Lay Abstracts

Authors: Zeglam and Maouna

DOI: 10.1177/1362361310393535

Lay abstract: There has been a true and significant increase in the number of people diagnosed with autism worldwide. To date, the health and education authorities have not paid enough attention to this serious issue and its present and future impact. Many of those being diagnosed are still not in any form of education or any form of early intervention programme. The biggest problem in any developing country, including Libya, is that parents often lack awareness of key features of autism and hence there is a lack of early interventions that may be available. Special education is rarely started early enough and even if, against all difficulties, a child gains a place in the school, the majority only start at 6 or 7 years, by which time they are “fixed observers” (becoming fixated on an object for long durations; the later this is addressed, due to lack of early intervention programs, the harder it is to remove the behavior in school). It is possible to take the view that there are far worse medical problems than autism in many developing countries (including Libya) or that there are other problems that can be helped by simple procedures; as the rates of autism are low, why divert scarce resources and efforts to this condition? There are indeed many other pediatric problems in Libya and other developing countries but autism is such a severe disability for both the individual and his/her family that every professional in the field of pediatrics must positively contribute to highlighting the problems associated with the disorder to ensure that adequate resources are available to care of children with such conditions in developing countries.

Authors: Tsai, Soong, and Lotus Shyu

DOI: 10.1177/1362361311429694

Lay abstract: Since early detection will benefit children with autism by promoting early treatment and training (which can result in positive outcomes), developing an appropriate screening instrument for detecting autism can facilitate clinical and preventive health practices, as well as health policies regarding the mental health of children. However, no feasible screening instrument is available for early detection of children with autism in Taiwan. The existing instruments may not be appropriate for use in Taiwan due to different health care systems and child-rearing cultures. The purpose of this study was to develop and test a screening questionnaire for generic autism. This study describes the initial steps in developing and validating a parental self-report instrument that is potentially useful for identifying autism. The initial 18-item screening questionnaire was developed by a child psychiatrist using face-to-face interviews with 10 families of children with autism. It was then tested on a sample of families of 18 children with autism and 59 typically developing children. Of these 18 items, 15 were deemed suitable for the revised screening questionnaire. The revised instrument, with cutoff scores of 5 and 6, has high sensitivity (the ability to detect those who have autism) and specificity (the ability to detect those who do not have autism), making it potentially useful for screening Taiwanese children at risk for autism. This instrument should be further tested in a population-based study.

Authors: Chuthapisith, Taycharpipranai, Ruangdaraganon, Warrington, and Skuse

DOI: 10.1177/1362361311433770

Lay abstract: Diagnosis of Autism Spectrum Disorders (ASDs) is based on extensive information gathered from the child, parents, school and other collateral sources, together with assessments using standard diagnostic instruments, such as the Developmental, Dimensional and Diagnostic Interview (3Di). The 3Di was developed as a standardized computer-based diagnostic interview to assess for autism spectrum and other psychiatric disorders. In Thailand, there have been no studies of the application of the instruments for diagnosing ASDs in Thai populations. Therefore, this study aimed to validate the short 3Di-Thai version. Two groups comprising 63 children with clinically ascertained ASDs, and 67 typically developing children, were interviewed with the short 3Di translated version. Mean 3Di scale scores in each domain of autistic symptoms (social reciprocity, communication, and repetitive/stereotyped behaviors) were significantly higher in the ASDs group than in the typically developing group. The optimal cut-off scores for discriminating children with ASDs and typically developing children were identical to the original English standardization. Corresponding sensitivities and specificities were acceptable in each domain. This research suggests that the short 3Di-Thai version is a useful diagnostic instrument for differentiating between clinically diagnosed children with ASDs and typically developing children, although further replication is needed.

