Autism recent issues

Editorial

Zwaigenbaum, L., Stone, W. — 2008-09-19

Clinical assessment of autism in high-risk 18-month-olds

2008-09-19

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.

Atypical object exploration at 12 months of age is associated with autism in a prospective sample

Ozonoff, S., Macari, S., Young, G. S., Goldring, S., Thompson, M., Rogers, S. J. — 2008-09-19

This prospective study examined object exploration behavior in 66 12-month-old infants, of whom nine were subsequently diagnosed with an autism spectrum disorder. Previous investigations differ on when the repetitive behaviors characteristic of autism are first present in early development. A task was developed that afforded specific opportunities for a range of repetitive uses of objects and was coded blind to outcome status. The autism/ASD outcome group displayed significantly more spinning, rotating, and unusual visual exploration of objects than two comparison groups. The average unusual visual exploration score of the autism/ASD group was over four standard deviations above the mean of the group with no concerns at outcome. Repetitive behaviors at 12 months were significantly related to cognitive and symptomatic status at 36 month outcome. These results suggest that repetitive or stereotyped behaviors may be present earlier than initially thought in very young children developing the autism phenotype.

Visual disengagement in the infant siblings of children with an autism spectrum disorder (ASD)

Ibanez, L. V., Messinger, D. S., Newell, L., Lambert, B., Sheskin, M. — 2008-09-19

Children with autism spectrum disorders (ASDs) are impaired in visually disengaging attention in both social and non-social contexts. These impairments may, in subtler form, also affect the infant siblings of children with ASD (ASD-sibs). We investigated patterns of visual attention (gazing) in 6-month-old ASD-sibs (n = 17) and the siblings of typically developing children (COMP-sibs: n =17) during the Face-to-Face/Still-Face Protocol (FFSF), in which parents are sequentially responsive, non-responsive, and responsive to their infants. Throughout the protocol, ASD-sibs shifted their gaze to and from their parents' faces less frequently than did COMP-sibs. The mean durations of ASD-sibs' gazes away from their parents' faces were longer than those of COMP-sibs. ASD-sibs and COMP-sibs did not differ in the mean durations of gazes at their parents' faces. In sum, ASD-sibs showed no deficits in visual interest to their parents' faces, but greater interest than COMP-sibs in non-face stimuli.

Validation of the Infant--Toddler Checklist as a broadband screener for autism spectrum disorders from 9 to 24 months of age

Wetherby, A. M., Brosnan-Maddox, S., Peace, V., Newton, L. — 2008-09-19

There is an urgent requirement for the improvement of early detection of ASDs. This article provides a brief review of research on the accuracy of screeners for children with ASD that have been administered to general pediatric samples and then present results of a population-based study with a broadband screener to detect children with communication delays including children with ASD.

Screening for autism in older and younger toddlers with the Modified Checklist for Autism in Toddlers

2008-09-19

The Modified Checklist for Autism in Toddlers (M—CHAT) was used to screen younger (16—23 months) versus older (24—30 months) high- and low-risk toddlers. Refusal rates for follow-up interview showed no group differences, but parents of younger/low-risk children were more likely to refuse evaluation than parents of high-risk children. PPP for an ASD diagnosis was: younger/high-risk 0.79, older/high-risk 0.74, younger/low-risk 0.28, and older/low-risk 0.61, with PPP differing by age within the low-risk group. Most of the children in all groups, however, were diagnosed with a developmental disorder. Symptom severity generally did not differ among groups. Cognitive and adaptive measures showed minimal group differences. Therefore, older and younger toddlers had similar symptomatology and developmental delays; PPP for ASD is better at 24 than 18 months for low-risk children; however, these children are still highly likely to show a developmental disorder. Clinical decision making should balance early identification against the lower specificity of M—CHAT screening for the younger/low-risk group.

Screening for autism spectrum disorders in primary care settings

Robins, D. L. — 2008-09-19

The need for autism-specific screening during pediatric well-child visits has been established. However, additional support for specific screening instruments is needed. The current study used the Modified Checklist for Autism in Toddlers (M—CHAT) and the M—CHAT Follow-Up Interview to screen 4797 children during toddler checkups. Of the 4797 cases, 466 screened positive on the M—CHAT; of the 362 who completed the follow-up interview, 61 continued to show risk for autism spectrum disorders (ASDs). A total of 41 children have been evaluated; 21 children have been diagnosed with ASD, 17 were classified with non-ASD delays, and three were typically developing. The PPV of M—CHAT plus interview was .57. It is notable that only four of the 21 cases of ASD were flagged by their pediatrician. These findings suggest that the M—CHAT is effective in identifying ASD in primary care settings. Future research will follow this sample longitudinally.

