Characteristics of stereotypic movement disorder and self-injurious behavior assessed with the Diagnostic Assessment for the Severely Handicapped (DASH-II)

The Effect of Tai Chi Chuan Training on Stereotypic Behavior of Children with Autism Spectrum Disorder

This quasi-experimental study investigated effects of Tai Chi Chuan training on stereotypic behavior of children with autism spectrum disorder. Twenty-three participants (mean age = 9.60 ± 1.40 years) were assigned to experimental (N = 12) and control (N = 11) groups. The experimental group received 12 weeks of Tai Chi training and all participants had pre, post, and one-month follow-up assessments. Stereotypic behavior measured using Gilliam Autism Rating Scale 2 Scores, was significantly altered by ~ 25% in the Tai Chi Chuan group. Behavioral change was maintained at follow up since there was no significant difference between that and the posttest. In conclusion, Tai Chi Chuan training is a useful and appropriate intervention to modulate behavior in individuals with autism spectrum disorder.

The Relationship of Comorbid Problem Behaviors to Social Skills in Persons With Profound Mental Retardation

Research into behavior problems among individuals with mental retardation has been well developed. However, few studies have addressed the effect of multiple problem behaviors on social skills. In the present study, the authors examined the relationship between two problem behaviors, stereotypy and self-injury, and social skills among individuals with profound mental retardation. A total of 120 participants were divided into four groups based on the presence of stereotypic and self-injurious behavior. Persons with comorbid stereotypy and self-injury evinced more negative nonverbal social skills than did those with self-injury alone or no problem behaviors. In the past, researchers examined behavior problems as isolated phenomena. However, a recent shift in the conceptualization of problem behaviors has exposed the lack of research regarding the nature of social and adaptive skills in the face of multiple topographies of problem behaviors using broader conceptualizations.

Premature birth as a risk factor for autism spectrum disorder

OBJECTIVE

Autism spectrum disorder (ASD) is common, life-long in nature, and can be very debilitating. Thus, an intensive search is on to identify the potential risk factors for the disorder. Premature birth has been identified as one potential factor that could influence potential symptoms of ASD.

METHOD

The sample for this study consisted of 1655 at risk children for developmental delays who were 17-37 months of age. Participants were divided into those diagnosed with ASD (n = 916) and children with atypical development only (n = 739).

RESULTS

Premature births were almost twice as common for the atypical development group versus the ASD group.

CONCLUSIONS

Implications of these data are discussed.

Examining the psychometrics of the Psychopathology Inventory for Mentally Retarded Adults-II for individuals with mild and moderate intellectual disabilities

With growing recognition of the occurrence of psychological disorders in individuals with intellectual disability (ID), researchers and clinicians alike have placed emphasis on developing measures to assess for psychopathologies in this population. Despite an increased interest in the topic, there is still a dearth of psychometrically robust measures available to assess for psychopathology in adults with mild and moderate ID. The purpose of this study was to examine the psychometric properties of a revised measure for psychopathology in individuals with mild and moderate ID, the Psychopathology Inventory for Mentally Retarded Adults - second edition (PIMRA-II). Internal consistency, inter-rater reliability, and test-retest reliability were investigated. Validity was studied via convergent validity by comparing the PIMRA-II to the Assessment of Dual Diagnosis (ADD) and via discriminate validity by comparing the PIMRA-II to the Social Performance Survey Schedule (SPSS) prosocial scores. Lastly, an exploratory factor analysis was conducted to determine the factor structure of the scale.

