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Wilkinson EH, Britton TC, Hall SS. Examining Phenotypic Differences in Gaze Avoidance Between Autism Spectrum Disorder and Fragile X Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:435-454. [PMID: 36306410 PMCID: PMC9667749 DOI: 10.1352/1944-7558-127.6.435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 08/31/2021] [Indexed: 05/22/2023]
Abstract
We examined potential phenotypic differences in eye gaze avoidance exhibited by boys with autism spectrum disorder (ASD) and boys with fragile X syndrome (FXS). In Study 1, the Eye Contact Avoidance Scale (ECAS) was administered to caregivers of boys aged 7-18 years with FXS (n = 148), ASD (n = 168), and mixed developmental disabilities (MDD; n = 128). In Study 2, subsets of boys with FXS (n = 31) and boys with ASD (n = 25) received a brief behavioral treatment probe to improve eye contact. Results showed that boys with FXS obtained significantly higher scores on the ECAS compared to boys with ASD and MDD. Exposure to the brief behavioral treatment probe resulted in significant decreases in scores for boys with FXS, but not for boys with ASD.
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Affiliation(s)
- Ellen H Wilkinson
- Ellen H. Wilkinson, Tobias C. Britton, and Scott S. Hall, Stanford University School of Medicine
| | - Tobias C Britton
- Ellen H. Wilkinson, Tobias C. Britton, and Scott S. Hall, Stanford University School of Medicine
| | - Scott S Hall
- Ellen H. Wilkinson, Tobias C. Britton, and Scott S. Hall, Stanford University School of Medicine
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2
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Drapalik KN, Grodberg D, Ventola P. Feasibility and Acceptability of Delivering Pivotal Response Treatment for Autism Spectrum Disorder via Telehealth: Pilot Pre-Post Study. JMIR Pediatr Parent 2022; 5:e32520. [PMID: 36066927 PMCID: PMC9490533 DOI: 10.2196/32520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 04/28/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pivotal response treatment (PRT), an evidence-based and parent-delivered intervention, is designed to improve social communication in autistic individuals. OBJECTIVE The aim of this study was to assess the feasibility, acceptability, and clinical effects of an online model of PRT delivered via MindNest Health, a telehealth platform that aims to provide self-directed and engaging online modules, real-time coaching and feedback, and accessible stepped-care to large populations of parents seeking resources for their autistic children. METHODS Male and female autistic children, aged 2-7 years with single-word to phrase-level speech, and their parents were eligible to participate in the study. Families were randomized to the online parent training condition or control condition. The online component of the intervention consisted of eight 20-minute online courses of content describing parent training principles in PRT. Four 1-hour videoconferences were held after course 1, course 3, course 5, and course 8. Parents were given 1-2 weeks to complete each course. Parents completed the Client Credibility Questionnaire (CCQ) at week 2 and at the study endpoint, as well as the Behavioral Intervention Rating Scale (BIRS) at the study endpoint to assess parental expectancies, and treatment acceptability and effectiveness. RESULTS Nine of 14 participants completed the study curriculum in the online parent training condition, and 6 of 12 participants completed the control condition. Thus, a total of 58% (15/26) participants across both groups completed the study curriculum by study closure. Within the online parent training condition, there was a significant increase in mean CCQ total scores, from 25.38 (SD 3.25) at baseline to 27.5 (SD 3.74) at study endpoint (P=.04); mean CCQ confidence scores, from 6.0 (SD 1.07) at baseline to 6.75 (SD 0.89) at study endpoint (P=.02); and mean CCQ other improvement scores, from 5.25 (SD 0.89) at baseline to 6.25 (SD 1.28) at study endpoint (P=.009). Within the control condition, a modest increase in mean CCQ scores was noted (Confidence, difference=+0.25; Recommend, difference=+0.25; Total Score, difference=+0.50), but the differences were not statistically significant (Confidence P=.38, Recommend P=.36, Total Score P=.43). Among the 11 parents who completed the BIRS at the study endpoint, 82% (n=9) endorsed that they slightly agree or agree with over 93% of the Acceptability factor items on the BIRS. CONCLUSIONS The feasibility of this online treatment is endorsed by the high rate of online module completion and attendance to videoconferences within the online parent training group. Acceptability of treatment is supported by strong ratings on the CCQ and significant improvements in scores, as well as strong ratings on the BIRS. This study's small sample size limits the conclusions that can be drawn; however, the PRT MindNest Health platform holds promise to support parents of autistic children who are unable to access traditional, in-person parent-mediated interventions for their child.
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Affiliation(s)
- Krista N Drapalik
- Center for Autism and Related Disabilities, University at Albany, State University of New York, Albany, NY, United States
- Yale Child Study Center, Yale University, New Haven, CT, United States
| | - David Grodberg
- Yale Child Study Center, Yale University, New Haven, CT, United States
| | - Pamela Ventola
- Yale Child Study Center, Yale University, New Haven, CT, United States
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Franz L, Goodwin CD, Rieder A, Matheis M, Damiano DL. Early intervention for very young children with or at high likelihood for autism spectrum disorder: An overview of reviews. Dev Med Child Neurol 2022; 64:1063-1076. [PMID: 35582893 PMCID: PMC9339513 DOI: 10.1111/dmcn.15258] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/19/2022]
Abstract
AIM To identify which interventions are supported by evidence and the quality of that evidence in very young children with or at high likelihood for autism spectrum disorder (ASD) to improve child outcomes. METHOD We conducted an overview of reviews to synthesize early intervention literature for very young children with or at high likelihood for ASD. Cochrane guidance on how to perform overviews of reviews was followed. Comprehensive searches of databases were conducted for systematic reviews and meta-analyses between January 2009 and December 2020. Review data were extracted and summarized and methodological quality was assessed. Primary randomized controlled trial evidence was summarized and risk of bias assessed. This overview of reviews was not registered. RESULTS From 762 records, 78 full texts were reviewed and seven systematic reviews and meta-analyses with 63 unique studies were identified. Several interventional approaches (naturalistic developmental behavioral intervention, and developmental and behavioral interventions) improved child developmental outcomes. Heterogeneity in design, intervention and control group, dose, delivery agent, and measurement approach was noted. Inconsistent methodological quality and potential biases were identified. INTERPRETATION While many early interventional approaches have an impact on child outcomes, study heterogeneity and quality had an impact on our ability to draw firm conclusions regarding which treatments are most effective. Advances in trial methodology and design, and increasing attention to mitigating measurement bias, will advance the quality of the ASD early intervention evidence base. WHAT THIS PAPER ADDS Naturalistic developmental behavioral interventions, as well as developmental and behavioral interventions, improve child outcomes in autism spectrum disorder (ASD). If only randomized controlled trials are considered, guidelines for early intensive behavioral intervention in younger children should be revisited. The greatest intervention impacts were on proximal, intervention-specific outcomes. Inadequacies in the quality of the early ASD intervention evidence base were observed.
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Affiliation(s)
- Lauren Franz
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke Global Health Institute, Duke University, Durham, NC, USA
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, Cape Town, South Africa
| | | | - Amber Rieder
- Duke Global Health Institute, Duke Institute for Brain Sciences, Duke University, Durham, NC, USA
| | - Maya Matheis
- Center on Disability Studies, College of Education, University of Hawai’i at Mānoa, Honolulu, Hawai’i, USA
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Factor RS, Rea HM, Laugeson EA, Scarpa A. Examining Feasibility and Outcomes of the PEERS® for Preschoolers Program. J Autism Dev Disord 2022; 53:1821-1833. [PMID: 35267147 DOI: 10.1007/s10803-022-05502-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
Abstract
Social impairments characteristic of autism spectrum disorder (ASD) are evident in early childhood and often worsen. There is a paucity of evidence-based interventions explicitly targeting social skill development for young children with ASD and few actively integrate caregivers. The PEERS® program, an evidence-based caregiver-assisted social skills program, was extended for young children with ASD (i.e., PEERS® for Preschoolers (P4P)). This pilot study expands upon initial results by examining the feasibility of a briefer intervention period and the effectiveness in improving child social skills among 15 children with ASD. Results suggest P4P recruitment, participant retention, and implementation are feasible across clinicians and sites. Further, P4P appears to improve social skills, maintained post-intervention. Future research might examine mechanisms that lead to results.
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Affiliation(s)
- Reina S Factor
- Department of Psychology, Virginia Tech 109 Williams Hall, 890 Drillfield Drive, Blacksburg, VA, 24061, USA. .,Virginia Tech Autism Clinic & Center for Autism Research, 3110 Prices Fork Road, Blacksburg, VA, 24061, USA. .,Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 300 Medical Plaza, Los Angeles, CA, 90095, USA.
| | - Hannah M Rea
- Research in Autism and the Brain Lab, University of Washington, CHDD Box 357920, Seattle, WA, 98195, USA
| | - Elizabeth A Laugeson
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 300 Medical Plaza, Los Angeles, CA, 90095, USA
| | - Angela Scarpa
- Department of Psychology, Virginia Tech 109 Williams Hall, 890 Drillfield Drive, Blacksburg, VA, 24061, USA.,Virginia Tech Autism Clinic & Center for Autism Research, 3110 Prices Fork Road, Blacksburg, VA, 24061, USA
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Factor RS, Glass L, Baertschi D, Laugeson EA. Remote PEERS ® for preschoolers: A pilot parent-mediated social skills intervention for young children with social challenges over telehealth. Front Psychiatry 2022; 13:1008485. [PMID: 36523874 PMCID: PMC9745198 DOI: 10.3389/fpsyt.2022.1008485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/09/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Social differences characteristic of autism spectrum disorder (ASD) and other developmental disabilities are evident in early childhood and are associated with later difficulties. Unfortunately, there is a paucity of evidence-based interventions explicitly targeting social skills development for young children, few actively integrate parents and caregivers, and even fewer have remote models. The importance of providing accessible, tailored services for families in the wake of the COVID-19 pandemic, prompted the creation of a parent-mediated telehealth version of Program for the Education and Enrichment of Relational Skills (PEERS®) for Preschoolers (P4P), a pre-existing, evidence-based social skills intervention for children 4-6 years focused on making and keeping friends. METHOD This methodological paper documents the implementation, feasibility, and satisfaction of a novel telehealth group-based delivery of P4P. RESULTS Qualitative results indicate acceptable feasibility and satisfaction. Additionally, following completion there was an increase in parental confidence in social coaching and increased use of child social skills. DISCUSSION Future work will evaluate quantitative outcomes and comparisons between delivery methods (e.g., telehealth vs. in-person).
