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Montazeri F, Buitelaar JK, Oosterling IJ, de Bildt A, Anderson GM. Network Structure of Autism Spectrum Disorder Behaviors and Its Evolution in Preschool Children: Insights from a New Longitudinal Network Analysis Method. J Autism Dev Disord 2023; 53:4293-4307. [PMID: 36066728 DOI: 10.1007/s10803-022-05723-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
Network modeling of the social, communication and restrictive/repetitive behaviors (RRBs) included in the definition of Autism Spectrum Disorder was performed. The Autism Diagnostic Interview-Revised (ADI-R) assessed behaviors in 139 pre-school cases at two cross-sections that averaged 34.8 months apart. Cross-sectional networks were based on the correlation matrix of the ADI-R behavioral items and the "bootCross" method was developed and enabled the estimation of a longitudinal network. At both stages, RRB items/nodes formed a consistent peripheral cluster, while social and communication nodes formed a core cluster that diverged with time. These differences in the nature and evolution of the RRB and socio-communicative dimensions indicate that their inter-behavior dynamics are very different. The most central behaviors across stages are proposed as prime targets for efficient therapeutic intervention.
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Affiliation(s)
- Farhad Montazeri
- Child Study Center, Yale University School of Medicine, 230 S. Frontage Rd, New Haven, CT, USA.
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Iris J Oosterling
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Annelies de Bildt
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Lübeckweg 2, NL-9723 HE, Groningen, The Netherlands
- Accare, Child Study Center, Groningen, The Netherlands
| | - George M Anderson
- Child Study Center, Yale University School of Medicine, 230 S. Frontage Rd, New Haven, CT, USA
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2
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Snijder MIJ, Dietz C, van Andel M, Ruiter ELM, Buitelaar JK, Oosterling IJ. Social COmmunication Program supported by E-health (SCOPE) for infants and toddlers at elevated likelihood of autism spectrum disorder: study design of a cluster randomized controlled trial. BMC Psychiatry 2022; 22:772. [PMID: 36482453 PMCID: PMC9733381 DOI: 10.1186/s12888-022-04351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 10/29/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although the importance of early detection and early intervention of autism spectrum disorders (ASD) is widely recognized, multiple barriers exist in accessing early intervention services. As an alternative to these barriers, the SCOPE project presents a new, easy accessible and blended intervention called BEAR (Blended E-health for children at eArly Risk). This paper describes this BEAR intervention and study design of an ongoing two arm cluster randomized controlled trial (RCT). METHODS BEAR (Blended E-health for children at eArly Risk) is a blended e-health intervention, based on evidence-based naturalistic developmental behavioral interventions (NDBI's) and can be offered to parents and infants/toddlers at high likelihood for ASD. During the ongoing RCT, N = 88 high risk infants and toddlers will be cluster randomized over the BEAR intervention and care-as-usual (CAU) conditions. The finalized version of the intervention protocol and study design are presented in this paper. The primary outcome measure is joint engagement measured by the Joint Engagement Rating Inventory (JERI) during videotaped parent-child interaction. Secondary outcome measures include severity of ASD symptoms, global level of adaptive functioning, parental well-being, parental skills and satisfaction with healthcare. Also, costs will be estimated from society's perspective. Assessments take place at the start of the study (T1), after eight weeks (T2) and after six months (T3) and include behavioral home observations and parental questionnaires. DISCUSSION The SCOPE project aims to contribute to improved early identification and timely start of suitable interventions for infants and toddlers at elevated likelihood for ASD. This ongoing RCT will offer insight in the feasibility, short-term and six months effects of the innovative BEAR intervention. It is estimated that inclusion for the trial (N = 88) is completed in spring 2023. TRIAL REGISTRATION Dutch Trial Register, NTR7695. Registered at December 17th, 2018, www.trialregister.nl .
