Theory of Mind Training in Children with Autism: A Randomized Controlled Trial Effects and Moderators of a Short Theory of Mind Intervention for Children with Autism Spectrum Disorder: A Randomized Controlled Trial Developing the Frith‐Happé animations: A quick and objective test of Theory of Mind for adults with autism Neuronal correlates of theory of mind and empathy: A functional magnetic resonance imaging study in a nonverbal task Randomized comparative trial of a social cognitive skills group for children with autism spectrum disorder. Inflammation impairs social cognitive processing: A randomized controlled trial of endotoxin Teaching emotion recognition skills to young children with autism: a randomised controlled trial of an emotion training programme. Thought-Bubbles Help Children with Autism Acquire an Alternative to a Theory of Mind Improvement in Social Competence Using a Randomized Trial of a Theatre Intervention for Children with Autism Spectrum Disorder Intranasal oxytocin versus placebo in the treatment of adults with autism spectrum disorders: a randomized controlled trial Theory of Mind and Emotional Functioning in Fibromyalgia Syndrome: An Investigation of the Relationship between Social Cognition and Executive Function Effectiveness of sensory integration interventions in children with autism spectrum disorders: a pilot study. Mindfulness-based therapy in adults with an autism spectrum disorder: a randomized controlled trial. Reducing Specific Phobia/Fear in Young People with Autism Spectrum Disorders (ASDs) through a Virtual Reality Environment Intervention A systematic review of peer-mediated interventions for children with autism spectrum disorder. Episodic but not semantic order memory difficulties in autism spectrum disorder: Evidence from the Historical Figures Task Epidemiology of autism spectrum disorders in adults in the community in England. Cluster Randomized Trial of the Classroom SCERTS Intervention for Elementary Students with Autism Spectrum Disorder Clinical assessment of autism in high-risk 18-month-olds Effects of a brief Early Start Denver model (ESDM)-based parent intervention on toddlers at risk for autism spectrum disorders: a randomized controlled trial. Using The Transporters DVD as a Learning Tool for Children with Autism Spectrum Disorders (ASD) Improving autism perinatal risk factors: A systematic review. Early identification and intervention in autism spectrum disorders: Some progress but not as much as we hoped An open clinical trial assessing a novel training program for social cognitive impairment in schizophrenia Time-Based and Event-Based Prospective Memory in Autism Spectrum Disorder: The Roles of Executive Function and Theory of Mind, and Time-Estimation Working memory and cognitive flexibility-training for children with an autism spectrum disorder: a randomized controlled trial. Managing Repetitive Behaviours in Young Children with Autism Spectrum Disorder (ASD): Pilot Randomised Controlled Trial of a New Parent Group Intervention ‘Everyday Memory’ Impairments in Autism Spectrum Disorders A two-year prospective follow-up study of community-based early intensive behavioural intervention and specialist nursery provision for children with autism spectrum disorders. Group-based cognitive behavioural psychotherapy for children and adolescents with ASD: the randomized, multicentre, controlled SOSTA-net trial. Neurofibromatosis Type 1 and Autism Spectrum Disorder Cognitive behavior therapy for comorbid obsessive-compulsive disorder in high-functioning autism spectrum disorders: a randomized controlled trial. Use of Social Stories to Improve Self-Regulation in Children with Autism Spectrum Disorders Examining the intertwined development of prosocial skills and ASD symptoms in adolescence A randomised controlled trial of an iPad‐based application to complement early behavioural intervention in Autism Spectrum Disorder Two to Ten Years: Developmental Trajectories of Joint Attention in Children With ASD Who Received Targeted Social Communication Interventions Anatomical differences in the mirror neuron system and social cognition network in autism. Avatar Assistant: Improving Social Skills in Students with an ASD Through a Computer-Based Intervention Diminished Time-Based, but Undiminished Event-Based, Prospective Memory Among Intellectually High-Functioning Adults With Autism Spectrum Disorder: Relation to Working Memory Ability Early intervention in 208 Swedish preschoolers with autism spectrum disorder. A prospective naturalistic study. Intranasal Oxytocin Improves Emotion Recognition for Youth with Autism Spectrum Disorders Intervention targeting development of socially synchronous engagement in toddlers with autism spectrum disorder: a randomized controlled trial. A randomized controlled trial of an inference generation strategy intervention for adults with high-functioning autism spectrum disorder. Theory of Mind in first-episode schizophrenia patients: Correlations with cognition and personality traits A prospective study of autistic-like traits in unaffected siblings of probands with autism spectrum disorder. Impact of providing psychiatry specialty pharmacist intervention on reducing drug‐related problems among children with autism spectrum disorder related to disruptive behavioural symptoms: A prospective randomized open‐label study Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model Stepping Stones Triple P: An RCT of a Parenting Program with Parents of a Child Diagnosed with an Autism Spectrum Disorder Aetiological relationship between language performance and autistic-like traits in childhood: a twin study. 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. Social Skills Training for Young Adults with High-Functioning Autism Spectrum Disorders: A Randomized Controlled Pilot Study A Chinese Mind-Body Exercise Improves Self-Control of Children with Autism: A Randomized Controlled Trial Evaluation of a New Computer Intervention to Teach People with Autism or Asperger Syndrome to Recognize and Predict Emotions in Others
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 Limited perspective taking or “ Theory of Mind ” ( ToM ) abilities are a core deficit of autism , and many interventions are aim ed to improve ToM abilities . In this study , we investigated the effectiveness of a ToM treatment for children with autism spectrum disorders ( ASD ) and , for the first time , the moderating roles of social interaction style ( SIS ) and disruptive behavior ( DB ) , to determine which children are most likely to respond to this intervention . The trial protocol is registered at www.trialregister.nl , trial number 2327 and published before the data collection was finished ( www.trialsjournal.com ) . Children with autism aged 7–12 years ( n = 97 ) were r and omized over a waitlist control or a treatment condition . Outcome measures included ToM and emotion underst and ing , parent and teacher question naires on children 's social skills , ToM‐related social behavior , and autistic traits . Six‐month follow‐up parent reported data were collected for the treatment group . The treatment had a positive effect on ToM underst and ing , parent‐reported ToM behavior , and autistic traits , but not on parent or teacher‐reported social behavior . Passive SIS was associated with diminished treatment effects on autistic traits , but DB was unrelated to outcomes . The ToM intervention  improved conceptual social underst and ing and ToM‐related behavior of children with ASD . However , broader application of learned skills to other domains of functioning was limited . Individual differences with regard to treatment response are discussed . Autism Res 2015 , 8 : 738–748 . © 2015 International Society for Autism Research , Wiley Periodicals , It is now widely accepted that individuals with autism have a Theory of Mind ( ToM ) or mentalizing deficit . This has traditionally been assessed with false‐belief tasks and , more recently , with silent geometric animations , an on‐line ToM task . In adults with milder forms of autism st and ard false‐belief tests , originally devised for children , often prove insensitive , while the Frith‐Happé animations have had rather better success at capturing the on‐line ToM deficit in this population . However , analysis of participants ' verbal descriptions of these animations , which span scenarios from “ R and om ” to “ Goal ‐Directed ” and “ ToM , ” is time consuming and subjective . In this study , we developed and established the feasibility of an objective method of response through a series of multiple‐choice questions .  