Connie Kasari, PhD, details what contemporary research reveals about supporting non-speaking or minimally verbal autistic children. She highlights how far the field has come in the past two decades and emphasizes the need for contemporary research to focus on what strategies benefit whom and why. The speaker discusses JASPER, a modular intervention based on social communication. She outlines recent studies and video examples showing positive language outcomes for JASPER on its own and in tandem with other interventions. Kasari underscores the usefulness of AAC devices in spoken language development, noting the lack of interventions that use even low-tech augmentative supports. The speaker summarizes her presentation and focus for future research before the Q&A.

Handouts are online HERE

In this webinar

2:00 – Early intervention in autism
7:00 – Core challenges: Video
14:16 – Study: JASPER intervention outcomes
26:00 – Intervention trajectories
31:50 – Study: Intervention combinations and AAC
36:11 – Implications for practice
45:45 – AAC case studies
46:45 – Summary
48:00 – Q&A

Early intervention and social communication

Kasari explains that nearly all autistic children will require support/intervention on engagement, imitation, joint attention, and play (2:00). She states that the goal of early intervention is to reduce the number of autistic children who have significant language impairment by the time they start school. Language ability remains one of the strongest predictors of positive long-term outcomes, making support strategies that target social communication skills—such as joint attention, engagement, and play—especially critical (4:00). Importantly, Kasari notes that research hasn’t focused on for whom an intervention works or why a particular intervention provides benefit for certain people. Understanding this is critical to expanding care and assessment across the board (5:30).

The speaker discusses core challenges that may trigger an intervention and shows videos comparing social communication in an autistic and a non-autistic child at 18 months old. Kasari highlights differences between the videos, noting the child with autism is more interested in looking at the objects than communicating (7:00). She explains how this pattern often translates to parent play, making it feel frustrating or not enjoyable for many parents/caregivers, and discusses two video examples of this (9:30).

Social Communication Research

The speaker says we know the least about children who are most delayed in development, who have limited language skills, and those whose families have less access to information about studies in their communities. She explains that most autistic children have never been in a research study. As a result, our evidence base does not represent the entire spectrum of autism (13:15). Kasari and her team focus on researching interventions for non-speaking and minimally verbal autistic children that can be conducted in community settings.

JASPER: Joint Attention, Symbolic Play, Engagement, and Regulation

The presenter describes JASPER, a comprehensive social communication/language intervention that can float inside other interventions, be used on its own or used sequentially (14:60). Kasari presents one of her recent publications comparing outcomes in 164 children, 3 -5 years old, across three sites after four months receiving Discrete Trial Training (DTT) or JASPER (video examples) (19:00). Results from the study show that both groups made significant language gains, and 45% moved toward phrased speech (putting words together).

Intervention trajectories

The goal of the intervention was to avoid the label of minimally verbal or profound autism by school age. Kasari defines profound autism as children with a developmental quotient (DQ) below 50, aged 8 or older, with poor adaptive skills (often minimally verbal or non-speaking). She notes that this is a relatively new term and considers how early we can predict these outcomes (26:00). The speaker reviews DQ data for a group of 264 children at very young ages. By age 8, 47% did not meet criteria for profound autism, although 25% of this group had a DQ lower than 50 at age 4 (28:30).

Kasari summarizes study takeaways, noting that DQ can help predict later development but is not a perfect predictor on its own. She reiterates the importance of early intervention and highlights understanding the 25% who moved off trajectory as a critical next step (29:25).

Combination interventions and assistive technology (AAC)

The presenter reiterates the heterogeneity in response to interventions, underscoring the need to personalize, tailor, and target interventions according to each person. This will also help us address for whom the intervention works and why. Kasari defines adaptive intervention designs as a sequence of decision rules that specify whether, how, when (timing), and based on which measures, to alter the dosage (duration, frequency, or amount), type, or delivery of treatment(s) at decision stages in the course of care – this is what her group employs (29:45).

Kasari details a study with 61 children, 5-8 years old, who are minimally verbal and had received 2 years of intensive early intervention (most ABA). All children received JASPER plus EMT, a spoken language intervention. Half of the children were randomized to receive AAC devices to test if these supports help with spoken language. Children attended two sessions per week, and at the 12-week follow-up, those assessed as slow responders were re-randomized to either add AAC or to up to 3 sessions per week. Outcomes for socially communicative utterances were assessed after another 12 weeks (31:50). Those who used AAC devices from the beginning showed significant increases and also had more novel words and joint attention language. Those with only JASPER and EMT made slow but steady progress. Researchers also found that from entry to midpoint to exit, parent-initiated engagement stayed the same while child-initiated engagement increased (34:15).

Implications for practice

The speaker notes that assistive technology are still not used regularly with children, be it a device, sign language, or another low-tech augmentative device; they are not being used as much as they should (36:11). Kasari returns to the child from the first video and describes how they changed tactics the second day by lowering the play level and adding an AAC device with button-words (video provided) (40:00). She notes that this child entered regular education at age 7, speaking full sentences. He used the AAC for a few years as a transition to spoken language. The presenter describes another case in which a child used AAC to support communication. He made progress over time, eventually asking the therapist to put phrases that he hears in the AAC device so he can listen to them and learn the sounds. In a follow-up video, the child is speaking in full sentences (45:45).