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Affiliation(s)
- Michelle I. J. Snijder
- grid.461871.d0000 0004 0624 8031Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands ,grid.5590.90000000122931605Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Claudine Dietz
- grid.461871.d0000 0004 0624 8031Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands
| | - Mieke van Andel
- grid.461871.d0000 0004 0624 8031Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands
| | | | - Jan K. Buitelaar
- grid.461871.d0000 0004 0624 8031Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands ,grid.5590.90000000122931605Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Iris J. Oosterling
- grid.461871.d0000 0004 0624 8031Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, the Netherlands
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de Korte MWP, van Dongen-Boomsma M, Oosterling IJ, Buitelaar JK, Staal WG. Pivotal Response Treatment (PRT) parent group training for young children with autism spectrum disorder: a pilot study. Sci Rep 2022; 12:7691. [PMID: 35546154 PMCID: PMC9095862 DOI: 10.1038/s41598-022-10604-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
Pivotal Response Treatment (PRT) is a promising intervention addressing core symptoms of autism spectrum disorder (ASD), with parent involvement as key component. Parent group-delivered PRT may be an effective treatment model, but currently the evidence is limited. Also, little attention has been paid to therapeutic involvement of multiple important contexts (e.g. home, school, community) of the young child. The current study explores a 14-week protocol of PRT parent group training (PRT-PG), complemented with individual parent–child sessions and involvement of teachers and other childcare providers. Children aged 2–6 years old with ASD and their parents (n = 20) were included. Preliminary results showed a significant increase in spontaneous initiations during a semi-structured therapist-child interaction together with widespread gains in clinical global functioning. No significant improvement on parent-rated general social-communication skills was observed. These findings justify further research on parent group delivered PRT models.
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Affiliation(s)
- Manon W P de Korte
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands. .,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | | | - Iris J Oosterling
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wouter G Staal
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands.,Leiden University, Leiden, The Netherlands
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4
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Snijder MIJ, Langerak IPC, Kaijadoe SPT, Buruma ME, Verschuur R, Dietz C, Buitelaar JK, Oosterling IJ. Parental Experiences with Early Identification and Initial Care for their Child with Autism: Tailored Improvement Strategies. J Autism Dev Disord 2021; 52:3473-3485. [PMID: 34468907 PMCID: PMC9296376 DOI: 10.1007/s10803-021-05226-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 10/26/2022]
Abstract
Whereas it is well documented how parents experience the diagnostic process of their child with autism spectrum disorder (ASD), less is known about parental experiences with the course of the early identification process and first steps in receiving care for their child with ASD symptoms. This mixed-method study investigated these experiences as well as barriers and improvement strategies regarding early detection in the Netherlands. A parental survey (N = 45) showed that, on average, initial concerns started at 22 months. A focus group (N = 10) revealed multiple barriers and proposed strategies of improvement in three domains: "Knowledge and Expertise", "Attention to Parental Needs" and "System and Organization". Strategies to improve early identification will be discussed based on parental perspectives and professional perspectives.
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Affiliation(s)
- Michelle I J Snijder
- Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, Nijmegen, 6525 GC, The Netherlands. .,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands.
| | | | - Shireen P T Kaijadoe
- Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, Nijmegen, 6525 GC, The Netherlands
| | | | | | - Claudine Dietz
- Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, Nijmegen, 6525 GC, The Netherlands
| | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, Nijmegen, 6525 GC, The Netherlands.,Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - Iris J Oosterling
- Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, Nijmegen, 6525 GC, The Netherlands
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Snijder MI, Kaijadoe SP, van 't Hof M, Ester WA, Buitelaar JK, Oosterling IJ. Early detection of young children at risk of autism spectrum disorder at well-baby clinics in the Netherlands: Perspectives of preventive care physicians. Autism 2021; 25:2012-2024. [PMID: 33884893 DOI: 10.1177/13623613211009345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT To improve early detection of autism spectrum disorder in preventive care, a Dutch guideline was developed 5 years ago. The guideline provides preventive care physicians at well-baby clinics action-oriented advice and describes a step-by-step approach for children identified at an increased risk for autism spectrum disorder during general healthcare surveillance. The present qualitative study evaluated adherence to the guideline and studied barriers regarding early detection of autism spectrum disorder at well-baby clinics. Interviews were undertaken with 12 preventive care physicians (one representative per province). It was found that the vast majority of participants did not follow-up general surveillance with an autism spectrum disorder -specific screener as prescribed by the guideline. Six barriers (limited knowledge about autism spectrum disorder symptoms in infant and toddlerhood, professional attitude toward early detection, problems in discussing initial worries with parents, limited use of screening instruments, perceptions toward cultural and language differences and constraints regarding availability of healthcare services) were found. The results of this study highlight the importance of an integrative approach, raising awareness of the benefits regarding early detection of autism spectrum disorder in preventive care, the need of continuous investment in easy and accessible training and active screening, and a closer collaboration between preventive care organizations and autism spectrum disorder experts.
