Autism

A sample of 1047 parents completed an online survey about their experiences and opinions regarding the process of attaining a diagnosis of autism spectrum disorder for their children. The results revealed that parents usually waited a year from when they first had concerns about their child's development before they sought professional help. On average, there was a delay of around 3.5 years from the point at which parents first approached a health professional with their concerns to the confirmation of an autism spectrum disorder diagnosis. Just over half of the parents surveyed were dissatisfied with the diagnostic process as a whole. Several factors predicted parents' overall levels of satisfaction with the diagnostic process, including the time taken to receive a diagnosis, satisfaction with the information provided at diagnosis, the manner of the diagnosing professional, the stress associated with the diagnostic process and satisfaction with post-diagnostic support. Post-diagnosis, the support (if any) that was provided to parents was deemed unsatisfactory, and this was highlighted as an area of particular concern among parents. © The Author(s) 2015.

The study aimed to establish prevalence of the broader autistic spectrum, including Asperger syndrome, in 5- to 11-year-olds in Cambridgeshire, UK. Cases of diagnosed autism spectrum condition (ASC) in children who were in Cambridgeshire schools and aged between 5 and 11 years on 31 December 1999 were sought using public records, screening instruments, educational psychology and special educational needs coordinator (SENCO) records. We report a prevalence of ASC in the age group 5-11 years of almost 0.6 percent (57 in 10,000). This is 11 times higher than the rate of classic autism but in line with other recent national and international rates for the broader spectrum. In the responding mainstream schools the prevalence was 0.33 percent. In the responding special school population it was 12.5 percent. The overall sex ratio of the children with ASC replicated findings for classical autism of 4:1 (M:F), but in those children being educated in mainstream schools the sex ratio was 8:1 (M:F).

Infant siblings of children with an autism spectrum disorder are at heightened genetic risk to develop autism spectrum disorder. We observed high risk (n = 35) and low risk (n = 27) infants at 11 months during free play with a parent. Children were assessed for autism spectrum disorder in toddlerhood. High-risk infants with a later diagnosis (n = 10) were less socially engaged with their parents than were low-risk infants. Parent behavior during play did not vary by group. Within the high-risk group, ratings of social reciprocity at 11 months predicted Autism Diagnostic Observation Schedule severity scores at follow-up, suggesting that systematic observations of parent-infant play may be a useful addition to early assessments of emerging autism spectrum disorder. © The Author(s) 2014.

Autism has lifetime consequences, with potentially a range of impacts on the health, wellbeing, social integration and quality of life of individuals and families. Many of those impacts are economic. This study estimated the costs of autism spectrum disorders (ASDs) in the UK. Data on prevalence, level of intellectual disability and place of residence were combined with average annual costs of services and support, together with the opportunity costs of lost productivity. The costs of supporting children with ASDs were estimated to be pound 2.7 billion each year. For adults, these costs amount to pound 25 billion each year. The lifetime cost, after discounting, for someone with ASD and intellectual disability is estimated at approximately pound 1.23 million, and for someone with ASD without intellectual disability is approximately pound 0.80 million.

Unusual sensory processing has been widely reported in autism spectrum disorders (ASDs); however, the majority of research in this area has focused on children. The present study assessed sensory processing in adults with ASD using the Adult/Adolescent Sensory Profile (AASP), a 60-item self-report questionnaire assessing levels of sensory processing in everyday life. Results demonstrated that sensory abnormalities were prevalent in ASD, with 94.4 percent of the ASD sample reporting extreme levels of sensory processing on at least one sensory quadrant of the AASP. Furthermore, analysis of the patterns of sensory processing impairments revealed striking within-group variability in the ASD group, suggesting that individuals with ASD could experience very different, yet similarly severe, sensory processing abnormalities. These results suggest that unusual sensory processing in ASD extends across the lifespan and have implications regarding both the treatment and the diagnosis of ASD in adulthood.

