Association between impairment, function, and daily life task management in children and adolescents with autism

Application of the international classification of functioning, disability, and health in autism and attention-deficit hyperactivity disorder: A scoping review

LAY ABSTRACT

The International Classification of Functioning, Disability, and Health (ICF) is a framework designed by the World Health Organization (WHO) to help different sectors, such as healthcare, social services, education, and policy, understand how people with health-related issues function (do the things they want to and need to do) in their daily lives. This framework has also been used to guide clinical practice and research in autism and attention-deficit hyperactivity disorder (ADHD). To make it more practical, shorter versions of the ICF called Core Sets have been developed. We wanted to explore how the ICF and the ICF Core Sets have been used in research relating to autism and ADHD. We looked at the research that had been previously published on this topic by conducting a systematic search and review. Seventy-eight studies meeting our criteria were included in our review. Results show that the ICF has been applied in many ways across various contexts. However, most of the research has focused on autism, mainly involving children. The review highlights that although the ICF was used in some studies, the underlying philosophies of the framework were not always followed. The medical perspective still influenced the way research was done and interpreted. Nevertheless, using the ICF in the right way can help shift research on neurodevelopmental conditions like autism and ADHD toward a more holistic approach, moving away from solely focusing on medical aspects.

Exploring the use of rehabilitation in individuals with head and neck cancer undergoing treatment: a scoping review

Explore the use, characteristics, feasibility, and functional outcomes of rehabilitation interventions used for individuals with head and neck cancer (HNC) during treatment.

Searches were conducted in four databases from Jan 2011 to Dec 31, 2022. Included studies had to include adults with HNC undergoing treatment, a rehabilitation intervention, an assessment of functional outcome(s) addressed by the International Classification of Functioning Framework (ICF) and be published in English language. Title and abstract screening, full-text review, and data extraction were completed independently, in duplicate. Descriptive statistics and a qualitative synthesis summarized findings.

Twenty-seven studies were included in this review. The majority of studies were randomized controlled trials (70%). Most individuals represented in the included studies were males (92% of all participants) between 50 and 60 years of age. Interventions led by a speech language pathologist (33%) were most commonly described. Sixteen studies (59%) described primary outcomes that fit the ICF "impairment" domain.

We identified few studies that explored the use, feasibility, and effectiveness of rehabilitation interventions for individuals with HNC during treatment. Future research should assess the effectiveness of rehabilitation interventions on functional outcomes beyond the ICF body function and structure domain.

Adolescents' Perspectives on Learning to Manage the Responsibilities of Adulthood

IMPORTANCE

Throughout childhood, youth learn the skills they need to carry out their daily life tasks. Despite the importance of being able to manage these tasks to succeed in adulthood, limited research has examined the process through which youth learn to do so.

OBJECTIVE

To investigate adolescents' perspectives of parental approaches that help them learn to manage daily responsibilities.

DESIGN

Qualitative pilot study.

SETTING

Community.

PARTICIPANTS

Eight adolescents with and without disabilities.

RESULTS

Semistructured interviews with adolescents were analyzed using recursive, conventional content analysis. Interviews asked about how adolescents viewed the process of developing the skills needed to manage daily responsibilities independently. Parent approaches identified by the adolescents fit into three overarching themes: Parents teach them how to carry out and manage responsibilities, monitor them as they become more responsible for tasks, and provide varied levels of independence. The approaches described by the adolescents explain an implicit and transactional process of shifting responsibility for daily life tasks from parents to youth.

CONCLUSIONS AND RELEVANCE

Further investigation of the transfer of responsibility for daily life tasks is necessary to build our understanding of this complex process and support successful transition to adulthood. What This Article Adds: Adolescents described several approaches parents used to help them to learn to manage tasks, which may provide direction for occupational therapy clinicians working with youth who are transitioning to adulthood.

Self-management of daily life tasks in diploma-track youth with disabilities

PURPOSE

Youth with disabilities who graduate with a regular high school diploma often continue to have difficulties in their daily functioning that ultimately impact adulthood outcomes. To better understand these functional difficulties and determine how best to address them, it is important to distinguish deficits in discrete skills from difficulty organizing skills to self-manage complex tasks associated with adult roles. The purpose of this study was to explore the extent to which challenges in social, executive function and behavior management factors relate to these two aspects of daily functioning.

