1. Ajzenman HF, Standeven JW, Shurtleff TL. {{Effect of hippotherapy on motor control, adaptive behaviors, and participation in children with autism spectrum disorder: a pilot study}}. {Am J Occup Ther};2013 (Nov-Dec);67(6):653-663.
OBJECTIVE. The purpose of this investigation was to determine whether hippotherapy increased function and participation in children with autism spectrum disorder (ASD). We hypothesized improvements in motor control, which might increase adaptive behaviors and participation in daily activities. METHOD. Six children with ASD ages 5-12 participated in 12 weekly 45-min hippotherapy sessions. Measures pre- and post-hippotherapy included the Vineland Adaptive Behavior Scales-II and the Child Activity Card Sort. Motor control was measured preintervention and postintervention using a video motion capture system and force plates. RESULTS. Postural sway significantly decreased postintervention. Significant increases were observed in overall adaptive behaviors (receptive communication and coping) and in participation in self-care, low-demand leisure, and social interactions. CONCLUSION. These results suggest that hippotherapy has a positive influence on children with ASD and can be a useful treatment tool for this population.
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2. Breslin CM, Rudisill ME. {{Relationships among assessment time, time on task, and motor skill performance in children with autism spectrum disorder}}. {Adapt Phys Activ Q};2013 (Oct);30(4):338-350.
Twenty-two children (age range of 3.5-10.92 years old) with autism spectrum disorder (ASD) were assessed using the Test of Gross Motor Development (Second Edition; TGMD-2) using three different protocols. The total duration of assessment time and the percentage of time engaged in on-task behavior during the assessments were measured and analyzed using within-subjects repeated measure ANOVA designs to compare performance across the three protocols. Significant differences emerged across the duration of assessment time by assessment protocol, while no significant differences emerged for time on-task during the assessments by protocol used. In addition, correlations were calculated between the TGMD-2 scores and the duration of assessment time and the percentage of time on-task. An inverse relationship was found between TGMD-2 scores and total duration of assessment time by protocol used, (r = .726, .575, .686), while a positive relationship was found between the TGMD-2 scores and time on-task (r = -.570, -.535, -.798). These results suggest a direct relationship between skill proficiency and contextually appropriate behaviors.
3. Callenmark B, Kjellin L, Ronnqvist L, Bolte S. {{Explicit versus implicit social cognition testing in autism spectrum disorder}}. {Autism};2013 (Nov 8)
Although autism spectrum disorder is defined by reciprocal social-communication impairments, several studies have found no evidence for altered social cognition test performance. This study examined explicit (i.e. prompted) and implicit (i.e. spontaneous) variants of social cognition testing in autism spectrum disorder. A sample of 19 adolescents with autism spectrum disorder and 19 carefully matched typically developing controls completed the Dewey Story Test. ‘Explicit’ (multiple-choice answering format) and ‘implicit’ (free interview) measures of social cognition were obtained. Autism spectrum disorder participants did not differ from controls regarding explicit social cognition performance. However, the autism spectrum disorder group performed more poorly than controls on implicit social cognition performance in terms of spontaneous perspective taking and social awareness. Findings suggest that social cognition alterations in autism spectrum disorder are primarily implicit in nature and that an apparent absence of social cognition difficulties on certain tests using rather explicit testing formats does not necessarily mean social cognition typicality in autism spectrum disorder.
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4. Classen S, Monahan M, Wang Y. {{Driving characteristics of teens with attention deficit hyperactivity and autism spectrum disorder}}. {Am J Occup Ther};2013 (Nov-Dec);67(6):664-673.
