Executive functions in children with Autism Spectrum Disorders

Executive dysfunction is a characteristic impairment of individuals with Autism Spectrum Disorders (ASD). However whether such deficits are related to autism per se, or to associated intellectual disability is unclear. This paper examines executive functions in a group of children with ASD (N = 54, all IQ?70) in relation to a typically developing control group individually matched on the basis of age, gender, IQ and vocabulary. Significant impairments in the inhibition of prepotent responses (Stroop, Junior Hayling Test) and planning (Tower of London) were reported for children with ASD, with preserved performance for mental flexibility (Wisconsin Card Sorting Task) and generativity (Verbal Fluency). Atypical age-related patterns of performance were reported on tasks tapping response inhibition and self-monitoring for children with ASD compared to controls. The disparity between these and previous research findings are discussed. A multidimensional notion of executive functions is proposed, with difficulties in planning, the inhibition of prepotent responses and self-monitoring reflecting characteristic features of ASD that are independent of IQ and verbal ability, and relatively stable across the childhood years.     

Executive functions in children with Autism Spectrum Disorders

Executive dysfunction is a characteristic impairment of individuals with Autism Spectrum Disorders (ASD). However whether such deficits are related to autism per se, or to associated intellectual disability is unclear. This paper examines executive functions in a group of children with ASD (N = 54, all IQ⩾70) in relation to a typically developing control group individually matched on the basis of age, gender, IQ and vocabulary. Significant impairments in the inhibition of prepotent responses (Stroop, Junior Hayling Test) and planning (Tower of London) were reported for children with ASD, with preserved performance for mental flexibility (Wisconsin Card Sorting Task) and generativity (Verbal Fluency). Atypical age-related patterns of performance were reported on tasks tapping response inhibition and self-monitoring for children with ASD compared to controls. The disparity between these and previous research findings are discussed. A multidimensional notion of executive functions is proposed, with difficulties in planning, the inhibition of prepotent responses and self-monitoring reflecting characteristic features of ASD that are independent of IQ and verbal ability, and relatively stable across the childhood years.     

An Abbreviated Screening Instrument for Autism Spectrum Disorders

The reliability and validity of the Parent's Observations of Social Interactions (POSI), a new, seven‐item screening instrument for autism spectrum disorders (ASD), is examined in two substudies. In Study 1, parents of 217 children (18–48 months) evaluated at a developmental clinic completed intake questionnaires that included the POSI and the Modified Checklist for Autism in Toddlers (M‐CHAT) checklist. POSI and M‐CHAT scores were compared to clinical evaluation results to assess reliability and validity. In Study 2, parents of 232 children (16–36 months) from both primary care and subspecialty settings completed the POSI, the M‐CHAT, and a report of their child's diagnoses. POSI and M‐CHAT scores were compared to reported diagnoses to assess reliability and validity. In both studies, the POSI demonstrated adequate internal reliability (Cronbach α = 0.83 and 0.86, respectively). In Study 1, POSI sensitivity (89%) was higher than that for the M‐CHAT (71%; p < .05); specificities were not significantly different (POSI: 54%, M‐CHAT: 62%). In Study 2, sensitivity (83%) compared favorably to that for the M‐CHAT (50%), although specificity was lower (75 vs. 84%). Despite its brevity, the POSI demonstrated good internal reliability and comparable sensitivity/specificity to the M‐CHAT checklist in two independent populations. If results are reproduced in larger, more diverse samples, the POSI may provide an efficient method for ASD screening in young children.     

The Brief Family Distress Scale: A Measure of Crisis in Caregivers of Individuals with Autism Spectrum Disorders

Parents of individuals with autism spectrum disorders (ASD) often experience stressors associated with caring for their child. These stressors can cause considerable distress for families, which at times can develop into full blown crisis, and it is important that professionals be able to quickly identify when families are approaching or are in crisis to respond appropriately. The current study presents an initial attempt at measuring the subjective experience of crisis in 164 caregivers of people with ASD through a single item instrument, the Brief Family Distress Scale. The BFDS was negatively correlated with helpful coping mechanisms (family hardiness, and parent empowerment), and positive adjustment (caregiver quality of life and positive parenting experiences), and positively correlated with known stressors (severity of aggressive behavior, negative life events) and problematic coping and outcomes (caregiver burden, worry, mental health problems). As expected, caregivers at Marked levels of distress (approaching or in crisis) were significantly different from caregivers at lower levels of distress in nearly all of the dependent variables. Having a quick way of measuring where families are in terms of distress and crisis can be helpful for researchers and clinicians alike.     

