FEAT DAILY NEWSLETTER
Sacramento, California http://www.feat.org
November 7, 2001
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** PUBLISHING NOTE TO READERS: There will be a temporary
increase in publication postings to cover these
proceedings in addition to regular news coverage, for the next two days only.
The International Meeting for Autism Research (IMFAR) is a
satellite event taking place on November 9-10, 2001 in conjunction with the
Society for Neuroscience meeting in San Diego, California.
It is a two-day scientific meeting comprised of all types
of autism research - from molecular biology to neuropsychology to treatment
will be represented at the meeting. Funding for this meeting is underwritten collaboratively
by Cure Autism Now, the M.I.N.D Institute and the National Alliance for Autism
Research.
The abstracts below are of the scientific papers being
presented
Friday morning by the researchers. Friday afternoon and Saturday’s reports
will be reproduced here in subsequent postings of the FEAT
Newsletter. All
of the information is from the IMFAR website:
http://www.imfar.org/index2.html
Turning Treatment Nonresponders Into Treatment Responders:
Development Of Individualized Treatment Protocols For Children With Autism.
L. Schreibman*, A. C. Stahmer, and V. Cestone. Autism
Research Laboratory, Univ. of CA., San Diego, Dept. of Psy., La Jolla, CA.
92093-0109.
The heterogeneity in treatment outcome for children with
autism argues strongly for the development of a strategy for individualizing
treatment. While behavioral treatments
enjoy the widest support as effective for these children, no single behavioral
treatment has proven to be truly effective for a majority of the children. Preliminary
studies in our laboratory have suggested two distinct behavioral profiles that
seem to be predictive of outcomes to a specific naturalistic treatment.
Thus we have developed a preliminary ‘responder and a
nonresponder” profile that has allowed us to begin to predict which children
will benefit substantially from a specific naturalistic behavioral intervention
(Pivotal Response Training) and which children will show little benefit. The
current project was designed to refine the profile, and to determine if another
well-substantiated behavioral strategy, Discrete Trial Training, will prove to
be effective for children who do not respond to Pivotal Response Training.
Results to date indicate that specific behavioral
indicators may be used to determine the most appropriate intervention type for
young children with autism. Children with a particular profile responded
differentially to the different treatments. This is the first demonstration
that a pretreatment behavioral profile may allow for clinicians and teachers to
design a treatment protocol specifically designed for an individual child. Tailoring treatment to individual children
should have the overall effect of reducing the heterogeneity of treatment
outcome in this population. Funding:
ASA Foundation.
* * *
Long Term Follow-Up Of Children With Autism Receiving
Early Intensive Behavioral Interventions (Eibi): Plastic Or Pre-Determined
Responses?
Bryna Siegel, Adriana Schuler, Cynthia Arnold, Pervasive
Developmental Disorders Laboratory, Langley Porter Psychiatric Institute,
University of California, San Francisco, San Francisco, CA 94143-0984 Scm
Francisco State University, Pacific Graduate School of Psychology.
Thirty-three children with autistic spectrum disorders
were followed from time of diagnosis in early childhood through early to
mid-adolescence to determine if there was differential benefits for the 17 who
had received substantial EIBI versus the 16 receiving high quality school based
intervention (581) during the same early period.
Measures included initial diagnosis and IQ; outcome
measures included DSM and ADI-R diagnosis, IQ and Vineland Adaptive Behavior
Scale scores, and type of educational placement and educational supports. There
were no significant group differences on numbers meeting ‘normalization’
criteria (29% vs. 19% for EIBI vs. SBI, respectively).
Initial diagnosis and IQ were the strongest predictors of
outcome irrespective of treatment group. Those with initially more normal lQs
and PDD,NOS versus autistic disorder were most likely to meet normalization criteria
defined as no autistic spectrum disorder per DSM or ADI-R criteria, normal IQ,
and regular education placement with no or minimal supports.
Implications for understanding the relation between
intensive treatment and brain plasticity will be discussed in light of there
results.
* * *
Evaluation Of Autistic Children After Three Years Of
Intensive Behavioral Treatment.
G. 0. Sallows and T. 0. Graupner. Wisconsin Farly Autism
Project, Madison, WI 53719.
Twenty-four children recruited from birth to three special
education classes began treatment in 1996 and 1997. Selection criteria were age
2-0 to 3-6, diagnosis of autism by unaffiliated child psychiatrists and by the ADI-R,
Bayley IQ of 35 or higher, and no other easily detected neurological disorders.
