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Chetcuti L, Varcin KJ, Boutrus M, Smith J, Bent CA, Whitehouse AJO, Hudry K. Feasibility of a 2-minute eye-tracking protocol to support the early identification of autism. Sci Rep 2024; 14:5117. [PMID: 38429348 PMCID: PMC10907367 DOI: 10.1038/s41598-024-55643-z] [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: 09/14/2022] [Accepted: 02/26/2024] [Indexed: 03/03/2024] Open
Abstract
We tested the potential for Gazefinder eye-tracking to support early autism identification, including feasible use with infants, and preliminary concurrent validity of trial-level gaze data against clinical assessment scores. We embedded the ~ 2-min 'Scene 1S4' protocol within a comprehensive clinical assessment for 54 consecutively-referred, clinically-indicated infants (prematurity-corrected age 9-14 months). Alongside % tracking rate as a broad indicator of feasible assessment/data capture, we report infant gaze data to pre-specified regions of interest (ROI) across four trial types and associations with scores on established clinical/behavioural tools. Most infants tolerated Gazefinder eye-tracking well, returning high overall % tracking rate. As a group, infants directed more gaze towards social vs. non-social (or more vs. less socially-salient) ROIs within trials. Behavioural autism features were correlated with increased gaze towards non-social/geometry (vs. social/people) scenes. No associations were found for gaze directed to ROIs within other stimulus types. Notably, there were no associations between developmental/cognitive ability or adaptive behaviour with gaze towards any ROI. Gazefinder assessment seems highly feasible with clinically-indicated infants, and the people vs. geometry stimuli show concurrent predictive validity for behavioural autism features. Aggregating data across the ~ 2-min autism identification protocol might plausibly offer greater utility than stimulus-level analysis alone.
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Affiliation(s)
- Lacey Chetcuti
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Kandice J Varcin
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Maryam Boutrus
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Jodie Smith
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Catherine A Bent
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | | | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.
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O'Connor E, Grant M, Green CC, Treyvaud K, Hudry K. Prospective Association of Parenting Stress with Later Child Behavior Problems in Early Childhood Autism. J Autism Dev Disord 2023:10.1007/s10803-023-06177-2. [PMID: 38060104 DOI: 10.1007/s10803-023-06177-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE Autistic children are reported to display higher levels of externalizing and internalizing behaviors than neurotypical children, and their parents report more stress than parents of neurotypical children. It is unclear whether child behavior difficulties contribute to increased parenting stress, whether parenting stress contributes to child behavior difficulties, or whether the relationship may be bidirectional. METHODS We investigated prospective bidirectional associations between parenting stress and child externalizing and internalizing behaviors when autistic children were aged on average 3.5, 4.5, and 5.5 years. Data collected at these three timepoints were examined across two panels: Time 1 to Time 2 (n = 38 parent-child dyads) and Time 2 to Time 3 (n = 27 dyads). RESULTS Across Time 1 to Time 2, early parenting stress was significantly associated with later child externalizing behavior, and cross-lagged panel analysis supported a uni- rather than a bidirectional association between these factors. There was some evidence of a bidirectional association between parenting stress and child internalizing behavior, though this was non-significant when the strong stability of child internalizing behavior was statistically controlled. In contrast, across Time 2 to Time 3, there were no significant prospective associations found between variables, highlighting the importance of considering the impact of parenting stress early in the course of childhood autism. CONCLUSION Our results add to research indicating that support targeting parent characteristics, especially parenting stress, could ameliorate subsequent outcomes for both parents and children.
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Affiliation(s)
- Erin O'Connor
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Megan Grant
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Cherie C Green
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Karli Treyvaud
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Smith J, Sulek R, Van Der Wert K, Cincotta-Lee O, Green CC, Bent CA, Chetcuti L, Hudry K. Parental Imitations and Expansions of Child Language Predict Later Language Outcomes of Autistic Preschoolers. J Autism Dev Disord 2023; 53:4107-4120. [PMID: 35976507 PMCID: PMC9382601 DOI: 10.1007/s10803-022-05706-9] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/26/2022]
Abstract
Both the amount and responsiveness of adult language input contribute to the language development of autistic and non-autistic children. From parent-child interaction footage, we measured the amount of adult language input, overall parent responsiveness, and six discrete parent responsive behaviours (imitations, expansions, open-ended questions, yes/no questions, comments and acknowledgements) to explore which types of responsiveness predicted autistic preschoolers' language five months later, after controlling for adult language input. We found expansions and particularly imitations to be more important for later language than overall responsiveness. This study emphasises the need to capture what exactly about parent language input influences child language acquisition, and adds to the evidence that imitating and expanding early language might be particularly beneficial for autistic preschoolers.
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Affiliation(s)
- Jodie Smith
- School of Allied Health, Human Services and Sport, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia.
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia.
| | - Rhylee Sulek
- School of Allied Health Sciences, Griffith University, Parklands Drive, Southport, QLD, 4222, Australia
| | - Kailia Van Der Wert
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia
| | - Olivia Cincotta-Lee
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia
| | - Cherie C Green
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia
| | - Catherine A Bent
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia
| | - Lacey Chetcuti
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia
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Loncarevic A, Maybery MT, Barbaro J, Dissanayake C, Green J, Hudry K, Iacono T, Slonims V, Varcin KJ, Wan MW, Wray J, Whitehouse AJO. Parent-Child Interactions May Help to Explain Relations Between Parent Characteristics and Clinically Observed Child Autistic Behaviours. J Autism Dev Disord 2023:10.1007/s10803-023-05914-x. [PMID: 37209200 DOI: 10.1007/s10803-023-05914-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] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 05/22/2023]
Abstract
The importance of supporting parent-child interactions has been noted in the context of prodromal autism, but little consideration has been given to the possible contributing role of parental characteristics, such as psychological distress. This cross-sectional study tested models in which parent-child interaction variables mediated relations between parent characteristics and child autistic behaviour in a sample of families whose infant demonstrated early signs of autism (N = 103). The findings suggest that associations between parent characteristics (psychological distress; aloofness) and child autistic behaviours may be mediated by the child's inattentiveness or negative affect during interactions. These findings have important implications in developing and implementing interventions in infancy which target the synchrony of parent-child interaction with the goal to support children's social communication development.
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Affiliation(s)
- Antonina Loncarevic
- CliniKids, Telethon Kids Institute, Nedlands, WA, Australia.
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia.
| | - Murray T Maybery
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Josephine Barbaro
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, QLD, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Cheryl Dissanayake
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, QLD, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Kristelle Hudry
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, QLD, Australia
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Teresa Iacono
- Living with Disability Research Centre, College of Science, Health, and Engineering, Victoria, Australia
| | - Vicky Slonims
- Children's Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, Evelina London Children's Hospital, Kings College London, London, UK
| | - Kandice J Varcin
- CliniKids, Telethon Kids Institute, Nedlands, WA, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Brisbane, QLD, Australia
| | - Ming Wai Wan
- Perinatal Mental Health and Parenting Research Unit, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - John Wray
- Child and Adolescent Health Service, Child Development Service, West Perth, WA, Australia
| | - Andrew J O Whitehouse
- CliniKids, Telethon Kids Institute, Nedlands, WA, Australia
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, QLD, Australia
- University of Western Australia, Crawley, WA, Australia
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Bent C, Glencross S, McKinnon K, Hudry K, Dissanayake C, Vivanti G. Predictors of Developmental and Adaptive Behaviour Outcomes in Response to Early Intensive Behavioural Intervention and the Early Start Denver Model. J Autism Dev Disord 2023:10.1007/s10803-023-05993-w. [PMID: 37171764 DOI: 10.1007/s10803-023-05993-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/13/2023]
Abstract
Many autistic children require support to meet their learning needs. Given the heterogeneity within the autism spectrum it is plausible that different types of support might be better suited to different children. However, knowledge on what interventions work best for which children is limited. We examined the outcomes of autistic preschool-aged children receiving one of two community early intervention approaches. Our main objective was to understand which baseline child characteristics might be associated with the degree of individual response to intervention-whether prognostically (i.e., irrespective of intervention received) or predictively (i.e., specifically in the context of one or other EI approach). Participants comprised two matched groups of preschool-aged autistic children receiving either Group-based Early Start Denver Model (G-ESDM; n = 42) delivered in a 1:3-4 staff:child ratio or an Early Intensive Behavioural Intervention (EIBI; n = 40) delivered in combination of 1:1 and 1:2 staff:child ratio. Over an approximate one-year follow-up period, children in both groups made significant gains in Developmental Quotient (DQ) scores, and trend-level gains in adaptive behaviour composite scores. Higher attention to a playful adult measured via an eye-tracking task was prognostically indicative of better verbal DQ and adaptive behaviour outcomes for the cohort overall. Moderation analyses indicated a single predictive effect-of pre-program sustained attention for subsequent NVDQ outcomes specific to those children receiving G-ESDM. These findings suggest that fine-grained measures of learning skills offer promise towards the selection and tailoring of intervention approaches to meet individual children's learning needs.
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Affiliation(s)
- Catherine Bent
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | | | | | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Giacomo Vivanti
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, USA
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Berends D, Bent CA, Vivanti G, Dissanayake C, Hudry K. Developmental Skills Moderate the Association Between Core Autism Features and Adaptive Behaviour in Early Childhood. J Autism Dev Disord 2023:10.1007/s10803-023-05932-9. [PMID: 37142900 DOI: 10.1007/s10803-023-05932-9] [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] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE While research indicates that both the core features of autism and associated developmental skills influence adaptive behaviour outcomes, results to date suggest greater influence of the latter than the former, and little attention has been given to how the interaction of both together might impact functional disability. Seeking to expand understanding of associations between young children's core social autism features, developmental skills, and functional ability/disability, we specifically tested whether early developmental skills might have a moderating effect on the association between early social features and subsequent functional disability. METHODS Data from 162 preschool children were available for this study. These included time-1 measures of social autism features (ADOS-Social Affect score) and developmental skills (MSEL-Developmental Quotient; DQ), and a measure of functional ability/disability (VABS-Adaptive Behaviour Composite; ABC) available at follow-up 1-year later (time-2). RESULTS Time-1 ADOS-SA and MSEL-DQ scores were concurrently associated with one another, and both prospectively associated with time-2 VABS-ABC scores. Examination of partial correlations (i.e., controlling for MSEL-DQ) demonstrated that the association of time-1 ADOS-SA and time-2 VABS-ABC was accounted for by shared variance with DQ. Formal moderation analysis returned a non-significant overall interaction term, but showed a lower-bound region of significance whereby the association of time-1 ADOS-SA with time-2 VABS-ABC was significant for children with baseline DQ ≤ 48.33. CONCLUSION Our results add to a body of empirical evidence consistent with an understanding of the needs of and resources available to autistic people through a 'cognitive compensation' lens.
