Title: Title: Awareness about autism among school teachers in Oman: A cross-sectional study
Authors: Al-Sharbati, Al-Farsi, Ouhtit, Waly, Al-Shafaee, Al-Farsi, Al-Khaduri, Al-Said and Al-Adawi
DOI: 10.1177/1362361313508025
Lay abstract: Children with special needs, such as autism spectrum disorder (ASD), have been stigmatized in many parts of the world. The aim of this study was to evaluate the awareness of, and attitudes towards, children with ASD among school teachers in an urban region of Oman. A total of 164 school teachers, from five schools within Muscat, Oman, took part in this study. Teachers’ awareness of, and attitudes towards, children with ASD was elicited using a questionnaire. The results showed that while the majority of teachers (89%) reported that they had heard about ASD, only 11% reported that they had contact with children with ASD. Merely 1% knew the magnitude of children with ASD and several stereotypes were observed: 8.1% of teachers concurred that vaccination triggered ASD; 10.4% thought that children with ASD were ‘over talkative’; about 63% believed that ASD can occur owing to maltreatment or neglect by family members during early childhood; and 58.6% believed that some types of food can cause ASD. Only 49% believed that genetics play an important role in causing ASD. In total, 44.5% believed that autism was associated with negative stigma in the Omani society, and 6.1% believed that services provided for ASD children in Oman are inadequate. In conclusion, misconceptions about ASD are common among school teachers in Oman. Mass educational programs are urgently needed to improve the awareness about ASD in schools.
Title: Health-related quality of life in children with high-functioning autism
Authors: Authors: Potvin, Snider, Prelock, Wood-Dauphinee and Kehayia
DOI: 10.1177/1362361313509730
Lay abstract: It is often believed that people with disabilities experience a decreased quality of life. However, research findings so far are inconsistent, in part because they differ in those with different conditions and diagnoses. Specifically, the quality of life of people with autism is poorly understood. This study addressed this, comparing the quality of life of school-age children with high functioning autism (HFA) to typically developing peers. The study documented children’s quality of life from both the child and parental viewpoints, using the Pediatric Quality of Life Inventory (PedsQL) questionnaire. The PedsQL provides information about a component of children’s quality of life as it relates to the impact of their own disability, referred to as health-related quality of life (HRQL). The study found that children with HFA had poorer HRQL (i.e. physical well-being, psychosocial well-being and total HRQL) than their peers, whether reported by them or their parents. The large size of the difference clearly suggests that children with HFA experience an important decrease in HRQL compared with their peers. The study also found that parents reported their children with HFA had lower HRQL than what the children themselves reported, reinforcing the need to seek both points of view clinically. Ultimately, this study points to the importance of clinicians working closely with families to identify specific areas in children’s lives that might hinder and, alternatively, promote quality of life.
Title: Parents’ first concerns about toddlers with autism spectrum disorder: Effect of sibling status
Authors: Herlihy, Knoch, Vibert and Fein
DOI: 10.1177/1362361313509731
Lay abstract: Symptoms of autism spectrum disorders (ASD) may appear as early as six months of age, but parents may not recognize symptoms or delays until months or years later. The presence of older siblings (with or without ASD) can change parents’ sensitivity to departures from typical development. The current study investigated the type and age of parent’s first concerns in toddlers with ASD, before they received a diagnosis. Participants had: (1) at least one older sibling with ASD; (2) only typically developing older siblings; or (3) were only/oldest child. Specific ASD diagnoses and symptom severity were similar among the three groups. The only/oldest group showed the largest delays, followed by children with only typical older siblings, followed by children with older siblings with ASD. First concerns were noted at around 16 months for only/oldest children, 14 months for children with typical siblings, and 10 months for children with siblings with ASD. Concern about language and communication was widespread in all groups. Thus, the presence of an older child (with or without ASD) was associated with earlier concerns for the affected child, despite milder developmental delays. These findings underscore the importance of encouraging parents to report concerns to pediatricians, routine standardized screening for ASD, and the need for pediatrician vigilance, especially for only or oldest children.
