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Huang Z, Wang F, Xue L, Zhu H, Zou X. Relationships between Sensory Processing and Executive Functions in Children with Combined ASD and ADHD Compared to Typically Developing and Single Disorder Groups. Brain Sci 2024; 14:566. [PMID: 38928566 PMCID: PMC11201769 DOI: 10.3390/brainsci14060566] [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: 04/11/2024] [Revised: 05/17/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
The prevalence of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) is increasing, with a tendency for co-occurrence. Some studies indicate a connection between atypical sensory processing and executive function. This study aims to explore the distinctive etiology of executive function deficits in children with ASD+ADHD by investigating the relationship between sensory processing and executive function, comparing children with ASD, ASD+ADHD, ADHD, and typically developing children (TD). METHOD Sensory Profile 2 (SP-2) and Behavior Rating Inventory of Executive Function 2 (BRIEF-2) were measured in 120 school-aged children. The results of the above scales were compared across these four groups, and correlation and regression analyses between BRIEF2 and SP2 were conducted. RESULTS Our research revealed varying levels of atypical sensory processing and executive function anomalies across the three neurodevelopmental disorder groups compared to the TD group. The ASD+ADHD group showed particularly significant differences. The heightened emotional problems observed in ASD+ADHD children may be associated with more prominent atypical sensory processing. Variance analysis of inhibitory function revealed differences between ASD+ADHD and ADHD children, suggesting distinct etiological mechanisms for attention issues between ASD+ADHD and ADHD. CONCLUSIONS ASD+ADHD represents a phenotype distinct from both ASD and ADHD. Special consideration should be given to interventions for children with ASD+ADHD. The results of this study may offer a new perspective on understanding the occurrence of ASD+ADHD and potential individualized intervention methods.
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Affiliation(s)
| | | | | | | | - Xiaobing Zou
- Child Developmental-Behavioral Center, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Rd., Guangzhou 510630, China
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Ko CL, Lin CK, Lin CL. Relationship between executive function and autism symptoms in preschoolers with autism spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 147:104692. [PMID: 38354483 DOI: 10.1016/j.ridd.2024.104692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/16/2024]
Abstract
Executive dysfunction and other symptomatology could have links in preschoolers with autism spectrum disorder (ASD). This study contains three objectives: to explore the difference in executive function between preschoolers with ASD and typically developing individuals (TD), to investigate correlations between executive function and multiple domains of autism symptoms in preschoolers with ASD, and to examine the impact of executive function on symptoms of autism. Participants of this study included preschoolers (4-6 years) with ASD (24 boys, 20 girls) according to DSM-5-TR criteria and TD (24 boys, 20 girls). BRIEF-P (Behavior Rating Inventory of Executive Function-Preschool Version) and CASD-C (Checklist for Autism Spectrum Disorder-Chinese Version) were used as measurement tools. Data were analyzed using MANOVA, ANOVA, Pearson correlations, and simple regression. For the results, the study found results of executive function were significantly lower in preschoolers with ASD than in preschoolers without ASD; the greater the executive dysfunction, the greater the autistic symptomatology, and executive dysfunction predicted 57 % of the variability of autism symptoms. In conclusion, preschoolers with ASD had more executive dysfunction than those without ASD. Based on our findings, the study recommends incorporating executive function into clinical assessment programs to understand how executive function is related to autism symptoms.
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Affiliation(s)
- Chun-Ling Ko
- Department of Early Childhood Education, National Taichung University of Education, Taichung, Taiwan
| | - Chin-Kai Lin
- Department of Early Childhood Education, National Taichung University of Education, Taichung, Taiwan.
| | - Chien-Lin Lin
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
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3
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Yuan A, Sabatos-DeVito M, Bey AL, Major S, Carpenter KL, Franz L, Howard J, Vermeer S, Simmons R, Troy J, Dawson G. Automated movement tracking of young autistic children during free play is correlated with clinical features associated with autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2530-2541. [PMID: 37151032 DOI: 10.1177/13623613231169546] [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: 05/09/2023]
Abstract
LAY ABSTRACT Play-based observations allow researchers to observe autistic children across a wide range of ages and skills. We recorded autistic children playing with toys in the center of a room and at a corner table while a caregiver remained seated off to the side and used video tracking technology to track children's movement and location. We examined how time children spent in room regions and whether or not they approached each region during play related to their cognitive, social, communication, and adaptive skills to determine if tracking child movement and location can meaningfully demonstrate clinical variation among autistic children representing a range of ages and skills. One significant finding was that autistic children who spent more time in the toy-containing center of the room had higher cognitive and language abilities, whereas those who spent less time in the center had higher levels of autism-related behaviors. In contrast, children who spent more time in the caregiver region had lower daily living skills and those who were quicker to approach the caregiver had lower adaptive behavior and language skills. These findings support the use of movement tracking as a complementary method of measuring clinical differences among autistic children. Furthermore, over 90% of autistic children representing a range of ages and skills in this study provided analyzable play observation data, demonstrating that this method allows autistic children of all levels of support needs to participate in research and demonstrate their social, communication, and attention skills without wearing any devices.
