Mortality risk among Autistic children and young people: A nationwide birth cohort study

LAY ABSTRACT

Existing literature indicates that Autistic people have shorter life expectancy, but little is known about the mortality risk among Autistic children and young people (0-24 years). We used a 15-year nationwide birth cohort study to estimate the mortality risk among Autistic children and young people in Aotearoa/New Zealand. The study included 895,707 children and 11,919 (1.4%) were Autistic. We found that autism was associated with a significantly higher mortality risk compared to the non-Autistic population. In addition, we found that this risk was significantly higher among females compared to males and for those with a co-occurring intellectual disability. Increased efforts are required to better meet the health needs of this population.

Telehealth-delivered naturalistic developmental behavioural intervention with and without caregiver acceptance and commitment therapy for autistic children and their caregivers: protocol for a multi-arm parallel group randomised clinical trial

INTRODUCTION

Timely access to early support that optimises autistic children's development and their caregiver's mental health is critical. Naturalistic developmental behavioural interventions (NDBIs) and acceptance and commitment therapy (ACT) are evidence-based supports that can enhance child learning and behaviour, and adult well-being, respectively. The traditional face-to-face delivery of these approaches is resource intensive. Further, little is known about the benefit of parallel child-focused and caregiver-focused supports. The aims of this trial are to evaluate the effectiveness and social validity of telehealth-delivered, caregiver-implemented, child-focused NDBI and caregiver-focused ACT when delivered alone and in parallel, on autistic children's social communication and caregiver well-being.

METHODS AND ANALYSIS

The study will use a randomised, single-blind clinical trial with three parallel arms: NDBI; ACT and ACT+NDBI. We will recruit a minimum of 78, 2-5-year-old autistic children and their families throughout Aotearoa New Zealand. Support will be delivered over 13 weeks using a combination of culturally enhanced web-based modules and online group coaching. Primary outcome variables include children's social communication/engagement with their caregiver as well as caregiver stress and will be evaluated using a repeated measures multivariate analysis of variance. Outcome variables are assessed at baseline (before randomisation), immediately postparticipation and at 3-month follow-up.

ETHICS AND DISSEMINATION

The trial is approved by the Health and Disability Ethics Committee (2022 FULL 12058). The findings of this trial will be disseminated through peer-reviewed journals and national and international conference proceedings regardless of the magnitude/direction of effect. Additionally, data will be shared with stakeholder groups, service providers and health professionals.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN12622001134718).

A portfolio analysis of autism research funding in Aotearoa New Zealand 2007-2021

LAY ABSTRACT

We aimed to document the areas of autism research that have previously been funded in Aotearoa New Zealand. We searched for research grants awarded to autism research in Aotearoa New Zealand between 2007 and 2021. We compared the funding distribution in Aotearoa New Zealand to other countries. We asked people from the autistic community and broader autism community whether they were satisfied with this funding pattern, and whether it aligned with what is important to them and to autistic people. We found that the majority of funding for autism research was awarded to biology research (67%). Members of the autistic and autism communities were dissatisfied with the funding distribution, and expressed a lack of alignment with what is important to them. People from the community indicated that the funding distribution did not address the priorities of autistic people, and that it indicated a lack of engagement with autistic people. Autism research funding needs to reflect the priorities of the autistic and autism communities. Autistic people need to be included in autism research and related funding decisions.

Endogenous melatonin and sleep in individuals with Rare Genetic Neurodevelopmental Disorders (RGND): A systematic review

Individuals with Rare Genetic Neurodevelopmental Disorders (RGND) present with significant sleep problems and circadian rhythm abnormalities of uncertain aetiology. Abnormal melatonin secretion may play a role in sleep disturbance in individuals with higher incidence developmental disabilities, however, RGND research is limited. This review compared the melatonin profiles in a range of RGND with that of the general population and considered the impact of any differences on sleep. A systematic search identified 19 studies that met inclusion criteria. Each study was examined to extract data relating to the study design, participant characteristics, objectives, sleep measures and results, and melatonin measures and findings. Studies were evaluated using the BIOCROSS quality appraisal tool. Nine studies focussed on Smith-Magenis syndrome (SMS), the rest included individuals with Angelman (AS), Fragile-X (FXS), Prader-Willi (PWS), septo-optic dysplasia, PAX6/WAGR and Williams (WS) syndromes (N = 349). Individuals with RGND present with a range of sleep problems, particularly dyssomnias. The melatonin profile varied within and between RGND, with low nocturnal melatonin levels commonly reported. Understanding the relationship between specific sleep and melatonin parameters within RGND may help inform sleep intervention.

