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Risk factors for self-injurious behaviors among 222 young children with autistic disorders

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Abstract

The aim of this study was to identify risk factors for self-injurious behaviours (SIBs) in children with autistic disorders. The occurrence of SIB was examined in comparison with the following variables: chronological age, sex, adaptive skills, speech level, associated medical condition, degree of autism and parental social class. The subjects were 222 children aged under 7 years and all of them fulfilled the ICD-10 criteria for infantile autism. Retrospective data were collected on demographic characteristics and medical condition. Children were assessed in terms of speech, degree of autism and adaptive skills in communication, socialization and daily living skills domains. Results indicated that 50% of the children experienced SIB and 14.6% had severe SIBs. Lower chronological age, associated perinatal condition, a higher degree of autism and a higher daily living skills delay were risk factors of SIBs but parental class, sex and epilepsy were not.

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... Research examining the association between spoken language ability and child behavior problems is mixed. Studies have found no differences, more severe behaviors in less verbal children, and more severe behaviors in more verbal children (Baghdadli et al., 2003;Matson et al., 2009;Williams et al., 2018). The limited research largely focuses on preschool and school-age children, and it is unclear if findings from young children apply to adolescents and adults. ...
... The limited research largely focuses on preschool and school-age children, and it is unclear if findings from young children apply to adolescents and adults. Interestingly, research has found that children with lower spoken language abilities demonstrate more frequent self-injurious behaviors but less aggression per caregiver report, suggesting the importance of examining behavior problems individually (Baghdadli et al., 2003;Matson et al., 2009). Matson et al. (2009) found that lower language abilities were associated with lower levels of parent-reported aggressive/disruptive behaviors but higher levels of stereotyped behaviors in toddlers with ASD. ...
... Having a minimally verbal adolescent or adult with ASD may alter the association between mother-child relationship quality and child behavior problems, particularly if either the quality of the mother-child relationship and/or severity of behavior problems differs based on child verbal status. Moreover, child verbal status may moderate the association between these two variables based on the results of previous research indicating a unique profile of behavior problems present in minimally verbal individuals with ASD (Baghdadli et al., 2003;Matson et al., 2009;Williams et al., 2018). This study asked the following questions: ...
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This study examined differences in mother–child relationship quality and parent-rated child behavior problems based on child verbal status (i.e., minimally verbal versus verbal) in mothers and their adolescent and adult children with autism spectrum disorder (n = 219 dyads; child Mage = 25.38 years, SD = 10.22). Relationship quality was assessed via parent-reported maternal burden and mother–child closeness, and coded speech samples ascertaining maternal critical and positive remarks regarding the child. Groups did not differ in relationship quality. The verbal group was more likely to display disruptive and socially inappropriate behaviors, but otherwise the groups did not differ in behavior problems. Verbal status moderated the relationship between behavior problems and negative (maternal burden, critical remarks) but not positive (mother–child closeness, positive remarks) aspects of relationship quality.
... Intellectual functioning has also been linked to challenging behaviors in individuals with autism spectrum disorder, with greater deficits in intellectual functioning predicting greater frequencies of stereotypy [7,8], aggression [8], and self-injurious behavior [8,9]. In addition, deficits in adaptive skills [10,11] and expressive language skills [11] have been associated with engagement in challenging behaviors in individuals with autism spectrum disorder, but studies [8][9][10][11][12] that investigated the relationship between gender and challenging behaviors found no significant differences in engagement in challenging behaviors between boys and girls with autism spectrum disorder. ...
... Intellectual functioning has also been linked to challenging behaviors in individuals with autism spectrum disorder, with greater deficits in intellectual functioning predicting greater frequencies of stereotypy [7,8], aggression [8], and self-injurious behavior [8,9]. In addition, deficits in adaptive skills [10,11] and expressive language skills [11] have been associated with engagement in challenging behaviors in individuals with autism spectrum disorder, but studies [8][9][10][11][12] that investigated the relationship between gender and challenging behaviors found no significant differences in engagement in challenging behaviors between boys and girls with autism spectrum disorder. ...
... Significant gender differences were found across clusters, however. Specifically, both girls and boys in Cluster 4 (stereotypy) displayed stronger rates of skill mastery than boys in Cluster 2 (self-injurious behavior); however, no significant differences were found between boys and girls in Cluster 4 and girls in Cluster 2. In previous research, gender was found to be a risk factor for the occurrence of challenging behaviors in individuals with autism spectrum disorder [8][9][10][11][12]. While the role of gender is unclear, this finding provides further support for the significant differences in treatment response across clusters, particularly for Cluster 4 and Cluster 2. ...
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Background Challenging behaviors are prevalent among individuals with autism spectrum disorder; however, research exploring the impact of challenging behaviors on treatment response is lacking. Objective The purpose of this study was to identify types of autism spectrum disorder based on engagement in different challenging behaviors and evaluate differences in treatment response between groups. Methods Retrospective data on challenging behaviors and treatment progress for 854 children with autism spectrum disorder were analyzed. Participants were clustered based on 8 observed challenging behaviors using k means, and multiple linear regression was performed to test interactions between skill mastery and treatment hours, cluster assignment, and gender. ResultsSeven clusters were identified, which demonstrated a single dominant challenging behavior. For some clusters, significant differences in treatment response were found. Specifically, a cluster characterized by low levels of stereotypy was found to have significantly higher levels of skill mastery than clusters characterized by self-injurious behavior and aggression (P
... The main characteristics of the eligible studies are outlined in Table 2. Of the design of studies included, five were cross sectional observational studies (Duerden et al., 2012;Gulsrud, Lin, Park, Hellemann, & McCracken, 2018;Handen et al., 2018;Poustka & Lisch, 1993;Richards, Davies, & Oliver, 2017), and three were cross sectional observational studies which utilised existing data (Baghdadli, Pascal, Grisi, & Aussilloux, 2003;Lance et al., 2014;Soke et al., 2018). Four studies were observational studies based on information obtained from databases and data repositories (Dempsey, Dempsey, Guffey, Minard, & Goin-Kochel, 2016;Richman et al., 2013;Soke et al., 2017Soke et al., , 2019. ...
... The majority of studies sought ethics approval or consent from participants or parents, although this was not explicitly achieved by Duerden et al. (2012), Lance et al. (2014), or Richman et al. (2013), however there was no evidence of ethical misconduct. Limitations and theoretical or practical implications were discussed in all studies except two which were Baghdadli et al. (2003) and Poustka and Lisch (1993). This may not be reported in the latter case because the study was continued and findings published in a separate article (Baghdadli et al., 2008) which did report such details. ...
... Using the critical appraisal tool the lowest scoring study was appraised at 41% (Poustka & Lisch, 1993) and the highest scoring article was appraised at 83% (Richards et al., 2016). Studies by Baghdadli et al. (2003), Baghdadli et al. (2008), Rattaz et al. (2015) received similar critiques largely focused around their methodology and lack of transparency. Upon reading the full text it becomes apparent to the reader that each study uses a subset of data from primary publications (Aussilloux, Baghdadli, Bursztejn, HochMann, & Lazartigues, 2001;Baghdadli, Picot, Michelon, Bodet, & Pernon, 2007). ...
Article
Background Self-injurious behaviour (SIB) is a persistent and distressing difficulty which may be more prevalent and enduring for individuals with an Autism Spectrum Disorder (ASD). SIB has been largely conceptualised in research as a challenging behaviour or a repetitive and restricted behaviour, rather than a unique construct to research. As its own construct, the aetiology of SIB has been conceptualised from a neurobiological perspective, however there remains a need to explore psychosocial and behavioural factors associated with SIB and ASD. A review was conducted to compile evidence and establish current understanding of this behaviour. Method 6 databases were systematically searched for research exploring factors relating specifically to SIB limited to ASD populations. Studies were critically appraised using a tool developed for the purpose of this review, adapted from the CASP, AXIS and STROBE quality appraisal tools. Results 15 studies met the eligibility criteria. SIB was found to be associated with impairments in adaptive ability, communicative ability, IQ, sleep, atypical sensory processing, and impulsivity/over-activity. There were mixed findings supporting an association between autism severity and self-injury. Conclusions The development of SIB in ASD populations is complex. The range of factors associated with SIB and ASD imply a clinical need for a robust assessment and a multi-disciplinary approach to intervention. Theoretical perspectives regarding the role of impaired behavioural inhibition, communication, and sensory processing difficulties are considered. Limitations and future research are discussed.
... A one-unit increase in the Vineland Composite Standard Score leads to a 2% decrease in SIB frequency and severity (Flowers et al. 2020). Baghdadli et al. identified younger chronological age, associated perinatal conditions, severity of autism and developmental delay as risk factors for SIB (Baghdadli et al. 2003). The link between psychiatric comorbidities and SIB has not been extensively studied, but some studies indicate an association between SIB and low mood (Arron et al. 2011) and overactivity/impulsivity (Davies and Oliver 2016). ...
... Most of the studies on SIB in children with autism and Unspecified Intellectual Developmental Disorder (UIDD) did not have severe phenotypes of SIB as their primary focus (Flowers et al. 2020, Baghdadli et al. 2003, Arron et al. 2011, Oliver et al. 2012, Davies and Oliver 2014, Lundqvist 2013, Richman et al. 2013, Cooper et al. 2009, Soke et al. 2017, Handen et al. 2018. It is important to define severe SIB as it likely causes more impairment, is more refractory to intervention, and may be more associated with psychiatric comorbidities. ...