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Affiliation(s)
- Reina S Factor
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Leila Glass
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Daliah Baertschi
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Elizabeth A Laugeson
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
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Garnett R, Davidson B, Eadie P. Parent perceptions of a group telepractice communication intervention for autism. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2022; 7:23969415211070127. [PMID: 36382075 PMCID: PMC9620687 DOI: 10.1177/23969415211070127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND & AIMS Estimates suggest that one in 59 children receive a diagnosis of autism and that early intervention can be effective if applied consistently and intensively. Parent implemented intervention can increase intervention consistency and intensity however, availability of providers, geographical factors, time constraints, and parental stress levels can all act as barriers to service access. Limitations in understanding elements that support family engagement can also impact participation in intervention. Telepractice can increase availability of intervention services and decrease the time and costs associated with face-to-face delivery. Research focused on children with autism has shown that telepractice is acceptable to parents. Despite positive findings for telepractice services with individual clients, limited research has been conducted on telepractice services for parent groups; parent perceptions and preferences regarding intervention; and service delivery methods. This research aimed to investigate parent perceptions of a group intervention programme for autism; the telepractice approach; parent and child outcomes; and parental stress. The purpose of the investigation was to build an understanding of parent's intervention preferences to inform future service offerings, increase choice, and support participation. METHODS Eleven parents of preschool children with autism participated in a telepractice delivered group training programme called Hanen More Than Words (HMTW). The intervention is traditionally delivered face to face and teaches strategies to facilitate social-communication development in young children.Quantitative and qualitative measures were used to evaluate parent perceptions of the telepractice HMTW intervention. Data were collected via the Parenting Stress Index, HMTW programme evaluation forms, and online parent survey.Quantitative data was analysed using descriptive statistics. Pre- and post-intervention comparisons of parenting stress were conducted using paired T-Tests. Open comment field responses were analysed qualitatively using a directed content analysis. RESULTS Parents reported high levels of satisfaction with telepractice delivered HMTW across intervention and post programme evaluations. Interactive learning opportunities, group participation, video coaching, individualisation of service, and programme facilitation were identified as key supports to learning.Parents perceived increased insight into the interaction, learning, and behaviour of themselves and their children. They reported positive changes in strategy implementation and confidence. Parents also perceived improvements in their children's communication, responsiveness, interaction, and play following intervention. Parental stress measurements from pre- to post intervention, were not significantly different. CONCLUSIONS Telepractice may reduce service barriers and improve access, particularly with the efficiency of a group delivery approach. Utilising technology to deliver group intervention was acceptable to parents and perceived to have positive outcomes for both parent and child. Further investigation into parent perceptions of intervention types and delivery approaches, could facilitate a broader understanding of family needs with respect to service access and engagement. IMPLICATIONS Expansion of telepractice offerings can increase efficiencies and service choice for families and providers. Limitations in service availability and barriers to service access and engagement, confirm the importance of pursuing ongoing service improvements and evaluating the preferences of service users. Development of standardised tools to measure and compare parent perceptions across intervention types and service delivery approaches would be beneficial.
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Affiliation(s)
- Robyn Garnett
- Robyn Garnett, Department of Audiology and
Speech Pathology, University of Melbourne, 550 Swanston Street Carlton, VIC
3053, Australia.
| | - Bronwyn Davidson
- Department of Audiology and Speech Pathology,
University of Melbourne, 550 Swanston Street Carlton, VIC 3053,
Australia
| | - Patricia Eadie
- Melbourne Graduate School of Education,
University of Melbourne, 234 Queensberry Street, Parkville VIC 3053,
Australia
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7
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Schertz HH, Liu X, Odom SL, Baggett KM. Parents' application of mediated learning principles as predictors of toddler social initiations. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1536-1549. [PMID: 34825577 DOI: 10.1177/13623613211061128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Little is known about what parents can do to promote initiating joint attention for their toddlers with autism. Initiating joint attention is important because it is an indicator of social motivation and is associated with later communication ability. In this study, parents applied mediated learning principles to help their toddlers engage with them socially. The principles included helping their child focus on social interaction, giving meaning to the social elements of interaction (and de-emphasizing nonsocial elements), and helping their toddlers understand their own social ability by encouraging. At the end of the intervention period, we compared two groups. One group received the Joint Attention Mediated Learning intervention and the other received community-based early intervention services. We found that the Joint Attention Mediated Learning participants applied mediated learning principles more often than the other group. Then, we explored how parents' application of mediated learning principles related to toddler initiating joint attention and found that parents who were successful in applying the principles had toddlers who were more likely to show initiating joint attention. Our findings indicate that the mediated learning process shows promise as a way to promote early social learning, although other elements of the Joint Attention Mediated Learning intervention, such as actively engaging parents in the learning process, may have also contributed to both child and parent learning.
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Amonkar N, Su WC, Bhat AN, Srinivasan SM. Effects of Creative Movement Therapies on Social Communication, Behavioral-Affective, Sensorimotor, Cognitive, and Functional Participation Skills of Individuals With Autism Spectrum Disorder: A Systematic Review. Front Psychiatry 2021; 12:722874. [PMID: 34867515 PMCID: PMC8637167 DOI: 10.3389/fpsyt.2021.722874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder affecting multiple developmental domains including social communication, behavioral-affective, sensorimotor, and cognitive systems. There is growing evidence for the use of holistic, whole-body, Creative Movement Therapies (CMT) such as music, dance, yoga, theater, and martial arts in addressing the multisystem impairments in ASD. We conducted a comprehensive quantitative and qualitative review of the evidence to date on the effects of CMT on multiple systems in individuals with ASD. The strongest evidence, both in terms of quantity and quality, exists for music and martial arts-based interventions followed by yoga and theater, with very limited research on dance-based approaches. Our review of 72 studies (N = 1,939 participants) across participants with ASD ranging from 3 to 65 years of age suggests that at present there is consistent evidence from high quality studies for small-to-large sized improvements in social communication skills following music and martial arts therapies and medium-to-large improvements in motor and cognitive skills following yoga and martial arts training, with insufficient evidence to date for gains in affective, sensory, and functional participation domains following CMT. Although promising, our review serves as a call for more rigorous high-quality research to assess the multisystem effects of CMT in ASD. Based on the existing literature, we discuss implications of our findings for autism researchers and also provide evidence-based guidelines for clinicians to incorporate CMT approaches in their plan of care for individuals with ASD.
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Affiliation(s)
- Nidhi Amonkar
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, United States
- Institute for Health, Intervention, and Policy, University of Connecticut, Storrs, CT, United States
- The Connecticut Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs, CT, United States
| | - Wan-Chun Su
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States
| | - Anjana N. Bhat
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, United States
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Sudha M. Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, United States
- Institute for Health, Intervention, and Policy, University of Connecticut, Storrs, CT, United States
- The Connecticut Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs, CT, United States
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9
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Park JE. Effectiveness of creative arts-based parent training for parents with children with Autism Spectrum Disorder. ARTS IN PSYCHOTHERAPY 2021. [DOI: 10.1016/j.aip.2021.101837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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Grzadzinski R, Amso D, Landa R, Watson L, Guralnick M, Zwaigenbaum L, Deák G, Estes A, Brian J, Bath K, Elison J, Abbeduto L, Wolff J, Piven J. Pre-symptomatic intervention for autism spectrum disorder (ASD): defining a research agenda. J Neurodev Disord 2021; 13:49. [PMID: 34654371 PMCID: PMC8520312 DOI: 10.1186/s11689-021-09393-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/16/2021] [Indexed: 12/26/2022] Open
Abstract
Autism spectrum disorder (ASD) impacts an individual's ability to socialize, communicate, and interact with, and adapt to, the environment. Over the last two decades, research has focused on early identification of ASD with significant progress being made in understanding the early behavioral and biological markers that precede a diagnosis, providing a catalyst for pre-symptomatic identification and intervention. Evidence from preclinical trials suggest that intervention prior to the onset of ASD symptoms may yield more improved developmental outcomes, and clinical studies suggest that the earlier intervention is administered, the better the outcomes. This article brings together a multidisciplinary group of experts to develop a conceptual framework for behavioral intervention, during the pre-symptomatic period prior to the consolidation of symptoms into diagnosis, in infants at very-high-likelihood for developing ASD (VHL-ASD). The overarching goals of this paper are to promote the development of new intervention approaches, empirical research, and policy efforts aimed at VHL-ASD infants during the pre-symptomatic period (i.e., prior to the consolidation of the defining features of ASD).
