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ABA, EIBI, and Neurofeedback
Advances in Autism Research
April 2010
The training of autistic children is an important component of therapeutics. Many parents have reported that the combination of biomedical and ABA-like training is more effective than either modality by itself.
1. Applied behavior analytic interventions for children with autism: a description and review of treatment research
Granpeesheh D, Tarbox J, Dixon DR.
Ann Clin Psychiatry. 2009 Jul-Sep;21(3):162-73.
BACKGROUND: Autism is a disorder characterized by pervasive delays in the development of language and socialization, and the presence of stereotyped, repetitive behaviors or nonfunctional interests. Although a multitude of treatments for autism exist, very few have been the subject of scientific research. The only treatment that has been supported by substantial empirical research is treatment based on applied behavior analysis (ABA). METHODS: This article describes components of comprehensive ABA treatment programs, reviews research on effectiveness, and discusses issues related to collaboration between ABA and psychiatry. RESULTS: ABA has been supported by several hundred single case experiments and an increasing number of between-groups studies. Comprehensive ABA treatment programs are comprised of multiple intervention procedures, such as discrete trial instruction and natural environment training, and are founded on basic principles of learning and motivation, such as positive reinforcement, extinction, stimulus control, and generalization. Clinicians in the fields of ABA and psychiatry have similar goals regarding client outcome, and several ABA measurement and analysis procedures produce information that may be useful to psychiatrists. CONCLUSIONS: ABA treatment programs for individuals with autism are supported by a significant amount of scientific evidence and are therefore recommended for use. Patient care would likely benefit from a greater degree of collaboration between practitioners in the fields of ABA and psychiatry.
2. Randomized Controlled Trial for Early Intervention for Autism: A Pilot Study of the Autism 1-2-3 Project
Wong VC, Kwan QK.
J Autism Dev Disord. 2009 Dec 18. [Epub ahead of print]
We piloted a 2-week "Autism-1-2-3" early intervention for children with autism and their parents immediately after diagnosis that targeted at (1) eye contact, (2) gesture and (3) vocalization/words. Seventeen children were randomized into the Intervention (n = 9) and Control (n = 8) groups. Outcome measures included the Autism Diagnostic Observation Schedule, Ritvo-Freeman Real Life Rating Scale, Symbolic Play Test, and Parenting Stress Index. Children with autism improved in language/communication, reciprocal social interaction, and symbolic play. Parents perceived significant improvement in their children's language, social interaction, and their own stress level. This intervention can serve as short-term training on communication and social interaction for children with autism, and reduce the stress of their parents during the long waiting time for public health services.
3. Retrospective analysis of clinical records in 38 cases of recovery from autism
Granpeesheh D, Tarbox J, Dixon DR, Carr E, Herbert M.
Ann Clin Psychiatry. 2009 Oct-Dec;21(4):195-204.
https://www.aacp.com/Abstract.asp?AID=8145&issue=&page=C&UID=
BACKGROUND: Twenty years of research on early intensive treatment using applied behavior analysis (ABA) for children with autism has consistently produced robust effects. There appears to be a subset of children whose response to intensive ABA treatments includes achieving a level of functioning that is indistinguishable from typically developing peers. The purpose of this study was to describe a subset of children who recovered from autism following intensive ABA interventions. METHODS: We reviewed the clinical files of 38 children with autism who achieved an optimal outcome after receiving intensive ABA services. RESULTS: The mean age at intake was 40 months. Average IQ was 83.6 at intake and 107.9 at discharge. Mean adaptive skills were 68.04 at intake and 88.87 at discharge. CONCLUSIONS: Our study corroborates the finding that some children with autism who receive early intensive behavioral intervention achieve functioning in the average range.
4. Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review
Ospina MB et al.
University of Alberta
PLoS One. 2008;3(11):e3755. Epub 2008 Nov 18.
