Journal of Autism and Developmental Disorders

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Online ISSN: 1573-3432
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Association between WB5-HT levels and age. Our findings show no significant relationship between WB5-HT levels and age r(31) = − 0.30, p > 0.05
Individual values of WB5-HT observed in the three groups (F(2,28) = .51, p > .05. Median values and interquartile ranges are indicated by horizontal lines
Association between T-Lymphocytes and WB5-HT. The y-axis consists of log10 WB5-HT after adjusting for chronological age. The x-axis consists of T-lymphocyte cell counts. The blue linear indicates a positive linear relationship between WB5-HT levels and T-Lymphocytes where the gray shading represents the confidence intervals (Regression β = 0.532, p = .019)
Association between Chromogranin Cells and WB5-HT. The y-axis consists of log10 WB5-HT after adjusting for chronological age. The x-axis consists of the Chromogranin cell count. The blue linear indicates a negative linear relationship between WB5-HT levels and Chromogranin cells where the gray shading represents the confidence intervals (Regression β = − 0.415, p = .034)
Article
Hyperserotonemia, or elevated levels of whole blood serotonin (WB5-HT), was the first biomarker linked to autism spectrum disorder (ASD). Despite numerous studies investigating the etiology of hyperserotonemia, results have been inconsistent. Recent findings suggest a relationship between the immune system and hyperserotonemia. The current study investigated whether intestinal 5-HT levels, 5-HT gene expression, or intestinal cell types predict WB5-HT. Participants included thirty-one males aged 3–18 who were classified into one of three groups: ASD and functional GI issues, typically developing with GI issues, and typically developing without GI issues. Samples from a lower endoscopy were analyzed to examine the pathways in predicting WB-5HT. Results demonstrated an association between T-Lymphocytes and WB5-HT.
 
Article
Relatively little has been published about the prevalence of autism in adults with psychiatric disorders. In this study, all new patients referred to an adult psychiatric outpatient clinic in Sweden between November 2019 and October 2020 (n = 562) were screened for autism spectrum disorders using the Ritvo Autism and Asperger Diagnostic Scale Screen (RAADS-14). Out of the 304 (58%) responders, 197 who scored above the cut off (14) were invited to participate in an in-depth assessment. Twenty-six of the 48 that participated in the assessment met criteria for ASD and an additional eight had subthreshold ASD symptoms. We estimated the prevalence of ASD in this population to at least 18.9%, with another 5–10% having subthreshold symptoms.
 
Article
Emotion recognition research in autism has provided conflicting results and has ignored the role of context. We examined if autistic adolescents use context to identify displayed and felt emotion. Twenty adolescents with autism and 20 age-matched neurotypical adolescents identified emotions from a standardised set of images. The groups also viewed videos scenes with actors displaying a feigned emotion masking their true feelings. Participants identified the displayed and felt emotions. Both groups identified emotions from static images equally well. In the video condition, the autism group was unable to distinguish between the displayed and felt emotions. Emotion research is often divorced from context. Our findings suggest that autistic individuals have difficulty integrating contextual cues when processing emotions.
 
Article
Strengthening systems of care to meet the needs of individuals with autism spectrum disorder (ASD) is of growing importance. Administrative data provide advantages for research and planning purposes, including large sample sizes and the ability to identify enrollment in insurance coverage and service utilization of individuals with ASD. Researchers have employed varying strategies to identify individuals with ASD in administrative data. Differences in these strategies can limit the comparability of results across studies. This review describes implications of the varying strategies that have been employed to identify individuals with ASD in US claims databases, with consideration of the strengths and limitations of each approach.
 
Xavier’s percentage of verbal initiations during baseline, comparison (Electronic and Paper format), and follow-up phases
Xavier’s percentage of on-topic responses during baseline, comparison (Electronic and Paper format), and follow-up phases
Tommy’s percentage of verbal initiations during baseline, comparison (Electronic and Paper format), and follow-up phases
Tommy’s percentage of on-topic responses during baseline, comparison (Electronic and Paper format), and follow-up phases
Article
This research used an alternating treatment design to investigate the relative effectiveness of participant specific social stories delivered using two distinct formats (i.e., technology-based, paper/book), on increasing the frequency of initiations and responses of two adolescents with ASD. Visual analysis of baseline, intervention, maintenance, and generalization data results indicated the intervention increased the frequency of initiations and on-topic responses regardless of delivery format; however, calculation of Percentage of Nonoverlapping Pairs and TAU-U for both formats indicated variable levels of effectiveness for each condition, with ranges of 43–86% and 0.02381–0.76190 respectively. Finally, despite varied results, both participants preferred the technology-based social story format and parents of both participants agreed the social story intervention increased communicative skills.
 
Latino/a/x and non-Latino/a/x siblings described their conceptualization of autism and its effects on the sibling relationship, emotional functioning, and identity. High-level themes are indicated by capital letters; subthemes are indicated by boldfont. Differences across ethnicity are indicated by italics
Article
Siblings describe positive and negative aspects of autism and often assume lifelong support roles. Less is known about cultural influences on sibling relationships. This qualitative study characterizes processes linking siblings’ autism conceptualizations, sibling relationships, and self-concept using a multicultural framework. Siblings (12 Latino/a/x, 9 non-Latino/a/x white) participated. Data were stratified by ethnicity and analyzed using applied thematic analysis. Latino/a/x and non-Latino/a/x siblings described processes linking autism, relationships, and self-concept differently. Latino/a/x siblings emphasized family roles and identified as caregivers and protectors. Non-Latino/a/x siblings emphasized general sensitivity toward individuals who differed from themselves. Findings may reflect cultural differences in familism, caregiving expectations, and autism conceptualizations, thereby illuminating foundations of siblings’ lifelong caregiving roles and highlighting the importance of culturally-sensitive, family-centered care.
 
