Research Round-Up #5

child playing with colorful toys

Research Round-Up #5

Theraplay Impact on Parents and Children with Autism Spectrum Disorder: Improvements in Affect, Joint Attention, and Social Cooperation
Theraplay is an early intervention method used to improve the relationship between children and their parents. It is a play therapy approach for treatment that uses positive interactions to impact the non-verbal aspects of children’s communication. In this study, researchers evaluated the effectiveness of Theraplay with children with autism spectrum disorder (ASD). Participants included eight children with ASD ranging in age from three to nine years old. To collect baseline data, the children and their parents participated in pre-testing two weeks before the start of intervention. Pre-testing included tasks such as putting hats on each other, playing peek-a-boo, and feeding each other a snack. Two weeks after pre-testing, the Theraplay intervention began. During the intervention, the parents and children engaged in attachment-based Theraplay activities with a trained Theraplay therapist. The treatment consisted of 19 therapy sessions over the course of nine days. The parents and children participated in two-week and three-month post-testing following the Theraplay intervention.

 To analyze the effect of Theraplay, researchers compared pre-post changes in the parent-child interactions and behavior. The results of this treatment were notable. Over time, parents displayed more facial expressions, were more responsive to their child, maintained better eye contact, and offered more guidance following the intervention. In addition, over time children became more vocal, maintained closer proximity to their parents, had better eye contact, and were more receptive to parent guidance after the intervention. The results of this study suggest that Theraplay can be a useful intervention for improving the relationship between children with ASD and their caregiver.

Behavioral Problems and Psychosocial Strengths: Unique Factors Contributing to the Behavioral Profile of Youth with Down Syndrome
In order to create beneficial treatment plans for Down syndrome (DS), the behavioral phenotype must first be defined. In this study, researchers aimed to further understand the behavioral phenotype of DS, as well as identify the strengths and weaknesses that accompany DS in children. Participants included 67 parents of children with DS ranging in age from 4 to 19 years old. Data was collected using a variety of parent-report questionnaires. The children’s developmental age, emotional and behavioral problems, and psychosocial strengths were measured using various rating scales.

On average, parents reported their children as having high amounts of social problems, attention problems, and thought problems. Data also suggested that children with DS experience less intrapersonal skills such as being self-confident, expressing their sense of humor, and identifying their own feelings. This information is useful for identifying target areas for DS treatment. On the other hand, parents most often reported their children’s psychosocial strengths as expressing and receiving affect, effectively communicating emotions, and being highly involved in the family. In order to analyze the relationships between the emotional-behavioral problems and psychosocial strengths in children with DS, researchers conducted statistical analyses. Results suggested that these problems and strengths were not mutually exclusive and are not indicative of each other. It is important to identify the children’s weakness and strengths to secure a better understanding of the DS phenotype, along with identifying areas of improvement for treatment. Psychosocial strengths could potentially be used in each individual treatment plan.

Child Challenging Behavior Influences Maternal Mental Health and Relationship Quality Over Time in Fragile X Syndrome
One of the common characteristics of fragile X syndrome (FXS) is challenging behavior, which can create strain on the mother-child relationship. Researchers were interested in how these challenging behaviors, along with maternal mental health, would impact the quality of the mother-child relationship over time. Fifty-five children with FXS and their mothers participated in this longitudinal study. Data was collected over three time periods with varying ages: Time 1 (7 to 10 years old), Time 2 (11 to 15 years old), and Time 3 (13 to 18 years old). Four assessments were used to measure mother-child closeness, the child’s challenging behaviors, maternal depressive symptoms, and maternal anxiety and anger.

