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Corbett BA, White S, Lerner M, Preacher KJ, Klemencic ME, Simmons GL, Pilkington J, Gable P, Gioia A, Key AP. Peers, play, and performance to build social salience in autistic youth: A multisite randomized clinical trial. J Consult Clin Psychol 2023; 91:411-425. [PMID: 37199977 PMCID: PMC10330829 DOI: 10.1037/ccp0000821] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Individuals with autism spectrum disorder (ASD) have significant impairment in social competence and reduced social salience. SENSE Theatre, a peer-mediated, theater-based intervention has demonstrated posttreatment gains in face memory and social communication. The multisite randomized clinical trial compared the Experimental (EXP; SENSE Theatre) to an Active Control Condition (ACC; Tackling Teenage Training, TTT) at pretest, posttest, and follow-up. It was hypothesized that the EXP group would demonstrate greater incidental face memory (IFM) and better social behavior (interaction with novel peers) and social functioning (social engagement in daily life) than the ACC group, and posttest IFM would mediate the treatment effect on follow-up social behavior and functioning. METHOD Two hundred ninety participants were randomized to EXP (N = 144) or ACC (N = 146). Per protocol sample (≥ 7/10 sessions) resulted in 207 autistic children 10-16 years. Event-related potentials measured IFM. Naive examiners measured social behavior (Vocal Expressiveness, Quality of Rapport, Social Anxiety) and functioning (Social Communication). Structural equation modeling was used to assess treatment effects. RESULTS SENSE Theatre participants showed significantly better IFM (b = .874, p = .039) at posttest, and significant indirect effects on follow-up Vocal Expressiveness a × b = .064, with 90% CI [.014, .118] and Quality of Rapport a × b = .032, with 90% CI [.002, .087] through posttest IFM. CONCLUSIONS SENSE Theatre increases social salience as reflected by IFM, which in turn affected Vocal Expressiveness and Quality of Rapport. Results indicate that a neural mechanism supporting social cognition and driven by social salience is engaged by the treatment and has a generalized, indirect effect on clinically meaningful functional outcomes related to core symptoms of autism. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Blythe A. Corbett
- Vanderbilt University Medical Center, Department of Psychiatry and Behavioral Sciences
- Vanderbilt University Medical Center, Vanderbilt Kennedy Center
- Vanderbilt University, Department of Psychology
| | - Susan White
- University of Alabama, Department of Psychology, Tuscaloosa
| | | | | | - Mark E. Klemencic
- Vanderbilt University Medical Center, Department of Psychiatry and Behavioral Sciences
| | | | - Jennifer Pilkington
- Vanderbilt University Medical Center, Department of Psychiatry and Behavioral Sciences
| | - Philip Gable
- University of Delaware, Department of Psychological and Brain Sciences
| | - Ayla Gioia
- Stony Brook University, Department of Psychology
| | - Alexandra P. Key
- Vanderbilt University Medical Center, Department of Psychiatry and Behavioral Sciences
- Vanderbilt University Medical Center, Vanderbilt Kennedy Center
- Vanderbilt University Medical Center, Department of Hearing and Speech Sciences
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2
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Baker E, Stavropoulos KKM. The effects of oxytocin administration on individuals with ASD: Neuroimaging and behavioral evidence. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2020; 173:209-238. [PMID: 32711811 DOI: 10.1016/bs.pmbts.2020.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by difficulties in social communication and the presence of restricted interests and repetitive behaviors. Although behavioral interventions are numerous, there are no Federal Drug Administration approved pharmacological treatments for the core symptoms of ASD. The neuropeptide oxytocin has been studied in animals for decades, and is involved in pair bonding and social affiliation. Given oxytocin's involvement in social communication in animals, researchers have begun exploring whether oxytocin administration in humans affects social behaviors and attachment. Particular attention has been paid to whether oxytocin has therapeutic benefits for improving social behaviors in individuals with ASD. Research on oxytocin administration in ASD has utilized both behavioral and brain-based outcomes. This chapter reviews the effects of oxytocin administration in ASD, with a focus on functional outcomes from neuroimaging investigations. Evidence of potential therapeutic benefits are reviewed, as well as limitations of extant research. A proposed model for future research into the therapeutic benefits of oxytocin includes combining pharmacological (e.g. oxytocin) and behavioral (e.g. evidence-based behavioral interventions) techniques to improve social communication skills in ASD.
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Affiliation(s)
- Elizabeth Baker
- University of California, Graduate School of Education, Riverside, CA, United States
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DiBari JN, Azuine RE, Linares DE, Rocha I, Park HY, Raskin Ramos L, Kogan MD, Kavanagh L. Maternal and Child Health Bureau's Autism Research Program. Pediatrics 2020; 145:S5-S12. [PMID: 32238526 DOI: 10.1542/peds.2019-1895c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To provide an overview and quantitatively demonstrate the reach of the Health Resources and Services Administration's Maternal and Child Health Bureau autism research program. METHODS We reviewed program reports and internal data from 59 autism research grantees. The US federal Interagency Autism Coordinating Committee's strategic plan questions were used as a framework to highlight the contributions of the autism research program in advancing the field. RESULTS The autism research program grantees advance research in several ways. Grantees have strengthened the evidence for autism interventions by conducting 89 studies at 79 distinct research sites. A total of 212 708 participants have enrolled in autism research program studies and 361 researchers have contributed to furthering autism research. The program addresses topics that align with the majority of the Interagency Autism Coordinating Committee's priority topic areas, including advancements in treatments and interventions, services and supports, and identifying risk factors. Grantee products include 387 peer-reviewed publications, 19 tools, and 13 practice guidelines for improving care and intervention practices. CONCLUSIONS The autism research program has contributed to medical advances in research, leveraged innovative training platforms to provide specialized training, and provided access to health services through research-based screening and diagnostic procedures. Autism research program studies have contributed to the development of evidence-based practice guidelines, informed policy guidelines, and quality improvement efforts to bolster advancements in the field. Although disparities still exist, the Health Resources and Services Administration's Maternal and Child Health Bureau can reduce gaps in screening and diagnosis by targeting interventions to underserved populations including minority and rural communities.
