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Abstract

In order to identify factors associated with the early detection and referral of children with pervasive developmental disorders, a sample of 82 consecutive referrals to an outpatient diagnostic service was studied. All children were thoroughly assessed with the Autism Diagnostic Interview (ADI), standardized psychological tests and direct observations. Data from the ADI on the first symptoms to arouse parental concern and on the first professional advice sought were analyzed. The mean age of children was 19.1 months (SD = 9.4) when the parents first became concerned, and the first professional advice was sought when children were 24.1 months old (SD = 11.7). The most common parental concerns were for speech and language development, followed by abnormal socio-emotional response, and medical problem or delay in milestone. In both bivariate and multiple regression analyses, the mean age of children at first parental concern and professional advice was significantly lower in the presence of mental retardation in the child, of an older sibling in the family, and of first parental concerns for medical problem/delay in milestone. More specific autistic behaviours, child's gender, social class and place of residence did not influence the age of recognition of the disorder in this sample. Health visitors and general practitioners were the first professionals contacted by parents. The implications of these findings for early detection and diagnosis of autism are discussed.

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... All these types of questions are likely to cross a parent's mind at one point or another. The things that parents are most concerned about in early childhood are "speech and language development, followed by abnormal socio-emotional response, and medical problem or delay in milestone" (Giacomo & Fombonne, 1998). In general, 20% of parents have concerns of their children under 5 years old, but few have received service or supports (Marshall et al., 2016). ...
... Therefore, concerns or lack thereof at 12 months of age tend to reflect observed developmental differences and do tend to predict diagnostic outcomes (Ozonoff et al., 2009). Symptoms of autism are usually present by two years of age and approximately 33% of parents cite concerns before one year of age (Giacomo & Fombonne, 1998). The average age of children was 19.1 months (SD = 9.4) when parents were first concerned, and children were on average 24.1 months old (SD= 11.7) when professional advice was sought for the first time. ...
... (Marshall et al., 2020). If the parent decides to seek information from formal sources, primary care physicians are most often the first professionals that parents contact (Giacomo & Fombonne, 1998). ...
Article
Although early intervention (EI) services have been shown to be highly effective and beneficial for young children, only 12% of those who qualify at 24 months receive services (Feinberg et al., 2011). There is a myriad of barriers that impedes access to EI services for those who need them. These barriers include myths about development and intervention, parent’s concerns being ignored, social inequalities limited access to early intervention, systemic barriers within the professional world, unperceived benefits of intervention, and limited communication flow to parents. However, there are some supports that help more families access EI services including doctors, early interventionists, and the prevalence of screeners. If there is a greater focus on intentionally filling the gap between early intervention services and those who need them, we could see more children receiving speech/language/communication services. Further suggestions for this are also discussed.
... They reported acceptable levels of sensitivity (>.70) for distinguishing children with ASD from children without ASD children under 4 years old (Giserman Kiss, Feldman, Sheldrick, & Carter, 2017;Kruizinga et al., 2014). Although the hallmarks of ASD are impairments in social communication and restricted, repetitive behavior and interests (American Psychiatric Association, 2013), social-emotional difficulties have been recalled by parents of children with ASD (De Giacomo & Fombonne, 1998) and prospectively noted by parents of infant siblings of children who are later diagnosed with ASD (Sacrey et al., 2015) by their first birthday. ...
... Asking caregivers to fill out a questionnaire about socialemotional development may reduce discomfort that can accompany questionnaires that query ASD specifically, especially for families who have not raised any concerns about ASD-related behavior in their younger children Zwaigenbaum et al., 2015). Furthermore, querying social-emotional differences in HR siblings provides clinically meaningful information by age one; up to 30% of caregivers have retrospectively recalled social-emotional developmental challenges (De Giacomo & Fombonne, 1998) and parents of HR siblings have prospectively endorsed more such challenges in children who are later diagnosed with ASD (Sacrey et al., 2015) during this period. ...
Article
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Understanding differences in social-emotional behavior can help identify atypical development. This study examined the differences in social-emotional development in children at increased risk of an autism spectrum disorder (ASD) diagnosis (infant siblings of children diagnosed with the disorder). Parents completed the Brief Infant-Toddler Social-Emotional Assessment (BITSEA) to determine its ability to flag children with later-diagnosed ASD in a high-risk (HR) sibling population. Parents of HR ( n = 311) and low-risk (LR; no family history of ASD; n = 127) children completed the BITSEA when their children were 18 months old and all children underwent a diagnostic assessment for ASD at age 3 years. All six subscales of the BITSEA (Problems, Competence, ASD Problems, ASD Competence, Total ASD Score, and Red Flags) distinguished between those in the HR group who were diagnosed with ASD ( n = 84) compared to non-ASD-diagnosed children (both HR-N and LR). One subscale (BITSEA Competence) differentiated between the HR children not diagnosed with ASD and the LR group. The results suggest that tracking early social-emotional development may have implications for all HR children, as they are at increased risk of ASD but also other developmental or mental health conditions.
