Concerns raised by parents regarding their child’s development are compatible with the child’s final diagnosis of autism spectrum disorder. A better understanding of the relationship between parental concerns and a final diagnosis of... more
Concerns raised by parents regarding their child’s development are compatible with the child’s final diagnosis of autism spectrum disorder. A better understanding of the relationship between parental concerns and a final diagnosis of autism spectrum disorder is therefore critical. In the current study, we compared the frequencies of parental concerns related to DSM-5 criteria for autism spectrum disorder between pair-matched groups with and without a final diagnosis of autism spectrum disorder and determined which parental concerns predicted a final diagnosis of autism spectrum disorder. The cohort included 80 participants (48–154 months of age, IQ > 70) assessed for a possible autism spectrum disorder diagnosis. Parental concerns were retrieved from the free-description portion of the introductory questions of the Autism Diagnostic Interview-Revised and analyzed to assess whether they corresponded to any of the seven DSM-5 criteria for ASD. The two groups only differed in the fr...
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Research Interests: Autism, Adolescent, Medicine, Humans, Child, and 15 moreMicrocephaly, Female, Male, Infant, Developmental disabilities, Autism Spectrum Disorder, Clinical Sciences, Joint Instability, Neurosciences, Cognition disorders, Cohort Studies, Neuropsychological Tests, Child preschool, Musculoskeletal abnormalities, and Megalencephaly
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BACKGROUND Studies of children with autism spectrum disorder (ASD) report a high prevalence of eating abnormalities (46-92%) compared to typically developed (TD) toddlers (25-50%), and food selectivity is considered the most frequent... more
BACKGROUND Studies of children with autism spectrum disorder (ASD) report a high prevalence of eating abnormalities (46-92%) compared to typically developed (TD) toddlers (25-50%), and food selectivity is considered the most frequent eating problem in ASD.1,2 Notwithstanding, there is no consensus regarding the meaning of the term "food selectivity". Children with ASD and food selectivity are at a greater risk for having inadequate intake of various minerals and vitamins that might affect development. Previous research reported that food selectivity was positively related to parent-reported autism symptoms but unrelated to autism severity or linguistic and cognitive abilities as measured by professionals.3 Two possible mechanisms4 may underlie co-morbid food selectivity in ASD: sensory over-responsivity and inflexible adherence to routines or rituals that are part of the restricted and repetitive behaviors (RRB) criterion for ASD. In addition, as meals often have social facets, food selectivity might also be related to deficits in the social-communication domain.
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Research Interests: Psychology, Clinical Psychology, Early Intervention, Autism, Autism Spectrum Disorders, and 9 moreSocial Interaction, Applied Behavior Analysis, Effect size, Autism Spectrum Disorder, Cognitive Ability, Young Children, Applied Behavioral Analysis, Guidance and Counseling Intervention Programs, and Behavioral Intervention
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Unusual responses to sensory stimuli have been described in autism spectrum disorder (ASD).The study examined the frequencies of 'unusual sensory... more
Unusual responses to sensory stimuli have been described in autism spectrum disorder (ASD).The study examined the frequencies of 'unusual sensory interests' and 'negative sensory responses' and their relation to functioning in a large ASD population (n = 679). Having 'unusual sensory interests' was reported in 70.4 % and 'negative sensory responses' in 66.0 % of the ASD group. Having 'unusual sensory interests' was associated with more severe reported and observed autism symptoms, lower cognitive ability and lower adaptive skills. In contrast, having 'negative sensory responses' was only associated with more severe reported stereotyped behaviors. It is suggested that having 'unusual sensory interests' is a part of a primary more severe type of ASD involving numerous developmental domains that might have a unique neurobiological origin.
