Mismatch Negativity and P3a in Adolescents and Young Adults with Autism Spectrum Disorders: Behavioral Correlates and Clinical Implications.

In a sample of 37 adolescents and young adults with autism spectrum disorder (ASD) and 35 typically-developing controls (TDC), we investigated sensory symptoms by clinical measures, and Mismatch Negativity and P3a component at Fz with the frequency and duration oddball paradigms of event-related potentials. Results showed that compared to TDC, ASD participants reported more sensory symptoms, and presented a shorter P3a peak latency in the duration paradigm, which was correlated with more social awareness deficits. In the frequency paradigm, P3a parameters were correlated with sensation avoiding and attention characteristics of ASD. Our findings suggest that sensory abnormality in ASD may extend into adolescence and young adulthood. P3a latency might be a potential neurophysiological marker for ASD.

Temporal voice areas exist in autism spectrum disorder but are dysfunctional for voice identity recognition.

The ability to recognise the identity of others is a key requirement for successful communication. Brain regions that respond selectively to voices exist in humans from early infancy on. Currently, it is unclear whether dysfunction of these voice-sensitive regions can explain voice identity recognition impairments. Here, we used two independent functional magnetic resonance imaging studies to investigate voice processing in a population that has been reported to have no voice-sensitive regions: autism spectrum disorder (ASD). Our results refute the earlier report that individuals with ASD have no responses in voice-sensitive regions: Passive listening to vocal, compared to non-vocal, sounds elicited typical responses in voice-sensitive regions in the high-functioning ASD group and controls. In contrast, the ASD group had a dysfunction in voice-sensitive regions during voice identity but not speech recognition in the right posterior superior temporal sulcus/gyrus (STS/STG)-a region implicated in processing complex spectrotemporal voice features and unfamiliar voices. The right anterior STS/STG correlated with voice identity recognition performance in controls but not in the ASD group. The findings suggest that right STS/STG dysfunction is critical for explaining voice recognition impairments in high-functioning ASD and show that ASD is not characterised by a general lack of voice-sensitive responses.

Gaze and visual search strategies of children with Asperger syndrome/high functioning autism viewing a magic trick.

OBJECTIVE: To examine visual search patterns and strategies used by children with and without Asperger syndrome/high functioning autism (AS/HFA) while watching a magic trick. Limited responsivity to gaze cues is hypothesised to contribute to social deficits in children with AS/HFA. METHODS: Twenty-one children with AS/HFA and 31 matched peers viewed a video of a gaze-cued magic trick twice. Between the viewings, they were informed about how the trick was performed. Participants' eye movements were recorded using a head-mounted eye-tracker. RESULTS: Children with AS/HFA looked less frequently and had shorter fixation on the magician's direct and averted gazes during both viewings and more frequently at not gaze-cued objects and on areas outside the magician's face. After being informed of how the trick was conducted, both groups made fewer fixations on gaze-cued objects and direct gaze. CONCLUSIONS: Information may enhance effective visual strategies in children with and without AS/HFA.

Reducing distress in mothers of children with autism and other disabilities: a randomized trial.

BACKGROUND: Compared with other parents, mothers of children with autism spectrum disorder or other neurodevelopmental disabilities experience more stress, illness, and psychiatric problems. Although the cumulative stress and disease burden of these mothers is exceptionally high, and associated with poorer outcomes in children, policies and practices primarily serve the identified child with disabilities. METHODS: A total of 243 mothers of children with disabilities were consented and randomized into either Mindfulness-Based Stress Reduction (mindfulness practice) or Positive Adult Development (positive psychology practice). Well-trained, supervised peer mentors led 6 weeks of group treatments in 1.5-hour weekly sessions, assessing mothers 6 times before, during, and up to 6 months after treatment. Mothers had children with autism (65%) or other disabilities (35%). At baseline, 85% of this community sample had significantly elevated stress, 48% were clinically depressed, and 41% had anxiety disorders. RESULTS: Using slopes-as-outcomes, mixed random effects models, both treatments led to significant reductions in stress, depression, and anxiety, and improved sleep and life satisfaction, with large effects in depression and anxiety. Mothers in Mindfulness-Based Stress Reduction versus Positive Adult Development had greater improvements in anxiety, depression, sleep, and well-being. Mothers of children with autism spectrum disorder improved less in anxiety, but did not otherwise differ from their counterparts. CONCLUSIONS: Future studies are warranted on how trained mentors and professionals can address the unmet mental health needs of mothers of children with developmental disabilities. Doing so improves maternal well-being and furthers their long-term caregiving of children with complex developmental, physical, and behavioral needs.

