The temperament of Down's syndrome infants: a research note

Annotation: what do we know about sensory dysfunction in autism? A critical review of the empirical evidence

BACKGROUND

Unusual responses to sensory stimuli are seen in many children with autism. Their presence was highlighted both in early accounts of autism and in more recent first-person descriptions. There is a widespread belief that sensory symptoms characterize autism and differentiate it from other disorders. This paper examines the empirical evidence for this assumption.

METHOD

All controlled experimental laboratory investigations published since 1960 were identified through systematic searches using Medline/PubMed and PsycInfo search engines. A total of 48 empirical papers and 27 theoretical or conceptual papers were reviewed.

RESULTS

Sensory symptoms are more frequent and prominent in children with autism than in typically developing children, but there is not good evidence that these symptoms differentiate autism from other developmental disorders. Certain groups, including children with fragile X syndrome and those who are deaf-blind, appear to demonstrate higher rates of sensory symptoms than children with autism. In reviewing the evidence relevant to two theories of sensory dysfunction in autism, over- and under-arousal theory, we find that there is very little support for hyper-arousal and failure of habituation in autism. There is more evidence that children with autism, as a group, are hypo-responsive to sensory stimuli, but there are also multiple failures to replicate findings and studies that demonstrate lack of group differences.

CONCLUSIONS

The use of different methods, the study of different sensory modalities, and the changing scientific standards across decades complicate interpretation of this body of work. We close with suggestions for future research in this area.

Issues in the taxonomy of psychopathology in mental retardation

Several factors appear to impede the development of a valid taxonomy of psychopathology in children and adolescents with mental retardation. These include (a) the lack of a widely accepted definition of psychopathology in mental retardation, (b) disagreement on the nature of the relationship between mental retardation and psychopathology, and (c) insufficient evidence for the reliability and validity of current DSM or ICD systems in this population. In this article, we offer a definition of psychopathology in children with mental retardation; review concepts of the relationship between psychopathology and mental retardation; argue that in moving toward a valid taxonomy factors to be considered should include data from multivariate studies, findings related to behavior phenotypes, and diagnostic considerations with stereotypic behavior and self-injury, organic brain syndromes and pervasive developmental disorders. Finally, we outline a research strategy that may serve as a useful framework for developing a valid taxonomy of psychopathology in this population.

Environmental and temperament assessments of children with Down's syndrome

This study was designed to investigate the family environment and the temperament of children with Down's syndrome (DS). Parents of 40 children with DS completed the Family Environmental Scale (FES). They also were asked to fill out the Temperament Assessment Battery for Children (TABC) for both the child with DS and the nearest same-sex sibling. A similar questionnaire of the TABC (teacher form) was sent to the children's teachers. The results of these investigations revealed that there were high scores in categories cohesion, expressiveness, achievement, moral/religious emphasis, organization and control on the FES, indicating that family members in the study cohort are relationship oriented, provide support for one another, emphasize ethical values and are able to express their feelings. Comparing TABC results between children with DS with their siblings, significant differences were observed in such categories as adaptability, approach/withdrawal and persistence. Control children were scoring higher in the adaptability and persistence categories, whereas children with DS achieved significantly higher scores than the control children in the approach/withdrawal category.

Clinical assessment of psychiatric symptoms in mentally retarded individuals

Mentally retarded Australians with emotional and behavioural disorders are seriously under-served by psychiatrists, despite such individuals being as prevalent as those with schizophrenia. These disorders have serious consequences for the individual, family and carers, and the community as a whole. In the psychiatric assessment of mentally retarded persons, a key principle is that while intellectual handicap increases vulnerability to psychiatric illness, it does not of itself cause psychopathology. A biopsychosocial framework provides a model whereby those factors which are contributing to psychopathology can be systematically elucidated. Biological factors include brain pathology associated with particular mental retardation syndromes, drug side-effects and epilepsy. Psychological factors include temperament, a history of abuse, and current life stresses. Social factors include distortions in family roles and hostel or workshop conflicts. Although clinical assessment can be challenging, and confident syndrome diagnosis is not always possible, a systematic approach to the analysis of symptoms will provide a guide to useful interventions.

The effects of experience on attribution of a stereotyped personality to children with Down's syndrome

A questionnaire in the form of a bipolar rating scale was constructed using 26 personality attributes drawn from the literature on personality of children with Down's syndrome (DS). This was administered to nine groups of adults with differing levels of experience and contact with children with DS. Adults who had frequent contact proved to be significantly less likely to rate the personality of children with DS as stereotypical than those with little contact. The implications of acceptance of the stereotype are discussed in relation to integration and to development of the mother-child relationship.

