Autism recent issues

Editorial

Bowler, D. — Mon, 23 Nov 2009 06:35:07 PST

Establishing a sexual identity: Case studies of learners with autism and learning difficulties

Tissot, C. — Mon, 23 Nov 2009 06:35:08 PST

The physical and emotional changes that occur in adolescence are part of the process of sexual maturity. These changes occur irrespective of ability and are often aligned with psychological and social factors. When the nature of a disability has an inherent limitation in social awareness, as is the case for individuals with autism, the achievement of personal sexual identity can become much more complex. Challenges in supporting individuals in this respect can be caused by the sensitive aspects of inappropriate behaviour, the abstract nature of teaching the topic, and the general reluctance on the part of parents and staff to discuss sexuality in individuals with disabilities. This article explores how a residential school addressed this gap. It provides details of how this need was met for seven students and the process undertaken to involve staff, parents and other stakeholders to establish ongoing support.

Autistic disorder symptoms in Rett syndrome

Wulffaert, J., Van Berckelaer-Onnes, I. A., Scholte, E. M. — Mon, 23 Nov 2009 06:35:08 PST

According to the major classification systems it is not possible to diagnose a comorbid autistic disorder in persons with Rett syndrome. However, this is a controversial issue, and given the level of functioning of persons with Rett syndrome, the autistic disorder is expected to be present in a comparable proportion as in people with the same level of functioning. To investigate, parents of 52 females with classical and atypical Rett syndrome (2.4—49.3 years) completed the Developmental Behavior Checklist (DBC), the Diagnostic Interview for Social and Communication Disorders (DISCO) and the Dutch Vineland Screener 0—6 (VS 0—6). All participants had a severe to profound intellectual disability (ID) according to the VS 0—6. Behavior indicated an autistic disorder in 42 (DBC) to 58 percent (DISCO) of the Rett cases. Autistic behavior had decreased in 19 percent such that they no longer met the criteria for autistic disorder. Some participants were suspected of having a comorbid autistic disorder, though not more often than can be expected at their level of functioning. Clinicians should be aware of the possibility of a comorbid autistic disorder as much as they should be in other people with this level of functioning.

Multi-informant reports of psychiatric symptoms among high-functioning adolescents with Asperger syndrome or autism

Mon, 23 Nov 2009 06:35:08 PST

The aim of the study was to examine psychiatric symptoms in high-functioning adolescents with autism spectrum disorders reported by multiple informants. Forty-three 11- to 17-year-old adolescents with Asperger syndrome (AS) or high-functioning autism (HFA) and 217 typically developed adolescents completed the Youth Self-Report (YSR), while their parents completed the Child Behavior Checklist (CBCL). Teachers of adolescents with AS/HFA completed the Teacher Report Form (TRF). The informants reported significantly more psychiatric symptoms, especially withdrawn, anxious/depressed, social and attention problems, in adolescents with AS/HFA than in controls. In contrast to findings in the general population, the psychiatric problems of adolescents with AS/HFA are well acknowledged by multiple informants, including self-reports. However, anxiety and depressive symptoms were more commonly reported by adolescents with AS/HFA and their teachers than their parents, indicating that some emotional distress may be hidden from their parents.

Imitation in fragile X syndrome: Implications for autism

Mon, 23 Nov 2009 06:35:08 PST

To address the specific impairment of imitation in autism, the imitation abilities of 22 children with fragile X syndrome (FXS) with and without autism were compared. Based on previous research, we predicted that children with FXS and autism would have significantly more difficulty with non-meaningful imitation tasks. After controlling for full-scale IQ and age, the groups did not differ in their overall imitation accuracy scores, but analysis of error patterns revealed that children with FXS and autism made more groping errors and additional movements than the comparison group. These error patterns are consistent with the hypothesis that an action production system deficit plays an important role in the overall imitation deficit in autism, at least in children with FXS.

Assessing progress during treatment for young children with autism receiving intensive behavioural interventions

Hayward, D., Eikeseth, S., Gale, C., Morgan, S. — Mon, 23 Nov 2009 06:35:08 PST

This study examined progress after 1 year of treatment for children with autism who received a mean of 36 hours per week one-to-one University of California at Los Angeles Applied Behavior Analysis (UCLA ABA) treatment. Two types of service provision were compared: an intensive clinic based treatment model with all treatment personnel (N = 23), and an intensive parent managed treatment model with intensive supervision only (N = 21). A non-concurrent multiple baseline design across participants (N = 13) examined whether progress was associated with ABA treatment or confounders. Between intake and follow-up, children in both groups improved significantly on IQ, visual-spatial IQ, language comprehension, expressive language, social skills, motor skills and adaptive behaviour. There were no significant differences between the two groups on any of the measures at follow-up. Mean IQ for participants in both groups increased by 16 points between intake and follow-up. These findings are consistent with previous studies demonstrating the benefits of ABA treatment.