Kasari summarizes her presentation, highlighting that we can improve social communication and language outcomes for delayed autistic children and that these early skills need to be direct targets for support/intervention strategies. She reiterates how research must inform practice and, therefore, focus on answering questions about personalized interventions (how long do we wait, what do we change to?) (46:45) before the Q&A (48:00).

Patricia Wright, PhD, MPH, and Katie Curran, MAAP, introduce Proof Positive – The Autism Well-being Alliance. The speakers describe positive psychology, its impact on well-being, and why it matters for autistic people and their communities. Curran details four skills to help with thinking positively and provides suggestions for practicing and applying them to daily life. The speakers emphasize the lack of focus on positive emotions in autism care and how this plays into isolation and mental health issues. They affirm that individuals “can control [their] own well-being” by employing positive psychology and training their minds to build on the things that go well each day. Wright and Curran outline Proof Positive’s free learning and teaching resources before the Q&A. 

Handouts are online HERE

In this webinar:

1:00 – Proof Positive and the need for positive psychology
5:00 – What is positive psychology
14:00 – PERMA + Snapshot for well-being
18:30 – What Went Well?
27:45 – Jolts of Joy
30:43 – Broaden and Build vs. Fight or Flight
39:44 – Showcase the Good
48:20 – Q &A

Background

Patricia Wright, PhD, MPH, Executive Director at Proof Positive, introduces The Autism Well-Being Alliance, a nonprofit dedicated to improving the well-being of autistic people and their families, providers, and communities. By intersecting positive psychology with autism services, Proof Positive spreads the science and skills of happiness (1:00). She notes high rates of underemployment and mental health issues in autistic adults and underscores how difficult it is to find and retain social service providers. Over the last decade, the demand for these roles has increased 41%, and the U.S. healthcare system is experiencing major staff shortages. Although well-being is a relatively new term within autism care vocabulary, Wright underscores its importance and potential for quality of life management (3:00). 

Why Positive Psychology

Katie Curran, MAPP, Chief Well-being Officer at Proof Positive, says that those who practice positive psychology experience increased well-being and life satisfaction, better sleep, stronger relationships, less depression, and more success in school and work (5:00). Positive psychology considers the components of a life full of purpose and what makes life worth living. In other words, Curran continues, it asks, “Who are you at your best, and how do we get more of it?” Over thirty years of research, six elements critical to human thriving have arisen (8:10): 

1. Positive emotions – A sense of inspiration; a wide variety of positive emotions felt most days
2. Engagement – A good sense of what interests you; ability to spend time in flow and follow interests
3. Relationships – Other people matter, and relationships are critical to who we are and how we navigate the good and bad times
4. Mattering – A sense that your life has meaning and purpose; a feeling of connection to something larger than yourself. 
5. Accomplishment – Having a healthy sense of where you are going in the future; you have goals you are pursuing, and you believe you can achieve them
6. Physical health – Sleep, nutrition, and movement are key to maintaining happiness; when we move, our muscles pump food to the brain.

These six aspects of human thriving, referred to as PERMA+, are critical to understanding and empowering people to impact their well-being. 

To explore the research behind these elements, visit Proof Positive’s Science Page. 

Skills for well-being support

Curran asserts that “You can control your well-being” and outlines four practical tools that enhance well-being skills. 

#1 – PERMA+ Snapshot

The PERMA+ Snapshot asks you to stop and reflect on your well-being around once a week (14:00). Proof Positive offers a well-being survey that helps measure well-being and provides suggestions about skills to practice. The speaker emphasizes that no matter where you are on the scales, you are improving your well-being simply by taking time to take this survey because you are telling yourself that you are important and worth spending time and energy on (17:30). She suggests referring back to the PERMA+ survey for snapshots and tracking personal well-being.

#2 – What Went Well?

The goal of this exercise is to train your brain to mindfully notice, remember, and track the good things that happen each day (18:30). The presenter notes that left on their own, our brains default to spotting danger and things that have gone wrong as a means of self-preservation and protection. However, we need to shift our focus and ensure that every day, we intentionally focus on things that have gone well. 

To practice What Went Well, Curran suggests using a journal or gratitude app on your device and setting a time to write down at least three things that went well each day. It’s also helpful to consider what made each good thing special and to share your list with a family member or friend (22:55). The presenter notes that people who do this exercise before bed fall asleep faster and sleep longer but also that anxiety tends to be worse first thing in the morning. Therefore, she continues, it can be good to capture What Went Well before bed and then read the list in the morning (23:40). The speaker provides a few more tips and free teaching resources from the Proof Positive Website. 

