{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:39:07Z","timestamp":1787243947410,"version":"build-2736575974"},"reference-count":113,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T00:00:00Z","timestamp":1774137600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Jack H. Rubinstein Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behavioral Sciences"],"abstract":"<jats:p>Challenging behaviors, including noncompliance, aggression, hyperactivity, and impulsivity, are common among individuals with Fragile X Syndrome (FXS) and Down Syndrome (DS). To identify treatment needs specific to these populations, we conducted focus groups with caregivers and educators and used their input to adapt an evidence-based caregiver training program originally designed for caregivers of autistic children (i.e., The Research Units in Behavioral Intervention; RUBI). We then completed a feasibility trial in which five families of children with FXS and four families of children with DS completed a nine-session caregiver training program targeting behavioral principles, syndrome-specific information, and visual supports tailored to the unique needs of FXS or DS (adapted version of RUBI for non-autism developmental disabilities; RUBI-DD). The program demonstrated strong acceptability, with high caregiver satisfaction, 100% retention, and 100% session attendance. Across the combined sample, caregiver reports indicated significant improvements in irritability\/aggression (F(2,15.14) = 4.42, p = 0.03), lethargy\/social withdrawal (F(2,14.47) = 3.97, p = 0.04), stereotypies (F(2,15.29) = 4.45, p = 0.03), hyperactivity (F(2,15.14) = 6.51, p = 0.009), social inflexibility (F(2,15.43) = 6.33, p = 0.01), demand-based noncompliance (F(2,15.41) = 4.95, p = 0.02), and the impact of behavior on the family (F(2,15.07) = 4.23, p = 0.04) following participation in RUBI-DD. Caregivers of children with FXS reported significant reductions in lethargy\/social withdrawal (F(2,8.000) = 6.256, p = 0.023) and hyperactivity (F(2,8.000) = 12.497, p = 0.003) immediately post-treatment and upon 12-week follow-up (g = 1.153, p = 0.044, and g = 1.178, p = 0.003, respectively). Among families of children with DS, caregivers reported reductions in irritability and aggression (F(2,5.047) = 14.073, p = 0.009) and improvements in the impact on the family (F(2,6.000) = 5.489, p = 0.044) immediately post-treatment and at follow-up (g = 1.643, p = 0.016, and g = 0.448, p = 0.045, respectively). These findings support the feasibility, acceptability, and preliminary efficacy of RUBI-DD for children with FXS or DS.<\/jats:p>","DOI":"10.3390\/bs16030472","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T13:07:06Z","timestamp":1774271226000},"page":"472","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Adapting a Behavioral Intervention for Caregivers of Children with Down Syndrome or Fragile X Syndrome: A Pilot Study of RUBI-DD"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1032-9494","authenticated-orcid":false,"given":"Allison D.","family":"Blackburn","sequence":"first","affiliation":[{"name":"Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH 45229, USA"},{"name":"Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45219, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walker","family":"McKinney","sequence":"additional","affiliation":[{"name":"Division of Developmental and Behavioral Health, Children\u2019s Mercy Hospital, Kansas City, MO 64108, USA"},{"name":"Department of Pediatrics, University of Missouri\u2014Kansas City, Kansas City, MO 64108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison M.","family":"Birnschein","sequence":"additional","affiliation":[{"name":"Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH 45229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2649-7791","authenticated-orcid":false,"given":"Anna J.","family":"Esbensen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45219, USA"},{"name":"Division of Developmental and Behavioral Pediatrics, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH 45229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelley","family":"McKinley","sequence":"additional","affiliation":[{"name":"Division of Child and Adolescent Psychiatry, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH 45229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3620-5098","authenticated-orcid":false,"given":"Hilary","family":"Rosselot","sequence":"additional","affiliation":[{"name":"National Fragile X Foundation, Washington, DC 20005, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9344-2110","authenticated-orcid":false,"given":"Emily K.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Division of Developmental and Behavioral Pediatrics, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH 45229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Erickson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45219, USA"},{"name":"Division of Child and Adolescent Psychiatry, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH 45229, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Shaffer","sequence":"additional","affiliation":[{"name":"Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH 45229, USA"},{"name":"Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45219, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1352\/0895-8017(2004)109<237:PWACIM>2.0.CO;2","article-title":"Psychological well-being and coping in mothers of youths with autism, Down Syndrome, or Fragile X Syndrome","volume":"109","author":"Abbeduto","year":"2004","journal-title":"American Journal on Mental Retardation"},{"key":"ref_2","unstructured":"Abidin, R. 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