Anxiety and avoidance in psychogenic nonepileptic seizures: The role of implicit and explicit anxiety

This study examined implicit and explicit anxiety in individuals with epilepsy and psychogenic nonepileptic seizures (PNESs) and explored whether these constructs were related to experiential avoidance and seizure frequency. Based on recent psychological models of PNESs, it was hypothesized that nonepileptic seizures would be associated with implicit and explicit anxiety and experiential avoidance. Explicit anxiety was measured by the State-Trait Anxiety Inventory; implicit anxiety was measured by an Implicit Relational Assessment Procedure; and experiential avoidance was measured with the Multidimensional Experiential Avoidance Questionnaire. Although both groups with epilepsy and PNESs scored similarly on implicit measures of anxiety, significant implicit–explicit anxiety discrepancies were only identified in patients with PNESs (p < .001). In the group with PNESs (but not in the group with epilepsy), explicit anxiety correlated with experiential avoidance (r = .63, p < .01) and frequency of seizures (r = .67, p < .01); implicit anxiety correlated with frequency of seizures only (r = .56, p < .01). Our findings demonstrate the role of implicit anxiety in PNESs and provide additional support for the contribution of explicit anxiety and experiential avoidance to this disorder.     

Effects of overweight and obese body mass on motor planning and motor skills during obstacle crossing in children

Little is known about how obesity relates to motor planning and skills during functional tasks. We collected 3-D kinematics and kinetics as normal weight (n = 10) and overweight/obese (n = 12) children walked on flat ground and as they crossed low, medium, and high obstacles. We investigated if motor planning and motor skill impairments were evident during obstacle crossing. Baseline conditions showed no group differences (all ps > .05). Increased toe clearance was found on low obstacles (p = .01) for the overweight/obese group and on high obstacles (p = .01) for the normal weight group. With the crossing leg, the overweight/obese group had larger hip abduction angles (p = .01) and medial ground reaction forces (p = .006) on high obstacles and high anterior ground reaction forces on low obstacles (p = .001). With the trailing leg, overweight/obese children had higher vertical ground reaction forces on high obstacles (p = .005) and higher knee angles (p = .01) and anterior acceleration in the center of mass (p = .01) on low obstacles. These findings suggest that differences in motor planning and skills in overweight/obese children may be more apparent during functional activities.     

Toward a motor signature in autism: Studies from human-machine interaction

BackgroundAutism spectrum disorder (ASD) is a heterogeneous group of neurodevelopmental disorders which core symptoms are impairments in socio-communication and repetitive symptoms and stereotypies. Although not cardinal symptoms per se, motor impairments are fundamental aspects of ASD. These impairments are associated with postural and motor control disabilities that we investigated using computational modeling and developmental robotics through human-machine interaction paradigms.MethodFirst, in a set of studies involving a human–robot posture imitation, we explored the impact of 3 different groups of partners (including a group of children with ASD) on robot learning by imitation. Second, using an ecological task, i.e. a real-time motor imitation with a tightrope walker (TW) avatar, we investigated interpersonal synchronization, motor coordination and motor control during the task in children with ASD (n = 29), TD children (n = 39) and children with developmental coordination disorder (n = 17, DCD).ResultsFrom the human–robot experiments, we evidenced that motor signature at both groups’ and individuals’ levels had a key influence on imitation learning, posture recognition and identity recognition. From the more dynamic motor imitation paradigm with a TW avatar, we found that interpersonal synchronization, motor coordination and motor control were more impaired in children with ASD compared to both TD children and children with DCD. Taken together these results confirm the motor peculiarities of children with ASD despite imitation tasks were adequately performed.DiscussionStudies from human-machine interaction support the idea of a behavioral signature in children with ASD. However, several issues need to be addressed. Is this behavioral signature motoric in essence? Is it possible to ascertain that these peculiarities occur during all motor tasks (e.g. posture, voluntary movement)? Could this motor signature be considered as specific to autism, notably in comparison to DCD that also display poor motor coordination skills? We suggest that more work comparing the two conditions should be implemented, including analysis of kinematics and movement smoothness with sufficient measurement quality to allow spectral analysis.     

