The United States of Autism

A Second Look at Faces

2009-03-05T15:59:00.010-05:00

In a previous post (Looking at Faces) I reported on one of a growing number of studies that investigate why people with autism have social difficulties. This research shows that - unlike people without autism - individuals with autism spectrum disorders tend to avoid looking at pictures of faces. Obviously, if you are avoiding looking at people, you will be at a major disadvantage when trying to learn social skills. But why would they avoid faces?

Some have looked at arousal and have theorized that other people make those with autism anxious - therefore, resulting in avoiding others. But when researchers have looked at arousal, they often get mixed results. A new yet-to-be published study seems the help explain these puzzling results.

Natalia Kleinhans and her colleagues had people with and without autism look at pictures of faces (see sample) at two different times. They monitored their brain activity through an fMRI (which assesses brain function). What they found was that the first time they showed the picture of a face both groups had increased arousal in the amygdala (a part of the brain involved with fear and anger). A new, unfamiliar face may be mildly anxiety producing for anyone because of all the new features to consider. However, when they showed the picture a second time, the control group habituated - meaning, they did not have the same hyperarousal response. However, the people with autism did not habituate, and continued to show hyperarousal. Without getting use to faces, people with autism may experience stimulus overload each time they see a person. This study may help make sense of why people with autism avoid faces.

Reference
Kleinhans, N. M., Johnson, L. C., Richards, T., Mahurin, R., Greenson, J., Dawson, G., et al. (in press). Reduced neural habituation in the amygdala and social impairments in Autism Spectrum Disorders. American Journal of Psychiatry.

Looking at Faces

2009-02-13T15:28:00.007-05:00

The characteristic social deficits of people with autism are studied in a number of ways. A recent study used an innovative technology as well as a unique comparison. The researchers compared eye gaze at pictures among people with autism, those with Williams Syndrome (which is characterized by over socialness) and those without a diagnosis. Look at the photo on the right. There is a human face embedded in the lower right corner of each photo. The colored spots in the photo represent the amount of time each group look at the parts of the photo. Can you match photos "a" (top), "b" (middle), and "c" (bottom) with the correct group?

They found that people with Williams Syndrome looked primarily at faces (photo "b" - middle), undiagnosed persons looked primarily at faces but scanned other aspects as well (photo "c" - bottom), and those with autism primarily looked at aspects of the photo other than the face (photo a - top). This interesting study helps us look at the world through the eyes of people with autism and gives us a glimpse into their world.

Reference

Riby, D., & Hancock, P. (2009). Do faces capture the attention of individuals with Williams Syndrome or autism? Evidence from tracking eye movements. Journal of Autism and Developmental Disorders, 39(3), 421-431.

Autism Controversies

2009-01-15T12:55:00.003-05:00

A new book by Paul A. Offit, M.D. takes a look at many of the controversies surrounding the nature and treatment of autism (Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure). Of particular interest is his discussion of how people make arguments for and against particular approaches, including how celebrities use their status to promote ideas that may or may not be backed by science. See an excerpt by clicking the link below.
http://cup.columbia.edu/book/978-0-231-14636-4/autisms-false-prophets/excerpt

Early Intervention

2008-12-29T13:29:00.006-05:00

In class I note the landmark study by Lovaas (1987) (UCLA Young Autism Project Model) that studied the effects of using applied behavior analysis (ABA) with very young children with autism (younger than 3 1/2 years of age). [now referred to as Early and Intensive Behavioral Intervention - EIBI] In that study, Lovaas suggested that almost half of the children "recovered" from their autism - meaning that several years later teachers could not tell them apart from their students without autism. That study - now over 20 years old - generated a great deal of controversy. Over the years, over 20 studies have sought to replicate Lovaas' (1987) original study. Several new reviews look at progress to date (see references below).

First, the original study did not randomly assigned children to the treatment groups. This is a potential problem because we do not know if children who received the intensive intervention (40 hours per week for 2 years) were somehow different from those who did not - potentially affected the outcomes. Newer studies have attempted to remedy this problem.

Second, the study used educational placement as an outcome measure. This is a problem because where a child is placed (for example, in a regular class or a special education class) has more to do with the educational philosophy of the school than the abilities of the child. Other studies use IQ scores as well as adaptive and maladaptive behavior as outcomes.

Third, many people questioned whether or not 40 hours per week for 2 years (which is very expensive) was necessary. More recent work suggests that the range may be more like 30-40 hours per week to achieve optimal results.

To date, these newer studies generally support the effectiveness of EIBI for some children with autism. Researchers are now examining the characteristics of children that may predict the best outcomes (for example, language ability). Overall, the treatment progress seems to greatly improve for some children if early intensive behavioral intervention is implemented properly.