No chromosome studies, metabolic screens, LEGs, or imaging procedures were
done.
Children were randomly assigned by matched pairs (on IQ)
to Clinic Directed (replicating Lovaas - 40 hrs/wk and heavy supervision) or
Parent Directed (parents determined hours, 6 hrs/mo consultant supervision) treatment
groups. A non-treated control group matched by age was obtained from local
public schools. Pre-post measures included cognitive ability, language, and
adaptive skills.
Treatment results showed a mean 22 point increase in IQ,
over 90% of which occurred in the first year. Nine children showed a mean 47
point increase to the average range. Prior to treatment 46% were mute. After
three years, 92% spoke, with over 70% speaking in phrases or full sentences.
For the 9 “best outcome” children, representing 450/o of treated children who met
Lovaas’ 1987 intake criteria, mean Vineland ABC increased to the average range.
Non-treated children showed no change in IQ after four-plus years in special
education.
There was little difference between Clinic and Parent
Directed groups, an unanticipated finding. Pre-treatment predictors of outcome
included imitation, IQ, Vineland ABC and speech. Non predictors included
severity of autistic symptoms and whether or not children received supplemental
treatments such as special education services.
* * *
Assessing The Outcome Of Toddlers With Autistic Spectrum
Disorder In
Inclusive Programming: Standardized And Functional
Measures
A. C. Stahmer and B. Ingersoll. Autism Intervention
Center, Children’s Hospital, San Diego, CA 92123 and Univ. of Calif Son Diego,
CA 92093.
With the passage of IDEA ‘97, intervention for young
children with autistic spectrum disorder (ASD) is now provided for children
under three. While research suggests
that children with autism benefit from inclusive programming, inclusive early
intervention programs are rare (Strain, McGee, & Kohler, in press). The
current study used a quasi-experimental design to analyze the outcomes of 20
young children with ASD in an inclusive program for children under three.
Both functional outcomes, as well as outcomes on
standardized assessments such as the Bayley Scales of Infant Development, 2nd
Ed. and the Vineland Adaptive Behavior Scales were compared at entry into the
program and exit from the program. Significant improvements were seen in
performance on standardized assessments and functional measures. At intake,
fifty percent of the subjects had no functional communication skills.
At exit (approximately six months later), ninety percent
of the children utilized a functional communication system. Communication
systems were individually determined for each subject based on child preference
and included verbal, sign, and PECS. Eighty percent of the children used functional
phrases with their chosen communication system and verbal language at program
exit. In addition, social and play behaviors increased substantially.
These data suggest that inclusive programming for children
under three is a successful method for increasing children’s communication,
play, and social skills. Use of augmentative communication systems and a
combination of research based programming is discussed.
* * *
The Facilitation Of Social-Emotional Understanding And
Social Interaction In High-Functioning Children With Autism: Intervention Outcomes.
N. Baurninger. Bar-I/an University, Ramat-Gan, Israel
52900.
This study evaluated the effectiveness of a 7-month
cognitive behavioral intervention for the facilitation of the social emotional understanding
and social interaction of 15 high functioning children (8-16 years old) with
autism. Intervention focused on teaching interpersonal problem-solving,
affective knowledge, and social interaction. Pre- and post-intervention
measures included: observations of social interaction, measures of problem
solving and of emotion understanding, and teacher-rated social skills.
Results demonstrated progress in three areas of
intervention. Children were more likely to initiate positive social interaction
with peers after treatment; in particular, they improved eye contact and their
ability to share experiences with peers and to show interest in peers. In
problem solving after treatment, children provided more relevant solutions and
more social solutions to different social situations.
In emotional knowledge after treatment, children provided
more examples of basic as well as complex emotions, supplied more specific
rather then general examples, and included an audience more often in complex emotions
(e.g., embarrassment). Children also obtained higher teacher-rated social
skills scores in cooperation, assertion, and self-control after treatment.
The implications of these findings are discussed in terms
of the effectiveness of the current model of intervention for high functioning children
with autism. This research was supported by agrantfroni the Israel Foundation
Trustees.
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* * *
Targeting Fathers As Treatment Providers: Designing Parent
Training Interventions For Fathers Of Children With Autism.
M. Winter and L. Schreibman. Autism Research Laboratory,
University of California, San Diego, Department of Psychology, La Jolla, CA
92093-0109.
Previous studies indicate that training parents to
implement behavioral treatment is an effective means to increase skills of
children with autism (e.g. Koegel, Bimbela & Schreibman, 1996), the
benefits of which include maximizing treatment time, minimizing cost and
enhancing generalization.
