1
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Fucà E, Costanzo F, Vicari S. Characterising repetitive behaviours in children and adolescents with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024. [PMID: 39105267 DOI: 10.1111/jir.13179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/09/2024] [Accepted: 07/19/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Individuals with intellectual disability, including people with Down syndrome (DS), often exhibit restricted and repetitive behaviours (RRBs). However, RRBs have not been deeply characterised in children and adolescents with DS. METHOD The study encompassed a cohort of 151 participants aged 4 to 18 years with DS. RRBs were assessed utilising the Repetitive Behaviour Scale-Revised. Additionally, data pertaining to cognitive and adaptive functioning, linguistic abilities, sleep patterns and emotional/behavioural issues were gathered. RESULTS Self-injurious behaviours were reported less frequently whereas parents most commonly endorsed items related to behaviours associated with the need for sameness and ritualistic behaviours. We observed very few gender differences, whereas some age-related differences emerged, with adolescents exhibiting higher scores in items related with higher-level RRBs. The analysis of the association between RRBs and clinical features revealed that RRBs were associated with parent-reported sleep difficulties, as well as with internalising and externalising problems. We also observed a negative correlation with IQ whereas associations with adaptive skills emerged mainly for lower-level RRBs, such as motor stereotypies. Finally, RRBs were negatively associated with linguistic abilities, both expressive and receptive. CONCLUSIONS RRBs in children and adolescents with DS are of significant clinical interest due to their associations with various clinical dimensions. Therefore, psychological and neuropsychiatric assessment should include an accurate evaluation of RRBs for young people with DS.
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Affiliation(s)
- E Fucà
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - F Costanzo
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - S Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Department of Life Science and Public Health, Catholic University of the Sacred Heart, Rome, Italy
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2
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Yekezare M, Handley P, Clough S. Diagnostic overshadowing: self-injurious behaviour as a manifestation of pain in the head and neck. Br Dent J 2024; 236:876-880. [PMID: 38877248 DOI: 10.1038/s41415-024-7449-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 06/16/2024]
Abstract
In the healthcare domain, diagnostic overshadowing is a concerning issue involving the erroneous attribution of physical symptoms to a patient's mental health, behavioural intricacies, or pre-existing disabilities. Individuals facing learning and communication challenges are particularly susceptible to this phenomenon, struggling to articulate or comprehend their experienced symptoms. Likewise, patients with autism spectrum disorder can have an escalated risk due to possible challenges in interpreting bodily cues. This article delves into the specialised care required for individuals with learning disabilities and/or autism, highlighting the pervasive risk of diagnostic overshadowing and the potential manifestation of pain as self-injurious behaviour in these patient groups. By underscoring the need to mitigate diagnostic overshadowing within dental practice, we advocate for reasonable adjustments in care delivery and comprehensive education of the dental team. Proficient tools for pain assessment and effective communication are emphasised to collectively improve the healthcare experience for these vulnerable patient cohorts.
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Affiliation(s)
- Mona Yekezare
- Clinical Fellow in Oral and Maxillofacial Surgery, Barts Health, The Royal London Hospital, London, UK.
| | - Patricia Handley
- Lead Nurse for Learning Disability, Barts Health, Barts Health NHS Trust, London, UK
| | - Stacey Clough
- Consultant in Special Care Dentistry, The Royal London Dental Hospital, London, UK
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3
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Kahveci G, Caylak E, Kara DN. The effect of the home environment on children with autism spectrum disorder. Int J Dev Neurosci 2024; 84:14-21. [PMID: 37776025 DOI: 10.1002/jdn.10304] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/29/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023] Open
Abstract
The estimated prevalence of autism spectrum disorders (ASD) is 1% worldwide. Autistic individuals typically have a high level of sensitivity to the various environmental stimuli (smell, noise, light). These stimuli have a positive or negative influence on the person-environment interaction, and an excess of stimuli may create inappropriate or unanticipated behavioral responses (such as a crisis) effecting their well-being. The Model of Competence, which provides an explanation of the interaction between the individual and the environment, was selected as the conceptual framework to direct this study. The purpose of this study is to investigate the opinions and experiences of mothers regarding the influence of the characteristics of the home environment on autistic individuals. A qualitative interpretative description design was utilized for this study's framework. Participants in the study were mothers who have autistic children. The study with focus groups was continued until data saturation was reached. There was a thematic investigation carried out. The findings show that the factors that have an effect on autistic individuals can be categorized into several subsets like sensory, routines, and physical environment. Despite the fact that the home setting is often a secure and consistent environment, these aspects were identified as crucial. Consequently, one should give some thought to the consequences that this could have in other settings where it would be harder to exercise control. The identification of these factors and the impact they have enables a better understanding of the interaction between an autistic individual and their environment and serves to guide professionals in their interventions.
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Affiliation(s)
- Gul Kahveci
- Department of Special Education, Faculty of Education, European University of Lefke, Lefka, Cyprus
| | - Emrah Caylak
- Department of Biochemistry, Faculty of Medicine, Girne American University, Kyrenia, Cyprus
| | - Donay Nisa Kara
- Department of Computer Education and Instructional Technology, Girne American University, Kyrenia, Cyprus
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4
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Ferina J, Kruger M, Kruger U, Ryan D, Anderson C, Foster J, Hamlin T, Hahn J. Predicting Problematic Behavior in Autism Spectrum Disorder Using Medical History and Environmental Data. J Pers Med 2023; 13:1513. [PMID: 37888124 PMCID: PMC10608042 DOI: 10.3390/jpm13101513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
Autism spectrum disorder (ASD), characterized by social, communication, and behavioral abnormalities, affects 1 in 36 children according to the CDC. Several co-occurring conditions are often associated with ASD, including sleep and immune disorders and gastrointestinal (GI) problems. ASD is also associated with sensory sensitivities. Some individuals with ASD exhibit episodes of challenging behaviors that can endanger themselves or others, including aggression and self-injurious behavior (SIB). In this work, we explored the use of artificial intelligence models to predict behavior episodes based on past data of co-occurring conditions and environmental factors for 80 individuals in a residential setting. We found that our models predict occurrences of behavior and non-behavior with accuracies as high as 90% for some individuals, and that environmental, as well as gastrointestinal, factors are notable predictors across the population examined. While more work is needed to examine the underlying connections between the factors and the behaviors, having reasonably accurate predictions for behaviors has the potential to improve the quality of life of some individuals with ASD.
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Affiliation(s)
- Jennifer Ferina
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA; (J.F.); (U.K.)
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY 12180, USA;
| | - Melanie Kruger
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY 12180, USA;
- Department of Mechanical, Aerospace, and Nuclear Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Uwe Kruger
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA; (J.F.); (U.K.)
| | - Daniel Ryan
- The Center for Discovery, Harris, NY 12742, USA; (D.R.); (C.A.); (J.F.); (T.H.)
| | - Conor Anderson
- The Center for Discovery, Harris, NY 12742, USA; (D.R.); (C.A.); (J.F.); (T.H.)
| | - Jenny Foster
- The Center for Discovery, Harris, NY 12742, USA; (D.R.); (C.A.); (J.F.); (T.H.)
| | - Theresa Hamlin
- The Center for Discovery, Harris, NY 12742, USA; (D.R.); (C.A.); (J.F.); (T.H.)
| | - Juergen Hahn
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA; (J.F.); (U.K.)
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY 12180, USA;
- Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
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5
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Shelley L, Waite J, Tarver J, Oliver C, Crawford H, Richards C, Bissell S. Behaviours that Challenge in SATB2-associated Syndrome: Correlates of Self-injury, Aggression and Property Destruction. J Autism Dev Disord 2023:10.1007/s10803-023-06123-2. [PMID: 37751087 DOI: 10.1007/s10803-023-06123-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/27/2023]
Abstract
SATB2-associated syndrome (SAS) is a genetic syndrome characterised by intellectual disability, severe speech delay, and palatal and dental problems. Behaviours that challenge (BtC) are reported frequently; however, there is limited research on specific forms of BtC and the correlates of these behaviours. The current study explores correlates of well-defined BtC, self-injury, aggression, and property destruction, in SAS. Eighty-one parents/caregivers of individuals with SAS (53.1% male, Mage 10.12 years) completed questionnaire measures of health, behavioural, emotional, and autism characteristics. Individuals with SAS were grouped based on caregiver responses to the presence or absence of self-injury, aggression, and property destruction on the Challenging Behaviour Questionnaire. Rates of self-injury, aggression and property destruction were 42%, 77% and 49%, respectively. Between-group comparisons were conducted to compare characteristics between behaviour groups. Significantly differing characteristics were entered into separate hierarchical logistic regressions for each form of BtC. Behavioural comparisons indicated variation in the characteristics associated with each behaviour. All hierarchical logistic regression models were significant (p < .001): self-injury (χ2(5) = 38.46, R2 = 0.571), aggression (χ2(4) = 25.12, R2 = 0.414), property destruction (χ2(4) = 23.70, R2 = 0.346), explaining between 34.6% and 57.1% of the variance in behaviour presence. This is the first study to identify correlates of self-injury, aggression, and property destruction in SAS. Variability in the characteristics associated with each behaviour highlights the importance of specificity when examining BtC. Understanding correlates of specific forms of BtC has important implications for informing SAS-associated pathways to behavioural outcomes and the implementation of tailored behavioural interventions.
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Affiliation(s)
- Lauren Shelley
- College of Health and Life Sciences, Aston University, Birmingham, UK.
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK.
| | - Jane Waite
- College of Health and Life Sciences, Aston University, Birmingham, UK
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
| | - Joanne Tarver
- College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Chris Oliver
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - Hayley Crawford
- Mental Health and Wellbeing Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
| | - Stacey Bissell
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
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6
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Valdovinos MG, Epperson C, Johnson C. A review of the use of psychotropic medication to address challenging behaviour in neurodevelopmental disorders. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 173:43-65. [PMID: 37993179 DOI: 10.1016/bs.irn.2023.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Engagement in challenging behaviour (e.g., aggression, self-injury) is reported to occur in neurodevelopmental disorders such as intellectual disabilities (ID), autism spectrum disorder (ASD), and fragile X syndrome (FXS). Common interventions to address these behaviours include both behavioural and pharmacological approaches. Although psychotropic medications are commonly used to address challenging behaviour in ID, ASD, and FXS, demonstration of the effectiveness of treatment is limited. Furthermore, research examining interaction effects between psychotropic medication, challenging behaviour, and environmental events within specific neurodevelopmental disorders such as ID, ASD, and FXS is scarce. The purpose of this chapter is to provide an overview of challenging behaviour within ID, ASD, and FXS and of the effectiveness of psychotropic medication as an intervention for challenging behaviour within these neurodevelopmental disorders. Finally, research examining how psychotropic medication may impact the relationship between challenging behaviour and environmental events is reviewed.
