1. Brady NC, Storkel HL, Bushnell P, Barker RM, Saunders K, Daniels D, Fleming K. {{Investigating a Multimodal Intervention for Children with Limited Expressive Vocabularies Associated with Autism}}. {Am J Speech Lang Pathol};2015 (Apr 24)
Purpose: To investigate a new intervention package aimed at increasing expressive word learning by school-age children with autism who have limited expressive vocabularies. This pilot investigation was intended to show proof of concept. Method: Ten children between the ages of 6-10 years with educational diagnoses of autism and limited expressive vocabularies at the outset of the study participated. A multimodal intervention composed of speech sound practice and AAC was used to teach individualized vocabulary words that were selected based on initial speech sound repertoires and principles of phonotactic probability and neighborhood density. A multiple-probe design was used to evaluate learning outcomes. Results: Five children showed gains in spoken- word learning across successive word sets (High Responders). Five children did not meet learning criteria (Low Responders). Comparisons of behaviors measured prior to intervention indicated that High Responders had relatively higher skills in receptive language, prelinguistic communication, vocal/verbal imitation, adaptive behavior and consonant productions. Conclusions: The intervention package holds promise for improving spoken word productions for some children with autism who have limited expressive vocabularies. Further research is needed to better describe who may most benefit from this approach as well as investigate generalized benefits to untaught contexts and targets.
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2. Cianfaglione R, Hastings RP, Felce D, Clarke A, Kerr MP. {{Psychological Well-Being of Mothers and Siblings in Families of Girls and Women with Rett Syndrome}}. {J Autism Dev Disord};2015 (Apr 25)
Few published studies have reported on the psychological well-being of family members of individuals with Rett syndrome (RTT). Eighty-seven mothers of girls and women with RTT completed a questionnaire survey about their daughters’ behavioral phenotype, current health, and behavior problems, and their own and a sibling’s well-being. Mothers reported increased anxiety but similar levels of depression when compared to a normative sample. Across all problem domains on the Strengths and Difficulties Questionnaire, child and adolescent siblings (n = 39) were reported by mothers to have fewer difficulties than a normative sample. The severity of their daughters’ RTT behavioral phenotype predicted increased anxiety and stress for mothers. Increased RTT daughters’ current health problems predicted more maternal perceptions of positive gain.
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3. Croen LA, Zerbo O, Qian Y, Massolo ML, Rich S, Sidney S, Kripke C. {{The health status of adults on the autism spectrum}}. {Autism};2015 (Apr 24)
Compared to the general pediatric population, children with autism have higher rates of co-occurring medical and psychiatric illnesses, yet very little is known about the general health status of adults with autism. The objective of this study was to describe the frequency of psychiatric and medical conditions among a large, diverse, insured population of adults with autism in the United States. Participants were adult members of Kaiser Permanente Northern California enrolled from 2008 to 2012. Autism spectrum disorder cases (N = 1507) were adults with autism spectrum disorder diagnoses (International Classification of Diseases-9-Clinical Modification codes 299.0, 299.8, 299.9) recorded in medical records on at least two separate occasions. Controls (N = 15,070) were adults without any autism spectrum disorder diagnoses sampled at a 10:1 ratio and frequency matched to cases on sex and age. Adults with autism had significantly increased rates of all major psychiatric disorders including depression, anxiety, bipolar disorder, obsessive-compulsive disorder, schizophrenia, and suicide attempts. Nearly all medical conditions were significantly more common in adults with autism, including immune conditions, gastrointestinal and sleep disorders, seizure, obesity, dyslipidemia, hypertension, and diabetes. Rarer conditions, such as stroke and Parkinson’s disease, were also significantly more common among adults with autism. Future research is needed to understand the social, healthcare access, and biological factors underlying these observations.
