The Evidence Debate for Behavioural Interventions for Autism

For more than fifty years evidence has been accrued regarding the efficacy of applied behaviour analysis-based interventions for individuals with autism spectrum disorders. Despite this history of empirical evidence, some researchers and ASD experts still are reluctant to accept behavioral interventions as best practice for ASD. In this paper, we consider both random control trials and single subject experimental designs as forms of evidenced-based practice (EBP). Specific application of these methods to ASD research is considered. In an effort to provide scientifically based evidence for interventions for ASD, EBP standards have been debated without a consensus being achieved. Service users of ASD interventions need access to sound empirical evidence to choose appropriate programmes for those they care for with ASD rather than putting their hopes in therapies backed by pseudoscience and celebrity endorsements.

Attention during social interaction in children with autism: Comparison to specific language impairment, typical development, and links to cognition

Eye-tracking studies have shown how people with autism spend significantly less time looking at socially relevant information on-screen compared to those developing typically. This has been suggested to impact on the development of socio-cognitive skills in autism. We present novel evidence of how attention atypicalities in children with autism extend to real-life interaction, in comparison to typically developing (TD) children and children with specific language impairment (SLI). We explored the allocation of attention during social interaction with an interlocutor, and how aspects of attention (awareness checking) related to traditional measures of social cognition (false belief attribution). We found divergent attention allocation patterns across the groups in relation to social cognition ability. Even though children with autism and SLI performed similarly on the socio- cognitive tasks, there were syndrome-specific atypicalities of their attention patterns. Children with SLI were most similar to TD children in terms of prioritising attention to socially pertinent information (eyes, face, awareness checking). Children with autism showed reduced attention to the eyes and face, and slower awareness checking. This study provides unique and timely insight into real-world social gaze (a)typicality in autism, SLI and typical development, its relationship to socio-cognitive ability, and raises important issues for intervention.

Multidisciplinary Teamwork in Autism: Can One Size Fit All?

Multidisciplinary practice has become an accepted approach in many education and social and health care fields. In fact, the right to a multidisciplinary assessment is enshrined in the United Nations Convention of the Rights for Persons with Disabilities (United Nations, 2007). In order to avert a 'one size fits all' response to particularly heterogeneous diagnoses, such as autism spectrum disorders (ASD), the National Institute for Clinical Excellence (NICE) recommends multidisciplinary input. Yet, multidisciplinarity lacks empirical evidence of effectiveness, is fraught with conceptual difficulties and methodological incompatibilities, and therefore there is a danger of resorting to an ill-defined eclectic 'hodgepodge' of interventions. Virtually all evidence-based interventions in autism and intellectual disabilities are behaviourally based. Not surprisingly, therefore, professionals trained in behaviour analysis to international standards are increasingly becoming key personnel in multidisciplinary teams. In fact, professionals from a range of disciplines seek training in behaviour analysis. In this article we brought together a multidisciplinary group of professionals from education, health, and social care, most of whom have a dual qualification in an allied health, social care, or educational profession, as well as in behaviour anlaysis. Together we look at the initial training in these professions and explore how behaviour analysis can offer a common and coherent conceptual framework for true multidisciplinarity, based on sound scientific knowledge about behaviour, without resort to reifying theories. We illustrate how this unifying approach can enhance evidence-based multidisciplinary practice so that 'one size' will fit all. Copyright © Australian Psychological Society Ltd 2014.

Autism in the air: using Point of View Video Priming and Natural Environment Teaching to help children with autism travel by plane

This paper describes a study that used video materials and visits to an airport to prepare children on the autism spectrum for travel by plane. Twenty parents and carers took part in the study with children aged from 3 to 16 years. The authors explain that the methods they used were based on Applied Behaviour Analysis (ABA) research; a video modeling technique called Point-Of-View Video-priming and during visits to an airport they used procedures known as Natural Environment Teaching. The findings suggest that using video and preparing children by taking them through what is likely to happen in the real environment when they travel by plane is effective and the authors suggest these strategies could be used to support children with autism with other experiences they need or would like to engage in such as visits to the dentist or hairdressers and access to leisure centres and other public spaces.

