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Maksimović S, Marisavljević M, Stanojević N, Ćirović M, Punišić S, Adamović T, Đorđević J, Krgović I, Subotić M. Importance of Early Intervention in Reducing Autistic Symptoms and Speech-Language Deficits in Children with Autism Spectrum Disorder. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010122. [PMID: 36670672 PMCID: PMC9857540 DOI: 10.3390/children10010122] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/05/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023]
Abstract
The intervention focused on starting treatment at an early age to develop the child’s full potential, which is known as early intervention. Given that autistic symptoms and language deficits occur at an early age and affect other areas of development in children with autistic spectrum disorder, we wanted to examine if early intervention is more effective in the reduction in autistic symptoms and language deficits in children aged 36−47 months old when compared to children 48−60 months old. The sample consisted of 29 children diagnosed with ASD who were admitted for integrative therapy. All participants were divided into two groups based on age: G1: 36−47 months old children, and G2: 48−60 months old children. To estimate the presence of autistic symptoms, we used the GARS-3, and for the assessment of speech−language abilities, we used the subscale Estimated Speech and Language Development (ESLD). Our results regarding the effect of the group on the difference in the scores at two time points showed that there was a statistically significant effect of the group on the reduction in autistic symptoms (p < 0.05) but no effect of the group on the differences in speech−language abilities between the two time points (p > 0.05). Our study highlights the importance of emphasizing the exact age when using the terms “early intervention” and “early development” in future studies and practice because it is necessary to determine and establish guidelines about which particular ages are crucial for starting treatment in certain developmental aspects.
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Affiliation(s)
- Slavica Maksimović
- Cognitive Neuroscience Department, Research and Development Institute “Life Activitites Advancement Center”, 11000 Belgrade, Serbia
- Department of Speech, Language, and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology “Đorđe Kostić”, 11000 Belgrade, Serbia
| | - Maša Marisavljević
- Cognitive Neuroscience Department, Research and Development Institute “Life Activitites Advancement Center”, 11000 Belgrade, Serbia
- Department of Speech, Language, and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology “Đorđe Kostić”, 11000 Belgrade, Serbia
| | - Nina Stanojević
- Cognitive Neuroscience Department, Research and Development Institute “Life Activitites Advancement Center”, 11000 Belgrade, Serbia
- Department of Speech, Language, and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology “Đorđe Kostić”, 11000 Belgrade, Serbia
- Correspondence:
| | - Milica Ćirović
- Cognitive Neuroscience Department, Research and Development Institute “Life Activitites Advancement Center”, 11000 Belgrade, Serbia
- Department of Speech, Language, and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology “Đorđe Kostić”, 11000 Belgrade, Serbia
| | - Silvana Punišić
- Cognitive Neuroscience Department, Research and Development Institute “Life Activitites Advancement Center”, 11000 Belgrade, Serbia
- Department of Speech, Language, and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology “Đorđe Kostić”, 11000 Belgrade, Serbia
| | - Tatjana Adamović
- Cognitive Neuroscience Department, Research and Development Institute “Life Activitites Advancement Center”, 11000 Belgrade, Serbia
- Department of Speech, Language, and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology “Đorđe Kostić”, 11000 Belgrade, Serbia
| | - Jelena Đorđević
- Clinic for Neurology and Psychiatry for Children and Youth, 11000 Belgrade, Serbia
- Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Ivan Krgović
- Institute for Children’s Diseases, Clinical Center of Montenegro, 81000 Podgorica, Montenegro
| | - Miško Subotić
- Cognitive Neuroscience Department, Research and Development Institute “Life Activitites Advancement Center”, 11000 Belgrade, Serbia
- Department of Speech, Language, and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology “Đorđe Kostić”, 11000 Belgrade, Serbia
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McKinney A, Weisblatt EJ, Hotson KL, Bilal Ahmed Z, Dias C, BenShalom D, Foster J, Murphy S, Villar SS, Belmonte MK. Overcoming hurdles to intervention studies with autistic children with profound communication difficulties and their families. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1627-1639. [PMID: 33827289 PMCID: PMC8323331 DOI: 10.1177/1362361321998916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Autistic children and adults who are non-verbal/minimally verbal or have an
intellectual disability have often been excluded from Autism Spectrum Disorder
research. Historical, practical and theoretical reasons for this exclusion
continue to deter some researchers from work with this underserved population.
