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Loo KK, Hutman T, Yang JH, McAdam DB, Nyp SS. Disorders, Disabilities, and Differences: Reconciling the Medical Model with a Neurodiversity Perspective. J Dev Behav Pediatr 2021; 42:763-766. [PMID: 34740214 DOI: 10.1097/dbp.0000000000001032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CASE SECTION Zoe is a 25-month-old girl who presented to developmental-behavioral pediatrics with her parents for follow-up after receiving a diagnosis of autism spectrum disorder with global developmental delay and language impairment 3 months ago. Zoe was born by spontaneous vaginal delivery at term after an uncomplicated pregnancy, labor, and delivery. She had a routine newborn course and was discharged home with her parents 2 days after her birth.At 7 months, Zoe was not able to sit independently, had poor weight gain, and had hypertonia on physical examination. Her parents described her to tense her arms and have hand tremors when she held her bottle during feedings and reported that she had resisted their attempts to introduce pureed or other age-appropriate table foods into her diet. The Bayley Scales of Infant and Toddler Development Screening Test was administered and found a cognitive composite score of 70, language composite score of 65, and motor composite score of 67. Chromosomal microarray analysis, testing for fragile X syndrome, laboratory studies for metabolic disorders, magnetic resonance imaging of the brain, and an audiologic examination were normal. Zoe was referred to and received early intervention services including physical therapy, feeding therapy, and infant stimulation services. By 16 months, Zoe was walking independently and was gaining weight well but continued to have sensory aversions to some foods.At 22 months, Zoe was evaluated by a multidisciplinary team because of ongoing developmental concerns and concerning results on standardized screening for autism spectrum disorder completed at her 18-month preventive care visit. Her parents also reported concern about the possibility of autism spectrum disorder (ASD) because they both were diagnosed with ASD as young children. Both parents completed college and were employed full-time. Zoe's mother seemed to be somewhat anxious during the visit and provided fleeting eye contact throughout the evaluation. Zoe's father was assertive, but polite, and was the primary historian regarding parental concerns during the evaluation.Zoe was noted to have occasional hand flapping and squealing vocalizations while she roamed the examination area grabbing various objects and casting them to the floor while watching the trajectory of their movements. She did not use a single-finger point to indicate her wants or needs and did not initiate or follow joint attention. She met criteria for ASD. In discussing the diagnosis with Zoe's parents, they shared that they were not surprised by the diagnosis. They expressed feeling that Zoe was social and playful, although delayed in her language. Hence, they were more concerned about her disinterest in eating. They were not keen on behavioral intervention because they did not want Zoe to be "trained to be neurotypical." Although the mother did not receive applied behavior analysis (ABA), the father had received ABA for 3 years beginning at age 5 years. He believed that ABA negatively changed his personality, and he did not want the same for Zoe.How would you assist Zoe's parents in identification of priorities for her developmental care while ensuring respect for their perspective of neurodiversity?
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Affiliation(s)
- Kek K Loo
- Department of Pediatrics, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | | | - Jeffrey H Yang
- Department of Pediatrics, Kaiser Permanente Los Angeles Medical Center, Keck School of Medicine of USC, Pasadena, CA
| | - David B McAdam
- Division of Behavioral and Developmental Pediatrics, University of Rochester, Warner School of Education and Human Development, Rochester, NY
| | - Sarah S Nyp
- Developmental-Behavioral Pediatrician, Division of Developmental and Behavioral Health, Children's Mercy Kansas City, UMKC School of Medicine, Kansas City, MO
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202
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Sandham V, Hill AE, Hinchliffe F. The current practices of Australian speech-language pathologists in providing communication services to children with autism spectrum disorder. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:641-651. [PMID: 34229560 DOI: 10.1080/17549507.2021.1923800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Evidence-Based Practice (EBP) is fundamental to speech-language pathology practice. Australian speech-language pathologists (SLPs) who treat communication disorders in children with autism spectrum disorder (ASD) face unique challenges in implementing EBP. Challenges may include selecting an intervention from a myriad of available interventions for use within a complex population. Identification of current practices of Australian SLPs in communication service provision to children with ASD will provide a baseline for use of EBP and may guide future efforts to engage in EBP. METHOD A total of 109 Australian SLPs who provide communication services to children with ASD completed an online survey. Descriptive and inferential statistics were used to analyse service delivery and participant experiences of EBP. RESULT The most common barrier to delivering EBP was inadequate resources. The most utilised strategy was discussing evidence with colleagues. Most participants reported using therapies which did not adhere to a standard protocol, such as eclectic approaches. The majority also reported use of outcome measures which they believe adequately represent functional communication changes for their client. CONCLUSION Resource limitations may result in over-reliance on interventions lacking empirical support and over-reliance on subjective outcome measurement tools. Reflective practice and self-evaluation of communication services to children with ASD may support improved provision of EBP.
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Affiliation(s)
- Victoria Sandham
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Anne E Hill
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Fiona Hinchliffe
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Mater Misericordiae Ltd, South Brisbane, Australia
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203
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Odom SL, Hall LJ, Morin KL, Kraemer BR, Hume KA, McIntyre NS, Nowell SW, Steinbrenner JR, Tomaszewski B, Sam AM, DaWalt L. Educational Interventions for Children and Youth with Autism: A 40-Year Perspective. J Autism Dev Disord 2021; 51:4354-4369. [PMID: 33866461 PMCID: PMC8531076 DOI: 10.1007/s10803-021-04990-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 01/18/2023]
Abstract
Commemorating the 40 th anniversary of the Diagnostic and Statistical Manual (DSM) III, the purpose of this commentary is to describe school-based and school-relevant interventions and instructional approaches for children and youth with autism that have been developed and employed during that time period. The commentary begins with a brief description of foundational research that provides an historical context. Research themes shaped by science, ethics, social policy, and the changes in the DSM provide an organization for describing the evolution of intervention and instructional practices over the four previous decades. The commentary concludes with a discussion of school-contextual variables that influence implementation and the promise of the "iSciences" for closing the research to practice gap in the future.
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Affiliation(s)
- Samuel L Odom
- University of North Carolina At Chapel Hill, Chapel Hill, NC, USA.
- San Diego State University, San Diego, CA, USA.
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, CB 8040, Chapel Hill, NC, 27599-8040, USA.
| | | | | | | | - Kara A Hume
- University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | | | - Sallie W Nowell
- University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Ann M Sam
- University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
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204
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Schertz HH, Liu X, Odom SL, Baggett KM. Parents' application of mediated learning principles as predictors of toddler social initiations. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1536-1549. [PMID: 34825577 DOI: 10.1177/13623613211061128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Little is known about what parents can do to promote initiating joint attention for their toddlers with autism. Initiating joint attention is important because it is an indicator of social motivation and is associated with later communication ability. In this study, parents applied mediated learning principles to help their toddlers engage with them socially. The principles included helping their child focus on social interaction, giving meaning to the social elements of interaction (and de-emphasizing nonsocial elements), and helping their toddlers understand their own social ability by encouraging. At the end of the intervention period, we compared two groups. One group received the Joint Attention Mediated Learning intervention and the other received community-based early intervention services. We found that the Joint Attention Mediated Learning participants applied mediated learning principles more often than the other group. Then, we explored how parents' application of mediated learning principles related to toddler initiating joint attention and found that parents who were successful in applying the principles had toddlers who were more likely to show initiating joint attention. Our findings indicate that the mediated learning process shows promise as a way to promote early social learning, although other elements of the Joint Attention Mediated Learning intervention, such as actively engaging parents in the learning process, may have also contributed to both child and parent learning.
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205
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Amonkar N, Su WC, Bhat AN, Srinivasan SM. Effects of Creative Movement Therapies on Social Communication, Behavioral-Affective, Sensorimotor, Cognitive, and Functional Participation Skills of Individuals With Autism Spectrum Disorder: A Systematic Review. Front Psychiatry 2021; 12:722874. [PMID: 34867515 PMCID: PMC8637167 DOI: 10.3389/fpsyt.2021.722874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder affecting multiple developmental domains including social communication, behavioral-affective, sensorimotor, and cognitive systems. There is growing evidence for the use of holistic, whole-body, Creative Movement Therapies (CMT) such as music, dance, yoga, theater, and martial arts in addressing the multisystem impairments in ASD. We conducted a comprehensive quantitative and qualitative review of the evidence to date on the effects of CMT on multiple systems in individuals with ASD. The strongest evidence, both in terms of quantity and quality, exists for music and martial arts-based interventions followed by yoga and theater, with very limited research on dance-based approaches. Our review of 72 studies (N = 1,939 participants) across participants with ASD ranging from 3 to 65 years of age suggests that at present there is consistent evidence from high quality studies for small-to-large sized improvements in social communication skills following music and martial arts therapies and medium-to-large improvements in motor and cognitive skills following yoga and martial arts training, with insufficient evidence to date for gains in affective, sensory, and functional participation domains following CMT. Although promising, our review serves as a call for more rigorous high-quality research to assess the multisystem effects of CMT in ASD. Based on the existing literature, we discuss implications of our findings for autism researchers and also provide evidence-based guidelines for clinicians to incorporate CMT approaches in their plan of care for individuals with ASD.
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Affiliation(s)
- Nidhi Amonkar
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, United States
- Institute for Health, Intervention, and Policy, University of Connecticut, Storrs, CT, United States
- The Connecticut Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs, CT, United States
| | - Wan-Chun Su
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States
| | - Anjana N. Bhat
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Sudha M. Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, United States
- Institute for Health, Intervention, and Policy, University of Connecticut, Storrs, CT, United States
- The Connecticut Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs, CT, United States
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206
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Training Coaches in Community Agencies to Support Parents of Children with Suspected Autism: Outcomes, Facilitators, and Barriers. J Autism Dev Disord 2021; 52:4931-4948. [PMID: 34796421 PMCID: PMC8601100 DOI: 10.1007/s10803-021-05363-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 11/16/2022]
Abstract
This study evaluated the fidelity and effectiveness of a parent coach training program for toddlers at risk for autism spectrum disorder and identified factors required for successful training implementation under real-world conditions. Training addressed four tiers of clinical competence and was delivered to early intervention providers across 23 partner agencies in a large Canadian province. Results indicated that mean trainee fidelity scores were within the range reported in previous community-based training studies but there was considerable variability across trainees. Implementation facilitators included agency learning climate, leadership support, and trainee readiness for change. Implementation barriers included time/caseload demands and challenges related to technology learning and infrastructure. Results have implications for parent coach training in community settings.
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207
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Towson JA, Akemoglu Y, Watkins L, Zeng S. Shared Interactive Book Reading Interventions for Young Children With Disabilities: A Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2700-2715. [PMID: 34586887 DOI: 10.1044/2021_ajslp-20-00401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose Shared interactive book reading (SIBR) is an evidence-based practice for young children who are typically developing and those with developmental disabilities or considered at risk for developmental delays. The purpose of this review was to provide a comprehensive examination of the evidence of using SIBR to facilitate growth in language skills for young children with developmental disabilities and/or delays. Specifically, authors examined the descriptive characteristics, study rigor, and effect sizes for language and literacy outcomes. Method We extracted data from studies meeting specified criteria (n = 23) published in peer-reviewed journals on a wide range of variables, including participant characteristics, setting, training/coaching, defined independent and dependent variables, study rigor, and overall outcomes. Descriptive and study rigor data were aggregated using descriptive statistics. Effect-size estimates were calculated for all child outcomes related to language. Results Descriptive data were variable across studies. Three single-case experimental design and three group design studies met design standards without reservations. Single-case experimental design studies overall showed positive effects on child language and communication. Within group design studies, expressive language outcomes showed the largest effect sizes. Conclusion A review of SIBR studies indicates this as a viable intervention to positively impact the language skills of young children with developmental disabilities and/or delays. Supplemental Material https://doi.org/10.23641/asha.16674355.
