Autism is a life-long neurodevelopmental condition. Autistic individuals have difficulties in communicative and social ability, and repetitive and stereotypic behavior. It has proposed that these symptoms are caused by underconnectivity in the autistic brain. Functional imaging studies have reported functional underconnectivity in autism. In this thesis, the structural connectivity of the autistic brain was studied. White matter contains axon fibers, which connect different cortical and subcortical brain regions. To measure the structural connectivity, Diffusion tensor imaging (DTI) was applied. Since water diffusion in axons inside the white matter is directional, by measuring the magnitude and direction of water diffusion in white matter, the structural integrity of white matter fibers could be estimated. In this thesis, the background of autism as a genetic, neurological and behavioral condition is outlined. The methods needed to acquire and analyze DTI data are illustrated. A meta-analysis on abnormalities found in autistic brain using DTI was conducted and the most consistently reported regions with DTI differences in autism compared to typically developing controls are described. The results of the metaanalysis were localized to white matter tracts likely to be involved, and the possible associations between anatomy and autistic behavioral features are discussed. Finally, a DTI tractography study was conducted in a sample but clinically representative sample of patients with ASD and eighteen major white matter tracts were explored. Underconnectivity in several tracts was identified. It is hoped that the findings reported here will enhance our understanding of widespread underconnectivity in autism. / published_or_final_version / Psychiatry / Master / Master of Philosophy

The main purpose of this research was to collect information regarding clinical and counseling psychologists', school psychologists', and child psychiatrists' (a) current knowledge about autism, (b) levels of training and preparedness to provide diagnoses and interventions, (c) common tools and methods used to assess autism, (d) the disorders that are most difficult to differentiate from autism, and (e) the most common recommendations and interventions used for children with autism. Autism currently affects 1 out of 166 children and it has been estimated to have a 10-17% growth annually (Center for Disease Control, 2005). Therefore it is imperative that professionals who work with children who have autism be trained and knowledgeable. No research was found regarding the training, knowledge, assessment, and intervention practices of professionals.A survey was developed to address training, diagnostic techniques, knowledge, and intervention practices of professionals. The survey was initially mailed to a total of 987 professionals within the state of Indiana (394 members of the Indiana Association of School Psychology, 500 members from the Indiana Association of Psychologists, and 99 members from the Council of Child and Adolescent Psychiatrists). A total of 343 usable surveys were returned.Overall, professionals demonstrated a good knowledge base about autism facts verses myths. Professionals also demonstrated good knowledge of disorders that can be comorbid with autism. Professionals underestimated the rate of seizure disorder and mental retardation with autism. Most professionals reported receiving training on autism from workshops and very little training from graduate programs or internships.Professionals reported wanting to have more opportunities for hands-on training with children who have autism. Professionals most often used rating scales when performing assessments for autism and rarely used instruments such as the Autism Diagnostic Observation Schedule (ADOS) or the Autism Diagnostic Interview- Revised (ADI-R). Respondents felt most comfortable with assessment of autism and least comfortable with providing interventions. Communication disorder was ranked as the most difficult disorder to differentiate from autism by all professionals. Respondents differed on specific interventions they recommended and interventions they actually provided. Implications for professionals, training, and future research are discussed. / Department of Educational Psychology

