Helping Give Away Psychological Science/Autism Speaker Series/The Heterogenous Phenotype part 2

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The Heterogenous Phenotype: Predicting Outcomes in ASD[edit | edit source]

Rebecca Grzadzinski PhD. Research Assistant Professor University of North Carolina at Chapel Hill. Carolina Institute for developmental Disabilities (CIDD)

Introduction[edit | edit source]

ASD has a complex heterogeneity in areas including

  • Genetic vulnerability, adaptive skills and IQ, sex/ geneder, resiliancy factors, co-occuring psychiatric conditions, age/ maturation/ development, langiage abilities, brain substrates, outcomes and response to treatment, co-occuring medical conditions, and environmental exposures.
  • With all this complexity it becomes very hard for families to pinpoint an intervention that will help their children
    • On average parents spend 20 plus hours a week planning and attempting intervention causing a great deal of stress on families.

Children with ASD vary in their outcomes and treatment related change

  • Every child responds to ASD intervention extremely differently
  • Progress isn't linear; there is a lot of variability.
  • Children ho dont get proper help may see their skills decrease over time
    • Problem: the field has struggled to find a standardized way to measure the changes in skill levels of aSD children over short periods of time.

Measuring ASD symptom change is very hard

  • The changes may be very subtle and hard to detect
  • Diagnostic tools are not sensitive enough
  • Relying on parent or clinical report has inherent bias.

Overview[edit | edit source]

In a review of 195 trials of intervention over 200 different outcome measures were used

  • There was a huge variety of measurement methods used
    • Single studies
    • Not flexible enough to be used across sites/ studies
    • Time consuming
    • Expensive
    • Require substantial training and experience
  • Wanted to create a method that would alleviate some of these issues called BOSCC.

The goals include[edit | edit source]

  • Sensitive to changes over short periods of time
  • Observation = the objective
  • Standardized yet flexible procedure
  • Easy to use for whoever is applying the intervention
  • The coding scheme is applied to video observations and is based off of the autism diagnostic observation schedule (ADOS)
    • ADOS is put on a scale from 0-2.
    • Instead, BOSCC is put on a scale of 0-5 in order to accommodate for small nuances that may be present.
      • Zero says that abnormality is not present
      • 5 says that abnormality is present and significantly impairs functioning

Methods[edit | edit source]

Items included on the BOSCC are broken into categories[edit | edit source]

  1. Social communication
    • Eye contact
    • Facial expressions
    • Gestures
    • Vocalization
    • Integration of vocal and non vocal communication
    • Social overtunes
    • Social responses
    • Engagement
    • Play
  2. Restricted, repetitive behavior (RRB)
    • Unusual sensory interests
    • hand/ finger/ body mannerisms
    • repetitive/ stereotyped interests/ behaviors
  3. Other abnormal behaviors
    • Activity level
    • Disruptive behavior/ irritability
    • Anxious behaviors

All of these items were rated on a scale when it comes to quantity and quality of actions, behaviors, mannerism, etc.

Results[edit | edit source]

Study found inside and outside of the lab high inter-rater and test retest reliability.

BOSCC was able to detect significant amounts of change over a six month period compared to ADOS[edit | edit source]

BOSCC change aligns with receptive language change

  • These changes aligned with other measures over the same time period
  • BOSCC change aligns with parent report of communication change

Children with ASD vary in their outcomes and treatment-related changes[edit | edit source]

  • The BOSCC is a way to measure the variability and the variety of ASD related treatment outcomes

There are many things that change and influence a child's progress trajectory

  • It appears that children who start out with lower skills progress more than children who begin with middle of the range skills.
    • This suggest that child's social skill severity may be a predictor of the treatment success and trajectory
  • Baseline cognitive skills can also impact the treatment trajectory.
  • Language qualities can also be a predictor for treatment trajectory.
  • Child sensory reactivity can lead to varied child outcomes
    • Children with or a risk for ASD often display sensory reactivity which can include
      • Hypo-reactivity
      • Hyper-reactivity
      • Seeking behavior
    • Child sensory responsivity impact outcome slike communications

Discussion[edit | edit source]

The study hypothesized that sensory domains at the age of 14 months and changes from 14 to 23 months may contribute to the heterogenous severity of ASD between 3 and 5 years of age.

  • Hypo and hyper reactivity can lead to later child ASD symptoms

Observation:

  • Increased hypo-reactivity at 14 months lead to an increase in ASD SA severity between the ages of 2-5 years

Parental report

  • Hyper-reactivity at 14 months increased ASD RRB severity between 3-5 years

The question is whether or not it is possible to intervene on these influencing factors and if so, can it lead to better outcomes

What is known

  • An increase in child hyporeactivity is associated with decreased child communication
  • An increase in hyporeactivity is associated with decreased parent verbal response (PVR)
  • And an increase in PVR is associated with an increase in child communication

Future Directions[edit | edit source]

Can parent verbal responsiveness ameliorate the impact of child hyporeactivity?

  • It is possible that parental responsiveness is a mediator between the relationship of child hypo-reactivity and the later decrease in child communication skills
    • This is based on the idea that an increase in PVR is associated with an increase in parental affect which subsequently leads to an increase in parental sensitivity
    • All of which are significant mediators
  • Looking at Qualities of the parent-child interaction