Predictors of parent-child interaction style in dyads with autism

Parent synchrony has been shown to be developmentally important for the growth of communication skills in young children with autism. Understanding individual-differences in parent synchrony and other associated features of dyadic interaction therefore presents as an important step toward the goal of appreciating how and why some parent-child dyads come to adopt more optimal interaction styles, while for others, parent interaction is more asynchronous and less developmentally facilitative. Within the large, well-characterized Preschool Autism Communication Trial (PACT) cohort, baseline parent-child interaction samples were coded for three key aspects of dyadic interaction style; - Parent Synchrony, Child Initiation, and Shared Attention. We explored associations among these measures, demographic characteristics and standardized child assessment scores. While various child factors were associated with each of the interaction measures, very few associations were observed with parent/familial factors. Child language age-equivalence was a significant positive predictor of variation in each interaction measure, while child repetitive symptoms predicted reduced Shared Attention. The three interaction measures were moderately positively inter-related. In the context of childhood autism, variation in dyadic interaction style appears to be driven more by child language and repetitive behaviors than age, social-communication symptoms and non-verbal ability. Parent/family factors contributed little to explaining variability in parent-child interaction, in the current study.

The development of face orienting mechanisms in infants at-risk for autism

A popular idea related to early brain development in autism is that a lack of attention to, or interest in, social stimuli early in life interferes with the emergence of social brain networks mediating the typical development of socio-communicative skills. Compelling as it is, this developmental account has proved difficult to verify empirically because autism is typically diagnosed in toddlerhood, after this process of brain specialization is well underway. Using a prospective study, we directly tested the integrity of social orienting mechanisms in infants at-risk for autism by virtue of having an older diagnosed sibling. Contrary to previous accounts, infants who later develop autism exhibit a clear orienting response to faces that are embedded within an array of distractors. Nevertheless, infants at-risk for autism as a group, and irrespective of their subsequent outcomes, had a greater tendency to select and sustain attention to faces. This pattern suggests that interactions among multiple social and attentional brain systems over the first two years give rise to variable pathways in infants at-risk.

Intellectual development in autism spectrum disorders: new insights from longitudinal studies

The presence/absence of Intellectual Disability (ID) is considered to be the most critical factor affecting outcomes in individuals with Autism Spectrum Disorders (ASD). However, the question of the specific nature of ID in ASD has received little attention, with the current view being that ID is a comorbid condition (i.e., one that is unrelated in etiology and causality from the ASD itself). Recent advances in developmental neuroscience, highlighting the importance of early exposure to social experiences for cognitive development, support an alternative view; that ID in ASD might emerge as a consequence of severe social-communication deficits on the experience-dependent mechanisms underlying neurocognitive development. We tested this prediction in two independent samples of young children with ASD (Ns = 23 and 60), finding that children with greater ASD severity at an initial assessment were more likely to present with poorer cognitive outcomes at a later assessment, irrespective of initial cognitive level. The results of this proof of principle study suggest that ASD symptom severity contributes to the extent to which the environmental input required to support “typical” brain development can be processed by the individual, so that the risk of developing ID increases as the number and severity of ASD social-communicative impairments increase.

Sub-threshold autism traits: the role of trait emotional intelligence and cognitive flexibility

Theory and research suggests that features of autism are not restricted to individuals diagnosed with autism spectrum disorders (ASDs), and that autism-like traits vary throughout the general population at lower severities. The present research first investigated the relationship of autism traits with trait emotional intelligence and empathy in a sample of 163 adults aged between 18 and 51 years (44% male). It then examined performance on a set of tasks assessing social cognition and cognitive flexibility in 69 participants with either high or low scores on ASD traits. Results confirm that there is pronounced variation within the general population relating to ASD traits, which reflect similar (though less severe) social-cognitive and emotional features to those observed in ASDs.

