A qualitative study of three parents and their toddlers with autism was conducted to investigate the communicative functions underlying parent–toddler interactions and how the instrumental or social nature of one partner’s actions influenced the other’s engagement. Parent–child interaction videos collected from a separate intervention study were transcribed with thick description, coded for literal and inferential meaning by independent coders, and analyzed for emergent themes following an iterative process of code categorization. Themes converged around the partner as instrument, attempted but missed social connections, and congruent social engagement. A complementary interactional sequential analysis revealed that communicative functions of initiating partners were largely mirrored in their partners’ responding actions, suggesting that actively supporting parents to interact with their toddlers socially, rather than prescriptively or instrumentally, may be a potent intervention strategy to address the core social communication challenge in autism during the formative early developmental period.

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Background Rett syndrome (RTT) is associated with severe motor and communicative impairment making optimal postoperative pain management a challenge. There are case-reports documenting reduced postoperative analgesic requirement in RTT. Aim The goal of this preliminary investigation was to compare postoperative analgesic management among a sample of girls with RTT compared to girls with and without developmental disability undergoing spinal fusion surgery. Method The medical records of 8 girls with Rett syndrome (mean age=13.2 years, SD=1.9), 8 girls with developmental disability (cerebral palsy [CP]; mean age= 13.1 years, SD= 2.0), and 8 girls without developmental disability (adolescent idiopathic scoliosis [AIS]; mean age=13.4, SD=1.8) were reviewed. Data related to demographics, medications, and route of drug administration were recorded. Results Girls with RTT received significantly fewer morphine equivalent opioids postoperatively (M = 0.26 mg/kg/day, SD = 0.10) compared to girls with AIS (M = 0.47 mg/kg/day, SD= 0.13; 95% CI −0.34 to −0.08; p=.001) and girls with CP (M = 0.40 mg/kg/day, SD = 0.14; 95% CI −0.27 to −0.02; p = .01). Girls with RTT received significantly fewer opioid patient controlled analgesic (PCA) bolus doses (given by proxy; M=42.63, SD=17.84) compared to girls with AIS (M=98.25, SD=52.77; 95% CI −96.42 to −14.83; p = .01). There was also some evidence indicating girls with RTT received fewer bolus doses compared to girls with CP (M=80.88, SD=38.93; 95% CI −79.05 to 2.55; p=.06). On average, girls with RTT also received smaller total doses of acetaminophen, diazepam and hydroxyzine. Conclusion This study highlights possible discrepancies in postoperative pain management specific to girls with RTT and suggests further investigation is warranted to determine best practice for postoperative analgesic management for this vulnerable patient population.