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Affiliation(s)
- Maria G Valdovinos
- Drake University, Department of Psychology and Neuroscience, Des Moines, IA, United States.
| | - Claire Epperson
- Drake University, Department of Psychology and Neuroscience, Des Moines, IA, United States
| | - Carissa Johnson
- Drake University, Department of Psychology and Neuroscience, Des Moines, IA, United States
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7
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Dimian AF, Estes AM, Dager S, Piven J, Wolff JJ. Predicting self-injurious behavior at age three among infant siblings of children with autism. Autism Res 2023; 16:1670-1680. [PMID: 37439184 DOI: 10.1002/aur.2981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/16/2023] [Indexed: 07/14/2023]
Abstract
Existing research suggests that self-injurious behavior (SIB) is a relatively common interfering behavior that can occur across the lifespan of individuals with autism spectrum disorder (ASD). We previously reported that SIB or proto-injurious SIB at 12 months was related to increased risk of SIB at 24 months among a preschool sample of children with a high familial likelihood for ASD (Dimian et al., 2017). In the present study, we extend these findings, examine SIB occurrence, and associated potential risk factors at 36 months. The present sample included 149 infants with an older sibling with ASD (65.8% male) who completed assessments at ages 12, 24, and 36 months. Descriptive analyses and binary logistic regression models were utilized. SIB was more prevalent among those children who received a diagnosis of ASD. Logistic regression indicated that presence of SIB, stereotypy, hyper- and hypo- sensory responsivity, and lower intellectual functioning at age 12 months significantly predicted the occurrence of SIB at 36 months. These findings have implications for understanding developmental processes culminating in persistent SIB and may inform prevention programming.
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Affiliation(s)
- Adele F Dimian
- Institute on Community Integration, University of Minnesota, Minneapolis, Minnesota, USA
| | - Annette M Estes
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington, USA
| | - Stephen Dager
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Joseph Piven
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jason J Wolff
- Department of Educational Psychology, University of Minnesota, Minneapolis, Minnesota, USA
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8
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Gaitanis J, Nie D, Hou T, Frye R. Developmental Regression Followed by Epilepsy and Aggression: A New Syndrome in Autism Spectrum Disorder? J Pers Med 2023; 13:1049. [PMID: 37511662 PMCID: PMC10381960 DOI: 10.3390/jpm13071049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
Autism spectrum disorder (ASD) with regression (ASD-R) involves the loss of previously attained developmental milestones, typically during the first or second year of life. As children age, it is not uncommon for them to develop comorbid conditions such as aggressive behaviors or epilepsy, which can inhibit habilitation in language and social function. In this paper, we hypothesize that aggressive behaviors and epilepsy more commonly develop in patients with ASD-R than in those without a history of regression (ASD-NR). We conducted a retrospective review of non-syndromic patients with ASD over 12 years of age and compared the rates of epilepsy and aggression between ASD-R and ASD-NR patients. Patients with ASD-R, as compared to ASD-NR patients, demonstrated non-significantly higher rates of epilepsy (51.8% vs. 38.1%, p = 0.1335) and aggressive behaviors (73.2% vs. 57.1%, p = 0.0673) when evaluated separately. The rates for combined epilepsy and aggression, however, were statistically significant when comparing ASD-R versus ASD patients (44.5% vs. 23.8%, p = 0.0163). These results suggest that epilepsy with aggression is more common in ASD-R as compared to ASD-NR patients. When considering the impact of epilepsy and aggression on quality of life, these co-morbidities effectively cause a second regression in patients who experienced an earlier regression as toddlers. A larger, prospective trial is recommended to confirm these associations and further define the timeline in which these characteristics develop from early childhood to adolescence.
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Affiliation(s)
- John Gaitanis
- Hasbro Children's Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Duyu Nie
- Hasbro Children's Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Tao Hou
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Richard Frye
- Autism Discovery and Treatment Foundation, Phoenix, AZ 85050, USA
- Rossignol Medical Center, Phoenix, AZ 85050, USA
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9
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Marini S, D'Agostino L, Ciamarra C, Gentile A. Deep brain stimulation for autism spectrum disorder. World J Psychiatry 2023; 13:174-181. [PMID: 37303931 PMCID: PMC10251363 DOI: 10.5498/wjp.v13.i5.174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/09/2023] [Accepted: 03/29/2023] [Indexed: 05/19/2023] Open
Abstract
Deep brain stimulation (DBS) is a medical treatment that aims to obtain therapeutic effects by applying chronic electrical impulses in specific brain structures and neurological circuits. Over the years, DBS has been studied for the treatment of many psychiatric disorders. Scientific research on the use of DBS in people with autism has focused this interest mainly on treatment-resistant obsessive-compulsive disorder, drug-resistant epilepsy, self-injurious behaviors (SIB), and aggressive behaviors toward the self. Autism spectrum disorder (ASD) includes a group of developmental disabilities characterized by patterns of delay and deviance in the development of social, communicative, and cognitive skills and the presence of repetitive and stereotyped behaviors as well as restricted interests. People with autism often have numerous medical and psychiatric comorbidities that worsen the quality of life of patients and their caregivers. Obsessive-compulsive symptoms can be found in up to 81.3% of people with autism. They are often severe, refractory to treatment, and particularly difficult to treat. SIB has a high prevalence in severely retarded individuals and is often associated with autism. Drug treatment of both autism and SIB presents a therapeutic challenge. To describe the current state of the art regarding the efficacy of DBS in people with ASD, a literature search was conducted for relevant studies using the PubMed database. Thirteen studies have been considered in this paper. Up to date, DBS has been used for the stimulation of the nucleus accumbens, globus pallidus internus, anterior limb of the internal capsule, ventral anterior limb of the internal capsule, basolateral amygdala, ventral capsule and ventral striatum, medial forebrain bundle, and posterior hypothalamus. In the total sample of 16 patients, 4 were adolescents, and 12 were adults. All patients had symptoms resistant to multiple drug therapy. Many patients taken into consideration by the studies showed clinical improvements as evidenced by the scores of the psychopathological scales used. In some cases, clinical improvements have varied over time, which may require further investigation. Among the new therapeutic perspectives, DBS could be a valid option. However, further, and more in-depth research is needed in this field.
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Affiliation(s)
- Stefano Marini
- Department of Mental Health, National Health Service, Termoli 86039, Italy
| | - Lucia D'Agostino
- Department of Mental Health, National Health Service, Termoli 86039, Italy
| | - Carla Ciamarra
- Department of Mental Health, National Health Service, Termoli 86039, Italy
| | - Alessandro Gentile
- Department of Mental Health, National Health Service, Termoli 86039, Italy
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10
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Laverty C, Agar G, Sinclair-Burton L, Oliver C, Moss J, Nelson L, Richards C. The 10-year trajectory of aggressive behaviours in autistic individuals. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:295-309. [PMID: 36654499 DOI: 10.1111/jir.13004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/30/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Aggressive behaviours are common in people with neurodevelopmental conditions, contributing to poorer quality of life and placement breakdown. However, there is limited empirical research documenting the prevalence and persistence of aggressive behaviours in autism. In this longitudinal study, aggressive behaviours were investigated in a sample of autistic individuals over 10 years. METHODS Caregivers of autistic individuals, both with and without intellectual disability, completed questionnaires relating to the presence of aggressive behaviours at T1 [N = 229, mean age in years 11.8, standard deviation (SD) 5.9], T2 (T1 + 3 years, N = 81, mean age in years 15.1, SD 5.9) and T3 (T1 + 10 years, N = 54, mean age in years 24.5, SD 8.1). Analyses examined the presence and persistence of aggressive behaviours and the predictive value of established correlates of aggression. RESULTS Aggressive behaviours were common at baseline (61.6%) but only persistent in 30% of the sample over 10 years. Higher composite scores of overactivity and impulsivity at T1 were significantly associated with the persistence of aggressive behaviours at T2 (P = 0.027) and T3 (P = 0.012) with medium effect size. CONCLUSIONS Aggressive behaviours are common in autism, but reduce with age. Behavioural correlates of attention deficit hyperactivity disorder (ADHD) predict the presence and persistence of aggressive behaviour and as such may be useful clinical indicators to direct proactive intervention resources to ameliorate aggressive behaviours.
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Affiliation(s)
- C Laverty
- School of Psychology, University of Birmingham, Birmingham, UK
| | - G Agar
- School of Psychology, University of Birmingham, Birmingham, UK
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | | | - C Oliver
- School of Psychology, University of Birmingham, Birmingham, UK
| | - J Moss
- School of Psychology, University of Surrey, Guildford, UK
| | - L Nelson
- School of Psychology, University of Birmingham, Birmingham, UK
| | - C Richards
- School of Psychology, University of Birmingham, Birmingham, UK
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11
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Greer BD. Barriers to Accessing Effective Treatments for Destructive Behavior. POLICY INSIGHTS FROM THE BEHAVIORAL AND BRAIN SCIENCES 2023; 10:68-74. [PMID: 38840711 PMCID: PMC11150915 DOI: 10.1177/23727322221144653] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
The field of applied behavior analysis has developed and refined a comprehensive methodology for the assessment and successful treatment of destructive behavior: An individualized approach emphasizes (a) function of responding (or its cause) over its form; (b) objective and reliable measurement of behavior; (c) systematic procedures and their application; (d) rigorous, single-case experimental designs; and (e) determinations of successful intervention judged by improvements in the same individual's performance. Outcomes of this approach are often dramatic and reliably surpass those obtained by alternative means. However, significant barriers limit the accessibility of this proven therapy. Too few intensive behavioral intervention units, diagnosis- and age-dependent insurance authorization and reimbursement practices, long waitlists and slow approval processes, and the possibility of treatment relapse represent a few such barriers. This article describes these barriers and suggests some potential solutions.
