Ann Le Couteur

Newcastle University, Newcastle-on-Tyne, England, United Kingdom

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Publications (88)501.37 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: A set of 14, mostly social-communication items has been identified from the DISCO.•An algorithm applied to this set discriminated ASD from non-ASD cases.•Excellent agreement with outcome on DISCO algorithms for both ICD-10 and DSM-5.•Good sensitivity for children, adolescents, and adults.•An interview based on these items could highlight cases for full diagnostic assessment.
    Research in Autism Spectrum Disorders 01/2015; 9. · 2.96 Impact Factor
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    ABSTRACT: Background The PACT randomised-controlled trial evaluated a parent-mediated communication-focused treatment for children with autism, intended to reduce symptom severity as measured by a modified Autism Diagnostic Observation Schedule-Generic (ADOS-G) algorithm score. The therapy targeted parental behaviour, with no direct interaction between therapist and child. While nonsignificant group differences were found on ADOS-G score, significant group differences were found for both parent and child intermediate outcomes. This study aimed to better understand the mechanism by which the PACT treatment influenced changes in child behaviour though the targeted parent behaviour.Methods Mediation analysis was used to assess the direct and indirect effects of treatment via parent behaviour on child behaviour and via child behaviour on ADOS-G score. Alternative mediation was explored to study whether the treatment effect acted as hypothesised or via another plausible pathway. Mediation models typically assume no unobserved confounding between mediator and outcome and no measurement error in the mediator. We show how to better exploit the information often available within a trial to begin to address these issues, examining scope for instrumental variable and measurement error models.ResultsEstimates of mediation changed substantially when account was taken of the confounder effects of the baseline value of the mediator and of measurement error. Our best estimates that accounted for both suggested that the treatment effect on the ADOS-G score was very substantially mediated by parent synchrony and child initiations.Conclusions The results highlighted the value of repeated measurement of mediators during trials. The theoretical model underlying the PACT treatment was supported. However, the substantial fall-off in treatment effect highlighted both the need for additional data and for additional target behaviours for therapy.
    Journal of Child Psychology and Psychiatry 07/2014; · 5.42 Impact Factor
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    ABSTRACT: The objective of this study was to identify a set of ‘essential’ behaviours sufficient for diagnosis of DSM-5 Autism Spectrum Disorder (ASD). Highly discriminating, ‘essential’ behaviours were identified from the published DSM-5 algorithm developed for the Diagnostic Interview for Social and Communication Disorders (DISCO). Study 1 identified a reduced item set (48 items) with good predictive validity (as measured using receiver operating characteristic curves) that represented all symptom sub-domains described in the DSM-5 ASD criteria but lacked sensitivity for individuals with higher ability. An adjusted essential item set (54 items; Study 2) had good sensitivity when applied to individuals with higher ability and performance was comparable to the published full DISCO DSM-5 algorithm. Investigation at the item level revealed that the most highly discriminating items predominantly measured social-communication behaviours. This work represents a first attempt to derive a reduced set of behaviours for DSM-5 directly from an existing standardised ASD developmental history interview and has implications for the use of DSM-5 criteria for clinical and research practice.
    Research in Autism Spectrum Disorders 06/2014; 8(6):701–715. · 2.96 Impact Factor
  • B. Koshy, J. Rodgers, A. S. Le Couteur, H. McConachie, J. Parr
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    ABSTRACT: Background: Children with autism spectrum disorder (ASD) have multiple co-existing emotional and behavioural conditions ranging from disorders of sensory perception to psychiatric co-morbidities. These co-existing conditions add a significant burden to the care of children with ASD. Objectives: * To identify the prevalence of parent/carer–reported unmet needs regarding support for co-existing conditions in children with ASD * To understand the interactions between co-existing emotional and behavioural conditions, parents’ unmet needs regarding the services received and the impact on family. Methods: Parents were recruited from either the population-based Database of children with ASD living in the North East of England (Daslne), or a research register - the Autism Spectrum Database – UK (ASD-UK). 630 families responded to a postal survey that included parent report questionnaires about co-morbid psychopathology (ASD-CC – Autism Spectrum Disorder Comorbidity – Child Version) and problem behaviour (ASD-PBC – Autism Spectrum Disorder Problem Behaviour – Child Version) in children. Questionnaires about parents’ unmet needs, and Impact on Family (IOF) were also completed. ASD-CC and ASD-PBC were used to define co-existing emotional and behavioural conditions. The parent questionnaire on unmet needs was developed with the help of parents of children with ASD and covered services received in relation to feeding, sleep, anxiety, hyperactivity, other behavioural problems and sensory issues. Results: More than two-thirds of families had at least one unmet need; only 30% of families had their needs for support for managing co-existing conditions fully met. Parents of children with moderate to severe impairment in co-existing emotional and behavioural conditions (as defined in the ASD-CC), had greater unmet needs than parents of children with no/minimal impairment (2.96 vs. 1.51; p=.000); they also reported greater impact on the family (45.45 vs. 35.39; p=.000). Two linear regression models were built with total unmet needs and impact on the families as the criterion variables. For unmet service needs, total co-existing emotional and behavioural conditions (β=.440; p=.000) and younger age (β=.132;p=.003) contributed significantly to the model while type of diagnosis, gender, language level, school type and sibling/s with ASD did not make a significant contribution. For impact on the family, total co-existing emotional and behavioural conditions (β=.513; p=.000), total unmet needs (β=.155; p=.000), siblings with ASD (β=.089; p=.015) and type of ASD diagnosis (β= -.082; p=.033) contributed significantly to the model while age, language level and type of school made no significant contribution. Conclusions: Co-existing emotional and behavioural conditions had a direct significant impact on the family. Unmet service needs had an amplifying effect on this relationship. Improving support/intervention services for parents of children with ASD and co-existing emotional and behavioural conditions is necessary in an attempt to reduce the impact of these conditions on family life.
