Annual Research Review: The state of autism intervention science: progress, target psychological and biological mechanisms and future prospects

Green, Jonathan; Garg, Shruti

doi:10.1111/jcpp.12892

Cited by 103 publications

(101 citation statements)

References 127 publications

(193 reference statements)

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“…While diagnosis in males exceeds that of females threefold, the rate of ASD among girls and women is likely underestimated by male-centric operationalization of the autism phenotype, female “camouflaging” and internalizing psychiatric comorbidity [19, 20]. Increased understanding of the autism phenotype has underpinned the development of effective evidence-based behavioral interventions [21], and poor etiological insight limits the development of biological treatments or the discovery of a “cure” [22]. The conceptualization of ASD as a psychiatric disease has been challenged by evolving societal perceptions and increasing tolerance of neurodiversity, and recognition of the role of environmental factors in supporting the functioning [23].…”

Section: Introductionmentioning

confidence: 99%

The contribution of environmental exposure to the etiology of autism spectrum disorder

Bölte

Girdler

Marschik

2018

Cell. Mol. Life Sci.

343

246

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Autism spectrum disorder (ASD) is a neurodevelopmental condition of heterogeneous etiology. While it is widely recognized that genetic and environmental factors and their interactions contribute to autism phenotypes, their precise causal mechanisms remain poorly understood. This article reviews our current understanding of environmental risk factors of ASD and their presumed adverse physiological mechanisms. It comprehensively maps the significance of parental age, teratogenic compounds, perinatal risks, medication, smoking and alcohol use, nutrition, vaccination, toxic exposures, as well as the role of extreme psychosocial factors. Further, we consider the role of potential protective factors such as folate and fatty acid intake. Evidence indicates an increased offspring vulnerability to ASD through advanced maternal and paternal age, valproate intake, toxic chemical exposure, maternal diabetes, enhanced steroidogenic activity, immune activation, and possibly altered zinc–copper cycles and treatment with selective serotonin reuptake inhibitors. Epidemiological studies demonstrate no evidence for vaccination posing an autism risk. It is concluded that future research needs to consider categorical autism, broader autism phenotypes, as well as autistic traits, and examine more homogenous autism variants by subgroup stratification. Our understanding of autism etiology could be advanced by research aimed at disentangling the causal and non-causal environmental effects, both founding and moderating, and gene–environment interplay using twin studies, longitudinal and experimental designs. The specificity of many environmental risks for ASD remains unknown and control of multiple confounders has been limited. Further understanding of the critical windows of neurodevelopmental vulnerability and investigating the fit of multiple hit and cumulative risk models are likely promising approaches in enhancing the understanding of role of environmental factors in the etiology of ASD.

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Section: Introductionmentioning

confidence: 99%

The contribution of environmental exposure to the etiology of autism spectrum disorder

Bölte

Girdler

Marschik

2018

Cell. Mol. Life Sci.

343

246

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“…The design of the study addresses a number of relevant issues in ASD-specific early intervention research and also aims to overcome limitations of previous studies, i.e. study quality [84], questionable use of primary outcome measures [43] and missing moderator analyses [33].…”

Section: Discussionmentioning

confidence: 99%

Study protocol of the multi-centre, randomized controlled trial of the Frankfurt Early Intervention Program A-FFIP versus early intervention as usual for toddlers and preschool children with Autism Spectrum Disorder (A-FFIP study)

