Risk Factors Associated with Self-Injurious Behaviors in Children and Adolescents with Autism Spectrum Disorders

While self-injurious behaviors (SIB) can cause significant morbidity for children with autism spectrum disorders (ASD), little is known about its associated risk factors. We assessed 7 factors that may influence self-injury in a large cohort of children with ASD: (a) atypical sensory processing; (b) impaired cognitive ability; (c) abnormal functional communication; (d) abnormal social functioning; (e) age; (f) the need for sameness; (g) rituals and compulsions. Half (52.3%, n?=?126) of the children (n?=?241, aged 2–19?years) demonstrated SIB. Abnormal sensory processing was the strongest single predictor of self-injury followed by sameness, impaired cognitive ability and social functioning. Since atypical sensory processing and sameness have a greater relative impact on SIB, treatment approaches that focus on these factors may be beneficial in reducing self-harm in children with ASD.     

The quality of life of parents of children with autism spectrum disorder: A systematic review

BackgroundPrevious research has raised concerns about the quality of life (QoL) of parents of children with autism spectrum disorder (ASD). A better understanding of parental QoL can inform clinicians and policymakers and lead to improved outcomes for both parents and children.AimsThis review aimed to systematically examine studies measuring the QoL among parents of children with ASD (<18 years) and to investigate its parental, child-related and contextual associated factors.MethodologyAn electronic database search was conducted using Medline, Psycinfo, Embase, CINAHL, Biosis, ASSIA, Social Services Abstracts, Sociological Abstracts and Open grey.ResultsThis review indicated poorer QoL among parents of children with ASD compared to parents of typically developing children or to population norms. Variables associated with lower parental QoL within this group included child behavioural difficulties, unemployment, being a mother and lack of social support.ConclusionThis review verified previous reports on lower QoL among parents of children with ASD and highlighted potential areas of support. Implications for future research, policy and practice are discussed.     

Psychopharmacologic intervention for adults with autism spectrum disorder: A systematic literature review

BackgroundThe increased recognition of psychiatric and behavioural disorder in adults with autism spectrum disorder (ASD) has been associated with more frequent use of psychopharmacologic intervention in this population. However, limited evidence supports the effectiveness of these interventions for adults with ASD.ObjectiveTo review and synthesise the evidence regarding the effectiveness of psychotropic medication in reducing behavioural disturbance in adults with ASD.Data sources and study selectionElectronic literature search of PubMed plus manual reference checks of all articles on psychopharmacology in adults with ASD published in the English language between 1985 and 2015.Results and conclusionsA total of 43 studies were included in the analysis. The results indicate that only two medications, fluoxetine and risperidone, can be considered as promising evidence-based practices for adults with ASD. Given the rising prevalence of ASD, along with increased use of psychopharmacologic intervention in this population, there is a clear need for methodologically rigorous research to establish the effectiveness of these interventions. The subsequent establishment of clinical guidelines for medication use in this population is essential.     

Family level processes associated with outcomes for individuals with autism spectrum disorder: A scoping review

BackgroundFamilies of individuals with autism spectrum disorder (ASD) face distinct challenges, and there is a need for research that attends specifically to the family. Despite the recognition of reciprocal influences in the family, research on families of individuals with ASD has tended to focus on child effects within a dyadic subsystem and not necessarily family effects. Thus, this review focuses on whether and how family processes are associated with the behavioral, social, and/or emotional development of individuals with ASD.MethodA scoping review was conducted to synthesize existing empirical literature regarding links from family functioning to individual outcomes. Family systems approaches are used along with ecological models to provide an inclusive, guiding framework for research design and interpretation of findings in family-based ASD research.ResultsResults suggest that family-wide factors such as adaptability, cohesion, social support, dynamics, and functioning may be important for child development. However, the heterogeneity of the body of literature reviewed makes definitive conclusions difficult.ConclusionsRecommendations for future research, including the need for theoretically grounded, developmentally appropriate, models that highlight the unique strengths, challenges, and cultural influences of families of an individual with ASD are discussed.     