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Objective: This study aims to delineate the characteristics of severe self-injurious behaviors (SIB) in a cohort of children with autism and unspecified intellectual developmental disorder (UIDD) (intellectual disability) and examine potential risk factors for developing SIB. Methods: A retrospective chart review studied characteristics of severe SIB in 30 children with autism spectrum disorder (ASD) and UIDD referred to a tertiary care center. Characteristics examined include genetic syndromes, brain MRI abnormalities, verbal ability, adaptive functioning, SIB frequency and severity, age of onset, number of psychopharmacological agents, irritability, hyperactivity, stereotypy, psychiatric and physical comorbidities, among others. Descriptive and bivariate analysis were applied to explore potential relationships between factors. Results: Children with severe SIB exhibit this behaviour with high frequency, inflicting moderate to severe injury. Most children in the study sample are non-verbal and have ASD (93.3%; n = 28) with psychiatric (96.7%; n = 29) and physical (90%; n = 27) comorbidities. Overall SIB improvement using the Clinical Global Impression, Improvement Score (CGI-I) was 3.0 (minimally improved). A minority were much or very much improved following appropriate intervention. Conclusions: The severity of SIB is much higher in this sample than previously noted in the literature. Severe SIB is associated with ADHD, early onset mood disorders, tics, avoidant restrictive food intake disorder and Obsessive-Compulsive Disorder.
... It includes a series of aggressive behaviors that an individual directs towards themselves which could potentially result to physical injury, in form of tissue damage (Matson & Turygin 2012). They include head banging, hand-to-head banging, body slamming, hitting or punching oneself, eyeball pressing, biting oneself, wound picking, and hair pulling (Baghdadli, et al., 2003). It can also take a form of self-mutilation which may involve cutting one's skin, burning, or bone breaking. ...
... Hand-hitting topography is the most common (23%), while self-cutting topography is the least common (3%) (Steenfeldt-Kristensen, 2020). General prevalence rates of self-injurious behavior vary from 33 to 71% (Baghdadli, et al., 2003). It is also one of the reasons behind exclusion from the mainstream schooling Incontinence This is defined as lack of voluntary control of urination or defecation. ...
... In low-and middle-income countries, this rate is estimated to vary between 0.15% and 0.8%, whereas in a developing country such as Bangladesh this rate is reported to be 3% [9][10][11]. ASD symptoms gradually show up before 1 year of age, with nearly 80% of problems being identified by 2 years of age [12,13]. In particular, boys are affected 3 to 4 times more than girls with ASD [14]. ...
... Concerning parents' demography, educational level, occupation, family income and expenditures, number of siblings, and living area remain very important factors in the development of children with ASD [27][28][29][30]. Environmental factors such as the socioeconomic condition, neighborhood, and society's attitudes toward children with ASD are very significant [12,13]. Although genes increasing the risk for ASD in children are mostly prenatal [32], demography of parents remains very important [33], as it can affect the improvement of patients with ASD. ...
Article
Full-text available
Background: Care for children with autism spectrum disorder (ASD) can be challenging for families and medical care systems. This is especially true in Low-and-Middle-Income-countries (LMIC) like Bangladesh. To improve family-practitioner communication and developmental monitoring of children with ASD, [spell out] (mCARE) was developed. Within this study, mCARE was used to track child milestone achievement and family socio-demographic assets to inform mCARE feasibility/scalability and family-asset informed practitioner recommendations. Objective: The objectives of this paper are three-fold. First, document how mCARE can be used to monitor child milestone achievement. Second, demonstrate how advanced machine learning models can inform our understanding of milestone achievement in children with ASD. Third, describe family/child socio-demographic factors that are associated with earlier milestone achievement in children with ASD (across five machine learning models). Methods: Using mCARE collected data, this study assessed milestone achievement in 300 children with ASD from Bangladesh. In this study, we used four supervised machine learning (ML) algorithms (Decision Tree, Logistic Regression, k-Nearest Neighbors, Artificial Neural Network) and one unsupervised machine learning (K-means Clustering) to build models of milestone achievement based on family/child socio-demographic details. For analyses, the sample was randomly divided in half to train the ML models and then their accuracy was estimated based on the other half of the sample. Each model was specified for the following milestones: Brushes teeth, Asks to use the toilet, Urinates in the toilet or potty, and Buttons large buttons. Results: This study aimed to find a suitable machine learning algorithm for milestone prediction/achievement for children with ASD using family/child socio-demographic characteristics. For, Brushes teeth, the three supervised machine learning models met or exceeded an accuracy of 95% with Logistic Regression, KNN, and ANN as the most robust socio-demographic predictors. For Asks to use toilet, 84.00% accuracy was achieved with the KNN and ANN models. For these models, the family socio-demographic predictors of "family expenditure" and "parents' age" accounted for most of the model variability. The last two parameters, Urinates in toilet or potty and Buttons large buttons had an accuracy of 91.00% and 76.00%, respectively, in ANN. Overall, the ANN had a higher accuracy (Above ~80% on average) among the other algorithms for all the parameters. Across the models and milestones, "family expenditure", "family size/ type", "living places" and "parent's age and occupation" were the most influential family/child socio-demographic factors. Conclusions: mCARE was successfully deployed in an LMIC (i.e., Bangladesh), allowing parents and care-practitioners a mechanism to share detailed information on child milestones achievement. Using advanced modeling techniques this study demonstrates how family/child socio-demographic elements can inform child milestone achievement. Specifically, families with fewer socio-demographic resources reported later milestone attainment. Developmental science theories highlight how family/systems can directly influence child development and this study provides a clear link between family resources and child developmental progress. Clinical implications for this work could include supporting the larger family system to improve child milestone achievement. Clinicaltrial: We took the IRB from Marquette University Institutional Review Board on July 9, 2020, with the protocol number HR-1803022959, and titled "MOBILE-BASED CARE FOR CHILDREN WITH AUTISM SPECTRUM DISORDER USING REMOTE EXPERIENCE SAMPLING METHOD (MCARE)" for recruiting a total of 316 subjects, of which we recruited 300. (Details description of participants in Methods section).
... In low-and middle-income countries, this rate is estimated to vary between 0.15% and 0.8%, whereas in a developing country such as Bangladesh this rate is reported to be 3% [9][10][11]. ASD symptoms gradually show up before 1 year of age, with nearly 80% of problems being identified by 2 years of age [12,13]. In particular, boys are affected 3 to 4 times more than girls with ASD [14]. ...
... Concerning parents' demography, educational level, occupation, family income and expenditures, number of siblings, and living area remain very important factors in the development of children with ASD [27][28][29][30]. Environmental factors such as the socioeconomic condition, neighborhood, and society's attitudes toward children with ASD are very significant [12,13]. Although genes increasing the risk for ASD in children are mostly prenatal [32], demography of parents remains very important [33], as it can affect the improvement of patients with ASD. ...
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BACKGROUND Care for children with autism spectrum disorder (ASD) can be challenging for families and medical care systems. This is especially true in Low-and-Middle-Income-countries (LMIC) like Bangladesh. To improve family-practitioner communication and developmental monitoring of children with ASD, [spell out] (mCARE) was developed. Within this study, mCARE was used to track child milestone achievement and family socio-demographic assets to inform mCARE feasibility/scalability and family-asset informed practitioner recommendations. OBJECTIVE The objectives of this paper are three-fold. First, document how mCARE can be used to monitor child milestone achievement. Second, demonstrate how advanced machine learning models can inform our understanding of milestone achievement in children with ASD. Third, describe family/child socio-demographic factors that are associated with earlier milestone achievement in children with ASD (across five machine learning models). METHODS Using mCARE collected data, this study assessed milestone achievement in 300 children with ASD from Bangladesh. In this study, we used four supervised machine learning (ML) algorithms (Decision Tree, Logistic Regression, k-Nearest Neighbors, Artificial Neural Network) and one unsupervised machine learning (K-means Clustering) to build models of milestone achievement based on family/child socio-demographic details. For analyses, the sample was randomly divided in half to train the ML models and then their accuracy was estimated based on the other half of the sample. Each model was specified for the following milestones: Brushes teeth, Asks to use the toilet, Urinates in the toilet or potty, and Buttons large buttons. RESULTS This study aimed to find a suitable machine learning algorithm for milestone prediction/achievement for children with ASD using family/child socio-demographic characteristics. For, Brushes teeth, the three supervised machine learning models met or exceeded an accuracy of 95% with Logistic Regression, KNN, and ANN as the most robust socio-demographic predictors. For Asks to use toilet, 84.00% accuracy was achieved with the KNN and ANN models. For these models, the family socio-demographic predictors of “family expenditure” and “parents’ age” accounted for most of the model variability. The last two parameters, Urinates in toilet or potty and Buttons large buttons had an accuracy of 91.00% and 76.00%, respectively, in ANN. Overall, the ANN had a higher accuracy (Above ~80% on average) among the other algorithms for all the parameters. Across the models and milestones, “family expenditure”, “family size/ type”, “living places” and “parent’s age and occupation” were the most influential family/child socio-demographic factors. CONCLUSIONS mCARE was successfully deployed in an LMIC (i.e., Bangladesh), allowing parents and care-practitioners a mechanism to share detailed information on child milestones achievement. Using advanced modeling techniques this study demonstrates how family/child socio-demographic elements can inform child milestone achievement. Specifically, families with fewer socio-demographic resources reported later milestone attainment. Developmental science theories highlight how family/systems can directly influence child development and this study provides a clear link between family resources and child developmental progress. Clinical implications for this work could include supporting the larger family system to improve child milestone achievement. CLINICALTRIAL We took the IRB from Marquette University Institutional Review Board on July 9, 2020, with the protocol number HR-1803022959, and titled “MOBILE-BASED CARE FOR CHILDREN WITH AUTISM SPECTRUM DISORDER USING REMOTE EXPERIENCE SAMPLING METHOD (MCARE)” for recruiting a total of 316 subjects, of which we recruited 300. (Details description of participants in Methods section)
... Self-injury, aggression, and property destruction have all been associated with a diagnosis of ASD (Felce & Kerr, 2013). Of the aforementioned topographies, SIB is thought to be more prevalent in ASD, with 27% (Soke et al., 2016) to 40-50% of the population engaging in this behaviour (Baghdadli, Pascal, Grisi, & Aussilloux, 2003;Richards, Oliver, Nelson, & Moss, 2012). Whereas with aggression, the prevalence varies by a greater degree and appears to be influenced by age, comorbidities, and definitions of aggression applied (some of which include property destruction). ...