Mindfulness-based therapy in adults with an autism spectrum disorder: a randomized controlled trial.

Research shows that depression and anxiety disorders are the most common psychiatric concern in autism spectrum disorders (ASD). Mindfulness-based therapy (MBT) has been found effective in reducing anxiety and depression symptoms, however research in autism is limited. Therefore, we examined the effects of a modified MBT protocol (MBT-AS) in high-functioning adults with ASD. 42 participants were randomized into a 9-week MBT-AS training or a wait-list control group. Results showed a significant reduction in depression, anxiety and rumination in the intervention group, as opposed to the control group. Furthermore, positive affect increased in the intervention group, but not in the control group. Concluding, the present study is the first controlled trial to demonstrate that adults with ASD can benefit from MBT-AS.

A social competence intervention for young children with high functioning autism and Asperger syndrome: a pilot study.

The key features of Asperger Syndrome (AS) and high functioning autism (HFA) include marked and sustained impairment in social interactions. A multi-session, small group program was developed to increase social perception based on the assumption perceptual or interpretive problems underlying these social difficulties. Additionally, the group format espoused a play therapy orientation and the use of sociodramatic play was the primary therapeutic modality used. Qualitative analyses of the data resulted in an explanation of the key changes in social interactions that took place through the course of the intervention. Although each participant's experience in this group was unique, all children in this program demonstrated improvements in their social interactions, as they experienced development both emotionally and behaviorally. Findings suggest that, despite their rigid interests and behavior patterns, the social limitations of these children improved when provided with the necessary environmental resources.

Socio-dramatic affective-relational intervention for adolescents with asperger syndrome & high functioning autism: pilot study.

This study examined the effectiveness of a novel intervention called 'socio-dramatic affective-relational intervention' (SDARI), intended to improve social skills among adolescents with Asperger syndrome and high functioning autism diagnoses. SDARI adapts dramatic training activities to focus on in vivo practice of areas of social skill deficit among this population. SDARI was administered as a six-week summer program in a community human service agency. Nine SDARI participants and eight age- and diagnosis-group matched adolescents not receiving SDARI were compared on child- and parent-report of social functioning at three week intervals beginning six weeks prior to intervention and ending six weeks post-intervention. Hierarchical Linear Modeling (HLM) was used to estimate growth trends between groups to assess treatment outcomes and post-treatment maintenance. Results indicated significant improvement and post-treatment maintenance among SDARI participants on several measures of child social functioning. Implications for practice and research are discussed.

How magic changes our expectations about autism.

In the vanishing-ball illusion, the magician's social cues misdirect the audience's expectations and attention so that the audience "sees" a ball vanish in the air. Because individuals with autism spectrum disorder (ASD) are less sensitive to social cues and have superior perception for nonsocial details compared with typically developing individuals, we predicted that they would be less susceptible to the illusion. Surprisingly, the opposite result was found, as individuals with ASD were more susceptible to the illusion than a comparison group. Eye-tracking data indicated that subtle temporal delays in allocating attention might explain their heightened susceptibility. Additionally, although individuals with ASD showed typical patterns of looking to the magician's face and eyes, they were slower to launch their first saccade to the face and had difficulty in fixating the fast-moving observable ball. Considered together, the results indicate that individuals with ASD have difficulties in rapidly allocating attention toward both people and moving objects.

Neurofeedback outcomes in clients with Asperger's syndrome.

