Journal of Intellectual Disability - Diagnosis and Treatment

185-190

Authors: Matteo Pardini, Francesco G. Garaci, Laszlo Zaborszky, Filadelfo Coniglione, Gianluca Serafini, Martina Siracusano, Francesca Benassi, Leonardo Emberti Gialloreti

Introduction: Cholinergic dysfunction has been proposed to play a role in autistic symtomatology. However, to date, its structural correlates are poorly understood. Methods: Twenty-five low-functioning, non-verbal males with Autism Spectrum Disorders (ASD) and 25 controls were enrolled in the study. All underwent MR T1-weighted 3D Structural Imaging and Diffusion Tensor Imaging. Grey and white matter components of the Meynert's Nucleus Complex were then identified on MR images, and both grey matter density and white matter mean Fractional Anisotropy in the Meynert's Nucleus region of interest were quantified for each subject. Non-verbal IQ was assessed in all subjects with ASD. Results: We showed reduced white matter Fractional Anisotropy in the bundles surrounding the Meynert's Nucleus in ASD subjects compared to controls. Fractional Anisotropy in these bundles was positively associated with non-verbal IQ, independently from whole brain white matter mean Fractional Anisotropy. ASD subjects did not show significant abnormalities in Meynert's Nucleus grey matter density. Conclusions: Our findings suggest that white matter abnormalities in the Meynert's Nucleus might be involved in the cholinergic deficits of ASD.

204-216

Authors: Monika Parchomiuk

The article describes the results of research involving mothers with intellectual disabilities. The aim of author's own study was to learn about maternal experiences related to raising children with intellectual disabilities. The experiences were described in greater detail in relation to the diagnosed disabilities of their children, early stage of their upbringing, problems emerging during their development, involvement of significant (supporting) persons. In addition, issues addressed in the study included description of maternal competences, the subjective meaning and essence of motherhood, and perception of the role of one's own disability in acting as a mother. Moreover, factors related to life situation of mothers, their previous experiences, especially experiences in their families of origin and personality features significant for the quality of motherhood, were identified.

142-151

Authors: Kourtney M. Mraz, Gina Amadio, Pamela Diener, Grace Eisenberg, Jack R. Engsberg

Introduction: Rett Syndrome is a genetic disorder that limits a girl's ability to use her upper extremities for daily activities, such as dressing and playing. One possible intervention to improve upper extremity function in this population is virtual reality, which can be used to increase activity demands during therapy sessions. Objectives: To determine the feasibility of using internet-based virtual reality intervention for Rett Syndrome (RTT-IVR), to decrease hand wringing/mouthing and increase hand and arm movements away from the midline by identifying attributes and limitations to the proposed intervention. Materials and Methods: Using FAAST Software and Microsoft Kinect sensor, RTT-IVR was trialed with 6 girls with RTT. Upper extremity movements were used to play free Internet games as means of increasing repetitions and purposeful arm movements. Data regarding attributes and limitations of the RTT-IVR intervention were collected via observation and post-session parent interviews. Results: Interviews and observation revealed successful game play when games were motivating, clearly established cause and effect, and matched level of cognitive ability of the participant. Limitations include technological glitches regarding Kinect sensor sensitivity and identifying appropriate games for each participant's interests and abilities. Conclusion: Internet based virtual reality interventions for girls with RTT should be highly individualized to increase motivation and success of intervention.

160-169

Authors: Cherie Behar, Maxwell Lustick, Matthew H. Foreman, Jennifer Webb, Jack R. Engsberg

Introduction: Traditional rehabilitation does not provide adequate repetitions for maximal motor recovery in the clinic and home exercise programs (HEPs) have low compliance rates. Personalized virtual reality (PVR) is a promising low-cost therapeutic tool for improving compliance by incorporating the client's interests, abilities, and goals into a motivating and engaging intervention using internet games. Objectives: The current study aimed to develop and refine a clinic-to-home PVR intervention, determine its feasibility and usability in an outpatient rehabilitation clinic and as a HEP, and examine its effects on motivation/engagement, compliance, motor repetitions, and functional motor performance. Methods: The PVR system utilizes a Microsoft Kinect sensor to track the participants' movements, free software to translate movements to keystrokes, and free internet games. The therapist matched participants' interests to internet games, customized therapeutic movements for game play, and increased the movement thresholds for game activation as participants improved. Two participants who had strokes resulting in upper extremity (UE) hemiplegia were recruited. The participants attended outpatient occupational therapy (OT) services twice weekly. Following training, the participants used the PVR system at home in place of their UE HEP. They continued to receive traditional OT once a week and clinic-PVR once a week for 5-8 weeks. Results: The PVR intervention was successfully implemented in the clinic and the clients' homes. PVR increased motivation and treatment compliance. The clients exhibited improvements in UE active range of motion, function, symptoms, and occupational performance. Conclusion: Preliminary evidence suggests PVR can improve motivation, compliance, function, and occupational performance. However, larger scale studies and protocol refinement are necessary.

