A Replication and Extension of the PEERS Intervention: Examining Effects on Social Skills and Social Anxiety in Adolescents with Autism Spectrum Disorders Improvement in Social Competence Using a Randomized Trial of a Theatre Intervention for Children with Autism Spectrum Disorder A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders. Epidemiology of autism spectrum disorders in adults in the community in England. Teacher-implemented joint attention intervention: pilot randomized controlled study for preschoolers with autism. Developmental Profiles of Infants and Toddlers with Autism Spectrum Disorders Identified Prospectively in a Community-Based Setting Chelation for autism spectrum disorder (ASD). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial. Effects of a brief Early Start Denver model (ESDM)-based parent intervention on toddlers at risk for autism spectrum disorders: a randomized controlled trial. Theory of Mind Training in Children with Autism: A Randomized Controlled Trial Cognitive behavioral therapy for early adolescents with autism spectrum disorders and clinical anxiety: a randomized, controlled trial. Clinical assessment of autism in high-risk 18-month-olds Use of Social Stories to Improve Self-Regulation in Children with Autism Spectrum Disorders Reducing Specific Phobia/Fear in Young People with Autism Spectrum Disorders (ASDs) through a Virtual Reality Environment Intervention Randomized controlled trial of vitamin D supplementation in children with autism spectrum disorder Social Skills Training for Young Adults with High-Functioning Autism Spectrum Disorders: A Randomized Controlled Pilot Study Impact of comorbid autism spectrum disorders on stimulant response in children with attention deficit hyperactivity disorder: a retrospective and prospective effectiveness study. Five-fold increase in national prevalence rates of attention-deficit/hyperactivity disorder medications for children and adolescents with autism spectrum disorder, attention-deficit/hyperactivity disorder, and other psychiatric disorders: a Danish register-based study. The Coping Cat Program for Children with Anxiety and Autism Spectrum Disorder: A Pilot Randomized Controlled Trial Social involvement of children with autism spectrum disorders in elementary school classrooms. Effects of Cognitive-Behavioral Therapy on Anxiety in Children with Autism Spectrum Disorders: A Randomized Controlled Trial Autism spectrum disorders in extremely preterm children. The Effect of Karate Techniques Training on Communication Deficit of Children with Autism Spectrum Disorders The Social Communication Intervention Project: a randomized controlled trial of the effectiveness of speech and language therapy for school-age children who have pragmatic and social communication problems with or without autism spectrum disorder. Early intervention in 208 Swedish preschoolers with autism spectrum disorder. A prospective naturalistic study. Mindfulness-based therapy in adults with an autism spectrum disorder: a randomized controlled trial. The Efficacy of a Brief Behavioral Sleep Intervention in School-Aged Children With ADHD and Comorbid Autism Spectrum Disorder The effect of cognitive-behavioral therapy versus treatment as usual for anxiety in children with autism spectrum disorders: a randomized, controlled trial. A systematic review of peer-mediated interventions for children with autism spectrum disorder. Impact of Cognitive Behavioral Therapy on Observed Autism Symptom Severity During School Recess: A Preliminary Randomized, Controlled Trial Using the preschool language scale, fourth edition to characterize language in preschoolers with autism spectrum disorders. Sleep behaviors and sleep quality in children with autism spectrum disorders. Incorporating a Peer-Mediated Approach Into Speech-Generating Device Intervention: Effects on Communication of Preschoolers With Autism Spectrum Disorder. Improving emotion regulation with CBT in young children with high functioning autism spectrum disorders: a pilot study. A Pilot Study of Parent Training in Young Children with Autism Spectrum Disorders and Disruptive Behavior Effect of Omega-3 and -6 Supplementation on Language in Preterm Toddlers Exhibiting Autism Spectrum Disorder Symptoms A randomised controlled trial of an iPad‐based application to complement early behavioural intervention in Autism Spectrum Disorder Randomized comparative trial of a social cognitive skills group for children with autism spectrum disorder. The bidirectional association between sleep problems and autism spectrum disorder: a population-based cohort study Do Adults with Autism Spectrum Disorders Compensate in Naturalistic Prospective Memory Tasks? Managing Repetitive Behaviours in Young Children with Autism Spectrum Disorder (ASD): Pilot Randomised Controlled Trial of a New Parent Group Intervention Effectiveness of sensory integration interventions in children with autism spectrum disorders: a pilot study. A Virtual Week study of prospective memory function in autism spectrum disorders. Internet-based, randomized, controlled trial of omega-3 fatty acids for hyperactivity in autism. Innate Immunity Associated with Inflammatory Responses and Cytokine Production against Common Dietary Proteins in Patients with Autism Spectrum Disorder
This study aim ed to evaluate the Program for the Education and Enrichment of Relational Skills ( PEERS : Laugeson et al. in J Autism Dev Disord 39(4):596–606 , 2009 ) . PEERS focuses on improving friendship quality and social skills among adolescents with higher-functioning ASD . 58 participants aged 11–16 years-old were r and omly assigned to either an immediate treatment or waitlist comparison group . Results revealed , in comparison to the waitlist group , that the experimental treatment group significantly improved their knowledge of PEERS concepts and friendship skills , increased in their amount of get-togethers , and decreased in their levels of social anxiety , core autistic symptoms , and problem behaviors from pre-to post-PEERS . This study provides the first independent replication and extension of the empirically-supported PEERS social skills intervention for adolescents with ASD The efficacy of a peer-mediated , theatre-based intervention on social competence  in participants with autism spectrum disorder ( ASD ) was tested . Thirty 8-to-14 year-olds with ASD were r and omly assigned to the treatment ( n = 17 ) or a wait-list control ( n = 13 ) group . Immediately after treatment , group effects were seen on social ability , ( d = .77 ) , communication symptoms ( d = −.86 ) , group play with toys in the company of peers ( d = .77 ) , immediate memory of faces as measured by neuropsychological ( d = .75 ) and ERP methods ( d = .93 ) , delayed memory for faces ( d = .98 ) , and theory of mind ( d = .99 ) . At the 2 month follow-up period , group effects were detected on communication symptoms ( d = .82 ) . The results of this pilot clinical trial provide initial support for the efficacy of the theatre-based intervention BACKGROUND This prospect i ve study compared outcome for pre-school children with autism spectrum disorders ( ASD ) receiving autism-specific nursery provision or home-based Early Intensive Behavioural Interventions ( EIBI ) in a community setting . METHODS Forty-four 23- to 53-month-old children with ASD participated ( 28 in EIBI home-based programmes ; 16 in autism-specific nurseries ) . Cognitive , language , play , adaptive behaviour skills and severity of autism were assessed at intake and 2 years later . RESULTS Both groups showed improvements in age equivalent scores but st and ard scores changed little over time . At follow-up , there were no significant group differences in cognitive ability , language , play or severity of autism . The only difference approaching significance ( p = .06 ) , in favour of the EIBI group , was for Vinel and Daily Living Skills st and ard scores . However , there were large individual differences in progress , with intake IQ and language level best predicting overall progress . CONCLUSIONS Home-based EIBI , as implemented in the community , and autism-specific nursery provision produced comparable outcomes after two years of intervention CONTEXT To our knowledge , there is no published information on the epidemiology of autism spectrum disorders ( ASDs ) in adults . If the prevalence of autism is increasing , rates in older adults would be expected to be lower than rates among younger adults . OBJECTIVE To estimate the prevalence and characteristics of adults with ASD living in the community in Engl and . DESIGN A stratified , multiphase r and om sample was used in the third national survey of psychiatric morbidity in adults in Engl and in 2007 . Survey data were weighted to take account