#3 – Jolts of Joy

The Jolts of Joy exercise teaches us to intentionally experience higher levels of well-being and bursts of positive emotions across the day (27:45). Curran describes the negativity bias, noting that across 130 languages, six of the seven shared words to describe emotions are negative – again due to survival because fear keeps us alive (30:45). Barbara Frederickson was the first researcher to ask what good our positive emotions are and why we feel hope. She discovered that where negative emotions trigger a fight or flight response, positive emotions trigger the broaden and build response. “Broaden and Build’ refers to how our minds open up for creativity and problem-solving when we feel good. The presenter explains it as the opposite of tunnel vision (related to stress), where our vision expands and we see more of the world around us. Because growth is a critical part of the human experience, positive emotions are just as essential to survival as negative ones (31:50). 

Practicing jolts of joy can be a solitary or group activity. Carrun suggests listing 10 ways you experience positive emotions, be it cat videos, family photo albums, music, etc. It is good to include a variety of positive emotions in the list. Place your list where it’s easy to see, and then be sure to engage in a minimum of three (3) Jolts of Joy every day (35:45). The presenter underscores the importance of positive emotions, noting that many emotion regulation programs do not include these in the curriculum (39:00). 

#4 – Showcase the Good

Responding to other people’s good news in a way that enhances their joy and enables them to relive the positive experience is a critical differentiator between thriving relationships (39:45). Shelley Gable’s research shows that there are four ways people tend to respond to good news and that three of the styles are detrimental to relationships where only one boosts them. The four response styles are outlined below using the example of responding to a child who got a 90% on their math test (39:45):

1. Passive – Quiet, understated support.
   1. “Hey, look! I got a 90% on my math test!”
   2. “Great Job.”
2. Passive Destructive – You ignore the information altogether or “change the channel.”
   1. “Hey, look! I got a 90% on my math test!”
   2. “Do you have your cleats? It’s almost time for soccer.” or “Oh, where is your sister? She got a 100% on her history test.”
3. Active Destructive – Someone brings good news, and you squish it – a literal joy killer.
   1. “Hey, look! I got a 90% on my math test!”
   2. “A 90%? I thought we studied so hard! What did you get wrong?”
4. Active Constructive – Authentically engaged and asking questions
   1. “Hey, look! I got a 90% on my math test!”
   2. “Wow! Great job! We studied so hard for that! What did your teacher say? How do you feel?”

Curran highlights that when we Showcase the Good, both parties experience increases in trust, belonging, and intimacy. How we celebrate the good together is at the center of positive relationships. To practice Showcasing the Good, the speaker suggests sharing good news, leaning in when someone else shares their good news, asking questions to help that person relive their experience, and utilizing your own strengths to show interest (what are you curious about? Let that guide your questions and observations) (46:00). 

Proof Positive provides free learning and teaching resources for parents, school teachers, and professionals to help intersect positive psychology with autism care strategies. Each skill has an associated resource bundle that you can use to boost positive thinking and well-being. Curran and Wright thank the attendees before opening the Q&A (48:20). 

Originally posted September 24, 2024

Xinru Page, Ph. D., discusses the benefits and challenges of using social media for autistic young adults. She cites recent survey studies involving autistic people, support networks, and field sites and highlights how social media are not designed with neurodiversity in mind. The speaker considers the importance of supportive communities and repetition in online safety mediation and problem-solving for adults with autism. Page gives guidelines for working with young adults on social media and outlines a social media literacy course currently in its fourth iteration. She provides acknowledgments and study sign-up details before the Q&A.

Ph.D. candidate Kristen Chapman moderates the presentation and summarizes attendee responses after each section.

Handouts are online HERE (.pdf)

In this webinar:

2:35 – Background
4:45 – Research & presentation outline
7:38 – Social media outcomes
12:07 – Number 1: Literal interpretation of the interface
16:00 – Number 2: Suggestions as instructions
19:55 – Number 3: Always engaging with content
25:15 – Number 4: Clear expectations
30:55 – Support networks
36:55 – Mediation timing and outcomes
47:50 – Recommendations for working with young adults on social media
53:00– Social media literacy course
57:40 – Q&A

Introduction

Social media can connect people to communities, potential employees, and other resources crucial for successfully navigating the world. However, people with autism experience more online harassment and harm than the general population (2:35). Page acknowledges preferences for person-first and identity-first language within the autism community, noting that her studies assume the language her participants use (3:50). The presenter outlines data collection methods for a recent survey study including interviews, observations, and feedback from autistic people (with and without intellectual disability), support networks (family, service providers), and field sites (day programs, community members) (4:45). 

• Perceiving Affordances Differently: The Unintended Consequences When Young Autistic Adults Engage with Social Media (Page et al., 2022)
• Towards Digital Independence: Identifying the Tensions between Autistic Young Adults and Their Support Network When Mediating Social Media (Cullen et al., 2024)

Outcomes of social media use

For people with autism, the most frequently cited positive outcomes of social media were social connection, especially with people who moved away, and interest-based immersion, or the ability to focus on a special interest with others who are passionate about the same thing (7:38). Negative outcomes include risk of physical harm due to misinterpreting intent, social/relational damage due to not understanding social etiquette, and psychological harm like increased anxiety from intense rumination about online communications (10:17). 