Chapter
Engagement in challenging behaviour (e.g., aggression, self-injury) is reported to occur in neurodevelopmental disorders such as intellectual disabilities (ID), autism spectrum disorder (ASD), and fragile X syndrome (FXS). Common interventions to address these behaviours include both behavioural and pharmacological approaches. Although psychotropic medications are commonly used to address challenging behaviour in ID, ASD, and FXS, demonstration of the effectiveness of treatment is limited. Furthermore, research examining interaction effects between psychotropic medication, challenging behaviour, and environmental events within specific neurodevelopmental disorders such as ID, ASD, and FXS is scarce. The purpose of this chapter is to provide an overview of challenging behaviour within ID, ASD, and FXS and of the effectiveness of psychotropic medication as an intervention for challenging behaviour within these neurodevelopmental disorders. Finally, research examining how psychotropic medication may impact the relationship between challenging behaviour and environmental events is reviewed.
... The biobehavioral or psychosocial factors associated with the emergence and persistence of SIB in ASD need to be characterized to identify who is likely to develop chronic versus transient SIB. Putative risk markers and predictors investigated for the emergence and persistence of SIB among individuals with ASD include symptom severity (Baghdadli et al., 2003;Rattaz et al, 2015), impulsivity/hyperactivity (Richards et al., 2012;Richards et al., 2016), intellectual functioning (Dimian et al., 2017;Richards et al., 2012), sensory features (Duerden et al., 2012), and stereotypy (Richman et al., 2013). Methodological variability regarding how SIB was measured, the age groups included, sampling methods, and the study designs utilized make it difficult to generalize and come to a consensus about risk factors for SIB. ...
Article
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Existing research suggests that self-injurious behavior (SIB) is a relatively common interfering behavior that can occur across the lifespan of individuals with autism spectrum disorder (ASD). We previously reported that SIB or proto-injurious SIB at 12 months was related to increased risk of SIB at 24 months among a preschool sample of children with a high familial likelihood for ASD (Dimian et al., 2017). In the present study, we extend these findings, examine SIB occurrence, and associated potential risk factors at 36 months. The present sample included 149 infants with an older sibling with ASD (65.8% male) who completed assessments at ages 12, 24, and 36 months. Descriptive analyses and binary logistic regression models were utilized. SIB was more prevalent among those children who received a diagnosis of ASD. Logistic regression indicated that presence of SIB, stereotypy, hyper- and hypo- sensory responsivity, and lower intellectual functioning at age 12 months significantly predicted the occurrence of SIB at 36 months. These findings have implications for understanding developmental processes culminating in persistent SIB and may inform prevention programming.
... Additionally, the children in this study not only had co-occurring ABI and ASD, but over 71.4% of the children had three or more comorbid DSM-5 diagnoses. The phenomenon of comorbidities "masking" ASD symptomology would also be in accordance with the current study finding that, on average, the age of first ASD symptoms noted in medical records was later than the average age suggested in the literature for the general ASD population [67,68]. ...
Article
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Autism spectrum disorder (ASD) is a neurodevelopmental condition that arises from a combination of both genetic and environmental risk factors. There is a lack of research investigating whether early acquired brain injury (ABI) may be a risk factor for ASD. The current study comprehensively reviewed all hospital records at The Brain Injury Service, Kids Rehab at the Children’s Hospital at Westmead (Australia) from January 2000 to January 2020. Of the approximately 528 cases, 14 children with paediatric ABI were subsequently given an ASD diagnosis (2.7%). For this ASD sample, the mean age at the time of the ABI was 1.55 years, indicating a high prevalence of early ABI in this diagnostic group. The mean age of ASD diagnosis was, on average, 5 years later than the average ASD diagnosis in the general population. Furthermore, 100% of children had at least one medical comorbidity and 73% had three or more co-occurring DSM-5 diagnoses. Although based on a small data set, results highlight early paediatric ABI as a potential risk factor for ASD and the potential for a delayed ASD diagnosis following early ABI, with comorbidities possibly masking symptoms. This study was limited by its exploratory case series design and small sample size. Nonetheless, this study highlights the need for longitudinal investigation into the efficacy of early screening for ASD symptomatology in children who have sustained an early ABI to maximise potential intervention.
... Contributors to aggression include self-injurious behavior, ritualistic behavior, and resistance to change [36]. Self-injurious behaviors are also common in ASD, with prevalence rates ranging from 30% to 53% [38][39][40][41]. Self-injurious behaviors are significant precursors of later aggression among children with intellectual disability [42]. ...
Article
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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.
... Children with ASD exhibit challenging behaviours frequently at varying intensities and in different forms, such as meltdowns, tantrums, property destruction, and aggression [2][3][4]. The prevalence rate of challenging behaviours and aggression among children with ASD is high [5][6][7]. It is reported by the Autism Society of Minnesota that one in every 68 people have ASD [8]. ...
Article
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Children with autism face challenges in various skills (e.g., communication and social) and they exhibit challenging behaviours. These challenging behaviours represent a challenge to their families, therapists, and caregivers, especially during therapy sessions. In this study, we have investigated several machine learning techniques and data modalities acquired using wearable sensors from children with autism during their interactions with social robots and toys in their potential to detect challenging behaviours. Each child wore a wearable device that collected data. Video annotations of the sessions were used to identify the occurrence of challenging behaviours. Extracted time features (i.e., mean, standard deviation, min, and max) in conjunction with four machine learning techniques were considered to detect challenging behaviors. The heart rate variability (HRV) changes have also been investigated in this study. The XGBoost algorithm has achieved the best performance (i.e., an accuracy of 99%). Additionally, physiological features outperformed the kinetic ones, with the heart rate being the main contributing feature in the prediction performance. One HRV parameter (i.e., RMSSD) was found to correlate with the occurrence of challenging behaviours. This work highlights the importance of developing the tools and methods to detect challenging behaviors among children with autism during aided sessions with social robots.
... Prevalence of self-harm risk in this study was 48%. For comparison, the rate of self-harm in early identified autistic young people up to seven years old has been reported at 50% [48]. Rates vary widely from 10% to 70% for young Fig. 1 Comparing group mean scores on statistically significant 'Thinking Patterns Profiling Model' variables for those with/without selfharm risk and those with/without trait impulsivity. ...
Article
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Background Autism has been linked to higher rates of self-harm. Research is yet to establish the reason for the association between autism and self-harm as a distress response. Methods Using the ‘thinking patterns profiling model’, this study explored characteristics associated with self-harm risk in 100 autistic young people. Secondary analysis of routinely collected clinical data was conducted using odds ratios and t-tests. Results We found the prevalence of reported self-harm risk was 48%. Young people with reported self-harm risks had significantly lower regulation skills (p ≤ 0.01) and lower social flexibility skills (p ≤ 0.01) compared to those without reported self-harm risk. For those described as impulsive, mean scores on the following skills were significantly lower: perspective-taking skills (p ≤ 0.01), flexible thinking for creative problem-solving (p ≤ 0.05) and sensory tolerating (p ≤ 0.05). There was no relationship between reported self-harm risk and adverse childhood experiences. Conclusions These findings suggest that profiling tools such as ‘Thinking Patterns Profiling Model’ can be used to explore unique patterns of vulnerability and resilience related to self-harm risk in autism. The findings suggest that autistic thinking patterns might interplay with other factors (e.g. impulsivity). Patterns are based on each person’s profile across four core skill-sets: regulation, flexible thinking, sensory coherence, and social perspective-taking. These findings motivate a person-centred and profile-informed approach to planning support and adjustments. Further studies are needed to confirm the ways in which mechanisms typically involved in self-harm risk, may interact with core cognitive and affective differences found in autism.
... According to Al-Qabandi et al. (2011) the symptoms of ASD are evident to parents when they arise in association with cognitive impairments, delays in the emergence of motor developmental milestones, speech delays, or medical problems such as epilepsy. Baghdadli et al. (2003) mention that difficulties in daily required skills and the presence of neurological problems or hearing deficits in the child are the main milestones for the recognition of this spectrum. Children who do not have language delays, on the other hand, tend to be diagnosed with ASD later in life (Fountain et al., 2011). ...
Chapter
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Temos de prazer de lançar o primeiro livro internacional do ano de 2023, voltado a área de saúde, que tem como título Collection of International Topics in Health Science- V1 , essa obra é editada pela Seven Publicações Ltda, tendo a composição de diversos capítulos voltados ao desenvolvimento e disseminação do conhecimento na área da saúde.
... The relationship between expressive language and composite externalizing behavior was also mostly consistent across studies, where 78% of studies found that greater expressive language ability was associated with less composite externalizing behavior. Our findings are consistent with a meta-analysis by Curtis We attempted to contact the authors of Baghdadli et al. (Baghdadli et al., 2003) and Baghdadli et al.(Baghdadli et al., 2008) to determine if an overlapping sample was used. While we received no response, we have assumed that both papers are from the same study since the sample size and first author is the same and both relate to a large longitudinal study. ...
Article
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.
... They were included in different Questionnaires (Activity Questionnaire [133], Self-Restraint Questionnaire, Challenging Behaviour Questionnaire, Repetitive Behaviour Questionnaire, and Social Communication Questionnaire) in his study. Baghdadli et al. [152] found that there is no correlation between gender and self-injury. But Frazier et al. [153] found that females showed more selfinjury, compared to males. ...
