Long-Term Aripiprazole in Youth With Developmental Disabilities Including Autism

We retrospectively reviewed clinic charts of 21 children and adolescents with developmental disabilities including autism spectrum disorders (ASD) treated consecutively with aripiprazole (ARI) for irritability and severe challenging behaviors. Data extracted include age, sex, and race; level of intellectual disability (ID); Diagnostic and Statistical Manual-IV diagnoses including comorbidity, ARI dosage, and treatment duration; other psychoactive medications and Clinical Global Impressions–Improvement (CGI-I) at baseline and end point; weight; height; and side effects. Body mass index (BMI) z scores are compared with Centers for Disease Control norms. Eleven boys and 10 girls with ID and/or ASD ages 8 to 18 years (mean age 13.4 years) received ARI; mean dose was 8.4 mg/day (range 2.5 to 15); average duration was 60.6 weeks (7 to 132). Eleven of 21 patients (52%) met CGI-I response of ≤ 2. ARI was well tolerated, including together with stimulants, divalproex, or less commonly other medications. Mean BMI was 23.8 ± 5.9 at baseline and 24.2 ± 5.2 at end. Mean BMI z score increase was 0.06 ± 0.67. Four individuals (19%) manifested early intolerable weight gain. In this long-term clinical sample, ARI was effective in 52% and well tolerated. ARI was mostly weight neutral; early weight gain was intolerable in 19%. Larger long-term outcome studies are warranted in this population.     

Recognition of Immaturity and Emotional Expressions in Blended Faces by Children with Autism and Other Developmental Disabilities

The recognition of facial immaturity and emotional expression by children with autism, language disorders, mental retardation, and non-disabled controls was studied in two experiments. Children identified immaturity and expression in upright and inverted faces. The autism group identified fewer immature faces and expressions than control (Exp. 1 & 2), language disordered (Exp. 1), and mental retardation (Exp. 2) groups. Facial inversion interfered with all groups’ recognition of facial immaturity and with control and language disordered groups’ recognition of expression. Error analyses (Exp. 1 & 2) showed similarities between autism and other groups’ perception of immaturity but differences in perception of expressions. Reasons for similarities and differences between children with and without autism when perceiving facial immaturity and expression are discussed.     

The Role of Consultation Clinics in Services for Children and Young People with Learning Disabilities and/or Autism

Background:  Consultation and supervision are familiar to many professionals, and their relevance to those working with children with learning disabilities and autism is discussed.
Method:  Consultation Clinics for Community Learning Disability Nurses and others were set up by a specialist Child and Adolescent Mental Health team servicing an area with a general population of 750,000. They were provided by a clinical psychologist and a psychiatrist, and data on their use were collected over a 16 month period.
Results:  There were differences in frequency of use between nurses based in more rural teams and those in city teams. The number of children discussed increased over time, and approximately half continued to be supported by the discussant, rather than being referred to the Tier 3 service.
Conclusions:  Suggestions are made as to the possible impact and benefits, with discussion also considering the role of professional responsibilities in consultative services.     

Differentiating between Autism Spectrum Disorders and Other Developmental Disabilities in Children Who Failed a Screening Instrument for ASD

This study compared behavioral presentation of toddlers with autistic spectrum disorders (ASD) and toddlers with global developmental delay (DD) or developmental language disorder (DLD) who display some characteristics of ASD using the diagnostic algorithm items from the Autism Diagnostic Observation Schedule, Generic (ADOS), the Childhood Autism Rating Scale (CARS), and Modified Checklist for Autism in Toddlers (M-CHAT). To date, 195 children have failed the M-CHAT and have been diagnosed with ASD, DD or DLD. Children with ASD had prominent and consistent impairments in socialization skills, especially joint attention skills and were more impaired in some aspects of communication, play, and sensory processing. Children with ASD and children with DD/DLD shared common features, but certain behavioral markers differentiated the two groups.     

Nonverbal Communication Skills in Young Children with Autism

Objective The study was to examine nonverbal communication in young children with autism. Methods The participants were 23 young children with autism (mean CA = 32.79 months), 23 CA and MA-matched children with developmental delay and 22 18–20-month-old, and 22 13–15-month-old typically developing toddlers and infants. The abbreviated Early Social Communication Scales [Mundy et al. 1996, Early social communication scales (ESCS)] were used to test three types of nonverbal communicative skills, i.e., joint attention, requesting, and social interaction. Both frequency and proportion analyses were done in group comparisons. Results (1) Two- to three-year-old children with autism displayed deficits in joint attention ability, especially high-level skills. (2) The deficit in terms of frequency of communication was marked even compared with typically developing infants with younger mental age. (3) Young children with autism had different nonverbal communication profile compared with all three comparison groups. Conclusion Early social-communicative difficulties in autism involve early triadic communications involving joint attention and possibly dyadic turn-taking skills, which has implications for both early screening and early intervention.     

