Title: Pediatric provider’s perspectives on the transition to adult health care for youth with autism spectrum disorder: Current strategies and promising new directions
Authors: Kuhlthau, Warfield, Hurson, Delahaye and Crossman
DOI: 10.1177/1362361313518125
Lay abstract: Few youth with autism spectrum disorder (ASD) nationally report receiving services to help them transition from the pediatric health care system to the adult health care system. For example, only one-fifth (21.1%) of youth with ASD receive any transition planning services. To better understand why the transition from pediatric to adult health care is so difficult, we interviewed pediatric health care providers with extensive experience serving children and youth with ASD. We gathered information about the strategies and interventions they use to transition their patients with ASD to an adult provider. Five interventions or strategies are currently being used. These include providing families with written medical summaries to give to adult providers, compiling lists of available adult providers or community resources, coordinating care and communication between individual pediatric and adult providers, making transition-specific appointments, and using checklists to track transition progress. Other interventions or strategies were identified as needed and these focused on education and training. For example, informational workshops were suggested to train families and youth about transition. Training adult providers and medical students was also seen as important. Several respondents additionally identified the need for a transition center where all services could be coordinated in one place. With large numbers of youth with ASD becoming young adults, it seems that pediatric practices might want to consider some of the activities endorsed and described here. Some of these activities, such as family educational seminars and written medical summaries, are likely relatively easy for a practice to implement.
Title: Examining the criterion-related validity of the Pervasive Developmental Disorder Behavior Inventory
Authors: McMorris and Perry
DOI: 10.1177/1362361313518123
Lay abstract: The Pervasive Developmental Disorder Behavior Inventory (PDDBI) is a tool that is sometimes used to help in diagnosing Pervasive Developmental Disorders (PDDs) or autism spectrum disorder (ASD), or to see how symptoms are changing when a child is receiving treatment. The PDDBI is a questionnaire that measures both adaptive and maladaptive behaviors that are associated with PDDs, and provides an overall Autism Composite score that is based on the individual’s age. In previous research, the PDDBI has demonstrated moderate to strong accuracy (validity) and consistency (reliability). In the present study, we wanted to see if we could repeat these results and extend previous research by investigating the “criterion-related validity” of the PDDBI, or how well the PDDBI does at assessing the behaviors that it is supposed to measure, compared with other measures known to be strong. Data from 40 children were analyzed in relation to a number of other well-established tools. As expected, the PDDBI adaptive scores were moderately related to scores on other measures used to assess adaptive behavior. However, surprisingly, no significant relationships were found between the maladaptive and Autism Composite scores of the PDDBI and the Childhood Autism Rating Scale (CARS), a longstanding diagnostic tool used for assessing ASD symptom severity. Results lead to concerns regarding the accuracy of some scores of the PDDBI.
Title: Aggression in children with autism spectrum disorders and a clinic-referred comparison group
Authors: Farmer, Butter, Mazurek, Cowan, Lainhart, Cook, DeWitt and Aman
DOI: 10.1177/1362361313518995
Lay abstract: Aggressive behavior is a leading cause of residential placement and results in fewer opportunities for independent functioning and interpersonal relationships for people with autism spectrum disorders (ASD). Accurate measurement of aggression is crucial for clinicians to provide appropriate treatment and measure improvement. Popular tools, like the Child Behavior Checklist (CBCL), measure only physical aggression and were not developed for populations with developmental disabilities. The Children’s Scale for Hostility and Aggression: Reactive/Proactive (C-SHARP) asks parents to rate items about different types of aggression: Verbal Aggression, Bullying, Covert Aggression, Hostility, and Physical Aggression. In the current study, parents rated the C-SHARP and CBCL for 657 children (414 with ASD and 243 referred to developmental clinics but not diagnosed with ASD) aged 1–21 years. Relative to this comparison group, children with ASD were reported to have less aggression of all types and were more likely to be rated as reactive (e.g. “hot” or provoked) rather than proactive (i.e. “cool” or calculated). Still, nearly 20% of children with ASD in this sample received higher scores on CBCL Aggressive Behavior than 97% of the general population. Higher levels of IQ/adaptive behavior and older age were associated with more sophisticated types of aggression, while lower scores on IQ, adaptive behavior, and communication measures were associated with more physical aggression. The results of this study suggest that while aggression may be more common in children with ASD than in the general population, these behaviors occur less than for other children who have been referred for evaluation in developmental clinics. These findings underscore the importance of assessing different types of aggression, because children with varying levels of ability and age may engage in different types of aggression.