79-80

Authors: Zika Virus and Microcephaly, Challenges in Brazil

Zika Virus and Microcephaly: Challenges in Brazil

94-109

Authors: Lucia Bigozzi, Amanda Grazi, Sara Pezzica

In the school population, attentional problems are one of the most frequent causes of failure in learning; sometimes these take the form of a specific deficit and in other cases an attention disorder occurs in comorbidity with a learning disorder. It seems crucial to focus on what peculiar characteristics of attention are involved in basic learning in order to contribute to the diagnostic order and to arrange paths of development. This research aims to verify the weight of the different components of attention involved in the outcomes of the first stages of learning. A total of 69 children (34 males and 35 females, aged 6.4 ±1.1 years and 7.3 ±1.2 years respectively) in first grade, participated in the study. The results of the correlational analysis carried out show that there are specific significant relationships between the various components of attention and performance in reading, writing and calculation. In particular, visual attention appears to be the aspect most involved in the initial development of the learning of these three abilities. Factorial analysis shows a single factor involved in the learning of reading, writing and calculation: "Rapid Visual Attention". The processes identified in the factor are: Selective Attention, Visual Selective Attention, Shifting Focus, Focused Attention, Planning and Inhibition. This factor is characterised by speed in Selective/Sustained Visual Attention and this explains the role of attention in success in reading, writing and calculation in the early stages of school learning. The Rapid Visual Attention Factor contributes to rapidity in reading, speed in writing and numerical knowledge in first grade children, confirming the causal relationship between visual attention and initial learning in this age group. This "Rapid Visual Attention" Factor may be crucial in accounting for the comorbidity between Attention Deficit Hyperactivity Disorder and Learning Disabilities.

117-128

Authors: Mila Vulchanova, Liubomir Djalev, Margarita Stankova, Valentin Vulchanov, Carrie Allison, Simon Baron-Cohen

The number of studies addressing the latent structure of specific screening and diagnostic tools for autism spectrum conditions is still limited. The current study explored the latent structure of the Bulgarian CAST (Childhood Autism Spectrum Test) in screening for autism in the Bulgarian population. The data were analysed using factor analyses. A hierarchical model with two primary factors yielded best data fit. This structure is consistent with the two main categories adopted in the DSM-5 and current accounts of the range of conditions broadly falling into two main clusters of symptoms. These results confirm the validity of CAST as a tool for screening for autism spectrum conditions in other cultures and support the construct validity of the model and criteria included in the DSM-5. Furthermore, our results demonstrate how factor analysis can be exploited to reveal the underlying structure of screening tools aimed at capturing the behavioural traits of deficit phenotypes.

3-16

Authors: Lina Slim, Genevieve Pinto Zipp

Increased prevalence of Autism Spectrum Disorder (ASD) has generated higher special needs enrollment in schools requiring teachers and therapists to acquire, incorporate and implement specialized strategies needed to address unique educational and behavioral challenges facing children diagnosed with ASD. Budget cuts have generated a shortage of qualified professionals with expertise in autism interventions. Currently, staff training is minimal, ineffective or lacking on how to do acquire these skills. More effective staff training may provide an avenue for addressing this shortage. This study investigates the impact that an Interprofessional Staff Training Procedure (STP), consisting of Video Self‐Monitoring (VSM), Performance Feedback (PF) and Reflection (R) with and without Mentoring has on sustained and generalized teacher performance on two Dependent Variables – application of the Learn Unit (LU) and Rate of Effective Instruction (ROI). An exploratory study was conducted with 10 female teachers instructing 3‐5 year old autistic children in two private schools utilizing principles of Applied Behavior Analysis. Teacher performance on LU and ROI was evaluated after: Phase 1 – 2‐hour workshop; Phase 2 – training period using STP with and without Mentoring and Phase 3 – follow‐up period when STP and Mentoring are removed. While the STP appeared to enhance teacher performance and sustainability of procedural integrity, the greatest and most consistent improvement in performance was observed among teachers who received STP plus Mentoring as opposed to STP alone. Findings revealed that adding Mentoring to an existing STP appears to enhance teacher performance and Procedural Integrity with sustainable outcome.

