Le numéro d’Août 2016 d’Australian Psychologist est consacré à l’autisme :

Autism Spectrum Disorder : Research and Practice

1. Anderson A, Barbaro J, Maybery M. Introduction to Special Issue “Autism Spectrum Disorder : Research and Practice”. Australian Psychologist ;2016 ;51(4):259-260.

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2. Young RL, Nah Y-H. Examining Autism Detection in Early Childhood (ADEC) in the Early Identification of Young Children with Autism Spectrum Disorders (ASD). Australian Psychologist ;2016 ;51(4):261-271.

Objective Screening for autism spectrum disorder (ASD) is an important first step in the identification of children considered at risk of developing the disorder and in need of further assessment, intervention, and services. In this paper, we reviewed some commonly used ASD-specific screening tools and focused on the use of an ASD-specific screening tool developed in Australia, the Autism Detection in Early Childhood (ADEC), in enhancing the early identification of young children with ASD. The ADEC was developed as a clinician-administered screening tool that was time-efficient, suitable for children under 3 years, easy to administer, and suitable for persons with minimal training and experience with ASD. Method A systematic search of published research studies was performed to review key findings of the ADEC and some commonly used ASD-specific screening tools through February 2015. The Psych-Info and Google Scholar online databases were searched concurrently for entries containing any combination of the terms (a) autism screening and (b) autism detection in early childhood. Results We found four studies suggesting that screening for ASD using the ADEC can be sensitive and specific in children under the age of three. The ADEC is comparable to some commonly used ASD-specific screening tools. Conclusions Based on the studies presented, as compared to some commonly used ASD-specific screening tools, the ADEC is a sound and effective ASD screening tool, suitable for use with young children ranging from 12–36 months of age, and can be used with confidence to compliment the developmental surveillance and assessment processes. There is also the potential and possibility of translating the ADEC across different socio-economic populations, including developing and low-resource countries.

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3. Ward SL, Sullivan KA, Gilmore L. Practitioner Perceptions of the Assessment and Diagnosis of Autism in Australia. Australian Psychologist ;2016 ;51(4):272-279.

Objective Autism Spectrum Disorder (ASD) can potentially be diagnosed by 3 years of age. Yet, 2012 Australian diagnostic data showed most children are diagnosed after this age. This study examined whether an ASD diagnostic “gap” exists and explored practitioners’ perceptions of the assessment and diagnostic process. Method Using a modified version of an existing questionnaire, we undertook a national survey of Australian practitioners who assess infants and children with possible ASD (psychologists, n=54 ; paediatricians, n=42 ; psychiatrists, n=8). Results Approximately 63% of practitioners reported most likely recommending an ASD diagnosis in a child 3 years or older. Over 60% of practitioners identified the following factors as influencing their practice in relation to ASD diagnosis in children under 3 years of age : preference for a “watch and wait approach” (92%) ; the perceived difficulty of the diagnosis (79%) ; inability to see children early enough because of initial assessment waiting list (75%), and the perceived limitations of diagnostic aids, including assessment measures (63%) and the diagnostic criteria (69%). Variations in assessment and diagnostic practices were reported by the three professional groups. Conclusion A number of factors may influence the timing of ASD diagnosis for children in Australia and could contribute to a diagnostic “gap.” The practitioner-reported challenges suggest potential improvements to the ASD diagnosis process.

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4. Murillo L, Shih A, Rosanoff M, Daniels AM, Reagon K. The Role of Multi-Stakeholder Collaboration and Community Consensus Building in Improving Identification and Early Diagnosis of Autism in Low-Resource Settings. Australian Psychologist ;2016 ;51(4):280-286.

Objective Research has demonstrated that early intervention for children with autism can lead to improvements in core symptoms and enhance cognition, adaptive functioning, and quality of life. Unfortunately, most children are diagnosed too late to fully benefit from these services. Even in regions where diagnosis of autism can reliably be made, families often face additional barriers in accessing quality services. This article describes case examples in which Autism Speaks’ Global Autism Public Health (GAPH) Initiative partnered with communities to facilitate a process of multi-stakeholder collaboration to better understand local autism priorities related to awareness activities, early diagnosis, and developing autism surveillance systems. Method This paper utilised a nested case study to demonstrate how GAPH employs multi-stakeholder collaboration, community-based participatory research (CBPR) and consensus building to enhance early identification in low-resource settings. Each of these processes influenced different phases of the projects. Results In the first example, Autism Speaks adopted a CBPR approach to understand and address barriers to help-seeking behaviour among the Korean community affected by autism in New York City. The second example describes an international effort to develop open-source screening and diagnostic tools for autism that can be delivered by non-specialists in low-resource settings. The last example describes efforts to facilitate the development of an autism registry in Ireland to inform health policy decisions. Conclusions Collectively, these examples outline approaches the GAPH initiative uses to support global communities in working to overcome challenges related to the needs of individuals with autism and their families.

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5. Taylor LJ, Whitehouse AJO. Autism Spectrum Disorder, Language Disorder, and Social (Pragmatic) Communication Disorder : Overlaps, Distinguishing Features, and Clinical Implications. Australian Psychologist ;2016 ;51(4):287-295.

