Developmental Functioning of Infants and Toddlers with Neurodevelopmental Disorders

PURPOSE

The current study aimed to investigate developmental functioning in infants and toddlers with autism spectrum disorder (ASD), seizures, cerebral palsy (CP), and atypical development.

METHODS

An ANOVA was utilized to investigate the differences between neurodevelopmental group on BDI-2 developmental quotient and a MANOVA was used to investigate the differences between the groups and five developmental domains.

RESULTS

The results indicated statistically significant differences in overall developmental functioning and each subdomain of the BDI-2.

DISCUSSION

These findings provide the basis for further research to investigate comorbidities of the three neurodevelopmental disorders and parse out the impact of intellectual disability (ID).

Developmental Functioning of Toddlers At-Risk for Autism With and Without Down Syndrome

PURPOSE

Due to the difficulties in differentiating between impairments associated with intellectual disability and ASD symptomology, DS often leads to delayed or misdiagnoses of ASD.

METHOD

An ANOVA was run to investigate the effects of ASD risk and DS on overall developmental functioning across three groups: ASD+, DS-, and DS+ (n = 138). A MANOVA was run to investigate the differences of group on five developmental subdomains.

RESULTS

The results revealed significant group differences in the overall developmental functioning and each developmental subdomain. Children in the DS+ group demonstrated significantly lower overall developmental functioning, as well as lower adaptive, cognitive, motor, and communication skills compared to their peers; however, children in the DS- group demonstrated significantly better social skills compared to their peers in the ASD+ group.

DISCUSSION

These findings support the need for early screening and identification of ASD among those with DS.

Examination of multiple birth as a predictor of autism symptom severity and developmental functioning in an early intervention sample

Multiple birth is one of several perinatal factors associated with increased risk for autism spectrum disorder (ASD); however, complexity in its relationship to ASD symptoms and developmental functioning remains. The present study investigated perinatal risk factors for ASD, primarily focusing on birth status, within a large early intervention sample. In particular, the relationship between ASD, perinatal factors, and the effect of birth status on developmental functioning and ASD symptom severity were examined in youth with and without ASD classification who were born singly or were the product of a multiple birth. Overall, the presence of other perinatal risk factors, including prematurity, low birth weight, and advanced parental age, was primarily related to birth status and not to ASD classification, while severity of ASD symptoms and developmental impairments were primarily related to ASD classification and not to birth status. Study findings and implications for early screening of children with developmental delays are discussed.

Challenging behaviour in children with developmental disabilities: an overview of behavioural assessment and treatment methods

Challenging behaviours often co-occur at high rates among those with autism spectrum disorder and intellectual disability. Challenging behaviours, including self-injury, aggression and property destruction, can be associated with social impairment and increased caregiver demands and stress. These behaviours often arise from and are maintained by a combination of biological and environmental risk factors throughout the lifespan. Given the impact of challenging behaviours on development, function-based assessment and intervention approaches are crucial. The prevalence, risk factors, assessment tools and evidence-based treatment options utilised for individuals with developmental disorders are discussed.

Development and initial testing of the BABY-BISCUIT in an at-risk population

PURPOSE

Early identification of autism spectrum disorder (ASD) via screeners for diagnostic measures are a high priority. At present, there is no consensus on one screener due to the need for better sensitivity and specificity. In this study, we report on the development and utility of the BABY-BISCUIT, a six-item screener based on a modified subset of items from the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT).

METHODS

A sample of 504 children between 17-3 9months of age, who consisted of toddlers identified as at-risk for neurodevelopmental and other health disorders, were tested during an annual screening through the Louisiana EarlySteps program.

RESULTS

An exploratory factor analysis yielded a one-factor solution (X2 = 48.62, df = 9, p = <.001). High sensitivity (i.e., 100.0%) at the cost of reduced specificity (i.e., 33.3%, AUC = 0.957) was found for an optimal screening cutoff score of 1.

CONCLUSIONS

Findings from this study suggest that the BABY-BISCUIT has the potential to be a short and easily administered screener for ASD to inform whether further ASD assessment is necessary. Further investigation of convergent validity with established ASD measures is recommended.