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Affiliation(s)
| | | | | | | | - Hae Young Park
- Division of Maternal and Child Health Workforce Development
| | | | | | - Laura Kavanagh
- Office of the Associate Administrator, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
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4
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Abstract
Over one billion people in the world suffer from some form of disability. Nevertheless, according to the World Health Organization, people with disabilities are particularly vulnerable to deficiencies in services, such as health care, rehabilitation, support, and assistance. In this sense, recent technological developments can mitigate these deficiencies, offering less-expensive assistive systems to meet users’ needs. This paper reviews and summarizes the research efforts toward the development of these kinds of systems, focusing on two social groups: older adults and children with autism.
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Amanullah S, Rajeh A, Sivakumar K. An overview of autism in the elderly. Asian J Psychiatr 2020; 48:101897. [PMID: 32004801 DOI: 10.1016/j.ajp.2019.101897] [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] [Received: 04/08/2019] [Revised: 11/16/2019] [Accepted: 12/06/2019] [Indexed: 11/19/2022]
Abstract
The overall improvement in quality of health care in many countries across the globe will likely see an increase in the number of elderly patients with ASDs (Autism Spectrum Disorders) and will result in a need for extra and more adaptive educational, occupational, social, and environmental supports. An earlier diagnosis will auger well for better long-term outcomes in ASD. Therefore, better and more evidence based screening and diagnostic tools are needed. The lack of research and studies surrounding ASD in the elderly raises many real concerns about the wellbeing of those diagnosed with ASD as adults as they enter old age. This review will help provide information on prevalence, available screening tools and diagnostic instruments along with symptoms and manifestations, patients' quality of life related issues and current interventions. We will also highlight research needs and help create a clearer understanding of ASD and the challenges patients and professionals face and are confronted with.
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Affiliation(s)
- Shabbir Amanullah
- University of Toronto, Western University and Dalhousie University, Chief of Psychiatry, Woodstock General Hospital.
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Velikonja T, Fett AK, Velthorst E. Patterns of Nonsocial and Social Cognitive Functioning in Adults With Autism Spectrum Disorder: A Systematic Review and Meta-analysis. JAMA Psychiatry 2019; 76:135-151. [PMID: 30601878 PMCID: PMC6439743 DOI: 10.1001/jamapsychiatry.2018.3645] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
IMPORTANCE Many studies have investigated impairments in cognitive domains in adults with autism spectrum disorder (ASD). Yet, to date, a comprehensive overview on the patterns of cognitive functioning is lacking. OBJECTIVE To provide an overview of nonsocial and social cognitive functioning in various domains in adults with ASD, allowing for comparison of the severity of deficits between different domains. DATA SOURCES A literature search performed in an academic medical setting was conducted using PubMed, PsycINFO, Embase, and Medline databases with the combination of the following free-text and Medical Subject Headings where applicable: [cogniti* OR neurocogniti* OR neuropsycholog* OR executive function* OR IQ OR intelligence quotient OR social cognition OR emotion perception OR affect perception OR emotion recognition OR attribution OR ToM OR mentalising OR mentalizing OR prosody OR social knowledge OR mind reading OR social cue OR social judgment] AND [autis* OR ASD OR Asperger OR Asperger's OR PDD OR pervasive developmental disorder]. The search was further limited to studies published between 1980 (first inclusion of autism diagnosis in the DSM-III) and July 2018. STUDY SELECTION Studies included were published as a primary peer-reviewed research article in English, included individuals with ASD 16 years or older, and assessed at least 1 domain of neurocognitive functioning or social cognition using standard measures. DATA EXTRACTION AND SYNTHESIS Of 9892 articles identified and screened, 75 met the inclusion criteria for the systematic review and meta-analysis. MAIN OUTCOMES AND MEASURES Hedges g effect sizes were computed, and random-effects models were used for all analyses. Moderators of between-study variability in effect sizes were assessed using meta-regressions. RESULTS The systematic review and meta-analysis included 75 studies, with a combined sample of 3361 individuals with ASD (mean [SD] age, 32.0 [9.3] years; 75.9% male) and 5344 neurotypical adults (mean [SD] age, 32.3 [9.1] years; 70.1% male). Adults with ASD showed large impairments in theory of mind (g = -1.09; 95% CI, -1.25 to -0.92; number of studies = 39) and emotion perception and processing (g = -0.80; 95% CI, -1.04 to -0.55; n = 18), followed by medium impairments in processing speed (g = -0.61; 95% CI, -0.83 to -0.38; n = 21) and verbal learning and memory (g = -0.55; 95% CI, -0.86 to -0.25; n = 12). The least altered cognitive domains were attention and vigilance (g = -0.30; 95% CI, -0.81 to 0.21; n = 5) and working memory (g = -0.23; 95% CI, -0.47 to 0.01; n = 19). Meta-regressions confirmed robustness of the results. CONCLUSIONS AND RELEVANCE Results of this systematic review and meta-analysis suggest that adults with ASD show impairments in social cognitive domains and in specific nonsocial cognitive domains. These findings contribute to the understanding of the patterns of cognitive functioning in adults with ASD and may assist in the identification of targets for cognitive interventions.
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Affiliation(s)
- Tjasa Velikonja
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York,The Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anne-Kathrin Fett
- Department of Psychology, City University of London, London, United Kingdom
| | - Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York,The Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York
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Rivard M, Morin M, Mello C, Terroux A, Mercier C. Follow-Up of Children With Autism Spectrum Disorder 1 Year After Early Behavioral Intervention. Behav Modif 2018; 43:490-517. [PMID: 29726269 DOI: 10.1177/0145445518773692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effectiveness of early intensive behavioral intervention (EIBI) for children with autism spectrum disorders (ASDs) has been demonstrated by many studies and meta-analyses. Although it is considered an exemplary practice in several countries, few studies have investigated the maintenance of gains made in EIBI over time. Thirty-two children were assessed at posttreatment and 1-year follow-up after they attended a low-to-moderate-intensity (10 to 20 hr per week) EIBI program delivered by a public rehabilitation center. Between baseline and posttreatment, children showed significant gains in most areas of intellectual functioning and a significant decrease of autism symptom severity, but no change in adaptive behavior. Gains in intellectual functioning were maintained over a 1-year period after treatment termination, but autism symptom severity had increased to approximately pretreatment levels during that interval. Considerable individual variability was noted in the evolution of outcomes.