This paper summarizes data from a review of neurofeedback (NFB) training with 150 clients with Asperger's Syndrome (AS) and 9 clients with Autistic Spectrum Disorder (ASD) seen over a 15 year period (1993-2008) in a clinical setting. The main objective was to investigate whether electroncephalographic (EEG) biofeedback, also called neurofeedback (NFB), made a significant difference in clients diagnosed with AS. An earlier paper (Thompson et al. 2009) reviews the symptoms of AS, highlights research findings and theories concerning this disorder, discusses QEEG patterns in AS (both single and 19-channel), and details a hypothesis, based on functional neuroanatomy, concerning how NFB, often paired with biofeedback (BFB), might produce a change in symptoms. A further aim of the current report is to provide practitioners with a detailed description of the method used to address some of the key symptoms of AS in order to encourage further research and clinical work to refine the use of NFB plus BFB in the treatment of AS. All charts were included for review where there was a diagnosis of AS or ASD and pre- and post-training testing results were available for one or more of the standardized tests used. Clients received 40-60 sessions of NFB, which was combined with training in metacognitive strategies and, for most older adolescent and adult clients, with BFB of respiration, electrodermal response, and, more recently, heart rate variability. For the majority of clients, feedback was contingent on decreasing slow wave activity (usually 3-7 Hz), decreasing beta spindling if it was present (usually between 23 and 35 Hz), and increasing fast wave activity termed sensorimotor rhythm (SMR) (12-15 or 13-15 Hz depending on assessment findings). The most common initial montage was referential placement at the vertex (CZ) for children and at FCz (midway between FZ and CZ) for adults, referenced to the right ear. Metacognitive strategies relevant to social understanding, spatial reasoning, reading comprehension, and math were taught when the feedback indicated that the client was relaxed, calm, and focused. Significant improvements were found on measures of attention (T.O.V.A. and IVA), core symptoms (Australian Scale for Asperger's Syndrome, Conners' Global Index, SNAP version of the DSM-IV criteria for ADHD, and the ADD-Q), achievement (Wide Range Achievement Test), and intelligence (Wechsler Intelligence Scales). The average gain for the Full Scale IQ score was 9 points. A decrease in relevant EEG ratios was also observed. The ratios measured were (4-8 Hz)(2)/(13-21 Hz)(2), (4-8 Hz)/(16-20 Hz), and (3-7 Hz)/(12-15 Hz). The positive outcomes of decreased symptoms of Asperger's and ADHD (including a decrease in difficulties with attention, anxiety, aprosodias, and social functioning) plus improved academic and intellectual functioning, provide preliminary support for the use of neurofeedback as a helpful component of effective intervention in people with AS.

Functional neuroanatomy and the rationale for using EEG biofeedback for clients with Asperger's syndrome.

This paper reviews the symptoms of Asperger's Syndrome (AS), a disorder along the autism continuum, and highlights research findings with an emphasis on brain differences. Existing theories concerning AS are described, including theory of mind (Hill and Frith in Phil Trans Royal Soc Lond, Bull 358:281-289, 2003), mirror neuron system (Ramachandran and Oberman in Sci Am 295(5):62-69, 2006), and Porges' (Ann N Y Acad Sci 1008:31-47, 2003, The neurobiology of autism, Johns Hopkins University Press, Baltimore, 2004) polyvagal theory. (A second paper, Outcomes using EEG Biofeedback Training in Clients with Asperger's Syndrome, summarizes clinical outcomes obtained with more than 150 clients.) Patterns seen with QEEG assessment are then presented. Single channel assessment at the vertex (CZ) reveals patterns similar to those found in Attention-Deficit/Hyperactivity Disorder. Using 19-channel data, significant differences (z-scores > 2) were found in the amplitude of both slow waves (excess theta and/or alpha) and fast waves (beta) at various locations. Differences from the norm were most often found in mirror neuron areas (frontal, temporal and temporal-parietal). There were also differences in coherence patterns, as compared to a normative database (Neuroguide). Low Resolution Electromagnetic Tomography Analysis (Pascual-Marqui et al. in Methods Find Exp Clin Pharmacol 24C:91-95, 2002) suggested the source of the abnormal activity was most often the anterior cingulate. Other areas involved included the amygdala, uncus, insula, hippocampal gyrus, parahippocampal gyrus, fusiform gyrus, and the orbito-frontal and/or ventromedial areas of the prefrontal cortex. Correspondence between symptoms and the functions of the areas found to have abnormalities is evident and those observations are used to develop a rationale for using EEG biofeedback, called neurofeedback (NFB), intervention. NFB training is targeted to improve symptoms that include difficulty reading and mirroring emotions, poor attention to the outside world, poor self-regulation skills, and anxiety. Porges' polyvagal theory is used to emphasize the need to integrate NFB with biofeedback (BFB), particularly heart rate variability training. We term this emerging understanding the Systems Theory of Neural Synergy. The name underscores the fact that NFB and BFB influence dynamic circuits and emphasizes that, no matter where we enter the nervous system with an intervention, it will seek its own new balance and equilibrium.

