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Profiles of Adaptive Functioning: Autism Spectrum Disorders, Mental Retardation, and Beyond . California Association of School Psychologists February 17, 2005 8:30-10:15 Sara S. Sparrow, PhD Yale Child Study Center. How I Discovered Adaptive Behavior. Speech Pathology Psychology

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Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Profiles of Adaptive Functioning: Autism Spectrum Disorders, Mental Retardation, and Beyond.

California Association of School PsychologistsFebruary 17, 2005

8:30-10:15

Sara S. Sparrow, PhD

Yale Child Study Center


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

How I Discovered Adaptive Behavior

Speech Pathology

Psychology

Doman-Delacato

Measurement Dilemmas


4 areas for today

4 AREAS FOR TODAY

  • NEW FEATURE OF THE VINELAND II

  • CHANGES IN THE PURPOSES OF ADAPTIVE BEHAVIOR ASSESSMENTS

  • RECENT RESEARCH ON EFFECTS OF INTERVENTION WITH PERSONS WTH HIGH FUNCTIONING ASD

  • CLINICAL APPLICATIONS AND ADAPTIVE PROFILES


Adaptive behavior assessment

Adaptive Behavior Assessment

Working our way back:

30 years since Pl 94-142 (1975)

16 years earlier AAMD (1959)

24 years earlier Edgar Doll published

The Vineland Social Maturity Scale (1935)


Purpose

Purpose

Diagnosis of Mental Retardation


Things have changed

Things Have Changed

More and more assessing adaptive behavior has had broader applications

One reason is that different research has demonstrated that there appear to be different profiles for various diagnostic groups


Uses of adaptive behavior assessments

USES OF ADAPTIVE BEHAVIOR ASSESSMENTS

  • Confirming or establishing diagnosis

  • Special services qualification

  • Program planning

  • Progress reporting/tracking

  • Identifying changes over time


Uses conintued

USES, conintued

  • Mental Retardation

  • Early Childhood Special Education

  • Autism Spectrum Disorders

  • Traumatic Brain Injury

  • Adult Mental Problems

  • As a measure to support the diagnosis ofother disabilities

  • Death Penalty Cases and

  • Many others


A word about death penalty cases

A word about Death penalty cases:

Atkins versus Virginia.

Psychologists will be increasingly asked to provide testimony in these cases, mainly regarding adaptive functioning

A Virginia court just ruled that Atkins did not meet criteria for a diagnosis of mental retardation


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

2005

Supreme Court rules that individuals with (chronological) age under 18 years cannot be executed.

What about mental age?


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

THUS

  • Implications for the development of the Vineland II


Introducing the vineland ii

Introducing the Vineland-II


Vineland ii overview

VINELAND-II Overview

  • Because clinicians have different needs when it comes to assessing adaptive behavior, we now offer four forms:

    --Survey Interview Form

    • NEW Parent/Caregiver Rating Form

    • Teacher Rating Form

    • Expanded Interview Form


Major new features

MAJOR NEW FEATURES

  • Ages: Birth to 90 years of age

  • New Norms

  • Increase Item density at floor and ceiling

  • Extensive investigation and elimination of item bias

  • Increase items relevant to ASD and young children

  • Eliminate outdated items

  • Increase Items reflecting our society’s technological advances

  • Subdomain standard scores

  • New Maladaptive


Other new features

Other New Features

  • Parent Caregiver Forms

  • Teacher report Form –

    • Daily Living Skills

      • Personal Subdomain

      • Academic Subdomain

      • School-Community Subdomain


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Validity Evidence: 11 Clinical Groups

  • Attention Deficit/Hyperactivity Disorder

  • Autism – nonverbal

  • Autism – verbal

  • Learning Disability

  • Mental Retardation – Mild (child)

  • Mental Retardation – Moderate (child)

  • Mental Retardation – Mild (adult)

  • Mental Retardation – Moderate (adult)

