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Garon N, Hecker O, Kwan A, Crocker TA, English SD. Integrated versus trial specific focus improves decision-making in older preschoolers. Child Neuropsychol 2023; 29:28-55. [PMID: 35430949 DOI: 10.1080/09297049.2022.2063269] [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: 10/18/2022]
Abstract
This study explored the effect of integrated-focus (focusing on a depiction of overall gains/losses) versus trial-focus (focusing on gains/losses at each trial) on choice in a preschool variant of the Iowa Gambling task. Participants included 65 preschoolers (M = 47.82, SD = 7.29). Children completed two versions of the Preschool Gambling task, three cool executive function tasks, a moral reasoning task, and an affective perspective taking task. The results indicated that while the integrated-focus condition led to improvement in the awareness of the game, the condition effect was moderated by age for decision-making choice; older preschoolers showed improvement in decision-making in the integrated focus condition, while younger preschoolers showed no condition effect. Further analysis indicated that differences in the increase of advantageous choice across blocks and the condition effect were partly explained by these differences in awareness. Furthermore, a component of cool executive function (shifting) was associated with the latter phase of decision-making. The findings additionally indicated an association of advantageous decision-making with moral/emotional measures, suggesting that the PGT may be a potentially useful clinical tool for early assessment. Finally, the findings of the current study have implications for how hot and cool executive function abilities may work together to enable adaptive decisions.
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Affiliation(s)
- Nancy Garon
- Department of Psychology, Mount Allison University, Sackville, Canada
| | - Olivia Hecker
- Department of Psychology, Mount Allison University, Sackville, Canada
| | - Andrea Kwan
- Department of Psychology, Mount Allison University, Sackville, Canada
| | - Terese A Crocker
- Department of Psychology, Mount Allison University, Sackville, Canada
| | - Sarah D English
- Department of Psychology, University of Waterloo, Waterloo, Canada
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2
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Garon N, Zwaigenbaum L, Bryson SE, Smith IM, Brian J, Roncadin C, Vaillancourt T, Armstrong VL, Sacrey LR, Roberts W. Front Cover: Cover Image, Volume 25, Issue 5. Dev Sci 2022. [DOI: 10.1111/desc.13311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sacrey LAR, Zwaigenbaum L, Bryson SE, Brian JA, Smith IM, Garon N, Vaillancourt T, Roncadin C. Temperament in Infancy Predicts Internalizing and Externalizing Problem Behavior at Age 5 in Children With an Increased Likelihood of Autism Spectrum Disorder. Front Psychol 2022; 13:816041. [PMID: 35519644 PMCID: PMC9062223 DOI: 10.3389/fpsyg.2022.816041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Differences in temperament have been linked to later mental health. Children with autism spectrum disorder (ASD) have an increased likelihood of experiencing such problems, including anxiety, depression, attention deficit/hyperactivity disorder, and oppositional defiant disorder; yet, relations between early temperament and later mental health are not well understood. In this paper, we assess the relationship between temperament in infancy and internalizing and externalizing behavior at age 5, in 178 children at an increased likelihood of being diagnosed with ASD (i.e., younger siblings of children with ASD). Temperament was assessed using the parent-reported Infant Behavior Questionnaire (IBQ) at 6 and 12 months of age and the Toddler Behavior Assessment Questionnaire-Revised (TBAQ-R) at 24 months of age. Mental health problems were assessed using the parent-reported Child Behavior Checklist (CBCL) at age 5. The data were analyzed using hierarchical multiple regressions, with individual temperament subscale scores as single predictor variables (Subscale Score) or temperament profiles using confirmatory factor analyses (Person-Centered Profile) in the first block, Autism Diagnostic Observation Schedule total severity scores at age 3 in the second block, and expressive and receptive language scores (from Mullen Scales of Early Learning) at age 3 in the third block for each model. Three main findings were: (1) 4 of 6 IBQ subscales at both 6 and 12 months significantly predicted internalizing and externalizing problems at age 5; (2) 9 and 8 of 13 TBAQ-R subscales at 24 months significantly predicted internalizing and externalizing problems, respectively, at age 5; and (3) a "sticky attention" temperament profile significantly predicted internalizing problems, whereas a "low-focused" profile significantly predicted externalizing problems, both at age 5. The results of this study support the supposition that temperament is a trans-diagnostic risk factor for later mental health conditions. Exploring temperament profiles and trajectories may illuminate early avenues for prevention in siblings of children with ASD who are at an increased likelihood of experiencing mental health problems, regardless of ASD diagnostic status.
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Affiliation(s)
- Lori-Ann R. Sacrey
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Susan E. Bryson
- Dalhousie University, IWK Health Centre, Halifax, NS, Canada
| | - Jessica A. Brian
- Bloorview Research Institute, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Isabel M. Smith
- Dalhousie University, IWK Health Centre, Halifax, NS, Canada
| | - Nancy Garon
- Department of Psychology, Mount Allison University, Sackville, NB, Canada
| | | | - Caroline Roncadin
- McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
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4
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Garon N, Zwaigenbaum L, Bryson SE, Smith IM, Brian J, Roncadin C, Vaillancourt T, Armstrong VL, Sacrey LAR, Roberts W. Precursors of Self-Regulation in Infants at Elevated Likelihood for Autism Spectrum Disorder. Dev Sci 2022; 25:e13247. [PMID: 35174584 DOI: 10.1111/desc.13247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/19/2021] [Accepted: 02/04/2022] [Indexed: 12/01/2022]
Abstract
Research concerning temperament in children and adults with autism spectrum disorder (ASD) has suggested a consistent profile of low positive affect, high negative affect, and low regulation (Visser et al., 2016). One area receiving less attention is individual differences among children diagnosed with ASD. The primary objective of this study was to use a person-centered approach to explore heterogeneity of early temperament precursors of regulation in a large sample of infants with elevated familial likelihood of ASD. Early precursors of regulation included temperament assessed at 6, 12, and 24 months whereas outcome measures were diagnosis of ASD, cognitive ability and adaptive behavior at 36 months. Participants included 176 low-likelihood and 473 elevated-likelihood infants, 129 of whom were diagnosed with ASD at 3 years. Results supported a three-profile solution: a well-regulated profile (high positive affect and high attentional focus and shifting), a low attention focus profile (higher attentional shifting compared to attentional focus), and a low attention shifting profile (higher attentional focus compared to attentional shifting). A higher proportion of children diagnosed with ASD were classified into the low attention shifting profile. Furthermore, children with the well-regulated profile were differentiated from the other profiles by a pattern of higher social competence and lower dysregulation whereas children with the low attention focus profile were distinguished from the other profiles by higher cognitive ability at 3 years. The findings indicate that the combination of early positive affect with attention measures may provide an enhanced tool for prediction of self-regulation and later outcomes. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Nancy Garon
- Mount Allison University, Sackville, NB, Canada
| | - Lonnie Zwaigenbaum
- Departments of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Department of Pediatrics, Autism Research Centre, Edmonton, AB, Canada
| | - Susan E Bryson
- Dalhousie University/IWK Health Centre, Halifax, NS, Canada
| | - Isabel M Smith
- Dalhousie University/IWK Health Centre, Halifax, NS, Canada
| | - Jessica Brian
- Bloorview Research Department of Pediatrics, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Caroline Roncadin
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | | | | | - Lori-Ann R Sacrey
- Departments of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Department of Pediatrics, Autism Research Centre, Edmonton, AB, Canada
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5
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Waschbusch DA, Babinski DE, Fosco WD, Haas SM, Waxmonsky JG, Garon N, Nichols S, King S, Santor DA, Andrade BF. Inhibitory Control, Conduct Problems, and Callous Unemotional Traits in Children with ADHD and Typically Developing Children. Dev Neuropsychol 2022; 47:42-59. [DOI: 10.1080/87565641.2022.2032713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Daniel A. Waschbusch
