Social perception in children with fetal alcohol spectrum disorder

Although the profile of social cognitive difficulties is well recognized in children with certain neurodevelopmental disorders such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), this profile is not as well established in other clinical pediatric populations. The objective of the present study is to examine patterns of social perception in children with fetal alcohol spectrum disorder (FASD) compared to typically-developing (TD) control children. A total of 56 children between 8 and 12 years of age—35 with FASD and 21 TD—completed the Reading the Mind in the Eyes Task – Children’s Version (RMET-C). The RMET-C accuracy scores were compared between groups and also by item difficulty and emotional valence. The relation between cognitive functioning, age, FASD severity, and RMET-C performance was also investigated. The children in the FASD group did not perform as well as the children in the TD group on the RMET-C Total score and Easy items, as well as the Positive, Negative, and Neutral emotional valence items. When age and IQ were investigated, there was a significant effect of age on the Positive items in the TD group, with scores increasing with age. With regard to FASD severity, children with alcohol-related neurodevelopmental disorder were outperformed by children with full/partial fetal alcohol syndrome on the Positive and Negative items. Overall, these results further the understanding of the social cognitive profile in children with FASD and how this profile relates to other childhood-onset neurodevelopmental disorders.     

Autism characteristics in children with fetal alcohol spectrum disorders

Background: Children with fetal alcohol spectrum disorders (FASD) exhibit difficulties in many cognitive and behavioral domains and also have high comorbidity with other disorders such as attention deficit/hyperactivity disorder (ADHD) and conduct disorder as well as autism. Although the FASD profile is shown to be distinct from ADHD and conduct disorder, far less is known about the commonalities with autism. The current study used a parent-rated questionnaire containing an autism subscale to explore the autistic-like features that children with FASD exhibit. Methods: Studied were 25 children with FASD (age: M = 10.3 years) and 17 normal controls (NCs; age: M = 10.2 years). As part of a larger study, all parents/caregivers completed the Social Skills Improvement System (SSIS; Gresham & Elliot, 2008), which in addition to evaluating social skills and behavior problems globally, includes an Autism subscale. Results: Between-group comparisons showed the FASD group not only scored significantly lower in social skills and significantly higher in behavior problems than the NC group but children with FASD also scored significantly higher on the Autism subscale. Item analysis revealed they showed the most difficulty in terms of social and communicative functioning and the least in repetitive and restrictive behaviors. Conclusion: Current findings signify that FASD and autism share similarities with regard to social and communicative functioning. These findings, which further our knowledge of the FASD phenotype, may be useful in specifying the particular interventions these children need.     

Factors predictive of a fetal alcohol spectrum disorder: Neuropsychological assessment

A variety of neurodevelopmental impairments related to fetal alcohol spectrum disorder (FASD) diagnoses have been consistently documented. However, it is not clear whether such variables are predictive of a diagnosis. The purpose of the present study is to use logistic regressions to identify predictors of FASD in neuropsychological assessment. Charts of 180 children and adolescents with prenatal alcohol exposure (PAE) who underwent psychological and diagnostic assessment for FASD were retrospectively reviewed. A total of 107 received an FASD diagnosis (the PAE-FASD group) and 73 did not (the PAE group). Following preliminary analyses, direct logistic regressions were performed to assess the contribution of different neuropsychological testing measures on the likelihood of a child or adolescent receiving an FASD diagnosis. The results indicate that the classification accuracy of the PAE-FASD and PAE groups is clinically significant across models of intelligence, academic achievement, memory, and executive functioning. Classification rates across the various models range from 67.1% to 75.5%, with models incorporating 10 intelligence subtests or 3 academic subtests emerging as superior to those using broad indices of intelligence and/or individual subtests of memory or executive functioning. A “test battery” model incorporating verbal intelligence, verbal/auditory working memory (digit span), basic reading and spelling skills, math calculations, delayed story recall, and spatial planning and problem-solving yielded a classification rate of 74.7%. These results suggest that neuropsychological testing is a critical component of FASD assessment and help guide decisions to maximize the efficiency and efficacy of the diagnostic process and treatment recommendations.     