Autism traits that aren’t supported by social media

Many of these outcomes, Page explains, could be avoided if social media were designed with neurodiversity in mind. She describes common autism characteristics not supported by social media rules or interfaces: 

Number 1: Literal interpretation of the interface

Interpreting things in a literal sense is a common characteristic of people with autism. The speaker explains how taking things at face value can lead to dangerous interactions with deleterious parties online (12:07). Many study participants report that it can be difficult to understand what labels like “friend” on social media mean. For example, assuming that a “Facebook friend” is the same as a “real-life friend” can create tensions in relationships (14:07).  

Number 2: Suggestions as instructions

Many autistic people follow online prompts as if they were directions. For example, the Facebook status section asks, “What’s on your mind?” or the comments section asks, “Respond” or “Write an Answer.” When read as instructions, these can lead to oversharing about work or personal life online, affecting employment and relationships (16:00). Likewise, in the profile section, many people with autism share too much sensitive information, assuming that if it asks for an email or current residence, that you have to provide it (18:50). 

Number 3: Always engaging

Page explains that numerous study participants cited a need to respond to everything that appears on the interface, which can lead to anxiety and stress (19:55). Similarly, many autistic adults report feeling stressed by other people’s conflicts and often comment on the amount of drama online. The speaker highlights that the ability to “just ignore” it does not apply to many autistic people’s lived experiences (21:45). Respondents also describe uncertainty and anxiety related to the ambiguity of check marks and a lack or misinterpretation of feedback from other users online (22:45). 

Number 4: Clear expectations

In many cases, people with autism expect friends to be completely accessible online and feel like they’re not liked when their friends post photos of them hanging out with other people. Page reminds viewers that social media allows us to see things we wouldn’t otherwise, which makes it challenging to manage the feeling that you’re friends, so you should be doing everything together (25:15). The speaker notes single rule-based decision-making and how this can be dangerous. For example, a female only accepts friend requests from other females and not males (thinking this will keep her safe), although people frequently lie about their identities online. Many autistic people also assume a single audience and may post things publicly that could lead to unintended consequences (27:30).

Chapman summarizes attendees’ responses to the first part of the presentation (29:17). 

How adults with autism are supported by their networks

Page explains that most study participants were open about online issues with caseworkers and care staff by default. They even talk openly about instances where they may have done something unusual and ask their parents’/caretakers’ opinions (30:55). Support networks are critical to the well-being of autistic adults, and siblings can be a huge source of support because the power dynamic is balanced. The speaker describes how communities can detect problems and work together to support autistic young adults. For example, someone says, “Hey, you should check on [name], they’ve been making some odd posts online.” (32:35). 

Having people who understand privacy rules and online safety involved in care strategies for autistic youth and adults is critical (34:15). Many study participants cited rules about what to share and who to friend that are externally defined (e.g., I won’t do this because my family told me so, or this person will get upset). These results underscore the importance of defining rules and providing guidelines for online interactions. Page iterates the need for ongoing conversations around online safety to support learning via repetition (35:20). 

Timing of mediation

Immediate mediation for online safety is more effective than delayed support. For example, care staff report that, even though clients share what happens to them online, it’s after the fact, so there is little they can do to support them at that point (36:55). However, clients who can reach out to an adult sibling or parent to ask about what’s happening can troubleshoot in real-time and understand more about the situation. Page reiterates the importance of having someone to reach out to in real-time (online or in person) and having parents or others checking social media regularly to scan for conflicts and safety (38:45). 

Benefits of mediation

The benefits of online safety mediation included socio-emotional co-regulation (both parents and young adults learned more about each other), digital literacy (real-time troubleshooting), collective effort for safety (staff and family work together), and general alignment and understanding of specific problem points for the individual (39:20). 

Tensions of mediation

A significant tension of social media mediation is the general overwhelm that support networks feel across the U.S. Social media is often low on the list due to other physical needs that take priority (42:15). Page highlights the balance between safety and independence and suggests avoiding taking kids off of social media altogether. She notes that young adults who felt someone would remove their social media were far less likely to be open about their experiences. The speaker underscores that social media is a lifeline to social interests and community and that many individuals shut down due to the threat of losing this connection (43:40).

Chapman summarizes attendee responses to this point in the presentation (45:00). 

Recommendations for working with young adults on social media

The presenter outlines six recommendations for working with young autistic adults on social media and online safety:

Number 1: Establish a common vocabulary

• Understand what it means to be a “friend” and take time to define anything on the interface labeled as “friend” or any other social relationship. 
• Understand what the message indicators mean (sent, received, read) (47:50).

Number 2: Understand audience and purpose

• Purposefully consider online audiences and know how to set privacy settings accordingly (e.g., public vs. friends vs. private posts). 
• Understand that posts can be interpreted differently than intended.

Number 3: Cooling-off period before reacting

• Do not post, comment, or message immediately when you are upset or feeling a strong emotion. 
• Take a pause period and, where possible, consult with an ally for advice on the situation (50:30).

