Pubmed du 12/07/19

vendredi 12 juillet 2019

1. Carpenter KL, Williams DM, Nicholson T. Putting Your Money Where Your Mouth is : Examining Metacognition in ASD Using Post-decision Wagering. J Autism Dev Disord ;2019 (Jul 10)

It has been argued that metacognition and mindreading rely on the same cognitive processes (Carruthers in The opacity of mind : an integrative theory of self-knowledge, Oxford University Press, Oxford, 2011). It is widely accepted that mindreading is diminished among individuals diagnosed with autism (Brunsdon and Happe in Autism 18(1):17-30, 2014), however, little is known about metacognition. This study examined metacognition in relation to mindreading and autism using post-decision wagering. Results from a student sample showed negative associations between autism traits and metacognitive accuracy, and metacognitive reaction times and mindreading. These findings were replicated in a general population sample, providing evidence of a reliable association between metacognition, mindreading and autism traits. However, adults diagnosed with autism showed equivalent levels of metacognitive accuracy to age- and IQ-matched comparison participants, albeit only with an overall increase in meta-level processing time.

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2. Cogram P, Deacon RMJ, Warner-Schmidt JL, von Schimmelmann MJ, Abrahams BS, During MJ. Gaboxadol Normalizes Behavioral Abnormalities in a Mouse Model of Fragile X Syndrome. Front Behav Neurosci ;2019 ;13:141.

Fragile X syndrome (FXS) is the most common inherited form of intellectual disability and autism. FXS is also accompanied by attention problems, hyperactivity, anxiety, aggression, poor sleep, repetitive behaviors, and self-injury. Recent work supports the role of gamma-aminobutyric-acid (GABA), the primary inhibitory neurotransmitter in the brain, in mediating symptoms of FXS. Deficits in GABA machinery have been observed in a mouse model of FXS, including a loss of tonic inhibition in the amygdala, which is mediated by extrasynaptic GABAA receptors. Humans with FXS also show reduced GABAA receptor availability. Here, we sought to evaluate the potential of gaboxadol (also called OV101 and THIP), a selective and potent agonist for delta-subunit-containing extrasynaptic GABAA receptors (dSEGA), as a therapeutic agent for FXS by assessing its ability to normalize aberrant behaviors in a relatively uncharacterized mouse model of FXS (Fmr1 KO2 mice). Four behavioral domains (hyperactivity, anxiety, aggression, and repetitive behaviors) were probed using a battery of behavioral assays. The results showed that Fmr1 KO2 mice were hyperactive, had abnormal anxiety-like behavior, were more irritable and aggressive, and had an increased frequency of repetitive behaviors compared to wild-type (WT) littermates, which are all behavioral deficits reminiscent of individuals with FXS. Treatment with gaboxadol normalized all of the aberrant behaviors observed in Fmr1 KO2 mice back to WT levels, providing evidence of its potential benefit for treating FXS. We show that the potentiation of extrasynaptic GABA receptors alone, by gaboxadol, is sufficient to normalize numerous behavioral deficits in the FXS model using endpoints that are directly translatable to the clinical presentation of FXS. Taken together, these data support the future evaluation of gaboxadol in individuals with FXS, particularly with regard to symptoms of hyperactivity, anxiety, irritability, aggression, and repetitive behaviors.

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3. Davies K, Eagleson C, Weise J, Cvejic RC, Trollor JN. Clinical capacity of Australian and New Zealand psychiatrists who work with people with intellectual and developmental disabilities. Australas Psychiatry ;2019 (Jul 11):1039856219859286.

OBJECTIVE : To describe the characteristics and clinical capacity of Australian and New Zealand psychiatrists working in intellectual and developmental disability mental health (IDDMH). METHOD : Consultant psychiatrists (n=71) with an interest or expertise in IDDMH completed an online survey about their roles, experience and time spent in intellectual developmental disability (IDD)-related activities. RESULTS : Psychiatrists had worked in IDDMH for a median of 11.34 years and half (53.5%) reported expertise in the area. One-fifth of psychiatrists reported IDDMH as their main area of practice. The majority of respondents (85.1%) reported that they were working clinically with people with IDD. Respondents practicing clinically worked a median of 8 hours in clinical and 3 hours in non-clinical IDD-related work per week. CONCLUSIONS : Surveyed psychiatrists had considerable experience in IDDMH. However, their work in IDDMH represented a relatively small proportion of their overall work hours, and a minority of respondents were responsible for a large proportion of clinical work. Exploring ways to broaden capacity is crucial to ensuring the mental health needs of people with IDD are met.