Intervención psicoeducativa basada en imágenes en niños y niñas con trastornos generalizados del desarrollo / Psycho-educative intervention based on children images with pervasive development disorder

Esta investigación consiste en el diseño, ejecución y evaluación de un programa de intervención psicoeducativa basado en imágenes, aplicado a nueve niños con Trastorno Generalizado del Desarrollo (TGD) de tipo autista, cuyas edades fluctuaban entre los 3 y 8 años de edad en Temuco. El programa se enfocó para activar el desarrollo de las dimensiones de anticipación y flexibilidad en niños con TGD. Con el propósito de determinar el perfil de desarrollo inicial de los participantes, se les aplicó el Inventario de Desarrollo de Espectro Autista IDEA. Una vez ejecutado el programa se les evaluó nuevamente con el mismo instrumento, evidenciándose diferencias significativas en las dimensiones de anticipación t = 0,039 (P<0.05), complementariamente se encontraron resultados no esperados, en la escala de trastorno de desarrollo social t = 0,040 (P<0.05). No hubo evidencias significativas en la dimensión de sentido de actividad propia, obteniéndose un resultado de t = 0, 57 (P>0, 05). Los resultados reflejan la efectividad de la aplicación del programa de intervención con imágenes cuyo propósito es aportar a la sistematización del trabajo con niños que padecen algún trastorno generalizado del desarrollo.

This investigation is about the design, execution and evaluation of a psycho-educative intervention program based on the use of images, tested on nine children with autistic type of Pervasive Developmental Disorder (PDD) from 3 to 8 years old in Temuco, Chile. This program was implemented to activate de development in the anticipation and flexibility dimensions en children with PDD. In order to determine the initial participant’s profile, the autism spectrum disorders development inventory IDEA was applied. After the program was finished, this instrument was also used, showing significant differences in the anticipation dimension with t = 0,039 (P<0.05). As a non expected result in the social development dimension there was found that t = 0,040 (P<0.05). There was no significant change in the own activity self perception dimension, obtaining a t = 0, 57 (P>0, 05). These results show the effectiveness of the image based intervention program applied which purpose is to make a contribution to systematize the work with children suffering some Pervasive Developmental Disorder.

Union and separation in the therapy of pervasive developmental disorders and ADHD.

This paper discusses the characteristics of psychotherapy for pervasive developmental disorders (PDD) in the context of the curative effects of the movement of images. The 'autistic spectrum' is widened here and includes not only PDD, but also ADHD. The main common characteristic in these two sets of disorders seems to be the lack of a subject, which manifests itself as the absence of awareness of otherness and difficulties with boundaries and language. In these cases a normal psychotherapy is ineffective as it presupposes an established subject. However a psychotherapeutic approach with these patients can contribute to the emergence of a subject. In severe cases the process of union and separation which is enacted either in the therapeutic relationship or in symbolic play leads to the birth of a subject, and of language. In milder cases, such as ADHD, the moments of separation and confrontation with the therapist suffice. I will discuss a case of my own with Asperger's syndrome in which union and separation in the play therapy occurred simultaneously. This indicates that union and separation are not a consecutive process, but are simultaneous and lead to dialectical movement. However, in neurotic cases with an established subjectivity the symbolic meaning of image plays a central role. This corresponds to Jung's understanding of image in alchemy.