METHODS

This is a secondary analysis of the National Longitudinal Transition Study 2 funded by the United States Department of Education. The direct and indirect associations between youth underlying factors and self-management of daily life tasks (SMDLT) versus discrete functional skills were modelled using structural equation modelling.

RESULTS

A model incorporating social skills, communication, and behavior regulation explained 55% of the variance in SMDLT. In contrast, the model predicting discrete functional skills had fewer significant associations and described less variance (37%) in the outcome.

CONCLUSIONS

Findings suggest that using measures of SMDLT and designing targeted interventions for SMDLT might help improve participation in independent living and productivity for diploma-track youth with disabilities.Implications for rehabilitationSuccessful transition from high school to adult roles requires the ability to self-manage the daily life tasks required for those roles, such as employment, post-secondary education, and independent living.The ability to self-manage daily tasks is distinct from mastery of discrete functional skills and should be assessed with measures that uniquely examine this domain.Social and communication skills, executive functioning, and behavioral regulation, are important contributors to the ability to self-manage life tasks for diploma-track youth with disabilities and should be incorporated into multifaceted interventions.Interventions to improve self-management of tasks should include teaching strategies and practice coordinating underlying skills in flexible ways that meet the varying demands of tasks and diverse environments.

Cross-sectional, quantitative analysis of motor function in females with HNRNPH2-related disorder

AIMS

To describe the gross motor function of individuals with HNRNPH2-related disorder (OMIM 300986, Mental Retardation, X-linked, Syndrome, Bain Type; MRXSB) and determine the associations between clinician-measured motor function and caregiver-reported mobility scores.

METHODS

Developmental histories of 17 female participants with HNRNPH2-related disorder (mean age 11.2 years, range 2.7-37.1 years) with various genotypes within and adjacent to the nuclear localization sequence (NLS) were analyzed. Participants performed the Gross Motor Function Measure-88 (GMFM-88) and caregivers completed developmental histories and the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT).

RESULTS

All participants had measurable and quantifiable motor impairments. A strong positive correlation between the clinician-measured GMFM-88 total score and the caregiver-reported PEDI-CAT mobility domain score was established. Motor deficits were noted more often in individuals who were nonverbal. The 2 participants with genotypes adjacent to the NLS appear to have milder motor phenotypes.

CONCLUSIONS

The GMFM-88 and PEDI-CAT are useful and feasible measures of mobility in individuals with HNRNPH2-related disorders. Convergent validity was established between the clinician-measured GMFM-88 raw scores and caregiver-reported PEDI-CAT mobility domain scores. Factors including verbal status and genotype may impact motor abilities.

Metacognition Mediates the Effect of Social Communication and Internalizing Behaviors on Self-management of Daily Life Tasks for Diploma-Track Autistic Youth

Social communication and executive functioning challenges as well as co-occurring anxiety/depression may make acquiring the skills needed to manage daily life tasks difficult for diploma-track autistic youth, thus limiting their participation in adult roles. This study describes the associations between executive function, social communication skills, and internalizing behaviors on task management in academically capable autistic adolescents (n = 46) using multiple regression with mediator analysis. The three predictors and youth age explained a moderate amount of variance in task management. Metacognition mediated the effect of social communication skills and internalizing behaviors on task management. Relations between underlying factors that influence self-management of daily life tasks are complex, supporting the need for multifaceted assessment and intervention approaches for academically capable autistic youth.

Exploring the relationships between motor proficiency, independence and quality of life in adolescents with autism spectrum disorder

The aim of this study was to explore the relationships between autism severity, motor performance, independence in daily living skills and quality of life in adolescents with autism spectrum disorder (ASD). The study included 31 participants, aged 13-18 years. Evaluations were made with the Gilliam Autistic Disorders Rating Scale-2 (GARS-2), Bruininks-Oseretsky Test of Motor Proficiency-2 Short Form (BOT-2-SF), Functional Independence Measure (WeeFIM II), and Pediatric Quality of Life Inventory (PedsQL). Motor performance of the participants was determined as below average according to the norms of BOT-2 SF, and were negatively correlated with GARS-2 at a moderate level (r = -0.61, p < 0.001), and a moderate negative correlation was determined between GARS-2 and WeeFIM II (r = -0.65, p < 0.001) and PedsQL (r = -0.61, p < 0.001). Independence in daily living skills (DLS) and autism severity were found to be significant predictors of PedsQL (R2 = 0.463, p < 0.05). Motor impairment still appears to be a missing piece of the puzzle for this age group. Promoting motor skill acquisition and independence could be a key factor in preventing the deterioration of physical health and improving quality of life in adolescents with ASD.

