Health-related quality of life of preterm children and their caregivers

As advances in medical science have extended the limit of viability downward to 23 or 24 weeks gestation, interest has turned from long-term health outcomes to quality of life for survivors. During the last decade, the first studies of the health-related quality of life (HRQOL) of children and young adults who were born extremely preterm were published. Taken from the fields of anthropology, economics, sociology, and psychology, the foundation of HRQOL is formed by theories of functionalism, positive well-being, and utility. HRQOL can be defined as the physical, psychological, and social domains of health, which can be influenced by an individual's experiences and perception. HRQOL instruments are generally composed of multiple domains and measure physical functioning, mental health, and social role functioning in some form. Utilities, or preferences for health outcomes under conditions of uncertainty, are also used. Studies of HRQOL to-date indicate that preterm children have, on average, poorer health than their normal birthweight peers, but the majority do not perceive their quality of life as significantly different than others of their own age. Measures of HRQOL should not replace the traditional measures of morbidity, but should become part of the standard battery of tools used to assess a preterm child's health and well-being. Ultimately, studies of the HRQOL of preterm children should identify aspects of life, physical, psychological, or social, that could be improved with intervention.     

Expressive drawing ability in children with autism

The autistic impairments in emotional and social competence, imagination and generating ideas predict qualitative differences in expressive drawings by children with autism beyond that accounted by any general learning difficulties. In a sample of 60 5–19‐year‐olds, happy and sad drawings were requested from 15 participants with non‐savant autism and compared with those drawn by three control groups matched on either degree of learning difficulty (MLD), mental age (MA) or chronological age (CA). All drawings were rated by two artists on a 7‐point quality of expression scale. Contrary to our predictions, the drawings from the autistic group were rated similar to those of the MA and MLD groups. Analysis of the people and social content of the drawings revealed that although children with autism did not draw fewer people, they did draw more immature forms than mental age controls. Furthermore, there was tentative evidence that fewer social scenes were produced by the autism sample. We conclude that the overall merit of expressive drawing in autism is commensurate with their general learning difficulties, but the social/emotional impairment in autism affects their drawings of people and social scenes.     

Increasing response diversity in children with autism

Repetitive and invariant behavior is a diagnostic feature of autism. We implemented a lag reinforcement schedule to increase response diversity for 6 participants with autism aged 6 to 10 years, 4 of whom also received prompting plus additional training. These procedures appeared to increase the variety of building-block structures, demonstrating that an intervention that includes differential reinforcement can increase response diversity for children with an autism spectrum disorder.     

Development of motion processing in children with autism

Recent findings suggest that children with autism may be impaired in the perception of biological motion from moving point-light displays. Some children with autism also have abnormally high motion coherence thresholds. In the current study we tested a group of children with autism and a group of typically developing children aged 5 to 12 years of age on several motion perception tasks, in order to establish the specificity of the biological motion deficit in relation to other visual discrimination skills. The first task required the recognition of biological from scrambled motion. Three quasi-psychophysical tasks then established individual thresholds for the detection of biological motion in dynamic noise, of motion coherence and of form-from-motion. Lastly, individual thresholds for a task of static perception--contour integration (Gabor displays)--were also obtained. Compared to controls, children with autism were particularly impaired in processing biological motion in relation to any developmental measure (chronological or mental age). In contrast, there was some developmental overlap in ability to process other types of visual motion between typically developing children and the children with autism, and evidence of developmental change in both groups. Finally, Gabor display thresholds appeared to develop typically in children with autism.     

Generalization of tacting actions in children with autism

This intervention compared the effects of two procedures on the generalization of a tacting repertoire (labeling) in 6 children with autism spectrum disorder. In one procedure the verbal antecedent stimulus “What is she doing?” appeared together with a person performing an action; in the other procedure, the antecedent stimulus was just the presence of the action. In initial tests, children emitted tacts only when the action was presented with the verbal antecedent. Thereafter, they learned to tact an action without the verbal antecedent and received tests to evaluate generalization to another action. Results indicated that in order to obtain generalization of tacting actions, it was necessary to learn to tact other actions without the verbal antecedent as well as learning to tact the action with the verbal antecedent. These findings have relevance for generalization of tacting actions from control by verbal antecedents to natural conditions and the production of spontaneous language.     

