Journal of Autism and Developmental Disorders

The current study aimed to investigate the Autism Diagnostic Interview-Revised (ADI-R) algorithms for toddlers and young preschoolers (Kim and Lord, J Autism Dev Disord 42(1):82-93, 2012) in a non-US sample from ten sites in nine countries (n = 1,104). The construct validity indicated a good fit of the algorithms. The diagnostic validity was lower, with satisfactorily high specificities but moderate sensitivities. Young children with clinical ASD and lower language ability were largely in the mild-to-moderate or moderate-to-severe concern ranges of the ADI-R, nearly half of the older and phrase speech ASD-group fell into the little-to-no concern range. Although broadly the findings support the toddler algorithms, further work is required to understand why they might have different properties in different samples to further inform research and clinical use.

The algorithm of the Autism Diagnostic Interview-Revised provides criteria for autism versus non-autism according to DSM-IV. Criteria for the broader autism spectrum disorders are needed. This study investigated the validity of seven sets of criteria from the literature, in 1,204 Dutch children (aged 3-18 years) with and without mental retardation. The original criteria (Rutter et al. in ADI-R Autism Diagnostic Interview Revised. Manual. Western Psychological Services, Los Angeles, 2003) well discriminated ASD from non-ASD in MR. All other criteria (IMGSAC in Am Soc Hum Genet 69:570-581 2001; Sung et al. in Am J Hum Genet 76: 68-81, 2005; Risi et al. in J Am Acad Child Adolesc Psychiatry 45: 1094-1103, 2006) were sensitive at the cost of specificity, bearing the risk of overinclusiveness. In the group without MR, clinicians should decide whether sensitivity or specificity is aimed for, to choose the appropriate criteria. Including the Autism Diagnostic Observation Schedule revised algorithms in the classification, the specificity increases, at the cost of sensitivity. This study adds to a more valid judgment on which criteria to use for specific objectives.

The present study utilized meta-analytic procedures to estimate the diagnostic validity of instruments used to screen young children, ages 1.5-5 years, for autism. Five scales met inclusion criteria, and data from 18 studies contributed the meta-analysis. Results revealed that 4 of 5 scales met criteria for "good" validity, including two broad band scales (instruments not restricted to screening for autism). The current results suggest that validity differences might be a function of how instruments sample across the DSM content domains. Specifically, high validity instruments included a higher proportion of items assessing social interaction skills. The availability of valid broad- and narrow-band instruments, as well as implications for constructing future screening instruments, is discussed.

Validity studies of measures for emotional and behavioral disorders (EBD) for use with preschool children with autism spectrum disorders (ASD) are lacking. The Child Behavior Checklist 1.5-5 (CBCL; Achenbach and Rescorla, Manual for the ASEBA Preschool Forms & Profiles. VT: University of Vermont, Research Center for Children, Youth, and Families, Burlington, 2000), a widely used measure for EBD, contains several norm-referenced scales derived through factor analysis of data from the general pediatric population. In this study, confirmatory factor analysis of archival data evaluated the adequacy of the CBCL factor model in a well characterized sample of preschoolers with ASD (N = 128). Psychometric results supported the model and suggested that practitioners can use the CBCL to assess for EBD in young children with ASD in conjunction with other clinical data. This will increase the likelihood of accurate identification and EBD-specific intervention.

