Patient centric intervention for children with high functioning autism spectrum disorder. Can ICT solutions improve the state of the art ?

In my PhD research we developed an integrated technological platform for the acquisition of neurophysiologic signals in a semi-naturalistic setting where children are free to move around, play with different objects and interact with the examiner. The interaction with the examiner rather than with a screen is another very important feature of the present research, and allows recreating a more real situation with social interactions and cues. In this paradigm, we can assume that the signals acquired from the brain and the autonomic system, are much more similar to what is generated while the child interacts in common life situations. This setting, with a relatively simple technical implementation, can be considered as one step towards a more behaviorally driven analysis of neurophysiologic activity. Within the context of a pilot open trial, we showed the feasibility of the technological platform applied to the classical intervention solutions for the autism. We found that (1) the platform was useful during both children-therapist interaction at hospital as well as children-parents interaction at home, (2) tailored intervention was compatible with at home use and non-professional therapist/parents. Going back to the title of my thesis: 'Can ICT solution improve the state-of-the-art ?' the answer could be: 'Yes it can be an useful support for a skilled professional in the field of autis

Pilot study for subgroup classification for autism spectrum disorder based on dysmorphology and physical measurements in Chinese children

Poster Sessions: 157 - Comorbid Medical Conditions: abstract 157.058 58BACKGROUND: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder affecting individuals along a continuum of severity in communication, social interaction and behaviour. The impact of ASD significantly varies amongst individuals, and the cause of ASD can originate broadly between genetic and environmental factors. Objectives: Previous ASD researches indicate that early identification combined with a targeted treatment plan involving behavioural interventions and multidisciplinary therapies can provide substantial improvement for ASD patients. Currently there is no cure for ASD, and the clinical variability and uncertainty of the disorder still remains. Hence, the search to unravel heterogeneity within ASD by subgroup classification may provide clinicians with a better understanding of ASD and to work towards a more definitive course of action. METHODS: In this study, a norm of physical measurements including height, weight, head circumference, ear length, outer and inner canthi, interpupillary distance, philtrum, hand and foot length was collected from 658 Typical Developing (TD) Chinese children aged 1 to 7 years (mean age of 4.19 years). The norm collected was compared against 80 ASD Chinese children aged 1 to 12 years (mean age of 4.36 years). We then further attempted to find subgroups within ASD based on identifying physical abnormalities; individuals were classified as (non) dysmorphic with the Autism Dysmorphology Measure (ADM) from physical examinations of 12 body regions. RESULTS: Our results show that there were significant differences between ASD and TD children for measurements in: head circumference (p=0.009), outer (p=0.021) and inner (p=0.021) canthus, philtrum length (p=0.003), right (p=0.023) and left (p=0.20) foot length. Within the 80 ASD patients, 37(46%) were classified as dysmorphic (p=0.00). CONCLUSIONS: This study attempts to identify subgroups within ASD based on physical measurements and dysmorphology examinations. The information from this study seeks to benefit ASD community by identifying possible subtypes of ASD in Chinese population; in seek for a more definitive diagnosis, referral and treatment plan.published_or_final_versio

The development of a British assessment of inferential and idiom comprehension for 5:00 to 9:11 year-old typically-developing children