Participant flow through the study.
Adapted from “CONSORT 2010 Statement: Extension to Randomized Pilot and Feasibility Trials” by S. Eldridge, C. Chan, M. Campbell, C. Bond, S. Hopewell, L. Thabane, and G. Lancaster, 2016, BMJ, 355, p. 20
Example goal attainment scale
Article
The purpose of this study was to identify appropriate outcome measures and assess preliminary efficacy of occupational therapy in an equine environment (OTee HORSPLAY) for youth with autism spectrum disorder (ASD). Twenty-four youth with ASD aged 6–13 were randomized to 10 weeks of OTee HORSPLAY or to a waitlist control condition, occupational therapy in a garden. Youth demonstrated significantly improved goal attainment and social motivation, and decreased irritability after OTee HORSPLAY. When compared to the subset of participants who completed the waitlist control condition, the OTee HORSPLAY group still demonstrated significant improvements in goal attainment. This study provides preliminary evidence that horses can be integrated into occupational therapy for youth with ASD to improve social and behavioral goals.
 
Article
Measurement of social-pragmatic communication skills is essential for clinicians and researchers working with school-aged children on the autism spectrum. Many measures of these skills require time-intensive training and coding that is impractical for clinical assessment settings. Using a sample of 299 elementary school children (M = 8.6 years, sd = 1.7) with autism whose teachers completed the Children’s Communication Checklist-2, we evaluated the psychometric properties of the CCC-2, a commonly used measure of social-pragmatic skills in order to assist researchers and clinicians in identifying the utility of this measure related to their assessment needs. Our results indicate strong psychometric properties for the CCC-2 with this population and a 3-factor model fit: Structural Language, Pragmatic Communication, and Pragmatic Social. Evidence of racial/ethnic bias was found for the structural language factor. Clinical recommendations are provided for using the CCC-2 with students with autism as reported by teachers.
 
Responses to stranger lures during baseline, intervention and post-intervention sessions
Article
Video modeling was used to teach children with autism spectrum disorder how to respond to taped stranger lure scenarios and in-situ stranger lures. A multiple baseline design across participants was used to assess treatment effects. Measures consisted of reported verbal and motor responses to three abduction scenarios and actual responses to stranger lures planted near the children’s therapy program and within the children’s communities. Each child displayed increases in appropriate responses to taped abduction scenarios and in-situ stranger lures post-treatment. One year following the intervention 90% of the participants maintained and generalized the skills. This study indicated that children with ASD could learn to respond to taped stranger lure scenarios and correspondingly demonstrate these skills in situ and maintain these skills for at least one year following treatment.
 
An example of the saliency score calculation (conducted for each response category per prompt)
Response categories and saliency scores for Prompt 2 PROMPT 2 In what ways have you effectively included children with ASD in your general education classroom or schooling settings?
Response categories and saliency scores for Prompt 3 PROMPT 3 Identify and describe any strategies or techniques that are particularly effective in developing relationships with your students with autism
Article
To identify target areas for professional development, this mixed-methods study examined general education teachers’ perceptions of autism and pedagogical practices in early elementary classrooms in the United States. In focus groups, teachers ( N = 18) identified terms they associated with autism and strategies they used for inclusion and relationship building. Participants systematically free-listed and ranked their responses to three prompts. Using ranked responses, saliency scores were calculated to assess the perceived importance and frequency of responses. Teachers’ most salient perceptions of autism (e.g., social difficulties, focused/fixed interests) revealed an awareness of core symptoms. Salient inclusion practices included assigning special classroom responsibilities and showcasing student talents; salient relationship-building strategies included embracing students’ special interests and engaging in one-on-one time. Implications for teacher trainings are discussed.
 
Proportion of the sample with clinically-significant behavior problems on the Child Behavior Checklist by age
Attention Problems on the Child Behavior Checklist by Age and Sex
Aggressive Behavior on the Child Behavior Checklist by Age and Sex
Anxious Depressed on the Child Behavior Checklist by Age and Sex
Predicted Attention Problems on the Child Behavior Checklist by Flexibility and Autism Status
Article
In this study, we examined trajectories of specific domains of behavior problems (i.e., attention problems, depression/anxiety, and aggressive behavior) from age 6 to 18 in a sample of 55 children with fragile X syndrome. We also examined autism status and early parenting as predictors of subsequent behavioral trajectories. We found that attention problems and aggressive behavior declined steadily from childhood through adolescence whereas anxious/depressed behavior demonstrated relative stability over the same period. Youth with highly flexible mothers displayed more optional trajectories of improvement in attention problems.
 
Article
Self-determination refers to an individual's capacity and opportunities to act as a causal agent in their own lives to make choices, decisions, and set goals. The current study examined self- and parent-reports of the AIR Self-Determination Scale in transition-aged autistic youth (Based on stakeholder preferences, we use identity-first(autistic) or neutral language (on the autism spectrum) (Bottema-Beutel in JAMA 3:18–29, 2020)). Autistic youth completed depression and executive function measures, and parents rated their child's social-communication and executive function difficulties. Despite differences between youth and parent reports, both youth and their parents reported lower self-determination skills (capacity) than opportunities to practice self-determined behaviors. Both depression and executive function skills were related to self-determination capacity, highlighting potential intervention targets for transition-aged youth to facilitate increased self-determination and potentially improved adult outcomes.
 
