Lessons that Linger: A 40-Year Follow-Along Note About a Boy with Autism Taught to Communicate by Gestures when Aged Six.

We draw on an article published in 1973 in this journal. We described how we taught "Geoff," a 6-year old boy with autism, an elementary form of sign language during the course of 24 one-hour sessions held over a 12-week period (Webster et al. in J Autism Child Schizophr 3:337-346, 1973; Fruchter in Autism: new directions in research and education, pp 184-186, 1980). Here, we describe how it is that Geoff has maintained the vestiges of what we taught him (and indeed what he taught us) over the long span. This basic communication strategy has endured well and continues to contribute to his enjoyment of life.

Autistic disorder and schizophrenia: diagnostic overlaps.

Data on 14 males with autism and 14 with schizophrenia were collected to examine symptom overlap. The Structured Clinical Interview (SCID), the schedule for positive symptoms (SAPS) and the schedule for negative symptoms (SANS) of schizophrenia, the Childhood Autism Rating Scale (CARS), and the DSM-III-R were administered. On the SCID, none of the men with paranoid schizophrenia met criteria for autism while 7 of those with autism met criteria for schizophrenia, disorganized type, showing negative symptoms. In addition, 5 showed positive symptoms on the SAPS and 6 negative symptoms on the SANS. As the difference in measured nonverbal intelligence was not significant, the effects could not be attributed to it. Although the findings continue to support the differentiation of autism and schizophrenia, they are also consistent with a comorbidity of the two disorders, mainly in those diagnosed with autism.

Preschoolers perceptions of the unfairness of maternal disciplinary practices.

OBJECTIVE: The aim of this study was to examine preschoolers' perceptions of maternal discipline's unfairness. The participants' gender, age, SES, family intactness and sibship size were examined for their possible relevance to such perceptions. METHOD: Five vignettes, describing forms of discipline the literature suggests constitute psychological maltreatment, were presented to 57 preschoolers (27 boys and 30 girls). They included excessive withdrawal of privileges, withdrawal of entertainment, differential treatment of siblings, threatening power assertion, and public humiliation. The children had to decide on the fairness or unfairness of each vignette in which a child was disciplined in each of these ways by his/her mother. They were then asked to offer an explanation for each of their choices. RESULTS: Of the five forms of discipline employed in the vignettes, children judged differential treatment of siblings as more unfair than either power assertion (threatening spanking), or public humiliation. No differences were found for withdrawal of privileges or entertainment. Of the various predictor variables employed, preschoolers from smaller families were more likely to judge threatening to spank as unfair. As well, compared to boys, girls and children from larger families were more likely to judge differential treatment as unfair. Age, SES, and family intactness had no effect on discipline judgements likely because of their limited range. CONCLUSIONS: The findings suggest that preschoolers can offer views on the fairness or unfairness of parental disciplinary practices, and can differentiate among them. Further, not all forms of parental discipline were viewed by preschoolers as unfair. Yet it has to be appreciated that the vignettes employed here were adapted for younger children, hence they may not have appeared as negative as in studies involving older children and adults.

Alzheimer dementia in Down's syndrome: the relevance of cognitive ability.

More years of education have been found to be associated with a lower rate of Alzheimer disease (AD) in individuals without intellectual disability. It has been proposed that education reflects greater 'synaptic reserve' and that greater synaptic reserve may defer the development of AD. The present study compared individuals with Down's syndrome (DS) who were found to have symptoms of dementia with those who remained symptom-free to determine if the two groups differed in their level of education, employment, recreational activities, years in an institution or overall level of cognitive functioning. Thirty-five adults with DS aged between 29 and 67 years were assessed. The participants were recruited from a community health facility and included individuals with a wide range of ability levels. Neuropsychological testing, caregiver report and the Dementia Scale for Down Syndrome (Gedye 1995) were used to identify decline in participants over periods of 6 months to 3 years. After the effect of age was statistically removed, multiple regression analyses revealed that level of cognitive functioning was significantly associated with decline such that a higher level of cognitive functioning predicted less decline. None of the environmental variables (i.e. educational level, years in an institution and employment) were directly associated with decline; however, a post hoc regression using level of cognitive functioning as the outcome variable revealed that level of cognitive functioning itself was associated with these environmental variables. A higher level of cognitive functioning was associated with fewer cases of dementia in individuals with DS, and level of cognitive functioning appears to be associated with environmental factors such as level of education, years in an institution and employment. The present findings suggest that environmental interventions aimed at improving level of cognitive functioning may also be useful in deferring the onset of dementia.

