Improving Access to Autism Evaluation: A Coordinated Developmental-Behavioral Pediatrics and Pediatric Neurology Diagnostic Pathway.

A shortage of board-certified developmental-behavioral pediatricians generates a bottleneck for children and families who seek autism diagnostic services. Wait time for autism evaluation commonly exceeds a year. To improve access, clinicians developed a coordinated Developmental-Behavioral Pediatrics and Pediatric Neurology autism diagnostic pathway. For a subset of children referred to neurology clinic, pediatric neurologists completed the medical part of an autism evaluation and Knights of Columbus Developmental Center psychologists or speech-language pathologists completed developmental assessments. Forty-four autism diagnostic evaluations completed through this coordinated pathway over the course of six months had shortened wait time [mean=50.89 days; range 3 to 184 days; median= 48.50 day]. Parents reported satisfaction with the autism evaluation and resources navigation process. Sustainability and scalability efforts are discussed.

Ostracism and Peer Victimization in Adolescents With and Without Mental Health Diagnoses in a Public Middle School Setting.

To better understand adolescents experiencing peer victimization, ostracism, and emotional health problems, this study aimed to describe a cohort of middle school students identified as having school peer-related social difficulties as 2 groups: those with mental health diagnoses (MHDs; n = 17) and those without diagnoses (n = 8). Participants were administered a test battery to examine communication ability, social responsiveness, social activity, ostracism, victimization, and emotional health. Results showed that adolescents with MHDs, relative to those without, scored significantly lower on measures of communication ability, social responsiveness, and social activity but similarly on measures of victimization, ostracism, and internalizing/externalizing factors. Results suggest that adolescents with and without MHDs can endure ostracism and peer victimization to a similar extent. Because ostracism and victimization have serious morbidity in adolescents, physicians and caregivers must look for signs in all adolescents, irrespective of MHD. Recommendations for appropriate primary care management are discussed.

Parents Perceive Improvements in Socio-emotional Functioning in Adolescents with ASD Following Social Skills Treatment.

The current study examined the effectiveness of a social skills treatment (PEERS) for improving socio-emotional competencies in a sample of high-functioning adolescents with ASD. Neuropsychological and self- and parent-report measures assessing social, emotional, and behavioral functioning were administered before and after treatment. Following social skills treatment, adolescents with ASD exhibited decreased aggression, anxiety, and withdrawal, as well as improvements in emotional responsiveness, adaptability, leadership, and participation in activities of daily living, though no change was found in affect recognition abilities. These findings suggest that PEERS social skills treatment improves particular aspects of emotional, behavioral, and social functioning that may be necessary for developing and maintaining quality peer relationships and remediating social isolation in adolescents with ASD.

Patterns of Gesture Use in Adolescents With Autism Spectrum Disorder.

PURPOSE: The purpose of this study was to examine patterns of spontaneous gesture use in a sample of adolescents with autism spectrum disorder (ASD). METHOD: Thirty-five adolescents with ASD ages 11 to 16 years participated (mean age = 13.51 years; 29 boys, 6 girls). Participants' spontaneous speech and gestures produced during a narrative task were later coded from videotape. Parents were also asked to complete questionnaires to quantify adolescents' general communication ability and autism severity. RESULTS: No significant subgroup differences were apparent between adolescents who did not gesture versus those who produced at least 1 gesture in general communication ability and autism severity. Subanalyses including only adolescents who produced gesture indicated a statistically significant negative association between gesture rate and general communication ability, specifically speech and syntax subscale scores. Adolescents who gestured produced higher proportions of iconic gestures and used gesture mostly to add information to speech. CONCLUSIONS: The findings relate spontaneous gesture use to underlying strengths and weaknesses in adolescents' speech and syntactical language development. More research examining cospeech gesture in fluent speakers with ASD is needed.

A Few Close Friends: The Pediatrician's Role in the Management of Social Skills Deficits in Adolescent Children.

Pediatricians must recognize and respond to adolescents with social skills deficits because they are at heightened risk for mental health disorders, peer victimization, and social isolation. The aim of this project was to describe a group of adolescent children at the time of enrollment into social skills treatment. Ninety participants with neurodevelopmental weaknesses or disorders, to include high-functioning autism spectrum disorder, participated. Results showed that adolescents referred for social skills deficits had communication weaknesses and concerns in everyday social reciprocal behavior. They rarely hosted get-togethers with same-aged peers and were not often invited by same-aged peers to get-togethers. Twenty-nine percent of participants reported that they were victims of bullying, and more than half of participants reported clinically significant ostracism experiences. Results are discussed in terms of the pediatrician's role in the prevention, identification, and treatment of social skills deficits in light of recent research showing brain neuroplasticity extending into adolescence.

Reported communication ability of persons with trisomy 18 and trisomy 13.

