Michael Alessandri

Autism and epilepsy: Historical perspective

Autism spectrum disorders (ASD) and epilepsy co-occur in approximately 30% of individuals with either ASD or epilepsy. While there is no single unifying ASD-epilepsy phenotype, understanding potential commonalities in subgroups of children with an ASD-epilepsy phenotype will help us disentangle the pathophysiology of both ASD and epilepsy. Throughout this brief historical perspective we selectively review critical trends in ASD-epilepsy research and highlight challenges to clinical and research efforts including terminology, heterogeneity of both ASD and epilepsy, and lack of careful characterization of children affected with both ASD and epilepsy. These complex issues continue to burden research on the diagnosis, neurobiology and management of children with ASD and epilepsy. A key concept that has emerged during the past 40 years is the strong association between intellectual disability and a higher prevalence of epilepsy in individuals with ASD. In addition, the two peaks of seizure onset, one in early childhood and one in adolescence and continuing through adulthood may be unique to individuals with ASD. The overlap of language and autistic regression to epilepsy, EEG epileptiform activity, sleep, and to epileptic encephalopathies such as Landau-Kleffner syndrome continue to be controversial areas of research and of clinical interest. An emerging consensus is that shared developmental genetic, molecular and pathophysiological mechanisms exist and account for the common co-occurrence of ASD and epilepsy.

The Personality Variable Openness to Experience as It Relates to Homophobia

ABSTRACT The present study investigated personality and demographic variables of homophobic and non-homophobic individuals. Variables explored included the personality characteristics Neuroticism, Extroversion, and Openness to Experience. The following demographic variables were also explored: gender role beliefs, gender, and personal contact. Participants included 123 students from a large Western university, enrolled in introductory courses in psychology or sociology. Participants completed a questionnaire packet containing a demographic inquiry and three psychological measures-the NEO Personality Inventory, the Assessment of Attitudes Towards Lesbians and Gay Men, and the Bem Sex Role Inventory. Results revealed the variable contact as the most critical predictor of homophobia, followed by gender, and the personality variable Openness to Experience. Furthermore, those who had not had previous contact with a homosexual individual and men were significantly more homophobic. No significant differences were found among gender roles in relation to self-reported indices of homophobia. The results provide attitudinal and behavioral differences that differentiate individuals who are intolerant of homosexuality from those that are more accepting of alternative lifestyles.

Autism spectrum disorders and epilepsy : Moving towards a comprehensive approach to treatment

The biological and phenotypic heterogeneity of children with autism spectrum disorders (ASD) and epilepsy presents a significant challenge to the development of effective treatment protocols. There is no single treatment or treatment protocol for children with ASD or epilepsy. Children with co-occurring ASD and epilepsy should undergo a comprehensive assessment that includes investigation of underlying biological etiologies as well assessment of cognitive, language, affective, social and behavioral function prior to initiating treatment. The comprehensive treatment of children with ASD is based on a combination of therapeutic psychosocial interventions in combination with pharmacological agents. A process-oriented approach to assessment and intervention allows careful analysis of the childs response to treatment such that treatment protocols may be revised secondary to any changes in developmental trajectory of the child with ASD and epilepsy. The possibility of developing pharmacological interventions that target both ASD and epilepsy awaits definitive evidence. The best hope for good developmental outcomes in children with ASD and epilepsy is early recognition and comprehensive treatment of both the ASD and epilepsy.

The Power of Positivity: Predictors of Relationship Satisfaction for Parents of Children with Autism Spectrum Disorder

The current study uses the actor-partner interdependence model to examine the predictors of relationship satisfaction for mothers and fathers of children with autism spectrum disorder. Sixty-seven couples completed measures of optimism, benefit finding, coping strategies, social support, and relationship satisfaction. Results indicated that parent’s positive strengths predicted better personal relationship satisfaction. Moreover, parents’ benefit finding, use of emotional support, and perceived social support from their partner also predicted their partner’s relationship satisfaction. The results of this study highlight the importance of focusing on positive factors that can enhance relationship quality. Implications for the development of parent-focused interventions are discussed.

Social policy on the use of aversive interventions: Empirical, ethical, and legal considerations

In an effort to address the controversy regarding the use of aversive interventions in the treatment of individuals with developmental disabilities, this paper presents a review of the literature on the efficacy of such interventions, along with brief reviews of the ethical and legal issues involved. In general, there appears to be empirical, ethical, and legal support for the continued availability of aversive interventions as treatment options, but only if sufficient safeguards are in place.