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Affiliation(s)
| | | | - Catherine Mello
- 2 The Pennsylvania State University - Berks, Reading, PA, USA
| | - Amélie Terroux
- 3 Centre de réadaptation en déficience intellectuelle et trouble envahissant du développement de la Montérégie-Est, St-Hubert, Québec, Canada
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8
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Conallen K, Reed P. Children with autism spectrum disorder: teaching conversation involving feelings about events. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:279-291. [PMID: 27723165 DOI: 10.1111/jir.12339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/10/2016] [Accepted: 09/13/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Two procedures were developed to teach individuals with Autism Spectrum Disorders labels (tacts) for various private events (emotions): Study 1 attempted to distinguish them from pure tacts and mands (requests); and Study 2 attempted to train initiating a conversation with grammatically correct subject-verb-comment construction. METHODS A multiple treatment reversal design was used in both studies, followed by a probe to see if the tacts were used across novel settings. RESULTS The children were prompted to initiate a series of language exchanges, which resulted in an increased ability to participate in conversations about private events. CONCLUSIONS Together, the results of both studies suggest that, by providing an effective and reinforcing means of teaching both the function and the form of these tacts, conversations can be successfully initiated by children with ASD.
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Affiliation(s)
- K Conallen
- Department of Psychology, Swansea University, Swansea, UK
| | - P Reed
- Department of Psychology, Swansea University, Swansea, UK
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9
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Chen YW, Cordier R, Brown N. A preliminary study on the reliability and validity of using experience sampling method in children with autism spectrum disorders. Dev Neurorehabil 2016; 18:383-9. [PMID: 24304202 DOI: 10.3109/17518423.2013.855274] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study investigated the feasibility of using experience sampling method (ESM) to study everyday experiences in children with autism spectrum disorders. METHODS Six boys, aged 8-12 years, with high-functioning autism or Asperger syndrome carried an iPod touch with a pre-installed ESM survey about what they were doing, where, with whom and the quality of their experiences and associated emotions. They were randomly signalled seven times daily for seven consecutive days to respond to the survey. RESULTS The average signal response rates (56.8%) was acceptable and the mean time of survey completion (1 minute 53 seconds) was within acceptable range. Split-week analysis supported the consistency of experiences reporting while correlations among theoretically linked quality of experiences and emotions showed the internal logic of participants' responses; thus supporting internal reliability and validity, respectively. CONCLUSION The study demonstrated the feasibility and usefulness of using ESM in exploring participants' everyday life experiences.
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Affiliation(s)
- Yu-Wei Chen
- a Discipline of Occupational Therapy, The University of Sydney , Sydney , NSW , Australia
| | - Reinie Cordier
- b School of Occupational Therapy and Social Work, Curtin University , Perth , WA , Australia , and
| | - Nicole Brown
- c Discipline of Occupational Therapy, James Cook University , Townsville , QLD , Australia
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10
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Stahmer AC, Suhrheinrich J, Mandell DS. The importance of characterizing intervention for individuals with autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 20:386-7. [DOI: 10.1177/1362361316637503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Aubyn C Stahmer
- MIND Institute and Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, USA
| | - Jessica Suhrheinrich
- Child and Adolescent Services Research Center and Department of Psychiatry, School of Medicine, University of California, San Diego, USA
| | - David S Mandell
- Center for Mental Health Policy and Services Research & Department of Psychiatry and Pediatrics, Perlman School of Medicine, University of Pennsylvania, USA
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11
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Kamps D, Thiemann-Bourque K, Heitzman-Powell L, Schwartz I, Rosenberg N, Mason R, Cox S. A comprehensive peer network intervention to improve social communication of children with autism spectrum disorders: a randomized trial in kindergarten and first grade. J Autism Dev Disord 2015; 45:1809-24. [PMID: 25510450 DOI: 10.1007/s10803-014-2340-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The purpose of this randomized control group study was to examine the effects of a peer network intervention that included peer mediation and direct instruction for Kindergarten and First-grade children with autism spectrum disorders. Trained school staff members provided direct instruction for 56 children in the intervention group, and 39 children participated in a comparison group. Results showed children in the intervention group displayed significantly more initiations to peers than did the comparison group during non-treatment social probes and generalization probes. Treatment session data showed significant growth for total communications over baseline levels. Children in treatment also showed more growth in language and adaptive communication. Finally, teachers' ratings of prosocial skills revealed significantly greater improvements for the intervention group.
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Affiliation(s)
- Debra Kamps
- Life Span Institute, Juniper Gardens Children's Project, University of Kansas, 444 Minnesota Avenue, 3rd floor, Kansas City, KS, 66101, USA,
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12
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Kretzmann M, Shih W, Kasari C. Improving peer engagement of children with autism on the school playground: a randomized controlled trial. Behav Ther 2015; 46:20-8. [PMID: 25526832 DOI: 10.1016/j.beth.2014.03.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 02/26/2014] [Accepted: 03/11/2014] [Indexed: 11/29/2022]
Abstract
This study aimed to test the effects of a psychosocial intervention, Remaking Recess, on peer engagement for children with autism spectrum disorder (ASD). Using a randomized, wait-list-controlled design, the intervention was implemented during recess at four elementary schools. The immediate treatment (IT) group consisted of 13 (2 female) elementary school students with ASD and the wait-list (WL) group contained 11 (4 female) students with ASD. All of the children with ASD were fully included in the general education program. Analyses revealed that time spent engaged with peers was significantly increased for the IT group and maintained over the follow-up. School playground staff in the IT group showed increased behaviors aimed at improving peer engagement for children with ASD compared to playground staff at the WL sites. These improvements did not maintain to follow-up. These results suggest that a low dose, brief intervention can be beneficial in increasing peer engagement for children with autism in inclusive settings, but continued support of playground staff is likely needed.
