Search

Social identities relate to psychological perceptions of group memberships and form part of the self-concept. Socially identifying with groups has previously been found to associate with better mental well-being outcomes. This study first examined the factor structure and the reliability of measuring social identification in autistic adults. Confirmatory factor analysis showed that a factor structure was replicated in this sample for social identification with other autistic people, but not the family. Second, the study assessed the level to which autistic adults socially identified with different groups, the total number of social identities and whether these were associated with their mental well-being. Autistic adults reported feelings of social identification with many kinds of groups, some with multiple groups, whereas others did not socially identify with any group. Stronger feelings of social identification towards other autistic people and towards one's family, and with more groups overall, were associated with less severe self-reported depression symptoms and more facets of positive mental health. These findings indicate the importance of facilitating autistic people's engagement with social groups.

Visual supports are recommended in autism spectrum disorder clinical guidelines. They can reduce anxiety, increase predictability, support communication and improve participation. They are implemented regularly in schools, but evidence about home visual supports is limited. This article reports results of a scoping literature review, alongside qualitative evaluation with parents and professionals. We report findings from 34 studies, identifying four categories of visual support and heterogeneity in participant characteristics, intervention methods, environments and outcome measures. Qualitative data from questionnaires (n = 101) and focus groups generated key themes about home visual supports, through thematic analysis: (1) Accessibility, (2) Participation-focussed (3) Individualisation, (4) Teaching Methods, (5) Consistency, and (6) Information and Training. We propose consensus with terminology and implications for practice and research.

This study examined waiting times for diagnostic assessment of Autism Spectrum Disorder in 11 adult services, prior to and following the implementation of a 12 month change program. Methods to support change are reported and a multi-level modelling approach determined the effect of the change program on overall wait times. Results were statistically significant (b = - 0.25, t(136) = - 2.88, p = 0.005). The average time individuals waited for diagnosis across all services reduced from 149.4 days prior to the change program and 119.5 days after it, with an average reduction of 29.9 days overall. This innovative intervention provides a promising framework for service improvement to reduce the wait for diagnostic assessment of ASD in adults across the range of spectrum presentations.

Children affected by Specific Language Impairment (SLI) fail to acquire age appropriate language skills despite adequate intelligence and opportunity. SLI is highly heritable, but the understanding of underlying genetic mechanisms has proved challenging. In this study, we use molecular genetic techniques to investigate an admixed isolated founder population from the Robinson Crusoe Island (Chile), who are affected by a high incidence of SLI, increasing the power to discover contributory genetic factors. We utilize exome sequencing in selected individuals from this population to identify eight coding variants that are of putative significance. We then apply association analyses across the wider population to highlight a single rare coding variant (rs144169475, Minor Allele Frequency of 4.1% in admixed South American populations) in the NFXL1 gene that confers a nonsynonymous change (N150K) and is significantly associated with language impairment in the Robinson Crusoe population (p = 2.04 × 10-4, 8 variants tested). Subsequent sequencing of NFXL1 in 117 UK SLI cases identified four individuals with heterozygous variants predicted to be of functional consequence. We conclude that coding variants within NFXL1 confer an increased risk of SLI within a complex genetic model.

The 'autism diagnosis crisis' and long waiting times for assessment are as yet unresolved, leading to undue stress and limiting access to effective support. There is therefore a significant need for evidence to support practitioners in the development of efficient services, delivering acceptable waiting times and effectively meeting guideline standards. This study reports statistically significant reductions in waiting times for autism diagnostic assessment following a children's health service improvement programme. The average wait between referral and first appointment reduced from 14.2 to 10.4 weeks (t(21) = 4.3, p < 0.05) and between referral and diagnosis shared, reduced from 270 to 122.5 days, (t(20) = 5.5, p < 0.05). The proportion of girls identified increased from 5.6 to 2.7:1. Methods reported include: local improvement action planning; evidence based pathways; systematic clinical data gathering and a training plan. This is a highly significant finding for many health services wrestling with the challenges of demand and capacity for autism diagnosis and assessment.

This study evaluated a technology-based early intervention for social communication skills in pre-schoolers in a randomised controlled trial. Participants were 54 children aged under 6 years with a diagnosis of autism, assigned to either intervention or control conditions. The app engaged children, who played consistently, regardless of developmental level, and was rated highly by parents. There were no significant group differences in parent-report measures post-intervention, nor in a measure of parent-child play at follow-up. Therefore, this intervention did not have an observable impact on real-world social communication skills and caution is recommended about the potential usefulness of iPad™ apps for amelioration of difficulties in interaction. However, positive attitudes among participants, lack of harms and the potential of apps to deliver therapeutic content at low economic cost suggest this approach is worth pursuing further, perhaps targeting other skill domains.