- Department of Psychiatry and Behavioral Health, Penn State Hershey Medical Center and College of Medicine
| | - Dara E. Babinski
- Department of Psychiatry and Behavioral Health, Penn State Hershey Medical Center and College of Medicine
| | - Whitney D. Fosco
- Department of Psychiatry and Behavioral Health, Penn State Hershey Medical Center and College of Medicine
| | - Sarah M. Haas
- Department of Psychiatry and Behavioral Health, Penn State Hershey Medical Center and College of Medicine
| | - James G. Waxmonsky
- Department of Psychiatry and Behavioral Health, Penn State Hershey Medical Center and College of Medicine
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Sacrey LAR, Zwaigenbaum L, Bryson S, Brian J, Smith IM, Roberts W, Szatmari P, Vaillancourt T, Roncadin C, Garon N. Screening for Behavioral Signs of Autism Spectrum Disorder in 9-Month-Old Infant Siblings. J Autism Dev Disord 2021; 51:839-848. [PMID: 31939081 DOI: 10.1007/s10803-020-04371-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 11/29/2022]
Abstract
Despite considerable progress in characterizing the early signs of autism spectrum disorder (ASD), more remains to be learned about how symptoms emerge in the first year of life. Parents with a new baby who already had at least one biological child diagnosed with ASD (high-risk) or no family history of ASD (low-risk) completed two measures when their baby was 9 months of age, the Autism Parent Screen for Infants (APSI) questionnaire and the interview-based Parent Concerns Form. Children underwent a blinded independent diagnostic assessment for ASD at age 3 years. Total scores on the APSI and the Parent Concerns Form were both able to independently differentiate high-risk children who were later diagnosed with ASD from other high-risk and low-risk children who were not. Using logistic regression, we found that the total score on the APSI predicted ASD outcomes at age 3 with 70% accuracy, but the Parent Concerns Form did not contribute any unique variance when the APSI was already in the model. The results suggest that the APSI identifies early features predictive of ASD in high-risk infants and can be used to flag them for targeted follow-up and screening.
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Affiliation(s)
- Lori-Ann R Sacrey
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. .,Department of Pediatrics, Autism Research Centre - E209, Glenrose Rehabilitation Hospital, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada.
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Department of Pediatrics, Autism Research Centre - E209, Glenrose Rehabilitation Hospital, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada
| | - Susan Bryson
- Dalhousie University/IWK Health Centre, Halifax, NS, Canada
| | - Jessica Brian
- Bloorview Research Institute, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Isabel M Smith
- Dalhousie University/IWK Health Centre, Halifax, NS, Canada
| | | | - Peter Szatmari
- University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Caroline Roncadin
- University of Toronto, Toronto, ON, Canada.,McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Nancy Garon
- Mount Allison University, Sackville, NB, Canada
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7
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Zwaigenbaum L, Bryson SE, Brian J, Smith IM, Sacrey L, Armstrong V, Roberts W, Szatmari P, Garon N, Vaillancourt T, Roncadin C. Assessment of Autism Symptoms From 6 to 18 Months of Age Using the Autism Observation Scale for Infants in a Prospective High-Risk Cohort. Child Dev 2020; 92:1187-1198. [PMID: 33368222 DOI: 10.1111/cdev.13485] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The objectives were to characterize behavioral signs of autism spectrum disorder (ASD) in younger siblings of diagnosed children (high-risk; HR) and examine classification features of the Autism Observation Scale for Infants (AOSI). Participants (501 HR and 180 low-risk [LR]) were assessed between 6 and 18 months using the AOSI and at age 3 for ASD diagnoses. Total AOSI scores differentiated HR infants later diagnosed with ASD starting at 12 months. ROC analyses identified 12- and 18-month cutoff scores associated with 0.52 sensitivity and 0.74 specificity and 0.73 sensitivity and 0.65 specificity, respectively. Although classification accuracy does not support use as a standalone screen, the AOSI identifies features associated with ASD starting at 6 months and differentiates HR infants with ASD by 12 months.
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Affiliation(s)
| | | | | | | | | | | | - Wendy Roberts
- Integrated Services for Autism and Neurodevelopmental Disorders
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Smith IM, Waddell C, Ungar WJ, den Otter J, Murray P, Vezina F, D'Entremont B, Flanagan HE, Garon N. Preschool autism services: A tale of two Canadian provinces and the implications for policy. Paediatr Child Health 2020; 26:145-148. [PMID: 33936332 DOI: 10.1093/pch/pxaa097] [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: 03/24/2020] [Accepted: 07/22/2020] [Indexed: 11/13/2022] Open
Abstract
For children with autism spectrum disorder (ASD), a lifelong neurodevelopmental condition, assessment and treatment services vary widely across Canada-potentially creating inequities. To highlight this, the Preschool Autism Treatment Impact study compared children's services and outcomes in New Brunswick (NB) and Nova Scotia (NS). Diagnostic practices, service delivery models, wait times, and treatment approaches differed, as did children's 1-year outcomes and costs for families and the public sector. Considering NB and NS strengths, we suggest that an optimal system would include: rapid access to high-quality diagnostic and intervention services; adherence to research-informed practice guidelines; interventions to enhance parents' skills and self-efficacy; and measures to minimize financial burdens for families. Our results also suggest that provinces/territories must do more to ensure equitable access to effective services, including sharing and reporting on national comparative data. Canadian children with ASD deserve access to effective and consistent services, no matter where they live.
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Affiliation(s)
- Isabel M Smith
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia.,Department of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia.,Autism Research Centre, IWK Health Centre, Halifax, Nova Scotia
| | - Charlotte Waddell
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia
| | - Wendy J Ungar
- Hospital for Sick Children Research Institute, Toronto, Ontario.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
| | - Jeffrey den Otter
- Department of Education and Early Childhood Development, Government of New Brunswick, Fredericton, New Brunswick
| | - Patricia Murray
- Department of Health and Wellness, Government of Nova Scotia, Halifax, Nova Scotia
| | - Francine Vezina
- Health Promotion and Mental Health & Addictions, Department of Health and Wellness, Government of Nova Scotia, Halifax, Nova Scotia
| | - Barbara D'Entremont
- Department of Psychology, University of New Brunswick, Fredericton, New Brunswick
| | | | - Nancy Garon
- Department of Psychology, Mount Allison University, Sackville, New Brunswick
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Franchini M, Hamodat T, Armstrong VL, Sacrey LAR, Brian J, Bryson SE, Garon N, Roberts W, Zwaigenbaum L, Smith IM. Infants at Risk for Autism Spectrum Disorder: Frequency, Quality, and Variety of Joint Attention Behaviors. J Abnorm Child Psychol 2020; 47:907-920. [PMID: 30146674 DOI: 10.1007/s10802-018-0471-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Initiation of joint attention is a critical developmental function related to further social communicative development in infancy. Joint attention appears to be impaired very early in life for children with autism spectrum disorder (ASD), well before a formal diagnosis is established. To observe the early development of joint attention, we prospectively followed infant siblings at high risk for ASD (HR) and low-risk (LR) infants. Initiations of joint attention behaviors were coded with respect to frequency, quality, and variety from videos taken during the administration of the Autism Observation Schedule for Infants. Participants were further stratified based on the presence of ASD (n = 17) or language delay (n = 19) at 3 years of age. Our results revealed that initiations of joint attention are impaired from 12 months of age in both children with ASD and those with language delay, especially for use of gestures (i.e., showing and pointing). At 18 months, fewer initiations of joint attention in all three dimensions distinguished infants with ASD, compared to infants with language delay and HR and LR infants without a diagnosis. Beyond the definition of initiation of joint attention as an early sign for ASD, clinical implications of these results concern the importance of intervening on frequency, quality, and variety of joint attention as early as possible in infants at heightened risk for ASD.
