N Ollington

Functional analysis of insistence on sameness in an 11-year old boy with Asperger syndrome

Objective: To identify the functional properties of insistence on sameness associated with autism spectrum disorders. Method: An 11-year-old boy with Asperger syndrome was observed during play where scenarios (mistakes, misplaced items, interrupted activity) were created to correspond with parent-reported scenarios where the child would insist on sameness. The extent of problem behaviour was observed under four functional assessment conditions (restore environment, tangible, attention, escape), according to a multi-element design. Results: The results showed an interaction between the scenario type and type of functional assessment condition. Problem behaviour appeared to have a restorative function related to correcting a mistake, an attention function related to attempting to recruit help in finding a missing item and a tangible function suggesting an attempt to regain access to the materials and activity. Conclusion: Problem behaviours related to insistence on sameness may be motivated by different consequences depending on the scenario created.

Children with low literacy and poor stereoacuity: an evaluation of complex interventions in a community-based randomized trial.

Purpose: To assess, among children with low literacy and poor stereoacuity, the efficacy of two intervention programs on child vision and education compared to a control program. Methods: Eighty-eight children aged 8 to 13 years who had reading problems, and demonstrated poor stereoacuity as measured by the Titmus stereocircle test (> 100 seconds arc) or computerized assessment were randomized to one of two intervention programs: Lawson vision or Phono-Graphix, or a control group: Parental Literacy Support. Vision (Lang test, visual acuity, convergence insufficiency symptom survey) and education assessments (Woodcock Reading Mastery Tests–Revised) were conducted at baseline, intervention end (10 weeks), and 36 weeks. Analysis used intention to treat multi-level models. Results: Compared to the parental literacy support group, convergence insufficiency symptoms were reduced 36 weeks post-randomization amongst those receiving the Lawson orthoptic intervention (mean difference −5.55; 95% confidence interval (CI): −11.1 to −0.05, P < 0.05). Stereoacuity, measured by the Lang test, improved for both the Lawson and Phono-Graphix interventions compared to the parental literacy support group (−1.01; 95% CI: −1.6 to −0.4, P = 0.001, and −0.77; 95% CI: −1.4 to −0.2, P = 0.01). At the 36 week follow-up assessment, word identification had also improved for the Lawson and Phono-Graphix groups but other educational outcomes did not improve. Conclusion: A formal randomized control trial was feasible in this setting. Intervention among children with poor stereoacuity and low literacy produced small improvements in stereopsis and convergence insufficiency symptom scores. Further randomized control trials should be conducted to clarify the role of orthoptic intervention on literacy in selected child populations.

Comparison of a direct and an indirect approach for the functional assessment of insistence on sameness in a child with autism spectrum disorder and a typically developing child

Abstract Objective: To compare indirect and direct functional assessment of insistence on sameness associated with autism spectrum disorder (ASD) and typical development. Methods: Parents rated the function of insistence on sameness for a 6-year-old boy with ASD (Peter) and a typically developing 4-year-old boy (Nathan) using the Motivation Assessment Scale (MAS). Ratings were compared to the results of a direct assessment. Results: The results of the assessment procedures were mainly consistent for Peter and suggested that his tendency to insist on sameness was maintained by sensory consequences. The finding of an attention function for Nathan in the play-based assessment was consistent with previous functional assessment studies surrounding typically developing children, but in contrast to the MAS. Conclusion: While the play-based assessment may be more suitable for assessing the high rate insistence on sameness observed in individuals with ASD, the MAS may be more suitable for low rate insistence on sameness.