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A Randomized Clinical Trial Targeting Daily Living Skills in Autistic Adolescents Without an Intellectual Disability Before the Transition to Adulthood. J Dev Behav Pediatr 2023; 44:e590-e596. [PMID: 37862694 PMCID: PMC10843140 DOI: 10.1097/dbp.0000000000001222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/07/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVES In the United States, more than 75,000 autistic adolescents graduate from high school each year, and many lack the skills to successfully transition to college, work, and independent living. Daily living skills (DLS) in autistic adolescents without an intellectual disability (ID) fall 6 to 8 years behind peers. Better DLS are linked to more positive adult outcomes for autistic individuals. Surviving and Thriving in the Real World (STRW) is the only known evidence-based intervention that targets age-appropriate DLS in autistic adolescents without ID. The study objective was to evaluate STRW's efficacy compared with an active comparator (Program for the Evaluation and Enrichment of Relational Skills [PEERS]). METHOD Autistic adolescents in their last 2 years of high school were randomized to STRW or PEERS. Outcome measures were the Vineland Adaptive Behavior Scales, Third Edition (VABS-3), DLS domain and subdomains (Personal, Domestic, Community), and DLS Goal Attainment Scaling (DLS-GAS) areas (Morning Routine, Cooking, Laundry, Money). RESULTS Adolescents were randomly assigned to STRW (n = 34) or PEERS (n = 30). Owing to COVID-19, 28.1% received in-person intervention and 71.9% received telehealth intervention. STRW youth made significant gains on the VABS-3 DLS domain ( p = 0.01) and Domestic subdomain ( p = 0.005) and DLS-GAS Total, Laundry, and Money areas (all p 's < 0.05) compared with PEERS. CONCLUSION STRW shows promise for acquiring age-appropriate DLS compared with PEERS. Adolescents in STRW progressed toward achieving DLS in the average range and closing the gap between chronological age and DLS. By improving DLS, STRW may facilitate more successful adult outcomes.
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Using smart phone technology to improve daily living skills for individuals with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1169-1178. [PMID: 37417242 DOI: 10.1111/jar.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Individuals with intellectual disabilities need continued supports in completing daily living tasks to increase the likelihood of achieving independence. Fortunately, research has shown that assistive technology, and particularly video prompting helps support independent living for individuals with intellectual disabilities. AIMS This study investigated the efficacy of a highly customizable task analysis smartphone application in assisting three young adults with intellectual disabilities learn how to cook three different multistep recipes. MATERIALS & METHODS Three young adults with intellectual disabilities enrolled in a four-year postsecondary education program (PSE) participated in a multiple probe design across participants to examine the effect of a Task Analysis app on the participants' completion of three cooking tasks. RESULTS In this present study, the use of video prompting to teach a daily living skill resulted in large and meaningful effect size gains of 99%-100% for all three participants, as measured by Tau-U. DISCUSSION Video prompting is an effective instructional strategy which allows the user to self-prompt and manage their ability to successfully complete daily living skills. In this current study, video prompting made a substantial difference in the safety of participants. CONCLUSION The use of video prompting can decrease the reliance on others (e.g., teachers and caregivers), improve self-confidence of the user, and improve the user's level of autonomy.
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Piloting a Novel Daily Living Skills Assessment in Autistic Adolescents and Young Adults. AUTISM IN ADULTHOOD 2023; 5:86-92. [PMID: 36941860 PMCID: PMC10024265 DOI: 10.1089/aut.2021.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background There are a few ecologically valid measurements of Daily Living Skills (DLS)-a critical component of adaptive functioning (AF)-for autistic adolescents and young adults. This is particularly important given that DLS predict outcomes as autistic adolescents transition to adulthood. Methods We pilot-tested the assessment section of two modules of the Computerized Functional Skills Assessment and Training program (CFSAT) in 25 autistic (n = 4 female) and 25 non-autistic (n = 6 female) adolescents and young adults to evaluate preliminary feasibility in an autistic sample. Tasks involved using an ATM and ticket-buying machine. We also assessed AF and DLS with a well-validated self-report questionnaire. We examined group differences in performance and relationships between performance on CFSAT and an existing measure of AF and DLS. We also conducted regression analyses to investigate the associations between age, IQ, executive functioning (EF), and CFSAT task performance. Results All but one autistic participant were able to complete the CFSAT tasks. Autistic participants made more errors, but did not take longer to complete the task, than non-autistic participants. Performance correlated strongly with self-reported AF generally and DLS specifically. The regression analyses revealed that task performance was associated with EF in the autistic group, but not the non-autistic group. Conclusions These results provide preliminary support for the use of a new performance-based ecologically valid assessment of DLS in an autistic population. Two CFSAT modules were well-tolerated and detected differences in DLS ability. Strong correlations with an existing measure of AF suggest evidence of construct validity. The EF was associated with CFSAT task performance in autistic individuals. Such a tool could help identify individuals who would benefit from a DLS intervention.