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Autism Spectrum Disorder (ASD), according to The Diagnostic and Statistical Manual of Mental Disorders- Fifth Edition (DSM-5), is a neurodevelopmental disorder that includes deficits of social interaction and social communication with the presence of restricted/repetitive behaviors. Due to communication deficits, ASD children have difficulties in joint attention and social reciprocity. Genetic disorders and/or environmental aspects are the leading causes of ASD. In 2021, the Centers for Disease Control and Prevention reported that approximately 1 among 44children in the U.S. is diagnosed with ASD. As per World Health Organization, ASD affects 14 out of every 10,000 children in Asian countries, which is approximately 23 children per 10,000 children in India. The Reported work shows that the early detection and intervention of ASD improve the language and communication deficiency of ASD children. This paper provides a comprehensive survey on various approaches to monitoring and detecting ASD children. Some monitoring and detection approaches covered in the study are clinical-based detection, MachineLearning -based ASD detection, Internet of Things (IoT)-based ASDdetection, Affective state detection, and Self Injurious Behaviour (SIB)detection of autistic children. This review also lists the several unaddressed challenges of early ASD detection. The purpose of this article is to enhance the understanding, provide guidelines for the domain, and provide insight into developing more practical and close-to-market products.
... Maladaptive behaviors are particularly common in ASD-affecting over half of individuals with ASD [17][18][19][20]-and have been shown to significantly impact a range of short-and long-term outcomes, including academic achievement, social competence, and adult psychiatric functioning [16,21]. Therefore, it is important to understand factors that may exacerbate or ameliorate such maladaptive behaviors in ASD across multiple social contexts (i.e., home and school via parent and teacher reports); the presence of a sibling, serving as a behavioral model, may be one such factor. ...
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Siblings play an important role in the behavioral trajectories of individuals with autism spectrum disorder (ASD). While having siblings has been associated with positive outcomes in ASD, including stronger adaptive functioning, social and non-verbal communication, and theory of mind, little is known about the impact of siblings on more negative outcomes, such as maladaptive behaviors. To address this gap, the present longitudinal study tested sibling predictors of trajectories of maladaptive behaviors (e.g., teacher- and parent-reported hyperactivity, irritability, and social withdrawal) from childhood through early adulthood among individuals with ASD and non-spectrum delays. Multilevel models revealed that, while the mere presence of a sibling did not impact maladaptive behavior trajectories apart from teacher-reported hyperactivity, the diagnostic profile of the sibling (e.g., emotional/behavioral disorder, ASD, medical condition) emerged as an important predictor. Specifically, although findings varied across teacher and parent reports, more hyperactivity and irritability across time was identified when the sibling had diagnoses of an emotional/behavioral disorder, ASD, and/or a medical condition. Overall, this study provides novel insight into the broader family-level factors that influence the presentation of maladaptive behaviors across time and across contexts.
... (2)(3)(4) The behavioural comorbidities of ASD include aggressive behaviour (up to 68%)(5, 6) and repetitive self-injurious behaviour (up to 50%). (7,8) In children with ASD and self-injurious behaviours (SIB), over 75% of children will have persistence of these behaviours into adulthood, sometimes resulting in severe harm and even death. (5,(9)(10)(11)) SIB can be de ned as repetitive "behaviour which produces physical injury to the individual's own body" with several different subclassi cations. ...
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Background Children and youth with Autism Spectrum Disorder (ASD) may manifest self-injurious behaviours (SIB) that may become severe and refractory with limited pharmacologic or behavioural treatment options. Here, we present the protocol of a prospective, mixed-methods study to assess the safety and efficacy of deep brain stimulation (DBS) of the nucleus accumbens (NAcc) for children and youth with ASD and severe, refractory SIB. Methods This is a prospective, single-center, single-cohort, open-label, non-randomized pilot trial of 6 patients. Participants will be recruited through specialized behavioural clinics with persistent severe and refractory SIB following standard and intensive interventions. Following NAcc-DBS, participants will be enrolled in the study for 12 months. The primary objectives of the study are safety and feasibility, assessed by rate of recruitment and identification of factors impacting adherence to follow-up and study protocol. Treatment efficacy will be assessed by changes in the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), the Behaviour Problems Index (BPI), the Inventory of Statements about Self-Injury (ISAS) and the Repetitive Behaviour Scale-Revised (RBS-R) questionnaires. Additional clinical outcomes will be assessed, including measures of participant and caregiver quality of life, actigraph measurements, and positron emission tomography (PET) changes following DBS. Discussion This study will be the first to evaluate the effect of DBS of the NAcc on a pediatric population in a controlled, prospective trial. Secondary outcomes will improve the understanding of behavioural, neuro-imaging and electrophysiologic changes in children with ASD and SIB treated with DBS. This trial will provide an estimated effect size of NAcc-DBS for severe refractory SIB in children with ASD in preparation for future comparative trials. Trial Registration Registration on ClinicalTrials.gov was completed on June 12 of 2019 with the Identifier: NCT03982888. https://clinicaltrials.gov/ct2/show/NCT03982888
... 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. ...
Article
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. We tested an intonation‐based speech treatment for minimally verbal children with autism (Auditory‐Motor Mapping Training, AMMT) against a non‐intonation–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 co‐activating shared auditory and motor neural representations of manual and vocal actions, and mimicking the “babbling and banging” stage of typical development.
... Children with autism have higher rates of challenging behaviours and aggression compared to others with developmental disabilities and it was reported to start since infancy [7][8][9][10]. The challenging behaviours rates are high (e.g., 49% to 69%) and increase with the severity of autism [11][12][13][14][15]. A challenging behaviour might manifest as meltdown, tantrum, withdrawing, or as a stereotypical behaviour that could pose a risk on the children themselves or others around them [16,17]. ...
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Aggression in children is frequent during the early years of childhood. Among children with psychiatric disorders in general, and autism in particular, challenging behaviours and aggression rates are higher. These can take on different forms, such as hitting, kicking, and throwing objects. Social robots that are able to detect undesirable interactions within its surroundings can be used to target such behaviours. In this study, we evaluate the performance of five machine learning techniques in characterizing five possible undesired interactions between a child and a social robot. We examine the effects of adding different combinations of raw data and extracted features acquired from two sensors on the performance and speed of prediction. Additionally, we evaluate the performance of the best developed model with children. Machine learning algorithms experiments showed that XGBoost achieved the best performance across all metrics (e.g., accuracy of 90%) and provided fast predictions (i.e., 0.004 s) for the test samples. Experiments with features showed that acceleration data were the most contributing factor on the prediction compared to gyroscope data and that combined data of raw and extracted features provided a better overall performance. Testing the best model with data acquired from children performing interactions with toys produced a promising performance for the shake and throw behaviours. The findings of this work can be used by social robot developers to address undesirable interactions in their robotic designs.
... Tem-se destacado que sintomas gastrointestinais como constipação, diarreia, dores no estômago e náuseas são comumente observados no autismo 3 o que impacta diretamente no comportamento do indivíduo, que pode manifestar irritabilidade e ansiedade em razão desses incômodos, trazendo assim a premissa do papel do eixo Cérebro-Intestino-Microbiota (CIM) como via fisiopatológica no TEA 5 . Esses eventos, muitas vezes podem ser intensos levando a hospitalizações e piores prognósticos 6,7,8 . ...
Article
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Objetivo: caracterizar os estudos relacionados ao uso de probióticos na prática clínica do transtorno do espectro autista. Métodos: trata-se de uma pesquisa exploratória e descritiva, sob forma de revisão integrativa, onde foram incluídos artigos originais realizados com indivíduos com diagnóstico de autismo que utilizavam probióticos, em um recorte temporal de dez anos (2009 a 2019). Resultados: as cepas probióticas utilizadas no autismo mais descritas nos estudos foram do gênero Lactobacillus (77,7%), Bifidobacterium (55,5%) e Streptococcus (33,3%). Foram relatadas melhoras em distúrbios comportamentais, cognitivos e gastrointestinais, assim como perda de sobrepeso e diminuição de marcadores inflamatórios. Os efeitos adversos de maior ocorrência foram diarreia (44,4%), constipação (22,2%), erupção cutânea (22,2%). Conclusão: Os estudos demonstraram associação benéfica com o uso de probióticos em crianças e jovens com autismo. A população dos estudos foi considerada pequena pelos autores, o que leva a proposta de ensaios clínicos controlados por placebo, com populações maiores, para obtenção de dados mais confiáveis.
... Individual cultural, social and economic capital builds a field of opportunities for pursuing a career (Iellatchitch et al., 2003). Simultaneously, two major kinds of boundaries to the "boundaryless career" have been identified: the competence-based boundary (industry boundary) and the relation-based boundary (social capital boundary) (Baghdadli et al., 2003). In the last two decades, increasing environmental awareness has pushed researchers towards addressing the issue of HRM as a strategic tool for making companies sustainabilitydriven organizations (e.g. ...
