Journal of Intellectual Disability - Diagnosis and Treatment

102-112

Authors: H. Manolova, S. Staykova, M. Hristova, D. Terziev, G. Markova

The authors present a synthesised review of the methods for assessing mental development and autism, with an emphasis on the general tendency to reduce the age of diagnosis. Based on clinical experience, a number of particularities are described in terms of: testing, working with parents, observing and reflecting on the nature and meaning of autistic behaviours. On focus is a toolkit for detailed assessment of mental development that was elaborated within the inter-university cooperation between Sofia Medical University and Universite catholique de Louvain (UCL) - Belgium. Illustrated and discussed are typical profiles of cognitive and socio-communicative functioning of children with ASD and other neurodevelopmental disorders, which help a differential diagnosis to be made by the multidisciplinary clinical team. Further described are the advantages of early assessment of mental development as a basis for future educational and therapeutic programs.

117-123

Authors: S Staykova, D Terziev, H Manolova, M Hristova, A Bistrian

Asperger’s Syndrome (AS) is an autism spectrum disorder without mental retardation and language delay. AS often remains unrecognized until these children fail to adapt to school or kindergarten. The comorbid psychiatric disorders, achieving clinical significance, were considered as another pathway to diagnosis. This study is aimed to elucidate the reasons for referral, the frequency and the kinds of comorbidities in a clinical sample of consecutive cases of children and adolescents with AS. To this objective, clinical records of children and adolescents, who have received a DSM-IV diagnosis of AS after multidisciplinary assessment in a given time period were reviewed. After excluding 3 cases due to insufficient information, 24 cases of children and adolescents with Asperger’s Syndrome (23 boys and one girl) were identified. The mean age at the time of assessment and receiving diagnosis was 9.6 yrs. (age range 4 to 17 years). In twenty-one (87%) of the cases the reason for referral was an episode of disorganized behavior following an attempt to enrollthe child at school or kindergarten, and more rare referral occurred within the significant school transition period. In the remaining 3 cases, the reason for referral was a comorbid condition. Comorbid conditions identified at the moment of assessment include: ADHD documented in 4 cases, tics in 3 cases, obsessive-compulsive behaviors in 4 cases, Stereotypic Movement Disorder or Trichotilomania in 4 of the cases. Within the clinical sample, a priori expected to include relatively severe cases, a higher frequency of comorbidity was found as compared to the rates in the general population. Adjustment reactions and comorbidities occasioned the referr

130-136

Authors: G Markova, H Manolova, M Hristova

The authors present the child welfare policy reform and the process of deinstitutionalization of children's services in Bulgaria. These developments are examined in the context of the country's transition from a post-totalitarian to a liberal democratic state and from collectivistic to individual-centred practices. Therefore, the implementation of social policy promoting and regulating individualised community-based services faces challenges related to attitudes that support group-oriented and institutional-based care. There are three key contextual barriers to the provision of quality services for children with disability: engaging with the individual client, involving parents, and working in multidisciplinary teams. Clinical social work vignettes are presented to illustrate the above challenges.

61-76

Authors: Melissa Patriquin, Diane MacKenzie, Joan Versnel

Objective: To identify evidence-based behavioural interventions used to decrease restricted and repetitive behaviour (RRB) in children with autism (ages 0-18); to understand the application of these strategies within the PEO (Person, Environment, Occupation) Model of Occupational Performance and the role of the occupational therapist in addressing this limitation. Background: RRB is a core feature of autism that often impedes functional behaviour. Decreasing RRB to enable functional behaviours is central to the occupational therapist’s role with this population. Many interventions identified as effective for this impairment are based on the principles of applied behaviour analysis (ABA). Method: An integrative review of the literature was completed to identify interventions targeting RRBs. Those found to be effective are described within an ABA framework and within the PEO Model of Occupational Performance. Results: This review identified twenty-eight effective interventions used to treat RRBs in autism relevant to the field of occupational therapy. Categorization of interventions using an ABA framework and the PEO Model allowed comparison between approaches and application to occupational therapy practice. Conclusion:A functional behaviour approach (FBA) used in combination with the PEO model will enable greater understanding of RRBs and provide a more comprehensive approach to the treatment of RRBs in children with autism.

85-89

Authors: Wenn B. Lawson

The following paper addresses some of the issues presented by students with Special Needs, (especially autism) at school. It particularly focusses upon sexuality and gender. For example, autism and gender dysphoria appear to co-occur more often than in typically developing students. However, these young people may not understand how their reality translates to living within the public arena. This is also true of sexuality. Acceptance, understanding and accommodation of these students needs to inform our measures for keeping safe at school; this is of utmost priority.

96-99

Authors: Aldo Rosano, Alessandra Battisti

People with intellectual disabilities today have an high life expectancy, routine screening and preventive services are essential to their overall quality of care. We used the 2012-2013 Italian National Health Interview Survey (NHIS) to examine screening and preventive service use for persons with intellectual disability. We estimated about 953 thousand people with intellectual disability, 58% of which are female and the 59% are over 65 years. Their quality of life, in terms of physical and mental status, was significant lower than general population. Intellectually disabled women generally reported screening and preventive services at lower as compared to women without intellectual disability: the risk of not attending a Pap smear test in a due time, in terms of odds ratio, was 4.5 (95% confidence interval, 3.6-5.7), as for mammography was 2.4 (95% confidence interval, 1.8-3.2). The risk of not attending colorectal screening was also significant, even if lower than female screening, (OR: 1.5; 95% confidence interval, 1.2-2.0). Various approaches can be adopted to improve access for intellectually disabled persons to preventive health care services.

