A function-based treatment package aiming at decreasing self-injurious behaviour and tantrums.

Self-injurious and aggressive behaviours have often been identified as the cause for students’ lack of academic progress, parental distress, health risks and teachers´ low satisfaction levels. Functional analysis has been identified in the research literature as the benchmark of effective treatments for disruptive and/or inappropriate behaviours. The present study was completed with a girl diagnosed with ASD. An experimental functional analysis was conducted identifying the function of self-injurious behaviours and tantrums to be escaping from tasks. A treatment package was consequently put in place integrating several components that aimed at reducing overall levels of inappropriate behaviours. Results showed a clear and meaningful improvement in the student´s overall health and academic progress, as well as in parental involvement, teachers’ satisfaction and school inclusion. These outcomes are discussed in the light of evidence-based experimental procedures based on applied behaviour analysis and more specifically on the functional-analytic literature, which, if put in place consistently, can bring valuable positive changes in the quality of life of individuals with ASD.

Co-occurring anger in young people with Asperger's syndrome

Objectives: The co-occurrence of anger in young people with Asperger's syndrome (AS) has received little attention despite aggression, agitation, and tantrums frequently being identified as issues of concern in this population. The present study investigated the occurrence of anger in young people with AS and explores its relationship with anxiety and depression. Method: Sixty-two young people (12-23 years old) diagnosed with AS were assessed using the Beck Anger Inventory for Youth, Spence Children's Anxiety Scale, and Reynolds Adolescent Depression Scale. Results: Among young people with AS who participated in this study, 41% of participants reported clinically significant levels of anger (17%), anxiety (25.8%) and/or depression (11.5%). Anger, anxiety, and depression were positively correlated with each other. Depression, however, was the only significant predictor of anger. Conclusion: Anger is commonly experienced by young people with AS and is correlated with anxiety and depression. These findings suggest that the emotional and behavioral presentation of anger could serve as a cue for further assessment, and facilitate earlier identification and intervention for anger, as well as other mental health problems.

Temper outbursts in Prader-Willi syndrome: causes, behavioural and emotional sequence and responses by carers

Background: Temper outbursts are common in Prader-Willi syndrome but rarely described in detail. This study investigated the phenomenology of temper outbursts in terms of antecedents, sequence of behaviours and emotions and intervention strategies used.

Method: A semi-structured interview about temper outbursts was conducted with the main carers of seven children (9.5 to 16.7 years) and seven adults (24.7 to 47.10 years) with Prader-Willi syndrome (10 male, 4 female). Reliability and validity of the interview results was established.

Results: Various setting events increased and reduced the likelihood of temper outbursts. The most common antecedent was a change to routine or expectation. There were marked similarities in the sequence of behaviours and emotions during temper outbursts, with anger rising quickly followed by expressions of remorse and distress at the end of an outburst.

Discussion: The sequence of behaviours and emotions within outbursts was similar to that described in temper tantrums in typical development. Cognitive and emotional processes are likely to be important in the understanding of temper outbursts with implications for early intervention.

Increased Exposure to Rigid Routines can Lead to Increased Challenging Behavior Following Changes to Those Routines

Several neurodevelopmental disorders are associated with preference for routine and challenging behavior following changes to routines. We examine individuals with Prader–Willi syndrome, who show elevated levels of this behavior, to better understand how previous experience of a routine can affect challenging behavior elicited by disruption to that routine. Play based challenges exposed 16 participants to routines, which were either adhered to or changed. Temper outburst behaviors, heart rate and movement were measured. As participants were exposed to routines for longer before a change (between 10 and 80 min; within participants), more temper outburst behaviors were elicited by changes. Increased emotional arousal was also elicited, which was indexed by heart rate increases not driven by movement. Further study will be important to understand whether current intervention approaches that limit exposure to changes, may benefit from the structured integration of flexibility to ensure that the opportunity for routine establishment is also limited.

