Social Communication Problems Research Articles

Feasibility and Validity of Early Screening for Identifying Infants With Poor Social-Communication Development in a Well-Baby Clinic System

This study examined the feasibility and validity of implementing an autism spectrum disorders (ASD) screening for 12-month-old infants. Parents of 583 infants, 12months of age attending well baby clinics (WBCs), completed the First Year Inventory-Lite (FYI-L). Ten infants who failed the FYI-L and a subset of 12 infants who passed the identified FYI-L were evaluated using the Autism Observation Scale for Infants (AOSI) and the Mullen Scales of Early Learning. Information regarding social-communication development ≥24months of age was extracted from medical records of 153 of the 583 infants. Mean response rate across clinics was 26.63%. Infants at risk compared to controls showed significantly higher scores on the AOSI, lower composite scores on the MSEL, and a higher rate of referral for a developmental evaluation. At 24months, 95% of infants who were negatively screened had no social-communication problems on their medical records; 60% of those who were screened positive had documented problems on medical records. ASD screening using the FYI-L at 12months in a healthcare setting identifies infants with poor social-communication development, yet parents had low compliance with screening.

ADHD Is a Risk Factor for Overweight and Obesity in Children

Although hyperactivity would seem to increase energy expenditure, attention-deficit hyperactivity disorder (ADHD) appears to increase the risk for being overweight. This study examined the body mass index (BMI) in children with ADHD and its relationship with age, gender, ADHD and comorbid symptom severity, inhibitory control, developmental coordination disorder, sleep duration, and methylphenidate use. Participants were 372 Dutch children with ADHD combined type aged 5 to 17 years participating in the International Multicenter ADHD Genetics (IMAGE) study. We categorized BMI according to international age- and gender-specific reference values and calculated BMI-standard deviation scores (BMI-SDS). The control population was matched for age, gender, and ethnicity and originated from the same birth cohort as the ADHD group. Inhibitory control was measured by the computerized Stop-signal task. Prevalence differences of underweight, overweight, and obesity between groups were expressed in odds ratios. We used linear regression analyses with gender, age, parent- and teacher-rated ADHD and comorbid scores, inhibitory control, sleep duration, motor coordination, and methylphenidate use to predict BMI-SDS. Boys with ADHD aged 10 to 17 years and girls aged 10 to 12 years were more likely to be overweight than children in the general Dutch population. Younger girls and female teenagers, however, seemed to be at lower risk for being overweight. Higher oppositional behavior and social communication problems related to higher BMI-SDS scores, whereas more stereotyped behaviors related to lower BMI-SDS scores. We found no effects of the other examined associated risk factors on BMI-SDS. Attention-deficit hyperactivity disorder in boys is a risk factor for overweight. In girls with ADHD, the prevalence of overweight is age dependent and most pronounced in girls aged 10 to 12 years. They have a 4-fold risk of being obese. Higher oppositional and social communication problems pose an increased risk for overweight, whereas sleep duration, motor coordination problems, and methylphenidate use do not.

Common variation contributes to the genetic architecture of social communication traits.

BackgroundSocial communication difficulties represent an autistic trait that is highly heritable and persistent during the course of development. However, little is known about the underlying genetic architecture of this phenotype.MethodsWe performed a genome-wide association study on parent-reported social communication problems using items of the children’s communication checklist (age 10 to 11 years) studying single and/or joint marker effects. Analyses were conducted in a large UK population-based birth cohort (Avon Longitudinal Study of Parents and their Children, ALSPAC, N = 5,584) and followed-up within a sample of children with comparable measures from Western Australia (RAINE, N = 1364).ResultsTwo of our seven independent top signals (P-discovery <1.0E-05) were replicated (0.009 <P-replication ≤0.02) within RAINE and suggested evidence for association at 6p22.1 (rs9257616, meta-P = 2.5E-07) and 14q22.1 (rs2352908, meta-P = 1.1E-06). The signal at 6p22.1 was identified within the olfactory receptor gene cluster within the broader major histocompatibility complex (MHC) region. The strongest candidate locus within this genomic area was TRIM27. This gene encodes an ubiquitin E3 ligase, which is an interaction partner of methyl-CpG-binding domain (MBD) proteins, such as MBD3 and MBD4, and rare protein-coding mutations within MBD3 and MBD4 have been linked to autism. The signal at 14q22.1 was found within a gene-poor region.Single-variant findings were complemented by estimations of the narrow-sense heritability in ALSPAC suggesting that approximately a fifth of the phenotypic variance in social communication traits is accounted for by joint additive effects of genotyped single nucleotide polymorphisms throughout the genome (h2(SE) = 0.18(0.066), P = 0.0027).ConclusionOverall, our study provides both joint and single-SNP-based evidence for the contribution of common polymorphisms to variation in social communication phenotypes.

Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD)

Autism spectrum disorders (ASD) are characterised by abnormalities in social interaction and communication skills, as well as stereotypic behaviours and restricted activities and interests. Selective serotonin reuptake inhibitors (SSRIs) are prescribed for the treatment of conditions often comorbid with ASD such as depression, anxiety and obsessive-compulsive behaviours. To determine if treatment with an SSRI:1. improves the core features of autism (social interaction, communication and behavioural problems);2. improves other non-core aspects of behaviour or function such as self-injurious behaviour;3. improves the quality of life of adults or children and their carers;4. has short- and long-term effects on outcome;5. causes harm. We searched the following databases up until March 2013: CENTRAL, Ovid MEDLINE, Embase, CINAHL, PsycINFO, ERIC and Sociological Abstracts. We also searched ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP). This was supplemented by searching reference lists and contacting known experts in the field. Randomised controlled trials (RCTs) of any dose of oral SSRI compared with placebo, in people with ASD. Two authors independently selected studies for inclusion, extracted data and appraised each study's risk of bias. Nine RCTs with a total of 320 participants were included. Four SSRIs were evaluated: fluoxetine (three studies), fluvoxamine (two studies), fenfluramine (two studies) and citalopram (two studies). Five studies included only children and four studies included only adults. Varying inclusion criteria were used with regard to diagnostic criteria and intelligence quotient of participants. Eighteen different outcome measures were reported. Although more than one study reported data for Clinical Global Impression (CGI) and obsessive-compulsive behaviour (OCB), different tool types or components of these outcomes were used in each study. As such, data were unsuitable for meta-analysis, except for one outcome (proportion improvement). One large, high-quality study in children showed no evidence of positive effect of citalopram. Three small studies in adults showed positive outcomes for CGI and OCB; one study showed improvements in aggression, and another in anxiety. There is no evidence of effect of SSRIs in children and emerging evidence of harm. There is limited evidence of the effectiveness of SSRIs in adults from small studies in which risk of bias is unclear.

Blunted feelings: Alexithymia is associated with a diminished neural response to speech prosody

How we perceive emotional signals from our environment depends on our personality. Alexithymia, a personality trait characterized by difficulties in emotion regulation has been linked to aberrant brain activity for visual emotional processing. Whether alexithymia also affects the brain's perception of emotional speech prosody is currently unknown. We used functional magnetic resonance imaging to investigate the impact of alexithymia on hemodynamic activity of three a priori regions of the prosody network: the superior temporal gyrus (STG), the inferior frontal gyrus and the amygdala. Twenty-two subjects performed an explicit task (emotional prosody categorization) and an implicit task (metrical stress evaluation) on the same prosodic stimuli. Irrespective of task, alexithymia was associated with a blunted response of the right STG and the bilateral amygdalae to angry, surprised and neutral prosody. Individuals with difficulty describing feelings deactivated the left STG and the bilateral amygdalae to a lesser extent in response to angry compared with neutral prosody, suggesting that they perceived angry prosody as relatively more salient than neutral prosody. In conclusion, alexithymia may be associated with a generally blunted neural response to speech prosody. Such restricted prosodic processing may contribute to problems in social communication associated with this personality trait.

A randomized controlled examination of a potentially promising social-communication of speech/language intervention for school-age children

Adams, C., Lockton, E., Freed, J., Gaile, J., Earl, G., McBean, K., Nash, M., Green, J., Vail, A., & Law, J. (2012). The social communication intervention project: A randomized controlled trial of the effectiveness of speech and language therapy for school-aged children who have pragmatic and social communication problems with and without autism spectrum disorder. International Journal of Language and Communication Disorders, 47, 233–244. Source of funding and disclosure of interest: This study was supported by a grant from Nuffield Foundation (Grant Reference: EDU/32953) and University of Manchester; the original authors of this research report no conflicts of interest.

