By using the gap overlap task, we investigated disengagement from faces and objects in children (9-17 years old) with and without autism spectrum disorder (ASD) and its neurophysiological correlates. In typically developing (TD) children, faces elicited larger gap effect, an index of attentional engagement, and larger saccade-related event-related potentials (ERPs), compared to objects. In children with ASD, by contrast, neither gap effect nor ERPs differ between faces and objects. Follow-up experiments demonstrated that instructed fixation on the eyes induces larger gap effect for faces in children with ASD, whereas instructed fixation on the mouth can disrupt larger gap effect in TD children. These results suggest a critical role of eye fixation on attentional engagement to faces in both groups.
autism spectrum disorder; face; disengagement; saccade-related ERPs; gap overlap task
Inflexibility is a major characteristic of autism. In the present study we addressed inflexible mealtime behaviors and collected longitudinal data across 48 foods for 3 children, ages 6.4–7.8 years, diagnosed with autism spectrum disorder, for up to 22 weeks. Participants exhibited severe challenges with adherence to an extremely restricted repertoire of foods. We employed clinical replication and multiple baseline designs across participants to assess the effects of individualized reinforcement and hierarchical exposure to increase flexibility. Results showed that following intervention, all participants expanded their food repertoire and spontaneously requested new foods during follow up/generalization. Implications for clinical practice and directions for further research are discussed.
Food refusal; Inflexibility; Rigidity; Autism; Positive reinforcement; Stimulus fading
To this day, I can recite the Sara Sparrow definition of adaptive behavior. To this day, I recall Sara sitting on the other side of a one-way mirror observing me, an inexperienced clinical psychology intern, administer the Vineland Adaptive Behavior Scales to the mother of a child with learning disabilities. Talk about nervous-- the world’s expert on adaptive behavior held my very internship and career success in her hands! Even though I stumbled through it, Sara reassured me that I did great…all I needed was more practice. So, thousands of Vineland’s later, I was launched.
Both my first and my latest publications in the disability field used assessment tools that I learned from Sara—primarily the Vineland, but also several cognitive tests. Beyond these tools, I cherish key insights from Sara that have stayed with me over the long haul. First and foremost, Sara taught me how to be a real psychologist, how to carefully observe and assess people with standardized tools and with my own eyes and ears. Second, she instilled a practical skill that I still am working on—always be on time even if others are late!
Third, Sara imbued a sense of fun and adventure into our training and she continued to be a source of inspiration and fun in the years after I left Yale. For us data-driven types, the process of research and discovery is inherently fun—it is a total blast. Yet Sara modeled that fun and enjoyment need to come in other ways that are more balanced or well-rounded—that are, in a word, adaptive. It seems a fitting tribute to Sara to submit a paper that related her treasured Vineland Scales to how people with developmental disabilities have fun. Thank you, Sara.
This study examined whether language skills and nonverbal cognitive skills were associated with clinician-observed restricted and repetitive behaviors (RRBs) in a sample of 115 children with ASD at ages 2 and 3. By age 3, RRBs were significantly negatively correlated with receptive and expressive language, as well as nonverbal cognitive skills. Increases in receptive and expressive language from age 2 to 3 significantly predicted decreases in RRBs, controlling for age in months, time between visits, and gains in nonverbal cognitive skills. This study contributes to the limited research that has examined early patterns and predictors of RRBs in young children with ASD.
restricted and repetitive behaviors (RRBs); language; autism; nonverbal cognitive skills; toddlers; preschoolers
To examine the validity of oppositional defiant disorder (ODD) as a clinical phenotype distinct from attention-deficit hyperactivity disorder (ADHD), parents and teachers completed a DSM-IV-referenced rating scale and a background questionnaire for 608 children (ages 3–12 years) with autism spectrum disorder (ASD). The ASD sample was separated into four groups: ODD, ADHD, ODD + ADHD, and neither (NONE). Comparison samples were non-ASD clinic (n = 326) and community (n > 800) controls. In the ASD sample, all three ODD/ ADHD groups were clearly differentiated from the NONE group, and the ODD + ADHD group had the most severe co-occurring symptoms, medication use, and environmental disadvantage. There were few differences between ASD + ODD and ASD + ADHD groups. Findings for ASD and control samples were similar, supporting overlapping mechanisms in the pathogenesis of ODD.
