Teaching preschool age autistic children to make spontaneous initiations to peers using priming

Children with autism rarely initiate social interactions with their peers. Currently available interventions have not increased autistic children' spontaneous initiations in natural settings without extensive teacher involvement. A priming strategy consisting of a low demand, high reinforcement session prior to the regular school activity was used to increase the spontaneous social initiations of 2 preschool age autistic boys to typically developing peers in a regular preschool classroom. Peers were also trained to independently respond to initiations. Implications for developing practical ways to improve autistic children's social functioning in regular school settings are discussed.     

Social attachments in autistic children

Social responses of young autistic children to separation from and reunion with their caregivers did not differ from the social responses to similar situations of young mentally retarded nonautistic children. Most autistic children directed more social behaviors to their caregivers than to strangers and increased their preferential behavior after separation. Individual differences in social responses were not associated with the level of representational skills shown by the autistic children.     

Effects of peer-mediated social initiations and prompting/reinforcement procedures on the social behavior of autistic children

Peer-mediated social initiations and prompting/reinforcement procedures were evaluated (in training and generalization sessions) as interventions for increasing the positive social behavior of four autistic children. During base-line, the peer trainer made few social initiations and did not prompt or socially reinforce subjects. For two subjects, baseline was followed by social initiation intervention, and for the other two, baseline was followed by prompting and social reinforcement. Both interventions produced dramatic and comparable increases in positive social behavior in training sessions. Post-treatment responding was not observed for either intervention. When interventions terminated in a second baseline period, the subjects' behavior returned to the level observed during the initial baseline. The subjects were then exposed to the intervention procedure they had not yet experienced. Again, there were positive and comparable behavior changes in the treatment setting, but no increase in positive social behavior was observed during generalization assessment.     

Hand dominance of parents and other relatives of autistic children

Hand preferences of 219 mothers and 186 fathers of autistic children were assessed using the Annett Handedness questionnaire. Subgroups of 54 mothers and 57 fathers with a family history of language-related developmental disorders were identified. Parents also reported the handedness of other relatives. Mothers (but not fathers) in the main group were significantly more likely to be consistently right-handed than females in the general population, but this was not specifically associated with a family history of language problems. There was no evidence of an increased incidence of consistent left-handedness in either the whole group of parents or the subgroups. Reported handedness of other relatives showed no abnormal distribution in relation to a comparison group. The findings are discussed in relation to theories about genetic factors in language-related developmental disorders in general, and autism in particular.     

Social skills training with verbal autistic adolescents and adults: A program model

An ongoing social skills training program was implemented with 15 verbal autistic adolescents and adults. The major long-range goals were for the participants to have positive peer-related social experiences in a supportive atmosphere and to learn useful skills in this way. Short-term training objectives included how to meet other people, stay on a topic of conversation, ask questions, pay attention, and express one's feelings and emotions. Teaching techniques included modeling, coaching, and role-playing. Preliminary indications suggest that the main goals and training objectives were being accomplished and that clients were progressing in their conversational skills, their selection of relevant topics, and their perceptions of themselves. The implications of this program for the understanding and treatment of autistic adolescents and adults is described, as well as the viability of a social skills training model. The need for more research on this most important issue is highlighted. The author gratefully acknowledges the invaluable assistance of Bruce Schaffer, Janet Martin, Amy Woods, Rhoda Landrus, Joanne Honeycutt, Marie Bristol, Pat Fennell, and the other TEACCH staff and students who have participated in the groups and helped to conceptualize the program.     

Atypical antipsychotics in children and adolescents with autistic and other pervasive developmental disorders

Atypical antipsychotics are emerging as the first-line pharmacologic treatment for irritability (i.e., aggression, self-injurious behavior, and severe tantrums) in children and adolescents with autistic and other pervasive developmental disorders. Results from placebo-controlled and open-label studies of clozapine, risperidone, olanzapine, quetiapine, ziprasidone, and aripiprazole in this subject population are reviewed. Additional placebo-controlled trials and studies of longer-term safety and tolerability are needed.     

Fluoxetine treatment of children and adults with autistic disorder and mental retardation.