of study design and nonresponse so that the results were representative of the household population . SETTING General community ( ie , private households ) in Engl and . PARTICIPANTS Adults ( people 16 years or older ) . MAIN OUTCOME MEASURES Autism Diagnostic Observation Schedule , Module 4 in phase 2 vali date d against the Autism Diagnostic Interview-Revised and Diagnostic Interview for Social and Communication Disorders in phase 3 . A 20-item subset of the Autism-Spectrum Quotient self-completion question naire was used in phase 1 to select respondents for phase 2 . Respondents also provided information on sociodemographics and their use of mental health services . RESULTS Of 7461 adult participants who provided a complete phase 1 interview , 618 completed phase 2 diagnostic assessment s. The weighted prevalence of ASD in adults was estimated to be 9.8 per 1000 ( 95 % confidence interval , 3.0 - 16.5 ) . Prevalence was not related to the respondent 's age . Rates were higher in men , those without educational qualifications , and those living in rented social ( government-financed ) housing . There was no evidence of increased use of services for mental health problems . CONCLUSIONS Conducting epidemiologic research on ASD in adults is feasible . The prevalence of ASD in this population is similar to that found in children . The lack of an association with age is consistent with there having been no increase in prevalence and with its causes being temporally constant . Adults with ASD living in the community are socially disadvantaged and tend to be unrecognized OBJECTIVE The vast majority of children with an autism spectrum disorder ( ASD ) attend public preschools at some point in their childhood . Community preschool practice s often are not evidence based , and almost none target the prelinguistic core deficits of ASD . This study investigated the effectiveness of public preschool teachers implementing a vali date d intervention ( the Joint Attention and Symbolic Play/Engagement and Regulation intervention ; JASP/ER ) on a core deficit of autism , initiating joint attention . METHOD Sixteen dyads ( preschoolers with ASD and the public school teachers who worked in the child 's classroom ) were r and omly assigned to the 6-week JASP/ER intervention or a control group . RESULTS At the end of the intervention , JASP/ER teachers used more  JASP/ER strategies than the control teachers , and JASP/ER preschoolers used more joint attention in their classroom than control children . Additionally , JASP/ER children spent more time in supported engagement and less time in object engagement than control preschoolers on a taped play interaction . CONCLUSIONS Findings suggest that teachers were able to improve a core deficit of children with ASD in a public preschool context This prospect i ve , longitudinal , study charted the developmental profiles of young children with Autism Spectrum Disorders ( ASD ) identified through routine developmental surveillance . 109 children with Autistic Disorder ( AD ) , ‘ broader ’ ASD , and developmental and /or language delays ( DD/LD ) were assessed using the Mullen Scales of Early Learning ( MSEL ) at 12-months ( n = 10 assessment s ) , 18-months ( n = 45 assessment s ) , and 24-months ( n = 99 assessment s ) . The children with AD performed most poorly , overall , than the ASD and DD/LD groups on the MSEL . Furthermore , the children with AD/ASD displayed an uneven cognitive profile , with poorer performance on verbal ( particularly receptive language ) relative to nonverbal skills . There was also evidence of developmental slowing in verbal skills from 18- to 24-months for children on the spectrum , especially those with AD . Given that the poor receptive , relative to expressive , language profile emerges very early in life for children with AD/ASD , this cognitive profile may serve as an additional red flag to social attention and communication deficits . Receptive language should therefore be stringently monitored in any developmental surveillance program for autism spectrum disorders in the second year of life BACKGROUND It has been suggested that the severity of autism spectrum disorder ( ASD ) symptoms is positively correlated with the level of circulating or stored toxic metals , and that excretion of these heavy metals , brought about by the use of pharmaceutical chelating agents , results in improved symptoms . OBJECTIVES To assess the potential benefits and adverse effects of pharmaceutical chelating agents ( referred to as chelation therapy throughout this review ) for autism spectrum disorder ( ASD ) symptoms . SEARCH METHODS We search ed the following data bases on 6 November 2014 : CENTRAL , Ovid MEDLINE , Ovid MEDLINE In-Process , Embase , PsycINFO , Cumulative Index to Nursing and Allied Health Literature ( CINAHL ) and 15 other data bases , including three trials registers . In addition we checked references lists and contacted experts . SELECTION CRITERIA All r and omised controlled trials of pharmaceutical chelating agents compared with placebo in individuals with ASD . DATA COLLECTION AND ANALYSIS Two review authors independently selected studies , assessed them for risk of bias and extracted relevant data . We did not conduct a meta- analysis , as only one study was included . MAIN RESULTS We excluded nine studies because they were non-r and omised trials or were withdrawn before enrolment . We included one study , which was conducted in two phases . During the first phase of the study , 77 children with ASD were r and omly assigned to receive seven days of glutathione lotion or placebo lotion , followed by three days of oral dimercaptosuccinic acid ( DMSA ) .  Forty-nine children who were found to be high excreters of heavy metals during phase one continued on to phase two to receive three days of oral DMSA or placebo followed by 11 days off , with the cycle repeated up to six times . The second phase thus assessed the effectiveness of multiple doses of oral DMSA compared with placebo in children who were high excreters of heavy metals and who received a three-day course of oral DMSA . Overall , no evidence suggests that multiple rounds of oral DMSA had an effect on ASD symptoms . AUTHORS ' CONCLUSIONS This review included data from only one study , which had method ological limitations . As such , no clinical trial evidence was found to suggest that pharmaceutical chelation is an effective intervention for ASD . Given prior reports of serious adverse events , such as hypocalcaemia , renal impairment and reported death , the risks of using chelation for ASD currently outweigh proven benefits . Before further trials are conducted , evidence that supports a causal link between heavy metals and autism and methods that ensure the safety of participants are needed BACKGROUND Children with autism spectrum disorders often present with comorbid anxiety disorders that cause significant functional impairment .  This study tested a modular cognitive behavioral therapy ( CBT ) program for children with this profile . A st and ard CBT program was augmented with multiple treatment components design ed to accommo date or remediate the social and adaptive skill deficits of children with ASD that could pose barriers to anxiety reduction . METHOD Forty children ( 7 - 11 years old ) were r and omly assigned to 16 sessions of CBT or a 3-month waitlist ( 36 completed treatment or waitlist ) . Therapists worked with individual families . The CBT model emphasized behavioral experimentation , parent-training , and school consultation . Independent evaluators blind to treatment condition conducted structured diagnostic interviews and parents and children completed anxiety symptom checklists at baseline and posttreatment/postwaitlist . RESULTS In intent-to-treat analyses , 78.5 % of the CBT group met Clinical Global Impressions-Improvement scale criteria for positive treatment response at posttreatment , as compared to only 8.7 % of the waitlist group . CBT also outperformed the waitlist on diagnostic outcomes and parent reports of child anxiety , but not children 's self-reports . Treatment gains were maintained at 3-month follow-up . CONCLUSIONS The CBT manual employed in this study is one of the first adaptations of an evidence -based treatment for children with autism spectrum disorders . Remission of anxiety disorders appears to be an achievable goal among high-functioning children with autism OBJECTIVE This study was carried out to examine the efficacy of a 12-week , low-intensity ( 1-hour/wk of therapist contact ) , parent-delivered intervention for  toddlers at risk for autism spectrum disorders ( ASD ) aged 14 to 24 months and their families . METHOD A r and omized controlled trial involving 98 children and families was carried out in three