What is the evidence for environmental causes of challenging behaviors in persons with intellectual disabilities and autism spectrum disorders?

Toward improved understanding and treatment of self-injurious behaviors in autistic individuals with profound intellectual disability

Self-injurious behaviors (SIB) commonly occur in autism spectrum disorder (ASD) and span diverse topographies of self-inflicted behaviors ranging from head banging to hitting oneself against hard objects. Despite the high rates of SIB in autistic individuals, relatively little research has focused on psychological factors associated with the development and maintenance of SIB in individuals with autism and moderate-profound intellectual disability (ID). This commentary synthesizes existing literature on SIB and highlights the need for more research focused on psychological correlates and mechanisms in autistic individuals with moderate-profound ID. We highlight the key role of difficulties in emotion regulation (ER) and co-occurring internalizing symptoms in the manifestation of self-harm behaviors in clinical samples and autism. Furthermore, this commentary proposes a framework for understanding the interplay between poor ER and internalizing symptoms in the development and maintenance of SIB in autistic individuals with moderate-profound ID. Specifically, we explore the emergence of SIB in the context of precipitating cues that trigger strong emotions, ER processes and strategy deployment, and co-occurring internalizing symptoms. Future directions and implications for longitudinal research, measurement development, and clinical treatments are discussed.

Frontal EEG alpha asymmetry in youth with autism: Sex differences and social-emotional correlates

In youth broadly, EEG frontal alpha asymmetry (FAA) associates with affective style and vulnerability to psychopathology, with relatively stronger right activity predicting risk for internalizing and externalizing behaviors. In autistic youth, FAA has been related to ASD diagnostic features and to internalizing symptoms. Among our large, rigorously characterized, sex-balanced participant group, we attempted to replicate findings suggestive of altered FAA in youth with an ASD diagnosis, examining group differences and impact of sex assigned at birth. Second, we examined relations between FAA and behavioral variables (ASD features, internalizing, and externalizing) within autistic youth, examining effects by sex. Third, we explored whether the relation between FAA, autism features, and mental health was informed by maternal depression history. In our sample, FAA did not differ by diagnosis, age, or sex. However, youth with ASD had lower total frontal alpha power than youth without ASD. For autistic females, FAA and bilateral frontal alpha power correlated with social communication features, but not with internalizing or externalizing symptoms. For autistic males, EEG markers correlated with social communication features, and with externalizing behaviors. Exploratory analyses by sex revealed further associations between youth FAA, behavioral indices, and maternal depression history. In summary, findings suggest that individual differences in FAA may correspond to social-emotional and mental health behaviors, with different patterns of association for females and males with ASD. Longitudinal consideration of individual differences across levels of analysis (e.g., biomarkers, family factors, and environmental influences) will be essential to parsing out models of risk and resilience among autistic youth.

Experiences of parents and stakeholders in caring for, and supporting children with special needs in Ghana

We studied the caring, parenting, and support services for children with special needs in Ghana. Many of the study participants reported re-adjusting their lives in virtually every domain-social, economic, and emotional to deal with and manage the new realities. How parents navigate this space varied considerably from setting to setting. Regardless of individual and interpersonal resources, community, institutional, and policy circumstances seemed to exacerbate notions of disability. In many instances, parents had a low depth of suspicion about the precursors to disabling events in their children. Parents are constantly pursuing health care, including a cure for their children with disabilities. Views about "otherness" were noted, and these tended to undermine medical interpretations/explanations of disability generally, which in turn affected formal education and health-seeking for children. Institutional arrangements exist to encourage parents to invest in their children regardless of their perceived abilities. However, these do not seem to be sufficient, particularly for health and formal education. Programming and policy implications are highlighted.

The role of physical environmental characteristics and intellectual disability in conduct problem trajectories across childhood: A population-based Cohort study

BACKGROUND

The paucity of research investigating the role of the physical environment in the developmental progression of conduct problems and the potential moderating effects of intellectual disability (ID) is surprising, given the clinical relevance of elucidating environmental determinants of disruptive behaviours.

