Identifying neuroanatomical and behavioral features for autism spectrum disorder diagnosis in children using machine learning.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that can cause significant social, communication, and behavioral challenges. Diagnosis of ASD is complicated and there is an urgent need to identify ASD-associated biomarkers and features to help automate diagnostics and develop predictive ASD models. The present study adopts a novel evolutionary algorithm, the conjunctive clause evolutionary algorithm (CCEA), to select features most significant for distinguishing individuals with and without ASD, and is able to accommodate datasets having a small number of samples with a large number of feature measurements. The dataset is unique and comprises both behavioral and neuroimaging measurements from a total of 28 children from 7 to 14 years old. Potential biomarker candidates identified include brain volume, area, cortical thickness, and mean curvature in specific regions around the cingulate cortex, frontal cortex, and temporal-parietal junction, as well as behavioral features associated with theory of mind. A separate machine learning classifier (i.e., k-nearest neighbors algorithm) was used to validate the CCEA feature selection and for ASD prediction. Study findings demonstrate how machine learning tools might help move the needle on improving diagnostic and predictive models of ASD.

The Development and Preliminary Psychometric Evaluation of the Theory of Mind Inventory: Self Report-Adult (ToMI:SR-Adult).

This study describes the development and psychometric evaluation of a new self-report measure of social cognition: the Theory of Mind Inventory:Self-report-Adult (ToMI:SR-Adult). Adults with autism (or a suspicion of autism; n = 111) and typically developing adults (n = 109) completed a demographic questionnaire and the ToMI:SR-Adult online. Both quantitative and qualitative self-reports of one's own theory of mind functioning were collected. The ToMI:SR-Adult performed well under all examinations of reliability and validity (internal consistency, accuracy of classification, contrasting-groups). The qualitative data confirmed impressions of validity and revealed that the adults in our sample had high levels of self-insight regarding their own theory of mind. The ToMI:SR-Adult is offered as a promising research and clinical tool for the assessment of social cognition in adults.

Brief Report: Me, Reporting on Myself: Preliminary Evaluation of the Criterion-Related Validity of the Theory of Mind Inventory-2 when Completed by Autistic Young Adults.

There is a need for increased understanding of self-report measures for autistic individuals. In this preliminary study, we examine how a theory of mind self-report relates to other self-report measures for groups of autistic and neurotypical individuals, as well as eye tracking outcomes. Expected patterns of relatedness emerged between self-reports and the eye tracking findings, which lends validity to the theory of mind measure. Self-report measures are critical for autistic individuals to share their own experiences and this is the first step in establishing a theory of mind self-report tool.

Using Story-Based Interventions to Improve Episodic Memory in Autism Spectrum Disorder.

Episodic memory (EM) and scene construction are critical for organizing and understanding personally experienced events and for developing several aspects of social cognition including self-concept, identity, introspection, future thinking, counterfactual reasoning, theory of mind, self-regulation, flexible problem-solving, and socially adaptive behavior. This article challenges the reader to think differently about EM in children with autism spectrum disorder (ASD), as we expand our understanding of autobiographical memory that requires an ability to travel back in time and re-experience an event. The role of EM in cognitive and behavioral functioning for children with and without ASD is described. The value of story-based interventions such as Social Stories and Comic Strip Conversations for supporting EM is discussed with adaptations recommended to ensure a rich personal recall of an event. By focusing on EM and scene construction, there is potential for increasing the potency of story-based interventions for achieving maximum therapeutic impact.

Supporting Children with Autism and Their Families: A Culturally Responsive Family-Driven Interprofessional Process.

This article describes the Coaching in Context (CinC) process, a family-driven, culturally responsive structure that facilitates family identification and achievement of goals. CinC focuses on modification of the demands of an activity with guidance from a health care professional who coaches the family to increase their participation in everyday activities. An interprofessional team is key in this process. Working as a team and communicating effectively across professions supports the health professional who serves as the coach. Effective interprofessional team collaboration is possible; health professions share values for the delivery of the highest quality of care.

Mothers' and Children's Story-Telling: A Study of Dyads with Typically Developing Children and Children with ASD.

The production of specific mental state terms types and functions by caregivers and their TD children and caregivers and their children with ASD were assessed in two contexts: a parent's story-telling task and a child's story-telling task. Caregivers of children with ASD produced less causal talk and proportionally less desire and cognitive talk than did caregivers of TD children. When focusing only on variation in our ASD sample, caregivers' and children's production of different mental state references varied with context and were predicted by different child characteristics (i.e., theory of mind, autism severity, language level). We conclude that caregivers are likely adjusting different aspects of mental state input depending on different aspects of child development although these adjustments may not always be optimal.

Bridging the Gap Between Research and Practice: Implementation Science.