Factors predictive of a fetal alcohol spectrum disorder diagnosis: Parent and teacher ratings

Diagnostic assessment in Fetal Alcohol Spectrum Disorder (FASD) is informed by multidisciplinary assessment incorporating objective (i.e., test measures) and subjective means, such as parent and teacher behavior ratings. The purpose of this study was to extend our previous neuropsychological test findings by identifying parent and teacher ratings of academic achievement, attention, executive functioning, and adaptive functioning as predictors of an FASD diagnosis. The charts of 315 children and adolescents with prenatal alcohol exposure (PAE) who underwent assessment for FASD were retrospectively reviewed. Direct logistic regressions analyzed the contribution of different ratings on the likelihood of an FASD diagnosis. The results suggest that a number of rating measures do contribute toward accurately differentiating those with FASD from within a PAE population, including teacher ratings of learning problems, inattention, and adaptive skills. The classification accuracy for each regression was clinically significant (59.1–70.8%). Children with worse ratings on these variables are approximately 1.5 to 2 times more likely to receive an FASD diagnosis. Only teacher ratings (not parent) significantly contributed to whether a diagnosis was made, suggesting that teacher observational rating scales are a critical component of an FASD assessment. Together with our previous research examining neuropsychological evaluation and FASD diagnostic assessment, this study helps to further guide decisions to streamline care in multidisciplinary assessment and intervention planning.     

Improving executive functioning in children with fetal alcohol spectrum disorders

An extensive body of literature has documented executive function (EF) impairments in children with fetal alcohol spectrum disorders (FASD); however, few studies have aimed specifically at improving EF. One treatment program that shows promise for children with FASD is the Alert Program for Self-Regulation®, which is a 12-week treatment specifically designed to target self-regulation, a component of EF. The present study sought to examine if Alert would produce improvements in self-regulation that would generalize to other aspects of EF, behavior, and social skills in children with FASD. Twenty-five children aged 8–12 years diagnosed with an FASD were assigned in alternating sequence to either an immediate treatment (TXT) or a delayed treatment control (DTC) group. Both groups received a comprehensive evaluation of EF at baseline and upon completing therapy (TXT), or after a 12- to 14-week interval from baseline (DTC). Parents also completed questionnaires assessing EF and behavior at both time points. For the TXT group only, parent questionnaires were readministered at 6-month follow-up. At the 12-week follow-up, the TXT group displayed significant improvements in inhibitory control and social cognition. Parents of children in the TXT group reported improved behavioral and emotional regulation, as well as reduced externalizing behavior problems. These behavioral improvements along with further improved parent-rated inhibitory control was maintained at the 6-month follow-up. The EF disabilities in children with FASD can be remediated through a targeted treatment approach aimed at facilitating self-regulation skills.     

Facial memory deficits in children with fetal alcohol spectrum disorders

Prenatal exposure to alcohol may lead to a range of neurobehavioral effects, including impaired learning and memory. Although children with fetal alcohol spectrum disorders (FASD) exhibit both verbal and nonverbal memory impairments, their memory for faces has not been as thoroughly investigated and the extent literature provides inconsistent results. The aim of the current study was to determine whether difficulties in face memory exist in children with FASD and whether the difficulties are mediated by task demands. To address this, we used two measures of immediate and delayed facial recognition memory, the Children's Memory Scale (CMS) and Test of Memory and Learning (TOMAL). Compared to typically developing controls, children with FASD showed memory deficits on all tests and were more likely to perform in a clinically significant range. As well, children performed more poorly on the CMS compared to TOMAL, a finding consistent with the greater difficulty of the CMS task. Our results are consistent with our hypothesis that children with FASD show impairment in facial memory, particularly on demanding memory tasks.     

Choice for reinforced behavioral variability in children with autism spectrum disorder

Although individuals with autism spectrum disorder (ASD) tend to behave repetitively, certain reinforcement contingencies (e.g., lag schedules) can be used to increase behavioral variability. In a lag schedule, reinforcers only follow responses that differ from recent responses. The present study was designed to promote variable play behavior in preschoolers with ASD interacting with playsets and figurines and to assess preference for variability and repetition contingencies. Data have shown a preference for variability in pigeons and college students, but this effect has not been explored in clinical populations. In this experiment, preschoolers with ASD were taught to discriminate between variability and repetition contingencies. Only play behaviors that met a lag schedule were reinforced in the presence of one color, and only repetitive behaviors were reinforced in the presence of another. After differential performance was established, participants experienced a concurrent chains schedule. Participants chose between the colors taught in training and then completed a play session with the selected contingency. One participant selected variability and repetition equally. The other participants showed a slight preference for variability. These results indicate that some individuals with ASD may play repetitively, not because they prefer repetition, but because they require additional teaching to play variably.     

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.     