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Affiliation(s)
- Rebecca Grzadzinski
- Carolina Institute for Developmental Disabilities, University of North Carolina, Chapel Hill, NC, USA.
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina, Chapel Hill, NC, USA.
| | - Dima Amso
- Department of Psychology, Columbia University, New York, NY, USA
| | - Rebecca Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Linda Watson
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina, Chapel Hill, NC, USA
- Division of Speech and Hearing Sciences, University of North Carolina, Chapel Hill, NC, USA
| | - Michael Guralnick
- Center on Human Development and Disability, University of Washington, Seattle, WA, USA
| | | | - Gedeon Deák
- Department of Cognitive Science, University of California, San Diego, San Diego, CA, USA
| | - Annette Estes
- Department of Speech and Hearing Sciences, University of Washington Autism Center, University of Washington, Seattle, WA, USA
| | - Jessica Brian
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Kevin Bath
- Department of Neuroscience, Brown University, Providence, RI, USA
| | - Jed Elison
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Leonard Abbeduto
- University of California, Davis, MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Jason Wolff
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Joseph Piven
- Carolina Institute for Developmental Disabilities, University of North Carolina, Chapel Hill, NC, USA
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Wolff JJ, Piven J. Predicting Autism in Infancy. J Am Acad Child Adolesc Psychiatry 2021; 60:958-967. [PMID: 33161062 PMCID: PMC8158398 DOI: 10.1016/j.jaac.2020.07.910] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/09/2020] [Accepted: 10/28/2020] [Indexed: 12/17/2022]
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication and interaction deficits and restricted, repetitive patterns of interests and behavior that are evident in early childhood. Its prevalence has grown substantially over the past several decades, with current estimates ranging from 1.7% to 2.5% in the United States.1,2 This represents more than 1.5 million children with ASD, the vast majority of whom receive or will receive specialized services.2 Each year, approximately 100,000 (and growing) individuals with ASD reach adulthood, and many face myriad challenges related to employment, housing, mental health, and overburdened or insufficient support services.3-5 A host of significant costs can be associated with ASD, from direct costs related to the provision of special education programs, housing, and medical care to indirect costs, such as loss of productivity affecting both individuals with ASD and their families.6 Currently, overall lifetime cost of care per person with ASD can exceed $3 million, totaling more than $265 billion annually in the United States and rising to an estimated $1 trillion by 2025.7,8.
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Affiliation(s)
- Jason J. Wolff
- Department of Educational Psychology, University of Minnesota
| | - Joseph Piven
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill
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12
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Law ML, Singh J, Mastroianni M, Santosh P. Parent-Mediated Interventions for Infants under 24 Months at Risk for Autism Spectrum Disorder: A Systematic Review of Randomized Controlled Trials. J Autism Dev Disord 2021; 52:2553-2574. [PMID: 34236590 PMCID: PMC9114042 DOI: 10.1007/s10803-021-05148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
Prodromal symptoms of Autism Spectrum Disorder (ASD) have been detected within the first year of life. This review evaluated evidence from randomized controlled trials (RCTs) of parent-mediated interventions for infants under 24 months who are at risk for ASD. Electronic databases, including grey literature, were searched up till November 2019. Seven RCTs were identified. There was substantial heterogeneity in recruitment, outcome measures and effect size calculations. Interventions did not reduce the risk of later ASD diagnosis and post-intervention effects on infant outcomes were inconsistent, with five studies reporting significant improvements across both treatment and control groups. Moderate level of evidence of intervention effects on parental interaction skills and the small number of RCTs, and significant limitations restrict generalizability across studies.
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Affiliation(s)
- Mei L Law
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King's College London, Addiction Sciences Building, 1-4 Windsor Walk, Denmark Hill, London, London, SE5 8BB, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jatinder Singh
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King's College London, Addiction Sciences Building, 1-4 Windsor Walk, Denmark Hill, London, London, SE5 8BB, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - Mathilde Mastroianni
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King's College London, Addiction Sciences Building, 1-4 Windsor Walk, Denmark Hill, London, London, SE5 8BB, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King's College London, Addiction Sciences Building, 1-4 Windsor Walk, Denmark Hill, London, London, SE5 8BB, UK.
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK.
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Sacrey LAR, Zwaigenbaum L, Bryson S, Brian J, Smith IM, Roberts W, Szatmari P, Vaillancourt T, Roncadin C, Garon N. Screening for Behavioral Signs of Autism Spectrum Disorder in 9-Month-Old Infant Siblings. J Autism Dev Disord 2021; 51:839-848. [PMID: 31939081 DOI: 10.1007/s10803-020-04371-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite considerable progress in characterizing the early signs of autism spectrum disorder (ASD), more remains to be learned about how symptoms emerge in the first year of life. Parents with a new baby who already had at least one biological child diagnosed with ASD (high-risk) or no family history of ASD (low-risk) completed two measures when their baby was 9 months of age, the Autism Parent Screen for Infants (APSI) questionnaire and the interview-based Parent Concerns Form. Children underwent a blinded independent diagnostic assessment for ASD at age 3 years. Total scores on the APSI and the Parent Concerns Form were both able to independently differentiate high-risk children who were later diagnosed with ASD from other high-risk and low-risk children who were not. Using logistic regression, we found that the total score on the APSI predicted ASD outcomes at age 3 with 70% accuracy, but the Parent Concerns Form did not contribute any unique variance when the APSI was already in the model. The results suggest that the APSI identifies early features predictive of ASD in high-risk infants and can be used to flag them for targeted follow-up and screening.
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Affiliation(s)
- Lori-Ann R Sacrey
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. .,Department of Pediatrics, Autism Research Centre - E209, Glenrose Rehabilitation Hospital, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada.
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Department of Pediatrics, Autism Research Centre - E209, Glenrose Rehabilitation Hospital, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada
| | - Susan Bryson
- Dalhousie University/IWK Health Centre, Halifax, NS, Canada
| | - Jessica Brian
- Bloorview Research Institute, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Isabel M Smith
- Dalhousie University/IWK Health Centre, Halifax, NS, Canada
| | | | - Peter Szatmari
- University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Caroline Roncadin
- University of Toronto, Toronto, ON, Canada.,McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Nancy Garon
- Mount Allison University, Sackville, NB, Canada
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14
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Talbott MR, Miller MR. Future Directions for Infant Identification and Intervention for Autism Spectrum Disorder from a Transdiagnostic Perspective. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2020; 49:688-700. [PMID: 32701034 PMCID: PMC7541743 DOI: 10.1080/15374416.2020.1790382] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
By the time they are typically detected, neurodevelopmental disorders like autism spectrum disorder (ASD) are already challenging to treat. Preventive and early intervention strategies in infancy are critical for improving outcomes over the lifespan with significant cost savings. However, the impact of prevention and early intervention efforts is dependent upon our ability to identify infants most appropriate for such interventions. Because there may be significant overlap between prodromal symptoms across neurodevelopmental disorders and child psychopathology more broadly which may wax and wane across development, we contend that the impact of prevention and early intervention efforts will be heightened by identifying early indicators that may overlap across ASD and other commonly co-occurring disorders. This paper summarizes the existing literature on infant symptoms and identification of ASD to demonstrate the ways in which a transdiagnostic perspective could expand the impact of early identification and intervention research and clinical efforts, and to outline suggestions for future empirical research programs addressing current gaps in the identification-to-treatment pipeline. We propose four recommendations for future research that are both grounded in developmental and clinical science and that are scalable for early intervention systems: (1) development of fine-grained, norm-referenced measures of ASD-relevant transdiagnostic behavioral domains; (2) identification of shared and distinct mechanisms influencing the transition from risk to disorder; (3) determination of key cross-cutting treatment strategies (both novel and extracted from existing approaches) effective in targeting specific domains across disorders; and (4) integration of identified measures and treatments into existing service systems.
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Affiliation(s)
- Meagan R Talbott
- MIND Institute and Department of Psychiatry & Behavioral Sciences, University of California
| | - Meghan R Miller
- MIND Institute and Department of Psychiatry & Behavioral Sciences, University of California
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15
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Bradshaw J, Trumbull A, Stapel-Wax J, Gillespie S, George N, Saulnier C, Klaiman C, Woods J, Call N, Klin A, Wetherby A. Factors associated with enrollment into a clinical trial of caregiver-implemented intervention for infants at risk for autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1874-1884. [PMID: 32594763 DOI: 10.1177/1362361320928829] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
LAY ABSTRACT Early intervention helps to address developmental delays in young children with autism spectrum disorder. Yet, research suggests there are barriers to enrollment into research studies that test the effectiveness of these interventions for infants at risk. This study identifies family characteristics that were associated with agreement to enroll in a clinical trial of early intervention for 12-month-old infants at risk for autism spectrum disorder. As part of a large longitudinal study, infants were evaluated for early signs of autism spectrum disorder at 1 year of age. Of the fifty-seven infants who were showing signs of autism and deemed eligible for the early intervention trial, 44% declined enrollment. Results suggest that families were more likely to decline enrolling into the intervention study if the mother was working full time, the total household income was between US$60,000 and US$100,000, and they lived further from the clinic. In contrast, infant autism symptoms and parental concern at 12 months were not significantly associated with enrollment. These findings highlight the need for intervention studies that are more accessible to parents, for example, intervention that takes place in the home, in addition to more research on how parental understanding of, and willingness to act on, early social-communication delays impact intervention study enrollment. Future research can then examine how to address these barriers to enrollment in early intervention studies. Such findings will shed light on best practices for dissemination of early identification and intervention strategies.