Temperament in Williams syndrome

Anecdotal reports suggest that children with Williams syndrome are loquacious, affectionate, charming, open, and gentle. The temperament, or behavioral style, of individuals with Williams syndrome was assessed using standard temperament scales of parental response. Children with Williams syndrome appear, on average, to display higher activity, lower rhythmicity, greater approach, lower adaptability, greater intensity, more negative mood, less persistence, greater distractibility, and lower threshold to arousal than will average children. Older children with Williams syndrome will likely be viewed as "difficult." Despite this overrepresentation in the "difficult" cluster, on average, this population differs from the usual population of "difficult" children in being approaching, rather than displaying a tendency to withdraw. Parents of a child with Williams syndrome should be apprised of potentially negative temperament characteristics, relieved of the burden of responsibility for having a difficult child who "should" be easy, and counselled, when appropriate, regarding the efficacy of modification of parent-child interactions with children having the difficult temperament.

Temperament characteristics of mentally retarded children

In a comparative study of temperament and intelligence in groups of mentally retarded and normal children, it was found that mentally retarded children who also had excess of psychopathology in them, showed greater signs of 'difficult' child temperament. Relationship between intelligence and emotionality variable of temperament was linear and positive in the mentally retarded children. This study generates the hypothesis that negative mood may be temperamental correlated with mental retardation.

Down's syndrome and toddler temperament

The temperament profiles of infants and toddlers with Down's syndrome were compared with those of a non-handicapped, age reference group. The comparison revealed that the children with Down's syndrome were generally similar to the non-handicapped group in terms of temperament characteristics. The results provide support for examining the temperament of children with Down's syndrome as a function of chronological rather than developmental age. The significance of documenting the diversity of behavioural styles among toddlers with Down's syndrome in evaluation and intervention is discussed.

Fact and fantasy: psychosocial consequences of facial surgery in 24 Down syndrome children

Twenty-four children with Down syndrome were evaluated to investigate whether appearance, family functioning and intellectual functioning improved after facial reconstruction. Pre- and postoperatively, families were interviewed by a psychosocial team, the children's intellectual functioning was measured and parents were asked to rate their child's facial appearance on the Hay's Scale and to complete the FACES II, a questionnaire determining family functioning. Parents' ratings were compared with the scores of lay raters who viewed randomly presented pre- and postoperative photographs. Measurements of intelligence and family functioning revealed no postoperative improvement and lay raters considered postoperative appearance as slightly less attractive. However, parents rated their children's appearance as noticeably improved and reported happier personal, family and social lives. Thus, positive psychosocial consequences may largely be the result of parents' satisfaction with surgical results, providing them with hope for the future. Presurgical family assessment to clarify surgical limitations and parental expectations is essential.

The temperament of Down's syndrome toddlers and their siblings

The Toddler Temperament Scale was completed by mothers of 37 Down's syndrome children. Questionnaires were also completed for 13 siblings. Comparisons with standardization scores on the difficult dimensions suggested that the Down's syndrome children were more rhythmic, less intense and of more positive mood than children of the same CA. In addition, they were less withdrawn and more adaptable than children of similar MA. The siblings were more rhythmic than the standardization sample and more persistent than the Down's syndrome children. There was no trend for Down's syndrome ratings to be strongly associated with own-sibling ratings.

Temperament in Australian infants

A convenience sample of 240 infants aged 4-8 months was studied to evaluate the suitability of a revised version of Carey's Infant Temperament Questionnaire (ITQ) for an Australian population. Data analyses indicated all item/dimension correlations significant at P less than 0.01 or better, satisfactory internal consistency of the instrument as measured by alpha coefficients, and test retest reliability of 0.79. Infants rated as having a 'difficult' temperament were significantly more likely to be reported as having problem behaviours. Significant differences were found between Australian and American infants on three of the nine temperament dimensions - rhythmicity, activity and intensity. The results of this study indicate that this revised ITQ is suitable for use with Australian infants.

The temperament of Down's syndrome toddlers: a research note

A toddler temperament questionnaire was completed by the mothers of fifteen Down's syndrome children who had been assessed two years earlier with the Carey infant temperament questionnaire. The results suggest that infants who have been scored as showing signs of difficult temperament move towards the easier signs on the toddler scale. If these temperament questionnaires are biased by maternal perceptions, this move may reflect a reduced level of maternal anxiety.