We discuss why these reasons are neither convincing nor ethical, and provide
strategies for dealing with practical issues. As part of a randomised controlled
trial of an intervention for children with profound autism, we reflected as a
multi-disciplinary team on what we had learnt from these children, their
families and each other. We provide 10 strategies to overcome what appeared
initially to be barriers to collecting data with this population. These hurdles
and our solutions are organised by theme: interacting physically with children,
how to play and test, navigating difficult behaviours, selecting suitable
outcome measures, relating with parents, managing siblings, involving
stakeholders, timing interactions, the clinician’s role in managing
expectations, and recruitment. The aim of this article is to provide researchers
with the tools to feel motivated to conduct research with children with profound
autism and their families, a difficult but worthwhile endeavour. Many of these
lessons also apply to conducting research with non-autistic children with
intellectual disabilities.
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Affiliation(s)
- Ailbhe McKinney
- Nottingham Trent University, UK.,The University of Edinburgh, UK
| | - Emma Jl Weisblatt
- University of Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | | | | | - Claudia Dias
- Cambridgeshire and Peterborough NHS Foundation Trust, UK
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Andrew DR, Moe ME, Chen D, Tello JA, Doser RL, Conner WE, Ghuman JK, Restifo LL. Spontaneous motor-behavior abnormalities in two Drosophila models of neurodevelopmental disorders. J Neurogenet 2020; 35:1-22. [PMID: 33164597 DOI: 10.1080/01677063.2020.1833005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Mutations in hundreds of genes cause neurodevelopmental disorders with abnormal motor behavior alongside cognitive deficits. Boys with fragile X syndrome (FXS), a leading monogenic cause of intellectual disability, often display repetitive behaviors, a core feature of autism. By direct observation and manual analysis, we characterized spontaneous-motor-behavior phenotypes of Drosophila dfmr1 mutants, an established model for FXS. We recorded individual 1-day-old adult flies, with mature nervous systems and prior to the onset of aging, in small arenas. We scored behavior using open-source video-annotation software to generate continuous activity timelines, which were represented graphically and quantitatively. Young dfmr1 mutants spent excessive time grooming, with increased bout number and duration; both were rescued by transgenic wild-type dfmr1+. By two grooming-pattern measures, dfmr1-mutant flies showed elevated repetitions consistent with perseveration, which is common in FXS. In addition, the mutant flies display a preference for grooming posterior body structures, and an increased rate of grooming transitions from one site to another. We raise the possibility that courtship and circadian rhythm defects, previously reported for dfmr1 mutants, are complicated by excessive grooming. We also observed significantly increased grooming in CASK mutants, despite their dramatically decreased walking phenotype. The mutant flies, a model for human CASK-related neurodevelopmental disorders, displayed consistently elevated grooming indices throughout the assay, but transient locomotory activation immediately after placement in the arena. Based on published data identifying FMRP-target transcripts and functional analyses of mutations causing human genetic neurodevelopmental disorders, we propose the following proteins as candidate mediators of excessive repetitive behaviors in FXS: CaMKIIα, NMDA receptor subunits 2A and 2B, NLGN3, and SHANK3. Together, these fly-mutant phenotypes and mechanistic insights provide starting points for drug discovery to identify compounds that reduce dysfunctional repetitive behaviors.