Sixteen adults with autism and 15 typically developing adults took part , matched for age and intelligence . The adults with autism were less accurate as a group at categorizing the Frith‐Happé animations by the presence or absence of mental and physical interactions . Furthermore , they were less able to select the correct emotions that are typically attributed to the triangles in the mental state animations . This new objective method for assessing the underst and ing of the animations succeeded in being as sensitive as the original subjective method in detecting the mentalizing difficulties in autism , as well as being quicker and easier to administer and analyze . Autism Res 2011 , 4 : 149–154 . © 2011 , International Society for Autism Research , Wiley Periodicals , Theory of Mind ( ToM ) , the ability to attribute mental states to others , and empathy , the ability to infer emotional experiences , are important processes in social cognition . Brain imaging studies in healthy subjects have described a brain system involving medial prefrontal cortex , superior temporal sulcus and temporal pole in ToM processing . Studies investigating networks associated with empathic responding also suggest involvement of temporal and frontal lobe regions . In this fMRI study , we used a cartoon task derived from Sarfati et al. ( 1997 ) [ Sarfati , Y. , Hardy-Bayle , M.C. , Besche , C. , Widlocher , D. 1997 . Attribution of intentions to others in people with schizophrenia : a non-verbal exploration with comic strips . Schizophrenia Research 25 , 199 - 209.]with both ToM and empathy stimuli in order to allow comparison of brain activations in these two processes . Results of 13 right-h and ed , healthy , male volunteers were included . Functional images were acquired using a 1.5 T Phillips Gyroscan . Our results confirmed that  ToM and empathy  stimuli are associated with overlapping but distinct neuronal networks . Common areas of activation included the medial prefrontal cortex , temporoparietal junction and temporal poles . Compared to the empathy condition , ToM stimuli revealed increased activations in lateral orbitofrontal cortex , middle frontal gyrus , cuneus and superior temporal gyrus . Empathy , on the other h and , was associated with enhanced activations of paracingulate , anterior and posterior cingulate and amygdala . We therefore suggest that ToM and empathy both rely on networks associated with making inferences about mental states of others . However , empathic responding requires the additional recruitment of networks involved in emotional processing . These results have implication s for our underst and ing of disorders characterized by impairments of social cognition , such as autism and psychopathy 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 UNLABELLED Neuropsychiatric disorders ( e.g. , autism , schizophrenia ) are partially characterized by social cognitive deficits , including impairments in the ability to perceive others ' emotional states , which is an aspect of social cognition known as theory of mind ( ToM ) . There is also evidence that inflammation may be implicated in the etiology of these disorders , but experimental data linking inflammation to deficits in social cognition is sparse . Thus , we examined whether exposure to an experimental inflammatory challenge led to changes in ToM. One hundred and fifteen ( n=115 ) healthy participants were r and omly assigned to receive either endotoxin , which is an inflammatory challenge , or placebo . Participants completed a social cognition task  , the Reading the Mind in the Eyes ( RME ) test , at baseline and at the peak of the inflammatory response for the endotoxin group . The RME test , a vali date d measure of ToM , evaluates how accurately participants can identify the emotional state of another person by looking only at their eyes . We found that endotoxin ( vs. placebo ) led to decreases in performance on the RME test from baseline to the peak of inflammatory response , indicating that acute inflammation can lead to decreases in the ability to accurately and reliably comprehend emotional information from others . Given that deficits in ToM are implicated in neuropsychiatric disorders , including those which may have an inflammatory basis , these results may have implication s for underst and ing the links between inflammation , social cognition , and neuropsychiatric disorders . CLINICAL TRIALS REGISTRATION Clinical Trials.gov NCT01671150 BACKGROUND Children with autism have difficulties in emotion recognition and a number of interventions have been design ed to target these problems . However , few emotion training interventions have been trialled with young children with autism and co-morbid ID . This study aim ed to evaluate the efficacy of an emotion training programme for a group of young children with autism with a range of intellectual ability . METHODS Participants were 55 children with autistic disorder , aged 4 - 7 years ( FSIQ 42 - 107 ) . Children were r and omly assigned to an intervention ( n = 28 ) or control group ( n = 27 ) . Participants in the intervention group watched a DVD design ed to teach emotion recognition skills to children with autism  ( the Transporters ) , whereas the control group watched a DVD of Thomas the Tank Engine . Participants were assessed on their ability to complete basic emotion recognition tasks , mindreading and theory of mind ( TOM ) tasks before and after the 4-week intervention period , and at 3-month follow-up . RESULTS Analyses controlled for the effect of chronological age , verbal intelligence , gender and DVD viewing time on outcomes . Children in the intervention group showed improved performance in the recognition of anger compared with the control group , with few improvements maintained at 3-month follow-up . There was no generalisation of skills to TOM or social skills . CONCLUSIONS The Transporters programme showed limited efficacy in teaching basic emotion recognition skills to young children with autism with a lower range of cognitive ability . Improvements were limited to the recognition of expressions of anger , with poor maintenance of these skills at follow-up . These findings provide limited support for the efficacy of the Transporters programme for young children with autism of a lower cognitive range Children with autism have specific difficulties underst and ing complex mental states like thought , belief , and false belief and their effects on behaviour . Such children benefit from focused teaching , where beliefs are likened to photographs-in-the-head . Here two studies , one with seven participants and one with 10 , tested a picture- in-the-head strategy for dealing with thoughts and behaviour by teaching children with autism  about cartoon thought-bubbles as a device for representing such mental states . This prosthetic device led children with autism to pass not only false belief tests , but also related theory of mind tests . These results confirm earlier findings of the efficacy of picture-in-the-head teaching about mental states , but go further in showing that thought-bubble training more easily extends to children ’s underst and ing of thoughts ( not just behaviour ) and to enhanced performance on several transfer tasks . Thought-bubbles provide a theoretically interesting as well as an especially easy and effective teaching technique 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 There are no effective medications for the treatment of social cognition/function