Number 4: Do not take content at face value

• Understand that someone sending you a friend request isn’t necessarily telling you the truth.
• Check for spelling errors, missing profile pictures, and other signs of fake accounts. 
• Where possible, consult with an ally to understand whether to accept friend requests. 

Number 5: Do not follow the interface prompts without a good reason 

• Ask why you would want to share or do something instead of following online prompts as directions. 
• Even though they’re worded like instructions, they are meant to show what you could do (52:25). 

Number 6: Remember that what people say and do is not always clear

• Remember that just because the technology makes it look like someone has read your message does not mean they have or are available to answer. 
• When you read something that upsets you, talk to an ally to see if it might mean something different than you think. 

Page reiterates that these recommendations require ongoing conversations to reinforce these ideas and learn about their experiences, individual pain points, and how the community can support them. 

Social media literacy course (4th iteration)

The speaker outlines aspects of a social media literacy course currently in its fourth iteration, including social media norms, privacy settings, how to identify fake profiles, types of social media groups and associated interactions, misinformation, and social media vs. reality. The course provides educational slides on each topic and practice modules for navigating each situation (53:00). 

Initial results from the fourth iteration show that repeated practice questions and gamification help autistic adults with and without intellectual disabilities learn (56:16). Future plans for this research include covering more social media platforms and enrolling more field sites. Page gives acknowledgments and provides sign-up links for interested participants before the Q&A (57:40). 

Megan MacDonald, Ph.D., and Megan McClelland, Ph.D., discuss emerging research on the relationship between motor skill development and executive function in autism. They define motor skills and executive function, discuss their long-term impact on health and academic success, and consider their co-development during childhood and adolescence. The speakers highlight the importance of EF and motor skills in daily life, underscoring their malleability and potential for learning and building new skills. MacDonald and McClelland consider the effect of cultural contexts on skill development before the Q&A session. 

Handouts are online HERE

In this webinar: 

2:45 – Presentation overview
3:20 – Executive function
6:25 – Motor Skills
9:20 – Motor skills and autism
13:30 – Motor skill development
19:00 – Executive function and motor skills
22:20 – Cultural contexts
28:13 – Conclusions
30:20 – Q&A

Executive function

McClelland defines executive function (EF) as cognitive processes/skills like attention, working memory, and inhibitory control that lay the foundation for self-regulation (3:20). She explains that EF skills have emerged as a key indicator for a variety of short and long-term behaviors, including social competence in children and academic success throughout adolescents and early adulthood (4:55). She notes a recent publication that found that children with strong attention/persistence at age four had nearly 50% greater odds of completing university by age 25, underscoring long-term health, educational, and employment outcomes associated with EF (6:10). 

• Self-regulation in childhood as a predictor of future outcomes: A meta-analytic review. (Robson et al., 2020)
• Predictors of early growth in academic achievement: the head-toes-knees-shoulders task (McClelland et al., 2013)

Motor skills

MacDonald discusses gross motor skills, highlighting their importance for everyday activities like walking, running, lifting, and throwing. Both EF and motor skills are foundational for learning and early development, and children begin to have a core set of motor skills between seven and eleven years old (6:25). The speaker relates motor skills to a mountain of motor development, where each level builds on top of the last (8:15). Fine motor skills involve coordinating perceptions with motor movements (visuomotor integration), allowing us to control handwriting, buttoning shirts, drawing, and coloring in the lines. Visuomotor integration has also been linked to children’s academic success (8:25). 

Motor skills in autism

The presenter briefly reviews key autistic characteristics and prevalence rates, highlighting the role of gross motor skills in social and physical development during childhood (9:20). She cites references to motor skill deficits dating back to the first descriptions of autism. MacDonald explains that early delays in motor development milestones (i.e., walking and crawling) are common in autistic children and that parents/caregivers may start noticing delays between fourteen and twenty-four months (10:50). Motor skills used by school-aged children are different and center around social interactions and sports (12:48). 

• Developing together: The role of executive function and motor skills in children’s early academic lives. (McClelland & Cameron, 2019)
• Fine motor skills and early comprehension of the world: two new school readiness indicators (Grissmer et al., 2010)
• Fine Motor Skills and Executive Function Both Contribute to Kindergarten Achievement (Cameron et al., 2012)

Motor skill development

MacDonald outlines one of her publications on gross motor development across the first three years of life in autistic children (13:30). Gross motor skill development for autistic children showed consistent delays at each check-up, with children being nearly one year behind expected development targets by age three (14:15). Similarly findings for fine motor skill development in autistic children was slightly more than one year behind expected development by age three (15:15). Another study on school-aged children found that kids between ten and twelve years old were chronologically about half their age in terms of motor skill development (16:05). Therefore, the speaker asserts that gross and fine motor skill development in autism is delayed in autism from early life at least through childhood. 

Despite these delays, the speaker remains hopeful and iterates to viewers that motor skills are incredibly malleable and can be taught and improved with time (17:15). McClelland cites accumulating research suggesting that EF skills are a vital buffer/protective factor for children experiencing early risk factors. She reiterates that EF and motor skills are highly malleable and that we can do a lot to improve these aspects of development in autistic children (18:00). 

