Zoe Mailloux

Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research

This article reviews current evidence for autism spectrum disorder (ASD) interventions for children aged <3 years, based on peer-reviewed articles published up to December 2013. Several groups have adapted treatments initially designed for older, preschool-aged children with ASD, integrating best practice in behavioral teaching methods into a developmental framework based on current scientific understanding of how infants and toddlers learn. The central role of parents has been emphasized, and interventions are designed to incorporate learning opportunities into everyday activities, capitalize on “teachable moments,” and facilitate the generalization of skills beyond the familiar home setting. Our review identified several comprehensive and targeted treatment models with evidence of clear benefits. Although some trials were limited to 8- to 12-week outcome data, enhanced outcomes associated with some interventions were evaluated over periods as long as 2 years. Based on this review, recommendations are proposed for clinical practice and future research.

Early identification of autism spectrum disorder: Recommendations for practice and research

Early identification of autism spectrum disorder (ASD) is essential to ensure that children can access specialized evidence-based interventions that can help to optimize long-term outcomes. Early identification also helps shorten the stressful “diagnostic odyssey” that many families experience before diagnosis. There have been important advances in research into the early development of ASDs, incorporating prospective designs and new technologies aimed at more precisely delineating the early emergence of ASD. Thus, an updated review of the state of the science of early identification of ASD was needed to inform best practice. These issues were the focus of a multidisciplinary panel of clinical practitioners and researchers who completed a literature review and reached consensus on current evidence addressing the question “What are the earliest signs and symptoms of ASD in children aged ≤24 months that can be used for early identification?” Summary statements address current knowledge on early signs of ASD, potential contributions and limitations of prospective research with high-risk infants, and priorities for promoting the incorporation of this knowledge into clinical practice and future research.

Early Screening of Autism Spectrum Disorder: Recommendations for Practice and Research.

This article reviews current evidence for autism spectrum disorder (ASD) screening based on peer-reviewed articles published to December 2013. Screening provides a standardized process to ensure that children are systematically monitored for early signs of ASD to promote earlier diagnosis. The current review indicates that screening in children aged 18 to 24 months can assist in early detection, consistent with current American Academy of Pediatrics’ recommendations. We identify ASD-specific and broadband screening tools that have been ev-aluated in large community samples which show particular promise in terms of accurate classification and clinical utility. We also suggest strategies to help overcome challenges to implementing ASD screening in community practice, as well as priorities for future research.

Oral care and sensory sensitivities in children with autism spectrum disorders

Children with autism spectrum disorders (ASD) are at high risk for oral disease. The aim of this study was to examine the contribution of sensory processing problems to challenges in receiving oral care for children with ASD. A questionnaire was sent to the parents of 206 children with disabilities to test the hypotheses that children with ASD, relative to children with other disabilities, experience greater difficulty with home-based and professional oral care, and that these difficulties may relate in part to sensory processing problems. The results partially supported these hypotheses. Compared to children with other disabilities, those with ASD had greater behavioral difficulties and sensory sensitivities that parents believed interfered with their childs oral care. Among children with ASD, sensory sensitivities were associated with oral care difficulties in the home and dental office, and with behavioral difficulties in the dental office. Utilizing strategies to modify the sensory environment may help facilitate oral care in children with ASD.

Evidence for the effectiveness of different service delivery models in early intervention services.

Consideration of the evidence for all aspects of service delivery is a growing relevant concern of occupational therapists, including those providing early intervention to children and families. We conducted a review of the literature to uncover what evidence existed for determining the effectiveness of different service delivery models and methods used to improve occupational performance for children and families who receive early intervention services. Through a comprehensive search, we reviewed and synthesized studies, finding common themes of family-centered and routine-based approaches, service setting, and the inclusion of parent participation and training. Families consistently reported positive perceptions of family-centered and routine-based approaches. Parent participation and training resulted in positive outcomes. No specific setting or method of service delivery was identified as clearly most effective, with most studies reporting combined approaches and environments for interventions.