A systematic literature review of the experiences and supports of students with autism spectrum disorder in post-secondary education

BackgroundPost-secondary students with ASD experience a range of academic and non-academic difficulties and represent approximately one percent of the post-secondary cohort. The purpose of this review is to conduct a systematic literature review of articles that examined the barriers, challenges, and benefits experienced by post-secondary students with ASD, and the supports and services provided to them, and also to analyze student satisfaction with those supports.MethodThree databases were searched and articles were screened against eligibility criteria.The twenty-three studies (reported in twenty-nine articles) that met criteria were also assessed for quality. Data pertaining to the benefits, challenges, and barriers experienced, and student satisfaction with supports and services provided, were extracted and analyzed.ResultsThe studies highlighted the diverse range of social, emotional and sensory difficulties experienced by students with ASD, and how those difficulties negatively impacted all aspects of their post-secondary education. Also, the supports provided were often incongruous with need and produced idiosyncratic benefits, demonstrating the need for individualized supports and novel solutions to be identified. Suggestions for future research were made.ConclusionsWhile prior research on post-secondary students with ASD is limited and geographically circumscribed, the current body of research suggests that students with ASD are often more concerned with non-academic issues than with their academic studies. Also, many post-secondary educational institutions were found proficient at providing traditional academic supports while non-academic supports and resources were often found inadequate. In addition, many students with ASD experienced anxiety or had poor advocacy skills and this impeded their ability to access available supports. Finally, students with ASD were found to be very diverse and to experience idiosyncratic responses to supports, suggesting that supports ideally needed to be individualized, ubiquitous, and continually monitored.     

Picture of Autism Spectrum Disorder (ASD) Research in West Africa—A Scoping Review

Research evidence is required to guide health policy and capacity development on specific health condition. Despite the high prevalence of autism spectrum disorders (ASD) worldwide, there is dearth of data in the West African sub-region to inform evidence-based policy and practice. This review aimed to describe the volume and scope of existing research evidence on ASD across countries in the West African sub-region. This is with the view of identifying gaps in research and capacity development.MethodsLiterature search was done for all original peer-reviewed research articles on ASD in each of the West African Countries using PubMed, Google Scholar, Google search, African Index Medicus and a direct search of reference list of pertinent journal articles. Publications included were peer-reviewed original articles, irrespective of their quality, carried out within the West African countries and which were available in English or translated to English. Case reports, dissertations, abstracts, publications whose primary focus was not ASD, and studies on ASD among West African populations living outside the sub-region were excluded. The methodological framework described by Arksey and O’Malley (2005) was used to synthesize and present the results.ResultsA total of 41 studies that met the inclusion criteria across 5 countries in the sub-region were identified. Five thematic areas emerged from the literature, namely; prevalence/associated factors, professional knowledge and attitude, family and social aspects of ASD, screening/diagnosis and interventions/treatment. Only 6 out of the 16 countries in the sub-region had at least one study with the bulk of the research coming from Nigeria. Research articles on the prevalence/associated factors and professional knowledge of ASD appear modest in the sub-region. A huge gap still exists in the area of epidemiology, aetiology, diagnosis and treatments/intervention.ConclusionFurther research is needed in the identified gaps in the sub-region and this cannot be done without addressing deficit in human capacity development. The results of this study will be useful in comprehensive policies and action plan development for addressing the problems of persons with ASD and capacity development in the sub-region.     

Social anxiety in adult males with autism spectrum disorders

BackgroundPsychiatric conditions, notably anxiety, commonly co-occur with autism spectrum disorders (ASD).MethodThis study investigated self-reported behavioural, cognitive and affective symptoms of social anxiety (SA) in 50 adult males with ASD. Associations between SA, core ASD symptoms and facets of neuropsychological functioning were also examined.ResultsTwenty-six participants (52%) endorsed levels of SA that exceeded the suggested caseness threshold for social anxiety disorder. Categorical and dimensional data analyses indicated that there were no relationships between SA symptoms, present-state or childhood ASD symptom-severity, or measures of socio-emotional processing in this sample.ConclusionsStudy findings suggest that severity of SA is not merely a reflection of ASD symptom-severity. Further research is needed to ascertain the prevalence of SA in adult ASD epidemiological samples, and identify causal and maintaining mechanisms for these co-morbid symptoms.     

Stereotyped behaviours in children with autism spectrum disorders and atypical development as measured by the BPI-01

Objective: As repetitive behaviours in children with autism spectrum disorders (ASDs) can significantly interfere with one's daily functioning, continued research on these behaviours is needed.

Methods: This study examined the occurrence of repetitive motor movements in toddlers (17–37 months) with ASD and atypical development and the relationship between stereotypies and sensory impairment.