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4. Eagleson C, Cvejic RC, Weise J, Davies K, Trollor JN. Subspecialty training pathways in intellectual and developmental disability psychiatry in Australia and New Zealand : current status and future opportunities. Australas Psychiatry ;2019 (Jul 11):1039856219839468.

OBJECTIVES : This study aimed to examine the training experiences of and determine capacity to train future Australian and New Zealand psychiatrists working in intellectual and developmental disability mental health. METHODS : Australian and New Zealand psychiatrists with expertise or interest in intellectual and developmental disability mental health completed an online survey detailing their training pathway, support for subspecialty training and capacity to provide rotations in this area. RESULTS : Psychiatrists (n=71) indicated the most common reasons they started practicing in intellectual and developmental disability mental health, and these included seeing people with intellectual or developmental disability in a service in which they worked, or personal experience with intellectual or developmental disability. Compared to those trained overseas, psychiatrists trained in Australia or New Zealand had lower ratings of the sufficiency of education received in intellectual and developmental disability mental health. Of the total respondents, 80% supported the development of subspecialty training. Augmentation of intellectual and developmental disability mental health content in the intermediate stage of training was also strongly supported. Participants identified 80 potential six-month training rotations in this area. CONCLUSIONS : Psychiatrists working in intellectual and developmental disability mental health strongly support enhancements to intellectual or developmental disability training, including the development of subspecialty training, and can identify potential training capacity if such subspecialty training was developed.

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5. Hanney NM, Carr JE, LeBlanc LA. Teaching children with autism spectrum disorder to tact auditory stimuli. J Appl Behav Anal ;2019 (Jul) ;52(3):733-738.

Studies on teaching tacts to individuals with autism spectrum disorder (ASD) have primarily focused on visual stimuli, despite published clinical recommendations to teach tacts of stimuli in other sensory domains as well. In the current study, two children with ASD were taught to tact auditory stimuli under two stimulus-presentation arrangements : isolated (auditory stimuli presented without visual cues) and compound (auditory stimuli presented with visual cues). Results indicate that compound stimulus presentation was a more effective teaching procedure, but that it interfered with prior object-name tacts. A modified compound arrangement in which object-name tact trials were interspersed with auditory-stimulus trials mitigated this interference.

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6. Kay JC, Kisamore AN, Vladescu JC, Sidener TM, Reeve KF, Taylor-Santa C, Pantano NA. Effects of exposure to prompts on the acquisition of intraverbals in children with autism spectrum disorder. J Appl Behav Anal ;2019 (Jul 12)

The current experiment is a systematic replication of previous studies that evaluated the efficiency of echoic and tact prompts on the acquisition of intraverbals (i.e., French-to-English translations) following exposure to each prompt type. We extended these studies by (a) evaluating participants’ language skills on standardized assessments, (b) incorporating descriptive praise for correct responding, (c) presenting trials via voice recording, and (d) evaluating teacher preference for each prompt type as a social validity measure. All participants learned at least one set of intraverbals faster with the procedure that was most recently used during teaching. These findings suggest that results from previous prompt comparison studies might be a function of previous exposure to prompt types and that it might be possible to manipulate learning histories such that a particular prompt type becomes more efficient.

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7. Kuo SS, Wojtalik JA, Mesholam-Gately RI, Keshavan MS, Eack SM. Transdiagnostic validity of the MATRICS Consensus Cognitive Battery across the autism-schizophrenia spectrum. Psychol Med ;2019 (Jul 12):1-10.

BACKGROUND : Autism Spectrum Disorder (ASD) and schizophrenia are neurodevelopmental disorders which share substantial overlap in cognitive deficits during adulthood. However, treatment evaluation in ASD and treatment comparisons across ASD and schizophrenia are limited by a dearth of empirical work establishing the validity of a standard cognitive battery across ASD and schizophrenia. Promisingly, the MATRICS Consensus Cognitive Battery (MCCB) has been validated in schizophrenia and encompasses cognitive domains that are impacted in ASD. Thus, this study aimed to establish MCCB’s generalizability from schizophrenia to ASD. METHODS : Community-residing adults with schizophrenia (N = 100) and ASD (N = 113) underwent MCCB assessment. Using multigroup confirmatory factor analysis, MCCB’s transdiagnostic validity was evaluated by examining whether schizophrenia and ASD demonstrate the same configuration, magnitude, and directionality of relationships within and among measures and their underlying cognitive domains. RESULTS : Across schizophrenia and ASD, the same subsets of MCCB measures inform three cognitive domains : processing speed, attention/working memory, and learning. Except for group means in category fluency, continuous performance, and spatial span, both groups show vastly comparable factor structures and characteristics. CONCLUSIONS : To our knowledge, this study is the first to establish the validity of a standard cognitive battery in adults with ASD and furthermore the first to establish a cognitive battery’s comparability across ASD and schizophrenia. Cognitive domain scores can be compared across new samples using weighted sums of MCCB scores resulting from this study. These findings highlight MCCB’s applicability to ASD and support its utility for standardizing treatment evaluation of cognitive outcomes across the autism-schizophrenia spectrum.

