Core Deficit Research Articles

Children and Adolescents with Autism Spectrum Disorder: Psychopharmacologic Treatment

Autism spectrum disorders (ASDs) are a diverse collection of illnesses characterised by a wide variety of impairments ranging from mild to severe. ASDs are diagnosed when three core deficits are present, according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revised) (DSM-IV-TR)1: (1) impairment of social interactions, (2) impaired communication, and (3) repetitive and stereotyped patterns of behaviour, interests, and activities. Aggression, self-injury, impulsivity, poor concentration, anxiety, depression, and sleep disturbance are common associated/comorbid symptoms that can become a major cause of additional suffering and impairment in functioning, even though they are not required for a diagnosis. While developments in psychopharmacology have resulted in dramatic improvements in the symptoms and prognosis of many psychiatric disorders, this has not been the case for treating ASD's basic symptoms. Applied behavioural analysis (ABA), occupational therapy, speech therapy, physical therapy, and pharmacological, psychopharmacologic therapy are the most effective treatments available today.

Chapter 13 - Bálint syndrome

This chapter starts by reviewing the various interpretations of Bálint syndrome over time. We then develop a novel integrative view in which we propose that the various symptoms, historically reported and labeled by various authors, result from a core mislocalization deficit. This idea is in accordance with our previous proposal that the core deficit of Bálint syndrome is attentional (Pisella et al., 2009, 2013, 2017) since covert attention improves spatial resolution in visual periphery (Yeshurun and Carrasco, 1998); a deficit of covert attention would thus increase spatial uncertainty and thereby impair both visual object identification and visuomotor accuracy. In peripheral vision, we perceive the intrinsic characteristics of the perceptual elements surrounding us, but not their precise localization (Rosenholtz et al., 2012a,b), such that without covert attention we cannot organize them to their respective and recognizable objects; this explains why perceptual symptoms (simultanagnosia, neglect) could result from visual mislocalization. The visuomotor symptoms (optic ataxia) can be accounted for by both visual and proprioceptive mislocalizations in an oculocentric reference frame, leading to field and hand effects, respectively. This new pathophysiological account is presented along with a model of posterior parietal cortex organization in which the superior part is devoted to covert attention, while the right inferior part is involved in visual remapping. When the right inferior parietal cortex is damaged, additional representational mislocalizations across saccades worsen the clinical picture of peripheral mislocalizations due to an impairment of covert attention.

Impaired adaptation of learning to contingency volatility in internalizing psychopathology.

Using a contingency volatility manipulation, we tested the hypothesis that difficulty adapting probabilistic decision-making to second-order uncertainty might reflect a core deficit that cuts across anxiety and depression and holds regardless of whether outcomes are aversive or involve reward gain or loss. We used bifactor modeling of internalizing symptoms to separate symptom variance common to both anxiety and depression from that unique to each. Across two experiments, we modeled performance on a probabilistic decision-making under volatility task using a hierarchical Bayesian framework. Elevated scores on the common internalizing factor, with high loadings across anxiety and depression items, were linked to impoverished adjustment of learning to volatility regardless of whether outcomes involved reward gain, electrical stimulation, or reward loss. In particular, high common factor scores were linked to dampened learning following better-than-expected outcomes in volatile environments. No such relationships were observed for anxiety- or depression-specific symptom factors.

Administration of the Repertory Grid Assessment Technique for Exploring Social Cognition of Individuals With Autism

Social communication is a core deficit of autism spectrum disorder (ASD). Speech-Language Pathologists (SLPs) play a key role in evaluating social skills of individuals with autism. Use of person-centered assessment tools in individuals with autism to explore social communication may facilitate improved consideration of perspectives of individuals with autism, which is critical for developing interventions and supports that align with their perspectives and values. An assessment process called the repertory grid can be used to explore one’s personal construction systems as they relate to social relationships. This article describes a process for administering this person-centered diagnostic process in individuals with autism using a semi-structured format established by Hess and colleagues. Data obtained through repertory grids may expand upon information gleaned from traditional assessment protocols when evaluating social communication strengths and challenges of individuals with autism. Furthermore, it offers clinicians and clients insight into clients’ unique personal experiences and relationships.