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Affiliation(s)
- David R Andrew
- Department of Neurology, University of Arizona Health Sciences, Tucson, AZ, USA.,Center for Insect Science, University of Arizona, Tucson, AZ, USA.,Department of Biological Sciences, Lycoming College, Williamsport, PA, USA
| | - Mariah E Moe
- Department of Neurology, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Dailu Chen
- Department of Neurology, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Judith A Tello
- Department of Neurology, University of Arizona Health Sciences, Tucson, AZ, USA.,Graduate Interdisciplinary Program in Neuroscience, University of Arizona, Tucson, AZ, USA
| | - Rachel L Doser
- Department of Neurology, University of Arizona Health Sciences, Tucson, AZ, USA
| | - William E Conner
- Department of Biology, Wake Forest University, Winston-Salem, NC, USA
| | - Jaswinder K Ghuman
- Department of Psychiatry, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Linda L Restifo
- Department of Neurology, University of Arizona Health Sciences, Tucson, AZ, USA.,Center for Insect Science, University of Arizona, Tucson, AZ, USA.,Graduate Interdisciplinary Program in Neuroscience, University of Arizona, Tucson, AZ, USA.,BIO5 Interdisciplinary Research Institute, University of Arizona, Tucson, AZ, USA
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McKinney A, Hotson KL, Rybicki A, Weisblatt EJL, Días C, Foster J, Villar SS, Murphy S, Belmonte MK. Point OutWords: protocol for a feasibility randomised controlled trial of a motor skills intervention to promote communicative development in non-verbal children with autism. Trials 2020; 21:109. [PMID: 31973713 PMCID: PMC6979327 DOI: 10.1186/s13063-019-3931-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/23/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Point OutWords is a caregiver-delivered, iPad-assisted intervention for non-verbal or minimally verbal children with autism. It aims to develop prerequisite skills for communication such as manual and oral motor skills, sequencing, and symbolic representation. This feasibility trial aims to determine the viability of evaluating the clinical efficacy of Point OutWords. METHODOLOGY We aim to recruit 46 non-verbal or minimally verbal children with autism and their families, approximately 23 per arm. Children in the intervention group will use Point OutWords for half an hour, five times a week, for 8 weeks. Children in the control group will have equal caregiver-led contact time with the iPad using a selection of control apps (e.g. sensory apps, drawing apps). Communication, motor, and daily living skills are assessed at baseline and post-intervention. Parents will keep diaries during the intervention period and will take part in focus groups when the intervention is completed. DISCUSSION Point OutWords was developed in collaboration with children with autism and their caregivers, to provide an intervention for a subgroup of autism that has been historically underserved. As autism is a heterogeneous condition, it is unlikely that one style of intervention will address all aspects of its symptomatology; the motor skills approach of Point OutWords can complement other therapies that address core autistic symptoms of social cognition and communication more directly. The current feasibility trial can inform the selection of outcome measures and design for future full-scale randomised controlled trials of Point OutWords and of other early interventions in autism. TRIAL REGISTRATION ISRCTN, ISRCTN12808402. Prospectively registered on 12 March 2019.
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Affiliation(s)
- Ailbhe McKinney
- Division of Psychology, Nottingham Trent University, Nottingham, UK
| | | | - Alicia Rybicki
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Emma J. L. Weisblatt
- Department of Psychology, University of Cambridge, Cambridge, UK
- Peterborough Integrated Neurodevelopmental Service, Cambridgeshire and Peterborough NHS Foundation Trust, Peterborough, UK
| | - Claudia Días
- Peterborough Integrated Neurodevelopmental Service, Cambridgeshire and Peterborough NHS Foundation Trust, Peterborough, UK
| | - Juliet Foster
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sofía S. Villar
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Suzanne Murphy
- Institute for Health Research, University of Bedfordshire, Bedford, UK
| | - Matthew K. Belmonte
- Division of Psychology, Nottingham Trent University, Nottingham, UK
- The Com DEALL Trust, Bangalore, India
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Whose words are these? Statements derived from Facilitated Communication and Rapid Prompting Method undermine the credibility of Jaswal & Akhtar's social motivation hypotheses. Behav Brain Sci 2019. [DOI: 10.1017/s0140525x18002236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Jaswal & Akhtar provide several quotes ostensibly from people with autism but obtained via the discredited techniques of Facilitated Communication and the Rapid Prompting Method, and they do not acknowledge the use of these techniques. As a result, their argument is substantially less convincing than they assert, and the article lacks transparency.
