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Doctor of Philosophy / Aim. This study aims to investigate self-understanding in young males with high-functioning autism spectrum disorders (ASD) and to determine whether self-understanding is related to social functioning and theory of mind (ToM). In addition, this study aims to examine the characteristics and abilities of young males with high-functioning autism (HFA) and Asperger’s disorder (AD) to determine whether there are significant differences in selfunderstanding and whether self-understanding is related to social functioning and ToM between these two groups. The results have important implications for social skills interventions for young people with ASD. Method. Forty three young males diagnosed with one of the ASD (25 diagnosed with HFA and 18 diagnosed with AD) were compared with 38 TD males. Participants were assessed using the Autism Diagnostic Interview- Revised (ADI-R), the Kaufman Brief Intelligence Test (KBIT), the Vineland Adaptive Behavior Scales (VABS), the Peabody Picture Vocabulary Test- Third Edition (PPVT-III), Damon and Hart’s Self-understanding Interview, and two false-belief ToM tasks. Results. Children with ASD had difficulties recognising and attributing their own mental states and failed to integrate various aspects of the self. Specifically, the ASD group produced fewer self-statements that reflected agency (the awareness and understanding that one is in control of their actions), social aspects of self (such as personality characteristics and group membership) and psychological aspects of self (such as emotions, thoughts and cognitive processes). Instead, children with ASD produced more concrete physical self-statements (such as body characteristics and material possessions). A significant positive relationship was found between selfunderstanding and social functioning for the ASD group. Within the ASD group, the relationship held for the HFA group only. In terms of ToM, children with ASD were less able to correctly answer the second-order false-belief ToM question compared to the TD group. For the ASD group, there was a significant positive correlation between self-understanding and ToM. Within the ASD group, the relationship held for the HFA group only. Conclusions. The results show young males with high-functioning ASD are less aware of their own and others’ mental states perhaps reflecting a general delay in the development of self-understanding and ToM. Furthermore, a more developed self-understanding may translate to improved social functioning and ToM ability for young males with high-functioning ASD. For young males with HFA, self-understanding and ToM may stem from a common underlying cognitive framework. Consequently, treatments aimed at improving self-understanding may simultaneously improve ToM, or vice versa. For individuals with AD there may be a separate cognitive mechanism responsible for self-understanding and another for ToM. Therefore, different interventions may be required; one to improve self-understanding and another to improve the understanding of others’ minds. Overall, these results may assist in the development of practice parameters for social skills training for those with ASD.

Thesis (M.A.)--Miami University, Dept. of Speech Pathology and Audiology, 2007. / Title from first page of PDF document. Includes bibliographical references (p. 39-45).

The present dissertation on autism spectrum disorders (ASD) addressed several questions. First, the behavioral symptoms of speaking and mute individuals with ASD were compared on the Autism Behavior Checklist (ABC), a commonly used diagnostic instrument. In addition, questions about the construction of the ABC were investigated. In Study I it was found that although the two groups did not significantly differ on the total ABC score, the mute group demonstrated significantly more pathology on 21 of 57 items and 3 of 5 subscales. The speaking group obtained significantly higher scores on only 8 items and 1 subscale (Language). The appropriateness of providing greater pathology scores to speaking, rather than mute, individuals with ASD was called into question. In addition, it was speculated that the expressive language items are weighted too heavily, on both the Language subscale and the total score. Second, because the 57 items of the ABC were categorized into 5 subscales on a subjective basis, an empirical investigation of the factor structure of the ABC was performed. In Study II, a 5-factor model that contained 39 of the items accounted for 80% of the total variance in the checklist. No support was found for classifying the 57 items into the existing 5 subscales. Finally, the two most common forms of instruction to teach children with ASD, discrete-trial teaching and incidental teaching, were assessed. In Study III it was ascertained that discrete-trial teaching was more efficient and produced faster acquisition and initially, greater generalization. However, by follow-up, the incidental teaching methods resulted in equal retention, greater generalization, and equal or greater spontaneous usage. The findings indicate that although it takes a longer time for children with autism to learn with incidental teaching procedures, once they have acquired an ability, it may be more permanent.

