Assessment of the 9-item Patient Health Questionnaire (PHQ-9) as a screen tool for symptoms of depression in community caregivers for adults with intellectual disabilities

The study aim was to determine the extent and determinants of reporting depressive symptoms in caregivers for persons with intellectual disabilities based on assessment of the 9-item Patient Health Questionnaire (PHQ-9). A cross-sectional study was conducted, recruiting 455 caregivers for adults with ID who were providing care in community residences, with complete PHQ-9 data being analyzed. The results indicated that the mean of each item scored on the PHQ-9 varied from 0.3 (Q9) to 1.1 (Q4). For two items (Q3 – “sleeping difficulties” and Q4 – “fatigue”), the respondents reported occurrence during several days in the previous two weeks. However, after scrutinizing the distribution of each item in the PHQ-9, 3.3–14.5% respondents reported that each item happened nearly every day, and 4.0–17.8% expressed that each happened more than half of the days in the previous two weeks. With respect to difficulties examined on the PHQ, 47% of cases expressed that it was somewhat difficult, 8.2% expressed that it was very difficult, and 4.5% felt that it was extremely difficult to work, care for things at home, or get along with others. Finally, a logistic regression model revealed that only one factor of self-perceived health status (fair/poor vs. excellent/very good, OR = 7.519, 95% CI = 3.03–18.68, p < 0.001) exhibited a statistically significant correlation with depressive symptom occurrence (PHQ-9 score ≧ 10) among the caregivers. The study highlights the need to strengthen appropriate health initiatives for monitoring mental health status and to provide necessary services for community caregivers for adults with ID.     

Risk for osteopenia and osteoporosis in institution-dwelling individuals with intellectual and/or developmental disabilities

The purpose of this study was to investigate the prevalence of and contributing factors to osteopenia and osteoporosis among people with intellectual disabilities (ID) or/and developmental disabilities (DD) residing in a disability institution in Taiwan. The present study was conducted at one disability institution in Taiwan and recruited 184 institutionalized residents with ID and/or DD (115 men and 69 women aged 18–72 years) for analysis. For all residents with ID and/or DD, information was obtained about their age, gender, level of ID, BMI, and bone mineral density (BMD). BMD is a measurement of calcium levels in bones that can estimate the risk of osteoporosis and bone fractures. Bone tests were divided into three outcome categories based on their calcaneal BMD T-scores: Normal BMD, a T-score ≧ −1; Osteopenia, −2.5 ≦ T-score < −1; and Osteoporosis, a T-score < −2.5. The results revealed that 46.2% of cases were normal and that 27.7% and 26.1% of cases had osteopenia and osteoporosis, respectively. Multiple logistic regression analyses found that male gender (OR = 2.482, 95% CI = 1.04–5.93, p < 0.05), age ≧ 40 years (OR = 3.051, 95% CI = 1.07–8.69, p < 0.05) and being overweight/obese (OR = 0.395, 95% CI = 0.17–0.93, p < 0.05) were more likely to be associated with osteoporosis. Another model indicated that males (OR = 2.169, 95% CI = 1.12–4.19, p < 0.05) and those aged ≧ 40 years (OR = 3.026, 95% CI = 1.32–7, p < 0.01) tended to have an increased risk for osteopenia and osteoporosis. To improve the bone quality of individuals with ID or/and DD and to decrease the occurrence of osteopenia and osteoporosis, this study highlights that we should pay much attention to the potential risk factors for bone quality in these vulnerable populations.     

Burnout syndrome and associated factors among university teaching staff in Cameroon: Effect of the practice of sport and physical activities and leisures