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Lupi E, Tucci F, Casula L, Novello RL, Guerrera S, Vicari S, Valeri G. Early and stable difficulties of everyday executive functions predict autism symptoms and emotional/behavioral problems in preschool age children with autism: a 2-year longitudinal study. Front Psychol 2023; 14:1092164. [PMID: 37583604 PMCID: PMC10425204 DOI: 10.3389/fpsyg.2023.1092164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 07/10/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Longitudinal studies of autistic children show that autism symptoms and emotional/behavioral problems vary and change over time. However, the factors that affect this variability remain far from certain and very little is known about what take place in the preschool period and the role of executive functions (EF). Methods Here, we test the influence of stable difficulties in everyday executive functioning (EEF) during early childhood across 2 years on autistic symptoms and emotional and behavioral problems. Twenty-nine autistic children (24 males and 5 females) were assessed twice within the space of 2 years. At baseline (M = 29 months, SD =5.6 months), participants were assessed for EEF, cognitive development, autistic symptoms, and emotional/behavioral problems. At follow-up, we repeated the same assessment except for cognitive development. Results The group with stable difficulties (across 2 years) in EEF during early childhood showed a worsening in the severity of autistic symptoms and emotional and behavioral problems compared with children without EEF difficulties (p < 0.05), and these effects cannot be attributable to cognitive development. Discussion Our results suggest that early and stable EEF plays the role of a modifier by interacting with the core domains of autism, in particular with the social affect domain (SA CSS), influencing social cognition and exacerbating or lessening symptom expression and emotional behavioral problems. These short-term longitudinal and preliminary findings underscore the importance of EEF as necessary target for early intervention in children with autism.
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Affiliation(s)
- Elisabetta Lupi
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Federico Tucci
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - Laura Casula
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Roberta Lucia Novello
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Silvia Guerrera
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giovanni Valeri
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Kaminski A, You X, Flaharty K, Jeppsen C, Li S, Merchant JS, Berl MM, Kenworthy L, Vaidya CJ. Cingulate-Prefrontal Connectivity During Dynamic Cognitive Control Mediates Association Between p Factor and Adaptive Functioning in a Transdiagnostic Pediatric Sample. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:189-199. [PMID: 35868485 PMCID: PMC10152206 DOI: 10.1016/j.bpsc.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Covariation among psychiatric symptoms is being actively pursued for transdiagnostic dimensions of psychopathology with predictive utility. A superordinate dimension, the p factor, reflects overall psychopathology burden and has support from genetic and neuroimaging correlates. However, the neurocognitive correlates that link an elevated p factor to maladaptive outcomes are unknown. We tested the mediating potential of dynamic adjustments in cognitive control rooted in functional connections anchored by the dorsal anterior cingulate cortex (dACC) in a transdiagnostic pediatric sample. METHODS A multiple mediation model tested the association between the p factor (derived by principal component analysis of Child Behavior Checklist syndrome scales) and outcome measured with the Vineland Adaptive Behavior Scale-II in 89 children ages 8 to 13 years (23 female) with a variety of primary neurodevelopmental diagnoses who underwent functional magnetic resonance imaging during a socioaffective Stroop-like task with eye gaze as distractor. Mediators included functional connectivity of frontoparietal- and salience network-affiliated dACC seeds during conflict adaptation. RESULTS Higher p factor scores were related to worse adaptive functioning. This effect was partially mediated by conflict adaptation-dependent functional connectivity between the frontoparietal network-affiliated dACC seed and the right dorsolateral prefrontal cortex. Post hoc follow-up indicated that the p factor was related to all Vineland Adaptive Behaviors Scale-II domains; the association was strongest for socialization followed by daily living skills and then communication. Mediation results remained significant for socialization only. CONCLUSIONS Higher psychopathology burden was associated with worse adaptive functioning in early adolescence. This association was mediated by weaker dACC-dorsolateral prefrontal cortex functional connectivity underlying modulation of cognitive control in response to contextual contingencies. Our results contribute to the identification of transdiagnostic and developmentally relevant neurocognitive endophenotypes of psychopathology.
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Affiliation(s)
- Adam Kaminski
- Department of Psychology, Georgetown University, Washington, D.C..
| | - Xiaozhen You
- Children's Research Institute, Children's National Medical Center, Washington, D.C
| | - Kathryn Flaharty
- Department of Psychology, Georgetown University, Washington, D.C
| | - Charlotte Jeppsen
- Children's Research Institute, Children's National Medical Center, Washington, D.C
| | - Sufang Li
- Department of Psychology, Georgetown University, Washington, D.C
| | | | - Madison M Berl
- Children's Research Institute, Children's National Medical Center, Washington, D.C
| | - Lauren Kenworthy
- Children's Research Institute, Children's National Medical Center, Washington, D.C
| | - Chandan J Vaidya
- Department of Psychology, Georgetown University, Washington, D.C.; Children's Research Institute, Children's National Medical Center, Washington, D.C..
