Mecanismos de comprensión lectora en el trastorno del espectro autista: procesos metacognitivos y función ejecutiva

This thesis aims to increase the understanding of the metacognitive processes and executive function underlying reading comprehension deficits in autism spectrum disorder (ASD). This aim was achieved using behavioural assessments and eye-tracker technology. Although the problems in reading comprehension in ASD have been broadly investigated, the reasons why they occur and the processes that are involved are still poorly understood. Chapter 1 of the thesis provides an overview of the literature related to the cognitive components that influence reading comprehension in typically developing and individuals with ASD. The next chapters present three experiments respectively exploring different components that may influence reading comprehension in ASD: inference generation (Chapter 2), reading monitoring (Chapter 3) and adaptation to reading goals (Chapter 4). In order to observe if differences in reading behaviour where present in absence of cognitive and language impairment, all the studies include children and adolescents with ASD carefully matched with individuals without ASD on chronological age, receptive oral language, nonverbal intelligence and reading speed. Chapter 2 confirmed the hypothesis that individuals with ASD and a high level of oral language show subtle differences in reading strategies compared to the control group. In order to see if differences in reading behavior could be due to top-down modulation strategies, we explored the adaptation to different instructions. Chapter 3 shows limited evidence that individuals with ASD can positively affect their ability to detect errors in reading in response to specific instructions. However, they still seemed to have a different reading pattern compared to controls showing to be less responsive to the type of error. Finally, since the error-detection task is an artificial task, with the next experiment, we further explored top-down modulation strategies using a more ecological task. Chapter 4 reveals that individuals with ASD change their reading behavior according to the reading goals differently from controls, with less adaptation of their deep-level processing strategies when necessary. Planning, measured by the Tower of Hanoi, was the only executive component that predicted the strategy change between specific reading conditions. This pattern of behavior illustrates that reading comprehension problems may be partially explained by difficulties in adjusting the reading behavior according to the task and in planning. Taken together these studies confirm the already suspected differences in the online processing of reading materials for individuals with ASD, above and beyond oral language deficits, and reveal novel cognitive sources such as metacognition and executive function that may impact reading comprehension in ASD.Esta tesis tiene como objetivo explorar el papel de los procesos metacognitivos y de la función ejecutiva en la comprensión lectora en personas con trastorno del espectro del autismo (TEA). Para ello se han desarrollado experimentos conductuales y con eye-tracker. Los problemas de comprensión lectora en TEA han sido ampliamente investigados; sin embargo, las razones por la que se producen y los procesos que están involucrados en ellos todavía han sido poco explorados. El Capítulo 1 describe los componentes cognitivos que influyen en la comprensión lectora en personas de desarrollo típico y con TEA. Los capítulos siguientes exploran tres componentes que pueden influenciar la comprensión lectora: la generación de inferencias (Capitulo 2), la monitorización de la lectura (Capitulo 3) y la adaptación a los objetivos de lectura (Capitulo 4). Para observar si las diferencias en el comportamiento lector están presentes en ausencia de discapacidades cognitivas o lingüísticas, todos los estudios incluyen niños y adolescentes con TEA cuidadosamente emparejados con un grupo de individuos sin TEA en edad cronológica, lenguaje oral receptivo, inteligencia no verbal y velocidad lectora. El Capítulo 2 demuestra que los individuos con TEA, a pesar de tener un nivel equivalente de comprensión inferencial, muestran sutiles diferencias en las estrategias lectoras en comparación con el grupo de control. Con el fin de ver si las diferencias en el comportamiento de lectura podrían ser debidas a las estrategias de modulación top-down, hemos explorado la adaptación a diferentes instrucciones. El capítulo 3 muestra pruebas limitadas de que las personas con TEA pueden modificar positivamente su capacidad de detectar errores en la lectura en respuesta a instrucciones específicas. Sin embargo, todavía parecen tener un patrón de lectura diferente en comparación con los controles. Finalmente, dado que la tarea de detección de errores es una tarea artificial, con el siguiente experimento, exploramos más las estrategias de modulación top-down usando una tarea más ecológica. El Capítulo 4 revela que las personas con TEA cambian menos su comportamiento lector de acuerdo con los objetivos de lectura, mostrando una menor tendencia a adaptar sus estrategias profundas de procesamiento a los requisitos de la tarea. La planificación, medida con la Torre de Hanoi, fue el único componente ejecutivo que predijo el cambio de estrategia entre condiciones específicas de lectura. Este patrón de comportamiento ilustra que los problemas de comprensión lectora pueden explicarse en parte por las dificultades para ajustar el comportamiento de lectura a la tarea y en la planificación. En conjunto, estos estudios confirman las ya sospechadas diferencias en el procesamiento on-line de materiales de comprensión lectura para individuos con TEA en comparación con un grupo de control, y también revelan nuevos procesos cognitivos, tales como la metacognición y la función ejecutiva, que podrían impactar en su comprensión lectora.Premio Extraordinario de Doctorado U

