Breif Report: Sensory Abnormalities as Distinguishing Symptoms of Autism Spectrum Disorders in Young Children

The purpose of this study was to explore the sensory profile of young children with ASD compared to young children with other developmental delays (DD) at first ASD assessment. Results found that young children with ASD had more tactile and taste/smell sensitivities and difficulties with auditory filtering than young children with other DD. Moreover, sensory scores were significantly correlated with stereotyped interests and behaviors. These findings support the hypotheses that young children with ASD show more sensory impairments than young children with other DD and that sensory symptoms are significantly related to stereotyped interests and behaviors. Results also suggest that sensory abnormalities are distinguishing symptoms of ASD that should be considered in diagnostic algorithms for younger cohorts.     

An Investigation of Sleep Characteristics,EEG Abnormalities and Epilepsy in Developmentally Regressed and Non-regressed Children with Autism

This study investigated sleep of children with autism and developmental regression and the possible relationship with epilepsy and epileptiform abnormalities. Participants were 104 children with autism (70 non-regressed, 34 regressed) and 162 typically developing children (TD). Results suggested that the regressed group had higher incidence of circadian rhythm disorders than non-regressed children. The regressed group showed higher Children’s Sleep Habits Questionnaire Bedtime Resistance, Sleep Onset Delay, Sleep Duration and Night-Wakings scores. Epilepsy and frequent epileptiform EEG abnormalities were more frequent in regressed children. Past sleep disorders and a history of developmental regression were significantly associated with sleep disorders. This study is an initial step in better understanding sleep problems in regressed children with autism, further studies are necessary to better investigate these aspects.     

Adherence to Behavioral and Medical Treatment Recommendations by Parents of Children with Autism Spectrum Disorders

The extent to which parents of children with intellectual or developmental disabilities are adherent to prescribed treatments has not been investigated. In this treatment adherence study, parents (n = 220) of children with autism spectrum disorders were surveyed regarding implementation of recommended treatments to manage problem behavior of their children living at home. Overall adherence to medical treatment recommendations was significantly greater than adherence to behavioral treatment recommendations (p < .002). Of the behavioral treatment recommendations, parents reported greater adherence to reinforcement (81.7%) than punishment (68.9%). Child diagnosis (p < .002) and the diagnosis × marital status interaction (p < .05) were significantly associated with reported adherence to behavioral and medical treatment, respectively. Results are discussed in light of the need to address adherence enhancement and measurement methods. Portions of this work were presented at the Annual Gatlinburg Conference on Research and Theory in Intellectual and Developmental Disabilities, San Diego, CA, March 2008.     

Metabolic Approaches to the Treatment of Autism Spectrum Disorders

Although the exact prevalence of metabolic abnormalities in autism spectrum disorders is unknown, several metabolic defects have been associated with autistic symptoms. These include phenylketonuria, histidinemia, adenylosuccinate lyase deficiency, dihydropyrimidine dehydrogenase deficiency, 5-nucleotidase superactivity, and phosphoribosylpyrophosphate synthetase deficiency. When the metabolic consequences of an enzyme defect are well defined (e.g., phenylketonuria, 5-nucleotidase superactivity), treatment with diet, drugs, or nutritional supplements may bring about a dramatic reduction in autistic symptoms. This review evaluates evidence for metabolic etiologies in autism spectrum disorders, as well as for the efficacy of dietary and vitamin treatments. The relationship between gastrointestinal abnormalities and autism spectrum disorders is also considered.     

Developmental Correlates of Different Types of Motor Imitation in Young Children with Autism Spectrum Disorders

This study used a concurrent correlational design to examine associations between three types of motor imitation with objects and three proposed correlates in 32 two- and three-year-old children diagnosed with ASD. Attention-following and fine motor ability were significant, unique correlates of imitation in an observational learning context. Attention-following was a significant correlate of imitation in a direct elicitation context. Social reciprocity was a significant correlate of imitation in an interactive play context. These associations were observed after controlling for general developmental level. Results support previous findings that motor imitation may not reflect a unitary construct for children with ASD and that different skills may underlie the performance of different types of motor imitation. Implications for interventions targeting motor imitation are discussed. This research was supported by NICHD Grant R21 HD42437 to Dr Wendy Stone.     

Hyperlexia in Children with Autism Spectrum Disorders

We compared the reading-related skills of children with Autism Spectrum Disorders who have hyperlexia (ASD + HPL) with age-matched children with ASD without HPL (ASD - HPL) and with single-word reading-matched typically developing children (TYP). Children with ASD + HPL performed (1) better than did children with ASD - HPL on tasks of single-word reading and pseudoword decoding and (2) equivalently well compared to word-reading-matched TYP children on all reading-related tasks except reading comprehension. It appears that the general underlying model of single-word reading is the same in principle for "typical" and hyperlexic reading. Yet, the study revealed some dissimilarities between these two types of reading when more fine-grained cognitive and linguistic abilities were considered; these dissimilarities warrant further investigations.     

