Personalized interventions help autistic children

Personalized interventions help improve communication in children with autism.

A UCLA-led study has found that the communication skills of minimally verbal children with autism can be greatly improved through personalized interventions that are combined with the use of computer tablets.

The three-year study examined different approaches to improving communication abilities among children with autism spectrum disorder and minimal verbal skills. Approximately 30 percent of children with ASD overall remain minimally verbal even after years of intervention.

UCLA professor Connie Kasari, the paper's senior author, worked with researchers at Vanderbilt University and the Kennedy Krieger Institute. They found that children's language skills greatly improved when spoken- and social-communication therapy was tailored based on their individual progress and delivered using computer tablets.

The trial involved 61 children with ASD, ages 5 to 8. For six months, each child received communication therapy focusing on social communication gestures, such as pointing, as well as play skills and spoken language.

Half of the children were randomly selected to also use speech-generating applications on computer tablets for at least half of the time during their sessions. The tablets were programmed with audio clips of words the children were learning about during their therapy sessions and images of the corresponding objects. Working with a therapist, the child could tap a picture of a block, for example, and the tablet would play audio of the word "block." The researchers found that children who had access to the tablets during therapy were more likely to use language spontaneously and socially than the children who received the communication intervention alone -- and that incorporating the tablets at the beginning of the treatment was more effective than introducing it later in the therapy.

"It was remarkable how well the tablet worked in providing access to communication for these children," said Kasari, professor of human development and psychology in the UCLA Graduate School of Education and professor of psychiatry at UCLA's Semel Institute for Neuroscience and Human Behavior. "Children who received the behavioral intervention along with the tablet to support their communication attempts made much faster progress in learning to communicate, and especially in using spoken language."

Researchers also conducted follow-up visits with the children three months after the initial study period and found that their improvement had been maintained during that time. The study was the first ASD research to use a sequential multiple assignment randomized trial, or SMART, design. The approach, which enables researchers to tailor interventions according to how each child in the study responds, was designed by Daniel Almirall and Susan Murphy, biostatisticians at the University of Michigan who were members of the research team. It also was the first randomized, controlled trial on this underserved population of children to use a computer tablet combined with an effective behavioral intervention.

Other study authors were Rebecca Landa of Kennedy Krieger and Johns Hopkins University, and Ann Kaiser of Vanderbilt. The study was funded by a High Risk High Impact grant from the Autism Speaks Foundation.

The findings were published in the June issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

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iPod and iPad apps help children with autism communicate

A study shows that apps on the iPod and iPad tremendously help children with autism communicate.

Already embraced by millions for their portability and ease-of-use, new Canadian research suggests that smart technologies such as the iPad and iPod may also serve as therapeutic tools for a very specific group: children with autism.

Rhonda McEwen, an assistant professor with the Institute of Communication Culture and Information Technology at the University of Toronto Mississauga in Ontario, and her team found that such devices can go a considerable distance in terms of helping these kids significantly improve their ability to express themselves and engage with others.

"I was surprised by some of the findings, and so were the teachers who participated in the research," McEwen said. "Using the touch devices, the study participants demonstrated knowledge gathered throughout their education that could not be elicited via traditional assessment means that rely on verbal communication. We can surmise that the receptive communication skills are more advanced than first thought," she said.

"Further, the role that the devices play in brokering peer-to-peer social interaction was unanticipated," McEwen added. "Finally, the progress in expressive communication among study participants exceeded expectations."

McEwen and her team were scheduled to discuss their findings Friday at the American Psychological Association annual convention in Honolulu.

Autism experts hailed the effort to unlock this technology's potential.

"We have heard from many parents about how much their children enjoy mobile devices like the iPad, and how it is helping with learning and communication," noted Andy Shih, senior vice president of scientific affairs at Autism Speaks in New York City. "[So] we need more research in this rapidly developing field to understand how to maximize the benefits these devices can deliver to individuals and families living with autism."

McEwen and her colleagues set out to assess how off-the-shelf consumer technology might be harnessed to boost communication and social skills among children with autism.

In 2010, the Canadian team launched a case study in a downtown Toronto public elementary school.

Investigators initially studied 12 children in six specific classrooms, all of whom had been diagnosed as having autism spectrum disorder and most of whom were classified as "nonverbal."