Kitzerow

Freitag²,

Hackbusch

et al. 2019

Preprint

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Background: Naturalistic developmental behavioural interventions (NDBI) have been shown to improve autism-specific symptoms in young children with Autism Spectrum Disorder (ASD). NDBI approaches, such as the ASD-specific Frankfurt Early Intervention Program for ASD (A-FFIP), are based on ASD-specific developmental and learning aspects. A-FFIP is a low-intensity intervention which can easily be implemented in the local health care / social welfare system. The aim of the present study is to establish one-year efficacy of the manualised early intervention program A-FFIP in toddlers and preschool children with ASD. It is hypothesized that A-FFIP will result in improved ASD-specific symptoms compared to early intervention as usual (EIAU). Child and family specific secondary outcomes, as well as moderators and mediators of outcome will be explored. Methods/design: A prospective multi-centre, parallel-group, randomized, controlled, phase-III trial comparing A-FFIP versus EIAU. A total of 134 children (A-FFIP: 67, EIAU: 67) aged 24–66 months at baseline assessment meeting criteria for ASD (DSM-5) will be included. The primary outcome is the absolute change of the total score of the Brief Observation of Social Communication Change (BOSCC-AT) between baseline (T2) and one-year follow-up (T6). The treatment effect will be tested adjusted for relevant covariates applying a mixed model for repeated measures. Secondary outcomes are BOSCC social communication and repetitive behaviour scores, single ASD symptoms, language, cognition, psychopathology, parental well-being and family quality of life. Predictors, moderators and mediating mechanisms will be explored. Discussion: If efficacy of the manualised A-FFIP early intervention is established, the current study has the potential to change clinical practice strongly towards the implementation of low-intensity, evidence based, natural early intervention in ASD. Early intervention in ASD requires specialist training, which subsequently needs to be developed or included into current training curricula.

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“…Designing and testing interventions targeting communication skills in children with autism has proven difficult given its heterogeneous presentation and the lack of measures sensitive to change over time [1], yet substantive progress has taken place in recent years [2][3][4]. Applied behaviour analysis (ABA) [5] is effective but not routinely provided in most jurisdictions as its labourintensive nature presents an economic barrier.…”

Section: Introductionmentioning

confidence: 99%

Point OutWords: protocol for a feasibility randomised controlled trial of a motor skills intervention to promote communicative development in non-verbal children with autism

McKinney

Hotson

Rybicki

et al. 2020

Trials

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Background: Point OutWords is a caregiver-delivered, iPad-assisted intervention for non-verbal or minimally verbal children with autism. It aims to develop prerequisite skills for communication such as manual and oral motor skills, sequencing, and symbolic representation. This feasibility trial aims to determine the viability of evaluating the clinical efficacy of Point OutWords. Methodology: We aim to recruit 46 non-verbal or minimally verbal children with autism and their families, approximately 23 per arm. Children in the intervention group will use Point OutWords for half an hour, five times a week, for 8 weeks. Children in the control group will have equal caregiver-led contact time with the iPad using a selection of control apps (e.g. sensory apps, drawing apps). Communication, motor, and daily living skills are assessed at baseline and post-intervention. Parents will keep diaries during the intervention period and will take part in focus groups when the intervention is completed. Discussion: Point OutWords was developed in collaboration with children with autism and their caregivers, to provide an intervention for a subgroup of autism that has been historically underserved. As autism is a heterogeneous condition, it is unlikely that one style of intervention will address all aspects of its symptomatology; the motor skills approach of Point OutWords can complement other therapies that address core autistic symptoms of social cognition and communication more directly. The current feasibility trial can inform the selection of outcome measures and design for future full-scale randomised controlled trials of Point OutWords and of other early interventions in autism. Trial registration: ISRCTN, ISRCTN12808402. Prospectively registered on 12 March 2019.

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Annual Research Review: The state of autism intervention science: progress, target psychological and biological mechanisms and future prospects

Cited by 103 publications

References 127 publications

The contribution of environmental exposure to the etiology of autism spectrum disorder

The contribution of environmental exposure to the etiology of autism spectrum disorder

Study protocol of the multi-centre, randomized controlled trial of the Frankfurt Early Intervention Program A-FFIP versus early intervention as usual for toddlers and preschool children with Autism Spectrum Disorder (A-FFIP study)

Point OutWords: protocol for a feasibility randomised controlled trial of a motor skills intervention to promote communicative development in non-verbal children with autism

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