Title: Post-traumatic growth in mothers of children with autism: A phenomenological study
Authors: Zhang, Yan, Barriball, While and Liu
DOI: 10.1177/1362361313509732
Lay abstract: While the adverse effects of raising a child with autism are well demonstrated, there have been few reports of the post-traumatic growth (PTG) of mothers of children with autism. Post-traumatic growth refers to positive psychological change experienced as a result of the struggle with highly challenging life circumstances. The purpose of this research was to explore dimensions of PTG in this population in Mainland China and identify the factors facilitating PTG. Eleven mothers of pre-school children were recruited from five rehabilitation centres of children with disabilities in Shanghai. The semi-structured interviews were analysed using a technique called ‘thematic analysis’, which aims to identify important and established patterns or themes from interview data. The findings partially supported the theory of PTG. A new philosophy of life, appreciation of life, relating to others, personal strength and spiritual change were five aspects of PTG in mothers of children with autism. Perceived social support, peer example, effective coping style and self-efficacy enhancement were facilitating factors of PTG. Further studies are needed to understand how to promote the PTG of mothers of children with autism.
Title: Measuring repetitive behaviors as a treatment endpoint in youth with autism spectrum disorder
Authors: Scahill, Aman, Lecavalier, Halladay, Bishop, Bodfish, Grondhuis, Jones, Horrigan, Cook, Handen, King, Pearson, McCracken, Sullivan and Dawson
DOI: 10.1177/1362361313510069
Lay abstract: The development and testing of new treatments for repetitive behavior in children and adults with autism spectrum disorder (ASD) require accurate measurement of symptom severity before and after treatment. Autism Speaks convened a group of researchers and clinicians to evaluate available measures of repetitive behavior for use in treatment studies in children and adults with ASD. The work group reviewed the medical literature and identified 24 candidate measures of repetitive behavior. Five measures were classified as appropriate with conditions. This classification reflects the consensus view that these measures are reliable and valid, but may have one of more drawbacks. For example, a measure with a limited number of items may not be able to capture a full range of severity, because individuals with severe symptoms might hit the maximum score and cannot go higher. Others instruments in this group of five measures may have had limited use in treatment studies and not demonstrated sensitivity to change. The clinician-rated Children’s Yale-Brown Obsessive Compulsive Scales for Pervasive Developmental Disorder (CYBOCS-PDD), which has been used as an outcome measure in several clinical trials in children with ASD, is undergoing additional revision. Of the 19 measures classified as potentially appropriate, unproven or not appropriate for use as outcome measures for repetitive behavior in ASD, the work group noted that these measures may be well suited for clinical and research purposes.
Title: Narrowing the gap: Effects of intervention on developmental trajectories in autism
Authors: Klintwall, Eldevik and Eikeseth
DOI: 10.1177/1362361313510067
Lay abstract: Studies have shown that with treatment, children with autism can learn to interact better with others, take better care of themselves, and score better on IQ-tests. Particularly, behaviorally focused treatments seem to be efficient. Behavioral treatments are a kind of pedagogical intervention with the aim of teaching the child any lacking skills (talking, listening, etc.) in small steps, and with a focus on motivation. How much children learn in treatments, their outcome, can be measured in different ways. In this study we show how outcome can be presented as “developmental trajectories”. Children who learn nothing can be said to have flat trajectories, and children who learn lots of new skills have a steep upward trajectory. To exemplify this, we looked at 453 children, all younger than 5 years. Some of these children received many hours every day of behavioral treatments. Another group received other treatments, usually just a few hours every day. All children were tested before treatment and then again 1–2 years later. Comparing the developmental trajectories of these two groups, we found than children in behavioral treatments had steeper trajectories than children who received other treatments. In other words, children in behavioral interventions learned more new skills. We also found that the more hours per day of treatment the children received, the more they learned. Also, children who were high-functioning learned more in treatment. However, we were surprised to find that the age of the child did not matter: younger and older children learned just as much.