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Affiliation(s)
- Brian D. Greer
- Rutgers Brain Health Institute
- Children’s Specialized Hospital–Rutgers
University Center for Autism Research, Education, and Services
(CSH–RUCARES)
- Department of Pediatrics, Rutgers Robert Wood Johnson
Medical School
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12
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Chezan LC, McCammon MN, Wolfe K, Drasgow E, Tabacu LM. Teachers' Familiarity, Confidence, Training, and Use of Problem Behavior Interventions for Learners with Autism Spectrum Disorder in School Settings. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2022; 35:1-25. [PMID: 36373127 PMCID: PMC9638298 DOI: 10.1007/s10882-022-09885-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Our main purpose in this study was to investigate the levels of and the relationship between familiarity, confidence, training, and use of problem behavior interventions by special education teachers working with learners with autism spectrum disorder (ASD) in school settings. A total of 80 special education teachers in South Carolina and Virginia completed an online survey. Results indicate a positive correlation between teachers' familiarity, confidence, training, and use of problem behavior interventions. Across all intervention categories, providing choices, prompting, modeling, and direct instruction received the highest rankings for familiarity, confidence, and use. In addition, our results reveal that familiarity and confidence in implementing these interventions differs across groups of special education teachers based on years of experience. The most frequently reported factors that limit the use of problem behavior interventions in school settings were competing responsibilities, the need to involve multiple people, the amount of time required, and the difficulty using interventions during typical routines. Implications for research and practice are discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s10882-022-09885-2.
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Affiliation(s)
- Laura C. Chezan
- Old Dominion University, 110 Child Study Center, 4501 Hampton Blvd., Norfolk, VA 23529 US
| | - Meka N. McCammon
- Department of Child and Family Studies, University of South Florida, 4202 Fowler Ave, Tampa, FL 33620 US
| | - Katie Wolfe
- University of South Carolina, 820 Main St, Columbia, SC 29208 US
| | - Erik Drasgow
- University of South Carolina, 820 Main St, Columbia, SC 29208 US
| | - Lucia M. Tabacu
- Old Dominion University, 2300 Engineering and Computational Sciences Building, Norfolk, VA 23529 US
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13
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Holingue C, Poku O, Pfeiffer D, Murray S, Fallin MD. Gastrointestinal concerns in children with autism spectrum disorder: A qualitative study of family experiences. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1698-1711. [PMID: 34903078 PMCID: PMC9192824 DOI: 10.1177/13623613211062667] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
LAY ABSTRACT Gastrointestinal problems are common in the autism spectrum disorder community and may affect both the person with autism spectrum disorder and their families. However, little research is available on the experiences of families who have a child with both autism spectrum disorder and gastrointestinal symptoms. We held one-on-one interviews with 12 parents of children who had both autism spectrum disorder and gastrointestinal symptoms. We analyzed the raw text responses from these interviews and identified four main themes. First, parents shared that their children had trouble verbally communicating when they were experiencing gastrointestinal symptoms (Theme 1). This led parents to use bodily signs, such as changes in the stool, and non-verbal behaviors, such as irritability, to recognize when their child was having gastrointestinal symptoms. Next, gastrointestinal issues affected both the child's well-being and their ability to attend class and extracurricular or social activities (Theme 2). The gastrointestinal issues also affected the family's routines, overall well-being, and their ability to go out and do activities together as a family (Theme 3). Finally, parents often had challenges receiving accessible and quality healthcare for their child's gastrointestinal problems (Theme 4). Together, these findings highlight the enormous burden that gastrointestinal symptoms have on the wellness of children with autism spectrum disorder and their families.
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Affiliation(s)
- Calliope Holingue
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health
- Center for Autism and Related Disorders, Kennedy Krieger Institute
| | - Ohemaa Poku
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Danika Pfeiffer
- Center for Autism and Related Disorders, Kennedy Krieger Institute
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine
| | - Sarah Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - M. Daniele Fallin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine
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14
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Ding H, Zhu L, Wei H, Geng J, Huang F, Lei L. The Relationship between Cyber-Ostracism and Adolescents' Non-Suicidal Self-Injury: Mediating Roles of Depression and Experiential Avoidance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12236. [PMID: 36231539 PMCID: PMC9564981 DOI: 10.3390/ijerph191912236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/18/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Based on the experiential avoidance model, the current study aims to test the relationship between cyber-ostracism and adolescents' non-suicidal self-injury and to explore the mediating roles of depression and experiential avoidance. A sample of 1062 middle school students completed questionnaires on cyber-ostracism, depression, experiential avoidance, and self-injurious behavior. The results showed that cyber-ostracism, depression, experiential avoidance, and non-suicidal self-injury were positively correlated with each other. After controlling for gender and age, the mediation model test shows that cyber-ostracism was significantly and positively associated with non-suicidal self-injury. Depression and experiential avoidance mediated the relationship between cyber-ostracism and non-suicidal self-injury parallelly and sequentially. This study highlights the potential mechanisms of action between cyber-ostracism and adolescent non-suicidal self-injury and finds that cyber-ostracism is a risk factor for non-suicidal self-injury. This founding suggests that extra attention should be paid to the role of the online environment in addition to the offline environment experiences for the intervention of non-suicidal self-injury.
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Affiliation(s)
- Huimin Ding
- School of Education, Renmin University of China, Beijing 100872, China
| | - Liyue Zhu
- Zhengzhou Shuqing Medical College, Zhengzhou 450064, China
| | - Hua Wei
- Normal College, Qingdao University, Qingdao 266071, China
| | - Jingyu Geng
- Department of Psychology, Renmin University of China, Beijing 450064, China
| | - Feng Huang
- Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Li Lei
- School of Education, Renmin University of China, Beijing 100872, China
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15
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Reyes-Martín J, Simó-Pinatella D, Font-Roura J. Assessment of Challenging Behavior Exhibited by People with Intellectual and Developmental Disabilities: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8701. [PMID: 35886552 PMCID: PMC9324269 DOI: 10.3390/ijerph19148701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022]
Abstract
The assessment of challenging behavior exhibited by people with intellectual and developmental disabilities is essential for the planning of prevention and intervention programs. This review aimed to identify and analyze the standardized instruments that exclusively focus on the assessment of challenging behavior. We identified and organized 141 articles into four categories: original instrument studies, validation studies, relational studies, and intervention studies. The results identified 24 instruments that generally show high-quality psychometric properties and other utilities beyond the observation of the presence of challenging behavior and diagnostic categorization. Age, level of adaptive behavior, disability, presence of autism spectrum disorder, and medication are some of the variables that were found to be possibly related to the occurrence of challenging behavior. Additionally, the results suggest that interventions focused on supporting positive behavior or providing training on behavior to professionals and caregivers significantly reduced the occurrence of these behaviors. Instruments that help us to understand and measure the challenging behavior exhibited by people with intellectual and developmental disabilities are essential for the design of effective evaluation and intervention protocols.
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Affiliation(s)
- Juliana Reyes-Martín
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport, Blanquerna, Ramon Llull University, 08022 Barcelona, Spain;
- Fundació Vallparadís, Mutua Terrassa, 08221 Barcelona, Spain
| | - David Simó-Pinatella
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport, Blanquerna, Ramon Llull University, 08022 Barcelona, Spain;
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16
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Dimian AF, Symons FJ. A systematic review of risk for the development and persistence of self-injurious behavior in intellectual and developmental disabilities. Clin Psychol Rev 2022; 94:102158. [PMID: 35580423 PMCID: PMC10229071 DOI: 10.1016/j.cpr.2022.102158] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 02/13/2022] [Accepted: 04/13/2022] [Indexed: 11/24/2022]
Abstract
Self-injurious behavior (SIB) by individuals with intellectual and developmental disabilities including autism (I/DD) is among the most clinically disturbing, socially costly, and scientifically challenging behavior disorders. Forty years of clinical research has produced a knowledge base supporting idiographic behavioral assessment and treatment approaches. Despite the treatment progress, from a public health and population perspective, we argue it is less clear that we have reduced the disorder's burden. The developmental course of the disorder is mostly unknown and empirically informed population-level models of risk are absent. In this review, we systematically examined the published scientific literature specific to risk for SIB in the I/DD population. We reviewed study methodology in detail intentionally informed by an epidemiological perspective with a set of questions intended to test the quality of the inferences about risk. Results are discussed in terms of conceptual, methodological, and translational issues with respect to what needs to be done to create credible and useful clinical models for SIB risk in the I/DD population.
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Affiliation(s)
- Adele F Dimian
- Institute on Community Integration, University of Minnesota(,) Minneapolis, MN, USA.
| | - Frank J Symons
- Dept. of Educational Psychology, University of Minnesota(,) Minneapolis, MN, USA
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17
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Muharib R, Dowdy A, Rajaraman A, Jessel J. Contingency-based delay to reinforcement following functional communication training for autistic individuals: A multilevel meta-analysis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:761-781. [PMID: 34961394 DOI: 10.1177/13623613211065540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Functional communication training, an intervention for challenging behavior rooted in principles of applied behavior analysis, has copious empirical support dating back to the mid-1980s for autistic individuals. Recently, there has been a concerted effort to thin reinforcement delivery during functional communication training using contingency-based delays that, in turn, are designed to enhance practicality and feasibility while not compromising efficacy. In this synthesis, we meta-analyzed the literature base with the goal of investigating both combined and across type effectiveness of contingency-based delays. We also aimed to investigate moderating variables that might impact intervention outcomes. Findings showed that contingency-based delays were effective for individuals with an autism spectrum disorder diagnosis and most effective when the delay incorporated some form of positive reinforcement. In addition, differential reinforcement of alternative-based delays was overall more effective when compared to differential reinforcement of other behavior-based delays. Noteworthy moderating variables found to impact contingency-based delay efficacy included the intervention dosage and the topography of behavior. We discuss these findings and highlight directions where additional empirical research is warranted to improve our understanding about contingency-based delays for individuals diagnosed with autism spectrum disorder.
