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Over the past four decades there have been significant advances in our understanding of autism, yet services for autistic adults continue to lag far behind those for children, and prospects for employment and independent living remain poor. Adult outcomes also vary widely and while cognitive and language abilities are important prognostic indicators, the influence of social, emotional, familial and many other factors remains uncertain. For this special issue marking the 40th anniversary of DSM-III, the present paper describes the changing perspectives of autism in adulthood that have occurred over this period, explores individual and wider environmental factors related to outcome, and suggests ways in which services need to be changed to improve the future for adults living with autism. [ABSTRACT FROM AUTHOR]

Extreme demand avoidance (EDA) is increasingly described as part of the autism spectrum and is sometimes diagnosed as Pathological Demand Avoidance (PDA). Yet little is known, about the educational experiences of children with and without EDA behaviours. Using an online survey collecting both quantitative and qualitative data, 211 parents reported on the school experiences of their autistic children. 57 parents had a child with an additional diagnosis of PDA (AUT-PDA); 91 had a child with no diagnosis of PDA but, according to parent report, displayed EDA behaviours (AUT-EDA); and 63 had a child with neither a PDA diagnosis nor EDA behaviours (AUT). Results demonstrated that there were few group differences in terms of the frequency of failed school placements and exclusions. However, children in the AUT-EDA/-PDA groups had higher levels of behaviour that challenges, which were particularly high in those with a PDA diagnosis. There were no significant differences in school exclusions, but the fact that these occurred across all groups is of concern. Qualitative results suggested overwhelmingly negative school experiences for all groups but especially the AUT-EDA and AUT-PDA groups. Parents attributed such experiences to misunderstanding of their children's diagnoses and a lack of targeted support. [ABSTRACT FROM AUTHOR]

Background: Autism spectrum disorder and epilepsy often co-occur; however, the extent to which the association between autism symptoms and epilepsy is due to shared aetiology or to the direct effects of seizures is a topic of ongoing debate. Angelman syndrome (AS) is presented as a suitable disease model to explore this association. Methods: Data from medical records and questionnaires were used to examine the association between age of epilepsy onset, autism symptoms, genetic aberration and communication level. Forty-eight participants had genetically verified AS (median age 14.5 years; range 1-57 years). A measure of autism symptoms (the Social Communication Questionnaire; SCQ) was completed for 38 individuals aged ≥ 4 years. Genetic cause was subgrouped into deletion and other genetic aberrations of the 15q11-q13 area. The number of signs used to communicate (< 20 sign and ≥ 20 signs) was used as a measure of nonverbal communication. Results: Mean age of epilepsy onset was 3.0 years (range 3 months-7.8 years). Mean SCQ score for individuals without epilepsy was 13.6 (SD = 6.7) and with epilepsy 17.0 (SD = 5.6; p = 0.17); 58% used fewer than 20 signs to communicate. There were no age differences between groups according to presence of epilepsy, level of nonverbal communication or type of genetic aberration. SCQ scores were higher in individuals with the deletion than in those with other genetic aberrations (18.7 vs 10.8 p = 0.008) and higher in the group who used < 20 signs to communicate (19.4 vs 14.1 p = 0.007). Age of epilepsy onset was correlated with SCQ (r = - 0.61, p < 0.001). Multiple regression showed that age of seizure onset was significantly related to SCQ score (β = - 0.90; p = 0.006), even when the type of genetic abnormality was controlled (R² = 0.53; F = 10.7; p = 0.001). Conclusions: The study provides support for the notion that seizures themselves contribute more to autism symptoms than expected from the underlying genetic pathology alone. The study demonstrates how a rare genetic syndrome such as Angelman syndrome may be used to study the relation between epilepsy and autism symptomatology. [ABSTRACT FROM AUTHOR]

This RCT investigated whether the effect of a Theory of Mind (ToM) intervention for children with ASD was moderated by parental education level and employment, family structure, and parental ASD. Children with autism aged 8-13 years ( n = 136) were randomized over a waitlist control or treatment condition. At posttest, children in the treatment condition had more ToM knowledge, showed fewer autistic features, and more ToM-related behavior than children in the control condition. Children who had one or two parents with at least a college degree, and children with parents not diagnosed with/suspected of having ASD themselves benefitted from the training. These findings provide valuable information about family variables that need to be taken into account in treatment design and implementation. [ABSTRACT FROM AUTHOR]

The relationship between dissociable components of autobiographical memory (e.g. semantic personality traits and episodic memory retrieval) and other cognitive skills that are proposed to enable one to develop a sense of self (e.g. introspection) have not previously been explored for children with autism spectrum disorder. This study compared autobiographical memory (semantic and episodic) and knowledge of self (internal/external self-knowledge and introspection/mentalising abilities) in children (aged 11–18 years) with high-functioning autism spectrum disorder and typically developing controls (total N = 48). Novel and standard tasks were employed. Compared to typically developing controls, young people with autism spectrum disorder had autobiographical memory difficulties that were characterised by a reduction in the retrieval of semantic personality traits, with more initial prompts required to facilitate episodic memory retrieval and fewer episodic memories containing emotional and sensory information. Knowledge of the self and others was also impaired, with reduced introspection and poorer mentalising abilities. Young people with autism spectrum disorder were also identified as presenting with an atypical relationship between autobiographical memory and self-knowledge, which was significantly different from typically developing controls. Test performance is discussed in relation to the functions of autobiographical memory, with consideration of how these cognitive difficulties may contribute to clinical practices and the social and behavioural characteristics of autism spectrum disorder. [ABSTRACT FROM AUTHOR]

