Defining autism: professional best practices and published case law

There are clear indications that both the reported incidence of autism in children and litigation involving this developmental disorder are increasing. However, to date there has been a dearth of research analyzing court cases and legal decisions concerning students with autism. The purpose of this review was to examine published hearing/review and court decisions concerning autism eligibility in educational settings in relation to empirically supported best practices in the assessment of autism. A total of 13 cases were identified for inclusion in the review. In general, the results indicated that hearing/review officers and judges neither relied upon nor explicitly acknowledged empirically supported assessment methods in their published eligibility decisions. It appeared that many hearing/review officers and judges relied on expert witnesses, who may or may not have had particular expertise and knowledge regarding current best practices in autism eligibility assessment. Implications of the findings and areas for future research are discussed.     

自闭症儿童依恋研究述评

摘要　　研究者曾一度认为自闭症儿童无法建立起依恋关系。本文系统回顾了自闭症儿童依恋研究的最新进展,将自闭症儿童是否存在依恋行为（尤其是安全型依恋行为）、依恋发展解释理论、研究方法、类型分布以及影响因素等问题进行了详细梳理,并结合研究分析,提出有关自闭症儿童依恋研究的几点启示,以供参考。     

Examining the Efficacy of Parent–Child Interaction Therapy with Children on the Autism Spectrum

Externalizing behaviors are a common component of the clinical presentation of autism spectrum disorders. Although traditionally used with typically-developing children, parent–child interaction therapy (PCIT) is one behaviorally-based parent training program that has demonstrated success in increasing child compliance, reducing problem behavior, and improving parent–child communication. The study examined the efficacy of PCIT as a treatment for children with autism spectrum disorders by employing a single subject, non-concurrent multiple baseline design across three subjects. Primary findings revealed increases in child compliance, reductions in child disruptive behavior, and improved parenting skills across participants. In addition, each caregiver reported high levels of satisfaction with the intervention. Results suggested that PCIT may be a treatment option for children on the autism spectrum with co-occurring behavioral difficulties. Although the non-concurrent nature of the multiple baseline design is a limitation, this study replicates and extends previous research investigating the efficacy of PCIT with children with autism and their parents.     

Current Perspectives on Interventions for Self-Injurious Behavior of Children with Autism Spectrum Disorder: A Systematic Review of the Literature

Our purpose in this systematic review was to identify, evaluate, and summarize the single-case research design studies examining behavioral interventions to address self-injurious behavior for young children with autism spectrum disorder. We identified 24 studies published between 2000 and 2016 that met the inclusion criteria. We reviewed and coded each study across five content areas using systematic procedures. These content areas consisted of the methodological quality of single-case research designs, children’s demographic information, conditions under which the intervention was implemented, characteristics of intervention, and outcomes. Our findings indicate that procedural integrity data were reported for only one study and social validity for two studies. The majority of studies were implemented by researchers or therapists in the school setting. For 24 of 30 children included in the studies reviewed, the authors taught a replacement behavior selected on the basis of an assessment conducted prior to intervention. All authors reported a decrease in the self-injurious behavior post-intervention. A limited number of authors examined generalization and maintenance of low rates of self-injurious behavior. Limitations of the present review and future directions and implications for research and practice are discussed.     

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.     

The associations between autistic and communication traits in parents and developmental outcomes in children at familial risk of autism at 6 and 24 months of age

BackgroundSeveral studies have explored relationships between parent broader autism phenotype and offspring communication, and have reported that autistic-like traits in parents are related to offspring communication difficulties and autism severity. However, past research has focused on studying such associations in childhood and we know very little about them in infancy. With accumulating evidence that interventions administered during infancy may be most effective in reducing ASD symptoms, it is imperative to examine whether relationships between parent autistic-like traits and child communication appear even earlier during this critical period of life.MethodThis longitudinal study collected data from infant siblings of autistic children (N = 32) and infants with no family history of autism (N = 45) to explore how autistic-like traits in parents related to child developmental outcomes during infancy.ResultsParental communication difficulties and autistic-like traits were found to be associated with a range of child behaviours in the first two years of life, including social-emotional difficulties at 6 and 24 months, lower communication and emerging cognition at 24 months, and increased autistic behaviours at 24 months.ConclusionsBased on the results, it appears that some of the difficulties seen in parents are relayed to children genetically. These findings contribute to ASD research concerning early communication development in children and heritability of ASD traits and may have important implications in monitoring child development. Furthermore, since the current study found a significant association between autistic traits in parents and child social-emotional behaviour as early as 6 months of age, it provides evidence of the value of assessing interventions that target infancy.     