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0003755
BACKGROUND: Much controversy exists regarding the clinical efficacy of behavioural and developmental interventions for improving the core symptoms of autism spectrum disorders (ASD). We conducted a systematic review to summarize the evidence on the effectiveness of behavioural and developmental interventions for ASD. METHODS AND FINDINGS: Comprehensive searches were conducted in 22 electronic databases through May 2007. Further information was obtained through hand searching journals, searching reference lists, databases of theses and dissertations, and contacting experts in the field. Experimental and observational analytic studies were included if they were written in English and reported the efficacy of any behavioural or developmental intervention for individuals with ASD. Two independent reviewers made the final study selection, extracted data, and reached consensus on study quality. Results were summarized descriptively and, where possible, meta-analyses of the study results were conducted. One-hundred-and-one studies at predominantly high risk of bias that reported inconsistent results across various interventions were included in the review. Meta-analyses of three controlled clinical trials showed that Lovaas treatment was superior to special education on measures of adaptive behaviour, communication and interaction, comprehensive language, daily living skills, expressive language, overall intellectual functioning and socialization. High-intensity Lovaas was superior to low-intensity Lovaas on measures of intellectual functioning in two retrospective cohort studies. Pooling the results of two randomized controlled trials favoured developmental approaches based on initiative interaction compared to contingency interaction in the amount of time spent in stereotyped behaviours and distal social behaviour, but the effect sizes were not clinically significant. No statistically significant differences were found for: Lovaas versus special education for non-verbal intellectual functioning; Lovaas versus Developmental Individual-difference relationship-based intervention for communication skills; computer assisted instruction versus no treatment for facial expression recognition; and TEACCH versus standard care for imitation skills and eye-hand integration. CONCLUSIONS: While this review suggests that Lovaas may improve some core symptoms of ASD compared to special education, these findings are based on pooling of a few, methodologically weak studies with few participants and relatively short-term follow-up. As no definitive behavioural or developmental intervention improves all symptoms for all individuals with ASD, it is recommended that clinical management be guided by individual needs and availability of resources.
5. Evidence-based comprehensive treatments for early autism
Rogers SJ, Vismara LA.
M.I.N.D. Institute, University of California Davis
J Clin Child Adolesc Psychol. 2008 Jan;37(1):8-38.
Early intervention for children with autism is currently a politically and scientifically complex topic. Randomized controlled trials have demonstrated positive effects in both short-term and longer term studies. The evidence suggests that early intervention programs are indeed beneficial for children with autism, often improving developmental functioning and decreasing maladaptive behaviors and symptom severity at the level of group analysis. Whether such changes lead to significant improvements in terms of greater independence and vocational and social functioning in adulthood is also unknown. Given the few randomized controlled treatment trials that have been carried out, the few models that have been tested, and the large differences in interventions that are being published, it is clear that the field is still very early in the process of determining (a) what kinds of interventions are most efficacious in early autism, (b) what variables moderate and mediate treatment gains and improved outcomes following intervention, and (c) the degree of both short-term and long-term improvements that can reasonably be expected. To examine these current research needs, the empirical studies of comprehensive treatments for young children with autism published since 1998 were reviewed. Lovaas's treatment meet Chambless and colleague's (Chambless et al., 1998; Chambless et al., 1996) criteria for "well-established" and no treatment meets the "probably efficacious" criteria, though three treatments meet criteria for "possibly efficacious" (Chambless & Hollon, 1998). Most studies were either Type 2 or 3 in terms of their methodological rigor based on Nathan and Gorman's (2002) criteria. Implications of these findings are also discussed in relation to practice guidelines as well as critical areas of research that have yet to be answered.
6. Parents' experiences of home-based applied behavior analysis programs for young children with autism
Grindle CF, Kovshoff H, Hastings RP, Remington B.
Bangor University
J Autism Dev Disord. 2009 Jan;39(1):42-56. Epub 2008 Jun 6.
Although much research has documented the benefits to children with autism of early intensive behavioral intervention (EIBI), little has focused on the impact of EIBI on families. Using a semi-structured format, we interviewed 53 parents whose children had received 2 years of EIBI to obtain detailed first person accounts of the perceived benefits and pitfalls of running a home program, and the impact of EIBI on family life and support systems. In general, parents were positive about EIBI, its benefits for them, their child, and the broader family. Interviews also, however, revealed some of the more challenging aspects of managing home-based EIBI. The implications of these findings for more supportive interventions for families on home programs are discussed.