Aim: To assess the frequency, pervasiveness, associated features, and persistence of emotional and behavioural problems in a community sample of young children with autism spectrum disorder (ASD).Method: Parents (n=277) and teachers (n=228) of 4- to 8-year-olds completed the Developmental Behaviour Checklist (DBC). Intellectual ability and autism symptomatology were also assessed. A subsample repeated the DBC.Results: Three-quarters of the cohort scored above the clinical cut-off on the Developmental Behaviour Checklist Primary Carer Version (DBC-P) questionnaire; almost two-thirds of these scored above cut-off on the Developmental Behaviour Checklist Teacher Version (DBC-T) questionnaire. In 81%, problems persisted above threshold 14 months later. Higher DBC-P scores were associated with greater autism symptomatology, higher deprivation index, parental unemployment, and more children in the home but not with parental education or ethnicity, or child's age or sex. Children with IQ>70 scored higher for disruptive behaviour, depression, and anxiety symptoms; those with IQ<70 scored higher for self-absorption and hyperactivity.Interpretation: The DBC identifies a range of additional behaviour problems that are common in ASD and which could be the focus for specific intervention. The results highlight the potential benefit of systematic screening for co-existing problems. [ABSTRACT FROM AUTHOR]

The article discusses the highlights of a roundtable discussion convened at The University of Sydney, Australia in August 2014 involving clinicians and/or researchers in the fields of autism spectrum disorder (ASD). It provides a summary of the principal issues raised such why there is a need to focus on adults with ASD, why there is a need to focus on adults with ASD and public policy about service delivery for adults with ASD.

Data on psychiatric problems in adults with autism are inconsistent, with estimated rates ranging from around 25% to over 75%. We assessed difficulties related to mental health in 58 adults with autism (10 females, 48 males; mean age 44years) whom we have followed over four decades. All were of average non-verbal intelligence quotient when diagnosed as children. Overall ratings of mental health problems were based on data from the Family History Schedule (Bolton et al., 1994). Informant reports indicated that many of the cohort (44%) had experienced no mental health problems in adulthood; 28% had experienced mild to moderate difficulties, 23% had severe and 5% very severe problems. Depression was the most commonly reported problem. Among those adults (n = 22) able to report on their own mental state, again many (45%) reported no mental health problems, although 27% reported very severe mental health problems related to anxiety, depression and/or obsessive-compulsive symptoms. Informant ratings of poor mental health were not associated with gender, severity of autism in childhood, or child or adult intelligence quotient, but there were small correlations with overall social functioning (rho = 0.34) and current autism severity (rho = 0.37). The findings highlight the difficulties of assessing mental health problems in adults with autism and the need for appropriately validated measures. [ABSTRACT FROM AUTHOR]

Little is known about adult siblings of individuals with autism. We report on cognitive, social and mental health outcomes in 87 adult siblings (mean age 39 years). When younger all had been assessed either as being 'unaffected' by autism (n = 69) or as meeting criteria for the 'Broader Autism Phenotype' (BAP, n = 18). As adults, all scored within the average range on tests of intelligence, numeracy and literacy. 'Unaffected' siblings were functioning well in terms of jobs, independence and social relationships. Levels of social relationships and employment were significantly lower in the BAP group; autism traits and mental health problems were significantly higher. The data suggest that the 'broader autism phenotype' is a meaningful concept but more sensitive diagnostic measures are required. [ABSTRACT FROM AUTHOR]

Summary: Children and adolescents with autism spectrum disorder (ASD) have much higher rates of anxiety disorders relative to their typically developing peers. However, there have been few attempts to investigate what physiological parameters may be associated with this elevated rate of anxiety. Therefore, this study investigated the physiological correlates of anxiety in ASD, with a focus on whether measures of heart rate and cortisol responsiveness to psychosocial stress differentiate those participants with ASD with and without a co-occurring anxiety disorder. A total of 75 male participants aged 10–16 years with normal intellectual ability underwent a psychosocial stress test. The participants included healthy controls (n =23), ASD only (ASD; n =20) and ASD with a comorbid anxiety disorder (ASDanx; n =32). Heart rate, heart rate variability and salivary cortisol were compared by fitting a piecewise regression model to examine baseline levels and change over time within and between the rest, stress and recovery phases of the stress test. The ASDanx group had different response patterns from both the ASD and control groups. The ASDanx group was characterized by a blunted cortisol and heart rate response to psychosocial stress. Furthermore, in the ASDanx group, reduced heart rate and cortisol responsiveness were significantly related to increased anxiety symptoms. This is the first study to report a possible physiological basis for co-occurring anxiety disorders in children and adolescents with ASD. It is possible that a non-adaptive physiological response to psychosocial stress may be related to the high prevalence of co-occurring anxiety disorders in people with ASD. [ABSTRACT FROM AUTHOR]

