University of Missouri

When Sara Estrapala started her career as a high school paraeducator supporting students with disabilities such as autism, down syndrome, learning disorders and challenging behaviors, she quickly recognized a challenge — her teenage students desire to make their own decisions and their teachers’ struggle to keep them engaged and following directions.

Now an assistant research professor in the University of Missouri College of Education and Human Development, Estrapala is leading a four-year, $519,939 early career development and mentoring grant aimed at increasing academic engagement and decreasing disruptive behavior by empowering select students to self-regulate their own behavior.

“The interventions that teachers provide to support high school students might not be sufficient for their needs, because students want an opportunity to make their own decisions and have a say in anything that they decide to do,” Estrapala said. “Ultimately, we want the students to have the skills they need to increase academic engagement and decrease their disruptive behaviors so that they can access the school curriculum.” 

To test the intervention, approximately 50 public high school students from Jefferson City, Hallsville and Fulton will participate. The students will first set goals on how they want to improve, whether that is paying closer attention to the teacher or following directions better. Then, they will self-monitor and self-evaluate their goal progress using a self-monitoring application called I-Connect.

After downloading I-Connect, the students will receive periodic alerts with prompts to determine whether they are using goal-oriented behaviors, such as paying attention or participating in classwork. Additionally, the app will graph students’ progress, which the students, teachers, and support staff can analyze to track improvements.

Estrapala will be mentored by Erica Lembke, a professor of special education at MU, and by Howard Wills, a professor at the University of Kansas.

“We need to leverage that developmental need for students to make independent decisions and have a say in what they want to do, and I want to combine that with some evidence-based practices that we already know work, such as goal-setting, self-monitoring and self-evaluation,” Estrapala said. “Adults often feel like they know what is best for the students, but going forward, let’s ask the students themselves what their goals are and then have them go through a process of learning about their own behavior and how to change it in a systematic way that can be helpful in the classroom.” 

A young participant in the study completes an eye-tracking test in Delhi, India, 23 March 2018 CREDIT University of Reading

Children with autism and related neurodevelopmental disorders in India can be successfully identified by community healthcare workers using a low-cost app, a study has found.

The results, published today (Friday 14 July) in Autism, could open the door to help millions of children with autism spectrum conditions to get earlier screening quickly and inexpensively, leading to life-changing support.

Researchers from India, the UK and US tested the app with 131 two- to seven-year-olds living in low-resource neighbourhoods of Delhi, India.

The tests were carried out at the homes of the children, by non-specialist healthcare workers, educated to high school level, using the research team’s app, called START (Screening Tools for Autism Risk using Technology).

Through a series of simple games, questions, images and activities on a tablet computer – such as popping bubbles and looking at patterns and images – the app measured the social preference, sensory interests and motor skills of the children.

Screen screening

The app was 86% accurate in identifying children with any neurodevelopmental disorders, and 78% accurate in specifically identifying autism. This performance is significantly higher than standard screening assessments for neurodevelopmental disorders used by non-specialists.

Professor Bhismadev Chakrabarti, director of the Centre for Autism at the University of Reading’s School of Psychology and Clinical Language Sciences, led the study. He said the results could help faster identification of children with autism and other neurodevelopmental disorders, in all parts of the world.

 “Autism is diagnosed by highly trained professionals, but most autistic people live in parts of the world that harbour few or no such autism specialists, and with little autism awareness,” he said.

“So many autistic people go undiagnosed, misdiagnosed or misunderstood, so we designed the START app to identify autism and related conditions anywhere.

“The START app puts a successful screening tool for autism and related conditions into the hands of the people already working in communities for children’s health.”

Games and questions

The app makes use of a series of tests that measure different domains of behaviour associated with atypicalities in autism. Children with neurodevelopmental conditions preferred looking at geometric patterns rather than social scenes, were fascinated by predictable, repetitive sensory stimuli, and had more trouble completing precise tasks with their hands.

The app also included questions for parents, combining all the scores to help distinguish autistic from non-autistic children.

The families and healthcare workers using the app said START was easy to use, fun for children to take part in, and could be used in family homes even with background noise and distractions.

Dr Teodora Gliga, associate professor at the School of Psychology, University of East Anglia, a co-author of the study, said: “This work gives us hope that we could one day provide timely objective diagnosis of autism, wherever this is needed, regardless of financial or cultural barriers.”

Researchers from the Universitat Oberta de Catalunya (UOC) and Parc Taulí University Hospital have developed a mobile application that compiles and presents valuable pieces of information and advice for people who interact with children or adults with autism spectrum disorder (ASD). The content is drawn from an in-depth analysis of scientific evidence and the clinical experience of professionals who treat people with this neurodevelopmental disorder on a daily basis. The director of the UOC’s eHealth Center, Marta Aymerich, is a member of the eHealthLab, the research group at the UOC Faculty of Health Sciences that designed the new app, which was “created to help address the lack of tools for interacting and communicating with people with ASD”.