Socialization and nonverbal communication in atypically developing infants and toddlers

Emphasis on early identification of atypical development has increased as evidence supporting the efficacy of intervention has grown. These increases have also directly affected the availability of funding and providers of early intervention services. A majority of research has focused on interventions specific to an individual's primary diagnoses. For example, interventions for those with cerebral palsy (CP) have traditionally focused on physiological symptoms, while intervention for individuals with Autism Spectrum Disorder (ASD) focus on socialization, communication, and restricted interests and repetitive behaviors. However deficits in areas other than those related to their primary diagnoses (e.g., communication, adaptive behaviors, and social skills) are prevalent in atypically developing populations and are significant predictors of quality of life. Therefore, the purpose of the current study was to examine impairments in socialization and nonverbal communication in individuals with Down's syndrome (DS), CP, and those with CP and comorbid ASD. Individuals with comorbid CP and ASD exhibited significantly greater impairments than any diagnostic group alone. However, individuals with CP also exhibited significantly greater impairments than those with DS. The implications of these results are discussed.

Gender and age differences in the core triad of impairments in autism spectrum disorders: a systematic review and meta-analysis

Autism is an extensively studied disorder in which the gender disparity in prevalence has received much attention. In contrast, only a few studies examine gender differences in symptomatology. This systematic review and meta-analysis of 22 peer reviewed original publications examines gender differences in the core triad of impairments in autism. Gender differences were transformed and concatenated using standardized mean differences, and analyses were stratified in five age categories (toddlerhood, preschool children, childhood, adolescence, young adulthood). Boys showed more repetitive and stereotyped behavior as from the age of six, but not below the age of six. Males and females did not differ in the domain of social behavior and communication. There is an underrepresentation of females with ASD an average to high intelligence. Females could present another autistic phenotype than males. As ASD is now defined according to the male phenotype this could imply that there is an ascertainment bias. More research is needed into the female phenotype of ASD with development of appropriate instruments to detect and ascertain them.

RETRACTED: Co-occurring disorder clusters in adults with mild and moderate intellectual disability in residential treatment settings

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 lack of original methodology. 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. Also, one of the conditions of submission of a paper for publication is that authors declare explicitly that the paper has not been previously published and is not under consideration for publication elsewhere. This article is being retracted because it duplicates significant parts of a paper that had already appeared in Research in Developmental Disabilities 35 (2014) 1802-1808 http://dx.doi.org/10.1016/j.ridd.2014.01.027. Also, 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.

RETRACTED: Prevalence of co-occurring disorders in a sample of adults with mild and moderate intellectual disabilities who reside in a residential treatment setting

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.

Sensory symptoms in autism spectrum disorders

The aim of this review is to summarize the recent literature regarding abnormalities in sensory functioning in individuals with autism spectrum disorder (ASD), including evidence regarding the neurobiological basis of these symptoms, their clinical correlates, and their treatment. Abnormalities in responses to sensory stimuli are highly prevalent in individuals with ASD. The underlying neurobiology of these symptoms is unclear, but several theories have been proposed linking possible etiologies of sensory dysfunction with known abnormalities in brain structure and function that are associated with ASD. In addition to the distress that sensory symptoms can cause patients and caregivers, these phenomena have been correlated with several other problematic symptoms and behaviors associated with ASD, including restrictive and repetitive behavior, self-injurious behavior, anxiety, inattention, and gastrointestinal complaints. It is unclear whether these correlations are causative in nature or whether they are due to shared underlying pathophysiology. The best-known treatments for sensory symptoms in ASD involve a program of occupational therapy that is specifically tailored to the needs of the individual and that may include sensory integration therapy, a sensory diet, and environmental modifications. While some empirical evidence supports these treatments, more research is needed to evaluate their efficacy, and other means of alleviating these symptoms, including possible psychopharmacological interventions, need to be explored. Additional research into the sensory symptoms associated with ASD has the potential to shed more light on the nature and pathophysiology of these disorders and to open new avenues of effective treatments.

Stereotyped behaviours in children with autism spectrum disorders and atypical development as measured by the BPI-01

OBJECTIVE

As repetitive behaviours in children with autism spectrum disorders (ASDs) can significantly interfere with one's daily functioning, continued research on these behaviours is needed.