deficits in autism spectrum disorder ( ASD ) , and adult intervention literature in this area is sparse . Emerging data from animal models and genetic association studies as well as early , single-dose intervention studies suggest that the oxytocin system may be a potential therapeutic target for social cognition/function deficits in ASD . The primary aim of this study was to examine the safety/therapeutic effects of intranasal oxytocin versus placebo in adults with ASD , with respect to the two core symptom domains of social cognition/functioning and repetitive behaviors . Methods This was a pilot , r and omized , double-blind , placebo-controlled , parallel design trial of intranasal oxytocin versus placebo in 19 adults with ASD ( 16 males ; 33.20 ± 13.29 years ) . Subjects were r and omized to 24 IU intranasal oxytocin or placebo in the morning and afternoon for 6 weeks . Measures of social function/cognition ( the Diagnostic Analysis of Nonverbal Accuracy ) and repetitive behaviors ( Repetitive Behavior Scale Revised ) were administered . Secondary measures included the Social Responsiveness Scale , Reading-the-Mind-in-the-Eyes Test and the Yale Brown Obsessive Compulsive Scale – compulsion subscale and quality of life ( World Health Organization Quality of Life Question naire – emotional/social subscales ) . Full-information maximum-likelihood parameter estimates were obtained and tested using mixed-effects regression analyses . Results Although no significant changes were detected in the primary outcome measures after correcting for baseline differences , results suggested improvements after 6 weeks in measures of social cognition ( Reading-the-Mind-in-the-Eyes Test , p = 0.002 , d = 1.2 ) , and quality of life ( World Health Organization Quality of Life Question naire – emotion , p = 0.031 , d = 0.84 ) , both secondary measures . Oxytocin  was well tolerated and no serious adverse effects were reported . Conclusions This pilot study suggests that there is therapeutic potential to daily administration of intranasal oxytocin in adults with ASD and that larger and longer studies are warranted . Trial registration Background Fibromyalgia ( FM ) is a syndrome primarily characterised by chronic , widespread musculoskeletal pain . In the aetiology of this syndrome a crucial role is played by complex interactions among biological , genetic , psychological , and socio-cultural factors . Recently , research ers have started to explore emotional functioning in FM , with their attention focused on alexithymia , a personality construct that affects the regulation of a person ’s own emotions . On the other h and , the detection and experience of emotional signals from other people have only been sparsely investigated in FM syndrome and no studies have investigated the ability to represent other people ’s mental states ( i.e. Theory of Mind , ToM ) in these patients . Here we present the first study investigating a large set of social-cognitive abilities , and the possible relationships between these abilities and the performance on executive-function tasks , in a homogenous sample of patients with FM . Methodology Forty women with FM and forty-one healthy women matched for education and age were involved in the study .  Social cognition was assessed with a set of vali date d experimental tasks .  Measures of executive function were used to test the correlations between this dimension and the social-cognitive profile of patients with FM . Relationships between social-cognitive abilities and demographic , clinical and psychological variables were also investigated . Principal Findings Patients with FM have impairments both in the regulation of their own affect and in the recognition of other ’s emotions , as well as in representing other people ’s mental states . No significant correlations were found between social cognition tasks and the subcomponents of the executive function that were analysed . Conclusions The results show the presence of several impairments in social cognition skills in patients with FM , which are largely independent of both executive function deficits and symptoms of psychological distress . The impairments reported highlight the importance of adequately assessing ToM and emotional functioning in clinical practice 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 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 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 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 Considerable evidence suggests that the episodic memory system operates abnormally in autism spectrum disorder ( ASD ) whereas the functions of the semantic memory system are relatively preserved . Here we show that the same dissociation also applies to the domain of order memory . We asked adult participants to order the names of famous historical figures either according to their chronological order in history ( probing semantic memory ) or according to a r and om sequence shown once on a screen ( probing episodic memory ) . As predicted , adults with ASD  performed less well than age- and IQ-matched comparison individuals only on the  episodic task .  This observation is of considerable importance in the context of developmental theory because semantic and episodic order memory abilities can be dissociated in typically developing infants before they reach the age at which the behavioural markers associated with ASD are first apparent . This raises the possibility that early emerging memory abnormalities play a role in shaping the developmental trajectory of the disorder . We discuss the broader implication s of this possibility and highlight the urgent need for greater scrutiny of memory competences in ASD early in development 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 : This cluster r and omized trial ( CRT ) evaluated the efficacy of the Classroom Social , Communication , Emotional Regulation , and Transactional Support ( SCERTS ) Intervention ( CSI ) compared with usual school-based education with autism training modules ( ATM ) . Method : Sixty schools with 197 students with autism spectrum disorder ( ASD ) in 129 classrooms were r and omly assigned to CSI or ATM .  Mean student age was 6.79 years ( SD 1.05 ) and 81.2 % were male . CSI teachers were trained on the model and provided coaching throughout the school year to assist with implementation . A CRT , with students nested within general and special education classrooms nested within schools , was used to evaluate student outcomes . Results : The CSI group showed significantly better outcomes than the ATM group on observed measures of classroom active engagement with respect to social interaction . The CSI group also had significantly better outcomes on measures of adaptive communication , social skills , and executive functioning with Cohen ’s d effect sizes ranging from 0.31 to 0.45 . Conclusion : These findings support the preliminary efficacy of CSI , a classroom-based , teacher-implemented intervention for improving active engagement , adaptive communication , social skills , executive functioning , and problem behavior within a heterogeneous sample of students with ASD . This makes a significant contribution to the literature by demonstrating efficacy of a classroom-based teacher-implemented intervention with a heterogeneous group of students with ASD using both observed and reported measures 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 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 Data from two groups of children who were r and omly allocated to those groups showed that the ability of children with ASD to identify and label basic and complex facial expressions following a 3-week home based DVD intervention significantly improved when viewing The Transporters DVD . Improvements in emotion recognition appear related to the content of the DVD as participants in a control group who observed an alternate DVD showed no such improvement . Although social behaviour improved significantly as a result of watching The Transporters , a significant