  • Emotional Disturbance

  • Visual Impairment

  • Hearing Impairment


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Validity Evidence: Criterion

  • Vineland Adaptive Behavior Scales

  • Adaptive Behavior Assessment System (ABAS)

  • WISC III

  • WAIS-III

  • BASC-2


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

SUBDOMAIN

V-SCALED SCORES

Mean = 15

SD = 3


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Yale University

VINELAND II

NEW MALADAPTIVE DOMAIN


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

STILL BOTH

MINOR AND MAJOR

MALADAPTIVE


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

FACTOR ANALYTIC STUDIES

REVEALED

THREE FACTORS


Internalizing items

Internalizing Items

  • Is overly dependent 

  • Avoids others and prefers to be alone 

  • Has eating difficulties 

  • Has sleep difficulties 

  • Refuses to go to work or school because of fear, feelings of rejection, or isolation 

  • Is overly anxious or nervous 

  • Cries or laughs too easily 

  • Has poor eye contact 

  • Is sad for no clear reason 

  • Avoids social interaction 

  • Lacks energy or interest in life 


Externalizing items

Externalizing Items

  • Is impulsive

  • Has temper tantrums

  • Intentionally disobeys or defies those in authority

  • Taunts, teases, or bullies

  • Is inconsiderate or insensitive of others

  • Lies, cheats, or steals

  • Is physically aggressive

  • Is stubborn or sullen

  • Says embarrassing things or asks embarrassing questions in public

  • Behaves inappropriately at the urging of others


Group maladaptive differences

Group Maladaptive Differences


Maladaptive behavior by age for individuals with mr

Maladaptive Behavior by Age for Individuals with MR

School-aged children with MR (all levels) had maladaptive means significantly higher than age matched clinical groups but < 1SD difference.

Adults (19-90) with MR (all levels) had maladaptive means significantly higher than age matched clinical groups AND school aged groups with MR


Maladaptive behaviors by age for individuals with mr

Maladaptive Behaviors by Age for Individuals with MR

Differences were greatest in the adult severe-profound group

Only Internalizing behaviors fell into the “elevated range” (the highest level) for this group


Adaptive functioning of mental retardation groups

Adaptive Functioning of Mental Retardation Groups

For all levels and ages, mean levels of all domains and the adaptive behavior composite were at least 2SD below the mean


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Severe

Moderate

Mild


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Mean Subdomain Scores


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Mean Subdomain Scores


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Validity Evidence: Mental Retardation

Ages >18

Ages 6-18

Mean scores by age group and level

Mild, Moderate, Severe to Profound


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Validity Evidence: Autism, ADHD, EBD, LD

Mean scores by age group and disability


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Validity Evidence:

Visual Impairments, Hearing Impairments

Mean scores by age group and disability


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Clinical Group Summary

Vineland-II differentiates clinical groups from nonclinical groups.

  • Documented significant deficits for MR groups (at least 2 SDs below mean)

  • Demonstrated expected mean score changes for mild, moderate, and severe to profound levels of mental retardation

  • Differentiated between Verbal and Nonverbal Autism groups

  • Demonstrated distinctive profile patterns


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Validity Evidence: Criterion

  • Vineland Adaptive Behavior Scales

  • Adaptive Behavior Assessment System (ABAS)

  • WISC III

  • WAIS-III

  • BASC-2


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Vineland-II and Vineland ABS

High degree of consistency between forms

Correlations corrected for restriction of range


Important

IMPORTANT

THERE APPEARS TO BE NO FLYNN

EFFECT


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Vineland-II and WISC-III and WAIS-III

Documents the distinct difference between IQ and Adaptive Behavior.

Confirms the need to assess both when making diagnostic decisions.

Correlations corrected for restriction of range


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Ages 6-11

Vineland-II and Behavior Assessment System for Children, 2nd Edition (BASC-2)

Correlations corrected for restriction of range


Conclusions

Conclusions

  • Much is the same but much is better!

