Navigating and exploring the ASD-friendly landscape

As a society we have a responsibility to provide an inclusive built environment. For those with Autistic Spectrum Disorder (ASD) however, the world can be a frightening, difficult and confusing place. The challenge of integrating more fully into society can be distanced by an alienating built environment. This is particularly debilitating for younger children who can find themselves detached from learning and interaction with their peers by uncomfortable surroundings. Subsequently there has been a growing interest in promoting ASD-friendly environments, especially in a school setting. Strategies to date have generally followed a widely accepted reductionist or generalist approach. However, the authors now contend that there needs to be a greater discussion of what truly constitutes an ASD-friendly environment, in conjunction with investigating what strategies best articulate a progressive approach to supporting those, and especially the young, with ASD in our built environment. Hence this paper first introduces some of the challenges faced by those with ASD in trying to cope with their surroundings. It then outlines a triad of challenges to overcome when considering what truly constitutes an ASD-friendly environment. The authors then highlight the need and advantage of supporting change and adaption in our shared inhabited landscape through providing both choice and reassurance for the child with ASD. It is hoped that by increasing awareness and then questioning what genuinely constitutes an ASD-friendly environment, it might ultimately help facilitate greater inclusion of the ASD child into mainstream education and society at large.

Planning for the Unseen and Unheard: the child with ASD

“Children are a kind of indicator species.
If we can build a successful city for children,
we will have a successful city for all people.”

Enrique Peñalosa (former mayor of Bogotá)

Should society be judged by how they treat their weakest members, the concept of the Child Friendly City offers more than ample scope for critiquing the genuine health and inclusivity of our urban environments. If we accept childhood as a crucial human development phase that demands inclusive and welcoming places for play, exploration and growth, many cities today are becoming increasingly barren habitats, arguably full of nothing but empty childhoods. (Raven-Ellison 2015) With children today less able to roam and explore our streets than those of yesteryear, (Bird 2007) the situation is now developing where our young are becoming increasingly socially and spatially excluded from our supposedly shared Built Environment. That progressively restrictive urban realm is particularly pronounced for those with Autism Spectrum Disorder, for whom our cities can be disorientating, difficult and even frightening places.

As a profession we have a responsibility to provide inclusive built environments that do not preclude the presence of the most vulnerable in society, among them those with ASD. Accordingly this paper seeks to introduce emerging research into the current challenges facing these young urban stakeholders before discussing how planning processes and design interventions might make our cities more accessible to those with ASD.

References:

Bird, W. (2007) Natural Thinking, Sandy, Bedfordshire: RSPB.

Raven-Ellison, D. (2015) “London’s Empty Childhoods” in London Essays – Green Spaces, Issue 3 – found at: http://essays.centreforlondon.org/issues/green/londons-empty-childhoods/ accessed 9th May 2016.

Factors influencing success of clinical genome sequencing across a broad spectrum of disorders

To assess factors influencing the success of whole-genome sequencing for mainstream clinical diagnosis, we sequenced 217 individuals from 156 independent cases or families across a broad spectrum of disorders in whom previous screening had identified no pathogenic variants. We quantified the number of candidate variants identified using different strategies for variant calling, filtering, annotation and prioritization. We found that jointly calling variants across samples, filtering against both local and external databases, deploying multiple annotation tools and using familial transmission above biological plausibility contributed to accuracy. Overall, we identified disease-causing variants in 21% of cases, with the proportion increasing to 34% (23/68) for mendelian disorders and 57% (8/14) in family trios. We also discovered 32 potentially clinically actionable variants in 18 genes unrelated to the referral disorder, although only 4 were ultimately considered reportable. Our results demonstrate the value of genome sequencing for routine clinical diagnosis but also highlight many outstanding challenges.

Dissociation in performance of children with ADHD and high-functioning autism on a task of sustained attention