Inhibitory control and impulsive responses in neurodevelopmental disorders.

The impairment of inhibitory control is often assumed to be the core deficit of several neurodevelopmental disorders characterized by poor impulse control. However, could the same deficit explain different clinical phenotypes? Evidence from behavioural studies is very mixed. This is partly because inhibition is a highly complex executive function. Thus, the different types of tasks that generically tap into inhibitory control are likely to provide different outcomes. Additionally, sample inhomogeneity in terms of age, comorbidity, and medical treatment are confounding factors. Therefore, to make a reliable assessment of the deficit of inhibitory control in a given disorder, the same task and samples with similar characteristics must be employed. This article reviews and discusses studies on five neurodevelopmental disorders with impaired impulse control where these criteria have been used: Tourette syndrome; obsessive-compulsive disorder; attention-deficit/hyperactivity disorder; primary motor stereotypies; and autism spectrum disorder. Overall, they suggest that the mechanisms underlying the inability to control urges are extremely heterogeneous and cannot be ascribed to a general impairment of inhibition. These findings do not support the hypothesis that inhibitory deficits represent a transdiagnostic feature of neurodevelopmental disorders with poor impulse control. WHAT THIS PAPER ADDS: The mechanisms underlying the inability to control urges in neurodevelopmental disorders are heterogeneous. Inhibition impairments cannot generally explain all neurodevelopmental disorders characterized by poor urge control.

The Urine Metabolome of Young Autistic Children Correlates with Their Clinical Profile Severity.

Autism diagnosis is moving from the identification of common inherited genetic variants to a systems biology approach. The aims of the study were to explore metabolic perturbations in autism, to investigate whether the severity of autism core symptoms may be associated with specific metabolic signatures; and to examine whether the urine metabolome discriminates severe from mild-to-moderate restricted, repetitive, and stereotyped behaviors. We enrolled 57 children aged 2–11 years; thirty-one with idiopathic autism and twenty-six neurotypical (NT), matched for age and ethnicity. The urine metabolome was investigated by gas chromatography-mass spectrometry (GC-MS). The urinary metabolome of autistic children was largely distinguishable from that of NT children; food selectivity induced further significant metabolic differences. Severe autism spectrum disorder core deficits were marked by high levels of metabolites resulting from diet, gut dysbiosis, oxidative stress, tryptophan metabolism, mitochondrial dysfunction. The hierarchical clustering algorithm generated two metabolic clusters in autistic children: 85–90% of children with mild-to-moderate abnormal behaviors fell in cluster II. Our results open up new perspectives for the more general understanding of the correlation between the clinical phenotype of autistic children and their urine metabolome. Adipic acid, palmitic acid, and 3-(3-hydroxyphenyl)-3-hydroxypropanoic acid can be proposed as candidate biomarkers of autism severity.

Common and unique multimodal covarying patterns in autism spectrum disorder subtypes

BackgroundThe heterogeneity inherent in autism spectrum disorder (ASD) presents a substantial challenge to diagnosis and precision treatment. Heterogeneity across biological etiologies, genetics, neural systems, neurocognitive attributes and clinical subtypes or phenotypes has been observed across individuals with ASD.MethodsIn this study, we aim to investigate the heterogeneity in ASD from a multimodal brain imaging perspective. The Autism Diagnostic Observation Schedule (ADOS) was used as a reference to guide functional and structural MRI fusion. DSM-IV-TR diagnosed Asperger’s disorder (n = 79), pervasive developmental disorder-not otherwise specified [PDD-NOS] (n = 58) and Autistic disorder (n = 92) from ABIDE II were used as discovery cohort, and ABIDE I (n = 400) was used for replication.ResultsDorsolateral prefrontal cortex and superior/middle temporal cortex are the primary common functional–structural covarying cortical brain areas shared among Asperger’s, PDD-NOS and Autistic subgroups. Key differences among the three subtypes are negative functional features within subcortical brain areas, including negative putamen–parahippocampus fractional amplitude of low-frequency fluctuations (fALFF) unique to the Asperger’s subtype; negative fALFF in anterior cingulate cortex unique to PDD-NOS subtype; and negative thalamus–amygdala–caudate fALFF unique to the Autistic subtype. Furthermore, each subtype-specific brain pattern is correlated with different ADOS subdomains, with social interaction as the common subdomain. The identified subtype-specific patterns are only predictive for ASD symptoms manifested in the corresponding subtypes, but not the other subtypes.ConclusionsAlthough ASD has a common neural basis with core deficits linked to social interaction, each ASD subtype is strongly linked to unique brain systems and subdomain symptoms, which may help to better understand the underlying mechanisms of ASD heterogeneity from a multimodal neuroimaging perspective.LimitationsThis study is male based, which cannot be generalized to the female or the general ASD population.