We report a 4-year-old girl with a de novo, apparently balanced complex chromosome rearrangement. She initially presented for assessment of velopharyngeal insufficiency due to hypernasal speech. She has distinctive facial features (long face, broad nasal bridge, and protuberant ears with simplified helices), bifid uvula, strabismus, and joint laxity. She is developmentally delayed, with language and cognitive skills approximately 2 SD below the mean expected for her age, and meets ADI, ADOS, and DSM-IV criteria for pervasive developmental disorder. She has poor eye contact, atypical communication and social interaction, repetitive behaviours and significant difficulties with processing sensory input. Her karyotype is characterized by the presence of two derivative chromosomes; 46,XX, der(8)(10pter- >10pl2.32::8p12- >8qter), der(l0)(8pter- >8p21.3::10p12.32- >10p11.23::8p21.3- > 8p12::10p11.23- >l0qter). The der(8) is a result of translocation of the segment 10p12.32-pter onto 8p12. The der(l0) has two 8p segments collectively from 8p12-pter in that the segment 8p21.3-pter is translocated onto 10p12.32 and the segment 8p12-p21.3 is inserted at 10p11.23. FISH analysis showed no microdeletion of the major locus at 22q11.2 nor for the minor locus at 10p13p14. This case suggests that aberrations at 8p12, 8p21.3, 10p11.23 and/or 10p12.32 may result in pervasive developmental disorder, associated with mild cognitive delay and specific facial anomalies.

An Autism Spectrum Disorder (ASD) diagnosis is often used to access services. We investigated whether ASD diagnostic outcome varied when DSM-5 was used compared to ICD-10R and DSM-IV-TR in a clinical sample of 150 intellectually able adults. Of those diagnosed with an ASD using ICD-10R, 56 % met DSM-5 ASD criteria. A further 19 % met DSM-5 (draft) criteria for Social Communication Disorder. Of those diagnosed with Autistic Disorder/Asperger Syndrome on DSM-IV-TR, 78 % met DSM-5 ASD criteria. Sensitivity of DSM-5 was significantly increased by reducing the number of criteria required for a DSM-5 diagnosis, or by rating 'uncertain' criteria as 'present', without sacrificing specificity. Reduced rates of ASD diagnosis may mean some ASD individuals will be unable to access clinical services.

An epidemiological study is outlined that shows that Kanner's syndrome is one group among a wider range of children, all with impairment of social interaction, communication, and imagination. Most, but not all, children with this triad of impairments are severely mentally retarded, although severe retardation also occurs in those who are sociable and communicative. It is hypothesized that the socially impaired lack certain abilities that are inborn in normal children and the sociable mentally retarded: namely, the capacity to produce and monitor the normal species-specific preverbal sounds, the drive to explore the environment and form concepts to explain experiences, and the ability to recognize that other human beings are of special interest and importance. A possible neurological basis for these problems is briefly considered.

There are studies suggesting possible hereditary influence in autism. Data on 102 autistic children, 78 boys and 24 girls, showed that there was a significantly greater proportion of autistic girls than boys with IQs less than 50 and with evidence of brain damage. The autistic girls also had a greater proportion of relatives affected with autism or cognitive-language deficit than did the boys. The implication of sex differences in the possible mode of familial transmission of autism is discussed.

The Childhood Autism Rating Scale (CARS) was factor analyzed. Three factors emerged: Social Impairment (SI), Negative Emotionality (NE), and Distorted Sensory Response (DSR). Unit-weight factor scales showed moderate-to-good internal consistency. Cross-sectional analyses demonstrated that autistic (AUT) subjects were distinguished from subjects with pervasive developmental disorders (PDD) and nonpervasive developmental disorders (NPDD) by higher scores on SI. An SI cutoff score of 26 classified individuals as autistic vs. nonautistic with 78% accuracy. Longitudinal analyses showed that DSR was stable over 6 months of treatment, with little indication of symptom reduction. SI decreased over time across the diagnostic groups, but still showed significant continuity over the period. NE was most malleable and apparently sensitive to the effects of treatment.

Sustained interactions and responses to social bids made by children with autism and verbal-age-matched children with mental retardation were recorded in two naturalistic settings. Children with autism produced fewer positive responses and more "no responses" than children with mental retardation; both groups were more likely to make positive responses to adults and not to respond to other children. Furthermore, although the frequency of conversations was not different for the two groups, children with autism were significantly less likely to engage in sustained play compared to children with mental retardation. Results suggest that children with autism are able to master the more rote and need-oriented social skills, such as simple conversation, but may not develop other forms of social interactions, like play.