OBJECTIVE: The aim of this study was to describe the communication ability of individuals with trisomy 18 and trisomy 13 syndromes. METHODS: Parents reported on children's potential communication acts, words, spontaneous gesture, and augmentative and alternative communication (AAC) using a parent report inventory (n = 32; age range 3-35 years). Potential communicative acts are defined as behaviors produced by an individual that may be interpreted by others to serve communicative functions. RESULTS: Potential communicative acts categorized as body movement displayed the highest median rank for reported occurrence followed by vocalization and facial expression. Although symbolic forms were ranked lower, more than half of the parents (66%) reported that their children produced at least one word, gesture or AAC form. Challenging behaviors or stereotypic movement displayed lowest median ranks. CONCLUSIONS: Results are discussed in terms of communication potential and the need to address AAC in trisomy 18 and 13.

Potential communicative acts in children with autism spectrum disorders.

OBJECTIVE: To describe potential communicative acts in a sample of 17 children with autism spectrum disorders who produced few to no intelligible words (mean age = 32.82 months). METHODS: Parents reported on children's potential communicative acts for 10 different communicative functions. A potential communicative act was defined as any behavior produced by an individual that may be interpreted by others to serve a communicative purpose. RESULTS: Significant associations were found between higher number of gesture types and increased scores on language comprehension, language expression, and non-verbal thinking measures. Relative to other types of potential communicative acts, parents reported that children used higher proportions of body movement. CONCLUSION: Number of body movement types was not related to child ability, while number of gesture types was related to receptive and expressive language. Findings underscore the link between language and gesture, and offer support for an ecological systems perspective of language learning.

Access to treatment for toddlers with autism spectrum disorders.

New research shows that intensive and early intervention (EI) has the potential to change brain function in young children with Autism Spectrum Disorders (ASD). Despite the positive benefit of EI, many families (n = 16) reported difficulties accessing EI services following an ASD diagnosis at the intensity viewed necessary for optimal child outcome. Parents reported that on average they secured 6.81 hours of services per month and that limited access to EI services led to increased parental stress at a time when a new ASD diagnosis was often overwhelming. Findings are discussed in terms of support to families who are experiencing difficulties accessing care after new ASD diagnosis.

Communication ability in persons with trisomy 18 and trisomy 13.

The purpose of this study was to assess communication abilities among a sample of 10 individuals with Trisomy 18 and Trisomy 13. These 10 individuals were diagnosed with Trisomy 18 (n = 8) or Trisomy 13 (n = 2) and had a mean age of 15.96 years. The sample consisted of one male and nine females. Caregivers completed a case history and reported on words and gestures understood and/or produced. Participants were also videotaped during communication temptation tasks. Auditory comprehension was reported to be higher than expressive language. No participant produced intelligible words or word approximations, yet most produced hand gestures. The process and results of these 10 cases point to a potentially promising approach for assessing communication abilities in individuals with Trisomy 18 and Trisomy 13.

Gesture and motor skill in relation to language in children with language impairment.

PURPOSE: To examine gesture and motor abilities in relation to language in children with language impairment (LI). METHOD: Eleven children with LI (aged 2;7 to 6;1 [years;months]) and 16 typically developing (TD) children of similar chronological ages completed 2 picture narration tasks, and their language (rate of verbal utterances, mean length of utterance, and number of different words) and gestures (coded for type, co-occurrence with language, and informational relationship to language) were examined. Fine and gross motor items from the Battelle Developmental Screening Inventory (J. Newborg, J. R. Stock, L. Wneck, J. Guidubaldi, & J. Suinick, 1994) and the Child Development Inventory (H. R. Ireton, 1992) were administered. RESULTS: Relative to TD peers, children with LI used gestures at a higher rate and produced greater proportions of gesture-only communications, conventional gestures, and gestures that added unique information to co-occurring language. However, they performed more poorly on measures of fine and gross motor abilities. Regression analyses indicated that within the LI but not the TD group, poorer expressive language was related to more frequent gesture production. CONCLUSIONS: When language is impaired, difficulties are also apparent in motor abilities, but gesture assumes a compensatory role. These findings underscore the utility of including spontaneous gesture and motor abilities in clinical assessment of and intervention for preschool children with language concerns.

Oromotor and communication findings in joubert syndrome: further evidence of multisystem apraxia.

This study provides descriptive information in the areas of oromotor abilities and communication to better understand the spectrum of disability in individuals with Joubert syndrome. Participants included 21 individuals with the diagnosis of Joubert syndrome (mean age 10.45 years). Participants completed oromotor and receptive language measures. In addition, all of the participants' speech and gesture communication from a narrative task was coded and analyzed from videotape. Caregivers reported the participants' level of fine and gross motor function. The results show that individuals with Joubert syndrome exhibit a distinct oromotor pattern consistent with verbal and lingual apraxias. Despite significant motor skills deficits and oculomotor apraxia, persons with Joubert syndrome produced gestures when communicating, and those whose speech was less intelligible used a higher rate of gesture compared with those with greater verbal output. These findings suggest a new form of apraxia not previously described in the condition and are consistent with previous research that suggests that persons with Joubert syndrome typically do not exhibit classic symptoms of autism spectrum disorder.