Regional Brain Correlates of Beta Bursts in Health and Psychosis: A Concurrent Electroencephalography and Functional Magnetic Resonance Imaging Study

BackgroundThere is emerging evidence for abnormal beta oscillations in psychosis. Beta oscillations are likely to play a key role in the coordination of sensorimotor information that is crucial to healthy mental function. Growing evidence suggests that beta oscillations typically manifest as transient beta bursts that increase in probability following a motor response, observable as post-movement beta rebound. Evidence indicates that post-movement beta rebound is attenuated in psychosis, with greater attenuation associated with greater symptom severity and impairment. Delineating the functional role of beta bursts therefore may be key to understanding the mechanisms underlying persistent psychotic illness. MethodsWe used concurrent electroencephalography and functional magnetic resonance imaging to identify blood oxygen level–dependent correlates of beta bursts during the n-back working memory task and intervening rest periods in healthy control participants (n = 30) and patients with psychosis (n = 48). ResultsDuring both task blocks and intervening rest periods, beta bursts phasically activated regions implicated in task-relevant content while suppressing currently tonically active regions. Patients showed attenuated post-movement beta rebound that was associated with persisting disorganization symptoms as well as impairments in cognition and role function. Patients also showed greater task-related reductions in overall beta burst rate and showed greater, more extensive, beta burst–related blood oxygen level–dependent activation. ConclusionsOur evidence supports a model in which beta bursts reactivate latently maintained sensorimotor information and are dysregulated and inefficient in psychosis. We propose that abnormalities in the mechanisms by which beta bursts coordinate reactivation of contextually appropriate content can manifest as disorganization, working memory deficits, and inaccurate forward models and may underlie a core deficit associated with persisting symptoms and impairment.

The ecological validity of the Uniform Data Set 3.0 neuropsychological battery in individuals with mild cognitive impairment and dementia

Objective Ecological validity refers to the ability of neuropsychological measures to predict real world performance. Questions remain as to the ecological validity of commonly used measures, particularly regarding their relationships to global versus specific activities of daily living among those with neurodegenerative disease. We explored these issues through the lens of the Uniform Data Set 3.0 Neuropsychological battery (UDS3NB) in individuals with mild cognitive impairment and dementia. Method: UDS3NB and informant rated Functional Activities Questionnaire scales were evaluated from 2,253 individuals with mild cognitive impairment and dementia. Ordinal regression equations were used to explore the relationships of demographic and cognitive variables with overall and specific instrumental activities of daily living. Results: Delayed recall for visual and verbal material, and performance on trail making tests were consistent predictors of global and specific functions. Specific skills (i.e. naming or figure copy) showed differential relationships with specific activities, while phonemic fluency was not related to any particular activity. Conclusions: Measures in the UDS3NB predicted activities of daily living in individuals with MCI and dementia, providing initial support for the ecological validity of these tests. Specifically, measures that tap core deficits of Alzheimer’s disease, such as delayed recall and sequencing/shifting, are consistent predictors of performance in daily tasks.

Bridging sensory and language theories of dyslexia: Toward a multifactorial model.

