Task-related differences in the gesture production of young autistic children.

BACKGROUND: In typically developing (TD) children, gesture emerges around 9 months of age, allowing children to communicate prior to speech. Due to the important role gesture plays in the early communication of autistic and TD children, various tasks have been used to assess gesture ability. However, few data exist on whether and how tasks differentially elicit gesture, particularly for samples of racially and ethnically diverse autistic children. AIMS: In this study, we explored if task (a naturalistic parent-child interaction [NPCI]; structured assessment of child communication) differentially elicited rate or type of gesture production for young autistic children. METHODS AND PROCEDURES: This secondary analysis included baseline data from 80 racially and ethnically diverse autistic children aged 18-59 months who participated in one of two larger studies. Video recordings of NPCIs and an assessment of child communication with standardised administration procedures were collected at baseline. Child gesture rate (number of gestures produced per 10 min) and type were extracted from these recordings and analysed. OUTCOMES AND RESULTS: The structured assessment elicited more gestures than the NPCI. In terms of gesture type, points, gives, and reaches accounted for 76% of child gestures. Points (which are developmentally more advanced than reaches and gives) were produced at the highest rates within book exploration. Distal points (which are more developmentally advanced than proximal or contact points) were produced at the highest rates when children were tempted to request. CONCLUSIONS AND IMPLICATIONS: Our findings indicate elicitation tasks differentially elicit type and rate of gesture for young autistic children. To assess the gesture production of young autistic children, a structured task designed to elicit child requests will probe the developmental sophistication of the child's gesture repertoire, eliciting both the most gestures and the most developmentally advanced gestures. WHAT THIS PAPER ADDS: What is already known on the subject Because of the importance of gesture in early communication for autistic and typically developing children, various tasks have been used to assess it. However, little is known about whether tasks differentially elicit type or rate of gesture for young autistic children from diverse racial and ethnic backgrounds. What this paper adds to existing knowledge Elicitation tasks differentially elicit type and rate of gesture for young autistic children in the early stages of gesture. What are the potential or actual clinical implications of this work? We recommend a structured task designed to elicit child requests to assess the developmental sophistication of a child's gesture repertoire.

You Do What You Got To Do: African-American Women's Perspectives of Managing Breast Cancer.

The purpose of this study is to build a grounded theory of the process of diagnosis, treatment, and coping in African-American women diagnosed with stage 1-3 breast cancer, and identifying factors that may lead to resiliency in these women. Factors promoting resiliency identified by the participants included having a voice, self-attunement, spirituality, pragmatism, and keeping positive. Based on the findings, the researchers suggest health care providers work to create patient-centered healthcare,facilities for cancer treatment, validate patient self-agency, encourage communion, and hire staff that have been previously diagnosed with breast cancer to act as mentors.

The Role of Pathways Early Autism Intervention in Improving Social Skills and Respeto for Young Hispanic Autistic Children.

PURPOSE: We know very little about Hispanic autistic children's response to intervention as, historically, Hispanic children are underrepresented in intervention studies. Pathways parent-mediated early autism intervention is one of the few naturalistic developmental behavioral interventions (NDBIs) that is contextually and linguistically responsive to Hispanic families. However, some child-centered NDBI strategies do not align with the Hispanic caregiving value of respeto. A child exhibiting respeto demonstrates affiliative obedience by displaying deference and respect toward adults. Furthermore, theories of the ontogeny of cultural learning suggest that certain levels of social development may be necessary to learn cultural values. The current study investigates (1) the relationship between Hispanic autistic children's social skills and affiliative obedience and (2) the efficacy of Pathways in improving affiliative obedience in Hispanic children. METHODS: This quasi-experimental design study used preexisting standardized test data and video recordings from 26 Hispanic participants who took part in a previous Pathways efficacy study. Recordings were coded for affiliative obedience and social connectedness. Residual change variables were used to measure progress from baseline to post-intervention, and correlation and hierarchical regression analyses were conducted to analyze the data. RESULTS: We found significant positive correlations between social skills and children's affiliative obedience for baseline and change variables. In addition, we found Pathways had a significant medium-large magnitude effect on change in affiliative obedience skills. CONCLUSION: This study highlights the benefits of NDBI interventions that advance social development in autistic children and support Hispanic parents in enculturating their children in the value of respeto.

The cross-racial/ethnic gesture production of young autistic children and their parents.

