Profiles and trajectories of executive functioning in young children with Down syndrome.

BACKGROUND: Language acquisition strongly predicts executive functioning (EF) in early childhood in typical development and in children with Down syndrome (DS). Both language and EF are critical contributors to later positive social and academic outcomes yet are often areas of concern in children with DS. Despite the wider availability of interventions targeting language development in DS, no efforts have been made to understand how these interventions may influence the development of EF in this population. METHODS: This study examined secondary data from 76 preschoolers with DS collected as part of a randomised waitlist control trial of an early social communication intervention (JASPER-EMT). Children's EF skills were measured using the BRIEF-P, at three timepoints over 6 months. Linear regression was used to examine the baseline relationship between child characteristics and the three indices of the BRIEF-P: Emergent Metacognition, Flexibility and Inhibitory Self-Control. Linear mixed effects models were used to estimate change across the three indices of the BRIEF-P and whether that change was moderated by treatment. RESULTS: Children in this sample exhibited an uneven profile of EF at baseline, with relative strengths in the Flexibility Index and the Inhibitory Self-Control Index, and relative weaknesses in the Emerging Metacognition Index. Chronological age was associated with all indices at baseline (all P < 0.05). Children in the intervention group exhibited improvements in the Flexibility Index from entry to exit (3 months later) compared with the control, although this treatment effect did not maintain at the follow up at 6 months. CONCLUSIONS: Baseline EF profiles of children were consistent with findings of other studies with children with DS. Longitudinal findings suggest that behavioural interventions targeting language may have positive collateral effects on certain EF skills, however these effects may be transitory without ongoing support. These findings illustrate both the need for further exploration of the impact of early language interventions on EF abilities and the malleability of certain EF domains in young children with DS.

Early interaction in autism spectrum disorder: Mothers' and children's behaviours during joint engagement.

BACKGROUND: More knowledge about the interaction between young children with autism spectrum disorder and their parents is one way to improve intervention. This study aims to investigate the behaviours of mothers and children with autism spectrum disorder during joint engagement, with a focus on pacing or rate (i.e., incidences per minute) of their behaviours when being in this state. METHOD: Video recordings of 10 min of free-play between 58 children (2-4 years) diagnosed with childhood autism and their mothers were used to examine rate of mothers' and children's behaviours (i.e., toy introduction, toy expansion, positive affect, and language) during joint engagement, the association between rate of mothers and children's behaviours, the relation between rate of mothers' behaviours and time in joint engagement, and how child factors might be associated with the latter. RESULTS: Mothers(m) and children(c) showed similar rate of positive affect (Mm  = 0.6/Mc  = 0.5) and toy expansion (Mm  = 0.7/Mc  = 0.7) per minute, whereas mothers talked almost three times more than their children (Mm  = 10.2/Mc  = 3.8). In contrast, mothers introduced fewer toys compared to the children (Mm  = 0.7/Mc  = 1.2). Rate of mothers' toy introduction, toy expansion, and positive affect was inversely related to time in joint engagement (Regression coefficient = -70.7 to -48.5, p = .006 to .024). Rates of mothers' and children's behaviours were associated (Spearman rank order coefficient = .53 to .29, p < .001 to .03), but neither rate of children's behaviours nor mental age was associated with the observed relation between rate of these maternal behaviours and time in joint engagement. CONCLUSION: Time in joint engagement was related to rate of mothers' behaviours and children's mental age but not to rate of children's behaviours in this study. Thus, intervention teaching parents of young children with autism strategies designed to increase time in joint engagement may be vital. The complex nature of the interaction between mother and child behaviours in promoting joint engagement warrants further elucidation.

Task-related social behavior in children with Down syndrome.

The specificity and stability of task-related social behaviors in children ages 5 to 12 was examined. Social behaviors during solvable and unsolvable puzzles were compared among children with Down syndrome, children with mental retardation, and typically developing children matched on mental age (MA). Compared to children without Down syndrome, those with the disorder looked to an adult and requested help more frequently. They also took longer to complete the tasks. These findings suggest that the overuse of social behaviors observed in young children with Down syndrome remains stable over the early school years and are specific to children with Down syndrome.