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Affiliation(s)
- Martina Franchini
- Autism Research Centre, IWK Health Centre, 5850/5980 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada. .,Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.
| | - T Hamodat
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - V L Armstrong
- Autism Research Centre, IWK Health Centre, 5850/5980 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada
| | - L-A R Sacrey
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - J Brian
- Bloorview Research Institute, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - S E Bryson
- Autism Research Centre, IWK Health Centre, 5850/5980 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada.,Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - N Garon
- Department of Psychology, Mount Allison University, Sackville, NB, Canada
| | - W Roberts
- Integrated Services for Autism and Neurodevelopmental Disorders, Toronto, ON, Canada
| | - L Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - I M Smith
- Autism Research Centre, IWK Health Centre, 5850/5980 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada.,Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.,Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
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Tsiplova K, Ungar WJ, Flanagan HE, den Otter J, Waddell C, Murray P, D'Entremont B, Léger N, Garon N, Bryson S, Smith IM. Types of Services and Costs of Programs for Preschoolers with Autism Spectrum Disorder Across Sectors: A Comparison of Two Canadian Provinces. J Autism Dev Disord 2019; 49:2492-2508. [PMID: 30937737 DOI: 10.1007/s10803-019-03993-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/23/2022]
Abstract
This study measured resource utilization and costs for pre-school autism spectrum disorder (ASD)-related services in community-based sectors from multiple payer perspectives in two Canadian provinces, Nova Scotia (NS) and New Brunswick (NB), during the 12 months prior to and following the start of early intensive behavioural intervention (EIBI). The results indicate significant differences between NB and NS in utilization of services and costs to families, public sector and society. Differences can be attributed to variation in EIBI delivery models and may also be influenced by differences in diagnostic assessment practices. The study results provide resource utilization rates and costs which could be used in future economic evaluations and to inform policy making to improve outcomes for children with ASD.
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Affiliation(s)
- Kate Tsiplova
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, 686 Bay Street, Toronto, ON, M5G 0A4, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada. .,Program of Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, 11th floor, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
| | - Helen E Flanagan
- Autism Research Centre, IWK Health Centre, 4th Floor Link Building, 5850/5980 University Avenue, Halifax, NS, B3K 6R8, Canada
| | - Jeffrey den Otter
- Department of Education and Early Childhood Development, Government of New Brunswick, Place 2000, P. O. Box 6000, Fredericton, NB, E3B 5H1, Canada
| | - Charlotte Waddell
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Patricia Murray
- Department of Health and Wellness, Government of Nova Scotia, PO Box 488, Halifax, NS, B3J 2R8, Canada
| | - Barbara D'Entremont
- Department of Psychology, University of New Brunswick, PO Box 4400, Fredericton, NB, E3B 5A3, Canada
| | - Natalie Léger
- Department of Education and Early Childhood Development, Government of New Brunswick, Place 2000, P. O. Box 6000, Fredericton, NB, E3B 5H1, Canada
| | - Nancy Garon
- Department of Psychology, Mount Allison University, 49A York St., Sackville, NB, E4L 1C7, Canada
| | - Susan Bryson
- Autism Research Centre, IWK Health Centre, 4th Floor Link Building, 5850/5980 University Avenue, Halifax, NS, B3K 6R8, Canada.,Department of Pediatrics, Dalhousie University, 5850 University Avenue, P. O. Box 9700, Halifax, NS, B3K 6R8, Canada
| | - Isabel M Smith
- Autism Research Centre, IWK Health Centre, 4th Floor Link Building, 5850/5980 University Avenue, Halifax, NS, B3K 6R8, Canada.,Department of Pediatrics, Dalhousie University, 5850 University Avenue, P. O. Box 9700, Halifax, NS, B3K 6R8, Canada
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11
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Sacrey LAR, Zwaigenbaum L, Bryson S, Brian J, Smith IM, Raza S, Roberts W, Szatmari P, Vaillancourt T, Roncadin C, Garon N. Developmental trajectories of adaptive behavior in autism spectrum disorder: a high-risk sibling cohort. J Child Psychol Psychiatry 2019; 60:697-706. [PMID: 30295313 DOI: 10.1111/jcpp.12985] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 08/21/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Children with autism spectrum disorder (ASD) often experience impairments in adaptive behavior. METHODS Developmental trajectories of adaptive behavior in ASD were examined in children from high-risk (siblings of children diagnosed with ASD, n = 403) and low-risk (no family history of ASD, n = 163) families. Children were assessed prospectively at 12, 18, 24, and 36 months of age using the Vineland Adaptive Behavior Scales and underwent a blind independent diagnostic assessment for ASD at 36 months of age. RESULTS The semi-parametric group-based modeling approach using standard scores on the Adaptive Behavior Composite revealed three distinct developmental trajectories: (a) Group 1 (21.2% of sample) showed average performance at 12 months and a declining trajectory; (b) Group 2 (52.8% of the sample) showed average performance at 12 months with a slightly declining trajectory; and (c) Group 3 (26.0% of the sample) showed a higher level of adaptive behavior at 12 months and a stable trajectory. The Mullen Scales of Early Learning Early Learning Composite and the Autism Observation Scale for Infants total score at 6 and 12 months predicted trajectory membership. CONCLUSIONS The results emphasize heterogeneous development associated with ASD and the need for interventions tailored to individual presentations.
