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Brian JA, Dowds EM, Bernardi K, Velho A, Kantawalla M, de Souza N. Transporting and implementing a caregiver-mediated intervention for toddlers with autism in Goa, India: evidence from the social ABCs. Front Rehabil Sci 2024; 5:1214009. [PMID: 38420365 PMCID: PMC10900983 DOI: 10.3389/fresc.2024.1214009] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/11/2024] [Indexed: 03/02/2024]
Abstract
Introduction Autism is a global health priority with an urgent need for evidence-based, resource-efficient, scalable supports that are feasible for implementation in low- and middle-income countries (LMICs). Initiating supports in the toddler years has potential to significantly impact child and family outcomes. The current paper describes the feasibility and outcomes associated with a Canadian-developed caregiver-mediated intervention for toddlers (the Social ABCs), delivered through a clinical service in Goa, India. Methods Clinical staff at the Sethu Centre for Child Development and Family Guidance in Goa, India, were trained by the Canadian program development team and delivered the program to families seen through their clinic. Using a retrospective chart review, we gathered information about participating families and used a pre-post design to examine change over time. Results Sixty-four families were enrolled (toddler mean age = 28.5 months; range: 19-35), of whom 55 (85.94%) completed the program. Video-coded data revealed that parents learned the strategies (implementation fidelity increased from M = 45.42% to 76.77%, p < .001, with over 90% of caregivers attaining at least 70% fidelity). Toddler responsivity to their caregivers (M = 7.00% vs. 46.58%) and initiations per minute (M = 1.16 vs. 3.49) increased significantly, p's < .001. Parents also reported significant improvements in child behaviour/skills (p < .001), and a non-significant trend toward reduced parenting stress (p = .056). Discussion Findings corroborate the emerging evidence supporting the use of caregiver-mediated models in LMICs, adding evidence that such supports can be provided in the very early years (i.e., under three years of age) when learning may be optimized.
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Affiliation(s)
- Jessica A. Brian
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Rehabilitation Hospital, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Erin M. Dowds
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Rehabilitation Hospital, Toronto, ON, Canada
| | - Kate Bernardi
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Rehabilitation Hospital, Toronto, ON, Canada
| | - Andre Velho
- Sethu Centre for Child Development and Family Guidance, Goa, India
| | | | - Nandita de Souza
- Sethu Centre for Child Development and Family Guidance, Goa, India
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Sacrey LAR, Zwaigenbaum L, Brian JA, Smith IM, Armstrong V, Vaillancourt T, Schmidt LA. Behavioral and physiological differences during an emotion-evoking task in children at increased likelihood for autism spectrum disorder. Dev Psychopathol 2024; 36:404-414. [PMID: 36573373 DOI: 10.1017/s0954579422001286] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 12/28/2022]
Abstract
Literature examining emotional regulation in infants with autism spectrum disorder (ASD) has focused on parent report. We examined behavioral and physiological responses during an emotion-evoking task designed to elicit emotional states in infants. Infants at an increased likelihood for ASD (IL; have an older sibling with ASD; 96 not classified; 29 classified with ASD at age two) and low likelihood (LL; no family history of ASD; n = 61) completed the task at 6, 12, and 18 months. The main findings were (1) the IL-ASD group displayed higher levels of negative affect during toy removal and negative tasks compared to the IL non-ASD and LL groups, respectively, (2) the IL-ASD group spent more time looking at the baseline task compared to the other two groups, and (3) the IL-ASD group showed a greater increase in heart rate from baseline during the toy removal and negative tasks compared to the LL group. These results suggest that IL children who are classified as ASD at 24 months show differences in affect, gaze, and heart rate during an emotion-evoking task, with potential implications for understanding mechanisms related to emerging ASD.
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Affiliation(s)
- Lori-Ann R Sacrey
- Department of Pediatrics, University of Alberta/Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta/Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Jessica A Brian
- Bloorview Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Isabel M Smith
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Autism Research Centre, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Vickie Armstrong
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Autism Research Centre, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Tracy Vaillancourt
- Department of Education and Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Louis A Schmidt
- Department of Psychology, McMaster University, Hamilton, Ontario, Canada
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Sacrey LAR, Zwaigenbaum L, Elshamy Y, Smith IM, Brian JA, Wass S. Comparative strengths and challenges on face-to-face and computer-based attention tasks in autistic and neurotypical toddlers. Autism Res 2023; 16:1501-1511. [PMID: 37448306 DOI: 10.1002/aur.2983] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
The objectives were to compare patterns of visual attention in toddlers diagnosed with autism spectrum disorder (ASD) as compared to their sex- and age-matched neurotypical (NT) peers. Participants included 23 toddlers with ASD and 19 NT toddlers (mean age: 25.52 versus 25.21 months, respectively) assessed using computerized tasks to measure sustained attention, disengaging attention, and cognitive control, as well as an in-person task to assess joint attention. Toddlers in the ASD group showed increased looking durations on the sustained attention task, as well as reduced frequencies of responding to and initiating joint attention compared to NT peers, but showed no differences on tasks of disengaging attention and cognitive control. The results suggest that toddlers with ASD have attentional strengths that may provide a foundation for building attention, communicative, and ultimately, academic skills.