Physical Illness,Pain, and Problem Behavior in Minimally Verbal People with Developmental Disabilities

There is growing interest in the role that physical illness and pain might play in exacerbating problem behavior in individuals with developmental disabilities. Assessment of these factors, however, is often difficult since many individuals have minimal verbal communication skills. In response to this difficulty, we developed a sequential method of assessment involving retrospective and prospective measurement strategies. We found that the frequency and intensity of problem behavior was greater on “sick” days than on “well” days. Further, the higher the level of pain, the greater was the frequency and intensity of problem behavior. We discuss the concept of pain as a setting event for problem behavior and the intervention strategies that follow from this conceptualization.     

Screening for Autism in Young Children with Developmental Delay: An Evaluation of the Developmental Behaviour Checklist: Early Screen

The ability to identify children who require specialist assessment for the possibility of autism at as early an age as possible has become a growing area of research. A number of measures have been developed as potential screening tools for autism. The reliability and validity of one of these measures for screening for autism in young children with developmental problems was evaluated. The parents of 207 children aged 20-51 months completed the Developmental Checklist-Early Screen (DBC-ES), prior to their child undergoing assessment. Good interrater agreement and internal consistency was found, along with significant correlations with a clinician completed measure of autism symptomatology. High sensitivity was found, with lower specificity for the originally proposed 17-item screening tool and a five-item version.     

Gastrointestinal Problems in Children with Autism,Developmental Delays or Typical Development

To compare gastrointestinal (GI) problems among children with: (1) autism spectrum disorder (ASD), (2) developmental delay (DD) and (3) typical development (TD), GI symptom frequencies were obtained for 960 children from the CHildhood Autism Risks from Genetics and Environment (CHARGE) study. We also examined scores on five Aberrant Behavior Checklist (ABC) subscales comparing ASD children with high versus low frequency GI symptoms. Compared to TD children, those with ASD [aOR 7.92 (4.89–12.85)] and DD [aOR 4.55 (2.51–8.24)] were more likely to have at least one frequent GI symptom. Restricting to ASD children, those with frequent abdominal pain, gaseousness, diarrhea, constipation or pain on stooling scored worse on irritability, social withdrawal, stereotypy, and hyperactivity compared with children having no frequent GI symptoms. Frequent GI problems affect young children with ASD and DD more commonly than those with TD. Maladaptive behaviors correlate with GI problems, suggesting these comorbidities require attention.     

Stresses and Coping Strategies of Chinese Families with Children with Autism and Other Developmental Disabilities

Data from 368 families of children with autism and other developmental disabilities in the People’s Republic of China were gathered to understand the stresses that families experience and the coping strategies they employ. Chinese families of children with developmental disabilities perceived high levels of stress related to pessimism, child characteristics, and parent and family problems. Regarding coping strategies, acceptance, active coping, positive reinterpretation and growth, suppression of competing activities, and planning were the most frequently employed coping strategies. Parents of children with autism experienced more stress and used planning as a coping strategy to a greater degree than parents of children with other developmental disabilities. The implications and limitations of these findings are discussed.     

A Comparison of Behavioral and Emotional Characteristics in Children with Autism,Prader-Willi Syndrome,and Williams Syndrome

In order to investigate unique and shared characteristics and to determine factors predictive of group classification, quantitative comparisons of behavioral and emotional problems were assessed using the Developmental Behavior Checklist (DBC-P) and the Vineland Adaptive Behavior Scales in autistic disorder, Williams syndrome (WS), and Prader-Willi syndrome (PWS). The DBC-P Total Behavior Problem Score did not differ between groups. However, at the subscale level, the autism group showed more behavioral and emotional problems in the Self-Absorbed and Communication Disturbance domains than the WS and PWS group. Discriminant analysis revealed 16 variables that predicted group membership with 90.9% accuracy. Within-group analyses revealed problems decreased with age among individuals with autism. However, as people with WS aged, they had greater difficulty with Social Relating. Distinct age and IQ correlates of adaptive behavior among groups were also found. These findings both confirm and refine the behavioral phenotypes of these developmental disorders.     

The Adjustment of Non-Disabled Siblings of Children with Autism

This study compared the psychosocial and emotional adjustment of siblings of children with autism and siblings of non-disabled children. In addition, differences between self and parent reports, as well as various demographic characteristics were examined. Fifty-one siblings of children with autism and 35 siblings of non-disabled children, between the ages of 7 and 17, along with one parent of each sibling, participated. Results indicated that the presence of a child with autism appears to enhance the psychosocial and emotional development of non-disabled siblings when demographic risk factors are limited. However, the presence of a child with autism appears to have an increasingly unfavorable impact on the non-disabled sibling as demographic risk factors increase.     

