A 3-Month interdisciplinary Process Drama Program to Build Social Skills in Pre-Schoolers with ASD: A Feasibility Study

Objectives: To test the feasibility and effect of an interdisciplinary process drama program targeting social skill development in 3-5 year-old children with Autism Spectrum Disorder (ASD) characteristics To develop a paradigm for testing brain-behavior relationships related to social skills in these children using EEG and testing its ability to detect intervention-related changes. Background: Social skill deficits are a hallmark cause of disability in ASD. Such disability is of critical concern given the rising prevalence (1 in 54 Utah children) of ASD. [1] As children learn through social experiences, difficulty in social interactions can limit development and ability to succeed in school and eventually employment. One possible contributor to social interaction difficulties in ASD is a deficit in theory of mind (ToM), the ability to understand others\u27 perspectives, proposed to rely on memories of cognitive and emotional events that allow one to experience others\u27 situations as if they were one\u27s own. [2.3] Children with ASD have deficits in ToM [2,3] and show aberrant neural activation patterns in areas most typically activated during ToM tasks in healthy children. [4,5] An effective intervention fostering generalizable social skill development in children with ASD remains elusive. We propose to address this need with an interdisciplinary process drama intervention involving collaboration among occupational therapists (OT), theatre faculty/teachers, and speech language pathologists (SLP) to improve social interactions in preschoolers with ASD. Process drama may be an excellent medium for fostering social skill development due to the ability to create specific learning experiences in an autotelic manner [6] in which people experience the embodied cognition and emotions without conscious commitment to abstract social skill improvement goals. The scenes can emphasize social and emotional cues and explicit identification of scene-related feelings for the formation of social cognitive and emotional memories that can be recalled as the basis for later social functioning.[3] Process drama programs foster communication development in typically developing children [7] and a few studies have shown such programs enhance social skills of children aged 8-17 with ASD [8,9] However, targeting process drama intervention in preschool children may have the greatest potential for effect on ToM and subsequent social skill development. The overpruning hypothesis [10] proposes that ASD results from abnormal neural pruning in widespread neural networks, with weaker long-range connections being more vulnerable to major disruption. As neural connections strengthen through experience,[11] providing interventions targeting desired processing will strengthen associated connections making them less susceptible to pruning and resulting in preserved function. Peak synaptic density for auditory and prefrontal cortices, both involved in social skills, occurs between age 3-5 years [11], suggesting an optimal period for strengthening connections through intervention. Impact: The deficits in social skills of people with ASD significantly affect their ability to function in society. These deficits take a large toll on families and on independence and employability of the individual. Finding effective interventions to facilitate social skills would have a large impact on society by reducing disability in this prevalent population. Results: The primary goal of the proposed study is to gather preliminary data on potential utility of an interdisciplinary process drama intervention to improve social skills in children with ASD. We will address the following specific aims: 1) determine the feasibility of: a) the protocol for collecting neural activation data via EEG on preschoolers with ASD characteristics; b) conducting a 3 month, 3x/week process drama intervention program led by a collaborative team of theatre teachers, OTs and SLPs aimed at improving social skills. 2) Determine preliminary effects of this interdisciplinary intervention on: a) increasing positive social behaviors; b) changes in neural activation during social tasks

A scoping review of deictic gesture use in toddlers with or at-risk for autism spectrum disorder