English

Introduction Unusual responses to sensory stimuli were noticed from the very beginning of the official history of autism, and the pioneering research started in the 1960s; since then for many decades, sensory hypotheses were not considered important because there were no empirical evidence for this assumption. At present, however, we witness an explosion of interest in sensory perceptual issues, and the sensory perceptual theory of autism is steadily taking shape, incorporating findings from other related fields and producing a framework for studying sensory differences in autism and their impact not only on behaviours but also on language, cognition and social impairments of individuals with autism spectrum disorder. As a review of all the available literature is beyond the scope of this paper, only a selection of research studies relevant to some methodological and conceptual problems of sensory perception in autism is included. This review challenges the conventional interpretation that gives primacy to social communication problems. The recognition of sensory perceptual differences in autism can assist in improving diagnostic instruments and provide information about appropriate support for each individual. Conclusion Current research has aimed to explain sensory perceptual processes and their mechanisms, but there is no real understanding regarding sensory processing. We call on more research to be done on sensory processing in autism to improve our understanding and to actually be able to help individuals with autism correctly. Introduction First sensory hypotheses Unusual responses to sensory stimuli were noticed from the very beginning of the official history of autism. Both Kanner1 and Asperger2 described bizarre reactions of their patients to sound, touch, sights, taste and smell. Based on their clinical observations, Bergman and Escalona3 put forward a sensory hypothesis to explain the development of autism: autistic children start life with a higher degree of sensory sensitivity, which makes them acquire defensive strategies to protect themselves from overload, which, in turn, results in developmental distortions that are reflected in autistic conditions. Eveloff4 described severe perceptual difficulties encountered by children with autism. Creak5 included unusual sensory perceptual experiences in the list of core symptoms of autism. Rimland6 emphasized the importance of exploring perceptual abilities of autistic children. Lorna Wing7 showed that autistic children have significantly more sensory perceptual problems than both typically developing children and children with Down’s syndrome and included sensory perceptual features into ‘basic impairments in autism’. Ornitz8 researched disorders of perception common in autism and extended the notion of a disorder of sensory processing to the notion of sensory and information processing. This approach allowed him to clarify and identify separate stages and functions of sensory perception and consider information processing in terms of more discrete functions, such as attention, memory and learning9. It was suggested that autism might be identified in young children if we look at very specific and easily described behaviours caused by sensory perceptual differences. For example, before the age of 6, these behaviours were observed with almost the same frequencies as behaviours related to social and communication impairments10. Delacato11 hypothesized that unusual sensory experiences were a primary characteristic feature of autism, which were able to account for the basic symptoms of the condition considered to be essential in the diagnostic classifications. Thus, abnormal perceptions might give rise to high levels of anxiety; this, in turn, results in obsessive or compulsive behaviours, social and communication problems, making the more commonly accepted criteria, in fact, secondary developmental problems. Another strand of research has been carried out in the field of occupational therapy (OT). It was started by Ayres12 who formulated the theory of sensory integration (SI) dysfunction to describe a variety of neurological disorders. This theory attempted to account for the relationship between sensory processing and behavioural deficits in different developmental disorders including autism. Ayres originally limited her investigation to three senses—tactile, vestibular and proprioceptive—and identified the * Corresponding author: Email: bogdashina.kspu@mail.ru International Autism Institute at the KSPU, Russia 100, Marx Street, Krasnoyarsk, Russia, 660049

Relatives’ Experiences of Frontal-Variant Frontotemporal Dementia

In this article we address how relatives of people with frontal-variant frontotemporal dementia (fvFTD) experience the illness and how it impacts their lives. We interviewed 6 participants and carried out interpretative phenomenological analysis. We report on 11 themes that reflect distinctive challenges. Five themes relate to witnessing bizarre and strange changes: changed appetites and drives, loss of planning ability, loss of inhibition leading to social embarrassment, risky behavior, and communication problems. Four relate to managing these changes and two to the impact on the person and his or her relationships. Relatives must live with unusual changes in the person with fvFTD and the stigma this carries in social settings. They learn to act assertively for their relatives and put effort into promoting quality of life, using strategies adapted for fvFTD. Relatives grieve the loss of the person with fvFTD and their mutual relationship, but nonetheless find sources of solace and hope.

