Professor Anne O’Hare ARICD 15 International Scientific Meeting Birmingham 2013 Current Perspectives on Child Development in the 21 st Century Cognitive

Professor Anne O’Hare

ARICD15 International Scientific

MeetingBirmingham 2013

Current Perspectives on Child Development in the 21st Century

Cognitive conundrums coming our way?

Cognitive Conundrums Coming our Way?

DEFINITIONS

COGNITIVE:Relating to the mental processes involved in knowing, learning and understanding thingsAs children grow older, their cognitive processes become sharper(Collins Cobuild Advanced Dictionary)

CONUNDRUM:A problem that is difficult to solve

Cognitive Conundrums Coming our Way?

Motor planning and executive functionLanguage pragmaticsSocial cognition

Motor planning and executive functionLanguage pragmaticsSocial cognition

Acute Lymphoblastic Leukaemia

Normal Blood

• Prevalence 2-3 per 10,000

• 35% of all childhood malignancies

• Second most common cause of death in 1-15 year olds

• CNS involved in 5% at presentation

• Migration of leukaemic cells along perivascular and perineural tissues

• CNS relapse ‘inevitable’ without cranial prophylaxis

Acute Lymphoblastic Leukaemia

Event Free Survival by Trial

Survival UKALL VIII

Impact of Cranial Irradiation

Animal Model:• Radiosensitivity of brain decreases with age

• Inhibition of differentiation of myelin

• Less myelin and immature fatty acid composition

Children:• Intellectual morbidity - ↓ performance IQ and short-term memory but

verbal IQ maintained (Sizer 1980)

• Effect more marked under 3 years

• Arrests normal intellectual growth - gap widens over time (Janoun 1983)

Neurological Morbidity in ALL

CSF biochemical studies: - Hypoxanthene and Xanthene - Cyclic adenosine 3’ 5’, monophosphate- 2’ 3’ -cyclic nucleotide 3’, phosphohydrolase

Cranial CT and CSF Procoagulant activity

10 children

Pre-treatment, induction and remission, all free of overt CNS involvement

33 children -5 year period, 25 controls undergoing LP to exclude CNS infection

Neurological Morbidity - Visual evoked responses and computerised psychometry

Long term survivors – no CNS involvement, mainstream

school 29 (20 girls, 9 boys)

Matched controls – age, gender and socio-economic status

O'Hare A E, Eden O B, Aitken K. Computerised psychometry screening in long-term survivors of childhood acute lymphoblastic leukaemia. Paediatric Haematology and Oncology,1988; 5: 197-208

Computerised Psychometry

• Visual spatial ability• Symbol coding• Visual perceptual analysis• Visual spatial recognition memory• Verbal recognition memory• Abstract problem solving

Neurological Morbidity in ALL

1. CSF hypoxanthene raised at diagnosis and induction(p>0.001, p>0.005, p>0.001): ischaemic brain parenchyma from perivascular infiltration of the arachnoid vessels.

2. Cranial radiotherapy breaches the blood/brain barrier, myelin maturation disturbed during subsequent 2 years of treatment (p>0.001 procoagulant activity).

3. Cranial CT abnormal at diagnosis in 20% but only 6% at 4-5 years from treatment.

4. Subtle Neurological Morbidity:

• verbal recognition short term memory (p>0.02)

• abstract problem solving– Errors after positive feedback p>0.005– Number of sorts p>0.005– Overall performance p>0.01

O'Hare A,Clarke M, McInnes A, Eden O B. The latency of the visual evoked response as an index of myelin disturbance in children treated for acute lymphoblastic leukaemia. Clinical Electroencephalography, 1987; Vol 18 (2): 68-73).O'Hare A E, Eden O B, Simpson R McD, Donaldson A, Sainsbury C P Q. Cranial computerised tomography and CSF procoagulant activity in childhood acute lymphoblastic leukaemia. Haematology and Oncology 1987; Vol 5: 103-113.

Development of an instrument to measure manual praxis

Establish typical development of manual praxis – ability to gesture, use tools and sequence movement.

Design standardised assessment of ‘hidden’ difficulty for children who struggle to learn everyday hand skills.

Explain the role of ‘communication’ in the learning of manual praxis.

O’Hare A E, Gorzkowska J, Elton R. Development of an instrument to measure manual praxis. Developmental Medicine and Child Neurology, 1999; 41: 597-607

O’Hare A E, Khans S, Hailey J. Delayed development of manual praxis in the presumed normal pre-term survivor. European Journal of Paediatric Neurology, 1999; 3(6): A137.