Competing theories of dyslexia posit that reading difficulties arise from impaired visual, auditory, phonological, or statistical learning mechanisms. Importantly, many theories posit that dyslexia reflects a cascade of impairments emanating from a single “core deficit”. Here we report two studies evaluating core deficit and multifactorial models. In Study 1, we use publicly available data from the Healthy Brain Network to test the accuracy of phonological processing measures for predicting dyslexia diagnosis and find that over 30% of cases are misclassified (sensitivity = 66.7%; specificity = 68.2%). In Study 2, we collect a battery of psychophysical measures of visual motion processing and standardized measures of phonological processing in 106 school‐aged children to investigate whether dyslexia is best conceptualized under a core‐deficit model, or as a disorder with heterogenous origins. Specifically, by capitalizing on the drift diffusion model to analyze performance on a visual motion discrimination experiment, we show that deficits in visual motion processing, perceptual decision‐making, and phonological processing manifest largely independently. Based on statistical models of how variance in reading skill is parceled across measures of visual processing, phonological processing, and decision‐making, our results challenge the notion that a unifying deficit characterizes dyslexia. Instead, these findings indicate a model where reading skill is explained by several distinct, additive predictors, or risk factors, of reading (dis)ability.

Design of an Intelligent Agent to Measure Collaboration and Verbal-Communication Skills of Children with Autism Spectrum Disorder in Collaborative Puzzle Games.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by core deficits in social interaction and communication. Collaborative puzzle games are interactive activities that can be played to foster the collaboration and verbal-communication skills of children with ASD. In this paper, we have designed an intelligent agent that can play collaborative puzzle games with children and verbally communicate with them as if it is another human player. Furthermore, this intelligent agent is also able to automatically measure children's task-performance and verbal-communication behaviors throughout game play. Two preliminary studies were conducted with children with ASD to evaluate the feasibility and performance of the intelligent agent. Results of Study I demonstrated the intelligent agent's ability to play games and communicate with children within the game-playing domain. Results of Study II indicated its potential to measure the communication and collaboration skills of human users.

Phenotypic Subtyping and Re-Analysis of Existing Methylation Data from Autistic Probands in Simplex Families Reveal ASD Subtype-Associated Differentially Methylated Genes and Biological Functions.

Autism spectrum disorder (ASD) describes a group of neurodevelopmental disorders with core deficits in social communication and manifestation of restricted, repetitive, and stereotyped behaviors. Despite the core symptomatology, ASD is extremely heterogeneous with respect to the severity of symptoms and behaviors. This heterogeneity presents an inherent challenge to all large-scale genome-wide omics analyses. In the present study, we address this heterogeneity by stratifying ASD probands from simplex families according to the severity of behavioral scores on the Autism Diagnostic Interview-Revised diagnostic instrument, followed by re-analysis of existing DNA methylation data from individuals in three ASD subphenotypes in comparison to that of their respective unaffected siblings. We demonstrate that subphenotyping of cases enables the identification of over 1.6 times the number of statistically significant differentially methylated regions (DMR) and DMR-associated genes (DAGs) between cases and controls, compared to that identified when all cases are combined. Our analyses also reveal ASD-related neurological functions and comorbidities that are enriched among DAGs in each phenotypic subgroup but not in the combined case group. Moreover, relational gene networks constructed with the DAGs reveal signaling pathways associated with specific functions and comorbidities. In addition, a network comprised of DAGs shared among all ASD subgroups and the combined case group is enriched in genes involved in inflammatory responses, suggesting that neuroinflammation may be a common theme underlying core features of ASD. These findings demonstrate the value of phenotype definition in methylomic analyses of ASD and may aid in the development of subtype-directed diagnostics and therapeutics.

Polychlorinated Biphenyls (PCBs): Risk Factors for Autism Spectrum Disorder?

Autism spectrum disorder (ASD) includes a group of multifactorial neurodevelopmental disorders defined clinically by core deficits in social reciprocity and communication, restrictive interests and repetitive behaviors. ASD affects one in 54 children in the United States, one in 89 children in Europe, and one in 277 children in Asia, with an estimated worldwide prevalence of 1–2%. While there is increasing consensus that ASD results from complex gene x environment interactions, the identity of specific environmental risk factors and the mechanisms by which environmental and genetic factors interact to determine individual risk remain critical gaps in our understanding of ASD etiology. Polychlorinated biphenyls (PCBs) are ubiquitous environmental contaminants that have been linked to altered neurodevelopment in humans. Preclinical studies demonstrate that PCBs modulate signaling pathways implicated in ASD and phenocopy the effects of ASD risk genes on critical morphometric determinants of neuronal connectivity, such as dendritic arborization. Here, we review human and experimental evidence identifying PCBs as potential risk factors for ASD and discuss the potential for PCBs to influence not only core symptoms of ASD, but also comorbidities commonly associated with ASD, via effects on the central and peripheral nervous systems, and/or peripheral target tissues, using bladder dysfunction as an example. We also discuss critical data gaps in the literature implicating PCBs as ASD risk factors. Unlike genetic factors, which are currently irreversible, environmental factors are modifiable risks. Therefore, data confirming PCBs as risk factors for ASD may suggest rational approaches for the primary prevention of ASD in genetically susceptible individuals.

