The Autism Toolbox : An Autism Resource for Scottish Schools

The Autism Toolbox will draw upon a range of practice experience, literature and research to offer guidance for authorities and schools providing for children and young people with Autism Spectrum Disorders (ASD)

A Psychophysical Assessment of Multisensory Processing and Multiple Object Tracking in Autism Spectrum Disorders

Les troubles du spectre autistique (TSA) sont actuellement caractérisés par une triade d'altérations, incluant un dysfonctionnement social, des déficits de communication et des comportements répétitifs. L'intégration simultanée de multiples sens est cruciale dans la vie quotidienne puisqu'elle permet la création d'un percept unifié. De façon similaire, l'allocation d'attention à de multiples stimuli simultanés est critique pour le traitement de l'information environnementale dynamique. Dans l'interaction quotidienne avec l'environnement, le traitement sensoriel et les fonctions attentionnelles sont des composantes de base dans le développement typique (DT). Bien qu'ils ne fassent pas partie des critères diagnostiques actuels, les difficultés dans les fonctions attentionnelles et le traitement sensoriel sont très courants parmi les personnes autistes. Pour cela, la présente thèse évalue ces fonctions dans deux études séparées. La première étude est fondée sur la prémisse que des altérations dans le traitement sensoriel de base pourraient être à l'origine des comportements sensoriels atypiques chez les TSA, tel que proposé par des théories actuelles des TSA. Nous avons conçu une tâche de discrimination de taille intermodale, afin d'investiguer l'intégrité et la trajectoire développementale de l'information visuo-tactile chez les enfants avec un TSA (N = 21, âgés de 6 à18 ans), en comparaison à des enfants à DT, appariés sur l’âge et le QI de performance. Dans une tâche à choix forcé à deux alternatives simultanées, les participants devaient émettre un jugement sur la taille de deux stimuli, basé sur des inputs unisensoriels (visuels ou tactiles) ou multisensoriels (visuo-tactiles). Des seuils différentiels ont évalué la plus petite différence à laquelle les participants ont été capables de faire la discrimination de taille. Les enfants avec un TSA ont montré une performance diminuée et pas d'effet de maturation aussi bien dans les conditions unisensorielles que multisensorielles, comparativement aux participants à DT. Notre première étude étend donc des résultats précédents d'altérations dans le traitement multisensoriel chez les TSA au domaine visuo-tactile. Dans notre deuxième étude, nous avions évalué les capacités de poursuite multiple d’objets dans l’espace (3D-Multiple Object Tracking (3D-MOT)) chez des adultes autistes (N = 15, âgés de 18 à 33 ans), comparés à des participants contrôles appariés sur l'âge et le QI, qui devaient suivre une ou trois cibles en mouvement parmi des distracteurs dans un environnement de réalité virtuelle. Les performances ont été mesurées par des seuils de vitesse, qui évaluent la plus grande vitesse à laquelle des observateurs sont capables de suivre des objets en mouvement. Les individus autistes ont montré des seuils de vitesse réduits dans l'ensemble, peu importe le nombre d'objets à suivre. Ces résultats étendent des résultats antérieurs d'altérations au niveau des mécanismes d'attention en autisme quant à l'allocation simultanée de l'attention envers des endroits multiples. Pris ensemble, les résultats de nos deux études révèlent donc des altérations chez les TSA quant au traitement simultané d'événements multiples, que ce soit dans une modalité ou à travers des modalités, ce qui peut avoir des implications importantes au niveau de la présentation clinique de cette condition.Autism spectrum disorders (ASD) are currently characterized by a triad of impairments including social dysfunction, communication deficits and perseverative behaviours. The simultaneous integration of multiple senses is crucial in everyday life as it allows for the creation of a unified percept. Similarly, the allocation of attention to multiple events at the same time is critical in the processing of dynamic environmental information. In daily interactions with the environment, both sensory processing as well as attentional functions are building blocks to typical development (TD). Although not part of the current diagnostic criteria, difficulties with attention functions and sensory processing are very common among autistic persons. The present thesis therefore examined both these functions in two separate studies. The first study is based on the premise that alterations in basic sensory processing might underlie atypical sensory behaviours in ASD, as proposed by current theories of ASD. We conceived a cross-modal size discrimination task to assess the integrity and developmental course of visuo-tactile information in children with ASD (N = 21, aged 6-18 years), compared to age- and performance IQ-matched children with TD. In a simultaneous two-alternative forced-choice task, participants were asked to make a judgement on the size of two stimuli, based on unisensory (visual or tactile) or multisensory (visuo-tactile) inputs. Difference thresholds evaluated the smallest difference at which participants were capable to discriminate size. Children with ASD showed diminished performance and no maturational effects in both unisensory and multisensory conditions, compared to TD participants. Our first study therefore extends previous results of alterations in multisensory processing in ASD to the visuo-tactile domain. In our second study, we evaluated 3D-Multiple Object Tracking (3D-MOT) capacities in autistic adults (N = 15, aged 18-33 years), compared to age- and IQ-matched control participants, who were asked to track one or three moving targets amongst a set of distracters in a virtual reality environment. Performances were measured based on speed thresholds, which evaluates the greatest speed at which observers are capable of successfully tracking moving objects. Autistic individuals displayed overall reduced speed thresholds, whatever the number of spheres to track. These findings extend previous results of altered attention mechanisms in autism with regards to the simultaneous allocation of attention to multiple areas. Together, the findings of our two studies reveal alterations in ASD with regards to the processing of multiple events at the same time, be it within one modality or across modalities, which may have important implications for the clinical presentation of this condition

