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The Effects of Severity of Autism and PDD-NOS Symptoms on Challenging Behaviors in Adults with Intellectual Disabilities
Abstract
Autism Spectrum Disorders (ASD) constitute a group of neurodevelopmental conditions that result in marked delays and impairments.
The ASD can be defined by a good deal of heterogeneity and severity of specific behaviors within the general domains of communication,
social behavior, and repetitive/stereotyped behavior. ASD also puts the afflicted individual at risk for other problems such
as intellectual disability and challenging behaviors. This study assessed the relationship between severity of ASD core symptoms
and the rate and types of challenging behaviors evinced in 298 adults with severe intellectual disabilities (ID). General
categories of aggression/destruction disruptive behavior, and self-injury were studied. More severe core ASD symptoms were
associated with higher rates of challenging behaviors. The implications of these findings are discussed.
... More specifically, much of the current literature on aggression has focused on those with intellectual disability (ID), while little work has included autistic people across a range of cognitive abilities. In one of few studies on adults, Matson and Rivet (2007) found that between 15 and 18% of adults with autism and cooccurring ID exhibited aggression based on a clinicianrated questionnaire completed by doctoral students who had known participants for at least six months. It remains unclear how often aggression persists from childhood through adolescence or adulthood among autistic people and to what extent adults with aggression demonstrated these behaviors as children. ...
... These findings also align with prior cross-sectional studies, which found a negative relationship between age and likelihood of aggression. (Hartley et al., 2008;Kanne & Mazurek, 2010;Matson & Rivet, 2007). Although our overall pattern of findings is consistent with prior work, it is important to note that the estimated rate of aggression at age 2 in our sample (54%) was much larger than what has been found by previous studies (e.g., 22.5% for a sample of autistic children with a mean age of 3.5 years and comparable cognitive ability to the current sample; Hartley et al., 2008). ...
... Correlational findings in the current study were consistent with prior cross-sectional research investigating factors related to aggression (Hartley et al., 2008;Kanne & Mazurek, 2010;Matson & Rivet, 2007;Murphy et al., 2005). Specifically, VIQ and NVIQ, autism symptoms, and adaptive behavior were correlated with aggression in the expected directions at most time points. ...
Aggression is common in autism and neurodevelopmental disorders, but longitudinal research on aggression is lacking. We longitudinally tracked aggression in 254 individuals from toddlerhood to emerging adulthood. Our sample included participants with a range of cognitive abilities, with 39.9% classified as more-cognitively-abled (MCA; IQ ≥ 70) and 60.1% as less-cognitively-abled (LCA; IQ < 70). Aggression Composite scores were derived from data from the autism diagnostic observation schedule, autism diagnostic interview-revised, and child behavior checklist at ages 2, 9, and 18. Fifty-four percent, 69%, and 42% of the sample showed aggression in toddlerhood, school age, and emerging adulthood, respectively. LCA individuals had higher rates of aggression in school age (80%) and emerging adulthood (58%) compared to MCA individuals (48 and 22%, respectively). Longitudinal aggression profiles revealed distinct patterns of change over time: 31% displayed persistent aggression, 25% increased, 23% decreased, and 13% never displayed aggression. Higher autism symptoms, lower VIQ, NVIQ, and less-developed adaptive skills correlated with more aggression cross-sectionally. Nonverbal IQ and repetitive behaviors related to aggression longitudinally: people in decreasing or absent profiles had higher NVIQ and fewer RRBs than those with persistent or increasing profiles. Participants with aggression at 9 were four times likelier to exhibit aggression at 18. Aggression is common in autism and NDDs, peaking around age 9, and declining in emerging adulthood. Patterns of change varied widely, with evidence that higher NVIQ and fewer RRBs may be protective. Findings have implications for clinical practices, highlighting important developmental periods and high-risk subgroups.
... Table 3, most of the relational studies used a version of the BPI [29,31,, the ABC [94][95][96][97][98][99][100][101], or the ABC-C [33,[105][106][107][108][109][110][111]. The other instruments used for these studies were ASD-BPA [115][116][117][118][119], CCB [30,[147][148][149][150][151], MOAS [153][154][155], RBS-S [157][158][159], IBR-MOAS [152], RBQ [156], and A-SHARP [121]. Thirteen studies used different combinations of the aforementioned instruments [28,32,[102][103][104]112,113,120,[143][144][145][146]. ...
... All of the studies that explored the relationship between autism spectrum disorder and CB concluded that people with IDDs and autism spectrum disorder exhibited significantly more CBs than people with IDDs alone [32,95,99,100,103,107,[115][116][117]119,120,126,129,141,143,145]. According to Sappok et al. (2014), autism was the only mental disorder associated with CB in general. ...
... The instruments most commonly used to establish this relationship were the ABC, ABC-C, some versions of the BPI-01, or a combination of different instruments. Age [36,98,106,108,151]; the level of adaptive behavior, disability, and language [29,30,68,95,97,99,100,106,107,118,124,129,135,138,145,158]; the presence of autism spectrum disorder [32,95,99,100,103,107,[115][116][117]119,120,126,129,141,143,145]; the type of diagnosis linked to a genetic syndrome [101,105,109,111,122,142,145,146,156,158]; psychiatric disorders associated with the severity of the disability [29,96,107,113,125,127,134,139,[152][153][154][155]158]; medication and sleep problems [100,107], [113,129]; and the level of stress and emotional exhaustion of family members and caregivers [114,121,128,132,133,137,149,150] were the variables identified as being related to the occurrence of these behaviors. There appears to be robust evidence for some of the variables studied. ...
The assessment of challenging behavior exhibited by people with intellectual and developmental disabilities is essential for the planning of prevention and intervention programs. This review aimed to identify and analyze the standardized instruments that exclusively focus on the assessment of challenging behavior. We identified and organized 141 articles into four categories: original instrument studies, validation studies, relational studies, and intervention studies. The results identified 24 instruments that generally show high-quality psychometric properties and other utilities beyond the observation of the presence of challenging behavior and diagnostic categorization. Age, level of adaptive behavior, disability, presence of autism spectrum disorder, and medication are some of the variables that were found to be possibly related to the occurrence of challenging behavior. Additionally, the results suggest that interventions focused on supporting positive behavior or providing training on behavior to professionals and caregivers significantly reduced the occurrence of these behaviors. Instruments that help us to understand and measure the challenging behavior exhibited by people with intellectual and developmental disabilities are essential for the design of effective evaluation and intervention protocols.
... Sixteen studies included people with all levels of intellectual disability (Bowring et al., 2017;Crocker et al., 2006;Hartley & MacLean, 2007;Hemmings et al., 2006;Horovitz et al., 2013;Hurley, 2008;Lundqvist, 2013;Matson & Rivet, 2008;Nøttestad & Linaker, 2002;Rojahn et al., 2004Rojahn et al., , 2010Sappok et al., 2014;Thorson et al., 2008;Tsiouris et al., 2011;Turygin et al., 2013;Tyrer et al., 2006), six studies included people with mild intellectual disability (Alexander et al., 2010(Alexander et al., , 2015Didden et al., 2009;Drieschner et al., 2013;Phillips & Rose, 2010;Tenneij et al., 2009), five studies included people with mild or moderate intellectual disability (Clark et al., 2016;Crocker et al., 2014;Davies et al., 2015;Larson et al., 2011;Lunsky et al., 2012), one study included people with mild, moderate or severe intellectual disability (Esbensen & Benson, 2006), one included people with moderate or severe intellectual disability (Totsika et al., 2008), one study included people with moderate, severe, or profound intellectual disability (Bernstein et al., 2015) and three included people with severe or profound intellectual disability (Cervantes & Matson, 2015;Matson et al., 2009;Ross & Oliver, 2002). ...
... Thirteen studies recruited people living in a residential facility (Bernstein et al., 2015;Cervantes & Matson, 2015;Drieschner et al., 2013;Horovitz et al., 2013;Matson et al., 2009;Matson & Rivet, 2008;Owen et al., 2004;Phillips & Rose, 2010;Rojahn et al., 2004Rojahn et al., , 2010Thorson et al., 2008;Totsika et al., 2008;Turygin et al., 2013), 13 had a mix of settings (Allen et al., 2012;Bowring et al., 2017;Clark et al., 2016;Crocker et al., 2006;Esbensen & Benson, 2006;Hartley & MacLean, 2007;Hemmings et al., 2006;Koritsas & Iacono, 2015;Lundqvist, 2013;Lunsky et al., 2012;Nøttestad & Linaker, 2002;Sappok et al., 2014;Tyrer et al., 2006), six concerned people living in a forensic or inpatient treatment facility (Alexander et al., 2010(Alexander et al., , 2015Didden et al., 2009;Lindsay et al., 2013;Novaco & Taylor, 2004;Tenneij et al., 2009) and two studies recruited people living in a community setting (Crocker et al., 2014;Tsiouris et al., 2011). Four studies did not report the living arrangements of individuals (Davies et al., 2015;Hurley, 2008;Larson et al., 2011;Ross & Oliver, 2002). ...
... The majority of studies used informant reports (n = 23) (Allen et al., 2012;Bernstein et al., 2015;Bowring et al., 2017;Cervantes & Matson, 2015;Crocker et al., 2006;Drieschner et al., 2013;Esbensen & Benson, 2006;Hartley & MacLean, 2007;Horovitz et al., 2013;Koritsas & Iacono, 2015;Lundqvist, 2013;Matson et al., 2009;Matson & Rivet, 2008;Nøttestad & Linaker, 2002;Owen et al., 2004;Phillips & Rose, 2010;Rojahn et al., 2004Rojahn et al., , 2010Ross & Oliver, 2002;Tenneij et al., 2009;Thorson et al., 2008;Totsika et al., 2008;Turygin et al., 2013), whereas others used chart reviews to collect relevant information (n = 7) (Alexander et al., 2010(Alexander et al., , 2015Didden et al., 2009;Hurley, 2008;Lindsay et al., 2013;Sappok et al., 2014;Tyrer et al., 2006). ...
Background
Aggressive behaviour is prevalent in people with intellectual disabilities. To understand the aetiology, it is important to recognize factors associated with the behaviour.
Method
A systematic review was conducted and included studies published between January 2002 and April 2017 on the association of behavioural, psychiatric and psychosocial factors with aggressive behaviour in adults with intellectual disabilities.
Results
Thirty‐eight studies were included that presented associations with 11 behavioural, psychiatric and psychosocial factors. Conflicting evidence was found on the association of these factors with aggressive behaviour.
Conclusions
The aetiology of aggressive behaviour is specific for a certain person in a certain context and may be multifactorial. Additional research is required to identify contributing factors, to understand causal relationships and to increase knowledge on possible interaction effects of different factors.
... The overall prevalence of aggression in ASD is 53.7% [2], with as many as 68% of individuals exhibiting physical aggression toward caregivers [36]. Aggressive behaviors can continue into adulthood in 15 to 18% of patients with ASD and intellectual disability [37]. Contributors to aggression include self-injurious behavior, ritualistic behavior, and resistance to change [36]. ...
... Identifying a strong association between ASD-R, epilepsy, and aggression may also clarify if they share etiologic underpinnings, and perhaps respond to similar treatment pathways. Since epilepsy has a higher prevalence in ASD patients over 13 years of age [25], and aggression may occur in adulthood [37], this study only examined patients 12 years of age and over. Younger patients were excluded, since their inclusion would have risked underestimating the true prevalence of these co-morbidities. ...