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Affiliation(s)
| | | | - Jennifer Stapel-Wax
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
| | - Scott Gillespie
- Emory-Children's-Georgia Tech Pediatric Research Alliance, USA
| | - Nisha George
- Emory-Children's-Georgia Tech Pediatric Research Alliance, USA
| | - Celine Saulnier
- Emory University, USA.,Neurodevelopmental Assessment & Consulting Services, USA
| | - Cheryl Klaiman
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
| | | | - Nathan Call
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
| | - Ami Klin
- Emory University, USA.,Marcus Autism Center, USA.,Children's Healthcare of Atlanta, USA
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16
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McDonald NM, Hyde C, Choi AB, Gulsrud AC, Kasari C, Nelson CA, Jeste SS. Improving Developmental Abilities in Infants With Tuberous Sclerosis Complex: A Pilot Behavioral Intervention Study. INFANTS AND YOUNG CHILDREN 2020; 33:108-118. [PMID: 32467653 PMCID: PMC7255424 DOI: 10.1097/iyc.0000000000000160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Tuberous sclerosis complex (TSC) is a rare genetic syndrome that confers risk for neurodevelopmental disorders, including autism spectrum disorder and intellectual disability. Delays in social communication and early cognitive abilities are observable as early as 9 months of age in children with TSC; however, there have been no studies of early behavioral intervention in TSC. We conducted a pilot study of an evidence-based, parent-mediated behavioral intervention focused on improving early social communication and play skills in 5 children with TSC (aged 1-3 years). Participants showed maintenance and sometimes gains in developmental abilities, relative to peers, following intervention. Parents generally found the intervention to be helpful and were able to administer the intervention with fidelity. Preliminary results demonstrate initial feasibility of an early play-based, parent-mediated intervention and support the need for a large-scale, randomized clinical trial in TSC.
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Affiliation(s)
- Nicole M McDonald
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California (Dr McDonald, Gulsrud, Kasari, and Jeste and Ms Hyde); Harvard Graduate School of Education, Boston, Massachusetts (Ms Choi); and Boston Children's Hospital, Harvard University, Boston, Massachusetts (Dr Nelson)
| | - Carly Hyde
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California (Dr McDonald, Gulsrud, Kasari, and Jeste and Ms Hyde); Harvard Graduate School of Education, Boston, Massachusetts (Ms Choi); and Boston Children's Hospital, Harvard University, Boston, Massachusetts (Dr Nelson)
| | - April Boin Choi
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California (Dr McDonald, Gulsrud, Kasari, and Jeste and Ms Hyde); Harvard Graduate School of Education, Boston, Massachusetts (Ms Choi); and Boston Children's Hospital, Harvard University, Boston, Massachusetts (Dr Nelson)
| | - Amanda C Gulsrud
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California (Dr McDonald, Gulsrud, Kasari, and Jeste and Ms Hyde); Harvard Graduate School of Education, Boston, Massachusetts (Ms Choi); and Boston Children's Hospital, Harvard University, Boston, Massachusetts (Dr Nelson)
| | - Connie Kasari
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California (Dr McDonald, Gulsrud, Kasari, and Jeste and Ms Hyde); Harvard Graduate School of Education, Boston, Massachusetts (Ms Choi); and Boston Children's Hospital, Harvard University, Boston, Massachusetts (Dr Nelson)
| | - Charles A Nelson
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California (Dr McDonald, Gulsrud, Kasari, and Jeste and Ms Hyde); Harvard Graduate School of Education, Boston, Massachusetts (Ms Choi); and Boston Children's Hospital, Harvard University, Boston, Massachusetts (Dr Nelson)
| | - Shafali S Jeste
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California (Dr McDonald, Gulsrud, Kasari, and Jeste and Ms Hyde); Harvard Graduate School of Education, Boston, Massachusetts (Ms Choi); and Boston Children's Hospital, Harvard University, Boston, Massachusetts (Dr Nelson)
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17
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Tanner A, Dounavi K. Maximizing the potential for infants at-risk for autism spectrum disorder through a parent-mediated verbal behavior intervention. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/15021149.2020.1731259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Amy Tanner
- School of Social Sciences Education & Social Work, Queen’s University of Belfast, Belfast, Northern Ireland
| | - Katerina Dounavi
- School of Social Sciences Education & Social Work, Queen’s University of Belfast, Belfast, Northern Ireland
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18
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Douglas PS. Pre-emptive Intervention for Autism Spectrum Disorder: Theoretical Foundations and Clinical Translation. Front Integr Neurosci 2019; 13:66. [PMID: 31798425 PMCID: PMC6877903 DOI: 10.3389/fnint.2019.00066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/04/2019] [Indexed: 12/28/2022] Open
Abstract
Autism spectrum disorders (ASD) are an emergent public health problem, placing significant burden upon the individual, family and health system. ASD are polygenetic spectrum disorders of neural connectome development, in which one or more feedback loops amplify small genetic, structural, or functional variations in the very early development of motor and sensory-motor pathways. These perturbations trigger a 'butterfly effect' of unpredictable cascades of structural and functional imbalances in the global neuronal workspace, resulting in atypical behaviors, social communication, and cognition long-term. The first 100 days post-term are critically neuroplastic and comprise an injury-sensitive developmental window, characterized by a neural biomarker, the persistence of the cortical subplate, and a behavioral biomarker, the crying diathesis. By the time potential diagnostic signs are identified, from 6 months of age, ASD neuropathy is already entrenched. The International Society for Autism Research Special Interest Group has called for pre-emptive intervention, based upon rigorous theoretical frames, and real world translation and evaluation. This paper responds to that call. It synthesizes heterogenous evidence concerning ASD etiologies from both psychosocial and biological research literatures with complexity science and evolutionary biology, to propose a theoretical framework for pre-emptive intervention. This paper hypothesizes that environmental factors resulting from a mismatch between environment of evolutionary adaptedness and culture initiate or perpetuate early motor and sensory-motor lesions, triggering a butterfly effect of multi-directional cascades of atypical developmental in the complex adaptive system of the parent and ASD-susceptible infant. Chronic sympathetic nervous system/hypothalamic-pituitary-adrenal axis hyperarousal and disrupted parent-infant biobehavioral synchrony are the key biologic and behavioral mechanisms perpetuating these atypical developmental cascades. A clinical translation of this evidence is proposed, for application antenatally and in the first 6 months of life, as pre-emptive intervention for ASD.
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Affiliation(s)
- Pamela S Douglas
- Transforming Maternity Care Collaborative, Griffith University, Brisbane, QLD, Australia.,Discipline of General Practice, The University of Queensland, Brisbane, QLD, Australia
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19
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Caregiver-Implemented Intervention for Young Children with Autism Spectrum Disorder: A Systematic Review of Coaching Components. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2019. [DOI: 10.1007/s40489-019-00186-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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20
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Factor RS, Ollendick TH, Cooper LD, Dunsmore JC, Rea HM, Scarpa A. All in the Family: A Systematic Review of the Effect of Caregiver-Administered Autism Spectrum Disorder Interventions on Family Functioning and Relationships. Clin Child Fam Psychol Rev 2019; 22:433-457. [DOI: 10.1007/s10567-019-00297-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Larsen K, Aasland A, Diseth TH. Brief Report: Agreement Between Parents and Day-Care Professionals on Early Symptoms Associated with Autism Spectrum Disorders. J Autism Dev Disord 2019; 48:1063-1068. [PMID: 29086212 DOI: 10.1007/s10803-017-3355-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Early identification of Autism Spectrum Disorders (ASD) has the potential to elicit effective early intervention, improving children's level of functioning and developmental trajectories as well as reducing parental stress. Multiple sources of information, including several informants may facilitate early identification. This study examined the agreement between parents and day-care professionals on how they retrospectively recall early symptoms associated with ASD. In this study, we found fair to excellent agreement on early symptoms between parents and day-care professionals. The finding indicates that day-care centres may be a supplementary area for early identification of ASD. More research is needed to explore day-care centers possible role in this early identification.
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Affiliation(s)
- Kenneth Larsen
- Regional resource centre for autism, ADHD, Tourette´s syndrome and narcolepsy, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
| | - Astrid Aasland
- Section of Psychosomatics and CL-Child Psychiatry, Department of Clinical Neurosciences for Children, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Trond H Diseth
- Section of Psychosomatics and CL-Child Psychiatry, Department of Clinical Neurosciences for Children, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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22
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Macari SL, Wu GC, Powell KK, Fontenelle S, Macris DM, Chawarska K. Do Parents and Clinicians Agree on Ratings of Autism-Related Behaviors at 12 Months of Age? A Study of Infants at High and Low Risk for ASD. J Autism Dev Disord 2019; 48:1069-1080. [PMID: 29181689 DOI: 10.1007/s10803-017-3410-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Given the emphasis on early screening for ASD, it is crucial to examine the concordance between parent report and clinician observation of autism-related behaviors. Similar items were compared from the First Year Inventory (Baranek et al. First-Year Inventory (FYI) 2.0. University of North Carolina, Chapel Hill, 2003), a parent screener for ASD, and the ADOS-2 Toddler Module (Lord et al. 2013), a standardized ASD diagnostic tool. Measures were administered concurrently to 12-month-olds at high and low risk for ASD. Results suggest that clinicians and parents rated behaviors similarly. In addition, both informants rated high-risk infants as more impaired in several social-communication behaviors. Furthermore, the format of questions impacted agreement across observers. These findings have implications for the development of a new generation of screening instruments for ASD.
