[Comprehensive models of treatment in individuals with autism spectrum disorders]

INTRODUCTION. The steady increase in the number of children with autism spectrum disorders, has led to a better social awareness but also to a higher demand for specific interventions. This has questioned what the most appropriate and effective procedures for detection, diagnosis and treatment are. AIM. To review different approaches and classifications of interventions with individuals with autism spectrum disorders based on scientific evidence. DEVELOPMENT. According to the latest revisions, there are three types of classifications to categorize evidence-based interventions: practice-based intervention, comprehensive models of treatment and drug treatments. There are difficulties in comparing results of different methods of intervention, however, some common elements to prove their effectiveness have been identified. CONCLUSIONS. All intervention models should include functional communication skills, meaningful learning, carried out in various contexts, addressing challenging behaviors through positive behavioral support, promoting activities with peers and emphasize the role of parents in the planning and implementation of the objectives.

[Autism spectrum disorders in children and adolescents]

Childhood autism, Asperger's syndrome and atypical autism together make up autism spectrum disorders (ASDs) with a prevalence of 0.6-0.7%. These disorders are defined by qualitative impairments in social interaction, qualitative abnormalities in communication, and by restricted, stereotyped, repetitive patterns of behaviour, interests and activities. Many children or adolescents with ASDs have sensory abnormalities, neurological disorders and additional disabilities of vision, hearing or ambulation. Psychiatric co-morbidity is common. Diagnostics and rehabilitation are implemented in multi-professional collaboration. Early recognition makes up the basis for early intervention that improves the prognosis. Screening of these disorders in well-baby clinics is being developed.

Early intervention in 208 Swedish preschoolers with autism spectrum disorder. A prospective naturalistic study

Early intervention has been reported to improve outcome in children with autism spectrum disorders (ASDs). Several studies in the field have been randomized controlled trials (RCTs). The aim of this study was to assess ASD outcome in a large naturalistic study. Two hundred and eight children, aged 20-54 months, with a clinical diagnosis of ASD were given intervention and monitored prospectively in a naturalistic fashion over a period of 2 years. The toddlers were considered representative of all but the most severely multiple disabled preschool children with ASD in Stockholm county. They fell into three cognitive subgroups: one with learning disability, one with developmental delay, and one with normal intellectual functioning. Data on intervention type and intensity were gathered prospectively in a systematic fashion. Intervention was classified into intensive applied behaviour analysis (ABA) and non-intensive, targeted interventions, also based on ABA principles. Children were comprehensively assessed by a research team before the onset of intervention, and then, again, 2 years later. Change in Vineland adaptive behaviour scales composite scores from intake (T1) to leaving the study (T2) was set as the primary outcome variable. The research team remained blind to the type and intensity of interventions provided. One hundred and ninety-eight (95%) of the original samples stayed in the study throughout the whole 2-year period and 192 children had a complete Vineland composite score results both at T1 and T2. Vineland composite scores increased over the 2-year period. This increase was accounted for by the subgroup with normal cognitive functioning. There was no significant difference between the intensive and non-intensive groups. Individual variation was considerable, but no child in the study was "problem-free" at follow-up. Our data do not support that children with ASD generally benefit more from the most intensive ABA intervention programs than from less intensive interventions or targeted interventions based on ABA.

Comparing residential programmes for adults with autism spectrum disorders and intellectual disability: outcomes of challenging behaviour and quality of life

BACKGROUND

Owing to methodological issues, little research has been conducted to examine quality of life (QoL) as a treatment outcome in autism spectrum disorders (ASD) and intellectual disabilities (ID). This study was conducted to combine QoL measures and objective observations of challenging behaviours (CB) in order to evaluate changes over time in adults with ASD and ID who were treated in two different residential programmes; we hypothesised that a decrease in CB would be related to an improved QoL.

METHOD

In a longitudinal study (45 months), we followed 31 adults with ASD and ID who had been integrated into two residential programmes [Autism Programme with a Structured Method (PAMS) vs. traditional programme for ID (No-PAMS)] for 2-19 years. QoL [Quality of Life Inventory in a Residential Environment (IQVMR)] and severity of autistic features (Childhood Autism Rating Scales) were evaluated annually. CB, as measured by the Aberrant Behaviour Checklist (ABC), including stereotypic behaviour and inappropriate speech, were repeatedly assessed every 3 months.

