Autism Center Research Articles

Interdisciplinary Team Evaluation: An Effective Method for the Diagnostic Assessment of Autism Spectrum Disorder.

The objective of this research is to assess the feasibility of an interdisciplinary team diagnostic assessment model for autism spectrum disorder (ASD). Medical records from 366 patients evaluated for ASD at the Seattle Children's Autism Center (SCAC) were reviewed. ASD diagnostic outcomes, provider satisfaction, engagement in follow-up care, billed time, and reimbursement amounts were compared in patients evaluated through an interdisciplinary team approach (n = 91) with those seen in multidisciplinary evaluations led by either a psychologist (n = 165) or a physician (n = 110). Diagnostic determination was made in 90% of patients evaluated through the interdisciplinary team model in a single day. Rates of ASD diagnosis were similar across the 3 tracks, ranging from 61% to 72%. Demographic characteristics did not impact the likelihood of ASD diagnosis. Rates of patient follow-up care and provider satisfaction were significantly higher in interdisciplinary versus multidisciplinary teams. Interdisciplinary team evaluations billed 1.8 fewer hours yet generated more net hourly clinic income compared with psychology-led multidisciplinary evaluations. An interdisciplinary team approach, focusing on ruling-in or ruling-out ASD, was sufficient to determine ASD diagnosis in most patients seen at the SCAC Interdisciplinary teams generated more clinic income and decreased the time spent in evaluation compared with a psychology-led approach. They did so while maintaining consistency in diagnostic rates, demonstrating increased provider satisfaction and an increased likelihood of engagement in follow-up care.

Editorial introductions

Current Opinion in Neurology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of neurology is divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Shafali S. JesteShafali S. JesteDr Jeste is a behavioral child neurologist specializing in autism and related neurodevelopmental disorders. She is an Associate Professor in Psychiatry, Neurology, and Pediatrics in the UCLA David Geffen School of Medicine, USA, and a lead investigator in the UCLA Center for Autism Research and Treatment (CART), USA. After earning her BA in Philosophy from Yale University, USA, and MD from Harvard Medical school, USA, she completed both child neurology and developmental neuroscience fellowships at Boston Children's Hospital, USA. Her extensive research program at UCLA integrates genetics with functional electroencephalography (EEG) to inform early risk prediction, treatment targets, and clinical trials in autism. She has designed innovative studies in early predictors of autism in high risk infants that integrate biomarkers with behavior to define atypical development prior to the onset of clinical symptoms. Within this framework, she has been investigating and treating infants and children with neurogenetic syndromes associated with ASD, such as tuberous sclerosis complex and Dup15q syndrome. She is the principal investigator of a study of early development and intervention for infants with tuberous sclerosis complex and a UCLA Autism Center of Excellence study of high-risk infant siblings. Dr Jeste also serves as the UCLA site director for the multisite National Institutes of Health Autism Biomarkers Consortium for Clinical Trials. Clinically, she founded and directs the UCLA Developmental Neurogenetics Clinic, a multidisciplinary program that evaluates and treats children with genetically defined neurodevelopmental disorders. Dr Jeste has published more than 50 peer-reviewed articles in high impact journals such as Neurology and Science Translational Medicine. She has been the recipient of the Child Neurology Foundation's Researcher-in-Training Award, the American Academy of Neurology's Clinical Researcher-in- Training Award, and she recently joined the American Academy of Neurology Emerging Leaders Forum. She holds several national leadership roles, serving on the board of directors of the Child Neurology Foundation, the American Brain Foundation, and the International Society for Autism Research. Christian E. ElgerChristian E. ElgerDr Christian E. Elger is a Professor of Epileptology and the Director of the Department of Epileptology at the University of Bonn in Germany. He received his degree in medicine from the University of Münster, Germany, and while there, obtained his education in Physiology and then Neurology. Later, he became a Professor of Epileptology at the University of Bonn, Germany. Dr Elger was instrumental in transforming the small Epileptology Department in Bonn into a department in which neurologists, neuropsychologists, and basic scientists could work together in pursuit of new developments in epilepsy surgery and human brain research. The epilepsy center has one of the most active epilepsy surgery programs within Europe. Dr Elger is renowned for his role in studying seizure prediction and his pioneering work within the field of epilepsy and cognition. Critically, he was involved in developing pre-surgical evaluation techniques which enable the prediction of postsurgical cognitive outcome. His vision involves the use of epilepsy as a window to human brain function, and within this context, he founded the Center for Economics and Neuroscience in Bonn. He is widely published in highly-ranked journals and has over 780 peer-reviewed PubMed referenced publications. He also served as Associate Editor for Brain and Epilepsy and Behavior. In 2005, Dr Elger received the Zülch Prize from the Max-Planck-Foundation in recognition of his scientific studies in experimental epilepsy research and cognition. Additionally, the ILAE (International League Against Epilepsy) granted him the Ambassador of Epilepsy award. In 2010, he received the Hans-Berger Award of the DGKN (Deutsche Gesellschaft für Klinische Neurophysiologie und Funktionelle Bildgebung) for merit within the field of electrophysiology in epilepsy. He was presented with The Victor and Clara Soriano Award at the 20th World Congress of Neurology Meeting in Marrakesh in 2011. The following year, the ILAE granted him the European Epileptology Award. In 2015, he was presented with the William G. Lennox Award from the American Epilepsy Society. The European Academy of Neurology (EAN) presented him with the EAN Clinical Award: The Moritz Romberg Lecture in Amsterdam in 2017.