THE ITALIAN NETWORK FOR EARLY DETECTION OF AUTISM SPECTRUM DISORDER: RESEARCH ACTIVITIES AND NATIONAL POLICIES

Background: Well-structured monitoring system is crucial to identify interventions for children with Neurodevelopmental Disorders (NDD). Subjects and methods: The NIDA Network enrolled more than 760 at risk for NDD and typically developing infants to detect early signs of NDD. Results: The NIDA Network was born in some Italian regions to engage clinical centers in a research project. It is increasingly turning out to be a national monitoring project well integrated in the Italian National Health System policies. Conclusions: The NIDA Network activities are finalized at diagnosis and interventions to improve quality of life of children with NDD and their families

Early behavioral markers for neurodevelopmental disorders in the first 3 years of life: An overview of systematic reviews

Being able to recognize red flags for neurodevelopmental disorders (NDD) is crucial to provide timely intervention programs. This work aims to support - within a scientific framework - the construction of an instrument capable to early detect all spectrum of NDD and explore all areas of development, detect failures in typical developmental pathways and point out atypical signs at all ages. This overview of reviews provides evidence for differences in children later diagnosed with NDD compared to typically developing peers such as delays in motor, language development and temperament in the first three years of age, repetitive/stereotyped behaviors, atypicalities/delays in play, object use, attention, visual, sensory processing and social engagement in the first and second year, and difficulties in feeding and sleeping in the first year. These behaviors must be carefully observed as potential red flags for NDD. However, data of the systematic reviews are not yet useful to develop an evidence-based clinical screening. It urges to increase efforts in producing systematic reviews on early behavioral markers for each NDD. Trial registration:CRD42019137731. (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=137731)

Benefits and challenges of a personal budget for people with mental health conditions or intellectual disability: A systematic review

Personal budgets (PBs) may improve the lives of people with mental health conditions and people with intellectual disability (ID). However, a clear definition of PB, benefits, and challenges is still faded. This work aims to systematically review evidence on PB use in mental health and ID contexts, from both a qualitative and quantitative perspective, and summarize the recent research on interventions, outcomes, and cost-effectiveness of PBs in beneficiaries with mental health conditions and/or ID. The present systematic review is an update of the existing literature analyzed since 2013. We performed a systematic search strategy of articles using the bibliographic databases PubMed and PsycINFO. Six blinded authors screened the works for inclusion/exclusion criteria, and two blinded authors extracted the data. We performed a formal narrative synthesis of the findings from the selected works. A total of 9,800 publications were screened, and 29 were included. Improvement in responsibility and awareness, quality of life, independent living, paid work, clinical, psychological, and social domains, and everyday aspects of the users' and their carers' life have been observed in people with mental health conditions and/or ID. However, the PBs need to be less stressful and burdensome in their management for users, carers, and professionals. In addition, more quantitative research is needed to inform PBs' policymakers

Prevalence of co-occurring conditions in children and adults with autism spectrum disorder: A systematic review and meta-analysis.

This systematic review estimates the prevalence of co-occurring conditions (CCs) in children and adults with autism. A comprehensive search strategy consulting existing guidelines, diagnostic manuals, experts, carers, and autistic people was developed. PubMed and PsycInfo databases from inception to May 2022 were searched. PROSPERO registration: CRD42019132347. Two blind authors screened and extracted the data. Prevalence estimates for different CCs were summarized by using random effects models. Subgroup analyses were performed for age groups (children/adolescents vs adults) and study designs (population/registry-based vs clinical sample-based). Of 19,932 studies, 340 publications with about 590,000 participants were included and meta-analyzed to estimate the prevalence of 38-point prevalence, 27-lifetime, and 3 without distinction between point and lifetime prevalence. Point prevalence of developmental coordination disorder, sleep-wake problem, gastrointestinal problem, ADHD, anxiety disorder, overweight/obesity, feeding and eating disorder, elimination disorder, disruptive behavior, and somatic symptoms and related disorder were the most frequent CCs. Prevalence differed depending on the age group and study design. Knowing specific CCs linked to autism helps professional investigations and interventions for improved outcomes