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Affiliation(s)
- Jacqueline A Towson
- School of Communication Sciences and Disorders, University of Central Florida, Orlando
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208
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Haglund N, Dahlgren S, Råstam M, Gustafsson P, Källén K. Improvement of Autism Symptoms After Comprehensive Intensive Early Interventions in Community Settings. J Am Psychiatr Nurses Assoc 2021; 27:483-495. [PMID: 32321353 PMCID: PMC8581718 DOI: 10.1177/1078390320915257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Preschool children with autism in southern Sweden participated in a comprehensive Naturalistic Developmental Behavioral Intervention (NDBI) program. AIMS To evaluate the ongoing NDBI program by comparing the pre- and postintervention outcomes in terms of improved autism symptom severity. METHOD The improvement of Autism Diagnostic Observation Schedule (ADOS-R) test results between baseline and evaluation among children participating in the NDBI program (n = 67) was compared with the results among children receiving community treatment as usual (n = 27) using analysis of covariance. RESULTS The study showed that children in the NDBI group improved their ADOS-R total scores between baseline and evaluation (-0.8 scores per year; 95% CI [-1.2, -0.4]), whereas no improvement was detected in the comparison group (+0.1 scores per year; 95% CI [-0.7, +0.9]). The change in the NDBI group versus the change in the comparison group was statistically significant after adjusting for possible confounders as well. Children in the NDBI group also significantly improved their ADOS severity scores, but the scores were not significantly different from those of the comparison group. CONCLUSIONS The results from the current naturalistic study must be interpreted cautiously, but they do support earlier studies reporting on improvement of autism symptoms after early intensive interventions. Results from observational studies are difficult to interpret, but it is nevertheless of uttermost importance to evaluate costly autism intervention programs. The results do indicate that children with autism benefit from participating in early comprehensive intensive programs.
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Affiliation(s)
- Nils Haglund
- Nils Haglund, PhD, Lund University, Lund, Sweden
| | - SvenOlof Dahlgren
- SvenOlof Dahlgren, PhD, University of Gothenburg, Gothenburg, Sweden
| | - Maria Råstam
- Maria Råstam, MD, Lund University, Lund, Sweden; University of Gothenburg, Gothenburg, Sweden.,Peik Gustafsson, MD, Lund University, Lund, Sweden
| | | | - Karin Källén
- Karin Källén, PhD, Lund University, Lund, Sweden
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209
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Clinician Delivery of Virtual Pivotal Response Treatment with Children with Autism during the COVID-19 Pandemic. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10110414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This concept paper describes how the evidence-based Pivotal Response Treatment (PRT) model of autism treatment was adapted for delivery via telehealth during the COVID-19 pandemic. Multiple features of existing video conference technology were utilized for implementation of PRT motivational strategies with young children with autism spectrum disorder (ASD). PRT is an empirically supported treatment for ASD which can be taught to parents and delivered directly by trained therapists. During the COVID-19 pandemic, when the majority of clinical care for children with ASD had to be transitioned to telehealth delivery, models for parent training had been previously established. However, no model for direct clinician delivery of virtual PRT existed. This manuscript outlines practical details of the model developed by our team and provided to a total of 17 families between April 2020 and May 2021. Key lessons from technological adaptations of the PRT motivational strategies are described in order to inform future empirical investigation of this approach. The virtual PRT delivery model can serve as a guide for engaging children in meaningful social interaction and communication practice via video conference software, with implications for expanding access to autism treatment as well as for motivating a wide range of children in distance learning activities.
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210
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Grzadzinski R, Amso D, Landa R, Watson L, Guralnick M, Zwaigenbaum L, Deák G, Estes A, Brian J, Bath K, Elison J, Abbeduto L, Wolff J, Piven J. Pre-symptomatic intervention for autism spectrum disorder (ASD): defining a research agenda. J Neurodev Disord 2021; 13:49. [PMID: 34654371 PMCID: PMC8520312 DOI: 10.1186/s11689-021-09393-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/16/2021] [Indexed: 12/26/2022] Open
Abstract
Autism spectrum disorder (ASD) impacts an individual's ability to socialize, communicate, and interact with, and adapt to, the environment. Over the last two decades, research has focused on early identification of ASD with significant progress being made in understanding the early behavioral and biological markers that precede a diagnosis, providing a catalyst for pre-symptomatic identification and intervention. Evidence from preclinical trials suggest that intervention prior to the onset of ASD symptoms may yield more improved developmental outcomes, and clinical studies suggest that the earlier intervention is administered, the better the outcomes. This article brings together a multidisciplinary group of experts to develop a conceptual framework for behavioral intervention, during the pre-symptomatic period prior to the consolidation of symptoms into diagnosis, in infants at very-high-likelihood for developing ASD (VHL-ASD). The overarching goals of this paper are to promote the development of new intervention approaches, empirical research, and policy efforts aimed at VHL-ASD infants during the pre-symptomatic period (i.e., prior to the consolidation of the defining features of ASD).
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Affiliation(s)
- Rebecca Grzadzinski
- Carolina Institute for Developmental Disabilities, University of North Carolina, Chapel Hill, NC, USA.
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina, Chapel Hill, NC, USA.
| | - Dima Amso
- Department of Psychology, Columbia University, New York, NY, USA
| | - Rebecca Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Linda Watson
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina, Chapel Hill, NC, USA
- Division of Speech and Hearing Sciences, University of North Carolina, Chapel Hill, NC, USA
| | - Michael Guralnick
- Center on Human Development and Disability, University of Washington, Seattle, WA, USA
| | | | - Gedeon Deák
- Department of Cognitive Science, University of California, San Diego, San Diego, CA, USA
| | - Annette Estes
- Department of Speech and Hearing Sciences, University of Washington Autism Center, University of Washington, Seattle, WA, USA
| | - Jessica Brian
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Kevin Bath
- Department of Neuroscience, Brown University, Providence, RI, USA
| | - Jed Elison
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Leonard Abbeduto
- University of California, Davis, MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Jason Wolff
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Joseph Piven
- Carolina Institute for Developmental Disabilities, University of North Carolina, Chapel Hill, NC, USA
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211
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Hampton LH, Rodriguez EM. Preemptive interventions for infants and toddlers with a high likelihood for autism: A systematic review and meta-analysis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1364-1378. [PMID: 34628968 DOI: 10.1177/13623613211050433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Interventions to address core symptoms for young children on the autism spectrum have a strong and growing evidence base. Adapting and delivering evidence-based interventions to infants and toddlers with a high likelihood for autism is a logical next step. This systematic review and meta-analysis summarize the association between infant and toddler interventions and developmental and family outcomes. Results indicate that these early interventions are effective for improving parent implementation of core strategies, yet the effects do not readily translate to child outcomes. However, key studies demonstrate conditional results that indicate that parent implementation is associated with child outcome. Implications for research and practice toward building adaptive interventions that respond to parent implementation and changing child characteristics are discussed.
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212
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Gabbay-Dizdar N, Ilan M, Meiri G, Faroy M, Michaelovski A, Flusser H, Menashe I, Koller J, Zachor DA, Dinstein I. Early diagnosis of autism in the community is associated with marked improvement in social symptoms within 1-2 years. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1353-1363. [PMID: 34623179 PMCID: PMC9340129 DOI: 10.1177/13623613211049011] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT It is widely believed that early diagnosis and treatment of autism spectrum disorder is essential for better outcome. This is demonstrated by the American Academy of Pediatrics recommendation to screen all 1.5-2.5-year-old toddlers for autism spectrum disorder. However, multiple longitudinal studies of children diagnosed with autism spectrum disorder at 1.5-6 years of age and treated in community settings have not reported any associations between earlier diagnosis and improved outcome in core autism spectrum disorder symptoms. In this study, we measured changes in core autism spectrum disorder symptoms over a 1-2-year period in 131 children diagnosed with autism spectrum disorder at 1.2-5 years of age, and treated in the community. The results revealed that children who were diagnosed before 2.5 years of age were three times more likely to exhibit considerable improvements in social autism spectrum disorder symptoms in comparison to children diagnosed at later ages. These results highlight the importance of early diagnosis and treatment of autism spectrum disorder even in community settings with heterogeneous services. In addition, these results motivate further prioritization of universal screening for autism spectrum disorder before 2.5 years of age.
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Affiliation(s)
| | - Michal Ilan
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel
| | - Gal Meiri
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel
| | - Michal Faroy
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel
| | - Analya Michaelovski
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel
| | - Hagit Flusser
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel
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213
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Bravo A, Schwartz I. Teaching Imitation to Young Children with Autism Spectrum Disorder Using Discrete Trial Training and Contingent Imitation. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2021; 34:655-672. [PMID: 34629832 PMCID: PMC8492814 DOI: 10.1007/s10882-021-09819-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 06/13/2023]
Abstract
Imitation is a pivotal skill for children with and without disabilities, serving both learning and social interaction functions for young children. Children with autism spectrum disorder (ASD) frequently experience delays in acquiring this skillset, demonstrating challenges in the ability and/or propensity to imitate the actions of others. Current intervention programs frequently use discrete trial teaching (DTT) or contingent imitation to support imitation development in young children with ASD. This study combined contingent imitation with DTT to teach imitation to individuals who had previously struggled with acquiring this skill. A multiple probe design across three preschool children with ASD was conducted within participants' early learning classrooms. Response to intervention varied across participants, with participants with more advanced imitation skills at study onset demonstrating greater outcomes. Combining contingent imitation with DTT may facilitate the propensity to imitate for individuals who exhibit some appropriate object engagement and are inconsistently imitating others' actions with objects. However, further research using stronger research design is needed to improve the teaching of imitation to young children with ASD who exhibit challenges with this skillset.
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Affiliation(s)
- Alice Bravo
- University of Washington, Box 357925, Seattle, WA 98195 USA
| | - Ilene Schwartz
- University of Washington, Box 357925, Seattle, WA 98195 USA
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214
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Manohar H, Kandasamy P. Clinical outcomes of children with ASD - Preliminary findings from a 18 month follow up study. Asian J Psychiatr 2021; 64:102816. [PMID: 34461368 DOI: 10.1016/j.ajp.2021.102816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/27/2021] [Accepted: 08/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Parent-mediated intervention for children with Autism Spectrum Disorder (ASD) is a critical component to deliver evidence-based interventions in resource-limited settings. There is a need for methodologically rigorous longitudinal and follow-up studies of children with ASD to understand clinical outcome and developmental trajectories. METHODS We report the clinical outcome at 18-month follow-up of children diagnosed with ASD who received parent-mediated intervention for a 3-month period as part of a feasibility study. The study participants were followed up for 18 months as part of Treatment As Usual (TAU). Symptom severity and adaptive functioning were assessed on Childhood Autism Rating Scale (CARS) and Vineland Social Maturity Scale (VSMS) respectively. RESULTS All the study participants(n = 42), continued to show improvement between baseline and the two follow-up evaluations at 3 months and 18 months respectively, with reduction in symptom severity, improvement in core features of ASD and adaptive functioning. The maximum gains were attained during the first three months. Three subgroups were identified based on the trajectory of improvement: 1) Children with best possible outcomes, 2) Child with maintenance of gains, and 3) Children with minimal improvement. Seven participants (16.7 %) had the 'best possible' outcome at 18-month follow-up with CARS scores in the non-autistic range and they no longer qualified for a DSM-5 diagnosis of ASD. CONCLUSION The intensity of early intervention is pivotal to positively alter the developmental trajectories in children with ASD. Parent-mediated intervention is the best possible mode of intervention delivery to initiate early intervention and address the prevailing challenges in resource-limited settings.