ObjectivesThis study aimed to evaluate the epidemiology of burnout syndrome among university teaching staff in Cameroon; and to establish if the practice of physical activities and leisures could have preventive effect.MethodsA cross-sectional study using a self-administered questionnaire on socio-demographic characteristics, socio-professional conditions, Maslach Burnout Inventory-Educator Survey (MBI-ES) to evaluate burnout syndrome, and Ricci-Gagnon metrics to assess level of physical activities practice among grades of teaching staff, in the various faculties of the University of Douala, Cameroon.ResultsThree hundreds and three teaching staff members aged 43 ± 7 years were included (69% males). The prevalence of burnout syndrome was 68%, distributed within the three dimensions as follows: emotional exhaustion (15.2%), depersonalization (32.1%) and loss of personal accomplishment (22.1%), with 57% low level, 38% moderate and 6% severe. Burnout affected respectively 55.4% lecturers, 38.3% senior lecturers and 6.3% professors. Burnout was significantly associated with poor working conditions (P = 0.0001), unsatisfactory salary (P = 0.0001), part time teaching in private university institutions (P = 0.027), sensation of strenuous job (P = 0.002), conflict with colleagues (P = 0.028), sedentariness (P = 0.007). Sport and physical activities showed significant protective effect against burnout (P = 0.004), the same with leisures (P = 0.016).ConclusionThe prevalence burnout syndrome is high among university teaching staff in Cameroon. The practice of sport and physical activities and leisures has a protective effect against burnout syndrome.     

A national survey of caregivers’ perspective of early symptoms of dementia among adults with an intellectual disability based on the DSQIID scale

As life expectancy increases for persons with an intellectual disability, concerns have been raised that there will be an increased demand for health or social services, particularly to address the challenges posed by the problems of dementia. To plan services for people with an intellectual disability who might experience the consequences of aging, an important first step is to obtain epidemiological data on the prevalence of dementia in this vulnerable population. This study aimed to investigate the dementia prevalence rate and its associated demographical factors in adults with an intellectual disability in Taiwan. A national survey was conducted to recruit 460 community residents of at least 45 years of age with an intellectual disability. The Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID) was administered to caregivers to determine the symptoms of dementia in adults with an intellectual disability. The results indicated that 16.5% of the adults with an intellectual disability might have dementia conditions (DSQIID score ≧ 20). After controlling for other factors in a multiple logistic regression analysis, the older adults with intellectual disability (≧55 vs. 45–54, OR = 2.594, 95% CI = 1.438–4.679) and those individuals with a comorbid diagnosis of mental illness or neurological disease (with vs. without, OR = 2.826, 95% CI = 1.593–5.012) had a higher risk of dementia than their counterparts. This study suggests that further longitudinal studies are needed to examine the specific aspects of the functions of living and morbidity that might be affected by aging and concomitant conditions in adults with an intellectual disability.     

Staff members of community services for people with intellectual disability and severe mental illness: Values,attitudes, and burnout

The study focused on the connections between the value preferences, attitudes toward community living, and burnout among staff members of community services for people with intellectual disability (n = 126) and severe mental illness (n = 96) in Israel. A higher preference for the self-transcendence values and a lower preference for the self-enhancement values were associated with the staff members’ positive attitudes toward their clients’ empowerment, a higher sense of similarity, and a negative attitude toward exclusion. In addition, a higher preference for the self-transcendence values and a lower preference for the self-enhancement values were associated with a lower level of depersonalization and a higher sense of professional accomplishment. Finally, a more positive attitude toward empowerment, a higher sense of similarity, and a more negative attitude toward exclusion were associated with a lower level of burnout.     

Differences in the intellectual profile of children with intellectual vs. learning disability

The WISC-IV was used to compare the intellectual profile of two groups of children, one with specific learning disorders (SLDs), the other with intellectual disabilities (ID), with a view to identifying which of the four main factor indexes and two additional indexes can distinguish between the groups. We collected information on WISC-IV scores for 267 children (M_age = 10.61 [SD = 2.51], range 6–16 years, females = 99) with a diagnosis of either SLD or ID. Children with SLD performed better than those with ID in all measures. Only the SLD children, not the ID children, revealed significant differences in the four main factor indexes, and their scores for the additional General Ability Index (GAI) were higher than for the Cognitive Proficiency Index (CPI). Children with a diagnosis of SLD whose Full-Scale Intelligence Quotient (FSIQ) was <85 showed a similar pattern. Our findings confirm the hypothesis that children with SLD generally obtain high GAI scores, but have specific deficiencies relating to working memory and processing speed, whereas children with ID have a general intellectual impairment. These findings have important diagnostic and clinical implications and should be considered when making diagnostic decisions in borderline cognitive cases.     

