Showing papers in "Autism in 2003"
TL;DR: Diagnosis of autistic spectrum disorders at age 2 was found to be reliable and stable, and the development of an early diagnostic service in Southampton is described.
Abstract: Twenty children who presented with severe and communication difficulties at age 2 underwent a comprehensive assessment for autism, and were reassessed at age 4-5. In common with other recent studies, diagnosis of autistic spectrum disorders at age 2 was found to be reliable and stable. The communication and social skills of the children showed little change overall by the second assessment. However, children whose scores deteriorated in the social domain tended to have presented initially with more significant behaviour problems. Few repetitive behaviours were observed at age 2, whereas these were more apparent by age 4-5. The finding that early diagnosis of autism is reliable and stable has led to the development of an early diagnostic service in Southampton, which is described. The importance of early diagnosis is that it opens the door to early intervention programmes, which in turn prevent many problems from occurring in later life.
274 citations
TL;DR: To understand the effect of IQ and age on ability in children with autism, psychological data were analyzed for 164 3- to 15-year-olds with autism (IQs 14-143).
Abstract: To understand the effect of IQ and age on ability in children with autism, psychological data were analyzed for 164 3- to 15-year-olds with autism (IQs 14-143). As age increased, so did IQ, which probably reflects both an actual increase in IQ over time and the likelihood that brighter children are diagnosed later. Early in life, 67 percent had normal motor and delayed speech milestones. Verbal IQ continued to lag behind non-verbal IQ during the preschool years. By school age, the gap between verbal and non-verbal IQs had closed. Visual reasoning exceeded graphomotor scores for all children, and surpassed IQ for most. Graphomotor scores were significantly below IQ for both high-IQ groups. For school-age children with low IQs, math, spelling, and writing scores were consistent with IQ and reading was above IQ. School-age children with high IQs had average reading, math, and spelling scores and a weakness in writing.
242 citations
TL;DR: The article considers the nature of the presumed social play deficit in autistic spectrum disorders (ASDs) and suggests that social play is a confluence of two strands of development that are affected in autism: social and emotional development, and the cognitive development of play.
Abstract: The article considers the nature of the presumed social play deficit in autistic spectrum disorders (ASDs). The nature of play and its typical development is outlined and discussed in relation to play development in ASDs. It is suggested that social play is a confluence of two strands of development that are affected in autism: social and emotional development, and the cognitive development of play. It is shown that social play develops in a transactional way and in ASDs initial social difficulties prevent the development of social interaction, with its role in eliciting and enriching spontaneous play. At the same time, cognitive and affective difficulties prevent the play of children with autism developing to the extent of attracting other children and being of a complexity from which social play might develop. This cycle of impoverished play opportunities for children with ASDs may be broken through direct teaching and there are encouraging models of teaching social play with some success.
225 citations
TL;DR: In a sample of 137 children, age 24-96 months, classified as having autism or ASD by the Autism Diagnostic Observation Schedule-Generic, 24 percent had a history of at least one chronic gastrointestinal symptom.
Abstract: The purpose of this study was to estimate the prevalence of chronic gastrointestinal symptoms in a general population of children with autism or autistic spectrum disorder (ASD). The study site was a clinic specializing in ASD in a large pediatric medical center serving a 10 county area in the midwestern USA. In a sample of 137 children, age 24-96 months, classified as having autism or ASD by the Autism Diagnostic Observation Schedule-Generic, 24 percent had a history of at least one chronic gastrointestinal symptom. The most common symptom was diarrhea, which occurred in 17 percent. There was no association between chronic gastrointestinal symptoms and a history of developmental regression. The potential phenotypic association between autism and gastrointestinal symptoms is discussed.
223 citations
TL;DR: There was a significant interval between parents first noticing abnormalities and the making of a definitive diagnosis, and the notion that the nature and prevalence of these deficits depend on age supported.