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Controlled studies examining canine therapy in autism spectrum disorder are scarce. This study examined the effectiveness of a “Dog Training Intervention” on adaptive skills, autism severity, and anxiety using a controlled crossover... more
Controlled studies examining canine therapy in autism spectrum disorder are scarce. This study examined the effectiveness of a “Dog Training Intervention” on adaptive skills, autism severity, and anxiety using a controlled crossover design. Seventy-three participants diagnosed with autism spectrum disorder ( Mage = 4:10 ± 1:0) were divided into two groups that received the dog training intervention during half of the school year in addition to standard-of-care interventions. The dog training intervention, in which the children were taught how to interact with and train dogs, was given twice weekly for 4 months within autism spectrum disorder–specific special education school. Those receiving the dog training intervention first showed significantly increased adaptive social and communication skills compared to the controls, and the gains were maintained after the dog training intervention. Belonging to the first dog training intervention group, higher pre-intervention adaptive skills, higher baseline cognitive ability, and less severe autism severity predicted better adaptive social and communication skills. The controls improved in adaptive skills only during their receipt of dog training intervention after crossover. The positive impact on social communication skills suggests that dog training may serve as an effective model for establishing social interaction. Dog training intervention appears to be an effective adjunct treatment to interventions provided in special education schools for children with autism spectrum disorder. Lay abstract There is some evidence that using therapy dogs for children with autism spectrum disorder generally results in improved social communication skills and reduced behavioral problems. However, well-controlled studies that examine its effectiveness are scarce. This study examined the effectiveness of a “Dog Training Intervention.” The study included 73 participants diagnosed with autism spectrum disorder (61 males, 12 females) with age range of 2:10–7:6 years ( M = 4:10 ± 1:0) who attend autism spectrum disorder–specific special education schools. The study population was divided into two groups. Each group received the dog training intervention during one part of the school year (first half or second half) in addition to the standard interventions provided by the special education school settings. The dog training intervention was given twice weekly for 4 months within the school setting. The group that received the dog training intervention first showed a significant increase in adaptive social and communication skills in comparison to the second group that did not receive the intervention in this period. This improvement was maintained after the dog training intervention. The second group, which received intervention at the second half of the year, showed improvement in communication and socialization adaptive skills only during the period in which they received the dog training intervention. The positive impact on social communication adaptive skills of the dog training intervention among young children with autism spectrum disorder suggests that dogs may serve as an effective model for establishing social interaction. Dog training intervention appears to be an effective adjunct treatment to the interventions provided in special education schools for young children with autism spectrum disorder.
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Abstract Background Food selectivity is a frequent eating problem identified among children with autism spectrum disorders (ASD). Previous studies identified a positive association between parental reports of atypical eating habits and... more
Abstract Background Food selectivity is a frequent eating problem identified among children with autism spectrum disorders (ASD). Previous studies identified a positive association between parental reports of atypical eating habits and ASD symptom severity, and a simultaneous absence of this association among the professionals’ reports. However, the professionals in these studies had only short acquaintances with the children. Method We examined parental and day care professional (DCP) assessments of ASD symptom severity among children at school year start and end, in relation to selective eating. We included 62 children aged 19–45 months diagnosed with ASD attending government-funded Early Intervention Day Care Centers (EIDCCs). EIDCCs, designated for children diagnosed with ASD, provide standard comprehensive multidisciplinary ASD-specific treatments. Results Results showed parental reports of children’s ASD symptoms were positively associated with selective eating consistently over time. In contrast, DCP reports were not associated with selective eating, despite long acquaintance with the children. When comparing ASD symptoms of selective eaters vs. non-selective eaters, the gap between parental and DCP assessments was smaller among selective eaters. Generally, parents reported less severe ASD symptoms compared to DCPs, yet, over time, both parents and DCPs reported improvement. A decrease in food diversity was also found associated with age, originating as early as toddlerhood. Conclusion Differences between parents and day care professionals on assessments of ASD symptom severity, in relation to parent reports of selective eating behavior, were maintained over time. Our findings emphasize the importance of early interventions that address atypical eating habits at young ages.