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Affiliation(s)
- Daniel Berends
- Department of Psychology Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Catherine A Bent
- Department of Psychology Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Giacomo Vivanti
- A.J.Drexel Autism Institute, Drexel University, Philadelphia, USA
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Kristelle Hudry
- Department of Psychology Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Segal L, Green J, Twizeyemariya A, Hudry K, Wan MW, Barbaro J, Iacono T, Varcin KJ, Pillar S, Cooper MN, Billingham W, Upson G, Whitehouse AJO. Estimated Therapy Costs and Downstream Cost Consequences of iBASIS-Video Interaction to Promote Positive Parenting Intervention vs Usual Care Among Children Displaying Early Behavioral Signs of Autism in Australia. JAMA Netw Open 2023; 6:e235847. [PMID: 37017966 PMCID: PMC10077097 DOI: 10.1001/jamanetworkopen.2023.5847] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/07/2023] [Indexed: 04/06/2023] Open
Abstract
Importance The growing global prevalence of autism spectrum disorder (ASD) is associated with increasing costs for support services. Ascertaining the effects of a successful preemptive intervention for infants showing early behavioral signs of autism on human services budgets is highly policy relevant. Objective To estimate the net cost impact of the iBASIS-Video Interaction to Promote Positive Parenting (iBASIS-VIPP) intervention on the Australian government. Design, Setting, and Participants Infants (aged 12 months) showing early behavioral indicators of autism were recruited through community settings into the multicenter Australian iBASIS-VIPP randomized clinical trial (RCT), a 5- to 6-month preemptive parent-mediated intervention, between June 9, 2016, and March 30, 2018, and were followed up for 18 months to age 3 years. This economic evaluation, including cost analysis (intervention and cost consequences) and cost-effectiveness analyses of iBASIS-VIPP compared with usual care (treatment as usual [TAU]), modeled outcomes observed at age 3 through to 12 years (13th birthday) and was conducted from April 1, 2021, to January 30, 2023. Data analysis was conducted from July 1, 2021, to January 29, 2023. Exposures iBASIS-VIPP intervention. Main Outcomes and Measures To project the diagnostic trajectory and associated disability support costs drawing on the Australian National Disability Insurance Scheme (NDIS), the main outcome was the differential treatment cost of iBASIS-VIPP plus TAU vs TAU and disability-related government costs modeled to age 12 years, using a clinical diagnosis of ASD and developmental delay (with autism traits) at 3 years. Costs were calculated in Australian dollars and converted to US dollars. Economic performance was measured through the following: (1) differential net present value (NPV) cost (iBASIS-VIPP less TAU), (2) investment return (dollars saved for each dollar invested, taking a third-party payer perspective), (3) break-even age when treatment cost was offset by downstream cost savings, and (4) cost-effectiveness in terms of the differential treatment cost per differential ASD diagnosis at age 3 years. Alternate values of key parameters were modeled in 1-way and probabilistic sensitivity analysis, the latter identifying the likelihood of an NPV cost savings. Results Of the 103 infants enrolled in the iBASIS-VIPP RCT, 70 (68.0%) were boys. Follow-up data at age 3 years were available for 89 children who received TAU (44 [49.4%]) or iBASIS-VIPP (45 [50.6%]) and were included in this analysis. The estimated mean differential treatment cost was A $5131 (US $3607) per child for iBASIS-VIPP less TAU. The best estimate of NPV cost savings was A $10 695 (US $7519) per child (discounted at 3% per annum). For each dollar invested in treatment, a savings of A $3.08 (US $3.08) was estimated; the break-even cost occurred at age 5.3 years (approximately 4 years after intervention delivery). The mean differential treatment cost per lower incident case of ASD was A $37 181 (US $26 138). We estimated that there was an 88.9% chance that iBASIS-VIPP would deliver a cost savings for the NDIS, the dominant third-party payer. Conclusions and Relevance The results of this study suggest that iBASIS-VIPP represents a likely good-value societal investment for supporting neurodivergent children. The estimated net cost savings were considered conservative, as they covered only third-party payer costs incurred by the NDIS and outcomes were modeled to just age 12 years. These findings further suggest that preemptive interventions may be a feasible, effective, and efficient new clinical pathway for ASD, reducing disability and the costs of support services. Long-term follow-up of children receiving preemptive intervention is needed to confirm the modeled results.
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Affiliation(s)
- Leonie Segal
- Health Economics and Social Policy Group, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Asterie Twizeyemariya
- Health Economics and Social Policy Group, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Ming Wai Wan
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Teresa Iacono
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Kandice J. Varcin
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Sarah Pillar
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Matthew N. Cooper
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Wesley Billingham
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Gemma Upson
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
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Hudry K, Smith J, Pillar S, Varcin KJ, Bent CA, Boutrus M, Chetcuti L, Clark A, Dissanayake C, Iacono T, Kennedy L, Lant A, Robinson Lake J, Segal L, Slonims V, Taylor C, Wan MW, Green J, Whitehouse AJO. The Utility of Natural Language Samples for Assessing Communication and Language in Infants Referred with Early Signs of Autism. Res Child Adolesc Psychopathol 2023; 51:529-539. [PMID: 36602626 DOI: 10.1007/s10802-022-01010-3] [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] [Accepted: 12/15/2022] [Indexed: 01/06/2023]
Abstract
Natural Language Sampling (NLS) offers clear potential for communication and language assessment, where other data might be difficult to interpret. We leveraged existing primary data for 18-month-olds showing early signs of autism, to examine the reliability and concurrent construct validity of NLS-derived measures coded from video-of child language, parent linguistic input, and dyadic balance of communicative interaction-against standardised assessment scores. Using Systematic Analysis of Language Transcripts (SALT) software and coding conventions, masked coders achieved good-to-excellent inter-rater agreement across all measures. Associations across concurrent measures of analogous constructs suggested strong validity of NLS applied to 6-min video clips. NLS offers benefits of feasibility and adaptability for validly quantifying emerging skills, and potential for standardisation for clinical use and rigorous research design.
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Affiliation(s)
- Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Jodie Smith
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Sarah Pillar
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
| | - Kandice J Varcin
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Catherine A Bent
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Maryam Boutrus
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
- Cooperative Research Centre for Living With Autism, Brisbane, QLD, 4068, Australia
| | - Lacey Chetcuti
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
- Cooperative Research Centre for Living With Autism, Brisbane, QLD, 4068, Australia
| | - Alena Clark
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Teresa Iacono
- Living with Disability Research Centre, La Trobe University, Bendigo, VIC, 3550, Australia
| | - Lyndel Kennedy
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Alicia Lant
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
| | - Jemima Robinson Lake
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
| | - Leonie Segal
- Australian Centre for Precision Health Sciences, School of Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Vicky Slonims
- Children's Neurosciences, Evelina London Children's Hospital, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, SE5 8AF, UK
| | - Carol Taylor
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, M13 PL9, UK
| | - Ming Wai Wan
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, M13 PL9, UK
| | - Jonathan Green
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, M13 PL9, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - Andrew J O Whitehouse
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
- Cooperative Research Centre for Living With Autism, Brisbane, QLD, 4068, Australia
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Chetcuti L, Uljarević M, Varcin KJ, Boutrus M, Dimov S, Pillar S, Barbaro J, Dissanayake C, Green J, Whitehouse AJO, Hudry K. Continuity of temperament subgroup classifications from infancy to toddlerhood in the context of early autism traits. Autism Res 2023; 16:591-604. [PMID: 36511365 DOI: 10.1002/aur.2874] [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] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
Our previous cross-sectional investigation (Chetcuti et al., 2020) showed that infants with autism traits could be divided into distinct subgroups based on temperament. This longitudinal study builds on this existing work by exploring the continuity of temperament subgroup classifications and their associations with behavioral/clinical phenotypic features from infancy to toddlerhood. 103 infants (68% male) showing early signs of autism were referred to the study by community healthcare professionals and seen for assessments when aged around 12-months (Time 1), 18-months (Time 2), and 24-months (Time 3). Latent profile analysis revealed inhibited/low positive, active/negative reactive, and sociable/well-regulated subgroups at each timepoint, and a unique reactive/regulated subgroup at Time 3. Cross-tabulations indicated a significant likelihood of children having a recurrent subgroup classification from one timepoint to the next, and no apparent patterns to the movement of children who did change from one subgroup to another over time. Temperament subgroups were associated with concurrent child social-emotional functioning and autism traits, but unrelated to child age, sex, or developmental level. These findings suggest that temperament subgroup classifications might represent a reliable and very early indicator of autism characteristics and social-emotional functioning among infants/toddlers with autism traits.
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Affiliation(s)
- Lacey Chetcuti
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia
| | - Mirko Uljarević
- Stanford Autism Center, Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, School of Medicine, Stanford University, Palo Alto, USA.,Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kandice J Varcin
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia.,Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Maryam Boutrus
- Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia.,Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Stefanie Dimov
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Sarah Pillar
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Josephine Barbaro
- Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia.,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Cheryl Dissanayake
- Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia.,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, The University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Andrew J O Whitehouse
- Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia.,Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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10
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Trembath D, Varcin K, Waddington H, Sulek R, Bent C, Ashburner J, Eapen V, Goodall E, Hudry K, Roberts J, Silove N, Whitehouse A. Non-pharmacological interventions for autistic children: An umbrella review. Autism 2023; 27:275-295. [PMID: 36081343 DOI: 10.1177/13623613221119368] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 02/02/2023]
Abstract
LAY ABSTRACT What is already known about the topic?The delivery of evidence-based interventions is an important part of the clinical pathway for many autistic children and their families. However, parents, practitioners, and policymakers face challenges making evidence informed decisions, due to the wide variety of interventions available and the large, and often inconsistent, body of evidence regarding their effectiveness.What this paper adds?This is a comprehensive umbrella review, also known as a 'review of reviews', which examined the range of interventions available, the evidence for their effectiveness, and whether effects were influenced by factors relating to individual children (e.g. chronological age, core autism characteristics, and related skills) or the ways interventions were delivered (by whom and in what setting, format, mode, and amount). There was evidence for positive therapeutic effects for some, but not all, interventions. No single intervention had a positive effect for all child and family outcomes of interest. The influence of child and delivery characteristics on effects was unclear.Implications for practice, research, and policyThe findings provide parents, practitioners, and policymakers with a synthesis of the research evidence to inform decision-making and highlight the importance of individualised approaches in the absence of clear and consistent evidence. The findings also highlight the need to improve consistency and completeness in reporting of research studies, so that the same questions may be answered more comprehensively in the future.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Andrew Whitehouse
- Telethon Kids Institute and The University of Western Australia, Australia
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11
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Smith J, Chetcuti L, Kennedy L, Varcin KJ, Slonims V, Bent CA, Green J, Iacono T, Pillar S, Taylor C, Wan MW, Whitehouse AJO, Hudry K. Caregiver sensitivity predicts infant language use, and infant language complexity predicts caregiver language complexity, in the context of possible emerging autism. Autism Res 2022; 16:745-756. [PMID: 36563289 DOI: 10.1002/aur.2879] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
While theory supports bidirectional effects between caregiver sensitivity and language use, and infant language acquisition-both caregiver-to-infant and also infant-to-caregiver effects-empirical research has chiefly explored the former unidirectional path. In the context of infants showing early signs of autism, we investigated prospective bidirectional associations with 6-min free-play interaction samples collected for 103 caregivers and their infants (mean age 12-months; and followed up 6-months later). We anticipated that measures of caregiver sensitivity/language input and infant language would show within-domain temporal stability/continuity, but also that there would be predictive associations from earlier caregiver input to subsequent child language, and vice versa. Caregiver sensitive responsiveness (from the Manchester Assessment of Caregiver-Infant interaction [MACI]) predicted subsequent infant word tokens (i.e., amount of language, coded following the Systematic Analysis of Language Transcripts [SALT]). Further, earlier infant Mean Length of Utterance (MLU; reflecting language complexity, also derived from SALT coding) predicted later caregiver MLU, even when controlling for variability in infant ages and clear within-domain temporal stability/continuity in key measures (i.e., caregiver sensitive responsiveness and infant word tokens; and infant and caregiver MLU). These data add empirical support to theorization on how caregiver input can be both supportive of, and potentially influenced by, infant capacities, when infants have social-communication differences and/or communication/language delays suggestive of possible emerging autism.
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Affiliation(s)
- Jodie Smith
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Lacey Chetcuti
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Lyndel Kennedy
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kandice J Varcin
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Vicky Slonims
- Children's Neurosciences, Evelina London Children's Hospital, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Catherine A Bent
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Jonathan Green
- School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Teresa Iacono
- Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Sarah Pillar
- School of Biological Sciences, University of Manchester, Manchester, UK
| | - Carol Taylor
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Ming Wai Wan
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Andrew J O Whitehouse
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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Bent CA, Pellicano E, Iacono T, Hudry K. Perspectives from parents of autistic children on participating in early intervention and associated research. Autism 2022:13623613221141540. [PMID: 36510841 DOI: 10.1177/13623613221141540] [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] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
LAY ABSTRACT Support for autistic children early in life should help them to lead flourishing lives. However, many of the early intervention programmes for young autistic children are time-consuming and costly for families. These programmes are also often conducted in settings that are not closely matched to real life. We spoke to 23 parents (of 22 autistic children) to understand their experiences of their children's involvement in early intervention. Parents told us they were grateful for the opportunity, that they had 'hit the jackpot', and their children had 'gained so much' from the programme. They seemed to value the service because it made them feel safe and secure during an uncertain time in their children's lives. Parents told us they trusted staff, felt that they weren't 'doing it alone', and this 'took that pressure off' and helped them feel empowered. They also spoke of feelings of safety from being linked to the university research programme which offered 'accountability' and 'integrity'. Parents' comments showed a strong commitment to the early intervention model and staff - but also common feelings of abandonment and disempowerment as their child's time with the programme came to an end and they went 'back to the real world' and needed to find new supports for their children. These parents' insights should help to inform the design and delivery of community supports for preschool-aged autistic children and their families, which match the reality of their lived experiences.