Title: Understanding the gap between cognitive abilities and daily living skills in adolescents with autism spectrum disorders with average intelligence
Authors: Duncan and Bishop
DOI: 10.1177/1362361313510068
Lay abstract: Daily living skills, which are commonly measured by a tool called the Vineland Adaptive Behavior Scales, are critical to achieving independence in adulthood and include activities such as personal hygiene, cooking, cleaning, navigating the community, and managing money. Recent studies have found that increased daily living skills may predict a more successful outcome in adulthood. The current study examined the scores obtained by 417 adolescents with high functioning autism spectrum disorder on the Vineland scales, and identified participants who had a “daily living skills deficit”. Overall, 56% of adolescents had a daily living skills deficit, which indicated that their daily living skills were at a level below their cognitive abilities. Further, a quarter of the sample had daily living skills that were in the ‘low’ or ‘very low’ range. The only factors that significantly predicted whether an individual had a daily living skills deficit were older age and greater social-communication impairments. Future research needs to develop and evaluate interventions to target the acquisition and generalization of daily living skills.
Title: “Bill is now singing”: Joint engagement and the emergence of social communication of three young children with autism
Authors: Vaiouli, Grimmet and Ruich
DOI: 10.1177/1362361313511709
Lay abstract: Young children with autism spectrum disorder (ASD) have significant challenges in joint attention (that is the ability to share attention about an object or event with another person) and social communication. Challenges in joint attention undermine the broader capacity of children with autism to share experiences and benefit from the learning opportunities found in interactive social contexts. These challenges do not abate with age. As school social environments become more complex, children with autism tend to face more difficulties in organizing information from the environment, transitioning from one activity to another, and completing activities with multiple steps. In this study, a child-centered, improvisational, music therapy intervention was implemented to promote engagement in three young children with autism in a kindergarten classroom. We compared the children’s performance through three phases of intervention: focus on faces, response to joint attention, and initiation of joint attention. A complimentary analysis of the experiences of teachers and parents allowed for an in-depth understanding of the role of the social environment in supporting emerging social communication skills among the three children. As all children showed improvement in joint attention and social engagement following the intervention, this study provides evidence for the potential of music therapy as a promising intervention for promoting the social skills of young children with ASD.
Title: ‘I’m really glad this is developmental’: Autism and social comparisons – an interpretative phenomenological analysis
Authors: Huws and Jones
DOI: 10.1177/1362361313512426
Lay abstract: Young people with autism (aged 16–21 years old) were interviewed about their views about autism. By analysing their interviews, three themes linked to an overall ‘Making Comparisons’ theme were found: (a) Changes over time: ‘I’m really glad this is developmental’; (b) Degrees of autism: ‘They’ve got it really bad’; and (c) Degrees of ability: ‘I’m not really disabled-disabled’. The young people viewed themselves more positively now in comparison with the past, and saw themselves as being in a better position than other people with, or without, autism. Autism was also thought to be more favourable than what was termed as ‘proper’ disability. These findings are discussed in relation to other social comparison literature.
Title: Reduced delay of gratification and effortful control among young children with autism spectrum disorders
Authors: Faja and Dawson
DOI: 10.1177/1362361313512424
Lay abstract: In order to effectively respond to new situations and to balance immediate needs against long-term consequences, children must learn to control their behavior. In this study, we examined the ability of young children with autism spectrum disorder (ASD) to control their behavior. We used a task that required children to control their desire for an immediate treat in order to wait and earn a larger treat. In addition, we asked parents to report on the ability of their children to exert effortful control over their behaviors. Relative to a group of children without autism who had a comparable level of intelligence, young children with ASD were less able to exert control over their behavior in order to receive a larger, delayed treat. Parents of children with ASD also reported lower levels of effortful control than parents of comparison children. Among the children with ASD, lower levels of effortful control corresponded with higher levels of autism symptoms in the social domain. That is, the ability to exert control over behavior may account for some of the individual variability observed in symptoms of ASD. This finding may allow for better understanding of the challenges that children with ASD have in controlling their social behavior in novel or complex situations.