Background and aims Young children use deictic gestures, such as pointing, to indicate referents in their immediate environment. Early deictic gesture use is important in facilitating the development of language. In toddlers with or at-risk for autism spectrum disorder, the emergence and use of gestures may be delayed, and deficits in deictic gesture may inform clinical practice regarding early identification, differential diagnosis, and early intervention. The aim of this scoping review was to investigate the extent to which deictic gesture use has been examined in young children with or at-risk for autism spectrum disorder ≤ 36 months of age. Methods Four databases (PubMed, PsycINFO, CINAHL, and ERIC) were comprehensively searched for relevant articles. Articles were reviewed in two phases: titles and abstracts followed by full text. Key variables related to participant/study characteristics and group differences on deictic gesture use were extracted. A narrative review was used to synthesize findings across studies. Main contribution Nineteen studies met inclusion criteria – 12 studies of toddlers with autism spectrum disorder and 7 studies of high-risk infant siblings of children diagnosed with autism spectrum disorder. Overall, toddlers with autism spectrum disorder were found to demonstrate reduced gesture use across deictic gesture types and ages compared to those with typical development. Findings were more variable when comparing toddlers with autism spectrum disorder to those with other developmental delays and in high-risk infant sibling studies. Although only measured in a limited number of studies, results suggest differences in gesture use in toddlers with autism spectrum disorder based on communicative function. Conclusions This review provides insight into the gesture use of toddlers with or at-risk for autism spectrum disorder. Results indicate the particular types of deictic gestures that may be delayed and the age ranges we might expect to observe these deficits in toddlers with autism spectrum disorder compared to those with typical development and other developmental delay groups. Results also reveal variability across studies in the measurement of gestures, and highlight where gaps remain in understanding deictic gesture use in young children with autism spectrum disorder. Implications Findings have research and clinical implications related to profiling and targeting gesture use as part of the assessment and treatment process, including identifying patterns of strength and weakness in deictic gesture use of young children with or at-risk for autism spectrum disorder

The gesture–language association over time in toddlers with and without language delays

Background and aims Young children with language delays or other factors that heighten risk for autism spectrum disorder often show reduced gesture use. In particular, deictic gestures such as pointing and showing are reported to be deficient in young children with autism spectrum disorder, and their use has been found to predict expressive vocabulary development. The first aim of this study was to examine the production of two types of gestures (deictic and conventional) for two communicative functions (behavior regulation and joint attention) across two observational contexts in a sample of 18-month-old toddlers with significant language delays compared to typical controls. The second aim was to examine if and how gesture use (type and communicative function) at 18 months is associated with later receptive and expressive language. Methods Toddlers with significant language delays ( n  = 30) or typical development ( n  = 62) were drawn from longitudinal studies of early language delay as a risk factor for autism spectrum disorder. Toddlers identified with early language delay were classified based on a diagnosis of autism spectrum disorder ( n  = 12) or non-autism spectrum disorder ( n  = 18) after an evaluation at 36 months. Gestures were coded from video recordings of the Communication and Symbolic Behavior Scales Developmental Profile–Behavior Sample and a naturalistic parent–child interaction obtained at 18 months. Language outcomes included receptive and expressive age equivalents from the Mullen Scales of Early Learning and the number of words produced on the MacArthur–Bates Communicative Development Inventories. Results At 18 months, toddlers with language delay showed reduced deictic and conventional gesture use in both the Communication and Symbolic Behavior Scales Developmental Profile–Behavior Sample and parent–child interaction compared to toddlers with typical development. Within the language delay group, toddlers with an autism spectrum disorder diagnosis at outcome also produced significantly fewer deictic gestures than those without an autism spectrum disorder diagnosis across both communicative functions and observational contexts. While all groups of toddlers gestured more in the Communication and Symbolic Behavior Scales Developmental Profile–Behavior Sample, the mean difference in gesture use between the Communication and Symbolic Behavior Scales Developmental Profile–Behavior Sample and parent–child interaction was significantly larger in toddlers with typical development than language delay for deictic gestures, as compared to the difference between the two contexts for conventional gestures. In the combined sample, a significant association was found between deictic gestures used in the Communication and Symbolic Behavior Scales Developmental Profile–Behavior Sample and change in the number of words produced from 18 to 36 months, accounting for significant demographic and developmental confounders. Conclusions Findings show that early language delay is associated with reduced deictic and conventional gestures across observational contexts. Importantly, deictic gesture use, but not conventional, was associated with the development of expressive language in toddlers with and without language delays. Implications Deictic gestures play an important role in the development of expressive language in toddlers, including those with language delays. Assessment of young children with language delays should include evaluation of types of gestures used and communicative function of gestures, with assessments utilizing communicative temptations yielding higher rates of gesture production. Directly targeting both gesture type and function in early intervention may be important in facilitating the development of language

The Early Screening for Autism and Communication Disorders: Field-testing an autism-specific screening tool for children 12 to 36 months of age.

