Disengagement, Shifting and Engagement of Attention in Children And Adolescents With Autism Spectrum Disorder (ASD)

The present study examined the disengaging, shifting, and engaging abilities of children and adolescents with ASD compared to age- and cognitive ability-matched typically developing (TD) peers. Previous research has found that individuals with ASD have difficulty disengaging and shifting their attention or what has been termed sticky attention. This sticky attention has been hypothesized as a general deficit of the broader ASD phenotype, and subsequently as an aid in the early identification of ASD. However, researchers to date have only examined endogenous and exogenous attention abilities, which pertain to when the cue to shift and disengage attention is externally provided. Given that this type of attention may not be representative of everyday attention situations, in the present study I investigated autogenous attention abilities, which relate to when the cue to shift and disengage is internally generated. Due to the implications of attention on later social and language development and repetitive behaviour, a richer understanding of attention abilities in children and adolescents with ASD is critical. Using a novel eye-tracking task, an aim of the present study was to determine whether sticky attention is a core deficit of ASD or whether it is task dependent by evaluating performance on two types of attention tasks: exogenous (attention that is externally cued) and autogenous (attention that is internally cued). Additionally, I examined how the type of stimuli, level of complexity of the stimuli, and participants engagement effect attention abilities. Lastly, I determined if demographic and clinical factors predict attention abilities in children with ASD and TD children. Overall, findings from the present study do not support previous research indicating inferior disengaging and shifting abilities in children with ASD, as attention abilities in the present study varied based on attention type, and other task-dependent variables, including trial type and task stimuli. Although only chronological age and verbal cognitive ability predicted performance, engagement in the trial was associated with attention abilities, regardless of group. Given the numerous variables that predicted disengaging and shifting abilities in children with ASD, the current study does not provide support for the hypothesis that sticky attention is a core deficit of ASD, and thus its potential as a diagnostic marker in this population is questionable

Automatization and Retention of Literacy Skills in Adult Learners

Findings from recent efficacy studies comparing literacy program types suggest that struggling adult readers often make limited to moderate gains across varied types of literacy interventions, with no specific approach consistently surpassing others to date. An alternative to comparing program types is to investigate whether there are specific characteristics or skills that vary by individual that can predict higher gains and skill retention across program type. Using an experimental, prospective, longitudinal design, the present study examined the role of automatization (over-learning) of component skills involved in reading during participation in general literacy programs. On average, participants in the study gained the equivalent of one full reading grade-level after participation in programs for six months. The degree of automatization of reading skills was found to be the strongest predictor of gains made during programs; a measure of automatization was also the strongest predictor of subsequent retention of skills, months later at follow-up testing. Implications for adult literacy practitioners and directions for future research related to skill retention are discussed

Prescriptions for Alpha Agonists and Antipsychotics in Children and Youth with Tic Disorders: A Pharmacoepidemiologic Study

Background: Trends in the use of antipsychotics and alpha agonists for the treatment of tic disorders in Canadian children, and how closely these trends align with evidence-based guidelines on the pharmacotherapy of tic disorders, have not been explored. Methods: IQVIA’s Canadian Disease and Therapeutic Index, a survey-based data set, was used to identify prescription patterns by physicians. Respondents recorded all patient visits during a 48-hour period in each quarter of the year, including patient age, gender, drug recommendation and therapeutic indication. Recommendations for alpha agonists and antipsychotics from 2012 to 2016 were analysed for children and adolescents with tic disorders. Results: Risperidone and clonidine were the most commonly recommended medications for tic disorders over the study period, with 36,868 and 35,500 recommendations in 2016, respectively. Recommendations for clonidine increased over the study period, whereas those for risperidone decreased. Guanfacine (approved in Canada in 2013) was used less frequently than clonidine. Clonidine was more frequently recommended than antipsychotics in children younger than 6, in whom antipsychotic recommendations were uncommon. Aripiprazole was the second most commonly recommended antipsychotic for tic disorders, with 22,892 recommendations in 2016. Of the first-generation antipsychotics, pimozide was most commonly recommended (11,334 recommendations in 2016); haloperidol was infrequently recommended. Discussion: The trends observed are in line with guideline recommendations reflected in the decreasing use of risperidone, and the growing use of clonidine and guanfacine. The growing use of aripiprazole is likely due to emerging evidence from clinical trials supporting its efficacy for tics. Recommendations for pimozide and haloperidol were limited, likely due to the greater adverse effects associated with these medications