Paralinguistic abilities of adults with intellectual disability

The aim of this research was to determine the ability level of paralinguistic production and comprehension in adults with intellectual disability (ID) with regard to the level of their intellectual functioning and presence of co-morbid psychiatric conditions or dual diagnosis (DD).The sample consisted of 120 participants of both genders, ranging in age between 20 and 56 years (M = 31.82, SD = 8.702). Approximately 50% of the sample comprised participants with a co-existing psychiatric condition. Each of these two sub-samples (those with ID only and those with DD) consisted of 25 participants with mild ID and 35 participants with moderate ID. The paralinguistic scale from The Assessment Battery for Communication (ABaCo; Sacco et al., 2008) was used to assess the abilities of comprehension and production of paralinguistic elements.The results showed that the participants with mild ID are more successful than the participants with moderate ID both in paralinguistic comprehension tasks (p = .000) and in paralinguistic production tasks (p = .001). Additionally, the results indicated the presence of separate influences of both ID levels on all of the paralinguistic abilities (F [1 1 6] = 42.549, p = .000) and the existence of DD (F [1 1 6] = 18.215, p = .000).     

Association of early-onset dementia with activities of daily living (ADL) in middle-aged adults with intellectual disabilities: The caregiver's perspective

Few studies have investigated in detail which factors influence activities of daily living (ADL) in adults with intellectual disabilities (ID) comorbid with/without dementia conditions. The objective of the present study was to describe the relation between early onset dementia conditions and progressive loss of ADL capabilities and to examine the influence of dementia conditions and other possible factors toward ADL scores in adults with ID. This study was part of the “Healthy Aging Initiatives for Persons with an Intellectual Disability in Taiwan: A Social Ecological Approach” project. We analyzed data from 459 adults aged 45 years or older with an ID regarding their early onset symptoms of dementia and their ADL profile based on the perspective of the primary caregivers. Results show that a significant negative correlation was found between dementia score and ADL score in a Pearson's correlation test (r = −0.28, p < 0.001). The multiple linear regression model reported that factors of male gender (β = 4.187, p < 0.05), marital status (β = 4.79, p < 0.05), education level (primary: β = 5.544, p < 0.05; junior high or more: β = 8.147, p < 0.01), Down's syndrome (β = −9.290, p < 0.05), severe or profound disability level (β = −6.725, p < 0.05; β = −15.773, p < 0.001), comorbid condition (β = −4.853, p < 0.05) and dementia conditions (β = −9.245, p < 0.001) were variables that were able to significantly predict the ADL score (R² = 0.241) after controlling for age. Disability level and comorbidity can explain 10% of the ADL score variation, whereas dementia conditions can only explain 3% of the ADL score variation in the study. The present study highlights that future studies should scrutinize in detail the reasons for the low explanatory power of dementia for ADL, particularly in examining the appropriateness of the measurement scales for dementia and ADL in aging adults with ID.     

A national survey on the impact of the COVID-19 pandemic upon burnout and career satisfaction among neurosurgery residents

The coronavirus disease 2019 (COVID-19) pandemic has posed significant changes to resident education and workflow. However, the impact of the pandemic on U.S. neurosurgery residents has not been well characterized. We investigated the impact of the COVID-19 pandemic on U.S. neurosurgery resident workflow, burnout, and career satisfaction. In 2020, a survey evaluating factors related to career satisfaction and burnout was emailed to 1,374 American Association of Neurological Surgeons (AANS) residents. Bivariate and multivariate (logistic) analyses were performed to characterize predictors of burnout and career satisfaction. 167 survey responses were received, with a response rate (12.2%) comparable to that of similar studies. Exclusion of incomplete responses yielded 111 complete responses. Most respondents were male (65.8%) and White (75.7%). Residents reported fewer work hours (67.6%) and concern that COVID-19 would impair their achievement of surgical milestones (65.8%). Burnout was identified in 29 (26.1%) respondents and career satisfaction in 82 (73.9%) respondents. In multivariate analysis, burnout was significantly associated with alterations in elective rotation/vacation schedules (p = .013) and the decision to not pursue neurosurgery again if given the choice (p < .001). Higher post-graduate year was associated with less burnout (p = .011). Residents displayed greater career satisfaction when focusing their clinical work upon neurosurgical care (p = .065). Factors related to COVID-19 have contributed to workflow changes among U.S. neurosurgery residents. We report a moderate burnout rate and a paradoxically high career satisfaction rate among neurosurgery residents. Understanding modifiable stressors during the COVID-19 pandemic may help to formulate interventions to mitigate burnout and improve career satisfaction among residents.     