Background It is well established that very few individuals with autism spectrum disorders ( ASD) and an IQ below 70 are able to live independently as adults. However, even amongst children with an IQ in the normal range, outcome is very variable. Childhood factors that predict later stability, improvement or decline in cognitive functioning remain uncertain and, in particular, very little is known about trajectories in later adulthood. Method Changes in cognitive and language ability from childhood to adulthood were assessed in 60 individuals with autism, all of whom had an IQ in the average range as children. Mean age in childhood = 6 years (range 2-13 years); mean age in adulthood = 44 years (range 29-64 years). Trajectories of change and factors related to current cognitive abilities were explored. Results For the majority of participants ( N = 45, 75%), who were testable both as children and adults, IQ remained very stable and language also improved over time. However, 15 individuals could not be assessed on standard tests as adults and their developmental level could be estimated only on the Vineland Adaptive Behavior Scales. Almost all these adults (apart from one who had suffered a major stroke) showed severe aggressive or self-injurious behaviours; none had ever developed language above a 3-year level, and seven had developed epilepsy. Conclusions For most individuals with autism who had an IQ in the average range (i.e. ≥70) as children, childhood IQ proved a reliable predictor of cognitive functioning well into mid- to- later adulthood. However, a significant minority was no longer testable on standard tests as adults. Their current very low levels of functional ability were generally associated with severe behavioural disturbance and persisting and severe language impairment; 50% of these individuals had also developed epilepsy, pointing to the role of organic brain dysfunction. Implications for early intervention are discussed. [ABSTRACT FROM AUTHOR]

Objective: To describe current social functioning in a clinical sample of 60 adults with autism (mean age = 44 years) who were all of average nonverbal IQ (70+) when first diagnosed (mean age = 6.75 years). Method: Outcome measures included standardized diagnostic and cognitive assessments and questionnaires on social functioning. Child and adult variables related to current outcomes were explored. Results: All individuals continued to meet criteria for autism spectrum disorder (ASD) on the Autism Diagnostic Interview-Revised (ADI-R), but severity of autism symptoms declined over time. Nevertheless, only 10 individuals (17%) were rated as having a "good" or "very good" outcome; the majority (60%) were assessed as having "poor" or "very poor" outcomes. The strongest predictor of adult outcome was the Reciprocal Social Interaction domain score on the ADI at diagnostic confirmation. Change over time was further examined in a subgroup (n = 44) previously assessed 20 years ago earlier (mean age = 26 years). Although severity of autism had continued to decrease during the adult period, social outcomes were poorer than in younger adulthood. Conclusions: In this cohort of adults first diagnosed with autism, on average, 37 years previously, social inclusion remains very limited, despite general improvements in autism symptomatology with age. Whether these findings will be replicated in future generations of children with autism, who now have the benefits of earlier diagnosis and wider access to specialist provision, needs to be the focus of further longitudinal research. [ABSTRACT FROM AUTHOR]

Background: The prevalence of autism spectrum disorder (ASD) symptomatology is comparatively high in Cornelia de Lange syndrome (CdLS). However, the profile and developmental trajectories of these ASD characteristics are potentially different to those observed in individuals with idiopathic ASD. In this study we examine the ASD profile in CdLS in comparison to a matched group of individuals with ASD. Method: The Autism Diagnostic Observation Schedule (ADOS) was administered to 20 individuals with CdLS (mean age = 11.34; range = 6-13 years) and 20 individuals with idiopathic ASD (mean age = 10.42; range = 8-11 years). Participants were matched according to adaptive behaviour and receptive language skills. Results: Sixty-five percent ( N = 13) of individuals with CdLS met the cut-off score for autism on the total ADOS score. Further analysis at domain and item level indicated that individuals with CdLS showed significantly less repetitive behaviour, (specifically sensory interests); more eye contact, more gestures and less stereotyped speech than the ASD group. The CdLS group also showed higher levels of anxiety. Conclusions: The comparison between CdLS and idiopathic ASD indicates subtle group differences in the profile of ASD symptomatology that are not accounted for by degree of intellectual disability or receptive language skills. These differences may not be evident when relying solely upon clinical and domain level scores, but may be distinguishing features of the ASD presentations in the two disorders. The findings have implications for the conceptualisation and assessment of ASD in individuals with genetic syndromes. [ABSTRACT FROM AUTHOR]

In the decades since autism was first formally described in the 1940s, there have been major advances in research relating to diagnosis, causation, and treatment approaches for children with this condition. However, research into prognosis, outcomes, or effective interventions for adults with autism spectrum disorders (ASDs) is much more limited. In this paper, we review studies of outcome in adulthood. The findings indicate that, as adults, many people with ASD, including those of normal IQ, are significantly disadvantaged regarding employment, social relationships, physical and mental health, and quality of life. Support to facilitate integration within the wider society is frequently lacking, and there has been almost no research into ways of developing more effective intervention programs for adults. Moreover, most of the research on outcome has involved relatively young people in their 20s and 30s--much less is known about outcomes for people with ASD as they reach mid-late adulthood. Systematic follow-up studies from childhood through adulthood are needed if we are to gain a better understanding of trajectories of development over the lifespan, to identify the factors that influence prognosis, and to determine how these factors exert their effects and how they may be modified to ensure a better future. INSET: Clinical Implications. [ABSTRACT FROM AUTHOR]

In spite of increasing interest in cognitive behaviour therapy for emotional disorders in children with autism spectrum disorders (ASD), little research has explored the relevance of the cognitive model in this population. This study explores dysfunctional attitudes and perfectionism in boys with ASD and the relationship with anxious and depressive symptoms. Compared to a typically developing group ( n = 42), boys with ASD ( n = 41) endorsed more dysfunctional attitudes and reported higher emotional symptoms. The relationship between emotional and cognitive variables was weak in both groups, although in the ASD group dysfunctional attitudes were significantly associated with reported obsessive-compulsive symptoms. Reasons for elevated dysfunctional attitudes in the ASD group are discussed and the roles of cognitive inflexibility and social impairments are explored. [ABSTRACT FROM AUTHOR]