This article reports on gender ratio, age of diagnosis and the duration of assessment procedures in autism spectrum disorder diagnosis in a national study which included all types of clinical services for children and adults. Findings are reported from a retrospective case note analysis undertaken with a representative sample of 150 Scottish children and adults recently diagnosed with autism spectrum disorder. The study reports key findings that the gender ratio in this consecutively referred cohort is lower than anticipated in some age groups and reduces with increasing age. The gender ratio in children, together with the significant difference in the mean age of referral and diagnosis for girls compared to boys, adds evidence of delayed recognition of autism spectrum disorder in younger girls. There was no significant difference in duration of assessment for males and females suggesting that delays in diagnosis of females occur prior to referral for assessment. Implications for practice and research are considered.

The aim of this study was to explore the extent to which the Scottish Intercollegiate Guidelines Network 98 guidelines on the assessment and diagnosis of autism spectrum disorder were adhered to in child autism spectrum disorder diagnostic services in Scotland and whether there was a significant relationship between routine practice which more closely reflected these recommendations (increased adherence) and increased waiting times. Retrospective, cross-sectional case note analysis was applied to data from 80 case notes. Adherence ranged from a possible 0 (no adherence) to 19 (full adherence). Overall, 17/22 of the recommendations were adhered to in over 50 of the 80 cases and in 70 or more cases for 11/22 of the recommendations, with a mean adherence score of 16 (standard deviation = 1.9). No significant correlation was found between adherence and total wait time for untransformed (r = 0.15, p = 0.32) or transformed data (r = 0.12, p = 0.20). The results indicated that the assessment and diagnostic practices were consistent with the relevant Scottish Intercollegiate Guidelines Network 98 guideline recommendations. Increased adherence to the 19 included recommendations was not significantly related to increased total waiting times, indicating that the Scottish Intercollegiate Guidelines Network 98 recommendations have generally been integrated into practice, without a resultant increase in patient waits.

Despite their range and complexity, adherence to Scottish Intercollegiate Guidelines Network guideline for the diagnosis and assessment of autism spectrum disorders (ASD) was shown to be high within child development and specialist diagnostic clinics serving a geographical cohort of children diagnosed under the age of 7 years. A retrospective analysis of comprehensive clinical notes demonstrated that the recommended discretionary use of structured history instruments was increased after medical training (p = 0.003). 56% (51/90) of children received the diagnosis of ASD at their initial specialist appointment. 51% underwent the recommended discretionary structured observational instrument. This further assessment was more likely to be required for older children in the reaudited group (p = 0.001). The implications for service capacity planning when delivering best practice recommendations are discussed.

Parents of children with autism spectrum disorders (ASD) use a wide range of interventions including poorly evidenced dietary interventions. To investigate parents' and professionals' experience of dietary interventions and attitudes towards a proposed trial to evaluate the gluten free casein free diet (GFCFD). Survey of UK parents of children with ASD, and professionals. 258 parents and 244 professionals participated. 83% of children had received a range of dietary manipulations; three quarters of professionals have been asked for advice about GFCFD. Respondents identified an inadequate evidence base for dietary interventions in ASD and suggested modifications to a proposed trial design. Both parents and professionals supported the need for further evaluation of dietary interventions in ASD.

Studies indicate that language impairment that cannot be accounted for by factors such as below-average non-verbal ability, hearing impairment, behaviour or emotional problems, or neurological impairments affects some 6% of school-age children. Language impairment with a receptive language component is more resistant to intervention than specific expressive or phonological delays, and carries a greater risk of comorbid behavioural difficulties as well as adverse outcomes for language development and academic progress. This paper considers underlying explanations that may account for receptive-expressive language impairment. It also reviews evidence for the effectiveness of intervention from theory and recent systematic reviews, trials, and speech and language therapy practice.

One hundred forty typically developing 5- to 12-year-old children were assessed with a test of advanced theory of mind employing Happe's strange stories. There was no significant difference in performance between boys and girls. The stories discriminated performance across the different ages with the lowest performance being in the younger children who nevertheless managed to achieve a third of their potential total. However, some of the individual mentalising concepts such as persuasion were too difficult for these younger children. This normative data provides a useful clinical tool to measure mentalising ability in more able children with autism spectrum disorder.

