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Communication delays appear early in children later diagnosed with ASD

Communication deficits may appear as early as 12 months - Because developmental milestones such as baby’s first words and first steps appear within a range of what is considered “typical” development, parents are often encouraged to be patient, in spite of their concerns, and wait for the skill to emerge. However, a recent study suggests that the communication deficits of an autism spectrum disorder (ASD) may be observed in children as young as 12 months of age, and that intervention could begin even before a child is diagnosed with an ASD.

Because most parent reports on their child’s communication or social deficits are retrospective, based on memory or a close examination of home videos of the child’s first months, this study attempted to record language skills in infants at high risk for an ASD in a “prospective” fashion. The study also hoped to gather data that would help researchers learn more about how children with ASD, and their siblings at high-risk for also having an ASD, develop language and communication skills.

Researchers compared parent reports on communication and language development for a group of 97 infant siblings of children with ASD and 49 low-risk controls. Parents with children participating in the study provided information on their infants’ communication and language development and completed the form at 12 and 18 months. Later analysis of the parents’ reports compared the infants at 24 months: siblings with an autism spectrum disorder, siblings not meeting the diagnostic criteria for ASD, and the low-risk controls.

The study also gathered data on development of gestural communication among the infant groups. Gestural communication behavior includes the way a child shows or points (intentional communication) as well as conventional gestures, such as lifting arms to say “pick me up,” or shaking head to indicate “yes” or “no.” This group of “Early Gestures” demonstrates a child’s ability to engage in purposeful communication along with his or her degree of social interest. The way the subjects engaged in games like peek-a-boo and patty cake were also studied. Another group of communication behaviors known as “Late Gestures,” include they way a child uses real and toy objects – such as how to eat with a spoon or put a telephone to ear.

One of the study’s most notable results was evidence of limited use of gestures as described above in children with ASD at as young as 12 months of age. This finding suggests that a closer examination of a child’s use of gestures may help parents and clinicians get a better picture of the child’s communication development and the potential need for intervention. Intervention could even begin before the child receives a confirmed diagnosis of an ASD.

This longitudinal study will follow the infant siblings through age 3, potentially providing more data on how language and communication develops among young children who have a sibling diagnosed with an ASD.

Mitchell, S., Brian, J., Zwaigenbaum, L., Roberts, W., Szatmari, P., Smith, I., Bryson, S. (2006). Early language and communication development of infants later diagnosed with autism spectrum disorder. Journal of Developmental & Behavioral Pediatr

New study shows memory difficulties in children with ASD

Reminder strategies may help fill in the gaps

Autobiographical memory – the recall of past personally experienced events – is central to psychological and social functioning. This is an important concept as it allows individuals to define themselves in relation to others and to the past. This issue is particularly worth highlighting in the context of children with Autism Spectrum Disorders where social challenges are already so common. This is because it is often the shared experience with friends and family that provides much of the foundation for maintaining close ties with those people. A new study in the journal, Development and Psychopathology, compares children with ASD with typically developing peers related to their autobiographical memory and suggestibility – the degree to which their memories of past events might be changed with false details provided using suggestive interviewing techniques. The authors found that children with ASD showed deficits in memory for personally experienced events. Relative to typically developing peers, children with ASD showed these deficits for events in their far past as well as their recent past. Interestingly, the autobiographical recall of children with ASD was relatively free of memory errors (i.e., distortions). They were also as likely as their age-matched control subjects to agree to misleading questions from interviewers and to incorporate misinformation into later reports of what happened to them. Thus, the autobiographical recall of children with ASD is characterized by the sparseness of true memories but not by the overrepresentations of false reports. And, even when children with ASD did accurately recall a past event, they provided significantly fewer details. Some strategies for helping children with Autism recall past events might include showing photos to children with ASD to help them reconstruct past experiences – for example when friends and family come to visit to provide background information about the ways that other people are connected with the family. This might be particularly useful given the propensity for so many children on the spectrum to be drawn toward visual cues. Another strategy might be to retell stories, including as many important details as possible about shared experiences with others in order to give them another way to build memories of past events.

Bruck, M, London, K., Landa, R., Goodman, J. (2007). Autobiographical memory and suggestibility in children with autism spectrum disorder. Development and Psychopathology, 19(1):73-95.