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Affiliation(s)
- Lori-Ann R Sacrey
- Autism Research Centre, Glenrose Rehabilitation Hospital and Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lonnie Zwaigenbaum
- Autism Research Centre, Glenrose Rehabilitation Hospital and Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Yomna Elshamy
- Autism Research Centre, Glenrose Rehabilitation Hospital and Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Isabel M Smith
- IWK Health Centre and Departments of Pediatrics and Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jessica A Brian
- Bloorview Research Institute and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sam Wass
- Department of Psychological Sciences, University of East London, London, UK
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Susko M, Armstrong VL, Brian JA, Bryson SE, Kushki A, Sacrey LAR, Zwaigenbaum L, Smith IM. Behavioural reactions to an emotion evoking task in infants at increased likelihood for autism spectrum disorder. Infant Behav Dev 2023; 72:101848. [PMID: 37307722 DOI: 10.1016/j.infbeh.2023.101848] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/14/2023]
Abstract
Infants at increased likelihood for autism spectrum disorder (ASD) exhibit more negative affect and avoidance behaviour than typically developing infants, and children with ASD express fear differently than typically developing peers. We examined behavioural reactions to emotion-evoking stimuli in infants at increased familial likelihood for ASD. Participants included 55 increased likelihood (IL) infants (i.e., siblings of children diagnosed with ASD) and 27 typical likelihood (TL) infants (i.e., no family history of ASD). At 18 months, we showed infants two masks that commonly elicit fearful responses in older children and examined potential behavioural differences in approach, avoidance, 'freezing', crying, gaze aversion, and smiling. At 24 months, infants were assessed with the Toddler Module of the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2). Results of video-based coding showed that (1) IL infants exhibited more intense avoidance behaviour than TL infants in response to masks, and (2) intensity of avoidance and duration of freezing were positively correlated with ADOS-2 symptom severity scores. Findings suggest that differences in response to emotion-eliciting stimuli may predict later ASD symptoms. Such behavioural differences may inform early detection and intervention in ASD.
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Affiliation(s)
- Melissa Susko
- Autism Research Centre, IWK Health Centre, Halifax, NS, Canada; Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
| | | | - Jessica A Brian
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Susan E Bryson
- Autism Research Centre, IWK Health Centre, Halifax, NS, Canada; Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Azadeh Kushki
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, ON, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | | | | | - Isabel M Smith
- Autism Research Centre, IWK Health Centre, Halifax, NS, Canada; Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
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Sacrey LAR, Zwaigenbaum L, Bryson SE, Brian JA, Smith IM, Garon N, Vaillancourt T, Roncadin C. Temperament in Infancy Predicts Internalizing and Externalizing Problem Behavior at Age 5 in Children With an Increased Likelihood of Autism Spectrum Disorder. Front Psychol 2022; 13:816041. [PMID: 35519644 PMCID: PMC9062223 DOI: 10.3389/fpsyg.2022.816041] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Differences in temperament have been linked to later mental health. Children with autism spectrum disorder (ASD) have an increased likelihood of experiencing such problems, including anxiety, depression, attention deficit/hyperactivity disorder, and oppositional defiant disorder; yet, relations between early temperament and later mental health are not well understood. In this paper, we assess the relationship between temperament in infancy and internalizing and externalizing behavior at age 5, in 178 children at an increased likelihood of being diagnosed with ASD (i.e., younger siblings of children with ASD). Temperament was assessed using the parent-reported Infant Behavior Questionnaire (IBQ) at 6 and 12 months of age and the Toddler Behavior Assessment Questionnaire-Revised (TBAQ-R) at 24 months of age. Mental health problems were assessed using the parent-reported Child Behavior Checklist (CBCL) at age 5. The data were analyzed using hierarchical multiple regressions, with individual temperament subscale scores as single predictor variables (Subscale Score) or temperament profiles using confirmatory factor analyses (Person-Centered Profile) in the first block, Autism Diagnostic Observation Schedule total severity scores at age 3 in the second block, and expressive and receptive language scores (from Mullen Scales of Early Learning) at age 3 in the third block for each model. Three main findings were: (1) 4 of 6 IBQ subscales at both 6 and 12 months significantly predicted internalizing and externalizing problems at age 5; (2) 9 and 8 of 13 TBAQ-R subscales at 24 months significantly predicted internalizing and externalizing problems, respectively, at age 5; and (3) a "sticky attention" temperament profile significantly predicted internalizing problems, whereas a "low-focused" profile significantly predicted externalizing problems, both at age 5. The results of this study support the supposition that temperament is a trans-diagnostic risk factor for later mental health conditions. Exploring temperament profiles and trajectories may illuminate early avenues for prevention in siblings of children with ASD who are at an increased likelihood of experiencing mental health problems, regardless of ASD diagnostic status.
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Affiliation(s)
- Lori-Ann R. Sacrey
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Susan E. Bryson
- Dalhousie University, IWK Health Centre, Halifax, NS, Canada
| | - Jessica A. Brian
- Bloorview Research Institute, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Isabel M. Smith
- Dalhousie University, IWK Health Centre, Halifax, NS, Canada
| | - Nancy Garon
- Department of Psychology, Mount Allison University, Sackville, NB, Canada
| | | | - Caroline Roncadin
- McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
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Sacrey LAR, Zwaigenbaum L, Brian JA, Smith IM, Armstrong V, Raza S, Vaillancourt T, Schmidt LA. Affect and gaze responses during an Emotion-Evoking Task in infants at an increased likelihood for autism spectrum disorder. Mol Autism 2021; 12:63. [PMID: 34615540 PMCID: PMC8493694 DOI: 10.1186/s13229-021-00468-0] [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] [Received: 02/12/2021] [Accepted: 09/06/2021] [Indexed: 12/04/2022] Open
Abstract
Background The majority of research examining emotional difficulties in autism spectrum disorder (ASD) prior to age 2 relies on parent report. Methods We examined behavioral responses (affect and gaze) during emotionally salient tasks designed to elicit mildly positive and negative emotional states in infants. At 12 and 18 months, infants at an increased likelihood for an ASD diagnosis (IL; have an older sibling with ASD; n = 60) and low likelihood (LL; no family history of ASD; n = 21) completed the Emotion-Evoking (EE) Task and parents completed the Infant Behavior Questionnaire-Revised (IBQ-R). All children received an Autism Diagnostic Observation Scale—second Edition assessment for ASD symptomatology at 24 months. Results The main findings were (1) the IL group displayed higher rates of negative affect and spent less time looking at the task objects compared to the LL group, and (2) affect and gaze scores at 12 and 18 months, but not scores on the IBQ-R, predicted ASD symptoms at 24 months. Limitations The data were drawn from an IL sample and may not be generalizable to the general ASD population, and the children were not followed to determine a diagnosis of ASD. Conclusion These results suggest that behavioral responses can provide important information that complements parent reports of emotional regulation in IL infants as early as 12 months of age. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-021-00468-0.