    2014 International Meeting for Autism Research; 05/2014
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    ABSTRACT: Rare copy-number variation (CNV) is an important source of risk for autism spectrum disorders (ASDs). We analyzed 2,446 ASD-affected families and confirmed an excess of genic deletions and duplications in affected versus control groups (1.41-fold, p = 1.0 × 10(-5)) and an increase in affected subjects carrying exonic pathogenic CNVs overlapping known loci associated with dominant or X-linked ASD and intellectual disability (odds ratio = 12.62, p = 2.7 × 10(-15), ∼3% of ASD subjects). Pathogenic CNVs, often showing variable expressivity, included rare de novo and inherited events at 36 loci, implicating ASD-associated genes (CHD2, HDAC4, and GDI1) previously linked to other neurodevelopmental disorders, as well as other genes such as SETD5, MIR137, and HDAC9. Consistent with hypothesized gender-specific modulators, females with ASD were more likely to have highly penetrant CNVs (p = 0.017) and were also overrepresented among subjects with fragile X syndrome protein targets (p = 0.02). Genes affected by de novo CNVs and/or loss-of-function single-nucleotide variants converged on networks related to neuronal signaling and development, synapse function, and chromatin regulation.
    The American Journal of Human Genetics 04/2014; · 11.20 Impact Factor
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    ABSTRACT: The purpose of this study was to explore how atypical reactions to sensory stimuli contribute to the relation between restricted and repetitive behaviors and anxiety in children with autism spectrum disorders (ASD). In Study 1, factor analysis of restricted and repetitive behaviors was carried out using the Repetitive Behavior Questionnaire-2 (RBQ-2), completed by 120 parents of 2- to 17-year-olds with ASD. Two subtypes resulted: repetitive sensory and motor behaviors, and insistence on sameness, accounting for 40% of the variance. This two-factor solution was retained even when the sensory items of the RBQ-2 were removed. In Study 2, 49 of the same parents also completed the Spence Anxiety Scales and the Sensory Profile. The insistence on sameness factor was significantly associated with anxiety while the repetitive motor behaviors factor was not. The relation between anxiety and insistence on sameness was mediated by sensory avoiding and to a lesser extent by sensory sensitivity. Implications for arousal explanations of ASD and for clinical practice are discussed.
    Research in Autism Spectrum Disorders 02/2014; 8(2):82–92. · 2.96 Impact Factor
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    ABSTRACT: Objective: Everyday decision making requires integration of a broad range of information from a variety of sources, including cognitive and emotional processes. For individuals with autism spectrum disorder (ASD), everyday decision making can be difficult. The mechanisms that underlie decision making in young people diagnosed with ASD have not been fully explored. Method: We studied children and young adolescents with autism spectrum disorder (ASD; n = 48) compared with an age- and ability-matched typical control group (CON; n = 54). We evaluated performance and psycho-physiological responsivity during the Iowa Gambling Task (IGT), an affective decision-making task. Results: ASD participants were superior to control participants on overall performance (p < .05), especially because of significantly better learning in later stages of the task. While both groups showed robust and equal psycho-physiological arousal to disadvantageous decks, the groups differed in their choice of card type, with the CON group choosing more often from the frequent-gain disadvantageous deck, despite occasional large losses; while the ASD group chose prominently from the advantageous decks. Conclusions: A decision-making style characterized by a drive to avoid potential loss rather than to seek possible reward may help decision making for ASD in some situations, but ultimately hinder functioning in relation to prosocial engagement and other complex situations where gain rather than punishment is the most effective motivating factor. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Neuropsychology 11/2013; · 3.58 Impact Factor
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    ABSTRACT: Aim:To investigate the acceptability and feasibility of adapted group therapy for anxiety in children with autism spectrum disorder in a pilot randomised controlled trial.Method:A total of 32 children aged 9-13 years were randomised to immediate or delayed therapy using the 'Exploring Feelings' manual (Attwood, 2004). Child and parent groups were run in parallel, for seven weekly sessions, under the supervision of experienced psychologists. The primary blinded outcome measures addressed change in overall functioning and in severity of the primary anxiety diagnosis after 3 months.Results:Children met diagnostic criteria for 1-6 anxiety disorders (median 3). At end point, both parents and children in the immediate therapy group were more likely to report a reduction in anxiety symptoms. Fidelity of delivery of the group therapy was high, and attendance was 91%.Conclusions:This pilot trial established that children and families were willing to be recruited and randomised, the outcome measures were acceptable, the format and content of the groups were feasible within UK child and adolescent mental health services, the intervention was appreciated by families and attrition was very small.
