Clinical assessment of autism in high-risk 18-month-olds Chelation for autism spectrum disorder (ASD). Improving autism perinatal risk factors: A systematic review. A systematic review of peer-mediated interventions for children with autism spectrum disorder. A Virtual Week study of prospective memory function in autism spectrum disorders. A Randomized Controlled Trial of the Korean Version of the PEERS® Parent‐Assisted Social Skills Training Program for Teens With ASD Social Skills Training for Young Adults with High-Functioning Autism Spectrum Disorders: A Randomized Controlled Pilot Study Anatomical differences in the mirror neuron system and social cognition network in autism. Risperidone for children and adolescents with autism spectrum disorder: a systematic review Developmental Profiles of Infants and Toddlers with Autism Spectrum Disorders Identified Prospectively in a Community-Based Setting Enhancing interactions during daily routines: A randomized controlled trial of a web‐based tutorial for parents of young children with ASD Randomized comparative trial of a social cognitive skills group for children with autism spectrum disorder. Cluster Randomized Trial of the Classroom SCERTS Intervention for Elementary Students with Autism Spectrum Disorder Early identification and intervention in autism spectrum disorders: Some progress but not as much as we hoped Intervention targeting development of socially synchronous engagement in toddlers with autism spectrum disorder: a randomized controlled trial. Time-Based and Event-Based Prospective Memory in Autism Spectrum Disorder: The Roles of Executive Function and Theory of Mind, and Time-Estimation Epidemiology of autism spectrum disorders in adults in the community in England. A randomised controlled trial of an iPad‐based application to complement early behavioural intervention in Autism Spectrum Disorder Avatar Assistant: Improving Social Skills in Students with an ASD Through a Computer-Based Intervention Using the preschool language scale, fourth edition to characterize language in preschoolers with autism spectrum disorders. Two to Ten Years: Developmental Trajectories of Joint Attention in Children With ASD Who Received Targeted Social Communication Interventions Measurement Tools and Target Symptoms/Skills Used to Assess Treatment Response for Individuals with Autism Spectrum Disorder A prospective study of autistic-like traits in unaffected siblings of probands with autism spectrum disorder.
Earlier intervention improves outcomes for children with autism spectrum disorders ( ASDs ) , but existing identification tools are at the limits of st and ardization with 18-month-olds . We assessed potential behavioural markers of ASD at 18 months in a high-risk cohort of infant siblings of children with ASD . Prospect i ve data were collected using the Autism Diagnostic Observation Schedule ( ADOS ) and Autism Observation Scale for Infants ( AOSI ) on 155 infant siblings and 73 low-risk controls at 18 months . Infants were classified into three groups ( ASD sibs , non-ASD sibs , controls ) based on blind best-estimate diagnosis at age 3 . Fisher 's exact tests , followed by discriminant function analyses , revealed that the majority of informative ADOS items came from the social and behavioural domains , and AOSI items measuring behavioural reactivity and motor control contributed additional information . Findings highlight the importance of considering not only social-communication deficits , but also basic dimensions of temperament including state regulation and motor control when assessing toddlers with suspected ASD BACKGROUND It has been suggested that the severity of autism spectrum disorder ( ASD ) symptoms is positively correlated with the level of circulating or stored toxic metals , and that excretion of these heavy metals , brought about by the use of pharmaceutical chelating agents , results in improved symptoms . OBJECTIVES To assess the potential benefits and adverse effects of pharmaceutical chelating agents ( referred to as chelation therapy throughout this review ) for autism spectrum disorder ( ASD ) symptoms . SEARCH METHODS We search ed the following data bases on 6 November 2014 : CENTRAL , Ovid MEDLINE , Ovid MEDLINE In-Process , Embase , PsycINFO , Cumulative Index to Nursing and Allied Health Literature ( CINAHL ) and 15 other data bases , including three trials registers . In addition we checked references lists and contacted experts . SELECTION CRITERIA All r and omised controlled trials of pharmaceutical chelating agents compared with placebo in individuals with ASD . DATA COLLECTION AND ANALYSIS Two review authors independently selected studies , assessed them for risk of bias and extracted relevant data . We did not conduct a meta- analysis , as only one study was included . MAIN RESULTS We excluded nine studies because they were non-r and omised trials or were withdrawn before enrolment . We included one study , which was conducted in two phases . During the first phase of the study , 77 children with ASD were r and omly assigned to receive seven days of glutathione lotion or placebo lotion , followed by three days of oral dimercaptosuccinic acid ( DMSA ) .  