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Affiliation(s)
- Lori-Ann R Sacrey
- Department of Pediatrics, Autism Research Centre - E209, Glenrose Rehabilitation Hospital, University of Alberta, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada.
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, Autism Research Centre - E209, Glenrose Rehabilitation Hospital, University of Alberta, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada
| | - Jessica A Brian
- Bloorview Research Institute, University of Toronto, Toronto, ON, Canada
| | - Isabel M Smith
- IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | | | - Sarah Raza
- Department of Pediatrics, Autism Research Centre - E209, Glenrose Rehabilitation Hospital, University of Alberta, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada
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Sacrey LR, Raza S, Armstrong V, Brian JA, Kushki A, Smith IM, Zwaigenbaum L. Physiological measurement of emotion from infancy to preschool: A systematic review and meta-analysis. Brain Behav 2021; 11:e01989. [PMID: 33336555 PMCID: PMC7882167 DOI: 10.1002/brb3.1989] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Emotion regulation, the ability to regulate emotional responses to environmental stimuli, develops in the first years of life and plays an important role in the development of personality, social competence, and behavior. Substantial literature suggests a relationship between emotion regulation and cardiac physiology; specifically, heart rate changes in response to positive or negative emotion-eliciting stimuli. METHOD This systematic review and meta-analysis provide an in-depth examination of research that has measured physiological responding during emotional-evoking tasks in children from birth to 4 years of age. RESULTS The review had three main findings. First, meta-regressions resulted in an age-related decrease in baseline and task-related heart rate (HR) and increases in baseline and task-related respiratory sinus arrhythmia (RSA). Second, meta-analyses suggest task-related increases in HR and decreases in RSA and heart rate variability (HRV), regardless of emotional valence of the task. Third, associations between physiological responding and observed behavioral regulation are not consistently present in children aged 4 and younger. The review also provides a summary of the various methodology used to measure physiological reactions to emotional-evoking tasks, including number of sensors used and placement, various baseline and emotional-evoking tasks used, methods for extracting RSA, as well as percentage of loss and reasons for loss for each study. CONCLUSION Characterizing the physiological reactivity of typically developing children is important to understanding the role emotional regulation plays in typical and atypical development.
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Affiliation(s)
- Lori‐Ann R. Sacrey
- University of Alberta/Autism Research CentreGlenrose Rehabilitation HospitalEdmontonABCanada
| | - Sarah Raza
- University of Alberta/Autism Research CentreGlenrose Rehabilitation HospitalEdmontonABCanada
| | - Vickie Armstrong
- Dalhousie University/Autism Research CentreIWK Health CentreHalifaxNSCanada
| | - Jessica A. Brian
- University of Toronto/Autism Research CentreBloorview Research InstituteTorontoONCanada
| | - Azadeh Kushki
- University of Toronto/Autism Research CentreBloorview Research InstituteTorontoONCanada
| | - Isabel M. Smith
- Dalhousie University/Autism Research CentreIWK Health CentreHalifaxNSCanada
| | - Lonnie Zwaigenbaum
- University of Alberta/Autism Research CentreGlenrose Rehabilitation HospitalEdmontonABCanada
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McDonald NM, Senturk D, Scheffler A, Brian JA, Carver LJ, Charman T, Chawarska K, Curtin S, Hertz-Piccioto I, Jones EJH, Klin A, Landa R, Messinger DS, Ozonoff S, Stone WL, Tager-Flusberg H, Webb SJ, Young G, Zwaigenbaum L, Jeste SS. Developmental Trajectories of Infants With Multiplex Family Risk for Autism: A Baby Siblings Research Consortium Study. JAMA Neurol 2020; 77:73-81. [PMID: 31589284 PMCID: PMC6784852 DOI: 10.1001/jamaneurol.2019.3341] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/18/2019] [Indexed: 01/01/2023]
Abstract
Importance Autism spectrum disorder (ASD) is a neurodevelopmental disorder associated with different genetic etiologies. Prospective examination of familial-risk infants informs understanding of developmental trajectories preceding ASD diagnosis, potentially improving early detection. Objective To compare outcomes and trajectories associated with varying familial risk for ASD across the first 3 years of life. Design, Setting, and Participants This longitudinal, prospective cohort study used data from 11 sites in the Baby Siblings Research Consortium database. Data were collected between 2003 and 2015. Infants who were younger siblings of children with ASD were followed up for 3 years. Analyses were conducted in April 2018. Of the initial 1008 infants from the database, 573 were removed owing to missing necessary data, diagnostic discrepancies, or only having 1 older sibling. Exposures Number of siblings with ASD. Main Outcomes and Measures Outcomes included ASD symptoms, cognitive abilities, and adaptive skills. Diagnosis (ASD or no ASD) was given at 36-month outcome. The no-ASD group was classified as atypical (developmental delays and/or social-communication concerns) or typical for some analyses. Generalized linear mixed models examined developmental trajectories by ASD outcome and familial-risk group. Results In the 435 analyzed participants (age range at outcome, 32-43 months; 246 male [57%]), 355 (82%) were from single-incidence families (1 sibling with ASD and ≥1 sibling without ASD) and 80 (18%) were from multiplex families (≥2 siblings with ASD). There were no significant group differences in major demographics. Children from multiplex families were more likely than those from single-incidence families to be classified as having ASD (29 of 80 [36%] vs 57 of 355 [16%]; 95% CI, 9%-31%; P < .001) and less likely as typical (26 of 80 [33%] vs 201 of 355 [57%]; 95% CI, -36% to -13%; P < .001), with similar rates of atypical classifications (25 of 80 [31%] vs 97 of 355 [27%]; 95% CI, -7% to 15%; P = .49). There were no differences in ASD symptoms between multiplex and single-incidence groups after controlling for ASD outcome (95% CI, -0.02 to 0.20; P = .18). During infancy, differences in cognitive and adaptive abilities were observed based on ASD outcome in the single-incidence group only. At 36 months, the multiplex/no-ASD group had lower cognitive abilities than the single-incidence/no-ASD group (95% CI, -11.89 to -2.20; P = .02), and the multiplex group had lower adaptive abilities than individuals in the single-incidence group after controlling for ASD outcome (95% CI, -9.01 to -1.48; P = .02). Conclusions and Relevance Infants with a multiplex family history of ASD should be monitored early and often and referred for early intervention at the first sign of concern. Direct examination of genetic contributions to neurodevelopmental phenotypes in infants with familial risk for ASD is needed.
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Affiliation(s)
- Nicole M. McDonald
- Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles
| | - Damla Senturk
- Department of Biostatistics, University of California, Los Angeles, Los Angeles
| | - Aaron Scheffler
- Department of Biostatistics, University of California, Los Angeles, Los Angeles
- now with Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Jessica A. Brian
- Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Leslie J. Carver
- Department of Psychology, University of California, San Diego, La Jolla
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Katarzyna Chawarska
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Suzanne Curtin
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Irva Hertz-Piccioto
- MIND Institute, Department of Public Health Sciences, University of California, Davis, Davis
| | - Emily J. H. Jones
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London, United Kingdom
| | - Ami Klin
- Marcus Autism Center, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Rebecca Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
| | - Daniel S. Messinger
- Department of Psychology, University of Miami, Coral Gables, Florida
- Department of Pediatrics, University of Miami, Coral Gables, Florida
- Department of Electrical & Computer Engineering, University of Miami, Coral Gables, Florida
- Department of Music Engineering, University of Miami, Coral Gables, Florida
| | - Sally Ozonoff
- MIND Institute, Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Wendy L. Stone
- Department of Psychology, University of Washington, Seattle
| | - Helen Tager-Flusberg
- Department of Psychology & Brain Sciences, Boston University, Boston, Massachusetts
| | - Sara Jane Webb
- Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Gregory Young
- MIND Institute, Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Shafali S. Jeste
- Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles
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Zwaigenbaum L, Brian JA, Ip A. Canadian Paediatric Society clinical practice recommendations for assessment of children and youth with autism spectrum disorder. Paediatr Child Health 2019; 24:421-423. [PMID: 31660040 DOI: 10.1093/pch/pxz126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/23/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Jessica A Brian
- Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Angie Ip
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
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Ip A, Zwaigenbaum L, Brian JA. Post-diagnostic management and follow-up care for autism spectrum disorder. Paediatr Child Health 2019; 24:461-477. [PMID: 31660043 DOI: 10.1093/pch/pxz121] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/27/2019] [Indexed: 11/13/2022] Open
Abstract
Paediatricians and other primary care providers are well positioned to provide or coordinate ongoing medical and psychosocial care and support services for children with autism spectrum disorder (ASD). This statement provides recommendations and information on a range of interventions and resources, to help paediatric care providers optimize care for children with ASD and support their families. The management of ASD includes treating medical and psychiatric co-morbidities, behavioural and developmental interventions, and providing supportive social care services to enhance quality of life for affected children and families.
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Affiliation(s)
- Angie Ip
- Canadian Paediatric Society, Autism Spectrum Disorder Guidelines Task Force, Ottawa, Ontario
| | - Lonnie Zwaigenbaum
- Canadian Paediatric Society, Autism Spectrum Disorder Guidelines Task Force, Ottawa, Ontario
| | - Jessica A Brian
- Canadian Paediatric Society, Autism Spectrum Disorder Guidelines Task Force, Ottawa, Ontario
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Abstract
RésuméLe trouble du spectre de l’autisme (TSA) est un trouble neurodéveloppemental permanent qui se caractérise par des déficits de la communication sociale, un mode répétitif et restreint des comportements et des sensibilités ou des intérêts sensoriels inhabituels. Le TSA a des répercussions importantes sur la vie des enfants et de leur famille. À l’heure actuelle, sa prévalence estimative est de un cas sur 66 enfants et adolescents canadiens dans le groupe d’âge des cinq à 17 ans. Les pédiatres généraux, les médecins de famille et les autres professionnels de la santé rencontrent donc plus d’enfants ayant un TSA qu’auparavant dans leur pratique. Le diagnostic rapide de ce trouble et l’orientation des cas vers des interventions comportementales et éducationnelles intensives dès le plus jeune âge peuvent favoriser un meilleur pronostic clinique à long terme grâce à la neuroplasticité du cerveau à un plus jeune âge. Le présent docu-ment de principes contient des recommandations et des outils clairs, détaillés et fondés sur des données probantes pour aider les pédiatres communautaires et les autres dispensateurs de soins de première ligne à surveiller les tout premiers signes de TSA, ce qui constitue une étape importante vers un diagnostic précis et une évaluation détaillée des besoins pour planifier les interventions.