AIMS

To use data from a large UK cohort study to assess associations between physical environmental exposures, ID, and conduct problem trajectories.

METHOD

The sample included 8168 Millennium Cohort Study children (1.9% with ID). Multilevel growth curve modelling was used to examine the role of physical environment characteristics in the developmental trajectories of conduct problems after adjustments for ID status.

RESULTS

Exposure to external environmental domains was not associated with differences in children's conduct problems across development. Alternatively, internal aspects of the household environment: spatial density (b = 0.40, p < .001) and damp problems (b = 0.14, p < .001) were both significantly associated with increased trajectories. Various individual and familial covariates were positively associated with conduct problems over time, including: presence of ID (b = 0.96, p < .001), autism spectrum disorder (b = 1.18, p < .001), male sex (b = 0.26, p < .001), poverty (b = 0.19, p < .001), maternal depression (b = 0.65, p < .001), and non-nuclear family structure (b = 0.35, p < .001). Positive ID status appeared to moderate the effects of internal household spatial density, reporting a non-linear negative association with spatial density and conduct problems across development (b = -1.08, p < .01).

CONCLUSIONS

Our findings highlight the potential harmful consequences of poor internal residential conditions on children's development of disruptive behaviours.

Establishing the transdiagnostic contextual pathways of emotional outbursts

Emotional outbursts or temper outbursts are challenging behaviours commonly experienced by people with neurodevelopmental disorders and people who have experienced childhood adversity, which can negatively impact individuals and their families. Emotional outbursts may manifest in different situations via unique pathways distinguished by context-specific differences in the regulation and expression of emotions. Caregivers (N = 268) of young people (6-25 years) with emotional outbursts completed a bespoke caregiver-report questionnaire. Potential pathways were identified by examining the patterns of antecedents and setting events related to outbursts through factor and cluster analyses. Six contextual factors were derived from the Emotional Outburst Questionnaire. Based on these factors, the responses were classified into three clusters, which may represent potential pathways of emotional outbursts. The three clusters were characterized by the increased likelihood of outbursts: (1) across all setting events and triggers; (2) in safe setting events; (3) in unsafe setting events. These potential pathways may be related to: (1) differences in sensory processing; (2) masking of emotions in unsafe environments; (3) differences in safety perception. This framework supports a transdiagnostic account of emotional outbursts and may facilitate the development of pathway-specific intervention strategies.

Behavioural phenomena in persons with an intellectual developmental disorder according to the level of emotional development

BACKGROUND

Challenging behaviours in people with an intellectual developmental disorder (IDD) are complex and often difficult to understand. The developmental perspective may provide additional insights into the specific behavioural patterns and underlying motives in different emotional reference ages.

METHODS

The behaviours of 185 adults with IDD who were admitted to psychiatry were systematically assessed with the Aberrant Behaviour Checklist (ABC) and the Modified Overt Aggression Scale (MOAS). The association of the different behaviours with various emotional reference age groups as assessed with the Scale of Emotional Development - Short (SED-S) was analysed to deduce behavioural patterns typical for a certain level of functioning.

RESULTS

Overall, the severity of challenging behaviours decreases in higher emotional reference age groups. Physical aggression was most prevalent in persons in the second phase of emotional development (7-18 months reference age). In SED-S-1 (reference age 0-6 months), the persons appeared to be searching for physical comfort and showed high scores in social withdrawal, stereotypies and aggression towards the self. Persons functioning in SED-S-2 (reference age 7-18 months) scored highest in irritability and physical aggression (searching for security), while those in SED-S-3 (19-36 months) exhibited the searching for autonomy type characterised by defiant and socially inappropriate behaviours. Persons with an emotional reference age of 4-7 years (SED-S-4) showed inappropriate speech, verbal self-regulation and depressive-like behavioural aspects (searching for identity).

CONCLUSIONS

The behavioural phenomena exhibited in a certain emotional reference age may support the clinician to differentiate behavioural problems from psychopathological symptoms to yield the proper diagnosis.