Use of the Screening Tool for Autism in Two-Year-Olds (STAT) for children under 24 months: An exploratory study

Stone, W. L., McMahon, C. R., Henderson, L. M. — 2008-09-19

The study examined the properties of the Screening Tool for Autism in Two-Year-Olds (STAT) for children under 24 months. The STAT provides a standard context for observing social-communicative behavior in play, imitation, and communication. Seventy-one children received the STAT between 12 and 23 months of age and a follow-up diagnostic evaluation after 24 months. All had an older sibling with an autism spectrum diagnosis (n = 59) or had been referred for evaluation for concerns about autism (n = 12). Signal detection analysis resulted in a cut score of 2.75 for this sample, which yielded a sensitivity of 0.95, specificity of 0.73, positive predictive value of 0.56, and negative predictive value of 0.97. False positives were highest for the 12- to 13-month-old age group; STAT screening properties were improved when the sample was limited to children 14 months and older. Implications for using the STAT with children under 24 months are discussed.

Reaction to diagnosis and parenting styles among mothers of young children with ASDs

Wachtel, K., Carter, A. S. — 2008-09-19

When a child is diagnosed with an autism spectrum disorder (ASD) parents often experience a range of difficult feelings, which typically are not addressed in child-focused interventions. This study examined the relationship between a mother's acceptance of and sense of resolution regarding her child's diagnosis of an ASD and maternal interaction style, controlling for child competence, autism symptoms and maternal depression. Participants included 63 children with an ASD between 20 and 50 months of age and their mothers. Mothers who were more emotionally resolved were rated as higher in Cognitive Engagement and Supportive Engagement in play interactions, reflecting greater verbal and nonverbal scaffolding to enhance the child's play and attention to activities and greater reciprocity and mutual enjoyment. This study highlights the importance of considering a mother's resolution about her child's diagnosis, suggesting that maternal emotions and cognitions associated with the diagnosis may be potential targets for intervention.

Editorial

Bowler, D. — 2008-06-25

Referential communication in children with autism spectrum disorder

Dahlgren, S., Sandberg, A. D. — 2008-06-25

Referential communication was studied in children with autism spectrum disorder (ASD) including children with autism and Asperger syndrome. The aim was to study alternative explanations for the children's communicative problems in such situations. Factors studied were theory of mind, IQ, verbal ability and memory. The main results demonstrated diminished performance in children with autism spectrum disorder, mirroring performance in everyday life, in comparison to verbal IQ and mental age matched typically developing children. Among children with autism spectrum disorders, there was a positive relationship between performance in referential communication and theory of mind. Memory capacity also proved to play a role in success in the task.

Can autistic children read the mind of an animated triangle?

Salter, G., Seigal, A., Claxton, M., Lawrence, K., Skuse, D. — 2008-06-25

Are children with an autism spectrum disorder (ASD), but normal-range intelligence, impaired on theory of mind skills measured by responses to abstract animations in the form of a computerized cartoon? Fifty-six cases and closely matched comparisons were tested. We rated verbal responses according to the length of their descriptions, their appropriateness and the children's use of `mentalizing' terms. Children with ASD used `mentalizing' language to describe the animations as well as comparisons, although the content of their descriptions was significantly less appropriate. Performance on this task was not well correlated with standardized measures of parent-reported behaviour or the child's interactions with an observer. The implications of our results are discussed in relation to previous studies that have used this methodology.

New-onset psychiatric disorders in individuals with autism

Hutton, J., Goode, S., Murphy, M., Le Couteur, A., Rutter, M. — 2008-06-25

A follow-up study to at least the age of 21 years of 135 individuals with an autism spectrum disorder diagnosed in childhood and an IQ of over 30 was conducted. The study is distinctive in its large size, low attrition rate and use of systematic interviews to obtain clinical information. Questionnaires completed by caregivers asked about the development of new psychiatric disorders. For the 39 individuals with a possible new disorder, a detailed psychiatric assessment was undertaken through parental interview. Of all participants, 16 percent developed a definite new psychiatric disorder. A further 6 percent developed a possible new disorder. Five individuals developed an obsessive-compulsive disorder and/or catatonia; eight an affective disorder with marked obsessional features; three complex affective disorders; four more straightforward affective disorders; one a bipolar disorder; and one an acute anxiety state complicated by alcohol excess. There was no case of schizophrenia.