Autism spectrum disorder (ASD) with regression (ASD-R) involves the loss of previously attained developmental milestones, typically during the first or second year of life. As children age, it is not uncommon for them to develop comorbid conditions such as aggressive behaviors or epilepsy, which can inhibit habilitation in language and social function. In this paper, we hypothesize that aggressive behaviors and epilepsy more commonly develop in patients with ASD-R than in those without a history of regression (ASD-NR). We conducted a retrospective review of non-syndromic patients with ASD over 12 years of age and compared the rates of epilepsy and aggression between ASD-R and ASD-NR patients. Patients with ASD-R, as compared to ASD-NR patients, demonstrated non-significantly higher rates of epilepsy (51.8% vs. 38.1%, p = 0.1335) and aggressive behaviors (73.2% vs. 57.1%, p = 0.0673) when evaluated separately. The rates for combined epilepsy and aggression, however, were statistically significant when comparing ASD-R versus ASD patients (44.5% vs. 23.8%, p = 0.0163). These results suggest that epilepsy with aggression is more common in ASD-R as compared to ASD-NR patients. When considering the impact of epilepsy and aggression on quality of life, these co-morbidities effectively cause a second regression in patients who experienced an earlier regression as toddlers. A larger, prospective trial is recommended to confirm these associations and further define the timeline in which these characteristics develop from early childhood to adolescence.
... Matson et al. (2009) determined that challenging externalizing and internalizing behaviors contributed significantly to the severity of the ASD condition. When comparing a population of individuals with mild and severe ASD, Matson and Rivet (2008) reported that individuals with severe ASD were more likely to endorse a variety of maladaptive behaviors. ...
... In general, the existing research supports variance in both externalizing and internalizing behaviors based on ASD severity (Matson et al., 2009). Similar to Matson and Rivet's (2008) findings, we found that externalizing behaviors were impacted by ASD symptom severity. In other words, individuals with severe ASD were more likely to engage in repetitive, self-injurious, aggressive, and destructive behaviors. ...
Being in a caregiver role for a child with autism spectrum disorder (ASD) brings a unique set of stressors and challenges to the entire family unit. This study examined a model hypothesizing that (a) parenting stress and the parenting style used by the parents of a child with ASD are correlated; (b) ASD severity, parenting stress, and parenting style uniquely explain the variance in the presentation of internalizing and externalizing symptoms among children with ASD; and (c) parenting style moderates the association between ASD severity and the presentation of internalizing and externalizing behaviors after controlling for specific demographic variables. A group of online participants were recruited through personal contacts, social media, and Amazon’s Mechanical Turk. The group of subjects, made up of 70 primary caregivers of children ages 3 to 18 years diagnosed with ASD, completed a self-report measure. Statistical analyses revealed that ASD severity and parenting style contributed to externalizing behaviors but did not have a significant impact on internalizing behaviors. Parenting stress was the primary predictor of both internalizing and externalizing child behaviors. Parenting style was not related to the stress level of parents of children with ASD and was not found to moderate the relationship between ASD severity and internalizing and externalizing behaviors. Implications for future research and clinical practice are discussed, highlighting the importance of reducing parenting stress and providing parent training to promote positive parenting styles for children with ASD.
... (2) impulsive and repetitive behaviours (e.g. increased stereotypy, motor inhibition difficulties, overactive behaviour; Matson & Rivet 2008;Oliver et al. 2009;Arron et al. 2011;Oliver et al. 2011); and (3) low affect (Carr et al. 2003;Arron et al. 2011). ...
... Emerson et al. (2001) and Murphy et al. (1999) failed to demonstrate a significant association between severity of autism symptoms and challenging behaviour (including SIB). Yet, Matson & Rivet (2008) reported that adults living in a residential facility with severe symptoms of ASD had significantly higher levels of SIB and disruptive behaviours than participants with mild ASD symptoms. It is unclear whether such discrepancy in findings is due to differences in participant sampling techniques (e.g. ...
... El Trastorno del Espectro Autista (TEA) es una condición neurobiológica que afecta la comunicación, la interacción social y los comportamientos repetitivos (American Psychiatric Association, 2013). Los niños con TEA pueden experimentar dificultades significativas para regular sus emociones y son propensos a crisis emocionales más frecuentes que los niños neurotípicos (Bölte y Poustka,2006) Estas crisis pueden manifestarse a través de conductas desafiantes como rabietas, autolesiones o comportamientos disruptivos (Matson y Rivet, 2008), y son desencadenadas por factores como cambios en la rutina, dificultades sensoriales, problemas de comunicación no resueltos o estrés ambiental (Anderson et al., 2007). Las actitudes de las educadoras de párvulos hacia los niños con autismo y sus crisis emocionales pueden influir significativamente en la eficacia de la intervención educativa. ...
Introducción: La falta de conocimiento y estrategias metodológicas para abordar crisis emocionales en niños con Trastorno del Espectro Autista (TEA) es un problema identificado por educadoras en centros educativos. Este estudio tiene dos objetivos principales: identificar las actitudes de las educadoras de párvulos respecto a su formación para manejar crisis emocionales en niños con TEA y determinar las áreas específicas en las que perciben fortalezas o debilidades en su preparación. Metodología: La investigación fue cuantitativa y exploratoria, con una muestra no probabilística de 40 educadoras de párvulos de la región metropolitana que trabajan o han trabajado con niños con diagnóstico de autismo. Resultados: Las educadoras de párvulos sienten una necesidad urgente de mejorar su formación y apoyo en el manejo de niños con TEA junto con la necesidad de herramientas específicas para el aprendizaje y manejo de crisis emocionales en estos niños. Discusión: El 95% desea asesoramiento de expertos y el 85% colaborar con otros docentes. Estas cifras revelan deficiencias en su formación inicial y acceso a recursos especializados. Conclusiones: Es crucial que las instituciones educativas implementen programas de desarrollo profesional y proporcionen recursos adecuados para mejorar la preparación y apoyo continuo de las educadoras.
... There are varying reports on the prevalence of aggression in the literature, with some studies reporting aggression as low as 15% among adults with autism spectrum disorder (ASD; Matson & Rivet, 2007) and others reporting aggression as high as 53% among autistic children (Mazurek et al., 2013). Although such destructive behavior is common in individuals with neurodevelopmental disorders (Emerson et al., 2001;Esteves et al., 2021;Richards et al., 2012), the presence of destructive behavior is not a defining characteristic of any neurodevelopmental disorder, including ASD (Greer, 2023). ...
A successful intervention for aggressive-destructive behavior starts with a clear understanding of why the behavior occurs. Behavior analysts use functional behavior assessments, including functional analysis, to determine the conditions under which responding occurs and does not occur. Assessment results are then used to inform the development of a function-based treatment. This chapter provides an overview of the key elements for conducting a valid functional analysis and walks the reader through the process of using those results to build an effective treatment plan for aggressive-destructive behavior, including a discussion of the conceptual underpinnings of different approaches to treatment. Modifications to improve the practicality of the treatment plan are also discussed, as are more advanced topics, including whether and how to incorporate the use of supplemental procedures into the treatment plan. The chapter ends with a brief discussion of treatment relapse and methods to mitigate its occurrence.
... The most prevalent forms of aggressive behaviour in children with ASD are any forms of aggression toward others, aggression toward self and property destruction (Hill et al., 2014;Elkhamisi & Almutery, 2018). Matson & Rivet (2008) obtained the results that 7% of children with ASD engaged in throwing objects at others, 15% engaged in aggression towards others, while 14% of them engaged in property destruction. ...
The aim of this research was to examine characteristics and predictors of aggressive behaviour in children with autism spectrum disorders (ASD), as well as to determine the presence of aggressive behaviour exhibited by children with ASD. The sample included 43 participants diagnosed with ASD. The instrument used was the Behaviour Problems Inventory-BPI-01 (Rojahn et al., 2002), aggression subscale. Our findings indicate that the children with ASD from our sample exhibit low rates of aggressive behaviour. Among those participants who do exhibit aggression towards others, the most prevalent forms of aggression were verbal aggression, grabbing and pulling others, cruelty and property destruction. Gender and the type of school the participants attended were not predictors of aggressive behaviours, while aggressive behaviour can be predicted by the child's functionality level, where participants with low functioning ASD exhibit more aggressive behaviours in comparison with participants with high functioning ASD. Also, aggressive behaviour can be predicted by age, where increase in chronological age is negatively correlated with aggression. It is crucial that special educators address the aggressive behaviour exhibited by children with ASD from an early age. Even though it is important to know the topographies of aggression among children with ASD, which were presented in our findings, it is more important to examine the most common functions of aggression, or the reasons why the children with ASD exhibit these behaviours.
... significant predictor of maladaptive behavior trajectories, such that individuals with ASD with lower cognitive ability not only present with higher levels of maladaptive behaviors, but also experience slower improvement in these behaviors over time (Anderson et al., 2011;McTiernan et al., 2011;Shattuck et al., 2007;Woodman et al., 2015). Greater autism features have also been found to be associated with higher levels of maladaptive behaviors (Anderson et al., 2011;Matson & Rivet, 2008;McClintock et al., 2003), though the impact of ASD features on patterns of maladaptive behaviors in ASD over time is not well-studied and findings have been mixed. For example, some studies have found no significant relationship between the severity of ASD and maladaptive behavior trajectories (Stringer et al., 2020), while others have found an association between greater severity of ASD and greater improvement in maladaptive behaviors (Anderson et al., 2011). ...
People with autism spectrum disorder (ASD) and non-spectrum developmental delays frequently exhibit maladaptive behaviors throughout the lifespan, which can have pervasive effects on quality of life. Maladaptive behaviors have been shown to change over time as a function of various individual-level factors (e.g., cognitive ability), yet research is primarily limited to parent-reported measures. To expand upon this work, the present study aimed to examine trajectories of teacher- and parent-reported maladaptive behaviors (i.e., hyperactivity, irritability, social withdrawal) and to test whether individual-level predictors (e.g., autism features, verbal intelligence quotient) and school-related predictors (e.g., teacher type, student-adult ratio, personal aide, school type) impact these trajectories among 165 individuals with ASD or non-spectrum delays from ages 9 to 18. Multilevel models revealed that, according to both teacher and parent report, participants showed the greatest improvement in hyperactivity, less but still notable improvement in irritability, and stable levels of social withdrawal over time. Higher verbal ability and fewer ASD features, in addition to mainstream school placement, emerged as important individual- and school-related differences associated with fewer maladaptive behaviors over time. The multi-informant perspective and longitudinal design provide novel insight into the manifestations of these maladaptive behaviors across different contexts and across time. Findings highlight the consistency of teacher- and parent-reported trajectories over time and further emphasize the importance of targeting maladaptive behaviors using a multisystem intervention approach in both school and home contexts.
... Of the approximately 1 in 44 U.S. children each year who receive diagnoses of autism spectrum disorder 1 (ASD), roughly one-quarter will remain minimally verbal past age 5. 2 These children use a limited vocabulary of single words or fixed phrases to communicate, and they experience high rates of challenging behaviors, such as aggression and self-injury. [3][4][5][6] Until recently, these children were not included in research studies because they are challenging to assess, especially with standardized tests. However, in the past decade or so, assessment techniques have been refined and more studies investigating the effects of communication treatment for these severely affected children have been conducted. ...
We tested an intonation‐based speech treatment for minimally verbal children with autism (auditory‐motor mapping training, AMMT) against a nonintonation–based control treatment (speech repetition therapy, SRT). AMMT involves singing, rather than speaking, two‐syllable words or phrases. In time with each sung syllable, therapist and child tap together on electronic drums tuned to the same pitches, thus coactivating shared auditory and motor neural representations of manual and vocal actions, and mimicking the “babbling and banging” stage of typical development. Fourteen children (three females), aged 5.0–10.8, with a mean Autism Diagnostic Observation Schedule‐2 score of 22.9 (SD = 2.5) and a mean Kaufman Speech Praxis Test raw score of 12.9 (SD = 13.0) participated in this trial. The main outcome measure was percent syllables approximately correct. Four weeks post‐treatment, AMMT resulted in a mean improvement of +12.1 (SE = 3.8) percentage points, compared to +2.8 (SE = 5.7) percentage points for SRT. This between‐group difference was associated with a large effect size (Cohen's d = 0.82). Results suggest that simultaneous intonation and bimanual movements presented in a socially engaging milieu are effective factors in AMMT and can create an individualized, interactive music‐making environment for spoken‐language learning in minimally verbal children with autism.
