BackgroundMagnetic resonance imaging (MRI) has been widely used in studies evaluating the neuropathology of autism spectrum disorder (ASD). Studies are often limited, however, to higher functioning individuals with ASD. MRI studies of individuals with ASD and comorbid intellectual disability (ID) are lacking, due in part to the challenges of acquiring images without the use of sedation.MethodsUtilizing principles of applied behavior analysis (ABA), we developed a protocol for acquiring structural MRI scans in school-aged children with ASD and intellectual impairment. Board certified behavior analysts worked closely with each child and their parent(s), utilizing behavior change techniques such as pairing, shaping, desensitization, and positive reinforcement, through a series of mock scanner visits to prepare the child for the MRI scan. An objective, quantitative assessment of motion artifact in T1- and diffusion-weighted scans was implemented to ensure that high-quality images were acquired.ResultsThe sample consisted of 17 children with ASD who are participants in the UC Davis Autism Phenome Project, a longitudinal MRI study aimed at evaluating brain developmental trajectories from early to middle childhood. At the time of their initial scan (2–3.5 years), all 17 children had a diagnosis of ASD and development quotient (DQ) <70. At the time of the current scan (9–13 years), 13 participants continued to have IQs in the range of ID (mean IQ = 54.1, sd = 12.1), and four participants had IQs in the normal range (mean = 102.2, sd = 7.5). The success rate in acquiring T1-weighted images that met quality assurance for acceptable motion artifact was 100 %. The success rate for acquiring high-quality diffusion-weighted images was 94 %.ConclusionsBy using principles of ABA in a research MRI setting, it is feasible to acquire high-quality images in school-aged children with ASD and intellectual impairment without the use of sedation. This is especially critical to ensure that ongoing longitudinal studies of brain development can extend from infancy and early childhood into middle childhood in children with ASD at all levels of functioning, including those with comorbid ID.Electronic supplementary materialThe online version of this article (doi:10.1186/s11689-016-9154-9) contains supplementary material, which is available to authorized users.
Using a single case design, a parent-mediated spoken language intervention was delivered to three mothers and their school-aged sons with fragile X syndrome, the leading inherited cause of intellectual disability. The intervention was embedded in the context of shared story-telling using wordless picture books and targeted three empirically-derived language support strategies. All sessions were implemented via distance video-teleconferencing. Parent education sessions were followed by 12 weekly clinician coaching and feedback sessions. Data was collected weekly during independent homework and clinician observation sessions. Relative to baseline, mothers increased their use of targeted strategies and dyads increased the frequency and duration of story-related talking. Generalized effects of the intervention on lexical diversity and grammatical complexity were observed. Implications for practice are discussed.
While the prevalence of ASD is equivalent across racial demographics, there persists a significant difference in identifying developmental concerns and accurately diagnosing children from Black backgrounds as compared to their white peers. Research has identified a number of barriers to accurate diagnosis including inadequate screening, slow response to parent concerns, lack of awareness of symptoms, and misdiagnosis. This chapter will explore systematic factors such as socioeconomic inequities leading to lack of access to adequate clinical services, historical medical mistrust, racial bias within healthcare leading to improper diagnosis, and barriers to appropriate services and interventions for Black children with ASD. Additionally, a closer examination of the diagnostic criteria for ASD will be discussed alongside cultural factors that should be considered when interpreting the behavioral and developmental profile of the Black child.
<i>This is a qualitative, phenomenological study of parents with children with autism who come from non-White backgrounds (N=7). Subjects were interviewed via recorded phone calls, during which they were asked a standard set of questions pertaining to their experiences with in-home family and child treatment. The problem examined in this study was the inequity experienced by families of color who have at least one child with autism and who received in-home early intervention autism services. Parents were interviewed to determine which aspects of treatment were perceived to be effective. The data were coded for emerging themes, with special attention given to opportunities for service amendment, seeking maximal perceived effectiveness. Families benefitted from an individualized approach to treatment that considered the family context, and culture, designed by listening to the family’s needs, concerns, and availability. Assuming a one-size-fits-all approach, based on recommendations not made with diverse family backgrounds in mind, was less effective. Future directions in the field should include improved training for psychologists on cultural competence, encourage self-reflections on bias, and training on the development of individualized treatment plans.</i>
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