Lauren Turner-Brown

Children with autism demonstrate circumscribed attention during passive viewing of complex social and nonsocial picture arrays

Although circumscribed interests are a hallmark characteristic of autism spectrum disorders, providing a means for quantifying their functional impairment has proven difficult. We developed a passive viewing task to measure aspects of visual attention in children with autism spectrum disorders and typically developing controls. Task stimuli included picture arrays that were matched for social and nonsocial content. Nonsocial content was balanced to include items related to circumscribed interests (e.g., trains) as well as more commonplace items (e.g., furniture). Discrete aspects of gaze behavior were quantified using eye‐tracking technology. Results indicate that visual attention in the autism group was more circumscribed (as indicated by the exploration of fewer images), more perseverative (as indicated by longer fixation times per image explored), and more detail oriented (as indicated by a greater number of discrete fixations on explored images). This pattern of results was similar for both social and object arrays. Within the autism group, overall severity of repetitive behavior symptoms correlated positively with exploration of object pictures and negatively with perseveration on social pictures. Results suggest that children with autism have a domain‐general pattern of atypical visual attention that may represent an exaggeration of a typical attentional process and is related to a tendency to perseverate on images of interest and explore them in a more detail‐oriented manner. Discrete measures of visual attention may therefore provide a reasonable means of quantifying aspects of the repetitive behavior phenotype in autism.

Phenomenology and measurement of circumscribed interests in autism spectrum disorders

Circumscribed interests (CI) are important and understudied symptoms that affect individuals with autism spectrum disorders (ASD). The present study sought to develop quantitative measures of the content, intensity and functional impairment of CI in 50 children with high-functioning ASD compared to an age-, IQ-, and gender-matched sample of 50 typically developing (TD) peers. The Interests Scale, a parent-rating questionnaire, and the Interview for Repetitive Behaviors, a semi-structured interview, were used to assess CI. Groups did not differ on the number of interests children held, but they did differ on types of interests and impairment associated with them. The interests of ASD participants were more likely to be nonsocial in nature (e.g. mechanical systems) than TD participants. Parents of children with ASD endorsed higher degrees of functional impairment on metrics including frequency, interference, resistance when interrupted, flexibility, and accommodation required, as well as less involvement of other people, than parents of children with TD. These findings suggest that interests of individuals with ASD differ qualitatively and in intensity from individuals with TD. The present study offers further support for the notion that CI reflect a clinically significant feature of ASD that warrants intervention in some children.

The First Year Inventory: a longitudinal follow-up of 12-month-old to 3-year-old children:

The First Year Inventory is a parent-report measure designed to identify 12-month-old infants at risk for autism spectrum disorder. First Year Inventory taps behaviors that indicate risk in the developmental domains of sensory–regulatory and social–communication functioning. This longitudinal study is a follow-up of 699 children at 3 years of age from a community sample whose parents completed the First Year Inventory when their children were 12 months old. Parents of all 699 children completed the Social Responsiveness Scale–Preschool version and the Developmental Concerns Questionnaire to determine age 3 developmental outcomes. In addition, children deemed at risk for autism spectrum disorder based on liberal cut points on the First Year Inventory, Social Responsiveness Scale–Preschool, and/or Developmental Concerns Questionnaire were invited for in-person diagnostic evaluations. We found 9 children who had a confirmed diagnosis of autism spectrum disorder from the sample of 699. Receiver operating characteristic analyses determined that a two-domain cutoff score yielded optimal classification of children: 31% of those meeting algorithm cutoffs had autism spectrum disorder and 85% had a developmental disability or concern by age 3. These results suggest that the First Year Inventory is a promising tool for identifying 12-month-old infants who are at risk for an eventual diagnosis of autism spectrum disorder.

The Home TEACCHing Program for Toddlers with Autism

The study evaluated the efficacy a parent training intervention for children with autism based on the TEACCH model. Twenty families were randomly assigned to the treatment or waitlist group. All families were compared at pre- and post-treatment on formal dependent measures. Direct measures of behavior were compared across six matched pairs using a multiple baseline probe design. The results of the multiple baseline design showed robust support for improvement in child and parent behavior. Due to the sample size and short time frame, results of a repeated measures analysis of variance did not reach significance.

Performance of Children with Autism Spectrum Disorders on the Dimension-Change Card Sort Task.

Restricted and repetitive behaviors in autism spectrum disorders have been conceptualized to reflect impaired executive functions. In the present study, we investigated the performance of 6–17-year-old children with and without an autism spectrum disorder on a dimension-change card sort task that explicitly indicated sorting rules on every trial. Diagnostic groups did not differ in speed of responses after the first rule switch or in speed or accuracy on blocks with mixed versus single sort rules. However, performance of the ASD group was significantly slower and less accurate overall than the typically-developing group. Furthermore, within the ASD group, poorer DCCS task performance did not predict more severe autism symptoms. Implications for the executive dysfunction theory of autism are discussed.