Aggression Dimensions in Students with Autism

The current study is intended to explore the prevalence of aggression level of students with autism based on gender, age, and intellectual state. The study sample is composed of parents for (108) of children with autism. These students are aged 5-16 years old who have been attending the autism centers in the State of Kuwait. The current study has utilized a three-dimensional aggression scale, which includes aggression toward others, aggression toward self, and aggression toward things. The result of the study reveals that among the participant's aggression toward others has been ranked the highest on subscale, followed by aggression toward self, and lastly aggression toward things. The study further exposed that the most significant aspects of aggression were explicit obstinacy and refusal when asking the participant to perform an action, the act of pinching others in a state of anger, kicking others without any legit or obvious reason, throwing himself on the floor, and hitting himself with his hand or any other part of his body. In addition, the results of the study suggests that there are a statistically significant differences based on gender in aggression toward things, which is in favour of female. No statistically significant difference has been observed based on gender on aggression toward others. As per the total score of aggression scale, there is no statistically significant difference found based on age or intellectual state of all aggression subscales.

Myoclonus in Angelman syndrome

Angelman syndrome (AS) is a neurogenetic imprinting disorder caused by loss of the maternally inherited Ube3a gene and is characterized by generalized epilepsy, limited expressive speech, sleep dysfunction, and movement disorders. Myoclonic seizures are often the first seizure type to appear, and myoclonic status, associated with developmental regression, may occur in the first few years of life. Additionally, there have been rare reports of prolonged episodes of myoclonus without electrographic correlate in adults with AS.The medical records of 200 individuals seen in the Angelman Syndrome Clinic at the Massachusetts General Hospital and the Lurie Center for Autism were retrospectively reviewed to identify and characterize myoclonic seizures and episodes of nonepileptic myoclonus. Myoclonic seizures were reported in 14% of individuals with age of onset occurring before 8years. These are brief events, unless the individual was experiencing myoclonic status, and electroencephalographs show interictal generalized spike and wave activity. Nonepileptic myoclonus occurred in 40% of individuals over 10years of age, and prevalence appears to increase with age. The episodes of nonepileptic myoclonus arise during puberty or later, with age of onset ranging from 10 to 26years. These events were captured on 5 video electroencephalographs and had no electrographic correlate. They can last from seconds to hours, always occurring in the hands and spreading to the face and all extremities in some individuals. Episodes of nonepileptic myoclonus have a discrete beginning and end, lacks a postictal period, and are not associated with significant alteration of consciousness or developmental regression. These episodes can be difficult to treat and are often refractory to medication; however, levetiracetam, clobazam, and clonazepam appear to be effective for some individuals. Myoclonic seizures are common in AS, typically occurring in young children and associated with epileptiform changes on electroencephalographs. Prolonged episodes are associated with developmental regression. In contrast, nonepileptic myoclonus typically begins in adolescence or early adulthood and has no electroencephalogram (EEG) correlate, alteration in consciousness, or regression but can significantly impact quality of life.