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Affiliation(s)
- Michelle Ij Snijder
- Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,Radboudumc, The Netherlands
| | | | - Maarten van 't Hof
- Lucertis Child and Adolescent Psychiatry, The Netherlands.,Parnassia Psychiatric Institute, The Netherlands
| | - Wietske A Ester
- Lucertis Child and Adolescent Psychiatry, The Netherlands.,Parnassia Psychiatric Institute, The Netherlands.,Leiden University, The Netherlands
| | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,Radboudumc, The Netherlands
| | - Iris J Oosterling
- Karakter Child and Adolescent Psychiatry University Centre, The Netherlands
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De Korte MW, van den Berk-Smeekens I, van Dongen-Boomsma M, Oosterling IJ, Den Boer JC, Barakova EI, Lourens T, Buitelaar JK, Glennon JC, Staal WG. Self-initiations in young children with autism during Pivotal Response Treatment with and without robot assistance. Autism 2020; 24:2117-2128. [PMID: 32730096 DOI: 10.1177/1362361320935006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT The initiation of social interaction is often defined as a core deficit of autism spectrum disorder. Optimizing these self-initiations is therefore a key component of Pivotal Response Treatment, an established intervention for children with autism spectrum disorder. However, little is known about the development of self-initiations during intervention and whether this development can be facilitated by robot assistance within Pivotal Response Treatment. The aim of this study was to (1) investigate the effect of Pivotal Response Treatment and robot-assisted Pivotal Response Treatment on self-initiations (functional and social) of young children with autism spectrum disorder over the course of intervention and (2) explore the relation between development in self-initiations and additional gains in general social-communicative skills. Forty-four children with autism spectrum disorder (aged 3-8 years) were included in this study. Self-initiations were assessed during parent-child interaction videos of therapy sessions and coded by raters who did not know which treatment (Pivotal Response Treatment or robot-assisted Pivotal Response Treatment) the child received. General social-communicative skills were assessed before start of the treatment, after 10 and 20 weeks of intervention and 3 months after the treatment was finalized. Results showed that self-initiations increased in both treatment groups, with the largest improvements in functional self-initiations in the group that received robot-assisted Pivotal Response Treatment. Increased self-initiations were related to higher parent-rated social awareness 3 months after finalizing the treatment.
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Affiliation(s)
- Manon Wp De Korte
- Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,Radboud University Nijmegen Medical Centre, The Netherlands
| | - Iris van den Berk-Smeekens
- Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,Radboud University Nijmegen Medical Centre, The Netherlands
| | | | - Iris J Oosterling
- Karakter Child and Adolescent Psychiatry University Centre, The Netherlands
| | | | | | | | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,Radboud University Nijmegen Medical Centre, The Netherlands
| | | | - Wouter G Staal
- Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,Radboud University Nijmegen Medical Centre, The Netherlands.,Leiden University, The Netherlands
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7
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van den Berk-Smeekens I, van Dongen-Boomsma M, De Korte MWP, Den Boer JC, Oosterling IJ, Peters-Scheffer NC, Buitelaar JK, Barakova EI, Lourens T, Staal WG, Glennon JC. Adherence and acceptability of a robot-assisted Pivotal Response Treatment protocol for children with autism spectrum disorder. Sci Rep 2020; 10:8110. [PMID: 32415231 PMCID: PMC7229010 DOI: 10.1038/s41598-020-65048-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/20/2020] [Indexed: 12/16/2022] Open
Abstract
The aim of this study is to present a robot-assisted therapy protocol for children with ASD based on the current state-of-the-art in both ASD intervention research and robotics research, and critically evaluate its adherence and acceptability based on child as well as parent ratings. The robot-assisted therapy was designed based on motivational components of Pivotal Response Treatment (PRT), a highly promising and feasible intervention focused at training “pivotal” (key) areas such as motivation for social interaction and self-initiations, with the goal of establishing collateral gains in untargeted areas of functioning and development, affected by autism spectrum disorders. Overall, children (3–8 y) could adhere to the robot-assisted therapy protocol (Mean percentage of treatment adherence 85.5%), showed positive affect ratings after therapy sessions (positive in 86.6% of sessions) and high robot likability scores (high in 79.4% of sessions). Positive likability ratings were mainly given by school-aged children (H(1) = 7.91, p = .005) and related to the movements, speech and game scenarios of the robot. Parent ratings on the added value of the robot were mainly positive (Mean of 84.8 on 0–100 scale), while lower parent ratings were related to inflexibility of robot behaviour.
