Introduction: Le trouble du spectre de l’autisme (TSA) touche 1% de la population mondiale. Pour les personnes vivant avec un TSA, certains éléments de l’environnement (ex.: bruit, lumière, aménagement) constituent des facteurs perturbateurs ; les manifestations peuvent se maintenir durant toute la vie. Il est donc important de pouvoir évaluer l’environnement afin d’y faire des interventions pour les adultes vivant avec un TSA et d’améliorer leur qualité de vie. But: Développer un instrument d’évaluation du milieu de vie des adultes vivant avec un TSA. Méthodologie: Cette étude a été développée en deux étapes: 1) exploration des éléments de l’environnement ayant un impact sur les jeunes vivant avec un TSA auprès des parents et 2) Consultation des utilisateurs potentiels sur une version préliminaire de l’ÉDIPE-version TSA Résultats: L’ÉDIPE-version TSA a été développée sur les bases du Modèle de compétence, qui explique la relation personne-environnement, en considérant les éléments de l’environnement humain et non humain ayant un impact sur les adultes vivant avec un TSA (ex.: éléments sensoriels, concernant la sécurité, la stabilité ou les visiteurs). Lors de la consultation des utilisateurs potentiels (ergothérapeutes), certaines modifications en lien avec le contenu, le mode de passation, le format et l’applicabilité de l’instrument, ont été suggérées. Conclusion: L’ÉDIPE-version TSA pourrait combler un manque dans la pratique clinique et scientifique des ergothérapeutes auprès des adultes vivant avec un TSA. Ainsi, des interventions sur l’environnement adaptées à cette population, seront favorisées. / Introduction: Autism Spectrum Disorder (ASD) is prevalent in 1% of the world's population. Within individuals living with ASD, some environmental elements (e.g., noise, light, distribution) are just some disruptive factors; the manifestations may persist throughout life. Therefore, it is important to assess the environment in order to provide interventions for adults living with ASD, improving their quality of life. Purpose: To develop tool for assessing the environment of adults living with ASD. Methods: This study was developed in two steps: 1) Exploration of environmental factors that impact young people living with ASD with parents and 2) Consultation of potential users about the first version of the HoPE - ASD version. Results: The HoPE-ASD version was developed on the basis of the Model of Competence, explaining the person-environment relationship, considering the human and non-human environmental components that have an impact on adults living with ASD (e.g., sensory elements, related to the safety and functionality of spaces, stability, visitors or trusted persons). During the consultation of potential users (occupational therapists), some modifications related to the content, mode of administration, format and applicability of the instrument were suggested. Conclusion: The HoPE-ASD version could fill a gap in the clinical and scientific practice of occupational therapists working with adults living with ASD. Thus, environmental interventions adapted to this population will be promoted.

Indiana University-Purdue University Indianapolis (IUPUI) / The empathizing-systemizing (E-S) theory states that individuals with autism spectrum conditions (ASC) can be identified by a deficit in empathy (social skills, communication skills, and theory of mind) and a propensity for systemizing (islets of ability, obsessions with systems, and repetitive behavior). This theory has been tested in various contexts, but never with adolescents between the ages of 12 and 16. The EQ-A (Empathizing Quotient for Adolescents) and the SQ-A (Systemizing Quotient for Adolescents) were administered to 47 adolescents between the ages of 12 and 16 who had been diagnosed with ASC and 97 adolescents with no reported physical or mental disorders to discover differences in empathizing and systemizing. To test the specific elements and predictions of the E-S theory, the EQ-A was divided into a set of three subscales derived by conceptually mapping items to factors corresponding to the concepts theoretically underlying the scale. The SQ-A was divided into subscales using factor analysis. It was found that all four subscales resulting from the factor analysis on the SQ-A were associated with obsessions with systems. A weak positive correlation was found between the SQ-A and the EQ-A. Although the EQ-A was able to differentiate significantly between individuals with an ASC and those without, the SQ-A was not. In addition, although the EQ-A and EQ-A subscales scores correlated with similar subscales scores of the GARS-2 (a well-validated existing autism screening test), the SQ-A and its subscales did not. Implications for the E-S Theory are discussed.