Increasing physical activity for children with Autism

Activities with fewer social demands and performance expectations may reduce stress for participants

Many parents are concerned that their child on the spectrum does not engage in the recommended 60 minutes or more of physical activity on all or most days of the week – and new research confirms that youth with ASD may indeed be less active than their typically developing peers. This is an issue worth addressing, because less active children on the spectrum may be at risk for health complications associated with a sedentary lifestyle. Children with ASD often have low muscle tone, loose joints, poor balance and coordination, making physical activity difficult for them. Children who are less physically active also have poor endurance and may tire more quickly than their active peers. In addition, weight gain can be a side effect of medications children with ASD take to regulate their behavior.

In a study published in the Journal of Autism and Developmental Disorders, thirty children and adolescents with ASD wore an accelerometer (or step counter) and completed an activity questionnaire for seven consecutive days. The study found that less than half of the participants were moderately active on a regular basis. While elementary school age children were more active, in part due to opportunities for activity during school recess, teenagers in the group were particularly inactive. These results are consistent with findings for typically developing children—that activity decreases significantly in adolescence for many youth.

There are several reasons why children with ASD may live a less active life style. Difficulties with social and communication skills—understanding social cues, making eye contact, taking turns in conversation, and interacting appropriately with peers—often make it hard for youth on the spectrum to enjoy active games and to participate in team sports. Some participants in the study reported that they just didn’t enjoy physical activity or the feeling of “being sweaty.” Most participants indicated a lack of enjoyment for team sports and preferred individual activities such as martial arts and swimming. These activities typically occurred within a group context, but there were no performance expectations that could influence group outcomes (i.e., winning the game), and this made those experiences less stressful. Walking was the most frequently reported non-school activity, and it was the only activity in which almost all youth consistently participated.

The authors of the study identified several factors at the school or societal level that also contribute to inactivity among children and youth with ASD. While many communities offer school- and community-based “adaptive sport” recreation programs for children with special needs, children on the spectrum are sometimes ineligible to participate due to diagnostic criteria or because of their real or perceived behavior problems. In the school setting, few physical education teachers have adequate training to adapt their curriculum to the needs of a child on the spectrum. Children and youth on the spectrum may have sensory problems related to physical activity—for example, a strong aversion to feeling hot and sweaty.

The study suggests ways for families, communities and schools to increase opportunities for children with ASD to become more active through:

  • maximizing opportunities for physical activity during recess periods for elementary school-aged children
  • working with schools to deliver quality physical education instruction by adequately trained teachers who have experience working with children with ASD
  • working with their communities to create adequate supports and instruction for community based recreation programs that address the unique needs of children and youth on the spectrum.

The study recommends that parents and communities focus on promoting life-long fitness activities that require fewer societal supports, such as running, swimming, tennis, and walking. The rhythmic nature of these activities could have a calming effect and help children and youth with ASD regulate their emotional states. Citing other research, the authors also advise that children and youth with ASD might be more inclined to be physically active if they can choose an activity based on their own preference, rather than as an opportunity for socialization.

Source: Pan, Chien-Yu, Frey, Georgi (2006). Physical Activity Patterns in Youth with Autism Spectrum Disorders, Journal of Autism Developmental Disorders.

Parents trained to improve children’s communication during daily routines and activities

New research provides more support that parents can effectively improve outcomes for their children with autism.

Most parents visiting RelateNow will not be surprised by the results of a new study that provides more support for the intuitive idea that parents can be effective partners in improving outcomes for their children with autism. Specifically, the study demonstrates that parents can be taught how to facilitate their child’s communication during daily routines and activities. Helping children in the course of everyday living is important because parent-focused interventions that occur throughout the day in natural settings have been found to decrease parents’ stress while also resulting in greater communication gains for the child. One noteworthy aspect to this study is that it taught parents generalizable strategies they could use across numerous contexts, offering a more flexible approach than teaching them specific techniques for each unique new situation. Parents were taught a variety of strategies including:

  1. Arranging the environment to promote interaction (e.g., putting preferred toys out of reach but in sight, requiring children to request assistance);
  2. Using natural reinforcement (e.g., verbally acknowledging a child's communication attempts and providing access to objects or events in response to child's requests;
  3. Using time delay (presenting an object of interest to the child such as an unopened toy and waiting briefly before giving the child a verbal prompt to respond);
  4. Imitating contingently (e.g., imitating the child's actions within the child's field of vision immediately following the child's actions);
  5. Modeling (e.g., parent provides verbal models describing the activity or labeling the objects that the child is interested in but does not ask the child to imitate).
  6. Gestural/visual cuing (e.g., using gestures and visual prompts to prompt the child's participation in a routine).