Factors Associated with Restricted, Repetitive Behaviors and Interests and Diagnostic Severity Level Ratings in Young Children with Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by restricted, repetitive patterns of behavior and interests (RRBIs). With the latest update to the Diagnostic and Statistical Manual of Mental Disorders, a severity level rating is assigned to the two core features of ASD (American Psychiatric Association in Diagnostic and statistical manual of mental disorders 5 American Psychiatric Association Washington, D.C., 2013). Previous studies have identified factors associated with RRBI severity; however, the relationship among RRBIs, adaptive functioning, and diagnostic severity level remains unclear. The present study investigated whether adaptive functioning and parent-reported ASD symptoms predict RRBI severity in young children with ASD. Additionally, a fine-grained analysis was conducted to examine the factors associated with diagnostic severity level ratings. Several significant associations were found. Study findings and implications for assessment and treatment of RRBIs are discussed.

Comparing Rates of Diagnosis Using DSM-IV-TR Versus DSM-5 Criteria for Autism Spectrum Disorder

With the publication of DSM-5, many changes were introduced regarding how Autism Spectrum Disorder (ASD) would be diagnosed. Changes from DSM-IV-TR were controversial, with many arguing that individuals would lose their diagnosis with the new criteria. The purpose of this study was to examine differences in the application of diagnostic criteria across both recent versions in a sample of infants and toddlers. Fewer individuals met criteria according to DSM-5; however, a larger proportion of individuals met criteria for both. Additionally, individuals with higher levels of symptoms were more likely to meet criteria for both versions as compared to either alone. Overall, results suggest that there are meaningful differences in how DSM criteria may apply to individuals with an ASD.

Parental Age at Conception and the Relationship with Severity of Autism Symptoms

BACKGROUND

Previous research has examined the relationship between advanced parental age at conception and the incidence of autism, and has noted strong relationships between advanced parental age and other developmental disabilities.

AIM

The purpose of this study was to confirm that and extend that knowledge to the association between advanced parental age and severity of autism symptoms as measured by a parental report of ASD symptom severity.

METHODS

The current study included 252 participants between the ages of 2-17 years and their parents.

RESULTS

Child's gender and paternal age were found to be significant predictors of autism severity with males and children with older fathers at conception showing the highest severity. Interestingly, maternal age was not found to be a significant predictor of autism risk or severity of symptoms in this sample.

CONCLUSION

Possible explanations for these findings are discussed, as well as future directions for research in this area.

Rett syndrome in adults with severe intellectual disability: Exploration of behavioral characteristics

Rett syndrome is a genetically linked form of autism spectrum disorder (ASD) accompanied by intellectual disability (ID). The disorder is also characterized by cardiorespiratory dysregulation, disturbance in muscle tone, reduced brain growth and scoliosis. Over 300 studies have been published on the disorder, most of which has focused on identification of causative factors, which appears to be the result of mutations of gene MECP2. Rarely have adults with Rett syndrome been studied, and behavioral characteristics in these individuals are largely unknown. The present study aimed to extend what little is known about behavioral characteristics of Rett syndrome in adults, with particular emphasis on social, communicative, and adaptive behavior. Rett syndrome adults with severe ID were matched to autistic adults with ID and ID only controls. The implications of these data for more fully describing and diagnosing the condition in adults are discussed.

Increasing Recognition Distance and Assessing Generalized Effects in Visually Impaired Persons

Earlier studies with behavioral procedures demonstrated increased recognition efficiency after training at distances greater than initially obtained on visual acuity tests. These changes have been regarded as improved acuity and attributed to increased control over accommodation. This study investigated these assumptions. Improved acuity was investigated by observing the generalization of effects in recognition efficiency from trained to untrained stimuli. Control over accommodation was investigated by observing the effects of training on recognition efficiency at increased distances with individuals who were physically incapable of accommodating. Neither hypothesis was supported. However, increased efficiency at increased distances was demonstrated with subjects who had had the physical mechanism for accommodation surgically removed. Implications for training are discussed.