Forty-nine children who were found to be high excreters of heavy metals during phase one continued on to phase two to receive three days of oral DMSA or placebo followed by 11 days off , with the cycle repeated up to six times . The second phase thus assessed the effectiveness of multiple doses of oral DMSA compared with placebo in children who were high excreters of heavy metals and who received a three-day course of oral DMSA . Overall , no evidence suggests that multiple rounds of oral DMSA had an effect on ASD symptoms . AUTHORS ' CONCLUSIONS This review included data from only one study , which had method ological limitations . As such , no clinical trial evidence was found to suggest that pharmaceutical chelation is an effective intervention for ASD . Given prior reports of serious adverse events , such as hypocalcaemia , renal impairment and reported death , the risks of using chelation for ASD currently outweigh proven benefits . Before further trials are conducted , evidence that supports a causal link between heavy metals and autism and methods that ensure the safety of participants are needed BACKGROUND Current underst and ing of the etiology of autism is based on the interaction of multiple genes with each other and with environmental factors , leading to a neurodevelopmental process that results in the expression of autism spectrum disorder ( ASD ) in the child . This suggests that it might be possible to strengthen resilience to environmental stressors during the perinatal period to improve outcomes and possibly prevent the development of ASD . METHODS We search ed the MEDLINE data base for multiple perinatal factors associated with the development of ASD published between January 1 , 2005 and July 1 , 2018 . The search terms used were " autism " crossed with either " perinatal , " " prenatal , " " gestational , " or " pregnancy , " and crossed again with each perinatal risk factor highlighted in this review including topics on parental health , infections , medications , and environmental stressors . We then search ed interventions that may improve neurodevelopmental outcome before and during pregnancy , including supplements , breastfeeding , and postpartum stress reduction . We identified recent or unique metanalyses and systematic review s of the identified focus and on r and omized controlled trials and summarized these using the most recent and comprehensive review s. RESULTS Folate , omega-3 , vitamin D3 , environmental toxin avoidance , correcting deficiencies , immune boosting , and prolonged breast feeding are all reported to be linked to the possible reduction of adverse pregnancy outcomes including ASD . CONCLUSIONS Studies of individual components for improving pregnancy outcomes and several uncontrolled preconception to infancy medical practice s suggest that multiple interventions might improve the outcomes of pregnancies where there is risk for developing ASD BACKGROUND Peer mediated intervention ( PMI ) is a promising practice used to increase social skills in children with autism spectrum disorder ( ASD ) .  PMIs engage typically developing peers as social models to improve social initiations , responses , and interactions . METHOD The current study is a systematic review examining PMIs for children and adolescents with ASD conducted using group design s. Five studies met the pre-specified review inclusion criteria : four r and omized controlled trials and one pre- and post-test design . RESULTS Four of the studies were conducted in school setting s , whereas one study was conducted in a camp setting . The studies all reported that participants improved in social skills ( e.g. , social initiations , social responses , social communication ) post intervention . Additionally , sustainment , generalization , and fidelity of implementation were examined . CONCLUSION PMI is a promising approach to address social skills in children with ASD , and this approach can be conducted in meaningful real-word context s , such as schools . Limitations of the studies as well as future directions are discussed Prospect i ve memory ( PM ) refers to the implementation of delayed intentions , a cognitive ability that plays a critical role in daily life because of its involvement in goal -directed behavior and consequently the development and maintenance of independence . Emerging evidence indicates that PM may be disrupted in autism spectrum disorders ( ASDs ) , potentially contributing to the functional difficulties that characterize this group . However , the degree , nature , and specificity of ASD-related impairment remains poorly understood . In the current study , children between 8 and 12 years of age who were diagnosed with ASDs ( n=30 ) were compared with typically developing children ( n=30 ) on a child-appropriate version of the Virtual Week board game . This measure provides an opportunity to investigate the different sorts of PM failures that occur . The ASD group showed significant PM impairment on measures of time-based ( but not event-based ) prospect i ve remembering . However , only a subtle difference emerged between regular and irregular PM tasks , and group differences were consistent across these tasks . Because regular and irregular tasks differentially load retrospective memory , these data imply that the PM difficulties seen in ASDs may primarily reflect a monitoring deficit and not an encoding and memory storage deficit . PM performance was poorer under conditions of high ongoing task absorption , but the magnitude of this effect did not vary as a function of group . In both groups , time-based ( but not event-based ) PM difficulties were associated with functional outcomes in daily life , but only an inconsistent association with executive control emerged Impaired social functioning is a hallmark feature of autism spectrum disorder ( ASD ) , often requiring treatment throughout the life span . PEERS ® ( Program for the Education and Enrichment of Relational Skills ) is a parent‐assisted  social skills training for teens with ASD . Although PEERS ® has an established evidence base in improving the social skills of adolescents and young adults with ASD in North America , the efficacy of this treatment has yet to be established in cross‐cultural validation trials . The objective of this study is to examine the feasibility and treatment efficacy of a Korean version of PEERS ® for enhancing social skills through a r and omized controlled trial ( RCT ) .The English version of the PEERS ® Treatment Manual ( Laugeson & Frankel , 2010 ) was translated into Korean and review ed by 21 child mental health professionals . Items identified as culturally sensitive were surveyed by 447 middle school students , and material was modified accordingly . Participants included 47 teens between 12 and 18 years of age with a diagnosis of ASD and a verbal intelligence quotient ( IQ ) ≥ 65 . Eligible teens were r and omly assigned to a treatment group ( TG ) or delayed treatment control group ( CG ) . Primary outcome measures included question naires and direct observations quantifying social ability and problems directly related to ASD . Secondary outcome measures included scales for depressive symptoms , anxiety , and other behavioral problems . Rating scales for parental depressive symptoms and anxiety were examined to detect changes in parental psychosocial functioning throughout the PEERS ® treatment . Independent sample s t‐tests revealed no significant differences at baseline across the TG and CG conditions with regard to age ( 14.04 ± 1.64 and 13.54 ± 1.50 years ) , IQ ( 99.39 ± 18.09 & 100.67 ± 16.97 ) , parental education , socioeconomic status , or ASD symptoms ( p < 0.05 ) , respectively . Results for treatment outcome suggest that the TG showed significant improvement in communication and social interaction domain scores on the Autism Diagnostic Observation Schedule , interpersonal relationship and play/leisure time on the subdomain scores of the Korean version of the Vinel and Adaptive Behavior Scale ( p 's < 0.01 ) , social skills knowledge total scores on the Test of Adolescent Social Skills Knowledge — Revised ( p < 0.01 ) , and decreased depressive symptoms on the Child Depression Inventory following treatment ( p < 0.05 ) . Analyses of parental outcome reveal a significant decrease in maternal state anxiety in the TG after controlling for potential confounding variables ( p < 0.05 ) . Despite cultural and linguistic differences , the PEERS ® social skills intervention appears to be efficacious for teens with ASD in Korea with modest cultural adjustment . In an RCT , participants receiving the PEERS ® treatment showed significant improvement in social skills knowledge , interpersonal skills , and play/leisure skills , as well as a decrease in depressive symptoms and ASD symptoms . This study represents one of only a few cross‐cultural validation trials of an established evidence ‐based treatment for adolescents with ASD . Autism Res 2014 , 7 : 145–161 . © 2014 International Society for Autism Research , Wiley Periodicals , Despite the psychosocial difficulties common among young adults with autism spectrum disorders ( ASD ) , little to no evidence -based social skills interventions exist for this population . Using a r and omized controlled trial ( RCT ) design , the current study tested the effectiveness of an evidence -based , caregiver-assisted social skills intervention known as PEERS for Young Adults  with high-functioning young adults with ASD ( ages 18–23 ) using self- and caregiver-report measures . Results revealed that treated young adults reported significantly less loneliness and improved social skills knowledge , while caregivers reported significant improvements in young adults ’ overall social skills , social responsiveness , empathy , and frequency of get-togethers . Results support the effectiveness of using this caregiver-assisted , manualized intervention for young adults with ASD Autism spectrum disorder ( ASD ) is a neurodevelopmental disorder associated with impaired social and emotional skills , the anatomical substrate of which is still unknown . In this study , we compared a group of 14 high-functioning ASD adults with a group of controls matched for sex , age , intelligence quotient , and h and edness . We used an automated