Problems with social anxiety are frequently reported in people with autism spectrum disorders (ASD). It is possible that social anxiety, when present, exacerbates the experience of hostility and other forms of aggression in relation to ASD symptoms. This study sought to determine if social anxiety symptoms mediate the relationship between features of ASD and feelings of hostility in young adults. Self-report measures of social anxiety, ASD, and facets of aggression were collected in a non-clinical sample (n = 618) of college students. Social anxiety was found to partially mediate the relationship between ASD features and self-reported hostility. There was also evidence for inconsistent mediation, such that social anxiety dampened the strength of the relationship between ASD symptoms and verbal and physical aggression. Findings highlight the potential influence of associated psychiatric symptoms in people with ASD. In addition, dimensional conceptualization of ASD symptoms, as opposed to a categorical approach solely, may be a useful approach to studying complex personality processes.

Earlier intervention improves outcomes for children with autism spectrum disorders (ASDs), but existing identification tools are at the limits of standardization 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. Prospective 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.

This paper presents a review of past and current research on the diagnosis of Asperger syndrome (AS) in children. It is suggested that the widely used criteria for diagnosing AS in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV are insufficient and invalid for a reliable diagnosis of AS. In addition, when these diagnostic criteria are applied, there is the potential bias of receiving a diagnosis towards the high-functioning end of the autism spectrum. Through a critical review of 69 research studies carried out between 1981 and 2010, this paper shows that six possible criteria for diagnosing AS (specifically, the age at which signs and symptoms related to autism become apparent, language and social communication abilities, intellectual abilities, motor or movement skills, repetitive patterns of behaviour and the nature of social interaction) overlap with the criteria for diagnosing autism. However, there is a possibility that some finer differences exist in the nature of social interaction, motor skills and speech patterns between groups with a diagnosis of AS and autism. These findings are proposed to be of relevance for designing intervention studies aimed at the treatment of specific symptoms in people with an autism spectrum disorder.

In the first edition of this journal, we published a paper reporting that fathers and grandfathers of children with autism were over-represented in the field of engineering. This result was interpreted as providing supporting evidence for the folk-psychology/folk-physics theory of autism. After carrying out further analyses on the same data, Jarrold and Routh found that fathers of children with autism were also over-represented in accountancy and science. They suggested that these results could either provide additional support for the folk-psychology/folk-physics theory or be accounted for by an over-representation of professionals amongst the fathers of children with autism. Here we present evidence that engineers are still over-represented among fathers of children with autism, even taking into account the professional bias.

Prospective questionnaire data from a longitudinal population sample on children with autism spectrum disorders (ASD), developmental delay, specific language impairment, or typical development (TD), were collected at ages eight, 12 and 24 months, via the Communication and Symbolic Behavior Scale Developmental Profile (CSBS) - Infant Toddler Checklist, and the Actions and Gesture section of the MacArthur-Bates Communicative Development Inventory (CDI):Words and Gestures. The four groups were compared at four years of age to identify whether any early behaviours differentiated the groups. While children with ASD differed from TD children on most social communicative measures by 12 months of age, the only social communication characteristic which could differentiate the children with ASD from the other groups were gesture scores on the CDI at 12 months and the CSBS at 24 months. Significant markers of ASD were identifiable in this community sample at an early age, although discrimination between clinical groups was rarely evident.

The study examined the properties of the Screening Tool for Autism in Two-Year-Olds (STAT) for children under 24 months. The STAT provides a standard context for observing social-communicative behavior in play, imitation, and communication. Seventy-one children received the STAT between 12 and 23 months of age and a follow-up diagnostic evaluation after 24 months. All had an older sibling with an autism spectrum diagnosis (n=59) or had been referred for evaluation for concerns about autism (n=12). Signal detection analysis resulted in a cut score of 2.75 for this sample, which yielded a sensitivity of 0.95, specificity of 0.73, positive predictive value of 0.56, and negative predictive value of 0.97. False positives were highest for the 12- to 13-month-old age group; STAT screening properties were improved when the sample was limited to children 14 months and older. Implications for using the STAT with children under 24 months are discussed.

There is an urgent requirement for the improvement of early detection of ASDs. This article provides a brief review of research on the accuracy of screeners for children with ASD that have been administered to general pediatric samples and then present results of a population-based study with a broadband screener to detect children with communication delays including children with ASD.