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Affiliation(s)
- Iris van den Berk-Smeekens
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, P.O. Box 9104, 6500 HB, Nijmegen, The Netherlands. .,Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands.
| | - Martine van Dongen-Boomsma
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, P.O. Box 9104, 6500 HB, Nijmegen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Manon W P De Korte
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, P.O. Box 9104, 6500 HB, Nijmegen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Jenny C Den Boer
- Karakter Child and Adolescent Psychiatry, Postbus 68, 6710 BB, Ede, The Netherlands
| | - Iris J Oosterling
- Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Nienke C Peters-Scheffer
- Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500 HE, Nijmegen, The Netherlands.,Driestroom, PO box 139, 6660 AC, Elst, The Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, P.O. Box 9104, 6500 HB, Nijmegen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - Emilia I Barakova
- Faculty of Industrial Design, University of Technology, Eindhoven, P.O. Box 513 5600 MB, Eindhoven, The Netherlands
| | - Tino Lourens
- TiViPE, Kanaaldijk ZW 11, 5706 LD, Helmond, The Netherlands
| | - Wouter G Staal
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, P.O. Box 9104, 6500 HB, Nijmegen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Centre, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands.,Institute for Brian and Cognition, Leiden University, P.O. Box 9600 (C2-S), 2300 RC, Leiden, Netherlands
| | - Jeffrey C Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, P.O. Box 9104, 6500 HB, Nijmegen, The Netherlands
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Möricke E, Greven CU, Visser JC, Oosterling IJ, Buitelaar JK, Rommelse NNJ. Social-communicative and attention problems in infancy and toddlerhood as precursors of preschool autistic traits. ACTA ACUST UNITED AC 2019; 11:113-122. [DOI: 10.1007/s12402-018-00284-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 12/30/2018] [Indexed: 01/08/2023]
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Magán-Maganto M, Jónsdóttir SL, Sánchez-García AB, García-Primo P, Hellendoorn A, Charman T, Roeyers H, Dereu M, Moilanen I, Muratori F, Posada de la Paz M, Rogé B, Oosterling IJ, Yliherva A, Canal-Bedia R. Building a theoretical framework for autism spectrum disorders screening instruments in Europe. Child Adolesc Ment Health 2018; 23:359-367. [PMID: 32677135 DOI: 10.1111/camh.12256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND This study addresses the need for a theoretical base to develop more effective early autism spectrum disorders (ASD) detection tools. The structure that underlies early ASD detection is explored by evaluating the opinions of experts on ASD screening tools currently used in Europe. METHOD A process of face and content validity was performed. First, the best constructs were selected from the relevant tests: Checklist for Early Signs of Developmental Disorders (CESDD), Checklist for Autism in Toddlers (CHAT), Early Screening of Autistic Traits Questionnaire (ESAT), Modified Checklist for Autism in Toddlers (M-CHAT), Social Communication Questionnaire (SCQ) and Communication and Symbolic Behaviour Scales Developmental Profile (CSBS-DP). The diagnostic content validity model by Fehring (1986, 1994) was adapted to make the selection. Afterwards, the items, taken from these tests, were selected to fit into each construct, using the same methodology. RESULTS Twelve of the 18 constructs were selected by the experts and 11 items were chosen from a total of 130, reduced to eight after eliminating tautologies. CONCLUSIONS Mapping these constructs and items on to the DSM-5 diagnostic criteria for ASD indicated good face and content validity. Results of this research will contribute to efforts to improve early ASD screening instruments and identify the key behaviours that experts in ASD see as the most relevant for early detection.
