This is a mixed-methods study investigating parental satisfaction and wait times as parents inquire about an autism spectrum disorder diagnosis for their child in a Northern Ontario community. Satisfaction and wait times of those diagnosed with an autism spectrum disorder (ASD) by a single practitioner were compared to satisfaction and wait times of those diagnosed by the multidisciplinary assessment team in the Sudbury/Manitoulin region (the Autism Diagnostic Team; ADT). No significant differences were noted between groups on satisfaction or wait times. However, ADT group received much more consistent service, with less variation in wait times between clients, and more consistent provision of comprehensive services prior to the diagnostic meeting. Points of interest are noted for practitioners including increased wait times for parents of children with milder forms of ASD and for girls. No differences in wait time or satisfaction were noted between language groups. Content analysis of the qualitative interviews representing mainly single practitioners saw the emergence of themes including difficulty activating the assessment process, concerns regarding the wait, and appointment demands. The importance of professional expertise, empathy, and respectful communication also emerged. Parents felt the experience was deeply distressing and they often experienced abandonment following the diagnostic process. Additionally, parents whose children did not receive a diagnosis often felt confusion about what to do next. Reducing wait times, increasing professional expertise, completing comprehensive assessments, and using truly interdisciplinary teams should continue to be the focus of service improvements that may translate into improved satisfaction.

Young children with Autism Spectrum Disorder (ASD) experience significant delays in their fundamental motor skills (FMS) yet, FMS are virtually ignored in the intervention literature as traditional therapies focus on the core challenges in the social, communicative, and behavioural domains. This study sought to examine the effectiveness of a FMS intervention at improving the motor skills, adaptive behaviour, and social skills of 4 year old children with ASD. Motor Outcomes (Manuscript 1): Results demonstrated significant improvements in motor skills following the intervention; these improvements were retained at the 6-week follow-up. Adaptive Behaviour and Social Skill Outcomes (Manuscript 2): Results demonstrated individual gains in adaptive behaviour and social skills; although no significant group improvements were found. Conclusion: The results of this study suggest that a FMS intervention can be effective at improving motor skills, and may result in individual behavioural improvements. These findings warrant further research with a larger sample.

Children with autism spectrum disorder show imaginative and representational drawing deficits, despite reports of a “visual thinking style”. I examined whether these two drawing characteristics could be explained by the unique cognitive style of children with autism (specifically, executive dysfunction and a local processing bias). I administered a cognitive/drawing task battery to a group of 24 school-age children with autism and 29 mental age-matched neurotypically developing controls. I expected that better executive function ability would be associated with better imaginative and representational drawing, and that a local processing bias (weak central coherence) would be associated with better representational drawing but worse imaginative drawing. In children with autism, better executive function was associated with better imaginative drawing. Greater central coherence was associated with better representational drawing, but executive function was associated with worse representational drawing. Underlying cognitive components of imaginative and representational drawing were different for the neurotypically developing children. Overall, findings were unexpected, leading to novel theoretical suggestions for the field of autism cognition and drawing research. / Graduate / 0620 / 0623 / kd.teneycke@gmail.com

Although a modest body of literature has emerged to investigate the experiences of youth with Autism Spectrum Disorder (ASD), there is a need to better understand their experiences to guide developmentally appropriate interventions and supports. This exploratory mixed-methods project included two studies aimed at gathering information about the self-perceptions and lived experiences of adolescents with ASD. In study 1, 27 adolescents (ages 13-18) completed measures to examine their self-concept and self-perceived competence, self-awareness of ASD characteristics and behaviours, and the types of behavioural attributions and stigmatizing beliefs they ascribe to their problematic behaviours. Two comparison groups (adolescents with Attention Deficit Hyperactivity Disorder and typically developing adolescents) were used for self-concept and behavioural attribution comparisons. Study 2 comprised a smaller sub-set of 13 participants who participated in interviews designed to capture how ASD is perceived and experienced by those living with this disorder. Study 1 results suggested that adolescents with ASD have some awareness of the social, behavioural and adaptive challenges associated with their diagnosis and, as a group, hold some self-perceptions of competence and behavioural attributions that are different from those of adolescents without ASD. In Study 2, interviews were analyzed thematically to capture how adolescents talk about their diagnosis and psychosocial experiences, and how this may impact their self-concept and self-image. Four major categories emerged: (1) self-awareness and understanding of ASD; (2) psychosocial stress; (3) social-ecological factors; and (4) sources of support. Together, these results provide insights about how they perceive themselves and their diagnosis and some of the individual, family, and school factors related to their self-perceptions and self-awareness. Results from both studies converge to provide support for a systems approach to understanding the interactions between adolescents, families, peers, school, community, and greater society when undertaking individual assessments of needs and treatment planning for ASD. Findings from the studies are discussed with respect to the positive and negative effects of awareness and knowledge about one’s diagnosis on self-perceptions and psychological adaptation. This research has important implications for clinical and educational interventions that address the unique needs and strengths of adolescents with ASD to promote positive developmental outcomes.