New Research in Children with Neurodevelopmental Disorders

This book collects recent research in the field of care for neurodevelopmental disorders, emphasizing transdisciplinary work in clinical, educational and family contexts. It presents an opportunity to learn about the impact of participation on children and adolescents with neurodevelopmental disorders. Mainly, new therapeutic approaches are presented in children and adolescents with autism spectrum disorder, attention-deficit/hyperactivity disorder, or motor coordination disorders

Psychotherapy with people with Asperger Syndrome; exploring ways to improve client and therapist well-being

It is well documented that people with Asperger Syndrome show a propensity to mental health problems (e.g. Tantam, 1988); one contributor possibly being difficulties with social interaction (Frith, 2004). People with Asperger Syndrome and mental health problems may therefore require support, one form being psychotherapy (e.g. Schopler & Mesibov, 1983). However, despite the possible need of this population and the recent drives towards improving access to psychological therapies to the wider population (Department of Health, 2010) there is relatively little literature on psychotherapeutic interventions for people with Asperger Syndrome (Weiss & Lunsky, 2010), which might possibly impact on the client and therapist. Furthermore, the author postulated that when people with Asperger Syndrome do access psychological therapy, the difficulties that contributed to them seeking therapy such as interpersonal difficulties may also impact on basic therapeutic assumptions and therapist preferences as outlined in the literature. Thus the overall premise of this current study derives from the way Asperger Syndrome is defined (however, provisionally) as a disorder of interpersonal functioning, this would lead to an expectation that doing therapy (an intrinsically interpersonally process) with those with Asperger Syndrome might negatively impact on basic therapeutic assumptions and therapist attitudes in some way. In this study, therapists’ attitudes to working psychotherapeutically with clients with Asperger Syndrome were explored. Following preliminary discussions with colleagues, interviews with five trainee psychologists and 129 completed questionnaires from therapists, a number of areas were revealed as potentially important to psychotherapists working with people with Asperger Syndrome. These areas were the quality of supervision, therapist satisfaction, the quality of the working alliance, therapist knowledge and experience, the model(s) used and co-morbid psychopathology and other co-morbid concerns. Despite people with Asperger Syndrome being viewed from the dominate discourse as not necessarily contributing to the fulfilment of a number of therapist preferences and therapeutic assumptions as described within the literature, interviews and questionnaire, overall the sample in this study viewed clients with Asperger Syndrome as satisfying to work with and the therapists viewed the working alliance as good, supervision effective and satisfaction was not contingent on the use of the dominant cognitive behavioural therapy model

'Hidden Voices': an exploratory single case study into the multiple worlds of a 15 year old young man with autism

This thesis presents a 31-day case study carried out with a 15 year old young man who has classical autism. The study involved introducing him to a number of new and challenging activities, in a variety of contexts, over 31 days, that were previously assumed to be outside of his range of capability. The case study found that the application of the concepts of choice, control, challenge and risk had an unexpectedly positive impact upon the young man’s performance. This study further attempts to explore the concept of narrative as a ‘pedagogical bridge’ between the ‘worlds’ of autism and neurotypicality, arguing that narrative may provide a ‘way in’ to the world of autism. ‘Narrative’, this study contends, may provide a tapestry across which the world of autism may be connected with the world that surrounds it; by revealing a multiplicity of selves in a multiplicity of contexts. Methods of data collection included field notes, interviews, photographs and film footage. Ultimately, the study found that the use of ‘performance texts’ (DVDs featuring the young man’s achievements) constituted a powerful means of celebrating his accomplishments within the school and its wider community. Research approaches were participatory and ethnographic in the data collection phases, while a more phenomenological approach was adopted in the data analysis phase. The overarching analytical framework was that of ‘narrative analysis’ in telling a story of bravery, courage, hope and optimism