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Executive functions in daily living skills: A study in adults with autism spectrum disorder. Front Psychol 2023; 14:1109561. [PMID: 37113122 PMCID: PMC10127455 DOI: 10.3389/fpsyg.2023.1109561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/26/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction Adults with autism and adults with schizophrenia show difficulties in adaptive skills, especially those related to daily functioning. Some studies suggest that adaptive skills are associated with deficits in executive functions (EF), while others indicate that intelligence quotient (IQ) might also play a role. Literature suggests that autistic symptoms further affect adaptive skills. The interest of the current study, therefore, was to explore to what extent IQ, EFs as well as core autistic symptoms predict adaptive skills. Methods To do this, 25 controls, 24 adults with autism, and 12 with schizophrenia were assessed on IQ (Wechsler Adult Intelligence Scale), and executive functioning. The EF was measured with neuropsychological tasks (inhibition, updating, and task switching) and with the Dysexecutive-Spanish Questionnaire (DEX-Sp) which assessed everyday life EF problems. Core ASD symptoms were measured using the Autism Diagnostic Observation Schedule, the Autism Spectrum Quotient-Short version (AQ-S), and the Repetitive Behavior Questionnaire - 3 (RBQ-3). Results The results indicated EF difficulties in both, autism and schizophrenia. The IQ explained a high percentage of the variance found in adaptive skills, but only in the autism group. We can conclude, therefore, that high IQ is associated with low adaptive skills levels and EFs affect adaptive functioning in people with autism; however, this does not explain the difficulties in adaptive functioning in the schizophrenia group. Core features of autism assessed with self-report questionnaires (but not the ADOS-2) predicted low scores on the adaptive skills, only in the autism group. Discussion Both EF measures predicted adaptive skills scores in autism, but not in schizophrenia. Our results suggest that different factors affect the adaptive functioning in each disorder. For instance, the EFs should be a central focus for improvement, especially for individuals with autism.
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Co-occurring ADHD symptoms in autistic adults are associated with less independence in daily living activities and lower subjective quality of life. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:2188-2195. [PMID: 35916251 DOI: 10.1177/13623613221112198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Outcomes for autistic adults are generally poor, including activities of daily living and self-ratings of quality of life. Co-occurring psychiatric conditions contribute to these poor outcomes. Attention-deficit/hyperactivity disorder is one of the most common co-occurring conditions in autistic individuals. However, we know little about the association between attention-deficit/hyperactivity disorder symptoms and outcomes in autistic adults. A total of 724 autistic adults (18-83 years; 58% female) recruited from the Simons Foundation Powering Autism Research participant registry completed questionnaires on demographics, co-occurring psychiatric conditions, activities of daily living, and subjective quality of life. Autistic adults who rated themselves as having more attention-deficit/hyperactivity disorder symptoms also rated themselves as having less independence in activities of daily living and a lower quality of life. This is the first study to show these relationships in autistic adults. These findings highlight that additional research and better supports for co-occurring attention-deficit/hyperactivity disorder symptoms may be critical to improving independence and quality of life for autistic adults.
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The Efficacy of Animal-Assisted Therapy in Patients with Dual Diagnosis: Schizophrenia and Addiction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116695. [PMID: 35682281 PMCID: PMC9180053 DOI: 10.3390/ijerph19116695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022]
Abstract
The objective of the study was to evaluate the efficacy of an animal-assisted-therapy (AAT) program in patients diagnosed with schizophrenia-spectrum disorders and substance-use disorders in residential treatment in order to intervene in the remission of negative and positive symptoms and improve quality of life and adherence to treatment, favouring the clinical stabilization of patients who participate in the AAT program, within the context of a mental-illness-treatment device. This was a quasi-experimental prospective study with intersubject and intrasubject factors. The sample comprised 36 patients (21 in the experimental group and 15 in the control group) who were evaluated at three time points (in the 3rd, 6th, and 10th sessions). The program lasted 3 months and consisted of 10 sessions that were implemented once a week, with a maximum participation of 10 patients per group. The participants were evaluated with the Positive and Negative Syndrome Scale (PANSS) for schizophrenia and the Life Skills Profile-20 (LSP-20) questionnaire. We observed a decrease in the positive symptoms of psychosis (F: 27.80, p = 0.001) and an improvement in functionality (F: 26.70, p < 0.001) as the sessions progressed. On the basis of these results, we concluded that AAT seems to be valid as a coadjuvant therapy as part of the rehabilitation processes of patients diagnosed with schizophrenia and addiction-spectrum disorders (dual diagnosis).