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13
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Vivanti G, Bent C, Capes K, Upson S, Hudry K, Dissanayake C. Characteristics of children on the autism spectrum who benefit the most from receiving intervention in inclusive versus specialised early childhood education settings. Autism Res 2022; 15:2200-2209. [PMID: 36416303 PMCID: PMC9826059 DOI: 10.1002/aur.2815] [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: 02/21/2022] [Accepted: 09/01/2022] [Indexed: 01/11/2023]
Abstract
This study examined the factors associated with social-communicative outcomes for children on the autism spectrum receiving early intervention in inclusive versus specialised early childhood education programmes. Fifty-eight preschool-aged children randomly assigned to receive the Group-Early Start Denver Model (G-ESDM) in either inclusive or specialised (i.e., autism-specific) classrooms across one calendar year showed similar outcomes at group mean-level across measures of communication and social behaviour. We examined factors moderating outcomes across settings. Novel moderation analyses revealed that higher baseline social interest and nonverbal cognitive skills were associated with increased social communication gains for children in the inclusive classrooms, but not for those in specialised settings. Children who spend more time paying attention to people and have higher cognitive skills might benefit from receiving early intervention in inclusive settings, whilst these factors might be less relevant for children educated in specialised settings.
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Affiliation(s)
- Giacomo Vivanti
- A.J. Drexel Autism InstituteDrexel UniversityPhiladelphiaPennsylvaniaUSA,Olga Tennison Autism Research Centre, School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
| | - Catherine Bent
- Department of Psychology, Counselling & Therapy, School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
| | - Kristy Capes
- Victorian Autism Specific Early Learning and Care CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Shannon Upson
- Victorian Autism Specific Early Learning and Care CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Kristelle Hudry
- Department of Psychology, Counselling & Therapy, School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
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McGowan K, Berends D, Hudry K, Vivanti G, Dissanayake C, Bent CA. Brief report: bidirectional association of core autism features and cognitive abilities in early childhood. J Autism Dev Disord 2022:10.1007/s10803-022-05618-8. [PMID: 35917020 DOI: 10.1007/s10803-022-05618-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 11/29/2022]
Abstract
We explored associations among the core behavioural features and developmental/cognitive abilities of 155 autistic children, assessed between ages 13-67 months and again around 1-year later to understand predictive directionality. Bidirectional, cross-domain association was apparent, albeit with stronger direction of effect from earlier cognition to later autism features (than vice versa). Exploratory sub-domain analysis showed that early non-verbal developmental/cognitive abilities (only) predicted subsequent social- and restricted/repetitive autism features, whereas early social features (only) predicted both subsequent verbal and non-verbal abilities. Although observational study design precludes causal inference, these data support contemporary notions of the developmental interconnectedness of core autism presentation and associated abilities-that behavioural autism features may influence cognitive development, but are likely also influenced by an individuals' cognitive capacity.
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Affiliation(s)
- Kelsie McGowan
- Department of Psychology Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Daniel Berends
- Department of Psychology Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Kristelle Hudry
- Department of Psychology Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
- , Melbourne, Australia.
| | - Giacomo Vivanti
- A.J.Drexel Autism Institute, Drexel University, Philadelphia, USA
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Catherine A Bent
- Department of Psychology Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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15
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Sulek R, Smith J, Bent CA, Hudry K, Trembath D, Vivanti G, Dissanayake C. The utility of LENA as an indicator of developmental outcomes for young children with autism. Int J Lang Commun Disord 2022; 57:103-111. [PMID: 34676948 DOI: 10.1111/1460-6984.12678] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND There is growing understanding of the potential benefits of a multi-method approach to accurately capture language skills of children on the autism spectrum. Tools such as Language ENvironment Analysis (LENA) provide an efficient means of capturing and analysing early child vocalizations (CVs) and the language learning environment. While developed to capture whole-day recordings of child language in naturalistic settings, there is potential utility in capturing, but little knowledge about, primary LENA metrics-including CVs and conversational turns (CTs)-and novel metrics, such as vocalization ratios (VRs), sampled in clinical practice settings where children are often seen. Moreover, recent research indicates that the novel VR may offer a broad indicator of children's developmental level, beyond just their language abilities, a hypothesis yet to be investigated in a large sample of children for whom the LENA was designed (i.e., pre-schoolers). AIMS To explore the extent to which primary and novel LENA metrics collected during brief one-to-one clinical interaction was a useful indicator of developmental outcomes for children on the autism spectrum. METHODS & PROCEDURES Participants were recruited as part of an on-going research programme evaluating early intervention outcomes (n = 99; age 14-47 months). Language samples were collected at intake (T1) using the wearable LENA Digital Language Processors during a one-to-one, play-based assessment with a clinician. Direct (Mullen Scales of Early Learning-MSEL) and parent-report (Vineland Adaptive Behavior Scales-VABS) measures of verbal and non-verbal skills were also collected at intake (T1) and again at exit (T2), approximately 12 months later. OUTCOMES & RESULTS Few correlations were observed between child measures and CVs, a primary LENA metric. The novel VR metric was associated with concurrent direct assessment (MSEL) (and to a lesser extent parent report; VABS) measures of verbal and non-verbal skills, with moderate positive correlations found between VRs and all directly assessed subscale scores. However, VRs did not uniquely contribute to the prediction of child outcomes when baseline skills were also considered. CONCLUSIONS & IMPLICATIONS The novel VR may provide an insight into autistic children's overall development in addition to their language ability, suggesting that even when collected in a short recording format, LENA might be a useful component of a multi-method assessment approach. WHAT THIS PAPER ADDS What is already known on the subject To accurately capture language skills of children on the autism spectrum, multi-method approaches, including natural language sampling, are recommended. Tools such as LENA provide an efficient means of capturing and analysing naturalistic child language and the language learning environment. What this paper adds to existing knowledge This study demonstrates the potential benefits, and limitations, of using LENA to augment assessment of young children on the autism spectrum. Specifically, LENA provides a complementary, and low burden, method for capturing child language samples. What are the potential or actual clinical implications of this work? Novel metrics, such as the VR, collected during brief clinical interactions might be a useful component of a multi-method assessment approach for children on the autism spectrum.
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Affiliation(s)
- Rhylee Sulek
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- Menzies Health Institute Queensland, School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
| | - Jodie Smith
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Catherine Anne Bent
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Kristelle Hudry
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - David Trembath
- Menzies Health Institute Queensland, School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
| | - Giacomo Vivanti
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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Whitehouse AJO, Varcin KJ, Pillar S, Billingham W, Alvares GA, Barbaro J, Bent CA, Blenkley D, Boutrus M, Chee A, Chetcuti L, Clark A, Davidson E, Dimov S, Dissanayake C, Doyle J, Grant M, Green CC, Harrap M, Iacono T, Matys L, Maybery M, Pope DF, Renton M, Rowbottam C, Sadka N, Segal L, Slonims V, Smith J, Taylor C, Wakeling S, Wan MW, Wray J, Cooper MN, Green J, Hudry K. Effect of Preemptive Intervention on Developmental Outcomes Among Infants Showing Early Signs of Autism: A Randomized Clinical Trial of Outcomes to Diagnosis. JAMA Pediatr 2021; 175:e213298. [PMID: 34542577 PMCID: PMC8453361 DOI: 10.1001/jamapediatrics.2021.3298] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Intervention for individuals with autism spectrum disorder (ASD) typically commences after diagnosis. No trial of an intervention administered to infants before diagnosis has shown an effect on diagnostic outcomes to date. OBJECTIVE To determine the efficacy of a preemptive intervention for ASD beginning during the prodromal period. DESIGN, SETTING, AND PARTICIPANTS This 2-site, single rater-blinded randomized clinical trial of a preemptive intervention vs usual care was conducted at 2 Australian research centers (Perth, Melbourne). Community sampling was used to recruit 104 infants aged 9 to 14 months showing early behaviors associated with later ASD, as measured by the Social Attention and Communication Surveillance-Revised. Recruitment occurred from June 9, 2016, to March 30, 2018. Final follow-up data were collected on April 15, 2020. INTERVENTIONS Infants were randomized on a 1:1 ratio to receive either a preemptive intervention plus usual care or usual care only over a 5-month period. The preemptive intervention group received a 10-session social communication intervention, iBASIS-Video Interaction to Promote Positive Parenting (iBASIS-VIPP). Usual care comprised services delivered by community clinicians. MAIN OUTCOMES AND MEASURES Infants were assessed at baseline (approximate age, 12 months), treatment end point (approximate age, 18 months), age 2 years, and age 3 years. Primary outcome was the combined blinded measure of ASD behavior severity (the Autism Observation Scale for Infants and the Autism Diagnostic Observation Schedule, second edition) across the 4 assessment points. Secondary outcomes were an independent blinded clinical ASD diagnosis at age 3 years and measures of child development. Analyses were preregistered and comprised 1-tailed tests with an α level of .05. RESULTS Of 171 infants assessed for eligibility, 104 were randomized; 50 infants (mean [SD] chronological age, 12.40 [1.93] months; 38 boys [76.0%]) received the iBASIS-VIPP preemptive intervention plus usual care (1 infant was excluded after randomization), and 53 infants (mean [SD] age, 12.38 [2.02] months; 32 boys [60.4%]) received usual care only. A total of 89 participants (45 in the iBASIS-VIPP group and 44 in the usual care group) were reassessed at age 3 years. The iBASIS-VIPP intervention led to a reduction in ASD symptom severity (area between curves, -5.53; 95% CI, -∞ to -0.28; P = .04). Reduced odds of ASD classification at age 3 years was found in the iBASIS-VIPP group (3 of 45 participants [6.7%]) vs the usual care group (9 of 44 participants [20.5%]; odds ratio, 0.18; 95% CI, 0-0.68; P = .02). Number needed to treat to reduce ASD classification was 7.2 participants. Improvements in caregiver responsiveness and language outcomes were also observed in the iBASIS-VIPP group. CONCLUSIONS AND RELEVANCE Receipt of a preemptive intervention for ASD from age 9 months among a sample of infants showing early signs of ASD led to reduced ASD symptom severity across early childhood and reduced the odds of an ASD diagnosis at age 3 years. TRIAL REGISTRATION http://anzctr.org.au identifier: ACTRN12616000819426.
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Affiliation(s)
- Andrew J. O. Whitehouse
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia,University of Western Australia, Crawley, Western Australia, Australia,Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia
| | - Kandice J. Varcin
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia,School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Sarah Pillar
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Wesley Billingham
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Gail A. Alvares
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Josephine Barbaro
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Catherine A. Bent
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Daniel Blenkley
- Perinatal Mental Health and Parenting Research Unit, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Maryam Boutrus
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia,Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia
| | - Abby Chee
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Lacey Chetcuti
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Alena Clark
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Emma Davidson
- Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Stefanie Dimov
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Cheryl Dissanayake
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Jane Doyle
- Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Megan Grant
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Cherie C. Green
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Megan Harrap
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Teresa Iacono
- Living with Disability Research Centre, College of Science, Health, and Engineering, Victoria, Australia
| | - Lisa Matys
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Murray Maybery
- School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia
| | - Daniel F. Pope
- Perinatal Mental Health and Parenting Research Unit, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Michelle Renton
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia,Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Catherine Rowbottam
- Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Nancy Sadka
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Leonie Segal
- Australian Centre for Precision Health, Allied Health and Human Movement, University of South Australia, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, Australia
| | - Vicky Slonims
- Children’s Neurosciences, Evelina London Children’s Hospital/Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
| | - Jodie Smith
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Carol Taylor
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Scott Wakeling
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Ming Wai Wan
- Perinatal Mental Health and Parenting Research Unit, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - John Wray
- Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Matthew N. Cooper
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Trust, Manchester, United Kingdom
| | - Kristelle Hudry
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
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17
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Trembath D, Waddington H, Sulek R, Varcin K, Bent C, Ashburner J, Eapen V, Goodall E, Hudry K, Silove N, Whitehouse A. An evidence-based framework for determining the optimal amount of intervention for autistic children. Lancet Child Adolesc Health 2021; 5:896-904. [PMID: 34672993 DOI: 10.1016/s2352-4642(21)00285-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 12/28/2022]
Abstract
The provision of timely, effective, and socially valid non-pharmacological intervention is at the core of efforts to support the development of young autistic children. These efforts are intended to support children to develop skills, empower their caregivers, and lay the foundation for optimal choice, independence, and quality of life into adulthood. But what is the optimal amount of intervention? In this Viewpoint, we review current guidelines and consider evidence from an umbrella review of non-pharmacological interventions for autistic children aged up to 12 years. We show the lack of consensus on the issue, identify factors that might be relevant to consider, and present an evidence-based framework for determining the optimal amount of intervention for each child, along with recommendations for future research.