Results: Children with ASD (n?=?13) exhibited significantly more repetitive behaviours than the non-ASD group (n?=?12). Greater percentages of endorsement were evident for the ASD group on nearly all items of the Behaviour Problems Inventory-01 (BPI-01) Stereotypy subscale. More repetitive behaviours tended to co-occur with other stereotypies for the ASD group. A moderate correlation was found between stereotypy severity and sensory deficits.

Conclusion: These findings suggest that stereotyped behaviours can be identified at very young ages, negatively affect the behavioural presentation of those with ASDs and should be considered when developing treatment plans.     

The Relationship Between Autistic Traits and Atypical Sensory Functioning in Neurotypical and ASD Adults: A Spectrum Approach

Sensory processing atypicalities are a common feature in Autism Spectrum Disorders (ASD) and have previously been linked to a range of behaviours in individuals with ASD and atypical neurological development. More recently research has demonstrated a relationship between autistic traits in the neurotypical (NT) population and increased levels of atypical sensory behaviours. The aim of the present study is to extend previous research by examining specific patterns across aspects of autistic traits and sensory behaviours within both ASD and NT populations. The present study recruited 580 NT adults and 42 high-functioning ASD adults with a confirmed diagnosis to investigate the relationship between specific aspects of autistic traits and sensory processing using the subscales of the autism spectrum quotient (AQ) and adult/adolescent sensory profile (AASP). Results showed a significant relationship between all subscales except for attention to detail and imagination on the AQ and provided the first evidence that the strength and pattern of this relationship is identical between NT and ASD adults. These data also provided support for the broader autism phenotype, uncovering a clear progression of sensory atypicalities in line with an increase in autistic traits, regardless of diagnostic status, which has potential implications for the spectrum approach to ASD and how sensory behaviours across the whole of the neurotypical population are conceptualised.     

Causal explanations, concern and optimism regarding self-injurious behaviour displayed by individuals with Cornelia de Lange syndrome: the parents' perspective

Research into behaviours associated with specific syndromes, such as Cornelia de Lange syndrome (CdLS), has neglected to explore the parents' perspective, particularly the potential impact of the notion of behavioural phenotypes on parents' causal explanations. Given the research focus on self‐injurious behaviour (SIB) in CdLS, the present study examined parental concern across four topographies of challenging behaviour, causal explanations for these behaviours and optimism for change. As part of a larger study, a questionnaire survey of 86 parents of children and adults with CdLS was conducted. Quantitative data on parental concern and optimism with regard to behaviour problems were collected. Causal explanations for behaviour problems were examined by subjecting open‐ended responses to a content analysis. Parents were as concerned about physical aggression and disruptive behaviours as they were about SIB. The majority of parents had deconstructed how CdLS might be associated with SIB in terms of other factors associated with CdLS, such as degree of intellectual disability. Parents did not believe that CdLS influenced SIB more than other challenging behaviours and their beliefs did not effect optimism regarding future change in the behaviour. Despite the focus of research on SIB in CdLS, parents of children and adults with CdLS are also concerned about other challenging behaviours. There was no evidence that a deterministic perspective had been adopted by parents and causal explanations were unrelated to optimism for future change.     

An investigation of self-injurious behaviors in adults with severe intellectual disabilities

Self-injurious behavior (SIB) is commonly observed among individuals with intellectual disability (ID) living in state-run supports and services centers. Specific examples of SIB include poking oneself in the eye; harming oneself by hitting, scratching, or pinching; and pica (i.e., swallowing objects causing bodily harm). Previous research has focused on SIB in individuals with ID more generally without focusing on specific levels of ID or taking into account other important personal variables. This study examined 45 adults with severe ID living in two large state-run facilities in the Southeastern United States who were separated into groups for comparison (ASD and non ASD; verbal and nonverbal). Data was collected on the presence of SIB using the Autism Spectrum Disorder-Problem Behavior Adult Version (ASD-PBA). A two-way analysis of variance (ANOVA) was conducted to determine if there were significant differences between groups on rates of SIB. Individuals with ID and ASD exhibited significantly higher rates of SIB than individuals with only ID, F (1,43) = 50.84, p < 0.05. Furthermore, verbal individuals had significantly higher rates of SIB than nonverbal individuals, F (1,43) = 57.612, p < 0.05. There was a significant interaction between the effects of ASD diagnosis and verbal ability on rates of SIB, F (1,43) = 50.84, p < 0.05. The implications of these findings in the context of other research on ID, ASD, SIB, and verbal abilities are discussed.     