A comparison of cognitive/neuropsychological impairments of nonretarded autistic and schizophrenic children

The performance of children meeting DSM-III criteria for schizophrenic disorder and infantile autism and of normal children (ages 7 years 10 months to 14 years 4 months) was compared on the Wisconsin Card Sorting Test, Rey's Tangled Line Test, Benton Judgment of Line Orientation, Digit Symbol Substitution Test, and Peabody Picture Vocabulary Test. The mean performance IQ of the schizophrenic and autistic children was equal and in the normal range. The normal children were of average intelligence as estimated by the PPVT. As compared to normal children, both autistic and schizophrenic children were impaired on the DSST and RTLT. The autistic children had significantly lower scores on the PPVT than schizophrenic and normal children. The schizophrenic children made significantly more perseverative responses on the WCST than did normal children. They significantly increased their nonperseverative errors on the second half of the WCST, after having been taught the correct sorting principles. It is argued that in schizophrenia a core deficit in momentary processing capacity underlies the above performance pattern. In contrast, in autism the core cognitive deficit involves an inability to use language to regulate and control ongoing behavior.Preparation of this article was supported in part by a John D. and Catherine T. MacArthur Foundation Grant to Robert Asarnow, and NIMH Grant MH 30897 to the UCLA Clinical Research Center for the Study of Childhood Psychoses. We gratefully acknowledge the assistance of Michael J. Goldstein, Ph.D., who acted as reseach advisor to the first author over the course of this study; Delores Adams, who assisted us in data analysis; and Sara Lerner, who enthusiastically helped us in data collection. We also acknowledge the assistance of the staff of the Clinical Research Center for the Study of Childhood Psychosis at UCLA, as well as the many children who participated in this study, and their parents.     

Enhanced discrimination in autism

Children with autism are superior to typically developing children at visual search tasks (O'Riordan, Plaisted, Driver, & Baron-Cohen, in press; Plaisted, O'Riordan, & Baron-Cohen, l998b). This study investigates the reasons for this phenomenon. The performance of children with autism and of typically developing children was compared on a series of visual search tasks to investigate two related problems. The first issue was whether the critical determinant of search rate in children is the discriminability of the display items, as it is in normal adults. The second question investigated was whether the superior performance of individuals with autism on visual search tasks is due to an enhanced ability to discriminate between display items. The results demonstrated that discriminability is the rate-determining factor for children with and without autism, replicating earlier findings with normal adults, and that children with autism have an enhanced ability to discriminate between display items. Thus, it seems that an enhanced ability to discriminate between display items underlies superior visual search in autism.     

AUTISM TREATMENTS IN PRINT: MEDIA'S COVERAGE OF SCIENTIFICALLY SUPPORTED AND ALTERNATIVE TREATMENTS

Professionals, celebrities, and media frequently suggest to parents the possible treatment options for their children with autism. Some treatment recommendations advocate for scientifically supported treatments whereas others suggest novel, untested interventions, or potentially ineffective or harmful treatments. The current study examined the print media's coverage of applied behavior analysis (ABA) and non‐scientifically supported autism treatments. Over the last 10 years, print media have increasingly published articles referring to autism treatments with little scientific support and a decreased coverage of ABA. Print media's positive statements about non‐scientifically supported treatments also increased over the last decade, whereas positive statements about ABA decreased. ABA received two times as many positive comments as negative; however, non‐scientifically supported treatments as a group received four times as many positive comments as negative. These results could contribute to parents' decisions to implement treatments for their children with autism. To contribute to future positive perception of ABA, we provided suggestions for the dissemination of information to increase positive reporting of ABA in print media. Copyright © 2013 John Wiley & Sons, Ltd.     

Brain development in autism: early overgrowth followed by premature arrest of growth

Due to the relatively late age of clinical diagnosis of autism, the early brain pathology of children with autism has remained largely unstudied. The increased use of retrospective measures such as head circumference, along with a surge of MRI studies of toddlers with autism, have opened a whole new area of research and discovery. Recent studies have now shown that abnormal brain overgrowth occurs during the first 2 years of life in children with autism. By 2-4 years of age, the most deviant overgrowth is in cerebral, cerebellar, and limbic structures that underlie higher-order cognitive, social, emotional, and language functions. Excessive growth is followed by abnormally slow or arrested growth. Deviant brain growth in autism occurs at the very time when the formation of cerebral circuitry is at its most exuberant and vulnerable stage, and it may signal disruption of this process of circuit formation. The resulting aberrant connectivity and dysfunction may lead to the development of autistic behaviors. To discover the causes, neural substrates, early-warning signs and effective treatments of autism, future research should focus on elucidating the neurobiological defects that underlie brain growth abnormalities in autism that appear during these critical first years of life.     

