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Meera SS, Srikar M, Raju R, Swaminathan D, Johnson RE, Watson LR, Nair DB, Kommu JVS, Chopra-McGowan J, Vasuki PP. Feasibility and acceptability of a caregiver-mediated early support program, delivered online, for infants at elevated familial likelihood for autism: A feasibility randomized controlled trial. Autism Res 2024. [PMID: 39205330 DOI: 10.1002/aur.3217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024]
Abstract
Preliminary evidence indicates potential benefit of providing caregiver-mediated intervention, prior to diagnosis, for infants at elevated familial likelihood for autism and related developmental delays including language delay (EL-A). However, delivering such interventions online and in low-resource settings like India has not been reported. This study aimed to evaluate the feasibility and acceptability of delivering a novel manualized caregiver-mediated early support program, the "LiL' STEPS," online in India, for EL-A infants. LiL' STEPS stands for Language development & Intervention Lab's (LiL') Supporting Early social-communication and language by Promoting caregiver Sensitive responsiveness (STEPS). The program comprised 14 sessions with a focus on social-communication and language, conducted over 12-weeks using demonstration and video feedback. Families of 36 EL-A infants aged 9 to 15-months participated in this feasibility randomized controlled trial (RCT). Families were randomized in a 2:1 ratio (n = 24 LiL' STEPS and n = 12 care as usual groups). Information on feasibility and acceptability was collated following a mixed methods approach from caregiver interviews, fidelity forms, session notes, and study register. Findings indicated the LiL' STEPS study trial as feasible and acceptable with recruitment rate of 4 per month, 100% willingness for randomization, 8.3% attrition, and 3.03% loss of blinding. Interventionist and caregiver fidelity was maintained above 80%. Despite challenges like interruptions during sessions, 100% families found the program acceptable and satisfactory, 86% said they would recommend the program to others, and 71% preferred online modality. Caregivers' perspectives on beneficial components and experience attending the program have been described. Accordingly, recommendations for future definitive RCTs have been presented.
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Affiliation(s)
- Shoba S Meera
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Malavi Srikar
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Reny Raju
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Divya Swaminathan
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Rachel Elizabeth Johnson
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Linda R Watson
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - John Vijay Sagar Kommu
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - Prathyusha P Vasuki
- Departemnt of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Grigore B, Peters J, Williams J, Russell G, Coles P, Visintin C, Rogers M, Hayward R, Zhelev Z, Logan S, Hyde C. Screening for Autism Spectrum Disorder in Young Children: Still Not Enough Evidence. J Prim Care Community Health 2024; 15:21501319241263223. [PMID: 39077980 PMCID: PMC11289826 DOI: 10.1177/21501319241263223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/16/2024] [Accepted: 06/01/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Early detection of autism spectrum disorder (ASD) has the potential to significantly reduce the impact of the condition, however previous reviews have found little evidence to support screening programs for ASD in young children. METHODS We conducted a review with the aim of updating evidence on 3 aspects: (a) diagnostic stability of ASD in young children; (b) accuracy of ASD screening tools in young children; and (c) the benefits of early interventions in screen-detected young children with ASD. RESULTS A total of 33 studies were included in our review. Five studies looking at diagnostic stability reported estimates ranging from 71.9% to 100%, however the majority only included a follow-up of 24 months and all studies raised concerns regarding the risk of bias due particularly to lack of blinding, sample size, and patient flow. A total of 25 studies, reported in 26 articles, were identified that reported accuracy data on 11 screening tools. Most of the reports were concerned with versions of M-CHAT, reporting sensitivity estimates from 0.67 to 1.0; however, many of these were deemed to be of high risk of bias due to lack of blinding and follow-up. Four studies reported on early interventions in screen-detected children; however, the majority did not find significant improvements on the relevant outcomes. CONCLUSIONS Overall, the evidence on screening for ASD in young children captured by this review is not conclusive regarding the 3 aspects of screening in this population. Future studies should attempt to ensure blinded diagnostic assessments, include longer follow-up periods and limit attrition.
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Tardy L, Gonnet L, Breyton M, Gardette F, Guivarch J. [Sensory regulation disorders in child psychiatry]. L'ENCEPHALE 2023; 49:617-623. [PMID: 36443135 DOI: 10.1016/j.encep.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 08/14/2022] [Accepted: 08/25/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The processing of sensory information determines the development and growth of a child's abilities. Dysfunction in the processing of sensory stimuli can affect a child's behavior and can disrupt development. Sensory Regulation Disorders are frequently associated with Autism Spectrum Disorder (ASD), with the DSM-5 even including it as a diagnostic criterion. However, they are also observed in other neurodevelopmental disorders. At present, the frequency of Sensory Regulation Disorders in children consulting child psychiatry has never been evaluated, although it seems to be a population at risk. OBJECTIVES To evaluate the frequency of sensory regulation disorders in children between 3 and 6 years old who first consult a child psychiatrist in Marseille. To determine whether certain reasons for consultation are correlated with the presence of sensory regulation disorders. METHODS A multicenter cross-sectional study was conducted for four months in Marseille. Sensory regulation disorders were assessed by the second version of Dunn's short sensory profile. RESULTS Fifty-eight patients were included. A significant difference was found between the frequency of SRT in our primary child psychiatry population and the general population. Subgroup analyses according to the reason for consultation showed that there would be more SRT in the Motor Instability/Inattention, Conduct Disorder and Socialization Disorder subgroups. CONCLUSION We observed a higher frequency of SRT in the child psychiatry consultation population. SRT could explain, or at least partly participate in, the children's symptomatology. The results are in favor of an early detection of SRT in the population of children consulting child psychiatry. The evaluation of the sensory profiles of these children allows a better understanding of the child's functioning and an adjustment of the intervention and support strategies proposed to the family.
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Affiliation(s)
- L Tardy
- AP-HM (Assistance publique-Hôpitaux de Marseille), 13005 Marseille, France.
| | - L Gonnet
- CEDDE (Centre d'évaluation diagnostique du développement de l'enfant), 13008 Marseille, France
| | - M Breyton
- Aix Marseille Université, Institut national de la santé et de la recherche médicale, Institut de neurosciences des Systèmes (INS) UMR1106, 13005 Marseille, France
| | - F Gardette
- ISRP (Institut supérieur de rééducation psychomotrice), 13009 Marseille, France
| | - J Guivarch
- Aix-Marseille université, AP-HM, Institut de neurosciences de la Timone, AMU, CNRS, CanoP, UMR 7289, 13005 Marseille, France
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Uzonyi TE, Grissom AC, Anderson RV, Lee H, Towner-Wright S, Crais ER, Watson LR, Landa RJ. Scoping review of behavioral coding measures used to evaluate parent responsiveness of children with autism or elevated risk of autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:1856-1875. [PMID: 36802822 DOI: 10.1177/13623613231152641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
LAY ABSTRACT The topic of how parents react (e.g., how they talk and act) to their child with autism or elevated likelihood of autism, often called parent responsiveness, has been studied by researchers for over 50 years. Many methods for measuring behaviors around parent responsiveness have been created depending on what researchers were interested in discovering. For example, some include only the behaviors that the parent does/says in reacting to something the child does/says. Other systems look at all behaviors in a period of time between child and parent (e.g., who talked/acted first, how much the child or parent said/did). The purpose of this article was to provide a summary of how and what researchers looked at around parent responsiveness, describe the strengths and barriers of these approaches, and suggest a "best practices" method of looking at parent responsiveness. The model suggested could make it more possible to look across studies to compare study methods and results. The model could be used in the future by researchers, clinicians, and policymakers to provide more effective services to children and their families.
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Affiliation(s)
- Thelma E Uzonyi
- Kennedy Krieger Institute, USA
- The University of Tennessee Health Science Center, USA
| | | | | | - Helen Lee
- University of Southern California, USA
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McGlade A, Whittingham K, Barfoot J, Taylor L, Boyd RN. Efficacy of very early interventions on neurodevelopmental outcomes for infants and toddlers at increased likelihood of or diagnosed with autism: A systematic review and meta-analysis. Autism Res 2023; 16:1145-1160. [PMID: 37036800 PMCID: PMC10946707 DOI: 10.1002/aur.2924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 03/18/2023] [Indexed: 04/11/2023]
Abstract
The aim of this systematic review was to determine the efficacy of very early interventions for infants and toddlers at increased likelihood of or diagnosed with autism for autism symptomatology, developmental outcomes and/or neurocognitive markers. Eight databases were searched (14 April 2022) with inclusion criteria: (i) RCTs with care as usual (CAU) comparison group, (ii) participants at increased likelihood of or diagnosed with autism and aged <24 months corrected age (CA), (iii) parent-mediated and/or clinician directed interventions, and (iv) outcome measures were autism symptomatology, cognition, language, adaptive skills, or neurocognitive assessments (EEG and eye tracking). Quality was assessed using Risk of Bias 2 and GRADE. Nineteen publications from 12 studies reported on 715 infants and toddlers. There was low to moderate certainty evidence that clinician-assessed outcomes did not show significant treatment effects for: autism symptomatology (ADOS CSS: MD -0.08, 95% CI -0.61, 0.44, p = 0.75), cognitive outcome (Mullen Scales of Early Learning-Early Learning Composite (MSEL-ELC): SMD 0.05, 95% CI -0.19, 0.29, p = 0.67), receptive language (MSEL-Receptive Language: SMD 0.04, 95% CI -0.21, 0.3, p = 0.74) or expressive language (MSEL-Expressive Language: SMD 0.06, 95% CI -0.1, 0.23, p = 0.45). Neurocognitive outcomes (EEG and eye tracking) were heterogeneous, with inconsistent findings. There is low to moderate certainty evidence that very early interventions have limited impact on neurodevelopmental outcomes by age 3 years.
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Affiliation(s)
- Andrea McGlade
- Faculty of MedicineThe University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research CentreBrisbaneQueenslandAustralia
| | - Koa Whittingham
- Faculty of MedicineThe University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research CentreBrisbaneQueenslandAustralia
| | - Jacqui Barfoot
- Faculty of MedicineThe University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research CentreBrisbaneQueenslandAustralia
| | - Leisa Taylor
- Department of Humanities EducationUniversity of New EnglandArmidaleNew South WalesAustralia
| | - Roslyn N. Boyd
- Faculty of MedicineThe University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research CentreBrisbaneQueenslandAustralia
- Queensland Paediatric Rehabilitation ServiceQueensland Children's HospitalBrisbaneQueenslandAustralia
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Guthrie W, Wetherby AM, Woods J, Schatschneider C, Holland RD, Morgan L, Lord CE. The earlier the better: An RCT of treatment timing effects for toddlers on the autism spectrum. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:13623613231159153. [PMID: 36922406 PMCID: PMC10502186 DOI: 10.1177/13623613231159153] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
LAY ABSTRACT Behavioral interventions that incorporate naturalistic, developmental strategies have been shown to improve outcomes for young children who receive an autism spectrum disorder (ASD) diagnosis. Although there is broad consensus that children on the spectrum should begin supports as soon as possible, the empirical evidence for this is relatively limited and little is known about the optimal age to start autism-specific interventions. Our team conducted a randomized controlled trial (RCT) to test the effects of starting intervention at different ages, using the Early Social Interaction (ESI) model, a parent-implemented intervention for toddlers on the spectrum. Participants included 82 autistic toddlers and their caregiver(s) who received 9 months of Individual-ESI and 9 months of Group-ESI, with the timing/order of these two treatment conditions randomized. Thus, families received the more intensive and individualized Individual-ESI at either 18 or 27 months of age. Results revealed that children who received Individual-ESI earlier showed greater treatment gains than those who received this intervention later. Gains were demonstrated in several areas, which included the use and understanding of language, social use of communication skills, and self-help skills. Importantly, these findings were specific to the intensive and individualized parent coaching model compared to group-based treatment, allowing us to rule out the possibility that these timing effects were due to children getting older rather than the treatment itself. Our results suggest that even a narrow window of 18 versus 27 months may have an impact on outcomes and underscore the importance of screening and evaluation as young as possible.