Vehicle crashes are a leading cause of death among teens. Teens with attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), or both (ADHD-ASD) may have a greater crash risk. We examined the between-groups demographic, clinical, and predriving performance differences of 22 teens with ADHD-ASD (mean age = 15.05, standard deviation [SD] = 0.95) and 22 healthy control (HC) teens (mean age = 14.32, SD = 0.72). Compared with HC teens, the teens with ADHD-ASD performed more poorly on right-eye visual acuity, selective attention, visual-motor integration, cognition, and motor performance and made more errors on the driving simulator pertaining to visual scanning, speed regulation, lane maintenance, adjustment to stimuli, and total number of driving errors. Teens with ADHD-ASD, compared with HC teens, may have more predriving deficits and as such require the skills of a certified driving rehabilitation specialist to assess readiness to drive.
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5. Fujiwara T. {{Socioeconomic Status and the Risk of Suspected Autism Spectrum Disorders Among 18-Month-Old Toddlers in Japan: A Population-Based Study}}. {J Autism Dev Disord};2013 (Nov 8)
The association between family socioeconomic status (SES) and the suspected autism spectrum disorder (ASD) status of 18-month-old toddlers was investigated using a population-based sample in Japan, which has a universal healthcare system and a mandatory health checkup system for toddlers. Questionnaires including SES measurements and modified checklist for autism in toddlers were mailed to all families with 18-month-old toddlers in Chiba, a city near Tokyo (N = 6,061; response rate: 64 %). The results of logistic regression analysis (which were adjusted for potential confounders) indicated that low maternal education, but not paternal education or family income, were associated with having suspected ASD offspring. Lower maternal education was associated with an increased risk of autistic traits in Japan.
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6. Goldingay S, Stagnitti K, Sheppard L, McGillivray J, McLean B, Pepin G. {{An intervention to improve social participation for adolescents with autism spectrum disorder: Pilot study}}. {Dev Neurorehabil};2013 (Nov 8)
Abstract Objective: To increase flexible thinking, self-regulation and empathy for adolescents with ASD. Method: Five adolescents (M = 13.5 years; SD = 0.84 years; four males) were assessed pre and post intervention for flexible thinking and social competence (as measured by the SSIS). Parents rated their adolescent’s social competence pre and post intervention. Results: A large decrease was found in parent rating of their child’s level of hyperactivity (12.8, SD = 2.3; 11, SD = 2.2) (p = 0.034) (Cohen’s d = 0.95). Parents increased their rating of their child’s cooperation and empathy (Cohen’s d = 0.71 and 0.56, respectively). A medium effect for flexible thinking was observed in three items (Cohen’s d = 0.5 to 0.62) and a large effect for one item (Cohen’s d = 1.35). Adolescents decreased self-scoring on the social scale post intervention. Conclusion: Improvements were observed in adolescents’ flexible thinking and social insights, and parent’s perception of their child’s self-regulation.
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7. Hartley SL, Schaidle EM, Burnson CF. {{Parental Attributions for the Behavior Problems of Children and Adolescents With Autism Spectrum Disorders}}. {J Dev Behav Pediatr};2013 (Nov 8)
OBJECTIVE:: The authors examined parental attributions for child behavior problems in 63 married couples of children and adolescents (aged 3-20 years) with autism spectrum disorders (ASDs). Both child-referent attributions (i.e., beliefs about causes related to the child or adolescent) and parent-referent attributions (i.e., beliefs about causes related to the parent) were examined along the dimensions of locus, stability, and controllability. Parent and child/adolescent factors related to parental attributions were identified, and the associations between parental attributions and parenting burden were explored. METHOD:: Mothers and fathers independently completed self-reported measures of parental attributions, parenting burden, and child behavior problems. Couples jointly reported on their son or daughter’s severity of autism symptoms, intellectual disability status, age, and gender. RESULTS:: Parents tended to attribute the behavior problems of their child/adolescent with an ASD to characteristics that were not only internal to and stable in the child/adolescent but also controllable by the child/adolescent. Mothers were more likely to attribute their son or daughter’s behavior problems to characteristics that were less internal to and less stable in the child/adolescent with an ASD than were fathers. In addition, parents with a higher level of symptoms of the broader autism phenotype, parents of younger children, and parents of children/adolescents with intellectual disability, a higher severity of autism symptoms, and a higher severity of overall behavior problems were more likely to attribute their son or daughter’s behavior problems to characteristics that were more internal to and stable in the child/adolescent and factors that were less controllable by the child/adolescent. Parental attributions were related to parents’ level of parenting burden. IMPLICATIONS:: Findings have implications for designing appropriate interventions and services for families of children and adolescents with ASDs.