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Affiliation(s)
- David Trembath
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Hannah Waddington
- Faculty of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Rhylee Sulek
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Kandice Varcin
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Catherine Bent
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia
| | | | - Valsamma Eapen
- Academic Unit of Child Psychiatry South West Sydney Local Health District and Ingham Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Kristelle Hudry
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia
| | - Natalie Silove
- School of Medicine, University of Sydney, NSW, Australia
| | - Andrew Whitehouse
- Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, Nedlands, WA, Australia.
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18
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Smith J, Sulek R, Green CC, Bent CA, Chetcuti L, Bridie L, Benson PR, Barnes J, Hudry K. Relative predictive utility of the original and Autism-Specific Five-Minute Speech Samples for child behaviour problems in autistic preschoolers: A preliminary study. Autism 2021; 26:1188-1200. [PMID: 34519569 DOI: 10.1177/13623613211044336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/15/2022]
Abstract
LAY ABSTRACT Parental Expressed Emotion refers to the intensity and nature of emotion shown when a parent talks about their child, and has been linked to child behaviour outcomes. Parental Expressed Emotion has typically been measured using the Five-Minute Speech Sample; however, the Autism-Specific Five-Minute Speech Sample was developed to better capture Expressed Emotion for parents of children on the autism spectrum. In each case, parents are asked to talk for 5 min about their child and how they get along with their child. Parents' statements are then coded for features such as number of positive and critical comments, or statements reflecting strong emotional involvement. While both the Five-Minute Speech Sample and Autism-Specific Five-Minute Speech Sample have been used with parents of autistic school-aged children, their relative usefulness for measuring Expressed Emotion in parents of preschool-aged children - including their links to child behaviour problems in this group - is unclear. We collected speech samples from 51 parents of newly diagnosed autistic preschoolers to investigate similarities and differences in results from the Five-Minute Speech Sample and Autism-Specific Five-Minute Speech Sample coding schemes. This included exploring the extent to which the Five-Minute Speech Sample and Autism-Specific Five-Minute Speech Sample, separately, or together, predicted current and future child behaviour problems. While the two measures were related, we found only the Autism-Specific Five-Minute Speech Sample - but not the Five-Minute Speech Sample - was related to child behavioural challenges. This adds support to the suggestion that the Autism-Specific Five-Minute Speech Sample may be a more useful measure of parental Expressed Emotion in this group, and provides a first step towards understanding how autistic children might be better supported by targeting parental Expressed Emotion.
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Affiliation(s)
| | - Rhylee Sulek
- La Trobe University, Australia
- Griffith University, Australia
| | | | | | | | | | | | - Jacqueline Barnes
- Birkbeck, University of London, UK
- University of Wollongong, Australia
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19
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Chetcuti L, Uljarević M, Varcin KJ, Boutrus M, Pillar S, Dimov S, Barbaro J, Dissanayake C, Green J, Wan MW, Segal L, Slonims V, Whitehouse AJO, Hudry K. Caregiver Psychological Distress Predicts Temperament and Social-Emotional Outcomes in Infants with Autism Traits. Res Child Adolesc Psychopathol 2021; 49:1669-1681. [PMID: 34216330 DOI: 10.1007/s10802-021-00838-5] [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] [Accepted: 06/07/2021] [Indexed: 01/10/2023]
Abstract
Child temperament and caregiver psychological distress have been independently associated with social-emotional difficulties among individuals with autism. However, the interrelationship among these risk factors has rarely been investigated. We explored the reciprocal interplay between child temperament (surgency, negative affectivity, and self-regulation) and caregiver psychological distress in the development of child internalizing and externalizing symptoms, in a cohort of 103 infants showing early autism traits. Caregivers completed questionnaires when children were aged around 12-months (Time 1 [T1]), 18-months (Time 2 [T2]), and 24-months (Time 3 [T3]). Cross-lagged path models revealed a significant pathway from T1 caregiver psychological distress through lower T2 child self-regulation to subsequently greater T3 child internalizing symptoms. No such caregiver-driven pathway was evident through T2 child negative affectivity or in the prediction of T3 child externalizing symptoms. Further, no support was found for temperament-driven pathways through caregiver psychological distress to child social-emotional difficulties. Child surgency was mostly unrelated to caregiver psychological distress and social-emotional difficulties. These findings implicate the need to support the mental health of caregivers with an infant with autism traits in order to enhance the emotion regulation and social-emotional development of their infants.
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Affiliation(s)
- Lacey Chetcuti
- Department of Psychology and Counseling, School of Psychology and Public Health, La Trobe University, Melbourne, Australia. .,Cooperative Research Centre for Living With Autism (Autism CRC), Brisbane, Australia.
| | - Mirko Uljarević
- Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, School of Medicine, Stanford University, Stanford Autism Center, Stanford, California, USA.,School of Psychological Sciences, Faculty of Medicine, The University of Melbourne, Dentistry and Health Sciences, Melbourne, Australia
| | - Kandice J Varcin
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Maryam Boutrus
- Cooperative Research Centre for Living With Autism (Autism CRC), Brisbane, Australia.,Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Sarah Pillar
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Stefanie Dimov
- Department of Psychology and Counseling, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Josephine Barbaro
- Cooperative Research Centre for Living With Autism (Autism CRC), Brisbane, Australia.,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Cheryl Dissanayake
- Cooperative Research Centre for Living With Autism (Autism CRC), Brisbane, Australia.,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester Mental Health NHS Trust, Manchester, UK
| | - Ming Wai Wan
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Leonie Segal
- Australian Centre for Precision Health, Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Vicky Slonims
- Evelina Children's Hospital / Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
| | - Andrew J O Whitehouse
- Cooperative Research Centre for Living With Autism (Autism CRC), Brisbane, Australia.,Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Kristelle Hudry
- Department of Psychology and Counseling, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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20
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Licari MK, Varcin K, Hudry K, Leonard HC, Alvares GA, Pillar SV, Stevenson PG, Cooper MN, Whitehouse AJO. The course and prognostic capability of motor difficulties in infants showing early signs of autism. Autism Res 2021; 14:1759-1768. [PMID: 34021977 DOI: 10.1002/aur.2545] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/08/2020] [Revised: 04/01/2021] [Accepted: 05/03/2021] [Indexed: 11/12/2022]
Abstract
Delays within the motor domain are often overlooked as an early surveillance marker for autism. The present study evaluated motor difficulties and its potential as an early predictive marker for later autism likelihood in a cohort of infants (N = 96) showing early behavioral signs of autism aged 9-14 months. The motor domain was evaluated using the motor subscales of the Mullen Scales of Early Learning at baseline, and at a 6-month follow-up. The Autism Diagnostic Observation Schedule - Toddler Module (ADOS-T) was completed at follow-up as a measure of autism likelihood. Motor difficulties were common at baseline, with 63/96 (65.6%) infants scoring very low or below average in the gross motor domain and 29/96 (30.2%) in the fine motor domain. At follow-up, gross motor difficulties had resolved for many, with 23/63 (36.5%) infants maintaining these difficulties. Fine motor difficulties resolved in fewer infants, with 20/29 (69.0%) continuing to present with fine motor delays at follow-up. Adjusted linear regression models suggested that fine motor scores at baseline (β = -0.12, SE = 0.04) and follow-up (β = -0.17, SE = 0.05) were associated with higher ADOS-T scores; with difficulties across both timepoints (β = 5.60, SE = 1.35) the strongest (largest in magnitude) association with ADOS-T scores of the predictors examined. Motor difficulties are prominent in children displaying emerging signs of autism, with persistent fine motor difficulties predictive of the developing autism phenotype. The findings indicate the potential clinical value of including evaluation of motor skills within early autism surveillance measures. LAY SUMMARY: This prospective study evaluated motor development over a 6-month period in infants showing early behavioral signs of autism. Atypical motor development was a common feature of infants showing early signs of autism and persistent fine motor difficulties were predictive of the emerging autism phenotype.
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Affiliation(s)
- Melissa K Licari
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Kandice Varcin
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Kristelle Hudry
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | | | - Gail A Alvares
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Sarah V Pillar
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Paul G Stevenson
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew N Cooper
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Andrew J O Whitehouse
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
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21
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Smith J, Sulek R, Abdullahi I, Green CC, Bent CA, Dissanayake C, Hudry K. Comparison of mental health, well-being and parenting sense of competency among Australian and South-East Asian parents of autistic children accessing early intervention in Australia. Autism 2021; 25:1784-1796. [PMID: 33896231 DOI: 10.1177/13623613211010006] [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: 11/16/2022]
Abstract
LAY ABSTRACT We know that parents of autistic children experience poorer mental health and lower well-being than parents of non-autistic children. We also know that poorer mental health among parents of autistic children has been observed across different cultures. Most research focuses on Western cultures, so we know little about parental mental health and well-being of parents from different cultural backgrounds; yet, it is likely that cultural background contributes to how parents view their child's condition and respond to the diagnosis. Here, we compared mental health, quality of life and well-being between families raising an autistic child from Australian backgrounds to families from South-East Asian backgrounds. All children in the current study were receiving the same community-based early intervention. When compared to the general population, parents had poorer mental health overall, but there were no differences between the two groups of parents. However, parents from South-East Asian backgrounds reported higher well-being and fewer difficulties associated with their child's autism. These findings suggest that cultural background likely influences not only parent's view of, and response to, their child's autism, but also their own sense of well-being. As researchers and clinicians working with families of autistic children, we should more explicitly consider family's cultural background within our work.
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22
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Chetcuti L, Uljarević M, Ellis-Davies K, Hardan AY, Whitehouse AJO, Hedley D, Putnam S, Hudry K, Prior MR. Temperament in individuals with Autism Spectrum Disorder: A systematic review. Clin Psychol Rev 2021; 85:101984. [PMID: 33607568 DOI: 10.1016/j.cpr.2021.101984] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 01/09/2023]
Abstract
The study of temperament in Autism Spectrum Disorder (ASD) has the potential to provide insight regarding variability in the onset, nature, and course of both core and co-morbid symptoms. The aim of this systematic review was to integrate existing findings concerning temperament in the context of ASD. Searches of Medline, PsychInfo and Scopus databases identified 64 relevant studies. As a group, children and adolescents with ASD appear to be temperamentally different from both typically developing and other clinical non-ASD groups, characterized by higher negative affectivity, lower surgency, and lower effortful control at a higher-order level. Consistent with research on typically developing children, correlational findings and emerging longitudinal evidence suggests that lower effortful control and higher negative affect are associated with increased internalizing and externalizing problems in ASD samples. Longitudinal studies suggest there may be temperamental differences between high familial risk infants who do and do not develop ASD from as early as 6-months of age. Limitations of existing research are highlighted, and possible directions for future research to capitalize on the potential afforded through the study of temperament in relation to ASD are discussed.
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Affiliation(s)
- Lacey Chetcuti
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Mirko Uljarević
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia; Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, Stanford Autism Center, School of Medicine, Stanford University, USA.
| | | | - Antonio Y Hardan
- Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, Stanford Autism Center, School of Medicine, Stanford University, USA
| | | | - Darren Hedley
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Samuel Putnam
- Department of Psychology, Bowdoin College, United States
| | - Kristelle Hudry
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Margot R Prior
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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23
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Green CC, Smith J, Bent CA, Chetcuti L, Sulek R, Uljarević M, Hudry K. Differential predictors of well-being versus mental health among parents of pre-schoolers with autism. Autism 2021; 25:1125-1136. [PMID: 33472386 DOI: 10.1177/1362361320984315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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 Raising a child with autism has been linked to mental health difficulties. Poor parental mental health is likely influenced by various factors - including child-, parent-, and family/socioeconomic characteristics. However, little is known about what influences and promotes well-being (as opposed to mental health) among parents of young, newly diagnosed autistic children who may be particularly vulnerable. We examined child-, parent-, and family/socioeconomic factors associated with each of mental health and well-being in a sample of 136 parents of pre-school-aged children. Parental mental health was linked to both child- (i.e. autism symptom severity) and parent-related factors (i.e. personality traits reflecting a tendency to experience negative emotions). By contrast, in additional to mental health difficulties, which were linked to well-being, only other parent-related characteristics (and not child characteristics) were related to well-being. These included personality traits reflecting a tendency to be more extraverted/sociable, and also mindfulness. Other child-related and family/socioeconomic context factors (including household income, parental education level) were not linked to parental mental health or well-being in this sample. These results support the idea that poorer mental health and well-being are not simply the opposite of one another. That is, while these two factors were related, they were linked to different personal characteristics. Perhaps most importantly, the link between well-being and mindfulness - a personal characteristic that parents can improve - suggests mindfulness-based interventions may be helpful in directly supporting parental well-being in the context of raising a young child with autism.