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Affiliation(s)
- Whitney Guthrie
- Children’s Hospital of Philadelphia, USA
- University of Pennsylvania, USA
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Kulasinghe K, Whittingham K, Mitchell AE, Boyd RN. Psychological interventions targeting mental health and the mother-child relationship in autism: Systematic review and meta-analysis. Dev Med Child Neurol 2023; 65:329-345. [PMID: 36208472 PMCID: PMC10953452 DOI: 10.1111/dmcn.15432] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 01/18/2023]
Abstract
AIM To investigate the efficacy of psychological interventions delivered to mothers of young children with autism spectrum disorder (ASD) in improving maternal mental health and the parent-child relationship. METHOD Electronic databases were searched from inception to December 2021. Studies were included if they were randomized controlled trials (RCTs) of psychological interventions that targeted maternal mental health (primary outcome) and/or the parent-child relationship (secondary outcome), delivered to mothers of children (mean age < 60 months) with ASD. Meta-analyses of three parent mental health outcomes (stress, depressive symptomatology, and general mental health) and seven parent-child relationship outcomes (parent responsiveness, affect, directiveness, non-directiveness, child initiation, infant positive affect, and infant attentiveness) were conducted using both mean and standardized mean differences. RESULTS Thirty-two RCTs met the inclusion criteria (2336 participants). Six RCTs showed improved maternal mental health (Cohen's d = 0.41-1.15), with moderate certainty of evidence for improvement in parental stress. There was low and high certainty of evidence of treatment effect on parental depressive symptoms and general mental health respectively, which did not show significant treatment effects post-intervention. Seventeen RCTs showed improved parent-child relationship (d = 0.33-2.28; low certainty of evidence). INTERPRETATION Results demonstrated that parenting interventions promoting responsiveness had the largest positive effect on the parent-child relationship and a moderate effect on overall parenting stress; however, the studies were heterogeneous, making it difficult to identify the intervention components that were responsible for the positive treatment effects. There was no significant treatment effect for studies targeting depression or general mental health, likely due to the lack of an interventional component directly targeting mental health.
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Affiliation(s)
- Kavindri Kulasinghe
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of MedicineUniversity of QueenslandBrisbaneQLDAustralia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of MedicineUniversity of QueenslandBrisbaneQLDAustralia
| | - Amy E. Mitchell
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQLDAustralia
- Menzies Health Institute QueenslandGriffith UniversityBrisbaneQLDAustralia
- Parenting and Family Support Centre, School of PsychologyUniversity of QueenslandBrisbaneQLDAustralia
| | - Roslyn N. Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of MedicineUniversity of QueenslandBrisbaneQLDAustralia
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Franz L, Goodwin CD, Rieder A, Matheis M, Damiano DL. Early intervention for very young children with or at high likelihood for autism spectrum disorder: An overview of reviews. Dev Med Child Neurol 2022; 64:1063-1076. [PMID: 35582893 PMCID: PMC9339513 DOI: 10.1111/dmcn.15258] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/19/2022]
Abstract
AIM To identify which interventions are supported by evidence and the quality of that evidence in very young children with or at high likelihood for autism spectrum disorder (ASD) to improve child outcomes. METHOD We conducted an overview of reviews to synthesize early intervention literature for very young children with or at high likelihood for ASD. Cochrane guidance on how to perform overviews of reviews was followed. Comprehensive searches of databases were conducted for systematic reviews and meta-analyses between January 2009 and December 2020. Review data were extracted and summarized and methodological quality was assessed. Primary randomized controlled trial evidence was summarized and risk of bias assessed. This overview of reviews was not registered. RESULTS From 762 records, 78 full texts were reviewed and seven systematic reviews and meta-analyses with 63 unique studies were identified. Several interventional approaches (naturalistic developmental behavioral intervention, and developmental and behavioral interventions) improved child developmental outcomes. Heterogeneity in design, intervention and control group, dose, delivery agent, and measurement approach was noted. Inconsistent methodological quality and potential biases were identified. INTERPRETATION While many early interventional approaches have an impact on child outcomes, study heterogeneity and quality had an impact on our ability to draw firm conclusions regarding which treatments are most effective. Advances in trial methodology and design, and increasing attention to mitigating measurement bias, will advance the quality of the ASD early intervention evidence base. WHAT THIS PAPER ADDS Naturalistic developmental behavioral interventions, as well as developmental and behavioral interventions, improve child outcomes in autism spectrum disorder (ASD). If only randomized controlled trials are considered, guidelines for early intensive behavioral intervention in younger children should be revisited. The greatest intervention impacts were on proximal, intervention-specific outcomes. Inadequacies in the quality of the early ASD intervention evidence base were observed.
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Affiliation(s)
- Lauren Franz
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke Global Health Institute, Duke University, Durham, NC, USA
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, Cape Town, South Africa
| | | | - Amber Rieder
- Duke Global Health Institute, Duke Institute for Brain Sciences, Duke University, Durham, NC, USA
| | - Maya Matheis
- Center on Disability Studies, College of Education, University of Hawai’i at Mānoa, Honolulu, Hawai’i, USA
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Law ML, Singh J, Mastroianni M, Santosh P. Parent-Mediated Interventions for Infants under 24 Months at Risk for Autism Spectrum Disorder: A Systematic Review of Randomized Controlled Trials. J Autism Dev Disord 2022; 52:2553-2574. [PMID: 34236590 PMCID: PMC9114042 DOI: 10.1007/s10803-021-05148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
Prodromal symptoms of Autism Spectrum Disorder (ASD) have been detected within the first year of life. This review evaluated evidence from randomized controlled trials (RCTs) of parent-mediated interventions for infants under 24 months who are at risk for ASD. Electronic databases, including grey literature, were searched up till November 2019. Seven RCTs were identified. There was substantial heterogeneity in recruitment, outcome measures and effect size calculations. Interventions did not reduce the risk of later ASD diagnosis and post-intervention effects on infant outcomes were inconsistent, with five studies reporting significant improvements across both treatment and control groups. Moderate level of evidence of intervention effects on parental interaction skills and the small number of RCTs, and significant limitations restrict generalizability across studies.
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Affiliation(s)
- Mei L Law
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King's College London, Addiction Sciences Building, 1-4 Windsor Walk, Denmark Hill, London, London, SE5 8BB, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jatinder Singh
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King's College London, Addiction Sciences Building, 1-4 Windsor Walk, Denmark Hill, London, London, SE5 8BB, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - Mathilde Mastroianni
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King's College London, Addiction Sciences Building, 1-4 Windsor Walk, Denmark Hill, London, London, SE5 8BB, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King's College London, Addiction Sciences Building, 1-4 Windsor Walk, Denmark Hill, London, London, SE5 8BB, UK.
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK.
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Hladik L, Meyer R, Allen S, BONNICI S, Froelke NA, Romaniak H, Ougayour Y, Nelson N, Alkhamees AK, Davis H, Ausderau KK. Accessibility and Inclusion for Families with Children with Autism Spectrum Disorders in Cultural Institutions. CURATOR : A QUARTERLY PUBLICATION OF THE AMERICAN MUSEUM OF NATURAL HISTORY 2022; 65:435-449. [PMID: 36249990 PMCID: PMC9540669 DOI: 10.1111/cura.12468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This project aimed to develop a comprehensive set of evaluation tools to assess the accessibility and inclusion of families with children on the autism spectrum in cultural institutions. A stakeholder team conducted interviews, reviewed museum artifacts, and observed museum programming. An evaluation toolkit was constructed by incorporating best practices from current literature and collected data. Tools were piloted and revised after being implemented in the museum context. The Toolkit to Increase Accessibility and Inclusion for Children on the Autism Spectrum and with Sensory Processing Differences in Cultural Institutions was developed with five unique tools, the Dimensions of Accessibility framework, and further resources to provide a self-assessment of cultural institutions. The toolkit can be used broadly across many types of institutions and self-assessment can lead to proactive development of public spaces, institutions, and programming that is accessible and inclusive of diverse groups of people, beyond families with children on the autism spectrum.
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Davis PH, Elsayed H, Crais ER, Watson LR, Grzadzinski R. Caregiver responsiveness as a mechanism to improve social communication in toddlers: Secondary analysis of a randomized controlled trial. Autism Res 2022; 15:366-378. [PMID: 34799999 PMCID: PMC8821206 DOI: 10.1002/aur.2640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 10/19/2021] [Accepted: 10/23/2021] [Indexed: 02/03/2023]
Abstract
Early intensive behavioral interventions (EIBI) for children at elevated likelihood for a later diagnosis of autism spectrum disorder (EL-ASD), are often delivered through parent-mediated models. An area of current exploration is whether changes in caregiver behaviors are a mechanism through which to improve and track child behaviors in these interventions. Toddlers and their caregivers participated in an intervention trial (randomized controlled trial) and were randomized to either a parent-mediated intervention (adapted responsive teaching; ART) or a control condition (referral to early intervention and monitoring; REIM). Changes in toddler social communication (SC) behaviors and characteristics of caregiver responsiveness (CR) were quantified over 8 months. Analyses were conducted to assess whether changes in CR mediated the relation between group (ART vs. REIM) and changes in child SC. Results of the current study indicated that caregivers who participated in a parent-mediated intervention improved in three domains of CR (contingent verbal sensitivity, responsivity, affect). CR was also found to be a mechanism through which children's SC skills improved. This work provides evidence that qualities of CR serve as mechanisms through which to improve and monitor child behaviors over the course of EIBIs. These results may lead to novel intervention targets, methods for tracking change, and tailored treatment planning for toddlers with EL-ASD. The data used in this study comes from a clinical trial that was prospectively registered with the Registry of Efficacy and Effectiveness Studies (Registry ID: 316.1v1). LAY SUMMARY: Interventions for toddlers with high likelihood for a later diagnosis of autism often include the caregiver as an active participant in the intervention. In this study, we aimed to understand qualities of caregiver responsiveness (CR) that facilitate improvements in child behaviors during intervention. Results show that increasing verbal CR and affect are ways to improve child social skills over the course of intervention.