    Autism 10/2013; · 2.27 Impact Factor
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    ABSTRACT: Aspects of family environment (FE) such as family support, organisational structure and levels of conflict can increase risk of Bipolar Disorder (BD) in offspring of BD parents. The family environment of 16 BD and 23 healthy control (HC) families was assessed using the Family Environment Scale (FES). Canonical Correspondence Analysis (CCA) was used to determine the degree of variation in scores on the FES dimensions within each family and a Generalised Linear Modelling (GLM) approach was used to investigate the extent to which scores on the different FES dimensions differed between families. On the FES, BD families experienced an environment with higher levels of conflict and lower levels of expressiveness, organisation, intellectual-cultural orientation and active-recreational orientation than healthy control families. Differences in FES scores were driven by presence of parental BD and total number of children in the family. However, socio-economic status (SES) was not found to have an effect in this study. As an American instrument the FES may not have been sensitive enough to the cultural context of a UK sample. The relatively small sample size used may have limited the statistical power of the study. Greater numbers of children have the same effect on levels of conflict as the presence of BD, while SES does not appear to be as important a factor in FE as previously thought. Our results suggest that family based interventions focusing on psychoeducation and improved communication within these families may address issues of conflict, organisation and expressiveness.
    Journal of affective disorders 09/2013; · 3.76 Impact Factor
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    ABSTRACT: Parents of children with autism spectrum disorders (ASD) use a wide range of interventions including poorly evidenced dietary interventions. To investigate parents' and professionals' experience of dietary interventions and attitudes towards a proposed trial to evaluate the gluten free casein free diet (GFCFD). Survey of UK parents of children with ASD, and professionals. 258 parents and 244 professionals participated. 83 % of children had received a range of dietary manipulations; three quarters of professionals have been asked for advice about GFCFD. Respondents identified an inadequate evidence base for dietary interventions in ASD and suggested modifications to a proposed trial design. Both parents and professionals supported the need for further evaluation of dietary interventions in ASD.
    Journal of Autism and Developmental Disorders 09/2013; · 3.06 Impact Factor
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    ABSTRACT: Young people with complex health needs have impairments that can limit their ability to carry out day-to-day activities. As well as coping with other developmental transitions, these young people must negotiate the transfer of their clinical care from child to adult services. The process of transition may not be smooth and both health and social outcomes may suffer.Increasingly, policy-makers have recognised the need to ensure a smoother transition between children's and adult services, with processes that are holistic, individualised, and person-centred; however, there is little outcome data to support proposed models of care. This study aims to identify the features of transitional care that are potentially effective and efficient for young people with complex health needs making their transition.Methods/designLongitudinal cohort study. 450 young people aged 14 years to 18 years 11 months (with autism spectrum disorder and an additional mental health problem, cerebral palsy or diabetes) will be followed through their transition from child to adult services and will contribute data at baseline, 12, 24 and 36 months. We will collect data on: health and wellbeing outcomes (participation, quality of life, satisfaction with services, generic health status (EQ-5D-Y) and condition specific measure of disease control or management); exposure to proposed beneficial features of services (such as having a key worker, appropriate involvement of parents); socio-economic characteristics of the sample; use of condition-related health and personal social services; preferences for the characteristics of transitional care.We will us regression techniques to explore how outcomes vary by exposure to service features and by characteristics of the young people. These data will populate a decision-analytic model comparing the costs and benefits of potential alternative ways of organising transition services.In order to better understand mechanisms and aid interpretation, we will undertake qualitative work with 15 young people, including interviews, non-participant observation and diary collection. This study will evaluate the effect of service components of transitional care, rather than evaluation of specific models that may be unsustainable or not generalisable. It has been developed in response to numerous national and international calls for such evaluation.
