstream signaling mechanisms.