Chromosomal abnormalities in a series of children with autistic disorder.

In a series of 127 children diagnosed with autistic disorder the karyotypes of 8, on whom data were available, showed the following chromosomal abnormalities: breakage, a 47 XY pattern, trisomy 13, inversion-duplication of chromosome 15, 47 XY, +der (15) (pter q15: p11 pter), 47 XXY and 46 XY, inv (2) (p11:q13pat, 3q+). Compared to those who were not karyotyped or had normal karyotypes, the children with abnormalities, although cognitively more delayed, were not rated as more severely autistic. Facial dysmorphias and minor physical anomalies tended to be more frequent in the chromosomally deviant subgroup. No differences in demographic characteristics or parental ages were evident. Results are consistent with the view of variability of expression of marker chromosome deviations and a greater severity of retardation and symptoms of autism in those affected. The relevance of the findings to a multimodal genetic etiology of autistic disorder is discussed.

Child involvement and stress in Greek mothers of deaf children.

Forty-two mothers of Greek deaf children reported their level of stress, availability of support, duration and frequency of involvement with their children, and affective tone of involvement, using an adaptation of Hill's ABCX model of stress and support (1949). Data on the interaction among six caregiving categories were collected over a 2-day period. Mothers of younger children and of boys, as well as mothers reporting greater stress, had longer and more frequent involvement. Mothers with greater stress were also more likely to rate the affective tone of their involvement as more neutral or as chorelike. Support availability was unrelated to involvement, with the exception of supporting neighbors. Compared to Canadian mothers of children both with and without disabilities, exposed to the same study protocol, the mothers in the present study were not more stressed. However, they were more likely to report a negative affective tone in their caregiving.

Allegations of sexual abuse by nonverbal autistic people via facilitated communication: testing of validity.

OBJECTIVE: The aim of the paper is to offer a comprehensive approach to establishing the validity of allegations of sexual abuse by nonverbal autistic children and adults produced through facilitated communication (FC). This approach is offered as an alternative to existing methodology that relies exclusively on the "message passing" task, and has been used to advantage in the courts. METHOD: Three components to the battery are included: (a) specialized psychometric testing; (b) a variant of the message passing task; and (c) systematic analysis of the allegations themselves. Through the juxtaposition of the data from the different sources, conclusions can be reached as to the allegations' authorship. RESULTS: The results of a series of studies addressing the issue of validity of FC in general are briefly presented. Then a case presentation is offered to demonstrate how the technique can be employed to clarify allegations of sexual abuse. Elements of two other cases are also briefly discussed. CONCLUSIONS: Facilitated communication has been heralded as a breakthrough, allowing nonverbal people with autism to express themselves. It relies on manual guidance by a facilitator. Its proponents' resistance to allowing the technique's validation relying on the paradigm of normal science has resulted in its broad dissemination without support. In the case of sexual abuse allegations thus far the "message passing" task has been used to assess their verity. The present methodology is offered as a more comprehensive alternative to "message passing," with relevance to other populations of nonverbal individuals.

Sociosexual knowledge, experience, attitudes, and interests of individuals with autistic disorder and developmental delay.

Thirty-one individuals, 15 with autistic disorder and 16 with developmental delay, male and female, were asked to select from a series of drawings depicting sexually relevant activities and to define them. In addition they were asked to describe their sexual experiences, attitudes, and interests, using a semistructured interview format. Ability to select through pointing out sexually relevant body parts or activities was not different by level of functioning, group, or gender. There were differences in providing a sociosexual label, however, with better performance for those with developmental delay and for the higher functioning. No differences were evident for sexual experiences, likely because of the considerable variability across subjects and types of activity, with some individuals reporting very many and others very few. As to attitudes, individuals with autistic disorder endorsed more sexual activities than those with developmental delay. Higher knowledge of sexuality terms and activities was inversely related to their endorsement. Literalness and perseveration were evident in the responses of some, primarily those with autistic disorder. Results are discussed for their relevance to the reliability and validity of information on sexual awareness among the developmentally disabled. Suggestions for future research are offered.

Stress in Greek mothers with deaf children. Effects of child characteristics, family resources and cognitive set.

