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Young BN, Mohanty E, Levine K, Klein-Tasman BP. Addressing fears of children with Williams syndrome: therapist and child behavior in the context of a novel play-and humor-infused exposure therapy approach. Front Psychol 2023; 14:1098449. [PMID: 37599735 PMCID: PMC10434791 DOI: 10.3389/fpsyg.2023.1098449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 06/13/2023] [Indexed: 08/22/2023] Open
Abstract
Many children with Williams syndrome struggle with fears and phobias that significantly impact their daily lives. Yet, there is sparse literature about the impact of behavioral interventions to treat anxiety and phobias among children with Williams syndrome. Using observational coding of intervention videos, the current study examines patterns of the therapist's use of play and humor and relations to child behavioral responses for four children with Williams syndrome who were identified as treatment responders to humor- and play-infused exposure therapy for fears and anxieties. Sessions were coded for therapist behaviors (exposure with or without play/humor, stimulus type used during exposure, passive or invited attention to feared stimulus, and spontaneous parent participation in exposure) as well as positive, negative, and neutral child behaviors (verbalizations and behaviors). Temporal patterns between therapist and child behaviors were analyzed using lag sequential analyses. The results showed that tolerance of feared stimuli improved for two of the four children following this play- and humor-infused exposure therapy approach, and the remaining two participants demonstrated progress beyond tolerating the feared stimulus and showed increased positive behaviors with the feared stimulus across sessions. Findings also showed patterns of therapist attunement to the child's anxiety level demonstrated through efforts to flexibly adjust the degrees of exposure. Therapist-initiated invited attention behaviors, indicative of the therapist's use of narration and priming, were associated with child tolerance and positive behaviors during exposure to the feared stimulus. Limitations of this study include a very small sample size, short duration of intervention, and a single-subject research design, which limit the generalizability of findings. Implications and future directions of this research are discussed.
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Affiliation(s)
- Brianna N. Young
- Child Neurodevelopment Research Lab, Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Ellora Mohanty
- Child Neurodevelopment Research Lab, Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Karen Levine
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Bonita P. Klein-Tasman
- Child Neurodevelopment Research Lab, Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
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Kozel BA, Barak B, Ae Kim C, Mervis CB, Osborne LR, Porter M, Pober BR. Williams syndrome. Nat Rev Dis Primers 2021; 7:42. [PMID: 34140529 PMCID: PMC9437774 DOI: 10.1038/s41572-021-00276-z] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 11/09/2022]
Abstract
Williams syndrome (WS) is a relatively rare microdeletion disorder that occurs in as many as 1:7,500 individuals. WS arises due to the mispairing of low-copy DNA repetitive elements at meiosis. The deletion size is similar across most individuals with WS and leads to the loss of one copy of 25-27 genes on chromosome 7q11.23. The resulting unique disorder affects multiple systems, with cardinal features including but not limited to cardiovascular disease (characteristically stenosis of the great arteries and most notably supravalvar aortic stenosis), a distinctive craniofacial appearance, and a specific cognitive and behavioural profile that includes intellectual disability and hypersociability. Genotype-phenotype evidence is strongest for ELN, the gene encoding elastin, which is responsible for the vascular and connective tissue features of WS, and for the transcription factor genes GTF2I and GTF2IRD1, which are known to affect intellectual ability, social functioning and anxiety. Mounting evidence also ascribes phenotypic consequences to the deletion of BAZ1B, LIMK1, STX1A and MLXIPL, but more work is needed to understand the mechanism by which these deletions contribute to clinical outcomes. The age of diagnosis has fallen in regions of the world where technological advances, such as chromosomal microarray, enable clinicians to make the diagnosis of WS without formally suspecting it, allowing earlier intervention by medical and developmental specialists. Phenotypic variability is considerable for all cardinal features of WS but the specific sources of this variability remain unknown. Further investigation to identify the factors responsible for these differences may lead to mechanism-based rather than symptom-based therapies and should therefore be a high research priority.