Current work is focused on the development of a project of a career guidance complex using virtual reality for schoolchildren with autism spectrum disorders (ASD). Various issues related to the subject were highlighted in the work. One of such is the inconsistency of current career guidance methods with current and future labor markets. Another problem is the lack of accessible career guidance techniques for people with health limitations, and in particular with ASD. Current work also underlines the lack of effective assistance to people with disabilities and with ASD in their professional self-determination, despite the allocation of state quotas for vacancies for people with health limitations. In the course of the work, a detailed analysis of various domestic and foreign literature on the stated problems was carried out, and a draft career guidance methodology using virtual reality for schoolchildren with ASD was developed. In the future, it is planned to continue work on the project of a career guidance complex. And, although the project is complex, resource-consuming, and long-term, its implementation can be a step towards solving the problems of career guidance for people with autism spectrum disorders and, in general, the problems of their inclusion in public life. / Работа посвящена созданию проекта профориентационного комплекса с использованием виртуальной реальности для школьников с расстройствами аутистического спектра (РАС). В работе были освящены такие проблемы как несоответствие использующихся в настоящее время методов профориентации современному и будущему рынкам труда; отсутствие доступных профориентационных методик для лиц с ограниченными возможностями здоровья (ОВЗ), и в частности – с РАС; а также отсутствие эффективной помощи лицам с ОВЗ, и с РАС – в частности, в их профессиональном самоопределении, несмотря на выделение государственных квот на вакансии для лиц с ОВЗ. В ходе работы был проведён подробный анализ различной отечественной и зарубежной литературы по заявленным проблемам, а также был разработан проект профориентационной методики с использованием виртуальной реальности для школьников с РАС. В дальнейшем планируется продолжить работу над проектом профориентационного комплекса. И, не смотря на то, что проект является сложным, ресурсозатратным и долгосрочным, его реализация может стать шагом в сторону решения проблем профориентации лиц с расстройствами аутистического спектра и в целом проблем их включённости в общественную жизнь.

In comparison to normally developing children, many children with Autism Spectrum Disorders (ASD) do not possess the same opportunities to be physically active due to the impairments exhibited by their disorder. A systematic review using the Downs and Black checklist and the PEDro scale was conducted to assess the methodological quality of the literature on promoting physical activity in children with ASD. The following inclusion criteria had to be met: (1) subjects must include children with a clinical ASD diagnosis (2) the children have to be under the age of thirteen years old (3) the interventions must target physical activity; lastly, (4) they must be a relevant peer-reviewed English language study. The search was conducted using four electronic databases: MEDLINE, ERIC, PsycInfo, and CINHL with no restriction on the publication year. The following keywords were utilized: "Autism", "ASD/ Autism Spectrum Disorder", "Asperger", "Pervasive Developmental Disorder" Those terms were paired with "physical activity", "physical exercise", "exercise", "fitness", "aerobic", "swim", "aquatic", "jog", "walk", "recreational activity" Which were also paired with the terms "school age", "child", "toddler", "preadolescent". This multi-step search procedure occurred during February 2013. The methodological quality of six studies was evaluated in February 2013. Overall, the conclusive scores determined by the Downs and and Black checklist and the PEDro scale varied greatly. The scores reported by the Downs and Black checklist ranged from 19 to 21 on a 27-point scale. PEDro scale yielded scores ranging between two and six on a 10-point scale. A vote count revealed that the exercise interventions increased the physical fitness, aquatic skills, social behaviors, and sensory integration children with ASD. In summary, the variation within the scores and the quality of the studies leads to a demand for future research.; In order to adequately determine what exercise interventions effectively increase physical activity in children with ASD, future researchers should conduct randomized controlled trials in order to produce the highest quality of evidence.