Laying the Foundation for Policy: Measuring Local Prevalence for Autism Spectrum Disorder

Claims have been made that families with children living with autism spectrum disorders (ASD) have been migrating to Alberta because of higher funding available for ASD supports compared to other provinces. The legitimacy of these claims, along with many others about the adequacy or inadequacy of funding for supporting persons living with ASD, has not been evaluated because we simply don’t know how many people in Alberta are living with ASD. Typically in Canada, ASD prevalence is reported in national figures, based on international estimates. Canadian prevalence estimates for ASD are needed. With no national surveillance system in place, national estimates are difficult to determine. In addition, such broad measurements are problematic as they may not adequately inform the service delivery needs for specific jurisdictions. A new study shows that 1,711, or 1 in 94, school age children in the Calgary region have an ASD diagnosis. As this number matches what is often reported for the national prevalence of ASD, it suggests that Alberta’s relatively higher ASD funding is not inducing in-migration of families seeking better support. The data also show that the prevalence is higher in elementary-grade children, with a diagnosis in one of every 86 children. In the senior grades, there are significantly fewer students with ASD diagnoses, specifically within the Calgary Board of Education. There is no evident reason for diagnoses to seemingly dematerialize in the older grades. These students could be dropping out or choosing home-schooling in greater numbers. Possibly there has been an increase in prevalence. These prevalence estimates help to inform the demand for special-needs services within the local school system. In addition, there is growing concern that upon graduation there is a “support cliff” resulting from a less systematized, less generous support system available for adults with neurodevelopmental disability. Families that need support for ASD face enough challenges; it is critical for policy-makers to be aware of the extent of the situation in their own jurisdiction so as to develop the right kinds of supports for these families

Impact of clinical subtypes of preterm birth on child health and development

Introduction Preterm birth (birth <37 weeks of gestation) is common. While the clinical conditions leading to preterm birth are heterogeneous, most studies examining the short- and long-term consequences of preterm birth on child health and development, only consider the gestational age at delivery, and not the underlying mechanism of preterm birth. Objectives and Approach Maternal hospitalization and perinatal data for deliveries occurring in Alberta, Canada in 2004, 2009, and 2014 were linked to identify underlying mechanisms for delivery (i.e., infection/inflammation (I/I), placental dysfunction (PD), both, or neither). Linked hospitalization, emergency department, and physician claims data were used to assess child health outcomes up to age 10. Chi-square tests were used to assess differences in the absolute rate of each outcome stratified by gestational age at delivery and underlying mechanism for delivery. Logistic regression was used to assess relative differences following adjustment for confounders compared to term infants without exposure to I/I or PD. Results A total of 134,424 children were included in the analysis. For preterm births occurring <32 weeks of gestation, no differences were observed in child health outcomes based on the underlying mechanism of preterm birth. However, infants born at 32-33 weeks following PD compared to I/I had significantly higher odds (PD:69.1%, OR=29.7, 95% CI:25.7-34.2 vs. I/I:47.2%, OR=18.7, 95% CI:16.8-20.9) of neonatal morbidity; while those born at 34-36 weeks had increased odds of neonatal morbidity (PD:21.1%, OR=5.1, 95% CI: 4.7-5.5 vs. I/I:16.2%, OR=3.7, 95% CI:3.4-3.9) and developmental disabilities (PD:3.3%, OR=2.2, 95% CI:1.8-2.6 vs. I/I:1.6%, OR=1.7, 95% CI:1.4-2.0). No differences were observed in mortality by sub-type of preterm birth; however, as expected perinatal mortality rates were significantly more common in preterm than term births. Conclusion/Implications Both the short- and long-term outcomes of preterm birth differ by the underlying mechanism leading to preterm delivery. Having a clearer prognosis for infants born preterm may promote the use of clinical interventions earlier for children at increased risk, leading to improved child health and development

Cross-Sectional Study Protocol for the COVID-19 Impact Survey of Mothers and Their 7–11 Year Old Children in Alberta, Canada

