Jonathan Wilkins

Psychometric testing methods for children's social skills

Social skill excesses and deficits have garnered considerable attention from researchers and clinicians over the last three decades. This trend is undoubtedly due to the central role these problems play in psychopathology and the general adjustment of children of all ages. Not surprisingly, these concerns and attention to such problems have also fostered a substantial literature on scaling methods specifically designed to help define and identify social skill deficits as well as track treatment progress. In this paper, for example, we identified 48 scales and related testing methods specifically designed for this purpose. Our goal here was to critically review the psychometric properties and patterns of research with existing social skill tests for children. Current strengths and weaknesses along with future directions for research are considered for this highly researched topic.

The Relationship of Challenging Behaviors to Severity and Symptoms of Autism Spectrum Disorders

Challenging behaviors were assessed in 313 children, and it was demonstrated that children with autism spectrum disorders (ASD) exhibited greater levels of challenging behavior than both normally developing controls and children with psychopathology or atypical development. Next, we examined the relation between challenging behaviors and symptoms of autism in children with ASD. Severity of ASD was positively related to the number and intensity of challenging behaviors, and those with severe ASD exhibited significantly higher levels of problem behaviors than children with mild or moderate ASD. In addition, clusters of ASD symptoms were able to accurately predict endorsements of 8 of the 18 challenging behaviors assessed. Implications for the assessment and intervention of ASD and challenging behaviors are discussed.

Factor structure and diagnostic fidelity of the Baby and Infant Screen for Children with aUtIsm Traits–Part 1 (BISCUIT–part 1)

Objective: Due to the effectiveness of early intervention on the outcome of individuals with ASD, there is a race to identify children with ASD at younger ages. The Baby and Infant Screen for Children with aUtIsm Traits–Part 1 (BISCUIT–Part 1) is a new assessment tool designed to assess symptoms of ASD in children between the ages of 17–37 months. The aim of this study was to identify the factor structure of BISCUIT–Part 1 and investigate group differences with regards to these factors. Methods: Participants (n = 1287) were enrolled in a state-funded early intervention programme for children at-risk for a developmental disability. The BISCUIT was administered to a parent or other significant caregiver along with other developmental measures as part of the assessment protocol for the early intervention programme. Results: The exploratory factor analysis yielded a three-factor solution consistent with symptom clusters characteristic of ASD. Furthermore, participants diagnosed with ASD exhibited significantly higher scores on the factors of the BISCUIT–Part 1, compared to toddlers without a diagnosis of ASD. Conclusion: The BISCUIT–Part 1 shows promise in aiding clinicians in the diagnosis of ASD in infants and toddlers.

Antipsychotic drugs for aggression in intellectual disability

See Articles page 57 The use of antipsychotic drugs to treat behaviours such as aggression and self-injury in people with intellectual disability is one of the most controversial issues in mental health. The need to treat these serious problems eff ectively has resulted in high rates of use of antipsychotic drugs in both community and inpatient settings. This trend has continued despite sparse evidence of drug effi cacy for treating aggression in people with intellectual disability and the potential for long-term side-eff ects with both typical and atypical antipsychotics. For these and other reasons, researchers have continued to stress the urgent need for research. Thus the randomised controlled trial in today’s Lancet by Peter Tyrer and colleagues is both timely and important. Tyrer and colleagues measured the eff ects of risperidone, haloperidol, and placebo on the aggressive behaviour of 86 individuals with intellectual disability. Participants were drawn from inpatient and community settings in the UK and Australia. The main fi nding was that although there were decreases in aggression in all three groups after 4 weeks, patients receiving placebo had the most signifi cant reductions. There is much to commend about Tyrer and colleagues’ study. The data are international, and the method was sophisticated and paid careful attention to dose, which is rare. Although the authors note that a larger sample size would have been better, the numbers are impressive in view of the practical, legal, and cultural issues associated with recruiting for such research. However, a point of contention about the conclusions is whether the measures used to assess aggression were suffi ciently sensitive to detect treatment eff ects. In this respect, operational defi nitions of aggression specifi c enough to account for the heterogeneity of the problem are required. This becomes particularly problematic in comparisons of individuals living in community-based settings with those living in institutions, because aggressive behaviours are likely to be more severe in the latter setting. Tyrer and colleagues’ main conclusion is that antipsychotic drugs should no longer be regarded as routine treatment for aggression in people with intellectual disability, although special cases of psychotropic drug therapy might still be warranted in extreme forms of disruptive behaviour or the presence of a comorbid psychiatric condition, for example. We concur, particularly for children, and especially because most aggression in people with intellectually disability has an environmental function, such as escape from demands, attracting carer’s attention, or gaining access to preferred items. However, this opinion is a departure from conventional wisdom. Additionally, there are several factors that might hinder a change in practice. One major issue is that two parallel theoretical models govern modern-day treatments. One approach is biologically oriented and emphasises diff erential diagnosis and drug treatment. The second model is applied behavioural analysis, which rejects symptom complexes in favour of operant explanations of behaviour and treatment. With such an approach, the functions that maintain the behaviour are assessed, and this information is used to create individualised treatment protocols. Much has been published on the treatment of challenging behaviour in people with developmental disabilities. For example, Machalicek and colleagues identifi ed 26 studies in a 10-year span specifi c to school settings. The total published work in all settings since 1970 is thus large. Both approaches do have merit and may benefi t the person with intellectual disability and aggression, yet rarely are the two methods used together. Second, insuffi ciently trained staff makes implementation of applied behavioural analysis diffi cult outside university clinics and hospitals, and in many routine settings this is a strong motivator for the use of drugs.

