Moving beyond the mother-child dyad: a commentary on Oppenheim et al. (2023).

The research presented by Oppenheim et al. (J Child Psychol Psychiatry, 2023) breaks important new ground by moving beyond the mother-child dyad and investigating the coparenting alliance between mothers and fathers of young children with autism. By integrating family systems thinking, developmental science, and research on autism spectrum disorder, this line of research is bound to improve our understanding of how family systems influence the social emotional development of young children with autism, how children's development and learning can be optimized, and how parents' marital relationship and mental health can be strengthened. Future research should investigate the coparenting alliance across a range of family functions aside from triadic play (e.g. caregiving, teaching, attachment, and behavior management) and move beyond nuclear family structures to capture the lived experiences of families within industrialized countries more adequately and embrace cultural differences across the globe.

Abnormal autonomic and associated brain activities during rest in autism spectrum disorder.

Autism spectrum disorders are associated with social and emotional deficits, the aetiology of which are not well understood. A growing consensus is that the autonomic nervous system serves a key role in emotional processes, by providing physiological signals essential to subjective states. We hypothesized that altered autonomic processing is related to the socio-emotional deficits in autism spectrum disorders. Here, we investigated the relationship between non-specific skin conductance response, an objective index of sympathetic neural activity, and brain fluctuations during rest in high-functioning adults with autism spectrum disorder relative to neurotypical controls. Compared with control participants, individuals with autism spectrum disorder showed less skin conductance responses overall. They also showed weaker correlations between skin conductance responses and frontal brain regions, including the anterior cingulate and anterior insular cortices. Additionally, skin conductance responses were found to have less contribution to default mode network connectivity in individuals with autism spectrum disorders relative to controls. These results suggest that autonomic processing is altered in autism spectrum disorders, which may be related to the abnormal socio-emotional behaviours that characterize this condition.

Feasibility and acceptability of a low-resource-intensive, transdiagnostic intervention for children with social-communication challenges in early childhood education settings.

ABSTRACT: Preschool classrooms provide a unique context for supporting the development of children with social-communication challenges. This study is an uncontrolled clinical trial of an adapted professional development intervention for preschool teachers (Social Emotional Engagement-Knowledge & Skills-Early Childhood). Social Emotional Engagement-Knowledge & Skills-Early Childhood is a low-resource-intensive, transdiagnostic intervention to address the learning needs of children with social-communication challenges and consists of four asynchronous online modules and three synchronous coaching sessions. The current research evaluated the feasibility and acceptability of intervention and research procedures, implemented in authentic early childhood education settings. Participants included one teacher and one target child with social-communication challenges from 25 preschool classrooms, sampled to maximize variability. Overall, the current research revealed high levels of feasibility, with 9 out of 10 benchmarks met: (a) procedures for participant recruitment reliably identified a neurodiverse sample of children with teacher-reported social-communication challenges; (b) teachers showed high levels of program engagement and Social Emotional Engagement-Knowledge & Skills-Early Childhood completion (76%); and (c) results revealed a robust pattern of gains in Social Emotional Engagement-Knowledge & Skills-Early Childhood classrooms and associations among key outcome measures (including active engagement, student teacher relationship, social-communication competencies). Implications for the design of a subsequent, larger effectiveness-implementation hybrid trial (Type 1) are discussed.

Editorial: Individualizing Interventions for Young Children With Autism: Embracing the Next Generation of Intervention Research.

If you have known one child with autism, you have known one child with autism. Clinical heterogeneity is a defining feature of autism spectrum disorder (ASD). This includes heterogeneity of implicated genes, etiological pathways, neurocognitive mechanisms, behavioral characteristics, comorbid conditions, and developmental trajectories. It is not surprising that children with ASD also vary greatly in their response to interventions. A better understanding of which children benefit from which intervention is critical to ensure that each child has access to the most effective intervention, delivered at optimal intensity and implemented within a context that is most conducive to learning/generalization (eg, home, preschool). Evidence-based strategies to individualize intervention programs can guide parents and clinicians as they consider different intervention options throughout development.1 The study that is the focus of this editorial expands the available literature in 2 important ways. First, the authors evaluate predictors of treatment response across multiple intervention approaches. Second, their results highlight the conceptual and practical distinction between child characteristics that predict outcome and child characteristics that predict treatment response.

Inclusive Early Childhood Education for Children With and Without Autism: Progress, Barriers, and Future Directions.

