Over the last decade, not only has the awareness of ASD increased dramatically, but the rates of children diagnosed with autism has increased as well. The Center of Disease Control (CDC) now estimates that autism affects approximately 1 in every 59 children, a 150% increase since 2000. Autism Spectrum Disorder is characterized by impaired social interactions and the presence of stereotyped behaviors that results in lifelong impaired functioning. There is significant clinical heterogeneity within ASD suggesting a multifactorial pathophysiology with contribution from both genetic and environmental risk factors. Given the complexity of ASD pathophysiology, existing treatments are directed at each clinical manifestation and are not considered curative. Antipsychotic medications have been shown to be efficacious in reducing the repetitive patterns of behavior, while behavioral therapy is effective in alleviating the social impairment associated with ASD. Notably, epilepsy occurs in approximately 33% of individuals with ASD. The high co-occurrence of epilepsy and autism has been hypothesized to be the result of a shared underlying pathophysiology. Current treatment guidelines for epilepsy include anti-epileptic medications with varying mechanisms of action, however approximately one-third of patients with epilepsy fail to achieve adequate seizure control with drug therapy. In these individuals with refractory epilepsy, studies have demonstrated that the ketogenic diet has proven efficacy in achieving seizure control. Numerous mouse models and several human trials have also evaluated the efficacy of the ketogenic diet in reversing the symptoms of autism, though these studies have largely been limited in generalizability, sample size, and randomization. This proposed study will be a randomized controlled study and will assess the utility of the ketogenic diet in reversing the core deficits of autism, social impairment and restricted, repetitive behaviors. Several assessment tools will be utilized to evaluate the behavioral response to the ketogenic diet. The applicability of the ketogenic diet to improve the symptoms of ASD can have a potentially profound impact on the financial burden of the disease. Additionally, it can reduce the need for both anti-epileptic and anti-psychotic medications, thus reducing both the side effects associated with those medications, while concurrently improving the symptoms of ASD.

The current study evaluated three subjects with developmental disabilities, using a Mindfulness activity protocol to promote psychological flexibility, as well as exercising this developed flexibility to reduce problem behaviors. The success of the Mindfulness procedure was evaluated using a multiple baseline across participants design. Results of this study presented that after partaking in Mindfulness activities, all participants displayed decreases in problematic behavior, as well as increased scores on the Children’s Psychological Flexibility Questionnaire (CPFQ). Overall, there was a general trend of reduced problematic behavior from baseline to post-intervention. Participants’ behavioral frequency rates were reduxed an overall average of 25.2%. In addition to general maladaptive behavior reductions, participants’ CPFQ scores were improved across participants by an overall average improvement of 11.8%.

One fundamental conceptualization of the biomedical category of autism is that of the withdrawn child, isolated in an impenetrable world. This trope, and associated neurobiological, cognitive and linguistic markers, have become central to how autism is recognized in both academic research and in popular understanding. In this paper, I draw on fieldwork in Ethiopia, where the first education and care center for autism was founded in the capital of Addis Ababa in 2002. My research explores the relatively recent introduction of the diagnostic category, working principally with Ethiopian parents who have identified and sought care at the center, and educators on staff. I find that the adults understand these children not as withdrawn, but in terms of three key characteristics: a “tied mouth,” an inability to listen, and experiencing inner disturbance. Colloquially, any of these three may mean that a son or daughter is “ye otizm lij” [lit. autism’s child]. Drawing on ethnographic material, I show how, for these parents, these three markers shape how they understand and work to care for their children, and therefore, autism.

