Early non-social behavioural indicators of autism spectrum disorder (ASD) in siblings at elevated likelihood for ASD: a systematic review.

We aimed at identifying early non-social behavioural indicators that predict later ASD. Likewise, we were interested in the moment in which non-social signs discriminate between children at elevated likelihood for ASD with a later diagnosis of ASD, and children at elevated likelihood for ASD with a typical developmental outcome. In addition, we intended to explore the developmental evolution of children's symptomatology over time. A systematic literature search was conducted for longitudinal studies on early non-social behavioural indicators among siblings at elevated likelihood for ASD. The following databases were searched: PUBMED, Web of Science, PsycINFO, CINAHL and EMBASE. The study identification process was conducted by two reviewers independently. Compared to siblings at elevated likelihood for ASD with a typical developmental outcome, siblings at elevated likelihood for ASD with later ASD show impairments in attention disengagement, in gross and fine motor development and characteristic restricted and repetitive interests and behaviours, starting at 12 months of age. Moreover, early attention disengagement exerts a predictive role towards a later ASD diagnosis, given that from 12 months siblings at elevated likelihood for ASD who will receive an independent ASD diagnosis towards 24-36 months present marked difficulties in disengaging in comparison with siblings at elevated likelihood for ASD that will not satisfy the criteria for an ASD diagnosis. The findings call for a more comprehensive vision on early indicators of ASD. Further research is needed to extend results to other behavioural domains.

The relationship of undernutrition/psychosocial factors and developmental outcomes of children in extreme poverty in Ethiopia.

BACKGROUND: Extreme poverty is severe deprivation of basic needs and services. Children living in extreme poverty may lack adequate parental care and face increased developmental and health risks. However, there is a paucity of literature on the combined influences of undernutrition and psychosocial factors (such as limited play materials, playground, playtime, interactions of children with their peers and mother-child interaction) on children's developmental outcomes. The main objective of this study was, therefore, to ascertain the association of developmental outcomes and psychosocial factors after controlling nutritional indices. METHODS: A community-based cross-sectional study design was used to compare the developmental outcomes of extremely poor children (N = 819: 420 girls and 399 boys) younger than 5 years versus age-matched reference children (N = 819: 414 girls and 405 boys) in South-West Ethiopia. Using Denver II-Jimma, development in personal-social, language, fine and gross motor skills were assessed, and social-emotional skills were evaluated using the Ages and Stages Questionnaires: Social-Emotional (ASQ: SE). Nutritional status was derived from the anthropometric method. Independent samples t-test was used to detect mean differences in developmental outcomes between extremely poor and reference children. Multiple linear regression analysis was employed to identify nutritional and psychosocial factors associated with the developmental scores of children in extreme poverty. RESULTS: Children in extreme poverty performed worse in all the developmental domains than the reference children. Among the 819 extremely poor children, 325 (39.7%) were stunted, 135 (16.5%) were underweight and 27 (3.3%) were wasted. The results also disclosed that stunting and underweightness were negatively associated with all the developmental skills. After taking into account the effects of stunting and being underweight on the developmental scores, it was observed that limited play activities, limited child-to-child interactions and mother-child relationships were negatively related mainly to gross motor and language performances of children in extreme poverty. CONCLUSION: Undernutrition and psychosocial factors were negatively related to the developmental outcomes, independently, of children living in extreme poverty. Intervention, for these children, should integrate home-based play-assisted developmental stimulation and nutritional rehabilitation.

Objectivity and stability of the Preschool Imitation and Praxis Scale.

OBJECTIVE: We examined rater and test-retest reliability of the Preschool Imitation and Praxis Scale (PIPS). METHOD: We administered the PIPS to 119 typically developing children ages 1.5-4.9 yr. RESULTS: The PIPS demonstrated acceptable intra- and interrater reliability on item level (k(w) = 0.45-1) and scale level (intraclass correlation coefficient ICC = 0.996; 95% CI: 0.968-0.999 and ICC = 0.995; 95% CI: 0.990-0.997, respectively). The smallest detectable difference of the PIPS was 5.6%, indicating that the change score rated by different raters for an individual child is valid and that the PIPS can be used by different raters as an outcome measure to determine children's improvement or maturation. Results of test-retest analysis revealed that the PIPS score is stable over time (r = .93). CONCLUSION: The PIPS appears to meet the required standards regarding objectivity and stability. The PIPS may assist clinicians and researchers in evaluating and reevaluating preschoolers' imitation ability, which is a primary learning strategy of young children.