Development of an instrument to measure manual praxis – some interesting outcomes

Aquired dyspraxia

Mis-locations

Omissions

1. Developmental dyspraxia

Mis-sequence, spatial errors and few perseverations

2. Deprivation in childhood

Learning to use tools

Imitation of motor sequences

No disadvantage

Ability to imitate complex gesture and to undertake more ‘novel’ motor tasks to verbal instructions (p>0.01)

Disadvantage

ASSOCIATED FEATURES OF ASPERGER’S SYNDROME AND THEIR RELATIONSHIP TO

PARENTING STRESS

Epstein T, Saltzman-Benaiah J, O’Hare A, Goll J, Tuck S. Child: Care, Health & Development, 2008; 34 (4) 503–511.

• Explore the relationship between some of the associated features of AS and levels of reported parenting stress in families of children affected

• Determine whether children with AS show impairment in executive function and heightened sensory sensitivity

• Determine whether parent report of their child’s demanding characteristics would be positively associated with their self-reported levels of parenting stress

AIMS OF THE STUDY

ASSOCIATED FEATURES OF ASPERGER’S SYNDROME AND THEIR RELATIONSHIP TO

PARENTING STRESS

• 92.1% of mothers and 81.8% of fathers rated their children as having clinically elevated levels of executive dysfunction

• Correlation between mother’s and father’s overall score on the BRIEF approached significance (r=0.49; p>0.05)

RESULTS – EXECUTIVE DYSFUNCTION

RELATIONSHIP BETWEEN MOTHERS’ (M) AND FATHERS’ (F) SCORES ON EACH VARIABLE AS WELL

AS RELATIONSHIP BETWEEN CHILDREN'S DIFFICULTIES AND PARENTING STRESS

Variables CorrelationConfidence interval

P-value

•*P < 0.01.•Note that the total raw scores for each measure are used for the correlations.

PSI/SF-M

PSI/SF-F 0.62 0.29 to 0.82 0.001458*

BRIEF-M

BRIEF-F 0.67 0.34 to 0.86 0.0007974*

SSP-M

SSP-F 0.73 0.35 to 0.91 0.001890*

BRIEF-M

PSI/SF-M 0.60 0.34 to 0.77 0.000099*

SSP-M

PSI/SF-M −0.56 −0.80 to −0.18 0.006478*

BRIEF-F

PSI/SF-F 0.30 −0.15 to 0.65 0.1793

SSP-F

PSI/SF-F 0.06 −0.46 to 0.56 0.8195

*P < 0.01

Epstein T, Saltzman-Benaiah J, O’Hare A, Goll JC, Tuck S. Associated features of Asperger Syndrome and their relationship to parenting stress. Child: care, health and development 2008

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2214.2008.00834.x/full%23t2n1





ASPERGER’S SYNDROME AND PARENTING STRESS

• 75.7% of mothers and 75% of fathers reported clinically elevated stress levels

• No significant difference between mothers and fathers for overall levels of parenting stress or on any of the sub-scales

• Mothers’ and fathers’ scores were significantly correlated on total stress (r=0.62; p>0.01), parenting distress (r=0.71; p>0.01) and parent-child dysfunctional interaction (r=0.57; p>0.01)

• However mothers’ and fathers’ scores on the difficult child index were not significantly correlated

RESULTS – STRESS LEVELS OF PARENTS OF A.S. CHILDREN

Vision and proprioception in ASD, DCD and typical development

Does the use of vision and proprioception differentiate ASD and DCD?

British Psychological Society, September 2013

Louisa Miller, Rob McIntosh, Anne O’HareUniversity of Edinburgh

Task 1: MABC results

71% 67% 14%

Fail: <15th percentileon MABC

Findings confirmmovement deficits in majority of ASD

ASD (n=31)

DCD (n=9)

TD(n=28)

Per

cent

Task 2: Visual-proprioceptive matching task

ASD ‘pure’ vs clumsy ASD/DCD

ASD ‘pure’ (n=9)

Clinical motor deficit

(n=28)

ASD with spared motor skills tend to weight vision less

0.8

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t(35)=2.168, p=0.037, d=0.73

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Clinical assessment in ASD Second order mentalising abilities

Pettigrew L M, O’Hare A E, Bremner L, Nash M, Happe F, Rutherford M. Journal of Autism and Developmental Disorder (in press).