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Affiliation(s)
- Beth A. Kozel
- Translational Vascular Medicine Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, USA
| | - Boaz Barak
- The Sagol School of Neuroscience and The School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Chong Ae Kim
- Department of Pediatrics, Universidade de São Paulo, São Paulo, Brazil
| | - Carolyn B. Mervis
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, USA
| | - Lucy R. Osborne
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Melanie Porter
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Barbara R. Pober
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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Miodrag N, Richards DA, Fedoroff JP, Watson SL. Sex and genes, part 2: A biopsychosocial approach to assess and treat challenging sexual behavior in persons with intellectual disabilities including fragile X syndrome and 22q11.2 deletion syndrome. BEHAVIORAL SCIENCES & THE LAW 2020; 38:152-172. [PMID: 32017177 DOI: 10.1002/bsl.2447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 06/10/2023]
Abstract
Individuals with intellectual disabilities (IDs) - and specifically those with genetic disorders - are more prone to medical and psychological challenges that affect their sexual development, experiences, and fertility. In this review paper we first provide an overview of the biopsychosocial (BPS) model and then explain how the model can guide and improve the assessment and treatment of challenging sexual behaviors by persons with IDs. We discuss two genetic conditions - fragile X syndrome and 22q11.2 deletion syndrome - in case studies, showing how the BPS model can be used to assess and treat the sexual problems of individuals with various types of ID. We conclude with BPS-formulated treatment considerations in three key domains: biomedical treatment (e.g., medication side effects; stopping or changing medications), psychological treatment (e.g., providing psychological therapies), and socio-environmental interventions (e.g., providing socio-sexual education and staff training). Together, these treatment interventions can aid clinicians to prevent and/or treat problematic sexual behaviors of people with IDs.
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Affiliation(s)
- Nancy Miodrag
- Department of Child and Adolescent Development, California State University Northridge, Northridge, CA, U.S.A
| | - Deborah A Richards
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - J Paul Fedoroff
- Division of Forensic Psychiatry, Ottawa University, Ottawa, Ontario, Canada
| | - Shelley L Watson
- Department of Psychology, Laurentian University, Sudbury, Ontario, Canada
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Dagnan D, Jackson I, Eastlake L. A systematic review of cognitive behavioural therapy for anxiety in adults with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:974-991. [PMID: 30225989 DOI: 10.1111/jir.12548] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 06/20/2018] [Accepted: 08/23/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND Anxiety disorders have high prevalence in people with intellectual disabilities. In populations without intellectual disabilities, cognitive behavioural therapy is a first line psychological therapy for these presentations. There is no existing review of the range of methods and outcomes from intervention studies in this area. METHOD A systematic review was carried out following guidance in the Cochrane handbook for systematic reviews of interventions. RESULTS Nineteen studies were identified. The majority of reports were descriptive case studies; the most frequently described presentations were non-specific anxiety disorders and post-traumatic stress disorder; the most frequently described cognitive techniques were psycho-education and interventions directly aimed at thoughts and beliefs and most studies reported positive outcomes, although the better controlled studies tended to report less comprehensive impacts. CONCLUSIONS A range of presentations have been described although the area is still at a primarily descriptive stage. We discuss intervention structures and approaches that require further research.
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Affiliation(s)
- D Dagnan
- Community Learning Disabilities Service, Cumbria Partnership NHS Foundation Trust and Lancaster University, UK
| | - I Jackson
- Community Learning Disability Service, Cumbria Partnership NHS Foundation Trust, UK
| | - L Eastlake
- Community Learning Disability Service, Cumbria Partnership NHS Foundation Trust, UK
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Surley L, Dagnan D. A review of the frequency and nature of adaptations to cognitive behavioural therapy for adults with Intellectual Disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:219-237. [PMID: 30353630 DOI: 10.1111/jar.12534] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 06/28/2018] [Accepted: 09/14/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is increasing evidence that cognitive behavioural therapy (CBT) can be effective for people with intellectual disabilities. The aim of this review was to report the nature and frequency of adaptations reported in studies of CBT for people with intellectual disabilities. METHOD This review updated and extended a previous review by (Whitehouse et al. 2006, J Appl Res Intellect Disabil, 19, 55), which used a framework of adaptations developed by (Hurley et al., 1998, J Dev Phys Disabil, 10, 365). Adaptations included simplification, language, activities, developmental level, use of directive style, flexible methods, involve caregivers, transference/countertransference and disability/rehabilitation approaches. A search identified peer-reviewed papers that reported individual CBT informed psychological interventions for people with an Intellectual Disability. RESULTS The search identified 23 studies which met the inclusion criteria for review. Studies reported the majority of the categories of adaptation described by (Hurley et al., 1998, J Dev Phys Disabil, 10, 365). CONCLUSIONS The results suggest that the framework of adaptations needs further development to increase sensitivity in identifying and categorizing adaptations of CBT. Increased, systematic reporting of adaptations to studies of CBT with people with intellectual disabilities is recommended.