Objective: Although autism spectrum disorder (ASD) is a relatively common, well-known but heterogeneous neuropsychiatric disorder, specific knowledge about characteristics of this heterogeneity is scarce. There is consensus that IQ contributes to this heterogeneity as well as complicates diagnostics and treatment planning. In this study, we assessed the accuracy of the Autism Diagnostic Observation Schedule (ADOS/2) in the whole and IQ-defined subsamples, and analyzed if the ADOS/2 accuracy may be increased by the application of machine learning (ML) algorithms that processed additional information including the IQ level. Methods: The study included 1,084 individuals: 440 individuals with ASD (with a mean IQ level of 3.3 ± 1.5) and 644 individuals without ASD (with a mean IQ level of 3.2 ± 1.2). We applied and analyzed Random Forest (RF) and Decision Tree (DT) to the ADOS/2 data, compared their accuracy to ADOS/2 cutoff algorithms, and examined most relevant items to distinguish between ASD and Non-ASD. In sum, we included 49 individual features, independently of the applied ADOS module. Results: In DT analyses, we observed that for the decision ASD/Non-ASD, solely one to four items are sufficient to differentiate between groups with high accuracy. In addition, in sub-cohorts of individuals with (a) below (IQ level ≥4)/ID and (b) above average intelligence (IQ level ≤ 2), the ADOS/2 cutoff showed reduced accuracy. This reduced accuracy results in (a) a three times higher risk of false-positive diagnoses or (b) a 1.7 higher risk for false-negative diagnoses; both errors could be significantly decreased by the application of the alternative ML algorithms. Conclusions: Using ML algorithms showed that a small set of ADOS/2 items could help clinicians to more accurately detect ASD in clinical practice across all IQ levels and to increase diagnostic accuracy especially in individuals with below and above average IQ level.

A qualitative case study research design is used to investigate the results of a neuropsychological test battery, collated and used with four individual cases. A literature study consisting of research with respect to AS as well as neuropsychological assessments provides the theoretical framework from which existing theory is tested and expanded on. The cases are analysed individually and then by cross case analysis to ascertain any patterns of strength and weaknesses which could result in a "typical" profile of a learner with AS. Findings conclude confusions with respect to diagnostic criteria for AS and a distinction of DSM-IV-TR criteria is used. The neuropsychological test battery includes questionnaires (personal history, Gilliam Asperger's disorder scale, Conners' parent and teacher questionnaire, Dunn's sensory profile) interviews (parents, teachers), observations (classroom and playground) and formal testing (intelligence, motor functions, academic achievement, theory of mind and executive functions). Findings from the literature show similarities between AS children and children with non verbal learning disabilities. Evidence of AS differing from individuals with high functioning autism is conclusive in all previous research using theory of mind tests. Evidence from the literature shows many children had been given another diagnosis, typically ADHD, before being given the diagnosis of AS. Additional disorders such as anxiety and depression were also given. AS children had consistent difficulties with social interaction. A typical neuropsychological profile of AS is not identified, but rather a "personality type" that is dominated by anxiety and individual "quirks" of personality which affects responses to the formal test battery - thereby influencing the scores obtained. Two of the cases presented with an academic profile similar to that of a non verbal learning disability and one presented with similarities with a semantic pragmatic disorder. The thesis concludes with a proposed differentiating model of behavioural, communication and learning disorders in which AS is defined in terms of that originally described by Hans Asperger himself, and specifically treated within the education environment. / Educational Studies / D.Ed. (Psychology of Education)