Background Little is known about trajectories of cognitive functioning as individuals with Williams syndrome (WS) move though adulthood. Method The present study investigated cognitive, linguistic and adaptive functioning in adults with WS aged 19–55 years, using both cross-sectional and longitudinal approaches. Results Data from the cross-sectional study ( n = 92; mean age = 32 years) indicated that IQ was comparable across age groups (Full-Scale IQ mean = 56–57) with Verbal IQ being slightly higher than Performance IQ. Daily Living Skills (as measured by the Vineland Adaptive Behavior Scales) were significantly higher in older individuals. Language abilities showed no consistent age-related differences. On formal tests of language, comprehension scores were higher than expressive language scores for almost all individuals, although this pattern was not replicated on the Vineland. In the longitudinal study, a follow-up of 47 individuals (mean age = 37 years) first assessed 12 years previously, similar trajectories were found. IQ remained very stable (FSIQ = 61–62 at both time points); there were significant improvements on the Social and Daily Living domains of the Vineland and significant decreases in Maladaptive scores. There were no improvements in language over time. Conclusions The data indicate that adults with WS (at least up to the age of 50 years) show no evidence of deterioration in cognitive skills. Adaptive abilities continue to develop although language shows relatively little improvement with time. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented which discusses various papers published within the issue, including one on the potential importance of helping individuals with autism to develop daily living skills, one on the well-being of mothers and fathers of individuals with autism, and another on the medical insurance records of adults with autism in the U.S.

Objective: To assess the effectiveness of expert training and consultancy for teachers of children with autism spectrum disorder in the use of the Picture Exchange Communication System (PECS). Method: Design: Group randomised, controlled trial (3 groups: immediate treatment, delayed treatment, no treatment). Participants: 84 elementary school children, mean age 6.8 years. Treatment: A 2-day PECS workshop for teachers plus 6 half-day, school-based training sessions with expert consultants over 5 months. Outcome measures: Rates of: communicative initiations, use of PECS, and speech in the classroom; Autism Diagnostic Observation Schedule-Generic (ADOS-G) domain scores for Communication and Reciprocal Social Interaction; scores on formal language tests. Results: Controlling for baseline age, developmental quotient (DQ) and language; rates of initiations and PECS usage increased significantly immediately post-treatment (Odds Ratio (OR) of being in a higher ordinal rate category 2.72, 95% confidence interval 1.22–6.09, p < .05 and OR 3.90 (95%CI 1.75–8.68), p < .001, respectively). There were no increases in frequency of speech, or improvements in ADOS-G ratings or language test scores. Conclusions: The results indicate modest effectiveness of PECS teacher training/consultancy. Rates of pupils’ initiations and use of symbols in the classroom increased, although there was no evidence of improvement in other areas of communication. Treatment effects were not maintained once active intervention ceased. [ABSTRACT FROM AUTHOR]

Difficulties in social interaction are a central feature of Asperger syndrome. Effective social interaction involves the ability to solve interpersonal problems as and when they occur. Here we examined social problem-solving in a group of adults with Asperger syndrome and control group matched for age, gender and IQ. We also assessed autobiographical memory, on a cueing task and during social problem-solving, and examined the relationship between access to specific past experiences and social problem-solving ability. Results demonstrated a social problem-solving impairment in the Asperger group. Their solutions were less detailed, less effective and less extended in time. Autobiographical memory performance was also impaired with significantly longer latencies to retrieve specific memories and fewer specific memories retrieved in comparison to controls. [ABSTRACT FROM AUTHOR]

The requirement for educational provision for all children to be evidence based has been highlighted in many government policies.1 The significant additional costs of educating children with autism, and difficulties in recruiting adequately trained teachers, have placed increasing pressure on education authorities to provide more cost-effective instruction methods for pupils with autism. Computer-assisted interventions (CAI) have been suggested as a possible means of meeting the educational needs of this group, and findings from mostly small, uncontrolled studies have indicated positive improvements in areas such as academic ability, social and communication skills, and adaptive behavior.2 The present study by Pellecchia et al.3 describes an evaluation of one such program: TeachTown: Basics. This is a computer-assisted intervention that aims to increase students' vocabulary, listening skills, socio-emotional development, and academic and cognitive abilities. It is designed for children with autism or other developmental disabilities with a nonverbal mental age equivalent of 2 to 7 years. A brief (20 minutes per day for 3 months), small-scale (n = 22, children 3-6-years of age), randomized control trial (RCT) of TeachTown: Basics, previously conducted in the Los Angeles Unified School District,4 produced some positive but generally nonsignificant changes in language and cognitive measures compared with a control group. Although the authors themselves were cautious about the results, this very limited evidence from a single RCT was enough for the School District of Philadelphia (the eighth largest district in the country) to decide to roll out the program to students in all of its kindergarten to second grade autism support classrooms. [ABSTRACT FROM AUTHOR]