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8. Hesselmark E, Plenty S, Bejerot S. {{Group cognitive behavioural therapy and group recreational activity for adults with autism spectrum disorders: A preliminary randomized controlled trial}}. {Autism};2013 (Nov 8)
Although adults with autism spectrum disorder are an increasingly identified patient population, few treatment options are available. This preliminary randomized controlled open trial with a parallel design developed two group interventions for adults with autism spectrum disorders and intelligence within the normal range: cognitive behavioural therapy and recreational activity. Both interventions comprised 36 weekly 3-h sessions led by two therapists in groups of 6-8 patients. A total of 68 psychiatric patients with autism spectrum disorders participated in the study. Outcome measures were Quality of Life Inventory, Sense of Coherence Scale, Rosenberg Self-Esteem Scale and an exploratory analysis on measures of psychiatric health. Participants in both treatment conditions reported an increased quality of life at post-treatment (d = 0.39, p < 0.001), with no difference between interventions. No amelioration of psychiatric symptoms was observed. The dropout rate was lower with cognitive behavioural therapy than with recreational activity, and participants in cognitive behavioural therapy rated themselves as more generally improved, as well as more improved regarding expression of needs and understanding of difficulties. Both interventions appear to be promising treatment options for adults with autism spectrum disorder. The interventions’ similar efficacy may be due to the common elements, structure and group setting. Cognitive behavioural therapy may be additionally beneficial in terms of increasing specific skills and minimizing dropout.
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9. Jones W, Klin A. {{Attention to eyes is present but in decline in 2-6-month-old infants later diagnosed with autism}}. {Nature};2013 (Nov 6)
Deficits in eye contact have been a hallmark of autism since the condition’s initial description. They are cited widely as a diagnostic feature and figure prominently in clinical instruments; however, the early onset of these deficits has not been known. Here we show in a prospective longitudinal study that infants later diagnosed with autism spectrum disorders (ASDs) exhibit mean decline in eye fixation from 2 to 6 months of age, a pattern not observed in infants who do not develop ASD. These observations mark the earliest known indicators of social disability in infancy, but also falsify a prior hypothesis: in the first months of life, this basic mechanism of social adaptive action-eye looking-is not immediately diminished in infants later diagnosed with ASD; instead, eye looking appears to begin at normative levels prior to decline. The timing of decline highlights a narrow developmental window and reveals the early derailment of processes that would otherwise have a key role in canalizing typical social development. Finally, the observation of this decline in eye fixation-rather than outright absence-offers a promising opportunity for early intervention that could build on the apparent preservation of mechanisms subserving reflexive initial orientation towards the eyes.
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10. Kakooza-Mwesige A, Ssebyala K, Karamagi C, Kiguli S, Smith K, Anderson MC, Croen LA, Trevathan E, Hansen R, Smith D, Grether JK. {{Adaptation of the ‘ten questions’ to screen for autism and other neuro-developmental disorders in Uganda}}. {Autism};2013 (Nov 8)
Neurodevelopmental disorders are recognized to be relatively common in developing countries but little data exist for planning effective prevention and intervention strategies. In particular, data on autism spectrum disorders are lacking. For application in Uganda, we developed a 23-question screener (23Q) that includes the Ten Questions screener and additional questions on autism spectrum disorder behaviors. We then conducted household screening of 1169 children, 2-9 years of age, followed by clinical assessment of children who screened positive and a sample of those who screened negative to evaluate the validity of the screener. We found that 320 children (27% of the total) screened positive and 68 children received a clinical diagnosis of one or more moderate to severe neurodevelopmental disorders (autism spectrum disorder; cerebral palsy; epilepsy; cognitive, speech and language, hearing, or vision impairment), including 8 children with autism spectrum disorders. Prevalence and validity of the screener were evaluated under different statistical assumptions. Sensitivity of the 23Q ranged from 0.55 to 0.80 and prevalence for >/=1 neurodevelopmental disorders from 7.7/100 children to 12.8/100 children depending on which assumptions were used. The combination of screening positive on both autism spectrum disorders and Ten Questions items was modestly successful in identifying a subgroup of children at especially high risk of autism spectrum disorders. We recommend that autism spectrum disorders and related behavioral disorders be included in studies of neurodevelopmental disorders in low-resource settings to obtain essential data for planning local and global public health responses.