The profound language deficit in early infantile autism has led to speculation about the similarities between autistic and language-impaired children. Since aphasia in adults and many children is typically the result of left cerebral hemisphere damage, some researchers have suggested that autistic children also suffer from left hemisphere damage. So far, only indirect or unreliable evidence has been offered in support of this hypothesis. In the present experiment, autistic, language-impaired, and non-language-impaired children were compared on a dichotic listening task designed to overcome some of the deficiencies of earlier research. Language-impaired children were found to exhibit a left ear bias for language material (indicating right hemisphere lateralization for language), whereas the autistic and non-language-impaired children showed the opposite, right ear bias. As the autistic children showed a pattern similar to that of normal children, the present experiment found no evidence for either left hemisphere damage or aphasiclike performance among autistic children. The implications of these findings for understanding the autistic language deficit are explored.

Cytogenetic abnormalities in the Prader-Willi/Angelman syndrome (PWS/AS) critical region have been described in individuals with autism. Maternal duplications and linkage disequilibrium in families with autism suggest the existence of a susceptibility locus at 15q11-q13. Here, we describe a 6-year-old girl diagnosed with autism, developmental delay, and delayed expressive and receptive language. The karyotype was designated de novo 47, XX, idic(15)(q13). Fluorescence in situ hybridization (FISH) and molecular analysis with 15q11-q13 markers revealed an additional copy of the region being of maternal origin. Duplication of the 15q11-q13 segment represents the most consistent known chromosomal abnormality reported in association with autism. This present case report reinforces the hypothesis that additional copies of this chromosome segment are causally related to autism.

Motor impairment in children with Asperger syndrome (AS) or high functioning autism (HFA) has been reported previously. This study presents results of a quantitative assessment of neuromotor skills in 14-22 year old HFA/AS. Sixteen HFA/AS and 16 IQ-matched controls were assessed by the Zurich Neuromotor Assessment (ZNA). The HFA/AS group showed strongest impairments of dynamic balance skills and diadochokinesis. Motor abilities were associated with degree of social withdrawal in the full sample and severity of current autistic symptoms in the HFA/AS group. Similar motor patterns as in younger children were found in the older adolescents. The association of autistic symptoms with motor performance points towards an essential role of motor impairment in autism spectrum disorders.

A case of an 18-year-old male who meets the DSM-IV criteria for autistic disorder and borderline intelligence is described. Cytogenetic evaluation revealed a karyotype of 46, XY, del(13)(q14q22). The relevance of this case to the etiology of autism is discussed.

Many reports can be found in the theoretical literature that refer to a lack of self-awareness or a failure to distinguish self from nonself as a characteristic of autistic children. The empirical literature also contains reports of behaviors in autistic children that have often been taken as reflective of a failure to differentiate self, i.e., pronominal reversal, gaze aversion. The present study investigated the development of self-recognition in 15 autistic children in an effort to determine whether failures of self-recognition were of possible diagnostic significance for the syndrome or rather were reducible to general indices of developmental function, i.e., mental age. Fifty-three percent of the sample showed clear self-recognition. On the basis of a developmental assessment and data from a teacher questionnaire, these children were found to be functioning at mental ages akin to developmental norms for self-recognition. Those who failed to show self-recognition had mental ages below the developmental level at which many children recognize themselves and significantly lower than those autistic children who showed self-recognition. The results suggest that even when autistic children fail to recognize their self-images, this failure can be taken not as evidence for a syndrome-specific deficit but as a reflection of a general developmental delay.

