Assessing Spoken Language Development in Children with Autism Spectrum Disorder

In this chapter, the author discusses assessment of language development in children with autism spectrum disorder (ASD). According to evidence-based practice, it is vital to evaluate all aspects of communication in order to determine a specific diagnosis or to direct intervention. While this is true for any child suspected of having a language impairment, it is especially true for children also diagnosed with ASD. Although there are a number of accepted standardized measures to evaluate receptive and expressive language and speech articulation, evaluation of pragmatic abilities is often more complicated. With the incidence of children and young adults with ASD, and social (pragmatic) communication disorders, on the rise in all settings, it is vital to thoughtfully consider best practice related to the thorough assessment of communication abilities for those with ASD, from our youngest learners to adolescents.

Effects of A Gamified, Behavior Change Techniques-Based Mobile Application on Increasing Physical Activity and Reducing Anxiety in Adults with Autism Spectrum Disorder: A Preliminary Study (Preprint)

BACKGROUND Physical activity (PA) has an impact on physical and mental health in neurotypical populations, and addressing these variables may improve the prevalent burden of anxiety in adults with autism spectrum disorder (ASD). Gamified mobile applications using behavior change techniques (BCTs) present a promising way to increase PA and reduce sedentary time, thus reducing anxiety in adults with ASD. OBJECTIVE This study aimed to compare the efficacy of a gamified and BCTs-based mobile application, PuzzleWalk vs. a commercially available application Google Fit (Google LLC, CA) on increasing PA and reducing sedentary time as an adjunct anxiety treatment for this population. METHODS Twenty-four adults with ASD were assigned to either PuzzleWalk or Google Fit group for five weeks, using a covariate adaptive randomization design. Physical activity and anxiety were assessed over 7 days at three different data collection periods (i.e., baseline, intervention start, intervention end) using triaxial accelerometers and the Beck Anxiety Inventory. Group differences in outcome variables were assessed by repeated measures ANCOVA adjusting for age, sex, and BMI. RESULTS Findings indicated that PuzzleWalk group spent a significantly larger amount of time for application use compared to Google Fit group (F 2, 38 = 5.07, p = 0.011, partial η2 = 0.21) while anxiety was unfavorably associated with increases in light PA and decreases in sedentary time after intervention (all p < 0.05). CONCLUSIONS Additional research is needed to clarify the determinants of physical and mental health as well as their interrelationship in adults with ASD. In addition, more research is needed to identify the factors that facilitate the use and adoption of mobile health technology in these individuals. The small, albeit insignificant, changes in PA and/or anxiety may be of clinical significance to adults with ASD. CLINICALTRIAL N/A

Psychoeducational Group Intervention for Adults with Autism Spectrum Disorder and Their Close Relations (Prisma) – An Open Feasibility Study

Background: Autism spectrum disorder (ASD) in adulthood is associated with severe impairments in functioning and poor health, while ASD is also affecting close relations. Accessible first-line interventions addressing the complex clinical needs and care coordination are lacking. Methods: This study investigated the feasibility and preliminary effects of a new psychoeducational group intervention (Prisma) developed for intellectually able adults with ASD and their close relations in an outpatient setting. Results: Completion rate was 77% (n=71) of the 92 adults with ASD and 73% (n=69) of the 94 close relations. Participants considered Prisma to be an acceptable intervention and their feedback will be used to further improve the Prisma for an upcoming RCT. Preliminary analyses of effects showed promising results with an increase in knowledge of ASD. Conclusions: Overall, results indicate that the Prisma is a feasible first-line intervention in a stepped-care process in outpatient services. Trial registration: Clinicaltrials.org (NCT04460976).