technique of analysis that accurately measures the thickness of the cerebral cortex and generates cross-subject statistics in a coordinate system based on cortical anatomy . We found local decreases of gray matter in the ASD group in areas belonging to the mirror neuron system ( MNS ) , argued to be the basis of empathic behavior . Cortical thinning of the MNS was correlated with ASD symptom severity . Cortical thinning was also observed in areas involved in emotion recognition and social cognition . These findings suggest that the social and emotional deficits characteristic of autism may reflect abnormal thinning of the MNS and the broader network of cortical areas subserving social cognition Background Various clinical trials suggested that risperidone was beneficial in the treatment of autism spectrum disorder ( ASD ) in children and adolescents . Objective The aim of this systematic review was to determine the efficacy , acceptability and tolerability of risperidone in the treatment of children and adolescents with ASD . Data sources The data bases of Scopus , PubMed , CINAHL and Cochrane Controlled Trials Register were search ed in February 2017 . Study eligibility criteria , participants and interventions Eligible RCTs of risperidone in the treatment of child and adolescent patients with ASD . Language s were not restricted . Study appraisal and synthesis methods The full-text versions of relevant studies were thoroughly assessed and extracted . The primary efficacy of outcome was the pooled response rate and the pooled mean changed scores of the st and ardized rating scales for ASD . Results A total of 372 r and omized subjects from seven RCTs were included in this review . In acute treatment , the pooled mean change score of the Aberrant Behavior Checklist for irritability subscale ( ABC-I ) and response rate for the risperidone-treated group had a greater significance than that of the placebo-treated group . In the long-term treatment , the pooled mean change score of the CARS in the risperidone-treated group was significantly greater than that in the placebo-treated group . According to the discontinuation phase , the overall pooled relapse rate of the risperidone-treated group was significantly less than that of the placebo-treated group . The rates of pooled overall discontinuation and discontinuation due to adverse events rates were not different between the two groups in acute and long-term treatments . Limitations A small study was included in the current review . Conclusion In relation to the current systematic review , risperidone is efficacious in the treatment of symptoms in children and adolescents with ASD . Although its acceptability is comparable to placebo , treatment with risperidone is well tolerated in children and adolescents with ASD This prospect i ve , longitudinal , study charted the developmental profiles of young children with Autism Spectrum Disorders ( ASD ) identified through routine developmental surveillance . 109 children with Autistic Disorder ( AD ) , ‘ broader ’ ASD , and developmental and /or language delays ( DD/LD ) were assessed using the Mullen Scales of Early Learning ( MSEL ) at 12-months ( n = 10 assessment s ) , 18-months ( n = 45 assessment s ) , and 24-months ( n = 99 assessment s ) . The children with AD performed most poorly , overall , than the ASD and DD/LD groups on the MSEL . Furthermore , the children with AD/ASD displayed an uneven cognitive profile , with poorer performance on verbal ( particularly receptive language ) relative to nonverbal skills . There was also evidence of developmental slowing in verbal skills from 18- to 24-months for children on the spectrum , especially those with AD . Given that the poor receptive , relative to expressive , language profile emerges very early in life for children with AD/ASD , this cognitive profile may serve as an additional red flag to social attention and communication deficits . Receptive language should therefore be stringently monitored in any developmental surveillance program for autism spectrum disorders in the second year of life Children with Autism Spectrum Disorder ( ASD ) often experience difficulty participating in everyday home routines , such as bed time or bath time . This r and omized controlled trial examined the efficacy of an interactive , web‐based parenting tutorial for improving children 's engagement in daily routines ( i.e. , proximal outcomes ) as well improving children 's social communication and parenting efficacy and stress ( i.e. , broad outcomes ) . Parents of children with ASD between 18 and 60 months were r and omly assigned to the  Tutorial  group ( n = 52 ) or the  Control group ( n = 52 ) . All parents completed question naires at baseline ( T1 ) , 1 month after T1 ( T2 ; post‐tutorial completion ) , and 2 months after T1 ( T3 ) . Relative to the Control group , parents in the Tutorial group reported significantly higher use of evidence ‐based instructional strategies and higher levels of child engagement during routines at T2 and T3 . In addition , parents in the Tutorial group reported significantly lower parenting stress and higher parenting efficacy at T3 , as well as higher ratings of child social communication at T2 and T3 , compared to the Control group . Parents reported being highly satisfied with both the clinical content and technical aspects of the tutorial . These improvements in both proximal and broad parent‐child outcomes suggest that this tutorial may be a promising and accessible way for empowering some parents and improving parent‐child interactions . Autism Res 2018 , 11 : 667–678 . © 2018 International Society for Autism Research , Wiley Periodicals , OBJECTIVE This study evaluated the efficacy of a targeted social skills training group in school-aged children with autism spectrum disorder ( ASD ) . The intervention , Seaver-NETT ( Nonverbal communication , Emotion recognition , and Theory of mind Training ) , is a 12-session cognitive-behavioral intervention ( CBI ) for verbal , school-aged children targeting ASD-specific social behavioral impairments . METHOD Sixty-nine children with ASD , 8 to 11 years of age , with verbal IQs greater than 70 , participated in a r and omized comparative trial to examine the efficacy of NETT relative to a facilitated play group . Treatment outcomes included caregiver reports of social behavior and neuropsychological assessment s of social cognition conducted by blinded raters . Outcomes were collected at baseline , endpoint , and 3 months posttreatment . RESULTS Significant improvements were found on social behavior outcomes such as nonverbal communication , empathic responding , and social relations in the NETT condition relative to the active control at endpoint . Verbal IQ moderated the interaction effect on social behavior , with higher verbal IQ associated with improvements in the CBI condition . No significant improvements were found on social cognitive outcomes . No significant group differences were found at 3-month follow-up conducted with approximately half the sample ( n = 34 ) . CONCLUSION These data indicate that targeted CBI social skills groups such as NETT improve social communication deficits in verbal , school-aged children with ASD . The moderating effects of high verbal IQ suggest a need to consider participant and treatment characteristics associated with outcomes in future studies . Clinical trial registration information-Neural and Behavioral Outcomes of Social Skills Groups in Children With Autism Spectrum Disorder ; https:// clinical trials.gov ; NCT01190917 Objective : This cluster r and omized trial ( CRT ) evaluated the efficacy of the Classroom Social , Communication , Emotional Regulation , and Transactional Support ( SCERTS ) Intervention ( CSI ) compared with usual school-based education with autism training modules ( ATM ) . Method : Sixty schools with 197 students with autism spectrum disorder ( ASD ) in 129 classrooms were r and omly assigned to CSI or ATM .  Mean student age was 6.79 years ( SD 1.05 ) and 81.2 % were male . CSI teachers were trained on the model and provided coaching throughout the school year to assist with implementation . A CRT , with students nested within general and special education classrooms nested within schools , was used to evaluate student outcomes . Results : The CSI group showed significantly better outcomes than the ATM group on observed measures of classroom active engagement with respect to social interaction . The CSI group also had significantly better outcomes on measures of adaptive communication , social skills , and executive functioning with Cohen ’s d effect sizes ranging from 0.31 to 0.45 . Conclusion : These findings support the preliminary efficacy of CSI , a classroom-based , teacher-implemented intervention for improving active engagement , adaptive communication , social skills , executive functioning , and problem behavior within a heterogeneous sample of students with ASD . This makes a significant contribution to the literature by demonstrating efficacy of a classroom-based teacher-implemented intervention with a heterogeneous group of students with ASD using both observed and reported measures Abstract Camarata 's ( 2014 ) review summarizes the progress that has been made in the field of early identification and early intervention in autism spectrum disorders ( ASD ) over the past few decades , but also provides a salutary reminder that much still needs to be done . Whilst it is possible to prospect ively identify cases of ASD using screening instruments ; it is critical that those using such screens in clinical practice underst and how to interpret data from published studies and consider how screening information is communicated to parents . After several decades when few r and omized controlled trials of early intervention in ASD were conducted , the last decade has seen an explosion of new studies . Despite initial optimism , as more trials are published they have highlighted the limits of , and challenges to , early intervention in ASD . Given the complex nature of ASD these sobering lessons are perhaps not surprising . Rather than promote despondency , they need to inspire and inform the next decade of clinical research to move the field forward to the benefit of young children with ASD and those who care for them