Toward a technology of treatment individualization for young children with autism spectrum disorders

The Power Card Strategy: Strength-Based Intervention Against Bullying for Children with Autism Spectrum Disorder

The pattern of behaviors and abilities that reflect the core characteristics of students with autism spectrum disorder (ASD) and an environment that lacks the ability to understand individuals with ASD can make these students targets of bullying. Bullying is a serious problem for students with ASD, and practices against it are important in terms of improving students' coping strategies and overall well-being. In this study, we used a multiple probe model with an interprobe phase across participants to evaluate the effectiveness of the power card strategy to teach three students with ASD to respond to bullying. At baseline, the students gave few appropriate responses based on coping strategies for bullying after listening to stories about bullying. During the application of the power cards, the students read scenarios and power cards created for their favorite heroes or special interests, which included coping strategies for three different bullying situations (exclusion, being pushed, and being tickled). Then, they watched animations prepared for these bullying situations and were asked to answer questions about strategies to deal with bullying. The findings showed that all three students learned targeted strategies for coping with bullying in the context of the sessions using power cards. The students were able to generalize to different bullying situations (teasing, damaging one's belongings, being ignored) while retaining their strategies for coping with bullying in the context of the sessions held after the teaching was completed. The social validity findings of the power card strategy showed that one out of three students exhibited coping strategies for bullying in the school environment. The findings of the present study are discussed in the context of bullying and ASD, limitations, and recommendations.

Profiles of nonverbal skills used by young pre-verbal children with autism on the ADOS-2: Relation to screening disposition and outcomes

Autistic individuals exhibit differences in their use and understanding of nonverbal communication; however, individual patterns of nonverbal strengths and challenges vary significantly. This heterogeneity can complicate the diagnostic and screening processes and can result in delayed or missed diagnoses. In this study, we characterize various profiles of nonverbal communication skills among 215 pre-verbal children with autism (Mage = 36.27 months, range = 18-70) and explore how these profiles are related to screening outcomes, diagnostic certainty, and developmental and behavioral features. We conducted a latent class analysis of nine items assessing nonverbal communication skills from the Toddler Module and Module 1 of the Autism Diagnostic Observation Schedule, 2nd Edition. Five nonverbal profiles were identified that differentiated children based on the form, function, and frequency of their nonverbal communication skills. Furthermore, screening outcomes and clinician certainty in autism diagnosis varied by nonverbal profile. False negative screening outcomes based on parent report were highest for children who used a range of nonverbal skills but with limited frequency or consistency. Clinicians, on the other hand, tended to have high certainty in an autism diagnosis for children with this profile, and instead rated their lowest certainty in diagnosing children who demonstrated consistent integration of eye contact with their nonverbal communication. The profiles identified in this study could be clinically useful in helping to identify children at highest likelihood of being overlooked during the screening or diagnostic processes, providing an opportunity to improve early identification and intervention for autism.

Peer-Mediated Social Skills Interventions in Primary School Settings for Autistic Children in the Light of the ICF Bio-psycho-social Model. A Systematic Review

This systematic review expands the current knowledge about Peer-Mediated Interventions (PMIs) for children with Autism Spectrum Disorder, focusing exclusively on primary school age (6-12 years). The study has three aims: (1) describing the main features of the PMI programs; (2) discussing the PMIs efficacy on autistic children's social skills; (3) analyzing whether the PMIs were coherent with the bio-psycho-social model promoted by the International Classification of Functioning, Disability and Health (ICF) classification system, by referring to the person-environment interaction and to the concepts of body functions and structures, environmental factors, and activity and participation. The systematic review followed the PRISMA-P method. The literature search was conducted in August 2024 through PsycInfo, PsycArticles, Education Source, and PubMed databases. A total of 558 articles were generated; 1 study was later added. Twenty-four articles were finally included. Most of the studies used a multiple baseline design across subjects and proved to be effective. Yet, only 5 studies included a follow-up assessment, which showed contrasting results. PMIs partly fit the ICF bio-psycho-social vision, even if they were not designed for this purpose. Our analysis arises from the belief that systematically including the perspective of individual-environment interaction could better guarantee the intervention efficacy.

Research on pragmatic impairment in autistic children during the past two decades (2001-2022): hot spots and frontiers-based on CiteSpace bibliometric analysis

Pragmatic impairment has become a critical aspect of language development in autistic children and has gained significant academic attention over the past two decades. This study leverages bibliometric methods to conduct an exhaustive analysis of literature derived from Web of Science database. Utilizing CiteSpace software, we construct a knowledge map to dissect the academic hotspots in research related to pragmatic impairment in autistic children. This enables us to delineate the evolutionary trajectory of this research domain, analyze the prevailing research dimensions, and anticipate potential future dimensions. Our findings indicate that research hotspots in this field over the past two decades predominantly concentrate on assessing and diagnosing pragmatic impairment in autistic children, intervention strategies, and theory of mind. The research scope on pragmatic impairment in autistic children has progressively broadened and deepened. Research has evolved from initial descriptions and interpretations of autism to exploring the theory of mind in high-functioning, school-aged children. The current emphasis is on examining the specific skills that these children possess.

Supporting Autistic College Students: Examining the Mentoring, Organization and Social Support for Autism Inclusion on Campus (MOSSAIC) Program

Recent trends suggest that autistic young adults are increasingly accessing postsecondary education than in years past. However, these students often face unique challenges that negatively impact their college experience resulting in high dropout. The Mentoring, Organization and Social Support for Autism Inclusion on Campus (MOSSAIC) Program is a peer-mentorship college transition program intended to support autistic students with executive functioning, social, and self-advocacy skills. This study investigated the experiences of 13 autistic mentees and 12 non-autistic mentors enrolled in the MOSSAIC program. Program feedback was collected using semi-structured interviews in order to understand student experiences, highlight benefits, and identify areas of improvement. Participants reported a general positive experience and improved skills in the domains of socialization, executive functioning, academic performance, and professional development. The most common suggestion for the program was the inclusion of autistic peer mentors. Mentees noted difficulty relating with non-autistic peers and feeling burdened with the need to educate their mentor on how to support autistic adults. These data provide valuable insight into how colleges can better improve support for autistic college students to ensure postsecondary success. Future peer mentorship programs should consider recruiting neurodiverse mentors from diverse backgrounds to improve congruence between mentor and mentee identities.