Le syndrome de West (SW), communément appelé spasmes infantiles (SI), est un trouble épileptique généralement caractérisé par la triade de spasmes infantiles, un modèle d'électroencéphalogramme (EEG) pathognomonique appelé hypsarythmie, et la régression du développement. Alors que des études précédentes ont été en mesure d'obtenir une réponse relativement adéquate par rapport au contrôle des spasmes et la résolution d’hypsarythmie, elles n’ont pas réussi à fournir des options thérapeutiques décisives à l’égard des séquelles neurodéveloppementales souvent associées aux SI. Notre étude, sur laquelle est basée cette thèse, est la première à utiliser un traitement complémentaire aux médicaments antiépileptiques conventionnels, avec l'intention d'améliorer les résultats neurodéveloppementaux de cette population. Les patients recrutés dans notre essai clinique randomisé (ECR) original ont suivi un protocole de traitement standardisé composé de vigabatrin (VGB) comme traitement de première intention pendant deux semaines, suivi de l'hormone corticotrope (ACTH) chez les non-répondeurs pour une période de deux autres semaines, et le topiramate dans les cas réfractaires. En plus, les patients ont été randomisés pour recevoir soit le traitement expérimental, flunarizine, soit un placebo, pendant six mois. Notre ECR multicentrique consistait à recruter et évaluer 68 patients, la plupart suivis à 8 différentes visites sur une période de cinq ans afin de précisément évaluer leurs progrès neurodéveloppementaux. Notre essai clinique a généré trois études principales qui forment le coeur de cette thèse. Dans une première étude, les données cliniques et cognitives des deux premières années d’évaluation ont été analysées. Les résultats cliniques à court terme indiquent un taux élevé de cessation de spasmes et de l’hypsarythmie. De plus, cette étude rapporte les premiers résultats cognitifs mesurés par le Bayley Scales of Infant Development (BSID) et le Vineland Adaptive Behavior Scale (VABS). Notre deuxième étude a essentiellement fourni des données cognitives à plus long terme, 5 ans après le début de son initiation. Les réponses cognitives ont été mesurées par le BSID, le VABS, et aussi par le Stanford-Binet Intelligence Scale (SB5) chez les patients ayant un fonctionnement cognitif plus élevé. Une amélioration significative et progressive des fonctions cognitives a été observée, indépendamment de la thérapie adjuvante. Des facteurs de risque cognitifs à long terme ont également été révélés dans cette étude. Notre dernière étude a essayé d’élucider la relation entre les SI et les troubles du spectre autistique (TSA). Un test de dépistage avec le Checklist for Autism in Toddlers (CHAT) a été effectué à 24 mois, et un diagnostic a été obtenu par moyen du Autism Diagnostic Observation Schedule (ADOS) à 30 et 60 mois. L’ADOS a évalué 44 patients, dont 10 ont été diagnostiqués avec TSA. Une description des facteurs de risque associés aux TSA ont été présentés dans cet article. Enfin, basé sur nos résultats et les informations à ce sujet dans la littérature, nous avons tenté d'élucider les caractéristiques physiopathologiques de la maladie. Une description des mécanismes biologiques sous-jacents impliqués dans le syndrome de West et des traitements cibles associés ont été présentés. Bien que le traitement complémentaire, le flunarizine ne se soit pas avéré être avantageux pour notre cohorte, notre protocole de traitement a tout de même été en mesure de démontrer des résultats cliniques et cognitifs supérieurs dans le sous-groupe de patients avec SI dont l’étiologie est inconnue. Ces résultats, ainsi que l’identification de nouveaux facteurs de risque neurodéveloppementaux potentiels, pourraient être utilisés cliniquement afin d’améliorer le diagnostic et le suivi médical des patients atteints du syndrome de West. / West syndrome (WS), commonly referred to as infantile spasms (IS), is an epileptic disorder usually characterized by the triad of infantile spasms, a pathognomonic electroencephalogram (EEG) pattern called hypsarrhythmia, and developmental regression. While previous treatment studies were able to achieve relatively adequate spasm control and hypsarrhythmia resolution in this population of patients, they have failed to provide conclusive and definite therapeutic options aimed at improving the poor cognitive outcome often associated to IS. Our study, on which this thesis is based, was the first to use an add-on treatment to conventional antiepileptic drugs, with the intent to