different sites investigating the efficacy of a parent delivery of the Early Start Denver model ( P-ESDM ) , which fosters parental use of a child-centered responsive interaction style that embeds many teaching opportunities into play , compared to community treatment as usual . Assessment s were completed at baseline and 12 weeks later , immediately after the end of parent coaching sessions . RESULTS There was no effect of group assignment on parent-child interaction characteristics or on any child outcomes . Both groups of parents improved interaction skills , and both groups of children demonstrated progress . Parents receiving P-ESDM demonstrated significantly stronger working alliances with their therapists than did the community group . Children in the community group received significantly more intervention hours than those in the P-ESDM group . For the group as a whole , both younger child age at the start of intervention and a greater number of intervention hours were positively related to the degree of improvement in children 's behavior for most variables . CONCLUSIONS Parent-implemented intervention studies for early ASD thus far have not demonstrated the large effects seen in intensive-treatment studies . Evidence that both younger age and more intervention hours positively affect developmental rates has implication s for clinical practice , service delivery , and public policy Many children with Autism Spectrum Disorders ( ASD ) participate in social skills or Theory of Mind ( ToM ) treatments . However , few studies have shown evidence for their effectiveness . The current study used a r and omized controlled design to test the effectiveness of a 16-week ToM treatment in 8–13 year old children with ASD and normal IQs ( n = 40 ) . The results showed that , compared to controls , the treated children with ASD improved in their conceptual ToM skills , but their elementary underst and ing , self reported empathic skills or parent reported social behaviour did not improve . Despite the effects on conceptual underst and ing , the current study does not indicate strong evidence for the effectiveness of a ToM treatment on the daily life mindreading skills Clinical ly elevated anxiety is a common , impairing feature of autism spectrum disorders ( ASD ) . A modular CBT program design ed for preteens with ASD , Behavioral Interventions for Anxiety in Children with Autism ( BIACA ; Wood et al. , 2009 ) was enhanced and modified to address the developmental needs of early adolescents with ASD and clinical anxiety . Thirty-three adolescents ( 11 - 15 years old ) were r and omly assigned to 16 sessions of CBT or an equivalent waitlist period . The CBT model emphasized exposure , challenging irrational beliefs , and behavioral supports provided by caregivers , as well as numerous ASD-specific treatment elements . Independent evaluators , parents , and adolescents rated symptom severity at baseline and posttreatment/postwaitlist . In intent-to-treat analyses , the CBT group outperformed the waitlist group on independent evaluators ' ratings of anxiety severity on the Pediatric Anxiety Rating Scale ( PARS ) and 79 % of the CBT group met Clinical Global Impressions-Improvement scale criteria for positive treatment response at posttreatment , as compared to only 28.6 % of the waitlist group . Group differences were not found for diagnostic remission or question naire measures of anxiety . However , parent-report data indicated that there was a positive treatment effect of CBT on autism symptom severity . The CBT manual under investigation , enhanced for early adolescents with ASD , yielded meaningful treatment effects on the primary outcome measure ( PARS ) , although additional developmental modifications to the manual are likely warranted . Future studies examining this protocol relative to an active control are needed Earlier intervention improves outcomes for children with autism spectrum disorders ( ASDs ) , but existing identification tools are at the limits of st and ardization with 18-month-olds . We assessed potential behavioural markers of ASD at 18 months in a high-risk cohort of infant siblings of children with ASD . Prospect i ve data were collected using the Autism Diagnostic Observation Schedule ( ADOS ) and Autism Observation Scale for Infants ( AOSI ) on 155 infant siblings and 73 low-risk controls at 18 months . Infants were classified into three groups ( ASD sibs , non-ASD sibs , controls ) based on blind best-estimate diagnosis at age 3 . Fisher 's exact tests , followed by discriminant function analyses , revealed that the majority of informative ADOS items came from the social and behavioural domains , and AOSI items measuring behavioural reactivity and motor control contributed additional information . Findings highlight the importance of considering not only social-communication deficits , but also basic dimensions of temperament including state regulation and motor control when assessing toddlers with suspected ASD ABSTRACT A multiple baseline across participants design was used to evaluate the effects of Social Stories to help preschool-aged children with characteristics of Autism Spectrum Disorders ( ASD ) increase their engagement in functional behaviors and use sensory integrative-based strategies to promote self-regulation . Three children , 3–5 years old , from a self-contained preschool classroom were selected to participate in the study . The intervention package included reading individualized Social Stories that discussed desired behaviors and self-regulation strategies . The research ers measured the percentage of intervals in which participants engaged in desired behaviors . The frequency of desired behaviors increased for all participants . The use of self-regulation strategies varied across participants . These findings suggest that the intervention was successful in increasing desired behaviors of the three children . Further research is recommended on the effectiveness of embedding sensory integrative strategies into Social Stories . Practitioners may consider the use of Social Stories as a tool to increase independence and encourage self-regulated behaviors in children with characteristics of ASD Anxiety is common in children with autism spectrum disorders ( ASD ) , with specific fears and phobias one of the most frequent subtypes . Specific fears and phobias can have a serious impact on young people with ASD and their families . In this study we developed and evaluated a unique treatment combining cognitive behaviour therapy ( CBT ) with graduated exposure in a virtual reality environment ( VRE ) .  Nine verbally fluent boys with an ASD diagnosis and no reported learning disability , aged 7 to 13 years old , were recruited . Each had anxiety around a specific situation ( e.g. crowded buses ) or stimulus ( e.g. pigeons ) . An individualised scene was recreated in our ‘ wrap-around ’ VRE . In the VRE participants were coached by a psychologist in cognitive and behavioural techniques ( e.g. relaxation and breathing exercises ) while the exposure to the phobia/fear stimulus was gradually increased as the child felt ready . Each child received four 20–30 minute sessions . After participating in the study , eight of the nine children were able to tackle their phobia situation . Four of the participants completely overcame their phobia . Treatment effects were maintained at 12 months . These results provide evidence that CBT with VRE can be a highly effective treatment for specific phobia/fear for some young people with ASD . Trial Registration Controlled-Trials.com IS RCT N58483069 BACKGROUND Autism spectrum disorder ( ASD ) is a frequent developmental disorder characterized by pervasive deficits in social interaction , impairment in verbal and nonverbal communication , and stereotyped patterns of interests and activities . It has been previously reported that there is vitamin D deficiency in autistic children ; however , there is a lack of r and omized controlled trials of vitamin D supplementation in ASD children . METHODS This study is a double-blinded , r and omized clinical trial ( RCT ) that was conducted on 109 children with ASD ( 85 boys and 24 girls ; aged 3 - 10 years ) . The aim of this study was to assess the effects of vitamin D supplementation on the core symptoms of autism in children . ASD patients were r and omized to receive vitamin D3 or placebo for 4 months . The serum levels of 25-hydroxycholecalciferol ( 25 (OH)D ) were measured at the beginning and at the end of the study . The autism severity and social maturity of the children were assessed by the Childhood Autism Rating Scale ( CARS ) , Aberrant Behavior Checklist ( ABC ) , Social Responsiveness Scale ( SRS ) , and the Autism Treatment Evaluation Checklist ( ATEC ) . TRIAL