Differences in Developmental Concerns of Young Children with Autism Spectrum Disorder Across Racial/Ethnic Groups

PURPOSE

Parents/caregivers of children with autism spectrum disorder (ASD) have varying types of initial concerns regarding their child's development, which may be culturally bound to parents' perceptions of their child's development. This study investigated differences in the types of initial developmental concerns reported by parents or caregivers of different racial/ethnic groups with children in an early intervention program.

METHOD

This study examined the frequency of endorsement of different types of concerns in African American, Caucasian, and Hispanic families.

RESULTS

No significant differences between racial/ethnic groups were found in the endorsement of concerns related to communication, language/speech, motor, problem behavior, sensory, feeding, prematurity, attention, adaptive functioning, and medical conditions. Racial/ethnic groups differed significantly in their endorsement for social concerns.

CONCLUSION

Racial/ethnic group differences were confirmed regarding initial developmental concerns related to social behavior, which may be due to cultural beliefs. The implications of these findings on early identification are discussed.

An investigation of the association between seizures, autism symptomology, and developmental functioning in young children

OBJECTIVE

The aim of the present study was to explore whether a history of seizures was associated with autism symptom severity and developmental functioning in young children.

METHODS

Autism symptom severity and developmental functioning were compared between children with and without a history or seizures who either had atypical development or met criteria for autism spectrum disorder (ASD) based on review of records by a licensed clinical psychologist.

RESULTS

Parents of children who met criteria for ASD reported lower levels of autism symptomology when the child had a history of seizures, while the opposite trend was found for children with atypical development. Participants without ASD or seizures had greater developmental functioning than the other groups.

CONCLUSION

The present study emphasizes the need for early identification and diagnosis of both ASD and seizure disorders, as timely intervention for these two conditions may be related to improved outcomes for young children.

An evaluation of the clinical application of the DSM-5 for the diagnosis of autism spectrum disorder

INTRODUCTION

The changes to the diagnostic criteria for autism spectrum disorder (ASD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) were met with much controversy by researchers, clinicians, and families of individuals with ASD. The goal of this paper is to review the literature on the impact of these changes. Areas covered: This paper reviews the major changes to diagnostic criteria from DSM-IV-TR to DSM-5. It emphasizes how these changes are hypothesized to impact prevalence rates, as well as trends in characteristics of individuals who would have met previous criteria for ASD but no longer qualify for a diagnosis under DSM-5. Policy issues such as access to services and research considerations are also briefly reviewed. Expert commentary: Researchers have found that the DSM-5 diagnostic criteria for ASD may significantly impact which children receive diagnoses, which in turn affects access to services that address impairments characteristic of this disorder. Despite the fact that the DSM-5 has now been in use for four years, fewer recent studies were identified than was expected. Future research should continue to focus on the impact of changes in criteria, as well as on translational scientific advances across disciplines.

An abbreviated scoring algorithm for the baby and infant screen for children with autism traits

PURPOSE

Autism spectrum disorder (ASD) screening is recommended for all children aged 18-24 months. However, healthcare providers may be burdened with the responsibility of conducting these screens in addition to necessary services. Therefore, developing a time-efficient screener with sound psychometric properties is essential.

METHODS

This study sought to update the abbreviated scoring algorithm of the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) and increase its clinical utility. Six thousand and three children with ASD or atypical development enrolled in an early intervention program participated.

RESULTS

A 6-item algorithm with a cutoff score of 3 was found to be optimal and yielded a sensitivity of 0.960 and a specificity of 0.864.

CONCLUSION

Sensitivity and specificity estimates were similar to that of the complete BISCUIT-Part 1; thus, the 6-item algorithm can reliably differentiate children at-risk for ASD requiring further assessment. The algorithm appears to be a promising tool for early identification.

Factors related to parental age of first concern in toddlers with autism spectrum disorder

PURPOSE

The age of first concern (AOC) of parents of children with autism spectrum disorders (ASD) has substantial implications for early diagnosis and intervention. The current study sought to determine the average AOC, what types of first concerns are most common, and what factors predict earlier AOC in toddlers with ASD.

METHODS

This study analyzed the predictive influence of the type of concern, symptom severity, medical diagnoses, and other independent variables on AOC among toddlers with ASD using multiple regressions.