improvement in social behaviour was however , also observed in the Thomas the Tank Engine condition suggesting the unique content of The Transporters DVD was not pivotal to the improvement of social behaviour in general BACKGROUND Current underst and ing of the etiology of autism is based on the interaction of multiple genes with each other and with environmental factors , leading to a neurodevelopmental process that results in the expression of autism spectrum disorder ( ASD ) in the child . This suggests that it might be possible to strengthen resilience to environmental stressors during the perinatal period to improve outcomes and possibly prevent the development of ASD . METHODS We search ed the MEDLINE data base for multiple perinatal factors associated with the development of ASD published between January 1 , 2005 and July 1 , 2018 . The search terms used were " autism " crossed with either " perinatal , " " prenatal , " " gestational , " or " pregnancy , " and crossed again with each perinatal risk factor highlighted in this review including topics on parental health , infections , medications , and environmental stressors . We then search ed interventions that may improve neurodevelopmental outcome before and during pregnancy , including supplements , breastfeeding , and postpartum stress reduction . We identified recent or unique metanalyses and systematic review s of the identified focus and on r and omized controlled trials and summarized these using the most recent and comprehensive review s. RESULTS Folate , omega-3 , vitamin D3 , environmental toxin avoidance , correcting deficiencies , immune boosting , and prolonged breast feeding are all reported to be linked to the possible reduction of adverse pregnancy outcomes including ASD . CONCLUSIONS Studies of individual components for improving pregnancy outcomes and several uncontrolled preconception to infancy medical practice s suggest that multiple interventions might improve the outcomes of pregnancies where there is risk for developing ASD Abstract Camarata 's ( 2014 ) review summarizes the progress that has been made in the field of early identification and early intervention in autism spectrum disorders ( ASD ) over the past few decades , but also provides a salutary reminder that much still needs to be done . Whilst it is possible to prospect ively identify cases of ASD using screening instruments ; it is critical that those using such screens in clinical practice underst and how to interpret data from published studies and consider how screening information is communicated to parents . After several decades when few r and omized controlled trials of early intervention in ASD were conducted , the last decade has seen an explosion of new studies . Despite initial optimism , as more trials are published they have highlighted the limits of , and challenges to , early intervention in ASD . Given the complex nature of ASD these sobering lessons are perhaps not surprising . Rather than promote despondency , they need to inspire and inform the next decade of clinical research to move the field forward to the benefit of young children with ASD and those who care for them Objective : Social cognition is profoundly impaired in patients with schizophrenia . This study describes ‘ Mental-State Reasoning Training for Social Cognitive Impairment ’ ( SoCog-MSRT ) , a 5-week program developed to improve social cognition in patients with schizophrenia . We aim ed to investigate the feasibility of implementing SoCog-MSRT in a rehabilitation setting and to evaluate whether our training methods produced improvements . Method The feasibility and benefits of SoCog-MSRT were evaluated in an open clinical trial with 14 participants with schizophrenia or schizoaffective disorder . Training comprised 10 twice-weekly sessions , for 5 weeks , with a pre- and post-training assessment . Results : There were significant improvements on : ( a ) a classic false-belief test of Theory of Mind ( ToM ) ; ( b ) inferring complex mental states from the eyes ; and ( c ) a self-reported measure of social underst and ing . Some of these improvements were associated with baseline levels of working memory and premorbid Intelligence Quotient ( IQ ) . Conclusions SoCog-MSRT can improve ToM abilities and social underst and ing , but individuals with poorer working memory and lower premorbid IQ may be less able to benefit from this type of training Prospect i ve memory ( remembering to carry out an action in the future ) has been studied relatively little in ASD . We explored time-based ( carry out an action at a pre-specified time ) and event-based ( carry out an action upon the occurrence of a pre-specified event )  prospect i ve memory , as well as possible cognitive correlates , among 21 intellectually high-functioning children with ASD , and 21 age- and IQ-matched neurotypical comparison children . We found impaired time-based , but undiminished event-based , prospect i ve memory among children with ASD . In the ASD group , time-based prospect i ve memory performance was associated significantly with diminished theory of mind , but not with diminished cognitive flexibility . There was no evidence that time-estimation ability contributed to time-based prospect i ve memory impairment in ASD BACKGROUND People with autism spectrum disorders ( ASDs ) experience executive function ( EF ) deficits . There is an urgent need for effective interventions , but in spite of the increasing research focus on computerized cognitive training , this has not been studied in ASD . Hence , we investigated two EF training conditions in children with ASD . METHODS In a r and omized controlled trial , children with ASD ( n = 121 , 8 - 12 years , IQ > 80 ) were r and omly assigned to an adaptive working memory ( WM ) training , an adaptive cognitive flexibility-training , or a non-adaptive control training ( mock-training ) . Braingame Brian , a computerized EF-training with game-elements , was used . Outcome measures ( pretraining , post-training , and 6-week-follow-up ) were near-transfer to trained EFs , far-transfer to other EFs ( sustained attention and inhibition ) , and parent 's ratings of daily life EFs , social behavior , attention deficit hyperactivity disorder (ADHD)-behavior , and quality of life . RESULTS Attrition-rate was 26 % . Children in all conditions who completed the training improved in WM , cognitive flexibility , attention , and on parent 's ratings , but not in inhibition . There were no significant differential intervention effects , although children in the WM condition showed a trend toward improvement on near-transfer WM and ADHD-behavior , and children in the cognitive flexibility condition showed a trend toward improvement on near-transfer flexibility . CONCLUSION Although children in the WM condition tended to improve more in WM and ADHD-behavior , the lack of differential improvement on most outcome measures , the absence of a clear effect of the adaptive training compared to the mock-training , and the high attrition rate suggest that the training in its present form is probably not suitable for children with ASD 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 Abstract ‘ Everyday memory ’ is conceptualised as memory within the context of day-to-day life and , despite its functional relevance , has been little studied in individuals with autism spectrum disorders ( ASDs ) . In the first study of its kind , 94 adolescents with an ASD and 55 without an ASD completed measures of everyday memory  from the Rivermead Behavioural Memory Test ( RBMT ) and a st and ard word recall task ( Children ’s Auditory Verbal Learning Test-2 : CAVLT-2 ) . The ASD group showed significant impairments on the RBMT  , including in prospect i ve memory , alongside impaired performance on the CAVLT-2 . Social and communication ability was significantly associated with prospect i ve remembering in an everyday memory context but not with the CAVLT-2 . The complex nature of everyday memory and its relevance to ASD is discussed 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 BACKGROUND Group-based psychotherapy in Autism Spectrum Disorder ( ASD ) has predominantly been studied in the United States by small studies in school-aged children without long-term follow-up . We report results of a large , confirmatory , multicentre r and omized-controlled phase-III trial in children and adolescents study ing the ASD specific , manualized group-based cognitive behavioural SOSTA-FRA approach . METHODS High-functioning ASD individuals aged 8 - 19 years old were r and omized to 12 sessions SOSTA-FRA or treatment as usual . Primary outcomes were change in total raw score of the parent-rated Social Responsiveness Scale ( pSRS ) between baseline ( T2 ) and end of intervention ( T4 ) , and between T2 and 3 months after end of intervention ( T5 ) . TRIAL REGISTRATION IS RCT N94863788 . RESULTS Between 20/5/2010 and 14/2/2013 , n = 320 ASD patients were screened , n = 228 patients were r and omized , and N = 209 analysed .  