Theoretical framework
(Adapted from Lai et al., 2015)
Plot of effect size of sex/gender difference (male—female) in estimated mean of latent severity distribution for each CARS2-ST item. Note: Error bars represent the HDI80%. Horizontal grey lines depict the ROPE’s upper and lower bounds. Differences were judged to be meaningful when the HDI80% lay entirely outside of the ROPE. Probable evidence of a difference is obtained when the HDI80% excludes zero, but still overlaps the ROPE
Plots of the probability of a score ≥ 2 on each CARS2-ST item by sex/gender (left panel) and of sex/gender difference (male—female) in probability of obtaining ≥ 2 (right panel)
Plot of effect size of sex/gender difference (male—female) in estimated mean of latent severity distribution for each GARS-3 item
Plots of the probability of a score ≥ 2 on each GARS-3 item by sex/gender (upper panel) and of sex/gender difference (male—female) in probability of obtaining ≥ 2 (lower panel)
Article
Growing evidence suggests that autistic females are more likely to be diagnostically overlooked than males, perhaps due to differences in ASD presentations (van Wijngaarden-Cremers in JAMA 44:627-635, 2014). To investigate specific behaviours in which differences lie, we analysed profiles of 777 children using the Childhood Autism Rating Scale (Scholper in JAMA 29:489-493, 2010) or Gilliam Autism Rating Scale (Gilliam, 2014). Males demonstrated greater difficulty in six CARS2-ST items and seven behaviours on the GARS-3, mostly reflecting restricted and repetitive behaviours. Across all instruments, the only area in which females showed greater difficulty was fear or nervousness (CARS2-ST). No meaningful differences emerged from the CARS2-HF analysis. Where males showed greater difficulty, females were more likely to present with developmentally typical behaviour.
 
ROC curve based on the total MABC-2-NL score
Article
Although motor problems are highly prevalent in children with autism spectrum disorder (ASD), they remain underdiagnosed. Questionnaire-based screening for motor problems could optimize current clinical practice. This study aimed to examine the psychometric properties of the developmental coordination disorder questionnaire (DCDQ) to screen for co-occurring motor problems in individuals with ASD (n = 115; aged 5–15 years). Results indicated an excellent internal consistency; concurrent and discriminant validity with the Movement Assessment Battery for Children, second edition. Sensitivity was excellent, but specificity was lower. The positive and negative predictive values indicate that the DCDQ can be used to detect motor problems in children with ASD and can exclude the presence of developmental coordination disorder.
 
Time-to-collision task from perspective of participant
Article
Individuals with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) may exhibit driving difficulties due to cognitive impairments such as time perception difficulties, a construct related to the perception of time-to-collision (TTC). This study examined the timing abilities of drivers with ASD and ADHD. Sixty participants (nADHD = 20, nASD = 20, nTD = 20) completed a time reproduction task and a TTC estimation task in a driving simulator. Results indicated drivers with ASD were less precise in time reproduction across all time intervals and over-reproduced time at shorter intervals. Drivers with ASD produced larger TTC estimates when driving at a faster speed compared to typically developing drivers. Drivers with ASD, but not ADHD, appear to present difficulties in time estimation abilities.
 
Article
Autistic individuals who are also people of color or from lower socioeconomic strata are historically underrepresented in research. Lack of representation in autism research has contributed to health and healthcare disparities. Reducing these disparities will require culturally competent research that is relevant to under-resourced communities as well as collecting large nationally representative samples, or samples in which traditionally disenfranchised groups are over-represented. To achieve these goals, a diverse group of culturally competent researchers must partner with and gain the trust of communities to identify and eliminate barriers to participating in research. We suggest community-academic partnerships as one promising approach that results in high-quality research built on cultural competency, respect, and shared decision making.
 
This visual representation is based upon Bronfenbrenner’s (1994) Ecological Systems Theory, with our thematic results displayed within the respective ecological system levels (labeled on the right side of the figure). Themes identified as supports are displayed in the top half of the figure in italic lettering, and themes identified as barriers are displayed in the bottom half of the figure in bold lettering
Article
Knowledge is needed about specific supports and barriers for successful transitions to adulthood for autistic youth, especially from the perspective of parents, who are highly involved in transition preparation. We conducted a qualitative thematic analysis of previously conducted semi-structured interviews with 39 parents of 41 autistic adolescents to identify themes related to supports and barriers; we then used Bronfenbrenner’s Ecological System’s Theory to aid in interpreting the themes. We identified three main supports and four main barriers to the transition to adulthood from the parent interviews. The supports and barriers represent factors to consider at each theorized ecological level. Results point to opportunities to promote person-environment fit and support the transition to adulthood for autistic youth at multiple system levels.
 
Article
Decreased sound tolerance (DST) is the most common sensory difficulty experienced by autistic individuals. Parents of 88 autistic children and young adults between the ages of 3 and 30 described coping strategies and physical and emotional responses used to deal with distressing sounds, and their impact on daily activities. Loud, sudden, and high-pitched sounds were most commonly endorsed as distressing, most often causing autistic children and young adults to cover their ears or yell, while producing stress, irritation, fear, and anxiety. Parents reported warning their child, providing breaks, or avoiding noisy settings as the most used coping strategies. Overall, findings indicate that DST leads to fewer opportunities for autistic children and young adults to participate at home, at school, and in the community. Further, results suggest hyperacusis, misophonia, and phonophobia, subtypes of DST, are present in autistic children and young adults.
 
PRISMA flow diagram
Article
Obesity is linked with health and psychosocial outcomes among many populations. However, it is unclear the extent to which obesity is linked with these outcomes among autistic adults. We searched seven research databases for articles examining the association between obesity and autistic adults’ health and psychosocial outcomes. Three studies found that obesity was associated with health outcomes, including: in-hospital mortality, risk of type II diabetes, cardiovascular disease, and number of co-occurring medical conditions. One study found no significant association between autism diagnosis, mental health conditions, and body mass index. Obesity increases the risk of in-hospital mortality and some chronic conditions among autistic adults, highlighting the need for clinicians trained to promote weight management among autistic adults.
 
