A multidisciplinary perspective on motor impairment as an early behavioural marker in children with autism spectrum disorder

Objectives: There is no medical test for autism spectrum disorder (ASD), a heterogeneous condition currently defined in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) by dysfunction in social, communication, and behavioural dimensions. There is agreement in the literature that the motor profile of ASD may hold the key to improving clinical and diagnostic definition, with DSM-5 now referring to motor deficits, including “odd gait” (p. 55), as part of the ASD clinical description. This review describes the history of motor impairment in ASD, types of motor problems, and age-related motor findings and highlights evidence gaps and future research. Method: A narrative review is provided of the research literature describing motor impairment in ASD and its ability to differentiate between ASD versus non-ASD cohorts. Results: Findings show differences in motor development in children with ASD from infancy onwards, including difficulties across motor coordination, arm movements, gait, and postural stability. Motor disturbance may appear in young children with ASD prior to social and language difficulties becoming clinically apparent. However, challenges remain in defining and measuring the early motor profile that is specific to ASD. Despite well-established motor impairments in ASD, there is a lack of evidence regarding which motor-based interventions will be effective in this group. Conclusions: Motor impairment holds promise as an early diagnostic sign, a behavioural marker, and a means by which to improve identification and possibly phenotypic delineation in ASD. Further research is required to determine whether motor abnormalities can sensitively differentiate ASD from other developmental conditions and to establish evidenced-based interventions to reduce the associated impairment.

Including play in a social skills intervention for children with autism

Group-based social skills training (SST), is a common treatment for individuals diagnosed with Autism Spectrum Disorder (ASD) - a condition characterised by social impairments. The aim of this study was to evaluate the effectiveness of an 8-week SST intervention with a play component (unstructured versus semi-structured) for children with ASD. Forty-five children aged 8 to 12 years participated in the study. Data were collected from a parent, teacher and the child at pre-test, post-test and at 3-month follow-up. Compared to a waitlist control group, children who participated in the SST intervention showed significant gains in social skills and social competence and they exhibited a reduction in social worries and emotional distress over time. Observational data during SST sessions, however, revealed that those in the unstructured play environment exhibited lower levels of social participation and engagement with peers compared to children assigned to semi-structured play.

Applied machine learning for personalised early intervention in autism

This thesis is the first to address the problems of early intervention in Autism Spectrum Disorder through the lens of machine learning and data analytics. The key contribution is the establishment of large datasets in this domain for the first time together with a systematic data-based approach to extract knowledge relevant to Autism.

Traumatic stress in parents of children with autism spectrum disorder.

A traumatic stress framework was identified as a valid way of conceptualising high levels of parenting stress in a subpopulation of parents raising a child with autism. An association between traumatic stress symptoms and child behaviours that posed a threat to child safety (e.g., elopement, aggression, self-injury) was found.

Sexual orientation and gender-identity in high functioning individuals with autism spectrum disorder.

When compared to typically-developing individuals, individuals with Autism Spectrum Disorder(ASD) demonstrated significantly higher sexual diversity, with higher rates of non-heterosexuality, and reported more gender non-conforming identities. The ASD group reported poorer mental health than typically-developing individuals and belonging to a sexual or gender-diverse group worsened this effect.

Randomised controlled trial of an iPad based early intervention for autism: TOBY playpad study protocol

BACKGROUND: Evidence for early intensive behavioural interventions (EIBI) by therapists as an effective treatment for children with an Autism Spectrum Disorder (ASD) is growing. High-intensity and sustained delivery of quality EIBI is expensive. The TOBY (Therapy Outcomes by You) Playpad is an App-based platform delivering EIBI to facilitate learning for young children with ASD, while enabling parents to become co-therapists. Intervention targets include increasing joint attention, imitation and communication of children with ASD. The primary aim of the study presented in this protocol is to determine the effectiveness of the TOBY App in reducing ASD symptoms when used as a complement to conventional EIBI. The secondary aim is to examine parental attributes as a result of TOBY App use.

METHODS AND DESIGN: Children aged less than 4;3 years diagnosed with ASD and parents will be recruited into this single-blind, randomised controlled trial using a pragmatic approach. Eligible participants will be randomised to the treatment group 'TOBY therapy + therapy as usual' or, the control group 'therapy as usual' for six months. The treatment will be provided by the TOBY App and parent where a combination of learning environments such as on-iPad child only (solo), partner (with parent) and off-iPad - Natural Environment (with parent) Tasks will be implemented. Parents in the treatment group will participate in a TOBY training workshop. Treatment fidelity will be monitored via an App-based reporting system and parent diaries. The primary outcome measure is the Autism Treatment Evaluation Checklist. The secondary outcome measures involve diagnostics, functional and developmental assessments, including parent questionnaires at baseline (T0), three months (T1) and six months (T2).

DISCUSSION: This trial will determine the effectiveness of the TOBY App as a therapeutic complement to other early interventions children with ASD receive. The trial will also determine the feasibility of a parent delivered early intervention using the iPad as an educational platform, and assess the impact of the TOBY App on parents' self-efficacy and empowerment in an effort to reduce children's ASD symptoms. The outcomes of this trial may have EIBI services implications for newly diagnosed children with ASD and parents.