References
Eikeseth, S. (2009). Outcome of comprehensive psycho-educational interventions for young children with autism. Research in Developmental Disabilities, 30(1), 158-178.

Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3–9.

Reichow, B., & Wolery, M. (2009). Comprehensive synthesis of early intensive behavioral interventions for young children with autism based on the UCLA Young Autism Project Model. Journal of Autism and Developmental Disorders, 39(1), 23-41.

Playtime

2008-12-29T12:58:00.006-05:00

Play is considered a fundamental activity of childhood. In addition to being fun, play is thought to be crucial to developing important cognitive and social skills. This leads us to an important question. Do children with autism play and if so is their play different from other children?

Researchers in the UK studied the play of children with and without autism (ages 7 to 14 years). Note two things about this study. First, these are not very young children. Second, the researchers matched children by their language abilities. This means that the children with autism had language abilities that were similar to children their own (chronological) age - making them different from many children with autism who have delayed language skills. They matched the two groups to see if something other than language delays contributed to play skills. It is important to know this when you try to make generalizations about the play of all children with autism.

They found that both groups could play - meaning they could use toys to represent things and stories. For example, both groups could pretend that dolls were people and could make up stories for them. However, the children with autism showed less creativity in their play and, unfortunately appeared to have less "fun" when they played. They had the cognitive ability to represent toys as other objects, but seemed to enjoy this play less than children without autism.

Could this lack of enjoyment be related to their social deficits? In other words, although they could understand what was expected of them, was the lack of social interest interfering with what makes play fun?

Reference

Hobson, R., Lee, A., & Hobson, J. (2009). Qualities of symbolic play among children with autism: A social-developmental perspective. Journal of Autism and Developmental Disorders, 39(1), 12-22.

Home Grown Activists

2008-12-12T14:11:00.008-05:00

What would it take to turn you into an activist (someone who devotes a part of his or her life to creating social change)? How about having a child with autism?

In class we discuss how parents have to play an important role in advocating for their child - often battling with schools or professionals to get the best possible services. Some parents have a difficult time doing this, which sometimes shows itself as depression or a lack of confidence in their abilities. We are doing research with this group and I describe this work in another post (Optimistic Parenting).

Other parents are quite successful in taking on this role as advocate. And, as someone who has worked in the field for many years, I've seen those parents who make the transition from advocating just for their child to "taking on the system" in order to make services better for others as well.

A recent qualitative study from Great Britain supports these impressions. The researchers interviewed parents to get their perceptions of their roles as parents (Ryan & Cole, 2009). They found that indeed some parents were overwhelmed with the experience. Others have different experiences - with the new challenges actually have positive effects such as making them feel better about themselves. And still other parents became "Uber parents" - those who took on more than their own child's issues and became autism activists. The study makes a point to note that the parents would not characterize themselves as "activists", perhaps because of negative connotations. However, they describe their evolution from going after help for their own child to trying to improve help for other children. For example, one parent notes;

I have been in talks with the National Autistic Society to get a representative to come to the school at some point to talk to the teachers and I also want to get the parents involved as well…But they have also asked me – they want to raise the profile of disability in the school – and they have asked me whether or not I would be willing to be involved in that and the different things that are going on and of course I’m like ‘Yep, definitely.’ (Chris, part-time administrator, son aged 8) (pg., 48)

As a qualitative study, this work can't tell us what percentage of parents will have each of these experiences. Nor can it tell us ahead of time who might have these experiences. However it provides some detail for researchers to follow-up on who might be likely to have positive or negative experiences and perhaps provide clues as to how to make the experience better for more families.

Reference
Ryan, S., & Cole, K. R. (2009). From advocate to activist? Mapping the experiences of mothers of children on the autism spectrum. Journal of Applied Research in Intellectual Disabilities, 22(1), 43-53.

Autism Prevalence

2008-12-05T14:07:00.003-05:00

One of the most frequently asked questions about Autism Spectrum Disorders is why there seems to be such a large increase in the number of children receiving these diagnoses. Several decades ago we referred to these disorders as rare, and estimated that perhaps 1 in every 10,000 births resulted in autism. Today, the prevalence rate is thought to be as high as 1 in every 150 births (Hughes, 2008). Why this change?

One recent study sought to answer this question by looking at the diagnoses of children in British Columbia and how their diagnoses changed over time (Coo et al., 2008). Unlike some previous studies which tracked diagnoses in groups of children, this study followed each individual child's diagnosis between 1996 and 2004. They found that a large number of these children had their diagnosis changed from another special education designation (for example, learning disability) to autism over this time period. In fact, this switching of diagnosis accounted for at least 1/3 of the increase in the diagnosis during this period of time.