... Moreover, the hypothesis of serotonin disruption in ASD is supported by reports of beneficial effects of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) for patients with autism (Zafeiriou et al, 2009;West et al, 2009). Therefore, the hormonal changes in adolescence (mainly of testosterone) and the possible dysregulation of the serotonergic system, which increases the severity of ASD, seem to place autistic adolescents at particular risk of aggressive behaviour against both themselves and others, as described in (Matson & Rivet, 2008). ...
Aggression in adolescents with autism spectrum disorder (ASD) can force parents either to medicate them or to place them in residential care programs. Here, some key issues related to adolescents' behavioural problems are summarized both for typical populations and for people with ASD, the aim being to provide parents and caregivers with a social perspective that goes beyond purely clinical approaches. Despite the challenges they face, autistic adolescents usually overcome them by early adulthood, though aggressive behaviour seems to be more a function of the autistic condition itself (e.g. repetitive behaviours) than of the passage through adolescence. Inter-parental conflicts and parenting styles may influence ASD children's mental health and even autistic symptoms. Provisions and education for the whole family are advocated.
... Autism is regarded as a spectrum of disorder as the symptoms can be reflected in diversified types ranging from mild to severe [68]. Due to its heterogeneous condition, each individual with autism has a unique profile of symptoms. ...
Autism Spectrum Disorder (ASD) is a neuro-developmental disorder that limits social interactions, cognitive skills, and abilities. Since ASD can last during an affected person's entire life cycle, the diagnosis at the early onset can yield a significant positive impact. The current medical diagnostic systems (e.g., DSM-5/ICD-10) are somewhat subjective; rely purely on the behavioral observation of symptoms, and hence, some individuals often go misdiagnosed or late-diagnosed. Therefore, researchers have focused on developing data-driven automated diagnosis systems with less screening time, low cost, and improved accuracy while significantly reducing professional intervention. Human Activity Analysis (HAA) is considered one of the most promising niches in computer vision research. This paper aims to analyze its potentialities in the automated detection of autism by tracking the exclusive characteristics of autistic individuals such as repetitive behavior, atypical walking style, and unusual visual saliency. This review provides a detailed inspection of HAA-based autism detection literature published in 2011 on-wards depicting core approaches, challenges, probable solutions, available resources, and scopes of future exploration in this arena. According to our study, deep learning outperforms machine learning in ASD detection with a classification accuracy of 76\% to 95\% on different datasets comprise of video, image, or skeleton data that recorded participants performing a large number of actions. However, machine learning provides satisfactory results on datasets with a small number of action classes and has a range of 60\% to 93\% accuracy among numerous studies. We hope this extensive review will provide a comprehensive guideline for researchers in this field.
... The interplay of communication, social, and adaptive difficulties associated with ASD provides unique challenges for youth and their care providers, especially in novel environments ). Further, many individuals with ASD display challenging behaviors, which often interfere with effective assessment, intervention, and support services (American Psychiatric Association 2013; Matson and Rivet 2008;Siegel 2018). Despite accessing medical, psychiatric, and child welfare services at high rates (L. ...
Caring for individuals with autism spectrum disorder (ASD) can be complicated, especially when challenging behaviors are present. Providers may feel unprepared to work with these individuals because specialized training for medical and social service providers is limited. To increase access to specialized training, we modified an effective half-day ASD-Care Pathway training (Kuriakose et al. 2018) and disseminated it within five different settings. This short, focused training on strategies for preventing and reducing challenging behaviors of patients with ASD resulted in significant improvements in staff perceptions of challenging behaviors, increased comfort in working with the ASD population, and increased staff knowledge for evidence-informed practices. Implications, including the impact of sociodemographic characteristics on pre/post changes, and future directions are discussed.
... Deficits in executive functioning have been linked to challenging and offending behaviour (Nesik, 2008;Saleh et al., 2009). For individuals on the autistic spectrum, the more pronounced the deficits in executive functioning the greater the intensity and frequency of challenging behaviour (Matson and Rivet, 2008). ...
Purpose
Assessment of executive functioning is an important element of a comprehensive assessment of intellectual abilities. Few assessments available are accessible for individuals with intellectual disabilities (ID) and none have population-specific norms. This paper aims to describe the adaptation of the behavioural assessment of dysexecutive syndrome (BADS).
Design/methodology/approach
Adaptations were made to the BADS tests to create the BADS – intellectual disabilities (BADS-ID). Data from three doctoral dissertations were combined to explore the utility, reliability, validity and component structure of the BADS-ID. Properties of the BADS-ID were compared with the Cambridge Executive Functioning Assessment (CEFA).
Findings
The BADS-ID is accessible to IQ range 50–70 and has a two-component structure. It has good inter-rater reliability, but poor internal consistency. It has a good face and content validity but evidence for concurrent and discriminative validity is weak. All properties are comparable to or better than the CEFA.
Research limitations/implications
Further research is needed to improve reliability and validity. The development of an accessible test battery with known reliability and validity for individuals with ID should facilitate research into executive functioning in this population. There is the potential to develop population-specific norms from the data.
Practical implications
An accessible test battery for individuals with ID is helpful in clinical situations.
Originality/value
To the best of the authors’ knowledge, this is the first study to explore the adaptation of the BADS for use with individuals with ID.
... Although the majority of research examines aggression as a singular category, autism, the individuals with more severe forms of autism exhibited higher rates of aggression, property destruction, disruptive behavior, and self-injury compared to individuals with mild impairments (Matson & Rivet, 2008). Examination of other international samples revealed that psychiatric conditions and symptomology such as restlessness, irritability, sadness, poor concentration, and fear/panic were also associated with challenging behaviors (Holden & Gitlesen, 2003;Holden & Gitlesen, 2009). ...
Individuals with intellectual disabilities represent a unique population with an array of needs. High rates of comorbid mental and hysical health conditions as well as the presence of disruptive behaviors pose significant challenges to service providers and funding entities. Existing cost models may underestimate these specialized needs and limit access to required services. Through secondary analysis of archival health data from individuals with intellectual disabilities at one agency in Nebraska (N=73), the current study examines how individual characteristics and aggression influence cost and caregiver strain from a systems theory perspective. Bivariate comparisons revealed that more severe aggression and more frequent aggressive behaviors (including verbal aggression, aggression against others, aggression against self, and aggression against property) relate to higher levels of caregiver strain and higher costs. Correlation and regression analyses revealed that existing rate models used to set service rates overlook significant factors when predicting actual costs. Individuals with comorbid physical and mental health conditions, especially those with serious and persistent mental illnesses, who also exhibit aggressive behaviors (measured by frequency and severity), significantly predict higher direct costs better than models that only account for levels of functioning. Despite consistent acuity based on similar behavioral severity ratings, IQ, and adaptive functioning scores, individuals served in extended family home settings displayed fewer aggressive behaviors and induced less strain on their caregivers, while receiving services at over $10,000 per month cost savings compared to their counterparts served in group home settings. Examination of emerging setting effects offers a progressive interpretation of the results with practical implications for developing rate-setting methodologies and public policy considerations.
... The severity of ASD symptoms is inconsistently related to the manifestation of aggressive behaviour. With regard to that, Matson & Rivet (2008) point to the existence of such relation, while other authors have not found significant correlations between these two constructs (Kanne & Mazurek, 2011;Visser, Berger, Prins, Van Schrojenstein Lantman-De Valk, & Teunisse, 2014). Sleep difficulties are one of the most common problems in people with ASD (Cortesi, Giannotti, Ivanenko, & Johnson, 2010). ...
Introduction: Aggressive behaviour is not the main symptom of autism spectrum disorders, and if it occurs in this population, it is a consequence of some other factors.
Objectives: With regard to that, the aim of this paper is to determine to what extent certain aspects of executive functions, severity of autism, sleep habits, and parenting actions contribute to the manifestation of different forms of aggressive behaviour in children with an autism spectrum disorder.
Methods: The sample included 40 children with autism spectrum disorders, 5-7 years of age (M=6.18, SD= .55). The following instruments were used in the assessment: The Children’s Scale of Hostility and Aggression – Reactive/Proactive, Gilliam Autism Rating Scale – Third Edition, The Children’s Sleep Habits Questionnaire and Behavior Rating Inventory of Executive Function.
Results: The obtained results showed that sleep problems were the most significant predictor of verbal, physical and covert aggression. From the domain of behavioural aspects of executive functions, only task monitor was a significant predictor of bullying, and inhibit and shift were significant predictors of hostility. From the field of autistic disorders, significant predictors of aggressive behaviour were emotional responses (as predictors of bullying, covert aggression and hostility), and maladaptive speech (as a predictor of verbal aggression, covert aggression and hostility). Punitive discipline was a significant factor only in explaining verbal aggression.
Conclusion: Practical implications of this research indicate that, in treating aggressive behaviour in children with ASD, more attention should be paid to sleep habits, practising task monitor, inhibit and shift skills, and avoiding rigorous punitive measures.
... Individual interviews with every included child and his/her parents were conducted to clinically assess the severity of their autistic symptomatology using the Childhood Autism Rating Scale (CARS) as described in previously published works 24,25 with total scores of 30 or above strongly suggest autism diagnosis, 30-36 have mild to moderate autism, 37-60 suggest severe autism. 26 The questionnaires were administrated by two well-trained and experienced clinical psychologists. ...
Objective
The current study aimed to assess the profiles of plasma amino acids, serum ammonia and oxidative stress status among autistic children in terms of electroencephalogram findings and clinical severity among the cohort of autistic Egyptian children.
Patients and methods
The present study included 118 Egyptian children categorized into 54 children with autism who were comparable with 64 healthy controls. Clinical assessments of cases were performed using CARS in addition to EEG records. Plasma amino acids were measured using high-performance liquid chromatography (HPLC), while, serum ammonia and oxidative stress markers were measured using colorimetric methods for all included children.
Results
The overall results revealed that 37.04% of cases had abnormal EEG findings. Amino acid profile in autistic children showed statistically significant lower levels of aspartic acid, glycine, β-alanine, tryptophan, lysine and proline amino acids with significantly higher asparagine amino acid derivative levels among autistic patients versus the control group (p˂0.05). There were significantly higher serum ammonia levels with significantly higher total oxidant status (TOS) and oxidative stress index (OSI) values among the included autistic children vs controls (p˂0.05). There were significantly negative correlations between CARS with aspartic acid (r=−0.269, P=0.049), arginine (r= - 0.286, p= 0.036), and TAS (r= −0.341, p= 0.012), and significantly positive correlations between CARS with TOS (r=0.360, p= 0.007) and OSI (r= 0.338, p= 0.013).
Conclusion
Dysregulated amino acid metabolism, high ammonia and oxidative stress were prevalent among autistic children and should be considered in autism management. Still EEG records were inconclusive among autistic children, although may be helpful in assessment autism severity.
... A second risk marker, autism severity, may also contribute to the increased likelihood of an individual exhibiting self-harm. Indeed, within autistic samples with ID both increased severity and quantity of autistic characteristics are associated with the presence of SIB (Rattaz et al. 2015;Matson and Rivet 2008;Baghdadli et al. 2003). However, Moseley et al. (2019) found no differences between current, historic and non-self-harmers in the number of autism traits measured using The Autism Spectrum Quotient ( Baron-Cohen et al. 2001). ...
Self-harm is purportedly common in autistic individuals, but under-researched, particularly in younger samples and those without intellectual disability. This study aimed to describe prevalence, profile and correlates of self-harm in autistic individuals without impairments in adaptive functioning. Parents of autistic participants (n = 83) completed questionnaires regarding the presence/topography of self-harm, demographic characteristics, autism severity, age of diagnosis, affect, activity levels and repetitive behaviour. 24.10% of participants engaged in self-harm. Self‐harm was associated with significantly higher levels of impulsivity, over-activity, negative affect, compulsive behaviour and insistence on sameness. Low mood and overactivity/impulsivity predicted the presence of self-harm, with the model correctly classifying 82.9% of cases. Findings highlight a role for impaired behavioural inhibition and low mood in the aetiological mechanisms underpinning self-harm in autism.