Although a modest body of literature has emerged to investigate the experiences of youth with Autism Spectrum Disorder (ASD), there is a need to better understand their experiences to guide developmentally appropriate interventions and supports. This exploratory mixed-methods project included two studies aimed at gathering information about the self-perceptions and lived experiences of adolescents with ASD. In study 1, 27 adolescents (ages 13-18) completed measures to examine their self-concept and self-perceived competence, self-awareness of ASD characteristics and behaviours, and the types of behavioural attributions and stigmatizing beliefs they ascribe to their problematic behaviours. Two comparison groups (adolescents with Attention Deficit Hyperactivity Disorder and typically developing adolescents) were used for self-concept and behavioural attribution comparisons. Study 2 comprised a smaller sub-set of 13 participants who participated in interviews designed to capture how ASD is perceived and experienced by those living with this disorder. Study 1 results suggested that adolescents with ASD have some awareness of the social, behavioural and adaptive challenges associated with their diagnosis and, as a group, hold some self-perceptions of competence and behavioural attributions that are different from those of adolescents without ASD. In Study 2, interviews were analyzed thematically to capture how adolescents talk about their diagnosis and psychosocial experiences, and how this may impact their self-concept and self-image. Four major categories emerged: (1) self-awareness and understanding of ASD; (2) psychosocial stress; (3) social-ecological factors; and (4) sources of support. Together, these results provide insights about how they perceive themselves and their diagnosis and some of the individual, family, and school factors related to their self-perceptions and self-awareness. Results from both studies converge to provide support for a systems approach to understanding the interactions between adolescents, families, peers, school, community, and greater society when undertaking individual assessments of needs and treatment planning for ASD. Findings from the studies are discussed with respect to the positive and negative effects of awareness and knowledge about one’s diagnosis on self-perceptions and psychological adaptation. This research has important implications for clinical and educational interventions that address the unique needs and strengths of adolescents with ASD to promote positive developmental outcomes.

Autism spectrum disorder (ASD) presents with difficulties in social communication, repetitive and/or restricted behaviors, as well as variable language development. Individuals with suspected ASD ideally participate in assessments which include measures of cognitive abilities, adaptive functioning, language functioning, and ASD specific measures (i.e., ADOS, ADI-R). Diagnosis of ASD can occur confidently at 2 years of age, however, the mean age at diagnosis is 4-5 years old. Delays in diagnosis are accounted for by lacking professionals and centers with the capabilities to assess ASD, as well as long waitlists for assessments. Early identification and intervention have been shown to provide the best improvements in ASD symptomology. The aim of the current study was to conduct a program evaluation of an autism treatment center that was designed to provide high quality evidence-based interventions. The study determined if treatment-as-usual in that center yields the expected gains in adaptive functioning and corresponding decreases in barriers to learning. Results indicated improvement in scores on standardized direct assessment of milestone achievement and barriers to learning, but no significant improvement in adaptive skills via secondary informant questionnaire measures following 6 months of treatment. The overall sample size was small due to COVID-19 complications, lack of institutional procedures, and limited client pool. Further investigation into the treatment practices and reevaluation strategies for individuals with ASD is required.

