Lang, R., Davis, T., O’Reilly, M. F., Machalicek, W., Rispoli, M. J., Sigafoos, J.,
Lancioni, G., & Regester, A. (in press). Assessment and treatment of elopement with a child with Aspergers syndrome. Journal of Applied Behavior Analysis.

Abstract: The elopement of a child with Asperger’s syndrome was assessed using functional analyses and treated in two school settings (classroom and resource room). Functional analyses results indicated that elopement was maintained by access to attention in the resource room and obtaining a preferred activity in the classroom. Two interventions (an attention-based intervention and a tangible-based intervention) were then compared in an alternating treatments design in both settings. Results of this comparison validated the findings of the functional analyses. Implications regarding the assessment and treatment of elopement are discussed.

Shogren, K. A., Lang, R., Machalicek, W., Rispoli, M., & O'Reilly, M. (in press). Self-
versus teacher-management of behavior for elementary school students with Asperger syndrome: Impact on classroom behavior. Journal of Positive Behavior Interventions.

Abstract: The purpose of this study was to evaluate and compare the effectiveness of a token economy and a self-management intervention in an inclusive kindergarten classroom. Two five year old children with Asperger syndrome who were struggling to follow classroom rules participated in the study. An ABACABAC (A = baseline, B = token economy, C = self-management) design with a maintenance phase was used. Results show improvements in appropriate classroom behavior and academic engagement during the token economy and self-management phases. The improvements were maintained 2, 4, and 8 weeks after the study ended. The classroom teacher continued to use the self-management system with the target students and independently created and implemented a classwide self-management system. Social validity data suggested a strong teacher preference for the self-management intervention because of its ease of implementation and focus on student responsibility. Implications for future research are discussed.

University of Bari, Italy

O'Reilly, M., Rispoli, M., Davis, T., Machalicek, W., Lang, R., Sigafoos, Kang, S., Lancioni, G., Green, V., & Didden, R. (in press). Functional analysis of challenging behavior in children with autism spectrum disorders: A summary of 10 cases. Research in Autism Spectrum Disorders.

Abstract: Children with autism spectrum disorders (ASDs) often present with challenging behavior, such as aggression and self-injury. In studies of children with other types of developmental disabilities challenging behavior appears more often to be maintained by attention or escape from demands. Less is known about the operant function of challenging behavior in children with ASD. The aim of the present study was to provide an analysis of the function of challenging behaviors in 10 children with an ASD. Each child was assessed across five conditions (i.e., attention, escape, tangible, alone, and play). Each condition was presented 8–10 times in a multielement design while the percentage of 10-s intervals with challenging behavior (e.g., aggression, self-injury) was recorded. The results showed that for 8 of the 10 children, challenging behavior was maintained by automatic reinforcement, but by multiple sources of reinforcement for the other 2 children. The overall findings differ from the results of studies on children with other types of developmental disabilities, suggesting the possibility of a characteristically more non-social function to the challenging behavior of children with ASD.

Lang, R., Machalicek, W., Rispoli, M. J., & Regester, A. (in press). Training parents to implement communication interventions for children with autism spectrum disorders: A systematic review of training procedures. Evidenced Based Communication Assessment and Intervention.

Abstract: This review identifies procedures used to train parents to implement communication interventions to children with autism spectrum disorders. Systematic search procedures identified 11 studies that met predetermined inclusion criteria. Across studies, 60 parents were trained to implement Pivotal Response Training, Enhanced Milieu Teaching, Natural Language Paradigm, or Early Start Denver Model. The mean time spent training parents was 17 hours. Training procedures used most often included: (a) verbal instruction and/or instruction manuals, (b) in vivo practice, (c) role-playing, (d) modeling by trainer, and (e) reviewing videos of intervention sessions. Improvements in parent ability to implement intervention and child communication were ubiquitous. However, a paucity of studies in which baseline parent behavior was measured, coupled with the absence of studies evaluating individual training procedures, precludes definitive statements regarding the most effective and efficient approach to parent training and, therefore, warrant future research.

Lang, R., Regester, A., Lauderdale, S., Ashbaugh, K., & Haring, A. (in press). Treatment of anxiety in autism spectrum disorders using cognitive behavior therapy: A systematic review. Developmental Neurorehabilitation.

Abstract: Objective: To review studies involving the treatment of anxiety in people with autism spectrum disorders (ASD) using Cognitive Behavior Therapy (CBT) with the intent to inform practice and to identify areas for future research.
Methods: Systematic searches of electronic databases, references lists, and journals identified 9 studies. Each identified study that met pre-determined inclusion criteria was analyzed and summarized in terms of: (a) participants, (b) intervention procedures (c) dependent variables, (d) results of intervention, and (e) certainty of evidence. To assess the certainty of evidence, we critically appraised each study’s design and related methodological details.
Results: Positive outcomes were ubiquitous, suggesting CBT is an effective treatment for anxiety in individuals with Asperger’s. However, data involving other ASD diagnostic subtypes is limited.
Conclusions: CBT has been modified for individuals with ASD by adding intervention components typically associated with applied behavior analysis (e.g., systematic prompting & differential reinforcement). Future research involving a component analysis could potentially elucidate the mechanisms by which CBT reduces anxiety with individuals with ASD, ultimately leading to more efficient or effective interventions.

Chan, J. M., Lang, R., Rispoli, M., O’Reilly, M. F., Sigafoos, J., & Cole, H. (in press).
Use of Peer-Mediated Interventions in the Treatment of Autism Spectrum Disorders: A Systematic Review. Research in Autism Spectrum Disorders.