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4. Flouri E, Midouhas E, Charman T, Sarmadi Z. {{Poverty and the Growth of Emotional and Conduct Problems in Children with Autism With and Without Comorbid ADHD}}. {J Autism Dev Disord};2015 (Apr 25)
We investigated the longitudinal relationship between socio-economic disadvantage (SED) and trajectories of emotional and conduct problems among children with autism spectrum disorder (ASD) who had comorbid attention deficit/hyperactivity disorder (ADHD; ASD + ADHD) or not (ASD – ADHD). The sample was 209 children with ASD who took part in the UK’s Millennium Cohort Study. Trajectories of problems across ages 3, 5 and 7 years were analyzed using growth curve models. The ASD – ADHD group decreased in conduct problems over time but the ASD + ADHD group continued on a high trajectory. Although SED was not a risk factor for ASD + ADHD, it was associated with elevated emotional problems among children with ASD + ADHD. This effect of SED on emotional problems was not attenuated by parenting or peer problems.
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5. Gengoux GW, Berquist KL, Salzman E, Schapp S, Phillips JM, Frazier TW, Minjarez MB, Hardan AY. {{Pivotal Response Treatment Parent Training for Autism: Findings from a 3-Month Follow-Up Evaluation}}. {J Autism Dev Disord};2015 (Apr 26)
This study’s objective was to assess maintenance of treatment effects 3 months after completion of a 12-week Pivotal Response Treatment (PRT) parent education group. Families who completed the active treatment (N = 23) were followed for an additional 12 weeks to measure changes in language and cognitive skills. Results indicated a significant improvement in frequency of functional utterances, with maintenance at 3-month follow-up [F(2, 21): 5.9, p = .009]. Children also made significant gains on the Vineland Communication Domain Standard Score [F(2, 12):11.74, p = .001] and the Mullen Scales of Early Learning Composite score [F(1, 20) = 5.43, p = .03]. These results suggest that a brief PRT parent group intervention can lead to improvements in language and cognitive functioning that are maintained 12 weeks post treatment.
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6. Merryman MB, Miller NA, Shockley E, Eskow KG, Chasson GS. {{State adoption of Medicaid 1915(c) waivers for children and youth with Autism Spectrum Disorder}}. {Disabil Health J};2015 (Mar 14)
BACKGROUND: The prevalence of Autism Spectrum Disorder (ASD) has increased dramatically, with one in every 68 children in the U.S. currently diagnosed with ASD. Medicaid is the primary public funder of health care services for individuals with ASD. One mechanism state Medicaid agencies can use to craft ASD-specific services is a 1915(c) waiver. OBJECTIVE: This study investigated what state policy makers perceived to be primary success factors and barriers to adopting an ASD specific 1915(c) waiver, as well as what services and supports are available in each state for children and transition-age youth with ASD. METHODS: Data were collected by contacting state Medicaid directors via email with an electronic survey, with an 84% response rate. RESULTS: Support from state legislators and parents and family members were the primary success factors in adopting an ASD specific waiver. The primary barrier was insufficient funding. States not adopting an ASD specific waiver also perceived that children and youth with ASD were served sufficiently well through other Medicaid benefits. Analysis of specific services indicated that the majority of states provide their services to children and transition age youth with ASD through a 1915(c) waiver for individuals with intellectual or developmental disabilities, often coupled with an ASD specific waiver for children, another 1915(c) waiver for children, and/or a another 1915(c) waiver, most often for children with serious emotional disturbance. CONCLUSION: Further research is needed to determine which approach(es) is most effective in enhancing access and improving outcomes for children and youth with ASD.
