Intensive Behavioural Intervention (IBI) is one of the most widely used treatments for children with an autism spectrum disorder (ASD). While IBI has been recognized as the treatment of choice for very young children with an ASD, its sensible use among school age children is a matter of dispute. The aim of this thesis was to determine the clinical effectiveness of IBI, as compared with no treatment or treatment-as-usual, for the management of cognitive functioning and adaptive skills in preschool and school age children with an ASD, as well as to examine predictors of treatment response. Peer-reviewed, English language publications were identified using MEDLINE, EMBASE, PsychINFO, CINAHL, and ERIC from 1995 to September 1, 2014. Grey literature and reference lists of published papers were also searched for relevant records. Retrieved citations were screened by two independent reviewers, and data extraction was performed by a single reviewer with verification by a second reviewer. The methodological quality and procedural fidelity of included studies was assessed by one reviewer, and a subset of included studies were pooled in a random-effects meta-analysis using the standardized mean difference (SMD) effect size. A total of 24 unique studies were selected for inclusion in this review, comprising a total of 1,816 participants. Findings revealed that IBI improves full-scale IQ (SMD ES = 0.66, 95% CI 0.46 to 0.85, p<0.00001; 13 studies) and adaptive skills (SMD ES = 0.57, 95% CI 0.33 to 0.82, p<0.00001; 12 studies) in preschool and school age children with an ASD, with seemingly higher clinical benefits in children aged under 4 years at intake. Better outcomes with IBI are predicted by children’s relatively younger age, increased cognitive and adaptive ability, as well as a milder severity of symptoms at treatment entry. Results warrant careful interpretation in light of several methodological limitations and inadequate monitoring of procedural fidelity.

Teaching children how to swim provides them with the necessary skills to maintain a physically active lifestyle. Many children with an Autism Spectrum Disorder (ASD) diagnosis have shown interest in participating in swimming lessons. Studies have demonstrated that teaching students with ASD how to swim has aided in their motor performance (Yanardag, Nurgil, & Akmanoglu, 2013), their ability to initiate social interactions with peers (Chu & Pan, 2012) and a reduction in stereotypical behaviours associated with ASD (Vonder Hulls, Walker, & Powell, 2006). In order to meet the needs of this unique group of students, swim instructors take part in a variety of training programs amongst other experiences to effectively prepare themselves to teach their students with ASD. This study consists of three individual case studies designed to examine the journeys that swim instructors have taken in order to effectively coach students with ASD how to swim, along with encouraging motor skill development, social interactions and reducing stereotypical behaviours. Two research questions guide this study: What are the experiences of swim instructors who work with children with ASD? What are the practical teaching strategies in swimming lessons that are effective for social skill development, reducing stereotypical behaviours and motor skill development in children with ASD? The findings of this study which focus on strategies of effective practice include: gestural communication, positive practice, contact communication, complexities of choice, and encouraging independence and confidence. Along with these findings, the instructors credit the following sources for their construction of knowledge: peer learning and mentorship, parental/caregiver support, and the value of certification and training. It is clear that instructors access a number of sources for their coaching development, but current swim instructor certification programs require revisions to increase instructor preparedness. This study contributes to current literature which focuses on coaching individuals with developmental disabilities. The findings may provide coaches with insight into strategies of effective practice for a more inclusive and equitable community.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第22009号 / 社医博第95号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中山 健夫, 教授 村井 俊哉, 教授 川村 孝 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Many individuals with autism spectrum disorder (ASD) have atypical sensory processing and behaviors including sensory sensitivity and low registration of sensory stimuli as well as sensory seeking and avoiding behaviors. Additionally, many individuals with ASD have clinically distressing levels of anxiety. Previous research suggests that there is a link between abnormal sensory processing, anxiety, and ASD. The purpose of this study was to experimentally observe auditory sensory processing using pupillometry methods, between ASD, control, and high-anxious control groups. While a difference in tonic pupil size was observed, there were no reactivity or habituation differences between the groups. There were no significant correlations between the pupillometry measures and behavioral measures of emotional distress and anxiety. These results do not indicate a relationship between anxiety and unimodal auditory response in ASD. Implications and directions for future research are discussed.