7. Systematic review of early intensive behavioral interventions for children with autism
Howlin P, Magiati I, Charman T.
King's College, London
Am J Intellect Dev Disabil. 2009 Jan;114(1):23-41.
Recent reviews highlight limitations in the evidence base for early interventions for children with autism. We conducted a systematic review of controlled studies of early intensive behavioral interventions (EIBI) for young children with autism. Eleven studies met inclusion criteria (including two randomized controlled trials). At group level, EIBI resulted in improved outcomes (primarily measured by IQ) compared to comparison groups. At an individual level, however, there was considerable variability in outcome, with some evidence that initial IQ (but not age) was related to progress. This review provides evidence for the effectiveness of EIBI for some, but not all, preschool children with autism.
8. Evidence-based review of interventions for autism used in or of relevance to occupational therapy
Case-Smith J, Arbesman M.
The Ohio State University
Am J Occup Ther. 2008 Jul-Aug;62(4):416-29.
Occupational therapy practitioners are among the professionals who provide services to children and adults with autism spectrum disorder (ASD), embracing both leadership and supportive roles in service delivery. The study's primary aims were as follows: (1) to identify, evaluate, and synthesize the research literature on interventions for ASD of relevance to occupational therapy and (2) to interpret and apply the research literature to occupational therapy. A total of 49 articles met the authors' criteria and were included in the review. Six categories of research topics were identified, the first 3 of which are most closely related to occupational therapy: (1) sensory integration and sensory-based interventions; (2) relationship-based, interactive interventions; (3) developmental skill-based programs; (4) social cognitive skill training; (5) parent-directed or parent-mediated approaches; and (6) intensive behavioral intervention. Under each category, themes supported by research evidence and applicable to occupational therapy were defined. The findings have implications for intervention methods, communication regarding efficacious practices to professionals and consumers, and future occupational therapy research.
9. The effects of intellectual functioning and autism severity on outcome of early behavioral intervention for children with autism
Ben-Itzchak E, Zachor DA.
Bar-Ilan University
Res Dev Disabil. 2007 May-Jun;28(3):287-303. Epub 2006 May 30.
This study assessed the relation between pre-intervention variables (cognition, socialization and communication) to outcome in young children with autism. METHOD: Twenty five children with autism (20-32 months) were enrolled in intensive behavior intervention. The children were divided into groups based on their IQ scores and on the severity of their social interaction and communication deficits [per autism diagnostic observation schedule (ADOS) scores]. Six developmental-behavioral domains including, imitation, receptive language, expressive language, nonverbal communication skills, play skills and stereotyped behaviors were assessed at pre- and post-1 year of intervention times. RESULTS: Significant progress was noted in all the six developmental-behavioral domains after 1 year of intervention. Children with higher initial cognitive levels and children with fewer measured early social interaction deficits showed better acquisition of skills in three developmental areas, receptive language, expressive language and play skills. Both groups showed better progress in Receptive language skills. Better progress in expressive language was associated with the child's social abilities, while more significant progress in play skills was related to pre-intervention cognitive level. CONCLUSIONS: These findings emphasize the importance of early intensive intervention in autism and the value of pre-intervention cognitive and social interaction levels for predicting outcome.
10. Parent implemented early intervention for young children with autism spectrum disorder: a systematic review
McConachie H, Diggle T.
University of Newcastle
J Eval Clin Pract. 2007 Feb;13(1):120-9.
BACKGROUND: Recent estimates concerning the prevalence of autism spectrum disorder (ASD) suggest that at least one in 200 children is affected. This group of children and families have important service needs. The involvement of parents in implementing intervention strategies designed to help their autistic children has long been accepted as helpful. The potential benefits are increased skills and reduced stress for parents as well as children. METHODS: This research review focused on interventions for children aged 1-6 years, and was carried out using systematic methodology: a comprehensive search of psychological, educational and biomedical databases, as well as bibliographies and reference lists of key articles, contact with experts in the field, and hand search of key journals. Only studies which involved a concurrent element of control were included. RESULTS: The review found very few studies that had adequate research design from which to draw conclusions about the effectiveness of parent-implemented early intervention. Both randomized and controlled studies tended to suggest that parent training leads to improved child communicative behaviour, increased maternal knowledge of autism, enhanced maternal communication style and parent child interaction, and reduced maternal depression. CONCLUSION: It seems that parent training can successfully contribute to intervention for young children with ASD. However, the review highlights the need for improved research in this area.