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Westby C. Playing to Pretend or "Pretending" to Play: Play in Children with Autism Spectrum Disorder. Semin Speech Lang 2022; 43:331-346. [PMID: 35896409 DOI: 10.1055/s-0042-1750348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Children diagnosed with autism spectrum disorder (ASD) exhibit early delays and deficits in play. In infancy, they engage in unusual exploratory behaviors with toys. As toddlers, they are slow to develop functional play, and in preschool some children with ASD fail to develop symbolic play despite having the necessary cognitive and language skills. Furthermore, when children with ASD are engaged in play, they demonstrate less playfulness. This article reviews the literature on the characteristics of exploratory, functional, and symbolic/pretend play in children with ASD and possible reasons for their unusual patterns of play development. Increased quantity and quality of play are frequent therapeutic goals for children with ASD. If play interventions are to be successful, it is critical that speech-language pathologists have an adequate assessment of children's play skills. Several frameworks and tools appropriate for assessing play in typical children and children with ASD are described.
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Affiliation(s)
- Carol Westby
- Bilingual Multicultural Services in Albuquerque, Albuquerque, New Mexico
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Tschida JE, Yerys BE. Real-world executive functioning for autistic children in school and home settings. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1095-1107. [PMID: 34465230 PMCID: PMC8882695 DOI: 10.1177/13623613211041189] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Executive functioning skills are important for children to be able to control thoughts, emotions, and actions, and for their ability to adapt to different settings. Previous studies have found that autistic children have difficulty with executive functioning, but most of these studies took place in the home setting. Executive functioning skills in autistic children have not yet been fully examined in the school setting. This is a knowledge gap that needs to be addressed because the school setting is potentially one of the most demanding in terms of executive functioning and is a setting where executive function interventions are already being used for autistic children. In order to learn more about executive functioning for autistic children in the school setting, this study compared ratings of executive function from autistic children's caregivers and school professionals. The study found that autistic children experience similar but not identical executive function challenges across school and home settings and that supports may differ in each setting. Having information about differences in executive functioning challenges and supports for autistic children across settings can help lead to development of supports that are tailored to each setting.
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Affiliation(s)
- Jessica E. Tschida
- Center for Autism Research, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychology, Michigan State University, East Lansing, MI 48824, USA
| | - Benjamin E. Yerys
- Center for Autism Research, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Kenworthy L, Verbalis A, Bascom J, daVanport S, Strang JF, Pugliese C, Freeeman A, Jeppsen C, Armour AC, Jost G, Hardy K, Wallace GL. Adding the missing voice: How self-report of autistic youth self-report on an executive functioning rating scale compares to parent report and that of youth with attention deficit hyperactivity disorder or neurotypical development. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:422-433. [PMID: 34238038 PMCID: PMC8742839 DOI: 10.1177/13623613211029117] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
LAY ABSTRACT Executive functions are often impaired in autistic people and relate to important outcomes such as mental health, success in school and work, and quality of life. Evaluating executive functions helps autistic people, clinicians, and families identify targets for external supports and skill building. Youth self-report of executive function has not been studied, yet we know that self-report from autistic youth is key to understanding other cognitive/behavioral phenomena in autism such as anxiety, obsessions/compulsions, sensory sensitivities, and repetitive behaviors. We investigated self- and parent-report of executive function problems in 197 autistic youth without intellectual disability (ages 11-18 years), including the magnitude and profiles of executive function problems autistic youth report across subdomains of executive function. We compared autistic self-report with that of 114 youth with attention deficit hyperactivity disorder without intellectual disability and 197 neurotypical youth. We found that autistic youth report significant executive function problems compared to neurotypical youth and a distinctive profile of challenges in comparison to attention deficit hyperactivity disorder youth. Parents and their autistic children diverged regarding the magnitude of the youth's executive function difficulties, but both identify inflexibility as the most impaired executive function subdomain. Autistic youth and their parents were somewhat more concordant in their report of executive function problems than youth with attention deficit hyperactivity disorder and their parents, but only showed moderate concordance at best. These findings elevate the importance of asking autistic youth directly about their executive functioning when engaging them in assessment and intervention, or researching executive functions in autism.