Few supported employment programmes have been specifically designed for people with autism, especially those who are more able. This study examines the outcome of a supported employment service (NAS Prospects) for adults with autism or Asperger syndrome (IQ 60+) over an 8 year period. Approximately 68 percent of clients found employment. Of the 192 jobs, the majority were permanent contracts and most involved administrative, technical or computing work. Assessment of current clients indicates that IQ, language skills and educational attainments are high. However, work has also been found for those of lower abilities. Individuals supported by Prospects show a rise in salaries, contribute more tax and claim fewer benefits. Satisfaction with the scheme is high among clients, employers and support workers. Although the programme continues to incur a financial deficit, this has decreased. Moreover, there are many non-financial benefits, which are difficult to quantify. The importance of specialist employment support of this kind is discussed. [ABSTRACT FROM AUTHOR]

Diagnostic criteria for Cohen Syndrome are based largely on physical characteristics, and systematic information about behaviour and social functioning is limited. Typically, individuals with this condition are described as being very sociable and as showing low rates of pathology. However, recent studies have indicated that behavioural difficulties may occur more frequently than previously suggested and that autistic features may be relatively common. The present investigation of 45 individuals with Cohen Syndrome (age 4-48 years) found that, although 57% of the sample were reported as showing some behavioural disturbance, problems related mainly to anxiety and social interactions; marked anti-social behaviours were rare. Twenty-two individuals met criteria for autism on standardised diagnostic assessments, although the “autistic profile” was somewhat atypical. The implications of these findings for our understanding of Cohen Syndrome are discussed. [ABSTRACT FROM AUTHOR]

Presents a study which examines the presence of autistic spectrum disorders in persons with Cohen syndrome. Potential value of the Social Communication Questionnaire in the diagnosis of autism and related disorders; Presence of autistic symptoms in study participants with Cohen syndrome.

Increasing numbers of children with autism spectrum disorder (ASD) are diagnosed in the preschool years, and their educational progress must be monitored. Parent questionnaire data can augment psychometric assessments and individual planning at low cost. One hundred and twenty-five parents of UK children who entered dedicated autism primary schools and units in two consecutive calendar years were asked to complete three questionnaires. Fifty-seven parents repeated the questionnaire measures one year later. Encouraging developmental progress was observed on the Vineland Adaptive Behavior Scales-Screener. Symptom severity as measured by the Social Communication Questionnaire did not change over time. The pattern of change scores on the Autism Treatment Evaluation Checklist was mixed, and confounding disadvantages this questionnaire. The study demonstrated that it is possible to collect useful information on the progress of children with ASD using parents as informants. Such data would assist in judging claims regarding developmental progress within particular programmes. [ABSTRACT FROM AUTHOR]

Information on long-term prognosis in autism is limited. Outcome is known to be poor for those with an IQ below 50, but there have been few systematic studies of individuals with an IQ above this. Sixty-eight individuals meeting criteria for autism and with a performance IQ of 50 or above in childhood were followed up as adults. Their mean age when first seen was 7 years (range 3–15 years); at follow-up the average age was 29 years (range 21–48 years). Outcome measures included standardised cognitive, language and attainment tests. Information on social, communication and behavioural problems was obtained from the Autism Diagnostic Interview (ADI). Although a minority of adults had achieved relatively high levels of independence, most remained very dependent on their families or other support services. Few lived alone, had close friends, or permanent employment. Communication generally was impaired, and reading and spelling abilities were poor. Stereotyped behaviours or interests frequently persisted into adulthood. Ten individuals had developed epilepsy. Overall, only 12% were rated as having a ‘Very Good’ outcome; 10% were rated as ‘Good’ and 19% as ‘Fair’. The majority was rated as having a ‘Poor’ (46%) or ‘Very Poor’ (12%) outcome. Individuals with a childhood performance IQ of at least 70 had a significantly better outcome than those with an IQ below this. However, within the normal IQ range outcome was very variable and, on an individual level, neither verbal nor performance IQ proved to be consistent prognostic indicators. Although outcome for adults with autism has improved over recent years, many remain highly dependent on others for support. This study provides some information on prognostic indicators, but more fine-grained research is needed into the childhood variables that are associated with good or poor outcome. [ABSTRACT FROM AUTHOR]

A pilot study was conducted to evaluate the effects of training teachers of children with autistic spectrum disorders (ASDs) in the use of the Picture Exchange Communication System (PECS). Thirty-four children with ASDs (29 boys and 5 girls) were selected from eight specialist schools. Teaching staff attended a 1 day PECS workshop and received six half-day visits from PECS consultants. Data on the children's use of PECS, spontaneous communication, and adaptive behavior were collected before the study and at set times following the workshop. Significant, rapid increases were recorded in the level of PECS attained by the children, in their PECS vocabulary, and in their frequency of PECS use over time. Improvements in children's general level of communication were slower to occur. The majority of participants showed improvements in their ability to use PECS. The results are discussed in relation to the methodological and practical difficulties that arose during the project. [ABSTRACT FROM AUTHOR]

Discusses early intervention for children with autism and related disorders. Parent training approaches to language intervention; Issues in the assessment of intelligence quotient; Recommendations for improving the quality of autism intervention research in Great Britain.