Overselectivity,developmental level,and overtraining in autistic and normal children

Thirteen autistic children were compared to 13 normal children, matched to them in mental age, on performance of a visual discrimination task. Form, color, and size were relevant and redundant cues. The groups did not differ significantly in mean trials to reach criterion or in breadth of learning, and both groups increased their breadth of learning after 50 trials of overtraining. Form was preferred to color and size by both autistic and normal children. Within each group, rank on mental age was highly correlated with rank in breadth of learning. Verbal and nonverbal autistic children did not differ in breadth of learning or in dimensional preference. Even nonverbal autistics equaled the performance of their normal controls. Our results suggest that overselective attention is better understood as part of a general developmental lag in cognition in autistic children than as a specific deficit underlying psychotic behavior.This research was supported in part by NIMH Grant 11440, O. I. Lovaas, principal investigator. The authors thank Dr. Lovaas and Dennis C. Russo for their helpful criticisms of an earlier draft.     

Behavior Analysts' Use of and Beliefs in Treatments for People with Autism: A 5‐Year Follow‐up

As autism prevalence rises, parents of children with autism rely upon professionals to recommend the most effective treatment for their children. Historically, these professionals have chosen a range of treatments from empirically supported to nonempirically supported treatments. This study replicated and extended that work by surveying Board Certified Behavior Analysts to determine what treatments they promoted and used. Results showed that although most respondents used evidence‐based, behavioral procedures, many did not. Influential stimuli most likely to contribute to behavior analysts' choices of treatments were beliefs in effectiveness, ease of implementation, and persuasion by others. Self‐reported reinforcers for treatment use included perceived observed success, praise from others, and financial gain. Behavior analysts continue to use a variety of nonscientifically supported treatments, including those that have been deemed ineffective and harmful to people with autism. Future training of Board Certified Behavior Analysts must stress adherence to the ethical code for certified behavior analysts, adherence to data‐based decision‐making, and strict fealty to the scientific process in which all behavior analysts have been trained. Copyright © 2016 John Wiley & Sons, Ltd.     

Aspects pragmatiques de la communication et du langage chez des enfants typiques et des enfants ultérieurement diagnostiqués autistes

The aim of this study is to show that the analysis of pragmatic aspects of communication can allow to locate communicative dysfunctions before the diagnosis of autism is established. The identification of these dysfunctions can be done retrospectively through the analysis of the first gestures and early words. Home movies from children having autism and control ones are collected when they were one, two and three-years old. Data analysis takes into account both forms of communicative gestures and words and functions. Differences between the two groups as a less variety of functions used by children having autism and a fall in their results after the age of two are discussed as possible indicators for an early detection of autism.     

fNIRS在自闭症脑功能研究中的应用与展望

社会交往能力是人类生存的基本技能。社交能力的缺失会导致严重的行为障碍和精神疾病,如自闭症。由于自闭症儿童的特殊性,绝大多数的自闭症脑成像研究多集中在年龄较大的高功能自闭症儿童在静息态或简单的任务态下的脑激活模式或功能连接状态。自闭症的核心症状—社会交往障碍和语言交流障碍却较少有研究触及。近年来,近红外光学脑功能成像技术的发展为我们在真实的交流和互动中研究自闭症儿童的神经病理机制提供了新的工具和机遇。     

Pivotal areas in intervention for autism

Discusses several core pivotal areas that appear to be influential in intervention for autism. Literature and outcome data are reviewed with respect to several core areas that appear to be particularly helpful in intervention for autism, including improving motivation, responsivity to multiple cues, self-management, and self-initiation of social interactions. A conceptual framework is described, and outcome data are reviewed suggesting that when children with autism are motivated to initiate complex social interactions, it may reverse a cycle of impairment, resulting in exceptionally favorable intervention outcomes for many children. Because the peripheral features of autism can be numerous and extensive, the concept of intervention for pivotal areas of functioning may be critical if children are to be habilitated in a time- and cost-efficient manner.     