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Affiliation(s)
- Lauren Kenworthy
- Center for Autism Spectrum Disorders, Children’s National, Washington, DC
| | - Alyssa Verbalis
- Center for Autism Spectrum Disorders, Children’s National, Washington, DC
| | | | | | - John F. Strang
- Center for Autism Spectrum Disorders, Children’s National, Washington, DC
| | - Cara Pugliese
- Center for Autism Spectrum Disorders, Children’s National, Washington, DC
| | | | - Charlotte Jeppsen
- Center for Autism Spectrum Disorders, Children’s National, Washington, DC
| | - Anna C. Armour
- Center for Autism Spectrum Disorders, Children’s National, Washington, DC
| | - Geneva Jost
- Center for Autism Spectrum Disorders, Children’s National, Washington, DC
| | - Kristina Hardy
- Neuropsychology Division, Children’s National, Washington, DC
| | - Gregory L. Wallace
- Deparment of Speech, Language, and Hearing Sciences, The George Washington University, Washington, DC
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Tonizzi I, Giofrè D, Usai MC. Inhibitory Control in Autism Spectrum Disorders: Meta-analyses on Indirect and Direct Measures. J Autism Dev Disord 2021; 52:4949-4965. [PMID: 34816341 DOI: 10.1007/s10803-021-05353-6] [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] [Accepted: 11/01/2021] [Indexed: 11/25/2022]
Abstract
This manuscript aimed to advance our understanding of inhibitory control (IC) in autism spectrum disorders (ASD), adopting a meta-analytic multilevel approach. The first meta-analysis, on 164 studies adopting direct measures, indicated a significant small-to-medium (g = 0.484) deficit in the group with ASD (n = 5140) compared with controls (n = 6075). Similar effect sizes between response inhibition and interference control were found, but they were differentially affected by intellectual functioning and age. The second meta-analysis, on 24 studies using indirect measures, revealed a large deficit (g = 1.334) in the group with ASD (n = 985) compared with controls (n = 1300). Presentation format, intellectual functioning, and age were significant moderators. The effect of comorbidity with ADHD was not statistically significant. Implications are discussed for IC research and practice in autism.
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Affiliation(s)
- Irene Tonizzi
- Department of Educational Sciences, University of Genoa, Corso Podestà 2, 16128, Genoa, Italy
| | - David Giofrè
- Department of Educational Sciences, University of Genoa, Corso Podestà 2, 16128, Genoa, Italy
| | - Maria Carmen Usai
- Department of Educational Sciences, University of Genoa, Corso Podestà 2, 16128, Genoa, Italy.
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Wisner-Carlson R, Uram S, Flis T. The Transition to Adulthood for Young People with Autism Spectrum Disorder. Psychiatr Clin North Am 2020; 43:673-686. [PMID: 33127001 DOI: 10.1016/j.psc.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The transition to adulthood for individuals with autism spectrum disorder is difficult and outcomes are suboptimal. Social cognition deficits and executive dysfunction continue to be barriers to young people's success, lack of societal acceptance and loss of previous support can exacerbate the condition, and mental health issues increase. All areas of adult functioning are affected. To help manage the transition and improve outcomes for this population, psychiatrists and other health care providers need to be aware of the issues and possible interventions, including social skills training, educational transition programs, and supported employment programs.
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Affiliation(s)
- Robert Wisner-Carlson
- Neuropsychiatry Outpatient Program, Adult Developmental Neuropsychiatry Clinic, Adult Inpatient Intellectual Disability and Autism Unit, Sheppard Pratt Autism Registry, Ethics Committee, Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA.
| | - Sara Uram
- Adult Developmental Neuropsychiatry Clinic, Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA
| | - Thomas Flis
- Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA
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Roberts SB, Franceschini MA, Silver RE, Taylor SF, de Sa AB, Có R, Sonco A, Krauss A, Taetzsch A, Webb P, Das SK, Chen CY, Rogers BL, Saltzman E, Lin PY, Schlossman N, Pruzensky W, Balé C, Chui KKH, Muentener P. Effects of food supplementation on cognitive function, cerebral blood flow, and nutritional status in young children at risk of undernutrition: randomized controlled trial. BMJ 2020; 370:m2397. [PMID: 32699176 PMCID: PMC7374799 DOI: 10.1136/bmj.m2397] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess the effects of food supplementation on improving working memory and additional measures including cerebral blood flow in children at risk of undernutrition. DESIGN Randomized controlled trial. SETTING 10 villages in Guinea-Bissau. PARTICIPANTS 1059 children aged 15 months to 7 years; children younger than 4 were the primary population. INTERVENTIONS Supervised isocaloric servings (≈1300 kJ, five mornings each week, 23 weeks) of a new food supplement (NEWSUP, high in plant polyphenols and omega 3 fatty acids, within a wide variety and high fortification of micronutrients, and a high protein content), or a fortified blended food (FBF) used in nutrition programs, or a control meal (traditional rice breakfast). MAIN OUTCOME MEASUREMENTS The primary outcome was working memory, a core executive function predicting long term academic achievement. Additional outcomes were hemoglobin concentration, growth, body composition, and index of cerebral blood flow (CBFi). In addition to an intention-to-treat analysis, a predefined per protocol analysis was conducted in children who consumed at least 75% of the supplement (820/925, 89%). The primary outcome was assessed by a multivariable Poisson model; other outcomes were assessed by multivariable linear mixed models. RESULTS Among children younger than 4, randomization to NEWSUP increased working memory compared with the control meal (rate ratio 1.20, 95% confidence interval 1.02 to 1.41, P=0.03), with a larger effect in the per protocol population (1.25, 1.06 to 1.47, P=0.009). NEWSUP also increased hemoglobin concentration among children with anemia (adjusted mean difference 0.65 g/dL, 95% confidence interval 0.23 to 1.07, P=0.003) compared with the control meal, decreased body mass index z score gain (-0.23, -0.43 to -0.02, P=0.03), and increased lean tissue accretion (2.98 cm2, 0.04 to 5.92, P=0.046) with less fat (-5.82 cm2, -11.28 to -0.36, P=0.04) compared with FBF. Additionally, NEWSUP increased CBFi compared with the control meal and FBF in both age groups combined (1.14 mm2/s×10-8, 0.10 to 2.23, P=0.04 for both comparisons). Among children aged 4 and older, NEWSUP had no significant effect on working memory or anemia, but increased lean tissue compared with FBF (4.31 cm2, 0.34 to 8.28, P=0.03). CONCLUSIONS Childhood undernutrition is associated with long term impairment in cognition. Contrary to current understanding, supplementary feeding for 23 weeks could improve executive function, brain health, and nutritional status in vulnerable young children living in low income countries. Further research is needed to optimize nutritional prescriptions for regenerative improvements in cognitive function, and to test effectiveness in other vulnerable groups. TRIAL REGISTRATION ClinicalTrials.gov NCT03017209.