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Affiliation(s)
| | | | | | | | - Rhylee Sulek
- La Trobe University, Australia.,Griffith University, Australia
| | - Mirko Uljarević
- The University of Melbourne, Australia.,Stanford University, USA
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24
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Vivanti G, Hudry K, Trembath D, Barbaro J, Richdale A, Dissanayake C. Towards the DSM‐5 Criteria for Autism: Clinical, Cultural, and Research Implications. Australian Psychologist 2020. [DOI: 10.1111/ap.12008] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Giacomo Vivanti
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University,
| | - Kristelle Hudry
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University,
| | - David Trembath
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University,
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University,
| | - Amanda Richdale
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University,
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University,
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25
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Hudry K, Chetcuti L, Boutrus M, Pillar S, Baker EK, Dimov S, Barbaro J, Green J, Whitehouse AJO, Varcin KJ. Performance of the Autism Observation Scale for Infants with community-ascertained infants showing early signs of autism. Autism 2020; 25:490-501. [DOI: 10.1177/1362361320965397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Often included within ‘high-risk sibling’ studies, the Autism Observation Scale for Infants (AOSI) has only one independent replication study and no evaluation with community-ascertained cohorts. We administered the AOSI and established clinical measures with 103 infants (68% male) at ‘high autism likelihood’ on the Social Attention and Communication Surveillance - Revised (SACS-R) tool, at 9–14 months of age and again 6 months later. AOSI Total scores showed adequate internal consistency and strong inter-rater agreement (live- or video-coded) and were approximately normally distributed at each visit. Modest significant associations presented between Time 1 AOSI scores and concurrent developmental/adaptive skills measures. Concurrent associations were stronger at Time 2, particularly between AOSI Total and Autism Diagnostic Observation Schedule (ADOS) Social Affect scores. AOSI scores were only moderately associated across Time 1 and 2 assessments, as were Time 1 AOSI with Time 2 ADOS scores. These data from a clinically indicated cohort broadly replicate previous AOSI validity accounts from ‘high-risk sibling’ studies, particularly beyond the first year. Strong inter-rater agreement indicates viable AOSI inclusion within protocols necessitating blinded evaluation (e.g. intervention trials). Moderate within-participant stability suggests that, like ‘high-risk siblings,’ community-ascertained infants experience variable early trajectories. Lay Abstract We investigated whether a commonly used research assessment – the Autism Observation Scale for Infants (AOSI) – accurately measures autism behaviours among infants showing early signs of autism identified within the community. The AOSI is often included in studies tracking the development of infants at increased likelihood of autism, such as the infant siblings of diagnosed children. However, the suitability of this measure has not previously been tested with community-referred infants. We administered the AOSI with infants when aged 9 to 14 months and again 6 months later. Our researchers – independent of the AOSI development team and newly trained on this measure – were able to administer the brief interactive assessment and score it accurately. The infants’ AOSI scores were linked to their scores on other established and validated clinical assessments, particularly at the second visit when average age was 18 months. Stronger correspondence of AOSI and other scores at this second visit suggests early autism behaviours are better established and more consistent by 18 months of age, even though these infants showed clear enough signs of possible autism to prompt referral to our study around 12 months of age. However, the moderate association of AOSI scores over time suggests that, like infant siblings – who mostly do not develop autism – community-identified infants showing early signs may also have variable developmental pathways in early life.
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Affiliation(s)
| | - Lacey Chetcuti
- La Trobe University, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
| | - Maryam Boutrus
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
- Telethon Kids Institute, University of Western Australia, Australia
| | - Sarah Pillar
- Telethon Kids Institute, University of Western Australia, Australia
| | - Emma K Baker
- La Trobe University, Australia
- Murdoch Children’s Research Institute, The Royal Children’s Hospital, Australia
- University of Melbourne, Australia
| | | | | | - Jonathan Green
- University of Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Andrew JO Whitehouse
- Cooperative Research Centre for Living with Autism (Autism CRC), Australia
- Telethon Kids Institute, University of Western Australia, Australia
| | - Kandice J Varcin
- Telethon Kids Institute, University of Western Australia, Australia
- Griffith University, Australia
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26
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Hudry K, Chetcuti L, Hocking DR. Motor functioning in developmental psychopathology: A review of autism as an example context. Res Dev Disabil 2020; 105:103739. [PMID: 32712240 DOI: 10.1016/j.ridd.2020.103739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 04/30/2020] [Accepted: 07/10/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Motor development research has seen substantial recent growth. However, much remains to be understood about the nature and extent of motor impairments in neurodevelopmental disorders, including their potential as early markers and/or causal determinants of downstream functioning in other domains. AIMS AND METHODS In this narrative review, drawing primarily on the autism literature by way of example, we review current accounts of the nature and consequences of motor functioning. We consider conventional approaches to measurement and study design, and current limited approaches to tackling heterogeneity. CONCLUSIONS AND IMPLICATIONS We argue that ongoing adherence to traditional diagnostic outcome classification stands in the face of mounting evidence that characteristics of neurodevelopmental disorders lie on a continuum with variability in the general population, and that three broad research avenues stand to offer a better understanding of motor functioning: The use of technology and advanced statistical methods for a more nuanced understanding of motor abilities; exploiting the prospective longitudinal tracking of at-risk infants to understand developmental consequences of early motor difference; and employing randomized controlled trials to test the utility of motor therapies whilst also testing causal hypotheses about the role of motor functioning.
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Affiliation(s)
- Kristelle Hudry
- Department of Psychology and Counseling, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086 Australia.
| | - Lacey Chetcuti
- Department of Psychology and Counseling, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086 Australia.
| | - Darren R Hocking
- Developmental Neuromotor and Cognition Lab, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086 Australia.
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27
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Chetcuti L, Uljarević M, Varcin KJ, Boutrus M, Wan MW, Green J, Iacono T, Dissanayake C, Whitehouse AJO, Hudry K. Subgroups of Temperament Associated with Social-Emotional Difficulties in Infants with Early Signs of Autism. Autism Res 2020; 13:2094-2101. [PMID: 32924317 DOI: 10.1002/aur.2381] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/06/2020] [Revised: 06/24/2020] [Accepted: 08/01/2020] [Indexed: 01/05/2023]
Abstract
Links between temperament and social-emotional difficulties are well-established in normative child development but remain poorly characterized in autism. We sought to characterize distinct temperament subgroups and their associations with concurrent internalizing and externalizing symptoms in a sample of 103 infants (Mage = 12.39 months, SD = 1.97; 68% male) showing early signs of autism. Latent profile analysis was used to identify subgroups of infants with distinct temperament trait configurations on the Infant Behavior Questionnaire-Revised. Derived subgroups were then compared in terms of internalizing and externalizing symptoms on the Infant-Toddler Social and Emotional Assessment. Three distinct temperament subgroups were identified: (a) inhibited/low positive (n = 22), characterized by low Smiling and Laughter, low High-Intensity Pleasure, low Vocal Reactivity, and low Approach; (b) active/negative reactive (n = 23), characterized by high Activity Level, high Distress to Limitations, high Sadness, high Fear, and low Falling Reactivity; and (c) well-regulated (n = 51), characterized by high Cuddliness, high Soothability, and high Low-Intensity Pleasure. There were no differences in infant sex ratio, mean age or developmental/cognitive ability. Inhibited/low-positive infants had significantly more behavioral autism signs than active/negative reactive and well-regulated infants, who did not differ. Inhibited/low-positive and active/negative reactive infants had higher internalizing symptoms, relative to well-regulated infants, and active/negative reactive infants also had higher externalizing symptoms. These findings align closely with those garnered in the context of normative child development, and point to child temperament as a putative target for internalizing and externalizing interventions. LAY SUMMARY: This study explored whether infants with early signs of autism could be grouped according to temperament characteristics (i.e., emotional, behavioral, and attentional traits). Three subgroups were identified that differed with respect to emotional and behavioral difficulties. Specifically, "inhibited/low-positive" infants had high emotional difficulties, "active/negative reactive" infants had high emotional and behavioral difficulties, while "well-regulated" infants had the lowest difficulties.
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Affiliation(s)
- Lacey Chetcuti
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Mirko Uljarević
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kandice J Varcin
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Maryam Boutrus
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.,Telethon Kids Institute, Nedlands, Western Australia, Australia.,University of Western Australia, School of Psychological Science, Crawley, Western Australia, Australia
| | - Ming Wai Wan
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Teresa Iacono
- La Trobe Rural Health School, Bendigo, Victoria, Australia
| | - Cheryl Dissanayake
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Andrew J O Whitehouse
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.,Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Kristelle Hudry
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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Chetcuti L, Uljarević M, Varcin KJ, Boutrus M, Wan MW, Slonims V, Green J, Segal L, Iacono T, Dissanayake C, Whitehouse AJO, Hudry K. The Role of Negative Affectivity in Concurrent Relations Between Caregiver Psychological Distress and Social-Emotional Difficulties in Infants With Early Signs of Autism. Autism Res 2020; 13:1349-1357. [PMID: 32390345 DOI: 10.1002/aur.2296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/15/2019] [Revised: 02/24/2020] [Accepted: 03/22/2020] [Indexed: 12/14/2022]
Abstract
Recent evidence suggests the link between caregiver psychological distress and offspring social-emotional difficulties may be accounted for by offspring temperament characteristics. However, existing studies have only focused on neurotypical children; thus, the current study sought to provide an initial examination of this process among children with varying levels of early autism features. Participants included 103 infants aged 9-16 months (M = 12.39, SD = 1.97; 68% male) and their primary caregiver (96% mothers) referred to a larger study by community healthcare professionals. We utilized caregiver-reported measures of psychological distress (Depression Anxiety Stress Scales), infant temperament (Infant Behavior Questionnaire-Revised) and internalizing and externalizing symptoms (Infant-Toddler Social and Emotional Assessment) and administered the Autism Observation Schedule for Infants (AOSI) at an assessment visit to quantify autism features. Infant negative affectivity was found to mediate positive concurrent relations between caregiver psychological distress and infant internalizing and externalizing symptoms, irrespective of the infants' AOSI score. While preliminary and cross-sectional, these results replicate and extend previous findings suggesting that the pathway from caregiver psychological distress to negative affectivity to social-emotional difficulties might also be apparent among infants with varying levels of autism features. More rigorous tests of causal effects await future longitudinal investigation. LAY SUMMARY: Offspring of caregivers experiencing psychological distress (i.e., symptoms of depression, anxiety, and/or stress) may themselves be at increased risk of poor mental health outcomes. Several previous studies conducted with neurotypical children suggest that this link from caregiver-to-child may be facilitated by children's temperament qualities. This study was a preliminary cross-sectional exploration of these relationships in infants with features of autism. We found that infants' elevated negative emotions were involved in the relation between caregiver heightened psychological distress and children's mental health difficulties, consistent with neurotypical development. Autism Res 2020, 13: 1349-1357. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Lacey Chetcuti
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Mirko Uljarević
- Stanford Autism Center, Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, School of Medicine, Stanford University, Stanford, California, USA.,Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kandice J Varcin
- Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia
| | - Maryam Boutrus
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.,Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia.,School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Ming Wai Wan
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Vicky Slonims
- Children's Neurosciences, Evelina London Children's Hospital, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Jonathan Green
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Leonie Segal
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Teresa Iacono
- La Trobe Rural Health School, Bendigo, Victoria, Australia
| | - Cheryl Dissanayake
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Andrew J O Whitehouse
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.,Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia
| | - Kristelle Hudry
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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- The AICES Team in Alphabetical Order: Josephine Barbaro, Stefanie Dimov, Murray Maybery, Michelle Renton, Nancy Sadka, Scott Wakeling, and John Wray
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Hudry K, Pellicano E, Uljarević M, Whitehouse AJO. Setting the research agenda to secure the wellbeing of autistic people. Lancet Neurol 2020; 19:374-376. [PMID: 32142627 DOI: 10.1016/s1474-4422(20)30031-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/24/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Kristelle Hudry
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia.
