A comparison of functional behaviour assessment rating scales in a sample of children and youth with autism spectrum disorders

This study sought to compare the results of the Motivation Assessment Scale (MAS; Durand & Crimmins, 1988), Questions About Behavior Function Scale (QABF; Matson & Vollmer, 1996) and Functional Analysis Screening Tool (FAST; Iwata & Deleon, 1996), when completed by parent informants in a sample of children and youth with autism spectrum disorders (ASD) who display challenging behaviour. Results indicated that there was low agreement between the functional hypotheses derived from each of three measures. In addition, correlations between functionally analogous scales were substantially lower than expected, while correlations between non-analogous subscales were stronger than anticipated. As indicated by this study, clinicians choosing to use FBA questionnaires to assess behavioural function, may not obtain accurate functional hypotheses, potentially resulting in ineffective intervention plans. The current study underscores the caution that must be taken when asking parents to complete these questionnaires to determine the function(s) of challenging behaviour for children/youth with ASD.

Which words are hard for autistic children to learn?

Motivated by accounts of concept use in autistic spectrum disorder (ASD), and a computational model of weak central coherence (O’Loughlin & Thagard, 2000) we examined comprehension and production vocabulary in typically-developing children, and those with ASD and Down syndrome (DS). Controlling for frequency, familiarity, length, and imageability, Colorado Meaningfulness played a hitherto unremarked role in the vocabularies of children with ASD. High Colorado Meaningful words were underrepresented in the comprehension vocabularies of 2- to 12-year-olds with ASD. The Colorado Meaningfulness of a word is a measure of how many words can be associated with it. Situations in which high Colorado Meaningfulness words are encountered are typically highly variable, and words with High Colorado Meaningfulness often involve extensive use of context. Our data suggest that the number of contexts in which a particular word can appear has a role in determining vocabulary in ASD. This suggestion is consistent with the weak central coherence theory of autism.

Developing social skills in autistic children through ‘Relaxed Performances’

Families living with autism often feel unable to attend social and cultural events largely due to the fear of their child attracting negative or even aggressive reactions from others. The ‘joint attention’ that is part of the theatre experience however may be a powerful factor in the development of social and communication skills for such children. ‘Relaxed performances’ offer an opportunity for them to access and engage with theatre by making special arrangements designed to reduce tensions associated with visits to public places. Aspects of the production such as the use of lighting and sound effects which may trigger adverse reactions are also adjusted. This paper reports on how one local theatre drew on the findings of a national project to mount a ‘relaxed performance’ of their annual pantomime. It discusses the theatre’s preparations and presents evidence of the impact the event had on local children with autism and their families. The success of both the national and this local project marks a new beginning for improved access to the theatre for an audience that has hitherto felt largely excluded.

Randomised controlled trials of homeopathy in hyperactive children: treatment procedure leads to an unconventional study design. Experience with open-label homeopathic treatment preceding the Swiss ADHD placebo controlled, randomised, double-blind, cross-over trial

BACKGROUND: Treatment of patients with attention deficit hyperactivity disorder (ADHD) with homeopathy is difficult. The Swiss randomised, placebo controlled, cross-over trial in ADHD patients (Swiss ADHD trial) was designed with an open-label screening phase prior to the randomised controlled phase. During the screening phase, the response of each child to successive homeopathic medications was observed until the optimal medication was identified. Only children who reached a predefined level of improvement participated in the randomised, cross-over phase. Although the randomised phase revealed a significant beneficial effect of homeopathy, the cross-over caused a strong carryover effect diminishing the apparent difference between placebo and verum treatment. METHODS: This retrospective analysis explores the screening phase data with respect to the risk of failure to demonstrate a specific effect of a randomised controlled trial (RCT) with randomisation at the start of the treatment. RESULTS: During the screening phase, 84% (70/83) of the children responded to treatment and reached eligibility for the randomised trial after a median time of 5 months (range 1-18), with a median of 3 different medications (range 1-9). Thirteen children (16%) did not reach eligibility. Five months after treatment start, the difference in Conners Global Index (CGI) rating between responders and non-responders became highly significant (p = 0.0006). Improvement in CGI was much greater following the identification of the optimal medication than in the preceding suboptimal treatment period (p < 0.0001). CONCLUSIONS: Because of the necessity of identifying an optimal medication before response to treatment can be expected, randomisation at the start of treatment in an RCT of homeopathy in ADHD children has a high risk of failure to demonstrate a specific treatment effect, if the observation time is shorter than 12 months.