Educational advocacy for children with autism

There exists a great divide between parents' demands for intensive behavioral interventions for their children with autism and the public education system's reluctance to support early intensive behavioral intervention programs. More and more, professionals with expertise in applied behavior analysis are being asked to advocate for effective, early behavioral intervention for autism in education litigation brought about by frustrated parents. The progress made in recent years in the behavioral treatment of children with autism and the schools' lack of adherence to the requirements of IDEA have made it possible for educational policy change through effective advocacy by behavioral interventionists. This paper discusses preparing for educational advocacy on behalf of young children with autism. We explore the personal and emotional reasons why parents choose to engage in the financially risky endeavor of educational litigation. We then outline an approach to developing expert testimony based upon evaluation of the target child and his/her educational history. Issues related to assessment, training, and ethical practice are addressed. Copyright © 2002 John Wiley & Sons, Ltd.     

Task-switching abilities in children with autism spectrum disorder

Task-switching performance is often used as a measure of executive control functions. Various task-switching studies in children with autism spectrum disorder (ASD) found, in contrast to expectations, no impairments in cognitive flexibility. Here, we studied whether the role of memory for arbitrary task rules can explain these findings, and how studying rule memory can help to generally better understand executive control. We designed a novel task-switching paradigm to separate cognitive flexibility from demand on memory for arbitrary rules, and we compared 19 children with ASD (9 to 16 years old) with an age- and IQ-matched control group. Children with ASD had increased difficulty with task switching only when memorizing arbitrary rules was required. When no arbitrary rules needed to be memorized, they performed accurately and quickly. Nevertheless, they showed less distraction from task-irrelevant stimulus features, suggesting that they represented tasks differently from the children in the comparison group. We conclude that children with ASD have a weaker capacity of forming rule representations, which only leads to performance impairment when they need to memorize arbitrary rules. Further, executive control impairments in ASD seem more complex than hitherto hypothesized due to mutual interactions between memory demand and task representations.     

The differential outcomes effect in children with autism

The differential outcomes procedure uses reinforcement unique to each alternative in a conditional discrimination, leading to faster and more accurate learning relative to non‐differential outcomes procedures. In this study, the differential outcomes procedure was used to teach novel tacts of musical instrument sounds to children with autism. For one set of instruments, response‐specific reinforcers were used in combination with social reinforcement. For the other set, reinforcers were provided non‐differentially. Two out of three participants showed enhanced learning in the differential outcomes condition, providing some support of the differential outcomes procedures as a useful tool for teaching individuals with autism. Future research into the differential outcomes effect is warranted to identify the procedural and individual factors that predict its effectiveness.     

Evidence for syntactic alignment in children with autism

We report an experiment that examined whether children with Autistic Spectrum Disorder (ASD) spontaneously converge, or align, syntactic structure with a conversational partner. Children with ASD were more likely to produce a passive structure to describe a picture after hearing their interlocutor use a passive structure to describe an unrelated picture when playing a card game. Furthermore, they converged syntactic structure with their interlocutor to the same extent as did both chronological and verbal age-matched controls. These results suggest that the linguistic impairment that is characteristic of children with ASD, and in particular their difficulty with interactive language usage, cannot be explained in terms of a general deficit in linguistic imitation.     

Treatment of resistance to change in children with autism

“Resistance to change” represents a core symptom of autism that we conceptualized and assessed as resulting in part due to factors known to govern free‐operant choice. During a free‐choice baseline, participants chose between problematic, resistive responses and an appropriate alternative response. During the asymmetrical‐choice condition, we delivered their most highly preferred item if the participant chose the alternative response (i.e., differential reinforcement of alternative behavior [DRA]). During the guided‐ (Experiment 1) and singular‐ (Experiment 2) choice conditions, we prompted participants to choose the alternative response and then delivered their most highly preferred item (i.e., DRA with escape extinction). All participants learned to tolerate (Experiment 1) or choose (Experiment 2) the alternative response when we combined DRA with escape extinction. After exposure to escape extinction, two participants showed strong maintenance effects with DRA alone. We discuss these finding relative to the effects of DRA and escape extinction on resistance to change.     

Quality of life for children and suicide rates

The quality of life in 1982 of children in nations of the world reported by Jordan in 1993 was positively associated with youth suicide rates only for males in 1982.     

Impaired task switching performance in children with dyslexia but not in children with autism

Problems with cognitive control in both autism and dyslexia have already been reported in different studies. The present study specifically examined task-switching performance in children with autism and dyslexia. For this purpose, a multiple-trial paradigm was used with cues for colour- and shape-matching tasks presented before a run of trials. The cue could imply a task switch (when the cue changed the task) or a task repetition (when the cue did not change the task). Both reaction times and error rates were measured for switching, restarting, and general task performance. Participants were children with autism (24) and with dyslexia (25) and healthy controls (27) with normal IQ and ages from 12 to 18 years. The main finding was that while similar switching performance was observed between children with autism and the healthy controls, children with dyslexia showed a significant switch-specific delay relative to both healthy controls and children with autism. Furthermore, no deficit in restarting performance was observed for any of the two patient groups. Finally, additional evidence is provided for a more general deficit in information processing in dyslexia. Our data suggest that children with autism are able to switch between tasks in a similar way as do normally developing children as long as the tasks are unambiguously specified. Furthermore, the data imply switch-specific deficits in dyslexia additionally to the deficits in general information processing already reported in the literature. The implications of our data are further discussed in relation to the interpretation of the Wisconsin Card Sorting Test.     