Abstract: The aim of the study was to identify early behavioural abnormalities in children later diagnosed with autistic disorder. Accurate identification of such deficits has implications for early diagnosis, intervention and prognosis. The parents of 153 children with autistic disorder completed a questionnaire asking them to describe early childhood behaviours of concern and to recall the age of onset. Core deficit-linked behaviours were then identified and the ontogeny of their development was noted. Behaviour categories were: (1) gross motor difficulties, (2) social awareness and play deficits, (3) language and communication difficulties, and (4) unusual preoccupations. The findings supported the notion that the nature and prevalence of these deficits depend on age. Consistent with past research, there was a significant interval between parents first noticing abnormalities and the making of a definitive diagnosis. The implications for this delay are discussed.
192 citations
TL;DR: The empirical evidence of difficulties in pretend play in autism is reviewed, and data suggest that individuals with autism have a marked difficulty in producing pretend play, but one that is reduced by providing substantial structure to the play situation or by testing comprehension of pretence.
Abstract: Autism is currently diagnosed, in part at least, on the basis of problems in imagination. The article reviews the empirical evidence of difficulties in pretend play in autism, and focuses in particular on individuals' ability to engage in pretence in free play conditions, to produce pretence in more structured situations, and to make sense of pretend actions carried out by another person. These data suggest that individuals with autism have a marked difficulty in producing pretend play, but one that is reduced by providing substantial structure to the play situation or by testing comprehension of pretence. The implications of these findings for theories of pretend play in autism, in terms of an inability to conceive of non-literal situations, a difficulty in imposing a pretend usage on an object, or a failure to gain a benefit from engaging in pretend play, are discussed.
176 citations
TL;DR: Investigation of mothers’ perceptions of the development of friendship in high-functioning children with autism and in typically developing children indicated that both groups tended to have same-gender and same-age friendships.
Abstract: The current study investigated mothers' perceptions of the development of friendship in high-functioning children with autism and in typically developing children. Fourteen mothers in each group (autism, typical) completed the Childhood Friendship Survey regarding their children's friendships. Main results indicated that both groups (autism and typical) tended to have same-gender and same-age friendships. However, friendships of children with autism differ compared with typical children's friendships on number of friends, friendship duration, frequency of meetings, and type of activities. Half of the friendships in the autism group were mixed (friendship with a typically developing child). Mixed differed from non-mixed friendships in that mixed pairs met and played mostly at home, whereas non-mixed pairs met and played at school. Factors contributing to the development and formation of friendship in each group are discussed.
170 citations
TL;DR: A significant improvement in the three domains relevant for the diagnosis of autism, independent of age or IQ level is revealed, and it is suggested that improvement belongs to the ‘natural history’ of the handicap.
Abstract: The study examined developmental changes in autistic symptoms retrospectively in a sample of 28 verbal children and adolescents with autism. Individuals with Asperger syndrome, PDD-NOS, and related medical conditions were not included in the study. We compared autistic symptoms present at the retrospective assessment and during the 4- to 5-year age period using the ADI-R. Our findings revealed a significant improvement in the three domains relevant for the diagnosis of autism, independent of age or IQ level. Improvement occurred in more symptoms from the social than the communication domain, and for more symptoms from the latter than the restricted interest and repetitive behavior domains. The finding that improvement was not linked to level of functioning and was found in individuals still positive for a diagnosis of autism suggests that improvement belongs to the 'natural history' of the handicap.
150 citations
TL;DR: This case report outlines the cognitive-behavioral treatment of obsessive-compulsive disorder in a 7-year-old female with Asperger syndrome and issues regarding symptom presentation, assessment, and treatment of a dually diagnosed patient are discussed.
Abstract: This case report outlines the cognitive-behavioral treatment of obsessive-compulsive disorder in a 7-year-old female with Asperger syndrome. Interventions were based upon the work of March and Mulle and were adapted in light of the patient's cognitive, social, and linguistic characteristics. Obsessive-compulsive symptoms improved markedly after approximately 6 months of treatment. Issues regarding symptom presentation, assessment, and treatment of a dually diagnosed patient are discussed.