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8. Micai M, Vulchanova M, Saldana D. Do Individuals with Autism Change Their Reading Behavior to Adapt to Errors in the Text ?. J Autism Dev Disord ;2019 (Jul 10)

Reading monitoring is poorly explored, but it may have an impact on well-documented reading comprehension difficulties in autism. This study explores reading monitoring through the impact of instructions and different error types on reading behavior. Individuals with autism and matched controls read correct sentences and sentences containing orthographic and semantic errors. Prior to the task, participants were given instructions either to focus on semantic or orthographic errors. Analysis of eye-movements showed that the group with autism, differently from controls, were less influenced by the error’s type in the regression-out to-error measure, showing less change in eye-movements behavior between error types. Individuals with autism might find it more difficult to adapt their reading strategies to various reading materials and task demands.

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9. Ning M, Daniels J, Schwartz J, Dunlap K, Washington P, Kalantarian H, Du M, Wall DP. Identification and Quantification of Gaps in Access to Autism Resources in the United States : An Infodemiological Study. J Med Internet Res ;2019 (Jul 10) ;21(7):e13094.

BACKGROUND : Autism affects 1 in every 59 children in the United States, according to estimates from the Centers for Disease Control and Prevention’s Autism and Developmental Disabilities Monitoring Network in 2018. Although similar rates of autism are reported in rural and urban areas, rural families report greater difficulty in accessing resources. An overwhelming number of families experience long waitlists for diagnostic and therapeutic services. OBJECTIVE : The objective of this study was to accurately identify gaps in access to autism care using GapMap, a mobile platform that connects families with local resources while continuously collecting up-to-date autism resource epidemiological information. METHODS : After being extracted from various databases, resources were deduplicated, validated, and allocated into 7 categories based on the keywords identified on the resource website. The average distance between the individuals from a simulated autism population and the nearest autism resource in our database was calculated for each US county. Resource load, an approximation of demand over supply for diagnostic resources, was calculated for each US county. RESULTS : There are approximately 28,000 US resources validated on the GapMap database, each allocated into 1 or more of the 7 categories. States with the greatest distances to autism resources included Alaska, Nevada, Wyoming, Montana, and Arizona. Of the 7 resource categories, diagnostic resources were the most underrepresented, comprising only 8.83% (2472/28,003) of all resources. Alarmingly, 83.86% (2635/3142) of all US counties lacked any diagnostic resources. States with the highest diagnostic resource load included West Virginia, Kentucky, Maine, Mississippi, and New Mexico. CONCLUSIONS : Results from this study demonstrate the sparsity and uneven distribution of diagnostic resources in the United States, which may contribute to the lengthy waitlists and travel distances-barriers to be overcome to be able to receive diagnosis in specific regions. More data are needed on autism diagnosis demand to better quantify resource needs across the United States.

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10. Nowell SW, Watson LR, Boyd B, Klinger LG. Efficacy Study of a Social Communication and Self-Regulation Intervention for School-Age Children With Autism Spectrum Disorder : A Randomized Controlled Trial. Lang Speech Hear Serv Sch ;2019 (Jul 12) ;50(3):416-433.