11. The effectiveness of intervention on the behavior of individuals with autism: a meta-analysis using percentage of data points exceeding the median of baseline phase (PEM)
Ma HH.
National Chengchi University
Behav Modif. 2009 May;33(3):339-59. Epub 2009 Mar 11.
The aim of the present study is to demonstrate the percentage of data points exceeding the median of baseline phase (PEM) approach using data on autism treatment for illustrative purposes to compare the effectiveness of different interventions on the problem behaviors of individuals with autism. Electronic databases such as The ProQuest and Google were searched. A total of 163 articles were located, producing 1,502 effect sizes. The results demonstrate that five highly effective intervention strategies were priming, self-control, training, positive reinforcement and punishment, and presenting preferential activities. The least effective strategy was to teach perspective-taking skills. The PEM approach is recommended for use in meta-analysis for single-case experimental designs.
12. Social skills interventions for children with Asperger's syndrome or high-functioning autism: a review and recommendations
Rao PA, Beidel DC, Murray MJ.
Pennsylvania State Hershey College of Medicine
J Autism Dev Disord. 2008 Feb;38(2):353-61. Epub 2007 Jul 20.
This paper reviews the literature examining social skills training (SST) programs for youth with AS/HFA, with an emphasis on critically evaluating efficacy and highlighting areas of future research. The review highlights the disparity between SST programs described in the extant literature, including lack of a universal definition of social skills, various levels of intensity and duration of treatment, divergent theoretical backgrounds, and variety in services provided in clinic or classroom settings. Overall, it is clear that, despite their widespread clinical use, empirical support for SST programs for children with AS/HFA is minimal at this time. Based on this critical review, a "roadmap" for future research, consistent with recommendations put forth by a leading group of autism researchers, is presented.
13. Behavioral assessment and treatment of self-injurious behavior in autism
Minshawi NF.
Indiana University School of Medicine
Child Adolesc Psychiatr Clin N Am. 2008 Oct;17(4):875-86, x.
Self-injurious behaviors (SIB) are common in individuals who have autism and related developmental disabilities. When an individual engages in SIB, these behaviors frequently become the primary treatment target because of the potential for injury. A thorough behavioral assessment aimed at determining the function of the behaviors is the first step to developing a treatment plan. This article presents a brief background of SIB and a discussion of the behavioral assessment and treatment of these behaviors to familiarize readers with the behavioral perspective on SIB in individuals who have autism and other developmental disabilities.
14. Cognitive, behavior and intervention outcome in young children with autism
Ben Itzchak E, Lahat E, Burgin R, Zachor AD.
Asaf Harofeh Medical Center
Res Dev Disabil. 2008 Sep-Oct;29(5):447-58. Epub 2007 Oct 17.
The relations between cognition and autism severity, head size and intervention outcome, were examined. Change in cognitive level with intervention was measured in children with autism and compared to children with developmental disabilities (DD). Eighty-one children (mean age 25.9 months) with autism (n=44) and DD (n=37) were assessed at pre- and post 1 year of intervention. Cognitive abilities and autism severity were measured by standardized tests. Three pre-intervention cognitive level groups: normal (IQ>90), borderline (70
15. Adaptive Behavior Ratings Correlate With Symptomatology and IQ Among Individuals With High-Functioning Autism Spectrum Disorders
Kenworthy L, Case L, Harms MB, Martin A, Wallace GL.
National Institute of Mental Health
J Autism Dev Disord. 2009 Dec 1. [Epub ahead of print]
$ http://www.springerlink.com/content/k6238x5701v42214/
Caregiver report on the Adaptive Behavior Assessment System-II (ABAS) for 40 high-functioning individuals with Autism Spectrum Disorders (ASD) and 30 typically developing (TD) individuals matched for age, IQ, and sex ratio revealed global adaptive behavior deficits in ASD, with social skills impairments particularly prominent. Within the ASD group, adaptive communication skills were positively related to IQ while global adaptive functioning was negatively associated with autism symptomatology. Autistic behavior ratings related negatively to ABAS scores in the TD but not the ASD group. This investigation demonstrates: the utility of an adaptive functioning checklist for capturing impairments, even in high-functioning individuals with ASD; and that a relationship between social abilities and autism exists independently of intelligence.
16. Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model
Dawson G, Rogers S, Munson J, Smith M, Winter J, Greenson J, Donaldson A, Varley J.
Pediatrics. 2009 Nov 30. [Epub ahead of print]
$ http://pediatrics.aappublications.org/cgi/reprint/peds.2009-0958v1
Objective: To conduct a randomized, controlled trial to evaluate the efficacy of the Early Start Denver Model (ESDM), a comprehensive developmental behavioral intervention, for improving outcomes of toddlers diagnosed with autism spectrum disorder (ASD). Methods: Forty-eight children diagnosed with ASD between 18 and 30 months of age were randomly assigned to 1 of 2 groups: (1) ESDM intervention, which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents for 2 years; or (2) referral to community providers for intervention commonly available in the community. Results: Compared with children who received community-intervention, children who received ESDM showed significant improvements in IQ, adaptive behavior, and autism diagnosis. Two years after entering intervention, the ESDM group on average improved 17.6 standard score points (1 SD: 15 points) compared with 7.0 points in the comparison group relative to baseline scores. The ESDM group maintained its rate of growth in adaptive behavior compared with a normative sample of typically developing children. In contrast, over the 2-year span, the comparison group showed greater delays in adaptive behavior. Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder, not otherwise specified, than the comparison group. Conclusions: This is the first randomized, controlled trial to demonstrate the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis. Results of this study underscore the importance of early detection of and intervention in autism.
17. Children with autism show specific handwriting impairments
Fuentes CT, Mostofsky SH, Bastian AJ.
Johns Hopkins School of Medicine
Neurology. 2009 Nov 10;73(19):1532-7.
$ http://www.neurology.org/cgi/content/full/73/19/1532
BACKGROUND: Handwriting skills, which are crucial for success in school, communication, and building children's self-esteem, have been observed to be poor in individuals with autism. Little information exists on the handwriting of children with autism, without delineation of specific features that can contribute to impairments. As a result, the specific aspects of handwriting in which individuals with autism demonstrate difficulty remain unknown. METHODS: A case-control study of handwriting samples from children with and without autism spectrum disorders (ASD) was performed using the Minnesota Handwriting Assessment. Samples were scored on an individual letter basis in 5 categories: legibility, form, alignment, size, and spacing. Subjects were also tested on the Wechsler Intelligence Scale for Children-IV and the Physical and Neurological Examination for Subtle (Motor) Signs. RESULTS: We found that children with ASD do indeed show overall worse performance on a handwriting task than do age- and intelligence-matched controls. More specifically, children with ASD show worse quality of forming letters but do not show differences in their ability to correctly size, align, and space their letters. Within the ASD group, motor skills were significantly predictive of handwriting performance, whereas age, gender, IQ, and visuospatial abilities were not. CONCLUSIONS: We addressed how different elements of handwriting contribute to impairments observed in children with autism. Our results suggest that training targeting letter formation, in combination with general training of fine motor control, may be the best direction for improving handwriting performance in children with autism.
18. Word learning in children with autism spectrum disorders
Luyster R, Lord C.
Dev Psychol. 2009 Nov;45(6):1774-86.
$ http://psycnet.apa.org/journals/dev/45/6/1774.pdf
Autism spectrum disorders (ASD) have been gaining attention, partly as an example of unusual developmental trajectories related to early neurobiological differences. The present investigation addressed the process of learning new words to explore mechanisms of language delay and impairment. The sample included 21 typically developing toddlers matched on expressive vocabulary with 21 young children with ASD. Two tasks were administered to teach children a new word and were supplemented by cognitive and diagnostic measures. In most analyses, there were no group differences in performance. Children with ASD did not consistently make mapping errors, even in word learning situations that required the use of social information. These findings indicate that some children with ASD, in developmentally appropriate tasks, are able to use information from social interactions to guide word-object mappings. This result has important implications for understanding of how children with ASD learn language.