[The use of verbal communicative abilities to increase the mean length of utterance in high-functioning autism and Asperger Syndrome]. / O uso de habilidades comunicativas verbais para aumento da extensão de enunciados no autismo de alto funcionamento e na S índrome de Asperger.

BACKGROUND: high-functioning autism (HFA) and Asperger Syndrome (AS) are pervasive developmental disorders that present alterations in the communicative and social skills. AIM: to use verbal communicative skill strategies (VCS) to increase the mean length of utterance (MLU) produced by individuals with HFA and AS. METHOD: participants were three 12-year-old males with HFA or AS. Data was collected from videotape recordings of structured verbal interaction sessions with the researcher and each participant during eight months. In order to verify the effects of the intervention, a multiple baseline research design across the participants was used, being composed by two phases: baseline (BL) and intervention (I). In the BL phase, spontaneous interaction situations occurred between the researcher and each participant. In the first phase of I, the intervention sessions occurred twice a week and gradually worked their way to once a week, but only after each participant had reached the goal of increasing the MLU. The number of sessions decreased gradually to avoid any drop in performance. The strategies which were used were divided in blocks of activities: spontaneous conversation; activities involving specific language difficulties; games with rules; story/report telling; and meta-linguistic activities. RESULTS: the application of the proposed strategies for verbal communicative abilities achieved the purpose of increasing the MLU of all three participants. CONCLUSION: suggestions are made for further researches that investigate the maintenance of the results in other environments and during the interaction with different communication partners.

O uso de habilidades comunicativas verbais para aumento da extensão de enunciados no autismo de alto funcionamento e na S índrome de Asperger / The use of verbal communicative abilities to increase the mean length of utterance in high-functioning autism and Asperger Syndrome

TEMA: o autismo de alto funcionamento (AAF) e a síndrome de Asperger (SA) são transtornos globais do desenvolvimento que apresentam alterações nas habilidades comunicativas e sociais. OBJETIVO: o objetivo desta pesquisa foi promover o aumento da extensão média dos enunciados (EME) produzidos por indivíduos com AAF e SA por meio de estratégias que utilizavam habilidades comunicativas verbais (HCV). MÉTODO: participaram deste estudo três indivíduos com AAF ou SA do gênero masculino, com doze anos. Os dados foram coletados mediante gravações em vídeo de sessões estruturadas de interação verbal entre cada participante e a pesquisadora durante oito meses. Foi utilizado um delineamento experimental de linha de base múltipla cruzando com sujeitos, composto por duas fases: linha de base (LB) e intervenção (I). Na LB, ocorreram situações espontâneas de interação adulto e cada participante. Na primeira fase da I, inicialmente foram realizadas sessões duas vezes por semana e só se passava para a realização de sessões semanais após o indivíduo alcançar o objetivo de aumentar a EME. Houve a diminuição gradual do número de sessões, para que não houvesse queda no desempenho. As estratégias aplicadas foram divididas em blocos atividades com conversa espontânea; atividades que envolvessem dificuldades específicas de linguagem; jogos de regras; solicitações de relatos de histórias ou acontecimentos e atividades metalingüísticas. RESULTADOS: os resultados demostraram que a utilização de HCV foi efetiva para promover o aumento da EME. CONCLUSÃO: ficam sugestões para outras pesquisas que investiguem a manutenção dos resultados obtidos em outros ambientes e em interação com vários interlocutores.