Purpose This study aimed to examine the initial efficacy of a parent-assisted blended intervention combining components of Structured TEACCHing and Social Thinking, designed to increase social communication and self-regulation concept knowledge in 1st and 2nd graders ( n = 17) diagnosed with autism spectrum disorder (ASD) and their parents. Method A randomized delayed treatment control group design with pre- and postintervention assessments of both parents and children was implemented within a community practice setting. Two follow-up assessments at 3 and 6 months postintervention were also completed. Results Overall, results indicate that the intervention is efficacious in teaching social communication and self-regulation concept knowledge to children with ASD and their parents. Both parents and children demonstrated an increase in social communication and self-regulation knowledge after participating in the Growing, Learning, and Living With Autism Group as compared to a delayed treatment control group. The effects of the intervention did not extend to parent-child interactions coded from video recordings. Child treatment effects were maintained at the 3- and 6-month follow-up assessments. Conclusions Preliminary efficacy of the Growing, Learning, and Living With Autism Group was established. Based on parent report at the conclusion of the intervention, this is a socially valid intervention for teaching social communication and self-regulation skills to school-age children with ASD. Supplemental Material

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11. O’Keeffe C, Taboada LP, Feerick N, Gallagher L, Lynch T, Reilly RB. Complexity based measures of postural stability provide novel evidence of functional decline in fragile X premutation carriers. J Neuroeng Rehabil ;2019 (Jul 12) ;16(1):87.

BACKGROUND : Fragile X Associated Tremor/Ataxia Syndrome (FXTAS) is a neurodegenerative movement disorder characterized by tremor, ataxic gait, and balance issues resulting from a premutation of the Fragile X Mental Retardation 1 (FMR1) gene. No biomarkers have yet been identified to allow early diagnosis of FXTAS, however, recent studies have reported subtle issues in the stability of younger premutation carriers, before disease onset. This study investigates the efficacy of multiscale entropy analysis (MSE) in detecting early changes in the motor system of premutation carriers without FXTAS. METHODS : Sway complexity of 12 female Premutation carriers and 15 healthy Controls were measured under four conditions : eyes open, closed, and two dual-task conditions. A Sustained Attention Response Task (SART) and a working memory based N-Back task were employed to increase cognitive load while standing on the forceplate. A Complexity Index (Ci) was calculated for anterior-posterior (AP) and mediolateral (ML) sway. Independent t-tests were used to assess between-group differences and Oneway repeated measures ANOVA were used to assess within group differences with Bonferroni corrections to adjust for multiple comparisons. RESULTS : Group performances were comparable with eyes open and closed conditions. The Carrier group’s Ci was consistent across tasks and conditions while the Control group’s AP Ci increased significantly during the cognitive dual-task (p = 0.001). There was also a strong correlation between CGG repeat length and complexity for the Carrier group (p = 0.004). SIGNIFICANCE : Increased sway complexity is believed to stem from reallocation of attention to facilitate the increased cognitive demands of dual-tasks. Carriers’ complexity did not change during dual-tasks, possibly indicating capacity interference and inefficient division of attention. Lower sway complexity in carriers suggests diminished adaptive capacity under stress as well as degradation of motor functioning. Therefore, sway complexity may be a useful tool in identifying early functional decline in FMR1 premutation carriers as well as monitoring progression towards disease onset.

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12. Parsons L, Cordier R, Munro N, Joosten A. A Play-Based, Peer-Mediated Pragmatic Language Intervention for School-Aged Children on the Autism Spectrum : Predicting Who Benefits Most. J Autism Dev Disord ;2019 (Jul 10)

This study explored characteristics of children with autism with large intervention effects following a peer-mediated pragmatic language intervention, to devise algorithms for predicting children most likely to benefit. Children attended a 10-week intervention with a typically-developing peer. Data from a pilot study and RCT formed the dataset for this study. The POM-2 measured intervention outcomes. Children completed the EVT-2, TACL-4, and Social Emotional Evaluation at baseline, and parents completed the CCC-2 and CCBRS. High CCC-2 Use of Context and CCBRS Separation Anxiety scores and comparatively lower EVT-2, CCC-2 Nonverbal Communication and Cohesion scores predicted children with large intervention effects. Results can be used by clinicians to predict which children within their clinics might benefit most from participating in this intervention.

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13. Rispoli KM, Lee GK, Nathanson EW, Malcolm AL. The parent role in school-based teams for adolescents with autism spectrum disorder. Sch Psychol ;2019 (Jul) ;34(4):458-467.

For youth with autism spectrum disorder (ASD) and their families, adolescence presents unique challenges that require parents work closely with school teams. Both parent involvement in education and family school partnerships are associated with positive student outcomes. However, research characterizing parents’ role in working with school-based teams across the middle and high school years for youth with ASD is limited. The present study presents qualitative data illustrating the perspectives of 23 parents of students with ASD regarding their experiences working with middle and high school teams. Participants completed semistructured interviews, which were analyzed using interpretative phenomenological analysis. Six themes were reflected in the experiences and perspectives of parents, including collaboration/partnership, advocacy, relationships, parental background, expectations, and impact on the parent. Results indicated variability in the nature and impact of parents’ experiences and a need for intentional formation of meaningful partnerships between educators and families that honor the unique needs and strengths of youth and maximize team effectiveness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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14. Rispoli KM, Mathes NE, Malcolm AL. Characterizing the parent role in school-based interventions for autism : A systematic literature review. Sch Psychol ;2019 (Jul) ;34(4):444-457.