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Affiliation(s)
- Susan B Roberts
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Maria A Franceschini
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Rachel E Silver
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Salima F Taylor
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Augusto Braima de Sa
- International Partnership for Human Development, Leesburg, VA, USA and Bissau, Guinea Bissau
| | - Raimundo Có
- International Partnership for Human Development, Leesburg, VA, USA and Bissau, Guinea Bissau
| | - Aliu Sonco
- International Partnership for Human Development, Leesburg, VA, USA and Bissau, Guinea Bissau
| | | | - Amy Taetzsch
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Patrick Webb
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sai Krupa Das
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - C-Y Chen
- Biofortis, Mérieux NutriSciences, Addison, IL, USA
| | - Beatrice L Rogers
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Edward Saltzman
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Pei-Yi Lin
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Nina Schlossman
- Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Global Food and Nutrition, Washington, DC, USA
| | - William Pruzensky
- International Partnership for Human Development, Leesburg, VA, USA and Bissau, Guinea Bissau
| | - Carlito Balé
- International Partnership for Human Development, Leesburg, VA, USA and Bissau, Guinea Bissau
| | - Kenneth Kwan Ho Chui
- Department of Public Health and Community Medicine, Tufts School of Medicine, Boston, MA, USA
| | - Paul Muentener
- Department of Psychology, Tufts University, Medford, MA, USA
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12
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Wisner-Carlson R, Uram S, Flis T. The Transition to Adulthood for Young People with Autism Spectrum Disorder. Child Adolesc Psychiatr Clin N Am 2020; 29:345-358. [PMID: 32169266 DOI: 10.1016/j.chc.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The transition to adulthood for individuals with autism spectrum disorder is difficult and outcomes are suboptimal. Social cognition deficits and executive dysfunction continue to be barriers to young people's success, lack of societal acceptance and loss of previous support can exacerbate the condition, and mental health issues increase. All areas of adult functioning are affected. To help manage the transition and improve outcomes for this population, psychiatrists and other health care providers need to be aware of the issues and possible interventions, including social skills training, educational transition programs, and supported employment programs.
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Affiliation(s)
- Robert Wisner-Carlson
- Neuropsychiatry Outpatient Program, Adult Developmental Neuropsychiatry Clinic, Adult Inpatient Intellectual Disability and Autism Unit, Sheppard Pratt Autism Registry, Ethics Committee, Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA.
| | - Sara Uram
- Adult Developmental Neuropsychiatry Clinic, Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA
| | - Thomas Flis
- Sheppard Pratt Health System, 6501 North Charles Street, Baltimore, MD 21204, USA
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13
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Faja S, Nelson L. Variation in restricted and repetitive behaviors and interests relates to inhibitory control and shifting in children with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:1262-1272. [PMID: 30394786 PMCID: PMC6499722 DOI: 10.1177/1362361318804192] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Symptoms of restricted and repetitive behaviors and interests in autism are theoretically linked to executive functioning, which includes problem-solving abilities such as inhibition and cognitive flexibility. This study examined whether inhibition and flexibility are related to higher order restricted and repetitive behaviors and interests (e.g. circumscribed interests and ritualistic behavior) and sensorimotor behaviors (e.g. stereotyped and repetitive movements and sensory preoccupations) among 102 school-aged children with autism spectrum disorder who had cognitive abilities in the average or above average range. The ability to inhibit interfering information and shifting ability were related to higher order restricted and repetitive behaviors and interests, and each uniquely accounted for variance. This suggests that the ability to suppress interfering information as well as the ability to flexibly shift between patterns of responding is protective against higher order restricted and repetitive behaviors and interest symptoms in autism. In addition, the ability to proactively slow one's reaction time in order to respond more carefully was related to sensorimotor restricted and repetitive behaviors. These results support the importance of distinguishing between higher order and sensorimotor symptoms due to their distinct relationships to executive functioning abilities.