148 citations
TL;DR: The developmental, individual-difference, relationship-based model (DIR), a theoretical and applied framework for comprehensive intervention, examines the functional developmental capacities of children in the context of their unique biologically based processing profile and their family relationships and interactive patterns.
Abstract: The developmental, individual-difference, relationship-based model (DIR), a theoretical and applied framework for comprehensive intervention, examines the functional developmental capacities of children in the context of their unique biologically based processing profile and their family relationships and interactive patterns. As a functional approach, it uses the complex interactions between biology and experience to understand behavior and articulates the developmental capacities that provide the foundation for higher order symbolic thinking and relating. During spontaneous 'floor time' play sessions, adults follow the child's lead utilizing affectively toned interactions through gestures and words to move the child up the symbolic ladder by first establishing a foundation of shared attention, engagement, simple and complex gestures, and problem solving to usher the child into the world of ideas and abstract thinking. This process is illustrated by a case example of a young boy on the autism spectrum interacting with his father during 'floor time' over a 3 year period.
147 citations
TL;DR: Psychosocial functioning in Swedish adults with Asperger syndrome (AS) or high-functioning autism (HFA) is reported on, with a systematically selected sample of patients and relatives interviewed concerning their psychosocial situation.
Abstract: This study reports on psychosocial functioning in Swedish adults with Asperger syndrome (AS) or high-functioning autism (HFA). A systematically selected sample of patients and relatives was interviewed concerning their psychosocial situation. The majority was living independently. All persons but one were unemployed. None was married and none had children. Only a few had some kind of partner. Most persons needed a high level of public and/or private support. The overall adjustment was rated good in 12 percent, fair in 75 percent and poor in 12 percent. Adult persons with AS/HFA have extensive need for support from their families and/or society. This information is important in order to provide adequate interventions that are in accordance with the expressed needs of the individuals themselves.
TL;DR: Using an ABAB design, the Social Story program appeared to result in a decrease in the number of food and drink spills and an increase in the frequency of appropriate mouth- wiping during lunch at school.
Abstract: This study assessed the utility of a Social Story intervention to improve the lunchtime eating behaviors of an adolescent diagnosed with Asperger syndrome. Using an ABAB design, the Social Story program appeared to result in a decrease in the number of food and drink spills and an increase in the frequency of appropriate mouth-wiping during lunch at school.
TL;DR: Those gaining higher scores were more likely to have been given the diagnosis of Asperger syndrome (as opposed to autism), to have had a definite diagnosis, and to have children who were not currently in an educational placement.
Abstract: Satisfaction with disclosure of the diagnosis of an autistic spectrum disorder was investigated using a self-report questionnaire completed by 126 parents On a rating of satisfaction, 55 percent indicated that they were satisfied or very satisfied with the disclosure Parents were more likely to be satisfied if they gave positive ratings to the manner of the professional and the quality of the information provided; if they had been given written information and the opportunity to ask questions; and if their early suspicions had been accepted by professionals These factors were combined into a global index of satisfaction; those gaining higher scores were more likely to have been given the diagnosis of Asperger syndrome (as opposed to autism), to have had a definite diagnosis, and to have children who were not currently in an educational placement These results underline the importance of the interaction between parent and professional during the disclosure interview
TL;DR: A pilot study was conducted to evaluate the effects of training teachers of children with autistic spectrum disorders in the use of the Picture Exchange Communication System (PECS), and the majority of participants showed improvements in their ability to use PECS.
Abstract: A pilot study was conducted to evaluate the effects of training teachers of children with autistic spectrum disorders (ASDs) in the use of the Picture Exchange Communication System (PECS). Thirty-four children with ASDs (29 boys and 5 girls) were selected from eight specialist schools. Teaching staff attended a 2 day PECS workshop and received six half-day visits from PECS consultants. Data on the children's use of PECS, spontaneous communication, and adaptive behaviour were collected before the study and at set times following the workshop. Significant, rapid increases were recorded in the level of PECS attained by the children, in their PECS vocabulary, and in their frequency of PECS use over time. Improvements in children's general level of communication were slower to occur. The majority of participants showed improvements in their ability to use PECS. The results are discussed in relation to the methodological and practical difficulties that arose during the project.