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Affiliation(s)
- Suzanne L Macari
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
| | - Grace C Wu
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
- Stanford University, Stanford, CA, USA
| | - Kelly K Powell
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Scuddy Fontenelle
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Deanna M Macris
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
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23
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Vivanti G, Hamner T, Lee NR. Neurodevelopmental Disorders Affecting Sociability: Recent Research Advances and Future Directions in Autism Spectrum Disorder and Williams Syndrome. Curr Neurol Neurosci Rep 2018; 18:94. [DOI: 10.1007/s11910-018-0902-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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24
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Vivanti G, Hamner T, Lee NR. Neurodevelopmental Disorders Affecting Sociability: Recent Research Advances and Future Directions in Autism Spectrum Disorder and Williams Syndrome. Curr Neurol Neurosci Rep 2018. [PMID: 30328520 DOI: 10.1007/s11910–018–0902-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW In this review, we summarize current knowledge and hypotheses on the nature of social abnormalities in autism spectrum disorder (ASD) and Williams syndrome (WS). RECENT FINDINGS Social phenotypes in ASD and WS appear to reflect analogous disruptions in social cognition, and distinct patterns of social motivation, which appears to be reduced in ASD and enhanced in WS. These abnormalities likely originate from heterogeneous vulnerabilities that disrupt the interplay between domain-general and social domain-specific cognitive and motivational processes during early development. Causal pathways remain unclear. Advances and research gaps in our understanding of the social phenotypes in ASD and WS highlight the importance of (1) parsing the construct of sociability, (2) adopting a developmental perspective, (3) including samples that are representative of the spectrum of severity within ASD and WS in neuroscientific research, and (4) adopting transdiagnostic treatment approaches to target shared areas of impairment across diagnostic boundaries.
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Affiliation(s)
- Giacomo Vivanti
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104-3734, USA. .,Department of Psychology, Drexel University, Philadelphia, PA, 19104-3734, USA.
| | - Taralee Hamner
- A.J. Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104-3734, USA.,Department of Psychology, Drexel University, Philadelphia, PA, 19104-3734, USA
| | - Nancy Raitano Lee
- Department of Psychology, Drexel University, Philadelphia, PA, 19104-3734, USA
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25
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Parent–Child Interaction Synchrony for Infants At-Risk for Autism Spectrum Disorder. J Autism Dev Disord 2018; 48:3562-3572. [DOI: 10.1007/s10803-018-3624-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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26
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Abstract
With advances in the field's ability to identify autism spectrum disorders (ASD) at younger ages, the need for information about the evidence-base for early intervention continues to rise. This review of the ASD early intervention (EI) literature focuses on efficacy studies published within the past 15 years. The neurodevelopmental context for early intervention, timing of initiating intervention, primary intervention approaches, and predictors of treatment outcomes are discussed. The evidence indicates that young children with ASD benefit from EI, and their parents learn to implement child-responsive engagement strategies when a parent-coaching intervention is provided. Evidence supports combining parent-mediated and direct clinician-implemented intervention to maximize child developmental gains. Clinical practice recommendations are presented, based on the literature reviewed.
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Affiliation(s)
- Rebecca J. Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
- Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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27
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Strength-Based Approaches to Working with Families of Children with ASD. HANDBOOK OF PARENT-IMPLEMENTED INTERVENTIONS FOR VERY YOUNG CHILDREN WITH AUTISM 2018. [DOI: 10.1007/978-3-319-90994-3_10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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28
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Green J, Pickles A, Pasco G, Bedford R, Wan MW, Elsabbagh M, Slonims V, Gliga T, Jones E, Cheung C, Charman T, Johnson M. Randomised trial of a parent-mediated intervention for infants at high risk for autism: longitudinal outcomes to age 3 years. J Child Psychol Psychiatry 2017; 58:1330-1340. [PMID: 28393350 PMCID: PMC5724485 DOI: 10.1111/jcpp.12728] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND There has been increasing interest in the potential for pre-emptive interventions in the prodrome of autism, but little investigation as to their effect. METHODS A two-site, two-arm assessor-blinded randomised controlled trial (RCT) of a 12-session parent-mediated social communication intervention delivered between 9 and 14 months of age (Intervention in the British Autism Study of Infant Siblings-Video Interaction for Promoting Positive Parenting), against no intervention. Fifty-four infants (28 intervention, 26 nonintervention) at familial risk of autism but not otherwise selected for developmental atypicality were assessed at 9-month baseline, 15-month treatment endpoint, and 27- and 39-month follow-up. PRIMARY OUTCOME severity of autism prodromal symptoms, blind-rated on Autism Observation Schedule for Infants or Autism Diagnostic Observation Schedule 2nd Edition across the four assessment points. SECONDARY OUTCOMES blind-rated parent-child interaction and child language; nonblind parent-rated communication and socialisation. Prespecified intention-to-treat analysis combined estimates from repeated measures within correlated regressions to estimate the overall effect of the infancy intervention over time. RESULTS Effect estimates in favour of intervention on autism prodromal symptoms, maximal at 27 months, had confidence intervals (CIs) at each separate time point including the null, but showed a significant overall effect over the course of the intervention and follow-up period (effect size [ES] = 0.32; 95% CI 0.04, 0.60; p = .026). Effects on proximal intervention targets of parent nondirectiveness/synchrony (ES = 0.33; CI 0.04, 0.63; p = .013) and child attentiveness/communication initiation (ES = 0.36; 95% CI 0.04, 0.68; p = .015) showed similar results. There was no effect on categorical diagnostic outcome or formal language measures. CONCLUSIONS Follow-up to 3 years of the first RCT of a very early social communication intervention for infants at familial risk of developing autism has shown a treatment effect, extending 24 months after intervention end, to reduce the overall severity of autism prodromal symptoms and enhance parent-child dyadic social communication over this period. We highlight the value of extended follow-up and repeat assessment for early intervention trials.
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Affiliation(s)
- Jonathan Green
- Social Development Research GroupSchool of Biological SciencesUniversity of ManchesterManchesterUK,Royal Manchester Children's HospitalManchesterUK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK,National Institute for Health Research Medical Health Biomedical Research CentreSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Greg Pasco
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK,Centre for Brain and Cognitive DevelopmentBirkbeck CollegeLondonUK
| | - Rachael Bedford
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Ming Wai Wan
- School of Health SciencesUniversity of ManchesterManchesterUK
| | - Mayada Elsabbagh
- Centre for Brain and Cognitive DevelopmentBirkbeck CollegeLondonUK,Department of PsychiatryMcGill UniversityWest MontréalQCCanada
| | - Vicky Slonims
- Evelina London Children's Hospital and King's College London Neurosciences CentreLondonUK
| | - Teea Gliga
- Centre for Brain and Cognitive DevelopmentBirkbeck CollegeLondonUK
| | - Emily Jones
- Centre for Brain and Cognitive DevelopmentBirkbeck CollegeLondonUK
| | - Celeste Cheung
- Centre for Brain and Cognitive DevelopmentBirkbeck CollegeLondonUK
| | - Tony Charman
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Mark Johnson
- Centre for Brain and Cognitive DevelopmentBirkbeck CollegeLondonUK
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29
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Duifhuis EA, den Boer JC, Doornbos A, Buitelaar JK, Oosterling IJ, Klip H. The Effect of Pivotal Response Treatment in Children with Autism Spectrum Disorders: A Non-randomized Study with a Blinded Outcome Measure. J Autism Dev Disord 2017; 47:231-242. [PMID: 27815645 PMCID: PMC5309302 DOI: 10.1007/s10803-016-2916-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose of this quasi-experimental trial was to investigate the effect of Pivotal response treatment (PRT) versus treatment as usual (TAU) on autism symptoms. Children with autism spectrum disorder (ASD), aged 3–8 years, received either PRT (n = 11) or TAU (n = 13). Primary outcome measure was the total score on the Autism Diagnostic Observation Schedule at pre- and posttreatment. Additionally, general problem behavior and parental stress levels were measured. Children in the PRT condition improved on the primary outcome measure compared to the TAU group with a small effect size [partial η2 = 0.22 (95 % CI 0.00–0.46)]. Neither group demonstrated significant changes in the secondary outcomes. This study suggests that PRT may improve autism symptoms in children with ASD over TAU.