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Rudovic O, Lee J, Mascarell-Maricic L, Schuller BW, Picard RW. Measuring Engagement in Robot-Assisted Autism Therapy: A Cross-Cultural Study. Front Robot AI 2017. [DOI: 10.3389/frobt.2017.00036] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hemsley B. Evidence does not support the use of Rapid Prompting Method (RPM) as an intervention for students with autism spectrum disorder and further primary research is not justified. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/17489539.2016.1265639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Bronwyn Hemsley
- Faculty of Education and Arts, The University of Newcastle, Newcastle, Australia
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Kramvis I, Mansvelder HD, Loos M, Meredith R. Hyperactivity, perseveration and increased responding during attentional rule acquisition in the Fragile X mouse model. Front Behav Neurosci 2013; 7:172. [PMID: 24312033 PMCID: PMC3836024 DOI: 10.3389/fnbeh.2013.00172] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 11/05/2013] [Indexed: 01/09/2023] Open
Abstract
Attentional deficits and executive function impairments are common to many neurodevelopmental disorders of intellectual disability and autism, including Fragile X syndrome (FXS). In the knockout mouse model for FXS, significant changes in synaptic plasticity and connectivity are found in the prefrontal cortex (PFC)-a prominent region for attentional processing and executive control. Given these alterations in PFC synaptic function, we tested whether adult Fragile X knockout mice exhibited corresponding impairments in inhibitory control, perseveration, and sustained attention. Furthermore, we investigated individual performance during attentional rule acquisition. Using the 5-choice serial reaction time task, our results show no impairments in inhibitory control and sustained attention. Fragile X knockout mice exhibited enhanced levels of correct and incorrect responding, as well as perseveration of responding during initial phases of rule acquisition, that normalized with training. For both knockout and wild type mice, pharmacological attenuation of metabotropic glutamate receptor 5 signaling did not affect response accuracy but reduced impulsive responses and increased omission errors. Upon rule reversal, Fragile X knockout mice made more correct and incorrect responses, similar to the initial phases of rule acquisition. Analogous to heightened activity upon novel rule acquisition, Fragile X knockout mice were transiently hyperactive in both a novel open field (OF) arena and novel home cage. Hyperactivity ceased with familiarization to the environment. Our findings demonstrate normal inhibitory control and sustained attention but heightened perseveration, responding, and hyperactivity during novel rule acquisition and during exposure to novel environments in Fragile X knockout mice. We therefore provide evidence for subtle but significant differences in the processing of novel stimuli in the mouse model for the FXS.
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Affiliation(s)
- Ioannis Kramvis
- Department of Integrative Neurophysiology, Centre for Neurogenomics and Cognitive Research, VU University Amsterdam Amsterdam, Netherlands ; Sylics (Synaptologics BV) Amsterdam, Netherlands
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Belmonte MK, Saxena-Chandhok T, Cherian R, Muneer R, George L, Karanth P. Oral motor deficits in speech-impaired children with autism. Front Integr Neurosci 2013; 7:47. [PMID: 23847480 PMCID: PMC3696837 DOI: 10.3389/fnint.2013.00047] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 06/02/2013] [Indexed: 01/01/2023] Open
Abstract
Absence of communicative speech in autism has been presumed to reflect a fundamental deficit in the use of language, but at least in a subpopulation may instead stem from motor and oral motor issues. Clinical reports of disparity between receptive vs. expressive speech/language abilities reinforce this hypothesis. Our early-intervention clinic develops skills prerequisite to learning and communication, including sitting, attending, and pointing or reference, in children below 6 years of age. In a cohort of 31 children, gross and fine motor skills and activities of daily living as well as receptive and expressive speech were assessed at intake and after 6 and 10 months of intervention. Oral motor skills were evaluated separately within the first 5 months of the child's enrolment in the intervention programme and again at 10 months of intervention. Assessment used a clinician-rated structured report, normed against samples of 360 (for motor and speech skills) and 90 (for oral motor skills) typically developing children matched for age, cultural environment and socio-economic status. In the full sample, oral and other motor skills correlated with receptive and expressive language both in terms of pre-intervention measures and in terms of learning rates during the intervention. A motor-impaired group comprising a third of the sample was discriminated by an uneven profile of skills with oral motor and expressive language deficits out of proportion to the receptive language deficit. This group learnt language more slowly, and ended intervention lagging in oral motor skills. In individuals incapable of the degree of motor sequencing and timing necessary for speech movements, receptive language may outstrip expressive speech. Our data suggest that autistic motor difficulties could range from more basic skills such as pointing to more refined skills such as articulation, and need to be assessed and addressed across this entire range in each individual.