Learning of writing letter-like sequences in children with physical and multiple disabilities

This study compared implicit and explicit learning instructions in hand writing. Implicit learning is the ability to acquire a new skill without a corresponding increase in knowledge about the skill. In contrast, explicit learning uses declarative knowledge to build up a set of performance rules that guide motor performance or skills. Explicit learning is dependent on working memory, implicit learning is not. Therefore, implicit learning was expected to be easier than explicit learning in children in special education, given their expected compromised working memory. Two groups of children (5–12 years) participated, children in special education with physical or multiple disabilities (study group, n = 22), and typically developing controls (n = 32). Children learned to write letter-like patterns on a digitizer by tracking a moving target (implicitly) and verbal instruction (explicitly). We further tested visual working memory, visual-motor integration, and gross manual dexterity. Learning curves were similar for both groups in both conditions; children in the study group did learn both implicitly and explicitly. Motor performance was related to the writing task. In contrast to our hypothesis, visual working memory was not an important factor in the explicit condition. These results shed new light on the conceptual difference between implicit and explicit learning, and the role of working memory therein.     

Inattention and hyperactivity in association with autism spectrum disorders in the CHARGE study

BackgroundAttention deficits in young children with autism spectrum disorder (ASD) are not well understood. This study sought to determine: 1) the prevalence of ADHD symptoms in young children with ASD, typical development (TD), and developmental delay (DD) and 2) the association between ADHD symptoms and cognitive and behavioral functioning in children with ASD.MethodADHD symptoms, defined according to Aberrant Behavior Checklist (ABC) hyperactivity subscale scores, were compared across children aged 2–5 from a large case-control study with ASD (n = 548), TD (n = 423), and DD (n = 180). Inattention and hyperactivity items within this subscale were also explored. Within the ASD group, linear and logistic regression were used to examine how ADHD symptoms were associated with cognition as assessed by the Mullen Scales of Early Learning and adaptive functioning as assessed by the Vineland Adaptive Behavior Scales.ResultsMean hyperactivity subscale scores were lowest in children with TD (mean = 3.19), higher in children with DD (12.3), and highest in children with ASD (18.2; between-group p < 0.001). Among children with ASD, significant associations were observed with higher ADHD symptoms and poorer adaptive and cognitive functioning (adjusted beta for hyperactivity score in association with: Vineland composite = −5.63, p = 0.0005; Mullen visual reception scale = −2.94, p = 0.02; for the highest vs. lowest quartile of hyperactivity score, odds of lowest quintile of these scores was approximately doubled). Exploratory analyses highlighted associations with inattention-related items specifically.ConclusionThese results suggest ADHD symptoms may play a key role in the functioning of young children with ASD.     

Psychometric properties of the French Version of the Social Responsiveness Scale in autism spectrum disorder with or without attention deficit hyperactivity disorder

ObjectivesThe Social Responsiveness Scale (SRS) is an instrument that is commonly used to screen for Autism Spectrum Disorder (ASD). Attention Deficit Hyperactive Disorder (ADHD) frequently occurs with ASD and both disorders share some phenotypic similarities. In the present study, we aimed to determine the psychometric properties of the French version of the Social Responsiveness Scale (SRS) and its 5 subscales (social awareness, social cognition, social communication, social motivation, and autistic mannerisms) to discriminate between children with ADHD and those with ASD (differential diagnosis) and children with ADHD from those with a dual diagnosis of ADHD and ASD (comorbid diagnosis).MethodSRS total scores and the 5 subscores of the SRS were compared between 4 groups of children: ADHD (n = 32), ASD + ADHD (n = 30), ASD (n = 31) and typical neurodevelopment (TD; n = 30) children. The discriminant validity was estimated using the Area Under the ROC Curves (AUC).ResultsSRS Social cognition (AUC = 0.73) and Autistic mannerisms (AUC = 0.70) subscores were the most discriminating for differential diagnosis of ASD and ADHD. SRS total scores (AUC = 0.70), and Social communication (AUC = 0.66) and Autistic mannerisms (AUC = 0.75) subscores were the most discriminating for comorbid diagnosis of ASD among ADHD children.ConclusionThe SRS autistic mannerisms subscore was found to be clinically relevant for both differential diagnosis of ASD and ADHD and comorbid diagnoses of ASD among ADHD children but with a modest discriminant power.     