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Affiliation(s)
- Harshini Manohar
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hembegowda Nagar, Hosur Road, Bangalore, 560029, India.
| | - Preeti Kandasamy
- Department of Child and Adolescent Psychiatry, Neuro Foundation, Salem, India.
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Djerassi M, Ophir S, Atzil S. What Is Social about Autism? The Role of Allostasis-Driven Learning. Brain Sci 2021; 11:1269. [PMID: 34679334 PMCID: PMC8534207 DOI: 10.3390/brainsci11101269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 12/27/2022] Open
Abstract
Scientific research on neuro-cognitive mechanisms of autism often focuses on circuits that support social functioning. However, autism is a heterogeneous developmental variation in multiple domains, including social communication, but also language, cognition, and sensory-motor control. This suggests that the underlying mechanisms of autism share a domain-general foundation that impacts all of these processes. In this Perspective Review, we propose that autism is not a social deficit that results from an atypical "social brain". Instead, typical social development relies on learning. In social animals, infants depend on their caregivers for survival, which makes social information vitally salient. The infant must learn to socially interact in order to survive and develop, and the most prominent learning in early life is crafted by social interactions. Therefore, the most prominent outcome of a learning variation is atypical social development. To support the hypothesis that autism results from a variation in learning, we first review evidence from neuroscience and developmental science, demonstrating that typical social development depends on two domain-general processes that determine learning: (a) motivation, guided by allostatic regulation of the internal milieu; and (b) multi-modal associations, determined by the statistical regularities of the external milieu. These two processes are basic ingredients of typical development because they determine allostasis-driven learning of the social environment. We then review evidence showing that allostasis and learning are affected among individuals with autism, both neurally and behaviorally. We conclude by proposing a novel domain-general framework that emphasizes allostasis-driven learning as a key process underlying autism. Guided by allostasis, humans learn to become social, therefore, the atypical social profile seen in autism can reflect a domain-general variation in allostasis-driven learning. This domain-general view raises novel research questions in both basic and clinical research and points to targets for clinical intervention that can lower the age of diagnosis and improve the well-being of individuals with autism.
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Affiliation(s)
| | | | - Shir Atzil
- Department of Psychology, Hebrew University of Jerusalem, Jerusalem 9190501, Israel; (M.D.); (S.O.)
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216
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Holingue C, Jang Y, Azad G, Landa R. Key stakeholder perspectives on obstacles to an autism-specific Medicaid waiver service delivery model. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 35:205-216. [PMID: 34558157 DOI: 10.1111/jar.12940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Children and youth with autism spectrum disorder have significant, multi-system needs that require supports, such as the autism waiver (AW) service delivery model. This study aimed to identify and describe characteristics of the AW, define obstacles and strengths in the provision of adequate services and provide recommendations for improving overall effectiveness. METHODS This mixed-methods exploratory study used an electronic survey to gain information and perceptions of AW provider agency directors (n = 27) and service coordinators (n = 30). RESULTS The key barriers reported were the shortage of qualified staff, inadequate staff training, complexity of cases or symptom severity of clients and lack of communication at multiple levels throughout the agency as well as with parents. CONCLUSIONS Recommendations include reinforcing the workforce through higher salaries, greater training and communication interventions. These strategies may reduce staff turnover and shortage, lighten the caseload, reduce the waitlist period and improve the effectiveness and responsiveness of AW services.
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Affiliation(s)
- Calliope Holingue
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yeon Jang
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Gazi Azad
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University, New York, New York, USA.,Center for Autism and the Developing Brain, Weill Cornell Medicine, New York State Psychiatric Institute, New York, New York, USA
| | - Rebecca Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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217
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Heimann M, Holmer E. Neonatal Imitation, Intersubjectivity, and Children With Atypical Development: Do Observations on Autism and Down Syndrome Change Our Understanding? Front Psychol 2021; 12:701795. [PMID: 34512459 PMCID: PMC8430258 DOI: 10.3389/fpsyg.2021.701795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/30/2021] [Indexed: 11/26/2022] Open
Abstract
Almost all studies on neonatal imitation to date seem to have focused on typically developing children, and we thus lack information on the early imitative abilities of children who follow atypical developmental trajectories. From both practical and theoretical perspectives, these abilities might be relevant to study in children who develop a neuropsychiatric diagnosis later on or in infants who later show impaired ability to imitate. Theoretical in the sense that it will provide insight into the earliest signs of intersubjectivity—i.e., primary intersubjectivity—and how this knowledge might influence our understanding of children following atypical trajectories of development. Practical in the sense that it might lead to earlier detection of certain disabilities. In the present work, we screen the literature for empirical studies on neonatal imitation in children with an Autism spectrum disorder (ASD) or Down syndrome (DS) as well as present an observation of neonatal imitation in an infant that later was diagnosed with autism and a re-interpretation of previously published data on the phenomenon in a small group of infants with DS. Our findings suggest that the empirical observations to date are too few to draw any definite conclusions but that the existing data suggests that neonatal imitation can be observed both in children with ASD and in children with DS. Thus, neonatal imitation might not represent a useful predictor of a developmental deficit. Based on current theoretical perspectives advocating that neonatal imitation is a marker of primary intersubjectivity, we propose tentatively that an ability to engage in purposeful exchanges with another human being exists in these populations from birth.
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Affiliation(s)
- Mikael Heimann
- Infant and Child Lab, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Emil Holmer
- Department of Behavioural Sciences and Learning, The Swedish Institute for Disability Research, Linköping University, Linköping, Sweden
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218
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Perzolli S, Bentenuto A, Bertamini G, de Falco S, Venuti P. Father-Child Interactions in Preschool Children with ASD: A Systematic Review. Brain Sci 2021; 11:1202. [PMID: 34573223 PMCID: PMC8465967 DOI: 10.3390/brainsci11091202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022] Open
Abstract
Studies on parental interaction in the context of ASD has mainly focused on mothers, even if fathers and their children seem to form close and supportive relationships that may have unique effects on child development. Given the impact of ASD symptoms on a child's ability to interact with significant others, recent findings strengthen the importance of including caregivers during treatment to guarantee a better adaptation to the child's impairments. Despite this, fathers are scarcely involved, and interventions seem to not be tailored to their interactive characteristics and needs. For this reason, a systematic review was conducted to investigate fathers and children with ASD behaviors during interaction. This review found 12 observational studies that identified social, cognitive, and affective interactive modalities in father-child dyads through three psychology-focused journal databases: PubMed, PsycINFO and Scopus. The significant variation in both sample size and in the measures used to assess dyadic outcomes limits the ability of this work to make robust recommendations for intervention. Despite this, the results revealed characteristic behaviors of this dyad that consequently allow specific targets to be worked on during intervention. In fact, from fathers' individual strengths and weaknesses, it is possible to implement interventions that are complementary with maternal characteristics from the perspective of personalized and optimized treatment.
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Affiliation(s)
- Silvia Perzolli
- Laboratory of Observation, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38122 Trento, Italy; (A.B.); (G.B.); (S.d.F.); (P.V.)
| | - Arianna Bentenuto
- Laboratory of Observation, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38122 Trento, Italy; (A.B.); (G.B.); (S.d.F.); (P.V.)
| | - Giulio Bertamini
- Laboratory of Observation, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38122 Trento, Italy; (A.B.); (G.B.); (S.d.F.); (P.V.)
- Data Science for Health (DSH), Bruno Kessler Foundation (FNK), 38123 Povo, Italy
| | - Simona de Falco
- Laboratory of Observation, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38122 Trento, Italy; (A.B.); (G.B.); (S.d.F.); (P.V.)
| | - Paola Venuti
- Laboratory of Observation, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38122 Trento, Italy; (A.B.); (G.B.); (S.d.F.); (P.V.)
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219
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Reichle J, O'Neill RE, Johnston SS. Advances in AAC intervention: some contributions related to applied behavior analysis. Augment Altern Commun 2021; 37:206-216. [PMID: 34499000 DOI: 10.1080/07434618.2021.1962405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
This article extends Dr. Bob Remington's call for collaborations between those supporting behavioral approaches and those supporting more natural developmental approaches to beginning communication intervention. This article expands areas previously discussed by Dr. Remington. Topics that are addressed include pivotal behaviors that may facilitate communication acquisition, matching law and response efficiency, generalization, maintenance, and the related topics of general case instruction (which involves an understanding of stimulus and response classes). These topics reflect contemporary areas of research that could be better integrated into translational research and have not been extensively integrated into augmentative and alternative communication (AAC) practice. Dr. Remington's article discussed the value of behavioral approaches and corresponding methodology to AAC researchers and practitioners. We agree and discuss the need for greater interaction among proponents of varying approaches to intervention.
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Affiliation(s)
- Joe Reichle
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Robert E O'Neill
- Department of Special Education, University of Utah, Salt Lake City, UT, USA
| | - Susan S Johnston
- Department of Special Education, University of Utah, Salt Lake City, UT, USA
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220
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Shire SY, Worthman LB, Arbuckle S. A Technology-Enabled Adaptation of Face-to-Face Caregiver-Mediated JASPER Intervention: Preliminary Examination of Video Conferenced Caregiver Coaching. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:421-434. [PMID: 34428271 DOI: 10.1352/1944-7558-126.5.421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 01/19/2021] [Indexed: 06/13/2023]
Abstract
Family-centered practices that involve direct participation of caregivers as part of intervention is critical to effective early intervention. However, regularly scheduled, in person service delivery is not always possible in remote communities, prompting a need for adaptations to the delivery of services, such as the use of live video conferencing to coach caregivers in strategies to promote their children's development. In this study, caregivers and their children ages 2-9 with autism who were living in rural and remote Canadian communities were included. A concurrent multiple baseline design across participants was applied to examine the effects of live video conference caregiver coaching on children's time jointly engaged with caregivers and caregivers' intervention strategy implementation. Results indicated that all children demonstrated greater time jointly engaged and caregivers demonstrated greater use of strategies in comparison to baseline. The results of this study offer preliminary evidence of the effectiveness of real time video conference coaching for caregivers engaging their children with ASD in play.
