The Relationship Between Attention, Sensory Processing, and Social Responsiveness Among Adults on the Autism Spectrum

This study evaluated attention, sensory processing, and social responsiveness and the relationship between these constructs among autistic and neurotypical adults. Participants included 24 autistic adults (17-30 years) and 24 neurotypical peers who completed the Test of Everyday Attention, Adolescent/Adult Sensory Profile (AASP), and the Social Responsiveness Scale-2. Autistic individuals showed greater attention, sensory processing, and social responsiveness challenges compared to neurotypical peers. Using mediation models, we showed that the relationship between attention and social responsiveness was mediated by sensory processing, specifically the low registration and sensation-seeking AASP quadrants. The relationship between attention, sensory processing, and social responsiveness suggests that adults with greater attention issues may have greater sensory and social challenges. Specifically, having poor attention may lead to poor sensory processing skills which compound poor social responsiveness. Understanding the relationships between these domains is critical for developing effective interventions and support for autistic adults.

Developmental trends of auditory novelty oddball P3 while accounting for N2 in 7- to 25-year-olds

Many previous studies examining developmental trends in P3 amplitude or latency have used a two-stimulus (standard and target) oddball paradigm. Fewer studies exist using the novelty oddball paradigm, a three-tone (standard, target, and novel) paradigm. In this study with 204 typically developing participants aged 7-25 years, the influence of participant traits-age and sex-on the developmental trends of P3 peak-to-peak amplitude and latency were examined. Additionally, interactions between the three tones of the novelty oddball paradigm and scalp sites on P3 amplitude and latency were evaluated. While previous studies using baseline-to-peak measures have shown smaller P3 amplitude in children compared with adults, this study, using peak-to-peak measures (P3 minus N2 amplitude), found the opposite effect with children having larger P3 amplitudes than adults. This finding is explained by further analyses of N2, representing discrimination. N2 baseline-to-peak amplitude significantly predicted P3 baseline-to-peak amplitude; a mediation effect such that as N2 becomes less negative, P3 becomes larger. Regression analyses revealed that developmental trends of the P3 amplitude were primarily linear, but trends in P3 latency were mostly non-linear. Sex differences were observed, although limited to latency measures. Results from ancovas found significant interactions between the three tones and between frontal (Fz) and parietal (Pz) sites, with larger P3 amplitude during target and novel tones at Pz than Fz, and larger amplitudes during frequent tones at Fz than Pz. These findings highlight the importance of considering more than P3 amplitude in understanding developmental trends in cognitive processing during oddball paradigms.

Modeling electrophysiological measures of decision-making and performance monitoring in neurotypical children engaging in a speeded flanker task

This study aims to use structural equation modeling (SEM) to investigate the role of error processing in behavioral adaptation in children by testing relationships between error-related and stimulus-related event-related potentials (ERPs) obtained from two sessions of a speeded Eriksen flanker task. First, path models of averaged ERP components and mean response times (N1 → P2 → N2 → P3 → RTs) while controlling for trait effects, age, and sex, on each was examined separately for correct and incorrect trials from each session. While the model demonstrated acceptable fit statistics, the four models yielded diverse results. Next, path models for correct and incorrect trials were tested using latent variables defined by factoring together respective measures of ERP component amplitudes from each session. Comparison of correct and incorrect models revealed significant differences in the relationships between the successive measures of neural processing after controlling for trait effects. Moreover, latent variable models controlling for both trait and session-specific state variables yielded excellent model fit while models without session-specific state variables did not. In the final model, the error-related neural activity (i.e., the ERN and Pe) from incorrect trials was found to significantly relate to the stream of neural processes contributing to trials with the correct behavior. Importantly, the relationship between RT and error detection in the final model signifies a brain-and-behavior feedback loop. These findings provided empirical evidence that supports the adaptive orienting theory of error processing by demonstrating how the neural signals of error processing influence behavioral adaptations that facilitate correct behavioral performance.

Importance of Attention in Sensory Processing and Social Functioning in Young Adults With and Without Autism Spectrum Disorder

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

Statistical modeling analysis reveal that attention skills mediate the relationship between brain measures of sensory processing (measured by electroencephalography) and behavioral sensory processing in young adults with and without autism. Thus, attention abilities facilitate brain mechanisms to better process sensory stimuli to perform everyday sensory processing activities and social skills. Results suggest that therapy emphasizing attention skills in autism can modify sensory and social participation.

Primary Author and Speaker: Jewel Elias Crasta

Additional Authors and Speakers: Patricia Davies

Contributing Authors: William J. Gavin

Expanding our understanding of sensory gating in children with autism spectrum disorders

OBJECTIVE

This study examined sensory gating in children with autism spectrum disorders (ASD). Gating is usually examined at the P50 component and rarely at mid- and late-latency components.

METHODS

Electroencephalography data were recorded during a paired-click paradigm, from 18 children with ASD (5-12 years), and 18 typically-developing (TD) children. Gating was assessed at the P50, N1, P2, and N2 event-related potential components. Parents of all participants completed the Short Sensory Profile (SSP).

RESULTS

TD children showed gating at all components while children with ASD showed gating only at P2 and N2. Compared to TD children, the ASD group showed significantly reduced gating at P50, N1, and P2. No group differences were found at N2, suggesting typical N2 gating in the ASD group. Time-frequency analyses showed reduced orientation and neural synchronization of auditory stimuli. P50 and N1 gating significantly correlated with the SSP.

CONCLUSION

Although children with ASD have impaired early orientation and filtering of auditory stimuli, they exhibited gating at P2 and N2 components suggesting use of different gating mechanisms compared to TD children. Sensory deficits in ASD may relate to gating.