Oppositional defiant disorder; Autism spectrum disorder; Autism; Asperger’s syndrome; PDDNOS; Pervasive developmental disorder; Attention-deficit/hyperactivity disorder; DSM-IV; Diagnosis
We performed cerebellum segmentation and parcellation on magnetic resonance images from right-handed boys, aged 6–13 years, including 22 boys with autism (16 with language impairment (ALI)), 9 boys with Specific Language Impairment (SLI), and 11 normal controls. Language-impaired groups had reversed asymmetry relative to unimpaired groups in posterior-lateral cerebellar lobule VIIIA (right side larger in unimpaired groups, left side larger in ALI and SLI), contralateral to previous findings in inferior frontal cortex language areas. Lobule VIIA Crus I was smaller in SLI than in ALI. Vermis volume, particularly anterior I-V, was decreased in language-impaired groups. Language performance test scores correlated with lobule VIIIA asymmetry and with anterior vermis volume. These findings suggest ALI and SLI subjects show abnormalities in neurodevelopment of fronto-corticocerebellar circuits that manage motor control and the processing of language, cognition, working memory, and attention.
autism; specific language impairment; cerebellum; Broca’s area; asymmetry
Little is known about whether early symptom presentation differs in toddlers with ASD from ethnic minority versus non-minority backgrounds. Within a treatment study for toddlers with ASD, we compared 19 minority to 65 Caucasian children and their parents on variables obtained from the Mullen Scales of Early Learning, Autism Diagnostic Observation Schedule, and Communication and Symbolic Behavior Scales Caregiver Questionnaire. The majority of parents were from the upper classes irrespective of ethnic membership. Minority children had lower language and communication scores than non-minority children. Findings indicate that subtle communication delays may be undetected or presumed unremarkable by parents of minority toddlers, and that more significant delays are needed to prompt the search for intervention services.
autism spectrum disorder; toddlers; early symptoms; minority
Health symptoms of mothers of adolescents and adults with fragile X syndrome (FXS; n = 112) were compared to a nationally-representative sample of mothers of similarly-aged children without disabilities (n = 230) as well as to a sample of mothers of adolescents and adults with autism spectrum disorders (ASD; n = 96). Health symptoms experienced in the previous 24 h were recorded during 8 consecutive days of a daily diary study. Both mothers of a son or daughter with FXS and mothers of a son or daughter with ASD had a higher proportion of days with headaches, backaches, muscle soreness, fatigue, and hot flashes than mothers of children without disabilities. Mothers of children with disabilities appear to be at particular risk for health problems, highlighting a need for comprehensive services for families across the lifespan.
Fragile X premutation; Autism spectrum disorders; Health symptoms
The present study investigated the impact of social support on the
psychological well-being of mothers of adolescents and adults with ASD
(n = 269). Quantity of support (number of social
network members) as well as valence of support (positive support and negative
support) were assessed using a modified version of the “convoy
model” developed by Antonucci and Akiyama
(1987). Having a larger social network was associated with
improvements in maternal well-being over an 18-month period. Higher levels of
negative support as well as increases in negative support over the study period
were associated with increases in depressive symptoms and negative affect and
decreases in positive affect. Social support predicted changes in well-being
above and beyond the impact of child behavior problems. Implications for
clinical practice are discussed.
Social support; Mothers; Well-being; Adolescence; Adulthood
Children with autism often suffer from sleep disturbances, and compared to age-matched controls, have decreased melatonin levels, as indicated by urine levels of the primary melatonin metabolite, 6-sulfatoxymelatonin (6-SM). We therefore investigated the relationship between 6-SM levels and sleep architecture in children with autism spectrum disorders (ASD). Twenty-three children, aged 4–10 years, completed two nights of polysomnography and one overnight urine collection for measurement of urinary 6-SM excretion rate. Parents completed the Children’s Sleep Habits Questionnaire. We found that higher urinary 6-SM excretion rates were associated with increased N3 sleep, decreased N2 sleep, and decreased daytime sleepiness. The results warrant further examination to examine the effects of supplemental melatonin on sleep architecture and daytime sleepiness.
