Early sensory over‐responsivity in toddlers with autism spectrum disorders as a predictor of family impairment and parenting stress

Background: Sensory over‐responsivity (SOR) affects many individuals with autism spectrum disorders (ASD), often leading to stressful encounters during daily routines. Methods: This study describes the associations between early SOR symptoms and the longitudinal course of restrictions in family life activities and parenting stress across three time‐points in families raising a child with ASD (n = 174). Covariates were child diagnostic severity, emotional problems, and maternal affective symptoms. At time 1 mean chronological age was 28.5 months. Children were administered the Autism Diagnostic Observation Schedule (ADOS) and Mullen Scales of Early Learning (MSEL). Parents completed the Infant Toddler Sensory Profile (ITSP), Infant‐Toddler Social Emotional Assessment (ITSEA), Beck Anxiety Index (BAI), and the Center for Epidemiologic Studies Depression Inventory (CES‐D) at time 1; and the Parenting Stress Index (PSI) and Family Life Impairment Scale (FLIS) at the three annual time‐points. Results: Latent Growth Curve Models indicated that higher SOR scores on the ITSP at time 1 were associated with higher initial levels of family life impairment and parenting stress and with a smaller magnitude of change over time. These associations were independent of severity of ADOS social‐communication symptoms, MSEL composite score, ITSEA externalizing and anxiety symptoms, and maternal affective symptoms as measured by the BAI and CES‐D. On average FLIS and PSI did not change over time, however, there was significant individual variability. Concurrently, SOR at time 1 explained 39–45% of the variance in family stress and impairment variables. Conclusions: An evaluation of SOR should be integrated into the assessment of toddlers with ASD considering their role in family life impairment and stress.     

Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: a randomized trial

Background: Children with high‐functioning autism spectrum disorders (ASD) are at high risk for developing significant anxiety. Anxiety can adversely impact functioning across school, home and community environments. Cognitive behavioral therapies (CBT) are frequently used with success for children with anxiety symptoms. Modified CBT interventions for anxiety in children with ASD have also yielded promising results. Methods: Fifty children with high‐functioning ASD and anxiety were randomized to group CBT or treatment‐as‐usual (TAU) for 12 weeks. Independent clinical evaluators, blind to condition, completed structured interviews (Anxiety Disorders Interview Schedule – Parent Version; ADIS‐P) pre‐ and post‐intervention condition. Results: Forty‐seven children completed either the CBT or TAU condition. Results indicated markedly better outcomes for the CBT group. Significant differences by group were noted in Clinician Severity Ratings, diagnostic status, and clinician ratings of global improvement. In the intent‐to‐treat sample, 10 of 20 children (50%) in the CBT group had a clinically meaningful positive treatment response, compared to 2 of 23 children (8.7%) in the TAU group. Conclusions: Initial results from this randomized, designed treatment study suggest that a group CBT intervention specifically developed for children with ASD may be effective in decreasing anxiety. Limitations of this study include small sample size, lack of an attention control group, and use of outcome measures normed with typically developing children.     

Context modulates attention to social scenes in toddlers with autism

Background: In typical development, the unfolding of social and communicative skills hinges upon the ability to allocate and sustain attention toward people, a skill present moments after birth. Deficits in social attention have been well documented in autism, though the underlying mechanisms are poorly understood. Methods: In order to parse the factors that are responsible for limited social attention in toddlers with autism, we manipulated the context in which a person appeared in their visual field with regard to the presence of salient social (child‐directed speech and eye contact) and nonsocial (distractor toys) cues for attention. Participants included 13‐ to 25‐month‐old toddlers with autism (autism; n = 54), developmental delay (DD; n = 22), and typical development (TD; n = 48). Their visual responses were recorded with an eye‐tracker. Results: In conditions devoid of eye contact and speech, the distribution of attention between key features of the social scene in toddlers with autism was comparable to that in DD and TD controls. However, when explicit dyadic cues were introduced, toddlers with autism showed decreased attention to the entire scene and, when they looked at the scene, they spent less time looking at the speaker’s face and monitoring her lip movements than the control groups. In toddlers with autism, decreased time spent exploring the entire scene was associated with increased symptom severity and lower nonverbal functioning; atypical language profiles were associated with decreased monitoring of the speaker’s face and her mouth. Conclusions: While in certain contexts toddlers with autism attend to people and objects in a typical manner, they show decreased attentional response to dyadic cues for attention. Given that mechanisms supporting responsivity to dyadic cues are present shortly after birth and are highly consequential for development of social cognition and communication, these findings have important implications for the understanding of the underlying mechanisms of limited social monitoring and identifying pivotal targets for treatment.     

Sensory abnormalities in children with autism spectrum disorder

Objective

The clinical picture of children with autism spectrum disorder is characterized by deficits of social interaction and communication, as well as by repetitive interests and activities. Sensory abnormalities are a very frequent feature that often go unnoticed due to the communication difficulties of these patients. This narrative review summarizes the main features of sensory abnormalities and the respective implications for the interpretation of several signs and symptoms of autism spectrum disorder, and therefore for its management.