University-affiliated lab and model schools play an important role in creating educational innovations in inclusive early childhood education (ECE) for young children with Autism Spectrum Disorder (ASD). In the United States, access to inclusive high-quality ECE programs for young children with disabilities has been required by law for over 40 years, has been recommended by leading professional organizations, and has been emphasized in federal public policy initiatives. Yet, improvement in the rates of young children with disabilities experiencing inclusion has been limited. This review article consists of three parts. First, we identify and describe four barriers to wide-scale implementation of inclusive ECE programs for children with ASD in the US. These barriers include (1) the fragmented nature of the ECE system in the United States, (2) the age at which ASD is typically first diagnosed in the community, (3) the diverse presentation/support needs of children with ASD, and (4) the thoughts and feelings of parents of children without disability about inclusion. Second, we used a snowball sampling approach to identify nine leading university-affiliated, inclusive lab and model schools for young children with ASD. By describing these programs, we highlight similarities and differences between programs, and capture the unique ways in which these programs adapt to local conditions, resources, and barriers (e.g., federal and state regulations, funding sources, community resources, institutional structures and priorities, professional orientation and training, access to families and staff). Finally, we propose a roadmap for researchers focused on the development, evaluation, and implementation of community-viable inclusive ECE programs in ASD. This roadmap leverages synergies between inclusive university-affiliated lab and model preschools in ASD, and proposes the formation of a research network that creates an infrastructure for cross-program collaboration.

Mothers' narratives regarding their child with autism predict maternal synchronous behavior during play.

BACKGROUND: Mothers' synchronous playtime behaviors have been linked to language development in children with autism (Siller & Sigman, 2002, 2008). This study sought to explain individual differences in maternal synchrony in order to improve parent-training programs targeting communication skills in children with autism. METHODS: Participants were 67 children with autism under the age of 7 and their biological mothers. Maternal cognitions were assessed using two narrative measures, the Insightfulness Assessment (Koren-Karie & Oppenheim, 1997) and the Reaction to Diagnosis Interview (Pianta & Marvin, 1992). Mean levels of maternal synchrony, measured with a micro-analytic coding system (Siller & Sigman, 2002, 2008), were compared between groups formed according to mothers' interview classifications. RESULTS: Variation in maternal synchrony was related to classification of the Insightfulness Assessment, but not the Reaction to Diagnosis Interview. Child characteristics were not related to interview classifications or ratings of maternal synchrony. CONCLUSION: Qualities of mothers' narratives about their child with autism and the relationship with the child are associated with variability in maternal synchronous behavior during play.

Modeling longitudinal change in the language abilities of children with autism: parent behaviors and child characteristics as predictors of change.

The objective of the current study was to evaluate the patterns of longitudinal change in the language abilities of 28 children with autism during early and middle childhood. Results from fitting a series of multilevel models showed that children's rate of language growth was independently predicted by (a) children's responsiveness to others' bids for joint attention and (b) parents' responsiveness to their children's attention and activity during play. Both predictive relations could not be explained by initial variation in global developmental characteristics, such as IQ, mental age, or language abilities. These findings support a social?pragmatic view on language acquisition, which emphasizes the collaborative process through which children and their parents negotiate shared meaning.

Designing a Summer Transition Program for Incoming and Current College Students on the Autism Spectrum: A Participatory Approach.

Students with Autism Spectrum Disorder (ASD) face unique challenges transitioning from high school to college and receive insufficient support to help them navigate this transition. Through a participatory collaboration with incoming and current autistic college students, we developed, implemented, and evaluated two intensive week-long summer programs to help autistic students transition into and succeed in college. This process included: (1) developing an initial summer transition program curriculum guided by recommendations from autistic college students in our ongoing mentorship program, (2) conducting an initial feasibility assessment of the curriculum [Summer Transition Program 1 (STP1)], (3) revising our initial curriculum, guided by feedback from autistic students, to develop a curriculum manual, and (4) pilot-testing the manualized curriculum through a quasi-experimental pre-test/post-test assessment of a second summer program [Summer Transition Program 2 (STP2)]. In STP2, two autistic college students assumed a leadership role and acted as "mentors" and ten incoming and current autistic college students participated in the program as "mentees." Results from the STP2 pilot-test suggested benefits of participatory transition programming for fostering self-advocacy and social skills among mentees. Autistic and non-autistic mentors (but not mentees) described practicing advanced forms of self-advocacy, specifically leadership, through their mentorship roles. Autistic and non-autistic mentors also described shared (e.g., empathy) and unique (an intuitive understanding of autism vs. an intuitive understanding of social interaction) skills that they contributed to the program. This research provides preliminary support for the feasibility and utility of a participatory approach in which autistic college students are integral to the development and implementation of programming to help less experienced autistic students develop the self-advocacy skills they will need to succeed in college.