SIGNIFICANCE

The data provide novel evidence for impaired neural orientation, filtering, and synchronization in children with ASD.

Test-Retest Reliability of Electroencephalographic Measures of Performance Monitoring in Children and Adults

This study examined the test-retest reliability of the error-related negativity (ERN) and error positivity (Pe) amplitudes using a Flanker task in 118 neurotypical children and 53 adults before and after latency jitter adjustments. The reliability of the ERN and Pe amplitudes was moderate for children and moderate to strong for adults. The latency variability adjustment did not improve the reliability of the ERN and Pe amplitudes for either group, suggesting that latency variability may be a trait-like measure. For comparison purposes, the reliability of the stimulus-locked ERPs was strong for correct trials, yet the reliability was weak for incorrect trials.

Sensory Processing and Attention Profiles Among Children With Sensory Processing Disorders and Autism Spectrum Disorders

This study explores the differences in the profile of relationships between sensory processing and attention abilities among children with sensory processing disorder (SPD), autism spectrum disorder (ASD), and typically developing (TD) children. The Test of Everyday Attention for Children (TEA-Ch), a performance-based measure of attention, was administered to 69 children (TD: n = 24; SPD: n = 21; ASD: n = 24), ages 6-10 years. All participants' parents completed the Short Sensory Profile (SSP), a standardized parent-report measure of sensory-related behaviors. Discriminant analyses using the TEA-Ch and the SSP domains revealed two classification functions; the first revealed that both clinical groups significantly differed from the TD group with greater sensory processing challenges in the categories of auditory filtering, under-responsive/seeks sensation, low energy/weak, and taste/smell sensitivity subscales of the SSP. The second function discriminated between the two clinical groups, indicating that children with ASD had significantly greater control and sustained attention deficits and less sensory issues than did children with SPD. Together, the two functions correctly classified 76.8% of the participants as to their group membership. The different profiles of sensory processing and attention abilities in children with SPD and ASD may provide guidance in identifying appropriate individualized therapeutic strategies for these children.

Assessing the Impact of Music Therapy on Sensory Gating and Attention in Children With Autism: A Pilot and Feasibility Study

Children with autism spectrum disorder (ASD) frequently demonstrate atypical processing of sensory information and deficits in attentional abilities. These deficits may impact social and academic functioning. Although music therapy has been used to address sensory and attentional needs, there are no studies including physiologic indicators of sensory processing to determine the impact of music therapy. The objective of this study was to determine the feasibility of conducting study protocols, determine the adequacy of electroencephalography (EEG) and behavioral measures in identifying attentional differences in children with ASD compared with typically developing (TD) children, and to gather preliminary evidence of intervention effects on brain responses and attention outcomes. Seven children with high functioning ASD ages 5 -12 and seven age- and gender-matched TD completed procedures measuring brain responses (EEG) and behaviors (the Test of Everyday Attention for Children). Children with ASD then completed a 35-min individual music therapy attention protocol delivered by a board-certified music therapist ten times over 5 weeks. Children with ASD completed measures of brain responses and behavior post-intervention to determine pre- to post-test differences. Consent and completion rates were 100% for children who met the study criteria. Feasibility measures indicated that measures of brain responsivity could be used to determine attentional differences between children with ASD and typical children. Initial outcome data for brain responses and behavior indicated positive trends for the impact of music therapy on selective attention skills.

Developmental trends of performance monitoring measures in 7- to 25-year-olds: Unraveling the complex nature of brain measures

This study explores how trial-to-trial latency variability contributes to the developmental trends observed in ERN amplitude found in the incorrect trials of a performance monitoring task, the visual flanker task. An Adaptive Woody filter was used to measure and correct for the trial-to-trial latency variability of the ERN in 240 participants aged 7-25 years. Using three measures of latency variability, the degree of trial-to-trial latency variability was shown to decrease as the age of the participants increased from 7 to 25 years. The success of the Adaptive Woody filter technique to remove the trial-to-trial latency variability was demonstrated in a straightforward manner by the significant changes in the measures of fit and intraindividual variability obtained before and after applying the filter. After the latency variability effects were removed and adjusted averaged ERPs were obtained, a more subtle but significant nonlinear developmental trend was still found in the amplitude of the ERN component.

Towards a unified model of event-related potentials as phases of stimulus-to-response processing

This study demonstrates the utility of combining principles of connectionist theory with a sophisticated statistical approach, structural equation modeling (SEM), to better understand brain-behavior relationships in studies using event-related potentials (ERPs). The models show how sequential phases of neural processing measured by averaged ERP waveform components can successfully predict task behavior (response time; RT) while accounting for individual differences in maturation and sex. The models assume that all ERP measures are affected by individual differences in physical and mental state that inflate measurement error. ERP data were collected from 154 neurotypical children (7-13 years, M = 10.22, SD = 1.48; 74 males) performing a cued Go/No-Go task during two separate sessions. Using SEM, we show a latent variable path model with good fit (e.g., χ²(51) = 56.20, p = .25; RMSEA = .03; CFI = .99; SRMR = .06) yielding moderate-to-large predictive coefficients from N1 through the E-wave latent variables (N1 β = -.29 → P2 β = -.44 → N2 β = .28 → P3 β =.64→ E-wave), which in turn significantly predicted RT (β =.34, p = .02). Age significantly related to N1 and P3 latent variables as well as RT (β =.31, -.58, & -.40 respectively), and Sex significantly related to the E-wave latent variable and RT (β =.36 & 0.21 respectively). Additionally, the final model suggested that individual differences in emotional and physical state accounted for a significant proportion of variance in ERP measurements, and that individual states systematically varied across sessions (i.e., the variance was not just random noise). These findings suggest that modeling ERPs as a system of inter-related processes may be a more informative approach to examining brain-behavior relationships in neurotypical and clinical groups than traditional analysis techniques.