Culture affects how the symptoms of Autism Spectrum Disorder (ASD) are perceived and addressed, and Korean culture has been affecting how individuals with ASD are perceived, diagnosed and treated in Korea, specifically the Republic of Korea. Stigmas about individuals with ASD have historically existed in Korean culture, and those stigmas have been affecting the diagnosis and social environment of individuals with ASD. Recent changes have been made to increase acceptance for individuals with ASD in Korea, but the literature has not yet brought this information together in a way that comprehensively portrays the current status of ASD perceptions, identification, intervention efforts, and research in Korea. We conducted a systematic review of American and Korean literature, and to add popular perspective, we also searched news articles that show the recent changes of the general environment for individuals with ASD in Korea and included 12 of them. A few general characteristics of the articles and findings were made into tables and a narrative synthesis was used to summarize the key findings of the research articles and the news articles. Results show there have been some positive changes improving education, diagnosis and treatment for individuals with ASD in Korea and there are a number of ASD research studies from Korea that were not published in English. While the majority of Korean language articles focused on ASD education and treatment, the majority of English articles focused on cultural impact, social perspectives, and diagnostic or screening tools for Korean people. Even with positive efforts of the government and researchers however, social stigmas Korean people have toward individuals with ASD are still affecting individuals with ASD and their families in Korea and in Korean immigrants to the USA. More education about understanding ASD in education or community settings for Korean people may further improve lives for individuals with ASD and their families.

Cultural views are known to play a critical role in the identification, diagnosis and intervention of developmental disorders, such as Autism Spectrum Disorder (ASD). Indigenous views regarding the nature and causes of ASD have often been overlooked. Based on the paucity of research on indigenous perspectives on ASD in South Africa, as well as the alarming rise in the incidence of ASD, the purpose of the study is to investigate the views held by members of the Sepedi group in South Africa regarding ASD. Research relating to ASD has mostly been conducted in other countries or according to Western or conventional scientifically proven positions. The study attempts to answer the following primary research question: “What are Sepedi cultural views regarding the nature, cause/s as well as intervention of Autism Spectrum Disorder?” The theoretical framework that was utilised during the study was that of Indigenous Knowledge Systems (IKS). Furthermore, the study was approached from a phenomenological paradigm. A qualitative approach as well as case study design were followed, and purposive sampling was used. The first method of data collection was a focus group and subsequently, semi-structured interviews were conducted. The data were analysed using inductive thematic analysis to pinpoint recurring themes. These five themes are (1) Indigenous African Views, (2) Participants’ views of causes, (3) Circumstances surrounding diagnosis, (4) Personally coping with ASD, and (5) Intervention with a child with ASD. Results obtained from the study could be utilised within a diagnostic, intervention and educational approach that is uniquely South African. / Dissertation (MEd)--University of Pretoria, 2020. / Educational Psychology / MEd / Unrestricted

Individuals with Autism Spectrum Disorder (ASD) experience a variety of symptoms that vary dramatically across individuals and can range from severe impairments to minor issues with social interactions and communication. The underlying cause of ASD is still unknown, and the level of influence that genetic and environmental factors have on the severity and occurrence of ASD is still a topic of great debate. Since the theories concerning cause or causes of ASD are multifactorial, the treatment options available are extremely limited and are based on behavioral testing. Alternatively, genetic testing might be considered in a diagnosis protocol. This study is designed to investigate ASD by assessing the variability of three genes associated with neuronal inhibition. Based on previous studies this experiment hypothesized that GAD1, GAD2, and PAVLB expression is decreased in Broca’s area in individuals with ASD when compared to controls, with the premise that this alteration could contribute to the symptoms involving language and communication. In situ hybridization was used to quantify the expression of the GAD1, GAD2, and PVALB genes in Broca’s area in postmortem human tissue. The variability of these three genes was quantified by measuring the amount of radioactively tagged mRNA in fifty cell bodies in each brain sample. This study used twenty-two brains of individuals with ASD and twenty-one control brains, including age matched males and females. The variables of age and sex are analyzed and discussed as well as the emulsion and film analyses. A decrease in parvalbumin expression was found between the ASD and control groups in Broca’s area. These finding were discussed in the context of symptoms and neuropathological features of ASD.