The question of whether Asperger syndrome and high-functioning autism should be considered as the same or different conditions has been a source of debate and controversy over recent years. In the present study, 34 adults with autism who had shown early delays in language were compared with 42 individuals who were reported to have had no such delays, either in their use of words or phrases. All participants were at least 18 years of age, had a nonverbal IQ of 70 or above and met ADI-R criteria for age of onset, communication and social impairments, and stereotyped behaviors. Those in the language delay group were diagnosed as having high-functioning autism. The remainder were designated as having Asperger syndrome. The groups were matched for age, nonverbal IQ and gender. No significant differences were found between the groups either in their total ADI-R algorithm scores, or in their algorithm scores on individual domains. Social outcome ratings and ADI-R scores based on current functioning also failed to differentiate between the groups. Scores on tests of language comprehension and expression were also similar, but in both groups language abilities were well below chronological age level. The implications of these results with respect to the differences between Asperger syndrome and high-functioning autism are discussed. The poor performance on language tests also challenges the assumption that early language development in Asperger syndrome is essentially normal. [ABSTRACT FROM AUTHOR]

Editorial. Discusses the aspects of psychological functioning in autistic spectrum disorders. Aspects of the social functioning of individuals or families where there is an autistic spectrum disorder; Social integration scheme for adolescents with Asperger syndrome.

This report examines how conclusions about the progress of preschool children enrolled in early intervention programmes may be influenced by the use of different cognitive assessment tools. As part of a longitudinal treatment outcome study, 24 children with autism aged between 27 and 58 months were each tested on the Bayley, Merrill-Palmer and Vineland scales. Their performance on each of these tests was compared. Results showed that, while scores on the different tests were highly correlated, actual test scores varied considerably, with the Bayley tending to produce the lowest IQ scores and the Merrill-Palmer the highest. These findings have important implications, as it is evident that judgements about the effects of therapy may be significantly influenced by the selection of the tests for pre- and post-treatment assessments. Possible ways of collecting, recording and reporting test data, so as to avoid spurious conclusions about treatment effects, are discussed. [ABSTRACT FROM AUTHOR]

This review describes the current situation with regard to diagnostic instruments for Asperger syndrome. The paucity of such instruments, and the lack of adequate standardisation data amongst the few that do exist, represent a serious omission for both clinicians and researchers. The major problem limiting the development of effective diagnostic or screening instruments is the confusion inherent in ICD-10 and DSM-1V systems in differentiating autism from Asperger syndrome. In the absence of clear and clinically satisfactory diagnostic criteria, efforts to develop valid assessment instruments may be attempting to put the horse before the cart! [ABSTRACT FROM AUTHOR]

This paper focuses on general social functioning in two groups of young men, one with autism and one with developmental receptive language disorders, who were first assessed at the ages of 7-8 years. At that time, although matched for nonverbal IQ (mean 92-93) and expressive language, the Language group showed significantly fewer social and behavioural problems. At follow-up, when aged on average, 23 to 24 years, the Autism group continued to show significantly more impairments in terms of stereotyped behaviour patterns, social relationships, jobs, and independence. However, problems in all these areas were also common in the Language group. Many still lived with their parents, few had close friends or permanent jobs, and ratings of social interaction indicated abnormalities in a number of different areas. On a composite measure of social competence only 10% of the Language group was assessed as having severe social difficulties compared to 74% of the Autism group. Nevertheless, 65% were rated as having moderate social problems and only 25% were rated as being of near/normal social functioning. Two individuals in the Language group, but none in the Autism group, had also developed a florid paranoid psychosis in late adolescence. As in the follow-up of cognitive and linguistic functioning (see Mawhood et al., 2000, this volume, pp. 547-559), discriminant function analysis, which had clearly distinguished between the groups as children, now showed much greater overlap between them. Regression analysis indicated that although early language ability appeared to be related to outcome in the Autism group, there was little association between any measures of childhood functioning and prognosis in the Language group. Theoretically, these findings have implications for our understanding of the nature of autism and other pervasive language disorders, and of the relationship between them. Practically, they demonstrate the very persistent problems experienced by individuals with developmental language disorders, and their need for much greater help and support than is presently available. [ABSTRACT FROM AUTHOR]

In this paper we compare adult outcome in a group of young men with autism and a group with developmental receptive language disorders. The two groups were first assessed in early childhood, when aged 7 to 8 years of age. Although matched at that time for nonverbal IQ (mean 92-93) and expressive language ability, the Autism group was significantly more impaired on most measures of social and communication skills and stereotyped behaviours. A later follow-up, in mid-childhood, suggested that although the groups were still quite distinct, social and behavioural problems had become more apparent in the Language group. The current study was completed when the participants were aged, on average, 23 to 24 years. The findings indicated that verbal IQ and receptive language scores had improved significantly more in the Autism group than in the Language group over time. Moreover, although the Language group were less severely impaired in their social use of language, many showed a number of abnormal features in this domain. There were no differences between the groups on tests of reading or spelling. Discriminant function analysis, which had clearly distinguished between the groups as children, now showed much greater overlap between them. Regression analysis indicated that although early language ability appeared to be related to outcome in the Autism group, in the Language group there was little association between measures of childhood functioning and later progress. The implications of these findings for understanding the nature of the underlying deficit in autism and the relationship between the two disorders are discussed. [ABSTRACT FROM AUTHOR]

The paper reviews what is known about outcome in adult life for more able individuals within the autistic spectrum. Because of the problems associated with differential diagnosis, the results of studies involving high-functioning people with autism and Asperger syndrome are combined. The review focuses predominantly on long-term follow-up research and covers outcome in terms of cognitive, linguistic, academic and adaptive functioning; educational and employment history; independence and social relationships; and behavioural and psychiatric problems. The stability of IQ and other measures over time, and variables related to outcome, are also investigated. [ABSTRACT FROM AUTHOR]

Discusses the potential effectiveness of social skills groups for adults with autism and Asperger syndrome. Previous reports of social skills training; Description of a social skills group held at a hospital in London, England; Goal of the group to provide participants with a better understanding of their social difficulties and to foster ways of dealing with them.