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7. Patel N, Crider A, Pandya CD, Ahmed AO, Pillai A. {{Altered mRNA Levels of Glucocorticoid Receptor, Mineralocorticoid Receptor, and Co-Chaperones (FKBP5 and PTGES3) in the Middle Frontal Gyrus of Autism Spectrum Disorder Subjects}}. {Mol Neurobiol};2015 (Apr 26)
Although stress has been implicated in the pathophysiology of autistic spectrum disorder (ASD), it is not known whether glucocorticoid receptor (GR) levels are altered in the brain of subjects with ASD. The messenger RNA (mRNA) levels of GR isoforms (GRalpha, GRbeta, GRgamma, and GRP), mineralocorticoid receptor (MR), GR co-chaperones (FKBP5, PTGES3, and BAG1), and inflammatory cytokines (IL-6, IL-1beta, and IFN-gamma) were examined in the postmortem middle frontal gyrus tissues of 13 ASD and 13 age-matched controls by qRT-PCR. The protein levels were examined by Western blotting. We found significant decreases in GRalpha (64 %), GRgamma (48 %), GRP (20 %) and MR (46 %) mRNA levels in ASD subjects as compared to controls. However, significant increases in FKBP5 (42 %) and PTGES3 (35 %) mRNA levels were observed in ASD subjects. There were no differences in the mRNA levels of GRbeta and BAG1 in ASD subjects as compared to controls. MR mRNA was found to be negatively correlated with the diagnostic score for abnormality of development. On the protein level, significant reductions in GR and MR, but no change in FKBP5 and PTGES3 were found in ASD subjects as compared to controls. Moreover, we observed significant increases in IL-1beta and IFN-gamma mRNA levels in ASD subjects, and these cytokines were negatively associated with GR levels. Our data, for the first time, reports dysregulation of GR, MR, FKBP5, and PTGES3 in ASD and suggest a possible role of inflammation in altered GR function in ASD.
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8. Pellecchia M, Connell JE, Beidas RS, Xie M, Marcus SC, Mandell DS. {{Dismantling the Active Ingredients of an Intervention for Children with Autism}}. {J Autism Dev Disord};2015 (Apr 25)
This study evaluated the association of fidelity to each of the components of the Strategies for Teaching based on Autism Research (STAR) program, a comprehensive treatment package for children with autism that includes discrete trial training, pivotal response training, and teaching in functional routines, on outcomes for 191 students ages 5-8 years in a large public school district. Fidelity to all components was relatively low, despite considerable training and support, suggesting the need to develop new implementation strategies. Fidelity to pivotal response training, but not discrete trial training or functional routines, was positively associated with gains in cognitive ability despite low levels of fidelity, and may be an effective intervention choice in under-resourced settings.
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9. Pellecchia M, Connell JE, Kerns CM, Xie M, Marcus SC, Mandell DS. {{Child characteristics associated with outcome for children with autism in a school-based behavioral intervention}}. {Autism};2015 (Apr 24)
This study examined the extent to which clinical and demographic characteristics predicted outcome for children with autism spectrum disorder. Participants included 152 students with autism spectrum disorder in 53 kindergarten-through-second-grade autism support classrooms in a large urban public school district. Associations between child characteristics (including age, language ability, autism severity, social skills, adaptive behavior, co-occurring psychological symptoms, and restrictive and repetitive behavior) and outcome, as measured by changes in cognitive ability following one academic year of an intervention standardized across the sample were evaluated using linear regression with random effects for classroom. While several scales and subscales had statistically significant bivariate associations with outcome, in adjusted analysis, only age and the presence of symptoms associated with social anxiety, such as social avoidance and social fearfulness, as measured through the Child Symptom Inventory-4, were associated with differences in outcome. The findings regarding the role of social anxiety are new and have important implications for treatment. Disentangling the construct of social anxiety to differentiate between social fearfulness and social motivation has important implications for shifting the focus of early treatment for children with autism spectrum disorder.
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10. Samadi SA, McConkey R. {{Screening for Autism in Iranian Preschoolers: Contrasting M-CHAT and a Scale Developed in Iran}}. {J Autism Dev Disord};2015 (Apr 26)
Suitable screening instruments for the early diagnosis of autism are not readily available for use with preschoolers in non-Western countries. This study evaluated two tools: M-CHAT which is widely used internationally and one developed in Iran called Hiva. A population sample was recruited of nearly 3000 preschoolers in one Iranian city. Parents self-completed the two tools and children who screened positive were invited for a follow-up interview followed by a diagnostic assessment. The Hiva scale proved to be more efficacious in identifying children with ASD and the resulting prevalence rate was higher than that previously reported for Iranian 5 year olds. The study confirms the need to attune screening tools to the cultural contexts in which they are used.