Evaluation of oral health status and oral disorders of children with autism spectrum disorders by gender

AimThe aim of this study was to evaluate whether there is a relationship between gender and oral health status of children with autism spectrum disorders (CASD).Material-methodsThe study was carried out with 348 children. The children were separated into two groups to evaluate the prevalence of caries and to assess oral disorders in terms of gender. The following factors were evaluated: mean dmft (decayed missed filled permanent tooth in primary dentition), mean DMFT (decayed missed filled permanent tooth in permanent dentition), plaque index, caries prevalence scores, dental crowding, open bite, deep palate, drooling of saliva, tongue thrusting habit, bruxism, dental and soft tissue trauma, tooth wear, delayed eruption, and hypodontia.ResultsThe results showed that the mean dmft in boys with CASD (BCASD) was lower than the mean dmft in healthy boys. The mean dmft of the girls with CASD (GCASD) was also lower than that of the healthy girls. The prevalence of dental caries and mean DMFT in GCASD were higher than those of BCASD in permanent dentition. While the plaque index value of BCASD was higher than that of healthy boys, the plaque index value of GCASD was lower than that of healthy girls. The plaque index value of BCASD was higher than that of GCASD. GCASD were reported to have significantly more bruxism than their healthy counterparts. However, no statistically significant difference was found between BCASD and healthy boys regarding bruxism. Moreover, there was no significant difference between BCASD and GCASD in terms of bruxism. Drooling of saliva in BCASD was less than GCASD.ConclusionThere were significant gender differences between CASD and healthy children in terms of dental caries and oral disorders in this study. There were also significant differences regarding dental caries and oral disorders between GCASD and BCASD.     

孤独症谱系障碍中免疫异常的研究进展

孤独症谱系障碍(ASD)是一组以社会交往和交流障碍、兴趣狭窄和重复刻板性行为为主要特征的神经发育障碍性疾病.其发病原因尚不明确.目前许多研究发现ASD患儿免疫功能异常.该文综述了ASD的免疫学异常研究进展,包括免疫细胞、抗体蛋白、补体、细胞因子、主要组织相容性复合体的异常及他们与ASD之间的潜在关系,同时阐述了母体免疫激活等与ASD发病相关的免疫学影响.     

Neural activation to emotional faces in adolescents with autism spectrum disorders

Background: Autism spectrum disorders (ASD) involve a core deficit in social functioning and impairments in the ability to recognize face emotions. In an emotional faces task designed to constrain group differences in attention, the present study used functional MRI to characterize activation in the amygdala, ventral prefrontal cortex (vPFC), and striatum, three structures involved in socio‐emotional processing in adolescents with ASD. Methods: Twenty‐two adolescents with ASD and 20 healthy adolescents viewed facial expressions (happy, fearful, sad and neutral) that were briefly presented (250 ms) during functional MRI acquisition. To monitor attention, subjects pressed a button to identify the gender of each face. Results: The ASD group showed greater activation to the faces relative to the control group in the amygdala, vPFC and striatum. Follow‐up analyses indicated that the ASD relative to control group showed greater activation in the amygdala, vPFC and striatum (p < .05 small volume corrected), particularly to sad faces. Moreover, in the ASD group, there was a negative correlation between developmental variables (age and pubertal status) and mean activation from the whole bilateral amygdala; younger adolescents showed greater activation than older adolescents. There were no group differences in accuracy or reaction time in the gender identification task. Conclusions: When group differences in attention to facial expressions were limited, adolescents with ASD showed greater activation in structures involved in socio‐emotional processing.     

Autism and autism spectrum disorders: diagnostic issues for the coming decade

A decade and a half have elapsed since DSM-IV and ICD-10 appeared. During this time the convergent definitions of autism and related disorders in these two diagnostic systems have stimulated tremendous research. In this brief review we summarize areas of progress and continuing controversy, including approaches to diagnosis in more cognitively able individuals on the autism spectrum, diagnosis in very young infants, the issue of subtypes, and the potential contribution of genetic research. The use of dimensional assessments has some advantages as do the insights from prospective studies. At this point it will be important to study not only causative factors but developmental processes disrupted in these disorders.     

Social involvement of children with autism spectrum disorders in elementary school classrooms

Background: Children with autism spectrum disorders (ASD) are increasingly included in general education classrooms in an effort to improve their social involvement. Methods: Seventy‐nine children with ASD and 79 randomly selected, gender‐matched peers (88.6% male) in 75 early (K‐1), middle (2nd–3rd), and late (4th–5th) elementary classrooms across 30 schools completed social network surveys examining each child’s reciprocal friendships, peer rejection, acceptance, and social involvement. Results: Across grade levels, peers less frequently reciprocated friendships with children with ASD than students in the matched sample. While children with ASD were not more likely to be rejected by peers, they were less accepted and had fewer reciprocal friendships than matched peers at each grade level. Although 48.1% of children with ASD were involved in the social networks of their classrooms, children with ASD were more likely to be isolated or peripheral to social relationships within the classroom across all grade levels, and this difference is even more dramatic in later elementary grades. Conclusions: In inclusive classrooms, children with ASD are only involved in peers’ social relationships about half of the time, and appear to be even less connected with increasing grade level. Promoting children with ASD’s skills in popular activities to share with peers in early childhood may be a key preventive intervention to protect social relationships in late elementary school grades.     