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13
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Kamps D, Mason R, Thiemann-Bourque K, Feldmiller S, Turcotte A, Miller T. The Use of Peer Networks to Increase Communicative Acts of First Grade Students with Autism Spectrum Disorders. FOCUS ON AUTISM AND OTHER DEVELOPMENTAL DISABILITIES 2014; 29:230-245. [PMID: 26312013 PMCID: PMC4547562 DOI: 10.1177/1088357614539832] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Peer networks including social groups using typical peers, scripted instruction, visual text cues, and reinforcement were examined with students with autism spectrum disorders (ASD). A multiple baseline design across four participants was used to measure students’ use of communication acts with peers during free play following instruction. Peer Network groups occurred over a 3-month period for 30 min 3 times per week. Visual inspection of trends and TauU effect size calculations showed significant changes in total communication acts for all four participants during peer network sessions and increased initiations for three of the four participants. Generalization probes during classroom centers indicated increased communications following interventions for three of the four participants.
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Affiliation(s)
- Debra Kamps
- University of Kansas, Juniper Gardens Children’s Project, 444 Minnesota Avenue, Kansas City, KS 66101
| | - Rose Mason
- University of Kansas, Juniper Gardens Children’s Project, 444 Minnesota Avenue, Kansas City, KS 66101
| | - Kathy Thiemann-Bourque
- University of Kansas, Juniper Gardens Children’s Project, 444 Minnesota Avenue, Kansas City, KS 66101
| | - Sarah Feldmiller
- University of Kansas, Juniper Gardens Children’s Project, 444 Minnesota Avenue, Kansas City, KS 66101
| | - Amy Turcotte
- University of Kansas, Juniper Gardens Children’s Project, 444 Minnesota Avenue, Kansas City, KS 66101
| | - Todd Miller
- University of Kansas, Juniper Gardens Children’s Project, 444 Minnesota Avenue, Kansas City, KS 66101
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Eack SM, Greenwald DP, Hogarty SS, Bahorik AL, Litschge MY, Mazefsky CA, Minshew NJ. Cognitive enhancement therapy for adults with autism spectrum disorder: results of an 18-month feasibility study. J Autism Dev Disord 2014; 43:2866-77. [PMID: 23619953 DOI: 10.1007/s10803-013-1834-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Adults with autism experience significant impairments in social and non-social information processing for which few treatments have been developed. This study conducted an 18-month uncontrolled trial of Cognitive Enhancement Therapy (CET), a comprehensive cognitive rehabilitation intervention, in 14 verbal adults with autism spectrum disorder to investigate its feasibility, acceptability, and initial efficacy in treating these impairments. Results indicated that CET was satisfying to participants, with high treatment attendance and retention. Effects on cognitive deficits and social behavior were also large (d = 1.40-2.29) and statistically significant (all p < .001). These findings suggest that CET is a feasible, acceptable, and potentially effective intervention for remediating the social and non-social cognitive impairments in verbal adults with autism.
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Affiliation(s)
- Shaun M Eack
- School of Social Work, University of Pittsburgh, 2117 Cathedral of Learning, Pittsburgh, PA, 15260, USA,
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15
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Harrop C. Evidence-based, parent-mediated interventions for young children with autism spectrum disorder: The case of restricted and repetitive behaviors. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2014; 19:662-72. [PMID: 25186943 DOI: 10.1177/1362361314545685] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Restricted and repetitive behaviors represent a core symptom of autism spectrum disorders. While there has been an increase in research into this domain in recent years, compared to social-communication impairments experienced by children with autism spectrum disorders, much less is known about their development, etiology, and management. Parent-mediated interventions have become increasingly popular in the field, with a surge of studies reporting significant findings in social communication and cognitive development in early childhood. Restricted and repetitive behaviors are often not specifically targeted or measured as an outcome within these interventions. This article reviews how 29 parent-mediated interventions approached the management, treatment, and measurement of restricted and repetitive behaviors. Recommendations for research and practice are presented.
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16
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Chen YW, Bundy A, Cordier R, Einfeld S. Feasibility and usability of experience sampling methodology for capturing everyday experiences of individuals with autism spectrum disorders. Disabil Health J 2014; 7:361-6. [DOI: 10.1016/j.dhjo.2014.04.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 02/05/2014] [Accepted: 04/28/2014] [Indexed: 11/16/2022]
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17
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Kenworthy L, Anthony LG, Naiman DQ, Cannon L, Wills MC, Luong-Tran C, Werner MA, Alexander KC, Strang J, Bal E, Sokoloff JL, Wallace GL. Randomized controlled effectiveness trial of executive function intervention for children on the autism spectrum. J Child Psychol Psychiatry 2014; 55:374-83. [PMID: 24256459 PMCID: PMC4532389 DOI: 10.1111/jcpp.12161] [Citation(s) in RCA: 163] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Unstuck and On Target (UOT) is an executive function (EF) intervention for children with autism spectrum disorders (ASD) targeting insistence on sameness, flexibility, goal-setting, and planning through a cognitive-behavioral program of self-regulatory scripts, guided/faded practice, and visual/verbal cueing. UOT is contextually-based because it is implemented in school and at home, the contexts in which a child uses EF skills. METHODS To evaluate the effectiveness of UOT compared with a social skills intervention (SS), 3rd-5th graders with ASD (mean IQ = 108; UOT n = 47; SS n = 20) received interventions delivered by school staff in small group sessions. Students were matched for gender, age, race, IQ, ASD symptomotolgy, medication status, and parents' education. Interventions were matched for 'dose' of intervention and training. Measures of pre-post change included classroom observations, parent/teacher report, and direct child measures of problem-solving, EF, and social skills. Schools were randomized and evaluators, but not parents or teachers, were blinded to intervention type. RESULTS Interventions were administered with high fidelity. Children in both groups improved with intervention, but mean change scores from pre- to postintervention indicated significantly greater improvements for UOT than SS groups in: problem-solving, flexibility, and planning/organizing. Also, classroom observations revealed that participants in UOT made greater improvements than SS participants in their ability to follow rules, make transitions, and be flexible. Children in both groups made equivalent improvements in social skills. CONCLUSIONS These data support the effectiveness of the first contextually-based EF intervention for children with ASD. UOT improved classroom behavior, flexibility, and problem-solving in children with ASD. Individuals with variable background/training in ASD successfully implemented UOT in mainstream educational settings.
