I tawt i taw a puddy tat: Gestures in canary row narrations by high-functioning youth with autism spectrum disorder.

This study examined whether individuals with autism spectrum disorder (ASD) produce co-speech gestures similarly to typically developing (TD) peers. Participants were 20 youth ages 10-18 years with high-functioning ASD and 21 TD controls matched on age, gender, verbal IQ, and handedness. Gestures were elicited using a classic narrative-retelling task, in which participants watched a Tweety and Sylvester cartoon and retold the cartoon to a confederate. Analyses compared gesture rate, type, and viewpoint (character, observer, dual) across groups. Communicative utility of gestures was measured via naïve coder ratings of whether a movement was a gesture, and the clarity of a gesture's meaning. The ASD group produced shorter narratives and fewer total gestures than the TD group. Accounting for narrative length, the ASD group produced fewer gestures per clause than the TD group; however, proportions of gesture types (iconic, deictic, beat, metaphoric, emblems) did not differ. Most notably, the ASD group's gestures were rated as less clearly gestures in terms of timing and well formedness, with lower certainty ratings for gesture meaning. Gesture clarity and gesture meaning scores were related to diagnostic measures of gesture competence in ASD. Findings suggest that although fluent children and adolescents with ASD use the same type of gestures as controls, their gestures are more difficult to understand, which has significant implications for their communicative abilities more broadly. Autism Res 2017, 10: 1353-1363. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Atomoxetine and Parent Training for Children With Autism and Attention-Deficit/Hyperactivity Disorder: A 24-Week Extension Study.

OBJECTIVE: The authors previously reported on a 2-by-2 randomized clinical trial of individual and combined treatment with atomoxetine (ATX) and parent training (PT) for attention-deficit/hyperactivity disorder (ADHD) symptoms and behavioral noncompliance in 128 5- to 14-year-old children with autism spectrum disorder. In the present report, they describe a 24-week extension of treatment responders and nonresponders. METHOD: One-hundred seventeen participants from the acute trial (91%) entered the extension; 84 of these were in 2 subgroups: "treatment responders" (n = 43) from all 4 groups in the acute trial, seen monthly for 24 weeks, and "placebo nonresponders" (n = 41), treated with open-label ATX for 10 weeks. Participants originally assigned to PT continued PT during the extension; the remainder served as controls. Primary outcome measurements were the parent-rated Swanson, Nolan and Pelham ADHD scale and the Home Situations Questionnaire. RESULTS: Sixty percent (26 of 43) of treatment responders in the acute trial, including 68% of responders originally assigned to ATX, still met the response criteria at the end of the extension. The response rate of placebo nonresponders treated with 10-week open-label ATX was 37% (15 of 41), similar to the acute trial. Children receiving open-label ATX + PT were significantly more likely to be ADHD responders (53% versus 23%) and noncompliance responders (58% versus 14%) than those receiving open-label ATX alone. CONCLUSION: Most ATX responders maintained their responses during the extension. PT combined with ATX in the open-label trial appeared to improve ADHD and noncompliance outcomes more than ATX alone. Clinical trial registration information-Atomoxetine, Placebo and Parent Management Training in Autism (Strattera); http://clinicaltrials.gov; NCT00844753.

Atomoxetine, Parent Training, and Their Combination in Children With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: Impairments associated with attention-deficit/hyperactivity disorder (ADHD) and noncompliance are prevalent in children with autism spectrum disorder (ASD). However, ADHD response to stimulants is well below rates in typically developing children, with frequent side effects. Group studies of treatments for noncompliance are rare in ASD. We examined individual and combined-effectiveness of atomoxetine (ATX) and parent training (PT) for ADHD symptoms and noncompliance. METHOD: In a 3-site, 10-week, double-blind, 2 × 2 trial of ATX and PT, 128 children (ages 5-14 years) with ASD and ADHD symptoms were randomized to ATX, ATX+PT, placebo+PT, or placebo. ATX was adjusted to optimal dose (capped at 1.8 mg/kg/day) over 6 weeks and maintained for 4 additional weeks. Nine PT sessions were provided. Primary outcome measures were the parent-rated DSM ADHD symptoms on the Swanson, Nolan and Pelham (SNAP) scale and Home Situations Questionnaire (HSQ). RESULTS: On the SNAP, ATX, ATX+PT and placebo+PT were each superior to placebo (effect sizes 0.57-0.98; p values of .0005, .0004, and .025, respectively). For noncompliance, ATX and ATX+PT were superior to placebo (effect sizes 0.47-0.64; p values .03 and .0028, respectively). ATX was associated with decreased appetite but was otherwise well tolerated. CONCLUSION: Both ATX and PT resulted in significant improvement on ADHD symptoms, whereas ATX (both alone and combined with PT) was associated with significant decreases on measures of noncompliance. ATX appears to have a better side effects profile than psychostimulants in the population with ASD. CLINICAL TRIAL REGISTRATION INFORMATION: Atomoxetine, Placebo and Parent Management Training in Autism; http://clinicaltrials.gov/; NCT00844753.

A review of atomoxetine effects in young people with developmental disabilities.

UNLABELLED: This review summarizes the pharmacokinetic characteristics, pharmacodynamic properties, common side effects, and clinical advantages and disadvantages associated with atomoxetine (ATX) treatment in typically developing children and adults with ADHD. Then the clinical research to date in developmental disabilities (DD), including autism spectrum disorders (ASD), is summarized and reviewed. Of the 11 relevant reports available, only two were placebo-controlled randomized clinical trials, and both focused on a single DD population (ASD). All trials but one indicated clinical improvement in ADHD symptoms with ATX, although it was difficult to judge the magnitude and validity of reported improvement in the absence of placebo controls. Effects of ATX on co-occurring behavioral and cognitive symptoms were much less consistent. Appetite decrease, nausea, and irritability were the most common adverse events reported among children with DD; clinicians should be aware that, as with stimulants, irritability appears to occur much more commonly in persons with DD than in typically developing individuals. Splitting the dose initially, starting below the recommended starting dose, and titrating slowly may prevent or ameliorate side effects. Patience is needed for the slow build-up of benefit. CONCLUSIONS: ATX holds promise for managing ADHD symptoms in DD, but properly controlled, randomized clinical trials of atomoxetine in intellectual disability and ASD are sorely needed. Clinicians and researchers should be vigilant for the emergence of irritability with ATX treatment. Effects of ATX on cognition in DD are virtually unstudied.

Speech-and-gesture integration in high functioning autism.

This study examined iconic gesture comprehension in autism, with the goal of assessing whether cross-modal processing difficulties impede speech-and-gesture integration. Participants were 19 adolescents with high functioning autism (HFA) and 20 typical controls matched on age, gender, verbal IQ, and socio-economic status (SES). Gesture comprehension was assessed via quantitative analyses of visual fixations during a video-based task, using the visual world paradigm. Participants' eye movements were recorded while they watched videos of a person describing one of four shapes shown on a computer screen, using speech-and-gesture or speech-only descriptions. Participants clicked on the shape that the speaker described. Since gesture naturally precedes speech, earlier visual fixations to the target shape during speech-and-gesture compared to speech-only trials, would suggest immediate integration of auditory and visual information. Analyses of eye movements supported this pattern in control participants but not in individuals with autism: iconic gestures facilitated comprehension in typical individuals, while it hindered comprehension in those with autism. Cross-modal processing difficulties in autism were not accounted for by impaired unimodal speech or gesture processing. The results have important implications for the treatment of children and adults with this disorder.