Interventions targeting attention in young children with autism

Effectiveness of animal-assisted activities and therapies for autism spectrum disorder: a systematic review and meta-analysis

Background

Given the rising interest in complementary therapeutic strategies for autism spectrum disorder (ASD), this research aims to provide a comprehensive analysis of the impact of animal-assisted activities and therapies (AAAT) on various ASD symptoms.

Methods

A meticulous search of databases, including Scopus and PubMed, was conducted to gather relevant research on AAAT for ASD. This process led to the selection of 45 studies encompassing 1,212 participants. The chosen studies were then subjected to a meta-analysis to evaluate the efficacy of AAAT in alleviating core ASD symptoms.

Results

The meta-analysis revealed significant improvements in several core ASD symptoms due to AAAT. Notably, there were improvements in social communication (MD = -4.96, 95% CI [-7.49, -2.44]), irritability (MD = -2.38, 95% CI [-4.06, -0.71]), hyperactivity (MD = -4.03, 95% CI [-6.17, -1.89]), and different word usage skills (MD = 20.48, 95% CI [7.41, 33.55]). However, social awareness (MD = -1.63, 95% CI [-4.07, 0.81]), social cognition (MD = -3.60, 95% CI [-9.36, 2.17]), social mannerisms (MD = -0.73, 95% CI [-2.55, 1.09]), social motivation (MD = -1.21, 95% CI [-2.56, 0.13]), lethargy (MD = -1.12, 95% CI [-3.92, 1.68]), and stereotypical behaviors (MD = -0.23, 95% CI [-1.27, 0.80]) did not significantly improve.

Conclusion

The study demonstrates the potential of AAAT in improving certain core symptoms of ASD, such as social communication, irritability, hyperactivity, and word usage skills. However, the effectiveness of AAAT in other ASD symptom domains remains uncertain. The research is limited by the absence of long-term follow-up data and a high risk of bias in existing studies. Therefore, while the findings indicate the promise of AAAT in specific areas, caution is advised in generalizing its efficacy across all ASD symptoms.

The effect of compression on repetitive behaviors and task participation in children with autism spectrum disorder

Compression clothes are marketed to relieve anxiety and decrease hyperactivity in children with autism. However, few studies have examined the impact of compression for individuals with autism spectrum disorder (ASD). In this study, nine children with autism were observed during Applied Behavioral Analysis therapy sessions while wearing compression clothing. The participants were randomly assigned to wear compression clothing for either their first five sessions or their last five sessions. Videos of the therapy sessions were reviewed and each child's "off task" behavior was identified in the following domains: motor, verbal, and visual. In addition, frequency of the child's repetitive behaviors and external visual stimuli were recorded. The compression clothes failed to increase task participation or reduce the participants' repetitive behavior suggesting that the clothing may not contribute to professional practice of ABA therapy.

Increasing Vocabulary and Listening Comprehension During Adapted Shared Reading: An Intervention for Preschoolers with Autism Spectrum Disorder

PURPOSE

This study examined the improvement in vocabulary and listening skills of children with ASD through adapted shared reading. It also investigated the generalisation effect of this increase to new books and social validity.

METHODS

A multiple probe across participants design was used to investigate the effect of ASR (adapted shared reading) on the vocabulary and listening comprehension skills of young children with autism spectrum disorder (ASD). The participants were Turkish-speaking children diagnosed with ASD attending a preschool special education institution in Turkey. The researcher analysed the data obtained from the baseline, intervention, generalization and mastery phases using the visual analysis method.

RESULTS

Following the intervention, all three participating children gradually improved their vocabulary and listening comprehension skills. The findings suggest that young children with ASD can participate in and benefit from shared reading interventions with support.

CONCLUSION

The adapted shared reading method (ASR) is an effective method for increasing the vocabulary and listening comprehension skills of young children with ASD.

Exploring the Clinical Feasibility of Alternative Word-Understanding Measures for Autistic Children With Minimal Spoken Language

PURPOSE

The primary aim of this study was to explore the clinical feasibility of using alternate word-understanding assessment modalities for autistic children who have minimal verbal skills. Specifically, assessment duration, occurrence of disruptive behavior, and no-response trials were examined across three word-understanding assessment conditions: a low-tech condition, a touchscreen condition, and a condition that used real-object stimuli. A secondary aim was to examine the relationship between disruptive behavior and assessment outcomes.

