Sensory Profile-2 in Autism Spectrum Disorder: An Analysis within the International Classification of Functioning, Disability and Health Framework

Autism spectrum disorder (ASD) is characterized by impairments in many functional areas requiring long-term interventions to promote autonomy. This study aims to map The Sensory Profile™ 2 (SP-2), one of the most widely used assessment tools in children with ASD, with the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), developed by the World Health Organization (WHO). This will allow the identification of the functional dimensions covered by this instrument and the comparison with the ICF shortlist proposed for autism (ICF Core Set [ICF-CS]). The deductive content analysis described in the ICF Linking Rules was followed, along with a systematized process including statistical and reasoning techniques that could contribute to the improvement of ICF linking studies (Cohen's Kappa and percentage of agreement). 218 codes were identified, 71% of them were codes related to the body functions chapters, mainly linked to perceptual functions (b160), emotional functions (b152), and temperament and personality functions (b126). Concerning activities and participation chapters (29%) the most frequently used codes were: focusing attention (d160), carrying out daily routine (d230), and walking (d450). Even though the SP-2 items do not assess most of the functional features regarded as essential in the ASD ICF-CS, SP-2 encompasses a majority of problems concerning body functions. This instrument may be considered as part of a multidimensional assessment approach, to complement other sources that are more likely to assess activity and participation dimensions and guide a functional intervention.

Spanish versions of assessment tools for functioning and activities daily living in schizophrenia: What do they measure?

From the psychosocial rehabilitation perspective, the use of instruments based on a theoretical framework to assess the level of functioning in activities of daily living with good clinimetric properties is essential for people diagnosed with schizophrenia. In Spain, scales translated from other languages, usually English, are very frequently used; this involves a process of adaptation, beyond translation. The objective of this study was to review and compare a series of different scales used in psychosocial functioning assessment in the Spanish population focused on daily living activities. The selected instruments have been adapted into Spanish over the last 19 years and are aimed at people diagnosed with a severe mental disorder, usually schizophrenia. The results showed that the number of instruments adapted to the Spanish population was small, with several shortcomings in the adaptation process, either in translation, the confusion of concepts or metric properties of the scale. In conclusion, the conceptualisation and assessment of functioning in this field remains a complex and controversial issue. The development of new instruments based on a theoretical approach, such as the International Classification of Functioning, Disability and Health (ICF)1 may be a great help in improving the psychosocial treatment of people diagnosed with a psychotic disorder.

[Confabulations (II): explicative models]

INTRODUCTION

Confabulations, or the production of false memories without deliberate intent to lie, is an intriguing phenomenon for which an attempt has been made to explain it since they were first described. Confabulations are a good example for illustrating the reconstructive character of memory. Nevertheless, their exact nature and the way in which they are produced are still controversial.

OBJECTIVE

To review the different models proposed to explain the appearance of confabulations.

DEVELOPMENT

Neuropsychological models that currently have some theoretical development and empirical evidence are reviewed. In addition, a brief reference to motivational models, that have recently begun to recover popularity, are presented. We conclude by presenting the last version of the strategic retrieval model that makes it possible to integrate the relevant elements from the others.

CONCLUSIONS

Early models of confabulations, which considered them a result of the need to fill memory gaps, are outdated nowadays. Nevertheless, emotional processes are taken into account to explain their content. From neuropsychological approaches, it is possible to distinguish models that consider confabulation as a result of a temporal or contextual problem, and those which consider that the main problem is on the memory retrieval process. More specifically, the strategic retrieval hypothesis states that confabulations are the result of a dysfunction in a complex system of monitoring the recovered information. This model would make it possible to integrate explanations and evidences coming from the other proposals.

Confabulations (I): concept, classification and neuropathology

INTRODUCTION

A working definition of confabulation could be that of describing them as false memories due to a retrieval problem, where the patient is unaware that he/she is confabulating, and has the belief that the memory is true. Several types of confabulations have been described, according to a broad variety of criteria. Confabulations can be seen in very different neurological conditions, which have lead to a controversy on their pathophysiological mechanisms.

OBJECTIVE

To obtain an updated revision in Spanish of the definitions, types, brain regions involved and neuropsychological correlates of the confabulations.

DEVELOPMENT

After reviewing the concept and several types of confabulations, the damaged brain regions associated to two conditions where confabulations occur, such as Korsakoff syndrome and patients with anterior communicating artery aneurysm, are described. The neuropsychological correlates associated to them are then reviewed.

CONCLUSIONS

Confabulations are a difficult-to-define complex phenomenon. Probably, the most accepted classification, in accordance with how they appear, would be that which distinguishes spontaneous from provoked confabulations, although the validity of this distinction is not clear. Regarding to crucial cerebral regions involved in the confabulations, it seems that prefrontal cortex lesions, specifically in ventromedial and orbitofrontal areas, are necessary. Neuropsychological evidence suggests the presence in most of the cases of executive dysfunction and at least some degree of memory dysfunction as an underlying mechanism of confabulation. Nevertheless, the specific characteristics of these neuropsychological dysfunctions are not well-known.