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Daily living skills of autistic adolescents and young adults: A scoping review. Aust Occup Ther J 2022; 69:456-474. [PMID: 35488176 PMCID: PMC9543116 DOI: 10.1111/1440-1630.12806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/16/2022] [Accepted: 04/09/2022] [Indexed: 11/30/2022]
Abstract
Introduction Daily living skills (DLS) are essential for an increased quality of life and autonomous living. DLS are a focus of occupational therapy practice; however, there has been no identified review of DLS acquisition in autistic adolescents or adults. A scoping review was undertaken of which the objective was to evaluate and synthesise the extent, range, and nature of research activity, and to identify research gaps in the existing literature as they relate to DLS acquisition and autistic adolescents and adults. Methods A structured search of the literature was conducted. Studies published in English between 2011 and 2021 that included a focus on the acquisition of DLS in autistic adolescents and young adults were included. The titles and abstracts of 103 records were screened, and the full text of 53 records was reviewed. These reference lists were hand searched. Following this process, 25 papers were found to meet the inclusion criteria. Results Findings indicate inconsistencies throughout the literature, with a lack of consensus on best practice methods, mediums, and/or tools to support optimal outcomes in terms of DLS acquisition for the autistic population. Themes related to (1) Generalisation of Skills Across Contexts, (2) Skill Maintenance, (3) Technology as a Teaching Method, (4) Participant and Family Perspectives, and (5) The Balance of Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) focus in research were extracted from the reviewed literature. There is a strong consensus in the findings of the identified papers that autistic adolescents and young adults experience poorer outcomes in terms of DLS acquisition than non‐autistic peers, and peers with other developmental or intellectual disabilities. Conclusion Future research is needed to fill these identified gaps and provide a clearer understanding on interventions to support optimal outcomes for autistic individuals.
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Effectiveness of a Parent Training Programme for Parents of Adolescents with Autism Spectrum Disorders: Aiming to Improve Daily Living Skills. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042363. [PMID: 35206550 PMCID: PMC8871773 DOI: 10.3390/ijerph19042363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 01/19/2023]
Abstract
Parent training (PT) has been well established in younger children with autism spectrum disorder (ASD) but is less well studied in adolescents. This study examined the effects of attempting PT to enhance the daily living skills (DLSs) of adolescents with ASD. Twenty-five parents of adolescents with ASD participated in either the immediate- or delayed-treatment control condition. Children's DLSs were evaluated using the DLS domain of the Vineland Adaptive Behaviour Scales-II, and the achievement of the DLSs practised by the children at home was the subject of the evaluation. The DLS domain score showed no improvement in the treatment group compared to the control group. However, some parents in the treatment group reported that their children acquired the target DLSs and more sophisticated communication behaviours. In addition, one measure suggested that parents increased their praising behaviours. These changes may have been driven by the completion of the parent training. We discuss several aspects of developing parent-mediated interventions based on the current intervention situation and observed changes.
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Daily Living Skills in Adolescent and Young Adult Males With Fragile X Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:64-83. [PMID: 34979036 PMCID: PMC8740615 DOI: 10.1352/1944-7558-127.1.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 04/27/2021] [Indexed: 05/04/2023]
Abstract
By adulthood, most males with fragile X syndrome (FXS) require support to navigate day-to-day settings. The present study cross-sectionally: (1) characterized the profile of daily living skills in males with FXS and (2) examined associated participant characteristics (i.e., fragile X mental retardation protein [FMRP] expression, nonverbal cognition, language, autism symptomatology, and anxiety symptomatology) using the Waisman-Activities of Daily Living questionnaire. Males with FXS (n = 57, ages 15-23 years) needed more help/support in the areas of domestic and community daily livings skills, than in the area of personal daily living skills. Significant associations were observed between reduced daily living skills and lower nonverbal cognition, receptive language, expressive language, and increased autism symptomatology. Receptive language emerged as the strongest unique predictor of daily living skill performance.
