Young Autistic Children Research Articles

Virtual Parent Coaching of Music Interventions for Young Autistic Children in Mexico

Abstract The coronavirus disease (COVID-19) pandemic disrupted education, peer interactions, and social access for a large percentage of learners and created increased stress and workloads for parents, particularly in families of autistic children, who lost access to specialized services. Providing parents with resources to support their children at home became a necessity. This exploratory study investigated the feasibility of a parent coaching model of music interventions through virtual sessions in a low-resource country. Eight families participated in six 1-hr weekly sessions where the music therapist shared music interventions for young autistic children through videoconferencing. Results show that parent coaching in a virtual setting is feasible, useful, and acceptable for parents. All parents improved in their ability to modify the environment to address child’s needs, adequately respond to their child’s communication attempts, and provide opportunities for engagement and natural reinforcement. Parents found the coaching important, useful, and supportive. Initial recommendations for practice include providing guidelines for safe sessions; adapting to family needs, strengths, and culture; relaying information quickly and concisely; and ensuring that parents can access local services to continue their parenting journey.

The RITA-T (Rapid Interactive Screening Test for Autism in Toddlers) Community Model to Improve Access and Early Identification of Autism in Young Children.

Objective: To evaluate improved identification and the generalization of the RITA-T (Rapid interactive Screening Test for Autism in Toddlers) model through partnerships with Primary Care (PC), Early Intervention (EI), and Autism Diagnosticians. Methods: Over 3 years (2018-2021), 15 EI and 9 PC (MD and NP) centers participated in this project. We trained providers on the RITA-T and established screening models. We reviewed charts of all toddlers referred through this model and compared wait times, and diagnoses, to those evaluated through regular referral in a tertiary-based autism clinic. We also examined the RITA-T psychometrics. Results: 377 toddlers met our inclusion criteria. Wait time for diagnosis was an average of 2.8 months and led to further collaboration between community providers. RITA-T cut-off scores stayed consistent. Providers reported improved confidence and easy integration of this model. Conclusions: This model is generalizable and improves the Early Identification of ASD.

For ASD, Psychiatrists Must Continuously Monitor Patients, Assess Therapies

For ASD, Psychiatrists Must Continuously Monitor Patients, Assess Therapies

The cross-racial/ethnic gesture production of young autistic children and their parents.

Early gesture plays an important role in prelinguistic/emerging linguistic communication and may provide insight into a child's social communication skills before the emergence of spoken language. Social interactionist theories suggest children learn to gesture through daily interactions with their social environment (e.g., their parents). As such, it is important to understand how parents gesture within interactions with their children when studying child gesture. Parents of typically developing (TD) children exhibit cross-racial/ethnic differences in gesture rate. Correlations between parent and child gesture rates arise prior to the first birthday, although TD children at this developmental level do not yet consistently exhibit the same cross-racial/ethnic differences as their parents. While these relationships have been explored in TD children, less is known about the gesture production of young autistic children and their parents. Further, studies of autistic children have historically been conducted with predominantly White, English-speaking participants. As a result, there is little data regarding the gesture production of young autistic children and their parents from diverse racial/ethnic backgrounds. In the present study, we examined the gesture rates of racially/ethnically diverse autistic children and their parents. Specifically, we explored (1) cross-racial/ethnic differences in the gesture rate of parents of autistic children, (2) the correlation between parent and child gesture rates, and (3) cross-racial/ethnic differences in the gesture rates of autistic children. Participants were 77 racially/ethnically diverse cognitively and linguistically impaired autistic children (age 18 to 57 months) and a parent who participated in one of two larger intervention studies. Naturalistic parent-child and structured clinician-child interactions were video recorded at baseline. Parent and child gesture rate (number of gestures produced per 10 min) were extracted from these recordings. (1) Parents exhibited cross-racial/ethnic differences in gesture rate such that Hispanic parents gestured more frequently than Black/African American parents, replicating previous findings in parents of TD children. Further, South Asian parents gestured more than Black/African American parents. (2) The gesture rate of autistic children was not correlated with parent gesture, a finding that differs from TD children of a similar developmental level. (3) Autistic children did not exhibit the same cross-racial/ethnic differences in gesture rate as their parents, a result consistent with findings from TD children. Parents of autistic children-like parents of TD children-exhibit cross-racial/ethnic differences in gesture rate. However, parent and child gesture rates were not related in the present study. Thus, while parents of autistic children from different ethnic/racial backgrounds appear to be conveying differences in gestural communication to their children, these differences are not yet evident in child gesture. Our findings enhance our understanding of the early gesture production of racially/ethnically diverse autistic children in the prelinguistic/emerging linguistic stage of development, as well as the role of parent gesture. More research is needed with developmentally more advanced autistic children, as these relationships may change with development.