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Affiliation(s)
- María Magán-Maganto
- Institute of Community Integration (INICO), Faculty of Education, University of Salamanca, Salamanca, Spain
| | | | - Ana B Sánchez-García
- Institute of Community Integration (INICO), Faculty of Education, University of Salamanca, Salamanca, Spain
| | | | - Annika Hellendoorn
- Department of Educational Sciences, Utrecht University, Utrecht, The Netherlands
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Herbert Roeyers
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Mieke Dereu
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Irma Moilanen
- University and University Hospital of Oulu, Oulu, Finland
| | - Filippo Muratori
- Department of Clinical and Experimental Medicine, University of Pisa, IRCCS Stella Maris Foundation, Pisa, Italy
| | | | - Bernadette Rogé
- CERPPS, Université Toulouse, IUF (Institut Universitaire de France), Toulouse, France
| | - Iris J Oosterling
- Karakter Child and Adolescent Psychiatry, University Centre Nijmegen, Nijmegen, The Netherlands
| | - Anneli Yliherva
- Child Language Research Center, Faculty of Humanities, Logopedics, University of Oulu, Oulu, Finland
| | - Ricardo Canal-Bedia
- Institute of Community Integration (INICO), Faculty of Education, University of Salamanca, Salamanca, Spain
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van den Berk-Smeekens I, Oosterling IJ, den Boer JC, Buitelaar JK, Staal WG, van Dongen-Boomsma M. Pivotal Response Treatment for autism spectrum disorder (ASD). Hippokratia 2017. [DOI: 10.1002/14651858.cd012887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Iris van den Berk-Smeekens
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour; Radboud University Nijmegen Medical Centre; Nijmegen Netherlands
- Karakter Child and Adolescent Psychiatry University Centre; Nijmegen Netherlands
| | - Iris J Oosterling
- Karakter Child and Adolescent Psychiatry University Centre; Nijmegen Netherlands
| | - Jenny C den Boer
- Karakter Child and Adolescent Psychiatry Centre; Ede Netherlands
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour; Radboud University Nijmegen Medical Centre; Nijmegen Netherlands
- Karakter Child and Adolescent Psychiatry University Centre; Nijmegen Netherlands
| | - Wouter G Staal
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour; Radboud University Nijmegen Medical Centre; Nijmegen Netherlands
- Karakter Child and Adolescent Psychiatry University Centre; Nijmegen Netherlands
| | - Martine van Dongen-Boomsma
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour; Radboud University Nijmegen Medical Centre; Nijmegen Netherlands
- Karakter Child and Adolescent Psychiatry University Centre; Nijmegen Netherlands
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11
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Pijl MK, Buitelaar JK, de Korte MW, Rommelse NN, Oosterling IJ. Sustainability of an early detection program for autism spectrum disorder over the course of 8 years. Autism 2017; 22:1018-1024. [PMID: 29068245 PMCID: PMC6196591 DOI: 10.1177/1362361317717977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The importance of early detection of autism spectrum disorder followed by early intervention is increasingly recognized. This quasi-experimental study evaluated the long-term effects of a program for the early detection of autism spectrum disorder (consisting of training of professionals and use of a referral protocol and screening instrument), to determine whether the positive effects on the age at referral were sustained after the program ended while controlling for overall changes in the number of referrals. Before, during, and after the program, the proportion of children referred before 3 years (versus 3–6 years) of age was calculated for children subsequently diagnosed with autism spectrum disorder (N = 513) or another, non-autism spectrum disorder, condition (N = 722). The odds of being referred before 3 years of age was higher in children with autism spectrum disorder than in children with another condition during the program than before (3.1, 95% confidence interval: 1.2–7.6) or after (1.7, 95% confidence interval: 1.0–3.0) the program but was not different before versus after the program. Thus, although the program led to earlier referral of children with autism spectrum disorder, after correction for other referrals, the effect was not sustained after the program ended. This study highlights the importance of continued investment in the early detection of autism spectrum disorder.
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Affiliation(s)
- Mirjam Kj Pijl
- 1 Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,2 Radboud University Medical Centre, Nijmegen
| | - Jan K Buitelaar
- 1 Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,2 Radboud University Medical Centre, Nijmegen
| | - Manon Wp de Korte
- 1 Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,2 Radboud University Medical Centre, Nijmegen
| | - Nanda Nj Rommelse
- 1 Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,2 Radboud University Medical Centre, Nijmegen
| | - Iris J Oosterling
- 1 Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,2 Radboud University Medical Centre, Nijmegen
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Duifhuis EA, den Boer JC, Doornbos A, Buitelaar JK, Oosterling IJ, Klip H. The Effect of Pivotal Response Treatment in Children with Autism Spectrum Disorders: A Non-randomized Study with a Blinded Outcome Measure. J Autism Dev Disord 2017; 47:231-242. [PMID: 27815645 PMCID: PMC5309302 DOI: 10.1007/s10803-016-2916-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose of this quasi-experimental trial was to investigate the effect of Pivotal response treatment (PRT) versus treatment as usual (TAU) on autism symptoms. Children with autism spectrum disorder (ASD), aged 3–8 years, received either PRT (n = 11) or TAU (n = 13). Primary outcome measure was the total score on the Autism Diagnostic Observation Schedule at pre- and posttreatment. Additionally, general problem behavior and parental stress levels were measured. Children in the PRT condition improved on the primary outcome measure compared to the TAU group with a small effect size [partial η2 = 0.22 (95 % CI 0.00–0.46)]. Neither group demonstrated significant changes in the secondary outcomes. This study suggests that PRT may improve autism symptoms in children with ASD over TAU.
