Stephen J. Sheinkopf

Home-based behavioral treatment of young children with autism

This study evaluated the impact of intensive behavioral treatment on the development of young autistic children. The treatment reported in this study was home based and was implemented by parents of autistic children with the assistance of community-based clinicians. Although treatment was unable to be observed directly, parents reported that therapy was based on methods developed by Lovaas et al. (1981). Treatment differed from that described in previous reports of intensive behavior therapy for this population in that it was implemented outside an academic setting and for a shorter period. In addition, children received fewer hours per week of therapy than in previous reports. Children in the experimental treatment group were pairwise matched to children in a control group (who received conventional school-based and brief one-on-one interventions) on the basis of pretreatment chronological and mental age, diagnosis (autism vs. PDD), and length of treatment. The groups did not differ on pretreatment IQ. Children receiving the experimental treatment had significantly higher posttreatment IQ scores. Smaller, but still statistically significant effects on symptom severity were also found, though experimental subjects still met diagnostic criteria for autism or PDD.

Vocal Atypicalities of Preverbal Autistic Children

This study was designed to evaluate the nature of early vocal behaviors in young children with autism. Recent methodological and conceptual advances in the study of infant preverbal vocalizations were used to provide a detailed examination of the vocal behavior of young preverbal children with autism and comparison children with developmental delays. Results revealed that children with autism did not have difficulty with the expression of well-formed syllables (i.e., canonical babbling). However, children with autism did display significant impairments in vocal quality (i.e., atypical phonation). Specifically, autistic children produced a greater proportion of syllables with atypical phonation than did comparison children. Consistent with prior reports, the children with autism also displayed a deficit in joint attention behaviors. Furthermore, the atypicalities in the vocal behavior of children with autism appeared to be independent of individual differences in joint attention skill, suggesting that a multiple process model may be needed to describe early social-communication impairments in children with autism. Data are discussed in terms of their implications for future theoretical and applied research, including efforts to enhance the specificity of early diagnostic procedures.

Infant joint attention skill and preschool behavioral outcomes in at-risk children

This study examined whether infant joint attention (JA) skills predicted social behaviors in a sample of at-risk preschool children (n = 30) with a history of prenatal exposure to cocaine. JA behaviors were assessed with the Early Social and Communication Scales at 12, 15, and 18 months of age. Three classes of JA were measured: Initiating JA (IJA), Responding to JA (RJA), and Requests. Behavioral outcomes were measured at 36 months and included ratings of disruptive and withdrawn behaviors and social competence. JA behaviors were related to behavioral outcomes after controlling for language and cognitive ability. The functionally distinct uses of JA were differentially related to behavioral outcome. IJA negatively predicted disruptive behaviors, whereas Requests positively predicted disruptive behaviors. Infant RJA negatively predicted withdrawn behaviors and positively predicted social competence. These results are interpreted in the context of competing theories that attempt to explain variability in the expression of JA skills in the second year of life.

Parenting Intervention for Externalizing Behavior Problems in Children Born Premature: An Initial Examination

Objective: To examine the initial efficacy of parent-child interaction therapy (PCIT) for treating behavior problems in young children who were born premature. Method: In this randomized, controlled trial, 28 children between the ages of 18 and 60 months, who were born <37 weeks gestation and presented with clinically significant externalizing behavior problems, were randomly assigned to an immediate treatment (IT) or waitlist (WL) control group. Results: After 4 months, children who received PCIT were reported by their mother to have less attention problems, aggressive behaviors, and externalizing and internalizing behavior problems, and they were observed to be more compliant to maternal commands than children in the WL group. In addition, mothers in the IT group interacted more positively with their child, reported lower parenting stress related to difficult child behavior and demonstrated improved parenting practices compared with WL mothers. Behavior change maintained for 80% of the IT children 4 months after treatment completion. Conclusions: This study demonstrates preliminary efficacy of PCIT for the treatment of behavior problems in young children who were born premature.

Atypical Cry Acoustics in 6-Month-Old Infants at Risk for Autism Spectrum Disorder

This study examined differences in acoustic characteristics of infant cries in a sample of babies at risk for autism and a low‐risk comparison group. Cry samples derived from vocal recordings of 6‐month‐old infants at risk for autism spectrum disorder (ASD; n = 21) and low‐risk infants (n = 18) were subjected to acoustic analyses using analysis software designed for this purpose. Cries were categorized as either pain‐related or non‐pain‐related based on videotape coding. At‐risk infants produced pain‐related cries with higher and more variable fundamental frequency (F 0) than low‐risk infants. At‐risk infants later classified with ASD at 36 months had among the highest F 0 values for both types of cries and produced cries that were more poorly phonated than those of nonautistic infants, reflecting cries that were less likely to be produced in a voiced mode. These results provide preliminary evidence that disruptions in cry acoustics may be part of an atypical vocal signature of autism in early life. Autism Res 2012, ••: ••–••.

