Response of the child with autism to preferred prosody during instruction

It has been found that incorporating preferences leads to improvements in target skills for children with autism. No studies have been found, however, that assess the preferences of children for prosody of teacher instruction. Prosody has been defined by fluency of speech, modification of pitch and stress of syllables. This research assessed the preference for, and effectiveness of, prosody of instruction by teachers of children with autism. The preferences of children with autism for monotone, conversational and enthusiastic voice prosodies were assessed. The children's teachers made recording of their own voice reading a story passage in the three selected prosodies. The children with autism were requested to listen to these recordings and select a preferred prosody over thirty three trials. Chi square analyses were conducted to determine the significant preferences from these trials. The selections of prosody of the children with autism were compared with the selections of typical children of the same age. Significant preferences were found for three children with autism and seven typical children. The three children with autism with significant preferences were observed in their classrooms. Teachers were cued with flashcards to use the different prosodies and the children's responses were recorded. An additional twenty instructions were recorded in which the teachers were not given a cue for voice prosody Chi square and Fisher's exact tests indicated that children's preferences did not influence their responses to prosody during classroom instruction. In other words the response in class was not related to prosody preference. Overall children were more likely to not respond to the monotone prosody. The enthusiastic and conversational prosodies were equally effective. Therefore it was concluded that continued and varied use of enthusiastic and conversational prosodies during classroom instruction would be effective for children with autism. It was recommended that future research focus on evaluating the effectiveness of variety of prosody for children with autism.

Discriminant validity of the sensory profile in Australian children with autism spectrum disorder

Objective. The discriminant validity of the Sensory Profile was evaluated by comparing the sensory processing scores of Australian children, 5 to 8 years of age, diagnosed with autism spectrum disorder (ASD) to a control group of children with typical development matched for age and gender. Method. Twenty-six parents of children with ASD and 26 parents of typically developing children without ASD completed the Sensory Profile. Sensory Profile category, factor, and quadrant scores were compared using multivariate analysis to investigate if there were differences between the two groups. Results. The results indicated that the children with ASD had significantly lower sensory processing scores on all fourteen categories, eight out of nine factors, and all four quadrants of the Sensory Profile. Conclusion. The results also provide evidence of discriminant validity of Sensory Profile scores between children with ASD and children with typical development. In addition, the study findings indicate that the Sensory Profile can be used with confidence in cross-cultural contexts, such as Australia.

Online motor control in children with developmental coordination disorder: chronometric analysis of double-step reaching performance

Background
Although there are a number of plausible accounts to explain movement clumsiness in children [or developmental coordination disorder (DCD)], the cause(s) of the disorder remain(s) an issue of debate. One aspect of motor control that is particularly important to the fluid expression of skill is rapid online control (ROC). Data on DCD have been conflicting. While some recent work using double-step reaching suggests no difficulty in online control, others suggest deficits (e.g. based on sequential pointing). To help resolve this debate, we suggest two things: use of recent neuro-computational models as a framework for investigating motor control in DCD, and more rigorous investigation of double-step reaching. Our working assumption here is that ROC is only viable through the seamless integration of predictive (or forward) models of movement and feedback-based mechanisms.

Aim
The aim of this chronometric study was to explore ROC in children with DCD using a double-step reaching paradigm. We predicted slower online adjustments in DCD based on the argument that these children manifest a core difficulty in predictive control.

Methods
Participants were a group of 17 children with DCD and 27 typically developing children aged between 7 and 12 years. Visual targets were presented on a 17-inch LCD touch screen, inclined to an angle of 15° from horizontal. The children were instructed to press each target as it appeared as quickly and accurately as possible. For 80% of the trials, the central target location remained unchanged for the duration of the movement (non-jump trials), while for the remaining 20% of trials, the target jumped at movement onset to one of the two peripheral locations (jump trials). Reaction time (RT), movement time (MT) and reaching errors were recorded.

Results
For both groups, RT did not vary according to trial condition, while children with DCD were slower to initiate movement. Further, the MT of children with DCD was prolonged to a far greater extent on jump trials relative to controls, with a large effect size. As well, children with DCD committed significantly more errors, notably a reduced ability to inhibit central responses on jump trials.

Conclusion
Our findings help reconcile some disparate findings in the literature using similar tasks. The pattern of performance in children with DCD suggests impairment in the ability to make rapid online adjustments that are based on a predictive (or internal) model of the action. These results pave the way for future kinematic investigation.

