Communicative interaction between mothers and their autistic children: application of a new instrument and changes after treatment

Disturbances of Shared Intentionality in Schizophrenia and Autism

Schizophrenia and autism are today considered complex spectrum disorders characterized by difficulties in social behavior. Drawing on recent advances in collective or shared intentionality studies, we present a novel theoretical approach to these social difficulties by exploring them from the angle of shared intentionality. We begin by describing two forms of shared intentionality: joint intentionality and we-intentionality. Joint intentionality crucially relies on the agents' mentalizing abilities such as mind reading and the ability to factor in (or "to be moved" by) their partner's intentions in deliberation and action planning. By contrast, we-intentionality relies on the agents' capacity to understand themselves as group members and to adopt the group's perspective. In schizophrenia spectrum disorders, we propose that joint intentionality remains unaffected, but we-intentionality may be impaired. In severe autism spectrum disorder (i.e., infantile autism), we propose that both forms of shared intentionality are impaired. We suggest that the source of the problems affecting we-intentionality in schizophrenia spectrum disorders lies primarily in trait-like, anomalous self-experiences. In severe autism spectrum disorder, we suggest that problems with mind reading, the ability to "be moved" by others' intentions, and with the capacity for perspective-taking impede both forms of shared intentionality.

Parenting behavior and the development of children with autism spectrum disorder

Autism spectrum disorders (ASD) are neurodevelopmental disorders in which multiple genetic and environmental factors play roles. Symptoms of deficits in social communication and restrictive, repetitive behavioral patterns emerge early in a child's development. While parents do not cause these difficulties, impairments in social relatedness can strain parent child interactions and parental stress can have negative transactional effects that impede children development. Conversely, as with typically developing children, parental behavior can also enhance development in ASD and parents play a role in many interventions. In this review we examine parental contributions to the development of children with ASD, focusing on social communication and emotion regulation. We address parent and family characteristics that may impede development so they can be identified in families and interventions developed to target them.

Treatment mechanism in the MRC preschool autism communication trial: implications for study design and parent-focussed therapy for children

BACKGROUND

The PACT randomised-controlled trial evaluated a parent-mediated communication-focused treatment for children with autism, intended to reduce symptom severity as measured by a modified Autism Diagnostic Observation Schedule-Generic (ADOS-G) algorithm score. The therapy targeted parental behaviour, with no direct interaction between therapist and child. While nonsignificant group differences were found on ADOS-G score, significant group differences were found for both parent and child intermediate outcomes. This study aimed to better understand the mechanism by which the PACT treatment influenced changes in child behaviour though the targeted parent behaviour.

METHODS

Mediation analysis was used to assess the direct and indirect effects of treatment via parent behaviour on child behaviour and via child behaviour on ADOS-G score. Alternative mediation was explored to study whether the treatment effect acted as hypothesised or via another plausible pathway. Mediation models typically assume no unobserved confounding between mediator and outcome and no measurement error in the mediator. We show how to better exploit the information often available within a trial to begin to address these issues, examining scope for instrumental variable and measurement error models.

RESULTS

Estimates of mediation changed substantially when account was taken of the confounder effects of the baseline value of the mediator and of measurement error. Our best estimates that accounted for both suggested that the treatment effect on the ADOS-G score was very substantially mediated by parent synchrony and child initiations.

CONCLUSIONS

The results highlighted the value of repeated measurement of mediators during trials. The theoretical model underlying the PACT treatment was supported. However, the substantial fall-off in treatment effect highlighted both the need for additional data and for additional target behaviours for therapy.

Why synchrony matters during mother-child interactions: a systematic review

BACKGROUND

Assessment of mother-child interactions is a core issue of early child development and psychopathology. This paper focuses on the concept of "synchrony" and examines (1) how synchrony in mother-child interaction is defined and operationalized; (2) the contribution that the concept of synchrony has brought to understanding the nature of mother-child interactions.

METHOD

Between 1977 and 2013, we searched several databases using the following key-words: "synchrony" "interaction" and "mother-child". We focused on studies examining parent-child interactions among children aged 2 months to 5 years. From the 63 relevant studies, we extracted study description variables (authors, year, design, number of subjects, age); assessment conditions and modalities; and main findings.