Goal perspectives and sport participation motivation of Special Olympians and typically developing athletes

Based on social-learning and self-determination motivational theories, the purpose of this study was to determine the sources of motivation in youth and young adults with intellectual disability (ID) who participate in Special Olympics (SO) competitions and those of typically developed (TD) age- and activity-matched athletes. A convenience sample of 63 SO (25 females and 38 males) and 59 TD (16 females and 43 males) athletes was retrieved through communication with local club coaches. Three sub-groups of SO athletes were identified based on disability, including non specified intellectual disability (NSID = 39), Down syndrome (DS = 17), and Autism (Aut = 7). Mean SO and TD athlete ages were 20.35 (SD = 7) and 18.8 (SD = 8), respectively. For analysis purposes four age groups were created (<15, 15–17, 18–20, >20 years). Participants completed the 13-item, two-factor Task and Ego Orientation in Sport Questionnaire (TEOSQ) and a 16-item four-factor abridged version of the Sport Motivation Scale (SMS). SO and TD athletes were active in swimming (54 and 48, respectively) and basketball (9 and 11, respectively). Groups with and without ID were compared by means of t-tests in the dichotomized variables gender and activity, as well as by 1-way ANOVA with Tukey HSD post hoc comparisons across disability and age groups. Gender distribution was the same in both groups. Participants with DS and NSID scored significantly higher than TD athletes in most motivational scales. Participants with ID increased their external motivation with increasing age, while a reversed pattern was observed in TD. In summary, significant differences between motivational patterns of SO athletes with ID and TD athletes can be observed. These differences should be considered when developing training and competition programs.     

Acceptance and mindfulness-based stress management for support staff caring for individuals with intellectual disabilities

Support staff working with individuals with intellectual disability (ID) and challenging behaviour experience high levels of work-related stress. Preliminary theoretical and experimental research has highlighted the potential suitability of acceptance and mindfulness approaches for addressing support staff stress. This study examines the effectiveness of an acceptance and mindfulness-based stress management workshop on the levels of psychological distress and well-being of support staff working with individuals with ID and challenging behaviour. Support staff (n = 120) were randomly assigned to a workshop intervention condition (n = 66) or to a waiting list control condition (n = 54). Measurements were completed at three time points (pre-, post and 6 week follow-up) for: psychological distress, well-being, perceived work stressors, thought suppression, and emotional avoidance/psychological inflexibility. Main Findings: The intervention led to significantly greater reductions in distress in the intervention group than in the control group. This was largely maintained at 6 week follow-up. This effect was more pronounced amongst a subsample that had shown higher levels of psychological distress at baseline. Thought suppression was found to reduce significantly in the intervention group between post intervention and follow-up, although no significant change was found in well-being or experiential avoidance/psychological inflexibility. Overall, results demonstrated support for the effectiveness of an acceptance and mindfulness-based intervention in reducing distress.     

Self-reported awareness and coping behaviors of low back pain among institutional caregivers for people with intellectual,autistic and associated multiple disabilities

This study aimed to investigate the self-reported knowledge and coping behaviors for low back pain (LBP) among institutional caregivers for people with intellectual, autistic and associated multiple disabilities and to gather information about factors that affect these coping behaviors in the workplace. A cross-sectional survey was conducted to recruit 1073 caregivers (response rate of 89.5%) from 15 medium to large disability welfare institutions in this study. This study specifically developed a scale to examine objective (10 question items) and subjective knowledge (one question item) of LBP and its coping behaviors (10 question items). The mean score of objective knowledge of LBP was 7.15 (range of 0–10; over 70% correct). A total of 54.2% of respondents expressed that they had a low level of subjective knowledge of LBP, and 45.8% or respondents had a high level. The study also found that many objective knowledge items need to be improved in future health promotion initiatives regarding LBP. Without adjusting for other factors, the study indicated that those caregivers with more subjective LBP knowledge were more likely to adopt higher levels of LBP coping behaviors than their counterparts (OR = 1.536, 95% CI = 1.152–2.046). After adjusting for demographics, working conditions and health status factors, LBP knowledge was not statistically correlated with LBP coping behaviors. Caregivers who worked more days per week (OR = 1.984, 95% CI = 1.408–2.795), had break time on duty (OR = 2.457, 95% CI = 1.5–4.025), exercised regularly (OR = 1.594, 95% CI = 1.115–2.28), had poor health status (OR = 0.497, 95% CI = 0.249–0.995), or had a history of LBP (OR = 1.433, 95% CI = 1.008–2.039) were more likely to adopt higher levels of coping behaviors than their counterparts. This study highlights that institutional managers should pay attention to factors that influence LBP coping behaviors in caregivers, and future studies should examine the effects of the characteristics of care recipients and caregivers’ families on caregivers’ perception of LBP.     