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Affiliation(s)
- Lonnie Zwaigenbaum
- Société canadienne de pédiatrie, groupe de travail des directives sur le trouble du spectre de l’autisme, Ottawa (Ontario)
| | - Jessica A Brian
- Société canadienne de pédiatrie, groupe de travail des directives sur le trouble du spectre de l’autisme, Ottawa (Ontario)
| | - Angie Ip
- Société canadienne de pédiatrie, groupe de travail des directives sur le trouble du spectre de l’autisme, Ottawa (Ontario)
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Zwaigenbaum L, Brian JA, Ip A. Early detection for autism spectrum disorder in young children. Paediatr Child Health 2019; 24:424-443. [PMID: 31660041 DOI: 10.1093/pch/pxz119] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/27/2019] [Indexed: 12/14/2022] Open
Abstract
Autism spectrum disorder (ASD) is a life-long neurodevelopmental disorder, characterized by impairments in social communication, repetitive, restricted patterns of behaviour, and unusual sensory sensitivities or interests. ASD significantly impacts the lives of children and their families. Currently, the estimated prevalence of ASD is 1 in 66 Canadians aged 5 to 17 years. General paediatricians, family physicians, and other health care professionals are, therefore, seeing more children with ASD in their practices. The timely diagnosis of ASD, and referral for intensive behavioural and educational interventions at the earliest age possible, may lead to better long-term outcomes by capitalizing on the brain's neuroplasticity at younger ages. This statement provides clear, comprehensive, evidence-informed recommendations and tools to help community paediatricians and other primary care providers monitor for the earliest signs of ASD-an important step toward an accurate diagnosis and comprehensive needs assessment for intervention planning.
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Affiliation(s)
- Lonnie Zwaigenbaum
- Canadian Paediatric Society, Autism Spectrum Disorder Guidelines Task Force, Ottawa, Ontario
| | - Jessica A Brian
- Canadian Paediatric Society, Autism Spectrum Disorder Guidelines Task Force, Ottawa, Ontario
| | - Angie Ip
- Canadian Paediatric Society, Autism Spectrum Disorder Guidelines Task Force, Ottawa, Ontario
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Abstract
Résumé
Les pédiatres et les autres dispensateurs de soins de première ligne sont bien placés pour fournir ou coordonner des soins médicaux et psychosociaux continus et des services de soutien aux enfants ayant un trouble du spectre de l’autisme (TSA). Le présent document de principes fournit des recommandations et de l’information sur une série d’interventions et de ressources en vue d’aider les dispensateurs de soins pédiatriques à optimiser les soins aux enfants ayant un TSA et de soutenir les familles. La prise en charge du TSA inclut le traitement des affections physiques et psychiatriques associées, les interventions comportementales et développementales et la prestation de services sociaux pour améliorer la qualité de vie des enfants touchés et de leur famille.
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Affiliation(s)
- Angie Ip
- Société canadienne de pédiatrie, groupe de travail des directives sur le trouble du spectre de l’autisme, Ottawa (Ontario)
| | - Lonnie Zaigenbaum
- Société canadienne de pédiatrie, groupe de travail des directives sur le trouble du spectre de l’autisme, Ottawa (Ontario)
| | - Jessica A Brian
- Société canadienne de pédiatrie, groupe de travail des directives sur le trouble du spectre de l’autisme, Ottawa (Ontario)
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Abstract
Résumé
En raison de la prévalence croissante du trouble du spectre de l’autisme (TSA), il est devenu nécessaire d’accroître la capacité diagnostique des pédiatres communautaires et des autres dispensateurs de soins de première ligne à l’égard de cette affection. Même si les données probantes indiquent que certains enfants peuvent obtenir un diagnostic définitif avant l’âge de deux ans, nombreux sont ceux qui ne sont pas diagnostiqués avant l’âge de quatre ou cinq ans. La plupart des directives cliniques recommandent de faire participer une équipe multidisciplinaire au processus diagnostique de TSA. Même si trois directives récentes sur le TSA recommandent une période d’attente maximale de trois à six mois, dans bien des lieux au Canada, il faut souvent attendre plus d’un an entre la demande de consultation et la tenue de l’évaluation diagnostique du TSA par une équipe. Il faudrait former plus de dispensateurs de soins pédiatriques pour diagnostiquer les cas de TSA moins complexes. Le présent document de principes fournit aux cliniciens pédiatriques communautaires des recommandations, des outils et des ressources pour effectuer l’évaluation diagnostique du TSA ou y contribuer. Il contient également des conseils sur les consultations en vue d’une évaluation complète des besoins pour la planification des traitements et des interventions, selon une approche flexible et multiniveau.