Second order mentalising abilities Pettigrew L M, O’Hare A E, Bremner L, Nash M, Happe F, Rutherford M. Journal of Autism and Developmental Disorder (in press).Disorders of sensory processing

O’Hare A E, Adamson A, Graham C. British Journal of Occupational Therapy, 2006;

Disorders of sensory processingO’Hare A E, Adamson A, Graham C. British Journal of Occupational Therapy, 2006;

Identifying need and service requirements O’Hare A E, Quew R, Aitken K. Autism, 1998;

Harrison M J, O’Hare A E, Campbell H, Adamson A, McNeillage J. Developmental Mental Medicine Child Neurology, 2004

Identifying need and service requirements O’Hare A E, Quew R, Aitken K. Autism, 1998;

Harrison M J, O’Hare A E, Campbell H, Adamson A, McNeillage J. Developmental Mental Medicine Child Neurology, 2004

Executive function and parental stress

Epstein T, Saltzman-Benaiah J, O’Hare A, Goll J, Tuck S. Child: Care, Health & Development, 2008.

Executive function and parental stress

Epstein T, Saltzman-Benaiah J, O’Hare A, Goll J, Tuck S. Child: Care, Health & Development, 2008.

Prosody and pragmatic ability

Peppé S, McCann J, Gibbon F, O'Hare A, Rutherford M. Journal Speech Language Hearing Research, 2007.

McCann J, Peppe S, Gibbon F, O’Hare A, Rutherford M. International Journal of Language and Communication Disorders 2007.

Peppe S, McCann J, Gibbon F, O’Hare A, Rutherford M. Journal of Pragmatics, 2006.

Prosody and pragmatic ability

Peppé S, McCann J, Gibbon F, O'Hare A, Rutherford M. Journal Speech Language Hearing Research, 2007.

McCann J, Peppe S, Gibbon F, O’Hare A, Rutherford M. International Journal of Language and Communication Disorders 2007.

Peppe S, McCann J, Gibbon F, O’Hare A, Rutherford M. Journal of Pragmatics, 2006.

Prevalence of ASD

The prevalence rate of ASD in children in the UK is 1 in 86 children (Baird et al 2006)

The prevalence rate of ASD in adults in the UK is 1 in 100 adults (Brugha et al 2009)

The USA Center for Disease Control (2012) reports a prevalence of 1 in 88 children in the USA

Brugha et al (2012) report a prevalence of 1 in 90 adults in the UK

24

4.11 Evidence statements: conditions with an increased prevalence of ASD

ASD is observed more frequently in children with the following coexisting conditions than in the general population:

• Intellectual disability (prevalence of ASD: 8-27.9%)• Fragile X (prevalence of ASD: 24–60%)• Tuberous sclerosis (prevalence of ASD: 36–79%)• Neonatal encephalopathy/epileptic/encephalopathy/infantile

spasms (prevalence of ASD: 4–14%)

• Cerebral palsy (prevalence of ASD: 15%)• Down‟s syndrome (prevalence of ASD: 6–15%)• Muscular dystrophy (prevalence of ASD: 3–37%)• Neurofibromatosis (prevalence of ASD: 4–8%).

The quality of the evidence was very low in all studies.

Child characteristics (n=258)Child characteristic % (n=)GenderMale: Female

84.16 (216:42) (ratio 4:1)

Age at survey completion< 2 years 11 months 3 years – 5 years 11 months 6 – 11 years

2 (5)31(81)67 (172)

ASD diagnosis AutismAsperger’s Syndrome Autism Spectrum DisorderPDD-NOS/ atypical autism

27 (70)20 (52)49 (127)4 (9)

Age at diagnosis < 2 years 11 months 3 years – 5 years 11 months 6 – 11 years

27 (70)57 (146)16 (42)

Language levelNo meaningful speech Single words and phrases Sentences with good grammar Other( no details)

19 (50)28 (70)51 (132)1 (5)

Learning disability 31 (81)Type of educational establishment attendedMainstream (school, nursery, unit attached) Specialist provision Home ed.

71 (179)28 (70)2 (4)

Educational support*Individual Education Plan **Statement of Special Educational Needs

57 (150)55 (144)

* An Individual Education Plan (IEP) is a teaching and learning plan devised to identify the targets, provision and outcomes for a child identified with special educational needs. ** Statement of Special Educational Needs is a legal document issued by the Local Authority responsible for education, following an in-depth multidisciplinary assessment of the child’s needs.

Adams S J, Burton N, Cutress A, Adamson A J, McColl E, O’Hare A E, Baird G, Le Couteur A. Parents’ and Child Health Professionals’ Attitudes Towards Dietary Interventions for Children with Autism Spectrum Disorders. JADD. Accepted August 2013

em pathos : ‘feeling into’

Empathy is understanding a person’s subjective experience by sharing it

vicariously but maintaining an observant stance

Casebook MPS January 2011

Descriptions of empathy difficulties by a man affected with Asperger’s syndrome

and diagnosed at the age of 50 The Guardian Weekend: 15 Jan 2011

“How can they interact with each other so unselfconsciously …”

“I like people, I long to have friends and most of all to be in a relationship…”

“The bottom line is, human beings were not meant to have to live like this. Social interaction is a basic human need”

How do we measure empathy in young children?

