Numerous interventions have been identified by research as being effective in reducing the severity of some of the core impairments and challenging behaviours of young people with autistic spectrum disorders (ASDs) and learning difficulties. However, the literature cites significant disparity between what is demonstrated to be effective in supporting young people with ASD and challenging behaviour and the support young people and families actually receive in practice. Paper 1 examines the extent to which evidence-based practice translates into actual practice in special schools in the UK for young people with ASD, severe learning difficulties (SLD) and challenging behaviour. A questionnaire survey targeting 64 special schools in the Midlands was used in conjunction with a series of follow-up semi-structured interviews of school staff. The findings indicate that: 1) the ideal of eclectic provision is potentially undermined by a limited range of training received by staff in evidence-based approaches; 2) mechanisms for supporting staff emotional reactions are inconsistently implemented; 3) limited mechanisms exist for developing staff understandings of challenging behaviour. Furthermore, staff attributions regarding challenging behaviour are pivotal to the consistency and effectiveness of any support programme. Implications and future research directions are discussed.

Anesthetics are provided to millions of patients every year in the United States mostly by anesthesiologists. However, there is a lack of literature or documentation on how anesthetics are administered by various anesthesia providers. In order to have a better understanding on the pattern, we performed retrospective chart review on anesthetic practice for surgical atrial septal defect repair procedures performed in Boston Children's Hospital. Our collected data included: premedication, anesthesia induction methods, anesthesia maintenance methods, choice of vasoactive agents, analgesics, and intravenous accesses, extubation in the operating room, postoperative sedation, and choice of antiemetics and postoperative nausea and vomiting. In addition, the studied patients were divided into two groups based on the institutional initiation of the Fast-track protocol: before and after the implementation of the Fast-track protocol (the Non-fast-track group and the Fast-track group). Some results fell under expectation; for example, in the Non-fast-track group, all patients who were induced intravenously were older than 10 years old, and received propofol for induction, which is the most popular choice of intravenous induction drug. The Fast-track group showed a similar trend; 80% of all intravenously induced patients were 10 years or older and induced with propofol. Also, in both groups, anesthesia was maintained with the combination of IV and volatile anesthetics. An anticipated change in practice pattern was seen in the Fast-track group for the choice of analgesics and postoperative sedation for non-extubated patients; acetaminophen was introduced as an adjunct to other analgesics, and propofol infusion was introduced as a standard drug of postoperative sedation for non-extubated patients, both of which are part of the Fast-track protocol. Interestingly, however, overall intraoperative opioid doses did not show any change. The variation in the choice of intravenous access showed difference before and after the Fast-track implementation; in the Non-fast-track group, extra jugular vein was accessed as the most popular choice, whereas in the Fast-track group, central venous line was the most popular choice. Also, the incidence of postoperative nausea and vomiting was notably lower in patients who were not given anti-emetics after the Fast-track protocol implementation. This calls for a need for a future research on what part of the Fast-track protocol could have resulted this improvement without intraoperative administration of regular anti-emetics. Overall, our results provide future directions for researches on anesthetic practice that may help improve patient safety and efficiency beyond the practice in Boston Children's Hospital.

With an expansion of knowledge and interest in ASD, widening diagnostic criteria and an increasing number of students being diagnosed, it is important to address whether schools are meeting the needs of this population adequately and to examine which methods are most effective in achieving this end. The study aimed to develop a clearer insight into the special educational needs of young people with ASD and how these needs can best be met in educational settings. Questionnaires were distributed (through parent support groups) to young people with ASD and their families regrading their high school experiences. The findings from the questionnaire were used to derive a model of good practice for supporting pupils with ASD.The main factors were found to be: the existence of trained staff in the field of autism, higher staffing ratios to support these pupils, flexibility of staff to respond to their individual needs and an inclusive ethos throughout the school. To 'test' this hypothetical model of good practice a case study of an educational setting deemed by parents and pupils to be 'successful' was undertaken in order to test the strength of these hypotheses and also to potentially identify any additional factors to include in the model. Many of the factors identified in the model were found to be present in the 'successful' school yet other significant features included: good relationships between staff and parents, between staff and pupils and between pupils and peers. the case study highlighted that these relationships as well as an inclusive ethos were pivotal to the success of the school. However, it was apparent that an element of inclusion dissonance existed across the school: the perceived commitment of staff to achieving inclusion for these pupils was not always seen in reality.