This study investigated effects of commercially available picture activity schedules (PAS) and system of least prompts (SLP) to teach recreation skills to four high school students with Autism Spectrum Disorders and intellectual disabilities using Lego sets. Results were evaluated through a multiple probe across participants design and indicate that a combination of PAS and SLP was effective for teaching the students to build Lego sets. All students improved their ability to build and were able to generalize the skill to novel sets after the completion of intervention. Limitations and implications for future practioners are discussed.

Les troubles du spectre autistique (TSA) sont actuellement caractérisés par une triade d'altérations, incluant un dysfonctionnement social, des déficits de communication et des comportements répétitifs. L'intégration simultanée de multiples sens est cruciale dans la vie quotidienne puisqu'elle permet la création d'un percept unifié. De façon similaire, l'allocation d'attention à de multiples stimuli simultanés est critique pour le traitement de l'information environnementale dynamique. Dans l'interaction quotidienne avec l'environnement, le traitement sensoriel et les fonctions attentionnelles sont des composantes de base dans le développement typique (DT). Bien qu'ils ne fassent pas partie des critères diagnostiques actuels, les difficultés dans les fonctions attentionnelles et le traitement sensoriel sont très courants parmi les personnes autistes. Pour cela, la présente thèse évalue ces fonctions dans deux études séparées. La première étude est fondée sur la prémisse que des altérations dans le traitement sensoriel de base pourraient être à l'origine des comportements sensoriels atypiques chez les TSA, tel que proposé par des théories actuelles des TSA. Nous avons conçu une tâche de discrimination de taille intermodale, afin d'investiguer l'intégrité et la trajectoire développementale de l'information visuo-tactile chez les enfants avec un TSA (N = 21, âgés de 6 à18 ans), en comparaison à des enfants à DT, appariés sur l’âge et le QI de performance. Dans une tâche à choix forcé à deux alternatives simultanées, les participants devaient émettre un jugement sur la taille de deux stimuli, basé sur des inputs unisensoriels (visuels ou tactiles) ou multisensoriels (visuo-tactiles). Des seuils différentiels ont évalué la plus petite différence à laquelle les participants ont été capables de faire la discrimination de taille. Les enfants avec un TSA ont montré une performance diminuée et pas d'effet de maturation aussi bien dans les conditions unisensorielles que multisensorielles, comparativement aux participants à DT. Notre première étude étend donc des résultats précédents d'altérations dans le traitement multisensoriel chez les TSA au domaine visuo-tactile. Dans notre deuxième étude, nous avions évalué les capacités de poursuite multiple d’objets dans l’espace (3D-Multiple Object Tracking (3D-MOT)) chez des adultes autistes (N = 15, âgés de 18 à 33 ans), comparés à des participants contrôles appariés sur l'âge et le QI, qui devaient suivre une ou trois cibles en mouvement parmi des distracteurs dans un environnement de réalité virtuelle. Les performances ont été mesurées par des seuils de vitesse, qui évaluent la plus grande vitesse à laquelle des observateurs sont capables de suivre des objets en mouvement. Les individus autistes ont montré des seuils de vitesse réduits dans l'ensemble, peu importe le nombre d'objets à suivre. Ces résultats étendent des résultats antérieurs d'altérations au niveau des mécanismes d'attention en autisme quant à l'allocation simultanée de l'attention envers des endroits multiples. Pris ensemble, les résultats de nos deux études révèlent donc des altérations chez les TSA quant au traitement simultané d'événements multiples, que ce soit dans une modalité ou à travers des modalités, ce qui peut avoir des implications importantes au niveau de la présentation clinique de cette condition. / Autism spectrum disorders (ASD) are currently characterized by a triad of impairments including social dysfunction, communication deficits and perseverative behaviours. The simultaneous integration of multiple senses is crucial in everyday life as it allows for the creation of a unified percept. Similarly, the allocation of attention to multiple events at the same time is critical in the processing of dynamic environmental information. In daily interactions with the environment, both sensory processing as well as attentional functions are building blocks to typical development (TD). Although not part of the current diagnostic criteria, difficulties with attention functions and sensory processing are very common among autistic persons. The present thesis therefore examined both these functions in two separate studies. The first study is based on the premise that alterations in basic sensory processing might underlie atypical sensory behaviours in ASD, as proposed by current theories of ASD. We conceived a cross-modal size discrimination task to assess the integrity and developmental course of visuo-tactile information in children with ASD (N = 21, aged 6-18 years), compared to age- and performance IQ-matched children with TD. In a simultaneous two-alternative forced-choice task, participants were asked to make a judgement on the size of two stimuli, based on unisensory (visual or tactile) or multisensory (visuo-tactile) inputs. Difference thresholds evaluated the smallest difference at which participants were capable to discriminate size. Children with ASD showed diminished performance and no maturational effects in both unisensory and multisensory conditions, compared to TD participants. Our first study therefore extends previous results of alterations in multisensory processing in ASD to the visuo-tactile domain. In our second study, we evaluated 3D-Multiple Object Tracking (3D-MOT) capacities in autistic adults (N = 15, aged 18-33 years), compared to age- and IQ-matched control participants, who were asked to track one or three moving targets amongst a set of distracters in a virtual reality environment. Performances were measured based on speed thresholds, which evaluates the greatest speed at which observers are capable of successfully tracking moving objects. Autistic individuals displayed overall reduced speed thresholds, whatever the number of spheres to track. These findings extend previous results of altered attention mechanisms in autism with regards to the simultaneous allocation of attention to multiple areas. Together, the findings of our two studies reveal alterations in ASD with regards to the processing of multiple events at the same time, be it within one modality or across modalities, which may have important implications for the clinical presentation of this condition.

