Family therapy for autism spectrum disorders.

BACKGROUND: Autism spectrum disorders (ASDs) are characterised by impairments in communication and reciprocal social interaction. These impairments can impact on relationships with family members, augment stress and frustration, and contribute to behaviours that can be described as challenging. Family members of individuals with ASD can experience high rates of carer stress and burden, and poor parental efficacy. While there is evidence to suggest that individuals with ASD and family members derive benefit from psychological interventions designed to reduce stress and mental health morbidity, and enhance coping, most studies to date have targeted the needs of either individuals with ASD, or family members. We wanted to examine whether family (systemic) therapy, aimed at enhancing communication, relationships or coping, is effective for individuals with ASD and their wider family network. OBJECTIVES: To evaluate the clinical effectiveness and acceptability of family therapy as a treatment to enhance communication or coping for individuals with ASD and their family members. If possible, we will also seek to establish the economic costs associated with family therapy for this clinical population. SEARCH METHODS: On 16 January 2017 we searched CENTRAL, MEDLINE, Embase, 10 other databases and three trials registers. We also handsearched reference lists of existing systematic reviews and contacted study authors in the field. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs investigating the effectiveness of family therapy for young people or adults with ASD or family members, or both, delivered via any modality and for an unspecified duration, compared with either standard care, a wait-list control, or an active intervention such as an alternative type of psychological therapy. DATA COLLECTION AND ANALYSIS: Two authors independently screened each title and abstract and all full-text reports retrieved. To enhance rigour, 25% of these were independently screened by a third author. MAIN RESULTS: The search yielded 4809 records. Of these, we retrieved 37 full-text reports for further scrutiny, which we subsequently excluded as they did not meet the review inclusion criteria, and identified one study awaiting classification. AUTHORS' CONCLUSIONS: Few studies have examined the effectiveness of family therapy for ASD, and none of these are RCTs. Further research studies employing methodologically robust trial designs are needed to establish whether family therapy interventions are clinically beneficial for enhancing communication, strengthening relationships, augmenting coping and reducing mental health morbidity for individuals with ASD and family members.

Feeling, caring, knowing: different types of empathy deficit in boys with psychopathic tendencies and autism spectrum disorder.

BACKGROUND: Empathy dysfunction is one of the hallmarks of psychopathy, but it is also sometimes thought to characterise autism spectrum disorders (ASD). Individuals with either condition can appear uncaring towards others. This study set out to compare and contrast directly boys with psychopathic tendencies and boys with ASD on tasks assessing aspects of affective empathy and cognitive perspective taking. The main aim of the study was to assess whether a distinct profile of empathy deficits would emerge for boys with psychopathic tendencies and ASD, and whether empathy deficits would be associated with conduct problems in general, rather than psychopathic tendencies or ASD specifically. METHODS: Four groups of boys aged between 9 and 16 years (N = 96) were compared: 1) psychopathic tendencies, 2) ASD, 3) conduct problems and 4) comparison. Tasks were included to probe attribution of emotions to self, empathy for victims of aggression and cognitive perspective-taking ability. RESULTS: Boys with psychopathic tendencies had a profile consistent with dysfunctional affective empathy. They reported experiencing less fear and less empathy for victims of aggression than comparison boys. Their cognitive perspective-taking abilities were not statistically significantly different from those of comparison boys. In contrast, boys with ASD had difficulties with tasks requiring cognitive perspective taking, but reported emotional experiences and victim empathy that were in line with comparison boys. Boys with conduct problems did not differ from comparison boys, suggesting that the affective empathy deficit seen in boys with psychopathic tendencies was specific to that group, rather than common to all boys with conduct problems. CONCLUSIONS: Although both groups can appear uncaring, our findings suggest that the affective/information processing correlates of psychopathic tendencies and ASD are quite different. Psychopathic tendencies are associated with difficulties in resonating with other people's distress, whereas ASD is characterised by difficulties in knowing what other people think.

Research note: exceptional absolute pitch perception for spoken words in an able adult with autism.

