Autism Diagnosis Observation Schedule Research Articles

358 Using autism symptom profiles at intervention baseline to predict social cognitive outcomes

OBJECTIVES/GOALS: 1) Investigate the utility of pragmatic communication profiles in a sample of children with autism at baseline to predict response to treatment in a randomized clinical trial (RCT) of oxytocin augmentation and social cognitive skills training at week 12. 2) Determine if levels of anxiety or hyperactivity moderate child outcome performance. METHODS/STUDY POPULATION: 40 children (37M, 3F), aged 8-11(M=9.25, SD=1.10), with confirmed autism spectrum disorder (ASD), enrolled in an RCT(NCT02918864) were evaluated at baseline on: an assessment of ASD (Autism Diagnosis Observation Schedule, ADOS-2), a task of perspective taking, Theory of Mind ToM, (Reading the Mind from the Eyes Task), pragmatic communication (Pragmatic Rating Scale-School Aged; PRS-SA), IQ (WAIS_I, WISC-V) and anxiety and hyperactivity (Behavior Assessment Scales for Children-3; BASC-3). A Tobii T60 XL was used for eye-tracking visual patterns and attention during the RMET. The PRS-SA was coded by trained, reliable clinicians. Parent ratings indicated over half of the participants’ had At Risk levels or higher on anxiety and hyperactivity on the BASC-3. Week 12 measures included all but the PRS-SA and ADOS-2. RESULTS/ANTICIPATED RESULTS: Baseline preliminary analysis indicated the participants spent more time looking at words (.41ms) than eye images on the RMET(.15ms, p DISCUSSION/SIGNIFICANCE: Findings at baseline suggest pragmatic communication skills are more related to ToM than gaze and attention on the RMET. This relationship will be further investigated over the time of the trial. Mental health indicators need to be considered further in this population. Child profiles at baseline may inform appropriate triage and treatment targets.

Особенности понимания речи у детей с расстройствами аутистического спектра младшего школьного возраста

The objective of the present study is to investigate the relationship between the receptive language, and the index of non-verbal intelligence and the level of severity of autistic disorders in primary-school-aged children with Autism spectrum disorder. One of the main areas influenced by autistic disorders is communication. Therefore, the study of the language abilities of such children and factors that affect them provides a better approach to the therapy and education. The sample included 50 children aged 7–11 years diagnosed with autism spectrum disorders. Children were tested using the KORABLIK method (basic linguistic skills), the Kaufman Assessment Battery for Children (KABC-II) or the Wechsler Intelligence Scale for Children ― Third Edition (WISC-III) (non-verbal intelligence), the Autism Diagnosis Observation Schedule ― Second Edition (ADOS-II) (autistic traits). The results support the hypothesis of the relationship between receptive language skills, the index of non-verbal intelligence, and symptoms of autism. The severity of autistic traits is negatively associated with some phonological and lexical levels of the receptive speech, as well as with understanding of discourse. The non-verbal intelligence index is positively associated with speech comprehension at all levels. A specific feature of receptive language in children with Autism spectrum disorder aged 7–11 years is the uneven development, which is associated with the severity of autistic traits and is not associated with the intelligence level.

Identifying brain areas correlated with ADOS raw scores by studying altered dynamic functional connectivity patterns.

Altered functional connectivity patterns play an important role in explaining autism spectrum disorder related impairments. In order to examine such connectivity, resting state functional MRI is the most commonly used technique. To date, the majority of works in this area examine a whole time series of brain activation as a discrete stationary process. This study proposes a more detailed analysis of how functional connectivity fluctuates over time and how it is used to quantify instances demonstrating overconnectivity or underconnectivity. Non-parametric surrogates test identifies the areas where underconnectivity or overconnectivity correlate with the Autism Diagnosis Observation Schedule. In addition, this study shows how the areas identified affect the subjects behaviors. Our ultimate goal is a personalized autism diagnosis and treatment CAD system, where each subject impairments are distinctly mapped so they can be addressed with targeted treatments.