The importance of the eyes: communication skills in infants of blind parents

The effects of selectively different experience of eye contact and gaze behaviour on the early development of five sighted infants of blind parents were investigated. Infants were assessed longitudinally at 6–10, 12–15 and 24–47 months. Face scanning and gaze following were assessed using eye tracking. In addition, established measures of autistic-like behaviours and standardized tests of cognitive, motor and linguistic development, as well as observations of naturalistic parent–child interaction were collected. These data were compared with those obtained from a larger group of sighted infants of sighted parents. Infants with blind parents did not show an overall decrease in eye contact or gaze following when they observed sighted adults on video or in live interactions, nor did they show any autistic-like behaviours. However, they directed their own eye gaze somewhat less frequently towards their blind mothers and also showed improved performance in visual memory and attention at younger ages. Being reared with significantly reduced experience of eye contact and gaze behaviour does not preclude sighted infants from developing typical gaze processing and other social-communication skills. Indeed, the need to switch between different types of communication strategy may actually enhance other skills during development.

Failure to learn from feedback underlies word learning difficulties in toddlers at risk for autism

Children's assignment of novel words to nameless objects, over objects whose names they know (mutual exclusivity; ME) has been described as a driving force for vocabulary acquisition. Despite their ability to use ME to fast-map words (Preissler & Carey, 2005), children with autism show impaired language acquisition. We aimed to address this puzzle by building on studies showing that correct referent selection using ME does not lead to word learning unless ostensive feedback is provided on the child's object choice (Horst & Samuelson, 2008). We found that although toddlers aged 2;0 at risk for autism can use ME to choose the correct referent of a word, they do not benefit from feedback for long-term retention of the word-object mapping. Further, their difficulty using feedback is associated with their smaller receptive vocabularies. We propose that difficulties learning from social feedback, not lexical principles, limits vocabulary building during development in children at risk for autism.

Infant neural sensitivity to dynamic eye gaze is associated with later emerging autism

Autism spectrum disorders (henceforth autism) are diagnosed in around 1% of the population [1]. Familial liability confers risk for a broad spectrum of difficulties including the broader autism phenotype (BAP) [2, 3]. There are currently no reliable predictors of autism in infancy, but characteristic behaviors emerge during the second year, enabling diagnosis after this age [4, 5]. Because indicators of brain functioning may be sensitive predictors, and atypical eye contact is characteristic of the syndrome [6–9] and the BAP [10, 11], we examined whether neural sensitivity to eye gaze during infancy is associated with later autism outcomes [12, 13]. We undertook a prospective longitudinal study of infants with and without familial risk for autism. At 6–10 months, we recorded infants' event-related potentials (ERPs) in response to viewing faces with eye gaze directed toward versus away from the infant [14]. Longitudinal analyses showed that characteristics of ERP components evoked in response to dynamic eye gaze shifts during infancy were associated with autism diagnosed at 36 months. ERP responses to eye gaze may help characterize developmental processes that lead to later emerging autism. Findings also elucidate the mechanisms driving the development of the social brain in infancy.

A comparison of the trait emotional intelligence profiles of individuals with and without Asperger syndrome

The extent to which the socioemotional impairments of Asperger syndrome (AS) might be extreme manifestations of individual differences within the general population remains under-explored. We compared the trait emotional intelligence (trait EI) profiles of 30 individuals with AS against the profiles of 43 group-matched controls using the Trait Emotional Intelligence Questionnaire (TEIQue). Participants with AS scored significantly lower than controls on 12 of the 15 TEIQue facets (ηp2 = 0.09 to 0.49) as well as on all four factors and the global score of the construct (ηp2 = 0.07 to 0.41). There was a significant main effect of gender, with men generally scoring higher than women. Results are discussed from the perspective of trait EI theory, with emphasis on its implications for the socioemotional impairments associated with AS.