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18
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McLaughlin CJ, Childress P, Armen SB, Allen SR. Adult Trauma Patients with Autism Spectrum Disorder: A Case-Control Study to Evaluate Disparities After Injury. Injury 2021; 52:3327-3333. [PMID: 34526236 DOI: 10.1016/j.injury.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/23/2021] [Accepted: 09/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Adult trauma patients with autism spectrum disorder (ASD) may have distinct care needs that have not been previously described. We hypothesized that due to differences in clinical care and disposition issues, injured adults with ASD would have increased lengths of stay, higher mortality, and increased rates of complications compared to adults without ASD. METHODS The Pennsylvania Trauma Outcomes Study database was queried from 2010-2018 for trauma patients with ASD. Case-control matching was performed for two controls per ASD patient accounting for age, gender, injury mechanism, and injury severity score. Primary outcomes included length of stay, mortality, and complication rate. Univariate analysis compared presentation and clinical care between the two groups. Multivariate regression and Kaplan-Meier curves modeled length of stay. Significance was defined as p < 0.05. RESULTS A total of 185 patients with ASD were matched to 370 controls. Age (mean +/- standard deviation) was 33.4 +/- 16.5 years. Gender was 81.1% male. Mechanisms were 88.1% blunt, 5.9% penetrating, and 5.9% burns. Significant clinical differences identified in patients with ASD vs. case-controls included presenting verbal GCS (median [IQR]) (5 [2] vs. 5 [0], p < 0.01), proportion of patients intubated at presentation (20.0% vs. 13.0%, p = 0.031), and hospital length of stay (4 [6] days vs. 3 [4] days, p = 0.002). Adult patients with ASD were less likely to be discharged home and more often discharged to a skilled nursing facility (p < 0.01). There were no differences in mortality, rates of complications, imaging, or operations. Multivariate regression analysis controlling for demographic and clinical differences revealed the diagnosis of ASD independently contributed 3.13 days (95% Confidence Interval: 1.85 to 4.41 days) to injured adults' length of stay. Kaplan-Meier curves showed injured patients with ASD were less likely to be discharged than case-controls starting from time of admission (log rank test, p < 0.001). CONCLUSIONS This statewide analysis suggests injured patients with ASD have increased lengths of stay without other clinical or outcome differences. Given significant differences in discharge destination, these findings support early involvement of a multidisciplinary care collaborative. Further research is needed to identify factors that contribute to disparities in care for adults with ASD.
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Affiliation(s)
| | - Patra Childress
- Department of Surgery, Danbury Hospital, Danbury, CT, United States.
| | - Scott B Armen
- Department of Surgery, Division of Trauma, Critical Care, and Acute Care Surgery, Hershey, PA, United States.
| | - Steven R Allen
- Department of Surgery, Division of Trauma, Critical Care, and Acute Care Surgery, Hershey, PA, United States.
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19
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Blanchard A, Chihuri S, DiGuiseppi CG, Li G. Risk of Self-harm in Children and Adults With Autism Spectrum Disorder: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2130272. [PMID: 34665237 PMCID: PMC8527356 DOI: 10.1001/jamanetworkopen.2021.30272] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Multiple studies have reported that people with autism spectrum disorder (ASD) are at a higher risk for self-injurious behavior and suicide. However, the magnitude of this association varies between studies. OBJECTIVE To appraise the available epidemiologic studies on the risk of self-injurious behavior and suicidality among children and adults with ASD. DATA SOURCES PubMed, Embase, CINAHL, PsycINFO, and Web of Science were systematically searched for epidemiologic studies on the association between ASD and self-injurious behavior and suicidality. Databases were searched from year of inception to April through June 2020. No language, age, or date restrictions were applied. STUDY SELECTION This systematic review and meta-analysis included studies with an observational design and compared self-injurious behavior (defined as nonaccidental behavior resulting in self-inflicted physical injury but without intent of suicide or sexual arousal) and/or suicidality (defined as suicidal ideation, suicide attempt, or suicide) in children (aged <20 years) or adults (aged ≥20 years) with ASD. DATA EXTRACTION AND SYNTHESIS Information on study design, study population, ASD and self-harm definitions, and outcomes were extracted by independent investigators. Study quality was assessed using the Newcastle-Ottawa Scale. Overall summary odds ratios (ORs) and 95% CIs were estimated using DerSimonian-Laird random-effects models. MAIN OUTCOMES AND MEASURES The ORs for the associations of ASD with self-injurious behavior and suicidality were calculated. Analyses were stratified by study setting and age groups as planned a priori. RESULTS The search identified 31 eligible studies, which were of moderate to high quality. Of these studies, 16 (52%) were conducted in children, 13 (42%) in adults, and 2 (6%) in both children and adults. Seventeen studies assessed the association between ASD and self-injurious behavior and reported ORs that ranged from 1.21 to 18.76, resulting in a pooled OR of 3.18 (95% CI, 2.45-4.12). Sixteen studies assessed the association between ASD and suicidality and reported ORs that ranged from 0.86 to 11.10, resulting in a pooled OR of 3.32 (95% CI, 2.60-4.24). In stratified analyses, results were consistent between clinical and nonclinical settings and between children and adults. CONCLUSIONS AND RELEVANCE This study found that ASD was associated with a substantial increase in odds of self-injurious behavior and suicidality in children and adults. Further research is needed to examine the role of primary care screenings, increased access to preventive mental health services, and lethal means counseling in reducing self-harm in this population.
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Affiliation(s)
- Ashley Blanchard
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Stanford Chihuri
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Carolyn G. DiGuiseppi
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Guohua Li
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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20
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Lew-Koralewicz A, Gagat-Matuła A. QABF - Polish adaptation and validation of the tool for assessing the functions of challenging behaviors. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 116:104032. [PMID: 34293633 DOI: 10.1016/j.ridd.2021.104032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/15/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Autism spectrum disorders are a diagnostic unit predisposing the occurrence of challenging behaviors. Depending on their frequency and severity, behavioral problems may significantly limit the developmental possibilities of people with ASD, and also significantly affect family life and the therapeutic process. Aggressive, self-injury, destructive or stereotypic behaviors require intervention based on individualized support, the basis of which should be a functional assessment. AIMS The aim of the study was to develop and adapt the Polish version of the Question About Behavioral Function (QABF) questionnaire by Matson and Vollmer used to assess the functions of challenging behaviors. METHOD Data was obtained from 107 people with ASD. Material was analyzed relating to 168 problem behaviors manifested by these people. To determine the psychometric properties of the tool, reliability and validity analyses were carried out with confirmatory factor analysis using the maximum likelihood method. The Fornell and Larcker method (1981) was used to estimate the convergent and differential validity. RESULT The analysis confirmed the structure of 5-factor QABF. Composite reliability (CR) achieved values at a level of 0.855 and higher. An AVE value of above 0.5 for all factors, while at the same time lower than the CR value, confirmed the convergent validity of the tool. The differential value was confirmed on the basis of the AVE and MSV values. The results obtained confirm that the analyzed tool is accurate and reliable. CONCLUSION QABF, in the Polish language version, is a reliable tool for assessing the behavioral functions of people with ASD. The limitations of the research are also discussed.
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Affiliation(s)
- Aneta Lew-Koralewicz
- University of Rzeszów, Institute of Pedagogy, Ks. Jałowego 24 St., 35-010, Rzeszów, Poland.
| | - Anna Gagat-Matuła
- Pedagogical University of Krakow, Institute of Special Needs Education, R. Ingardena 4 St., 30-060, Cracow, Poland.
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21
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Alakhzami M, Chitiyo M. Using Functional Communication Training to Reduce Self-Injurious Behavior for Individuals with Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:3586-3597. [PMID: 34417654 DOI: 10.1007/s10803-021-05246-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
Children with autism spectrum disorders (ASD) have a high risk of developing self-injurious behavior (SIB), which is often a result of deficits in communication skills. The use of functional communication training (FCT) to address SIB maintained by negative reinforcement among children with ASD is supported by an emerging trend of behavioral research. The purpose of this study was to examine the effects of FCT on the SIB of children with ASD and to find out if the results would be maintained during periods of nonreinforcement. The results indicated significant reduction in SIB for all three participants and maintained for over two weeks following the withdrawal of the intervention. However, resurgence of SIB occurred when extinction was implemented for all participants.
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Affiliation(s)
- Maryam Alakhzami
- Special Education-Autism Spectrum Disorder At Duquesne University, Pittsburgh, PA, USA.
| | - Morgan Chitiyo
- School of Education, Duquesne University, Pittsburgh, PA, USA.,School of Education, University of North Carolina, Greensboro, NC, USA
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22
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Torres A, Lecusay D, Valdez D, Rosoli A, Garrido G, Cukier S, Paula CS, Garcia R, Rattazzi A, Montiel-Nava C. Use of allied-health services and medication among adults with ASD in Latin America. Autism Res 2021; 14:2200-2211. [PMID: 34338424 DOI: 10.1002/aur.2583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 07/04/2021] [Accepted: 07/17/2021] [Indexed: 11/10/2022]
Abstract
ASD is a neurodevelopmental disorder that affects people across the entire lifespan, yet most of the research identifying the health and medical needs for autistic individuals have been among minors. As individuals with ASD transition to emerging adulthood, the services, already limited, become less available. This study aimed to identify the use of services for Latin American adults on the spectrum. We surveyed 295 caregivers of adults with ASD from six Latin American countries. Comparing the results for all the possible services observed in this study, the adults in our sample were primarily underserved: 84.4%-95.9% were receiving zero hours per week, 3.7%-12.9% 1%-10 h, 0%-1.7% 11-20, and only 0%-1% above 20 h of services. Almost half of the sample used medication, and neurologists were the most consulted health providers. Next to inexistent health care usage in Latin American adults with ASD highlights socioeconomic and health disparities in service provision for ASD in the region. The lack of services places adults with ASD in Latin America at a higher risk of worse symptom severity than autistic adults from regions with broader access to services. LAY SUMMARY: This study aimed to identify the quantity of services received by adults with autism in Latin America. Most of our sample was not receiving health services yet almost half had access to medication. This could mean that adults with autism in Latin America are at higher risk for poorer health.
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Affiliation(s)
- Andy Torres
- Department of Psychological Sciences, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Denise Lecusay
- Department of Psychological Sciences, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Daniel Valdez
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Analía Rosoli
- Organización Estados Iberoamericanos para la Educación la Ciencia y la Cultura (OEI), Santo Domingo, Dominican Republic
| | | | - Sebastián Cukier
- Programa Argentino para Niños, Adolescentes y Adultos con Condiciones del Espectro Autista, Buenos Aires, Argentina
| | - Cristiane Silvestre Paula
- Programa de Pós-Graduação em Distúrbios do Desenvolvimento Universidade Presbiteriana Mackenzie (UPM), São Paulo, SP, Brazil
| | | | - Alexia Rattazzi
- Programa Argentino para Niños, Adolescentes y Adultos con Condiciones del Espectro Autista, Buenos Aires, Argentina
| | - Cecilia Montiel-Nava
- Department of Psychological Sciences, University of Texas Rio Grande Valley, Edinburg, Texas, USA
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23
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Barnard-Brak L, Watkins L, Richman DM. Examining the Relation between Self-reported ASD Symptoms and Sensory Sensitivities from a Community-based Sample of Adults. Dev Neurorehabil 2021; 24:388-396. [PMID: 33781158 DOI: 10.1080/17518423.2021.1898056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Atypical responses to sensory stimuli, termed sensory sensitivities, are a commonly reported symptom for individuals diagnosed with Autism Spectrum Disorder (ASD). In this community-based study of 604 adults, the correlation between sensory sensitivities and ASD symptoms was r = 0.23, p < .001, representing a smaller relation than estimates previously reported in the peer-reviewed research. Additionally, when examining only participants who met or exceeded the ASD screening cutoff score, the relation between sensory sensitivities and ASD symptoms was only slightly larger at r = 0.25, p < .001. Forty-four percentage who met the screening cutoff score for ASD also reported the lowest degree of sensory sensitivities. Finally, just over one-third who met the screening cutoff score for ASD had the highest sensory sensitivities. Sensory sensitivities did not appear to be a consistent feature across adults meeting the ASD screening cutoff score, but a proportion meeting the ASD screening cutoff score also exhibited the most extreme sensory sensitivities.