Measuring procedural imitation aptitude in children: further validation of the Preschool Imitation and Praxis Scale (PIPS).

The Preschool Imitation and Praxis Scale (PIPS) was developed to measure bodily and procedural imitation aptitude in young children. However, the investigation of procedural imitation is more complex than that of bodily imitation. The procedural imitation tasks of the PIPS mainly consisted of unusual acts upon objects (for example, switching on a lamp in a toy animal with the forehead). This study assessed the suitability of these tasks by ruling out nonimitative learning in 15 typically developing children between 12 and 55 mo. of age (6 girls, 9 boys). Results indicated that the tasks seem novel and unlikely to be performed spontaneously by the children. In addition, the number of target acts performed by the children in the imitation condition was significantly higher than in the baseline, investigator-manipulation, and imitation-enhancement nonimitative control conditions. Finally, the tasks elicited more frequently imitative behaviour than end-state emulation. Therefore, the tasks appear appropriate to measure procedural imitation, and the findings support the theoretical validity of the PIPS.

Preserved imitation in contrast to limited free application of comfortable hand actions in intellectually able young adults with an autism spectrum disorder.

Imitation problems are commonly reported in children with an autism spectrum disorder. However, it has not yet been determined whether imitation problems persist into young adulthood. In this study, we investigated imitation skills of 20 intellectually able young adults with autism spectrum disorder relative to 19 age-matched neurotypical adults. For this purpose, we used a bar-transport task, which evokes the application of the end-state comfort principle. Specifically, we examined whether young adults with autism spectrum disorder imitated the means-end structure of a demonstrator's bar-transport action with and without application of the end-state comfort principle (imitation task). In addition, we examined whether participants spontaneously applied the end-state comfort principle during a similar bar-transport task (free execution task). Results revealed that young adults with autism spectrum disorder imitated the means-end structure of observed actions to the same degree as neurotypical adults ( p = 0.428). In contrast, they applied the end-state comfort principle less often during free executed actions ( p = 0.035). Moreover, during these actions, they were slower to place the bar into the penholder ( p = 0.023), which contributed to the reduced efficiency of their performance. Findings suggest that imitation abilities of young adults with autism spectrum disorder are preserved and that observing others' actions might promote more efficient action planning in this population.

Nature of motor imitation problems in school-aged boys with autism: a motor or a cognitive problem?

This case-control study explores the underlying mechanisms of imitation problems in boys with autism by manipulating imitation task variables and by correlating imitation performance with competence on general motor tests (Movement Assessment Battery for Children and Peabody Developmental Motor Scales). Fifty-five boys participated in this study: eight low-functioning with autism (LFA), 13 with mental retardation (MR), 17 high-functioning with autism (HFA) and 17 typically developing (TD). LFA performed significantly worse than MR on the motor test and on all imitation tasks. HFA performed significantly worse than TD on the motor test, but not on imitation tasks, with the exception of non-meaningful gestures. This study supports the notion that mainly perceptual-motor impairment, and not a cognitive weakness of symbolic representation, causes imitation problems in autism. In addition, in boys with autism, general motor as well as imitation abilities were impaired. We suggest that imitation ability has to be assessed in conjunction with motor competence.

Screening accuracy of the parent-completed Ages and Stages Questionnaires - second edition as a broadband screener for motor problems in preschoolers with autism spectrum disorders.

Children with autism spectrum disorders are at risk for motor problems. However, this area is often overlooked in the developmental evaluation in autism diagnostic clinics. An alternative can be to identify children who should receive intensive motor assessment by using a parent-based screener. The aim of this study was to examine whether the Ages and Stages Questionnaires - second edition may be used to identify gross and fine motor problems in children. High-functioning children with autism spectrum disorder (n = 43, 22-54 m) participated in this study. Sensitivity, specificity, predictive values and areas under the receiver operating characteristic curve were calculated by comparing the Ages and Stages Questionnaires - second edition scores to the developmental evaluation of the Peabody Developmental Motor Scale - second edition. The results revealed that both the Ages and Stages Questionnaires - second edition gross and fine motor domain may be used to identify children without motor problems. In contrast, sensitivity analyses revealed the likelihood of under screening motor problems in this population. The Ages and Stages Questionnaires - second edition met only the criteria of a fair to good accuracy to identify poor gross motor (sensitivity = 100%) and below-average fine motor development (sensitivity = 71%) in this sample. Hence, the capacity of the Ages and Stages Questionnaires - second edition to identify motor problems in preschoolers with autism spectrum disorder appears to be limited. It is recommended to include a formal standardized motor test in the diagnostic procedure for all children with autism spectrum disorder.