An ongoing social skills training program was implemented with 15 verbal autistic adolescents and adults. The major long-range goals were for the participants to have positive peer-related social experiences in a supportive atmosphere and to learn useful skills in this way. Short-term training objectives included how to meet other people, stay on a topic of conversation, ask questions, pay attention, and express one's feelings and emotions. Teaching techniques included modeling, coaching, and role-playing. Preliminary indications suggest that the main goals and training objectives were being accomplished and that clients were progressing in their conversational skills, their selection of relevant topics, and their perceptions of themselves. The implications of this program for the understanding and treatment of autistic adolescents and adults is described, as well as the viability of a social skills training model. The need for more research on this most important issue is highlighted.

A two-stage protocol for screening for autistic spectrum disorders (ASD) was evaluated in a random population of 31,724 children aged 14-15 months. Children were first pre-screened by physicians at well-baby clinics using a 4-item screening instrument. Infants that screened positive were then evaluated during a 1.5-h home visit by a trained psychologist using a recently developed screening instrument, the 14-item Early Screening of Autistic Traits Questionnaire (ESAT). Children with 3 or more negative scores were considered to be at high-risk of developing ASD and were invited for further systematic psychiatric examination. Eighteen children with ASD were identified. The group of children with false positive results had related disorders, such as Language Disorder (N = 18) and Mental Retardation (N = 13).

This article describes the development of a screening instrument for young children. Screening items were tested first in a non-selected population of children aged 8-20 months (n = 478). Then, parents of children with clinically diagnosed ASD (n = 153, average age 87 months) or ADHD (n = 76, average age 112 months) were asked to score the items retrospectively for when their child was 14 months old. A 14-item screening instrument, Early Screening of Autistic Traits (ESAT) which had maximal sensitivity and specificity for ASD was developed. The sensitivity of the ESAT was checked in an independent sample of 34 children aged 16-48 months clinically diagnosed with ASD. A 4-item version appears to be a promising prescreening instrument.

Fourteen children (12 infantile autism full syndrome present, 2 atypical pervasive developmental disorder) between 5 and 13 years of age participated in a double-blind placebo-controlled cross-over trial. Each child received 20 mg Org 2766 (synthetic analog of ACTH 4-9)/day during 4 weeks, or placebo in a randomly assigned sequence. Drug effects were monitored by ethological playroom observation and by Aberrant Behavior Checklist ratings by parents and teachers. Data of the playroom observation pointed to an activating influence of Org 2766, as revealed by a significant decrease of stereotypic behavior and significant increases in "change toys," "locomote," and "talk." Checklist ratings did not show significant changes. The clinical implications of these findings are discussed.

Medial temporal lobe amnesic disorder is characterized by an impairment in explicit memory (e.g., remembering a shopping list) and intact implicit memory (e.g., a woman seems familiar although you cannot remember having met her before). This study examined whether children with high-functioning autism have this same dissociation between explicit and implicit memory abilities. Children with autism and normal development participated in three memory tasks: one implicit task (perceptual identification) and two explicit tasks (recognition and recall). Children with autism showed intact implicit and explicit memory abilities. However, they did not show the typical pattern of recalling more items from both the beginning and end of a list and instead only recalled items from the end of the list. These results do not support the theory that high-functioning autism is a type of medial temporal lobe amnesia. However, these findings suggest that persons with autism use different organizational strategies during encoding or retrieval of items from memory.

Disruptive behaviors are often exhibited by children with severe disabilities during difficult teaching tasks. Because learning verbal communication can be a difficult task for nonverbal children with autism, disruptive behaviors are common during such interventions. The purpose of this experiment was to assess whether the incorporation of parameters of natural language interactions and motivational techniques might reduce disruptive behavior during language teaching tasks. Within a repeated reversals design with order of conditions and number of sessions varied within and across children, treatment was conducted for two language teaching conditions. During one condition trials were presented serially in a traditional analog clinical format where the therapist presented instructions, prompts, and reinforcers for correct responses. The other condition incorporated parameters of natural language interactions and motivational techniques, such that stimulus items were functional and varied; natural reinforcers were employed; communicative attempts were reinforced; and trials were conducted within a natural interchange. Results showed that greater improvements in responding and considerably less (often negligible) disruptive behavior occurred during the natural language teaching conditions. Results are discussed with respect to their implications for improving language interventions, and with respect to reducing disruptive behavior without the need for specialized or severe interventions focused specifically on the disruptive behavior.

