To systematically examine the patterns of psychiatric comorbidity and functioning in clinically referred adults with autism spectrum disorders (ASD). Psychiatrically referred adults with and without ASD were compared on measures assessing for psychiatric comorbidity and psychosocial functioning. Sixty-three adults with ASD participated in the study (mean age: 29 ± 11 years). Adults with ASD in their lifetime suffered from a higher burden of psychiatric disorders (6 ± 3.4 vs. 3.5 ± 2.7; p < 0.001) including major depressive disorder and multiple anxiety disorders, and were functionally more impaired with a significant proportion having received both counseling and pharmacotherapy. Adults with ASD have high levels of psychiatric comorbidity and dysfunction comparable to a clinically referred population of adults without ASD.

Current reviews of the caregiver intervention literature have focused primarily on the outcomes of interventions for caregivers and general methodological limitations of individual studies (i.e., sampling and recruitment issues, adequacy of outcome measures, and generalization issues). Little attention has been paid to the specific factors affecting the therapeutic process, including the intensity and integrity of the interventions used. The purpose of this review is to examine closely the content and process of Alzheimer's disease (AD) caregiver interventions. We describe the types of interventions currently in use, factors affecting intervention outcomes, and we conclude with specific recommendations for the application of intervention technology and for the documentation of intervention research.

The effectiveness of teaching Alzheimer's disease subjects to use a prosthetic memory aid when conversing with familiar partners was evaluated. Effects of the training of three topics by caregivers was assessed in daily probes with the experimenter and twice weekly probes with a familiar conversational partner. All 3 subjects learned to use the memory aid with both conversational partners and improved the quality of their conversational content. Subjects made significantly more statements of fact and fewer ambiguous utterances after training on each topic according to a multiple baseline design. All subjects also generated novel, untrained statements in conversations with both partners. Treatment effects were maintained at high levels throughout training and at 3‐ and 6‐week followup sessions. Naive judges rated baseline and posttreatment conversational samples as significantly improved on all eight conversational dimensions.

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Interpersonal communication has been described as a critical tool for life adjustment, linking people to their environment.1 When communication disorders are present these links can be easily broken. Communication disorders form a diverse group of conditions that vary in terms of type, severity, and co-occurrence with other symptoms that limit mobility, vision, endurance, or cognition. Although communication disorders affect people of all ages, the prevalence and complexity of these conditions increase with age, and may be characterized by a stable, recovering or degenerative course. Disabilities associated with communication disorders may best be viewed as a dynamic process that varies over time instead of as a single static event that remains constant. Two broad trajectories of disability and aging have been described2 and can be applied to those with communication disorders. The disability with aging group includes people who live most of their lives without disability and either experience the subtle communication problems associated with age or the onset of conditions such as stroke that occur most commonly in old age. The aging with disability group includes people who either have lifelong or early onset communication disorders as a result of cerebral palsy or multiple sclerosis (MS) and age in the context of the already-existing disability. Regardless of the trajectory, the burden of communication disorder is cumulative; it grows with age and has important implications for health care providers. This article describes various communication disabilities associated with aging and how these disabilities affect important functions such as access to health care and maintenance of social roles. Suggestions that preserve and enhance communication function in older adults are also provided in this article.

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Objectives-Evaluate Internet training to help Nurse Aides decrease resident aggression.Design-Randomized treatment and control design; pre-post assessment.Setting-The study was conducted entirely on the Internet. Participants-Nurse Aides; N=62Intervention-Internet based interactive training using video modeling and mastery learning instructional design.Measurements-Video situations testing and assessment of psycho-social constructs associated with behavior change; follow-up interviews with a sample of treatment participants.Results-MANCOVA analysis showed positive results (p=.001) for knowledge, attitudes, self efficacy, and behavioral intention, with large effect sizes; it was well received by the users.Conclusions-Interactive training is an effective approach to shaping appropriate staff reactions to aggressive resident behaviors. The training can effectively be delivered on the Internet. In this research, it was both valued and well received by study participants.Keywords resident aggression; training; Internet; Nurse Aides; long term care; interactive Violence and assaults by residents against staff or other residents in the long-term care system are a major public health concern 1-5 . Direct care workers in long-term care facilities (LTCs) are the workers at highest risk to suffer from workplace violence 6 (e.g., grabs, chokes, hair pulls, kicks, hits, bites, etc,) and injury due to interactions with residents. Aggressive behavior in the form of threats, harassment, and assaults by residents often occurs daily in LTCs and is widely accepted as part of the job by Nurse Aides (NAs) 4,7-10 . Aggressive resident behaviors can take a physical and emotional toll on both NAs and residents 8,11 , impacting the quality of care provided 4 , and potentially making workers more prone to aggressive responses towards residents 12,13 . The frequency of assaults has been poorly documented, but in a recent study, 138 NAs reported an average of 4.69 assaults during 80 hours of work with a range of 0-67 assaults 14 . Morgan, Stewart, D'Arcy, Forbes, and Lawson 15 reported that 73.4% of NAs in Conflict of interest: None of the authors has a conflict of interest related to this research.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. An interactive multimedia (IMM) training approach that links video presentations with the interactive capabilities of computers has the potential to solve many of these problems 42,43 . IMM programs potentially can blend video modeling vignettes and testimonials, graphics and text, and test questions into a criterion-referenced mastery learning ins...

The use of memory wallets to self-prompt factual information during prompted conversations with familiar partners was evaluated for 9 subjects with dementia. Memory wallets contained 30 pictures and sentences about familiar persons, places, and events that each participant had difficulty remembering. The amount of training by caregivers was the one component of the intervention package that varied among the nine attempts to replicate condition effects observed on introduction of the wallets. All subjects learned to use the memory wallets to improve their conversations by making more accurate factual statements. Even when caregiver training was not provided to 3 subjects, condition effects were still demonstrated, with only 1 subject requiring a brief orientation to his wallet. Long-term maintenance of condition effects was demonstrated for 3 subjects up to 30 months'postintervention. These results support the clinical utility of a memory wallet intervention package for persons with dementia and provide preliminary evidence that often little more than preparing memory wallets and providing a brief orientation are required to facilitate their use in improving conversations with familiar conversational partners.