The purpose of the study was to evaluate the current literature on the use of weighted vests with individuals with autism spectrum disorder. A literature review using the What Works Clearinghouse Standards was conducted. The results of the review show that the use of weighed vests with individuals with autism spectrum disorder is not an evidence-based practice.

The Autistic Spectrum Disorder (ASD) is a behavioral syndrome whose indicative signs are already perceived in the early years of childhood. Considering the development as sensitive in particular to the early experiences of the child in the environment, early diagnosis and educational interventions are indicated consensus in the literature as catalysts of development in cases of ASD. There fore vocational training geared to the specific disorder that enables those responsible for this intervention is needed. From this, we elaborated this work in order to develop a program for training professionals in the fields of health and education for educational activities with people with ASD and evaluate its effectiveness. For that were identified through the literature review, which the knowledge necessary for teachers to work with students with ASD and from the systematization of this knowledge, built a curriculum for a training course aimed at professionals working in favor education of people with ASD. From the curriculum the study was conducted with a sample of eight professionals in the fields of health and education of a gaucho municipality. This was a survey applied quantitative and qualitative nature which offered and assessed the effectiveness of a training course for 30h with psychopedagogy, special educators, speech therapists and psychologists members of the Center for Specialized care in the city of Santiago/Rio Grande do Sul. The training included knowledge necessary for the care of people with ASD, including explanatory theories, characterization, evaluation of the syndrome, and intervention possibilities. The effectiveness of the course is evaluated both by module, as this as a whole, as well as maintaining knowledge and social validity formation was evaluated. The data coming from the realization of this study were submitted to content analysis and descriptive statistics. The main results was that the course was effective and that there have been important advances in knowledge and perception of participants regarding the person with ASD and, moreover, had a consistent impact in reality it was intended, considered as positive the validity social. / O Transtorno do Espectro do Autismo (TEA) é uma síndrome comportamental cujos sinais indicativos são percebidos já nos primeiros anos da infância. Considerando o desenvolvimento como sensível de modo especial às primeiras experiências da criança no ambiente, o diagnóstico e intervenções educacionais precoces são consensualmente indicadas na literatura como catalisadoras do desenvolvimento nos casos de TEA. Para tanto é necessária uma formação profissional voltada para as especificidades do transtorno que capacite àqueles responsáveis por essa intervenção. A partir disso, elaborou-se este trabalho com o objetivo de desenvolver um programa para formação de profissionais das áreas da saúde e educação para atuação educacional com pessoas com TEA e avaliar sua efetividade. Para tanto foram identificados, através da revisão da literatura, quais os saberes necessários aos professores para atuarem com alunos com TEA e, a partir da sistematização desses saberes, considerando que são traduzíveis à diferentes áreas, construiu-se uma matriz curricular de um curso de formação destinado a profissionais que atuam em prol da educação de pessoas com TEA. A partir da matriz curricular o estudo foi desenvolvido com uma amostra de oito profissionais das áreas da saúde e da educação de um município gaúcho. Tratou-se de uma pesquisa quanti-qualitativa de natureza aplicada que ofereceu e avaliou a efetividade de um curso de capacitação de 30h com psicopedagogos, educadores especiais, fonoaudiólogos e psicólogos integrantes do Núcleo de Atendimento Especializado da cidade de Santiago/Rio Grande do Sul. A formação contemplou conhecimentos necessários ao atendimento de pessoas com TEA, incluindo teorias explicativas, caracterização, avaliação da síndrome, além de possibilidades de intervenção. Foi avaliada a efetividade do curso tanto por módulo, quanto deste como um todo, assim como foi avaliada a manutenção do conhecimento e a contribuição da formação para os participantes. Os dados advindos da realização desse estudo foram submetidos à análise de conteúdo e estatística descritiva. Como resultados principais teve-se que o curso foi efetivo sendo que houve alterações importantes no conhecimento e percepção dos participantes em relação a pessoa com TEA e, além disso, teve um impacto consistente na realidade a que se destinava, sendo considerado positivo quanto a contribuição para o contexto de atuação dos participantes.