METHOD

Twenty-seven autistic children between the ages of 3 and 12 years who had minimal verbal skills completed 12 test items on the three assessment conditions. Repeated-measures analyses of variance with post hoc Bonferroni procedures were used to describe and compare assessment duration, occurrence of disruptive behavior, and no-response trials across conditions. A Spearman rank-order correlation coefficient was used to examine the relationship between disruptive behavior and assessment outcomes.

RESULTS

The real-object assessment condition took significantly longer than the low-tech and touchscreen conditions. Participants engaged in disruptive behavior most frequently during the low-tech condition; however, differences among conditions were not significant. There were significantly more no-response trials in the low-tech condition than in the touchscreen condition. There was a significant, weak negative correlation between disruptive behavior and experimental assessment outcomes.

CONCLUSION

Results show there is promise in using real objects and touchscreen devices to assess word understanding in autistic children who have minimal verbal skills.

Joint Attention and Its Relationship with Autism Risk Markers at 18 Months of Age

(1) Joint attention is the ability to coordinate attention to share a point of reference with another person. It has an early onset and is a clear indicator of understanding the representations of others, and it is essential in the development of symbolic thought and the acquisition of language. Deficiencies in this prelinguistic early communication skill are strong markers of the risk of autism spectrum disorder (ASD); (2) this longitudinal study aimed to evaluate joint attention skills in a group of 32 infants at two developmental moments (8 and 12 months) in order to explore whether their performance on this skill was related to the presence of early signs of ASD at 18 months. Logistic multiple regressions were carried out for the data analysis; (3) results of the analysis showed that the variables of initiating joint attention at 8 months and responding to joint attention at 12 months were linked to the risk of ASD at 18 months of age; (4) in conclusion, early joint attention skills had a pivotal role in defining early manifestations of ASD.

Facilitating the emergence of intraverbal tacts in children with autism spectrum disorder: A preliminary analysis

Intraverbal tacts are an example of multiply controlled verbal behavior. More specifically, they are verbal responses under control of both a nonverbal (visual) stimulus (e.g., a green ball) and a verbal (auditory) stimulus (e.g., "What color?" vs. "What shape?"). Studies have shown that verbal behavior training can be arranged in a way that would lead to the emergence of other verbal operants, including multiply controlled (convergent) intraverbals. Our study sought to evaluate the relevance of a specific set of component skills on the emergence of intraverbal tacts in children with an autism spectrum disorder. Intraverbal tacts were observed only when all component skills were mastered, suggesting that this set of skills was sufficient to produce emergent verbal performance. Preliminary data were obtained on the necessity of 4 of the 6 component skills and tentatively suggest that they may be necessary to produce emergent intraverbal tacts, at least under some conditions.

Visual Sensory Experiences From the Viewpoint of Autistic Adults

Although previous research has investigated altered sensory reactivity in autistic individuals, there has been no specific focus on visual sensory experiences, particularly in adults. Using qualitative methods, this study aimed to characterize autistic visual sensory symptoms, contextualize their impact and document any associated coping strategies. A total of 18 autistic adults took part in four focus groups which involved questions around visual experiences, the impact of these on daily life, and strategies for their reduction. Transcripts of each session were thematically analyzed allocating six key themes. Participants described a range of visual hypersensitivities, including to light, motion, patterns and particular colors, which contributed to distraction and were frequently part of a wider multisensory issue. Such experiences had significant negative impacts on personal wellbeing and daily life with participants describing fatigue, stress and hindrances on day-to-day activities (e.g., travel and social activities). However, the degree of understanding that participants had about their visual experiences influenced their emotional response, with greater understanding reducing concern. Participants employed a variety of coping strategies to overcome visual sensory experiences but with varied success. Discussions also highlighted that there may be a poor public understanding of sensory issues in autism affecting how well autistic individuals are able manage their sensory symptoms. In summary, autistic adults expressed significant concern about their visual experiences and there is a need to improve understanding of visual experiences on a personal and public level as well as for developing potential support.