... Post-secondary . Social-communication Deficits in communication, poor social interaction, and rigid patterns of thinking and behavior (Matson and Rivet 2008) are characteristics associated with the diagnosis of Autism. These deficits may include difficulty with changing conversation topics and engaging in conversational turn taking (Klin and Volkmar 2003) ...
Deficits in social-communication skills are a core feature of autism spectrum disorder (ASD). Deficits in social communication progress into adolescence and adulthood, making complex social interactions particularly difficult and preventing the development of meaningful friendships. Interventions aimed to improve conversational skills needed to foster development of relationships for this age group are needed. Thus, the purpose of the current study was to evaluate the effectiveness and feasibility of instructional modules and covert audio coaching (CAC), on the frequency of question asking skills among college students diagnosed with ASD. Four college females diagnosed with ASD and six neurotypical peers participated in the current study. The effects of the instructional modules and covert audio coaching were evaluated using a concurrent multiple-baseline design. CAC was associated with variable increases in the frequency of question asking across participants. The introduction of a feedback phase resulted in further increases in the frequency of question asking for two of the participants. Results suggest that CAC is feasible and may be an effective tool to teach conversation skills to female college students with ASD. Further, participants indicated they found the intervention helpful and preferred it to other interventions in which they had previously experienced. Implications for practice and future research are discussed.
... This finding is consistent with the results of a large number of studies. 2,11,14,26,[28][29][30] The study of Zhang 8 indicated that deficiency in executive functions can lead to defects in social skills and cause people to fail in the evolution of social capabilities, and to be exposed to unsocial and high-risk behaviors. Executive functions guide behaviors, improve control, and encourage thinking about consequences; any defect in emotional control and emotional regulation causes inappropriate social behaviors. ...
Objective:
This study was performed to investigate the effect of strengthening executive functions through group games on social skills of preschool children.
Materials and Methods:
This was a quasiexperimental study with experimental and control groups and pretest-posttest design. The statistical population included all the preschool children in Bojnord, Iran. The study population consisted of 30 preschool children who were randomly assigned to experimental and control groups. The intervention of strengthening executive functions was based on games that were performed in twelve 45-minute sessions in the experimental group. The collected data were analyzed using independent t-test and Mann-Whitney U test in SPSS, version 23.
Results:
At the posttest stage, suitable social behaviors, nonsocial behaviors, and aggressive-impulsive behaviors were significantly different between the experimental and control groups by controlling the effect of pretest.
Discussion:
Strengthening the dimensions of executive functions, such as inhibitory response, self-regulation, and cognitive flexibility, through team games improves social skills in children.
Conclusion:
Group games by strengthening executive functions can develop social skills in preschool children.
... CARS assesses children based on a scale ranging from 1 to 4 for each item evaluated (a total of 15 categories); total scores of 30 or above strongly suggest the presence of autism. Children with scores from 30 to 36 have mild to moderate autism, and scores ranging from 37 to 60 points indicate severe autism (Mick 2005;Matsonand and Rivet 2008). Some of the evaluated items, such as social relatedness, verbal communication, listening response, visual response, activity level and imitation, have been correlated with the studied metabolic markers. ...
The present cross-sectional, hospital-based study was carried out on 146 Egyptian male children, 73 males with autism who were comparable with another 73 healthy age-and sex-matched children, recruited from the outpatients' psychiatric clinics of the Neuropsychiatric and Pediatric Departments of South Valley and Assiut University Hospitals, Egypt. Neuropsychological assessments of autistic males were done using CARS, short sensory profile, and intelligent quotients. Serum markers of mitochondrial dysfunction (lactate, pyruvate, and lactate to pyruvate ratio, creatine kinase (CK), L-carnitine, ammonia, lactate dehydrogenase, pyruvate kinase, alanine transaminase, and aspartate transaminase), oxidative stress, and blood levels of heavy metals (mercury, lead and aluminium) were measured. Serum cholesterol, cortisol, free testosterone, estradiol, dehyroepiandrostenedione, adenosine deaminase, and H.prlori antigen in stool were also performed. There was evidence of mitochondrial dysfunction among autistic children. Additionally, there were significantly lower serum total cholesterol, cortisol and estradiol as well as significantly higher dehydroepiandrostenedione (DHEA) and free testosterone (p<0.05 for all markers). Twenty-eight (38%) cases were positive for H.pylori antigen in their stool with significant higher serum ammonia and lower adenosine deaminase than in H.pylori- negative autistic children. Mitochondrial dysfunction, H.pylori infection, and low cholesterol were prevalent among autistic male children, which should be targeted during autism management.
... Given that upward of 25% of children with ASD fall into this category Anderson et al., 2007;Norrelgen et al., 2015;Rose, Trembath, Keen, & Paynter, 2016], of particular importance are investigations that target spoken language acquisition in this population. Such research has shown that better expressive language skills are associated both with better long-term outcomes and fewer maladaptive behaviors [Baghdadli, Pascal, Grisi, & Aussilloux, 2003;Dominick, Davis, Lainhart, Tager-Flusberg, & Folstein, 2007;Hartley, Sikora, & McCoy, 2008;Matson & Rivet, 2008]. Because maladaptive behaviors decrease and long-term outcomes improve when children learn to communicate more successfully [Buschbacher & Fox, 2003], efforts to identify and understand the factors that predict improvement in spoken language have become increasingly important as we seek to develop more effective treatments for these MV children. ...
We investigated the relationship between eight theoretically motivated behavioral variables and a spoken‐language‐related outcome measure, after 25 sessions of treatment for speech production in 38 minimally verbal children with autism. After removing potential predictors that were uncorrelated with the outcome variable, two remained. We used both complete‐case and multiple‐imputation analyses to address missing predictor data and performed linear regressions to identify significant predictors of change in percent syllables approximately correct after treatment. Baseline phonetic inventory (the number of English phonemes repeated correctly) was the most robust predictor of improvement. In the group of 17 participants with complete data, ADOS score also significantly predicted the outcome. In contrast to some earlier studies, nonverbal IQ, baseline levels of expressive language, and younger age did not significantly predict improvement. The present results are not only consistent with previous studies showing that verbal imitation and autism severity significantly predict spoken language outcomes in preschool‐aged minimally verbal children with autism, but also extend these findings to older minimally verbal children with autism. Autism Res 2018. © 2018 International Society for Autism Research, Wiley Periodicals, Inc.
Lay Summary
We wished to understand what baseline factors predicted whether minimally verbal children with autism would improve after treatment for spoken language. The outcome measure was change in percentage (%) syllables approximately correct on a set of 30 two‐syllable words or phrases. Fifteen were both practiced in treatment and tested; the remainder were not practiced in treatment, but only tested, to assess how well children were able to generalize their new skills to an untrained set of words. Potential predictors tested were sex, age, expressive language, phonetic inventory (the number of English speech sounds repeated correctly), autism severity, and nonverbal IQ. Phonetic inventory and (for some children) autism severity predicted children's posttreatment improvement. Nonverbal IQ and expressive language ability did not predict improvement, nor did younger age, suggesting that some older children with autism may be candidates for speech therapy.
... Between 15 to 18% of adults with intellectual disabilities and comorbid ASD have been reported to engage in aggression to others (Matson and Rivet 2008). In another study, about 22% of children with ASD alone were rated on a behavioral measure to be in the clinically significant range for aggression (Hartley et al. 2008). ...
Several methods have been used to assist children with autism spectrum disorder (ASD) to self-manage their anger and aggression, including psychopharmacological, behavioral, and mindfulness-based interventions. However, no intervention works well with all children who engage in aggression and there is a need to investigate alternative management techniques. Four children with ASD were taught to use SOBER Breathing Space as an informal mindfulness-based practice to control their verbal and physical aggression in the family home. The SOBER Breathing Space required the child to Stop and see what is happening, Observe physical sensations and emotion regulation changes in the body, Breathe by deliberately bringing attention to the breath, Expand awareness of the situation, his or her response to the situation and longer term consequences, and Respond (versus react) mindfully. Effects of the SOBER Breathing Space on verbal and physical aggression were recorded in the family home, as well as generalization effects at school. In addition, parental use of physical restraints contingent on the children’s aggressive behavior was also recorded. In a multiple baseline design across subjects, the children showed they could control their verbal and physical aggression, and could respond mindfully to the emotionally arousing situation instead of automatically reacting in an aggressive manner. Results showed the training effects generalized from home to school, without training in the school setting. In addition, the effects were maintained during the 12-month follow-up period. Furthermore, parental use of physical restraints decreased rapidly and was eliminated within weeks of the children learning to use the SOBER Breathing Space for emotional regulation. This study suggests that some children with ASD may be able to successfully use the SOBER Breathing Space to self-manage their aggressive behavior, thereby eliminating the need for parents to use physical restraints.
... Visoka učestalost stereotipnog ponašanja je značajan prediktor samopovređivanja kod dece i odraslih osoba sa poremećajem autističkog spektra, i u slučaju kada se težina kliničke slike i koeficijent inteligencije drže pod kontrolom (Richman et al., 2013). Signifikantna korelacija između restriktivnog/repetitivnog ponašanja i samopovređivanja utvrđena je i u populaciji osoba sa težim oblicima IO i prisutnom autističkom simptomatologijom, nezavisno od stepena njene težine (Matson & Rivet, 2008). Međutim, u nekim drugim istraživanjima nije utvrđen značajan doprinos stereotipnog ponašanja samopovređivanju osoba sa poremećajem autističkog spektra (Richards, Oliver, Nelson & Moss, 2012). ...
Maladaptive behavior has a high incidence rate in populations with autism spectrum disorder and intellectual disability (ID). Early studies indicate its higher incidence in people with autism spectrum disorder compared to those with ID and atypical development of a second nature. The research aims to determine the incidence and severity of self-injury, stereotypic behavior and aggression/destruction in children with autism spectrum disorder and children with ID, as well as possible differences between diagnostic groups; association of ages with forms of maladaptive behavior and the relationship between all three forms of maladaptive behavior within diagnostic groups. The Behavior Problems Inventory was applied to a sample of 22 subjects with autism spectrum disorder and 30 subjects with ID, 7 to 12 years of age. In both cases, these people had more severe forms of ID. The results indicate that stereotypic behavior had the highest frequency and severity in both diagnostic groups, followed by self-injury and aggression/destruction. Self-injuring and stereotypic behavior had a significantly higher frequency and severity in children with autism spectrum disorder. The frequency of self-injury significantly correlated with stereotypic behavior in children with ID, while in children with autism spectrum disorder there was a significant relationship between the frequency of self-injury and aggression/destruction. Significant correlation in both groups of subjects was also determined in relation to the severity of these forms of maladaptive behavior. The age significantly correlated with maladaptive behavior only in children with autism spectrum disorder, with both dimensions of self-injuries. It is necessary to develop adaptive abilities of children with autism spectrum disorder and ID in order to minimize the risks of maladaptive behavior, as well as for parents and experts to acquire knowledge about.
... Baghdadli et al. (2003) found that younger age, perinatal conditions (e.g., presence of a genetic syndrome), more severe ASD symptoms and greater delays in daily living skills were most predictive of SIB in a sample of 222 young children with ASD (age range 2-7 years). Similarly, Matson and Rivet (2008a) documented a significant relationship between ASD severity and SIB severity. A recent study of 180 young children (ages 4-48 months) at risk for intellectual and developmental disabilities (identified via mass screening and an interdisciplinary evaluation) found that those at-risk for ASD displayed greater rates of SIB (as well as aggression and stereotyped behavior) than children with Down syndrome or those with atypical development but without higher ASD risk (Schroeder et al. 2014). ...
Limited information about self-injurious behavior (SIB) is known for children and adolescents with Autism Spectrum Disorder (ASD) who require intensive behavioral health interventions. We examined risk-factors for SIB in 302 individuals with ASD (ages 4–20) admitted to six specialized psychiatric inpatient units. Seventy-four percent were reported by a caregiver to display SIB, however, only 25% were observed to engage in daily SIB during hospitalization. Those exhibiting SIB across environments had significantly higher ratings on caregiver questionnaires of SIB severity. Tree-structured classification was used to develop and validate two predictive models, one indicating which inpatient youth with ASD are likely to have SIB and a second indicating which individuals with SIB at home are likely to continue in an inpatient setting.