Book review: The Autistic Spectrum: Characteristics, causes and practical issues by Jill Boucher. London: SAGE Publications, 2009. ISBN 978--0--7619--6211--3

Fletcher-Watson, S. — Mon, 23 Nov 2009 06:35:08 PST

Editorial

Wed, 16 Sep 2009 03:36:57 PDT

Emotional and behavioural adjustment in siblings of children with intellectual disability with and without autism

Petalas, M. A., Hastings, R. P., Nash, S., Lloyd, T., Dowey, A. — Wed, 16 Sep 2009 03:36:57 PDT

Siblings of children with autism may be at greater risk for psychological problems than siblings of children with another disability or of typically developing (TD) children. However, it is difficult to establish whether autism or the presence of intellectual disability (ID) explains the findings in previous research. Mothers rated the emotional and behavioural adjustment of siblings of children with ID with (N = 25) or without (N = 24) autism. Data were also available 18 months later for siblings of children with autism and ID (N = 15). Siblings of children with autism and ID had more emotional problems compared with siblings of children with ID only and with normative data. Three variables were pertinent: increasing age of the child with autism, having a brother with autism, and being younger than the child with autism. Behavioural and emotional difficulties of siblings of children with autism and ID were relatively stable over 18 months.

Which DSM-IV-TR criteria best differentiate high-functioning autism spectrum disorder from ADHD and anxiety disorders in older children?

Hartley, S. L., Sikora, D. M. — Wed, 16 Sep 2009 03:36:57 PDT

Diagnosis of autism spectrum disorder (ASD) is often delayed in high-functioning children with milder and more varied forms of ASD. The substantial overlap between ASD and other psychiatric disorders is thought to contribute to this delay. This study examined the endorsement of DSM-IV-TR diagnostic criteria for ASD based on semi-structured parent interviews across three groups of older children referred to an ASD clinic: 55 children diagnosed with high-functioning ASD, 27 children diagnosed with attention-deficit/hyperactivity disorder (ADHD), and 23 children diagnosed with anxiety disorder. Results indicate that the criteria within the domains of communication and social relatedness were largely able to discriminate the high-functioning ASD group from the ADHD and anxiety disorder groups, but criteria within the domain of restricted/repetitive/stereotyped patterns were not.

Autistic features in girls from a psychiatric sample are strongly associated with a low 2D:4D ratio

Wed, 16 Sep 2009 03:36:57 PDT

Autistic features such as deficits in social interactions and communication have been associated with a low 2D:4D ratio in normal children.This study assessed this association in a large sample of children with a variety of psychiatric disorders (n = 35 girls and n = 147 boys). Autistic features were assessed with a highly valid and reliable measure (Autism Diagnostic Observation Schedule—Generic). Correlations between the 2D:4D ratio and autistic features were computed separately for boys and girls. Some small negative correlations (r = —0.17 and r = —0.19) were found in the right hand for boys; however, particularly in girls, large negative correlations (r = —0.51 to r = —0.64) were found in the left hand. A low 2D:4D ratio in girls was highly predictive of the presence of autistic features. Thus, a low ratio could possibly be used as a diagnostic predictor in clinical practice.

Set-shifting in children with autism spectrum disorders: Reversal shifting deficits on the Intradimensional/Extradimensional Shift Test correlate with repetitive behaviors

Wed, 16 Sep 2009 03:36:57 PDT

Research examining set-shifting has revealed significant difficulties for adults with autism spectrum disorders (ASDs). However, research with high-functioning children with ASDs has yielded mixed results. The current study tested 6- to 13-year-old high-functioning children with ASD and typically developing controls matched on age, gender, and IQ using the Intradimensional/Extradimensional (ID/ED) Shift Test from the Cambridge Neuropsychological Test Automated Battery. Children with ASDs completed as many ED shifts and reversal ED shifts as controls; however, they made significantly more errors than controls while completing the ED reversal shifts. Analyses on a subset of cases revealed a significant positive correlation between ED reversal errors and the number of repetitive behavior symptoms in the ASD group. These findings suggest that high-functioning children with ASDs require additional feedback to shift successfully. In addition, the relationship between set-shifting and non-social symptoms suggests its utility as a potentially informative intermediate phenotype in ASDs.