As hypothesized, high rates of challenging behaviors in a child were associated with lower rates of maternal mental health and negatively influenced the mother-child relationship over time. However, high levels of maternal depression, tension/anxiety, and anger/hostility did not affect the mother-child relationship over time. This suggests that the mother’s feelings about her child are independent of her mental health problems. Fortunately, longitudinal data suggested that challenging behaviors in children with FXS drastically decrease between 9 and 15.9 years of age, which could have a positive effect on the mother-child relationship and maternal mental health. This study highlights the importance of treatment for younger children with FXS who engage in challenging behaviors, along with treatment for maternal mental health. If the challenging behaviors and maternal mental health are left untreated, it could have negative effects on the mother-child relationship.

woman and child looking at an iPad

Research Round-Up #4

Links between sleep and daytime behaviour problems in children with Down syndrome
In the general population, it is common for poor sleep to negatively impact daytime performance. However, the impact of poor sleep in children with Down syndrome (DS) is understudied. Researchers at Cincinnati Children’s Hospital Medical Center examined the relationship between sleep quality and daytime behavior in children with DS. Participants included 30 children with DS ranging in age from 6 to 17 years old. The children wore a Micro-Mini Motionlogger Actigraph on their non-dominant wrist for seven consecutive nights to collect sleep data. The actigraph detects movement and measures sleep duration and quality. To measure daytime behavior, parents and teachers completed two assessments measuring behavior problems and inattention and hyperactivity were measured using the Vanderbilt ADHD Rating Scales. Results showed that short duration of sleep was associated with higher parent ratings of inattention and hyperactivity, but not behavior problems. Parent reports of low quality/restless sleep were predictive of increased conduct problems, anxious behavior, inattention, and hyperactivity during the day. While the results of this study do not suggest a correlation between sleep problems and daytime behavior, it is possible that poor sleep can lead to increased behavioral problems during the day. Future interventions could include treatment for sleep problems, treatment for behavior problems, or both.

Telehealth Delivery of Function-Based Behavioral Treatment for Problem Behaviors Exhibited by Boys with Fragile X Syndrome
Researchers at the Stanford University School of Medicine used telehealth to deliver a treatment plan over a 12-week period to eight boys with Fragile X syndrome (FXS), aged three to ten years. This study used function-based behavioral treatment, which aims to prevent and decrease problem behavior by reinforcing positive and appropriate behavior. Before beginning treatment, each caregiver/parent was trained on how to conduct the function-based behavioral treatment. Training included information on behavioral principles and how to block their child’s problem behavior effectively.  Additionally, each caregiver/parent was given a trial session to practice what they learned before beginning the treatment protocols. The caregiver conducted different procedures based on seven experimental conditions such as interacting with their child, letting them use preferred leisure items, instructing them to do an activity, etc. When a problem behavior occurred, the caregiver discouraged the behavior in different ways depending on the experimental condition.

After completing 12 weeks of treatment, problem behavior across participants was reduced by 78-95%. In addition, 75% of children reached mastery level on all treatment conditions. The results of this study suggest that function-based behavioral treatment can be delivered successfully through telehealth.

Screen time in 36-month-olds at increased likelihood for ASD and ADHD
Children’s use of electronic media, also known as screen time, has increased in the past two decades. Doctors recommend limiting screen time for children due to its potential negative effects on development, attention, and communication skills. Researchers at the MIND institute were interested in the relationship between screen time, diagnostic status, and language development in 36-month-old children who were at increased risk of developing autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) due to family history.

This study included 120 children aged 36 months with a family history of ASD (62 children), ADHD (30 children), or with no family history of either disorder (28 children). The children were placed in one of three groups based on their diagnostic evaluations: the ASD group (20 children), the ADHD Concerns group (14 children), and the Comparison group (86 children) which included the children who did not meet criteria for ASD or ADHD concerns. Parents completed a questionnaire about the amount of time their children spent watching television, movies, or using other electronic devices. Language development, ASD symptoms, and ADHD symptoms were measured. Data analysis showed that screen time was significantly associated with language scores. Children with higher amounts of screen time showed decreased receptive and expressive language scores. In addition, the amount of screen time was greater in the ADHD Concerns group than the Comparison group. The results of this study show the importance of parental education and awareness on the topic of screen time in young children. Reducing screen time could help prevent declines in language skills and may positively affect overall child development.