... Other studies have also reported that the prevalence of problem behaviors such as noncompliance and tantrums in persons with ASD is significantly higher than in other populations such as ID (McCarthy et al. 2010;Poon 2012;Smith and Matson 2010). SIB has been reported to be more severe in persons with ASD compared to ID, and severity of SIB to be positively correlated to number and severity of autistic core symptoms (Baghdadli et al. 2003;Furniss and Biswas 2012;Matson and Rivet 2007). Farmer and Aman (2011) reported a higher incidence of aggression in a sample of children with autism compared with ID alone (see Cohen et al. 2011 for a discussion of aggression in autism). ...
In addition to the core symptoms of autism (restricted/repetitive behaviors, language deficits, and social deficits), behavior problems such as tantrums, self-injurious behaviors, and aggression are common and present a great challenge to caregivers, increase social isolation, and lead to placement in restrictive educational and living settings. Transitions between activities seem to present challenges to people with autism-triggering problem behaviors, and methods for managing transitions are widely included in treatment programs. There is little objective research on the causes of transition problems in this population. The primary hypothesis is that for individuals with autism, environmental uncertainty is aversive, and transitions between activities are a common source of uncertainty given the social and communication deficits in autism. This chapter describes the literature on behavior problems related to transitions and presents some areas of basic behavioral research that may direct the understanding and treatment of transition difficulties in autism.
... Typically, those with challenging behaviour have a more severe or profound intellectual disability, with or without autism, whereas those who are involved in the criminal justice system tend to have milder disabilities or no disabilities (partly due to the mens rea requirement in many jurisdictions). There is an established body of research into challenging behaviour in individuals with ASCs, including studies on intervention and investigation into use of medication for behaviour that challenges (Matson & Rivet, 2008;Sawyer, Lake, Lunsky, Liu, & Desarkar, 2014). For those with more severe intellectual disabilities or younger individuals (perhaps below the age of criminal responsibility) some behaviours such as fetish or hypersexualised displays may manifest as acts that constitute offending but are not labelled as such due to the age and/or cognitive functioning of the individual (e.g. ...
Theoretical suppositions suggest a potential vulnerability in some individuals with autism spectrum conditions (ASCs) to displaying offending behaviours. Additionally, it is recognised that the features of ASCs may result in possible barriers to treatment. A systematic review was undertaken to identify empirical evidence examining the effectiveness of treatment programmes for offenders with ASCs and to explore the potential impact of ASC symptoms on treatment outcomes. The studies identified consisted of a small number of case series and a collection of case reports with little or no direct comparisons to offenders without ASCs. A synthesis of the findings highlighted variability in treatment approach and impact. Effectiveness was primarily defined by reduction in further offending behaviours and was found to be variable across the data. The potential relationship between the symptoms of ASCs and treatment outcome was explored with all case reports identifying the need for adaptations to treatment programmes, necessitated by the symptoms of ASCs. This systematic review joins an existing body of literature emphasising need for more controlled research into the effectiveness of offending behaviour treatment programmes for individuals with ASCs, and for further investigation into the impact of the clinical features of ASCs on treatment outcomes.
... ASD is usually diagnosable by the age of 3 years, but ∼25%-46% of children diagnosed with ASD remain minimally verbal (MV) past 5 years of age (Tager-Flusberg et al., 2005;Kasari et al., 2013;Tager-Flusberg and Kasari, 2013;Rose et al., 2016). Several studies have shown that, in MV children and adults with ASD, communication impairment is an independent predictor of high rates of aggression (Hartley et al., 2008;Matson and Rivet, 2008), that self-injurious behavior is negatively related to expressive language level (Baghdadli et al., 2003;Dominick et al., 2007), and that problem behavior decreases when children learn effective and appropriate communication skills (Buschbacher and Fox, 2003). Thus, communication therapy is critical for MV children with ASD. ...
We investigated the relationship between imaging variables for two language/speech-motor tracts and speech fluency variables in 10 minimally verbal (MV) children with autism. Specifically, we tested whether measures of white matter integrity—fractional anisotropy (FA) of the arcuate fasciculus (AF) and frontal aslant tract (FAT)—were related to change in percent syllable-initial consonants correct, percent items responded to, and percent syllable insertion errors (from best baseline to post 25 treatment sessions). Twenty-three MV children with autism spectrum disorder (ASD) received Auditory-Motor Mapping Training (AMMT), an intonation-based treatment to improve fluency in spoken output, and we report on seven who received a matched control treatment. Ten of the AMMT participants were able to undergo a magnetic resonance imaging study at baseline; their performance on baseline speech production measures is compared to that of the other two groups. No baseline differences were found between groups. A canonical correlation analysis (CCA) relating FA values for left- and right-hemisphere AF and FAT to speech production measures showed that FA of the left AF and right FAT were the largest contributors to the synthetic independent imaging-related variable. Change in percent syllable-initial consonants correct and percent syllable-insertion errors were the largest contributors to the synthetic dependent fluency-related variable. Regression analyses showed that FA values in left AF significantly predicted change in percent syllable-initial consonants correct, no FA variables significantly predicted change in percent items responded to, and FA of right FAT significantly predicted change in percent syllable-insertion errors. Results are consistent with previously identified roles for the AF in mediating bidirectional mapping between articulation and acoustics, and the FAT in its relationship to speech initiation and fluency. They further suggest a division of labor between the hemispheres, implicating the left hemisphere in accuracy of speech production and the right hemisphere in fluency in this population. Changes in response rate are interpreted as stemming from factors other than the integrity of these two fiber tracts. This study is the first to document the existence of a subgroup of MV children who experience increases in syllable- insertion errors as their speech develops in response to therapy.
... A significant challenge that has been shown to contribute to parenting stress in parents of children with ASD is the frequency and severity of their child's externalising behaviours. These behaviours include antisocial or aggressive behaviours (Matson & Rivet, 2008), inappropriate social behaviours such as faecal smearing and chronic screaming (Oberleitner, Ball, Gillette, Naseef, & Stamm, 2006), "meltdowns" (McClintock, Hall, & Oliver, 2003), elopement (Anderson et al., 2012), and selfinjurious behaviours (Duerden et al., 2012). The severity of core ASD symptoms, including social deficits and restricted/repetitive behaviours, have also been linked to elevated parenting stress (Davis & Carter, 2008). ...
Background Although parents of children with autism spectrum disorder (ASD) exhibit high levels of parenting stress, minimal research has examined the type of stress they experience. Understanding parenting stress is critical as the effects are not limited to the parent. The aim of this study was to investigate the validity of conceptualising parenting stress within a traumatic stress framework.
Method Twelve mothers participated in focus groups, which were recorded and transcribed verbatim. Interpretative phenomenological analysis was used, then researchers examined for spontaneous reporting of DSM-5-defined traumatic stressors and trauma symptomatology.
Results Forty percent of mothers experienced traumatic stressors and trauma-related symptomatology. Sixty percent of mothers did not report traumatic stressors but reported trauma-related symptomatology regardless.
Conclusions The use of a traumatic stress framework to conceptualise some parenting experiences was supported. This finding has important implications for the development of interventions to prevent or reduce stress.
... El déficit en habilidades de comunicación está asociado a problemas de conducta (Matson y Tessa, 2008). En particular, la capacidad de comunicación receptiva parece desempeñar un papel más importante en la determinación de los resultados a nivel conductual y funcional en los niños con TEA, que las habilidades lingüísticas estructurales (es decir, los aspectos más formales del lenguaje como el vocabulario o la gramática) (Paul, 2005;Park, Yelland, Taffe y Gray, 2012). ...
The objectives of this study were: 1) Compare the perceived parental stress between a group of parents of children with ASD and a group of parents of children with typical development. The rest of the objectives are focused on the analysis of the ASD group.
2) Compare the perceived parental stress between the parents of the ASD children with language and the parents of the ASD children without language. 3) Analyze the relationship between the perceived parental stress and the child’s receptive linguistic skills. 4) Analyze the relationship between the perceived parental stress and the child’s expressive linguistic skills. The Parenting Stress Index scale (the child domain) was used to evaluate the parental stress. The main results obtained were: 1) Parental stress in the parents of ASD children was higher than in the parents of the children with typical development. 2) There was no significant difference on the perceived parental stress between the parents of ASD children with and without language. 3) Parental stress showed a statistically significant relation with some of the evaluated variables, both receptive and expressive language. Thus, the child’ limitations on language skills were linked to a higher parental stress in the child domain, particularly the one obtained in the Acceptability subscale, relative to the parental expectations about the child’s capacities. This result is discussed in the context of the importance that our culture gives to the achievement motivation and the possible connection of this with parental stress.
... In a population of adults with ID and comorbid ASD, 15%-18% were found to engage in aggression toward others. 12 Scores in the clinically significant range for aggression on a broad behavioral measure were found in 22% of young children diagnosed with autistic disorder in another study. 7 In a population of children with an educational diagnosis of pervasive developmental disorder, between 9% and 14% were reported to exhibit aggression. ...
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by persistent difficulties in social communication and social interaction, coupled with restricted, repetitive patterns of behavior or interest. Research indicates that aggression rates may be higher in individuals with ASD compared to those with other developmental disabilities. Aggression is associated with negative outcomes for children with ASD and their caregivers, including decreased quality of life, increased stress levels, and reduced availability of educational and social support. Therapeutic strategies including functional behavioral assessment, reinforcement strategies, and functional communication training may have a significant impact in reducing the frequency and intensity of aggressive behavior in individuals with ASD. Pharmacologic treatments, particularly the use of second-generation antipsychotics, may also be of some benefit in reducing aggression in individuals with ASD. With the ever-increasing rate of ASD diagnosis, development of effective therapeutic and pharmacologic methods for preventing and treating aggression are essential to improving outcomes in this disorder.
... There is emerging evidence of demographic and behavioural characteristics that are associated with selfinjury in ASD at a single time point. These putative risk markers include impairments in adaptive skills [1][2][3], greater severity of autism [1,2,33], younger age [34], perinatal conditions [1] and repetitive and impulsive behaviours [3,4]. Studies of populations of individuals with intellectual disabilities have identified lower ability [25], lower verbal ability [35], attention deficit hyperactivity disorder [25], visual impairment [25] and the site of selfinjury [23,35] as variables which independently predict the persistence of self-injury over time. ...
Background:
There are few studies documenting the persistence of self-injury in individuals with autism spectrum disorder (ASD) and consequently limited data on behavioural and demographic characteristics associated with persistence. In this longitudinal study, we investigated self-injury in a cohort of individuals with ASD over 3 years to identify behavioural and demographic characteristics associated with persistence.
Methods:
Carers of 67 individuals with ASD (Median age of individuals with ASD in years = 13.5, Interquartile Range = 10.00-17.00), completed questionnaires relating to the presence and topography of self-injury at T1 and three years later at T2. Analyses were conducted to evaluate the persistence of self-injury and to evaluate the behavioural and demographic characteristics associated with persistence of self-injury.
Results:
At T2 self-injurious behaviour had persisted in 77.8 % of individuals. Behavioural correlates of being non-verbal, having lower ability and higher levels of overactivity, impulsivity and repetitive behaviour, were associated with self-injury at both time points. Risk markers of impulsivity (p = 0.021) and deficits in social interaction (p = 0.026) at T1 were associated with the persistence of self-injury over 3 years.
Conclusions:
Impulsivity and deficits in social interaction are associated with persistent self-injury in ASD and thus may act as behavioural risk markers. The identification of these risk markers evidences a role for behaviour dysregulation in the development and maintenance of self-injury. The findings have clinical implications for proactive intervention; these behavioural characteristics may be utilised to identify 'at risk' individuals for whom self-injury is likely to be persistent and therefore those individuals for whom early intervention may be most warranted.
