Differentiating "Attachment Difficulties" From Autism Spectrum Disorders and Attention Deficit Hyperactivity Disorder: Qualitative Interviews With Experienced Health Care Professionals

OBJECTIVES

"Attachment difficulties" is an umbrella term often used to describe various forms of non-secure attachment. Differentiating "attachment difficulties" from autism spectrum disorder (hereafter autism) and attention deficit hyperactivity disorder (ADHD) has been characterized as challenging. Few studies have explored how this happens in practice, from the perspective of professionals.

DESIGN

Qualitative study.

METHODS

We conducted in-depth semi-structured interviews with (n = 17) healthcare professionals from five NHS Foundation Trusts in the United Kingdom. Participants were recruited using a combination of snowballing, convenience and purposive sampling. Data were analyzed using a thematic approach.

RESULTS

We identified six interrelated themes that might reflect difficulties with differential conceptualization. These include: a clinical lexicon of attachment; approaching attachment with caution; contextual factors; perceived characteristic behaviors; assessing attachment and adjacent supports; spotlighting intervention and dual conceptualization.

CONCLUSION

Our results indicate some of the ways suspicions around attachment are raised in practice. We advocate for more dialogue between research and practice communities on issues of differential conceptualization. We call for collaboration between a panel of experts consisting of attachment and neurodevelopmental orientated practitioners and researchers, to clarify issues around differentiating between attachment difficulties, ASD, and ADHD.

Point OutWords: protocol for a feasibility randomised controlled trial of a motor skills intervention to promote communicative development in non-verbal children with autism

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.

Speech-in-noise perception in high-functioning individuals with autism or Asperger's syndrome

BACKGROUND

High-functioning individuals with autism (HFA) or Asperger's syndrome (AS) commonly report difficulties understanding speech in situations where there is background speech or noise. The objective of this study was threefold: (1) to verify the validity of these reports; (2) to quantify the difficulties experienced; and (3) to propose possible mechanisms to explain the perceptual deficits described.

METHOD

Speech-in-noise perception abilities were measured using speech reception thresholds (SRTs), defined as the speech-to-noise ratio (SNR) at which approximately 50% of the speech is correctly identified. SRTs were measured for 11 individuals with HFA/AS and 9 age/IQ-matched normal-hearing control subjects, using an adaptive procedure, in a non-reverberant sound-attenuating chamber. The speech materials were standardised lists of everyday sentences spoken by a British male speaker. The background sounds were: (1) a single female talker; (2) a steady speech-shaped noise; (3) a speech-shaped noise with temporal dips; (4) a steady speech-shaped noise with regularly spaced spectral dips; and (5) a speech-shaped noise with temporal and spectral dips.

RESULTS

SRTs for the HFA/AS group were generally higher (worse) than those for the controls, across the five background sounds. A statistically significant difference in SRTs between the subject groups was found only for those background sounds that contained temporal or spectro-temporal dips. SRTs for the HFA/AS individuals were 2 to 3.5 dB higher than for the controls, equivalent to a substantial decrease in speech recognition. Expressed another way, the HFA/AS individuals required a higher SNR, whenever there were temporal dips in the background sound, to perform at the same level as the controls.

CONCLUSIONS

The results suggest that the speech-in-noise perception difficulties experienced by individuals with autism may be due, in part, to a reduced ability to integrate information from glimpses present in the temporal dips in the noise.