As the number of students diagnosed with Autism Spectrum Disorder (ASD) increases, many classrooms are turning to an inclusion model of learning. To gain the perspective of program users rather than providers, this study explored parents' perceptions of the inclusion model. Pearlin's stress process model served as the theoretical framework for this study. Ten parents in Pennsylvania were recruited via snowball sampling for participation, and 7 completed the study. Parents completed a short demographic questionnaire and then participated in individual interviews. The research questions were concerned with the lived experiences of parents of children with autism enrolled in inclusion programs or who have participated in inclusion programs within the past 5 years, their perceived roles, and the stresses they felt in those roles. Transcripts were iteratively reviewed to identify consistent themes across interviews. Findings from this study showed: (a) the inclusion model of education had both positive and negative effects on different children diagnosed with autism, (b) the development of emotional skills of children with autism enriched their participation and social relationships with other people, and (c) a strengthened support system for children with autism must be advocated through accessible information and services. These findings support available literature, which is largely against the inclusion model. Findings suggest that support systems for information dissemination should be strengthened, and educators should develop their emotional skills to help students with disabilities.

The ADNP (Activity dependent neuroprotective protein) gene encodes a transcription factor that is essential for embryonic development and brain formation. Mutations within this gene cause a neurodevelopmental disorder known as Helsmoortel-Van Der Aa syndrome. ADNP is one of the most commonly mutated single genes associated with autism spectrum disorder. However, its role in neurodevelopment is unclear. Our goal in this study is to dissect the role of Adnp in neurogenesis using the mouse retina as a tractable model system. We hypothesized that Adnp might have a crucial role in retinal neurogenesis. We found that Adnp was consistently expressed in all progenitor cells throughout retinal development. Interestingly, Adnp expression was relatively high in differentiated cells and persisted in the adult retina. Adnp was found to regulate retinal size, possibly by controlling cell survival during retinal development. In the retina, Adnp was found to interact with the Chd4 chromodomain helicase protein and might therefore be involved in chromatin remodelling. On the other hand, it also interacted with Pogz – a zinc finger protein associated with heterochromatin and might have a specific role in neural gene regulation. Altogether, these findings indicate that Adnp plays a crucial role in retinal neurogenesis and identify possible neurodevelopmental mechanisms that might depend on Adnp.

The prevalence of Autism Spectrum Disorder (ASD) has increased 54.7% from 2000 to 2016 nationally (CDC, 2016), and comparably, 52.38% in the district where this program evaluation was conducted. This increase, paired with legislative requirements through the Individuals with Disabilities Education Act and recommendations from the National Research Council on educating students with ASD, has challenged school districts to develop programming targeting specific impairments characteristic of students with ASD. The purpose of this study was to evaluate programming through the evaluation of individualized education plans (IEPs) of students with ASD in kindergarten through third grade for the presence of Individuals with Disabilities Education Act requirements and National Research Council recommendations. Additionally, 13 special education teachers providing services to one or more students in the category of ASD completed a 30 item self-report questionnaire on their confidence in developing IEPs and programming for students with ASD. Sixty-three IEPs were evaluated in the study for IDEA and NRC indicator proficiency levels and cross-referenced with teacher confidence levels on developing IEPs and programming for students with ASD. The study concluded data analysis of IEPs and special education teacher confidence levels resulted in the identification of programming strengths and weakness that can be used by the district in this study to develop a structured plan for improvements in the development of IEPs specific to the identified areas of impairments for students with ASD (behavior, communication, socialization). Specific to the district in this study is a recommended focus on the development of IEP goals based on individual student needs and NRC recommendations for students with ASD, descriptions of student motivational systems when appropriate, specially designed instruction, educational placement and the relationship of teacher knowledge and confidence about ASD to IEP and program development. / Ed. D. / The prevalence of Autism Spectrum Disorder (ASD) has increased nationally by 54.7% from 2000 to 2016 (CDC, 2016), and 52.38% in the district where this program evaluation was conducted. The increase has challenged school districts to develop programming specific to the areas of impairment characteristic of students with ASD. The purpose of this study was to evaluate programming for students with ASD through the evaluation of individual education plans (IEPs). Additionally, special education teachers completed a self-report questionnaire on their level of confidence in developing programming and support systems for students with ASD. The areas of in need of improvement, indicated by the IEP evaluation, were cross-referenced with low confidence levels reported by teachers in the self-efficacy questionnaire. The study identified areas of weaknesses and strengths in programming that can be used by the district to develop a plan for improvement of the development of IEPs and programming specific to the areas of impairment (communication, socialization, behavior) characteristic of students with ASD.