A Review of Sensory Design Physical Learning Environment for Autism Centre in Malaysia

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that impairs verbal and non-verbal communication and social interaction by showing themselves in repetitive behaviour, sensory issues, and cognitive delay. With proper learning environment, autistic children can continue their lives with their peers who exhibit regular development. The paper aims to develop a conceptual sensory design of Autism Physical Learning Environment. The objective is to identify sensory issues for design consideration in a physical learning environment. Perhaps, this could help designers to gain better understand the variables of certain school design features and school facilities.

Stress Management Training among Mothers with Autistic Children Referred to Autism Centres in Tehran

Stress Management Training among Mothers with Autistic Children Referred to Autism Centres in Tehran

One Discipline, Two Professions

One Discipline, Two Professions

Preparing for Our Future: Translating Research Into Practice

Preparing for Our Future: Translating Research Into Practice

A guide to indicators for the evaluation of specialist autism centres, based on the quality-of-life model

Objective: The evaluation of individual and organizational quality of life through the Guide to Quality-of-Life Indicators and its promotion in English-speaking areas. This guide was initially designed for people living with Autism Spectrum Disorder in specialist autism centers in Spanish and Italian-speaking areas where its effectiveness has been validated.Method: The Delphi technique is applied to the design of a qualitative investigation, with expert validation for the adaptation to English-speaking areas.Results: The results have facilitated the adaptation and validation of the tool, which has 68 indicators grouped into six areas, for its application in both the planning and the evaluation processes of organizations and support services in English-speaking areas.Conclusion: The adaptation of the questionnaire on QoL indicators for people with ASD is a reliable service-provision tool intended to assess integrated programs and to improve them throughout their life-cycles; this aim is approached from the objective perspective and through a subjective evaluation. The Guide will require further updating and review procedures as new needs and contexts emerge.

Using behavioral skills training to teach high school students to implement discrete trial training.

Discrete trial training (DTT) is widely recognized as an evidence-based intervention for children with autism spectrum disorder (ASD; National Autism Center, 2010), but it is not typically provided to students with ASD in school settings (Stahmer et al., 2015), presumably due to personnel resource l

A ‘Big Picture’ Learning Experience

A ‘Big Picture’ Learning Experience

Utility of the Autism Observation Scale for Infants in Early Identification of Autism in Tuberous Sclerosis Complex

BackgroundTuberous sclerosis complex (TSC) is a genetic disorder with high prevalence of associated autism spectrum disorder (ASD). Our primary objectives were to determine early predictors of autism risk to identify children with TSC in most need of early interventions. The Autism Observation Scale for Infants (AOSI) was evaluated as a measure of ASD-associated behaviors in infants with TSC at age 12 months and its ability to predict ASD at 24 months. MethodsChildren ages 0 to 36 months with TSC were enrolled in the TSC Autism Center of Excellence Research Network (TACERN), a multicenter, prospective observational study to identify biomarkers of ASD. The AOSI was administered at age 12 months and the Autism Diagnostic Observation Schedule-2 (ADOS-2) and Autism Diagnostic Interview-Revised (ADI-R) at 24 months. Developmental functioning was assessed using the Mullen Scales of Early Learning. Children were classified as ASD or non-ASD according to the ADOS-2. ResultsAnalysis included 79 children who had been administered the AOSI at 12 months and ADOS-2 and ADI-R at 24 months. The ASD group had a mean AOSI total score at 12 months significantly higher than the non-ASD group (11.8 ± 7.4 vs 6.3 ± 4.7; P < 0.001). An AOSI total score cutoff of 13 provided a specificity of 0.89 to detect ASD with the ADOS-2. AOSI total score at 12 months was similarly associated with exceeding cutoff scores on the ADI-R. ConclusionsThe AOSI is a useful clinical tool in determining which infants with TSC are at increased risk for developing ASD.

