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Kaale A, Smith L, Nordahl-Hansen A, Fagerland MW, Kasari C. Early interaction in autism spectrum disorder: Mothers' and children's behaviours during joint engagement. Child Care Health Dev 2018; 44:312-318. [PMID: 29034499 DOI: 10.1111/cch.12532] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 09/01/2017] [Accepted: 09/25/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND More knowledge about the interaction between young children with autism spectrum disorder and their parents is one way to improve intervention. This study aims to investigate the behaviours of mothers and children with autism spectrum disorder during joint engagement, with a focus on pacing or rate (i.e., incidences per minute) of their behaviours when being in this state. METHOD Video recordings of 10 min of free-play between 58 children (2-4 years) diagnosed with childhood autism and their mothers were used to examine rate of mothers' and children's behaviours (i.e., toy introduction, toy expansion, positive affect, and language) during joint engagement, the association between rate of mothers and children's behaviours, the relation between rate of mothers' behaviours and time in joint engagement, and how child factors might be associated with the latter. RESULTS Mothers(m) and children(c) showed similar rate of positive affect (Mm = 0.6/Mc = 0.5) and toy expansion (Mm = 0.7/Mc = 0.7) per minute, whereas mothers talked almost three times more than their children (Mm = 10.2/Mc = 3.8). In contrast, mothers introduced fewer toys compared to the children (Mm = 0.7/Mc = 1.2). Rate of mothers' toy introduction, toy expansion, and positive affect was inversely related to time in joint engagement (Regression coefficient = -70.7 to -48.5, p = .006 to .024). Rates of mothers' and children's behaviours were associated (Spearman rank order coefficient = .53 to .29, p < .001 to .03), but neither rate of children's behaviours nor mental age was associated with the observed relation between rate of these maternal behaviours and time in joint engagement. CONCLUSION Time in joint engagement was related to rate of mothers' behaviours and children's mental age but not to rate of children's behaviours in this study. Thus, intervention teaching parents of young children with autism strategies designed to increase time in joint engagement may be vital. The complex nature of the interaction between mother and child behaviours in promoting joint engagement warrants further elucidation.
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Affiliation(s)
- A Kaale
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - L Smith
- Department of Psychology, University of Oslo, Oslo, Norway
| | - A Nordahl-Hansen
- Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - M W Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - C Kasari
- Center for Autism Research & Treatment, University of California, Los Angeles, Semel Institute, Los Angeles, CA, USA
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Abstract
With advances in the field's ability to identify autism spectrum disorders (ASD) at younger ages, the need for information about the evidence-base for early intervention continues to rise. This review of the ASD early intervention (EI) literature focuses on efficacy studies published within the past 15 years. The neurodevelopmental context for early intervention, timing of initiating intervention, primary intervention approaches, and predictors of treatment outcomes are discussed. The evidence indicates that young children with ASD benefit from EI, and their parents learn to implement child-responsive engagement strategies when a parent-coaching intervention is provided. Evidence supports combining parent-mediated and direct clinician-implemented intervention to maximize child developmental gains. Clinical practice recommendations are presented, based on the literature reviewed.
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Affiliation(s)
- Rebecca J. Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
- Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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53
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Warren SF, Brady N, Fleming KK, Hahn LJ. The Longitudinal Effects of Parenting on Adaptive Behavior in Children with Fragile X Syndrome. J Autism Dev Disord 2017; 47:768-784. [PMID: 28074357 DOI: 10.1007/s10803-016-2999-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Several studies have reported declines in adaptive behavior amongst children with fragile X syndrome (FXS) starting in middle childhood. We examined the effects of maternal responsivity on adaptive behavior in 55 children with FXS visited 5-6 times in their homes from early through middle childhood. Our analyses indicated that sustained maternal responsivity had a significant positive impact on the trajectories of communication and to a lesser extent other adaptive behavior domains through middle childhood with many effects remaining significant after controlling for autism symptoms and developmental level. For children who showed declines in adaptive behavior during middle childhood, sustained high levels of maternal responsivity minimized the amount of decline observed in the communication, socialization, and daily living domains.