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Daily living skills scale: Development and preliminary validation of a new, open-source assessment of daily living skills. Front Psychiatry 2022; 13:1108471. [PMID: 36756637 PMCID: PMC9900738 DOI: 10.3389/fpsyt.2022.1108471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/30/2022] [Indexed: 01/25/2023] Open
Abstract
Autistic individuals and individuals with a range of other neurodevelopmental conditions (NDD) often present with lower levels of daily living skills (DLS) when compared to their neurotypical peers. Importantly, lower levels of DLS have been linked to a range of negative outcomes, including lower rates of post-secondary education, lower employment rates, and higher daily support needs across autism and NDD. However, there are currently no open-source informant-reported instruments for capturing key aspects of DLS. This study describes the development, refinement, and initial psychometric evaluation of a new, relatively brief (53-item). Daily Living Skills Scale (DLSS) in a sample of 1,361 children aged 2-17 years, Confirmatory Factor Analysis demonstrated an excellent fit of unidimensional model to the data (CFI = 0.953, TLI = 0.951, RMSEA = 0.073 [95% CI: 0.071-0.074]). The single-factor CFA model showed evidence of measurement invariance of factor loadings, thresholds, and residual variance (strict invariance) across sex, age, race, and ethnicity. Model reliability and internal consistency were excellent (ω = 0.98; α = 0.97). Conditional reliability estimates indicated very good reliability (= 0.80) for the total DLS scale from very low (θ = -4.2) to high (θ = +2.4) scores. Conceptually derived self-care, homecare, and community participation subscales also showed strong reliability and internal consistency. With further replication, the EFS has excellent potential for wide adoption across research and clinical contexts.
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College Readiness: Differences Between First-Year Undergraduates With and Without ADHD. JOURNAL OF LEARNING DISABILITIES 2021; 54:403-411. [PMID: 33238816 DOI: 10.1177/0022219420972693] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is characterized by inattentive, hyperactive, and impulsive behaviors. Impairment in individuals diagnosed with ADHD is significant; one such domain of impairment is achieving a college education. College students with ADHD tend to have lower grade point averages, take longer to graduate, and have higher dropout rates than individuals without ADHD. Those with ADHD may be inadequately prepared for college. College readiness can be broken into self-determination, academic skills, and daily living skills, all of which are possible areas of deficit for individuals with ADHD, given their common characteristics. In the current study, we examined differences in college readiness in undergraduates with and without ADHD. In general, students with ADHD were found to be less prepared for college than those without ADHD, and specific areas of unpreparedness were identified. The findings support the need for intervention for students with ADHD before or early in their college careers. Further research on specific skill deficits and ameliorative steps is needed.
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A cluster analysis of daily living skills in school aged children with autism spectrum disorder. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 69:593-601. [PMID: 37484209 PMCID: PMC10358589 DOI: 10.1080/20473869.2021.1980350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/07/2021] [Accepted: 09/08/2021] [Indexed: 07/25/2023]
Abstract
For individuals with autism spectrum disorder (ASD) daily living skills (DLS) fall below chronological age and have been linked to factors such as language. Given the impact of DLS on daily life, it is critical to gain a comprehensive understanding of DLS profiles in children to guide effective treatment. Using a large dataset from the Autism Speaks Autism Treatment Network, the current study sought to (1) examine whether there are subgroups of children with ASD defined by both their Vineland-II DLS scores and language abilities and (2) explore the relationship between internalizing and externalizing symptoms on subgroups using the Child Behavior Checklist. A five-cluster solution was found, but one group was subsequently dropped. Four clusters were examined: Low Language-Low DLS (n = 143); Low-Language High DLS (n = 170); High Language-Low DLS (n = 189); and High Language-High DLS (n = 203). The High Language-Low DLS group had significantly higher internalizing and externalizing symptoms as compared to the other groups. The results highlight the importance of targeting DLS in school-age children with ASD, especially for those with comorbid internalizing and externalizing symptom to ensure that the gap between age and functional DLS does not continue to widen.
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Concurrent Associations between Expressive Language Ability and Independence in Adolescents and Adults with Fragile X Syndrome. Brain Sci 2021; 11:brainsci11091179. [PMID: 34573200 PMCID: PMC8465941 DOI: 10.3390/brainsci11091179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Few individuals with fragile X syndrome (FXS) successfully meet adult normative expectations in education, employment, peer relations, and habitation, although there is within-syndrome variability in this regard. The primary goal of this study was to determine whether expressive language skills contribute to the capacity for independent functioning in adulthood even after controlling for nonverbal cognitive ability. METHODS Participants were 18- to 23-year-olds with FXS. Expressive language was assessed using the psychometrically validated Expressive Language Sampling (ELS) conversation and narration procedures. The language produced was transcribed and analyzed to yield measures of expressive vocabulary, syntax, and intelligibility. Parents concurrently completed questionnaires on the independent functioning of the participants with FXS. RESULTS All three ELS measures were significantly corelated with multiple measures of independence. The magnitudes of the correlations were reduced when nonverbal IQ was controlled through partial correlation. Nonetheless, many of the partial correlations were medium to large and several were statistically significant. CONCLUSIONS Expressive language skills appear to contribute uniquely to the capacity for independence, although longitudinal data are needed to evaluate the possibility of a bidirectional relationship between these domains. Thus, language intervention may be a prerequisite for preparing youth with FXS for an independent adult life.