Differential Diagnosis of Hispanic Children Referred for Autism Spectrum Disorders: Complex Issues

This study examines the decision-making process used for differential diagnosis of a sample of Hispanic children referred for autism spectrum disorders (ASDs). Of the sample of 28 children, 18 were diagnosed with ASDs. Of the 10 children who were not diagnosed with ASDs, 80% were found to have multiple diagnostic labels or comorbidities. Mann-Whitney U analyses determined the differences between the children with the most severe social impairment, children with less severe social impairment and the non-autistic children on several domains commonly used to assess ASDs. These analyses indicated significant differences in some characteristics of the children in the sample. Based on these results, a decision-tree for the diagnosis of children with and without ASDs with comorbid disorders was developed.     

Effects of Social Stories on Prosocial Behavior of Preschool Children with Autism Spectrum Disorders

Social Stories are a popular intervention for preschool children with autism spectrum disorders (ASD), but little research on Social Stories has been conducted with this population. This study investigated the effects of Social Stories on prosocial behavior of three preschool children with ASD in an inclusive setting. An ABAB design was used for two participants, while an ABACBC was used for the third. Social Stories increased appropriate behavior and decreased inappropriate behavior for two participants. The addition of verbal prompts (condition C) was necessary to increase appropriate behavior for the third participant. Maintenance probes were conducted to assess whether stories became imbedded in classroom routines. Results are discussed in relation to applications, study limitations, and areas for future research.     

Autism Treatment Survey: Services Received by Children with Autism Spectrum Disorders in Public School Classrooms

The Autism Treatment Survey was developed to identify strategies used in education of children with autism spectrum disorders (ASD) in Georgia. Respondents of the web-based survey included a representative sample of 185 teachers across the state, reporting on 226 children with ASD in grades preschool-12th. The top five strategies being used in Georgia (Gentle Teaching, sensory integration, cognitive behavioral modification, assistive technology, and Social Stories^TM) are recognized as lacking a scientific basis for implementation. Analysis revealed the choice of strategies varied by grade level and classroom type (e.g., general education, special education). Results highlight clear implications for preservice and inservice educator training, and the need for continued research to document evidence-based strategy use in public schools for students with ASD.     

Diagnostic Stability in Very Young Children with Autism Spectrum Disorders

Autism Spectrum Disorders (ASD) diagnosis in very young children may be delayed due to doubts about validity. In this study, 77 children received a diagnostic and developmental evaluation between 16 and 35 months and also between 42 and 82 months. Diagnoses based on clinical judgment, Childhood Autism Rating Scale, and the Autism Diagnostic Observation Schedule were stable over time. Diagnoses made using the Autism Diagnostic Interview were slightly less stable. According to clinical judgment, 15 children (19%) moved off the autism spectrum by the second evaluation; none moved onto the spectrum. Results indicate diagnostic stability at acceptable levels for diagnoses made at age 2. Movement off the spectrum may reflect true improvement based on maturation, intervention, or over-diagnosis at age 2.     

An Open-Label Study of Controlled-Release Melatonin in Treatment of Sleep Disorders in Children with Autism

Long-term effectiveness of controlled-release melatonin in 25 children, aged 2.6–9.6 years with autism without other coexistent pathologies was evaluated openly. Sleep patterns were studied using Children’s Sleep Habits Questionnaire (CSHQ) and sleep diaries at baseline, after 1–3–6 months melatonin treatment and 1 month after discontinuation. Sleep diary and CSHQ showed a more problematic sleep in autistic children compared with controls. During treatment sleep patterns of all children improved. After discontinuation 16 children returned to pre-treatment score, readministration of melatonin was again effective. Treatment gains were maintained at 12 and 24-month follow-ups. No adverse side effects were reported. In conclusion, controlled-release melatonin may provide an effective and well-tolerated treatment for autistic children with chronic sleep disorders.     