Background & Aims: Early gesture plays an important role in prelinguistic/emerging linguistic communication and may provide insight into a child's social communication skills before the emergence of spoken language. Social interactionist theories suggest children learn to gesture through daily interactions with their social environment (e.g., their parents). As such, it is important to understand how parents gesture within interactions with their children when studying child gesture. Parents of typically developing (TD) children exhibit cross-racial/ethnic differences in gesture rate. Correlations between parent and child gesture rates arise prior to the first birthday, although TD children at this developmental level do not yet consistently exhibit the same cross-racial/ethnic differences as their parents. While these relationships have been explored in TD children, less is known about the gesture production of young autistic children and their parents. Further, studies of autistic children have historically been conducted with predominantly White, English-speaking participants. As a result, there is little data regarding the gesture production of young autistic children and their parents from diverse racial/ethnic backgrounds. In the present study, we examined the gesture rates of racially/ethnically diverse autistic children and their parents. Specifically, we explored (1) cross-racial/ethnic differences in the gesture rate of parents of autistic children, (2) the correlation between parent and child gesture rates, and (3) cross-racial/ethnic differences in the gesture rates of autistic children. Methods: Participants were 77 racially/ethnically diverse cognitively and linguistically impaired autistic children (age 18 to 57 months) and a parent who participated in one of two larger intervention studies. Naturalistic parent-child and structured clinician-child interactions were video recorded at baseline. Parent and child gesture rate (number of gestures produced per 10 min) were extracted from these recordings. Results: (1) Parents exhibited cross-racial/ethnic differences in gesture rate such that Hispanic parents gestured more frequently than Black/African American parents, replicating previous findings in parents of TD children. Further, South Asian parents gestured more than Black/African American parents. (2) The gesture rate of autistic children was not correlated with parent gesture, a finding that differs from TD children of a similar developmental level. (3) Autistic children did not exhibit the same cross-racial/ethnic differences in gesture rate as their parents, a result consistent with findings from TD children. Conclusions: Parents of autistic children-like parents of TD children-exhibit cross-racial/ethnic differences in gesture rate. However, parent and child gesture rates were not related in the present study. Thus, while parents of autistic children from different ethnic/racial backgrounds appear to be conveying differences in gestural communication to their children, these differences are not yet evident in child gesture. Implications: Our findings enhance our understanding of the early gesture production of racially/ethnically diverse autistic children in the prelinguistic/emerging linguistic stage of development, as well as the role of parent gesture. More research is needed with developmentally more advanced autistic children, as these relationships may change with development.

Reexamining Pathways Early Autism Intervention in Children Before and After the Third Birthday: A Randomized Control Trial.

We reexamined the efficacy of Pathways early autism intervention using generalized measures of social communication and language skills administered by an unfamiliar adult in a novel environment. Generalized measures improve on sources of measurement bias. Sixty-seven autistic children blocked on age (under versus over 3 years) were randomly assigned to 15 weeks of Pathways or services-as-usual. Age moderated the effects of Pathways for social communication. Specifically, Pathways had a significantly large effect for children under 3 and a small effect that approached significance for children over 3. Pathways also had a small effect on expressive speech/language skills. Results replicate previous findings of the efficacy of Pathways on proximal and distal skills and support the importance of early intervention.

Examining Cultural and Linguistic Sensitivity of Pathways Early Autism Intervention with Hispanic Families.

PURPOSE: This research aimed to evaluate evidence of Pathways parent-mediated early autism intervention as a culturally and linguistically sensitive intervention (CLSI) for Hispanic families with autistic children. METHODS: We used Bernal et al.'s ecologically valid (EV) framework to evaluate current practice and Hispanic parents' perceptions of Pathways 1 ½ years after completing the intervention. Both quantitative and qualitative methods were used. Nineteen parents were contacted, of which 11 completed a semi-structured interview about their experience with Pathways. RESULTS: On average, the group that completed the interview was less educated, had more monolingual Spanish speakers, and rated their general experience with the intervention slightly more positively than those who did not agree to complete the interview. A review of Pathways's current practices through the lens of the EV framework suggested that Pathways was a CLSI for Hispanic participants in the domains of context, methods, language, and persons. Parental interviews echoed these strengths. However, Pathways did less well balancing evidence-based intervention strategies for autistic children with the heritage value of respeto. CONCLUSION: Pathways demonstrated strengths regarding cultural and linguistic sensitivity for Hispanic families with young autistic children. Future work with our community stakeholder group will integrate heritage and majority culture perspectives to strengthen Pathways as a CLSI.

Sanctioned licensing board violations for marriage and family therapists spanning a 10-year period.

