"It just depends": Parent, teacher, and expert conceptualization of social communication in young autistic children.

LAY ABSTRACT: Improving social communication is often one goal during early autism services. However, researchers do not yet know whether their ideas about which social communication skills should be targeted during services for young autistic children are the same as the goals of autism community members, such as parents, teachers, and expert clinicians. This study used focus groups (meetings of small groups of community members) to ask people from these groups about what aspects of social communication are most important to support in young autistic children. A total of 43 people participated in these focus groups. These groups included parents (three groups; 21 people), teachers (two groups; 8 people), and experts in early social communication and autism (two groups; 14 people). Focus group participants talked about several aspects of social communication that were already familiar to the research team, such as problems with expressive communication, language understanding, and social interaction. However, participants also talked about several parts of social communication that were less familiar to the research team and had usually not been mentioned in previous research. These included (1) considering the value of unusual forms of communication, (2) taking context and setting into account when considering social communication, and (3) how communication and emotion regulation impact one another. The information from these focus groups will be helpful to making sure that researchers and clinicians focus their social communication supports on areas that are most important to parents and teachers.

Enhancing stakeholder roles in autism early interventions in the United States: A stakeholder-driven research agenda.

LAY ABSTRACT: In this article, we outline a stakeholder-driven research agenda to guide future early intervention research for children with autism. Our research team collaborated with autism service providers, parents of individuals with autism, and autistic people to create this research agenda by (1) conducting workshops with community members and (2) distributing a survey to a larger number of community members around the country. The finalized research agenda includes (1) Guiding Principles for current and future research, (2) Research Priorities focused on early intervention for individuals with autism, and (3) Systems Implications to consider in future clinical, research, and policy efforts for early intervention. The full version of the research agenda is available in Supplemental Material. This article lists the main points of the research agenda and discusses unique themes highlighted by the community members. One main conclusion is that researchers need to include community members in decision-making and consultant positions throughout the research process to best meet the needs of the broader autism community. We have created a researcher workbook which we hope may facilitate these community consultation efforts. This workbook is available in Supplemental Material.

Symptoms of Autism Spectrum Disorder in Children With Down Syndrome and Williams Syndrome.

Research suggests that people with a Williams syndrome (WS) or Down syndrome (DS) diagnosis display an increased prevalence of autism spectrum disorder (ASD) when compared to the general population. This study aimed to examine characteristics of ASD in a group of children with DS or WS. Results suggest that children with DS and WS exhibit higher levels of autism symptoms than the general population, particularly in the area of unusual behaviors, and that these elevations are not solely due to deficits in adaptive behavior. There are many possible explanations for these elevations, such as issues with measurement, etiological overlap, or similar behavioral phenotypes. More research is needed to further our understanding of the overlap of ASD symptoms in these populations.

Social endophenotypes in autism spectrum disorder: A scoping review.

Endophenotypes are measurable markers of genetic vulnerability to current or future disorder. Autism spectrum disorder (ASD) is well-suited to be examined within an endophenotype framework given past and current emphases on the broader autism phenotype and early detection. We conducted a scoping review to identify potential socially-related endophenotypes of ASD. We focused on paradigms related to sociality (e.g., theory of mind (TOM), social attention), which comprise most of this literature. We integrated findings from traditional behavioral paradigms with brain-based measures (e.g., electroencephalography, functional magnetic resonance imaging). Broadly, infant research regarding social attention and responsivity (Research Domain Criteria (RDoC) domain of affiliation) and attention to faces and voices (social communication) finds consistent abnormality in vulnerable infant siblings. Several additional paradigms that have shown differences in vulnerable infants and young children include animacy perception tasks (perception and understanding of others), measures of recognition and response to familiar faces (attachment), and joint attention and false-belief tasks (understanding mental states). Research areas such as alexithymia (the perception and understanding of self), empathic responding, and vocal prosody may hold interest; however, challenges in measurement across populations and age ranges is a limiting factor. Future work should address sex differences and age dependencies, specificity to ASD, and heterogeneous genetic pathways to disorder within samples individuals with ASD and relatives.

Brief report: Does "healthy" family functioning look different for families who have a child with autism?

