The relationship of attention-deficit hyperactivity disorder and autism spectrum disorder to adaptive skills in young children.

OBJECTIVE: Attention-deficit hyperactivity disorder (ADHD) has been linked to deficits in socialization and communication, similar to those observed in children with ASD. In the present study, we examine the differences in developmental quotient and subscale scores between children with ASD and children with ADHD. METHODS: We compared the developmental scores in a sample of 2990 children who presented to an early intervention program, who met criteria for ASD, inattentive ADHD, hyperactive/impulsive ADHD, combined ASD/ADHD, or are at risk for developmental disorders. RESULTS: The overall developmental quotient did not significantly differ between those in the ADHD inattentive and hyperactive subtype groups. Adaptive skills differed most greatly between the ASD groups and the ADHD/atypically-developing groups. CONCLUSION: The present study represents a first step towards understanding the relationship of ADHD to ASD in early childhood. Young children with ASD symptoms are more greatly impaired than those with symptoms of ADHD.

Autism severity as a predictor of inattention and impulsivity in toddlers.

OBJECTIVE: Evaluate how severity of autism spectrum disorder (ASD) symptoms predicts attention-deficit/hyperactivity disorder (ADHD) symptoms in atypically developing toddlers. METHOD: Parents/caregivers of 2300 atypically developing toddlers' ages 18-37 months were assessed about their children's behaviours using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) Part 1 and the inattention/impulsivity subscale of the BISCUIT-Part 2. RESULTS: ASD symptom severity was positively and significantly correlated with inattention/impulsivity, indicating that children with more severe symptoms of ASD tended to have higher scores on the measure of inattention/impulsivity, R(2) = 0.49, F (1, 2298) = 2234.72, p < 0.001. Additionally, ASD symptom severity significantly predicted inattention/impulsivity, ß = 0.70, t (2298) = 47.27, p < 0.001. CONCLUSIONS: ASD symptom severity predicts rates of ADHD symptoms in atypically developing toddlers. The implications of these findings are discussed in the context of other research.

Co-occurring disorder clusters in adults with mild and moderate intellectual disability in residential treatment settings.

In the typically developing population, co-occurring psychopathology is not uncommon and is a topic of importance among psychologists. It is only recently that the psychopathology in individuals with intellectual disability (ID) has become an area of significant clinical and research interest. Individuals with ID are believed to be at a greater risk for co-occurring disorders compared to the typical population. By definition, ID involves deficits in adaptive behavior, which necessitates the use of community services, or specialized services at residential facilities to manage severe challenging behaviors or psychiatric disorders. The presence of co-occurring disorders in addition to ID can complicate treatment, limit available services, and restrict opportunities for individuals with ID. The present study examines the prevalence of co-occurring psychiatric disorders and ID in a sample of 78 individuals with mild to moderate ID living in a long-term residential treatment facility diagnosed with psychiatric disorders. Certain psychiatric disorders were more likely to co-occur together in this population. Identifying and treating individuals with multiple psychopathologies in addition to ID poses challenges unique to the population.

Prevalence of co-occurring disorders in a sample of adults with mild and moderate intellectual disabilities who reside in a residential treatment setting.

The presence of an intellectual disability (ID) is associated with a myriad of co-occurring conditions, including psychiatric and genetic disorders, behavior problems, physical disabilities, and seizure disorders. Often the most severely affected individuals reside in residential treatment facilities, where they may obtain specialized treatment and management of their challenging behavior. The present study examines the prevalence of psychiatric disorders, seizures, and ID within the context of demographic categories in a sample of 101 individuals with mild to moderate ID living in a long-term residential treatment facility. Autism spectrum disorders (ASDs) were more prevalent among individuals with moderate ID, whereas personality disorders were more likely to be diagnosed in individuals with mild ID. Impulse disorders were more frequently observed in females. Further research is needed in order to determine appropriate treatment for such individuals, which should include therapies that are targeted to the specific problems of this population.

ADHD symptom prevalence and risk factors in a sample of toddlers with ASD or who are at risk for developmental delay.

Individuals with attention deficit/hyperactivity disorder (ADHD) experience difficulties with inattention, hyperactivity, and impulsivity which significantly interfere with their daily functioning. Symptoms of the disorder occur in children, but the developmental trajectory of ADHD symptoms is not known. The present study examines the prevalence of ADHD symptomology in a sample of 2956 children who were determined to be at risk for developmental delay. Prevalence rates for ADHD in the overall sample was 4.50%, and prevalence rates by gender, race, and presence of autism spectrum disorder (ASD) were comparable. The prevalence was not significantly different in children with an ASD diagnosis. No significant effects of gender or ASD diagnosis were observed. ADHD should be considered as a diagnosis among young children who present to clinics for children at risk for developmental delay, and future researchers should further study its developmental trajectory, beginning at an early age.