    Manual

    Criteria

    Case studies

    Summer 2006

  • Teacher checklist

    Winter 2006

  • Expanded Form


Adaptive profiles from research studies

Adaptive Profiles from Research Studies

Since 1984 over 1400 studies have been published investigating adaptive functioning in the following groups:

Mental retardation Autism Spectrum

Closed Head InjuryHearing Impaired

HomelessHIV

Learning disabilityGifted

Emotionally DisturbedSpina Bifida

Tourette SyndromeConduct Disorder

Cocain ExposedLow Birthweight

Children exposed to Violence ETC.!


Groups with mental retardation

Groups with Mental Retardation

Non Specific MR

All levels of MR

Genetic Forms of MR

Fragile X

Down Syndrome

Praeder Willi

William Syndrome

Special Olympics


Groups on the autism spectrum

Groups on the Autism Spectrum

PDD NOS

Asperger Syndrome

High functioning Autism

Low functioning Autism

Multiplex

Nonverbal Learning Disability (?)


Atypical and normally developing children

Atypical and Normally DevelopingChildren

Sparrow, S.S. Rescorla, L.A., Provence, S., Condon, S.O., Goudreau, D., Cicchetti, D.V., (1986). Follow-up of “atypical” children Journal of American Academy of Child Psychiatry. 25, 2:181-185.


Atypical and normally developing children1

Atypical and NormallyDevelopingChildren


Pddnos atypical and non atypical pddnos

PDDnos (Atypical) and Non (Atypical) PDDnos


Social deficits in autism

Social Deficits In Autism

Volkmar, F.R., Sparrow, S.S., Goudreau, D., Cicchetti, D.V., Paul, R., Cohen, D.J., (1987) Social deficits in autism: An operational approach using the Vineland Adaptive Behavior Scales. Journal of the American Academy of Child and Adolescent Psychiatry. 26,

2:156-161.


Autism

AUTISM

  • Carter,A. S., Volkmar,F. R., Sparrow,S. S., Wang,J. J., Lord,C., Dawson,G., Fombonne,E., Loveland,K., Mesibov,G., Schopler,E., (1998),The Vineland Adaptive Behavior Scales - Supplementary Norms for Individuals with Autism, Journal of Autism & Developmental Disorders, 28:4, pp. 287-302.


Autism and asperger

AUTISM AND ASPERGER


Subject characteristics

Subject Characteristics

Age and IQ matched children with mental retardation without and with autism

Mean age 11.8

Mean IQ 54

Vineland scores were so low we had to use age equivalents/mental age ratios

Thus, if Adaptive Behavior was consistent with MA, Score should be

near 100.


Social deficits in autism1

SOCIAL DEFICITS IN AUTISM


Social deficits in autism2

SOCIAL DEFICITS IN AUTISM


Social deficits in autism3

SOCIAL DEFICITS IN AUTISM


Other populations

Other Populations

Precocious readers (not hyperlexic)

IQs: 121 to 122

Ages: 3-2 to 4-9

Asperger and high functioning autism


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Special Thanks

  • Ami Klin

  • Fred R. Volkmar

  • Celine Saulnier

  • Kathy Lord

  • Domenic V. Cicchetti

  • All the participating families from the Yale Child Study Center and the Autism and Communication Disorders Center at the University of Michigan

  • NICHD grant 5-PO1-HD03008


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Recent Research in ASD

  • Autism symptoms have a severe impact on a person’s ability to meet the demands of everyday life

  • Extreme variability in symptomatology and cognitive ability affects daily functioning

  • “Higher-functioning” individuals, despite potential, fail to translate their skills to real-life adaptation


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Outcome in ASD

  • Increasing focus on early diagnosis & intensive intervention = progress

  • Still enormous variability in outcome

    • 12% achieving “very good outcome”

    • 60% with “poor” or “very poor outcome” (Howlin, Goode, Hutton, & Rutter, 2004)

  • Cognitive & language measures

  • Does higher cognitive ability = greater outcome in adulthood???