TL;DR: Results are discussed with respect to the effectiveness of adaptive behaviour profiles in the detection of autism and the importance of employing limited chronological and developmental age ranges in the study of autism in infancy.
Abstract: The purpose of this study was to examine adaptive behaviour profiles in children with autism and moderate to severe developmental delay. Previous research has found that children with autism present a characteristic pattern of adaptive behaviour, as measured by the Vineland Adaptive Behavior Scales (VABS) (deficit in the domain of socialization, relative deficit in the domain of communication and relative strength in the domain of daily living). In this study VABS were administered (as part of a comprehensive evaluation of abilities) to a sample of 50 children with moderate to severe developmental delay (23 children with autism and 27 chronological and developmental age matched non-autistic children). Contrary to initial predictions, the sample presented fairly homogeneous adaptive behaviour profiles. Results are discussed with respect to the effectiveness of adaptive behaviour profiles in the detection of autism and the importance of employing limited chronological and developmental age ranges in the study of autism in infancy.
TL;DR: A set of efficacious methods, which range from highly structured techniques to more naturalistic strategies, are introduced, which focuses on object play as other authors in the issue discuss social play in greater depth.
Abstract: A variety of techniques grounded in behavioral psychology, and more specifically in applied behavior analysis, have been established to increase and improve play skills in children with autistic spectrum disorders. This article introduces a set of efficacious methods, which range from highly structured techniques to more naturalistic strategies. It focuses on object play as other authors in the issue discuss social play in greater depth. Behavioral techniques that are reviewed include: discrete trial training, use of stereotyped behaviors to increase play skills, pivotal response training, reciprocal imitation training, differential reinforcement of appropriate behavior, in vivo modeling and play scripts, and video modeling. A discussion of expanding behavior techniques to teach more complex play as well as training in varied environments is also presented. References are provided to allow the reader to obtain more in-depth information about each technique.
TL;DR: The findings suggest that the lack of social attention often demonstrated by children with autism does not stem from increased arousal in social situations, and both groups showed heart rate slowing compared with a baseline condition.
Abstract: The behavioral and heart rate responses of 22 children with autism and 22 children with other developmental disabilities were compared whilst they were watching videotapes of a baby either playing or crying. We expected both groups to show arousal as increased heart rate when watching the video of the crying baby, and the children with autism to attend less than the other children to both videos. However, the children with autism were as attentive to the videos as the other children, and both groups showed heart rate slowing compared with a baseline condition. There was no change in heart rate during interactions with a stranger or separation from mothers. The findings suggest that the lack of social attention often demonstrated by children with autism does not stem from increased arousal in social situations. An alternative explanation is considered.
TL;DR: It is proposed that longitudinal studies, which make a detailed examination of the form and developmental trajectory of early play, are needed if the authors are to devise the most effective content, design and outcome measures for intervention programmes using play as a therapeutic medium.
Abstract: The article reviews the empirical evidence relating to the development of early solitary object and parent-infant play in typical infants and children diagnosed with autism. Whilst, collectively, the findings indicate that there may be both qualitative and quantitative differences in the early play of children with autism, relative to that of other children, it is also clear that significant gaps exist in our current knowledge. It is proposed that longitudinal studies, which make a detailed examination of the form and developmental trajectory of early play, are needed if we are to devise the most effective content, design and outcome measures for intervention programmes using play as a therapeutic medium.
TL;DR: It is concluded that autism can be diagnosed in the deaf; that it resembles autism in the hearing; and that it is not a consequence of deafness per se.
Abstract: Autism spectrum disorders are particularly difficult to diagnose in the presence of early profound deafness because of communication related issues. Two parts of the Autism Screening Instrument were administered to 13 deaf individuals with autism and two comparison groups: hearing autistic and deaf learning disabled. A parental questionnaire was also used. No differences in autistic symptomatology were found between the deaf autistic and the hearing autistic group. However, the deaf autistic group was diagnosed later than the hearing autistic group. It is concluded that autism can be diagnosed in the deaf; that it resembles autism in the hearing; and that it is not a consequence of deafness per se. Learning disabled deaf individuals who are not autistic do not resemble people with autism in behavioural terms. The findings have implications for remediation, education, and the emergence and management of challenging behaviours.