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Affiliation(s)
- Lori-Ann R Sacrey
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Susan Bryson
- Dalhousie University/IWK Health Centre, Halifax, NS, Canada
| | - Jessica Brian
- Bloorview Research Institute, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Isabel M Smith
- Dalhousie University/IWK Health Centre, Halifax, NS, Canada
| | - Sarah Raza
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | | | - Peter Szatmari
- University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Caroline Roncadin
- University of Toronto, Toronto, ON, Canada.,McMaster Children's Hospital/Hamilton Health Sciences, Hamilton, ON, Canada
| | - Nancy Garon
- Mount Allison University, Sackville, NB, Canada
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12
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Smith IM, Flanagan HE, Ungar WJ, D'Entremont B, Garon N, den Otter J, Waddell C, Bryson SE, Tsiplova K, Léger N, Vezina F, Murray P. Comparing the 1-year impact of preschool autism intervention programs in two Canadian provinces. Autism Res 2019; 12:667-681. [PMID: 30632299 DOI: 10.1002/aur.2072] [Citation(s) in RCA: 5] [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: 07/07/2018] [Revised: 12/03/2018] [Accepted: 12/10/2018] [Indexed: 12/25/2022]
Abstract
Autism spectrum disorder (ASD) is associated with early differences in children's social interactions, communication, and play/interests. In many countries, considerable resources are invested in early intensive behavioral intervention (EIBI) programs for children with ASD, which aim to build adaptive skills and prevent or treat problem behavior. However, these programs vary widely in structure and delivery. Research evidence supports the efficacy of EIBI, but large knowledge gaps remain about the effectiveness of publicly funded EIBI programs. With policy-makers as formal research partners, we compared children's progress over 1 year in public preschool programs in adjacent Canadian provinces, New Brunswick (NB) and Nova Scotia (NS). In NB, children received up to 20 hr/week of comprehensive EIBI in a publicly funded, privately provided program. In NS, children received up to 15 hr/week of Pivotal Response Treatment and Positive Behavior Support delivered through the publicly funded healthcare system. In this observational parallel cohort study, we collected parent-reported data on 298 NB preschoolers (76.5% boys) and 221 NS preschoolers (86.9% boys) at EIBI start and 1 year later. Multilevel analysis revealed significant differences at baseline: NS children were older, with lower adaptive functioning and more severe ASD symptoms than NB children. Despite these pre-treatment differences that favor NB, children in both provinces showed similar adaptive functioning gains and reductions of maladaptive behavior. No changes were seen in mean ASD symptom severity in either province over time. Results highlight the value of evaluating interventions in their implementation contexts, and have important implications for devising optimal ASD policy. Autism Research 2019, 12: 667-681. © 2019 International Society for Autism Research,Wiley Periodicals, Inc. LAY SUMMARY: We need to know more about the impact of different forms of early intensive behavioral intervention (EIBI) for young children with autism spectrum disorder (ASD). We showed that preschoolers with ASD gained important skills while in public EIBI programs in two Canadian provinces. We also saw that differences in how EIBI programs are structured and characteristics of children who are served may affect outcomes. For these reasons, policy making requires evidence that fits the local context.
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Affiliation(s)
- Isabel M Smith
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.,Autism Research Centre, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Helen E Flanagan
- Autism Research Centre, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,The Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Barbara D'Entremont
- Department of Psychology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Nancy Garon
- Department of Psychology, Mount Allison University, Sackville, New Brunswick, Canada
| | - Jeffrey den Otter
- Department of Education and Early Childhood Development, Government of New Brunswick, Fredericton, New Brunswick, Canada
| | - Charlotte Waddell
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Susan E Bryson
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.,Autism Research Centre, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Kate Tsiplova
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Natalie Léger
- Department of Education and Early Childhood Development, Government of New Brunswick, Fredericton, New Brunswick, Canada
| | - Francine Vezina
- Department of Health and Wellness, Government of Nova Scotia, Halifax, Nova Scotia, Canada
| | - Patricia Murray
- Department of Health and Wellness, Government of Nova Scotia, Halifax, Nova Scotia, Canada
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Sacrey LAR, Zwaigenbaum L, Bryson S, Brian J, Smith IM, Roberts W, Szatmari P, Vaillancourt T, Roncadin C, Garon N. Parent and clinician agreement regarding early behavioral signs in 12- and 18-month-old infants at-risk of autism spectrum disorder. Autism Res 2018; 11:539-547. [PMID: 29356441 DOI: 10.1002/aur.1920] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/21/2017] [Accepted: 12/27/2017] [Indexed: 11/07/2022]
Abstract
Parent and clinician agreement regarding early behavioral signs of Autism Spectrum Disorder (ASD) in children from a high-risk cohort (siblings of children diagnosed with ASD, n = 188) was examined. Infants were assessed prospectively at 12 and 18 months of age using the clinician administered Autism Observational Scale for Infants (AOSI) and the Autism Parent Screen for Infants (APSI) and underwent a blind independent diagnostic assessment for ASD at 36 months of age. Direct comparison of parent and clinician ratings showed poor agreement on all early behavioral signs, with parent-reported symptoms being better able to differentiate between children with and without ASD at both 12 and 18 months of age compared to clinician observations during a brief office visit. The results suggest that parents may detect some clinically informative behaviors based on their day-to-day observations more readily than do clinicians during brief clinical assessments, a result that needs to be replicated in a non-sibling cohort. Autism Res 2018, 11: 539-547. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY Parents of children at high-risk of autism spectrum disorder (ASD; have an older sibling with ASD) and clinicians were compared on their reporting of 19 early signs of autism. Direct comparison of parent and clinician ratings showed poor agreement on all early behavioral signs, with parent-reported symptoms being better able to differentiate between children with and without ASD at both 12 and 18 months of age compared to clinician observations during a brief office visit. This suggests that parents may have important information regarding early development of their high-risk child.
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Affiliation(s)
- Lori-Ann R Sacrey
- Department of Pediatrics, University of Alberta, Edmonton, Alberta.,Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, Alberta
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta.,Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, Alberta
| | - Susan Bryson
- Dalhousie University/IWK Health Centre, Halifax, Nova Scotia
| | - Jessica Brian
- Bloorview Research Institute, Toronto, Ontario.,University of Toronto, Toronto, Ontario
| | - Isabel M Smith
- Dalhousie University/IWK Health Centre, Halifax, Nova Scotia
| | | | - Peter Szatmari
- University of Toronto, Toronto, Ontario.,The Hospital for Sick Children, Toronto, Ontario.,Centre for Addiction and Mental Health, Toronto, Ontario
| | | | - Caroline Roncadin
- University of Toronto, Toronto, Ontario.,McMaster Children's Hospital/Hamilton Health Sciences, Hamilton, Ontario
| | - Nancy Garon
- Mount Allison University, Sackville, New Brunswick
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Garon N, Smith IM, Bryson SE. Early executive dysfunction in ASD: Simple versus complex skills. Autism Res 2017; 11:318-330. [PMID: 29149519 DOI: 10.1002/aur.1893] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/19/2017] [Accepted: 10/29/2017] [Indexed: 11/05/2022]
Abstract
Despite the strong evidence of executive function (EF) impairment in Autism Spectrum Disorder (ASD), findings in the preschool period have been inconsistent. Whereas some research has supported an early deficit, many studies have not found early differences in EF. The present study assessed simple and complex components of three EF abilities: working memory, inhibition, and shifting, using a novel battery, the Preschool EF Battery (PEFB; Garon, Smith & Bryson, Child Neuropsychology, 20, 713-736, 2014). Previous research has indicated that the PEFB is sensitive to age differences in typically developing (TD) children aged 18-60 months. Current participants were 34 preschoolers (M = 54.79 months) diagnosed with ASD and 255 TD preschoolers (M = 42.98 months). Results indicated significant differences between the two groups in the three EF abilities, but specific findings were moderated by mental and chronological age. The findings highlight the importance of testing simpler EF skills in very young children with ASD. Autism Res 2018, 11: 318-330. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY Given that executive functions (EF) have been found to predict various outcomes such as academic ability and occupational success, sensitive early assessment is important. The current study suggests the presence of early EF deficits in preschool children with autism spectrum disorder. The study highlights the importance of considering how EF develops during early life in typically developing children in order to design sensitive EF measures.
