Title: Use of complementary and alternative medicine in children and adolescents with autism spectrum disorder: A systematic review
Authors: Höfer, Hoffmann and Bachmann
DOI: 10.1177/1362361316646559
Lay abstract: Although little is known about their effectiveness, complementary and alternative medicine (CAM) treatments, for example gluten-free diets or animal assisted therapies, are commonly used in people with autism spectrum disorder (ASD). Before this study, it was not known how many people with ASD use CAM. The aim of this review was to summarize the available evidence on CAM use (and frequency) in ASD and to assess the quality of those studies.
We reviewed the existing literature on this topic, including all research studies in English or German that reported data on the frequency of CAM use in individuals with ASD. Two independent reviewers extracted information on study design and results, and assessed the quality of the studies.
Twenty studies with a total of 9540 participants were included. The frequency of any CAM use ranged from 28% to 95%. Special diets or dietary supplements (including vitamins) were the most frequent CAM treatments, ranking first in 75% of studies. Some studies suggest that children and adolescents with ASD use CAM treatments more frequently than children with other psychiatric disorders and children in the general population.
To summarize, approximately half of children and adolescents with ASD use CAM. Doctors should be aware of this and should discuss CAM use with patients and their carers, especially as the evidence is mixed and some CAM treatments are potentially harmful.
Title: Social analogical reasoning in school-aged children with autism spectrum disorder and typically developing peers
Authors: Green, Kenworthy, Gallagher, Antezana, Mosner, Krieg, Dudley, Ratto and Yerys
DOI: 10.1177/1362361316644728
Lay abstract: Analogical reasoning reveals the ways that different experiences are similar to each other, even when those experiences don’t seem the same on the surface. This makes analogical reasoning important for children’s developing understanding of the world around them. Recent evidence suggests that some forms of analogical reasoning may be preserved in autism spectrum disorder (ASD). An unanswered question is whether children with ASD can apply analogical reasoning to social information. Ninety-two children with ASD completed a social analogical reasoning task presented via photographs of real-world social interactions. Children with ASD performed well overall; their performance was not significantly worse than typical children of a similar age and level of ability. We also found that analogical reasoning improved with age at a similar rate in children with and without ASD. These findings provide new evidence of social analogical reasoning abilities in ASD, even on social tasks. This was despite children with ASD often struggling to process social content. As this is an initial study of social analogical reasoning in children with ASD, this study had a basic research question with limited applicability to the real-world. Evidence that children with ASD can apply analogical reasoning ability to social content in the real-world may have implications for exploring how this ability might be channelled to improve social abilities in daily life.
Title: Untended wounds: Non-suicidal self-injury in adults with autism spectrum disorder
Authors: Maddox, Trubanova and White
DOI: 10.1177/1362361316644731
Lay abstract: Non-suicidal self-injury (NSSI) is defined as deliberately injuring oneself without suicidal intent. Examples include self-cutting, burning, hitting, and scratching. Recent studies have examined NSSI in a variety of populations, but there is no published research on NSSI in individuals with autism spectrum disorder (ASD). This lack of research is surprising, since people with ASD have high rates of risk factors for NSSI, including depression and poor regulation of emotion. Using an anonymous online survey, we examined NSSI characteristics in 42 adults with ASD and compared them to 42 adults without ASD who engaged in NSSI. Of the survey respondents with ASD, 50% reported a history of NSSI. This proportion is higher than NSSI rates previously reported for college students, adults in the community, and teenagers with ASD, which suggests that adults with ASD have increased risk for engaging in NSSI during their lifetimes. NSSI characteristics among the adults with ASD were similar to NSSI in adults without ASD, suggesting that NSSI in the context of ASD is similar to NSSI in the general population. Our preliminary findings suggest that NSSI is a common problem among adults with ASD, although it may be overlooked in research and clinical practice. We discuss the need for increased awareness about NSSI within ASD. Future research is also needed to understand how to effectively prevent and treat NSSI in people with ASD.
Title: Trajectories and correlates of special education supports for youth with autism spectrum disorder and psychiatric comparisons
Authors: Spaulding, Lerner and Gadow
DOI: 10.1177/1362361316645428
Lay abstract: In the US, many youth with autism spectrum disorder (ASD) are eligible for supportive services through their school districts. However, little is known about the number and frequency of school-based supportive services or how the number of services change over time. A better understanding of these patterns would be useful for clinicians, teachers, and families. Among 283 youth with ASD, we calculated the number of school-based supportive services (such as speech therapy, counseling and physical therapy) received in their current grade and how the number changed over time. Interestingly, the overall number of supportive services youth received remained stable with increasing grade. As students reached higher grades, the most common supportive services (speech therapy, occupational therapy, social skills therapy) represented a smaller percentage of their overall service use. Another aspect of our study compared youth with ASD and 1088 non-ASD youth referred to an outpatient psychiatric clinic. We found that youth with ASD were more likely to receive special education and be placed in less inclusive classroom settings than youth with non-ASD psychiatric diagnoses. These findings suggest that school-based supportive service use and classroom placement change with age. Future research should consider why some supportive services are used less frequently in higher grades, how the symptoms of ASD impact eligibility for these services, and how the relation of these variables change with age.