Autistic features such as deficits in social interactions and communication have been associated with a low 2D:4D ratio in normal children.This study assessed this association in a large sample of children with a variety of psychiatric disorders (n = 35 girls and n = 147 boys). Autistic features were assessed with a highly valid and reliable measure (Autism Diagnostic Observation Schedule-Generic). Correlations between the 2D:4D ratio and autistic features were computed separately for boys and girls. Some small negative correlations (r = -0.17 and r = -0.19) were found in the right hand for boys; however, particularly in girls, large negative correlations (r = -0.51 to r = -0.64) were found in the left hand. A low 2D:4D ratio in girls was highly predictive of the presence of autistic features. Thus, a low ratio could possibly be used as a diagnostic predictor in clinical practice.

This study aimed to examine the effectiveness of a translated version of the short version of the Developmental, Dimensional and Diagnostic Interview (3Di) in discriminating children with autism spectrum disorders (ASDs) from typically developing children. Two groups, comprising 63 children with clinically ascertained ASDs and 67 typically developing children, were interviewed with the short 3Di translated version. Mean 3Di scale scores in each domain of autistic symptoms (social reciprocity, communication, and repetitive/stereotyped behaviors) were significantly higher in the ASD group than in the typically developing group. The optimal receiver operating characteristics curve cut-off scores were found to be 10, 8, and 3 for social reciprocity domain, communication domain, and repetitive/stereotyped behaviors domain, respectively, which are identical to the original English standardization. Corresponding sensitivities and specificities were 76.2% and 80.9% for the social reciprocity domain; 85.7% and 73.5% for the communication domain; and 66.7% and 80.9% for the repetitive behaviors domain. The areas under the curve were 0.89 (95% CI = 0.84-0.94), 0.88 (95% CI = 0.82-0.94), and 0.79 (95% CI = 0.71-0.87), respectively. The short 3Di-Thai version is found to be a useful diagnostic instrument for differentiating between clinically diagnosed children with ASDs and typically developing children, although further replication is needed.

The psychometric properties of a questionnaire developed to assess symptoms of anxiety disorders (SCARED-71) were compared between two groups of children: children with high-functioning autism spectrum disorder and comorbid anxiety disorders (ASD-group; n = 115), and children with anxiety disorders (AD-group; n = 122). Anxiety disorders were established with a semi-structured interview (ADIS-C/P), using child- as well as parent-report. Internal consistency, construct validity, sensitivity, specificity, and discriminant validity of the SCARED-71 was investigated. Results revealed that the psychometric properties of the SCARED-71 for the ASD-group were quite comparable to the AD-group, however, the discriminant validity of the SCARED-71 child-report was less in the ASD-group. Raising the parental cutoffs of the SCARED-71 resulted in higher specificity rates, which suggests that research should focus more on establishing alternative cutoffs for the ASD-population.

Sleep problems are commonly reported in children with autistic disorders. Most studies are based on sleep questionnaires and sleep diaries, but polysomnographic and actigraphic data have also been used. In this study we investigated sleep in older individuals (aged 15-25 years) with autism and Asperger syndrome, using sleep questionnaires, sleep diaries and actigraphy. Although the sleep questionnaires completed by parents and caretakers revealed only a moderate degree of sleep problems, greater sleep disturbance was recorded with actigraphy. Using the latter method, low sleep efficiency (below 85 percent) or long sleep latency (more than 30 minutes) were found in 80 percent of the individuals. There was no early morning awakening, contrary to some earlier reports. This study suggests that even though subjective complaints of sleep disturbances are less common in adolescents and young adults with autism, this may be due to an adaptation process rather than an actual reduction in sleep disturbances.