The effect of DSM-5 criteria on externalizing, internalizing, behavioral and adaptive symptoms in children diagnosed with autism.

OBJECTIVE: Diagnostic criteria for autism spectrum disorders (ASDs) are changing with the fifth edition of the Diagnostic and Statistical Manual (DSM-5), which simplifies the diagnostic categories into social/emotional deficits and repetitive and restricted behavior. ASDs have been closely linked to a variety of other disorders, in particular externalizing disorders such as ADHD, and internalizing disorders including anxiety disorders and obsessive compulsive disorder. The present study examines the externalizing, internalizing, behavioral and adaptive symptoms of children with ASD. METHOD: Children diagnosed with the DSM-IV who do not meet diagnostic criteria for DSM-5 and were compared to a non-ASD sample and a sample of those who meet the new criteria. Differences were examined between the three experimental groups with respect to internalizing, externalizing, behavioral severity and adaptive behavior. RESULTS: No significant differences were observed between the DSM-5 and DSM-IV groups with respect to composite and subscale scores on the externalizing, behavior severity index and adaptive behavior domains of the Behavior Assessment System for Children, Second Edition. CONCLUSIONS: Significantly more impairment was evident for both ASD groups compared to the no-ASD group.

The relationship of early communication concerns to developmental delay and symptoms of autism spectrum disorders.

OBJECTIVE: Parental concerns related to communication are an oft-cited reason that children present to early intervention clinics. We examine the relationship between early communication first concerns (FCs) and symptoms of ASD. METHODS: The present study included 3173 toddlers at risk for developmental delay. The Battelle Developmental Inventory, 2nd edition and the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) were used to examine developmental quotient scores and autism symptoms. RESULTS: Significant results were observed with respect to FC group and gender. A significant effect of FC-Communication group was observed with respect to developmental quotient overall and subscale scores, as well as autism symptom scores. CONCLUSION: Those with communication disorders are a heterogeneous population and do not account for all children who will meet criteria for a diagnosis of an ASD.

The effect of DSM-5 criteria on the developmental quotient in toddlers diagnosed with autism spectrum disorder.

OBJECTIVE: To determine the effect of the changing fifth edition of the Diagnostic and Statistical Manual (DSM-5) criteria on the developmental profiles of children diagnosed with an Autism spectrum disorder (ASD). METHODS: This study examines the effect of DSM-5 changes on impairment profiles of a population of 2054 at-risk toddlers aged 17-36 months using the Battelle Developmental Inventory, Second Edition. RESULTS: Toddlers diagnosed with an ASD according to the DSM-5 were found to represent a more impaired population compared to those who qualified for a diagnosis of an ASD based on the DSM-IV-TR, but not the DSM-5. The group diagnosed according to the DSM-IV-TR represented a population of toddlers who were more impaired than atypically developing peers. CONCLUSIONS: The proposed changes to the DSM will likely result in those diagnosed with an ASD according to the new criteria representing a more functionally impaired group. Implications of this proposed change are discussed.

Externalizing and tantrum behaviours in children with ASD and ADHD compared to children with ADHD.

OBJECTIVE: Compare rates of externalizing in children with autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) symptoms to children with ADHD. METHOD: Parents/caregivers of 85 children with ASD and/or ADHD were surveyed about their children's behaviours using the Autism Spectrum Disorders-Comorbidity for Children and the Autism Spectrum Disorders-Behaviour Problem for Children. RESULTS: Specific main effects analyses were then conducted. Children with ASD exhibited a higher number of externalizing (F(1, 83) = 83.34, p < 0.001) and tantrum behaviours (F(1,83) = 781.86, p < 0.001) than children without ASD. CONCLUSIONS: ASD exacerbates the externalizing symptoms of ADHD during childhood. This study adds to the literature on the importance of assessing for a wide-range of possible behaviour problems in children presenting with ADHD symptomatology. The implications of these findings are discussed in the context of other research.

Functions of maladaptive behavior in intellectual and developmental disabilities: behavior categories and topographies.

Research has shown that different maladaptive behavior categories may be maintained by different contingencies. We examined whether behavior categories or behavior topographies determine functional properties. The Questions about Behavioral Function with its five subscales (Attention, Escape, Nonsocial, Physical, and Tangible) was completed by direct care staff for one target behavior for each of 115 adults with varying degrees of intellectual disabilities. In the first step we examined the functional properties of three broad behavior categories (self-injurious behavior [SIB], stereotypic behavior, and aggressive/destructive behavior). Consistent with previous research stereotyped behaviors and SIB had significantly higher QABF Nonsocial (i.e., automatic positive reinforcement or self-stimulation) subscale scores than aggressive behavior, while none of the other subscales showed differences across the three behavior categories. Contrary to earlier studies, escape (or negative social reinforcement) was an important function not only for aggressive behavior, but also for SIB and stereotypies. A second analysis examined functional properties depending on two factors: the behavior topography (hitting vs. non-hitting behaviors) and their respective behavior category (SIB vs. aggression). SIB topographies had higher ratings than aggressive behavior on the QABF Nonsocial subscale. Of the five QABF subscales, only the subscale Nonsocial differed between categories of maladaptive behavior. Furthermore it was the behavior categories rather than the topographies that determined functional properties.