Abstract: This review involved a systematic analysis of studies that focused on the use of peer-mediated interventions (PMI) in the treatment of individuals with autism spectrum disorders (ASD). Forty-two studies that met pre-determined inclusion criteria were analyzed and summarized in terms of: (a) participants receiving intervention, (b) peers implementing, (c) method of training peers, (d)intervention procedures, and (e) desired outcomes. Further, we critically appraised each study’s design and related methodological details in order to determine certainty of evidence. Collectively, the 42 studies involved a total of 172 participants who received intervention from a total of 396 trained peers. The reported outcomes were mostly positive (91%), but the studies are limited because treatment fidelity was only rarely assessed. Overall, the reviewed studies suggest that PMI is a versatile and potentially effective intervention approach for individuals with ASD.

Lang, R., Didden, R., Sigafoos, J., Rispoli, M., Regester, A., & Lancioni, G. (in press).
Treatment of Chronic Skin Picking in a Woman with Aspergers Syndrome and Borderline Intellectual Disability. Clinical Case Studies.

Abstract: We present the case of a 17-year-old girl with Asperger syndrome and borderline intellectual disability with a 5-year history of chronic skin-picking. Our intervention approach included an initial functional assessment to identify variables maintaining skin-picking, followed by evaluation of a behavioral treatment package. Results of the functional assessment suggested that skin-picking was maintained by automatic reinforcement in the form of tactile and visual stimulation. The intervention, consisting of an antecedent control procedure (covering areas with bandages) and differential reinforcement, was evaluated in an ABAC single-case experimental design. The number of open sores decreased from an average of 37 in baseline to zero during intervention. No new sores were found 4 months following intervention. These results suggest that the treatment package was effective in reducing skin-picking and that the treatment effects were maintained, but it was not clear if both treatment components were necessary and/or sufficient for behavior change.

University of New England, Austrailia

University of Bari, Italy

Sigafoos, J., Lang, R., Davis, T., Rispoli, M., Tait, K., Cannell-Malone, H., O’Reilly, M.,
& Lancioni, G. (in press). Developmental and Physical Disabilities. In V. A. Green and S. Cherrington (Eds.), Delving into diversity: An international exploration of issues of diversity in education. New York: Nova Science Publishers.

Developmental and physical disabilities represent a significant and increasingly prevalent source of diversity in educational settings. Consequently, it is important for educators to gain a basic understanding of the learning and behavioral characteristics associated with the various types of developmental and physical disabilities. This chapter describes the most common types of developmental and physical disabilities that affect school-aged children and highlights their associated learning and behavioral characteristics. The specific disability categories described are: (a) attention-deficit, hyperactivity disorder, (b) autism spectrum disorder, (c) cerebral palsy, (d) intellectual disability, (e) learning disabilities, and (f) multiple disabilities. This general overview is intended to increase understanding of the educational needs of children with these types of developmental and physical disabilities.

Etherton, M.R., Blaiss, C.A., Powell, C.M., & Sudhof, T.C. (2009). Mouse neurexin-1 alpha deletion causes correlated electrophysiological and behavioral changes consistent with cognitive impairments. Proceedings of the National Academy of Sciences, U.S.A.

Deletions in the neurexin-1alpha gene were identified in large-scale unbiased screens for copy-number variations in patients with autism or schizophrenia. To explore the underlying biology, we studied the electrophysiological and behavioral phenotype of mice lacking neurexin-1alpha. Hippocampal slice physiology uncovered a defect in excitatory synaptic strength in neurexin-1alpha deficient mice, as revealed by a decrease in miniature excitatory postsynaptic current (EPSC) frequency and in the input-output relation of evoked postsynaptic potentials. This defect was specific for excitatory synaptic transmission, because no change in inhibitory synaptic transmission was observed in the hippocampus. Behavioral studies revealed that, compared with littermate control mice, neurexin-1alpha deficient mice displayed a decrease in prepulse inhibition, an increase in grooming behaviors, an impairment in nest-building activity, and an improvement in motor learning. However, neurexin-1alpha deficient mice did not exhibit any obvious changes in social behaviors or in spatial learning. Together, these data indicate that the neurexin-1alpha deficiency induces a discrete neural phenotype whose extent correlates, at least in part, with impairments observed in human patients.

Hardan, A.Y., Pabalan, M. Gupta, N., Bansal, R., Melhem, N.M., Fedorov, S., Keshavan, M.S., & Minshew, N.J. (2009). Corpus callosum volume in children with autism. Psychiatry Research.

The corpus callosum (CC) is the main commissure connecting the cerebral hemispheres. Previous evidence suggests the involvement of the CC in the pathophysiology of autism. However, most studies examined the mid-sagittal area and investigations applying novel methods are warranted. The goal of this investigation is to apply a volumetric method to examine the size of the CC in autism and to identify any association with clinical features. An MRI-based morphometric study of the total CC volume and its seven subdivisions was conducted and involved 22 children with autism (age range 8.1-12.7 years) and 23 healthy, age-matched controls. Reductions in the total volume of the CC and several of its subdivisions were found in the autism sample. Associations were observed between CC structures and clinical features including social deficits, repetitive behaviors, and sensory abnormalities. Volumetric alterations of the CC observed in this investigation are consistent with midsagittal area tracings of decreased CC size in autism. These findings support the aberrant connectivity hypothesis with possible decrease in interhemispheric communications.

Koegel, R. L. Koegel, L. K., Vernon, T. W. and Brookman-Frazee, L. I. (2009). Empirically Supported Pivotal Response Treatment for Autism Spectrum Disorders. In Weisz and Kazdin (2009). Evidence-based Psychotherapies for Children and Adolescents. New York: Guilford Press.