Mean pSRS difference between groups at T4 was -6.5 ( 95 % CI -11.6 to - 1.4 ; p = .013 ) , and at T5 -6.4 ( -11.5 to -1.3 , p = .015 ) . Pre-treatment SRS and IQ were positively associated with stronger improvement at T4 and T5 . CONCLUSIONS Short-term ASD-specific add-on group-based psychotherapy has shown postintervention efficacy with regard to parent-rated social responsiveness predominantly in male high-functioning children and adolescents with ASD . Future studies should implement blinded st and ardized observational measures of peer-related social interaction OBJECTIVE : To determine the prevalence of autism spectrum disorder ( ASD ) in Neurofibromatosis Type 1 ( NF1 ) . METHODS : Second-phase population -based epidemiologic study using an allcase NF1 registry in a defined UK 4.1 million population area . A total of 109 ( 52.7 % ) of 207 responders from the initial screening phase were grouped by using the parent-rated Social Responsiveness Scale ( SRS ) as significant ASD ( SRS≥76 ; n = 32 ) , moderate ASD ( SRS ≥ 60<76 ; n = 29 ) , or non-ASD ( SRS < 60 , n = 48 ) . Twenty-three cases from the significant ASD group , 16 from moderate ASD , and 8 from non-ASD ( total n = 47 ) , invited proportionately by r and om selection , were seen for detailed confirmatory ascertainment . Assessment s on Autism Diagnostic Interview-Revised , Autism Diagnostic Observation Scale-Generic , and verbal IQ were combined by using st and ard Collaborative Program for Excellence in Autism criteria into an ASD categorization for each case ( ASD , broad ASD with partial features , non-ASD ) . A preplanned weighted analysis was used to derive prevalence estimates for the whole population . RESULTS : Fourteen ( 29.5 % ) of 47 showed ASD , 13 ( 27.7 % ) broad ASD , and 20 ( 42.5 % ) non-ASD . The ASD/broad ASD group showed male predominance ( 1.7:1.0 ) , but did not differ significantly from the non-ASD group on IQ , age , socioeconomic status , inheritance , physical severity , or education . The population prevalence estimate is 24.9 % ASD ( 95 % confidence interval 13.1%–42.1 % ) and 20.8 % broad ASD ( 95 % confidence interval 10.0%–38.1 % ) ; a total of 45.7 % showing some ASD spectrum phenotype . CONCLUSIONS : Findings indicate high prevalence of ASD in NF1 , with implication s for clinical practice and further research into NF1 as a single-gene model for autism BACKGROUND High rates of anxiety disorders , particularly obsessive compulsive disorder ( OCD ) are reported in people with Autism spectrum disorders ( ASD ) .  Group cognitive behavioral treatment ( CBT ) has been found effective for anxiety in young people with ASD but not been OCD specific . One uncontrolled pilot study of individual CBT for OCD for adults with ASD showed good treatment efficacy . METHODS Forty-six adolescents and adults ( mean age 26.9 years , 35 Males ) with ASD and comorbid OCD were r and omized to CBT for OCD or anxiety management ( AM ) , a plausible control treatment . Treatments were matched in duration ( mean of 17.4 sessions CBT ; 14.4 sessions AM ) , the Yale-Brown Obsessive Compulsive Severity Scale ( YBOCS ) as primary outcome measure and evaluations blind to treatment group . Treatment response was defined as > 25 % reduction in YBOCS total severity scores . RESULTS Both treatments produced a significant reduction in OCD symptoms , within-group effect sizes of 1.01 CBT group and 0.6 for the AM group . There were no statistically significant differences between the two groups at end of treatment , although more responders in the CBT group ( 45 versus 20 % ) . Effect sizes for self-rated improvement were small ( 0.33 CBT group ; -0.05 AM group ) . Mild symptom severity was associated with improvement in the AM but not the CBT group . Family/carer factors were important for both groups , in that increased family accommodation was associated with poorer outcome . CONCLUSIONS Evidence -based psychological interventions , both AM and CBT , were effective in treating comorbid OCD in young people and adults with 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 Autism spectrum disorder ( ASD ) and reduced prosocial behaviour are strongly intertwined . However , social interactions with peers may be increasingly practice d over the course of development and may instigate a reduction in ASD symptoms and vice versa . We , therefore , sought to determine if , during adolescence , possible improvements in prosocial behaviours and ASD symptoms may benefit one another over time . Participants were 2773 adolescents from the Tracking Adolescents ’ Individual Lives Survey ( TRAILS ) cohorts . Measurements took place over three waves ( mean ages : 11.1 , 13.4 , and 16.2 years ) . Longitudinal associations between teacher-rated classroom prosocial skills and parent-rated ASD symptoms were examined using the r and om intercept cross-lagged panel model ( RI-CLPM ) . In addition to estimating the stable , between-person associations , the dynamical effects between prosocial skills and ASD symptoms over time were estimated at the within-person level . At the between-person level , prosocial skills and ASD symptoms were substantially negatively correlated . At the within-person level , a small and unexpected positive cross-lagged effect from wave 1 ASD symptoms on wave 2 prosocial skills was observed . We added to the existing literature by showing that , in addition to replicating the already firmly established between-person association between low prosocial skills and ASD , within-person gains in prosocial skills do not lead to subsequent reduction of ASD symptoms , and reductions in ASD symptoms do not lead to subsequent enhancement of prosocial skills . We , therefore , conclude from our findings that the inverse association between autistic symptoms and prosocial skills in adolescence is highly stable 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 This study follows 40 children who were participants in a r and omized controlled early intervention trial ( Kasari et al. ) from early childhood ( 2–5 years of age ) to elementary school age ( 8–10 years ) . To fully utilize the available longitudinal data , the general linear mixed model was the primary analytical approach . The growth trajectories of joint attention skills ( pointing , coordinated joint looking , and showing ) and expressive language outcomes in these children were estimated based on five time points during the measurement period . The children were grouped by diagnosis at the last follow‐up ( autism , autism spectrum disorder ( ASD ) , no diagnosis ) and by their original treatment group assignment ( joint attention , symbolic play , control ) , and differences between these groups were evaluated . Results showed that joint attention skills of coordinated joint looking and showing increased over time , and pointing to share interest increased over the first year measured and decreased thereafter . These trajectories were influenced by both original treatment assignment and diagnostic status at follow‐up . In addition , a cross‐lagged panel analysis revealed a causal relationship