* Self report* Observer report eg ASD screening instruments* Direct measurement eg theory of mind

assessments* Indirect measurement eg perception of facial

expression * Response to intervention* Neuroscience modalities eg electrophysiology,

neuroimaging, genetics and animal models

29

Total Social Communication Questionnaire (SCQ) scores for extremely preterm children with (n=11) and without (n=162) an

autism spectrum disorder (ASD) diagnosis at 11 years of age

Johnson S et al. Arch Dis Child 2011;96:73-77

Clinical diagnoses were assigned using the Development and Well Being Assessment (DAWBA) diagnostic interview. Horizontal bars indicate the mean SCQ score. Dashed lines indicate published SCQ cut-offs for positive screening.

Performance of children with transposition of the great arteries (TGA) and of comparison

individuals on theory of mind tasks (Calderon 2010)

bSecond-order false belief task (level 2)

aFirst-order false belief task (level 1)

INDIRECT MEASUREMENT

• Reversible autism among congenitally blind children – a controlled follow-up study (Hobson & Lee 2010)

• Cognitive processing of social cues and in particular facial expression in high risk girls of a major depressive disorder (Joorman 2009)

Module 1Preverbal/single words eg spontaneous initiation of joint attention. This rating codes the child’s attempts to draw another person’s attention to objects that neither of them is touching.

Module 4Fluent speech.Adolescent/adult.Empathy/comments on other’s emotions.The focus of this item is on the participants communication of his/her understanding and empathy for the feelings of other people, real or conveyed in stories or other tasks.

ADOS

Was it true what Peter said?Why did he say it?

White lie (Hat)

One day Aunt Jane came to visit Peter. Now Peter loves his aunt very much, but today she is wearing a new hat; a new hat which Peter thinks is very ugly indeed. Peter thinks his aunt looks silly in it, and much nicer in her old hat. But when Aunt Jane asks Peter, “How do you like my new hat?” Peter says, “Oh, it’s very nice”.

A Clinical Assessment Tool for Advanced Theory of Mind Performance in 5 to 12 Year Olds

J Autism Dev Disord. 2009; 39(6): 916-928

IncorrectPHYSICALIt’s got a(u)nts on itIt looked nicePSYCHOLOGICALHe liked the hatHe wanted oneHe liked the old hat

Physical State (2P)The lady asked himIt looked horrible

Partial Psychological State (2M)He didn’t want to get a rowHe didn’t want to get into troubleHe didn’t like the hatHe loved his aunt

Psychological State Full and Accurate Answer (2M)To make his auntie feel that he likes itHe didn’t want his auntie to think that he didn’t like itHe didn’t want her to get sad/to make his auntie sadHe didn’t want to hurt her feelingsHe didn’t want to upset his auntieSo his auntie wouldn’t be offendedHe didn’t want to tell her he hated itHe didn’t want to be rudeHe didn’t want to be nasty to herHe wanted to make his auntie feel goodHe wanted to make his auntie happy

Story 5;0-5;11 6;0-6;11 7;0-7;11 8;0-8;11 9;0-9;11 10;0-10;11

11;0-11;11

12;0-12;11

P-value

1 Lie (Dentist) 0.75 0.83 1.44 1.43 1.33 1.57 1.45 1.29 0.004

2 White Lie (Hat) 0.50 1.00 1.31 1.40 1.83 1.71 1.73 1.86 <0.001

3 Misunderstanding (Glove) 0.00 0.43 0.69 1.00 1.17 1.57 1.23 1.43 <0.001

4 Sarcasm (Picnic) 0.00 0.09 0.62 0.62 0.78 0.90 1.14 1.71 <0.001

5 Persuasion (Kittens) 0.00 0.30 0.44 0.67 1.39 1.43 1.36 1.71 <0.001

6 Contrary Emotion (Swings) 0.67 0.48 0.75 0.52 1.56 1.19 0.95 1.43 0.002

7 Pretend (Bananas) 1.00 0.61 1.50 1.05 1.56 1.52 1.59 1.86 <0.001

8 Joke (Haircut) 0.25 0.17 0.69 0.95 1.06 0.67 1.05 1.71 <0.001

9 Figure of Speech (Cough) 0.00 0.13 0.31 0.62 1.17 0.81 1.05 1.57 <0.001

10 Double Bluff (Ping-Pong) 0.00 0.48 0.56 0.62 0.67 1.14 0.55 0.86 0.006

11 Appearance/Reality (Santa Claus)

1.00 1.00 1.19 1.24 1.39 1.48 1.50 1.57 0.001

12 Forget (Doll) 0.50 0.83 1.38 1.24 1.17 1.57 1.09 2.00 0.001

Total 4.67 6.35 10.88 11.65 15.06 15.57 14.68 19.00 <0.001

Mean scores for individual stories and the total according to age for Question 2M. P-value is for significance of association with

