Do Types of Information in an Animated Video Intervention Affect University Students' Autism Knowledge and Openness Towards Peers on the Autism Spectrum?

This pre-test post-test control group design sought to compare the effectiveness of delivering different types of information ([1] factual information vs. [2] factual information + descriptive and explanatory information vs. [3] factual information + descriptive, explanatory + directive information) in an animated video intervention in increasing university students' autism knowledge and openness toward peers on the autism spectrum. The sample consisted of 92 undergraduates (27 males, 65 females; age range = 18-36) from various universities in Singapore. Participants were randomly assigned to one of the three experimental conditions/videos, where they completed a measure of their autism knowledge and openness scale, before viewing a 5-minute long animated video containing different types of information about autism. After which, participants completed the measure of autism knowledge and openness scale again, followed by a measure of their empathy level. Results indicated that participants' autism knowledge improved following the viewing of the animated video. However, the three different videos containing different types of information did not differ in influencing participants' openness toward peers on the autism spectrum. Nevertheless, qualitative responses proposed that the video containing factual information, with descriptive, explanatory, and directive information was useful in helping participants to know how to interact with their peers on the autism spectrum. The findings of this study provide preliminary support for the most effective method to educate and raise awareness about autism, among the general student population in order to foster a supportive and inclusive environment.

Development and Psychometric Properties of a Culturally Adapted Video Version of Strange Stories as a Measure of Advanced Theory of Mind in Youths

This study described the development of a culturally adapted video version of Strange Stories test as a measure of advanced theory of mind for youths in an Asian country (i.e. Singapore), the Y-ToM, and to provide preliminary psychometric properties. Participants were 170 youths (82 male, 88 female) aged from 13 to 16 years old (M = 14.77, SD = 1.16) in Singapore. The youths completed the Y-ToM, an abbreviated IQ test and the Happé’s Strange Stories in a counterbalanced order while their parents completed the Child Behavior Checklist (CBCL). A two-factor structure consisting of social and physical subscales was suggested. Concurrent, convergent, divergent and diagnostic validity of the Y-ToM was examined. Internal consistency of the Y-ToM social subscale was acceptable though it was not satisfactory for the Y-ToM physical subscale. Inter-rater reliability was good while test-retest reliability was lower.

Developing and Piloting a Computerized Adaptive Test for a Culturally Appropriate Measure of Adaptive Behavior

Culturally bounded in nature, adaptive behavior is the degree to which a person meets the requirements of personal independence and social responsibilities. This study aimed to develop a computerized adaptive test (CAT) of a culturally appropriate adaptive behavior measure (i.e., the Activities and Participation Rating Scale [APRS]) in the Singapore context for children aged 7 to 12 years, that is, the CAT-APRS-Primary. In Study 1, an item bank consisting of 310 adaptive skills was developed and piloted among 56 caregivers. In Study 2, the refined 310 items were calibrated using Rasch analysis among 352 caregivers. After the removal of five poor items based on the Rasch analysis, the finalized 305 items were used for the CAT development, with these items showing good Rasch person and item fit statistics. Preliminary utility of the CAT-APRS-Primary was established, with participants completing 24 items on average. Limitations and implications for future research were discussed.

Pre-school teachers’ perceptions of challenging behaviours of students with autism spectrum disorder within inclusive settings

Purpose

Students with autism spectrum disorder (ASD) often have challenging behaviours that can create significant teaching challenges in group settings such as in mainstream pre-school inclusive settings. This study aims to identify and understand, from the perspectives of mainstream pre-school teachers in Singapore, the type of common challenging behaviours observed in pre-schoolers (mean age = 4.5 years, SD = 1.1, range = 3-6) with ASD.

Design/methodology/approach

Participants consisted of 62 teachers (mean age = 35.8 years; SD = 10.8) teaching in mainstream pre-school centres located in Singapore completed an open-ended survey. Twelve codes were generated and served as guidelines for coding the qualitative data. Codes with similar themes were then grouped to form four construct categories: social communication, restricted and repetitive behaviours, attention and learning and others.

Findings

Results indicated that difficulty with change/transition and social/peer interaction were the most concerning issues across all settings, whereas “lesson time” and “circle time” were the two most common activities/settings in which the concerns were reported by teachers.

Originality/value

Findings from this paper may add to the limited research looking at the challenging behaviours exhibited by children with ASD in mainstream pre-school settings in Singapore. Understanding the type of challenging behaviours presented in pre-schoolers with ASD and the activities/settings in which these behaviours occur may help the teachers to link the difficulties to specific interventions to further support their inclusion in a mainstream pre-school setting.