Physical activity and self-determined motivation of adolescents with and without autism spectrum disorders in inclusive physical education

The main purpose of this study was to compare the objectively measured physical activity (PA) and the motivation process between adolescents with (n = 25) and without (n = 75) autism spectrum disorders (ASD) in inclusive physical education (PE); and assess the associations of the PA levels to a sequence of motivational processes. Independent t-tests revealed significant PA and motivational process differences between adolescents with and without ASD. External regulation was positively correlated with the percentage of time that adolescents with ASD spent in moderate PA (r₂₅ = 0.58, p < .01) and moderate-to-vigorous PA (r₂₅ = 0.50, p < .05), and this extrinsic motive was associated with their needs of being attached or related in the class (r₂₅ = 0.53, p < .01). No significant associations of PA in PE on the motivational sequences of adolescents without ASD were observed. It is concluded that adolescents with ASD had less PA levels in PE and lower motives toward PE than adolescents without ASD, and external regulation was important in facilitating PA participation in adolescents with ASD.     

Postural sway patterns in children with autism spectrum disorder compared with typically developing children

Postural control is a fundamental building block of each child's daily activities. The aim of this study was to compare patterns of postural sway in children with autism spectrum disorder (ASD) with typically developing children (TD). We recruited 21 schoolchildren diagnosed with ASD aged 9–14 and 30 TD pupils aged 8–15. Postural sway parameters in composite, anteroposterior and mediolateral axis were reported. Furthermore we examined the impact of age and characteristics of autism on postural sway. Children with ASD exhibited higher amount of sway in anteroposterior range (p < 0.001), mediolateral range (p = 0.002), root mean square (p = 0.001), mean velocity (p = 0.03), and sway area (p = 0.007) compared with their TD peers. Children with ASD showed higher instability in mediolateral than anteroposterior axis though TD children demonstrated higher sway scores in anteroposterior than mediolateral direction. The rate of autism symptom severity significantly affected the postural sway in children with ASD (p < 0.05). In conclusion, patterns of postural control seem to be different in children with ASD compared with TD counterparts. This could be partially due to clinical features were underlying in ASD.     

Implicit and explicit self-esteem discrepancies in people with psychogenic nonepileptic seizures

PurposeSelf-esteem (SE), or one's sense of competence and worth, is reduced in many mental and physical disorders. Low SE is associated with perceived stigma and disability and poor treatment outcomes. The present study examined implicit and explicit SE (automatic and deliberate views about the self) in people with epilepsy and people with psychogenic nonepileptic seizures (PNESs). Discrepancies between implicit SE and explicit SE have been found to correlate with psychological distress in disorders often associated with PNESs but are relatively unexplored in PNESs. We hypothesized that, compared with epilepsy, PNESs would be associated with lower self-reported SE and greater discrepancies between implicit SE and explicit SE.MethodsThirty adults with PNESs, 25 adults with epilepsy, and 31 controls without a history of seizures were asked to complete the Rosenberg Self-esteem Scale as a measure of explicit SE and an Implicit Relational Assessment Procedure as a measure of implicit SE. The State–Trait Anxiety Inventory and Patient Health Questionnaire—15 (a somatic symptom inventory) were also administered.ResultsWe found significant group differences in explicit (p < 0.001) but not implicit SE. Patients with PNESs reported lower SE than the other groups. No group differences were found in implicit SE. Implicit–explicit SE discrepancies were larger in the group with PNESs than in the other groups (p < 0.001). Higher frequency of PNESs (but not epileptic seizures) was associated with lower explicit SE (r_s = − .83, p < 0.01) and greater SE discrepancies (i.e., lower explicit relative to implicit SE; r_s = .65, p < 0.01). These relationships remained significant when controlling for anxiety and somatization.ConclusionPatients with PNESs had lower explicit SE than those with epilepsy or healthy controls. In keeping with our expectations, there were greater discrepancies between implicit SE and explicit SE among patients with PNESs than in the other groups. Our results, including the strong relationship between PNES frequency, anxiety, and explicit–implicit SE discrepancies, support the interpretation that PNESs serve to reduce cognitive dissonance, perhaps protecting patients' implicit SE.     