BACKGROUND Social and communication impairments are core deficits and prognostic indicators of autism . We evaluated the impact of supplementing a comprehensive intervention with a curriculum targeting socially synchronous behavior on social outcomes of toddlers with autism spectrum disorders ( ASD ) . METHODS Fifty toddlers with ASD , ages 21 to 33 months , were r and omized to one of two six-month interventions : Interpersonal Synchrony or Non-Interpersonal Synchrony . The interventions provided identical intensity ( 10 hours per week in classroom ) , student-to-teacher ratio , schedule , home-based parent training ( 1.5 hours per month ) , parent education ( 38 hours ) , and instructional strategies , except the Interpersonal Synchrony condition provided a supplementary curriculum targeting socially engaged imitation , joint attention , and affect sharing ; measures of these were primary outcomes . Assessment s were conducted pre-intervention , immediately post-intervention , and , to assess maintenance , at six-month follow-up . R and om effects models were used to examine differences between groups over time . Secondary analyses examined gains in expressive language and nonverbal cognition , and time effects during the intervention and follow-up periods . RESULTS A significant treatment effect was found for socially engaged imitation ( p = .02 ) , with more than doubling ( 17 % to 42 % ) of imitated acts paired with eye contact in the Interpersonal Synchrony group after the intervention . This skill was generalized to unfamiliar context s and maintained through follow-up . Similar gains were observed for initiation of joint attention and shared positive affect , but between-group differences did not reach statistical significance . A significant time effect was found for all outcomes ( p < .001 ) ; greatest change occurred during the intervention period , particularly in the Interpersonal Synchrony group . CONCLUSIONS This is the first ASD r and omized trial involving toddlers to identify an active ingredient for enhancing socially engaged imitation . Adding social engagement targets to intervention improves short-term outcome at no additional cost to the intervention . The social , language , and cognitive gains in our participants provide evidence for plasticity of these developmental systems in toddlers with ASD . http://www . clinical trials.gov/ct2/show/NCT00106210?term = l and a&rank = 3 Prospect i ve memory ( remembering to carry out an action in the future ) has been studied relatively little in ASD . We explored time-based ( carry out an action at a pre-specified time ) and event-based ( carry out an action upon the occurrence of a pre-specified event )  prospect i ve memory , as well as possible cognitive correlates , among 21 intellectually high-functioning children with ASD , and 21 age- and IQ-matched neurotypical comparison children . We found impaired time-based , but undiminished event-based , prospect i ve memory among children with ASD . In the ASD group , time-based prospect i ve memory performance was associated significantly with diminished theory of mind , but not with diminished cognitive flexibility . There was no evidence that time-estimation ability contributed to time-based prospect i ve memory impairment in ASD CONTEXT To our knowledge , there is no published information on the epidemiology of autism spectrum disorders ( ASDs ) in adults . If the prevalence of autism is increasing , rates in older adults would be expected to be lower than rates among younger adults . OBJECTIVE To estimate the prevalence and characteristics of adults with ASD living in the community in Engl and . DESIGN A stratified , multiphase r and om sample was used in the third national survey of psychiatric morbidity in adults in Engl and in 2007 . Survey data were weighted to take account of study design and nonresponse so that the results were representative of the household population . SETTING General community ( ie , private households ) in Engl and . PARTICIPANTS Adults ( people 16 years or older ) . MAIN OUTCOME MEASURES Autism Diagnostic Observation Schedule , Module 4 in phase 2 vali date d against the Autism Diagnostic Interview-Revised and Diagnostic Interview for Social and Communication Disorders in phase 3 . A 20-item subset of the Autism-Spectrum Quotient self-completion question naire was used in phase 1 to select respondents for phase 2 . Respondents also provided information on sociodemographics and their use of mental health services . RESULTS Of 7461 adult participants who provided a complete phase 1 interview , 618 completed phase 2 diagnostic assessment s. The weighted prevalence of ASD in adults was estimated to be 9.8 per 1000 ( 95 % confidence interval , 3.0 - 16.5 ) . Prevalence was not related to the respondent 's age . Rates were higher in men , those without educational qualifications , and those living in rented social ( government-financed ) housing . There was no evidence of increased use of services for mental health problems . CONCLUSIONS Conducting epidemiologic research on ASD in adults is feasible . The prevalence of ASD in this population is similar to that found in