This study examines change in 152 children over an almost 10-year period (T1: 4.9 (± 1.3) years; T2: 8.1 (± 1.3) years; T3: 15(± 1.6) years) using a group-based, semi-parametric method in order to identify distinct developmental trajectories. Important deficits remain at adolescence in the adaptive abilities of children with Autism spectrum disorders, but changes in adaptive skills show two distinct growth rates. The univariate analysis reveals that low growth trajectories for both social and communication outcome are associated with the following characteristics at age 5: low cognitive and language skills, presence of epilepsy, and severity of autism. The multivariate analysis confirms that risk factors at age 5, were low language and severity of autism for both social and communication outcomes 10 years later, and that hours of early intervention was protective factor for communication.

The relationship between cognitive deficits in high-level autism and those in learning disabilities has received little attention. To determine whether high-functioning autistic patients and individuals with severe dyslexia display different cognitive characteristics, 10 nonretarded men (mean age 26 years) with infantile autism, residual state, were compared with 15 severely dyslexic men (mean age 22 years) and 25 matched controls on a neuropsychological test battery. The two clinical groups were dissociated by a reduced digit span seen in the dyslexics and by impaired problem-solving skills (Wisconsin Card Sort and selected subtests from the Binet) seen in the autistic group. These results suggest different localization of brain dysfunction and different educational/habilitative needs.

The purpose of this report is to bring up to date available information on the defining features and diagnostic issues relating to autism and related disorders. We review the validity of the syndrome based on our last review (Rutter, 1978; Schopler, 1978). Subsequent data have produced refinement in our understanding of both diagnostic criteria and the nature of the basic deficit. Controversies over both the boundaries and the heterogeneity within the autism syndrome are evaluated according to available evidence. Diagnostic rating instruments for expediting systematic sample selection are critiqued, and leads for new research directions are suggested.

Duplications of chromosome 15 may be one of the most common single genetic causes of autism spectrum disorders (ASD), aside from fragile X. Most of the cases are associated with maternally derived interstitial duplication involving 15q11-13. This case report describes a female proband with a maternally derived interstitial duplication of proximal 15q. She did not exhibit any symptoms of ASD apart from some developmental delay. By adolescence, she showed mild dysmorphism, a discrepant profile on the Wechsler Intelligence Scale for Children (Verbal IQ = 87; Performance IQ = 65) and a major deficit in visual-spatial abilities affecting fine motor skills, mathematical reasoning, visual memory and some global reading tasks. This is one of the first reports of a child with a maternal duplication who exhibits a visual-spatial deficit without ASD.

This paper highlights clinical challenges faced when diagnosing and then treating an individual presenting to a child and adolescent psychiatry clinic because of unwelcome comments he made to female peers about their feet. Novel use of exposure therapy helped him effectively decrease his comments from 1 to 2 times per month to once every 6 months. Conceptualizing this case as the individual's failed attempts toward relationships with females instead of sexual harassment led to diminution of problematic behavior. Implications for diagnosis and treatment of individuals with Autistic Disorder displaying problematic behaviors are presented.

Results of a study observing autistic children's interactions with nonhandicapped and autistic peers are reported. Six 8- to 12-year-old autistic children played in dyads with younger, normally developing kindergarten children and with nonhandicapped peers matched on chronological age for 10 15-minute sessions spaced over 3 weeks and then with a playmate of the alternate age for another 10 sessions. After intervention, all subjects showed gains in proximity, orientation, and responsiveness when playing with nonhandicapped peers and with autistic classmates. Same-age nonhandicapped playmates initiated more frequently than did younger nonhandicapped playmates and were better able to modify their initiations in ways that increased the likelihood of response from the autistic children.