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Affiliation(s)
- Jessica A Brian
- Société canadienne de pédiatrie, groupe de travail des directives sur le trouble du spectre de l’autisme, Ottawa (Ontario)
| | - Lonnie Zwaigenbaum
- Société canadienne de pédiatrie, groupe de travail des directives sur le trouble du spectre de l’autisme, Ottawa (Ontario)
| | - Angie Ip
- Société canadienne de pédiatrie, groupe de travail des directives sur le trouble du spectre de l’autisme, Ottawa (Ontario)
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Brian JA, Zwaigenbaum L, Ip A. Standards of diagnostic assessment for autism spectrum disorder. Paediatr Child Health 2019; 24:444-460. [PMID: 31660042 DOI: 10.1093/pch/pxz117] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/27/2019] [Indexed: 12/30/2022] Open
Abstract
The rising prevalence of autism spectrum disorder (ASD) has created a need to expand ASD diagnostic capacity by community-based paediatricians and other primary care providers. Although evidence suggests that some children can be definitively diagnosed by 2 years of age, many are not diagnosed until 4 to 5 years of age. Most clinical guidelines recommend multidisciplinary team involvement in the ASD diagnostic process. Although a maximal wait time of 3 to 6 months has been recommended by three recent ASD guidelines, the time from referral to a team-based ASD diagnostic evaluation commonly takes more than a year in many Canadian communities. More paediatric health care providers should be trained to diagnose less complex cases of ASD. This statement provides community-based paediatric clinicians with recommendations, tools, and resources to perform or assist in the diagnostic evaluation of ASD. It also offers guidance on referral for a comprehensive needs assessment both for treatment and intervention planning, using a flexible, multilevel approach.
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Affiliation(s)
- Jessica A Brian
- Canadian Paediatric Society, Autism Spectrum Disorder Guidelines Task Force, Ottawa, Ontario
| | - Lonnie Zwaigenbaum
- Canadian Paediatric Society, Autism Spectrum Disorder Guidelines Task Force, Ottawa, Ontario
| | - Angie Ip
- Canadian Paediatric Society, Autism Spectrum Disorder Guidelines Task Force, Ottawa, Ontario
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Leung RC, Pang EW, Brian JA, Taylor MJ. Happy and Angry Faces Elicit Atypical Neural Activation in Children With Autism Spectrum Disorder. Biol Psychiatry Cogn Neurosci Neuroimaging 2019; 4:1021-1030. [PMID: 31171500 DOI: 10.1016/j.bpsc.2019.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by significant impairments in social interactions and communication. The ability to accurately perceive and interpret emotional faces is critical to successful social interactions. However, few studies have investigated the spatiotemporal profile of the neural mechanisms underlying emotional face processing in ASD, particularly in children. The current study fills this important gap. METHODS Participants were 55 children: 28 children with ASD (mean age = 9.5 ± 1.3 years) and 27 control children (mean age = 8.5 ± 1.3 years). All children completed an implicit emotional face task while magnetoencephalography was recorded. We examined spatiotemporal differences between the groups in neural activation during implicit processing of emotional faces. RESULTS Within-group analyses demonstrated greater right middle temporal (300-375 ms) and superior temporal (300-400 ms) activation to angry faces than to happy faces in control children, while children with ASD showed greater activation from 250 to 500 ms to happy faces than to angry faces across frontal and temporal regions. Between-group analyses demonstrated that children with ASD showed similar patterns of late (425-500 ms) posterior cingulate and thalamic underactivity to both angry and happy faces relative to control children, suggesting general atypical processing of emotional information. CONCLUSIONS Atypical posterior cingulate cortex and thalamus recruitment in children with ASD to emotional faces suggests poor modulation of toggling between the default mode network and task-based processing. Increased neural activity to happy faces compared with angry faces in children with ASD suggests reduced salience or immature response to anger, which in turn could contribute to deficits in social cognition in ASD.
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Affiliation(s)
- Rachel C Leung
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychology, University of Toronto, Toronto, Ontario, Canada.
| | - Elizabeth W Pang
- Division of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada; Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Jessica A Brian
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Autism Research Centre, Bloorview Research Institute, Holland Bloorview Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Margot J Taylor
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada; Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychology, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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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: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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Brian JA, Smith IM, Zwaigenbaum L, Roberts W, Bryson SE. The Social ABCs caregiver-mediated intervention for toddlers with autism spectrum disorder: Feasibility, acceptability, and evidence of promise from a multisite study. Autism Res 2015; 9:899-912. [PMID: 26688077 PMCID: PMC5064621 DOI: 10.1002/aur.1582] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [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] [Received: 07/06/2015] [Accepted: 10/29/2015] [Indexed: 11/08/2022]
Abstract
The Social ABCs is a parent-mediated intervention for toddlers with suspected or confirmed autism spectrum disorder (ASD). We undertook a multi-site pilot study to evaluate feasibility and acceptability, and to identify trends in child and parent behavior to inform future research using a larger sample and a rigorous research design. The program involved 12 weeks of parent coaching, followed by 12 weeks' implementation, and 3-month follow-up assessment for 20 parent-toddler dyads (age range: 12-32 months). Parents successfully learned the techniques and rated the intervention as highly acceptable. Paired samples t-tests revealed significant gains in children's functional communication (responsivity, initiations), and language gains (age-equivalents on standardized measures) commensurate with typical developmental rates. Significant increases in shared smiling and social orienting also emerged, but were attenuated at follow-up. Parents' fidelity was positively associated with child responsivity. Training parents as mediators is a feasible and highly acceptable approach that provides a potentially cost-effective opportunity for intensive intervention at a very young age at the first signs of ASD risk. Child and parent gains in several key variables demonstrate the promise of this intervention. Autism Res 2016, 9: 899-912. © 2015 The Authors Autism Research published by Wiley Periodicals, Inc. on behalf of International Society for Autism Research.