Competing Perceptual Salience in a Visual Word Recognition Task Differentially Affects Children With and Without Autism Spectrum Disorder

Differences in visual attention have long been recognized as a central characteristic of autism spectrum disorder (ASD). Regardless of social content, children with ASD show a strong preference for perceptual salience-how interesting (i.e., striking) certain stimuli are, based on their visual properties (e.g., color, geometric patterning). However, we do not know the extent to which attentional allocation preferences for perceptual salience persist when they compete with top-down, linguistic information. This study examined the impact of competing perceptual salience on visual word recognition in 17 children with ASD (mean age 31 months) and 17 children with typical development (mean age 20 months) matched on receptive language skills. A word recognition task presented two images on a screen, one of which was named (e.g., Find the bowl!). On Neutral trials, both images had high salience (i.e., were colorful and had geometric patterning). On Competing trials, the distracter image had high salience but the target image had low salience, creating competition between bottom-up (i.e., salience-driven) and top-down (i.e., language-driven) processes. Though both groups of children showed word recognition in an absolute sense, competing perceptual salience significantly decreased attention to the target only in the children with ASD. These findings indicate that perceptual properties of objects can disrupt attention to relevant information in children with ASD, which has implications for supporting their language development. Findings also demonstrate that perceptual salience affects attentional allocation preferences in children with ASD, even in the absence of social stimuli. LAY SUMMARY: This study found that visually striking objects distract young children with autism spectrum disorder (ASD) from looking at relevant (but less striking) objects named by an adult. Language-matched, younger children with typical development were not significantly affected by this visual distraction. Though visual distraction could have cascading negative effects on language development in children with ASD, learning opportunities that build on children's focus of attention are likely to support positive outcomes.

Initiation of joint attention and related visual attention processes in infants with autism spectrum disorder: Literature review

Autism spectrum disorder (ASD) represents a group of neurodevelopmental disabilities that can be difficult to identify before the age of 2 or 3 years, the age when the full range of behavioral symptoms has emerged in most cases. Initiation of joint attention is an important developmental function in which impairments are already observable before the second birthday and can predict children's ASD symptomatology. In the first part of this review, we summarize results pertaining to retrospective studies of initiation of joint attention in children with ASD and prospective studies of infants at high risk for ASD during the first 2 years, when this behavior is becoming more complex in terms of frequency, quality, and variety. We will also discuss the implications of impairments in dyadic engagement, a precursor of joint attention behavior, for the early development of joint attention. Finally, the early development of initiation of joint attention has been related to specific visual attention mechanisms such as social orienting and visual disengagement. In the second part of this review, we provide an overview of the relationship between those visual attention mechanisms and subsequent social-communication impairments. Clinical and research implications of these findings for both early detection and early intervention will be discussed.

Equine-Assisted Occupational Therapy: Increasing Engagement for Children With Autism Spectrum Disorder

Engagement in meaningful activities is essential to development and is often reduced in children with autism spectrum disorder (ASD) who have limited engagement in activities or relationships. A multiple-baseline design was used with 7 children with ASD ages 4-8 yr to assess the effect of including a horse in occupational therapy intervention on task engagement. The children showed improvements in engagement. Including horses in occupational therapy sessions may be a valuable addition to conventional treatments to increase task engagement of children with ASD. Factors related to the environment, therapeutic strategies, and individual participation need to be considered in understanding why this intervention may be effective and developing a theoretical basis for implementation.

Spoken word recognition in children with autism spectrum disorder: The role of visual disengagement

Deficits in visual disengagement are one of the earliest emerging differences in infants who are later diagnosed with autism spectrum disorder. Although researchers have speculated that deficits in visual disengagement could have negative effects on the development of children with autism spectrum disorder, we do not know which skills are disrupted or how this disruption takes place. As a first step in understanding this issue, this study investigated the relationship between visual disengagement and a critical skill in early language development: spoken word recognition. Participants were 18 children with autism spectrum disorder (aged 4-7 years). Consistent with our predictions, children with poorer visual disengagement were slower and less accurate to process familiar words; disengagement explained over half of the variance in spoken word recognition. Visual disengagement remained uniquely associated with spoken word recognition after accounting for children's vocabulary size and age. These findings align with a recently proposed developmental model in which poor visual disengagement decreases the speed and accuracy of real-time spoken word recognition in children with autism spectrum disorder-which, in turn, may negatively affect their language development.

Attention and working memory training: A feasibility study in children with neurodevelopmental disorders

The current study investigated the efficacy of a game-based process specific intervention for improving attention and working memory in children with Fetal Alcohol Spectrum Disorders (FASD) and Autism Spectrum Disorders (ASD). The Caribbean Quest (CQ) is a 'serious game' that consists of five hierarchically structured tasks, delivered in an adaptive format, targeting different aspects of attention and/or working memory. In addition to game play, the intervention incorporates metacognitive strategies provided by trained educational assistants (EAs), to facilitate generalization and far transfer to academic and daily skills. EAs delivered the intervention to children (ages 6-13) during their regular school day, providing children with instruction in metacognitive strategies to improve game play, with participants completing approximately 12 hours of training over an 8 to 12 school week period. Pre- and post-test analyses revealed significant improvement on measures of working memory and attention, including reduced distractibility and improved divided attention skills. Additionally, children showed significant gains in performance on an academic measure of reading fluency, suggesting that training-related gains in attention and working memory transferred to classroom performance. Exit interviews with EAs revealed that the intervention was easily delivered within the school day, that children enjoyed the intervention, and that children transferred metacognitive strategies learned in game play into the classroom. Preliminary results support this game-based process specific intervention as a potentially effective treatment and useful tool for supporting cognitive improvements in children with FASD or ASD, when delivered as part of an overall treatment plan.

