Claudia List Hilton

Autism recurrence in half siblings: strong support for genetic mechanisms of transmission in ASD

Autism recurrence in half siblings: strong support for genetic mechanisms of transmission in ASD

Motor impairment in sibling pairs concordant and discordant for autism spectrum disorders.

Aim: Although motor impairment is frequently observed in children with autism spectrum disorders (ASD), the manner in which these impairments aggregate in families affected by autism is unknown. We used a standardized measure of motor proficiency to objectively examine quantitative variation in motor proficiency in sibling pairs concordant and discordant for ASD. Methods: Motor impairment of sibling pairs from 67 ASD-affected families comprising 29 concordant pairings and 48 discordant pairings were assessed using the Bruininks Oseretsky Test of Motor Proficiency, 2nd Edition, a standardized measure of motor proficiency. Results: Motor skills were substantially impaired among ASD-affected children and highly correlated with autistic severity and IQ, whereas motor skills in unaffected siblings were essentially normal. Total motor composite scores of at least one standard deviation below the general population mean were seen in 83% of the affected group compared with 6% in the unaffected siblings. Interpretation: Findings indicate that motor impairment constitutes a core characteristic of ASD (not necessarily an ASD endophenotype), which has distinct implications for taxonomy, diagnosis, and approaches to intervention.

Brief Report: Under-Representation of African Americans in Autism Genetic Research: A Rationale for Inclusion of Subjects Representing Diverse Family Structures

African American children with autism are seriously under-represented in existing genetic registries and biomedical research studies of autism. We estimated the number of African American children with autism in the St. Louis region using CDC surveillance data and present the outcomes of a concerted effort to enroll approximately one-third of that population into either of two large national genetic autism registries. The results revealed that even after traditional barriers to research participation were addressed and all contacted families expressed a willingness to participate, 67% of the reachable families were disqualified from participation because of family structure alone. Comprehensive efforts—including expansion of eligibility to families of diverse structure—are warranted to facilitate the inclusion of African American children in biomedical research.

Effects of exergaming on executive function and motor skills in children with autism spectrum disorder: a pilot study.

Executive function (EF) and motor deficits have consistently been documented in studies of people with autism spectrum disorders (ASD). We investigated the effects of a pilot 30-session Makoto arena training intervention, a light and sound speed-based exergame, on response speed, EF, and motor skills in school-aged children with ASD. Strong correlations were seen between certain EF and motor scores, suggesting a relationship between the two constructs. Participants increased their average reaction speed (effect size = 1.18). Significant improvement was seen in the EF areas of working memory and metacognition and the motor area of strength and agility. Findings suggest that use of exergaming, specifically the Makoto arena, has the potential to be a valuable addition to standard intervention for children with ASD who have motor and EF impairments.

An occupational justice perspective of domestic violence against women with disabilities

This article explores domestic violence against women with disabilities from an occupational justice perspective. Domestic violence against these women warrants special attention because they are abused at rates equal to or greater than women without disabilities and they experience disability‐specific forms of abuse. The discussion adds to the body of knowledge of domestic violence by analyzing the occupational imbalance, marginalization, deprivation and alienation that women with disabilities experience as instances of occupational injustice that ultimately undermine health. Domestic violence against women with disabilities is also posited as an appropriate issue to examine from this perspective because of the layered injustices experienced. Finally, empowerment is proposed as a strategy to address the issues identified.

The Evolving Postbaccalaureate Entry: Analysis of Occupational Therapy Entry-Level Master's Degree in the United States

At the American Occupational Therapy Associations Annual Conference in 1999, the Representative Assembly passed Resolution J, which became Resolution 670–99 and mandated that entry to the professional level of practice in occupational therapy be at the post-baccalaureate degree level. The Accreditation Council for Occupational Therapy Education (ACOTE) set the effective date as 2007. As a result, more than 50 of the existing 157 occupational therapy educational programs faced the challenge of developing postbaccalaureate entry degree programs. These programs had previously offered only baccalaureate entry degrees. This article compiles the expectations that were articulated as outcomes of transitioning to postbaccalaureate entry, describes findings from an analysis of the current structure of the evolving masters entry level occupational therapy education and identifies concerns for consideration by educational programs and practitioners.

Review of instrument development and testing studies for children and youth

We reviewed 12 articles from 2012 that addressed development and testing of instruments for children and youths and American Journal of Occupational Therapy articles from 2009-2013 that addressed 11 activity and participation instruments to determine how well this group of instruments facilitates the generation of evidence sufficient to support practice in accordance with the Centennial Vision. We observed an increase in the number of instrument development and testing studies and in higher level studies and larger cohorts; funding was provided for almost half of the studies, and attention was given to use of blind testing and transition to adult-age assessments. Further development of performance-based activity and participation instruments; instruments that examine biomedical molecular-cellular, biomedical, and environmental mechanisms; and intervention fidelity measures and increased use of blind testing are necessary for occupational therapy to meet the Centennial Vision.

Sensory Processing and Motor Issues in Autism Spectrum Disorders

Although sensory processing and motor abnormalities are not among the three pathognomonic features of autism spectrum disorders (ASDs; American Psychiatric Association, 2000), many studies have found children with autism to have a higher incidence of both compared to the typically developing population. Atypical sensory processing may limit participation in meaningful activities, such as playing with others or participating in other social activities. Children who have motor impairments also tend to engage in less diversity of activities than do other children, with more frequent participation in quiet recreational activities and less frequent participation in social activities, especially social activities that are spontaneous (Brown & Gordon, 1987; Margalit, 1981; Sillanpaa, 1987). Significant differences were seen in participation between children with ASD and typically developing children in the number of activities in which children participate, the numbers of individuals with whom they participate, and the variety of environments in which they participate (Hilton, Crouch, & Israel, 2008). Both sensory processing and motor abnormalities can limit children with ASD from participation in meaningful activities.

Research focused on children and youth

We reviewed 22 articles on children and youth published in 2011 in the American Journal of Occupational Therapy and organized the articles by level of research and research type according to a framework adapted from the International Classification of Functioning, Disability and Health (ICF; World Health Organization, 2007). The largest percentage of articles described intervention effectiveness studies classified as Level III or IV. The bulk focused on the Body Function/Body Structure construct of the ICF, but as a whole the studies addressed all the constructs except Biomedical Molecular/Cellular. Rigor remains a concern, although laudable efforts have been made to increase strength of the evidence. Longitudinal, efficacy, and qualitative studies, as well as studies examining adolescents and the transition to adulthood, were absent from articles in this review and are important areas for future investigation. Several studies explicitly addressed intervention fidelity, an imperative in evidence-based research needed to move the profession toward the Centennial Vision.

Healthy Habit Changes in Pre-Professional College Students: Adherence, Supports, and Barriers

This study examined the impact of participation in a wellness assignment on healthy habit changes in pre-professional undergraduate students. Participants consisted of 58 students enrolled in an undergraduate occupational science health and wellness course. Students were given an assignment to alter three to five habits that would improve their wellness over the semester, and follow-up surveys tracked their adherence to the changes. The assignment and outcomes were retrospectively analyzed using social cognitive and self-determination theories. Students believed that participation in the assignment increased (1) their own wellness status, (2) their understanding of how to impact their own wellness, and (3) their ability to understand client and therapist perspectives on making habit changes. The outcomes suggest that using the principles of social cognitive and self-determination theories appears to support the success of and adherence to healthy habit changes. Implications for occupational therapy educators and practitioners in the use of these theoretical models to support behavior changes are discussed.