Ethnic Group Differences in the Timing of Autism Diagnosis, Intellectual Disability, and Educational Placement of Autistic Children in Singapore.

AIM: Given Singapore's distinct multicultural identity, this study examined the hypotheses that there may be ethnic group differences in diagnosis and outcomes in autistic children in Singapore. METHODS: Retrospective data were obtained from medical records of all children born between 2008 and 2011 who were diagnosed with clinical or confirmed autism. One-way ANOVAs and regression analyses were used to analyze data. RESULTS: Data from 2577 medical records were extracted. There were more boys (82.5%) and ethnic group distribution was Chinese (67%), Malay (14%), Indian (10%), and Others (10%). Chinese children were more likely to present at a developmental clinic with concerns 3-4 months younger compared to Malay children and those from Other Races (F(3, 2038) = 9.58, p < .001, Cohen's F = 0.12). Chinese children were also more likely to receive an autism diagnosis approximately 3 months younger compared to Malay children. Fewer autistic Chinese children were diagnosed with co-occurring intellectual disability (13.1%) while there were almost twice more Malay children than expected with co-occurring intellectual disability (29.9%) (χ2 (3) = 55.17, p < .001). There are correspondingly more Malay children on the autism spectrum who attend special education schools. Possible confounding variables such as household income level and mother's level of education were identified in some of these findings. CONCLUSION: Several significant ethnic group differences in autistic children in Singapore exist that warrant more investigation into possible causes and support systems needed, with implications for other ethnically diverse nations.

The vocal dialogue in 9/11 pregnant widows and their infants: Specificities of co-regulation.

Mothers who were pregnant and widowed on September 11, 2001, and their 4-6-month infants (in utero on 9/11) were filmed during face-to-face interaction and their vocal dialogues were examined via microanalysis. Mothers were White, well-educated, mean age 34.3 years, and far from the World Trade Center site on 9/11; infants were 4-6 months, half female. We examined the bi-directional, moment-by-moment co-regulation of the timing of vocal dialogue, and particularly turn taking, in mother-infant and stranger-infant interactions, with time-series models. We analyzed the contingent coordination of durations of (1) vocalizations of the turn-holder, and (2) switching-pauses at the moment of the turn exchange. The switching pause is an aspect of the rhythm of the turn-holder who, after taking a turn, yields the floor to the partner through the switching pause. Turn taking is the lynchpin of dialogue, and the bi-directional contingent coordination of the switching-pause regulates the turn exchange. Both partners showed signs of risk and resilience. The 9/11 mothers did not coordinate the timing of turn taking with their infants, a highly unusual finding. In contrast, the 9/11 infants did coordinate the timing of turn taking with their mothers, and with the "stranger," forms of resilience. We propose that the 9/11 mother's difficulty coordinating with the infant's turn taking rhythm is a mode of transmission of her trauma to the infant. This work expands our knowledge of the specificities of co-regulation in the context of the 9/11 trauma.

The role of dance/movement therapy in the treatment of negative symptoms in schizophrenia: a mixed methods pilot study.

BACKGROUND: Optimizing psychosocial functioning by reducing the severity of negative symptoms are important outcomes for individuals with schizophrenia. Movement-based interventions could be uniquely capable of addressing the non-verbal nature of negative symptoms. AIMS: To examine the treatment effects of a 10-week group dance/movement therapy program on negative symptoms and psychosocial functioning of individuals diagnosed with schizophrenia. METHODS: A mixed methods intervention design (with explanatory intent) was used in which a randomized controlled trial was followed by semi-structured exit interviews. Participants diagnosed with schizophrenia (N = 31) were randomized to two conditions: treatment as usual (TAU) and dance/movement therapy (DMT). Before and after the program participants reported on negative symptoms and psychosocial functioning outcomes. Fifteen participants completed interviews. RESULTS: Quantitative data showed no improvement nor worsening of clinical status in the DMT group. Qualitative data suggested that participation in DMT had a physical impact, resulted in enhanced interpersonal connectivity, sense of integration, emotional support, and symptom management. CONCLUSIONS: Qualitative but not quantitative findings suggest that DMT has potential to enhance psychosocial functioning and to reduce severity of negative symptoms for schizophrenia.

Urgent engagement in 9/11 pregnant widows and their infants: Transmission of trauma.

