Profiles and Predictors of Academic and Social School Functioning among Children with Autism Spectrum Disorder

Social and joint attention during shared book reading in young autistic children: a potential marker for social development

BACKGROUND

Atypical patterns of social engagement and joint attention behaviors are diagnostic criteria for people with autism spectrum disorder. Experimental tasks using eye-tracking methodologies have, however, shown inconsistent results. The development of tasks with greater ecological validity and relevance for developmentally appropriate social milestones has been identified as important for the field.

METHODS

We developed a novel, dynamic eye-tracking task emulating a shared book reading (SBR) scenario. Four SBR videos of an adult reader engaging with the viewer while reading a children's picture book and including sequenced bids for joint attention were developed. Participants included 90 children (N = 56 autistic children, N = 34 neurotypical children; aged 3-12). Social attention was also measured in a live free play task between participants and an experimenter.

RESULTS

Compared to neurotypical children, autistic children displayed reduced attention to socially salient stimuli including the reader's face and picture book across SBR videos and during joint attention bids specifically. In contrast, they showed increased attention to nonsalient background stimuli compared to their neurotypical peers. These attention patterns in autistic children were associated with reduced verbal and nonverbal cognitive skills and increased symptoms associated with autism. Interestingly, positive correlations in the frequency of eye gaze between SBR and free play suggested a potential predictive value for social attention in live social interactions.

CONCLUSIONS

Findings highlight the utility of SBR eye-tracking tasks in understanding underlying divergences in social engagement and joint attention between autistic and neurotypical children. This commonly practiced early childhood activity may provide insights into the relationship between social engagement and learning to reveal how such attentional patterns might influence broader developmental and educational outcomes.

Reading comprehension improvement in autism

Introduction

A subset of autistic children excel at word decoding but have difficulty with reading comprehension (i.e., the discrepant poor comprehender reading profile). Prior research suggests the Visualizing and Verbalizing (V/V) for language comprehension and thinking intervention helps improve reading comprehension in autistic children with this reading profile. Previous studies have demonstrated the role of vocabulary, memory, and social functioning in reading comprehension; however, predictors and moderators of reading comprehension within this specific profile of autistic readers have not been thoroughly explored.

Methods

In this study, we examined the effectiveness of the V/V intervention by comparing reading comprehension scores between groups and across time. Participants included a sample of autistic children (AUT-EXP; n=22) and a waitlist control group of autistic children (AUT-WLC; n=17) with reading comprehension difficulties, as well as a sample of non-autistic children (Non-AUT; n=26) (all age 8-13 years). AUT-EXP and AUT-WLC groups completed a battery of cognitive assessments during pre and post tests. We also analyzed whether cognitive assessment scores predicted reading comprehension, and examined the moderating effects of group (AUT-EXP vs. AUT-WLC) on these relationships.

Results

The AUT-EXP group significantly improved in their pre to post reading comprehension scores (t(21)=4.19, p<.001, d=.89), whereas the AUT-WLC group did not. Verbal memory significantly predicted reading comprehension, though group did not moderate relationships between cognitive test performance and reading comprehension.

Discussion

Results suggest that the V/V intervention may help improve reading comprehension for autistic children with the discrepant poor comprehender reading profile. Additionally, strategies for improving verbal memory may indirectly enhance reading comprehension in autistic children with this reading profile.

Social Interaction Profiles Among Youth with Intellectual Disabilities: Associations with Indicators of Psychosocial Adjustment

This study investigates the nature of the social interaction profiles observed among youth with intellectual disabilities (ID), defined while considering their relationships with their parents, peers, and teachers, as well as the implication of these profiles for self-esteem, aggressive behaviors, and prosocial behaviors. A sample of 393 youth with mild (48.2%) to moderate (51.8%) levels of ID, aged between 11 and 22 (M = 15.70), was recruited in Canada (n = 141) and Australia (n = 253). Our results revealed four profiles, corresponding to Socially Isolated (23.24%), Socially Integrated (39.83%), Socially Rejected (28.37%) and Socially Connected (8.57%) youth with ID. The socially integrated and connected profiles both presented higher self-esteem, more prosocial behaviors, and less aggressive behaviors than the socially isolated and rejected profiles.