Comparative Analysis of Gender-Based Differences in Behavioral Mastery, Goals, and Characteristics in Autistic Individuals: An Applied Behavior Analysis Study

Introduction  It is widely recognized that the prevalence and diagnosis of autism spectrum disorder (ASD) are more common in males than in females. Despite this, there is a significant gap in the body of autism research that investigates gender differences for treatment effects of applied behavior analysis (ABA) across a variety of measured variables. This research aims to comprehensively evaluate gender distinctions concerning target behavioral objectives, goals, and deficit variables. Materials and methods This study analyzed retrospective data from 100 participants, including 89 juveniles and four adults, with seven cases lacking age documentation, who underwent a three-month ABA program from March 19 to June 11, 2023. The ABA program included various methodologies such as functional analysis, discrete trial training, mass trials, and naturalistic training. Data on outcome measures, including target behavioral proficiency, age, average trials to proficiency, average teaching days to proficiency, open behavioral objectives, and target trends, were collected using the "Catalyst" software (Catalyst Software Corporation, New York, NY). Participant demographics were summarized using statistical analyses for categorical (gender and race/ethnicity) and continuous variables (percentage of mastered behavioral objectives, age, average trials, average teaching days, open objectives, percentage of failed objectives during maintenance, percentage of objectives with upward, downward, and flat trends). These statistics included mean, standard deviation, median, and range and were analyzed inferentially using nine separate two-sample independent t-tests and corresponding effect sizes using Cohen's d. Results There were no statistically significant disparities based on gender (p > 0.05) across all nine variables examined: Percentage of Targets Mastered, Age, Average Trials to Mastery, Average Teaching Days to Mastery, Open Targets, Percentage of Targets Failed in Maintenance, Percentage of Targets Trending Up, Percentage of Targets Trending Down, and Percentage of Targets Trending Flat, and wide confidence intervals were detected. Conclusions  Non-significant gender differences in response to ABA treatments regarding these nine behavioral goals, mastery, and deficit variables may be relevant. They suggest that ABA treatments could be equally beneficial for both male and female autistic individuals. These results should be interpreted cautiously. The general pattern observed, characterized by broad confidence intervals, carries a degree of statistical uncertainty, which may suggest substantial gender differences. These results might question the prevailing beliefs about the variation in treatment response based on gender. This could profoundly impact clinical practices, implying that healthcare professionals should not favor one gender over another when suggesting ABA therapies. Instead, the treatment advice should be tailored to each child's unique requirements and traits, regardless of gender. The investigators expect these results to encourage additional research in this field. Comprehending the elements that affect treatment response is vital for improving treatment results and customizing care.

Designing and deploying a virtual social sandbox for autistic children

PURPOSE

This exploratory study was intended to investigate the design and feasibility of using a web virtual reality based social learning space for autistic children at home.

MATERIALS AND METHODS

The researchers of the current study developed and implemented an open-source, web virtual reality based learning program for children with autism. Endorsing mixed-method convergent parallel design, we collected both qualitative and quantitative data from four autistic children, including repeated measures of social skills performance, self- and parent-reported social and communication competence, observation notes, and individual interviews.

RESULTS

The study found preliminary evidence for a positive impact of deploying a virtual reality-based social sandbox on the practice and development of complex social skills for autistic children. All participants showed significant reduced social communication impairments from the pre- to the post-intervention phases. Nevertheless, participants' social skills performance in the virtual world was mediated by two social task design features-external goal structure and individualization.

CONCLUSIONS

Play- and design-oriented social tasks in the three-dimensional virtual world framed meaningful social experiences or the naturalistic intervention for social skills development.

Comparative Effects of Applied Behavior Analysis on Male and Female Individuals With Autism Spectrum Disorder

Introduction Current evidence-based treatments for autism spectrum disorder (ASD) are based on applied behavior analysis (ABA). However, research on gender differences in ABA therapy response is limited. This study seeks to (1) confirm the 4:1 male-to-female ratio reported in the literature and (2) identify any possible gender differences in target behaviors over seven timepoints measured every two weeks. Materials and methods  For three months, from March 19, 2023, to June 11, 2023, a team of 3-5 behavioral technicians per individual collected daily data on general target mastery for 100 individuals with ASD treated with ABA. Data was collected at seven timepoints every two weeks. Descriptive demographics were computed. Two independent sample t-tests were performed to determine significant or nonsignificant gender differences with the seven timepoint variables.  Results Nonstatistically significant gender differences (p > .05) were found on all seven cumulative target behavior timepoints measured at two-week intervals. For targets mastered Time 1, baseline between males and females, there was no significant difference in the means for males (M = 1.0571, SD = 1.9196) and females (M = 2.0455, SD = 3.9457) (t(90) = -1.591, p = 0.115, confidence interval (CI) = -2.2223, 0.2456, d = -0.389). For targets mastered Time 2, two weeks between males and females, there was no significant difference in the means for males (M = 3.7132; SD = 4.5065) and females (M = 4.0682, SD = 5.1508) (t(88) = -0.310, p = 0.757, CI = -2.6305, 1.92056, d = -0.076). For targets mastered Time 3, four weeks between males and females, there was no significant difference in the means for males (M = 7.0956; SD = 8.7781) and females (M = 8.6136; SD = 11.2799) (t(88) = -0.656, p = 0.514, CI = -6.1173, 3.0811, d = -0.161). For targets mastered Time 4, six weeks between males and females, there was no significant difference in the means for males (M = 13.1728, SD = 16.2003) and females (M = 13.0682, SD = 16.9272) (t(88) = 0.026, p = 0.979, CI = -7.8779, 8.0871, d = 0.006). For targets mastered Time 5, eight weeks between males and females, there was no significant difference in the means for males (M = 17.2096; SD = 18.8546) and females (M = 17.4286, SD = 22.1683) (t(87) = -0.045, p = 0.965, CI = -9.9773, 9.5393, d = -0.011). For targets mastered Time 6, 10 weeks between males and females, there was no significant difference in the means for males (M = 21.0074, SD = 21.3329) and females (M = 20.6818, SD = 26.1231) (t(88) = 0.059, p = 0.953, CI = -10.6752, 11.3262, d = 0.014). For targets mastered Time 7, 12 weeks between males and females, there was no significant difference in the means for males (M = 26.1196, SD = 24.2235) and females (M = 29.6364, SD = 33.7406) (t(89) = -0.536, p = 0.593, CI = -16.5431, 9.5094, d = -0.131). Conclusions The study indicates that ABA treatments may be equally beneficial for both genders with ASD, showing no significant gender differences. However, the broad CIs in this study imply a level of statistical uncertainty, indicating potential gender differences, suggesting the results may not be uniform across genders. These findings challenge assumptions on gender-specific treatment responses, implying that ABA treatments shouldn't be recommended based on gender. Instead, individual needs should guide treatment recommendations. Future research could consider other response moderators like age, ASD severity, or coexisting mental health conditions.

Setting Families Up for Success: A Pilot Study of a Toolkit to Enhance the Autism Spectrum Disorder Diagnostic Evaluation Process

Families of children with autism spectrum disorder (ASD) face challenges engaging in services following diagnosis. This study: (1) developed and implemented a toolkit to tailor ASD evaluation feedback to families' needs, and (2) evaluated caregiver and provider perceptions of the toolkit. Focus groups with providers (N = 11) informed toolkit development. Seven providers participated in pilot training and implementation. Provider and caregiver toolkit perceptions were assessed using interviews, surveys, and a fidelity checklist. Toolkit strategies reflect focus group themes. Provider and caregiver ratings suggest the initial feasibility, acceptability, and utility of the toolkit. This toolkit may be feasible to implement in community settings and may increase caregiver satisfaction, though further refinements are needed to support service connection.

Predicting Communication Skills Outcomes for Preschool Children with Autism Spectrum Disorder Following Early Intervention

Purpose

This study aims to assess changes in the receptive and expressive language skills and to determine if the baseline characteristics such as communication, cognitive and motor skills, predict outcomes in preschool children with Autism Spectrum Disorder (ASD) following early intervention.

Methods

We recruited 64 children participating in the Early Start Denver Model (ESDM) early intervention program at an Autism Specific Early Learning and Care Center (ASELCC) in Australia. Baseline characteristics across various developmental domains was measured using the Mullen Scales of Early Learning (MSEL), Vineland Adaptive Behaviour Scales, 2nd Edition (VABS-II), and the ESDM Curriculum Checklist. Linear mixed-effects models were used to examine the effects of the intervention on outcomes. Fixed-effects such as time, groups (verbal and minimally verbal), and time-by-group interactions were assessed whilst adjusting for covariates. Further, multiple linear regression models were used to determine if the baseline characteristics were significant predictors of the outcomes following the early intervention.