Differences in counter-movement jump between boys with and without intellectual disability

The purpose of this study was to describe the performance and biomechanical parameters of the counter-movement jump for young people with ID, in comparison with age matched individuals without ID. Volunteers with ID (n = 13; age = 15.3 ± 1.6 years; Wisk III intelligence quotient 55.6 ± 11.2) and without ID (n = 13; age = 15.4 ± 1.2 years) performed maximal counter-movement jumps, while knee kinematics, vertical ground reaction forces and electromyographic activity of the vastus lateralis and biceps femoris were captured. Individuals without ID jumped higher than their counterparts with ID and had lower take-off velocity, lower knee joint power and stiffness, lower knee joint extension angle and angular velocity, longer braking and propulsion phase, lower agonist and higher antagonist EMG activity. These results give an insight on possible causes for the performance deficit in CMJ in persons with ID and give the potential for such individuals to improve their ability to jump higher and more efficiently.     

Burnout académique en doctorat. Validation d’une échelle de burnout adaptée aux étudiants francophones en doctorat

ObjectivesAcademic burnout is a major public health issue, especially among PhD students who are particularly vulnerable to the syndrome. Although early identification of burnout would prevent its effects on mental health and academic performance, the validation of such instrument in French adapted to the specificities of PhD students still had to be established.Materiel and methods This study proposes the validation of a PhD student academic burnout scale (MBI-SS-D) adapted from the French version of the Maslach Burnout Inventory-Student Survey (MBI-SS). No less than 1150 PhD students from more than ten courses in France answered the online questionnaire. There were still 862 of them at the retest 6 months later.ResultsExploratory and confirmatory factorial analyses at both times irremediably confirmed the three-dimensional structure of burnout (emotional exhaustion, cynicism, academic self-efficacy). The alpha and omega indices close to.80 and the split-half coefficients between.70 and.89 reinforced this observation. In addition, the metric and structural invariance tests proved the high test-retest stability of MBI-SS-D up to the most stringent criterion. Regarding divergent validity, the burnout measure was negatively related to both optimism (Rs = − .41; P < .001) and resilience (Rs = − .32; P < .001).ConclusionsThe MBI-SS-D shows real psychometric qualities. It is currently the only French-language tool that provides a valid measure of academic burnout for research or clinical practice purposes among PhD students.     

Age-related change of the mean level and intraindividual variability of saccadic reaction time performance in persons with intellectual disabilities

The current study examined age-related change of saccadic reaction time (SRT) in persons with intellectual disabilities (ID). Participants were 29 persons with intellectual disabilities aged between 14 and 34 years whose IQs were between 14 and 70. Participants were divided into Group I (IQ ≧ 35) and Group II (IQ ≦ 34). The mean and the standard deviation of SRT (SRTM and SRTSD, respectively) reduced through adolescence in both groups. This result suggests that the speed and stability of information processing develops during adolescence irrespective of the level of ID. Although SRTM and SRTSD of Group I stabilized after adolescence, those of Group II increased after their thirties. This outcome indicates that persons with severe ID may show signs of the aging process. The results of multiple regression analyses and path analyses indicated that SRTM was influenced by both the speed of information processing and the variability of the response. However, given that the extent of increase of SRTSD in Group II was smaller as compared with that of SRTM, this increase of SRTM after the thirties in Group II appears to be mainly affected by the slowness of information processing.     