School's out forever: Postsecondary educational trajectories of students with autism

Objective:Postsecondary educational attainment is the key for successful transition to adulthood, economic self-sufficiency, and good mental and physical health.Method:Secondary analyses of school leavers’ data were carried out to establish postsecondary educational trajectories of students on the autism spectrum in the United Kingdom.Results:Findings show that students with autism who had attended mainstream secondary schools enter Further Education (post-16 vocational training) and Higher Education (University) institutions at a similar rate to other students to study the full range ofsubjects on offer. However, they are more likely to be younger, study at a lower academic level, and remain living at home.Conclusion:While course completion data were not yet available, attainment data showed that prospects were improving, although more needs to be done to enable these young adults to a achieving their post secondary educational potential.

Fast response to human voices in autism

Individuals with autism spectrum disorders (ASD) are reported to allocate less spontaneous attention to voices. Here, we investigated how vocal sounds are processed in ASD adults, when those sounds are attended. Participants were asked to react as fast as possible to target stimuli (either voices or strings) while ignoring distracting stimuli. Response times (RTs) were measured. Results showed that, similar to neurotypical (NT) adults, ASD adults were faster to recognize voices compared to strings. Surprisingly, ASD adults had even shorter RTs for voices than the NT adults, suggesting a faster voice recognition process. To investigate the acoustic underpinnings of this effect, we created auditory chimeras that retained only the temporal or the spectral features of voices. For the NT group, no RT advantage was found for the chimeras compared to strings: both sets of features had to be present to observe an RT advantage. However, for the ASD group, shorter RTs were observed for both chimeras. These observations indicate that the previously observed attentional deficit to voices in ASD individuals could be due to a failure to combine acoustic features, even though such features may be well represented at a sensory level.

Families with Children with Autism, Developmental Delay, and Typical Development: The Relationships of Parenting Self-Efficacy, Parenting Strategies, and Child Problem Behaviour

Parents of children with autism spectrum disorders (ASD) and developmental delays (DD) may experience more child problem behaviours, report lower parenting selfefficacy (PSE), and be more reactive than proactive in their parenting strategies than those who have children with typical development (TD). Differences in PSE and parenting strategies may also influence the extent to which child problem behaviours are experienced by parents who have children with ASD and DD, compared to those who have children with TD. Using a convenience sample of parents of children with ASD (n = 48), DD (n = 51), and TD (n = 72), this study examined group differences on three key variables: PSE, parenting strategies, and child problem behaviour. Results indicated that those in the DD group scored lower on PSE in preventing child problem behaviour than the ASD group. The TD group used fewer reactive strategies than the DD group, and fewer proactive strategies than both the ASD and DD groups. For the overall sample, higher reactive strategies use was found to predict higher ratings of child problem behaviour, while a greater proportion of proactive to reactive strategies use predicted lower ratings of child problem behaviour. PSE was found to moderate DD diagnosis and child problem behaviour. Implications for a behavioural (i.e., parenting strategies) or cognitive (i.e., PSE) approach to parenting are discussed.

Temple Grandin fonds, 1974-2006 (non-inclusive)

Temple Grandin was born in Boston, Massachusetts on August 29,1947 to Richard Grandin and Eustacia Cutler. She was diagnosed with autism at age 2. She suffered from delayed speech development and did not begin to speak until the age of 4. Temple’s mother defied the doctors and kept her out of institutions. Temple was given speech therapy as well as an intensive education. Her high school science teacher and her aunt on a ranch in Arizona inspired Temple to continue her studies and pursue a career as a scientist and livestock equipment designer.She graduated from Hampshire Country School (a boarding school for gifted children) in Ridge, New Hampshire in 1966, and earned a bachelor’s degree in psychology from Franklin Pierce College in 1970. In 1975, she received a master’s degree in animal science from Arizona State University and then a doctoral degree in animal science from the University of Illinois in 1989. She is currently a professor at Colorado State University. Dr. Grandin is one of the world’s leaders in the design of livestock handling facilities. She has done extensive work in design of handling facilities for animals and has developed animal welfare guidelines for the meat industries. Dr. Grandin is a past member of the board of directors of the Autism Society of America. She lectures to parents and teachers throughout the U.S. on her experiences with autism. She makes the case that the world needs people on the autism spectrum: visual thinkers, pattern thinkers and verbal thinkers. Some of Temple Grandin’s books include: Animals Make Us Human, Animals in Translation, The Way I See It, The Autistic Brain, and Different…Not Less. In 2010, a movie entitled “Temple Grandin” starring Clare Danes was released. The movie was based on Grandin’s own writings. Temple Grandin is an expert on animal behavior, a bestselling author, and an autism activist. In 2010, she was listed in the “Heroes” category in the “Time” list of the world’s 100 most influential people. She has received numerous awards including an honorary doctorate from McGill, the University of Illinois and Duke University. Temple Granin is a philosophical leader of both the animal welfare and autism advocacy movements. sources: http://www.templegrandin.com/ http://en.wikipedia.org/wiki/Temple_Grandin