Acceptability and feasibility of a parent-mediated social-communication therapy for young autistic children in Brazil: A qualitative implementation study of Paediatric Autism Communication Therapy.

Parents of autistic children and health professionals who work with autistic children in Brazil had positive views about introducing Paediatric Autism Communication Therapy as a therapy for autistic children in Brazil. The parents and clinicians also mentioned some difficulties about using Paediatric Autism Communication Therapy in Brazil. We made adaptations to Paediatric Autism Communication Therapy to address these difficulties. Paediatric Autism Communication Therapy is a therapy to support the development of social and communication skills for autistic children aged 2-10 years. The therapy is conducted with the autistic child's parent. Paediatric Autism Communication Therapy has not been used in Brazil before. There are few therapy options available for autistic children in Brazil and we believed that Paediatric Autism Communication Therapy may be useful. We asked three groups of people in Brazil about their views of Paediatric Autism Communication Therapy, after explaining how the therapy works. Group 1 included 18 parents of autistic children aged 2-10 years. Group 2 included 20 health professionals such as psychologists who work with autistic children. Group 3 included 15 parents of autistic children aged 2-7 years who received the Paediatric Autism Communication Therapy. We learned that parents and clinicians felt that Paediatric Autism Communication Therapy would be a beneficial therapy for autistic children in Brazil. We also found out about the challenges of using Paediatric Autism Communication Therapy in Brazil. We used these findings to make small cultural adaptations to Paediatric Autism Communication Therapy to make it more suitable for Brazil.

Community perspectives on support goals for young autistic children: A qualitative investigation

Goal setting is integral to the provision of effective support, but little is known about community perspectives on support goals for autistic children. A total of 41 autistic adults, 50 parents of autistic children and 31 clinical professionals living in New Zealand and Australia completed open-ended survey questions regarding their perceptions of support goals for young autistic children. Reflexive thematic analysis resulted in five overarching themes related to early support goals: (a) neurodiversity affirming, (b) change the environment, not the child, (c) helping adults to support autistic children, (d) quality of life and (e) respect boundaries. The perspectives of autistic adults, parents and professionals were mostly aligned.

Factors that influence clinical decisions about offering parent coaching for autistic youth served within the Medicaid system.

Parent coaching is an evidence-based practice for young autistic children, but it is underutilized in lower-resourced community settings like the Medicaid system (Straiton et al., 2021b). Clinicians often struggle to implement parent coaching with low-income and marginalized families (Tomczuk et al., 2022), but little is known about which factors influence clinician decision making processes about providing parent coaching to this population. This qualitative analysis used the framework method and thematic analysis. We used the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework (Aarons et al., 2011) to identify factors in the clinical decision-making process that community providers use when offering parent coaching to families of Medicaid-enrolled autistic children. Interviews with 13 providers and a focus group with 13 providers were analyzed. The following themes emerged: 1) Policies drive provider task priorities and affect competing demands; 2) Providers are more likely to use parent coaching when agency leaders monitor parent coaching benchmarks, though this is rarely done; 3) Logistical factors like scheduling and treatment location affect perceived feasibility of using parent coaching; 4) Previous experience or coursework in parent coaching and/or family systems supports the quality of parent coaching implementation; 5) Provider perceptions of "parent readiness" are initially indicated by overt expressions of parent interest. In the absence of outer-context and inner-context policies, providers have more decision-making power to offer parent coaching based on their own judgements and preferences, which may result in fewer families being offered parent coaching and increased bias related to which families are offered this service. State-, agency-, and clinician-level recommendations are provided for increasing equitable provision of this evidence-based practice for autism.