Les troubles schizophréniques et les troubles du spectre autistique (TSA) ont en commun des troubles de la communication, des interactions sociales, des affects et des émotions. Dans le domaine de la cognition sociale, ces similitudes suscitent des questions sur la similarité ou les différences des processus neurocognitifs sous-jacents. Cependant, à l’heure actuelle, très peu d’études expérimentales comparent directement les personnes avec un trouble schizophrénique et les personnes avec un TSA dans les différents domaines de la cognition. Dans cette thèse, ces questions seront abordées à travers 3 domaines : le profil cognitif (évaluation du fonctionnement cognitif général et analyse qualitative de la fluence verbale), le domaine du langage pragmatique : (compréhension du langage figuré en contexte et des métaphores) et le domaine de la cognition sociale (reconnaissance des émotions faciales et style d’attribution). Ainsi, il sera examiné, si les similitudes apparentes entre les troubles schizophréniques et les TSA à ces différents domaines se matérialisent par des performances similaires et si des comportements et des performances similaires résultent de mécanismes neurocognitifs communs, différents, ou diamétralement opposés. Nos résultats ont montré que malgré des similitudes apparentes, le fonctionnement neurocognitif observé dans les troubles du spectre schizophrénique et autistique se caractérise par des différences qualitatives importantes que nous discutons dans le contexte de la littérature internationale et des perspectives cliniques de ces recherches. / Schizophrenia Spectrum Disorders and Autism Spectrum Disorders (ASD) have similar difficulties in communication, social interaction, affects and emotions. These apparent similarities raise the question whether similar or different neurocognitive processes might underlie similar symptoms and cognitive profiles. However, currently, very few experimental studies directly compare individuals with autism and schizophrenia in different cognition areas.The major aim of the present Doctoral Dissertation was to address these issues by exploring three areas: cognitive profile (the assessment of general cognitive functioning and the quantitative and the qualitative analysis of verbal fluency), pragmatic language (idiom comprehension in context and novels metaphors’ comprehension) and social cognition (facial affect recognition and attributional style). In each of these areas, the major results showed that despite apparent cognitive similarities, neurocognitive functioning observed in patients with schizophrenic disorders and autism were characterized by significant qualitative differences that were examined and discussed in the context of the international literature and in relation to the possible clinical perspectives.

