Fostering Friendship

Background: Social communication (SC) includes the use and interpretation of verbal and non-verbal messages within a social context and thus requires more than knowledge of language. Social communication skills are essential for connecting and engaging with others, and SC deficits are often associated with emotional and behavioral problems. There is a lack of feasible instruments for assessing SC skills in individuals with intellectual disability (ID).Methods: A questionnaire on social communication in adults with ID (QSC-ID) comprising 20 Likert-scaled items was developed and completed on behalf of participants (n = 52) from three Austrian therapeutic living communities for people with ID and deafness by their living- and working-facility key caregivers. The sample of adults with hearing loss was considered ideal for the development of a measure of SC that is not restricted to a specific communication mode or overly related with language skills.Results: The preliminary results showed high construct validity. Correlations were high between SC and language, social skills, and severity of autism spectrum disorder (ASD), moderate between SC and adaptive skills, and non-verbal intelligence and, as expected, low between SC and motor skills. Interrater reliability was found to be good or at least acceptable for all items. Total raw scores were well-distributed over the whole range—Cut-offs based on the 10th and 20th percentile are suggested to identify atypical and borderline SC skills. Caregiver feedback and completeness of data suggest that the questionnaire is highly feasible.Conclusion: Questionnaire on social communication in adults with ID is an easy-to-use caregiver-reported questionnaire for use with individuals with mild to severe forms of ID. Initial testing of validity looks promising. Further validation in populations with typical hearing is required. Due to substantial correlations between SC and structural language skills the calculation of specific SC cut-offs for different levels of linguistic skills should be considered when sufficient data is available.

Autism in DSM-5

The study examines the effectiveness of the iPad application "AutisMate" in promoting the modeling of social communication and social interaction skills in a 12 year-old boy with Autism Spectrum Disorder (ASD). The study uses a single-subject, embedded, case study design. It calls attention to the use of assistive technology in school settings for students with Autism Spectrum Disorder. The themes explored are the participant’s independence, his social communication skills, and social interaction skills. A late theme was the participant’s non-compliant behavior in math class. Researchers found that many factors could have affected the difference on the two measures Gilliam Autism Rating Scale and Social Communication Questionnaire from pre- to post-tests, and further research is needed. There were no conclusive results that "AutisMate" had a relationship with the boy’s social interaction and communication skills.

Social communication in autism spectrum disorder not improved by Theory of Mind interventions.

BackgroundSensory processing dysfunction (SPD) is a salient feature of autism spectrum disorder (ASD) that has garnered substantial clinical and research attention. Individuals with ASD often exhibit atypical responses to sensory stimuli, including hypersensitivity, hyposensitivity, and seeking behaviors across multiple modalities. These sensory challenges frequently contribute to the disorder’s core symptoms, influencing social interactions, communication abilities, and repetitive behaviors. However, the precise relationship of SPD with ASD characteristics is not well understood. This study aimed to identify the association between SPD behaviors and regression of milestones, severity of ASD, and age of children with ASD. This observational study was conducted on 112 ASD patients (3–16 years, 6.88 SD ± 3.18). The inclusion criteria for ASD patient recruitment required an ASD diagnosis by a healthcare professional, based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). After signing an informed written consent form, the parents and therapists filled out Winnie Dunn’s Short Sensory Profile (SSP) questionnaire. The data collection included sensitivities on tactile, oral/olfactory, vestibular, proprioception, visual/auditory inputs, and energy profiles of children with ASD, gauged as a typical performance, probable difference, and definite difference using a Likert scale.ResultsThis study highlights the significant association between SPD and ASD factors, such as milestones regression (MR), severity of ASD, and age of patients. Key findings include significant associations between MR and vestibular dysfunction, visual/auditory, and auditory filtering. The study also indicated a significant association between the severity of ASD (CARS scores) and tactile dysregulation (p < 0.001). Furthermore, the age of the patients was significantly correlated with vestibular, visual/auditory processing, auditory filtering, and energy profiles of the ASD patients (p < 0.001).ConclusionsThese findings can be utilized to understand the pattern of sensory challenges associated with ASD factors. They may assist practitioners in developing targeted interventions, potentially reducing costs and intervention time while improving outcomes for individuals with ASD.