The Facial and Subjective Emotional Reaction in Response to a Video Game Designed to Train Emotional Regulation (Playmancer)

Several aspects of social and emotional functioning are abnormal in people with eating disorders. The aim of the present study was to measure facial emotional expression in patients with eating disorders and healthy controls whilst playing a therapeutic video game (Playmancer) designed to train individuals in emotional regulation. Participants were 23 ED patients (11 AN, 12 BN) and 11 HCs. ED patients self reported more anger at baseline but expressed less facial expression of anger during the Playmancer game. The discrepancy between self-report and non-verbal expression may lead to problems in social communication.

Family history interview of a broad phenotype in specific language impairment and matched controls

The aim was to study a broader phenotype of language-related diagnoses and problems in three generations of relatives of children with specific language impairment (SLI). Our study is based on a family history interview of the parents of 59 children with SLI and of 100 matched control children, exploring the prevalence of problems related to language, reading, attention, school achievement and social communication as well as diagnoses such as attention-deficit hyperactivity disorder (ADHD), autism, Asperger syndrome, dyslexia, mental retardation, cleft palate and stuttering. The results show a spectrum of language-related problems in families of SLI children. In all three generations of SLI relatives, we found significantly higher prevalence rates of language, literacy and social communication problems. The risk of one or both parents having language-related diagnoses or problems was approximately six times higher for the children with SLI (85%) than for the control children (13%) (odds ratio = 37.2). We did not find a significantly higher prevalence of the diagnoses ADHD, autism or Asperger syndrome in the relatives of the children with SLI. However, significantly more parents of the children with SLI had problems with attention/hyperactivity when compared with the parents of controls. Our findings suggest common underlying mechanisms for problems with language, literacy and social communication, and possibly also for attention/hyperactivity symptoms.

Inference in conversation of adults with traumatic brain injury

Objective: To examine elaborative and automatic linguistic inferences in conversations between adults with and without traumatic brain injury (TBI) and their frequent communication partners.Design and methods: Participants with TBI were four female and three male adults and seven female communication partners. Comparison peers were two males and five females and one male and six female communication partners. Each participant completed 20-minute video-recorded conversation with his or her frequent communication partner. Conversations were transcribed, implicatures were identified and the percentage of correct inferences was determined. Inferences were categorized as automatic or elaborative and as missed or understood.Results: Participants in both groups made significantly more errors on elaborative inferences than automatic inferences and participants with TBI made significantly more elaborative inference errors than comparison peers. There was no significant between-groups difference in error rates for automatic inferences.Conclusions: Individuals with TBI may show impairments in social language skills not only on standardized tests but also in everyday conversations. This may contribute to everyday partners’ perceptions of social communication problems in adults with TBI.

DRD2 and PPP1R1B (DARPP-32) polymorphisms independently confer increased risk for autism spectrum disorders and additively predict affected status in male-only affected sib-pair families

BackgroundThe neurotransmitter dopamine (DA) modulates executive functions, learning, and emotional processing, all of which are impaired in individuals with autism spectrum disorders (ASDs). Our previous findings suggest a role for dopamine-related genes in families with only affected males.MethodsWe examined two additional genes which affect DA function, the DRD2 and PPP1R1B (DARPP-32) genes, in a cohort of 112 male-only affected sib-pair families. Selected polymorphisms spanning these genes were genotyped and both family-based and population-based tests were carried out for association analysis. General discriminant analysis was used to examine the gene-gene interactions in predicting autism susceptibility.ResultsThere was a significantly increased frequency of the DRD2 rs1800498TT genotype (P = 0.007) in affected males compared to the comparison group, apparently due to over-transmission of the T allele (P = 0.0003). The frequency of the PPP1R1B rs1495099CC genotype in affected males was also higher than that in the comparison group (P = 0.002) due to preferential transmission of the C allele from parents to affected children (P = 0.0009). Alleles rs1800498T and rs1495099C were associated with more severe problems in social interaction (P = 0.0002 and P = 0.0016, respectively) and communication (P = 0.0004 and P = 0.0046), and increased stereotypic behaviours (P = 0.0021 and P = 0.00072). General discriminant analysis found that the DRD2 and PPP1R1B genes additively predicted ASDs (P = 0.00011; Canonical R = 0.26) and explain ~7% of the variance in our families. All findings remained significant following corrections for multiple testing.ConclusionOur findings support a role for the DRD2 and PPP1R1B genes in conferring risk for autism in families with only affected males and show an additive effect of these genes towards prediction of affected status in our families.

