Anxiety and social worries in children with Asperger syndrome

Objective: The current study examined anxiety and social worries in a group of children with Asperger syndrome (AS). Method: Sixty-five children with AS were compared with a clinically anxious sample and a normative sample using parent and child reports. Results: Comparisons between clinically anxious children and children with AS showed similar scores on overall anxiety and on six anxiety subscales using child reports. Parent reports revealed higher ratings of overall anxiety and described children with AS experiencing more obsessive-compulsive symptoms and physical injury fears than clinically anxious children. Conclusions: Children with AS without a diagnosis of anxiety, present with more anxiety symptoms than a normal population and with a different profile than a clinically anxious population. Study limitations are identified and considerations for future research presented.

A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome

Background: The aim of the study was to evaluate the effectiveness of a brief CBT intervention for anxiety with children diagnosed with Asperger syndrome (AS). A second interest was to evaluate whether more intensive parent involvement would increase the child's ability to manage anxiety outside of the clinic setting. Methods: Seventy-one children aged ten to twelve years were recruited to participate in the anxiety programme. All children were diagnosed with AS and the presence of anxiety symptoms was accepted on parent report via brief interview. Children were randomly assigned to one of three conditions: intervention for child only, intervention for child and parent, wait-list control. Results: The two intervention groups demonstrated significant decreases in parent-reported anxiety symptoms at follow-up and a significant increase in the child's ability to generate positive strategies in an anxiety-provoking situation. There were a number of significant differences between the two interventions to suggest parent involvement as beneficial. Conclusions: The sample of children with AS in this study presented with a profile of anxiety similar to a sample of clinically diagnosed anxious children. The intervention was endorsed by parents as a useful programme for children diagnosed with Asperger syndrome and exhibiting anxiety symptoms, and active parent involvement enhanced the usefulness of the programme. Limitations of the study and future research are discussed.

Play behaviours and play object preferences of young children with autistic disorder in a clinical play environment

Play is the primary occupation of childhood and provides a potentially powerful means of assessing and treating children with autistic disorder. This study utilized a cross-sectional comparison design to investigate the nature of play engagement in children with AD (n = 24), relative to typically developing children (n = 34) matched for chronological age. Play behaviours were recorded in a clinical play environment. Videotapes comprising 15 minutes of the children's spontaneous play behaviour were analysed using time-interval analysis. The particular play behaviours observed and play objects used were coded. Differences in play behaviours (p < 0.0001) and play object preferences (p < 0.0001) were identified between the groups. Findings regarding play behaviour contribute to contention in the literature surrounding functional and symbolic play. Explanations for play object preferences are postulated. Recommendations are made regarding clinical application of findings in terms of enhancing assessment and intervention by augmenting motivation.

Playfulness in children with autistic disorder and their typically developing peers

This study investigated the playfulness of 24 children with autistic disorder (AD) and 34 typically developing children aged 3-7 years, in free (unstructured) and adult-facilitated (structured) play conditions within a clinical play environment. Video recordings of play were rated using the Test of Playfulness (Bundy 2003). The data were analysed using repeated measures ANOVA and ANCOVA and qualitative observations. The children with AD were less playful compared with the typically developing children (F = 49.64, p < 0.001), even when developmental age was accounted for (F = 28.20, p < 0.001). Both groups of children were slightly more playful in a structured environment with adult facilitation (F = 7.72, p = 0.007). Despite statistically significant differences in playfulness between play conditions, considerable overlap in observations for both groups suggests that this may not be as clinically meaningful. When developmental age was accounted for, the play conditions no longer had a significant effect on playfulness (F = 1.54, p = 0.220). The implications of the findings and the limitations of the study are discussed

Balance and gait in children with dyslexia

Tests of postural stability have provided some evidence of a link between deficits in gross motor skills and developmental dyslexia. The ordinal-level scales used previously, however, have limited measurement sensitivity, and no studies have investigated motor performance during walking in participants with dyslexia. The purpose of this study was to investigate if continuous-scaled measures of standing balance and gait could discriminate between groups of impaired and normal readers when investigators were blind to group membership during testing. Children with dyslexia (n=22) and controls (n=18), aged 10-12 years, performed walking tests at four different speeds (slow-preferred-fast-very fast) on an even and an uneven surface, and tests of unperturbed and perturbed body sway during standing. Body movements were registered by a triaxial accelerometer over the lower trunk, and measures of reaction time, body sway, walking speed, step length and cadence were calculated. Results were controlled for gender differences. Tests of standing balance with eyes closed did not discriminate between groups. All unperturbed standing tests with eyes open showed significant group differences (P<0.05) and classified correctly 70-77.5% of the subjects into their respective groups. Mean walking speed during very fast walking on both flat and uneven surface was ≥0.2 m/s (P≤0.01) faster for controls than for the group with dyslexia. This test classified 77.5% and 85% of the subjects correctly on flat and uneven surface, respectively Cadence at preferred or very fast speed did not differ statistically between groups, but revealed significant group differences when all subjects were compared at a normalised walking speed (P≤0.04). Very fast walking speed as well as cadence at a normalised speed discriminated better between groups when subjects were walking on an uneven surface compared to a flat floor. Continuous-scaled walking tests performed in field settings may be suitable for motor skill assessment as a component of a screening tool for developmental dyslexia.