METHODS

This study examined the occurrence of repetitive motor movements in toddlers (17-37 months) with ASD and atypical development and the relationship between stereotypies and sensory impairment.

RESULTS

Children with ASD (n = 13) exhibited significantly more repetitive behaviours than the non-ASD group (n = 12). Greater percentages of endorsement were evident for the ASD group on nearly all items of the Behaviour Problems Inventory-01 (BPI-01) Stereotypy subscale. More repetitive behaviours tended to co-occur with other stereotypies for the ASD group. A moderate correlation was found between stereotypy severity and sensory deficits.

CONCLUSION

These findings suggest that stereotyped behaviours can be identified at very young ages, negatively affect the behavioural presentation of those with ASDs and should be considered when developing treatment plans.

Pica in persons with developmental disabilities: approaches to treatment

Pica is a very serious problem in which an individual ingests substances without nutrition value, such as paper and paint. As this behavior is often life-threatening resulting in surgery, pica has received attention from researchers for several decades. During that time, a number of interventions have been devised, such as behavioral methods (e.g., aversive stimuli, overcorrection, time-out, reinforcement) and biological interventions (e.g., pharmacotherapy, nutritional supplements). This paper is a broad review of the research on treatment studies for this problem, with a focus on persons with autism and/or intellectual disability (ID), which constitutes almost all of the published treatment papers. In addition, strengths and weaknesses of different pica treatments are discussed. Upon review, applied behavior analysis (ABA) was found to have the most robust empirical support to treat this behavior. Most clinicians are drifting away from aversive techniques and relying on more positive procedures to guide their treatment plans. The implications of current status and future directions for research are also addressed.

An investigation of self-injurious behaviors in adults with severe intellectual disabilities

Self-injurious behavior (SIB) is commonly observed among individuals with intellectual disability (ID) living in state-run supports and services centers. Specific examples of SIB include poking oneself in the eye; harming oneself by hitting, scratching, or pinching; and pica (i.e., swallowing objects causing bodily harm). Previous research has focused on SIB in individuals with ID more generally without focusing on specific levels of ID or taking into account other important personal variables. This study examined 45 adults with severe ID living in two large state-run facilities in the Southeastern United States who were separated into groups for comparison (ASD and non ASD; verbal and nonverbal). Data was collected on the presence of SIB using the Autism Spectrum Disorder-Problem Behavior Adult Version (ASD-PBA). A two-way analysis of variance (ANOVA) was conducted to determine if there were significant differences between groups on rates of SIB. Individuals with ID and ASD exhibited significantly higher rates of SIB than individuals with only ID, F (1,43)=50.84, p<0.05. Furthermore, verbal individuals had significantly higher rates of SIB than nonverbal individuals, F (1,43)=57.612, p<0.05. There was a significant interaction between the effects of ASD diagnosis and verbal ability on rates of SIB, F (1,43)=50.84, p<0.05. The implications of these findings in the context of other research on ID, ASD, SIB, and verbal abilities are discussed.

Current status of the Matson Evaluation of Drug Side Effects (MEDS)

The Matson Evaluation of Drug Side Effects (MEDS) is currently the best established and most researched measure of drug side effects in the intellectual disability (ID) literature. Initial research was conducted on its psychometric properties such as reliability and validity. More recent research studies have used the measure to determine the interactive effects of severity of drug side effects on adaptive and social behaviors as well as symptoms of commonly medicated psychiatric conditions among persons with ID. Most recently the MEDS has been used to study potential risk factors of psychotropic drugs. The present study was written to review the current status of MEDS research in the broader context of psychotropic drug side effect research in general.

