Behaviors and corresponding functions addressed via functional assessment.

One-hundred seventy-three studies that employed functional assessment were evaluated with respect to types of challenging behaviors studied and the functions identified that maintained those behaviors. For most studies, two to three behaviors were targeted. Of the 38 different challenging behaviors identified, self-injurious behavior (SIB) and aggression were by far the most studied. Other commonly studied behaviors were tantrums, stereotypies, property destruction, bizarre/inappropriate speech/vocalizations, and disruptive behaviors. The most commonly identified functions for both SIB and aggressions were attention and escape/demands. The implications of these and other data complied on target behaviors and maintaining variables are discussed.

Person characteristics of individuals in functional assessment research.

This paper is a review of person characteristics that were present in 173 studies that were reviewed on functional assessment. The purpose was to give the reader an idea about the types of individuals for which functional assessment is appropriate and to outline persons and their characteristics which have the best research support. The majority of participants were diagnosed with intellectual disability and/or autism. Additionally more males that females were included and children were frequently studied versus adolescents and older adults. Finally, while the majority of studies employed experimental functional analysis, the number of participants per study was small. Conversely, functional analysis scales were used in far fewer studies, but with much larger sample sizes. Thus, relatively equal numbers of individuals have been studied with both methods.

The relationship between autism spectrum disorders and symptoms of conduct problems: the moderating effect of communication.

OBJECTIVE: To examine the relationship between ASD diagnosis (i.e. Autism, Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) and atypical developing control) and tantrum/conduct symptoms in infants and toddlers. Then examine the moderating role of communication. DESIGN: Analysis of Covariance was conducted for study 1 followed by hierarchical regression analyses for study 2. METHODS: The Baby and Infant Screen for Children with aUtIsm Traits, Part 2 was administered to the caregivers of 774 infants and toddlers. RESULTS: Those with autism exhibited the greatest tantrum/conduct symptoms followed by those with PDD-NOS and then atypical controls, F(3, 771) =94.42, p=0.003. Communication was not a significant moderator. CONCLUSIONS: Those with Autistic Disorder exhibited greater symptoms of tantrum/conduct problems, which is consistent with previous research. It seems that the relationship with communication as a moderator may differ in young children as their language skills are still in the early stages of development.

Incidence and trends in psychopathology symptoms over time in adults with severe to profound intellectual disability.

Individuals with intellectual disability (ID) have a high risk for developing comorbid psychopathology. While researchers have shown that symptoms of psychopathology remain relatively stable in children with ID over time, little research has been conducted to demonstrate symptom stability for adults with ID. Incidence of psychopathology symptoms was examined in 124 adults with severe to profound ID. Then, trends in symptoms of psychopathology over time were studied in 74 of those individuals who had data collected quarterly over the span of one year. Data from the Diagnostic Assessment for the Severely Handicapped-Second Edition (DASH-II) were evaluated for each of the 13 subscales, as well as the total DASH-II score. For all of the scales except PDD/Autism, symptoms did not fluctuate significantly over the one year period. The PDD/Autism scale revealed a significant change in symptoms from Time 1 to Time 3. The implications of these results are discussed.

What is the evidence for environmental causes of challenging behaviors in persons with intellectual disabilities and autism spectrum disorders?

An extensive literature on the causes of challenging behaviors has been developed, primarily in the applied behavior analysis literature. One hundred and seventy-three empirical studies were reviewed where functional assessment serves as the primary method of identifying these causes. Most of the studies were able to identify a clear function or functions. Most commonly established causes were attention, the efforts to acquire tangibles, negative reinforcement in the form of escape from tasks or environments, and sensory stimulation, also described as an alone condition. Examples are provided regarding how these conditions are investigated across studies. Biological and cognitive causes have also been demonstrated. However, to date the empirical literature is limited with the bulk of studies being correlational. Considerably more research is needed, but some causes and methods to identify them are beginning to emerge.

Replacement behaviors for identified functions of challenging behaviors.