Brief report:effects of sensory sensitivity and intolerance of uncertainty on anxiety in mothers of children with autism spectrum disorder

This study examined the relations between anxiety and individual characteristics of sensory sensitivity (SS) and intolerance of uncertainty (IU) in mothers of children with ASD. The mothers of 50 children completed the Hospital Anxiety and Depression Scale, the Highly Sensitive Person Scale and the IU Scale. Anxiety was associated with both SS and IU and IU was also associated with SS. Mediation analyses showed direct effects between anxiety and both IU and SS but a significant indirect effect was found only in the model in which IU mediated between SS. This is the first study to characterize the nature of the IU and SS interrelation in predicting levels of anxiety.

The relationship between spoken language and speech and nonspeech processing in children with autism:a magnetic event-related field study

It has been proposed that language impairments in children with Autism Spectrum Disorders (ASD) stem from atypical neural processing of speech and/or nonspeech sounds. However, the strength of this proposal is compromised by the unreliable outcomes of previous studies of speech and nonspeech processing in ASD. The aim of this study was to determine whether there was an association between poor spoken language and atypical event-related field (ERF) responses to speech and nonspeech sounds in children with ASD (n = 14) and controls (n = 18). Data from this developmental population (ages 6-14) were analysed using a novel combination of methods to maximize the reliability of our findings while taking into consideration the heterogeneity of the ASD population. The results showed that poor spoken language scores were associated with atypical left hemisphere brain responses (200 to 400 ms) to both speech and nonspeech in the ASD group. These data support the idea that some children with ASD may have an immature auditory cortex that affects their ability to process both speech and nonspeech sounds. Their poor speech processing may impair their ability to process the speech of other people, and hence reduce their ability to learn the phonology, syntax, and semantics of their native language.

Predictors of developmental gains in children enrolled in an early intervention setting

The purpose of this research was to determine whether initial developmental delay, site of intervention, frequency of intervention, age of the child, socio-economic status (SES), gender and ethnicity significantly predict developmental gains in a group of children enrolled in an early intervention setting. The records of 134 children enrolled in an inner-city program in Miami, Florida were reviewed for inclusion in this study. ^ Demographic variables, site placement and treatment frequencies were collected during a retrospective chart review. Level of delay was expressed using the developmental quotient and developmental gain was calculated using the mean gain on age equivalent scores or developmental tests. A multiple regression analysis was performed to determine which of the above variables significantly predicted developmental gains. Multivariate analysis compared developmental gains for all the developmental domains based on intervention site (center versus home-based) while controlling for developmental delay. ^ Children made greater developmental gains if they had higher developmental quotients and if they were younger at the time services were initiated. Frequency of intervention significantly improved developmental outcomes in children attending center-based programs. Children attending center-based programs also made significantly greater gains in gross motor skills compared to children attending home-based programs. ^ These findings emphasize the importance of early screening and referral of children with developmental delay and adjusting intervention for the child's developmental quotient. Children should receive intense treatment to maximize results. Decisions regarding program placement should be individualized according to the child's unique developmental pattern. Policy and program decisions affecting the curriculum of a child in early intervention need to reflect these multivariate considerations. ^