An Open Trial of Cognitive-Behavioral Therapy for Anxiety Disorders in Adolescents With Autism Spectrum Disorders

The frequent co-occurrence of anxiety disorders and autism spectrum disorders (ASD) in youth has spurred study of intervention practices for this population. As anxiety disorders in the absence of ASD are effectively treated using cognitive-behavioral therapy (CBT) protocols, an initial step in evaluating treatments for comorbid youth has necessarily centered on adaptation of CBT. One primary limitation of this research, to date, is that interventions for adolescents with anxiety disorders and ASD have not been systematically tested. In this study, 20 adolescents (90% male) with ASD and a comorbid anxiety disorder, between ages 11 and 14 years (M = 12.2 years, SD = 1.11 years), participated in an open trial of modified CBT targeting anxiety with ASD. Findings demonstrated significant reductions in anxiety severity, as assessed by clinician and parent ratings, from baseline to post-treatment. In addition, reductions in parent-rated externalizing symptoms were observed. Gains were maintained at a 1-month follow-up.

Commitment to Classroom Model Philosophy and Burnout Symptoms Among High Fidelity Teachers Implementing Preschool Programs for Children with Autism Spectrum Disorders

Teacher commitment to classroom model philosophy and burnout were explored in a sample of 53 teachers implementing three preschool models at high levels of fidelity for students with autism: Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH); Learning Experiences and Alternative Program for Preschoolers and Their Parents (LEAP); and high quality special education programs (HQSEP’s). Relative to the other groups, LEAP teachers reported significantly higher levels of commitment to LEAP philosophy while TEACCH teachers did not report significantly higher commitment levels to TEACCH philosophy. Teachers in HQSEP’s reported similar levels of commitment to TEACCH and LEAP. Burnout was also low to moderate in this sample relative to normative data. Implications for school districts and teachers are discussed.

Genetic testing and corresponding services among individuals with autism spectrum disorder (ASD)

The purpose of this study was to assess use of genetic testing and corresponding genetic services for children with Autism Spectrum Disorder (ASD). Survey data from 397 parents of individuals with ASD was collected using the Center for Autism and Related Disabilities client registry. Participants reported that 41.2% of the individuals with ASD had undergone any type of genetic testing. However, only 21.3% of individuals with ASD had been referred to a genetics specialist. Diagnosis and level of functioning were significantly associated with both referral to a genetics specialist and having undergone any genetic testing. In addition, Hispanic ancestry was associated with increased referral to genetic testing. Concerns about the limited benefits of genetic testing and prohibitive costs were potential barriers to pursuing genetic testing. Overall, low numbers of individuals with ASD have a history of undergoing genetic testing or receiving genetic services. Possible reasons include low referral rates as well as concerns by parents about cost and relevance, and lack of availability. These findings confirm the historical trend for providing genetic testing and genetic services to those with the greatest impairments.

A Specialized Program for Preschool Children With Autism

In this paper, the work being conducted at the Douglass Developmental Disabilities Center of Rutgers University is described. Specifically, the recent results of research supporting the value of gr...

Validation of the Pictorial Infant Communication Scale for preschool-aged children with autism spectrum disorder

Joint attention, or the shared focus of attention between objects or events and a social partner, is a crucial milestone in the development of social communication and a notable area of deficit in children with autism spectrum disorder. While valid parent-report screening measures of social communication are available, the majority of these measures are designed to assess a wide range of behaviors. Targeted assessment of joint attention and related skills is primarily limited to semi-structured, examiner-led interactions, which are time-consuming and laborious to score. The Pictorial Infant Communication Scale is an efficient parent-report measure of joint attention that can be used as a complement to structured assessments in fully characterizing early social communication development. This study examined the psychometric properties of the Pictorial Infant Communication Scale. Results revealed a high degree of internal consistency and strong intercorrelations between subscales. Additionally, confirmatory factor analysis supported a three-factor model of joint attention. Furthermore, significant correlations between the Pictorial Infant Communication Scale and direct clinical measures of child joint attention, language skills, and autism spectrum disorder symptom severity were suggestive of concurrent validity. Findings suggest that the Pictorial Infant Communication Scale is a promising tool for measuring joint attention skills in preschool-aged children with autism spectrum disorder.