REGISTRATION NUMBER UMIN-CTR Study Design : trial number : UMIN000020281 . RESULTS Supplementation of vitamin D was well tolerated by the ASD children . The daily doses used in the therapy group was 300 IU vitamin D3/kg/day , not to exceed 5,000 IU/day . The autism symptoms of the children improved significantly , following 4-month vitamin D3 supplementation , but not in the placebo group . This study demonstrates the efficacy and tolerability of high doses of vitamin D3 in children with ASD . CONCLUSIONS This study is the first double-blinded RCT proving the efficacy of vitamin D3 in ASD patients . Depending on the parameters measured in the study , oral vitamin D supplementation may safely improve signs and symptoms of ASD and could be recommended for children with ASD . At this stage , this study is a single RCT with a small number of patients , and a great deal of additional wide-scale studies are needed to critically vali date the efficacy of vitamin D in ASD Despite the psychosocial difficulties common among young adults with autism spectrum disorders ( ASD ) , little to no evidence -based social skills interventions exist for this population . Using a r and omized controlled trial ( RCT ) design , the current study tested the effectiveness of an evidence -based , caregiver-assisted social skills intervention known as PEERS for Young Adults  with high-functioning young adults with ASD ( ages 18–23 ) using self- and caregiver-report measures . Results revealed that treated young adults reported significantly less loneliness and improved social skills knowledge , while caregivers reported significant improvements in young adults ’ overall social skills , social responsiveness , empathy , and frequency of get-togethers . Results support the effectiveness of using this caregiver-assisted , manualized intervention for young adults with ASD BACKGROUND In the recent past , psychiatrists and paediatricians have avoided prescribing stimulant medication , such as methylpheni date and dexamphetamine to patients with autism spectrum disorders ( ASD ) because of both doubts about efficacy and concern that these medications make stereotypies worse . Recently , a number of small trials have suggested that methypheni date does have a role in the management of hyperactivity in children with autistic spectrum disorders . METHODS Children with ASD and attention deficit hyperactivity disorder ( ADHD ) , and children with ADHD without ASD received st and ard treatment with methypheni date from one specialist centre . A combination of st and ardized and novel outcome tools was used to allow both an exploratory retrospective study of 174 children and then a prospect i ve study of a further 52 children to be carried out . RESULTS After treatment with stimulants , the subjects in both groups showed statistically significant improvements in target symptoms of ' hyperactivity ' , ' impulsivity ' , ' inattention ' , ' oppositionality ' , ' aggression ' and ' intermittent explosive rage ' . The Clinical Global Impression-Improvement and efficacy index measures also improved in each group . In both the retrospective and the prospect i ve studies , there was no statistically significant difference in the degree of improvements between each group . Importantly , neither tics nor repetitive behaviours worsened in either group . Children in the ' ADHD-only ' group who were prescribed stimulants experienced significant ' nausea ' , ' giddiness ' , ' headaches ' and ' sleep difficulties ' , whereas sleep difficulties were the only side effect that emerged in children in the ASD with ADHD group . CONCLUSIONS Both studies presented here support previous findings from smaller studies that show children with autism and ADHD can respond as well to stimulants as children with ADHD alone . Although r and omized controlled trials remain the gold st and ard for efficacy studies , systems like this that allow clinicians to continue rigorous and consistent monitoring for many years have a valuable role to play . Furthermore , such monitoring systems which now exist electronically can easily accumulate large data sets and reveal details about long-term effectiveness and long-term side effects of medication that are unlikely to be discovered in short-term trials OBJECTIVE The purpose of this study was to estimate the prevalence and time trends in prescriptions of methylpheni date , dexamphetamine , and atomoxetine in children and adolescents , within three diagnostic groups : 1 ) autism spectrum disorder ( ASD ) , 2 ) attention-deficit/hyperactivity disorder ( ADHD ) , and 3 ) other psychiatric disorders . METHODS Data from six different national registers were used and merged to identify a cohort of all children and adolescents born in Denmark between 1990 and 2001 ( n=852,711 ) . Sociodemographic covariates on cohort members and their parents and lifetime prescriptions of methylpheni date , dexamphetamine , and atomoxetine were extracted from the registers . Prescriptions were also stratified by duration ( < 6 months . vs.≥ 6 months ) . RESULTS Sixteen percent of 9698 children and adolescents with ASD ( n=1577 ) , 61 % of 11,553 children and adolescents with ADHD ( n=7021 ) and 3 % of 48,468 children and adolescents with other psychiatric disorders ( n=1537 ) were treated with one or more ADHD medications . There was a significant increase in prescription rates of these medications for all three groups . From 2003 to 2010 , youth 6 - 13 years of age with ASD , ADHD , and other psychiatric disorders had 4.7-fold ( 4.4 - 4.9 ) , 6.3-fold ( 6.0 - 6.4 ) , and 5.5-fold ( 5.0 - 5.9 ) increases , respectively , in prescription rates of ADHD medications . CONCLUSION This is the largest study to date assessing stimulant treatment in children and adolescents with ASD , and is the first prospect i ve study quantifying the change over time in the prevalence of treatment with ADHD medications in a population -based national cohort of children and adolescents with ASD . The prevalence of stimulant treatment in youth with ASD of 16 % is consistent with earlier studies . The past decade has witnessed a clear and progressive increase in the prescription rates of medications typically used to treat ADHD in children and adolescents in Denmark . This increase is not limited to only those with ADHD , but includes others with neuropsychiatric disorders , including ASD . The risks and benefits of this practice await further study The purpose of this pilot study was to evaluate whether a modified version of the Coping Cat program could be effective in reducing anxiety in children with autism spectrum disorder ( ASD ) . Twenty-two children ( ages 8–14 ; IQ ≥ 70 ) with ASD and clinical ly significant anxiety  were r and omly assigned to 16 sessions of the Coping Cat program ( cognitive-behavioral therapy ; CBT ) or a 16-week waitlist . Children in the CBT condition evidence d significantly larger reductions in anxiety than those in the waitlist . Treatment gains were largely maintained at two-month follow-up . Results provide preliminary evidence that a modified version of the Coping Cat program may be a feasible and effective program for reducing clinical ly significant levels of anxiety in children with high-functioning ASD BACKGROUND Children with autism spectrum disorders ( ASD ) are increasingly included in general education classrooms in an effort to improve their social involvement . METHODS Seventy-nine children with ASD and 79 r and omly selected , gender-matched peers ( 88.6 % male ) in 75 early ( K-1 ) , middle ( 2nd-3rd ) , and late ( 4th-5th ) elementary classrooms across 30 schools completed social network surveys  examining each child 's reciprocal friendships , peer rejection , acceptance , and social involvement . RESULTS Across grade levels , peers less frequently reciprocated friendships with children with ASD than students in the matched sample . While children with ASD were not more likely to be rejected by peers , they were less accepted and had fewer reciprocal friendships than matched peers at each grade level . Although 48.1 % of children with ASD were involved in the social networks of their classrooms , children with ASD were more likely to be isolated or peripheral to social relationships within the classroom across all grade levels , and this difference is even more dramatic in later elementary grade s. CONCLUSIONS In inclusive classrooms , children with ASD are only involved in peers ' social relationships about half of the time , and appear to be even less connected with increasing grade level . Promoting children with ASD 's skills in popular activities to share with peers in early childhood may be a key preventive intervention to protect social relationships in late elementary school grade We compared the effects