The relationship among early functional milestones and core deficits in Autism Spectrum Disorder

BackgroundAutism Spectrum Disorder (ASD) is now the highest among the developmental disabilities in the United States, with recent statistics estimates of 1 in every 54 children. While growing attention on the early intervention services is warranted, what is not well understood is the relationship between the core deficits of ASD and the early functional skills in young children with ASD. ObjectivesThe primary objective of this study was to determine the relationship between early developmental functional skills and behavioral outcomes in the core deficits of ASD. The secondary objective was to determine if the onset of early developmental functional milestones were related to age of diagnosis. MethodsThe current study is a secondary data analysis of the Simons Foundation Powering Autism Research for Knowledge cohort from the Simons Foundation Research Initiative (SFARI). Study objectives were examined using multiple linear regression analyses. To address the first objective, independent analyses were conducted for each behavioral subscale (Communication, Repetitive Behavior, Atypical Behavior, Social Reciprocity, and Peer Interaction). For the second objective a linear regression analysis was conducted to determine the relationship between core deficits and age of diagnosis. ResultsMultiple early functional milestones were significantly associated with current communication deficits, including the month of first independent walking (b = 0.11, p = .03), using words (b = -0.05, p = .02), and using combined phrases (b = 0.20, p < .001). However, the child's current age was the strongest predictor of current communication deficits (b = -0.53, p <. 001). The other core ASD deficit domains (i.e., Repetitive Behavior, Atypical Behavior, Social Reciprocity, and Peer Interaction) also had multiple significant associations with early functional milestones, but variance explained was negligible (R2 = 0.02−0.05). In terms of the second objective, significant predictors of the age of ASD diagnosis (in order of average attainment) included: month of first reported smiling (b = - 0.17, p = .007), walking (b = 0.24, p = .002), use of combined words (b = -0.10, p = .02), combined phrases (b = -0.40, p < .001), bladder-trained (b = -0.07, p = .03), and bowel-trained (b = -0.17, p <.001). ConclusionThis study represents one of the first attempts at examining relationships among the acquisition of early functional milestones and outcomes in children with ASD. The current study may provide critical information related to the screening, diagnosis and intervention prescription for young children with ASD.

Deficits of sustained attention in pediatric obsessive-compulsive disorder comorbid with Tic disorders