Two hand-held touch technology devices currently sold by the computer manufacturer Apple were introduced into the classroom setting: the phone-sized iPod Touch and the tablet-sized iPad.

Costing roughly between $200 to $600 a piece, the mobile devices incorporate brightly illuminated screens that display a multitude of applications that range in price from free to less than $10 each. In turn, users can manipulate and respond to visual and audio content by means of simple finger gestures, such as touching or swiping.

Over a six-month trial, the students became accustomed to using the two devices.

The result: nine of the students showed a statistical improvement ranging from mild to significant in their overall communication skills. For example, when one boy took a visual identification quiz on an iPad, his teacher realized the child knew far more than the teacher had thought.

This meant that using the devices helped to boost motivation among 75 percent of the children, while also increasing their attention span and ability to interact socially. The researchers now have detailed data on 36 students.

But why and how?

According to Brenda Smith Myles, an autism consultant for the Ohio Center for Autism and Low Incidence in Columbus, Ohio, this kind of readily accessible technology works by "evening the playing field for individuals with autism."

"Many are nonverbal or low-verbal, and even those who are highly verbal often have a big degree of anxiety when interacting with someone," she noted. "They tend to like structure and predictability, and are largely visual learners. And these platforms and these apps address all three of those issues in a very nonstigmatizing and motivating way. They allow our folks to reach out in a way that is comfortable, so they can really communicate what they know," Myles explained.

"Of course, in addition, the technology is also cool, and automatically draws interest from other peers," said Myles, who was formally chief of programs for the Autism Society of America. "But certainly not all apps will work for all children, or will work in the same way. You do have to match the app to the learner, and each learner will be different. But generally speaking, these devices enhance skills and interest in communication. And they're easy to learn, easy to use and, best of all, low-cost."

The importance of the latter point is not lost on Dr. Jeffrey Brosco, associate director of the Mailman Center for Child Development at the University of Miami Miller School of Medicine.

"Practically speaking, the older tech was extraordinarily expensive and cumbersome," he noted. "So this is a real advance, because you're not comparing the cost of an iPad and apps with books and other low-tech tools. You're really comparing these new devices with the old world of technology, in which machines that produce language cost thousands of dollars."

But what should parents make of this finding?

"Certainly, many families worry that if they rely too much on a communication device it will interfere with their autistic child's ability to talk," acknowledged Brosco. "But we find that it's actually a bridge to talking, because it gives these children a different mode with which to communicate. It helps them use language in a functional capacity, by giving them a way to get there faster and more efficiently. So, in general, I'd say this is a wonderful boon to families of autistic children."

The data and conclusions of research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.

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Study: Autistic children with low IQ could predict epilepsy

A recent study shows that autistic children who also have a low IQ are at a greater risk of developing epilepsy.

At first glance, IQ and epilepsy may seem to have no clinical relation whatsoever. Unlike the association between IQ and autism(ASD), which appears to manifest through cognitive, communication, and social impairments, the association between IQ and epilepsy is less evident. But according the results of a recent study, low IQ in children with ASD puts them at increased risk for epilepsy.

Emma W. Viscidi of the Department of Epidemiology of the Division of Biology and Medicine at Brown University in Rhode Island conducted a study comparing the IQs of children with autism to see if it could provide insight into which children were at risk for epilepsy. Using a sample of 5,815 children with ASD, Viscidi found that 12.5% had epilepsy. When she looked at adolescents between the ages of 13 and 17, the rate increased to 26%.

The study revealed that the children with epilepsy had lower IQs than those without and that language impairment, functional regression, and severity of symptoms were all common in those with comorbid ASD and epilepsy. “The association between epilepsy and the majority of these characteristics appears to be driven by the lower IQ of participants with epilepsy,” said Viscidi. In fact, the risk of epilepsy decreased by nearly 50% with every one point increase in IQ.

Interestingly, Viscidi did not find gender differences in epilepsy rates. Aside from IQ, the other strongest predictor of epilepsy was older age, with children over the age of 10 having 2.5-fold increased risk of developing epilepsy. Viscidi is unsure if this is due to the longer duration of ASD, and if the chronicity increases the vulnerability for epilepsy. Or, as has been suggested by other research, the neurological deficits responsible for ASD are also responsible for epilepsy, predisposing ASD children for epilepsy. Regardless of the exact reason for the comorbidity, this research clearly shows that IQ could be an indicator of epilepsy and that clinicians treating children with ASD should be aware of this association early on.