children . The lack of an association with age is consistent with there having been no increase in prevalence and with its causes being temporally constant . Adults with ASD living in the community are socially disadvantaged and tend to be unrecognized BACKGROUND Technology-based interventions for Autism Spectrum Disorder ( ASD ) have proliferated , but few have been evaluated within the context of a r and omised controlled trial ( RCT ) . This RCT evaluated the efficacy of one technology-based early intervention programme ( Therapy Outcomes By You ; TOBY ) in young children with ASD . METHODS TOBY is an app-based learning curriculum design ed for children and parents as a complement to early behavioural intervention . Eighty children ( 16 female ) were recruited to this RCT within 12 months of receiving a diagnosis of ASD ( M age = 3.38 ; SD = 0.69 ) and r and omised to receive either treatment-as-usual ( community-based intervention , n = 39 ) or the TOBY therapy ( at least 20 min/day ) plus treatment-as-usual ( n = 41 ) for a period of 6 months . Outcomes were assessed at 3 and 6 months postbaseline . ( Australian New Zeal and Clinical Trials Registry : ACTRN12614000738628 ; www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?id=365463 ) . RESULTS Children in the TOBY intervention group averaged 19 min/day engaging with the app in the first 3 months , but only 2 min/day during the second 3 months . There was no group difference in scores on the primary outcome , the Autism Treatment Evaluation Checklist , at either the 3- or 6-month follow-up . However , significant improvements at the 6-month follow-up were observed in the TOBY intervention group relative to the treatment-as-usual group on three secondary outcomes : the Fine Motor and Visual Reception subscales of the Mullen Scale of Early Learning and the Total Words Understood scale of the MacArthur-Bates Communicative Development Index . Statistical trends towards improvement in the TOBY intervention group were observed on measures of adaptive function , although these decreased in magnitude from the 3- to 6-month follow-up . CONCLUSIONS This study provides evidence that technology-based interventions may provide a relatively low-cost addition to existing therapist-delivered interventions for children with ASD . However , sustained use of the app over the full 6-month period was a challenge for most families This study assessed the efficacy of FaceSay , a computer-based social skills training program for children with Autism Spectrum Disorders ( ASD ) . This r and omized controlled study ( N = 49 ) indicates that providing children with low-functioning autism ( LFA ) and high functioning autism ( HFA ) opportunities to practice attending to eye gaze , discriminating facial expressions and recognizing faces and emotions in FaceSay ’s structured environment with interactive , realistic avatar assistants improved their social skills abilities . The children with LFA demonstrated improvements in two areas of the intervention : emotion recognition and social interactions . The children with HFA demonstrated improvements in all three areas : facial recognition , emotion recognition , and social interactions . These findings , particularly the measured improvements to social interactions in a natural environment , are encouraging PURPOSE The Preschool Language Scale , Fourth Edition ( PLS-4 ; Zimmerman , Steiner , & Pond , 2002 ) was used to examine syntactic and semantic language skills in preschool children with autism spectrum disorders ( ASD ) to determine its suitability for use with this population . We expected that PLS-4 performance would be better in more intellectually able children and that receptive skills would be relatively more impaired than expressive abilities , consistent with previous findings in the area of vocabulary . METHOD Our sample consisted of 294 newly diagnosed preschool children with ASD . Children were assessed via a battery of developmental measures , including the PLS-4 . RESULTS As expected , PLS-4 scores were higher in more intellectually able children with ASD , and overall , expressive communication was higher than auditory comprehension . However , this overall advantage was not stable across nonverbal developmental levels . Expressive skills were significantly better than receptive skills at the youngest developmental levels , whereas the converse applied in children with more advanced development . CONCLUSIONS The PLS-4 can be used to obtain a general index of early syntax and semantic skill in young children with ASD . Longitudinal data will be necessary to determine how the developmental relationship between receptive and expressive language skills unfolds in children with ASD This study follows 40 children who were participants in a r and omized controlled early intervention trial ( Kasari et al. ) from early childhood ( 2–5 years of age ) to elementary school age ( 8–10 years ) . To fully utilize the available longitudinal data , the general linear mixed model was the primary analytical approach . The growth trajectories of joint attention skills ( pointing , coordinated joint looking , and showing ) and