Parents of children with autism have been identified across research as having unique experiences in comparison to parents of children with other disabilities. The focus to date has been on identifying factors impacting on parental well-being post-diagnosis, with some more recent studies looking more specifically at parent experience of the diagnostic process. However, there is less literature that explores the impact that this diagnosis may have on parental perspectives of, and aspirations for, their child. In addition, within this current research, little is known about how parents of toddlers make meaning of their situation pre and post-diagnosis, with limited literature so far that looks at the influence that geographical location may have on this. As an exploratory, qualitative study of parent experience of early autism diagnosis in Massachusetts and central Scotland, this thesis aimed to bridge this gap by investigating parents’ experience in these early years, in two similar, yet contrasting settings with significant differences in policy and practice. Utilising Blumer’s (1969) principles of symbolic interactionism, this thesis examined the factors that had an effect on participants’ meaning making, drawing on extended premises of SI (Snow, 2001; Stryker, 2008) to explore the extent to which structural and social influences in each country may have impacted on this. It looked at the similarities and differences between parents’ experiences of: the autism diagnostic process; access to, and engagement with, post-diagnosis services; changes in perceptions of autism over time; and whether perspectives of, and aspirations for, their child altered since diagnosis. All 18 participants (14 mothers and 4 fathers) had a child (13 boys and 5 girls) under 5 years old with a diagnosis of autism. Data were generated through semi-structured interviews, using open coding to group initial categories, before moving into interpretive, inductive analysis to identify wider themes. Findings highlighted key differences between policy and practice, which influenced parent experience in a number of ways. In particular, the differences between the services and support available to young children with autism and their families in each location appeared to have a significant impact on participants. However, this study also concluded that, in spite of differences in policy and practice, there were also a number of similarities in the ways in which parents made meaning and sense of their child’s diagnosis. Interaction with other parents (both face to face and online) had a strong influence on this, alongside parents’ exposure to media portrayals of autism, which were similar in both locations. Conversely, in spite of their experiences with a wide range of professionals, these interactions had a more limited effect overall on the perspectives that parents developed of their child. In addition, in spite of recognising previously held beliefs regarding stigma and stereotype in autism, all parents in this study actively rejected these perceptions after receiving a diagnosis for their child. Overall, data reflected a shared understanding of autism that crossed geographical and structural boundaries, with parents from both countries experiencing the same hopes, aspirations and fears for their child’s future. These findings may have implications for policy considerations and for services in both locations delivering pre and post-diagnostic support, with potential for more positive outcomes overall for those receiving an early diagnosis for their child.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Direct observation of the child remains an essential part of the gold standard clinical practice in the diagnosis, assessment, and treatment planning for children with Autism and related developmental conditions. Clinical professionals acknowledge that observing behavior in the natural environment is crucial to obtain an accurate and comprehensive assessment of child behavior. However, direct observation in the natural environment is not feasible for wide-scale implementation into clinical practice. Another key challenge with respect to autism diagnosis is that there is significant time lag (about 20-60 months) between age at which parents first get concerned and the age at which the child finally gets diagnosed. Delay in diagnosis can lead to delay in invaluable early interventions which could impact a child’s future developmental outcomes. A capture and access solution can play a role to fill these gaps. This thesis presents the design, development, and evaluation of a Clinician-directed Capture and Access System that can enable parents to easily collect in-home behavior specimens that have clinical utility and clinicians to use this data to complete a diagnostic assessment for autism. Analogous to a traditional lab specimen collection and assessment procedure, this approach involves three steps: 1) the clinician’s prescription of behavior specimens to be collected; 2) in-home collection and remote sharing of prescribed behavior specimens by parents; and 3) diagnostic assessment of behavior specimens by a remote and qualified clinician. The contributions of this thesis are as follows: a) identified potential opportunities and challenges specific to the design and adoption of a technology solution that enables in-home behavior specimen collection and diagnostic assessment for autism; b) identified key features and functionalities of a smart-phone based Capture System that can enable parents to easy collect in-home behavior specimens that have clinical utility; c) identified key features and functionalities of the web-based Access System that facilitate clinicians to complete remote diagnostic assessment based on in-home behavior specimens.; d) demonstrated through an end-to-end study with parents and clinicians that parents can easily capture behavior specimens through the Capture System and clinicians can complete remote autism diagnostic assessment based on in-home behavior specimens via the Access System.

