Profiles and trajectories of executive functioning in young children with Down syndrome.

BACKGROUND: Language acquisition strongly predicts executive functioning (EF) in early childhood in typical development and in children with Down syndrome (DS). Both language and EF are critical contributors to later positive social and academic outcomes yet are often areas of concern in children with DS. Despite the wider availability of interventions targeting language development in DS, no efforts have been made to understand how these interventions may influence the development of EF in this population. METHODS: This study examined secondary data from 76 preschoolers with DS collected as part of a randomised waitlist control trial of an early social communication intervention (JASPER-EMT). Children's EF skills were measured using the BRIEF-P, at three timepoints over 6 months. Linear regression was used to examine the baseline relationship between child characteristics and the three indices of the BRIEF-P: Emergent Metacognition, Flexibility and Inhibitory Self-Control. Linear mixed effects models were used to estimate change across the three indices of the BRIEF-P and whether that change was moderated by treatment. RESULTS: Children in this sample exhibited an uneven profile of EF at baseline, with relative strengths in the Flexibility Index and the Inhibitory Self-Control Index, and relative weaknesses in the Emerging Metacognition Index. Chronological age was associated with all indices at baseline (all P < 0.05). Children in the intervention group exhibited improvements in the Flexibility Index from entry to exit (3 months later) compared with the control, although this treatment effect did not maintain at the follow up at 6 months. CONCLUSIONS: Baseline EF profiles of children were consistent with findings of other studies with children with DS. Longitudinal findings suggest that behavioural interventions targeting language may have positive collateral effects on certain EF skills, however these effects may be transitory without ongoing support. These findings illustrate both the need for further exploration of the impact of early language interventions on EF abilities and the malleability of certain EF domains in young children with DS.

Early interaction in autism spectrum disorder: Mothers' and children's behaviours during joint engagement.

BACKGROUND: More knowledge about the interaction between young children with autism spectrum disorder and their parents is one way to improve intervention. This study aims to investigate the behaviours of mothers and children with autism spectrum disorder during joint engagement, with a focus on pacing or rate (i.e., incidences per minute) of their behaviours when being in this state. METHOD: Video recordings of 10 min of free-play between 58 children (2-4 years) diagnosed with childhood autism and their mothers were used to examine rate of mothers' and children's behaviours (i.e., toy introduction, toy expansion, positive affect, and language) during joint engagement, the association between rate of mothers and children's behaviours, the relation between rate of mothers' behaviours and time in joint engagement, and how child factors might be associated with the latter. RESULTS: Mothers(m) and children(c) showed similar rate of positive affect (Mm  = 0.6/Mc  = 0.5) and toy expansion (Mm  = 0.7/Mc  = 0.7) per minute, whereas mothers talked almost three times more than their children (Mm  = 10.2/Mc  = 3.8). In contrast, mothers introduced fewer toys compared to the children (Mm  = 0.7/Mc  = 1.2). Rate of mothers' toy introduction, toy expansion, and positive affect was inversely related to time in joint engagement (Regression coefficient = -70.7 to -48.5, p = .006 to .024). Rates of mothers' and children's behaviours were associated (Spearman rank order coefficient = .53 to .29, p < .001 to .03), but neither rate of children's behaviours nor mental age was associated with the observed relation between rate of these maternal behaviours and time in joint engagement. CONCLUSION: Time in joint engagement was related to rate of mothers' behaviours and children's mental age but not to rate of children's behaviours in this study. Thus, intervention teaching parents of young children with autism strategies designed to increase time in joint engagement may be vital. The complex nature of the interaction between mother and child behaviours in promoting joint engagement warrants further elucidation.

Parental perception of emotional expressiveness in children with autism.

Parents' perceptions of their children's emotional expressiveness, and possible bases for these perceptions, were investigated in a study comparing older, nonretarded autistic and normal children and in another study comparing young autistic, mentally retarded, and normal children. Both groups of autistic children were perceived as showing more negative emotion and less positive emotion than comparison children. In the younger sample, parental perceptions correlated with the children's attention and responsiveness to others' displays of emotion in 2 laboratory situations. Findings contradict the view that autism involves the "absence of emotional reaction" (American Psychiatric Association, 1987, p. 35).

Linking parental perceptions to interactions in young children with autism.

This study examines the relation of parental perceptions and observed parent-child interactive behaviors. Samples observed included normally developing children, children with autism, and children with mental retardation who were equivalent on mental age. Parental perceptions of children's temperament and parental feelings of parenting stress were examined. Results indicated that parental perceptions of autistic children's behavior were more often linked to actual child and parental behaviors than in the comparison samples. Parents who reported their autistic children as more difficult in temperamental style had children who were less engaged during a social game with the parent and less responsive in interaction with an experimenter. Parents who reported greater stress had autistic children who were less responsive in social interactions with others.

A longitudinal study of joint attention and language development in autistic children.