Available on Android and iOS devices, the TEAppAutism app consists of a series of videos featuring accredited professionals from Parc Taulí that could prove tremendously useful for family members, friends and educators of people with ASD. These videos can also serve as a vital resource for healthcare, education and human resource professionals who treat or support these individuals, as well as for researchers carrying out studies on the condition. The AUTAPP project under which the app was developed also involved researchers from the UOC’s Faculty of Health Sciences and Faculty of Computer Science, Multimedia and Telecommunications. According to Aymerich, “this application’s greatest value lies in the fact that it was created together with end users, who guided us until we achieved a tool that we hope will be very useful.”

The challenges of research into psychosocial interventions

The researchers performed a systematic review of scientific papers on psychosocial interventions for ASD published within the last ten years. Their findings revealed a significant number of studies with room for improvement in terms of methodological quality. In fact, after having analysed more than 400 papers, only 30 were found to meet quality criteria comparable to those in other health science disciplines.

Aymerich said that “due to the complexity and stigma of mental health problems, research has not been able to advance as quickly as it has in other fields, nor has it received the same amount of funding. That plus difficulties recruiting volunteers and isolating the effects of psychosocial interventions from other factors are the challenges for research in this field.”

Five keys to furthering research

The UOC researchers lay out a series of methodology-related recommendations for ensuring rigorous, representative and more valid research.

One core recommendation is to form groups that are more homogeneous in terms of cognitive ability, but more diverse as far as gender and other social factors are concerned. Some of the studies looked at in the review had only male participants.

They also recommend using blinding and randomization, i.e. well-blinded control groups and randomly assigned participants who are unaware of whether they are receiving treatment or not. In addition, they advise professionals to consider the possibility of splitting participants into groups where clinical dynamics differ as regards the duration and frequency of the same psychosocial intervention, in order to determine which option may be more effective. In this line, they also suggest implementing follow-up programmes that last at least a year to ascertain whether a one-off treatment is enough or if the treatment needs to be repeated over time to ensure its efficacy.

Finally, they call on researchers to establish international consensus on the tests for diagnosing ASD and the tools for assessing its progression in clinical research settings. According to Aymerich, “the use of standardized research methodologies will help to build international consensus around which diagnostic tools for clinical ASD research enable adequate cross-study comparisons.”

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The efficacy of psychosocial interventions in people with ASD

Autism spectrum disorder is a neurodevelopmental disorder. Its main symptom involves difficulties communicating and engaging in social interaction, although this varies depending on the severity of the condition. While the exact cause of ASD is still unknown, there is a strong genetic component. Evidence also shows that early diagnosis and prompt treatment of the difficulties mentioned can improve prognosis in terms of quality of life of patients and their families. It was for this reason that the AUTAPP project set out to systematically review the corpus of scientific evidence on the efficacy of psychosocial therapies, with a view to supporting clinical decision-making.

By analysing randomized controlled trials involving at least ten patients with ASD who were receiving some form of psychosocial therapy in a health centre as a primary intervention (and not as an adjunct to drugs or technological solutions), the researchers were able to draw several conclusions. For instance, they found that most of these studies (20 out of the 30 selected) addressed communication and social interaction, and that the target interventions, such as PEERS© and social skills training, were effective in improving the social interaction and communication skills of people with ASD. They also found that there were far fewer randomized controlled trials (only four) conducted to reduce the persistence of repetitive behaviours, and that interventions such as cognitive behavioural therapy and sensory integration therapy with sensory-motor stimulation did indeed lead to improvements.

Children with autism have memory challenges that hinder not only their memory for faces but also their ability to remember other kinds of information, according to new research from the Stanford School of Medicine. These impairments are reflected in distinct wiring patterns in the children’s brains, the study found.

The research, which will be published July 10 in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, clarifies a debate about memory function in kids with autism, showing that their memory struggles surpass their ability to form social memories. The finding should prompt broader thinking about autism in children and about treatment of the developmental disorder, according to the scientists who conducted the study.

“Many high-functioning kids with autism go to mainstream schools and receive the same instruction as other kids,” said lead author Jin Liu, PhD, a postdoctoral scholar in psychiatry and behavioral sciences. Memory is a key predictor of academic success, said Liu, adding that memory challenges may put kids with autism at a disadvantage.

The study’s findings also raise a philosophical debate about the neural origins of autism, the researchers said. Social challenges are recognized as a core feature of autism, but it’s possible that memory impairments significantly contribute to the ability to engage socially.

“Social cognition cannot occur without reliable memory,” said senior author Vinod Menon, PhD, the Rachael L. and Walter F. Nichols, MD, Professor and a professor of psychiatry and behavioral sciences.

“Social behaviors are complex, and they involve multiple brain processes, including associating faces and voices to particular contexts, which require robust episodic memory,” Menon said. “Impairments in forming these associative memory traces could form one of the foundational elements in autism.”