25-28

Authors: Caren M. Cajares, Carolyn M. Rutledge, Tina S. Haney

Purpose: Individuals with intellectual and developmental disabilities (IDD) suffer from poor oral hygiene and periodontal disease that may predispose them to systemic diseases. In order to receive dental care, the assistance of a certified registered nurse anesthetist (CRNA) is often needed. The role of the CRNA is to provide sedation to reduce the high level of anxiety demonstrated by many individuals with intellectual disabilities in the dental suite. However, this can become a challenge with patients that are anxious when they arrive. The purpose of this paper is to describe an interprofessional dental team that added a certified therapy dog and handler to reduce anxiety of individuals with IDD when they arrive in the dental suite. Methods: A convenience sample of 30 individuals with intellectual disability seen for dental care in an outpatient setting met with a therapy dog prior to receiving preventative dental care. Comparisons were made between observed anxiety levels and behaviors measured by the ADAMS (anxiety scale) and a researcher-developed behavior tool prior to and after the interaction with the therapy dog. Results: This program suggested that the addition of the therapy dog to the interprofessional team prior to sedation decreased anxiety levels and improved the behavioral outcomes of the individual with intellectual disabilities. Conclusions: The incorporation of a certified therapy dog and handler as part of an interprofessional healthcare team in the dental suite may pay great dividends in improving the compliance and comfort of the individual with intellectual and developmental disabilities during dental care visits.

41-43 PDF

Authors: Pat Frankish

The service is providing supported living for a number of people, male and female, age 21 to 55, who all have intellectual disability and a range of extra needs. These include physical disability, communication difficulties, trauma related personality difficulties, self-harming behaviour and aggression towards others. They are all perceived to have emotional developmental needs, all having suffered traumatic experiences in early childhood, causing developmental delay. All have difficulties with relationships associated with attachment disorders. All direct support staff are trained in models of emotional development and how to assess the emotional level, which leads to identifying the needs. Managers of services are alto trained to support the staff to provide the level of support needed, and to understand the systemic effects of trauma so as to be able to provide trauma-informed-care. The training, supervision, support and individual therapy for clients, where needed, is provided by psychologists and psychotherapists trained in Disability Psychotherapy. The comprehensive approach allows people with very complex and distressed behaviour to live in ordinary housing in the community. Data is provided on 10 people, the history, the initial problem behaviour and the present position after being provided with the emotionally nurturing environment

55-62

Authors: Ching Fen Hsu

Contextual integration is seldom explored in people with Down syndrome (DS). This study aimed to investigate this ability by comparing causal inferences made by people with DS who were presented with homonyms embedded within sentences and asked to choose which of three interpretations (figurative meaning, literal meaning, or unrelated meaning) was correct. Accuracy was the dependent variable. Each homonym was presented in a scenario familiar to the participants. The results revealed that the participants with DS were the least accurate in responding to figurative meanings and erred most compared to matched controls in chronological age and mental age. It was concluded that people with DS were developmentally delayed in causal inferences and weak central coherence is indeed a syndrome-general phenotype across populations with developmental disorders.

74-78

Authors: Hideaki Kanemura, Masao Aihara

Some epilepsy is, in general, often associated with cognitive problems that can also affect a patient's adjustments. Epileptic seizures result from an excessive, synchronous discharge of cerebral neurons. Interictal paroxysmal electroencephalogram (EEG) abnormalities are regarded as a correlate of persistent pathological neuronal discharges. Thus, correlation between cognitive deterioration and seizure severities/EEG paroxysmal abnormalities should be investigated. We have previously measured frontal/prefrontal lobe volumes using three-dimensional (3D)-magnetic resonance imaging (MRI) in children with benign childhood epilepsy with centrotemporal spikes, epilepsy with continuous spike-waves during slow sleep, frontal lobe epilepsy, and Panayiotopoulos syndrome, and confirmed that longer active seizure period as frequent spike-waves coupled with the occurrence of frequent seizures and presence of status epilepticus may be associated with prefrontal lobe growth disturbance, which relates to cognitive impairments. These findings suggest that seizure severities such as repeated seizures and presence of status epilepticus, and the subclinical paroxysmal EEG abnormalities may induce prefrontal lobe growth disturbance, which leads to intellectual impairments. Achieving better seizure control and remission for paroxysmal EEG abnormalities is a key to improve quality of life (QOL) in children with epilepsy. From the perspective of decreased cognitive problems and improving QOL, management may be required to remit seizures and paroxysmal EEG abnormalities as soon as possible to achieve optimal prognosis in epilepsy.