improve long-term cognitive outcome in this population. Patients recruited in our original randomized clinical trial (RCT) followed a standardized treatment protocol consisting of vigabatrin (VGB) as first-line treatment for two weeks, followed by adrenocorticotropic hormone (ACTH) in non-responders for another two-week period, and topiramate in refractory cases. In addition, patients were randomized to either receive placebo or flunarizine adjunct therapy for six months. Our multi-centric RCT recruited and evaluated 68 patients, most of which were followed at 8 different time points over a five-year period, to precisely evaluate their neurodevelopmental progress. Our clinical trial generated three main studies which comprise the core of this thesis. In a first study, clinical and cognitive data from the first two years were analyzed. Spasm arrest and hypsarrhythmia resolution were the short-term clinical endpoint measures, while the Vineland Adaptive Behavior Scale (VABS) and Bayley Scales of Infant Development (BSID) were used as cognitive outcome measures at 2 years. This first study most importantly reports on the superior short-term clinical response rate achieved in our study population. Preliminary cognitive results were also presented in this work. Our second study essentially presented long-term cognitive data 5 years after the start of the study. Cognitive outcome measures were similar to those used at two years with the addition of the Stanford-Binet Intelligence Scale, Fifth Edition (SB5) for higher functioning patients. Most IS patients, particularly those with no known etiology, displayed a significant and progressive improvement of cognitive functions, irrespective of adjunctive therapy. Risk factors of long term poor cognitive outcome were also revealed in this study. Our last study tried to understand the relationship between IS and autism spectrum disorders (ASD). Autism was initially screened by means of the Checklist for Autism in Toddlers (CHAT) at 24 months, and formally assessed at the 30-and 60-month follow-up visits using the Autism Diagnostic Observation Schedule (ADOS). ADOS was performed in 44 patients, 10 of which were diagnosed with ASD. A description of risk factors associated with an ASD outcome in the IS population were presented in this article. Finally, based on our study results and in conjunction with literature information on the topic, we attempted to elucidate the pathophysiological characteristics of the disorder. A conceivable description of the underlying biological mechanisms implicated in West syndrome and associated target treatments were presented. Although our complementary treatment, flunarizine, did not prove to be beneficial in our cohort, our treatment protocol was nonetheless able to demonstrate superior clinical and cognitive outcomes in patients with unknown etiologies. These findings, as well as the identification of new potential neurodevelopmental risk factors, could be used clinically to improve the diagnosis and medical follow-up of patients with West syndrome.

TITLE: Developing Communication Skills in Children with Autism Using Verbal Behavior - Applied Behavior Analysis AUTHOR: Bc. Kateřina Chrapková DEPARTMENT: The Department of Special Education SUPERVISOR: doc. PaedDr. Jiřina Klenková, Ph.D. ABSTRACT: This thesis deals with the development of communication skills in children with autism using Verbal Behavior - Applied Behavioral Analysis (VB-ABA). The aim of this work is to introduce VB-ABA approach as an effective intervention for people with Autism Spectrum Disorders (ASD). It is a monographic work with emphasis on a theory. The empirical part consist evaluative single-case study. The thesis is devided into six theoretical and one empirical chapter. The first theoretical chapter presents the issue of communication in a view of behaviorism and compares this approach with classical linguistics. The second chapter describes theories of language acquisition and language development from behavioral and linguistic perspective. The third chapter discusses the development of children's speech in the context of ontogeny and its functions. The fourth chapter deals with the issue of communication skills in the context of ASD. The fifth chapter introduces evidence based practice and provides information on current international research of interventions for persons...