A comparative study of sensory processing in children with and without Autism Spectrum Disorder in the home and classroom environments

Sensory processing and higher integrative functions impairments are highly prevalent in children with ASD. Context should be considered in analyzing the sensory profile and higher integrative functions. The main objective of this study is to compare sensory processing, social participation and praxis in a group of 79 children (65 males and 14 females) from 5 to 8 years of age (M = 6.09) divided into two groups: ASD Group (n = 41) and Comparison Group (n = 38). The Sensory Processing Measure (SPM) was used to evaluate the sensory profile of the children: parents reported information about their children's characteristics in the home environment, and teachers reported information about the same characteristics in the classroom environment. The ASD Group obtained scores that indicate higher levels of dysfunction on all the assessed measures in both environments, with the greatest differences obtained on the social participation and praxis variables. The most affected sensory modalities in the ASD Group were hearing and touch. Only in the ASD Group were significant differences found between the information reported by parents and what was reported by teachers: specifically, the teachers reported greater dysfunction than the parents in social participation (p = .000), touch (p = .003) and praxis (p = .010). These results suggest that the context-specific qualities found in children with ASD point out the need to receive information from both parents and teachers during the sensory profile assessment process, and use context-specific assessments.     

The relationship of motor skills and adaptive behavior skills in young children with autism spectrum disorders

ObjectiveTo determine the relationship of motor skills and adaptive behavior skills in young children with autism.DesignA multiple regression analysis tested the relationship of motor skills on the adaptive behavior composite, daily living, adaptive social and adaptive communicative skills holding constant age, non-verbal problem solving, and calibrated autism severity.SettingMajority of the data collected took place in an autism clinic.ParticipantsA cohort of 233 young children with ASD (n = 172), PDD-NOS (n = 22) and non-ASD (developmental delay, n = 39) between the ages of 14–49 months were recruited from early intervention studies and clinical referrals. Children with non-ASD (developmental delay) were included in this study to provide a range of scores indicted through calibrated autism severity.InterventionsNot applicable.Main outcome measuresThe primary outcome measures in this study were adaptive behavior skills.ResultsFine motor skills significantly predicted all adaptive behavior skills (p < 0.01). Gross motor skills were predictive of daily living skills (p < 0.05). Children with weaker motor skills displayed greater deficits in adaptive behavior skills.ConclusionsThe fine and gross motor skills are significantly related to adaptive behavior skills in young children with autism spectrum disorder. There is more to focus on and new avenues to explore in the realm of discovering how to implement early intervention and rehabilitation for young children with autism and motor skills need to be a part of the discussion.     

Social skills: Differences among adults with intellectual disabilities,co-morbid autism spectrum disorders and epilepsy

Assessing social skills is one of the most complex and challenging areas to study because behavioral repertoires vary depending on an individual's culture and context. However, researchers have conclusively demonstrated that individuals with intellectual disabilities (ID) have impaired social skills as well as those with co-morbid autism spectrum disorders (ASD) and epilepsy. However, it is unknown how these groups differ. Assessment of social skills was made with the Matson Evaluation of Social Skills for Individuals with Severe Retardation. One hundred participants with ID were matched and compared across four equal groups comprising 25 participants with ID, 25 participants with epilepsy, 25 participants with ASD, and 25 participants with combined ASD and epilepsy. When controlling for age, gender, race, level of ID, and hearing and visual impairments, significant differences were found among the four groups on the MESSIER, Wilks's Λ = .58, F(18, 257) = 3.05, p < .01. The multivariate η² based on Wilks's Λ was .17. Significant differences were found on the Positive Verbal subscale, F(3, 96) = 3.70, p < .01, η² = .10, Positive Non-verbal subscale, F(3, 96) = 8.95, p < .01, η² = .22, General Positive subscale, F(3, 96) = 7.30, p < .01, η² = .19, Negative Non-verbal subscale, F(3, 96) = 5.30, p < .01, η² = .14, and General Negative subscale, F(3, 96) = 3.16, p < .05, η² = .09. Based on these results, individuals with ID expressing combined co-morbid ASD and epilepsy had significantly more impaired social skills than the ID only or groups containing only a single co-morbid factor with ID (ASD or epilepsy only). Implications of these findings are discussed.     

