Frontally mediated functions in Down syndrome and autism with intellectual disability

Intellectual disability (ID) is a condition with a myriad of aetiologies. Given the aetiological heterogeneity, it is logical that researchers are beginning to find syndrome specific cognitive strengths and weaknesses within the ID population. Knowledge regarding such strengths and weaknesses has important implications for education strategies and interventions. In the context of education research, the three frontally mediated functions of sustained attention, response inhibition and working memory can be grouped under the umbrella term cognitive control. There has been very little research examining sustained attention and response inhibition in Down syndrome and autism and ID, and also negligible research into working memory in autism and co-morbid ID. The only pocket of research in this field seems to be in the area of working memory in DS. A thorough literature search identified a clear lack of investigation of cognitive function for those with autism and ID, and also studies that systematically vary the modality of stimulus presentation. With both DS and autism and ID, most research has compared performances on task involving predominately visual or auditory processing, with few using multiple versions of the same task that differ only in the modality of presentation. Accordingly, the main aims of this study were, to firstly investigate the three aspects of cognitive control in adolescents with DS, autism and ID and a comparison group with non-specific intellectual disability (NSID). Secondly, performances were compared using identical versions of tasks that had either a visual or auditory mode of presentation. The final aim of this research was to consider the results in the context of classroom performance, and provide recommendations for the education sector. Participants were recruited from schools and support organisations throughout metropolitan and regional areas of Victoria, Australia. Participants were administered a two-hour test battery of clinical and experimental neuropsychological tasks at either their school or at Monash University. Data from 15 males with DS, 12 males with autism and co-morbid and 12 males with non specific intellectual disability (NSID) were utilised for this research. With regard to sustained attention, the groups were compared on omission errors from visual and auditory versions of the child friendly version of the sustained attention to response task (SART). The group with DS had more difficulty sustaining their attention than both the groups with autism and ID and NSID. The males with autism and ID performed similarly to those with NSID on sustained attention tasks. Modality differences were not observed in any of the groups. For response inhibition, the groups were compared on commission errors from the SART. While no group differences were evident overall, a double dissociation arose between the group with DS and the group with autism and ID. The group with DS were stronger in the visual condition than the group with autism and ID, while the reverse was evident in the auditory condition. For working memory, a novel task was developed for the purposes of this research, which also had visual and auditory versions. On this task, the group with DS performed similarly to the group with autism and ID, with both groups demonstrating poorer performances than the group with NSID. Results from this research suggest that individuals with DS may benefit from more support than their peers in maintaining attention, with targeted strategies capitalising on visual strengths in the classroom. The results with regard to response inhibition also support this approach, and also suggest the converse for those with autism, i.e. presenting material verbally, provided it is kept concise. Both the group with DS and the group with autism and ID had weaknesses in working memory when compared to NSID, with broad recommendations involving reducing the amount of information to be processed at any one point in time as well as providing visual or verbal (as appropriate) prompts and cues to reduce the need to hold information in working memory. This study highlights the need for an individual approach to supporting those with an ID, both within the classroom and beyond. It provides suggestions for future education and intervention strategies that are well informed by the growing body of evidence supporting unique patterns of cognitive strengths and weaknesses within both DS and autism and ID