Objectives: Our aim is to understand the effect of the COVID-19 pandemic on families who have been followed longitudinally in two cohorts studied in Alberta, Canada. We will examine household infections during the COVID-19 pandemic, financial impact, domestic violence, substance use, child school and daily life and relationships in the home. We will identify risk and protective factors for maternal mental health outcomes using longitudinal data that can inform policy and government resource allocation in future disasters.Methods: Mothers who are currently participating in two longitudinal studies, Alberta Pregnancy Outcomes and Nutrition (APrON; N = 1,800) and All Our Families (AOF: N = 2,534) were eligible to participate. Mothers were invited to complete the baseline COVID-19 Impact Survey (20–30 min) within 4 months of March 15, 2020, which was when the province of Alberta, Canada, implemented school closures and physical-distancing measures to prevent the spread of COVID-19. Mothers were asked to report on their own, their child's and their family's functioning. Mothers were re-surveyed at 6 months after completion of the initial COVID-19 Impact Survey, and will be re-surveyed again at 12 months.Results: Responses from participants in both cohorts will be examined in harmonized analyses as well as separately. Descriptive, multivariable analysis will be undertaken to examine risk and resiliency over time and factors that predict mental health and well-being.Conclusions: This study will provide timely information on the impact of COVID-19 for Albertan families. It will identify risk and protective factors for mental health and well-being among contemporary urban families supported by a publicly funded health care system to inform allocation of resources to support those most vulnerable during a global pandemic

Canadian Mapping of Postsecondary Supports for Autistic Students

Background. Many autistic students have a variety of strengths and the desire to succeed in postsecondary education. Nonetheless, most autistic students report not receiving adequate support in postsecondary education to ensure their success. Students also report difficulty in navigating complex institutional systems. We conducted an environmental scan of autism-specific supports (e.g., website information, transition programs, peer mentoring) available to autistic students within Canada’s publicly-funded postsecondary institutions. We also examined distribution of autism-specific supports across institutional type (i.e., university, junior college, technical/vocational) and geographic region. Method. A Boolean search strategy was used to collect data from institutional websites. Results. Of the 258 publicly-funded postsecondary institutions in Canada, only 15 institutions (6%) had at least one support. Of the 15 institutions identified, the most common autism-specific support included information on the institution’s website (67%), followed by transition to university support (47%), social group(s) (33%), peer mentoring (27%), specialist tutoring and support with daily living (20%), transition to employment support (13%), and student-led societies and autistic student advocate (7%). In general, universities and institutions in Central Canada (i.e., Ontario, British Columbia) had a disproportionate number of supports. Conclusions. There are promising advances with respect to autism-specific supports in post-secondary institutions across Canada. We recommend further research to better understand how students access these supports and more comprehensive evaluations of such supports, specifically informed by collaborations with autistic students

Spontaneous strategy use in children with autism spectrum disorder: The roles of metamemory and language skills

Metamemory, or beliefs about one’s own memory capabilities, knowing what you know, and don’t know, has frequently been linked to the spontaneous use of rehearsal strategies in typically developing children. However, limited research has investigated mnemonic strategy use, metamemory, or the relationship between these two cognitive processes in children with autism spectrum disorders (ASDs). The current study examined the relative strength of metamemory knowledge and language skills as predictors of rehearsal use and memory performance in individuals with ASD. Twenty-one children with ASD and 21 children in a combined comparison group were matched on chronological and verbal mental age. Over two sessions, participants completed a serial recall task, a language measure, and a metamemory questionnaire. Children were classified as rehearsers/non-rehearsers based on behavioral observations and/or verbal reports of strategy use.As expected the comparison group had a significantly higher proportion of rehearsers than the ASD group. However, spontaneous rehearsers performed significantly better on the serial recall task than non-rehearsers, regardless of group membership. Children in the comparison group had a higher mean total score on the metamemory questionnaire than the ASD group. However, when examined by rehearsal use, participants classified as rehearsers, regardless of diagnostic group, scored significantly higher on the metamemory questionnaire than non-rehearsers. Finally, across groups, hierarchical regression analyses identified both metamemory and language proficiency as significant predictors of rehearsal strategy use. The fact that the predictors showed the same relationship across groups implies that metamemory and language proficiency, while separate entities, are both fundamental underlying skills contributing to the emergence of rehearsal strategies, and that the results are likely generalizable to other populations with developmental challenges