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Purpose The purpose of the study was to detect trends in human resource management (HRM) research presented in journals during the 2000–2020 timeframe. The research question is: How are the interests of researchers changing in the field of HRM and which topics have gained popularity in recent years? Design/methodology/approach The approach adopted in this study was designed to overcome all the limitations specific to the systematic literature reviews and bibliometric studies presented in the Introduction. The full texts of papers were analyzed. The text-mining tools detected first clusters and then trends, moreover, which limited the impact of a researcher's bias. The approach applied is consistent with the general rules of systematic literature reviews. Findings The article makes a threefold contribution to academic knowledge. First, it uses modern methodology to gather and synthesize HRM research topics. The proposed approach was designed to allow early detection of nascent, non-obvious trends in research, which will help researchers address topics of high value for both theory and practice. Second, the results of our study highlight shifts in focus in HRM over the past 19 years. Third, the article suggests further directions of research. Research limitations/implications In this study, the approach designed to overcome the limitations of using systematic literature review was presented. The analysis was done on the basis of the full text of the articles and the categories were discovered directly from the articles rather than predetermined. The study's findings may, however, potentially be limited by the following issues. First, the eligibility criteria included only papers indexed in the Scopus and WoS database and excluded conference proceedings, book chapters, and non-English papers. Second, only full-text articles were included in the study, which could narrow down the research area. As a consequence, important information regarding the research presented in the excluded documents is potentially lost. Third, most of the papers in our database were published in the International Journal of Human Resource Management, and therefore such trends as “challenges for international HRM” can be considered significant (long-lasting). Another – the fourth – limitation of the study is the lack of estimation of the proportion between searches in HRM journals and articles published in other journals. Future research may overcome the above-presented limitations. Although the authors used valuable techniques such as TF-IDF and HDBSCAN, the fifth limitation is that, after trends were discovered, it was necessary to evaluate and interpret them. That could have induced researchers' bias even if – as in this study – researchers from different areas of experience were involved. Finally, this study covers the 2000–2020 timeframe. Since HRM is a rapidly developing field, in a few years from now academics will probably begin to move into exciting new research areas. As a consequence, it might be worthwhile conducting similar analyses to those presented in this study and compare their results. Originality/value The present study provides an analysis of HRM journals with the aim of establishing trends in HRM research. It makes contributions to the field by providing a more comprehensive and objective review than analyses resulting from systematic literature reviews. It fills the gap in literature studies on HRM with a novel research approach – a methodology based on full-text mining and a big data toolset. As a consequence, this study can be considered as providing an adequate reflection of all the articles published in journals strictly devoted to HRM issues and which may serve as an important source of reference for both researchers and practitioners. This study can help them identify the core journals focused on HRM research as well as topics which are of particular interest and importance.
... verbais e motoras são frequentes, repertório restrito de atividades e interesses, também, são apontados. Segundo Al-Qabandi et al. (2011) os sintomasdo TEA são evidentes aos pais quando surgem associados a comprometimentos cognitivos, atrasos no surgimento de marcos desenvolvimentais motores, atrasos na fala ou problemas médicos, como a epilepsia.Baghdadli et al. (2003) menciona que dificuldades em competências requeridas diariamente e a presença de problemas neurológicos ou de déficits auditivos na criança são os principais marcos para o reconhecimento desse espectro. Já as crianças que não possuem atraso na linguagem, tendem a ser diagnosticadas com TEA mais tardiamente(Fountain et al., 2011). ...
Article
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Frente ao aumento nos diagnósticos de Transtorno do Espectro Autista em crianças e adolescentes, a nível mundial, faz-se necessário um estudo, a fim, de entender de que forma tais diagnósticos são realizados. Desta forma, o presente estudo objetivou investigar a idade na realização do diagnóstico do Transtorno do Espectro Autista (TEA) em pacientes de uma clínica privada, de uma cidade da região metropolitana de Porto Alegre, no estado do Rio Grande do Sul, bem como, quais foram os profissionais envolvidos nesse processo. Participaram 9 país, sendo 7 mães e 2 pais, com idades entre 29 e 62 anos, todos possuíam união estável, somente um dos entrevistados não possuía ensino médio completo. Trata-se de um estudo qualitativo, com delineamento de estudos de casos múltiplos. Os resultados foram organizados em categorias referentes a idade das crianças no momento do diagnóstico. Importante destacar que a maioria dos pais entrevistados observaram comportamentos atípicos em seus filhos antes dos 3 anos de idade, sendo o comprometimento e o atraso no desenvolvimento da comunicação e da linguagem o sintoma mais precocemente observado pelos mesmos, seguido pelos comprometimentos no comportamento social.
... The behavioral comorbidities of ASD include aggressive behavior (up to 68%) [5,6] and repetitive self-injurious behavior (up to 50%) [7,8]. In children with ASD and self-injurious behaviors (SIB), over 75% of children will have persistence of these behaviors into adulthood, sometimes resulting in severe harm and even death [5,[9][10][11]. ...
Article
Full-text available
Background: Children and youth with autism spectrum disorder (ASD) may manifest self-injurious behaviors (SIB) that may become severe and refractory with limited pharmacologic or behavioral treatment options. Here, we present the protocol of a prospective, mixed-methods study to assess the safety and efficacy of deep brain stimulation (DBS) of the nucleus accumbens (NAcc) for children and youth with ASD and severe, refractory SIB. Methods: This is a prospective, single-center, single-cohort, open-label, non-randomized pilot trial of 6 patients. Participants will be recruited through specialized behavioral clinics with persistent severe and refractory SIB following standard and intensive interventions. Following NAcc-DBS, participants will be enrolled in the study for 12 months. The primary objectives of the study are safety and feasibility, assessed by rate of recruitment and identification of factors impacting adherence to follow-up and study protocol. Potential treatment efficacy will be assessed by changes in the Children's Yale-Brown Obsessive-Compulsive Scale in ASD (CYBOCS-ASD), the Behavior Problems Index (BPI), the Inventory of Statements about Self-Injury (ISAS) and the Repetitive Behavior Scale-Revised (RBS-R) questionnaires. Additional clinical outcomes will be assessed, including measures of participant and caregiver quality of life, actigraph measurements, and positron emission tomography (PET) changes following DBS. Discussion: This study will be the first to evaluate the effect of DBS of the NAcc on a pediatric population in a controlled, prospective trial. Secondary outcomes will improve the understanding of behavioral, neuro-imaging, and electrophysiologic changes in children with ASD and SIB treated with DBS. This trial will provide an estimated effect size of NAcc-DBS for severe refractory SIB in children with ASD in preparation for future comparative trials. Trial registration: Registration on ClinicalTrials.gov was completed on 12 June 2019 with the Identifier: NCT03982888 .
... The findings of this study, however, remind us that acts of aggression or violence, when they do occur in individuals with ASD, may be indicators of severe pain or distress, and underlying medical issues need to be assessed as possible causes of these serious behaviors. Self-injurious behavior is also, unfortunately, common in ASD, and again, may point to distress due to a medical problem (Baghdadli et al., 2003;Richards et al., 2012;Soke et al., 2016). This should be considered in the context of emergency response and deescalation of situations where there is a risk of harm to self or others. ...
Article
Lay abstract: Gastrointestinal problems are common in the autism spectrum disorder community and may affect both the person with autism spectrum disorder and their families. However, little research is available on the experiences of families who have a child with both autism spectrum disorder and gastrointestinal symptoms. We held one-on-one interviews with 12 parents of children who had both autism spectrum disorder and gastrointestinal symptoms. We analyzed the raw text responses from these interviews and identified four main themes. First, parents shared that their children had trouble verbally communicating when they were experiencing gastrointestinal symptoms (Theme 1). This led parents to use bodily signs, such as changes in the stool, and non-verbal behaviors, such as irritability, to recognize when their child was having gastrointestinal symptoms. Next, gastrointestinal issues affected both the child's well-being and their ability to attend class and extracurricular or social activities (Theme 2). The gastrointestinal issues also affected the family's routines, overall well-being, and their ability to go out and do activities together as a family (Theme 3). Finally, parents often had challenges receiving accessible and quality healthcare for their child's gastrointestinal problems (Theme 4). Together, these findings highlight the enormous burden that gastrointestinal symptoms have on the wellness of children with autism spectrum disorder and their families.
... 12 On the other hand, while some MV children with ASD have low expressive and receptive verbal skills, others have good (or relatively good) receptive abilities, which somehow seem to be related to their nonverbal skills, 13 though being difficult to evaluate in these children. 14 This heterogeneity in intellectual functioning and linguistic abilities between MV individuals with ASD suggests there is no single mechanism underlying their difficulties in learning to speak. 3 Language impairment in ASD children, and particularly in MV ones, can lead to various unfavorable consequences, including behavior problems (such as self-aggression, hetero-aggression, and property destruction), [15][16][17] poorer daily living and social skills. 18 Sometimes, behavior problems can become so severe and difficult to manage, and they start being called "challenging behaviors." ...
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Objective: To review clinical and neurobiological features of minimally verbal children with autism spectrum disorder. Data source: We carried out a narrative review using the PubMed database. We considered the following search terms combined through the Boolean operator "AND": "autism spectrum disorder"; "minimally verbal." Data synthesis: To date, there is no shared definition of minimally verbal children with autism spectrum disorder. The heterogeneity in intellectual functioning and in linguistic abilities among these individuals suggests there is no single mechanism underlying their difficulties in learning to speak. However, the reasons why these children do not speak and the biological markers that can identify them are still unknown. Language impairment in these children can lead to several unfavorable consequences, including behavior problems (such as self-aggression, hetero-aggression, and property destruction), poorer daily living and social skills. Psychiatric comorbidities (including attention deficit/hyperactivity disorder, specific phobias, and compulsions) consist in a serious problem related to the lack of verbal language in individuals with autism spectrum disorder. Although in the literature there are very few evidence-based results, several findings suggest that an alternative and augmentative communication intervention, creating an extra-verbal communication channel, may be effective in these individuals. Conclusions: The exact definition, clinical characteristics, associated disorders, etiology, and treatment of minimally verbal subjects with autism spectrum disorder must still be further studied and understood.
... Autism spectrum disorder (ASD) is characterized by impairments in social-communication skills and the presence of rigid and repetitive patterns of behavior (American Psychiatric Association, 2013). Children with ASD often experience an array of behavioral difficulties (Baghdadli, 2003;Hartley, 2008;Kanne & Mazurek, 2011;Militerni, 2002) that are commonly exacerbated by cooccurring psychiatric conditions including anxiety, depression, attention deficits, and hyperactivity (Hallet, 2009;Machalicek et al., 2016;Matson & Nebel-Schwalm, 2007;Matson & Williams, 2014;Simonoff et al., 2008). ...
