Abstract
Prader-Willi syndrome (PWS) is a rare genetic disorder typically characterized by hyperphagia, hypotonia, intellectual disabilities, insistence on routines, and obsession and compulsion related to food. Although current medical interventions primarily include growth hormones to address the biological symptoms of the individual, behavioral therapy is an alternative option for skill acquisition and decreasing problem behaviors. There is a growing need for applied behavior analysis (ABA) research on targeting problem behaviors and teaching requisite skills to individuals with this syndrome. This article reviews the current literature on PWS, highlights treatments and their limitations, suggests how ABA providers can provide ethical services, and proposes future research needs with this syndrome.
Similar content being viewed by others
References
Behavior Analyst Certification Board. (2014). Professional and ethical compliance code for behavior analysts.
Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. Littleton, CO: Author.
Bellicha, A., Coupaye, M., Léonore, H., Speter, F., Oppert, J.-M., & Poitou, C. (2019). Increasing physical activity in adult women with Prader-Willi syndrome: a transferability study. Journal of Applied Research in Intellectual Disabilities, 33(2), 258–267. https://doi.org/10.1111/jar.12669.
Bennett, J. A., Germani, T., Haqq, A. M., & Zwaigenbaum, L. (2015). Autism spectrum disorder in Prader-Willi syndrome: a systematic review. American Journal of Medical Genetics, Part A, 167a(12), 2936–2944. https://doi.org/10.1002/ajmg.a.37286.
Brodhead, M. T. (2015). Maintaining professional relationships in an interdisciplinary setting: Strategies for navigating nonbehavioral treatment recommendations for individuals with autism. Behavior Analysis in Practice, 8(1), 70–78.
Cassidy, S. B., & Driscoll, D. J. (2009). Prader-Willi syndrome. European Journal of Human Genetics, 17(1), 3–13. https://doi.org/10.1038/ejhg.2008.165.
Chen, C., Visootsak, J., Dills, S., & Graham, J. (2007). Prader-Willi syndrome: an update and review for the primary pediatrician. Clinical Pediatrics, 46(7), 580–591.
Crinò, A., Fintini, D., Bocchini, S., Carducci, C., & Grugni, G. (2016). Prader-Willi syndrome: Clinical problems in transition from pediatric to adult care. Research & Reports in Endocrine Disorders, 6, 49–57. https://doi.org/10.2147/RRED.S56401.
Dimitropoulos, A., Feurer, I. D., Roof, E., Stone, W., Butler, M. G., Sutcliffe, J., & Thompson, T. (2000). Appetitive behavior, compulsivity, and neurochemistry in Prader-Willi syndrome. Mental Retardation 7 Developmental Disabilities Research Reviews, 6(2), 125–130. https://doi.org/10.1002/1098-2779(2000)6:2.
Dudley, O., McManus, B., Vogels, A., Whittington, J., & Muscatelli, F. (2008). Cross-cultural comparisons of obesity and growth in Prader-Willi syndrome. Journal of Intellectual Disability Research, 52(5), 426–436. https://doi.org/10.1111/j.1365-2788.2008.01044.x.
Dykens, E. M., Maxwell, M. A., Pantino, E., Kossler, R., & Roof, E. (2007). Assessment of hyperphagia in Prader-Willi syndrome. Obesity, 15(7), 1816–1826. https://doi.org/10.1038/oby.2007.216.
Dykens, E. M., Roof, E., & Hunt-Hawkins, H. (2017). Cognitive and adaptive advantages of growth hormone treatment in children with Prader-Willi syndrome. Journal of Child Psychology & Psychiatry, 58(1), 64–74. https://doi.org/10.1111/jcpp.12601.
Dykens, E. M., Roof, E., Hunt-Hawkins, H., Daniell, C., & Jurgensmeyer, S. (2019). Profiles and trajectories of impaired social cognition in people with Prader-Willi syndrome. PLoS One, 14(10), 1–19. https://doi.org/10.1371/journal.pone.0223162.
Gondoni, L. A., Vismara, L., Marzullo, P., Vettor, R., Liuzzi, A., & Grugni, G. (2008). Growth hormone therapy improves exercise capacity in adult patients with Prader-Willi syndrome. Journal of Endocrinological Investigation, 31(9), 765–772. https://doi.org/10.1007/BF03349255.
Greaves, N., Prince, E., Evans, D. W., & Charman, T. (2006). Repetitive and ritualistic behaviour in children with Prader-Willi syndrome and children with autism. Journal of Intellectual Disability Research, 50(2), 92–100. https://doi.org/10.1111/j.1365-2788.2005.00726.x.
Griffiths, D., Condillac, R. A., & Legree, M. (2014). Genetic syndromes and applied behaviour analysis: A handbook for ABA practitioners (pp. 225–256). Jessica Kinsley.
Gross-Tsur, V., Eldar-Geva, T., Benarroch, F., Rubinstein, O., & Hirsch, H. J. (2011). Body image and sexual interests in adolescents and young adults with Prader-Willi syndrome. Journal of Pediatric Endocrinology & Metabolism, 24(7–8), 469–475.
Haig, E. L., & Woodcock, K. A. (2017). Rigidity in routines and the development of resistance to change in individuals with Prader-Willi syndrome. Journal of Intellectual Disability Research, 61(5), 488–500. https://doi.org/10.1111/jir.12368.
Hall, S. S., Hustyi, K. M., Chui, C., & Hammond, J. L. (2014). Experimental functional analysis of severe skin-picking behavior in Prader-Willi syndrome. Research in Developmental Disabilities, 35(10), 2284–2292. https://doi.org/10.1016/j.ridd.2014.05.025.
Ho, A. Y., & Dimitropoulos, A. (2010). Clinical management of behavioral characteristics of Prader-Willi syndrome. Neuropsychiatric Disease & Treatment, 6, 107–118.