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Affiliation(s)
- Paige Huguely Davis
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC
| | - Heba Elsayed
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,Phoniatrics unit, ENT Department, Faculty of Medicine, Alexandria University, Egypt
| | - Elizabeth R. Crais
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,University of North Carolina, Division of Speech and Hearing Sciences
| | - Linda R. Watson
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,University of North Carolina, Division of Speech and Hearing Sciences
| | - Rebecca Grzadzinski
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,University of North Carolina, Carolina Institute for Developmental Disabilities, Chapel Hill, NC
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12
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Stephens RL, Elsayed HE, Reznick JS, Crais ER, Watson LR. Infant Attentional behaviors Are Associated With ADHD Symptomatology and Executive Function in Early Childhood. J Atten Disord 2021; 25:1908-1918. [PMID: 32749184 PMCID: PMC8427808 DOI: 10.1177/1087054720945019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: We explored associations between infant attentional behaviors as measured by the First Year Inventory (FYIv2.0) and dimensional ratings of ADHD symptomatology and executive function (EF) in early childhood. Methods: This study included parents (N = 229) who filled out the FYIv2.0 when their children were 12 months of age. When children were approximately 54 months (4.5 years) of age, parents completed reports of children's ADHD symptomatology and EF abilities. Correlation and regression analyses were conducted among measures. Results: We found significant associations among the variables of interest, both cross-sectionally and longitudinally, as well as gender differences. Notably, non-social sensory attention (NSA) was significantly related to 54-month ADHD symptom severity. All three 12-month attention variables were significantly related to 54-month EF. Conclusion: Results suggest that infant attentional behaviors predict later ADHD-related behaviors in early childhood. Future research should explore associations using laboratory-based measures and could inform early intervention efforts.
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Affiliation(s)
| | - Heba E. Elsayed
- University of North Carolina at Chapel Hill, USA
- Alexandria University, Egypt
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Grzadzinski R, Amso D, Landa R, Watson L, Guralnick M, Zwaigenbaum L, Deák G, Estes A, Brian J, Bath K, Elison J, Abbeduto L, Wolff J, Piven J. Pre-symptomatic intervention for autism spectrum disorder (ASD): defining a research agenda. J Neurodev Disord 2021; 13:49. [PMID: 34654371 PMCID: PMC8520312 DOI: 10.1186/s11689-021-09393-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/16/2021] [Indexed: 12/26/2022] Open
Abstract
Autism spectrum disorder (ASD) impacts an individual's ability to socialize, communicate, and interact with, and adapt to, the environment. Over the last two decades, research has focused on early identification of ASD with significant progress being made in understanding the early behavioral and biological markers that precede a diagnosis, providing a catalyst for pre-symptomatic identification and intervention. Evidence from preclinical trials suggest that intervention prior to the onset of ASD symptoms may yield more improved developmental outcomes, and clinical studies suggest that the earlier intervention is administered, the better the outcomes. This article brings together a multidisciplinary group of experts to develop a conceptual framework for behavioral intervention, during the pre-symptomatic period prior to the consolidation of symptoms into diagnosis, in infants at very-high-likelihood for developing ASD (VHL-ASD). The overarching goals of this paper are to promote the development of new intervention approaches, empirical research, and policy efforts aimed at VHL-ASD infants during the pre-symptomatic period (i.e., prior to the consolidation of the defining features of ASD).
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Affiliation(s)
- Rebecca Grzadzinski
- Carolina Institute for Developmental Disabilities, University of North Carolina, Chapel Hill, NC, USA.
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina, Chapel Hill, NC, USA.
| | - Dima Amso
- Department of Psychology, Columbia University, New York, NY, USA
| | - Rebecca Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Linda Watson
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina, Chapel Hill, NC, USA
- Division of Speech and Hearing Sciences, University of North Carolina, Chapel Hill, NC, USA
| | - Michael Guralnick
- Center on Human Development and Disability, University of Washington, Seattle, WA, USA
| | | | - Gedeon Deák
- Department of Cognitive Science, University of California, San Diego, San Diego, CA, USA
| | - Annette Estes
- Department of Speech and Hearing Sciences, University of Washington Autism Center, University of Washington, Seattle, WA, USA
| | - Jessica Brian
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Kevin Bath
- Department of Neuroscience, Brown University, Providence, RI, USA
| | - Jed Elison
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Leonard Abbeduto
- University of California, Davis, MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Jason Wolff
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Joseph Piven
- Carolina Institute for Developmental Disabilities, University of North Carolina, Chapel Hill, NC, USA
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14
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Talbott MR, Dufek S, Young G, Rogers SJ. Leveraging telehealth to evaluate infants with prodromal autism spectrum disorder characteristics using the telehealth evaluation of development for infants. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1242-1254. [PMID: 34549613 DOI: 10.1177/13623613211045596] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Many families seeking early evaluations for autism spectrum disorder face long waitlists, must often travel to centers with appropriate expertise, and are frequently told by providers to "wait and see." This results in significant stress for families and delayed supports to infants and their caregivers who could benefit. This study evaluated whether telehealth could be used to identify and evaluate infants with early autism spectrum disorder characteristics in the first year of life. In this study, we evaluated 41 infants via telehealth using a standard set of probes and scored behavior related to social communication, play, imitation, and other developmental domains. We found the majority of infants demonstrated elevated likelihood of autism spectrum disorder on both parent-reported questionnaires and examiner-rated behavior. Caregiver ratings of the overall utility of the protocol used in this study were high. Overall, this study demonstrates the feasibility for telehealth-based approaches to evaluate infants' with elevated likelihood of autism spectrum disorder in the first year of life, which could help to improve families' access to care and to expand our capacity to conduct studies evaluating possible intervention supports.
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15
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Grzadzinski R, Nowell SW, Crais ER, Baranek GT, Turner-Brown L, Watson LR. Parent responsiveness mediates the association between hyporeactivity at age 1 year and communication at age 2 years in children at elevated likelihood of ASD. Autism Res 2021; 14:2027-2037. [PMID: 34128355 DOI: 10.1002/aur.2557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/05/2021] [Accepted: 05/18/2021] [Indexed: 11/11/2022]
Abstract
Studies suggest that higher parent responsiveness is associated with higher child language abilities. Infants and toddlers later diagnosed with autism spectrum disorder (ASD) often display hyporeactivity to sensory stimuli, which has also been associated with lower child communication abilities and lower parent responsiveness. Yet, whether parent responsiveness mediates the relationship between child hyporeactivity and later communication outcomes remains unexplored. This study is a secondary data analysis which includes children (n = 83; 56 males) identified as at elevated likelihood of later ASD. Children completed an observational measure of sensory reactivity and a standard developmental assessment at 14 (Time 1) and 23 months old (Time 2). At each time point, parents reported on the child's adaptive communication behaviors and sensory behaviors, and Parent Verbal Responsiveness (AvgPVR) was coded from parent-child free-play videos. Results indicated that the association between child sensory hyporeactivity at Time 1 (observed and parent-reported) and communication at Time 2 (observed and parent reported) was significantly mediated by AvgPVR. Although child hyporeactivity predicts poorer communication outcomes, increased parent verbal responsiveness may attenuate this negative impact. Parent responsiveness, a focus of many parent-mediated interventions, may be an important mechanism of treatment response that should be directly tested in future research. LAY SUMMARY: Toddlers at elevated likelihood of autism spectrum disorder (ASD) are often under-reactive (hyporeactive) to sensory stimuli. This hyporeactivity slows learning of communication skills and provides parents with fewer opportunities to respond to their children. In this study, children with hyporeactivity at 14 months generally had poorer communication at 23 months; however, the more responsive their parents were, the weaker the relationship between early hyporeactivity and later communication. Thus, increasing parent responsiveness may lead to better communication outcomes for toddlers with the early ASD symptom of hyporeactivity.
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Affiliation(s)
- Rebecca Grzadzinski
- Program for Early Autism Research, Leadership, and Service (PEARLS), University of North Carolina, Chapel Hill, North Carolina, USA.,University of North Carolina, Carolina Institute for Developmental Disabilities, Chapel Hill, North Carolina, USA
| | - Sallie W Nowell
- University of North Carolina, Frank Porter Graham Child Development Institute, Chapel Hill, North Carolina, USA
| | - Elizabeth R Crais
- Program for Early Autism Research, Leadership, and Service (PEARLS), University of North Carolina, Chapel Hill, North Carolina, USA.,Division of Speech and Hearing Sciences, University of North Carolina
| | - Grace T Baranek
- Program for Early Autism Research, Leadership, and Service (PEARLS), University of North Carolina, Chapel Hill, North Carolina, USA.,The Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Lauren Turner-Brown
- Program for Early Autism Research, Leadership, and Service (PEARLS), University of North Carolina, Chapel Hill, North Carolina, USA.,University of North Carolina, TEACCH Autism Program, Chapel Hill, North Carolina, USA
| | - Linda R Watson
- Program for Early Autism Research, Leadership, and Service (PEARLS), University of North Carolina, Chapel Hill, North Carolina, USA.,Division of Speech and Hearing Sciences, University of North Carolina
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16
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Keating J, Bramham J, Downes M. Sensory modulation and negative affect in children at familial risk of ADHD. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 112:103904. [PMID: 33639605 DOI: 10.1016/j.ridd.2021.103904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/05/2021] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND/AIMS Sensory modulation difficulties are commonly reported in patients with ADHD, however there has been little focus on the development of these difficulties in young children at a higher risk of later ADHD diagnosis. This study investigated whether children with a familial history of ADHD show greater sensory modulation difficulties. We also explored whether sensory modulation was linked to negative affectivity, which has been highlighted as a potential early marker of ADHD. METHODS Parents of children under 6 years with a family history of ADHD (n = 65) and no family history (n = 122) completed questionnaires on sensory modulation and temperament. RESULTS Children from families with ADHD were reported to display extreme patterns of hyperresponsiveness and hyporesponsiveness, relative to controls. No differences emerged for the sensory seeking domain. Some children within the high-risk group reported high scores across all three sensory modulation patterns. Regression analysis revealed that hyperresponsiveness predicted higher levels of negative affect. CONCLUSIONS/IMPLICATIONS This study is the first to report greater sensory modulation difficulties in children at familial risk of ADHD. Future research should establish whether children with sensory modulation and temperament difficulties in early childhood are more vulnerable to developing ADHD.
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Affiliation(s)
- J Keating
- School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland.
| | - J Bramham
- School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland
| | - M Downes
- School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland
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17
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Grzadzinski R, Donovan K, Truong K, Nowell S, Lee H, Sideris J, Turner-Brown L, Baranek GT, Watson LR. Sensory Reactivity at 1 and 2 Years Old is Associated with ASD Severity During the Preschool Years. J Autism Dev Disord 2021; 50:3895-3904. [PMID: 32157566 DOI: 10.1007/s10803-020-04432-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Children with Autism Spectrum Disorder (ASD) often display atypical sensory reactivity within the first years of life, prior to a diagnosis. This study examined sensory reactivity patterns at 14 months, changes from 14 to 23 months, and later ASD severity at 3 to 5 years of age in children (n = 87) at elevated likelihood of ASD. Results indicated that observed hyporeactivity at 14 months and increases from 14 to 23 months were related to higher ASD severity during the preschool years. Parent report of hyperreactivity at 14 months was associated with higher ASD severity in the RRB domain during the preschool years. Early hypo and hyperreactivity may predict later severity of ASD and aid in subtyping and developing individualized treatments.