State and Trait Anxiety of Adolescents with Autism Spectrum Disorders

Objective This study examined how state and trait anxiety of adolescents with autism spectrum disorders (ASD) are associated with their demographic characteristics, repetitive and restricted behaviors (RRBs), and internalizing and externalizing problem behaviors. Methods A total of 96 participants with ASD (mean age=14.30 years; 91 males) completed a battery of tests including the State/Trait Anxiety Inventory (STAI), the Autism Diagnostic Interview-Revised, the Social Responsiveness Scale (SRS), and a cognitive test measuring intelligence quotient (IQ). Participants’ parents completed the Child Behavior Checklist (CBCL). Pearson’s correlations among age, IQ, two subscales of the STAI (i.e., STAIS and STAIT, measuring self-reported state and trait anxiety, respectively), and the Anxiety subscale of CBCL (i.e., CBCL-Anxiety, measuring parent-reported trait anxiety) were computed. Subsequently, Pearson’s correlations were computed among the three anxiety measures, RRBs, and problem behaviors, while controlling for participants’ age and IQ. Results The STAIS and CBCL-Anxiety were both significantly correlated with higher age, sensory sensitivity, depressive symptoms, somatic complaints, and aggressive behaviors. All three anxiety variables were significantly and positively correlated with total SRS RRB scores. Additionally, the STAIS and STAIT were significantly associated with more severe Compulsion/Adherence behaviors, and the CBCL-Anxiety was also significantly associated with more severe Rule-breaking Behaviors. Conclusion Self-reported state anxiety showed association patterns similar to those of parent-reported trait anxiety. Future studies investigating the precise operationalization of different anxiety instruments are needed to accurately measure the anxiety of adolescents with ASD.     

Brief Report: Self-Presentation of Children with Autism Spectrum Disorders

The self-presentational behaviour of 43 6- to 12-year-old children with high functioning autism spectrum disorders (HFASD) and normal intelligence and 43 matched comparisons was investigated. Children were prompted to describe themselves twice, first in a baseline condition and then in a condition where they were asked to convince others to select them for a desirable activity (self-promotion). Even after controlling for theory of mind skills, children with HFASD used fewer positive self-statements at baseline, and were less goal-directed during self-promotion than comparison children. Children with HFASD alter their self-presentation when seeking personal gain, but do this less strategically and convincingly than typically-developing children.     

Predictors of Language Acquisition in Preschool Children with Autism Spectrum Disorders

In 118 children followed from age 2 to 5 (59 with autism, 24 with PDD-NOS and 35 with non-spectrum developmental disabilities), age 2 and age 3 scores of non-verbal ability, receptive communication, expressive communication and socialization were compared as predictors of receptive and expressive language at age 5. Non-verbal cognitive ability at age 2 was generally the strongest predictor of age 5 language, while at age 3 communication scores were a stronger predictor of age 5 language for children with autism. Early joint attention as well as vocal and motor imitation skills were more impaired in children who did not develop language by age 5 (but had relatively strong non-verbal cognitive skills) than in children who did develop language by 5.     

Effects of Circumscribed Interests on the Social Behaviors of Children with Autism Spectrum Disorders

This study compared the effects of circumscribed interests (CI) to less preferred (LP) tangible stimuli on the social behaviors of three children with autism spectrum disorders (ASD). Based on single subject design methodology, the CI experimental sessions resulted in longer durations of target-child initiated social interactions in comparison to LP sessions. In addition, latency of participant’s initial social bids to peers was decreased when CI were present. The results suggest that embedding CI into dyadic play situations with typical peers can be used to increase the social behavior children with ASD direct toward typical peers. Future research should examine the specific environmental conditions that must be present in naturalistic settings to facilitate generalization of social behavior.     

Standardizing ADOS Scores for a Measure of Severity in Autism Spectrum Disorders

The aim of this study is to standardize Autism Diagnostic Observation Schedule (ADOS) scores within a large sample to approximate an autism severity metric. Using a dataset of 1,415 individuals aged 2–16 years with autism spectrum disorders (ASD) or nonspectrum diagnoses, a subset of 1,807 assessments from 1,118 individuals with ASD were divided into narrow age and language cells. Within each cell, severity scores were based on percentiles of raw totals corresponding to each ADOS diagnostic classification. Calibrated severity scores had more uniform distributions across developmental groups and were less influenced by participant demographics than raw totals. This metric should be useful in comparing assessments across modules and time, and identifying trajectories of autism severity for clinical, genetic, and neurobiological research.     

Abnormalities on the Neurological Examination and EEG in Young Children with Pervasive Developmental Disorders

This study examined the nature and frequency of neurological and EEG abnormalities in 60 young children (ages 2–6 years) with pervasive developmental disorders. A number of standard neurological functions could not be adequately assessed due to the young age of the children and/or limited comprehension and cooperation. The most common neurological deficits were hyporeflexia, stereotypies, and hypotonia. EEG abnormalities were identified in 32% of the children while only two children were known to have clinical seizures. The frequency of cases with hypotonia or hyporeflexia was more common than in older children with this diagnosis. Results also indicate that EEG abnormalities are common in this young population but clinical seizures are rare, confirming other studies.