Psychometrics and utility of Psycho-Educational Profile-Revised as a developmental quotient measure among children with the dual disability of intellectual disability and autism

There is no agreement about the measure to quantify the intellectual/developmental level in children with the dual disability of intellectual disability and autism. Therefore, we studied the psychometric properties and utility of Psycho-Educational Profile-Revised (PEP-R) as a developmental test in this population. We identified 116 children with dual disability from the day care and inpatient database of a specialised Autism Clinic. Scale and domain level scores of PEP-R were collected and analyzed. We examined the internal consistency, domain-total correlation of PEP-R and concurrent validity of PEP-R against Gesell's Developmental Schedule, inter-rater and test-retest reliability and utility of PEP-R among children with dual disability in different ages, functional level and severity of autism. Besides the adequate face and content validity, PEP-R demonstrates a good internal consistency (Cronbach's α ranging from 0.91 to 0.93) and domain-total correlation (ranging from 0.75 to 0.90). The inter-rater reliability (intraclass correlation coefficient, ICC = 0.96) and test-retest reliability (ICC = 0.87) for PEP-R is good. There is moderate-to-high concurrent validity with GDS (r ranging from 0.61 to 0.82; all Ps = 0.001). The utility of PEP-R as a developmental measure was good with infants, toddlers, pre-school and primary school children. The ability of PEP-R to measure the developmental age was good, irrespective of the severity of autism but was better with high-functioning children. The PEP-R as an intellectual/developmental test has strong psychometric properties in children with dual disability. It could be used in children with different age groups and severity of autism. PEP-R should be used with caution as a developmental test in children with dual disability who are low functioning.

Kata techniques training consistently decreases stereotypy in children with autism spectrum disorder

The effects of 14 weeks of Kata techniques training on stereotypic behaviors of children with autism spectrum disorders (ASD) were investigated. The study included 30 eligible (diagnosed ASD, school age) children with ages ranging from 5 to 16 years whom they assigned to an exercise (n=15) or a no-exercise control group (n=15). Participants of the exercise group received Kata techniques instruction four times per week for 14 weeks (56 sessions). Stereotypy was assessed at baseline (pre-intervention), week 14 (post-intervention), and at one month follow up in both groups. Results showed that Kata techniques training significantly reduced stereotypy in the exercise group. Following participation in Kata techniques training, stereotypy decreased from baseline levels by a M of 42.54% across participants. Interestingly, after 30 days of no practice, stereotypy in the exercise group remained significantly decreased compared to pre-intervention time. The participants of the control group did not show significant changes in the stereotypy. Teaching martial arts techniques to children with ASD for a long period of time consistently decreased their stereotypic behaviors.

Psychopathology and intellectual disability

PURPOSE OF REVIEW

To provide an update on recent trends and developments in the study of psychopathology in persons with intellectual disability. This topic is of considerable importance to mental health professionals as rates of psychopathology are much higher for persons with intellectual disabilities relative to the general population.

RECENT FINDINGS

The number of studies on this topic is growing. The development of several areas is of particular significance. These topics include the impact of the burgeoning study of autism; the development of more specialized measures of psychopathology specific to particular forms of psychopathology, levels of intellectual disability and age; the development of psychologically based treatments, specifically the rise of functional assessment; the recognition that pharmacotherapy treatments are best aimed at core symptoms of classic forms of psychopathology such as psychosis, bipolar disorder, anxiety, and depression versus behavioral equivalents of psychopathology such as aggression, self-injurious behavior, property destruction, and pica; and establishing co-occurring patterns of personal features as they relate to psychopathology and intellectual disability.

SUMMARY

A better understanding of psychopathology and how to assess and treat it in persons with intellectual disability is occurring. However, much is yet to be learned in this relatively new field of study.

Gender differences in symptoms of comorbidity in toddlers with ASD using the BISCUIT-Part 2

OBJECTIVE

Examine if gender differences exist with respect to comorbid symptoms in young children with Autistic Disorder (AD), Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) and atypical controls.

DESIGN

A factorial MANOVA was conducted for the main analysis and follow-up post-hocs were conducted where significant differences were found.

METHODS

The Baby and Infant Screen for Children with aUtIsm Traits, Part 2 was administered to caregivers of 438 young children.

