Tessa T. Rivet

Social-Skills Treatments for Children With Autism Spectrum Disorders An Overview

Marked advances in the treatment of children with autism spectrum disorders (ASDs) has occurred in the past few decades, primarily using applied behavior analysis. However, reviews of trends in social skills treatment for children with ASDs have been scant, despite a robust and growing empirical literature on the topic. In this selective review of 79 treatment studies, the authors note that the research has been particularly marked by fragmented development, using a range of intervention approaches and definitions of the construct. Modeling and reinforcement treatments have been the most popular model from the outset, with most studies conducted in school settings by teachers or psychologists. Investigators have been particularly attentive to issues of generalization and follow-up. However, large-scale group studies and comparisons of different training strategies are almost nonexistent. These trends and their implications for future research aimed at filling gaps in the existing literature are discussed.

Characteristics of Challenging Behaviours in Adults with Autistic Disorder, PDD-NOS, and Intellectual Disability.

Abstract Background Challenging behaviours are frequently a problem for people with autism spectrum disorders (ASD) and intellectual disability (ID). A better understanding of which individuals display which behaviours, at what rates, and the relationship of these behaviours to comorbid psychopathology would have important implications. Method A group of 161 adults with ASD (autistic disorder or Pervasive Developmental Disorder – Not Otherwise Specified [PDD-NOS]) and 159 matched controls with ID only residing in two large residential facilities in Southeastern United States, were studied using the Autism Spectrum Disorders – Behavior Problems for Adults (ASD-BPA). Results In all four categories of challenging behaviour measured by the ASD-BPA (Aggression/Destruction, Stereotypy, Self-Injurious Behavior, and Disruptive Behavior), frequency of challenging behaviours increased with severity of autistic symptoms. The greatest group differences were found for Stereotypy (repeated/unusual vocalisations/body movements and unusual object play), Self-Injurious Behavior (harming self and mouthing/swallowing objects), Aggression/Destruction (banging on objects), and Disruptive Behavior (elopement). Conclusions Challenging behaviours in people with ASD and ID are barriers to effective education, training, and social development, and often persist throughout adulthood. Thus, programs designed to remediate such behaviours should continue across the life-span of these individuals.

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.

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.

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.

Reliability and Factor Structure of the Autism Spectrum Disorders-Behavior Problems for Adults (ASD-BPA) With Intellectual Disabilities and Autism

This study was designed to establish the initial psychometric properties of the first scale specifically developed for behavior problems of adults with Autism Spectrum Disorders (ASD) and intellectual disability (ID). The Autism Spectrum Disorders-Behavior Problems for Adults (ASD-BPA) consists of 20 items in which raters indicate if each item is a “problem” or “no problem.” One hundred seventy-one adults with ASD and ID from two developmental centers participated. The majority of participants (88%) had profound ID. Inter-rater, test-retest, and internal consistency correlation coefficients were computed. Item and factor analyses were also examined and a four-factor model was chosen including Aggression/Destruction, Stereotypy, Self-Injurious Behavior, and Disruptive Behavior. Reliability was moderate to good, internal consistency was very good, and model fit was good. The ASD-BPA may prove to be a useful tool for future research in delineating aspects of problem behaviors in adults that are associated with ASD symptoms. In addition, this research may also distinguish behaviors associated with ASD versus cormorbid psychopathology and/or ID, thus providing implications for clinical practice.

The convergent and divergent validity of the Matson Evaluation of Drug Side-effects (MEDS) and the Dyskinesia Identification System: Condensed User Scale (DISCUS)

Abstract Background Medication side-effects such as tardive dyskinesia (TD) are known to occur in individuals with a history of psychotropic drug use. This study aimed to contribute to the development of measures for assessing TD by examining the validity of the Matson Evaluation of Drug Side-effects (MEDS) with the Dyskinesia Identification System: Condensed User Scale (DISCUS) in 163 adults with intellectual disability (ID). Method To establish convergent validity, the relationship between the MEDS and the DISCUS in identifying TD was examined. To establish divergent validity, the ability of the MEDS to differentiate between TD and other side-effects was investigated. Results The MEDS demonstrated convergent validity with the DISCUS on the Central Nervous System – Parkinsonism/Dyskinesia (CNS-PD) Subscale. The MEDS showed divergent validity with the DISCUS in cardiovascular and gastrointestinal side-effects, Parkinsonism symptoms (i.e., tremor, mask-like face), dystonia, and akathisia. Discussion The MEDS appears to have significant clinical utility in measuring tardive dyskinesia and other medication side-effects in individuals with ID.

Medical and Physical Impairments and Chronic Illness

Children with chronic conditions face a number of challenges which place them at risk for difficulties in psychosocial functioning. Aspects related to the condition itself or the treatment of the condition may serve as significant stressors. These include hospitalizations, excessive school absences, pain, fatigue, changes in physical appearance, teasing, restrictions on physical activity, extensive monitoring and treatment regimens, lifestyle modifications, and mobility, sensory, or neurocognitive impairments (La Greca,1990; Schuman & La Greca,1999). Multiple aspects of social functioning have important implications in several areas for children with chronic conditions, including adjustment to and management of the condition. For example, peers may be a significant source of social support, influence treatment adherence, and impact health-promoting and health-risk behaviors

Behavioral and Psychiatric Differences in Medication Side Effects in Adults with Severe Intellectual Disabilities.

Participants were 109 adults with severe intellectual disabilities and long histories of psychotropic drug use. Side effect profiles were examined in the context of types of mental health disorders observed using the Diagnostic Assessment for the Severely Handicapped-Revised (DASH-II) and the Behavior Problems Inventory-Revised (BPI-01). The best predictor of severe side effects were challenging behaviors, especially aggression and to a lesser degree self-injurious behavior. The implications of these data for current and future practice are discussed.