Neuropsychological Assessment in Autism Spectrum Disorder.

PURPOSE OF REVIEW: Neuropsychological assessment involves the comprehensive evaluation of intellectual, attentional, executive, social-cognitive, language, and motor functioning. Such assessments are used to characterize areas of strength and weakness, inform differential diagnosis, guide treatment planning, and evaluate change over time. Individuals with autism spectrum disorder (ASD) present with varied clinical presentations, which can make the design of testing batteries and subsequent interpretation of results challenging. Here we provide an overview of neuropsychological domains as they relate to the evaluation of individuals with ASD. RECENT FINDINGS: Individuals with ASD demonstrate unique patterns of neuropsychological functioning across various domains. Recent findings related to intellectual, adaptive, executive, attentional, social, language, motor, and autism-specific functioning are reviewed. Clarifying the relationship between ASD symptoms and neuropsychological functioning is critical for differential diagnosis and for optimal treatment planning. Tools and methods for developing appropriate neuropsychological testing protocols for individuals with ASD are discussed.

Sibling Relationships: Parent-Child Agreement and Contributions of Siblings With and Without ASD.

Research on the experiences of siblings of individuals with ASD and the quality of their sibling relationships has yielded mixed results. The present study examined the significance of parent- versus child-report of both positive and negative behaviors exhibited by siblings and their brothers and sisters with ASD within sibling dyads. Findings indicated that siblings were more positive in their assessment of the sibling relationship than were their parents. Siblings exhibited more positive behaviors within the sibling relationship than did their brothers and sisters with ASD, and were recipients of aggression. These findings are consistent with prior research suggesting that siblings tend to take on a caretaking role, and point to important targets for intervention.

Brief report: Reduced anxiety following Pivotal Response Treatment in young children with Autism Spectrum Disorder.

Up to 40% of children with Autism Spectrum Disorder (ASD) exhibit co-occurring anxiety symptoms. Despite recent success in mitigating anxiety symptoms in school-aged children with ASD (mean age >9 years) using adapted versions of Cognitive Behavioural Therapy, little is known about potential treatment outcomes for younger children. To address the gap in the literature, this open-label study evaluated change in anxiety following a 16-week open-label trial of Pivotal Response Treatment (PRT) in children with ASD aged 4-8 years. PRT is a behavioural treatment based on the principles of Applied Behaviour Analysis and has a primary aim of increasing social communication skills in children with ASD through natural reinforcements. To minimise conflation of anxiety and other co-occurring symptoms such as disruptive behaviour and attention-deficit hyperactivity disorder, we measured anxiety using the autism anxiety subscale of the Child and Adolescent Symptom Inventory (CASI) devised by Sukhodolsky et al. (2008). We observed significant anxiety reduction over 16-weeks of PRT. Furthermore, anxiety reduction was independent of changes in autism symptom severity. This study shows promising results for PRT as an intervention for reducing anxiety in young children with ASD.

Brief Report: Reduced Restricted and Repetitive Behaviors after Pivotal Response Treatment.

Children with ASD show high frequency of restricted and repetitive behaviors (RRBs); however, higher-order RRBs, such as restricted interests, have remained largely resistant to treatment. This study evaluated change in severity of RRBs following a 16-weeks open trial of Pivotal Response Treatment (PRT). Participants included 15 children with ASD ages 4-7 years. RRBs, as measured by the repetitive behavioral scales-revised (RBS-R) and aberrant behaviors checklist, decreased significantly after treatment. These reductions remained significant after controlling for change in social communication skills. PRT shows promise in reducing RRBs; although PRT explicitly addresses pivotal social communication skills, there is a secondary and less direct effect on RRBs.