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11. Klintwall L, Eldevik S, Eikeseth S. {{Narrowing the gap: Effects of intervention on developmental trajectories in autism}}. {Autism};2013 (Nov 8)
Although still a matter of some debate, there is a growing body of research supporting Early and Intensive Behavioral Intervention as the intervention of choice for children with autism. Learning rate is an alternative to change in standard scores as an outcome measure in studies of early intervention. Learning rates can be displayed graphically as developmental trajectories, which are easy to understand and avoid some of the counter-intuitive properties of changes in standard scores. The data used in this analysis were from 453 children with autism, previously described by Eldevik et al. Children receiving Early and Intensive Behavioral Intervention exhibited significantly steeper developmental trajectories than children in the control group, in both intelligence and adaptive behaviors. However, there was a considerable variability in individual learning rates within the group receiving Early and Intensive Behavioral Intervention. This variability could partly be explained by the intensity of the treatment, partly by children’s intake intelligence quotient age-equivalents. Age at intake did not co-vary with learning rate.
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12. Kroon T, Sierksma MC, Meredith RM. {{Investigating mechanisms underlying neurodevelopmental phenotypes of autistic and intellectual disability disorders: a perspective}}. {Front Syst Neurosci};2013;7:75.
Brain function and behavior undergo significant plasticity and refinement, particularly during specific critical and sensitive periods. In autistic and intellectual disability (ID) neurodevelopmental disorders (NDDs) and their corresponding genetic mouse models, impairments in many neuronal and behavioral phenotypes are temporally regulated and in some cases, transient. However, the links between neurobiological mechanisms governing typically normal brain and behavioral development (referred to also as « neurotypical » development) and timing of NDD impairments are not fully investigated. This perspective highlights temporal patterns of synaptic and neuronal impairment, with a restricted focus on autism and ID types of NDDs. Given the varying known genetic and environmental causes for NDDs, this perspective proposes two strategies for investigation: (1) a focus on neurobiological mechanisms underlying known critical periods in the (typically) normal-developing brain; (2) investigation of spatio-temporal expression profiles of genes implicated in monogenic syndromes throughout affected brain regions. This approach may help explain why many NDDs with differing genetic causes can result in overlapping phenotypes at similar developmental stages and better predict vulnerable periods within these disorders, with implications for both therapeutic rescue and ultimately, prevention.
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13. Lenroot RK, Yeung PK. {{Heterogeneity within Autism Spectrum Disorders: What have We Learned from Neuroimaging Studies?}}. {Front Hum Neurosci};2013;7:733.
Autism spectrum disorders (ASD) display significant heterogeneity. Although most neuroimaging studies in ASD have been designed to identify commonalities among affected individuals, rather than differences, some studies have explored variation within ASD. There have been two general types of approaches used for this in the neuroimaging literature to date: comparison of subgroups within ASD, and analyses using dimensional measures to link clinical variation to brain differences. This review focuses on structural and functional magnetic resonance imaging studies that have used these approaches to begin to explore heterogeneity between individuals with ASD. Although this type of data is yet sparse, recognition is growing of the limitations of behaviorally defined categorical diagnoses for understanding neurobiology. Study designs that are more informative regarding the sources of heterogeneity in ASD have the potential to improve our understanding of the neurobiological processes underlying ASD.