Exploring the relationship between measures of self-esteem and psychological adjustment among adolescents with Asperger Syndrome

Williamson, S., Craig, J., Slinger, R. — 2008-06-25

This exploratory study examines the relationships between self-esteem and psychological adjustment among 19 adolescents with Asperger syndrome and 19 typically developing adolescents using a model developed by Harter. The groups were matched for age (mean 13 years), sex (M:F 16:3) and ethnicity (white British). Participants completed four quantitative measures examining self-competencies, social approval, anxiety, depression and self-worth. Findings revealed significant group differences: the adolescents with Asperger syndrome perceived themselves to be less competent in social and athletic domains, and to receive less peer approval. Logistic regression analyses indicated that the variables studied were particularly relevant in distinguishing group differences and worked together in predicting group membership. Indeed the variables in the final model accurately predicted group membership for all individuals in the sample. Exploratory hierarchical multiple regression analyses suggested that the two groups had different patterns of relationships between measures of self-competencies, social approval and psychological outcomes.

Mortality and causes of death in autism spectrum disorders: An update

Mouridsen, S. E., Bronnum-Hansen, H., Rich, B., Isager, T. — 2008-06-25

This study compared mortality among Danish citizens with autism spectrum disorders (ASDs) with that of the general population. A clinical cohort of 341 Danish individuals with variants of ASD, previously followed over the period 1960—93, now on average 43 years of age, were updated with respect to mortality and causes of death. Standardized mortality ratios (SMRs) were calculated for various times after diagnosis. In all, 26 persons with ASD had died, whereas the expected number of deaths was 13.5. Thus the mortality risk among those with ASD was nearly twice that of the general population. The SMR was particularly high in females. The excess mortality risk has remained unchanged since our first study in 1993. Eight of the 26 deaths were associated with epilepsy and four died from epilepsy. Future staff education should focus on better managing of the complex relationships between ASD and physical illness to prevent avoidable deaths.

Book review: Interactive Play for Children with Autism: by Diana Seach. Abingdon: Routledge, 2007. ISBN 978 0 415 33326 1. {pound}19.99 pbk. 223 pp

Hudry, K. — 2008-06-25

Editorial

Bowler, D. — 2008-04-29

Associative learning of pictures and words by low-functioning children with autism

Preissler, M. A. — 2008-04-29

This research investigates whether children with autism learn picture, word and object relations as associative pairs or whether they understand such relations as referential. In Experiment 1, children were taught a new word (e.g. `whisk') repeatedly paired with a novel picture. When given the picture and a previously unseen real whisk and asked to indicate a whisk, children with autism, unlike typically developing peers matched on receptive language, associated the word with the picture rather than the object. Subsequent experiments respectively confirmed that neither a bias for selecting pictures nor perseverative responding accounted for these results. Taken together, these results suggest that children with autism with cognitive difficulties are learning picture—word and picture—object relations via an associative mechanism and have difficulty understanding the symbolic nature of pictures.

Brief report: Inhibition of return in young people with autism and Asperger's disorder

Rinehart, N. J., Bradshaw, J. L., Moss, S. A., Brereton, A. V., Tonge, B. J. — 2008-04-29

The aim of this study was to investigate whether the superior search abilities observed in autism/Asperger's disorder may in part be a consequence of a more pronounced inhibition of return (IOR). Contrary to our prediction, IOR in individuals with autism was comparable to the matched comparison group. However, the autism group committed more false alarm responses than the matched comparison group; this may reflect a possible inhibitory deficit, or suggest that individuals with autism rely more on probabilities to determine their behavioural responses. There was a borderline-significant trend (p = 0.052) to indicate that IOR may be more pronounced in individuals with Asperger's disorder. In contrast to the autism group, the Asperger's disorder group had a pattern of false alarm responses similar to that of the comparison group. The findings further inform Minshew's complex information processing theory which seeks to establish which areas of neuropsychological functioning are preserved and deficit in autism.