Preparation for Adulthood: Shifting Responsibility for Management of Daily Tasks From Parents to Their Children

Importance: Limited research has described the timing of acquisition of the broad range of skills required for the transition to adulthood.

Objective: To describe the timing of the shift of responsibility for daily tasks from parent to child.

Design: This study used an existing data set of parent responses to 49 items in the Responsibility domain of the Pediatric Evaluation of Disability Inventory Computer Adaptive Tests.

Participants: A U.S. nationally representative sample of 2,205 typically developing children and youth ages 0 to 20 yr.

Outcomes and Measures: Descriptive analyses focused on two ages: (1) starting age (when >50% of parents reported their child was taking at least some responsibility for a task) and (2) full responsibility age (when >50% of parents reported their child was taking full responsibility for the task).

Results: The process of shifting responsibility for daily life tasks from parent to child typically occurred over a long period. Many task items had an interval of 5 yr from starting age to full responsibility age; the longest interval was 15 yr. Youth began assuming responsibility for more complex tasks and tasks that involved more risk at ages 10 to 15.

Conclusions and Relevance: Results can serve as a reference for the timing of the transition to greater self-management of daily life tasks across childhood and adolescence. Timing of responsibility shifts may reflect a combination of development of underlying capacities and social transitions. Executive functioning may be especially relevant for management of the more complex tasks required in daily life in adulthood.

What This Article Adds: The transfer of responsibility for managing tasks of daily life from parents to children often extends over a period of many years. Clinicians may find the results helpful when discussing the future with parents of young people with disabilities and other chronic conditions and the tasks that their children must learn to manage for independent living as an adult.

Variables Associated With Shift of Responsibility for Daily Tasks From Parents to Children With and Without Disabilities

IMPORTANCE

No study has directly investigated which variables are associated with the shift of responsibility for managing daily tasks from parent to child in the transition to adulthood.

OBJECTIVE

To examine characteristics associated with responsibility for managing daily life tasks in youth with and without disabilities.

DESIGN

A secondary data analysis of parent-report data on typically developing (TD) youth and youth with disabilities.

SETTING

An online panel that has regularly participated in online surveys.

PARTICIPANTS

A nationally representative sample of 2,205 TD U.S. children and youth, ages 0 to 20 yr, 11 mo (about 100 children per age year) and a sample of 617 children and youth with disabilities, ages 0 to 20 yr, 11 mo.

OUTCOMES AND MEASURES

The dependent variable was the Responsibility domain scaled score (from the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test), which reflects the extent to which responsibility for daily tasks has shifted from parent to youth.

RESULTS

Youth with higher levels of responsibility were older in age, reported to be more focused, and youngest in birth order (TD, R 2 = .79; disability, R 2 = .35). Youth with developmental delay, intellectual disability, autism spectrum disorder, or orthopedic or movement impairments had assumed less responsibility.

CONCLUSIONS AND RELEVANCE

Other personal characteristics in addition to disability may have important influences on parents' decision making as they prepare their children to manage daily life tasks.

WHAT THIS ARTICLE ADDS

Clinicians who work with adolescents in the process of transition to adulthood need to consider the potential influence of the personal characteristics, such as birth order and child temperament, on preparation for adulthood.