Book review: Assessment of Autism Spectrum Disorders by S. Goldstein, J.A. Naglieri and S. Ozonoff (Eds). London: Guildford Press, 2009. ISBN 978--1--59385 --983--1. {pound}27.45 hdk. 384 pp

Loucas, T. — Wed, 16 Sep 2009 03:36:57 PDT

Editorial

Bowler, D. — Wed, 17 Jun 2009 07:30:51 PDT

Are there more bowel symptoms in children with autism compared to normal children and children with other developmental and neurological disorders?: A case control study

Smith, R.A., Farnworth, H., Wright, B., Allgar, V. — Wed, 17 Jun 2009 07:30:51 PDT

There is considerable controversy as to whether there is an association between bowel disorders and autism. Using a bowel symptom questionnaire we compared 51 children with autism spectrum disorder with control groups of 35 children from special school and 112 from mainstream school. There was a significant difference in the reporting of certain bowel symptoms (constipation, diarrhoea, flatulence) and food faddiness between the autism group and the mainstream school control group. There was no significant difference between the autism group and children in the special schools except for faddiness, which is an autism specific symptom and not a bowel symptom. This study confirms previously reported findings of an increase in bowel symptoms in children with autism. It would appear, however, that this is not specifically associated with autism as bowel symptoms were reported in similar frequency to a comparison group of children with other developmental and neurological disorders.

Developmental regression in children with an autism spectrum disorder identified by a population-based surveillance system

Wiggins, L. D., Rice, C. E., Baio, J. — Wed, 17 Jun 2009 07:30:51 PDT

This study evaluated the phenomenon of autistic regression using population-based data. The sample comprised 285 children who met the autism spectrum disorder (ASD) case definition within an ongoing surveillance program. Results indicated that children with a previously documented ASD diagnosis had higher rates of autistic regression than children who met the ASD surveillance definition but did not have a clearly documented ASD diagnosis in their records (17—26 percent of surveillance cases). Most children regressed around 24 months of age and boys were more likely to have documented regression than girls. Half of the children with regression had developmental concerns noted prior to the loss of skills. Moreover, children with autistic regression were more likely to show certain associated features, including cognitive impairment.These data indicate that some children with ASD experience a loss of skills in the first few years of life and may have a unique symptom profile.

Parenting stress and psychological functioning among mothers of preschool children with autism and developmental delay

Estes, A., Munson, J., Dawson, G., Koehler, E., Zhou, X.-H., Abbott, R. — Wed, 17 Jun 2009 07:30:51 PDT

Parents of children with developmental disabilities, particularly autism spectrum disorders (ASDs), are at risk for high levels of distress. The factors contributing to this are unclear. This study investigated how child characteristics influence maternal parenting stress and psychological distress. Participants consisted of mothers and developmental-age matched preschool-aged children with ASD (N = 51) and developmental delay without autism (DD) ( N = 22). Evidence for higher levels of parenting stress and psychological distress was found in mothers in the ASD group compared to the DD group. Children's problem behavior was associated with increased parenting stress and psychological distress in mothers in the ASD and DD groups. This relationship was stronger in the DD group. Daily living skills were not related to parenting stress or psychological distress. Results suggest clinical services aiming to support parents should include a focus on reducing problem behaviors in children with developmental disabilities.

Emotional, motivational and interpersonal responsiveness of children with autism in improvisational music therapy

Kim, J., Wigram, T., Gold, C. — Wed, 17 Jun 2009 07:30:51 PDT

Through behavioural analysis, this study investigated the social-motivational aspects of musical interaction between the child and the therapist in improvisational music therapy by measuring emotional, motivational and interpersonal responsiveness in children with autism during joint engagement episodes. The randomized controlled study (n = 10) employed a single subject comparison design in two different conditions, improvisational music therapy and toy play sessions, and DVD analysis of sessions. Improvisational music therapy produced markedly more and longer events of `joy', `emotional synchronicity' and `initiation of engagement' behaviours in the children than toy play sessions. In response to the therapist's interpersonal demands, `compliant (positive) responses' were observed more in music therapy than in toy play sessions, and `no responses' were twice as frequent in toy play sessions as in music therapy. The results of this exploratory study found significant evidence supporting the value of music therapy in promoting social, emotional and motivational development in children with autism.