Child playing with dough

Research Round-Up #3

Brief Report: Parent Perspectives on Sensory-Based Interventions for Children with Autism Spectrum Disorder
Sensory-Based Interventions (SBIs) are treatments that use sensory tools to address behavioral challenges in children with autism spectrum disorders (ASD). SBIs work to help children process and recognize environmental stimuli. In this study, researchers interviewed 152 parents of children with ASD and collected data on the families’ use of SBIs along with their views on the importance and helpfulness of the tools they used. The most commonly used SBIs included massage, trampoline, joint compressions and brushing, weighted backpack, and oral-motor tools. When asked about the importance of SBIs, approximately 75% of parents said that they were important or very important. In addition, 53.3% said SBIs were helpful in addressing challenging behaviors in their child. The results of this study are useful in identifying parents’ perspectives on which equipment or tools have shown to be most beneficial for their children with ASD. Many parents request the use of SBIs, therefore knowing which are most accessible and beneficial can help clinicians, therapists, and parents work SBI’s into the children’s treatment.

The Longitudinal Effects of Parenting on Adaptive Behavior in Children with Fragile X Syndrome
Studies suggest that children with Fragile X syndrome (FXS) often have a decline in their adaptive behavior skills beginning in middle childhood. Researchers at the University of Kansas measured the maternal responsivity in parents of children with FXS to analyze the effect it has on their children’s adaptive behavior. Maternal responsivity is a parenting method involving “warmth, nurturance, and stability,” along with positive responses to children. This study focused on certain behaviors such as “commenting on their child’s behavior and/or focus of attention, requesting a verbal response, and recoding and/or expanding a child’s previous response.” Maternal responsivity was measured using observation.

Fifty-five children with FXS participated in this study from the ages of 2 to 10 and completed assessments measuring their adaptive behavior skills and autism symptoms. The results showed that children with highly responsive mothers displayed larger increases in communication over time than those with less responsive mothers. Autism severity also impacted the performance in adaptive skill behaviors. Children with high autism severity typically ranked lower in adaptive behavior than those with low autism severity, despite level of maternal responsivity. For children who were showing declines in adaptive behavior, having mothers with high maternal responsivity lessened the amount of decline in the communication, daily living, and socialization domains compared to children whose mothers displayed low maternal responsivity. The researchers suggest training efforts be put in to place to support highly responsive parenting for children with FXS.

Group-Based Social Skills Training with Play for Children on the Autism Spectrum.
Social Skills Training (SST) has been shown to be a helpful intervention for improving social skills in children with autism spectrum disorders (ASD). Using an eight-week SST treatment program, researchers examined the effects of play within SST by providing semi-structured playtime and unstructured playtime. Forty-five children with ASD aged 8 to 12 years old were assigned to one of three treatment groups: a group of SST with unstructured play, a group of SST with semi-structured play, and a waitlist control group. Teacher and parent observation reports were both used to provide more accurate data. The two groups of children receiving SST showed clinical improvements in social skills and social competency compared to the control group. The children in the semi-structured playgroup made the most significant gains in social skills and social competence compared to the two other groups. The results of this study suggest using SST can be a beneficial treatment for strengthening social skills and social competency in children with ASD.

Two toddlers playing with toys

NDD Lab Undergrad Featured in Caravel

We’re excited to share that one of our former undergraduate research assistants recently had his work published in USC’s undergraduate research journal!

Nicolas Poupore spent several years as an undergrad working in our lab on physiological data. He’s currently attending medical school at the University of South Carolina School of Medicine-Greenville. Before graduating, Nicolas submitted an article to the Caravel, the Office of the Vice President for Research’s online undergraduate research journal, which chronicles student research and creativity. His paper “Early Behavioral and Physiological Predictors of Autism in 12-month-old Siblings of Children with Autism” can be read online here.

Congratulations, Nicolas!

Girl listening with headphones

Research Round-Up #2

Melatonin may ease autistic children’s sleep troubles
Children with autism often have difficulties falling asleep and staying asleep. This study by Beth Malow at Vanderbilt University looked into the safety of melatonin, an over-the-counter supplement used as a sleep aid. Eighty children aged 2-17 years, most of which had autism and a few with Smith-Magnesis syndrome, took a slow-release form of melatonin called PedPRM for 91 weeks with the option to increase the dosage if needed. The children had significant improvements in sleep and quality of life. Researchers also found that PedPRM did not delay puberty for these children, which was an initial concern due to the melatonin hormone. This study shows that melatonin can be a safe and helpful way for children with autism to get a good night’s sleep, which can also lead to improvements in general quality of life.

