Behavioral Changes in Autistic Individuals as a Result of Wearing Ambient Transitional Prism Lenses

A double-blind crossover design was used to assess the efficacy of wearing ambient lenses to reduce the behavioral symptoms of autism. Eighteen autistic individuals, ranging in age from 7 to 18 years, participated in the study. Behavior, attention, and orientation were evaluated at 1 1/2 months, 2 months, 3 months, and 4 months. Compared to the placebo condition, the results showed a decrease in behavior problems at the 1 1/2 and 2 month assessment periods and a slight loss of these benefits at the 3 and 4 month assessment periods. These findings support the prediction that ambient lenses, worn without engaging in visual-motor exercises, have positive effects on autistic individuals.     

Paradoxical autonomic response to mental tasks in autism

Autonomic responses to mental tasks requiring sustained attention were examined in individuals with autism and age- and ability-matched controls. Cardiac autonomic function (CAF) was evaluated based on heart rate variability. While the control group showed a significant decrease in the parasympathetic function during mental tasks, the autistic group showed no significant changes in CAF. When examined individually, parasympathetic function was suppressed in all subjects in the control group. On the other hand, parasympathetic function was activated in half of the autistic subjects. The paradoxical autonomic response suggests that some autistic subjects were more stressed under resting conditions than while performing mechanical or repetitive mental tasks. The results seem to support autonomic hyperarousal in some people with autism.     

Cortisol circadian rhythms and response to stress in children with autism

BACKGROUND: Autism is a severe neurodevelopmental disorder characterized by impairment in communication, social interaction, repetitive behaviors and difficulty adapting to novel experiences. The Hypothalamic-Pituitary-Adrenocortical (HPA) system responds consistently to perceived novel or unfamiliar situations and can serve as an important biomarker of the response to a variety of different stimuli. Previous research has suggested that children with autism may exhibit dysfunction of the HPA system, but it is not clear whether altered neuroendrocrine regulation or altered responsiveness underlies the differences between children with and without autism. In order to provide preliminary data concerning HPA regulation and responsiveness, we compared circadian rhythms and response to a non-social, environmental stressor in children with and without autism. METHODS: Circadian rhythms of cortisol were estimated in children with (N=12) and without (N=10) autism via analysis of salivary samples collected in the morning, afternoon and evening on 2 consecutive days. HPA responsiveness was assessed by examining the time course of changes in salivary cortisol in response to a mock MRI. RESULTS: Both groups showed expected circadian variation with higher cortisol concentration in morning than in the evening samples. The children with autism, but not typical children, showed a more variable circadian rhythm as well as statistically significant elevations in cortisol following exposure to a novel, nonsocial stimulus. CONCLUSIONS: The results suggest that children with autism process and respond idiosyncratically to novel and threatening events resulting in an exaggerated cortisol response.     

An examination of response variability in children with autism and the relationship to restricted repetitive behavior subtypes

The current study investigated response variability in children with autism and its relationship to restricted repetitive behaviors, one of the core symptoms of the disorder. The “Penny-Hiding Game” (Baron-Cohen, 1992) was used as a measure of response variability. Variability was compared for children with autism (n = 65) and typically developing children (n = 65) and patterns of response variability were categorized from least variable to most variable for both groups. For the participants with a diagnosis of autism, these patterns were examined relative to their scores on the Repetitive Behavior Scale-Revised (RBS-R; Bodfish, Symons, & Lewis, 1999). Results showed that children with autism demonstrated significantly lower variability in their responding in the “Penny-Hiding Game” than their typically developing peers. Variability was significantly negatively correlated with total RBS-R scores and with the Stereotypy subscale and the self-injurious behavior subscale, indicating that lower variability in responding was related to higher rates of these types of restricted and repetitive behaviors. No significant correlations were observed between variability and the Compulsion subscale, the Ritualistic/Sameness behaviors subscale or the Restricted Interests subscale.     

Fronto-limbic functioning in children and adolescents with and without autism

We used neuropsychological tasks to investigate integrity of brain circuits linking orbitofrontal cortex and amygdala (orbitofrontal-amygdala), and dorsolateral prefrontal cortex and hippocampus (dorsolateral prefrontal-hippocampus), in 138 individuals aged 7-18 years, with and without autism. We predicted that performance on orbitofrontal-amygdala tasks would be poorer in the Autism group compared to the Non-Autism group regardless of intellectual level (verbal mental age, VMA) and that performance on dorsolateral prefrontal-hippocampus tasks would be associated primarily with intellectual level. Predicted differences between Autism and Non-Autism groups on orbitofrontal-amygdala tasks were present but greater in individuals with higher VMA. On dorsolateral prefrontal-hippocampus tasks, poorer performance by the Autism compared to the Non-Autism group was found at all VMA levels. Group differences suggest both brain circuits are impaired in autism, but performance on all tasks is also associated with intellectual level.     

