Title: The uses of cognitive training technologies in the treatment of autism spectrum disorders
Authors: Wass and Porayska-Pomsta
DOI: 10.1177/1362361313499827
Lay abstract: In this review we focus on research that has used technology to provide cognitive training, i.e. to improve performance on some measurable aspect of behavior, in individuals with Autism Spectrum Disorders (ASD). We review technological interventions that target three different cognitive areas: (a) emotion and face recognition, (b) language and literacy, and (c) social skills. The interventions that we reviewed allow for interaction through different modes, including point-and-click (i.e. moving a pointer to a location on a screen and pressing a button on a mouse or similar device) and eye-gaze contingent software (whereby a computer is able to track where the user is looking), and are delivered through diverse methods, including virtual reality and robotics. In each case, we examine the degree to which individuals with ASD showed an improvement following the intervention, including whether they were able to transfer their new skills to real-life contexts. We conclude that a number of technological interventions that have resulted in improvements, do not result in changes to behaviour in more naturalistic settings. This may result from problems that people with ASD experience in generalising and extrapolating knowledge more generally. However, we also point to several promising findings in this area and discuss possible directions for future work.
Title: The contribution of epigenetics to understanding genetic factors in autism
Authors: Hall and Kelley
DOI: 10.1177/1362361313503501
Lay abstract: Autism spectrum disorders (ASD) are characterized by difficulties with social interaction and communication, as well as by repetitive behaviours. While the environment is believed to play a role in the development of ASD, there is now strong evidence for a genetic link. Despite such evidence, studies investigating single genes that might cause ASD have not led to a complete understanding of the genetic link in ASD. A consideration of an epigenetic approach seems to be very promising in helping to understand the genetic factors involved in ASD. Epigenetics refers to non-permanent changes that change the expression of genes without changing the genes themselves. These changes can be inherited by future generations. Epigenetics also takes into account the role of environment in changing gene expression. This review provides a brief description of epigenetic processes, highlights evidence in the literature of irregularities in epigenetic processes in ASD, and makes use of noteworthy findings to illustrate how a consideration of epigenetic factors can deepen our understanding of the development of ASD. The present article is intended to provide a review of key findings related to epigenetics in ASD in such a manner that a broader audience of individuals who do not have a strong background in genetics may better understand this highly specific and scientific content. Furthermore, this discussion will present a promising new approach for moving forward in the investigation of genetic factors within ASD.
Title: Carers’ experiences of being exposed to challenging behaviour in services for autism spectrum disorders
Authors: Butrimaviciute and Grieve
DOI: 10.1177/1362361313508022
Lay abstract: Previous studies have shown that being exposed to challenging behaviour in services of care can have a negative impact on staff. Challenging behaviour has also been linked to people with autism spectrum disorders. Little research has been aimed at exploring the impact of such behaviour on staff working in services for autism spectrum disorders in particular. In the current study, ten individuals were interviewed and their personal accounts were thoroughly analysed using a technique called interpretative phenomenological analysis. Four themes were discovered by analysing the interview transcripts. Participants emphasised the intense mental and physical engagement with the role, the importance of adaptive coping, experiences of failure and achievement, and experiencing destructive emotional reactions. These results allow some insight into personal worlds of staff and might be useful for improving their working environment. This could also result in ensuring a higher quality of care for service users.
Title: Augmentative and alternative communication supports for adults with autism spectrum disorders
Authors: Trembath, Iacono, Lyon, West and Johnson
DOI: 10.1177/1362361313486204
Lay abstract: Many adults with autism spectrum disorders (ASD) have complex communication needs that make it difficult for them to understand, and to be understood by, others. Accordingly, augmentative and alternative communication (AAC) strategies, including picture symbols, communication boards, and electronic communication aids, are often prescribed in an attempt to address these communication needs. However, few studies have examined the outcomes of AAC interventions for adults with ASD. We interviewed six support workers and two family members of six men and women with ASD, who had received picture-based AAC interventions, to learn about their experiences and outcomes. Using a qualitative research methodology, we found strong support for the use of AAC interventions among participants and identified a range of potential benefits. However, participants also reported a high degree of variability in the way that AAC interventions were administered and in individual outcomes for the adults with ASD. Two key barriers to the use of AAC were (a) a lack of training and support for staff, carers, and family members, and (b) negative attitudes towards the use of AAC at both an individual and organisational level.