6-Sulfatoxymelatonin; 6-SM; Sleep stages; Children’s Sleep Habits Questionnaire; Parental Concerns Questionnaire; Polysomnography
We investigated linguistic and visuospatial processing during pictorial reasoning in high-functioning autism (HFA), Asperger’s syndrome (ASP), and age and IQ-matched typically developing participants (CTRL), using three conditions designed to differentially engage linguistic mediation or visuospatial processing (Visuospatial, V; Semantic, S; Visuospatial+Semantic, V+S). The three groups did not differ in accuracy, but showed different response time profiles. ASP and CTRL participants were fastest on V+S, amenable to both linguistic and nonlinguistic mediation, whereas HFA participants were equally fast on V and V+S, where visuospatial strategies were available, and slowest on S. HFA participants appeared to favor visuospatial over linguistic mediation. The results support the use of linguistic vs. visuospatial tasks for characterizing subtypes on the autism spectrum.
high-functioning autism; Asperger's syndrome; reasoning; pictures; language; visuospatial
Fragile X syndrome (FXS) is the leading known inherited cause of intellectual disability and the most common known biological cause of autism. Approximately 25% to 50% of males with FXS meet full diagnostic criteria for autism. Despite the high comorbidity between FXS and autism and the ability to diagnose FXS prenatally or at birth, no studies have examined indicators of autism in infants with FXS. The current study focused on indices of visual attention, one of the earliest and most robust behavioral indicators of autism in idiopathic (non-FXS) autism. Analyses revealed lower HR variability, shallower HR decelerations, and prolonged look durations in 12-month old infants with FXS that were correlated with severity of autistic behavior but not mental age.
fragile X; autism; early detection; heart rate; visual attention; high-risk infants
We examined motor and tactile-perceptual skills in individuals with high-functioning autism (IHFA) and matched typically developing individuals (TDI) ages 5 – 21 years. Grip strength, motor speed and coordination were impaired in IHFA compared to matched TDI, and the differences between groups varied with age. Although tactile-perceptual skills of IHFA were impaired compared to TDI on several measures, impairments were statistically and clinically significant only for stereognosis. Motor and tactile-perceptual skills should be assessed in children with IHFA and intervention should begin early because these skills are essential to school performance. Impairments in coordination and stereognosis suggest a broad though selective under-development of the circuitry for higher order abilities regardless of domain that is important in the search for the underlying disturbances in neurological development.
autism; motor skills; coordination; strength; tactile-perceptual skills; stereognosis
Supplemental melatonin has shown promise in treating sleep onset insomnia in children with autism spectrum disorders (ASD). Twenty-four children, free of psychotropic medications, completed an open-label dose-escalation study to assess dose-response, tolerability, safety, feasibility of collecting actigraphy data, and ability of outcome measures to detect change during a 14-week intervention. Supplemental melatonin improved sleep latency, as measured by actigraphy, in most children at 1 or 3 mg dosages. It was effective in week 1 of treatment, maintained effects over several months, was well tolerated and safe, and showed improvement in sleep, behavior, and parenting stress. Our findings contribute to the growing literature on supplemental melatonin for insomnia in ASD and inform planning for a large randomized trial in this population.
melatonin; insomnia; actigraphy; clinical trial; Children’s Sleep Habits Questionnaire; Child Behavior Checklist; Autism Diagnostic Observation Schedule
Young boys with autism were compared to typically developing boys on responses to nonsocial and child-directed speech (CDS) stimuli. Behavioral (looking) and physiological (heart rate and respiratory sinus arrhythmia) measures were collected. Boys with autism looked equally as much as chronological age-matched peers at nonsocial stimuli, but less at CDS stimuli. Boys with autism and language age-matched peers differed in patterns of looking at live versus videotaped CDS stimuli. Boys with autism demonstrated faster heart rates than chronological age-matched peers, but did not differ significantly on respiratory sinus arrhythmia. Reduced attention during CDS may restrict language-learning opportunities for children with autism. The heart rate findings suggest that young children with autism have a nonspecific elevated arousal level.