... Factors that influence parental mental health and well-being Disruptive, challenging, and dangerous behaviours Parents have reported the core deficits associated with ASD (impaired social communication and restricted and/or repetitive behaviours) as distressing and disruptive behaviours, which at times challenge their parenting capacity (Davis & Carter, 2008). Other common behaviours that are likely to influence parental mental health include aggression (Matson & Rivet, 2008;Richards, Oliver, Nelson, & Moss, 2012), property destruction and violence towards others, primarily in the form of kicking or biting (McClintock, Hall, & Oliver, 2003). Longitudinal studies demonstrate that these behaviours tend to be unremitting (Eisenhower, Baker, & Blacher, 2005) and may lead to hospitalisation, out of home care, or police involvement (Myers, Mackintosh, & Goin-Kochel, 2009). ...
The impact on parental psychological functioning as a result of living with disruptive, challenging, and dangerous behaviours exhibited by some children with Autism Spectrum Disorder (ASD) is investigated. Core features of ASD along with aggression, elopement, self-injury, and suicidal ideation can cause significant parental distress. This parenting experience may be associated with depression, anxiety, somatisation, and anger-hostility. It is proposed that a traumatic stress framework may assist in conceptualising some parents’ experiences and psychological symptomatology. A systematic review revealed only one study that had explored posttraumatic stress symptoms amongst parents of children with ASD. Consequently, a narrative literature review has been conducted to explore this emerging area of enquiry. The Diagnostic and Statistical Manual of Mental Health Disorders (fifth edition) recognises direct experience as well as witnessing actual or threatened serious injury as a traumatic event that can lead to trauma-related psychopathology. Despite some parents of children with ASD experiencing traumatic events (e.g. their child engaging in self-injurious behaviours), prevalence rates of Posttraumatic Stress Disorder amongst this population are unknown. Further research is required to determine the validity of adopting a traumatic stress framework when considering parent symptomatology, and if such a framework were valid, there would be significant implications for optimising support and intervention for parents.
... The ASD-DA was designed for and tested on adults with severe and profound intellectual disability in residential settings. Several studies were published on its development, psychometric properties and the relationships between ASD symptoms, IQ and challenging behaviours (Matson et al., 2007a;2007c;2008c;Matson & Rivet, 2007;Rojahn et al., 2010;Wilkins & Matson, 2008). However it goes not appear to have been used outside of this research group. ...
PhD thesis for King's College London 2012
... Therefore, any disruption to motor process affects perceptual systems and learning and causes disorders and deficits in learning (2). Autism spectrum disorder (ASD) is a developmental and neurological disorder, which typically presents during the early life and persists throughout lifespan (3,4). The main features due to autism include failure in interchange (5,6), stereotyped behaviors (7,8) and significant deficits in communicational skills (9). ...
Background: Autism spectrum disorder (ASD) is a developmental and neurological disorder that impairers many processes as perceptual, motor and cognitive function. Feedback frequency and its influences on ASD aspects indicate conflict impairs.
Objectives: The aim of the current study was to investigate the frequency of feedback in children with autism and comparison with normal children during learning a new throwing task.
Patients and Methods: In this study, 21 children with autism and 21 normal children were selected and each group was randomly divided into three subgroups (receiving 0%, 50%, 100% feedback). Participant’s task was throwing beanbags toward the goal. In the acquisition phase, each participant performed 60 throws. Experimentally, group (0%) did not receive any feedback, group (50%) received feedback in half efforts and group (100%) received feedback in all the efforts. The retention test was performed 24 hours after the acquisition phase. One-way analysis of variance and Tukey post hoc test were used to analyze data.
Results: Children with autism showed more learning by 100% feedback. Nonetheless, normal children learned more through reduced feedback (50%).
Conclusions: In learning a new task, children with autism bring more performance in high frequency of feedback, but normal children showed better performance using reduced feedback. This finding indicates that children with autism need to get feedback different from normal children in learning.
... Behaviors that showed the most differences between groups were stereotypy (repeated/unusual body vocalizations/ body movements, unusual object play), self-injurious behavior (harming self, mouthing/swallowing objects), aggression/destruction (banging on objects), and disruptive behavior (elopement). Matson and Rivet (2008c) investigated the effects of autism and PDD-NOS symptoms on challenging behaviors in adults with intellectual disabilities, using the ASD-BPA. ...
One of the most common co-occurring problems with autism is challenging behaviors. Many methods have been developed to address this topic such as scales for identifying CB. Other measures have been designed to assess maintaining variables (functional assessment). This chapter reviews these methods and discusses them in the context of autism.
This review systematically synthesized evidence on the association between structural language ability and behaviors of concern (BoC) in autism. Four databases were searched for studies that included >10 autistic participants, measures of structural language (content and/or form of language) and BoC, and an analysis of their association. BoCs included self-injurious behavior (SIB), aggression, tantrums, and externalizing behavior. Methodological quality of studies were assessed using the Newcastle Ottawa Scale. Forty-five publications (n = 11,961) were included. Forty studies were cross-sectional and five were prospective cohort studies. Over 70% of the studies investigating expressive language and SIB (n = 10), aggression (n = 5), tantrums (n = 3), and externalizing behavior (n = 17) reported an inverse association, where lower expressive language ability was associated with increased BoC. Eleven out of sixteen studies of combined expressive and receptive language reported an inverse relationship with SIB or aggression. All outcomes were rated as moderate to very low certainty of evidence. This review highlights evidence showing an inverse association between expressive or combined language ability and SIB, and externalizing behavior in autism. However, further high-quality studies that use standardized, consistent measures of language and behavior and investigate longitudinal associations are needed. Early detection and support for reduced structural language difficulties have substantial potential to assist in reducing BoC.
Individuals with a diagnosis of Autism Spectrum Disorder (ASD) and individuals with Intellectual Disabilities (ID) are at a higher risk of developing challenging behavior as compared to other populations. In this chapter, we discuss the nature, prevalence, and characteristics of challenging behaviors in individuals with ASD and ID. Aggressive behavior, self-injurious behavior, and stereotypic behavior are addressed separately. Each of these behaviors is discussed in terms of nature and characteristics, definition, topography, prevalence, and risk factors. Clearly, addressing these behaviors is pivotal to improving outcomes for affected individuals, and interventions informed by functional analysis provide an effective technology for achieving this.
Autism spectrum disorder (ASD) is a multifactorial, pervasive neurodevelopmental disorder defined by the core symptoms of significant impairment in social interaction and communication as well as restricted, repetitive patterns of behavior. In addition to these core behaviors, persons with ASD frequently have associated non-core behavioral disturbance (i.e. self-injury, aggression), as well as several medical comorbidities. Currently, no effective treatment exists for the core symptoms of ASD. This review reports the available pre-clinical and clinical data regarding the use of cannabis and cannabidiol (CBD) in the treatment of core symptoms, non-core symptoms and comorbidities associated with ASD. Additionally, we describe our clinical experience working with children and young adults with ASD who have used cannabis or CBD. At present, pre-clinical and clinical data suggest a potential for therapeutic benefit amongst some persons with ASD and that it is overall well tolerated. Further research is required to better identify patients who may benefit from treatment without adverse effects.
This chapter reviews research on the phenomenology, incidence and prevalence, and natural history of self-injurious behavior. The chapter also reviews evidence regarding risk factors for development of self-injurious behavior, with particular reference to distinguishing risk factors specifically related to self-injury from those more broadly associated with behavioral difficulties in general and also distinguishing risk factors for initial development of self-injurious behavior from those predictive of chronicity of the disorder once developed. Approximately 1 child in 10 with an intellectual disability, up to 50% of children with autism spectrum conditions, and about 1 in 20 adults with intellectual disabilities engage in self-injurious behavior of sufficient severity to cause tissue damage. Self-injury typically emerges before the age of 25 months, but around 40–50% of children who begin to self-injure later cease to do so. If self-injury continues into adulthood however, it constitutes a highly persistent problem, although between 16 and 38% of those who engage in SIB are still able eventually to refrain from doing so. The proportion of those people who later “relapse” into self-injury is however unknown. Personal characteristics including characteristics associated with autism such as “insistence on sameness,” engaging in stereotyped behaviors, and overactivity and impulsivity are all strongly associated with self-injury. However, there is also increasing evidence that for even the most robust overall risk markers for self-injurious behavior, associations differ across neurodevelopmental conditions. Features of the social environment associated with persistence vs. remission of self-injury have received little research attention.
Unpredictable and potentially dangerous aggressive behavior by youth with Autism Spectrum Disorder (ASD) can isolate them from foundational educational, social, and familial activities, thereby markedly exacerbating morbidity and costs associated with ASD. This study investigates whether preceding physiological and motion data measured by a wrist‐worn biosensor can predict aggression to others by youth with ASD. We recorded peripheral physiological (cardiovascular and electrodermal activity) and motion (accelerometry) signals from a biosensor worn by 20 youth with ASD (ages 6–17 years, 75% male, 85% minimally verbal) during 69 independent naturalistic observation sessions with concurrent behavioral coding in a specialized inpatient psychiatry unit. We developed prediction models based on ridge‐regularized logistic regression. Our results suggest that aggression to others can be predicted 1 min before it occurs using 3 min of prior biosensor data with an average area under the curve of 0.71 for a global model and 0.84 for person‐dependent models. The biosensor was well tolerated, we obtained useable data in all cases, and no users withdrew from the study. Relatively high predictive accuracy was achieved using antecedent physiological and motion data. Larger trials are needed to further establish an ideal ratio of measurement density to predictive accuracy and reliability. These findings lay the groundwork for the future development of precursor behavior analysis and just‐in‐time adaptive intervention systems to prevent or mitigate the emergence, occurrence, and impact of aggression in ASD. Autism Res 2019, 12: 1286–1296 . © 2019 International Society for Autism Research, Wiley Periodicals, Inc.
Lay Summary
Unpredictable aggression can create a barrier to accessing community, therapeutic, medical, and educational services. The present study evaluated whether data from a wearable biosensor can be used to predict aggression to others by youth with autism spectrum disorder (ASD). Results demonstrate that aggression to others can be predicted 1 min before it occurs with high accuracy, laying the groundwork for the future development of preemptive behavioral interventions and just‐in‐time adaptive intervention systems to prevent or mitigate the emergence, occurrence, and impact of aggression to others in ASD.
Background:
Autism spectrum disorder (ASD) has an estimated prevalence of around 1.7% of the population. People with ASD often also have language difficulties, and about 25% to 30% of children with ASD either fail to develop functional language or are minimally verbal. The ability to communicate effectively is an essential life skill, and difficulties with communication can have a range of adverse outcomes, including poorer academic achievement, behavioural difficulties and reduced quality of life. Historically, most studies have investigated communication interventions for ASD in verbal children. We cannot assume the same interventions will work for minimally verbal children with ASD.
Objectives:
To assess the effects of communication interventions for ASD in minimally verbal children.
Search methods:
We searched CENTRAL, MEDLINE and Embase as well as 12 other databases and three trials registers in November 2017. We also checked the reference lists of all included studies and relevant reviews, contacting experts in the field as well as authors of identified studies about other potentially relevant ongoing and unpublished studies.
Selection criteria:
Randomised controlled trials (RCTs) of communication-focused interventions for children (under 12 years of age) diagnosed with ASD and who are minimally verbal (fewer than 30 functional words or unable to use speech alone to communicate), compared with no treatment, wait-list control or treatment as usual.
Data collection and analysis:
We used standard Cochrane methodological procedures.