A Comparison of Social Skills Profiles in Intellectually Disabled Adults With and Without ASD

The purpose of this study was to systematically examine the social-skills profiles among adults with autism spectrum disorders (ASD) and intellectual disability (ID). Using one-way multivariate analysis of variance (MANOVA), three groups (autism, pervasive developmental disorder—not otherwise specified [PDD-NOS], and ID only) were compared on seven global measures of social behavior. There were 72 individuals in each group matched on level of ID, verbal ability, age, and gender. Distinctions were noted in the areas of positive social behaviors and negative nonverbal social behaviors. Those with autism displayed the greatest deficits in these areas, followed by those with PDD-NOS. The results support the notions that social impairment remains a distinct feature of ASD in adults with ID, that autism and PDD-NOS are two conditions on the same spectrum, and that this spectrum is relevant for adults with ID. Implications of the results and directions for future research are discussed.

Autism in Adults with Severe Intellectual Disability: An Empirical Study of Symptom Presentation.

Abstract Background Autism is one of the most intriguing and highly studied conditions in the field of mental health. However, most research has been carried out with young children to the exclusion of adults, particularly adults with intellectual disability (ID). The present study represents a first attempt to describe symptom patterns of autism for adults with severe ID. Method Fifty‐seven adults with ID who met DSM‐IV‐TR and ICD‐10 diagnostic criteria for autism were compared to 57 matched controls with ID only (no Axis I diagnosis). Results Marked differences were noted in a range of symptoms, particularly with respect to impairments in social interaction and restricted or repetitive behaviours and interests. These items were able to predict the presence or absence of autism at a high rate of diagnostic accuracy. Conclusions Based on these findings, it appears that adults with ID and autism evince a distinct pattern of impairment when compared to controls with ID alone.

Sleep Disturbances in Adults with Autism Spectrum Disorders and Severe Intellectual Impairments

Sleep disturbances are a significant problem for persons with developmental disabilities. These problems occur at a higher rate than what is observed in the typically developing population, and persons with Autism Spectrum Disorders (ASD) appear to be at a higher risk than individuals with other developmental disabilities. However, another major risk is intellectual disability (ID). These two groups of disorders overlap to a substantial degree. Thus, persons with ASD and ID appear to be particularly susceptible to sleep disturbances. These sleep problems can have serious consequences beyond sleep, particularly with respect to increased challenging behaviors and as an impediment to learning. Despite these concerns, adults with ASD and ID have been largely neglected with respect to the study of these nocturnal difficulties. In this report, 168 adults with ASD and ID were compared to 166 adults with ID alone in regard to sleep disturbance and related difficulties. Individuals in the ASD group presented with much higher rates of sleep disturbances, and greater severity of sleep disorder was related to the expression of more serious challenging behaviors. The implications of our results are discussed for future assessment and treatment of these disorders.

Rett syndrome in adults with severe intellectual disability : Exploration of behavioral characteristics

Rett syndrome is a genetically linked form of autism spectrum disorder (ASD) accompanied by intellectual disability (ID). The disorder is also characterized by cardiorespiratory dysregulation, disturbance in muscle tone, reduced brain growth and scoliosis. Over 300 studies have been published on the disorder, most of which has focused on identification of causative factors, which appears to be the result of mutations of gene MECP2. Rarely have adults with Rett syndrome been studied, and behavioral characteristics in these individuals are largely unknown. The present study aimed to extend what little is known about behavioral characteristics of Rett syndrome in adults, with particular emphasis on social, communicative, and adaptive behavior. Rett syndrome adults with severe ID were matched to autistic adults with ID and ID only controls. The implications of these data for more fully describing and diagnosing the condition in adults are discussed.

Children with autism spectrum disorders: A comparison of those who regress vs. those who do not

Objective: While autism spectrum disorders (ASD) constitute a group of similar conditions, considerable heterogeneity in symptoms of these neurodevelopmental disorders have been noted. One of the most important, yet least studied, of these factors is developmental regression. Methods: One-hundred and twenty-five children were studied and broken down into the following three groups: ASD children with and without substantial regression and typically developing children. In study one, the three groups were compared on global measures of ASD symptomatology, comorbid psychopathology, challenging behaviour and social skills. In study two, the two ASD groups were compared on each individual item from the dependent measures. Results: Mean age when regression occurred was 27.76 months. The ASD children as a whole differed from the typically developing controls, showing more symptoms of ASD, as would be expected, and poorer social skills, while differences were also noted between the two ASD groups. Conclusions: It was determined that children with ASD who regress present with a distinct behavioural profile when compared to children with ASD who do not regress, which included greater levels of impairment on global measures of ASD symptomatology, comorbid psychopathology, challenging behaviour and social skills.

Factors Associated With the Questions About Behavior Function for Functional Assessment of Low and High Rate Challenging Behaviors in Adults With Intellectual Disability

The assessment of maintaining variables with the goal of developing prosocial intervention plans has become a driving force in the intellectual disabilities (ID) literature. One particularly crucial variable is whether the behavior is low or high rate and whether the challenging behavior is best characterized by self-injury or aggression. Because low rate behaviors present such a challenge to experimental functional analysis, checklist data in the form of the Questions About Behavior Function (QABF) may therefore be particularly useful. The reliability, frequency, and related characteristics of aggression and self-injury of 95 adults with ID were studied. High rate behaviors were reliable, but reliability of QABF functions varied with respect to the challenging behavior assessed. Individual items had higher interrater reliability for aggression compared to self-injury.