Research in Autism Spectrum Disorders最新文献

Purpose

Although sensory sensitivities are common among autistic people, few studies have explored how they may be impacted by ageing. Little is known about the experiences of autistic people across adulthood or about the experiences of people assigned female-at-birth. Some results suggest that autistic people assigned female-at-birth report more sensory sensitivities, but little is known about experiences in middle-aged and older autistic people assigned female-at-birth.

Methods

This study explored self-reported sensory sensitivities and sensory acuity in 210 autistic people aged 42–80 years old. Associations between age and sensory sensitivities were examined using correlational and regression analyses, and t-tests explored differences based on sex-assigned-at-birth.

Results

No significant correlation was observed between age and sensory sensitivities, although older age was associated with poorer sensory acuity. Poorer acuity in vision and hearing was associated with more sensory sensitivities. People assigned female-at-birth reported higher scores for overall sensory sensitivities and low temperature/pain tolerance. Sex-assigned-at-birth, sensory acuity and an age-x-sensory acuity interaction term contributed significantly to a regression model explaining overall sensory sensitivity, but age did not contribute significantly.

Conclusion

This cross-sectional study suggests that sensory sensitivities are stable across middle-age and older adulthood. Results contrast with previous studies in young adults which have suggested reduction in sensory sensitivities with age. In keeping with studies of younger people, middle-age and older autistic adults assigned female-at-birth report higher rates of sensory sensitivities than comparably aged autistic adults assigned male-at-birth. If further studies examining individual change in sensory sensitives replicate these results, then they may contribute to understanding care needs of autistic older people.

Background

Research suggests that individuals with autism spectrum disorder (ASD) exhibit heightened responses to social stressors, putting them at higher risk to psychopathology. However, the findings are inconsistent. Considering the unavoidable social interactions in daily life, synthesizing the literature on physiological reactivity to social stressor stimuli in individuals with ASD is crucial.

Aims

To investigate the cardiac autonomic reactivity to face-to-face social stressor stimuli in children and adolescents with ASD.

Methods

Literature was identified from four databases and grey literature. The inclusion criteria were children and youth with ASD aged 18 or below, social stimuli that occurred face-to-face, and physiological measures of cardiac autonomic reactivity.

Results

Twenty studies were included, with a sample size of 1064 (548 ASD samples). Five unique measures were reported. A preliminary pattern of blunted respiratory sinus arrhythmia (RSA) reactivity was found in ASD compared to the typically developing (TD) individuals. Interestingly, a pattern of higher or no significant differences in heart rate (HR) responses in ASD compared to TD was noted when a familiar person was used, but blunted when a novel person was used.

Conclusions

Atypical cardiac autonomic reactivity in ASD was demonstrated with contrasting responses depending on familiarity. Implications for interventions are discussed.

Background

Children and adolescents with Autism Spectrum Disorder (ASD) often present motor signs and symptoms, including toe walking (TW). The pathophysiology of TW in ASD is not fully understood. In particular, it is debated whether it may represent a persistent primitive walking pattern or the result of abnormal processing of sensory input from the lower limbs and feet. The present study is aimed at assessing the association between TW and cognitive, sensory, motor and language functions, as well as autism severity.

Method

We enrolled 112 children and adolescents with ASD, 61 with TW and 51 without TW. A complete psychodiagnostic assessment was performed, including ADOS-2, ADI-R, PEP-3, IQ testing or Griffiths Mental Developmental Scales, and Short Sensory Profile.

Results

Children and adolescents with TW have significantly lower cognitive level, greater language and motor impairment, as well as greater autism severity. Instead, no difference in severity of sensory abnormalities or in sensory profile emerges between cases with and without TW.

Conclusions

the present data are most compatible with a model interpreting TW as a behavioral pattern resulting from the persistence of a primitive walking pattern (i.e. lack of heel strike, prior to the acquisition of plantar walking) or possibly of archaic tonic reflexes, rather than as a consequence primarily of abnormal sensory processing. Health practitioners should monitor the gait of autistic children and plan appropriate interventions, aimed at promoting the adoption of more mature plantar walking patterns.