Evaluating Motor Control Improves Discrimination of Adolescents with and without Sports Related Concussion

Disrupted motor performance is increasingly recognized as a critical sequela of concussion which may have relevance for diagnosis and treatment. In 17 adolescents with recent concussion and 20 never-concussed controls, we evaluated the discriminant ability of a commonly used neurocognitive measure compared to a motor subtle sign exam, which evaluates gait, balance, and fine and gross motor control. We found that the motor subtle sign exam had better discriminant ability than the neurocognitive measure, but combining both measures was superior to analyses with individual measures (Wilks' ƛ = .297, p < .001). This supports that there is an added benefit of evaluating motor control along with neurocognitive capacities after suspected concussion to enhance diagnosis and treatment of injury.

Modeling the interrelationships between brain activity and trait attention measures to predict individual differences in reaction times in children during a Go/No-Go task

Many researchers are utilizing event-related potentials (ERPs) to better understand brain-behavior relationships across development. The present study demonstrates how structural equation modeling (SEM) techniques can be used to refine descriptions of brain-behavior relationships in a sample of neurotypical children. We developed an exploratory latent variable model in which trait measures of maturation and attention are related to neural processing and task behaviors obtained during a cued Go/No-Go task. Model findings are compared to results of traditional analysis techniques such as bivariate correlations. The data suggest that more sophisticated statistical approaches are beneficial to accurately interpreting the nature of brain-behavior relationships.

Attention and Sensory Characteristics in Children With High-Functioning Autism and Sensory Processing Disorder

Date Presented 3/30/2017

Children with sensory processing disorder and high-functioning autism have different attention and sensory processing characteristics. These results can help therapists identify specific treatment strategies while working on attention and sensory processing skills with these children.

Primary Author and Speaker: Mei-Heng Lin

Additional Authors and Speakers: Jewel Mascarenhas, Patricia L. Davies

Contributing Authors: Emily Marshall, Blythe LaGasse, William J. Gavin

Motor skill development in low-income, at-risk preschoolers: A community-based longitudinal intervention study

OBJECTIVES

This study aimed to: (1) determine the status of fundamental movement skill (FMS) performance in low-income, at-risk preschoolers; and (2) evaluate the impact of the Food Friends Get Movin' with Mighty Moves (MM) program on improving children's FMS at two-year follow-up.

DESIGN

Longitudinal, quasi-experimental study with matched controls.

METHODS

The Colorado LEAP study was conducted in four Head Start/preschools (two intervention, two control) serving children aged 3-5 years. MM was delivered to the intervention group during preschool. The Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) subtests for balance, running speed and agility, upper-limb coordination (object control (OC) skills) and strength were administered to children at baseline, post-intervention in preschool, one-year follow-up (kindergarten), and two-year follow-up (first grade).

RESULTS

Compared to the normative sample's mean, the mean scaled score for all participants at baseline was significantly lower for balance (p=0.016) and OC skills (p<0.001). At two-year follow-up, the means of balance for all participants and OC skills for just the control group were significantly lower than those of the normative sample (p≤0.001). Hierarchical linear regression analyses revealed a significant intervention effect for OC skills with the overall model accounting for 41% of variance at two-year follow-up, F_(6,165)=20.45, p<0.001. No intervention effects were found for the other three BOT-2 subtests.

CONCLUSIONS

Delivering the MM program in preschool confers a lasting impact on FMS, specifically OC skills, in at-risk elementary school children. Results suggest that at-risk preschoolers are already behind in FMS development and these delays will continue through first grade.

Brain–Behavior Relationships Measuring Attention Differences Among Children With Autism and Age-Matched Peers

Date Presented 4/10/201

Children with high-functioning autism have different brain processing and brain–behavior relationships than typically developing peers. Results may inform how occupational therapists select therapeutic approaches and stimulate adaptive responses during therapy for improving everyday activities.

Primary Author and Speaker: Emily Marshall

Contributing Authors: Mary Khetani, Blythe LaGasse, Mei-Heng Lin, Jewel Crasta, William J. Gavin, Patricia Davies

Sensory Gating and Sensory Processing in Children With High-Functioning Autism Spectrum Disorders

Date Presented 4/10/2016

Children with high-functioning autism (HFA) display significantly reduced brain responses while processing auditory information compared with typically developing children. Our results can help practitioners understand the neurophysiological basis of some behavioral manifestations of HFA.

Primary Author and Speaker: Jewel Crasta

Additional Author and Speaker: Patricia Davies

Contributing Authors: Blythe LaGasse, William J. Gavin

Validation of School Function Assessment with Elementary School Children

The present study was conducted to examine the validity of the School Function Assessment (SFA). The study sample consisted of 64 children: 29 in general education (GEN) without disabilities, 18 with learning disabilities (LD), and 17 with cerebral palsy (CP). Convergent validity was supported by the significant correlation (r values ranged from .56 to .72) found between the scores on the Vineland Adaptive Behavior Scales (classroom edition) to comparable scales of the SFA. Construct validity of the SFA using the known groups method was also supported. Significant differences in SFA scores among the 3 groups were found using the Kruskal-Wallis analysis of variance and multiple comparisons. The GEN group differed from the LD group in cognitive/behavioral subtests, the CP group differed from the GEN group in all areas of the SFA, and the LD and CP groups differed on the physical domain of the SFA. Finally, the discriminant analysis of scores on the SFA showed the high percentage of participants being correctly classified in the respective groups (93.1% for GEN, 55.8% for LD, and 88.2% for CP). These results provide new evidence for the validity of the SFA using methodologies not previously reported in the literature. Given the unique features as well as the provided psychometrical properties of the SFA, this recently developed functional assessment should be considered a valid instrument for use in school settings.