BACKGROUND: For families of typically developing children, extremes of family cohesion (enmeshed and disengaged) and flexibility (rigid and chaotic) are associated with negative outcomes (Olson, 2011). Some work suggests that this may not be true for families of children with autism spectrum disorder (ASD; Altiere & von Kluge 2009). Specifically, regimented daily routines (increased rigidity) and highly involved caregivers (increased enmeshment) might theoretically be associated with positive outcomes. OBJECTIVES: This study examined whether families who have a child with ASD report different family dynamics than families with typically developing children, and if these dynamics are equally predictive of outcomes for both groups. METHOD: Regression-based interaction analyses using data from an online survey (n = 235) were used to examine how diagnostic group (typically-developing child or child with ASD) affected the relationships between elements of family functioning and parent outcomes of happiness, depression, and satisfaction with family life. RESULTS: Higher parent-reported enmeshment was associated with decreased parent-reported happiness in typical families only; these variables were unrelated in families with a child with ASD. In addition, the relationship between disengagement and parent happiness was marginally weaker in the ASD group. Other scales (rigid and chaotic) exhibited similar relationships with family outcomes across both diagnostic groups. CONCLUSION: In alignment with previous findings (Altiere & von Kluge 2009), elevated levels of enmeshment were not predictive of poorer outcomes in families of children with ASD. There is a need to critically consider whether behaviors traditionally thought of as "enmeshed" may represent different, more adaptive support strategies for families who have a child with ASD.

Meta-analysis of naturalistic developmental behavioral interventions for young children with autism spectrum disorder.

Naturalistic developmental behavioral intervention is an emerging class of interventions for young children with autism spectrum disorder. The present article is a meta-analysis of outcomes of group-design studies (n = 27) testing interventions using naturalistic developmental behavioral intervention strategies. Small, significant positive effects of naturalistic developmental behavioral intervention were found for expressive language (g = 0.32), reduction in symptoms of autism spectrum disorder (g = -0.38), and play skills (g = 0.23). Larger effects were found for social engagement (g = 0.65) and overall cognitive development (g = 0.48). A marginal effect was found for joint attention (g = 0.14) and receptive language (g = 0.28). For joint attention, improvement was moderated by hours of professional involvement. Evidence of publication and reporting bias was present for language outcomes. This meta-analysis grows the evidence base for naturalistic developmental behavioral interventions, particularly in the key areas of social engagement and cognition.

Leisure time and family functioning in families living with autism spectrum disorder.

Family leisure can provide opportunities for both enjoyment and family growth. However, families of children with autism spectrum disorder experience multiple barriers to engaging in satisfying family leisure activities. This study surveyed parents of children with autism spectrum disorder (n = 112) and parents of children with typical development (n = 123) to examine relationships among family leisure involvement, leisure satisfaction, family functioning, and satisfaction with family life. Parents of children with autism spectrum disorder reported a similar amount of leisure involvement as families of typically developing children. However, they reported lower leisure satisfaction, poorer family functioning, and less satisfaction with family life. Mediation models suggested that low leisure satisfaction was related to less effective family communication, which in turn led to poorer family functioning and less satisfaction with family life. Amount of time spent in leisure made relatively small contributions to predicting other family variables. These results suggest that leisure-focused interventions for families of children with autism spectrum disorder should focus on improving quality, rather than quantity, of family leisure time.

Efficacy of low intensity, therapist-implemented Project ImPACT for increasing social communication skills in young children with ASD.

Project ImPACT is a Naturalistic Developmental Behavioral Intervention (NDBI) for young children with ASD. Preliminary research supports its feasibility and efficacy as a parent-mediated intervention; however, its efficacy as a low-intensity, therapist-implemented intervention is unclear. A single-case, multiple-baseline design evaluated the effect of 2 h per week of therapist-implemented Project ImPACT on social engagement, language, and play in nine children with ASD. Language and play skills were targeted separately for five children and together for four children. Children increased their rates of social engagement and language when language or play was the sole target and when language and play were targeted together; however, gains in play skills were evident only when they were targeted separately. This study provides support for the efficacy of the Project ImPACT when implemented by therapists at a low intensity and suggests the way in which skills are targeted can affect child learning.

Risk Factors for Behavioral and Emotional Difficulties in Siblings of Children With Autism Spectrum Disorder.

This study examined risk factors for behavioral and emotional problems in 1973 siblings of children with autism spectrum disorders (ASD). Results revealed six correlates of sibling internalizing and externalizing problems: male gender, smaller family size, older age of the child with ASD, lower family income, child with ASD behavior problems, and sibling Broader Autism Phenotype. Siblings with few risk factors were at low risk for behavioral and emotional problems. However, siblings with many risk factors were at increased risk for both internalizing and externalizing problems. These results highlight the need to assess risk for individual siblings to best identify a sub-population of siblings who may be in need of additional support.

The utility of Thin Slice ratings for predicting language growth in children with autism spectrum disorder.