Fine motor skill and expressive language in minimally verbal and verbal school-aged autistic children.

Fine motor skill is associated with expressive language outcomes in infants who have an autistic sibling and in young autistic children. Fewer studies have focused on school-aged children even though around 80% have motor impairments and 30% remain minimally verbal (MV) into their school years. Moreover, expressive language is not a unitary construct, but it is made up of components such as speech production, structural language, and social-pragmatic language use. We used natural language sampling to investigate the relationship between fine motor and speech intelligibility, mean length of utterance and conversational turns in MV and verbal autistic children between the ages of 4 and 7 while controlling for age and adaptive behavior. Fine motor skill predicted speech production, measured by percent intelligible utterances. Fine motor skill and adaptive behavior predicted structural language, measured by mean length of utterance in morphemes. Adaptive behavior, but not fine motor skill, predicted social-pragmatic language use measured by number of conversational turns. Simple linear regressions by group corrected for multiple comparisons showed that fine motor skill predicted intelligibility for MV but not verbal children. Fine motor skill and adaptive behavior predicted mean length of utterance for both MV and verbal children. These findings suggest that future studies should explore whether MV children may benefit from interventions targeting fine motor along with speech and language into their school years.

Clinician Intentions to use the Components of Parent Coaching Within Community Early Intervention Systems.

Parent coaching is a complex, psychosocial intervention with multiple core components. Clinicians' use of these core components may be influenced by distinct factors; no research has examined whether clinician perceptions of parent coaching vary across core coaching components. This study aimed to examine the extent to which clinicians working with families of young autistic children in publicly funded early intervention intend to use core parent coaching components, and to examine how closely psychological factors relate to providers' intentions to use each component. Using the Theory of Planned Behavior as a framework, this study compared the strength of clinicians' intentions across five core parent coaching components: collaboration with parents, delivering the intervention within daily routines, demonstrating the intervention, providing in-vivo feedback, and reflection and problem solving. We examined the associations between intentions and psychological determinants of intentions (i.e., attitudes, norms, and self-efficacy) for each component. Clinicians' average intentions varied by core component, with strongest intentions for demonstrating the intervention strategy for a parent. The associations between intentions and psychological determinants also varied by core component. Attitudes, injunctive norms, and self-efficacy, but not descriptive norms, significantly related to clinicians' intentions to use collaboration and daily routines, whereas attitudes and descriptive norms, but not injunctive norms and self-efficacy, significantly related to clinicians' intentions to use feedback and reflection and problem solving. These results suggest that implementation strategies should be tailored to the specific intervention component to be most efficient and effective. The results also provide examples of potentially malleable factors that implementation strategies can strategically target.

Perspectives from parents of autistic children on participating in early intervention and associated research.

Support for autistic children early in life should help them to lead flourishing lives. However, many of the early intervention programmes for young autistic children are time-consuming and costly for families. These programmes are also often conducted in settings that are not closely matched to real life. We spoke to 23 parents (of 22 autistic children) to understand their experiences of their children's involvement in early intervention. Parents told us they were grateful for the opportunity, that they had 'hit the jackpot', and their children had 'gained so much' from the programme. They seemed to value the service because it made them feel safe and secure during an uncertain time in their children's lives. Parents told us they trusted staff, felt that they weren't 'doing it alone', and this 'took that pressure off' and helped them feel empowered. They also spoke of feelings of safety from being linked to the university research programme which offered 'accountability' and 'integrity'. Parents' comments showed a strong commitment to the early intervention model and staff - but also common feelings of abandonment and disempowerment as their child's time with the programme came to an end and they went 'back to the real world' and needed to find new supports for their children. These parents' insights should help to inform the design and delivery of community supports for preschool-aged autistic children and their families, which match the reality of their lived experiences.