The Test-Retest Reliability of the Visually Evoked Contingent Negative Variation (CNV) in Children and Adults

Establishing the reliability of event-related potentials is critical for future applications to biomarker development and clinical research. Few studies have examined the reliability of the contingent negative variation (CNV), and only in adults. The current study explored test-retest reliability of the visually evoked CNV and its embedded components, the O-wave and the E-wave, in children (7-13 years) and young adults (19-28 years) during a visual Go/No-Go task over 1-2 weeks. Test-retest reliability of the components was moderate for children, and low-to-moderate for adults. These findings were in contrast to previous work with adults showing moderate-to-high reliability of the auditory-evoked CNV.

Young Children's Food Neophobia Characteristics and Sensory Behaviors Are Related to Their Food Intake

BACKGROUND

Food neophobia in children has been associated with poor dietary variety and nutrient intakes. Underlying characteristics that may predispose a child to neophobia have not been widely studied.

OBJECTIVE

We investigated the associations between children's food neophobia, sensory sensitivity, and dietary intake in a diverse sample of typically developing preschoolers.

METHODS

Caregiver reports of children's food neophobia and sensory behaviors (SBs) as measured by the Food Neophobia Scale and the Sensory Profile, children's observed weight outcome [body mass index z score (BMIz)], and children's food intake as estimated from the Block Kids Food Screener were collected at baseline in the Colorado LEAP (Longitudinal Eating and Physical Activity Study) study of childhood obesity. Preschool-aged children (n = 249; 136 girls, 113 boys; aged 55.6 ± 4.7 mo; BMIz = 0.54 ± 1.14) and caregivers [n = 180; 57 Hispanic, 119 non-Hispanic white (NHW), 4 unknown] participated. Data were analyzed by Pearson correlations and multivariate hierarchical linear regression analyses.

RESULTS

Lower scores for children's oral sensory characteristics (i.e., more atypical) were related to higher neophobia ratings (r = -0.53, P < 0.001), and neophobia was negatively associated with reported vegetable intake (r = -0.31, P = 0.001) and dietary variety (r = -0.22, P < 0.001). Hispanic caregivers reported more atypical child SB scores (46.2 ± 8.8) than did NHW caregivers (50.5 ± 7.6; P = 0.006); however, no differences were noted for neophobia and SB scores by parent income and education or child sex. Neophobia was negatively associated with vegetable intake and dietary variety (P < 0.001 for both). SBs were associated with children's energy intake from sugar-sweetened beverages in bivariate analyses (r = -0.18, P < 0.05); however, in regression models, only ethnicity was significantly associated with energy from sugar-sweetened beverages (P < 0.001). Hispanic ethnicity was positively associated with sugar-sweetened beverage consumption (P < 0.001).

CONCLUSIONS

Children's neophobia and sensory sensitivity may be important in understanding underlying issues related to limited food acceptance in typically developing young children and for helping caregivers facilitate healthy dietary intake patterns for their children. This trial was registered at clinicaltrials.gov as NCT01937481.

Obesity Prevention Study: A Physical Activity Program Improved Gross Motor Skills in Preschool Children

Date Presented 4/18/2015

A physical activity program, part of an obesity prevention study implemented by teachers in rural areas, improved the motor skills in children. This study demonstrates that programs developed by an interdisciplinary team, including occupational therapists (OTs), affected healthy outcomes in young children in underserved areas.

Home food and activity assessment. Development and validation of an instrument for diverse families of young children

The purpose of this study was to refine and psychometrically test an instrument measuring the home food and activity environment of geographically and economically diverse families of preschool aged children. Caregivers of preschool aged children (n = 83) completed a modified self-report questionnaire. Reliably trained researchers conducted independent observations on 25 randomly selected homes. Agreement statistics were conducted at the item level (154 total items) to determine reliability. Frequency counts were calculated to identify item availability. Results showed Kappa statistics were high (.67-1.00) between independent researchers but varied between researchers and parents resulting in 85 items achieving criterion validity (Kappa >.60). Analyses of reliable items revealed the presence in the home of a high frequency of unhealthy snack foods, high fat milk and low frequency of availability of fruits/vegetables and low fat milk. Fifty-two percent of the homes were arranged with a television in the preschool child's bedroom. Physical Activity devices also were found to have high frequency availability. Families reporting lower education reported higher levels of sugar sweetened beverages and less low-fat dairy (p < .05) compared with higher education families. Low-income families (<$27K per year) reported significantly fewer Physical Activity devices (p < .001) compared with higher income families. Hispanic families reported significantly higher numbers of Sedentary Devices (p < .05) compared with non-Hispanic families. There were no significant differences between demographic comparisons on available fruits/vegetables, meats, whole grains, and regular fat dairy. A modified home food and activity instrument was found to reliably identify foods and activity devices with geographically and economically diverse families.

The Colorado LEAP study: rationale and design of a study to assess the short term longitudinal effectiveness of a preschool nutrition and physical activity program

BACKGROUND

The preschool years are a critical window for obesity prevention efforts; representing a time when children establish healthy eating habits and physical activity patterns. Understanding the context in which these behaviors develop is critical to formulating a model to address childhood obesity. The Colorado LEAP Study, an intervention study designed to prevent early childhood obesity, utilizes a social ecological approach to explore individual, family and environmental factors and their relationship to child weight status over a 3 year timeframe.