• Motor skills of toddlers with autism spectrum disorders (Lloyd et al., 2013)
• Fundamental Movement Skills and Autism Spectrum Disorders (Staples & Reid, 2010)
• School Readiness and Self-Regulation: A Developmental Psychobiological Approach (Blair & Raver, 2015)
• Relations between early family risk, children’s behavioral regulation, and academic achievement (Sektnan et al., 2010)
• Developing together: The role of executive function and motor skills in children’s early academic lives. (McClelland & Cameron, 2019)

Executive function and motor skills

McClelland discusses contemporary evidence suggesting the co-development of EF and motor skills in young children. She explains that some brain regions are involved in both EF and motor skill development, and certain EF traits (e.g., memory and inhibitory control) are related to fine motor skills (19:00). McDonald notes that, until very recently, motor skills and EF were studied independently. She highlights contemporary collaborative research and its importance in understanding autism (20:50). 

• Behavioral self-regulation and executive function both predict visuomotor skills and early academic achievement (Becker et al., 2014)
• Visuomotor integration and inhibitory control compensate for each other in school readiness (Cameron et al., 2015)
• Exercise improves executive function and achievement and alters brain activation in overweight children: A randomized, controlled trial (Davis et al., 2010)
• Prefrontal cortex development and development of cognitive functions (Diamond, 2000)
• Relations of Preschoolers’ Visual-Motor and Object Manipulation Skills With Executive Function and Social Behavior (MacDonald et al., 2016)

Cultural contexts

McDonald states that fine motor skills are associated with cognitive flexibility but that much of the research is based in the U.S. or other Western countries (22:20). A recent study found that Chinese children exhibit better fine motor skill performance while U.S. students have better object control skills (23:00). Similarly, gross motor skills of pre-schoolers in China were significantly lower than pre-schoolers in the U.S. Such findings, the speaker asserts, suggest that different cultures emphasize different skill sets in early life (fine vs gross) (24:15). 

The speaker outlines a recent survey study on EF and motor skills in autistic children from Taiwan and the U.S. (24:45). She outlines data collection and analysis methods, including regressions and covariates (26:10). Results show that motor skills are associated with EF across countries. Further, the relationship between EF and motor skills is culturally comparable, with significant and positive correlations of magnitude in both countries. She asserts that this preliminary evidence suggests the relationship between EF and motor skills is not specific to region or culture (27:15). 

• Association between motor skills and executive function of children with autism spectrum disorder in Taiwan and the United States (Sung et al., 2024)

Conclusions

McClellan reviews the presentation, highlighting that EF and motor skills contribute to healthy development and academic success for children from diverse backgrounds. She reiterates the malleability of these skills and their importance for daily activities. The speaker considers how improvements in EF may impact motor skills and vice versa (28:13). She gives thanks and acknowledgments before the Q&A, where the presenters discuss the impact of COVID on EF, intervention options, monitoring EF supports in daily life, the importance of routine and planning, and much more (30:20). 

Originally published on May 7, 2024

Dr. Waizbard-Bartov discusses changes in autism symptoms across childhood. She outlines the Autism Phenome Project and study methods for her recent work. The speaker presents findings on the frequency, patterns, and predictors of symptom severity changes across childhood periods in autism. Waizbard-Bartov touches on the intersection of autism symptom severity, assigned sex, and environmental factors. She summarizes presentation findings and considers pathways of future research before the Q&A. 

In this webinar:

1:09 – What is autism
5:00 – Social communication and RRB
12:06 – Autism Phenome Project
16:15 – Study methods
20:15 – Changes in autism symptom severity across childhood
24:30 – Variations in patterns of symptom change
28:05 – Predictors of changes in severity across childhood
30:25 – Sex differences
35:40 – Adaptive function
37:44 – Parental characteristics
39:10 – Co-occurring mental health conditions

What is autism?

Waizbard-Bartov describes autism as a neurodevelopmental condition broadly defined by difficulties with social communication and restrictive, repetitive behaviors (RRB) (1:09). For an autism assessment, social communication differences are subcategorized into social-emotional behavior, atypical nonverbal social behavior, and difficulty creating and maintaining relationships (2:15). RRBs are also subcategorized into stereotyped repetitive speech or actions, excessive adherence to non-functional routines, restricted/fixated interests, and atypical sensory behaviors (4:19). The speaker draws on her time working with preschoolers to illustrate how core characteristics/symptoms of autism range in presentation and severity across individuals and time (8:00). 

Study methods

The presenter outlines the Autism Phenome Project (APP), a longitudinal study of nearly 700 autistic and non-autistic children across five time points from early childhood to early adulthood (12:06). At each time point, the ongoing study assesses blood, MRI, language development, memory and attention, co-occurring conditions, and parental perspectives (14:20). Waizbard-Bartov describes her recent work on autism symptom trajectories across early (ages 3 – 6) and middle childhood (ages 6 – 11.5) (11:25). Her team used APP data for 183 autistic children (30% female-presenting) at three times points: between ages two and three and a half (2 – 3.5 yrs), between ages four and six (4 – 6 yrs), and again between ages nine and twelve (9 – 12 yrs) (16:15). Researchers used the calibrated severity scores from the Autism Diagnostic Observation Schedule (ADOS) to track symptom severity across time and domains (17:50). 