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Affiliation(s)
- Lauren Kenworthy
- Children's National Medical Center, Center for Autism Spectrum Disorders, Maryland, USA,The George Washington University School of Medicine, District of Columbia, USA
| | - Laura Gutermuth Anthony
- Children's National Medical Center, Center for Autism Spectrum Disorders, Maryland, USA,The George Washington University School of Medicine, District of Columbia, USA
| | - Daniel Q. Naiman
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lynn Cannon
- The Ivymount School, Rockville, Maryland, USA
| | - Meagan C. Wills
- Children's National Medical Center, Center for Autism Spectrum Disorders, Maryland, USA
| | - Caroline Luong-Tran
- Children's National Medical Center, Center for Autism Spectrum Disorders, Maryland, USA
| | | | | | - John Strang
- Children's National Medical Center, Center for Autism Spectrum Disorders, Maryland, USA,The George Washington University School of Medicine, District of Columbia, USA
| | - Elgiz Bal
- Children's National Medical Center, Center for Autism Spectrum Disorders, Maryland, USA
| | - Jennifer L. Sokoloff
- Children's National Medical Center, Center for Autism Spectrum Disorders, Maryland, USA
| | - Gregory L. Wallace
- Laboratory of Brain & Cognition, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
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Brief report: is cognitive rehabilitation needed in verbal adults with autism? Insights from initial enrollment in a trial of cognitive enhancement therapy. J Autism Dev Disord 2014; 43:2233-7. [PMID: 23381484 DOI: 10.1007/s10803-013-1774-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cognitive rehabilitation is an emerging set of potentially effective interventions for the treatment of autism spectrum disorder, yet the applicability of these approaches for "high functioning" adults who have normative levels of intelligence remains unexplored. This study examined the initial cognitive performance characteristics of 40 verbal adults with autism enrolled in a pilot trial of Cognitive Enhancement Therapy to investigate the need for cognitive rehabilitation in this population. Results revealed marked and broad deficits across neurocognitive and social-cognitive domains, despite above-average IQ. Areas of greatest impairment included processing speed, cognitive flexibility, and emotion perception and management. These findings indicate the need for comprehensive interventions designed to enhance cognition among verbal adults with autism who have intact intellectual functioning.
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Mason R, Kamps D, Turcotte A, Cox S, Feldmiller S, Miller T. Peer Mediation to Increase Communication and Interaction at Recess for Students with Autism Spectrum Disorders. RESEARCH IN AUTISM SPECTRUM DISORDERS 2014; 8:334-344. [PMID: 26180543 PMCID: PMC4500175 DOI: 10.1016/j.rasd.2013.12.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Recess plays an integral role in the social and emotional development of children given the time provided to engage in interactions with others and practice important social skills. Students with ASD, however, typically fail to achieve even minimal benefit from recess due to social and communication impairments as well as a tendency to withdraw. Implementation of evidence-based interventions such as peer-mediated social skills groups, are necessary to ensure recess is an advantageous learning environment for students with ASD. A multiple-baseline design across participants was used to determine if a functional relationship exists between a social skills instructional program combined with peer networks with school staff as implementers and increases in level of communicative acts for participants with ASD at recess. Results indicate all participants demonstrated an immediate increase in the number of communicative acts with the introduction of the intervention. Implications for practice are discussed.
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Affiliation(s)
- Rose Mason
- Juniper Gardens Children’s Project, University of Kansas, Kansas City, KS 66101
| | - Debra Kamps
- Juniper Gardens Children’s Project, University of Kansas, Kansas City, KS 66101
| | - Amy Turcotte
- Juniper Gardens Children’s Project, University of Kansas, Kansas City, KS 66101
| | - Suzanne Cox
- Juniper Gardens Children’s Project, University of Kansas, Kansas City, KS 66101
| | - Sarah Feldmiller
- Juniper Gardens Children’s Project, University of Kansas, Kansas City, KS 66101
| | - Todd Miller
- Juniper Gardens Children’s Project, University of Kansas, Kansas City, KS 66101
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Gillies D, Carroll L, Loos M. Commentary on 'Social skills groups for people aged 6 to 21 with autism spectrum disorders (ASD)'. ACTA ACUST UNITED AC 2014; 8:316-7. [PMID: 23877885 DOI: 10.1002/ebch.1902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This is a commentary on a Cochrane review, published in this issue of EBCH, first published as: Reichow B, Steiner AM, Volkmar F. Social skills groups for people aged 6 to 21 with autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews 2012, Issue 7. Art. No.: CD008511. DOI: 10.1002/14651858.CD008511.pub2. Further information for this Cochrane review is available in this issue of EBCH in the accompanying Summary article.
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Affiliation(s)
- Donna Gillies
- Mental Health Service, Western Sydney Local Health District, Sydney, Australia.
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Isquith PK, Roth RM, Kenworthy L, Gioia G. Contribution of rating scales to intervention for executive dysfunction. APPLIED NEUROPSYCHOLOGY-CHILD 2014; 3:197-204. [PMID: 24559500 DOI: 10.1080/21622965.2013.870014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Executive dysfunction is present in children, adolescents, and adults with a wide range of clinical conditions. A growing body of literature has demonstrated the usefulness of rating scales designed to gauge executive functioning in everyday life. In this article, we discuss evidence supporting the use of such rating scales to assess intervention outcome, how they may inform development of interventions, and how comparing rater perspectives can assess awareness of cognitive dysfunction. We provide an example of how an executive function rating scale helped define intervention targets and measured outcomes in a recently published real-world intervention for children with autism spectrum disorder. Rating scales of executive function provide valuable information with respect to treatment planning and assessment of intervention outcome.