Quantitative-Analysis of Behavioral Interventions to Treat Sleep Problems in Children with Autism

Sleep is an essential activity for human development. Often, children with autism spectrum disorder (ASD) are affected by a lack of sleep due to various types of sleep problems. We identified and analyzed studies that were aimed at utilizing sleep interventions for children with ASD. A systematic search of databases, reference lists, and ancestral searches identified 18 studies for inclusion. Studies were summarized in terms of (a) participants, (b) targeted sleep problem and measures, (d) intervention components, (e) research design and rigor, and (f) results. The aim of this review was to analyze the literature by evaluating the most commonly treated sleep problems, the various treatment components, and strength of the results using a between case parametric effect size estimate. The most commonly treated sleep problems were night wakings and bedtime disturbance. For interventions, all the studies incorporated multiple treatment components, most often including the use of a consistent bedtime routine. Effect size calculations indicated a moderate effect size, however, limited due to the small number of studies. Results suggest the overall effectiveness of behavioral interventions for the treatment of sleep problems for children with ASD. Based on our analysis, suggestions for practitioners regarding current practices and future directions for research are discussed.

Attributions, causal beliefs, and help-seeking behavior of parents of children with autism spectrum disorder and sleep problems

Sleep problems in children with autism spectrum disorder are prevalent and persistent but also treatable. Little is known about how and why parents of such children seek help for sleep disturbance. Via an online survey ( n = 244 respondents), we gathered information about parents’ attributions about children’s sleep problems and beliefs about causes and on sources of information about, and their decisions regarding, help-seeking. Eighty-two percent of parents reported seeking some kind of help for their child’s sleep disturbance, and the average parent had tried six different treatment strategies, most commonly medical. Alignment of parents’ treatment choices with empirical evidence about treatment efficacy was poor, but belief in effectiveness was closely related to frequency of use of a treatment. In a Principal Components Analysis, parental attributions loaded on two factors: one which suggests the sleep problems are viewed as intrinsic to autism and stable (factor one) and the other as located within the child, stable, and treatment resistant (factor two). These findings have important implications for parental education and clinical practice in the treatment of sleep problems in children with autism spectrum disorder.

Lay abstract

Sleep problems are commonly reported among parents of children with autism spectrum disorder (ASD). Without effective treatment, such problems are unlikely to resolve. To date, we know very little about how and why parents of children with ASD seek help for sleep disturbance. Via an online survey, we gathered information about how parents make sense of their children’s sleep problems, beliefs about their causes, sources of information, and help-seeking behavior. The analysis of responses from 244 parents revealed that parents commonly view sleep problems (a) as a consequence of their child’s ASD, and unlikely to change over time (stable), and (b) as located within the child (intrinsic), stable over time, and difficult to treat. Despite this, parents also rated sleep problems as being important to treat. Eighty-two percent of parents surveyed reported seeking some kind of help for their child’s sleep disturbance, and the average parent had tried six different treatment strategies, most commonly medical approaches (e.g. melatonin). The alignment between parents’ treatment choices and those strategies that are supported by research was poor, but belief in the effectiveness of treatments was closely related to how often the treatment was used. These findings have important implications for parental education and clinical practice in the treatment of sleep problems in children with ASD.

Response to name and its value for the early detection of developmental disorders: Insights from autism spectrum disorder, Rett syndrome, and fragile X syndrome. A perspectives paper

BACKGROUND

Responding to one's own name (RtN) has been reported as atypical in children with developmental disorders, yet comparative studies on RtN across syndromes are rare.

AIMS

We aim to (a) overview the literature on RtN in different developmental disorders during the first 24 months of life, and (b) report comparative data on RtN across syndromes.

METHODS AND PROCEDURES

In Part 1, a literature search, focusing on RtN in children during the first 24 months of life with developmental disorders, identified 23 relevant studies. In Part 2, RtN was assessed utilizing retrospective video analysis for infants later diagnosed with ASD, RTT, or FXS, and typically developing peers.

OUTCOMES AND RESULTS

Given a variety of methodologies and instruments applied to assess RtN, 21/23 studies identified RtN as atypical in infants with a developmental disorder. We observed four different developmental trajectories of RtN in ASD, RTT, PSV, and FXS from 9 to 24 months of age. Between-group differences became more distinctive with age.

CONCLUSIONS AND IMPLICATIONS

RtN may be a potential parameter of interest in a comprehensive early detection model characterising age-specific neurofunctional biomarkers associated with specific disorders, and contribute to early identification.