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Affiliation(s)
- Rebecca Grzadzinski
- University of North Carolina, Carolina Institute for Developmental Disabilities, Chapel Hill, NC, USA.
| | - Kevin Donovan
- University of North Carolina, Department of Biostatistics, Chapel Hill, NC, USA
| | - Kinh Truong
- University of North Carolina, Department of Biostatistics, Chapel Hill, NC, USA
| | - Sallie Nowell
- University of North Carolina, Frank Porter Graham Child Development Institute, Chapel Hill, NC, USA
| | - Helen Lee
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - John Sideris
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | | | - Grace T Baranek
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Linda R Watson
- University of North Carolina, Division of Speech and Hearing Sciences, Chapel Hill, NC, USA
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18
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MacDuffie KE, Turner-Brown L, Estes AM, Wilfond BS, Dager SR, Pandey J, Zwaigenbaum L, Botteron KN, Pruett JR, Piven J, Peay HL. "If He Has it, We Know What to Do": Parent Perspectives on Familial Risk for Autism Spectrum Disorder. J Pediatr Psychol 2020; 45:121-130. [PMID: 31764985 DOI: 10.1093/jpepsy/jsz076] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 09/06/2019] [Accepted: 09/16/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Predictive testing for familial disorders can guide healthcare and reproductive decisions. Familial disorders with onset in childhood (e.g., autism spectrum disorder [ASD]) are promising targets for presymptomatic prediction; however, little is known about parent perceptions of risk to their children in the presymptomatic period. The current study examined risk perceptions in parents of infants at high familial risk for ASD enrolled in a longitudinal study of brain and behavior development. METHODS Semistructured interviews were conducted with 37 parents of high-risk infants during the presymptomatic window (3-15 months) that precedes an ASD diagnosis. Infants were identified as high familial risk due to having an older sibling with ASD. Parent interview responses were coded and interpreted to distill emerging themes. RESULTS The majority of parents were aware of the increased risk of ASD for their infants, and risk perceptions were influenced by comparisons to their older child with ASD. Parents reported a variety of negative emotions in response to perceived risk, including worry, fear, and sadness, and described impacts of perceived risk on their behavior: increased vigilance to emerging symptoms, altered reproductive and healthcare decisions, and seeking ongoing assessment through research. CONCLUSIONS Parents of children at high familial risk for childhood-onset disorders like ASD face a period of challenging uncertainty during early development. In anticipation of a future in which presymptomatic testing for ASD is made available, it is important to understand how parents react to and cope with the elevated-but still highly uncertain-risk conveyed by family history.
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Affiliation(s)
- Katherine E MacDuffie
- University of Washington Autism Center, Department of Speech & Hearing Sciences.,Seattle Children's Hospital, Treuman Katz Center for Pediatric Bioethics
| | - Lauren Turner-Brown
- University of North Carolina at Chapel Hill, TEACCH Autism Program, Department of Psychiatry
| | - Annette M Estes
- University of Washington Autism Center, Department of Speech & Hearing Sciences
| | - Benjamin S Wilfond
- Seattle Children's Hospital, Treuman Katz Center for Pediatric Bioethics
| | | | - Juhi Pandey
- Children's Hospital of Philadelphia, Center for Autism Research
| | | | - Kelly N Botteron
- Department of Psychiatry, Washington University School of Medicine in Saint Louis
| | - John R Pruett
- Department of Psychiatry, Washington University School of Medicine in Saint Louis
| | - Joseph Piven
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Holly L Peay
- Research Triangle Institute, Center for Newborn Screening, Ethics, and Disability Studies
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19
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Role of Occupational Therapy in Primary Care. Am J Occup Ther 2020; 74:7413410040p1-7413410040p16. [DOI: 10.5014/ajot.2020.74s3001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
The American Occupational Therapy Association (AOTA) affirms that occupational therapy practitioners1 are well prepared to contribute to interprofessional collaborative care teams addressing the primary care needs of individuals across the life course. Because of an increased focus on preventive population health and social determinants of health by health care organizations, synergy between primary care and occupational therapy is growing, with support for client-centered,2 comprehensive whole-person care, health promotion and prevention, disease self-management, and quality of life (Halle et al., 2018). Occupational therapy practitioners’ distinct knowledge of the significant impact that roles, habits, and routines have on health and wellness makes their contribution to primary care valuable (AOTA, 2020b). Occupational therapy’s focus on meaningful engagement in occupations is relevant and vital to participation in individual, family, and community life (AOTA, 2020c). In addition, occupational therapy practitioners’ holistic and population perspectives allow them to be effective both as interprofessional health care team members and as direct care providers to support client, family, and community needs in primary care delivery models (Leland et al., 2017). The purposes of this position paper are to define primary care and to describe occupational therapy’s evolving and advancing role in primary care, including expansion of services into specialty primary care areas such as pediatric primary care and obstetrics and gynecology (AOTA, 2018).
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20
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Talbott MR, Miller MR. Future Directions for Infant Identification and Intervention for Autism Spectrum Disorder from a Transdiagnostic Perspective. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2020; 49:688-700. [PMID: 32701034 PMCID: PMC7541743 DOI: 10.1080/15374416.2020.1790382] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
By the time they are typically detected, neurodevelopmental disorders like autism spectrum disorder (ASD) are already challenging to treat. Preventive and early intervention strategies in infancy are critical for improving outcomes over the lifespan with significant cost savings. However, the impact of prevention and early intervention efforts is dependent upon our ability to identify infants most appropriate for such interventions. Because there may be significant overlap between prodromal symptoms across neurodevelopmental disorders and child psychopathology more broadly which may wax and wane across development, we contend that the impact of prevention and early intervention efforts will be heightened by identifying early indicators that may overlap across ASD and other commonly co-occurring disorders. This paper summarizes the existing literature on infant symptoms and identification of ASD to demonstrate the ways in which a transdiagnostic perspective could expand the impact of early identification and intervention research and clinical efforts, and to outline suggestions for future empirical research programs addressing current gaps in the identification-to-treatment pipeline. We propose four recommendations for future research that are both grounded in developmental and clinical science and that are scalable for early intervention systems: (1) development of fine-grained, norm-referenced measures of ASD-relevant transdiagnostic behavioral domains; (2) identification of shared and distinct mechanisms influencing the transition from risk to disorder; (3) determination of key cross-cutting treatment strategies (both novel and extracted from existing approaches) effective in targeting specific domains across disorders; and (4) integration of identified measures and treatments into existing service systems.
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Affiliation(s)
- Meagan R Talbott
- MIND Institute and Department of Psychiatry & Behavioral Sciences, University of California
| | - Meghan R Miller
- MIND Institute and Department of Psychiatry & Behavioral Sciences, University of California
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21
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Whittingham K, McGlade A, Kulasinghe K, Mitchell AE, Heussler H, Boyd RN. ENACT (ENvironmental enrichment for infants; parenting with Acceptance and Commitment Therapy): a randomised controlled trial of an innovative intervention for infants at risk of autism spectrum disorder. BMJ Open 2020; 10:e034315. [PMID: 32819928 PMCID: PMC7440709 DOI: 10.1136/bmjopen-2019-034315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 05/04/2020] [Accepted: 06/08/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition with impacts on behaviour, cognition, communication, social interaction and family mental health. This paper reports the protocol of a randomised controlled trial (RCT) of a very early intervention, ENACT (ENvironmental enrichment for infants; parenting with Acceptance and Commitment Therapy), for families of infants at risk of ASD. METHODS AND ANALYSIS We aim to recruit 66 mothers of infants at risk of ASD (ie, infants with a sibling or parent diagnosed with ASD) to this RCT. Families will be randomly assigned to care-as-usual or ENACT. ENACT is a very early intervention, leveraging parent-child interactions to improve early social reciprocity, while supporting parental mental health and the parent-child relationship through Acceptance and Commitment Therapy. Intervention content is delivered online (approximately 8 hours) and supported by more than 7 consultations with a clinician. Parents will perform the social reciprocity intervention with their child (30 min per day). Assessments at four time points (baseline, 3 months, 6 months, and 12 months corrected age) will assess parent-infant interaction, parental mental health, infant development and early ASD markers. Analysis will be by intention to treat using general linear models for RCTs. ETHICS AND DISSEMINATION This protocol has been approved by the Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/19/QCHQ/50131) and the University of Queensland Human Research Ethics Committee (2019000558). If efficacy is demonstrated, the intervention has the potential for wide and accessible dissemination. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12618002046280).
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Affiliation(s)
- Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea McGlade
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Kavindri Kulasinghe
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Amy E Mitchell
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Honey Heussler
- Mater Medical Research Institute, South Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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22
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Grzadzinski R, Janvier D, Kim SH. Recent Developments in Treatment Outcome Measures for Young Children With Autism Spectrum Disorder (ASD). Semin Pediatr Neurol 2020; 34:100806. [PMID: 32446440 PMCID: PMC7248125 DOI: 10.1016/j.spen.2020.100806] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Significant advancements have been made in early intervention programs for children with Autism spectrum disorder (ASD). However, measuring treatment response for children with ASD is difficult due to the heterogeneity of changes in symptoms, which can be subtle, especially over a short period of time. Here we outline the challenge of evaluating treatment response with currently available measures as well as newly developed or refined measures that may be useful in clinical trials for young children with ASD. Continued development of treatment outcome measures will help the field identify and compare efficacious interventions and tailor treatments for children with ASD.
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Affiliation(s)
- Rebecca Grzadzinski
- University of North Carolina, Carolina Institute for Developmental Disabilities, Chapel Hill, NC.
| | - Denisse Janvier
- Center for Autism and the Developing Brain, Weill Cornell Medical College, New York-Presbyterian Hospital, White Plains, NY
| | - So Hyun Kim
- Center for Autism and the Developing Brain, Weill Cornell Medical College, New York-Presbyterian Hospital, White Plains, NY
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23
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Bradshaw J, Trumbull A, Stapel-Wax J, Gillespie S, George N, Saulnier C, Klaiman C, Woods J, Call N, Klin A, Wetherby A. Factors associated with enrollment into a clinical trial of caregiver-implemented intervention for infants at risk for autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1874-1884. [PMID: 32594763 DOI: 10.1177/1362361320928829] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
LAY ABSTRACT Early intervention helps to address developmental delays in young children with autism spectrum disorder. Yet, research suggests there are barriers to enrollment into research studies that test the effectiveness of these interventions for infants at risk. This study identifies family characteristics that were associated with agreement to enroll in a clinical trial of early intervention for 12-month-old infants at risk for autism spectrum disorder. As part of a large longitudinal study, infants were evaluated for early signs of autism spectrum disorder at 1 year of age. Of the fifty-seven infants who were showing signs of autism and deemed eligible for the early intervention trial, 44% declined enrollment. Results suggest that families were more likely to decline enrolling into the intervention study if the mother was working full time, the total household income was between US$60,000 and US$100,000, and they lived further from the clinic. In contrast, infant autism symptoms and parental concern at 12 months were not significantly associated with enrollment. These findings highlight the need for intervention studies that are more accessible to parents, for example, intervention that takes place in the home, in addition to more research on how parental understanding of, and willingness to act on, early social-communication delays impact intervention study enrollment. Future research can then examine how to address these barriers to enrollment in early intervention studies. Such findings will shed light on best practices for dissemination of early identification and intervention strategies.