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Affiliation(s)
- Laura Surley
- Northumberland, Tyne and Wear NHS Foundation Trust, Northumberland, UK
| | - Dave Dagnan
- Cumbria Partnership NHS Foundation Trust, Workington, UK
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Benson R, Stickney L, Smetter J, Steglitz J. Modified Exposure and Response Prevention for the Treatment of Comorbid OCD-Like Repetitive Behavior and Developmental Disability. Clin Case Stud 2016. [DOI: 10.1177/1534650116672006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adults with developmental disabilities are particularly vulnerable to experiencing obsessive-compulsive disorder (OCD). However, the application of evidence-based treatments such as Exposure and Response Prevention (ERP) to individuals with comorbid OCD and developmental disabilities is a relatively new and emerging field of study. The present article presents a case study of modified ERP for the treatment of an adult woman with comorbid OCD-like repetitive behavior and developmental disabilities. Target behaviors, including OCD-like repetitive behavior, verbal agitation, and physical aggression, decreased over the course of the 7-month active treatment phase, and reductions in physical aggression and verbal agitation were maintained during follow-up. This case study provides important lessons about the individual-level and systems-level assessment and treatment of comorbid OCD-like repetitive behavior and developmental disabilities.
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Affiliation(s)
- Rodney Benson
- Depression and Anxiety Specialty Clinic of Chicago, IL, USA
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Boggio PS, Asthana MK, Costa TL, Valasek CA, Osório AAC. Promoting social plasticity in developmental disorders with non-invasive brain stimulation techniques. Front Neurosci 2015; 9:294. [PMID: 26388712 PMCID: PMC4555066 DOI: 10.3389/fnins.2015.00294] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 08/05/2015] [Indexed: 12/11/2022] Open
Abstract
Being socially connected directly impacts our basic needs and survival. People with deficits in social cognition might exhibit abnormal behaviors and face many challenges in our highly social-dependent world. These challenges and limitations are associated with a substantial economical and subjective impact. As many conditions where social cognition is affected are highly prevalent, more treatments have to be developed. Based on recent research, we review studies where non-invasive neuromodulatory techniques have been used to promote Social Plasticity in developmental disorders. We focused on three populations where non-invasive brain stimulation seems to be a promising approach in inducing social plasticity: Schizophrenia, Autism Spectrum Disorder (ASD) and Williams Syndrome (WS). There are still very few studies directly evaluating the effects of transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) in the social cognition of these populations. However, when considering the promising preliminary evidences presented in this review and the limited amount of clinical interventions available for treating social cognition deficits in these populations today, it is clear that the social neuroscientist arsenal may profit from non-invasive brain stimulation techniques for rehabilitation and promotion of social plasticity.
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Affiliation(s)
- Paulo S Boggio
- Social and Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University Sao Paulo, Brazil
| | - Manish K Asthana
- Social and Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University Sao Paulo, Brazil
| | - Thiago L Costa
- Social and Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University Sao Paulo, Brazil
| | - Cláudia A Valasek
- Social and Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University Sao Paulo, Brazil
| | - Ana A C Osório
- Social and Cognitive Neuroscience Laboratory and Developmental Disorders Program, Center for Health and Biological Sciences, Mackenzie Presbyterian University Sao Paulo, Brazil
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Conelea CA, Klein-Tasman BP. Habit Reversal Therapy for Body-Focused Repetitive Behaviors in Williams Syndrome: A Case Study. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2013; 25:10.1007/s10882-013-9335-3. [PMID: 24357918 PMCID: PMC3864825 DOI: 10.1007/s10882-013-9335-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Williams syndrome (WS) is genetic neurodevelopmental disorder with a well-characterized cognitive and behavioral phenotype. Research has consistently demonstrated high rates of psychopathology in this population; however, little research has examined the use of empirically-supported psychosocial interventions in those with WS. The current case study reports on the use of Habit Reversal Therapy (HRT) to treat multiple body-focused repetitive behaviors in a child with WS. Although HRT is a well-established cognitive-behavioral intervention for body-focused repetitive behaviors, it has been infrequently used in populations with developmental disabilities. An etiologically-informed approach was used to adapt HRT to fit the known behavioral and cognitive phenotype of WS. Results suggest that HRT may be beneficial for this population. Modified treatment elements are described and future research areas highlighted.