expressive language outcomes in these children were estimated based on five time points during the measurement period . The children were grouped by diagnosis at the last follow‐up ( autism , autism spectrum disorder ( ASD ) , no diagnosis ) and by their original treatment group assignment ( joint attention , symbolic play , control ) , and differences between these groups were evaluated . Results showed that joint attention skills of coordinated joint looking and showing increased over time , and pointing to share interest increased over the first year measured and decreased thereafter . These trajectories were influenced by both original treatment assignment and diagnostic status at follow‐up . In addition , a cross‐lagged panel analysis revealed a causal relationship between early pointing and later language development . This study highlights the longitudinal and developmental importance of measures of early core deficits in autism , and suggests that both treatment and ASD symptomatology may influence growth in these skills over time . Autism Res 2014 , 7 : 207–215 . © 2014 International Society for Autism Research , Wiley Periodicals , This study examined the  measurement tools and target symptoms/skills  used to assess treatment response during Autism Spectrum Disorder ( ASD ) intervention trials from 2001 through 2010 . Data from 195 prospect i ve trials were analyzed . There were 289 unique  measurement  tools , of which 61.6 % were used only once , and 20.8 % were investigator- design ed . Only three tools were used in more than 2 % of the studies , and none were used in more than 7 % of studies . Studies investigated an average of 11.4 tool-symptom combinations per trial , with as many as 45 in one study . These results represent a lack of consistency in outcome measurements in ASD intervention trials . These findings highlight the need to set guidelines for appropriate outcome measurement in the ASD field CONTEXT The presence of autistic-like traits in relatives of individuals with autism spectrum disorder ( ASD ) is well recognized , but , to our knowledge , the emergence of these traits early in development has not been studied . OBJECTIVE To prospect ively investigate the emergence of autistic-like traits in unaffected ( no ASD diagnosis ) infant siblings of prob and s diagnosed as having ASD . DESIGN Two groups of children unaffected with ASD were assessed prospect ively-siblings of prob and s diagnosed as having ASD ( high risk [ HR ] ) and control subjects with no family history of ASD ( low risk [ LR ] ) . Scores on a measure of autistic-like traits at 12 months of age were used in a cluster analysis of the entire sample . SETTING A prospect i ve study of infant siblings of prob and s with ASD from 3 diagnostic centers in Canada . PARTICIPANTS The study included 170 HR and 90 LR children , none of whom was diagnosed as having ASD at age 3 years . MAIN OUTCOME MEASURES The Autism Observation Scale for Infants was used to measure autistic-like traits and derive clusters at 12 months of age . Clusters were compared on ASD symptoms , cognitive abilities , and social-emotional difficulties at age 3 years . RESULTS Two clusters were identified . Cluster 1 ( n = 37 ; 14.2 % of total sample ) had significantly higher levels of autistic-like traits compared with cluster 2 . Within cluster 1 , 33 children came from the siblings ( 19.4 % of HR group ) and only 4 came from the control subjects ( 4.5 % of LR group ) . At age 3 years , children from cluster 1 had more social-communication impairment ( effect size > 0.70 ; P < .001 ) , lower cognitive abilities ( effect size = -0.59 ; P < .005 ) , and more internalizing problems ( effect size = 0.55 ; P = .01 ) . Compared with control subjects , HR siblings had a relative risk of 4.3 ( 95 % CI,1.6 - 11.9 ) for membership in cluster 1 . CONCLUSIONS Study findings suggest the emergence of autistic-like traits resembling a broader autism phenotype by 12 months of age in approximately 19 % of HR siblings who did not meet ASD diagnostic criteria at age 3 years
The studies examined suggest moderate evidence about the effectiveness of  VR-based treatments in ASD .
VR can add many advantages to the treatment of ASD symptomatology , but it is necessary to develop consistent validations in future studies to state that VR can effectively complement the traditional treatments
Autism Spectrum Disorder ( ASD ) is a neurodevelopmental disease that is specially characterized by impairments in social communication and social skills .
ASD has a high prevalence in children , affecting 1 in 160 subjects .
Virtual reality ( VR ) has emerged as an effective tool for intervention in the health field .
Different recent papers have review ed the VR-based treatments in ASD , but they have an important limitation because they only use clinical data bases and do not include important technical indexes such as the Web of Science index or the Scimago Journal & Country Rank .
To our knowledge , this is the first contribution that has carried out an evidence -based systematic review including both clinical and technical data bases about the effectiveness of VR-based intervention in ASD .