Title: Pain as a predictor of sleep problems in youth with autism spectrum disorders
Authors: Tudor, Walsh, Mulder and Lerner
DOI: 10.1177/1362361313518994
Lay abstract: Sleep problems are quite common for child-ren and teenagers with autism spectrum disorders (ASD). Other factors may play a role in these sleep problems or may make them worse. One such factor is pain, which youth with ASD may have difficulty communicating to others. Mothers of 62 youths with an ASD completed surveys related to their observation of their child or teenager’s (ages 3–18) pain (over a 2-week period) and sleep problems (over a 1-week period). Results showed that both pain and sleep problems were commonly experienced by these youth. Moreover, when children were said to recently experience more pain, they were more likely to have more sleep problems (e.g. fewer hours of sleep, sleep parasomnias (such as restless legs and night terrors), and problems with breathing while sleeping). Results also showed connections between these sleep problems and the way the youth communicated their experience of pain; youth who had less sleep communicated their pain in social ways, like seeking comfort from parents; youth who experienced parasomnias were likely to communicate pain through facial grimacing; youth with problems breathing while sleeping were more likely to communicate pain through groaning or yelling. Virtually none of these relationships were affected by existing medical conditions, such as asthma or gastrointestinal problems. Together, this study shows that pain and sleep problems may both be related and important factors when considering the well-being of youth with ASD.
Title: Perceptual inference and autistic traits
Authors: Skewes, Jegindø and Gebauer
DOI: 10.1177/1362361313519872
Lay abstract: Scientists have shown that autistic people are better at perceiving fine detail, but that they also have difficulties interpreting the context in which that detail is presented. For instance, autistic people are better at discriminating pitch in sound, but have trouble using pitch to interpret emotions in speech. Scientists have also shown that these differences extend to the neurotypical population. People who self-report having higher degrees of autistic traits are also better at perceiving detail. These phenomena have been notoriously difficult to explain. Scientists have focused on differences in ‘bottom-up’ sensory processing (i.e. differences in how much detail people are able to get out of their sensory experiences) and on differences in ‘top-down’ cognitive integration of sensory information (i.e. differences in how much people attend to structure and patterns in sensory information). Neither has been able to account for the wide range of phenomena that scientists and clinicians have observed. Recently, a third model has offered a way to synthesize top-down and bottom-up approaches, and provide a fuller integration of existing findings. According to this theory, the function of the perceptual system – and the brain more generally – is to integrate prior expectations about the world with new evidence from the senses. The question we addressed in this experiment was whether people with higher degrees of autistic traits are better at perceiving fine detail because they receive better sensory information (a bottom-up process), or because they rely less on prior expectations and take sensory information more at face value (a top-down process).
Title: Misinterpretation of facial expressions of emotion in verbal adults with autism spectrum disorder
Authors: Eack, Mazefsky and Minshew
DOI: 10.1177/1362361314520755
Lay abstract: The ability to accurately understand emotions presented in facial expressions is significantly affected in autism spectrum disorder (ASD). However, little is known about how individuals with ASD misinterpret facial expressions of emotion or whether such misinterpretations are associated with social and communication difficulties. This study examined the ability to recognize facial expressions of emotion in 45 verbal adults with ASD and 30 healthy volunteers to better understand the nature of these challenges in the adult ASD population. Results revealed that difficulty distinguishing emotional from non-emotional facial expressions characterized much of the impairments exhibited by participants with autism. In particular, adults with ASD only were more likely to mistake happy for neutral faces, and were more likely to attribute negative emotions to non-emotional faces. The tendency to misattribute emotions to neutral faces was related to greater communication and emotional intelligence difficulties in individuals with ASD. These findings suggest some potential negative lens when perceiving facial expressions of emotion and may have implications for interventions designed to improve emotion perception in ASD.
Title: Sensory experiences of children with autism spectrum disorder: In their own words
Authors: Kirby, Dickie and Baranek
DOI: 10.1177/1362361314520756
Lay abstract: To gain insights into the world of children with autism spectrum disorder (ASD), it is important to consider how the children describe their own experiences. Many children with ASD have unusual responses to sensations in their daily lives. For example, some children experience extreme sensitivities to loud noises or bright lights, or refuse to eat certain foods because of the taste or texture. Whereas others may seem oblivious to loud sounds or demonstrate unusual interests in spinning objects. Previous research on this topic primarily represents the perspectives of parents and professionals. In this study, we successfully interviewed 12 children with ASD, ages 4–13 with a wide range of ability levels, and analyzed how they described their sensory experiences. Our results provide insight into how they perceive these experiences and what aspects of the experiences are most important to them. Some children expressed that their sensory experiences were normal, or at least that they wanted them to be. Others used storytelling techniques such as anecdotes, demonstration, or internal dialogue to share about how their sensory experiences play out in their daily lives. The way the children spoke about their sensory experiences revealed the importance to them of how their bodies react to sensory stimuli; reactions they described included pain, fear, and uncontrollable physical responses. With an enhanced understanding of how children perceive these experiences, we can develop better supports and interventions for them to engage in meaningful activities in a multi-sensory world.