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Affiliation(s)
- Christine A. Conelea
- Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI, USA. Bradley/Hasbro Children’s Research Center, Coro West Suite 204, 1 Hoppin St., Providence, RI 02903, USA
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Vereenooghe L, Langdon PE. Psychological therapies for people with intellectual disabilities: a systematic review and meta-analysis. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:4085-4102. [PMID: 24051363 DOI: 10.1016/j.ridd.2013.08.030] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 08/16/2013] [Indexed: 06/02/2023]
Abstract
The aim of this study was to evaluate the efficacy of psychological therapies for people with intellectual disabilities (IDs) through a systematic review and meta-analysis of the current literature. A comprehensive literature search identified 143 intervention studies. Twenty-two trials were eligible for review, and 14 of these were subsequently included in the meta-analysis. Many studies did not include adequate information about their participants, especially the nature of their IDs; information about masked assessment, and therapy fidelity was also lacking. The meta-analysis yielded an overall moderate between-group effect size, g=.682, while group-based interventions had a moderate but smaller treatment effect than individual-based interventions. Cognitive-behaviour therapy (CBT) was efficacious for both anger and depression, while interventions aimed at improving interpersonal functioning were not effectual. When CBT was excluded, there was insufficient evidence regarding the efficacy of other psychological therapies, or psychological therapies intended to treat mental health problems in children and young people with IDs. Adults with IDs and concurrent mental health problems appear to benefit from psychological therapies. However, clinical trials need to make use of improved reporting standards and larger samples.
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Affiliation(s)
- Leen Vereenooghe
- Department of Psychological Sciences, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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Lima SDFB, Carreiro LRR, Seraceni MFF, Khoury LP, Braga AC, Araújo MVD, Teixeira MCTV. Inattention and Hyperactivity Behavioral Pattern of a Child With Williams Syndrome. Clin Case Stud 2012. [DOI: 10.1177/1534650112457020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Children and adolescents with Williams syndrome (WS) frequently present inattention and hyperactivity. This study aims to compare the number of behaviors of inattention and hyperactivity/impulsivity in one child with WS in two school settings: a regular class setting and an experimental class setting with the introduction of strategies for behavioral management. A case study was conducted with a child with WS, his regular teacher at school, his mother, and a teacher of the experimental class setting. A protocol was used to observe behavioral patterns of inattention, hyperactivity, and impulsivity. Behavioral strategies of stimulus control and reinforcement were also used. Results indicated a significant improvement in the rates of inattention and hyperactivity responses for the experimental class condition. Behavioral strategies, if adapted to the needs of students with WS, may optimize an effective school inclusion and contribute to the child’s adaptation to classroom setting.
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Jawaid A, Riby DM, Owens J, White SW, Tarar T, Schulz PE. 'Too withdrawn' or 'too friendly': considering social vulnerability in two neuro-developmental disorders. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2012; 56:335-350. [PMID: 21801261 DOI: 10.1111/j.1365-2788.2011.01452.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In some neuro-developmental disorders, the combined effect of intellectual disability and atypicalities of social cognition may put individuals at increased vulnerability in their social environment. The neuro-developmental disorders Williams syndrome, characterised by 'hypersociability', and autism spectrum disorders, characterised by 'social withdrawal', are at two extremes of atypical social functioning in humans. In this article, we use Williams syndrome and autism spectrum disorders as exemplars to demonstrate how atypicalities of social cognition may contribute to social vulnerability in these populations. The lives of individuals with both these disorders are marred by an increased risk of social isolation, bullying, unsteady relationships, employment difficulties and abuse. While different behavioural interventions have been tried to improve social functioning in these populations, there has been great variability in their success. Finally, we discuss different issues regarding social independence of these individuals; including employment, safety and decision making.