age

Lower limit: Total = -13.76 + 1.96 x age

Question 2M (psychological/mental state) : Age specific lower limits calculated by subtracting twice the residual

standard deviation from the linear regression line

Autism and Reactive Attachment Disorder: some research

evidenceSocial relationship difficulties in autism and reactive attachment disorder; improving diagnostic validity through structured assessment.

Davidson C, Minnis H, O'Hare A, MacTaggart F, Green J, Gillberg C, Young D

Submitted to Journal of Child Psychology and Psychiatry

RAD “is a syndrome characterised by relative failure to develop committed intimate social relationships” Michael Rutter JCPP 2009

“…the clearest early sign [of autism], is when a child seems to lose interest in social interaction”

Cathy Lord, NYU Child Study Centre

Disorders of social interaction

Deficits in social communication and social interaction

Restricted, repetitive behaviours, interests and activities

Autism spectrum disorders

Highly heritable

Usually life-long

NOT related to abuse, neglect or “refrigerator parenting”!

Autism spectrum disorders

Disinhibited type indiscriminate sociability with marked inability to exhibit appropriate selective attachments

Reactive Attachment Disorder

N.B. now called Disinhibited Social Engagement Disorder in DSM V

Inhibited type excessively inhibited, hypervigilant or highly ambivalent and contradictory responses

Reactive Attachment Disorder

Emotional, behavioural and developmental features indicative of neglect or emotional abuse in preschool

children: a systematic review(Naughton, JAMA Pediatric 2013)

Key features in the child:

Aggression (11 studies): exhibited as angry, disruptive behaviour, conduct problems, oppositional behaviour and low ego control

Withdrawal or passivity (12 studies): including negative self esteem, anxious or avoidant behaviour, poor emotional knowledge and difficulties in interpreting emotional expressions in others

Developmental delay (17 studies): delayed language, cognitive function and overall development quotient

Poor peer interaction (5 studies): poor social interactions, unlikely to act to relieve distress in others

Transition (6 studies): from ambivalent to avoidant insecure attachment pattern and from passive to increasingly aggressive behaviour and negative self-representation

Emotional, behavioural and developmental features indicative of neglect or emotional

abuse in preschool children: a systematic review(Naughton, JAMA Pediatric 2013)

Children aged 20-30 months: Less positive social interaction Toddler spent the least time with adults and

were avoidant even of their mothers Deficits of memory in neglected children

Children aged 3-4 years:• Specific delays in receptive language • In free play and play initiated by a

parent, neglected children demonstrated significantly more negative affect

• Ability to discriminate amongst emotions did not differ between groups of abused, emotionally neglected and physically neglected children with IQ as entered as a co-variate.

Emotional, behavioural and developmental features indicative of neglect or emotional abuse

in preschool children: a systematic review(Naughton, JAMA Pediatric 2013)

Children aged 4-5 years:• Delay in syntatic development of language• Increasing social difficulties in interaction with other

children• Lower scores on cognitive functioning• Exhibited disruptive behaviour that correlated with

aggression• Neglected children perceive other children as responding

less often to relieve their distress• Neglected children have difficulty recognising angry faces,

preferentially selecting sad faces, more difficulty in discriminating among emotional expressions

• Neglected children are more likely to demonstrate under-controlled or ambivalent emotional response to simulated intra-adult aggression



Children aged 5-6 years:• Low self esteem• Insecure avoidant pattern of attachment• Self-rating as angry and oppositional• Rating others as sad, hurt or anxious• Poor peer relationship



The Scottish Index of Multiple Deprivation (SIMD) quintile for our sample:

Children:

SIMD 1 SIMD 2 SIMD 3 SIMD 4 SIMD 5

Note: According to the Scottish Index of Multiple Deprivation, SIMD 1 is the most deprived and SIMD 5 is the least deprived.

Total LAC Population in Edinburgh 1998-2012

Citation from Stuart Osborough. Planning and performance, City of Edinburgh Council. Putting the looked after children population in context. 2012.