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221
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Martinez-Torres K, Boorom O, Nogueira Peredo T, Camarata S, Lense MD. Using the Ecological Validity Model to adapt parent-involved interventions for children with Autism Spectrum Disorder in the Latinx community: A conceptual review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 116:104012. [PMID: 34153646 PMCID: PMC8349824 DOI: 10.1016/j.ridd.2021.104012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 05/18/2021] [Accepted: 06/04/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND Parent involvement in interventions for children with Autism Spectrum Disorder (ASD) provides parents with education about ASD diagnosis and treatment, improves parent-child interactions, and offers access to cost-effective resources. The Latinx population represents the fastest growing minority population in the United States and a growing percentage of children seeking ASD intervention services. AIMS Identify factors that impact Latinx parent involvement in interventions for children with ASD as an example of cultural considerations for diverse families and communities. METHODS AND PROCEDURES In this conceptual overview, we synthesize literature on cultural considerations for intervention design/adaptation for Latinx families and parent involvement in interventions for children with ASD through the lens of the Ecological Validity Model. OUTCOMES AND RESULTS Frameworks such as the Ecological Validity Model can be used when creating or adapting interventions for specific cultural groups. Parent-involved interventions for children with ASD in the Latinx community should consider language of intervention delivery, family make-up, community support, disability knowledge of the family, the therapeutic alliance, and methods of implementation. CONCLUSIONS AND IMPLICATIONS Incorporating cultural components into parent-involved interventions will best support intervention implementation and dissemination in diverse communities. Research is needed into the process and outcomes of intervention programs in order to increase understanding of how specific cultural dimensions impact participation in and efficacy of parent-involved interventions for Latinx families of children with ASD.
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Affiliation(s)
| | - Olivia Boorom
- Hearing and Speech Sciences Department, Vanderbilt University, United States.
| | | | - Stephen Camarata
- Hearing and Speech Sciences Department, Vanderbilt University, United States.
| | - Miriam D Lense
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, United States.
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222
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Adrien JL, Taupiac E, Thiébaut E, Paulais MA, Van-Gils J, Kaye K, Blanc R, Gattegno MP, Contejean Y, Michel G, Dean A, Barthélémy C, Lacombe D. A comparative study of cognitive and socio-emotional development in children with Rubinstein-Taybi syndrome and children with Autism Spectrum Disorder associated with a severe intellectual disability, and in young typically developing children with matched developmental ages. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 116:104029. [PMID: 34271530 DOI: 10.1016/j.ridd.2021.104029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 03/19/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cognitive and socio-emotional profiles of children with CREBBP-related Rubinstein-Taybi syndrome (RSTS 1), children with Autism Spectrum Disorder (ASD) with severe intellectual disability and developmental ages (DA) under 24 months, and typically developing (TD) children with similar DA were compared. PARTICIPANTS Thirty-one children with RSTS 1 (mean chronological age, CA = 59,8 months; 33-87) and thirty children with ASD, matched on CA and DA and developmental quotients (DQ), were compared to thirty TD children (CA ranged from 12 to 24 months). METHODS Cognitive and socio-emotional developmental levels, DA and DQ were assessed with appropriated tests. RESULTS More socio-emotional developmental similarities were observed between TD and RSTS 1 than between TD and ASD children. Clinical groups displayed similar developmental delays in cognitive (self-image, symbolic play, means-ends, and object permanence) and socio-emotional domains (language and imitation). Children with RSTS 1 exhibited higher developmental levels in behavior regulation, joint attention, affective relations, emotional expression domains, and a lower developmental level in spatial relations domain. CONCLUSIONS Common interventions centered on symbolic play, self-image, language, and imitation for both clinical groups, and differentiated interventions centered on spatial abilities for RSTS 1 children and on social abilities for ASD could be used by caregivers were suggested.
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Affiliation(s)
- Jean-Louis Adrien
- Laboratory of Psychopathology and Health Processes (EA n°4057), Department of Psychology, University of Paris, 71 avenue Edouard Vaillant, 92774 Boulogne-Billancourt, France.
| | - Emmanuelle Taupiac
- Department of Medical Genetics, CHU Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux Cedex, France
| | - Eric Thiébaut
- Lorrain Laboratory of Psychology and Neuroscience of Behavior Dynamics (2LPN), University of Lorraine, 34, Cours Léopold, BP 3397, 54015 Nancy, France
| | - Marie-Anna Paulais
- Psychology Practice ESPAS-Sup, 18, rue René-Firmin, 60700 Pont-Ste-Maxence, France
| | - Julien Van-Gils
- Department of Medical Genetics, CHU Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux Cedex, France; INSERM Unit 1211, Laboratory "Rare Diseases: Genetics and Metabolism", University of Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux Cedex, France
| | - Kelley Kaye
- Child Psychiatry Department of Sainte Anne Hospital, CREDAT, 1, rue Cabanis 75014, Paris, France
| | - Romuald Blanc
- Laboratory of Psychopathology and Health Processes (EA n°4057), Department of Psychology, University of Paris, 71 avenue Edouard Vaillant, 92774 Boulogne-Billancourt, France; Child Psychiatry Department of University Hospital Bretonneau, 2, boulevard Tonnellé, 37000 Tours, France; Direction of the Scientific Interest Grouping for Autism and Neurodevelopmental Disorders, INSERM, Paris, France
| | - Maria Pilar Gattegno
- Laboratory of Psychopathology and Health Processes (EA n°4057), Department of Psychology, University of Paris, 71 avenue Edouard Vaillant, 92774 Boulogne-Billancourt, France; Psychology Practice ESPAS-Sup, 3 rue Victoire-Américaine, 33000 Bordeaux, France
| | - Yves Contejean
- Child Psychiatry Department of Sainte Anne Hospital, CREDAT, 1, rue Cabanis 75014, Paris, France
| | - Grégory Michel
- Institute of Criminal Sciences and Justice (ISCJ - EA 4061), University Victor Segalen Bordeaux 2, 4, rue du Maréchal Joffre - CS, 61752 - 33075 Bordeaux Cedex, France
| | - Annika Dean
- Fondation Les Amis de l'Atelier, 17 rue de l'égalité, 92290 Châtenay-Malabry, France
| | - Catherine Barthélémy
- Direction of the Scientific Interest Grouping for Autism and Neurodevelopmental Disorders, INSERM, Paris, France
| | - Didier Lacombe
- Department of Medical Genetics, CHU Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux Cedex, France; INSERM Unit 1211, Laboratory "Rare Diseases: Genetics and Metabolism", University of Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux Cedex, France
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223
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Clipperton-Allen AE, Zhang A, Cohen OS, Page DT. Environmental Enrichment Rescues Social Behavioral Deficits and Synaptic Abnormalities in Pten Haploinsufficient Mice. Genes (Basel) 2021; 12:1366. [PMID: 34573348 PMCID: PMC8468545 DOI: 10.3390/genes12091366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/20/2021] [Accepted: 08/26/2021] [Indexed: 01/16/2023] Open
Abstract
Pten germline haploinsufficient (Pten+/-) mice, which model macrocephaly/autism syndrome, show social and repetitive behavior deficits, early brain overgrowth, and cortical-subcortical hyperconnectivity. Previous work indicated that altered neuronal connectivity may be a substrate for behavioral deficits. We hypothesized that exposing Pten+/- mice to environmental enrichment after brain overgrowth has occurred may facilitate adaptation to abnormal "hard-wired" connectivity through enhancing synaptic plasticity. Thus, we reared Pten+/- mice and their wild-type littermates from weaning under either standard (4-5 mice per standard-sized cage, containing only bedding and nestlet) or enriched (9-10 mice per large-sized cage, containing objects for exploration and a running wheel, plus bedding and nestlet) conditions. Adult mice were tested on social and non-social assays in which Pten+/- mice display deficits. Environmental enrichment rescued sex-specific deficits in social behavior in Pten+/- mice and partially rescued increased repetitive behavior in Pten+/- males. We found that Pten+/- mice show increased excitatory and decreased inhibitory pre-synaptic proteins; this phenotype was also rescued by environmental enrichment. Together, our results indicate that environmental enrichment can rescue social behavioral deficits in Pten+/- mice, possibly through normalizing the excitatory synaptic protein abundance.
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Affiliation(s)
| | | | | | - Damon Theron Page
- Department of Neuroscience, The Scripps Research Institute, Jupiter, FL 33458, USA; (A.E.C.-A.); (A.Z.); (O.S.C.)
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224
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A Systematic Review of Play-Based Interventions Targeting the Social Communication Skills of Children with Autism Spectrum Disorder in Educational Contexts. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractChildren with autism spectrum disorder (ASD) experience social communication difficulties which can be compounded by increased social demands and expectations of the school environment. Play offers a unique context for social communication development in educational settings. This systematic review aimed to synthesize play-based interventions for the social communication skills of children with ASD in educational contexts and identified nine studies. Overall, studies in this review provided a promising evidence base for supporting social communication skills through play in education for children with ASD. The review also highlighted gaps in research on play-based interventions for the social communication skills of children with ASD within naturalistic educational settings.
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225
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Dai Y, Zhang L, Yu J, Zhou X, He H, Ji Y, Wang K, Du X, Liu X, Tang Y, Deng S, Langley C, Li WG, Zhang J, Feng J, Sahakian BJ, Luo Q, Li F. Improved symptoms following bumetanide treatment in children aged 3-6 years with autism spectrum disorder: a randomized, double-blind, placebo-controlled trial. Sci Bull (Beijing) 2021; 66:1591-1598. [PMID: 36654288 DOI: 10.1016/j.scib.2021.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/26/2020] [Accepted: 12/23/2020] [Indexed: 02/03/2023]
Abstract
With the current limited drug therapy for the core symptoms of autism spectrum disorder (ASD), we herein report a randomized, double-blind, placebo-controlled trial to investigate the efficacy, safety, and potential neural mechanism of bumetanide in children with ASD aged 3-6 years old. A total of 120 children were enrolled into the study and randomly assigned to either 0.5 mg bumetanide or placebo. In the final sample, 119 children received at least one dose of bumetanide (59 children) or placebo (60 children) were included in the final analysis. The primary outcome was a reduction in the Childhood Autism Rating Scale (CARS) score, and the secondary outcomes were the Clinical Global Impressions Scale (CGI) -Global Improvement (CGI-I) score at 3 months and the change from baseline to 3-month in the Autism Diagnostic Observation Schedule (ADOS). Magnetic resonance spectroscopy (MRS) was used to measure γ-aminobutyric acid (GABA) and glutamate neurotransmitter concentrations in the insular cortex (IC) before and after the treatment. As compared with the placebo, bumetanide treatment was significantly better in reducing the severity. No patient withdrew from the trial due to adverse events. The superiority of bumetanide to placebo in reducing insular GABA, measured using MRS, was demonstrated. The clinical improvement was associated with a decrease in insular GABA in the bumetanide group. In conclusion, this trial in a large group of young children with predominantly moderate and severe ASD demonstrated that bumetanide is safe and effective in improving the core symptoms of ASD. However, the clinical significance remains uncertain, and future multi-center clinical trials are required to replicate these findings and confirm the clinical significance using a variety of outcome measures.