Stronger Associations Between Sleep and Mental Health in Adults with Autism: A UK Biobank Study

This study examined sleep and its cognitive and affective correlates in adults with and without autism spectrum disorder (ASD), utilizing UK Biobank data. There were no group differences in subjective sleep duration [n = 220 ASD; n = 2200 general population (GP)]. Accelerometer measures of sleep duration or nighttime activity did not differ by group, but sleep efficiency was marginally lower in ASD (n = 83 ASD; n = 824 GP). Sleep efficiency was associated with wellbeing and mental health, and pathways between accelerometer sleep measures and wellbeing and mental health were significantly stronger for adults with ASD (who also reported substantially poorer wellbeing and > 5 × likelihood of experiencing mental distress). These findings highlight the need to monitor sleep to maintain good mental health in adult ASD.

Assessment of Anxiety in Cognitive-Behavior Therapy in Young University Students with Autism Spectrum Disorders: A Review

The university provides academic support to disabled students, however, few institutions provide academic, extra-academic or preventive support to students with Autism Spectrum Disorders High-Functioning (ASD-HF). Among the most commonly requested needs is support for coping with anxiety arising from academic and social activity itself. When planning an intervention program, it is necessary to screen those who have problems and are likely to benefit from such a program. In this article we propose a systematic search for measures of anxiety for young people and adults with ASD-HF. Of a total of 683 documents, only 7 met the selection criteria. Of these, a total of 35 tools were detected, of which only 11 mediated anxiety. Screening should be carried out for all students, so that we can detect the “risk” of anxiety disturbance in all cases and, in particular, in students with ASD-HF. However, the instruments eligible for assessing intervention outcomes should be agreed upon in order to be able to compare results from different trials.

Relationship between sensory characteristics and cortical thickness/volume in autism spectrum disorders

Individuals with autism spectrum disorders (ASDs) exhibit atypical sensory characteristics, impaired social skills, deficits in verbal and nonverbal communication, and restricted and repetitive behaviors. The relationship between sensory characteristics and brain morphological changes in ASD remains unclear. In this study, we investigated the association between brain morphological changes and sensory characteristics in individuals with ASD using brain image analysis and a sensory profile test. Forty-three adults with ASD and 84 adults with typical development underwent brain image analysis using FreeSurfer. The brain cortex was divided into 64 regions, and the cortical thickness and volume of the limbic system were calculated. The sensory characteristics of the participants were evaluated using the Adolescent/Adult Sensory Profile (AASP). Correlation analysis was performed for cortical thickness, limbic area volume, and AASP scores. In the ASD group, there was a significant positive correlation between visual sensory sensitivity scores and the right lingual cortical thickness (r = 0.500). There were also significant negative correlations between visual sensation avoiding scores and the right lateral orbitofrontal cortical thickness (r = −0.513), taste/smell sensation avoiding scores and the right hippocampal volume (r = −0.510), and taste/smell sensation avoiding scores and the left hippocampal volume (r = −0.540). The study identified associations among the lingual cortical thickness, lateral orbitofrontal cortical thickness, and hippocampal volume and sensory characteristics. These findings suggest that brain morphological changes may trigger sensory symptoms in adults with ASD.

Resilience in Family Caregivers of Adults With Autism Spectrum Disorder: An Integrative Review of the Literature

Care of adults with Autism Spectrum Disorder (ASD) is a public health priority and costs are projected to be 549 billion US dollars by 2025. Middle and older adult FCGs of adults with ASD often provide lifelong care, experience chronic stress, consequently, are at risk of poor mental health and QOL. An integrative review examined factors associated with resilience in studies of middle and older adult FCGs of adults with ASD. A comprehensive literature search found 10 reports of 8 studies published in peer-reviewed scholarly journals before October 13, 2020. Studies and/or reports of factors associated with resilience in middle and older adult FCGs of adults with ASD were examined using PRISMA, and quality checklists. Some 340 articles met search criteria, 14 were fully reviewed, and 10 were included. Findings suggest FCGs of adults with ASD show capacity for resilience consistent with research on FCGs of children with ASD significant chronic stress. A broad range of resilience factors were studied, and resilience was associated with positive social support, higher QOL, self-efficacy, and problem and meaning-focused coping styles. There is a dearth of research on middle and older adult FCGs of adults with ASD. Increased reporting of social determinants of health and participation of underrepresented groups is needed. Future research must address FGC heterogeneity and specify theoretically grounded conceptual and operational definitions of resilience. Identifying resilience factors is necessary for intervention studies to enhance resilience.