METHODS

The study is located in 5 rural Colorado preschool centers and elementary schools (2 treatment and 3 control). Treatment sites receive The Food Friends nutrition (12 weeks) and physical activity (18 weeks) interventions during preschool. Observational measures assess 3 layers of the social ecological model including individual, family and organizational inputs. Children's food preferences, food intake, gross motor skills, physical activity (pedometers/accelerometers), cognitive, physical and social self-competence and height/weight are collected. Parents provide information on feeding and activity practices, child's diet, oral sensory characteristics, food neophobia, home food and activity environment, height/weight and physical activity (pedometers). School personnel complete a school environment and policy assessment. Measurements are conducted with 3 cohorts at 4 time points - baseline, post-intervention, 1- and 2-year follow-up.

DISCUSSION

The design of this study allows for longitudinal exploration of relationships among eating habits, physical activity patterns, and weight status within and across spheres of the social ecological model. These methods advance traditional study designs by allowing not only for interaction among spheres but predictively across time. Further, the recruitment strategy includes both boys and girls from ethnic minority populations in rural areas and will provide insights into obesity prevention effects on these at risk populations.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01937481.

Service-learning-based instruction enhances students' perceptions of their abilities to engage in evidence-based practice

ABSTRACT Education leaders in occupational therapy (OT) propose that active learning is one means to developing critical thinking skills essential for successful integration of knowledge into evidence-based practice. This study examines the impact of one type of active learning, service-learning, on students' perceptions of their knowledge, skills, and confidence in their abilities to provide OT services to adults with neurological conditions. Change in OT students' (n == 43) perceptions before and after engagement in service-learning were assessed using quantitative and qualitative data in a triangulation mixed-methods design. Results support previous studies indicating that service-learning can influence positive gains in student knowledge and confidence.

Bandpass filter settings differentially affect measurement of P50 sensory gating in children and adults

OBJECTIVE

This study investigated the effect of four different bandpass filter settings on measures of the P50 component and the signal-to-noise ratios (SNR) of averaged ERPs obtained from a sensory gating paradigm employing paired-click stimuli.

METHODS

Participants were adults (n=18) 20-55years old and children (n=25) 5-10years old who were free of neurological disorders.

RESULTS

Results show that the filter settings (0.23-75Hz, 10-50Hz, 10-75Hz, and 10-200Hz) differentially affected the P50 amplitude, noise power and SNR measures of the conditioning and test clicks, and P50 T/C ratios.

CONCLUSIONS

The 10-50Hz filter setting may be optimal in studies that include only adults as these settings resulted in the smallest mean P50 T/C ratio, a reasonable standard deviation (SD) for the ratio, and the highest SNRs. The 10-200Hz filter may be the best for studying young children as this setting had the smallest mean and SD of P50 T/C ratios for these participants.

SIGNIFICANCE

In studies that include both adults and children investigators are advised to use the 10-200Hz filter setting because the smaller variability of sensory gating in the child group helps ensure better homogeneity of variance measures between the groups.

Electroencephalography in children with and without sensory processing disorders during auditory perception

OBJECTIVE

We sought to determine whether children with sensory processing disorder (SPD) differ from typically developing children on a neurophysiological measure, the P300 component of event-related potentials produced in response to brief auditory stimulation.

METHOD

We used electroencephalographic measures (i.e., N200 and P300 components) to examine auditory processing in 20 children with SPD and 71 typically developing children, ages 5-10 yr.

RESULTS

Children with SPD demonstrated significantly smaller P300 amplitudes and shorter N200 latencies than typically developing children. Brain activity correctly distinguished children with SPD from typically developing children with 77% accuracy. We also found a significant relationship between the neurophysiological measures and functional performance on sensory and motor tasks.

CONCLUSION

This study presents empirical evidence that children with SPD display unique brain processing mechanisms compared with typical children and, therefore, provide further evidence for the neural deviations associated with SPD.

Middle and Late Latency ERP Components Discriminate between Adults, Typical Children, and Children with Sensory Processing Disorders

This study examined whether combinations of middle latency sensory evoked potential components and late components, possibly indicative of cognitive processing, can discriminate between three sample groups; 18 adults (20–55 years), 25 typical children (5–10 years) and 28 children with sensory processing disorders (SPD) (5–12 years). Electroencephalography (EEG) recordings were made while participants heard random presentations of two auditory stimuli (1 and 3 kHz) each at two intensities (50 and 70 dB). Amplitude and latency measurements were obtained for the N1, P2, N2, and P3 components from the averaged event-related potential (ERP) for each of the four auditory stimuli. Discriminant analyses revealed two functions, one which described the relationship of the components on SPD deficit continuum and one which described the relationship of these components on a developmental continuum. Together, these two functions correctly classified 90.5% of the participants as to their group membership. These results are discussed in relation to neurodevelopmental theories.

Error Monitoring in College Students with Attention-Deficit/Hyperactivity Disorder

Recent error-related event-related potential (ERP) studies suggest that children with attention-deficit/hyperactivity disorder (ADHD) display deficits in error monitoring compared to control children. Information regarding error monitoring deficit in adults with ADHD, however, is scarce. We investigated error monitoring in a sample of college students with ADHD and compared them to their control peers. In addition to error (-related) negativity (Ne/ERN) and error positivity (Pe), we examined behavioral performance such as reaction time (RT) as well as self-reported monitoring behaviors in daily-life situations. Thirty-two college students with no known disorders and 36 college students with ADHD between 18 and 30 years of age participated in this study. Results showed that college students with ADHD were slower in their RT and displayed more RT variability. College students with ADHD also demonstrated significantly smaller Ne/ERN amplitude and shorter Ne/ERN latency compared to control students. There were, however, no significant group differences in either Pe amplitude or Pe latency. With self-reported monitoring behaviors, ADHD students reported significantly more difficulties in both the Self-Monitor and Task Monitor scales of the Behavioral Rating Inventory of Executive Function – Adult Version (BRIEF-A) compared to control students. Collectively, these results suggest that college students with ADHD have atypical error monitoring as measured by brain processing, behavioral performance, and self-report.