of a 16-week Cognitive-Behavioral Therapy ( CBT ) program and a Social Recreational ( SR ) program on anxiety in children with Autism Spectrum Disorders ( ASD ) . Seventy children ( 9–16 years old ) were r and omly assigned to either of the programs ( nCBT = 36 ; nSR = 34 ) . Measures on child ’s anxiety using the Spence Child Anxiety Scale — Child ( SCAS-C ) and the Clinical Global Impression — Severity scale ( CGI-S ) were administered at pre- , post-treatment , and follow-ups ( 3- and 6-month ) . Children in both programs showed significantly lower levels of generalized anxiety and total anxiety symptoms at 6-month follow-up on SCAS-C. Clinician ratings on the CGI-S demonstrated an increase in the percentage of participants rated as “ Normal ” and “ Borderline ” for both programs . Findings from the present study suggest factors such as regular sessions in a structured setting , consistent therapists , social exposure and the use of autism-friendly strategies are important components of an effective framework in the management of anxiety in children and adolescents with ASD OBJECTIVES To investigate the prevalence , correlates , and antecedents of autism spectrum disorders ( ASD ) in extremely preterm children . STUDY DESIGN We conducted a prospect i ve study of all births < 26 weeks gestation in the United Kingdom and Irel and in 1995 . Of 307 survivors at 11 years , 219 ( 71 % ) were assessed and compared with 153 term-born classmates . Parents completed the  Social Communication Question naire ( SCQ )  to assess autism spectrum symptoms , and ASD were diagnosed by using a psychiatric evaluation . An IQ test and clinical evaluation were also administered . Longitudinal outcome data were available for extremely preterm children . RESULTS Extremely preterm children had significantly higher SCQ scores than classmates ( mean difference , 4.6 points ; 95 % CI , 3.4 - 5.8 ) . Sixteen extremely preterm children ( 8 % ) were assigned an ASD diagnosis , compared with none of the classmates . By hospital discharge , male sex , lower gestation , vaginal breech delivery , abnormal cerebral ultrasound scanning results , and not having had breast milk were independently associated with autism spectrum symptoms . By 6 years , independent associates were cognitive impairment , inattention and peer problems , withdrawn behavior at 2.5 years , and not having had breast milk . CONCLUSIONS Extremely preterm children are at increased risk for autism spectrum symptoms and ASD in middle childhood . These symptoms and disorders were associated with neurocognitive outcomes , suggesting that ASD may result from abnormal brain development in this population Abstract This investigation examined the long term effect of Karate techniques training on communication of children with autism spectrum disorders ( ASD ) . Thirty school aged children with ASD were r and omly assigned to an exercise ( n = 15 ) or a control group ( n = 15 ) . Participants in the exercise group were engaged in 14 weeks of Karate techniques training .  Communication deficit at baseline , post-intervention ( week 14 ) , and at 1 month follow up were evaluated . Exercise group showed significant reduction in communication deficit compared to control group . Moreover , reduction in communication deficit in the exercise group at one month follow up remained unchanged compared to post-intervention time . We concluded that teaching Karate techniques to children with ASD leads to significant reduction in their communication deficit BACKGROUND Children who show disproportionate difficulty with the pragmatic as compared with the structural aspects of language are described as having pragmatic language impairment ( PLI ) or social communication disorder ( SCD ) . Some children who have PLI also show mild social impairments associated with high-functioning autism or autism spectrum disorder ( ASD ) . There is little robust evidence of effectiveness of speech- language interventions which target the language , pragmatic or social communication needs of these children . AIMS To evaluate the effectiveness of an intensive manualized social communication intervention ( SCIP ) for children who have PLI with or without features of ASD . METHODS & PROCEDURES In a single-blind RCT design , 88 children with pragmatic and social communication needs aged 5;11 - 10;8 , recruited from UK speech and language therapy services , were r and omly assigned in a 2:1 ratio to SCIP or to treatment-as-usual . Children in the  SCIP  condition received up to 20 sessions of direct intervention from a specialist research speech and language therapist working with supervised assistants . All therapy content and methodology was derived from an intervention manual . A primary outcome measure of structural language and secondary outcome measures of narrative , parent-reported pragmatic functioning and social communication , blind-rated perceptions of conversational competence and teacher-reported ratings of classroom learning skills were taken pre-intervention , immediately post-intervention and at 6-month follow-up . Analysis was by intention to treat . OUTCOMES & RESULTS No significant treatment effect was found for the primary outcome measure of structural language ability or for a measure of narrative ability . Significant treatment effects were found for blind-rated perceptions of conversational competence , for parent-reported measures of pragmatic functioning and social communication , and for teacher-reported ratings of classroom learning skills . CONCLUSIONS & IMPLICATION S There is some evidence of an intervention effect on blind and parent/teacher-reported communication outcomes , but not st and ardized language assessment outcomes , for 6 - 11-year-old children who have pragmatic and social communication needs . These findings are discussed in the context of the increasingly central role of service user outcomes in providing evidence for an intervention . The substantial overlap between the presence of PLI and ASD ( 75 % ) across the whole cohort suggests that the intervention may also be applicable to some verbally able children with ASD who have pragmatic communication needs Early intervention has been reported to improve outcome in children with autism spectrum disorders ( ASDs ) . Several studies in the field have been r and omized controlled trials ( RCTs ) . The aim of this study was to assess ASD outcome in a large naturalistic study . Two hundred and eight children , aged 20 - 54 months , with a clinical diagnosis of ASD were given intervention and monitored prospect ively in a naturalistic fashion over a period of 2 years . The toddlers were considered representative of all but the most severely multiple disabled preschool children with ASD in Stockholm county . They fell into three cognitive subgroups : one with learning disability , one with developmental delay , and one with normal intellectual functioning . Data on intervention type and intensity were gathered prospect ively in a systematic fashion . Intervention was classified into intensive applied behaviour analysis ( ABA ) and non-intensive , targeted interventions , also based on ABA principles . Children were comprehensively assessed by a research team before the onset of intervention , and then , again , 2 years later . Change in Vinel and adaptive behaviour scales composite scores from intake ( T1 ) to leaving the study ( T2 ) was set as the primary outcome variable . The research team remained blind to the type and intensity of interventions provided . One hundred and ninety-eight ( 95 % ) of the original sample s stayed in the study throughout the whole 2-year period and 192 children had a complete Vinel and composite score results both at T1 and T2 . Vinel and composite scores increased over the 2-year period . This increase was accounted for by the subgroup with normal cognitive functioning . There was no significant difference between the intensive and non-intensive groups . Individual variation was considerable , but no child in the study was " problem-free " at follow-up . Our data do not support that children with ASD generally benefit more from the most intensive ABA intervention programs than from less intensive interventions or targeted interventions based on ABA Research shows that depression and anxiety disorders are the most common psychiatric concern in autism spectrum disorders ( ASD ) . Mindfulness-based therapy ( MBT ) has been found effective in reducing anxiety and depression symptoms , however research in autism is limited . Therefore , we examined the effects of a modified MBT protocol ( MBT-AS ) in high-functioning adults with ASD . 