Psychiatric Symptom Impairment in Children with Autism Spectrum Disorders

The general aim of this study was to examine the relation of psychiatric symptom-induced impairment with other common parameters of mental health in children with autism spectrum disorder (ASD). Prevalence rates are used to illustrate the implications of different criteria for caseness. Parents/teachers completed DSM-IV-referenced rating scales for 6–12 year old children with ASD (N?=?115), the majority of whom were boys (86 %). Most children were rated by parents (81 %) or teachers (86 %) as being socially or academically impaired by symptoms of at least one psychiatric disorder. The most common impairing conditions (parent/teacher) were attention-deficit/hyperactivity disorder (67 %/71 %), oppositional defiant disorder (35 %/33 %), and anxiety disorder (47 %/34 %), and the combined rates based on either informant were generally much higher. Agreement between symptom cutoff and impairment cutoff was acceptable for most disorders. A larger percentage of youth were impaired by psychiatric symptoms than met symptom cutoff criteria, and the discrepancy between impairment cutoff and clinical cutoff (impairment cutoff plus symptom cutoff) was even greater. Impairment was moderately to highly correlated with both number and severity of symptoms. Parents’ and teachers’ ratings indicated little agreement as to whether a child was impaired. Findings for youth with ASD were similar to non ASD child psychiatry outpatient referrals, but clearly different in several ways from comparable studies of community-based samples.     

Parentification of Adult Siblings of Individuals with Autism Spectrum Disorder

Many typically-developing (TD) siblings provide care for their siblings with autism spectrum disorder (ASD), both as children and as adults. Research on parentification (i.e., when children assume responsibilities typically reserved for adults) has been mixed, with some studies supporting positive outcomes for TD siblings and others indicating negative outcomes. Some of these discrepancies may be due to inconsistencies in differentiating types of parentification. The current study examined how different types of parentification during childhood (retrospectively-reported) related to distress outcomes and attitudes about sibling relationships among 41 TD adult siblings of individuals with ASD. Results indicated that parent-focused parentification was positively related with anxiety and stress among TD siblings. Sibling-focused parentification was positively related to stress but was also related to more positive sibling relationship attitudes. Accounting for demographic variables and the other form of parentification, parent-focused parentification was a unique predictor of distress, whereas sibling-focused parentification was a unique predictor of positive sibling relationship attitudes. Although parentification is often viewed negatively, sibling-focused parentification and perceived benefits of parentification may predict positive outcomes. Results suggest that parentification may prove important in understanding the complex nature of sibling relationships. Specifically, strengthening the sibling bond and reducing parent-focused parentification during childhood may curtail sibling relationship problems and general distress in TD siblings later in life.     

Multi-family Psychoeducational Psychotherapy (MF-PEP) for Children with High Functioning Autism Spectrum Disorder

This article describes the development and methodology of a novel psychosocial intervention for children with high functioning autism spectrum disorder (HFASD). Originally developed as an adjunctive treatment for children with mood disorders, Multi-Family Psychoeducational Psychotherapy (MF-PEP) has been adapted for children with ASD (MF-PEP-ASD). Consisting of eight sessions, children with ASD and their parents receive psychoeducation and social support, and learn coping, problem-solving, communication, and symptom-management skills in separate and joint sessions. Core treatment components of MF-PEP-ASD include psychoeducation, social skills treatment, cognitive-behavioral therapy, and parent training and involvement. Preliminary qualitative data from parent and child participants have indicated positive and promising findings. Continued evaluation of this treatment using comprehensive outcome and treatment fidelity measures is warranted.     

A Meta-Analysis of Behavioral Interventions for Adolescents and Adults with Autism Spectrum Disorders

Evaluation of evidence-based treatments is important for adolescents and adults with autism spectrum disorders (ASD) given the increasing number of interventions available and the prevalence of ASD. In this study, we sought to evaluate the effectiveness of behavioral interventions for this population by conducting a meta-analysis of published single-case research studies. A new metric for calculating effect size in single-case research, nonoverlap of all pairs, was utilized. In addition, the certainty of evidence, a system to evaluate research methodology, was applied to the reviewed articles. Forty-three articles were identified in the study. Results suggested that the behavioral interventions in the areas of academic skills, adaptive skills, problem behavior, phobic avoidance, social skills, and vocational skills have medium-to-strong effect sizes. Medium-to-high confidence in findings was noted for 81 % of the studies in the meta-analysis; however, three-fourths of the reviewed studies did not include treatment integrity, which may affect the ability to draw conclusions about the effectiveness of the interventions. Overall, the evidence is promising for the use of behavioral interventions for this population; however, additional research and dissemination are needed to fill the gap between research and practice in order for practitioners to meet the increasing demand as individuals with ASD age.     

