Jill C. Fodstad

Stereotypies and repetitive/restrictive behaviours in infants with autism and pervasive developmental disorder

Purpose: Autism Spectrum Disorders (ASD) are characterized by severe and debilitating symptoms including stereotyped and repetitive behaviours. Stereotypies and repetitive behaviours constitute core features of ASD and markedly impede attempts to remediate the disorder. Little previous research has examined characteristics of the core features of ASD in infants. Method: In the present study, 760 infants with autism, PDD-NOS or no diagnosis of ASD but at risk for other developmental delays or physical disabilities were evaluated with respect to the nature and extent of their stereotyped and ritualistic behaviour using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT). A Kruskal-Wallis test with follow-up Mann-Whitney tests were employed to test for significant differences. Results: Infants with autism evinced the highest amount of stereotypic behaviour, followed by those with PDD-NOS and atypical development. A sub-set of BISCUIT items could accurately predict diagnostic group membership. Conclusions: These data suggest that many core features of ASD are distinct and can be reliably identified early in life. The potential early identification of these behavioural challenges could lead to earlier intervention practices and symptom alleviation for children in this population.

Examination of adaptive behavior differences in adults with autism spectrum disorders and intellectual disability

Autism spectrum disorders (ASD) and intellectual disabilities (ID) are high prevalence developmental disabilities that co-occur at high rates. Furthermore, Axis I psychopathology is known to occur more frequently in individuals with ID than the general population. The problems are lifelong and can be major impediments to independent living. Despite this, little research with adults is available to determine the effects of these disabilities on specific adaptive skills. In this study, 337 adults were evaluated using the Vineland Adaptive Behavior Scale to assess the effects of these disabilities on looking at an ID, ID plus ASD, and ID and ASD plus Axis I psychopathology group. Adaptive skills were greatest for the ID group followed by the ID plus ASD, and ID and ASD plus psychopathology. Thus, the more handicapping conditions, the greater the skills deficits observed, particularly where psychopathology was concerned. As such, accurately identifying the causes of adaptive skill deficits will likely result in more precise and effective treatment.

The Effect of Autism Spectrum Disorders on Adaptive Independent Living Skills in Adults with Severe Intellectual Disability.

Autism Spectrum Disorders are a class of conditions categorized by communication problems, ritualistic behaviors, and deficits in social behaviors. While evidence supporting a genetic component of Autism Spectrum Disorders (ASDs) is strong, no specific genetic marker has been identified. Thus, professionals have had to utilize intelligence tests and measures of adaptive functioning to aid in the diagnosis of individuals with ASD. The present study aimed to isolate specific differences in adaptive functioning in adults with ASD. Two hundred and thirty-four adults with ASD (Autism Spectrum Disorder) or Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) and intellectual disabilities (IDs) were evaluated with respect to the nature and extent of their independent living skill functioning. The implications of these data for more fully describing and diagnosing autism and PDD-NOS in adults are discussed.

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.

Challenging Behaviors Should Not Be Considered Depressive Equivalents in Individuals with Intellectual Disabilities. II. A Replication Study.

Previous research has proposed behavioral equivalents for depression, but evidence for behavioral equivalents has been contradictory. The relationship between a measure of depression and several proposed behavioral equivalents of depression was assessed in 693 adults living in a large residential setting. Most were adults with severe or profound intellectual disability. The frequency of language-based measures of depression was very low. A scale to assess depression was constructed based on an item analysis of a larger pool of items. Both item and factor analysis and correlations between scores on the depression scale and individual maladaptive behavior items showed little or no relationship between proposed behavioral equivalents and depression. No support was found for behavioral equivalents of depression. This replicated the findings of Tsiouris, Mann, Patti, and Sturmey (2003). Practitioners are cautioned against using maladaptive behaviors as evidence of depression in people with severe or profound intellectual disabilities.

Effect of developmental quotient on symptoms of inattention and impulsivity among toddlers with Autism Spectrum Disorders

The effect of developmental quotient on symptoms of inattention and impulsivity was examined among 198 toddlers with Autism Spectrum Disorders. There were two levels of developmental quotient: (1) low (less than or equal to 70; n=80), and (2) typical (greater than 70; n=118). Symptoms of inattention and impulsivity were assessed using 14 items that comprise the BISCIUT-Part 2 inattention/impulsivity subscale. There was no significant effect of developmental quotient on these items representing inattention and impulsivity when severity of Autism Spectrum Disorder symptoms was controlled for. However, the covariate, severity of Autism Spectrum Disorder symptoms, was significantly related to 12 of the 14 items. Percent endorsement of impairment of symptoms relating to inattention and impulsivity for the low and typical developmental quotient groups is also listed. Implications of the results are also discussed.

Cutoffs, norms, and patterns of comorbid difficulties in children with developmental disabilities on the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT-Part 2).

Behavioral symptoms of comorbid psychopathology of 651 children 17-37 months of age who were at risk for developmental disabilities were studied using the BISCUIT-Part 2. In Study 1, norms and cutoff scores were established for this new scale on this sample. In Study 2, frequency of response on the 52 items measured was reported. Problems in eating and sleep were the most common with just over 15% of the sample experiencing these difficulties of either a moderate or severe nature. For severe problems, the most commonly reported difficulties were inattention/impulsivity, and tantrums/conduct behavior problems. Implications of this scale and these data for early identification of behavior disorders in atypically developing children are discussed.

Issues in the Management of Challenging Behaviours of Adults with Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a particularly important risk factor for challenging behaviours such as aggression, tantrums, self-injury and pica. Adults with ASD have rarely been studied with respect to these problems. This is particularly disconcerting since there are far more adults than children with ASD. In addition, because of adults’ increased physical size and longer history of these problems, treating these behaviours effectively is important.Psychological methods, particularly applied behaviour analysis, and pharmacotherapy have been the most frequently addressed treatments for challenging behaviours associated with ASD in the research literature. In many cases, challenging behaviours have clear environmental antecedents. In these cases, behavioural interventions, such as applied behaviour analysis, should be used to reduce the behaviours. When environmental factors cannot be identified or when challenging behaviours are very severe, pharmacological treatments may be necessary in combination with behavioural interventions. Newer antipsychotics are the most researched medications for use with this population. Currently, risperidone and aripiprazole are the only medications that have US FDA approval for the treatment of behaviours associated with ASD, specifically irritability; however, they are indicated for use in children not adults. It is important not to use medications unnecessarily, due to possible side effects associated with their use.Based on available research, some recommendations for the treatment of challenging behaviours of adults (and children) with ASD include the use of functional assessment, side-effect monitoring of medications and behavioural methods whenever possible. Additionally, future research in this area needs to focus more on adults, as most current research has used child samples.

Mania and behavioral equivalents: A preliminary study

Previous research has failed to address the possibility of behavioral equivalents in people with ID and mania. The relationship between a measure of mania and possible behavioral equivalents was assessed in 693 adults, most with severe or profound ID, living in a large residential setting. The mania subscale of the DASH-II proved to be a homogenous scale, suggesting that this may be a valid measure of mania in individuals with ID. Both item and factor analyses and correlations showed that many behavioral items acceptably correlated with the mania items. There may be some challenging behaviors that are related to mania in individuals with ID. A factor analysis noted a decreased need for sleep, restlessness, agitation, and irritability as items associated with mania.

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.