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Affiliation(s)
- Steven F Warren
- Dole Human Development Center, Department of Speech-Language-Hearing: Sciences and Disorders, The Schiefelbusch Institute for Life Span Studies, The University of Kansas, 1000 Sunnyside Avenue, #3045, Lawrence, KS, 66045-7555, USA.
| | - Nancy Brady
- Department of Speech-Language-Hearing: Sciences and Disorders, The Schiefelbusch Institute for Life Span Studies, The University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS, 66045-7555, USA
| | - Kandace K Fleming
- Schiefelbusch Institute for Life Spans Studies, The University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS, 66045-7555, USA
| | - Laura J Hahn
- Schiefelbusch Institute for Life Spans Studies, The University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS, 66045-7555, USA
- Department of Speech and Hearing Science, University of Illinois, 901S. Sixth St., Champaign, IL, 61820, USA
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Campbell SB, Mahoney AS, Northrup J, Moore EL, Leezenbaum NB, Brownell CA. Developmental Changes in Pretend Play from 22- to 34-Months in Younger Siblings of Children with Autism Spectrum Disorder. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 46:639-654. [PMID: 28685398 DOI: 10.1007/s10802-017-0324-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Developmental trajectories of children's pretend play and social engagement, as well as parent sensitivity and stimulation, were examined in toddlers with an older sibling with autism spectrum disorder (ASD, high risk; HR) and toddlers with typically-developing older siblings (low risk; LR). Children (N = 168, 97 boys, 71 girls) were observed at 22, 28, and 34 months during free play with a parent and elicited pretend play with an examiner. At 28 and 34 months, children were asked to imagine the consequences of actions pantomimed by the examiner on a pretend transformation task. At 36 months children were assessed for ASD, yielding 3 groups for comparison: HR children with ASD, HR children without ASD (HR-noASD), and LR children. Children in all 3 groups showed developmental changes, engaging in more bouts of pretend play and obtaining higher scores on the elicited pretend and transformation tasks with age, but children with ASD lagged behind the other 2 groups on most measures. Children with ASD were also less engaged with their parents or the examiner during play interactions than either LR or HR-noASD children, with minimal developmental change evident. Parents, regardless of group, were highly engaged with their children, but parents of HR-noASD children received somewhat higher ratings on stimulation than parents of LR children. Most group differences were not accounted for by cognitive functioning. Instead, lower social engagement appears to be an important correlate of less advanced pretend skills, with implications for understanding the early development of children with ASD and for early intervention.
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Affiliation(s)
- Susan B Campbell
- Department of Psychology, University of Pittsburgh, 210 South Bouquet Street, Pittsburgh, PA, 15260, USA.