Early Identification and Interventions for Autism Spectrum Disorder: Executive Summary

* Abbreviations: ASD — : autism spectrum disorder DSM-5 — : Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition M-CHAT — : Modified Checklist for Autism in Toddlers Autism spectrum disorders (ASDs) are neurodevelopmental disorders characterized by impaired social communication skills and isolated areas of interest.1 The current prevalence of these disorders is estimated to be 1 in 68,2 and recent estimates of the risk of recurrence in families with at least 1 child diagnosed with ASD are 10% to 19%.3–5 Advances have been made in identifying genetic variants that can account for biological vulnerability to ASD,6,7 although recent studies examining patterns of heredity implicate environmental factors and potential gene-by-environment interactions.8 Although the exact etiology remains unknown in most families, some researchers suggest that the pathogenesis of the disorder begins during prenatal life.9,10 It is likely that ASD is heterogeneous in its etiology as well as in its clinical presentation.11 The American Academy of Pediatrics has recommended screening for ASDs at 18 and 24 months of age,12 but recent research suggests that atypical behaviors may be detectable in some children at even younger ages.13,14 However, we are still learning how the timing and developmental course of early ASD symptoms vary across children and how best to detect such symptoms across the continuum of children seen in community practice. In addition, reports15 that early intervention can improve developmental and behavioral outcomes in infants and toddlers have lent urgency to identifying children across the autism spectrum at an earlier age. Advances in genetic, neuroimaging, and other neurobiological research have also raised the potential of biomarker screening. Given the progress in these areas, a review of the current state of the science on early identification, screening, and intervention of ASD was warranted. These issues were the focus of an international, multidisciplinary panel of clinical practitioners and researchers with expertise in ASD and developmental … Address correspondence to Lonnie Zwaigenbaum, MD, Autism Research Center, Glenrose Rehabilitation Hospital, Room E209, 10230 111 Ave, Edmonton, AB, Canada T5G 0B7. E-mail: lonniez{at}ualberta.ca

Linking Sensory Factors to Participation: Establishing Intervention Goals With Parents for Children With Autism Spectrum Disorder

Parents often focus on independence in activities of daily living and social participation when setting goals for their children with autism spectrum disorders. Occupational therapy practitioners use clinical reasoning to translate these goals to define occupation-based outcomes. This article describes an exploratory analysis of 160 parent-identified goals for children with autism. We identified sensory integrative factors hypothesized to influence each goal and then categorized the goals using the Occupational Therapy Practice Framework: Domain and Process and the International Classification of Functioning, Disability and Health (ICF). Most goals were at the ICF participation and activity levels. Activities of daily living were the most common area of occupation identified, followed by social participation and play. Sensory reactivity and somatopraxis were the most frequently occurring sensory integrative factors. The value of addressing parent goals using a systematic reasoning process to identify factors affecting participation and the importance of measuring participation outcomes are discussed.

Interrater Reliability and Discriminative Validity of the Structural Elements of the Ayres Sensory Integration® Fidelity Measure©

This study examined the reliability and validity of the structural section of the Ayres Sensory Integration® Fidelity Measure© (ASIFM), which provides a method for monitoring the extent to which an intervention was implemented as conceptualized in studies of occupational therapy using sensory integration intervention methods (OT-SI). We examined the structural elements of the measure, including content of assessment reports, availability of specific equipment and adequate space, safety monitoring, and integration of communication with parents and other team members, such as collaborative goal setting with parents or family and teacher education, into the intervention program. Analysis of self-report ratings by 259 occupational therapists from 185 different facilities indicated that the structural section of the ASIFM has acceptable interrater reliability (r ≥ .82) and significantly differentiates between settings in which therapists reportedly do and do not practice OT-SI (p < .001).

Sensory Differences and Mealtime Behavior in Children With Autism.

This study examined sensory differences and mealtime behaviors in children with autism spectrum disorder (ASD; n=34) and compared the results with those of similarly aged peers who were typically developing (TD; n=34). Results from parent-report and child-report questionnaires indicated that children with ASD scored significantly differently from TD peers on the measures of sensory differences and eating behaviors. Data also supported a correlation between sensory differences and eating difficulties in children with ASD. The results of this study will help caregivers and their children with ASD identify problem eating behaviors that may be associated with sensory differences. Sensory strategies and techniques offered by occupational therapy practitioners may contribute to greater success during mealtimes for children with ASD and their families, with increased comfort and less stress. The findings also support a need to further explore the influence of sensory differences on mealtime behaviors.

State of the Science: A Roadmap for Research in Sensory Integration

This article builds on the work of Case-Smith and colleagues and proposes a roadmap to guide future research in occupational therapy. To foster best practice in the application of principles and practices of sensory integration (SI), the pillars of practice, advocacy, and education are identified as elements that provide the foundation for research. Each pillar ensures that SI research is conducted in a rigorous and relevant manner. To this end, achievements to date are discussed, with proposed goals presented for each pillar. Finally, the roadmap builds on the pillars and outlines implications for occupational therapy with the overarching theme that a wide array of scientists, educators, therapists, and service recipients will be needed to ensure that those who may benefit most have access to intervention that is evidence based, theory driven, and provided within the highest standards of service delivery.