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Affiliation(s)
- Yuan Dai
- Department of Developmental and Behavioural Pediatric & Child Primary Care, Brain and Behavioural Research Unit of Shanghai Institute for Pediatric Research and MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Lingli Zhang
- Department of Developmental and Behavioural Pediatric & Child Primary Care, Brain and Behavioural Research Unit of Shanghai Institute for Pediatric Research and MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Juehua Yu
- Department of Developmental and Behavioural Pediatric & Child Primary Care, Brain and Behavioural Research Unit of Shanghai Institute for Pediatric Research and MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; Centre for Experimental Studies and Research, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
| | - Xin Zhou
- Clinical Research Unit, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Hua He
- Department of Developmental and Behavioural Pediatric & Child Primary Care, Brain and Behavioural Research Unit of Shanghai Institute for Pediatric Research and MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yiting Ji
- Department of Developmental and Behavioural Pediatric & Child Primary Care, Brain and Behavioural Research Unit of Shanghai Institute for Pediatric Research and MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Kai Wang
- Department of Developmental and Behavioural Pediatric & Child Primary Care, Brain and Behavioural Research Unit of Shanghai Institute for Pediatric Research and MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Xiujuan Du
- Department of Developmental and Behavioural Pediatric & Child Primary Care, Brain and Behavioural Research Unit of Shanghai Institute for Pediatric Research and MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Xin Liu
- Department of Developmental and Behavioural Pediatric & Child Primary Care, Brain and Behavioural Research Unit of Shanghai Institute for Pediatric Research and MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yun Tang
- Department of Developmental and Behavioural Pediatric & Child Primary Care, Brain and Behavioural Research Unit of Shanghai Institute for Pediatric Research and MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; The School of Psychology and Cognitive Science, East China Normal University, Shanghai 200062, China
| | - Shining Deng
- Department of Developmental and Behavioural Pediatric & Child Primary Care, Brain and Behavioural Research Unit of Shanghai Institute for Pediatric Research and MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Christelle Langley
- Department of Psychiatry and the Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB21TN, UK
| | - Wei-Guang Li
- Collaborative Innovation Center for Brain Science, Department of Anatomy and Physiology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jun Zhang
- Department of Developmental and Behavioural Pediatric & Child Primary Care, Brain and Behavioural Research Unit of Shanghai Institute for Pediatric Research and MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Ministry of Education-Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence and Research and Research Institute of Intelligent Complex Systems, Fudan University, Shanghai 200433, China
| | - Barbara J Sahakian
- Department of Developmental and Behavioural Pediatric & Child Primary Care, Brain and Behavioural Research Unit of Shanghai Institute for Pediatric Research and MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; Department of Psychiatry and the Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB21TN, UK; Institute of Science and Technology for Brain-Inspired Intelligence, Ministry of Education-Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence and Research and Research Institute of Intelligent Complex Systems, Fudan University, Shanghai 200433, China
| | - Qiang Luo
- Institute of Science and Technology for Brain-Inspired Intelligence, Ministry of Education-Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence and Research and Research Institute of Intelligent Complex Systems, Fudan University, Shanghai 200433, China; State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Institutes of Brain Science and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China.
| | - Fei Li
- Department of Developmental and Behavioural Pediatric & Child Primary Care, Brain and Behavioural Research Unit of Shanghai Institute for Pediatric Research and MOE-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
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226
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Quinn ED, Kaiser AP, Ledford J. Hybrid Telepractice Delivery of Enhanced Milieu Teaching: Effects on Caregiver Implementation and Child Communication. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:3074-3099. [PMID: 34289320 PMCID: PMC9128738 DOI: 10.1044/2021_jslhr-20-00430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/06/2020] [Accepted: 03/23/2021] [Indexed: 05/22/2023]
Abstract
Purpose This study investigated the effects of enhanced milieu teaching (EMT) on caregiver implementation of language support strategies and child communication skills using a hybrid telepractice service delivery model. Method Four caregivers and children with language delays aged 18-27 months participated in a multiple baseline across behaviors single-case research design. The therapist provided EMT to each caregiver-child dyad using a hybrid telepractice service delivery model with approximately 40% in-person and 60% telepractice sessions. Caregivers were taught to use five EMT language support strategies: matched turns, target talk, expansions, time delays, and milieu teaching episodes. Caregiver instruction followed the Teach-Model-Coach-Review approach. Caregiver outcomes were two measures of EMT implementation fidelity, accuracy, and frequency of EMT strategy use. Accuracy was measured by the percentage of spoken turns in which caregivers used each strategy correctly. Frequency was measured by the number of spoken turns in which caregivers used each strategy correctly. Child outcomes were number of communication acts, weighted count of communication acts, and number of different words. Results There was a functional relation between the intervention and the accuracy of EMT strategy use for all four dyads, and the frequency of strategy use for three dyads. Caregiver use of EMT strategies maintained for 6 weeks post-intervention. After caregivers learned EMT strategies, gradual increases in the number of communication acts, weighted count of communication acts, and number of different words occurred for three children. Conclusion Results demonstrate the preliminary efficacy of using a hybrid telepractice service delivery model to teach caregivers EMT language support strategies. Supplemental Material https://doi.org/10.23641/asha.14977605.
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Affiliation(s)
- Emily D. Quinn
- Institute on Development and Disability, Department of Pediatrics, Oregon Health & Science University, Portland
| | - Ann P. Kaiser
- Department of Special Education, Vanderbilt University, Nashville, TN
| | - Jennifer Ledford
- Department of Special Education, Vanderbilt University, Nashville, TN
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227
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Salomone E, Ferrante C, Salandin A, Ferrara F, Torchio E, Foletti G, Ghersi S, Pacione L, Servili C. Acceptability and feasibility of the World Health Organization's Caregiver Skills Training implemented in the Italian National Health System. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:859-874. [PMID: 34362266 DOI: 10.1177/13623613211035228] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Across the globe, children with neurodevelopmental disorders, including autism, have limited access to care through public services. To improve access to care the World Health Organization developed a novel, open-access programme: the Caregiver Skills Training programme. The Caregiver Skills Training consists of nine group sessions and three individual home visits, focused on training the caregiver on how to use everyday play and home routines as opportunities for learning and development. We implemented Caregiver Skills Training in public child neuropsychiatry services in Italy and examined with questionnaires and focus groups how feasible it was to deliver the programme in public health settings and how acceptable and relevant it was for caregiver users. We found that the Caregiver Skills Training was largely considered acceptable and relevant for families and feasible to deliver. We discuss potential solutions to address the specific implementation challenges that were identified, such as strategies to improve training of interventionists and overcome barriers to caregiver participation.
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Affiliation(s)
- Erica Salomone
- University of Milano-Bicocca, Italy.,World Health Organization, Switzerland
| | | | | | | | | | | | | | | | | | - Laura Pacione
- World Health Organization, Switzerland.,University of Toronto, Canada
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228
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Waddington H, Reynolds JE, Macaskill E, Curtis S, Taylor LJ, Whitehouse AJ. The effects of JASPER intervention for children with autism spectrum disorder: A systematic review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:2370-2385. [PMID: 34348479 DOI: 10.1177/13623613211019162] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Naturalistic developmental behavioural interventions are promising approaches for young children with, or suspected of having, autism spectrum disorder. Joint attention, symbolic play, engagement and regulation intervention (JASPER) is a well-researched naturalistic developmental behavioural intervention but, to date, no reviews have specifically evaluated its effects. This systematic literature review examined the effects of JASPER intervention and its components on child, parent and educator outcomes. Of the 96 articles screened, 19 were eligible for inclusion in the review. Most studies found that children who received JASPER intervention showed significantly greater improvements in at least one outcome related to child joint attention, joint engagement, play skills and language skills compared to the comparison group. Implementation outcomes for parents and educators were generally positive. There were no consistent predictors or mediators of treatment effects. None of the studies met all of the quality indicators outlined by the Council of Exceptional Children, and the majority of outcome measures were classified as proximal. Overall, JASPER intervention appears promising in improving child outcomes directly targeted during treatment. More research is needed to determine whether it is also effective in improving a wider range of outcomes for children with autism spectrum disorder.Lay abstractInterventions which are delivered in natural contexts and use both developmental and behavioural techniques may be helpful for children with, or suspected of having, autism spectrum disorder. Joint attention, symbolic play, engagement and regulation (JASPER) is a type of intervention, which falls under this category. Although several studies have examined the effects of JASPER, this has not yet been summarised in a review. This systematic literature review examined the effects of JASPER intervention, and the techniques that make up JASPER, on child, parent and educator outcomes. We screened 96 articles and, of these, 19 were included in the review. Most studies found that children who received JASPER intervention showed significantly greater improvements in at least one outcome related to child joint attention, joint engagement, play skills, and language skills compared to children who did not receive JASPER intervention. Parents and educators were mostly able to use the JASPER techniques. There were no consistent child, parent, teacher or treatment characteristics that influenced the effects of the JASPER intervention. None of the studies met all of the indicators of being a good quality study outlined by the Council of Exceptional Children. Overall, JASPER intervention appears promising in improving child outcomes directly targeted during treatment. More research is needed to determine whether it is also effective in improving a wider range of outcomes for children with autism spectrum disorder.
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Affiliation(s)
| | | | | | | | | | - Andrew Jo Whitehouse
- Telethon Kids Institute, Australia.,The University of Western Australia, Australia
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229
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Latrèche K, Kojovic N, Franchini M, Schaer M. Attention to Face as a Predictor of Developmental Change and Treatment Outcome in Young Children with Autism Spectrum Disorder. Biomedicines 2021; 9:942. [PMID: 34440147 PMCID: PMC8392329 DOI: 10.3390/biomedicines9080942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/16/2022] Open
Abstract
The beneficial effect of early intervention is well described for children with autism spectrum disorder (ASD). Response to early intervention is, however, highly heterogeneous in affected children, and there is currently only scarce information about predictors of response to intervention. Based on the hypothesis that impaired social orienting hinders the subsequent development of social communication and interactions in children with ASD, we sought to examine whether the level of social orienting modulates treatment outcome in young children with ASD. We used eye-tracking technology to measure social orienting in a group of 111 preschoolers, comprising 95 young children with ASD and 16 children with typical development, as they watched a 29 s video of a woman engaging in child-directed speech. In line with previous studies, we report that attention to face is robustly correlated with autistic symptoms and cognitive and adaptive skills at baseline. We further leverage longitudinal data in a subgroup of 81 children with ASD and show that the level of social orienting at baseline is a significant predictor of developmental gains and treatment outcome. These results pave the way for identifying subgroups of children who show a better response to early and intensive intervention, a first step toward precision medicine for children with autism.
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Affiliation(s)
- Kenza Latrèche
- Department of Psychiatry, Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland; (N.K.); (M.S.)
| | - Nada Kojovic
- Department of Psychiatry, Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland; (N.K.); (M.S.)
| | | | - Marie Schaer
- Department of Psychiatry, Faculty of Medicine, University of Geneva, 1206 Geneva, Switzerland; (N.K.); (M.S.)
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230
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Wolff JJ, Piven J. Predicting Autism in Infancy. J Am Acad Child Adolesc Psychiatry 2021; 60:958-967. [PMID: 33161062 PMCID: PMC8158398 DOI: 10.1016/j.jaac.2020.07.910] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/09/2020] [Accepted: 10/28/2020] [Indexed: 12/17/2022]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication and interaction deficits and restricted, repetitive patterns of interests and behavior that are evident in early childhood. Its prevalence has grown substantially over the past several decades, with current estimates ranging from 1.7% to 2.5% in the United States.1,2 This represents more than 1.5 million children with ASD, the vast majority of whom receive or will receive specialized services.2 Each year, approximately 100,000 (and growing) individuals with ASD reach adulthood, and many face myriad challenges related to employment, housing, mental health, and overburdened or insufficient support services.3-5 A host of significant costs can be associated with ASD, from direct costs related to the provision of special education programs, housing, and medical care to indirect costs, such as loss of productivity affecting both individuals with ASD and their families.6 Currently, overall lifetime cost of care per person with ASD can exceed $3 million, totaling more than $265 billion annually in the United States and rising to an estimated $1 trillion by 2025.7,8.