Attentional processes in autism

Attentional processes in individuals with high-functioning autism were compared with a matched control group. Participants for the study were 103 children and adults with autism and 103 control subjects. Measures administered corresponded to Mirsky et al.'s (1991) factor analysis of tests of attention. Diminished performance was noted on measures that loaded on the Focus-Execute and Shift factors, but not on the Sustain and Encode factors. For tests in which psychomotor speed was used as the score, and the difference between groups was significant, covariance analyses were performed, using tests of basic motor functions as covariates. This procedure led to attenuation to the point of nonsignificant differences in the case of some of the attention tests. Thus, this comprehensive analysis of attention in individuals with high-functioning autism only found differences on measures in which the task placed demands on cognitive flexibility or psychomotor speed. Thus, purported attention deficits in autism may actually be primary deficits in complex decision making or psychomotor abilities.     

Using the autism diagnostic interview--revised to increase phenotypic homogeneity in genetic studies of autism.

BACKGROUND: Many chromosomal regions for susceptibility to autism spectrum disorders (ASDs) have been identified, but few have reached genomewide significance. In response, researchers have attempted to increase the power of their analyses by stratifying samples to increase phenotypic homogeneity. Although homogeneity has typically been defined by a single variable, resultant groups often differ in other dimensions that may be directly pertinent. Group differences in age, gender, IQ, and measures of autism severity are examined as related to Autism Diagnostic Interview-Revised (ADI-R) domains previously used for subsetting or Quantitative Trait Analysis (QTL). METHODS: Participants were research participants and clinic referrals for assessment of possible autism. Assessments included the ADI-R, Autism Diagnostic Observation Schedule, Vineland Adaptive Behavior Scales, and a developmental or cognitive test. Data were collected for 983 individuals, ages 4 to 52 years, with diagnoses of autism and ASDs. RESULTS: Findings suggest that, of several potential grouping variables, only restricted and repetitive behaviors associated with Insistence on Sameness were independent of age, IQ, and autism severity. CONCLUSIONS: Results emphasize the potential unintended effects of stratification and the importance of understanding such interrelationships between phenotypic characteristics when defining subgroups or performing QTL.     

Altered pre-ejection period response to social evaluative threat in adolescents with autism spectrum disorder

IntroductionThe autonomic nervous system (ANS) is involved in regulating social behavior; Autism Spectrum Disorder (ASD) is characterized by alterations in social behavior and reduced physiological response to threat. We hypothesized that adolescents with ASD would show reduced ANS response to social threat.MethodsEighteen males with ASD and thirteen males with typical development (TD), ages 12 to 17, completed a social threat paradigm while wearing an impedance cardiography apparatus. We calculated pre-ejection period (PEP) and tested for between-group differences in PEP response to social threat. We also conducted correlation analyses between PEP change scores and clinical symptom scales.ResultsThere was an effect of diagnosis on change in PEP from baseline to the onset of social threat (F = 7.60, p = 0.01), with greater changes in PEP in TD compared to ASD. PEP change score and the Social Communication Questionnaire (r = 0.634, p = 0.005) and the ADHD Problems Subscale of the Child Behavior Checklist (r = 0.568, p = 0.014) were correlated.ConclusionsThese findings suggest reduced arousal in response to social threat in ASD, with preliminary evidence that reduced sympathetic activation is associated with increased social behavior symptoms.     

Studies in infantile autism

The most dominant view about the etiology of infantile autism is that it is biologically determined. None of the attributed causes have withstood the test of time. Arguments supporting the organic ideology is that parents of autistic children are not of higher SES, they seem to be adjusted and the disorder is to be found all over the world. An analysis of the literature indicates that such conclusions are open to question. Conflicting findings may be due to the fact that children that do not fulfill Kanner's criteria are included in the samples studied.     

Association between amygdala response to emotional faces and social anxiety in autism spectrum disorders

Difficulty interpreting facial expressions has been reported in autism spectrum disorders (ASD) and is thought to be associated with amygdala abnormalities. To further explore the neural basis of abnormal emotional face processing in ASD, we conducted an fMRI study of emotional face matching in high-functioning adults with ASD and age, IQ, and gender matched controls. In addition, we investigated whether there was a relationship between self-reported social anxiety and fMRI activation. During fMRI scanning, study participants were instructed to match facial expressions depicting fear or anger. The control condition was a comparable shape-matching task. The control group evidenced significantly increased left prefrontal activation and decreased activation in the occipital lobes compared to the ASD group during emotional face matching. Further, within the ASD group, greater social anxiety was associated with increased activation in right amygdala and left middle temporal gyrus, and decreased activation in the fusiform face area. These results indicate that level of social anxiety mediates the neural response to emotional face perception in ASD.     