Q1: How common is change in autism symptom severity across childhood?

Researchers divided children into three groups based on observed changes in symptom severity across the first two time points (early childhood; ages 3 – 6). Of these, 54% remained stable, 29% significantly decreased, and 17% increased dramatically in symptom severity across early childhood (20:15). Correlations between behaviors and brain development were also found, where children with increased severity had slower white matter development compared to those with decreased symptom severity (21:43). When assessments were extended to the third time point (middle childhood; around age 11.5), the same three groups were identified, where 49% remained stable, 27% experienced a consistent decrease, and 24% experienced a consistent increase in symptom severity (22:55). Waizbard-Bartov reiterates that about half of children in the study demonstrated changes in severity across early and middle childhood, suggesting that such changes may be expected in autism (24:00). 

Q2: Do patterns of change vary across periods of childhood?

To understand patterns of symptom change across time, the presenter and her team compared early childhood severity changes to those of middle childhood (third time point). Results showed increases in symptom severity are equally as likely to occur during early and middle childhood, while decreases in severity are significantly more likely to occur in early childhood only (24:30). Researchers also found that more than 60% of the sample showed different patterns of change across childhood periods (i.e., decreased in early childhood and stable or increasing during middle childhood) (25:35). Waizbard-Bartov summarizes these findings, asserting that patterns of severity change across periods of childhood in autism (27:15). 

Q3: What predicts directional changes in symptoms across childhood?

To assess predictors of symptom severity changes in autism, Waizbard-Bartov and her team assessed related variables:

Cognitive ability/IQ

Results showed that children with decreased severity in early childhood had a higher IQ at the first two time points and exhibited IQ gains over time (28:45). Comparatively, those with increased severity had lower IQ at both time points that remained stable across time (29:30). The speaker asserts that these findings suggest a strong association between cognitive abilities and symptom severity during early development. 

Sex differences

Researchers found in female-presenting participants, symptom severity is likely to decrease or remain stable. However, for male-presenting participants, increases and decreases in severity are equally likely to occur (30:25). Further, calibrated severity scores revealed that female-presenting individuals show significant severity decreases in total symptoms and, more specifically, in RRB, especially during middle school. Conversely, male-presenting individuals show stable total symptom and RRB scores across childhood (31:15). The presenter discusses sex-compared changes across ADOS items, highlighting the stark trajectory differences between sex groups (33:15).  

Adaptive function

Adaptive functioning is meaningful for everyday life, and all three groups had the same score at age one. However, by age six, those experiencing decreases in severity had significantly higher adaptive functioning than those with increasing severity (35:40). The presenter explains how those with increasing severity did not necessarily lose adaptive function skills but that their rate of progress steadily slowed over time (36:40). 

Parental characteristics

Waizbard-Bartov and her team also found that fathers and mothers of children with decreasing severity were generally older and more educated. Contrastingly, parents of children with increasing severity were younger and less educated. The speaker notes the intersectionality of education and socioeconomic status and its impact on resource accessibility and self-advocacy (37:44). 

Co-occurring mental health conditions

Results showed a significant correlation between aspects of mental health and autism symptom domains (39:10). For example, 21% of participants had significant increases in both the severity of social communication issues and anxiety as they entered elementary school. ADHD levels also rose across middle school, and by age eleven, 84% of participants met the clinical requirements for an anxiety disorder (41:25). In female-presenting participants, improvements in RRB overtime ran parallel to increases in anxiety, where 94% had clinical anxiety disorders by age eleven (44:26). Waizbard-Bartov and her team found no evidence that initial symptom severity can predict changes across childhood, meaning everyone has the same potential for change (45:05). The presenter summarizes the findings for question three, noting that severity changes are correlated with assigned sex, IQ, adaptive functioning, parental characteristics, and mental health conditions (46:45).

• Trajectories of Autism Symptom Severity Change During Early Childhood (Waizbard-Bartov et al., 2021)
• Identifying autism symptom severity trajectories across childhood (Waizbard-Bartov et al., 2022)
• Changes in the severity of autism symptom domains are related to mental health challenges during middle childhood (Waizbard-Bartov et al., 2023)

Conclusion

Waizbard-Bartov summarizes research findings, underscoring that the severity of autism symptoms can change substantially across childhood periods and that patterns of change are not linear. She highlights that a child’s characteristics and environment can predict directional changes and that children have the potential for different severity trajectories regardless of their initial levels (47:55). 

She outlines future research directions, including how severity is affected during adolescence and how interactions between symptom severity and other characteristics play out over time (49:15). The presenter highlights current research around the impact of sex on symptom severity, underscoring the potential effects of camouflaging specific to female-presenting individuals (51:10). The speaker provides thanks and acknowledgments before the Q&A (53:25). 