Functional MRI and Response Inhibition in Children Exposed to Cocaine in utero: Preliminary Findings

This study investigated the potential long-term effects of cocaine exposure on brain functioning using fMRI in school-aged children. The sample included 12 children with prenatal cocaine exposure and 12 non-exposed children (8–9 years old). Groups did not differ on IQ, socioeconomic status, or perinatal risk factors. A response inhibition task was administered during an fMRI scan using a 1.5-T MRI system. Task performance did not differentiate groups, but groups were differentiated by patterns of task-related brain activity. Cocaine-exposed children showed greater activation in the right inferior frontal cortex and caudate during response inhibition, whereas non-exposed children showed greater activations in temporal and occipital regions. These preliminary findings suggest that prenatal cocaine may affect the development of brain systems involved in the regulation of attention and response inhibition.

Screening for Autism Spectrum Disorders in Extremely Preterm Infants

Background: Extremely preterm (EP) infants screen positive for autism spectrum disorders (ASD) at high rates. However, it is not clear whether this is because of high rates of ASD in EPs or to high rates of false-positive screens for ASD in children with a high rate of underlying neurodevelopmental impairments. Combining a parent questionnaire designed to distinguish developmental delay from ASD with direct observation of infant behavior may more accurately screen for ASD in EPs. Objectives: To determine rates of positive screen for ASD at 18 to 22 months(m) in EPs using 3 screens; to determine factors associated with a positive screen. Methods: Five hundred fifty-four infants born <27 weeks were screened at 18 to 22 m using the Pervasive Developmental Disorders Screening test, second edition Stage 2, and the response to name and response to joint attention items from the Autism Diagnostic Observation Schedule. Infants with severe cerebral palsy, deafness, and blindness were excluded. Associations between positive screen and neonatal/ infant characteristics were determined. Results: Of 554 infants, 113 (20%) had ≥ 1 positive screen. 10% had a positive Pervasive Developmental Disorders Screening test, second edition, 6% response to name, 9% response to joint attention; in only 1 % all 3 screens were positive. Positive screen was associated with male gender, more hospital days, white race, lower maternal education, abnormal behavioral scores, and cognitive/ language delay. Conclusions: The use of 3 screens for ASD in EPs results in higher screen positive rates than use of 1 screen alone. Diagnostic confirmation is needed before true rates of ASD in EPs are known.

Vagal tone as a resilience factor in children with prenatal cocaine exposure

Studies have investigated the potential effects of prenatal cocaine exposure (CE) on childrens development. However, few studies have examined predictors of resilient outcomes in this population. We examined vagal tone (VT) as a resilience factor in prenatal CE. Utilizing data from the Maternal Lifestyle Study, a cumulative risk index was derived for children with and without prenatal CE. Presence of CE and other prenatal drugs was summed with postnatal risks in infancy to yield a 15-item risk index. Preschool cognitive outcomes, problem behaviors, and adaptive behaviors were measured. VT was assessed during an infant exam at 1 month and toy exploration at 36 months. We included children with complete physiologic data (217 CE, 333 non-CE). Children were classified as having consistently high, consistently low, or fluctuating VT at 1 and 36 months. Children were also classified as high versus low risk. High-risk children had lower IQ scores, more problem behaviors, and lower ratings of adaptive behaviors than low-risk children. A significant risk by VT-stability interaction indicated that for high-risk children, those with stable low VT had higher ratings of adaptive behaviors at 36 months. This is consistent with theory linking reduced VT during tasks to adaptive regulation and indicates that such regulatory functioning may serve as a protective factor in prenatal CE.

Impact of Prenatal Exposure to Cocaine and Tobacco on Diffusion Tensor Imaging and Sensation Seeking in Adolescents

OBJECTIVE To study white matter integrity with diffusion tensor imaging in adolescents with prenatal cocaine exposure, tobacco exposure, or both. STUDY DESIGN Subjects included 20 adolescents with prenatal cocaine exposure (15 with tobacco exposure) and 20 non-cocaine-exposed subjects (8 with tobacco exposure). Diffusion tensor imaging measures were assessed in 5 subregions of the corpus callosum. The Sensation Seeking Scale for Children was administered to evaluate behavioral inhibition. RESULTS No significant differences were found between the cocaine-exposed and non-cocaine-exposed groups in each subregion of the corpus callosum on measures of fractional anisotropy (FA) and mean diffusivity, although the cocaine-exposed group showed a trend (P = .06) toward higher FA in projections to the supplementary motor area and premotor cortex. Prenatal tobacco exposure was associated with decreased FA in the supplementary motor area and premotor cortex projections after adjustment for relevant co-variates (P = .03). Decreased FA was related to more sensation seeking in the adolescents who were prenatally exposed to tobacco. CONCLUSION Prenatal tobacco exposure could affect white matter integrity, which is related to sensation seeking in adolescents. Developmental neurotoxins might have differential influences on white matter maturation in adolescence.

Bottom-up attention orienting in young children with autism.

We examined the impact of simultaneous bottom-up visual influences and meaningful social stimuli on attention orienting in young children with autism spectrum disorders (ASDs). Relative to typically-developing age and sex matched participants, children with ASDs were more influenced by bottom-up visual scene information regardless of whether social stimuli and bottom-up scene properties were congruent or competing. This initial reliance on bottom-up strategies correlated with severity of social impairment as well as receptive language impairments. These data provide support for the idea that there is enhanced reliance on bottom-up attention strategies in ASDs, and that this may have a negative impact on social and language development.