RESULTS

The MANOVA was significant, F(10, 858) = 19.38, p < 0.001, Pillai's Trace = 0.37. No gender differences were found; however, diagnostic groups differed significantly on symptoms with AD exhibiting more symptoms than PDD-NOS, followed by atypical controls. No interaction between gender and diagnosis was found.

CONCLUSIONS

Those with AD exhibited greater comorbid symptoms which is consistent with previous research. Current finding also support previous literature which state that gender differences are evident only during certain periods in the lifespan.

Behaviors and corresponding functions addressed via functional assessment

One-hundred seventy-three studies that employed functional assessment were evaluated with respect to types of challenging behaviors studied and the functions identified that maintained those behaviors. For most studies, two to three behaviors were targeted. Of the 38 different challenging behaviors identified, self-injurious behavior (SIB) and aggression were by far the most studied. Other commonly studied behaviors were tantrums, stereotypies, property destruction, bizarre/inappropriate speech/vocalizations, and disruptive behaviors. The most commonly identified functions for both SIB and aggressions were attention and escape/demands. The implications of these and other data complied on target behaviors and maintaining variables are discussed.

Person characteristics of individuals in functional assessment research

This paper is a review of person characteristics that were present in 173 studies that were reviewed on functional assessment. The purpose was to give the reader an idea about the types of individuals for which functional assessment is appropriate and to outline persons and their characteristics which have the best research support. The majority of participants were diagnosed with intellectual disability and/or autism. Additionally more males that females were included and children were frequently studied versus adolescents and older adults. Finally, while the majority of studies employed experimental functional analysis, the number of participants per study was small. Conversely, functional analysis scales were used in far fewer studies, but with much larger sample sizes. Thus, relatively equal numbers of individuals have been studied with both methods.

The expression and assessment of emotions and internal states in individuals with severe or profound intellectual disabilities

The expression of emotions and internal states by individuals with severe or profound intellectual disabilities is a comparatively under-researched area. Comprehensive or standardized methods of assessing or understanding the emotions and internal states within this population, whose ability to communicate is significantly compromised, do not exist. The literature base will be discussed and compared to that applicable to the general population. Methods of assessing broader internal states, notably depression, anxiety, and pain within severe or profound intellectual disabilities are also addressed. Finally, this review will examine methods of assessing internal states within genetic syndromes, including hunger, social anxiety, and happiness within Prader-Willi, Fragile-X and Angelman syndrome. This will allow for identification of robust methodologies used in assessing the expression of these internal states, some of which may be useful when considering how to assess emotions within individuals with intellectual disabilities.

Reviewing risk for individuals with developmental disabilities

There are many categories of risky behaviors that are of interest to individuals, agencies, and institutions interested in care for developmentally disabled persons. These include challenging behaviors such as aggression and self-injury, psychiatric diagnoses, medical problems, criminal behaviors, and victimization. The literature in this area is difficult to digest due to a number of methodological problems. This paper reviews the research on one of these behaviors, self-injury, and provides a framework that can be applied to other research on predicting risk. Additionally, it attempts to organize the findings in such a way as to maximize the utility to providers and suggest useful directions for future research.

Relationships between stereotyped movements and sensory processing disorders in children with and without developmental or sensory disorders

OBJECTIVE

Stereotyped movements (SM) are a defining characteristic of autism but are also present in children with a range of sensory and developmental disorders. We examined whether the severity of sensory processing disorders (SPD) was associated with the severity of SM and whether SPD accounted for between-group differences in SM.

METHOD

The Short Sensory Profile and the Stereotyped and Self-Injurious Movements Interview were administered to children with autism, intellectual disability, visual impairment, and hearing impairment and to typically developing children.

RESULTS

SPD predicted the severity of SM in all samples and accounted for differences in SM between the groups. Other differences in the severity of SM were the result of diagnosis and the interaction between diagnosis and an intellectual disability.