Schizophrenic children admitted as inpatients to a child psychiatric unit over a 10-year period were reviewed in terms of demographic characteristics, clinical features, and social adaptation using the DSM-III as a frame of reference. Ten children who were first seen at least 1 year previously were followed up and reassessed as regards clinical status and level of adaptive functioning. As in other studies, outcome was related to age at onset, premorbid level of adaptation, rapidly of onset, clinical subtype, and presence of affective symptoms. However, deterioration following the active phase of the illness occurred in only four cases. The outcome in childhood schizophrenia may be more favorable than generally assumed, but there is a need for longer and larger studies of carefully diagnosed groups.

The category knowledge and receptive language skills of 16 autistic, mentally retarded, and normal children were assessed. The autistic children's knowledge of function, form, and color categories was comparable to that of the mental-age-matched mentally retarded and normal comparison groups. Category knowledge and receptive language were more closely associated for mentally retarded and normal children than for autistic children. The findings indicate that category knowledge is not sufficient for the development of receptive language in autistic children.

Hyperbaric oxygen therapy (HBOT) has been used to treat individuals with autism. However, few studies of its effectiveness have been completed. The current study examined the effects of 40 HBOT sessions at 24% oxygen at 1.3 ATA on 11 topographies of directly observed behavior. Five replications of multiple baselines were completed across a total of 16 participants with autism spectrum disorders. No consistent effects were observed across any group or within any individual participant, demonstrating that HBOT was not an effective treatment for the participants in this study. This study represents the first relatively large-scale controlled study evaluating the effects of HBOT at the level of the individual participant, on a wide array of behaviors.

This study investigated time trends and associated factors of incidence rates of diagnosed autism spectrum disorders (ASD) across the lifespan from 1995 to 2010, using data from the Danish Psychiatric Central Research Registry. First time diagnosis of childhood autism, atypical autism, Asperger's syndrome, or pervasive developmental disorder-unspecified (PDD-NOS) were identified, incidence rates were calculated, and data were fitted using non-linear least squares methods. A total of 14.997 patients were identified and incidence rates for ASD increased from 9.0 to 38.6 per 100,000 person years during the 16-year period. The increases were most pronounced in females, adolescents, adults, and patients with Asperger's syndrome and PDD-NOS.

A peer-initiation training procedure was implemented across multiple peer trainers to investigate social interactions between severely withdrawn autistic children and their nonhandicapped peers. For one subject, substantial increases in spontaneous interactions with training and nontraining peers occurred after the peer-initiation procedure was applied across two training exemplars. Spontaneous social interactions continued even after the training procedure was removed. Although experimental control was established with the second subject during training, spontaneous interactions during nontraining periods were primarily with training peers. The results contribute to an emerging data base on the social interactions of autistic and severely withdrawn handicapped children and on peer-initiation training procedures.

Two mentally retarded boys with autism and one mentally retarded girl with Down syndrome were taught to initiate and play a ball game with an adult confederate. The program targeted both nonverbal responses related to the actual execution of the ball game as well as verbal responses for play initiation and providing compliments for the confederate's behavior. Training sessions provided ample practice in all aspects of the game from initiation to termination through use of brief play cycles. Instruction was provided using a combination of physical and verbal prompts as well as reinforcement and time-out. All three children learned the game and by the study's completion executed multiple play cycles each session. The implications of combining play and social skills training in programming for developmentally handicapped children are discussed.