The article describes the outcome of a 2 year supported employment project for high-functioning adults with autism. Thirty individuals with a diagnosis of autism or Asperger syndrome living within the London area took part in the scheme. The control group comprised 20 individuals of similar intellectual and linguistic ability, and previous employment history, living in metropolitan areas outside London. Over the course of the project significantly more of the supported group than the controls found work; job levels were higher; they were in work for a greater percentage of the time; and they received significantly higher wages. Thirteen different employers (mostly multinational companies) were involved during the course of the project and several were willing to take more than one employee because of their positive experience of employing someone with autism. Although existing resources within the disability employment service had not previously been able to provide effective job finding and support services for this group, the current scheme demonstrated that, with specialist input, supported employment can be very effective. Moreover the costs, although initially high, reduced significantly over time. One of the most expensive and time-consuming aspects of the scheme, but one that appeared to be crucial for success, was the need for close liaison with employers in order to explore appropriate job opportunities and to match these carefully to the skills and abilities of individual clients. However, although some elements of the scheme can continue to be supported through government funding, no financial provision is available for this initial and essential stage of job finding. If programmes of this kind are to continue to provide help for individuals with autism, it is crucial that such funding is provided. [ABSTRACT FROM AUTHOR]

Introduces some books about child mental health. 'Autism: Understanding the Disorder,' by G.B. Mesibov, L.W. Adams, and L.G. Klinger; 'Psychotic States in Children,' by M. Rustin, M. Rhode, A. and H. Rubinsky; 'Anorexics on Anorexia,' edited by R. Shelley.

This paper reports the results of cognitive, linguistic, and academic assessments in a representative sample of 62 adults with Williams syndrome. The average age of the group was 26 years and their mean full scale IQ was 61. Differences between Verbal and Performance IQ, and between receptive and expressive language skills, were smaller than generally found in studies of children with this condition. However, an examination of subtest scores revealed an almost identical cognitive profile to that found in children. Skills in other areas, such as reading, spelling, arithmetic, and social adaptation remained at a low level, with functioning generally being around a 6-8-year age equivalent. The consistency of reports on intellectual abilities in both child and adult studies of individuals with Williams syndrome lends increased support to the notion of a syndrome specific pattern of cognitive, linguistic, and adaptive functioning. [ABSTRACT FROM AUTHOR]

Changes over time in the language patterns of autistic children and their parents were examined during the course of a home-based intervention programme. Although the language used by parents to their autistic children was not deficient, language modification procedures were found to lead to rapid changes in the verbal interaction between parents and children. Parents in the non-intervention, control group showed little change in their communication style. In the experimental group, but not in the control group, a close relationship was found between increases in the use of language-eliciting utterances by their mothers and improvements in children's socialized language. The pattern of association between parent and child language suggested that the main effect was of the parent on the child but that the extent of the child's language handicap constrained what could be achieved by treatment. [ABSTRACT FROM AUTHOR]

SUMMARY The study investigated the syntactical level of spontaneous and echolalic utterances of 26 autistic children at different stages of phrase-speech development. In children using very brief utterances, echolalic phrases were significantly longer than their spontaneous speech. At higher levels of language development there were no significant differences between the lengths of echoed and spontaneous utterances. The frequency of echolalic phrases in children's speech was also found to be significantly less than the frequency of their spontaneous remarks, and the frequency of echolalic utterances declined as children advanced in linguistic competence. [ABSTRACT FROM AUTHOR]

This paper describes attempts to implement a ‘functional analysis’ approach to the treatment of severe self-injurious behaviour in a 4-year-old boy living at home. Although a degree of success is reported, problems in systematically applying assessment and intervention procedures are described. The paper discusses the successes and limitations of such an approach in the home environment and in a crisis situation. [ABSTRACT FROM AUTHOR]

Many workers have described the strong attachment most autistic children form at sometime to unusual objects. Although these objects differ in texture and shape from the normal child's teddy bear or blanket, there are obvious parallels in the way these objects are used. In some autistic children the attachment object is so large or bizarre that merely carrying it interferes with other activities of the child. A method of introducing slight and gradual changes into the autistic child's environment is discussed in this article.

The author comments on a study published within the issue that examined the employment situation for adults with autism in the U.S. and compared their job prospects with those of people with other disability types. The researchers found that prospects for young people with autism leaving school are extremely poor. It is asserted that the lack of employment opportunities for young adults with autism puts them at risk for social exclusion, financial difficulty and decreased quality of life.

The author discusses various reports published within the issue, including one on the delays experienced by families in obtaining a diagnosis for their children and another on the parents' beliefs about the aetiology, diagnosis, and treatment of autism spectrum disorders.

The article presents information on the articles that have been published in the October 2005 issue of the "Austism: The International Journal of Research and Practice." The articles from the United States deal with the important perspectives of people with autism spectrum disorders (ASD). The study on which these articles are based used a qualitative analysis of three discussion groups of adults with ASD to determine the issues of concern around the topic of social challenges. The article from Great Britain deals with ways of coping with stress by parents of children with ASD. Researchers studied 89 parents of preschoolers with ASD and 46 parents of school-aged children with ASD. The coping strategies that were found were categorized as active avoidance problem focused on religious denial. The results showed that avoidance coping was associated with more stress, anxiety and depression in both parents and religious denial. Positive coping was associated with less depression in both parents.