Title: Drug-refractory aggression, self-injurious behavior, and severe tantrums in autism spectrum disorders: A chart review study
Authors: Adler, Wink, Early, Shaffer, Minshawi, McDougle and Erickson
DOI: 10.1177/1362361314524641
Lay abstract: Aggression, self-injurious behavior (SIB), and severe tantrums are impairing symptoms frequently experienced by individuals with autism spectrum disorders (ASD). Despite the United States Food and Drug Administration approving two medications targeting these symptoms in children with autism, many individuals do not improve following treatment. The term ‘drug-refractory’ is used if symptoms are not able to be controlled by the use of medication. In this article, we define drug-refractory aggression, SIB, and severe tantrums in people with ASD as behavioral symptoms requiring the adjustment of medication, despite the individual previously having been administered drugs (in this case, either risperidone or aripiprazole, or both of these drugs). We reviewed the medical records of individuals of all ages referred to our clinic for ASD evaluation, as well as follow-up notes for those individuals meeting ASD criteria, for drug-refractory symptoms. Among 250 individuals referred to our clinic, 135 met the criteria for ASD, and 53 of these individuals met drug-refractory symptom criteria (as outlined above). Individuals over 12 years of age, diagnosed with Autistic Disorder, and with intellectual disability were more likely to suffer from drug-refractory symptoms. This preliminary report underscores the significance of drug-refractory aggression, SIB, and severe tantrums, and suggests the need for future study clarifying factors related to the development of symptoms, and identifies the need for further treatment studies targeting these refractory symptoms.
Title: The role of emotion perception in adaptive functioning of people with autism spectrum disorders
Authors: Hudepohl, Robins, King and Henrich
DOI: 10.1177/1362361313512725
Lay abstract: Cognitive functioning has historically been used to predict adaptive outcomes of people with autism spectrum disorders (ASDs); however, research shows that it is does not fully explain adaptive functioning. The current study explored whether emotion perception was a predictor of adaptive outcomes. Participants in the study included people with ASDs and a typically developing (TD) comparison group. The ASD group demonstrated significantly lower adaptive functioning and emotion perception skills compared with the TD group. Emotion perception explained socialization, but not communication or daily living skills, highlighting that in people with ASDs, lower socialization abilities is the result, in part, of emotion perception deficits. It was unexpected that emotion perception did not explain communication skills. This may be related to limitations of the people in this study, or the narrow focus on emotion perception. Future research should involve a larger, more inclusive ASD sample, broaden approaches to exploring relationships between social perception and adaptive outcomes, and relate findings to brain mechanisms underlying emotion perception.
Title: Validity of the Revised Children’s Anxiety and Depression Scale for youth with autism spectrum disorders
Authors: Sterling, Renno, Storch, Ehrenreich-May, Lewin, Arnold, Lin and Wood
DOI: 10.1177/1362361313510066
Lay abstract: Feelings related to anxiety and depression are common among youth with autism spectrum disorders (ASD). Such feelings can be difficult to identify in youth with ASD because measures of psychiatric symptoms have generally been designed for typically developing youth. It is not clear whether such measures are valid for youth with ASD. The current study sought to investigate the validity of a questionnaire called The Revised Children’s Anxiety and Depression Scale (RCADS) in 67 youth (ages 11–15 years) with ASD. In addition to the RCADS, parents and children in the study completed a number of other measures designed to assess anxiety and depression, including the Pediatric Anxiety Rating Scale, the Multidimensional Anxiety Scale for Children, the Anxiety Disorders Interview, and the Child Behavior Checklist. Results from the study indicate acceptable ‘internal consistency’ of the RCADS; for example, questions on the RCADS that measure anxiety are related to each other, suggesting they are indeed measuring the same construct (anxiety) in youth with ASD. In addition, the total scores on the RCADS correlated with subscales of other widely used measures of anxiety and depression, suggesting that these tools may reliably measure anxiety and depression. Overall, these results provide some preliminary support for using the RCADS to measure anxiety and depression in youth with ASD.