RESULTS

The most common terms referring to synchrony were mutuality, reciprocity, rhythmicity, harmonious interaction, turn-taking and shared affect; all terms were used to characterize the mother-child dyad. As a consequence, we propose defining synchrony as a dynamic and reciprocal adaptation of the temporal structure of behaviors and shared affect between interactive partners. Three main types of assessment methods for studying synchrony emerged: (1) global interaction scales with dyadic items; (2) specific synchrony scales; and (3) micro-coded time-series analyses. It appears that synchrony should be regarded as a social signal per se as it has been shown to be valid in both normal and pathological populations. Better mother-child synchrony is associated with familiarity (vs. unknown partner), a healthy mother (vs. pathological mother), typical development (vs. psychopathological development), and a more positive child outcomes.

DISCUSSION

Synchrony is a key feature of mother-infant interactions. Adopting an objective approach in studying synchrony is not a simple task given available assessment tools and due to its temporality and multimodal expression. We propose an integrative approach combining clinical observation and engineering techniques to improve the quality of synchrony analysis.

Brief report: mediation of treatment effect in a communication intervention for pre-school children with autism

Tests of mediation in treatment trials can illuminate processes of change and suggest causal influences in development. We conducted a mediation analysis of a previously published randomised controlled trial of parent-mediated communication-focused treatment for autism against ordinary care, with 28 children aged 2-5 years (Aldred et al. in J Child Psychol Psychiatr 45:1-11, 2004). The hypothesised mediating process, targeted by the intervention, was an increase in parental synchronous response within parent-child interaction. The results showed partial mediation, with change in synchrony accounting for 34% of the positive intervention effect on autism symptomatology (Autism Diagnostic Observation Schedule communication and social domain algorithm); the result was confirmed by bootstrap estimation. Improved parental synchronous response to child communication can alter short-term autism symptom outcome with targeted therapy.

Attachment security in infants at-risk for autism spectrum disorders

Little is known about attachment security and disorganization in children who are at genetic risk for an Autism Spectrum Disorder (ASD) prior to a possible diagnosis. The present study examined distributions of attachment security and disorganization at 15-months of age in a sample of infant siblings of older children with (ASD-sibs; n = 51) or without (COMP-sibs; n = 34) an ASD. ASD-sibs were not more or less likely to evince attachment insecurity or disorganization than COMP-sibs. However, relative to COMP-sibs, the rate of B1-B2 secure subclassifications was disproportionately larger in the ASD-sib group. Results suggest that ASD-sibs are not less likely to form secure affectional bonds with their caregivers than COMP-sibs, but may differ from COMP-sibs in their expression of attachment security.

Explaining autism: Ten reasons to focus on the developing self

My aim in this paper is to present reasons for adopting a focus on the development of self/other-awareness when characterizing the developmental psychopathology of autism. The strengths of such a position include an emphasis on children's emotional relations with embodied persons as foundational for their growing understanding of minds. I give special attention to the process of identifying with the attitudes of others, and experience of other-person-centred emotions, for the development of communication and thinking. The study of limitations in these aspects of self-other relatedness among individuals with autism is pivotal for understanding the pathogenesis of the syndrome.

Joint attention and social-emotional approach behavior in children with autism

Autism is a development disorder that is characterized by a significant disturbance of social development. Research strongly suggests that this disorder results from neurological anomalies or deficits. However, both the specific neural systems involved in autism, and the most pertinent behavioral functions of those systems remains unclear. One current topic of debate concerns the degree to which the social disturbance of autism may result from developmental anomalies in neurological systems that subserve cognitive, or affective processes. In this paper a model of the neurological, cognitive, and affective processes involved in the pathogenesis of autism will be described in the context of an attempt to understand dissociations in the early social-skill development of these children. Young children with autism are better able to use social-communication gestures to request objects or events than they are able to use similar gesture simply to initiate joint or socially shared attention relative to an object or event. An integration of recent research suggests that joint attention skill development differs from requesting skill development with regard to affective and cognitive processes that may be associated with frontal and midbrain neurological systems. In particular, this integration of the literature suggests the following: (a) there is a specific neurological subsystem that regulates and promotes what are called social-emotional approach behaviors; (b) the tendency to initiate joint attention bids is prototypical of a social-emotional approach behavior; and (c) attenuation of social-approach behaviors in children with autism leads to a specific impoverishment of social information processing opportunities. This impoverishment has a lifelong negative effect on the social cognitive development of these children.