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Affiliation(s)
- Jason J. Wolff
- Department of Educational Psychology, University of Minnesota
| | - Joseph Piven
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill
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231
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Hampton LH, Sandbank MP. Keeping up with the evidence base: Survey of behavior professionals about Naturalistic Developmental Behavioral Interventions. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:875-888. [PMID: 34320872 DOI: 10.1177/13623613211035233] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Primary service providers for young children on the autism spectrum and developmentally delayed children use many strategies under the umbrella of applied behavior analysis therapy. The evidence supporting interventions for children on the autism spectrum has changed last decade, and powerful research supports the relative effectiveness of Naturalistic Developmental Behavior Interventions, yet a few professionals serving young children on the autism spectrum receive training in this category of interventions. Board Certified Behavior Analysts and related professionals are the primary service providers for this population. The purpose of this survey study is to describe and understand the knowledge and beliefs that Behavior Analyst Certification Board certificants have around Naturalistic Developmental Behavior Interventions. The survey was completed by 901 respondents. Respondents indicated, on average, little to no knowledge of Naturalistic Developmental Behavior Intervention practices and few believe that these practices are effective or appropriate for the field. Recommendations include increasing training opportunities for related professionals, and changing certification requirements to match the current evidence.
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232
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The Early Start Denver Model Intervention and Mu Rhythm Attenuation in Autism Spectrum Disorders. J Autism Dev Disord 2021; 52:3304-3313. [PMID: 34309743 DOI: 10.1007/s10803-021-05190-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
We examined the relationship between the Early start Denver model (ESDM) intervention and mu rhythm attenuation, an EEG paradigm reflecting neural processes associated with action perception and social information processing. Children were assigned to either receive comprehensive ESDM intervention for two years, or were encouraged to pursue resources in the community. Two years after intervention, EEG was collected during the execution and observation of grasping actions performed by familiar and unfamiliar agents. The ESDM group showed significantly greater attenuation when viewing a parent or caregiver executing a grasping action, compared with an unfamiliar individual executing the same action. Our findings suggest that the ESDM may have a unique impact on neural circuitry underlying social cognition and familiarity.
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233
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Tripathi I, Estabillo JA, Moody CT, Laugeson EA. Long-Term Treatment Outcomes of PEERS ® for Preschoolers: A Parent-Mediated Social Skills Training Program for Children with Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:2610-2626. [PMID: 34302574 PMCID: PMC9114088 DOI: 10.1007/s10803-021-05147-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 12/02/2022]
Abstract
Although parent-assisted social skills interventions may reduce early social challenges in preschool-aged children with autism spectrum disorder (ASD), limited research has explored whether intervention gains maintain several years after treatment. This study examined the durability of PEERS® for Preschoolers, a parent-mediated social skills training program for preschool-aged children with ASD and other social challenges. Twenty-nine parents reported on child and family outcomes 1–5 years following treatment. Results demonstrated maintenance of treatment gains on measures of ASD-related social impairments including social communication, social responsiveness, social motivation, and peer engagement. Post-treatment improvements in problem behaviors and parenting stress were not maintained at long-term follow-up. Implications of these results are discussed.
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Affiliation(s)
- Isita Tripathi
- Semel Institute for Neuroscience and Human Behavior, University of California, 300 UCLA Medical Plaza, Los Angeles, CA, 90095-6967, USA. .,Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Jasper A Estabillo
- Semel Institute for Neuroscience and Human Behavior, University of California, 300 UCLA Medical Plaza, Los Angeles, CA, 90095-6967, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, 300 UCLA Medical Plaza, Los Angeles, CA, 90095-6967, USA.,Department of Psychology, University of California, 1264 Franz Hall, Los Angeles, CA, 90095-1759, USA
| | - Christine T Moody
- Semel Institute for Neuroscience and Human Behavior, University of California, 300 UCLA Medical Plaza, Los Angeles, CA, 90095-6967, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, 300 UCLA Medical Plaza, Los Angeles, CA, 90095-6967, USA
| | - Elizabeth A Laugeson
- Semel Institute for Neuroscience and Human Behavior, University of California, 300 UCLA Medical Plaza, Los Angeles, CA, 90095-6967, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, 300 UCLA Medical Plaza, Los Angeles, CA, 90095-6967, USA
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234
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Reetzke R, Pfeiffer D, Kalb LG, Holingue C, Zetlmeisl C, Hong JS, Landa R. Informant (Dis)Agreement on Ratings of Challenging Behaviors and Social Communication in Preschool Children With Autism Spectrum Disorder. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2766-2775. [PMID: 34048667 PMCID: PMC8632507 DOI: 10.1044/2021_jslhr-20-00707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/03/2021] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
Purpose Cross-informant ratings are considered best practice for assessing children with autism spectrum disorder (ASD). However, informant disagreement often occurs, which can pose significant challenges to various aspects of clinical services. This study explored the degree of parent and speech-language pathologist (SLP) agreement on ratings of challenging behaviors and social communication skills in preschool children with ASD. Method Fifty-eight informant ratings of challenging behaviors and social communication skills were collected from parents and SLPs on the same 29 preschool children with ASD (M = 49.93 months, SD = 11.67 months) using the Pervasive Developmental Disorder Behavior Inventory. Parent versus SLP group rating comparisons were assessed with paired t tests and Cohen's d effect sizes. Intraclass correlation coefficients were calculated to examine interrater reliability between individual parent and SLP ratings. Bland-Altman plots were generated to evaluate informant agreement across the entire range of Pervasive Developmental Disorder Behavior Inventory composite scores. Results Group comparisons indicated that parents rated arousal regulation problems as more severe than SLPs, with no other group differences observed. Parents and SLPs exhibited poor agreement on ratings of challenging behaviors; however, moderate to good agreement was observed for social communication ratings. Conclusions These results highlight the importance of including parents in the assessment and treatment planning process for preschool children with ASD, as parents may report key behavioral concerns that clinicians may not otherwise observe. Understanding behaviors that may be more prone to informant disagreement has implications for promoting a shared understanding of behavioral concerns and treatment targets between parents and clinicians.
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Affiliation(s)
- Rachel Reetzke
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Danika Pfeiffer
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Luther G. Kalb
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Mental Health, Kennedy Krieger Institute, Baltimore, MD
| | - Calliope Holingue
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Mental Health, Kennedy Krieger Institute, Baltimore, MD
| | - Carrie Zetlmeisl
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD
| | - Ji Su Hong
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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235
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Vasilevska Petrovska I, Giannakopoulou AC, Tsecoura V, Winstanley A, Miletto R, Roşca GC, Ivanova B, Kaisa V, Trajkovski V. Parental perspectives on support needs and availability of autism services in South and South-Eastern Europe. ADVANCES IN AUTISM 2021. [DOI: 10.1108/aia-11-2020-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Amid the expanding demand on the autism service delivery system, little knowledge is accumulated regarding access and availability of support and services in the region of Southern and South-Eastern Europe – critical for improvement of individual outcomes, as well as family quality of life. The purpose of this paper is to explore how service delivery systems are responding to the specific needs of autistic individuals with autism, as perceived by parents.
Design/methodology/approach
A qualitative exploratory descriptive method was used. Thematic analysis was used as a pragmatic method to report on the experiences of parents (92% mothers, n = 55) of children, youth and young autistic adults (76% male) across six South and South-Eastern European counties that participated in a survey involving a combination of qualitative and quantitative data collection.
Findings
Thematic analysis revealed three broad themes: challenging pathways to service utilization, insufficient service options and providers’ competences and lack of continuous and meaningful support across life span.
Originality/value
The findings from this study add to the small body of literature specific to South and South-Eastern Europe, by exposing problems related to meeting the needs of autistic children and youth and potential ways to strengthen services, as perceived by parents. The findings have potential policy ramifications for the region in which the research was conducted.
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236
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Abstract
This article describes the current understanding of the identification, classification, and diagnosis of autism spectrum disorder (ASD) as it relates to the practice of primary care providers. In addition, the most updated information regarding risk factors, as well as effective treatment strategies are provided. Although primary care providers are not typically the experts in ASD treatment, they constitute a critical component of the care team responsible for early identification and intervention initiation for patients with ASD.
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Affiliation(s)
- Ashley Iles
- 215 Central Avenue Suite 100, Louisville, KY 40208, USA.
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237
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Hernandez Ruiz E, Braden BB. Improving a Parent Coaching Model of Music Interventions for Young Autistic Children. J Music Ther 2021; 58:278-309. [PMID: 34219172 DOI: 10.1093/jmt/thab008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Parenting a child on the autism spectrum can be rewarding and enriching, but it may also increase risk of parental fatigue, stress, anxiety, and depression. Parent-mediated interventions contribute to increase family satisfaction and child social communication while helping to decrease parental stress and fatigue. Parent coaching, the education of parents in evidence-based strategies, has become common in the autism field. However, parent coaching in music therapy has only recently emerged and has limited research with families with an autistic member. In this study, we attempted to improve a previously published model of parent coaching, adapting only one aspect of the Early Start Denver Model (ESDM), the sensory social routine (SSR) to create a music intervention. Four parents participated in this 6-session parent coaching study. We compared the SSR-based intervention with and without music, in an alternating treatment design. Measures included parental responsiveness, child receptive and initiation joint attention, parent-child similar affect and synchronized gaze, and the Parent Coaching-ESDM (PC-ESDM) parent fidelity rating system. Results from these observational measures were mixed, with better parental responses in the no-music condition, but improved child responses and parent-child synchrony in the music condition for 3 out of the 4 participants. Parent learning increased for all participants, and 3 out of the 4 reached fidelity (a score of at least 80%), according to the PC-ESDM. Although mixed results were observed across participants, implications for practice are possible. Better outcome measures of this complex intervention are needed.