CONCLUSION

SPD may be a source of SM, but functional connections between these phenomena will need to be tested in future research. Implications for occupational performance are addressed.

Trichotillomania (hair pulling disorder), skin picking disorder, and stereotypic movement disorder: toward DSM-V

In DSM-IV-TR, trichotillomania (TTM) is classified as an impulse control disorder (not classified elsewhere), skin picking lacks its own diagnostic category (but might be diagnosed as an impulse control disorder not otherwise specified), and stereotypic movement disorder is classified as a disorder usually first diagnosed in infancy, childhood, or adolescence. ICD-10 classifies TTM as a habit and impulse disorder, and includes stereotyped movement disorders in a section on other behavioral and emotional disorders with onset usually occurring in childhood and adolescence. This article provides a focused review of nosological issues relevant to DSM-V, given recent empirical findings. This review presents a number of options and preliminary recommendations to be considered for DSM-V: (1) Although TTM fits optimally into a category of body-focused repetitive behavioral disorders, in a nosology comprised of relatively few major categories it fits best within a category of motoric obsessive-compulsive spectrum disorders, (2) available evidence does not support continuing to include (current) diagnostic criteria B and C for TTM in DSM-V, (3) the text for TTM should be updated to describe subtypes and forms of hair pulling, (4) there are persuasive reasons for referring to TTM as "hair pulling disorder (trichotillomania)," (5) diagnostic criteria for skin picking disorder should be included in DSM-V or in DSM-Vs Appendix of Criteria Sets Provided for Further Study, and (6) the diagnostic criteria for stereotypic movement disorder should be clarified and simplified, bringing them in line with those for hair pulling and skin picking disorder.

Intellectual disability and its relationship to autism spectrum disorders

Intellectual disability (ID) and autism spectrum disorders (ASDs) covary at very high rates. Similarly, greater severity of one of these two disorders appears to have effects on the other disorder on a host of factors. A good deal of research has appeared on the topic with respect to nosology, prevalence, adaptive functioning, challenging behaviors, and comorbid psychopathology. The purpose of this paper was to provide a critical review and status report on the research published on these topics. Current status and future directions for better understanding these two covarying disorders was reviewed along with a discussion of relevant strengths and weaknesses of the current body of research.

Parent training: a review of methods for children with developmental disabilities

Great strides have been made in the development of skills and procedures to aid children with developmental disabilities to establish maximum independence and quality of life. Paramount among the treatment methods that have empirical support are treatments based on applied behavior analysis. These methods are often very labor intensive. Thus, parent involvement in treatment implementation is advisable. A substantial literature on parent training for children has therefore emerged. This article reviews recent advances and current trends with respect to this topic.

Encopresis, soiling and constipation in children and adults with developmental disability

Children and adults with developmental disabilities are more likely to evince encopresis, soiling and constipation than the general population. This set of related behaviors can produce a great deal of stress and can be a major restriction in independent living. This paper provides a review of the current state of knowledge on the prevalence, etiology, assessment and treatment of this co-occurring set of disorders. These problems are more common in persons with developmental disabilities then the general population. Furthermore, classical and operant treatment methods appear to be the best supported interventions for most cases. Strengths and weaknesses of the current research base are discussed along with potential avenues for future research.

Stereotypies and repetitive/restrictive behaviours in infants with autism and pervasive developmental disorder

PURPOSE

Autism Spectrum Disorders (ASD) are characterized by severe and debilitating symptoms including stereotyped and repetitive behaviours. Stereotypies and repetitive behaviours constitute core features of ASD and markedly impede attempts to remediate the disorder. Little previous research has examined characteristics of the core features of ASD in infants.

METHOD

In the present study, 760 infants with autism, PDD-NOS or no diagnosis of ASD but at risk for other developmental delays or physical disabilities were evaluated with respect to the nature and extent of their stereotyped and ritualistic behaviour using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT). A Kruskal-Wallis test with follow-up Mann-Whitney tests were employed to test for significant differences.