Expressive language development in adolescents with Down syndrome and fragile X syndrome: change over time and the role of family-related factors. 
Down syndrome (DS) and fragile X syndrome (FXS) often coincide with early language difficulties. Researchers at the MIND Institute in California were interested in finding out how expressive language changes over time, and whether or not those changes are syndrome specific. The expressive language skills of 57 adolescent males with intellectual disabilities (20 DS and 37 FXS) were analyzed. Family-related predictors such as maternal IQ, maternal psychological distress, closeness of the mother-child relationship, maternal and paternal level of education, and family income were also analyzed to see the roles they played in predicting expressive language.
Over the span of three years, adolescents with DS and FXS had increased in talkativeness but decreased in amount of words spoken and complexity. The participants with FXS displayed a greater increase in talkativeness than those with DS. In addition, participants whose mothers had a college education displayed greater talkativeness over time compared to those whose mothers had a high school education. This research could benefit children by helping clinicians identify the strengths and weaknesses in expressive language in children with DS and FXS, as well as help treat the children in the areas they could improve such as number of words spoken and their complexity.

Music improves social communication and auditory–motor connectivity in children with autism.
Music can be used as a tool in therapy to help improve mood and reduce stress. More specifically, music therapy could be beneficial for children with Autism Spectrum Disorder (ASD). In this study, 51 children with ASD aged 6-12 years were randomly chosen to receive either music (26 children) or non-music intervention (25 children). The music intervention used song and rhythm to target social communication, while the non-music intervention used structurally matched behavioral intervention. Children who participated in music intervention improved in social communication, social relations, and interests. In addition, brain functional connectivity was greater in children who received music vs non-music intervention. The results of this study suggest that music therapy can be a useful tool by reducing sensory distractions and improving social communication skills.

woman using laptop while sitting on couch next to child

Research Round-Up

In our first research round-up, we share research about improving early identification of autism spectrum disorder (ASD) in the primary care setting using different screening processes.

Utilizing Two-Tiered Screening for Early Detection of Autism Spectrum Disorder
In the primary care setting, many physicians use a parent questionnaire called the Modified Checklist for Autism in Toddlers (M-CHAT-R/F) as an initial screener for ASD. However, problems exist with the M-CHAT-R/F and other early screeners as they produce a high false positive rate for ASD, resulting in lengthened waiting lists for comprehensive evaluations and delayed interventions for children. This study measured the effectiveness of combining a level one screener, the M-CHAT-R/F, with a level two screener, the Screening Tool for Autism in Toddlers & Young Children (STAT), with the purpose of separating children at risk for ASD from those at risk for other developmental concerns. This would allow those at risk for ASD to receive diagnostic evaluations and interventions sooner. Results using the two-tiered approach in a sample of 109 toddlers were promising. They found that the rate of false positives decreased, sensitivity of the tests was improved, and identification of true positives was not adversely affected. These results suggest that referrals for ASD services can be streamlined, lowering the age of diagnosis and providing access to interventions earlier.

Improving Early Identification and Intervention for Children at Risk for Autism Spectrum Disorder
Challenges exist for many state-run systems in early identification of ASD. To combat these foundational, statewide issues in South Carolina (SC), researchers developed the South Carolina Act Early Team (SCAET). Under existing policies in SC, children deemed to be at risk using screening measures could only access intervention services with a formal diagnosis of ASD. The SCAET piloted policy changes to use a two-tiered screening process, including the M-CHAT and STAT, two parent-report questionnaires. Additionally, under this updated policy, children under the age of 3 found to be at risk using the two screening measures were provided the BabyNet Early Intensive Behavioral Intervention (EIBI) without a diagnosis of ASD. The implementation of presumptive eligibility rather than a formal diagnosis produced a fivefold increase of children who were eligible for EIBI, saving families years of waiting for an ASD diagnosis and earlier access to interventions. Through this study, the SCAET increased collaboration and efforts among services and leaders in SC, was able to improve early identification, and provided a successful policy that can be replicated in other states.

