Daniene Neal

Psychotropic Medication Use for Challenging Behaviors in Persons with Intellectual Disabilities: An Overview.

Challenging behaviors in persons with intellectual disabilities are primary target for treatment in mental health clinics and institutions. Furthermore, an increasing number of people are receiving psychotropic medications for the management of their challenging behaviors. Many people are often treated with high doses of multiple psychotropic medications for extended periods of time with little or no data collected to determine treatment efficacy. Similarly, data demonstrating treatment effectiveness is at best questionable at this time. It is for these reasons that controversy exists regarding the use of psychotropic medication for challenging behaviors. The purpose of this paper was to summarize past and current studies of drug related interventions for challenging behaviors for persons with intellectual disabilities. Based on the results of this review, the effectiveness of psychotropic medications in managing challenging behaviors is best described as minimal and a need exists for controlled studies of higher scientific quality in this area. Considering alternative psychologically based interventions and careful functional assessments appear to be advisable.

Social and communication behaviours in infants and toddlers with autism and pervasive developmental disorder-not otherwise specified

Purpose: Autism Spectrum Disorders (ASD) are a group of conditions characterized by symptoms that onset in early childhood. Deficits in social skills and communication are two of the core features of ASD and, if not remediated, can lead to poor long-term outcomes. Few researchers have examined characteristics of social skills and communication in infants with ASD. Method: The social skills and communicative ability of 886 infants and toddlers 17–37 months of age with autism, PDD-NOS or ‘at risk’ for other developmental delays were evaluated using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT). A Kruskal-Wallis test with follow-up Mann-Whitney tests were used to test for significance. Results: Infants and toddlers with autism, followed by PDD-NOS, had greater social and communication deficits than children ‘at risk’ for developmental delays. Items which distinguished between these diagnostic groups were determined. Conclusions: Outcomes suggest that social and communication deficits can be identified at early ages in a population of developmentally delayed toddlers. Implications are that pinpointing emerging social and communicative autistic traits earlier will allow for more accurate assessment and diagnosis in infants with ASD. This translates into earlier intervention and more effective treatment practices.

Parents’ first concerns of their child's development in toddlers with autism spectrum disorders

Objective: Investigations about first concerns among parents of toddlers with ASD and comparisons of the same with children diagnosed with other developmental disorders are scarce. Method: The current study utilized a sample of toddlers diagnosed with an ASD or other developmental delay and examined the nature of parents’ first concern and the age of first concern compared to the age of first assessment. Results: The majority of parents of both toddlers diagnosed with ASD and non-ASD related developmental delays indicated that the area of first concern was in communication. However, the age of first concern was significantly younger for toddlers with an ASD diagnosis. In addition, there was a significant positive correlation between the age at which concerns were first noted and the age at which assessment was sought. Conclusion: The implications of these findings are discussed as they relate to early assessment and intervention.

Reliability and Validity of the Matson Evaluation of Social Skills with Youngsters.

Social skills are an important part of development, and deficits in this area have long-term impacts on a child. As a result, clinicians should include a measure of social skills as part of a comprehensive assessment. There are a few well-researched measures of social skills that are currently used, including the Matson Evaluation of Social Skills with Youngsters (MESSY). The MESSY has been translated and studied internationally in more than nine countries; however, updated norms for the United States have not been conducted since the inception of the measure. The purpose of this article is to examine the psychometric properties of the MESSY using an updated norm sample and age cohorts. Overall results indicated strong internal consistency and good to strong convergent and divergent validity. Psychometric properties for the older age cohorts were stronger and more consistent than those for the 2- to 5-year-olds. This reflects the variability of development and difficulty of assessing social skills at this young age.

The relation of social behaviours and challenging behaviours in infants and toddlers with Autism Spectrum Disorders.

Purpose: Challenging behaviours are a commonly co-occuring problem in children with ASD and are often present during the toddler years. The relationship that these challenging behaviours have with core features of ASD, specifically social behaviours, was examined in this study. Method: This study analysed the relationship between socialization and challenging behaviours among 153 toddlers with autism spectrum disorder. Social behaviour was evaluated using the Battelle Developmental Inventory, 2nd Edition and challenging behaviours were assessed using Baby and Infant Screen for Children with aUtIsm Traits, Part 3. Result: Lower levels of adult interaction and peer interaction were associated with higher levels of stereotypic behaviour, aggressive/destructive behaviour and to a lesser extent self-injury. Conclusions: The nature of the relationships between socialization and challenging behaviours likely interact in several ways. A better understanding of these relationships is essential to early identification and treatment of children with ASD.