This study suggests that some - but not all - of the increase in prevalence could be the result of changes in diagnostic practices, rather than an actual increase in the number of children with autism.

Reference:

Coo, H., Ouellette-Kuntz, H., Lloyd, J., Kasmara, L., Holden, J., & Lewis, M. (2008). Trends in autism prevalence: Diagnostic substitution revisited. Journal of Autism and Developmental Disorders, 38(6), 1036-1046.

Hughes, J. R. (2008). A review of recent reports on autism: 1000 studies published in 2007. Epilepsy & Behavior, 13(3), 425-437.

Optimistic Parenting

2008-12-04T16:05:00.007-05:00

One of the core symptoms seen in Autism Spectrum Disorders is disruptive and repetitive behavior. Research shows that we can be very successful helping families with their disruptive children. Problems such as tantrums, aggression and even self-injury can be significantly improved with the right parent training methods. However, some families have a very difficult time when they try to follow these techniques. Our latest research is looking at how we can help these families.

Using a technique we call "Positive Family Intervention" we are finding that we can help parents become more optimistic about their own ability to parent and their child's ability to behave better. When we add this optimism training to our behavioral parent training, families are more likely to stick with the treatments. And, if families finish our 8-week program, we see significant improvements in even the most serious behavior problems. This research points to how important it is to design plans that not only fit the needs of the child but also of the whole family.

References:

Durand, V.M., Hieneman, M., Clarke, S., & Zona, M. (2009). Optimistic parenting: Hope and help for parents with challenging children. In W. Sailor, G. Dunlap, G. Sugai, & R. Horner (Eds.), Handbook of positive behavior support (pp., 233-256). New York: Springer.

Durand, V.M. & Hieneman, M. (2008). Helping parents with challenging children: Positive family intervention, Facilitator’s guide. New York: Oxford University Press.

Durand, V.M. & Hieneman, M. (2008). Helping parents with challenging children: Positive family intervention, Workbook. New York: Oxford University Press.

Decision Making

2008-12-04T14:43:00.002-05:00

How would your ability to make decisions be affected if you had autism? Think about it. If you were not influenced by emotions (such as jealousy, greed, etc.) you might make decisions based purely on the facts. And, this seems to be what happens. Typically, the way we make decisions can be influenced by how the decision choices are "framed." For example, we are more likely to agree to a surgical procedure if we are told "You have an 80% chance of surviving the procedure." rather than being told "You have a 20% chance of not surviving the procedure." - even though this is the same information! In a sense we are distracted by the emotional content. Research in the UK with people who had autism and average IQ scores showed that they were less likely to be influenced by these types of emotional "framing" techniques and more likely to make decisions based solely on the facts. This type of research gives us a glimpse of emotional lives of people with this disorder.

Reference: De Martino, B., Harrison, N. A., Knafo, S., Bird, G., & Dolan, R. J. (2008). Explaining enhanced logical consistency during decision making in autism. Journal of Neuroscience, 28(42), 10746-10750.

Language and Autism

2008-12-04T14:32:00.002-05:00

There are three general areas where children with autism show severe impairments - language, social skills and behavioral flexibility. One of the questions raised in class has to do with whether language problems are a primary symptom (meaning, they comes out of the neurobiological processes that cause autism) or are secondary (language difficulties develop because of deficits in other areas). A recent important review helps to answer this question. The authors of this review describe research on language problems in autism and in those with "specific language impairment" (SLI) - a diagnosis thought by some to be part of autism (Williams, Botting & Boucher, 2008). In fact, there is relatively little overlap in the genetics and brain involvement in these two groups. This suggests that the neurobiological processes that lead to autism are different than those that lead to SLI.

One explanation of the language problems in autism is that they are secondary to the social skills problems. According to this view, children with autism are born (or quickly develop) a lack of interest or aversion to other people. In turn, they have a difficult time with lanuguage because most of what we communicate involves interacting with other people. If a child doesn't like to interact with others - what would motivate him or her to learn to communicate? This is what is meant by language problems being secondary - they may develop differently because of their social motivational problems.

The implication for early intervention, then, is to try to get children with autism to associate other people with positive things and to teach them to interact socially to get what they want and need. If you can improve their interest in other people, this should help them be more motivated to learn verbal and non-verbal communication skills.

Reference: Williams, D., Botting, N., & Boucher, J. (2008). Language in autism and specific language impairment: Where are the links? Psychological Bulletin, 134(6), 944-963.