Abstract: Autism spectrum disorders have received much attention both due to the steady rise in prevalence (Center for Disease Control and Prevention, 2007) and the fact that the etiological basis continues to remain largely unknown. Since the recognition of autism as a distinct developmental disorder by Kanner (1943), the three defining characteristics (impairments in social interaction, communication, and restricted and repetitive behaviors) have remained, although the specific diagnostic criteria have changed over the years. Due to difficulties with social communication, individuals with autism spectrum disorders who fail to receive appropriate intervention may also exhibit disruptive behaviors, such as tantrums, aggression, and/or self-injury. In addition, almost all parents of children with autism experience high levels of stress related to having a child with a disability (cf. Symon, Koegel, & Singer, 2006). Thus, there has been a growing demand for systematically-evaluated interventions that address the comprehensive needs of the child and the family as a whole, and that result in meaningful outcomes over time and across widespread areas of functioning. This chapter provides an overview of empirically supported intervention procedures for improving autism spectrum disorders using Pivotal Response Treatment procedures.

Zhang, C., Milunsky, J.M., Newton, S., Ko, J., Zhao, G., Maher, T.A., Tager-Flusberg, H., Bollinger, M.F., Carter, A.S., Boucard, A.A., Powell, C.M., & Sudhof, T.C. (2009). A neuroligin-4 missense mutation associated with autism impairs neurologin-4 folding and endoplasmic reticulum export. The Journal of Neuroscience.

Neuroligins (NLs) are postsynaptic cell-adhesion molecules essential for normal synapse function. Mutations in neuroligin-4 (NL4) (gene symbol: NLGN4) have been reported in some patients with autism spectrum disorder (ASD) and other neurodevelopmental impairments. However, the low frequency of NL4 mutations and the limited information about the affected patients and the functional consequences of their mutations cast doubt on the causal role of NL4 mutations in these disorders. Here, we describe two brothers with classical ASD who carry a single amino-acid substitution in NL4 (R87W). This substitution was absent from the brothers' asymptomatic parents, suggesting that it arose in the maternal germ line. R87 is conserved in all NL isoforms, and the R87W substitution is not observed in control individuals. At the protein level, the R87W substitution impaired glycosylation processing of NL4 expressed in HEK293 and COS cells, destabilized NL4, caused NL4 retention in the endoplasmic reticulum in non-neuronal cells and neurons, and blocked NL4 transport to the cell surface. As a result, the R87W substitution inactivated the synapse-formation activity of NL4 and abolished the functional effect of NL4 on synapse strength. Viewed together, these observations suggest that a point mutation in NL4 can cause ASD by a loss-of-function mechanism.

Supekar, K., Musen, M., & Menon, V. (2009). Development of large-scale functional brain networks in children. Public Library of Science Biology.

The ontogeny of large-scale functional organization of the human brain is not well understood. Here we use network analysis of intrinsic functional connectivity to characterize the organization of brain networks in 23 children (ages 7-9 y) and 22 young-adults (ages 19-22 y). Comparison of network properties, including path-length, clustering-coefficient, hierarchy, and regional connectivity, revealed that although children and young-adults' brains have similar "small-world" organization at the global level, they differ significantly in hierarchical organization and interregional connectivity. We found that subcortical areas were more strongly connected with primary sensory, association, and paralimbic areas in children, whereas young-adults showed stronger cortico-cortical connectivity between paralimbic, limbic, and association areas. Further, combined analysis of functional connectivity with wiring distance measures derived from white-matter fiber tracking revealed that the development of large-scale brain networks is characterized by weakening of short-range functional connectivity and strengthening of long-range functional connectivity. Importantly, our findings show that the dynamic process of over-connectivity followed by pruning, which rewires connectivity at the neuronal level, also operates at the systems level, helping to reconfigure and rebalance subcortical and paralimbic connectivity in the developing brain. Our study demonstrates the usefulness of network analysis of brain connectivity to elucidate key principles underlying functional brain maturation, paving the way for novel studies of disrupted brain connectivity in neurodevelopmental disorders such as autism.

Hardan, A.Y., Libove, R.A., Keshavan, M.S., Melham, N.M., & Minshew, N.J. (2009). A preliminary longitudinal magnetic resonance imaging study of brain volume and cortical thickness in autism. Neuroscience and Biobehavioral Reviews.

BACKGROUND: Autism is a developmental neurobiologic disorder associated with structural and functional abnormalities in several brain regions including the cerebral cortex. This longitudinal study examined developmental changes in brain volume and cortical thickness (CT) using magnetic resonance imaging (MRI) in children with autism. METHODS: MRI scans and behavioral measures were obtained at baseline and after a 30-month interval in a sample of male subjects with autism (n = 18) and healthy age-, and sex-matched control subjects (n = 16) between ages 8 and 12 years at baseline. RESULTS: No differences in brain volumes were observed between the autism and control subjects at baseline or follow-up. However, differences in total gray matter volumes were observed over time with significantly greater decreases in the autism group compared with control subjects. Differences in CT were observed over time with greater decreases in the autism group compared with control subjects in several brain regions including the frontal lobe. When accounting for multiple comparisons, differences between the two groups became nonsignificant except for changes in occipital CT. Furthermore, associations were observed between several clinical features and changes in CT with greater thinning of the cortex being correlated with more severe symptomatology. CONCLUSIONS: Findings from this study provide preliminary evidence for age-related changes in gray matter volume and CT in children with autism that are associated with symptoms severity. Future longitudinal studies of larger sample sizes are needed to evaluate developmental changes and examine the relationships between structural abnormalities and clinical expressions of the disorder.

Reiss, A.L. (2009). Childhood developmental disorders: An academic and clinical convergence point for psychiatry, neurology, psychology and pediatrics. The Journal of Child Psychology and Psychiatry.