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Affiliation(s)
- E A Duifhuis
- Karakter Child and Adolescent Psychiatry, Postbus 68, 6710 BB, Ede, The Netherlands.
| | - J C den Boer
- Karakter Child and Adolescent Psychiatry, Postbus 68, 6710 BB, Ede, The Netherlands
| | - A Doornbos
- Karakter Child and Adolescent Psychiatry, Vriezenveenseweg 213, 6700 AP, Almelo, The Netherlands
| | - J K Buitelaar
- Karakter Child and Adolescent Psychiatry University Center, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, P.O. Box 9101 (204), 6500 HB, Nijmegen, The Netherlands
| | - I J Oosterling
- Karakter Child and Adolescent Psychiatry University Center, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
| | - H Klip
- Karakter Child and Adolescent Psychiatry University Center, Reinier Postlaan 12, 6525 GC, Nijmegen, The Netherlands
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Whitehouse AJO. Elizabeth Usher Memorial Lecture: Rethinking the clinical pathway for autism spectrum disorder and challenging the status quo. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:208-217. [PMID: 28084105 DOI: 10.1080/17549507.2016.1276963] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/24/2016] [Indexed: 06/06/2023]
Abstract
Autism spectrum disorder (ASD) is typically diagnosed between 2 and 5 years of age, which is currently thought to be the earliest that the behavioural symptoms are able to be identified without ambiguity. A significant problem with this relatively "late" age of diagnosis is that by the time a child has been identified and diagnosed with ASD, many of the best opportunities for therapies to capitalise upon brain plasticity very early in development are not realised. This paper provides an overview of the benefits and drawbacks of the current clinical pathway that places primacy on a diagnostic assessment for triggering the commencement of therapy. The paper then presents an alternative clinical pathway - the identification and provision of therapy to infants at risk of ASD - and provides a critical review of current evidence supporting this model. The aim of the paper is to outline a vision for the future of early identification and intervention of individuals with ASD, and the research goals that need to be addressed to achieve this vision.
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Affiliation(s)
- Andrew J O Whitehouse
- a Telethon Kids Institute, The University of Western Australia , Subiaco , Australia
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31
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Bradshaw J, Koegel LK, Koegel RL. Improving Functional Language and Social Motivation with a Parent-Mediated Intervention for Toddlers with Autism Spectrum Disorder. J Autism Dev Disord 2017; 47:2443-2458. [DOI: 10.1007/s10803-017-3155-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Singh R, Turner RC, Nguyen L, Motwani K, Swatek M, Lucke-Wold BP. Pediatric Traumatic Brain Injury and Autism: Elucidating Shared Mechanisms. Behav Neurol 2016; 2016:8781725. [PMID: 28074078 PMCID: PMC5198096 DOI: 10.1155/2016/8781725] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 11/23/2016] [Indexed: 02/08/2023] Open
Abstract
Pediatric traumatic brain injury (TBI) and autism spectrum disorder (ASD) are two serious conditions that affect youth. Recent data, both preclinical and clinical, show that pediatric TBI and ASD share not only similar symptoms but also some of the same biologic mechanisms that cause these symptoms. Prominent symptoms for both disorders include gastrointestinal problems, learning difficulties, seizures, and sensory processing disruption. In this review, we highlight some of these shared mechanisms in order to discuss potential treatment options that might be applied for each condition. We discuss potential therapeutic and pharmacologic options as well as potential novel drug targets. Furthermore, we highlight advances in understanding of brain circuitry that is being propelled by improved imaging modalities. Going forward, advanced imaging will help in diagnosis and treatment planning strategies for pediatric patients. Lessons from each field can be applied to design better and more rigorous trials that can be used to improve guidelines for pediatric patients suffering from TBI or ASD.
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Affiliation(s)
- Rahul Singh
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26505, USA
| | - Ryan C. Turner
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26505, USA
| | - Linda Nguyen
- Department of Basic Pharmaceutical Sciences, West Virginia University School of Medicine, Morgantown, WV 26505, USA
| | - Kartik Motwani
- Department of Medical Sciences, University of Florida School of Medicine, Gainesville, FL 32611, USA
| | - Michelle Swatek
- Department of Psychology, North Carolina State University, Raleigh, NC 27695, USA
| | - Brandon P. Lucke-Wold
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26505, USA
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Pierce K, Courchesne E, Bacon E. To Screen or Not to Screen Universally for Autism is not the Question: Why the Task Force Got It Wrong. J Pediatr 2016; 176:182-94. [PMID: 27421956 PMCID: PMC5679123 DOI: 10.1016/j.jpeds.2016.06.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 04/27/2016] [Accepted: 06/02/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Karen Pierce
- Department of Neurosciences and Autism Center of Excellence, School of Medicine, University of California San Diego, La Jolla, CA.
| | - Eric Courchesne
- Department of Neurosciences and Autism Center of Excellence, School of Medicine, University of California San Diego, La Jolla, CA
| | - Elizabeth Bacon
- Department of Neurosciences and Autism Center of Excellence, School of Medicine, University of California San Diego, La Jolla, CA
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Abstract
The current paper provides an overview of an evidence-based treatment, Pivotal Response Treatment (PRT), for autism spectrum disorder (ASD). The paper describes PRT principles and then illustrates the approach using two case reports. The children are preschool-aged children with high-functioning ASD. They were participating in a four-month clinical trial of PRT. At the start of treatment, they presented with significant social communication impairments, including a minimal understanding of reciprocity, limited play skills, and repetitive behaviors and speech. The paper outlines how behavioral treatment goals were identified and then how activities were designed, using principles of PRT, to target skill acquisition. Following the treatment course, both children made substantial and meaningful gains in social communication skill development.
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35
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Srinivasan SM, Eigsti IM, Neelly L, Bhat AN. The effects of embodied rhythm and robotic interventions on the spontaneous and responsive social attention patterns of children with Autism Spectrum Disorder (ASD): A pilot randomized controlled trial. RESEARCH IN AUTISM SPECTRUM DISORDERS 2016; 27:54-72. [PMID: 27453721 PMCID: PMC4955647 DOI: 10.1016/j.rasd.2016.01.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
We compared the effects of 8-weeks of rhythm and robotic interventions with those of a comparison, standard-of-care intervention, on the spontaneous and responsive social attention patterns of school-age children with Autism Spectrum Disorder. Attention patterns were examined within a standardized pretest/posttest measure of joint attention (JA) and a training-specific social attention measure during early, mid, and late training sessions. The rhythm and comparison groups demonstrated improvements in JA. Social attention was greater in the rhythm followed by the robot and lastly the comparison group. The robot and comparison groups spent maximum time fixating on the robot and objects, respectively. Across sessions, the robot group decreased attention to the robot and increased attention to elsewhere. Overall, rhythmic movement contexts afford sustained social monitoring in children with autism.
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Affiliation(s)
- Sudha M. Srinivasan
- Department of Physical Therapy, Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE, USA
| | - Inge-Marie Eigsti
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Linda Neelly
- Neag School of Education & School of Music, University of Connecticut, Storrs, CT, USA
| | - Anjana N. Bhat
- Department of Physical Therapy, Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE, USA
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
- Neag School of Education & School of Music, University of Connecticut, Storrs, CT, USA
- Center for Health, Intervention, and Prevention, Department of Psychology, University of Connecticut, Storrs, CT, USA
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36
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The Autism Diagnostic Observation Schedule, Toddler Module: Standardized Severity Scores. J Autism Dev Disord 2016; 45:2704-20. [PMID: 25832801 DOI: 10.1007/s10803-015-2432-7] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Standardized calibrated severity scores (CSS) have been created for Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) Modules 1-4 as a metric of the relative severity of autism-specific behaviors. Total and domain CSS were created for the Toddler Module to facilitate comparison to other modules. Analyses included 388 children with ASD age 12-30 months and were replicated on 435 repeated assessments from 127 children with ASD. Compared to raw scores, associations between total and domain CSS and participant characteristics were reduced in the original sample. Verbal IQ effects on Social Affect-CSS were not reduced in the replication sample. Toddler Module CSS increases comparability of ADOS-2 scores across modules and allows studies of symptom trajectories to extend to earlier ages.
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Abstract
We investigated the mechanisms by which Pivotal Response Treatment (PRT) improves social communication in a case series of 10 preschool-aged children with Autism Spectrum Disorder (ASD). Functional magnetic resonance imaging (fMRI) identified brain responses during a biological motion perception task conducted prior to and following 16 weeks of PRT treatment. Overall, the neural systems supporting social perception in these 10 children were malleable through implementation of PRT; following treatment, neural responses were more similar to those of typically developing children (TD). However, at baseline, half of the children exhibited hypoactivation, relative to a group of TD children, in the right posterior superior temporal sulcus (pSTS), and half exhibited hyperactivation in this region. Strikingly, the groups exhibited differential neural responses to treatment: The five children who exhibited hypoactivation at baseline evidenced increased activation in components of the reward system including the ventral striatum and putamen. The five children who exhibited hyperactivation at baseline evidenced decreased activation in subcortical regions critical for regulating the flow of stimulation and conveying signals of salience to the cortex-the thalamus, amygdala, and hippocampus. Our results support further investigation into the differential effects of particular treatment strategies relative to specific neural targets. Identification of treatment strategies that address the patterns of neural vulnerability unique to each patient is consistent with the priority of creating individually tailored interventions customized to the behavioral and neural characteristics of a given person.
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Brian JA, Smith IM, Zwaigenbaum L, Roberts W, Bryson SE. The Social ABCs caregiver-mediated intervention for toddlers with autism spectrum disorder: Feasibility, acceptability, and evidence of promise from a multisite study. Autism Res 2015; 9:899-912. [PMID: 26688077 PMCID: PMC5064621 DOI: 10.1002/aur.1582] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/29/2015] [Indexed: 11/08/2022]
Abstract
The Social ABCs is a parent-mediated intervention for toddlers with suspected or confirmed autism spectrum disorder (ASD). We undertook a multi-site pilot study to evaluate feasibility and acceptability, and to identify trends in child and parent behavior to inform future research using a larger sample and a rigorous research design. The program involved 12 weeks of parent coaching, followed by 12 weeks' implementation, and 3-month follow-up assessment for 20 parent-toddler dyads (age range: 12-32 months). Parents successfully learned the techniques and rated the intervention as highly acceptable. Paired samples t-tests revealed significant gains in children's functional communication (responsivity, initiations), and language gains (age-equivalents on standardized measures) commensurate with typical developmental rates. Significant increases in shared smiling and social orienting also emerged, but were attenuated at follow-up. Parents' fidelity was positively associated with child responsivity. Training parents as mediators is a feasible and highly acceptable approach that provides a potentially cost-effective opportunity for intensive intervention at a very young age at the first signs of ASD risk. Child and parent gains in several key variables demonstrate the promise of this intervention. Autism Res 2016, 9: 899-912. © 2015 The Authors Autism Research published by Wiley Periodicals, Inc. on behalf of International Society for Autism Research.