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Affiliation(s)
- Nancy Garon
- Department of Psychology, Mount Allison University, Sackville, Canada
| | - Isabel M Smith
- Department of Pediatrics and Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada.,IWK Health Centre, Halifax, Canada
| | - Susan E Bryson
- Department of Pediatrics and Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada.,IWK Health Centre, Halifax, Canada
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15
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Sacrey LAR, Zwaigenbaum L, Szatmari P, Bryson S, Georgiades S, Brian J, Smith IM, Vaillancourt T, Garon N, Roncadin C, Elsabbagh M. Brief Report: Characteristics of preschool children with ASD vary by ascertainment. J Autism Dev Disord 2017; 47:1542-1550. [PMID: 28224344 DOI: 10.1007/s10803-017-3062-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 12/28/2022]
Abstract
Prospective studies of infant siblings of children diagnosed with autism spectrum disorder (ASD) provide a unique opportunity to characterize ASD as it unfolds. A critical question that remains unanswered is whether and how these children with ASD resemble other children identified from the community, including those with no family history. The purpose of this study was to compare clinical characteristics of children with ASD identified by each method (n = 86 per group), drawn from two Canadian longitudinal research cohorts. Children ascertained from a prospective cohort were less severely affected and included a larger proportion of girls, compared to the clinically referred sample. These results may have important implications for conclusions drawn from studies of high-risk and clinically referred cohorts.
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Affiliation(s)
- Lori-Ann R Sacrey
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. .,Autism Research Centre-E209, Glenrose Rehabilitation Hospital, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada.
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Autism Research Centre-E209, Glenrose Rehabilitation Hospital, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada
| | - Peter Szatmari
- University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Susan Bryson
- Dalhousie University/IWK Health Centre, Halifax, NS, Canada
| | | | - Jessica Brian
- University of Toronto, Toronto, ON, Canada.,Bloorview Research Institute, Toronto, ON, Canada
| | - Isabel M Smith
- Dalhousie University/IWK Health Centre, Halifax, NS, Canada
| | | | - Nancy Garon
- Mount Allison University, Sackville, NB, Canada
| | - Caroline Roncadin
- University of Toronto, Toronto, ON, Canada.,McMaster Children's Hospital/Hamilton Health Sciences, Hamilton, ON, Canada
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Bryson S, Garon N, McMullen T, Brian J, Zwaigenbaum L, Armstrong V, Roberts W, Smith I, Szatmari P. Impaired disengagement of attention and its relationship to emotional distress in infants at high-risk for autism spectrum disorder. J Clin Exp Neuropsychol 2017; 40:487-501. [PMID: 28914144 DOI: 10.1080/13803395.2017.1372368] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 10/18/2022]
Abstract
INTRODUCTION We provide data on visual orienting and emotional distress in infants at high and low risk for autism spectrum disorder (ASD). METHOD Participants included 83 high-risk (HR) infants with an older sibling with ASD and 53 low-risk (LR) control infants with no family history of ASD. Infants were assessed on the gap-overlap task and a parent-completed temperament questionnaire at 6 and 12 months of age. At 36 months of age, an independent, gold standard diagnostic assessment for ASD was conducted. RESULTS HR infants subsequently diagnosed with ASD were distinguished at 12 months by an asymmetric disengage impairment (for left- vs. right-sided stimuli) that was associated with an increase in latencies between 6 and 12 months. Across groups, prolonged left-directed disengage latencies at 12 months were associated with emotional distress (high irritability and difficult to soothe). CONCLUSIONS The asymmetry in our findings raises the question of whether the disengage problem in ASD is at base one of orienting or alerting attention. Our findings also raise the question of whether attention training might be a critical ingredient in the early treatment of ASD.
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Affiliation(s)
- Susan Bryson
- a Department of Pediatrics , Dalhousie University , Halifax , NS , Canada.,b Department of Psychology & Neuroscience , Dalhousie University , Halifax , NS , Canada.,c Autism Research Centre , IWK Health Centre , Halifax , NS , Canada
| | - Nancy Garon
- d Department of Psychology , Mount Allison University , Sackville , NB , Canada
| | - Tracey McMullen
- e Department of Psychology , York University , Toronto , ON , Canada
| | - Jessica Brian
- f Autism Research Centre , Bloorview Research Institute/University of Toronto , Toronto , ON , Canada
| | - Lonnie Zwaigenbaum
- g Department of Pediatrics , University of Alberta , Edmonton , AB , Canada.,h Autism Research , Glenrose Rehabilitation Hospital , Edmonton , AB , Canada
| | - Vickie Armstrong
- c Autism Research Centre , IWK Health Centre , Halifax , NS , Canada
| | | | - Isabel Smith
- a Department of Pediatrics , Dalhousie University , Halifax , NS , Canada.,b Department of Psychology & Neuroscience , Dalhousie University , Halifax , NS , Canada.,c Autism Research Centre , IWK Health Centre , Halifax , NS , Canada
| | - Peter Szatmari
- j Department of Psychiatry , University of Toronto , Toronto , ON , Canada.,k Hospital for Sick Children , Toronto , ON , Canada.,l Child and Youth Mental Health Collaborate , Centre for Addiction and Mental Health , Toronto , ON , Canada
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Fossum KL, Williams L, Garon N, Bryson SE, Smith IM. Pivotal response treatment for preschoolers with autism spectrum disorder: Defining a predictor profile. Autism Res 2017; 11:153-165. [PMID: 28861936 DOI: 10.1002/aur.1859] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/24/2017] [Accepted: 08/14/2017] [Indexed: 12/22/2022]
Abstract
Behavioral characteristics of children with autism spectrum disorder (ASD) who respond positively to Pivotal Response Treatment (PRT) have been described previously, based on single-subject design research. The present study examined several such characteristics, as well as positive affect, as predictors of expressive language (EL) gains in a representative sample of preschoolers with ASD (n = 57) enrolled in a PRT-based community early intervention program. Children's cognitive ability, positive affect, and levels of appropriate toy contact measured at the start of intervention each contributed significantly to the prediction of EL outcomes. Together these variables accounted for 40% of the total outcome variance. In addition, a profile of increased EL ability, positive affect and appropriate toy contact, and decreased social avoidance and stereotyped and repetitive vocalizations was associated with greater gains during intervention. Results are discussed in relation to their implications for understanding both the variable treatment response documented in children with ASD and how to tailor treatment to optimize individual benefit. Autism Res 2018, 11: 153-165. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY The study examined behavior of 57 preschoolers who made the greatest and least gains from 1 year of a community Pivotal Response Treatment program. Using pre-treatment videos, we saw that children who made the most progress showed more language, positive affect, and appropriate interactions with toys, also less avoidance of people and fewer repetitive vocalizations. Behavior profiles can be used to match treatment to individual children's needs.
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Affiliation(s)
- Kristin-Lee Fossum
- Department of Psychology & Neuroscience, Dalhousie University, PO Box 15000 Halifax, NS, B3H 4R2, Canada
| | - Loriann Williams
- Department of Psychology & Neuroscience, Dalhousie University, PO Box 15000 Halifax, NS, B3H 4R2, Canada
| | - Nancy Garon
- Department of Psychology, Mount Allison University, 49A York Street, Sackville, NB, E4L 1C7, Canada
| | - Susan E Bryson
- Department of Pediatrics, Dalhousie University, Autism Research Centre, IWK Health Centre, PO Box 9700, Halifax, NS, B3J 6R8, Canada
| | - Isabel M Smith
- Department of Pediatrics, Dalhousie University, Autism Research Centre, IWK Health Centre, PO Box 9700, Halifax, NS, B3J 6R8, Canada
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Abstract
Working memory (WM) plays an important role in children's learning and is linked to later academic and occupational success. Understanding the early development of WM can provide critical clues regarding the underlying structure of executive functions and how they change over the life span. The main objectives of the present study were to (1) investigate age differences in the development of three components of WM (retrieval, substitution, transformation) on a novel preschool WM measure and (2) explore whether findings are consistent with the hierarchical model of WM development by examining perseverative and non-perseverative WM errors. Perseverative errors were hypothesized to be more strongly associated with problems substituting and transforming a representation held in mind, whereas non-perseverative errors were hypothesized to be associated with problems maintaining a representation in mind. Participants were 64 children ranging in age from 3.0 to 5.6 years. The results provide evidence for the sensitivity of the WM task to age differences from 3 to 5 years and support for the hierarchical model of WM development.