Etude des déterminants génétiques des psychoses à début précoce. Génétique de la schizophrénie et hypothèse glutamatergique

Les troubles schizophréniques (SCZ) ont une forte héritabilité, de l’ordre de 80%, mais, une très faible part du risque génétique a été identifiée. La plupart des études ont considéré l’implication de polymorphismes fréquents, chacun ayant un effet relativement faible individuellement, alors que les études de variants du nombre de copies (CNVs) ainsi que les études d’anomalies chromosomiques ont pointé l’implication possible de variants rares et de novo à une forte pénétrance. Dans une première partie, nous présentons une synthèse sur les facteurs génétiques dans la SCZ, puis une revue des arguments en faveur de l’implication d’anomalies du système glutamatergique dans la SCZ, domaine sur lequel s’est centré notre travail. Notre travail s’inscrit dans un projet plus vaste, Synapse to Disease (S2D) ayant pour objectif de séquencer 1000 gènes synaptiques dans des cohortes de patients atteints de schizophrénie ou de troubles du spectre autistique. Nous avons exploré en particulier le système glutamatergique et les récepteurs NMDA. Dans un premier article, nous montrons une association d’une mutation troncante de novo de la kinésine 17, impliquée dans le transport de la sous-unité GRIN2B des récepteurs NMDA. Dans un second article, nous explorons les mutations rares et de novo dans les sous-unités des récepteurs NMDA et montrons l’association de mutation de novo dans GRIN2A et GRIN2B avec des cas de SCZ et d’autisme. Nos résultats renforcent l’idée qu’une part des cas de schizophrénie pourrait être due à l’implication de mutations rare à effet majeur, hypothèse alternative mais non exclusive à l’hypothèse d’interactions entre variants génétiques fréquents à effet mineur.

Les neurosciences cognitives du langage, de l'autisme et des styles cognitifs

VERSION ANGLAISE DISPONIBLE AU DÉPARTEMENT; THÈSE RÉALISÉE CONJOINTEMENT AVEC L'ÉCOLE DES SCIENCES DE LA COMMUNICATION DE L'UNIVERSITÉ MCGILL (DRS. K. STEINHAUER ET J.E. DRURY).

Variabilité individuelle de l'allocation fonctionnelle des régions cérébrales perceptives dans l'autisme

