Rudi Črnčec

The cognitive and academic benefits of music to children : facts and fiction

There is considerable interest in the potential non‐musical cognitive and academic benefits of music listening and instruction to children. This report describes three lines of research relevant to this issue, namely, the effects of: (1) focused music listening on subsequent task performance (the Mozart effect); (2) music instruction; and (3) background music listening. Research suggests that while Mozart effect studies have attracted considerable media attention, the effect cannot be reliably demonstrated in children. In contrast, music instruction confers consistent benefits for spatiotemporal reasoning skills; however, improvements in associated academic domains, such as arithmetic, have not been reliably shown. Finally, background music may calm and focus children with special education needs, thereby enhancing learning. Additional research is required to determine whether this effect is evident in normal populations. Overall, evidence for the non‐musical benefits of music listening and instruction is limited. The inherent value of music and music education should not be overlooked by narrowly focusing on cognitive and academic outcomes.

Clinical outcomes of an early intervention program for preschool children with Autism Spectrum Disorder in a community group setting

BackgroundAvailable evidence indicates that early intervention programs, such as the Early Start Denver Model (ESDM), can positively affect key outcomes for children with Autism Spectrum Disorder (ASD). However, programs involving resource intensive one-to-one clinical intervention are not readily available or deliverable in the community, resulting in many children with ASD missing out on evidence-based intervention during their early and most critical preschool years. This study evaluated the effectiveness of the ESDM for preschool-aged children with ASD using a predominantly group-based intervention in a community child care setting.MethodsParticipants were 26 children (21 male) with ASD with a mean age of 49.6 months. The ESDM, a comprehensive early intervention program that integrates applied behaviour analysis with developmental and relationship-based approaches, was delivered by trained therapists during the child’s attendance at a child care centre for preschool-aged children with ASD. Children received 15–20 hours of group-based, and one hour of one-to-one, ESDM intervention per week. The average intervention period was ten months. Outcome measures were administered pre- and post-intervention, and comprised a developmental assessment - the Mullen Scales of Early Learning (MSEL); and two parent-report questionnaires - the Social Communication Questionnaire (SCQ) and Vineland Adaptive Behaviours Scales–Second Edition (VABS-II).ResultsStatistically significant post-intervention improvements were found in children’s performance on the visual reception, receptive language and expressive language domains of the MSEL in addition to their overall intellectual functioning, as assessed by standardised developmental quotients. Parents reported significant increases in their child’s receptive communication and motor skills on the VABS-II, and a significant decrease in autism-specific features on the SCQ. These effects were of around medium size, and appeared to be in excess of what may have been expected due to maturation. Nonetheless, these results need to be confirmed in a controlled study.ConclusionsThis study suggests community dissemination of the ESDM using predominantly group-based intervention may be an effective intervention. Making the ESDM accessible to the wider ASD community in child care settings has the potential for significant clinical and economic benefits. Further studies are indicated in this area, including those with younger children, and which incorporate a control group and standardised ASD assessments.Trial registrationThis trial is registered with the Australian New Zealand Clinical Trials Registry: Registry number ACTRN12612000461897.

Development of an Instrument to Assess Perceived Self-Efficacy in the Parents of Infants

In addition to research applications, the measurement of perceived parental self-efficacy (PPSE) could be useful clinically in screening for parenting difficulties, targeting interventions, and evaluating outcomes. In this research we examined the psychometric properties of the Karitane Parenting Confidence Scale (KPCS), a new 15-item PPSE measure. A no-problem control group and three clinical groups comprising 187 mothers with infants were recruited. The KPCS showed acceptable internal consistency (Cronbachs alpha = .81), test-retest reliability (r = .88), and discriminant and convergent validity. A cut-off score was determined, and the scales sensitivity and positive predictive power was 86% and 88%, respectively. The KPCS may prove a useful addition to tools for the assessment of parents and infants presenting to clinical services.