Background: Many school-age children with language impairments are enrolled in mainstream schools and receive indirect language therapy, but there have been, to the authors' knowledge, no previous controlled studies comparing the outcomes and costs of direct and indirect intervention delivered by qualified therapists and therapy assistants, and each delivery mode offered to children individually or in groups. Aims: To investigate the relative effectiveness of indirect and direct intervention therapy modes delivered individually or in groups for children with primary language impairment. Methods & Procedures: A multi-centre randomized controlled trial investigated 161 children with primary language impairment aged 6-11 years randomized to a usual-therapy control group or to direct individual, indirect individual, direct group or indirect group therapy modes. Intervention was delivered three times a week for 30-40-min sessions in mainstream schools over 15 weeks. Language performance was assessed at baseline, post-therapy and at 12 months. Cost analysis was based on salary and travel costs for intervention modes and usual therapy. Outcomes & Results: Compared with controls, children receiving project therapy made short-term improvements in expressive (p = 0.031), but not receptive, language immediately following intervention. Children with specific expressive language delay were more likely to show improvement than those with mixed receptive-expressive difficulties. The four project therapy modes did not differ on primary language outcomes (all p-values greater than 0.392) and there were no further improvements evident at follow-up. Indirect group therapy was the least costly mode, with direct individual therapy the most costly. Conclusions & Implications: Intervention in this age group can be effective for expressive language and can be delivered equally effectively though speech and language therapy assistants and to children in groups. (Contains 6 tables and 2 figures.)

Background: The study is the first within trial cost analysis of direct versus indirect and individual versus group modes of speech-and-language therapy for children with primary language impairment. Aims: To compare the short-run resource consequences of the four interventions alongside the effects achieved measured by standardized scores on a test of expressive and receptive language. Methods & Procedures: The study design was a cost analysis integrated within a randomized controlled trial using a 22 factorial design (direct/indirect versus individual/group therapy) together with a control group that received usual levels of community-based speech-and-language therapy. Research interventions were delivered in school settings in Scotland, UK. Children aged between 6 and 11 years, attending a mainstream school, with standard scores on the Clinical Evaluation of Language Fundamentals (CELF-III[superscript UK]) of less than -1.25 standard deviation (SD) (receptive and/or expressive) and non-verbal IQ on the Wechsler Abbreviated Scale of Intelligence (WASI) above 75, and no reported hearing loss, no moderate/severe articulation/phonology/dysfluency problems or otherwise requiring individual work with a speech-and-language therapist. The intervention involved speech-and-language therapists and speech-and-language therapy assistants working with individual children or small groups of children. A therapy manual was constructed to assist the choice of procedures and activities for intervention. The cost analysis focused on the salary and travel costs associated with each mode of intervention. The cumulative distribution of total costs arising from the time of randomization to post-intervention assessment was estimated. Arithmetic mean costs were compared and reported with their 95% confidence intervals. Outcomes & Results: The results of the intention-to-treat analysis revealed that there were no significant post-intervention differences between direct and indirect modes of therapy, or between individual and group modes on any of the primary language outcome measures. The cost analysis identified indirect therapy, particularly indirect group therapy, as the least costly of the intervention modes with direct individual therapy as the most costly option. The programme cost of providing therapy in practice over 30 weeks for children could represent between 30% and 75% of the total gross revenue spend in primary school per pupil, depending on the choice of assistant led group therapy or therapist-led individual therapy. Conclusions & Implications: This study suggests that speech-and-language therapy assistants can act as effective surrogates for speech-and-language therapists in delivering cost-effective services to children with primary language impairment. The resource gains from adopting a group-based approach may ensure that effective therapy is provided to more children in a more efficient way. (Contains 3 tables and 4 figures.)

The purpose of this study is to pilot a new notification system for children with visual impairment (VI) and describe the initial summary findings. A system of notification of children in Scotland with VI was established. Information concerning this system was distributed to professionals working with visually impaired children to forward to parents. Parents, teachers and health professionals were all encouraged to notify children with VI. 975 families with children with (VI) were notified and received information and support from Visual Impairment Scotland (VIS). For this review, the data from 850 parents were included in the analysis. The provision of a range of support services for parents and children with VI has led to a wide range of children being notified to VIS. The causes of VI can be recorded as well as other useful demographic information. The methods used could be applied across the range of low incidence childhood disabilities. (Contains 8 figures and 2 tables.)

Background: Disordered expressive prosody is a widely reported characteristic of individuals with autism. Despite this, it has received little attention in the literature and the few studies that have addressed it have not described its relationship to other aspects of communication. Aims: To determine the nature and relationship of expressive and receptive language, phonology, pragmatics, and non-verbal ability in school-aged children with high-functioning autism and to determine how prosody relates to these abilities and which aspects of prosody are most affected. Methods & Procedures: A total of 31 children with high-functioning autism and 72 typically developing children matched for verbal mental age completed a battery of speech, language, and non-verbal assessments and a procedure for assessing receptive and expressive prosody. Outcomes & Results: Language skills varied, but the majority of children with high-functioning autism had deficits in at least one aspect of language with expressive language most severely impaired. All of the children with high-functioning autism had difficulty with at least one aspect of prosody and prosodic ability correlated highly with expressive and receptive language. The children with high-functioning autism showed significantly poorer prosodic skills than the control group, even after adjusting for verbal mental age. Conclusions: Investigating prosody and its relationship to language in autism is clinically important because expressive prosodic disorders add an additional social and communication barrier for these children and problems are often life-long even when other areas of language improve. Furthermore, a receptive prosodic impairment may have implications not only for understanding the many functions of prosody but also for general language comprehension. PEPS-C Subtest Descriptions are appended. (Contains 4 tables.) [This study was funded by a grant from the Scottish Executive Chief Scientist Office.]