Quality of Primary Care for the Adult Population With Autism Spectrum Disorder: Protocol for a Scoping Review

Background A strong primary care system is vital to overall health. Research on the primary care of people with autism spectrum disorder (ASD) has mostly focused on children. A synthesis of the existing literature related to the quality of primary care for the adult population with ASD would elucidate what is known about the topic as well as inform future research and clinical practice. Objective The purpose of our scoping review is to describe what is known about the quality of primary care for adults with ASD and identify knowledge gaps. Methods Prior to beginning the literature search, we reviewed literature related to defining both primary care and primary care quality to establish the context and concept of the research question. The search strategy was designed and executed by a research librarian. The MEDLINE, CINAHL, EMBASE, PsycINFO, and ProQuest Dissertations and Theses databases were searched for relevant literature. Grey literature will include relevant reports from government websites and associations with a focus on ASD. Two members of the research team will independently screen the academic and grey literature. Quantitative, qualitative, or mixed methods study designs involving the quality of primary care services or patient-centered care for adults with ASD are eligible for inclusion in our scoping review. Studies that make it past the full-text review will undergo data extraction and quality appraisal by 2 independent reviewers. The data extraction results will be presented in a tabular format to clearly present what is known about the quality of primary care for adults with ASD; this table will be accompanied by a narrative synthesis. Literature selected for extraction will be coded for themes, which will form the basis of a thematic synthesis. The scoping review will follow the guidance proposed by the Joanna Briggs Institute. Results The search of electronic databases was conducted in October 2020, and it returned 2820 results. This research is still in progress. The results from our scoping review are expected to be available by fall 2021. Conclusions The results from our scoping review will be useful for guiding future research on the quality of primary care for adults with ASD. International Registered Report Identifier (IRRID) PRR1-10.2196/28196

Effects of Dog-Assisted Therapy on the Physical Function and Communication Skills of Adults with Autism: A Study Protocol for a Controlled Study

Background and Objectives: Despite the scientific evidence of the positive effects of animal-assisted therapy (AAT) in adults with autism spectrum disorder (ASD), it is not still considered an evidence-based practice for this population. The proposed study will aim to evaluate the effects of a dog-assisted therapy program on gait, posture, and communication skills. Materials and Methods: A total of 24 adults with ASD will participate in this non-randomized controlled trial. The experimental group will involve 12 participants who will receive AAT for 10 weeks, at two sessions per week. The focus of these sessions will be conducting different activities and physical exercises, facilitated by dogs. The control group will receive treatment as usual. The outcome measures will be the ability to walk and climbing stairs, balance, risk of falls and communication skills. Conclusions: The role of dogs as facilitators of the movement may lead to relevant benefits in the gait, posture and communication skills of adults with ASD, improving their ability to perform activities of daily living.

Using Augmented Reality and Modified Schema-Based Instruction to Teach Problem Solving to Students With Autism

Young adults with autism spectrum disorder (ASD) need both academic and social skills required to apply acquired knowledge and skills in real-world settings. This study evaluated the effects of a multicomponent intervention incorporating both Modified Schema-Based Instruction (MSBI) and video-based instruction delivered via augmented reality (AR) to teach the social and mathematical problem-solving skills needed to execute personal finance tasks in the community. Participants included four 21-year-old young adults with ASD enrolled in a public school transition program located on the campus of a technical college. Findings of the single-case multiple probe across participant design support a functional relation between the multicomponent treatment package and the social and mathematical problem-solving skills of the young adults with ASD. Furthermore, participants were also able to self-correct errors after watching AR-triggered model videos. Generalization to a novel setting was tested. Results, implications, and suggestions for future research are discussed