Emotion recognition by children with Down syndrome.

In three studies, children with Down syndrome were presented with emotion recognition tasks designed to tap their knowledge of simple emotions, their ability to label emotions, and their understanding of emotions from simple, story-based contexts. Results indicate that young children with Down syndrome perform similarly to typical controls matched on MAs of approximately 3 years. However, by developmental age of 4 years, children with Down syndrome performed worse than both MA-matched typical children and children with non-Down syndrome types of mental retardation. Although the MAs of children with Down syndrome increased over 2-years, their emotion recognition abilities did not. Taken together, findings suggest both etiological and developmental differences in the emotion recognition abilities of children with Down syndrome.

Prenatal alcohol exposure and depressive features in children.

BACKGROUND: This study examined the association between prenatal alcohol exposure and self-report of depressive symptoms in 5- to 6-year-old children. Higher levels of prenatal alcohol exposure were hypothesized to be associated with endorsement of a greater number of depressive symptoms in children. It was also hypothesized that maternal depression, although associated with drinking behavior, would contribute independently to outcome. Finally, the mother's behavior toward the child, as well as current drinking practices, were postulated to mediate the relationship between prenatal alcohol exposure and child depressive symptoms. METHODS: Participants were 41 mother-child dyads who had been followed longitudinally since the children were 1 year of age. Self-report questionnaires for maternal and child depression were used. RESULTS: Results revealed that prenatal alcohol exposure, maternal depression, and child gender seemed to be highly associated with child depressive symptoms. Girls who had higher levels of prenatal alcohol exposure and whose mothers acknowledged higher levels of depression endorsed the highest number of depressive symptoms. Neither the mother's behavior in interaction with the child nor her current level of alcohol consumption mediated the relationship. CONCLUSIONS: The importance of considering prenatal alcohol exposure as a risk variable in the prediction of childhood-onset depression and the possible neurological mechanisms underlying depression in children with alcohol exposure in utero are discussed.

Loneliness and friendship in high-functioning children with autism.

Loneliness and friendship were examined in 22 high-functioning children with autism and 19 typically developing children equated with the autistic children for IQ, CA, gender, mother's education, and ethnicity. Children between the ages of 8 and 14 were asked to report on both their understanding and feelings of loneliness and the quality of their friendship. Compared to typically developing children, children with autism were both lonelier and had less complete understandings of loneliness. Although all children with autism reported having at least one friend, the quality of their friendships was poorer in terms of companionship, security, and help. Fewer associations were found between loneliness and friendship for the autistic than for the non-autistic children, suggesting less understanding of the relation between loneliness and friendship. Implications of these results are discussed for conceptualizing the social deficits in autism.

Parental perspectives on inclusion: effects of autism and Down syndrome.

This study examined the effects of the child's diagnosis (autism vs. Down syndrome), age, and current educational placement on parental perceptions toward inclusion for their child with disabilities. Parents of children with autism and with Down syndrome completed surveys regarding their opinions on their child's current educational placement, their desire for changing the current placement, and their views on inclusive education. Results indicated that diagnosis, age, and current placement influenced parental opinion on the ideal educational placement for their child. Parents of children with Down syndrome were significantly more likely to endorse inclusion (full-time placement in general education) as the ideal educational program for their child whereas parents of children with autism were more likely to endorse mainstreaming (consistent part-time placement with general education students). Parents of younger children and parents whose children were already placed in general education programs were more positive towards inclusion than parents of older children or students currently in special education. Findings are discussed in terms of child characteristics and prevailing educational practices.

Maladaptive behavior in children with Prader-Willi syndrome, Down syndrome, and nonspecific mental retardation.