Teaching observational learning to children with autism

Observational learning (OL) is critical for the acquisition of social skills and may be an important skill for learning in traditional educational settings. Although OL occurs during early childhood in the typically developing population, research suggests that it may be limited in children diagnosed with autism spectrum disorder (ASD). The purpose of the present study was to develop an assessment to test for the presence of OL across a variety of tasks. If OL was deficient, we sought to teach it by training specific skills. Six participants who had been diagnosed with ASD demonstrated deficits in OL. After an initial assessment, a multiple-probe design across OL tasks showed that training produced acquisition of these skills across multiple exemplars. After training, 5 of the 6 participants engaged in OL across multiple tasks and task variations, demonstrating generalization. For 1 participant, generalization of performance did not occur across tasks but did occur within task variations.

Team collaboration: the use of behavior principles for serving students with ASD

PURPOSE

Speech-language pathologists (SLPs) and behavior analysts are key members of school-based teams that serve children with autism spectrum disorders (ASD). Behavior analysts approach assessment and intervention through the lens of applied behavior analysis (ABA). ABA-based interventions have been found effective for targeting skills across multiple domains for children with ASD. However, some SLPs may be unfamiliar with the breadth of ABA-based interventions. The intent of this tutorial is to briefly introduce key ABA principles, provide examples of ABA-based interventions used within schools, and identify strategies for successful collaboration between behavior analysts and SLPs.

METHOD

This tutorial draws from empirical studies of ABA-based interventions for children with ASD within school settings, as well as discussions in the extant literature about the use of behavior principles by SLPs and strategies for interdisciplinary collaboration.

CONCLUSION

Given the prevalence of ASD at 1 in 68 children (Centers for Disease Control and Prevention, 2014) and the high cost of serving these children within schools (an average cost of 286% over regular education; Chambers, Shkolnik, & Perez, 2003), the need for effective, comprehensive service provision and efficiency within interdisciplinary teams is paramount. Communication, mutual understanding, and recognition of common ground between SLPs and behavior analysts can lead to successful collaboration.

Cognitive training as a resolution for early executive function difficulties in children with intellectual disabilities

Core executive functions (EF) such as attention, and working memory have been strongly associated with academic achievement, language development and behavioral stability. In the case of children who are vulnerable to cognitive and learning problems because of an underlying intellectual disability, EF difficulties will likely exacerbate an already compromised cognitive system. The current review examines cognitive training programs that aim to improve EF, specifically focusing on the potential of this type of intervention for children who have intellectual disabilities. We conclude that despite considerable discrepancies regarding reported intervention effects, these inconsistencies can be attributed to flaws in both program and study design. We discuss the steps needed to address these limitations and to facilitate the advancement of non-pharmaceutical interventions for children with intellectual disabilities.

The modality shift experiment in adults and children with high functioning autism

This study used the modality shift experiment, a relatively simple reaction time measure to visual and auditory stimuli, to examine attentional shifting within and across modalities in 33 children and 42 adults with high-functioning autism as compared to matched numbers of age- and ability-matched typical controls. An exaggerated "modality shift effect" relative to the TD children occurred for the children with autism in conditions involving the reaction time when shifting from sound to light but not from light to sound. No exaggerated MSE was found for the adults with autism; rather, their responses were characterized by a generalized slowness relative to the adults with TD. These results suggest a lag in maturational development in autism in basic information processing mechanisms.