Exploring experiential elements, strategies and outcomes of quality participation for children with intellectual and developmental disabilities: A systematic scoping review

OBJECTIVE

Quality participation, defined as satisfying and enjoyable involvement, is one of the most valued life outcomes for children with intellectual and developmental disabilities. To broaden understandings of quality participation, our review explored participation experiences of children with intellectual and developmental disabilities.

METHOD

Utilising an established systematic scoping review methodology, data were collected using three search tools (peer-reviewed databases, grey literature databases and Google). Inclusion criteria required that children with intellectual and developmental disabilities and/or their proxies provided descriptions of quality participation experiences in any life domain.

RESULTS

A total of 35 articles met the inclusion criteria. Quality participation strategies (30 total) and outcomes (8 total) were categorised according to six experiential elements (autonomy, belongingness, challenge, engagement, mastery and meaning).

CONCLUSION

Findings provide novel insight for building quality experiences across current and future participation initiatives.

Comprehensive Assessment of Triggers for Behaviours of Concern Scale (CATS): Initial Development

Challenging behaviour displayed by people with intellectual disabilities (ID) can be difficult to manage if caregivers do not understand the reasons for the behaviour. Identifying the contextual variables/triggers for the behaviour is likely to help undertake a functional analysis leading to a person-centred positive behaviour support plan. Currently, a limited number of checklists are available for trigger assessment and none were developed using an interview with the family caregivers. This article describes the development and contents of the comprehensive assessment of triggers for behaviours of concern scale (CATS). CATS was developed in two stages. Stage 1 used a ‘bottom-up’ approach, in which caregivers of adults with ID who show aggressive behaviour were interviewed to identify the triggers for aggression. In stage two, using a ‘top-down’ approach, a comprehensive literature review was conducted to gather items from existing trigger checklists. Trigger items from both stages were combined and the duplicates were removed. The final list in CATS consists of 333 contextual triggers categorised under five main domains and 12 subdomains. CATS can be used by caregivers to identify triggers or antecedents of challenging behaviour. Further work is needed to test its psychometric properties, utility, and acceptability.

Peer influence on problem behaviors among students with intellectual disabilities

BACKGROUND

Students with intellectual disabilities (ID) exhibit increased rates of problem behaviors compared to those without ID.

AIMS

Given the evidence of peer influence in typical development, we examined the impact of classmates' characteristics on problem behaviors of students with ID. We expected higher levels of problem behaviors in special needs classrooms will influence individual development of such behaviors.

METHODS

A longitudinal design with measurements at the beginning and the end of a school year was applied. Staff reported on problem behaviors of 1125 students with ID (69 % boys; age 11.30 years,SD = 3.75) attending 16 Swiss special needs schools.

RESULTS

The peer influence hypothesis was not supported for an overall problem behavior score. However, exploratory analyses suggested that peer influence did occur for the domains anxiety, problems in relating socially, and communication disturbances (not disruptive/antisocial, self-absorbed and other types of problem behaviors). The influence of classmates on anxiety was lower when there was more variability in anxiety within the classroom. The development of communication skills benefitted from attending a classroom that was heterogeneous in the level of communication problems.

CONCLUSION

Our results suggest that the influence of peers on problem behaviors in special needs schools is not universal but varies between domains and depends on classroom characteristics.

Development of the parental self-efficacy scale for preventing challenging behaviors in children with autism spectrum disorder

BACKGROUND

Almost all children with autism spectrum disorder (ASD) have experienced challenging behavior, including disruptive and aggressive behavior symptoms to both themselves and others. In conjunction with appropriate strategic parenting, challenging behavior can be prevented by empowering children's sociality and optimizing their environment. However, a means of measuring such parenting has yet to appear. This study developed the Parental Self-Efficacy Scale for Preventing Challenging Behaviors in Children with Autism Spectrum Disorder (PASEC) and evaluated its reliability and validity.