Parent-focused intervention for children with autism spectrum disorder (ASD) has garnered considerable evidence of effectiveness for treating core symptoms of the disorder. However, these programs often teach parents discrete skills that may or may not align with school-based interventions. Family-school partnerships (FSPs) are essential for children with ASD given the complex presentation of symptoms characteristic of this disorder. It is unclear how and to what degree current school-based interventions for children with ASD include parents and whether their inclusion is consistent with definitions of parent involvement or FSPs established in the literature. A systematic review of the school-based intervention literature for children with ASD was conducted on studies published between 2002 and 2017. Thirty-six articles met inclusion criteria. Results indicated interventions included parents in ways consistent with both parent involvement and FSPs, though the former model was more common. Findings suggest a need for greater focus on measuring parent behavioral outcomes when evaluating intervention effectiveness and developing or refining interventions to include meaningful family-school partnering. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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15. Schalock RL, Luckasson R, Tasse MJ. The contemporary view of intellectual and developmental disabilities : Implications for psychologists. Psicothema ;2019 (Aug) ;31(3):223-228.

BACKGROUND : The field of intellectual and developmental disabilities (IDD) is currently experiencing a significant transformation that encompasses an integrated approach, especially regarding shared aspects such as a focus on the human and legal rights, the eligibility for services and supports, and an emphasis on individualized supports provided within inclusive community-based environments. Accompanying this transformation is the increased need of precision in both the operational definitions of IDD-related constructs, and the terminology used to describe the respective construct. METHOD : the specialized literature was revised, and previous works on the subject by the authors were updated. RESULTS : This article provides psychologists with the current definition of intellectual disability, operational definitions of intellectual disability and developmental disabilities constructs and associated terminology, and the parameters of an integrated approach to disability. CONCLUSIONS : Implications for psychologists who are involved in diagnosis, classification, and planning supports for persons with intellectual or developmental disability are discussed.

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16. Schuwerk T, Batz J, Trauble B, Sodian B, Paulus M. Do ostensive cues affect object processing in children with and without autism ? A test of natural pedagogy theory. Psychol Res ;2019 (Jul 10)

Theories suggest that the perception of others’ actions and social cues leads to selective processing of object features. Most recently, natural pedagogy theory postulated that ostensive cues lead to a selective processing of an object’s features at the expense of processing of its location. This study examined this hypothesis in 10-year-old children with and without autism spectrum condition (ASC) to better understand social information processing in ASC and the relevance of observing others in human object processing in general. Participants saw an agent either ostensively pointing to an object or non-ostensively grasping an object. Thereafter, the cued or uncued object changed either its location or identity. We assessed not only behavioral responses, but also participants’ gaze behavior by means of eye tracking. In contrast to natural pedagogy theory, we found that in the non-ostensive grasping context, participants rather noticed an identity change than a location change. Moreover, location changes were more readily identified in the ostensive pointing context. Importantly, there was no difference between children with and without ASC. Our study shows that the perception of ostensively vs. non-ostensively framed actions leads to different processing of object features, indicating a close link between action perception, object processing, and social cues. Moreover, the lacking group difference in our study suggests that these basic perception-action processes are not impaired in autism.

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17. Sullivan MO, Gallagher L, Heron EA. Gaining Insights into Aggressive Behaviour in Autism Spectrum Disorder Using Latent Profile Analysis. J Autism Dev Disord ;2019 (Jul 10)

Aggressive behaviour is a significant issue for individuals with autism spectrum disorder (ASD), yet our understanding is limited compared to aggression in typically developing populations. This study examined behavioural, adaptive and cognitive data provided by the Simons Simplex Collection (N = 2184) to identify behavioural subgroups in children and adolescents with ASD using latent profile analysis. Results showed five subgroups that differed with regards to behavioural severity, IQ and adaptive behaviour. In two profiles with higher aggression, individuals had greater comorbid anxiety symptoms and attentional deficits and also differed in adaptive behaviour and IQ. These results identify potentially important avenues for research in aggressive behaviour in ASD.