Book review: Cross M (2011) Children with social, emotional and behavioural difficulties and communication problems: There is always a reason

Book review: Cross M (2011) <i>Children with social, emotional and behavioural difficulties and communication problems: There is always a reason</i>

The Social Communication Intervention Project: a randomized controlled trial of the effectiveness of speech and language therapy for school‐age children who have pragmatic and social communication problems with or without autism spectrum disorder

Children who show disproportionate difficulty with the pragmatic as compared with the structural aspects of language are described as having pragmatic language impairment (PLI) or social communication disorder (SCD). Some children who have PLI also show mild social impairments associated with high-functioning autism or autism spectrum disorder (ASD). There is little robust evidence of effectiveness of speech-language interventions which target the language, pragmatic or social communication needs of these children. To evaluate the effectiveness of an intensive manualized social communication intervention (SCIP) for children who have PLI with or without features of ASD. In a single-blind RCT design, 88 children with pragmatic and social communication needs aged 5;11-10;8, recruited from UK speech and language therapy services, were randomly assigned in a 2:1 ratio to SCIP or to treatment-as-usual. Children in the SCIP condition received up to 20 sessions of direct intervention from a specialist research speech and language therapist working with supervised assistants. All therapy content and methodology was derived from an intervention manual. A primary outcome measure of structural language and secondary outcome measures of narrative, parent-reported pragmatic functioning and social communication, blind-rated perceptions of conversational competence and teacher-reported ratings of classroom learning skills were taken pre-intervention, immediately post-intervention and at 6-month follow-up. Analysis was by intention to treat. No significant treatment effect was found for the primary outcome measure of structural language ability or for a measure of narrative ability. Significant treatment effects were found for blind-rated perceptions of conversational competence, for parent-reported measures of pragmatic functioning and social communication, and for teacher-reported ratings of classroom learning skills. There is some evidence of an intervention effect on blind and parent/teacher-reported communication outcomes, but not standardized language assessment outcomes, for 6-11-year-old children who have pragmatic and social communication needs. These findings are discussed in the context of the increasingly central role of service user outcomes in providing evidence for an intervention. The substantial overlap between the presence of PLI and ASD (75%) across the whole cohort suggests that the intervention may also be applicable to some verbally able children with ASD who have pragmatic communication needs.