Recognition of biological motion in children with autistic spectrum disorders

2008-04-29

It is widely accepted that autistic children experience difficulties in processing and recognizing emotions. Most relevant studies have explored the perception of faces. However, context and bodily gestures are also sources from which we derive emotional meanings. We tested 23 autistic children and 23 typically developing control children on their ability to recognize point-light displays of a person's actions, subjective states and emotions. In a control task, children had to recognize point-light displays of everyday objects. The children with autism only differed from the control children in their ability to name the emotional point-light displays. This suggests that children with autism can extract complex meanings from bodily movements but may be less sensitive to higher-order emotional information conveyed by human movement. The results are discussed in the context of a specific deficit in emotion perception in children with autism.

A comparison of contexts for assessing joint attention in toddlers on the autism spectrum

Roos, E. M., McDuffie, A. S., Weismer, S. E., Gernsbacher, M. A. — 2008-04-29

Children on the autism spectrum often demonstrate atypical joint attention, leading some researchers to consider joint attention defecits a core feature of the autism spectrum. Structured measures, such as the Early Social Communication Scales (ESCS), are commonly used to provide a metric of joint attention. To explore the assessment of joint attention in multiple contexts, we implemented an alternative system for coding joint attention behaviors. We compared initiation of joint attention (IJA) and response to joint attention (RJA) behaviors coded from naturalistic examiner—child play samples with similar IJA and RJA behaviors elicited within the structured ESCS protocol. Participants were 20 toddlers on the autism spectrum. Levels of IJA and RJA within the two assessment contexts were significantly and positively correlated, providing support for the use of naturalistic sampling of joint attention skills as a viable alternative, or supplement, to structured measures.

Acetaminophen (paracetamol) use, measles-mumps-rubella vaccination, and autistic disorder: The results of a parent survey

2008-04-29

The present study was performed to determine whether acetaminophen (paracetamol) use after the measles-mumps-rubella vaccination could be associated with autistic disorder. This case-control study used the results of an online parental survey conducted from 16 July 2005 to 30 January 2006, consisting of 83 children with autistic disorder and 80 control children. Acetaminophen use after measles-mumps-rubella vaccination was significantly associated with autistic disorder when considering children 5 years of age or less (OR 6.11, 95% CI 1.42—26.3), after limiting cases to children with regression in development (OR 3.97, 95% CI 1.11—14.3), and when considering only children who had post-vaccination sequelae (OR 8.23, 95% CI 1.56—43.3), adjusting for age, gender, mother's ethnicity, and the presence of illness concurrent with measles-mumps-rubella vaccination. Ibuprofen use after measles-mumps-rubella vaccination was not associated with autistic disorder. This preliminary study found that acetaminophen use after measles-mumps-rubella vaccination was associated with autistic disorder.

Parents' perceptions of communication with professionals during the diagnosis of autism

Osborne, L. A., Reed, P. — 2008-04-29

In order to obtain the views of parents concerning their perceptions of the process of getting a diagnosis of an autistic spectrum disorder (ASD) for their child, 15 focus groups were conducted across a range of locations in England. These groups were split into parents of preschool-, primary- and secondary-aged children who had recently received an ASD diagnosis. At the time of diagnosis, most of the parents wished for a quicker and easier process. In particular, they would prefer the procedure to have a more coherent structure and content. They also requested greater professional training about ASD, in particular, regarding the information that professionals possess, and the interpersonal skills of some professionals. The idea of broad information sheets to be provided to parents at the time of diagnosis would be of value, especially to combat negative information provided from other sources.

Editorial

Hare, D. J. — 2008-02-28

Profiling executive dysfunction in adults with autism and comorbid learning disability

Barnard, L., Muldoon, K., Hasan, R., O'Brien, G., Stewart, M. — 2008-02-28

Executive dysfunction is thought to be primary to autism. We examined differences in executive function between 20 adults with autism and learning disability and 23 individuals with learning disabilities outside the autistic spectrum. All participants were matched for chronological age and full-scale IQ, and were given a battery of tasks assessing fluency, planning, set-shifting, inhibition and working memory. Analyses of the individual tasks revealed very few significant differences between the two groups. However, analyses of composite scores derived for each executive domain revealed that the group with autism showed impaired performance on the working memory and planning tests. Together, these two measures were sufficient to classify participants into their diagnostic groups significantly better than would be expected by chance (75% of the autism group; 65% of the control group). Executive impairments were neither universal nor exclusive to the autism group, and we suggest that an alternative cognitive theory may better explain the cognitive profile we found.