Results

Among the 64 children who participated in this study, 38 children were verbal, whereas 26 were deemed to have minimal verbal skills. The mean age of the sample was 4.1 years with a significant male predilection (83%) and from a culturally and linguistically diverse (CALD) background (64%). Findings of the linear mixed effects model showed significant within and between group differences in the ESDM subscales, indicating higher magnitude of changes in the verbal group compared to the minimally verbal group. Finally, the multiple linear regression models suggested that baseline MSEL visual reception and expressive language scores were predictive of changes in the ESDM receptive and expressive communication scores.

Conclusion

Understanding a child's baseline skill levels may provide valuable clues regarding what interventions would work best, or which interventions may be less suitable for individual preschool-aged children with ASD.

Age at initial diagnosis of autism spectrum disorders: a retrospective comparison of screening techniques between the southern and northwestern regions of Switzerland

AIMS

Early diagnosis of autism spectrum disorders (ASD) offers the possibility of early intervention and, in turn, gains in adaptive behaviour, language and cognition. The aim of the present study was to analyse whether age at diagnosis of autism spectrum disorders decreased in two regions of Switzerland from 2006 to 2016 following the implementation of different screening and referral techniques. In southern Switzerland, systematic paediatric screening using the Modified Checklist for Autism (M-CHAT) in toddlers was implemented in 2013, whereas in northwestern Switzerland, periodic trainings were used to increase paediatrician awareness of ASD. We investigated which method was associated with a younger average age at diagnosis.

METHODS

We conducted a retrospective, two-centre study searching clinical records of children and adolescents (aged 0-16 years) diagnosed with ASD in two neuropaediatric departments at Swiss hospitals between January 2006 and December 2016. All patients were diagnosed via a standardised evaluation based on two approved diagnostic tests: the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) and the Autism Diagnostic Interview-Revised (ADI-R).

RESULTS

In southern Switzerland, training and subsequent widespread use of the M-CHAT among paediatricians appeared to contribute to a significantly younger age at diagnosis. Age at diagnosis did not significantly decrease during the same period in northwestern Switzerland.

CONCLUSION

Our results point to the possibility of successfully reducing age at diagnosis in specific geographic areas through the implementation of screening questionnaires, such as the M-CHAT, at year 2 well-baby visits.

Examining the perceptions of needs, services and abilities of Czech and North Macedonian caregivers of children with autism and trainers

Effective practices for supporting families with autistic children ensure a match between their needs and the expectations and competencies of the clinician. Applied behavior analysis (ABA) services are a common provision for serving autistic individuals. However, in regions where ABA is in its infancy, like the Czech Republic and North Macedonia, culturally relevant resources, regulations for practice, and standardized coursework are missing. In their absence, it is necessary to investigate the degree to which practitioners in the regions are meeting the behavioral needs of families. Assessing this match can set the stage for establishing more stable and effective services in the areas, as well as neighboring countries with similar historical foundations. Therefore, a survey was conducted to examine the perceptions of caregivers and trainers (those who self-identified as providing support to families with autistic children). A total of 233 caregivers and 204 trainers participated. Analysis of the survey responses verified the lack of behavioral knowledge on the part of the trainers, the apparent lack of access to ABA services for families in both regions, a potential misalignment between family needs and training targets, and the disparities between the two countries. The information evaluated here can be used to guide preservice training, dissemination efforts, and regulations surrounding behavioral practices.

Examining Predictors of Different ABA Treatments: A Systematic Review

In the recent literature, there is a broad consensus on the effectiveness of Applied Behavior Analysis interventions for autism spectrum disorder (ASD). Despite their proven efficacy, research in clinical settings shows that these treatments are not equally effective for all children and the issue of which intervention should be chosen for an individual remains a common dilemma. The current work systematically reviewed studies on predictors and moderators of response to different types of evidence-based treatment for children with ASD. Specifically, our goal was to critically review the relationships between pre-treatment child characteristics and specific treatment outcomes, covering different aspects of functioning (i.e., social, communicative, adaptive, cognitive, motor, global functioning, play, and symptom severity). Our results questioned the binomial “better functioning-better outcome”, emphasizing the complex interplay between pre-treatment child characteristics and treatment outcomes. However, some pre-treatment variables seem to act as prerequisites for a specific treatment, and the issue of “what works for whom and why” remains challenging. Future research should focus on the definition of evidence-based decision-making models that capture those individual factors through which a specific intervention will exert its effects.

Super responders: Predicting language gains from JASPER among limited language children with autism spectrum disorder

Early intervention can provide a great benefit for children with autism spectrum disorder (ASD). However, no single intervention is effective for all children. Even when an intervention is effective overall, individual child response varies. Some children make incredible progress, and others make slow or no progress. Therefore, it is important that the field move towards developing methods to personalize intervention. Operationalizing meaningful change and predicting intervention response are critical steps in designing systematic and personalized early intervention. The present research used improvement in expressive language to group children that received a targeted social communication early intervention, Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER), into super responders and slow responders. Using baseline data from traditional standardized assessments of cognition and behavioral data from validated experimental measures of play and social communication, we used conditional inference tree models to predict responder status. From a sample of 99 preschool age, limited language children with ASD, play diversity was the most significant predictor of responder status. Children that played functionally with a wider variety of toys had increased odds of being a super responder to JASPER. A combination of lower play diversity and impairments in fine motor abilities increased the odds of children being slow responders to JASPER. Results from the present study can inform future efforts to individualize intervention and systematic approaches to augmenting treatment in real time. LAY SUMMARY: To help us answer the question of for whom an intervention works best, we examined 99 children, age three to five, who qualified as being limited spoken language communicators, and received a targeted intervention for social communication and language. We used child characteristics before intervention to predict which children would improve their language the most and found that the ability to play appropriately with a wider variety of toys predicted the best improvements in expressive language. These findings will help better inform future work to individualize intervention based on the unique needs of each child.

Virtual Reality Technology as an Educational and Intervention Tool for Children with Autism Spectrum Disorder: Current Perspectives and Future Directions

The worldwide rising trend of autism spectrum disorder (ASD) calls for innovative and efficacious techniques for assessment and treatment. Virtual reality (VR) technology gains theoretical support from rehabilitation and pedagogical theories and offers a variety of capabilities in educational and interventional contexts with affordable products. VR is attracting increasing attention in the medical and healthcare industry, as it provides fully interactive three-dimensional simulations of real-world settings and social situations, which are particularly suitable for cognitive and performance training, including social and interaction skills. This review article offers a summary of current perspectives and evidence-based VR applications for children with ASD, with a primary focus on social communication, including social functioning, emotion recognition, and speech and language. Technology- and design-related limitations, as well as disputes over the application of VR to autism research and therapy, are discussed, and future directions of this emerging field are highlighted with regards to application expansion and improvement, technology enhancement, linguistic diversity, and the development of theoretical models and brain-based research.