Using functional behavioral assessment to treat sleep problems in two children with autism and vocal stereotypy

Objectives: Sleep problems are prevalent among children with autism spectrum disorder (ASD) and are often accompanied by stereotypies, the function of which may be difficult to determine. Functional behavioral assessment (FBA) is an evidence-based approach to assessing and treating challenging behaviors, however, it has scarcely been used with sleep problems. This study investigates the effectiveness of FBA-based treatments for sleep disturbance (SD) in children with ASD, the short- and long-term maintenance of these effects, and parents' perspectives on the assessment and treatment process. Method: Two case studies used FBA to inform treatments for SD in two children with ASD and stereotypic behavior. The sleep-competing behaviors appeared to be multi-functional and included sleep interfering vocal stereotypy. The parents of each child implemented individualized, multi-component treatment packages. Results: Results demonstrate a reduction in SD for each participant, though delayed sleep onset latency remained for one participant. These results were maintained at short- and long-term follow-up. The interventions had high social validity. Conclusion: The implications of these findings for future research, and the assessment and treatment of SD in children with ASD and vocal stereotypy are discussed.

Using Functional Behavioral Assessment to Develop a Multicomponent Treatment for Sleep Problems in a 3-Year-Old Boy With Autism

A large number of children with autism spectrum disorder (ASD) and their families are affected by sleep disturbance. Given the concomitant negative effects of sleep problems, it is essential to identify effective treatments. This case study exemplifies the use of Functional Behavioral Assessment (FBA) to develop treatments for sleep problems in a 3-year old boy with ASD. A function-based, multicomponent intervention resulted in the elimination of nighttime breastfeeding, a reduction in the frequency of curtain calls, and the frequency and duration of nighttime awakenings, although not all gains were maintained at follow-up. This case study highlights the importance of FBA in the assessment of sleep problems for each individual, and the need to develop treatments that address the unique function of sleep disturbance for each individual. Further research into the assessment and treatment of sleep problems in children with ASD is required.

Research note: attitudes of teachers and undergraduate students regarding three augmentative and alternative communication modalities

The social validity of different communication modalities is a potentially important variable to consider when designing augmentative and alternative communication (AAC) interventions. To assess the social validity of three AAC modes (i.e., manual signing, picture exchange, and an iPad^®-based speech-generating device), we asked 59 undergraduate students (pre-service teachers) and 43 teachers to watch a video explaining each mode. They were then asked to nominate the mode they perceived to be easiest to learn as well as the most intelligible, effective, and preferred. Participants were also asked to list the main reasons for their nominations and report on their experience with each modality. Most participants (68-86%) nominated the iPad-based speech-generating device (SGD) as easiest to learn, as well as the most intelligible, effective, and preferred. This device was perceived to be easy to understand and use and to have familiar and socially acceptable technology. Results suggest that iPad-based SGDs were perceived as more socially valid among this sample of teachers and undergraduate students. Information of this type may have some relevance to designing AAC supports for people who use AAC and their current and future potential communication partners.

Variables affecting the emergence of untaught equivalence relations in children with and without autism

OBJECTIVE

This study examined the formation of equivalence classes among children with ASD and typically developing children.

DESIGN

A single-subject AB and BA design was used.

METHODS

Two of the six equivalence relations were taught. Participants were then tested to determine whether the remaining four equivalence relations were acquired without teaching. Half of the children were taught naming responses first, then selecting responses. Half were taught in the reverse order.

RESULTS

Five out of 10 participants with ASD demonstrated the emergence of all four untaught relations. The remaining five participants showed variability. Nine of the 10 typically developing children demonstrated emergence of all untaught relations. Variation in teaching conditions had no significant effect on outcomes.

CONCLUSIONS

Many children with ASD are capable of generalising to untaught equivalence relations. The results fail to support the claim that acquisition of naming responses is a pre-requisite for the emergence of untaught equivalence relations.

Undergraduates' perceptions of three augmentative and alternative communication modes

OBJECTIVE

To assess undergraduates' perceptions of three augmentative and alternative communication (AAC) modes.

METHOD

We showed 104 undergraduates a video clip of a person using each of the three AAC modes and asked them to rate each option in terms of perceived (a) intelligibility, (b) ease of acquisition, (c) effectiveness/acceptability, and (d) preference. The three AAC modes shown were (a) manual signing, (b) picture exchange, and (c) speech-generating device.

RESULTS

Mean ratings for perceived intelligibility and effectiveness/acceptability were significantly higher for the speech-generating device. The speech-generating device and manual signing options were rated as being more preferred over picture exchange. Picture exchange was rated significantly higher on perceived ease of acquisition.

CONCLUSION

Speech-generating devices were perceived to have greater social validity than manual signing and picture exchange.

Comparing acquisition of and preference for manual signs, picture exchange, and speech-generating devices in nine children with autism spectrum disorder

OBJECTIVE

To compare how quickly children with autism spectrum disorder (ASD) acquired manual signs, picture exchange, and an iPad/iPod-based speech-generating device (SGD) and to compare if children showed a preference for one of these options.