Autism is a neurodevelopmental disorder, characterised by deficits in socialisation and communication, with repetitive and stereotyped behaviours [American Psychiatric Association (1994). Diagnostic and statistical manual for mental disorders (4th ed.). Washington, DC: APA]. Whilst intellectual and language impairment is observed in a significant proportion of diagnosed individuals [Gillberg, C., & Coleman, M. (2000). The biology of the autistic syndromes (3rd ed.). London: Mac Keith Press; Klinger, L., Dawson, G., & Renner, P. (2002). Autistic disorder. In E. Masn, & R. Barkley (Eds.), Child pyschopathology (2nd ed., pp. 409-454). New York: Guildford Press], the disorder is also strongly associated with the presence of highly developed, idiosyncratic, or savant skills [Heaton, P., & Wallace, G. (2004) Annotation: The savant syndrome. Journal of Child Psychology and Psychiatry, 45 (5), 899-911]. We tested identification of fundamental pitch frequencies in complex tones, sine tones and words in AC, an intellectually able man with autism and absolute pitch (AP) and a group of healthy controls with self-reported AP. The analysis showed that AC's naming of speech pitch was highly superior in comparison to controls. The results suggest that explicit access to perceptual information in speech is retained to a significantly higher degree in autism.

Evidence of Reduced Global Processing in Autism Spectrum Disorder.

Frith's original notion of 'weak central coherence' suggested that increased local processing in autism spectrum disorder (ASD) resulted from reduced global processing. More recent accounts have emphasised superior local perception and suggested intact global integration. However, tasks often place local and global processing in direct trade-off, making it difficult to determine whether group differences reflect reduced global processing, increased local processing, or both. We present two measures of global integration in which poor performance could not reflect increased local processing. ASD participants were slower to identify fragmented figures and less sensitive to global geometric impossibility than IQ-matched controls. These findings suggest that reduced global integration comprises one important facet of weak central coherence in ASD.

Exploratory Study of Executive Function Abilities Across the Adult Lifespan in Individuals Receiving an ASD Diagnosis in Adulthood.

Little is known about cognition in autism spectrum disorder (ASD) across adulthood. We examined executive function abilities and autism traits in 134 adults receiving a first diagnosis of ASD. Participants aged 18-75 years with abilities in the normal range were assessed on executive function and self-report autism traits. Results suggest that for some abilities relying on speed and sequencing (Trails A and B; Digit Symbol), late-diagnosed individuals with ASD may demonstrate better performance than typical age-norms. On other executive measures (Digit Span, Hayling and Brixton tests) age-related correlations were similar to typical age-norms. Different domains of executive function may demonstrate different trajectories for ageing with ASD, with patterns of slower, accelerated or equivalent age-related change being observed across different measures.

Beyond perception: musical representation and on-line processing in autism.

Whilst findings from experimental studies suggest that perceptual mechanisms underpinning musical cognition are preserved or enhanced in autism, little is known about how higher-level, structural aspects of music are processed. Twenty participants with autism, together with age and intelligence matched controls, completed a musical priming task in which global and local musical contexts were manipulated. The results from the study revealed no between-group differences and showed that both global and local musical contexts influenced participants' congruity judgements. The findings were interpreted within the context of studies showing weakened sensitivity to verbal/semantic information in autism.

Anxiety and Attentional Bias to Threat in Children at Increased Familial Risk for Autism Spectrum Disorder.

Anxiety and threat bias were examined in 6-8-year-old children at familial-risk for Autism Spectrum Disorder (ASD) and low-risk (LR, n = 37) controls. The high-risk (HR) group was divided into those who met diagnostic criteria for ASD (HR-ASD, n = 15) and those who did not (HR-non ASD, n = 24). The HR-ASD group had highest levels of parent-reported anxiety. The HR-non ASD group exhibited increased threat bias on a spatial-cueing task, while the HR-ASD group did not. Anxiety symptoms were associated with both threat bias and ASD severity. These findings suggest that the mechanisms underlying anxiety in HR siblings without ASD are similar to those in non-ASD populations. However, among children with ASD, hypersensitivity to threat may not underlie anxiety symptoms.

Demographic and Cognitive Profile of Individuals Seeking a Diagnosis of Autism Spectrum Disorder in Adulthood.