Editorial: 2011 in Review

As has now been the case for several years, both the quality and quantity of research in autism has continued to increase dramatically. This past year, we instituted a policy of blinded reviews that has generally been found helpful by both authors and reviewers. We’ve also become more vigilant about the issue of duplicate publication and, sadly, have dealt with one instance of plagiarism (the first author was admonished, the paper rejected, and a letter went to the co-authors and the institution). During 2011, a record number of papers, reviews, and letters to the editor, 712 in total, were submitted. As in the past, the able staff both at Springer and my office and those of the associate editors have worked diligently to ensure that the papers conform to Journal guidelines before they are sent for review. As a practical matter, this means that most papers are returned quickly to the authors for revision even before going out for peer review. Whenever possible, we attempt to be expeditious with reviews—the turnaround time averaged about 8 weeks (with a few reviews being much faster and some being much slower). One of the problems that we, and other journals, face is ‘reviewer fatigue’. We have taken several steps to deal with the increase in submissions. The associate editors and I have now begun, occasionally to reject papers (about 5%) that we believe simply have little or no chance of making it through the peer review process. As noted previously, we have stopped accepting case reports except as letters to the editor (these take a disproportionate burden of time when submitted as regular papers and create special problems in terms of duplicate publication). We are enlarging our editorial board, and I’m pleased to welcome both the new members of the board, as we bid farewell to those rotating off. We are pleased to welcome two new associate editors to the Journal. Dr. Joshua Diehl from the University of Rochester will replace Dr. Rhea Paul as she steps down from her role of associate editor later this year. Dr. Diehl’s work has focused on improving and understanding social-communication problems in autism. His interests in such areas as adaptive technology bring another important strength to the board. We are also pleased to welcome Dr. Jeremy Veenstra-VanderWeele from Vanderbilt University as a new associate editor. Dr. Veenstra-VanderWeele’s work has focused on animal models and the neurobiology of autism and brings another important perspective to the Journal. Finally, Dr. Brian Reichow, a special educator and expert in evidence-based treatments and practice, is joining us as Book Review Editor. Although JADD is now published every month, the increasing number of submissions means that the rejection rate will continue to increase. Most papers (about 80%) are now revised to ensure that they conform to Journal style even before they enter the review process. Of the papers submitted in 2011 in which an editorial decision was made, the acceptance rate was approximately 38% compared to 45% in 2010; this does not include the small number of papers rejected without review. As always, the diligent efforts of the Editorial Board ensure that the leading scientific papers are selected for publication in JADD each year. As always I’m deeply grateful to the Associate Editors: Nancy Minshew, M.D., Sandra Harris, Ph.D., Christopher McDougle, M.D., Rhea Paul, Ph.D. and Tony Charman, Ph.D. who have so generously and diligently supported the work of the Journal even in the face of the growing number of submissions. I’m also grateful to Lori Klein and Emily F. R. Volkmar (&) Yale Child Study Center, New Haven, CT, USA e-mail: fred.vokmar@yale.edu

The association between early autistic traits and psychotic experiences in adolescence

BackgroundThere has been growing interest in the clinical and biological links between autistic spectrum disorder and psychotic disorders, and between symptoms of these disorders that exist below diagnostic thresholds. Whilst autism and schizophrenia are regarded as distinct disorders, recent studies support an overlap in the genetic architecture across these conditions. Although early neurodevelopmental impairment is associated with psychotic disorders in later life, evidence from longitudinal studies of the relationship between autistic traits and psychotic experiences is limited.AimsThe aim of the study is to explore whether children with early autistic traits (social interaction and communication problems, and restricted, repetitive interests and behaviours) are more likely to present with psychotic experiences in early adolescence. MethodLongitudinal study using the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. The mothers of 8232 children were asked about autistic traits in their children as part of the Development and Well-Being Assessment (DAWBA) at the age of 7. Of those, 6439 children completed a semi-structured clinical assessment for psychotic experiences at the age of 12. ResultsChildren whose mothers had concerns about autistic traits in early life, in particular with regard to speech development or ‘rituals’/‘habits’, were more likely to develop psychotic experiences in early adolescence. The greater the number of early autistic traits a child had, the greater their risk of developing psychotic experiences. These associations were not confounded by IQ, family history of depression or schizophrenia, gender or socio-demographic characteristics. ConclusionsChildhood autistic traits, and particularly speech problems and odd rituals or unusual habits, are associated with psychotic experiences in adolescence. This may be a result of a shared aetiology or because autistic traits may also be an early precursor of psychotic experiences.

Kompetencja komunikacyjna Romów. Strategie grzecznościowe w polsko-romskich relacjach interkulturowych

The authors of the article evaluate social-communicative problems of the minority group of Roma Gypsies in Poland. The existing low linguistic competence is additionally constrained by the accompanying insufficient communicative competence. The authors emphasize that teaching of a foreign language, in this particular case of the dominant language in the country, is effective only when it is simultaneously enhanced by a corresponding interaction between the two cultures in question. The authors indicate the barriers to cultural integration that hamper the community’s capacity and capability of establishing the relationships between these communities that would be based on partnership and mutual respect: these barriers include the orality and the tabooisation of Romany culture as well as its unfamiliarity to the Poles. This, in turn, generates patterns for statements and utterances in which ceremonial patterns are of secondary importance. It is rather the pragmatic factor that governs a particular linguistic behaviour: the Romany people simply want to understand the message and want to be understood. The article stresses that the present unfortunate social communication can be changed in the future by the implementation of appropriate activities within educational strategies directed towards the target group.