PURPOSE: This article introduces implementation science, which focuses on research methods that promote the systematic application of research findings to practice. METHOD: The narrative defines implementation science and highlights the importance of moving research along the pipeline from basic science to practice as one way to facilitate evidence-based service delivery. This review identifies challenges in developing and testing interventions in order to achieve widespread adoption in practice settings. A framework for conceptualizing implementation research is provided, including an example to illustrate the application of principles in speech-language pathology. Last, the authors reflect on the status of implementation research in the discipline of communication sciences and disorders. CONCLUSIONS: The extant literature highlights the value of implementation science for reducing the gap between research and practice in our discipline. While having unique principles guiding implementation research, many of the challenges and questions are similar to those facing any investigators who are attempting to design valid and reliable studies. This article is intended to invigorate interest in the uniqueness of implementation science among those pursuing both basic and applied research. In this way, it should help ensure the discipline's knowledge base is realized in practice and policy that affects the lives of individuals with communication disorders.

Health-related quality of life in children with high-functioning autism.

The health-related quality of life of school-aged children with high-functioning autism is poorly understood. The objectives of this study were to compare the health-related quality of life of children with high-functioning autism to that of typically developing peers and to compare child-self and parent-proxy reports of health-related quality of life of children. A cross-sectional study of children with high-functioning autism (n = 30) and peers (n = 31) was conducted using the Pediatric Quality of Life Inventory 4.0 Generic Core Scales. Children with high-functioning autism had significantly poorer health-related quality of life than peers whether reported by themselves (p < .001) or their parents (p < .001), although disagreement (intra-class coefficient = -.075) between children and parental scores suggested variance in points of view. This study specifically investigated health-related quality of life in children with high-functioning autism as compared to a sample of peers, from the child's perspective. It strengthens earlier findings that children with high-functioning autism experience poorer health-related quality of life than those without this disorder and points to the importance of clinicians working with families to identify areas in a child's life that promote or hinder their sense of well-being.

Does occupational therapy play a role for communication in children with autism spectrum disorders?

This study investigates occupational therapy for early communication in children with autism spectrum disorders (ASD). The research explored the role of occupational therapists in supporting children with ASD to become better communicators by considering their inter-professional collaboration with speech-language pathologists. Convenience samples of 21 clinical occupational therapists and speech-language pathologists were recruited to participate in semi-structured audio-recorded focus groups, using a qualitative design. Distinct views included a child-centred focus from speech-language pathologists, whereas occupational therapists spoke of the child through societal viewpoints, which later pointed to occupational therapists' proficiency in enabling skill generalization in ASD. An equal partnership was consistently reported between these clinicians, who identified the same objectives, shared strategies, joint treatments, and ongoing collaboration as the four main facilitators to inter-professional collaboration when treating children with ASD. Three unique roles of occupational therapy comprised developing non-verbal and verbal communication pre-requisites, adapting the setting, educating-partnering-advocating for the child, and providing occupation-based intervention. These three themes meshed with the discipline-specific occupational therapy domains represented in the Person-Environment-Occupation framework. When working in inter-professional collaboration, speech-language pathologists and occupational therapists agree that occupational therapy is indispensable to early intervention in enabling communication in ASD.

Using communication to reduce challenging behaviors in individuals with autism spectrum disorders and intellectual disability.

This article describes the relationship between expressive communication impairments and common challenging behaviors in individuals with Autism Spectrum Disorder and Intellectual Disability. The communication challenges of individuals with Autism Spectrum Disorder/Intellectual Disability are described and several evidence-based intervention strategies are proposed to support communication so as to decrease challenging behaviors. Recommendations for practice are offered.

Children's assessment of participation and enjoyment/preference for activities of children: psychometric properties in a population with high-functioning autism.

The psychometric properties of assessments must be established for specific populations. The psychometric properties of the Children's Assessment of Participation and Enjoyment/Preference for Activities of Children have been studied only in a sample of children with physical disability. We conducted a study to determine the appropriateness of drawing inferences from this assessment for children with high-functioning autism (HFA). The content validity and test-retest reliability (r > .7) were both found to be adequate for this population. Parents' agreement with most of their children's self-ratings on this assessment provided an estimate of interrater reliability. We also ascertained the feasibility of gathering recreational participation information from children with HFA and found that adaptations to facilitate the self-completion of the tool should be made available. The study findings support the use of this tool to assess recreational participation among children with HFA.

Recreational participation of children with High Functioning Autism.

The recreation of children with High Functioning Autism (HFA) is not well understood. The objective of this cross-sectional study was to compare the recreational engagement of children with HFA and their typically developing peers. Children with HFA (n = 30) and peers (n = 31) were similar on key characteristics that may impact recreation except those related to the HFA attributes. Children with HFA differed from peers in terms of diversity (p = .002), social aspects (p = .006) and locations (p < .001) of recreation. The two groups were not statistically different in personal intensity (p = .684), enjoyment (p = .239) or preferences (p = .788) of recreation. A recreational profile was developed to benefit parents and clinicians in supporting the recreation of these children.