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Affiliation(s)
| | | | - Jennifer Stapel-Wax
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
| | - Scott Gillespie
- Emory-Children's-Georgia Tech Pediatric Research Alliance, USA
| | - Nisha George
- Emory-Children's-Georgia Tech Pediatric Research Alliance, USA
| | - Celine Saulnier
- Emory University, USA.,Neurodevelopmental Assessment & Consulting Services, USA
| | - Cheryl Klaiman
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
| | | | - Nathan Call
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
| | - Ami Klin
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
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24
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Schertz HH, Lester JN, Erden E, Safran S, Githens P. Challenges and contributors to self-efficacy for caregivers of toddlers with autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1260-1272. [PMID: 31968998 DOI: 10.1177/1362361319899761] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Parent-participatory early intervention practices are linked to parents' positive views of their own and their children's capabilities, beliefs that are associated with a range of parent and child outcomes. A qualitative study was conducted with 11 mothers of toddlers with autism who had experience with both professionally directed and parent-mediated early intervention. Participants were interviewed to explore their perspectives on their roles in relation to professionals and on how they viewed their ability to support their toddlers' social learning. An in-depth analysis of the transcribed interviews resulted in four themes. First, in the early stages, participants experienced challenges to their self-efficacy as they adjusted to the diagnosis and reached to connect with their child when social challenges emerged. Second, participants' views of their capability were stronger when they were provided with background knowledge enabling them to take the lead in guiding their children's learning than when professionals modeled predetermined intervention strategies for them to copy. Third, participants provided specific examples of their expertise to support their toddlers' social learning and viewed their close parent-child relationship and intimate knowledge of their children as valuable to the intervention. Fourth, participants voiced respect for their toddlers' natures and preferences, positioning them to build on their toddlers' strengths in everyday interactions. The results support the need for early intervention providers to promote and leverage family capacity for facilitating toddler learning as social challenges begin to appear for toddlers with autism.
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25
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Douglas PS. Pre-emptive Intervention for Autism Spectrum Disorder: Theoretical Foundations and Clinical Translation. Front Integr Neurosci 2019; 13:66. [PMID: 31798425 PMCID: PMC6877903 DOI: 10.3389/fnint.2019.00066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/04/2019] [Indexed: 12/28/2022] Open
Abstract
Autism spectrum disorders (ASD) are an emergent public health problem, placing significant burden upon the individual, family and health system. ASD are polygenetic spectrum disorders of neural connectome development, in which one or more feedback loops amplify small genetic, structural, or functional variations in the very early development of motor and sensory-motor pathways. These perturbations trigger a 'butterfly effect' of unpredictable cascades of structural and functional imbalances in the global neuronal workspace, resulting in atypical behaviors, social communication, and cognition long-term. The first 100 days post-term are critically neuroplastic and comprise an injury-sensitive developmental window, characterized by a neural biomarker, the persistence of the cortical subplate, and a behavioral biomarker, the crying diathesis. By the time potential diagnostic signs are identified, from 6 months of age, ASD neuropathy is already entrenched. The International Society for Autism Research Special Interest Group has called for pre-emptive intervention, based upon rigorous theoretical frames, and real world translation and evaluation. This paper responds to that call. It synthesizes heterogenous evidence concerning ASD etiologies from both psychosocial and biological research literatures with complexity science and evolutionary biology, to propose a theoretical framework for pre-emptive intervention. This paper hypothesizes that environmental factors resulting from a mismatch between environment of evolutionary adaptedness and culture initiate or perpetuate early motor and sensory-motor lesions, triggering a butterfly effect of multi-directional cascades of atypical developmental in the complex adaptive system of the parent and ASD-susceptible infant. Chronic sympathetic nervous system/hypothalamic-pituitary-adrenal axis hyperarousal and disrupted parent-infant biobehavioral synchrony are the key biologic and behavioral mechanisms perpetuating these atypical developmental cascades. A clinical translation of this evidence is proposed, for application antenatally and in the first 6 months of life, as pre-emptive intervention for ASD.
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Affiliation(s)
- Pamela S. Douglas
- Transforming Maternity Care Collaborative, Griffith University, Brisbane, QLD, Australia
- Discipline of General Practice, The University of Queensland, Brisbane, QLD, Australia
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Jordan K. Occupational Therapy in Primary Care: Positioned and Prepared to Be a Vital Part of the Team. Am J Occup Ther 2019; 73:7305170010p1-7305170010p6. [PMID: 31484019 DOI: 10.5014/ajot.2019.735002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Reilly's (1962) now deeply cherished statement that "man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health" (p. 1) was followed a few years later with a question to current and future occupational therapy practitioners. In 1966, Reilly asked how the profession would respond to the challenges of an expanding knowledge base, accelerating health care costs, and escalating regulatory burden. Visionary Wilma West, a contemporary of Reilly's, expanded on these themes by focusing on ways occupational therapy practitioners could leverage the breadth and depth of their practice to confront these challenges. These issues are now paramount in the primary care arena. An expanding body of literature, including the articles in a special section in this issue of the American Journal of Occupational Therapy, supports occupational therapy's role as a vital part of the solution to contemporary health care challenges. Occupational therapy practitioners are educationally prepared and successfully poised through policy to engage in evidence-based practice in the primary care environment.
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Affiliation(s)
- Katie Jordan
- Katie Jordan, OTD, OTR/L, is Professor of Clinical Occupational Therapy and Associate Chair of Clinical Occupational Therapy Services, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles;
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Caregiver-Implemented Intervention for Young Children with Autism Spectrum Disorder: A Systematic Review of Coaching Components. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2019. [DOI: 10.1007/s40489-019-00186-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Althoff CE, Dammann CP, Hope SJ, Ausderau KK. Parent-Mediated Interventions for Children With Autism Spectrum Disorder: A Systematic Review. Am J Occup Ther 2019; 73:7303205010p1-7303205010p13. [PMID: 31120831 DOI: 10.5014/ajot.2019.030015] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of this systematic review was to evaluate the evidence for the effectiveness of parent-mediated interventions on occupational performance of children with autism spectrum disorder (ASD). METHOD We conducted a search of academic databases using terms such as autism spectrum disorder, parent, caregiver, and intervention. Five hundred eighty-two articles were reviewed, and 109 were selected for full-text review. The final analysis included 13 articles. RESULTS Strong evidence was found for the efficacy of parent-mediated intervention for increasing child joint attention. Moderate evidence was found for the improvement of language scores, expressive language, nonverbal communication, initiation and response to interaction, behavior, play, adaptive functioning, ASD symptoms, and social communication. CONCLUSION This systematic review suggests that parent-mediated interventions for children with ASD can improve various aspects of communication and ASD symptoms, with emerging support for occupational performance. Occupational therapy practitioners are well suited to facilitate these interventions to support families with children with autism.
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Affiliation(s)
- Colleen E Althoff
- Colleen E. Althoff, MS, OTR/L, is Occupational Therapist, John H. Stroger Jr. Hospital of Cook County, Chicago; . She was Student, Occupational Therapy Program, University of Wisconsin-Madison, at the time of the study
| | - Caitlin P Dammann
- Caitlin P. Dammann, MS, OTR/L, was Student, Occupational Therapy Program, University of Wisconsin-Madison, at the time of the study
| | - Sarah J Hope
- Sarah J. Hope, MS, OTR/L, was Student, Occupational Therapy Program, University of Wisconsin-Madison, at the time of the study
| | - Karla K Ausderau
- Karla K. Ausderau, PhD, OTR/L, is Assistant Professor, Occupational Therapy Program, and Investigator, Waisman Center, University of Wisconsin-Madison
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Afzaal T, Waqas A, Naveed S. A Short Commentary on Non-specialist-mediated Interventions for Children with Autism Spectrum Disorder. Cureus 2019; 11:e4831. [PMID: 31404333 PMCID: PMC6682336 DOI: 10.7759/cureus.4831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/04/2019] [Indexed: 11/05/2022] Open
Abstract
Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disability delineated by social and communication impairments, restricted interests and repetitive behaviors, and sensory hypo- or hyper reactivity to sensory inputs. Early recognition and timely intervention are essential for individuals with ASD and the long-term prognosis for these individuals. The specialist-mediated interventions can be expensive for patients, their families, and the healthcare system. It is important to provide a naturalistic intervention, especially in the context of cost issues, the impact of early intervention of prognosis, limited resources in developing countries, lack of healthcare providers, and healthcare disparities. The current article reviews non-specialist-mediated interventions of children and adolescents with ASD.
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Affiliation(s)
- Tayyaba Afzaal
- Psychology, Government College University, Lahore, Pakistan
| | - Ahmed Waqas
- Psychiatry, Combined Military Hospital Lahore Medical College and Dental College, Lahore, PAK
| | - Sadiq Naveed
- Psychiatry, University of Kansas Medical Center, Kansas City, USA
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DuBay M, Watson LR, Zhang W. In Search of Culturally Appropriate Autism Interventions: Perspectives of Latino Caregivers. J Autism Dev Disord 2019; 48:1623-1639. [PMID: 29188586 DOI: 10.1007/s10803-017-3394-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Most evidence-based autism spectrum disorder (ASD) interventions are tested with primarily White, mid-upper class, English-speaking populations, despite the increase in Latino children with ASD in early intervention programs throughout the United States. Unfortunately, interventions that are incongruent with a target population's culture may be relatively ineffective. This mixed-methods study explored how culturally appropriate, feasible, and acceptable Latino caregivers perceived intervention models, strategies, and targets. Survey data were compared for 28 Latino and 27 non-Latino White parents of young children with ASD. Further, 20 Latino caregivers participated in focus groups to describe their challenges, perspectives and preferences for intervention strategies and models, and unmet needs from providers. These findings underscore the need for culturally modified interventions for Latino children and families.