RESULTS

The mean AOC was found to be 13.97 months (SD = 7.86). The most commonly reported first concern was speech/language. First concerns related to communication, speech/language predicted later AOC, while motor concerns predicted earlier AOC.

CONCLUSIONS

Concerns that are more closely related to social communication deficits characteristic of ASD predicted later AOC. The implications of these findings on screening/assessment and intervention are discussed.

Examining cross-cultural differences in autism spectrum disorder: A multinational comparison from Greece, Italy, Japan, Poland, and the United States

Autism spectrum disorder (ASD) is characterized by social and communication impairments as well as restricted, repetitive behavior patterns. Despite the fact that ASD is reported worldwide, very little research exists examining ASD characteristics on a multinational scale. Cross-cultural comparisons are especially important for ASD, since cultural differences may impact the perception of symptoms. Identifying behaviors that are similarly reported as problematic across cultures as well as identifying behaviors in which there is cultural variation could aid in the development and refinement of more universally effective measures. The present study sought to examine similarities and differences in caregiver endorsement of symptom severity through scores on the Baby Infant Screen for Children with aUtIsm Traits (BISCUIT). The BISCUIT was utilized to examine ASD core symptomology in 250 toddlers diagnosed with ASD from Greece, Italy, Japan, Poland, and the United States. Significant differences in overall ASD symptom severity and endorsement were found between multinational groups. Implications of the results are discussed.

The baby and infant screen for children with autism traits-part 2: The development of age-based cutoffs

OBJECTIVE

To create age-based scoring procedures for the BISCUIT-Part 2, an assessment measure of comorbid psychopathology in infants and toddlers aged 17-37 months.

METHOD

The standard deviation from the mean method was used to develop separate age-based cutoffs for those with an autism spectrum disorder (ASD) and those with non-ASD related developmental delays, using a sample of 2867 infants and toddlers and their parents.

RESULTS

As age increased in those with ASD, higher cutoff scores were indicated. Less variation was seen in the cutoff scores established for those with non-ASD related delays.

CONCLUSION

The findings suggest that as children with ASD grow older, symptoms of comorbidity become more prevalent and easier to detect. The implications of these results, as well as possible areas of future research, are discussed.

Treating Obsessive-Compulsive Behavior in Mentally Retarded Adults

Three mildly mentally retarded adults who lived in the community were treated for obsessive-compulsive behaviors. The patients were all males who displayed clothes and body checking for extended periods of time prior to initiation of the study. Treatment consisted of differential reinforcement of incompatible behavior for not exhibiting target behaviors, and overcorrection as response suppression was used when inappropriate responses occurred. Experimental conditions were baseline, treatment, and follow up. This was carried out in a multiple baseline design across behaviors, settings, and targets, using time-sampling and self-ratings of response severity via retrospective analysis of videotapes. To establish a social validation criterion, community members were asked to rate tapes of patient behavior from baseline to the end of treatment. Statistical analyses of these ratings were significant with respect to perceived improvement in appropriateness on the target behaviors. Similarly, on frequency counts, target behaviors and self-ratings of anxiety rapidly improved with the advent of treatment. These gains were maintained at the three month follow-up.

Programming Treatment Effects to the Natural Environment

Four adult females in the moderate to severe range of retardation were compared on two social learning oriented behavioral training packages. Treatment involved self-monitoring, information feedback, modeling, role-playing, and social reinforcement provided in daily training sessions on the ward or in a therapy room, with the degree and time information feedback was given varying across treatment conditions. An analysis of results showed that onward training was necessary for correct performance of target behaviors (e.g., talking too loudly, pestering staff) in the natural environment. Once target behaviors had been decelerated for several days, gains were found to maintain by prompting subjects on the ward, without the necessity of training sessions in the "therapy room."

Increasing Appropriate Behavior of Explosive Chronic Psychiatric Patients with a Social-Skills Training Package

Social-skills training was used with four long-term chronic psychiatric female inpatients. Targeted behaviors within training sessions were tailored for each subject on the basis of pretreatment observations. Training involved instructions, modeling, role-playing, and feedback, and was effective with behaviors assessed within a multiple-baseline design. Trained skills generalized to the ward setting, and arguing and fighting of these patients were markedly reduced. Treatment effects maintained during postchecks up to three months.