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238
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Srinivasan SM, Su WC, Cleffi C, Bhat AN. From Social Distancing to Social Connections: Insights From the Delivery of a Clinician-Caregiver Co-mediated Telehealth-Based Intervention in Young Children With Autism Spectrum Disorder. Front Psychiatry 2021; 12:700247. [PMID: 34276452 PMCID: PMC8280343 DOI: 10.3389/fpsyt.2021.700247] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/07/2021] [Indexed: 12/11/2022] Open
Affiliation(s)
- Sudha M. Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Mansfield, CT, United States
| | - Wan-Chun Su
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States
| | - Corina Cleffi
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States
| | - Anjana N. Bhat
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States
- Department of Psychological and Brain Science, University of Delaware, Newark, DE, United States
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239
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Klinger LG, Cook ML, Dudley KM. Predictors and Moderators of Treatment Efficacy in Children and Adolescents with Autism Spectrum Disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021; 50:517-524. [PMID: 33210939 PMCID: PMC8986328 DOI: 10.1080/15374416.2020.1833735] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The heterogeneous symptom presentation of autism spectrum disorder (ASD) requires clinicians to consider each child's unique constellation of symptoms and tailor intervention accordingly. Treatment moderators, though necessary to guide evidence-based treatment decisions, are significantly under-studied. This brief report aims to expand on previous literature by providing an overview of characteristics which may influence treatment outcome and specifying future directions to build on this preliminary evidence base. METHOD A subset of treatment modalities was identified from the National Clearinghouse on Autism Evidence and Practice Review Team's most recent report including discrete trial early intensive behaviorally based treatment, social skills training, and cognitive behavioral interventions. Within these treatment modalities, individual interventions with significant support were specifically discussed. Due to the lack of research on treatment moderators, a discussion of significant predictors of treatment outcome is also included. RESULTS Preliminary evidence suggests that overall, treatment intensity, duration, and parent involvement are the most consistently identified predictors (and in some studies, moderators) of treatment outcome; sessions which occur more frequently, continue for longer periods of time, and include parent training or coaching may yield the best outcomes. Other characteristics, including age and IQ, have been widely debated, with differing results found across treatment modalities. CONCLUSIONS The sparsity of research demonstrates a clear need for continued research on moderators to guide clinical judgment. Future studies that recruit larger samples targeting specific ASD symptoms at specific ages may be more adequately powered to detect these moderating effects.
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Affiliation(s)
- Laura Grofer Klinger
- Department of Psychiatry, TEACCH Autism Program, University of North Carolina at Chapel Hill
| | - Michal L Cook
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | - Katerina M Dudley
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
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240
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Levitskiy D, Confair A, Wagner KE, DeVita S, Shea N, McKernan EP, Kopec J, Russo N, Middleton FA, Hicks SD. Longitudinal stability of salivary microRNA biomarkers in children and adolescents with autism spectrum disorder. RESEARCH IN AUTISM SPECTRUM DISORDERS 2021; 85:101788. [PMID: 34025747 PMCID: PMC8139124 DOI: 10.1016/j.rasd.2021.101788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a complex neurological condition with increasing prevalence. Few tools accurately predict the developmental trajectory of children with ASD. Such tools would allow clinicians to provide accurate prognoses and track the efficacy of therapeutic interventions. Salivary RNAs that reflect the genetic-environmental interactions underlying ASD may provide objective measures of symptom severity and developmental outcomes. This study investigated whether salivary RNAs previously identified in childhood ASD remain perturbed in older children. We also explored whether RNA candidates changed with therapeutic intervention. METHOD A case-control design was used to characterize levels of 78 saliva RNA candidates among 96 children (48 ASD, 48 non-ASD, mean age: 11 years). Thirty-one children (22 ASD, 9 non-ASD developmental delay, mean age: 4 years) were followed longitudinally to explore changes of RNA candidates during early intervention. Saliva RNA and standardized behavioral assessments were collected for each participant. Associations between candidate RNAs and behavioral scores were determined in both groups via Spearman Correlation. Changes in candidate RNAs across two time-points were assessed in the younger cohort via Wilcoxon rank-sum test. RESULTS Seven RNAs were associated with VABS-II and BASC scores in the older group ([R] >0.25, FDR< 0.15). Within the younger cohort, 12 RNAs displayed significant changes over time (FDR< 0.05). Three microRNAs were associated with behavioral scores and changed over time (miR-182-5p, miR-146b-5p, miR-374a-5p). CONCLUSION Several salivary RNAs are strongly associated with autistic behaviors in older individuals with ASD and change as early as three months after therapy initiation in younger children. These molecules could be used to track treatment effectiveness and provide prognoses. Further validation is necessary.
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Affiliation(s)
- David Levitskiy
- Quadrant Biosciences Inc., 505 Irving Ave, Suite 3100 AB, Syracuse, NY 13210
| | - Alexandra Confair
- Penn State College of Medicine, Department of Pediatrics, Hershey PA, 17033
| | - Kayla E. Wagner
- Quadrant Biosciences Inc., 505 Irving Ave, Suite 3100 AB, Syracuse, NY 13210
| | - Samantha DeVita
- Quadrant Biosciences Inc., 505 Irving Ave, Suite 3100 AB, Syracuse, NY 13210
| | - Nicole Shea
- Syracuse University, Department of Psychology, Syracuse NY13210
| | | | - Justin Kopec
- Syracuse University, Department of Psychology, Syracuse NY13210
| | - Natalie Russo
- Syracuse University, Department of Psychology, Syracuse NY13210
| | - Frank A. Middleton
- SUNY Upstate Medical University, Department of Neuroscience and Physiology, Syracuse, NY 13210
| | - Steven D. Hicks
- Penn State College of Medicine, Department of Pediatrics, Hershey PA, 17033
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241
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Carpente J, Casenhiser DM, Kelliher M, Mulholland J, Sluder HL, Crean A, Cerruto A. The impact of imitation on engagement in minimally verbal children with autism during improvisational music therapy. NORDIC JOURNAL OF MUSIC THERAPY 2021. [DOI: 10.1080/08098131.2021.1924843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- John Carpente
- Rebecca Center for Music Therapy at Molloy College, Rockville Centre, NY, USA
| | - Devin M. Casenhiser
- Department of Audiology & Speech Pathology, University of Tennessee Health Science Center, Knoxville, TN, USA
| | - Michael Kelliher
- Rebecca Center for Music Therapy at Molloy College, Rockville Centre, NY, USA
| | - Jill Mulholland
- Rebecca Center for Music Therapy at Molloy College, Rockville Centre, NY, USA
| | - H. Logan Sluder
- Department of Audiology & Speech Pathology, University of Tennessee Health Science Center, Knoxville, TN, USA
| | - Anne Crean
- Rebecca Center for Music Therapy at Molloy College, Rockville Centre, NY, USA
| | - Audra Cerruto
- Rebecca Center for Music Therapy at Molloy College, Rockville Centre, NY, USA
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242
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Beiting M, Maas E. Autism-Centered Therapy for Childhood Apraxia of Speech (ACT4CAS): A Single-Case Experimental Design Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1525-1541. [PMID: 33684309 DOI: 10.1044/2020_ajslp-20-00131] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose A subset of children with autism spectrum disorder (ASD) has speech sound disorders, including childhood apraxia of speech (CAS). To date, virtually all speech treatment studies consider ASD an exclusionary criterion, resulting in little scientific evidence for treatment of CAS for children who also have ASD. This study proposes and tests a novel approach, Autism-Centered Therapy for Childhood Apraxia of Speech (ACT4CAS), as a theoretically and clinically informed speech treatment option for this population. Method Using a multiple-baseline design within and across participants, three children with co-occurring ASD and CAS received 11-18 treatment sessions. Treatment targets were individually designed and matched with untreated control words. Probes were administered at the start of each session to assess speech production accuracy perceptually. Changes in production accuracy were examined through visual inspection and quantified with effect sizes. Results Findings were mixed, with one child showing significant gains for half of the treated targets at follow-up and two children showing no clear improvement. Conclusions Preliminary evidence suggests potentially positive treatment effects for ACT4CAS when implemented as intended, although treatment intensity and disorder severity likely influence treatment outcome. Replication and comparison of ACT4CAS to other speech treatments is needed. Supplemental Material https://doi.org/10.23641/asha.14110445.
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Affiliation(s)
- Molly Beiting
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
| | - Edwin Maas
- Department of Communication Sciences and Disorders, Temple University, Philadelphia, PA
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243
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Grzadzinski R, Nowell SW, Crais ER, Baranek GT, Turner-Brown L, Watson LR. Parent responsiveness mediates the association between hyporeactivity at age 1 year and communication at age 2 years in children at elevated likelihood of ASD. Autism Res 2021; 14:2027-2037. [PMID: 34128355 DOI: 10.1002/aur.2557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/05/2021] [Accepted: 05/18/2021] [Indexed: 11/11/2022]
Abstract
Studies suggest that higher parent responsiveness is associated with higher child language abilities. Infants and toddlers later diagnosed with autism spectrum disorder (ASD) often display hyporeactivity to sensory stimuli, which has also been associated with lower child communication abilities and lower parent responsiveness. Yet, whether parent responsiveness mediates the relationship between child hyporeactivity and later communication outcomes remains unexplored. This study is a secondary data analysis which includes children (n = 83; 56 males) identified as at elevated likelihood of later ASD. Children completed an observational measure of sensory reactivity and a standard developmental assessment at 14 (Time 1) and 23 months old (Time 2). At each time point, parents reported on the child's adaptive communication behaviors and sensory behaviors, and Parent Verbal Responsiveness (AvgPVR) was coded from parent-child free-play videos. Results indicated that the association between child sensory hyporeactivity at Time 1 (observed and parent-reported) and communication at Time 2 (observed and parent reported) was significantly mediated by AvgPVR. Although child hyporeactivity predicts poorer communication outcomes, increased parent verbal responsiveness may attenuate this negative impact. Parent responsiveness, a focus of many parent-mediated interventions, may be an important mechanism of treatment response that should be directly tested in future research. LAY SUMMARY: Toddlers at elevated likelihood of autism spectrum disorder (ASD) are often under-reactive (hyporeactive) to sensory stimuli. This hyporeactivity slows learning of communication skills and provides parents with fewer opportunities to respond to their children. In this study, children with hyporeactivity at 14 months generally had poorer communication at 23 months; however, the more responsive their parents were, the weaker the relationship between early hyporeactivity and later communication. Thus, increasing parent responsiveness may lead to better communication outcomes for toddlers with the early ASD symptom of hyporeactivity.
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Affiliation(s)
- Rebecca Grzadzinski
- Program for Early Autism Research, Leadership, and Service (PEARLS), University of North Carolina, Chapel Hill, North Carolina, USA.,University of North Carolina, Carolina Institute for Developmental Disabilities, Chapel Hill, North Carolina, USA
| | - Sallie W Nowell
- University of North Carolina, Frank Porter Graham Child Development Institute, Chapel Hill, North Carolina, USA
| | - Elizabeth R Crais
- Program for Early Autism Research, Leadership, and Service (PEARLS), University of North Carolina, Chapel Hill, North Carolina, USA.,Division of Speech and Hearing Sciences, University of North Carolina
| | - Grace T Baranek
- Program for Early Autism Research, Leadership, and Service (PEARLS), University of North Carolina, Chapel Hill, North Carolina, USA.,The Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Lauren Turner-Brown
- Program for Early Autism Research, Leadership, and Service (PEARLS), University of North Carolina, Chapel Hill, North Carolina, USA.,University of North Carolina, TEACCH Autism Program, Chapel Hill, North Carolina, USA
| | - Linda R Watson
- Program for Early Autism Research, Leadership, and Service (PEARLS), University of North Carolina, Chapel Hill, North Carolina, USA.,Division of Speech and Hearing Sciences, University of North Carolina
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244
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Sosnowski DW, Stough CO, Weiss MJ, Cessna T, Casale A, Foran A, Erwinski M, Wilson J, Farber SA, Farber MA. Brief Report: A Novel Digital Therapeutic that Combines Applied Behavior Analysis with Gaze-Contingent Eye Tracking to Improve Emotion Recognition in Children with Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:2357-2366. [PMID: 34060003 DOI: 10.1007/s10803-021-05101-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
This study examined the feasibility, acceptability, and efficacy of a video game-based digital therapeutic combining applied behavior analysis techniques and gaze-contingent eye tracking to target emotion recognition in youth with autism spectrum disorder (ASD). Children aged 4-14 years with ASD were randomized to complete Lookware™ (n = 25) or a control video game (n = 29). Results from a 2 × 2 mixed ANOVA revealed that children in the intervention condition demonstrated significant improvements in emotion recognition from pre- to post-intervention compared to children in the control condition, F(1,52) = 17.48, p < 0.001. Children and staff perceived high feasibility and acceptability of Lookware™. Study results demonstrated the feasibility, acceptability, and preliminary efficacy of Lookware™.