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18. Thorkelson G, Laughlin SF, Turner KS, Ober N, Handen BL. Selective Serotonin Reuptake Inhibitor Monotherapy for Anxiety Disorders in Children and Adolescents with Autism Spectrum Disorder : A Chart Review. J Child Adolesc Psychopharmacol ;2019 (Jul 11)

Objective : Anxiety disorders are one of the most commonly co-occurring psychiatric diagnoses in youth with autism spectrum disorder (ASD), with a frequency ranging from 22% to 84%. Methods : We conducted a chart review of 29 children and adolescents with ASD who had been treated with selective serotonin reuptake inhibitor (SSRI) monotherapy for an anxiety disorder for at least 2 months. Subsequent chart reviews were conducted for the first follow-up visit within 2-6 months (M = 4.2 months) and the visit closest to 9 months posttreatment (ranging from 7 to 12 months ; M = 10.5 months). The presence of adverse events (AEs) was examined, and a consensus Clinical Global Impressions Improvement (CGI-I) score was determined. Results : Fifty-five percent of patients were given a CGI-I of "improved" or "very much improved" at the 9-month follow-up. Four patients discontinued treatment owing to AEs. Other reported AEs not leading to discontinuation included vivid dreaming, increased emotional lability, and irritability. Responders included a number of patients who had failed previous SSRI trials. Conclusions : This study suggests that SSRI treatment should be considered for individuals with ASD and anxiety disorders, even if prior SSRI trials have been unsuccessful.

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19. Trembath D, Gurm M, Scheerer NE, Trevisan DA, Paynter J, Bohadana G, Roberts J, Iarocci G. Systematic review of factors that may influence the outcomes and generalizability of parent-mediated interventions for young children with autism spectrum disorder. Autism Res ;2019 (Jul 11)

Parent mediated interventions have the potential to positively influence the interactions and developmental outcomes of children with autism spectrum disorder (ASD). However, a range of factors relating to children, parents and caregivers, and study design may impact on outcomes and thus the generalizability of these interventions to the broader community. The objective of this review was to examine factors that may influence the feasibility, appropriateness, effectiveness, and generalizability of parent mediated interventions for children with ASD. We conducted a systematic review, yielding 41 articles. There was substantial variability in the intervention type, intensity, and study quality. Notably, 46 different inclusion/exclusion criteria were reported across studies including factors relating to children’s development, access to other services, comorbidities, parental factors, and access to the intervention. Fifteen articles included examination of 45 different factors potentially associated with, or influencing, intervention outcomes including child (e.g., language skills, ASD severity, cognition) and parent (e.g., adherence and fidelity, education) factors. Although there is clear evidence for an increasingly sophisticated (e.g., systematic phased research for some interventions) and diverse (e.g., studies in geographical diverse contexts including low-resource communities) approach to research examining parent mediated interventions, there remains a need for improved study quality and measurement consistency in research, including a detailed examination of factors that may predict, moderate, and mediate intervention effectiveness for children and their parents. Autism Res 2019, (c) 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY : Parent mediated interventions-in which parents adapt their own behavior or deliver interventions to help their children learn-appear to be effective for some children with autism spectrum disorder. In this review, we identified a range of child, parent, and study design factors that may influence intervention outcomes and ultimately the uptake of these approaches in the community. We suggest that research in this area could be further improved by ensuring that studies include diverse groups of children and parents, and by using study designs that help to establish not only if interventions work, but for whom they work best and why.

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20. Wilder DA, Ertel H, Hodges AC, Thomas R, Luong N. The use of auditory feedback and edible reinforcement to decrease toe walking among children with autism. J Appl Behav Anal ;2019 (Jul 10)

We replicated and extended previous research on the use of auditory feedback to decrease toe walking exhibited by 3 children with autism. After pretreatment screening analyses suggested that toe walking occurred independent of social consequences, we attached squeakers to the heels of each participants’ shoes. The squeakers provided auditory feedback when participants walked appropriately (i.e., with a heel-to-toe gait). For all participants, the auditory feedback itself produced increases in appropriate walking. For 1 participant, this feedback was sufficient to reduce toe walking to clinically acceptable levels ; however, for 2 other participants, delivery of edible items paired with the auditory feedback was necessary. Intervention effects maintained when the schedule for edible delivery was thinned for all participants. In addition, for 2 participants, effects maintained when the intervention was implemented in a different setting and with a different person with no edibles or a thin schedule of edibles.

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