between early pointing and later language development . This study highlights the longitudinal and developmental importance of measures of early core deficits in autism , and suggests that both treatment and ASD symptomatology may influence growth in these skills over time . Autism Res 2014 , 7 : 207–215 . © 2014 International Society for Autism Research , Wiley Periodicals , Autism spectrum disorder ( ASD ) is a neurodevelopmental disorder associated with impaired social and emotional skills , the anatomical substrate of which is still unknown . In this study , we compared a group of 14 high-functioning ASD adults with a group of controls matched for sex , age , intelligence quotient , and h and edness . We used an automated technique of analysis that accurately measures the thickness of the cerebral cortex and generates cross-subject statistics in a coordinate system based on cortical anatomy . We found local decreases of gray matter in the ASD group in areas belonging to the mirror neuron system ( MNS ) , argued to be the basis of empathic behavior . Cortical thinning of the MNS was correlated with ASD symptom severity . Cortical thinning was also observed in areas involved in emotion recognition and social cognition . These findings suggest that the social and emotional deficits characteristic of autism may reflect abnormal thinning of the MNS and the broader network of cortical areas subserving social cognition This study assessed the efficacy of FaceSay , a computer-based social skills training program for children with Autism Spectrum Disorders ( ASD ) . This r and omized controlled study ( N = 49 ) indicates that providing children with low-functioning autism ( LFA ) and high functioning autism ( HFA ) opportunities to practice attending to eye gaze , discriminating facial expressions and recognizing faces and emotions in FaceSay ’s structured environment with interactive , realistic avatar assistants improved their social skills abilities . The children with LFA demonstrated improvements in two areas of the intervention : emotion recognition and social interactions . The children with HFA demonstrated improvements in all three areas : facial recognition , emotion recognition , and social interactions . These findings , particularly the measured improvements to social interactions in a natural environment , are encouraging Objective : Prospect i ve memory ( PM ) is the ability to remember to carry out an intended action . Working memory is the ability to store information in mind while processing potentially distracting information . The few previous studies of PM in autism spectrum disorder ( ASD ) have yielded inconsistent findings . Studies of working memory ability in ASD have suggested a selective impairment of “ visual working memory . ” However , it remains unclear whether any such impairment is the result of diminished ( domain-specific ; visual/verbal ) storage capacity or diminished ( domain-general ) processing capacity . We aim to clarify these issues and explore the relation between PM and working memory in ASD . Method : Seventeen adults with ASD and 17 age- and IQ-matched comparison participants completed experimental measures of both event-based ( perform action x when event y occurs ) and time-based ( perform action a at time b ) PM , plus a self-report measure of PM skills  . Participants also completed a working memory test battery . Results : Participants with ASD self-reported diminished PM skill , and showed diminished performance on the time-based , but not event-based , PM task . On the working memory test battery , visual but not verbal storage capacity was diminished among participants with ASD , as was processing ability . Whereas visual storage was associated with event-based PM task performance among comparison participants , verbal storage was associated among ASD participants . Conclusions : ASD appears to involve a selective deficit in time-based PM and a selective difficulty with aspects of working memory that depend on the storage of visual information . However , event-based PM may be achieved through compensatory strategies in ASD 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 BACKGROUND A diagnostic hallmark of autism spectrum disorders is a qualitative impairment in social communication and interaction . Deficits in the ability to recognize the emotions of others are believed to contribute to this . There is currently no effective treatment for these problems . METHODS In a double-blind , r and omized , placebo-controlled , crossover design , we administered oxytocin nasal spray ( 18 or 24 IU ) or a placebo to 16 male youth aged 12 to 19 who were diagnosed with Autistic or Asperger 's Disorder . Participants then completed the Reading the Mind in the Eyes Task , a widely used and reliable test of emotion recognition . RESULTS In comparison with placebo , oxytocin administration improved performance on the Reading the Mind in the Eyes Task . This effect was also shown when analysis was restricted to the younger participants aged 12 to 15 who received the lower dose . CONCLUSIONS This study provides the first evidence that oxytocin nasal spray improves emotion recognition in young people diagnosed with autism spectrum disorders . Findings suggest the potential of earlier intervention and further evaluation of oxytocin nasal spray as a treatment to improve social communication and interaction in young people with autism spectrum disorders BACKGROUND Social and communication impairments are core deficits and prognostic indicators of autism . We evaluated the impact of supplementing a comprehensive intervention with a curriculum targeting socially synchronous behavior on social outcomes of toddlers with autism spectrum disorders ( ASD ) . METHODS Fifty toddlers with ASD , ages 21 to 33 months , were r and omized to one of two six-month interventions : Interpersonal Synchrony or Non-Interpersonal Synchrony . The interventions provided identical intensity ( 10 hours per week in classroom ) , student-to-teacher ratio , schedule , home-based parent training ( 1.5 hours per month ) , parent education ( 38 hours ) , and instructional strategies , except the Interpersonal Synchrony condition provided a supplementary curriculum targeting socially engaged imitation , joint attention , and affect sharing ; measures of these were primary outcomes . Assessment s were conducted pre-intervention , immediately post-intervention , and , to assess maintenance , at six-month follow-up . R and om effects models were used to examine differences between groups over time . Secondary analyses examined gains in expressive language and nonverbal cognition , and time effects during the intervention and follow-up periods . RESULTS A significant treatment effect was found for socially engaged imitation ( p = .02 ) , with more than doubling ( 17 % to 42 % ) of imitated acts paired with eye contact in the Interpersonal Synchrony group after the intervention . This skill was generalized to unfamiliar context s and maintained through follow-up . Similar gains were observed for initiation of joint attention and shared positive affect , but between-group differences did not reach statistical significance . A significant time effect was found for all outcomes ( p < .001 ) ; greatest change occurred during the intervention period , particularly in the Interpersonal Synchrony group . CONCLUSIONS This is the first ASD r and omized trial involving toddlers to identify an active ingredient for enhancing socially engaged imitation . Adding social engagement targets to intervention improves short-term outcome at no additional cost to the intervention . The social , language , and cognitive gains in our participants provide evidence for plasticity of these developmental systems in toddlers with ASD . http://www . clinical trials.gov/ct2/show/NCT00106210?term = l and a&rank = 3 PURPOSE The present intervention study investigated the efficacy of the ACT & Check Strategy intervention to improve inference generation when reading , metacognitive ability , general