36-40

Authors: Nadia Misbahuddin, L.L. Mason

This investigation evaluated the effectiveness of a priming intervention to decrease the latency to mand for a five-year-old boy diagnosed with autism spectrum disorder. Parent participation in clinical applied behavior analytic intervention was increased by providing the family members with a home- and community-based priming technique to increase the efficacy of clinical treatment. Using a multiple-baseline design across settings, mand response latency was analyzed as a function of the verbal behavior priming intervention employed by two different caregivers. Results of the study indicate that the caregiver-implemented priming intervention was successful in reducing the child's latency to vocalize a request, allowing for more efficient use of instructional time.

50-60

Authors: Abdur Rahman, Anamul Haque, Md. Sahab Uddin, Md. Mohsin Mian, Mohammad Abu Sufian, Md. Mosiqur Rahman, Yusuf Ali, Md. Rajdoula Rafe, Mohamed M. Abdel-Daim, Md. Josim Uddin, Md. Asaduzzaman

Background: Oxidative stress is strongly linked in the development of numerous chronic and degenerative disorders. Medicinal plants with antioxidant and anticholinesterase activities exert a key role for the management of oxidative stress related disorders mainly Alzheimer's disease (AD). Therefore the purpose of this study was to assess antioxidant potentiality and anticholinesterase inhibitory activity of crude methanolic extract (CME), petroleum ether fraction (PEF), chloroform fraction (CLF), ethyl acetate fraction (EAF) and aqueous fraction (AQF) of Uvaria littoralis (U. littoralis) leaves. Methods: The antioxidant compounds namely total flavonoids contents (TFCs) and total proanthocyanidins contents (TPACCs) were determined for quantities constituent’s characterization. Antioxidant capacity of U. littoralis leaves were estimated by the iron reducing power (IRPA), 1, 1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging and nitric oxide (NO) radical scavenging capacity. Anticholinesterase effects were estimated for acetylcholinesterase (AChE) and butyrylcholinestrase (BChE) activity. Results: The EAF of U. littoralis leaves showed the highest TFCs as compared to CLF, CME, PEF and AQF. TPACCs were also found highest in EAF. The highest absorbance for IRPA was found in EAF (2.220 nm) with respect to CME and other fractions at the highest concentration. The EAF showed best DPPH and NO radical scavenging activity with IC50 values of 31.63 and 55.47 μg/mL, respectively with regard to CME and remaining fractions. The PEF represents highest AChE inhibitory activity with IC50 values of 35.19 μg/mL and CLF showed highest BChE inhibitory activity with IC50 values of 32.49 μg/mL. Conclusions: The findings of the current study demonstrate the presence of antioxidant phytochemicals, likewise, turns out antioxidant and anticholinesterase potentiality of U. littoralis leaves which could be a prestigious candidate for the treatment of neurodegenerative diseases especially AD.

1-6

Authors: Wenn B. Lawson, Brynn A. Dombroski

Poor Theory of Mind (ToM) (or difficulties imputing mental states to self and others) [1], (See also [2-5]) is often blamed for certain responses and behaviour in autism. However, the Theory of Mind Task Battery requires an understanding of language, the use of cognitive skills, as well as the child’s motivation and attention to complete. All of these factors are either weak or under-developed in individuals with autism suggesting that this is not the best means to measure one’s understanding that other people have their own thoughts, plans, beliefs, or point of view. Behaviours like strong defiance, insistence on sameness, fear associated with sudden change and severe anxiety may be related to difficulties seeing beyond the ‘now’ [6]. This paper suggests that some of the stress and anxiety in the autism population may actually be due to delayed object permanence (OP) (knowing something may still exist even if it is out of sight), which can appear as poor ToM. This delay in establishing OP is governed by single focused attention. For more information on this concept see: Lawson, W. (2011) The passionate mind, JKP:London. Although ToM and OP are defined differently, this paper aims to show the relationship between them and how one concept can influence the other using examples in everyday life to illustrate how poor OP is associated with single focused attention, which detracts from the bigger picture.

18-23

Authors: Claudia Condoluci, Manuela Galli, Veronica Cimolin, Chiara Rigoldi, Giorgio Albertini

Down Syndrome (DS) has a significant impact on the development of many tissues, most notably in the heart and in the brain. According to the clinical need to better investigate these aspects, the main aim of this study was to make an overview on the cardiac features in adult individuals with DS. The following data of 37 individuals with DS (range: 18-60 years) were collected and analysed: age, gender, height, weight, waist to height ratio (WHER), smoking history and cardiac parameters (heart rate and blood pressure), blood glucose level or glycaemia, cholesterol (total, high-density lipoprotein – HDL - and low-density lipoprotein - LDL - cholesterol) and triglycerides. In addition, their gait pattern were quantified with 3D Gait Analysis. BMI, WHER and cholesterol HDL results were above the upper limits of the recommended range in people with DS; on the contrary, blood pressure, heart rate, glycaemia, cholesterol-LDL and triglycerides were within the recommended range. Comparing males and females in the DS group, the females showed statistically different values for cholesterol-total, and triglycerides values, with lower values in comparison to males. In motor performance, people with DS presented abnormal gait patterns. Some significant correlations were found: age with LDL, WHER with weight and BMI, systolic with diastolic blood pressure, total cholesterol with LDL and triglycerides. Our results showed that adults with DS suffer from a high prevalence of physical disorders, including overweight and obesity, and abnormal cholesterol values, together with abnormal gait pattern.