Moderating effect of children openness to experience on the relation between mother–child conversations about emotions and children theory of mind perceived skills
Moderating effect of children consciousness on the relation between mother–child conversations about emotions and children theory of mind perceived skills
Moderating effect of mothers’ conceptualization of emotion on the relation between mother–child conversations about emotions and children theory of mind perceived skills
Article
Mother–child emotion-related conversations, as a practice of parental socialization of emotion, can help children with autism spectrum disorder (ASD) develop socio-emotional skills. This study intends to explore relationships between mother–child conversations about emotions and socio-emotional skills of children with ASD by accounting for the moderating role of children personality traits and mothers’ emotional openness. Mothers of children with ASD (n = 49) responded to five questionnaires describing their conversations about emotions, emotional openness as well as their child’s socio-emotional skills and personality. We conducted hierarchical regression and moderation analyses. Our findings indicate that frequent mother–child conversations about emotions significantly predict higher emotional regulation and Theory of Mind (ToM) abilities in children with ASD (p < 0.05). Moreover, children’s consciousness and openness to experience, along with mothers’ emotional openness significantly moderate the relation between mother–child conversations about emotions and children’s ToM skills (p < 0.05). Mother–child conversations about emotions, as a practice of parental socialization of emotion, could be beneficial for children with ASD. Children’s personality traits and mothers’ openness to emotion may act as a protective factor of ToM skills in children with ASD.
 
Sample item, recursive embedding test (RET)
Pre and post-training accuracy, second-order false belief test. Note: Recursive embedding training, grey lines; Working memory training, solid black lines; Interactive control, dotted lines
Article
This study investigates the role of recursive language and working memory (WM) in second-order false belief skills in Danish-speaking children with autism spectrum disorder (ASD; n = 62; 8 females) and typical development (n = 41; 15 females), ages 6–16. Second-order false belief skills correlated with receptive grammar, vocabulary, and age; sentential complement production predicted second-order false beliefs, controlling for age, receptive grammar and WM. Regressions showed that second-order false belief was associated with age across groups, but with sentential complements in the ASD group only. Second-order false belief skills improved in children who received training in either recursive phrases (d = 0.21) or WM (d = 0.74), compared to an active control group. Results suggest that false belief skills are entwined with both linguistic and executive functions.
 
Article
This study examines partnerships between schools and businesses that are intended to foster training and employment opportunities for secondary students with developmental and other disabilities in Saudi Arabia. A survey was developed to investigate employers’ perspectives on students’ skills, practical strategies for training, and their contribution. Fifty-two employers participated in the survey. The findings revealed the most valued skills on job sites, such as self- determination, social, and job skills, and believed that coordination, job matching, and joint supervision are successful practices that improve training. The employers concluded that some of their contributions to such partnerships include participation in curriculum development, training students in their workplaces under their supervision, and offering financial support.
 
Patient recruitment flow chart outlining participant enrolment and and follow up across both sites
IL-17A is downregulated, at 20 weeks gestation in mothers of ASD children when compared to neurotypical controls. This remains after adjusting for confounding variables—folate intake at 15 weeks. All data are mean ± SEM; independent samples t-tests, analysed on a case vs control basis. * = p < 0.05. White bars represent controls, while orange bars represent cases (mothers of ASD affected offspring)
a IFN-γ, b IL-16, c eotaxin, d MCP1, e IL-8, f IL-1β and g IL-6 were not significantly altered at either 15 or 20 weeks gestation in mothers of ASD children when compared to neurotypical controls. All data are mean ± SEM; independent samples t-tests, analysed on a case vs control basis. White bars represent controls, while orange bars represent cases (mothers of ASD affected offspring)
Article
Autism spectrum disorder (ASD) is a developmental disorder characterised by deficits in social interactions and communication, with stereotypical and repetitive behaviours. Recent evidence suggests that maternal immune dysregulation may predispose offspring to ASD. Independent samples t-tests revealed downregulation of IL-17A concentrations in cases, when compared to controls, at both 15 weeks (p = 0.02), and 20 weeks (p = 0.02), which persisted at 20 weeks following adjustment for confounding variables. This adds to the growing body of evidence that maternal immune regulation may play a role in foetal neurodevelopment.
 
Emphasis of coded statements assigned to themes for each stakeholder group
Article
In Sweden, young autistic children typically attend community-based preschool programs, which may not be adapted to their needs. In the current study, stakeholders to autistic children receiving Early Intensive Behavioral Intervention were interviewed following a quasi-randomized study (#NCT03634761) aimed at improving the preschool program quality using the Swedish version of the Autism Program Environment Rating Scale (APERS). Stakeholders provided their perceptions and experiences concerning key factors for high quality preschool programs as well as well as their experiences of the abovementioned APERS study. Applying thematic analysis, stakeholder groups differed in what they emphasized, but all highlighted staff’s competence, children’s inclusion and participation, collaboration, and the learning environment as key program areas that had been positively influenced by the APERS-based intervention.
 
Article
This study uses factor mixture modelling of the Short Sensory Profile (SSP) at two time points to describe subgroups of young autistic and typically-developing children. This approach allows separate SSP subscales to influence overall SSP performance differentially across subgroups. Three subgroups were described, one including almost all typically-developing participants plus many autistic participants. SSP performance of a second, largely-autistic subgroup was predominantly shaped by a subscale indexing behaviours of low energy/weakness. Finally, the third subgroup, again largely autistic, contained participants with low (or more “atypical”) SSP scores across most subscales. In this subgroup, autistic participants exhibited large P1 amplitudes to loud sounds. Autistic participants in subgroups with more atypical SSP scores had higher anxiety and more sleep disturbances.
 
Article
This paper investigated the characteristics of mothers of children with a disability who registered for a mental health and wellbeing workshop. The questionnaire measured mental health, health-related behaviours, empowerment, family cohesion, wellbeing and child-related variables. Regression analysis identified factors associated with depressive symptoms and positive wellbeing. Fifty-seven percent of participants (N = 171) had depressive symptoms within the clinical range. Higher symptoms were associated with reduced: empowerment (r = − .39, p < .01); positive-wellbeing (r = − .66, p < .05); and healthy activity (r = − .41, p < .001). Low positive wellbeing (β = .55, p < .001) was the strongest predictor of depressive symptoms. Family cohesion (β = .25, p < .001), was the strongest predictor of positive-wellbeing. Future health and wellbeing interventions that support mothers with high care responsibilities should include psycho-education and strategies to address healthy maternal and family-related behaviour changes.
 