The social validity of Social Stories™ for supporting the behavioural and communicative functioning of children with autism spectrum disorder.

This study examines the social validity of a family-centred collaborative approach to developing Social Stories™ to support the behavioural and communicative functioning of children with autism spectrum disorder (ASD). Twenty children with Pervasive Developmental Disorder (PDD)/Autism, PDD-Not Otherwise Specified, or Asperger's Disorder (aged 4-12 years) participated in a multiple baseline design across behaviours with a 6-week follow-up. The effects of behaviour stories (to reduce problem behaviours) and communication stories (to facilitate communication) as assessed by parental subjective perceptions of child functioning were evaluated and compared. Using daily parental ratings, behaviour stories were deemed effective for 11 of 17 stories (64.7%), whereas communication stories were deemed effective for 10 of 19 stories (52.6%), with great variability in effect size for both. Results also indicated variability in performance across specific story targets, although parents' perceived effects of Social Stories™ were not linked to any known child characteristics. This study argues that intervention using Social Stories™ to address behavioural and communicative functioning can yield socially valid outcomes across a range of child characteristics and intervention targets. Implications for clinical practice and how present methodological limitations can be addressed in future research are considered.

Language and communication in autism: an integrated view.

Children with autism spectrum disorders can have varying degrees of difficulty acquiring spoken and written language, but symptoms of communication impairment associated with social impairment are uniformly present, distinguishing autism spectrum disorders from other neurodevelopmental disabilities. Early diagnosis and early intervention involving parents can improve prognosis. Red flags for social communication problems can be observed early. This article summarizes findings from the National Standards Project of the National Autism Center, which identified 11 types of treatment, 8 of which address communication. Both contemporary behavioral approaches and naturalistic developmental approaches are included in this set.

Psychometric evaluation of the Theory of Mind Inventory (ToMI): a study of typically developing children and children with autism spectrum disorder.

Two studies examined the psychometric properties of the Theory of Mind Inventory (ToMI). In Study One, 135 caregivers completed the ToMI for children (ages 3 through 17) with autism spectrum disorder (ASD). Findings revealed excellent test-retest reliability and internal consistency. Principle Components Analysis revealed three subscales related to the complexity of ToM understanding. In Study Two, data were collected for 124 typically developing children (2 through 12 years). Findings again revealed excellent test-retest and internal consistency. The ToMI distinguished groups by age (younger vs. older children) and developmental status (typically developing vs. ASD), and predicted child performance on a ToM task battery. Utility of the ToMI, study limitations and directions for future research are discussed.

Organizational Structure Reduces Processing Load in the Prefrontal Cortex During Discourse Processing of Written Text: Implications for High-Level Reading Issues After TBI.

Adults with traumatic brain injury (TBI) can demonstrate marked difficulty producing discourse during story retell and story generation tasks. Changes in discourse production have been detailed in terms of fewer content units and infrequent use of story grammar elements essential for organization. One implication is that poor use of story grammar elements during discourse production may signal reduced ability to utilize these elements in other communication realms (e.g., reading comprehension). The neural architecture that supports discourse organization, primarily the medial prefrontal cortex, is particularly susceptible to damage secondary to acquired brain injury. In this event related functional magnetic resonance imaging (fMRI) study, we describe cortical activation patterns of unimpaired readers as they are presented with discourse that is varied in terms of structural organization. The results suggest reading discourse with less structure is associated with increased cortical activity (e.g., higher processing demands) as compared to reading discourse with more traditional structural cues (e.g., story grammar). We discuss cortical areas implicated and potential implications for supporting discourse communication in persons following TBI.

Perceptions of communicative competence after traumatic brain injury: implications for ecologically-driven intervention targets.

The present study investigated the relationship between non-verbal behaviours and perceptions of the communication abilities of an individual with anomia secondary to traumatic brain injury (TBI). Thirty-four university students studying Communication Sciences and Disorders were randomly assigned to watch or listen to six short clips of an individual with TBI engaged in conversation. Participants rated the individual on communication parameters from a modified version of the Pragmatic Protocol and four other dependent measures of communicative competence. A significant positive correlation was identified between perceptions of gestures and ratings of overall communicative competence, and between perceptions of hand and arm movements and ratings of overall communicative competence. Participant raters who viewed the individual's movements as inappropriate also rated her overall communication abilities less favourably. This finding highlights individuality in perception of communication competence and the importance of assessing communication partners' perceptions in a client's environment to determine socially relevant treatment goals.