Initiatives to reduce the use of seclusion and restraints on people with developmental disabilities: A systematic review and quantitative synthesis

Contrary to the expectations articulated in public policy, restrictive interventions are commonly used in support services for people with developmental disabilities. This systematic review and quantitative synthesis was undertaken to investigate whether the use of seclusion and restraints on people with developmental disabilities can be reduced. Searches of the Academic Search Complete, CINAHL, MEDLINE, and PsycINFO electronic databases returned 7226 records, of which 11 met the inclusion criteria for this review. A further 3 papers were obtained through scanning the reference lists of those articles included from the initial literature search. All 14 studies were single-subject designs focusing on initiatives to reduce physical or mechanical restraint. Between the baseline and intervention phases, there were mean reductions in the frequency and duration of restraint use of 79% (SD = 21%, n = 13 subjects from 7 studies) and 45% (SD = 58%, n = 10 subjects from 6 studies), respectively. For studies in which restraint use to manage agitation and aggression was targeted, there was a 79% (SD = 21%, n = 13 subjects from 7 studies) decrease in the frequency and a 28% (SD = 67%, n = 6 subjects from 3 studies) reduction in the duration of restraint. With respect to studies in which restraint use to prevent self-harm was targeted, there was a 71% (SD = 34%, n = 4 subjects from 3 studies) reduction in restraint use. Effect sizes were calculable, using non-overlap approaches, for 9 of the 14 studies. The magnitudes of the effect sizes suggest that, on average, the interventions were effective in reducing the use of restraints. The effects generated in studies where restraint use for self-harm was targeted were typically more pronounced than those in which restraint use for agitation and aggression was addressed. There were broad variations, however, in the percentage reductions in restraint use and in the magnitudes of the effect sizes. Although the findings of this review are encouraging, more research is needed, in which greater attention must be paid to rigorous research design, application, and analysis.     

Caregivers’ reported functional limitations in activities of daily living among middle-aged adults with intellectual disabilities

This study was conducted to describe the functioning of Activities of Daily Living (ADL) and to examine socio-economic effects on ADL functioning among adults with intellectual disabilities (ID) aged 45 years and older (N = 480) in Taiwan. The Barthel Index (BI) was used to determine a baseline level of ADL functioning in the study participants. There are five categories of functional impairment using the following cut-off values in Taiwan: total dependence (BI score 0–20), severe (BI score 21–60), moderate (BI score 61–90), mild (BI score 91–99), and total independence (BI score 100) (Taiwan Department of Health, 2012). The results revealed that 2.3% of adults with ID were in total dependence, 11.9% were in severe dependence, 27.9% were in moderate dependence, 8.1% had a mild dependence, and 49.8% were totally independent. In the multiple linear regression model of the ADL score, we determined that educational level, comorbid Down's syndrome, and disability level are the variables able to significantly predict ADL score (R² = 0.190) after controlling for the factors of age, marital status, and other comorbidity conditions. Those ID adults with a lower education level (primary vs. literate, β = 4.780, p = 0.031; intermediate vs. literate, β = 6.642, p = 0.030), with comorbid Down's syndrome (β = ?7.135, p = 0.063), and with a more severe disability condition (severe vs. mild, β = ?7.650, p = 0.007; profound vs. mild, β = ?19.169, p < 0.001) had significantly lower ADL scores. The present study highlights the need to support mobility in older adults with ID as much as possible to optimize independence in this group.     

Outpatient visits and expenditures for children and adolescents diagnosed with autism spectrum disorders and co-occurring intellectual disability: An analysis of the national health insurance claims data