Mental Health Practitioners Perceptions’ of Presence in a Virtual Reality Therapy Environment for Use for Children Diagnosed with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) think and understand social contexts primarily from a visual stand point. Feelings of being present in their social environment are a key component to their development (Strickland, Marcus, Mesibov, & Hogan, 1996). A virtual reality environment (VRE) can provide a therapeutic setting for children with ASD to learn social skills (Ehrlich & Munger, 2012). In the present research, a pilot study was used to assess the validity of a Second Life VRE developed by the researcher (Markopoulos, 2016b) by comparing the VRE to a real life film by The National Autistic Society (2016) in the United Kingdom. Feedback from the pilot study was used to make revisions to the VRE. The validated virtual reality therapy environment (VRTE) was used in the main research study. Twenty-eight Louisiana mental health practitioners’ perceptions of the VRTE were assessed using two random order conditions. Condition A required participation in the VRTE twice, first using a laptop computer only and then using the laptop with the new 2016 Oculus Rift head-mounted display (HMD, Oculus VR, LLC, 2016). Condition B required participation in the VRTE twice, first using a laptop with the new 2016 Oculus Rift HMD and then using a Laptop alone. Four out of eight subscales from the Temple Presence Inventory (TPI) (Lombard, Weinstein, & Ditton, 2011) were used to assess practitioners’ perceptions of presence in the VRTE. Results of a repeated-measures MANOVA showed that the order of the conditions were not significantly different. Additionally, participants’ TPI total and subscales scores were significantly higher when using the HMD than when using the Laptop, as well as their likelihood of using the HMD with children diagnosed with ASD than using the Laptop. All of the correlations for participants’ age and experience with technology were insignificant except for the subscale III, engagement was significant for participants’ age. Keywords: Autism spectrum disorder, therapy, virtual reality environment, head-mounted display, temple presence inventory, presenc

Social and Non-Social Reward Processing in Autism and Autistic Traits

Belohnungen sind im Leben des Menschen von enormer Bedeutung. Es wurde vermutet, dass die zentralen sozialen Schwierigkeiten bei Autismus-Spektrum-Störungen (ASS) auf eine verminderte Reaktionsfähigkeit auf spezifische soziale Belohnungen zurückzuführen sein könnten. Die Literatur zu diesem Thema ist jedoch nicht schlüssig. Diese Dissertation umfasst vier Studien, die die Reaktionsfähigkeit auf soziale und nicht-soziale Belohnungen unter besonderer Berücksichtigung von ASS und autistischen Merkmalen untersuchen. In den Studien 1 und 2 wurden neuronale (ereigniskorrelierte Potenziale), autonome (Pupillengröße) und verhaltensbezogene (Selbstberichte und Reaktionszeiten) Indizes der Reaktion auf soziale und nicht-soziale Belohnungen bei Personen mit ASC sowie mit ausgeprägten und geringen autistischen Merkmalen untersucht. Wir stellten fest, dass ein höheres Maß an autistischen Merkmalen bei klinischen ASS und in der Allgemeinbevölkerung mit einer verstärkten neuronalen und autonomen Verarbeitung, typischen Leistungen und einer geringeren selbstberichteten Belohnungssensitivität verbunden war. Studie 3 untersuchte die Auswirkungen von sozialer Vertrautheit und Belohnungskontext auf die Pupillenreaktionen. Die Ergebnisse deuten darauf hin, dass der Belohnungswert eines positiven Reizes bei vertrauten Gesichtern höher ist und von der Assoziation zwischen Handlung und Ergebnis abhängt. Studie 4 ist eine theoretische Perspektive zum Verständnis der Multidimensionalität von Belohnungen und zum Umgang damit. In allen Studien konnte ich nachweisen, dass das Belohnungsverhalten von ASS vielfältig und atypisch, aber nicht defizitär ist. Außerdem schlage ich eine Definition von Belohnung vor, die sie von einem rein positiven Stimulus unterscheidet. Schließlich erörtere ich diese Arbeit im breiteren Rahmen der sozialneuropsychologischen Forschung und zeige Möglichkeiten auf, wie sie in künftigen Studien weiter verbessert werden kann.Rewards are immensely important in human lives. It has been suggested that the core social difficulties in autism spectrum conditions (ASC) may stem from lowered responsiveness to specifically social rewards. However, the literature on this topic is inconclusive. This dissertation includes four studies investigating reward responsiveness to social and non-social rewards with particular focus on ASC and autistic traits. Studies 1 and 2 investigated neuronal (event-related potentials), autonomic (pupil sizes) and behavioural (self-reports and reaction times) indexes of responsiveness to social and non-social rewards in individuals with ASC, and with high and low autistic traits. We observed that higher levels of autistic traits in clinical ASC and in the general population were linked to enhanced neuronal and autonomic processing, typical performance, and decreased self-reported reward sensitivity. Study 3 investigated the effects of social familiarity and rewarding context on pupillary responses. The results indicated that the reward value of a positive stimulus is higher for more familiar faces and depends on action-outcome associations. Study 4 is a theoretical perspective on understanding and working with multidimensionality of rewards. Across all studies, I provide evidence for multifaceted and atypical, but not deficient, reward responsiveness in ASC. Further, I propose a definition of reward which differentiates it from a merely positive stimulus. Finally, I discuss this work in the broader framework of social neuropsychology research and identify the ways in which it can be further improved in future studies