Traditional gamified interventions and serious games have been widely employed by therapists and researchers working with people with autism spectrum disorder. Recent studies have also indicated a trend towards technology-based gamification for training behavioral and social skills in autistic people. Nevertheless, the effectiveness of these gamified interventions in enhancing social interaction and communication outcomes among autistic people remains unclear. This systematic review and meta-analysis of existing gamified interventions focused on people with autism spectrum disorder aimed to provide an overview of commonly used gamification elements and features for enhancing their social interaction and communication outcomes. A total of 11 bibliographic databases were systematically searched from inception to April 2024. Experimental studies, including but not limited to randomized controlled trials, quasi-experimental studies (e.g., non-randomized studies, pre-post studies), and pilot studies. Medical Subject Heading terms, keywords, and free words such as 'ASD', 'gamification', and 'social interaction and communication' were used for the search. The extracted data were subjected to a narrative synthesis, and the study outcomes were subjected to a meta-analysis. Gamified elements were classified based on the most widely adopted gamification elements for learning purposes. Twenty studies involving 349 participants were eligible. Of 297 participants included for descriptive synthesis, 246 (82.8%) were male, with a mean age at study entry of 11.55years. Children and adolescents with autism spectrum disorder were the most common target populations (k=19, 95%), followed by the general adult population (k=1, 5%). Two main themes related to the application of gamification interventions emerged from the included studies: the augmentation of engagement in the intervention and the amplification of the desired interventional outcomes. Commonly used gamification elements included feedback (k=10, 50%), rewards (k=10, 50%), custom learning (k=9, 45%), monitoring (k=9, 45%), and personalization (k=8, 40%). Four of the included studies applied 5-7 elements in their interventions. Five studies were included in the meta-analysis, showing a positive overall effect of gamified interventions on social interaction and communication (pooled standardized mean difference: 0.46; 95% CI 0.08, 0.85; I2 0%). This study offers a comprehensive review of gamification elements and gamified interventions currently used in social interaction and communication skills among people with autism spectrum disorder. The potential benefits of included studies targeting social interaction and communication skills highlight the need for further in-depth investigation in this group. Future randomized controlled trials with more comprehensive development and trials that apply game-related design are suggested.

To evaluate whether anti-glutamic acid decarboxylase (Anti-GAD) antibodies and selected biochemical parameters are associated with autism spectrum disorder (ASD), symptom severity, and autistic regression in a case-control design. We hypothesized that Anti-GAD titers would be higher in ASD and associated with greater symptom burden. Children aged 2-9 years with ASD diagnosed according to DSM-5 criteria and age- and sex-matched healthy controls were included. Laboratory analyses assessed Anti-GAD, ASO, ferritin, iron, vitamin D, vitamin B12, thyroid-stimulating hormone, and folate. Clinical evaluations included the Autism Behavior Checklist (ABC), Modified Checklist for Autism in Toddlers (M-CHAT), and Ankara Developmental Screening Inventory (AGTE). Autistic regression was defined as loss of previously acquired language and/or social communication skills lasting ≥3 months between 15 and 30 months of age. Ninety children participated (45 with ASD and 45 controls). Anti-GAD antibody levels were higher in the ASD group than in controls (p = 0.003). Although statistically significant, the absolute difference between groups was modest. Among ASD cases, 62% met criteria for regression; this relatively high proportion may reflect the clinic-based sampling and the operational definition applied. Compared with those without regression, children with regression had higher Anti-GAD titers and ABC scores but lower iron and ferritin levels (all p < 0.05). Anti-GAD levels correlated positively with ABC total scores (r = 0.724, p = 0.01). These findings reflect statistical associations and do not imply causality. Higher Anti-GAD antibody levels were statistically associated with ASD, autistic regression, and greater behavioral symptom severity in this sample. These results suggest possible immune-related contributions to ASD heterogeneity; however, larger longitudinal studies are needed before clinical or biomarker implications can be established.

Evaluating caregiver-delivered programs in clinical settings is necessary to generate practice-based evidence. One challenge of such research is the burden placed on clinicians to complete additional measurement tools. This exploratory study examined the validity of clinical forms already completed as part of the standard delivery of the More Than Words® (MTW) program and explored whether this clinical data would reveal distinct clinical and outcome profiles in real-world contexts. The Social Communication Checklist (SCC), a MTW program-specific form completed by the speech-language pathologist, was collected for 36 autistic preschoolers during publicly funded delivery of MTW. We assessed the concurrent validity of autistic preschoolers' social communication stage and skills rated on the SCC pre- and post-program with two of their scores on reliable, validated tools: the Communication Function Classification System (CFCS) and the Focus on the Outcomes of Communication Under Six (FOCUS-34). We also explored autistic preschoolers' communicative participation outcome profiles on the FOCUS-34 with their assigned social communication stages on the SCC. Autistic preschoolers' pre-program social communication stage on the MTW SCC correlated with their pre-program CFCS communication level and FOCUS-34 score. Most children showed positive social communication changes post-program according to the SCC, and two-thirds showed meaningful or possibly meaningful clinical change on the FOCUS-34; however, scores on these measures did not correlate. Autistic preschoolers at different pre-program SCC stages showed distinct communicative participation outcome profiles on the FOCUS-34. Program-specific clinical forms like the SCC can be valuable for classifying autistic preschoolers' social communication skills, exploring differences in outcomes, capturing novel outcomes, and generating practice-based evidence.