42 participants were r and omized into a 9-week MBT-AS training or a wait-list control group . Results showed a significant reduction in depression , anxiety and rumination in the intervention group , as opposed to the control group . Furthermore , positive affect increased in the intervention group , but not in the control group . Concluding , the present study is the first controlled trial to demonstrate that adults with ASD can benefit from MBT-AS Objective : Sleep problems are common in children with autism spectrum disorders ( ASD ) and ADHD and impact adversely on child and parent well-being . The study evaluated the efficacy of a brief behavioral sleep intervention in children with comorbid ADHD – ASD . Method : A sub sample of children with ADHD – ASD ( n = 61 ; 5 - 13 years ; 89 % male ) participating in the Sleeping Sound With ADHD study were included in the current investigation . The sub sample comprised of 28 children r and omized to the sleep intervention group , while 33 were r and omized to usual clinical care .  The intervention consisted of two clinical consultations and a follow-up phone call covering sleep hygiene and st and ardized behavioral strategies . Results : Children with ADHD – ASD who received the intervention had large improvements in sleep problems and moderate improvements in child behavioral functioning 3 and 6 months post-r and omization . Conclusion : These findings suggest that a brief behavioral sleep intervention can improve sleep problems in children with ADHD – ASD OBJECTIVE To examine the efficacy of a modular cognitive-behavioral therapy ( CBT ) protocol relative to treatment as usual ( TAU ) among children with high-functioning autism spectrum disorders ( ASD ) and clinical ly significant anxiety .  METHOD A total of 45 children ( 7 - 11 years of age ) with high-functioning ASD and clinical ly significant anxiety were r and omized to receive 16 sessions of weekly CBT or TAU for an equivalent duration . After screening , assessment s were conducted at baseline , post-treatment , and 3-month follow-up . Raters were blind to treatment condition . RESULTS Youth receiving CBT showed substantial improvement relative to TAU on primary anxiety outcomes . Of 24 children r and omized to the CBT arm , 18 ( 75 % ) were treatment responders , versus only 3 of 21 children ( 14 % ) in the TAU arm . Gains were generally maintained at 3-month follow-up for CBT responders . CONCLUSIONS Relative to usual care , CBT adapted for anxious youth with high-functioning ASD demonstrates large effects in reducing anxiety symptoms . This study contributes to the growing literature supporting adapted CBT approaches for treating anxiety in youth with ASD BACKGROUND Peer mediated intervention ( PMI ) is a promising practice used to increase social skills in children with autism spectrum disorder ( ASD ) .  PMIs engage typically developing peers as social models to improve social initiations , responses , and interactions . METHOD The current study is a systematic review examining PMIs for children and adolescents with ASD conducted using group design s. Five studies met the pre-specified review inclusion criteria : four r and omized controlled trials and one pre- and post-test design . RESULTS Four of the studies were conducted in school setting s , whereas one study was conducted in a camp setting . The studies all reported that participants improved in social skills ( e.g. , social initiations , social responses , social communication ) post intervention . Additionally , sustainment , generalization , and fidelity of implementation were examined . CONCLUSION PMI is a promising approach to address social skills in children with ASD , and this approach can be conducted in meaningful real-word context s , such as schools . Limitations of the studies as well as future directions are discussed This study compared cognitive behavioral therapy ( CBT ) and treatment-as-usual ( TAU ) in terms of effects on observed social communication-related autism symptom severity during unstructured play time at school for children with autism spectrum disorders ( ASD ) . Thirteen children with ASD ( 7–11 years old ) were r and omly assigned to 32 sessions of CBT or community-based psychosocial treatment ( TAU ) for 16 weeks . The CBT program is based on the memory retrieval competition model and emphasizes the development of perspective-taking through guided behavioral experimentation supplemented with reflective Socratic discussion and supported by parent training and school consultation to promote generalization of social communication and emotion regulation skills . Trained observers blind to treatment condition observed each child during recess on two separate days at baseline and again at posttreatment , using a structured behavioral observation system that generates frequency scores for observed social communication-related autism symptoms .  CBT outperformed TAU at posttreatment on the frequency of self-isolation , the proportion of time spent with peers , the frequency of positive or appropriate interaction with peers , and the frequency of positive or appropriate peer responses to the target child ( d effect size range 1.34–1.62 ) . On average , children in CBT were engaged in positive or appropriate social interaction with peers in 68.6 % of observed intervals at posttreatment , compared to 25 % of intervals for children in TAU . Further investigation of this intervention modality with larger sample s and follow-up assessment s is warranted PURPOSE The Preschool Language Scale , Fourth Edition ( PLS-4 ; Zimmerman , Steiner , & Pond , 2002 ) was used to examine syntactic and semantic language skills in preschool children with autism spectrum disorders ( ASD ) to determine its suitability for use with this population . We expected that PLS-4 performance would be better in more intellectually able children and that receptive skills would be relatively more impaired than expressive abilities , consistent with previous findings in the area of vocabulary . METHOD Our sample consisted of 294 newly diagnosed preschool children with ASD . Children were assessed via a battery of developmental measures , including the PLS-4 . RESULTS As expected , PLS-4 scores were higher in more intellectually able children with ASD , and overall , expressive communication was higher than auditory comprehension . However , this overall advantage was not stable across nonverbal developmental levels . Expressive skills were significantly better than receptive skills at the youngest developmental levels , whereas the converse applied in children with more advanced development . CONCLUSIONS The PLS-4 can be used to obtain a general index of early syntax and semantic skill in young children with ASD . Longitudinal data will be necessary to determine how the developmental relationship between receptive and expressive language skills unfolds in children with ASD STUDY OBJECTIVES ( 1 ) Compare sleep behaviors of children with autism spectrum disorders ( ASD ) with sleep behaviors of typically developing ( TD ) children using the Children 's Sleep Habits Question naire ( CSHQ ) ; ( 2 ) compare sleep quality --defined as mean activity , sleep latency , number of awakenings , sleep efficiency and total sleep time -- of the cohort of children with ASD and TD , as measured by 10 nights of actigraphy ; and ( 3 ) estimate the prevalence of sleep disturbances in the ASD and TD cohorts . DESIGN Descriptive cross-sectional study . SETTING The Children 's Hospital of Philadelphia . PARTICIPANTS R and omly selected children from the Regional Autism Center . The ASD cohort of 59 children , aged 4 to 10 years , ( 26 with autism , 21 with pervasive developmental disorder-not otherwise specified [ PDD-NOS ] , and 12 with Asperger disorder ) were compared with 40 TD control subjects . MEASUREMENTS AND RESULTS The  CSHQ  ,  sleep diaries  , and 10 nights of actigraphy  using the Sadeh algorithm of children with ASD and TD control subjects were compared . CSHQ showed 66.1 % of parents of children with ASD ( 62.5 % autism , 76.2 % PDD-NOS , 58.3 % Asperger disorder ) and 45 % of parents of the control subjects reported that their children had sleep problems . Actigraphic data showed that 66.7 % of children with ASD ( 75 % autism , 52.4 % PDD-NOS , 75 % Asperger disorder ) and 45.9 % of the control subjects had disturbed sleep . CONCLUSIONS The prevalence estimate of 45 % for mild sleep disturbances in the TD cohort highlights pediatric sleep debt as a public health problem of concern . The prevalence estimate of 66 % for moderate sleep disturbances in the ASD cohort underscores the significant sleep problems that the families of these children face . The predominant sleep disorders in the ASD cohort were behavioral insomnia sleep-onset type and insomnia due to PDD Purpose This study examined the effects of incorporating a peer-mediated approach into a speech-generating device ( SGD ) intervention on communication of 45 nonverbal and minimally verbal preschoolers with autism spectrum disorder ( ASD ) and 95 peers without disabilities . The SGD was an iPad 2 ( Apple ) with voice output app . Method Effects were evaluated using a multivariate r and omized control trial design with repeated measures for 4 cohorts across baseline , intervention , generalization , and maintenance phases . Children were r and omly assigned to an experimental treatment that trained peers on use of the SGD or a business-as-usual comparison condition with untrained peers .  