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Children with autism may display an externalizing problem behavior, which are associated with increased parenting stress and depression in caregivers. Mindful parenting is defined as having a non-judgmental moment-to-moment awareness during caregiver-child interactions. The extant literature is mixed, with some reporting that associations between child problem behavior and parenting stress and depression vary by level of mindful parenting, while others have not found these relations. We sought to extend these explorations. Participants who were caregivers of 75 children with autism spectrum disorder (ASD) ages 5–10, in the Pacific Northwestern region of the United States. Child conduct problems, parenting stress and caregiver depression, and mindful parenting were measured using caregiver-reported measures. Child conduct problems, parenting stress, and caregiver depression, and mindful parenting were all significantly correlated. The association between child conduct problems and parenting stress was significant for caregivers with high and low levels of mindful parenting. In contrast, the association between child conduct problems and caregiver depression was significant only for caregivers with low levels of mindful parenting. Our results suggest that mindful parenting may be a promising protective factor for the well-being of caregivers of children with autism. Implications are discussed.
... The assessment of the prevalence of self-injury behaviors (SIB) varies depending on the adopted criteria and the degree of severity of the assessed behaviors. The results of research conducted by Baghdadli et al. (2003) showed that 50 % of people with ASD display SIB behavior, and 14.6 % have severe forms of SIB. In turn, in the studies of Soke et al. (2016), the occurrence of SIB was found in 27.7 % of respondents. ...
Article
Full-text available
Background: Autism spectrum disorders are a diagnostic unit predisposing the occurrence of challenging behaviors. Depending on their frequency and severity, behavioral problems may significantly limit the developmental possibilities of people with ASD, and also significantly affect family life and the therapeutic process. Aggressive, self-injury, destructive or stereotypic behaviors require intervention based on individualized support, the basis of which should be a functional assessment. Aims: The aim of the study was to develop and adapt the Polish version of the Question About Behavioral Function (QABF) questionnaire by Matson and Vollmer used to assess the functions of challenging behaviors. Method: Data was obtained from 107 people with ASD. Material was analyzed relating to 168 problem behaviors manifested by these people. To determine the psychometric properties of the tool, reliability and validity analyses were carried out with confirmatory factor analysis using the maximum likelihood method. The Fornell and Larcker method (1981) was used to estimate the convergent and differential validity. Result: The analysis confirmed the structure of 5-factor QABF. Composite reliability (CR) achieved values at a level of 0.855 and higher. An AVE value of above 0.5 for all factors, while at the same time lower than the CR value, confirmed the convergent validity of the tool. The differential value was confirmed on the basis of the AVE and MSV values. The results obtained confirm that the analyzed tool is accurate and reliable. Conclusion: QABF, in the Polish language version, is a reliable tool for assessing the behavioral functions of people with ASD. The limitations of the research are also discussed.
... In addition, atypical behavioral patterns and reactions are the most common sources of parental stress [47] and one of the most staggering obstacles in an autistic child's education [48]. Aggression towards oneself [49] and others [50], insistence on nonfunctional rituals and activities, noncompliance to behavior rules, and tantrums [50] are common among patients with ASD and cause more psychological familial distress than core autistic symptoms [47]. The level of intellectual development in children with ASD is a strong predictor of social and adaptive functioning in adult life [51] and is associated with restricted interests and repetitive behavior [52], sensory processing [53], language growth [54], atypical behavior and expressive language [50]. ...
Article
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Background: Autistic spectrum disorder (ASD) is a significant socio-biological problem due to its wide prevalence and negative outcomes. In the current study, we aimed to develop an autism scale for early and accurate differentiation of 3- to 4-year-olds at risk for ASD since there is no systematic monitoring of young children in Russia yet. Methods: The total sample (N = 324) included 116 children with ASD, 131 children without ASD (healthy controls), and 77 children with developmental delay (DD). An online survey of specialists working with children was conducted based on a specially designed autism questionnaire consisting of 85 multiple-choice tasks distributed across 12 domains. Initially, each child was assessed by 434 items using a dichotomous scale (0 = no, 1 = yes). Factor and discriminant analyses were performed to identify a compact set of subscales that most accurately and with sufficient reliability predicted whether a child belongs to the ASD group. Results: As a result, four subscales were obtained: Sensorics, Emotions, Hyperactivity, and Communication. The high discriminability of the subscales in distinguishing the ASD group from the non-ASD group was revealed (accuracy 85.5–87.0%). Overall, the obtained subscales meet psychometric requirements and allow for creating an online screening system for wide application.
... Τώρα, όσον αφορά τις επαναλαμβανόμενες στερεοτυπικές συμπεριφορές, αυτές γίνονται ανησυχητικές όταν προκαλούνται αυτοτραυματισμοί, όπως το χτύπημα του κεφαλιού, το τράβηγμα των μαλλιών ή το δάγκωμα του εαυτού τους (Baghdadli et al. 2003, στο O'Neil, 2008. Σχετικά με αυτό τοποθετήθηκε και ένας από τους συμμετέχοντας, ο οποίος τόνισε ότι όλες αυτές οι συμπεριφορές γινόντουσαν προκειμένου να διώξει το "δυσάρεστο" που ένιωθε. ...
... Communication is both a basic need and the right of all human beings (Brady et al., 2016), and better expressive communication is associated with fewer maladaptive behaviors in ASD (Baghdadli et al., 2003;Dominick et al., 2007;Hartley et al., 2008). Developing effective communication treatments for minimally verbal children is therefore an area of high clinical importance. ...
Article
Purpose Understanding what limits speech development in minimally verbal (MV) children with autism spectrum disorder (ASD) is important for providing highly effective targeted therapies. This preliminary investigation explores the extent to which developmental speech deficits predicted by Directions Into Velocities of Articulators (DIVA), a computational model of speech production, exemplify real phenotypes. Method Implementing a motor speech disorder in DIVA predicted that speech would become highly variable within and between tokens, while implementing a motor speech plus an auditory processing disorder predicted that DIVA's speech would become highly centralized (schwa-like). Acoustic analyses of DIVA's output predicted that acoustically measured phoneme distortion would be similar between the two cases, but that in the former case, speech would show more within- and between-token variability than in the latter case. We tested these predictions quantitatively on the speech of children with MV ASD. In Study 1, we tested the qualitative predictions using perceptual analysis methods. Speech pathologists blinded to the purpose of the study tallied the signs of childhood apraxia of speech that appeared in the speech of 38 MV children with ASD. K-means clustering was used to create two clusters from the group of 38, and analysis of variance was used to determine whether the clusters differed according to perceptual features corresponding to within- and between-token variability. In Study 2, we employed acoustic analyses on the speech of the child from each cluster who produced the largest number of analyzable tokens to test the predictions of differences in within-token variability, between-token variability, and vowel space area. Results Clusters produced by k-means analysis differed by perceptual features that corresponded to within-token variability. Nonsignificant differences between clusters were found for features corresponding to between-token variability. Subsequent acoustic analyses of the selected cases revealed that the speech of the child from the high-variability cluster showed significantly more quantitative within- and between-token variability than the speech of the child from the low-variability cluster. The vowel space of the child from the low-variability cluster was more centralized than that of typical children and that of the child from the high-variability cluster. Conclusions Results provide preliminary evidence that subphenotypes of children with MV ASD may exist, characterized by (a) comorbid motor speech disorder and (b) comorbid motor speech plus auditory processing disorder. The results motivate testable predictions about how these comorbidities affect speech. Supplemental Material https://doi.org/10.23641/asha.14384432
... Consistent with previous evidence [3,46], intellectual disability correlates with increased stereotypes and self-harming behaviour (SSP-SB and SSP-SI). Although the prevalence of self-injurious acts in ASD is estimated to be around 40-50% [58,59], they are not specific to ASD [55,60] but are more typical of patients with severe symptoms and severe intellectual deficits [61,62]. Recent evidence of an association between intellectual disability, repetitive-narrow behaviours, and hyperactivity and impulsivity [63,64] has led some authors to suggest that deficits in executive functions (particularly the impairment of the inhibitory function) would affect the severity and frequency of self-injurious acts. ...
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The relationship between sensory profile and repetitive behaviours in autism spectrum disorder (ASD) has long been known. However, there is no consensus on the type of relationship that exists between them. This monocentric retrospective–prospective observational study aimed (a) to detect a clinical correlation between the severity of repetitive behaviours and the alterations of sensory profile in a sample of 50 children diagnosed with ASD; (b) to evaluate how different patterns of stereotypies and sensory alterations correlate with each other and with the main clinical–instrumental variables in the same sample. We enrolled 29 children in the retrospective phase of the study and 21 in the prospective phase. The Repetitive Behaviour Scale-Revised (RBS-R) and the Short Sensory Profile (SSP) were administered to the caregivers, and clinical–instrumental data were collected. SSP and RBS-R total scores directly correlated with a high significance rate. Among the subscales, the strongest correlations involved “Visual/Auditory Sensitivity”, related to “Stereotyped Behaviour” and “Sameness Behaviour”. “Under-Responsive/Seeks Sensation” related to “Stereotyped Behaviour”. Sex and intellectual disability significantly influenced both the stereotypies and the sensory alterations of the examined population. In conclusion, this study provides new insights into the relationship between sensory alterations and repetitive behaviours in ASD children by using direct medical observation and parent observation.