BackgroundPediatric obsessive-compulsive disorder (OCD) and Tourette syndrome/chronic tics (tic disorders, TD), are associated with attention-deficit hyperactivity disorder (ADHD). Deficits in sustained attention are a core deficit in ADHD which can be captured by continuous performance tests (CPT). CPT data are used to examine deficits in sustained attention in youth with OCD, TD or both, and OCD symptom factors, to characterize the deficits in sustained attention in OCD and TD, testing the hypothesis whether comorbid OCD + TD is distinct from OCD only or TD only. MethodsA clinical registry of youth with OCD and/or TD included data on sustained attention, obtained with the Conner's CPT Test II (CPT-II). The CPT-II spans six time-blocks, capturing values for the capacity for sustained attention. The main outcome measure is the variability in the standard error (SE) of reaction time (RT) for correct responses (RT-SE), which is considered a core ADHD trait. Higher RT-SE values reflect a lack of uniformity in responses and is considered to reflect a deficit in sustained attention. Using generalized linear models (GLM), RT-SE is measured over the six time-blocks in three groups: OCD only, TD only and OCD + TS, with sex and age groups as moderators. Clinical ADHD diagnoses were contrasted between diagnostic groups while OCD dimensions (contamination-washing, aggressive-somatic, sexual-religious, counting-checking-repeating and hoarding) were tested for their effect on sustained attention. ResultsDeficits in sustained attention are significantly greater in the comorbid OCD + TD compared to OCD only and TD only, with the greatest differences apparent in blocks 5 and 6 (p < .001). While sex does not moderate sustained attention deficits, the higher RT-SE in blocks 5 and 6 is only seen in the younger age group (7–11 years), but not in adolescents (12–17 years). As expected, clinical ADHD is more prevalent in youth with comorbid OCD + TS (67%) compared to OCD only (21%) or TD only (33%) (p = .0002). The hoarding group, characterized by more frequent clinical ADHD diagnoses, has higher RT-SE for time blocks 3,4,5,6 compared to non-hoarders. Participants with contamination-washing symptoms, characterized by more prevalent anxiety disorders, have higher RT-SE than those with no contamination-washing symptoms for time block 4. ConclusionDeficits in sustained attention are associated with comorbid OCD + TD compared OCD only or TD only, evident only in a younger age group. Sustained attention deficits are also more common in youth with ADHD, OCD hoarding and OCD contamination-washing symptoms. In summary, sustained attention deficits are intrinsic to the comorbid OCD + TD group, suggesting a compounded developmental insult specific to sustained attention which tends to resolve by adolescence. A mechanistic commonality to sustained attention, tic disorders and OCD-related extinction learning may be aberrant oscillatory brain phenomena.

Thought Disorder on Object Sorting Test Is Associated with Executive Dysfunction in Schizophrenia.

Background:Thought disorder is considered to be central to the core disturbances in schizophrenia and was described by Goldstein as aberrant “concept formation.” Executive dysfunction is another core deficit in schizophrenia. With a greater emphasis on psychopathology in nosological systems, the classical thought disorder receives less prominence. The present study aimed to understand the association between classical thought disorder (aberrant concept formation and concrete abstraction) and executive dysfunction.Methods:Thirty patients with schizophrenia and thirty healthy subjects, matched on age, gender, education, and socioeconomic status, were screened using MINI 5.0, following which they were assessed on object sorting test (OST) and selected tests for executive functions (EFs).Results:Individuals with schizophrenia were found to have significantly decreased performance on all domains of EFs and OST. Total peculiar scores on OST were significantly associated with mental speed, focused attention, and divided attention. Total impoverished scores on OST was significantly associated with focused attention, sustained attention, planning, set shifting, perseveration, and concept formation.Conclusion:Several correlations, among performance on OST and neuropsychological tests, suggest that patterns of responses on OST can point to underlying executive dysfunction. Both thought disorder and executive dysfunction mirror similar constructs. This similarity represents a conceptual bridge between the classical and contemporary descriptions of the core deficits in schizophrenia.

Living with pathological narcissism: a qualitative study

BackgroundResearch into the personality trait of narcissism have advanced further understanding of the pathological concomitants of grandiosity, vulnerability and interpersonal antagonism. Recent research has established some of the interpersonal impacts on others from being in a close relationship with someone having such traits of pathological narcissism, but no qualitative studies exist. Individuals with pathological narcissism express many of their difficulties of identity and emotion regulation within the context of significant interpersonal relationships thus studying these impacts on others is warranted.MethodWe asked the relatives of people high in narcissistic traits (indexed by scoring above a cut-off on a narcissism screening measure) to describe their relationships (N = 436; current romantic partners [56.2%]; former romantic partners [19.7%]; family members [21.3%]). Participants were asked to describe their relative and their interactions with them. Verbatim responses were thematically analysed.ResultsParticipants described ‘grandiosity’ in their relative: requiring admiration, showing arrogance, entitlement, envy, exploitativeness, grandiose fantasy, lack empathy, self-importance and interpersonal charm. Participants also described ‘vulnerability’ of the relative: contingent self-esteem, hypersensitivity and insecurity, affective instability, emptiness, rage, devaluation, hiding the self and victimhood. These grandiose and vulnerable characteristics were commonly reported together (69% of respondents). Participants also described perfectionistic (anankastic), vengeful (antisocial) and suspicious (paranoid) features. Instances of relatives childhood trauma, excessive religiosity and substance abuse were also described.ConclusionsThese findings lend support to the importance of assessing the whole dimension of the narcissistic personality, as well as associated personality patterns. On the findings reported here, the vulnerable aspect of pathological narcissism impacts others in an insidious way given the core deficits of feelings of emptiness and affective instability. These findings have clinical implications for diagnosis and treatment in that the initial spectrum of complaints may be misdiagnosed unless the complete picture is understood. Living with a person with pathological narcissism can be marked by experiencing a person who shows large fluctuations in affect, oscillating attitudes and contradictory needs.