Use Developmental Stages to Guide Treatment in ASD

Use Developmental Stages to Guide Treatment in ASD

Predictors of Co-occurring Neurodevelopmental Disabilities in Children With Autism Spectrum Disorders

PurposeCo-occurring neurodevelopmental disabilities (including cognitive and language delays and attention deficit hyperactivity disorder) affect over half of children with ASD and may affect later behavioral, language, and cognitive outcomes beyond the ASD diagnosis. However, no studies have examined predictors of co-occurring neurodevelopmental disabilities in children with ASD. This study investigated whether maternal sociodemographic, perinatal and neonatal factors are associated with co-occurring disabilities. Design and MethodsThis study involved a retrospective analysis of medical records for children diagnosed with ASD between 2009 and 2010 at an Autism Center in the southeast United States. Logistic regression was used to identify predictors of co-occurring neurodevelopmental disabilities. ResultsOf the 385 children in the sample, 61% had a co-occurring neurodevelopmental disability. Children whose mothers had less education (OR: 0.905), had never been married (OR: 1.803), or had bleeding during pregnancy (OR: 2.233) were more likely to have a co-occurring neurodevelopmental disability. Both preterm birth and African American race were associated with bleeding during pregnancy. ConclusionsSeveral maternal and perinatal risk factors for ASD were found to put children at risk for further diagnoses of co-occurring neurodevelopmental disabilities. While prematurity, a well-established risk factor for ASD, as well as maternal ethnicity was not found to increase the risk of a co-occurring disability, this study suggests that bleeding during pregnancy may moderate these relationships. Practice ImplicationsUnderstanding maternal, perinatal, and neonatal risk factors may inform healthcare provider screening for ASD and co-occurring neurodevelopmental disabilities by helping providers recognize infants who present with multiple risk factors.

Prevalence, Trend, Determinants and Prediction of Autism Spectrum Disorders among Dubai Population, Diagnostic Approach and Management Contexts

Background: Autism spectrum disorder (ASD) is becoming a major threat, large public health challenge and most common persistent developing disorder to a public health in Dubai. Most of the families are facing lifelong challenge because of the different nature of disorders like neurodevelopment disorder, which often results in an array of motor impairments. These motor impairments are the main cause of decrease performance of activities of routine life as well as in societal tasks which require specific motor abilities and skills. Aim: To study the prevalence’s, determinants and prediction of Autism among Dubai population. To study some associated factors. Methodology: Retrospective records review approach has been applied; qualitative methodology has been focus on the groups with mental health experts working at: Dubai Autism Centre (DAC), Al-Jalila hospital (AJH), Latifa hospital, Private Sector Healthcare (PSH), Dubai Rehabilitation Centre for Disabilities. Quantitative methodology is based on the, Prevalence, incidence. Prevalence, incidence is associated on international research (a systematic research review) as estimated as well, along with expert interviews have been applied as well. Results: The study showed that 84.9% of the cases were males and 51.9% of the autism cases were females, 30.9% were UAE nationals and 69.1% were expatriate, about 72.4% were diagnosed as Autism spectrum disorders, 9.2% as ASD features and 9.2% were diagnosed as other disorders. Dubai Autism Centre estimates that autism is affected 1 in 146 births (0.68%). By applying these estimates to the total number of births in Dubai for 2014, it was predicted that approximately 199 children of which 58 (29.1%) were nationals and 141 (70.9%) were non– nationals suffering from autism at the same stage. Some of the families of about 16.4% of children searching help for ASD assessment between the age group 6–18+. Most of the families are not going to consult GPs for early diagnosis because of the number of reasons including cultural reasons. So, it became critical to understand late– stage diagnosis as ASD can be diagnosed much earlier and how many of these later presenters are diagnosed with ASD. The study reflected future prediction of the cases based on international standards prevalence and the population density as reflected by the figure which reflected the highest prevalence at the age intervals of 25-29 years, 30-34 years and 35-39 years respectively. Conclusion: Autism is still on-going challenging public health issue in Dubai, in terms of rising up prevalence, incidences, trends, cases sorting out and management context of autism is one of actual national health care system gaps. There is emergence need of the nurses who are qualified and have the experience to identify children with ASD which is required to implement in regular checkup of school health. Early diagnosis of Autism awareness is increased by giving training to GP’s. There is an urgent need of interdisciplinary innovative autism centre for adult when the children leave the safe environment of the school at 18 years. These needs are followed by further studies to cover take care of needed people with an Autism Spectrum Disorder (ASD).