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Affiliation(s)
| | - Laci Watkins
- The University of Alabama, Tuscaloosa, Alabama, USA
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24
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An Australian Cross-Sectional Survey of Parents' Experiences of Emergency Department Visits Among Children with Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:2046-2060. [PMID: 34061310 DOI: 10.1007/s10803-021-05091-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
Parents of children with ASD who had attended an Australian emergency department (ED; n = 421) completed a questionnaire relating to their experiences in the ED, including (1) child's reason for presentation and existing comorbidities, (2) quality of care during the visit (3) child's behaviour during visit, e.g. sensory responses to the ED environment, and disruptive behaviours. Children with comorbid ASD and intellectual disability were more likely to present with gastrointestinal issues and seizures, while those with comorbid ASD and oppositional defiant disorder were more likely to present with self-injury. ED staff awareness of ASD-related issues, including communication and expression of pain, were common difficulties for parents. The ED environment (e.g. lights, sounds, waiting areas), exacerbated child anxiety and led to disruptive behaviour.
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25
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Calver J, Balogh R, Rudoler D. Incidence of injury in children and adolescents with intellectual and developmental disability. JOURNAL OF SAFETY RESEARCH 2021; 77:56-60. [PMID: 34092328 DOI: 10.1016/j.jsr.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 09/26/2020] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Children and adolescents living with intellectual and developmental disability (IDD) have a higher risk of experiencing morbidities and premature death when compared to children and adolescents living without IDD. Childhood injuries are a leading cause of morbidity and death, yet there are limited studies that explore the prevalence of childhood injuries for individuals living with IDD. The purpose of this study was to analyze Ontario health administrative data to identify and compare rates of injury resulting in hospitalization in children and adolescents living with and without IDD. METHODS This is a cross-sectional study of all Ontarians aged 0-19 years with and without IDD. The outcome of interest was the rate of injury resulting in hospitalization. RESULTS This study found that children and adolescents with IDD had 1.79 (CI 1.66, 1.92) times higher rates of both intentional and unintentional injuries that resulted in hospitalization when compared to children and adolescents without IDD. Hospitalizations for self-harm related injuries were 3.16 (CI 3.09, 3.23) times higher in the IDD group. CONCLUSION Children and adolescents with IDD have a higher risk of sustaining serious injuries, particularly injuries resulting from self-harm. Practical Applications: This study provides evidence of increased injury related hospitalizations for children and adolescents with IDD when compared to their peers without IDD.
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Affiliation(s)
- Jen Calver
- Ontario Tech University, 2000 Simcoe St. N., Oshawa, ON L1G 0C5, Canada
| | - Robert Balogh
- Ontario Tech University, 2000 Simcoe St. N., Oshawa, ON L1G 0C5, Canada
| | - David Rudoler
- Ontario Tech University, 2000 Simcoe St. N., Oshawa, ON L1G 0C5, Canada.
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26
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Fetta A, Carati E, Moneti L, Pignataro V, Angotti M, Bardasi MC, Cordelli DM, Franzoni E, Parmeggiani A. Relationship between Sensory Alterations and Repetitive Behaviours in Children with Autism Spectrum Disorders: A Parents' Questionnaire Based Study. Brain Sci 2021; 11:brainsci11040484. [PMID: 33920440 PMCID: PMC8069400 DOI: 10.3390/brainsci11040484] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 02/06/2023] Open
Abstract
The relationship between sensory profile and repetitive behaviours in autism spectrum disorder (ASD) has long been known. However, there is no consensus on the type of relationship that exists between them. This monocentric retrospective-prospective observational study aimed (a) to detect a clinical correlation between the severity of repetitive behaviours and the alterations of sensory profile in a sample of 50 children diagnosed with ASD; (b) to evaluate how different patterns of stereotypies and sensory alterations correlate with each other and with the main clinical-instrumental variables in the same sample. We enrolled 29 children in the retrospective phase of the study and 21 in the prospective phase. The Repetitive Behaviour Scale-Revised (RBS-R) and the Short Sensory Profile (SSP) were administered to the caregivers, and clinical-instrumental data were collected. SSP and RBS-R total scores directly correlated with a high significance rate. Among the subscales, the strongest correlations involved "Visual/Auditory Sensitivity", related to "Stereotyped Behaviour" and "Sameness Behaviour". "Under-Responsive/Seeks Sensation" related to "Stereotyped Behaviour". Sex and intellectual disability significantly influenced both the stereotypies and the sensory alterations of the examined population. In conclusion, this study provides new insights into the relationship between sensory alterations and repetitive behaviours in ASD children by using direct medical observation and parent observation.
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Affiliation(s)
- Anna Fetta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’Età Pediatrica, 40139 Bologna, Italy; (V.P.); (M.A.); (D.M.C.); (A.P.)
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40137 Bologna, Italy; (E.C.); (L.M.); (M.C.B.); (E.F.)
- Correspondence:
| | - Elisa Carati
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40137 Bologna, Italy; (E.C.); (L.M.); (M.C.B.); (E.F.)
| | - Laura Moneti
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40137 Bologna, Italy; (E.C.); (L.M.); (M.C.B.); (E.F.)
| | - Veronica Pignataro
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’Età Pediatrica, 40139 Bologna, Italy; (V.P.); (M.A.); (D.M.C.); (A.P.)
| | - Marida Angotti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’Età Pediatrica, 40139 Bologna, Italy; (V.P.); (M.A.); (D.M.C.); (A.P.)
| | - Maria Chiara Bardasi
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40137 Bologna, Italy; (E.C.); (L.M.); (M.C.B.); (E.F.)
| | - Duccio Maria Cordelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’Età Pediatrica, 40139 Bologna, Italy; (V.P.); (M.A.); (D.M.C.); (A.P.)
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40137 Bologna, Italy; (E.C.); (L.M.); (M.C.B.); (E.F.)
| | - Emilio Franzoni
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40137 Bologna, Italy; (E.C.); (L.M.); (M.C.B.); (E.F.)
| | - Antonia Parmeggiani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell’Età Pediatrica, 40139 Bologna, Italy; (V.P.); (M.A.); (D.M.C.); (A.P.)
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna, 40137 Bologna, Italy; (E.C.); (L.M.); (M.C.B.); (E.F.)
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27
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Bodfish JW, Lecavalier L, Harrop C, Dallman A, Kalburgi SN, Hollway J, Faldowski R, Boyd BA. Measuring the Functional Impact of Behavioral Inflexibility in Children with Autism Using the Behavioral Inflexibility Scale: Clinical Interview (BIS-CI). J Autism Dev Disord 2021; 52:782-790. [PMID: 33811282 DOI: 10.1007/s10803-021-04984-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
For individuals with autism spectrum disorder (ASD), behavioral inflexibility can affect multiple domains of functioning and family life. The objective of this study was to develop and validate a clinical interview version of the Behavioral Inflexibility Scale. Trained interviewers conducted interviews with parents of 144 children with ASD and 70 typically developing children (ages: 3-17 years). Using exploratory factor analysis, the Behavioral Inflexibility Scale-Clinical Interview (BIS-CI) was found to be unidimensional. Reliability data indicated the measure was internally consistent (α = 0.80), achieved excellent inter-rater reliability (ICC = 0.97) and test-retest reliability (ICC = 0.87). These findings demonstrate that the BIS-CI is a reliable and valid measure to determine the functional impact of behavioral inflexibility.
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Affiliation(s)
- James W Bodfish
- Vanderbilt University Medical Center, 1215 21st Avenue South MCE, South Tower, Nashville, TN, 37232, USA
| | - Luc Lecavalier
- Ohio State University, 1581 Dodd Dr., Columbus, OH, 43210, USA
| | - Clare Harrop
- University of North Carolina-Chapel Hill, 2050 Bondurant Hall, Chapel Hill, NC, 27599, USA
| | - Aaron Dallman
- University of North Carolina-Chapel Hill, 2050 Bondurant Hall, Chapel Hill, NC, 27599, USA.,Towson University, Towson, MD, USA
| | | | - Jill Hollway
- Ohio State University, 1581 Dodd Dr., Columbus, OH, 43210, USA
| | - Richard Faldowski
- University of North Carolina-Chapel Hill, 2050 Bondurant Hall, Chapel Hill, NC, 27599, USA
| | - Brian A Boyd
- Juniper Gardens Children's Project, University of Kansas, 444 Minnesota Ave., Ste 300, Kansas, KS, 66101, USA.
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28
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Early Regulatory Skills and Social Communication Development in Infants with Down Syndrome. Brain Sci 2021; 11:brainsci11020208. [PMID: 33572121 PMCID: PMC7915648 DOI: 10.3390/brainsci11020208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 11/30/2022] Open
Abstract
Children with Down syndrome (DS) demonstrate substantial variability in communication and language outcomes. One potential source of variability in this skill area may be early regulatory function. Characterizing the early link between regulatory function and early social communication may benefit infants with DS at risk of difficulties with social communication and language skill acquisition. Forty-three infants with DS were assessed at two time points, six months apart. At Time 1, the average chronological age was 9.0 months (SD = 3.9) and caregivers completed the Infant Behavior Questionnaire-Revised (IBQ-R) to assess regulatory function. Six months later, caregivers rated infant communication at the second visit using the Communication and Symbolic Behavior Scales Infant Toddler Checklist (CSBS-ITC). Infant developmental level was assessed at both visits using the Bayley Scales of Infant and Toddler Development, Third Edition and caregivers reported on developmental history and biomedical comorbidities. Infant regulatory function at Time 1 predicted social communication outcomes at Time 2, six months later. Findings from this study suggest that elevated risk for pronounced communication challenges may be detectable as early as infancy in DS.