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Affiliation(s)
- E A Duifhuis
- Karakter Child and Adolescent Psychiatry, Postbus 68, 6710 BB, Ede, The Netherlands.
| | - J C den Boer
- Karakter Child and Adolescent Psychiatry, Postbus 68, 6710 BB, Ede, The Netherlands
| | - A Doornbos
- Karakter Child and Adolescent Psychiatry, Vriezenveenseweg 213, 6700 AP, Almelo, The Netherlands
| | - J K Buitelaar
- Karakter Child and Adolescent Psychiatry University Center, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, P.O. Box 9101 (204), 6500 HB, Nijmegen, The Netherlands
| | - I J Oosterling
- Karakter Child and Adolescent Psychiatry University Center, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - H Klip
- Karakter Child and Adolescent Psychiatry University Center, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
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Pijl MKJ, Rommelse NNJ, Hendriks M, De Korte MWP, Buitelaar JK, Oosterling IJ. Does the Brief Observation of Social Communication Change help moving forward in measuring change in early autism intervention studies? Autism 2016; 22:216-226. [DOI: 10.1177/1362361316669235] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The field of early autism research is in dire need of outcome measures that adequately reflect subtle changes in core autistic behaviors. This article compares the ability of a newly developed measure, the Brief Observation of Social Communication Change (BOSCC), and the Autism Diagnostic Observation Schedule (ADOS) to detect changes in core symptoms of autism in 44 toddlers. The results provide encouraging evidence for the Brief Observation of Social Communication Change as a candidate outcome measure, as reflected in sufficient inter- and intra-rater reliability, independency from other child characteristics, and sensitivity to capture change. Although the Brief Observation of Social Communication Change did not evidently outperform the Autism Diagnostic Observation Schedule on any of these quality criteria, the instrument may be better able to capture subtle, individual changes in core autistic symptoms. The promising findings warrant further study of this new instrument.
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Affiliation(s)
- Mirjam KJ Pijl
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Nanda NJ Rommelse
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Monica Hendriks
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Manon WP De Korte
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Iris J Oosterling
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
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Van Wijngaarden-Cremers PJM, van Eeten E, Groen WB, Van Deurzen PA, Oosterling IJ, Van der Gaag RJ. Gender and age differences in the core triad of impairments in autism spectrum disorders: a systematic review and meta-analysis. J Autism Dev Disord 2014; 44:627-35. [PMID: 23989936 DOI: 10.1007/s10803-013-1913-9] [Citation(s) in RCA: 305] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Autism is an extensively studied disorder in which the gender disparity in prevalence has received much attention. In contrast, only a few studies examine gender differences in symptomatology. This systematic review and meta-analysis of 22 peer reviewed original publications examines gender differences in the core triad of impairments in autism. Gender differences were transformed and concatenated using standardized mean differences, and analyses were stratified in five age categories (toddlerhood, preschool children, childhood, adolescence, young adulthood). Boys showed more repetitive and stereotyped behavior as from the age of six, but not below the age of six. Males and females did not differ in the domain of social behavior and communication. There is an underrepresentation of females with ASD an average to high intelligence. Females could present another autistic phenotype than males. As ASD is now defined according to the male phenotype this could imply that there is an ascertainment bias. More research is needed into the female phenotype of ASD with development of appropriate instruments to detect and ascertain them.