Introduction : Une augmentation de la plasticité cérébrale est susceptible d’être impliquée dans la réallocation des régions corticales et dans les nombreuses altérations microstructurelles observées en autisme. Considérant les nombreux résultats démontrant un surfonctionnement perceptif et un fonctionnement moteur atypique en autisme, l’augmentation de la plasticité cérébrale suggère une plus grande variabilité individuelle de l’allocation fonctionnelle chez cette population, plus spécifiquement dans les régions perceptives et motrices. Méthode : Afin de tester cette hypothèse, 23 participants autistes de haut-niveau et 22 non-autistes appariés pour l’âge, le quotient intellectuel, les résultats au test des Matrices de Raven et la latéralité, ont réalisé une tâche d’imitation visuo-motrice dans un appareil d’imagerie par résonnance magnétique fonctionnelle (IRMf). Pour chaque participant, les coordonnées du pic d’activation le plus élevé ont été extraites des aires motrices primaires (Aire de Brodmann 4 (BA4)) et supplémentaires (BA6), du cortex visuo-moteur pariétal supérieur (BA7) ainsi que des aires visuelles primaires (BA17) et associatives (BA18+19) des deux hémisphères. L’étendue des activations, mesurée en fonction du nombre de voxels activés, et la différence d’intensité des activations, calculée en fonction du changement moyen d’intensité du signal ont également été considérées. Pour chaque région d’intérêt et hémisphère, la distance entre la localisation de l’activation maximale de chaque participant par rapport à celle de la moyenne de son groupe a servi de variable d’intérêt. Les moyennes de ces distances individuelles obtenues pour chaque groupe et chacune des régions d’intérêt ont ensuite été soumises à une ANOVA à mesures répétées afin de déterminer s’il existait des différences de variabilité dans la localisation des activations entre les groupes. Enfin, l’activation fonctionnelle générale à l’intérieur de chaque groupe et entre les groupes a également été étudiée. Résultats : Les résultats démontrent qu’une augmentation de la variabilité individuelle en terme de localisation des activations s’est produite à l’intérieur des deux groupes dans les aires associatives motrices et visuelles comparativement aux aires primaires associées. Néanmoins, malgré le fait que cette augmentation de variabilité dans les aires associatives soit partagée, une comparaison directe de celle-ci entre les groupes a démontré que les autistes présentaient une plus grande variabilité de la localisation des activations fonctionnelles dans le cortex visuo-moteur pariétal supérieur (BA7) et les aires associatives visuelles (BA18+19) de l’hémisphère gauche. Conclusion : Des stratégies différentes et possiblement uniques pour chaque individu semblent être observées en autisme. L’augmentation de la variabilité individuelle de la localisation des activations fonctionnelles retrouvée chez les autistes dans les aires associatives, où l’on observe également davantage de variabilité chez les non-autistes, suggère qu’une augmentation et/ou une altération des mécanismes de plasticité est impliquée dans l’autisme.

Corticosteroides vs dosis bajas de adrenocorticotropina en el tratamiento de espasmos infantiles. Revisión sistemática de la literatura

Antecedentes: El tratamiento de los espasmos infantiles generalmente se realiza con ACTH a pesar de perfil de efectos secundarios y el alto costo financiero. Se ha propuesto el uso de los corticoides como primera línea de tratamiento para la enfermedad, no obstante no existe certeza sobre la eficacia de este esquema. Objetivos: Evaluar la eficacia del uso de los corticoides comparados con la ACTH como primera línea de tratamiento en el manejo de pacientes con espasmos infantiles. Metodología: Se realizó una revisión sistemática de la literatura. La búsqueda se efectuó en las bases de datos Pubmed, Embase, Ovid, LiLaCs y en el registro de ensayos clínicos de Estados Unidos. Se incluyeron estudios en portugués, ingles y español, no se fijo límite de tiempo para la publicación. Se realizó un análisis de riesgo de sesgo y de calidad de la evidencia utilizando el programa GRADEPRO. Se estimaron OR y sus respectivos intervalos de confianza al 95%. Resultados: Se incluyeron 4 estudios, un ensayo clínico y tres estudios de cohorte retrospectiva. Dos estudios aportaron evidencia de calidad moderada y alta. No se encontraron diferencias en la eficacia a corto plazo entre el uso de los corticoides y la ACTH sobre desenlaces clínicos o electroencefalográficos. No se encontraron estudios de seguridad a largo plazo. La seguridad a corto plazo no mostró diferencias. Conclusiones: Es muy probable que el uso de los corticoides como primera línea de tratamiento puedan reemplazar el uso de la ACTH, se requiere estudios de seguridad a largo plazo. La decisión de su uso rutinario debería estar basada en un análisis de costo efectividad y bajo la mirada del balance riesgo/beneficio.