A systematic review and evaluation of inhibitory stimulus control procedures as a treatment for stereotyped behavior among individuals with autism

ABSTRACTPurpose: Stereotypy is pervasive among persons with autism and may impact negatively on social inclusion and learning. The implementation of resource-intensive behavioral interventions to decrease these behaviors has been questioned. Inhibitory stimulus control procedures (ISCPs) comprise a type of antecedent-based intervention that has been proposed as an effective treatment approach for stereotypy but has received limited research attention to date. Method: The current systematic review sought to examine and synthesize the literature reporting applications of ISCPs in the treatment of stereotypy among persons with autism. Treatment outcomes were analyzed quantitatively and the status of ISCPs as evidence-based practice was evaluated in accordance with the National Autism Center’s National Standards Report guidelines. Results: A total of 11 studies were reviewed with results indicating that ISCPs constituted an emerging treatment for the stereotypy exhibited by persons with autism. Conclusions: ISCPs comprise a promising intervention for stereotyped behavior but further research is required.

Risk of Autism Associated With Hyperbilirubinemia and Phototherapy.

Whether neonatal hyperbilirubinemia and/or phototherapy increase the risk of autism spectrum disorder (ASD) is unclear. We sought to quantify the risk of ASD associated with elevated total serum bilirubin (TSB) levels and with phototherapy. In a retrospective cohort study of 525 409 infants born at ≥35 weeks' gestation in 15 Kaiser Permanente Northern California (KPNC) hospitals, 1995-2011, we obtained all TSB levels and determined which infants received phototherapy. From the KPNC Autism Registry, we identified patients with ASD diagnosed at a KPNC Autism Center, by a clinical specialist, or by a pediatrician. We calculated Cox proportional hazard ratios (HRs) for time to diagnosis of ASD, adjusting for confounding factors. Among infants in the birth cohort, 2% had at least 1 TSB level ≥20 mg/dL, and 8% received phototherapy. The rate of ASD was 13 per 1000 births. Crude analyses revealed an association between TSB ≥20 and ASD (relative risk: 1.4; 95% confidence interval [CI]: 1.1-1.6), and between phototherapy and ASD (relative risk: 1.7; 95% CI: 1.5-1.8). After adjusting for confounders, TSB ≥20 (HR: 1.09; 95% CI: 0.89-1.35) and phototherapy (HR: 1.10; 95% CI: 0.98-1.24) were no longer significantly associated with ASD. Independent risk factors for ASD included maternal and paternal age; maternal and paternal higher education; male sex; birth weight <2500 g or ≥4200 g; and later year of birth. After adjustment for the effects of sociodemographic factors and birth weight, neither hyperbilirubinemia nor phototherapy was an independent risk factor for ASD.

Autism Screening With Online Decision Support by Primary Care Pediatricians Aided by M-CHAT/F.