Professionals' Perspectives on Service Delivery: The impact of COVID-19 on early childhood special education providers

Early childhood special education (ECSE) professionals were forced to drastically change their methods of providing services as a result of the COVID-19 pandemic. In this qualitative study, we conducted interviews to understand how the COVID-19 pandemic has impacted ECSE professionals both personally and professionally. ECSE professionals described challenges as well as unexpected positive outcomes associated with continuing to work in the midst of the COVID-19 pandemic. Professionals also explained the importance of increasing parent interaction through coaching interventions while engaging in remote service delivery. The findings conclude with professionals' predictions about how the field will be impacted by the pandemic in the future. Results were discussed in the context of service provision and implications for supporting professionals who work with young children were addressed.

An investigation to choose the proper therapy technique in the management of autism spectrum disorder

Aim: Autism spectrum disorder is a class of neurological disorders that affect the development of brain functions. This study aims to evaluate, compare and rank the therapy techniques used in the management of autism spectrum disorder using multicriteria decision-making approaches. Materials & methods: Fuzzy PROMETHEE and fuzzy TOPSIS approaches were used. Fuzzy PROMETHEE utilizes a pair-wise comparison of alternatives under the fuzzy environment while fuzzy TOPSIS utilizes geometric distance from the positive ideal solution under the fuzzy environment for the evaluation of the effectiveness of the alternatives.The techniques selected for evaluation are applied behavioral analysis, cognitive behavioral therapy, speech therapy and pharmacological therapy such as Risperidone and Aripiprazole. Criteria used in this study include efficacy, cost and side effects, and their weights are assigned based on specific patient conditions. Results: The results indicate that applied behavioral analysis, cognitive behavioral therapy and speech therapy are the most preferred techniques, followed by Aripiprazole and Risperidone. Conclusion: More criteria could be considered and the weights could be assigned according to the patient profile.

Developmental associations between joint engagement and autistic children's vocabulary: A cross-lagged panel analysis

LAY ABSTRACT

In this study, we used a cross-lagged panel analysis to examine correlations over time between two types of engagement between children and their parents and children's later expressive and receptive vocabularies. This kind of design can help researchers understand which early developmental achievements "drive" later developmental achievements. It is important for intervention researchers to know which developmental achievements happen first, so that they can set intervention goals appropriately. The two joint engagement variables we examined were (a) higher order supported joint engagement, which occurs when caregivers influence their child's play with toys and the child reciprocally responds to the caregiver, but does not manage the interaction by shifting gaze between the toys and the caregiver, and (b) higher order supported joint engagement that co-occurs with caregiver's follow-in talk (higher order supported joint engagement + follow-in). Follow-in talk occurs when the caregiver talks about objects and events that the child is focused on. Ninety-one autistic children (n = 91) with language delay (mean chronological age = 39 months) participated, along with their primary caregivers. Each of the four variables was measured twice, 8 months apart. Our statistical procedures showed that early higher order supported joint engagement and early higher order supported joint engagement + follow-in were significantly associated with later expressive and receptive vocabulary. In contrast, associations between early vocabulary variables and later joint engagement variables were not significant. Our results suggest that higher order supported joint engagement and higher order supported joint engagement + follow-in may be useful initial intervention targets, for developmental interventions aimed at promoting language development in autistic children who are initially language delayed.

Examining Effectiveness and Predictors of Treatment Response of Pivotal Response Treatment in Autism: An Umbrella Review and a Meta-Analysis

The current study aimed to provide a comprehensive appraisal of the current evidence on the effectiveness of Pivotal Response Training (PRT) for individuals with autism spectrum disorder (ASD) and to explore predictors of treatment response. We conducted a systematic review of the following electronic databases and registers: PsycINFO, Medline, Embase, Cochrane Central Register of Controlled Trials, ERIC, Linguistics and Language Behavior Abstracts. Six systematic reviews were identified, two with meta-analytic component. Identified reviews varied widely in terms of their aims, outcomes, and designs which precluded a unified and consistent set of conclusions and recommendations. Ten RCTs were identified. Eight of identified RCTs reported at least one language and communication-related outcome. Statistically significant effects of PRT were identified across a majority of identified RCTs for a range of language and communication skills. However, evidence for positive treatment effects of PRT on outcome measures assessing other domains was less robust and/or specific. Overall, both previous systematic reviews and new meta-analysis of the RCTs suggest that PRT shows promise for improving language and communication. Only four RCTs examined the association between baseline child characteristics and treatment outcomes, however, no consistent pattern emerged. This review has identified several key methodological and design improvements that are needed to enable our field to fully capitalize on the potential of RCT designs and characterize detailed profiles of treatment responders. These findings are essential for informing the development of evidence-based guidelines for clinicians on what works for whom and why.

Needs of Grandparents of Preschool-Aged Children with ASD in Sweden

Little is known about needs of grandparents of young children with autism in family and community settings. This study investigated perceived needs of grandparents of preschool-aged children diagnosed with ASD in the cultural context of Sweden. Participants were 120 grandparents of children enrolled into autism intervention programs provided by the public disability services in Stockholm. The Grandparents' Needs Survey and the SDQ Impact supplement were used to collect data. Grandparents expressed most needs in topic areas of information and childcare. No significant relations were found between grandparents' demographics and perceptions of needs; grandparents' needs were predicted by their perceived burden. The findings provide insight into understanding of grandparents' needs essential for planning and provision of quality family-centered early intervention services.

Listening to parents to understand their priorities for autism research

Involving the autism community in research increases the real-world translation and impact of findings. The current study explored the research priorities of parents of school-aged children on the autism spectrum across the home, school, and community settings. A combination of content analysis of an online questionnaire (n = 134) and Q-sort methodology (n = 9) was used. The most commonly identified research priorities in the online questionnaire were child health and well-being (home setting), socialisation and social support (school), and community awareness and understanding of autism (community). The Q-sort method highlighted different top priorities, with understanding the parent, sibling, child and family impact and stress the highest ranked priority for home, teacher/staff education and support for the school, and recognizing and supporting anxiety for the community. The implications of the findings are discussed in relation to shifting the framework of autism research to align research agendas with parental priorities.

Culturally diverse families of young children with ASD in Sweden: Parental explanatory models

BACKGROUND

Research suggests that families' knowledge and cultural perceptions of autism spectrum disorder (ASD), and beliefs about its etiology and prognosis, can affect parents' recognition of the first signs of autism in their children and influence help seeking and treatment decisions.

OBJECTIVE

This study investigated explanatory models of autism among parents of young children with ASD in the multicultural context of Sweden.

METHOD

Seventeen parents from diverse cultural, ethnic and linguistic backgrounds participated in semi-structured interviews. A deductive approach to qualitative content analysis was used to analyze data. Five domains of the Explanatory Model supplementary module of the Cultural Formulation Interview (CFI) were used as coding categories, operationalized as 'Parents' understanding of autism'; 'Autism prototypes'; 'Causal explanations'; 'Course of autism', and 'Help seeking and treatment expectations'.

RESULTS

The results showed that parents' prior knowledge of autism and experience of young children's typical developmental trajectories, as well as the opinions of children's grandparents and preschool teachers, affected symptom recognition and help seeking. There were differences in parents' explanatory models before and after ASD diagnosis. Initial interpretations of the disorder included medical conditions and reaction to environmental influences, while genetic, supernatural/religious factors, and vaccinations were mentioned as definite causes after obtaining a clinical diagnosis. Parents also held multiple explanatory models, influenced by the views of family members and information obtained from media or from health care professionals. Parents' treatment decisions included use of available state-funded support services, and complementary and alternative treatments.