Article
Prader-Willi syndrome (PWS) is a rare genetic disorder characterised by neurodevelopmental delays, hyperphagia, difficulties with social communication and challenging behaviours. Individuals require intensive supervision from caregivers which may negatively affect caregiver quality of life. This study used data collected in the Australasian PWS Registry (n = 50, mean age 11.2 years) to evaluate associations between child behaviours and caregiver mental well-being. Symptoms of sleep-related breathing disorder, child depression and social difficulties were associated with poorer caregiver mental and physical well-being. Growth hormone therapy use was associated with better caregiver mental and physical well-being. Optimising management of problematic behaviours and sleep disturbances have the potential to support caregivers who are the most vital network of support for individuals affected by PWS.
 
Birth order × income interaction for expressive language. Average VABS-II expressive language v-scores for first-borns and later-borns across below-average and above-average income families. “Average” income was determined by the average of the current sample, (~ $78,000). Y-axis truncated to visibly present statistically significant results. Error bars show standard errors. VABS-II Vineland Adaptive Behavior Scales, 2nd Edition, gs gradient slope. *p < .05
Birth order × age interaction for expressive language. Average VABS-II expressive language v-scores for first-borns and later-borns across age. Error bars show standard errors. Y-axis truncated to visibly present statistically significant results. VABS-II Vineland Adaptive Behavior Scales, 2nd Edition, gs gradient slope. *p < .05
Birth Order x Income Interaction for Inappropriate Speech. Average ABC-Inappropriate Speech subscale scores for first-borns and later-borns across below-average and above-average income families. “Average” income was determined by the average of the current sample, (~ $78,000). Error bars show standard errors. ABC Aberrant Behavior Checklist, gs gradient slope. *p < .05
Article
The current study investigated the impact of birth order on vocabulary and social language development in 1338 first-born and 1049 s-born autistic youth (M age = 9.03 years, SD = 3.57; 86.4% male) from the Simons Simplex Collection. Frequentist and Bayesian analyses revealed mixed findings in language development. There were no differences in vocabulary or social language between first-born and second-born children. However, birth order and income together predicted expressive vocabulary and inappropriate speech such that birth order had a greater impact on language in lower-income families. This is the first study to investigate the impact of birth order on language outcomes in autistic youth and has implications for early intervention in lower-resourced communities.
 
Boxplot illustrating the distributions of the pragmatic language skills score in each group
Boxplot illustrating the distributions of the communicative intentions score in each group
Boxplot illustrating the distributions of the presupposition score in each group
Boxplot illustrating the distributions of the discourse management score in each group
Article
This study examined the early pragmatic language skills in typically developing (TD) preschool-age children, children with language impairment (LI) and children with autism spectrum disorder (ASD). Two hundred and sixty-two TD children, 73 children with LI, and 16 children with ASD were compared on early pragmatics through direct assessment (DA). Post hoc analysis revealed that children in two clinical groups displayed significant pragmatic language deficits. Children in the ASD group who were older exhibited comparable degree of impairments as their LI peers, suggesting a relatively stagnant development of pragmatic language skills in children with ASD. Findings also supported the use of DA in identifying pragmatic language deficits, which have implications for the adoption of this assessment approach in clinical settings.
 
Article
The autism-spectrum quotient (AQ) measures autistic traits and has been studied in different countries, sometimes with the English version, and sometimes with translated versions. However, the language of the questionnaire might influence non-native English speakers’ answering tendency. In the current study we compared the responses on the AQ of multilingual Malaysians (96 participants filled out the AQ in English and Mandarin, and 79 participants filled out English and Bahasa Malaysia). Participants scored higher on the English AQ compared to the Mandarin AQ, whereas there was no difference between the English and Bahasa Malaysia AQ score. Analysis of the response style suggests the same person might display discrepant response styles in different languages, which seems to be related to language proficiency.
 
Example of the stimuli from Tables 1 and 2 of the GHFT
Estimates of GHFT time centiles. Green, blue, light blue, purple, yellow, grey, and black curves represent the 3rd, 5th, 10th, 25th, 50th, 75th, and 90th percentiles, respectively (Color figure online)
Estimate of GHFT accuracy centiles. Green, blue, light blue, purple, yellow, grey, and black curves represent the 3rd, 5th, 10th, 25th, 50th, 75th, and 90th percentiles, respectively (Color figure online)
Percentiles of age-corrected GHFT accuracy and time scores achieved by single individuals with autism in reference to normative data obtained from Study 1. Dimension of symbol is proportional to density of observations (the smallest symbols represent one individual, the largest four individuals). The dotted lines represent the 50th percentile
Time and accuracy scores of the GHFT, separately for children with autism and typically developing participants. Boxes represent 25 and 75 percentiles. The solid line inside the box represents the median of the group, while the empty square in the box represents the mean. Bars above and below the boxes represent the interquartile range. Each individual dot represents a subject
Article
In two studies, we used the Gottschaldt’s Hidden Figure Test (GHFT) for assessing figure disembedding ability in children aged 7–11. Study 1 demonstrated in a large sample of typically developing children that GHFT accuracy and time scores differed across age groups, without sex and socioeconomic differences. Thus, we provided normative data only taking into account children’s age. In Study 2, GHFT normative values were used to assess children with autism, who were also compared with a closely age-matched group of typical controls. Children with autism achieved time scores at or above the 50th centile and significantly differed from the controls for time score. The GHFT seems a valuable tool for defining the cognitive profile of children with autism.
 
Article
  • Danielle A. WaldronDanielle A. Waldron
  • Jeffrey StokesJeffrey Stokes
  • Caitlin E. CoyleCaitlin E. Coyle
  • [...]
  • Elizabeth DuganElizabeth Dugan
This study explores factors associated with participation in moderate physical activity and muscle strengthening activity in adults with autism receiving state services (age: 18–78 years). Researchers analyzed the National Core Indicators-In Person Survey (2017–2018) data using multilevel mixed effects logistic regression. Older adults on the autism spectrum engaged in both moderate physical activity and muscle strengthening activity less often than younger adults on the autism spectrum (OR 0.99; p < 0.05; OR 0.98; p < 0.001). Individuals reportedly in fair/poor health had 50% lower odds of engaging in moderate physical activity and 30% lower odds of engaging in muscle strengthening compared to those in good/ excellent health (OR 0.50; p < 0.001; OR 0.70; p < 0.001). Moderate physical activity/muscle strengthening initiatives may help foster this group’s healthy aging.
 