Neurodevelopmental correlates of behavioural and emotional problems in a neuropaediatric sample

Most research does not address the overlap between neurodevelopmental disorders when investigating concomitant mental health problems. The purpose of the present study was to examine the association of intellectual disability (ID), autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD) with the presence of behavioural and emotional problems after controlling for other well-known correlates and risk factors. The sample included 4- to 18-year-old children who attended neuropaediatric clinics (N = 331). After controlling for adversity, age, gender, other developmental/neurological disorders, parental emotional problems, and parenting strategies, the presence of ADHD but not ASD or ID was uniquely associated with behaviour problems. Neither ADHD nor ASD nor ID was significantly associated with emotional problems after controlling for other risk factors. However, ADHD, ASD and behavioural/emotional disorders but not ID were significantly associated with functional impairment in everyday activities after controlling for other risk factors. Because children with neurodevelopmental disorders have complex needs, a holistic approach to diagnosis and interventions is highly warranted, including the assessment and treatment of behavioural and emotional disorders.     

Interoception in Autism Spectrum Disorder: A review

PurposeThis review article summarizes original scientific research published to date on interoception in individuals with Autism Spectrum Disorder (ASD). Sensory processing has been shown to be atypical in ASD, yet physiological processing and subjective experience of internal sensation processing, namely interoception, has not been reported sufficiently in research or clinical settings.BackgroundThere is a small but growing body of scientific research on interoception in ASD, which is relevant to understanding the behavioral and cognitive characteristics inherent in this condition, and may provide a foundation for clinical interventions such as biofeedback, pain management, and brain stimulation techniques.MethodsA literature review of original research was performed using major scientific databases.ResultsInteroception, which occurs due to multisensory connections and integration of internal afferents in cortical and subcortical areas, is atypical in ASD, but the degree and directionality of this abnormality is not yet clear due to the heterogeneity of the condition. Between-group interoceptive differences in individuals with and without ASD have been repeatedly demonstrated, with a slight tendency towards hyporeactivity in interoceptive awareness in individuals with ASD.SignificanceMultidimensional research combining neuroimaging with psychophysiological and self-report measures guided by a clear theoretical model is necessary to understand how interoceptive differences link to the behavioral and cognitive characteristics of ASD. Sensory processing models and autism theory should also be updated to incorporate these recent findings.     

Potential Risk Factors for the Development of Self-Injurious Behavior among Infants at Risk for Autism Spectrum Disorder

Prevalence of self-injurious behavior (SIB) is as high as 50% among children with autism spectrum disorder (ASD). Identification of risk factors for the development of SIB is critical to early intervention and prevention. However, there is little empirical research utilizing a prospective design to identify early risk factors for SIB. The purpose of this study was to evaluate behavioral characteristics predicting SIB at age 2 years among 235 infants at high familial risk for ASD. Logistic regression results indicated that presence of SIB or proto-SIB and lower developmental functioning at age 12 months significantly predicted SIB at 24 months. A pattern of persistent SIB over this period was associated with a diagnosis of autism and poorer cognitive and adaptive outcomes.     

A systematic review of problematic video-game use in people with Autism Spectrum Disorders

BackgroundIn recent years, an increasing number of studies documented potential links between gaming disorders (GD; including “digital-gaming” or “video-gaming”) and Autism Spectrum Disorders (ASD). Therefore, the aim of this systematic review was to summarize current research about problematic video game (PVG) use in people with ASD and identify specific factors associated with problematic video gaming behavior.MethodWe searched for articles indexed in PubMed, Scopus, Web of Science, and EBSCOhost electronic databases; using a combination of expressions including “autism spectrum disorder” OR “autism” OR “ASD” AND “video games” OR “gaming disorder” OR “Internet Gaming Disorder” OR “game addiction”.ResultsTwelve articles were included in this systematic review. The majority of them indicate that children, adolescents and adults with ASD may be at greater risk of PVG use than youths without ASD. Findings also suggested that several internal (sex, attention and oppositional behavior problems) and external factors (social aspects, access and time spent playing video, parental rules, and game genre) were significant predictors of problematic video game use in people with ASD. In addition, this review highlights the paucity of the literature on the consequences and individual effects of excessive video gaming in people with ASD.ConclusionsWe discuss unanswered questions and future directions and provide recommendations for improving clinicians and parents’ engagement in the prevention and management of problematic video game use in people with ASD.     