Auditory preference of children with autism spectrum disorders

Research on children with autism spectrum disorders suggests differences from neurotypical children in the preference for ‘social’ versus ‘nonsocial’ sounds. Conclusions have been based largely on the use of head-turn methodology which has various limitations as a means of establishing auditory preference. In the present study, preference was assessed by measuring the frequency with which children pressed a button to hear different sounds using an interactive toy. Contrary to prior results, both groups displayed a strong preference for the highly social sounds. These findings have implications for approaches to language intervention and for theoretical debates regarding social motivation.     

Error correction in discrimination training for children with autism

Three procedures for correcting errors made during discrimination training were examined: error statement (saying ‘no’), modeling the correct response, and No Feedback. Six children with autism (age 3–7 years) were taught to match words to pictures with each of the three procedures, and the number of trials to mastery was compared across conditions. Results varied across participants. Two participants performed as well with no feedback as they did with an error correction procedure; two acquired skills slightly more quickly with an error correction procedure than with no feedback, but showed no difference between error correction procedures; one did best with error statement; and one did best with modeling. Results indicate that the choice of error correction procedure can have a large effect on rate of skill acquisition but that the optimal procedure may vary across individuals. Copyright © 2006 John Wiley & Sons, Ltd.     

Atypical updating of face representations with experience in children with autism

Face identity aftereffects are significantly diminished in children with autism relative to typical children, which may reflect reduced perceptual updating with experience. Here, we investigated whether this atypicality also extends to non‐face stimulus categories, which might signal a pervasive visual processing difference in individuals with autism. We used a figural aftereffect task to measure directly perceptual updating following exposure to distorted upright faces, inverted faces and cars, in typical children and children with autism. A size‐change between study and test stimuli limited the likelihood that any processing atypicalities reflected group differences in adaptation to low‐level features of the stimuli. Results indicated that, relative to typical children, figural aftereffects for upright faces, but not inverted faces or cars, were significantly attenuated in children with autism. Moreover, the group difference was amplified when we isolated the ‘face‐selective’ component of the aftereffect, by partialling out the mid‐level shape adaptation common to upright and inverted face stimuli. Notably, the aftereffects of typical children were disproportionately larger for upright faces than for inverted faces and cars, but the magnitude of aftereffects of autistic children was not similarly modulated according to stimulus category. These findings are inconsistent with a pervasive adaptive coding atypicality relative to typical children, and suggest that reduced perceptual updating may constitute a high‐level, and possibly face‐selective, visual processing difference in children with autism.     

Attention and joint attention in preschool children with autism

Three experiments examined the role of attention in explaining dyadic (child-adult) and triadic (child-adult-object) joint attention difficulties in autism. Experiments 1 and 2 investigated children's ability to orient to an adult's attention bid and to follow the direction of a human or nonhuman cue. Experiment 3 tested ability to disengage and shift attention to objects. Results showed autism-specific difficulties at both dyadic and triadic levels. Children with autism were less responsive than developmentally delayed controls in orienting to attention bids and in following a human head-turn cue yet had no difficulty in shifting attention and were faster overall in orienting to targets. Results suggest a specific developmental delay in which children with autism rely on the presence of objects in the visual field to guide action. The relation between this problem and autistic children's difficulties with human communicative signals is discussed.     

Atypical categorization in children with high-functioning autism spectrum disorder

Children with autism spectrum disorder process many perceptual and social events differently from typically developing children, suggesting that they may also form and recognize categories differently. We used a dot pattern categorization task and prototype comparison modeling to compare categorical processing in children with high-functioning autism spectrum disorder and matched typical controls. We were interested in whether there were differences in how children with autism use average similarity information about a category to make decisions. During testing, the group with autism spectrum disorder endorsed prototypes less and was seemingly less sensitive to differences between to-be-categorized items and the prototype. The findings suggest that individuals with high-functioning autism spectrum disorder are less likely to use overall average similarity when forming categories or making categorical decisions. Such differences in category formation and use may negatively impact processing of socially relevant information, such as facial expressions. A supplemental appendix for this article may be downloaded from http://pbr.psychonomic-journals.org/content/supplemental.