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29
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Bergmann T, Camatta R, Birkner J, Sappok T. Vision, concretism, repetitism. Typical artistic design features in drawings of adults with autism and intellectual disability. ARTS IN PSYCHOTHERAPY 2021. [DOI: 10.1016/j.aip.2020.101723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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30
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Shepley C, Shepley SB, Allday RA, Tyner-Wilson M, Larrow D. Rationale, Development, and Description of a Brief Family-Centered Service Provision Model for Addressing Children's Severe Behavior. Dev Neurorehabil 2021; 24:107-117. [PMID: 33206001 DOI: 10.1080/17518423.2020.1839979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
For families with children with autism that engage in severe behavior, the American Academy of Pediatrics recommends that functional assessment and management of environmental variables contributing to severe behavior occur prior to the prescription of psychopharmacologic treatment. Despite the inclusion of this recommendation in guidance articles published in pediatric journals for more than a decade, access to such services may not be feasible, in particular for families living in rural and geographically isolated communities. Given that families often view pediatricians as their first line of professional guidance for addressing challenges surrounding child development, the inaccessibility of appropriate services for managing healthcare is a concern for many pediatricians. To address this issue, a brief family-centered service provision model was developed through a collaboration between healthcare providers at a university-based hospital and Applied Behavior Analysis program faculty of the affiliated university. The hospital served many families living in rural areas of the state; therefore, the model utilized research-based practices with evidence of ecological validity for providing function-based assessment and treatment services. Within this manuscript we present a description of the model and its current implementation at a university-based hospital. For a data-based evaluation of the clinic and model, we refer readers to https://osf.io/qx8ak.
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Affiliation(s)
- Collin Shepley
- Department of Early Childhood, Special Education, and Rehabilitation Counseling, University of Kentucky, College of Education , Lexington, KY, USA
| | - Sally B Shepley
- Department of Early Childhood, Special Education, and Rehabilitation Counseling, University of Kentucky, College of Education , Lexington, KY, USA
| | - R Allan Allday
- Department of Early Childhood, Special Education, and Rehabilitation Counseling, University of Kentucky, College of Education , Lexington, KY, USA
| | - Melanie Tyner-Wilson
- Developmental-Behavioral Pediatrics, University of Kentucky, College of Medicine , Lexington, KY, USA
| | - Daniel Larrow
- Developmental-Behavioral Pediatrics, University of Kentucky, College of Medicine , Lexington, KY, USA
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31
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Licence L, Oliver C, Moss J, Richards C. Prevalence and Risk-Markers of Self-Harm in Autistic Children and Adults. J Autism Dev Disord 2020; 50:3561-3574. [PMID: 31655964 PMCID: PMC7502049 DOI: 10.1007/s10803-019-04260-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Self-harm is purportedly common in autistic individuals, but under-researched, particularly in younger samples and those without intellectual disability. This study aimed to describe prevalence, profile and correlates of self-harm in autistic individuals without impairments in adaptive functioning. Parents of autistic participants (n = 83) completed questionnaires regarding the presence/topography of self-harm, demographic characteristics, autism severity, age of diagnosis, affect, activity levels and repetitive behaviour. 24.10% of participants engaged in self-harm. Self‐harm was associated with significantly higher levels of impulsivity, over-activity, negative affect, compulsive behaviour and insistence on sameness. Low mood and overactivity/impulsivity predicted the presence of self-harm, with the model correctly classifying 82.9% of cases. Findings highlight a role for impaired behavioural inhibition and low mood in the aetiological mechanisms underpinning self-harm in autism.
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Affiliation(s)
- Lucy Licence
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Chris Oliver
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Jo Moss
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,School of Psychology, University of Surrey, Surrey, GU2 7XH, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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32
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Steenfeldt-Kristensen C, Jones CA, Richards C. The Prevalence of Self-injurious Behaviour in Autism: A Meta-analytic Study. J Autism Dev Disord 2020; 50:3857-3873. [PMID: 32297123 PMCID: PMC7557528 DOI: 10.1007/s10803-020-04443-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Self-injurious behaviour is purportedly common in autism, but prevalence rates have not yet been synthesised meta-analytically. In the present study, data from 14,379 participants in thirty-seven papers were analysed to generate a pooled prevalence estimate of self-injury in autism of 42% (confidence intervals 0.38-0.47). Hand-hitting topography was the most common form of self-injury (23%), self-cutting topography the least common (3%). Sub-group analyses revealed no association between study quality, participant intellectual disability or age and overall prevalence rate of self-injury. However, females obtained higher prevalence rates than males (p = .013) and hair pulling and self-scratching were associated with intellectual disability (p = .008 and p = .002, respectively). The results confirm very high rates of self-injury in autism and highlight within group risk-markers.
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Affiliation(s)
- Catherine Steenfeldt-Kristensen
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Children's Neurodevelopmental Service, Coventry and Warwickshire Partnership Trust, City of Coventry Health Centre, Paybody Building, 2 Stoney Stanton Road, Coventry, CV1 4FS, UK
| | - Chris A Jones
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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33
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Cheung Y, Man Kit Cheung A, Ho Yan Luk E, Man Fung Y, Mountjoy T, Cihon JH, Leaf JB. An evaluation of a comprehensive training package for interventionists providing behavioral intervention for children with autism spectrum disorder. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2020; 66:358-369. [PMID: 34150198 PMCID: PMC7942800 DOI: 10.1080/20473869.2020.1827208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 08/23/2020] [Accepted: 09/04/2020] [Indexed: 06/12/2023]
Abstract
There has been rapid growth in the number of behavior analysts and interventionists in the world today. With this growth it is imperative to ensure that each behavior analyst and interventionist receives quality training. The training should be comprehensive (i.e. training multiple areas of behavior analysis) and should not conclude until the trainee is able to perform each behavior analytic procedure to a high degree of fidelity. The purpose of this study was to evaluate the effectiveness of a training package to train four participants how to implement multiple behavior analytic procedures. Using a multiple baseline design across participants the results indicate that each participant improved their implementation of behavioral intervention. Additionally, the participants maintained their skills over time.
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Affiliation(s)
| | | | | | | | | | - Joseph H. Cihon
- Autism Partnership Foundation, Seal Beach, CA, USA
- The Institute for Behavioral Studies, Endicott College, Beverly, MA, USA
| | - Justin B. Leaf
- Autism Partnership Foundation, Seal Beach, CA, USA
- The Institute for Behavioral Studies, Endicott College, Beverly, MA, USA
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34
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Cantin-Garside KD, Srinivasan D, Ranganathan S, White SW, Nussbaum MA. Multi-level modeling with nonlinear movement metrics to classify self-injurious behaviors in autism spectrum disorder. Sci Rep 2020; 10:16699. [PMID: 33028829 PMCID: PMC7542156 DOI: 10.1038/s41598-020-73155-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/14/2020] [Indexed: 11/09/2022] Open
Abstract
Self-injurious behavior (SIB) is among the most dangerous concerns in autism spectrum disorder (ASD), often requiring detailed and tedious management methods. Sensor-based behavioral monitoring could address the limitations of these methods, though the complex problem of classifying variable behavior should be addressed first. We aimed to address this need by developing a group-level model accounting for individual variability and potential nonlinear trends in SIB, as a secondary analysis of existing data. Ten participants with ASD and SIB engaged in free play while wearing accelerometers. Movement data were collected from > 200 episodes and 18 different types of SIB. Frequency domain and linear movement variability measures of acceleration signals were extracted to capture differences in behaviors, and metrics of nonlinear movement variability were used to quantify the complexity of SIB. The multi-level logistic regression model, comprising of 12 principal components, explained > 65% of the variance, and classified SIB with > 75% accuracy. Our findings imply that frequency-domain and movement variability metrics can effectively predict SIB. Our modeling approach yielded superior accuracy than commonly used classifiers (~ 75 vs. ~ 64% accuracy) and had superior performance compared to prior reports (~ 75 vs. ~ 69% accuracy) This work provides an approach to generating an accurate and interpretable group-level model for SIB identification, and further supports the feasibility of developing a real-time SIB monitoring system.
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Affiliation(s)
| | - Divya Srinivasan
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, USA
| | | | - Susan W White
- Center for Youth Development and Intervention, Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Maury A Nussbaum
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, USA.
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35
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Mitchell M, Bernie C, Newall F, Williams K. Simulation-based education for teaching aggression management skills to health care providers in the acute health care setting: a systematic review protocol. Syst Rev 2020; 9:208. [PMID: 32887661 PMCID: PMC7487524 DOI: 10.1186/s13643-020-01466-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical aggression episodes, that is aggression and externalising behaviours that create risk, in acute care hospitals are increasing. Acute care staff are often not confident or trained in the management of aggression. Various aggression management training formats have been described in practice including face to face training, written learning resources, web- and media-based training resources, and simulation training. The aim of this systematic review is to assess whether simulation-based training is effective in increasing de-escalation knowledge, skills, and behaviour of staff working in the acute care setting. METHODS We designed and registered a study protocol for a systematic review of studies evaluating simulation-based training for the management of patients with aggression. We will include randomised controlled trials, non-randomised controlled trials, quasi-experimental studies, and observational studies including health care professionals and trainees in acute health care settings. Comprehensive searches will be conducted in the following databases (from January 1980 onwards): PubMed, MEDLINE, PsycINFO, CINAHL, and the Cochrane Library. The reference lists of selected studies, trial registers, and leading journals will also be searched. Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential discrepancies will be resolved through discussion. The primary outcomes will include patient outcomes (e.g. frequency of clinical aggression), quality of care (e.g. frequency of emergency situations, physical/chemical/mechanical restraint), and adverse effects (e.g. patient/family complaints, patient harms, staff harms). Secondary outcomes will include workplace resource use, health care provider-related outcomes, knowledge (de-escalation techniques), performance, attitudes, and satisfaction. The study methodological risk of bias will be appraised using appropriate tools. A narrative synthesis will be performed for included studies. If feasible, we will conduct random-effects meta-analysis of data. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g. participant characteristics, interventions, and follow-up). DISCUSSION This systematic review will identify, evaluate, and integrate the evidence on simulation-based training programmes for acute care health professionals on managing clinical aggression. The results of this study will inform the implementation of effective training strategies. Implications for future research will be discussed. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42020151002.