Title: Understanding parents’ and professionals’ knowledge and awareness of autism in Nepal
Authors: Heys, Alexander, Medeiros, Tumbahangphe, Gibbons, Shrestha, Manandhar, Wickenden, Shrestha, Costello, Manandhar and Pellicano
DOI: 10.1177/1362361316646558
Lay abstract: Autism is a global phenomenon, affecting people in every country of the world. Yet, very little is known about how it is understood and how it affects children, families and communities in developing countries. We interviewed and listened to parents, teachers, doctors and other health workers in urban and rural Nepal, gathering information from a total of 106 individuals. We listened to parents who had a child diagnosed with autism and parents who did not. We used short stories of children both with and without behavioural and developmental difficulties to stimulate discussion. For example, we asked individuals how they thought children usually developed and what behaviours might make them worry. Only parents of autistic children and some doctors and teachers were aware of autism. Other parents and professionals did not use the word autism but instead used distinctive terms to describe children with autism – such as “stubborn” or “persisting”. These terms were different to those they used to describe children with other unusual behaviours or development. Most parents and professionals felt that factors outside the child, for example difficulties during pregnancy or birth, parenting style, and home or school environment, were key to explaining children’s developmental problems. These findings show for the first time the striking lack of awareness of autism by parents and professionals in Nepal. These results have important implications for future work designed to enhance support for Nepali autistic children and their families.
Title: Not knowing what I feel: Emotional empathy in autism spectrum disorders
Authors: Trimmer, McDonald and Rushby
DOI: 10.1177/1362361316648520
Lay abstract: The term empathy has been studied extensively in scientific research. Empathy is believed to involve both a cognitive component (understanding another person’s feelings, beliefs and intentions) and an emotional component (sharing or experiencing another person’s feelings). Most researchers in the field of Autism Spectrum Disorder (ASD) agree that individuals with ASD have difficulty with cognitive empathy, but much less is known about emotional empathy in ASD. Tests to measure this have usually focused on individuals reporting empathy themselves, in questionnaires, rather than by objective means, such as measurable physiological responses by the body. This study examined both physiological responses (e.g. levels of arousal, frown responses) and self-reported emotional empathy in young adults with ASD and a group of typical individuals of a similar age, whilst they watched emotionally distressing video scenes. The results of the study indicate that whilst those with ASD showed very similar physiological responses when watching the emotional videos, they did not interpret this physiological response as being an emotional one.
Title: Asperger syndrome in males over two decades: Quality of life in relation to diagnostic stability and psychiatric comorbidity
Authors: Helles, Gillberg, Gillberg and Billstedt
DOI: 10.1177/13623613650090
Lay abstract: Quality of life (QoL) refers to the general well-being of an individual. QoL can be divided into subjective (self-perceived) and objective (employment, relationships, education, living conditions) aspects. In this study we examined both objective and subjective QoL in a group of 50 males who had been diagnosed with Asperger syndrome (AS) in childhood and had been followed up over a period of 19 years. Of the whole group, 22% no longer met criteria for AS or any other Autism Spectrum Disorder (ASD). This subgroup functioned quite well, both regarding subjective and objective QoL. Another subgroup (30% of the group) still met criteria for ASD after 19 years and had no other psychiatric disorder (e.g. depression, anxiety, Attention Deficit Hyperactivity Disorder, Obsessive Compulsive Disorder). This group also functioned well regarding subjective QoL, but had extremely varied objective QoL, ranging from having low independence to functioning quite well with just minor support, with most functioning somewhere in between. Lastly, a subgroup (48% of the group) still met criteria for ASD and also for at least one other psychiatric disorder (most commonly depression or ADHD). This group also had extremely varied objective QoL, ranging from having low independence to functioning quite well with just minor support, with most functioning somewhere in between. They were the only subgroup with low subjective QoL. Most objective QoL factors were associated with ASD symptoms, but academic success was associated with high IQ.