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Affiliation(s)
- A Jawaid
- Institute of Neuropathology, University Hospital Zurich, Zurich, Switzerland.
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Watson SL, Richards DA, Miodrag N, Fedoroff JP. Sex and genes, part 1: sexuality and Down, Prader-Willi, and Williams syndromes. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2012; 50:155-168. [PMID: 22642969 DOI: 10.1352/1934-9556-50.2.155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Specific genetic syndromes affect individuals' sexual development, experiences, and fertility. Individuals with specific syndromes can also display inappropriate sexual behavior resulting from vulnerabilities presented by their genetic makeup. Using clinical case studies, we discuss the specific impact that Down, Prader-Willi, and Williams syndromes can have on sexual development and behavior. Applying a biopsychosocial approach, we present the primary sexual effects, such as delayed sexual development and infertility. These genetic syndromes are also associated with challenges that are not specifically sexual in nature but that affect sexual expression, such as self-injury, mental health issues, or epilepsy. Medication side effects are also discussed. We conclude with treatment recommendations for individuals with sexual challenges, considering the unique effects of these three syndromes on sexuality.
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Dodd HF, Porter MA. Interpretation of ambiguous situations: evidence for a dissociation between social and physical threat in williams syndrome. J Autism Dev Disord 2011; 41:266-74. [PMID: 20700639 DOI: 10.1007/s10803-010-1048-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Williams syndrome (WS) is associated with an unusual profile of anxiety, characterised by increased rates of non-social anxiety but not social anxiety (Dodd and Porter, J Ment Health Res Intellect Disabil 2(2):89-109, 2009). The present research examines whether this profile of anxiety is associated with an interpretation bias for ambiguous physical, but not social, situations. Sixteen participants with WS, aged 13-34 years, and two groups of typically developing controls matched to the WS group on chronological age (CA) and mental age (MA), participated. Consistent with the profile of anxiety reported in WS, the WS group were significantly more likely to interpret an ambiguous physical situation as threatening than both control groups. However, no between-group differences were found on the ambiguous social situations.
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Affiliation(s)
- Helen F Dodd
- Macquarie Centre for Cognitive Science, Macquarie University, Marsfield, NSW, 2109, Australia.
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Affiliation(s)
- Deborah M Riby
- School of Psychology, Newcastle University, United Kingdom
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Woodruff-Borden J, Kistler DJ, Henderson DR, Crawford NA, Mervis CB. Longitudinal course of anxiety in children and adolescents with Williams syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2010; 154C:277-90. [PMID: 20425787 DOI: 10.1002/ajmg.c.30259] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The longitudinal course of anxiety disorders in 45 children and adolescents with Williams syndrome (WS) was examined. Children were ages 4-13 years at the initial assessment. To assess their child's DSM-IV diagnoses, parents completed a structured diagnostic interview 3-9 times at intervals of at least 1 year. At the first assessment, 60% of the sample presented with at least one anxiety diagnosis; 82.2% received an anxiety diagnosis at some time during the study. Chronic, persistent anxiety within the period 5 years after their initial diagnosis was shown by 62.2% of those with an anxiety diagnosis (51.1% of the entire sample). The most common diagnoses were specific phobias and generalized anxiety disorder. Multilevel logistic regression models were estimated for the presence of any anxiety disorder, specific phobia, and specific phobia of loud noises. Developmental trajectories, expressed as the probability of a positive diagnosis, suggested that the odds of a positive diagnosis did not change with age. IQ was not significantly related to the presence of an anxiety disorder. However, there was a significant relation between executive functioning and anxiety such that the presence of an anxiety diagnosis was associated with increased scores on behavioral regulation, indicative of increased difficulty with inhibitory control of affect and behavior. These findings are discussed in terms of persistence of anxiety over time and the need to develop and test interventions to address the high levels of anxiety experienced by children and adolescents with WS.
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Affiliation(s)
- Janet Woodruff-Borden
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY 40292, USA.
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Matson JL, Dempsey T. The nature and treatment of compulsions, obsessions, and rituals in people with developmental disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2009; 30:603-611. [PMID: 19013755 DOI: 10.1016/j.ridd.2008.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
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.
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Affiliation(s)
- Johnny L Matson
- Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, USA.
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