Assessment of Seizures and Related Symptomatology in Persons with Mental Retardation

Seizures can be debilitating across a number of physical, social, occupational, and personal variables. Given the deficits in all of these areas frequently present in persons with mental retardation, effective assessment and subsequent treatment of seizures is a primary goal for individuals with both mental retardation and epilepsy. To thoroughly address the behavioral domains related to seizures in persons with mental retardation and epilepsy, areas of assessment should include seizure behavior, triggering stimuli, reinforcing consequences, and antiepileptic medication side effects. Assessment of these areas in this population often deviates from methods typically used with persons of normal intelligence. Specifically, direct behavioral observation and third-party report with structured interviews are the most viable and accessible means of assessment, and efforts to establish reliable and valid protocols have been successful in some areas. This article reviews this assessment methodology and discusses the extant issues in establishing and proliferating such approaches.

Preventing Home Accidents

Five retarded adults (moderate to severe) were trained in skills necessary for handling emergencies via classroom training and participant modeling. Training consisted of instructions, modeling, feedback, rehearsal, and social reinforcement. Skills for handling emergency situations were quickly trained and maintained during follow-up. Classroom training did not generalize to in vivo performance of target behaviors, although role-played training in combination with classroom training did. Determining if participant modeling is the only necessary component and analyzing other methods of modeling with various behaviors and populations are questions for further study.

The Relationship of Comorbid Problem Behaviors to Social Skills in Persons With Profound Mental Retardation

Research into behavior problems among individuals with mental retardation has been well developed. However, few studies have addressed the effect of multiple problem behaviors on social skills. In the present study, the authors examined the relationship between two problem behaviors, stereotypy and self-injury, and social skills among individuals with profound mental retardation. A total of 120 participants were divided into four groups based on the presence of stereotypic and self-injurious behavior. Persons with comorbid stereotypy and self-injury evinced more negative nonverbal social skills than did those with self-injury alone or no problem behaviors. In the past, researchers examined behavior problems as isolated phenomena. However, a recent shift in the conceptualization of problem behaviors has exposed the lack of research regarding the nature of social and adaptive skills in the face of multiple topographies of problem behaviors using broader conceptualizations.

Overcorrection Treatment of Stereotyped Behaviors

The efforts of an overcorrection treatment program for stereotyped responses by chronic psychiatric patients were assessed. Treatment in both studies involved the contingent use of "hand overcorrection" procedure, in which the subject was required to hold his hands in specified positions for 15 seconds each for a total of 5 minutes. In Study 1, wall-patting was reduced across three settings within a combined multiple-baseline reversal design. Collateral measures showed increased appropriate social responding (smiling and verbal comments) concurrent with treatment. In Study 2, contingent overcorrection eliminated stereotyped responses by three subjects who had topographically similar response patterns. Major findings of these studies were: (I) overcorrection effectively reduced stereotyed behaviors; (2) reduction of target behaviors did not generalize across settings and had to be programmed; (3) modeling effects were negligible for reduction of these behaviors; (4) the trainer became a discriminative stimulus for the overcorrection contingency; (5) maintenance of response reduction was accomplished by fading the trainer out of the treatment setting: and (6) positive side-effects were observed concurrent with treatment, but were not maintained as the target decreased in frequency.

Overcorrection of Aggressive Behavior in a Chronic Psychiatric Patient

A psychiatric patient who had been institutionalized for 43 years was treated for throwing small objects in the face of other patients and ward staff. Over-correction consisted of requiring her to perform the following behaviors contingent on each occurrence of object-throwing: (1) apologize to the offended person for her behavior, and (2) pick up objects from the floor and put them in the trash can for five minutes. This contingency reduced the frequency of the target behavior, whereas differential reinforcement of incompatible behavior had no effect. Elimination of object-throwing maintained over an 11-week posttreatment phase.