Comprehensive memory tests

Autism, which affects about one in every 36 children, is characterized by social impairments and restricted, repetitive behaviors. The condition exists on a wide spectrum. The most severely affected individuals cannot speak or care for themselves, and about one-third of people with autism have intellectual impairments. On the other end of the spectrum, many people with high-functioning autism have a normal or high IQ, complete higher education and work in a variety of fields.

Research has shown that children with autism have difficulty remembering faces. Some research has also suggested that children with autism have broader memory difficulties, but these studies were small and did not thoroughly assess participants’ memory abilities. They included children with wide ranges of age and IQ, both of which influence memory.

To clarify the impact of autism on memory, the new study included 25 children with high-functioning autism and normal IQ who were 8 to 12 years old, and a control group of 29 typically developing children with similar ages and IQs.

All participants completed a comprehensive evaluation of their memory skills, including their ability to remember faces; written material; and non-social photographs, or photos without any people. The scientists tested participants’ ability to accurately recognize information (identifying whether they had seen an image or heard a word before) and recall it (describing or reproducing details of information they had seen or heard before). The researchers tested participants’ memory after delays of varying lengths. All participants also received functional magnetic resonance imaging scans of their brains to evaluate how regions known to be involved in memory are connected to each other.

Distinct brain networks drive memory challenges

In line with prior research, children with autism had more difficulty remembering faces than typically developing children, the study found.

The research showed they also struggled to recall non-social information. On tests about sentences they read and non-social photos they viewed, their scores for immediate and delayed verbal recall, immediate visual recall and delayed verbal recognition were lower.

“The study participants with autism had fairly high IQ, comparable to typically developing participants, but we still observed very obvious general memory impairments in this group,” said Liu, adding that the research team had not anticipated such large differences.

Among typically developing children, memory skills were consistent. If a child had good memory for faces, he or she was also good at remembering non-social information.

This wasn’t the case in children with autism. “Among children with autism, some kids seem to have both impairments and some have more severe impairment in one area of memory or the other,” Liu said. 

The researchers had not expected this result, either.

“It was a surprising finding that these two dimensions of memory are both dysfunctional, in ways that seem to be unrelated — and that maps onto our analysis of the brain circuitry,” Menon said.

The brain scans showed that, among the children with autism, distinct brain networks drive different types of memory difficulty.

For children with autism, the ability to retain non-social memories was predicted by connections in a network centered on the hippocampus — a small structure deep inside the brain that is known to regulate memory. But face memory in kids with autism was predicted by a separate set of connections centered on the posterior cingulate cortex, a key region of the brain’s default mode network, which has roles in social cognition and distinguishing oneself from other people.

“The findings suggest that general and face-memory challenges have two underlying sources in the brain which contribute to a broader profile of memory impairments in autism,” Menon said.

In both networks, the brains of children with autism showed over-connected circuits relative to typically developing children. Over-connectivity — likely due to too little selective pruning of neural circuits — has been found in other studies of brain networks in children with autism.

New autism therapies should account for the breadth of memory difficulties the research uncovered, as well as how these challenges affect social skills, Menon said. “This is important for functioning in the real world and for academic settings.”

Older autistic adults have a significantly higher risk of injury, especially self-inflicted, and physical conditions such as type 2 diabetes, anaemia, heart failure and COPD. This is according to a large-scale registry study from Karolinska Institutet in Sweden published in The Lancet Healthy Longevity.

­“We found an increased disease burden in middle-aged and older autistic adults, both men and women, irrespective of the presence of intellectual disability,” says Shengxin Liu, doctoral student at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet. “Our findings point up the need to improve the support and care of older autistic adults.”

In the population-based study, the KI researchers linked different national registers and compared the risk for five types of injury and 39 age-related physical conditions in people over the age of 45. Of the four million-plus people born between 1932 and 1967, 1,930 women and 3,361 men had an autism diagnosis. For each physical condition, they evaluated the 25-year cumulative incidence and the relative risk in autistic people compared with non-autistic people of the same sex and age.

Seven-fold risk of self-harm

Autistic people had a higher risk of four of five studied injures, for which self-harm accounted for the greatest risk increase, followed by poisoning, falls and other physical injuries.

“The risk of self-harm was worryingly high, a full seven times higher than in non-autistic people,” says Liu. “Reasons behind this remain largely unknown. One possible contributing factor could be mental health conditions that commonly co-occur with autism, such as anxiety and depression.”

The researchers also found a risk increase for 15 physical conditions. For example, autistic people had three times the risk of anaemia and glucose dysregulation and almost double the risk of heart failure, type 2 diabetes, and COPD (chronic obstructive pulmonary disease).

Multiple contributory factors

“We now need to find out the cause of these associations and how they are affected by factors such as biology, age when diagnosed with autism, psychotropic treatment and psychosocial environment,” says the study’s last author Mark Taylor, senior researcher at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet. “But most importantly, researchers, health services and policymakers need to cooperate to make sure that older autistic adults have a better quality of life.”

Since this was an observational study, no causal relationships can be ascertained, and the researchers were not able to take into account variables such as socioeconomic status. Furthermore, given that the study used Swedish registers, it is difficult to make generalisations to other countries.