The role of every-day executive function in social impairment and adaptive skills in Autism Spectrum Disorder with intellectual disability

BackgroundAlthough executive function (EF) deficits are a recognised component of the cognitive phenotype of Autism Spectrum Disorder (ASD), particularly in children without general intellectual delay, little is known about ecological measures of EF and their outcome correlates among individuals with ASD and co-occurring intellectual disability. This exploratory study examined every-day EF in the classroom among children and adolescents diagnosed with both ASD and intellectual disability (ASD-ID) and their correlations with social impairment and adaptive functioning.MethodTeachers of 40 children and adolescents diagnosed with ASD-ID completed the Behavior Rating Inventory of Executive Function, the Vineland Adaptive Behavior Scales, and the Social Responsiveness Scale.ResultsA global executive dysfunction profile was found in ASD-ID, with most prominent deficits occurring in shifting. Results also showed that metacognitive executive processes predicted adaptive communication skills above and beyond IQ and social impairment in ASD-ID.ConclusionsOur findings corroborate a specific metacognitive executive function-adaptive communication association in ASD. EF interventions might be important treatment targets for improving functioning, especially in the communicative domain, in ASD-ID.     

The effect of Autism Spectrum Disorders on adaptive independent living skills in adults with severe intellectual disability

Autism Spectrum Disorders are a class of conditions categorized by communication problems, ritualistic behaviors, and deficits in social behaviors. While evidence supporting a genetic component of Autism Spectrum Disorders (ASDs) is strong, no specific genetic marker has been identified. Thus, professionals have had to utilize intelligence tests and measures of adaptive functioning to aid in the diagnosis of individuals with ASD. The present study aimed to isolate specific differences in adaptive functioning in adults with ASD. Two hundred and thirty-four adults with ASD (Autism Spectrum Disorder) or Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) and intellectual disabilities (IDs) were evaluated with respect to the nature and extent of their independent living skill functioning. The implications of these data for more fully describing and diagnosing autism and PDD-NOS in adults are discussed.     

Autism spectrum disorders in adults with intellectual disability and comorbid psychopathology: Scale development and reliability of the ASD-CA

Researchers and clinicians have generally agreed that persons with autism spectrum disorders (ASD) are susceptible to other DSM Axis I disorders. However, to date, little has been done to establish the specific disorders, their rate and severity of occurrence, and their interrelationship with ASD symptoms. One reason for the lack of research has been the absence of a comorbidity measure for this population. Additionally, when research has been conducted, it typically has been on one disorder with young children. The present study assessed comorbid DSM Axis I disorders in adults with ASD, either autism or PDDNOS and intellectual disabilities, using a new scale designed for the purpose. The reliability and factor structure of the scale was evaluated and implications for future research are discussed.     

ASH1L mutation caused seizures and intellectual disability in twin sisters

ASH1L mutations have been identified with variable phenotypes, including intellectual disability, autism spectrum disorder (ASD), and multiple congenital anomalies (MCA). However, the mechanisms underlying this phenotypic variation remain unknown. Here, we present twin sisters exhibiting mild intellectual disability and seizures. Whole-exome sequencing of the family revealed a novel de novo heterozygous sequence variant, NM_018489.2: c.2678dup (p.Lys894*) in exon 3 of ASH1L which was estimated to be pathogenic. Furthermore, we reviewed previously reported ASH1L mutations in order to evaluate genotype-phenotype correlations for ASH1L variants. We found that patients with missense mutations in ASH1L appeared to present with more severe phenotypes and a higher likelihood of ASD than those with truncating mutations. The relationship between phenotype and genotype reported across several patients may help to explain the mechanisms underlying the phenotypic variation commonly observed between ASH1L mutations.     

A review of behavioral interventions for the treatment of aggression in individuals with developmental disabilities

Aggression can present as a significant problem behavior in individuals with a diagnosis of developmental disability. Much research has focused on the prevalence of aggression in individuals with varying degrees of severity of intellectual disability (AD), autism spectrum disorders (ASD) and co-morbidity of ID and ASD. Research has also focused on the impact of aggressive behavior on individuals’ development including cognitive, adaptive and social functioning. The literature on Applied Behavior Analysis provides abundant examples of various interventions that are effective in reducing or eliminating aggressive behavior across a range of ages and degrees of developmental disabilities. Many interventions report success using antecedent alterations, reinforcement-based strategies and consequence manipulations. The current review provides a focused, comprehensive examination of aggressive behavior intervention research for individuals with developmental disabilities aged 3-18 years published between 1980 and 2009.     

Adults with Autism Spectrum Disorders using psychiatric hospitals in Ontario: Clinical profile and service needs

BackgroundAdults with Autism Spectrum Disorders (ASD) represent a small, but challenging sub-group of patients within Ontario's mental health care system. However, few studies have documented the clinical characteristics of this population and examined how such individuals differ from other psychiatric patients, with or without intellectual disabilities (ID).MethodA secondary analysis of data from the 2003 Comprehensive Assessment Projects from three psychiatric hospitals in Ontario was conducted to describe patients with ASD and ID and to determine how their profile compared to other hospital users.ResultsTwenty-three patients with ASD and ID were matched on gender and patient status (inpatient/outpatient) to individuals with and without ID. Individuals with ASD and ID were similar in terms of demographics to patients with and without ID. However, individuals with ASD and ID were younger, spent more days in hospital and were less likely to have a psychotic disorder diagnosis than both patients with and without ID. Inpatients with ASD and ID were recommended for a higher level of care than hospital service users without ID.ConclusionsClearly, this small sub-group of individuals within the hospital population has high clinical needs that are not always well met.     