This study was designed to examine the degree to which individual differences in gestural joint attention skills predicted language development among autistic children. A group of 15 autistic children (mean CA = 45 months) were matched with one group of mentally retarded (MR) children on mental age and another group of MR children on language age. These groups were administered the Early Social-Communication Scales. The latter provided measures of gestural requesting, joint attention, and social behaviors. The results indicated that, even when controlling for language level, mental age, or IQ, autistic children displayed deficits in gestural joint attention skills on two testing sessions that were 13 months apart. Furthermore, the measure of gestural nonverbal joint attention was a significant predictor of language development in the autistic sample. Other variables, including initial language level and IQ were not significant predictors of language development in this sample.

Compliance with parental prohibition in autistic children.

In a controlled observational study of young autistic children ages 3 to 5, responses to parental prohibition were compared to those of mental-age-matched mentally retarded and normal children. The children were prohibited from eating a candy offered to them by the experimenter. Behavioral response, affect, and gaze patterns were compared across the three groups. Autistic children exhibited significantly less compliant behavior than did children in the two control groups; this behavior correlated with chronological age, not with mental age, language development, or parental behavior. Although affect and gaze patterns of the autistic children were different from the controls, these patterns were not correlated with compliant behavior. In conclusion, when compared to mental-age-matched control groups, autistic children are significantly less compliant to parental prohibition and they show different gaze and affect patterns.

Affective sharing in the context of joint attention interactions of normal, autistic, and mentally retarded children.

Disturbances in the development of joint attention behaviors and the ability to share affect with others are two important components of the social deficits of young autistic children. We examined the association of shared positive affect during two different communicative contexts, joint attention and requesting. The pattern for the normal children was one of frequent positive affect displayed toward the adult during joint attention situations. Compared to the normal children, the autistic children failed to display high levels of positive affect during joint attention whereas the mentally retarded children displayed high levels of positive affect during requesting as well as joint attention situations. These results lend support to the hypothesis that the joint attention deficits in autistic children also are associated with a disturbance in affective sharing.

Parental perspectives on inclusion: effects of autism and Down syndrome.

This study examined the effects of the child's diagnosis (autism vs. Down syndrome), age, and current educational placement on parental perceptions toward inclusion for their child with disabilities. Parents of children with autism and with Down syndrome completed surveys regarding their opinions on their child's current educational placement, their desire for changing the current placement, and their views on inclusive education. Results indicated that diagnosis, age, and current placement influenced parental opinion on the ideal educational placement for their child. Parents of children with Down syndrome were significantly more likely to endorse inclusion (full-time placement in general education) as the ideal educational program for their child whereas parents of children with autism were more likely to endorse mainstreaming (consistent part-time placement with general education students). Parents of younger children and parents whose children were already placed in general education programs were more positive towards inclusion than parents of older children or students currently in special education. Findings are discussed in terms of child characteristics and prevailing educational practices.

Caregiver interactions with autistic children.

Caregiver interactions with young autistic children were contrasted with those involving caregivers and developmentally matched mentally retarded and normal infants. Caregivers of autistic children were similar to other caregivers in their responsiveness to child nonverbal communication bids and in their engagement in mutually sustained play. Caregivers of autistic children were similar to caregivers of mentally retarded children in their greater use of control strategies. However, these two groups of caregivers differed in the particular strategies they used to shape their children's behavior. Caregivers of mentally retarded children pointed to objects while caregivers of autistic children spent more time physically holding their children on task. Individual differences within the autistic sample indicated that caregivers regulated their children's behavior less and showed more mutual play and positive feedback to more communicatively able autistic children. These findings suggest that caregivers respond differentially to the specific deficiencies shown by their children.

Observational studies of retarded children with multiple stereotyped movements.

Stereotyped movements, such as body rocking and hand gesturing, are common among developmentally delayed children. However, very little is known concerning the naturally occurring circumstances that produce variability in this type of responding. Three relatively long-term observational studies, involving seven preschool children, each of whom exhibited multiple stereotypies, were conducted to determine the extent to which the type of activity or setting had any effect upon the rates of these responses. Repeated observations were made of each child during a variety of school activities. In two studies, adult-child interactions were also recorded. The results showed that, in general, the particular activity greatly affected rates of stereotyped behavior, although there were some marked individual differences. Moreover, in two studies variability was apparent across sessions within a particular setting. For some of the children, there was evidence that their multiple stereotypies were functionally interrelated. Adult interactions, as recorded in one study, appear to be both quantitatively and qualitatively different for stereotyping as contrasted with nonstereotyping children. An environmental analysis employing a sequential model indicated that there were teacher behaviors that affected the frequency and/or conditional probability of the child's aberrant behavior.

Task-related social behavior in children with Down syndrome.

The specificity and stability of task-related social behaviors in children ages 5 to 12 was examined. Social behaviors during solvable and unsolvable puzzles were compared among children with Down syndrome, children with mental retardation, and typically developing children matched on mental age (MA). Compared to children without Down syndrome, those with the disorder looked to an adult and requested help more frequently. They also took longer to complete the tasks. These findings suggest that the overuse of social behaviors observed in young children with Down syndrome remains stable over the early school years and are specific to children with Down syndrome.