Maturation of sensory gating performance in children with and without sensory processing disorders

Recent interest in sensory gating in children with and without neuropsychological disorders has resulted in a number of studies and the results regarding the developmental trajectory of sensory gating are inconsistent. We investigated the maturational course of sensory gating in samples of typically developing children and children with sensory processing deficits (SPD) and compared their performance to adults. Besides gating ratios, we also examined the brain responses to conditioning and test click stimuli in the sensory gating paradigm separately to clarify if the changes in click amplitudes could explain the maturational change in the T/C ratio in children. Eighteen adults with no known disorders, 25 typical children, and 28 children with SPD participated in this study. The children ranged in ages between 5 and 12 years. The three groups differed in their P50 and N100 ERP components. Both child groups displayed significantly less gating than the adults. Children with SPD demonstrated significantly less gating and more within-group variability compared to typical children. There were significant relationships between age and T/C ratios and between age and peak-to-peak amplitude of the conditioning click in typical children but not in children with SPD. Typical children demonstrated significantly smaller brain response amplitudes to the clicks as compared to adults. These findings suggest that there is a maturational course of sensory gating in typical children and if there is a maturational trajectory in children with SPD it appears to be different than typical children. In addition, children with SPD were found to be lacking in their ability to filter out repeated auditory input and failed to selectively regulate their sensitivity to sensory stimuli.

Multisensory integration in children: a preliminary ERP study

The spatio-temporal scalp distribution of multisensory auditory-somatosensory integration was investigated in typically developing children ages 6-13. Event-related potentials were recorded from 32 scalp electrodes while participants watched a silent cartoon. Three types of sensory stimulation were presented pseudo-randomly: auditory clicks, somatosensory median nerve electrical pulses, or simultaneous auditory and somatosensory stimuli. No behavioral responses were required of the participant. To examine integration, responses to simultaneous auditory and somatosensory stimulation were compared to the sum of unisensory auditory plus unisensory somatosensory responses for four time-windows: (60-80 ms, 80-110 ms, 110-150 ms and 180-220 ms). Results indicated significant multisensory integration occurred in central/post-central scalp regions between 60-80 ms in the hemisphere contralateral to the side of somatosensory stimulation and between 110-150 ms in the hemisphere ipsilateral to the side of somatosensory stimulation. Between 180-220 ms, significant multisensory integration was evident in central/post-central regions in both hemispheres as well as midline scalp regions. This study suggests that children exhibit differential processing of multisensory compared to unisensory stimuli, as has previously been reported in adults.

Early top-down influences on bistable perception revealed by event-related potentials

A longstanding debate exists in the literature concerning bottom-up vs. top-down influences on bistable perception. Recently, a technique has been developed to measure early changes in brain activity (via ERPs) related to perceptual reversals (Kornmeier & Bach, 2004). An ERP component, the reversal negativity (RN) has been identified, and is characterized as an increase in negative potential over the posterior scalp from 150 to 350 ms for perceptual reversals compared to perceptual stability. This finding, although interesting, has not helped resolve issues related to the bottom-up vs. top-down debate because top-down influences have not been directly manipulated. The current study focused on resolving some of these issues by measuring the RN while observers maintained one of three 'intentional approaches', (1) try to reverse perception as often as possible, (2) try to stabilize perception for as long as possible, and (3) maintain a passive approach. Enhancements in RN amplitude were found for the intention-to-reverse condition compared to the passive condition. This finding suggests an early influence (150 ms) of top-down control on perceptual reversals of bistable figures. Results are discussed in terms of competing attention shifting vs. fatigue-based theories of bistable perception.

Validating the diagnosis of sensory processing disorders using EEG technology

OBJECTIVE

This study tested the assumption of sensory integration theory that states that a relationship exists between brain function and the behavioral manifestations of sensory integrative dysfunction.

METHOD

Electroencephalographic measures were used to examine brain processing in 28 children with sensory processing disorders (SPD) and 25 children who were typically developing, ages 5-12 years.

RESULTS

Children with SPD demonstrated less sensory gating than children who were typically developing. A significant relationship between sensory gating and age was found in children who were typically developing but not in children with SPD. Brain activity correctly distinguished children with SPD from children who were typically developing with 86% accuracy.

CONCLUSION

These results present empirical evidence that children with SPD display unique brain processing mechanisms compared to children who are typically developing and provide external validity for the diagnosis of SPD.

Effects of an extended version of the lee silverman voice treatment on voice and speech in Parkinson's disease

PURPOSE

The present study examined vocal SPL, voice handicap, and speech characteristics in Parkinson's disease (PD) following an extended version of the Lee Silverman Voice Treatment (LSVT), to help determine whether current treatment dosages can be altered without compromising clinical outcomes.

METHOD

Twelve participants with idiopathic PD received the extended treatment version (LSVT-X), similar to LSVT except that it was administered twice a week in 1-hr sessions over 8 weeks and required substantially more home practice. Recordings were made in a sound-treated booth immediately before and after treatment, and again 6 months later. Vocal SPL was measured for 4 different tasks and compared with data from a previous study, in which participants with PD received traditional LSVT 4 times a week for 4 weeks. Listener ratings were conducted with audio samples from both studies, using sentence pairs from a standard passage. LSVT-X participants completed the Voice Handicap Index (VHI) before each set of recordings.

RESULTS

Participants receiving LSVT-X significantly increased vocal SPL by 8 dB after treatment and maintained increased vocal SPL by 7.2 dB at 6 months. VHI scores improved for 25% of the LSVT-X participants following treatment, and listener ratings indicated audible improvement in speech.