Originally published on May 15, 2024

Dr. Rajesh Kana considers the intersection of language comprehension, neuroplasticity, and autism interventions. He discusses contemporary research illustrating distinct patterns in autistic brain activity and underscores the importance of neuroplasticity in everyday life. The speaker examines brain connectivity and its relation to language comprehension and behavior. Kana details an ongoing reading intervention study and analyzes preliminary data that show significant improvements in reading and language comprehension for autistic participants. He provides thanks and acknowledgments before the Q&A.

Handouts are online HERE

In this webinar: 

0:45 – Conflict of interest
1:25 – Overview
2:10 – Introduction
5:30 – Descriptions of language and communication in autism
7:50 – Joint attention
10:30 – Difficult components of reading comprehension
13:35 – Brain, language & reading comprehension in autism
15:30 – Brain activity in autism
21:05 – Theory of mind and language comprehension
23:26 – Targeting brain plasticity in autism
25:05 – History and significance of neuroplasticity
30:25 – Neuroplasticity and reading comprehension
35:18 – Using reading intervention to change the brain
39:55 – Ongoing study: imagery reading intervention for language comprehension in autism
41:58 – Preliminary data trends
46:30 – Brain level changes and connectivity
51:40 – Summary and acknowledgments
54:05 – Q&A

Descriptions of language and communication in autism

Kana describes language and communication difficulties in autism and how they translate into social differences in everyday life (2:55). Descriptors of autistic communication within the literature include early language delays, atypical features (e.g., echolalia and jargon), failure to acquire spoken language across the lifespan, and discourse processing difficulties (5:30). The speaker lists conditions that commonly co-occur with language processing difficulties, emphasizing that these conditions often exacerbate obstacles to language comprehension (6:50). 

The presenter outlines a study that found that word comprehension plays a significant role in joint attention and that joint attention is critical to early language development (7:50). Two other studies suggest autistic children have strong decoding skills (11:30) but low language comprehension (9:15). Many components of reading comprehension, Kana explains, can be difficult for autistic children. Therefore, understanding how co-occurring conditions contribute to language and communication challenges is critical to implementing successful interventions (10:30). 

Brain, language, & reading comprehension in autism

Multiple studies on brain response to auditory word stimulations report higher activation of the right brain hemisphere (Wenicke’s area) in autistic groups compared to non-autistic controls (13:50) These findings, Kana continues, are supported by a recent meta-analysis, which also found lower activity in the left brain hemisphere (Broca’s area) of autistic participants compared to their non-autistic counterparts (18:10). The speaker asserts that these data show a distinct pattern of brain activity in autistic individuals.  

Sentence imagery findings indicate that autistic participants also have higher visual-spatial activation compared to controls, further evidencing that autistic people tend to be visually oriented (19:15). Kana cites a study that showed significant overlap in Theory of Mind and pragmatic (social) language processes between autistic and non-autistic groups. The study also found reduced activity in social cognitive networks in autistic groups compared to controls (21:05). These patterns in autistic brain activity can inform our general understanding and assessments of language and reading comprehension in autism (22:12). 

Targeting neuroplasticity in autism

The speaker uses the invention and development of reading to illustrate the human brain’s plasticity and capacity to learn (22:37). He reviews early brain plasticity studies (25:05) and explains how the discovery that new neurons can appear in the adult brain massively shifted our understanding of neuroplasticity (27:40). Kana describes differences in the brain structures of London taxi drivers (28:44) and meditative monks (29:50), highlighting the importance of brain plasticity in our everyday lives. Two studies on brain imagery and reading interventions in dyslexic children found changes in reading comprehension (30:25) and increased grey matter volume in participants following reading comprehension interventions (31:49). Kana ponders the creation and adoption of language, underlining the human brain’s capacity for change and how that can apply to evidence-based interventions (33:05). 

Using reading intervention to change the brain

The presenter describes an ongoing reading comprehension intervention trial, detailing study procedures (35:40), assessment protocol (38:00), and the Visualizing and Verbalizing for Language Comprehension and Thinking (V/V) Intervention Program (39:55). Preliminary data show significant improvement in comprehension skills for autistic participants (41:58) and that social cognition (43:40) and verbal working memory (45:15) may predict language comprehension. 

Kana discusses regional brain interactions (brain connectivity) and their use as a measure of changes in brain activity (47:55). Data from the ongoing reading comprehension study show (to this point) significant increases in local (51:00) and regional (49:00) brain connectivity, specifically between Broca’s and Wernicke’s areas. He notes that changes in connectivity are correlated to behavior function and advances in comprehension (49:40). These preliminary findings, the presenter asserts, provide an exciting peek at the potential of reading interventions in autism. 

The speaker summarizes initial data findings, highlighting the significant increases in comprehension following a reading intervention and how those changes are related to brain connectivity and neuroplasticity (51:40). He reiterates the parameters of the ongoing trial and provides information for interested participants (52:30) before the Q&A (54:05).