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Daily functioning involves identifying emotions in spoken language, a fundamental aspect of social interactions. To date, there is inconsistent evidence in the literature on whether individuals with autism spectrum disorder without... more
Daily functioning involves identifying emotions in spoken language, a fundamental aspect of social interactions. To date, there is inconsistent evidence in the literature on whether individuals with autism spectrum disorder without intellectual disability (ASD‐without‐ID) experience difficulties in identification of spoken emotions. We conducted a meta‐analysis (literature search following the PRISMA guidelines), with 26 data sets (taken from 23 peer‐reviewed journal articles) comparing individuals with ASD‐without‐ID (N = 614) and typically‐developed (TD) controls (N = 640), from nine countries and in seven languages (published until February 2020). In our analyses there was no sufficient evidence to suggest that individuals with HF‐ASD differ from matched controls in the identification of simple prosodic emotions (e.g., sadness, happiness). However, individuals with ASD‐without‐ID were found to perform significantly worse than controls in identification of complex prosodic emotion...
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BACKGROUND Studies of children with autism spectrum disorder (ASD) report a high prevalence of eating abnormalities (46-92%) compared to typically developed (TD) toddlers (25-50%), and food selectivity is considered the most frequent... more
BACKGROUND Studies of children with autism spectrum disorder (ASD) report a high prevalence of eating abnormalities (46-92%) compared to typically developed (TD) toddlers (25-50%), and food selectivity is considered the most frequent eating problem in ASD.1,2 Notwithstanding, there is no consensus regarding the meaning of the term "food selectivity". Children with ASD and food selectivity are at a greater risk for having inadequate intake of various minerals and vitamins that might affect development. Previous research reported that food selectivity was positively related to parent-reported autism symptoms but unrelated to autism severity or linguistic and cognitive abilities as measured by professionals.3 Two possible mechanisms4 may underlie co-morbid food selectivity in ASD: sensory over-responsivity and inflexible adherence to routines or rituals that are part of the restricted and repetitive behaviors (RRB) criterion for ASD. In addition, as meals often have social facets, food selectivity might also be related to deficits in the social-communication domain.
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Background: Research suggests that biological factors such as heredity, gender and parental ages may play a causal role in autism spectrum disorder (ASD). Male:Female (M:F) ratio of 4:1 was documented in most studies. The prevalence of... more
Background: Research suggests that biological factors such as heredity, gender and parental ages may play a causal role in autism spectrum disorder (ASD). Male:Female (M:F) ratio of 4:1 was documented in most studies. The prevalence of ASD among siblings of individuals with ASD ranges from 2% to 6% in comparison to 0.5-1% in the general population. Increased autism risk was documented with both advanced maternal and paternal ages. Objectives: 1. To define gender ratio, prevalence of ASD in first and second relatives and maternal ages in a cohort with ASD. 2. To examine possible relationships between gender, familial genetic factors and maternal ages and autism severity, adaptive skills and developmental trajectories (developmental regression/non-regression) Methods: The study included 564 children who came to a tertiary autism center in Israel for a comprehensive evaluation. A pediatric neurologist obtained birth and developmental histories and performed a neurological examination. ...
Background: Medical conditions, including, sleep, eating and gastrointestinal (GI) problems and the presence of minor neurological dysfunction (MND), have been reported in autism spectrum disorders (ASD). Few studies have investigated the... more
Background: Medical conditions, including, sleep, eating and gastrointestinal (GI) problems and the presence of minor neurological dysfunction (MND), have been reported in autism spectrum disorders (ASD). Few studies have investigated the relationship between these medical problems and clinical manifestations in ASD. Objectives: 1. To describe the frequencies of sleep, eating and GI problems and MND in a large cohort with ASD; 2. To examine the relationship between these medical conditions and autism severity and adaptive functioning Methods: Of 637 participants evaluated in a tertiary autism center, 529 were diagnosed with ASD and 108 received other diagnoses (developmental delay, specific language impairment, ADHD, and more). Medical histories were obtained from parents and a comprehensive neurological examination was performed by a pediatric neurologist. Evaluations of autism severity were based on the Autism Diagnosis Observation Schedule (ADOS) and the new ADOS severity scale. ...