Evaluation of publication bias in response interruption and redirection: A meta-analysis

Publication bias is the disproportionate representation of studies with large effects and statistically significant findings in the published research literature. If publication bias occurs in single-case research design studies on applied behavior-analytic (ABA) interventions, it can result in inflated estimates of ABA intervention effects. We conducted an empirical evaluation of publication bias on an evidence-based ABA intervention for children diagnosed with autism spectrum disorder, response interruption and redirection (RIRD). We determined effect size estimates for published and unpublished studies using 3 metrics, percentage of nonoverlapping data (PND), Hedges' g, and log response ratios (LRR). Omnibus effect size estimates across all 3 metrics were positive, supporting that RIRD is an effective treatment for reducing problem behavior maintained by nonsocial consequences. We observed larger PND for published compared to unpublished studies, small and nonsignificant differences in LRR for published compared to unpublished studies, and significant differences in Hedges' g for published compared to unpublished studies, with published studies showing slightly larger effect. We found little, if any, difference in methodological quality between published and unpublished studies. While RIRD appears to be an effective intervention for challenging behavior maintained by nonsocial consequences, our results reflect some degree of publication bias present in the RIRD research literature.     

Atypical shape bias and categorization in autism: Evidence from children and computational simulations

The shape bias, a preference for mapping new word labels onto the shape rather than the color or texture of referents, has been postulated as a word‐learning mechanism. Previous research has shown deficits in the shape bias in children with autism even though they acquire sizeable lexicons. While previous explanations have suggested the atypical use of color for label extension in individuals with autism, we hypothesize an atypical mapping of novel labels to novel objects, regardless of the physical properties of the objects. In Experiment 1, we demonstrate this phenomenon in some individuals with autism, but the novelty of objects only partially explains their lack of shape bias. In a second experiment, we present a computational model that provides a developmental account of the shape bias in typically developing children and in those with autism. This model is based on theories of neurological dysfunctions in autism, and it integrates theoretical and empirical findings in the literature of categorization, word learning, and the shape bias. The model replicates the pattern of results of our first experiment and shows how individuals with autism are more likely to categorize experimental objects together on the basis of their novelty. It also provides insights into possible mechanisms by which children with autism learn new words, and why their word referents may be idiosyncratic. Our model highlights a developmental approach to autism that emphasizes deficient representations of categories underlying an impaired shape bias.     

Counterfactual syllogistic reasoning in normal 4-year-olds, children with learning disabilities, and children with autism

Instruction encouraging imagery improves logical reasoning with counterfactual premises by normal preschool children. In contrast, children with autism have been reported to reason accurately with counterfactual premises in the absence of such instruction (F. J. Scott, S. Baron-Cohen, & A. M. Leslie, 1999). To investigate this pattern of findings, we compared the performance of children with autism, children with learning disabilities, and normally developing 4-year-olds, who were given reasoning problems both with and without instruction in two separate testing sessions 2 to 3 weeks apart. Overall, instruction to use imagery led to persistent logical performance. However, children with autism displayed a distinctive pattern of responding, performing around chance levels, showing a simple response bias, and rarely justifying their responses by elaborating on the premises. We propose that instruction boosts logical performance by clarifying the experimenter's intention that a false proposition be accepted as a basis for reasoning and that children with autism have difficulty grasping this intention.     

The epidemiology of autistic spectrum disorders: is the prevalence rising?

For decades after Kanner's original paper on the subject was published in 1943, autism was generally considered to be a rare condition with a prevalence of around 2-4 per 10,000 children. Then, studies carried out in the late 1990s and the present century reported annual rises in incidence of autism in pre-school children, based on age of diagnosis, and increases in the age-specific prevalence rates in children. Prevalence rates of up to 60 per 10,000 for autism and even more for the whole autistic spectrum were reported. Reasons for these increases are discussed. They include changes in diagnostic criteria, development of the concept of the wide autistic spectrum, different methods used in studies, growing awareness and knowledge among parents and professional workers and the development of specialist services, as well as the possibility of a true increase in numbers. Various environmental causes for a genuine rise in incidence have been suggested, including the triple vaccine for measles, mumps and rubella (MMR]. Not one of the possible environmental causes, including MMR, has been confirmed by independent scientific investigation, whereas there is strong evidence that complex genetic factors play a major role in etiology. The evidence suggests that the majority, if not all, of the reported rise in incidence and prevalence is due to changes in diagnostic criteria and increasing awareness and recognition of autistic spectrum disorders. Whether there is also a genuine rise in incidence remains an open question.