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Affiliation(s)
- Matthew K Belmonte
- The Groden Center, Providence RI, USA ; Division of Psychology, Nottingham Trent University Nottingham, UK ; Center for the Study of Human Development, Brown University, Providence RI, USA
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Emerson A, Dearden J. Accommodating to motor difficulties and communication impairments in people with autism: the MORE intervention model. Front Integr Neurosci 2013; 7:45. [PMID: 23785315 PMCID: PMC3685137 DOI: 10.3389/fnint.2013.00045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 05/28/2013] [Indexed: 11/25/2022] Open
Abstract
Motor impairment in individuals with autism potentially impacts on their development in all spheres. This paper is particularly concerned with people with severe communication impairments suggesting that recognition of the impact of motor impairments on their lives could lead to more effective interventions being developed. One such intervention is the MORE (Means, Opportunities, Reasons, and Expectations) model, founded on the "least dangerous assumption," that is assuming competence until otherwise established through long-term observation and assessment. Components of the model include recognizing the importance of having high expectations and linking this to the way people are spoken to; timing within an intervention and over long periods; the importance of eye-hand coordination and teaching independent pointing skills. It is suggested that literacy should be offered as an early step which could significantly enhance communication.
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Affiliation(s)
- Anne Emerson
- School of Education, University of NottinghamNottingham, UK
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Amos P. Rhythm and timing in autism: learning to dance. Front Integr Neurosci 2013; 7:27. [PMID: 23626527 PMCID: PMC3630367 DOI: 10.3389/fnint.2013.00027] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 04/02/2013] [Indexed: 01/30/2023] Open
Abstract
In recent years, a significant body of research has focused on challenges to neural connectivity as a key to understanding autism. In contrast to attempts to identify a single static, primarily brain-based deficit, children and adults diagnosed with autism are increasingly perceived as out of sync with their internal and external environments in dynamic ways that must also involve operations of the peripheral nervous systems. The noisiness that seems to occur in both directions of neural flow may help explain challenges to movement and sensing, and ultimately to entrainment with circadian rhythms and social interactions across the autism spectrum, profound differences in the rhythm and timing of movement have been tracked to infancy. Difficulties with self-synchrony inhibit praxis, and can disrupt the “dance of relationship” through which caregiver and child build meaning. Different sensory aspects of a situation may fail to match up; ultimately, intentions and actions themselves may be uncoupled. This uncoupling may help explain the expressions of alienation from the actions of one's body which recur in the autobiographical autism literature. Multi-modal/cross-modal coordination of different types of sensory information into coherent events may be difficult to achieve because amodal properties (e.g., rhythm and tempo) that help unite perceptions are unreliable. One question posed to the connectivity research concerns the role of rhythm and timing in this operation, and whether these can be mobilized to reduce overload and enhance performance. A case is made for developmental research addressing how people with autism actively explore and make sense of their environments. The parent/author recommends investigating approaches such as scaffolding interactions via rhythm, following the person's lead, slowing the pace, discriminating between intentional communication and “stray” motor patterns, and organizing information through one sensory mode at a time.
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Affiliation(s)
- Pat Amos
- Training and Private Consultation Ardmore, PA, USA
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