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Item A Quality Improvement Network for Interdisciplinary Training in Developmental Disabilities(American Academy of Pediatrics, 2022-11-09) Smith, Jennifer D.; Nidey, Nichole; Chödrön, Gail S.; Czyzia, Jackie; Donahue, Michelle L.; Ford, Kristie; James, Cristina; Klimova, Oksana; Macias, Michelle M.; Rabidoux, Paula; Whitaker, Toni M.; Brosco, Jeffrey P.; Pediatrics, School of MedicineChildren with developmental disabilities (DD), such as autism spectrum disorder (ASD), have complex health and developmental needs that require multiple service systems and interactions with various professionals across disciplines. The growing number of children and youth identified with ASD or DD, including anxiety and depression, has increased demand for services and need for highly qualified pediatric providers. Federally funded Leadership Education in Neurodevelopmental and related Disabilities (LEND) programs across the United States address today's health care shortages by providing comprehensive, interdisciplinary training to providers from multiple pediatric disciplines who screen, diagnose, and treat those with ASD and DD. Each LEND program develops training methods independently, including quality improvement efforts. In 2014, LEND programs began designing and validating common measures to evaluate LEND training. The LEND Program Quality Improvement (LPQI) Network was established in 2016. Participating LEND programs in the LPQI Network administer validated trainee self-report and faculty-observation measures that address skills in key competency domains of Interdisciplinary or Interprofessional Team Building, Family-Professional Partnerships, and Policy. This study reports data from faculty and trainees from 22 LEND programs that participated in the LPQI Network across the 5-year data collection period. The main outcome of this study was the change in trainee knowledge, skills, and attitudes scores in key competency domains across programs. Overall, trainees made significant knowledge, skills, and attitude gains based on both self-report and faculty observation scores for all 3 competency domains. Data demonstrate the value of LEND programs and feasibility of a national quality improvement approach to evaluate interdisciplinary training and systems-level improvement.Item Assessment and Treatment of Noise Hypersensitivity in a Teenager with Autism Spectrum Disorder: A Case Study(Springer, 2021-06) Fodstad, Jill C.; Kerswill, Stephanie A.; Kirsch, Alexandra C.; Lagges, Ann; Schmidt, Jonathan; Psychiatry, School of MedicineNoise hypersensitivity is a poorly understood symptom of Autism Spectrum Disorder (ASD). For some, problem behaviors co-occur with the aversive noise. Limited literature exists on treating noise hypersensitivity; however, noise hypersensitivity may be related to a specific phobia. This case study utilizes modified Cognitive Behavioral Therapy (CBT) to address anxiety, avoidance, and problem behaviors evoked by noise in a teen with ASD and mild Intellectual Disability (ID). Using multi-method assessment and individualized treatment, problem behaviors reduced, and independent coping strategies use occurred. Successful desensitization supports the efficacy of modified CBT as a treatment for noise-related anxiety and problem behaviors in individuals with ASD and ID. Outcomes are discussed considering intervention difficulties for noise hypersensitivity in a complex and diverse population.Item Auditory Attentional Disengagement in Children with Autism Spectrum Disorder(Springer, 2019-06-14) Keehn, Brandon; Kadlaskar, Girija; McNally Keehn, Rebecca; Francis, Alexander L.; Pediatrics, School of MedicineDespite early differences in orienting to sounds, no study to date has investigated whether children with ASD demonstrate impairments in attentional disengagement in the auditory modality. Twenty-one nine- to fifteen year old children with ASD and 20 age- and IQ-matched TD children were presented with an auditory gap-overlap paradigm. Evidence of impaired disengagement in ASD was mixed. Differences in saccadic reaction time for overlap and gap conditions did not differ between groups. However, children with ASD did show increased no-shift trials in the overlap condition, as well as reduced disengagement efficiency compared to their TD peers. These results provide further support for disengagement impairments in ASD, and suggest that these deficits include disengaging from and shifting to unimodal auditory information.Item The Autism Simplex Collection: an international, expertly phenotyped autism sample for genetic and phenotypic analyses(BioMed Central, 2014-05) Buxbaum, Joseph D.; Bolshakova, Nadia; Brownfeld, Jessica M.; Anney, Richard J. L.; Bender, Patrick; Bernier, Raphael; Cook, Edwin H.; Coon, Hilary; Cuccaro, Michael; Freitag, Christine M.; Hallmayer, Joachim; Geschwind, Daniel; Klauck, Sabine M.; Nurnberger, John I.; Oliveira, Guiomar; Pinto, Dalila; Poustka, Fritz; Scherer, Stephen