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Affiliation(s)
- Susan Faja
- Division of Developmental Medicine, Boston Children’s Hospital, 02215
- Harvard Medical School, 02215
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Bottema-Beutel K, Kim SY, Crowley S. A systematic review and meta-regression analysis of social functioning correlates in autism and typical development. Autism Res 2018; 12:152-175. [DOI: 10.1002/aur.2055] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/01/2018] [Accepted: 11/06/2018] [Indexed: 02/04/2023]
Affiliation(s)
| | - So Yoon Kim
- Lynch School of Education, Boston College; Chestnut Hill Massachusetts
| | - Shannon Crowley
- Lynch School of Education, Boston College; Chestnut Hill Massachusetts
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15
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Kenny L, Cribb SJ, Pellicano E. Childhood Executive Function Predicts Later Autistic Features and Adaptive Behavior in Young Autistic People: a 12-Year Prospective Study. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2018; 47:1089-1099. [DOI: 10.1007/s10802-018-0493-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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16
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The Association between Self-Regulation and Symptoms of Autism Spectrum Disorder in Preschoolers with Externalizing Behavior Problems. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2018. [DOI: 10.1007/s10862-018-9677-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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Feczko E, Balba NM, Miranda-Dominguez O, Cordova M, Karalunas SL, Irwin L, Demeter DV, Hill AP, Langhorst BH, Grieser Painter J, Van Santen J, Fombonne EJ, Nigg JT, Fair DA. Subtyping cognitive profiles in Autism Spectrum Disorder using a Functional Random Forest algorithm. Neuroimage 2017; 172:674-688. [PMID: 29274502 DOI: 10.1016/j.neuroimage.2017.12.044] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 12/21/2022] Open
Abstract
DSM-5 Autism Spectrum Disorder (ASD) comprises a set of neurodevelopmental disorders characterized by deficits in social communication and interaction and repetitive behaviors or restricted interests, and may both affect and be affected by multiple cognitive mechanisms. This study attempts to identify and characterize cognitive subtypes within the ASD population using our Functional Random Forest (FRF) machine learning classification model. This model trained a traditional random forest model on measures from seven tasks that reflect multiple levels of information processing. 47 ASD diagnosed and 58 typically developing (TD) children between the ages of 9 and 13 participated in this study. Our RF model was 72.7% accurate, with 80.7% specificity and 63.1% sensitivity. Using the random forest model, the FRF then measures the proximity of each subject to every other subject, generating a distance matrix between participants. This matrix is then used in a community detection algorithm to identify subgroups within the ASD and TD groups, and revealed 3 ASD and 4 TD putative subgroups with unique behavioral profiles. We then examined differences in functional brain systems between diagnostic groups and putative subgroups using resting-state functional connectivity magnetic resonance imaging (rsfcMRI). Chi-square tests revealed a significantly greater number of between group differences (p < .05) within the cingulo-opercular, visual, and default systems as well as differences in inter-system connections in the somato-motor, dorsal attention, and subcortical systems. Many of these differences were primarily driven by specific subgroups suggesting that our method could potentially parse the variation in brain mechanisms affected by ASD.
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Affiliation(s)
- E Feczko
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA; Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland OR, 97239, USA.
| | - N M Balba
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA
| | - O Miranda-Dominguez
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA
| | - M Cordova
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA
| | - S L Karalunas
- Department of Psychiatry, Oregon Health & Science University, Portland, OR 97239, USA
| | - L Irwin
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA
| | - D V Demeter
- The University of Texas at Austin, Department of Psychology, Austin, TX 78713, USA
| | - A P Hill
- Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA; Center for Spoken Language Understanding, Institute on Development & Disability, Oregon Health & Science University, Portland, OR 97239, USA
| | - B H Langhorst
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA
| | - J Grieser Painter
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA
| | - J Van Santen
- Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA; Center for Spoken Language Understanding, Institute on Development & Disability, Oregon Health & Science University, Portland, OR 97239, USA
| | - E J Fombonne
- Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR 97239, USA
| | - J T Nigg
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR 97239, USA; Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR 97239, USA
| | - D A Fair
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR 97239, USA; Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR 97239, USA
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18
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Camargo RG, Mezzomo CL. Characteristics of patients with language disorders and the theory of multiple intelligences. REVISTA CEFAC 2017. [DOI: 10.1590/1982-021620171952817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Purpose: to investigate which intelligence, described in the Theory of Multiple Intelligences, favors the development of language (linguistic intelligence) of the patients, in relation to the studied variables: development phase (children and adolescents), sex and preferential intelligences. Methods: the quantitative-qualitative approach was used, with the identification by content analysis of the preferred intelligences of the 107 patients participating in the investigation and the intelligences contemplated in each therapy. After the coding of these data in numbers, the results obtained in the 1,802 therapies analyzed were compared with the development phase, sex and preferential intelligences, using a statistical test. Results: in the analysis of the data, it was evidenced that the results obtained in the therapy differ between children and adolescents, according to the intelligences contemplated, which is also observed when considering females and males, but to a lesser extent. Conclusion: it is important to observe the characteristics of age, sex and preferential intelligences, in relation to the contemplation of the different intelligences in the activities developed in the therapy, with a view to the qualification of the results.