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Affiliation(s)
- Ainsley M Boudreau
- a Department of Psychology and Neuroscience , Dalhousie University , Halifax , NS , Canada
| | - Erin E Dempsey
- a Department of Psychology and Neuroscience , Dalhousie University , Halifax , NS , Canada
| | - Isabel M Smith
- a Department of Psychology and Neuroscience , Dalhousie University , Halifax , NS , Canada.,b Department of Pediatrics , Dalhousie University , Halifax , NS , Canada.,c IWK Health Centre , Halifax , NS , Canada
| | - Nancy Garon
- d Department of Psychology , Mount Allison University , Sackville , NB , Canada
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20
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Sacrey LAR, Bryson S, Zwaigenbaum L, Brian J, Smith IM, Roberts W, Szatmari P, Vaillancourt T, Roncadin C, Garon N. The Autism Parent Screen for Infants: Predicting risk of autism spectrum disorder based on parent-reported behavior observed at 6–24 months of age. Autism 2016; 22:322-334. [DOI: 10.1177/1362361316675120] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study examined whether a novel parent-report questionnaire, the Autism Parent Screen for Infants, could differentiate infants subsequently diagnosed with autism spectrum disorder from a high-risk cohort (siblings of children diagnosed with autism spectrum disorder (n = 66)) from high-risk and low-risk comparison infants (no family history of autism spectrum disorder) who did not develop autism spectrum disorder (n = 138 and 79, respectively). Participants were assessed prospectively at 6, 9, 12, 15, 18, and 24 months of age. At 36 months, a blind independent diagnostic assessment for autism spectrum disorder was completed. Parent report on the Autism Parent Screen for Infants was examined in relation to diagnostic outcome and risk status (i.e. high-risk sibling with autism spectrum disorder, high-risk sibling without autism spectrum disorder, and low-risk control). The results indicated that from 6 months of age, total score on the Autism Parent Screen for Infants differentiated between the siblings with autism spectrum disorder and the other two groups. The sensitivity, specificity, and positive and negative predictive validity of the Autism Parent Screen for Infants highlight its potential for the early screening of autism spectrum disorder in high-risk cohorts.
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Affiliation(s)
- Lori-Ann R Sacrey
- University of Alberta, Canada
- Glenrose Rehabilitation Hospital, Canada
| | | | | | - Jessica Brian
- Bloorview Research Institute, Canada
- University of Toronto, Canada
| | | | - Wendy Roberts
- University of Toronto, Canada
- The Hospital for Sick Children, Canada
| | - Peter Szatmari
- University of Toronto, Canada
- The Hospital for Sick Children, Canada
- Centre for Addiction and Mental Health, Canada
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Smith IM, Flanagan HE, Garon N, Bryson SE. Effectiveness of community-based early intervention based on pivotal response treatment. J Autism Dev Disord 2015; 45:1858-72. [PMID: 25563454 DOI: 10.1007/s10803-014-2345-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Preschoolers (n = 118) with autism spectrum disorder (ASD) participated in this prospective effectiveness study of an early intervention program. Treatment entailed parent training and therapist-implemented components, incorporating Pivotal Response Treatment and Positive Behaviour Support. Standardized ability and behavioural measures were gathered prior to and following the 1-year intervention. Analyses were conducted for three groups based on baseline IQ: Higher IQ (≥ 70; n = 36), Moderately Low IQ (40-69; n = 40), and Very Low IQ (<40, n = 42). Observed gains in key language and cognitive outcomes were significant for all groups. Baseline cognitive scores significantly predicted 1-year outcomes. Results are encouraging for this relatively low-intensity community-based intervention program.
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Affiliation(s)
- Isabel M Smith
- Departments of Pediatrics and Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada,
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22
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Zwaigenbaum L, Bryson SE, Brian J, Smith IM, Roberts W, Szatmari P, Roncadin C, Garon N, Vaillancourt T. Stability of diagnostic assessment for autism spectrum disorder between 18 and 36 months in a high-risk cohort. Autism Res 2015; 9:790-800. [PMID: 26613202 DOI: 10.1002/aur.1585] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [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: 12/17/2014] [Accepted: 10/30/2015] [Indexed: 12/24/2022]
Abstract
Children with autism spectrum disorder (ASD) are diagnosed, on average, around the age of 4 years. However, previous research has shown that the diagnosis can be made as early as 2 years, and that if the child is seen a year or more later, it is highly likely that the diagnosis will be confirmed. In this study, to examine whether diagnoses made as early as 18 months of age are also "stable," we followed a group of younger siblings of children with ASD (who are known to be at higher risk). We also examined whether the age of ASD diagnosis within this high-risk group was related to the severity of children's ASD symptoms or developmental delays. Participants (n = 381) were seen at three ages: 18 months, 24 months, and 3 years. ASD symptoms, general development, and adaptive functioning were assessed at each time point. Twenty-three children were diagnosed with ASD at 18 months and a total of 61 at 24 months. Of these diagnoses, 19/23 (82.6%) and 56/61 (91.8%), respectively, were confirmed independently at 3 years. However, 45 children were diagnosed with ASD at 3 years who had not been identified at earlier visits. Children diagnosed at 18 months, in comparison to those diagnosed at 24 months, had less advanced language and adaptive skills at 18 months. Children not diagnosed with ASD until 3 years, compared with those diagnosed earlier, had more advanced language and adaptive skills, and milder ASD symptoms. Autism Res 2016, 9: 790-800. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
| | - Susan E Bryson
- Departments of Pediatrics and Psychology & Neuroscience, Dalhousie University
| | | | - Isabel M Smith
- Departments of Pediatrics and Psychology & Neuroscience, Dalhousie University
| | | | - Peter Szatmari
- Bloorview Research Institute (J.B.), Centre for Addiction and Mental Health, Hospital for Sick Children, Department of Psychiatry, University of Toronto
| | | | - Nancy Garon
- Department of Psychology, Mount Allison University
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Garon N, Zwaigenbaum L, Bryson S, Smith IM, Brian J, Roncadin C, Vaillancourt T, Armstrong V, Sacrey LAR, Roberts W. Temperament and its Association with Autism Symptoms in a High-risk Population. J Abnorm Child Psychol 2015; 44:757-69. [DOI: 10.1007/s10802-015-0064-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Sacrey LAR, Zwaigenbaum L, Bryson S, Brian J, Smith IM, Roberts W, Szatmari P, Roncadin C, Garon N, Novak C, Vaillancourt T, McCormick T, MacKinnon B, Jilderda S, Armstrong V. Can parents' concerns predict autism spectrum disorder? A prospective study of high-risk siblings from 6 to 36 months of age. J Am Acad Child Adolesc Psychiatry 2015; 54:470-8. [PMID: 26004662 DOI: 10.1016/j.jaac.2015.03.014] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/18/2015] [Accepted: 03/25/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This prospective study characterized parents' concerns about infants at high risk for developing autism spectrum disorder (ASD; each with an older sibling with ASD) at multiple time points in the first 2 years, and assessed their relation to diagnostic outcome at 3 years. METHOD Parents of low-risk controls (LR) and high-risk infant siblings (HR) reported any concerns that they had regarding their children's development between 6 and 24 months of age regarding sleep, diet, sensory behavior, gross/fine motor skills, repetitive movements, communication, communication regression, social skills, play, and behavioral problems, using a parent concern form designed for this study. At 3 years of age, an independent, gold-standard diagnostic assessment for ASD was conducted for all participants. RESULTS As predicted, parents of HR children who received an ASD diagnosis reported more concerns than parents of LR and HR children who did not have ASD. The total number of concerns predicted a subsequent diagnosis of ASD as early as 12 months within the HR group. Concerns regarding sensory behavior and motor development predicted a subsequent diagnosis of ASD as early as 6 months, whereas concerns about social communication and repetitive behaviors did not predict diagnosis of ASD until after 12 months. CONCLUSION Parent-reported concerns can improve earlier recognition of ASD in HR children.