BACKGROUND: Significant advances in understanding brain development and behavior have not been accompanied by revisions of traditional academic structure. Disciplinary isolation and a lack of meaningful interdisciplinary opportunities are persistent barriers in academic medicine. To enhance clinical practice, research, and training for the next generation, academic centers will need to take bold steps that challenge traditional departmental boundaries. Such change is not only desirable but, in fact, necessary to bring about a truly innovative and more effective approach to treating disorders of the developing brain. METHODS: I focus on developmental disorders as a convergence point for transcending traditional academic boundaries. First, the current taxonomy of developmental disorders is described with emphasis on how current diagnostic systems inadvertently hinder research progress. Second, I describe the clinical features of autism, a phenomenologically defined condition, and Rett and fragile X syndromes, neurogenetic diseases that are risk factors for autism. Finally, I describe how the fields of psychiatry, psychology, neurology, and pediatrics now have an unprecedented opportunity to promote an interdisciplinary approach to training, research, and clinical practice and, thus, advance a deeper understanding of developmental disorders. RESULTS: Research focused on autism is increasingly demonstrating the heterogeneity of individuals diagnosed by DSM criteria. This heterogeneity hinders the ability of investigators to replicate research results as well as progress towards more effective, etiology-specific interventions. In contrast, fragile X and Rett syndromes are 'real' diseases for which advances in research are rapidly accelerating towards more disease-specific human treatment trials. CONCLUSIONS: A major paradigm shift is required to improve our ability to diagnose and treat individuals with developmental disorders. This paradigm shift must take place at all levels - training, research and clinical activity. As clinicians and scientists who are currently constrained by disciplinary-specific history and training, we must move towards redefining ourselves as clinical neuroscientists with shared interests and expertise that permit a more cohesive and effective approach to improving the lives of patients.

Koegel, L. K., Fredeen, R. M., Koegel, R. L., and Lin, E. (2009). Relationships, Independence, and Communication in Autism and Asperger’s Disorder. In Amaral, D., Dawson, G. and Geschwind, D. (2009). Autism Spectrum Disorders. New York: Oxford University Press.

Abstract: Accumulating research suggests that difficulties with social communication in children negatively affect psychological health and well-being in adulthood. Therefore, systematic research on treatment components and identification of pivotal areas that improve these areas in individuals with autism is necessary to ensure positive long-term outcomes. Intervention models utilizing a comprehensive, multi-component intervention approach that are implemented within natural settings appear to be most effective, and are associated with collateral gains and greater generalization. In this chapter, key areas for intervention are described. In particular, initiations and peer interactions appear to be integral to long term success and thus, these areas should be incorporated into the intervention plan. Promising research areas that appear to foster successful outcomes are discussed in detail.

Singh, J., Illes, J., Lazzeroni, L., & Hallmayer, J. (2009). Trends in US autism research funding. The Journal of Autism and Developmental Disorders.

This study shows that the number of autism research grants funded in the US from 1997 to 2006 significantly increased 15% per year. Although the majority of projects were concentrated in basic science (65%) compared to clinical (15%) and translational research (20%), there is a significant decrease in the proportion of basic research grants per year and a significant increase in the proportion of translational projects per year. The number of translational projects funded by the National Alliance for Autism Research and Cure Autism Now increased significantly, whereas the number of clinical projects significantly increased for the National Institutes of Health. In conclusion, this study demonstrates the shifting landscape of autism research from basic science to clinical and translational research.

Koegel, L.K. & LaZebnik, C. (2009) Growing up on the spectrum: A guide to life, love, and learning for teens and young adults with autism and aspergers. London: Viking Penguin.

Abstract: Adolescence is a fraught time for any child. But what if your child is among the more than half million currently estimated to fall on the autistic spectrum? The toddlers diagnosed during the first wave of this epidemic are growing up, and there is alarmingly little information available on how to guide them to independent and successful adulthood. At the renowned Koegel Autism Research Center in Santa Barbara, Lynn Koegel regularly helps parents tackle these issues every day. Like the acclaimed Overcoming Autism, Growing Up on the Spectrum integrates Koegel’s strategies and interventions with the questions and concerns of Claire LaZebnik, a writer and the parent of a teenager with autism. Additional pieces by LaZebnik’s sixteen-year-old son Andrew offer a unique first-person perspective. Addressing universal parental concerns, from first crushes, a changing body, and the challenges of being socially appropriate to how to succeed at college and beyond, this inspiring volume is the beacon of hope and wisdom that parents, therapists, and educators have been waiting for.

Sohal, V.S., Zhang, F., Yizhar, O., & Deisseroth, K. (2009). Parvalbumin neurons and gamma rhythms enhance cortical circuit performance. Nature.

Synchronized oscillations and inhibitory interneurons have important and interconnected roles within cortical microcircuits. In particular, interneurons defined by the fast-spiking phenotype and expression of the calcium-binding protein parvalbumin have been suggested to be involved in gamma (30-80 Hz) oscillations, which are hypothesized to enhance information processing. However, because parvalbumin interneurons cannot be selectively controlled, definitive tests of their functional significance in gamma oscillations, and quantitative assessment of the impact of parvalbumin interneurons and gamma oscillations on cortical circuits, have been lacking despite potentially enormous significance (for example, abnormalities in parvalbumin interneurons may underlie altered gamma-frequency synchronization and cognition in schizophrenia and autism). Here we use a panel of optogenetic technologies in mice to selectively modulate multiple distinct circuit elements in neocortex, alone or in combination. We find that inhibiting parvalbumin interneurons suppresses gamma oscillations in vivo, whereas driving these interneurons (even by means of non-rhythmic principal cell activity) is sufficient to generate emergent gamma-frequency rhythmicity. Moreover, gamma-frequency modulation of excitatory input in turn was found to enhance signal transmission in neocortex by reducing circuit noise and amplifying circuit signals, including inputs to parvalbumin interneurons. As demonstrated here, optogenetics opens the door to a new kind of informational analysis of brain function, permitting quantitative delineation of the functional significance of individual elements in the emergent operation and function of intact neural circuitry.

Uddin, L.Q., & Menon, V. (2008, 2009). The anterior insula in autism: Under-connected and under-examined. Nature. Public Library of Science Biology. Neuroscience and Biobehavioral Reviews.