Emotion Dysregulation Mediates the Relationship Between Sensory Processing and Behavior Problems in Young Children with Autism Spectrum Disorder: A Preliminary Study

Emotion dysregulation is one of the challenges that children with autism spectrum disorder (ASD) and their families face. It is unclear whether emotion dysregulation plays a mediating role in the relationship between sensory processing patterns and problem behaviors among these children. This study examined the relations between emotion dysregulation, behavioral problems, and sensory processing patterns among fifty-seven young children with ASD. Behavioral problems and sensory processing patterns were moderately to strongly correlated with emotion dysregulation. The relationship between sensory processing patterns and behavioral problems was significant with emotion dysregulation as a mediator. These findings help identify the relationship between emotion dysregulation, sensory processing patterns, and behavioral problems to facilitate the planning of intervention strategies for young children with ASD.

Educators Describe the "Best Things" About Students with Autism at School

This study examined educators' descriptions of the positive character traits of students with autism spectrum disorder at ages 7-8 and 10-11, using an adapted version of the Values in Action (VIA) Classification of Strengths. The most commonly endorsed strengths at both age intervals were kindness, specific skills, self-regulation, and perseverance. Higher scores for challenging behavior were associated with a lower likelihood of endorsement for Happiness and Courage traits. Higher autism symptom severity scores were associated with a lower likelihood of endorsement for Courage traits. Few significant differences were found for endorsement of trait categories by students' educational placement or the type of curriculum they received. Results may have implications for student-teacher relationships, educational assessments, and school-based interventions that emphasize strengths and resilience.

Characterizing mechanisms of caregiver-mediated naturalistic developmental behavioral interventions for autistic toddlers: A randomized clinical trial

LAY ABSTRACT

Caregiver-mediated early interventions support caregivers' use of strategies to improve their young autistic child's communication. In the current clinical trial, we sought to isolate the most effective strategies to improve short-term and long-term child communication outcomes. Results demonstrated how children may benefit from caregiver prompts to facilitate long-term language outcomes. In conclusion, the current study improves our understanding of how early intervention facilitates child communication outcomes.

Language acquisition can be truly atypical in autism: Beyond joint attention

Language profiles in autism are variable and atypical, with frequent speech onset delays, but also, in some cases, unusually steep growth of structural language skills. Joint attention is often seen as a major predictor of language in autism, even though low joint attention is a core characteristic of autism, independent of language levels. In this systematic review of 71 studies, we ask whether, in autism, joint attention predicts advanced or only early language skills, and whether it may be independent of language outcomes. We consider only conservative estimates, and flag studies that include heterogenous samples or no control for non-verbal cognition. Our review suggests that joint attention plays a pivotal role for the emergence of language, but is also consistent with the idea that some autistic children may acquire language independently of joint attention skills. We propose that language in autism should not necessarily be modelled as a quantitative or chronological deviation from typical language development, and outline directions to bring autistic individuals' atypicality within the focus of scientific inquiry.

Aggression Is Associated With Social Adaptive Functioning in Children With ASD and Anxiety

Social adaptive functioning is notably compromised and may be further impaired by aggressive behavior in children with autism spectrum disorder (ASD). This study examined the association between aggressive behavior and social adaptive skills in children with ASD and the contribution of aggressive behavior to social adaptive skills in a combined sample of children with and without ASD. Participants consisted of children, ages 8 to 15 years, with ASD (n = 52) and who were typically developing (n = 29). Results indicate that aggressive behavior is negatively associated with social adaptive skills in children with ASD and that it contributes to reduced social adaptive functioning above and beyond ASD diagnosis. Findings underscore the importance of considering the role of aggressive behavior when evaluating and promoting social functioning in children with ASD.

Longitudinal associations between early childhood irritability and adolescent depression symptoms in autistic children are mediated by peer relationships but not educational engagement

In the general population, irritability is associated with later depression. Despite irritability being more prevalent in autistic children, the long-term sequelae are not well explored. We tested whether irritability in early childhood predicted depression symptoms in autistic adolescents, and whether associations could be explained by difficulties in peer relationships and lower educational engagement. Analyses tested the longitudinal associations between early childhood irritability (ages 3-5) and adolescent depression symptoms (age 14) in a prospective inception cohort of autistic children (N = 390), followed from early in development shortly after they received a clinical diagnosis. Mediators were measured in mid-childhood (age 10) by a combination of measures, from which latent factors for peer relationships and educational engagement were estimated. Results showed early childhood irritability was positively associated with adolescent depression symptoms, and this association remained when adjusting for baseline depression. A significant indirect pathway through peer relationships was found, which accounted for around 13% of the association between early childhood irritability and adolescent depression, suggesting peer problems may partially mediate the association between irritability and later depression. No mediation effects were found for education engagement. Results highlight the importance of early screening and intervention for co-occurring irritability and peer problems in young autistic children.