This research extends previous research regarding the intellectual functioning of autistic individuals on standardized measures of intelligence (Wechsler Adult Intelligence Scale-Revised and the Wechsler Intelligence Scale for Children-Revised). In Study I 33 individuals with autism who closely fit the DSM-III criteria were studied. Clear evidence was found that differentiates these individuals' verbal intellectual processes from their visual-motor intellectual abilities. Principal components analysis was used to examine the interrelationship among the various intellectual abilities which such tests of intelligence measure. In Study II the intellectual abilities of a group of autistic 8- to 12-year-olds were compared to age-matched groups of children with receptive developmental language disorder, dysthymic disorder, or oppositional disorder. The intellectual abilities of autistic children were significantly different from the other groups of children.

The validity and reliability of the Childhood Autism Rating Scale (CARS) for autistic adolescents was tested. In the first study, CARS scores for autistic children and adolescents (matched on nonverbal IQ, sex, and ethnicity) were compared. In the second study, a group of nonautistic, handicapped adolescents were administered the CARS and these scores were compared with those of a group of autistic adolescents (matched on age, nonverbal IQ, sex, and ethnicity). The CARS clearly discriminated the two adolescent groups, suggesting that the scale may be an adequate measure of autism in adolescence. Although the CARS total score did not discriminate the younger from older autistic subjects, some interesting age-related differences emerged for specific items. A recommendation is made for elimination of one of the items on the CARS that negatively correlates with the CARS total score for both autistic groups.

Adults with autism experience significant impairments in social and non-social information processing for which few treatments have been developed. This study conducted an 18-month uncontrolled trial of Cognitive Enhancement Therapy (CET), a comprehensive cognitive rehabilitation intervention, in 14 verbal adults with autism spectrum disorder to investigate its feasibility, acceptability, and initial efficacy in treating these impairments. Results indicated that CET was satisfying to participants, with high treatment attendance and retention. Effects on cognitive deficits and social behavior were also large (d = 1.40-2.29) and statistically significant (all p < .001). These findings suggest that CET is a feasible, acceptable, and potentially effective intervention for remediating the social and non-social cognitive impairments in verbal adults with autism.

We report a major revision of the CHecklist for Autism in Toddlers (CHAT). This quantitative CHAT (Q-CHAT) contains 25 items, scored on a 5 point scale (0-4). The Q-CHAT was completed by parents of n = 779 unselected toddlers (mean age 21 months) and n = 160 toddlers and preschoolers (mean age 44 months) with an Autism Spectrum Condition (ASC). The ASC group (mean (SD) = 51.8 (14.3)) scored higher on the Q-CHAT than controls (26.7 (7.8)). Boys in the control group (27.5 (7.8)) scored higher than girls (25.8 (7.7)). The intraclass correlation for test-retest reliability was 0.82 (n = 330). The distribution in the control group was close to normal. Full examination of the clinical validity of the Q-CHAT and test properties is underway.

This study explored North Carolina pediatric healthcare professional's (PHP) perceptions of screening 12-18 month old infants for Autism Spectrum Disorder (ASD). Eight focus groups (66 PHPs) were conducted across practice settings. The purpose was to explore PHP's perspectives to: inform development of ASD screening tools and ultimately impact their use in PHP settings. PHPs reported concerns, barriers, and the need for research to support early ASD screening. Additionally, they expressed the need for: (a) clear "red flags" of ASD for 12-18 month olds; (b) socioculturally sensitive and effective screening tools; (c) effective early interventions; (d) systems to handle potential increases in referrals; and (e) continuing education. PHPs also demonstrated preferences about screening tool characteristics and processes for enhancing screening efforts.

The modified checklist for autism in toddlers (M-CHAT) is a tool developed for 16-30 month old children to screen for autism spectrum disorders (ASD). It is a well-researched tool, but little is known about its utility with Singaporean toddlers and with older children referred for developmental concerns. This study investigated the M-CHAT's performance with 18-30 month old (N = 173) and >30-48 month old (N = 407) developmentally at-risk Singaporean children, when used with three recommended scoring methods i.e., the total, critical and Best7 scoring methods. The results indicate that the critical and Best7 scoring methods detected most true cases of ASD without inflating the false positive rates in toddlers, and that only the total scoring method performed acceptably for the older children.

