Laura Schreibman

Unusual brain growth patterns in early life in patients with autistic disorder An MRI study

Objective: To quantify developmental abnormalities in cerebral and cerebellar volume in autism. Methods: The authors studied 60 autistic and 52 normal boys (age, 2 to 16 years) using MRI. Thirty autistic boys were diagnosed and scanned when 5 years or older. The other 30 were scanned when 2 through 4 years of age and then diagnosed with autism at least 2.5 years later, at an age when the diagnosis of autism is more reliable. Results: Neonatal head circumferences from clinical records were available for 14 of 15 autistic 2- to 5-year-olds and, on average, were normal (35.1 ± 1.3 cm versus clinical norms: 34.6 ± 1.6 cm), indicative of normal overall brain volume at birth; one measure was above the 95th percentile. By ages 2 to 4 years, 90% of autistic boys had a brain volume larger than normal average, and 37% met criteria for developmental macrencephaly. Autistic 2- to 3-year-olds had more cerebral (18%) and cerebellar (39%) white matter, and more cerebral cortical gray matter (12%) than normal, whereas older autistic children and adolescents did not have such enlarged gray and white matter volumes. In the cerebellum, autistic boys had less gray matter, smaller ratio of gray to white matter, and smaller vermis lobules VI–VII than normal controls. Conclusions: Abnormal regulation of brain growth in autism results in early overgrowth followed by abnormally slowed growth. Hyperplasia was present in cerebral gray matter and cerebral and cerebellar white matter in early life in patients with autism.

Impairment in shifting attention in autistic and cerebellar patients

MRI and autopsy evidence of early maldevelopment of cerebellar vermis and hemispheres in autism raise the question of how cerebellar maldevelopment contributes to the cognitive and social deficits characteristic of autism. Compared with normal controls, autistic patients and patients with acquired cerebellar lesions were similarly impaired in a task requiring rapid and accurate shifts of attention between auditory and visual stimuli. Neurophysiologic and behavioral evidence rules out motor dysfunction as the cause of this deficit. These findings are consistent with the proposal that in autism cerebellar maldevelopment may contribute to an inability to execute rapid attention shifts, which in turn undermines social and cognitive development, and also with the proposal that the human cerebellum is involved in the coordination of rapid attention shifts in a fashion analogous to its role in the coordination of movement.

Joint attention training for children with autism using behavior modification procedures

BACKGROUND Deficits in joint attention are considered by many researchers to be an early predictor of childhood autism (e.g., Osterling & Dawson, 1994) and are considered to be pivotal to deficits in language, play, and social development in this population (Mundy, 1995). Although many researchers have noted the importance of joint attention deficits in the development of children with autism (e.g., Mundy, Sigman, & Kasari, 1994) and have called for intervention strategies (e.g., Mundy & Crowson, 1997), few studies have attempted to target joint attention. In this study, joint attention behaviors were taught to children with autism using a behavior modification procedure. METHODS A multiple-baseline design was implemented to evaluate intervention effects. The following target behaviors were included in the intervention: 1) Responding to showing, pointing, and gaze shifting of adult; 2) Coordinated gaze shifting (i.e., coordinated joint attention); and 3) Pointing (with the purpose of sharing, not requesting). Generalization to setting and parent, follow-up sessions, and social validation measures were also analyzed. RESULTS Joint attention behaviors were effectively trained and targeted behaviors generalized to other settings. In addition, positive changes were noted by naive observers using social validation measures. CONCLUSIONS Integrating joint attention training into existing interventions may be important for children with autism. In addition, training parents in these techniques may help to maintain joint attention skills outside of the treatment setting.

Enhancing conversation skills in children with autism via video technology. Which is better, "self" or "other" as a model?

The present studywas designed to compare the efficacy of “self” versus “other” video-modeling interventions. Five children with autism ranging in age from 4 to 11 were taught to answer a series of conversation questions in both self and other video-modeled conditions. Results were evaluated using a combination of a multiple baseline and alternating treatments design. Three out of the five participants performed at levels of 100% accuracy at posttreatment. Results indicated no overall difference in rate of task acquisition between the two conditions, implying that children who were successful at learning from video in general, learned equally as well via both treatment approaches. Anecdotal evidence suggested that participants who were successful with video treatment had higher visual learning skills than children who were unsuccessful with this approach. Results are discussed in terms of a visual learning model for children with autism.

Consistent Stress Profiles in Mothers of Children with Autism.