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Affiliation(s)
- Michaela DuBay
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, 321 S Columbia St., Chapel Hill, NC, 27516, USA.
| | - Linda R Watson
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, 321 S Columbia St., Chapel Hill, NC, 27516, USA
| | - Wanqing Zhang
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, 321 S Columbia St., Chapel Hill, NC, 27516, USA
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Pierce K, Gazestani VH, Bacon E, Barnes CC, Cha D, Nalabolu S, Lopez L, Moore A, Pence-Stophaeros S, Courchesne E. Evaluation of the Diagnostic Stability of the Early Autism Spectrum Disorder Phenotype in the General Population Starting at 12 Months. JAMA Pediatr 2019; 173:578-587. [PMID: 31034004 PMCID: PMC6547081 DOI: 10.1001/jamapediatrics.2019.0624] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Universal early screening for autism spectrum disorder (ASD) in primary care is becoming increasingly common and is believed to be a pivotal step toward early treatment. However, the diagnostic stability of ASD in large cohorts from the general population, particularly in those younger than 18 months, is unknown. Changes in the phenotypic expression of ASD across early development compared with toddlers with other delays are also unknown. OBJECTIVES To examine the diagnostic stability of ASD in a large cohort of toddlers starting at 12 months of age and to compare this stability with that of toddlers with other disorders, such as developmental delay. DESIGN, SETTING, AND PARTICIPANTS In this prospective cohort study performed from January 1, 2006, to December 31, 2018, a total of 2241 toddlers were referred from the general population through a universal screening program in primary care or community referral. Eligible toddlers received their first diagnostic evaluation between 12 and 36 months of age and had at least 1 subsequent evaluation. EXPOSURES Diagnosis was denoted after each evaluation visit as ASD, ASD features, language delay, developmental delay, other developmental issue, typical sibling of an ASD proband, or typical development. MAIN OUTCOMES AND MEASURES Diagnostic stability coefficients were calculated within 2-month age bands, and logistic regression models were used to explore the associations of sex, age, diagnosis at first visit, and interval between first and last diagnosis with stability. Toddlers with a non-ASD diagnosis at their first visit diagnosed with ASD at their last were designated as having late-identified ASD. RESULTS Among the 1269 toddlers included in the study (918 [72.3%] male; median age at first evaluation, 17.6 months [interquartile range, 14.0-24.4 months]; median age at final evaluation, 36.2 months [interquartile range, 33.4-40.9 months]), the overall diagnostic stability for ASD was 0.84 (95% CI, 0.80-0.87), which was higher than any other diagnostic group. Only 7 toddlers (1.8%) initially considered to have ASD transitioned into a final diagnosis of typical development. Diagnostic stability of ASD within the youngest age band (12-13 months) was lowest at 0.50 (95% CI, 0.32-0.69) but increased to 0.79 by 14 months and 0.83 by 16 months (age bands of 12 vs 14 and 16 months; odds ratio, 4.25; 95% CI, 1.59-11.74). A total of 105 toddlers (23.8%) were not designated as having ASD at their first visit but were identified at a later visit. CONCLUSIONS AND RELEVANCE The findings suggest that an ASD diagnosis becomes stable starting at 14 months of age and overall is more stable than other diagnostic categories, including language or developmental delay. After a toddler is identified as having ASD, there may be a low chance that he or she will test within typical levels at 3 years of age. This finding opens the opportunity to test the impact of very early-age treatment of ASD.
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Affiliation(s)
- Karen Pierce
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Vahid H. Gazestani
- Department of Neurosciences, University of California, San Diego, La Jolla,Department of Pediatrics, University of California, San Diego, La Jolla
| | - Elizabeth Bacon
- Department of Neurosciences, University of California, San Diego, La Jolla
| | | | - Debra Cha
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Srinivasa Nalabolu
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Linda Lopez
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Adrienne Moore
- Department of Neurosciences, University of California, San Diego, La Jolla
| | | | - Eric Courchesne
- Department of Neurosciences, University of California, San Diego, La Jolla
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Carpenter KLH, Baranek GT, Copeland WE, Compton S, Zucker N, Dawson G, Egger HL. Sensory Over-Responsivity: An Early Risk Factor for Anxiety and Behavioral Challenges in Young Children. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 47:1075-1088. [PMID: 30569253 PMCID: PMC6508996 DOI: 10.1007/s10802-018-0502-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Anxiety disorders are prevalent and significantly impact young children and their families. One hypothesized risk factor for anxiety is heightened responses to sensory input. Few studies have explored this hypothesis prospectively. This study had two goals: (1) examine whether sensory over-responsivity is predictive of the development of anxiety in a large prospective sample of children, and (2) identify whether anxiety mediates the relationship between sensory over-responsivity and behavioral challenges. Children's sensory and anxiety symptoms were assessed in a community sample of 917 at 2-5 and again in 191 of these children at 6 years old. Parents also reported on a number of additional behavioral challenges previously found to be associated with both sensory over-responsivity and anxiety separately: irritability, food selectivity, sleep problems, and gastrointestinal problems. Forty three percent of preschool children with sensory over-responsivity also had a concurrent impairing anxiety disorder. Preschool sensory over-responsivity symptoms significantly and positively predicted anxiety symptoms at age six. This relationship was both specific and unidirectional. Finally, school-age anxiety symptoms mediated the relationship between preschool sensory over-responsivity symptoms and both irritability and sleep problems at school-age. These results suggest sensory over-responsivity is a risk factor for anxiety disorders. Furthermore, children who have symptoms of sensory over-responsivity as preschoolers have higher levels of anxiety symptoms at school-age, which in turn is associated with increased levels of school-age behavioral challenges.
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Affiliation(s)
- Kimberly L H Carpenter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA.
| | - Grace T Baranek
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Bondurant Hall, CB #7120, Chapel Hill, NC, 27599-7120, USA
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar Street, CHP 133, Los Angeles, CA, 90089-9003, USA
| | - William E Copeland
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Nancy Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Helen L Egger
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, 1 Park Avenue, 7th Floor, New York, NY, 10016, USA
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Edmunds SR, Kover ST, Stone WL. The relation between parent verbal responsiveness and child communication in young children with or at risk for autism spectrum disorder: A systematic review and meta-analysis. Autism Res 2019; 12:715-731. [PMID: 31050220 DOI: 10.1002/aur.2100] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/26/2019] [Accepted: 03/04/2019] [Indexed: 11/12/2022]
Abstract
Among preschool-age children with autism spectrum disorder (ASD) and typically developing children, parents' verbal responsiveness (PVR) has long been shown to predict children's later language ability. However, before the age of three, when language develops most rapidly, the early social communication deficits associated with ASD may impact parents' opportunities to facilitate early language development. The aim of this review was to characterize the relation between PVR and the vocal communication ability of children with or at high risk for ASD early in development. Specifically, we examined whether the relation between PVR and child communication varied by type of PVR and by child diagnostic status, as well as whether interventions increased PVR. A systematic multi-database search yielded 25 empirical studies (804 parent-toddler dyads; 30 effect sizes) that met inclusion criteria and related a variable of PVR to a variable of child vocalization or language. Meta-regression analyses revealed that the relation between PVR and child communication was significant regardless of PVR type or child diagnostic status. To date, interventions targeting both PVR and child communication were found to significantly increase PVR, but not child communication, for these populations. Future research should examine parent-child communication in a transactional, longitudinal manner. In addition, these findings have implications for interventions designed to target parents' responsiveness and child communication. Autism Research 2019, 12: 715-731. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: For families with children under 3 years old who are at risk for or diagnosed with ASD, this study revealed empirical evidence of a robust relation between parents'' verbal responsiveness to their children's play and communication and children's communication ability. This relation is similar to that reported in research on typically developing children. Interventions designed to improve parent-child interaction in children with or at risk for ASD may be effective in increasing parents' responsiveness.
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Affiliation(s)
- Sarah R Edmunds
- Department of Psychology, University of Washington, Seattle, Washington
| | - Sara T Kover
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington
| | - Wendy L Stone
- Department of Psychology, University of Washington, Seattle, Washington
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Li WH, Hu LF, Yuan L, Hao G, Zhu ZW. The Application of the First Year Inventory for ASD Screening in China. J Pediatr Nurs 2019; 44:e72-e78. [PMID: 30477945 DOI: 10.1016/j.pedn.2018.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 11/09/2018] [Accepted: 11/09/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The First Year Inventory (FYI) is a parent-report instrument, and is developed to assess behaviors of 12-month-old infants that could suggest risk for an eventual diagnosis of autism. This study was designed to examine the application of the FYI in the Chinese community. DESIGN AND METHODS FYIs were completed at a community health center by 541 families during the child's physical examination at 12 months of age from 2013 to 2015. The weighted risk scores used in this study were based on US norms, and compared the FYI differences between China and the U.S. RESULTS The total risk scores ranged from 5 to 42 points; the 95th percentile cutoff was 27.00(9.8 points higher than the 95th percentile cutoff in the US), the 98th percentile cutoff was 29.66(7.04 points higher than the 98th percentile cutoff in the US), and the 99th percentile cutoff was 31.83. Higher risk scores were found for boys than girls. Mothers with a junior college education reported significantly higher FYI risk scores than other three groups including high school, college graduates and post-graduates. CONCLUSIONS There were no significant effects of birth parity, investigator, or investigation year on risk scores. Large-scale longitudinal research is encouraged in the future to develop an early detection model of autism in China.
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Affiliation(s)
- Wen-Hao Li
- Department of Developmental Behavioral Pediatric, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Li-Fei Hu
- Department of Developmental Behavioral Pediatric, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Li Yuan
- Kaixuan community health center, Hangzhou, China
| | - Grace Hao
- Department of Allied Professions, North Carolina Central University, Durham, NC, USA.
| | - Zhi-Wei Zhu
- Department of Developmental Behavioral Pediatric, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Vismara LA, McCormick CEB, Shields R, Hessl D. Extending the Parent-Delivered Early Start Denver Model to Young Children with Fragile X Syndrome. J Autism Dev Disord 2018; 49:1250-1266. [DOI: 10.1007/s10803-018-3833-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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36
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Parent-Mediated Intervention for One-Year-Olds Screened as At-Risk for Autism Spectrum Disorder: A Randomized Controlled Trial. J Autism Dev Disord 2018; 47:3520-3540. [PMID: 28861651 DOI: 10.1007/s10803-017-3268-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Theoretically, interventions initiated with at-risk infants prior to the point in time a definitive autism spectrum disorder (ASD) diagnosis can be made will improve outcomes. Pursuing this idea, we tested the efficacy of a parent-mediated early intervention called Adapted Responsive Teaching (ART) via a randomized controlled trial with 87 one-year-olds identified by community screening with the First Year Inventory as at-risk of later ASD diagnoses. We found minimal evidence for main effects of ART on child outcomes. However, ART group parents showed significantly greater increases in responsiveness to their infants than control group parents. Further, significant indirect (mediation) effects of assignment group on multiple child outcomes through changes in parent responsiveness supported our theory of change.
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Bacon EC, Osuna S, Courchesne E, Pierce K. Naturalistic language sampling to characterize the language abilities of 3-year-olds with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:699-712. [PMID: 29754501 DOI: 10.1177/1362361318766241] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Characterization of language in naturalistic settings in autism spectrum disorder has been lacking, particularly at young ages, but such information is important for parents, teachers, and clinicians to better support language development in real-world settings. Factors contributing to this lack of clarity include conflicting definitions of language abilities, use of non-naturalistic standardized assessments, and restricted samples. The current study examined one of the largest datasets of naturalistic language samples in toddlers with autism spectrum disorder, and language delay and typically developing contrast groups at age 3. A range of indices including length of phrase, grammatical markings, and social use of language was assayed during a naturalistic observation of a parent-child play session. In contrast to historical estimates, results indicated only 3.7% of children with autism spectrum disorder used no words, and 34% were minimally verbal. Children with autism spectrum disorder and language delay exhibited similar usage of grammatical markings, although both were reduced compared to typically developing children. The greatest difference between autism spectrum disorder and language delay groups was the quantity of social language. Overall, findings highlight a range of language deficits in autism spectrum disorder, but also illustrate that the most severe level of impairments is not as common in naturalistic settings as previously estimated by standardized assessments.