自闭症谱系障碍者异常的大脑功能连接

自闭症谱系障碍(Autism spectrum disorders, ASD)是一种常见的神经发育障碍, ASD在社交、语言、行为等方面的障碍与其异常的大脑功能连接存在密切关系。与正常发育者相比, ASD大脑既表现出远距离功能连接不足, 也表现出局部功能连接过度增强。ASD这种异常的脑功能连接受到结构异常、扫描状态、个体发展、分析方法等多种因素的影响。未来的ASD脑机制研究中, 要综合分析脑功能与结构, 关注年龄发展变化, 并将任务状态、被试取样、数据分析标准等因素纳入考察。     

Parent Perspectives on Community Mental Health Services for Children with Autism Spectrum Disorders

The community mental health (CMH) system provides treatment for behavioral and psychiatric problems in children with autism spectrum disorders (ASD). Although parent stakeholder perspectives are important to improving care, these perspectives have not been systematically examined for this population in the CMH sector. Twenty-one semi-structured qualitative interviews were conducted with parents of children with ASD who received services in CMH clinics. Themes related to child clinical histories, service access and experiences with the CMH system revealed a specific trajectory of service need identification, obtaining a diagnosis, and experience with services. Each trajectory stage was marked by high parent stress. Results provide information about the characteristics of children with ASD served in community mental health clinics and direction for targeted improvement efforts.     

Interventions for Children With Autism Spectrum Disorders in Inclusive School Settings

Students with ASD present unique challenges to school systems. Despite these challenges, federal laws require that schools implement research-based practices in the least restrictive environment (LRE). The LRE is often deemed to be the general education classroom and the primary intervention agent is often the classroom teacher. Ensuring students with ASD receive effective intervention in these least restrictive and inclusive school settings will depend, in part, on the extent to which teachers and school personnel are prepared to implement research-based interventions. The purpose of this article is to provide a summary of research-based interventions for students with ASD. Our focus in this summary is on interventions that can be implemented in inclusive school settings by teachers and classroom support personnel. We first provide a general overview of interventions designed to reduce challenging behavior, teach communication skills, and improve social relationships. This is followed by a discussion of the obstacles to intervention implementation that may be present in school settings. Finally, we conclude by offering a list of intervention guidelines.     

Evolution of Research on Interventions for Individuals with Autism Spectrum Disorder: Implications for Behavior Analysts

The extraordinary success of behavior-analytic interventions for individuals with autism spectrum disorder (ASD) has fueled the rapid growth of behavior analysis as a profession. One reason for this success is that for many years behavior analysts were virtually alone in conducting programmatic ASD intervention research. However, that era has ended. Many investigators from other disciplines are now carrying out large-scale intervention studies and beginning to report successes of their own. The increasing number and range of studies has the potential to improve services for individuals with ASD, and it challenges behavior analysts to intensify their research efforts.     

Subjective Quality of Life for Parents of Children with Autism Spectrum Disorders in Croatia

The purpose of this study was to investigate the subjective quality of life (SQoL) of parents of children with autism spectrum disorders (ASD) who are primary carers. The study included 346 parents: 177 parents of children with ASD and 169 parents of non-disabled children comprised the control group. The Personal Wellbeing Index (PWI) was used to assess SQoL. Parents’ general health perception was assessed with a single question scored on a scale from 1 (poor health) to 5 (excellent health). Parents of children with ASD reported a significantly lower SQoL and general health perception with more physiological symptoms as compared to parents of non-disabled children. In Croatia parents of children with ASD, as primary caregivers, is an especially vulnerable part of the population and need increased social support and assistance in order to achieve and maintain the well-being of the whole family.     

Synthetiki Psychotherapy: An Integrative Psychotherapy for Individuals with Schizophrenic Symptoms

During the past 22 years, the author has developed an integrative psychotherapeutic model, called Synthetiki Psychotherapy (from the Greek word synthesis), for the treatment of individuals with schizophrenic symptoms. It has been influenced by certain philosophical and ethical principles, by ancient and modern Greek civilization and culture, and by the psychotherapy integration movement, and has been tested through research at the Laboratory of Clinical and Social Psychology of the University of Crete, Greece. The principles of Synthetiki Psychotherapy are presented and discussed.     