CONCLUSIONS

LSVT-X successfully increased vocal SPL (which was consistent with improvements following traditional LSVT), decreased perceived voice handicap, and improved functional speech in individuals with PD. Further large-scale research is required to truly establish LSVT-X efficacy.

Utterance length and lexical diversity in Cantonese-speaking children with and without specific language impairment

Two studies of children's conversational language abilities are reported. In the first, mean length of utterance (MLU) and lexical diversity (D) were examined in a group of typically developing Cantonese-speaking children in Hong Kong. Regression analyses indicated a significant linear relationship between MLU and age (R = .44) and a significant curvilinear relationship between D and age (R = .73) in children age 27-68 months. MLU and D were moderately correlated with each other (r = .23); however, the two measures showed no statistical relationship when the effect of age was partialled out. In a second study, the utterances of Chinese children with specific language impairment (SLI) were found to be significantly shorter and less lexically diverse than typically developing children matched for age but similar to children matched for comprehension level. Discriminant analyses revealed that the combination of age, MLU, and D could be used to accurately differentiate children with SLI from both age-matched and language-matched children. Based on these findings, we hypothesize that these measures can be used jointly as a marker of SLI in Cantonese-speaking children.

Development of response-monitoring ERPs in 7- to 25-year-olds

In a target discrimination task, trials with incorrect responses elicit event-related potentials (ERPs) that include an error-related negativity (ERN or Ne) and a later error-positivity (Pe). Substantial evidence points to the anterior cingulate cortex as the source generator of the ERN. We examined the development of ERP component morphology, amplitude and latency to processing of correct and incorrect responses in 124 children, 7 to 18 years of age, and 27 adults, 19 through 25 years of age. The ERN and Pe were recorded during a standard 480-trial visual flanker task. As expected, response times decreased significantly with age. The ERN amplitude in error trials increased with age, although this was qualified by a nonlinear change as well. The Pe amplitude did not change with age. In correct trials, most participants produced a small negativity corresponding to the timing of the ERN in error trials. This correct-response negativity (CRN) amplitude was larger in children than in adults. Results are discussed with respect to continued maturation of the anterior cingulate cortex and prefrontal cortex into young adulthood.

Development of Error-Monitoring Event-Related Potentials in Adolescents

In order to study the maturation of neurobehavioral systems involved in affect regulation and behavioral choices during adolescence, we examined brain activity associated with response monitoring and error detection using event-related potentials (ERPs). In a visual flanker test, trials with incorrect responses elicit ERP components including an error-related negativity (ERN) and a later error-positivity (Pe). We examined the amplitude and latency of the ERN and Pe of incorrect responses in 124 children from 7 to 18 years of age. The ERN amplitude in error trials increased with age although this was qualified by a nonlinear change. The quadratic distribution of the ERN indicated an initial drop in amplitude (lowest at age 10 for girls; age 13 for boys) with a subsequent rise through adolescence. The Pe amplitude did not change with age. Results are discussed with respect to continued maturation of the anterior cingulate cortex and possible influences on adolescent behaviors.

Occupational therapy effects on visual-motor skills in preschool children

OBJECTIVE

The purpose of this study was to evaluate the assumption that preschool children who receive occupational therapy will demonstrate significant improvement in their visual-motor skills as measured on the Developmental Test of Visual-Motor Integration (VMI) and the two supplemental Visual Perception and Motor Coordination tests.

METHOD

Preschool children with developmental delays (n = 12) received occupational therapy a minimum of one individual 30-minute session, and one group 30-minute session per week for 1 school year. Their performance was compared to that of two control groups; preschool students without disabilities who received occupational therapy (n = 16) for one 30-minute group session per week and students without disabilities (n = 15) who received no occupational therapy. The VMI and two supplemental tests were administered three times to each student, at the beginning, middle, and end of school year.

RESULTS

Planned comparison tests showed that students with developmental delays demonstrated statistically significant improvement in visual-motor skills and developed skills at a rate faster than expected when compared to typically developing peers on the VMI. The effect size for preschool students without disabilities who received occupational therapy exceeded the effect size for the VMI and Visual Perception supplemental test for the preschool students without disabilities who received no therapy, although, the difference in the post-test performance of these two groups was not statistically significant.

DISCUSSION

The results of this study demonstrate that intervention, including occupational therapy, can effectively improve visual-motor skills in preschool-aged children.

Measurement Issues in Treatment Effectiveness Studies

Improved understanding of the various test scores found in clinical norm-referenced assessment instruments will enable therapists to make informed decisions about selecting the best test scores for measuring and reporting applied clinical research activities (i.e., initial evaluation, progress report, program evaluation, treatment effectiveness research). The application of norm-referenced test scores in treatment effectiveness research is discussed, with all issues applying directly to the use of individual clients’ test scores in making clinical decisions and reporting assessment results. The scientific principles of measurement used by researchers are outlined, followed by a discussion of the various test scores that can be obtained from a norm-referenced test and how each score is interpreted. Recommendations are provided for the use of the various test scores in treatment effectiveness research, specifically addressing research questions that can be answered from results obtained using the different measures available in norm-referenced tests: Did the clients improve in performance? At what rate are the skills being gained?

Concurrent and predictive validity of an early language screening program

The efficacy of screening 2-year-old children for language delay using a parent-report questionnaire was investigated in three studies. The Language Development Survey (Rescorla, 1989) was mailed to 650 families at the time of their child's second birthday. Fifty-three percent of the surveys received by parents were completed and returned. Screening outcomes were then compared, in double-blind fashion, with the results of comprehensive clinical evaluations at ages 2 (N = 64) and 3 (N = 36). Parents' report of the size of their children's expressive vocabularies was highly correlated with clinical language measures at age 2. Children who screened positive performed significantly poorer than children who screened negative on standardized language tests and on measures taken from spontaneous conversation. The screening program demonstrated excellent sensitivity and specificity for identifying language delay at age 2 but somewhat lower levels for predicting developmental status one year later.