Autism in DSM-5

Autism in DSM-5

Cochrane Review: Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD)

AbstractBackgroundAutism spectrum disorders (ASD) are characterised by abnormalities in social interaction and communication skills, as well as stereotypic behaviours and restricted activities and interests. Selective serotonin reuptake inhibitors (SSRIs) are prescribed for the treatment of co‐morbidity associated with ASD such as depression, anxiety and obsessive‐compulsive behaviours.ObjectivesTo determine if treatment with an SSRI: 1. improves the core features of autism (social interaction, communication and behavioural problems); 2. improves other non‐core aspects of behaviour or function such as self‐injurious behaviour; 3. improves the quality of life of children and their carers; 4. has short and long term effects on outcome; 5. causes harms.Search strategyWe searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 4), MEDLINE ( December 2009), EMBASE (December 2009), CINAHL (December 2009), PsycINFO (December 2009) and ERIC (December 2009), without language restrictions.Selection criteriaRandomised controlled trials (RCTs) of any dose of oral SSRI compared with placebo, in participants with autism spectrum disorders. Trials must have included at least one standardised outcome measure.Data collection and analysisTwo authors independently selected and appraised studies for inclusion and risk of bias. All data were continuous. Meta‐analysis, where possible, used a random‐effects model.Main resultsSeven RCTs with a total of 271 participants were included. Four SSRIs were evaluated: fluoxetine (two studies), fluvoxamine (two studies), fenfluramine (two studies) and citalopram (one study). Five studies included only children and two studies included only adults. Varying inclusion criteria were used with regard to diagnostic criteria and intelligence of participants. Seventeen different outcome measures were reported. Although more than one study reported data for Clinical Global Impression (CGI) and obsessive‐compulsive behaviour (OCB), different tool types or components of these outcomes were used in each study. As such, data were unsuitable for meta‐analysis. One large, high quality study in children showed no evidence of positive effect of citalopram. Two small studies in adults showed positive outcomes for CGI and OCB; one study showed improvements in aggression, and another in anxiety.Authors' conclusionsThere is no evidence of effect of SSRIs in children and emerging evidence of harm. There is limited evidence of the effectiveness of SSRIs in adults from small studies in which risk of bias is unclear.Plain Language SummarySelective serotonin reuptake inhibitors for the treatment of autism spectrum disordersAutism spectrum disorders (ASD) are characterised by problems with social interaction and communication, as well as repetitive behaviours and limited activities and interests. Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants which are sometimes given to help anxiety or obsessive compulsive behaviours. We found seven trials which evaluated four SSRIs: fluoxetine, fluvoxamine, fenfluramine and citalopram. Five studies included only children and two studies included only adults. One trial enrolled 149 children, but all other trials were small. We found no trials which evaluated sertraline, paroxetine or escitalopram. There is no evidence to support the use of SSRIs to treat autism in children. There is limited evidence, which is not yet sufficiently robust, to suggest effectiveness of SSRIs in adults with autism. Treatment with an SSRI may cause side effects. Decisions about the use of SSRIs for established clinical indications that may co‐occur with autism, such as obsessive compulsive disorder and depression in adults or children, and anxiety in adults, should be made on a case by case basis.

Using multimedia to reveal the hidden code of everyday behaviour to children with autistic spectrum disorders (ASDs)

This paper describes a framework which was developed for carers (teachers and parents) to help them create personalised social stories for children with autistic spectrum disorders (ASDs). It explores the social challenges experienced by individuals with ASDs and outlines an intervention aimed at revealing the hidden code that underpins social interactions to them. It focuses on how technology can facilitate the implementation of this intervention by utilising multimedia-authoring tools. Findings from a case study, involving seven carers over a five-month period, are encouraging revealing that the participants quickly learned the basics of the intervention and either adapted or created social stories. They found the framework easy to use and sufficiently flexible to cater for children with social interaction, communication and behaviour problems.