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Post-High School Daily Living Skills in Autism Spectrum Disorder. J Am Acad Child Adolesc Psychiatry 2021; 60:978-985. [PMID: 33220430 PMCID: PMC8128936 DOI: 10.1016/j.jaac.2020.11.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/15/2020] [Accepted: 11/12/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Daily living skills (DLS) are a predictor of positive outcomes in youths with autism spectrum disorder (ASD), yet little is known about trajectories of DLS in adults with ASD. This study investigated the impact of high school exit on participants' trajectories of daily living skills age equivalent (DLS-AE) scores from ages 2 to 26 and the relationship between DLS-AE trajectories and employment and education outcomes. METHOD Participants were 98 adults with ASD drawn from an ongoing longitudinal study. The Vineland Adaptive Behavior Scales were administered 8 times from ages 2 to 26. Employment and education data were compiled from parent report demographic forms. RESULTS DLS-AE trajectories modestly increased with age before exiting school, at which point DLS-AE trajectories plateaued, then declined. A significant (p < .01) decrease occurred in the slope of DLS-AE trajectories following school exit. High DLS-AE scores predicted participation in postsecondary education (χ25 [n = 73] = 27.83, p < .001). Autism symptom severity predicted participation in employment (χ25 [n = 58] = 27.54, p < .001). CONCLUSION These findings provide evidence that DLS decline in adults with ASD, specifically after school exit, and highlight the importance of DLS in normative adult outcomes. Future work should examine the trajectories of DLS in middle and later adulthood and consider intervention targets for bolstering DLS following school exit.
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Daily living skills in adolescents with autism spectrum disorder: Implications for intervention and independence. RESEARCH IN AUTISM SPECTRUM DISORDERS 2021; 83:101761. [PMID: 33796139 PMCID: PMC8009320 DOI: 10.1016/j.rasd.2021.101761] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Challenges in adaptive behaviors are present in individuals with autism spectrum disorder (ASD), while variation in IQ, social skills, and comorbidities are possible influences on adaptive behaviors. However, adaptive behaviors do not consistently map onto cognitive abilities in ASD, as high IQ is not protective against challenges in adaptive behaviors. Additionally, individuals with both ASD and elevated levels of externalizing problem behaviors experience even worse adaptive behaviors. Identifying factors that contribute to the variance in adaptive behaviors, particularly daily living skills (DLS), may inform strategies to improve adaptive behaviors necessary for independence in adulthood. METHOD Adolescents with typical cognitive development (TD, n=84), intellectual disability (ID, n=30), or ASD (n=45) were included in this study to examine group differences in adaptive behaviors, identify relations between IQ and DLS, and determine factors that contribute to variance in DLS at youth age 13. The Vineland Adaptive Behavior Scales, 2nd Edition (VABS-II) was used to measure adaptive behaviors. RESULTS All domains of adaptive behavior were significantly higher in TD groups compared to ASD and ID youth. Significant positive correlations were observed between IQ and DLS in the ASD and ID groups. In the ASD youth group, higher externalizing behavior problems explained the most variance in DLS. CONCLUSIONS DLS are below age-expected levels in young adolescents with ASD, in part because of the higher externalizing behavior problems in this group. Incorporating adaptive skills training and behavior management strategies into current interventions may serve to prepare adolescents and families for the transition to adulthood.
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Exploring the relationships between motor proficiency, independence and quality of life in adolescents with autism spectrum disorder. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 68:850-857. [PMID: 36568624 PMCID: PMC9788684 DOI: 10.1080/20473869.2021.1900506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 05/30/2023]
Abstract
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.
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Telehealth parent coaching to improve daily living skills for children with ASD. J Appl Behav Anal 2021; 54:566-581. [PMID: 33600614 DOI: 10.1002/jaba.813] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 01/11/2023]
Abstract
Children with autism spectrum disorder often display deficits in daily living skills. Behavior analysts can use telehealth, such as videoconferencing technology, to deliver interventions to families of these children. Given the COVID-19 pandemic and the common barriers to accessing behavioral interventions, it is imperative to evaluate the effectiveness and practicality of delivering behavioral interventions via telehealth. This study evaluated the efficacy of a parent-implemented intervention with coaching via telehealth to improve daily living skills. Children ranging in age from 5 to 9 years participated in the study with 1 or 2 of their parents serving as the primary implementer(s). Parents implemented the intervention with fidelity and the intervention yielded increases in independent daily living skill completion for all 4 participants.