The effect of diagnostic labels on teachers' perceptions of behaviours of students with autism spectrum disorder

BACKGROUND

In Singapore, despite the availability of specialized services and resources in mainstream schools for students with special educational needs, parents can still be hesitant to disclose their child's diagnosis of autism spectrum disorder (ASD), for fear of stigma or negative attitudes from teachers and peers.

AIM

This study aims to understand how diagnostic labels affect teachers' perceptions of behaviours in students with ASD in mainstream primary schools, particularly behaviours which are difficult for educators to manage in the classroom setting. Based on research suggesting that a diagnostic label can provide an alternative explanation for atypical behaviours and reduce negative impressions, we hypothesize that teachers would perceive these behaviours of children with ASD less negatively as compared to children without any diagnostic labels.

SAMPLE

The sample consisted of 120 mainstream primary school teachers who reported a mean of 9.97 years (SD = 7.96) of teaching experience. Majority of participants (65%) indicated that they had direct experience of teaching students with ASD in mainstream schools (mean years = 3.58, SD = 4.77).

METHOD

Participants read a total of 20 vignettes depicting a range of behaviours typically observed in primary school-aged students with ASD. Participants were asked to rate the featured student's behaviour on a 5-point Likert scale (i.e., 1 = strongly negative, 2 = negative, 3 = neutral, 4 = positive, and 5 = strongly positive). The survey vignettes were presented in a randomized order, and participants were randomly assigned to either the experimental group (awareness of diagnostic label) or the control group (non-awareness of label).

RESULTS

Results indicated that the experimental group rated the behaviours less negatively than the control group. Qualitative feedback from participants also indicated that knowledge of the diagnostic label helped them to perceive the behaviours more positively.

CONCLUSION

Findings from this study have implications for parents regarding diagnosis disclosure and may serve as an encouragement to parents to consider disclosing their child's ASD diagnosis to the school.

Development of a brief version of the Autism Detection in Early Childhood

While autism spectrum disorder screening tools provide a useful resource for practitioners, the reality is they are underused. The justifications often provided include the time required for administration and the training involved. A brief tool with good psychometric properties that require minimal training is required. This study examined the development and the psychometric properties of a brief version of the Autism Detection in Early Childhood. The data showed the potential of the brief version of Autism Detection in Early Childhood for screening children age 12-36 months. Our dataset comprised 106 Diagnostic and Statistical Manual of Mental Disorders, 5th edition autism spectrum disorder, 86 non-typical development and 78 typical development participants age 12-36 months. Analyses comparing autism spectrum disorder and non-typical development groups supported the use of five critical items (i.e. response to name, social smiling, gaze switch, response to verbal command and use of gestures) to form the brief version Autism Detection in Early Childhood. The brief version of Autism Detection in Early Childhood's optimal cutoff score of 4 had sensitivity of 0.81, specificity of 0.78, positive predictive value of 0.81 and negative predictive value of 0.78. However, the results would need to be viewed as preliminary given the nature of the study sample and the findings might not be generalisable to samples with higher levels of cognitive functioning.

Using the Autism Detection in Early Childhood (ADEC) and Childhood Autism Rating Scales (CARS) to predict long term outcomes in children with autism spectrum disorders

This study evaluated the predictive validity of the Autism Detection in Early Childhood (ADEC; Young, Autism detection in early childhood: ADEC. Australian Council of Educational Research, Camberwell, VIC 2007) and a well-established screening tool, the Childhood Autism Rating Scale (CARS; Schopler et al. The childhood autism rating scale (CARS). Western Psychological Services, Los Angeles 1988), for long term outcomes of children with ASD engaged in an early intervention program. Participants were 55 children (44 male, 11 female) aged 19–42 months (M = 33.5, SD = 5.6) at initial assessment who were followed up 2 and 6 years after their initial assessment. The ADEC and the CARS performed similarly when predicting long term outcomes such as clinical diagnostic outcome and overall adaptive functioning level. However, only the ADEC score was significantly correlated with ASD symptom severity at the 6-year follow up. Although these findings need to be replicated with additional and larger samples, this study extends our understanding of the psychometric properties of both the ADEC and the CARS.