Time trends in socio-economic inequalities for women and men with disabilities in Australia: evidence of persisting inequalities

Introduction The socio-economic circumstances and health of people with disabilities has been relatively ignored in public health research, policy and practice in Australia and internationally. This is despite emerging evidence that the socio-economic circumstances that people with disabilities live in contributes to their poorer health. Compared to other developed countries, Australians with disabilities are more likely to live in disadvantaged circumstances, despite being an economically prosperous country; it is therefore likely that the socio-economic disadvantage experienced by Australians with disabilities makes a significant contribution to their health. Despite the importance of this issue Australia does not routinely monitor the socio-economic inequalities for people with disabilities. This paper addresses this gap by describing time trends in socio-economic conditions for Australians with and without disabilities according to the severity of the disability and sex. Methods Cross-sectional analyses of the Australian Bureau of Statistics Survey of Disability, Ageing and Carers were carried out at three time points (1998, 2003 and 2009) to estimate the proportions of women and men (aged between 25 and 64 years) who were living on low incomes, had not completed year 12, were not in paid work, living in private rental and experiencing multiple disadvantage (three or more of the indicators). Results People with disabilities are less likely to have completed year 12, be in paid work and are more likely to be living on low incomes and experiencing multiple disadvantage. These conditions worsened with increasing severity of disability and increased or persisted over time, with most of the increase between 1998 and 2003. While women with milder disabilities tended to fare worse than men, the proportions were similar for those with moderate and severe/profound disabilities. Conclusion People with disabilities experience high levels of socio-economic disadvantage which has increased or persisted over time and these are likely to translate into poorer health outcomes. A large proportion experience multiple forms of disadvantage, reinforcing the need to tackle disadvantage in a coordinated way across sectors. People with disabilities should be a priority population group for public health. Monitoring socio-economic conditions of people with disabilities is critical for informing policy and assessing the impact of disability reforms.

Retirement or just a change of pace: an Australian national survey of disability day services used by older people with disabilities

The increasing number of people with disabilities surviving to old age raises questions regarding the type of day support programs necessary to meet their needs. In this paper the results of a national survey of specialist disability day programs used by older2 people with a lifelong disability are discussed. A postal survey of 596 day programs for people with disabilities was conducted, with a response rate of 28%. Findings show that only 19% of service users were aged over 55, and the largest subgroup were people with intellectual disability. Many older people attended programs that were not age specific and a typology of the seven program types utilised was constructed. Individualised planning, flexibility and choice were perceived as fundamental to a successful program. The location of activities in the community, maintenance of social relationships, and opportunities to develop new contacts were also seen as important. Little understanding, however, of the diversity of the ageing process or notions of healthy ageing was demonstrated by service providers, many of whom had limited expectations of older people. Challenges identified in providing day support for older people were lack of financial resources, knowledge and expertise amongst staff, and difficulties interfacing with other service systems.

Differences in parent-provider concordance regarding prognosis and goals of care among children with advanced cancer

Purpose Concordance between parents of children with advanced cancer and health care providers has not been described. We aimed to describe parent-provider concordance regarding prognosis and goals of care, including differences by cancer type.

The subjectivities of ‘included’ students with disabilities in schools

The contextual precept of this paper is to re-theorise inclusive education beyond technical rational solutions to the ‘problem’ of disability. Drawing on Foucauldian and critical disability theories, I make the case for the analysis of inclusive schooling through the lens of students’ ‘included’ subjectivities – notwithstanding the presence of diagnosed special educational needs. I contend that there is a theoretical mismatch between humanist inclusive schooling and the posthumanist position of disability: an epistemic fissure that impedes inclusive development. Through analysis of the voices of students with disabilities from two different schooling contexts in Australia and Spain, I demonstrate how fragmented virtues of normalcy suffused their subjectivities. I conclude the paper with a discussion of the roles that DisHuman disability studies might play in recasting inclusive schooling by troubling normative discourse.

Minimising impairment: protocol for a multicentre randomised controlled trial of upper limb orthoses for children with cerebral palsy

BACKGROUND: Upper limb orthoses are frequently prescribed for children with cerebral palsy (CP) who have muscle overactivity predominantly due to spasticity, with little evidence of long-term effectiveness. Clinical consensus is that orthoses help to preserve range of movement: nevertheless, they can be complex to construct, expensive, uncomfortable and require commitment from parents and children to wear. This protocol paper describes a randomised controlled trial to evaluate whether long-term use of rigid wrist/hand orthoses (WHO) in children with CP, combined with usual multidisciplinary care, can prevent or reduce musculoskeletal impairments, including muscle stiffness/tone and loss of movement range, compared to usual multidisciplinary care alone.