19. Reading and arithmetic in adolescents with autism spectrum disorders: peaks and dips in attainment
Jones CR et al.
Neuropsychology. 2009 Nov;23(6):718-28.
$ http://psycnet.apa.org/journals/neu/23/6/718.pdf
In describing academic attainment in autism spectrum disorders (ASD), results are typically reported at the group mean level. This may mask subgroups of individuals for whom academic achievement is incommensurate with intellectual ability. The authors tested the IQ, literacy, and mathematical abilities of a large group (N = 100) of adolescents (14-16 years old) with ASD. Seventy-three percent of the sample had at least one area of literacy or mathematical achievement that was highly discrepant (approximately 14 standard score points) from full-scale IQ (FSIQ). The authors focused on four subgroups with either word reading ("Reading Peak" and "Reading Dip") or arithmetic ("Arithmetic Peak" and "Arithmetic Dip") higher or lower than FSIQ. These subgroups were largely mutually exclusive and were characterized by distinct intellectual profiles. The largest was the "Arithmetic Peak" subgroup of participants, who presented with average intellectual ability alongside superior arithmetic skills and who were predominantly in a mainstream educational setting. Overall, the most pervasive profile was discrepantly poor reading comprehension, which associated with severity of social and communication difficulties. The high rate of uneven academic attainment in ASD has implications for educational practice.
20. Can emotion recognition be taught to children with autism spectrum conditions?
Baron-Cohen S, Golan O, Ashwin E.
Philos Trans R Soc Lond B Biol Sci. 2009 Dec 12;364(1535):3567-74.
http://rstb.royalsocietypublishing.org/content/364/1535/3567.long
Children with autism spectrum conditions (ASC) have major difficulties in recognizing and responding to emotional and mental states in others' facial expressions. Such difficulties in empathy underlie their social-communication difficulties that form a core of the diagnosis. In this paper we ask whether aspects of empathy can be taught to young children with ASC. We review a study that evaluated The Transporters, an animated series designed to enhance emotion comprehension in children with ASC. Children with ASC (4-7 years old) watched The Transporters every day for four weeks. Participants were tested before and after intervention on emotional vocabulary and emotion recognition at three levels of generalization. The intervention group improved significantly more than a clinical control group on all task levels, performing comparably to typical controls at time 2. The discussion centres on how vehicles as mechanical systems may be one key reason why The Transporters caused the improved understanding and recognition of emotions in children with ASC. The implications for the design of autism-friendly interventions are also explored.
21. Rapid and spontaneous recovery in autistic disorder
Sitholey P, Agarwal V, Pargaonkar A.
Indian J Psychiatry. 2009 Jul-Sep;51(3):209-11.
$5 http://tinyurl.com/yl45k2l
Recovery in autistic disorder is rare. There are few reports of recovery from autistic disorder after a few years of therapeutic intervention. We report here a case of autistic disorder who recovered spontaneously without any intervention in 13 days.
22. Neurofeedback for Autistic Spectrum Disorder: A Review of the Literature
Coben R, Linden M, Myers TE.
Appl Psychophysiol Biofeedback. 2009 Oct 24. [Epub ahead of print]
$ http://www.springerlink.com/content/t635u7406531671r/
There is a need for effective interventions to address the core symptoms and problems associated with autistic spectrum disorder (ASD). Behavior therapy improves communication and behavioral functioning. Additional treatment options include psychopharmacological and biomedical interventions. Although these approaches help children with autistic problems, they may be associated with side effects, risks or require ongoing or long-term treatment. Neurofeedback is a noninvasive approach shown to enhance neuroregulation and metabolic function in ASD. We present a review of the literature on the application of Neurofeedback to the multiple problems associated with ASD. Directions for future research are discussed.
23. The relative efficacy of connectivity guided and symptom based EEG biofeedback for autistic disorders
Coben R, Myers TE.
Neurorehabilitation & Neuropsychological Services, NY,
Appl Psychophysiol Biofeedback. 2010 Mar;35(1):13-23. Epub 2009 Aug 1.