Title: The construction and evaluation of three measures of affectionate behaviour for children with Asperger’s syndrome
Authors: Sofronoff, Lee, Sheffield and Attwood
DOI: 10.1177/1362361313496336
Lay abstract: A key area of difficulty reported by parents raising a child with Asperger’s syndrome (AS) is that their child is not able to show them affection, and that affectionate behaviour in general is difficult for them to demonstrate and also to accept and understand from others. The purpose of this study was to develop and evaluate a measure that would capture the complex nature of affectionate behaviour. The process of developing a valid measure began with checking the literature for measures that already existed and then using parent and expert focus groups to check the usefulness of individual items for this population. Three related measures were developed: Affection for Others Questionnaire; Affection for You Questionnaire; and General Affection Questionnaire. These measures were then completed by 131 parents of children with AS. The evaluation of the measures showed that the measures were sound and could measure those factors that we were aiming to capture. The findings also showed that many children with AS do have difficulties with affectionate behaviour that, according to parents, have a significant effect on daily life and relationships with others. This suggests that an intervention that targets these issues would be useful. In this article we also discuss the limitations of our research.
Title: Media use among adolescents with autism spectrum disorder
Authors: Kuo, Orsmond, Coster and Cohn
DOI: 10.1177/1362361313497832
Lay abstract: This study had four aims: (1) to describe how teenagers with autism spectrum disorder (ASD) use media, focusing on watching TV and using a computer; (2) to find out the persons with whom they spent time using media; (3) to study the factors associated with their media use; and (4) to learn about the associations between media use and parent–child relationships and friendships. A total of 91 teenagers with ASD and their parents completed mail-based surveys during the summer months. Teenagers with ASD most frequently watched cartoons, played shooting computer or video games, and visited websites that had information on video games. They often watched TV alone or with their mothers, and played video games alone or with their peers. Teenagers who watched TV with their parents tended to have more positive relationships with their parents. Those who visited social networking websites or received emails from friends tended to have more positive friendships. The findings suggest that autism symptoms are associated with teenagers’ preferred media content. The findings also indicate that future research is needed to find out the causal relationship between watching TV together and parent–child relationships. Given that many teenagers in this study frequently played shooting games, it is also important to find out whether there is an association between shooting games and problem behaviors in teenagers with ASD.
Title: Longitudinal follow-up of factors associated with food selectivity in children with autism spectrum disorders
Authors: Suarez, Nelson and Curtis
DOI: 10.1177/1362361313499457
Lay abstract: The aim of this study was to examine how selective children with autism spectrum disorders (ASD) are about their food choices over time. We also sought to assess the relationships between food selectivity and two features of ASD: (1) responses to sensory information, and (2) restricted and repetitive behavior. Fifty-two parents of children with autism were surveyed twice: first they were asked to complete an initial questionnaire concerning food selectivity, as well as a measure of sensory over-responsivity. Approximately 20 months later, they were asked to complete identical questionnaires on food selectivity and sensory over-responsivity, as well as a measure of restricted and repetitive behaviors. Results comparing food selectivity at each time point indicated no change in the food selectivity of the children with ASD over time. There was also a stable, significant relationship between food selectivity and sensory over-responsivity. The measure of restrictive and repetitive behavior (taken at time two) was found to significantly predict whether the children with ASD were severely selective about their food choices or not. However, when assessing the impact of sensory over-responsivity and restricted and repetitive behaviors on food selectivity, we found that it was only sensory over-responsivity that significantly predicted severe food selectivity. These results support conclusions about the chronicity of food selectivity in young children with autism and the consistent relationship between food selectivity and sensory over-responsivity.