Understanding of inferences and non-literal language, such as idioms, is critical for successful communication and academic learning. Assessment of inferential and idiom comprehension is essential for children who are showing difficulties in these areas so that appropriate intervention and support can be provided. There is very little information on the typical development of these specific areas of verbal comprehension in the literature and there are very few current assessments of inferential and idiom comprehension for British school-aged children. While many assessments that do exist have face validity, very few are standardised. Some children with comprehension difficulties do well on existing picture-based assessments of verbal comprehension but they demonstrate significant difficulties with more abstract language comprehension. There is a gap in the current battery of assessments available to paediatric speech and language therapists for assessing inferential and idiom comprehension in detail. The primary aims of this thesis were to develop a robust standardised British assessment of inferential and idiom comprehension for 5:00 to 9:11 year-old children, to provide supporting validity and reliability data for the newly devised assessment, to provide normative and statistically significant data for inferential and idiom comprehension in typically developing children aged 5:00 to 9:11, to provide qualitative information on the typical development of these areas of verbal comprehension and to carry out exploratory studies using the new assessment with children with communication impairments. Secondary aims of the study were to examine if there was any relationship between gender and test performance and between socio-economic status and test performance. A new assessment, the Hewitt Inferential Comprehension and Idioms Test (HICIT) was created following a review of the literature and of the existing assessments in these areas of verbal comprehension. A pilot study was carried out with sixty-two 4:06 to 10:06 year-old children in two primary schools in the North West of England. The fourteen section, 210 item pilot test was reduced to the twelve section, 140 item final version of the HICIT. This was then trialled with a further 200 children, aged 5:00 to 9:11, making an overall standardisation sample of 250 children. Normative data were provided from the application of descriptive and inferential statistics to the results. A two-way ANOVA examined the effects of age group and gender on test scores and a one-way ANOVA and post-hoc independent T tests looked at the relationship between socio-economic status and test performance. The construct validity of the test was examined with exploratory and confirmatory factor analyses. These demonstrated a single factor loading and good model fit measurements. The reliability of the test, as assessed by Cronbach’s Alpha was moderate, similar to an existing published British standardised verbal language assessment. Rasch analysis indicated that the internal consistency of the test was good. The inter-rater reliability of 98.6% was excellent. The descriptive and inferential statistics demonstrated that there was a developmental progression between the age groups for inferential and idiom comprehension but that there was no effect for gender. The idioms sub-section was the only section not to reach ceiling scores by 9:11. The results for the relationship between socio-economic status and test scores were inconclusive. Quantitative analysis of the HICIT data demonstrated that the test is a robust assessment of inferential and idiom comprehension. Some sub-tests of the test are more robust with different age groups so different versions of the test could be used with different age groups. Qualitative analysis of the test responses, exploratory case studies using the HICIT to assess four children with communication impairments and feedback from practising speech and language therapists produced useful information on the possible applications of the test and suggested that it could be very useful to assist in differential diagnosis of different types of communication impairments

Un-strangering 'the stranger' in a strange land : a multi-perspective, participant-led, exploration of in/ex-clusion in NZ mainstream high schools - privileging the voices of senior 'high-functioning' autistic students : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University, Palmerston North, New Zealand

New Zealand’s (NZ) ‘inclusive’ school policies enable autistic students to attend a mainstream school of their choice, with the expectation they will belong, feel accepted, contribute, and participate in ‘school life’. Research has typically focused on biogenetic origins and diagnostic specificity, providing medicalised and stereotypical ways of understanding autistic people. Few qualitative studies have explored autistic students’ understandings and everyday lived experiences of ‘being autistic’ and ‘being in an inclusive mainstream high school’. Excluding their voice from research, necessarily constrains development of policy, pedagogy, and praxis, which might facilitate more inclusive experiences for this population of students. This study was the first in NZ to focus on the lived experiences of autistic adolescents in their senior years (Levels 1-3 NCEA). A multi-perspective, qualitative phenomenological design enabled three tertiary students, three parents, and seven advocates, to augment contributions from five high-functioning autistic adolescents. This research was underpinned by a feminist standpoint epistemology and Bronfenbrenner’s bioecological model, privileging first person experiences and contextual influences. Interpretative Phenomenological Analysis enabled participants’ understandings and experiences to be explored. Tertiary students illumined how medical model understandings of disability constrained and enabled identity formation in high school and implicated being understood. Most of the autistic participants drew on neoliberal ‘governmentality’ to problematise barriers to inclusion, namely ‘governance’ (dominant culture, school rules, and regulation of ‘space’), teacher performativity, and curriculum management. Salient interpersonal barriers included authoritative teachers, social cliques, ‘invisible’ bullying, and ‘one-off’ grievances. ‘Being excluded’ was painful and resulted in feeling ‘de-valued’, impacting motivation and opportunities for success. Facilitators to inclusion were embedded within meaningful interactions, demonstrative care, and common interests, aiding a sense of acceptance, and belonging, but not always resulting in ‘contributing’ and ‘participating’. High school was experienced by autistic participants as a political site where in/ex-clusion ‘gets done’ through ordinary technologies that ‘sift and shift’ students, according to sameness and difference, or ontological ‘otherness’. This study addresses prominent diagnostic and identity issues, academic and social achievement, and support, all of which are primary concerns for educationalists (including educational psychologists) striving to understand inclusion and improve outcomes for autistic students

