An Overview of Autism Spectrum Disorder, Heterogeneity and Treatment Options

 An Overview of Autism Spectrum Disorder, Heterogeneity

and Treatment Options

Abstract 

Since the documented observations of Kanner in

1943, there has been great debate about the diagnoses, the

sub-types, and the diagnostic threshold that relates to what

is now known as autism spectrum disorder (ASD).

Reflecting this complicated history, there has been continual 

refinement from DSM-III with ‘Infantile Autism’ to

the current DSM-V diagnosis. The disorder is now widely

accepted as a complex, pervasive, heterogeneous condition

with multiple etiologies, sub-types, and developmental

trajectories. Diagnosis remains based on observation of

atypical behaviors, with criteria of persistent deficits in

social communication and restricted and repetitive patterns

of behavior. This review provides a broad overview of the

history, prevalence, etiology, clinical presentation, and

heterogeneity of ASD. Factors contributing to heterogeneity, 

including genetic variability, comorbidity, and

gender are reviewed. We then explore current evidencebased 

pharmacological and behavioral treatments for ASD

and highlight the complexities of conducting clinical trials

that evaluate therapeutic efficacy in ASD populations.

Finally, we discuss the potential of a new wave of research

examining objective biomarkers to facilitate the evaluation

of sub-typing, diagnosis, and treatment response in ASD.

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Attention and written expression in school-age, high-functioning children with autism spectrum disorders

Attention and written expression in school-age, high-functioning children with autism spectrum disorders

Abstract

High-functioning  children  with  autism  spectrum  disorders  often  find  writing  challenging.  

These  writing  difficulties  may be specific to autism spectrum disorder or to a more general clinical effect of attention disturbance, as these children are often comorbid for attention-deficit/hyperactivity disorder (ADHD) symptomatology (and children  with attention- deficit/hyperactivity  disorder  often  also  find  writing  challenging).  To  examine  this  issue,  this  study  investigated  the role  of  attention  disturbance  on  writing  in  155  school-age  children  across  four   diagnostic  groups:  high-functioning autism spectrum disorder (HFASD)  with lower ADHD  symptoms  (HFASD-L), HFASD with higher  ADHD symptoms (HFASD-H),  ADHD  symptoms  but  no  autism  spectrum  disorder  symptoms,  and  typical  development.  Both  HFASD subgroups and the ADHD group displayed lower word production writing scores than the typical development group, but the clinical groups did not differ. The HFASD-H and ADHD groups had significantly lower theme development and text organization writing scores than the typical development group, but the HFASD-L and typical  development groups were not significantly different. The findings support prior research reporting writing problems in children with autism spectrum  disorder  but  also  suggest  that  children  with  HFASD-H  may  be  at  greater  risk  for  writing  difficulties  than children with HFASD-L. Better understanding the role of attention in writing development could  advance methods for assessment and intervention for children with high-functioning autism spectrum disorder at risk for  writing difficulties.

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Reducing Information’s Speed Improves Verbal Cognition and Behavior in Autism: A 2-Cases Report

Reducing Information’s Speed Improves Verbal Cognition and Behavior in Autism: A 2-Cases Report

According to the temporal theory of autism spectrum disorders (ASDs), abstract
audiovisual changes in environment, particularly those linked to facial and
verbal language, are often too fast to be faced, perceived, and/or interpreted
online by many children with ASD, which could help explain their facial,
verbal, and/or socioemotional interaction impairments.‍ Our goal here was
to test for the first time the impact of slowed-down audiovisual information
on verbal cognition and behavior in 2 boys with ASD and verbal delay.‍ Using
15 experimental sessions during 4 months, both boys were presented with
various stimuli (eg, pictures, words, sentences, cartoons) and were then
asked questions or given instructions regarding stimuli.‍ The audiovisual
stimuli and instructions/questions were presented on a computer's screen
and were always displayed twice: at real-time speed (RTS) and at sloweddown speed (SDS) using the software Logiral.‍ We scored the boys’ verbal
cognition performance (ie, ability to understand questions/instructions
and answer them verbally/nonverbally) and their behavioral reactions
(ie, attention, verbal/nonverbal communication, social reciprocity), and
analyzed the effects of speed and order of the stimuli presentation on these
factors.‍ According to the results, both participants exhibited significant
improvements in verbal cognition performance with SDS presentation
compared with RTS presentation, and they scored better with RTS
presentation when having SDS presentation before rather than after RTS
presentation.‍ Behavioral reactions were also improved in SDS conditions
compared with RTS conditions.‍ This initial evidence of a positive impact of
slowed-down audiovisual information on verbal cognition should be tested
in a large cohort of children with ASD and associated speech/language
impairments.‍