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Affiliation(s)
- Jessica A Brian
- Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Isabel M Smith
- Departments of Pediatrics and Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Autism Research Centre, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Wendy Roberts
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Autism Research Unit, The Hospital for Sick Children, Toronto, Ontario, Canada.,Integrated Services for Autism and Neurodevelopmental Disorders, Toronto, Ontario, Canada
| | - Susan E Bryson
- Departments of Pediatrics and Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Autism Research Centre, IWK Health Centre, Halifax, Nova Scotia, Canada
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40
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Sacrey LAR, Bennett JA, Zwaigenbaum L. Early Infant Development and Intervention for Autism Spectrum Disorder. J Child Neurol 2015; 30:1921-9. [PMID: 26323499 DOI: 10.1177/0883073815601500] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 07/25/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective is to overview recent findings on early detection/diagnosis of autism spectrum disorders, as well as clinical trials of early interventions for toddlers at risk for/diagnosed with autism spectrum disorder. FINDINGS Prospective studies of infants at high risk of autism spectrum disorder have yielded significant advances in understanding early development in autism spectrum disorder. Findings from prospective studies indicate that abnormalities in social communication and repetitive behaviors emerge during the second year, whereas additional "prodromal features" (motor and sensory abnormalities) emerge in the first year. Subsequently, exciting progress has been made in establishing the efficacy of autism spectrum disorder-specific interventions for toddlers as young as 15 months. Finally, efforts occur to characterize autism spectrum disorder-specific characteristics in genetic syndromes with concurrent autism spectrum disorder symptomatology. CONCLUSION Substantial progress in characterizing early developmental trajectories as well as the identification of specific behavioral markers has aided early detection. Work remains to ensure that research findings are translated into clinical practice for uptake in the health care system.
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Affiliation(s)
- Lori-Ann R Sacrey
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Jeffrey A Bennett
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
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41
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Zwaigenbaum L, Bauman ML, Choueiri R, Kasari C, Carter A, Granpeesheh D, Mailloux Z, Smith Roley S, Wagner S, Fein D, Pierce K, Buie T, Davis PA, Newschaffer C, Robins D, Wetherby A, Stone WL, Yirmiya N, Estes A, Hansen RL, McPartland JC, Natowicz MR. Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research. Pediatrics 2015; 136 Suppl 1:S60-81. [PMID: 26430170 PMCID: PMC9923898 DOI: 10.1542/peds.2014-3667e] [Citation(s) in RCA: 324] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This article reviews current evidence for autism spectrum disorder (ASD) interventions for children aged <3 years, based on peer-reviewed articles published up to December 2013. Several groups have adapted treatments initially designed for older, preschool-aged children with ASD, integrating best practice in behavioral teaching methods into a developmental framework based on current scientific understanding of how infants and toddlers learn. The central role of parents has been emphasized, and interventions are designed to incorporate learning opportunities into everyday activities, capitalize on "teachable moments," and facilitate the generalization of skills beyond the familiar home setting. Our review identified several comprehensive and targeted treatment models with evidence of clear benefits. Although some trials were limited to 8- to 12-week outcome data, enhanced outcomes associated with some interventions were evaluated over periods as long as 2 years. Based on this review, recommendations are proposed for clinical practice and future research.
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Affiliation(s)
- Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada;
| | - Margaret L. Bauman
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Roula Choueiri
- Division of Developmental and Behavioral Pediatrics, University of Massachusetts Memorial Children’s Medical Center, Worcester, Massachusetts
| | - Connie Kasari
- Graduate School of Education & Information Studies, University of California Los Angeles, Los Angeles, California
| | - Alice Carter
- Department of Psychology, University of Massachusetts, Boston, Massachusetts
| | | | - Zoe Mailloux
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Susanne Smith Roley
- USC Mrs T.H. Chan Division of Occupational Science and Occupational Therapy, Los Angeles, California
| | - Sheldon Wagner
- Behavioral Development & Educational Services, New Bedford, Massachusetts
| | - Deborah Fein
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Karen Pierce
- Department of Neurosciences, University of California San Diego, La Jolla, California
| | - Timothy Buie
- Harvard Medical School and Massachusetts General Hospital for Children, Boston, Massachusetts
| | | | - Craig Newschaffer
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Diana Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Amy Wetherby
- Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida
| | | | - Nurit Yirmiya
- Department of Psychology, Hebrew University of Jerusalem Mount Scopus, Jerusalem, Israel
| | - Annette Estes
- Speech and Hearing Sciences, University of Washington, Seattle, Washington
| | - Robin L. Hansen
- Department of Pediatrics, University of California Davis MIND Institute, Sacramento, California
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Wade M, Prime H, Madigan S. Using Sibling Designs to Understand Neurodevelopmental Disorders: From Genes and Environments to Prevention Programming. BIOMED RESEARCH INTERNATIONAL 2015; 2015:672784. [PMID: 26258141 PMCID: PMC4518166 DOI: 10.1155/2015/672784] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/05/2015] [Accepted: 06/28/2015] [Indexed: 01/30/2023]
Abstract
Neurodevelopmental disorders represent a broad class of childhood neurological conditions that have a significant bearing on the wellbeing of children, families, and communities. In this review, we draw on evidence from two common and widely studied neurodevelopmental disorders-autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD)-to demonstrate the utility of genetically informed sibling designs in uncovering the nature and pathogenesis of these conditions. Specifically, we examine how twin, recurrence risk, and infant prospective tracking studies have contributed to our understanding of genetic and environmental liabilities towards neurodevelopmental morbidity through their impact on neurocognitive processes and structural/functional neuroanatomy. It is suggested that the siblings of children with ASD and ADHD are at risk not only of clinically elevated problems in these areas, but also of subthreshold symptoms and/or subtle impairments in various neurocognitive skills and other domains of psychosocial health. Finally, we close with a discussion on the practical relevance of sibling designs and how these might be used in the service of early screening, prevention, and intervention efforts that aim to alleviate the negative downstream consequences associated with disorders of neurodevelopment.
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Affiliation(s)
- Mark Wade
- Department of Applied Psychology and Human Development, University of Toronto, 252 Bloor Street W., Toronto, ON, Canada M5S 1V6
| | - Heather Prime
- Department of Applied Psychology and Human Development, University of Toronto, 252 Bloor Street W., Toronto, ON, Canada M5S 1V6
| | - Sheri Madigan
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4
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43
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Ventola P, Friedman HE, Anderson LC, Wolf JM, Oosting D, Foss-Feig J, McDonald N, Volkmar F, Pelphrey KA. Improvements in social and adaptive functioning following short-duration PRT program: a clinical replication. J Autism Dev Disord 2015; 44:2862-70. [PMID: 24915928 DOI: 10.1007/s10803-014-2145-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pivotal Response Treatment (PRT) is an empirically validated behavioral treatment for individuals with autism spectrum disorders (ASD). The purpose of the current study was to assess the efficacy of PRT for ten cognitively-able preschool-aged children with ASD in the context of a short-duration (4-month) treatment model. Most research on PRT used individual behavioral goals as outcome measures, but the current study utilized standardized assessments of broader-based social communication and adaptive skills. The children made substantial gains; however, magnitude and consistency of response across measures were variable. The results provide additional support for the efficacy of PRT as well as evidence for improvements in higher-order social communication and adaptive skill development within the context of a short-duration PRT model.
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Affiliation(s)
- Pamela Ventola
- Yale Child Study Center, Yale University School of Medicine, 230 South Frontage Road, 207900, New Haven, CT, 06520-7900, USA,
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44
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Autism treatment in the first year of life: a pilot study of infant start, a parent-implemented intervention for symptomatic infants. J Autism Dev Disord 2015; 44:2981-95. [PMID: 25212413 DOI: 10.1007/s10803-014-2202-y] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The goal of early autism screening is earlier treatment. We pilot-tested a 12-week, low-intensity treatment with seven symptomatic infants ages 7-15 months. Parents mastered the intervention and maintained skills after treatment ended. Four comparison groups were matched from a study of infant siblings. The treated group of infants was significantly more symptomatic than most of the comparison groups at 9 months of age but was significantly less symptomatic than the two most affected groups between 18 and 36 months. At 36 months, the treated group had much lower rates of both ASD and DQs under 70 than a similarly symptomatic group who did not enroll in the treatment study. It appears feasible to identify and enroll symptomatic infants in parent-implemented intervention before 12 months, and the pilot study outcomes are promising, but testing the treatment's efficacy awaits a randomized trial.