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Affiliation(s)
- Peter K Isquith
- a Neuropsychology Program, Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire
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22
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Jaschke AC. Music intervention as system: Reversing hyper systemising in autism spectrum disorders to the comprehension of music as intervention. Med Hypotheses 2014; 82:40-8. [PMID: 24280561 DOI: 10.1016/j.mehy.2013.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 10/28/2013] [Accepted: 11/05/2013] [Indexed: 10/26/2022]
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Cognitive-Behavioral Approach for Children with Autism Spectrum Disorders: a Meta-Analysis. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2013. [DOI: 10.1007/s40489-013-0002-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wang X, Bey AL, Chung L, Krystal AD, Jiang YH. Therapeutic approaches for shankopathies. Dev Neurobiol 2013; 74:123-35. [PMID: 23536326 DOI: 10.1002/dneu.22084] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 03/21/2013] [Indexed: 12/13/2022]
Abstract
Despite recent advances in understanding the molecular mechanisms of autism spectrum disorders (ASD), the current treatments for these disorders are mostly focused on behavioral and educational approaches. The considerable clinical and molecular heterogeneity of ASD present a significant challenge to the development of an effective treatment targeting underlying molecular defects. Deficiency of SHANK family genes causing ASD represent an exciting opportunity for developing molecular therapies because of strong genetic evidence for SHANK as causative genes in ASD and the availability of a panel of Shank mutant mouse models. In this article, we review the literature suggesting the potential for developing therapies based on molecular characteristics and discuss several exciting themes that are emerging from studying Shank mutant mice at the molecular level and in terms of synaptic function.
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Affiliation(s)
- Xiaoming Wang
- Department of Pediatrics, Duke University School of Medicine Durham, North Carolina, 27710
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25
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Grofer Klinger L, Ence W, Meyer A. Caregiver-mediated approaches to managing challenging behaviors in children with autism spectrum disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2013. [PMID: 24174896 PMCID: PMC3811093 DOI: 10.31887/dcns.2013.15.2/lklinger] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A significant proportion of children with autism spectrum disorder (ASD) are referred to mental health centers due to the presence of challenging behaviors. Because challenging behaviors in children and adolescents with ASD often result from underlying social and communication difficulties and comorbid anxiety, traditional caregiver-mediated behavior intervention techniques developed for children with disruptive behavior disorders may need to be adapted for this population. Behavioral interventions that target communication skills, social skills, anxiety, and sensory responsiveness in children with ASD may be needed. Notably, while best practice necessitates the involvement of caregivers in treating children and adolescents with ASD, few randomized control studies have examined the effectiveness of caregiver-implemented interventions in reducing challenging behaviors. This review summarizes the current literature with regard to caregiver-mediated behavioral interventions for children with ASD, and suggests areas for intervention development and research.
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Affiliation(s)
- Laura Grofer Klinger
- TEACCH Autism Program and Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Whitney Ence
- TEACCH Autism Program and Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Allison Meyer
- TEACCH Autism Program and Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
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Siniscalco D, Bradstreet JJ, Antonucci N. Therapeutic role of hematopoietic stem cells in autism spectrum disorder-related inflammation. Front Immunol 2013; 4:140. [PMID: 23772227 PMCID: PMC3677147 DOI: 10.3389/fimmu.2013.00140] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/26/2013] [Indexed: 12/24/2022] Open
Abstract
Autism and autism spectrum disorders (ASDs) are heterogeneous, severe neuro-developmental disorders with core symptoms of dysfunctions in social interactions and communication skills, restricted interests, repetitive – stereotypic verbal and non-verbal behaviors. Biomolecular evidence points to complex gene-environmental interactions in ASDs. Several biochemical processes are associated with ASDs: oxidative stress (including endoplasmic reticulum stress), decreased methylation capacity, limited production of glutathione; mitochondrial dysfunction, intestinal dysbiosis, increased toxic metal burden, and various immune abnormalities. The known immunological disorders include: T-lymphocyte populations and function, gene expression changes in monocytes, several autoimmune-related findings, high levels of N-acetylgalactosaminidase (which precludes macrophage activation), and primary immune deficiencies. These immunological observations may result in minicolumn structural changes in the brain, as well as, abnormal immune mediation of synaptic functions. Equally, these immune dysregulations serve as the rationale for immune-directed interventions such as hematopoietic stem cells (HSCs), which are pivotal in controlling chronic inflammation and in the restoration of immunological balance. These properties make them intriguing potential agents for ASD treatments. This prospective review will focus on the current state-of-the-art knowledge and challenges intrinsic in the application of HSCs for ASD-related immunological disorders.
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Affiliation(s)
- Dario Siniscalco
- Department of Experimental Medicine, Second University of Naples , Naples , Italy ; Centre for Autism - La Forza del Silenzio , Caserta , Italy ; Cancellautismo , Florence , Italy
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Possible use of Trichuris suis ova in autism spectrum disorders therapy. Med Hypotheses 2013; 81:1-4. [PMID: 23597946 DOI: 10.1016/j.mehy.2013.03.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 03/01/2013] [Accepted: 03/17/2013] [Indexed: 12/24/2022]
Abstract
Autism and autism spectrum disorders (ASDs) are heterogeneous, severe neurodevelopmental pathologies. The main core symptoms are: dysfunctions in social interactions and communication skills, restricted interests, repetitive and stereotypic verbal and non-verbal behaviors. Several biochemical processes are associated with ASDs: oxidative stress; endoplasmic reticulum stress; decreased methylation capacity; limited production of glutathione; mitochondrial dysfunction; intestinal dysbiosis; increased toxic metal burden; immune dysregulation. Current available treatments for ASDs can be divided into behavioral, nutritional and medical approaches, although no defined standard approach exists. Current drugs fail to benefit the ASD core symptoms and can have marked adverse effects, are mainly palliative and only sometimes efficacy in attenuating specific autistic behaviors. Helminthic therapy shows potential for application as anti-inflammatory agent. Several human diseases can be treated by helminths (i.e. inflammatory bowel disease, asthma, multiple sclerosis and autoimmune diabetes). Trichuris suis ova (TSO) show strong immunomodulatory properties. Authors hypothesize that TSO could be useful in addressing ASD immune dysregulations. TSO could be a novel therapeutic option for ASD management.