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Affiliation(s)
- David W Sosnowski
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Tahra Cessna
- Positive Behavior Supports Corporation, Stuart, FL, USA
| | - Amy Casale
- Nashoba Learning Group, Inc., Bedford, MA, USA
| | | | | | | | - Steven A Farber
- Department of Embryology, Carnegie Institution for Science, Baltimore, MD, USA
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245
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Syriopoulou-Delli CK, Eleni G. Effectiveness of Different Types of Augmentative and Alternative Communication (AAC) in Improving Communication Skills and in Enhancing the Vocabulary of Children with ASD: a Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00269-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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246
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Janouschek H, Chase HW, Sharkey RJ, Peterson ZJ, Camilleri JA, Abel T, Eickhoff SB, Nickl-Jockschat T. The functional neural architecture of dysfunctional reward processing in autism. Neuroimage Clin 2021; 31:102700. [PMID: 34161918 PMCID: PMC8239466 DOI: 10.1016/j.nicl.2021.102700] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/30/2022]
Abstract
Functional imaging studies have found differential neural activation patterns during reward-paradigms in patients with autism spectrum disorder (ASD) compared to neurotypical controls. However, publications report conflicting results on the directionality and location of these aberrant activations. We here quantitatively summarized relevant fMRI papers in the field using the anatomical likelihood estimation (ALE) algorithm. Patients with ASD consistently showed hypoactivations in the striatum across studies, mainly in the right putamen and accumbens. These regions are functionally involved in the processing of rewards and are enrolled in extensive neural networks involving limbic, cortical, thalamic and mesencephalic regions. The striatal hypo-activations found in our ALE meta-analysis, which pooled over contrasts derived from the included studies on reward-processing in ASD, highlight the role of the striatum as a key neural correlate of impaired reward processing in autism. These changes were present for studies using social and non-social stimuli alike. The involvement of these regions in extensive networks associated with the processing of both positive and negative emotion alike might hint at broader impairments of emotion processing in the disorder.
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Affiliation(s)
- Hildegard Janouschek
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Henry W Chase
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Rachel J Sharkey
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Zeru J Peterson
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Department of Psychiatry, University of Iowa, Iowa City, IA, USA
| | - Julia A Camilleri
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ted Abel
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Department of Neuroscience and Pharmacology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Thomas Nickl-Jockschat
- Iowa Neuroscience Institute, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Department of Psychiatry, University of Iowa, Iowa City, IA, USA; Department of Neuroscience and Pharmacology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
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247
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Sone BJ, Kaat AJ, Roberts MY. Measuring parent strategy use in early intervention: Reliability and validity of the Naturalistic Developmental Behavioral Intervention Fidelity Rating Scale across strategy types. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:2101-2111. [PMID: 34030519 DOI: 10.1177/13623613211015003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Children with autism spectrum disorder benefit from early intervention to improve social communication, and parent-implemented interventions are a feasible and family-centered way to increase the amount of treatment they receive. For these treatments to be effective, it is important for the parent to implement the strategies as intended. However, measurement of parent strategy use is inconsistent across studies of parent-implemented interventions. This study evaluates the quality of the NDBI-Fi, an efficient measure, compared to a more time-consuming measure that is known to be precise. Videos of parents playing with their children were used to compare these two measurement methods. Results demonstrated that the NDBI-Fi was of good quality: scorers had high levels of agreement, the NDBI-Fi was similar to the more precise measure in rating parents after intervention, it detected changes from before to after intervention, and it detected differences when parents learned different types of intervention strategies. The NDBI-Fi was not as precise as the other measure across all strategies before parents learned intervention. Taken together, the findings of this study support the use of the NDBI-Fi as a high-quality outcome measure.
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248
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Chazin KT, Ledford JR, Pak NS. A Systematic Review of Augmented Input Interventions and Exploratory Analysis of Moderators. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1210-1223. [PMID: 33789063 PMCID: PMC10110354 DOI: 10.1044/2020_ajslp-20-00102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/13/2020] [Accepted: 12/17/2020] [Indexed: 06/12/2023]
Abstract
Purpose Augmented input is the act of concurrently modeling language verbally and on a communication device, and is one strategy for teaching individuals to effectively use aided modes of communication. The purpose of this literature review is to assess the efficacy of augmented input for increasing communication and to identify intervention components, participant characteristics, and instructional contexts related to therapeutic outcomes. Method We double screened all potential sources and double coded all included sources. Database, forward, and backward searches yielded 99 single case designs in 26 sources. We coded characteristics of participants, instructional contexts, independent variables, and dependent variables. We also coded quality/rigor and primary outcomes for each design or comparison. Results Across high-quality studies, two thirds of designs indicated that augmented input was effective compared to baseline conditions and alternative interventions, and exploratory analyses indicated that receptive language skills, age, and diagnoses may moderate intervention efficacy. Most augmented input interventions included additional components that may serve as "active ingredients" (e.g., systematic prompting, contextual reinforcement). Most studies also did not report participant characteristics hypothesized to moderate intervention efficacy (e.g., joint attention skills, imitation repertoire). Results also indicated high risk of publication bias, with peer-reviewed sources twice as likely to include positive effects than dissertations and theses. Conclusions Across high-quality studies, augmented input was inconsistently effective as a stand-alone intervention. Packaged interventions that included augmented input were typically more effective than augmented input in isolation, particularly for individuals who were young, had strong receptive language skills, or had no comorbid diagnoses.
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Affiliation(s)
- Kate T. Chazin
- Department of Special Education, Vanderbilt University, Nashville, TN
| | | | - Natalie S. Pak
- Department of Special Education, Vanderbilt University, Nashville, TN
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249
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Wainer AL, Arnold ZE, Leonczyk C, Valluripalli Soorya L. Examining a stepped-care telehealth program for parents of young children with autism: a proof-of-concept trial. Mol Autism 2021; 12:32. [PMID: 33964979 PMCID: PMC8105688 DOI: 10.1186/s13229-021-00443-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/30/2021] [Indexed: 12/15/2022] Open
Abstract
Background Intervention during the first years of life for children with autism spectrum disorder (ASD) may have the strongest impact on long-term brain development and functioning. Yet, barriers such as a shortage of trained professionals contribute to significant delays in service. The goal of this proof-of-concept study was to explore strategies that support timely and equitable deployment of ASD-specific interventions. Methods This 15-week, randomized proof-of-concept study explored the acceptability of a digital parent mediated intervention online reciprocal imitation training (RIT; a naturalistic developmental behavioral intervention) and compared it to a treatment as usual (TAU) control on parent and child outcomes. Eligible children were between 18 and 60 months, met the cutoff for ASD on the Autism Diagnostic Observation Schedule-2nd Edition and demonstrate significant social imitation deficits. Primary outcomes include the acceptability of RIT (Scale of Treatment Perceptions) and the feasibility of the Online RIT digital intervention (online RIT attributes). Secondary outcomes included parent fidelity (RIT parent fidelity form) and parental self-efficacy (Early Intervention Parenting Self-Efficacy Scale). Exploratory outcome measures included child social communication (Social Communication Checklist), child imitation skills (Unstructured Imitation Assessment), and family quality of life (Beach Center Family Quality of Life Scale). Results Twenty participants were randomized in a 1:1 fashion. The acceptability and feasibility of RIT and the Online RIT digital intervention were rated highly. Among the secondary outcomes, there were significant group differences in parent fidelity (p < .001) and self-efficacy (p = .029). On exploratory outcomes, there were group differences in child social communication (p = .048). There were no significant group differences in imitation ability (p = .05) or family quality of life (p = .22). Limitations There are several limitations with this study, including the small sample size as well as lack of data on enactment and website engagement. This study was not able to address questions related to which variables predict program engagement and treatment response, which will be critical for determining which families may benefit from such a stepped-care delivery model. Conclusions Overall, the Online RIT program delivered in a stepped-care format shows strong acceptability and holds promise as an innovative delivery model. Trial registration ClinicalTrials.gov, NCT04467073. Registered 10 July 2020- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04467073
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Affiliation(s)
- Allison L Wainer
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 603, Chicago, IL, 60612, USA.
| | - Zachary E Arnold
- Department of Psychology, University of Alabama At Birmingham, 1300 University Blvd., Birmingham, AL, 35233, USA
| | - Caroline Leonczyk
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 603, Chicago, IL, 60612, USA
| | - Latha Valluripalli Soorya
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 603, Chicago, IL, 60612, USA
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250
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Ibañez LV, Scott S, Stone WL. The implementation of reciprocal imitation training in a Part C early intervention setting: A stepped-wedge pragmatic trial. Autism Res 2021; 14:1777-1788. [PMID: 34080761 DOI: 10.1002/aur.2522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 03/18/2021] [Accepted: 04/01/2021] [Indexed: 11/08/2022]
Abstract
Despite the development of several evidence-based Naturalistic Developmental Behavioral Interventions (NDBIs), very few have been adapted for use in community-based settings. This study examines the implementation of Reciprocal Imitation Training (RIT)-an NDBI-by community Early Intervention (EI; IDEA Part C) providers serving toddlers from birth to 3 years. Of the 87 EI providers enrolled from 9 agencies in 4 counties across Washington State, 66 were included in the current sample. A stepped-wedge design was used to randomly assign counties to the timing of RIT training workshops. Self-report measures of practice and self-efficacy regarding ASD care were collected at baseline (T1, T2) and 6-months and 12-months post-training (T3, T4). At T3 and T4, providers reported on RIT adoption and rated items about RIT feasibility and perceived RIT effectiveness; at T4, they also reported on child characteristics that led to RIT use and modifications. From pre-training to post-training, there were significant increases in providers' self-efficacy in providing services to children with ASD or suspected ASD. At T3 and T4, provider ratings indicated high levels of RIT adoption, feasibility, and perceived RIT effectiveness. At T4, providers indicated that they most commonly: (a) initiated RIT when there were social-communication or motor imitation delays, or an ASD diagnosis; and (b) made modifications to RIT by repeating elements, blending it with other therapies, and loosening its structure. While additional research is needed, RIT may help families get an early start on accessing specialized treatment within an established infrastructure available across the United States. LAY SUMMARY: Reciprocal imitation training (RIT) is an evidence-based treatment for ASD that might be a good fit for use by intervention providers in widely accessible community-based settings. After attending an educational workshop on RIT, providers reported feeling more comfortable providing services to families with ASD concerns, used RIT with over 400 families, and believed that RIT improved important social communication behaviors.
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Affiliation(s)
- Lisa V Ibañez
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Sabine Scott
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Wendy L Stone
- Department of Psychology, University of Washington, Seattle, Washington, USA
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