22q13 deletion syndrome: communication disorder or autism? Evidence from a specific clinical and neurophysiological phenotype

Phelan–McDermid syndrome is related to terminal 22q13 deletions of various sizes affecting the SHANK3 gene. In this neurodevelopmental disorder, behavioural symptoms of autism spectrum disorder (ASD) are reported in half of cases. Extensive clinical and neurophysiological characterization is lacking to understand the genotype–phenotype correlation. Eighteen patients (8 males, mean age 12.7 years, SD = 9.2) with known 22q13 deletions were fully explored with determination of deletion size, along with behavioural, language and cognitive standardized assessments. Neurophysiological indices previously reported to be altered in autism (i.e., eye tracking in a social/non-social task and auditory evoked potential mismatch) were also recorded. Thirty-nine percent met ASD clinical criteria, exceeding cut-off scores on both ADI-R (Autism Diagnosis Interview based on the period spanning 4–5 years of age) and ADOS-2 (Autism Diagnosis Observation Schedule for the current period). All patients had intellectual disability and language disability. Deletion size was significantly correlated with expressive and receptive language disability but not with ASD standardized assessment scores. Developmental Quotient tended to be lower in patients with the largest deletions. Using Eye Tracking, smaller pupil size, which is typically described in ASD, was not observed in these patients. Furthermore, atypical shortened latency of mismatch negativity response previously reported in ASD was not observed, whereas the N250 pattern, related to language, was affected. Language disability combined with cognitive deficits may lead to autistic behavioural symptoms, but with different neurophysiological networks compared to typical autism. These results highlight the indication for early speech therapy rather than intensive autism programme to treat these patients.

Outcomes of An Early Intervention Programme on Children with Autism Spectrum Disorders

Background: Autism Spectrum Disorders (ASD) is becoming global problem as it is being diagnosed very frequently amongst the non communicable diseases. Lack of socialization, communication skill and behavioural abnormality are the main problem belongs to the disease. Cornerstone of the management is based on early intervention program directed to improve the communication and socialization skill. In Bangladesh different early intervention strategies are implicated adopting from evidence based practices in the developed countries. To determine the effect of early intervention program on the improvement of socialization and communication skills of children with ASD who attended an early intervention programme at the Institute of Autism and Child Development, Chattagram Maa Shishu -O-General Hospital.Methods: This is a quasi experimental study carried out at Institute of Autism and Child Development, Chattagram Maa Shishu-O-General Hospital from January 2015 to December 2015. Children with ASD (Autism Spectrum Disorder) aged 1-5 years enrolled as study subjects which is fifty in number. Screening of ASD was carried out by psychological tools like M—Chat (1-3yrs) & ASD assessment scale (> 3yrs). Diagnosis was confirmed by ADOS-G (Autism Diagnosis Observation Schedule- Generic). Internvention was provided on a 1:1 basis which was adopted from various evidence based practices including the ‘More Than Words’. Intervention were given for three subsequent session in one month interval. Level of communications were measured after intervention and compared with pre intevvention level.Results: Significant improvements has been observed in overall level of communication and activities of daily living which included eye contact, attention, joint attention, turn taking, toilet training.Conclusion: A well planned early intervention programme for children with ASD can speed up the social communication development in such a way that gives rise to a hope of mainstreaming these children in future.Chatt Maa Shi Hosp Med Coll J; Vol.16 (2); July 2017; Page 9-13

The categorisation of resistance: interpreting failure to follow a proposed line of action in the diagnosis of autism amongst young adults.

Many characteristics typical of autism, a neurodevelopmental condition characterised by socio-communicative impairments, are most evident during social interaction. Accordingly, procedures such as the Autism Diagnosis Observation Schedule (ADOS) are interactive and intended to elicit interactional impairments: a diagnosis of autism is given if interactional difficulties are attributed as a persistent quality of the individual undergoing diagnosis. This task is difficult, first, because behaviours can be interpreted in various ways and, second, because conversation breakdown may indicate a disengagement with, or resistance to, a line of conversation. Drawing upon conversation analysis, we examine seven ADOS diagnosis sessions and ask how diagnosticians distinguish between interactional resistance as, on the one hand, a diagnostic indicator and, on the other, as a reasonable choice from a range of possible responses. We find evidence of various forms of resistance during ADOS sessions, but it is a resistance to a line of conversational action that is often determined to be indicative of autism. However, and as we show, this attribution of resistance can be ambiguous. We conclude by arguing for reflexive practice during any diagnosis where talk is the problem, and for a commitment to acknowledge the potential impact of diagnostic procedures themselves upon results.