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28
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Hall D, Huerta MF, McAuliffe MJ, Farber GK. Sharing heterogeneous data: the national database for autism research. Neuroinformatics 2013; 10:331-9. [PMID: 22622767 DOI: 10.1007/s12021-012-9151-4] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The National Database for Autism Research (NDAR) is a secure research data repository designed to promote scientific data sharing and collaboration among autism spectrum disorder investigators. The goal of the project is to accelerate scientific discovery through data sharing, data harmonization, and the reporting of research results. Data from over 25,000 research participants are available to qualified investigators through the NDAR portal. Summary information about the available data is available to everyone through that portal.
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Affiliation(s)
- Dan Hall
- OMNITEC Solutions, Inc., 6001 Executive Boulevard, Suite 7161, Rockville, MD 20892-9640, USA.
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29
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Parent and family impact of autism spectrum disorders: a review and proposed model for intervention evaluation. Clin Child Fam Psychol Rev 2012; 15:247-77. [PMID: 22869324 DOI: 10.1007/s10567-012-0119-6] [Citation(s) in RCA: 371] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Raising a child with an autism spectrum disorder (ASD) can be an overwhelming experience for parents and families. The pervasive and severe deficits often present in children with ASD are associated with a plethora of difficulties in caregivers, including decreased parenting efficacy, increased parenting stress, and an increase in mental and physical health problems compared with parents of both typically developing children and children with other developmental disorders. In addition to significant financial strain and time pressures, high rates of divorce and lower overall family well-being highlight the burden that having a child with an ASD can place on families. These parent and family effects reciprocally and negatively impact the diagnosed child and can even serve to diminish the positive effects of intervention. However, most interventions for ASD are evaluated only in terms of child outcomes, ignoring parent and family factors that may have an influence on both the immediate and long-term effects of therapy. It cannot be assumed that even significant improvements in the diagnosed child will ameliorate the parent and family distress already present, especially as the time and expense of intervention can add further family disruption. Thus, a new model of intervention evaluation is proposed, which incorporates these factors and better captures the transactional nature of these relationships.
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Pineda J, Juavinett A, Datko M. Self-regulation of brain oscillations as a treatment for aberrant brain connections in children with autism. Med Hypotheses 2012; 79:790-8. [DOI: 10.1016/j.mehy.2012.08.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
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31
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Response to the letter to the editor: diffusion tensor imaging and long-term therapies. J Autism Dev Disord 2012; 43:493-4. [PMID: 22752752 DOI: 10.1007/s10803-012-1586-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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32
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Kohls G, Chevallier C, Troiani V, Schultz RT. Social 'wanting' dysfunction in autism: neurobiological underpinnings and treatment implications. J Neurodev Disord 2012; 4:10. [PMID: 22958468 PMCID: PMC3436671 DOI: 10.1186/1866-1955-4-10] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 05/17/2012] [Indexed: 12/27/2022] Open
Abstract
Most behavioral training regimens in autism spectrum disorders (ASD) rely on reward-based reinforcement strategies. Although proven to significantly increase both cognitive and social outcomes and successfully reduce aberrant behaviors, this approach fails to benefit a substantial number of affected individuals. Given the enormous amount of clinical and financial resources devoted to behavioral interventions, there is a surprisingly large gap in our knowledge of the basic reward mechanisms of learning in ASD. Understanding the mechanisms for reward responsiveness and reinforcement-based learning is urgently needed to better inform modifications that might improve current treatments. The fundamental goal of this review is to present a fine-grained literature analysis of reward function in ASD with reference to a validated neurobiological model of reward: the 'wanting'/'liking' framework. Despite some inconsistencies within the available literature, the evaluation across three converging sets of neurobiological data (neuroimaging, electrophysiological recordings, and neurochemical measures) reveals good evidence for disrupted reward-seeking tendencies in ASD, particularly in social contexts. This is most likely caused by dysfunction of the dopaminergic-oxytocinergic 'wanting' circuitry, including the ventral striatum, amygdala, and ventromedial prefrontal cortex. Such a conclusion is consistent with predictions derived from diagnostic criteria concerning the core social phenotype of ASD, which emphasize difficulties with spontaneous self-initiated seeking of social encounters (that is, social motivation). Existing studies suggest that social 'wanting' tendencies vary considerably between individuals with ASD, and that the degree of social motivation is both malleable and predictive of intervention response. Although the topic of reward responsiveness in ASD is very new, with much research still needed, the current data clearly point towards problems with incentive-based motivation and learning, with clear and important implications for treatment. Given the reliance of behavioral interventions on reinforcement-based learning principles, we believe that a systematic focus on the integrity of the reward system in ASD promises to yield many important clues, both to the underlying mechanisms causing ASD and to enhancing the efficacy of existing and new interventions.
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Affiliation(s)
- Gregor Kohls
- Center for Autism Research, The Children's Hospital of Philadelphia, 3535 Market Street, 8th floor, Suite 860, Philadelphia, PA, 19104, USA.
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Adults with autism spectrum disorders exhibit decreased sensitivity to reward parameters when making effort-based decisions. J Neurodev Disord 2012; 4:13. [PMID: 22958545 PMCID: PMC3443445 DOI: 10.1186/1866-1955-4-13] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 05/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Efficient effort expenditure to obtain rewards is critical for optimal goal-directed behavior and learning. Clinical observation suggests that individuals with autism spectrum disorders (ASD) may show dysregulated reward-based effort expenditure, but no behavioral study to date has assessed effort-based decision-making in ASD. METHODS The current study compared a group of adults with ASD to a group of typically developing adults on the Effort Expenditure for Rewards Task (EEfRT), a behavioral measure of effort-based decision-making. In this task, participants were provided with the probability of receiving a monetary reward on a particular trial and asked to choose between either an "easy task" (less motoric effort) for a small, stable reward or a "hard task" (greater motoric effort) for a variable but consistently larger reward. RESULTS Participants with ASD chose the hard task more frequently than did the control group, yet were less influenced by differences in reward value and probability than the control group. Additionally, effort-based decision-making was related to repetitive behavior symptoms across both groups. CONCLUSIONS These results suggest that individuals with ASD may be more willing to expend effort to obtain a monetary reward regardless of the reward contingencies. More broadly, results suggest that behavioral choices may be less influenced by information about reward contingencies in individuals with ASD. This atypical pattern of effort-based decision-making may be relevant for understanding the heightened reward motivation for circumscribed interests in ASD.