Résumé en français Objectifs : Ce mémoire propose d’explorer l’assiduité aux interventions psychosociales chez les personnes atteintes de troubles psychotiques en répondant à trois questions : 1- Quels sont les facteurs influençant l’assiduité aux interventions psychosociales pour une clientèle atteinte de troubles psychotiques? 2- Sont-ils comparables aux facteurs influençant l’observance à la médication? 3- Quel est le taux d’abandon des interventions psychosociales et quels sont les facteurs qui font varier ce taux? Méthodes : Cette étude a permis de faire la synthèse des facteurs influençant l’observance à la médication à partir des revues systématiques publiées sur le sujet, et d’établir les facteurs influençant l’assiduité aux interventions psychosociales à partir des raisons d’abandon citées dans les essais cliniques randomisés publiés. Une méta-analyse a permis de combiner les essais cliniques rapportant les abandons et ainsi d’en établir un taux. Résultats : Nous avons répertorié 92 essais cliniques randomisés sur les interventions psychosociales avec les personnes atteintes de troubles psychotiques. De ce nombre, 43 ont permis de répertorier les raisons d’abandon. Les raisons d’abandon s’avèrent principalement liées à la maladie et liées à l’accessibilité, la continuité et la qualité des soins et services. Un taux d’abandon de 13% a été obtenu à partir de l’agrégation de 74 études dans la méta-analyse. Des facteurs faisant varier ce taux ont été identifiés. Conclusion : Plusieurs facteurs (personnels, lié aux traitements, sociaux) influençant l’assiduité aux interventions psychosociales chez les personnes atteintes de troubles psychotiques ont été identifiés. De plus, le faible taux d’abandon obtenu démontre bien la faisabilité clinique de ce type d’intervention. S’ajoutant à l’efficacité déjà bien démontrée de certaines modalités d’intervention psychosociales, le taux d’assiduité à ces mêmes modalités constitue un argument supplémentaire pour en assurer la disponibilité aux personnes atteintes d’un trouble psychotique. / Abstract Aims : This report suggest investigating the compliance in the psychosocial treatment among persons with schizophrenia spectrum disorder by answering three questions : 1- What are factors influencing compliance in the psychosocial treatment among persons with schizophrenia spectrum disorder? 2- Are they comparable to factors influencing compliance with pharmacological treatment? 3- What is the dropout rate of the psychosocial treatment and which are the factors which make vary this rate? Methods : A systematic review allowed to make the synthesis of factors influencing the compliance in the medication from the systematic reviews published on the subject and to establish factors influencing the compliance in the psychosocial treatment from the reasons of drop-out specified in the published randomized clinical trials. A meta-analysis allowed to combine clinical trials reporting drop-out and so to establish a rate. Results : We listed 92 clinical trials randomized on the psychosocial treatment among persons suffering from schizophrenia spectrum disorder , of this number 43 allowed to list the reasons of drop-out. The reasons of drop-out turn out mainly related to the disease and related to the accessibility, the continuity and the quality of the care and the services. A 13 % dropout rate was obtained from the aggregation of 74 studies in the meta-analysis. Factors making vary this rate were identified. Conclusions: Several factors which influence the compliance in the psychosocial treatment among persons suffering from schizophrenia spectrum disorders are identified. Furthermore, the low drop-out rate calculated demonstrates well the clinical feasibility of this type of treatment. Being added to the efficiency already well demonstrated by certain psychosocial modalities of treatnebt, the compliance rate in these same modalities establishes an additional argument to assure the availability among persons suffering from schizophrenia spectrum disorders.