| | - Amanda S Mahoney
- Department of Psychology, University of Pittsburgh, 210 South Bouquet Street, Pittsburgh, PA, 15260, USA
| | - Jessie Northrup
- Department of Psychology, University of Pittsburgh, 210 South Bouquet Street, Pittsburgh, PA, 15260, USA
| | - Elizabeth L Moore
- Department of Psychology, University of Pittsburgh, 210 South Bouquet Street, Pittsburgh, PA, 15260, USA
| | | | - Celia A Brownell
- Department of Psychology, University of Pittsburgh, 210 South Bouquet Street, Pittsburgh, PA, 15260, USA
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Bradshaw J, Koegel LK, Koegel RL. Improving Functional Language and Social Motivation with a Parent-Mediated Intervention for Toddlers with Autism Spectrum Disorder. J Autism Dev Disord 2017; 47:2443-2458. [DOI: 10.1007/s10803-017-3155-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Blake JM, Rubenstein E, Tsai PC, Rahman H, Rieth SR, Ali H, Lee LC. Lessons learned while developing, adapting and implementing a pilot parent-mediated behavioural intervention for children with autism spectrum disorder in rural Bangladesh. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2017; 21:611-621. [PMID: 28366007 DOI: 10.1177/1362361316683890] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low- and middle-income countries often have limited resources, underdeveloped health systems and scarce knowledge of autism spectrum disorder. The objectives of this preliminary study were to develop and adapt intervention materials and to train a native clinician to implement a community-based parent-mediated behavioural intervention in rural Gaibandha, Bangladesh. Intervention materials to support parents' use of behavioural strategies were developed and refined by US behavioural intervention experts and Bangladesh field experts. Study investigators trained a native child psychologist in developmental milestones and behavioural intervention techniques. The native clinician delivered a 1-day group education session attended by 10 families of children aged 7-9 years with autism spectrum disorder, followed by two one-on-one training sessions with each family to train and practice individualized strategies for targeted challenging behaviours. Preliminary qualitative results indicate the importance of materials that are culturally appropriate and at an adequate literacy level. All families expressed strong desires to have learned the behavioural strategies when their child was younger and vocalized their need for further support and tools to help their children. This study is a preliminary step to creating sustainable and low-cost autism spectrum disorder interventions in rural Bangladesh, and possibly for families in regions with similar cultural and socioeconomic status backgrounds.
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Affiliation(s)
- Jasmine M Blake
- 1 Johns Hopkins Bloomberg School of Public Health, USA.,2 University of Maryland School of Medicine, USA
| | | | | | | | - Sarah R Rieth
- 5 San Diego State University, USA.,6 Child and Adolescent Services Research Center, USA
| | - Hasmot Ali
- 1 Johns Hopkins Bloomberg School of Public Health, USA.,4 Johns Hopkins University - Bangladesh, Bangladesh
| | - Li-Ching Lee
- 1 Johns Hopkins Bloomberg School of Public Health, USA
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Abstract
Social dysfunction is a core symptom of many psychiatric disorders and current medications have little or no remedial effects on this. Following on from extensive studies on animal models demonstrating that the neuropeptide oxytocin plays an important role in social recognition and bonding, human-based research has explored its therapeutic potential for social dysfunction in psychiatric disorders. Here we outline the historical background of this human-based research and some of the current methodological challenges it is facing. To date, research has primarily attempted to establish functional effects through measuring altered endogenous concentrations, observing effects of exogenous administration and by investigating the effects of polymorphisms and epigenetic modifications of the oxytocin receptor gene. We summarize some of the key findings on behavioral and neural effects that have been reported in healthy subjects in the context of social cognition which have provided encouragement that oxytocin could represent a promising therapeutic target. At the same time, we have identified a number of key areas where we urgently need further information about optimal dosing strategies and interactions with other peptide and transmitter systems. Finally, we have summarized current translational findings, particularly in the context of therapeutic outcomes of intranasal oxytocin administration in autism and schizophrenia. These clinical findings while somewhat varied in outcome do offer increasing cause for optimism that targeting the oxytocin system may provide a successful therapeutic approach for social dysfunction. However, future research needs to focus on the most effective treatment strategy and which types of individuals are likely to benefit most.
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Harrop C, Gulsrud A, Shih W, Hovsepyan L, Kasari C. The impact of caregiver-mediated JASPER on child restricted and repetitive behaviors and caregiver responses. Autism Res 2016; 10:983-992. [DOI: 10.1002/aur.1732] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 10/07/2016] [Accepted: 11/11/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Clare Harrop
- Allied Health Sciences, University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Amanda Gulsrud
- Center for Autism Research and Treatment, UCLA Semel Institute, University of California Los Angeles; Los Angeles California
| | - Wendy Shih
- Center for Autism Research and Treatment, UCLA Semel Institute, University of California Los Angeles; Los Angeles California
| | - Lilit Hovsepyan
- School of Behavioral Health - Psychology, Loma Linda University; Loma Linda California
| | - Connie Kasari
- Center for Autism Research and Treatment, UCLA Semel Institute, University of California Los Angeles; Los Angeles California
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