In an effort to understand the impact of their children's deafness on Greek mothers, demographic, disability-related and stress characteristics were examined with 42 hearing mothers and their deaf children. The work was based on Hill's ABCX model and Bronfenbrenner's social ecology model, entailing a microsystem, mesosystem, ecosystem, and macrosystem. In addition to child history obtained from school records, Rotter's locus of control scale, Coopersmith's self-esteem inventory and the Clarke questionnaire on resources and stress were given to mothers. Onset of deafness before 18 months of age was associated with greater maternal stress. A tendency for mothers of younger children to report more stress was evident. The mothers mainly had an external locus of control, attributing events to outside agents beyond their control. Self-esteem proved the best predictor of stress, with a low-esteem associated with greater reported stress. The findings are discussed with reference to disability-related and cultural factors.

Assessing resources and stress in parents of severely dysfunctional children through the Clarke modification of Holroyd's Questionnaire on Resources and Stress.

The Holroyd (1974) Questionnaire on Resources and Stress (QRS) although clinically useful may be too inclusive and not exclusively relevant to severely dysfunctional individuals. Hitherto, efforts at shortening and psychometrically validating the QRS have met with some success: the shorter forms however still target both mentally and physically handicapped children and are clinically not as useful as the original instrument. The 78-item Clarke modification of the QRS, mainly a subset of the original, was an attempt to remedy these problems. It was validated with mothers and fathers of autistic, mentally retarded, learning-disabled, and asymptomatic children. Good internal consistency, split-half reliability, and coefficient of stability were obtained. Construct and concurrent validities were also acceptable. The questionnaire discriminated best between the two more severely affected groups and the controls. Group differences were found for 8 of its 9 scales and sex of parent differences were found for 3. The Clarke modification of the QRS is recommended for clinical use with parents of children with autism and mental retardation.

Effects of developmental disorder on parents: theoretical and applied considerations.

Only recently have we begun to examine systematically the effect of dysfunctional children on other family members. This article addresses several issues: (1) It presents two models of family stress, the ABCX and the social ecology model, and discusses how they can be employed for a systematic mapping of known key variables that, in complex interplay, appear to influence the family's ability to cope with a dysfunctional child. (2) It reviews evidence from our own work and research by others related to the main elements of the ABCX model of family stress. (3) It offers an outline of what appear to us to be the key methodologic considerations for improving quality of research in this area. (4) It provides a few recommendations to clinicians working with families of severely dysfunctional children based on the evidence and our clinical experience.

Why families of children with biological deficits require a systems approach.

A number of assumptions related to the systemic therapists' view of family functioning in the case of biological deficit in the child are presented and challenged. The families' behavior, it is argued, may not be primarily responsible for the difficulties of their biologically impaired offspring. Severity of handicap need not be directly linked to stress in these families, nor is avoiding an individual diagnosis helpful to them. To further clarify the relevant issues, the family's "reactions" to a dysfunctional member, along with the professionals' previously unhelpful approaches to dealing with the impairment of these children, are presented. Finally, the therapeutic implications of the position presented in this article are drawn, and specific recommendations for working with these families are offered.

After diagnosis, what? Some of the possible problems around diagnostic assessments.

Psychopathologies of low frequency of occurrence, such as autistic disorder, constitute a challenge because of the diagnosticians' relatively low familiarity with both the presenting symptoms and, particularly, effective intervention strategies for them. This paper highlights the key potential pitfalls in the assessment of such rare conditions as autism. It then offers some suggestions as to what should be included in a diagnostic assessment of severely and chronically dysfunctional individuals. As well it discusses the need to coordinate the effects of different professionals on behalf of the dysfunctional child and his/her family. Such efforts should take into account the considerable stress and vulnerability of the families across the affected individual's lifespan.

Adaption of recent Soviet Jewish immigrants and their children to Toronto.

This retrospective study examined the prevalence of depression and psychosomatic disorders among Soviet Jewish immigrants, and how such problems might have affected their children's adaptation. A 36-item English and Russian questionnaire was sent to 452 Soviet Jewish immigrants, requesting information on possible problems they or their children had had during the first three years after immigration. Ninety people responded, 78% of whom had children. Immigrants with depression and psychosomatic illness reported greater behaviour, academic, peer interaction, and child-parent difficulties in their children. Those who were married, were proficient in English, were professionals in the USSR and/or Canada and who had supportive friends, were more likely to adapt well. Because of the low response rate, the failure to validate the questionnaire, and the possible overrepresentation of professionals the findings are presented as preliminary pending further exploration. They are discussed for their relevance to the early identification of difficulties in immigrants and their children, and to the need for timely and informed intervention.

Assessing child symptom severity and stress in parents of autistic children.