Terapia asistida con perros en niños con autismo revisión sistemática

Introducción: El autismo es un trastorno temprano y masivo del desarrollo en el cual se afecta la interacción social, el desarrollo del lenguaje, se presentan rituales y estereotipias. Hay evidencia que la interacción con un perro está asociada con efectos positivos en la salud del niño, lo cual se extiende al terreno terapéutico donde la compañía del perro estimula habilidades comunicativas para conectarse con el mundo exterior y romper el aislamiento que lo hace refractario a formas convencionales de tratamiento. El objetivo del estudio fue realizar una Revisión Sistemática sobre efectos de la terapia con perros en niños autistas entre dos y doce años. Metodología: Revisión sistemática de la literatura de artículos obtenidos de bases de datos, revisiones sistemáticas y Meta-buscadores que proporcionaron evidencia de la terapia con perros en niños autistas. Se describió características y resultados de estudios obtenidos. Resultados: Dos artículos cumplieron criterios de inclusión. Cuatro niños fueron evaluados en dichos estudios. La presencia del perro disminuyó la agresividad, las conductas ritualizadas y obsesivas. Potencializó los comportamientos positivos como contacto visual y comunicación social. Discusión: la terapia asistida con perros proporciona un gran potencial en la intervención del trastorno autista. Relevante tener en cuenta algunos factores como: efectos a largo plazo, el perro a utilizar y la heterogeneidad del espectro autista que pueden condicionar líneas de investigación futura. Conclusiones: Es importante la realización de estudios de mayor rigor metodológico que permitan fortalecer la evidencia sobre los resultados de la terapia con perros en niños con autismo.

Social perception gaze patterns, symptom severity and resting brain function measured using Arterial Spin Labelling

Autistic spectrum disorder (ASD) is characterised by qualitative alterations in reciprocal social interactions. Some recent studies show alterations in gaze patterns during social perception and rest-functional abnormalities in the ‘social brain network’. This study investigated: i) social perception gaze patterns in children with ASD and controls, ii) the relationship between autism clinical severity and social perception gaze patterns, iii) the relationship between resting cerebral blood flow (rCBF) and social perception gaze patterns. Methods: Nine children with ASD and 9 children with typical development were studied. Eye-tracking was used to detect gaze patterns during presentation of stimuli depicting social scenes. Autism clinical severity was established using the Autism Diagnostic Interview Revised (ADI-R). Arterial spin labelling MRI was used to quantify rCBF. Results: The ASD group looked less at social regions and more at non-social regions than controls. No significant correlation was found between ASD clinical severity and social perception gaze patterns. In the ASD group, gaze behaviour was related to rCBF in the temporal lobe regions at trend level. Positive correlations were found between temporal rCBF and gaze to the face region, while negative correlations were found between temporal rCBF and gaze to non-social regions. Conclusions: These preliminary results suggest that social perception gaze patterns are altered in children with ASD, and could be related to temporal rCBF.

Atypical neural self-representation in autism

The 'self' is a complex multidimensional construct deeply embedded and in many ways defined by our relations with the social world. Individuals with autism are impaired in both self-referential and other-referential social cognitive processing. Atypical neural representation of the self may be a key to understanding the nature of such impairments. Using functional magnetic resonance imaging we scanned adult males with an autism spectrum condition and age and IQ-matched neurotypical males while they made reflective mentalizing or physical judgements about themselves or the British Queen. Neurotypical individuals preferentially recruit the middle cingulate cortex and ventromedial prefrontal cortex in response to self compared with other-referential processing. In autism, ventromedial prefrontal cortex responded equally to self and other, while middle cingulate cortex responded more to other-mentalizing than self-mentalizing. These atypical responses occur only in areas where self-information is preferentially processed and does not affect areas that preferentially respond to other-referential information. In autism, atypical neural self-representation was also apparent via reduced functional connectivity between ventromedial prefrontal cortex and areas associated with lower level embodied representations, such as ventral premotor and somatosensory cortex. Furthermore, the magnitude of neural self-other distinction in ventromedial prefrontal cortex was strongly related to the magnitude of early childhood social impairments in autism. Individuals whose ventromedial prefrontal cortex made the largest distinction between mentalizing about self and other were least socially impaired in early childhood, while those whose ventromedial prefrontal cortex made little to no distinction between mentalizing about self and other were the most socially impaired in early childhood. These observations reveal that the atypical organization of neural circuitry preferentially coding for self-information is a key mechanism at the heart of both self-referential and social impairments in autism.