| | | | - Mirko Uljarević
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia; Child and Adolescent Psychiatry, School of Medicine, Stanford University, CA, USA
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Smith J, Bent CA, Green CC, Woollacott A, Hudry K. Non-native language proficiency may influence the responsiveness of bilingual parents towards young children with autism: A short report. Autism Dev Lang Impair 2020; 5:2396941519899684. [PMID: 36381552 PMCID: PMC9620455 DOI: 10.1177/2396941519899684] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIMS Although bilingualism is a common worldwide phenomenon, limited research has considered the experiences of children with autism growing up in bilingual environments. Here, we investigated the potential influence of parental bilingualism, and native vs. non-native language use, on responsiveness to children's communication attempts during parent-child interactions where the child had autism. Specifically, we investigated the amount of parent responses to child verbal communication (frequency) and the promptness of these responses (temporal synchrony). METHODS Participants were 22 monolingual and 20 bilingual parents and their children with autism aged 2-6 years, recruited from a multicultural, metropolitan city where English is the dominant language. Extending from our previous report on this sample, we identified the frequency and temporal synchrony of parent responses from filmed 10-minute free-play sessions. Monolingual parents were videoed during one free-play session in English. Bilingual parents were videoed during two free-play sessions; one in their native language and one in English. We compared the frequency and temporal synchrony of parental responses across monolingual and bilingual parent groups and, for bilingual parents, across native vs. non-native (English) language interaction samples. Finally, we examined how other measures of bilingual parents' non-native language proficiency were associated with interaction responsiveness measures. RESULTS When using their native language, bilingual parents demonstrated reduced frequency of responsiveness (even when controlling for opportunities provided by the child) and less temporal synchrony to child communication compared to English-speaking monolingual parents. Bilingual parents were also less frequently responsive (but not less temporally synchronous) during their native- compared to during their non-native (English) language interactions. Moreover, for bilingual parents, more frequent responsiveness to child communication bids when interacting in non-native English was associated with greater assessed English vocabulary knowledge. CONCLUSIONS In this sample, use of non-native English did not appear to adversely affect how often, or how quickly, bilingual parents responded to their children's verbal communication bids. However, nor did we find evidence of a native-language advantage. Rather, during English-language interactions, when these bilingual parents were responsive towards their children, this was on par with rates and timing of responsiveness shown by English-speaking monolinguals. This may partly be explained by bilinguals' non-native language proficiency, and habitual use/personal dominance patterns. IMPLICATIONS These data suggest no definitive drawback of non-native language use for synchronous responsiveness by bilingual parents interacting with young children with autism. However, our data also serve to highlight the complex, multifaceted nature of adult bilingualism, and indicate the need for more research - with large, well-characterised samples - to permit strong conclusions concerning how parental language-use choices may influence children's natural learning environments, including in the context of autism and developmental language impairments.
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Affiliation(s)
| | | | - Cherie C Green
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Alexandra Woollacott
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Kristelle Hudry
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Whitehouse AJO, Varcin KJ, Alvares GA, Barbaro J, Bent C, Boutrus M, Chetcuti L, Cooper MN, Clark A, Davidson E, Dimov S, Dissanayake C, Doyle J, Grant M, Iacono T, Maybery M, Pillar S, Renton M, Rowbottam C, Sadka N, Segal L, Slonims V, Taylor C, Wakeling S, Wan MW, Wray J, Green J, Hudry K. Pre-emptive intervention versus treatment as usual for infants showing early behavioural risk signs of autism spectrum disorder: a single-blind, randomised controlled trial. Lancet Child Adolesc Health 2019; 3:605-615. [PMID: 31324597 DOI: 10.1016/s2352-4642(19)30184-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Great interest exists in the potential efficacy of prediagnostic interventions within the autism spectrum disorder prodrome, but available evidence relates to children at high familial risk. We aimed to test the efficacy of a pre-emptive intervention designed for infants showing early behavioural signs of autism spectrum disorder. METHODS In this single-blind, randomised controlled trial done at two specialist centres in Australia, infants aged 9-14 months were enrolled if they were showing at least three early behavioural signs of autism spectrum disorder on the Social Attention and Communication Surveillance-Revised (SACS-R) 12-month checklist. Infants were randomly assigned (1:1) to receive a parent-mediated video-aided intervention (iBASIS-VIPP) or treatment as usual. Group allocation was done by minimisation, stratified by site, sex, age, and the number of SACS-R risk behaviours. Assessments were done at baseline (before treatment allocation) and at the 6 month endpoint. The primary outcome was Autism Observation Scale for Infants (AOSI), which measures early behavioural signs associated with autism spectrum disorder. Secondary outcomes were a range of infant and caregiver outcomes measured by Manchester Assessment of Caregiver-Infant interaction (MACI), Mullen Scales of Early Learning (MSEL), Vineland Adaptive Behaviour Scales, 2nd edition (VABS-2), MacArthur-Bates Communicative Development Inventory (MCDI), and Parenting Sense of Competence (PSOC) scale. This trial is registered with Australian New Zealand Clinical Trials Registry, number ANZCTR12616000819426. FINDINGS Between June 9, 2016, and March 30, 2018, 103 infants were randomly assigned, 50 to the iBASIS-VIPP group and 53 to the treatment-as-usual group. After the intervention, we observed no significant differences between groups on early autism spectrum disorder behavioural signs measured by the AOSI (difference estimate -0·74, 95% CI -2·47 to 0·98). We also observed no significant differences on secondary outcomes measuring caregiver non-directiveness (0·16, -0·33 to 0·65), caregiver sensitive responding (0·24, -0·15 to 0·63), and infant attentiveness (-0·19, -0·63 to 0·25) during parent-child interactions (MACI), as well as on researcher-administered measures of receptive (1·30, -0·48 to 3·08) and expressive language (0·54, -0·73 to 1·80), visual reception (0·31, -0·77 to 1·40), and fine motor skills (0·55, -0·32 to 1·41) using the MSEL. Compared with the treatment-as-usual group, the iBASIS-VIPP group had lower infant positive affect (-0·69, -1·27 to -0·10) on the MACI, but higher caregiver-reported receptive (37·17, 95% CI 10·59 to 63·75) and expressive vocabulary count (incidence rate ratio 2·31, 95% CI 1·22 to 4·33) on MCDI, and functional language use (difference estimate 6·43, 95% CI 1·06 to 11·81) on VABS. There were no significant group differences on caregiver-reported measures of MCDI infant gesture use (3·22, -0·60 to 7·04) and VABS social behaviour (3·28, -1·43 to 7·99). We observed no significant differences between groups on self-reported levels of parenting satisfaction (difference estimate 0·21, 95% CI -0·09 to 0·52), interest (-0·23, -0·62 to 0·16) and efficacy (-0·08, -0·38 to 0·22) on PSOC. INTERPRETATION A pre-emptive intervention for the autism spectrum disorder prodrome had no immediate treatment effect on early autism spectrum disorder symptoms, the quality of parent-child interactions, or researcher-administered measures of developmental skills. However, we found a positive effect on parent-rated infant communication skills. Ongoing follow-up of this infant cohort will assess longer-term developmental effects. FUNDING Western Australia Children's Research Fund, Autism Cooperative Research Centre, La Trobe University, and Angela Wright Bennett Foundation.
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Affiliation(s)
- Andrew J O Whitehouse
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia; Cooperative Research Centre for Living with Autism (Autism CRC), Indooroopilly, QLD, Australia.
| | - Kandice J Varcin
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Gail A Alvares
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Josephine Barbaro
- Cooperative Research Centre for Living with Autism (Autism CRC), Indooroopilly, QLD, Australia; Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Catherine Bent
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Maryam Boutrus
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia; Cooperative Research Centre for Living with Autism (Autism CRC), Indooroopilly, QLD, Australia; School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Lacey Chetcuti
- Cooperative Research Centre for Living with Autism (Autism CRC), Indooroopilly, QLD, Australia; Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Matthew N Cooper
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Alena Clark
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Emma Davidson
- Child and Adolescent Health Service, Child Development Service, West Perth, WA, Australia
| | - Stefanie Dimov
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Cheryl Dissanayake
- Cooperative Research Centre for Living with Autism (Autism CRC), Indooroopilly, QLD, Australia; Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Jane Doyle
- Child and Adolescent Health Service, Child Development Service, West Perth, WA, Australia
| | - Megan Grant
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Teresa Iacono
- La Trobe Rural Health School, Bendigo, VIC, Australia
| | - Murray Maybery
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Sarah Pillar
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia
| | - Michelle Renton
- Telethon Kids Institute, University of Western Australia, Nedlands, WA, Australia; Child and Adolescent Health Service, Child Development Service, West Perth, WA, Australia
| | - Catherine Rowbottam
- Child and Adolescent Health Service, Child Development Service, West Perth, WA, Australia
| | - Nancy Sadka
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Leonie Segal
- Australian Centre for Precision Health, School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Vicky Slonims
- Children's Neurosciences, Evelina London Children's Hospital, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Carol Taylor
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Scott Wakeling
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Ming Wai Wan
- School of Health Sciences, University of Manchester, Manchester, UK
| | - John Wray
- Child and Adolescent Health Service, Child Development Service, West Perth, WA, Australia
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Kristelle Hudry
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
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Chetcuti L, Uljarević M, Hudry K. Editorial Perspective: Furthering research on temperament in autism spectrum disorder. J Child Psychol Psychiatry 2019; 60:225-228. [PMID: 30673138 DOI: 10.1111/jcpp.12957] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Lacey Chetcuti
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | - Mirko Uljarević
- Stanford Autism Center, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, USA
| | - Kristelle Hudry
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia.,Victorian Autism Specific Early Learning and Care Centre, La Trobe University, Melbourne, Vic., Australia
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Ganea N, Hudry K, Vernetti A, Tucker L, Charman T, Johnson MH, Senju A. Development of adaptive communication skills in infants of blind parents. Dev Psychol 2018; 54:2265-2273. [PMID: 30335435 PMCID: PMC6254470 DOI: 10.1037/dev0000564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/04/2023]
Abstract
A fundamental question about the development of communication behavior in early life is how infants acquire adaptive communication behavior that is well-suited to their individual social environment, and how the experience of parent-child communication affects this development. The current study investigated how infants develop communication skills when their parents are visually impaired and cannot see their infants’ eye gaze. We analyzed 6-min video recordings of naturalistic interaction between 14 sighted infants of blind parents (SIBP) with (a) their blind parent, and (b) a sighted experimenter. Data coded from these interactions were compared with those from 28 age-matched sighted infants of sighted parents (controls). Each infant completed two visits, at 6–10 months and 12–16 months of age. Within each interaction sample, we coded the function (initiation or response) and form (face gaze, vocalization, or action) of each infant communication behavior. When interacting with their parents, SIBP made relatively more communicative responses than initiations, and used more face gaze and fewer actions to communicate, than did controls. When interacting with a sighted experimenter, by contrast, SIBP made slightly (but significantly) more communicative initiations than controls, but otherwise used similar forms of communication. The differential communication behavior by infants of blind versus sighted parents was already apparent by 6–10 months of age, and was specific to communication with the parent. These results highlight the flexibility in the early development of human communication behavior, which enables infants to optimize their communicative bids and methods to their unique social environment.
