Jacqueline Roberts

Echolalia and comprehension in autistic children

The research reported in this paper investigates the phenomenon of echolalia in the speech of autistic children by examining the relationship between the frequency of echolalia and receptive language ability. The receptive language skills of 10 autistic children were assessed, and spontaneous speech samples were recorded. Analysis of these data showed that those children with poor receptive language skills produced significantly more echolalic utterances than those children whose receptive skills were more age-appropriate. Children who produced fewer echolalic utterances, and had more advanced receptive language ability, evidenced a higher proportion of mitigated echolalia. The most common type of mitigation was echo plus affirmation or denial.

Do behavioural approaches teach children with autism to play or are they pretending

Play is, by definition, internally motivated, flexible, spontaneous and voluntary. Yet some researchers claim to have taught children with autism to play using behavioural interventions that are heavily structured, repetitive and make use of external reinforcements. In the current systematic review, we examine the extent to which these claims are supported by the evidence presented by the researchers themselves. We conclude that the most effective behavioural interventions have been those which have built on childrens existing abilities or have relied on the motivating nature of activities themselves rather than on external rewards. We discuss the problems inherent in distinguishing between behavioural and cognitive change in childrens play and highlight generalization as a poorly understood but focal process. Finally, we discuss the value of teaching children with autism play behaviours when these are not characterized by the defining qualities of play as a disposition.

Independence of Hot and Cold Executive Function Deficits in High-Functioning Adults with Autism Spectrum Disorder

Individuals with autistic spectrum disorder (ASD) display diverse deficits in social, cognitive and behavioral functioning. To date, there has been mixed findings on the profile of executive function deficits for high-functioning adults (IQ > 70) with ASD. A conceptual distinction is commonly made between “cold” and “hot” executive functions. Cold executive functions refer to mechanistic higher-order cognitive operations (e.g., working memory), whereas hot executive functions entail cognitive abilities supported by emotional awareness and social perception (e.g., social cognition). This study aimed to determine the independence of deficits in hot and cold executive functions for high-functioning adults with ASD. Forty-two adults with ASD (64% male, aged 18–66 years) and 40 age and gender matched controls were administered The Awareness of Social Inference Test (TASIT; emotion recognition and social inference), Letter Number Sequencing (working memory) and Hayling Sentence Completion Test (response initiation and suppression). Between-group analyses identified that the ASD group performed significantly worse than matched controls on all measures of cold and hot executive functions (d = 0.54 − 1.5). Hierarchical multiple regression analyses revealed that the ASD sample performed more poorly on emotion recognition and social inference tasks than matched controls after controlling for cold executive functions and employment status. The findings also indicated that the ability to recognize emotions and make social inferences was supported by working memory and response initiation and suppression processes. Overall, this study supports the distinction between hot and cold executive function impairments for adults with ASD. Moreover, it advances understanding of higher-order impairments underlying social interaction difficulties for this population which, in turn, may assist with diagnosis and inform intervention programs.

Autism in context 1: Classification, counting and causes

This review paper describes our current perspective of autism spectrum disorders (ASD), taking into account past, current and future classification systems and the evolving definitions of ASD. International prevalence rates from 1965 to 2012 are presented and key issues, including whether there is an epidemic of autism and what this means in terms of thinking about possible causes of autism, are discussed. Also discussed is the need for high quality national data collection in Australia and the evidence, and lack of evidence, for the many theoretical causes of ASD. The lack of robust classification of autism along with limited high quality evidence base about its prevalence and possible causes leaves ample space for future discoveries.

A review of research into stakeholder perspectives on inclusion of students with autism in mainstream schools

ABSTRACT Increasing numbers of students with autism are being educated in mainstream schools. However, outcomes for students with autism are poor when compared to typical students and students with other developmental disabilities. In order to better understand facilitators and barriers to success at school for students with autism, research into the attitudes of key stakeholders, educators, parents, people with autism, to inclusion in mainstream schools for students with autism, was reviewed. Key themes emerging included attitudes to inclusion, the characteristics of autism and social communication in particular and interaction with the school environment, and consequent student problem behaviour. Level of knowledge and understanding of school staff emerged as the primary issue with all stakeholders identifying the need for more training. Other support needs identified included the need for structural support, resources and funding. Parents, in particular, identified the need for a collaborative approach to the education process. The findings highlight the need to translate theory into practice to increase capacity in schools to provide effective educational programmes for students with autism.