RESULTS

Infants with autism evinced the highest amount of stereotypic behaviour, followed by those with PDD-NOS and atypical development. A sub-set of BISCUIT items could accurately predict diagnostic group membership.

CONCLUSIONS

These data suggest that many core features of ASD are distinct and can be reliably identified early in life. The potential early identification of these behavioural challenges could lead to earlier intervention practices and symptom alleviation for children in this population.

The nature and treatment of compulsions, obsessions, and rituals in people with developmental disabilities

Developmental disabilities such as intellectual disability and autism are often accompanied by special sets of behaviors which are major challenges for the person and those in their community. Among the most worrisome of these are compulsions, rituals and obsessions. Often these behaviors are left untreated; however, when intervention does occur it is often with pharmacotherapy. There are psychological treatments for these issues as well but a concerted focus to develop these procedures, unlike efforts in differential diagnosis, has not occurred. Additionally, no reviews of how best to treat these problematic behaviors have been published to date. The present paper reviews what is available with respect to these treatment approaches with an eye to what appears to be effective, what has been treated and what is yet to be explored from a research point of view.

The relationship between stereotyped movements and self-injurious behavior in children with developmental or sensory disabilities

We assessed whether the stereotyped movements (SM) that are a defining characteristic of autism are discriminable from those observed in other disorders, and whether stereotyped self-injurious movements, which are excluded as exemplars of SM in DSM-IV, differ from other SM in severity or in kind. We used the Stereotyped and Self-Injurious Movement Interview to assess self-injurious and other SM in children with autism (n=56), intellectual disability (n=29), vision impairment (n=50), or hearing impairment (n=51) and in typical children (n=30). Cross-tabulation of scores indicated that self-injurious behavior is rarely performed in the absence of other SM. Reliability analyses indicated that patterns of covariation among SM items differ across groups so that different item sets are necessary to reliably measure SM in each group. Analyses of variance indicated the autism group exceeded one or more other groups in the frequency of 15 SM, the vision impaired group exceeded others on 5 SM, and the hearing impaired group exceeded others on 1 SM. Discriminant function analysis of SM items indicated that although only 66% of participants were accurately classified, it was rare for a child with a different disorder to be misclassified as having autism or visual impairment. We concluded that self-injurious behavior is a more severe form of SM, and there is a distinctive pattern of SM, including self-injurious behavior, that characterizes children with autism.

Behaviour problems in institutionalised people with intellectual disability and schizophrenia spectrum disorders

BACKGROUND

Although our understanding of dual diagnosis has improved, a deficit still exists in our knowledge of how schizophrenia spectrum disorders (SSD) manifest themselves in individuals with intellectual disability (ID). In addition, little is known about the relationship between behaviour problems and psychopathology in this population.

METHOD

Utilising the Behavior Problems Inventory (BPI), three areas of problem behaviour (self-injurious, stereotyped, and aggressive/destructive) were assessed in 58 individuals with ID divided into three groups (with SSD, with a diagnosis of psychopathology other than SSD, and with ID only) and a total BPI score was calculated for each.

RESULTS

The SSD group was unique when compared to the Control group (ID only) for frequency of stereotyped behaviours. Further, severity of stereotyped behaviours in the SSD group was unique compared to the Psychopathology and Control groups.

CONCLUSION

The SSD group was unique compared to the other two groups, particularly for severity of stereotyped behaviours. Many specific behavioural differences were also related to either SSD or general psychopathology.

A rhesus monkey model of self-injury: effects of relocation stress on behavior and neuroendocrine function

BACKGROUND

Self-injurious behavior (SIB), a disorder that afflicts many individuals within both clinical and nonclinical populations, has been linked to states of heightened stress and arousal. However, there are no published longitudinal data on the relationship between increases in stress and changes in the incidence of SIB. This study investigated the short- and long-term behavioral and neuroendocrine responses of SIB and control monkeys to the stress of relocation.