Frequencies of High Points Related to Personal Experiences, Child with ASD, Spouse, and Other Children. Note: Percentage of responses in each category were similar across the three profiles, with one exception. Couples in the asymmetrically engaged group reported significantly fewer high points related to their spouse than the resilient couples and couples getting by
Frequencies of Low Points Related to Personal Experiences, Child with ASD, Spouse, and Other Children. Note: Percentage of responses in each category were similar across the three profiles, with one exception. Resilient couples reported significantly fewer low points related to their spouse than the couples getting by and the asymmetrically engaged couples
Article
This study describes parents’ daily “highs” and “lows” during their child’s transition to school for the first time and examines how those experiences relate to turbulence in the parents’ relationship. 106 parents (53 couples) rated their relationship qualities at pre-test and post-test and described “high” and “low” points of their day every three days for 42 days. Content analysis revealed experiences contributing to “high” or “low” points that were primarily related to: the child with ASD, the spouse, other children, personal situations, and other. Latent profile analysis identified three profiles that represented the relationship experiences of couples in the study: resilient couples, couples getting by, and asymmetrically engaged couples. Results highlight the variety of daily experiences these parents encounter.
 
Article
Prader-Willi Syndrome (PWS) is a rare neurodevelopmental disorder associated with social cognitive challenges, and pretend play has been demonstrated as a tool to achieve developmental goals. Following previous report on feasibility and acceptability of a remote, play-based parent-training program (Zyga, Russ, & Dimitropoulos, 2018), we now report on preliminary efficacy of this program to enhance pretend play skills and social cognitive skills in preschoolers with PWS. Results across two studies demonstrated efficacy when live-coaching play sessions incorporated children into the intervention. Increases in play skills were observed for children with the mUPD subtype of PWS who underwent intervention, compared with children with mUPD who were waitlisted. Children with DEL subtype were less likely to respond to intervention. Implications for results are discussed.
 
Relationship between T1 ADOS CSS and T3 TWT, T1 Time 1, T3 Time 3, ADOS Autism Diagnostic Observation Schedule, CSS Calibrated Severity Score, TWT total word types
Relationship between T1 ADOS social affect and T3 TWT. T1 Time 1, T3 Time 3, ADOS Autism Diagnostic Observation Schedule, SA Social Affect, TWT Total Word Types
Relationship between T1 ADOS restricted and repetitive behavior and T3 TWT. T1 Time 1, T3 Time 3, ADOS Autism Diagnostic Observation Schedule, RB restricted and repetitive behavior, TWT total word types
MLU at T1 and T3 grouped by mainstream inclusion intervention. T1 Time 1, T3 Time 3, MLU mean length of utterance
Article
This longitudinal study examined the degree to which standardized measures of language and natural language samples predicted later language usage in a heterogeneous sample of children with autism spectrum disorder (ASD), and how this relationship is impacted by ASD severity and interventions. Participants with a diagnosis of ASD (N = 54, 41 males) completed standardized assessments of language and social functioning; natural language samples were transcribed from play-based interactions. Findings indicated that standardized language measures, natural language measures, and ADOS severity were each unique predictors of later lexical use. Intervention types also appeared to impact later language; in particular, participation in mainstream inclusion accounted for significant amounts of variance in children’s mean length of utterance at T3.
 
Example images from the visual preference task developed by Sasson and Touchstone (2014). (A) Image of a face paired with a HAI; (B) Face paired with a LAI. HAI, high autism interest; LAI, low autism interest
Mean (+/- standard error) time to first fixation in seconds to faces adjacent to HAI and LAI objects in ASD and TYP groups. ASD, autism spectrum disorder; TYP, typically developing; HAI, high autism interest; LAI, low autism interest; C, condition effect.
*** p < 0.001. ** p < .05
Mean (+/- standard error) proportion of fixation duration in seconds to faces adjacent to HAI and LAI objects in ASD and TYP groups. ASD, autism spectrum disorder; TYP, typically developing; HAI, high autism interest; LAI, low autism interest; C, condition effect.
*** p < .001. ** p < .05.
Mean (+/- standard error) total duration of fixations to face and object stimuli in ASD and TYP groups. (A) Total fixation duration to face adjacent to HAI and LAI objects. (B) Total fixation duration to HAI and LAI objects. ASD, autism spectrum disorder; TYP, typically developing; HAI, high autism interest; LAI, low autism interest; C, condition effect.
*** p < .001. ** p < .05.
Article
Reduced social attention is characteristic of Autism Spectrum Disorder (ASD). It has been suggested to result from an early onset and excessive influence of circumscribed interests (CIs) on gaze behaviour, compared to typically developing (TYP) individuals. To date, these findings have been mixed. The current eye-tracking study utilised a visual preference paradigm to investigate the influence of CI versus non-CI objects on attention patterns in children with ASD (aged 3–12 years, n = 37) and their age-matched TYP peers (n = 30). Compared to TYP, social and object attention was reduced in the ASD group irrespective of the presence of CIs. Results suggest a reduced role for CIs and extend recent evidence of atypical attention patterns across social and non-social domains in ASD.
 
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram of the article selection process
Article
Law enforcement officers are the primary individuals called and who respond to situations of heightened concern. They make split-second observations and decisions based on how best to react to given safety situations and those involved. Characteristics of autism spectrum disorders (ASD), if not properly understood and reacted to, may quickly escalate a law enforcement officer call in a negative way, making autism training for law enforcement officers imperative. To ascertain what is known about autism training for law enforcement officers, a scoping review was conducted. Five studies met final inclusion criteria. The trainees, context and development of the training, evaluation procedures, and training outcomes are synthesized to provide guidance for future training implementation teams. Areas for future research are presented.
 
