Sleep patterns predictive of daytime challenging behavior in individuals with low-functioning autism

Sleep patterns predictive of daytime challenging behavior in individuals with low-functioning autism

Abstract
Increased severity of problematic daytime behavior has been associated with poorer
sleep quality in individuals with autism spectrum disorder. In this work, we
investigate whether this relationship holds in a real-time setting, such that an
individual’s prior sleep can be used to predict their subsequent daytime behavior. We
analyzed an extensive real-world dataset containing over 20,000 nightly sleep
observations matched to subsequent challenging daytime behaviors (aggression, selfinjury, tantrums, property destruction and a challenging behavior index) across 67
individuals with low-functioning autism living in two U.S. residential facilities. Using
support vector machine classifiers, a statistically significant predictive relationship
was found in 81% of individuals studied (P < 0.05). For all five behaviors examined,
prediction accuracy increased up to approximately eight nights of prior sleep used to
make the prediction, indicating that the behavioral effects of sleep may manifest on
extended timescales. Accurate prediction was most strongly driven by sleep
variability measures, highlighting the importance of regular sleep patterns. Our
findings constitute an initial step towards the development of a real-time monitoring
tool to pre-empt behavioral episodes and guide prophylactic treatment for individuals
with autism.

Lay Summary:
We analyzed over 20,000 nights of sleep from 67 individuals with autism to
investigate whether daytime behaviors can be predicted from prior sleep patterns.
Better-than-chance accuracy was obtained for 81% of individuals, with measures of
night-to-night variation in sleep timing and duration most relevant for accurate
prediction. Our results highlight the importance of regular sleep patterns for better  daytime functioning, and represent a step towards the development of ‘smart sleep technologies’ to pre-empt behavior in individuals with autism.

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Assessing Quality of Program Environments for Children and Youth with Autism: Autism Program Environment Rating Scale (APERS)

Assessing Quality of Program Environments for Children and Youth

with Autism: Autism Program Environment Rating Scale (APERS)

Abstract
The purpose of this study was to examine the psychometric properties of the Autism Program Environment Rating Scale (APERS), an instrument designed to assess quality of program environments for students with autism spectrum disorder. Data sets from two samples of public school programs that provided services to children and youth with autism spectrum disorder were utilized. Cronbach alpha analyses indicated high coefficients of internal consistency for the total APERS and moderate levels for item domains for the first data set, which was replicated with the second data set. A factor analysis of the first data set indicated that all domain scores loaded on one main factor, in alignment with the conceptual model, with this finding being replicated in the second data set. Also, the APERS was sensitive to changes resulting from a professional development program designed to promote program quality.

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Improvements in problem behavior in a child with autism spectrum diagnosis through synthesized analysis and treatment: A replication in an EIBI home program

Improvements in problem behavior in a child with autism spectrum diagnosis through synthesized analysis and treatment: A replication in an EIBI home program

A recent study described a synthesized treatment where a functional analysis was based on an open‐ended interview and combined with functional communication and delay‐tolerance training. The treatment resulted in a reduction in problem behaviors and an increase in appropriate requests. Most of the analysis and intervention were done in a clinic setting, and required weekly visits by the family. This present study is a systematic replication, where we conducted the same synthesized treatments, with a young child with Autism Spectrum Disorder (ASD) enrolled in a home‐based Early Intensive
Behavior Intervention program, EIBI. Outcomes were similar with a marked reduction in problem behaviors and an increase in appropriate requests. These findings suggest that it is possible to conduct this intervention in a home setting, with weekly consultations with parents. Our study show the utility of the synthesized treatment in an EIBI program in a home setting and how this can contribute to
client time and costs.