Title: Psychotropic medication use among children with autism spectrum disorders within the Simons Simplex Collection: Are core features of autism spectrum disorder related?
Authors: Mire, Nowell, Kubiszyn and Goin-Kochel
DOI: 10.1177/1362361313498518
Lay abstract: Psychotropic medications affect brain functioning and, as a result, behaviors and emotions; examples of types of these medicines include classes like stimulants and antidepressants. The current study investigated psychotropic medication use in children and adolescents with autism spectrum disorder (ASD). The sample of 1605 children with ASD came from across North America and had been diagnosed with ASD, or had ASD diagnoses confirmed, as a result of their participation in the Simons Simplex Collection (https://sfari.org/resources/simons-simplex-collection). The number and types of psychotropic medications being used by the children with ASD were calculated. The relationship between several variables (i.e. age, cognitive functioning, and core symptoms of ASD) and type of psychotropic medication being used was also investigated. The study found that 41.7% of the children with ASD had used one or more psychotropic medications, with the most commonly used medications being ADHD/stimulant medications. A weak relationship was found between psychotropic medication use and the core symptoms of ASD. Children who showed increased levels of repetitive behaviors were more likely to use psychotropic medications. There was also a relationship between age and psychotropic medication use. Older children used more psychotropic medications than younger children, and the older the child the higher the likelihood that they had ever taken psychotropic medications. Higher scores on tests of cognitive ability were related to less use of psychotropic medications, and the lower a child scored on a test of cognitive ability the higher the likelihood that they had ever taken a psychotropic medication. The authors discuss how the findings from this study apply to other individuals with ASD and suggest other research ideas that may help to increase our understanding of ASD treatment issues.
Title: Inversion effects in the perception of the moving human form: A comparison of adolescents with autism spectrum disorder and typically developing adolescents
Authors: Cleary, Looney, Brady and Fitzgerald
DOI: 10.1177/1362361313499455
Lay abstract: Autism spectrum disorders (ASDs) are characterized by impairments in social interaction that may reflect, in part, underlying impairments in ‘social perception’; people with ASD may have difficulty in perceiving social stimuli such as faces and bodies. This study investigates body perception and asks whether people with ASD differ in their sensitivity to body configuration—the relative position of the body’s parts—which allows us to discriminate bodies and actions. Body perception is far superior for upright than for inverted bodies, a phenomenon known as the ‘body inversion effect’. If people with ASD are impaired in their perception of bodies they may fail to show the body inversion effect or they may show a weakened effect. To test this we created a set of dynamic stick figures by adding form to motion recordings of a walking person and we added distortions by lengthening or shortening the limbs. Adolescents with ASD and typically developing adolescents (of a similar age and gender distribution) were asked to judge whether the moving stick figures—which were shown at a range of orientations from upright to inverted—were normal or distorted. We found clear effects of stimulus inversion; specifically, it took longer for the adolescents to correctly judge whether the walking stick figures were distorted or not as the stimuli were rotated away from the upright and they were more prone to make errors. Most importantly, these effects of body inversion were equally detrimental to both groups suggesting intact configural processing of moving bodies in ASD.