Bakgrund: Autism är en gammal diagnos som de senaste hundra åren genomgått flera förändringar. Även på senare år förändras diagnosen men grundproblematiken för individens och dess omgivning är den samma. Ett barn med autism påverkar hela familjen. Syfte: Syftet var att undersöka hur svenska föräldrar till barn med autism upplever familjens livssituation och hur den påverkas av barnets problematik. Metod: Studien genomfördes med en kvalitativ ansats baserad på fem självbiografier skrivna av föräldrar till barn med autism. Innehållet i självbiografierna analyserades med hjälp av en kvalitativ manifest innehållsanalys. Resultat: Två huvudkategorier framkom efter analysprocessen, Föräldrarnas känslor och Påverkan på vardagen, samt 14 underkategorier. Omgivningen kring barnet berörs i stor utsträckning. Föräldrarna påverkas både när det gäller deras känsloliv och de får se sin vardag förändras. Syskon till barn med autism får inte lika mycket uppmärksamhet som sitt syskon utan får i stor utsträckning klara sig själva.   Slutsats: Ett barn med autism påverkar hela familjen på ett eller annat sätt. En annan viktig del som kommit fram i föreliggande studie var behovet av ytterligare insatser och stöd från samhället. Föräldrarna känner ofta att de får klara sig själva och inte får den hjälp de behöver.

Facial expressions are a useful source of information about the emotional state of others. However, facial expressions do not always correspond with an underlying emotional state. It is advantageous for perceivers to be able to differentiate between those expressions that are associated with a corresponding emotional state (genuine expressions) and those which are not associated with underlying emotions (posed expressions). The present study investigated the sensitivity of children with Autism Spectrum Disorder (ASD), and age and sex-matched control children to the different emotions underlying posed and genuine smiles. The first task required participants to listen to 12 emotion eliciting stories and select, from a grid of 4 facial expressions (a genuine smile, a posed smile, a neutral expression and a sad expression) that which matched how the target in the story would feel. Children with ASD correctly matched facial expressions and stories than did participants without ASD. The second task required children to look at a series of faces, each displaying either a posed smile, a genuine smile or a neutral expression and indicate whether each target was or was not happy. Participants with ASD were less sensitive both to the underlying emotional state of the targets and to the difference between posed and genuine smiles than were the control participants. Results are discussed in terms of the social deficits symptomatic of ASD.

Heightened levels of stress are observed in mothers of children with autism spectrum disorders (ASD), yet little is known about the relationship between stress and coping in mothers of children recently diagnosed with an ASD. The objectives of this study were to determine the levels of maternal stress, identify coping strategies used by mothers, examine the relationship between stress and coping, and ascertain whether coping mediated the relationship between ASD symptom severity and subsequent maternal stress. Data on 128 mothers of children who had received a diagnosis of ASD in the last four months were examined. Results indicated that mothers presented with elevated levels of stress. With regards to coping, escape-avoidance and confrontive coping were positively correlated with stress, while seeking social support was negatively correlated with stress. Confrontive coping did not mediate the relationship between ASD symptom severity and maternal stress. Results confirm previous findings, while underscoring the importance of helping mothers understand the relationship between the coping strategies they adopt and the subsequent stress they experience.

Heightened levels of stress are observed in mothers of children with autism spectrum disorders (ASD), yet little is known about the relationship between stress and coping in mothers of children recently diagnosed with an ASD. The objectives of this study were to determine the levels of maternal stress, identify coping strategies used by mothers, examine the relationship between stress and coping, and ascertain whether coping mediated the relationship between ASD symptom severity and subsequent maternal stress. Data on 128 mothers of children who had received a diagnosis of ASD in the last four months were examined. Results indicated that mothers presented with elevated levels of stress. With regards to coping, escape-avoidance and confrontive coping were positively correlated with stress, while seeking social support was negatively correlated with stress. Confrontive coping did not mediate the relationship between ASD symptom severity and maternal stress. Results confirm previous findings, while underscoring the importance of helping mothers understand the relationship between the coping strategies they adopt and the subsequent stress they experience.