METHOD

Nine children with ASD and limited communication skills received intervention to teach requesting preferred stimuli using manual signs, picture exchange, and a SGD. Intervention was evaluated in a non-concurrent multiple-baseline across participants and alternating treatments design.

RESULTS

Five children learned all three systems to criterion. Four children required fewer sessions to learn the SGD compared to manual signs and picture exchange. Eight children demonstrated a preference for the SGD.

CONCLUSION

The results support previous studies that demonstrate children with ASD can learn manual signs, picture exchange, and an iPad/iPod-based SGD to request preferred stimuli. Most children showed a preference for the SGD. For some children, acquisition may be quicker when learning a preferred option.

Preference-Enhanced Communication Intervention and Development of Social Communicative Functions in a Child With Autism Spectrum Disorder

Individuals with autism spectrum disorder (ASD) who exhibit limited speech can learn to communicate using augmentative and alternative communication (AAC) systems. We describe the case of Ian, a 10-year-old boy with ASD who had learned to use an Apple iPod®- and iPad®-based speech-generating device (SGD)Note 1, picture exchange (PE), and manual signing (MS) for functional communication (e.g., requesting), but had difficulty in using these AAC systems for spontaneous and socially oriented functions of communication. His difficulties were originally conceptualized as reflecting the social interaction and communication deficits characteristic of ASD. Alternatively, we suggest that the intervention did not allow for the development of more advanced communication. A preference-enhanced intervention was introduced with Ian’s chosen AAC system only, that is the iPad®-based SGD. Opportunities for communication were created using highly motivating activities and behavioral strategies. Results suggest that the approach facilitated development of spontaneous and socially oriented communication.

Blood glucose overestimation in diabetic patients on continuous ambulatory peritoneal dialysis for end-stage renal disease

AIMS

Diabetic patients on continuous ambulatory peritoneal dialysis (CAPD) for renal failure depend on glucose analysers for regular monitoring of glycaemic control. We aim to inform health professionals of the potentially dangerous overestimation of blood glucose values by some analysers in patients using Icodextrin for dialysis.

METHODS

Twenty-five patients on continuous ambulatory peritoneal dialysis (10 patients on an 8-12-h nocturnal exchange of Icodextrin) had random glucose analysis performed on venous blood using standardized reference laboratory (lab) technique (glucose oxidase GOD-PAP), and simultaneously on capillary blood using the Precision Q.I.D System (glucose oxidase method) and the Advantage meter (glucose dehydrogenase method).

RESULTS

The Precision Q.I.D System agreed with the lab results in both the Icodextrin group and the non-Icodextrin group (80-90% of values fell within 20% of the corresponding lab result). In contrast, the Advantage meter agreed with the lab results only in the non-Icodextrin group (95% of values within 20% of the corresponding lab value), and not in the Icodextrin group, where only 5% of the analyser values fell within 20% of the corresponding lab value.

CONCLUSIONS

The Precision Q.I.D System, which utilizes glucose oxidase reaction, is safe for use in diabetic patients treated with Icodextrin. All analysers must be cross-checked with the laboratory reference method before use in these patients.

Germination and vigour of black gram (Vigna mungo (L.) Hepper) seed from plants grown with and without boron

Black gram (Vigna mungo (L.) Hepper) cv. Regur was grown to maturity in three potted soils [Badgingarra (Sl), Lancelin (S2) and Quailing (S3)] with (+B) or without (-B) added H3BO3. The subsequent germination and vigour of seeds from treated plants was tested by germinating them for 7 days with 2000 8M CaSO4 and 98M H3BO3and, for S2 and S3 only, by staining with tetrazolium. No symptoms of B deficiency were observed in plants on any soil:leaf B concentrations at early vegetative and flowering stages were above values regarded as critical for this species (7-8 mg kg-1). On S1, B depressed pod and seed dry matter (DM), weight per seed and % hard seed (14 v. 58); it enhanced % non-viable imbibed seed (18 v. 5) and abnormal seedlings (37 v. 2). On S2, -B had no effect on reproductive yield or % hard seed but increased the % abnormal seedlings (32 v. 0) and depressed the tetrazolium rating for seed vigour, and weight per seed. No effects of B were observed on seeds from plants grown on S3 soil. When considered over all replicates of all treatments, a B concentration of 6 mg kg-1 DM seed was critical for viability of imbibed seed and production of normal seedlings. The results suggest that the subsequent germination and morphology of seeds and seedlings are more sensitive to low B supply during seed production than are growth of the plant and the amount of seed produced. It is thus likely that black gram crops low in B but with no symptoms of B deficiency may produce seed with low % germination and a high % abnormality in their seedlings.