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Little LM, Pope E, Wallisch A, Dunn W. Occupation-Based Coaching by Means of Telehealth for Families of Young Children With Autism Spectrum Disorder. Am J Occup Ther 2018; 72:7202205020p1-7202205020p7. [PMID: 29426380 DOI: 10.5014/ajot.2018.024786] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We investigated the efficacy of Occupation-Based Coaching delivered via telehealth for families of young children with autism spectrum disorder (ASD). METHOD Participants were 18 families of children with ASD ages 2-6 yr. We used descriptive statistics to understand intervention characteristics and paired-sample t tests to examine changes in parent efficacy and child participation. RESULTS Parents identified many areas of child adaptive behavior as intervention goals. Results showed that parent efficacy and various domains of child participation significantly increased postintervention (both ps < .05). Additionally, children showed significant gains in parent-identified goals. CONCLUSION Occupation-Based Coaching delivered via telehealth appears to be an effective method of intervention to increase parent efficacy and child participation among families of children with ASD. Occupational therapists may consider how telehealth may be used to provide intervention to an increased number of families, in particular those in underserved areas.
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Affiliation(s)
- Lauren M Little
- Lauren M. Little, PhD, OTR, is Assistant Professor, Department of Occupational Therapy, Rush University of Kansas Medical Center, Chicago, IL;
| | - Ellen Pope
- Ellen Pope, OTD, OTR, is Cofounder, Dunn & Pope Strengths Based Coaching LLC, Albuquerque, NM
| | - Anna Wallisch
- Anna Wallisch, MOT, OTR, is Research Assistant, Juniper Gardens Children's Project, University of Kansas, Kansas City
| | - Winnie Dunn
- Winnie Dunn, PhD, OTR, FAOTA, is Distinguished Professor, Department of Occupational Therapy, University of Missouri, Columbia, and Cofounder, Dunn & Pope Strengths Based Coaching LLC, Albuquerque, NM
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Green J, Garg S. Annual Research Review: The state of autism intervention science: progress, target psychological and biological mechanisms and future prospects. J Child Psychol Psychiatry 2018; 59:424-443. [PMID: 29574740 DOI: 10.1111/jcpp.12892] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND There has been recent systematic review of key evidence in psychosocial intervention in autism but little review of biological treatments. METHODS We analyse the current literature from the perspective of intervention and mechanism targets across social and biological development. RESULTS The overall quality of trials evidence in autism intervention remains relatively low, despite some recent progress. Many treatments in common use have little or no evidence base. This is very concerning in such an important disorder. A variety of psychosocial interventions can show effect to improve some short-term effects on children's immediate dyadic social interactions, for instance with caregivers. But showing true effectiveness in this developmental disorder requires generalisation of such effects into wider social contexts, on autism symptoms and in long-term progress in development. Only a few interventions so far have begun to show this. A number of early phase interventions on biological targets have shown real promise, but none has yet progressed to larger scale effectiveness trials on behavioural or symptom outcomes. CONCLUSIONS There has been enough progress in psychosocial intervention research now to be able to begin to identify some evidence-based practice in autism treatment. To consolidate and improve outcomes, the next phase of intervention research needs improved trial design, and an iterative approach building on success. It may also include the testing of potential synergies between promising biological and psychosocial interventions.
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Affiliation(s)
- Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Shruti Garg
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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40
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French L, Kennedy EMM. Annual Research Review: Early intervention for infants and young children with, or at-risk of, autism spectrum disorder: a systematic review. J Child Psychol Psychiatry 2018; 59:444-456. [PMID: 29052838 DOI: 10.1111/jcpp.12828] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND There has been increased interest in early screening and intervention for young children with, or at risk of, autism spectrum disorder (ASD). This has generated a debate about the potential harms versus benefits of early identification and treatment. This review aims to identify the evidence base for early intervention in ASD. METHODS A systematic review searching for randomised controlled trials (RCTs) of interventions for children up to 6 years of age with, or at risk of, ASD was undertaken. Characteristics and outcomes of included studies were collated and described in tabular format, and all included studies were rated according to the Cochrane Risk of Bias Tool. RESULTS Forty-eight RCTs were identified, of which 40 were published since 2010. Most studies (n = 34) were undertaken in the United States. Included RCTs evaluated 32 different models of intervention. If blinding of participants and relevant personnel is overlooked as a source of bias, only six studies met criteria for low risk of bias across all domains of the Cochrane Risk of Bias Tool. The majority of studies had a relatively small sample size with only seven studies having a sample size >100. CONCLUSIONS There has been a substantial increase in the number of RCTs evaluating early interventions in ASD. However, few studies, only 12.5% of the total, were rated as being at low risk of bias. Small sample size, unclear concealment of allocation and lack of clarity in the identification of the active ingredients in a diverse range of differently named treatment models were identified as challenges to the design, conduct and interpretation of studies. Improved co-ordination and design of studies is, therefore, required if future research in the field is to more clearly investigate the effects of early intervention for ASD.
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Affiliation(s)
- Lorna French
- Children, Young Adults and Families Department, Tavistock Clinic, London, UK
| | - Eilis M M Kennedy
- Children, Young Adults and Families Department, Tavistock Clinic, London, UK.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Abstract
With advances in the field's ability to identify autism spectrum disorders (ASD) at younger ages, the need for information about the evidence-base for early intervention continues to rise. This review of the ASD early intervention (EI) literature focuses on efficacy studies published within the past 15 years. The neurodevelopmental context for early intervention, timing of initiating intervention, primary intervention approaches, and predictors of treatment outcomes are discussed. The evidence indicates that young children with ASD benefit from EI, and their parents learn to implement child-responsive engagement strategies when a parent-coaching intervention is provided. Evidence supports combining parent-mediated and direct clinician-implemented intervention to maximize child developmental gains. Clinical practice recommendations are presented, based on the literature reviewed.
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Affiliation(s)
- Rebecca J. Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
- Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Baranek GT, Woynaroski TG, Nowell S, Turner-Brown L, DuBay M, Crais ER, Watson LR. Cascading effects of attention disengagement and sensory seeking on social symptoms in a community sample of infants at-risk for a future diagnosis of autism spectrum disorder. Dev Cogn Neurosci 2018; 29:30-40. [PMID: 28869201 PMCID: PMC6414208 DOI: 10.1016/j.dcn.2017.08.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 07/18/2017] [Accepted: 08/09/2017] [Indexed: 01/05/2023] Open
Abstract
Recent work suggests sensory seeking predicts later social symptomatology through reduced social orienting in infants who are at high-risk for autism spectrum disorder (ASD) based on their status as younger siblings of children diagnosed with ASD. We drew on extant longitudinal data from a community sample of at-risk infants who were identified at 12 months using the First Year Inventory, and followed to 3-5 years. We replicate findings of Damiano et al. (in this issue) that a) high-risk infants who go on to be diagnosed with ASD show heightened sensory seeking in the second year of life relative to those who do not receive a diagnosis, and b) increased sensory seeking indirectly relates to later social symptomatology via reduced social orienting. We extend previous findings to show that sensory seeking has more clinical utility later in the second year of life (20-24 months) than earlier (13-15 months). Further, this study suggests that diminished attention disengagement at 12-15 months may precede and predict increased sensory seeking at 20-24 months. Findings add support for the notion that sensory features produce cascading effects on social development in infants at risk for ASD, and suggest that reduced attention disengagement early in life may set off this cascade.
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Affiliation(s)
- Grace T Baranek
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.
| | - Tiffany G Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Kennedy Center, Nashville, TN, USA; Vanderbilt Brain Institute, Nashville, TN, USA
| | - Sallie Nowell
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Speech and Hearing Sciences, Department of Allied Health Sciences University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lauren Turner-Brown
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; TEACCH Autism Program, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michaela DuBay
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Speech and Hearing Sciences, Department of Allied Health Sciences University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth R Crais
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Speech and Hearing Sciences, Department of Allied Health Sciences University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda R Watson
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Speech and Hearing Sciences, Department of Allied Health Sciences University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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43
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Green J, Pickles A, Pasco G, Bedford R, Wan MW, Elsabbagh M, Slonims V, Gliga T, Jones E, Cheung C, Charman T, Johnson M. Randomised trial of a parent-mediated intervention for infants at high risk for autism: longitudinal outcomes to age 3 years. J Child Psychol Psychiatry 2017; 58:1330-1340. [PMID: 28393350 PMCID: PMC5724485 DOI: 10.1111/jcpp.12728] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND There has been increasing interest in the potential for pre-emptive interventions in the prodrome of autism, but little investigation as to their effect. METHODS A two-site, two-arm assessor-blinded randomised controlled trial (RCT) of a 12-session parent-mediated social communication intervention delivered between 9 and 14 months of age (Intervention in the British Autism Study of Infant Siblings-Video Interaction for Promoting Positive Parenting), against no intervention. Fifty-four infants (28 intervention, 26 nonintervention) at familial risk of autism but not otherwise selected for developmental atypicality were assessed at 9-month baseline, 15-month treatment endpoint, and 27- and 39-month follow-up. PRIMARY OUTCOME severity of autism prodromal symptoms, blind-rated on Autism Observation Schedule for Infants or Autism Diagnostic Observation Schedule 2nd Edition across the four assessment points. SECONDARY OUTCOMES blind-rated parent-child interaction and child language; nonblind parent-rated communication and socialisation. Prespecified intention-to-treat analysis combined estimates from repeated measures within correlated regressions to estimate the overall effect of the infancy intervention over time. RESULTS Effect estimates in favour of intervention on autism prodromal symptoms, maximal at 27 months, had confidence intervals (CIs) at each separate time point including the null, but showed a significant overall effect over the course of the intervention and follow-up period (effect size [ES] = 0.32; 95% CI 0.04, 0.60; p = .026). Effects on proximal intervention targets of parent nondirectiveness/synchrony (ES = 0.33; CI 0.04, 0.63; p = .013) and child attentiveness/communication initiation (ES = 0.36; 95% CI 0.04, 0.68; p = .015) showed similar results. There was no effect on categorical diagnostic outcome or formal language measures. CONCLUSIONS Follow-up to 3 years of the first RCT of a very early social communication intervention for infants at familial risk of developing autism has shown a treatment effect, extending 24 months after intervention end, to reduce the overall severity of autism prodromal symptoms and enhance parent-child dyadic social communication over this period. We highlight the value of extended follow-up and repeat assessment for early intervention trials.
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Affiliation(s)
- Jonathan Green
- Social Development Research GroupSchool of Biological SciencesUniversity of ManchesterManchesterUK,Royal Manchester Children's HospitalManchesterUK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK,National Institute for Health Research Medical Health Biomedical Research CentreSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Greg Pasco
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK,Centre for Brain and Cognitive DevelopmentBirkbeck CollegeLondonUK
| | - Rachael Bedford
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Ming Wai Wan
- School of Health SciencesUniversity of ManchesterManchesterUK
| | - Mayada Elsabbagh
- Centre for Brain and Cognitive DevelopmentBirkbeck CollegeLondonUK,Department of PsychiatryMcGill UniversityWest MontréalQCCanada
| | - Vicky Slonims
- Evelina London Children's Hospital and King's College London Neurosciences CentreLondonUK
| | - Teea Gliga
- Centre for Brain and Cognitive DevelopmentBirkbeck CollegeLondonUK
| | - Emily Jones
- Centre for Brain and Cognitive DevelopmentBirkbeck CollegeLondonUK
| | - Celeste Cheung
- Centre for Brain and Cognitive DevelopmentBirkbeck CollegeLondonUK
| | - Tony Charman
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Mark Johnson
- Centre for Brain and Cognitive DevelopmentBirkbeck CollegeLondonUK
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Kinard JL, Sideris J, Watson LR, Baranek GT, Crais ER, Wakeford L, Turner-Brown L. Predictors of Parent Responsiveness to 1-Year-Olds At-Risk for Autism Spectrum Disorder. J Autism Dev Disord 2017; 47:172-186. [PMID: 27785592 DOI: 10.1007/s10803-016-2944-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Parent responsiveness is critical for child development of cognition, social-communication, and self-regulation. Parents tend to respond more frequently when children at-risk for autism spectrum disorder (ASD) demonstrate stronger social-communication; however, it is unclear how responsiveness is associated with sensory characteristics of children at-risk for ASD. To address this issue, we examined the extent to which child social-communication and sensory reactivity patterns (i.e., hyper- and hypo-reactivity) predicted parent responsiveness to 1-year-olds at-risk for ASD in a community sample of 97 parent-infant pairs. A combination of child social-communication and sensory hypo-reactivity consistently predicted how parents played and talked with their 1-year-old at-risk for ASD. Parents tended to talk less and use more play actions when infants communicated less and demonstrated stronger hypo-reactivity.