Learning the knowledge and procedures of the Assessment of Basic Learning Abilities (ABLA) is a major practical priority for direct-care service providers who work with individuals with intellectual disabilities (IDs) and autism spectrum disorders (ASDs). The present study compared the effects of two training conditions involving a self-instructional manual (SIM) alone and its combination with a Web-based computer-aided personalized system of instruction (WebCAPSI) program (SIM plus WebCAPSI) on teaching knowledge and implementation of the ABLA to university students. A multiple-baseline design across training conditions was used. The results indicate that the SIM combined with passing unit tests delivered via WebCAPSI was beneficial for knowledge acquisition while viewing demonstration videos was beneficial for conducting the ABLA. The findings suggest that a combination of a SIM combined with unit tests delivered via WebCAPSI and videos provides an effective approach to teach both knowledge and application of behavioural procedures to potential knowledge users.

The present study evaluated the use of a self-instructional manual supported by a computer-aided personalized system of instruction (CAPSI) for teaching Discrete-Trials Teaching (DTT) to university students. Prior to studying the manual, five participants taught three tasks, commonly taught to children with Autism Spectrum Disorders (ASD), to a confederate role-playing a child with an ASD. Using the Discrete-Trials Teaching Evaluation Form (DTTEF), the main researcher assessed the participants’ ability to perform DTT accurately. Subsequently, participants studied a self-instructional manual using CAPSI to demonstrate mastery of study questions about DTT. Finally, participants once again attempted to teach the three tasks to a confederate role-playing a child with an ASD. Overall mean baseline accuracy on the DTTEF was 54.86%, and improved to 84.73% in post-treatment, a 30% improvement. Participants’ self-recorded study time was an average of 12 hours and 48 minutes. The results suggest that CAPSI is an effective educational tool for the delivery of the self-instructional manual. Future research should investigate (1) how to make CAPSI even more effective, and (2) whether these results can be generalized to other populations such as ABA tutors, parents, and paraprofessionals working with children with ASD.

Learning the knowledge and procedures of the Assessment of Basic Learning Abilities (ABLA) is a major practical priority for direct-care service providers who work with individuals with intellectual disabilities (IDs) and autism spectrum disorders (ASDs). The present study compared the effects of two training conditions involving a self-instructional manual (SIM) alone and its combination with a Web-based computer-aided personalized system of instruction (WebCAPSI) program (SIM plus WebCAPSI) on teaching knowledge and implementation of the ABLA to university students. A multiple-baseline design across training conditions was used. The results indicate that the SIM combined with passing unit tests delivered via WebCAPSI was beneficial for knowledge acquisition while viewing demonstration videos was beneficial for conducting the ABLA. The findings suggest that a combination of a SIM combined with unit tests delivered via WebCAPSI and videos provides an effective approach to teach both knowledge and application of behavioural procedures to potential knowledge users.