Executive functioning usually refers to one’s ability to regulate one’s behavior, set goals, be mentally flexible, and understand the consequence of one’s actions. However, certain neurodevelopmental disabilities such as Autism, often can negatively impact executive function processes. Although applied behavior analytic (ABA) treatment is the most recommended intervention for autism treatment practitioners rarely assess or target executive functioning within their treatment planning. The present study assessed the relationship between direct and indirect executive functioning scores and a language assessment used by ABA providers. Thirty-nine children with autism spectrum disorder were administered a variety of scales including the Behavior Rating Inventory of Executive Functioning (BRIEF 2), Comprehensive Executive Functioning Inventory (CEFI), Tower of London (TOL), and the PEAK Comprehensive Assessment (PCA). Obtained data yielded a moderate, negative relationship between the total BRIEF and total PCA scores (r=-0.521, p=.032) and a moderate, positive relationship between CEFI planning and PCA scores (r=0.394, p=.017). However, there was a strong correlation between total PCA scores and TOL scores (r=0.708, p=.005).

The World Health Organization has recognised Autism Spectrum Disorder (ASD) as a public health concern and have recommended access to appropriate assessment and interventions. Psychoeducation and parent support soon after diagnosis are considered global best practice. Parent Education &amp; Training (PET) programmes provide education, skills and support to parents. Despite the high need for PET there has been limited research in this field and few programmes are available, particularly in low- and middle-income countries (LMIC). This project aimed to 1) evaluate the evidence-base for a UK-developed PET (EarlyBird/EarlyBird Plus); 2) evaluate the evidence-base for a broader range of PET; 3) generate a framework for evaluating global PET programmes; 4) conduct a comparative feasibility study of two PET programmes in South Africa. The EarlyBIrd/EarlyBird Plus scoping review identified a low level of evidence for the efficacy of the PET, and showed that relatively little implementation science examination of the programmes had been performed to date. Review of a broader range of PET showed very similar findings, suggesting that the field of PET (rather than any specific intervention) was still relatively immature. We proceeded to use an implementation science and participatory approach to generate a multi-stakeholder evaluation framework for PET in future studies. A mixed-methods quasi-experimental design was then used for a comparative feasibility study of two PET in a low-resource South African setting. In the feasibility study parents/carers found both programmes to be acceptable and adaptable for a South African context. Limited efficacy-testing showed positive outcomes for parents, children and families. Application of the Evaluation Framework proved to be a useful structural technique to identify the strengths and weaknesses of PET across the implementation themes of outcomes, processes &amp; procedures, and implementation landscape. Taken together, our results highlighted the relative infancy of this important field of ASD research and identified the need for multi-site, randomized controlled trials of PET, particularly in low-resource settings. In addition, results underlined the importance not only of efficacy of programmes, but of a range of implementation-related factors, that are crucial to ensure sustainable and scalable PET in real-life settings around the globe.

It is estimated that one in 59 children in the US are affected by autism spectrum disorder (ASD). ASD is distinguished by social and communication deficits that can be displayed throughout a wide range of severity. This resulting spectrum of behaviors observed in ASD suggests that a complex etiology is involved. Previous studies have shown a genetic susceptibility to autism including paternal age, twin and sibling concordance. Genetic sequencing of those affected as well as first order relatives have identified alterations in genes associated with neuronal synaptic communication. However, very little information is available regarding the pathophysiology of synapses in ASD. Neuronal communication between anterior cingulate cortical neurons via synapses with other brain regions is vital in the execution of social behaviors in individuals. The aim of this study was to evaluate the protein expression of the synaptic marker spinophilin and post-synaptic density protein-95 (PSD-95) in postmortem ASD gray matter brain tissue from the anterior cingulate and frontal cortex to compare to typically developing (TD) control brain tissue. Postmortem brain tissue of ASD and TD subjects was acquired from nationally funded brain repositories previously matched by brain area, age and gender. Immunoblotting for spinophilin and PSD-95 was performed using anterior cingulate and frontal cortical gray matter brain tissue from matched ASD and TD brain tissue. Spinophilin and PSD-95 protein amounts for all donors were normalized using GAPDH. Frontal cortical tissue demonstrated no significant differences in spinophilin protein expression between TD and ASD groups (N=6). Anterior cingulate tissue demonstrated no significant differences in spinophilin protein expression between TD and ASD groups (N=5). PSD-95 protein expression levels did not result in any significant differences between ASD donors and their control pairs for either brain tissue region. Although no changes were detected in the frontal cortex or anterior cingulate cortex, more brain areas and subjects must be evaluated to determine if spinophilin or PSD-95 can be reliable markers for synaptic alterations in ASD. These data are critical in determining synaptic pathology in ASD which may lead to future treatments.