BACKGROUND: high-functioning autism (HFA) and Asperger Syndrome (AS) are pervasive developmental disorders that present alterations in the communicative and social skills. AIM: to use verbal communicative skill strategies (VCS) to increase the mean length of utterance (MLU) produced by individuals with HFA and AS. METHOD: participants were three 12-year-old males with HFA or AS. Data was collected from videotape recordings of structured verbal interaction sessions with the researcher and each participant during eight months. In order to verify the effects of the intervention, a multiple baseline research design across the participants was used, being composed by two phases: baseline (BL) and intervention (I). In the BL phase, spontaneous interaction situations occurred between the researcher and each participant. In the first phase of I, the intervention sessions occurred twice a week and gradually worked their way to once a week, but only after each participant had reached the goal of increasing the MLU. The number of sessions decreased gradually to avoid any drop in performance. The strategies which were used were divided in blocks of activities: spontaneous conversation; activities involving specific language difficulties; games with rules; story/report telling; and meta-linguistic activities. RESULTS: the application of the proposed strategies for verbal communicative abilities achieved the purpose of increasing the MLU of all three participants. CONCLUSION: suggestions are made for further researches that investigate the maintenance of the results in other environments and during the interaction with different communication partners.

Eye-witness memory and suggestibility in children with Asperger syndrome.

BACKGROUND: Individuals with autism spectrum disorders (ASD) present with a particular profile of memory deficits, executive dysfunction and impaired social interaction that may raise concerns about their recall and reliability in forensic and legal contexts. Extant studies of memory shed limited light on this issue as they involved either laboratory-based tasks or protocols that varied between participants. METHOD: The current study used a live classroom event to investigate eye-witness recall and suggestibility in children with Asperger syndrome (AS group; N = 24) and typically developing children (TD group; N = 27). All participants were aged between 11 and 14 years and were interviewed using a structured protocol. Two measures of executive functioning were also administered. RESULTS: The AS group were found to be no more suggestible and no less accurate than their peers. However, free recall elicited less information, including gist, in the AS group. TD, but not AS, participants tended to focus on the socially salient aspects of the scene in their free recall. Both general and specific questioning elicited similar numbers of new details in both groups. Significant correlations were found between memory recall and executive functioning performance in the AS group only. CONCLUSIONS: The present study indicates that children with AS can act as reliable witnesses but they may be more reliant on questioning to facilitate recall. Our findings also provide evidence for poor gist memory. It is speculated that such differences stem from weak central coherence and lead to a reliance on generic cognitive processes, such as executive functions, during recall. Future studies are required to investigate possible differences in compliance, rates of forgetting and false memory.

[Asperger syndrome - a too late diagnosed disorder?]. / Asperger-Syndrom - eine zu spät diagnostizierte Störung?

Asperger syndrome is a disorder within the autistic spectrum, which was first described by Hans Asperger in 1944. It belongs to the group of pervasive developmental disorders and is particularly characterized by qualitative impairments of social interaction and communication as well as distinct special interests and stereotyped patterns of behaviour. We present a patient, showing the typical behavioural symptoms of the Asperger syndrome, which were first diagnosed at the age of sixteen.

Effects of vagus nerve stimulation in a patient with temporal lobe epilepsy and Asperger syndrome: case report and review of the literature.

Seizures are a common comorbidity of autism and occur in as many as 30% of patients. This case report describes a 23-year-old man diagnosed with both Asperger syndrome and bitemporal epilepsy. The patient had behavioral regression that correlated with worsening of his intractable seizures. He subsequently underwent implantation of a vagus nerve stimulation therapy device for his refractory epilepsy. Both his seizures and his behavior were monitored for 6 months. We describe the efficacy of vagus nerve stimulation therapy in reducing seizure severity as well as improving the behavioral components of his Asperger syndrome. We also review the current literature regarding epilepsy in autistic spectrum disorders.

Atypical pattern of discriminating sound features in adults with Asperger syndrome as reflected by the mismatch negativity.

Asperger syndrome, which belongs to the autistic spectrum of disorders, is characterized by deficits of social interaction and abnormal perception, like hypo- or hypersensitivity in reacting to sounds and discriminating certain sound features. We determined auditory feature discrimination in adults with Asperger syndrome with the mismatch negativity (MMN), a neural response which is an index of cortical change detection. We recorded MMN for five different sound features (duration, frequency, intensity, location, and gap). Our results suggest hypersensitive auditory change detection in Asperger syndrome, as reflected in the enhanced MMN for deviant sounds with a gap or shorter duration, and speeded MMN elicitation for frequency changes.