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Affiliation(s)
- Marijke Mitchell
- Neurodevelopment & Disability, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia. .,Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia. .,Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Charmaine Bernie
- Department of Allied Health, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia.,Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia.,Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia
| | - Fiona Newall
- Nursing Research, Nursing Education, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia.,Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia.,Department of Nursing, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia.,Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia
| | - Katrina Williams
- Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia.,Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia.,Department of Paediatrics, Education and Research, Monash Children's Hospital, Monash University, 246 Clayton Road, Clayton, Victoria, 3168, Australia
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36
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Repetitive and Self-injurious Behaviors in Children with Cornelia de Lange Syndrome. J Autism Dev Disord 2020; 51:1748-1758. [PMID: 32809170 DOI: 10.1007/s10803-020-04617-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cornelia de Lange syndrome (CdLS) is associated with repetitive and self-injurious behaviors (RBs, SIB). Evaluating children with CdLS, this study: (1) characterizes the spectrum of RBs; (2) characterizes the impact and severity of RBs including SIB; (3) describes how age and adaptive functioning relate to RBs including SIB. Fifty children (5-17 years) with CdLS were assessed with Children's Yale-Brown Obsessive Compulsive Scale Modified for PDD; Aberrant Behavior Checklist (ABC); Vineland Adaptive Behaviors Scales (VABS). All children had ≥ 1 type of RB; 44% had some form of SIB. 64% spent > 1 h/day displaying RBs. Lower VABS adaptive functioning was associated with higher stereotypy and SIB scores (ABC). In children with CdLS, RBs including SIB are common, impactful, and associated with lower adaptive functioning.
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37
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Shkedy G, Shkedy D, Sandoval-Norton AH, Fantaroni G. Visual communication analysis (VCA): Applying self-determination theory and research-based practices to autism. COGENT PSYCHOLOGY 2020. [DOI: 10.1080/23311908.2020.1803581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Gary Shkedy
- Research Department, Alternative Teaching Strategy Center, San Diego, CA, USA
| | - Dalia Shkedy
- Research Department, Alternative Teaching Strategy Center, San Diego, CA, USA
| | | | - Grace Fantaroni
- School of Education, Point Loma Nazarene University, San Diego, CA, USA
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38
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Lecavalier L, Bodfish J, Harrop C, Whitten A, Jones D, Pritchett J, Faldowski R, Boyd B. Development of the Behavioral Inflexibility Scale for Children with Autism Spectrum Disorder and Other Developmental Disabilities. Autism Res 2020; 13:489-499. [PMID: 31904198 PMCID: PMC8293897 DOI: 10.1002/aur.2257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/01/2019] [Accepted: 12/06/2019] [Indexed: 01/28/2023]
Abstract
Behavior inflexibility (BI) refers to rigid patterns of behavior that contrast with the need to be adaptable to changing environmental demands. We developed a parent-reported outcome measure of BI for children with autism spectrum disorder (ASD) and other developmental disabilities with a multi-step iterative process. A pool of 62 candidate items was generated through expert panel feedback, review of existing scales and focus groups. A consensus process was used to generate the final 38 items. Parents of 943 children (age range, 3-18 years; average, 11.4 years; 79% boys) with ASD completed an online survey. One hundred thirty-three parents rated their child twice within 3 weeks (average = 16.5 days). A series of factor analyses suggested that the 38 items measured a single construct. Scores had a weak correlation with level of functioning (-0.12) and did not differ based on sex. Scores had a negligible correlation with age (-0.07), although measurement invariance was not supported. The mean total score for the Behavioral Inflexibility Scale (BIS) was normally distributed. Internal consistency was α = 0.97 and temporal stability was r = 0.92. Correlations with parent ratings on the subscales of the Repetitive Behavior Scale-Revised varied from 0.48 to 0.89. The correlation with parent ratings on the Social Communication Questionnaire total score was 0.52. Our data show that BI in children with ASD ranges significantly from mild to severe and that the 38-item BIS is valid and reliable. Autism Res 2020, 13: 489-499. © 2020 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. LAY SUMMARY: We developed a parent-completed rating scale of behavior inflexibility (BI) for children with developmental disabilities using a multistep process. The Behavioral Inflexibility Scale (BIS) contains 38 questions rated on a 6-point scale. Parents of 943 children with autism spectrum disorder (ASD) completed an online survey. We examined associations between the BIS and other scales and demographic variables. The BIS is valid and reliable. BI in children with ASD ranges from mild to severe.
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Affiliation(s)
| | | | - Clare Harrop
- University of North Carolina at Chapel HillChapel HillNorth Carolina
| | | | | | | | - Richard Faldowski
- University of North Carolina at Chapel HillChapel HillNorth Carolina
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39
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Associated Factors of Self-injury Among Adolescents with Autism Spectrum Disorder in a Community and Residential Treatment Setting. J Autism Dev Disord 2020; 50:2987-3004. [PMID: 32056114 DOI: 10.1007/s10803-020-04389-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Self-injurious behavior (SIB) occurs in up to 50% of individuals with autism. As one of the most serious conditions in individuals with developmental disabilities, SIB affects the individual and his or her family in multiple contexts. A systematic analysis of factors most commonly associated with SIB could inform the development of individualized intervention strategies. The current study examined factors related to SIB in an analysis of client records of 145 children with autism in a comprehensive care center. Predictor variables included age, gender, the Adaptive Behavior Composite, sensory processing, aggression, stereotypies, irritability, adaptive skills, and medical conditions. Age, irritability, and the Adaptive Behavior Composite were found to significantly predict SIB.
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40
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Heald M, Adams D, Oliver C. Profiles of atypical sensory processing in Angelman, Cornelia de Lange and Fragile X syndromes. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:117-130. [PMID: 31828905 DOI: 10.1111/jir.12702] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/21/2019] [Accepted: 10/18/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND There is growing evidence to suggest that children with neurodevelopmental disorders may evidence differences in their sensory processing. The aim of this study was to compare sensory processing patterns in three genetic syndromes associated with sensory difference. METHODS Sensory processing in Angelman syndrome (n = 91), Cornelia de Lange syndrome (n = 28) and Fragile X syndrome (n = 40) was examined using the informant report measure the Sensory Experiences Questionnaire (SEQ). RESULTS All three groups were associated with a heightened prevalence of unusual sensory processing in comparison with normative data, evidenced in over 80% of all participants. Cross-syndrome comparisons highlighted syndrome-specific sensory processing profiles, with heightened hypo responsivity in Cornelia de Lange syndrome and sensory seeking in Angelman syndrome. CONCLUSIONS The results have important implications for the understanding of sensory processing in genetic syndromes and the development of tailored behavioural interventions.
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Affiliation(s)
- M Heald
- Cerebra Centre for Neurodevelopmental disorders, School of Psychology, University of Birmingham, Birmingham, UK
| | - D Adams
- Autism Centre of Excellence, School of Education and Professional Studies, Griffith University, Mount Gravatt, Queensland, Australia
- Griffith Institute for Educational Research, Griffith University, Brisbane, Queensland, Australia
| | - C Oliver
- Cerebra Centre for Neurodevelopmental disorders, School of Psychology, University of Birmingham, Birmingham, UK
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41
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Laverty C, Oliver C, Moss J, Nelson L, Richards C. Persistence and predictors of self-injurious behaviour in autism: a ten-year prospective cohort study. Mol Autism 2020; 11:8. [PMID: 31988707 PMCID: PMC6971887 DOI: 10.1186/s13229-019-0307-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/18/2019] [Indexed: 12/27/2022] Open
Abstract
Background Self-injurious behaviours, such as head banging, hair pulling, skin picking and scratching, are common in individuals with autism. Despite high prevalence rates, there is a paucity of longitudinal research to refine models of risk and mechanism and inform service planning. In this longitudinal study, we investigated self-injury in a cohort of individuals with autism over 10 years to identify behavioural and demographic characteristics associated with persistent self-injury. Methods Carers of 67 individuals with autism completed questionnaires relating to the presence of self-injury and relevant risk markers at T1 (mean [SD] age in years 13.4 [7.7]) and T3 (mean [SD] age in years 23.9 [7.7]) 10 years later. Forty-six of these also took part at T2 (3 years after initial participation). Analysis assessed demographic and behavioural risk markers for self-injury, as well as the predictive value of items assessed at T1and T2. Results Self-injury was persistent in 44% of individuals over the 10-year period, with behavioural characteristics of impulsivity (p < .001) and overactivity (p = .002), identified as risk markers for persistence. A predictive model of self-injury was derived from LASSO analysis, with baseline impulsivity, interest and pleasure, stereotyped behaviour, social communication and adaptive functioning predicting self-injury over 10 years. Conclusions In this unique longitudinal investigation into the persistence of self-injury in a non-clinical sample of individuals with autism over a 10 year period, we have identified a novel, robust and stable profile of behavioural characteristics associated with persistent self-injury. Findings support an early intervention strategy targeted towards individuals identified to be at a higher risk of developing self-injurious behaviour.
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Affiliation(s)
- Catherine Laverty
- School of Psychology, University of Birmingham, Birmingham, B15 2TT UK
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, B15 2TT UK
| | - Chris Oliver
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, B15 2TT UK
| | - Jo Moss
- School of Psychology, University of Surrey, Guildford, Surrey GU2 7XH UK
| | - Lisa Nelson
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, B15 2TT UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, Birmingham, B15 2TT UK
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, B15 2TT UK
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Channell MM. The Social Responsiveness Scale (SRS-2) in school-age children with Down syndrome at low risk for autism spectrum disorder. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2020; 5:2396941520962406. [PMID: 34179506 PMCID: PMC8232392 DOI: 10.1177/2396941520962406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND AND AIMS Little is known about how autism spectrum disorder (ASD) symptoms present in individuals with Down syndrome (DS). Some behaviors may be symptomatic of comorbid ASD or more broadly representative of the DS phenotype. A prior research study documented elevated ASD-like symptoms in adolescents and young adults with DS without comorbid ASD, using a common ASD risk screening tool-the Social Responsiveness Scale (SRS). The current study applied a similar approach to younger children with DS using the SRS-2. The primary aim was to document patterns of ASD-like symptoms in children with DS at low risk of comorbid ASD to distinguish the symptoms that may be present across DS in general. METHODS SRS-2 standard scores were analyzed in a sample of 40 children with DS, 6-11 years old, who were considered to be at low risk for ASD based on the Social Communication Questionnaire (SCQ) screener. Other developmental characteristics (i.e., age, nonverbal IQ, expressive language), social skills, and problem behaviors were also examined across the sample. RESULTS SRS-2 scores were significantly elevated in this sample compared to the normative population sample. A pattern of ASD-like symptomatology was observed across SRS-2 subdomains. These findings were similar to the findings of the prior study. However, nuanced differences were observed across the two samples that may represent developmental differences across different ages in this population. CONCLUSIONS Replicating and extending a prior study's findings, certain ASD-like behaviors may occur in individuals with DS who are at low risk for comorbid ASD. IMPLICATIONS Understanding the pattern of ASD-like behaviors that occur in children with DS who are at low risk for comorbid ASD will help clinicians in screening and identification efforts. In particular, it will lead to better specification of the behaviors or symptoms that are not characteristic of the DS phenotype and thus are red flags for comorbid ASD in this population.