Autism is a complex neurodevelopmental disorder of unknown etiology. While the past decade has witnessed a proliferation of neuroimaging studies of autism, theoretical approaches for understanding systems-level brain abnormalities remain poorly developed. We propose a novel anterior insula-based systems-level model for investigating the neural basis of autism, synthesizing recent advances in brain network functional connectivity with converging evidence from neuroimaging studies in autism. The anterior insula is involved in interoceptive, affective and empathic processes, and emerging evidence suggests it is part of a "salience network" integrating external sensory stimuli with internal states. Network analysis indicates that the anterior insula is uniquely positioned as a hub mediating interactions between large-scale networks involved in externally and internally oriented cognitive processing. A recent meta-analysis identifies the anterior insula as a consistent locus of hypoactivity in autism. We suggest that dysfunctional anterior insula connectivity plays an important role in autism. Critical examination of these abnormalities from a systems neuroscience perspective should be a priority for further research on the neurobiology of autism.

Research conducted and supervised at Radboud University Nijmegen

Didden, R., Scholte, R., Moor, J., Korzilius, H., Vermeulen, A., O'Reilly, M., Lang, R., Lancioni, G. (in press). Cyberbullying among students with mild to borderline intellectual disability and/or developmental disorders who visit a special school. Developmental Neurorehabilitation.

Abstract: Objective: To explore the types, prevalence, and associated variables of cyberbullying among students with intellectual and developmental disability attending special education settings. Methods: Students (n = 114) with intellectual and developmental disability who were between 12 and 19 years of age completed a questionnaire containing questions related to bullying and victimization via internet and cellphone. Other questions concerned sociodemographic characteristics (IQ, age, gender, diagnosis), self-esteem and depressive feelings. Results: Between 4 and 9% of students reported bullying or victimization of bullying at least once a week. Significant associations were found between cyberbullying and IQ, frequencey of computer usage, and self-esteem and depressive feelings. No associations were found between cyberbullying and age and gender. Conclusions: Cyberbullying is prevalent among students with intellectual and devolopmental disability in special education settings. Programs should be developed to deal with this issue in which students, teachers and parents work together.

Lang, R., Machalicek, W., O Reilly, M. F., Sigafoos, J., Rispoli, M. J., Shogren, K., & Regester, A. (In press). Review of interventions to increase functional and symbolic play in children with autism. Education and Training in Developmental Disabilities

Abstract: Play is widely acknowledged to be an integral part of human development and children with autism often experience substantial delays in the development of play behaviors. This review updates older reviews by covering the last 10 years of research targeting functional and symbolic play in children with autism. The review differs from other reviews concerning play by including all conceptual models and intervention environments, while also limiting inclusion to studies demonstrating experimental control. Additionally, this is the first review of play studies to report results in quantifiable terms (e.g. PND). Studies are grouped into two categories (i.e. studies of functional versus symbolic play). Three components (i.e. modeling, prompting with contingent reinforcement, and child directed or “naturalistic” instruction) appear related to successful play interventions. The results of this review suggest that these components underlie the effectiveness of successful play intervention for children with autism.

Lang, R., Shogren, K., Machalicek, W., Rispoli, M., O’Reilly, M.F., Regester, A., & Baker, S. (In press). Use of Video Self-Modeling to Teach Classroom Rules to Two Children with Asperger’s Syndrome. Research in Autism Spectrum Disorders.

Abstract: Classroom rules are an integral part of classroom management. Children with Asperger's may require systematic instruction to learn classroom rules, but may be placed in classrooms in which the rules are not explicitly taught. A multiple baseline design across students with probes for maintenance after the intervention ceased was used to evaluate the effectiveness of a video self-modeling (VSM) intervention to teach classroom rules to two children with Asperger's. Results indicated that each of the children improved their ability to recite classroom rules following the VSM intervention. These results were maintained for both students at 12 weeks post-intervention. The findings of this study suggest that VSM is an effective tool for teaching children with Asperger's classroom rules.

Regester, A. & Singer, G. (In preparation for press). Beyond High School: Participants' Perspectives on Their Participation with Inclusive Friendship Programs in High School. In Peck, C. A., Breen, C. G., & Kennedy, C. H. Contemporary Perspectives on Social Support and Intervention for People with Severe Disabilities: Essays in Honor of Thomas G. Haring. Baltimore: Paul H. Brookes.

Abstract: Research has shown inclusive education to be extremely beneficial for students with developmental disabilities. One reported benefit is the increased accessibility to typical peers with the implication of increased opportunities to develop meaningful friendships. Many researchers and educators have developed strategies to help facilitate the development of these friendships. The long-term impact of such strategies has rarely been investigated to determine their effectiveness over time for all students involved. Using qualitative research methods, five adult subjects with and without disabilities were interviewed to determine the impact of three inclusive friendship programs they participated in while in high school. Four themes emerged from the interviews as having an impact on the success of the programs. The influence of the special education teacher, the characteristics of the students without disabilities (at-risk), the self-defined characteristics of the friendships formed and the impact on adult working life were determined to be important in the design and implementation of the programs. Further research implications are discussed in order to develop future programs that have similar optimal outcomes.

Tu, S.W., Tennakoon, L., O'Connor, M., Shankar, R., & Das, A. (2008). Using an integrated ontology and information model for querying and reasoning about phenotypes: The case of autism. American Medical Informatics Association Symposium Proceedings.

The Open Biomedical Ontologies (OBO) Foundry is a coordinated community-wide effort to develop ontologies that support the annotation and integration of scientific data. In work supported by the National Database of Autism Research (NDAR), we are developing an ontology of autism that extends the ontologies available in the OBO Foundry. We undertook a systematic literature review to identify domain terms and relationships relevant to autism phenotypes. To enable user queries and inferences about such phenotypes using data in the NDAR repository, we augmented the domain ontology with an information model. In this paper, we show how our approach, using a combination of description logic and rule-based reasoning, enables high-level phenotypic abstractions to be inferred from subject-specific data. Our integrated domain ontologyinformation model approach allows scientific data repositories to be augmented with rule-based abstractions that facilitate the ability of researchers to undertake data analysis.