Sample size effects on temporal reliability of language sample measures of preschool children

The present study examined the temporal reliability of four quantitative measurements of operationally defined linguistic behaviors observed in a naturalistic setting. The measures of language production were computed using the Systematic Analysis of Language Transcripts (SALT) software from two 20-minute language samples obtained 3 to 14 days apart for each of 20 preschool-aged children. Samples were edited to different sizes based either on duration (12 or 20 minutes) or on limits of the total number of complete and intelligible utterances (from 25 to 175 in increments of 25). Inadequate reliability was found for the language sample measure, total number of words; hence, the validity of this measure is questionable. In contrast, very high temporal reliability coefficients (r > .92) were obtained for the language sample measures of number of different words, mean length of utterance in morphemes, and mean sentence length in morphemes when derived from a large number (> or = 175) of complete and intelligible utterances. The temporal reliability of these measures reached acceptable levels, not only for research purposes, but for diagnostic purposes as well.

Comparison of individual and group/consultation treatment methods for preschool children with developmental delays

OBJECTIVES

Although alternative treatment methods are becoming more widely discussed and implemented in pediatric occupational therapy, empirical data demonstrating the effectiveness of these treatment methods are lacking. The present study compares the effectiveness of an alternative treatment method (group/consultation) to traditional direct therapy.

METHOD

Eighteen preschool subjects classified as developmentally delayed received either individual/direct therapy or group/consultation therapy. Each child was assessed initially and again 7 months later with three standardized tests assessing fine motor and gross motor development, functional skills in the home, and nonverbal intelligence.

RESULTS

Subjects in both treatment methods demonstrated significant increases in both fine and gross motor skills with the rate approximating that of the normal distribution of typically developing children.

CONCLUSION

There were no statistically significant differences between treatment methods on any of the assessments.

Cross-linguistic perception in infancy: early effects of linguistic experience

The possibility that early linguistic experience affects infant speech perception was investigated in a cross-linguistic study with naturally produced speech stimuli. Using the Visually Reinforced Infant Speech Discrimination paradigm, three contrasts were presented to Spanish-and English-learning infants 6–8 months of age. Both groups of infants showed statistically significant discrimination of two contrasts, English and Czech. Only the Spanish-learning infants provided evidence of discrimination of the Spanish contrast. The groups discriminated the English contrast at similarly high levels, but the Spanish-learning infants showed significantly higher performance than the English on both the Spanish and the Czech contrast. The results indicate that early experience does affect early discrimination, and further (since the stimuli were natural) that the effect may be of practical consequence in language learning.

The perception of the sound of silence in early infancy

When brief periods of silence are inserted between the /s/ and /lit/ portions of the English word "slit" (/slit/), adult listeners typically hear the word as "split" (/split/). 2 experiments were conducted to investigate the ability of 6-8-month-old infants to discriminate brief periods of interconsonantal silence in "slit" versus "split" contrasts. Infants were tested in multiple sessions, using a conditioned head-turning paradigm. 3 sets of stimuli were employed: /slIt/, /slIt/ +Silence, and /splIt/, containing 0, 173, and 90 msec, respectively, of silence duration following the /s/ portion of the stimulus. In both experiments, infants reliably discriminated /slIt/ +Silence from the /slIt/ stimuli but not from the /splIt/ stimuli. Therefore, it appears that infants, like adults, do not treat stimuli containing 90 or 173 msec of silence in this interconsonantal context as different.

Discrimination of voice onset time in infancy

In an effort to determine whether infants can discriminate speech sounds on the basis of a single acoustic cue, timing onset of periodic voicing, two experiments were conducted employing synthetic speech sounds. Naturally produced syllable pairs were also used for comparison. In the first experiment infants evidenced discrimination of a naturally produced /ba/ versus /pa/ pair and a naturally /du/ versus /tu/ pair. In addition, infants discriminated a synthetic /ba/ versus /pa/ contrast that was cued by several acoustic differences in addition to timing onset of periodic voicing but failed to evidence an ability to discriminate a synthetic /du/ versus /tu/ contrast that contained flat first formants and differed only in timing onset of periodic voicing. A second experiment was conducted in which infants once again evidenced discrimination of naturally produced /du/ versus /tu/ stimuli but not of synthetic /du/ versus /tu/ stimuli containing slight first-formant transitions. These results suggest that timing onset of periodic voicing alone may not be a sufficient cue for infant discrimination of English voicing contrasts.

Vagueness and empathy: a Jamesian view

Three types of thought about the world are put forth by James in Pragmatism: common sense, science, and philosophy. The worlds of science and philosophy reified and idealized aspects of the vague, intersubjective world of common sense. However, once "formed" these two worlds are themselves "formative." They can and have infected the vague world of common sense with a quest for certainty and immediacy. Empathy arises as a problem through the conceptual world views of science and philosophy, insofar as the vague is not acceptable. Using James' views on language and his metaphysics, I argue that empathy appears epistemically as an issue unsolvable in terms of certainty, and empathy appear ontologically as an issue which compels action. In medicine, empathy exists as a problem because pure consciousness has come upon the scene as a "rip" or "tear," in Sartrean terminology. The physician finds himself "encrusted twice over"; consciousness has arisen and also professional consciousness has arisen. He/she works back, not simply toward the world of common sense, now infected, but toward the pre-reflective world. Such a recovery is never complete, yet such a recovery must always be attempted.