Researchers have noted a lack of father involvement in
parent training, and increasing evidence has supported the importance of the
father ’s participation in parent training programs (Budd & O’Brien, 1982;
Horton, 1984).
In spite of these findings, actual father participation in
parent training programs has not increased. In order to assess the factors that
influence father participation in parent training, a survey in questionnaire format
was designed to assess mothers and fathers’ reasons for non-participation, as
well as preferences regarding parent training content and format.
Results indicated that fathers and mothers differ in their
reasons for not participating, preferred content, and preferred format of
parent training. This provides preliminary evidence that existing methods of
parent training may not be adequate in meeting the needs of fathers, suggesting
that it may be possible to increase the rate of father participation in parent
training programs by developing alternative types of interventions more suited
to fathers.
Preliminary data suggest that a father-focused parent
training program would include elements such as flexible scheduling and
tailoring topics to participants’ specific areas of interest. Source of
support: NIMH.
* * *
Effectiveness Of Training Parents To Target Joint
Attention In Children With
Autism
M. Rocha* & Laura Schreibman Autism Research
Laboratory, University of California, San Diego, San Diego, CA 92122.
Specific to children with autism are deficits in
initiating and responding to joint attention initiations. The present study was
designed to examine a parent-implemented (rather than therapist-implemented)
autism intervention targeting joint attention responding in children with
autism.
Parents were trained to increase their joint attention
bids and use naturalistic behavior modification techniques to reinforce
appropriate responding.
This research suggests that parents of children with
autism can be effectively trained to employ joint attention training techniques
and this training can be linked to increases in target behaviors. Additionally,
results suggest that changes in both parent and child behavior generalize to the
home environment.
Although not directly targeted, increased joint
attention initiations
were also observed. Results are discussed in terms of
treatment implications
and future investigations. Funding: National Institute of
lslental Health
* * *
Training Spontaneous Imitation In Children With Autism
Using Naturalistic Teaching Strategies.
Ingersoll and L. Schreibman. Univ. of Calif, San Diego, CA
92093.
Children with autism exhibit syndrome-specific deficits in
imitation. These deficits are a barrier
to the acquisition of new skills and to socialization, and thus a focus of many
early intervention programs for young children with autism. Traditional
imitation training procedures are typically adult-directed and are implemented
in a highly structured environment.
A multiple-baseline design was used to investigate the
effectiveness of a more naturalistic, child-directed imitation intervention
incorporating contingent imitation, time delay, and direct response-reinforcer relationships.
Results indicate that imitation can be taught effectively in an unstructured,
play environment and that these skills maintain in the absence of
reinforcement.
Additional results suggest that this procedure produces
collateral changes in social and language behaviors.
* * *
DeVilliers,J. Fine and P. Szatmari. McMaster University,
Faculty of Health Sciences, Hamilton, ON L8S 4L8.
Social communication impairments have a substantial impact
on quality of life for individuals with Pervasive Developmental Disorder (PDD),
but there are few well-standardized, reliable and valid measures of conversational
breakdown that provide sufficient variation to be useful in a variety of
circumstances.
The objective of this study was to develop such a scale.
Forty-seven ten-minute semistructured conversations of children and adolescents
with high functioning autism and Asperger’s syndrome were audiotaped,
transcribed and analyzed using a functional linguistic paradigm (Halliday,
1994).
After analyzing the tapes, a sub-sample of nine pragmatic
features was developed: 1)Formal Intonation; 2)Topic Switching; 3)Terseness;
4)Pedantic Speech; 5)Perseveration; 6)Pausing; 7)Distractibility; 8)Attention
to Outside Environment; and 9)Atypical Stress Selection. The scale shows good interrater
reliability and is not simply a reflection of IQ or language competence.
The scale represents an initial construct for
characterizing language use in PDD and an initial step towards developing a
treatment program for social reciprocity impairments in conversation. Sources
of funding: Ontario Mental Health Foundation Social Sciences and Humanities
Research Council.
* * *
Relationship Of Age And Viq To Neuropsychological And
Social-Cognitive Task Performance In Autism .
F. Nagy*, K.A. Loveland, D.A. Pearson, & 3.
Bachevalier. Dept. Psych.& Beh.
Sci., and Dept. Neurobiol. & Anat., Univ. TX Med.
Sch., Houston, TX 77030.