autism; language; child-directed speech; attention; respiratory sinus arrhythmia; heart rate
There is a growing amount of evidence suggesting that individuals with autism have difficulty with categorization. One basic cognitive ability that may underlie this difficulty is the ability to abstract a prototype. The current study examined prototype and category formation with dot patterns in high-functioning adults with autism and matched controls. Individuals with autism were found to have difficulty forming prototypes and categories of dot patterns. The eye-tracking data did not reveal any between group differences in attention to the dot patterns. However, relationships between performance and intelligence in the autism group suggest possible processing differences between the groups. Results are consistent with previous studies that have found deficits in prototype formation and extend these deficits to dot patterns.
categorization; prototype; autism; cognition; eye-tracking; implicit
Anecdotal reports indicate that individuals with autism spectrum disorders (ASD) are often preoccupied with television, computers, and video games (screen-based media). However, few studies have examined this issue. The current study examined screen-based media use among a large, nationally representative sample of youths participating in the National Longitudinal Transition Study – 2 (NLTS2). The majority of youths with ASD (64.2%) spent most of their free time using non-social media (television, video games), while only 13.2% spent time on social media (email, internet chatting). Compared with other disability groups (speech/language impairment, learning disabilities, intellectual disabilities), rates of non-social media use were higher among the ASD group, and rates of social media use were lower. Demographic and symptom-specific correlates were also examined.
autism; autism spectrum disorder; video game; television; internet
Research on moving evidence-based practice (EBP) intervention strategies to community service settings for children with autism spectrum disorders (ASD) is urgently needed. The current pilot study addresses this need by examining the feasibility, acceptability and preliminary outcomes of training therapists practicing in community mental health (CMH) clinics to deliver a package of EBP strategies aimed to reduce challenging behaviors in school-age children with ASD. Results indicate that CMH therapists participated in both initial and ongoing training, were able to deliver the intervention with fidelity, and perceived the intervention strategies as useful. Parents participated in almost all sessions with their children and remained in therapy when therapists delivered the intervention. Meaningful reductions in child problem behaviors occurred over 5 months providing promising support for the intervention.
Autism spectrum disorders; Therapist training; Challenging behaviors; Community mental health services; Evidence-based practice
Imitation is an early skill thought to play a role in social development, leading some to suggest that teaching imitation to children with autism should lead to improvements in social functioning. This study used a randomized controlled trial to evaluate the effect of a focused imitation intervention on initiation of joint attention and social-emotional functioning in 27 young children with autism. Results indicated the treatment group made significantly more gains in joint attention initiations at post-treatment and follow-up and social-emotional functioning at follow-up than the control group. Although gains in social functioning were associated with treatment, a mediation analysis did not support imitation as the mechanism of action. These findings suggest the intervention improves social functioning in children with ASD.
Autism; Imitation; Intervention; Social; Reciprocal Imitation Training
The restricted and repetitive behaviors of children with autism can interfere with family functioning as well as learning and socialization opportunities for the child. To date, neither pharmacological nor comprehensive behavioral treatments have been found to be consistently effective at significantly reducing children’s engagement in repetitive behaviors. We developed Family-Implemented Treatment for Behavioral Inflexibility (FITBI) to target the full variety of repetitive behaviors found in autism. For the current study, a therapist and parents of five children with autism (mean age = 48 months) co-implemented FITBI in a clinic setting over a 12-week treatment period. Using single case design methodology, significant reductions in repetitive behaviors were found for all participants and maintenance of treatment effects for 4 of 5 participants.