Main results:
This review includes two RCTs (154 children aged 32 months to 11 years) of communication interventions for ASD in minimally verbal children compared with a control group (treatment as usual). One RCT used a verbally based intervention (focused playtime intervention; FPI) administered by parents in the home, whereas the other used an alternative and augmentative communication (AAC) intervention (Picture Exchange Communication System; PECS) administered by teachers in a school setting.The FPI study took place in the USA and included 70 participants (64 boys) aged 32 to 82 months who were minimally verbal and had received a diagnosis of ASD. This intervention focused on developing coordinated toy play between child and parent. Participants received 12 in-home parent training sessions for 90 minutes per session for 12 weeks, and they were also invited to attend parent advocacy coaching sessions. This study was funded by the National Institute of Child Health and Human Development, the MIND Institute Research Program and a Professional Staff Congress-City University of New York grant. The PECS study included 84 minimally verbal participants (73 boys) aged 4 to 11 years who had a formal diagnosis of ASD and who were not using PECS beyond phase 1 at baseline. All children attended autism-specific classes or units, and most classes had a child to adult ratio of 2:1. Teachers and parents received PECS training (two-day workshop). PECS consultants also conducted six half-day consultations with each class once per month over five months. This study took place in the UK and was funded by the Three Guineas Trust.Both included studies had high or unclear risk of bias in at least four of the seven 'Risk of bias' categories, with a lack of blinding for participants and personnel being the most problematic area. Using the GRADE approach, we rated the overall quality of the evidence as very low due to risk of bias, imprecision (small sample sizes and wide confidence intervals) and because there was only one trial identified per type of intervention (i.e. verbally based or AAC).Both studies focused primarily on communication outcomes (verbal and non-verbal). One of the studies also collected information on social communication. The FPI study found no significant improvement in spoken communication, measured using the expressive language domain of the Mullen Scale of Early Learning expressive language, at postintervention. However, this study found that children with lower expressive language at baseline (less than 11.3 months age-equivalent) improved more than children with better expressive language and that the intervention produced expressive language gains in some children. The PECS study found that children enrolled in the AAC intervention were significantly more likely to use verbal initiations and PECS symbols immediately postintervention; however, gains were not maintained 10 months later. There was no evidence that AAC improved frequency of speech, verbal expressive vocabulary or children's social communication or pragmatic language immediately postintervention. Overall, neither of the interventions (PECS or FPI) resulted in maintained improvements in spoken or non-verbal communication in most children.Neither study collected information on adverse events, other communication skills, quality of life or behavioural outcomes.
Authors' conclusions:
There is limited evidence that verbally based and ACC interventions improve spoken and non-verbal communication in minimally verbal children with ASD. A substantial number of studies have investigated communication interventions for minimally verbal children with ASD, yet only two studies met inclusion criteria for this review, and we considered the overall quality of the evidence to be very low. In the study that used an AAC intervention, there were significant gains in frequency of PECS use and verbal and non-verbal initiations, but not in expressive vocabulary or social communication immediately postintervention. In the study that investigated a verbally based intervention, there were no significant gains in expressive language postintervention, but children with lower expressive language at the beginning of the study improved more than those with better expressive language at baseline. Neither study investigated adverse events, other communication skills, quality of life or behavioural outcomes. Future RCTs that compare two interventions and include a control group will allow us to better understand treatment effects in the context of spontaneous maturation and will allow further comparison of different interventions as well as the investigation of moderating factors.
One of the most important and most highly studied comorbid conditions with intellectual disability (ID) are challenging behaviors (CB). These problems can be very debilitating and are a major reason for the prescription of psychotropic medication. Definition, prevalence, and intervention will be discussed.
Background:
Although there is a recommendation that toddlers be screened for Autism spectrum disorder (ASD) during their 18- and 24-month well-care child visits, diagnosis often occurs well after the child turns 4 years old. Such delayed diagnosis hinders the implementation of early intervention thus worsens the long-term prognosis of ASD.
Objective:
The current community-based study in its stage I aimed at early screening of Egyptian toddlers for ASD using an Arabic validated version of Modified Checklist for Autism in Toddlers (M-CHAT).
Methodology:
A cross-sectional community-based descriptive study was carried out enrolling 5546 Egyptian toddlers. They were randomly recruited from those attending Primary Health Care Units in six Egyptian governorates with a fair representation of the urban, semi-urban, and rural Egyptian populations. An Arabic validated version of M-CHAT was used as a screening tool for ASD.
Results:
The current study revealed failure of M-CHAT (suspected to have ASD and needs further evaluation) in 1320 out of the enrolled 5546 Egyptian toddlers (23.8%).
Conclusion:
M-CHAT as a screening tool for ASD has flagged a considerable percent of the enrolled toddlers that necessitates referral for further evaluation (stage II) to settle the diagnosis of ASD in the true positive cases. Perfecting the delicate balance between sensitivity and specificity for ASD screening tools is crucial in order not to miss early detection of ASD cases and at the same time, to avoid over-diagnosis with subsequent abuse of the limited healthcare resources in developing countries.
Mirroring the evolution of the conceptualization of autism has been changes in the diagnostic process, including the most recent revisions to the DSM-5 and the addition of severity-based diagnostic modifiers assigned on the basis of intensity of needed supports. A review of recent literature indicates that in research stratifying individuals on the basis of autism severity, core ASD symptomology is the primary consideration. This conceptualization is disparate from the conceptualization put forth in DSM-5 in which severity determination is based on level of needed support, which is also impacted by cognitive, language, behavioral, and adaptive functioning. This paper reviews literature in this area and discusses possible instruments that may be useful to inform clinical judgment in determining ASD severity levels.
One of the most common and debilitating of the comorbid psychological conditions among persons with autism spectrum disorder (ASD) are challenging behaviors. The purpose of this chapter will be to define the problems, discuss their prevalence, and how they overlap and/or interface.
The development of standardized tests to assess autism, particularly in young children, is a topic of considerable interest in the research community. Recent years have seen an exponential growth in scales for differential diagnosis. Particular emphasis has been placed on defining and better delineating the symptoms of the disorder relative to other forms of autism spectrum disorder (ASD) and intellectual disability (ID), and identifying the condition at the earliest possible age. The general consensus is that scaling methods are the core means of establishing a diagnosis. Thus, analyzing the research activity in the area for strengths and weaknesses in methodology would appear to be in order. A critical overview of existing psychometric properties of these tests is presented with suggestions for future research on the topic.
The etiology of autism is complex, and in most cases the underlying pathologic mechanisms are unknown. Autism is a hetereogeneous disorder, diagnosed subjectively on the basis of a large number of criteria. Recent research has investigated genetics, in utero insults and brain function as well as neurochemical and immunological factors. On the basis of family and twin studies, there appears to be a genetic basis for a wide "autistic syndrome." About a quarter of cases of autism are associated with genetic disorders such as fragile X syndrome or with infectious diseases such as congenital rubella. Genetic studies have shown an association between autism markers of brain development such as 3 markers of the c-Harvey-ros oncogene and the homeobox gene EN2. In some cases, autism is associated with insults early in gestation, including thalidomide embryopathy. Autism may arise from abnormal central nervous system functioning, since most autistic patients have indications of brain dysfunction, and about half of them have abnormal electroencephalograms. Similarly, the pattern of evoked response potentials and conduction time is altered in autistic children. There is substantial evidence from neuroimaging studies that dysfunctions in the cerebellum and possibly the temporal lobe and association cortex occur in autistic symptoms. Neurochemical studies have investigated the role of serotonin, epinephrine and norepinephrine, since levels of these neurotransmitters are altered in autism, although other hypotheses implicate overactive brain opioid systems and changes in oxytocin neurotransmission. Autoimmunity may also play a role; antibodies against myelin basic protein are often found in children with autism, who also have increased eosinophil and basophil response to IgE-mediated reactions. In summary, the prevailing view is that autism is caused by a pathophysiologic process arising from the interaction of an early environmental insult and a genetic predisposition.
Although high-functioning individuals with autistic disorder (i.e. autism and Asperger syndrome) are of normal intelligence, they have life-long abnormalities in social communication and emotional behaviour. However, the biological basis of social difficulties in autism is poorly understood. Facial expressions help shape behaviour, and we investigated if high-functioning people with autistic disorder show neurobiological differences from controls when processing emotional facial expressions. We used functional MRI to investigate brain activity in nine adults with autistic disorder (mean age +/- standard deviation 37 +/- 7 years; IQ 102 +/- 15) and nine controls (27 +/- 7 years; IQ 116 +/- 10) when explicitly (consciously) and implicitly (unconsciously) processing emotional facial expressions. Subjects with autistic disorder differed significantly from controls in the activity of cerebellar, mesolimbic and temporal lobe cortical regions of the brain when processing facial expressions. Notably, they did not activate a cortical 'face area' when explicitly appraising expressions, or the left amygdala region and left cerebellum when implicitly processing emotional facial expressions. High-functioning people with autistic disorder have biological differences from controls when consciously and unconsciously processing facial emotions, and these differences are most likely to be neurodevelopmental in origin. This may account for some of the abnormalities in social behaviour associated with autism.
The Behavior Problems Inventory (BPI-01) is a 52-item respondent-based behavior rating instrument for self-injurious, stereotypic, and aggressive/destructive behavior in mental retardation and other developmental disabilities. Items are rated on a frequency scale and a severity scale. The BPI-01 was administered by interviewing direct care staff of 432 randomly selected residents from a developmental center between the ages of 14 to 91 years. For 73% of those selected, at least one problem was endorsed on the BPI-01. A total of 43% showed self-injury, 54% stereotyped behavior, and 38% aggressive/destructive behavior. Confirmatory factor analysis and item-total correlations supported the three a priori factors. Analyses of variance (ANOVA) showed that of the variables age, sex, and level of mental retardation, only the latter had a significant effect on the BPI-01 total score, the SIB subscale score, and the Stereotyped Behavior subscale score. Aggression/destruction was not significantly related to any of the three variables. Individuals with a diagnosis of pervasive developmental disorder had higher scores on all three subscales than those without, whereas residents with a diagnosis of stereotyped movement disorder had higher Stereotyped Behavior scale scores than those without. The BPI-01 was found to be a reliable (retest reliability, internal consistency, and between-interviewer-agreement) and valid (factor and criterion validity) behavior rating instrument for problem behaviors in mental retardation and developmental disabilities with a variety of potentially useful applications. Strengths and limitations of the instrument are discussed.
A meta-analysis of prevalence and cohort studies conducted over the last 30 years was carried out to identify risk markers for challenging behaviour shown by individuals with intellectual disabilities (IDs). A total of 86 potential studies was identified from the review, with 22 (25.6%) containing sufficient data to enable a statistical analysis to be conducted. Results indicated that males were significantly more likely to show aggression than females, and that individuals with a severe/profound degree of ID were significantly more likely to show self-injury and stereotypy than individuals with a mild/moderate degree of ID. Individuals with a diagnosis of autism were significantly more likely to show self-injury, aggression and disruption to the environment whilst individuals with deficits in receptive and expressive communication were significantly more likely to show self-injury. In most cases, tests for heterogeneity were statistically significant, as expected. The meta-analysis highlighted the paucity of methodologically robust studies of risk markers for challenging behaviours and the lack of data on incidence, prevalence and chronicity of challenging behaviour in this population.
Studies in Britain and the US indicate that 10-15% of people with mental retardation show challenging behaviour, like attacking others (aggression), self-injurious behaviour, destruction, and other difficult, disruptive or socially unacceptable acts. Most researchers indicate that challenging behaviour is more common among adolescents and young adults, among males, is associated with autism, and increases with lack of communication skills and severity of mental retardation. These factors can be understood as risk markers, and some of them can be decreased by preventive and treatment interventions, at least in principle. The present study confirmed most of the previous findings, with some exceptions: the prevalence of more demanding challenging behaviour was somewhat lower in the present study, and no association between gender and challenging behaviour was found. We also concluded that declining prevalence of challenging behaviour at older ages is not a result of a young age structure of the population.
In two studies, Study 1 and Study 2, we examine whether attitudes toward people with intellectual disabilities, like sexism and racism, consist of two forms-a classical and a modern, where the classical is overt and blatant and the modern is more subtle and covert. Self-report scales tapping these two forms were developed in Study 1. Based on confirmatory factor analyses, the results in Study 1 supported our hypothesis and revealed that the modern and classical forms are correlated but distinguishable. This outcome was replicated in Study 2. Construct and discriminatory validations of the scales provided further support for the distinction. The theoretical and practical importance of the results is discussed in relation to previous research on attitudes toward people with intellectual disabilities and other social outgroups.