METHOD

Self-administered questionnaires were distributed to 1,344 parents of children with ASD at all 521 child development support centers in Japan. Confirmed construct validity of the PASEC was determined using confirmatory factor analysis. Internal consistency of the PASEC was calculated using Cronbach's alpha. The self-efficacy subscale of the Parenting Sense of Competence (PSOC) was administered to assess criterion-related validity of the PASEC.

RESULTS

In total, 260 parents provided valid responses. Exploratory and confirmatory factor analyses identified six items from two factors: empowerment of children's sociality and optimization of children's environment. The final model showed goodness-of-fit index, 0.981; adjusted goodness-of-fit index, 0.944; comparative fit index, 0.999; and root mean square error of approximation, 0.019. Cronbach's alpha for the entire PASEC was 0.82; that for each factor was above 0.70. The correlation coefficient between the self-efficacy subscale of the PSOC and the entire PASEC was r = 0.52 (P <0.001).

CONCLUSIONS

The PASEC demonstrated adequate reliability and validity to assess parents' self-efficacy for preventing challenging behavior for children with ASD. That scale can help prevent challenging behavior; it can contribute to improving the mental health of parents and children with ASD as well as to primary prevention of child maltreatment and abuse.

Practice Parameter for the Assessment and Treatment of Psychiatric Disorders in Children and Adolescents With Intellectual Disability (Intellectual Developmental Disorder)

Intellectual disability (intellectual developmental disorder) (ID/IDD) is both a psychiatric disorder and a risk factor for co-occurring psychiatric disorders in children and adolescents. DSM-5 introduced important changes in the conceptualization and diagnosis of ID/IDD, and current research studies clarify assessment and treatment of co-occurring psychiatric disorders in this population. Optimal assessment and treatment of psychiatric illness in children and adolescents with ID/IDD includes modifications in diagnostic and treatment techniques, appreciation of variations in the clinical presentation of psychiatric disorders, an understanding of the spectrum of etiologies of behavioral disturbance, and knowledge of psychosocial and medical interventions.

Prevalence and putative risk markers of challenging behavior in students with intellectual disabilities

Numerous studies have reported a high prevalence of challenging behavior among students with intellectual disabilities (ID). They discuss different putative risk markers as well as their influence on the occurrence of challenging behavior. The study investigates the prevalence of challenging behavior and evaluates in terms of a replication study well-known putative risk markers among a representative sample of students with ID (N=1629) in Bavaria, one of the largest regions in Germany. The research is based on a modified version of the Developmental Behavior Checklist (DBC). Findings indicate a prevalence rate of 52% for challenging behavior. The following putative risk markers are associated with challenging behavior: intense need for care, male gender, lack of communication skills, and residential setting. These risk markers explain 8.4% of the variance concerning challenging behavior. These results reveal that challenging behavior either is to a large extent determined by situations and interactions between individuals and environment and cannot be explained by the measured individual and social risk markers alone, or it is determined by further risk markers that were not measured.

Using qualitative methods to guide scale development for anxiety in youth with autism spectrum disorder

Anxiety is common in youth with autism spectrum disorder. Despite this common co-occurrence, studies targeting anxiety in this population are hindered by the under-developed state of measures in youth with autism spectrum disorder. Content validity (the extent to which an instrument measures the domain of interest) and an instrument’s relevance to the patient population are key components of measurement development. This article describes the application of qualitative research methods in the initial development of a parent-rated instrument of anxiety symptoms in youth with autism spectrum disorder. Overall, 48 parents of 45 children (aged 3–17 years) with autism spectrum disorder and at least mild anxiety participated in one of six focus groups at two sites (three groups per site). Systematic coding of the focus group transcripts identified broad themes reflecting the situations and events that trigger anxiety in children with autism spectrum disorder, the behavioral manifestations of anxiety in children with autism spectrum disorder, the parent and the child’s own response to anxiety, and broad behavioral patterns that could be associated with anxiety. From the focus group data, investigators generated 52 candidate items for a parent-rating of anxiety in youth with autism spectrum disorder. This report provides a detailed description of these early steps in developing a patient-oriented outcome measure.