The national picture for Looked After Children (LAC) populations 2011• LAC 1.5%• 34% of LAC ‘at home’• Ratio kinship; residential is 10:1• 59% under 12 years• 30% in LAC for over 3 years

Additional Support Needs (Social)

Reasons for being in day care• Respite/befriending• Share the care

Reasons for being in foster care• Neglect• Physical abuse• Behavioural difficulties• Supervise parental visits

Reasons for being in residential care

• Adolescent inpatient unit• Homeless young person

Reasons for under guardianship

• Parental abuse• Parental substance misuse• Under care of grandparents

Reasons for being under child protection

• Domestic violence• Inappropriate underage sexual

activity• Parental substance misuse• Physical violence• Parental psychotic illness

Identified risk factors for ASD

Risk factor % Child cases % Adult cases % Overall

Neurological disorder associated with ASD 4 3 3

Intellectual disability 21 37 29

Speech delay 55 47 51

Speech regression 9 3 6

Premature (born 35 weeks or below) 11 3 7

Additional support needs (education) 84 23 55

Involved in supported social care (adults only) n/a 23 n/a

Family history of ASD 14 9 11

Family history of related condition 44 14 30

Parental history of psychosis/affective disorder 34 7 21

























Antenatal risk factors : ASD

• Maternal folic acid supplements associated with reduced autism risk in the child (Suren et al, JAMA 2013 309 570-7)

• Schmidt 2013 Evidence for gestational nutrition influences on autism risk: renewed findings for iron (IMFAR abstract 2013)

• Offspring with a prenatal history of maternal depression were at higher risk of autism spectrum disorder, particularly autism without intellectual disability (Rai D, BMJ 2013 343)

• High maternally derived intrauterine androgen concentrations eg gestational diabetes, obstetric suboptimality may be a major environmental cause of autism (James, DMCN 2012)

Adjusted odds ratios (95% confidence intervals) for relation between maternal depression and autism spectrum disorder overall and autism with and without intellectual disability in

main and supplementary analyses (tables S3-S7).

Rai D et al. BMJ 2013;346:bmj.f2059

©2013 by British Medical Journal Publishing Group

Select findings after controlling for race, ethnicity, and mother’s education.

Close H A et al. Pediatrics 2012;129:e305-e316

©2012 by American Academy of Pediatrics

What do children with ASD look like on measures of

RAD?

Three groups (RAD, ASD, GP comparison) matched on age and verbal IQ

58 children with ASD recruited through Lothian and Lanarkshire

67 children with RAD

from previous studies

61 typically developing

children from previous studies

• Parent-report semi-structured interview on RAD symptoms

• Teacher questionnaire

• Videotaped observation for interaction with strangers

• Cognitive assessment

Assessment of children with ASD:

• Parent-report semi-structured interview on RAD symptoms (CAPA-RAD)

• Parent-report semi-structured interview for other diagnoses (DAWBA)

• Teacher questionnaire (RPQ)• Cognitive assessment in school with

videotaped observation for interaction with strangers


RAD?


RAD?

Table 1: group characteristics

Gender Mean Age & Standard Deviation

Mean full Scale IQ (FIQ)

Mean Verbal IQ (VIQ)

Mean performance IQ (PIQ)

Difference between VIQ & PIQ

RAD 45 Males (67%)

22 (33%)

7.08,

1.42 std

96.37 1

97.69

95.38

1.32

ASD 46 (79%) males

12 (21%) girls

7.97

1.96 std

88.783 83.92 98.31 14.39

Typically developing

38 (62%) males

23 (38%) girls

7.00

1.56 std

109.065

110.95

105.74 5.21

Differences between disinhibited symptom rates in RAD and ASD group

RAD ASD Significance level

Cuddliness with strangers

29 (45%) 8 (14 %) <0.001

Indiscriminate Adult Relationships (is a problem)

36 (55%) 5 (10%) <0.001

Comfort seeking from strangers

13 (20%) 0 <0.001

Personal Questions 34 (52%) 9 (16%) <0.001

Minimal Checking (is a problem)

31 (48%) 16 (28%) <0.001


RAD?

Differences between inhibited symptom rates in RAD and ASD group

Unpredictable Reunion response

12 (18%) 7 (12%) 0.327

Frozen watchfulness 8 (18%) 7 (12%) 0.388

Hypervigilance 19 (39%) 11 (19%) < 0.05

Avoids eye contact 38 (58%) 38 (66%) 0.421


RAD?


RAD?

Prosody and its relationship to language in school aged children with high functioning

autism (HFA)

• Disordered expressive prosody characteristic of the speech in people with autism.