CONCLUSION

The results demonstrate the utility of the CFI's Explanatory Model supplementary module in autism research. Implications for clinical practice are discussed.

Integrating the Early Start Denver Model into Israeli community autism spectrum disorder preschools: Effectiveness and treatment response predictors

Early intensive intervention has been shown to significantly affect the development of children with autism spectrum disorder. However, the costly implementation of such interventions limits their wide dissemination in the community. This study examined an integration of the Early Start Denver Model into community preschool programs for children with autism spectrum disorder in Israel. Four community preschools implemented the preschool-based Early Start Denver Model and four implemented a multidisciplinary developmental intervention which is widely applied in Israeli community autism spectrum disorder preschools. Fifty-one children (aged 33–57 months) participated in the study. Twenty-six attended the preschool-based Early Start Denver Model preschools and twenty-five attended the multidisciplinary developmental intervention settings. Groups were comparable on age, developmental functioning, and socio-economic status. Compared to the multidisciplinary developmental intervention group, children in the preschool-based Early Start Denver Model treatment made greater gains on blinded measures of overall cognitive development, receptive and expressive language skills, as well as on parent- and teacher-reported adaptive communication and socialization abilities. In the preschool-based Early Start Denver Model group, children with lower symptom severity, higher adaptive functioning, and receptive language abilities at pre-treatment showed greater improvement. This study documents the successful integration of an Early Start Denver Model intervention into pre-existing community preschools, underlining the importance of disseminating evidence-based early intervention in community settings.

A Pilot Trial of a Manualized Psychoeducation Module for Parents of Children with Autism with Intellectual Disability and Intellectual Disability Alone

Objectives

Children with autism with/without intellectual disability (ID) and ID alone require regular interventions. Psychoeducation (PE) can empower parents with intervention strategies. The aim of this study was to develop the test efficacy of a simple, short manualized PE module for parents of children with autism with/without comorbid ID and for ID alone. We focused on both autism and ID (A-ID) because we felt that both the groups could benefit from this module.

Methods

A special module for PE was developed after literature review, inputs from a study group, and discussion with experts. Parents attended eight fortnightly intervention sessions. Children were assessed on the Developmental Screening Test, Indian Scale for Assessment of Autism (ISAA), and the Behavioral Assessment Scale for Indian Children with Mental Retardation (BASIC-MR) before starting and 1 month after completing PE.

Results

Consenting parent of parents/of 16 children with A-ID and 14 with ID completed sessions with pre- and postassessment. There was a significant improvement in the majority of domains of ISAA and BASIC-MR Part B in children with both conditions.

Conclusions

PE has a wide scope for use across various developmental disorders. The module developed is promising for a wide variety of field workers.

Stress and Coping Styles in Mothers of Children with Autism Spectrum Disorder

BACKGROUND

Children with autism spectrum disorder (ASD) require well-balanced care and a comprehensive therapeutic approach. Mental health problems often go unnoticed in mothers of children with ASD due to the focus on training for the children. The presence of stress and depressive symptoms in mothers can interfere with the quality of care and therapy given to the child. The present study aimed to assess the quality of life, coping styles, and symptoms of depression, anxiety, and stress in mothers of children with ASD.

METHODS

This study recruited thirty mothers of children with ASD, to whom Depression, Anxiety and Stress Scale (DASS 21), WHO Quality of Life Scale (WHOQOL-BREF), and COPE Inventory were administered.

RESULTS

Results indicated the presence of depressive and anxiety symptoms and impaired quality of life among the mothers. Despite this, they exhibited positive coping styles.

CONCLUSION

As part of a comprehensive intervention for children with ASD, there is also a need to address the psychological distress and coping styles of mothers.

Adapting parent engagement strategies for an evidence-based parent-mediated intervention for young children at risk for autism spectrum disorder

AIMS

Aims included (a) characterizing provider feedback on parent engagement strategies integrated into a parent-mediated intervention for toddlers at risk for autism spectrum disorder (ASD) and (b) identifying provider characteristics that predict attitudes about parent engagement strategies.

METHODS

A mixed method approach was utilized, including gathering quantitative data via survey (breadth) and collecting qualitative data via interview (depth). Acceptability, utility, appropriateness, sustainment, generalizability, and perceived effectiveness were examined. Fourteen agency leaders and 24 therapists provided input.

RESULTS

Providers perceived the integration of parent engagement strategies as having a positive impact on implementation. Providers considered the strategies to be acceptable, appropriate, and effective, though barriers of time and complexity were noted. Provider characteristics did not consistently predict attitudes about the engagement strategies.

CONCLUSIONS

Incorporating parent engagement strategies into parent-mediated interventions for ASD is well-received by providers and may improve quality of service delivery for families served in early intervention for ASD.

Collaborative Research Project: Developing and Testing a Robot-Assisted Intervention for Children With Autism

The present work is a collaborative research aimed at testing the effectiveness of the robot-assisted intervention administered in real clinical settings by real educators. Social robots dedicated to assisting persons with autism spectrum disorder (ASD) are rarely used in clinics. In a collaborative effort to bridge the gap between innovation in research and clinical practice, a team of engineers, clinicians and researchers working in the field of psychology developed and tested a robot-assisted educational intervention for children with low-functioning ASD (N = 20) A total of 14 lessons targeting requesting and turn-taking were elaborated, based on the Pivotal Training Method and principles of Applied Analysis of Behavior. Results showed that sensory rewards provided by the robot elicited more positive reactions than verbal praises from humans. The robot was of greatest benefit to children with a low level of disability. The educators were quite enthusiastic about children's progress in learning basic psychosocial skills from interactions with the robot. The robot nonetheless failed to act as a social mediator, as more prosocial behaviors were observed in the control condition, where instead of interacting with the robot children played with a ball. We discuss how to program robots to the distinct needs of individuals with ASD, how to harness robots' likability in order to enhance social skill learning, and how to arrive at a consensus about the standards of excellence that need to be met in interdisciplinary co-creation research. Our intuition is that robotic assistance, obviously judged as to be positive by educators, may contribute to the dissemination of innovative evidence-based practice for individuals with ASD.

Study protocol of the multi-centre, randomised controlled trial of the Frankfurt Early Intervention Programme A-FFIP versus early intervention as usual for toddlers and preschool children with Autism Spectrum Disorder (A-FFIP study)

BACKGROUND

Naturalistic developmental behavioural interventions (NDBI) have been shown to improve autism-specific symptoms in young children with Autism Spectrum Disorder (ASD). NDBI approaches, such as the ASD-specific Frankfurt Early Intervention Programme for ASD (A-FFIP), are based on ASD-specific developmental and learning aspects. A-FFIP is a low-intensity intervention which can easily be implemented in the local health care/social welfare system. The aim of the present study is to establish 1-year efficacy of the manualised early intervention programme A-FFIP in toddlers and preschool children with ASD. It is hypothesised that A-FFIP will result in improved ASD-specific symptoms compared to early intervention as usual (EIAU). Child- and family-specific secondary outcomes, as well as moderators and mediators of outcome, will be explored.