Charwarska, K., Klin, A., & Volkmar, F.R. (2008). Autism spectrum disorders in infants and toddlers: Diagnosis, assessment, and treatment. New York, NY: Guilford Press.

Abstract: Although the earliest symptoms of autism spectrum disorders (ASD) often appear before a child's second birthday, most children are not diagnosed and appropriately treated until preschool or school age. What signs of ASD should professionals be aware of when working with infants and toddlers? What diagnostic and treatment tools are available for this age group, and how effective are they? Rich with clinical insights, this volume reviews the state of the science of identifying young children with ASD and helping them and their families achieve the best outcomes in all aspects of development. Edited and written by leading authorities, the book begins by explaining critical research issues and summarizing what is known about ASD symptomatology in the first, second, and third years of life. Subsequent chapters present innovative approaches to assessing social, cognitive, adaptive, communication, and sensory-motor impairments. The complexities of early identification are illustrated in detailed case studies of three children initially identified with ASD between 15 and 20 months, and followed through age 4. Developmental and behavioral treatment models are thoroughly described, including basic principles, procedures, and the status of the empirical evidence base. The book also explores ways to support families in coping with an ASD diagnosis and becoming effective advocates for their children. Frequently encountered medical issues are addressed, and a special chapter discusses popular but controversial treatments and how to help families make informed decisions about their use. Grounded in current knowledge about typical and atypical early development, this is a timely, eminently practical resource for a wide range of child health and education professionals, including clinical and developmental psychologists, child psychiatrists, early intervention specialists, speech-language pathologists, and pediatricians. Advanced students in these fields will find it a highly informative text.

Uddin, L.Q., Davies, M.S., Scott, A.A., Zaidel, E., Bookheimer, S.Y., Iacoboni, M., & Dapretto, M. (2008). Neural basis of self and other representation in autism: An FMRI study of self-face recognition. Public Library of Science One.

BACKGROUND: Autism is a developmental disorder characterized by decreased interest and engagement in social interactions and by enhanced self-focus. While previous theoretical approaches to understanding autism have emphasized social impairments and altered interpersonal interactions, there is a recent shift towards understanding the nature of the representation of the self in individuals with autism spectrum disorders (ASD). Still, the neural mechanisms subserving self-representations in ASD are relatively unexplored. METHODOLOGY/PRINCIPAL FINDINGS: We used event-related fMRI to investigate brain responsiveness to images of the subjects' own face and to faces of others. Children with ASD and typically developing (TD) children viewed randomly presented digital morphs between their own face and a gender-matched other face, and made "self/other" judgments. Both groups of children activated a right premotor/prefrontal system when identifying images containing a greater percentage of the self face. However, while TD children showed activation of this system during both self- and other-processing, children with ASD only recruited this system while viewing images containing mostly their own face. CONCLUSIONS/SIGNIFICANCE: This functional dissociation between the representation of self versus others points to a potential neural substrate for the characteristic self-focus and decreased social understanding exhibited by these individuals, and suggests that individuals with ASD lack the shared neural representations for self and others that TD children and adults possess and may use to understand others.

Sze, K. M., & Wood, J. J. (2008). Enhancing CBT for the treatment of autism spectrum disorders and concurrent anxiety: a case study. Behavioural and Cognitive Psychotherapy, 36, 403-409.

Abstract: Because anxiety and other concurrent psychological problems are common among children with high-functioning autism and Asperger syndrome, research initiatives have been devoted to the development of efficacious treatments to address the multifaceted needs of youth with this presentation. Emerging research indicates that when carefully adapted to accommodate for the unique needs of children with autism spectrum disorders (ASD), cognitive-behavioural therapy (CBT) may be a viable treatment modality. Because inherent features of ASD may compromise the efficacy of traditional CBT, our preliminary work suggests that it may be important to gear intervention efforts towards directly addressing core autism symptoms to promote optimal treatment response. This article describes an evidence-based CBT treatment manual modified and expanded to address core ASD features above and beyond anxiety symptomatology. A case example of a 10-year-old boy with Asperger syndrome is presented with supporting data to illustrate the treatment modifications and their rationale. The positive treatment response attained in this case suggests that an enhanced variant of a standard CBT programme may be an efficacious treatment approach for children with ASD and concurrent anxiety.

Koegel, A.K. (2008). Evidence suggesting the existence of asperger syndrome in the mid-1800s. Journal of Positive Behavior Interventions.

Abstract: Originally published in Putnam’s Monthly Magazinein 1853, nearly a century before autism spectrum disorder (ASD) was formally recognized, Herman Melville’s Bartleby is the naïve tale of a nonconforming, socially awkward character. However, when placed into contemporary context, retrospective analysis indicates that Bartleby may in fact have been a victim of the modern diagnosis of ASD, more specifically, a high-functioning form of autism termed Asperger syndrome. In 1853,it is unlikely that individuals who would now be characterized as having ASD would have been accepted by society. Without proper diagnosis and any appropriate form of treatment, such individuals had little chance of improvement or inclusion. The following is a modern case study, proposing that Melville’s Bartleby was affected with the modern syndrome of ASD, and his work was thus suggesting the existence of Asperger Syndrome in the mid-1800s.

Wood, J. J., Drahota, A., Sze, K. M., Har, K., Chiu, A., & Langer, D. (2008). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial. Journal of Child Psychology and Psychiatry, DOI: 10.1111/j.1469-7610.2008.01948.x.