Autism detection in early childhood (ADEC): reliability and validity data for a Level 2 screening tool for autistic disorder

The Autism Detection in Early Childhood (ADEC; Young, 2007) was developed as a Level 2 clinician-administered autistic disorder (AD) screening tool that was time-efficient, suitable for children under 3 years, easy to administer, and suitable for persons with minimal training and experience with AD. A best estimate clinical Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) diagnosis of AD was made for 70 children using all available information and assessment results, except for the ADEC data. A screening study compared these children on the ADEC with 57 children with other developmental disorders and 64 typically developing children. Results indicated high internal consistency (α = .91). Interrater reliability and test-retest reliability of the ADEC were also adequate. ADEC scores reliably discriminated different diagnostic groups after controlling for nonverbal IQ and Vineland Adaptive Behavior Composite scores. Construct validity (using exploratory factor analysis) and concurrent validity using performance on the Autism Diagnostic Observation Schedule (Lord et al., 2000), the Autism Diagnostic Interview-Revised (Le Couteur, Lord, & Rutter, 2003), and DSM-IV-TR criteria were also demonstrated. Signal detection analysis identified the optimal ADEC cutoff score, with the ADEC identifying all children who had an AD (N = 70, sensitivity = 1.0) but overincluding children with other disabilities (N = 13, specificity ranging from .74 to .90). Together, the reliability and validity data indicate that the ADEC has potential to be established as a suitable and efficient screening tool for infants with AD.

The perception of social situations by children with autism spectrum disorders

This study investigated how children with autism spectrum disorders (ASD) make social judgments of social situations and provide justifications for their responses. Fifteen children with ASD and 15 typically developing children (ages from 9 to 13 years old) were presented with eight vignettes, based on the Dewey Story Test (Dewey, 1991) and developed for the purposes of this study. The participants rated the appropriateness (on a 4-point Likert scale) of the socially inappropriate event (test item) and non-social appropriate event (control item) in each vignette. Justifications for each rating were also elicited at the end of each vignette. The children with ASD rated socially inappropriate behaviors in vignettes no differently from their typically developing peers but rated control items as stranger. They also had a higher tendency to provide inappropriate/bizarre and don’t know/no response justifications instead of appropriate/social justifications (that reflect social awareness). The impact of the method of eliciting social judgments of social situations and its impact on findings are discussed.

The role of gastrointestinal endoscopy in long-distance runners with gastrointestinal symptoms

BACKGROUND

Exercise-related gastrointestinal symptoms are not uncommon among athletes. The occurrence of gastrointestinal bleeding has been reported, especially in long-distance runners. We studied gastrointestinal mucosal damage, using gastrointestinal endoscopy, in competitive long-distance runners. Gastrointestinal blood loss and anaemia before and after running were also assessed.

METHODS

Sixteen competitive long-distance runners (all men; age range 16-19 years) participated in the study. All runners completed a symptom questionnaire prior to a 20 km race. Stool occult blood and haematological studies (haemoglobin, haematocrit, serum iron, total iron-binding capacity [TIBC] and ferritin) were performed before and immediately after the race. Gastrointestinal endoscopy was performed to assess macroscopic changes. Colonoscopy was also performed on the patients who had positive stool occult blood before or after the race.

RESULTS

Gastrointestinal symptoms were frequently experienced by the runners. Gastritis (n = 16), oesophagitis (n = 6) and gastric ulcer (n = 1) were found at gastroscopy. Colonoscopy was performed on four patients who had positive stool occult blood. One had multiple erosions at the splenic flexure and one had a rectal polyp. Five runners had anaemia, and all of these had at least one endoscopic lesion (three gastritis, two oesophagitis and one multiple erosion at the splenic flexure). There were significant changes in the following haematological parameters after the race: iron (decreased, P = 0.02), ferritin (decreased, P = 0.001) and TIBC (increased, P = 0.00005).

CONCLUSIONS

Gastrointestinal symptoms and gastrointestinal mucosal damage are prevalent among long-distance runners. Prior to treatment, gastrointestinal endoscopy should be considered in long-distance runners with gastrointestinal symptoms and/or anaemia.

Effect of graded running on esophageal motility and gastroesophageal reflux in fed volunteers

The effects of different grades of running on esophageal motility and gastroesophageal reflux in the fed state were evaluated. We studied healthy volunteers (male: 12, age: 27 +/- 5 yr) using ambulatory esophageal manometry, pH catheter and portable digital data recorder. Each exercise was performed 30 min after meal, with 20 min of rest between exercises. Subjects exercised on a treadmill at 40% and 70% maximal heart rate. The number of gastroesophageal reflux episodes, the duration of esophageal acid exposure and percent time pH below 4 were significantly (p < 0.01) increased during exercise at 70% maximal heart rate. The frequency of contraction (contraction/min) (p < 0.05), frequency of repetition (p < 0.01), percent of simultaneous contraction (p < 0.01), percent of above 100 mmHg amplitude (p < 0.05), and frequency of 2-peak contraction (p < 0.01) were significantly increased during exercise at 70% maximal heart rate. However, median amplitude and median duration showed no significant changes between each exercise session. Postprandial running exercises induce gastroesophageal reflux, which correlates with exercise intensity. These effects are mediated by disorganized esophageal motility.