Research on Positive Indicators for Teacher-Child Relationship in Children with Intellectual Disabilities

Teacher-child relationships (TCRs) are important factors in socio-emotional development and academic and behavioural outcomes. In Japan, occupational therapists (OTs) work with teachers and children with intellectual disabilities (ID) in school environment considering TCRs. This study aimed to identify positive indicators in TCRs among children with ID. We conducted interviews with 23 Japanese preschool teachers working with children with ID in child development support centres (CDSCs) and used the Delphi method to evaluate and select positive indicators. We obtained 49 positive indicators belonging to 15 conceptual indicators related to TCRs. The indicators that reached a high degree of agreement and consensus seems to be related to more fundamental social interaction aspects. These indicators could be used to enhance collaboration between OTs and teachers in the school environment, including CDSCs. We could not examine differences of positive social aspects depending on diagnostic features. It will be important for future work to examine differences in positive social aspects among children with other diagnostic features. Our findings could contribute to the development of an assessment tool to evaluate positive aspects of teacher-child interactions and their progress.

Teaching a Child With Autism to Request Breaks While Concurrently Increasing Task Engagement

PURPOSE

An intervention package, including teaching break requests and tolerance for delay in reinforcement delivery to increase task engagement, was implemented with a 4-year-old child with an autism spectrum disorder who did not engage for a duration commensurate with individual education program team expectations.

METHOD

A multiple-probe design across tasks was implemented. Dependent measures taken included engagement duration and the production of spoken break requests after work completion. Intervention was implemented with tasks involving short periods of engagement prior to the learner's disengagement. The possibility of the learner's overgeneralized production of break requests with tasks originally associated with longer engagement was also examined.

RESULTS

The participant learned to request breaks in short engagement tasks. In addition, engagement increased dramatically without off-task behavior. Overgeneralized use of break requests with long engagement tasks did not occur. Generalization of break requests to untrained short engagement tasks that were not the focus of intervention (but were associated with escape and short engagement) did not occur until the intervention package was implemented.

CONCLUSIONS

The combination of teaching break requests and tolerance for delay in reinforcement delivery was effective in addressing problem behavior. Implications for enhancing properly generalized and moderated use of break requests across different tasks or contexts are discussed.

The role of personality in aggressive behaviour among individuals with intellectual disabilities

BACKGROUND

Aggressive behaviour is associated with certain personality traits in both the general population and among individuals with mental health problems, but little attention has been paid to the relationship between aggressive behaviour and personality among individuals with intellectual disabilities (ID). The aim of this study was to circumscribe personality profiles associated with aggressive behaviour among individuals with ID.

METHOD

In this cross-sectional study of 296 adults with mild or moderate ID, information on mental health, personality and aggressive behaviour was gathered through structured interviews with the ID participants and their case manager, and a review of client files.

RESULTS

The results of the Reiss Profile were submitted to hierarchical cluster analysis method. Subsequently, the distribution of aggressive behaviour, sociodemographic characteristics and clinical characteristics across personality profiles was analysed. The analyses yielded seven distinct personality profiles in relation to patterns of aggressive behaviour: Pacifists, Socials, Confidents, Altruists, Conformists, Emotionals and Asocials.

CONCLUSION

The identification of distinct personality profiles sheds light on the risk factors for aggressive behaviour, and suggests new approaches to improving diagnostic and intervention strategies.

RETRACTED: Functional variables of challenging behavior in individuals with intellectual disabilities

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor in Chief, after review by an independent panel of experts, due to evidence of a compromised peer review process and the failure of one author to disclose significant conflicts of interest. An independent peer-review process is a cornerstone of scientific integrity that allows for research to be scrutinized before publication to ensure that conclusions are anchored in sound methodology and objective interpretation of the results. Equally important is that the readership of research is fully informed about any potential competing interests that may have influenced the research process. This article is being retracted because it did not include a declaration of a conflict of interest of one author in relation to diagnostic tools which the paper endorses. The same author was also the Editor in Chief of the journal at the time of publication and evidence indicates that the paper was accepted without any independent peer review by external reviewers. The article is therefore retracted in accordance with the ethical guidelines of Elsevier: https://www.elsevier.com/about/policies/publishing-ethics and the Committee on Publication Ethics (COPE) https://publicationethics.org/files/retraction-guidelines.pdf.