Authors: Begeer, Bernstein, van Wijhe, Scheeren, and Koot

DOI: 10.1177/1362361311434545

Lay abstract: Individuals with high-functioning Autism Spectrum Disorder (HFASD) find it difficult to take other people’s perspective. This difficulty indicates that they have a poorly developed “Theory of Mind”. Researchers measure perspective taking by testing a person’s ability to predict the actions of a story protagonist that has a false belief about the location of a hidden object. In this classic paradigm, a participant predicts in which of two discrete locations a deceived protagonist will look for the object. While young preschoolers generally fail this task, answering egocentrically (i.e., from their own viewpoint, without taking into account the perspective of others), adolescents with HFASD generally pass the task. The current study describes a new, more subtle task, where the protagonist buries an object in one location within a sandbox, and while away, another character moves the object to a new location. This reburying of the object creates a continuum between hiding locations. Compared to typically developing individuals (n=62), those with HFASD (n=62) showed a larger egocentric bias by failing to take the protagonist’s false belief into account when predicting where he will look for the object. This indicates that sensitive measures can reveal subtle perspective taking, or first

order Theory of Mind impairments in children and adolescents with HFASD.

Authors: Puleo, Schmeidler, Reichenberg, Kolevzon, Soorya, Buxbaum, and Silverman

DOI: 10.1177/1362361311427154

Lay abstract: Research suggests that novel genetic events, such as new mutations or small chromosomal changes, are more common in cases of autism spectrum disorder (ASD) that occur in females or in sporadic families (i.e. with no other child with an ASD). Such novel genetic events are more common as paternal age increases. This study compared 90 ASD cases from sporadic families with 587 ASD cases from 340 multiplex families (i.e. with multiple children with ASD). In 124 females with ASD, higher paternal age was associated with a relatively increased likelihood of sporadic cases of autism. In 553 males with ASD, the corresponding discrepancy was not significant, despite the larger sample size. This was true whether or not we controlled for maternal age. These findings suggest that, as paternal age increases, sporadic cases of ASD are relatively more prominent in females than in males. This may be attributable to novel genetic events for females, in contrast to a greater susceptibility of males with ASD to familial risk factors.

Authors: Chaidez, Hansen, and Hertz-Picciotto

DOI: 10.1177/1362361311434787

Lay abstract: Objectives: Hispanic ethnicity is self-identified and defined as people descended from Spanish or Latin American people. The aim of this study was to compare the presentation of autism between Hispanic and non-Hispanic children. We also examined the relationship between exposure to multiple languages and measures of behavior and cognitive ability. Methods: The Childhood Autism Risks from Genetics and the Environment (CHARGE) study is an ongoing investigation of 1061 children sampled from three groups: those with autism (AU) or autism spectrum disorder (ASD); developmental delay (DD); or the general population with typical development (TD). Results: Non-Hispanic children demonstrated higher overall scores on a set of tasks measuring cognitive and motor skills. There were significant associations between exposure to multiple languages and measures of language, in both the AU/ASD and TD groups, but not in those with DD. Analyses suggest several factors to be associated with lower language scores including: diagnosis of ASD/AU, speaking to the child in a second language 25-50% of the time and Hispanic ethnicity; while maternal college education was associated with higher language scores. Conclusion: Overall, the CHARGE Hispanic group displayed more similarities than differences compared to non-Hispanics in terms of diagnostic, cognitive and behavior scores for the AU/ASD groups. The relationship between multiple language use and cognitive scores warrants a closer look.

Authors: McDuffie, Lieberman, and Yoder

DOI: 10.1177/1362361309360983

Lay abstract: Children with autism may display limited interest in manipulating objects during play or may play with objects in a repetitive manner. Increased levels of object interest may support active engagement and provide adults with more opportunities to use language facilitation strategies. This study examined how participation in two different social communication interventions differentially impacted object interest in a group of 32 18-60 month olds who used limited spoken language before receiving any treatment. Children were randomly assigned to intervention groups receiving either the Picture Exchange Communication System (PECS) or Responsive Education Prelinguistic Milieu Teaching (RPMT). PECS focuses on teaching children to request by handing a picture of a desired item to a communication partner. RPMT uses play with objects embedded in joint action routines to prompt and reinforce child communication acts. Object interest, defined as the number of toys which the child purposefully manipulated during an unstructured play session with an examiner, was assessed before and after the child received PECS or RPMT using a standard toy set. After taking into account the child’s initial object interest scores and their level of expressive language, we found that children that received RPMT showed greater gains in object interest following their participation in the intervention program than children assigned to PECS. This study demonstrates that an educational intervention can improve children’s interest in objects. Future studies should examine how child characteristics, such as object interest, may influence response to interventions that are embedded in play-based activities.