Parenting Interventions for Children with Autism Spectrum and Disruptive Behavior Disorders: Opportunities for Cross-Fertilization

Empirical support exists for parent training/education (PT/PE) interventions for children with disruptive behavior disorders (DBD) and autism spectrum disorders (ASD). While the models share common roots, current approaches have largely developed independently and the research findings have been disseminated in two different literature traditions: mental health and developmental disabilities. Given that these populations often have overlapping clinical needs and are likely to receive services in similar settings, efforts to integrate the knowledge gained in the disparate literature may be beneficial. This article provides a systematic overview of the current (1995–2005) empirical research on PT/PE for children with DBD and ASD; attending to factors for cross-fertilization. Twenty-two ASD and 38 DBD studies were coded for review. Literature was compared in three main areas: (1) research methodology, (2) focus of PT/PE intervention, and (3) PT/PE procedures. There was no overlap in publication outlets between the studies for the two populations. Results indicate that there are opportunities for cross-fertilization in the areas of (1) research methodology, (2) intervention targets, and (3) format of parenting interventions. The practical implications of integrating these two highly related areas of research are identified and discussed.     

Story Recall and Narrative Coherence of High-Functioning Children with Autism Spectrum Disorders

Previous research has found few quantitative differences between children with high-functioning autism spectrum disorders (ASDs) and well-matched controls in the length, complexity, and structure of their narratives. Researchers have noted, however, that narratives of children with ASDs have an unusual and idiosyncratic nature. This study provides an analysis of narratives in 17 children with high-functioning ASDs and 17 typically developing children matched on age, gender, language abilities, and cognitive abilities. We examined story recall and narrative coherence. The study revealed no group differences in story length or syntactic complexity. Children with ASDs also did not differ from controls in their use of the gist of a story to aid recall, or in their sensitivity to the importance of story events. Children with ASDs did, however, produce narratives that were significantly less coherent than the narratives of controls. Children with ASDs appeared less likely to use the gist of the story to organize their narratives coherently. These findings are discussed with regard to their relationship to other cognitive and linguistic difficulties of children with ASDs.     

Autonomic Responses to Head-Up Tilt Test in Children with Autism Spectrum Disorders

Autism Spectrum Disorders (ASD) is a group of neurodevelopmental disorders often manifested by social and behavioral deficiencies. Autonomic dysfunction is frequently reported in the autistic population but the mechanisms remain largely unknown. We aimed to characterize the cardiac autonomic profile of children with autism during a head-up tilt test. Thirty-nine male children were recruited: 19 controls (9.9 ± 1.6 years) and 20 children with ASD without intellectual disability (10.7 ± 1.2 years). Each child underwent a head-up tilt test on a motorized tilt table. After a 10 min resting period in the supine position, subjects were tilted head-up to 70° on the table for 10 min. Heart rate and blood pressure variabilities were continuously recorded using non-invasive Nexfin monitoring. The head-up tilt test significantly altered heart rate variability (p < 0.001 for both groups) and greater parasympathetic responses were found in the ASD group compared to controls (p < 0.05). In the supine position baroreflex sensitivity was higher in children with ASD than in the controls (p < 0.05) and significantly decreased during the tilt test in the ASD group, but not in controls. Our results showed that children with ASD did not have clinical signs of dysautonomia in response to a head-up tilt test. However, in children with ASD higher parasympathetic responses with the same sympathetic modulations during orthostatic stress suggest parasympathetic dominance in this population.     

自闭症谱系障碍者面孔识别的神经机制

自闭症谱系障碍（ASD）是一种心理状况的谱系障碍,其症状是社交及沟通上的广泛性异常、异常局限性的兴趣和高度重复性的刻板行为。包括自闭症、亚斯伯格症候群和待分类的广泛性发展障碍3类。研究主要以事件相关电位和功能性磁共振成像两种技术为线索,通过深入分析ASD患者在面孔识别认知过程中脑的异常变化,探讨其面孔识别障碍的神经机制问题。研究表明,ASD患者面孔识别能力的损伤主要与N170、N300、P400和Nc等ERPs成份异常及梭状回面孔区和杏仁核的低激活有关。研究推论ASD患者面孔识别障碍是多个异常脑区联合作用的结果,且主要受异常脑区的数量和损伤程度的影响。