METHODS

Twenty adult male rhesus macaques were exposed to the stress of relocation to a new housing arrangement in a newly constructed facility. Daytime behavior, sleep, and multiple measures of hypothalamic-pituitary-adrenocortical (HPA) axis function were investigated before and after the move.

RESULTS

Relocation induced a complex pattern of short- and long-term effects in the animals. The SIB animals showed a long-lasting increase in self-biting behavior, as well as evidence of sleep disturbance. Both groups exhibited elevated cortisol levels in saliva, serum, and hair, and also an unexpected delayed increase in circulating concentrations of corticosteroid binding globulin (CBG).

CONCLUSIONS

Our results indicate that relocation is a significant stressor for rhesus macaques and that this stressor triggers an increase in self-biting behavior as well as sleep disturbance in monkeys previously identified as suffering from SIB. These findings suggest that life stresses may similarly exacerbate SIB in humans with this disorder. The HPA axis results underscore the potential role of CBG in regulating long-term neuroendocrine responses to major stressors.

The Importance of Catatonia and Stereotypies in Autistic Spectrum Disorders

Motor disturbances are often observed in individuals with autistic spectrum disorders (ASDs) and recognized as diagnostic features of these disorders. The movement disorders characteristically associated with autism include stereotypies and self-injurious behavior. Yet, individuals with ASD may also be at the risk for catatonia. Although not as frequent as stereotypies, up to 17% of older adolescents and adults with autistic disorder may have severe catatonic-like symptoms. Catatonia may be a comorbid risk factor of autism that warrants further empirical and clinical evaluations. Clinicians may need to be attentive to more subtle signs of catatonic-like symptoms in individuals diagnosed with ASDs, especially as they enter adolescence and young adulthood. Stress has been implicated as a possible precursor for symptoms; however, its role has not been empirically proven as a potential risk factor. Clinicians might also need to assess for signs of significant declines in motor movements, as this appears to be a useful diagnostic indicator of catatonic-like symptoms. The literature on stereotypies and autism is more extensive than for catatonia and ASDs, probably because of the higher rate of stereotypies with autism. Explanations for the occurrence of stereotypies range from genetic to behavioral contingencies, with evidence for a multifactor explanation. Assessment measures often include items that assess for stereotypies to aid with diagnosing these symptoms in individuals with autism. Treatment for stereotypies is largely behavioral at the present time and requires consistent reinforcement of treatment gains to manage the symptoms successfully. An important area of future research in autism is the relation among different types of motor abnormalities, including stereotypies and catatonia.

Using the Diagnostic Assessment of the Severely Handicapped-II (DASH-II) to measure the therapeutic effects of risperidone

BACKGROUND

Within the scope of a double-blind, placebo-controlled, crossover medication study, the Diagnostic Assessment of the Severely Handicapped-II (DASH-II) was evaluated as a measurement for determining the effectiveness of the medication risperidone in treating the problem behaviour of 21 people with intellectual disabilities (ID).

METHOD

Participants' caregivers completed the DASH-II during the placebo/baseline phase of the study and the maintenance phase of the study, and completed the Aberrant Behavior Checklist - Community (ABC-C) weekly throughout the entire study. The results obtained using the DASH-II were compared to those obtained using the ABC-C, an instrument shown to be well correlated with the DASH-II.

RESULTS

Results suggest that while the DASH-II and the ABC-C were well correlated during the placebo/baseline phase of the current study, they were not well correlated at completion of the 6-month maintenance phase of the medication trial.

CONCLUSION

The DASH-II, while appropriate for assisting in the diagnosis of psychopathology in people with ID, does not appear to monitor changes in problem behaviour as a result of risperidone use as well as the ABC-C. Differences in the frequency of problem behaviour that each measure evaluated and the applicability of using the DASH-II to measure medication effects on problem behaviour are discussed.