Autism spectrum disorders; Repetitive behaviors; Treatment
School-aged children and adolescents with autism demonstrate circumscribed attentional patterns to nonsocial aspects of complex visual arrays (Sasson et al.2008). The current study downward extended these findings to a sample of 2–5 year-olds with autism and 2–5 year-old typically developing children. Eye-tracking was used to quantify discrete aspects of visual attention to picture arrays containing combinations of social pictures, pictures of objects frequently involved in circumscribed interests in persons with autism (e.g., trains), and pictures of more commonplace objects (e.g., clothing). The children with autism exhibited greater exploration and perseverative attention on objects related to circumscribed interests than did typically developing children. Results suggest that circumscribed attention may be an early emerging characteristic of autism.
Autism; Attention; Visual exploration; Toddlers; Perseveration
Restricted and repetitive behaviors in autism spectrum disorders have been conceptualized to reflect impaired executive functions. In the present study, we investigated the performance of 6–17-year-old children with and without an autism spectrum disorder on a dimension-change card sort task that explicitly indicated sorting rules on every trial. Diagnostic groups did not differ in speed of responses after the first rule switch or in speed or accuracy on blocks with mixed versus single sort rules. However, performance of the ASD group was significantly slower and less accurate overall than the typically-developing group. Furthermore, within the ASD group, poorer DCCS task performance did not predict more severe autism symptoms. Implications for the executive dysfunction theory of autism are discussed.
Autism; Set shifting; Dimension-change card sort task; Repetitive behaviors; Executive functioning; Children
Individuals with Autism Spectrum Disorders (ASD) often demonstrate impaired generativity that is thought to mediate repetitive behaviors in autism (Turner in J Child Psychol Psychiatry, 40(6):839–849, 1999a). The present study evaluated generativity in children with and without ASD via the use-of-objects task (Turner in J Child Psychol Psychiatry, 40(2):189–201, 1999b) and an Animals Fluency Task (Lezak in Neuropsychological assessment. Oxford University Press, Oxford, 1995). Groups differed significantly on two of four metrics from the Animals Fluency Task and two of seven metrics from the Use of Objects task. In the ASD sample, no significant relations were found between generativity and repetitive behaviors. Significant relations were found, however, between performance on the Animals Fluency Task and communication symptoms. Results replicate reports of generativity deficits in ASD and suggest that impaired generativity may reflect communication deficits that are characteristic of the disorder.
Autism; Generativity; Repetitive behaviors; Communication; Severity of symptoms; Children
Restricted and repetitive behaviors (RRBs) are a core symptom of autism spectrum
disorders (ASD). There has been an increased research emphasis on repetitive behaviors; however,
this research primarily has focused on phenomenology and mechanisms. Thus, the knowledge base on
interventions is lagging behind other areas of research. The literature suggests there are
evidence-based practices to treat “lower order” RRBs in ASD (e.g., stereotypies); yet,
there is a lack of a focused program of intervention research for “higher order”
behaviors (e.g., insistence on sameness). This paper will (a) discuss barriers to intervention
development for RRBs; (b) review evidence-based interventions to treat RRBs in ASD, with a focus on
higher order behaviors; and (c) conclude with recommendations for practice and research.
Autism spectrum disorders; Evidence-based practices; Repetitive behaviors
Obsessive Compulsive Disorder (OCD) involves exaggerated or excessive worry about threatening and non-threatening stimuli coupled with impairing rituals believed to reduce anxiety. Autism Spectrum Disorders (ASD) are characterized by impairment in social and communicative activities as well as restricted and repetitive behaviors. Approximately 2% of children with ASD are also diagnosed with OCD. Although there is extensive research demonstrating the effectiveness of behavioral interventions for pediatric OCD, little is known about how effective these treatments are for children who have a dual diagnosis of OCD and ASD. This report describes a 12-year-old male with Autism who was treated successfully with cognitive behavioral therapy with exposure and response prevention. This case study provides initial support that cognitive-behavioral therapy is effective in symptom reduction for children with comorbid autism and OCD.
Cognitive behavioral therapy; Exposure and response prevention; Autism; Obsessive compulsive disorder