Psychiatric assessment of severe presentations in autism spectrum disorders and intellectual disability

Children with autism spectrum and related disorders and intellectual disability are not protected from the experience of psychiatric illnesses. Many factors can contribute to exacerbation of existing behavioral symptoms or to the emergence of new psychiatric problems. The psychiatric assessment must thus take into account a range of possible etiologic or contributory factors. The approach outlined in this article highlights the value of assessing 4 broad domains, including diagnostic (genetic) factors, medical considerations, developmental influences, and environmental factors. Examples of how the consideration of each of these domains may inform the diagnostic formulation are highlighted.

Measuring quality of life in people with intellectual and multiple disabilities: validation of the San Martín scale

Although there are numerous quality of life instruments in the, field of intellectual disability, most of them are addressed to those, people with the highest levels of functioning, while only a few are, suitable for people with the lowest levels (i.e., people with profound, and severe intellectual disabilities, or people with intellectual and, developmental disabilities and other significant medical conditions or, disabilities). This study provides reliability and validity evidence of, the San Martín Scale, a 95-item Likert scale questionnaire that is, completed by a third-party respondent. The validation sample was composed, of 1770 people from Spain with intellectual and developmental, disabilities that showed extensive or pervasive support needs (8.7% had, mild intellectual disability, 28.25% moderate, 41.6% severe, and 21.4%, profound). The age of the participants ranged between 16 and 77 years old, (M=7.78; SD=12.32). The results suggested that the eight quality of, life domains assessed on the scale are reliable (Cronbach's alpha ranging, from .821 to .933). Confirmatory Factor Analyses provided construct, validity evidences related to the internal structure of the San Martín, Scale, and indicated that the eight first-order factor solution provided, the best fit to the data over unidimensional and hierarchical solutions. Implications of these findings and guidelines for further research are, discussed.

Antecedent events as predictive variables for behavioral function

Challenging behavior is one of the largest barriers to ensuring that people with intellectual disabilities (ID) are able to participate in the community. These difficulties have become one of the main causes of social exclusion. The research into and treatment of challenging behavior has usually involved the identification of its function and the manipulation of the events or environmental conditions that influence its occurrence (antecedent variables). The present research explores the relationship between antecedents and behavioral function and the extent to which antecedent variables may act as predictors of behavioral function. This relationship is explored using two standardized instruments: Questions About Behavioral Function and Contextual Assessment Inventory. Data from the validation of these instruments for the Spanish population involved 300 participants with ID and 328 challenging behaviors. The results suggest that social/cultural variables are most related to challenging behavior, whereas biological variables seem to only be related to physically maintained behavior.

An examination of specific daily living skills deficits in adults with profound intellectual disabilities

While some researchers have investigated daily living skills deficits in individuals with intellectual disability (ID) as a whole, research on specific daily living skills in a profound ID population is limited. Two hundred and four adults with profound ID residing in two large developmental centers in the southeast portion of the United States were studied. Data were collected on these individuals' daily living skills, utilizing the Vineland Adaptive Behavior Scales (VABS). Three dependent t-tests were conducted comparing the proportion of items endorsed by informants on each of the three subdomains of daily living skills on the VABS (personal, domestic, and community). A significantly larger proportion of Personal Subdomain items were endorsed compared to Domestic or Community Subdomain items. Additionally, participants exhibited a significantly larger proportion of Domestic Skills Subdomain items compared to Community Skills Subdomain items which is consistent with theoretical models suggesting that institutional living may curb broader community skill sets. No gender differences were found in daily living skills. Lastly, individuals between the ages 30 and 39 exhibited significantly more Personal Subdomain skills than individuals who were 60 or older, while participants between the ages 30 and 39 exhibited significantly more Domestic Subdomain skills than individuals between the ages 60 and 69.