The present study extends the area of research on stress in parents of autistic children. In this study we used the Questionnaire on Resources and Stress (Holroyd, 1987) to compare the stress profiles across mothers (a) who lived in different cultural and geographic environments; (b) who had children of different ages; and (c) who had children with different functioning levels. Results showed a characteristic profile that was highly consistent across each of these subgroups. Major differences from the normative data occurred on scales measuring stress associated with dependency and management, cognitive impairment, limits on family opportunity, and life-span care. Results suggest the importance of developing treatment programs aimed at reducing stress in specific areas in families with autistic children.

Intensive Behavioral/Psychoeducational Treatments for Autism: Research Needs and Future Directions

It is widely acknowledged that, to date, the forms of treatment enjoying the broadest empirical validation for effectiveness with individuals with autism are those treatments based upon a behavioral model and that such treatments are best implemented intensively and early in the childs development. This paper describes several features important in the success of this model and presents remaining issues to be addressed for improving treatment effectiveness. While it is appreciated that there is no “one size fits all” treatment for children with autism, there is as yet no established protocol for relating specific child, family, target behavior, and treatment variables to individualized treatment regimens. Future research needs to include well-conceived and methodologically rigorous investigations allowing for the determination of these important variables.

Collateral effects of parent training on family interactions

Recent research suggests that using naturalistic teaching paradigms leads to therapeutic gains in clinic settings for children with autism and related disorders. More recent studies are demonstrating that implementing these strategies within a parent training format may produce collateral effects in other areas of family life. The present experiment assessed collateral effects of two very different parent training paradigms during unstructured dinnertime interactions in the family setting. One paradigm focused on teaching individual target behaviors (ITB) serially, and the other focused on a recently developed naturalistic paradigm that teaches the pivotal responses (PRT) of motivation and responsivity to multiple cues. Two groups of families were randomly assigned to each of the parent training conditions. Pretraining and post- parent- training videotapes of dinnertime interactions were scored in a random order across four interactional scales (level of happiness, interest, stress, and style of communication). Results obtained for the four interactional scales showed that the families in both conditions initially scored in the neutral range, and the ITB training paradigm produced no significant influence on the interactions from pretraining to posttraining. In contrast, however the PRT parent training paradigm resulted in the families showing positive interactions on all four scales, with the parent-child interactions rated as happier, the parents more interested in the interaction, the interaction less stressful, and the communication style as more positive.

Naturalistic Developmental Behavioral Interventions: Empirically Validated Treatments for Autism Spectrum Disorder

Earlier autism diagnosis, the importance of early intervention, and development of specific interventions for young children have contributed to the emergence of similar, empirically supported, autism interventions that represent the merging of applied behavioral and developmental sciences. “Naturalistic Developmental Behavioral Interventions (NDBI)” are implemented in natural settings, involve shared control between child and therapist, utilize natural contingencies, and use a variety of behavioral strategies to teach developmentally appropriate and prerequisite skills. We describe the development of NDBIs, their theoretical bases, empirical support, requisite characteristics, common features, and suggest future research needs. We wish to bring parsimony to a field that includes interventions with different names but common features thus improving understanding and choice-making among families, service providers and referring agencies.

Individual Behavioral Profiles and Predictors of Treatment Effectiveness for Children With Autism

Differential responsiveness to intervention programs suggests the inadequacy of a single treatment approach for all children with autism. One method for reducing outcome variability is to identify participant characteristics associated with different outcomes for a specific intervention. In this investigation, an analysis of archival data yielded 2 distinct behavioral profiles for responders and nonresponders to a widely used behavioral intervention, pivotal response training (PRT). In a prospective study, these profiles were used to select 6 children (3 predicted responders and 3 predicted nonresponders) who received PRT. Children with pretreatment responder profiles evidenced positive changes on a range of outcome variables. Children with pretreatment nonresponder profiles did not exhibit improvements. These results offer promise for the development of individualized treatment protocols for children with autism.

The Use of Video Priming to Reduce Disruptive Transition Behavior in Children with Autism

This study investigated the use of video priming, or exposure, as a means for reducing or eliminating the disruptive behavior of children with autism in transition situations. Specifically, it was hypothesized that such disruptive behavior would be reduced if the children received prior priming to upcoming transitions. Three children with autism who demonstrated severely disruptive behavior during transitions viewed short videos of specific transition situations in which parents reported behavioral difficulties. A multiple-baseline design across participants showed that the implementation of the video priming procedure led to a reduction or elimination of the disruptive behavior. Further, behavior reductions generalized to new transition situations. The results are discussed in terms of the possible mechanisms responsible for treatment effects and the potential advantages of using video interventions with this population.