reading comprehension , and social inference ability in adults with high-functioning autism spectrum disorder ( HF-ASD ) . METHOD Twenty-five adults with HF-ASD were r and omly assigned to either a treatment or a control group . Treatment sessions were conducted in 1-hr sessions , twice a week , for a total of 6 weeks . Treatment focused on explicit instruction of components of inference generation , categories of inferences , and increasingly independent strategy use . RESULTS The treatment group demonstrated significantly superior performance on 1 of 2 measures of inference generation in reading and 1 measure of metacognitive ability compared with the control group . Significant differences between groups were not found on measures of reading comprehension or social inference ability . CONCLUSION These findings suggest that the ACT & Check Strategy was effective in improving  participants ' ability to generate inferences in reading and certain metacognitive abilities , but the skills do not appear to generalize to other social communication context s , such as social inference generation . This research provides a measure of support for explicitly teaching inference generation to address a reading inference deficit in adults with HF-ASD INTRODUCTION There is substantial evidence for Theory of Mind ( ToM ) deficits in patients with schizophrenia . Many psychotic symptoms may best be understood in light of an impaired capacity to infer one 's own and other persons ' mental states and to relate those to executing behavior . The aim of our study was to investigate ToM abilities in first-episode schizophrenia patients and to analyze them in relation to neuropsychological and psychopathological functioning . MATERIAL S AND METHODS A modified Moving Shapes paradigm was used to assess ToM abilities in 23 first-episode patients with schizophrenia and 23 matched healthy controls . Participants had to describe animated triangles which moved ( 1 ) r and omly , ( 2 ) goal -directed , or ( 3 ) in complex , socially interactive ways ( ToM video sequences ) . Neuropsychological functioning , psychopathology , autistic and alexithymic features as well as empathetic abilities were correlated with ToM performance . RESULTS Compared to healthy controls , first-episode schizophrenia patients gave more incorrect descriptions and used less ToM-related vocabulary when responding to socially complex ToM video sequences . No group differences were revealed for videos with r and om movements . ToM abilities correlated significantly with positive symptoms , reasoning , verbal memory performance and verbal IQ , but not with empathetic abilities or autistic and alexithymic features . When controlling for reasoning , verbal memory performance and verbal IQ , the correctness of video descriptions was still significantly worse in schizophrenia patients . DISCUSSION The results of our study in first-episode schizophrenia patients underline recent findings on ToM deficits in the early course of schizophrenia . Only a moderate influence of neurocognitive deficits on ToM performance was observed . Impairment in ToM abilities seems to be predominantly independent of clinical state , alexithymia and empathy CONTEXT The presence of autistic-like traits in relatives of individuals with autism spectrum disorder ( ASD ) is well recognized , but , to our knowledge , the emergence of these traits early in development has not been studied . OBJECTIVE To prospect ively investigate the emergence of autistic-like traits in unaffected ( no ASD diagnosis ) infant siblings of prob and s diagnosed as having ASD . DESIGN Two groups of children unaffected with ASD were assessed prospect ively-siblings of prob and s diagnosed as having ASD ( high risk [ HR ] ) and control subjects with no family history of ASD ( low risk [ LR ] ) . Scores on a measure of autistic-like traits at 12 months of age were used in a cluster analysis of the entire sample . SETTING A prospect i ve study of infant siblings of prob and s with ASD from 3 diagnostic centers in Canada . PARTICIPANTS The study included 170 HR and 90 LR children , none of whom was diagnosed as having ASD at age 3 years . MAIN OUTCOME MEASURES The Autism Observation Scale for Infants was used to measure autistic-like traits and derive clusters at 12 months of age . Clusters were compared on ASD symptoms , cognitive abilities , and social-emotional difficulties at age 3 years . RESULTS Two clusters were identified . Cluster 1 ( n = 37 ; 14.2 % of total sample ) had significantly higher levels of autistic-like traits compared with cluster 2 . Within cluster 1 , 33 children came from the siblings ( 19.4 % of HR group ) and only 4 came from the control subjects ( 4.5 % of LR group ) . At age 3 years , children from cluster 1 had more social-communication impairment ( effect size > 0.70 ; P < .001 ) , lower cognitive abilities ( effect size = -0.59 ; P < .005 ) , and more internalizing problems ( effect size = 0.55 ; P = .01 ) . Compared with control subjects , HR siblings had a relative risk of 4.3 ( 95 % CI,1.6 - 11.9 ) for membership in cluster 1 . CONCLUSIONS Study findings suggest the emergence of autistic-like traits resembling a broader autism phenotype by 12 months of age in approximately 19 % of HR siblings who did not meet ASD diagnostic criteria at age 3 years WHAT IS KNOWN AND OBJECTIVES Psychopharmacologic therapy has so far focused on ameliorating disruptive behaviours to improve patient 's function and quality of life . Due to the complicated neurobiological aetiology of autism spectrum disorder ( ASD ) , a traditional pharmacist intervention may be insufficient to initiate the optimal care for this vulnerable population . We evaluate the impact of providing specialty psychiatry ( PS ) pharmacist intervention in identifying and resolving drug-related problems ( DRPs ) among children with ASD associated with disruptive behaviours . METHODS An eight-week-long , prospect i ve , r and omized open-label study was conducted . Children between 2.5 and 12 years of age with ASD and showing disruptive behaviours were included . They were r and omly assigned to an intervention or a control group . Patients in the intervention group received pharmacist interventions delivered by a PS pharmacist , while those in control group were cared by a hospital pharmacist . The primary outcome was the number of patients who resolved of at least one DRP by the end of the study . The secondary outcome was to compare the mean Aberrant Behavior Checklist-Irritability ( ABC-I ) scores between the two groups . RESULTS Twenty-five patients were r and omly assigned to either an intervention or control group . At week 8 , the total number of patients who resolved of at least one DRP was 13 ( 52 % ) in the intervention group and 4 ( 16 % ) in the control group , respectively ( P=.016 ) . Improper drug selection , medication non-adherence and subtherapeutic dosage were the most common DRPs . Mean ABC-I scores improved in the intervention group more than in the control group ( 9.8±5.6 vs 17.7±7.9 ; P<.001 ) . WHAT IS NEW AND CONCLUSION To the best of our knowledge , this is the first study which demonstrated that PS pharmacist intervention is an effective strategy to resolve DRPs in patient with ASD . The reduction in common DRPs mostly result ed from the PS pharmacist interventions , including selection of antipsychotic agent , adjustment of dosage based on ABC-I scores and provision of individualized drug counselling . Reducing DRPs led to the improvement of any disruptive behaviour . In addition , multidisciplinary team should develop drug therapy protocol s to promote the role of pharmacists in this setting OBJECTIVE : To conduct a r and omized , controlled trial to evaluate the efficacy of the Early Start Denver Model ( ESDM ) , a comprehensive developmental behavioral intervention , for improving outcomes of toddlers diagnosed with autism spectrum disorder ( ASD ) . METHODS : Forty-eight children diagnosed with ASD between 18 and 30 months of age were r and omly assigned to 1 of 2 groups : ( 1 ) ESDM intervention , which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents for 2 years ; or ( 2 ) referral to community providers for intervention commonly available in the community . RESULTS : Compared with children who received community-intervention , children who received ESDM showed significant improvements in IQ , adaptive behavior , and autism diagnosis . Two years after entering intervention , the ESDM group on average improved 17.6 st and ard score points ( 1 SD : 15 points ) compared with 7.0 points in the comparison group relative to baseline scores . The ESDM group maintained its rate of growth in adaptive behavior compared with a normative sample of typically developing children . In contrast , over the 2-year span , the comparison group showed greater delays in adaptive behavior . Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder , not otherwise specified , than the comparison group . CONCLUSIONS : This is the first r and omized , controlled trial to demonstrate the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis . Results of this study underscore the importance of early detection of and intervention in autism Whilst the Triple P Positive Parenting Program has a large evidence base ( S and ers , Clinical Child and Family Psychology Review 2:71–90 , 1999 ; S and ers , Journal of Consulting and Clinical Psychology 68:624–640 , 2000 ) and preliminary evidence indicates that Stepping Stones Triple P is also efficacious ( Roberts , Journal of Clinical Child and Adolescent Psychology , 35(2):180–193 , 2006 ) , to date Stepping Stones has not been evaluated with the ASD population . Fifty-nine families with a child with ASD aged between 2 and 9 participated in this r and omized controlled trial . The results demonstrate significant improvements in parental reports of child behaviour and parenting styles with the treatment effects for child behaviour , parental over reactivity and parental verbosity being maintained at follow-up 6 months later . Further , the results suggest significant improvements in parental satisfaction and conflict about parenting as well as a sleeper effect for parental efficacy . The results indicate that Stepping Stones Triple P is a promising intervention for parents of children with ASD . Limitations and future research are also addressed BACKGROUND Impairments in language and communication are core features of autism spectrum disorders ( ASDs ) . The basis for this association is poorly understood . How early language is related to each of the triad of impairments characteristic of ASDs is also in need of clarification . AIMS This is the first study that aims to determine the extent to which shared genetic and environmental factors underlie the association between  early language performance and autistic-like traits ( ALTs ) in middle childhood . METHODS & PROCEDURES Data came from a population -based twin sample ( n = 6087 pairs ) assessed prospect ively at 2 , 3 , 4 and 8 years .  ALTs  measured by the Childhood Asperger Syndrome Test ( CAST )  at 8 years were investigated in relation to language assessed by the MacArthur Communicative Development Inventory ( CDI ) at 2 , 3 and 4 years . Multivariate model fitting techniques were used to analyse the origins of this association . OUTCOMES & RESULTS Total CAST scores , as well as Social and Communication subscales , at 8 years were weakly but significantly negatively correlated with language ability at 2 , 3 and 4 years . Correlations between language and restrictive and repetitive behaviours and interests ( RRBI ) were not significant . The phenotypic correlations between language and Social and Communication ALTs were almost entirely mediated by shared genetic influences . There were specific genetic influences on early language that were not shared with ALTs , and specific genetic influences on ALTs not shared with earlier language performance . CONCLUSIONS This is the first study to demonstrate shared genetic influences in relation to language performance as an early antecedent of later ALTs . These results support the idea that the triad of core features in ALTs are aetiologically heterogeneous , with early language relating to social and communication impairments but not RRBIs 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 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 Self-control problems commonly manifest as temper outbursts and repetitive/rigid/impulsive behaviors , in children with autism spectrum disorders ( ASD ) , which often contributes to learning difficulties and caregiver burden . The present study aims to compare the effect of a traditional Chinese Chan-based mind-body exercise , Nei Yang Gong , with that of the conventional Progressive Muscle Relaxation ( PMR ) technique in enhancing the self-control of children with ASD . Forty-six age- and IQ-matched ASD children were r and omly assigned to receive group training in Nei Yang Gong ( experimental group ) or PMR ( control group ) twice per week for four weeks . The participants ’ self-control was measured by three neuropsychological tests and parental rating on st and ardized question naires  , and the underlying neural mechanism was assessed by the participants ’ brain EEG activity during an inhibitory-control task before and after intervention . The results show that the experimental group demonstrated significantly greater improvement in self-control than the control group , which concurs with the parental reports of reduced autistic symptoms and increased control of temper and behaviors . In addition , the experimental group showed enhanced EEG activity in the anterior cingulate cortex , a region that mediates self-control , whereas the PMR group did not . The present findings support the potential application of Chinese Chan-based mind-body exercises as a form of neuropsychological rehabilitation for patients with self-control problems . Chinese Clinical Trial Registry ; Registration No. : ChiCTR-TRC-12002561 ; URL : www.chictr.org This r and omized controlled trial looked at the effect of a new computer program design ed to teach people with autistic spectrum disorders to better recognize and predict emotional responses in others . Two groups of 11 children ( age 12 - 18 ) with autism or Asperger syndrome at two special schools participated :  one group used the computer program for 10 half-hour sessions over 2 weeks . Within-program data showed a significant reduction in errors made from first to last use . Students were assessed pre- and post-intervention using facial expression photographs , cartoons depicting emotion-laden situations , and non-literal stories . Scores were not related to age or verbal ability . The experimental group made gains relative to the control group on all three measures . Gains correlated significantly with the number of times the computer program was used and results suggest positive effects . Further research could assess whether these gains generalized into real life or improved performance on theory of mind measures
While there is some evidence that ToM , or a precursor skill , can be taught to people with ASD , there is little evidence of maintenance of that skill , generalisation to other setting s , or developmental effects on related skills .
It is possible that the continuing refinement of the ToM model will lead to better interventions which have a greater impact on development than those investigated to date
BACKGROUND The ' Theory of Mind ' ( ToM ) model suggests that people with autism spectrum disorder ( ASD ) have a profound difficulty underst and ing the minds of other people - their emotions , feelings , beliefs , and thoughts .
As an explanation for some of the characteristic social and communication behaviours of people with ASD , this model has had a significant influence on research and practice .
It implies that successful interventions to teach ToM could , in turn , have far-reaching effects on behaviours and outcome .
OBJECTIVES To review the efficacy of interventions based on the ToM model for individuals with ASD .