Although disciplinary data on violations committed by licensed mental health professionals are important information for training programs, supervisors, and regulators, little disciplinary information is available on licensed marriage and family therapists (MFTs). This study collected data publicly available from state regulatory board websites and open records requests from 35 states for a total of 1241 separate cases, 889 of which were from CA. The findings indicated that the five most common violations for MFTs in 34 states (not including CA) were nonsexual dual relationships, failure to meet CE hour requirements, sexual dual relationships, unlicensed practice, and misrepresentation on licensing applications or renewals. For CA, the most common violations included criminal charges-misdemeanor, DUI/inappropriate substance use, unprofessional conduct, misrepresentation on licensure paperwork, and failure to meet CE hour requirements. MFTs licensed between 2 and 5 years committed the majority of violations. Implications for training programs, supervisors, and regulators are discussed.

Pragmatic contributions to early vocabulary and social communication in young autistic children with language and cognitive delays.

INTRODUCTION: There are limited data on the interrelationships among pragmatic skills and expressive vocabulary and their contribution to later social communication. Understanding these relationships could inform developmental processes and early intervention strategies. This study explored the relationship among pragmatics skills (i.e., communicative intents and responding to parents' preceding utterances) and concurrent expressive vocabulary as well as the predictive nature of these skills on later social communication in young autistic children with language and cognitive delays. METHOD: Data from 56 autistic children (age 18-57 months) who participated in a larger randomized control trial of Pathways Early Autism Intervention were used in this secondary analysis. Video recordings of pre-intervention (Time 1) parent-child interactions were analyzed for number of different words (NDW; expressive vocabulary), number of different (ND) communicative intents, and response to parents' preceding utterances. Residual scores from an assessment of social communication were used to measure Time 2 social communication. First-order correlations and hierarchical regression were used for analyses. RESULTS: Adjusting for age and receptive language, both ND communicative intents and response to parents' preceding utterances were associated with pre-intervention NDW. Further, adjusting for receptive language age and intervention group, NDW and response to parents' preceding utterances - but not ND communicative intents-was related to Time 2 social communication. NDW, however, was no longer related to Time 2 social communication skills after accounting for response to parents' preceding utterances. CONCLUSIONS: This study provides evidence that autistic children with language and cognitive delays use their expressive vocabularies to respond, hence allocating attention to parent speech, a rudimentary form of social orienting. Our results support approaches to intervention that leverage responding as a rudimentary form of social orienting while encouraging more mature forms of social attention (i.e., social orienting to faces and joint attention) within developmentally appropriate activities, such as routines.

Mutual Gaze: An Active Ingredient for Social Development in Toddlers with ASD: A Randomized Control Trial.

We examined the efficacy of an early autism intervention for use in early childhood intervention (ECI) and mutual gaze as a contributor to social development. Seventy-eight families were randomly assigned to one of three 12-week interventions: Pathways (with a mutual gaze component), communication, or services-as-usual (SAU). The Pathways/SAU comparison concerned the efficacy of Pathways for ECI, and the Pathways/communication comparison, mutual gaze. The Pathways group made significantly more change on social measures, communicative synchrony, and adaptive functioning compared with the SAU group and on social measures compared with the communication group. There were no group differences for communicative acts. The results support Pathways as a potential ECI program and mutual gaze as an active ingredient for social and communication development.

Differential responses to child communicative behavior of parents of toddlers with ASD.

Background and aims: The quality of parent verbal input-diverse vocabulary that is well-matched to the child's developmental level within interactions that are responsive to their interests-has been found to positively impact child language skills. For typically developing (TD) children, there is evidence that more advanced linguistic and social development differentially elicits higher quality parent input, suggesting a bidirectional relationship between parent and child. The purpose of this study was to evaluate if toddlers with ASD also differentially elicit parental verbal input by (1) analyzing the quality of parent input to the communicative behavior of their toddlers with ASD, (2) examining if parents respond differentially to more advanced toddler communicative behavior, as measured by the coordination of multiple communicative behaviors, and (3) exploring the relationship between parental responsiveness to child communicative behaviors and change in child communication and social skills. Methods: Participants were 77 toddlers with ASD age 18-39 months and a parent who participated in a larger RCT. Ten-minute parent-toddler interactions were recorded prior to a 12-week intervention. Parent response to child communicative behaviors was coded following each child communicative behavior as no acknowledgment, responsive, directive, or nonverbal acknowledgment. Parent number of different words and difference between parent and child MLU in words were calculated separately for responsive and directive parent utterances. Child growth in language and social skills was measured using the Vineland II Communication and Socialization domain scores, respectively. Results: (1) Parents were largely responsive to their toddler's communication. When being responsive (as opposed to directive), parents used a greater number of different words within utterances that were well-matched to child language; (2) when toddlers coordinated communicative behaviors (versus producing an isolated communicative behavior), parents were more likely to respond and their replies were more likely to be responsive; and (3) parent responsiveness to child coordinated communication was significantly correlated with change in Vineland II Socialization but not Communication. A unique role of gaze coordinated child communication in eliciting responsive parental behaviors and improving growth in child social skills emerged. Conclusions: Our results support a bidirectional process between responsive parent verbal input and the social development of toddlers with ASD, with less sophisticated child communicative behaviors eliciting lower quality parent input.Implications: Our findings highlight the critical role of early parent-mediated intervention for children with ASD generally, and to enhance eye gaze through parent responsivity more specifically.