Change in autism core symptoms with intervention

It is still debated what is the best early intervention approach for autism. This study compared two intervention approaches, Eclectic-Developmental (ED) and Applied Behavioral Analysis (ABA) in very young children with autism/autism spectrum disorder (ASD). Nineteen children received ED intervention, using combination of methods. Twenty children received Applied Behavioral Analysis (ABA) intervention which used behavioral principles. Children in both groups were not significantly different in their autism severity, cognitive abilities and in socio-economic background at pre-intervention time. Change in the severity of autism symptoms was assessed by the Autism Diagnosis Observation Schedule (ADOS).

The ABA group showed significantly greater improvements than the ED group at post-intervention time. Pre–post intervention differences in language and communication domain were significant only for the ABA group. Both groups showed significant improvement in reciprocal social interaction domain. However, the effect size was greater for the ABA group. Changes in diagnostic classification were noted in both groups but were more pronounced for the ABA group. Pre-treatment IQ scores were positively related to ADOS scores at pre- and post-intervention times, but not to progress over time. Behavioral intervention is more effective than eclectic approach in improving autism core symptoms in young children with autism.     

Hippocampus in autism: a Golgi analysis

Autism is a behaviorally defined syndrome in which neuropathological abnormalities have been identified in the limbic system and cerebellum. The morphology of hippocampal neurons in two cases of infantile autism was studied and compared to age-matched controls. CA4 neurons in autistic children were smaller in perikaryon area and dendritic branching of both CA4 and CA1 neurons was less than in controls. These findings are consistent with previous studies and suggest a curtailment in maturation in the pathogenesis of autism. Received: 23 January 1995 / Revised, accepted: 6 September 1995     

Teaching students with autism to read pictures

This study examined the use of teaching three students with autism how to comprehend pictures. Students were elementary-aged, did not speak, and needed communication training. Students were provided systematic visual literacy instruction. Visual literacy instruction consisted of comprehending familiar people, objects, actions, and sequences through motor demonstration. Students successfully acquired how to read pictures and generalize its understanding. Visual literacy skills were maintained at a 100% level for up to nine weeks.     

Variables related to sleep problems in children with autism

Our study of 477 children with autism (1–15 years, IQs 9–146) showed that parent reported sleep problems are found in most children with autism and are not significantly related to age, IQ, gender, race, parent occupation, neuropsychological functioning, and learning ability. However, sleep problems increased with severity of autistic symptoms and with severity of parent reported symptoms known to be associated with autism (i.e., oppositional behavior, aggression, explosiveness, attention deficit, impulsivity, hyperactivity, anxiety, depression, and mood variability). This suggests that sleep disturbance is part of the autism symptom complex and increases with increasing autism severity. The strongest predictors of sleep disturbance were parent ratings of autism severity, hyperactivity, mood variability, and aggression. The most frequent sleep problems were difficulty falling asleep and restlessness during sleep. Daytime sleepiness was not significantly correlated with sleeping less than normal, but was associated with sleeping more than normal. Children who were sleepier during the day were also sleepier at night. Medical practitioners and clinicians should be aware of the risk of sleep disturbance in children with autism and should routinely screen for this. Empirically proven interventions (e.g., behavior therapy and melatonin) are available to improve sleep in children with autism.     

Postural orientation and equilibrium processes associated with increased postural sway in autism spectrum disorder (ASD)

Background

Increased postural sway has been repeatedly documented in children with autism spectrum disorder (ASD). Characterizing the control processes underlying this deficit, including postural orientation and equilibrium, may provide key insights into neurophysiological mechanisms associated with ASD. Postural orientation refers to children’s ability to actively align their trunk and head with respect to their base of support, while postural equilibrium is an active process whereby children coordinate ankle dorsi-/plantar-flexion and hip abduction/adduction movements to stabilize their upper body. Dynamic engagement of each of these control processes is important for maintaining postural stability, though neither postural orientation nor equilibrium has been studied in ASD.

Methods

Twenty-two children with ASD and 21 age and performance IQ-matched typically developing (TD) controls completed three standing tests. During static stance, participants were instructed to stand as still as possible. During dynamic stances, participants swayed at a comfortable speed and magnitude in either anterior-posterior (AP) or mediolateral (ML) directions. The center of pressure (COP) standard deviation and trajectory length were examined to determine if children with ASD showed increased postural sway. Postural orientation was assessed using a novel virtual time-to-contact (VTC) approach that characterized spatiotemporal dimensions of children’s postural sway (i.e., body alignment) relative to their postural limitation boundary, defined as the maximum extent to which each child could sway in each direction. Postural equilibrium was quantified by evaluating the amount of shared or mutual information of COP time series measured along the AP and ML directions.