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Neurology; Data on Autism Discussed by Researchers at Queen's University (Biological motion and the animate-inanimate distinction in children with high-functioning Autism Spectrum Disorder)

According to news reporting out of Kingston, Canada, by NewsRx editors, research stated, "The current study examined whether children with high-functioning Autism Spectrum Disorder (HF-ASD) preferentially attend to point-light displays of biological, compared to mechanical motion.

2016 APR 25 (NewsRx) -- By a News Reporter-Staff News Editor at Mental Health Weekly Digest -- Research findings on Neurology are discussed in a new report. According to news reporting out of Kingston, Canada, by NewsRx editors, research stated, "The current study examined whether children with high-functioning Autism Spectrum Disorder (HF-ASD) preferentially attend to point-light displays of biological, compared to mechanical motion. We hypothesized that children's attentional patterns toward the motion of living things would be reduced compared to typically developing (TD) children."

Our news journalists obtained a quote from the research from Queen's University, "Children also completed two categorization tasks measuring the animate-inanimate distinction. Children with HF-ASD were matched with TD children (n = 18 per group) on age, gender, and verbal ability. Overall, children with HF-ASD attended to biological and non-biological motion equally, whereas TD children demonstrated a preference for inanimate motion. Children with HF-ASD were also unimpaired in the formation of animate and inanimate concepts. Among children with HF-ASD, a link between attention to motion and categorization ability was observed, but only for inanimate objects. TD and HF-ASD groups differed in that visual exploration of the motion videos (e.g., saccades) was related to animate-inanimate categorization only among children with HF-ASD."

According to the news editors, the research concluded: "These results are discussed as a low-level test of the social attention/orienting hypothesis."

For more information on this research see: Biological motion and the animate-inanimate distinction in children with high-functioning Autism Spectrum Disorder. Research in Autism Spectrum Disorders, 2016;25():1-11. Research in Autism Spectrum Disorders can be contacted at: Elsevier Sci Ltd, The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, Oxon, England. (Elsevier - www.elsevier.com; Research in Autism Spectrum Disorders - www.journals.elsevier.com/research-in-autism-spectrum-disorders/)

Our news journalists report that additional information may be obtained by contacting K. Wright, Queen's University, Dept. of Psychol, Kingston, ON K7L 3N6, Canada. Additional authors for this research include E. Kelley and D. Poulin-Dubois.

Keywords for this news article include: Canada, Autism, Ontario, Kingston, Neurology, Pediatrics, North and Central America, Developmental Disabilities

Our reports deliver fact-based news of research and discoveries from around the world. Copyright 2016, NewsRx LLC

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Neurology; New Autism Findings from University of Waterloo Described (Supporting the Spectrum Hypothesis: Self-Reported Temperament in Children and Adolescents with High Functioning Autism)

Abstract

According to news reporting originating in Waterloo, Canada, by NewsRx journalists, research stated, "This study tested the spectrum hypothesis, which posits that children and adolescents with high functioning autism (HFA) differ quantitatively but not qualitatively from typically developing peers on self-reported temperament.

2016 APR 18 (NewsRx) -- By a News Reporter-Staff News Editor at Mental Health Weekly Digest -- Investigators discuss new findings in Neurology. According to news reporting originating in Waterloo, Canada, by NewsRx journalists, research stated, "This study tested the spectrum hypothesis, which posits that children and adolescents with high functioning autism (HFA) differ quantitatively but not qualitatively from typically developing peers on self-reported temperament. Temperament refers to early-appearing, relatively stable behavioral and emotional tendencies, which relate to maladaptive behaviors across clinical populations."

The news reporters obtained a quote from the research from the University of Waterloo, "Quantitatively, participants with HFA (N = 104, aged 10-16) self-reported less surgency and more negative affect but did not differ from comparison participants (N = 94, aged 10-16) on effortful control or affiliation. Qualitatively, groups demonstrated comparable reliability of self-reported temperament and associations between temperament and parent-reported behavior problems."

According to the news reporters, the research concluded: "These findings support the spectrum hypothesis, highlighting the utility of self-report temperament measures for understanding individual differences in comorbid behavior problems among children and adolescents with HFA."