Parent-Implemented Interventions via Telepractice in Autism Research: A Review of Social Validity Assessments.

Parent-implemented autism interventions are considered empirically validated interventions and the use of telepractice in these interventions is reported as effective. However, little is known about the social validity assessments and outcomes of these interventions. The purpose of this review is to explore the current practices of conducting social validity assessment and reporting its outcomes within parent-implemented telepractice autism interventions. The 11 reviewed studies included caregivers as participants, telepractice intervention focusing on social communication outcomes of young autistic children, and were published in a peer-reviewed journal within the past five years. The researchers in the reviewed articles reported positive outcomes for parent-implemented telepractice autism interventions. Notably, however, information about social validity assessments of the interventions was limited. Researchers are encouraged to evaluate the social validity of interventions using multiple data sources and methods, and report on their findings as they relate to other types of data.

Music-oriented parent counseling to promote improvement in level of parental stress, quality of life and the use of music in everyday life among parents of children with autism: A mixed-methods randomized controlled study

ABSTRACT Introduction Music-Oriented Parent Counseling (MOPC) is a clinical way to work with parents, using musical improvisations and listening. This study examined effects of MOPC on level of stress, quality of life perception and daily use of music by the parents of autistic children. Method Fourteen parents of young autistic children received either three MOPC sessions (n = 7) or ten MOPC sessions (n = 7), parallel to either music therapy (MT) or standard care for their children. Change in parental stress, parents’ perception on children’s and families’ quality of life and the daily use of music (routine and joint music activities) were measured with standardized assessments and parent interviews. Descriptive and inferential parametric statistics were conducted, as well as thematic analysis. Results We found little change and no significant effect on parental stress. Children’s quality of life showed improvement with but not without MT and a tendency towards a larger improvement with high-intensity than low-intensity MOPC. Family quality of life showed less change but a somewhat larger improvement in high-intensity than low-intensity MOPC. Routine music activities increased in high-intensity MOPC but decreased in low-intensity MOPC; joint music activities showed less change but a similar trend. Qualitative analysis of the interviews suggested that parents participating in high-intensity MOPC felt less stressed, perceived improved quality of life, and increased music use. Discussion Findings provide preliminary support for high-intensity MOPC to help parents of autistic children increase children’s and families’ quality of life and music use. More research is needed to confirm these findings.

Changes in the geometry and robustness of diffusion tensor imaging networks: Secondary analysis from a randomized controlled trial of young autistic children receiving an umbilical cord blood infusion.

Diffusion tensor imaging (DTI) has been used as an outcome measure in clinical trials for several psychiatric disorders but has rarely been explored in autism clinical trials. This is despite a large body of research suggesting altered white matter structure in autistic individuals. The current study is a secondary analysis of changes in white matter connectivity from a double-blind placebo-control trial of a single intravenous cord blood infusion in 2-7-year-old autistic children (1). Both clinical assessments and DTI were collected at baseline and 6 months after infusion. This study used two measures of white matter connectivity: change in node-to-node connectivity as measured through DTI streamlines and a novel measure of feedback network connectivity, Ollivier-Ricci curvature (ORC). ORC is a network measure which considers both local and global connectivity to assess the robustness of any given pathway. Using both the streamline and ORC analyses, we found reorganization of white matter pathways in predominantly frontal and temporal brain networks in autistic children who received umbilical cord blood treatment versus those who received a placebo. By looking at changes in network robustness, this study examined not only the direct, physical changes in connectivity, but changes with respect to the whole brain network. Together, these results suggest the use of DTI and ORC should be further explored as a potential biomarker in future autism clinical trials. These results, however, should not be interpreted as evidence for the efficacy of cord blood for improving clinical outcomes in autism. This paper presents a secondary analysis using data from a clinical trial that was prospectively registered with ClinicalTrials.gov(NCT02847182).