TL;DR: A pilot investigation that combined quantitative and qualitative methods to examine the effects of participation in IPGs on the symbolic and social play of two early elementary-aged children with autism suggests that each child made notable gains in reciprocal social interaction and symbolic/pretend play while participating in play groups.
Abstract: The article focuses on integrated play groups (IPGs) as a model to support children with ASD in play with typically developing peers/siblings, and its recent adoption with children in a home and school setting in Taiwan. The first part provides a brief overview of the IPG model and its essential features. The second part reports on a pilot investigation that combined quantitative and qualitative methods to examine the effects of participation in IPGs on the symbolic and social play of two early elementary-aged children with autism. Preliminary findings suggest that each child made notable gains in reciprocal social interaction and symbolic/pretend play while participating in play groups. Implications are discussed in terms of play's role in enhancing socialization, imagination and peer cultural inclusion.
TL;DR: If there is a relationship between play and language in children with autism it is weak, if it exists at all, and it is suggested that any relationship betweenplay and language may be mediated by how children and their parents interact when they are playing.
Abstract: It is well established that the play and language skills of children with autism are impaired. The article considers the relation- ship between these developments in typically developing children and children with autism. First, the evidence for a relationship between these two areas in typically developing children is reviewed. Despite many methodological differences between studies, this evidence supports a relationship, with specific developments emerging first in play and subsequently in language. Second, evidence for a relationship between play and language in children with autism is reviewed. From published and some previously unpublished data it is concluded that if there is a relationship between play and language in children with autism it is weak, if it exists at all. Finally, the implications of these findings are discussed and it is suggested that any relationship between play and language may be mediated by how children and their parents interact when they are playing.
TL;DR: Findings support the utility of the PIA-CV for obtaining ecologically valid information from parents and for measuring behavioral change in young children with autism.
Abstract: The Parent Interview for Autism-Clinical Version (PIA-CV) was developed to measure autism symptom severity across a wide range of behavioral domains. Two studies were conducted to examine the psychometric properties of the PIA-CV for a sample of children under 3 years old. Results of study 1 revealed adequate internal consistency for nine of the 11 PIA-CV dimensions, as well as significant group differences on social-communication domains between 2-year-old children with autism and a developmentally matched sample. Study 2 examined the association between changes in PIA-CV scores and changes in autism symptomatology from age 2 to age 4. Results revealed that changes on PIA-CV dimensions assessing social and communication skills were associated with clinically significant behavioral and diagnostic improvements. These findings support the utility of the PIA-CV for obtaining ecologically valid information from parents and for measuring behavioral change in young children with autism.
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TL;DR: A toy-play intervention for children with autism is described in this article, where the authors stress the importance of early manipulative and relational play for the development of meaningful perceptual representations and the subsequent development of functional and symbolic play.
Abstract: Early forms of play involving the exploration of objects is repetitive and limited in scope in children with autism, consistent with a weak drive towards central coherence. The importance is stressed of early manipulative and relational play for the development of meaningful perceptual representations and the subsequent development of functional and symbolic play. It is argued that intervention designed to promote these early forms of play is therefore of critical importance. A ‘toy-play’ intervention programme is described that was initially used in a research setting with 24 children with autism, using outcome measures and a 1 year follow-up assessment. The original intervention was successful. However, improvements in play were not maintained unless children continued to receive play support. A ‘play stimulation’ programme building on the toy-play programme is there- fore now carried out with children in small groups after completion of the one-to-one toy-play programme.
TL;DR: Investigation of reported differential preference of intuitive psychology and intuitive physics among children with autism by employing three tasks each with a psychological and a physical condition demonstrated thatChildren with autism preferred to employ physical causality when reasoning about novel physical and psychological events.