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Affiliation(s)
- Lori-Ann R Sacrey
- University of Alberta and the Autism Research Centre in the Glenrose Rehabilitation Hospital in Edmonton, Alberta, Canada.
| | - Lonnie Zwaigenbaum
- University of Alberta and the Autism Research Centre in the Glenrose Rehabilitation Hospital in Edmonton, Alberta, Canada
| | - Susan Bryson
- Dalhousie University/IWK Health Centre in Halifax, Nova Scotia, Canada
| | - Jessica Brian
- Bloorview Research Institute in Toronto; University of Toronto
| | - Isabel M Smith
- Dalhousie University/IWK Health Centre in Halifax, Nova Scotia, Canada
| | - Wendy Roberts
- University of Toronto and The Hospital for Sick Children in Toronto
| | - Peter Szatmari
- University of Toronto and The Hospital for Sick Children in Toronto; Centre for Addiction and Mental Health in Toronto
| | | | - Nancy Garon
- Mount Allison University in Sackville, New Brunswick, Canada
| | - Christopher Novak
- University of Alberta and the Autism Research Centre in the Glenrose Rehabilitation Hospital in Edmonton, Alberta, Canada
| | | | - Theresa McCormick
- Dalhousie University/IWK Health Centre in Halifax, Nova Scotia, Canada
| | | | | | - Vickie Armstrong
- Dalhousie University/IWK Health Centre in Halifax, Nova Scotia, Canada
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Garon N, Longard J. Loss Frequency Versus Long-Term Outcome in Preschoolers' Decision Making on a Child Variant of the Iowa Gambling Task. Appl Neuropsychol Child 2014; 4:221-9. [PMID: 25265197 DOI: 10.1080/21622965.2013.856311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The current study explored the effect of loss frequency and long-term expected outcome on decision making in 86 preschoolers. Children were randomly assigned to 2 versions of a child-friendly Iowa Gambling Task. In the high-conflict condition, the deck with the highest long-term outcome also had the highest frequency of loss, whereas the deck with the lowest long-term outcome had the lowest frequency of loss, setting up a conflict between preference for lower frequency of loss and preference for a higher long-term outcome. In the low-conflict condition, the highest long-term outcome deck had the lowest frequency of loss and the lowest long-term outcome deck had the highest frequency of loss. Results suggested age and sex differences in decision making. Specifically, the results suggested that preschoolers are able to make advantageous decisions when choices do not conflict in terms of loss frequency and long-term outcome. Finally, the results suggest that girls tend to focus more on loss frequency than boys when making choices. The findings have implications for assessment of decision making and hot executive functions in young children.
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Affiliation(s)
- Nancy Garon
- a Department of Psychology , Mount Allison University , Sackville , New Brunswick , Canada
| | - Julie Longard
- b Department of Psychology , Dalhousie University , Halifax , Nova Scotia , Canada
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Abstract
The present study investigated sensitivity to age differences in a novel executive function (EF) battery for children aged 18 months to 5 years, and whether the pattern of associations among the measures was consistent with a hierarchical model of EF development. Participants (n = 261, aged 18-67 months) were administered a battery of novel tasks designed to assess 3 key EF components (working memory, inhibition, and shifting). The results indicate that the EF tasks were sensitive to age differences and provide partial support for the hierarchical model of EF development.
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Affiliation(s)
- Nancy Garon
- a Department of Psychology , Mount Allison University , Sackville , Canada
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Garon N, Longard J, Craig B, Kent K. Loss Frequency and Awareness Predict Performance on a Preschool Variant of the Iowa Gambling Task. Journal of Cognition and Development 2013. [DOI: 10.1080/15248372.2013.826662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zwaigenbaum L, Bryson S, Garon N. Early identification of autism spectrum disorders. Behav Brain Res 2013; 251:133-46. [PMID: 23588272 DOI: 10.1016/j.bbr.2013.04.004] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 03/30/2013] [Accepted: 04/03/2013] [Indexed: 11/29/2022]
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Georgiades S, Szatmari P, Zwaigenbaum L, Bryson S, Brian J, Roberts W, Smith I, Vaillancourt T, Roncadin C, Garon N. A prospective study of autistic-like traits in unaffected siblings of probands with autism spectrum disorder. JAMA Psychiatry 2013; 70:42-8. [PMID: 22945359 DOI: 10.1001/2013.jamapsychiatry.1] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT The presence of autistic-like traits in relatives of individuals with autism spectrum disorder (ASD) is well recognized, but, to our knowledge, the emergence of these traits early in development has not been studied. OBJECTIVE To prospectively investigate the emergence of autistic-like traits in unaffected (no ASD diagnosis) infant siblings of probands diagnosed as having ASD. DESIGN Two groups of children unaffected with ASD were assessed prospectively-siblings of probands diagnosed as having ASD (high risk [HR]) and control subjects with no family history of ASD (low risk [LR]). Scores on a measure of autistic-like traits at 12 months of age were used in a cluster analysis of the entire sample. SETTING A prospective study of infant siblings of probands with ASD from 3 diagnostic centers in Canada. PARTICIPANTS The study included 170 HR and 90 LR children, none of whom was diagnosed as having ASD at age 3 years. MAIN OUTCOME MEASURES The Autism Observation Scale for Infants was used to measure autistic-like traits and derive clusters at 12 months of age. Clusters were compared on ASD symptoms, cognitive abilities, and social-emotional difficulties at age 3 years. RESULTS Two clusters were identified. Cluster 1 (n = 37; 14.2% of total sample) had significantly higher levels of autistic-like traits compared with cluster 2. Within cluster 1, 33 children came from the siblings (19.4% of HR group) and only 4 came from the control subjects (4.5% of LR group). At age 3 years, children from cluster 1 had more social-communication impairment (effect size > 0.70; P < .001), lower cognitive abilities (effect size = -0.59; P < .005), and more internalizing problems (effect size = 0.55; P = .01). Compared with control subjects, HR siblings had a relative risk of 4.3 (95% CI,1.6-11.9) for membership in cluster 1. CONCLUSIONS Study findings suggest the emergence of autistic-like traits resembling a broader autism phenotype by 12 months of age in approximately 19% of HR siblings who did not meet ASD diagnostic criteria at age 3 years.