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Affiliation(s)
- Jessica L Kinard
- Carolina Institute for Developmental Disabilities, The University of North Carolina at Chapel Hill, Campus Box #7255, Chapel Hill, NC, USA. .,Program for Early Autism Research, Leadership, and Service, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - John Sideris
- Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda R Watson
- Program for Early Autism Research, Leadership, and Service, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Grace T Baranek
- Program for Early Autism Research, Leadership, and Service, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth R Crais
- Program for Early Autism Research, Leadership, and Service, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linn Wakeford
- Program for Early Autism Research, Leadership, and Service, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Allied Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lauren Turner-Brown
- Program for Early Autism Research, Leadership, and Service, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Psychiatry and UNC TEACCH Autism Program, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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45
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Reynolds S, Glennon TJ, Ausderau K, Bendixen RM, Kuhaneck HM, Pfeiffer B, Watling R, Wilkinson K, Bodison SC. Using a Multifaceted Approach to Working With Children Who Have Differences in Sensory Processing and Integration. Am J Occup Ther 2017; 71:7102360010p1-7102360010p10. [PMID: 28218599 PMCID: PMC5317393 DOI: 10.5014/ajot.2017.019281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pediatric occupational therapy practitioners frequently provide interventions for children with differences in sensory processing and integration. Confusion exists regarding how best to intervene with these children and about how to describe and document methods. Some practitioners hold the misconception that Ayres Sensory Integration intervention is the only approach that can and should be used with this population. The issue is that occupational therapy practitioners must treat the whole client in varied environments; to do so effectively, multiple approaches to intervention often are required. This article presents a framework for conceptualizing interventions for children with differences in sensory processing and integration that incorporates multiple evidence-based approaches. To best meet the needs of the children and families seeking occupational therapy services, interventions must be focused on participation and should be multifaceted.
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Affiliation(s)
- Stacey Reynolds
- Stacey Reynolds, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, Virginia Commonwealth University, Richmond;
| | - Tara J Glennon
- Tara J. Glennon, EdD, OTR/L, FAOTA, is Professor of Occupational Therapy, Quinnipiac University, Hamden, CT
| | - Karla Ausderau
- Karla Ausderau, PhD, OTR/L, is Assistant Professor, Department of Kinesiology, Occupational Therapy Program, University of Wisconsin, Madison
| | - Roxanna M Bendixen
- Roxanna M. Bendixen, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Heather Miller Kuhaneck
- Heather Miller Kuhaneck, PhD, OTR/L, FAOTA, is Associate Professor of Occupational Therapy, Sacred Heart University, Fairfield, CT
| | - Beth Pfeiffer
- Beth Pfeiffer, PhD, OTR/L, BCP, is Associate Professor, Department of Rehabilitation Sciences, Temple University, Philadelphia, PA
| | - Renee Watling
- Renee Watling, PhD, OTR/L, FAOTA, is Visiting Assistant Professor, University of Puget Sound, Tacoma, WA
| | - Kimberly Wilkinson
- Kimberly Wilkinson, PhD, OTR/L, is Assistant Professor of Occupational Therapy, Ithaca College, Ithaca, NY
| | - Stefanie C Bodison
- Stefanie C. Bodison, OTD, OTR/L, is Assistant Professor, Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
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46
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Brian JA, Smith IM, Zwaigenbaum L, Bryson SE. Cross-site randomized control trial of the Social ABCs caregiver-mediated intervention for toddlers with autism spectrum disorder. Autism Res 2017; 10:1700-1711. [PMID: 28574669 DOI: 10.1002/aur.1818] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/21/2017] [Accepted: 05/08/2017] [Indexed: 12/21/2022]
Abstract
To evaluate the efficacy of the Social ABCs parent-mediated intervention for toddlers with suspected or confirmed autism spectrum disorder (ASD), through a cross-site randomized control trial, sixty-three parent-toddler dyads (toddler age: 16-30 months) were randomized into treatment (Social ABCs) or control (service-as-usual) conditions. Video data were obtained at three key time-points: Baseline; Post-training (PT; week 12); and Follow-Up (week 24). Analyses included 62 dyads. Treatment allocation significantly accounted for PT gains, all favouring the Treatment group, in (1) child functional vocal responsiveness to parent prompts (R2 = 0.43, P < .001), (2) child vocal initiations (R2 = 0.28, P < .001), (3) parent smiling (R2 = 0.09, P = .017), and (4) fidelity of implementation (R2 = 0.71, P < .001). A trend was observed for increased social orienting (R2 = 0.06, P = 0.054); gains in parent smiling significantly predicted increases in child smiling and social orienting. Parents in the treatment condition reported significant gains in self-efficacy following the intervention (P = 0.009). No differential effects emerged for performance on standardized measures. The Social ABCs is a relatively low-resource, efficacious intervention, with potential to be a cost-effective means of intervening at the first signs of possible ASD. Autism Res 2017, 10: 1700-1711. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. Clinical Trial Title: Social ABCs for Toddlers with Signs of Autism Spectrum Disorder: RCT of a Parent-Mediated Intervention http//ClinicalTrials.gov identifier: NCT02428452.
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Affiliation(s)
- Jessica A Brian
- Autism Research Centre, Bloorview Research Institute/University of Toronto, Toronto, ON
| | - Isabel M Smith
- Departments of Pediatrics and Psychology & Neuroscience, Dalhousie University, Halifax, NS.,Autism Research Centre, IWK Health Centre, Halifax, NS
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, and Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, AB
| | - Susan E Bryson
- Departments of Pediatrics and Psychology & Neuroscience, Dalhousie University, Halifax, NS.,Autism Research Centre, IWK Health Centre, Halifax, NS
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47
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Uljarević M, Baranek G, Vivanti G, Hedley D, Hudry K, Lane A. Heterogeneity of sensory features in autism spectrum disorder: Challenges and perspectives for future research. Autism Res 2017; 10:703-710. [PMID: 28266796 DOI: 10.1002/aur.1747] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/30/2016] [Accepted: 12/24/2016] [Indexed: 12/24/2022]
Abstract
Pronounced heterogeneity is apparent across every facet of autism spectrum disorder (ASD) and it remains difficult to predict likely future potential among individuals who share a common diagnosis of ASD on the basis of early presentation. In this commentary we argue that a fine-grained understanding of individual differences in sensory features and their influence across the life span can constrain noted clinical heterogeneity in ASD. We organize our discussion around the following three critical themes: (a) considering sensory features as dimensional construct; (b) taking an "individual differences" approach; and (c) adopting a comprehensive, multidimensional and multimodal approach to measurement of sensory features. We conclude that future research will need to investigate individual differences in sensory features via: (1) multidimensional and cross-disciplinary examination, (2) prospective longitudinal designs, and (3) dimensional and developmental frameworks that emphasize the potential value of early individual variability as indicators of later outcomes, not only in relation to the categorical diagnostic outcome status but also the presence of other clinical features. This is a key time for sensory-related research and in this commentary we provide some of the steps that, in our opinion, can shape future research in this area. Autism Res 2017, 10: 703-710. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Mirko Uljarević
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia
| | - Grace Baranek
- Division of Occupational Science & Occupational Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Giacomo Vivanti
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Victoria, Australia.,Early Detection & Intervention Program, A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Darren Hedley
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Victoria, Australia
| | - Kristelle Hudry
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Victoria, Australia
| | - Alison Lane
- School of Health Sciences, University of Newcastle, New South Wales, Australia.,Priority Research Centre GrowUpWell®
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Pierce K, Courchesne E, Bacon E. To Screen or Not to Screen Universally for Autism is not the Question: Why the Task Force Got It Wrong. J Pediatr 2016; 176:182-94. [PMID: 27421956 PMCID: PMC5679123 DOI: 10.1016/j.jpeds.2016.06.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 04/27/2016] [Accepted: 06/02/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Karen Pierce
- Department of Neurosciences and Autism Center of Excellence, School of Medicine, University of California San Diego, La Jolla, CA.
| | - Eric Courchesne
- Department of Neurosciences and Autism Center of Excellence, School of Medicine, University of California San Diego, La Jolla, CA
| | - Elizabeth Bacon
- Department of Neurosciences and Autism Center of Excellence, School of Medicine, University of California San Diego, La Jolla, CA
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49
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Benning SD, Kovac M, Campbell A, Miller S, Hanna EK, Damiano CR, Sabatino-DiCriscio A, Turner-Brown L, Sasson NJ, Aaron RV, Kinard J, Dichter GS. Late Positive Potential ERP Responses to Social and Nonsocial Stimuli in Youth with Autism Spectrum Disorder. J Autism Dev Disord 2016; 46:3068-77. [PMID: 27344337 PMCID: PMC4988236 DOI: 10.1007/s10803-016-2845-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We examined the late positive potential (LPP) event related potential in response to social and nonsocial stimuli from youths 9 to 19 years old with (n = 35) and without (n = 34) ASD. Social stimuli were faces with positive expressions and nonsocial stimuli were related to common restricted interests in ASD (e.g., electronics, vehicles, etc.). The ASD group demonstrated relatively smaller LPP amplitude to social stimuli and relatively larger LPP amplitude to nonsocial stimuli. There were no group differences in subjective ratings of images, and there were no significant correlations between LPP amplitude and ASD symptom severity within the ASD group. LPP results suggest blunted motivational responses to social stimuli and heightened motivational responses to nonsocial stimuli in youth with ASD.
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Affiliation(s)
- Stephen D Benning
- Department of Psychology, University of Nevada at Las Vegas, Las Vegas, NV, USA.
| | - Megan Kovac
- New York Presbyterian-Weill Cornell Medical Center, New York, NY, USA
| | - Alana Campbell
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie Miller
- University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, NC, USA
| | - Eleanor K Hanna
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Cara R Damiano
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Antoinette Sabatino-DiCriscio
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Geisinger Autism Center, 120 Hamm Drive, Lewisburg, PA, USA
| | | | - Noah J Sasson
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, 75080-3021, USA
| | - Rachel V Aaron
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Jessica Kinard
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gabriel S Dichter
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
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50
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