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Parental Occupation Executive Training (POET): An Efficient Innovative Intervention for Young Children with Attention Deficit Hyperactive Disorder. Phys Occup Ther Pediatr 2020; 40:47-61. [PMID: 31314651 DOI: 10.1080/01942638.2019.1640336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The American Academy of Pediatrics strongly recommends first-line treatment of preschool aged children with attention deficit hyperactivity disorder (ADHD) be parent- or teacher-administered behavior therapy.Aim: To assess the efficacy of Parental Occupation Executive Training (POET), a new intervention for young children with ADHD symptomatology.Materials and Methods: We implemented a controlled, counterbalanced design with a study and comparison group (72 children with mean age of 5.42 years identified as having ADHD symptomatology. using the DSM-IV and Conners Parents and Teachers Rating Scales). Intervention included parental-training sessions focused on children's occupational goals and capitalized on the assumed relationship between daily activities and executive functions. We evaluated achievement with the Canadian Occupational Performance Measure (COPM), Behavioral Rating Inventory of Executive Functions, and a questionnaire we developed related to parental knowledge and skills.Results: Executive functions and preselected daily functions significantly improved following the POET intervention. Parent perceptions related to their knowledge of their children's executive difficulties and appropriate management strategies changed significantly following the intervention, and significantly correlated with the COPM scores.Conclusions: A short-term parental training program, the POET improved daily functioning of young children with ADHD symptomatology by focusing on their parents' ability to cope with the children's executive delays.
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A 1.5-Year Longitudinal Study of Social Activity in Patients With Schizophrenia. Front Psychiatry 2019; 10:567. [PMID: 31447715 PMCID: PMC6697059 DOI: 10.3389/fpsyt.2019.00567] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 07/19/2019] [Indexed: 11/13/2022] Open
Abstract
Patients with schizophrenia exhibit impairments in their social activity, intelligence quotient (IQ), daily living skills, and social function. Social activity is a high-order outcome measure of their lives. Here we attempted to longitudinally evaluate the effects of IQ, daily living skills, social function, psychiatric symptoms, and medications on social activity in patients with schizophrenia. The purpose of the current study is to identify the specific factor that affects longitudinal changes in social activity. Sixty-five patients with schizophrenia were assessed at two time points [time 2 (T2, follow-up) - time 1 (T1, baseline) = 1.71 ± 0.79 years]. Social activity, IQ, daily living skills, and social function were assessed using the Social Activity Assessment (SAA; h/week), short form of the Wechsler Adult Intelligence Scale (WAIS)-III (WAIS-SF), University of California San Diego (UCSD) Performance-Based Skills Assessment (UPSA), and Social Functioning Scale (SFS), respectively. IQ, daily living skills, social function, and social activity were significantly improved between T1 and T2 (t = 2.0-4.4, p = 0.048-3.60 × 10-5). IQ, daily living skills, and social function positively correlated with social activity (lowest p = 1.27 × 10-5), and psychiatric symptoms negatively correlated with social activity over time (lowest p = 3.26 × 10-9). The longitudinal change in social activity was independently and positively correlated with a change in social function (beta = 0.35, p = 4.63 × 10-3), particularly interpersonal communication (beta = 0.35, p = 4.32 × 10-3). The longitudinal changes in other factors did not directly affect the change in social activity (p > 0.05). Based on these findings, social activity is more affected by social function than by other factors.