This dissertation examines the relationship between a clinical classification (autism) and the sociocultural and institutional contexts of its application. Historically in Morocco, as in many other global contexts, the autism label has not been widely used, and the professional disciplines typically charged with diagnosing and treating it (i.e., child psychiatry and special education) are relatively new there. Children have long been described and treated as majnun (“possessed”), mo’aq (“disabled”), hmaq (“crazy”), f shkel (“weird”) – but not typically as tawahhudi (“autistic”). Beginning in the 1980s, and then intensifying after 2000, Moroccan parent-activists have been working together with foreign and local experts to change that. Drawing on an Anglo-American neurocognitive behavioral model of autism diagnosis and treatment – in direct opposition to a French psychoanalytic one – they have been training a new cadre of experts, raising autism awareness, lobbying government agencies, and constructing an infrastructure to identify and educate children as autistic. This dissertation follows the category autism as it circulates with increasing speed and intensity across Morocco by way of nongovernmental parent associations operating special classrooms for disabled children and adolescents. It tracks the ways the category – as well as its attendant practices and concepts – reshapes local moral worlds and everyday domestic life. Drawing on philosopher Ian Hacking’s work on “making up people” and “the looping effect of human kinds” (2007), it seeks to understand how and to what extent activists and experts are making autism into a viable category, and thus a viable way to be a person in Morocco. In other words, what makes the category “stick” – or not? How does it gain traction in local worlds? How does it become alive and meaningful to Moroccan families? And in turn, how does the label autism itself – its meanings, definitions, uses, enactments – change and respond to complex processes initiated by its introduction to quotidian contexts of Moroccan social life? Through 26 months of fieldwork in family homes, a child psychiatry clinic in a public hospital, a parent-run classroom for disabled adolescents, 17 autism associations across the country, as well as several sites of vernacular healing, this dissertation provides an important ethnographic complement to Hacking’s work and extends his theoretical insights by focusing on the everyday practice of autism therapies. The first half of the dissertation examines the consequences of autism activism for the category itself. It shows how the histories of local institutions for the disabled, lexicons of disorder, and colonial encounters all shaped the prototypical image of the autistic child in Morocco. Further, it shows how novels institutional forms and mundane therapeutics practices lend the category a certain sense and vitality for parents. Drawing on life histories, it also demonstrates how the diagnosis “stick” (or become a durable identity) – or not – for a variety of economic, pragmatic, and sometimes idiosyncratic reasons. The second half of the dissertation examines the consequences of autism activism for the people involved. It shows how new styles of parenting circulate along with the category and it identifies a particular style of prosaic activism through which parents work to reframe understandings of autism by becoming experts on their own children and building “prosthetic environments” for them (Holmes 1990). Further, it situates autism activism in relation to highly publicized neoliberal development projects, showing how a complex triangulation between the Moroccan monarchy, state, and civil society creates novel expectations, aspirations, and exclusions. Through a close analysis of one family’s experience of attempting to implement autism behavioral therapies in their home, it also demonstrates the tensions internal to autism activism and examines struggles over the ethics of autism therapies. By detailing the dynamic ways in which the category autism interacts with and responds to the social, political, and institutional contexts of its application, this dissertation offers a novel perspective on international health activism and the globalization of psychiatric categories.

Autism Spectrum Disorders (ASD) are being diagnosed at alarmingly high rates and school psychologists are charged with evaluating, identifying, and providing interventions for students with ASD in the United States’ public school systems. A national survey probed Nationally Certified School Psychologists (NCSP) to determine their level of knowledge in the area of autism assessment; the assessment methods, measures, and techniques they employed; their level of training; and their level of preparation and confidence. Results indicated training positively affected NCSPs knowledge about autism; their levels of involvement with students with autism; and their perceived levels of preparation to work with this population. Of the 662 participants, the majority accurately identified true and false statements about autism and the diagnostic features suggesting they had a clear understanding of how to diagnose autism. Participants with more training reported an increased level of involvement on multidisciplinary teams and an ability to diagnose autism when compared to those with less training. Brief rating scales were among the most commonly used instruments, while lengthier, more robust diagnostic instruments were among the least-often employed suggesting school psychologists are not trained or are too strapped for time and resources to use these instruments. Participants felt more prepared to provide consultation and assessment services and less prepared to provide interventions. More than half (57.5%) of participants reported they had formal training (completed formal course work or internship experience) in autism, but just over 40% had only informal training in the form of workshop or in-service attendance. The National Research Council (2001) stresses that workshops are not an appropriate substitute for effective training, supervision, and consultation, indicating too many of the nation’s school psychologists lack sufficient training in the area of autism. These data and previous research (i.e., Filipek et al., 1999; Ikeda, 2002; Spears, Tollefson, & Simpson, 2001) suggest school psychologists need more formal training and experience in meeting the needs of individuals identified with autism. / Department of Educational Psychology