Recent Advances of Telepractice for Autism Spectrum Disorders in Speech and Language Pathology

Telepractice or teletherapy is defined as the means of service delivery via technology-based platforms that allow long-distance interventions across populations, age spans, and geographical locations. Specifically, telepractice capitalizes on communication technologies such as online modules, videoconferencing, and computerized software programs, in servicing populations with communication challenges. Notably, telepractice has emerged as a potentially effective, low-cost, and promising means of conducting and completing online assessment, diagnosis, and intervention sessions for individuals with autism spectrum disorders (ASD). Moreover, telepractice allows the inclusion of parents, caregivers, and educators as potential facilitators in supporting treatment delivery in populations with ASD. This thematic review article aims to highlight and acquaint practitioners and other stakeholders with relatively recent information regarding the advantages and disadvantages of the telepractice service delivery model in ASD. Furthermore, the emergence of the COVID-19 pandemic has impacted service delivery in the field of Health Sciences including speech and language pathology (SLP). Consequently, the need to avoid face-to-face therapy sessions, recommended to SLPs as to all health practitioners, resulted in the call for adaptation and adjustment of service telepractice. This paper attempts to answer this call by suggesting supplementing traditional diagnostic and therapy resources with training modules consisting of online materials and use of animated and specially designed programs in SLP intervention with individuals with ASD. Lastly, the paper includes a discussion of research findings in the field, a conclusion, and a take-home message.

The Effect of Comorbid Attention-Deficit/Hyperactivity Disorder Symptoms on Face Memory in Children with Autism Spectrum Disorder: Insights from Transdiagnostic Profiles

Face memory impairments are common but heterogeneous in autism spectrum disorder (ASD), which may be influenced by co-occurrence with attention-deficit/hyperactivity disorder (ADHD). Here, we aimed to investigate the phenotype change of face memory in children with ASD comorbid ADHD symptoms, and discuss the potential role of executive function (EF). Ninety-eight children were analyzed in the present study, including ASD- (ASD-only, n = 24), ADHD (n = 23), ASD+ (with ADHD symptoms, n = 23) and neurotypical controls (NTC, n = 28). All participants completed two tests: face encoding and retrieving task and Wisconsin Card Sorting Test (WCST) for measuring face memory and EF, respectively. Results revealed that: compared with the NTC group, children with ASD- exhibited lower accuracy in both face encoding and retrieving, and participants with ASD+ showed lower accuracy only in the retrieving, whereas no differences were found among participants with ADHD. Moreover, in the ASD+ group, face encoding performance was correlated with response perseverative errors (RPE) and failure to maintain sets (FMS) of WCST; significantly, there were no group differences between ASD+ and NTC in these two indices. The transdiagnostic profiles indicated that comorbid ADHD symptoms could modulate the face encoding deficiency of ASD, which may be partially compensated by EF. Shared and distinct intervention strategies to improve social cognition are recommended for children undergoing treatment for each condition.

Validation strategies for subtypes in psychiatry: A systematic review of research on autism spectrum disorder

Heterogeneity within autism spectrum disorder (ASD) is recognized as a challenge to both biological and psychological research, as well as clinical practice. To reduce unexplained heterogeneity, subtyping techniques are often used to establish more homogeneous subtypes based on metrics of similarity and dissimilarity between people. We review the ASD literature to create a systematic overview of the subtyping procedures and subtype validation techniques that are used in this field. We conducted a systematic review of 156 articles (2001-June 2020) that subtyped participants (range N of studies = 17-20,658), of which some or all had an ASD diagnosis. We found a large diversity in (parametric and non-parametric) methods and (biological, psychological, demographic) variables used to establish subtypes. The majority of studies validated their subtype results using variables that were measured concurrently, but were not included in the subtyping procedure. Other investigations into subtypes' validity were rarer. In order to advance clinical research and the theoretical and clinical usefulness of identified subtypes, we propose a structured approach and present the SUbtyping VAlidation Checklist (SUVAC), a checklist for validating subtyping results.

"Best Things": Parents Describe Their Children with Autism Spectrum Disorder Over Time

This study examined parental perceptions of the character traits of children with autism from early childhood to age 11. Parents (n = 153) provided descriptions of the "best things" about their children on the Child Behavior Checklist (CBCL) at ages 3-4, 7-8, and 10-11 years. Descriptions were coded using the framework of the Values in Action Classification of Strengths, with additional traits added as needed. Parent-endorsed traits included love, kindness, happiness, and humor in children across all ages and traits such as perseverance as children entered school. Higher CBCL scores were associated with a lower likelihood of endorsement for Humanity traits. Results are congruent with a contemporary neurodiversity perspective that emphasizes strengths and resilience.