Gilles de la Tourette syndrome

Gilles de la Tourette syndrome (GTS) is a childhood-onset neurodevelopmental disorder that is characterized by several motor and phonic tics. Tics usually develop before 10 years of age, exhibit a waxing and waning course and typically improve with increasing age. A prevalence of approximately 1% is estimated in children and adolescents. The condition can result in considerable social stigma and poor quality of life, especially when tics are severe (for example, with coprolalia (swearing tics) and self-injurious behaviours) or when GTS is accompanied by attention-deficit/hyperactivity disorder, obsessive–compulsive disorder or another neuropsychiatric disorder. The aetiology is complex and multifactorial. GTS is considered to be polygenic, involving multiple common risk variants combined with rare, inherited or de novo mutations. These as well as non-genetic factors (such as perinatal events and immunological factors) are likely to contribute to the heterogeneity of the clinical phenotype, the structural and functional brain anomalies and the neural circuitry involvement. Management usually includes psychoeducation and reassurance, behavioural methods, pharmacotherapy and, rarely, functional neurosurgery. Future research that integrates clinical and neurobiological data, including neuroimaging and genetics, is expected to reveal the pathogenesis of GTS at the neural circuit level, which may lead to targeted interventions.

Exploring Links between Genotypes, Phenotypes, and Clinical Predictors of Response to Early Intensive Behavioral Intervention in Autism Spectrum Disorder

Autism spectrum disorder (ASD) is amongst the most familial of psychiatric disorders. Twin and family studies have demonstrated a monozygotic concordance rate of 70–90%, dizygotic concordance of around 10%, and more than a 20-fold increase in risk for first-degree relatives. Despite major advances in the genetics of autism, the relationship between different aspects of the behavioral and cognitive phenotype and their underlying genetic liability is still unclear. This is complicated by the heterogeneity of autism, which exists at both genetic and phenotypic levels. Given this heterogeneity, one method to find homogeneous entities and link these with specific genotypes would be to pursue endophenotypes. Evidence from neuroimaging, eye tracking, and electrophysiology studies supports the hypothesis that, building on genetic vulnerability, ASD emerges from a developmental cascade in which a deficit in attention to social stimuli leads to impaired interactions with primary caregivers. This results in abnormal development of the neurocircuitry responsible for social cognition, which in turn adversely affects later behavioral and functional domains dependent on these early processes, such as language development. Such a model begets a heterogeneous clinical phenotype, and is also supported by studies demonstrating better clinical outcomes with earlier treatment. Treatment response following intensive early behavioral intervention in ASD is also distinctly variable; however, relatively little is known about specific elements of the clinical phenotype that may predict response to current behavioral treatments. This paper overviews the literature regarding genotypes, phenotypes, and predictors of response to behavioral intervention in ASD and presents suggestions for future research to explore linkages between these that would enable better identification of, and increased treatment efficacy for, ASD.

Reducing maladaptive behaviors in preschool-aged children with autism spectrum disorder using the early start denver model.

The presence of maladaptive behaviors in young people with autism spectrum disorder (ASD) can significantly limit engagement in treatment programs, as well as compromise future educational and vocational opportunities. This study aimed to explore whether the Early Start Denver Model (ESDM) treatment approach reduced maladaptive behaviors in preschool-aged children with ASD in a community-based long day care setting. The level of maladaptive behavior of 38 children with ASD was rated using an observation-based measure on three occasions during the intervention: on entry, 12 weeks post-entry, and on exit (post-intervention) over an average treatment duration of 11.8 months. Significant reductions were found in children’s maladaptive behaviors over the course of the intervention, with 68% of children showing a treatment response by 12 weeks and 79% on exit. This change was accompanied by improvement in children’s overall developmental level as assessed by the Mullen scales of early learning, but not by significant changes on the Vineland Adaptive Behavior Scales-II or Social Communication Questionnaire. Replication with a larger sample, control conditions, and additional measures of maladaptive behavior is necessary in order to determine the specific factors underlying these improvements; however, the findings of the present study suggest that the ESDM program may be effective in improving not only core developmental domains, but also decreasing maladaptive behaviors in preschool-aged children with ASD.

Review of scales of parenting confidence.

Interest in the measurement of parenting confidence in research and clinical contexts has grown considerably in recent decades, particularly in the area of health care. Psychometric and technical characteristics of scales assessing this construct suitable for the parents of children aged 0–12 years were reviewed in this research. In so doing, information is provided that will assist clinicians and researchers in selecting a measure suitable to their needs. Thirty-six instruments assessing parenting confidence were located. Two dominant approaches to item selection were evident: (1) general items suitable for a range of child ages, or (2) task-specific items suitable for parents of a child of a particular age. Psychometrically, most scales possessed adequate reliability data, although validity data for many scales was limited. In addition, only two of the instruments, both with general items, had stratified normative data. Scales appropriate for a range of research purposes and some clinical applications are available. Further research is necessary to provide normative data for task-specific parenting confidence scales.