Development of symbolic play through the use of virtual reality tools in children with autistic spectrum disorders: Two case studies

Herrera, G., Alcantud, F., Jordan, R., Blanquer, A., Labajo, G., De Pablo, C. — 2008-02-28

Difficulties in understanding symbolism have been documented as characteristic of autistic spectrum disorders (ASDs). In general, virtual reality (VR) environments offer a set of potential advantages for educational intervention in ASD. In particular, VR offers the advantage, for teaching pretend play and for understanding imagination, of it being possible to show these imaginary transformations explicitly. This article reports two case studies of children with autism (aged 8:6 and 15:7, both male), examining the effectiveness of using a VR tool specifically designed to work on teaching understanding of pretend play. The results, confirmed by independent observers, showed a significant advance in pretend play abilities after the intervention period in both participants, and a high degree of generalization of the acquired teaching in one of them.

How central is central coherence?: Preliminary evidence on the link between conceptual and perceptual processing in children with autism

Lopez, B., Leekam, S. R., Arts, G. R . J. — 2008-02-28

This study aimed to test the assumption drawn from weak central coherence theory that a central cognitive mechanism is responsible for integrating information at both conceptual and perceptual levels. A visual semantic memory task and a face recognition task measuring use of holistic information were administered to 15 children with autism and 16 typically developing children. If there is a central integration mechanism, performance on the two tasks should be positively associated. No relationship was found, however, between the two abilities in the comparison group and, unexpectedly, a strong significant inverse correlation was found in the autism group. Classification data further confirmed this finding and indicated the possibility of the presence of subgroups in autism. The results add to emerging evidence suggesting that central coherence is not a unitary construct.

Social challenges and supports from the perspective of individuals with Asperger syndrome and other autism spectrum disabilities

Muller, E., Schuler, A., Yates, G. B. — 2008-02-28

The study describes the perspectives of individuals with Asperger syndrome and other autism spectrum disabilities (ASDs) regarding social challenges and supports. Eighteen adults with ASDs were individually interviewed. They were asked to describe their experiences navigating their social worlds, and recommend effective social supports and strategies for improving social connectedness. Qualitative analyses of the interview transcripts revealed a number of common experiences including a profound sense of isolation, difficulty initiating social interactions, challenges relating to communication, longing for greater intimacy, desire to contribute to one's community, and effort to develop greater social/self-awareness. Commonly recommended social supports included external supports (e.g. activities based on shared interests, highly structured or scripted social activities, and small groups or dyads); communication supports (e.g. alternative modes of communication, explicit communication, and instruction in interpreting and using social cues); and self-initiated strategies for handling social anxiety (e.g. creative/improvisational outlets, physical activity, spiritual practice/organized religion, and time spent alone).

Epidemiological findings of pervasive developmental disorders in a Venezuelan study

Montiel-Nava, C., Pena, J. A. — 2008-02-28

The study aims to determine the prevalence of autism spectrum disorders (ASDs) for children receiving services in Maracaibo County, Venezuela. Children aged 3—9 with diagnosis of any ASD were recruited. We ascertained area, referral process, and definitions of ASD for each patient. A total of 430 children were identified, and 76.5 percent were boys. Prevalences were 1.7 per 1000 for all ASD, 1.1 per 1000 for autism, and 0.6 per 1000 for PDD-NOS and Asperger syndrome combined. These prevalences are lower than current reports in the literature. Differences in case-finding methods, diagnostic criteria, and lack of awareness in the general population may have influenced the number of cases identified. An ASD prevalence of 1.7 per 1000 should alert the health and education authorities to the need to reassess the services available for children with these disorders and their families.

Autism and pitch processing splinter skills: A group and subgroup analysis

Heaton, P., Williams, K., Cummins, O., Happe, F. — 2008-02-28

Autism is characterized by an uneven profile of cognitive abilities and population studies show that approximately 10 percent of diagnosed individuals possess a skill that is significantly better than would be predicted by global IQ. Recent evidence suggests that individuals with autism who possess special skills may represent a distinct genetic group within the autism spectrum. Intellectually high- and low-functioning children and adolescents with autism, together with age- and intelligence-matched comparison participants, completed two experiments that tested pitch discrimination and pitch memory within a visuo-spatial format. The analysis of the data from the studies showed that a subgroup of individuals with autism achieved performance scores that were between four and five standard deviations above the mean for the groups. Unlike comparison participants, their performance appeared to be independent of intelligence, musical training and experience. The findings were interpreted within the context of neuroconstructivist models of typical development and delayed language acquisition characteristic of autism and other neurodevelopmental disorders.