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Background: Autism affects as many as 1 in 68 children in the United States. Early identification and access to intervention services promote improved outcomes for children with autism and other developmental delays. Children living in rural and underserved areas have limited access to such services and are diagnosed later than those living more suburban and urban areas. Our Integrated Systems Using Telemedicine (ISUT) Model uses a cost-effective method for families to access diagnostic and other specialty care through telemedicine. This model links families, trained early intervention providers and educators, and university-based medical professionals. Materials and Methods: We trained autism diagnostic teams throughout the state who completed diagnostic measures and connected to university medical center teams for final diagnosis of autism and coexisting conditions. We gathered preliminary data to measure the impact of the ISUT model on access to services, potential cost savings for families, and parent satisfaction with the model. Results: Preliminary data indicate that our ISUT model provided families in rural and underserved areas improved access to diagnostic services as well as cost savings for travel. Our satisfaction data indicate that parents are equally satisfied with services received through the ISUT and through the University-Based Medical Center Team Model. Conclusions: The ISUT model provides a unique collaboration among the family, educational system, autism experts in the community, and the university medical center autism team while providing a cost-effective means for families to access specialty care while promoting coordination of care within the community. [ABSTRACT FROM AUTHOR]

Background: Autism affects as many as 1 in 88 children. Best practices recommend early identification and intervention for optimal outcomes. Currently, a gap exists between time of first concern and diagnosis, particularly for families living in rural areas. Telemedicine as a tool for assessment and diagnosis of autism is one way to address this disparity. Emerging evidence suggests telemedicine as a viable option for assessing children with a variety of special needs. Materials and Methods: This study expands upon the current literature by investigating clinicians' ability to assess autism via telemedicine. Using interactive videoconferencing, we simulated autism assessment procedures with families with an existing diagnosis (autism or developmental disability) using current gold-standard assessment tools. We compared diagnostic accuracy, item-by-item reliability on the Autism Diagnostic Observation Schedule (ADOS)-Module 1, and the Autism Diagnostic Interview-Revised (ADI-R) as well as parent satisfaction in an in-person and interactive videoconferencing condition. Ten children (3-5 years old) with developmental delays and 11 children matched on chronological age with a diagnosis of autism were assigned to be assessed and interviewed either in-person or over videoconferencing. Clinicians observed both in-person and through videoconferencing regardless of patient assignment. Results: Results indicated no significant difference in reliability of diagnostic accuracy, ADOS observations, ratings for ADI-R parent report of symptoms, and parent satisfaction between conditions. Results indicate adequate clinician agreement and parent satisfaction regardless of observational condition. Conclusions: Future research should include a larger sample size and assess children without an existing diagnosis. [ABSTRACT FROM AUTHOR]

A functional assessment interview (O'Neill et al., 1997) was conducted with the care providers of 100 young (2 to 5 years old) children with autism regarding reinforcement contingencies contributing to maintenance of their child's disruptive behavior. Care providers were interviewed regarding their child's disruptive behavior related to gaining attention and tangibles and escaping demands. In addition, we individualized the interview in more detail to include the possible relationship between their child's disruptive behavior and gaining access to perseverative activities, avoiding demands when engaged in perseverative activities, and avoiding specific types of sensory stimulation. Results of the study suggest that gaining access to perseverative activities and escaping demands while engaged in these activities frequently contribute to disruptive behavior in young children with autism. These findings are discussed in terms of assessment considerations and treatment for children with autism and other types of syndromes and disorders. [ABSTRACT FROM AUTHOR]

A treatment package consisting of a DRO procedure, token fines, and prompted relaxation was used to reduce the agitated-disruptive behavior of a person with autism and mental retardation living in a community group home. The agitated-disruptive behaviors (cursing, hitting, kicking, throwing objects, and verbal threats) were measured during three different activities in a group home. The baseline rates of the agitated-disruptive behavior during one of these activities was relatively low, during another was moderate, and during the third was high. DRO procedures were partially implemented by a peer with Down syndrome and mental retardation during a portion of the study. Effects of the DRO procedures were as follows: During each activity an initial reduction of agitated-disruptive behavior was dependent on choosing an appropriate DRO interval, with shorter DRO intervals required during activities in which the baseline rates of the agitated-disruptive behavior were higher. Once shorter DRO intervals had been used to reduce agitated-disruptive behavior, longer DRO intervals were effective in maintaining those reductions. Reductions were maintained for up to 6 months. [ABSTRACT FROM AUTHOR]

Examines the effects of behavioral state and pharmaceutical intervention on self-injurious behavior (SIB) in a man with profound handicaps. Rate of SIB under different contextual conditions; Altering of environmental conditions as a treatment methodology; effects of Fluphenazine.