The present study examined the applicability of the double ABCX model of family adjustment in explaining maternal adjustment to caring for a child diagnosed with Asperger syndrome. Forty-seven mothers completed questionnaires at a university clinic while their children were participating in an anxiety intervention. The children were aged between 10 and 12 years. Results of correlations showed that each of the model components was related to one or more domains of maternal adjustment in the direction predicted, with the exception of problem-focused coping. Hierarchical regression analyses demonstrated that, after controlling for the effects of relevant demographics, stressor severity, pile-up of demands and coping were related to adjustment. Findings indicate the utility of the double ABCX model in guiding research into parental adjustment when caring for a child with Asperger syndrome. Limitations of the study and clinical implications are discussed.

Deficits in theory of mind (ToM), evident in most individuals with autism, have been suggested as a core deficit of autism. ToM difficulties in young siblings of children with autism (SIBS-A) compared to siblings of typically developing children (SIBS-TD) would place the former within the broad phenotype. We examined ToM's possible associations with measures of language, cognition, and daily living skills. Participants comprised 24 SIBS-A and 24 matched SIBSTD aged 4.6 years. They completed the false belief and the strange stories tasks. We also collected measures of verbal and cognitive ability and daily living skills. Non-significant differences emerged between the groups on both ToM tasks. Differences did emerge in within-group associations between ToM ability and receptive language. The conclusion is that SIBS-A show resilience in ToM abilities. Possibly, these deficits are not genetically transferred to siblings, at least as measured in laboratory-based ToM tasks.

Daily living skills standard scores on the Vineland Adaptive Behavior Scales-2nd edition were examined in 417 adolescents from the Simons Simplex Collection. All participants had at least average intelligence and a diagnosis of autism spectrum disorder. Descriptive statistics and binary logistic regressions were used to examine the prevalence and predictors of a "daily living skills deficit," defined as below average daily living skills in the context of average intelligence quotient. Approximately half of the adolescents were identified as having a daily living skills deficit. Autism symptomatology, intelligence quotient, maternal education, age, and sex accounted for only 10% of the variance in predicting a daily living skills deficit. Identifying factors associated with better or worse daily living skills may help shed light on the variability in adult outcome in individuals with autism spectrum disorder with average intelligence.

This study examines the academic abilities of children and adolescents who were once diagnosed with an autism spectrum disorder, but who no longer meet diagnostic criteria for this disorder. These individuals have achieved social and language skills within the average range for their ages, receive little or no school support, and are referred to as having achieved "optimal outcomes." Performance of 32 individuals who achieved optimal outcomes, 41 high-functioning individuals with a current autism spectrum disorder diagnosis (high-functioning autism), and 34 typically developing peers was compared on measures of decoding, reading comprehension, mathematical problem solving, and written expression. Groups were matched on age, sex, and nonverbal IQ; however, the high-functioning autism group scored significantly lower than the optimal outcome and typically developing groups on verbal IQ. All three groups performed in the average range on all subtests measured, and no significant differences were found in performance of the optimal outcome and typically developing groups. The high-functioning autism group scored significantly lower on subtests of reading comprehension and mathematical problem solving than the optimal outcome group. These findings suggest that the academic abilities of individuals who achieved optimal outcomes are similar to those of their typically developing peers, even in areas where individuals who have retained their autism spectrum disorder diagnoses exhibit some ongoing difficulty.

Much controversy surrounds questions about whether humans have an aversion to inequity and how a commitment to equality might play a role in cooperation and other aspects of social interactions. Examining the social decisions of children with autism spectrum disorders provides a fascinating opportunity to explore these issues. Specifically, we evaluated the possibility that children with autism spectrum disorders may be less likely than typically developing children to show a prioritisation of equality. A total of 69 typically developing (mean age 11;6 years) and 57 cognitively able children with autism spectrum disorders (mean age 11;7 years) played a social decision game in which the equality option was pitted against alternatives that varied in instrumental outcomes. Results showed that both groups were more likely to choose the equality option when there was no cost to the self. However, even though children with autism spectrum disorders appeared to view equality as preferable to causing explicit harm to others, they departed from an equality stance when there was an opportunity to increase instrumental gain without any obvious harm to the self or the other. Typically developing children, in contrast, showed similar prioritisation of equality across these contexts. Future research needs to address the question of how differences in the commitment to equality affect children's social behaviour and relationships in daily life.