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45
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Nelson TM, Sheller B, Friedman CS, Bernier R. Educational and therapeutic behavioral approaches to providing dental care for patients with Autism Spectrum Disorder. SPECIAL CARE IN DENTISTRY 2015; 35:105-13. [PMID: 25470557 DOI: 10.1111/scd.12101] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Autism Spectrum Disorder (ASD) is a condition which most dentists will encounter in their practices. Contemporary educational and behavioral approaches may facilitate successful dental care. METHODS A literature review was conducted for relevant information on dental care for children with ASD. RESULTS Educational principles used for children with ASD can be applied in the dental setting. Examples include: parent involvement in identifying strengths, sensitivities, and goal setting; using stories or video modeling in advance of the appointment; dividing dental treatment into sequential components; and modification of the environment to minimize sensory triggers. Patients with ASD are more capable of tolerating procedures that they are familiar with, and therefore should be exposed to new environments and stimuli in small incremental steps. CONCLUSIONS By taking time to understand children with ASD as individuals and employing principles of learning, clinicians can provide high quality dental care for the majority of patients with ASD.
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Affiliation(s)
- Travis M Nelson
- Clinical Assistant Professor, Department of Pediatric Dentistry, University of Washington, Seattle, Washington
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46
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Cadogan S, McCrimmon AW. Pivotal response treatment for children with autism spectrum disorder: a systematic review of research quality. Dev Neurorehabil 2015; 18:137-44. [PMID: 24180635 DOI: 10.3109/17518423.2013.845615] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Research has indicated support for pivotal response treatment (PRT) as an effective, efficacious and naturalistic intervention for communication and social functioning of children with autism spectrum disorder (ASD). Previously not undertaken, this article describes a systematic evaluation of the adherence of PRT research studies to standards of ASD research quality. METHOD A systematic search was conducted on two databases. Seventeen PRT studies were evaluated on their use of seven specified research standards. RESULTS Strong adherence to research quality standards was demonstrated in the use of standardized protocols, systematic application of intervention procedures, inter-rater reliability and objective evaluators. Variation was found in adherence to treatment fidelity standards and in the use of longitudinal designs. Only two studies implemented comparison designs. CONCLUSION It is recommended that researchers compare interventions, use longitudinal designs, better describe their methodology and implement greater adherence to treatment fidelity to enhance research quality and strengthen conclusions.
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Affiliation(s)
- Sarah Cadogan
- Faculty of Education, University of Calgary , Calgary, Alberta , Canada
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47
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Ventola PE, Oosting DR, Keifer CM, Friedman HE. Toward optimal outcome following pivotal response treatment: a case series. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2015; 88:37-44. [PMID: 25745373 PMCID: PMC4345537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
There is a growing literature on children with autism spectrum disorder (ASD) who respond favorably to behavioral treatment, which is often termed "optimal outcome." Rates and definitions of optimal outcome vary widely. The current case series describes an empirically validated behavioral treatment approach called Pivotal Response Treatment (PRT). We present two preschool-aged children who received an intensive course of PRT and seem to be on a trajectory toward potential optimal outcome. Understanding response to treatment and predictors of response is crucial, not necessarily to predict who may succeed, but to individualize medicine and match children with customized treatment programs that will be best tailored to their unique and varied needs.
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Affiliation(s)
- Pamela E. Ventola
- Pamela Ventola, Yale Child Study Center, 230 South Frontage Road, New Haven, CT 06520; Tele: 203-785-5657;
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48
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Bradshaw J, Steiner AM, Gengoux G, Koegel LK. Feasibility and effectiveness of very early intervention for infants at-risk for autism spectrum disorder: a systematic review. J Autism Dev Disord 2015; 45:778-94. [PMID: 25218848 DOI: 10.1007/s10803-014-2235-2] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Early detection methods for autism spectrum disorder (ASD) in infancy are rapidly advancing, yet the development of interventions for infants under two years with or at-risk for ASD remains limited. In order to guide research and practice, this paper systematically reviewed studies investigating interventions for infants under 24 months with or at-risk for ASD. Nine studies were identified and evaluated for: (a) participants, (b) intervention approach (c) experimental design, and (d) outcomes. Studies that collected parent measures reported positive findings for parent acceptability, satisfaction, and improvement in parent implementation of treatment. Infant gains in social-communicative and developmental skills were observed following intervention in most of the reviewed studies, while comparisons with treatment-as-usual control groups elucidate the need for further research. These studies highlight the feasibility of very early intervention and provide preliminary evidence that intervention for at-risk infants may be beneficial for infants and parents.
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Affiliation(s)
- Jessica Bradshaw
- Counseling, Clinical, and School Psychology Department, Koegel Autism Center, Graduate School of Education, University of California, Santa Barbara, CA, USA,
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49
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Green J, Charman T, Pickles A, Wan MW, Elsabbagh M, Slonims V, Taylor C, McNally J, Booth R, Gliga T, Jones EJH, Harrop C, Bedford R, Johnson MH. Parent-mediated intervention versus no intervention for infants at high risk of autism: a parallel, single-blind, randomised trial. Lancet Psychiatry 2015; 2:133-40. [PMID: 26359749 PMCID: PMC4722333 DOI: 10.1016/s2215-0366(14)00091-1] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/18/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Risk markers for later autism identified in the first year of life present plausible intervention targets during early development. We aimed to assess the effect of a parent-mediated intervention for infants at high risk of autism on these markers. METHODS We did a two-site, two-arm assessor-blinded randomised controlled trial of families with an infant at familial high risk of autism aged 7-10 months, testing the adapted Video Interaction to Promote Positive Parenting (iBASIS-VIPP) versus no intervention. Families were randomly assigned to intervention or no intervention groups using a permuted block approach stratified by centre. Assessors, but not families or therapists, were masked to group assignment. The primary outcome was infant attentiveness to parent. Regression analysis was done on an intention-to-treat basis. This trial is registered with ISCRTN Registry, number ISRCTN87373263. FINDINGS We randomly assigned 54 families between April 11, 2011, and Dec 4, 2012 (28 to intervention, 26 to no intervention). Although CIs sometimes include the null, point estimates suggest that the intervention increased the primary outcome of infant attentiveness to parent (effect size 0.29, 95% CI -0.26 to 0.86, thus including possibilities ranging from a small negative treatment effect to a strongly positive treatment effect). For secondary outcomes, the intervention reduced autism-risk behaviours (0.50, CI -0.15 to 1.08), increased parental non-directiveness (0.81, 0.28 to 1.52), improved attention disengagement (0.48, -0.01 to 1.02), and improved parent-rated infant adaptive function (χ(2)[2] 15.39, p=0.0005). There was a possibility of nil or negative effect in language and responsivity to vowel change (P1: ES-0.62, CI -2.42 to 0.31; P2: -0.29, -1.55 to 0.71). INTERPRETATION With the exception of the response to vowel change, our study showed positive estimates across a wide range of behavioural and brain function risk-markers and developmental outcomes that are consistent with a moderate intervention effect to reduce the risk for later autism. However, the estimates have wide CIs that include possible nil or small negative effects. The results are encouraging for development and prevention science, but need larger-scale replication to improve precision. FUNDING Autistica, Waterloo Foundation, Autism Speaks, and the UK Medical Research Council.
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Affiliation(s)
- Jonathan Green
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
| | - Tony Charman
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychology, London, UK
| | - Andrew Pickles
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychology, London, UK; National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ming W Wan
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Mayada Elsabbagh
- Centre for Brain and Cognitive Development, Birkbeck College, London, UK; Department of Psychiatry, McGill University, West Montreal, QC, Canada
| | - Vicky Slonims
- Evelina London Children's Hospital and Kings College London Neurosciences Centre, London, UK
| | - Carol Taylor
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Janet McNally
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK; Institute of Psychological Sciences, University of Leeds, Leeds, UK
| | - Rhonda Booth
- Institute of Child Health, University College London, London, UK
| | - Teodora Gliga
- Centre for Brain and Cognitive Development, Birkbeck College, London, UK
| | - Emily J H Jones
- Centre for Brain and Cognitive Development, Birkbeck College, London, UK
| | - Clare Harrop
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK; Kasari Lab, UCLA Center for Autism Research and Treatment, Semel Institute, Los Angeles, CA, USA
| | - Rachael Bedford
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychology, London, UK
| | - Mark H Johnson
- Centre for Brain and Cognitive Development, Birkbeck College, London, UK
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Rowberry J, Macari S, Chen G, Campbell D, Leventhal JM, Weitzman C, Chawarska K. Screening for autism spectrum disorders in 12-month-old high-risk siblings by parental report. J Autism Dev Disord 2015; 45:221-9. [PMID: 25149178 PMCID: PMC4289092 DOI: 10.1007/s10803-014-2211-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examines whether parental report of social-communicative and repetitive behaviors at 12 months can be helpful in identifying autism spectrum disorder (ASD) in younger siblings of children with ASD [high-risk (HR)-siblings]. Parents of HR-siblings and infants without a family history of ASD completed the First Year Inventory at 12 months. Developmental outcomes were based on 24- or 36-month assessments. HR-siblings later diagnosed with ASD showed greater impairments in social communication than those with other developmental outcomes based on parental and clinician ratings. Parental report of decline in play and communication and impaired vocal imitation correctly classified a majority of ASD cases with high specificity. These preliminary findings have important implications for the development of early screening instruments for ASD in HR-siblings.
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Affiliation(s)
- Justin Rowberry
- Developmental and Behavioral Pediatrics, Mike O'Callaghan Federal Medical Center, 4700 Las Vegas Boulevard North, Building 1300, Nellis Air Force Base, NV, 89191, USA,
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