Primary social-emotional deficits of autism may be related
to dysfunction of a brain circuit including orbito-prefrontal cortex and amygdala,
and intellectual deficits to dysfunction of dorsolateral prefrontal cortex and
hippocampus. As part of a larger study to test these hypotheses, 43 children
and adolescents with autism (6 f, 37 as, VIQ: 40 - 154, m=83.79 (29.50); age 86
- 225 mos m=132.16 (28.55) were tested for dysfunction of orhitofrontal cortex
(object discrim. reversal), amygdala (emotion recognition: preferential
looking), dorsolateral prefrontal cortex (spatial delayed alternation and
attention set shift), and hippocampus (spatial span); along with sociocognitive
skills (theory of mind, empathy, joint attention behavior, following point and
gaze).
Relationship of age and Verbal IQ to measures was examined
using multiple regression. All except preferential looking to novel emotions
were significantly related to VIQ, while age was related only to preferential looking
(8=0.36, p=O.Ol6) and socio-cognitive skills (joint attention 8=0.43 p=O.002;
theory of mind 8=0.37, peO.OOl; pointing 8=0.53, p<O.OO1; gaze following
11=0.46, p=O.OOl).
No prefrontal or hippocampal tasks showed age-related development
when VIQ was controlled, suggesting that development of prefrontal and hippocampal
functions is delayed in children and adolescents with autism.
However, unexpectedly, emotion recognition showed
age-related development
but was not related to verbal level. Results support the
developmental
involvement of a prefrontal-limbic system in autistic
symptoms. Research
Supported by NICHD: P01 HD35471
* * *
The Social Reciprocity Scale: Validation Of A Quantitative
Genetic Measure Of Autistic Traits .
Constantino, R. Todd. Dept. of Psychiatry, Washington
Univ. Sch. of Med., St. Louis, MO, 63110.
Objective: To validate Ihe Social Reciprocity Scale (SRS),
a new 65-item questionnaire which measures autism spectrum symptomatology as a continuous
variable.
Methods: The SRS was completed by parents and/or teachers
of over 1800 children (age 4-17), including normal school children, child
psychiatric patients with and without PDD’s, and 557 epidemiologically
ascertained twin pairs. The Child Behavior Checklist (CBCL) was also obtained
on all of the male twin pairs (n=232 pairs), and the Autism Diagnostic
Interview-Revised (ADI-R) was obtained on 50 of the clinical subjects.
Results: The SRS takes 15-20 minutes to complete. SRS
scores are normally distributed in the population, unrelated to IQ in
non-retarded individuals, differentiate children with autism spectrum
conditions from those with other psychiatric diagnoses, and correlate strongly
(r~.80) with scores on the social deficit scale of the ADI-R. SRS scores are
strongly influenced by genetic factors (on the order of .76 in males), some of
which (.25-30) appear to be gender specific. Multivariate analyses of male
twins confirmed that the SRS measures aspects of psychopathology that are
largely distinct from those ascertained by the CBCL.
Conclusion: The SRS is a valid measure of social deficits
across the entire autism spectrum from mild to severe. Assuming that the
genetic factors influencing SRS scores are the same as those which confer susceptibility
to autism, the SRS will be useful for identifying discordant sib pairs for
population-based quantitative genetic studies of autism, as well as for large
scale clinical, epidemiologic, and treatment studies. Funding: NAAR, NICHD, CF. Dana Fdn.
* * *
Measuring Early Language Development In Preschool Children
With Autism Spectrum Disorder Using The Macarthur Communicative Development
Inventory (Infant Form)
I. Charman, A. Drew,
C. Baird, G. Baird. Institute of Child Health, University College London,
London, WC1N IEH, UK.
Parent report data on early language development measured
using the MacArthur Communicative Development Inventory (CDI - Infant Form) was
collected on 134 pre-school children with autism spectrum disorder. The pattern
of development of understanding of phrases, word comprehension and expression,
and production of gestures, was compared to the typical pattern.
In addition to the expected pattern of considerably
delayed language acquisition, atypical patterns were identified in the
emergence of language skills in the sample. Comprehension of words was delayed
in comparison to word and gesture production, and production of early gestures
(involving sharing reference) was delayed relative to production of later
gestures (involving use of objects).
However, other aspects of language development were
similar to that found in typically developing infants, including gesture
production acting as a “bridge” between word comprehension and word production
and the pattern of acquisition across word categories and word forms.
The implications for assessment and intervention with
pre-school children with autism spectrum disorder are discussed.
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