Autism spectrum disorder phenotype and intellectual disability in females with epilepsy and PCDH-19 mutations.

Autism features and various degrees of cognitive deficit are reported in patients with PCDH-19 mutations and epilepsy. Autism spectrum disorder (ASD) and, often, cognitive profile are usually assessed clinically. We studied autism phenotype and cognitive outcome in a series of patients using standardized tools for development and ASD. We aimed to describe the phenotype of ASD in this series and to understand whether ASD is strictly linked to intellectual disability (ID) or is present as a comorbidity. Eight females aged 5 to 17years old with PCDH-19 mutations and epilepsy were recruited. For ASD diagnosis, the Autism Diagnostic Interview - Revised (ADI-R) and the Autism Diagnosis Observation Schedule (ADOS) were administered. Patients underwent a neuropsychological examination with tests measuring global intellectual efficiency (WPPSI-III and WISC-IV), language, and executive and social cognition abilities. Parental adaptive behavioral questionnaires were also obtained (VABS, CBCL, and BRIEF). Six out of eight patients presented with ASD and ID. Two patients had neither ASD nor ID, and both had the latest age of onset for their epilepsy. All cognitive functions were deficient, but theory-of-mind abilities compared to other cognitive features were even impaired. Features of ASD lacked major repetitive and stereotyped behaviors and show some differences with the classical ASD features related to ID. Our results show a large spectrum of ID and a very high rate of ASD in patients with epilepsy and PCDH-19 mutations. Autism spectrum disorder seems to be a genuine comorbidity, more than a consequence of ID. It highlights the importance of standardized psychiatric and cognitive evaluation in order to establish a tailored rehabilitation program.

Advanced parental ages and low birth weight in autism spectrum disorders—Rates and effect on functioning

Objectives (1) To assess the distribution of parental age and birth weight in a large cohort with autism spectrum disorder (ASD) and to compare them to Israeli national data. (2) To examine possible relationships between these risk factors and functioning. Methods The study included 529 participants diagnosed with ASD using standardized tests: the Autism Diagnosis Interview-Revised and the Autism Diagnosis Observation Schedule (ADOS). Medical, developmental and familial histories (gender, age, pregnancy and birth information, parental ages) were obtained. Autism severity was assessed using the new ADOS severity scale and adaptive skill using the Vineland Adaptive Behavior Scales. Results Advanced parental age was associated with ASD. In the older age range the percentages of mothers (35–44 y) and fathers (30–40 y) were significantly higher in the ASD cohort in comparison to the Israeli newborn data. The ASD cohort had significantly higher percentages of low birth weight (<2500 g) and very low birth weight (VLBW < 1500 g) in comparison to the Israeli newborn data. Of these risk factors, only VLBW was associated with lower adaptive functioning. The group with VLBW had lower scores in daily living, socialization and motor skills in comparison to the >1500 g group. Autism severity was not associated with advanced parental age or VLBW. Conclusions The shift in parental age distribution and birth weight in our ASD cohort suggests that the increase in ASD prevalence in recent years might be associated with novel prenatal insults. An adverse fetal course resulting in VLBW may represent a “second hit” phenomenon, causing a poorer outcome.

A communication-based intervention for nonverbal children with autism: What changes? Who benefits?

This article examines the form and function of spontaneous communication and outcome predictors in nonverbal children with autism following classroom-based intervention (Picture Exchange Communication System [PECS] training). 84 children from 15 schools participated in a randomized controlled trial (RCT) of PECS (P. Howlin, R. K. Gordon, G. Pasco, A. Wade, & T. Charman, 2007). They were aged 4-10 years (73 boys). Primary outcome measure was naturalistic observation of communication in the classroom. Multilevel Poisson regression was used to test for intervention effects and outcome predictors. Spontaneous communication using picture cards, speech, or both increased significantly following training (rate ratio [RR] =1.90, 95% CI [1.46, 2.48], p < .001; RR = 1.77, 95% CI [1.35, 2.32], p < .001; RR = 3.74, 95% CI [2.19, 6.37], p < .001, respectively). Spontaneous communication to request objects significantly increased (RR = 2.17, 95% CI [1.75, 2.68], p < .001), but spontaneous requesting for social purposes did not (RR = 1.34, 95% CI [0.83, 2.18], p = .237). Only the effect on spontaneous speech persisted by follow-up (9 months later). Less severe baseline autism symptomatology (lower Autism Diagnosis Observation Schedule [ADOS] score; C. Lord et al., 2000) was associated with greater increase in spontaneous speech (RR = 0.90, 95% CI [0.83, 0.98], p = .011) and less severe baseline expressive language impairment (lower ADOS item A1 score), with larger increases in spontaneous use of speech and pictures together (RR = 0.62, 95% CI [0.44, 0.88], p = .008). Overall, PECS appeared to enhance children's spontaneous communication for instrumental requesting using pictures, speech, or a combination of both. Some effects of training were moderated by baseline factors. For example, PECS appears to have increased spontaneous speech in children who could talk a little at baseline.