Functional assessment has become a major feature of learning-based research. A critical element of the majority of these studies includes not only methods and procedures to identify the cause of the challenging behavior, but to establish replacement treatment methods. By far the most common intervention in the 176 studies we reviewed was reinforcement. Noncontingent reinforcement (NCR) was the most common reinforcement method, followed by differential reinforcement of other behavior (DRO). Reinforcement plus extinction was the second most commonly employed treatment followed by functional communication training with or without reinforcement. Researchers proved to be very creative. Forty different treatment methods were employed. The implications of these data are discussed.

Psychopathology and intellectual disability.

PURPOSE OF REVIEW: To provide an update on recent trends and developments in the study of psychopathology in persons with intellectual disability. This topic is of considerable importance to mental health professionals as rates of psychopathology are much higher for persons with intellectual disabilities relative to the general population. RECENT FINDINGS: The number of studies on this topic is growing. The development of several areas is of particular significance. These topics include the impact of the burgeoning study of autism; the development of more specialized measures of psychopathology specific to particular forms of psychopathology, levels of intellectual disability and age; the development of psychologically based treatments, specifically the rise of functional assessment; the recognition that pharmacotherapy treatments are best aimed at core symptoms of classic forms of psychopathology such as psychosis, bipolar disorder, anxiety, and depression versus behavioral equivalents of psychopathology such as aggression, self-injurious behavior, property destruction, and pica; and establishing co-occurring patterns of personal features as they relate to psychopathology and intellectual disability. SUMMARY: A better understanding of psychopathology and how to assess and treat it in persons with intellectual disability is occurring. However, much is yet to be learned in this relatively new field of study.

Developmental milestones in toddlers with autistic disorder, pervasive developmental disorder--not otherwise specified and atypical development.

OBJECTIVE: To investigate age differences in developmental milestone attainment among toddlers with Autistic Disorder, PDD-NOS and atypical development. METHODS: A questionnaire was administered to caregivers of toddlers to obtain ages of onset of developmental milestones. The study included 1044 participants with 442, 112, 498 and 497 participants in first word, first phrase, crawling and walking analyses, respectively. RESULTS: Significant differences were found between groups on the attainment of milestones within normal limits, delayed or not yet attained. Significant differences were also found between groups in age of saying first word and onset of crawling. There were no significant differences between groups for walking or first phrase. CONCLUSION: Increased severity of autism has been noted to be related to greater deficits in a multitude of areas. With basic human motor behaviours also appearing to follow that trend, motor and speech skills should be targeted in early intervention programmes.

Intellectual disability and its relationship to autism spectrum disorders.

Intellectual disability (ID) and autism spectrum disorders (ASDs) covary at very high rates. Similarly, greater severity of one of these two disorders appears to have effects on the other disorder on a host of factors. A good deal of research has appeared on the topic with respect to nosology, prevalence, adaptive functioning, challenging behaviors, and comorbid psychopathology. The purpose of this paper was to provide a critical review and status report on the research published on these topics. Current status and future directions for better understanding these two covarying disorders was reviewed along with a discussion of relevant strengths and weaknesses of the current body of research.

Evaluating initiatives to reduce seclusion and restraint.

The use of institutional measures of control such as seclusion and restraint within psychiatric hospitals is common and arguably countertherapeutic; however, little is known about how best to reduce the use of these measures. The development and implementation of new institutional strategies to reduce the use of seclusion and restraint are important. Although traditional performance improvement (PI) project methodology might seem well-suited to helping managers and administrators identify effective hospital-wide interventions to decrease seclusion and restraint rates, the Logic of the standard PI model precludes managers from making valid inferences about which interventions actually cause change. This article presents a model (derivative of the multiple baseline time-series design with randomization) for testing individual elements of a Large-scale PI project to reduce the use of seclusion and restraint in a behavioral healthcare organization. The proposed model is flexible, accommodates overlapping organizational initiatives, and simultaneously allows for meaningful inferences to be made about the active components of the interventions. The ability to make meaningful inferences is important because, if the initiatives to reduce seclusion and restraint rates work, other healthcare organizations would benefit from knowing Key Words which specific interventions actually Lead engagement model to change and which interventions have multiple baseline design Little impact on secLusion and restraint performance improvement rates. Early experiences with this model psychiatry from a hospital manager's perspective sanctuary trauma are discussed, along with the costs and benefits of using it.