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Autism spectrum disorders: is mesenchymal stem cell personalized therapy the future? J Biomed Biotechnol 2012; 2012:480289. [PMID: 22496609 PMCID: PMC3303614 DOI: 10.1155/2012/480289] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 09/29/2011] [Indexed: 12/16/2022] Open
Abstract
Autism and autism spectrum disorders (ASDs) are heterogeneous neurodevelopmental disorders. They are enigmatic conditions that have their origins in the interaction of genes and environmental factors. ASDs are characterized by dysfunctions in social interaction and communication skills, in addition to repetitive and stereotypic verbal and nonverbal behaviours. Immune dysfunction has been confirmed with autistic children. There are no defined mechanisms of pathogenesis or curative therapy presently available. Indeed, ASDs are still untreatable. Available treatments for autism can be divided into behavioural, nutritional, and medical approaches, although no defined standard approach exists. Nowadays, stem cell therapy represents the great promise for the future of molecular medicine. Among the stem cell population, mesenchymal stem cells (MSCs) show probably best potential good results in medical research. Due to the particular immune and neural dysregulation observed in ASDs, mesenchymal stem cell transplantation could offer a unique tool to provide better resolution for this disease.
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Kaale A, Smith L, Sponheim E. A randomized controlled trial of preschool-based joint attention intervention for children with autism. J Child Psychol Psychiatry 2012; 53:97-105. [PMID: 21883204 DOI: 10.1111/j.1469-7610.2011.02450.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Deficits in joint attention (JA) and joint engagement (JE) represent a core problem in young children with autism as these affect language and social development. Studies of parent-mediated and specialist-mediated JA-intervention suggest that such intervention may be effective. However, there is little knowledge about the success of the intervention when done in preschools. AIM Assess the effects of a preschool-based JA-intervention. METHODS 61 children (48 males) with autistic disorder (29-60 months) were randomized to either 8 weeks of JA-intervention, in addition to their preschool programs (n = 34), or to preschool programs only (n = 27). The intervention was done by preschool teachers with weekly supervision by trained counselors from Child and Adolescent Mental Health Clinics (CAMHC). Changes in JA and JE were measured by blinded independent testers using Early Social Communication Scale (ESCS) and video taped preschool teacher-child and mother-child play at baseline and post-intervention. CLINICAL TRIALS REGISTRATION Clinicaltrials.gov: NCT00378157. RESULTS Intention-to-treat analysis showed significant difference between the intervention and the control group, with the intervention group yielding more JA initiation during interaction with the preschool teachers. The effect generalized to significantly longer duration of JE with the mothers. CONCLUSIONS This is the first randomized study to show positive and generalized effects of preschool-based JA-intervention.
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Affiliation(s)
- Anett Kaale
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
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Behavioral interventions in children and adolescents with autism spectrum disorder: a review of recent findings. Curr Opin Pediatr 2011; 23:616-20. [PMID: 22037220 DOI: 10.1097/mop.0b013e32834cf082] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The study provides an overview of recent studies on behavioral interventions for children and adolescents with autism spectrum disorder (ASD). RECENT FINDINGS Recent reviews of the effectiveness of early intensive behavioral intervention (EIBI) conclude that EIBI can improve language and cognitive skills. The first randomized controlled trial (RCT) of a comprehensive early intervention for toddlers with ASD demonstrated gains in language, cognitive abilities, and adaptive behavior. Targeted, brief behavioral interventions are efficacious for improving social communication in young children with ASD. Parents can be taught to deliver behavioral interventions, which are associated with improvements in parent-child interaction; effects on child outcome, however, have been mixed. Several studies show that social skills interventions are efficacious for improving peer relationships and social competence. Behavioral interventions are also effective for reducing anxiety symptoms and aggression. Medication combined with behavioral intervention was found to be more effective for reducing aggression than medication alone. SUMMARY Behavioral interventions are effective for improving language, cognitive abilities, adaptive behavior, and social skills, and reducing anxiety and aggression. Medication combined with behavioral intervention appears to be more effective for reducing aggressive behavior than medication alone.
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Piven J, Rabins P. Autism spectrum disorders in older adults: toward defining a research agenda. J Am Geriatr Soc 2011; 59:2151-5. [PMID: 22091837 DOI: 10.1111/j.1532-5415.2011.03632.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Autism spectrum disorders (ASDs) are among the most common of the severe developmental disabilities, yet little is known about older adults with ASDs-in particular, how the disabilities and dependencies that result from aging interact with those resulting from ASDs. The aging of the population in Western countries, the increasing rate of diagnosis of ASDs, and the burgeoning use of services for ASDs are converging to create a large, growing influx of older adults with ASDs that could impose tremendous humanistic and economic burdens on the healthcare system and society. An understanding of the epidemiological, biological, psychological, and social aspects of ASDs in older adults is essential for preparing to meet their needs, but studies on ASDs in these individuals are practically nonexistent. This article outlines observations and recommendations of a multidisciplinary expert group convened in March 2010 to characterize gaps in knowledge regarding ASDs in older adults and defines research directions to help individuals, the healthcare system, and society prepare for meeting the needs of this population. The proposed research agenda could help improve the lives of older adults with ASDs and inform research and clinical practice involving younger individuals with ASDs.
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Affiliation(s)
- Joseph Piven
- Carolina Institute for Development Disabilities, University of North Carolina, Chapel Hill, NC, USA.
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Zhu H, Sun Y, Zeng J, Sun H. Mirror neural training induced by virtual reality in brain–computer interfaces may provide a promising approach for the autism therapy. Med Hypotheses 2011; 76:646-7. [DOI: 10.1016/j.mehy.2011.01.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 10/09/2010] [Accepted: 01/13/2011] [Indexed: 11/27/2022]
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Current World Literature. Curr Opin Neurol 2011; 24:183-90. [DOI: 10.1097/wco.0b013e32834585ec] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Autism and ADHD: How far have we come in the comorbidity debate? Neurosci Biobehav Rev 2011; 35:1081-8. [DOI: 10.1016/j.neubiorev.2010.11.002] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 10/11/2010] [Accepted: 11/10/2010] [Indexed: 12/30/2022]
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