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Mental health is considered a priority today all over the world; in terms of treatment and especially prevention. Studies also show that, year after year, mental health problems are becoming the cause of problems at work, absenteeism, disability, which, in addition to mental health, also affect productivity at work. For the realization of this study, a qualitative approach has been considered, in order to better understand such a problem, which has not been addressed often in our country. 6 focus groups were conducted: three in the private sector and three in the public sector. Each of them had 8-11 participants. The composition, in terms of sociodemographic variables, was diverse. The study showed that, in institutions, leaders and managers do not yet have the proper awareness to take care of the mental health of employees. Employees state that they cannot complain if they have such problems, that they cannot be absent from work for this reason and that, in general, elements such as relations between employees, etc., are not taken into consideration. No significant difference was observed in the comparison between the private and public sectors. This study brings attention to the need to focus on mental health at work, so that policy makers, managers and employees themselves appreciate its importance. A number of aspects are recommended to be taken into consideration, including division of labor based on skills and opportunities, fostering effective cooperation between employees, working conditions, etc. Received: 05 May 2022 / Accepted: 17 May 2023 / Published: 20 May 2023
Article
The purpose of this study was to review recent researches conducted abroad and domestic regarding functional communication training(FCT) to reduce self-injurious behavior for students with autism spectrum disorder(ASD). A total of 12 studies including 11 abroad studies and 1 domestic studies were selected according to inclusion criteria and exclusion criteria. For a more systematic analysis, we divided the FCT into three essential steps to examine the functional analysis of self-injurious behavior, alternative responses of communication, and intervention methods. The analysis revealed that all studies conducted a single subject research method. Self-injurious behaviors of students appeared in various forms, accompanied by aggression, destruction and disruption. In addition, the function of self-injurious behavior was ‘tangible’ with the highest frequency, followed by ‘escape demand’, ‘attention’ and ‘free play’. Alternative forms of communication were spoken, picture cards and AAC. The form was diversified in consideration of the student’s level of communication and preference. Out of a total of 12 studies 9 studies applied the prompts step by step. And nine of the studies confirmed that the schedule thinning was applied. The degree of the FCT effect differed according to the function of problem behavior, the amount of task, the mediator, and the communication response. The extent of the FCT effect was high when the intervention was provided through the student’s preferred communication style. Lastly, we suggested a limitation for the follow-up research along with discussions based on these findings.
Chapter
Self-injurious behavior (SIB) includes repetitive or persistent behavior that may cause physical harm or injury to oneself (Huisman et al., Neurosci Biobehav Rev 84: 483–491, 2018; Tate & Baroff, Behav Res Ther 4(1–2): 281–287, 1966). SIB can cause serious injury, require significant resources to treat, and greatly impact quality of life for the individual and their family, warranting the need for assessment and treatment. This chapter provides a general overview of the emergence and classification of SIB with an emphasis on operant principles related to the development and treatment of SIB. Following a brief description of functional assessment, we review general categories of behavioral treatments for SIB maintained by social and automatic reinforcement, with considerations for severity, safety, and long-term treatment success. Given the difficulty and complexity that may exist in the assessment and treatment of SIB, we close with some suggestions for how psychologists can incorporate their ethical guidelines into responsible, respectful, and humane care.KeywordsSelf-injurious behaviorBehavioral treatmentSIB subtypes
Chapter
Rituals, stereotypies, and other restricted interests are one of the behavioral characteristics that may lead to a diagnosis of autism spectrum disorder. Often, these behaviors are not inherently problematic, similar to anyone who repetitively taps their toes or cracks their knuckles. However, stereotypies can occur at such high and persistent levels that these behaviors compete with participation in educational activities (e.g., if children do not attend to teachers or if behaviors are disruptive to others education) or if such behaviors lead to social ostracization (e.g., peers may be less accepting when individuals engage in loud or otherwise overt forms of stereotyped behavior). For those cases in which the occurrence of stereotypies and rituals creates a problem for those who engage in these behaviors, this chapter describes (a) what we understand about the development of these behaviors, (b) how we assess the role of environmental influences on the occurrence of these behaviors, and (c) how we approach intervention design to help individuals choose when it is and is not appropriate to engage in stereotypic or ritualistic behavior.KeywordsAutomatic reinforcementDiscrimination trainingDifferential reinforcementEnvironmental enrichmentFunctional analysisFunction-based interventionRitualsStereotypy
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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.
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هدفت الدراسة إلى التعرف على فعالية برنامج عن بعد قائم على فنيات تحليل السلوك التطبيقي لإكساب الأمهات الأميات أساليب التعامل مع سلوكيات أطفالهن من ذوي اضطراب طيف التوحد. ولتحقيق ذلك استخدمت الدراسة المنهج الشبه تجريبي المتمثل في تصميم المجموعة الواحدة. وتمثلت عيِّنة الدراسة من (9) أمهات أميات لأطفال من ذوي اضطراب طيف التوحد المتواجدات بمركز التوحد بمنطقة الطائف، وعليه تألفت أدوات الدراسة من مقياس مستوى امتلاك الأمهات لفنيات تعديل السلوك إعداد هيثم الحيارى (2018)، وتصميم برنامج عن بعد قائم على فنيات تحليل السلوك التطبيقي من إعداد الباحثة. وتوصلت النتائج إلى وجود فروق ذات دلالة إحصائية بين متوسطي أفراد الدراسة في القياسين القبلي والبعدي لبعد أساليب زيادة السلوك المرغوب لصالح القياس البعدي، ووجود فروق ذات دلالة إحصائية بين متوسطي أفراد الدراسة في القياسين القبلي والبعدي لبعد أساليب خفض السلوك غير المرغوب لصالح القياس البعدي، وجود فروق ذات دلالة إحصائية بين متوسطي أفراد الدراسة في القياسين القبلي والبعدي لبعد أساليب تشكيل السلوك الجديد لصالح القياس البعدي.
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Objectives: Patients with autism spectrum disorder (ASD) may be more predisposed to oral pathology, including dentoalveolar trauma. Our aim was to assess the risk of dentoalveolar trauma in patients with ASD. Materials and methods: Meta-analysis methodology was used to compared the prevalence of dentoalveolar trauma in individuals with ASD compared to children without ASD. A literature search was carried out, with predefined inclusion and exclusion criteria, to identify controlled studies evaluating dentoalveolar trauma in individuals with ASD. Data were combined using the random-effects meta-analysis model. Results: Out of an initial 154 studies, 14 were selected for inclusion in the meta-analysis, resulting in a total of 1488 individuals with ASD. Meta-analysis results showed significant difference in the overall risk of dentoalveolar trauma between individuals with ASD versus a control group (RR = 1.45). Looking at specific types of dentoalveolar trauma, individuals with ASD were found to be more at risk for partial or total luxation injuries (RR = 3.02) than healthy individuals. Conclusions: Children with ASD are more at risk for dentoalveolar trauma than children without ASD, especially for more severe dentoalveolar trauma such as luxation and avulsion injuries.
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Self-injurious behavior (SIB) by individuals with intellectual and developmental disabilities including autism (I/DD) is among the most clinically disturbing, socially costly, and scientifically challenging behavior disorders. Forty years of clinical research has produced a knowledge base supporting idiographic behavioral assessment and treatment approaches. Despite the treatment progress, from a public health and population perspective, we argue it is less clear that we have reduced the disorder's burden. The developmental course of the disorder is mostly unknown and empirically informed population-level models of risk are absent. In this review, we systematically examined the published scientific literature specific to risk for SIB in the I/DD population. We reviewed study methodology in detail intentionally informed by an epidemiological perspective with a set of questions intended to test the quality of the inferences about risk. Results are discussed in terms of conceptual, methodological, and translational issues with respect to what needs to be done to create credible and useful clinical models for SIB risk in the I/DD population.
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Self-injurious behavior (SIB) is a challenging behavior in autism, and some issues about this theme is still unclear, mainly in children and adolescents without intellectual disability. According to the behavioral analysis theoretical model, SIB can fulfill different roles. We conducted a systematic review in order to investigate the prevalence rates and risk factors according to the classification framework based on functional SIB analysis in this group of patients. MEDLINE, Embase, and PsycINFO were searched, and 14 papers fulfilled the criteria for further investigation, which corresponds to 7649 non-intellectually-impaired autistic individuals (82.3% males). The prevalence rates of SIB in the sample ranged between 10.1–70.5%; Besides, some variables, such as sociodemographic characteristics and ASD severity, were analyzed as risk factors according to age and type of SIB described in studies. We discuss our findings based on a novel classification model to contribute to the gaps in understanding this complex phenomenon.
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Access to timely behaviour support services for children and adolescents with a disability in rural and remote regions of Australia is problematic due to the inadequate supply of specialised staff providing complex behaviour support in their local area. Technology has the potential to provide a timely, quality, low-cost option that extends access to behaviour support services for these children and their support teams in rural and remote areas. The purpose of this narrative review was to explore policy and practice guidelines on the delivery of behaviour support via telepractice for children and adolescents with a disability in Australia, and more specifically for those on the autism spectrum. Secondly, the review aimed to establish the evidence base of this model of service for children and adolescents with autism, in order to reflect on how it aligns with current Australian policy and practice. Practice and policy documents were drawn from selected websites relevant to the delivery of behaviour support via telepractice in Australia. Peer-reviewed literature (2004–2019) on the delivery of behaviour support via telepractice was sourced via four databases. While telepractice appears to have promising utility for the provision of support for children and adolescents with autism who present with challenging behaviour, there was very little policy documentation or guidelines found that related specifically to the delivery of this support. There is a need for further rigorous research to inform policy, establish efficacy, and develop practice guidelines that ensure delivery of high quality telepractice behaviour supports under the National Disability Insurance Scheme.
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Very little is known about the 30% of children with Autism Spectrum Disorder (ASD) who remain minimally verbal when they enter school. Restricted and repetitive behaviors (RRBs) are well‐characterized in younger, preschool, and toddler samples. However, the prevalence and impact of RRBs has not been characterized in older, minimally verbal children. The goal of this study was to characterize this core diagnostic feature in minimally verbal children with ASD ages 5–8 years over a 9‐month period to better understand how these behaviors manifest in this crucially understudied population. RRBs were coded from caregiver‐child interactions (CCX) at four timepoints. Upon entry into the study, children demonstrated an average of 17 RRBs during a 10‐min CCX. The most common category was Verbal. RRBs remained constant over 6 months; however, a slight reduction was observed at the final timepoint. Compared to prior literature on younger samples, minimally verbal children with ASD demonstrated higher rates of RRBs and higher rates of verbal RRBs. Further work is required to understand the function and impact of RRBs in minimally verbal children. Lay Abstract Approximately one‐third of children with autism spectrum disorder (ASD) remain minimally verbal at the time of school entry. In this study, we sought to characterize the presence of restricted and repetitive behaviors (RRBs) in school‐aged children (5–8) who were minimally verbal. Compared to prior studies, minimally verbal children with ASD had higher frequencies of RRBs and demonstrated a different profile of behaviors, including more verbal RRBs.