An evaluation of functional impairment among children with anxiety disorders

Despite a considerable progress in developing and testing psychosocial treatments to reduce youth anxiety disorders, much remains to learn about the relation between anxiety symptom reduction and change in youth functional impairment. The specific aims of this dissertation thus were to examine: (1) the relation between different levels of anxiety and youth functional impairment ratings; (2) incremental validity of the Children Global Assessment Scale (CGAS); (3) the mediating role of anxiety symptom reduction on youth functional impairment ratings; (4) the directionality of change between anxiety symptom reduction and youth functional impairment; (5) the moderating effects of youth age, sex, and ethnicity on the mediated relation between youth anxiety symptom reduction and change in functional impairment; and (6) an agreement (or lack thereof) between youths and their parents in their views of change in youth functional impairment vis-à-vis anxiety symptom reduction. ^ The results were analyzed using archival data set acquired from 183 youths and their mothers. Research questions were tested using SPSS and structural equation modeling techniques in Mplus. ^ The results supported the efficacy of psychosocial treatments to reduce the severity of youth anxiety symptoms and its associated functional impairment. Moreover, the results revealed that at posttreatment, youths who scored either low or medium on anxiety levels scored significantly lower on impairment, than youths who scored high on anxiety levels. Incremental validity of the CGAS was also revealed across all assessment points and informants in my sample. In addition, the results indicated the mediating role of anxiety symptom reduction with respect to change in youth functional impairment at posttest, regardless of the youth’s age, sex, and ethnicity. No significant findings were observed with regard to the bidirectionality and an informant disagreement vis-à-vis the relation between anxiety symptom reduction and change in functional impairment. ^ The study’s main contributions and potential implications on theoretical, empirical, and clinical levels are further discussed. The emphasis is on the need to enhance existing evidence-based treatments and develop innovative treatment models that will not only reduce youth’s symptoms (such anxiety) but also evoke genuine and palpable improvements in lives of youths and their families.^

Children with special health care needs: Comparison of the effects of home care setting, prescribed pediatric extended care setting, and long-term care setting on child and family health outcomes and health care service use

Technological advances during the past 30 years have dramatically improved survival rates for children with life-threatening conditions (preterm births, congenital anomalies, disease, or injury) resulting in children with special health care needs (CSHCN), children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services beyond that required by children generally. There are approximately 10.2 million of these children in the United States or one in five households with a child with special health care needs. Care for these children is limited to home care, medical day care (Prescribed Pediatric Extended Care; P-PEC) or a long term care (LTC) facility. There is very limited research examining health outcomes of CSHCN and their families. The purpose of this research was to compare the effects of home care settings, P-PEC settings, and LTC settings on child health and functioning, family health and function, and health care service use of families with CSHCN. Eighty four CSHCN ages 2 to 21 years having a medically fragile or complex medical condition that required continual monitoring were enrolled with their parents/guardians. Interviews were conducted monthly for five months using the PedsQL™ Generic Core Module for child health and functioning, PedsQL™ Family Impact Module for family health and functioning, and Access to Care from the NS-CSHCN survey for health care services. Descriptive statistics, chi square, and ANCOVA were conducted to determine differences across care settings. Children in the P-PEC settings had a highest health care quality of life (HRQL) overall including physical and psychosocial functioning. Parents/guardians with CSHCN in LTC had the highest HRQL including having time and energy for a social life and employment. Parents/guardians with CSHCN in home care settings had the poorest HRQL including physical and psychosocial functioning with cognitive difficulties, difficulties with worry, communication, and daily activities. They had the fewest hours of employment and the most hours providing direct care for their children. Overall health care service use was the same across the care settings.

The effectiveness of explicit individualized phonemic awareness instruction by a speech -language pathologist to preschool children with phonological speech disorders

This study investigated the effects of an explicit individualized phonemic awareness intervention administered by a speech-language pathologist to 4 prekindergarten children with phonological speech sound disorders. Research has demonstrated that children with moderate-severe expressive phonological disorders are at-risk for poor literacy development because they often concurrently exhibit weaknesses in the development of phonological awareness skills (Rvachew, Ohberg, Grawburg, & Heyding, 2003).^ The research design chosen for this study was a single subject multiple probe design across subjects. After stable baseline measures, the participants received explicit instruction in each of the three phases separately and sequentially. Dependent measures included same-day tests for Phase I (Phoneme Identity), Phase II (Phoneme Blending), and Phase III (Phoneme Segmentation), and generalization and maintenance tests for all three phases.^ All 4 participants made substantial progress in all three phases. These skills were maintained during weekly and biweekly maintenance measures. Generalization measures indicated that the participants demonstrated some increases in their mean total number of correct responses in Phase II and Phase III baseline while the participants were in Phase I intervention, and more substantial increases in Phase III baseline while the participants were in Phase II intervention. Increased generalization from Phases II to III could likely be explained due to the response similarities in those two skills (Cooper, Heron, & Heward, 2007).^ Based upon the findings of this study, speech-language pathologists should evaluate phonological awareness in the children in their caseloads prior to kindergarten entry, and should allocate time during speech therapy to enhance phonological awareness and letter knowledge to support the development of both skills concurrently. Also, classroom teachers should collaborate with speech-language pathologists to identify at-risk students in their classrooms and successfully implement evidence-based phonemic awareness instruction. Future research should repeat this study including larger groups of children, children with combined speech and language delays, children of different ages, and ESOL students.^