METHODS/DESIGN

A prospective, multi-centre, parallel-group, randomised controlled, phase-III trial comparing A-FFIP versus EIAU. A total of 134 children (A-FFIP: 67, EIAU: 67) aged 24-66 months at baseline assessment meeting the criteria for ASD (DSM-5) will be included. The primary outcome is the absolute change of the total score of the Brief Observation of Social Communication Change (BOSCC-AT) between baseline (T2) and 1-year follow-up (T6). The treatment effect will be tested, adjusted for relevant covariates applying a mixed model for repeated measures. Secondary outcomes are BOSCC social communication and repetitive-behaviour scores, single ASD symptoms, language, cognition, psychopathology, parental well-being and family quality of life. Predictors, moderators and mediating mechanisms will be explored.

DISCUSSION

If efficacy of the manualised A-FFIP early intervention is established, the current study has the potential to change clinical practice strongly towards the implementation of a low-intensity, evidence-based, natural early intervention in ASD. Early intervention in ASD requires specialist training, which subsequently needs to be developed or included into current training curricula.

TRIAL REGISTRATION

German Registry for Clinical Trials (Deutscher Register Klinischer Studien, DRKS); ID: 00016330. Retrospectively registered on 4 January 2019. URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016330.

Varied treatment response in young children with autism: A relative comparison of structured and naturalistic behavioral approaches

Heterogeneity of treatment response is common in children with autism spectrum disorder. Thus, many providers vary the intervention used based on child characteristics and learning domain. An improved understanding of how to match treatments to different children and domain areas may enhance efforts to individualize treatment and improve treatment response. This study evaluated the relative efficacy of discrete trial training and pivotal response training for teaching young children at risk for autism spectrum disorder receptive and expressive language, play, and imitation skills. Using a single-subject adapted alternating treatments design, children received both the treatments for 12 weeks. Data were collected during treatment and at 3-month follow-up. All participants acquired target skills in both treatments and demonstrated some generalization, maintenance, and spontaneous skill use. Pivotal response training and discrete trial training were each more effective for some children and domains. The results suggest that early rates of learning may be predictive of longer-term treatment response and useful in informing treatment decisions.

A Robotic Framework to Facilitate Sensory Experiences for Children with Autism Spectrum Disorder: A Preliminary Study

The diagnosis of Autism Spectrum Disorder (ASD) in children is commonly accompanied by a diagnosis of sensory processing disorders. Abnormalities are usually reported in multiple sensory processing domains, showing a higher prevalence of unusual responses, particularly to tactile, auditory and visual stimuli. This paper discusses a novel robot-based framework designed to target sensory difficulties faced by children with ASD in a controlled setting. The setup consists of a number of sensory stations, together with two different robotic agents that navigate the stations and interact with the stimuli. These stimuli are designed to resemble real world scenarios that form a common part of one's everyday experiences. Given the strong interest of children with ASD in technology in general and robots in particular, we attempt to utilize our robotic platform to demonstrate socially acceptable responses to the stimuli in an interactive, pedagogical setting that encourages the child's social, motor and vocal skills, while providing a diverse sensory experience. A preliminary user study was conducted to evaluate the efficacy of the proposed framework, with a total of 18 participants (5 with ASD and 13 typically developing) between the ages of 4 and 12 years. We derive a measure of social engagement, based on which we evaluate the effectiveness of the robots and sensory stations in order to identify key design features that can improve social engagement in children.

A Systematic Review of Linguistic and Verbal Behavior Outcomes of Pivotal Response Treatment

Pivotal Response Treatment (PRT) is a popular intervention for improving targeted and untargeted communication skills for learners with autism. We systematically reviewed communication outcomes reported in experimental research to determine linguistic forms and verbal behavior functions associated with PRT. We found most researchers aggregated results or did not report sufficient detail to determine linguistic forms and/or verbal behavior functions. Generalization of communication skills to untargeted people, settings, materials, and/or activities was evident. However, only one study clearly indicated untargeted linguistic forms emerged following PRT, and no researchers described results that indicated improved generalized and collateral verbal behavior functions. We suggest PRT researchers more clearly define and report primary, generalized, and collateral communication-specific outcomes in order to advance research and practice.

Effectiveness of Parent Education in Pivotal Response Treatment on Pivotal and Collateral Responses

In two studies, we investigated the effectiveness of parent education in Pivotal Response Treatment (PRT) on parent-created opportunities and spontaneous child initiations in two community-based treatment facilities for children with autism spectrum disorder (ASD). Changes in parental stress and self-efficacy were explored. Participants were 26 parents and their children who participated in group (Study 1) or individual (Study 2) parent education in PRT. Results indicated that group-based parent education resulted in moderate increases in opportunities, functional initiations, and empathic social initiations. Furthermore, parental stress reduced and self-efficacy increased. Individual parent education resulted in large increases in opportunities and functional initiations, but parental stress and self-efficacy did not change. Implications for clinical practice and directions for future research are discussed.

Predictors of Expressive Language Change for Children with Autism Spectrum Disorder Receiving AAC-Infused Comprehensive Intervention

Comprehensive interventions for children with autism spectrum disorder (ASD) often incorporate augmentative and alternative communication (AAC); however, variability in outcomes exists even among children who access similar intervention. This study investigated predictors of expressive language change for 48 children with ASD aged 31 to 67 months receiving AAC-infused intervention. The relationships between participants' initial responses to AAC and expressive language change were examined. Commonly reported predictors (IQ, chronological age, ASD symptomatology) did not significantly predict expressive language change. AAC factors (visual attention, object play, word learning) entered at Step 2 of a hierarchical multiple regression, explained an additional 42% of the variance. The findings provide preliminary data on child characteristics associated with expressive language changes within AAC-infused comprehensive interventions.

Do Student Characteristics Affect Teachers' Decisions to Use 1:1 Instruction?

One-to-one instruction is a critical component of evidence-based instruction for students with autism spectrum disorder, but is not used as often as recommended. Student characteristics may affect teachers' decisions to select a treatment and/or implement it. This study examined the associations between students' clinical and demographic characteristics and teachers' reported use of discrete trial training (DTT) and pivotal response training (PRT). Children's higher sensory symptoms, lower social approach, lower verbal skills and higher self-regulation difficulties were associated with more frequent 1:1 DTT and PRT. Results suggest that teachers give more frequent 1:1 instruction to children with more observable impairments, do not match children to type of 1:1 intervention, and may inadvertently neglect other students for whom individualized intervention may still be beneficial.

Examining relationships between child skills and potential key components of an evidence-based practice in ASD

BACKGROUND

Research in autism spectrum disorders (ASD) has identified a need to understand key components of complex evidence-based practices (EBP). One approach involves examining the relationship between component use and child behavior.

AIMS

This study provides initial evidence for identifying key components in a specific EBP, Pivotal Response Training (PRT). We examined which components were related to child response and evaluated relationships between provider characteristics, child characteristics and component intensity.

METHODS

Trained coders reviewed archival videos (n = 278) for PRT fidelity and child behavior. We completed multi-level regression and latent profile analysis to examine relationships between intensity of individual or combinations of PRT components and child behavior, and moderators of component use.

RESULTS

Analyses indicated differential relationships between specific components and child behaviors which may support methods of altering intensity of components to individualize intervention. Profile analysis suggested relatively intensive use of most PRT components, especially antecedent strategies, may maximize child responsivity. Providers with postgraduate education trended toward higher intensity component use. Child characteristics did not moderate use.

IMPLICATIONS

Careful examination of key components of ASD interventions may helps clarify the mechanisms of action. Recommendations specific to PRT implementation and use of the methodology for other interventions are discussed.