  • Translating potential into real-life skills becomes critical – Adaptive Behavior


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Adaptive Functioning in Autism

  • “Real-life” Skills

  • Vineland Adaptive Behavior Scales(Sparrow, Balla, & Cicchetti, 1984)

    • CommunicationDaily Living Skills

    • Socialization Motor

  • Communication & Socialization skills = central & defining features

  • Deficits in adaptive skills fall below cognitive ability across the spectrum

    • Significant deficits in socialization

    • Intermediate deficits in communication

      (Bolte & Pustka, 2002; Carter et al., 1998)


Adaptive communication

Adaptive Communication


Adaptive social skills

Adaptive Social Skills


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Relationship between

IQ and Adaptive Functioning

  • Consistent findings:

    • Adaptive impairments exist beyond MR

    • No entitlement for services without MR

  • Inconsistent findings:

    (Freeman, Del’Homme, Guthrie, & Zhang, 1999; Liss et al., 2001; Schatz & Hamden-Allen, 1995; Szatmari, Bryson, Boyle, Streiner, & Duku, 2003)

    • Positive relationship

      • e.g., Vineland Communication & VIQ

      • Early language and nonverbal IQ predicting outcome for both comm. & socialization skills

    • Negative relationship


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Relationship between

Age and Adaptive Functioning

  • Equally unclear relationship:

    • Stable relationship

      (e.g., Schatz & Hamden-Allen, 1995)

    • Increase in AF w/ age

      (e.g. Freeman et al., 1999)

    • Decrease in AF w/ age

      (e.g. Szatmari et al., 2003)


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Autism Symptomatology

  • Varying measures to assess severity of autism symptoms

    • Autism Behavior Checklist

    • Childhood Autism Rating Scale

    • Autism Diagnostic Observation Schedule

  • Other factors (e.g., adaptive behavior and language) appear to be stronger predictors of outcome than severity of symptoms

  • Very little research on relationship between symptomatology and adaptive behavior


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Many Unanswered Questions

  • Cognitive potential may or may not play a role in positive outcomes

  • Severity of autism symptoms may or may not play a role in positive outcomes

  • Early detection and intensive intervention are beneficial to some, but not all, individuals on the spectrum

  • “Real-life” skills are important for outcome

    • adaptive communication & social skills


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Present Study

  • Examines relationship between adaptive behavior (ability) and severity of symptoms (disability)

    • Vineland Adaptive Behavior Scales

    • Autism Diagnostic Observation Schedule

  • Investigates nature of ability & disability in relation to:

    • Age

    • IQ

    • Diagnostic Classification


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Participants

Total Sample

  • 187 males with a diagnosis of an ASD

  • Diagnosis based on ADI, ADOS, & clinical judgment of 2 licensed clinicians

  • Verbal IQ > 70

  • Age range from 7 to 18 years

    Yale Site

  • N = 84

    • Autism=32; Asperger’s=35; PDD-NOS=17

      Michigan Site

  • N = 103

    • Autism=31; Asperger’s=1; PDD-NOS=66


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Measures

  • Autism Diagnostic Observation Schedule

    (Lord, Rutter, DiLavore, & Risi, 1999)

  • Vineland Adaptive Behavior Scales (Sparrow, Balla, & Cicchetti, 1984)

  • Intelligence Scales

    • Yale:Wechsler scales: WISC-III, WAIS-R (The Psychological Corporation)

    • Michigan:Mix of Wechsler scales, Differential Ability Scales, & Stanford-Binet


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Characterization by Site

Note. ADOS Commun. scores range 0-8 & Social scores 0-14

*For Vineland scores, higher numbers indicate greater ability

**For ADOS scores, higher numbers indicate greater disability


Real life adaptive functioning in higher functioning individuals with autism and pdds

Real-life (adaptive functioning) in higher functioning individuals with autism and PDDs

  • N=187

  • Autism, AS, and PDD-NOS

  • Socialization (Vineland): Mean 52 Yale (SD 12.6)

  • Interpersonal Age Equivalent: Yale Mean 3.6 years (SD 1.7 years)

From Klin, Saulnier, Sparrow, Cicchetti, Lord & Volkmar (submitted)


Real life adaptive functioning in higher functioning individuals with autism and pdds1

Real-life (adaptive functioning) in higher functioning individuals with autism and PDDs

  • Social ability and disability: two relatively dissociated domains (correlation)!!!!!!!

