Article

Clinical Assessment and Management of Toddlers With Suspected Autism Spectrum Disorder: Insights From Studies of High-Risk Infants

Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
PEDIATRICS (Impact Factor: 5.3). 06/2009; 123(5):1383-91. DOI: 10.1542/peds.2008-1606
Source: PubMed

ABSTRACT With increased public awareness of the early signs and recent American Academy of Pediatrics recommendations that all 18- and 24-month-olds be screened for autism spectrum disorders, there is an increasing need for diagnostic assessment of very young children. However, unique challenges exist in applying current diagnostic guidelines for autism spectrum disorders to children under the age of 2 years. In this article, we address challenges related to early detection, diagnosis, and treatment of autism spectrum disorders in this age group. We provide a comprehensive review of findings from recent studies on the early development of children with autism spectrum disorders, summarizing current knowledge on early signs of autism spectrum disorders, the screening properties of early detection tools, and current best practice for diagnostic assessment of autism spectrum disorders before 2 years of age. We also outline principles of effective intervention for children under the age of 2 with suspected/confirmed autism spectrum disorders. It is hoped that ongoing studies will provide an even stronger foundation for evidence-based diagnostic and intervention approaches for this critically important age group.

Download full-text

Full-text

Available from: Daniel S Messinger, Jun 28, 2015
3 Followers
 · 
190 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The inhibition of return (IOR) refers the observer's slower response time when the target stimulus appears on the previously attended location. In the present study, we examined the time course of saccadic IOR by using five stimuli onset asynchronies (SOAs) in a group of adults with autism spectrum disorders (ASDs) and a comparison group. The results showed that the IOR effect occurred earlier (300 ms SOA) in participants with ASDs, relative to the comparison participants (500 and 700 ms SOAs). The ASD group also committed a greater number of anticipatory saccades, which positively correlated with scores on restricted and repetitive behaviors, as assessed by the Autism Diagnostic Interview-Revised (ADI-R; Lord et al. in J Autism Dev Disord 24:659-685, 1994). These findings reveal an accelerated time course for saccadic IOR along with diminished volitional oculomotor control in participants with ASDs. We discussed these results with reference to the atypical and the superior visual search abilities often reported in this population.
    Experimental Brain Research 11/2014; 233(3). DOI:10.1007/s00221-014-4152-1 · 2.17 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. Now that early identification of toddlers with autism spectrum disorder (ASD) is possible, efforts are being made to develop interventions for children under three years of age. Most studies on early intervention have focused on intensive and individual interventions. However, parent training interventions that help parents interact and communicate with their toddlers with ASD might be a good alternative to promote the development of their child's sociocommunicative skills. Objective. This review aims to systematically examine (1) the use of parent training interventions for children with ASD under three years of age and (2) their effects on children's development, parents' well-being and parent-child interactions. Methods. Systematic searches were conducted to retrieve studies in which at least one parent was trained to implement ASD-specific techniques with their toddlers (0-36 months old) with a diagnosis of or suspected ASD. Results. Fifteen studies, involving 484 children (mean age: 23.26 months), were included in this review. Only two of them met criteria for conclusive evidence. Results show that parents were able to implement newly learned strategies and were generally very satisfied with parent training programs. However, findings pertaining to the children's communication and socioemotional skills, parent-child interactions, and parental well-being were inconclusive.
    05/2014; 2014:839890. DOI:10.1155/2014/839890
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Accumulating evidence suggests that motor impairments are prevalent in autism spectrum disorder (ASD), relate to the social and communicative deficits at the core of the diagnosis and may reflect abnormal connectivity within brain networks underlying motor control and learning. Parcellation of resting-state functional connectivity data using spectral clustering approaches has been shown to be an effective means of visualizing functional organization within the brain but has most commonly been applied to explorations of normal brain function. This article presents a parcellation of a key area of the motor network, the primary motor cortex (M1), a key area of the motor control network, in adults, typically developing (TD) children and children with ASD and introduces methods for selecting the number of parcels, matching parcels across groups and testing group differences. The parcellation is based solely on patterns of connectivity between individual M1 voxels and all voxels outside of M1, and within all groups, a gross dorsomedial to ventrolateral organization emerged within M1 which was left-right symmetric. Although this gross organizational scheme was present in both groups of children, statistically significant group differences in the size and segregation of M1 parcels within regions of the motor homunculus corresponding to the upper and lower limbs were observed. Qualitative comparison of the M1 parcellation for children with ASD with that of younger and older TD children suggests that these organizational differences, with a lack of differentiation between lower limb/trunk regions and upper limb/hand regions, may be due, at least in part, to a delay in functional specialization within the motor cortex. Hum Brain Mapp, 2012. © 2012 Wiley Periodicals, Inc.
    Human Brain Mapping 02/2014; 35(2). DOI:10.1002/hbm.22188 · 6.92 Impact Factor