There is a critical need for accurate screening tools for autism spectrum disorder in very young children so families can access tailored intervention services as early as possible. However, there are few screeners designed for children 18-24 months. Developing screeners that pick up on the signs of autism spectrum disorder in very young children has proved even more challenging. In this study, we examined a new autism-specific parent-report screening tool, the Early Screening for Autism and Communication Disorders for children between 12 and 36 months of age. Field-testing was done in five sites with 471 children screened for communication delays in primary care or referred for familial risk or concern for autism spectrum disorder. The Early Screening for Autism and Communication Disorders was tested in three age groups: 12-17, 18-23, and 24-36 months. A best-estimate diagnosis of autism spectrum disorder, developmental delay, or typical development was made. Analyses examined all 46 items and identified 30 items that best discriminated autism spectrum disorder from the non-spectrum groups. Cutoffs were established for each age group with good sensitivity and specificity. Results provide preliminary support for the accuracy of the Early Screening for Autism and Communication Disorders as an autism-specific screener in children 12-36 months with elevated risk of communication delay or autism spectrum disorder

Prefrontal Hemodynamics in Toddlers at Rest: A Pilot Study of Developmental Variability

Functional near infrared spectroscopy (fNIRS) is a non-invasive functional neuroimaging modality. Although, it is amenable to use in infants and young children, there is a lack of fNIRS research within the toddler age range. In this study, we used fNIRS to measure cerebral hemodynamics in the prefrontal cortex (PFC) in 18–36 months old toddlers (n = 29) as part of a longitudinal study that enrolled typically-developing toddlers as well as those “at risk” for language and other delays based on presence of early language delays. In these toddlers, we explored two hemodynamic response indices during periods of rest during which time audiovisual children's programming was presented. First, we investigate Lateralization Index, based on differences in oxy-hemoglobin saturation from left and right prefrontal cortex. Then, we measure oxygenation variability (OV) index, based on variability in oxygen saturation at frequencies attributed to cerebral autoregulation. Preliminary findings show that lower cognitive (including language) abilities are associated with fNIRS measures of both lower OV index and more extreme Lateralization index values. These preliminary findings show the feasibility of using fNIRS in toddlers, including those at risk for developmental delay, and lay the groundwork for future studies

The Early Screening for Autism and Communication Disorders: Field-testing an autism-specific screening tool for children 12 to 36 months of age

There is a critical need for accurate screening tools for autism spectrum disorder in very young children so families can access tailored intervention services as early as possible. However, there are few screeners designed for children 18-24 months. Developing screeners that pick up on the signs of autism spectrum disorder in very young children has proved even more challenging. In this study, we examined a new autism-specific parent-report screening tool, the Early Screening for Autism and Communication Disorders for children between 12 and 36 months of age. Field-testing was done in five sites with 471 children screened for communication delays in primary care or referred for familial risk or concern for autism spectrum disorder. The Early Screening for Autism and Communication Disorders was tested in three age groups: 12-17, 18-23, and 24-36 months. A best-estimate diagnosis of autism spectrum disorder, developmental delay, or typical development was made. Analyses examined all 46 items and identified 30 items that best discriminated autism spectrum disorder from the non-spectrum groups. Cutoffs were established for each age group with good sensitivity and specificity. Results provide preliminary support for the accuracy of the Early Screening for Autism and Communication Disorders as an autism-specific screener in children 12-36 months with elevated risk of communication delay or autism spectrum disorder