As increased attention has been directed toward the disparities experienced by people with intellectual disabilities in achieving positive health outcomes, the importance of promoting the active involvement of people with intellectual disabilities in efforts to reduce such disparities and promote positive health and wellness outcomes has been acknowledged by researchers and policymakers. This parallels the larger movement within the disability field to promote the self-determination and empowerment of people with intellectual disabilities. The authors more explicitly discuss the implications of self-determination, as it has been conceptualized in the disability field, for promoting positive health and wellness outcomes in people with intellectual disabilities. They review the current research on self-determination and its impact on health, as well as the implications of this research for the development of strategies that promote self-determination in the achievement of health and wellness outcomes in people with intellectual disabilities. The authors posit the need to extend an understanding of the implications of self-determination for promoting health in people with disabilities not only to the disability field, but also to the medical and public health fields. They also provide recommendations for future research and practice. [ABSTRACT FROM AUTHOR]

Risperidone has shown safety and efficacy for aggressive and destructive behaviors in short-term studies. This longer-duration study includes a broad sample. Forty subjects, aged 8–56 years (mean=22), all with mental retardation and 36 with autism spectrum disorders participated in this 22-week crossover study, with 24 weeks of open maintenance thereafter. Of 40 subjects, 23 (57.5%) responded fully (50% decrease in Aberrant Behavior Checklist-Community Irritability subscale score), while 35 subjects (87.5%) showed a 25% decrease. Gender, mood disorder, and antiseizure medications did not alter response. Increased appetite and weight gain were common. Low dose risperidone was effective for aggressive behavior in persons with MR. More long-term studies are needed, incorporating weight control interventions. [ABSTRACT FROM AUTHOR]

Examines families' and professionals' perceptions of the interpretative conference that informed parents their child has autism. Perceptions of the definition and outcomes of autism; Ways of presenting the diagnosis of autism to families; Benefits of receiving a diagnosis; Reactions to giving and receiving a diagnosis of autism.

A plethora of literature suggests that collaborative partnerships among families, educators, and outside service providers are necessary and beneficial to address behavior problems, but there continues to be a lack of coordination among these stakeholders. The current study used conjoint behavioral consultation (CBC) to facilitate the development and implementation of collaborative intervention plans. Parents, teachers, and an outside mental health provider worked together to create and support behavioral intervention plans that were implemented at home and school. The results of this multiple baseline study indicate that collaborative interventions developed through the CBC process were effective in improving behavior at home and school. More specifically, visual analysis of the data, along with calculated effect sizes, showed an increase in the percentage of time that all 3 participants complied with expectations during problematic routines at home and school. Implications, limitations, and future research directions are discussed. [ABSTRACT FROM PUBLISHER]

Summary: The neurotransmitter oxytocin plays an important role in social affiliation. Low oxytocin levels and defects in the oxytocin receptor have been reported in childhood autism. However, little is known about oxytocin's post-receptor signaling pathways in autism. Oxytocin signals via stimulatory and inhibitory G proteins. c-fos mRNA expression has been used as a marker of OT signaling as well as of G protein signaling. Herein, we hypothesized that oxytocin and its signaling pathways would be altered in children with autism. We measured plasma oxytocin levels by ELISA, G-protein and c-fos mRNA by PCR, and G proteins by immunoblot in cultured peripheral blood mononuclear cells (PBMCs) in children with autism and in age-matched controls. Males with autism displayed elevated oxytocin levels compared to controls (p <0.05). Children with autism displayed significantly higher mRNA for stimulatory G proteins compared to controls (p <0.05). Oxytocin levels correlated strongly positively with c-fos mRNA levels, but only in control participants (p <0.01). Oxytocin, G-protein, and c-fos mRNA levels correlated inversely with measures of social and emotional behaviors, but only in control participants. These data suggest that children with autism may exhibit a dysregulation in oxytocin and/or its signaling pathways. [Copyright &y& Elsevier]