The behaviors of parents of children with autism predict the subsequent development of their children's communication.

The present study focused on behaviors that caregivers of children with autism show during play interactions, particularly the extent to which the caregiver's behavior is synchronized with the child's focus of attention and ongoing activity. The study had two major findings. First, caregivers of children with autism synchronized their behaviors to their children's attention and activities as much as did caregivers of children with developmental delay and caregivers of typically developing children, matched on language capacities. Second, caregivers of children with autism who showed higher levels of synchronization during initial play interactions had children who developed superior joint attention and language over a period of 1, 10, and 16 years than did children of caregivers who showed lower levels of synchronization initially. These findings suggest a developmental link between parental sensitivity and the child's subsequent development of communication skills in children with autism. Implications for parent training interventions are discussed.

Brief report: broad autism phenotype in adults is associated with performance on an eye-tracking measure of joint attention.

The current study takes advantage of modern eye-tracking technology and evaluates how individuals allocate their attention when viewing social videos that display an adult model who is gazing at a series of targets that appear and disappear in the four corners of the screen (congruent condition), or gazing elsewhere (incongruent condition). Data demonstrated the feasibility of administrating this experimental paradigm to a diverse sample of healthy adult college students (N = 44). Results revealed that individual differences in gaze allocation were significantly related to a self-report measure evaluating features of the broad autism phenotype, suggesting that individual variation in the broad autism phenotype is related to individual differences in gaze allocation.

Interview skills for adults with autism spectrum disorder: a pilot randomized controlled trial.

The purpose of this pilot study was to evaluate the efficacy of the interview skills curriculum (ISC), a manualized 12-week group-delivered intervention for young adults with autism spectrum disorder (ASD). This intervention aims to increase social-pragmatic skills essential to a successful job interview. Twenty-eight adults (18-36 years) were randomly assigned to one of two groups: ISC or waitlist control. Results revealed that the experimental group showed larger gains in social-pragmatic skills observed during a mock job interview than the control group. Treatment effects on distal outcomes, including social adaptive behaviors and depressive symptoms were not significant, although the respective effect sizes were medium/large. Results indicate that a brief, low-intensity treatment can improve the job-interview performance of young adults with ASD.

Pupillary responses during a joint attention task are associated with nonverbal cognitive abilities and sub-clinical symptoms of autism.

Measures of pupillary dilation provide a temporally sensitive, quantitative indicator of cognitive resource allocation. The current study included 39 typically developing children between 3 and 9 years of age. Children completed a free-viewing task designed to elicit gaze following, a core deficit of Autism Spectrum Disorders (ASD). Results revealed a negative association between children's pupil dilation and a standardized measure of nonverbal intelligence, suggesting that children with lower intelligence allocated more cognitive resources than children with higher intelligence. In addition, the results revealed a negative association between pupil dilation and a parent-report measure of sub-clinical symptoms of ASD, suggesting that children with fewer ASD-related symptoms allocated more cognitive resources than children who showed more sub-clinical symptoms of ASD. Both associations were independent of each other and could not be explained by variation in chronological age. These findings extend previous research demonstrating associations between basic aspects of visual processing and intelligence. In addition, these findings comport with recent theories of ASD that emphasize reduced sensitivity to the reward value of social situations. When confronted with social ambiguity, children with more ASD-related symptoms allocated fewer cognitive resources to resolving this ambiguity than children who showed fewer sub-clinical symptoms of ASD.

A parent-mediated intervention that targets responsive parental behaviors increases attachment behaviors in children with ASD: results from a randomized clinical trial.

The current study is a randomized clinical trial evaluating the efficacy of Focused Playtime Intervention (FPI) in a sample of 70 children with Autism Spectrum Disorder. This parent-mediated intervention has previously been shown to significantly increase responsive parental communication (Siller et al. in J Autism Dev Disord 43:540-555, 2013a). The current analyses focus on children's attachment related outcomes. Results revealed that children who were randomly assigned to FPI showed bigger increases in attachment-related behaviors, compared to children assigned to the control condition. Significant treatment effects of FPI were found for both an observational measure of attachment-related behaviors elicited during a brief separation-reunion episode and a questionnaire measure evaluating parental perceptions of child attachment. The theoretical and clinical implications of these findings are discussed.

Internal State Language in the Storybook Narratives of Children with and without Autism Spectrum Disorder: Investigating Relations to Theory of Mind Abilities.