Autism severity and motor abilities correlates of imitation situations in children with autism spectrum disorders

Impaired performance in a range of imitation tasks has been described in children with autism spectrum disorders (ASD) and several underlying mechanism have been suggested. This study examined whether imitation abilities are related to autism severity and to motor skills. Furthermore, the performance of children with ASD in four imitation situations (body movements and ‘action on objects’, using meaningful and non-meaningful tasks) was compared. Twenty-five children aged 32–51 months diagnosed with autism (23) and ASD (2) were evaluated for autism severity using the Autism Diagnosis Observation Schedule and for gross and fine motor skills using the Peabody Developmental Motor Scales. Controlling for cognitive level, imitation abilities in all four situations correlated significantly only with autism severity measures and mostly with socio-communication deficits. Motor abilities were below average and did not correlate with imitation abilities nor with autism severity. Comparison of the four imitation situations revealed that performances of meaningful actions were better than non-meaningful actions and imitation of ‘action on objects’ was better than imitation of body movements. The current research supports the fact that socio-communication deficits and not motor abilities are linked to imitation abilities in young children with autism.

Change in autism classification with early intervention: Predictors and outcomes

The current study characterized stability and changes of autism diagnostic classification with intervention in very young children and examined pre-treatment predictors and post-intervention outcome. Sixty-eight children diagnosed with autism, aged 18–35 months ( M = 25.4, SD = 4.0) participated in the study. Children underwent comprehensive evaluations at pre-intervention time (T1) and after 1 year of intervention (T2). The evaluation included autism classification based on Autism Diagnosis Observation Schedule (ADOS) original algorithm, cognitive abilities (Mullen) and adaptive skills evaluation (Vineland). At T2, two groups were identified: the Unchanged group ( n = 53) remained in the same autism classification and the Improved group ( n = 15) changed classification to Autism Spectrum Disorder (ASD) ( n = 13) or Off Spectrum ( n = 2). The verbal domain scores at T1 was the only significant variable that distinguished the two groups. Specifically, the Improved group had better receptive language scores than the Unchanged group. The Improved group gained significantly more than the Unchanged group in all the outcome measures (cognitive, adaptive and reduction of stereotyped behaviors). Two distinct subtypes of autism were identified, one with stable autism symptomatology, poor verbal abilities and limited cognitive and adaptive gains, and a second type with better baseline verbal abilities and overall better response to intervention.

Change in autism core symptoms with intervention

It is still debated what is the best early intervention approach for autism. This study compared two intervention approaches, Eclectic-Developmental (ED) and Applied Behavioral Analysis (ABA) in very young children with autism/autism spectrum disorder (ASD). Nineteen children received ED intervention, using combination of methods. Twenty children received Applied Behavioral Analysis (ABA) intervention which used behavioral principles. Children in both groups were not significantly different in their autism severity, cognitive abilities and in socio-economic background at pre-intervention time. Change in the severity of autism symptoms was assessed by the Autism Diagnosis Observation Schedule (ADOS). The ABA group showed significantly greater improvements than the ED group at post-intervention time. Pre–post intervention differences in language and communication domain were significant only for the ABA group. Both groups showed significant improvement in reciprocal social interaction domain. However, the effect size was greater for the ABA group. Changes in diagnostic classification were noted in both groups but were more pronounced for the ABA group. Pre-treatment IQ scores were positively related to ADOS scores at pre- and post-intervention times, but not to progress over time. Behavioral intervention is more effective than eclectic approach in improving autism core symptoms in young children with autism.