Towards the DSM‐5 Criteria for Autism: Clinical,Cultural, and Research Implications

The new edition of the DSM is proposing significant changes to current diagnostic definitions of autism and related conditions. In this article, we will discuss the clinical, research, and cultural implications of these changes. We conclude that the new criteria appear to better reflect current understanding of the autism spectrum disorder than the current DSM‐IV criteria. As expected with any major change in classification systems, there are also significant risks, which will have to be carefully monitored and addressed by both policy makers and the scientific community to ensure that best clinical practice and research are facilitated and advanced.     

The Role for Occupational Therapists in Community Mobility Training for People With Autism Spectrum Disorders

Symptoms and behaviors of Autism Spectrum Disorders can challenge community mobility, thus hindering independence and participation in occupation. Community mobility, also called travel training, helps people make journeys safely using public transportation, enabling engagement in activities/services otherwise unavailable. Yet, few articles have been written about this topic for people with Autism Spectrum Disorders. The purpose of the authors in this article is to: (1) explain the need for travel training with people diagnosed with Autism Spectrum Disorders; (2) describe specific travel training assessments; (3) review literature on travel training programs; and (4) define a role for occupational therapy in travel training with individuals diagnosed with Autism Spectrum Disorders.     

FUNCTIONAL ANALYSIS OF INAPPROPRIATE SOCIAL INTERACTIONS IN STUDENTS WITH ASPERGER'S SYNDROME

We analyzed the inappropriate social interactions of 3 students with Asperger's syndrome whose behavior was maintained by social positive reinforcement. We tested whether inappropriate social behavior was sensitive to social positive reinforcement contingencies and whether such contingencies could be reversed to increase the probability of socially appropriate responding. Our results show that social positive reinforcers can be identified for inappropriate social interactions and that appropriate social behaviors can be sensitive to reinforcement contingency reversals.     

Teaching multiply controlled intraverbals to children and adolescents with autism spectrum disorders

Reciprocal conversations, instructional activities, and other social interactions are replete with multiply controlled intraverbals, examples of which have been conceptualized in terms of conditional discriminations. Although the acquisition of conditional discriminations has been examined extensively in the behavior‐analytic literature, little research has evaluated procedures to establish multiply controlled intraverbals. Thus, the purpose of this investigation was to evaluate the effects of procedures based on conditional discrimination training on the acquisition of multiply controlled intraverbals with 7 participants who had been diagnosed with autism spectrum disorders. We evaluated the effects of prompt delay with error correction, a differential observing response (DOR), and a DOR plus blocked trials on the acquisition of intraverbals using a multiple baseline design. Accuracy of intraverbal performance increased for at least 1 set of stimuli for all participants under prompt delay with error correction conditions; however, 4 participants required additional teaching (i.e., DOR, modified DOR, modified prompt delay with error correction). Based on these findings, when prompt delay with error correction is not sufficient to establish multiply controlled intraverbals, prompted DORs may be an effective alternative.     

Children with Autism and Their Friends: A Multidimensional Study of Friendship in High-Functioning Autism Spectrum Disorder

This study of Israeli and American preadolescent children examined characteristics of friendship in 44 children with high-functioning autism spectrum disorder (HFASD) compared to 38 typically developing children (TYP), as they interacted with a close friend Participants were 8-12 years of age (HFASD: Israel, n = 24; USA, n = 20; TYP: Israel, n = 23; USA, n = 15), and were matched on SES, receptive language vocabulary, child age, and gender (each study group included one girl). Multidimensional assessments included: individual behaviors of target children and observed child-friend interactions during construction and drawing scenarios; target child's and friend's self-perceived mutual friendship qualities; and mother-reported characteristics (friendship's duration/frequency; friend's age/gender/disability status). Overall, children with HFASD displayed a number of differences on individual and dyadic friendship measures. Both age and verbal abilities affected friendship behaviors. Children with HFASD and their friends perceived friendship qualities similarly, suggesting that preadolescents with HFASD have capacities for interpersonal awareness. Between-group similarities also emerged on several complex social behaviors, suggesting that friendship follows a developmental trajectory in autism and may enhance social interaction skills in autism.     