An open trial of pharmacological treatment with fluoxetine, ranging from 20 mg every other day to 80 mg per day, led to a significant improvement in Clinical Global Impressions ratings of Clinical Severity in 15 of 23 subjects with autistic disorder and 10 of 16 subjects with mental retardation. Six of 23 patients with autistic disorder and 3 of 16 patients with mental retardation had side effects which significantly interfered with function, consisting predominantly of restlessness, hyperactivity, agitation, decreased appetite, or insomnia. Double-blind studies of the efficacy of pharmacological agents that potently inhibit 5-HT uptake in the treatment of mental retardation coexisting with Axis I psychiatric disorders (especially obsessive-compulsive disorder) and autistic disorder are warranted.     

Chinese autistic children

Summary The 14 Chinese autistic children studied have similar backgrounds and symptomatology to their Western counterparts. They differed in being more socialized and more aware of themselves. On the 204-item questionnaire, parents provided the most uniform response indicating their child had very sensitive hearing. Auditory hyperacuity might explain an autistic child's apparent aversion to communicating.     

Humor in high-functioning autistic adults

This study examined the humor used by a group of autistic adults. Subjects were nine autistic adults who were participating in a Social Skills Group. The jokes they told during a designated joke time over 15 consecutive group sessions were analyzed according to their developmental levels. The participants told a total of 87 unique jokes, almost all of which were riddles. The most common types were preriddles and those having lexical and phonological ambiguity. Along with empirically examining the jokes used by this group of high level autistic adults, the study demonstrates that they enjoy a wide range of jokes and that humor seems to enrich their lives.     

Training social initiations to a high-functioning autistic child: Assessment of collateral behavior change and generalization in a case study

The present case study used a multiple treatment design to assess the effects of two interventions—Peer social initiations and target child initiations— on the social and disruptive behavior of a high-functioning autistic child. Intervention included initiation training and videotaped feedback highlighting successful and unsuccessful initiations. During Interventions 1 and 2, nonhandicapped peers were trained to initiate social interaction with the autistic child, resulting in an increase in social interaction which dramatically decreased in a reversal phase. Social interaction quickly increased again in Intervention 3 when the autistic child was trained to initiate interaction using the same procedures. During Interventions 1 and 2 no decrease in the autistic child's disruptive behaviors was observed; however during Intervention 3 these behaviors decreased to a low rate. Social validation, generalization, and maintenance of these behavior changes are discussed.This research was supported by U.S. Public Health Service research grants MH 39434 and MH 28210 from the National Institute of Mental Health. The authors are grateful for the participation of the children and the parents. We thank the teachers for their cooperation in the school setting. We also thank Lauren Loos, Kim Litzenberg, and Wendy Kaneko for all their assistance on scoring procedures and data collection and Jamie Reed-Sutton for her assistance collecting social validation data.     

Factors related to outcome in autistic children

Thirty-two autistic children, identified in an epidemiological survey in England when they were 8 to 10 years old, were followed up 8 years later. The best single predictor of outcome was a measure of speech. Speech and IQ together correlated more highly with outcome than did any other combination of variables. The frequency of family mental illness was similar to that found in comparable studies. Onset of fits in adolescence in some autistic children confirms that evidence of neurological abnormalities increases with age. Subclassification among autistic children is urged. A scheme is offered which identifies main areas of uncertainty in classification.     

Social stigma for adults and children with epilepsy

Summary   For many people with epilepsy, the continuing social reality of their condition is as a stigma. Epilepsy stigma has three different levels; internalized, interpersonal, and institutional. While there have been documented improvements in public attitudes towards epilepsy, the remnants of "old" ideas about epilepsy continue to inform popular concepts resulting in a difficult social environment for those affected. The social and quality of life problems arising from a diagnosis of epilepsy can represent greater challenges than are warranted by its clinical severity. The relationship between stigma and impaired quality of life is well documented. Tackling the problem of stigma effectively requires that all three of different levels at which it operates are systematically addressed.     

Social adjustment and placement of autistic children in Middlesex: A follow-up study

A follow-up study of 32 autistic children identified in an epidemiological survey when they were 8 to 10 years of age and investigated 8 years later at 16 to 18 years of age is presented and discussed. Outcome is described in terms of general social adjustment, employment, and placement history. Results are contrasted with those for a comparison group identified in the original survey and those reported for comparably defined children in other studies. Only one autistic child was employed, and outcome was in general worse for the autistic group in which 62% required extensive care and supervision. There does not seem to be a direct relationship between employability and amount of schooling. Expectations with respect to outcome can be indicated with some confidence for comparable groups.This paper is based on research supported by a grant MH20537 awarded by the National Institute of Mental Health.     