Box plots for parent-reported and observed SOR, SC, and SUR in ASD and TD groups, with thresholds indicating the 75th, 90th, and 95th percentile scores for the TD group (Fig. 1a: observed SOR, Fig. 1b: reported SOR, Fig. 1c: observed SC, Fig. 1d: reported SC, Fig. 1e: observed SUR, Fig. 1f: reported SUR)
Correlations between age and reported and observed sensory modulation behaviors in ASD and TD groups (Fig. 2a: observed SOR, Fig. 2b: reported SOR, Fig. 2c: observed SC, Fig. 2d: reported SC, Fig. 2e: reported SUR). Across both diagnostic groups, age was significantly negatively correlated with observed SOR, reported SC, and reported SUR, and age by diagnostic group interactions were not significant. There was a significant age by diagnostic group interaction in observed SC, in which observed SC was negatively related to age in the ASD group but not in the TD group
Article
Sensory features are common and impairing in autism spectrum disorder (ASD), but there are few observational sensory assessments that are valid across ages. We used the Sensory Processing 3-Dimensional (SP3-D) observed Assessment and parent-reported Inventory to examine sensory responsivity in 41 ASD and 33 typically-developing (TD) youth across 7–17 years. ASD youth had higher and more variable observed and reported sensory responsivity symptoms compared to TD, but the two measures were not correlated. Observed sensory over-responsivity (SOR) and sensory craving (SC) decreased with age in ASD, though SOR remained higher in ASD versus TD through adolescence. Results suggest that in ASD, the SP3-D Assessment can identify SOR through adolescence, and that there is value in integrating multiple sensory measures.
 
Article
We compared short stories by autistic (n = 19) and non-autistic (n = 23) university students. We used automated software and content analysis to code students’ stories. We found that writings were more similar than different. However, autistic students’ stories were rated at a higher reading level (p = .013) than non-autistic students’. Autistic students’ stories contained fewer grammatical errors (p = .02) but were less likely to include a climax (p = .026). Autistic students reported more positive writing affect than non-autistic students (p = .026). Higher writing affect was associated with writing highly fictional texts (p = .03) that contained more sentences (p = .005). Findings suggest writing may be a strength for autistic students and opportunities to write creatively may promote positive affect toward writing.
 
Hierarchical linear regression model for autistic participants. Model 1: Verbal IQ predicts Accuracy scores. Model 2: Recognition scores do not improve prediction of Accuracy scores. Model 3: Pragmatics improves prediction of Vocabulary Accuracy scores beyond Verbal IQ and Recognition scores
Hierarchical linear regression model for non-autistic participants. Model 1: AQ Communication score predicts Vocabulary Accuracy scores. Model 2: Recognition scores improve prediction of Vocabulary Accuracy scores beyond AQ Communication scores. Model 3: Pragmatics improves prediction of Vocabulary Accuracy scores beyond AQ Communication and Recognition scores. AQ Com Autism Quotient Communication
Article
Autistic adults have similar levels of desire for sexual and romantic relationships as their non-autistic peers. However, autistic adults are less likely to be in relationships and have less dating experience. We compared sexual knowledge, experiences, and pragmatic language ability in a community sample of young adults with (n = 27, mean age = 22.11) and without autism (n = 122, mean age = 19.47). Receipt of sex education and sexual knowledge did not differ between groups. However, autistic adults had significantly fewer partnered experiences and impaired pragmatic language. Within both groups, pragmatic skill predicted accurate sexual knowledge above and beyond general communication abilities. Findings suggest that sex education for autistic adults must address the social communication component of healthy romantic and sexual relationships.
 
Generic Core Module PedsQL scores in 131 dyads of caregivers (white) and autistic children (gray). Box-lower boundary: 25th percentile. Box-upper boundary: 75th percentile. Horizontal box-line: 50th percentile. Whiskers above and below the box indicate the Tukey fences for outliers. Cliff’s delta for measuring the effect size. ICC (intraclass correlation coefficient) for measuring the agreement between caregiver and child. P-value based on the two samples Wilcoxon rank-sum (Mann–Whitney) test
Post-hoc analysis. A Influence of age on reporting HRQOL. The gray line represents the scores reported by child-caregiver dyads of individuals aged 5 to 7 years. The black line represents the scores reported by dyads of children and adolescents aged 8 to 12 years. B Influence of the use of antipsychotic or psychostimulant drugs on reporting HRQOL. The gray line represents the scores of children who do not receive medication. The black line represents the scores of those who receive medication
Article
This study examined the agreement of perceived health-related quality of life (HRQOL) between caregivers and autistic children and adolescents (n = 133, 5-12 years) using the Pediatric Quality of Life Inventory Generic Core Scales, Fourth Edition (PedsQL 4.0). Results reveal good to excellent agreement over this age range across the total, physical, and psychosocial health scales. However, the emotional, social, and school functioning scores demonstrated lower agreement in dyads with children aged 5-7 than in dyads with children aged 8-12 years. Despite these differences in agreement, overall, the PedsQL 4.0 caregiver-module is a reliable instrument for measuring HRQOL in autistic individuals aged 5-12 years.
 
Article
We explored associations among the core behavioural features and developmental/cognitive abilities of 155 autistic children, assessed between ages 13–67 months and again around 1-year later to understand predictive directionality. Bidirectional, cross-domain association was apparent, albeit with stronger direction of effect from earlier cognition to later autism features (than vice versa). Exploratory sub-domain analysis showed that early non-verbal developmental/cognitive abilities (only) predicted subsequent social - and restricted/repetitive autism features, whereas early social features (only) predicted both subsequent verbal and non-verbal abilities. Although observational study design precludes causal inference, these data support contemporary notions of the developmental interconnectedness of core autism presentation and associated abilities—that behavioural autism features may influence cognitive development, but are likely also influenced by an individuals’ cognitive capacity.
 