Abstract: Background: Children with autism spectrum disorders often present with comorbid anxiety disorders that cause significant functional impairment. This study tested a modular cognitive behavioral therapy (CBT) program for children with this profile. A standard CBT program was augmented with multiple treatment components designed to accommodate or remediate the social and adaptive skill deficits of children with ASD that could pose barriers to anxiety reduction. Method: Forty children (7-11 years old) were randomly assigned to 16 sessions of CBT or a 3-month waitlist (36 completed treatment or waitlist). Therapists worked with individual families. The CBT model emphasized behavioral experimentation, parent-training, and school consultation. Independent evaluators blind to treatment condition conducted structured diagnostic interviews and parents and children completed anxiety symptom checklists at baseline and posttreatment/postwaitlist. Results: In intent-to-treat analyses, 78.5% of the CBT group met Clinical Global Impressions-Improvement scale criteria for positive treatment response at posttreatment, as compared to only 8.7% of the waitlist group. CBT also outperformed the waitlist on diagnostic outcomes and parent reports of child anxiety, but not children’s self-reports. Treatment gains were maintained at 3-month follow-up. Conclusions: The CBT manual employed in this study is one of the first adaptations of an evidence-based treatment for children with autism spectrum disorders. Remission of anxiety disorders appears to be an achievable goal among high-functioning children with autism.

White, S. W., Scahill, L., Klin, A., Koenig, K., & Volkmar, F.R. (2007). Educational placements and service use patterns of individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37, 1403-1412.

Abstract: This project was undertaken to identify child characteristics associated with educational placement and service use in high-functioning children with autism spectrum disorders. The sample of 101 (nine females) had a mean age of 12±3 years (mean IQ=101.77±19.50). Results indicate that lower-cognitive ability and communication skill were associated with placement in special education. Based on parent-report, most students stayed in the same placement (regular or special education) in which they began first grade and the majority of students received special services in their schools (most often speech/language intervention). Findings highlight the emphasis placed on certain child characteristics (e.g., cognitive ability), with far less emphasis on other areas (e.g., degree of social deficit), in educational placement and service provision.

Duvall, J.A., Lu, A., Cantor, R.M., Todd, R.D., Constantino, J.N., & Geschwind, D. H. (2007). A quantitative trait locus analysis of social responsiveness in multiplex autism families. American Journal of Psychiatry, 164, 656-662.

Abstract: Autism is a complex genetic disorder with a highly heterogeneous phenotype defined by repetitive behaviors, language deficits, and problems with reciprocal social interactions. The authors present the first genome-wide scan for a social endophenotype in autism using the Social Responsiveness Scale, which provides a quantitative measure of autistic-like behavior, primarily focused on social relatedness. Method: A nonparametric quantitative genome scan was performed using the Social Responsiveness Scale in a cohort of about 100 families with two or more autistic probands from the Autism Genetic Resource Exchange to identify autism loci. To determine which additional loci were detected, linkage analysis with the same autism cohort using the qualitative diagnosis of autism was performed. To assess whether there were likely to be sex-specific genetic risk factors, the cohort was stratified by the sex of affected individuals. Results: The quantitative Social Responsiveness Scale genome scan identified two loci on chromosomes 11 and 17, with the highest score on chromosome 11 (z=3.22). In contrast, no linkage signals reached significance in the Autism Diagnostic Interview-Revised qualitative scan. The Social Responsiveness Scale scan with only male affecteds identified the same signals on chromosomes 11 and 17, as well as three other regions on chromosomes 4, 8, and 10. Conclusions: This study demonstrates the utility of the Social Responsiveness Scale quantitative endophenotype to detect autism-related genetic loci using quantitative behavioral information that may more closely relate to underlying genetic factors.

Klin, A., Saulnier, C.A., Sparrow, S.S., Cicchetti, D.V., Volkmar, F.R., & Lord, C. (2007). Social and communication abilities and disabilities in higher functioning individuals with autism spectrum disorders: The vineland and the ADOS. Journal of Autism and Developmental Disorders, 37, 748-759.

Abstract: The relationship between adaptive functioning (ability) and autism symptomatology (disability) remains unclear, especially for higher functioning individuals with autism spectrum disorder (ASD). This study investigates ability and disability using the Vineland and Autism Diagnostic Observation Schedule (ADOS), respectively, in two clinical samples of children with ASD. Participants included 187 males with VIQ > 70. Vineland scores were substantially below VIQ, highlighting the magnitude of adaptive impairments despite cognitive potential. A weak relationship was found between ability and disability. Negative relationships were found between age and Vineland scores and no relationships were found between age and ADOS scores. Positive relationships were found between IQ and Vineland Communication. Results stress the need for longitudinal studies on ability and disability in ASD and emphasize the importance of adaptive skills intervention.

Volkmar, F.R. (2007). Autism and pervasive developmental disorders. Cambridge child and adolescent psychiatry. New York, NY: Cambridge University Press.

Abstract: Featuring contributions from leading authorities in the clinical and social sciences, this thoroughly revised and updated new edition reflects the most recent progress in the understanding of autism and related conditions, and offers an international perspective on the present state of the discipline. Chapters cover current approaches to definition and diagnosis; prevalence and planning for service delivery; cognitive, genetic, and neurobiological features; and pathophysiological mechanisms. There is a new chapter covering communication issues. Interventions reviewed include the pharmacological, behavioral, and educational, and a thoughtful final chapter addresses the nature of the fundamental social disturbance that characterizes autism.

Kasari, C. & Rotheram-Fuller, E. (2007). Peer Relationships of Children with Autism: Challenges and Interventions. Arlignton, VA, US: American Psychiatric Publishing, Inc.