Title: Outcomes of an acceptance and commitment therapy-based skills training group for students with high-functioning autism spectrum disorder: A quasi-experimental pilot study
Authors: Pahnke, Lundgren, Hursti and Hirvikoski
DOI: 10.1177/1362361313501091
Lay abstract: Many students with autism spectrum condition (ASC) suffer from stress and emotional distress, such as anxiety, depression, and anger. To reduce stress and emotional distress we evaluated a 6-week skills training programme at a school for 15 students with AS (aged 13–21). (The skills training was based on acceptance and commitment therapy (ACT) and mindfulness training.) There were five students and one group leader in each group. Common skills that were trained were focusing and concentrating, coping with emotions and stress, and doing things that motivated the students. All the students in the training group completed the training and they felt that the training was useful. The students and their teachers also completed questionnaires concerning stress and emotional distress, before and after the training. We compared the answers with those of 13 students who also completed the questionnaires, although they did not take part in the training but had school classes as usual. The answers in the questionnaires showed that the students in the training group were less stressed and had less anxiety, depression, and anger after the skills training. They also felt less restless and were more socially interactive. Overall, it seems that the skills training programme can be useful and may reduce difficulties that many students with AS struggle with. Therefore, we want to further evaluate this kind of training for individuals with AS. If the skills training then proves to be useful and effective, the programme can be an aid for improving the level of functioning and quality of life of individuals with AS.
Title: Sex differences in co-occurring conditions of children with autism spectrum disorders
Authors: Stacy, Zablotsky, Yarger, Zimmerman, Makia and Lee
DOI: 10.1177/1362361313505719
Lay abstract: In this study, we wanted to know if there were differences in the number and type of other developmental conditions or diagnoses (for example, attention deficit hyperactivity disorder (ADHD), developmental delay, epilepsy, learning disability, speech problems) between boys and girls who currently have a diagnosis of autism spectrum disorder (ASD). The study used data from the National Survey of Children’s Health 2007, which collected information through phone interviews with caregivers. We included 913 children (746 boys and 167 girls) who had a current diagnosis of ASD and were living in the United States. We found that girls were diagnosed with fewer other conditions than boys were. In particular, girls were less likely to have a previous learning disability or anxiety disorder, or current learning disability than boys. However, girls were more likely than boys to have been diagnosed with a speech problem in the past. Finally, boys were more likely than girls to have been diagnosed with two or more current diagnoses in addition to ASD. The results may shed light on unique aspects of ASD in children and how this may affect diagnostic classification of ASD in boys and girls. The findings may also provide insight into trends in sex differences of developmental conditions that occur alongside ASD.
Title: The cost-effectiveness of supported employment for adults with autism in the United Kingdom
Authors: Mavranezouli, Megnin-Viggars, Cheema, Howlin, Baron-Cohen and Pilling
DOI: 10.1177/1362361313505720
Lay abstract: Adults with autism face high rates of unemployment. Supported employment schemes enable people with autism to secure and maintain a paid job in a regular work environment. This study compared the costs and benefits of supported employment and standard care (day services) for adults with autism in the UK, to explore whether supported employment is cost-effective, in other words, whether it represents value for money from the perspective of the NHS and personal social services. For this purpose, an economic model was developed, which used relevant clinical and cost data to predict costs and benefits associated with the two services over 8 years. The analysis showed that, compared with standard care, supported employment results in higher benefits (more time spent in paid employment and better quality of life) at a small additional cost. Moreover, if some people with autism move from supported to private accommodation or reduce their use of health and personal social services as a result of gaining employment, then supported employment may create future cost-savings that outweigh the additional costs associated with its provision. The analysis suggests that supported employment is cost-effective for adults with autism in the UK. Further research needs to confirm these findings.
Title: Defining crisis in families of individuals with autism spectrum disorders
Authors: Weiss, Wingsiong and Lunsky
DOI: 10.1177/1362361313508024
Lay abstract: Parents of children with autism spectrum disorder (ASD) often experience more distress compared with parents of children without ASD, and sometimes this distress comes in the form of crisis. The current study investigated the subjective experience of crisis in mothers of children with ASD. Their responses were examined and closely interpreted in order to identify the major themes that emerged when they were asked to define crisis in their own words. The results suggest that crisis is characterized by factors falling under four major categories: life’s demands (e.g. health-related needs), the individual’s capabilities (e.g. ability to cope with life challenges), external resources (e.g. use and availability of emergency services), and subjective appraisal of their current situation (e.g. hopefulness). Understanding the factors related to crisis is important as it can serve to inform the way we provide services to families.