Parents of 44 autistic children rated their children's symptom severity and their own stress on a 14-item symptom scale. Thirteen child and family characteristics were also examined to assess how they affected symptom perception and stress. Preschoolers were rated less symptomatic by their parents than by clinicians. Lower functioning, nonverbal, odd-looking, self-abusive, seizuring and hyperirritable children were rated more symptomatic than their peers. Best predictor of stress for both parents was a child's self-abuse; for mothers hyperirritability and older age were also associated with elevated stress scores. Compared with parents of matched normal children, mothers of autistic children reported the most aggravations and expressed the need for additional support from their spouses.

Parental perception of learning-disabled children's adjustment problems and related stress.

Mothers and fathers of learning-disabled (LD) children rated their children's problems on the Child Behavior Checklist (CBCL) and the stress they experienced as a result of each problem. Data were examined as a function of (a) the child's sex, age, birth order, IQ, discrepancy IQ, and degree of LD, (b) the parents' age, locus of control, and self-concept, and (c) family SES, family size, and mother's working status. Both parents rated externalizing behaviors higher than internalizing. Boys were rated as significantly more problematic and stressful than girls. Greater child adjustment problems and concomitant parental stress were reported by the younger half of the maternal sample and their spouses, and by fathers with a lower self-concept and their wives. Although mothers did not differ from fathers in behavior ratings, they reported greater stress in response to them. This was particularly true of mothers of middle or upper SES with an external locus of control.

Maternal speech to verbal and higher functioning versus nonverbal and lower functioning autistic children.

The relationship between autistic children's level of functioning and maternal speech to children was examined. Ten higher functioning verbal and 10 lower functioning nonverbal children were videotaped in a 15-minute interaction with their mothers. Results revealed that mothers of the higher functioning verbal children asked more questions, used more language modeling, gave more reinforcement for language, and answered more children-initiated questions than did mothers of the lower functioning nonverbal children. Mothers of the nonverbal children employed more directives, used shorter mean lengths of utterance, and reinforced their children's motoric rather than spoken behavior. Far from being poor models for linguistic behavior, mothers of autistic children appear, therefore, to be quite responsive to their children's relative capabilities.

Parent and professional evaluations of family stress associated with characteristics of autism.

This study assessed the impact of various individual symptoms of autism on mothers and fathers, and professionals' accuracy in estimating parents' perceived stress levels. Mothers and fathers of 20 autistic children, and 20 therapists working with those children, independently rated the severity of common symptoms of autism in their child, and how stressful they found each symptom; therapists estimated parental stress. The autistic child's language and cognitive impairment were judged by all raters as most severe and stressful. In contrast with other studies, individual parents agreed on both symptom severity and degree of stress. Parents of older children judged symptom severity to be lower, but fathers reported a continued high level of stress. Professionals judged families as more stressed by the child symptoms than did families themselves. Implications for intervention and casework are discussed.

Ear infections in autistic and normal children.

The frequency of ear infections, ear tube drainage, and deafness was examined through parental reports in autistic and yoke-matched, normal children. For the autistic group these difficulties were additionally examined as a function of the children's cognitive and communication abilities, verbal versus nonverbal status, sex, and degree of autistic symptomatology. Autistic children had a greater incidence of ear infections than matched normal peers. Lower-functioning children had an earlier onset of ear infections than their higher-functioning autistic peers. Ear infections coexisted with low-set ears, and with a higher autistic symptomatology score. The findings are discussed in terms of greater CNS vulnerability in the autistic children, which is likely present since embryogenesis. The possible adverse consequences of intermittent hearing loss on language, cognitive, and socioaffective development are considered.

Autistic children exposed to simultaneous communication training: a follow-up.

Fourteen originally mute, low-functioning autistic children, exposed to intensive simultaneous communication training, were followed up 1 to 4 years later. Psychometric testing, communication assessment, and teacher and parent interviews were employed. Results showed that at least half of the children who had become verbal by program termination remained verbal at follow-up. Higher-functioning and verbal children performed overall better than their lower-functioning and mute peers. Children exposed longer to the intensive program and those exposed to good schooling after termination fared better at follow-up, as did those whose parents were more involved in their training. Yet teachers and parents employed mainly speech rather than signs to communicate with these children, despite the children's difficulty with speech. Compared to the verbal children, who recalled signs and words equally well, the mute children recalled signs better than words. The findings are discussed for their relevance to choice of communication training with different subgroups of autistic children.