Maladaptive behavior in children with Prader-Willi syndrome, Down syndrome, and nonspecific mental retardation.

Although some genetic, mental retardation syndromes have well-described behavioral features, comparative studies have not yet assessed the relative uniqueness of these so-called phenotypes. Maladaptive behavior of 43 children with Prader-Willi syndrome was compared to age- and gender-matched children with Down syndrome and with nonspecific mental retardation. The Prader-Willi group showed more frequent and severe internalizing, externalizing, and total problem behaviors on the Child Behavior Checklist. Some problems were elevated in all groups, and 12 behaviors were significantly elevated in Prader-Willi subjects relative to both comparison groups. Seven behaviors predicted membership into the Prader-Willi group with 91% accuracy. Implications were discussed for research on behavioral phenotypes in general and for dual diagnosis in particular.

Emotion recognition by children with Down syndrome.

In three studies, children with Down syndrome were presented with emotion recognition tasks designed to tap their knowledge of simple emotions, their ability to label emotions, and their understanding of emotions from simple, story-based contexts. Results indicate that young children with Down syndrome perform similarly to typical controls matched on MAs of approximately 3 years. However, by developmental age of 4 years, children with Down syndrome performed worse than both MA-matched typical children and children with non-Down syndrome types of mental retardation. Although the MAs of children with Down syndrome increased over 2-years, their emotion recognition abilities did not. Taken together, findings suggest both etiological and developmental differences in the emotion recognition abilities of children with Down syndrome.

Joint attention and language gains in children with Down syndrome.

Joint attention and topic initiation in caregiver-child interactions was explored in relation to children's language gains over 13 months. Caregivers of 28 children with Down syndrome spent more time in joint attention and maintained more attention to caregiver-selected toys than did caregivers of 17 children with typical development. Receptive language gains of children with Down syndrome were associated with caregivers maintaining attention to child-selected toys and with longer lengths of joint attention. Caregivers redirecting attention away from child-selected toys and a greater frequency of joint attention episodes was negatively associated with children's language gains. More time spent in joint attention and caregivers maintaining attention to mother-selected toys was associated with receptive language gains in children who were developing typically.

Affect and attention in children with Down syndrome.

The association of the affective responsiveness and attention regulation with communication and language skills of children with Down syndrome was examined. Results both replicate and extend previous research on the attentional and affective characteristics of children with Down syndrome. These children tended to look more often to the face of the social partner but less often to nonfocal toys. They also tended to shift affect expressions more frequently but did not differ from MA-matched nonretarded children in overall durations of affect. The association of these variables with communication and language indicated that the more positive affect displayed toward people and the shorter the average looks to the partner's face, the higher the verbal language skills of young children with Down syndrome.

Attention regulation by children with Down syndrome: coordinated joint attention and social referencing looks.

We examined attention regulation of children in two different situations designed to elicit triadic interactions (i.e., between self, other, and object). Thirty-five children with Down syndrome and 23 children with typical development were observed in a semi-structured adult-child interaction designed to elicit coordinated joint attention and an ambiguous situation in which a moving robot prompted an emotional response from the adults in order to elicit social referencing looks from the child. Children with Down syndrome engaged in significantly fewer social referencing looks. Group differences were not found for coordinated joint attention looks, suggesting that the difficulty for children with Down syndrome is in cognitive appraisal abilities.

Attention to people and toys during social and object mastery in children with Down syndrome.

Attention to people versus objects by children with Down syndrome was examined. Subjects were presented with situations in which the primary focus alternated between an object stimulus (a toy) and a social stimulus (a singing experimenter). The children with Down syndrome monitored their environment in the same manner as did MA-matched typically developing children during object mastery and had a more focused attention style during social mastery. Reasons for this difference in attention across the two situations were discussed.

Object mastery motivation of children with Down syndrome.

Mastery motivation of children with Down syndrome and MA-matched typically developing children was examined. The two groups performed similarly with respect to the quality of their play but differed in level of task engagement and causality pleasure. The children with Down syndrome appeared to be less engaged in the task than were the typically developing group as indicated by shorter sequences of goal-directed behavior and higher rates of toy rejection. In addition, the children with Down syndrome displayed less causality pleasure with object exploration than did the typically developing children.

Loneliness and friendship in high-functioning children with autism.

Loneliness and friendship were examined in 22 high-functioning children with autism and 19 typically developing children equated with the autistic children for IQ, CA, gender, mother's education, and ethnicity. Children between the ages of 8 and 14 were asked to report on both their understanding and feelings of loneliness and the quality of their friendship. Compared to typically developing children, children with autism were both lonelier and had less complete understandings of loneliness. Although all children with autism reported having at least one friend, the quality of their friendships was poorer in terms of companionship, security, and help. Fewer associations were found between loneliness and friendship for the autistic than for the non-autistic children, suggesting less understanding of the relation between loneliness and friendship. Implications of these results are discussed for conceptualizing the social deficits in autism.