Considerations in implementing evidence-based early autism spectrum disorder interventions in community settings

Evidence-based practices (EBPs) in early intervention for autism spectrum disorder (ASD) have the potential to improve children's developmental trajectories and address family needs. However, the successful use of EBPs in community early intervention settings requires careful attention to the context in which services are delivered. Implementation science, and specifically the Exploration, Preparation, Implementation, and Sustainment (EPIS) Model, provides a framework to examine context across multiple levels and identify barriers and facilitators to community EBP use. This article identifies several considerations most relevant for early intervention in ASD at the outer and inner context levels, as well as bridging and innovation factors. Outer context considerations include the policies and funding streams surrounding service delivery, the role of advocacy in shaping the service landscape, the availability of appropriate specialists to provide services, and family cultural characteristics. Inner context factors include the individual characteristics of both the children receiving the service as well as the provider delivering the service, in addition to the leadership and organizational climate surrounding the use of a particular EBP. We also discuss considerations of the specific innovation (in this case, EBP early interventions) to be deployed, as well as bridging factors.

ERP evidence of semantic processing in children with ASD

25% of children with autism spectrum disorder (ASD) remain minimally verbal (MV), despite intervention. Electroencephalography can reveal neural mechanisms underlying language impairment in ASD, potentially improving our ability to predict language outcomes and target interventions. Verbal (V) and MV children with ASD, along with an age-matched typically developing (TD) group participated in a semantic congruence ERP paradigm, during which pictures were displayed followed by the expected or unexpected word. An N400 effect was evident in all groups, with a shorter latency in the TD group. A late negative component (LNC) also differentiated conditions, with a group by condition by region interaction. Post hoc analyses revealed that the LNC was present across multiple regions in the TD group, in the mid-frontal region in MVASD, and not present in the VASD group. Cluster analysis identified subgroups within the ASD participants. Two subgroups showed markedly atypical patterns of processing, one with reversed but robust differentiation of conditions, and the other with initially reversed followed by typical differentiation. Findings indicate that children with ASD, including those with minimal language, showed EEG evidence of semantic processing, but it was characterized by delayed speed of processing and limited integration with mental representations.

Diagnosis and treatment of ASD in women in secure and forensic hospitals

Purpose

The purpose of this paper is to explore the experience and possibilities for misdiagnosis of women with ASD in secure and forensic hospitals, via the medium of a lived experience case study. To consider the clinical value of the patient perspective of and insight into their disorder. The case study is supplemented by relevant associations to the MHA Code of Practice, the CQC report, Monitoring the Mental Health Act (MHA) 2016–2017, published on 27 February 2018 and current research findings in the fields of service provision, quality of care and treatment of female patients with a diagnosis of ASD.

Design/methodology/approach

A review and commentary of the author’s lived experience of a formal diagnostic assessment for ASD as a female patient in a secure and forensic hospital. In reviewing aspects of the author’s clinical assessment, the author has made contextual reference to the MHA Code of Practice, the CQC report, Monitoring the MHA 2016–2017, published on 27 February 2018, and current research findings. The account focuses on aspects of the author’s recent experience assessment and treatment for ASD which the author believes may be of use in informing clinical practice.

Findings

Open-ended exploration of a lived experience account/case study of a diagnostic assessment of an adult female patient for ASD, demonstrating the possible ambiguity of responses to questionnaire-based assessment tools and other deficiencies inherent to the assessment process and care and treatment of adult female ASD sufferers in secure and forensic hospitals.

Research limitations/implications

The author uses the lived experience as a patient to review and provide commentary on the clinical assessment for ASD. This review is, therefore, informed by an authentic patient perspective and not clinical perspectives. This paper highlights the need for further research into the diagnostic assessment of females for ASD in a secure and forensic hospitals.

Practical implications

First, to encourage practitioners to extend their range of thinking to be more inclusive of the patient perspective when performing a diagnostic assessment. Second, to increase practitioner awareness of the deficiencies in the current service provision for adult female patients diagnosed with ASD in secure and forensic hospitals.

Social implications

To improve patient experience of diagnostic assessment for ASD and the quality of the assessment and patient outcomes in secure and forensic hospitals.

Originality/value

The paper is original in concept in that it considers the inclusion of patient experience/views in assessment and formulation and links them to wider social policy and practice guidance. The case study is an authentic patient account informed by the author’s experience of secure and forensic psychiatric hospitals. The value of the paper may be determined by the extent to which the paper encourages practitioners to consider the patient perspective and experience of the diagnostic assessment and how this and subsequent care and treatment may affect the adult female patient in secure and forensic hospitals.

Hearing me hearing you: Reciprocal effects between child and parent language in autism and typical development

Language development in typically developing children (TD) has traditionally been investigated in relation to environmental factors, while language in children with autism spectrum disorder (ASD) has primarily been related to child-based factors. We employ a longitudinal corpus of 32 preschoolers with ASD and 35 linguistically matched TD peers recorded over 6 visits (ranging between 2 and 5 years of age) to investigate the relative importance of child-based and environmental factors in language development for both populations. We also investigate the reciprocal interaction between children's response to parents' input, and parents' response to children's production. We report six major findings. (1) Children's production of word types, tokens, and MLU increased across visits, and were predicted by their Expressive Language (EL) (positively) and diagnosis (negatively) from Visit 1. (2) Parents' production also increased across visits, and was predicted by their child's nonverbal cognition (positively) and diagnosis (negatively) from Visit 1. (3) At all visits and across groups, children and parents matched each other in lexical and syntactic production; (4) Parents who produced longer MLUs during a given visit had children who produced more word types and tokens, and had longer MLUs, at the subsequent visit. (5) When both child EL at Visit 1 and parent MLU were included in the model, both contributed significantly to future child language; however, EL accounted for a greater proportion of the variance. (6) Finally, children's speech significantly predicted parent speech at the next visit. Taken together, these results draw more attention to the importance of child-based factors in the early language development of TD children, and to the importance of parental language factors in the early language development of children with ASD.

Anti-inflammatory Effect of Ghrelin in Lymphoblastoid Cell Lines From Children With Autism Spectrum Disorder

The gut hormone ghrelin has been implicated in a variety of functional roles in the central nervous system through the brain-gut axis, one of which is an anti-inflammatory effect. An aberrant brain-gut axis producing immune dysfunction has been implicated in the pathobiology of autism spectrum disorder (ASD), and elevated expression of inflammatory markers has been shown in blood and brain tissue from subjects with ASD. We hypothesized that ghrelin may mitigate this effect. Lymphoblastoid cell lines from typically developed children (TD-C) (N = 20) and children with ASD (ASD-C) (N = 20) were cultured with PBS or human ghrelin (0.01 μM) for 24 h, and mRNA expression levels of the inflammation-related molecules interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and nuclear factor kappa B (NF-κB) were measured to examine the effects of ghrelin as an anti-inflammatory agent. Expression levels of TNF-α and NF-κB mRNA, but not IL-1β or IL-6, were significantly elevated in ASD-C compared to TD-C. Ghrelin showed a tendency to reduce the expression of TNF-α and NF-κB, but this was not statistically significant. Considering the heterogenous pathobiology of ASD, we examined the effects of ghrelin on TD-C and ASD-C with expression levels of TNF-α and NF-κB in the highest and lowest quartiles. We found that ghrelin markedly reduced mRNA expression of TNF-α and NF-κB s in ASD-C with highest-quartile expression, but there were no effects in ASD-C with lowest-quartile expression, TD-C with highest quartile expression, or TD-C with lowest quartile expression. Together, these findings suggest that ghrelin has potential as a novel therapeutic agent for ASD with inflammation and/or immune dysfunction.