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Rommelse NNJ, Peters CTR, Oosterling IJ, Visser JC, Bons D, van Steijn DJ, Draaisma J, van der Gaag RJ, Buitelaar JK. A pilot study of abnormal growth in autism spectrum disorders and other childhood psychiatric disorders. J Autism Dev Disord 2011; 41:44-54. [PMID: 20428954 PMCID: PMC3005115 DOI: 10.1007/s10803-010-1026-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aims of the current study were to examine whether early growth abnormalities are (a) comparable in autism spectrum disorders (ASD) and other childhood psychiatric disorders, and (b) specific to the brain or generalized to the whole body. Head circumference, height, and weight were measured during the first 19 months of life in 129 children with ASD and 59 children with non-ASD psychiatric disorders. Both groups showed comparable abnormal patterns of growth compared to population norms, especially regarding height and head circumference in relation to height. Thus abnormal growth appears to be related to psychiatric disorders in general and is mainly expressed as an accelerated growth of height not matched by an increase in weight or head circumference.
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Affiliation(s)
- Nanda N J Rommelse
- Karakter, Child and Adolescent Psychiatry University Center, Nijmegen, The Netherlands.
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Oosterling IJ, Wensing M, Swinkels SH, van der Gaag RJ, Visser JC, Woudenberg T, Minderaa R, Steenhuis MP, Buitelaar JK. Advancing early detection of autism spectrum disorder by applying an integrated two-stage screening approach. J Child Psychol Psychiatry 2010; 51:250-8. [PMID: 19843319 DOI: 10.1111/j.1469-7610.2009.02150.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Few field trials exist on the impact of implementing guidelines for the early detection of autism spectrum disorders (ASD). The aims of the present study were to develop and evaluate a clinically relevant integrated early detection programme based on the two-stage screening approach of Filipek et al. (1999), and to expand the evidence base for this approach. METHODS The integrated early detection programme encompassed: 1) training relevant professionals to recognise early signs of autism and to use the Early Screening of Autistic Traits Questionnaire (ESAT; Dietz, Swinkels et al., 2006; Swinkels, van Daalen, van Engeland, & Buitelaar, 2006), 2) using a specific referral protocol, and 3) building a multidisciplinary diagnostic team. The programme was evaluated in a controlled study involving children in two regions (N = 2793, range 0-11 years). The main outcome variables were a difference in mean age at ASD diagnosis and a difference in the proportion of children diagnosed before 36 months. RESULTS ASD was diagnosed 21 months (95% CI 9.6, 32.4) earlier in the experimental region than in the control region during the follow-up period, with the mean age at ASD diagnosis decreasing by 19.5 months (95% CI 10.5, 28.5) from baseline in the experimental region. Children from the experimental region were 9.4 times (95% CI 2.1, 41.3) more likely than children from the control region to be diagnosed before age 36 months after correction for baseline measurements. Most of these early diagnosed children had narrowly defined autism with mental retardation. CONCLUSIONS The integrated early detection programme appears to be clinically relevant and led to the earlier detection of ASD, mainly in children with a low IQ.
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Affiliation(s)
- Iris J Oosterling
- Karakter Child and Adolescent Psychiatry University Centre, 6525 GC Nijmegen, The Netherlands.
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Oosterling IJ, Swinkels SH, van der Gaag RJ, Visser JC, Dietz C, Buitelaar JK. Comparative analysis of three screening instruments for autism spectrum disorder in toddlers at high risk. J Autism Dev Disord 2009; 39:897-909. [PMID: 19205862 DOI: 10.1007/s10803-009-0692-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 01/13/2009] [Indexed: 11/26/2022]
Abstract
Several instruments have been developed to screen for autism spectrum disorders (ASD) in high-risk populations. However, few studies compare different instruments in one sample. Data were gathered from the Early Screening of Autistic Traits Questionnaire, Social Communication Questionnaire, Communication and Symbolic Behavior Scales-Developmental Profile, Infant-Toddler Checklist and key items of the Checklist for Autism in Toddlers in 238 children (mean age = 29.6 months, SD = 6.4) at risk for ASD. Discriminative properties are compared in the whole sample and in two age groups separately (8-24 months and 25-44 months). No instrument or individual item shows satisfying power in discriminating ASD from non-ASD, but pros and cons of instruments and items are discussed and directions for future research are proposed.
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Affiliation(s)
- Iris J Oosterling
- Karakter Child and Adolescent Psychiatry University Center, Reinier Postlaan 12, Nijmegen 6525 GC, The Netherlands.
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