Restricted and repetitive behaviours and interests (RRBIs) are common and integral to the everyday living of autistic persons. While RRBIs are often seen as negative behaviours to be subdued, they may serve regulatory roles that are central to an autistic way of being. Moreover, RRBIs are often present in early childhood and are associated with developmental benefits. Therefore, the continued presence of RRBIs among autistic persons beyond early childhood suggests that RRBIs may serve adaptive functions. To inform and improve clinical decision-making and gain a deeper understanding of the adaptive roles of RRBIs, a scoping review methodology was used to identify the key functions of RRBIs in autism. Our results resulted in 21 studies from the PsycINFO and Medline databases among the 3162 studies on RRBIs published between 2010 and 2023 retrieved. Four themes of functions were identified and mapped onto the subdomains of RRBIs. Specifically, results indicated that RRBIs (i) help autistic persons regulate sensory experiences, (ii) cope with feelings of anxiety, (iii) introduce certainty to their environment, and (iv) make sense of their world. This paper highlights the constructive characteristics of RRBIs and presents an alternative perspective to understand them and help inform decisions about whether and how RRBIs should be managed. Future research should focus on gathering qualitative insights into RRBIs from the perspectives of autistic persons and developing nuanced approaches to managing RRBIs by considering their functions.

Background

Autism spectrum disorder (ASD) is characterized by persistent deficits in reciprocal social interaction, communication, and restricted, repetitive, behaviour, that are atypical or excessive for the individual’s age and sociocultural context (Diagnostic and Statistical Manual 5th ed TR.; 2022). The rate of ASD continues to increase and remains a concern due to inequitable access to diagnosis and quality services. A lack of standardization in assessment and treatment presents further difficulty in benchmarking and improving care.

Method

The International Consortium for Health Outcomes Measurement (ICHOM) recruited a Working Group (WG) of 20 subject matter experts, including researchers, clinicians, policy makers, and lived-experience experts to identify a minimum set of measurable outcomes along with case mix variables (i.e., risk adjustment factors). A proposed set of Patient Centered Outcome Measures (henceforth known as the ASD Set) was identified and endorsed using a modified Delphi process to reach consensus.

Results

The WG took into consideration variation in global health, social care and educational systems were considered to ensure implementation of the ASD Set is feasible. The Set includes a core set of measurable outcomes (i.e., domains) that include core symptoms, daily functioning, accessibility, and support.

Conclusions

The ICHOM ASD Set is a scientifically-sound, internationally vetted tool that will enable assessment of care for individuals with ASD that can facilitate targeted, person-centered clinical and social inclusion strategies. Large scale implementation and use should generate standardized data describing the individual's health and wellbeing that can inform decision-making, quality improvement and best-practices insights.

Background

Joint attention (JA) is an area of delay associated with autism. Individual differences in JA are shown to relate to language development. The present study examined JA initiations (IJA) and responses to JA (RJA) of autistic children in structured and unstructured contexts with their mothers to examine the relation between mother attention and JA.

Method

Forty-two autistic children (ages 2.5 to 5.5 years) and their mothers engaged in 15 m interactions in three social contexts (competing demands, teaching, free play). Children were categorized by language level into limited language (N = 20) and verbal (N = 21) groups based on ADOS-2 module to assess group and contextual differences. Contingency analyses assessed bi-directional temporal relations between observed child JA and mother attention in lagged intervals.

Results

Rate of children’s IJA and maternal attention differed depending on the context of their interaction. Child IJA and mother attention showed a bi-directional temporally contingent association such that child IJA predicted subsequent maternal attention, and maternal attention predicted subsequent child IJA. RJA was unrelated to maternal attention in contingency analyses. Post-hoc analyses indicated a language level group by receptive communication, and group by expressive communication interaction on the contingency between child IJA and subsequent mother attention such that a stronger contingency emerged for dyads wherein children had limited language.

Conclusions

The present study illustrates the important role that children’s social communication behaviors may have within mother-child social interactions, and how children’s verbal ability, as well as the context of the social interaction may influence bi-directional social attention.

Background

Early diagnosis of autism spectrum disorders allows to start a therapy tailored to the child - the earlier it happens, the better the results. This study marked a preliminary attempt to prepare culturally and linguistically adapted Polish version of the Communication and Symbolic Behavior Scales-Developmental Profile – Infant-Toddler Checklist (CSBS-DP ITC).

Method

The study was conducted among 1471 Polish parents of children from the general population aged 6 to 24 months, 490 of them participated in the follow-up. An additional 122 pairs of parents completed the questionnaire to determine reliability using the inter-rater method. The collected data were statistically processed to calculate the reliability and validity of the Polish version of the CSBS-DP ITC questionnaire.

