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Steven F. Warren Nancy Brady Lizbeth H. Finestack Shelley L. Bredin-Oja University of Kansas, Kansas City Martha Fairchild Boone, NC Shari Sokol University of Kansas, Kansas City Paul J. Yoder Vanderbilt University, Nashville, TN Contact author: Marc E. Fey, Hearing and Speech Department, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160-7605. Email: mfey{at}kumc.edu PURPOSE: To evaluate the efficacy of a 6-month course of responsivity education/prelinguistic milieu teaching (RE/PMT) for children with developmental delay and RE/PMT's effects on parenting stress in a randomized clinical trial. METHOD: Fifty-one children, age 24–33 months, with no more than 10 expressive words or signs, were randomly assigned to treatment/no-treatment groups. Thirteen children in each group had a diagnosis of Down syndrome. RESULTS: In 1 of 2 multivariate comparisons, the RE/PMT group exhibited superior gains in communication compared with the no-treatment group. The treatment effect for overall use of intentional communication acts in the child–examiner context was significant ( d = .68, 95% confidence interval = 0.12–1.24). There were no effects on child outcomes due to presence or absence of Down syndrome. RE/PMT led to modest increases in recoding of child acts by parents of children who did not have Down syndrome. There were no effects on parenting stress associated with the intervention or the presence or absence of Down syndrome. CONCLUSIONS: RE/PMT may be applied clinically with the expectation of medium-size effects on the child's rate of intentional communication acts after 6 months of intervention. The approach warrants further investigation with modifications, such as delivery at higher intensity levels. KEY WORDS: early intervention, language intervention, early communication, milieu teaching, developmental delay CiteULike     Connotea     Del.icio.us     Digg     Facebook     Reddit     Technorati     Twitter     What's this?

While adults with intellectual disabilities have a high prevalence of obesity, few weight loss interventions exist for them, and those that do exist target people with mild or moderate disabilities. To address obesity in adults with severe intellectual disabilities who are highly dependent, we developed the “Conflict-Free Weight Loss Program for Adults with Severe ID and Autism” to support their mothers and piloted the program, and the results showed that it was effective for weight loss. This study aimed to determine the feasibility of day center nurses and dieticians implementing the “Conflict-Free Weight Loss Program for Adults with Severe ID and Autism” and whether this would support effective weight loss in adults with severe intellectual disabilities, both with and without autism. A cluster randomized controlled trial per day center was registered at UMIN Clinical Trials Registry (UMIM-CTR ID;UMIN000047478) and was conducted with 31 adults with severe intellectual disabilities in Aichi, Japan. The seven-month trial consisted of a four-month intervention and a three-month follow-up; 15 adults in the intervention group and 13 in the control group completed the follow-up. Primary outcomes included the adults’ weight and waist circumference, and differences between groups were analyzed using the Friedman tests. The secondary outcomes were mothers’ implementation, adults’ scores for inflexible adherence, and daily intake of target food. The intervention group showed significantly reduced weight (median; baseline 1, post-intervention 0.975, follow-up 0.983, p <  0.001), and slightly reduced waist circumference (median; baseline 1, post-intervention 0.975, follow-up 0.975, p =  0.226); however, the control group showed no change. Adults’ resistance was minimal, maternal implementations were high, and daily food intake decreased. Our findings indicate that our program was feasible for day center nurses and dietitians to implement and has the potential to reduce the weight of adults with severe intellectual disabilities.

Background: Eating behavior problems significantly affect the physical health and quality of life of children with autism spectrum disorder and intellectual disabilities (co-occurring ASD/ID). This study aimed to evaluate the effects of a 12-week Ball Combination Training Program (BCTP), continuous theta burst stimulation (cTBS), and an intervention combining both (in the CIG) on the eating behaviors of children with co-occurring ASD/ID. Methods: A total of 48 participants were assigned into one of four groups: the BCTP (n = 13), cTBS (n = 12), the CIG (n = 11), and a control group (n = 12). The intervention groups received their respective treatments in addition to the routine institutional rehabilitation, whereas the control group only received the standard institutional rehabilitation. The intervention outcomes were assessed using the parent-reported Children’s Eating Behavior Questionnaire (CEBQ). Results: The results indicated that all three intervention methods led to improvements in their eating behavior after 12 weeks. Specifically, the BCTP group and the CIG demonstrated significantly reduced Food Fussiness behavior, while the children’s Enjoyment of Food was markedly enhanced in the cTBS group and the CIG. Furthermore, the CIG experienced a particularly notable effect in terms of the improvement in the Satiety Responsiveness dimension of their eating behavior. Among the three approaches, the CIG demonstrated a clear advantage over the single interventions in terms of both the breadth and magnitude of its improvements. Conclusions: This study confirmed the effectiveness of these three intervention strategies in addressing dietary behavior problems among children with co-occurring ASD/ID. Future research should focus on exploring the combined intervention approach further, particularly its potential synergy, while delving deeper into the neural mechanisms underlying these behavioral improvements.