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Affiliation(s)
- Nataşa Ganea
- Centre for Brain and Cognitive Development, Birkbeck, University of London
| | - Kristelle Hudry
- Victorian Autism Specific Early Learning, La Trobe University
| | - Angélina Vernetti
- Centre for Brain and Cognitive Development, Birkbeck, University of London
| | - Leslie Tucker
- Centre for Brain and Cognitive Development, Birkbeck, University of London
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Mark H Johnson
- Centre for Brain and Cognitive Development, Birkbeck, University of London
| | - Atsushi Senju
- Centre for Brain and Cognitive Development, Birkbeck, University of London
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Vivanti G, Dissanayake C, Duncan E, Feary J, Capes K, Upson S, Bent CA, Rogers SJ, Hudry K. Outcomes of children receiving Group-Early Start Denver Model in an inclusive versus autism-specific setting: A pilot randomized controlled trial. Autism 2018; 23:1165-1175. [PMID: 30296845 DOI: 10.1177/1362361318801341] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 01/06/2023]
Abstract
A major topic of debate is whether children with autism spectrum disorder should be educated in inclusive or specialized settings. We examined the feasibility and preliminary effectiveness of delivering the Group-Early Start Denver Model to children with autism spectrum disorder in inclusive versus specialized classrooms. We randomly assigned 44 preschoolers with autism spectrum disorder to receive the Group-Early Start Denver Model across one school calendar year in classrooms that included only children with autism spectrum disorder or mostly children who were typically developing. Blind-rated indicators of teaching quality showed similar results across settings, which were above the local benchmark. Children showed improvements across blinded proximal measures of spontaneous vocalization, social interaction, and imitation and across distal measures of verbal cognition, adaptive behavior, and autism symptoms irrespective of intervention setting. Mothers of participants experienced a reduction in stress irrespective of child intervention setting. Across both settings, age at intervention start was negatively associated with gains in verbal cognition. Delivery of Group-Early Start Denver Model in an inclusive setting appeared to be feasible, with no significant differences in teaching quality and child improvements when the program was implemented in inclusive versus specialized classrooms.
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Affiliation(s)
- Giacomo Vivanti
- 1 A.J. Drexel Autism Institute, Drexel University, USA.,2 La Trobe University, Australia
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Bischof NL, Rapee RM, Hudry K, Bayer JK. Acceptability and caregiver-reported outcomes for young children with autism spectrum disorder whose parents attended a preventative population-based intervention for anxiety: A pilot study. Autism Res 2018; 11:1166-1174. [DOI: 10.1002/aur.1963] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 02/20/2018] [Accepted: 04/11/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Natalie L. Bischof
- School of Psychology and Public Health; La Trobe University; Melbourne Victoria Australia
| | - Ronald M. Rapee
- Centre for Emotional Health; Macquarie University; Sydney New South Wales Australia
| | - Kristelle Hudry
- Victorian Autism Specific Early Learning and Care Centre; La Trobe University; Melbourne Victoria Australia
- Olga Tennison Autism Research Centre; La Trobe University; Melbourne Victoria Australia
| | - Jordana K. Bayer
- School of Psychology and Public Health; La Trobe University; Melbourne Victoria Australia
- Murdoch Children's Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
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Vivanti G, Kasari C, Green J, Mandell D, Maye M, Hudry K. Implementing and evaluating early intervention for children with autism: Where are the gaps and what should we do? Autism Res 2017; 11:16-23. [DOI: 10.1002/aur.1900] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/09/2017] [Accepted: 11/14/2017] [Indexed: 01/27/2023]
Affiliation(s)
- Giacomo Vivanti
- A.J. Drexel Autism Institute, Drexel University; Philadelphia PA
| | - Connie Kasari
- Center for Autism Research and Treatment, UCLA; Los Angeles CA
| | | | - David Mandell
- Center for Mental Health Policy and Services Research, University of Pennsylvania; Philadelphia PA
| | | | - Kristelle Hudry
- Victorian Autism Specific Early Learning and Care Centre; and Olga Tennison Autism Research Centre, La Trobe University; Melbourne Australia
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Chetcuti L, Hudry K, Grant M, Vivanti G. Object-directed imitation in autism spectrum disorder is differentially influenced by motoric task complexity, but not social contextual cues. Autism 2017; 23:199-211. [PMID: 29139304 DOI: 10.1177/1362361317734063] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We examined the role of social motivation and motor execution factors in object-directed imitation difficulties in autism spectrum disorder. A series of to-be-imitated actions was presented to 35 children with autism spectrum disorder and 20 typically developing children on an Apple® iPad® by a socially responsive or aloof model, under conditions of low and high motor demand. There were no differences in imitation performance (i.e. the number of actions reproduced within a fixed sequence), for either group, in response to a model who acted socially responsive or aloof. Children with autism spectrum disorder imitated the high motor demand task more poorly than the low motor demand task, while imitation performance for typically developing children was equivalent across the low and high motor demand conditions. Furthermore, imitative performance in the autism spectrum disorder group was unrelated to social reciprocity, though positively associated with fine motor coordination. These results suggest that difficulties in object-directed imitation in autism spectrum disorder are the result of motor execution difficulties, not reduced social motivation.
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Affiliation(s)
- Lacey Chetcuti
- Olga Tennison Autism Research Center, School of Psychology and Public Health, La Trobe University, Australia
| | - Kristelle Hudry
- Olga Tennison Autism Research Center, School of Psychology and Public Health, La Trobe University, Australia.,Victorian Autism Specific Early Learning and Care Centre, La Trobe University, Australia
| | - Megan Grant
- Olga Tennison Autism Research Center, School of Psychology and Public Health, La Trobe University, Australia
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Hudry K, Dimov S. Spoken language shows some improvement following intervention for children with autism: but for which children and why? Evid Based Ment Health 2017; 20:e16. [PMID: 28663170 PMCID: PMC10699266 DOI: 10.1136/eb-2016-102435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 04/21/2017] [Accepted: 05/21/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Kristelle Hudry
- Victorian Autism Specific Early Learning and Care Centre, La Trobe University, Melbourne, VIC, Australia
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Stefanie Dimov
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
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Hudry K, Rumney L, Pitt N, Barbaro J, Vivanti G. Interaction Behaviors of Bilingual Parents With Their Young Children With Autism Spectrum Disorder. J Clin Child Adolesc Psychol 2017; 47:S321-S328. [PMID: 28323454 DOI: 10.1080/15374416.2017.1286592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Given concerns that bilingual exposure might confuse children with disabilities-including autism spectrum disorder (ASD)-bilingual parents may restrict exposure to one language, often the community-dominant language. We investigated a potential consequence of this decision; the possibility that non-native language use might influence parental communicative behaviors during interaction with the child. We recruited 39 parent-child dyads, each with a young child with ASD (mostly boys) and parent/carer (mostly mothers). Parents were either monolingual speakers of community-dominant English (n = 20) or bilingual with English as the second language (n = 19). We confirmed our assumption that the latter group would have significantly poorer non-native English language via standardized assessment of expressive vocabulary, and ensured children were matched on age, ASD symptoms, and developmental level. We sampled parent-child interaction-including in each of bilinguals' native and non-native languages-and coded parents' amount and complexity of speech, communicative synchrony, and imitations and expansions of their child's speech. Few differences presented across bilingual parents' native versus non-native language samples, but this group showed reduced synchrony and use of expansions compared to monolinguals. Further, bilinguals' English-language knowledge was associated with self-reported comfort using this language and with two coded interaction measures. These empirical data only partially support qualitative accounts that non-native language use may influence bilingual parents' interaction behaviors with their young children. With growing rates of ASD diagnosis and increasing cultural/linguistic diversity around the world, further dedicated clinical and experimental attention to this issue is clearly warranted.
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Affiliation(s)
- Kristelle Hudry
- a Victorian Autism Specific Early Learning and Care Centre and Olga Tennison Autism Research Centre , School of Psychology and Public Health, La Trobe University
| | - Lisa Rumney
- b Olga Tennison Autism Research Centre , School of Psychology and Public Health, La Trobe University
| | - Nicole Pitt
- b Olga Tennison Autism Research Centre , School of Psychology and Public Health, La Trobe University
| | - Josephine Barbaro
- b Olga Tennison Autism Research Centre , School of Psychology and Public Health, La Trobe University
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Uljarević M, Baranek G, Vivanti G, Hedley D, Hudry K, Lane A. Heterogeneity of sensory features in autism spectrum disorder: Challenges and perspectives for future research. Autism Res 2017; 10:703-710. [PMID: 28266796 DOI: 10.1002/aur.1747] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/30/2016] [Accepted: 12/24/2016] [Indexed: 12/24/2022]
Abstract
Pronounced heterogeneity is apparent across every facet of autism spectrum disorder (ASD) and it remains difficult to predict likely future potential among individuals who share a common diagnosis of ASD on the basis of early presentation. In this commentary we argue that a fine-grained understanding of individual differences in sensory features and their influence across the life span can constrain noted clinical heterogeneity in ASD. We organize our discussion around the following three critical themes: (a) considering sensory features as dimensional construct; (b) taking an "individual differences" approach; and (c) adopting a comprehensive, multidimensional and multimodal approach to measurement of sensory features. We conclude that future research will need to investigate individual differences in sensory features via: (1) multidimensional and cross-disciplinary examination, (2) prospective longitudinal designs, and (3) dimensional and developmental frameworks that emphasize the potential value of early individual variability as indicators of later outcomes, not only in relation to the categorical diagnostic outcome status but also the presence of other clinical features. This is a key time for sensory-related research and in this commentary we provide some of the steps that, in our opinion, can shape future research in this area. Autism Res 2017, 10: 703-710. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Mirko Uljarević
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia
| | - Grace Baranek
- Division of Occupational Science & Occupational Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Giacomo Vivanti
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Victoria, Australia.,Early Detection & Intervention Program, A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Darren Hedley
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Victoria, Australia
| | - Kristelle Hudry
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Victoria, Australia
| | - Alison Lane
- School of Health Sciences, University of Newcastle, New South Wales, Australia.,Priority Research Centre GrowUpWell®
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Uljarević M, Katsos N, Hudry K, Gibson JL. Practitioner Review: Multilingualism and neurodevelopmental disorders - an overview of recent research and discussion of clinical implications. J Child Psychol Psychiatry 2016; 57:1205-1217. [PMID: 27443172 DOI: 10.1111/jcpp.12596] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 05/05/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Language and communication skills are essential aspects of child development, which are often disrupted in children with neurodevelopmental disorders. Cutting edge research in psycholinguistics suggests that multilingualism has potential to influence social, linguistic and cognitive development. Thus, multilingualism has implications for clinical assessment, diagnostic formulation, intervention and support offered to families. We present a systematic review and synthesis of the effects of multilingualism for children with neurodevelopmental disorders and discuss clinical implications. METHODS We conducted systematic searches for studies on multilingualism in neurodevelopmental disorders. Keywords for neurodevelopmental disorders were based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition categories as follows; Intellectual Disabilities, Communication Disorders, Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder, Specific Learning Disorder, Motor Disorders, Other Neurodevelopmental Disorders. We included only studies based on empirical research and published in peer-reviewed journals. RESULTS Fifty studies met inclusion criteria. Thirty-eight studies explored multilingualism in Communication Disorders, 10 in ASD and two in Intellectual Disability. No studies on multilingualism in Specific Learning Disorder or Motor Disorders were identified. Studies which found a disadvantage for multilingual children with neurodevelopmental disorders were rare, and there appears little reason to assume that multilingualism has negative effects on various aspects of functioning across a range of conditions. In fact, when considering only those studies which have compared a multilingual group with developmental disorders to a monolingual group with similar disorders, the findings consistently show no adverse effects on language development or other aspects of functioning. In the case of ASD, a positive effect on communication and social functioning has been observed. CONCLUSIONS There is little evidence to support the widely held view that multilingual exposure is detrimental to the linguistic or social development of individuals with neurodevelopmental disorders. However, we also note that the available pool of studies is small and the number of methodologically high quality studies is relatively low. We discuss implications of multilingualism for clinical management of neurodevelopmental disorders, and discuss possible directions for future research.
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Affiliation(s)
- Mirko Uljarević
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia. .,Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Qld, Australia.
| | - Napoleon Katsos
- Department of Theoretical and Applied Linguistics, University of Cambridge, Cambridge, UK
| | - Kristelle Hudry
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | - Jenny L Gibson
- The Faculty of Education, University of Cambridge, Cambridge, UK
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Crea K, Dissanayake C, Hudry K. Proband Mental Health Difficulties and Parental Stress Predict Mental Health in Toddlers at High-Risk for Autism Spectrum Disorders. J Autism Dev Disord 2016; 46:3242-57. [DOI: 10.1007/s10803-016-2861-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
While sex differences in play have been extensively observed in typical development, only a handful of studies have explored this phenomenon in depth with children with autism spectrum disorders. This study explored sex differences in play complexity and toy engagement within caregiver-child interaction samples for preschool-aged children (2-5 years 11 months) with an autism spectrum disorder who were matched to typically developing children on sex and non-verbal development. Overall we found that girls and boys with autism spectrum disorder were largely equivalent in their play complexity. Despite similar play, girls and boys with autism spectrum disorder differed in a number of ways in their toy engagement, replicating traditional gender differences-girls played more with dolls and domestic items (though at lower rates than typically developing girls) and boys played more with the garage and cars (though at lower rates than typically developing boys). Our findings support the importance and utility of examining sex differences in autism spectrum disorder in light of those observed within typical development.