Parent rating of executive function in fetal alcohol spectrum disorder: A review of the literature and new data on Aboriginal Canadian children

Aboriginal children in Canada are at high risk of fetal alcohol spectrum disorder (FASD) but there is little research on the cognitive impact of prenatal alcohol exposure (PAE) in this population. This paper reviews the literature on parent report of executive functioning in children with FASD that used the Behavior Rating Inventory of Executive Function (BRIEF). New data on the BRIEF is then reported in a sample of 52 Aboriginal Canadian children with FASD for whom a primary caregiver completed the BRIEF. The children also completed a battery of neuropsychological tests. The results reveal mean scores in the impaired range for all three BRIEF index scores and seven of the eight scales, with the greatest difficulties found on the Working Memory, Inhibit and Shift scales. The majority of the children were reported as impaired on the index scores and scales, with Working Memory being most commonly impaired scale. On the performance-based tests, Trails B and Letter Fluency are most often reported as impaired, though the prevalence of impairment is greater for parent ratings than test performance. No gender difference is noted for the parent report, but the boys had slightly slower intellectual functioning and were more perseverative than the girls on testing. The presence of psychiatric comorbidity is unrelated to either BRIEF or test scores. These findings are generally consistent with prior studies indicating that parents observe considerable executive dysfunction in children with FASD, and that children with FASD may have more difficulty with executive functions in everyday life than is detected by laboratory-based tests alone.     

Graphomotor skills in children with developmental coordination disorder (DCD): Handwriting and learning a new letter

The aim of the present study was to analyze handwriting difficulties in children with developmental coordination disorder (DCD) and investigate the hypothesis that a deficit in procedural learning could help to explain them. The experimental set-up was designed to compare the performances of children with DCD with those of a non-DCD group on tasks that rely on motor learning in different ways, namely handwriting and learning a new letter. Ten children with DCD and 10 non-DCD children, aged 8–10 years, were asked to perform handwriting tasks (letter/word/sentence; normal/fast), and a learning task (new letter) on a graphic tablet. The BHK concise assessment scale for children’s handwriting was used to evaluate their handwriting quality. Results showed that both the handwriting and learning tasks differentiated between the groups. Furthermore, when speed or length constraints were added, handwriting was more impaired in children with DCD than in non-DCD children. Greater intra-individual variability was observed in the group of children with DCD, arguing in favor of a deficit in motor pattern stabilization. The results of this study could support both the hypothesis of a deficit in procedural learning and the hypothesis of neuromotor noise in DCD.     

An extension of commonly used toilet-training procedures to children with autism spectrum disorder

The current study evaluated a toilet-training treatment package described by Greer et al. (2016) with children diagnosed with autism spectrum disorder (ASD). Most of the current research on toilet-training interventions for children with ASD are replications and modifications of Azrin and Foxx (1971) or (more recently) LeBlanc et al. (2005). However, these procedures are composed of components that are not included in studies with typically developing (TD) children. For example, Greer et al. evaluated the effectiveness of three typical components within a toilet-training package, mostly with TD participants: a 30-min sit schedule, placing participants in underwear, and differential reinforcement. The primary purpose of the current study was to replicate and extend the treatment package described by Greer et al. to children with ASD. A secondary purpose was to evaluate modifications necessary for individualized toilet training when the commonly used components were ineffective. The results of Greer et al. were replicated for 11 participants with ASD in the current study, suggesting that intensive toileting interventions (e.g., interventions requiring overcorrection, reprimands, and dense sit schedules) may only be necessary for a subset of individuals with ASD.     

Current knowledge on motor disorders in children with autism spectrum disorder (ASD)

Motor symptomatology in autism is currently poorly understood, and still not included in the autism spectrum disorder (ASD) diagnostic criteria, although some studies suggest the presence of motor disturbances in this syndrome. We provide here a literature review on early motor symptoms in autism, focusing on studies on psychomotor issues (tone, postural control, manual dexterity, handedness, praxis). The approach adopted in research to study altered motor behaviors is generally global and there is no detailed semiology of the motor or neuromotor disorders observed in people with ASD. This global approach does not enable understanding of the neuro-developmental mechanisms involved in ASD. Identification of clinical neuro-psychomotor profiles in reference to a standard would help to better understand the origin and the nature of the disorders encountered in ASD, and would thus give new directions for treatment.     

Effects of socially appropriate singing on the vocal stereotypy of children with autism spectrum disorder

This study evaluated the effects of children with autism spectrum disorder engaging in socially acceptable singing on their vocal stereotypy. A multiple‐baseline across four participants with embedded multielement designs was used to assess the effects of the singing intervention upon later occurrence of vocal stereotypy for each participant. Results showed that fewer instances of vocal stereotypy occurred during and after singing intervention sessions. Additionally, two children began to emit appropriate singing after intervention, which suggests that the topography of their vocal stereotypy (e.g., monosyllabic or screeching sounds) was altered to some extent. Overall, results suggest positive implications for teaching appropriate vocal behaviors as functional replacements for vocal stereotypy.     

An evaluation of a multi-component intervention for loud speech among children with autism spectrum disorder

Idiosyncratic patterns of speech are common among individuals with autism spectrum disorder (ASD) and can greatly affect their ability to participate successfully in various social and educational settings. We evaluated a treatment package with three children with ASD and a history of loud speech. A multiple baseline across participants design and a decibel meter application were used to evaluate whether the multi-component intervention (i.e., a rule, differential reinforcement, and in vivo feedback) would effectively reduce participants' rates of loud speech. The results showed that the intervention decreased rates of loud speech for all participants. Results are discussed in terms of (a) their extension of the literature regarding speech prosody in ASD by demonstrating an effective intervention for loud speech, (b) clinical implications, and (c) potential future research regarding this nuanced, yet crucial aspect of social communication, including appropriate methods for addressing loud speech in individuals with ASD.     