METHODS/DESIGN: This pragmatic, multicentre, assessor-blinded randomised controlled trial with economic analysis will recruit 194 children with CP, aged 5-15 years, who present with flexor muscle stiffness of the wrist and/or fingers/thumb (Modified Ashworth Scale score ≥1). Children, recruited from treatment centres in Victoria, New South Wales and Western Australia, will be randomised to groups (1:1 allocation) using concealed procedures. All children will receive care typically provided by their treating organisation. The treatment group will receive a custom-made serially adjustable rigid WHO, prescribed for 6 h nightly (or daily) to wear for 3 years. An application developed for mobile devices will monitor WHO wearing time and adverse events. The control group will not receive a WHO, and will cease wearing one if previously prescribed. Outcomes will be measured 6 monthly over a period of 3 years. The primary outcome is passive range of wrist extension, measured with fingers extended using a goniometer at 3 years. Secondary outcomes include muscle stiffness, spasticity, pain, grip strength and hand deformity. Activity, participation, quality of life, cost and cost-effectiveness will also be assessed.

DISCUSSION: This study will provide evidence to inform clinicians, services, funding agencies and parents/carers of children with CP whether the provision of a rigid WHO to reduce upper limb impairment, in combination with usual multidisciplinary care, is worth the effort and costs.

Self-reported fatigue in children with advanced cancer: results of the PediQUEST study (TH309-A)

Background. Pediatric cancer-related fatigue, particularly self-reported, is poorly understood. Research Objectives. To describe fatigue and identify factors associated with it in the largest cohort of children with advanced cancer self-reporting symptoms to date.

The relationship between divorce and children with AD/HD of different subtypes and comorbidity: results from a clinically referred sample

This study investigated the relationship between divorce and thesymptom profile of children with attention deficit/hyperactivity disorder(AD/HD). The files of 1,201 children from a pediatric practicein Sydney, Australia were used in this study. Children wereaged 6 to 18 years, and were diagnosed with either the inattentiveor combined type of AD/HD. Results show that 213 children hadparents who were divorced. Children with the combined type, andespecially boys with comorbid conduct disorder/oppositional defiantdisorder (CD/ODD) were more common in the divorced group,and children of the inattentive type with comorbid learning disabilitieswere overrepresented in nondivorced families. Results suggestthat divorce is associated with disruptive behavior patterns inchildren with AD/HD. The importance of including marital status asan important correlate in AD/HD treatment outcomes is discussed.

Anxiety is more common in children with asthma

Objective There are a variety of reasons why there may be an association between asthma and anxiety in children. Research into the relation between asthma and anxiety has been limited by the sole use of parent-reported or self-reported asthma symptoms to define asthma status. The objective of this study was to determine if children with physician-defined asthma are more likely to suffer anxiety than children without asthma.

Design A population-based, cross-sectional assessment, of self-reported anxiety symptoms.

Setting and participants Children aged 5–13 years from Barwon region of Victoria, Australia. Asthma status was determined by review with a paediatrician. Controls were a sample of children without asthma symptoms (matched for age, gender and school).

Outcome measure The Spence Children's Anxiety Scale (SCAS) written questionnaire. The authors compared the mean SCAS score, and the proportion of children with an SCAS score in the clinical range, between the groups.

Results Questionnaires were issued to 205 children with asthma (158 returned, response rate 77%), and 410 controls (319 returned, response rate 78%). The SCAS scores were higher in asthmatics than controls (p<0.001); and were more likely to be in the clinical range (OR=2.5, 95% CI 1.1 to 5.8, p=0.036). There was no evidence that these associations could be explained by known confounding factors.

Conclusions Children with asthma are substantially more likely to suffer anxiety than children without asthma. Future studies are required to determine the sequence of events that leads to this comorbidity, and to test strategies to prevent and treat anxiety among children with asthma.