W.; Shih, Andy; Sutcliffe, James S.; Szatmari, Peter; Vicente, Astrid M.; Vieland, Veronica; Gallagher, Louise; Department of Psychiatry, IU School of MedicineBackground There is an urgent need for expanding and enhancing autism spectrum disorder (ASD) samples, in order to better understand causes of ASD. Methods In a unique public-private partnership, 13 sites with extensive experience in both the assessment and diagnosis of ASD embarked on an ambitious, 2-year program to collect samples for genetic and phenotypic research and begin analyses on these samples. The program was called The Autism Simplex Collection (TASC). TASC sample collection began in 2008 and was completed in 2010, and included nine sites from North America and four sites from Western Europe, as well as a centralized Data Coordinating Center. Results Over 1,700 trios are part of this collection, with DNA from transformed cells now available through the National Institute of Mental Health (NIMH). Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule-Generic (ADOS-G) measures are available for all probands, as are standardized IQ measures, Vineland Adaptive Behavioral Scales (VABS), the Social Responsiveness Scale (SRS), Peabody Picture Vocabulary Test (PPVT), and physical measures (height, weight, and head circumference). At almost every site, additional phenotypic measures were collected, including the Broad Autism Phenotype Questionnaire (BAPQ) and Repetitive Behavior Scale-Revised (RBS-R), as well as the non-word repetition scale, Communication Checklist (Children’s or Adult), and Aberrant Behavior Checklist (ABC). Moreover, for nearly 1,000 trios, the Autism Genome Project Consortium (AGP) has carried out Illumina 1 M SNP genotyping and called copy number variation (CNV) in the samples, with data being made available through the National Institutes of Health (NIH). Whole exome sequencing (WES) has been carried out in over 500 probands, together with ancestry matched controls, and this data is also available through the NIH. Additional WES is being carried out by the Autism Sequencing Consortium (ASC), where the focus is on sequencing complete trios. ASC sequencing for the first 1,000 samples (all from whole-blood DNA) is complete and data will be released in 2014. Data is being made available through NIH databases (database of Genotypes and Phenotypes (dbGaP) and National Database for Autism Research (NDAR)) with DNA released in Dist 11.0. Primary funding for the collection, genotyping, sequencing and distribution of TASC samples was provided by Autism Speaks and the NIH, including the National Institute of Mental Health (NIMH) and the National Human Genetics Research Institute (NHGRI). Conclusions TASC represents an important sample set that leverages expert sites. Similar approaches, leveraging expert sites and ongoing studies, represent an important path towards further enhancing available ASD samples.Item Dysregulation of temporal dynamics of synchronous neural activity in adolescents on autism spectrum(Wiley, 2020-01) Malaia, Evie A.; Ahn, Sungwoo; Rubchinsky, Leonid L.; Mathematical Sciences, School of ScienceAutism spectrum disorder is increasingly understood to be based on atypical signal transfer among multiple interconnected networks in the brain. Relative temporal patterns of neural activity have been shown to underlie both the altered neurophysiology and the altered behaviors in a variety of neurogenic disorders. We assessed brain network dynamics variability in autism spectrum disorders (ASD) using measures of synchronization (phase-locking) strength, and timing of synchronization and desynchronization of neural activity (desynchronization ratio) across frequency bands of resting-state electroencephalography (EEG). Our analysis indicated that frontoparietal synchronization is higher in ASD but with more short periods of desynchronization. It also indicates that the relationship between the properties of neural synchronization and behavior is different in ASD and typically developing populations. Recent theoretical studies suggest that neural networks with a high desynchronization ratio have increased sensitivity to inputs. Our results point to the potential significance of this phenomenon to the autistic brain. This sensitivity may disrupt the production of an appropriate neural and behavioral responses to external stimuli. Cognitive processes dependent on the integration of activity from multiple networks maybe, as a result, particularly vulnerable to disruption.Item An EEG based Channel Optimized Classification Approach for Autism Spectrum Disorder(IEEE, 2019) Haputhanthri, Dilantha; Brihadiswaran, Gunavaran; Gunathilaka, Sahan; Meedeniya, Dulani; Jayawardena, Yasith; Jayarathna, Sampath; Jaime, Mark; IUPUC Division of ScienceAutism Spectrum Disorder (ASD) is a neurodevelopmental condition which affects a person's cognition and behaviour. It is a lifelong condition which cannot be cured completely using any intervention to