The potential effects of maternal trauma on mother-infant interaction remain insufficiently studied empirically. This study examined the effects of the September 11, 2001, trauma on mother-infant interaction in mothers who were pregnant and widowed on 9/11, and their infants aged 4-6 months. Split-screen videotaped interaction was coded on a one-second basis for infant gaze, facial affect, and vocal affect; and mother gaze, facial affect, and touch. We examined the temporal dynamics of communication: self-contingency and interactive contingency of behavior by time-series methods. We documented heightened maternal and infant efforts at engagement in the 9/11 (vs. control) dyads. Both partners had difficulty tolerating moments of looking away as well as moments of negative behavior patterns. Heightened efforts to maintain a positive visual engagement may be adaptive and a potential source of resilience, but these patterns may also carry risk: working too hard to make it work. A vigilant, hyper-contingent, high-arousal engagement was the central mode of the interpersonal transmission of the trauma to these infants, with implications for intervention.

Using cluster analysis to provide new insights into development of very low birthweight (VLBW) premature infants.

BACKGROUND: Very low birthweight (VLBW) premature infant follow-up studies report on single developmental outcome variables but do not assess profiles of development. AIMS: To identify developmental profiles of VLBW premature infants based on cognitive and language development and their association with demographic, perinatal, and behavior variables. STUDY DESIGN: Retrospective chart review. SUBJECTS: 117 children<1250 g BW seen at 18 months post-term on the Bayley Scales-III and Child Behavior Checklist 1 ½-5 (CBCL 1 ½-5), a behavior problem questionnaire. Demographic and perinatal variables were obtained from medical records. OUTCOME MEASURES: Bayley Cognitive, Expressive Language, and Receptive Language scores were used to cluster the subjects into developmental profiles. Demographic, perinatal, and CBCL variables were analyzed as they related to clusters. RESULTS: Children were clustered into 4 groups based on their Bayley Cognitive, Expressive Language, and Receptive Language scores: Consistently High, Consistently Average, Average with Delayed Expressive Language, and Consistently Low. Socioeconomic status, bronchopulmonary dysplasia, Grades III-IV intraventricular hemorrhage, and summary Behavior Problems and Attention Deficit/Hyperactivity (ADHD) Problems scores were significantly related to clusters. CONCLUSION: Cluster analysis defined distinct outcome groups in VLBW premature children and provides an informative means of identifying factors related to developmental outcome. This approach may be useful in predicting later outcome and determining which groups of children will require early intervention.

Attachment and autism: parental attachment representations and relational behaviors in the parent-child dyad.

While attachment research has demonstrated that parents' internal working models of attachment relationships tend to be transmitted to their children, affecting children's developmental trajectories, this study specifically examines associations between adult attachment status and observable parent, child, and dyadic behaviors among children with autism and associated neurodevelopmental disorders of relating and communicating. The Adult Attachment Interview (AAI) was employed to derive parental working models of attachment relationships. The Functional Emotional Assessment Scale (FEAS) was used to determine the quality of relational and functional behaviors in parents and their children. The sample included parents and their 4- to 16-year-old children with autism and associated neurodevelopmental disorders. Hypothesized relationships between AAI classifications and FEAS scores were supported. Significant correlations were found between AAI classification and FEAS scores, indicating that children with autism spectrum disorders whose parents demonstrated secure attachment representations were better able to initiate and respond in two-way pre-symbolic gestural communication; organize two-way social problem-solving communication; and engage in imaginative thinking, symbolic play, and verbal communication. These findings lend support to the relevance of the parent's state of mind pertaining to attachment status to child and parent relational behavior in cases wherein the child has been diagnosed with autism or an associated neurodevelopmental disorder of relating and communicating. A model emerges from these findings of conceptualizing relationships between parental internal models of attachment relationships and parent-child relational and functional levels that may aid in differentiating interventions.

Nonmentalizing states in early-childhood survivors of the Holocaust: developmental considerations regarding treatment of child survivors of genocidal atrocities.

This paper attempts to coalesce considerations of attachment processes, trauma, mentalization, and nonverbal behavior to underscore some of the developmental and therapeutic challenges demonstrated by older-adult child survivors of the Holocaust, and by implication, other child victims of similar genocidal and traumatic events. Young child survivors experienced not only their own traumatic exposure to violence, harm, and loss, but also the stress-transmission of the adult caregivers who raised them in the years that followed. For some, the horrendous losses, combined with impediments to organizing relationships, and to experiences of predictable and trusted continuities, negatively impact the development of the reflective function, and of interpretive skills basic to successful implicit relatedness and explicit exchanges. "Neutral flow" of bodily tension and shape often signals the freezing accompanying nonmentalizing states. Misalignments in individual personality structure and discordances in interpersonal exchange underscore the need to address fundamental building blocks of relatedness and mentalization in the therapeutic process.