16. Chung, K.M., Jung, W., Yang, J., Ben-Itzchak E., Zachor, D. A., Furniss, F., Heyes, K., Matson8, J. L., Kozlowski, A. M., Barker, A. A (2011). Cross Cultural Differences in Challenging Behaviors of Children with Autism Spectrum Disorders: An International Examination between Israel, South Kor...more
ABSTRACT Background and purposes: Perceived stress (PS) among healthcare students worldwide is a recognized problem. To address the paucity of data about the actual degree of PS, this study aimed to: 1) evaluate and compare PS across... more
ABSTRACT Background and purposes: Perceived stress (PS) among healthcare students worldwide is a recognized problem. To address the paucity of data about the actual degree of PS, this study aimed to: 1) evaluate and compare PS across three healthcare programs (Physical Therapy [PT], Communication Disorders [CD], and Nutrition Sciences [NS]) in one university; 2) evaluate changes in PS across study years; 3) identify the contribution of academic- and socio-demographic-related variables to PS; and 4) determine whether the Israeli students' PS levels differ from those of their peers in other countries. Methods: A cross-sectional survey was performed among all undergraduate PT, CD, and NS students from one university. Data were collected using anonymous questionnaires. Instruments included the Perceived Stress Scale 10 (PSS) and the Undergraduate Sources of Stress (USOS). ANOVA was used to evaluate the differences between the three programs, and regression analysis to evaluate the contribution of socio-demographic factors to PS and USOS. Results: A total of 312 students (PT - 154; CD - 92; NS - 66) participated in the study. Mean PSS (range: 13.5-13.6) was similar in the three programs. The USOS academic factor was the most reported source of stress in all programs. Most socio-demographic variables were not related to either PS or USOS. Conclusions: Students from PT, CD, and NS programs perceived similar levels of stress. The academic factor was perceived as the most important source of stress by students from the three departments, despite differences in the academic educational programs. Further studies are needed to generalize these results and enable a comparison between healthcare students and other students' stress perceptions.
Research Interests: Psychology, Perception, Medicine, Israel, Humans, and 15 moreFemale, Male, Jews, Regression Analysis, Risk factors, Clinical Sciences, Adult, Health surveys, Chi Square Distribution, Risk Factors, Cross sectional Study, Cross Sectional Studies, Socioeconomic Factors, Severity of Illness Index, and cultural characteristics
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... University / Assaf Harofeh Medical Center, Zerifin, Israel and Esther Ben Itzchak, Ph.D, Communication Disorder, Ariel University Center of Samaria, Ariel, Israel. Background: Few studies have examined the variability in intervention... more
... University / Assaf Harofeh Medical Center, Zerifin, Israel and Esther Ben Itzchak, Ph.D, Communication Disorder, Ariel University Center of Samaria, Ariel, Israel. Background: Few studies have examined the variability in intervention outcomes of very young children with ASD. ...
Research Interests: Psychology, Developmental Psychology, Communication, Autism, Intelligence, and 15 moreCognition, Nonverbal Communication, Medicine, Humans, Behavior Therapy, Female, Imitation, Male, Infant, Developmental disabilities, Behavioral Intervention, Autistic disorder, Child preschool, Language Development Disorders, and Outcome Assessment Health Care
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Supplemental material, AUT840226_Lay_Abstract for Toddlers to teenagers: Long-term follow-up study of outcomes in autism spectrum disorder by Esther Ben-Itzchak and Ditza A Zachor in Autism
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This individual participant data meta-analysis is the most intensive possible evaluation of the effectiveness of early intensive applied behaviour analysis–based interventions for pre-school autistic children compared with treatment as... more
This individual participant data meta-analysis is the most intensive possible evaluation of the effectiveness of early intensive applied behaviour analysis–based interventions for pre-school autistic children compared with treatment as usual/eclectic interventions. Data from 491 participants (originally collected in 10 studies) were included. Children receiving early intensive applied behaviour analysis–based interventions improved more on the Vineland adaptive behaviour scale (MD = 7.00; 95% confidence interval = 1.95–12.06) and cognitive ability (intelligence quotient) (MD = 14.13; 95% confidence interval = 9.16–19.10) relative to comparators at 2 years; though effects varied considerably across studies. Evidence for other outcomes was inconclusive due to insufficient evidence and there were few data on longer-term effects. All studies were at risk of bias across several domains, often due to the lack of randomisation or blinding of outcome assessors. Given the emerging evidence o...