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Affiliation(s)
- Clare Harrop
- University of North Carolina at Chapel Hill, USA
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Abstract
Information-seeking behaviours occur when children look to adults in order to gain further information about a novel stimulus/situation. The current study investigated information seeking in children with developmental delays (DD) and those with autism spectrum disorders (ASD) during a simulated teaching situation. Twenty preschool-aged children with ASD and 15 children with DD were exposed to a series of videos where a teacher provided novel instructions and demonstrated novel actions. We found that children with DD, but not those with ASD, demonstrated information-seeking behaviours in response to instructions that exceeded their level of understanding. This suggests that children with DD may use information-seeking behaviours to compensate for their cognitive and language difficulties when novel actions are being taught, while the same is not true for children with ASD.
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Affiliation(s)
- Nicole Young
- Nicole Young and Kristelle Hudry, Olga Tennison Autism Research Centre, La Trobe University, Bundoora, VIC, Australia
| | - Kristelle Hudry
- Nicole Young and Kristelle Hudry, Olga Tennison Autism Research Centre, La Trobe University, Bundoora, VIC, Australia
| | - David Trembath
- David Trembath, Griffith Health Institute, Griffith University, Brisbane, QLD, Australia; and
| | - Giacomo Vivanti
- Giacomo Vivanti, Olga Tennison Autism Research Centre and Victorian Autism Specific Early Learning and Care Centre, La Trobe University, Bundoora, VIC, Australia
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Iacono T, Dissanayake C, Trembath D, Hudry K, Erickson S, Spong J. Family and Practitioner Perspectives on Telehealth for Services to Young Children with Autism. Stud Health Technol Inform 2016. [PMID: 27782017 DOI: 10.3233/978-1-61499-712-2-63] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Telehealth offers the potential to address inequalities in autism service access for young children living in regional and rural areas with limited access to autism specialists. Our aim was to explore parent and practitioner uses of technology, and views about telehealth, including perceived barriers, for autism early intervention service delivery in a regional town in Australia. Fifteen mothers and 19 front-line autism practitioners completed surveys distributed by local autism service and support providers in the regional town; eight front-line practitioners from one service participated in interviews. Mothers and practitioners had access to technology that could be used for video-communication, but had little or no experience with telehealth. Mothers appeared more willing to try telehealth for receiving autism services than practitioners appeared to believe, and practitioners preferred to use it for consulting with other professionals and professional development. Barriers to telehealth included limited experience and practitioners not knowing what a telehealth service would look like, poor access to reliable and high speed internet, lack of skill and technical supports, and practitioners believing families preferred face-to-face services. The success of telehealth in this regional town will rely on better infrastructure, and upskilling practitioners in evidence-based autism interventions so they can provide the required support remotely. Use of telehealth to upskill practitioners in evidence-based practice could provide a first step in ensuring equitable access to expert autism services to regional and rural families.
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Affiliation(s)
- Teresa Iacono
- Living with Disability Research Centre, La Trobe University, Bendigo, VIC Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC Australia
| | - David Trembath
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD Australia
| | - Kristelle Hudry
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC Australia
| | - Shane Erickson
- Living with Disability Research Centre, La Trobe University, Melbourne, VIC Australia
| | - Jo Spong
- La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
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Byford S, Cary M, Barrett B, Aldred CR, Charman T, Howlin P, Hudry K, Leadbitter K, Le Couteur A, McConachie H, Pickles A, Slonims V, Temple KJ, Green J. Cost-effectiveness analysis of a communication-focused therapy for pre-school children with autism: results from a randomised controlled trial. BMC Psychiatry 2015; 15:316. [PMID: 26691535 PMCID: PMC4685630 DOI: 10.1186/s12888-015-0700-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 12/14/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Autism is associated with impairments that have life-time consequences for diagnosed individuals and a substantial impact on families. There is growing interest in early interventions for children with autism, yet despite the substantial economic burden, there is little evidence of the cost-effectiveness of such interventions with which to support resource allocation decisions. This study reports an economic evaluation of a parent-mediated, communication-focused therapy carried out within the Pre-School Autism Communication Trial (PACT). METHODS 152 pre-school children with autism were randomly assigned to treatment as usual (TAU) or PACT + TAU. Primary outcome was severity of autism symptoms at 13-month follow-up. Economic data included health, education and social services, childcare, parental productivity losses and informal care. RESULTS Clinically meaningful symptom improvement was evident for 53 % of PACT + TAU versus 41 % of TAU (odds ratio 1.91, p = 0.074). Service costs were significantly higher for PACT + TAU (mean difference £4,489, p < 0.001), but the difference in societal costs was smaller and non-significant (mean difference £1,385, p = 0.788) due to lower informal care rates for PACT + TAU. CONCLUSIONS Improvements in outcome generated by PACT come at a cost. Although this cost is lower when burden on parents is included, the cost and effectiveness results presented do not support the cost-effectiveness of PACT + TAU compared to TAU alone. TRIAL REGISTRATION Current Controlled Trials ISRCTN58133827.
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Affiliation(s)
- Sarah Byford
- King's Health Economics, Box P024, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Maria Cary
- King's Health Economics, Box P024, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Barbara Barrett
- King's Health Economics, Box P024, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | | | - Tony Charman
- Department of Psychology, Box P077, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Patricia Howlin
- Department of Psychology, Box P077, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Kristelle Hudry
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Kathy Leadbitter
- Institute for Brain, Behaviour and Mental Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Ann Le Couteur
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
| | - Helen McConachie
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
| | - Andrew Pickles
- Biostatistics, Box P020, King`s College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Vicky Slonims
- Evelina Children`s Hospital, King`s College London, London, SE1 7EH, UK.
| | - Kathryn J. Temple
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
| | - Jonathan Green
- Manchester Academic Health Sciences Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
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Senju A, Vernetti A, Ganea N, Hudry K, Tucker L, Charman T, Johnson MH. Early Social Experience Affects the Development of Eye Gaze Processing. Curr Biol 2015; 25:3086-91. [PMID: 26752077 PMCID: PMC4683081 DOI: 10.1016/j.cub.2015.10.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/27/2015] [Accepted: 10/06/2015] [Indexed: 12/15/2022]
Abstract
Eye gaze is a key channel of non-verbal communication in humans [1, 2, 3]. Eye contact with others is present from birth [4], and eye gaze processing is crucial for social learning and adult-infant communication [5, 6, 7]. However, little is known about the effect of selectively different experience of eye contact and gaze communication on early social and communicative development. To directly address this question, we assessed 14 sighted infants of blind parents (SIBPs) longitudinally at 6–10 and 12–16 months. Face scanning [8] and gaze following [7, 9] were assessed using eye tracking. In addition, naturalistic observations were made when the infants were interacting with their blind parent and with an unfamiliar sighted adult. Established measures of emergent autistic-like behaviors [10] and standardized tests of cognitive, motor, and linguistic development [11] were also collected. These data were then compared with those obtained from a group of infants of sighted parents. Despite showing typical social skills development overall, infants of blind parents allocated less attention to adult eye movements and gaze direction, an effect that increased between 6–10 and 12–16 months of age. The results suggest that infants adjust their use of adults’ eye gaze depending on gaze communication experience from early in life. The results highlight that human functional brain development shows selective experience-dependent plasticity adaptive to the individual’s specific social environment. Infants of blind parents allocate less attention to adults’ eyes and gaze direction Differences in gaze processing in these infants become greater after 12 months of age Overall social communication skills development of them were within the typical range
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Affiliation(s)
- Atsushi Senju
- Centre for Brain and Cognitive Development, Birkbeck, University of London, Malet Street, London WC1E 7HX, UK.
| | - Angélina Vernetti
- Centre for Brain and Cognitive Development, Birkbeck, University of London, Malet Street, London WC1E 7HX, UK
| | - Natasa Ganea
- Centre for Brain and Cognitive Development, Birkbeck, University of London, Malet Street, London WC1E 7HX, UK
| | - Kristelle Hudry
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia
| | - Leslie Tucker
- Centre for Brain and Cognitive Development, Birkbeck, University of London, Malet Street, London WC1E 7HX, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, P.O. Box 077, De Crespigny Park, London SE5 8AF, UK
| | - Mark H Johnson
- Centre for Brain and Cognitive Development, Birkbeck, University of London, Malet Street, London WC1E 7HX, UK
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Pickles A, Harris V, Green J, Aldred C, McConachie H, Slonims V, Le Couteur A, Hudry K, Charman T. Treatment mechanism in the MRC preschool autism communication trial: implications for study design and parent-focussed therapy for children. J Child Psychol Psychiatry 2015; 56:162-70. [PMID: 25039961 DOI: 10.1111/jcpp.12291] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [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: 05/07/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The PACT randomised-controlled trial evaluated a parent-mediated communication-focused treatment for children with autism, intended to reduce symptom severity as measured by a modified Autism Diagnostic Observation Schedule-Generic (ADOS-G) algorithm score. The therapy targeted parental behaviour, with no direct interaction between therapist and child. While nonsignificant group differences were found on ADOS-G score, significant group differences were found for both parent and child intermediate outcomes. This study aimed to better understand the mechanism by which the PACT treatment influenced changes in child behaviour though the targeted parent behaviour. METHODS Mediation analysis was used to assess the direct and indirect effects of treatment via parent behaviour on child behaviour and via child behaviour on ADOS-G score. Alternative mediation was explored to study whether the treatment effect acted as hypothesised or via another plausible pathway. Mediation models typically assume no unobserved confounding between mediator and outcome and no measurement error in the mediator. We show how to better exploit the information often available within a trial to begin to address these issues, examining scope for instrumental variable and measurement error models. RESULTS Estimates of mediation changed substantially when account was taken of the confounder effects of the baseline value of the mediator and of measurement error. Our best estimates that accounted for both suggested that the treatment effect on the ADOS-G score was very substantially mediated by parent synchrony and child initiations. CONCLUSIONS The results highlighted the value of repeated measurement of mediators during trials. The theoretical model underlying the PACT treatment was supported. However, the substantial fall-off in treatment effect highlighted both the need for additional data and for additional target behaviours for therapy.
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Affiliation(s)
- Andrew Pickles
- Department of Biostatistics, Institute of Psychiatry, Kings College London, London, UK
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Hudry K, Chandler S, Bedford R, Pasco G, Gliga T, Elsabbagh M, Johnson MH, Charman T. Early language profiles in infants at high-risk for autism spectrum disorders. J Autism Dev Disord 2014; 44:154-67. [PMID: 23748385 DOI: 10.1007/s10803-013-1861-4] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [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] [Indexed: 01/05/2023]
Abstract
Many preschoolers with autism spectrum disorders (ASD) present relative lack of receptive advantage over concurrent expressive language. Such profile emergence was investigated longitudinally in 54 infants at high-risk (HR) for ASD and 50 low-risk controls, with three language measures taken across four visits (around 7, 14, 24, 38 months). HR infants presented three outcome subgroups: ASD, other atypicality, and typical development. Reduced receptive vocabulary advantage was observed in HR infants by 14 months, but was maintained to 24 months only in ASD/other atypicality outcome subgroups while typically-developing HR infants regained a more normative profile. Few group differences appeared on a direct assessment of language and parent-reported functional communication. Processes of early development toward ASD outcome and in intermediate phenotypes are discussed.
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Affiliation(s)
- Kristelle Hudry
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Melbourne, VIC, 3086, Australia,
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Abstract
OBJECTIVE To determine whether pre-school children with Autism Spectrum Disorders (ASD) interact differently with their peers with ASD compared to their typically developing (TD) peers, across three activities (free play, structured group time and semi-structured play) in an early intervention setting. METHODS We completed a series of non-experimental case studies involving 13 children with ASD and two TD peers. RESULTS We found trends, but no uniform differences, in the frequency or quality of means by which the children with ASD interacted with one another versus with their TD peers across the three contexts. The children with ASD interacted with both peer types more frequently during the semi-structured and structured activities, than during free play. CONCLUSIONS The children with ASD showed no clear bias towards one peer type over the other. Semi-structured activities may be the best context in which to facilitate peer interactions involving children with ASD in early intervention settings.
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Affiliation(s)
- Katrine Sophie Gunn
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University , Australia
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