Social competence group intervention (SOCO) for children with autism spectrum disorder: A pilot study

This study aimed to describe concept of social competence as a theoretical background for social skills group intervention for children with autism spectrum disorder (ASD). A model of social competence comprised of three components: social skills, social performance, and social adjustment. We also examined the feasibility and preliminary efficacy of the manualized Social Competence group intervention for children with autism spectrum disorder (SOCO) using a variety of outcome measures. The nine-month intervention included children groups, parental support groups and co-operation with teachers. A pilot study involved 23 children aged 7 to 12 years (n = 16 intervention, n = 7 control) and intervention outcomes were measured with questionnaires for parents and teachers, neuropsychological tests, and observations. The parents of the intervention group reported improvements in social skills and social adjustment, whereas the teachers reported increases in social performance. Findings also indicated that affect recognition skills, social overtures, and reactions to peers were improved in the intervention group. Although the evidence of the pilot study should be considered as preliminary, it gives some indication of the feasibility of the SOCO group intervention and supports the usability of the theoretical background and approach for multiple outcome measures.     

Executive functioning deficits in preschool children with Fetal Alcohol Spectrum Disorders

Executive function (EF) deficit is a hallmark of Fetal Alcohol Spectrum Disorders (FASD), but the vast majority of available evidence comes from school-age children and adolescents. Very little is known about EF during the critical developmental period prior to 6 years of age in FASD. We evaluated EF in 39 children with FASD (3.0–5.5 years) and a comparison group of 50 age-matched, nonexposed controls. Measures included the EF Scale for Early Childhood and a Delay of Gratification task. Compared to age-matched controls, preschool children with FASD had impairments on the EF Scale and showed more impulsivity on the Delay of Gratification task. To confirm the EF Scale finding, FASD group performance was compared to a separate normative dataset (N = 1,400). Those with FASD performed below normal (M = –0.57, SD = 0.92). Within the FASD group, IQ was correlated with the EF Scale (partial r = .60, p = .001) and Delay of Gratification (partial r = .58, p = .005). EF Scale performance did not differ significantly across levels of FASD severity (fetal alcohol syndrome [FAS], partial FAS, or alcohol-related neurobehavioral disorder [ARND]). However, compared to normative data, those with FAS had the largest deficits (M = –0.91 SD from the mean, SE = 0.23), followed by partial FAS (M = –0.66 SD from the mean, SE = 0.26), then ARND (M = –0.36 SD from the mean, SE = 0.20). These novel data show that EF deficits manifest well before the age of 6 years in children with FASD, that they occur across the spectrum, and that EF may be most impaired in children with more severe forms of FASD and/or lower IQs.     

Randomized controlled trial of an applied behavior analytic intervention for food selectivity in children with autism spectrum disorder

Food selectivity is a common problem for children with autism spectrum disorder (ASD; Schreck, Williams, & Smith, 2004). Behavior‐analytic interventions have the most empirical support for feeding disorders (Sharp, Jaquess, Morton, & Miles, 2011). However, there are no randomized controlled trials that have evaluated its effects with a well‐defined cohort of children with ASD. In the current investigation, we randomly assigned 6 young children with ASD and food selectivity to either an applied behavior analytic intervention or a wait‐list control. We used a crossover randomized controlled trial to evaluate the effects of a multicomponent applied behavior analytic intervention on independent acceptance and mouth clean of 16 novel foods. We subsequently exposed the wait‐list control group to the intervention. We also evaluated the effects of the intervention on individual participants with single‐case designs. The percentage of independent acceptance and mouth clean increased for the applied behavior analytic intervention group, but not for the wait‐list control group until we implemented the intervention.     

An interest‐based intervention package to increase peer social interaction in young children with autism spectrum disorder

The literature suggests that children with autism spectrum disorder (ASD) educated in inclusive settings generally do not interact with typically developing classmates during social activities. This study assessed whether an intervention package consisting of interest‐based structured play activities involving adult instruction, modeling, and response to child questions would result in an increase in social interaction with typically developing peers. A multiple baseline design across four participants with an embedded reversal was used to demonstrate the effects of the intervention on social interaction during structured play sessions. Initiations, responses, and interactive play increased for all participants. Generalization to novel peers was observed, and treatment gains were maintained during 6‐week follow‐up sessions. Recommendations for practitioners working with children with ASD in inclusive settings and potential areas of future research are discussed.