Article
During the diagnostic evaluation period for autism or intellectual disability (ID), families of young children are at risk for poor adjustment. The present study aimed to document family quality of life (FQOL), along with associated risk and protective factors, during this critical step of families’ services trajectory. FQOL was measured in a large sample of families of children recently diagnosed with a neurodevelopmental disorder and examined in relation to the type of services received, children’s clinical profile, and family variables. FQOL was related to types of services, children’s challenging behavior, parenting stress, and several aspects of family composition and status. These findings highlight a need for mental health support for parents, coaching interventions for challenging behaviors, and family-centered supports.
 
Percentage correct of parent implementation of DTT skills, and child performance on skill acquisition of tasks
Article
Discrete Trial Training (DTT) is a method of intervention for individuals with Autism Spectrum Disorder (ASD). Applications of DTT require prescribed repetitions of instruction. DTT is typically implemented via trained instructors or teachers. However, prior analysis has demonstrated the potential of parent-implemented DTT. Prior research demonstrated that DTT training can be implemented with a high degree of fidelity using a student teacher population. However, to date, no studies have evaluated the use of a DTT telehealth training with parents of children with ASD. The purpose of this study was to evaluate the feasibility of a remote parent training method to allow parents to implement DTT in home settings. To this end, three parent participants of children diagnosed with ASD were trained to implement DTT through a telehealth modality in a nonconcurrent multiple baseline design. Results suggested efficacy of this method at DTT skills acquisition.
 
Model of school social capital as the mediator between ASD traits and depression
Model of sex as a moderator of the mediation model
Mediation model of indirect of ASD traits on depression thorough school social capital. Standardized β coefficients between variables are displayed (with standard errors in brackets). Indirect effect is presented as italicized ***p < 0.001
Moderated mediation model of sex as moderator. Standardized β coefficients between variables are displayed (with standard errors in brackets). Indirect effects thorough school social capital are presented as italicized ***p < 0.001
Moderating role of sex on the association between ASD traits and depression. Depression, Depression Self-Rating Scale for Children score; school social capital, “school trust and social cohesion” subscale score of the Japanese version of the Social Capital Questionnaire for Adolescent Students
Article
Though autism spectrum disorder (ASD) traits are associated with depression, it is unclear if school social capital mediates their association. We examined whether school social capital mediates the association between ASD traits and depression, and moderation effect of sex on the mediation effect among adolescents in a general population sample (1750 males, 1779 females; equivalent 12–15 years old). The results of this study indicate that ASD traits are associated with depression among adolescents, and that this association is partly mediated by school social capital. Furthermore, the results of the moderated mediation analysis suggest that lower level of school social capital can lead to more increase level of depression for females than for males.
 
Face in the Cloud task
Probabilistic tractography for seed and termination masks
Mediation model with standardized coefficients. Note: *p < 0.05; **p < 0.01; ***p < 0.001
Mediation model with standardized coefficients. Note: *p < 0.05; **p < 0.01; ***p < 0.00
ROC curves of structural connectivity effects for emotion recognition accuracy and social skills. Note: ROC Receiver operating characteristic; AUC Area under the curve. A ROC of right Amy-FG FA effects for emotion recognition accuracy. B ROC of right Amy-FG FA effects for social skills
Article
Children with chromosome 22q11.2 deletion syndrome (22q11.2DS) exhibit impaired ability to process and understand emotions in others. We measured structural connectivity in children and adolescents with 22q11.2DS (n = 28) and healthy controls (n = 29). Compared to controls, those with 22q11.2DS had poorer social skills and more difficulty recognizing facial emotions. Children with 22q11.2DS also had higher fractional anisotropic diffusion in right amygdala to fusiform gyrus white matter pathways. Right amygdala to fusiform gyrus fractional anisotropy values partially mediated the relationship between 22q11.2DS and social skills, as well as the relationship between 22q11.2DS and emotion recognition accuracy. These findings provide insight into the neural origins of social skills deficits seen in 22q11.2DS and may serve as a biomarker for risk of future psychiatric problems.
 
a Scene camera and the coordinate system. x and y coordinates correspond to the horizontal and vertical directions of gaze behavior respectively. b Illustration of the coordinate system of the scene video camera and the position of gaze allocation
a Creation of gaze behavior segments with the length of k-second(s). b Illustration of the number of gaze behavior segments at different lengths in both groups of participants
a Range of gaze allocation on the x- and y-axis, and in the x–y coordinate plane. b Exemplary illustration of gaze allocation for an ASD participant with a 5-s segment
Classification accuracy for gaze behavior segments at different lengths using the SVM classifier (in orange) and major class predication approach (in blue), respectively
Receiver operator characteristic (ROC) of the threshold classifier when classifying children based on the proportion of the 7-s ASD-like behavior segments
Article
This study segmented the time series of gaze behavior from nineteen children with autism spectrum disorder (ASD) and 20 children with typical development in a face-to-face conversation. A machine learning approach showed that behavior segments produced by these two groups of participants could be classified with the highest accuracy of 74.15%. These results were further used to classify children using a threshold classifier. A maximum classification accuracy of 87.18% was achieved, under the condition that a participant was considered as ‘ASD’ if over 46% of the child’s 7-s behavior segments were classified as ASD-like behaviors. The idea of combining the behavior segmentation technique and the threshold classifier could maximally preserve participants’ data, and promote the automatic screening of ASD.
 
Article
In the original article there is an error in the Introduction Section (Sentence 2 of the Introduction after the Abstract) and it has been corrected in this erratum.
 
Top-cited authors
Catherine Lord
  • Weill Cornell Medical College
Katherine Gotham
  • Vanderbilt University
Marsha Mailick
  • University of Wisconsin–Madison
Simon Baron-Cohen
  • University of Cambridge
Andrew Pickles
  • King's College London