Pharmacotherapy of target symptoms in autistic spectrum disorders

There are no aetiologically-based treatments available to cure autism. Though psychotropics have a role in the management of some symptoms of autism, clinical trial evidence for the use of psychotropics is in its infancy and needs close monitoring. About half of the subjects with high functioning pervasive developmental disorders (PDDs) are currently reported to be on psychotropics (anti-depressants, stimulants and antipsychotics), with many of them being on anti-epileptic medication simultaneously. Despite this high level of psychotropic use, few studies exist investigating the pharmacokinetics, pharmacodynamics or side-effect profiles in this population. Multiprofessional and parent partnership is essential in managing autism and psychopharmacology should be used in conjunction with environmental manipulation, educational modification and/or behavioral management strategies. A symptomatic approach to managing the difficult behaviours associated with autism is recommended. Some symptoms of autism may bemedication responsive (hyperactivity, obsessions, rituals, inattention, tics, etc), while other symptoms may beresponsive to behavioural interventions, but may require medication (aggression, anxiety, depression, impulsivity, sleep difficulties, etc), and symptoms which needspecific skill remediation are usually nonresponsive to medication (deficits in academic, social or sport domains). The new atypical antipsychotics (such as risperidone, olanzapine, amisulpiride, quetiapine) and SSRIs are increasingly being used in autism, with encouraging results, but a risk-benefit ratio of pharmacotherapy is essential with due weight being given to the sideeffects of medication. Despite symptomatic improvement with medication, one should remain cautious about longterm use of psychotropics. It is also important to recognize that psychotropics can sometimes worsen behaviour, and can produce iatrogenic symptoms. Certain anti-epileptic medication and psychotropic drugs are metabolized by the same cytochrome P450 isoenzymes in the liver. In such circumstances, the addition of a psychotropic agent may drastically alter the levels of the anti-epileptic medication and vice versa. It is suggested that specialist clinics should be involved when one is considering complex medication regimes, experimental drugs, polypharmacy, or if patients show unusual side-effects or is drug resistant.     

Development in infants with autism spectrum disorders: a prospective study

BACKGROUND: Autism is rarely diagnosed before three years of age despite evidence suggesting prenatal abnormalities in neurobiological processes. Little is known about when or how development becomes disrupted in the first two years of life in autism. Such information is needed to facilitate early detection and early intervention. METHODS: This prospective study of autism spectrum disorders (ASD) examined development using the Mullen Scales of Early Learning (MSEL) in 87 infants tested at target ages 6, 14, and 24 months. Participants came from infants at high risk (siblings of children with autism) and low risk (no family history of autism) groups. Based on language test scores, Autism Diagnostic Observation Schedule, and clinical judgment at 24 months of age, participants were categorized as: unaffected, ASD, or language delayed (LD). Longitudinal linear regression and ANOVA models were applied to MSEL raw scores, and estimates were compared between the three diagnostic groups. RESULTS: No statistically significant group differences were detected at 6 months. By 14 months of age, the ASD group performed significantly worse than the unaffected group on all scales except Visual Reception. By 24 months of age, the ASD group performed significantly worse than the unaffected group in all domains, and worse than the language delayed group in Gross Motor, Fine Motor, and Receptive Language. The developmental trajectory of the ASD group was slower than the other groups', and showed a significant decrease in development between the first and second birthdays. CONCLUSIONS: Variations from typical and language delayed development are detectable in many children with ASD using a measure of general development by 24 months of age. Unusual slowing in performance occurred between 14 and 24 months of age in ASD.     

A randomized controlled trial of Hanen's 'More Than Words' in toddlers with early autism symptoms

Background: This randomized controlled trial compared Hanen’s ‘More than Words’ (HMTW), a parent‐implemented intervention, to a ‘business as usual’ control group. Methods:  Sixty‐two children (51 boys and 11 girls; M age = 20 months; SD = 2.6) who met criteria for autism spectrum disorders (ASD) and their parents participated in the study. The HMTW intervention was provided over 3.5 months. There were three measurement periods: prior to randomization (Time 1) and at 5 and 9 months post enrollment (Times 2 and 3). Children’s communication and parental responsivity were measured at each time point. Children’s object interest, a putative moderator, was measured at Time 1. Results:  There were no main effects of the HMTW intervention on either parental responsivity or children’s communication. However, the effects on residualized gains in parental responsivity from Time 1 to both Times 2 and 3 yielded noteworthy effect sizes (Glass’s Δ = .71, .50 respectively). In contrast, there were treatment effects on child communication gains to Time 3 that were moderated by children’s Time 1 object interest. Children with lower levels of Time 1 object interest exhibited facilitated growth in communication; children with higher levels of object interest exhibited growth attenuation. Conclusions:  The HMTW intervention showed differential effects on child communication depending on a baseline child factor. HMTW facilitated communication in children with lower levels of Time 1 object interest. Parents of children who evidence higher object interest may require greater support to implement the HMTW strategies, or may require different strategies than those provided by the HMTW curriculum.