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11. Yakubova G, Hughes EM, Hornberger E. {{Video-Based Intervention in Teaching Fraction Problem-Solving to Students with Autism Spectrum Disorder}}. {J Autism Dev Disord};2015 (Apr 25)
The purpose of this study was to determine the effectiveness of a point-of-view video modeling intervention to teach mathematics problem-solving when working on word problems involving subtracting mixed fractions with uncommon denominators. Using a multiple-probe across students design of single-case methodology, three high school students with ASD completed the study. All three students demonstrated greater accuracy in solving fraction word problems and maintained accuracy levels at a 1-week follow-up.
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12. Yui K, Sato A, Imataka G. {{Mitochondrial Dysfunction and Its Relationship with mTOR Signaling and Oxidative Damage in Autism Spectrum Disorders}}. {Mini Rev Med Chem};2015;15(5):373-389.
Mitochondria are organelles that play a central role in processes related to cellular viability, such as energy production, cell growth, cell death via apoptosis, and metabolism of reactive oxygen species (ROS). We can observe behavioral abnormalities relevant to autism spectrum disorders (ASDs) and their recovery mediated by the mTOR inhibitor rapamycin in mouse models. In Tsc2(+/-) mice, the transcription of multiple genes involved in mTOR signaling is enhanced, suggesting a crucial role of dysregulated mTOR signaling in the ASD model. This review proposes that the mTOR inhibitor may be useful for the pharmacological treatment of ASD. This review offers novel insights into mitochondrial dysfunction and the related impaired glutathione synthesis and lower detoxification capacity. Firstly, children with ASD and concomitant mitochondrial dysfunction have been reported to manifest clinical symptoms similar to those of mitochondrial disorders, and it therefore shows that the clinical manifestations of ASD with a concomitant diagnosis of mitochondrial dysfunction are likely due to these mitochondrial disorders. Secondly, the adenosine triphosphate (ATP) production/oxygen consumption pathway may be a potential candidate for preventing mitochondrial dysfunction due to oxidative stress, and disruption of ATP synthesis alone may be related to impaired glutathione synthesis. Finally, a decrease in total antioxidant capacity may account for ASD children who show core social and behavioral impairments without neurological and somatic symptoms.
13. Zablotsky B, Bramlett M, Blumberg SJ. {{Factors associated with parental ratings of condition severity for children with autism spectrum disorder}}. {Disabil Health J};2015 (Mar 20)
BACKGROUND: There is currently little consensus on how the severity of a child’s autism spectrum disorder (ASD) should be measured, and yet despite the lack of a standardized definition, parents were readily able to answer a question asking them to describe the severity of his/her child’s ASD in a national survey. OBJECTIVE/HYPOTHESES: The current study examined factors associated with a parent’s judgment of ASD severity, by identifying child and household characteristics that were associated with a parent’s severity rating of his/her child’s ASD, including child ASD symptomatology, child impact, and family impact. METHODS: Data came from the 2011 Survey of Pathways to Diagnosis and Services (« Pathways »). A total of 967 parents in households with a child diagnosed with ASD between the ages of 6-17 were eligible for the current study. A measurement model was used to create latent factors of child symptoms, child impact, and family impact; multivariate logistic regression models examined the relationship between these latent factors and the parent’s severity rating of their child’s ASD. RESULTS: Children with higher family impact factor scores were more likely to have parents who rated their child’s ASD as the most severe. Surprisingly, symptomatology and impact on the child were less predictive of severe ratings. CONCLUSIONS: A parent’s conceptualization of their child’s ASD severity may vary more as a function of the impact of the child’s condition on the family and less as a function of the symptoms exhibited by the child or the impact directly felt by the child.