Autism in context 2: Assessment, intervention and services in Australia

Continuing from part 1, part 2 of the autism spectrum disorders review explores clinical practice and service delivery aspects of autism spectrum disorders including current assessment approaches in Australia, family‐centred models of care, and key service structure and delivery issues. Treatments including behavioural interventions, established and emergent medication, and complementary and alternative therapies are discussed. The key role of paediatricians as both individual child and family care providers and advocates, as well as agents of service reform in Australia, is evident. Much still needs to be done.

Regression in autism spectrum disorders

Since the Journal of Paediatrics and Child Health was first published, there has been substantial change in the field of autism spectrum disorders (ASDs) with an exponential increase in the amount of funded and published research. In this paper, we focus on regression in children with ASD, a phenomenon that remains poorly understood. We discuss the implications of what we know about regression in ASD for the way we think about ASD more broadly and for paediatric practice.

Telehealth language assessments using consumer grade equipment in rural and urban settings: Feasible, reliable and well tolerated

Introduction Telehealth can be an effective way to provide speech pathology intervention to children with speech and language impairments. However, the provision of reliable and feasible standardised language assessments via telehealth to establish children’s needs for intervention and to monitor progress has not yet been well established. Further, there is limited information about children’s reactions to telehealth. This study aimed to examine the reliability and feasibility of conducting standardised language assessment with school-aged children with known or suspected language impairment via a telehealth application using consumer grade computer equipment within a public school setting. Method Twenty-three children (aged 8–12 years) participated. Each child was assessed using a standardised language assessment comprising six subtests. Two subtests were administered by a speech pathologist face-to-face (local clinician) and four subtests were administered via telehealth. All subtests were completed within a single visit to the clinic service, with a break between the face to face and telehealth sessions. The face-to-face clinician completed behaviour observation checklists in the telehealth and face to face conditions and provided feedback on the audio and video quality of the application from the child’s point of view. Parent feedback about their child’s experience was elicited via survey. Results There was strong inter-rater reliability in the telehealth and face-to-face conditions (correlation coefficients ranged from r = 0.96–1.0 across the subtests) and good agreement on all measures. Similar levels of attention, distractibility and anxiety were observed in the two conditions. Clinicians rated only one session of 23 as having poor audio quality and no sessions were rated as having poor visual quality. Parent and child reactions to the use of telehealth were largely positive and supportive of using telehealth to assess rural children. Discussion The findings support the use of telehealth in the language assessment of school-aged children using a web application and commercially available computer equipment. This reliable and innovative service delivery model has the potential to be used by speech pathologists to provide assessments to children in remote communities.

Anxiety-related symptomatology in young children on the autism spectrum:

Anxiety symptomatology is frequently reported in autistic children, and the prevalence of anxiety disorder is estimated at around 40%. However, most studies have focused upon children of age 8 years or above, so little is known about early signs of anxiety in younger children with autism. This study sought to describe anxiety-related symptomatology in 95 5- to 6-year-old autistic children using the Anxiety Scale for Children with Autism Spectrum Disorder. Wide variability was found in levels of symptomatology with the most frequently reported items within the ‘uncertainty’ subscale and the least frequently reported items in the ‘anxious arousal’ subscale. Comparisons of those with scores less than or greater than 70 on adaptive behaviour suggests some influence of ability on presentation of anxiety-related symptomatology.

Current status, opportunities, challenges and the paediatrician's role as the National Disability Insurance Scheme rolls out across Australia

Current status, opportunities, challenges and the paediatrician’s role as the National Disability Insurance Scheme rolls out across Australia Tamara May, Mike Forrester, Murray Webber, Jacqueline Roberts, Michelle Spreckley, Adam Scheinberg and Katrina Williams Department of Paediatrics, University of Melbourne, Developmental Disability and Rehabilitation Research, Murdoch Children’s Research Institute, School of Psychology, and Department of Medicine, Deakin University, Neurodevelopment and Disability, Royal Children’s Hospital, Department of Paediatrics, Monash University, Melbourne, Victorian Paediatric Rehabilitation Service, University Hospital Geelong, Barwon Health, Geelong, Victoria, Child and Family Health Team and KidsHealth, Hunter New England Local Health District NSW Government, Newcastle, New South Wales, Autism Centre of Excellence, School of Education and Professional Studies, Griffith University, Brisbane, Queensland, Australia