Title: Identification of infants at risk for autism spectrum disorder and developmental language delay prior to 12 months
Authors: Samango-Sprouse, Stapleton, Aliabadi, Graw, Vickers, Haskell, Sadeghin, Jameson, Parmele and Gropman
DOI: 10.1177/1362361314521329
Lay abstract: Studies have shown that an increased head circumference (HC) and the absence of the head tilt reflex (HTR) are possible risk factors for autism, allowing for the early detection of Autism (at 12 months) in typically developing infants. We aimed to develop a screening tool to identify infants prior to 12 months who were at risk for autism and developmental learning delay (DLD). We did not want this tool to be affected by literacy or the main language spoken by the parents, but that provides immediate determination of risk for autism. Infants were assessed for the presence or absence of this neonatal primitive reflex (HTR), and HC at their 4, 6 and 9 month well baby visits (WBVs). An abrupt acceleration of HC and the absence of HTR by 9 months were used to identify infants at risk for autism. We then investigated the stability of early findings compared with comprehensive neurodevelopmental assessment results and complete neurological and genetics evaluations of the child. This study demonstrates an efficient means to identify infants at risk of autism spectrum disorder (ASD) by 9 months of age and serves to alert primary care providers of infants who are vulnerable for ASD before symptoms are discernible by clinical judgment of the primary care physician, parental concerns or by screening questionnaires.
Title: Fixing the mirrors: A feasibility study of the effects of dance movement therapy on young adults with autism spectrum disorder
Authors: Koch, Mehl, Sobanski, Sieber and Fuchs
DOI: 10.1177/1362361314522353
Lay abstract: Since the 1970s, there have been case studies that have reported the effectiveness of a therapy involving mirroring the movements of children with autism spectrum disorder (ASD). In the present study, we tested a dance movement therapy (DMT) intervention based on mirroring movements in 31 young adults with ASD (mainly diagnosed with high-functioning autism and Asperger syndrome) with the aim of increasing body-awareness, social skills, self-other distinction, empathy, and well-being. We used a DMT-intervention implemented in hourly sessions once a week for seven weeks. The participants were split into a treatment group (16 participants) and a group who did not receive the intervention (15 participants). The participants in these groups were matched in terms of gender, age, and severity of symptoms. Participants were not involved in any other therapies for the duration of the study. After the treatment, participants in the intervention group reported improved well-being, improved body awareness, improved self-other distinction, and increased social skills. Results suggest that DMT can be an effective therapy approach for ASD, but future, larger studies are needed.
Title: Low endogenous neural noise in autism
Authors: Davis and Plaisted-Grant
DOI: 10.1177/1362361314552198
Lay abstract: Neurons in the human brain process information as changes in electrical activity. Many of these changes encode important signals, controlling how we think, move and perceive the world around us. Many other changes, however, seem to be random, encoding no information. These random fluctuations, often called ‘neural noise’, reduce our ability to detect faint patterns in a picture or to hear faint sounds. However, neural noise may also enhance some important brain functions. First, noise likely causes the brain to shift from thinking about, or looking at, one thing to thinking about or looking at another. While this can limit our ability to focus on a task, it prevents us getting stuck in one way of thinking or on one topic. Second, neural noise would be expected to increase how similar objects and situations seem to one another. This may reduce our ability to tell the difference between objects but also causes the brain to use what it has learned about one object or situation in many other similar cases. If these ideas about the effects of neural noise are correct, people whose brains have
less
neural noise than usual would be expected to see faint patterns or small objects very well. Their attention would tend to remain focused on one topic or way of thinking, and while they may learn quickly about a particular object in one in situation, they may not automatically apply that learning to slightly different objects or different situations. We suggest that the brains of children and adults with autism spectrum disorder (ASD) may have less neural noise than typical brains, bringing some benefits to those people, but also some difficulties.
Title: Emotion recognition from congruent and incongruent emotional expressions and situational cues in children with autism spectrum disorder
Authors: Tell and Davidson
DOI: 10.1177/1362361314535676
Lay abstract: In the present research, the emotion recognition abilities of children with autism spectrum disorder (ASD) and typically developing (TD) children were compared. When facial expressions and situational cues of emotion were congruent (e.g. a smiling girl opening a birthday present), accuracy in recognizing emotions was good for both children with ASD and TD children. When presented with facial expressions incongruent with situational cues, children with ASD relied more on facial cues than situational cues, whereas TD children relied more on situational cues. The exception was fear. When presented with incongruent information (i.e. a smiling boy surrounded by a swarm of bees), most children based their response on the situation and indicated that the boy felt scared. Compared with other emotional scripts, contextual cues describing a frightening situation may have more salience over an incongruent facial expression. Finally, while the majority of TD children spontaneously commented on the disparity between the facial expression and the contextual cues by providing copious reasons for the character’s emotional reactions, children with ASD rarely mentioned these conflicting cues. Because the level of verbal abilities was not so low as to preclude children with ASD from making similar spontaneous comments, it may be that they felt less compelled to explain the discrepancy. These findings suggest that children with ASD show an understanding of simple emotions in prototypical situations, but may prefer facial expressions when facial expressions and situational cues are incongruent. Reasons for these findings are discussed.