The current study examines narratives elicited using a wordless picture book, focusing on language used to describe the characters' thoughts and emotions (i.e., internal state language, ISL). The sample includes 21 children with Autism Spectrum Disorder (ASD) and 24 typically developing controls, matched on children's gender, IQ, as well as receptive and expressive vocabulary. This research had three major findings. First, despite equivalent performance on standardized language assessments, the volume of children's narratives (i.e., the number of utterances and words, the range of unique verbs and adjectives) was lower in children with ASD than in typically developing controls. Second, after controlling for narrative volume, the narratives of children with ASD were less likely to reference the characters' emotions than was the case for typically developing controls. Finally, our results revealed a specific association between children's use of emotion terms and their performance on a battery of experimental tasks evaluating children's Theory of Mind abilities. Implications for our understanding of narrative deficits in ASD as well as interventions that use narrative as a context for improving social comprehension are discussed.

Longitudinal change in the use of services in autism spectrum disorder: understanding the role of child characteristics, family demographics, and parent cognitions.

The aim of this study was to identify child characteristics, family demographics, and parent cognitions that may affect access to early intervention, special education, and related services. The sample included 70 families of young children with autism spectrum disorders. All parents were enrolled in a short education program, providing them with basic information and resources on advocating for a young child with autism spectrum disorders (Parent Advocacy Coaching). Longitudinal change in children's intervention program in the community was evaluated over a period of about 27 months, starting 12 months prior to enrollment in Parent Advocacy Coaching. Results revealed large individual differences in the intensity of children's individual and school-based services. Despite this variability, only two child characteristics (age, gender) emerged as independent predictors. In contrast, the intensity of children's intervention programs was independently predicted by a broad range of demographic characteristics, including parental education, child ethnicity and race, and family composition. Finally, even after child characteristics and family demographics were statistically controlled, results revealed associations between specific parental cognitions (parenting efficacy, understanding of child development) and the subsequent rate of change in the intensity of children's intervention programs. Implications for improving educational programs that aim to enhance parent advocacy are discussed.

Randomized controlled trial of parental responsiveness intervention for toddlers at high risk for autism.

This study tested the effects of a parent-mediated intervention on parental responsiveness with their toddlers at high risk for an autism spectrum disorder (ASD). Participants included caregivers and their 66 toddlers at high risk for ASD. Caregivers were randomized to 12 sessions of an individualized parent education intervention aimed at improving parental responsiveness or to a monitoring control group involving 4 sessions of behavioral support. Parental responsiveness and child outcomes were measured at three time points: at beginning and end of the 3-month treatment and at 12-months post-study entry. Parental responsiveness improved significantly in the treatment group but not the control group. However, parental responsiveness was not fully maintained at follow up. There were no treatment effects on child outcomes of joint attention or language. Children in both groups made significant developmental gains in cognition and language skills over one year. These results support parental responsiveness as an important intervention target given its general association with child outcomes in the extant literature; however, additional supports are likely needed to fully maintain the treatment effect and to affect child outcomes.

A parent-mediated intervention to increase responsive parental behaviors and child communication in children with ASD: a randomized clinical trial.

Longitudinal research has demonstrated that responsive parental behaviors reliably predict subsequent language gains in children with autism spectrum disorder. To investigate the underlying causal mechanisms, we conducted a randomized clinical trial of an experimental intervention (Focused Playtime Intervention, FPI) that aims to enhance responsive parental communication (N = 70). Results showed a significant treatment effect of FPI on responsive parental behaviors. Findings also revealed a conditional effect of FPI on children's expressive language outcomes at 12-month follow up, suggesting that children with baseline language skills below 12 months (n = 24) are most likely to benefit from FPI. Parents of children with more advanced language skills may require intervention strategies that go beyond FPI's focus on responsive communication.

Broad autism phenotype in typically developing children predicts performance on an eye-tracking measure of joint attention.

We examined visual attention allocation during a set of social videos that are intended to elicit the coordination of attention with another person, compared to a control condition. Deficits in joint attention are a characteristic of young children with autism spectrum disorder (ASD). Participants included a diverse sample of 50 typically developing school-aged children between 3 and 9 years of age (M = 6:3, SD = 1:8). Results demonstrated that gaze allocation differed significantly between the experimental and control condition. Further, individual differences in gaze allocation were significantly predicted by a parent-report measure evaluating features of the broad autism phenotype. This study contributes to a research program that aims to develop and validate an endophenotype measure of ASD.