A Qualitative Analysis of Imitation Performances of Preschoolers With Down Syndrome.

A number of studies suggest that imitation is a characteristic strength in children with Down Syndrome (DS). The present study aims to discover whether imitation performances are qualitatively phenotypical in DS. Eight preschoolers with DS were matched on chronological, mental, language and imitation age with 8 preschoolers with intellectual disability of undifferentiated etiology (ID-UND). Imitation performances on the Preschool Imitation and Praxis Scale were videotaped for blind scoring on 30 possible errors. Children with DS made fewer production errors (synkinesias, OR 0.3 [0.1-0.7]), but more conceptual errors (substitution, OR 2.5 [1.6-3.9]) compared to children with ID-UND. This finding is in line with the view of a cognitive phenotype in DS, which is characterized by preserved visuospatial and impaired language abilities.

Understanding the mechanisms behind deficits in imitation: do individuals with autism know 'what' to imitate and do they know 'how' to imitate?

Although imitation problems have been associated with autism for many years, the underlying mechanisms of these problems remain subject to debate. In this article, the question whether imitation problems are caused by selection or correspondence problems is explored and discussed. This review revealed that hypotheses on the nature of imitation problems in autism are complicated and inconclusive at the present time. There is some evidence for impaired selection, especially implicating poor preferential attention to biological motion and poor ascription of intention to action. There is also some evidence that both transformations of perspectives and mapping of visual to motor information are impaired, characterized as correspondence problems. However, it is not yet clear how poor selection processes contribute to correspondence problems and vice versa. Insight in this interaction may provide a valuable contribution to our understanding of imitation problems in autism. For further research we recommend that tasks should be constrained to target as few mechanisms as possible in given experiments.

Imitation assessment and its utility to the diagnosis of autism: evidence from consecutive clinical preschool referrals for suspected autism.

The present study sought to examine imitation difficulties as a risk factor for autism. Imitation aptitude was examined in 86 preschoolers suspected of autism (1.9-4.5 years) using the Preschool Imitation and Praxis Scale (PIPS). Differences between imitation, language, motor age-equivalents and nonverbal mental age were used to predict the diagnosis of autism. Multidisciplinary team diagnoses and ADOS-G classifications were used to differentiate children with autism spectrum disorders and non-spectrum developmental disorders. Two factors were found to be significantly associated with autism using simple logistic regression analyses: procedural imitation delay and receptive language delay. In a multivariable setting, only procedural imitation delay remained a significant predictor of autism. Results are new to the literature and require replications.

Nature of motor imitation problems in school-aged males with autism: how congruent are the error types?

This case-comparison study explores the underlying mechanisms of imitation problems in school-aged males with autism. Analysis of congruent error types in their imitation performance was made and compared with appropriate comparisons. Fifty-five males (eight low-functioning with autism: mean age 6y 2mo [SD 7.6mo]; 13 low-functioning with learning disabilities: mean age 6y 3mo [SD 2.8mo]; 17 high-functioning with autism: mean age 8y 9mo [SD 11mo]; and 17 typically developing: mean age 8y 8mo [SD 11.6mo]) were assessed on 18 single gestures and six sequences of hand postures. Imitation performance was videotaped for blind scoring on 21 possible errors by two independent observers. Results revealed that in both groups with autism, imitation required far more effort (more attempts) than in the comparison groups and was less precise (more spatial errors). Typical for low-functioning participants with autism was their less mature imaginary grip in transitive gestures. Typical for high-functioning participants with autism was their preference for immature mirror-image imitations. These observations support the assumption that the underlying mechanisms in motor imitation problems are linked more to the action production system and less to the action conceptual system or to behavioural problems. We postulate that the action production system is delayed rather than deficient.