• “Not what you say but how you say it” - attitude and emotion, emphasis, conversational turns.

• Impacts on socialising and making friends.• All children with HFA had a difficulty with prosody• This correlates with receptive and expressive

language• Prosody (PEPS-C) and theory of mind impairment

correlate• Abnormal prosody persists over time

• Disordered expressive prosody characteristic of the speech in people with autism.

• “Not what you say but how you say it” - attitude and emotion, emphasis, conversational turns.

• Impacts on socialising and making friends.• All children with HFA had a difficulty with prosody• This correlates with receptive and expressive

language• Prosody (PEPS-C) and theory of mind impairment

correlate• Abnormal prosody persists over time

McCann J, Peppe S, Gibbon F, O’Hare A, Rutherford M. International Journal of Language and Communication Disorders 2007; 42 (6) 682-702

Carroll L. Language development and its relationship to theory of mind in children with high functioning autism. 2007

Receptive and expressive prosodic ability in children with high-functioning autism

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Accuracy of signs and symptoms to predict ASD

Diagnostic Tool Quality assessment Summary of Findings

Number Diagnostic accuracy

Studies Design Limit-ations

Incons-istency

Indirect-ness

Quality ASD Con- trols

Sensitivity(95%CI)

Specificity (95%CI)

PRE-SCHOOL CHILDREN (0-5 years)

Failure to perform protodeclarative pointing, gaze monitoring and pretend play

1 Con obs

Some NA None Very low 10 23 100 (100,100)

100 (100,100)

Failure to perform protodeclarative pointing or protodeclarative pointing and pretend play

1 Con obs


70 (51,88)

No pretend play 1 Con obs


63 (41,85)

No functional play 1 Con obs

Some NA None Very low 10 19 40 (10,70) 84 (68,100)

No facial concern in response to others distress

1 Con obs


68 (48,89)

No attention to distress 1 Con obs


Atypical use of object 1 Con obs


77 (64,88)

Lack of orienting to name 2 Con obs


65

Accuracy of signs and symptoms to predict ASD

Diagnostic Tool Quality assessment Summary of Findings

Number Diagnostic accuracy

Studies Design Limit-ations

Incons-istency

Indirect-ness

Quality ASD Con- trols

Sensitivity (95%CI)

Specificity (95%CI)

PRIMARY SCHOOL CHILDREN (6-11 years)

No social play 1 Con obs

Serious NA None Very low 20 37 90 (77,100)

100 (100,100)

Social isolation 1 Con obs

Serious NA None Very low 20 37 80 (62,98) 70 (51,88)

No respect for personal boundaries

1 Con obs


Socially inappropriate behaviour

1 Con obs


Unable to follow rules of a game

1 Con obs


68 (48,89)

Doesn’t respond to winning/losing a game

1 Con obs


100 (100,100)

Doesn’t initiate communication with peers

1 Con obs


Doesn’t sustain conversation with peers

1 Con obs


88 (79,94)

Gross motor inco-ordination 1 Con obs


No functional use of playground equipment

1 Con obs


66

Discrimination maps for the five different morphometric features in the left and right hemispheres

• Mundy (2003): PET scanning of children undergoing hemispherectomy showed that left frontal hemisphere was predictive of being able to initiate joint attention

• Herber (2006): the implicit matching of emotions subserved by the subcortical limbic system, explicit by the prefrontal cortex

• Ecker (2010): the neuroanatomy of autism is inherently difficulty to describe. A multi-parametric classification showed that the neuroanatomy of autism is truly multidimensional and affects multiple and most likely independent cortical features

• Lombardo (2010): atypical neural self representation in autism

EEG in 5 year old girl with LKS

Neuroscience modalities for measuring empathy

Using eye tracking as an early assessment of cognitive and social functioning in at-risk infant groups

Karri Gillespie-Smith, Sue Fletcher-Watson, James Boardman, Ian Murray, Jane Norman, Anne O’Hare

INTRODUCTION

• Recent studies have identified that eye-tracking gaze behaviours in at-risk infants are predictive of later ASD diagnosis.

• Edinburgh Perinatal Injury Research Group are interested in exploring these same effects in babies born premature.

• We have developed novel eye-tracking assessments measuring social and cognitive constructs in typically developing infants aged 6-12 months.

• We explore if we can create valid cognitive assessments for the 1st year of life and relate these to clinically relevant variables.