Preliminary Efficacy of Adapted Responsive Teaching for Infants at Risk of Autism Spectrum Disorder in a Community Sample

This study examined the (a) feasibility of enrolling 12-month-olds at risk of ASD from a community sample into a randomized controlled trial, (b) subsequent utilization of community services, and (c) potential of a novel parent-mediated intervention to improve outcomes. The First Year Inventory was used to screen and recruit 12-month-old infants at risk of ASD to compare the effects of 6–9 months of Adapted Responsive Teaching (ART) versus referral to early intervention and monitoring (REIM). Eighteen families were followed for ~20 months. Assessments were conducted before randomization, after treatment, and at 6-month follow-up. Utilization of community services was highest for the REIM group. ART significantly outperformed REIM on parent-reported and observed measures of child receptive language with good linear model fit. Multiphase growth models had better fit for more variables, showing the greatest effects in the active treatment phase, where ART outperformed REIM on parental interactive style (less directive), child sensory responsiveness (less hyporesponsive), and adaptive behavior (increased communication and socialization). This study demonstrates the promise of a parent-mediated intervention for improving developmental outcomes for infants at risk of ASD in a community sample and highlights the utility of earlier identification for access to community services earlier than standard practice.

Generativity abilities predict communication deficits but not repetitive behaviors in Autism Spectrum Disorders.

Individuals with Autism Spectrum Disorders (ASD) often demonstrate impaired generativity that is thought to mediate repetitive behaviors in autism (Turner in J Child Psychol Psychiatry, 40(6):839–849, 1999a). The present study evaluated generativity in children with and without ASD via the use-of-objects task (Turner in J Child Psychol Psychiatry, 40(2):189–201, 1999b) and an Animals Fluency Task (Lezak in Neuropsychological assessment. Oxford University Press, Oxford, 1995). Groups differed significantly on two of four metrics from the Animals Fluency Task and two of seven metrics from the Use of Objects task. In the ASD sample, no significant relations were found between generativity and repetitive behaviors. Significant relations were found, however, between performance on the Animals Fluency Task and communication symptoms. Results replicate reports of generativity deficits in ASD and suggest that impaired generativity may reflect communication deficits that are characteristic of the disorder.

Designing Studies to Evaluate Parent-Mediated Interventions for Toddlers With Autism Spectrum Disorder

Given recent advances in science, policy, and practice of early identification in autism spectrum disorder (ASD), questions about the effectiveness of early intervention have far-reaching service and policy implications. However, rigorous research evaluating the efficacy and effectiveness of intervention programs for toddlers with ASD faces a multitude of novel scientific challenges. The Autism Speaks Toddler Treatment Network (ASTTN) was formed in 2007 to provide an infrastructure for ongoing communication between the investigators of eight research projects evaluating parent-mediated interventions for toddlers with ASD. The present article describes and compares the research studies of the ASTTN; highlights specific challenges with regard to research design, participants, recruitment, eligibility criteria, enrollment, and intervention approach; and outlines practical considerations that may guide the next generation of parent-mediated intervention studies involving toddlers with ASD.

Development of the Contextual Assessment of Social Skills (CASS): A Role Play Measure of Social Skill for Individuals with High-Functioning Autism

This study piloted a role play assessment of conversational skills for adolescents and young adults with high-functioning autism/Asperger syndrome (HFA/AS). Participants completed two semi-structured role plays, in which social context was manipulated by changing the confederate’s level of interest in the conversation. Participants’ social behavior was rated via a behavioral coding system, and performance was compared across contexts and groups. An interaction effect was found for several items, whereby control participants showed significant change across context, while participants with HFA/AS showed little or no change. Total change across contexts was significantly correlated with related social constructs and significantly predicted ASD. The findings are discussed in terms of the potential utility of the CASS in the evaluation of social skill.

Cultural Effects on the Diagnosis of Autism Spectrum Disorder among Latinos

The role of culture in autism spectrum disorders (ASD) has been too often neglected in research. The present study evaluated the implications of cultural factors for ASD screening and diagnosis by examining the parenting perceptions and diagnostic experiences of Latina and White mothers of children with ASD. The children of Latina mothers were diagnosed significantly later and were significantly more likely to be diagnosed with autism than with another ASD. Latina mothers demonstrated significantly less knowledge of developmental milestones and of ASD. Latina mothers were also significantly more likely to report early concerns about temperament. The results of this study suggest that both socioeconomic and culturally based differences likely influence the early perception and diagnosis of ASD.