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14. Luck AN, Bobst CE, Kaltashov IA, Mason AB. {{Human Serum Transferrin: Is There a Link among Autism, High Oxalate Levels, and Iron Deficiency Anemia?}}. {Biochemistry};2013 (Nov 8)
It has been previously suggested that large amounts of oxalate in plasma could play a role in autism by binding to the bilobal iron transport protein transferrin (hTF), thereby interfering with iron metabolism by inhibiting the delivery of iron to cells. By examining the effect of the substitution of oxalate for the physiologically utilized synergistic carbonate anion in each lobe of hTF, we sought to provide a molecular basis for or against such a role. Our work clearly shows both qualitatively (6 M urea gels) and quantitatively (kinetic analysis by stopped-flow spectrofluorimetry) that the presence of oxalate in place of carbonate in each binding site of hTF does indeed greatly interfere with the removal of iron from each lobe (in the absence and presence of the specific hTF receptor). However, we also clearly demonstrate that once the iron is bound within each lobe of hTF, neither anion can displace the other. Additionally, as verified by urea gels and electrospray mass spectrometry, formation of completely homogeneous hTF-anion complexes requires that all iron must first be removed and hTF then reloaded with iron in the presence of either carbonate or oxalate. Significantly, experiments described here show that carbonate is the preferred binding partner; i.e., even if an equal amount of each anion is available during the iron loading process, the hTF-carbonate complex is formed.
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15. Phelps R, Nickel R, Eisert D, Stein MT. {{Parental Influence on a Child’s Autistic Traits}}. {J Dev Behav Pediatr};2013 (Nov 8)
CASE: Robbie is a 4-year-old boy whose parents are concerned about his speech, social skills, and repetitive behaviors. He has poor articulation; at time, he is difficult to understand. On the other hand, he has a fair vocabulary, and he has good intent to communicate. He is generally able to communicate his needs and wants. He likes to tell his parents about his day.When he begins the day at preschool, Robbie initially stands by himself and watches. He slowly warms up and eventually participates in activities. He engages in parallel play or follows other children. He knows names of children at preschool, and he is well liked. He is affectionate with his parents.When Robbie is excited, he wiggles his fingers, flaps his arms, and grimaces. He can be quite rigid; for example, he gets very distressed when his mother sets his cup down on his right side instead of his left. However, in general, Robbie has a sunny personality. He likes to watch children’s television shows. He pretends plays with action figures. Robbie is an only child who lives with both parents. His mother works full-time, and his father is in home with Robbie during the day.When examined in the office, Robbie had a bright affect, good eye contact, and social referencing. He demonstrated good communicative intent, but poor articulation and some jargoning. He frequently wiggled his fingers and flapped his hands with excitement. Robbie had a borderline score on the Autism Diagnostic Observation Schedule.During the visit, the pediatrician noted that Robbie’s father was rather quiet and rarely responded to questions. When he did respond, he had a monotone quality to his voice. He maintained either a flat or nervous affect throughout the visit. He made limited eye contact, and occasionally he stared excessively.
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16. Potvin MC, Snider L, Prelock PA, Wood-Dauphinee S, Kehayia E. {{Health-related quality of life in children with high-functioning autism}}. {Autism};2013 (Nov 8)
The health-related quality of life of school-aged children with high-functioning autism is poorly understood. The objectives of this study were to compare the health-related quality of life of children with high-functioning autism to that of typically developing peers and to compare child-self and parent-proxy reports of health-related quality of life of children. A cross-sectional study of children with high-functioning autism (n = 30) and peers (n = 31) was conducted using the Pediatric Quality of Life Inventory 4.0 Generic Core Scales. Children with high-functioning autism had significantly poorer health-related quality of life than peers whether reported by themselves (p < .001) or their parents (p < .001), although disagreement (intra-class coefficient = -.075) between children and parental scores suggested variance in points of view. This study specifically investigated health-related quality of life in children with high-functioning autism as compared to a sample of peers, from the child’s perspective. It strengthens earlier findings that children with high-functioning autism experience poorer health-related quality of life than those without this disorder and points to the importance of clinicians working with families to identify areas in a child’s life that promote or hinder their sense of well-being.