Anthropometric measures of Spanish children with autism spectrum disorder

We aimed to compare body mass index (BMI) and healthy eating index (HEI) in children with autism spectrum disorder (ASD, n = 105) and typically developing (TD, n = 495) children. They were aged 6–9 years, lived in Valencia (Spain) and came from similar cultural and socio-economic backgrounds. In this case–control study, the weight, height and BMI were measured for both groups. Three-day food records were used to assess dietary intake. Although the differences between children with ASD and TD children in raw BMI (p = 0.44), BMI z-score (p = 0.37), HEI (p = 0.43) and total energy intake (p = 0.86) were not significant, children with ASD and the boys subgroup were shorter (p = 0.01), but not the girls subgroup, compared to TD children of the same gender. Using the controls values as a reference, the BMI distribution in children with ASD became distorted, with values below the 5th percentile (11% vs. 4%, p = 0.03) and above the 95th percentile (8% vs. 5%, p = 0.04). The gender- and age-adjusted odds ratios for being underweight in the groups of all children and boys with ASD were 3.03 and 2.39, respectively, vs. TD children. Our data suggest that routine monitoring of children with ASD should include anthropometric measurements and assessment of their dietary habits.     

The relationship between motor abilities and early social development in a preschool cohort of children with cerebral palsy

AimTo investigate the relationship between motor ability and early social development in a cohort of preschool children with cerebral palsy (CP).DesignPopulation-based cohort study.MethodsParticipants were 122 children with CP assessed at 18, 24 and 30 months, corrected age (ca). Motor ability was measured by the Gross Motor Function Classification System (GMFCS) with classification assigned by physiotherapists. The sample was representative of a population-based cohort (I = 48, 38.4%, II = 19, 15.2%, III = 17, 13.6%, IV = 22, 17.6% and V = 19, 15.2%). Social development was measured by the Paediatric Evaluation of Disability Inventory (PEDI) and included capabilities in social interaction, social communication, interactive play and household/community tasks.ResultsCross-sectional analyses indicated a significant relationship between motor ability and social development at 18 months, F(4, 56) = 11.44, p < .0001, η² = .45, at 24 months, F(4, 79) = 15.66, p < .0001, η² = .44 and at 30 months, F(4, 76) = 16.06, p < .0001, η² = .49. A longitudinal analysis with a subset of children (N = 24) indicated a significant interaction between age at assessment and GMFCS, F(2, 21) = 7.02, p = .005, η² = .40. Comparison with community norms indicated that at 18 months corrected age, 44.3% of the cohort was greater than two standard deviations below the mean (>2SD) for social development and a further 27.9% of the cohort was greater than one standard deviation below the mean (>1SD).InterpretationThere is a relationship between motor ability and social development in preschool children with CP. Children with CP may require support for social development in additional to physical interventions, from as early as 18 months.     

Stress in mothers of children with autism: Trait mindfulness as a protective factor

Mindfulness-based interventions may reduce parents’ stress and improve parent–child relationships. Given the chronic nature of autism spectrum disorder (ASD) and its influence on parents’ stress, interventions to promote mindfulness may be especially helpful for parents of children with ASD. Prior to undertaking intervention development, it is first necessary to establish the relationship between mindfulness and stress, as other factors like child behavioral difficulties may overshadow the mother's regulation strategies. In a sample of mothers of children with ASD (n = 67) and a comparison sample of mothers without ASD (n = 87), mindfulness was significantly associated with the level of maternal stress above and beyond child behavior problems (non-ASD: β = −.232; F(1, 64) = 15.749, p < .000; ASD: β = −.206; F(1, 84) = 15.576, p < .000). Results suggest that interventions to promote mindfulness may be helpful in reducing parenting stress among mothers of children with ASD, as well as mothers of typically developing children. Due to the chronic nature of ASD, such interventions may be particularly applicable.     