Manipulating establishing operations to promote initiations toward peers in children with autism

This study examined the effects of manipulating establishing operations on the frequency of initiations of three children with autism toward peers with autism. The EO targeted was deprivation of preferred edibles, and the target initiation was a mand for the preferred snack. A reversal design was used to assess the effects of the EO conditions on frequency of initiations. Results indicated that when the EO was absent, no spontaneous initiations toward the peer occurred. Two participants required training sessions with an adult to transfer initiations toward peers. Once the EO had been established and was present, the participants initiated mands for the snack. Results are discussed in terms of implications for the use of establishing operations in language training for children with autism.     

Teaching self-help skills to autistic and mentally retarded children

Three autistic, mentally retarded children, ranging in age from 4 to 11 years, and a six-year-old mentally retarded girl, were taught various adaptive behaviors using a multiple baseline design. Skills taught were shoe typing, toothbrushing, hair combing, putting on pants, shirt, and socks, and eating and drinking. Training included modeling, verbal instructions, prompting, and edible and social reinforcement. Treatment procedures involved the whole-task method of teaching self-help skills and consisted of three phases: (a) the trainer modeled and verbally described the target behavior; (b) the trainer physically and verbally guided the child through the entire sequence of task-analyzed steps; and, (c) the child was instructed to perform the behavior independently. The results of this study and their implications for future research are discussed.     

Leukodystrophies and other genetic metabolic leukoencephalopathies in children and adults

Abnormalities of CNS white matter are frequently detected in patients with neurological disorders when MRI studies are performed. Among the many causes of such abnormalities, a large group of rare genetic diseases poses considerable diagnostic problems. Here we present a compilation of genetic leukoencephalopathies to consider when one is confronted with white matter disease of possibly genetic origin. The table contains essentials such as age at onset of symptoms, clinical and MRI characteristics, basic defect, and useful diagnostic studies. The table serves as a diagnostic check list.     

The use of personal pronouns by autistic children

Spontaneously echolalic autistic children who had never used the pronoun Iwere exposed to short sentences containing several personal pronouns in all positions in a 3-word utterance. It was found that there was no tendency for children to avoid the repetition of I,once sentence position was controlled. A number of children echoed the final word of the sentence while others repeated the whole utterance. The findings provide no support for a psychogenic theory of speech behavior in autistic children.We are grateful to the principal and staff of the school from which subjects were drawn for their ready cooperation in providing facilities for testing the children and to parents for their permission to include their children in the study. The study was carried out with the financial support of the United Kingdom Department of Education and Science and the Calouste Goulbenkian Foundation as part of a wider follow-up.     

Handedness in autistic children

A test of handedness in a sample of 20 autistic children and 25 normal children revealed marked differences. The frequency of non-right-handedness in normal children was 12%, whereas it was 65% in autistic children. The significance of this difference for the etiology of autism is discussed.     

Self-recognition in autistic children

The hypothesis that the autistic child's impairment in social relatedness stems in part from underlying deficits in self-recognition was explored. Fifteen autistic children ranging from 4 to 6 years of age were assessed for visual self-recognition ability, as well as for skills in two cognitive areas that are believed to be related to the development of self-recognition — object permanence and gestural imitation. It was found that 13 of 15 autistic children showed evidence of self-recognition. The two autistic children who lacked self-recognition were the only two children to perform poorly on the object permanence tasks, which suggests that these two cognitive domains may be closely linked in development. In contrast, there appeared to be no consistent relationship between motor imitation ability and self-recognition. It was concluded that the autistic child's social deficits are not due to a basic lack of differentiation between self and other. This research was funded by the University of North Carolina Research Council. Part of the data presented here were from Fawn McKissick's undergraduate honors thesis from the University of North Carolina at Chapel Hill. We express our sincere appreciation to the autistic children who participated in the study, and to their parents, and to the staff of the TEACCH Division, Department of Psychiatry, University of North Carolina, for their assistance and cooperation. We would also like to thank several persons for their help in data collecting and coding: Karen Cotten, Pete Giordano, Vickie Hall, Lee Hendrix, Shari Jernigan, Kevin Lumley, Cindy Seagroves, Sheryl Solomon, Kathy Stetson, and Jeannie Teasley. Mary Lynn Eckert provided editorial and secretarial support. Dr. Robert Cairns made helpful comments on this paper.