Social and attention factors during infancy and the later emergence of autism characteristics

Characteristic features of autism include atypical social perception and social-communication skills, and atypical visual attention, alongside rigid and repetitive thinking and behavior. Debate has focused on whether the later emergence of atypical social skills is a consequence of attention problems early in life, or, conversely, whether early social deficits have knock-on consequences for the later development of attention skills. We investigated this question based on evidence from infants at familial risk for a later diagnosis of autism by virtue of being younger siblings of children with a diagnosis. Around 9months, at-risk siblings differed as a group from controls, both in measures of social perception and inhibitory control. We present preliminary data from an ongoing longitudinal research program, suggesting clear associations between some of these infant measures and autism-related characteristics at 3years. We discuss the findings in terms of the emergent nature of autism as a result of complex developmental interactions among brain networks.

Preschoolers with autism show greater impairment in receptive compared with expressive language abilities

BACKGROUND

In early typical language development, children understand words before they are able to use them in speech. Children with autism spectrum disorders (ASD) generally show impairments in both the comprehension and the production of language. However, the relative degree of delay or impairment in each of these sub-domains may also be atypical and remains less well-understood.

AIMS

Relative delay in receptive and expressive language skills was examined within a large sample of preschoolers with autism. Children's language abilities varied from pre-verbal to fluent speech.

METHOD & PROCEDURES

Scores on one direct clinician assessment and two parent-report measures of language were obtained for 152 preschoolers with core autism.

OUTCOMES & RESULTS

As expected, on average, the language ability of the children with autism was lower than typical age norms, albeit with substantial individual variability. On all three language measures, receptive ability was relatively more impaired than expressive ability. Higher non-verbal ability was associated with such an atypical language profile.

CONCLUSIONS & IMPLICATIONS

Recognition of the marked receptive language impairment relative to expressive language, found to affect at least one-third of preschoolers with autism in this sample, has important implications for interacting with these children and for informing appropriate targets in language and communication intervention.

Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial

BACKGROUND

Results of small trials suggest that early interventions for social communication are effective for the treatment of autism in children. We therefore investigated the efficacy of such an intervention in a larger trial.

METHODS

Children with core autism (aged 2 years to 4 years and 11 months) were randomly assigned in a one-to-one ratio to a parent-mediated communication-focused (Preschool Autism Communication Trial [PACT]) intervention or treatment as usual at three specialist centres in the UK. Those assigned to PACT were also given treatment as usual. Randomisation was by use of minimisation of probability in the marginal distribution of treatment centre, age (42 months), and autism severity (Autism Diagnostic Observation Schedule-Generic [ADOS-G] algorithm score 12-17 or 18-24). Primary outcome was severity of autism symptoms (a total score of social communication algorithm items from ADOS-G, higher score indicating greater severity) at 13 months. Complementary secondary outcomes were measures of parent-child interaction, child language, and adaptive functioning in school. Analysis was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN58133827.

RESULTS

152 children were recruited. 77 were assigned to PACT (London [n=26], Manchester [n=26], and Newcastle [n=25]); and 75 to treatment as usual (London [n=26], Manchester [n=26], and Newcastle [n=23]). At the 13-month endpoint, the severity of symptoms was reduced by 3.9 points (SD 4.7) on the ADOS-G algorithm in the group assigned to PACT, and 2.9 (3.9) in the group assigned to treatment as usual, representing a between-group effect size of -0.24 (95% CI -0.59 to 0.11), after adjustment for centre, sex, socioeconomic status, age, and verbal and non-verbal abilities. Treatment effect was positive for parental synchronous response to child (1.22, 0.85 to 1.59), child initiations with parent (0.41, 0.08 to 0.74), and for parent-child shared attention (0.33, -0.02 to 0.68). Effects on directly assessed language and adaptive functioning in school were small.

INTERPRETATION

On the basis of our findings, we cannot recommend the addition of the PACT intervention to treatment as usual for the reduction of autism symptoms; however, a clear benefit was noted for parent-child dyadic social communication.

FUNDING

UK Medical Research Council, and UK Department for Children, Schools and Families.