Adaptive Behavior in Young Autistic Children: Associations with Irritability and ADHD Symptoms.

Attention-deficit/hyperactivity disorder (ADHD) symptoms affect 40-60% of autistic children and have been linked to differences in adaptive behavior. It is unclear whether adaptive behavior in autistic youth is directly impacted by co-occurring ADHD symptoms or by another associated feature of both autism and ADHD, such as increased irritability. The current study examined relationships between irritability, ADHD symptoms, and adaptive behavior in 3- to 7-year-old autistic children. Results suggest that, after adjusting for co-occurring ADHD symptoms, higher levels of irritability are associated with differences in social adaptive behavior specifically. Understanding relationships between irritability, ADHD, and adaptive behavior in autistic children is critical because measures of adaptive behavior, such as the Vineland Scales of Adaptive Functioning, are often used as a proxy for global functioning, as well as for developing intervention plans and measuring outcomes as primary endpoints in clinical trials.

Cognitive flexibility in autism: Evidence from young autistic children.

We examined the cognitive flexibility performance of young autistic children and a group of neurotypical peers. Thirty-six autistic children (72-83 months) and 200 age-matched typically-developing children were assessed on the Children's Color Trails Test (CCTT), a semantic and a phonemic verbal fluency task. The results showed that the autistic children performed worse than their neurotypical peers in the switching component of the CCTT. In the fluency tests, the autistic group generated overall fewer word items than their neurotypical peers, however, their poorer performance was driven by specific linguistic stimuli in the fluency tasks. The findings suggest that cognitive flexibility for the autistic children was affected in the nonverbal CCTT only, while poor performance in semantic and phonemic fluency seemed to be inherent to the language properties of the verbal fluency tasks.

A Fusion-Based Machine Learning Approach for Autism Detection in Young Children Using Magnetoencephalography Signals

In this study, we aimed to find biomarkers of autism in young children. We recorded magnetoencephalography (MEG) in thirty children (4–7 years) with autism and thirty age, gender-matched controls while they were watching cartoons. We focused on characterizing neural oscillations by amplitude (power spectral density, PSD) and phase (preferred phase angle, PPA). Machine learning based classifier showed a higher classification accuracy (88%) for PPA features than PSD features (82%). Further, by a novel fusion method combining PSD and PPA features, we achieved an average classification accuracy of 94% and 98% for feature-level and score-level fusion, respectively. These findings reveal discriminatory patterns of neural oscillations of autism in young children and provide novel insight into autism pathophysiology.

PEERS® for Preschoolers preliminary outcomes and predictors of treatment response.

PEERS® for Preschoolers (P4P) is a social skills group program for young autistic children and their caregivers, which provides everyday tools for interacting and communicating with others. Twenty-two caregiver-child dyads participated and completed pre-treatment, post-treatment, and follow-up measures (4-16 weeks after). Using single-subject analyses to examine social skills, 60% demonstrated post-treatment improvement, and 53.85% demonstrated follow-up improvement. Regarding a secondary outcome of behavioral difficulties, 33.33% demonstrated post-treatment reduction, and 7.69% demonstrated follow-up reduction. Using regressions, autistic traits predicted outcomes; fewer social communication difficulties predicted both greater social skills and fewer behavioral difficulties at post-treatment, while fewer repetitive behaviors predicted fewer post-treatment and follow-up behavioral difficulties. These results preliminarily demonstrate the benefits of P4P and how autistic traits may impact P4P outcomes.

Describing (pre)linguistic oral productions in 3- to 5-year-old autistic children: A cluster analysis.

