Descriptive functional analysis of behavioral excesses shown by adults with Down syndrome and dementia

The Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) Scale: Comprehensive Assessment of Psychopathology in Down Syndrome

People with Down syndrome (DS) are prone to develop Alzheimer’s disease (AD). Behavioral and psychological symptoms of dementia (BPSD) are core features, but have not been comprehensively evaluated in DS. In a European multidisciplinary study, the novel Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) scale was developed to identify frequency and severity of behavioral changes taking account of life-long characteristic behavior. 83 behavioral items in 12 clinically defined sections were evaluated. The central aim was to identify items that change in relation to the dementia status, and thus may differentiate between diagnostic groups. Structured interviews were conducted with informants of persons with DS without dementia (DS, n = 149), with questionable dementia (DS+Q, n = 65), and with diagnosed dementia (DS+AD, n = 67). First exploratory data suggest promising interrater, test-retest, and internal consistency reliability measures. Concerning item relevance, group comparisons revealed pronounced increases in frequency and severity in items of anxiety, sleep disturbances, agitation & stereotypical behavior, aggression, apathy, depressive symptoms, and eating/drinking behavior. The proportion of individuals presenting an increase was highest in DS+AD, intermediate in DS+Q, and lowest in DS. Interestingly, among DS+Q individuals, a substantial proportion already presented increased anxiety, sleep disturbances, apathy, and depressive symptoms, suggesting that these changes occur early in the course of AD. Future efforts should optimize the scale based on current results and clinical experiences, and further study applicability, reliability, and validity. Future application of the scale in daily care may aid caregivers to understand changes, and contribute to timely interventions and adaptation of caregiving.

Behavior-Analytic Approaches to Working with People with Intellectual and Developmental Disabilities who Develop Dementia: a Review of the Literature

Behavior analysis has made contributions in the development of evidence-based interventions for people with intellectual and developmental disabilities (IDD), and there is a growing evidence base for behavior-analytic interventions for older adults with dementia. As there is an increased number of adults with IDD living to old age, and an increased prevalence of comorbid dementia in people with IDD, a review of the behavior-analytic contributions with this population is warranted. We searched Web of Science and PsycInfo and manually reviewed the last 20 years of five behavioral journals. Six behavior-analytic studies with people with IDD and dementia were identified, and all but one were published outside of core behavior-analytic journals. These articles were analyzed in terms of Baer, Wolf, and Risley's (Journal of Applied Behavior Analysis, 1, 91-97, 1968) seven dimensions of applied behavior analysis (ABA). The possible explanations and implications of these findings are discussed with consideration of the unique features of a comorbid diagnosis of IDD and dementia that may make it appropriate for increased focus in behavior-analytic research and practice.

Psychometric evaluation of the Italian version of the AADS questionnaire: a caregiver-rated tool for the assessment of behavioral deficits and excesses in persons with intellectual disabilities and dementia

BACKGROUND

The aim of this study was to verify the reliability and validity of the Italian version of the Assessment for Adults with Developmental Disabilities (AADS-I), the only available measure specifically designed to assess the frequency, management difficulties and impact on the quality of life (QoL) of positive and negative non-cognitive symptoms in persons with intellectual disabilities (ID) and dementia.

METHODS

AADS-I was administered to professional carers of 63 aging ID individuals. We computed the internal consistency separately of the frequency, management difficulty and effect on the QoL subscales of Behavioral Excesses and Behavioral Deficits and their inter-rater and test-retest reliabilities.

RESULTS

Homogeneity of AADS-I was found to range from good to excellent: Cronbach's α coefficients were 0.77, 0.83 and 0.82, respectively for frequency, management difficulty and effect on the QoL of Behavioral Excesses, and 0.82, 0.76 and 0.79 of Behavioral Deficits. Intraclass correlation coefficients (ICC) between two independent carers were 0.67, 0.79 and 0.73 and 0.67, 0.67 and 0.67 for frequency, management difficulty and effect on the QoL of Behavioral Excesses and Deficits, respectively. Corresponding ICC for test-retest reliability were 0.80, 0.75, 0.78 and 0.70, 0.81, 0.81. Age, gender and typology of ID did not correlate with the AADS-I subscale scores, whereas the severity of ID related only with the frequency subscale of Behavioral Deficits. This subscale also correlated with the Dementia Questionnaire for Persons with Intellectual Disabilities. Behavioral deficits are more frequent in subjects with dementia.

CONCLUSIONS

These results confirm the reliability and validity of the Italian version of AADS.

Stereotyped behaviour in children with autism and intellectual disability: an examination of the executive dysfunction hypothesis

BACKGROUND

Increasing attention has been paid to the executive dysfunction hypothesis argued to underpin stereotyped behaviour in autism. The aim of this study is to investigate one component of this model, that stereotyped behaviours are related to impaired generativity and compromised behavioural inhibition, by examining whether episodes of these behaviours terminate naturally without external intervention.

METHODS

Using a naturalistic observational methodology the stereotyped behaviours of six participants with autism were recorded in real time over periods ranging from 3.59 to 9.20 h. Data were also recorded for teaching staff interactions with participants and environmental settings (one-to-one, group and freetime).

RESULTS

In comparison with one-to-one settings stereotyped behaviours were more frequent when participants were in freetime settings with the exception of one participant. For the termination of stereotyped behaviours these behaviours stopped with no ongoing physical or verbal adult contact being evident for a median of 73.25% of the time. Additionally, for a median of 89.40% of the time stereotyped behaviour stopped without the initiation of adult contact.

DISCUSSION

The termination of bouts of stereotyped behaviour was frequently not associated with any adult contact and thus this form of external intervention. This finding warrants explanation by extending the hypothesis that compromised impaired generativity and behavioural inhibition offers a complete explanation of stereotyped behaviours.

Experimental functional analysis of aggression in children with Angelman syndrome

BACKGROUND

Kinship theory suggests that genomic imprinting could account for phenotypic behaviors that increase (in the case of Angelman syndrome) or decrease (for Prader-Willi syndrome) the drive to access social resources (adult contact) depending on the imprinting parent-of-origin. Difficult to manage behaviors, such as aggression that is common in Angelman syndrome, could serve the function of increasing social interaction. We hypothesise that the commonly reported aggressive behavior in children with Angelman syndrome will be attention maintained.

METHODS

Experimental functional analysis was carried out with twelve children with Angelman syndrome caused by either a deletion (n=10) or uniparental disomy (n=2). The relative increase and decrease of aggressive behaviors was observed in response to experimentally manipulated levels of adult attention and demand. Laughing and smiling, crying and frowning, and physical initiation with an adult were also measured.

RESULTS

Aggression was seen in ten of the twelve children. One child evidenced a pattern of aggression across conditions consistent with maintenance by attention, three children showed higher levels of aggression during social interaction and two children showed escape motivated aggression.

DISCUSSION

With the exception of one child the results did not confirm the hypothesis. However, the pattern of increased aggression in the high social contact condition combined with evidence of positive affect during this condition suggests aggression may serve to both maintain and initiate social contact and this interpretation is consistent with previous research. The negative results may also have been influenced by the age of the children and the low levels of observed aggression.