Abstract (Excerpt from Chapter): Positive peer relationships are a critical ingredient for healthy development across the lifespan. Peer relationships provide an invaluable context for refining interpersonal skills and developing a sense of self in relation to others. Out of these peer relationships, friendships often develop, and the value of friendships has been noted in many studies. For example, the presence of even a single friend can buffer an individual from the negative effects of stressful life events, including anxiety and depressive symptoms (Furman, 1989). Friends can also promote the development of social competence, self-esteem, and problem solving (Nelson and Aboud, 1985). Whereas some children may have brief periods of difficulty with peers, others find peer relationships a constant challenge. Children with autism are one group of children who report difficulties with peer relationships across ages and ability levels. Wing (1998) classified children with autism into categories of "passive", "aloof", and "interactive but odd." Those children classified as aloof, for example, appeared to lack even the most basic social motivation. Although there was a stronger social motivation among those children with autism who would be considered interactive but odd, the children still lacked the considerable skill needed to build positive social relationships. Indeed, for children with autism, the social world can bring major challenges, which if not properly addressed can lead to social rejection and victimization. The purpose of this chapter is to describe the significant social challenges children with autism face and to explore the treatment research aimed at improving their social situation.

Geschwind, D. H. & Levitt, P. (2007). Autism spectrum disorder: Developmental disconnection syndromes. Current Opinion in Neurobiology, 17, 103-11.

Abstract: Autism is a common and heterogeneous childhood neurodevelopmental disorder. Analogous to broad syndromes such as mental retardation, autism has many etiologies and should be considered not as a single disorder but, rather, as 'the autisms'. However, recent genetic findings, coupled with emerging anatomical and functional imaging studies, suggest a potential unifying model in which higher-order association areas of the brain that normally connect to the frontal lobe are partially disconnected during development. This concept of developmental disconnection can accommodate the specific neurobehavioral features that are observed in autism, their emergence during development, and the heterogeneity of autism etiology, behaviors and cognition.

Chamberlain, B., Kasari, C., & Rotheram-Fuller, E. (2007). Involvement or Isolation? The Social Networks of Children with Autism in Regular Classrooms. Journal of Autism and Developmental Disorders. 37(2), 230-242.

Abstract: Including children with autism in regular classrooms has become prevalent; yet some evidence suggests such placements could increase the risk of isolation and rejection. In this study, we used social network methods to explore the involvement of children with autism in typical classrooms. Participants were 398 children (196 boys) in regular 2nd through 5th grade classes, including 17 children (14 boys) with high functioning autism or Asperger's syndrome. Children reported on friendship qualities, peer acceptance, loneliness, and classroom social networks. Despite involvement in networks, children with autism experienced lower centrality, acceptance, companionship, and reciprocity: yet they did not report greater loneliness. Further research is needed to help children with autism move from the periphery to more effective engagement with peers.

Williams, S.T., Ontai, L.L., & Mastergeorge, A.M. (2007). Reformulating infant and toddler social competence with peers. Infant Behavior & Development, 30, 353-365.

Abstract: Efforts to identify children at risk for social and academic difficulties at an early age have begun to apply conceptualizations of social competence with peers from childhood to infancy and toddlerhood. These attempts have had limited success, in part because social behaviors studied in later childhood such as negative or aggressive acts may not capture relevant dimensions of social competence with peers during the infant and toddler years. The present study conducted an exploratory factor analysis to begin developing a conceptualization of social competence with peers that is appropriate for use with infants and toddlers, and that captures individual differences capable of predicting later social functioning. Results indicate three dimensions of infant and toddler social competence with peers: peer sociability, active peer refusal, and passive peer avoidance. Negative and aggressive behaviors loaded on each of the three factors rather than emerging as a unique dimension of social competence. Each factor demonstrated both convergent and predictive validity, indicating that early identification of social skills remains a reasonable goal for practitioners and researchers alike. Finally, antecedents within children, families, and out-of-home child care environments helped to explain individual variability in each of these three factors of social competence with peers.

Koegel, R.L. (2007). Social Development in Individuals with High Functioning Autism and Asperger Disorder. Research and Practice for Persons with Severe Disabilities. Vol. 32, No 2. 140-141.

Commentary

Sze, K. M., & Wood, J.J. (2007). Cognitive behavioral treatment of Comorbid Anxiety Disorders and Social Difficulties in Children with High-Functioning Autism: A Case Report. Journal of Contemporary Psychotherapy. 37, 133-143.

Abstract: A substantial proportion of children with high functioning autism (HFA) or Asperger syndrome (AS) have one or more comorbid anxiety disorders. Because anxiety disorders exacerbate the social difficulties and other functional impairments caused by and autism spectrum disorder (ASD), there is a need for efficacious treatments to address the clinical needs of youth with this comorbid presentation. This article describes and evidence-based cognitive behavioral therapy (CBT) treatment manual enhanced to address the unique characteristics and clinical needs of children with ASD. A case study is presented in which CBT was utilized in the successful treatment of an 11 year-old girl with HFA. The intervention was effective in reducing anxiety and improving social and adaptive functioning. These findings suggest that an enhanced CBT approach may be a viable intervention for children with comorbid HFA and anxiety disorders that should be further evaluated.

Training Paraprofessionals to Facilitate Social Interaction Between Children with Autism and Their Typical Peers in a Full Inclusive Educational Setting
Authors: Robert L. Koegel, Suzanne Robinson, & Lynn K. Koegel (dissertation)

Abstract: The purpose of this study was to examine the effectiveness of training paraprofessionals via modeling and in-vivo feedback to facilitate social interactions between children with autism and their typical peers. Specifically, paraprofessionals were taught to incorporate PRT (e.g., child choice, shared control, natural and contingent reinforcers) and peer-mediation strategies (e.g., peer-delivered antecedents and consequences) within the natural routines of the classroom. Results show that (a) the paraprofessionals were successfully trained to elicit social responses, and (b) social verbalizations of the children with autism and their peers immediately increased and maintained at follow-up. The results are discussed in terms of understanding and improving the training model for the purposes of increasing the social interactions of children with autism.