Parents Of Children With High-functioning Autism: Experiences In Child-parent Relationship Therapy (Cprt)

This qualitative study attempted to capture the experiences of parents of children with high-functioning autistic spectrum disorders participating in child-parent relationship therapy (CPRT). Parents of children with high-functioning autistic spectrum disorders (HFASD) are prone to experiencing stress in the parent-child relationship due to difficulty in social understanding and rigid behavioral patterns often found among children with HFASD. Moreover, parents of children with HFASD may feel challenged to find suitable interventions that are time-limited, affordable, and appropriate for parents and children with HFASD. Because no research currently investigates the perceived acceptability of CPRT for parents of children with HFASD, it was decided that a qualitative study would best capture the experiences of parents of children with HFASD participating in CPRT to understand more fully whether CPRT is an appropriate intervention for these parents. Four parents and one grandparent were interviewed prior to and following their participation in 10 sessions of CPRT. Thematic analysis of the pre- and post-intervention interviews as well as the 10 CPRT sessions revealed eight themes related to the parents overall experience of CPRT and change in the parent, child, and parent-child relationship: understanding of CPRT concepts, reactions to CPRT, group dynamic, child characteristics, parent characteristics, knowledge and experiences with HFASD, family context, and parent-child relationship. The emerging themes indicated that the five participants found CPRT to be a useful intervention for developing skills to deal with child-behavior concerns related to HFASD. The participants also reported developing a better understanding of their children with HFASD and four parents reported increased closeness in the parent-child relationship. The implications for this research are that CPRT may offer parents of children with HFASD a time-limited intervention that meets their needs as parents, as well as possibly helping parents and children with HFASD develop increased closeness in the parent-child relationship

A treatise on language methods and language-games in autism

Although it is generally understood that autism is a developmental disability affecting social learning, my social constructionist perspective suggested to me that, strangely, current theories aimed at explaining the nature of autism appeared not to fully reflect the essential social aspects of autism. Given that typically developing human beings become fully socialised through learning a first language, it appeared to me that autism research has, especially of late, failed to give sufficient attention to language despite Kanner’s advice. In researching this thesis I have sought to make a contribution to knowledge of my subject by: (1) developing a synthesis of current knowledge of autistic language methods as a practical framework to guide future research focused on language in autism; (2) critiquing ‘established’ autism theory; (3) drawing attention to Ludwig Wittgenstein’s neglected contributions to the philosophy of mind; and (4) reviewing the contribution of ‘alternative’ theory, including Wittgenstein’s criteriological theory, to an understanding of autism. My research has involved reviewing: (a) the literature on autistic language methods; (b)Conversation Analysis of autistic conversation; (c) narrative writing by authors diagnosed or retrospectively diagnosed with autism; and (d) existing autism theory. I conclude that there are specific features of talk and writing that reflect autism with some features of autistic writing being a ‘mirror image’ of features of autistic talk. A further, important, conclusion is that there are strengths as well as weaknesses associated with autistic talk and writing i.e., from a linguistic stance, it is wrong to regard autism as a disability; rather, it involves a different way of communicating – both verbally and in writing – than is seen in typically developing people. I also conclude that alternative theory has much to contribute to an understanding of autism, and that the atypical nature of autistic social development results in autistic people failing to fully come to terms with language-games