An Informant Report Behavior Diary for Measuring Temper Outbursts in an Intervention Setting

Temper outbursts are associated with several psychological disorders and comprise a high priority for intervention. However, the low frequency of outbursts presents a challenge for valid measurement. In the present study an informant report behavior diary for measuring temper outbursts was developed and its validity assessed in a case series. Caregivers of 12 individuals with the neurodevelopmental disorder Prader-Willi syndrome (PWS, in which temper outbursts are common) completed a behavior diary over 4 weeks, and a structured interview. Heart rate and movement data were recorded during a sample of the days subject to diary reporting. Individuals with PWS completed self-report ratings of negative emotion experience. Behavior diaries showed high concordance with the component behaviors and duration of temper outbursts reported in structured interviews; but tended to report a lower frequency. For outbursts reported in diaries during physiological recording, heart rate was consistently elevated above a resting state baseline; and was comparable to that recorded during high physical activity. Available self-report data demonstrated correspondence with the diaries but few self-report data were produced. The present results provide critical proof of principle data supporting the concurrent validity of the ecologically valid, resource efficient diaries, which can be exploited in future research.

As birras das crianças: o papel do educador e dos encarregados de educação

Relatório da Prática Profissional Supervisionada Mestrado em Educação Pré-Escolar

Neuropsychological long-term sequelae after posterior fossa tumour resection during childhood

The importance of the cerebellum for non‐motor functions is becoming more and more evident. The influence on cognitive functions from acquired cerebellar lesions during childhood, however, is not well known. We present follow‐up data from 24 patients, who were operated upon during childhood for benign cerebellar tumours. The benign histology of these tumours required neither radiotherapy nor chemotherapy. Post‐operatively, these children were of normal intelligence with a mean IQ of 99.1, performance intelligence quotient (PIQ) of 101.3 and verbal intelligence quotient (VIQ) of 96.8. However, 57% of patients showed abnormalities in subtesting. In addition, more extensive neuropsychological testing revealed significant problems for attention, memory, processing speed and interference. Visuo‐constructive problems were marked for copying the Rey figure, but less pronounced for recall of the figure. Verbal fluency was more affected than design fluency. Behavioural deficits could be detected in 33% of patients. Attention deficit problems were marked in 12.5%, whereas others demonstrated psychiatric symptoms such as mutism, addiction problems, anorexia, uncontrolled temper tantrums and phobia. Age at tumour operation and size of tumour had no influence on outcome. Vermis involvement was related to an increase in neuropsychological and psychiatric problems. The observation that patients with left‐sided cerebellar tumours were more affected than patients with right‐sided tumours is probably also influenced by a more pronounced vermian involvement in the former group. In summary, this study confirms the importance of the cerebellum for cognitive development and points to the necessity of careful follow‐up for these children to provide them with the necessary help to achieve full integration into professional life.

RELATIONSHIP OF ANTISOCIAL PERSONALITY SYNDROME IN BOYS TO PARENTAL ALCOHOL/DRUG DEPENDENCY

The study focused on the relationship between antisocial personality syndrome in boys ages 8-15 and parental alcohol/drug dependency. The population studied was case records of 101 boys coming to a private psychiatrist from 1966 through 1979. The boys were predominantly white and from middle to upper income families.^ A boy was determined to have antisocial personality syndrome if he exhibited antisocial behaviors in four or five major categories, did not exhibit a brain syndrome, and did not exhibit a thought disorder. The five major behavior categories were: (1) self-control (i.e., temper tantrums or hyperactivity), (2) behavior at home (i.e., disobedience or lying), (3) behavior at school (i.e., truancy or cheating), (4) behavior toward peers (i.e., bullying, fighting, or tattling), and (5) behavior against property (i.e., destructiveness or stealing). A boy was determined to be a control if he exhibited antisocial behaviors in two or less behavior categories.^ A parent was determined to have alcohol/drug dependency if s/he exhibited a score above the established threshold (1) for the MacAndrew Alcoholism Scale (28 or above), and (2) for the Holmes Alcoholism Scale (35 or above) which are used with the MMPI. A parent was classified not alcohol/drug dependent if s/he had scores below set thresholds (22 on the MacAndrew Alcoholism Scale and 28 on the Holmes Alcoholism Scale).^ For the final sample (N = 10), there was no reason to believe a relationship exists between antisocial personality syndrome in boys ages 8-15 and parental alcohol/drug dependency (Fisher's Exact Test {FET} P = 1.0). The small sample size primarily occurred as a result of 88.12% of the parents being classified in a questionable category in terms of alcohol/drug dependency.^ The sample was suggestive of a relationship between the fathers' Psychopathic Deviate (Pd) Scale scores as a measure of antisocial tendencies and the boy having antisocial personality syndrome (N = 75; P = .12). There was no evidence of such a relationship for mothers (N = 75; P = .97). ^