Understanding Atypical Emotions Among Children with Autism

Children with autism are said to be poor mind readers: They have a limited understanding of the role that mental states play in determining emotions and behavior. In this research, 23 high-functioning children from the autistic spectrum (M age 9 years 3 months), 42 6-year-old controls, and 43 10-year-old controls were presented with six emotion-evoking stories and they were asked to explain protagonists' typical and atypical emotions. In the case of typical emotions, as expected on the basis of the mindblind hypothesis, children from the autistic spectrum gave few mental state explanations, referring to fewer than even the 6-year-old control group. However, in the case of atypical emotions, the autistic group performed as well as the 10-year-old controls. Their explanations for the atypical emotions demonstrate that children from the autistic spectrum indeed have the capacity to mind read (with respect to both desires and beliefs), although they do not always use this capacity in the same way as normally developing children. It is argued that the mind-reading capacity of high-functioning children from the autistic spectrum might be basically intact; unused in everyday circumstances but not necessarily defective.     

The Effects of Psychopathology on the Pain Expression of Children and Youth With Intellectual and Developmental Disabilities

Behavioral pain assessment is possible for children and youth with intellectual and developmental disabilities (IDD). However, pain behavior is often misinterpreted as reflecting psychopathology. We examined whether psychopathology alters pain behavior. Caregivers of 123 children (56 girls ages 40 to 258 months) completed the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R) to assess pain behavior and the Diagnostic Assessment for the Severely Handicapped-II to assess psychopathology. Seventy-eight children had clinically significant psychological or behavioral symptoms. A principal components analysis revealed 3 independent components: Pain Behavior, Affective Disorders, and Developmental Disorders. The results indicate that psychopathology has little effect on pain behavior and that the NCCPC-R is suitable for children with IDD who also have psychological or behavior disorders.     

Development and Evaluation of a Computer-Animated Tutor for Vocabulary and Language Learning in Children with Autism

Using our theoretical framework of multimodal processing, we developed and evaluated a computer-animated tutor, Baldi, to teach vocabulary and grammar for children with autism. Baldi was implemented in a Language Wizard/Player, which allows easy creation and presentation of a language lesson involving the association of pictures and spoken words. The lesson plan includes both the identification of pictures and the production of spoken words. In Experiment 1, eight children were given initial assessment tests, tutorials, and reassessment tests 30 days following mastery of the vocabulary items. All of the students learned a significant number of new words and grammar. A second within-subject design with six children followed a multiple baseline design and documented that the program was responsible for the learning and generalization of new words. The research indicates that children with autism are capable of learning new language within an automated program centered around a computer-animated agent, multimedia, and active participation and can transfer and use the language in a natural, untrained environment.     

A Screening Questionnaire for Asperger Syndrome and Other High-Functioning Autism Spectrum Disorders in School Age Children

The high-functioning Autism Spectrum Screening Questionnaire (ASSQ) is a 27-item checklist for completion by lay informants when assessing symptoms characteristic of Asperger syndrome and other high-functioning autism spectrum disorders in children and adolescents with normal intelligence or mild mental retardation. Data for parent and teacher ratings in a clinical sample are presented along with various measures of reliability and validity. Optimal cutoff scores were estimated, using Receiver Operating Characteristic analysis. Findings indicate that the ASSQ is a useful brief screening device for the identification of autism spectrum disorders in clinical settings.     

Patient and Family Advocacy: Working with Individuals with Comorbid Mental Illness and Developmental Disabilities and their Families

There are many factors to consider when working with individuals with mental illness and developmental disabilities and their families. Working in collaboration with individuals and their families using a patient- and family-centered care approach is vital. This approach informs the professional's values and practice patterns thereby allowing them to help the individual and family deal with common challenges and stresses such as establishing relationships with care providers, ensuring coordination of care, family concerns, knowledge of important systems of care, and the need for advocacy.     

The Development of a Stress Survey Schedule for Persons with Autism and Other Developmental Disabilities

The Stress Survey Schedule is an instrument for measuring stress in the lives of persons with autism and other developmental disabilities. Development of the survey and analysis of the underlying measurement structure of the instrument is reported in three studies. Through the use of exploratory and confirmatory analysis procedures, eight dimensions of stress were identified: Anticipation/Uncertainty, Changes and Threats, Unpleasant Events, Pleasant Events, Sensory/Personal Contact, Food Related Activity, Social/Environmental Interactions, and Ritual Related Stress. These stress dimensions are highly relevant to the problems of autism and have not been addressed by other stress surveys. The information obtained from the Stress Survey can be used to plan for strategies to reduce the stress before it occurs or results in maladaptive behavior.     

Associations Between Resilience and the Well-Being of Mothers of Children with Autism Spectrum Disorder and Other Developmental Disabilities

There is variability in the extent to which mothers are affected by the behavior problems of their children with developmental disabilities (DD). We explore whether maternal resilience functions as a protective or compensatory factor. In Studies 1 and 2, using moderated multiple regression models, we found evidence that maternal resilience functioned as a compensatory factor—having a significant independent main effect relationship with well-being outcomes in mothers of children with DD and autism spectrum disorder. However, there was no longitudinal association between resilience and maternal well-being outcomes. There was little evidence of the role of resilience as a protective factor between child behavior problems and maternal well-being in both studies.