Effects of galvanic stimulation of the mastoid process on the gastric motility induced by caloric stimulation

The effects of galvanic stimulation to the mastoid portion on the vestibuloautonomic symptoms induced by caloric stimulation, such as nausea, vomiting, and vertigo, were evaluated in this study. Gastric motility was measured by electrogastrography (EGG) in 20 healthy volunteers (11 male and nine female) aged 20-30 (average: 25.4) years. Electrical stimulation of the mastoid process with 1.0-3.0 mA, 1.0 ms, 100 Hz was applied using a bipolar-biaural method during caloric stimulation of the external auditory canal. The dominant frequency and power of EGG were determined using running spectral frequency analysis and the time-course of EGG was evaluated in a pseudo three dimensional graphic. Frequency of EGG was classified into normogastria with 3 cpm, bradygastria with lower than 3 cpm, and tachygastria with higher than 3 cpm. At quiescent period, normogastria was 78.7 +/- 3.7%, bradygastria 5.0 +/- 1.1%, and tachygastria 16.4 +/- 3.7%. Caloric stimulation with warm water in the unilateral ear and cold water in the contralateral ear elicited vestibuloautonomic symptoms, with accompanied decreases in normogastria (57.7 +/-4.6%, P < 0.01) and increases in tachygastria (34.8 +/- 4.8%, P < 0.01). Cathodal stimulation to the mastoid process ipsilateral to cold water irrigation during caloric stimulation restored normal pattern of gastric motility: normogastria in 77.1 + 5.3% and tachygastria in 19.3 +/- 4.7%, and relieved vestibuloautonomic symptoms. Cathodal stimulation to the inhibited vestibular system ameliorates the vestibular symptoms induced by caloric stimulation.

Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation

PURPOSE

To correlate computed tomographic (CT) features of inflammatory pseudotumors of the liver with histopathologic results in patients with recurrent pyogenic cholangitis.

MATERIALS AND METHODS

CT features of 13 cases of inflammatory hepatic pseudotumor in 10 patients with recurrent pyogenic cholangitis were reviewed. Diagnosis was made by means of surgical resection in all patients. CT scans were analyzed for the appearance of masses and ancillary findings in correlation with the histopathologic findings in each resected specimen.

RESULTS

The masses were 2.0-7.0 cm (mean, 3.5 cm). At nonenhanced CT, the masses appeared as ill-defined, hypoattenuating lesions. At contrast material-enhanced CT, the masses exhibited central hypoattenuating areas with an iso- or hyperattenuating thickened periphery in four cases and a multiseptate appearance with hyperattenuating internal septa and periphery in nine cases. CT-histopathologic correlation showed that the central hypoattenuating area indicated the presence of chronic inflammatory infiltrates with foamy histiocytes, plasmacytes, and lymphocytes, while iso- or hyperattenuating areas in the periphery and internal septa of the mass represented fibroblastic proliferation. All patients had CT features of recurrent pyogenic cholangitis, such as hepatolithiasis, intrahepatic duct stricture and dilatation, common bile duct calculi, pneumobilia, or parenchymal atrophy.

CONCLUSION

Although CT features are not specific, inflammatory pseudotumor should be included in the differential diagnosis in patients with recurrent pyogenic cholangitis and a hepatic mass detected at CT.

Percutaneous endoscopic gastrostomy for enteral nutrition

From January to October, 1986, at Wonkwang University Hospital in Iri, percutaneous endoscopic gastrostomy(PEG) was attempted in 26 patients and was successful in 24. This study was designed to review the technique and to evaluate the efficacy of PEG. The mean operation time was 22 minutes (range: 14 to 42 minutes). After feeding started, early positive nitrogen balance was achieved in all patients. All gastrostomies functioned well throughout the patient’s survival with the longest functioning at 10 month. There were no procedure-related deaths, and morbidity was lower and less severe as compared with large-bore nasogastric tube feeding. Complications included minor wound infection in two patients, stomal growth in one patient, leaks around the tube in two patients, and intraperitoneal leak in one patient. No patient developed aspiration pneumonia or required laparotomy for complications from PEG. The gastrostomy tube was easily removed endoscopically when treatment was completed. Feeding via a large-bore tube increased the risk of aspiration pneumonia (72%) and the feeding cost via a small-bore tube with elemental diet exceeded that of PEG by more than tenfold. This author’s experience with these 26 patients has led to the conclusion that PEG is safe, easy to perform, and effective means of creating feeding gastrostomy without laparotomy or general anesthesia. The authors suggest that PEG be the preferred route of alimentation in those patients who are unable to swallow for prolonged periods of time.