Hoffman, C. J., Aultman, D., & Pipes, P. (1992). A nutrition survey of and recommendations for individuals with Prader-Willi syndrome who live in group homes. Journal of the American Dietetic Association, 92(7), 823–833.
Holland, A. J., Treasure, J., Coskeran, P., & Dallow, J. (1995). Characteristics of the eating disorder in Prader-Willi syndrome: Implications for treatment. Journal of Intellectual Disability Research, 39(5), 373–381. https://doi.org/10.1111/j.1365-2788.1995.tb00541.x.
Holsen, L. M., Zarcone, J. R., Brooks, W. M., Butler, M. G., Thompson, T. I., Ahluwalia, J. S., Nollen, N. L., & Savage, C. R. (2006). Neural mechanisms underlying hyperphagia in Prader-Willi syndrome. Obesity, 14(6), 1028–1037. https://doi.org/10.1038/oby.2006.118.
Irizarry, K. A., Miller, M., Freemark, M., & Haqq, A. M. (2016). Prader-Willi syndrome: Genetics, metabolomics, hormonal function, and new approaches to therapy. Advances in Pediatrics, 63(1), 47–77. https://doi.org/10.1016/j.yapd.2016.04.005.
Khan, M. J., Gerasimidis, K., Edwards, C. A., & Shaikh, M. G. (2016). Mechanisms of obesity in Prader-Willi syndrome. Pediatric Obesity, 13(1), 3–13. https://doi.org/10.1111/ijpo.12177.
Kundert, D. K. (2008). Prader-Willi syndrome. School Psychology Quarterly, 23(2), 246–257.
Lambert, J. M., Parikh, N., Stankiewicz, K. C., Houchins-Juarez, N. J., Morales, V. A., Sweeney, E. M., & Milam, M. E. (2019). Decreasing food stealing of child with Prader-Willi syndrome through function-based differential reinforcement. Journal of Autism & Developmental Disorders, 49(2), 721–728. https://doi.org/10.1007/s10803-018-3747-y.
Lang, R., Didden, R., Machalicek, W., Rispoli, M., Sigafoos, J., Lancioni, G., Mulloy, A., Register, A., Pierce, N., & Kang, S. (2010). Behavioral treatment of chronic skin-picking in individuals with developmental disabilities: A systematic review. Research in Developmental Disabilities, 31(2), 304–315. https://doi.org/10.1016/j.ridd.2009.10.017.
Lowe-Greenlee, B. (2019). Prader-Willi syndrome: Parent perceptions of school, professional, social, and informational support, and relations between support, child behavior, and stress [Unpublished doctoral dissertation]. University of North Carolina.
Maglieri, K. A., DeLeon, I. G., Rodriguez-Catter, V., & Sevin, B. M. (2000). Treatment of covert food stealing in an individual with Prader-Willi syndrome. Journal of Applied Behavior Analysis, 33(4), 615–618.
McAllister, C. J., & Whittington, J. E. (2011). A short clinical overview of Prader-Willi syndrome. Clinical Obesity, 1(4–6), 184–188. https://doi.org/10.1111/j.1758-8111.2011.00022.x.
Page, T. J., Finney, J. W., Parrish, J. M., & Iwata, B. A. (1983). Assessment and reduction of food stealing in Prader-Willi children. Applied Research in Mental Retardation, 4(3), 216–228.
Pokorski, E. A., & Barton, E. E. (2020). A systematic review of the ethics of punishment-based procedures for young children with disabilities. Remedial & Special Education. https://doi.org/10.1177/0741932520918859.
Prader-Willi Syndrome Association. (2020). Prader-Willi syndrome: Transforming and saving lives. https://www.pwsausa.org/
Rigamonti, A. E., Bini, S., Grugni, G., Agosti, F., DeColt, A., Mallone, M., Cella, S. G., & Sartorio, A. (2014). Unexpectedly increased anorexigenic postprandial responses of pyy and glp-1 to fast ice cream consumption in adult patients with Prader-Willi syndrome. Clinical Endocrinology, 81(4), 542–550. https://doi.org/10.1111/cen.12395.
Spendelow, J. S. (2011). Assessment of behavioral and psychiatric problems in people with Prader-Willi syndrome: A review of the literature. Journal of Policy & Practice in Intellectual Disabilities, 8(2), 104–112. https://doi.org/10.1111/j.1741-1130.2011.00296.x.
Veltman, M. W. M., Thompson, R. J., Roberts, S. E., Thomas, N. S., Whittington, J., & Bolton, P. F. (2004). Prader-Willi syndrome: A study comparing deletion and uniparental disomy cases with reference to autism spectrum disorders. European Child & Adolescent Psychiatry, 13, 42–50.
Whittington, J., & Holland, A. (2010). Neurobehavioral phenotype in Prader-Willi syndrome. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 154c(4), 438–447. https://doi.org/10.1002/ajmg.c.30283.
Zyga, O., Russ, S. W., & Dimitropoulos, A. (2018). The PRETEND program: Evaluating the feasibility of a remote parent-training intervention with children with Prader-Willi syndrome. American Journal of Intellectual & Developmental Disabilities, 123(6), 574–584.
Availability of Data and Material
All data and literature was freely available via EBSCO host and Google Scholar.
Funding
This project was independent of any funding streams.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare no conflict of interest.
Code Availability
Not applicable.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kennedy, D., Marten, H., O’Sullivan, C. et al. Biological, Behavioral, and Ethical Considerations of Prader-Willi Syndrome: A Primer for Behavior Analysts. Behav Analysis Practice 15, 562–570 (2022). https://doi.org/10.1007/s40617-021-00618-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40617-021-00618-z