Faecal microbiota of individuals with autism spectrum disorder

Many children with autistic spectrum disorders (ASDs) suffer from gastrointestinal problems such as diarrhoea, constipation and abdominal pain. Such symptoms may be due to a disruption of the indigenous gut microbiota promoting the overgrowth of potentially pathogenic micro-organisms. These observations have stimulated investigations into possible abnormalities of intestinal microbiota in autistic patients. The purpose of the present study was to determine if a relationship exists between ASD severity (mild – severe) and GI microbial populations. The faecal microbiota of 22 male and 6 female participants with ASDs (aged 7 ± 6 years) were analyzed by standard microbial culture methods and compared within-group (based on ASD severity) and with a standard laboratory reference range. Comparisons between children with mild ASD and those with moderate to severe ASD, as well as comparisons to a neurotypical control group previously reported, revealed that no significant differences appear to exist in the composition of the gut microbiota. Nevertheless, examination of each individual’s gut microbial composition showed 10 cases of unusual findings witch means 1out of 3 cases have unusual microbiota. Our data do not support consistent GI microbial abnormalities in ASD children, but the findings do suggest that aberrations may be found in a minority subset of ASD children. Further studies are required to determine the possible association between the microbiota and gastrointestinal dysfunctions in a subset of children with both ASD and gastro-intestinal problems.

Diet and sleep in children with attention deficit hyperactivity disorder : Preliminary data in Australian children

Sleep disturbances are common and consequential in children with attention deficit hyperactivity disorder (ADHD). Diet also influences ADHD symptoms. Interrelationships between diet, sleep and behaviour in children diagnosed with ADHD are little studied. We investigated, via parental report, the relationships between sleep and diet in 88 Australian children aged 6—13 years old (M = 8.94, SD = 1.78). This pilot data shows that 30 per cent of the children had sleep disturbance (≥ 2 standard deviations above the mean) with significant relationships between ADHD symptoms, sleep disturbance and diet. Parents who reported more sleep disturbance also reported a higher intake of carbohydrate, fats, and, most particularly, sugar which was also a significant predictor of night time sweating. These findings suggest an interrelationship between diet and sleep in children with ADHD. Given that both sleep and dietary intake are potentially modifiable behaviours within treatment regimes of children with ADHD, further investigation is needed.

Brief report: children with ADHA without co-morbid autism do not have impaired motor proficiency on the Movement Assessment Battery for Children

Motor proficiency was investigated in a sample of children with Attention Deficit Hyperactivity Disorder-Combined type (ADHD-CT) without autism. Accounting for the influence of co-morbid autistic symptoms in ADHD motor studies is vital given that motor impairment has been linked to social–communication symptoms in children who have co-morbid ADHD and autistic-like symptoms. Two groups of children aged between 7–14 years were recruited; children with ADHD-CT (n = 16; mean age 10 years, 7 months [SD = 1 year, 10 months]) and a typically developing (n = 16; mean age 10 years, 6 months [SD = 2 years, 6 months]) group. Motor proficiency was measured using the Movement Assessment Battery for Children-2nd Edition, ADHD symptoms were measured using the Conner’s Parent Rating Scale. Children with ADHD-CT who had been screened for co-morbid autism did not display motor difficulties on the MABC-2. Higher levels of inattention, but not hyperactivity or impulsivity were associated with poorer motor performance. These findings provide indirect evidence that the motor problems that children with ADHD experience may be related to co-occurring social responsiveness impairments.

Do children with autism and Asperger's disorder have difficulty controlling handwriting size? A kinematic evaluation

Children with autism spectrum disorders (ASD) often show difficulties in controlling letter size and consistent letter formation during handwriting; however, there has been little research into the underlying nature of handwriting impairments in this group. The aim of this study was to assess the ability of children with ASD to regulate the size and consistency of fundamental handwriting movements when using writing guides, and determine whether the kinematic profile during writing is different to typically developing children. Twenty-six boys with ASD (16 with high-functioning autism, 10 with Asperger's disorder) aged 8-13 years (IQ > 75), and 17 typically developing children wrote a series of four cursive letter l's using 10 mm and 40 mm writing guides, using a graphics tablet and stylus. Movement size and consistency was comparable between groups when the writing guides were set at 10 mm; however, handwriting movements of children with ASD were significantly faster and more fluent than typically developing children when writing guides were set at 40 mm. Neuromotor noise was comparable to that of typically developing children across both writing sizes. Clinically, our findings indicate that children with ASD have a well-automated motor plan for simple handwriting movements when writing guides are present and that problems of handwriting legibility in ASD are likely to arise from other factors, such as complex motor chaining (i.e. writing whole words and sentences), or attentional, working memory and linguistic demands when writing.