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Affiliation(s)
- Marie Moore Channell
- Marie Moore Channell, Department of Speech
and Hearing Science, University of Illinois at Urbana-Champaign, 901 S. Sixth
Street, Champaign, IL 61820, USA.
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Bergmann T, Heinrich M, Ziegler M, Dziobek I, Diefenbacher A, Sappok T. Developing a Diagnostic Algorithm for the Music-Based Scale for Autism Diagnostics (MUSAD) Assessing Adults with Intellectual Disability. J Autism Dev Disord 2019; 49:3732-3752. [PMID: 31161304 DOI: 10.1007/s10803-019-04069-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Initial studies have presented the Music-based Scale for Autism Diagnostics (MUSAD) as a promising DSM-5-based observational tool to identify autism spectrum disorder (ASD) in adults with intellectual disability (ID). The current study is the first to address its clinical utility in a new sample of 124 adults with ID (60.5% diagnosed with ASD). The derived diagnostic algorithm differentiated well between individuals with and without ASD (sensitivity 79%, specificity 74%, area under the curve = 0.81). Inter-rater reliability, assessed by the scorings of four independent experts in 22 consensus cases, was excellent (ICC = 0.92). Substantial correlations with scores from other ASD-specific measures indicated convergent validity. The MUSAD yields accurate and reliable scores, supporting comprehensive ASD diagnostics in adults with ID.
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Affiliation(s)
- Thomas Bergmann
- Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstrasse 79, 10365, Berlin, Germany.
| | - Manuel Heinrich
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schwendenerstrasse 27, 14195, Berlin, Germany
| | - Matthias Ziegler
- Faculty of Life Sciences/Department of Psychology, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany
| | - Isabel Dziobek
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany
| | - Albert Diefenbacher
- Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstrasse 79, 10365, Berlin, Germany
| | - Tanja Sappok
- Evangelisches Krankenhaus Königin Elisabeth Herzberge, Herzbergstrasse 79, 10365, Berlin, Germany
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Psychotropic Medication in Intellectual and Developmental Disabilities: Patterns of Use and Recommendations for Monitoring Effects. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2019. [DOI: 10.1007/s40474-019-00179-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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The Persistence of Self-injurious and Aggressive Behavior in Males with Fragile X Syndrome Over 8 Years: A Longitudinal Study of Prevalence and Predictive Risk Markers. J Autism Dev Disord 2019; 49:2913-2922. [PMID: 31020491 PMCID: PMC6606661 DOI: 10.1007/s10803-019-04002-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Self-injurious and aggressive behaviors are common in fragile X syndrome (FXS). However, little is known about the persistence of these behaviors and associated risk markers. We established the prevalence and persistence of self-injurious and aggressive behaviors over eight years in males with FXS, and associations with risk markers. Results showed 77% and 69% persistence rates for self-injurious and aggressive behavior, respectively. Baseline levels of repetitive behavior predicted persistent self-injurious behavior. Chronological age, impulsivity and overactivity were associated with persistent aggressive behavior but only impulsivity predicted persistence. This is the first study to document the persistence of self-injurious and aggressive behavior in FXS over the medium to long term and to identify behavioral risk markers that might facilitate targeted early intervention.
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Shields MC, Akobirshoev I, Dembo RS, Mitra M. Self-Injurious Behavior Among Adults With ASD: Hospitalizations, Length of Stay, and Costs of Resources to Deliver Care. Psychiatr Serv 2019; 70:457-464. [PMID: 30841844 DOI: 10.1176/appi.ps.201800318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Research on hospitalizations related to self-injurious behavior and ideation among adults with autism spectrum disorder (ASD) is limited. This study compared admissions, average length of stay, and costs of resources to deliver care for such hospitalizations between adults with and without ASD. METHODS The 2014 Healthcare Cost and Utilization Project National Inpatient Sample was used to compare 5,341 discharge records for adults with ASD and 16,023 records for adults without ASD, matched on age and gender in a 1:3 ratio. Hierarchical logistic and linear regressions accounted for clustering by hospital. Covariates included gender, race-ethnicity, age, region, comorbidities, number of procedures, and insurance. RESULTS Among hospitalized adults, those with ASD were twice as likely as those without ASD to have a hospitalization related to self-injurious behavior and ideation. Among hospital stays for self-injurious behavior and ideation, adults with ASD had average lengths of stay that were 2.14 days longer (95% confidence interval [CI]=1.20-3.08) compared with adults without ASD. Among adults with a hospitalization related to self-injurious behavior and ideation, unadjusted average costs for those with ASD were 36.8% higher than for adults without ASD. After the analysis accounted for covariates and length of stay, adults with ASD still had 7.48% (95% CI=1.05%-14.32%) higher costs. CONCLUSIONS Adults with ASD were twice as likely as adults without ASD to have a hospitalization related to self-injurious behavior and ideation. Among adults with such a hospitalization, those with ASD had longer stays and, even after the analysis accounted for length of stay, higher costs.
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Affiliation(s)
- Morgan C Shields
- Lurie Institute for Disability Policy (Shields, Akobirshoev, Dembo, Mitra) and Institute for Behavioral Health (Shields), Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Ilhom Akobirshoev
- Lurie Institute for Disability Policy (Shields, Akobirshoev, Dembo, Mitra) and Institute for Behavioral Health (Shields), Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Robert S Dembo
- Lurie Institute for Disability Policy (Shields, Akobirshoev, Dembo, Mitra) and Institute for Behavioral Health (Shields), Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Monika Mitra
- Lurie Institute for Disability Policy (Shields, Akobirshoev, Dembo, Mitra) and Institute for Behavioral Health (Shields), Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
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Characteristics Associated with Autism Spectrum Disorder Risk in Individuals with Down Syndrome. J Autism Dev Disord 2019; 49:3543-3556. [DOI: 10.1007/s10803-019-04074-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Sabus A, Feinstein J, Romani P, Goldson E, Blackmer A. Management of Self-injurious Behaviors in Children with Neurodevelopmental Disorders: A Pharmacotherapy Overview. Pharmacotherapy 2019; 39:645-664. [PMID: 30793794 DOI: 10.1002/phar.2238] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Neurodevelopmental disorders (NDDs), a group of disorders affecting ~1-2% of the general population, are caused by changes in brain development that result in behavioral and cognitive alterations, sensory and motor changes, and speech and language deficits. Neurodevelopmental disorders encompass a heterogeneous group of disorders including, but not limited to, Smith-Magenis syndrome, Lesch-Nyhan disease, cri du chat syndrome, Prader-Willi syndrome, pervasive developmental disorders, fragile X syndrome, Rett syndrome, Cornelia de Lange syndrome, and Down syndrome. Self-injurious behaviors (SIBs) are common in children with NDDs; depending on the specific NDD, the incidence of SIBs is nearly 100%. The management of SIBs in this population is complex, and little high-quality data exist to guide a consistent approach to therapy. However, managing SIBs is of the utmost importance for the child as well as the family and caregivers. Behavior therapies must be implemented as first-line therapy. If behavioral interventions alone fail, pharmacotherapy becomes an essential part of management plans. The limited available evidence for the use of common pharmacologic agents, such as second-generation antipsychotics, and less common agents, such as clonidine, n-acetylcysteine, riluzole, naltrexone, and topical anesthetics, is reviewed. Additional data from well-designed studies in children with NDDs are needed to gain a better understanding of this common and troublesome problem including efficacy and safety implications associated with pharmacotherapy. Until then, clinicians must rely on the limited available data, clinical expertise, and ongoing systematic monitoring when managing SIBs in children with NDDs.
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Affiliation(s)
- Ashley Sabus
- Department of Pharmacy, Children's Hospital Colorado, Aurora, Colorado
| | - James Feinstein
- Adult and Child Consortium for Health Outcomes Research & Delivery Science, University of Colorado and Children's Hospital Colorado, Aurora, Colorado.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.,Children's Hospital Colorado, Aurora, Colorado
| | - Patrick Romani
- Child and Adolescent Psychiatry, Children's Hospital Colorado, Aurora, Colorado.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
| | - Edward Goldson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.,Children's Hospital Colorado, Aurora, Colorado
| | - Allison Blackmer
- Department of Pharmacy, Children's Hospital Colorado, Aurora, Colorado.,Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado.,Special Care Clinic, Children's Hospital Colorado, Aurora, Colorado
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Tharian PR, Henderson S, Wathanasin N, Hayden N, Chester V, Tromans S. Characters with autism spectrum disorder in fiction: where are the women and girls? ADVANCES IN AUTISM 2019. [DOI: 10.1108/aia-09-2018-0037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Fiction has the potential to dispel myths and helps improve public understanding and knowledge of the experiences of under-represented groups. Representing the diversity of the population allows individuals to feel included, connected with and understood by society. Whether women and girls with autism spectrum disorder (ASD) are adequately and accurately represented in fictional media is currently unknown. The paper aims to discuss this issue.
Design/methodology/approach
Internet and library searches were conducted to identify female characters with ASD in works of fiction. Examples of such works were selected for further discussion based on their accessibility, perceived historical and cultural significance and additional characteristics that made the work particularly meaningful.
Findings
The search highlighted a number of female characters with ASD across a range of media, including books, television, film, theatre and video games. Many were written by authors who had a diagnosis of the condition themselves, or other personal experience. Pieces largely portrayed characters with traits that are highly recognised within the academic literature. However, some also appeared to endorse outdated myths and stereotypes. Existing works appear to preferentially portray high functioning autistic women, with limited representation of those whom also have intellectual disability.
Originality/value
This is the first exploration of the depiction of ASD in females within fiction. There is a need for more works of fiction responsibly depicting females with ASD, as this can help reduce stigma, develop public awareness and recognition and increase representation.
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Affiliation(s)
- Tina Felfeli
- Faculty of Medicine (Felfeli, Mireskandari) and Department of Ophthalmology and Vision Sciences (Mireskandari), The Hospital for Sick Children, University of Toronto, Toronto, Ont
| | - Kamiar Mireskandari
- Faculty of Medicine (Felfeli, Mireskandari) and Department of Ophthalmology and Vision Sciences (Mireskandari), The Hospital for Sick Children, University of Toronto, Toronto, Ont.
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