Stability of symptoms of autism spectrum disorders in toddlers: An examination using the Baby and Infant Screen for Children with aUtIsm Traits–Part 1 (BISCUIT)

Objective: The diagnostic stability of Autism Spectrum Disorders (ASD) at very young ages continues to be debated, despite empirical evidence that ASDs can be reliably diagnosed in children under the age of 3 years. This topic is of the upmost importance given that early intervention increases long-term outcomes in this population. Methods: The goal of the current study was to examine the stability of symptoms of ASD between two assessment times for 114 toddlers. The following was compared from the first to second assessment: diagnostic classification stability, correlations between scores and the impact of time between the first and second assessment. Results: Significant correlations were found for toddlers as young as 18 months of age. In addition, even with up to a year between assessment intervals, symptoms of ASD were relatively stable prior to 3 years of age. Conclusions: Implications of the current findings are discussed.

Risk factors for tardive dyskinesia in adults with intellectual disability, comorbid psychopathology, and long-term psychotropic use

Psychotropic medications are commonly used as an adjunct treatment in large-scale residential care facilities for adults with developmental disabilities. While the benefits of medication are noted, there are very severe conditions that can result from long term medication use. Tardive dyskinesia (TD) manifests as a variety of involuntary, repetitive movements caused by a history of neuroleptic medication use. Due to the serious nature of this disorder, it is necessary to find predisposing factors for TD in a population of adults with intellectual and developmental disabilities. The current study seeks to expand the literature related to TD utilizing a measure of medication side effects, the Matson evaluation of drug side effects (MEDS). Results and implications for assessment and practice are discussed.

Effects of symptoms of co-morbid psychopathology on challenging behaviours among infants and toddlers with Autistic Disorder and PDD-NOS as assessed with the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT).

Purpose: To examine whether level of symptoms of co-morbid psychopathology exacerbated challenging behaviours in young children with autism spectrum disorders (ASD). Method: Using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT)–Part 2 which measures co-morbid symptoms and the BISCUIT- Part 3 which examines challenging behaviours, 362 infants and toddlers with ASD were evaluated. Results: Findings showed that participants scoring high on symptoms of Avoidance and Tantrum/Conduct problems had greater rates of aggressive/destructive behaviours, self-injurious behaviours (SIB) and stereotypies compared to those with low scores. Participants with high levels of Inattention/Impulsivity or Eat/Sleep concerns, compared to those with low levels, demonstrated greater aggressive/destructive behaviour and stereotypies. For symptoms of Anxiety/Repetitive Behaviours, participants with high scores displayed greater levels of stereotypies. Conclusions: Symptoms of co-morbid psychopathology are present at a very early age for children with ASD and elevated levels of these symptoms may exacerbate challenging behaviours.

Tardive Dyskinesia and intellectual disability: An examination of demographics and topography in adults with dual diagnosis and atypical antipsychotic use

Atypical antipsychotic medications are commonly used in large-scale residential care facilities for adults with developmental disabilities. While the benefits of this class of psychotropics are noted, debate exists whether the side effect profile of these medications outweigh their therapeutic benefit, especially in those who use them long-term. Tardive Dyskinesia (TD) is a movement disorder often caused by a history of neuroleptic use which can cause deleterious effects. Due to the seriousness of TD and the impact on an individuals quality of life, it is necessary to identify predisposing factors for this condition in a population of adults with intellectual and developmental disabilities. The current study seeks to expand the literature related to TD and atypical antipsychotic medication utilizing a measure of medication side effects, the Matson Evaluation of Drug Side Effects (MEDS). Results and implications for assessment and practice are discussed.

Factor structure of the Matson Evaluation of Social Skills with Youngsters-II (MESSY-II)

The importance of social skills in development is a well studied area of research, and deficits in these skills can have implications long into adulthood. Therefore, assessment tools must be able to aid clinicians in identifying areas of weaknesses to target in treatment. The purpose of the current paper was to investigate the factor structure of a well researched measure of social skills, the Matson Evaluation of Social Skills with Youngsters (MESSY), which has recently been re-normed to update its psychometric properties. As such, this measure has now been dubbed the MESSY-II. This new norm sample was utilized in the current study to determine whether the original two factor structure for the MESSY would remain for the MESSY-II. Based on factor analysis, a three factor model was found to be ideal. Implications of these findings are discussed.