$ http://www.springerlink.com/content/j4527w5777550051/
Autism is a neurodevelopmental disorder characterized by deficits in communication, social interaction, and a limited range of interests with repetitive stereotypical behavior. Various abnormalities have been documented in the brains of individuals with autism, both anatomically and functionally. The connectivity theory of autism is a recently developed theory of the neurobiological cause of autisic symptoms. Different patterns of hyper- and hypo-connectivity have been identified with the use of quantitative electroencephalogray (QEEG), which may be amenable to neurofeedback. In this study, we compared the results of two published controlled studies examining the efficacy of neurofeedback in the treatment of autism. Specifically, we examined whether a symptom based approach or an assessment/connectivity guided based approach was more effective. Although both methods demonstrated significant improvement in symptoms of autism, connectivity guided neurofeedback demonstrated greater reduction on various subscales of the Autism Treatment Evaluation Checklist (ATEC). Furthermore, when individuals were matched for severity of symptoms, the amount of change per session was significantly higher in the Coben and Padolsky (J Neurother 11:5-23, 2007) study for all five measures of the ATEC. Our findings suggest that an approach guided by QEEG based connectivity assessment may be more efficacious in the treatment of autism. This permits the targeting and amelioration of abnormal connectivity patterns in the brains of people who are autistic.
24. Brainstem transcription of speech is disrupted in children with autism spectrum disorders
Russo N, Nicol T, Trommer B, Zecker S, Kraus N.
Northwestern University
Dev Sci. 2009 Jul;12(4):557-67.
$ http://www3.interscience.wiley.com/journal/122192200/abstract?CRETRY=1&SRETRY=0
Language impairment is a hallmark of autism spectrum disorders (ASD). The origin of the deficit is poorly understood although deficiencies in auditory processing have been detected in both perception and cortical encoding of speech sounds. Little is known about the processing and transcription of speech sounds at earlier (brainstem) levels or about how background noise may impact this transcription process. Unlike cortical encoding of sounds, brainstem representation preserves stimulus features with a degree of fidelity that enables a direct link between acoustic components of the speech syllable (e.g. onsets) to specific aspects of neural encoding (e.g. waves V and A). We measured brainstem responses to the syllable /da/, in quiet and background noise, in children with and without ASD. Children with ASD exhibited deficits in both the neural synchrony (timing) and phase locking (frequency encoding) of speech sounds, despite normal click-evoked brainstem responses. They also exhibited reduced magnitude and fidelity of speech-evoked responses and inordinate degradation of responses by background noise in comparison to typically developing controls. Neural synchrony in noise was significantly related to measures of core and receptive language ability. These data support the idea that abnormalities in the brainstem processing of speech contribute to the language impairment in ASD. Because it is both passively elicited and malleable, the speech-evoked brainstem response may serve as a clinical tool to assess auditory processing as well as the effects of auditory training in the ASD population.
25. Sensory Processing Subtypes in Autism: Association with Adaptive Behavior
Lane AE, Young RL, Baker AE, Angley MT.
The Ohio State University
J Autism Dev Disord. 2009 Jul 31. [Epub ahead of print]
$ http://www.springerlink.com/content/26u7j0420646g646/
Children with autism are frequently observed to experience difficulties in sensory processing. This study examined specific patterns of sensory processing in 54 children with autistic disorder and their association with adaptive behavior. Model-based cluster analysis revealed three distinct sensory processing subtypes in autism. These subtypes were differentiated by taste and smell sensitivity and movement-related sensory behavior. Further, sensory processing subtypes predicted communication competence and maladaptive behavior. The findings of this study lay the foundation for the generation of more specific hypotheses regarding the mechanisms of sensory processing dysfunction in autism, and support the continued use of sensory-based interventions in the remediation of communication and behavioral difficulties in autism.
26. Emotional, motivational and interpersonal responsiveness of children with autism in improvisational music therapy
Kim J, Wigram T, Gold C.
Autism. 2009 Jul;13(4):389-409.