Repeat-measures longitudinal study evaluating behavioural and gastrointestinal symptoms in children with autism before, during and after visceral osteopathic technique (VOT)

Summary: This study investigated the influence of visceral osteopathic technique (VOT) on the behaviour and gastrointestinal (GI) symptoms of children with autism using a validated questionnaire to measure outcome. Methods: The 49 recruited autistic children suffered GI symptoms and impaired social interaction and communication, but were otherwise healthy. Thirty minute VOT sessions were applied to the abdomens of the children over a 6 week period whilst their GI and behavioural parameters were recorded. Outcomes were measured using a modified Autism Research Institute Secretin Outcomes Survey Form, the ‘S.O.S Form’. Four questionnaires were completed by parents before treatment (control period), four completed during treatment (treatment period) and one completed six weeks after the last treatment (post treatment period). Subjects acted as their own controls. Results: Results from repeat ANOVA demonstrated a positive, overall significant, symptomatic improvement (p < 0.05) in ‘social behaviour and communication’ and ‘digestive signs’ subscales of the questionnaire comparing before and after VOT. Significant improvement in vomiting (p = 0.00029), poor appetite (p = 0.039) and eye contact (p = 0.035) was also demonstrated after VOT application. Discussion and conclusion: The experimental hypothesis has been supported indicating a positive effect of VOT on some of the measured GI symptoms and behavioural patterns in this group of children with autism. This data indicates that the application of VOT may be of benefit to children with autism and GI disturbance.

Field effectiveness of stimulus equivalence for teaching reading skills to children with autism

Stimulus equivalence involves teaching two conditional discriminations that share one stimulus in common and testing all possible conditional discriminations not taught (Saunders & Green, 1999). Despite considerable research in the laboratory, applied studies of stimulus equivalence have been limited (Vause, Martin, Marion, & Sakko, 2005). This study investigated the field-effectiveness of stimulus equivalence in teaching reading skills to children with Autism. Participants were four children with Autism receiving centre-based intensive behavioural intervention (lBI) treatment. Three of the participants, who already matched pictures to their dictated names, demonstrated six to eight more emergent performances after being taught only to match written words to the same names. One participant struggled with the demands of the study and his participation was discontinued. Results suggest that stimulus equivalence provided an effective and efficient teaching strategy for three of the four participants in this study.

Dyad function-based cognitive behavioural therapy as a treatment for obsessive compulsive disorder in two school aged children with high functioning autism

Children with High-Functioning Autism (HF A) are more vulnerable to developing Obsessive Compulsive Disorder (OCD) than typically developing children and those with Low-Functioning Autism (Gadow et al., 2005). This study used a multiple baseline design across behaviours (Cooper, Heron, & Heward, 2007) to investigate if a two phase function-based Cognitive Behaviour Therapy (CBT) would decrease obsessive compulsive behaviours (OCBs) in two children ages 7 and 9 who met criteria for OCD and HF A. This multimodal treatment package consisted of treatment enhancements to meet the children's cognitive, linguistic, and social challenges associated with their HF A diagnosis, as well as a manual and accompanied children's workbook (Vause, Neil, & Feldman, in progress). In line with previous research conducted on CBT as a treatment for OCD in this population (e.g., Wood et at, 2009), the children in this study experienced clinically significant decreases in their OCBs as a result of receiving the CBT protocol.

Teaching Tips from a Recovered Autistic

An article by Grandin sharing tips for teaching and working with autistic children. The focus is on: Structured Environment, Learning to Talk, Rhythm, Sensory Problems, Reducing Arousal, Tactile Stimulation, Fixations, Visual Thinking. The conclusion of the article reads "I cannot over emphasize the important role that good teachers and therapists play in enabling autistics to lead a fuller life. A good autism program needs dedicated people and should use a variety of treatment methods in combination with an intense structured environment".