Reference:
Viscidi, E.W., Triche, E.W., Pescosolido, M.F., McLean, R.L., Joseph, R.M., et al. (2013). Clinical characteristics of children with autism spectrum disorder and co-occurring epilepsy. PLoS ONE 8(7): e67797. doi:10.1371/journal.pone.0067797

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Non-Verbal Baby Communication Gives Clues to Autism

A new study uses non-verbal communication of infants and young children to show the risk of autism.

Approximately 19 percent of children with a sibling diagnosed with Autism Spectrum Disorder (ASD) will develop Autism due to shared genetic and environmental vulnerabilities, according to previous studies. For that reason, University of Miami (UM) psychologists are developing ways to predict the occurrence of ASD in high-risk children, early in life, in hopes that early intervention will lead to better outcomes in the future. Their findings are published in the journalInfancy.

The study is one of the first to show that measures of non-verbal communication in children, as young as eight months of age, predict autism symptoms that become evident by the third year of life. The results suggest that identifying children, who are having difficulties early enough, can enhance the effects of interventions.

"For children at risk of developing an ASD, specific communication-oriented interventions during the first years of life can lessen the severity of autism's impact," says Daniel Messinger, professor of Psychology in the College of Arts and Sciences at UM and principal investigator of the study. Before children learn to talk, they communicate non-verbally by using eye contact and gestures. These abilities are called referential communication and are in development by eight months of age. However, "impairments in non-verbal referential communication are characteristic of older children with ASD," says Caroline Grantz a doctoral candidate in the Department of Psychology at UM and co-author of the paper.

In the study, a team of researchers tested two groups of children. One group was at high-risk for ASD and the second group was at low-risk. The evaluations took place during 15 to 20 minutes sessions, at 8, 10, 12, 15 and 18 months of life. The team measured the development of three forms of non-verbal communication:

• Initiating Joint Attention (IJA) -- the way an infant shows interest in an object or event to a partner. For example, making eye contact and pointing to show a toy.
• Initiating Behavioral Requests (IBR)-the manner in which an infant requests help from a partner, by making eye contact to request a toy, reaching toward, pointing to, or giving the examiner a desired toy.
• Responding to Joint Attention (RJA)-the way infants respond and follow the behavior of a partner. For example, when the examiner points to something and the child follows the experimenter's gaze to look at that an object. The results show that lower levels of IJA and IBR growth between eight and 18 months predicted the severity of ASD symptoms for children that had a sibling with Autism.

"Overall, infants with the lowest rates of IJA at eight months showed lower social engagement with an examiner at 30 months of age," says Lisa Ibañez, research scientist at the University of Washington Autism Center and first author of the paper. Ibañez conducted the study as part of her dissertation research in the Department of Psychology at UM.

These results are important enough that the research team is following up the study with collaborator Wendy Stone, Professor of Psychology and Director of the University of Washington Autism Center.

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Babies Understand Thought Process of Others at 10 Months Old, Research Suggests

New research from the University of Missouri indicates that at 10 months, babies start to understand another person's thought process, providing new insights on how humans acquire knowledge and how communication develops.

"Understanding other people is a key factor in successful communication, and humans start to understand this at a very young age," said Yuyan Luo, associate professor of developmental psychology in the MU College of Arts and Science. "Our study indicates that infants, even before they can verbally communicate, can understand the thought processes of other people -- even if the thoughts diverge from what the infants know as truth, a term psychologists call false belief."

During the study, infants were monitored during different trials of a common psychological test in which an actor indicated preference for certain objects. Researchers timed the infant's gaze, which is an indication of infant knowledge. The infants watched longer when the actor's preferences changed. This led the researchers to believe that infants understood how the actor interacted with the objects.

"When the actor did not witness the removal or addition of the preferred object, the infants seemed to use that information to interpret the person's actions," Luo said. "The infants appear to recognize that the actor's behavior comes from what the actor could see or could not see and hence what the actor thinks, and this finding is consistent with similar false belief studies that involve older children."

Luo said her study is one of the first to explore the false belief understanding in the first year of life; evidence from other studies indicates that infant understanding could be present at an earlier age. As the research moves forward, Luo expects to find more understanding of how humans learn to communicate

Read more: http://www.sciencedaily.com/releases/2011/11/111101130204