Although some genetic, mental retardation syndromes have well-described behavioral features, comparative studies have not yet assessed the relative uniqueness of these so-called phenotypes. Maladaptive behavior of 43 children with Prader-Willi syndrome was compared to age- and gender-matched children with Down syndrome and with nonspecific mental retardation. The Prader-Willi group showed more frequent and severe internalizing, externalizing, and total problem behaviors on the Child Behavior Checklist. Some problems were elevated in all groups, and 12 behaviors were significantly elevated in Prader-Willi subjects relative to both comparison groups. Seven behaviors predicted membership into the Prader-Willi group with 91% accuracy. Implications were discussed for research on behavioral phenotypes in general and for dual diagnosis in particular.

Linking parental perceptions to interactions in young children with autism.

This study examines the relation of parental perceptions and observed parent-child interactive behaviors. Samples observed included normally developing children, children with autism, and children with mental retardation who were equivalent on mental age. Parental perceptions of children's temperament and parental feelings of parenting stress were examined. Results indicated that parental perceptions of autistic children's behavior were more often linked to actual child and parental behaviors than in the comparison samples. Parents who reported their autistic children as more difficult in temperamental style had children who were less engaged during a social game with the parent and less responsive in interaction with an experimenter. Parents who reported greater stress had autistic children who were less responsive in social interactions with others.

Long-term stability of individual differences in the emotional responsiveness of children with autism.

The results of two studies designed to investigate the short- and long-term stability of autistic children's responsiveness to displays of negative emotions in others are reported here. In the first study we measured the attention and behavioural responses of 22 autistic children to another's distress about a year and a half after initial assessments in a similar situation. In the second study, the children were re-assessed in two affective contexts over 5 years after initial testing. Individual differences in early responses to affect predicted affective responsiveness at each follow-up. Emotional responsiveness was positively associated with concurrent cognitive skills at each point of assessment. Furthermore, autistic children discriminated between affective and non-affective contexts when this discrimination was tested at the second follow-up.

Joint attention and language gains in children with Down syndrome.

Joint attention and topic initiation in caregiver-child interactions was explored in relation to children's language gains over 13 months. Caregivers of 28 children with Down syndrome spent more time in joint attention and maintained more attention to caregiver-selected toys than did caregivers of 17 children with typical development. Receptive language gains of children with Down syndrome were associated with caregivers maintaining attention to child-selected toys and with longer lengths of joint attention. Caregivers redirecting attention away from child-selected toys and a greater frequency of joint attention episodes was negatively associated with children's language gains. More time spent in joint attention and caregivers maintaining attention to mother-selected toys was associated with receptive language gains in children who were developing typically.

Attention regulation by children with Down syndrome: coordinated joint attention and social referencing looks.

We examined attention regulation of children in two different situations designed to elicit triadic interactions (i.e., between self, other, and object). Thirty-five children with Down syndrome and 23 children with typical development were observed in a semi-structured adult-child interaction designed to elicit coordinated joint attention and an ambiguous situation in which a moving robot prompted an emotional response from the adults in order to elicit social referencing looks from the child. Children with Down syndrome engaged in significantly fewer social referencing looks. Group differences were not found for coordinated joint attention looks, suggesting that the difficulty for children with Down syndrome is in cognitive appraisal abilities.

Nonverbal communication and early language acquisition in children with Down syndrome and in normally developing children.

Many children with Down syndrome display asynchrony in development with the acquisition of language preceding at a slower pace than the acquisition of other cognitive skills. Recent research suggests that the expressive language delays that are displayed by these children may be associated with an earlier disturbance in the development of nonverbal requesting skills (Mundy, Sigman, Kasari, & Yirmiya, 1988; Smith & von Tetzchner, 1986). To test this hypothesis, a longitudinal study of 37 children with Down syndrome and 25 children with normal development was conducted. The results of the study indicated that this sample of children with Down syndrome exhibited a disturbance in nonverbal requesting. Furthermore, individual differences in nonverbal requesting were associated with the subsequent development of expressive language in these children. This association was observed even after taking into account initial variance in developmental level and language status. These data suggested that some of the processes involved in the expressive language delay of children with Down syndrome were not unique to linguistic development. Instead, some aspects of this delay appeared to be associated with problems in an earlier nonverbal phase of communication development. Additionally, the results suggested that measures of nonverbal communication skills also made a unique contribution to the prediction of language development among children with normal development. These data supported the hypothesis that the acquisition of nonverbal communication skills provides an important foundation for the emergence of language in atypical as well as typical development.