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Affiliation(s)
- Stelios Georgiades
- Offord Centre for Child Studies and McMaster Children's Hospital, McMaster University, Ontario, Canada
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Abstract
Earlier intervention improves outcomes for children with autism spectrum disorders (ASDs), but existing identification tools are at the limits of standardization with 18-month-olds. We assessed potential behavioural markers of ASD at 18 months in a high-risk cohort of infant siblings of children with ASD. Prospective data were collected using the Autism Diagnostic Observation Schedule (ADOS) and Autism Observation Scale for Infants (AOSI) on 155 infant siblings and 73 low-risk controls at 18 months. Infants were classified into three groups (ASD sibs, non-ASD sibs, controls) based on blind best-estimate diagnosis at age 3. Fisher's exact tests, followed by discriminant function analyses, revealed that the majority of informative ADOS items came from the social and behavioural domains, and AOSI items measuring behavioural reactivity and motor control contributed additional information. Findings highlight the importance of considering not only social-communication deficits, but also basic dimensions of temperament including state regulation and motor control when assessing toddlers with suspected ASD.
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Affiliation(s)
- J Brian
- Hospital for Sick Children, University of Toronto, and Bloorview Kids' Rehab, Toronto, Canada.
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Volden J, Coolican J, Garon N, White J, Bryson S. Brief Report: Pragmatic Language in Autism Spectrum Disorder: Relationships to Measures of Ability and Disability. J Autism Dev Disord 2008; 39:388-93. [DOI: 10.1007/s10803-008-0618-y] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Accepted: 07/01/2008] [Indexed: 11/24/2022]
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Abstract
During the last 2 decades, major advances have been made in understanding the development of executive functions (EFs) in early childhood. This article reviews the EF literature during the preschool period using an integrative framework. The framework adopted considers EF to be a unitary construct with partially dissociable components (A. Miyake et al., 2000). The authors focus on 3 EF components: working memory, response inhibition, and shifting. For the present purposes, the central executive is conceived of as a central attention system that is involved in all EF component operations. Research to date suggests that elementary forms of the core EF components are present early during the preschool period. Changes in EF during the latter half of the preschool period appear to be due to the development of attention and integration of component EFs. Finally, the review outlines a number of areas that warrant further investigation if researchers are to move forward in understanding early EF development.
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Affiliation(s)
- Nancy Garon
- Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada.
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Abstract
During the last 2 decades, major advances have been made in understanding the development of executive functions (EFs) in early childhood. This article reviews the EF literature during the preschool period using an integrative framework. The framework adopted considers EF to be a unitary construct with partially dissociable components (A. Miyake et al., 2000). The authors focus on 3 EF components: working memory, response inhibition, and shifting. For the present purposes, the central executive is conceived of as a central attention system that is involved in all EF component operations. Research to date suggests that elementary forms of the core EF components are present early during the preschool period. Changes in EF during the latter half of the preschool period appear to be due to the development of attention and integration of component EFs. Finally, the review outlines a number of areas that warrant further investigation if researchers are to move forward in understanding early EF development.
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Affiliation(s)
- Nancy Garon
- Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada.
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Abstract
The authors' goal in conducting this study was to explore the association between temperament and future-oriented decision making. Forty-three preschoolers (mean age = 51 months) were given a child variant of the Iowa Gambling Task (IGT) and asked to choose between a deck with higher immediate rewards and a deck with higher future rewards. Children who were higher on the Extraversion/Surgency factor of the Child Behavior Questionnaire chose more frequently from the higher immediate rewards deck early in the game. The externalizing dimension of Negative Affectivity (anger/frustration, soothability and discomfort) made the greatest contribution to prediction of performance in the last block of the game. Children who were more easily frustrated and had difficulty regulating negative emotions chose more from the deck with higher immediate rewards. There was a significant interaction between the externalizing dimension of Negative Affectivity, the internalizing dimension of Negative Affectivity (sadness and fear) and Extraversion/Surgency on the last block. These results suggest a complex association between IGT performance and temperament in preschoolers.
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Affiliation(s)
- Nancy Garon
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada.
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Abstract
A child version of the Iowa Gambling task was used to explore the development of decision-making during the preschool period in two experiments. One hundred eighty-one children, 3.5 and 4.5 years of age, were asked to choose between a bad deck with higher immediate but lower long-term rewards and a good deck with lower immediate but higher long-term rewards. Experiment 1 explored age differences and the association of the gambling task with a delay of gratification task. Age differences in performance were found, supporting previous findings (Kerr & Zelazo, 2004) of a development difference between 3- and 4-year-old children in future-oriented decision making. Performance on the gambling task was found to be significantly associated with delay of gratification for 3.5-year-old children only. Experiment 2 explored the effect of labeling and symbol use on performance. Although having 4.5-year-old children label decks as good or bad improved their performance on the task, this labeling had no effect on 3.5-year-old childrens performance. However, having 3.5-year-old children place a symbol representing good and bad next to the decks did improve performance, but only for those children who were able to correctly label the decks. These results suggest an interaction between conscious awareness, symbol use, and making advantageous future-oriented decisions during the preschool period.
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Affiliation(s)
- Nancy Garon
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
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Abstract
A child version of the Iowa Gambling task was used to explore the developmental and gender differences in decision making of 4-year-olds (N = 141). The task required children to choose between two decks: a deck with higher immediate rewards and a deck with higher future rewards. Developmental differences between young (4.0-4.5) and older (4.6-4.11) children were found, with older 4-year-olds choosing more from the deck with higher future rewards. Gender differences were found for decision-making strategy. It is suggested that these differences in approaches might account for the pattern of gender differences found in past research.
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Affiliation(s)
- Nancy Garon
- Autism Research Centre, Dalhousie University, Nova Scotia, Canada.
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Garon N, Moore C, Waschbusch DA. Decision making in children with ADHD only, ADHD-anxious/depressed, and control children using a child version of the Iowa Gambling Task. J Atten Disord 2006; 9:607-19. [PMID: 16648228 DOI: 10.1177/1087054705284501] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The goal of this study is to investigate decision making in children with ADHD using a child version of the Iowa Gambling Task (IGT). The effect of internalizing symptoms is also of interest. METHOD Twenty-one children with ADHD (high anxiety/depression and no anxiety/depression) are compared to an age- and sex-matched control group on the gambling task. Children in the ADHD-alone group demonstrate impaired performance on the IGT. In contrast, children in the control group and the ADHD-anxiety/depression group learn to choose more from the advantageous decks over time. RESULTS These findings of impaired decision making in children with ADHD parallel findings of real-life decision-making problems in this population. CONCLUSION Furthermore, the findings suggest that having a high number of internalizing symptoms leads to better performance for children with ADHD on this variant of the IGT.
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Affiliation(s)
- Nancy Garon
- Autism Research Centre, Dalhousie University, Nova, Canada.
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Abstract
Decision-making over time is an important aspect of adaptive social functioning. The main goal of this study was to investigate the development of this ability in young children. A simplified version of the Iowa Gambling Task was given to 69 children at 3 ages (3, 4, and 6 years). Children were also given an awareness test to assess their knowledge of the task. Significant age differences were found for awareness of the task while significant sex effects were found for performance on the task. Females chose significantly more from the advantageous decks than would be expected by chance in the second block. Males demonstrated no significant difference in choice of decks. Further analysis indicated female superiority in the task was not due to greater knowledge of the game. One interpretation of these results is that there are two systems affecting decision-making over time.
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Affiliation(s)
- Nancy Garon
- Dalhousie University, Halifax, N.S., Canada, B3H 4J1.
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