Communication outcomes were measured for both children with ASD and peers . Results Children receiving the treatment demonstrated significant increases in rates of communication and more balanced responses and initiations ( a measure of reciprocity ) than children in the comparison group . They were able to generalize improvements and maintain communication gains . Treatment fidelity was high for school staff and peer implementation . Conclusions Results support positive effects on communication of teaching young children with ASD and peers without disabilities to use the same SGD system in typical preschool activities . SGD interventions that utilize peer-mediated approaches may improve core deficits in communication and reciprocity and allow for greater classroom social participation and interactions with peers BACKGROUND AND AIMS This pilot study tested the efficacy of a developmentally modified CBT for young children with Autism Spectrum Disorders ( ASD ) to teach emotion regulation strategies for reducing anger and anxiety , commonly noted problems in this population . METHOD Eleven 5 - 7 year-old children participated in a CBT-group while parents participated in psychoeducation . Children were r and omly assigned to an experimental or delayed-treatment control group . RESULTS From pre- to post-treatment , all children had less parent reported negativity/lability , better parent reported emotion regulation , and shorter outbursts , and also generated more coping strategies in response to vignettes . Parents also reported increases in their own confidence and their child 's ability to deal with anger and anxiety . CONCLUSIONS This study suggests that young children with high functioning ASD may benefit from CBT to improve regulation of anger and anxiety , and parent training may improve parental self-efficacy . Future studies are needed to make conclusions about its efficacy Guidance on effective interventions for disruptive behavior in young children with autism spectrum disorders ( ASDs ) is limited . We present feasibility and initial efficacy data on a structured parent training program for 16 children ( ages 3–6 ) with ASD and disruptive behavior . The 6-month intervention included 11 Core and up to 2 Optional sessions . The program was acceptable to parents as evidence d by an attendance rate of 84 % for Core sessions . Fourteen of 16 families completed the treatment . An independent clinician rated 14 of 16 subjects as much improved or very much improved at Week 24 . Using last observation carried forward , the parent-rated Aberrant Behavior Checklist-Irritability subscale decreased 54 % from 16.00 ( SD = 9.21 ) to 7.38 ( SD = 6.15 ) Delayed language development may be an early indicator of autism spectrum disorder ( ASD ) . Early intervention is critical for children with ASD , and the present study presents pilot data on a clinical trial of omega-3 and -6 fatty acid supplementation and language development , a secondary trial outcome , in children at risk for ASD . We r and omized 31 children to receive an omega-3 and -6 supplement or a placebo for 3 months , and measured their language abilities at baseline and after supplementation . Gesture use , but not word production , increased for children in the treatment group more than children in the placebo group . These results suggest possible effectiveness of omega-3 and -6 supplementation for language development in children at risk for ASD BACKGROUND Technology-based interventions for Autism Spectrum Disorder ( ASD ) have proliferated , but few have been evaluated within the context of a r and omised controlled trial ( RCT ) . This RCT evaluated the efficacy of one technology-based early intervention programme ( Therapy Outcomes By You ; TOBY ) in young children with ASD . METHODS TOBY is an app-based learning curriculum design ed for children and parents as a complement to early behavioural intervention . Eighty children ( 16 female ) were recruited to this RCT within 12 months of receiving a diagnosis of ASD ( M age = 3.38 ; SD = 0.69 ) and r and omised to receive either treatment-as-usual ( community-based intervention , n = 39 ) or the TOBY therapy ( at least 20 min/day ) plus treatment-as-usual ( n = 41 ) for a period of 6 months . Outcomes were assessed at 3 and 6 months postbaseline . ( Australian New Zeal and Clinical Trials Registry : ACTRN12614000738628 ; www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?id=365463 ) . RESULTS Children in the TOBY intervention group averaged 19 min/day engaging with the app in the first 3 months , but only 2 min/day during the second 3 months . There was no group difference in scores on the primary outcome , the Autism Treatment Evaluation Checklist , at either the 3- or 6-month follow-up . However , significant improvements at the 6-month follow-up were observed in the TOBY intervention group relative to the treatment-as-usual group on three secondary outcomes : the Fine Motor and Visual Reception subscales of the Mullen Scale of Early Learning and the Total Words Understood scale of the MacArthur-Bates Communicative Development Index . Statistical trends towards improvement in the TOBY intervention group were observed on measures of adaptive function , although these decreased in magnitude from the 3- to 6-month follow-up . CONCLUSIONS This study provides evidence that technology-based interventions may provide a relatively low-cost addition to existing therapist-delivered interventions for children with ASD . However , sustained use of the app over the full 6-month period was a challenge for most families OBJECTIVE This study evaluated the efficacy of a targeted social skills training group in school-aged children with autism spectrum disorder ( ASD ) . The intervention , Seaver-NETT ( Nonverbal communication , Emotion recognition , and Theory of mind Training ) , is a 12-session cognitive-behavioral intervention ( CBI ) for verbal , school-aged children targeting ASD-specific social behavioral impairments . METHOD Sixty-nine children with ASD , 8 to 11 years of age , with verbal IQs greater than 70 , participated in a r and omized comparative trial to examine the efficacy of NETT relative to a facilitated play group . Treatment outcomes included caregiver reports of social behavior and neuropsychological assessment s of social cognition conducted by blinded raters . Outcomes were collected at baseline , endpoint , and 3 months posttreatment . RESULTS Significant improvements were found on social behavior outcomes such as nonverbal communication , empathic responding , and social relations in the NETT condition relative to the active control at endpoint . Verbal IQ moderated the interaction effect on social behavior , with higher verbal IQ associated with improvements in the CBI condition . No significant improvements were found on social cognitive outcomes . No significant group differences were found at 3-month follow-up conducted with approximately half the sample ( n = 34 ) . CONCLUSION These data indicate that targeted CBI social skills groups such as NETT improve social communication deficits in verbal , school-aged children with ASD . The moderating effects of high verbal IQ suggest a need to consider participant and treatment characteristics associated with outcomes in future studies . Clinical trial registration information-Neural and Behavioral Outcomes of Social Skills Groups in Children With Autism Spectrum Disorder ; https:// clinical trials.gov ; NCT01190917 Background Sleep difficulties are prevalent in children with autism spectrum disorder ( ASD ) . The temporal nature of the association between sleep problems and ASD is unclear because longitudinal studies are lacking . Our aim is to clarify whether sleep problems precede and worsen autistic traits and ASD or occur as a consequence of the disorder . Methods Repeated sleep measures were available at 1.5 , 3 , 6 , and 9 years of age in 5151 children participating in the Generation R Study , a large prospect i ve birth cohort in the Netherl and s. Autistic traits were determined with the Pervasive Developmental Problems score ( PDP ) of the Child Behavior Checklist ( CBCL ) at 1.5 and 3 years and the Social Responsiveness