Autism: One or many spectrums?

Our conceptualisation of autism spectrum disorder has changed over time, with recent classifications reflecting a heterogeneous clinical presentation now regularly encountered in routine general paediatric practice. As the prevalence of autism and associated demands for services have increased so has research into understanding the cause and trials aimed at providing best care and intervention. However, the heterogeneity of autism has meant that no single aetiology can account for all differences in presentation, and not all children benefit from broad-based interventions. Now is the time to rethink how best to understand individual differences in order to focus research efforts and take steps towards more sophisticated strategies that go beyond the behaviours we look for when making an autism diagnosis. We suggest adopting a dimensional approach to autism assessment, with the consideration of eight spectrums of abilities, ways of thinking and behaviour. This eight-spectrum approach will assist clinicians to consider each individual's strengths and needs and personalise interventions and support accordingly. Profiling individual skills across these dimensions may also provide researchers with a greater capacity to link causal pathways with specific phenotypes, which is needed to develop precision medicine for autism.

RDoC-based categorization of amygdala functions and its implications in autism

Confusion endures as to the exact role of the amygdala in relation to autism. To help resolve this we turned to the NIMH's Research Domain Criteria (RDoC) which provides a classification schema that identifies different categories of behaviors that can turn pathologic in mental health disorders, e.g. autism. While RDoC incorporates all the known neurobiological substrates for each domain, this review will focus primarily on the amygdala. We first consider the amygdala from an anatomical, historical, and developmental perspective. Next, we examine the different domains and constructs of RDoC that the amygdala is involved in: Negative Valence Systems, Positive Valence Systems, Cognitive Systems, Social Processes, and Arousal and Regulatory Systems. Then the evidence for a dysfunctional amygdala in autism is presented with a focus on alterations in development, prenatal valproic acid exposure as a model for ASD, and changes in the oxytocin system therein. Finally, a synthesis of RDoC, the amygdala, and autism is offered, emphasizing the task of disambiguation and suggestions for future research.

Demographic and Clinical Characteristics Associated with Engagement in Behavioral Health Treatment Among Children with Autism Spectrum Disorders

This study investigates demographic and clinical factors associated with initiation, continuation, and adherence to behavioral health treatment (BHT) among children with autism spectrum disorder. Among 293 insured children referred for applied behavior analysis (ABA) based BHT, 23% never initiated treatment. Among those initiating treatment, 31% discontinued treatment within 1 year of treatment initiation, and only 15% received 80% or more of recommended treatment hours. Younger age at referral to treatment, private health insurance, and receiving more than 10 h/week of BHT were associated with treatment engagement. Co-occurring psychiatric and medical conditions were related to treatment discontinuation among children 5 years or older. These findings suggest specific subgroups that may benefit from additional support with engaging in recommended behavioral health treatment.

Broken bridges-new school transitions for students with autism spectrum disorder: A systematic review on difficulties and strategies for success

Transitioning to a new school is often challenging for students with autism spectrum disorder. Few studies have examined the transition needs of students with autism spectrum disorder or the benefits of specific supports. This review synthesizes research findings on the difficulties that school transitions pose for students with autism spectrum disorder and their parents and teachers, and the strategies used to support students and parents during school transition. The review included 27 studies (10 examining the transition to primary school, 17 the transition to secondary school), with data from 443 students with autism spectrum disorder, 453 parents, and 546 teachers, across four continents (North America, Europe, Africa, and Australia). Studies reported that children with autism spectrum disorder struggled with anxiety and increased social pressure, their parents felt overwhelmed with complex placement decisions and worried about the well-being of their children, and teachers strove to provide appropriate supports to their students with autism spectrum disorder, often with inadequate resources. Findings indicated that the most useful strategies involved helping the student adjust to the new school setting, individualizing transition supports, clarifying the transition process for parents, and fostering communication both between the sending and receiving schools, and school and home.

EEG-Based Affect and Workload Recognition in a Virtual Driving Environment for ASD Intervention

OBJECTIVE

To build group-level classification models capable of recognizing affective states and mental workload of individuals with autism spectrum disorder (ASD) during driving skill training.

METHODS

Twenty adolescents with ASD participated in a six-session virtual reality driving simulator-based experiment, during which their electroencephalogram (EEG) data were recorded alongside driving events and a therapist's rating of their affective states and mental workload. Five feature generation approaches including statistical features, fractal dimension features, higher order crossings (HOC)-based features, power features from frequency bands, and power features from bins () were applied to extract relevant features. Individual differences were removed with a two-step feature calibration method. Finally, binary classification results based on the k-nearest neighbors algorithm and univariate feature selection method were evaluated by leave-one-subject-out nested cross-validation to compare feature types and identify discriminative features.

RESULTS

The best classification results were achieved using power features from bins for engagement (0.95) and boredom (0.78), and HOC-based features for enjoyment (0.90), frustration (0.88), and workload (0.86).

CONCLUSION

Offline EEG-based group-level classification models are feasible for recognizing binary low and high intensity of affect and workload of individuals with ASD in the context of driving. However, while promising the applicability of the models in an online adaptive driving task requires further development.

SIGNIFICANCE

The developed models provide a basis for an EEG-based passive brain computer interface system that has the potential to benefit individuals with ASD with an affect- and workload-based individualized driving skill training intervention.

Predictors of longitudinal ABA treatment outcomes for children with autism: A growth curve analysis

BACKGROUND

Autism spectrum disorder (ASD) is a developmental disorder that causes lifelong disability. Applied Behavior Analysis (ABA) is one of the most empirically studied and validated approaches for treating children diagnosed with ASD. Due to the heterogeneity of ASD, it is important to ascertain who will most benefit from treatment.

METHODS

In this study, 35 participants, with a mean entry age of 3 years, received ABA therapy. Children were assessed at intake and every 6 months thereafter using the Developmental Profile-3 (DP-3) to measure their communication, social-emotional, adaptive behavior, and physical development (2-6 measures per participant). Using a growth curve analysis, we investigated if age, diagnosis severity, cognitive functioning, treatment hours, gender, parent education level, or primary language spoken at home significantly predicted the growth trajectories of ABA treatment outcomes.

RESULTS

Our findings indicated that higher cognitive functioning significantly predicted faster growth across all four developmental domains, age at entry predicted initial status, and other variables only predicted growth rates in one or two domains.

IMPLICATIONS

Knowing the predictors of treatment outcome is important information for customizing treatment and this study demonstrated how longitudinal analyses can illuminate how participant characteristics affect the course of ABA therapy.

How to Implement Robots in Interventions for Children with Autism? A Co-creation Study Involving People with Autism, Parents and Professionals

The aim of this study was to gain insight into how robots can be practically implemented into current education and therapy interventions for children with autism spectrum disorder (ASD). This qualitative study included focus groups and co-creation sessions. 73 Participants (professionals and adults with ASD) took part in 13 focus groups to elicit requirements for robot assisted interventions. Additionally, 22 participants (professionals, parents of children with ASD and adults with ASD) generated ideas for interventions using robot KASPAR in three co-creation sessions. This study resulted in: an overview of requirements concerning the robot, end-user, environment and practical implementation; a template to systematically describe robot interventions in general and for KASPAR in particular; and finally new interventions.