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17. Russell-Smith SN, Comerford BJ, Maybery MT, Whitehouse AJ. {{Brief Report: Further Evidence for a Link Between Inner Speech Limitations and Executive Function in High-Functioning Children with Autism Spectrum Disorders}}. {J Autism Dev Disord};2013 (Nov 7)
This study investigated the involvement of inner speech limitations in the executive dysfunction associated with autism spectrum disorders (ASDs). Seventeen children with ASD and 18 controls, statistically-matched in age and IQ, performed a computer-based card sorting test (CST) to assess cognitive flexibility under four conditions: baseline, with articulatory suppression, with a concurrent mouthing task, and while verbalizing their strategies aloud. Articulatory suppression adversely affected CST performance for the control group but not the ASD group. The results additionally showed that overtly verbalizing strategies did not benefit the ASD children as it did the typically developing children. The findings thus provide further evidence that ASD children do not use inner speech to the same extent, or with the same effectiveness, as typically developing children when performing executive tasks.
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18. Timimi S. {{Over-prescribing methylphenidate won’t be cured by autism-style assessments}}. {BMJ};2013;347:f6622.
19. Verhoeff B. {{The autism puzzle: challenging a mechanistic model on conceptual and historical grounds}}. {Philos Ethics Humanit Med};2013 (Nov 8);8(1):17.
Although clinicians and researchers working in the field of autism are generally not concerned with philosophical categories of kinds, a model for understanding the nature of autism is important for guiding research and clinical practice. Contemporary research in the field of autism is guided by the depiction of autism as a scientific object that can be identified with systematic neuroscientific investigation. This image of autism is compatible with a permissive account of natural kinds: the mechanistic property cluster (MPC) account of natural kinds, recently proposed as the model for understanding psychiatric disorders. Despite the heterogeneity, multicausality and fuzzy boundaries that complicate autism research, a permissive account of natural kinds (MPC kinds) provides prescriptive guidance for the investigation of objective causal mechanisms that should inform nosologists in their attempt to carve autism’s boundaries at its natural joints. However, this essay will argue that a mechanistic model of autism is limited since it disregards the way in which autism relates to ideas about what kind of behavior is abnormal. As historical studies and definitions of autism show, normative issues concerning disability, impairment and societal needs have been and still are inextricably linked to how we recognize and understand autism. The current search for autism’s unity in neurobiological mechanisms ignores the values, social norms and various perspectives on mental pathology that play a significant role in ‘the thing called autism’. Autism research needs to engage with these issues in order to achieve more success in the effort to become clinically valuable.
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20. Yonkman J, Lawler B, Talty J, O’Neil J, Bull M. {{Safely transporting children with autism spectrum disorder: evaluation and intervention}}. {Am J Occup Ther};2013 (Nov-Dec);67(6):711-716.
OBJECTIVE. The purpose of this study was to investigate transportation practices of caregivers who transport children diagnosed with autism spectrum disorders (ASD). METHOD. We reviewed documented transportation evaluations of children with ASD. The evaluations were conducted by pediatric occupational therapists at an outpatient center of a large children’s hospital. RESULTS. A review of 82 charts of patients diagnosed with ASD revealed that 74% of children with ASD were escaping their child safety restraint. More than 20% of parents reported that their child demonstrated aggressive or self-injurious behavior during travel, affecting not only their own safety but also that of others in the vehicle, including the driver. CONCLUSION. Escaping from a child restraint can be a life-threatening problem among children with ASD. Parents, caregivers, and health care professionals should be aware of services available from trained therapists, certified child passenger safety technicians, or both to maximize safety during personal travel in the family vehicle.