METHODOLOGY

PARTICIPANTS

• 30 typically developing infants (16 female; 14 male)• Age = 182–366 days old

PROCEDURE

• An eye-tracking battery was presented in three 8 minute blocks combining both novel visual tasks with previously tested tasks provided by British Autism Study of Infant Siblings (BASIS)

• Additional measures were also collected to investigate the relationship between eye tracking tasks, maternal mental health and stress

METHODOLOGY

AB

C D E

(A) Memory (B) Gap-Overlap Task (C) Face Scanning (D) Pop-Out Task (E) Social Scene Preference

Results: Validation of Tasks

Significant age effect with performance in memory task which indicated older infants showed a novelty effect and younger infants showed a familiarity effect (p<0.05)

Significant correlation between age and novelty effect during the memory task with

2000 (ms) gap only

Results: Links to Clinical Markers

Significant correlation between hassle scores and standardized social scores

Significant correlation between Daily Hassles Score and Social Score showing that mothers who view tasks as less stressful show more pro-social gaze (p<0.05)

DISCUSSION

Infants show high social preferences. Social tasks correlated with each other (validating new cognitive tasks); standardized social score was created.

Eye gaze data correlated with with clinical markers ie social standardized score and maternal stress/hassle; novel or familiarity preferences during memory task with age.

Future research directions will involve developing more visual tasks and exploring eye-tracking further as a clinical marker in at-risk infant groups ie babies born pre-term.

Grateful thanks to …

Prosody: Fiona Gibbon, Joanne McCann J, Sue Peppe, Leanne Carroll, Queen Margaret University, Edinburgh; Marion Rutherford, Royal Hospital for Sick Children, Edinburgh.

Dyspraxia/Sensory: Amanda Adamson, Kirsty Forsyth, Jill Gorzkowska, Queen Margaret University; Rob Elton, University of Edinburgh.

Mentalising Assessment: Lynne Bremner, Marysia Nash, Royal Hospital for Sick Children, Edinburgh.

Prevalence ASD: Harry Campbell, Mark Harrison, Edinburgh University.

Leukaemia and CNS: Tim Eden, Midge Clarke, Keith Brown, University of Edinburgh.

Autism Achieve Alliance: Iain McClure, Karen McKenzie, University of Edinburgh; Kirsty Forsyth, Marion Rutherford, Ciara Catchpole, Tess Johnson, Ashley Peter, Deborah McCartney, Queen Margaret University

ISS: Eye tracking: Karri Gillespie-Smith, Sue Fletcher-Watson, James Boardman, Ian Murray, Jane Norman, University of Edinburgh

Autism & Reactive Attachment Disorder: Fiona Minnis, Claire Davidson, Glasgow University; Fiona MacTaggart, NHS Lothian.

Prosody: Fiona Gibbon, Joanne McCann J, Sue Peppe, Leanne Carroll, Queen Margaret University, Edinburgh; Marion Rutherford, Royal Hospital for Sick Children, Edinburgh.

Dyspraxia/Sensory: Amanda Adamson, Kirsty Forsyth, Jill Gorzkowska, Queen Margaret University; Rob Elton, University of Edinburgh.

Mentalising Assessment: Lynne Bremner, Marysia Nash, Royal Hospital for Sick Children, Edinburgh.

Prevalence ASD: Harry Campbell, Mark Harrison, Edinburgh University.

Leukaemia and CNS: Tim Eden, Midge Clarke, Keith Brown, University of Edinburgh.

Autism Achieve Alliance: Iain McClure, Karen McKenzie, University of Edinburgh; Kirsty Forsyth, Marion Rutherford, Ciara Catchpole, Tess Johnson, Ashley Peter, Deborah McCartney, Queen Margaret University

ISS: Eye tracking: Karri Gillespie-Smith, Sue Fletcher-Watson, James Boardman, Ian Murray, Jane Norman, University of Edinburgh

Autism & Reactive Attachment Disorder: Fiona Minnis, Claire Davidson, Glasgow University; Fiona MacTaggart, NHS Lothian.

Funders:

CSO Action Medical Research ESRC MRC Autism Speaks NHS QIS RHSC Friends Foundation (Autism Research and Development Fund) Scottish Executive Surestart Programme and Innovation Fund NHS HTA Research and Development Fund, Western Hospital, Toronto LUHTR&D Action Against Autism Wellcome ISSF

Funders:

CSO Action Medical Research ESRC MRC Autism Speaks NHS QIS RHSC Friends Foundation (Autism Research and Development Fund) Scottish Executive Surestart Programme and Innovation Fund NHS HTA Research and Development Fund, Western Hospital, Toronto LUHTR&D Action Against Autism Wellcome ISSF

Documents

Professor Anne O’Hare ARICD 15 International Scientific Meeting Birmingham 2013 Current Perspectives on Child Development in the 21 st Century Cognitive