Autism is a severe, long-term developmental disorder that potentially has substantial influence on different aspects of the family system. Principles from family-systems theory are considered as they relate to the autistic child within the family. A selective and critical review is presented of research findings on the influence of the autistic child on the functioning and interactions of family members, including parents, siblings, and the family as a whole. Research findings are also reviewed on resources associated with successful family adaptation to the autistic child. Suggestions are offered for improved research to assess the relationship between certain child variables and measures of family functioning.

The association between family socioeconomic status (SES) and the suspected autism spectrum disorder (ASD) status of 18-month-old toddlers was investigated using a population-based sample in Japan, which has a universal healthcare system and a mandatory health checkup system for toddlers. Questionnaires including SES measurements and modified checklist for autism in toddlers were mailed to all families with 18-month-old toddlers in Chiba, a city near Tokyo (N = 6,061; response rate: 64 %). The results of logistic regression analysis (which were adjusted for potential confounders) indicated that low maternal education, but not paternal education or family income, were associated with having suspected ASD offspring. Lower maternal education was associated with an increased risk of autistic traits in Japan.

To determine whether the Modified Checklist for Autism in Toddlers (M-CHAT) in conjunction with the routine 18-month health check-up identifies Japanese toddlers with autism spectrum disorder (ASD). Two-stage screening using the M-CHAT was conducted with 1,851 children attending the check-up. Final ASD diagnosis was confirmed at age ≥3 years. Screening identified 20/51 children with ASD: 12/20 true positives were developmentally delayed, whereas 16/22 false negatives were high-functioning. Sensitivity was 0.476, specificity 0.986, positive predictive value 0.455, and likelihood ratio 33.4 for children with ASD. With a few modifications, M-CHAT screening successfully detected toddlers with ASD with and without developmental delay and is a promising screening tool to complement existing community surveillance.

We examined whether infants' preference for speech at 12 months is associated with autistic-like behaviors at 18 months in infants who are at increased risk for autism spectrum disorder (ASD) because they have an older sibling diagnosed with ASD and in low-risk infants. Only low-risk infants listened significantly longer to speech than to nonspeech at 12 months. In both groups, relative preference for speech correlated positively with general cognitive ability at 12 months. However, in high-risk infants only, preference for speech was associated with autistic-like behavior at 18 months, while in low-risk infants, preference for speech correlated with language abilities. This suggests that in children at risk for ASD an atypical species-specific bias for speech may underlie atypical social development.

Many students with autism are being served in inclusive settings. Early intervention programs, traditionally home-based, are beginning to create center-based options which incorporate typically developing peers. One of the arguments for the use of inclusive programs is that students with autism will benefit from their exposure to and interactions with typical peers. Unfortunately, research suggests that in inclusive settings, typical peers and peers with autism do not always interact without prompting from an adult. This study used an ABAB design to determine if a peer buddy approach in which all students were trained to interact in dyads would increase non-adult-directed interactions. Data collected on the students with autism indicate that the peer buddy approach significantly increased their appropriate social interactions. Follow-up data on one of the students indicates generalization of appropriate social interactions to a new classroom.

We assessed the effectiveness of using objects of obsession as token reinforcers to increase task performance for children with autism. The use of obsessions as tokens (e.g., letter "A", a picture of a train) was compared with the use of typical tokens (e.g., stars, happy faces). A multiple baseline design across children with a reversal within child was used. Data were collected on percentage correct of task responses and on the occurrence of inappropriate behaviors during work sessions. Results indicated that percentage correct on task performance was higher when objects of obsession were used as tokens as opposed to when typical tokens were used. Concomitant decreases in inappropriate behaviors during work sessions were also noted. Results are discussed in terms of primary versus secondary reinforcement and the effects of saliency and novelty of the reinforcing stimuli.