Introduction: Social communication is a comprehensive and complex skill domain that starts to take shape with the development of imitation, joint attention, play, and language skills in the first months of life. Autism spectrum disorder (ASD) can cause deficits in these basic social communication skills. Project ImPACT represents a parent-mediated naturalistic developmental behavioral intervention to ensure the development of individuals with deficits in social communication skills in this domain. The number of studies on Project ImPACT is gradually increasing, and there is a need for a review to identify the program’s place in the literature and guide future research. Accordingly, the current study systematically reviewed research on Project ImPACT. Method: This systematic review examined 18 experimental studies conducted on the Project ImPACT program between 2011 and 2024 and involving children with ASD. The findings regarding the participants and methods of the reviewed studies were compiled, and the descriptive analysis of the obtained data was performed. Findings: Most of the reviewed studies included children aged between 12 and 96 months. In most studies, mothers trained child participants, and experts from various occupational groups served as intervention agents. Research was conducted across different settings, including homes, schools, institutions, and clinics, and the program could be implemented for varying durations and intensities. Intervention agents could implement the Project ImPACT techniques in intervention sessions at a level meeting the target criteria or with high treatment fidelity, and child participants usually displayed improvement in the target basic social communication skills. Discussion: Project ImPACT is considered an effective early intervention program employed to enhance the social communication skills of children with ASD or at risk for ASD. The positive opinions of Project ImPACT users on the program are important for its dissemination. Keywords: Project ImPACT, naturalistic developmental behavioral interventions, parent-mediated intervention, early intervention, autism spectrum disorder, social communication.

A recent randomized controlled trial found that children with autism spectrum disorder who received a pivotal response treatment package showed improved language and social communication skills following the intervention. The pivotal response treatment package includes clinician-delivered and parent-implemented strategies. Reciprocal vocal contingency is an automated measure of vocal reciprocity derived from daylong audio samples from the child's natural environment. It may provide stronger and complementary evidence of the effects of the pivotal response treatment package because it is at lower risk for detection bias than parent report and brief parent-child interaction measures. The current study compared reciprocal vocal contingency for 24 children with autism spectrum disorder in the pivotal response treatment package group and 24 children with autism spectrum disorder in the control group. The pivotal response treatment package group received 24 weeks of the pivotal response treatment package intervention. The control group received their usual intervention services during that time. The groups did not differ in reciprocal vocal contingency when the intervention started or after 12 weeks of intervention. However, after 24 weeks the pivotal response treatment package group had higher ranked reciprocal vocal contingency scores than the control group. These findings are consistent with results from parent report and parent-child interaction measures obtained during the trial. The participants in the pivotal response treatment package exhibited greater vocal responsiveness to adult vocal responses to their vocalizations than the control group. Findings support the effectiveness of the pivotal response treatment package on vocal reciprocity of children with autism spectrum disorder, which may be a pivotal skill for language development.

ABSTRACT: Parent-mediated interventions (PMIs) are the most cost-effective way to target social communication and behavioral issues in individuals with Autism Spectrum Disorder (ASD). This research synthesis aims to (a) identify the types of PMI programs that have been used to improve the social communication skills of children with ASD and (b) record the outcomes of these programs that have been reported in previous research on children with ASD and their parents. The PRISMA guidelines were used to identify the published PMI studies from 2004 to 2022. The digital databases Scopus, ERIC, Web of Science, and B-on were screened for relevant publications using the keywords “autism spectrum disorder” AND “home-based intervention” OR “parent-mediated intervention” OR “family-mediated intervention” AND “educational program” OR “training program” AND “social skills” OR “communication skills” in the studies’ titles and/or abstracts. The inclusion criteria were as follows: studies with parent-mediated intervention programs primarily targeting the social communication skills of children with ASD, published in English, and reporting outcomes in children with ASD. The search yielded 462 publications, and only 37 studies were eligible for inclusion in the final analysis. Overall, these studies showed that PMIs were effective in improving social communication and other skills of children with ASD. Additionally, parents showed high fidelity, positive perception, self-efficacy, satisfaction, and a decrease in stress. The limitations of the studies and future implications were discussed.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder linked to several genetic and environmental factors including antenatal stress. Hence, we aimed to examine whether a mother's stress during pregnancy is associated with the severity of autism spectrum disorder in children. The study was conducted with 459 mothers of children with autism (aged 2-14 years) who were attending rehabilitation and educational centers in the two major cities of Makkah and Jeddah in Saudi Arabia. Environmental factors, consanguinity, and ASD family history were assessed using a validated questionnaire. The Prenatal Life Events Scale questionnaire was used to assess whether the mothers were exposed to stress during pregnancy. Two models of ordinal regression analysis were conducted including gender, child age maternal age, parental age, maternal education, parental education, income nicotine exposure, mother taking medication during pregnancy, family history of ASD, gestation, consanguinity, exposure of prenatal life events (in model 1), and severity of prenatal life events (in model 2). Family history of ASD showed a statistically significant association with the severity of ASD in both regression models (p = .015, odds ratio [OR]: 4.261 in Model 1, and p = .014, OR: 4.901 in model 2). In model 2, the moderate severity prenatal life events showed higher statistically significant adjusted odds ratio for ASD severity compared to no stress (p = .031; OR: 3.82). Within the limitations of this study, prenatal stressors showed some potential contribution to ASD severity. Family history of ASD was the only factor that showed a persistent association with ASD severity. A study that assesses the effect of COVID-19 stress on ASD prevalence and severity is recommended.