For most autistic children, spoken language emergence and development happen after the age of 3. Once they start developing and using spoken language, some eventually manage to reach typical levels of language abilities, while others remain minimally speaking into adulthood. It is therefore difficult to consider young autistic preschoolers as a homogeneous group in terms of spoken language levels. In our study, we breakdown a representative and inclusive group of children on the spectrum aged from 3 to 5 into five subgroups that correspond to different linguistic profiles. To do so, we qualitatively described children's (pre)verbal productions elicited during interactions with a parent and with an experimenter. We then used a type of statistical analysis called cluster analysis to group together the children that had a similar expressive (pre)linguistic behavior. Using this analysis, we were able to delineate five linguistic profiles with qualitatively different patterns of vocal production. Two of these profiles are composed of speaking children; the three others are composed of non- or minimally speaking children. Our findings show that traditional binary division of speaking versus nonspeaking autistic children is not precise enough to describe the heterogeneity of early spoken language in young autistic children. They also support the use of qualitative descriptions of vocal productions and speech to accurately document children's level of language, which could, in turn, help design very finely tailored language intervention specific to each child.

Profiles and correlates of language and social communication differences among young autistic children.

Delays in early language development are characteristic of young autistic children, and one of the most recognizable first concerns that motivate parents to seek a diagnostic evaluation for their child. Although early language abilities are one of the strongest predictors of long-term outcomes, there is still much to be understood about the role of language impairment in the heterogeneous phenotypic presentation of autism. Using a person-centered, Latent Profile Analysis, we first aimed to identify distinct patterns of language and social communication ability in a clinic-based sample of 498 autistic children, ranging in age from 18 to 60 months (M = 33 mo, SD = 12 mo). Next, a multinomial logistic regression analysis was implemented to examine sociodemographic and child-based developmental differences among the identified language and social communication profiles. Three clinically meaningful profiles were identified from parent-rated and clinician-administered measures: Profile 1 (48% of the sample) “Relatively Low Language and Social Communication Abilities,” Profile 2 (34% of the sample) “Relatively Elevated Language and Social Communication Abilities,” and Profile 3 (18% of the sample) “Informant Discrepant Language and Relatively Elevated Social Communication Abilities.” Overall, young autistic children from the lowest-resource households exhibited the lowest language and social communication abilities, and the lowest non-verbal problem-solving and fine-motor skills, along with more features of attention-deficit/hyperactivity disorder and atypical auditory processing. These findings highlight the need for effective community-based implementation strategies for young autistic children from low-resource households and underrepresented communities to improve access to individualized quality care.

Toward feeling, understanding, and caring: The development of empathy in young autistic children.

Empathy is a highly valued human capacity. Yet, autistic people are often portrayed as lacking in empathy. Recent research, which views empathy as a complex construct emerging from multiple interrelated emotional and cognitive processes, argues that, although many autistic people do have difficulty understanding others' emotions, and this may hinder them from responding to others in a prosocial manner, they are not indifferent to other people's feelings. Hoping to contribute to a better understanding of the unique challenges that autistic children face in their empathy development, we followed the development of four empathy abilities: emotion contagion, attention to others, emotion acknowledgment, and prosocial actions, in 1- to 6-year-old autistic children, in comparison with non-autistic children. Once a year, for 4 consecutive years, children's empathy abilities were evaluated by experimenters who acted out emotional episodes to provoke empathy in children, and by parents who filled out empathy questionnaires. We found that autistic children experienced indeed more difficulty attending to others, acknowledging others' emotions, and initiating prosocial actions toward others. However, according to parents, they did not differ from their non-autistic peers in feeling along with others' negative emotions. This indicates that it might not be the case that autistic children did not want to act empathetically toward others. Rather, they might not know how to do so. Notably, despite these difficulties, when looking at children's developmental trajectories, autistic children showed similar improvements over time as non-autistic children. This provides evidence that autistic children have the potential to learn and to improve their empathy skills.