Attachment security in children with autism

Nineteen autistic children were examined in a modified version of Ainsworth's Strange Situation. The attachment security of 15 children could be classified. Each of these children displayed disorganized attachment patterns, but almost half (40%) of them were subclassified as securely attached. To assess the validity of the attachment classifications, children and their mothers were observed in a separate interaction. Mothers of children who were subclassified as securely attached displayed greater sensitivity than mothers of children who were subclassified as insecurely attached. Children who were subclassified as securely attached more frequently initiated social interaction with their mothers than did children who were subclassified as insecurely attached. Children with secure and insecure subclassifications were compared to investigate correlations between attachment organization and representational ability and social-emotional understanding. Although children with underlying secure attachments were no more likely to initiate joint attention, they were more responsive to bids for joint attention, made requests more frequently, and demonstrated greater receptive language ability than children subclassified as insecurely attached. Discussion focuses on dynamics that may contribute to individual differences in the attachment organization of autistic children and on the reciprocal relationship between advances in our understanding of normal and pathological development.

Conversations with Barney: A Conversation Analysis of Interactions with a Child with Autism

This study arose from an intervention programme aimed to develop the communication and social interaction skills of Barney, a six-year-old child diagnosed with Pervasive Developmental Disorder (Autistic Spectrum). The approach we take is a social constructionist one that challenges the assumption of a Western psychiatric approach emphasising the impairment and deficits associated with autism. Conversation analysis is employed as a method of elucidating the collaborative mechanisms employed by Barney and his co-participants in making sense of one another. The aim of this study was to closely examine the communicative behaviour and interactive styles of Barney and his co-participants, their implications for communicative success ( co-ordinated interaction) or breakdown ( discordant interaction), and the implications for ways in which the child is positioned within the discourse in relation to his co-participants. Our constructions of the data suggested the following: A playful, activity-based interactive style constituted by non-verbal turns, affection, and short, simple utterances enhanced co-ordinated interaction. Discordant interaction seemed to result from a tendency of the co-participants to dominate the interaction (e.g., frequent and repetitive questioning) which directed and constrained interaction and resulted in the child's withdrawal. Other implications are highlighted. This research informs intervention efforts and encourages co-participants to reflect on ways in which interaction is co-constructed between themselves and the child with autism.

Following the child's lead: mothers' interactions with children with autism

This study examined the extent to which mothers of preschool children with autism use language that is related to the child's focus of attention. Fourteen mother-child dyads involving preschool children with autism participated in this study, along with 14 matched dyads involving typically developing preschool children. Both groups were observed during 15 minutes of free play. Results revealed that the mothers of children with autism directed verbalizations to something within the child's focus of attention as frequently as the mothers of typically developing children. Thus, children with autism had as many opportunities to benefit from verbal input related to their focus of attention as did typically developing children. However, mothers of children with autism directed verbalizations to something not within the child's focus of attention more frequently than mothers of typically developing children. This nonrelated input may have reflected the mothers' attempts to adapt to their children's difficulties in attention and interaction.

Current research findings on childhood autism

OBJECTIVE

To review the main areas of current research findings regarding the core deficits in autism and the implications of these findings for the practicing clinician.

METHOD

Behavioural, cognitive, emotional and neurophysiological aspects are covered with an emphasis on the importance of methodology.

RESULTS

The implication of these findings for the treatment of autism is discussed.

CONCLUSION

Autism can teach us how we learn about emotions and the possibility of sensitive periods of development.

Dilemmas of adolescents with developmental retardation: a review

Adolescence is highlighted in this review as the age of crisis and concern for those with developmental retardation. The complexities of this stage of life are considered from the perspectives of the individual's development and the commitment required by the family, school, professional services and society. These issues, illustrated with a case vignette, are critically examined using the evidence available in the literature.

Social attachments in autistic children

Social responses of young autistic children to separation from and reunion with their caregivers did not differ from the social responses to similar situations of young mentally retarded nonautistic children. Most autistic children directed more social behaviors to their caregivers than to strangers and increased their preferential behavior after separation. Individual differences in social responses were not associated with the level of representational skills shown by the autistic children.