Discriminant analysis of the autism spectrum disorder observation for children

PURPOSE

To run a discriminant analysis on the individual items and the total scale of the ASD-OC to determine if they significantly discriminated between ASD and atypical groups.

METHOD

The measure was administered to 78 children as part of an outpatient evaluation.

RESULTS

The DA revealed that all of the items, excluding five, were significant predictors by themselves. Additionally, Wilks' lambda was significant, λ = 0.16, χ(2)= 115.91, p < 0.001 for the function, indicating that all of the items together significantly discriminated between groups. The DA was run again excluding those items mentioned above and the variability accounted for by all of the items and prediction of group membership decreased. Therefore, all 45 items were retained for inclusion in the final version of the ASD-OC.

CONCLUSION

The ASD-OC is able to discriminate between ASD and atypical groups.

Treatments for the challenging behaviours of adults with intellectual disabilities

OBJECTIVE

To provide an overview and critical assessment of common problems and best evidence practice in treatments for the challenging behaviours (CBs) of adults with intellectual disabilities (IDs).

METHOD

Commonly observed problems that present obstacles to successful treatment plans are discussed, followed by an analysis of available research on the efficacy of behavioural and pharmacological therapies.

RESULTS

Behavioural and pharmacological interventions are most commonly used when addressing CBs in people with IDs. However, within each of these techniques, there are methods that have support in the literature for efficacy and those that do not. As clinicians, it is important to follow research so that we are engaging in best practices when developing treatment plans for CBs.

CONCLUSIONS

One of the most consuming issues for psychiatrists and other mental health professionals who work with people who evince developmental disabilities, such as IDs, are CBs. These problems are very dangerous and are a major impediment to independent, less restrictive living. However, there is a major gap between what researchers show is effective and much of what occurs in real-world settings.

Examination of an antecedent communication intervention to reduce tangibly maintained challenging behavior: a controlled analog analysis

We examined the influence of an antecedent communication intervention on challenging behavior for three students with developmental disorders. Students were taught to request tangible items that were identified as reinforcers for challenging behavior in a prior functional analysis. Individual participant multielement and reversal designs were used to compare the effects of the antecedent communication intervention versus a no antecedent communication intervention condition. Immediately following the antecedent manipulations students were exposed to the tangible condition of the functional analysis. Results indicate that the antecedent communication intervention reduced challenging behavior in the subsequent tangible test condition for all three students. The importance of examining antecedent interventions to treat challenging behavior from a function analytic perspective is discussed.

The Questions About Behavioral Function (QABF): current status as a method of functional assessment

Functional assessment has now entered the mainstream for evaluation and to aid in the treatment of challenging behaviors, while experimental functional analysis was at the forefront of this movement, this particular methodology has proven to be impractical, and thus has limited utility in real world settings. As a result of these factors standardized test have become a popular alternative for making a functional assessment. The most extensively studied of these scales to date is the Questions About Behavioral Function (QABF). This paper reviews the available research on this scale, its current status, and future directions.

An examination of specific communication deficits in adults with profound intellectual disabilities

Previous research has shown that adults with intellectual disability (ID) evince communication deficits. These communication problems can be divided into problems with receptive, expressive, and written domains. While much research has been devoted to investigating communication deficits in ID in general, scant research has been conducted on communication skills in specific levels of ID. This study examined 204 adults with profound ID residing in two large supports and services centers in the southeastern region of the United States. Data was collected on these individuals' receptive, expressive, and written communication skills using the Vineland Adaptive Behavior Scales (VABS). Three dependent t-tests were conducted comparing the proportion of items endorsed by informants on each of the three communication subdomains (receptive, expressive, and written) with one another. Participants displayed a significantly larger proportion of receptive subdomain items than expressive subdomain items, t(203) = 20.00, p < 0.01, and written subdomain items, t(203) = 20.53, p < 0.01. Additionally, it was found that the individuals exhibited a significantly larger proportion of expressive subdomain items than written subdomain items, t(203) = 10.80, p < 0.01. The implications of these findings are discussed.