date. However, early diagnosis and follow-up treatments have a major impact on autistic people. Unfortunately, the current diagnostic practices, which are subjective and behaviour dependent, delay the diagnosis at an early age and makes it harder to distinguish autism from other developmental disorders. Several works of literature explore the possible behaviour-independent measures to diagnose ASD. Abnormalities in EEG can be used as reliable biomarkers to diagnose ASD. This work presents a low-cost and straightforward diagnostic approach to classify ASD based on EEG signal processing and learning models. Possibilities to use a minimum number of EEG channels have been explored. Statistical features are extracted from noise filtered EEG data before and after Discrete Wavelet Transform. Relevant features and EEG channels were selected using correlation-based feature selection. Several learning models and feature vectors have been studied and possibilities to use the minimum number of EEG channels have also been explored. Using Random Forest and Correlation-based Feature Selection, an accuracy level of 93% was obtained.Item Effect of Parent Training on Adaptive Behavior in Children With Autism Spectrum Disorder and Disruptive Behavior: Results of a Randomized Trial(Elsevier, 2016-07) Scahill, Lawrence; Bearss, Karen; Lecavalier, Luc; Smith, Tristram; Swiezy, Naomi; Aman, Michael G.; Sukhodolsky, Denis G.; McCracken, Courtney; Minshawi, Noha; Turner, Kylan; Levato, Lynne; Saulnier, Celine; Dziura, James; Johnson, Cynthia; Department of Psychiatry, IU School of MedicineObjective This study examined the impact of parent training on adaptive behavior in children with autism spectrum disorder (ASD) and disruptive behavior. Methods This was a 24-week, 6-site, randomized trial of parent training versus parent education in 180 children with ASD (aged 3−7 years; 158 boys and 22 girls) and moderate or greater behavioral problems. Parent training included specific strategies to manage disruptive behavior over 11 to 13 sessions, 2 telephone boosters, and 2 home visits. Parent education provided useful information about autism but no behavior management strategies over 12 core sessions and 1 home visit. In a previous report, we showed that parent training was superior to parent education in reducing disruptive behavior in young children with ASD. Here, we test whether parent training is superior to parent education in improving daily living skills as measured by the parent-rated Vineland Adaptive Behavior Scales II. The long-term impact of parent training on adaptive functioning is also presented. Results At week 24, the parent training group showed a 5.7-point improvement from baseline on the Daily Living domain compared to no change in parent education (p = .004; effect size = 0.36). On the Socialization domain, there was a 5.9-point improvement in parent training versus a 3.1-point improvement in parent education (p = .11; effect size = 0.29). Gains in the Communication domain were similar across treatment groups. The gain in Daily Living was greater in children with IQ of >70. However, the interaction of treatment-by-IQ was not significant. Gains in Daily Living at week 24 were maintained upon re-evaluation at 24 weeks posttreatment. Conclusion These results support the model that reduction in disruptive behavior can lead to improvement in activities of daily living. By contrast, the expected trajectory for adaptive behavior in children with ASD is often flat and predictably declines in children with intellectual disability. In the parent training group, higher-functioning children achieved significant gains in daily living skills. Children with intellectual disability kept pace with time.Item Evidence for the Effectiveness of Occupation-Based Interventions to Improve Social Participation for School-Aged Autistic Children: A Rapid Systematic Review(2021-05-05) Hernandez, Jocelyne; Belkiewitz, Johnna; Feldman, Anna; Payne, Chafin; Smith, Cassie; Taylor, Abigail; Chase, Anthony; Department of Occupational Therapy, School of Health and Human SciencesA rapid systematic review of the literature was conducted to review effective occupational therapy interventions for promoting social participation in children with autism spectrum disorder (ASD) was conducted as part of the Evidence-Based Literature Review Project of the American Occupational Therapy Association. This review provides a comprehensive overview and analysis of 30 studies that addressed many of the occupation-based interventions commonly used for children with ASD. Findings reveal that the use of occupation-based activities has reasonable, yet limited evidence to support its effectiveness in increasing social participation within this population. This review supports the premise that many client factors can be positively affected through the use of several commonly used occupational therapy–related modalities and methods. Further research should be conducted assessing the implementation