The primary healthcare service profile is important and provides valuable information on healthcare policies for patients with autism spectrum disorders (ASD) and co-occurring conditions. The present study analyzed data associated with outpatient care visits and expenditures in patients with ASD and co-occurring intellectual disability (ID) using healthcare setting insurance claims data in Taiwan. A retrospective analysis was conducted by merging database of healthcare setting medical care discharge claims used by the Taiwan Bureau of National Health Insurance and Disability Registration System. There were 5273 children and adolescents with ASD who utilized outpatient services during the year 2005. Taiwan NHI claims (510 cases with co-occurring ID and 4763 cases without ID) were analyzed in the study. The study found that ASD subjects without ID have 1.6-fold the annual outpatient visits of those with ID (13 visits vs. 8 visits). Those ASD cases with ID are more likely to use psychiatric visits and that individuals without ID use more rehabilitation services. The total annual outpatient care expenditure from 5273 children and adolescents with ASD was 137,842,159 New Taiwan Dollars (NTD). Cases without ID have increased medical costs compared with cases with ID in annual outpatient care expenditure (OR = 1.274, 95% CI = 1.173–1.384). A logistic regression analysis of outpatient expenditure (low vs. high) showed that of the cases with ASD and ID, the factors of age (reference: 6–11 years; 0–5 years, OR = 1.383, 95% CI = 1.106–1.730), severe illness (reference: no; OR = 1.838, 95% CI = 1.538–2.196), low income family (reference: no; OR = 1.799, 95% CI = 1.344–2.408), medical care setting (reference: clinic; private hospital: OR = 1.769, 95% CI = 1.199–2.610; corporate hospital, OR = 1.624, 95% CI = 1.139–2.315) and clinical unit (reference: psychiatric; rehabilitation, OR = 1.913, 95% CI = 1.651–2.344; pediatrics, OR = 1.461, 95% CI = 1.014–2.017) had more outpatient costs (on average) than their counterparts. Finally, this study highlights that health authorities should pay much attention to the factors which correlated to medical needs and costs of children and adolescents with ASD and ID to ensure efficacy of medication and continuing support for patients in treatment.     

Personality and global cognitive decline in Japanese community-dwelling elderly people: A 10-year longitudinal study

ObjectivesTo examine the longitudinal associations between the big five personality and changes in global cognitive function among community-dwelling elderly people involved in the National Institute for Longevity Sciences - Longitudinal Study of Aging.MethodsThe participants were 594 individuals (age range 60–81 years) and followed for 10 years and tested six times. Personality was assessed by the Japanese version of NEO five factor inventory at baseline. Cognitive function was assessed by the Japanese version of Mini Mental State Examination (MMSE) at all visits. For participants with a baseline MMSE score ≥ 28, logistic generalized estimating equation models estimated the odds ratio (OR) and 95% confidence interval (CI) for MMSE score ≤ 27 at each follow-up visit, according to a 1-SD increase of the baseline personality score. Post hoc analyses were performed for mild cognitive deficits, baseline MMSE score ≥ 24 and ≤ 27, to estimate the OR and CI for MMSE score ≤ 23.ResultsThe adjusted OR for MMSE score ≤ 27 was 0.78 (95% CI, 0.69–0.88), with a 1-SD increase in Openness to Experience score. In post hoc analyses, the adjusted OR for MMSE score ≤ 23 was 0.50 (95% CI, 0.35–0.72) with a 1-SD increase in Conscientiousness score. Relationships between other personality traits and the decline in MMSE score were not significant.ConclusionsHigher Openness to Experience was associated with a reduction in risk for cognitive decline in community-dwelling older adults. Higher Conscientiousness might also predict lower risk for severe cognitive decline, especially for individuals with mild cognitive deficits.     

Motor functioning,exploration, visuospatial cognition and language development in preschool children with autism

In order to understand typical and atypical developmental trajectories it is important to assess how strengths or weaknesses in one domain may be affecting performance in other domains. This study examined longitudinal relations between early fine motor functioning, visuospatial cognition, exploration, and language development in preschool children with ASD and children with other developmental delays/disorders. The ASD group included 63 children at T1 (Mage = 27.10 months, SD = 8.71) and 46 children at T2 (Mage = 45.85 months, SD = 7.16). The DD group consisted of 269 children at T1 (Mage = 17.99 months, SD = 5.59), and 121 children at T2 (Mage = 43.51 months, SD = 3.81). A subgroup nested within the total sample was randomly selected and studied in-depth on exploratory behavior. This group consisted of 50 children, 21 children with ASD (Mage = 27.57, SD = 7.09) and 29 children with DD (Mage = 24.03 months, SD = 6.42). Fine motor functioning predicted language in both groups. Fine motor functioning was related to visuospatial cognition in both groups and related to object exploration, spatial exploration, and social orientation during exploration only in the ASD group. Visuospatial cognition and all exploration measures were related to both receptive and expressive language in both groups. The findings are in line with the embodied cognition theory, which suggests that cognition emerges from and is grounded in the bodily interactions of an agent with the environment. This study emphasizes the need for researchers and clinicians to consider cognition as emergent from multiple interacting systems.