Autism spectrum disorders (ASDs) often go undetected in toddlers. The Modified Checklist for Autism in Toddlers (M-CHAT) With Follow-up Interview (M-CHAT/F) has been shown to improve detection and reduce over-referral. However, there is little evidence supporting the administration of the interview by a primary care pediatrician (PCP) during typical checkups. The goal of this study was to evaluate the feasibility, validity, and reliability of the M-CHAT/F by PCPs with online prompts at the time of a positive M-CHAT screen. Forty-seven PCPs from 22 clinics completed 197 M-CHAT/Fs triggered by positive M-CHAT screens via the same secure Web-based platform that parents used to complete M-CHATs before an 18- or 24-month well-child visit. A second M-CHAT/F was administered live or by telephone by trained research assistants (RAs) at the Kennedy Krieger Institute Center for Autism and Related Disorders. The Autism Diagnostic Observation Schedule, Second Edition, and the Mullen Scales of Early Learning were administered as criterion measures. Measures of agreement between PCPs and RAs were calculated, and measures of test performance compared. There was 86.6% agreement between PCPs and RAs, with a Cohen's κ of 0.72. Comparison of sensitivity, specificity, positive predictive value (PPV), and overall accuracy for M-CHAT/F between PCPs and RAs showed significant equivalence for all measures. Use of the M-CHAT/F by PCPs resulted in significant improvement in PPV compared with the M-CHAT alone. Minimally trained PCPs can administer the M-CHAT/F reliably and efficiently during regular well-child visits, increasing PPV without compromising detection.

Developing “Family Integrated Treatment” for Autistic Disorders and Comparing its Efficacy on Decreasing Parenting Stress of Parents of Autistic Children with “Little Bird” Method

Introduction: Autism is one of the most famous neuro-developmental disorders and increases parental stresses. On the other hand, decrease of parental stress has positive effect on child response to treatment. So, the main goal of this study was to develop a family education program for parents of children with autism, which is effective on decreasing their parental stress. Materials and Methods: The first part of the study was a qualitative research of three categories of information resulted from deep interviews with 11 specialists, semi-structured interviews with 30 parents and review of 101 articles. The second part was an experimental research on two intervention, and one control groups, with three examination stages: before, after and one-month fallow-up. To fulfill this goal, 42 parents were selected from the parents of autistic children who received services in Tehran Autism Center, Iran, during the study period, and then, were divided randomly to tree groups. The material used for this section of study was Parental Stress Index (PSI). The results were analyzed using covariate analysis and analysis of variance techniques via SPSS 20 software. Results: Our family integrated treatment method for autistic disorders was more efficient on decreasing reinforcing (P = 0.032), mood (P = 0.010), acceptability (P = 0.013), and adaptability (P = 0.004), and total score of child stress (P = 0.004). In addition, it showed significant effect on competence (P = 0.002), depression (P = 0.001), social isolation (P = 0.002), attachment (P < 0.001), role restriction (P =0.001), parental health (P = 0.003), and total score of parental stress (P < 0.001), and also on PSI-total score (P < 0.001), in comparison with 2 other groups. Conclusion: In comparison with previous parental training programs like little bird program which mostly focuses on stress of child domain, family integrated treatment method pays attention to special needs of every single family and its comprehensiveness; and is effective on decreasing parental domain of stress as well.

Characteristics of Autism Center in Malaysia

Autism Spectrum Disorder (ASD) is a group of mental developmental disabilities; with one out of 625 Malaysian children has autism. Noting that, the existence of center that provides varieties of treatments is crucial to reduce numerous aberrant behaviors of children with Autism. This paper aims to explore the characteristics of autism centers in Malaysia. Based on phone interviews conducted with the staff of 22 Autism centers, it was found that majority of Autism centers in Malaysia requires children to undergo a diagnostic test, offered a combination of classes and charged classes fees in the range of RM356 to RM 600 per month.© 2016. The Authors. Published for AMER ABRA by e-International Publishing House, Ltd., UK. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning &amp; Surveying, Universiti Teknologi MARA, Malaysia.Keywords: Autism; Malaysia; center; characteristic