Clinical assessment of autism in high-risk 18-month-olds Chelation for autism spectrum disorder (ASD). Improving autism perinatal risk factors: A systematic review. A systematic review of peer-mediated interventions for children with autism spectrum disorder. A Virtual Week study of prospective memory function in autism spectrum disorders. A Randomized Controlled Trial of the Korean Version of the PEERS® Parent‐Assisted Social Skills Training Program for Teens With ASD
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 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 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 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 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 Impaired social functioning is a hallmark feature of autism spectrum disorder ( ASD ) , often requiring treatment throughout the life span . PEERS ® ( Program for the Education and Enrichment of Relational Skills ) is a parent‐assisted  social skills training for teens with ASD . Although PEERS ® has an established evidence base in improving the social skills of adolescents and young adults with ASD in North America , the efficacy of this treatment has yet to be established in cross‐cultural validation trials . The objective of this study is to examine the feasibility and treatment efficacy of a Korean version of PEERS ® for enhancing social skills through a r and omized controlled trial ( RCT ) .The English version of the PEERS ® Treatment Manual ( Laugeson & Frankel , 2010 ) was translated into Korean and review ed by 21 child mental health professionals . Items identified as culturally sensitive were surveyed by 447 middle school students , and material was modified accordingly . Participants included 47 teens between 12 and 18 years of age with a diagnosis of ASD and a verbal intelligence quotient ( IQ ) ≥ 65 . Eligible teens were r and omly assigned to a treatment group ( TG ) or delayed treatment control group ( CG ) . Primary outcome measures included question naires and direct observations quantifying social ability and problems directly related to ASD . Secondary outcome measures included scales for depressive symptoms , anxiety , and other behavioral problems . Rating scales for parental depressive symptoms and anxiety were examined to detect changes in parental psychosocial functioning throughout the PEERS ® treatment . Independent sample s t‐tests revealed no significant differences at baseline across the TG and CG conditions with regard to age ( 14.04 ± 1.64 and 13.54 ± 1.50 years ) , IQ ( 99.39 ± 18.09 & 100.67 ± 16.97 ) , parental education , socioeconomic status , or ASD symptoms ( p < 0.05 ) , respectively . Results for treatment outcome suggest that the TG showed significant improvement in communication and social interaction domain scores on the Autism Diagnostic Observation Schedule , interpersonal relationship and play/leisure time on the subdomain scores of the Korean version of the Vinel and Adaptive Behavior Scale ( p 's < 0.01 ) , social skills knowledge total scores on the Test of Adolescent Social Skills Knowledge — Revised ( p < 0.01 ) , and decreased depressive symptoms on the Child Depression Inventory following treatment ( p < 0.05 ) . Analyses of parental outcome reveal a significant decrease in maternal state anxiety in the TG after controlling for potential confounding variables ( p < 0.05 ) . Despite cultural and linguistic differences , the PEERS ® social skills intervention appears to be efficacious for teens with ASD in Korea with modest cultural adjustment . In an RCT , participants receiving the PEERS ® treatment showed significant improvement in social skills knowledge , interpersonal skills , and play/leisure skills , as well as a decrease in depressive symptoms and ASD symptoms . This study represents one of only a few cross‐cultural validation trials of an established evidence ‐based treatment for adolescents with ASD . Autism Res 2014 , 7 : 145–161 . © 2014 International Society for Autism Research , Wiley Periodicals ,
The studies examined suggest moderate evidence about the effectiveness of  VR-based treatments in ASD .
VR can add many advantages to the treatment of ASD symptomatology , but it is necessary to develop consistent validations in future studies to state that VR can effectively complement the traditional treatments
Autism Spectrum Disorder ( ASD ) is a neurodevelopmental disease that is specially characterized by impairments in social communication and social skills .
ASD has a high prevalence in children , affecting 1 in 160 subjects .
Virtual reality ( VR ) has emerged as an effective tool for intervention in the health field .
Different recent papers have review ed the VR-based treatments in ASD , but they have an important limitation because they only use clinical data bases and do not include important technical indexes such as the Web of Science index or the Scimago Journal & Country Rank .
To our knowledge , this is the first contribution that has carried out an evidence -based systematic review including both clinical and technical data bases about the effectiveness of VR-based intervention in ASD .