Auditory-motor rhythm synchronization in children with autism spectrum disorder

BackgroundAutism spectrum disorder (ASD) is characterized by difficulties in social and communication skills as well as atypical sensory perception and motor skills. Sensorimotor abilities such as auditory-motor integration are essential for social interaction and communication. The goal of this research was to investigate the development of auditory-motor rhythm synchronization for the first time in ASD versus typically-developing (TD) children.MethodsParticipants were 31 boys with ASD and 23 TD boys that were matched in age and IQ. Participants were tested on an auditory-motor rhythm synchronization task in which they tapped in synchrony with rhythms of varying metrical complexity.ResultsBoth children with ASD and TD performed similarly on this task and both groups performed better with age.ConclusionsThis work demonstrates that non-verbal rhythm synchronization is intact in ASD over the course of childhood development. This research serves to better understand sensorimotor interactions in ASD and to better define sensory phenotypes in ASD.     

Fluoxetine treatment of depression and associated self-injury in two adults with mental retardation

ABSTRACT. The use of fluoxeiine to treat chronic depression and associated self-injurious behaviour (SIB) in a woman with severe mental retardation and a man with profound mental retardation is reported. In the first case, behavioural monitoring of treatment response revealed a dramatic decrease in SIB and a normalization of the woman's sleep disturbance. In the second case, SIB and the use of mechanical restraint decreased substantially. In both cases, anecdotal reports also indicated a diminution of other depressive symptoms. These cases highlight the need to consider an affective disorder as a cause of SIB in persons with severe and profound developmental disabilities. The behaviour monitoring system proved to be a practical aid in the diagnosis of depression and evaluation of antidepressant treatment in individuals who were incapable of self-report.     

Autism spectrum disorder is associated with an increased risk of development of underweight in children and adolescents: A systematic review and meta-analysis

Background & AimsMultiple observational studies have examined the association between autism spectrum disorder (ASD) and underweight, yet the evidence remains ambiguous. We examined the pooled prevalence and relative risk of developing underweight among children with ASD in a systematic review and meta-analysis and examined the effects of potential risk factors in a meta-regression.MethodsProQuest, PubMed, Scopus and Web of Science databases were systematically searched and screened per the PRISMA guidelines. DerSimonian–Laird random-effects meta-analyses were performed using the ‘meta’ package in R to determine the pooled prevalence and the relative risk of underweight among children with ASD. Meta-regression analyses examined the moderator effects of risk factors.ResultsUnderweight had a prevalence of 6.5% (95% CI, 5.1–8.2) among children with ASD overall (29 study groups). Children with ASD possessed a 28.5% (8 studies) greater risk of being underweight vs. neurotypical controls. Meta-regression analyses revealed that non-Caucasian origin and male sex may increase the risk of being underweight in children with ASD.ConclusionsChildren with ASD seem to be at an increased risk of being underweight, which may further impair the clinical outcomes and quality of life. Clinicians need to vigilantly monitor weight and height among children with ASD to prevent underweight and associated complications. Future studies should aim to establish factors that may contribute to the development of underweight among children with ASD.     

Altered predictive contextual processing of emotional faces versus abstract stimuli in adults with Autism Spectrum Disorder

ObjectivesWe investigated the proposition that Autism Spectrum Disorder (ASD) is associated with predictive contextual processing deficits.MethodsWe recorded electroencephalography (EEG) in adults with ASD and controls during the performance of a predictive contextual processing task, using either triangles or emotional faces. Targets were preceded by either randomized sequences (R) or by sequences including a predictive sequence (P).ResultsASD subjects showed an attenuated behavioral facilitation (P versus R) compared with controls (faces). P3b amplitudes of P, R and the predictive sequence (n-1) were attenuated in ASD compared with controls. However, the attenuation of n-1 was more pronounced during the processing of faces. Controls demonstrated shorter peak P3b latencies of P versus R, while this facilitation was absent in ASD subjects. ASD subjects demonstrated functional connectivity alterations during the processing of random (triangles and faces) and predicted targets (faces). These changes were associated with weaker, more randomised, functional connections between frontal and parietal regions in ASD.ConclusionsWe found predictive contextual processing alterations in ASD, which were more pronounced during the processing of emotional faces compared with abstract stimuli.SignificanceWe provide novel evidence for the proposition that ASD is associated with deficits of top-down predictions.