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Varanda CDA, Fernandes FDM. Cognitive flexibility training intervention among children with autism: a longitudinal study. PSICOLOGIA-REFLEXAO E CRITICA 2017; 30:15. [PMID: 32026102 PMCID: PMC6974343 DOI: 10.1186/s41155-017-0069-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/08/2017] [Indexed: 12/27/2022] Open
Abstract
Autism is defined by persistent deficits in social communication and social interaction in multiple contexts as well as restricted and repetitive patterns of behavior. There are also reported difficulties in the dynamic activation and modification of cognitive processes in response to changes in tasks' demands. Such difficulties are believed to be due to poor flexible cognition. This research aimed to assess and intervene in cognitive flexibility in subjects with autism.Ten subjects diagnosed with autism by psychiatrists, aged 5 years to 13 years and 5 months, were assessed in non-verbal intelligence through Raven's Progressive Matrices in pretest. They were also assessed in cognitive flexibility through Wisconsin Card Sorting Test (WCST) and in patterns of social interactions, behaviors, and communication through Autism Diagnostic Interview-Revised (ADI-R). An intervention program of 14 to 21 sessions was established to enhance cognitive flexibility. In posttest, they were assessed in WCST and ADI-R.All measures of cognitive flexibility improved in posttest except for failure to maintain set. Among the measures improved in posttest, perseverative errors and responses improved in posttest with statistical significance as well as categories completed. Total scores on ADI-R were lower in posttest as well as scores on communication abilities.The qualitative improvement showed by the individuals of this research concerning cognitive flexibility and also patterns of restricted behavior, social interaction, and communication abilities suggests that individuals with autism can benefit from the development of strategies for the enhancement of cognitive flexibility. Nevertheless, more research is suggested with a larger sample among subjects on the autism spectrum.
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Affiliation(s)
- Cristina de Andrade Varanda
- Departamento de Fonoaudiologia, Fisioterapia e Terapia Ocupacional, Universidade de São Paulo-USP-Faculdade de Medicina, Rua Cipotânea, 51, CEP 05360-000, São Paulo, SP, Brazil.
| | - Fernanda Dreux Miranda Fernandes
- Departamento de Fonoaudiologia, Fisioterapia e Terapia Ocupacional, Universidade de São Paulo-USP-Faculdade de Medicina, Rua Cipotânea, 51, CEP 05360-000, São Paulo, SP, Brazil
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Pellicano E, Kenny L, Brede J, Klaric E, Lichwa H, McMillin R. Executive function predicts school readiness in autistic and typical preschool children. COGNITIVE DEVELOPMENT 2017. [DOI: 10.1016/j.cogdev.2017.02.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Constable PA, Ring M, Gaigg SB, Bowler DM. Problem-solving styles in autism spectrum disorder and the development of higher cognitive functions. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2017; 22:597-608. [PMID: 28482683 DOI: 10.1177/1362361317691044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The Vygotsky Blocks Test assesses problem-solving styles within a theoretical framework for the development of higher mental processes devised by Vygotsky. Because both the theory and the associated test situate cognitive development within the child's social and linguistic context, they address conceptual issues around the developmental relation between language and thought that are pertinent to development in autism. Our aim was to document the performance of adults with autism spectrum disorder on the Vygotsky Blocks Test, and our results showed that they made more errors than the typically developing participants and that these errors correlated with performance IQ. The autism spectrum disorder group also required more cues than the typically developing group to discern the conceptual structure of the blocks, a pattern that correlated with Autism Diagnostic Observational Schedule-Communication and Imagination/Creativity sub-scales. When asked to categorize the blocks in new ways, the autism spectrum disorder participants developed fewer principles on which to base new categorizations, which in contrast to the typically developing group correlated with verbal IQ and with the Imagination/Creativity sub-scale of the ADOS. These results are in line with a number of existing findings in the autism spectrum disorder literature and confirm that conceptualization in autism spectrum disorder seems to rely more on non-verbal and less on imaginative processes than in typically developing individuals. The findings represent first steps to the possibility of outlining a testable account of psychological development in autism spectrum disorder that integrates verbal, non-verbal and social factors into the transition from elementary to higher level processes.
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Nieto M, Ros L, Medina G, Ricarte JJ, Latorre JM. Assessing Executive Functions in Preschoolers Using Shape School Task. Front Psychol 2016; 7:1489. [PMID: 27729896 PMCID: PMC5037173 DOI: 10.3389/fpsyg.2016.01489] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 09/16/2016] [Indexed: 11/15/2022] Open
Abstract
Over the last two decades, there has been a growing interest in the study of the development of executive functions (EF) in preschool children due to their relationship with different cognitive, psychological, social and academic domains. Early detection of individual differences in executive functioning can have major implications for basic and applied research. Consequently, there is a key need for assessment tools adapted to preschool skills: Shape School has been shown to be a suitable task for this purpose. Our study uses Shape School as the main task to analyze development of inhibition, task-switching and working memory in a sample of 304 preschoolers (age range 3.25–6.50 years). Additionally, we include cognitive tasks for the evaluation of verbal variables (vocabulary, word reasoning and short-term memory) and performance variables (picture completion and symbol search), so as to analyze their relationship with EFs. Our results show age-associated improvements in EFs and the cognitive variables assessed. Furthermore, correlation analyses reveal positive relationships between EFs and the other cognitive variables. More specifically, using structural equation modeling and including age direct and indirect effects, our results suggest that EFs explain to a greater extent performance on verbal and performance tasks. These findings provide further information to support research that considers preschool age to be a crucial period for the development of EFs and their relationship with other cognitive processes.