Adaptive Skills in FXS: A Review of the Literature and Evaluation of the PEDI-Computer Adaptive Test (PEDI-CAT) to Measure Adaptive Skills

As adaptive skills (AS) are dynamic and may indicate the success of an intervention, they are a common domain measured in clinical trials. Typical interview tools for measuring AS are time-consuming, and questionnaire measures often lead to inconsistent information. The present study was designed to evaluate the feasibility, validity and test-retest performance of the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) in Fragile X syndrome (FXS). The PEDI-CAT is administered via tablet and uses the item response theory to efficiently determine the items administered. The PEDI-CAT was administered to 42 individuals with FXS (27 males; 15 females) aged 1.6-50.9 years (M = 14.9; SD = 11.2), followed by the Vineland-3 (VABS-3) interview for comparison. Administration was efficient (M = 21.7 min; SD = 9.5; range 8-45 min; mode = 19). Males and females did not significantly differ on the PEDI-CAT domains, except for daily activities (t(40) = -2.22, p = 0.037). Floor effects were significant for both measures, although the PEDI-CAT showed more floor effects in the mobility (35.7%) and social-cognitive (50%) domains. PEDI-CAT daily activities, mobility, social-cognitive and responsibility domains were all significantly correlated with most of the VABS-3 domains (all rho > 0.5; p < 0.01). Test-rest of the PEDI-CAT was comparable to the VABS-3. Results suggest that the PEDI-CAT is efficient, and minimal training is needed to administer it; however, it lacks specificity and shares a high rate of floor effects with the VABS-3.

Identifying Gaps in Research on Rehabilitation for Patients With Head and Neck Cancer: A Scoping Review

OBJECTIVES

Examine the amount and nature of research activity in head and neck cancer (HNC) rehabilitation; highlight publication trends, including information about the authors, settings, and study designs; and identify gaps in the existing literature.

DATA SOURCES

Eligible studies were identified using PubMed, Embase, and CINAHL databases.

STUDY SELECTION

Inclusion criteria included human subjects, English language, publication between 1/1/1990 and 4/30/2017, HNC patients at any timepoint in disease, and evaluation of rehabilitation outcomes as described by the International Classification of Functioning, Disability and Health (ICF) framework. Exclusion criteria included intervention or outcome not specific to rehabilitation or the HNC population, and protocols or abstracts without corresponding full manuscripts.

DATA EXTRACTION

An established 6-step scoping review framework was utilized to develop the review protocol. A 3-level review was then performed. Data on eligible studies were collected using a Research Electronic Data Capture (REDCap) tool.

DATA SYNTHESIS

Among 2201 publications, 258 met inclusion criteria. Publication rate increased by 390% over the study timeframe. Most studies were observational (n=150). Few were interventional (n=35). The most common interventions focused on chewing or swallowing (n=14), followed by exercise (n=10). Most primary outcome measures fit the ICF definition of impairment; fewer fit the definitions of activity limitation or participation restriction.

CONCLUSIONS

Although research volume in HNC rehabilitation is increasing, the literature is dominated by small (≤100 patients), outpatient-based observational studies involving chewing or swallowing-related impairments. More prospective studies in multidisciplinary domains across the cancer care continuum are needed. There is particular need for interventional studies and prospective observational studies. Future studies should evaluate clinically-relevant activity limitations and participation restrictions. Rehabilitation professionals have an important role in the design of future HNC rehabilitation research.

Association analysis of genetic variant of rs13331 in PSD95 gene with autism spectrum disorders: A case-control study in a Chinese population

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by high heritability. Recently, autism, the most profound form of ASD, has been increasingly attributed to synaptic abnormalities. Postsynaptic density 95 (PSD95), encoding PSD protein-95, was found essential for synaptic formation, maturation and plasticity at a PSD of excitatory synapse. It is possibly a crucial candidate gene for the pathogenesis of ASD. To identify the relationship between the rs13331 of PSD95 gene and ASD, we performed a case-control study in 212 patients and 636 controls in a Chinese population by using a polymerase chain reaction-restriction fragment length polymerase (PCR-RFLP) assay. The results showed that in genetic analysis of the heterozygous model, an association between the T allele of the rs13331 and ASD was found in the dominant model (OR=1.709, 95% CI 1.227-2.382, P=0.002) and the additive model (OR=1.409, 95% CI=1.104-1.800, P=0.006). Our data indicate that the genetic mutation C>T at the rs13331 in the PSD95 gene is strikingly associated with an increased risk of ASD.