Questions About Behavioral Function in Mental Illness (QABF-MI)

The Questions About Behavioral Function (QABF), a 25-item rating scale, was developed to identify the function(s) of maladaptive behavior in individuals with developmental disabilities. The authors adapted it for use with individuals with serious mental illness who engage in maladaptive behavior and assessed the psychometric characteristics of the new scale (Questions About Behavioral Function in Mental Illness; QABF-MI) in a sample of 135 adults with serious mental illness from three inpatient psychiatric hospitals. Staff most familiar with each person rated each item on a 5-point Likert-type rating scale, and the ratings were subjected to a number of psychometric analyses. The results of factor analyses provided a conceptually meaningful five-factor solution: physical discomfort, social attention, tangible reinforcement, escape, and nonsocial reinforcement. Congruence between the five factors derived with the QABF-MI and the corresponding factors in the original QABF was perfect. The results indicated that the QABF-MI has robust psychometric properties and may be useful as a screening tool for determining the nature of the variables that maintain maladaptive behavior exhibited by individuals with serious mental illness.

Assessment of Feeding and Mealtime Behavior Problems in Persons with Mental Retardation

Feeding and mealtime behavior problems are commonly observed among individuals with developmental disabilities. These problems include, but are not limited to, food refusal, food selectivity, mealtime aggression, rumination, pica, and insufficient feeding skills. Difficulties of this type can be associated with life-threatening consequences of other serious health-related problems. Because of the nature of these problems and the lack or accurate client self-reporting, an interdisciplinary assessment in addition to a thorough behavioral assessment is recommended to ensure the best quality of care. This article discusses the role of the various disciplines, and the types of behavioral assessments that are currently being utilized by clinicians and researchers.

Premature birth as a risk factor for autism spectrum disorder

OBJECTIVE

Autism spectrum disorder (ASD) is common, life-long in nature, and can be very debilitating. Thus, an intensive search is on to identify the potential risk factors for the disorder. Premature birth has been identified as one potential factor that could influence potential symptoms of ASD.

METHOD

The sample for this study consisted of 1655 at risk children for developmental delays who were 17-37 months of age. Participants were divided into those diagnosed with ASD (n = 916) and children with atypical development only (n = 739).

RESULTS

Premature births were almost twice as common for the atypical development group versus the ASD group.

CONCLUSIONS

Implications of these data are discussed.

The relationship of attention-deficit hyperactivity disorder and autism spectrum disorder to adaptive skills in young children

OBJECTIVE

Attention-deficit hyperactivity disorder (ADHD) has been linked to deficits in socialization and communication, similar to those observed in children with ASD. In the present study, we examine the differences in developmental quotient and subscale scores between children with ASD and children with ADHD.

METHODS

We compared the developmental scores in a sample of 2990 children who presented to an early intervention program, who met criteria for ASD, inattentive ADHD, hyperactive/impulsive ADHD, combined ASD/ADHD, or are at risk for developmental disorders.

RESULTS

The overall developmental quotient did not significantly differ between those in the ADHD inattentive and hyperactive subtype groups. Adaptive skills differed most greatly between the ASD groups and the ADHD/atypically-developing groups.

CONCLUSION

The present study represents a first step towards understanding the relationship of ADHD to ASD in early childhood. Young children with ASD symptoms are more greatly impaired than those with symptoms of ADHD.

Autism severity as a predictor of inattention and impulsivity in toddlers

OBJECTIVE

Evaluate how severity of autism spectrum disorder (ASD) symptoms predicts attention-deficit/hyperactivity disorder (ADHD) symptoms in atypically developing toddlers.

METHOD

Parents/caregivers of 2300 atypically developing toddlers' ages 18-37 months were assessed about their children's behaviours using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) Part 1 and the inattention/impulsivity subscale of the BISCUIT-Part 2.

RESULTS

ASD symptom severity was positively and significantly correlated with inattention/impulsivity, indicating that children with more severe symptoms of ASD tended to have higher scores on the measure of inattention/impulsivity, R(2) = 0.49, F (1, 2298) = 2234.72, p < 0.001. Additionally, ASD symptom severity significantly predicted inattention/impulsivity, β = 0.70, t (2298) = 47.27, p < 0.001.

CONCLUSIONS

ASD symptom severity predicts rates of ADHD symptoms in atypically developing toddlers. The implications of these findings are discussed in the context of other research.