Results

Consistent with prior studies, children with ASD showed increased postural sway during both static and dynamic stances relative to TD children. In regard to postural orientation processes, children with ASD demonstrated reduced spatial perception of their postural limitation boundary towards target directions and reduced time to correct this error during dynamic postural sways but not during static stance. Regarding postural equilibrium, they showed a compromised ability to decouple ankle dorsi-/plantar-flexion and hip abduction/adduction processes during dynamic stances.

Conclusions

These results suggest that deficits in both postural orientation and equilibrium processes contribute to reduced postural stability in ASD. Specifically, increased postural sway in ASD appears to reflect patients’ impaired perception of their body movement relative to their own postural limitation boundary as well as a reduced ability to decouple distinct ankle and hip movements to align their body during standing. Our findings that deficits in postural orientation and equilibrium are more pronounced during dynamic compared to static stances suggests that the increased demands of everyday activities in which children must dynamically shift their COP involve more severe postural control deficits in ASD relative to static stance conditions that often are studied. Systematic assessment of dynamic postural control processes in ASD may provide important insights into new treatment targets and neurodevelopmental mechanisms.

     

Medically refractory epilepsy in autism

Purpose: Epilepsy and electroencephalographic abnormalities are frequent in idiopathic autism, but there is little information regarding treatment‐resistant epilepsy (TRE) in this group. We sought to define the clinical and electrophysiologic characteristics and treatment outcomes in these patients. Methods: We retrospectively reviewed clinical and laboratory data of patients with idiopathic autism evaluated at NYU Epilepsy Center during a 20‐year period. Key Findings: One hundred twenty‐seven patients had idiopathic autism and at least one epileptic seizure; 33.9% had TRE and 27.5% were seizure free. The remaining 38.6% of patients had infrequent seizures or insufficient data to categorize. Patients with TRE had a significantly earlier onset of seizures than seizure‐free patients, and a trend for more developmental regression and motor and language delays. Three patients had surgical resection (two had limited improvement and one had no improvement) and one had an anterior callosotomy (no improvement). Vagus nerve stimulator (VNS) implantation provided limited improvement (2 patients) and no improvement (7). Significance: This study found that TRE is common in idiopathic autism and more common with early age of seizure onset. Relatively few patients underwent surgical resection due to multifocal partial epilepsy, comorbid generalized epilepsy, or limited impact of ongoing partial seizures given other problems related to autism. Our small sample suggests that surgical and VNS outcomes in this group are less favorable than in other TRE populations.     

Atypical lateralization of ERP response to native and non-native speech in infants at risk for autism spectrum disorder

Language impairment is common in autism spectrum disorders (ASD) and is often accompanied by atypical neural lateralization. However, it is unclear when in development language impairment or atypical lateralization first emerges. To address these questions, we recorded event-related-potentials (ERPs) to native and non-native speech contrasts longitudinally in infants at risk for ASD (HRA) over the first year of life to determine whether atypical lateralization is present as an endophenotype early in development and whether these infants show delay in a very basic precursor of language acquisition: phonemic perceptual narrowing. ERP response for the HRA group to a non-native speech contrast revealed a trajectory of perceptual narrowing similar to a group of low-risk controls (LRC), suggesting that phonemic perceptual narrowing does not appear to be delayed in these high-risk infants. In contrast there were significant group differences in the development of lateralized ERP response to speech: between 6 and 12 months the LRC group displayed a lateralized response to the speech sounds, while the HRA group failed to display this pattern. We suggest the possibility that atypical lateralization to speech may be an ASD endophenotype over the first year of life.     

Maternal stress and family quality of life in response to raising a child with autism: From preschool to adolescence

While the impact of raising a child with an Autism Spectrum Disorder (ASD) is well documented, with mothers reporting higher levels of stress than mothers of children with other disabilities, positive maternal outcomes have also been identified. What remains unclear, however, is the role of child age on maternal outcomes. We sought to clarify the role of child age in maternal stress and family quality of life (FQoL) in mothers raising a child with ASD. Participants included 140 mothers of children aged 3–16 years grouped to represent four key stages of childhood (preschool, early school years, middle school, early high school). Using a cross-sectional design, mothers completed questionnaires assessing potential risk (e.g., child problem behaviour, symptom severity) and protective (e.g., family characteristics) factors attributed to maternal outcomes. The results revealed significant age related group differences in child internalising behaviour and ASD symptomatology between the early and middle school years. Lower levels of adaptive social behaviour in older age groups were also found. Although mothers of older children reported significantly less support from professionals than mothers of younger children, no significant age effects were found to contribute to maternal reports of stress or FQoL. The current findings support the view that mothers appear to demonstrate stable levels of stress and FQoL despite fluctuations in key child variables and a reduction in supports, across age, highlighting the ongoing nature of maternal needs and heightened levels of child symptomatology during adolescence.