The role of vision for online control of manual aiming movements in persons with autism spectrum disorders

Glazebrook, Cherylm., Gonzalez, D., Hansen, S., Elliott, D. — Wed, 17 Jun 2009 07:30:51 PDT

Recent studies suggest motor skills are not entirely spared in individuals with an autism spectrum disorder (ASD). Previous reports demonstrated that young adults with ASD were able to land accurately on a target despite increased temporal and spatial variability during their movement. This study explored how a group of adolescents and young adults with an ASD used vision and proprioception to land successfully on one of two targets. Participants performed eye movements and/or manual reaching movements, either with or without vision. Although eye movements were executed in a similar timeframe, participants with ASD took longer to plan and execute manual reaching movements. They also exhibited significantly greater variability during eye and hand movements, but were able to land on the target regardless of the vision condition. In general, individuals with autism used vision and proprioception. However, they took considerably more time to perform movements that required greater visual-proprioceptive integration.

Perceiving the impossible: How individuals with autism copy paradoxical figures

Sheppard, E., Ropar, D., Mitchell, P. — Wed, 17 Jun 2009 07:30:51 PDT

Mottron and colleagues found that individuals with autism were less affected by geometric impossibility than comparison participants on a copying task. The current experiment sought to determine whether a local perceptual style could account for this. Participants with and without autism copied possible and impossible geometric figures. Geometric impossibility had a larger effect on drawing time for comparison participants than for those with autism. However, participants with autism did not use more localized drawing strategies. Strength of impossibility effect was associated with a global strategy amongst comparison participants but this relationship was not found amongst participants with autism. The findings suggest that differences in high-level conceptual processing may account for group differences in effects of impossibility.

Book review: Autism: An Integrated View from Neurocognitive, Clinical, and Intervention Research edited by Evelyn McGregor, Maria Nunez, Katie Cebula and Juan Carlos Gomez. Oxford: Blackwell, 2008. ISBN--978--1--4051--5696--7. {pound}24.99 pbk. 352 pp

Crane, L. — Wed, 17 Jun 2009 07:30:51 PDT

Book Review: Asperger Syndrome and Employment by Genevieve Edmonds and Luke Beardon (eds). London: Jessica Kingsley, 2008. ISBN 978--1--84310--648--7 pbk. 176 pp

Hill, E. L., Collins, A. — Wed, 17 Jun 2009 07:30:51 PDT

Editorial

Hare, D. J., Mills, R. — Wed, 15 Apr 2009 07:33:48 PDT

Sensory processing in adults with autism spectrum disorders

Crane, L., Goddard, L., Pring, L. — Wed, 15 Apr 2009 07:33:48 PDT

Unusual sensory processing has been widely reported in autism spectrum disorders (ASDs); however, the majority of research in this area has focused on children. The present study assessed sensory processing in adults with ASD using the Adult/Adolescent Sensory Profile (AASP), a 60-item self-report questionnaire assessing levels of sensory processing in everyday life. Results demonstrated that sensory abnormalities were prevalent in ASD, with 94.4 percent of the ASD sample reporting extreme levels of sensory processing on at least one sensory quadrant of the AASP. Furthermore, analysis of the patterns of sensory processing impairments revealed striking within-group variability in the ASD group, suggesting that individuals with ASD could experience very different, yet similarly severe, sensory processing abnormalities. These results suggest that unusual sensory processing in ASD extends across the lifespan and have implications regarding both the treatment and the diagnosis of ASD in adulthood.

Divided attention capacity in adults with autism spectrum disorders and without intellectual disability

Bogte, H., Flamma, B., Van Der Meere, J., Van Engeland, H. — Wed, 15 Apr 2009 07:33:48 PDT

Earlier research showed that divided attention, an aspect of executive function, is limited in both children and adults with autism spectrum disorders (ASDs). The current study explored divided attention capacity in adults with ASD and without intellectual disability (n = 36). Divided attention was tested using a computerized variant of a well-known memory recognition test, with two levels of cognitive load. The effect of cognitive load on reaction time performance is considered to be inversely proportional to divided attention capacity. The study failed to provide a relationship between divided attention and ASD, contrary to earlier research. Findings indicated that only the adults with ASD who used medication had a divided attention deficit, and that this group had specific difficulty reaching a binary decision in a memory search task. An additional finding was that the participants with ASD were overall slow. Possible causes and implications of these findings are discussed.