Promover a parentalidade : recomendações perante as birras e momentos de alimentação da criança

Enquadramento: A parentalidade é um tema de saúde com muita relevância na sociedade atual, intervindo o seu exercício na promoção da saúde e bem-estar da criança. A parentalidade envolve acontecimentos stressantes, nomeadamente em situações de problemas de saúde e necessidades básicas e de resposta ao comportamento da criança, como é o caso do choro/birra e no momento de alimentação, procurando a maioria dos cuidadores responder ao problema de forma independente enquanto outros solicitam apoio dos profissionais de saúde. Objetivo: Identificar recomendações concretas, baseadas na evidência científica, de boas práticas e recomendações a transmitir aos pais para lidarem com o choro /birras e no momento da alimentação da criança. Métodos: Realizou-se uma revisão sistemática da literatura de estudos realizados nos idiomas português, inglês e espanhol, publicados entre 2009 e 2014, em bases de dados internacionais CINAHL® Plus with Full-Text, Nursing & Allied Health Collection, Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews (CDSR) e Database of Abstracts of Reviews of Effects (DARE), MedicLatina , MEDLINE, com recurso a diversos descritores e operadores booleanos e recorrendo a dois revisores que avaliaram a qualidade dos estudos metodológicos. Resultados: Após avaliação crítica, foram excluídos 50 estudos e incluídos 7, sendo um de grau de evidência A, dois de evidência B e 4 de evidência D. Os outcomes evidenciaram que para gestão da parentalidade o aconselhamento deve feito pelo profissional de referência, que se necessário deverá acompanhar os pais através de contacto telefónico e visita domiciliária sobretudo se mães inexperientes. Os profissionais devem ampliar os seus conhecimentos sobre as dúvidas e preocupações que os pais têm sobre a educação dos seus filhos consultando os espaços de discussão online. A etnia e nacionalidade das mães tem forte impacto sobre os métodos usados para acalmar o bebé, pelo que os cuidados devem ser culturalmente congruentes. Na abordagem do choro/ birras torna-se necessário conhecer o normal desenvolvimento da criança e em que contextos surgem para minimizá-las, sendo importante que os pais dêem à criança atenção positiva, instituindo rotinas. Para melhorar o momento da alimentação os pais devem reconhecer que até aos dois anos decorre a janela de oportunidade de aprendizagem de rotinas e de novos sabores, salientando-se a importância do ambiente de atenção e reciprocidade durante as refeições. Conclusão: Os enfermeiros devem procurar orientar a sua prática com base nas evidências científicas e tendo como base o estudo efectuado, salienta-se a promoção da parentalidade positiva como central para a abordagem dos comportamentos de choro/birra e no momento da alimentação da criança. Palavras – chaves: educação parental, enfermeiro, aleitamento materno, alimentação, birra, choro, relação pais-filhos.

Mamie's watchword /

Mode of access: Internet.

Characteristics of change triggered temper outbursts in children with PWS and ASD and how these may impact on the efficacy of behavioural intervention strategies.