Title: Autism spectrum disorder reporting in lower socioeconomic neighborhoods
Authors: Dickerson, Rahbar, Pearson, Kirby, Bakian, Bilder, Harrington, Pettygrove, Zahorodny, Moyé III, Durkin and Slay Wingate
DOI: 10.1177/1362361316650091
Lay abstract: The Autism and Developmental Disabilities Monitoring (ADDM) Network is group of programs funded by the United States Centers for Disease Control and Prevention (CDC) tasked with estimating the number of children with autism spectrum disorder (ASD) and other developmental disabilities living in different areas of the United States. In this study, data were collected from five sites participating in the ADDM Network. We investigated whether characteristics of children with ASD, as well as the characteristics of residents living in the same neighborhoods, influenced how commonly ASD was reported from the years 2000 to 2008 in 2,489 census tracts (geographic regions defined for the purpose of taking a census). Analyses showed that the percentage of children with ASD who had both school and healthcare records increased with the percentage of children with ASD whose mothers had at least a bachelor’s university degree. We also found that there were fewer children with ASD having both school and health records in areas with more Hispanic residents. Conversely, there were more children with both school and health records in areas with more college-educated residents. Overall, we have identified factors associated with ASD reporting, which include race, ethnicity, education, and income. Figuring out which specific factors reduce access to services, and consequentially reduce ASD reporting is complicated; however, it appears that the influence of ethnicity can still be a key factor regardless of area education levels. These results suggest that race and income may influence access to ASD diagnostic clinics and special education services, potentially impacting the reported rates of ASD.
Title: The effects of an early motor skill intervention on motor skills, levels of physical activity, and socialization in young children with autism spectrum disorder: A pilot study
Authors: Ketcheson, Hauck and Ulrich
DOI: 10.1177/1362361316650611
Lay abstract: Recent research has shown that one of the first indicators of an eventual diagnosis of Autism Spectrum Disorder (ASD) is a delay in achieving several early motor milestones. Despite these findings, to date, there are very few interventions that specifically address motor skills in ASD. The purpose of this study was to examine the effects of an intensive motor skill intervention on motor skills, levels of physical activity and socialization in ASD. Twenty preschool aged children with ASD (aged 4–6) participated in this study. An ‘experimental group’ of 11 children participated in an 8-week long intervention that included direct motor skill instruction for 4 hours per day, 5 days per week. A ‘comparison group’ comprising nine children did not receive the intervention. The motor skills and socialization abilities of the experimental group significantly improved following the intervention. Findings highlight the importance of including motor skills in the early intervention of young children with ASD.
Title: The development trajectory of parent-report and objective sleep profiles in autism spectrum disorder: Associations with anxiety and bedtime routines
Authors: Fletcher, Foster-Owens, Conduit, Rinehart, Riby and Cornish
DOI: 10.1177/1362361316653365
Lay abstract: Many children with autism spectrum disorder (ASD) experience sleep problems. We aimed to examine how these sleep problems change over time, and how these changes may be related to other factors; such as anxiety or bedtime routines. We measured sleep using both parent-report questionnaires and actigraphy (a small device worn on the wrist which is used to measure sleep-wake patterns). Children with ASD were characterised by more parent-reported sleep problems than children without ASD. Over a 12-month period, we found that an increase in parent-reported sleep problems was associated with an increase in parent-reported anxiety, and vice versa. From actigraphy, we found that children with ASD took longer to fall asleep and spent less time asleep (relative to time spent in bed), than children without ASD. Over the same 12-month period, we found that an increase in the time taken to fall asleep was associated with an increase in the frequency of maladaptive behaviours in the hour before bedtime (e.g. playing video games), and vice versa. These results suggest that anxiety and sleep hygiene may play a role in the way in which sleep problems change and persist over time in children with ASD.
Title: The relationship between autism symptoms and arousal level in toddlers with autism spectrum disorder, as measured by electrodermal activity
Authors: Prince, Kim Wall, Gisin, Goodwin, Simmons, Chawarska and Shic
DOI: 10.1177/1362361316648816
Lay abstract: Autism spectrum disorders (ASD) are characterized by impairments in social communication and the presence of restricted and repetitive behaviors. One theory for why these symptoms occur is that individuals with ASD have problems with regulating arousal in social situations (e.g. they may be under or over aroused). Previous work has demonstrated that arousal regulation and dysregulation (i.e. impairments in regulating arousal) can be detected in individuals with ASD in social contexts by looking at changes in the electrical activity of the skin, known as electrodermal activity (EDA). However, much of this prior work has been done in older individuals with ASD and in tightly-controlled, laboratory settings. Therefore, in this study, we evaluated a younger age group and examined EDA in a naturalistic, social context.
For this study, 2-year olds with and without ASD wore a wireless EDA sensor on their calves while playing with different toys, including animal figurines, books, cars, wind-up toys, and bubbles. After the visit, we looked at how much EDA had changed when the toddlers played with the different types of toys. Toddlers with autism showed more of an increase in EDA than typically developing toddlers overall. Furthermore, the group with ASD displayed more restricted and repetitive behaviors as their EDA increased when playing with the cars and wind-up toys.
This preliminary work is an important step towards understanding the relationship between heightened physiological responses to social information and ASD, especially early in development. It is the first study to examine EDA in such a young population in a social play situation. Our findings support the heightened response theory of autism and suggest that EDA may relate to specialized interests in mechanical toys and difficulties with imaginative play.