Parents were also allowed to pick what routines of daily living they wanted to focus on such as play routines, outdoor or recreation, caregiving routines, household chores, and community activities. The results were promising in that all parents demonstrated proficient use of the teaching strategies and generalized their use across routines. Furthermore, the intervention had positive effects on child communication outcomes and all parents perceived the intervention to be beneficial. One clear weakness of the study is its small sample size, which included only five families. Even so, this study contributes to the growing body of research showing that parents can be effectively empowered to improve outcomes for their children with autism.

Baker, Kashinath, S., Woods, J., & Goldstein, H. (2006). Enhancing generalized teaching strategy use in daily routines by parents of children with autism. Journal of Speech, Language, and Hearing Research, 49 466-485.

Social Skills

Social skills training can help school-age children overcome some challenges, technique more likely to work for skills that are directly and explicitly taught

Social challenges are typically a central feature of the autism spectrum disorders (ASD). Or course, these difficulties can bring significant distress and loneliness and often these problems increase as children approach adolescence, social environments become more complex and the child becomes more aware of his or her social disability. Thus, it makes a lot of sense to offer interventions to address this issue because for a sizeable percentage of these children, social deficits are not explained by a lack of lack of social interest. A comprehensive new article in the Journal of Autism and Developmental Disorders summarizes the state of research in group-based social skills training programs for school-age children and adolescents with ASD including all available studies published between 1985 and 2006. Group social skills training involves teaching specific skills (e.g., maintaining eye contact, initiating conversation) through behavioral and social learning techniques.

Summarizing 14 studies on group social skills training, the authors concluded that targeted skills can be improved and that several strategies hold promise for youth with ASD. These targeted skills include the following goals:

  1. Increased social motivation, which can be addressed by strategies like increasing social motivation, fostering self-awareness and self-esteem, developing a nurturing, fun environment, interspersing new skills with previously mastered skills and starting with simple, easily learned skills (errorless teaching)
  2. Increased social initiations, which can be addressed by strategies like making social rules clear and concrete (e.g., stay one arm’s length from other person), modeling age-appropriate initiation strategies, using natural reinforcers for social initiations (e.g., follow child’s conversation lead/interest) and teaching simple social ‘scripts’ for common situations
  3. Improving appropriate social responding, which is addressed by strategies like teaching social response scripts, reinforcing response attempts and using modeling and role-play to teach skills
  4. Reduced interfering behaviors such as make teaching structured & predictable, differentially reinforcing positive behaviors, keeping behavior charts (e.g., checkmarks or stars) for positive behavior, and reviewing socially appropriate and inappropriate behaviors of the participants as a group, via video or audiotape segments
  5. Promoting skill generalization such as orchestrating peer involvement (e.g., prompting & initiating social interactions, physical proximity), using multiple trainers & individuals with which to practice skills, involving parents in training, providing opportunities to practice skills in safe, natural settings (e.g., field trips) and using time between session to practice skills (e.g., via ‘homework’).
  6. Based on the evidence, the authors also conclude that improvements from group-based social skills training may be confined to those skills that are directly and explicitly taught. For example, despite specific instruction in conversation skills, these showed smaller effects. This difference in improvement across skills may indicate that some skills are more amenable for teaching using scripts and concrete rules, while perhaps ‘higher level’ skills (e.g., maintaining a conversation) require different teaching approaches.

Source: White, S.W., Keonig, K. & Scahill, L (2006). Social Skills Development in Children with Autism Spectrum Disorders: A Review of the Intervention Research. Journal of Autism and Developmental Disorders. DOI 10.1007/s10803-006-0320-x