Sensory Response Patterns in Nonverbal Children with ASD

We sought to examine concurrent and longitudinal associations between sensory response patterns (i.e., hyperresponsiveness, hyporesponsiveness, and sensory seeking) and verbal status of young children with autism spectrum disorder (ASD) as a potential factor influencing the development of verbal communication. Seventy-nine children with ASD (verbal, n = 29; nonverbal, n = 50) were assessed using cross-sectional analyses (Study 1), and 14 children with ASD (verbal, n = 6; nonverbal, n = 8) were assessed using prospective longitudinal analyses (Study 2). Data were collected regarding sensory response patterns and verbal ability. Hyporesponsiveness and sensory seeking behaviors were associated with verbal status in both cross-sectional and longitudinal analyses; nonverbal children were more likely to demonstrate higher hyporesponsive and sensory seeking patterns. Hyperresponsiveness did not significantly differ between verbal and nonverbal groups in either design. Sensory hyporesponsiveness and seeking behaviors may be important factors hindering the development of functional verbal communication in children with ASD. Unusual sensory responsiveness can often be observed before the onset of speech and may yield important prognostic capabilities as well as inform early interventions targeting verbal communication or alternative communication options in young children with ASD.

Increasing observational learning of children with autism: a preliminary analysis

We evaluated the effects of monitoring responses on the acquisition of sight words with 3 children with autism. In the training condition, we taught participants a vocal imitation and matching response related to a peer's reading response. In another condition, participants were exposed only to a peer's reading responses. Participants read the words more accurately during test sessions when the monitoring response was required. Results and discussion highlight the importance of identifying component responses of observational learning and the need for additional research in this area.

Cognitive flexibility in ASD; task switching with emotional faces

Children with autism spectrum disorders (ASDs) show daily cognitive flexibility deficits, but laboratory data are unconvincing. The current study aimed to bridge this gap. Thirty-one children with ASD (8–12 years) and 31 age- and IQ-matched typically developing children performed a gender emotion switch task. Unannounced switches and complex stimuli (emotional faces) improved ecological validity; minimal working memory-load prevented bias in the findings. Overall performance did not differ between groups, but in a part of the ASD group performance was slow and inaccurate. Moreover, within the ASD group switching from emotion to gender trials was slower than vice versa. Children with ASD do not show difficulties on an ecological valid switch task, but have difficulty disengaging from an emotional task set.

Assisting autistic children with wireless EOG technology

We propose a novel intervention to train the speed and accuracy of attention orienting and eye movements in Autism Spectrum Disorder (ASD). Training eye movements and attention could not only affect those important functions directly, but could also result in broader improvement of social communication skills. To this end we describe a system that would allow ASD children to improve their fixation skills while playing a computer game controlled by an eye tracker. Because this intervention will probably be time consuming, this system should be designed to be used at homes. To make this possible, we propose an implementation based on wireless and dry electrooculography (EOG) technology. If successful, this system would develop an approach to therapy that would improve clinical and behavioral function in children and adults with ASD. As our initial steps in this direction, here we describe the design of a computer game to be used in this system, and the predictions of gaze position from EOG data recorded while a subject played this game.

Effect of classroom modification on attention and engagement of students with autism or dyspraxia

Students with autism display sensory sensitivities to environmental stimuli that affect their attending and engagement in classroom learning activities. The purpose of the study was to determine whether attending of 4 male students, ages 13-20, increased after the installation of sound-absorbing walls and halogen lighting. The multiple single-subject, mixed-method design, AB(B+C), included a 2-wk baseline and two intervention phases: 2 wk after sound-absorbing wall installation using the Owens Corning Basement Finishing System™ (Owens Corning, Toledo, OH) and 2 wk after halogen light installation. We calculated nonattending frequencies from videotaped class sessions and used visual analysis to measure within-phase and between-phase characteristics. Results included increased frequency and stability of attending and engagement and improved classroom performance, comfort, and mood. Journaling provided students' perspective on the modifications and reflected overall increased sensory comfort and themes of improved classroom environment, positive emotional response (mood), and improved classroom performance.

Observational learning and children with autism

A skill essential for successful inclusion in general education settings is the ability to learn by observing others. Research, however, has documented children with autism display significant deficits in the fundamental skills necessary for observational learning. This article outlines the skills essential for observational learning from an operant learning perspective, the research base on teaching observational learning to children with autism, and suggests practical strategies to increase these skills in children with autism so they may more fully benefit from inclusion in general education settings.

The neural circuitry of autism

Autism is a complex neurodevelopmental disorder, characterized by deficits in social emotional, and language domains, as well as repetitive restrictive behaviors. The vast heterogeneity of the clinical and behavioral symptoms has made it rather difficult to delineate the neural circuitry affiliated with these domains of dysfunction. The current review aims at broadly outlining the latest research into the neurobiology and neural circuitry underlying the core domains of deficits in autism. We further discuss new avenues of research that can further our understanding of the dimensions of this complex disorder.