RESULTS

Observed separately, the groups' results were different. In the PAMS programme, stereotypic behaviour and inappropriate speech (ABC scores) significantly decreased, and the IQVMR total score increased; in contrast, in the comparison group, ABC scores did not change and the IQVMR total score decreased. In all, three mixed-effect ANCOVAs partially confirmed that the PAMS programme had an effect on CB and that QoL improvement did not directly depend on the type of programme but on reducing CB as measured by the ABC.

CONCLUSION

The PAMS programme has a positive and indirect influence on QoL by reducing CB.

Are gross motor skills and sports participation related in children with intellectual disabilities?

This study compared the specific gross motor skills of 156 children with intellectual disabilities (ID) (50 ≤ IQ ≥ 79) with that of 255 typically developing children, aged 7-12 years. Additionally, the relationship between the specific gross motor skills and organized sports participation was examined in both groups. The Test of Gross Motor Development-2 and a self-report measure were used to assess children's gross motor skills and sports participation, respectively. The children with ID scored significantly lower on almost all specific motor skill items than the typically developing children. Children with mild ID scored lower on the locomotor skills than children with borderline ID. Furthermore, we found in all groups that children with higher object-control scores participated more in organized sports than children with lower object-control scores. Our results support the importance of attention for well-developed gross motor skills in children with borderline and mild ID, especially to object-control skills, which might contribute positively to their sports participation.

Effortful control in typically developing boys and in boys with ADHD or autism spectrum disorder

Despite increased interest in the role of effortful control (EC) in developmental disorders, few studies have focused on EC in autism spectrum disorders (ASD) and no study so far has directly compared children with ASD and children with ADHD. A first aim of this study was to investigate whether typically developing (TD) boys, boys with ADHD and boys with ASD can be differentiated based on EC levels. A second aim was to evaluate the relationship between EC and symptoms of ADHD and ASD. We assessed EC in 27 TD boys, 27 boys with ADHD and 27 boys with ASD (age 10-15) using different EC questionnaires. Clinical groups scored lower than the TD group on all EC total scales, but could only be differentiated from each other by means of self-reported persistence, impulsivity and activation control. Our data suggest that although EC is useful in differentiating TD boys from clinical groups, it is less efficient in distinguishing ADHD from ASD. Also, results suggest that EC plays a role in the manifestation of symptoms of both ADHD and ASD and that high levels of EC enable children to function more adequate in daily situations.

"Say Cheese": teaching photography skills to adults with developmental disabilities

We evaluated a video prompting procedure to teach adults with developmental disabilities to take a digital photograph and print it using a laptop computer and a printer. Participants were four men with developmental disabilities. Training was conducted at the participants' residential facility. During baseline, participants were told to take a photograph, but were given no other instruction. During intervention, participants received instruction using a video prompting procedure. Video prompting consisted of watching a clip of each step of the task analysis and then having the opportunity to imitate that step. Video prompting was evaluated using a multiple-probe across participants design. Following acquisition, video prompting was removed to assess maintenance at 2, 4 and 8 weeks and at 6 months. During naturalistic probes, participants had the opportunity to take a picture of their choice of flora, surroundings or persons. All four participants learned to take and print a digital photograph with the video prompting procedures. The skills generalized to novel situations and were maintained at each follow-up probe. These data suggest that video prompting may be an effective instructional strategy for teaching digital photography skills to adults with developmental disabilities.

Measuring pragmatic language in speakers with autism spectrum disorders: Comparing the children's communication checklist--2 and the test of pragmatic language

PURPOSE

To compare the Children's Communication Checklist-2 (CCC-2), a parent report instrument, with the Test of Pragmatic Language (TOPL), a test administered to the child, on the ability to identify pragmatic language impairment in speakers with autism spectrum disorders (ASD) who had age-appropriate structural language skills.

METHOD

Sixteen rigorously diagnosed children with ASD were matched to 16 typically developing children on age, nonverbal IQ, and structural language skill. Both groups were given the TOPL, and their parents completed the CCC-2.

RESULTS

The CCC-2 identified 13 of the 16 children with ASD as pragmatically impaired, while the TOPL identified only 9. Neither test identified any of the children in the control group as having pragmatic language impairment.

CONCLUSIONS

In these children with ASD, who displayed age-appropriate structural language skills, the CCC-2 identified pragmatic language impairment better than the TOPL. Clinically, this can be useful in documenting the presence of language dysfunction when traditional standardized language assessments would not reveal communication problems.