This study was designed to establish the initial psychometric properties of the first scale specifically developed for behavior problems of adults with Autism Spectrum Disorders (ASD) and intellectual disability (ID). The Autism Spectrum Disorders-Behavior Problems for Adults (ASD-BPA) consists of 20 items in which raters indicate if each item is a “problem” or “no problem.” One hundred seventy-one adults with ASD and ID from two developmental centers participated. The majority of participants (88%) had profound ID. Inter-rater, test-retest, and internal consistency correlation coefficients were computed. Item and factor analyses were also examined and a four-factor model was chosen including Aggression/Destruction, Stereotypy, Self-Injurious Behavior, and Disruptive Behavior. Reliability was moderate to good, internal consistency was very good, and model fit was good. The ASD-BPA may prove to be a useful tool for future research in delineating aspects of problem behaviors in adults that are associated with ASD symptoms. In addition, this research may also distinguish behaviors associated with ASD versus cormorbid psychopathology and/or ID, thus providing implications for clinical practice.
this chapter describes the manifestations of the abnormality of social interaction and of commonly associated impairments of psychological function
the relationship among the various named syndromes, other developmental disorders, and the autistic continuum is discussed
the current standard diagnostic criteria for childhood autism adopted, respectively, by the American Psychiatric Association (1980) and the World Health Organization (1977) are commented on in the light of the above formulation
the clinical implications of the hypothesis are outlined and suggestions made for further research (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A primary goal of scale development is to create a valid measure of an underlying construct. We discuss theoretical principles, practical issues, and pragmatic decisions to help developers maximize the construct validity of scales and subscales. First, it is essential to begin with a clear conceptualization of the target construct. Moreover, the content of the initial item pool should be overinclusive and item wording needs careful attention. Next, the item pool should be tested, along with variables that assess closely related constructs, on a heterogeneous sample representing the entire range of the target population. Finally, in selecting scale items, the goal is unidimensionality rather than internal consistency; this means that virtually all interitem correlations should be moderate in magnitude. Factor analysis can play a crucial role in ensuring the unidimensionality and discriminant validity of scales. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Most of the scale development work in autism spectrum disorders (ASD) to date has focused on instrumentation designed for
one disorder, autism, and mainly focused on young children. Three hundred seventy-one staff were administered a newly developed
assessment scale for adults with ID. The Autism Spectrum Disorders—Diagnosis Scale for Intellectually Disabled Adults (ASD—DA)
was designed to quickly provide relevant information to establish a diagnosis for the most common ASD (autism, PDD-NOS, and
Asperger’s syndrome). Staff completed the assessment for adults with ID (n = 192) some of which had a diagnosis of either autism or PDD-NOS (n = 107) or ID alone (n = 85). Inter-rater and test-retest reliability data were obtained. Item analysis reduced the scale to 31 items that were
found to be both reliable and significantly differentiate between groups. A factor analysis with a three-factor solution was
identified. The internal consistency of factor and total scale scores were found to be excellent.
Challenging behaviors are common and serious problems in adults with autism or pervasive developmental disorder—not otherwise
specified (PDD-NOS) and comorbid intellectual disability (ID). These difficulties impede learning and can compromise placement
in more independent living settings. Despite this, no scale has been developed for problems behaviors in adults with autism
spectrum disorders (ASD). The ASD-BPA is a 19 item scale developed recently, specifically for this purpose. This study is
the first attempt to establish the validity of the measure by correlating it to the more extensive, already established Behavior
Problems Inventory (BPI-01) for 27 adults with ID. The ASD-BPA proved to have good validity. A discussion of the results and
implications for future research is presented.
PDDNOS is a particularly important form of autism spectrum disorder (ASD) due to the frequency with which it is diagnosed. Having said that, it is often diagnosed by what it is not (not autism) as opposed to what it is. And, while PDDNOS is likely to be more common than autism, studies on PDDNOS are much less frequent. Perhaps with the exception of childhood degenerative disorder, PDDNOS has less diagnostic research on it than any other ASD. The purpose of the present paper was to review the available research on the definition and diagnosis of PDDNOS. The data are analyzed and future goals for conceptual and diagnostic research are discussed with the idea of further enhancing a neglected diagnostic category.
Establishing the cut-off scores for Autism Spectrum Disorder-Diagnostic (ASD-DA) scale for adults with intellectual disability (ID) and autism or PDD-NOS was the primary goal of this investigation. The aim of Study 1 was to determine if the ASD-DA was able to differentiate between adults with ID with and without an autism spectrum disorder, and to determine a total score cut-off for this purpose. The aim of Study 2 was to determine if the ASD-DA was able to differentiate between autism and PDD-NOS in this population. Sensitivity, specificity, and receiver operating characteristics (ROC) were computed for potential cut-off scores and were found to be acceptable. The implications of these data for diagnosing ASD in adults with ID are discussed.
A statistical study on the comparison of the comprehension skill levels between the group with and the group without each maladaptive behavior of nine items was done for autistic and mentally retarded children. Results indicated that the group of the autistic children with hyperactivity or withdrawal had slightly, not significantly, lower comprehension skill levels than the group of those without each of these maladaptive behaviors. On the other hand, the correlation between the prevalence of hyperactivity or withdrawal and lower comprehension skill levels was seen more clearly, with statistically significant differences, rather among the mentally retarded children.
Forty-seven autistic and 128 mentally retarded children, ages 6 to 14, from a special school were assessed in terms of nine maladaptive behaviors and speech skill levels. The results indicated that the group of the mentally retarded children with withdrawal had significantly lower speech skill levels than the group of those without withdrawal, and the group of the autistic children with self-injury had significantly lower speech skill levels than the group of those without self-injury.
This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.
Two experiments were conducted to increase the initiations and duration of social interactions between autistic and nonhandicapped youths. Experiment 1 taught two autistic youths to initiate and elaborate social interactions with three age-appropriate and commonly used leisure objects; a radio, a video game, and gum. The students were first taught to use the objects and subsequently instructed in the related social skills. The youths generalized these social responses to other non-handicapped peers in the same leisure setting. A second experiment trained a third autistic youth to emit similar social leisure skills. The use of the leisure objects and the related social skills were taught at the same time. The autistic youth learned these skills and generalized them to other handicapped peers in the same leisure setting. The importance of teaching generalized social responding in particular subenvironments was emphasized.
Thirty, 2-year-old children referred for possible autism were evaluated using a parent interview, a rating scale and psychometric tests and reassessed one year later. Clinical diagnosis was relatively stable across time; diagnosis using the formal measures changed significantly, particularly for younger and more developmentally delayed children. Several patterns contributed to the increasing differentiation of children with autism from age 2 to 3, including the development of clearly recognizable, repetitive behaviors in the autistic children and significant improvements in basic social skills in the children judged not to be autistic.
Although many adults with learning disabilities show features of autistic syndrome, there have been very few population-based studies. We explored the prevalence of autistic traits and their association with maladaptive behaviours in a geographically defined population of adults with learning disabilities.
The carers of 2201 adults with learning disabilities were interviewed, and information was sought concerning aspects of their behaviour and ability. Individuals were scored according to the number of core autistic traits displayed. The prevalence of autistic traits was examined in respect of aspects of behaviour and ability.
Autistic traits were common among adults with learning disabilities. Those with a higher number of autistic traits were more likely to be profoundly learning disabled and demonstrate a wide range of challenging behaviours.
Many adults with learning disabilities demonstrate autistic traits. The relationship of autistic traits with challenging behaviour has major implications in service planning and delivery.
This paper was commissioned by the committee on the Effectiveness of Early Education in Autism of the National Research Council (NRC). It provides a review of epidemiological studies of pervasive developmental disorders (PDD) which updates a previously published article (The epidemiology of autism: a review. Psychological Medicine 1999; 29: 769-786). The design, sample characteristics of 32 surveys published between 1966 and 2001 are described. Recent surveys suggest that the rate for all forms of PDDs are around 30/10,000 but more recent surveys suggest that the estimate might be as high as 60/10,000. The rate for Asperger disorder is not well established, and a conservative figure is 2.5/10,000. Childhood disintegrative disorder is extremely rare with a pooled estimate across studies of 0.2/10,000. A detailed discussion of the possible interpretations of trends over time in prevalence rates is provided. There is evidence that changes in case definition and improved awareness explain much of the upward trend of rates in recent decades. However, available epidemiological surveys do not provide an adequate test of the hypothesis of a changing incidence of PDDs.
In this paper, we give an overview of the diagnostic categories of autism and other pervasive developmental disorders (PDDs) and discuss the changes in the DSM classification system over the past 20 years. We describe each subtype of PDD, along with comorbid psychiatric conditions, assessment guidelines, and tools for diagnosis. The epidemiology of autism has generated much discussion and research; we report the most recent data, as well as recent findings about controversial issues purporting to cause the increased prevalence rate observed in the past decade. Finally, we discuss the prognosis for individuals with autism, indicating the challenges faced by patients, families, and professionals aiming to optimize their outcome.
A number of researchers have explored the attributions that care staff make about challenging behavior. The expectation, based on behavioral and cognitive models, is that these attributions may help predict why staff inadvertently reinforce challenging behavior. Two studies of staff attributions about challenging behavior are reported. In the first, a high level of consistency in attributions across staff was found. In a second quasi-experimental study, staff made attributions about two known clients' behavior. Analysis of these data showed that attributions varied in a manner broadly consistent with the hypothesized functions of the behaviors. The weight of the evidence suggests that staff may be sensitive to the causes of challenging behavior. The practical implications of these data are discussed.
Review of neurochemical investigations in autistic disorder revealed that a wide array of transmitter systems have been studied, including serotonin, dopamine, norepinephrine, acetylcholine, oxytocin, endogenous opioids, cortisol, glutamate, and gamma-aminobutyric acid (GABA). These studies have been complicated by the fact that autism is a very heterogeneous disorder which often presents with comorbid behavioral problems. In addition, many of these studies employed very small samples and inappropriate control groups, making it difficult to draw conclusions with confidence. Overall, serotonin appears to have the most empirical evidence for a role in autism, but this requires further investigation and replication. There is little support for the notion that a dysfunction of norepinephrine or the endogenous opioids are related to autism. The role of dopaminergic functioning has not been compelling thus far, though conflicting findings on central dopamine turnover require further study. Promising new areas of study may include possible dysfunction of the cholinergic system, oxytocin, and amino acid neurotransmitters. Implications for pharmacotherapy are briefly discussed for each neurotransmitter system with brief research examples. Review of this work emphasizes the need for future studies to control for subject variables, such as race, sex, pubertal status, and distress associated with blood draws, which can affect measures of neurochemical function. In addition, research in neurochemistry must continue to work in concert with other subspecialties to form a more comprehensive and theory-based approach to the neurobiological correlates of autistic disorder.
Emotional and behavioural disturbance was assessed in 82 individuals with severe intellectual disabilities and challenging behaviour using the Diagnostic Assessment for the Severely Handicapped-II (DASH-II). Levels of disturbance were compared firstly in individuals with and without features of autism as assessed by the DASH-II, and secondly in individuals with varying severities of autism. In both cases levels of ability and overall severity of behaviour disorder were comparable across groups. Individuals with autistic features were found to have significantly higher scores than nonautistic individuals on the DASH-II organic disorder, anxiety, mania, PDD/autism and stereotypies subscales. When participants with autistic features were separated into groups of severe and moderate autism and compared with nonautistic participants, significant effects of group were found for scores on the anxiety, mood, mania, PDD/autism, schizophrenia and stereotypies subscales. Scheffé tests were conducted to further evaluate between-group differences. Item analysis showed seven DASH-II items to have a 30% or more difference between levels of endorsement in autistic and nonautistic individuals, with six further items showing a 20% or greater difference in levels of endorsement. Findings are compared to those from previous research and implications for the conceptualisation of emotional and behavioural disorders in individuals with autism are discussed.
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