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Affiliation(s)
- Marta Nieto
- Department of Psychology, Faculty of Medicine and Research Institute of Neurological Disabilities, University of Castilla-La Mancha Albacete, Spain
| | - Laura Ros
- Department of Psychology, Faculty of Medicine and Research Institute of Neurological Disabilities, University of Castilla-La Mancha Albacete, Spain
| | - Gloria Medina
- Department of Psychology, Faculty of Medicine and Research Institute of Neurological Disabilities, University of Castilla-La Mancha Albacete, Spain
| | - Jorge J Ricarte
- Department of Psychology, Faculty of Medicine and Research Institute of Neurological Disabilities, University of Castilla-La Mancha Albacete, Spain
| | - José M Latorre
- Department of Psychology, Faculty of Medicine and Research Institute of Neurological Disabilities, University of Castilla-La Mancha Albacete, Spain
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St John T, Estes AM, Dager SR, Kostopoulos P, Wolff JJ, Pandey J, Elison JT, Paterson SJ, Schultz RT, Botteron K, Hazlett H, Piven J. Emerging Executive Functioning and Motor Development in Infants at High and Low Risk for Autism Spectrum Disorder. Front Psychol 2016; 7:1016. [PMID: 27458411 PMCID: PMC4932099 DOI: 10.3389/fpsyg.2016.01016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/21/2016] [Indexed: 11/13/2022] Open
Abstract
Existing evidence suggests executive functioning (EF) deficits may be present in children with autism spectrum disorder (ASD) by 3 years of age. It is less clear when, prior to 3 years, EF deficits may emerge and how EF unfold over time. The contribution of motor skill difficulties to poorer EF in children with ASD has not been systematically studied. We investigated the developmental trajectory of EF in infants at high and low familial risk for ASD (HR and LR) and the potential associations between motor skills, diagnostic group, and EF performance. Participants included 186 HR and 76 LR infants. EF (A-not-B), motor skills (Fine and Gross Motor), and cognitive ability were directly assessed at 12 months and 24 months of age. Participants were directly evaluated for ASD at 24 months using DSM-IV-TR criteria and categorized as HR-ASD, HR-Negative, and LR-Negative. HR-ASD and HR-Negative siblings demonstrated less improvement in EF over time compared to the LR-Negative group. Motor skills were associated with group and EF performance at 12 months. No group differences were found at 12 months, but at 24 months, the HR-ASD and HR-Negative groups performed worse than the LR-Negative group overall after controlling for visual reception and maternal education. On reversal trials, the HR-ASD group performed worse than the LR-Negative group. Motor skills were associated with group and EF performance on reversal trials at 24 months. Findings suggest that HR siblings demonstrate altered EF development and that motor skills may play an important role in this process.
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Affiliation(s)
- Tanya St John
- Speech and Hearing Sciences, University of WashingtonSeattle, WA, USA; UW Autism Center, Center on Human Development and Disability, University of WashingtonSeattle, WA, USA
| | - Annette M Estes
- Speech and Hearing Sciences, University of WashingtonSeattle, WA, USA; UW Autism Center, Center on Human Development and Disability, University of WashingtonSeattle, WA, USA
| | - Stephen R Dager
- UW Autism Center, Center on Human Development and Disability, University of WashingtonSeattle, WA, USA; Department of Radiology, University of WashingtonSeattle, WA, USA
| | - Penelope Kostopoulos
- McConnell Brain Imaging Centre, Montreal Neurological Institute Montreal, CA, USA
| | - Jason J Wolff
- Department of Educational Psychology, University of Minnesota Minneapolis, MN, USA
| | - Juhi Pandey
- Department of Pediatrics, The Center for Autism Research, Children's Hospital of Philadelphia, University of Pennsylvania Philadelphia, PA, USA
| | - Jed T Elison
- Institute of Child Development, University of Minnesota Minneapolis, MN, USA
| | - Sarah J Paterson
- Department of Pediatrics, The Center for Autism Research, Children's Hospital of Philadelphia, University of Pennsylvania Philadelphia, PA, USA
| | - Robert T Schultz
- Department of Pediatrics, The Center for Autism Research, Children's Hospital of Philadelphia, University of Pennsylvania Philadelphia, PA, USA
| | - Kelly Botteron
- Department of Psychiatry, Washington University School of Medicine Saint Louis, MO, USA
| | - Heather Hazlett
- Carolina Institute for Developmental DisabilitiesChapel Hill, NC, USA; Department of Psychiatry, University of North CarolinaChapel Hill, NC
| | - Joseph Piven
- Carolina Institute for Developmental DisabilitiesChapel Hill, NC, USA; Department of Psychiatry, University of North CarolinaChapel Hill, NC
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