A double-blind, placebo-controlled, crossover-designed probiotic feeding study in children diagnosed with autistic spectrum disorders

There is growing interest in the role of gastrointestinal (GI) pathology and clinical expression of autism. Recent studies have demonstrated differences in the faecal clostridial populations harboured by autistic and non-autistic children. The potential of Lactobacillus plantarum WCSF1 (a probiotic) to modulate the gut microbiota of autistic subjects was investigated during a double-blind, placebo-controlled, crossover-designed feeding study. The faecal microbiota, gut function and behaviour scores of subjects were examined throughout the 12-week study. Lactobacillus plantarum WCFS1 feeding significantly increased Lab158 counts (lactobacilli and enterococci group) and significantly reduced Erec482 counts (Clostridium cluster XIVa) compared to placebo. Probiotic feeding also resulted in significant differences in the stool consistency compared to placebo and behaviour scores (total score and scores for some subscales) compared to baseline. The major finding of this work was the importance of study protocol in relation to the specific considerations of this subject population, with an extremely high dropout rate seen (predominantly during the baseline period). Furthermore, the relatively high inter-individual variability observed suggests that subsequent studies should use defined subgroups of autistic spectrum disorders, such as regressive or late-onset autism. In summary, the current study has highlighted the potential benefit of L. plantarum WCFS1 probiotic feeding in autistic individuals.

Children with persistent conduct problems who dropout of treatment

Dropout of treatment is one of the key issues in outcome in a child and adolescent mental health service. We report two studies focusing on the treatment process and the dropout rate of children with persistent conduct problems presenting to a community mental health service, using a prospective design. The first study included 32 children and used a randomised controlled treatment design comparing a CBT approach with conjoint family therapy and an eclectic approach. The overall dropout rate was 36%. Dropout occurred significantly less frequently in the CBT group. The dropout group was associated with mothers who were younger and less educated, a poorer rating by the clinicians at the last meeting, parental dissatisfaction with the treatment service and perception that the treatment was less organised and having less behavioural tasks. In the second study we used a naturalistic follow-up design. Forty-six children were included. The overall dropout rate was 48%. Again, the children who defaulted were rated by clinicians as less likely to have improved and dropout was also  significantly associated with parental perception of a less organised treatment. In both studies dropout usually occurred after assessment and at the early phase of treatment.

Parent management training, comorbidity, and treatment of children with oppositional defiant disorder

This study found that Parent Management Training was a successful treatment for promary school aged children who were referred to a mental health clinic and diagnosed with Oppositional Defiant Disorder. The positive outcome was not affected by the child having comorbid disorders. These findings have relevance to the clinical field.

PTSD symptomatology in children and adolescents : treatment development and evaluation

This thesis developed, implemented and evaluated a cognitive-behavioural group treatment programme for children and adolescents experiencing symptoms of PTSD (Post-traumatic stress disorder). Results of the study indicate that symptoms of sleep disturbance and flashbacks, reduced markedly in the participants, providing a useful tool in reducing synptoms experiences by individuals exposed to trauma. The Professional portfolio presents four case studies that demonstrate the clinical application of the affect of chronic illness on the psychological adjustment of the sufferer and their families.

The paradox of autistic art

Certain autistic children whose linguistic ability is virtually nonexistent can draw natural scenes from memory with astonishing accuracy. In particular their drawings display convincing perspective. In contrast, normal children of the same preschool age group and even untrained adults draw primitive schematics or symbols of objects which they can verbally identify. These are usually conceptual outlines devoid of detail. It is argued that the difference between autistic child artists and normal individuals is that autistic artists make no assumptions about what is to be seen in their environment. They have not formed mental representations of what is significant and consequently perceive all details as equally important. Equivalently, they do not impose visual or linguistic schema -- a process necessary for rapid conceptualisation in a dynamic existence, especially when the information presented to the eye is incomplete.