This randomized controlled study evaluated a computer-based intervention on emotion understanding in 32 children with autism spectrum conditions with and without intellectual disability (ID) aged 7–15 years. The intervention group (n = 16) used the program for 12 h while the control group (n = 16) was not included in any intervention or training beside the usual educational curriculum. After controlling for pre-intervention scores and symptom severity, strong positive effects were observed in emotion recognition from real face photographs and pictograms, as well as in understanding situation-based emotion across both intellectual ability groups. The typical and ID intervention groups performed significantly better on all EU measures, compared to controls, at the level of feature based distant generalization.

Despite the evidence base for computer-assisted cognitive-behavioural therapy (CBT) in the general population, it has not yet been adapted for use with adults who have an intellectual disability. To evaluate the utility of a CBT computer game for adults who have an intellectual disability. A 2 × 3 (group × time) randomised controlled trial design was used. Fifty-two adults with mild to moderate intellectual disability and anxiety or depression were randomly allocated to two groups: computerised CBT (cCBT) or psychiatric treatment as usual (TAU), and assessed at pre-treatment, post-treatment and 3-month follow-up. Forty-nine participants were included in the final analysis. A significant group × time interaction was observed on the primary outcome measure of anxiety (Glasgow Anxiety Scale for people with an Intellectual Disability), favouring cCBT over TAU, but not on the primary outcome measure of depression (Glasgow Depression Scale for people with a Learning Disability). A medium effect size for anxiety symptoms was observed at post-treatment and a large effect size was observed after follow-up. Reliability of Change Indices indicated that the intervention produced clinically significant change in the cCBT group in comparison with TAU. As the first application of cCBT for adults with intellectual disability, this intervention appears to be a useful treatment option to reduce anxiety symptoms in this population.

IntroductionThe primary objective of this clinical trial is to determine the clinical and cost-effectiveness of psychoeducation and emotional stabilisation (PES), together with eye movement desensitisation and reprocessing (EMDR) plus treatment-as-usual (TAU) in reducing symptoms of post-traumatic stress disorder (PTSD) among adults with intellectual disabilities compared with TAU. Secondary objectives include: (1) determining whether PES/EMDR plus TAU is superior to TAU in improving mental health problems and quality of life (QoL) among adults with intellectual disabilities who had a diagnosis of PTSD and (2) completing a process evaluation to examine intervention implementation and acceptability.MethodsThis is a two-arm parallel single-blind randomised controlled trial comparing PES-EMDR+TAU to TAU including an internal pilot phase. Outcome data will be captured prior to randomisation, and at 4 (after PES), 8 (after EMDR) and 14 months postrandomisation by masked assessors. 144 adults with intellectual disabilities with a diagnosis of PTSD will be allocated (1:1) randomly using minimisation from National Health Service (NHS) community and inpatients services for adults with intellectual disabilities in England. Participants are eligible to take part in this trial if: (1) they are aged 18 or older, but younger than 66, (2) have a Full Scale IQ<75, (3) meet diagnostic criteria for PTSD and (4) have suffered a major identified trauma at least a year earlier and (5) are able to communicate using English and have capacity to consent to take part in this clinical trial. Participants allocated to the active intervention will receive 10 sessions of PES, followed by up to 15 sessions of EMDR alongside TAU. The active intervention is being delivered by psychologists experienced in working with adults with intellectual disabilities who have received additional intervention training. TAU is likely to include medication, behaviour support plans designed to target challenging behaviour, or non-trauma-focused psychological interventions. The primary outcome is a measure of PTSD symptoms. Secondary outcomes are other mental health problems, including anxiety and depression, challenging behaviour, participant and carer QoL, and carer burden. We are also capturing cost data to allow for a cost–utility analysis. A process evaluation will be completed using data generated from semistructured interviews with a sample of participants, therapists and carers alongside the capture of fidelity and adherence data.AnalysisThe primary outcome will be assessed using an intention-to-treat analysis. Baseline characteristics will be compared between arms to determine whether any potentially influential imbalance occurred. The primary outcome will be analysed by analysis of covariance, adjusting for baseline values of the outcome and any variables used in the randomisation process. Secondary outcomes will be analysed using linear or logistic regression models as appropriate reflecting the distribution of the outcome variable. The treatment effect will be estimated as an adjusted difference between sample means, presented with 95% CIs and p values. A complier average causal effect analysis will be considered should the data availability be sufficient to estimate the impact of non-compliance. A series of subgroup analyses on the primary outcomes will be considered considering differences in the Impact of Event Scale–Intellectual Disabilities scores at 14 months for (1) differing levels of general intellectual functioning and (2) PTSD versus complex PTSD.Ethics and disseminationThis clinical trial was designed to allow for conclusions about whether PES/EMDR+TAU is efficacious in reducing symptoms of PTSD, relative to TAU, for adults with intellectual disabilities. A favourable ethical opinion has been received from an NHS ethics committee in the UK. The findings from this trial will be published within peer-reviewed journals and shared at national and international conferences. We will also aim to record and distribute podcasts detailing our findings together with our partners.Trial registration numberISRCTN35167485.