Authors: Cascio, Foss-Feig, Burnette, Heacock, and Cosby

DOI: 10.1177/1362361311430404

Lay abstract: The way the brain allows us to perceive ownership of our own body is important in the development of self-awareness, imitation, and empathy, all of which are thought to be impacted in autism spectrum disorders (ASD). In the “rubber hand illusion”, simultaneous visual and touch input can transfer perceived hand ownership to a rubber hand. We tested the rubber hand illusion in children with and without ASD. Children with ASD were initially less susceptible to the illusion than the comparison group, yet eventually did experience the illusion as time went on. This delay in the effect of the rubber hand illusion may result from differences in the way the brain combines signals from touch and vision, or it may have other causes. Children with ASD who show less empathy were significantly less likely to experience he illusion than those with more intact ability to express empathy. A better understanding of body representation in ASD may help us understand the brain basis of social problems, which could eventually impact future intervention approaches.

Authors: Brisson, Warreyn, Serres, Foussier, and Adrien

DOI: 10.1177/1362361311423385

Lay abstract: Identifying the repetitiveness of routines is essential to anticipate events in day to day life. Previous studies have shown a lack of motor anticipation in children and adults with autism but few have shown this in the first months of life. In order to find evidence of early detection of autism, we focus on a daily situation: spoon-feeding. This anticipation deficit can be found early on by observing infant’s ability to anticipate and open his or her mouth as the spoon approaches it while being fed. This study is based on an analysis of the infant’s anticipation behavior from family home movies. These movies have been recorded by parents before they knew that their child had a diagnosis of a pervasive developmental disorder (PDD). By comparing 13 infants later diagnosed with PDD and 14 typically developing infants (between 4 and 6 months old), we showed that the PDD group has an early deficit of anticipation (i.e., they failed to open their mouths as the spoon approached significantly more often than the typical group). These preliminary findings must be replicated on a larger sample in order to consolidate what could be an early detection sign of PDD as early as 4 months.

Authors: Hilton, Zhang, White, Klohr, and Constantino

DOI: 10.1177/1362361311423018

Lay abstract: Aim: Although motor impairments are frequently observed in children with autism spectrum disorders (ASD), the manner in which these impairments aggregate in families affected by ASD is unknown. We attempted to determine whether motor impairment is an endophenotype of ASD (a trait that is associated with a diagnosis that is heritable, and may manifest in family members with or without the diagnosis). Methods: We assessed motor impairment in 67 sibling pairs. In 29 pairs, both children had ASD (referred to as concordant pairs) and in 48 pairs one child had ASD and the other did not (referred to as discordant pairs). We examined a wide range of motor skills, including placing pegs in a pegboard, cutting with scissors, copying forms, imitating movements, running, throwing a ball and doing push-ups. We compared the scores from the children with ASD to those of their siblings. Results: Motor skills were substantially impaired among the children with ASD and were highly correlated with the severity of their autism and their IQ. Motor skills in unaffected siblings were essentially normal. The association between the scores of the siblings was very strong for identical twins, moderate for non-identical (but concordant) siblings, and non-significant for non-identical (discordant) siblings. This is consistent with the pattern expected for an inherited trait that is associated with ASD. Interpretation: Findings indicate that motor impairments constitute a core characteristic of ASD, but not necessarily an endophenotype of the disorder. The higher association between scores from concordant identical twins compared to the other sibling pairs suggests that genetics play a role in the motor impairments observed in individuals with ASD. This further suggests that motor impairment, although not specified in the diagnostic criteria for ASD, may be one of the defining features of this largely genetic disorder.