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Affiliation(s)
- Jessica A Brian
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Isabel M Smith
- Departments of Pediatrics and Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Autism Research Centre, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Wendy Roberts
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Autism Research Unit, The Hospital for Sick Children, Toronto, Ontario, Canada.,Integrated Services for Autism and Neurodevelopmental Disorders, Toronto, Ontario, Canada
| | - Susan E Bryson
- Departments of Pediatrics and Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Autism Research Centre, IWK Health Centre, Halifax, Nova Scotia, Canada
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Leung RC, Pang EW, Cassel D, Brian JA, Smith ML, Taylor MJ. Early neural activation during facial affect processing in adolescents with Autism Spectrum Disorder. Neuroimage Clin 2014; 7:203-12. [PMID: 25610782 PMCID: PMC4300004 DOI: 10.1016/j.nicl.2014.11.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 10/24/2014] [Accepted: 11/14/2014] [Indexed: 01/01/2023]
Abstract
Impaired social interaction is one of the hallmarks of Autism Spectrum Disorder (ASD). Emotional faces are arguably the most critical visual social stimuli and the ability to perceive, recognize, and interpret emotions is central to social interaction and communication, and subsequently healthy social development. However, our understanding of the neural and cognitive mechanisms underlying emotional face processing in adolescents with ASD is limited. We recruited 48 adolescents, 24 with high functioning ASD and 24 typically developing controls. Participants completed an implicit emotional face processing task in the MEG. We examined spatiotemporal differences in neural activation between the groups during implicit angry and happy face processing. While there were no differences in response latencies between groups across emotions, adolescents with ASD had lower accuracy on the implicit emotional face processing task when the trials included angry faces. MEG data showed atypical neural activity in adolescents with ASD during angry and happy face processing, which included atypical activity in the insula, anterior and posterior cingulate and temporal and orbitofrontal regions. Our findings demonstrate differences in neural activity during happy and angry face processing between adolescents with and without ASD. These differences in activation in social cognitive regions may index the difficulties in face processing and in comprehension of social reward and punishment in the ASD group. Thus, our results suggest that atypical neural activation contributes to impaired affect processing, and thus social cognition, in adolescents with ASD. The ability to recognize and interpret emotions is central to social interaction. Deficits in social interactions are hallmarks of autism spectrum disorder (ASD). Adolescents with and without ASD completed an emotional face task in MEG. MEG data showed atypical neural activity in ASD to both angry and happy faces. Insula, cingulate, temporal and orbitofrontal activities were particularly affected in the ASD group.
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Affiliation(s)
- Rachel C Leung
- Diagnostic Imaging, Hospital for Sick Children, Canada ; University of Toronto, Canada
| | - Elizabeth W Pang
- University of Toronto, Canada ; Division of Neurology, Hospital for Sick Children, Canada ; Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Canada
| | - Daniel Cassel
- Diagnostic Imaging, Hospital for Sick Children, Canada
| | - Jessica A Brian
- Bloorview Research Institute, Holland Bloorview Rehabilitation Hospital, 150 Kilgour Road, Toronto, Canada ; Autism Research Unit, Hospital for Sick Children, Canada
| | - Mary Lou Smith
- University of Toronto, Canada ; Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Canada
| | - Margot J Taylor
- Diagnostic Imaging, Hospital for Sick Children, Canada ; University of Toronto, Canada ; Division of Neurology, Hospital for Sick Children, Canada ; Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Canada
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Dosman CF, Brian JA, Drmic IE, Senthilselvan A, Harford MM, Smith RW, Sharieff W, Zlotkin SH, Moldofsky H, Roberts SW. Children with autism: effect of iron supplementation on sleep and ferritin. Pediatr Neurol 2007; 36:152-8. [PMID: 17352947 DOI: 10.1016/j.pediatrneurol.2006.11.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Revised: 06/30/2006] [Accepted: 11/09/2006] [Indexed: 10/23/2022]
Abstract
To determine if there is a relationship between low serum ferritin and sleep disturbance in children with autism spectrum disorder, an 8-week open-label treatment trial with oral iron supplementation was conducted as a pilot study. At baseline and posttreatment visits, parents completed a Sleep Disturbance Scale for Children and a Food Record. Blood samples were obtained. Thirty-three children completed the study. Seventy-seven percent had restless sleep at baseline, which improved significantly with iron therapy, suggesting a relationship between sleep disturbance and iron deficiency in children with autism spectrum disorder. Sixty-nine percent of preschoolers and 35% of school-aged children had insufficient dietary iron intake. Mean ferritin increased significantly (16 microg/L to 29 microg/L), as did mean corpuscular volume and hemoglobin, suggesting that low ferritin in this patient group resulted from insufficient iron intake. Similar prevalence of low ferritin at school age as preschool age indicates that children with autism spectrum disorder require ongoing screening for iron deficiency.