Chapter
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.
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Celem studium była jakościowa analiza doświadczenia matki dziecka ze spektrum autyzmu (ASD) w zakresie otrzymywanego i oczekiwanego wsparcia. W procesie badawczym zastosowano wywiad ustrukturyzowany. Uzyskane wyniki dają obraz osamotnionej i przytłoczonej obowiązkami kobiety, o poczuciu braku wystarczających kompetencji wychowawczych. Pociąga to za sobą postulat rozwoju zróżnicowanych formy pomocy dla rodziców dzieci z ASD, np. grup wsparcia, indywidualnych konsultacji ze specjalistami, warsztatów rozwijających kompetencje wychowawcze. Istotne jest także objęcie wspar-ciem informacyjnym szerszych kręgów rodzinnych oraz tworzenie kampanii społecznych przybliżające tę problematykę społeczeństwu.
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A survey of self-injurious behaviour in people receiving services for mental handicap was carried out in one health region. Six hundred and sixteen adults and children were found to have engaged in self-injurious behaviour sufficient to have caused tissue damage in the previous 4 months and 596 of these were screened. Half were resident in hospital while 28% were in non-hospital residential care and the remainder (21%) were living at home. Nearly one-fifth (19%) showed self-injurious behaviour, of one or more types, at a rate of at least once per hour and a further 13% wore protective or restraining devices for all or part of the day or night. Only 2% were enrolled on formal psychological treatment programmes but nearly half were receiving psychotropic drugs (excluding anticonvulsants).
Article
In autism, individual and environmental factors lead to heterogeneous outcomes. Some individual and environmental factors such as intellectual and speech level in childhood are well known. Others — gender, age of onset or association of medical disease — are controversial. The influence of environmental factors and of interventions is less known.The aim of this collaborative and prospective study is to identify the relationship between the individual and environmental factors.The relationship between the differences as regards the two assessments realised at intervals of three years and interventions will be studied.In this paper, we present, retrospective data, social features and assessment results (diagnosis, intensity of autistic behavior, cognitive and speech profiles) in 193 autistic children with a mean age of five years.
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The paper is a theoretical analysis of the evolution of the concepts related primarily to the definition and to the antecedents of self-injurious behavior (SIB). It was found that the definition of SIB as currently used contains surplus meanings unrelated to its scientific utility. At present, a restricted definition of SIB is not warranted because its basic parameters have not been studied adequately. Analysis of SIB taxonomies suggests two subclasses of SIB: social and nonsocial. Epidemiological studies of SIB suggest chronic and acute subsamples that differ in organicity, chronicity, and length of institutionalization. Ecological analysis suggests that a variety of antecedent conditions affect rates and topographies of SIB, e.g., ambient environmental conditions, background settings, situational demands, self-restraint, and type of daily routine activity. Implications were drawn for the organization of therapeutic environments, the study of covariation among collateral topographies, the dynamics of SIB responding, and sequential dependencies among SIB and related topographies.
Article
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.
Article
Describes the Autism Diagnostic Interview-Revised (ADI-R), a revision of the Autism Diagnostic Interview, a semistructured, investigator-based interview for caregivers of children and adults for whom autism or pervasive developmental disorders is a possible diagnosis. The revised interview has been reorganized, shortened, modified to be appropriate for children with mental ages from about 18 months into adulthood and linked to ICD-10 and DSM-IV criteria. Psychometric data are presented for a sample of preschool children.
Article
In order to find out if self-injury is associated with the autistic syndrome or at least to specific autistic behaviour patterns, 69 probands were examined and assessed according to the criteria of the Autism Diagnostic Interview according to IQ. We found a high prevalence of self-injurious behaviour among autistic individuals at age 4-5 but no positive correlation between self-injury and the different areas of autistic behaviour. Possible aetiological factors are discussed.
Article
The Vineland Adaptive Behavior scale (survey form) was used in a sample of 151 normal children under age 18. Standardized mean scores of French children were comparable to those of the American normative sample. From the age of 6 onwards, French children scored consistently lower in the Daily Living Skills domain though the magnitude of this difference remained moderate. While the overall findings support the cross-cultural stability of the psychometric properties of this instrument, attention is drawn to potential problems in the use of the Vineland scales, with special reference to autistic samples.
Article
There have been few epidemiological studies of the disabling and poorly understood disorder self-injurious behaviour among adults with learning disabilities. Interviews were undertaken with the carers of adults known to the Leicestershire Learning Disabilities Register (n = 2277). The Disability Assessment Schedule was used and information was also collected on demographic characteristics, developmental and physical status. Self-injurious behaviour was present in 17.4% of the population. In 1.7% self-injurious behaviour occurred frequently and was severe. There was no gender difference between those with and without self-injurious behaviour. Both the chronological age and developmental quotient of individuals with self-injurious behaviour were lower than those of individuals without self-injurious behaviour. Autistic symptoms were more common among those with self-injurious behaviour. The association of self-injurious behaviour with a wide range of other maladaptive behaviours was highly significant. Logistic regression analysis retained age, developmental quotient, hearing status, immobility and number of autistic symptoms as explanatory variables for self-injurious behaviour. Self-injurious behaviour is a prevalent and disabling disorder among adults with learning disabilities.
Article
Very little is known about the early stages of self-injurious behaviour (SIB) in young children with developmental disabilities, even though there has been a great deal of research into the prevalence, assessment and treatment of well-established SIB in older individuals. In the present initial study, teachers in special schools for children under II years of age with severe intellectual disability and/or autism were asked to identify children who were beginning to show early self-injury (the index group). These children were then matched to classroom controls (of the same ability level and mobility), and teachers were interviewed about the children's behaviours and skills. The index children showed significantly more potential SIB than the control group children, but there was overlap between the groups in terms of percentage duration of potential SIB, suggesting that teachers do not find it easy to identify children with 'early' SIB. The index children's skills and problem behaviours, their sensory impairments and degree of autism did not differ significantly from those of the control group. When all the children showing any potential SIB were pooled together, it transpired that developmental age and degree of mobility were significantly correlated with percentage duration of SIB, suggesting that these characteristics may be important risk markers. The index children were also observed at 3-month intervals at school over the following 18 months and self-injury clearly escalated for some of the index children, while it did not do so for others. Using regression analysis, increases in SIB were shown to be associated only with the degree of concern expressed about the child's behaviour at time I by the teacher, no other variables predicting increases in SIB.
Article
Human growth modeling statistics were utilized to examine how Vineland Adaptive Behavior Scale (VABS) scores changed in individuals with autistic disorder as a function of both age and initial IQ. Results revealed that subjects improved with age in all domains. The rate of growth in Communication and Daily Living Skills was related to initial IQ while rate of growth in Social Skills was not. Results should provide hope for parents and further support for the importance of functional social-communication skills in the treatment of autism.
Article
In order to examine the importance of a range of potential risk factors for behaviour problems in children with severe intellectual disability, a sample was identified by the administration of a screening version of the Vineland Adaptive Behaviour Scales (VABS) to the parents of children aged 4-11 years attending six special needs schools in three adjacent inner London boroughs. Parents whose children had a VABS standard score of < or = 50 were interviewed using the Disability Assessment Schedule and both parents and teachers completed the Aberrant Behaviour Checklist. Most behaviour problems were more common in ambulant children, but problems less dependent on the ability to walk, such as sleeping difficulties, screaming and self-injury, were equally common in ambulant and non-ambulant children. Among ambulant children, there were few significant associations between the severity of the child's behaviour problems and the age or sex of the child, the presence or absence of epilepsy, and various indices of socio-economic disadvantage. Sleeping difficulties, overactivity, self-injury, destructive behaviour and autistic features, such as social withdrawal and stereotypies, were strongly associated with skills deficits, but aggression, temper tantrums and general disruptive behaviour were not. Limitations in daily living skills were better predictors of behaviour problems than were poor communication skills.
Article
The prevalence of self-injurious behavior (SIB) in an institution for people with mental retardation was investigated. The relationship between SIB and age, sex, level of retardation, length of institutionalization, adaptive behavior, and probable causes of mental retardation was examined. A factor analysis on the topographies of SIB indicated the existence of two forms of SIB, stereotyped and social. The results are discussed in terms of probable causes of SIB.
Article
The present study was designed to identify risk factors for injuries including falls and non fall-related injuries among adults with developmental disabilities. The following variables were examined as potential risk factors: age, gender, level of intellectual disability, health, seizures, ambulatory status, adaptive and maladaptive behaviours, use of antipsychotic drugs, and type of residential setting. The subjects were 268 adults with developmental disabilities > or = 30 years of age. A total of 30 participants (11%) were reported to have injuries. Over 50% of injuries were caused by falls. Individuals who had a higher frequency of seizures, had more destructive behaviour and used antipsychotic drugs had the highest risk of injuries. A sub-analysis of fall-related injuries indicated that individuals who were > or = 70 years of age, ambulatory and had a higher frequency of seizures had the highest risk of injurious falls. Adaptive behaviour, destructive behaviour and physical health were positively related to non-fall-related injuries. Individuals with developmental disabilities who have better health and greater adaptive behaviour may be more active, and therefore, at an increased risk of non-fall-related injuries.
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