BackgroundRestricted and repetitive behaviors (RRBs) are highly prevalent and reduce function in individuals with fragile X syndrome (FXS). As transdiagnostic features of intellectual disability, elevated rates of RRBs in FXS could represent various underlying known co-occurring conditions in FXS such as anxiety or autism spectrum disorder (ASD), yet this distinction has not been investigated. Further, delineating whether RRBs are more indicative of anxiety or ASD in FXS may clarify phenotypic profiles within FXS and improve differential assessment.MethodsWe longitudinally examined the potentially independent or multiplicative effect of ASD and anxiety symptom severity on RRBs in 60 children with FXS. Anxiety was measured using the Child Behavior Checklist (CBCL), ASD severity was measured using the Childhood Autism Rating Scale (CARS), and RRBs were measured using the Repetitive Behavior Scale – Revised (RBS-R). We estimated a series of moderated regression models with anxiety and ASD symptoms at the initial assessment (Time 1) as predictors of RRBs at the outcome assessment two years later (Time 2), along with an anxiety-by-ASD interaction term to determine the potential multiplicative effect of these co-occurring conditions on RRBs.ResultsResults identified a significant interaction between ASD and anxiety symptom severity at the initial assessment that predicted elevated sensory-motor RRBs two years later. Increased sensory-motor RRBs were predicted by elevated ASD symptoms only when anxiety symptom severity was low. Likewise, increased sensory-motor RRBs were predicted by elevated anxiety symptoms only when ASD symptom severity was low. Interestingly, this relationship was isolated to Sensory-Motor RRBs, with evidence that it could also apply to total RRBs.ConclusionsFindings suggest that ASD and anxiety exert independent and differential effects on Sensory-Motor RRBs when at high severity levels and a multiplicative effect when at moderate levels, which has important implications for early and targeted interventions.

Introduction Autism spectrum disorder (ASD) is a set of heterogeneous neurodevelopmental conditions, characterised by difficulties in social communication and restricted, repetitive behaviours and interests. There are several rehabilitative interventions for individuals with ASD but the evidence of their effectiveness is low or moderate overall. The transition phase of ASD individuals from adolescence to adulthood represents an important challenge. Adults with ASD struggle to access employment or independent living. Methods In our study, we evaluated the effect of three different high-intensity interventions, namely Applied Behaviour Analysis (ABA), Treatment and Education of Autistic and Communication-Handicapped Children (TEACCH) and Behavioural Educational Intervention (BEI), in 93 ASD (levels 2 and 3) adolescents (age range 12–18 years). Results Our results showed that all adolescents with ASD reported an improvement of core symptoms, regardless of the type of treatment. Conclusions A high intensity intervention ameliorates the core symptoms of ASD, enriching evidence of effectiveness regarding adolescents with ASD. KEY POINTS Individuals with ASD need lifespan support and they struggle to access employment, independent living and community inclusion. There are several rehabilitative interventions for individuals with ASD but the evidence of their effectiveness in adolescents is insufficient. The main purpose of this study was to evaluate the possible enhancement produced by three intensive interventions (ABA, TEACCH, BEI) of symptom severity and adaptive functions. Results show that independently of the treatment, individuals with ASD decrease in ASD severity. Individuals who were treated with the BEI and TEACCH programmes reported improvements in the adaptive domains.

Implementing a Uniform Outcome Measurement Approach for Early Interventions of Autism Spectrum Disorders