of these interventions by occupational therapy practitioners to ensure generalizability. The implications for occupational therapy practice, research, and education and limitations of reviewed articles are presented within this systematic review.Item An exploration of concomitant psychiatric disorders in children with autism spectrum disorder(Elsevier, 2019-01) Lecavalier, Luc; McCracken, Courtney E.; Aman, Michael G.; McDougle, Christopher J.; McCracken, James T.; Tierney, Elaine; Smith, Tristram; Johnson, Cynthia; King, Bryan; Handen, Benjamin; Swiezy, Naomi B.; Arnold, L. Eugene; Bearss, Karen; Vitiello, Benedetto; Scahill, Lawrence; Psychiatry, School of MedicineObjective We explored patterns of concomitant psychiatric disorders in a large sample of treatment-seeking children and adolescents with autism spectrum disorder (ASD). Methods Participants were 658 children with ASD (age 3–17 years; mean = 7.2 years) in one of six federally-funded multisite randomized clinical trials (RCT) between 1999 and 2014. All children were referred for hyperactivity or irritability. Study designs varied, but all used the Child and Adolescent Symptom Inventory or Early Childhood Inventory to assess Attention Deficit Hyperactivity Disorder (ADHD), Oppositional-Defiant Disorder (ODD), Conduct Disorder (CD), Anxiety Disorders, and Mood Disorders. In addition, several measures in common were used to assess demographic and clinical characteristics. Results Of the 658 children, 73% were Caucasian and 59% had an IQ >70. The rates of concomitant disorders across studies were: ADHD 81%, ODD 46%, CD 12%, any anxiety disorder 42%, and any mood disorder 8%. Two or more psychiatric disorders were identified in 66% of the sample. Of those who met criteria for ADHD, 50% also met criteria for ODD and 46% for any anxiety disorder. Associations between types of concomitant disorders and a number of demographic and clinical characteristics are presented. Conclusion In this well-characterized sample of treatment-seeking children with ASD, rates of concomitant psychiatric disorders were high and the presence of two or more co-occurring disorders was common. Findings highlight the importance of improving diagnostic practice in ASD and understanding possible mechanisms of comorbidity.Item An Exploratory Analysis of Current Autism Terminology Usage, Including Its Implications for Public Health and Special Education in the State of Indiana(2013-07-12) Brown, Stephen Lawrence; Jones, Josette F.; Gamache, Roland E.; Dixon, Brian E.Consistent under-reporting of autism cases by Indiana physicians to the Indiana Birth Defects and Problems Registry (IBDPR) has made quality autism-related data very difficult to obtain (Indiana Birth Defects and Problems Registry [IBDPR], 2011). As a result, the Indiana State Department of Health (ISDH) currently also utilizes data from billing information that it receives from hospital discharges. However, such cases must be investigated further because autism is often merely suspected as a possibility in the discharge data. A chart auditor must therefore review the child’s chart to determine if the condition is confirmed. Meanwhile, the Indiana Department of Education (IDOE) has a different diagnostic procedure from physicians for determining whether a student has an Autism Spectrum Disorder (ASD), which qualifies him or her for special education. A physician diagnosis of autism does not guarantee that a child will receive special education from public schools. With all of these current complications surrounding autism, announced changes in the definition of autism by the American Psychiatric Association (APA) will likely have effects on both the special education field and the public health field. There is a possibility that children who had previously received special education could cease to maintain their eligibility and may find it difficult to obtain benefits. The IDOE may find it necessary to reevaluate their criteria for determining special education eligibility. Additionally, public health officials may see the definition changes affect the number of autism cases they perceive their populations to have, thus impacting community and policy decisions. This study was performed as an attempt to investigate and compare the sources used by the IBDPR to obtain autism data, and determine whether or not the resulting data creates an accurate depiction of the autistic population of Indiana. It was also performed to speculate whether a stricter definition of autism will result in a higher quality of data for the IBDPR and a more consistent view on the disorder between the ISDH and the IDOE. Perhaps from such consistency and simpler definitions, future recorded data will more closely resemble that of reality, enabling the ISDH to utilize the IBDPR to its full extent. Using current definitions for an exploratory analysis of data from the past five years, a discrepancy clearly exists between the IBDPR and the reality of the population of Indiana.