$ http://aut.sagepub.com/cgi/reprint/13/4/389
Through behavioural analysis, this study investigated the social-motivational aspects of musical interaction between the child and the therapist in improvisational music therapy by measuring emotional, motivational and interpersonal responsiveness in children with autism during joint engagement episodes. The randomized controlled study (n = 10) employed a single subject comparison design in two different conditions, improvisational music therapy and toy play sessions, and DVD analysis of sessions. Improvisational music therapy produced markedly more and longer events of 'joy', 'emotional synchronicity' and 'initiation of engagement' behaviours in the children than toy play sessions. In response to the therapist's interpersonal demands, 'compliant (positive) responses' were observed more in music therapy than in toy play sessions, and 'no responses' were twice as frequent in toy play sessions as in music therapy. The results of this exploratory study found significant evidence supporting the value of music therapy in promoting social, emotional and motivational development in children with autism.
27. Patterns of growth in adaptive social abilities among children with autism spectrum disorders
Anderson DK, Oti RS, Lord C, Welch K.
J Abnorm Child Psychol. 2009 Oct;37(7):1019-34.
University of Michigan Autism and Communication Disorders Center
$ http://www.springerlink.com/content/380751320665h3x7/
Adaptive social skills were assessed longitudinally at approximately ages 2, 3, 5, 9, and 13 years in a sample of 192 children with a clinical diagnosis of autism (n = 93), PDD-NOS (n = 51), or nonspectrum developmental disabilities (n = 46) at age 2. Growth curve analyses with SAS proc mixed were used to analyze social trajectories over time. Both individual characteristics and environmental resources emerged as key predictors of adaptive social behavior outcome. The gap between children with autism and the other two diagnostic groups widened with time as the social skills of the latter groups improved at a higher rate. However, within diagnostic groups, improvement ranged from minimal to very dramatic. Children with autism most at risk for problems with social adaptive abilities later in life can be identified with considerable accuracy at a very young age so they can be targeted for appropriate early intervention services.
28. Concept mastery routines to teach social skills to elementary children with high functioning autism
Laushey KM, Heflin LJ, Shippen M, Alberto PA, Fredrick L.
Georgia State University
J Autism Dev Disord. 2009 Oct;39(10):1435-48. Epub 2009 May 27.
$ http://www.springerlink.com/content/28848g6547258r88/
Children with autism are included in general education classrooms for exposure to appropriate social models; however, simply placing children with autism with typical peers is insufficient for promoting desired gains in social skills. A multiple baseline design was used to explore the effects of concept mastery routines (CMR) on social skills for four elementary-age boys with high functioning autism. Visual and non-parametric analyses support the conclusion that small group instruction with typical peers via the CMR was effective for increasing responses, initiations, and recognition of emotional states. The skills taught in small groups generalized when the visual strategy of the completed concept diagram was taken to another setting. Most importantly, the four boys experienced improved social status following intervention.
29. Validation of the repetitive and restricted behaviour scale in autism spectrum disorders
Bourreau Y, Roux S, Gomot M, Bonnet-Brilhault F, Barthélémy C.
Université François Rabelais de Tours
Eur Child Adolesc Psychiatry. 2009 Nov;18(11):675-82. Epub 2009 May 19.
$ http://www.springerlink.com/content/u47g575x78g72713/
Repetitive and restricted behaviours represent a common problem for various psychiatric syndromes, especially in autistic spectrum disorders, and they include a wide range of heterogeneous behavioural manifestations. An accurate and standardized description of these behaviours is needed to advance the understanding of this complex and heterogeneous clinical dimension of autism. The present article reports the reliability and validity studies of a new assessment scale: the repetitive and restricted behaviour scale. 145 subjects with autism spectrum disorders were assessed using the RRB scale. The RRB scale has good interrater reliability, internal consistency and content validity. Factorial analysis produced four clinically meaningful factors, i.e. "sensorimotor stereotypies", "reaction to change", "restricted behaviours" and "modulation insufficiency". The RRB scale has good psychometric qualities and constitutes a real breakthrough towards a neurofunctional approach to autistic disorders. It should be valuable for research and treatment, and in clinical practice.
This document prepared by
Teresa Binstock
Researcher in Developmental & Behavioral Neuroanatomy
April 2010