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The Interrelationship Between Motor Coordination and Adaptive Behavior in Children With Autism Spectrum Disorder. Front Psychol 2018; 9:2350. [PMID: 30538659 PMCID: PMC6277471 DOI: 10.3389/fpsyg.2018.02350] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/09/2018] [Indexed: 11/14/2022] Open
Abstract
Objective: Children with autism spectrum disorder (ASD) experience significant challenges with their motor coordination. It is not, however, well understood how motor coordination may impact the behavioral functioning of children with ASD. Therefore the purpose of this study was to explore the relationships between motor coordination and adaptive behavior in 7-12-year-old children with ASD. Methods: Motor coordination was assessed using the Movement Assessment Battery for Children, 2nd Edition (MABC-2) and adaptive behavior was assessed by parental report using the Vineland Adaptive Behavior Scales, 2nd Edition (VABS-2) as part of a larger cross-sectional study. Descriptive characteristics were calculated for MABC-2 and VABS-2 scores and Spearman's rank order correlation analyses were used to examine the relationship between motor coordination and adaptive behavior. Results: On average, the participants (n = 26) exhibited significant challenges in regard to their motor coordination with all but two participants classified as having significant motor impairments by scoring at or below the 16th percentile on the MABC-2. Results from the correlation analyses indicated that manual dexterity was positively related to daily living skills (ρ = 0.58, p < 0.003), and overall motor coordination was positively related to daily living skills (ρ = 0.60, p < 0.003) and overall adaptive behavior (ρ = 0.57, p < 0.003). In all instances, better motor coordination was related to more adaptive behaviors. Conclusion: These results highlight the profound motor coordination challenges that children with ASD experience and also suggest that these challenges, particularly with manual dexterity, are related to the daily behavior of children with ASD. The interrelatedness of motor and adaptive behavior suggests the need to further explore the impact of motor-based interventions for this population, as well as conduct longitudinal studies to disentangle these relationships.
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Effects of a self-management training for people with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 32:390-400. [PMID: 30353637 PMCID: PMC7379658 DOI: 10.1111/jar.12536] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 09/14/2018] [Accepted: 09/19/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND To help people with intellectual disabilities lead a more independent life, it is important to promote their self-management. This study evaluated the effectiveness of a self-management training for people with intellectual disabilities directed at independent functioning in daily life. METHOD In the training, 17 people with intellectual disabilities worked on personal self-management goals covering a wide range of everyday affairs. Primary outcome measures focused on goal attainment, independence and support needs. Moreover, outcomes regarding psychopathological behaviour and quality of life were explored. Data were collected before and at the start of the training, and 3, 6, 9 and 12 months later. RESULTS The training contributed to the attainment of self-management goals and to the reduction in support needs (p < 0.01). There were no changes in independence, psychopathological behaviour and quality of life. CONCLUSIONS Results indicate that the training supports people with intellectual disabilities to self-manage their daily affairs.
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An assessment of health, social, communication, and daily living skills of adults with Down syndrome. Am J Med Genet A 2018; 176:1389-1397. [PMID: 29696786 DOI: 10.1002/ajmg.a.38721] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/26/2018] [Accepted: 04/01/2018] [Indexed: 11/12/2022]
Abstract
Adults with Down syndrome (DS) are surviving longer, yet data delineating life skills are lacking. As providers are encouraged to provide a "balanced" description of DS to family members/caregivers, more quantitative data are required to accurately describe the abilities and potential of adults with DS. This study assessed health, social, communication, and daily living skills of adults with DS to describe the range of abilities and to show how increasing age contributes to functional abilities. Caregivers of an adult with DS 20 years of age or older participated in an online questionnaire. Descriptive statistics and scores from scales assessed relationships between the number of health issues reported and functional abilities, and how the abilities changed as age increased. Of 188 participants, 157 completed the survey with partial results included. Communication, independence, and social activity scores were compared to the number of congenital and non-congenital health issues reported. Linear regression results showed those with more health issues were significantly less likely to be independent and social. However, only current health issues affected communication skills. No significant correlation occurred between the number of congenital abnormalities and scores for independence/life skills as an adult. T-test by age group found decreasing abilities after 40 years of age. In conclusion, quantitative data and information from this study is beneficial for providers in order to describe the potential for an individual with DS and to assist caregivers to plan accordingly for the future of their adult with DS.
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Preliminary efficacy of a daily living skills intervention for adolescents with high-functioning autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2017; 22:983-994. [PMID: 28914086 DOI: 10.1177/1362361317716606] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Daily living skills deficits are strongly associated with poor adult outcomes for individuals with high-functioning autism spectrum disorder, and yet, there are no group interventions targeting daily living skills. Seven adolescents with autism spectrum disorder and their parents participated in a feasibility pilot of a 12-week manualized group treatment targeting specific daily living skills (i.e. morning routine, cooking, laundry, and money management). Outcomes included the Vineland Adaptive Behavior Scales, Second Edition (Vineland-II) age equivalence scores and four goal attainment scaling scores. Adolescents demonstrated significant improvement on two Vineland-II subdomains and on all goal attainment scaling scores at post-treatment and 6-month follow-up. The intervention has promise for improving critical daily living skills' deficits that affect independent living and employment. Limitations and implications for future studies are discussed.