Given the broad public health concern, lack of reliability of diagnosis across providers and substantial resources needed to support individuals with Autism Spectrum Disorder, the current study serves to contribute to the field in informing the contexts of both research and clinical service. The utility of a standardized sensory-motor battery was investigated in regards to its ability (1) to determine what, if any, differences exist between ASD diagnoses or subgroups in both sensory functioning and motor functioning; and (2) to determine whether such discrepancies, if they exist, are capable of differentiating groups. Results from the quadratic discriminant analysis demonstrated that the factor scores derived from the Dean-Woodcock Sensory-Motor Battery significantly differentiated the ASD and nonclinical comparison groups. Factor 1 (Simple Sensory Skills) exhibited the strongest relationship, followed by Factor 2 (Cortical Motor and Complex Sensory Skills), then Factor 3 (Subcortical Motor Tasks and Auditory/Visual Acuity Skills). Findings from the study lend initial evidence of the use of the DWSMB as a potential measure to include within the two-stage diagnostic process for ASD. Use of the DWSMB as a screening measure may facilitate access to early intervention services given the primitive nature of sensory-motor tasks. In addition, the availability of the DWSMB as a standardized measure of sensory and motor functioning may promote increased sensitivity and specificity among diagnostic providers thus improving outcomes of individuals with ASD who can access services more readily with earlier, more reliable diagnoses. / Access to thesis permanently restricted to Ball State community only. / Department of Educational Psychology

[Truncated abstract] There are few existing screening instruments designed to identify Autism Spectrum Disorders (ASD) at an early age, such as the Checklist for Autism in Toddlers (CHAT) and the Modified Checklist for Autism in Toddlers (M-CHAT). Unfortunately, many are limited in their ability to identify children at risk in the first two years of life while displaying an acceptable level of reliability. Given this limitation, the present study aimed to identify any additional early markers of ASD from either the retrospective analysis of early autistic symptomatology (parental report and video analysis of footage made before the diagnosis) or performance-based measures linked to different theoretical accounts of ASD. Specifically, measures addressing theory of mind, executive dysfunction and weak central coherence were developed. In the first study, parents of three groups of children those of typical development (n = 19, mean CA = 26 months), children with an ASD (n = 39, mean CA = 34 months) and children with developmental delay (n = 14, mean CA = 28 months) were interviewed about their child's early development. In the first study, parents of three groups of children those of typical development (n = 19, mean CA = 26 months), children with an ASD (n = 39, mean CA = 34 months) and children with developmental delay (n = 14, mean CA = 28 months) were interviewed about their child's early development. Several behaviours discriminated children with ASD from children with typical development and children with delayed development. ... A discriminant function analysis using the two factor scores indicated that Factor 1 discriminated the ADI-R groups, while Factor 2 scores did not add to the ability of Factor 1 scores to discriminate the ADI-R groups. Furthermore, while the finding that joint attention behaviours differentiated children with ASD from children with typical development and children with delayed development, more research is needed to determine if this impairment is a precursor of a theory of mind deficit or if this impairment and later appearing impairments in theory of mind are the result of a more global impairment in social-emotional approach behaviours. Additional research is also needed to determine the relationship between the early appearing deficits in joint attention and the impairments in social relating behaviours that appear to develop later in the chronology of ASD development and how both of these relate to the theory of mind hypothesis of ASD.

The diploma thesis is focused on the socialization and integration of children with autism spectrum disorders. The theoretical part describes the characteristics of the disorders, the process of socialization, the rules of successful inclusion of children in society. It deals with ways of education, especially structured learning. The empirical part focuses on research off socialization and education from the perspective of parents and pedagogical staff. The research is performed through casuistry and interviews.