Introdução: O Transtorno do Espectro do Autismo (TEA) é caracterizado por prejuízos na interação social e comunicação, e por comportamentos repetitivos e repertório restrito de interesses. Alterações em diferentes sistemas de neurotransmissores, como o serotoninérgico, GABAérgico e glutamatérgico já foram estudadas e relatadas no TEA. Surpreendentemente, o sistema histaminérgico recebeu pouca atenção e poucos estudos sobre histamina (HA) e TEA estão disponíveis na literatura. Além disso, ligantes do receptor histaminérgico 3 (H3R) são considerados agentes terapêuticos promissores para o tratamento de diferentes desordens neurológicas e prejuízos cognitivos, mas seus efeitos em características do tipo autista ainda não foram determinados. Objetivos: Avaliar o efeito do ciproxifan (CPX), um agonista inverso do H3R, sobre o modelo animal de autismo induzido por exposição pré-natal ao ácido valpróico (VPA, do inglês: valproic acid) e medir a concentração de HA e os níveis do mRNA de H3R e H4R em diferentes estruturas encefálicas desse modelo. Além disso, investigar o papel do H3R no comportamento social e estereotipado. Métodos: Camundongos Swiss sofreram exposição pré-natal ao VPA no dia embrionário 11 e, aos 50 dias de vida pós-natal foram submetidos à avaliação de comportamento social, limiar de nocicepção e comportamento repetitivo, com ou sem tratamento com CPX. Após as avaliações comportamentais, os animais foram eutanasiados por exsanguinação depois de terem sido anestesiados com isoflurano. Córtex cerebral, estriado e hipocampo foram removidos, congelados em nitrogênio líquido e armazenados a -80°C para quantificação de mRNA do H3R e H4R por qPCR e de conteúdo de HA por cromatografia líquida de alta eficiência (HPLC, do inglês: High Performance Liquide Chromatography). Camundongos H3R KO e WT C57BL/6J, aos 50 dias de vida, foram usados nos testes com o aparato de três câmaras e marble burying para determinação do papel do H3R na sociabilidade e comportamento estereotipado. Resultados: O grupo VPA apresentou menor índice se sociabilidade quando comparado aos animais do grupo Controle, e o tratamento com CPX foi capaz de reverter completamente este efeito. Entretanto, o aumento no limiar de nocicepção observado no grupo VPA não foi revertido pelo tratamento. No teste marble burying, o grupo VPA enterrou um maior número de bolinhas de gude em relação ao grupo Controle, indicando comportamento repetitivo, um efeito também prevenido pelo CPX. Além disso, a análise molecular entre os grupos VPA e Controle mostrou um aumento significativo nos níveis de mRNA do H3R, bem como uma maior concentração de HA no estriado de animais VPA. O H3R pode ter um papel no interesse por novidade social, característica prejudicada no TEA, já que camundongos H3R KO demonstraram comportamento anormal quando testados para este parâmetro no teste com aparato de três câmaras. Conclusões: Uma dose aguda de CPX foi capaz de reverter prejuízo na sociabilidade, bem como comportamento repetitivo apresentados pelo modelo VPA de autismo. Além disso, este é o primeiro relato sobre anormalidades no sistema histaminérgico nesse modelo. Estes achados contribuem para investigações futuras sobre a fisiopatologia do TEA, bem como apontam para um possível novo tratamento para características do tipo autista. Mais estudos são necessários para corroborar e expandir esses dados iniciais. / Introduction: Autism spectrum disorder (ASD) is primarily characterized by impaired social interaction and communication, and by restricted repetitive behaviors and interests. Alterations in different neurotransmitter systems, such as serotonergic, GABAergic and glutamatergic have been studied and reported in ASD. Surprisingly, the histaminergic system has received less attention and few studies are available on the literature about histamine and ASD. In addition, ligands of histamine receptor 3 (H3R) are considered potential therapeutic agents for the treatment of different brain disorders and cognitive impairments, but its effects on autistic-like features have not been evaluated. Objectives: The objective of this study was to evaluate the actions of ciproxifan (CPX), an H3R inverse agonist, on the animal model of autism induced by prenatal exposure to valproic acid (VPA) and to measure the concentration of histamine and the H3R and H4R mRNA levels in different brain structures of this model. In addition, to investigate the role of H3R in sociability and stereotypic behavior. Methods: Swiss mice were prenatally exposed to VPA on embryonic day 11 and assessed for social behavior, nociceptive threshold and repetitive behavior at 50 days of life after treatment with CPX. After the behavioral tests, animals were killed by exsanguination after being anesthetized with isoflurane. Cerebral cortex, striatum and hippocampus were removed, frozen in liquid nitrogen and stored at -80°C for quantification of H3R and H4R mRNA by qPCR and histamine content by HPLC analysis. H3R KO and WT C57BL/6J mice, at 50 days of life, were used in the three-chamber test and marble burying test to determine the role of H3R in sociability stereotypic behavior. Results: The VPA group presented lower sociability index compared to VPA animals that were treated with CPX. Compared to the Control group, VPA animals presented a significantly higher nociceptive threshold, and treatment with CPX was not able to modify this parameter. In the marble burying test, the number of marbles buried by VPA animals was consistent with markedly repetitive behavior. VPA animals that received CPX buried a reduced amount of marbles. A significant increase in H3R mRNA, as well as higher concentration of histamine were detected in striatal samples from the VPA mice. H3R might influence the search for social novelty, a feature that is impaired in ASD, as H3R KO mice displayed abnormal behavior when tested for this parameter in the three chambers test. Conclusions: In summary, an acute dose of CPX is able to revert sociability deficits and stereotypies present in the VPA model of autism. In addition, this is the first report of abnormalities in the histaminergic system of this model. These findings have the potential to help the investigations of both the molecular underpinnings of ASD and of possible treatments to ameliorate the ASD symptomatology, although more research is still necessary to corroborate and expand this initial data.