Compliance with parental prohibition in autistic children.

In a controlled observational study of young autistic children ages 3 to 5, responses to parental prohibition were compared to those of mental-age-matched mentally retarded and normal children. The children were prohibited from eating a candy offered to them by the experimenter. Behavioral response, affect, and gaze patterns were compared across the three groups. Autistic children exhibited significantly less compliant behavior than did children in the two control groups; this behavior correlated with chronological age, not with mental age, language development, or parental behavior. Although affect and gaze patterns of the autistic children were different from the controls, these patterns were not correlated with compliant behavior. In conclusion, when compared to mental-age-matched control groups, autistic children are significantly less compliant to parental prohibition and they show different gaze and affect patterns.

Attention to people and toys during social and object mastery in children with Down syndrome.

Attention to people versus objects by children with Down syndrome was examined. Subjects were presented with situations in which the primary focus alternated between an object stimulus (a toy) and a social stimulus (a singing experimenter). The children with Down syndrome monitored their environment in the same manner as did MA-matched typically developing children during object mastery and had a more focused attention style during social mastery. Reasons for this difference in attention across the two situations were discussed.

Object mastery motivation of children with Down syndrome.

Mastery motivation of children with Down syndrome and MA-matched typically developing children was examined. The two groups performed similarly with respect to the quality of their play but differed in level of task engagement and causality pleasure. The children with Down syndrome appeared to be less engaged in the task than were the typically developing group as indicated by shorter sequences of goal-directed behavior and higher rates of toy rejection. In addition, the children with Down syndrome displayed less causality pleasure with object exploration than did the typically developing children.

Parental perception of emotional expressiveness in children with autism.

Parents' perceptions of their children's emotional expressiveness, and possible bases for these perceptions, were investigated in a study comparing older, nonretarded autistic and normal children and in another study comparing young autistic, mentally retarded, and normal children. Both groups of autistic children were perceived as showing more negative emotion and less positive emotion than comparison children. In the younger sample, parental perceptions correlated with the children's attention and responsiveness to others' displays of emotion in 2 laboratory situations. Findings contradict the view that autism involves the "absence of emotional reaction" (American Psychiatric Association, 1987, p. 35).

Pride and mastery in children with autism.

The goal of this study was to compare expressions of pride and mastery in samples of preschool autistic, mentally retarded and normal children. A paradigm was used in which children completed developmentally appropriate puzzles, both with and without praise. Results indicated that compared to the other children, as many autistic children smiled upon completion of the task, but many fewer looked up to share their pleasure with the parent or experimenter or drew attention to the task. Moreover, significantly more autistic children showed avoidant responses, particularly in response to praise. These findings are discussed in terms of theoretical issues regarding the development of pride and mastery in children with significant social deficiencies.

Responses to the negative emotions of others by autistic, mentally retarded, and normal children.

Attention, facial affect, and behavioral responses to adults showing distress, fear, and discomfort were compared for autistic, mentally retarded, and normal children. The normal and mentally retarded children were very attentive to adults in all 3 situations. In contrast, many of the autistic children appeared to ignore or not notice the adults showing these negative affects. As a group, the autistic children looked at the adults less and were much more engaged in toy play than the other children during periods when an adult pretended to be hurt. The autistic children were also less attentive to adults showing fear, although their behavior was not different from the normal children. Few of the children in any group showed much facial affect in response to these situations. The results are discussed in terms of the importance of affect in the social learning experiences of the young child.