Use of non-directive therapy for adolescents with autism spectrum disorder: A systematic review

In this review, we systematically explored research on the use of non-directive therapies with adolescents (aged 11–18 years) with autism spectrum disorder (ASD). N = 12 studies were eligible for inclusion. The findings suggested four therapeutic components which were consistently present across all non-directive interventions and held similarities with play therapy principles: (a) collaboration between adolescent and therapist; (b) adolescent-led discussions; (c) reflection and reframing; and (d) encouragement and acceptance of the adolescent as they were. Therapeutic outcomes improved when the therapists had an understanding of ASD in order to tailor the intervention to the individual. Future primary research investigating the applicability of play therapy principles and limitations is discussed.     

Gender variance in children and adolescents with autism spectrum disorder from the National Database for Autism Research

Previous studies suggest elevated rates of gender variance (GV), the wish to be of the other gender, in those with autism spectrum disorder (ASD). This study aimed to understand the rate of GV in children and adolescents with ASD and explore differences in sex, age, and emotional-behavioral problems relative to those referred to clinical services for mental health concerns (“referred”) and to the general population (“non-referred”). A secondary analysis of data from the National Database for Autism Research was used to explore GV using a child behavior checklist, parent report, in 176 children aged 6 to 18 year with ASD compared to referred and non-referred cohorts. GV was present in 4.0% of the ASD group, higher than for the non-referred group (0.7%) but similar to the referred group (4.0%). There were no significant sex differences in GV prevalence (males 3.7%, females 6.0%) in the ASD group. That the GV rate was elevated in ASD relative to non-referred samples but similar to clinically referred samples suggests that elevated rates of GV were not specific to ASD and may be more broadly associated with neurodevelopmental and psychiatric disorders of childhood. Further population-based research using clinical assessment for gender dysphoria is required in individuals with ASD and other neurodevelopmental disorders.     

Vulnerability to loneliness among fathers of children with autism spectrum disorder: The role of interpersonal and familial resources

Fathers of children with autism spectrum disorder (ASD) might be at increased risk of becoming lonely. In the current study, we explored the differences in loneliness between fathers of children with and without ASD and identified interpersonal and familial resources (social support, family cohesion, and family adaptability) that might be related to levels of loneliness. Using a cross-sectional design, 348 fathers (of 114 children with ASD and 234 without) completed a series of questionnaires. Fathers of children with ASD reported higher levels of loneliness and lower levels of social support and family cohesion. A moderated mediation model indicated that the interaction between social support and family cohesion mediated the association between ASD group (i.e., ASD vs. non-ASD) and fathers' loneliness. Findings suggest the importance of interpersonal and familial resources (e.g., perceived social support and family cohesion) for family members at risk of loneliness.     

Working with children with Asperger's Syndrome in the mainstream classroom: A psychodynamic take from the chalk face

There has been considerable discussion by those involved in teaching children with special educational needs (SENs) about how to appropriately categorize children with difficulties in learning. Increasingly, a social inclusion model of SEN has come to the fore in mainstream schools across the developed world. Asperger's Syndrome (AS), however, has presented a challenge to inclusionary approaches. This paper, based on the experiences of a teacher working with a child with AS in the mainstream classroom, explores the role of emotions in relation to the obsessional interests of children with AS. Particular reference is paid to the work of later object relations theorists on the emotional role of rigid patterns of thinking, behaviour and obsessional interest in AS. The possibility that an implicit deficit model may at times be relevant to the development of ‘live’ communication and learning for children with AS in the mainstream classroom is considered. Possible management strategies in the classroom in relation to obsessive interests are discussed.     

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.     

The influence of instructive feedback presentation schedule: A replication with children with autism spectrum disorder

Instructive feedback (IF) is a modification to discrete trial instruction that may increase instructional efficiency for individuals with autism spectrum disorder. Several variations of IF have recently been evaluated in the literature; however, few studies have assessed the effectiveness and efficiency of presenting secondary targets on continuous versus intermittent presentation schedules. The current study evaluated the effectiveness and efficiency of various presentation schedules of secondary targets during discrete trial instruction. Specifically, we replicated and extended Griffen et al. (1998) by comparing a condition in which secondary targets were presented during each trial of a session, a condition in which secondary targets were presented every other trial, and a condition in which secondary targets were presented about every 4 trials. Within-subject replications were included for both participants. One of the intermittent presentation schedules was associated with the most optimal outcomes in all 4 comparisons.     

A comparison of the effects of providing activity and material choice to children with autism spectrum disorders

The present study compares the effects of providing choice between activities or between materials for completion of activities on the on-task behavior of 4 boys with autism spectrum disorders. Results showed that the participants displayed higher levels of on-task behavior during the choice conditions than in the no-choice condition. However, the type of choice opportunity did not seem to have a differential effect.     