Autistic Adult Services Availability, Preferences, and User Experiences : Results From the Autism Spectrum Disorder in the European Union Survey

There is very little knowledge regarding autistic adult services, practices, and delivery. The study objective was to improve understanding of current services and practices for autistic adults and opportunities for improvement as part of the Autism Spectrum Disorder in the European Union (ASDEU) project. Separate survey versions were created for autistic adults, carers of autistic adults, and professionals in adult services. 2,009 persons responded to the survey and 1,085 (54%) of them completed at least one of the services sections: 469 autistic adults (65% female; 55% 50% responded "don't know"). Five of seven residential services features recommended for autistic adults were experienced byPeer reviewe

Intervention Services for Autistic Adults: An ASDEU Study of Autistic Adults, Carers, and Professionals' Experiences

The Autism Spectrum Disorders in the European Union (ASDEU) survey investigated local services' use experiences of autistic adults, carers and professionals with interventions for autistic adults. The majority of the 697 participants experienced recommended considerations prior to deciding on intervention and during the intervention plan and implementation. Psychosocial interventions were the most commonly experienced interventions, while pharmacological interventions NOT recommended for core autistic symptoms were reported by fairly large proportions of participants. Family interventions were experienced slightly more commonly by carers than adults or professionals. Less than the 26% of autistic adult responders who had experienced challenging behaviors reported receiving an intervention to change them. These results provide insights for improving gaps in service provision of interventions among autistic adults

Autistic Adult Health and Professional Perceptions of It: Evidence From the ASDEU Project

The Autism Spectrum Disorders in the European Union (ASDEU) survey investigated the knowledge and health service experiences of users and providers to generate new hypotheses and scientific investigations that would contribute to improvement in health care for autistic adults. An online survey designed for autistic adults, carers of autistic adults, and professionals in adult services was translated into 11 languages and distributed electronically by organizations and in-country adult service facilities in 2017; 522 autistic adults, 442 carers, and 113 professionals provided answers to the health questions. Professionals, the majority in non-medical services, appeared to be poorly informed about whether certain co-occurring conditions were more frequent in autistic adults than typical adults-especially some medical conditions, suicide attempts, accidents, and pain. A minority of autistic adults reported preventive health behaviors such as routine health check-ups. The majority of users and providers expressed the desire to make health care services more user-friendly for autistic adults. Among the three groups, <20% of responders knew an organization or clinician which has developed a way to monitor health, and prevent poor health, that works well for adults on the autism spectrum. The results point to means for better management of co-occurring conditions associated with autism in adulthood in order to reduce hospital admissions and potential areas of improvement in health and social services for autistic adults. Specifically, efforts should be focused on (1) professionals' education on risks for co-occurring conditions in autistic adults; (2) promoting preventive health behaviors; (3) making services user-friendly for autistic adults and their families; and (4) encouraging knowledge of good local services

Real-World Experiences in Autistic Adult Diagnostic Services and Post-diagnostic Support and Alignment with Services Guidelines: Results from the ASDEU Study

Research providing an evidence-base for autistic adult services is sparse. The Autism Spectrum Disorders in the European Union (ASDEU) network implemented an on-line survey to determine gaps in autistic adult diagnostic evaluation and post-diagnostic support services. More than 55% in all groups experienced most of the recommended features for diagnostic evaluation for autistic adults. In contrast, < 2% of adults or carers, and < 21% of professionals experienced each of the recommended features for post-diagnostic support. In contrast to 61% of professionals, only about 30% of autistic adults and carers had knowledge of good local services models for autism diagnosis in adulthood. There are major differences between good practice guidelines for diagnostic and post-diagnostic care for autistic adults, and what is actually experienced by services users and professionals

Executive function is associated with antisocial behavior and aggression in athletes

Poor executive function has been linked to increased antisocial and aggressive behavior in clinical and nonclinical populations. The present study investigated the relationship between executive and nonexecutive cognitive function and antisocial behavior in sport as well as reactive and proactive aggression. Cognitive function was assessed in young adult male and female athletes using the Cambridge Neuropsychological Test Automated Battery (CANTAB). Antisocial behavior in sport and aggression were assessed via self-report instruments and were found to be positively correlated. Executive function (but not nonexecutive function) scores were negatively correlated with both self-reported antisocial behavior and aggression in males but not females. Our findings suggest that prefrontal deficits among male athletes could contribute to poor impulse control and difficulty in anticipating the consequences of their antisocial and aggressive behavior