Pathways Early ASD Intervention as a Moderator of Parenting Stress on Parenting Behaviors: A Randomized Control Trial.

We examined the relationship between initial parenting stress and change in parental responsivity for 56 culturally and socioeconomically diverse families in a 12 week randomized control trial of Pathways Early ASD Intervention. Families were randomized into the Pathways (n = 32) or treatment-as-usual (TAU n = 24) group. Overall, Pathways parents experienced decreased stress, while TAU parents experienced an increase. The relationship between initial parental stress and change in parent responsivity was moderated by group membership. Pathways parents became more responsive but responsivity was not influenced by initial parental stress. In contrast, responsivity was negatively affected by initial parenting stress in the TAU group. Results are discussed in terms of components of a parent-mediated ASD intervention that may reduce parental stress.

A community-based early intervention program for toddlers with autism spectrum disorders.

This study examined Pathways Early Autism Intervention, a community-based, parent-mediated, intensive behavioral and developmental intervention program for children with autism spectrum disorders that could be used as a model for state-funded early intervention programs. A single-subject, multiple-baseline, across-participants design was used. Four boys with autism spectrum disorder and their mothers participated. Interventionists made weekly home visits and worked with caregivers to establish and maintain face-to-face reciprocal social interaction and eye contact. Each session included a 10-min video of parent-child interaction. Evidence of intervention effectiveness was measured by percentage of nonoverlapping data points. Social validity was measured using questionnaire items in regard to parents' perception of the intervention. The intervention was effective for the measures of eye contact, social engagement, and verbal reciprocity but not for nonverbal turn taking. Parents perceived the intervention as beneficial and easy to learn and incorporate into daily life.

The non-classical auditory pathways are involved in hearing in children but not in adults.

Auditory information ascends through the brainstem to the cerebral cortices in two parallel pathways, known as the classical and the non-classical ascending auditory pathways. The importance of the non-classical auditory pathway for hearing in humans is unknown but its subcortical connection to limbic structures may be important in tinnitus. In this study we show evidence that non-classical pathways are involved in loudness perception in young individuals but not in adults. We used the fact that some neurons in the non-classical auditory pathways receive somatosensory input and we determined the effect on loudness perception of monaural sounds from electrical stimulation of the median nerve at the wrist. Stimulation of the somatosensory system had the greatest effect on loudness perception in the youngest children that we studied (7-8 years) and the effect was minimal for individuals above 20 years of age. The effect was an increase in loudness in 20 of the 40 individuals we studied and a decrease in 4 individuals; 16 experienced no noticeable change in loudness during somatosensory stimulation.

Children's recognition of cartoon voices.

We examined developmental changes in talker recognition skills by assessing 3-, 4-, and 5-year-old children's recognition of 20 cartoon characters' voices. For each participant, the character set was subdivided into more and less familiar talkers based on the participant's ability to name each character. Four- and 5- year-old children recognized more of the voices (81% and 86%, respectively) than did 3-year-olds (61%), although performance of all age groups was well above chance. All groups of children were more accurate at recognizing more familiar than less familiar characters. These results suggest that indexical information about a talker becomes an integral part of the perceptual record in memory and can be used by children at a very young age. These results are important because children's ability to learn vocal sources may be an important aid to the development of spoken word recognition.

Is Oklahoma the weak link? The decline in vaccine coverage levels in Oklahoma.

Oklahoma has demonstrated a decline in vaccine coverage levels in children over the past two years, moving from a national ranking of 31st in 2000 to 48th in 2002. This decline has prompted a review of available evidence to identify approaches to move the state toward national averages and ultimately to the Healthy People 2010 Objectives. Oklahoma is one of nine states that are well below the established goal of 80% vaccine coverage for children. Oklahoma is near the bottom of this group with an estimated level of only 65%, placing not only Oklahomans at risk but the nation as well. The following is a plan aimed at both the health department and all health care professionals. Indeed, without physician involvement, the situation will not improve.