Literature on "Thin Slice" ratings indicates that a number of personality characteristics and behaviors can be accurately predicted by ratings of very short segments (<5 min) of behavior. This study examined the utility of Thin Slice ratings of young children with autism spectrum disorder for predicting developmental skills and language gains over time. A total of 22 preschool-aged children with autism spectrum disorder participated in a battery of developmental assessments and a video-taped therapist-child interaction at Time 1. They then participated in follow-up testing of language skills and a second therapist-child interaction 6 months later (Time 2). Groups of approximately 25 naïve undergraduate students provided impression ratings ("Thin Slice ratings") about each child's skills and behaviors during 2-min segments taken from the therapist-child interaction videos at each time point. Thin Slice ratings at Time 1 were highly correlated with child scores on several developmental assessments at Time 1. In addition, Thin Slice ratings at Time 1 predicted gain in parent-reported expressive vocabulary over the course of 6 months, over and above the predictive utility of Time 1 vocabulary size. These findings provide preliminary evidence for the concurrent and predictive validity of Thin Slice ratings in young children with autism spectrum disorder.

Psychosocial Adjustment and Sibling Relationships in Siblings of Children with Autism Spectrum Disorder: Risk and Protective Factors.

This study compared sibling adjustment and relationships in siblings of children with Autism Spectrum Disorder (ASD-Sibs; n = 69) and siblings of children with typical development (TD-Sibs; n = 93). ASD-Sibs and TD-Sibs demonstrated similar emotional/behavioral adjustment. Older male ASD-Sibs were at increased risk for difficulties. Sibling relationships of ASD-Sibs involved less aggression, less involvement, and more avoidance than those of TD-Sibs. Partial support for a diathesis-stress conceptualization of sibling difficulties was found for ASD-Sibs. For TD-Sibs, broader autism phenotype (BAP) was related to psychosocial difficulties regardless of family stressors. For ASD-Sibs, BAP was related to difficulties only when family stressors were present. This suggests that having a sibling with ASD may be a protective factor that attenuates the negative impact of sibling BAP.

The influence of maternal language responsiveness on the expressive speech production of children with autism spectrum disorders: a microanalysis of mother-child play interactions.

Adult responsiveness is related to language development both in young typically developing children and in children with autism spectrum disorders, such that parents who use more responsive language with their children have children who develop better language skills over time. This study used a micro-analytic technique to examine how two facets of maternal utterances, relationship to child focus of attention and degree of demandingness, influenced the immediate use of appropriate expressive language of preschool-aged children with autism spectrum disorders (n = 28) and toddlers with typical development (n = 16) within a naturalistic mother-child play session. Mothers' use of follow-in demanding language was most likely to elicit appropriate expressive speech in both children with autism spectrum disorders and children with typical development. For children with autism spectrum disorders, but not children with typical development, mothers' use of orienting cues conferred an additional benefit for expressive speech production. These findings are consistent with the naturalistic behavioral intervention philosophy and suggest that following a child's lead while prompting for language is likely to elicit speech production in children with autism spectrum disorders and children with typical development. Furthermore, using orienting cues may help children with autism spectrum disorders to verbally respond.

Improving social skills in adolescents and adults with autism and severe to profound intellectual disability: a review of the literature.

Social skills are important treatment targets for individuals with autism spectrum disorders (ASD) across the lifespan. However, few treatments are available for adolescents and adults with ASD who also have severe to profound intellectual disability (S/PID). Several social skill interventions have been described that may improve social skills in this population, including video modeling, developmental, peer-mediated, behavioral, and structured teaching interventions. However, significant challenges in research design and methodology exist across these studies. This paper reviews research examining social skill interventions for youth and adults with ASD and S/PID and points out weaknesses and challenges in this literature. We propose a developmental framework of adapting early childhood interventions for use with youth and adults with ASD and S/PID as one starting point for intervention development.

Evaluation of a Sibling-Mediated Imitation Intervention for Young Children with Autism.

Parents and peers have been successful at implementing interventions targeting social interactions in children with autism; however, few interventions have trained siblings as treatment providers. This study used a multiple-baseline design across six sibling dyads (four children with autism) to evaluate the efficacy of sibling-implemented reciprocal imitation training. All six typically developing siblings were able to learn and use contingent imitation, four of the six siblings were able to learn and use linguistic mapping, and all six siblings increased their use of at least one component of the imitation training procedure. Three of the four children with autism showed increases in overall imitation and all four showed evidence of increases in joint engagement. Parents and siblings reported high satisfaction with the intervention and ratings by naïve observers indicated significant changes from pre- to post-treatment. These results suggest that sibling-implemented reciprocal imitation training may be a promising intervention for young children with autism.