How do researchers define self-injurious behavior?

Self-injurious behavior is commonly observed among persons with intellectual disabilities. However, a second parallel use of this term is used in the general mental health field for self-mutilation. The authors describe these two disorders and how they differ. Characteristics of what we refer to as repetitive self-injurious behavior among persons with intellectual disabilities and risk factors for these behaviors are discussed. We also describe different assessment/testing methods which aid in defining this phenomenon. The implications of these data for research and clinical practice are discussed.

Communication deficits in infants and toddlers with developmental disabilities.

Research that focuses on detecting and assessing the presence of communication impairments in children with developmental disabilities exists. However, more research is needed which compares these deficits across individuals with various developmental disabilities. This information could inform the assessment process and treatment programs. Therefore, the purpose of the current study was to examine communication deficits in toddlers who were diagnosed with Down syndrome, Cerebral Palsy (CP), had a history of seizures or a seizure disorder, and who were born premature. A total of 140 toddlers 17-35 months of age met inclusion criteria for the study. Those diagnosed with CP evinced significantly fewer communication impairments on the Baby and Infant Screen for aUtIsm Traits-Part 1 (BISCUIT-Part 1) than children with Down syndrome and children with a history of seizures or seizure disorder. No significant differences were found on the communication subscale for the comparison of those with CP and those born prematurely. Children diagnosed with CP had fewer endorsements, indicating less impairment, on all six items of the Communication subscale of the BISCUIT-Part 1 when compared to the three other diagnostic groups. Implications of these results are discussed for children with differing handicaps.

The use of the Battelle Developmental Inventory-Second Edition (BDI-2) as an early screener for autism spectrum disorders.

PURPOSE: The purpose was to develop cut-off scores for a measure of developmental level (Battelle Developmental Inventory-Second Edition; BDI-2) which could be used as a screening tool to differentiate young children with possible autism spectrum disorders (ASD). METHODS: Infants and toddlers with ASD (n = 604) and atypically-developing infants and toddlers (n = 1064) were administered the BDI-2. Cut-off scores were determined based on standard deviations from the mean of the ASD group. RESULTS: Using 1.5 standard deviations from the mean of the ASD group, a cut-off score of 96 was determined which had a sensitivity of 0.94 and a specificity of 0.31. CONCLUSIONS: With high sensitivity, these cut-off scores can be used to identify children who require further assessment. In addition, the measure can be used to determine treatment targets.

Comparison of problem behaviours in atypically developing infants and toddlers as assessed with the baby and infant screen for children with aUtIsm traits (BISCUIT).

OBJECTIVE: Compares infants and toddlers with intellectual and developmental conditions in regard to the presence of challenging behaviour. METHODS: Parents and caregivers to 140 children ranging from 17-35 months with five different conditions (Down syndrome (n = 23), developmental delay (n = 18), prematurity (n = 56), Cerebral Palsy (n = 15) and Seizure disorder (n = 28)) were administered the BISCUIT-Part 3. An ANOVA on overall scores and a MANOVA on the sub-scale scores were conducted to determine if groups differed significantly. RESULTS: Results found no significant differences on total scores or differences on the sub-scales of the BISCUIT-Part 3: Aggressive/Destructive, Stereotypic and Self-Injurious. Some trends in individual item endorsement were found. CONCLUSIONS: It is possible that differences among individuals with these disorders are not apparent until later in life. These results emphasize the importance of monitoring challenging behaviours in all at-risk infants and toddlers to ensure that early interventions to treat these challenging behaviours are possible.

The relationship among side effects associated with anti-epileptic medications in those with intellectual disability.

Seizures are fairly common in those with intellectual disabilities. In order to treat these seizures, antiepileptic drugs (AEDs) are often used and in many cases are effective. However, these medications often create a variety of associated side effects. In order to monitor these side effects, measures such as the SEIZES-B have been used. While many side effects have been found to occur with the use of AEDs, research has not explored if certain side effects are more likely to co-occur. For the current study, 281 people with intellectual disability were administered the SEIZES-B to monitor side effects associated with AEDs. Correlations between side effect subscales were then computed. Several subscales were found to be significantly correlated: hepatic disturbance with dermatological changes and cognitive disturbance; respiratory disturbance with dermatological changes, sedation, and electrolyte disturbance; and cognitive disturbance with sedation and dermatological disturbance. Possible implications of these findings are discussed.