Editorial: Executive function(s): Conductor, Orchestra or Symphony? Towards a Trans-Disciplinary Unification of Theory and Practice Across Development, in Normal and Atypical Groups

There are several theories of executive function(s) that tend to share some theoretical overlap yet are also conceptually distinct, each bolstered by empirical data (Norman and Shallice, 1986; Shallice & Burgess, 1991; Stuss and Alexander, 2007; Burgess, Gilbert, & Dumentheil, 2007; Burgess & Shallice, 1996; Miyake et al., 2000). The notion that executive processes are supervisory, and most in demand in novel situations was an early conceptualization of executive function that has been adapted and refined over time (Norman & Shallice, 1986; Shallice, 2001; Burgess, Gilbert & Dumentheil, 2007). Presently there is general consensus that executive functions are multi-componential (Shallice, 2001), and are supervisory only in the sense that attention in one form or another is key to the co-ordination of other hierarchically organized ‘lower’ cognitive processes. Attention in this sense is defined as (i) independent but interrelated attentional control processes (Stuss & Alexander, 2007); (ii) automatic orientation towards stimuli in the environment or internally–driven thought (Burgess, Gilbert & Dumontheil, 2007); (iii) the automatically generated interface between tacit processes and strategic conscious thought (Barker, Andrade, Romanowski, Morton and Wasti, 2006; Morton and Barker, 2010); and (iv) distinct but interrelated executive processes that maintain, update and switch across different sources of information (Miyake et al., 2000). One problem is that executive dysfunction or dysexecutive syndrome (Baddeley & Wilson, 1988) after brain injury typically produces a constellation of deficits across social, cognate, emotional and motivational domains that rarely map neatly onto theoretical frameworks (Barker, Andrade & Romanowski, 2004). As a consequence there is debate that conceptual theories of executive function do not always correspond well to the clinical picture (Manchester, Priestley & Jackson, 2004). Several studies have reported cases of individuals with frontal lobe pathology and impaired daily functioning despite having little detectable impairment on traditional tests of executive function (Shallice & Burgess, 1991; Eslinger & Damasio, 1985; Barker, Andrade & Romanowski, 2004; Andrés & Van der Linden, 2002; Chevignard et al., 2000; Cripe, 1998; Fortin, Godbout & Braun, 2003). There is also some suggestion that weak ecological validity limits predictive and clinical utility of many traditional measures of executive function (Burgess et al, 2006; Lamberts, Evans & Spikman, 2010; Barker, Morton, Morrison, McGuire, 2011). Complete elimination of environmental confounds runs the risk of generating results that cannot be generalized beyond constrained circumstances of the test environment (Barker, Andrade & Romanowski, 2004). Several researchers have concluded that a new approach is needed that is mindful of the needs of the clinician yet also informed by the academic debate and progress within the discipline (McFarquhar & Barker, 2012; Burgess et al., 2006). Finally, translational issues also confound executive function research across different disciplines (psychiatry, cognitive science, and developmental psychology) and across typically developing and clinical populations (including Autism Spectrum Disorders, Head Injury and Schizophrenia – Blakemore & Choudhury, 2006; Taylor, Barker, Heavey & McHale, 2013). Consequently, there is a need for unification of executive function approaches across disciplines and populations and narrowing of the conceptual gap between theoretical positions, clinical symptoms and measurement