Research has shown lower rates of employment and independent living in adults with autism. Many of these findings are based on cross-sectional studies, predominantly involving male participants. In a 6-year longitudinal study, we examined determinants of psychosocial outcomes in 917 adults with autism spectrum disorder (425 men, 492 women, mean age 43.5 years). Most were diagnosed in adulthood and had (above) average intellectual abilities. Via a yearly online survey, participants' objective psychosocial functioning (based on employment, independent living and friendship) and subjective well-being were assessed. Averaged across the five waves of the study, 86% of the sample showed a fair to very good level of objective psychosocial functioning. Objective psychosocial functioning and subjective well-being were positively correlated, and both improved over time. Lower intellectual ability, more autism traits, co-occurring psychiatric conditions and younger age predicted poorer objective outcomes. More autism traits and co-occurring psychiatric conditions predicted lower subjective well-being. There were no gender differences in initial levels of, or changes in, objective and subjective outcomes over time. This study has identified important risk/protective factors for psychosocial outcomes across early and middle adulthood. In general, the findings offer a more positive outlook for adults with autism and average to high intellectual abilities. Previous research has shown that relatively few adults with autism have a paid job or live on their own. However, outcomes also vary a lot and may depend on many different factors. In this study, we examined the level of functioning and happiness of 917 adults with autism (425 men and 492 women) aged 18–65 years. Most of them were of average to high intellectual ability. Over 6 years, we measured whether they had a paid job, close friendships and lived on their own (i.e. their objective functioning). We also measured how happy they felt. Objectively, most autistic adults did fairly to very well. Those with better objective outcomes (e.g. those with paid work) also tended to be happier. Most adults improved in objective functioning and happiness over 6 years. Participants with a lower intellectual ability, more autism traits, mental health problems and younger age had poorer objective outcomes. Participants with more autism traits and mental health problems were less happy. Autistic men and women functioned at similar levels and were equally happy. We found important factors that predict a better (or worse) outcome for autistic adults. Overall, compared with some previous research, our findings give a more positive picture of the outcomes for autistic adults with average to high intellectual abilities. [ABSTRACT FROM AUTHOR]

This study examined the sustained and moderating effects of a behavioural sleep intervention for autistic children in a randomised controlled trial. Autistic children (5–13 years) with sleep problems were randomised to the Sleeping Sound intervention or Treatment as Usual (TAU). At 12-month follow-up (n = 150), caregivers of children in the Sleeping Sound group reported greater reduction in child sleep problems compared to TAU (p <.001, effect size: − 0.4). The long-term benefits of the intervention were greater for children taking sleep medication, children of parents who were not experiencing psychological distress, and children with greater autism severity. The Sleeping Sound intervention demonstrated sustained improvements in child sleep. Identified moderators may inform treatment by indicating which subgroups may benefit from further support. [ABSTRACT FROM AUTHOR]

Background: There are very few mechanistic studies of the long‐term impact of psychosocial interventions in childhood. The parent‐mediated Paediatric Autism Communication Therapy (PACT) RCT showed sustained effects on autistic child outcomes from pre‐school to mid‐childhood. We investigated the mechanism by which the PACT intervention achieved these effects. Methods: Of 152 children randomised to receive PACT or treatment as usual between 2 and 5 years of age, 121 (79.6%) were followed 5–6 years after the endpoint at a mean age of 10.5 years. Assessors, blind to the intervention group, measured Autism Diagnostic Observation Scale Calibrated Severity Score (ADOS CSS) for child autistic behaviours and Teacher Vineland (TVABS) for adaptive behaviour in school. Hypothesised mediators were child communication initiations with caregivers in a standard play observation (Dyadic Communication Measure for Autism, DCMA). Hypothesised moderators of mediation were baseline child non‐verbal age equivalent scores (AE), communication and symbolic development (CSBS) and 'insistence on sameness' (IS). Structural equation modelling was used in a repeated measures mediation design. Results: Good model fits were obtained. The treatment effect on child dyadic initiation with the caregiver was sustained through the follow‐up period. Increased child initiation at treatment midpoint mediated the majority (73%) of the treatment effect on follow‐up ADOS CSS. A combination of partial mediation from midpoint child initiations and the direct effect of treatment also contributed to a near‐significant total effect on follow‐up TVABS. No moderation of this mediation was found for AE, CSBS or IS. Conclusions: Early sustained increase in an autistic child's communication initiation with their caregiver is largely responsible for the long‐term effects from PACT therapy on autistic and adaptive behaviour outcomes. This supports the theoretical logic model of PACT therapy but also illuminates fundamental causal processes of social and adaptive development in autism over time: early social engagement in autism can be improved and this can have long‐term generalised outcome effects. [ABSTRACT FROM AUTHOR]

Editorial. Introduces the articles published in the 4th issue in the third volume of 'Autism.' Debate over conceptualization, classification and diagnosis in relation to the concept of a spectrum of autistic disorders; Useful and reliable way of distinguishing different kinds of imitation; Semantic-pragmatic disorder; Differentiation between the styles of two gifted artists with autism.