Autism spectrum disorder diagnoses in Stockholm preschoolers

The aims of this study were to estimate prevalence rates of children with autism spectrum disorder (ASD) diagnoses in a cohort of 6-year-old children with birth year 2002, referred to the Autism Centre for Young Children, serving the whole of Stockholm county and on the basis of the available data discuss clinical aspects of assessment, habilitation and follow-up. Records of 142 of a total of 147 (123 boys and 24 girls) identified children with ASD diagnoses were scrutinised with respect to type of diagnosis, cognitive level, other developmental disorders and medical/neurological disorders. The overall prevalence of such disorders was 6.2/1000 (95% confidence interval 5.2-7.2/1000). The rates of learning disability/mental retardation, developmental delay without a specified cognitive level and normal intelligence constituted about one third, respectively. AS and atypical autism tended to be diagnosed more often at age 5-6 years while AD with learning disability/mental retardation was more often diagnosed at age 3-4 years. The awareness of ASDs has resulted in increasing numbers of children being diagnosed at young ages. We conclude that it is important to take into account these children's broader developmental profiles, need for repeated assessment of cognitive functions and follow-up over time and also the requirement for medical/neurological consideration and work-up.

Cognitive modifiability of children with developmental disabilities: a multicentre study using Feuerstein's Instrumental Enrichment--Basic program

The study aimed at exploring the effectiveness of cognitive intervention with the new "Instrumental Enrichment Basic" program (IE-basic), based on Feuerstein's theory of structural cognitive modifiability that contends that a child's cognitive functioning can be significantly modified through mediated learning intervention. The IE-basic progam is aimed at enhancing domain-general cognitive functioning in a number of areas (systematic perception, self-regulation abilities, conceptual vocabulary, planning, decoding emotions and social relations) as well as transferring learnt principles to daily life domains. Participants were children with DCD, CP, intellectual impairment of genetic origin, autistic spectrum disorder, ADHD or other learning disorders, with a mental age of 5-7 years, from Canada, Chile, Belgium, Italy and Israel. Children in the experimental groups (N=104) received 27-90 h of the program during 30-45 weeks; the comparison groups (N=72) received general occupational and sensory-motor therapy. Analysis of the pre- to post-test gain scores demonstrated significant (p<0.05) advantage of experimental over comparison groups in three WISC-R subtests ("Similarities", "Picture Completion", "Picture Arrangement") and Raven Coloured Matrices. Effect sizes ranged from 0.3 to 0.52. Results suggest that it is possible to improve cognitive functioning of children with developmental disability. No advantage was found for children with specific aetiology. Greater cognitive gains were demonstrated by children who received the program in an educational context where all teachers were committed to the principles of mediated learning.

[Care continuity for patients with autism spectrum disorder during transition from childhood to adulthood]

Autism is a common and complex neurodevelopmental disorder. Clinically, autism appears as a spectrum, with a variety of severity in the core impairments in social interactions, communications, and repetitive behaviors, with or without mental retardation. As patients grow up, the difficulty they are confronted in everyday life is constantly changing and challenging. Child psychiatrists and pediatricians are familiar with the common symptoms, behavioral characteristics, and associated disorders of autism spectrum disorder(ASD) and are required to give timely advices to a patient and family members how to cope with problems they have. Because the limited number of specialists in Japan, practicing physicians are required to be participate in supporting ASD patients. In this article, we give general physicians a brief introduction to ASD core symptoms in adolescent and adulthood.

[Neurofeedback and personal development]

BACKGROUND

Development of neurofeedback was preceded by development of classical and quantitative EEG, construction of computer devices, programmes and individual medical protocols.

METHODS

The basic rule of this method is to achieve effective change of rhythm and power of brain bioelectric activity based on knowledge of normal activity and identification of abnormalities of present activity. Various types of disturbed activity occur in many syndromes and brain development disorders. Training process is characterized by repetitive local activation of chosen brain structures as well as by general activation. Moreover, this method enables monitoring of emotional and social development. In accordance with disorders pathogenesis consecutive technical modules of this method are being introduced.

RESULTS

Neurofeedback has been used in the treatment of post traumatic stress disorder, sequels of stroke and head trauma, emotional, anxiety disorders and depression. Good results of this neurotherapy have been also found in children with ADHD/ ADD, developmental dyslexia, tics and Tourette syndrome, learning difficulties and development disturbances and acquired speech disorders. It has been also used with a success in treatment of headaches, epilepsy and chosen disturbances in cerebral palsy.

SUMMARY

Neurofeedback as a method of instrumental therapy of CSN is now undergoing thorough evaluation. New requirements that place further demands on the quantitative bioelectric activity estimation when qualification for the treatment is performed and on the elaboration of therapy results as a material for future meta analysis.