Attention deficit hyperactivity disorder (ADHD) and autism are two neurodevelopmental disorders associated with prominent executive dysfunction, which may be underpinned by disruption within fronto-striatal and fronto-parietal circuits. We probed executive function in these disorders using a sustained attention task with a validated brain-behaviour basis. Twenty-three children with ADHD, 21 children with high-functioning autism (HFA) and 18 control children were tested on the Sustained Attention to Response Task (SART). In a fixed sequence version of the task, children were required to withhold their response to a predictably occurring no-go target (3) in a 1-9 digit sequence; in the random version the sequence was unpredictable. The ADHD group showed clear deficits in response inhibition and sustained attention, through higher errors of commission and omission on both SART versions. The HFA group showed no sustained attention deficits, through a normal number of omission errors on both SART versions. The HFA group showed dissociation in response inhibition performance, as indexed by commission errors. On the Fixed SART, a normal number of errors was made, however when the stimuli were randomised, the HFA group made as many commission errors as the ADHD group. Greater slow-frequency variability in response time and a slowing in mean response time by the ADHD group suggested impaired arousal processes. The ADHD group showed greater fast-frequency variability in response time, indicative of impaired top-down control, relative to the HFA and control groups. These data imply involvement of fronto-parietal attentional networks and sub-cortical arousal systems in the pathology of ADHD and prefromal cortex dysfunction in children with HFA. (c) 2007 Elsevier Ltd. All rights reserved.

Decontextualised Minds: Adolescents with Autism are Less Susceptible to the Conjunction Fallacy than Typically Developing Adolescents

The conjunction fallacy has been cited as a classic example of the automatic contextualisation of problems. In two experiments we compared the performance of autistic and typically developing adolescents on a set of conjunction fallacy tasks. Participants with autism were less susceptible to the conjunction fallacy. Experiment 2 also demonstrated that the difference between the groups did not result from increased sensitivity to the conjunction rule, or from impaired processing of social materials amongst the autistic participants. Although adolescents with autism showed less bias in their reasoning they were not more logical than the control group in a normative sense. The findings are discussed in the light of accounts which emphasise differences in contextual processing between typical and autistic populations.

Parents' experiences of applied behaviour analysis (ABA)-based interventions for children diagnosed with autistic spectrum disorder

Applied behaviour analysis (ABA)-based programmes are endorsed as the gold standard for treatment of children with autistic spectrum disorder (ASD) in most of North America. This is not the case in most of Europe, where instead a non-specified 'eclectic' approach is adopted. We explored the social validity of ABA-based interventions with 15 European families who had experience with home-based, mainly self-managed, ABA-based programmes for their own child/ren with ASD. The results of the study highlighted the overwhelmingly positive impact that ABA-based interventions had on their children in areas such as social skills, challenging behaviour, communication, gross and fine motor skills, concentration, interaction, independence, overall quality of life and, most importantly, a feeling of hope for the future. Implications for European policy on ASD are discussed. © 2013 NASEN.

Task-switching deficits and repetitive behaviour in genetic neurodevelopmental disorders: Data from children with Prader-Willi syndrome chromosome 15 q11-q13 deletion and boys with Fragile X syndrome

Prader-Willi syndrome (PWS) and Fragile X syndrome (FraX) are associated with distinctive cognitive and behavioural profiles. We examined whether repetitive behaviours in the two syndromes were associated with deficits in specific executive functions. PWS, FraX, and typically developing (TD) children were assessed for executive functioning using the Test of Everyday Attention for Children and an adapted Simon spatial interference task. Relative to the TD children, children with PWS and FraX showed greater costs of attention switching on the Simon task, but after controlling for intellectual ability, these switching deficits were only significant in the PWS group. Children with PWS and FraX also showed significantly increased preference for routine and differing profiles of other specific types of repetitive behaviours. A measure of switch cost from the Simon task was positively correlated to scores on preference for routine questionnaire items and was strongly associated with scores on other items relating to a preference for predictability. It is proposed that a deficit in attention switching is a component of the endophenotypes of both PWS and FraX and is associated with specific behaviours. This proposal is discussed in the context of neurocognitive pathways between genes and behaviour.

The Right to Appropriate and meaningful Education for Children with ASD

This paper will explore from a ‘child’s rights perspective’ the ‘right’ of children with autistic spectrum disorder (ASD) to appropriate and meaningful education.Human ‘rights’ principles within international law will be evaluated in relation to how they have been interpreted and applied in relation to achieving this ‘right’. The International Convention of the Rights of the Child (United Nations in Convention on the rights of the child, office of the high commissioner, United Nations, Geneva, 1989) and the convention on the rights of the person with disability (United Nations in Convention on the rights of person’s with disabilities and optional protocol, office of the high commissioner, United Nations, Geneva, 2006) amongst others will be utilised to argue the case for ‘inclusive’educational opportunities to be a ‘right’ of every child on the autistic spectrum. The efficacy of mainstream inclusion is explored, identifying the position that a ‘one size fits all’model of education is not appropriate for all children with ASD.