Little is known about ageing with autism spectrum disorder (ASD). We examined the characteristics of adults referred to a specialist diagnostic centre for assessment of possible ASD, 100 of whom received an ASD diagnosis and 46 did not. Few demographic differences were noted between the groups. Comorbid psychiatric disorders were high in individuals with ASD (58 %) and non-ASD (59 %). Individuals who received an ASD diagnosis had higher self-rated severity of ASD traits than non-ASD individuals. Within the ASD group, older age was associated with higher ratings of ASD traits and better cognitive performance. One interpretation is that general cognitive ability and the development of coping strategies across the lifespan, do not necessarily reduce ASD traits but may mitigate their effects.

The structure of language abilities at 4 years: a twin study.

Normal language development was studied in 310 pairs of 4-year-old twins born in the United Kingdom in 1994. Twins were assessed individually in their homes on a diverse battery of language and nonverbal measures. Rotated factor analyses indicated the presence of a general Language factor (L) as well as a general Nonverbal (NV) factor. Moderate genetic influence was found for both L and NV abilities. Bivariate genetic analysis estimated a genetic correlation of .63 between L and NV abilities, implying that over half of the genetic influence on L overlaps with genetic influence on NV. These results suggest that at age 4, genetic influences on individual differences in language overlap substantially with genetic influences on individual differences in other cognitive abilities, although perhaps less so than later in development.

Impaired comprehension of alternating syntactic constructions in autism.

Individuals on the higher-functioning end of the autism spectrum have significant impairments in communication. Language delay can occur, particularly in syntactic or structural linguistic knowledge. However, classically observed semantic deficits generally overshadow these structural deficits. This research examined the potential effects on comprehension of dative expressions that exhibited syntactic alternation versus those that were restricted, whether in syntactic construction or through marked semantic differences in construction. Children with autism and matched neurotypical control participants were presented with a sentence battery of dative statements representing these variations in construction and were asked to display basic comprehension of the sentence meaning by identifying the recipient, or indirect object, of the dative verb. Construction, restriction, and semantic differentiation variables were analyzed for potential effects on the rate of accurate comprehension. Both groups performed with greater accuracy when dative expressions used a prepositional phrase than when the dative action was expressed in the syntax. The autism group performed more poorly when the dative expression could syntactically alternate than when it was restricted. These effects improve our knowledge of how children with autism understand alternating grammatical constructions.

Brain correlates of non-symbolic numerosity estimation in low and high mathematical ability children.

Previous studies have implicated several brain areas as subserving numerical approximation. Most studies have examined brain correlates of adult numerical approximation and have not considered individual differences in mathematical ability. The present study examined non-symbolic numerical approximation in two groups of 10-year-olds: Children with low and high mathematical ability. The aims of this study were to investigate the brain mechanisms associated with approximate numerosity in children and to assess whether individual differences in mathematical ability are associated with differential brain correlates during the approximation task. The results suggest that, similarly to adults, multiple and distributed brain areas are involved in approximation in children. Despite equal behavioral performance, there were differences in the brain activation patterns between low and high mathematical ability groups during the approximation task. This suggests that individual differences in mathematical ability are reflected in differential brain response during approximation.

The power of the positive: revisiting weak coherence in autism spectrum disorders.

This paper reexamines Frith's original concept of weak coherence, its historical origins, recent reformulations, and alternative accounts. We suggest that the key notion of reduced global integration of information, which Frith proposed to underlie the assets in local processing, has been neglected in recent accounts of autism spectrum disorders (ASD). In fact, most paradigms used to test weak coherence conflate global and local processing, often placing them in direct trade-off, so that it is not possible to tell whether patterns of performance in ASD reflect reduced global processing, increased local processing, or both. We review the literature from typical development and ASD that may be pertinent to this distinction and examine some data from our own studies. Only once tasks are devised that measure separately the effects of reduced global processing and increased local processing will it be possible to test the on-line and developmental relations between these two aspects of "weak coherence". Some preliminary ideas about these relationships are discussed, and suggestions are made for why disentangling two possibly independent dimensions of weak coherence may be timely and productive.