A Statewide Tiered System for Screening and Diagnosis of Autism Spectrum Disorder
Creating effective systems of ASD screening to lead to interventions is a public health priority, particularly in underserved areas with a greater need for these services and an overall lack of access to care. Indiana fell behind in developmental screenings for children nationally and was in need of a screening and diagnosis system due to a higher number of children with developmental disorders. Researchers created the statewide Early Autism Evaluation (EAE) Hub system comprised of three tiers: 1) children receive screening measures in a primary care setting; 2) 18 – 48 month old children who are found to be at risk for ASD are referred to the EAE Hub for further evaluation; and 3) children with severe or atypical clinical presentation are referred for thorough evaluations at a specialty diagnostic center. The results concluded that the average age at evaluation was 30 months, considerably lower than the national average of 4-5 years. The average wait time for the EAE Hub evaluation was 62 days, drastically different from the statewide average of 9-12 months. This system was widely successful in serving a disadvantaged area and has implications for use beyond Indiana in states facing similar issues.

Congratulations to Kayla

Congratulations, Kayla!

Research specialist Kayla Jarvis has been accepted to the Doctor of Occupational Therapy (OTD) program at Presbyterian College! After joining the NDD Lab in January 2019, Kayla began working with infants and children with Down syndrome and fragile X syndrome. Through this work, she developed an interest in early intervention and its effects on motor skills. Kayla decided to pursue a career in occupational therapy and spent the last year shadowing occupational therapists in a variety of settings. She will start the OTD program in January 2021. Congrats, Kayla!

Mother and child wearing masks and using hand sanitizer

COVID-19 Resources

In response to the COVID-19 pandemic, many researchers and organizations are offering free resources to help families. Below we share some of the resources we’ve come across.

Social Stories
Social stories can be a very useful tool for all children because they help prepare them for what to expect in unfamiliar situations. The free stories listed on the link above cover COVID-19 and schools, but the author also has stories such as “When Can I Stop Wearing A Mask?” and “Getting a Haircut During COVID-19”.

Toolkit: “Supporting Individuals with Autism through Uncertain Times”
Researchers at UNC Chapel Hill worked with teachers, parents, and experts from various fields to develop a comprehensive guide for those who may feel unequipped to manage the changes brought on by the pandemic. Many of the resources are fully customizable to meet the individual needs of children with ASD and their family members.

Free Parent Workshops, Webinars, and Other Educational Resources
The Vanderbilt Kennedy Center has a variety of free educational resources available to families of children with autism.

Autism Research Study: Regulating Together
Cincinnati Children’s is conducting a research study that can be completed at home to test the effectiveness of an ASD treatment program called Regulating Together in people diagnosed with ASD and emotion regulation difficulties. The program is for children and teens 8 to 18 years old with ASD and their caregiver(s).

Pandemic Parenting
Pandemic Parenting is a collaboration between two psychologists, scholars, and moms committed to sharing their expertise and research in ways that are immediately accessible and useful to families.

Additional Resources
UCLA CART is maintaining a list of up-to-date resources, approved by leading clinicians and designed to help families feel informed and empowered.


Congratulations, Chandler!

We are excited to share that research specialist Chandler Knott will stay on in the lab as a doctoral student in the School Psychology program! Chandler first joined the lab as an undergraduate research assistant. After receiving her B.S. in Experimental Psychology from UofSC in 2017, she was hired as a full-time research specialist in the lab. She quickly developed a rapport with participants and became a valuable member of the assessment team. As lead research specialist, she trained new lab members on multiple measures and took on additional responsibilities during staff transitions. Her acceptance to the School Psychology program was no surprise to those who work with her, and we’re thrilled that she’s chosen to embark on this next stage of her career as a member of the NDD Lab!

Congratulations, Chandler!

Demonstration of participants in our study

Dr. Roberts Named Carolina Distinguished Professor

Dr. Jane Roberts is one of two professors named as 2020 recipients of the Carolina Distinguished Professorship, one of the highest honors awarded to South Carolina faculty! The position honors professors who show excellence in scholarship, a commitment to students and their colleagues and overall participation in the life of the university.

You can read the full story here.

Please join us in congratulating our amazing PI on this outstanding achievement!

Learn how you can take part in our research