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研究目的：欲瞭解自閉症類疾患兒童，橫跨幼兒期、學齡前期至學齡期的自閉症狀發展軌跡，探究當中是否存有不同的發展軌跡，並檢視不同發展軌跡的群體在認知功能與適應行為隨時間的變化型態是否有差異，以及不同群體在早期的社會溝通能力或療育經驗上是否有差異。 方法：本研究有37名自閉症類與24位非自閉症類受試者納入分析，共測量三次：時間點一平均生理年齡為2歲半、時間點二為4歲、時間點三為8歲半。於三個時間點皆以自閉症診斷觀察量表評估自閉症狀嚴重度、以及穆林發展量表或魏氏兒童智力量表第四版評估認知功能，在時間點二與時間點三以文蘭適應行為量表第二版評估適應行為；另外，在時間點一以台灣版兩歲期自閉症篩檢工具評估社會溝通能力，以及在時間點一至時間點二之間，以電話訪問的方式紀錄兒童每週參與療育的時數。 結果：由階層式集群分析結果顯示，社交情感嚴重度校正分數可將自閉症類與非自閉症類兒童分群，並於自閉症類兒童中可再分為維持高嚴重度組與退步組。兩組自閉症類兒童於學齡時期在社交情感症狀皆呈現嚴重度明顯上升的趨勢，在認知功能與適應行為隨時間的變化型態相似，不過維持高嚴重度組在認知功能與適應行為有較低的分數（但未達統計顯著）。此外，兩組自閉症類兒童於時間點一的意圖溝通能力即有差異，不過僅共享式注意力可預測日後社交情感症狀發展軌跡之分群。 總結：由結果可見自閉症狀維持高嚴重度組，於認知功能與適應行為有較明顯缺損，推論自閉症類兒童的自閉症狀嚴重度與認知功能及適應行為並非完全獨立的變項。兩組自閉症類兒童於學齡期症狀嚴重度上升，而此趨勢在退步組兒童更為明顯。雖然本研究並未發現早期療育經驗對於社交情感症狀發展的影響，不過共享式注意力對於日後社交情感症狀有預測力。進一步討論此結果在理論與臨床實務上的應用。 / Purposes: the purpose of the study was to plot longitudinal developmental trajectories of autism symptom severity in the children with autism spectrum disorders (ASDs) from toddler age to school age. And to examine whether these different trajectories are associated with the cognitive function, adaptive behavior, early social communication skill, and early intervention experience. Methods: Thirty-seven children with ASDs and 24 children with developmental delay participated at time 1 (mean chronological age was 2.5 years old), and then followed at time 2 (mean chronological age was 4 years old) and time 3 (mean chronological age was 8.5 years old). The study assessed the autism symptom severity by ADOS and cognitive function by MSEL or WISC-Ⅳ at three time points; adaptive behavior by VABS-II at time 2 and time 3; and early social communication skills by T-STAT at time 1 and also used telephone interviews to record participants’ weekly intervention hours during time 1 to time 2. Results: In hierarchical cluster analysis, social affect calibrated severity score (CSS) could discriminate ASDs and Non-ASDs groups, also could divided ASDs into two groups, called persistent high and worsening groups. The social affect symptom severity increased at school age in both groups. On the other hand, the change of cognitive function and adaptive behavior with time showed similar pattern in the two groups. However, participants in the persistent high group have relatively lower scores of cognitive function and adaptive behavior, although did not rearch statistically significant. Furthermore, two ASDs groups at toddler showed difference in intention communication skills; however, only joint attention could predict social affect trajectory subgrouping. Conclusions: In summery, the study showed that persistent high group has more cognitive and adaptive function impairments than the worsening group in the children with ASDs. It seemed that the autistic symptom are not entirely independent with cognitive function and adaptive behavior. Moreover, the symptom severity increased at school age in both the persistent high and the worsening groups, and this trend was more significant in the worsening group. Additionally, the experience of early intervention showed no significant effects on developmental trajectories of social affect symptom; however, the joint attention was found to be an index to predict the development of social affect symptom in ASDs groups. The theoretical and clinical implications were discussed.