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This prospective study examined the developmental changes over time of adolescents diagnosed in toddlerhood with autism spectrum disorder and searched for child characteristics at toddlerhood that predict outcome at adolescence. The study... more
This prospective study examined the developmental changes over time of adolescents diagnosed in toddlerhood with autism spectrum disorder and searched for child characteristics at toddlerhood that predict outcome at adolescence. The study included 65 participants who were divided into low cognitive (developmental quotient < 85; N = 41) and high cognitive (developmental quotient ⩾ 85; N = 21) groups in adolescence. Participants underwent a comprehensive assessment of cognitive ability, adaptive skills, and autism severity. Significant differences in the current clinical phenotypes and in developmental changes over time were found between the two cognitive groups. At baseline, the high cognitive group had significantly less severe social communication deficits. Only the high cognitive group showed a decrease in social communication deficits over time. Although the two groups did not differ in their adaptive skills at the time of diagnosis, the high cognitive group had better adapti...
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Heterogeneity in autism spectrum disorder (ASD) is reflected in the child's characteristics, including clinical variability in the severity of autism symptoms, cognitive ability, and language skills. Also, substantial individual... more
Heterogeneity in autism spectrum disorder (ASD) is reflected in the child's characteristics, including clinical variability in the severity of autism symptoms, cognitive ability, and language skills. Also, substantial individual differences are apparent about treatment outcomes. The effects of early intervention in ASD constitute one of the important questions ASD researchers face today. To what extent do factors such as child and family characteristics, intervention approach, and specific treatment components, influence outcome? This review focused on which preintervention factors better predicted outcome in each of the different outcome measures used most frequently in ASD research, including autism severity, cognitive ability, and adaptive behavior skills. For outcome in autism severity, predictors included child's baseline age, cognitive ability, autism severity, and the type of treatment approach used. For cognitive gains, predictors included baseline autism severity, m...
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Research Interests: Psychology, Communication, Interpersonal Communication, Autism, Outdoor Education, and 15 moreMedicine, Adventure, Adventure Education, Social behavior, Humans, Child, Female, Cognitive Therapy, Male, Interpersonal Relations, Autism Spectrum Disorder, Analysis of Variance, Social Behavior, Child preschool, and Medical and Health Sciences
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Background: Little is understood about the causal mechanisms underlying autism spectrum disorders (ASD). Prenatal risk factors, including maternal obstetric characteristics, labor and delivery complications, and neonatal problems have all... more
Background: Little is understood about the causal mechanisms underlying autism spectrum disorders (ASD). Prenatal risk factors, including maternal obstetric characteristics, labor and delivery complications, and neonatal problems have all been associated significantly with autism. Objectives: 1. To define the prevalence rates of in vitro fertilization (IVF) and prematurity in a cohort with ASD and compare them to the general Israeli population rates 2. To examine possible relationships between prenatal IVF and prematurity to autism severity, adaptive skills and developmental trajectories (regression/no regression) Methods: The study included 564 children who came to a tertiary autism center in Israel for a comprehensive evaluation. A pediatric neurologist obtained birth and developmental histories and performed a neurological examination. Evaluations of autism severity and of adaptive skills were performed using standardized tests [Autism Diagnosis Interview (ADI-R), Autism Diagnosi...