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Possible Facilitative Effects of Repeated Anodal Transcranial Direct Current Stimulation on Functional Outcome 1 Month Later in Schizophrenia: An Open Trial. Front Psychiatry 2017; 8:184. [PMID: 29033856 PMCID: PMC5626815 DOI: 10.3389/fpsyt.2017.00184] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/11/2017] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Recent research on neuromodulation techniques, such as transcranial direct current stimulation (tDCS), for the treatment of schizophrenia has mainly focused on psychotic symptoms. We aimed to determine whether repetitive tDCS is efficacious in improving determinants of outcome, such as cognitive function, daily living skills, and depressive mood in patients with schizophrenia. Twenty-eight patients underwent tDCS (2 mA × 20 min) two times per day for 5 consecutive days. The anodal electrode was placed over the left dorsolateral prefrontal cortex while the cathodal electrode was placed over the right supraorbital region. One month after the last stimulation, there was a significant improvement on cognitive function, measured by the brief assessment of cognition in schizophrenia (d = 0.49). Significant effects were also shown on daily living skills (functional capacity), measured by the UCSD performance-based skills assessment-brief (d = 0.70). Depressive symptoms, measured by the Calgary depression rating scale, as well as psychotic symptoms measured by on the positive and negative syndrome scale positive and general psychopathology subscales also responded to the treatment (d = 0.38, d = 0.48, and d = 0.50, respectively). This is the first study to suggest that tDCS with the anodal electrode on the left prefrontal cortex improves functional capacity and depressive symptoms in patients with schizophrenia. These results may add to the concept that tDCS provides a strategy to enhance functional outcomes in patients with schizophrenia. TRIAL REGISTRATION https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000018556, UMIN000015953.
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Abstract
Although not considered a diagnostic criterion in DSM-IV, motor difficulties in children with Attention Deficit Hyperactivity Disorder (ADHD) are commonly reported. Prevalence of co-morbidity of ADHD and Developmental Coordination Disorder is as high as 50%. Cognitive Orientation to daily Occupational Performance (CO-OP) is a problem-solving approach originally developed for children with Developmental Coordination Disorder. In this approach, therapists support children to use cognitive strategies in a process of guided discovery to solve occupational performance problems. A single case experimental design (multiple baselines) was used to examine the influence of a 12-week intervention using CO-OP with six children with ADHD. Outcome measures included the Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling and the Bruininks-Oseretsky Test of Motor Proficiency and Performance (BOTMP). The results of this study demonstrated improvements in both goals and motor performance in the participants due to the intervention. These results provide some support for the use of CO-OP with children with ADHD. Further research into the application of CO-OP with children with ADHD is warranted based on these preliminary positive findings regarding the efficacy of this intervention to address motor-based performance difficulties.
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Stability of parent report on Mobility and Self-Care item scores of the Pediatric Evaluation of Disability Inventory. Phys Occup Ther Pediatr 2014; 34:289-99. [PMID: 23931334 DOI: 10.3109/01942638.2013.823475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Secondary analysis using data from a clinical trial was performed to evaluate the stability of individual items of the Mobility and Self-Care functional skills scales of the Pediatric Evaluation of Disability Inventory (PEDI). Parents of 113 children aged 1-6 years old with cerebral palsy completed the PEDI twice by questionnaire 6 months apart. An item was classified "unstable" if the score changed from capable to unable. The number of children with more than five unstable items and the number of items with more than five children having unstable scoring patterns were calculated. Nineteen children (17%) and 13 items had unstable scoring patterns. The majority of PEDI items demonstrated stability of parent scoring. Examination of unstable items suggests that parents may need assistance in understanding the difference between "usual" and "best" performance, interpreting descriptors such as "thoroughly," and maintaining the same context reference for outdoor mobility items.
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Understanding the gap between cognitive abilities and daily living skills in adolescents with autism spectrum disorders with average intelligence. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2013; 19:64-72. [PMID: 24275020 DOI: 10.1177/1362361313510068] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Daily living skills standard scores on the Vineland Adaptive Behavior Scales-2nd edition were examined in 417 adolescents from the Simons Simplex Collection. All participants had at least average intelligence and a diagnosis of autism spectrum disorder. Descriptive statistics and binary logistic regressions were used to examine the prevalence and predictors of a "daily living skills deficit," defined as below average daily living skills in the context of average intelligence quotient. Approximately half of the adolescents were identified as having a daily living skills deficit. Autism symptomatology, intelligence quotient, maternal education, age, and sex accounted for only 10% of the variance in predicting a daily living skills deficit. Identifying factors associated with better or worse daily living skills may help shed light on the variability in adult outcome in individuals with autism spectrum disorder with average intelligence.
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