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Affiliation(s)
- Cara F Dosman
- Developmental-Behavioral Pediatrics, Glenrose Rehabilitation Hospital, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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Dosman CF, Drmic IE, Brian JA, Senthilselvan A, Harford M, Smith R, Roberts SW. Ferritin as an indicator of suspected iron deficiency in children with autism spectrum disorder: prevalence of low serum ferritin concentration. Dev Med Child Neurol 2006; 48:1008-9. [PMID: 17109795 DOI: 10.1017/s0012162206232225] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Dosman CF, Drmic IE, Brian JA, Harford MM, Sharieff W, Smith R, Moldofsky H, Zlotkin S, Roberts W. 57 Response to Iron Supplementation in Children with Autism Spectrum Disorder. Paediatr Child Health 2004. [DOI: 10.1093/pch/9.suppl_a.36a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Brian JA, Tipper SP, Weaver B, Bryson SE. Inhibitory mechanisms in autism spectrum disorders: typical selective inhibition of location versus facilitated perceptual processing. J Child Psychol Psychiatry 2003; 44:552-60. [PMID: 12751847 DOI: 10.1111/1469-7610.00144] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study examined the inhibitory control mechanisms of selective attention in autism spectrum disorders. Two issues were engaged: First, we extend previous findings of normal inhibition of distractor identity in autism by examining whether inhibition of spatial location is also spared. The second issue concerns the selectivity of inhibition. In non-clinical participants inhibition is selectively directed to the properties of the distractor that compete for the control of action; we examined whether individuals with autism also show normal selectivity of inhibition. METHOD A negative priming task was used to examine selective spatial inhibition in participants with autism relative to matched non-clinical controls. RESULTS We discovered that inhibition of distractor spatial location is within normal limits in autism, as is the ability to selectively direct inhibition to task-relevant stimulus features. In addition, we unexpectedly found that the irrelevant perceptual feature of colour produced a facilitation effect in autism, which has not been observed previously in typical controls. CONCLUSIONS Evidence of colour facilitation implicates more fluent, but presumably less adaptive, perceptual processes in autism.
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Affiliation(s)
- J A Brian
- Autism Research Unit, Hospital for Sick Children, Toronto, Canada.
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Brian JA, Landry R, Szatmari P, Niccols A, Bryson S. Habituation in high-risk infants: reliability and patterns of responding. Inf Child Develop 2003. [DOI: 10.1002/icd.327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
This study explored the claim that superior disembedding performance in autism reflects "less capture by meaning" and/or reduced "central coherence" [Shah & Frith, Journal of Child Psychology & Psychiatry, 24, 613-620 (1983); Shah & Frith, Journal of Child Psychology & Psychiatry, 34, 1351-1364 (1993)]. Meaningless as well as meaningful disembedding contexts were used, and memory for contextual information was examined. Neither qualitative (search strategy) nor quantitative (RT or accuracy) data indicated that high-functioning individuals with autism/PDD were superior to younger, developmentally matched controls. For both groups, disembedding was slowest from meaningful contexts, which generally were remembered best. No evidence was provided for "less capture by meaning" or reduced "central coherence" in autism/PDD, raising the possibility that earlier findings reflect a developmental, rather than a stable autism-specific, phenomenon.
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Affiliation(s)
- J A Brian
- Dept of Psychology, York University, North York, Ontario, Canada
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26
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Barr RG, Quek VS, Cousineau D, Oberlander TF, Brian JA, Young SN. Effects of intra-oral sucrose on crying, mouthing and hand-mouth contact in newborn and six-week-old infants. Dev Med Child Neurol 1994; 36:608-18. [PMID: 8034123 DOI: 10.1111/j.1469-8749.1994.tb11898.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To determine whether a single intra-oral administration of sucrose would calm infants and elicit mouthing and hand-mouth contact, crying newborn and six-week-old infants were given sucrose solution before one feed and sterile water before another in a cross-over trial. Six-week-old infants were also given sucrose and water after feeding. For the newborn infants, the calming effect was rapid, substantial and lasted for at least four minutes. Mouthing and hand-mouth contact increased, but for shorter durations. For the six-week-old infants, sucrose calmed for one minute only before feeding, but had no effects on mouthing or hand-mouth contact. The results imply that intra-oral sucrose has acute age-related effects on crying and suckling-feeding behaviour mediated by a pre-absorptive mechanism. Sucrose may tap a functional system for reducing distress related to feeding and/or regulation of infant state.
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Affiliation(s)
- R G Barr
- Department of Pediatrics, McGill University, Montreal, Canada
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27
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Oberlander TF, Barr RG, Young SN, Brian JA. Short-term effects of feed composition on sleeping and crying in newborns. Pediatrics 1992; 90:733-40. [PMID: 1408546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
To determine whether the composition of feedings would affect newborn behavior independently of the act of feeding itself, 53 two- to three-day-old normal newborns were randomly assigned to receive an extra feeding of water, carbohydrate (lactose), or balanced formula 3 hours after their usual early morning feeding. Previous studies in adult humans and animals, and a single study in human newborns, have indicated that more sleep might be expected following the carbohydrate feed compared with the water and balanced-formula feeds because of recruitment of centrally mediated serotonergic systems. Behavioral effects were assessed for 40 minutes postfeeding by direct observation of the newborn's states (quiet, active, and indeterminate sleep; drowsiness; non-cry wakefulness; and fret/cry). Feed composition did affect behavior, and the effects were fairly specific to particular newborn states. Non-cry wakefulness and drowsiness were unrelated to the presence or type of nutrients, but they tended to occur soon after the meal in all groups. Crying was increased in water-fed newborns relative to both carbohydrate- and formula-fed newborns. Sleeping showed specific patterns of change in all three groups. Sleep duration was increased in the balanced-formula group compared with the water group throughout the observation period. Contrary to the prediction, sleeping duration in carbohydrate-fed newborns never exceeded that of formula-fed newborns; rather, it resembled that of water-fed newborns early in the postprandial period, but formula-fed newborns later. These effects could not easily be explained by potential confounding factors such as handling, volume ingested, caloric intake, or plasma glucose concentration.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- T F Oberlander
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
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