Executive functioning differences between adults with attention deficit hyperactivity disorder and autistic spectrum disorder in initiation, planning and strategy formation

Wed, 15 Apr 2009 07:33:48 PDT

Executive functioning deficits characterize the neuropsychological profiles of the childhood neurodevelopmental disorders of attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD). This study sought to determine whether similar impairments exist in adults with ADHD (N = 53) and ASD (N = 45) in comparison with a healthy control group (N = 31), whether the two disorders can be distinguished on the basis of their executive functioning features, and whether these impairments are related to symptom severity. Both clinical groups were found to exhibit executive functioning deficits. The ADHD group had difficulty withholding a response, with relative preservation of initiation and planning abilities. In contrast, the ASD group exhibited significant impairments in initiation, planning and strategy formation. The specific executive functioning deficits were related to severity of response inhibition impairments in ADHD and stereotyped, repetitive behaviours in ASD. These findings suggest the pattern of executive functioning deficits follows a consistent trajectory into adulthood.

The `not guilty verdict': Psychological reactions to a diagnosis of Asperger syndrome in adulthood

Punshon, C., Skirrow, P., Murphy, G. — Wed, 15 Apr 2009 07:33:48 PDT

Asperger syndrome is a relatively new diagnostic classification. A number of factors make receiving a diagnosis of Asperger syndrome in adulthood a unique experience. This study used a phenomenological approach to examine the experiences of 10 adults receiving such a diagnosis. Results suggested that six major themes were associated with receiving a diagnosis of Asperger syndrome. Individuals discussed their negative life experiences and their experience of services prior to diagnosis, which led to individuals holding certain beliefs about the symptoms of Asperger syndrome. These beliefs had an effect on the formation of each individual's perceived self-identity. Participants made links between how they felt when they received the diagnosis and their current beliefs about both their `symptoms' and themselves. Finally, participants highlighted the importance of the societal view of Asperger syndrome. The implications of these findings are reappraised in the context of previous research and the wider literature on identity formation.

The costs of services and employment outcomes achieved by adults with autism in the US

Cimera, R. E., Cowan, R. J. — Wed, 15 Apr 2009 07:33:48 PDT

This article examines the cost of services and employment outcomes obtained by adults with autism within the United States vocational rehabilitation (VR) system. It found that the number of such individuals has increased by more than 121 percent from 2002 to 2006. Moreover, though adults with autism were employed at higher rates than most disability groups investigated, they tended to work far fewer hours and earn less in wages per week. The study also found that adults with autism were among the most costly individuals to serve.

Objective and subjective quality of life in adults with autism spectrum disorders in southern Spain

Saldana, D., Alvarez, R. M., Lobaton, S., Lopez, A. M., Moreno, M., Rojano, M. — Wed, 15 Apr 2009 07:33:48 PDT

Subjective and objective measures of quality of life (QoL) were obtained for adults with autism spectrum disorders (ASDs) living in Andalusia (Spain). Seventy-four families responded to questionnaires about objective QoL indicators such as employment, health, adaptive behaviour and social network, and were asked to act as proxies for subjective QoL measures. Outcome on objective QoL was extremely poor. Social networks were most frequently composed of family members. Community-oriented resources were absent in most cases. For two-thirds of the families, the ability to act as proxies for subjective QoL was seriously limited by the participants' poor social and communicative abilities. The results are indicative of the need for additional support to families of adults with ASD and increased community-based resources. Further conceptualization of indicators and measurement of subjective QoL in individuals with severe disabilities and ASD is also needed in order to include their own perspective in the evaluation of service provision.

Economic cost of autism in the UK

Knapp, M., Romeo, R., Beecham, J. — Wed, 15 Apr 2009 07:33:48 PDT

Autism has lifetime consequences, with potentially a range of impacts on the health, wellbeing, social integration and quality of life of individuals and families. Many of those impacts are economic. This study estimated the costs of autism spectrum disorders (ASDs) in the UK. Data on prevalence, level of intellectual disability and place of residence were combined with average annual costs of services and support, together with the opportunity costs of lost productivity. The costs of supporting children with ASDs were estimated to be £2.7 billion each year. For adults, these costs amount to £25 billion each year. The lifetime cost, after discounting, for someone with ASD and intellectual disability is estimated at approximately £1.23 million, and for someone with ASD without intellectual disability is approximately £0.80 million.