Conceptualisation and Development of a Quality of Life Measure for Parents of Children with Autism Spectrum Disorder

Parents of children with autism spectrum disorder (ASD) tend to experience greater psychological distress than parents of typically developing children or children with other disabilities. Quality of Life (QoL) is increasingly recognised as a critical outcome measure for planning and treatment purposes in ASD. There is a need for ASD-specific QoL measures as generic measures may not capture all relevant aspects of living with ASD. This paper describes the conceptualisation and development of an autism-specific measure of QoL, the Quality of Life in Autism Questionnaire (QoLA) for parents and caregivers of children with ASD, that is suitable to clinical and research settings. Preliminary psychometric properties (reliability and validity) of the measure are also presented. The QoLA has 48 items in two subscales: one comprising QoL items and the second a parent report of how problematic their childs ASD symptoms are. A study involving 39 families suggested the QoLA has excellent internal consistency as well as good known-groups validity between parents of children with ASD and those who were typically developing. The QoLA also showed good convergent validity with other measures of QoL and ASD symptom severity, respectively. The QoLA may be a valuable assessment tool and merits further psychometric evaluation.

Tourette syndrome, co-morbidities and quality of life.

Objective: Tourette syndrome is often associated with attention deficit hyperactivity disorder, obsessive compulsive disorder and other co-morbidities, the presence of which can reduce health-related quality of life. The relationship between the number and type of co-morbidities and tic severity upon health-related quality of life has been insufficiently examined in Tourette syndrome populations and not at all in the Australian context. We hypothesised that an increased number of co-morbid diagnoses would be inversely related to health-related quality of life and that the presence of attention deficit hyperactivity disorder and obsessive compulsive disorder in particular would negatively impact health-related quality of life. Method: In all, 83 people with a previously established diagnosis of Tourette syndrome, who responded to a letter of invitation sent to the Tourette Syndrome Association of Australia past-member database, formed the study sample. Participants completed the Gilles de la Tourette Syndrome-Quality of Life Scale and a short form of the National Hospital Interview Schedule to assess tics and related behaviours. Results: Participants with pure-Tourette syndrome had significantly better health-related quality of life than those with Tourette syndrome and three or more co-morbid diagnoses. Few differences were observed between the pure-Tourette syndrome and Tourette syndrome and one or two co-morbid diagnoses groups. Analysis of the impact of individual co-morbid disorders and Tourette syndrome symptoms on health-related quality of life indicated that attention deficit hyperactivity disorder exerted a significant negative effect, as did the presence of complex tics, especially coprolalia and copropraxia. When these variables were examined in multiple regression analysis, number of co-morbidities and the presence of coprophenomena emerged as significant predictors of health-related quality of life. Conclusion: While tics are the defining feature of Tourette syndrome, it appears to be the presence of co-morbidities, attention deficit hyperactivity disorder, in particular, and coprophenomena that have the greater impact on health-related quality of life. This has implications for symptom-targeting in the treatment of Tourette syndrome since all available treatments are symptomatic and not disease modifying.

Infant sleep problems and emotional health: a review of two behavioural approaches

Background: Infant sleep problems (ISP) are among the most common reasons for which parents seek advice from health professionals. A substantial literature supports the efficacy and effectiveness of behavioural approaches, based on the principal of extinction, in treating ISP. Questions have been raised, however, about the potential negative effects of temporarily withholding responding to infant crying during sleep‐time to infant mental health. Critics of this strategy have advocated an alternative approach where parents are immediately responsive to signs of infant distress. Aims: To evaluate critically the evidence for and against these approaches in infants aged 6–24 months, with particular reference to issues of clinical effectiveness and infant mental health. Discussion is included of clinical implications and cultural and attachment factors impacting on parents’ preferences for settling methods. Results: The weight of clinical effectiveness empirical support is with extinction‐based interventions. Moreover, the core arguments against this approach regarding disruption to the infant’s mental health do not have empirical support, with available studies indicating either no change or modest improvements to the infant’s mental health. At this stage the onus is on proponents of the immediate‐responding approach to undertake effectiveness research. Well‐designed comparative studies would also help to advance this debate.