For more information on this research see: Supporting the Spectrum Hypothesis: Self-Reported Temperament in Children and Adolescents with High Functioning Autism. Journal of Autism and Developmental Disorders, 2016;46(4):1184-1195. Journal of Autism and Developmental Disorders can be contacted at: Springer, Plenum Publishers, 233 Spring St, New York, NY 10013, USA. (Springer - www.springer.com; Journal of Autism and Developmental Disorders - www.springerlink.com/content/0162-3257/)

Our news correspondents report that additional information may be obtained by contacting C.A. Burrows, University of Waterloo, Dept. of Psychol, Waterloo, ON N2L 3G1, Canada. Additional authors for this research include L.V. Usher, C.B. Schwartz, P.C. Mundy and H.A. Henderson.

Keywords for this news article include: Canada, Autism, Ontario, Waterloo, Neurology, North and Central America, Developmental Disabilities

Our reports deliver fact-based news of research and discoveries from around the world. Copyright 2016, NewsRx LLC

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Irritability and Problem Behavior in Autism Spectrum Disorder: A Practice Pathway for Pediatric Primary Care

Irritability and Problem Behavior in Autism Spectrum Disorder: A Practice Pathway for Pediatric Primary Care

abstract 

OBJECTIVE: Pediatric primary care providers (PCPs) caring for patients with autism spectrum
disorder (ASD) often encounter irritability (vocal or motoric outbursts expressive of anger,
frustration, or distress) and problem behavior (directed acts of aggression toward other
people, self, or property). The Autism Intervention Research Network on Physical Health
and Autism Speaks Autism Treatment Network charged a multidisciplinary workgroup with
developing a practice pathway to assist PCPs in the evaluation and treatment of irritability
and problem behavior (I/PB).

METHODS: The workgroup reviewed the literature on the evaluation and treatment of
contributory factors for I/PB in ASD. The workgroup then achieved consensus on the content
and sequence of each step in the pathway.

RESULTS: The practice pathway is designed to help the PCP generate individualized treatment
plans based on contributing factors identified in each patient. These factors may include
medical conditions, which the PCP is in a key position to address; functional communication
challenges that can be addressed at school or at home; psychosocial stressors that may be
ameliorated; inadvertent reinforcement of I/PB; and co-occurring psychiatric conditions
that can be treated. The pathway provides guidance on psychotropic medication use, when
indicated, within an individualized treatment plan. In addition to guidance on assessment,
referral, and initial treatment, the pathway includes monitoring of treatment response and
periodic reassessment.

CONCLUSIONS: The pediatric PCP caring for the patient with ASD is in a unique position to help
generate an individualized treatment plan that targets factors contributing to I/PB and to
implement this plan in collaboration with parents, schools, and other providers.

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Telehealth and Autism: Treating Challenging Behavior at Lower Cost

 Telehealth and Autism: Treating Challenging Behavior at Lower Cost

OBJECTIVE: To determine whether challenging behavior in young children with autism and abstract
other developmental disabilities can be treated successfully at lower cost by using telehealth
to train parents to implement applied behavior analysis (ABA).
METHODS: We compared data on the outcomes and costs for implementing evidence-based ABA
procedures to reduce problem behavior by using 3 service delivery models: in-home therapy,
clinic-based telehealth, and home-based telehealth. Participants were 107 young children
diagnosed with autism or other neurodevelopmental disorders, and data analysis focused on
the 94 children who completed treatment.
RESULTS: All 3 service delivery models demonstrated successful reduction of problem
behavior by training parents to conduct functional analysis and functional communication
training. The mean percentage reduction in problem behavior was >90% in all 3 groups
after treatment, and treatment acceptability based on parent ratings was high for all groups.
Total costs for implementing treatment were lowest for home telehealth, but both telehealth
models were significantly less costly than in-home therapy.
CONCLUSIONS: This research demonstrated that parents can use ABA procedures to successfully
treat behavior problems associated with autism spectrum disorders regardless of whether
treatment is directed by behavior consultants in person or via remote video coaching.
Because ABA telehealth can achieve similar outcomes at lower cost compared with in-home
therapy, geographic barriers to providing access to ABA for treating problem behavior can
be minimized. These findings support the potential for using telehealth to provide researchbased behavioral treatment to any family that has access to the Internet

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