Psychopathology: Differences among adults with intellectually disabled,comorbid autism spectrum disorders and epilepsy

The goal of this study was to systematically examine group differences among adults with intellectual disabilities (ID), comorbid autism spectrum disorders (ASD), and epilepsy through a detailed exploration of the characteristics that these disorders present in the area of psychopathology. Previous studies indicating that individuals with ID have comorbid ASD and epilepsy tend to stop short of addressing these disorders’ impact on the full range of psychosocial issues, particularly in adult samples. Assessment of psychopathology was made with the ASD-comorbidity-adult version (ASD-CA). One hundred participants, with ID held constant, were matched and compared across four equal groups comprising 25 participants with ID, 25 participants with epilepsy, 25 participants with ASD, and 25 participants with combined ASD and epilepsy. When controlling for age, gender, race, level of ID, and hearing and visual impairments, results of the MANOVA revealed significant differences among groups, Wilks's Λ = .76, F(15, 254) = 1.82, p < .05, η² = .09. A one-way ANOVA was conducted for each of the five subscales of the ASD-CA as follow-up tests to the MANOVA. Groups differed significantly Anxiety/Repetitive Behavior subscale, F(3, 96) = 2.93, p < .05, η² = .08, Irritability/Behavior excess subscale, F(3, 96) = 4.74, p < .01, η² = .13, Attention/Hyperactivity subscale, F(3, 96) = 5.18, p < .01, η² = .14, and Depressive Symptoms subscale, F(3, 96) = 3.73, p < .01, η² = .10. Trend analysis demonstrated that individuals with ID expressing combined comorbid ASD and epilepsy were significantly more impaired than the control group (ID only) or groups containing only a single comorbid factor with ID (ASD or epilepsy only). Implications of these findings elucidate the nature of these disorders and their influence on patient care and management.     

Motor functioning,exploration, visuospatial cognition and language development in preschool children with autism

In order to understand typical and atypical developmental trajectories it is important to assess how strengths or weaknesses in one domain may be affecting performance in other domains. This study examined longitudinal relations between early fine motor functioning, visuospatial cognition, exploration, and language development in preschool children with ASD and children with other developmental delays/disorders. The ASD group included 63 children at T1 (Mage = 27.10 months, SD = 8.71) and 46 children at T2 (Mage = 45.85 months, SD = 7.16). The DD group consisted of 269 children at T1 (Mage = 17.99 months, SD = 5.59), and 121 children at T2 (Mage = 43.51 months, SD = 3.81). A subgroup nested within the total sample was randomly selected and studied in-depth on exploratory behavior. This group consisted of 50 children, 21 children with ASD (Mage = 27.57, SD = 7.09) and 29 children with DD (Mage = 24.03 months, SD = 6.42). Fine motor functioning predicted language in both groups. Fine motor functioning was related to visuospatial cognition in both groups and related to object exploration, spatial exploration, and social orientation during exploration only in the ASD group. Visuospatial cognition and all exploration measures were related to both receptive and expressive language in both groups. The findings are in line with the embodied cognition theory, which suggests that cognition emerges from and is grounded in the bodily interactions of an agent with the environment. This study emphasizes the need for researchers and clinicians to consider cognition as emergent from multiple interacting systems.     

Gaze patterns during scene processing in typical adults and adults with autism spectrum disorders

BackgroundLittle is known about how adults with autism spectrum disorder (ASD) process dynamic social scenes.MethodWe studied gaze behavior in 16 adults with ASD without intellectual impairment and 16 sex- and age-matched controls during passive scene processing.ResultsAdding more characters to a scene resulted in a drop in time spent looking at faces, and an increase in time spent looking at bodies (static trials) or off-person (dynamic trials) [Scene Type × AOI × Mode: F(2, 60) = 3.54, p = .04, η²_p = .11]. Unlike controls, adults with ASD showed only a small drop in the number of fixations made [Mode × Group: F(1, 30) = 11.30, p = .002, η²_p = .27] and no increase in the duration of face fixations [Mode × AOI × Group: F(2, 60) = 3.50, p = .04, η²_p = .11] when dynamic cues were added. Thus, particularly during dynamic trials, adults with ASD spent less time looking at faces and slightly more time looking off-person than did controls [Mode × AOI × Group: F(2, 60) = 3.10 p = .05, η²_p = .09]. Exhibiting more autistic traits and being less empathic were both associated with spending less time fixating on faces [.34 < |r| < .55, p < .05].ConclusionsThese results suggest that adults with ASD may be less sensitive to, or have more difficulty processing, dynamic cues—particularly those conveyed in faces. The findings demonstrate the importance of using dynamic displays in studies involving this clinical population.