Seventy-seven children between the ages of 6 and 10 years, with severe mixed receptive-expressive specific language impairment (SLI), participated in a randomized controlled trial (RCT) of Fast ForWord (FFW; Scientific Learning Corporation, 1997, 2001). FFW is a computer-based intervention for treating SLI using acoustically enhanced speech stimuli. These stimuli are modified to exaggerate their time and intensity properties as part of an adaptive training process. All children who participated in the RCT maintained their regular speech and language therapy and school regime throughout the trial. Standardized measures of receptive and expressive language were used to assess performance at baseline and to measure outcome from treatment at 9 weeks and 6 months. Children were allocated to 1 of 3 groups. Group A (n = 23) received the FFW intervention as a home-based therapy for 6 weeks. Group B (n = 27) received commercially available computer-based activities designed to promote language as a control for computer games exposure. Group C (n = 27) received no additional study intervention. Each group made significant gains in language scores, but there was no additional effect for either computer intervention. Thus, the findings from this RCT do not support the efficacy of FFW as an intervention for children with severe mixed receptive-expressive SLI.

A survey of one region in Scotland attempted to identify the number and characteristics of children with dysgraphia, multidisciplinary and inter-professional services and relationships, and the role of electronic keyboards or word processors. Among detailed findings was that 20 percent of children had stopped using keyboards with the most frequent reason given being slow typing speed. (Contains references.) (DB)

Parents of children with autism spectrum disorders (ASD) use a wide range of interventions including poorly evidenced dietary interventions. To investigate parents' and professionals' experience of dietary interventions and attitudes towards a proposed trial to evaluate the gluten free casein free diet (GFCFD). Survey of UK parents of children with ASD, and professionals. 258 parents and 244 professionals participated. 83% of children had received a range of dietary manipulations; three quarters of professionals have been asked for advice about GFCFD. Respondents identified an inadequate evidence base for dietary interventions in ASD and suggested modifications to a proposed trial design. Both parents and professionals supported the need for further evaluation of dietary interventions in ASD. Keywords Autism * ASD * Dietary interventions * Gluten * Casein, Introduction Recent ASD studies have reported a prevalence of at least 1% of the child population (Baird et al. 2006; Kogan et al. 2009). Although there is no cure for [...]

A high-density screen of SLI1region of chromosome 16q associated with phonological short-term memory in the specific language impairment (SLI) developmental disorder is conducted to identify its causative genes. Results suggest that variants in CMIP, a gene encoding c-maf-inducing protein and ATP2C2, a gene encoding calcium-transporting ATPase, type 2C, member2 protein, located in the SLI1 region modulate phonological short-term memory in SLI.

Purpose: This study aimed to identify the nature and extent of receptive and expressive prosodic deficits in children with high-functioning autism (HFA). Method: Thirty-one children with HFA, 72 typically developing [...]

Seventy-seven children between the ages of 6 and 10 years, with severe mixed receptive-expressive specific language impairment (SLI), participated in a randomized controlled trial (RCT) of Fast ForWord (FFW; Scientific Learning Corporation, 1997, 2001). FFW is a computer-based intervention for treating SLI using acoustically enhanced speech stimuli. These stimuli are modified to exaggerate their time and intensity properties as part of an adaptive training process. All children who participated in the RCT maintained their regular speech and language therapy and school regime throughout the trial. Standardized measures of receptive and expressive language were used to assess performance at baseline and to measure outcome from treatment at 9 weeks and 6 months. Children were allocated to 1 of 3 groups. Group A (n = 23) received the FFW intervention as a home-based therapy for 6 weeks. Group B (n = 27) received commercially available computer-based activities designed to promote language as a control for computer games exposure. Group C (n = 27) received no additional study intervention. Each group made significant gains in language scores, but there was no additional effect for either computer intervention. Thus, the findings from this RCT do not support the efficacy of FFW as an intervention for children with severe mixed receptive-expressive SLI. KEY WORDS: computer applications, Fast ForWord, language disorders, randomized controlled trial, Specific language impairment (SLI)--language delay that cannot be accounted for in terms of nonverbal ability, hearing impairment, behavior or emotional problems, or neurological impairments (Plante, 1998; Stark & Tallal, 1981)--affects [...]