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Experiences of Autism Acceptance and Mental Health in Autistic Adults

Experiences of Autism Acceptance and Mental Health in Autistic Adults

Abstract 

Mental health difficulties are highly prevalent in individuals on the autism spectrum. The current study examined how experiences and perceptions of autism acceptance could impact on the mental health of autistic adults. 111 adults on the autism spectrum completed an online survey examining their experiences of autism acceptance, along with symptoms of depression, anxiety and stress. Regression analyses showed that autism acceptance from external sources and personal acceptance significantly predicted depression. Acceptance from others also significantly predicted stress but acceptance did not predict anxiety. Further
analyses suggested that experiences of “camouflaging” could relate to higher rates of depression. The current study highlights the importance of considering how autism acceptance could contribute to mental health in autism.

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Barriers to Receipt of Services for Young Adults With Autism

 Barriers to Receipt of Services for Young Adults With Autism

Abstract:

OBJECTIVES: In this study, we examine experiences of families of young adults (YAs) on the
autism spectrum to better understand dynamics leading to poor YA outcomes.
METHODS: Twenty parents of YAs with autism spectrum disorder (ASD) who had completed
high school in the past 15 years took part in a 90-minute interview. They described their
YA’s experiences at the transition from high school and current status with regards to
services or postsecondary education. Qualitative interviews were digitally recorded,
transcribed, and analyzed by using the constant comparative method associated with a
grounded theory approach.
RESULTS: Few adults with ASD were receiving autism-specific assistance no matter their level
of cognitive functioning. Existing systems, such as service agencies and college disability
support offices, had seldom been designed to meet their needs. Some families gave up on
services, some used self-directed services they had to manage themselves, and others paid
out of pocket for services they could access no other way. Inadequate services often led
to YA failure and worsening of symptoms. The majority of families bore the financial and
emotional brunt of finding or creating services and community experiences to meet their
adult child’s needs.
CONCLUSIONS: Parent narratives highlight the difficulties that are faced as families attempt
to access appropriate services for YAs on the autism spectrum at all levels of functioning.
These insights can help pediatricians understand family concerns and develop anticipatory
guidance strategies. More research is needed to identify potential solutions to challenges
faced by specific subgroups of YAs with ASD.

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The Heritability of Autism Spectrum Disorder

The Heritability of Autism Spectrum Disorder

Studies have found that autism spectrum disorder (ASD) aggregates in families, and twin studies estimate the proportion of the phenotype variance due to genetic factors (heritability) to be about 90%.1
In a previous study,2 ASD heritability was estimated to be 0.50, and shared familial environmental influences to be 0.04. To define presence or absence of ASD, the study used a data set created to take into account time-to-event effects in the data, which may have reduced the heritability estimates
(detailed explanation in Figure). Using the same underlying data as in the previous study,2
we used an alternate method (used by previous studies in the field) to define concordant and discordant sibling pairs to calculate the heritability of ASD

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An Evaluation of Explicit Ethical Statements in Telehealth Research With Individuals With Autism Spectrum Disorder

 An Evaluation of Explicit Ethical Statements in Telehealth Research
With Individuals With Autism Spectrum Disorder

Principles and procedures derived from the science of behavior analysis have been
utilized to improve the quality of life for individuals across many domains (e.g., health
and education) and within many settings (e.g., business and home). Recently, greater
attention has been paid to behavior analytic treatments for individuals with autism
spectrum disorder, where it is considered to be the most effective treatment (e.g.,
Reichow, 2012). Similar to other health professions, the supply of competent practitioners is less than the demand in many geographical locations. A potential solution to
this dilemma is the delivery of behavior analytic services via telehealth. A previous
review of telehealth services for individuals with autism spectrum disorder indicated
that research for this type of service delivery model is limited (Boisvert, Lang,
Andrianopoulos, & Boscardin, 2010). An additional limitation of the research to date
is an absence of behavior-analytic specific ethical considerations when practitioners
utilize a telehealth service delivery model. The purpose of this paper is to review
whether special risk reduction strategies related to the use of telehealth with autism
spectrum disorder have been documented or reported in the literature. Results suggest
that explicit step-by-step documentation of practices is sparse.

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