Improving Social Skills of Adults With Autism Spectrum Disorder Through Physical Activity,Sports, and Games: A Review of the Literature

Socialization skill deficiencies among adults with autism spectrum disorder (ASD) can lead to depression, anxiety, aggression, and physical health problems. Clinical interventions must treat primary deficiencies and prevent secondary conditions. A treatment model emphasizing the integration of physical activity with social intervention strategies for adults with ASD is proposed.     

Sluggish cognitive tempo in children and adolescents with higher functioning autism spectrum disorders: Social impairments and internalizing symptoms

Sluggish cognitive tempo (SCT) was introduced in 1980s in the field of attention deficit hyperactivity disorder (ADHD). Studies indicate that symptoms of SCT are separate from symptoms of ADHD and independently associated with multiple domains of functioning in clinical groups and in typical development. We assessed whether similar pattern would apply to higher functioning autism spectrum disorders (ASD). Children with higher functioning ASD (N = 55; 5?15 years) were divided into the ASD+High SCT (n = 17), the ASD+Medium SCT (n = 18) and the ASD+Low SCT (n = 20) groups based on parent‐rated daydreaming and slowness on the Five to Fifteen questionnaire (FTF). The groups were compared on SCT‐related impairments found in previous studies: social skills, academic functioning, psychiatric symptoms, and processing speed. Assessment methods were the FTF, the Development and Well‐Being Assessment, and the Coding subtest of the WISC‐III. The ADHD symptoms were statistically controlled due to the overlap between SCT and ADHD. The ASD+High SCT and ASD+Medium SCT groups were significantly more likely to have the most pronounced social impairments, and the ASD+High SCT group had significantly higher rate of internalizing disorders compared to the ASD+Low SCT group. Our results suggest that children with higher functioning ASD and high or medium levels of SCT symptoms could be at higher risk for psychosocial impairments than children with higher functioning ASD with low levels of SCT symptoms. Co‐occurring ADHD symptoms do not explain the finding. Recognizing SCT symptoms in higher functioning ASD would be important to targeting preventive support.     

孤独症儿童潜在早期识别标志——发声异常及原因探析

孤独症谱系障碍(Autism Spectrum Disorder, ASD)儿童的早期识别及早期干预对其发育结果至关重要。发声是指儿童学会说话之前发出的声音。已有研究表明, 非类言语和类言语发声异常是ASD儿童2岁前的潜在识别标志。ASD儿童发声异常的理论解释主要有动机导向、神经运动导向、感知觉导向和社会反馈导向理论。未来研究可考虑探讨发声异常作为ASD儿童独特的早期识别标志的可能性, 加强哭声在ASD儿童早期筛查中的研究, 探索基于最具预测性声学参数集的自动学习分类模型, 探究内在动机与社会动机对ASD儿童类言语发声的影响和进一步探究ASD儿童类言语发声异常的神经机制。从而为ASD儿童的早期识别及早期干预提供更加客观的理论依据。     

Detail-oriented cognitive style and social communicative deficits,within and beyond the autism spectrum: Independent traits that grow into developmental interdependence

At the heart of debates over underlying causes of autism is the “Kanner hypothesis” that autistic deficits in social reciprocity, and a cognitive/perceptual ‘style’ favouring detail-oriented cognition, co-vary in autistic individuals. A separate line of work indicates these two domains are normally distributed throughout the population, with autism representing an extremity. This realisation brings the Kanner debate into the realm of normative co-variation, providing more ways to test the hypothesis, and insights into typical development; for instance, in the context of normative functioning, the Kanner hypothesis implies social costs to spatial/numerical prowess. In light of this growing body of research, we review relevant factor analytic and correlational, behavioural studies. Findings are then synthesised into three themes: an alternative triad of primary autistic trait categories – Social Interaction Deficits, Cognitive Inflexibility, and Sensory Abnormalities – that more accurately reflects the factor structure of autistic traits; continuity between clinical and non-clinical autism-spectrum trait presentation; and indications that although social and non-social autistic traits may be initially independent, Kanner-like co-variance emerges behaviourally from dynamic trait interactions over the course of development. A dynamic developmental model subsuming these patterns is offered, and its advantages demonstrated in a novel account of ritualistic behaviours: as developmentally emergent, compensatory mechanisms for interactions between cognitive inflexibility and sensory abnormalities. We conclude with the broader imperative that behavioural scientists appealing for directly and exclusively genetic links may instead benefit from a developmental framing within their own discipline.