Abstract: Many studies have documented poor understanding of intuitive psychology among children with autism; however, few have investigated claims of superior understanding of intuitive physics said to be evident in this group This study aimed to investigate the reported differential preference of intuitive psychology and intuitive physics among children with autism by employing three tasks each with a psychological and a physical condition In order to gain a detailed developmental picture the study compared children with autism, an age matched comparison group, and typically developing preschoolers, 7-year-olds and 10-year-olds Results demonstrated that children with autism preferred to employ physical causality when reasoning about novel physical and psychological events Furthermore, their performance on a multiple-choice task confirmed their impairment in intuitive psychology whilst highlighting a superior ability to reason about physical phenomena in relation to all other comparison groups The theoretical implications of this potential cognitive strength are discussed
TL;DR: Preliminary findings showed that vocabulary errors were similar in both groups, except under-extension, which was not used by the autism group, while unknown words were similarIn both groups.
Abstract: Semantic or vocabulary errors were measured among children with autism and mild learning disability and children with mild learning disability only (six children of 7.9-8.7 years in each group), testing the hypothesis that these were common in both groups. Different variables were investigated such as breadth of vocabulary and number of vocabulary errors, type of paraphasias, and mechanisms used to name the meanings that children were not aware of or could not recall, and the particular meanings that were difficult for each group. Preliminary findings showed that vocabulary errors were similar in both groups, except under-extension, which was not used by the autism group. Children with autism tended to use all mechanisms in order to name something they did not know and to focus on parts of the object in order to name it, while unknown words were similar in both groups.
TL;DR: There is currently no standardized assessment protocol to prescribe a specific educational intervention, to evaluate the progress of children or to make comparisons between interventions, and the development of such a protocol is recommended.
Abstract: Little is known about the progress of autistic children following specific interventions in England. Nor do we know how frequently standardized assessments are used to monitor progress or to evaluate specific educational interventions. The reports of 75 children with autism, for whom special educational provision had been determined by a local education authority, were reviewed. Parents were interviewed and educational psychologists were contacted for details of any norm-referenced assessments. Of these children, 39 percent had no standardized assessments before education authorities determined their provision, and only 9 percent had follow-up assessments that could be used to evaluate progress. Children with autism in the UK rarely have sufficient assessments to allow an objective evaluation of their progress. There is currently no standardized assessment protocol to prescribe a specific educational intervention, to evaluate the progress of children or to make comparisons between interventions. We recommend the development of such a protocol.
TL;DR: This is a personal account of the play behaviors of an individual who has autism as remembered by himself and his mother as well as attempts to involve Jean-Paul in typical play.
Abstract: This is a personal account of the play behaviors of an individual who has autism as remembered by himself and his mother. Jean-Paul Bovee explains the activities that were enjoyable for him and which were his play, although they were unusual and may not fit the typical definition of play. His mother, Dr Julie A. Donnelly, tells of her attempts to involve Jean-Paul in typical play and how important play is as a bridge to social skills and involvement with peers. Jean-Paul concludes that his play is a part of the unique individual he has become.
TL;DR: The use of play as a medium to extend and enrich the communicative exchanges and, more specifically, the symbolic language of children on the autistic spectrum has been discussed in this article, where a case illustration of how adult facilitated dramatic peer play led to a breakthrough in a 9-year-old girl with autism, who up to that point had not progressed beyond a semi-communicative use of echolalia, best described as'situation association'.
Abstract: The article was written to support the use of play as a medium to extend and enrich the communicative exchanges and, more specifically, the symbolic language of children on the autistic spectrum. The first argument in support of such use of play lies within the features of autistic communication, and particularly the extreme challenges encountered in imaginative play and narrative thought. The second argument on behalf of play lies within the selection of specific intervention strategies, which are discussed subsequently. Finally, the article presents a case illustration of how adult facilitated dramatic peer play led to a breakthrough in a range of symbolic behaviours in a 9-year-old girl with autism, who up to that point had not progressed beyond a semi-communicative use of echolalia, best described as 'situation association'.