Results

The results indicated a very good fit of the one-factor and three-factor models in confirmatory factor analysis. Both one-factor and three-factor model showed satisfactory fit in both sex subsamples. The total score of CSBS-DP ITC demonstrated satisfactory internal consistency, Cronbach's α = .92 and McDonald’s ω = .92. In test-retest all the correlation coefficients between the first and second measurements were above.70, proving a satisfactory level of stability.

Conclusions

The Polish version of the CSBS-DP-ITC is a reliable tool for the early screening of autism spectrum disorder, but further studies on sensitivity and specificity are essential.

Background

Autistic youth experience high rates of anxiety, which has been treated with modified cognitive-behavioral therapy (CBT), often integrating exposure therapy. Such anxiety treatments are effective for this population; however, there remains a gap between these evidence-based mental health interventions and their implementation in community mental health (CMH) services where autistic youth receive care.

Method

This qualitative study conducted semi-structured interviews with four types of community members in the United States: 15 autistic youth with anxiety, 15 caregivers of autistic youth with anxiety, 11 CMH clinicians, and 8 CMH clinic leaders. Participants identified the training needs of CMH clinicians to support the delivery of CBT for autistic youth with anxiety.

Results

Through inductive thematic analysis, three themes were found: presentation of autism and anxiety, intervention delivery, and training format. Participants highlighted the need for clinician education to understand the varying presentations of autism and co-occurring anxiety and how to effectively deliver a personalized mental health intervention for autistic youth. Clinicians also desired a clinician training program that includes engaging components and offers individualized, ongoing support while the intervention is delivered.

Conclusions

Findings from this study will inform the development of a clinician training program to deliver CBT modified for autistic youth with anxiety in CMH contexts.

Studies with animal models and humans show that alternations in the composition and activity of the gut microbiome can contribute to the etiopathogenesis of core symptoms in the ASD (autism spectrum disorder) patients. The role has been investigated by extending classic brain-gut axis to brain-gut-microbiome (BGM) axis. Nevertheless, there is not yet a consensus regarding the compositional changes associated with ASD. Here we fill a gap by computationally detecting and compiling the lists of US (unique species) and ES (enriched species) associated with ASD from big datasets on ASD-microbiome studies. The gap is that different existing studies generated conflicting evidence regarding the ES/US status, and the existing ES/US lists often lack rigorous statistical quantifications, which is likely responsible for the inconsistencies. To fill the gap, we apply and extend a recent computational advance for virome comparison (VC) that statistical rigorously determines the US/ES status and their holistic differences between the diseased treatments and healthy controls. We further extend the VC approach by building the first-order (nearest neighbor) network (FON) of US/ES taxa to deepen our understanding of the microbes associated with ASD, including their allies and foes. We obtained the US/ES lists from 8 individual datasets separately and their pooled datasets with statistical rigor and computed their union/intersection sets to make recommendations for practical applications of US/ES catalogues. We also built the FON and revealed possibly general species occurrence patterns of US/ES in ASD patients, analyzed the extreme complexity in gut microbiome alternations associated with ASD.

Background

Sleep problems are common among Autistic children and can have adverse effects on their development, well-being and quality of life. Telehealth offers a cost-effective and accessible model of delivering evidence-based sleep support. This study used a single-case design to evaluate the efficacy of telehealth-delivered behavioral sleep intervention (TDBSI), with intervention phases designed based according to a stepped-care approach.

Method

Fourteen Autistic children (3–17 years) and their parents participated in a 12-week program consisting of three sequential intervention phases: 1) self-directed online parent education supplemented with individualized intervention tip sheets, 2) group parent coaching via video conferencing, and 3) individualized parent coaching via video conferencing. The appropriateness of parent strategy selection and implementation fidelity was rated throughout. Sleep problem severity (SPS) scores are reported for each child as a measure of effect across intervention phases. The Children's Sleep Habits Questionnaire (CSHQ) and CSHQ-Autism are reported as measures of change from baseline to post-intervention.

Results

Online parent education and tip sheets facilitated early success in parent strategy selection and implementation fidelity. SPS scores demonstrated large and statistically significant improvements in child sleep following the self-directed phase. Parent implementation fidelity and child sleep outcomes were further improved with group and individualized coaching. Post-intervention, the CSHQ and CSHQ-Autism revealed large and statistically significant improvements across subscales and participants compared to baseline.

Conclusions

Online parent education supplemented with individualized tip sheets demonstrates potential for addressing sleep problems in Autistic children. Therapist-led group and individualized parent coaching via videoconferencing show promise as higher intensity support for parents who do not achieve satisfactory results initially.