CASE: A 6-year-old boy with a diagnosis of autism spectrum disorder (ASD) presented to primary care for a newpatient, transfer-of-care evaluation. At the initial encounter, the patient used a maximum of 60 words and was receiving speech and language therapy (SLT) through school. Family history was positive for seizures in the father and paternal grandfather as well as ASD in an older brother. Referrals to genetics, private SLT, and an autism specialist were offered, although the latter was declined by family. The subsequent genetics evaluation resulted in discovery of a small gain on chromosome 1q42.2 and associated partial duplication of the DISC1 gene. The assay could not determine the exact clinical significance of the abnormality, but similarly sized and located abnormalities involving the DISC1 gene are reported in some patients with ASD and developmental delay. During a follow-up pediatrics appointment, the father expressed his wish for further evaluation of causes of autism spectrum disorder (ASD) and requested an electroencephalography (EEG) evaluation. The family concomitantly reported slow improvement in speech with therapy, the use of up to 200 words, and the ability to count to 10. The primary care physician reiterated that EEG and imaging studies are not indicated for an isolated ASD diagnosis with no supporting history or physical examination indications. The clinician discussed ASD-recommended therapies with the family. Neurology referral was made per parental request. The patient subsequently presented to neurology at the age of 7 years. The parents reiterated during the initial neurologic developmental history that the patient had shown some improvement with speech and language therapy in the past 18 months, knew as many as 200 to 300 words, and could put some words together into simple sentences. Gross and fine motor development were felt to be within the normal range for age. The parents also reported some scripting, and mild echolalia was noted on examination. Notably, there was no history of language regression. Apart from language delay, the neurologic examination was otherwise normal at initial evaluation. Given this clinical picture, ASD treatment options were again discussed. Despite education, parents continued to request for EEG evaluation as a workup for the etiology of the patient's ASD. Electroencephalography was ultimately ordered owing to the strong and repeated paternal request despite denial of any seizure-like episodes in the patient. EEG unexpectedly showed extremely frequent, almost constant focal electrographic seizures arising from the T3/T5 electrodes in the speech area of the left temporal lobe, prompting the initiation of oxcarbazepine maintenance therapy. Because of the noted abnormalities on EEG, magnetic resonance imaging (MRI) was obtained. Mild abnormalities were noted on MRI study including possible minimal inferior cerebellar vermian hypoplasia, mildly prominent bodies of the lateral ventricles, and nonspecific, nonenhancing punctate T2 hyperintensities in the subcortical white matter. These findings were not felt to be clinically relevant to the patient's presentation or seizure evaluation. No repeat imaging was ordered. Hindsight is always 20/20. As a clinician evaluating the patient initially, would you have pursued further workup sooner?

Identification strategies and patterns of visual inspection in relation to non-perceptual variables, rapport and discrimination set, were studied in 3 "autistic" Ss, using experimental materials relevant to various forms of visual perception. A qualitative, single case approach was followed, using as controls, individually matched Ss representing various points on a developmental continuum. Marked differences were found between 2 "autistic" Ss as compared with the third "autistic" S and the majority of control Ss in all variables, although 2 young normal Ss exhibited features similar to the 2 "autistic" Ss. It therefore appeared that in some "autistic" Ss, there was disturbance at selective and identifying levels of perception associated with deficiencies in non-perceptual factors. The disturbance appeared developmental rather than deviant in nature.

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.

Indiana University-Purdue University Indianapolis (IUPUI) / To date, only two studies, both using the same sample at two different time points, have quantitatively examined outcomes in Black caregivers of individuals with autism spectrum disorder (ASD). This study examined family adaptational outcomes in Black and White caregivers of individuals with ASD using the double ABCX model of family adaptation to examine the impacts of stressors, the A in the model (e.g., autism symptom severity, general life demands), resources/supports, the B in the model (e.g., social support), and individual coping/stress appraisal styles, the C in the model (e.g., cognitive appraisal, religious coping) on caregiver positive and negative adaptation outcomes, the X in the model, (e.g., caregiver strain, benefit finding, family quality of life). Black and White caregivers were compared on adaptation outcomes at the family, dyadic, and individual level, including both positively valenced (e.g., benefit finding) and negatively valenced outcomes (e.g., depression, caregiver strain). Participants were Black (N = 24) and White (N = 32) primary caregivers of individuals with ASD. Racial differences were found for both the general and racial-specific factors in the ABCX model. White and Black caregivers reported moderate and equal levels of caregiver strain. However, Black caregivers reported greater levels of anxiety and depression and lower levels of life satisfaction. When adjusting for potential ABC covariates, racial differences in outcomes were no longer significant. That is, racial differences in outcomes could be explained by differences in the proximal elements represented by the ABC variables of the model (e.g., passive-avoidance coping, religious coping). Black caregivers reported higher levels of pile-up of demands, formal social support, threat appraisal, passive-avoidance coping, and positive and negative religious coping than White caregivers. Different factors were related to caregiver strain in the two racial groups. Conscientiousness was a protective factor against caregiver strain for Black caregivers, whereas greater use of passive-avoidance coping and threat appraisal, higher levels of neuroticism and barriers to care, and lower levels of satisfaction with services, parenting self-efficacy, and formal social support were explanatory factors for increased caregiver strain among White caregivers. These results are helpful in informing interventions and support the cultural adaptation of care as provided to Black caregivers of individuals with ASD.

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