Background The diagnostic boundaries between autism spectrum disorder (ASD) and specific language impairment (SLI) are not clear-cut. Evidence of the lack of distinct boundaries between these disorders comes from research identifying a group of children who have pragmatic language difficulties that can be distinguished from those in children with SLI and those with ASD. These findings have led to the inclusion of a new diagnostic category, social (pragmatic) communication disorder (SPCD), in the Diagnostic and Statistical Manual of Mental Disorders-5th Edition DSM-5. While this new diagnostic category appears to capture a subgroup of children who may not have been recognised in the DSM-IV, SPCD has been criticised due to a lack of empirical evidence, showing that the disorder is distinct from ASD in terms of aetiology, intervention, and prognosis. Objective The purpose of this paper was to summarise the literature that has investigated overlaps in the phenotypes of SLI, ASD, and SPCD. A secondary objective was to present a framework for the assessment and diagnosis of these three conditions. Method and Results In this paper, we review the research that has examined overlaps in the aetiologies and phenotypes of ASD, SPCD, and SLI. While the results highlighted overlaps in the language profiles and autistic symptomatology, these three conditions could also be distinguished based on the severity of the social communication deficits and the absence of rigid and repetitive behaviour in strictly defined cases of SPCD and SLI. Conclusions Strictly defined cases of SPCD and SLI can be distinguished from ASD. However, there is a lack of assessment tools that can reliably distinguish these three conditions. We consider the clinical implications of the findings and present a model of assessment and diagnosis for ASD, SLI, and SPCD.

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6. May T, McGinley J, Murphy A, Hinkley T, Papadopoulos N, Williams KJ, McGillivray J, Enticott PG, Leventer RJ, Rinehart NJ. A Multidisciplinary Perspective on Motor Impairment as an Early Behavioural Marker in Children with Autism Spectrum Disorder. Australian Psychologist ;2016 ;51(4):296-303.

Objectives There is no medical test for autism spectrum disorder (ASD), a heterogeneous condition currently defined in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) by dysfunction in social, communication, and behavioural dimensions. There is agreement in the literature that the motor profile of ASD may hold the key to improving clinical and diagnostic definition, with DSM-5 now referring to motor deficits, including “odd gait” (p. 55), as part of the ASD clinical description. This review describes the history of motor impairment in ASD, types of motor problems, and age-related motor findings and highlights evidence gaps and future research. Method A narrative review is provided of the research literature describing motor impairment in ASD and its ability to differentiate between ASD versus non-ASD cohorts. Results Findings show differences in motor development in children with ASD from infancy onwards, including difficulties across motor coordination, arm movements, gait, and postural stability. Motor disturbance may appear in young children with ASD prior to social and language difficulties becoming clinically apparent. However, challenges remain in defining and measuring the early motor profile that is specific to ASD. Despite well-established motor impairments in ASD, there is a lack of evidence regarding which motor-based interventions will be effective in this group. Conclusions Motor impairment holds promise as an early diagnostic sign, a behavioural marker, and a means by which to improve identification and possibly phenotypic delineation in ASD. Further research is required to determine whether motor abnormalities can sensitively differentiate ASD from other developmental conditions and to establish evidenced-based interventions to reduce the associated impairment.

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7. Karola D, Julie-Ann J, Lyn M. School’s out Forever : Postsecondary Educational Trajectories of Students with Autism. Australian Psychologist ;2016 ;51(4):304-315.

Objective Postsecondary educational attainment is the key for successful transition to adulthood, economic self-sufficiency, and good mental and physical health. Method Secondary analyses of school leavers’ data were carried out to establish postsecondary educational trajectories of students on the autism spectrum in the United Kingdom. Results Findings show that students with autism who had attended mainstream secondary schools enter Further Education (post-16 vocational training) at lower rates and Higher Education (University) institutions at a similar rate to other students. They study the full range of subjects on offer. However, they are more likely to be younger, study at a lower academic level, and remain living at home with their parents. Conclusion While course completion data were not yet available, attainment data showed that prospects are improving, although more needs to be done to enable these young adults to achieve their full postsecondary educational potential.

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8. Carr ME. Self-management of Challenging Behaviours Associated with Autism Spectrum Disorder : A Meta-Analysis. Australian Psychologist ;2016 ;51(4):316-333.

Objective A diagnosis of autism spectrum disorder (ASD) is often accompanied by challenging behaviour that may limit the ability to engage in education, employment, or social settings. The purpose of this review was to examine the effectiveness of self-management interventions in reducing challenging behaviours for individuals diagnosed with ASD. This review included self-management interventions that specifically targeted a reduction in challenging behaviours as well as studies that specifically targeted skill acquisition and described improvements in challenging behaviours as a collateral effect of the intervention Method Studies were located by conducting a systematic search of peer-reviewed literature published in English prior to October 2015. The PsycINFO and ERIC databases were searched. A quality assessment was conducted using the What Works Clearinghouse (WWC) guidelines. A final data set of 12 single-subject research design studies that met quality standards was subsequently analysed. Treatment effect sizes were calculated using the percentage of non-overlapping data. Results Results were analysed by age, gender, symptom severity, presentation of problem behaviour, and the presence of functional behaviour assessments. Results indicated that self-management interventions are effective at decreasing challenging behaviour for children aged four to 18 years who may be described as either high or low functioning. Conclusions Self-management of challenging behaviour was identified as an emerging treatment, and inclusion within a positive behaviour support framework was argued. Important areas for consideration in future research are described.

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