Title: The association between epilepsy and autism symptoms and maladaptive behaviors in children with autism spectrum disorder
Authors: Viscidi, Johnson, Spence, Buka, Morrow and Triche
DOI: 10.1177/1362361313508027
Lay abstract: Epilepsy is common in children with autism spectrum disorder (ASD), but little is known about how epilepsy affects autism symptoms and behavior. This article looks at the association between epilepsy and autism symptoms and behavior in children with ASD. A total of 2645 children with ASD, including 139 with epilepsy, from the Simons Simplex Collection (SSC), were studied. The SSC is a large collection of genetic samples from families who have one child affected with ASD, and unaffected parents and siblings. Using this repository, the relationship between epilepsy and autism symptoms and maladaptive behaviors (e.g. hyperactivity) was examined. Children with ASD and epilepsy had more autism symptoms and maladaptive behaviors than children without epilepsy. Hyperactivity symptoms in children with autism and epilepsy were the only symptoms that were also not associated with intellectual disability. In children with ASD who did not also have intellectual disability, children with epilepsy had more parent-reported irritability and hyperactivity symptoms. Children with ASD and epilepsy showed greater impairment than children without epilepsy. This was mostly explained by the lower IQ of the epilepsy group. However, children with ASD and epilepsy had significantly more hyperactivity symptoms, even after accounting for differences in IQ. These findings have important clinical implications for patients with ASD.
Title: Social conformity and autism spectrum disorder: A child-friendly take on a classic study
Authors: Yafai, Verrier and Reidy
DOI: 10.1177/1362361313508023
Lay abstract: Many studies have shown that people tend to conform to majority opinions, even if they privately feel that doing so is incorrect. The most famous studies looking at this effect were conducted by Solomon Asch in the 1950s, who found that participants incorrectly agreed that one line was the same length as another if they were surrounded by people who gave that response. This is a fundamentally social phenomenon, which may not be displayed by people with autism spectrum disorder (ASD) given their typical social deficits. In this study, the performance of 15 children with ASD was compared to that of 15 typically developing children on a line judgement task. Children were matched for age, gender, and numeracy and literacy ability. The children had to say which of three cartoon shapes was the same length as a comparison shape. On some occasions, children were misled as to what most people thought the answer was. Children with ASD were much less likely to conform in the misleading condition than typically developing children. Using a questionnaire designed to measure autism traits, it was also found that the higher the level of autism traits displayed by the typically developing children, the less likely they were to conform. This finding mirrors the observed group difference. Overall, this study demonstrates the resistance of children with autism to social pressure.
Title: Verbal fluency in children with autism spectrum disorders: Clustering and switching strategies
Authors: Begeer, Wierda, Scheeren, Teunisse, Koot and Geurts
DOI: 10.1177/1362361313500381
Lay abstract: Individuals with autism are limited in their flexibility. This limitation can be assessed by measuring the ability to spontaneously generate responses (fluency). However, performance of individuals with autism on fluency tasks has been inconsistent. The current study highlights differences between children and adolescents with and without autism spectrum disorders (n = 52) on a verbal fluency task. During this task, participants had to name as many words as possible (e.g. animals) within 60 seconds. The ability to form clusters of words (e.g. farm animals like “cow–horse–goat”) or to switch between unrelated words (e.g. “snake” and “cat”) was analyzed. We used a new coding method to more stringently differentiate between clustering and switching strategies. Results indicated that children and adolescents with autism spectrum disorders switched less frequently, but produced slightly larger clusters than the comparison group. This resulted in equal numbers of total words produced. The currently used measures of flexibility suggest atypical, but possibly equally efficient, fluency styles used by individuals with autism spectrum disorders.