  • Social disability is not correlated with age (stable)

  • Social ability is negatively correlated with age (decline relative to peers, relative to increasing demands of the environment)

  • Most programs emphasize reduction of symptoms

  • Conclusion: all programs should prioritize adaptive functioning (REAL-LIFE SKILLS)

From Klin, Saulnier, Sparrow, Cicchetti, & Volkmar (submitted)


High functioning asd

High Functioning ASD


Prototypical comparative profiles

Prototypical Comparative Profiles

Based on our work and those of many others

These are group data and some affected individuals may not demonstrate the prototypical profiles


Asperger and autism

ASPERGER AND AUTISM

  • Szatmari,Peter; Archer,Lynda; Fisman,Sandra; Streiner,David L. (1995), Asperger's syndrome and autism: Differences in behavior, cognition, and adaptive functioningJournal of the American Academy of Child & Adolescent Psychiatry, Dec. 34:12, pp.1662-1671.


Asperger and autism1

ASPERGER AND AUTISM

Klin, A., Volkmar, F.R., Sparrow, S.S., Cicchetti, D.V., and Rourke, B.P.

(1995). Validity and Neuropsychological Characterization of Asperger

Syndrome. Journal of Child Psychology and Psychiatry. 36:1127-1140.


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

High Functioning Autism and Asperger


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

ADHD

Roizen,N. J., Blondis,T. A., Irwin,M., Stein,M.(1994) Adaptive functioning in children with attention-deficit hyperactivity disorder, Archives of Pediatrics & Adolescent Medicine Nov,148:11, pp 1137-1142.


Adhd add

ADHD, ADD

  • Stein,Mark A., Szumowski,Emily, Blondis,Thomas A. (1995) Adaptive skills dysfunction in ADD and ADHD children, The Journal of Child Psychology and Psychiatry and Allied Disciplines, May, pp.36, 663-670.


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Cognitive and Adaptive Profiles of Normally developing

children and ADHD


Down syndrome

DOWN-SYNDROME


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Cognitive and Adaptive Profiles

of

Nonspecific MR and Down syndrome


Down syndrome1

DOWN-SYNDROME

Burack,J. A.; Shulman,C.; Katzir,E.; Schaap,T.; Brennan,J. M.; Iarocci,G.; Wilansky,P.; Amir,N.(1999) Cognitive and behavioural development of Israeli males with fragile X and Down Syndrome International Journal of Behavioral Development, JUNE, 23:2, pp. 519-531


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

  • Cicchetti,Domenic V., Sparrow,Sara S.(1990)Assessment of adaptive behavior in young children, pp173-196, Johnson,James H., Goldman, Jacquelin, Developmental assessment in clinical child psychology: A handbook. Pergamon general psychology series, 163 Pergamon Press, Inc, Elmsford, NY.


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Cognitive and Adaptive Profiles of Normal

Development and Hearing Impaired


Profiles of adaptive functioning autism spectrum disorders mental retardation and beyond

Cognitive and Adaptive Profiles of Prototypical Autism and Mental Retardation


Conclusions1

Conclusions

Assessment of Adaptive functioning is important for individuals within any diagnostic category

Determining how everyday life (adaptive functioning) is affected by nature or nurture (or both) should be our goal

Research and clinical work has shown us how different profiles are found in different groups

Aside:(Program planning and assessment of change after intervention are other goals of adaptive behavior assessment)


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