Background Oxytocin is increasingly considered as a new pharmacological option for mitigating social difficulties and regulating stress in autism spectrum disorder. However, in prior trials, autistic individuals with co-occurring intellectual disability (ID) have largely been overlooked, despite their high prevalence, poorer outcome, and the enhanced need but reduced availability of therapeutic interventions. Prior studies have also overlooked the importance of standardizing the context in which oxytocin is administered, rendering outcomes from prior trials inconclusive. Methods To meet these limitations, we propose a double-blind, randomized, placebo-controlled trial investigating the effects of intermittent multiple-dose intranasal oxytocin administration (4 weeks, 24 IU 3x/week), administered within a standardized psychosocial stimulating context at special need schools, in 80 children with autism and co-occurring ID (4–13 years old). Clinical-behavioral as well as stress-regulatory effects of oxytocin will be evaluated using the Autism Treatment Evaluation Checklist (ATEC), the Brief Observation of Social Communication Change (BOSCC) expert rating scale, and measurements of high-frequency heart rate variability (HF-HRV), a validated index of parasympathetic autonomic nervous system activity. To assess the possibility of retention and/or late-emerging effects, outcomes will be assessed immediately after the administration regime, and at two follow-up sessions, four-weeks and six months after administration. Discussion Significant clinical-behavioral improvements on the ATEC and BOSCC, and significantly higher parasympathetic HF-HRV power in the oxytocin compared to the placebo group would confirm beneficial clinical-behavioral and stress-regulatory effects of oxytocin in autistic children with co-occurring ID. This would also corroborate the use of intermittent dosing schemes in combination with concomitant psychosocial stimulation. Trial registration The trial was registered on the 9th of December 2022 at the European Clinical Trial Registry (EudraCT 2022-002423-36) and on 20th of September the trial was transferred to the EU Clinical Trial Register (EU CT 2024-513436-14).

To study the association between the socioeconomic environment of area of residence and prevalence and characteristics of children with cerebral palsy (CP). Data on 8-year-old children with CP born in 2000-2011 (n = 252) were extracted from a regional population-based register in France. The European Deprivation Index (EDI), available at census block level, characterised socioeconomic deprivation in the child's area of residence at age of registration. The prevalence of CP was estimated in each group of census units defined by EDI distribution tertiles in the general population. The association between deprivation level and CP severity was assessed according to term/preterm status. CP prevalence differed between deprivation risk groups showing a J-shaped form with the prevalence in the most deprived tertile (T3) being the highest but not significantly different of the prevalence in the least deprived one (T1). However, the prevalence in the medium deprivation tertile (T2) was significantly lower than that in the most deprived one with a prevalence risk ratio (PRR) of: PRRT2/T3 = 0.63 95% CI [0.44-0.89]). Prevalences of CP with associated intellectual disability (ID) and CP with inability to walk were significantly higher in the most deprived tertile compared to the least deprived one (respectively PRRT3/T1 = 1.86 95% CI [1.19-2.92] and PRRT3/T1 = 1.90 95% CI [1.07-3.37]). Compared to children living in the least deprived areas, children with CP born preterm living in the most deprived areas had more severe forms of motor impairment, such as an inability to walk or a combination of an inability to walk and moderate to severe impairment of bimanual function. They also had more associated intellectual disability. No associations were observed among term-born children. A significant association between area deprivation group and CP severity was observed among preterm children but not among term-born children.

Individuals with mild intellectual disability (MID; IQ 50-70) or borderline intellectual functioning (BIF; IQ 70-85) are at an elevated risk of post-traumatic stress disorder (PTSD), with PTSD symptoms possibly associated with behavioural problems. It is important to test the effectiveness of trauma-focused treatments, such as eye movement desensitisation and reprocessing (EMDR) therapy, for adults with MID-BIF, PTSD, and severe behavioural problems. To determine the safety and effectiveness of brief intensive EMDR therapy carried out by a team of rotating therapists in adults with MID-BIF, PTSD, and severe behavioural problems. Using a randomised non-concurrent multiple baseline between-subjects design, 11 adults with MID-BIF, PTSD, and severe behavioural problems received a maximum of 16 intensive EMDR sessions twice daily for a maximum of two weeks from six different EMDR therapists. Primary outcome measurements included severity of PTSD symptoms, PTSD diagnostic status, and adverse events. Secondary outcome measurements included the frequency and severity of behavioural problems, presence of adaptive behaviour, and the use of involuntary care. Outcome measurements were assessed at baseline, during the intervention and post-intervention phases, and at the follow-up phases, and subject to randomisation tests for statistical significance. Intensive EMDR therapy carried out by a team of rotating therapists resulted in significant decreases in PTSD symptoms (  = 15.84,  < .001) with nine of 11 participants no longer meeting the PTSD diagnostic criteria immediately following treatment and at the 9-week follow-up. Randomisation tests revealed no significant changes in adaptive behaviour, frequency, and severity of behavioural problems. Additionally, no decrease in the use of involuntary care measures was observed. One participant dropped out; no adverse events were observed. Brief intensive EMDR therapy for individuals with MID-BIF and severe behavioural problems, conducted by a team of rotating therapists, can be done safely and effectively to reduce PTSD symptoms.