Background
Temper outbursts are prevalent in individuals with PWS and are often triggered by unexpected changes to routines or plans. However, such outbursts are also common in individuals with several other neurodevelopmental disorders, including those with a diagnosis of autism spectrum disorder (ASD). We compared the profile of temper outbursts in children with PWS to that in children with ASD. We examined whether differences in the temper outburst profile predicted differences in the outcomes of two caregiver led intervention strategies aiming to reduce change triggered outbursts.
Methods and results
Thirteen 7-15 year olds with PWS – taking part in a larger study involving 60 children evidencing temper outbursts following changes – were individually matched for age to children with ASD (mean ages: 10.70; 10.76 yrs). Caregivers participated in a structured/semi-structured interview on children's outbursts; completed a web-based outburst diary over a 6 month baseline; and are currently using either a change signalling intervention to reliably warn children of forthcoming changes; or a planning ahead intervention to reduce children's exposure to unexpected changes.
As reported at interview, on average, children with PWS showed more frequent temper outbursts than those with ASD (closer to daily vs. weekly). For seven children with PWS and six with ASD, 60% or more of their temper outbursts were reported to be triggered by changes. Whilst outbursts had similar durations when triggered by changes or by other events in children with PWS; change triggered outbursts in children with ASD were generally shorter. The most commonly reported outburst components in children with PWS included indicators of heightened emotional arousal but this was not the case for children with ASD. Data on behavioural change associated with each of the intervention strategies will be discussed.
Conclusions
Change triggered temper outbursts can be a problem for children PWS and ASD, however subtle differences appear to exist in the profile of these outbursts. Some of these differences may be relevant for the expected efficacy of different behavioural intervention strategies that target outbursts.
Summary
Temper outbursts (tantrums) were compared in children with PWS or autism spectrum disorder before and during use of one of two helping strategies. Helping strategies were led by caregivers and aimed to reduce outbursts that follow changes to routines or plans by making such changes more predictable, or by reducing the quantity of changes. Characteristics of outbursts may be important to help us predict which helping strategies may be most effective.

As Práticas Educativas Parentais e as Birras das Crianças

As birras das crianças são uma característica do desenvolvimento normal das crianças e surgem por volta dos 15-18 meses que, normalmente, são desencadeadas devido ao desejo de independência e à incapacidade de escolher por parte das crianças. Para que as birras não se tornem um grave problema de comportamento das crianças, os pais devem adoptar práticas educativas adequadas para promover comportamentos desejáveis. O presente estudo analisou se os diferentes tipos de práticas educativas parentais se relacionam com a existência ou não de birras. Participaram 106 pais de crianças com idade compreendida entre os 2 e os 6 anos que responderam a três questionários: (a) Questionário Sociodemográfico; (b) Questionário da Caracterização dos Filhos; (c) Inventário de Práticas Educativas (I.P.E). Concluiu-se que as práticas educativas parentais mais utilizadas são as práticas educativas adequadas porém, aquando as birras das crianças, os pais recorrem à punição física e às práticas educativas inadequadas. Verificou-se, também, que o género e o estado civil dos pais não influenciam as práticas educativas utilizadas nos filhos. Quanto à influência da idade dos filhos nas práticas educativas parentais, concluímos que quanto mais velhos os filhos, menos os pais recorrem à punição física. / The tantrums are a feature of normal development of children, which appear at around 15-18 months. The tantrums in children are usually triggered due to the desire for independence and the inability of choice. To condition the tantrums in children in become a serious behavior problem, parents should adopt appropriate education to promote desirable behaviors. The present study examined whether different types of parenting practices relate to the presence or absence of tantrums. Participants 106 parents of children aged 2 to 6 years old, who responded to three questionnaires: (a) Socio-Demographic Questionnaire, (b) Characterization of the Children's Questionnaire, (c) Educational Practices Inventory (PSI). Conclusions demonstrated that parenting practices are the most commonly used adequate educational practices, however when children does tantrums, parents resort to physical punishment and inadequate educational practices. We also verified that gender and marital status of parents do not influence the educational practices used in children. Regarding the influence of age of children in parenting practices, we conclude that the older children, unless parents resort to physical punishment.