Psychopathology in Adults with Autism and Intellectual Disability

There have been few studies of psychopathology in adult with autism. This study examined psychiatric co-morbidity in 147 adults with intellectual disability (ID) and autism and 605 adults with ID but without autism. After controlling for the effects of gender, age, psychotropic medication and level of ID, people with autism and ID were no more likely to receive a psychiatric diagnosis than people with ID only. People with autism were less likely to receive a diagnosis of personality disorder. These findings cast doubts on the hypothesis that adults with ID and autism are more vulnerable to certain psychiatric disorders than non-autistic adults with ID.     

Maternal stress predicted by characteristics of children with autism spectrum disorder and intellectual disability

To determine maternal stress and child variables predicting maternal stress, 104 mothers of children with autism spectrum disorder (ASD) and intellectual disability (ID) completed the Dutch version of the Parental Stress Index (PSI; De Brock, Vermulst, Gerris, & Abidin, 1992) every six months over a period of two years. The level of maternal stress remained stable over time. Child characteristics predicting maternal stress are behavioral inflexibility toward objects and initiating social interactions. However, these factors do not predict maternal stress when analyzed in combination with children's emotional and behavioral problems measured on the Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2000). The subscales emotionally reactive behavior, withdrawn behavior and attention problems explain a third of the variance in maternal stress. This study revealed no relation between maternal stress and children's developmental age and IQ, receptive and expressive language, adaptive behavior, severity and subtype of ASD, behavioral flexibility toward the environment and persons, initiating and responding to joint attention, initiating and responding to behavioral requests, responding to social interactions and the other subscales of the CBCL. Findings are discussed in relation to the clinical and non-clinical norm groups of the PSI, the limitations of the study and clinical practice.     

Cognitive and emotional intelligence in young adults with Autism Spectrum Disorder without an accompanying intellectual or language disorder

Research in the neurosciences has identified distinctions between neural structures that subserve cognitive intelligence (CI) and those subserving emotional intelligence (EI). This study explored the performance of young adults with Autism Spectrum Disorder (ASD) without an accompanying intellectual or language disorder relative to typically-developing peers, on indices of CI and EI. Both the ASD and age- and sex-matched typically-developing groups exhibited high average cognitive intellectual abilities. In contrast, the ASD group reported lower levels of EI relative to their typically-developing peers, as expected given the social and emotional challenges faced by individuals with ASD. Importantly, cognitive intelligence did not correlate with EI in either group. Taken together, these findings further support the theory of dissociable neural systems underlying CI and EI. These findings also highlight the need to address not only the intellectual aspects of cognition, but also the emotional components to increase understanding of, and improve treatment for individuals on the autism spectrum. This understanding would enhance our ability to assess and support young adults with ASD, and ultimately ease their transition into adulthood.     

Level of sense-making in children with autistic disorder and intellectual disability: Patterns of delay and deviance in development

The present study examined levels of sense-making in relation to adaptive functioning and autism symptomatology in low-functioning children with autistic disorder. Thirty-six children with autistic disorder and intellectual disability were compared with 27 children with intellectual disability and 33 typically developing children with a comparable nonverbal mental age (2-5 years). Level of sense-making was measured with the ComFor. Delays and deviant behaviors were assessed by using the Vineland Screener 0-6-NL and the Diagnostic Interview for Social and Communication Disorders. Levels of sense-making were substantially lower in the group with autistic disorder. At nonsymbolic levels of sense-making, children with autistic disorder and intellectual disability were much lower functioning in terms of social and communicative adaptive behavior than the children in the comparison groups with the same level of sense-making. Within the autism group, lower levels of sense-making were associated with more severe autism symptomatology in the domains of social interaction, communication, and imagination.     

Bullying of youth with autism spectrum disorder,intellectual disability,or typical development: Victim and parent perspectives

In-depth interviews conducted separately with 13-year-olds with autism spectrum disorder (ASD), intellectual disability (ID), or typical development (TD) and their mothers investigated the experiences of victimization in the form of bullying. Coded constructs from the interviews were utilized to compare groups on the frequency, type, and impact of victimization. Youth with ASD were victimized more frequently than their ID or TD peers, and the groups differed with regard to the type of bullying and the impact it had, with ASD youth faring the worst. Higher internalizing problems and conflict in friendships were found to be significant predictors of victimization, according to both youth- and mother-reports. These predictors were found to be more salient than ASD status alone. Implications for practice are discussed.     

Epilepsy in children with intellectual disability in Bosnia and Herzegovina: Effects of sex, level and etiology of intellectual disability

The purpose of this study was to examine the occurrence of epilepsy in children with intellectual disability. An additional goal was to determine if there were statistical differences in the occurrence of epilepsy related to the sex, level and etiology of intellectual disability of children. The sample consisted of 167 children with intellectual disability attending two special education schools in Sarajevo, Bosnia and Herzegovina. The method for data collection was the examination of the children's medical records. A chi-square test was performed to determine if there were any significant differences in the occurrence of epilepsy among different categories of children with intellectual disability. Additionally, Phi coefficient and Cramer V coefficient were calculated to determine the strength of association. The occurrence of epilepsy in children with intellectual disability is high and certain etiological categories are associated with an even higher risk of epilepsy.The study confirmed a high occurrence of epilepsy in children with intellectual disability. Some psycho-educational implications of epilepsy were discussed and in the future there should be better cooperation between medical and educational institutions in treating the bio-psycho-social issues of a child with epilepsy.