    BMC Public Health 07/2013; 13(1):675. · 2.08 Impact Factor
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    ABSTRACT: BACKGROUND: Introduction of proposed criteria for DSM-5 Autism Spectrum Disorder (ASD) has raised concerns that some individuals currently meeting diagnostic criteria for Pervasive Developmental Disorder (PDD; DSM-IV-TR/ICD-10) will not qualify for a diagnosis under the proposed changes. To date, reports of sensitivity and specificity of the new criteria have been inconsistent across studies. No study has yet considered how changes at the 'sub domain' level might affect overall sensitivity and specificity, and few have included individuals of different ages and ability levels. METHODS: A set of DSM-5 ASD algorithms were developed using items from the Diagnostic Interview for Social and Communication Disorders (DISCO). The number of items required for each DSM-5 subdomain was defined either according to criteria specified by DSM-5 (Initial Algorithm), a statistical approach (Youden J Algorithm), or to minimise the number of false positives while maximising sensitivity (Modified Algorithm). The algorithms were designed, tested and compared in two independent samples (Sample 1, N = 82; Sample 2, N = 115), while sensitivity was assessed across age and ability levels in an additional dataset of individuals with an ICD-10 PDD diagnosis (Sample 3, N = 190). RESULTS: Sensitivity was highest in the Initial Algorithm, which had the poorest specificity. Although Youden J had excellent specificity, sensitivity was significantly lower than in the Modified Algorithm, which had both good sensitivity and specificity. Relaxing the domain A rules improved sensitivity of the Youden J Algorithm, but it remained less sensitive than the Modified Algorithm. Moreover, this was the only algorithm with variable sensitivity across age. All versions of the algorithm performed well across ability level. CONCLUSIONS: This study demonstrates that good levels of both sensitivity and specificity can be achieved for a diagnostic algorithm adhering to the DSM-5 criteria that is suitable across age and ability level.
    Journal of Child Psychology and Psychiatry 05/2013; · 5.42 Impact Factor
  • A. Le Couteur, P. James, D. Hammal, H. McConachie
    2013 International Meeting for Autism Research; 05/2013
  • 2013 International Meeting for Autism Research; 05/2013
  • 2013 International Meeting for Autism Research; 05/2013
  • S. Wigham, L. Gray, A. S. Le Couteur, H. McConachie, J. R. Parr
    2013 International Meeting for Autism Research; 05/2013
  • 2013 International Meeting for Autism Research; 05/2013
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    ABSTRACT: A 20 item observational measure of social functioning, the Impression of Interviewee rating scale, is one of three measures devised to assess the broader autism phenotype. The sample studied included families containing at least two individuals with autism spectrum disorder; observations were undertaken by the researcher who interviewed the subject. An exploratory factor analysis suggested a single factor was most appropriate (Cronbach's α of 0.78). There was a modest but significant retest correlation of 0.42. Correlations between live ratings and blind consensus ratings of vignettes were high (0.93). Correlations with the interview measures were moderate but statistically significant. In conclusion, the observational scale provides a promising start but further work is required before general use can be recommended.
    Journal of Autism and Developmental Disorders 04/2013; · 3.06 Impact Factor
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    Proceedings of The Nutrition Society 01/2013; 72(OCE4). · 3.67 Impact Factor
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    Proceedings of The Nutrition Society 01/2013; 72(OCE4). · 3.67 Impact Factor

Publication Stats

9k Citations
501.37 Total Impact Points

Institutions

  • 2003–2014
    • Newcastle University
      • Institute of Health and Society
      Newcastle-on-Tyne, England, United Kingdom
  • 2013
    • Solent NHS Trust
      Southampton, England, United Kingdom
  • 2010–2012
    • University of Pittsburgh
      • Department of Psychiatry
      Pittsburgh, PA, United States
  • 2011
    • University of Glasgow
      Glasgow, Scotland, United Kingdom
  • 2008
    • Northumbria Healthcare NHS Foundation Trust
      North Shields, England, United Kingdom
  • 2007
    • Northumberland, Tyne and Wear NHS Foundation Trust
      Newcastle-on-Tyne, England, United Kingdom
  • 2006–2007
    • Durham University
      • Department of Psychology
      Durham, ENG, United Kingdom
    • Northumbria University
      Newcastle-on-Tyne, England, United Kingdom
  • 2001
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom
  • 1996
    • The Newcastle upon Tyne Hospitals NHS Foundation Trust
      Newcastle-on-Tyne, England, United Kingdom
  • 1995
    • University of Virginia
      • Department of Psychology
      Charlottesville, Virginia, United States
  • 1994
    • University of Illinois at Chicago
      • Department of Psychiatry (Chicago)
      Chicago, IL, United States
  • 1988
    • London Research Institute
      Londinium, England, United Kingdom