Handwriting production in Spanish children with dyslexia: spelling or motor difficulties?

Spelling and handwriting are different processes; however, they are learned simultaneously, and numerous studies have shown that they interact. Besides the commonly reported presence of a spelling deficit, previous studies have indicated that handwriting difficulties can also be detected in children with dyslexia. Despite this, this issue has not been sufficiently explored. The goal of the study was to investigate the potential handwriting difficulties met by children with dyslexia and how they might relate to spelling difficulties and to basic graphic skills. Twenty children with dyslexia were compared with a chronological age-matched group and reading level-matched group. Participants completed a spelling-to-dictation task of words and pseudowords, an alphabet writing task, and two graphic tasks. Results showed that children with dyslexia were less accurate and slower in preparing and executing the written response than typically developing peers, but they showed the spelling level expected given their reading ability. Children with dyslexia also performed similarly to children with the same reading level in the alphabet and graphic tasks, with both groups being slower and less fluent than the control age group. Altogether, the results suggest the existence of a delay in the development of handwriting and graphic fluency related to the level of reading and spelling skills rather than the presence of a core deficit affecting fine motor skills in dyslexia. In this sense, it seems that reduced literacy skills can affect the development of other skills that are usually enhanced with handwriting practice, such as fine motor skills.

Examination of Stimulus Over-Selectivity in Children With Autism Spectrum Disorder and Its Relationship to Stereotyped Behaviors and Cognitive Flexibility

Stimulus over-selectivity describes a phenomenon in which an individual responds only to a subset of the stimuli present in the environment and, thus, may restrict learning. This study aimed to develop understanding of the nature and role of over-selectivity in autism spectrum disorder (ASD) by analyzing the relationship of over-selectivity to core deficits of ASD: stereotyped responding and inflexibility. Over-selectivity was investigated in a visual discrimination task in 24 children, 12 diagnosed with ASD and 12 mental-age-matched typically developing children. In addition, the participants’ levels of intellectual functioning, stereotypy, and cognitive flexibility were assessed using established tools. Results showed that over-selectivity was associated with IQ and stereotyped behavior but was not related to levels of cognitive flexibility nor did cognitive flexibility significantly correlate with stereotyped behavior in individuals with ASD. The current findings require consideration when designing behavioral interventions for individuals with ASD.

Self-initiations in young children with autism during Pivotal Response Treatment with and without robot assistance.

The initiation of social interaction is often defined as a core deficit of autism spectrum disorder. Optimizing these self-initiations is therefore a key component of Pivotal Response Treatment, an established intervention for children with autism spectrum disorder. However, little is known about the development of self-initiations during intervention and whether this development can be facilitated by robot assistance within Pivotal Response Treatment. The aim of this study was to (1) investigate the effect of Pivotal Response Treatment and robot-assisted Pivotal Response Treatment on self-initiations (functional and social) of young children with autism spectrum disorder over the course of intervention and (2) explore the relation between development in self-initiations and additional gains in general social-communicative skills. Forty-four children with autism spectrum disorder (aged 3-8 years) were included in this study. Self-initiations were assessed during parent-child interaction videos of therapy sessions and coded by raters who did not know which treatment (Pivotal Response Treatment or robot-assisted Pivotal Response Treatment) the child received. General social-communicative skills were assessed before start of the treatment, after 10 and 20 weeks of intervention and 3 months after the treatment was finalized. Results showed that self-initiations increased in both treatment groups, with the largest improvements in functional self-initiations in the group that received robot-assisted Pivotal Response Treatment. Increased self-initiations were related to higher parent-rated social awareness 3 months after finalizing the treatment.