Scale ( SRS ) at 6 years . This cohort included 81 children diagnosed with ASD . Results Sleep problems in early childhood were prospect ively associated with a higher SRS score , but not when correcting for baseline PDP score . By contrast , a higher SRS score and an ASD diagnosis were associated with more sleep problems at later ages , even when adjusting for baseline sleep problems . Likewise , a trajectory of increasing sleep problems was associated with ASD . Conclusions Sleep problems and ASD are not bidirectionally associated . Sleep problems do not precede and worsen autistic behavior but rather co-occur with autistic traits in early childhood . Over time , children with ASD have an increase in sleep problems , whereas typically developing children have a decrease in sleep problems . Our findings suggest that sleep problems are part of the construct ASD The present study is the first to directly compare event- and time-based prospect i ve memory in Autism Spectrum Disorders ( ASD ) using a context ual task mirroring real life dem and s of prospect i ve memory . Twenty-five individuals with ASD and 25 age- and ability-matched controls completed the Dresden Breakfast task which required participants to prepare breakfast following a set of rules and time restrictions . Overall , adults with ASD had less correct time- and event-based prospect i ve memory responses in comparison to controls , which is consistent with previous research in children with ASD . Moreover , ASD participants completed fewer tasks , followed rules less closely , and monitored the elapsing time less closely than controls . Individuals with ASD seem not to be compensating in naturalistic prospect i ve memory tasks Early intervention for autism spectrum disorder ( ASD ) tends to focus on enhancing social-communication skills . We report the acceptability , feasibility and impact on child functioning of a new 8 weeks parent-group intervention to manage restricted and repetitive behaviours ( RRB ) in young children with ASD aged 3–7 years . Forty-five families took part in the pilot RCT . A range of primary and secondary outcome measures were collected on four occasions ( baseline , 10 , 18 and 24 weeks ) to capture both independent ratings and parent-reported changes in RRB . This pilot established that parents were willing to be recruited and r and omised , and the format and content of the intervention was feasible . Fidelity of delivery was high , and attendance was 90 % . A fully powered trial is now planned The purpose of this pilot study was to establish a model for r and omized controlled trial research , identify appropriate outcome measures , and address the effectiveness of sensory integration ( SI ) interventions in children with autism spectrum disorders ( ASD ) . Children ages 6 - 12 with ASD were r and omly assigned to a fine motor or SI treatment group . Pretests and posttests measured social responsiveness , sensory processing , functional motor skills , and social-emotional factors . Results identified significant positive changes in Goal Attainment Scaling scores for both groups ; more significant changes occurred in the SI group , and a significant decrease in autistic mannerisms occurred in the SI group . No other results were significant . The study discusses considerations for design ing future outcome studies for children with ASD Prospect i ve memory ( PM ) refers to the implementation of delayed intentions , a cognitive ability that plays a critical role in daily life because of its involvement in goal -directed behavior and consequently the development and maintenance of independence . Emerging evidence indicates that PM may be disrupted in autism spectrum disorders ( ASDs ) , potentially contributing to the functional difficulties that characterize this group . However , the degree , nature , and specificity of ASD-related impairment remains poorly understood . In the current study , children between 8 and 12 years of age who were diagnosed with ASDs ( n=30 ) were compared with typically developing children ( n=30 ) on a child-appropriate version of the Virtual Week board game . This measure provides an opportunity to investigate the different sorts of PM failures that occur . The ASD group showed significant PM impairment on measures of time-based ( but not event-based ) prospect i ve remembering . However , only a subtle difference emerged between regular and irregular PM tasks , and group differences were consistent across these tasks . Because regular and irregular tasks differentially load retrospective memory , these data imply that the PM difficulties seen in ASDs may primarily reflect a monitoring deficit and not an encoding and memory storage deficit . PM performance was poorer under conditions of high ongoing task absorption , but the magnitude of this effect did not vary as a function of group . In both groups , time-based ( but not event-based ) PM difficulties were associated with functional outcomes in daily life , but only an inconsistent association with executive control emerged OBJECTIVE Preliminary evidence suggests that omega-3 fatty acids may reduce  hyperactivity in children with autism spectrum disorder ( ASD ) . We sought to examine the feasibility of a novel , Internet-based clinical trial design to evaluate the efficacy of this supplement . METHOD E-mail invitations were sent to parents of children aged 5 to 8 years enrolled in the Interactive Autism Network .  All study procedures , including screening , informed consent , and collection of outcome measures took place over the Internet . The primary outcome measures were parent- and teacher-rated changes in hyperactivity on the Aberrant Behavior Checklist ( ABC-H ) . RESULTS During the 6-week recruitment period , 57 children from 28 states satisfied all eligibility criteria and were r and omly assigned to 1.3 grams of  omega-3 fatty acids or an identical placebo daily for 6 weeks . Outcome assessment s were obtained from all 57 participants and 57 teachers , and the study was completed in 3 months . Children in the omega-3 fatty acid group had a greater reduction in hyperactivity ( -5.3 points ) compared to the placebo group ( -2.6 points ) , but the difference was not statistically significant ( 1.9-point greater improvement in the omega-3 group , 95 % CI = -2.2 to 5.2 ) . Adverse events were rare and not associated with omega-3 fatty acids . Participant feedback was positive . CONCLUSION Internet-based , r and omized controlled trials of therapies in children with ASD are feasible and may lead to marked reductions in the time and cost of completing trials . A larger sample size is required to definitively determine the efficacy of omega-3 fatty acids . Clinical trial registration information-Omega-3 Fatty Acids for Hyperactivity Treatment in Autism Spectrum Disorder ; http:// clinical trials.gov ; NCT01694667 Objectives : Children with autism spectrum disorder ( ASD ) frequently reveal various gastrointestinal ( GI ) symptoms that may resolve with an elimination diet along with apparent improvement of some of the behavioral symptoms . Evidence suggests that ASD may be accompanied by aberrant ( inflammatory ) innate immune responses . This may predispose ASD children to sensitization to common dietary proteins ( DP ) , leading to GI inflammation and aggravation of some behavioral symptoms . Methods : We measured IFN-γ , IL-5 , and TNF-α production against representative DPs [ gliadin , cow ’s milk protein ( CMP ) , and soy ] by peripheral blood mononuclear  cells ( P BMC s ) from ASD and control children [ those with DP intolerance ( DPI ) , ASD siblings , and healthy unrelated children ] . We evaluated the results in association with proinflammatory and counter-regulatory cytokine production with endotoxin ( LPS ) , a microbial product of intestinal flora and a surrogate stimulant for innate immune responses . Results : ASD P BMC s produced elevated IFN-γ and TNF-α , but not IL-5 with common DPs at high frequency as observed in DPI P BMC s. ASD P BMC s revealed increased proinflammatory cytokine responses with LPS at high frequency with positive correlation between proinflammatory cytokine production with LPS and IFN-γ and TNF-α production against DPs . Such correlation was less evident in DPI P BMC s. Conclusion : Immune reactivity to DPs may be associated with apparent DPI and GI inflammation in ASD children that may be partly associated with aberrant innate immune response against endotoxin , a product of the gut bacteria
An increasing number of interventions have some empirical support ; others are emerging as potentially efficacious .
This evidence base up date examines the level of empirical support for interventions for children with autism spectrum disorder ( ASD ) younger than 5 years old .