The relationship between existing residential services and the needs of autistic adults

Independent living in adults with autism spectrum disorder: Stakeholders' perspectives and experiences

Independent living is a basic human right that enables individuals with disabilities to determine where they live, who they live with and what kind of support that they receive. Limited research exists regarding the challenges that adults with autism spectrum disorder (ASD) may face when attempting to live independently. Given the importance of independent living for adults with ASD, this study aimed to examine the perspectives of stakeholders about independent living among adults with ASD.

METHODS

We recruited a total of 19 stakeholders including adults with ASD and parents of adults with ASD from Canadian provinces. In-depth, semi-structured interviews were conducted to identify factors affecting independent living among adults with ASD. Interviews were transcribed and analyzed using thematic analysis to identify overarching themes.

RESULTS

Three themes emerged in our findings, including: a) Psychophysical stability and daily living; b) Financial management and planning; and c) Integrated community living and independence.

CONCLUSION

The findings from this study suggest that adults with ASD face several challenges related to independent living. Factors related to psychophysical stability and daily living, financial management, and integrated community living and housing were all found to influence the ability of adults with ASD to live independently. By exploring stakeholders' perspectives of independent living for adults with ASD, this study provides some insight that can help inform the development of programs and services to facilitate independent living for adults with ASD.

Improving social functioning and challenging behaviors in adolescents with ASD and significant ID: A randomized pilot feasibility trial of reciprocal imitation training in a residential setting

There is a lack of effective social interventions for youths with ASD and co-morbid intellectual disability (ID). A previous single-case design study indicated that reciprocal imitation training (RIT) may improve social interaction and challenging behavior in this population. The current pilot study examined the feasibility of conducting an RCT to investigate the effectiveness of RIT for improving social functioning and challenging behaviors in 20 adolescents with ASD and severe ID in a residential program. The assessment protocol was feasible. RIT was well-tolerated by the adolescents and implemented with fidelity by teaching staff. Preliminary findings indicate that treatment had moderate to large effects on social functioning and challenging behavior, with mixed findings for imitation skills. A larger RCT of RIT for this population is feasible and warranted.

Reducing Aggression in Children with Autism toward Infant or Toddler Siblings

Children with autism often lack appropriate means to communicate and may rely on aggression and other disruptive behaviors to express their needs. This may be a particularly serious problem when aggression occurs toward an infant or toddler, who could be severely injured by an older sibling. This study examined the use of functional assessment and individualized parent-implemented intervention plans in the home setting, including functional communication training with relevant ecological manipulations. Data were collected in the context of a multiple baseline design across three families. The results showed that after the intervention there were: (1) large reductions in the children's aggression toward their infant or toddler sibling, (2) increases in parent and child happiness level, and (3) increases in strangers' level of comfort with respect to interacting with the family. The results are discussed in terms of improving the overall quality of life for families of children with autism.

Social intervention for adolescents with autism and significant intellectual disability: initial efficacy of reciprocal imitation training

Individuals with autism have difficulty with social skills across the lifespan. Few social interventions have been examined for older individuals with autism who also have significant intellectual disabilities (ID). Previous research suggests that reciprocal imitation training (RIT) improves imitation and social engagement in young children with autism. This study used a multiple-baseline design to examine whether RIT could improve social behaviors in four adolescents with autism and significant ID. All adolescents improved their spontaneous imitation and two improved their joint engagement. In addition, two adolescents decreased their rate of self-stimulatory behaviors over the course of treatment. Overall, these results suggest that RIT may be effective at improving social interaction and decreasing self-stimulatory behavior in adolescents with autism and significant ID.

Comparing residential programmes for adults with autism spectrum disorders and intellectual disability: outcomes of challenging behaviour and quality of life

BACKGROUND

Owing to methodological issues, little research has been conducted to examine quality of life (QoL) as a treatment outcome in autism spectrum disorders (ASD) and intellectual disabilities (ID). This study was conducted to combine QoL measures and objective observations of challenging behaviours (CB) in order to evaluate changes over time in adults with ASD and ID who were treated in two different residential programmes; we hypothesised that a decrease in CB would be related to an improved QoL.

METHOD

In a longitudinal study (45 months), we followed 31 adults with ASD and ID who had been integrated into two residential programmes [Autism Programme with a Structured Method (PAMS) vs. traditional programme for ID (No-PAMS)] for 2-19 years. QoL [Quality of Life Inventory in a Residential Environment (IQVMR)] and severity of autistic features (Childhood Autism Rating Scales) were evaluated annually. CB, as measured by the Aberrant Behaviour Checklist (ABC), including stereotypic behaviour and inappropriate speech, were repeatedly assessed every 3 months.

RESULTS

Observed separately, the groups' results were different. In the PAMS programme, stereotypic behaviour and inappropriate speech (ABC scores) significantly decreased, and the IQVMR total score increased; in contrast, in the comparison group, ABC scores did not change and the IQVMR total score decreased. In all, three mixed-effect ANCOVAs partially confirmed that the PAMS programme had an effect on CB and that QoL improvement did not directly depend on the type of programme but on reducing CB as measured by the ABC.

CONCLUSION

The PAMS programme has a positive and indirect influence on QoL by reducing CB.

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

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

Quality of life of adults with pervasive developmental disorders and intellectual disabilities

The purpose of this study was to observe quality of life (QoL) and global evolution of persons with Pervasive Developmental Disorders (PDD) in three different groups. Individualized programs for PDD were compared to traditional programs for intellectual disabilities. Behavioural disorders were repeatedly evaluated using the Aberrant Behaviour Checklist (ABC) and QoL once a year. Little research has investigated this domain due to methodological problems with a non-verbal population. Two preliminary studies of individualized programs showed a significant reduction in behaviour disorders over the course of the study. The recent inclusion of a control group indicates that a traditional program reduces lethargy/social withdrawal (ABC factor 2). A good QoL was measured for the three groups.

Short Breaks Services for Children with Autistic Spectrum Disorders: Factors Associated with Service Use and Non-use

Short break services in a UK county were studied using a postal survey of 256 families with a child with an autistic spectrum disorder (ASD). Results confirmed high degrees of stress and low levels of informal support for all families, but no significant difference in the informal support available to non-users as compared to users of short break services. Robinson & Stalker's (1990) 10-point dependency scale showed a significant difference in dependence and more difficult behaviors between children of users and non-users. However, a large number of non-users had children with high dependence (scoring >7 points). Access was denied by the age of the child (under 11) diagnosis (Asperger syndrome), educational placement (mainstream) and lack of social worker referral.

A comparison of social skills in adults with autistic disorder, pervasive developmental disorder not otherwise specified, and mental retardation

We examined the social skills of adults with autism, PDDNOS, and mental retardation. All participants were diagnosed with profound mental retardation. Participants in the autism and PDDNOS groups had been previously diagnosed using the Childhood Autism Rating Scale (CARS) and record review. These diagnoses were confirmed by readministering the CARS by one author and an independent rater. Social skills were assessed by using the Vineland Adaptive Behavior Scales and the Matson Evaluation of Social Skills in the Severely Retarded. Significant differences between the autism and mental retardation groups were found on both measures. The PDDNOS group demonstrated better positive nonverbal social skills than the autism group but not the mental retardation group. Special treatment needs of institutionalized adults with autism appear warranted along with a need to clarify further the differences between PDDNOS and mental retardation.

Critical issues in the residential care of people with autism

There is an ever-growing need to expand both the number and range of residential services for individuals with autism while developing strategies for assuring the quality of these programs. Future program development will be facilitated by an empirical approach to the critical elements that have been identified throughout the articles in this issue.