... One of the first parental concerns leading to an assessment for possible autism is a delay or atypicalities in language and communication [1,2]. The diagnosis of autism spectrum disorder, most commonly given at a preschool age, occurs frequently when the child may be functionally non-verbal [3]. ...
... Data on early milestones are also prone to a telescoping effect [16,45], meaning that the older the child is, the later their milestones are reported. However, caregivers are generally more sensitive to language than other behavioral abnormalities [2,46] and ELR is the most consistently reported type of regression [44,47]. ...
Article
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Background Language delay is one of the major referral criteria for an autism evaluation. Once an autism spectrum diagnosis is established, the language prognosis is among the main parental concerns. Early language regression (ELR) is observed by 10–50% of parents but its relevance to late language level and socio-communicative ability is uncertain. This study aimed to establish the predictive value of ELR on the progression of language development and socio-communicative outcomes to guide clinicians in addressing parents’ concerns at the time of diagnosis. Methods We used socio-communicative, language, and cognitive data of 2,047 autism spectrum participants from the Simons Simplex Collection, aged 4–18 years (mean = 9 years; SD = 3.6). Cox proportional hazard and logistic regression models were used to evaluate the effect of ELR on language milestones and the probability of using complex and flexible language, as defined by the choice of ADOS module at enrollment. Linear models were then used to evaluate the relationship of ELR and non-verbal IQ with socio-communicative and language levels. Results ELR is associated with earlier language milestones but delayed attainment of fluent, complex, and flexible language. However, this language outcome can be expected for almost all autistic children without intellectual disability at 18 years of age. It is mostly influenced by non-verbal IQ, not ELR. The language and socio-communicative level of participants with flexible language, as measured by the Vineland and ADOS socio-communicative subscales, was not affected by ELR. Limitations This study is based on a relatively coarse measure of ultimate language level and relies on retrospective reporting of early language milestones and ELR. It does not prospectively document the age at which language catches up, the relationship between ELR and other behavioral areas of regression, nor the effects of intervention. Conclusions For autistic individuals with ELR and a normal level of non-verbal intelligence, language development follows a “bayonet shape” trajectory: early first words followed by regression, a plateau with limited progress, and then language catch up.
... In low-and middle-income countries, this rate is estimated to vary between 0.15% and 0.8%, whereas in a developing country such as Bangladesh this rate is reported to be 3% [9][10][11]. ASD symptoms gradually show up before 1 year of age, with nearly 80% of problems being identified by 2 years of age [12,13]. In particular, boys are affected 3 to 4 times more than girls with ASD [14]. ...
... Concerning parents' demography, educational level, occupation, family income and expenditures, number of siblings, and living area remain very important factors in the development of children with ASD [27][28][29][30]. Environmental factors such as the socioeconomic condition, neighborhood, and society's attitudes toward children with ASD are very significant [12,13]. Although genes increasing the risk for ASD in children are mostly prenatal [32], demography of parents remains very important [33], as it can affect the improvement of patients with ASD. ...
Article
Full-text available
Background: Care for children with autism spectrum disorder (ASD) can be challenging for families and medical care systems. This is especially true in Low-and-Middle-Income-countries (LMIC) like Bangladesh. To improve family-practitioner communication and developmental monitoring of children with ASD, [spell out] (mCARE) was developed. Within this study, mCARE was used to track child milestone achievement and family socio-demographic assets to inform mCARE feasibility/scalability and family-asset informed practitioner recommendations. Objective: The objectives of this paper are three-fold. First, document how mCARE can be used to monitor child milestone achievement. Second, demonstrate how advanced machine learning models can inform our understanding of milestone achievement in children with ASD. Third, describe family/child socio-demographic factors that are associated with earlier milestone achievement in children with ASD (across five machine learning models). Methods: Using mCARE collected data, this study assessed milestone achievement in 300 children with ASD from Bangladesh. In this study, we used four supervised machine learning (ML) algorithms (Decision Tree, Logistic Regression, k-Nearest Neighbors, Artificial Neural Network) and one unsupervised machine learning (K-means Clustering) to build models of milestone achievement based on family/child socio-demographic details. For analyses, the sample was randomly divided in half to train the ML models and then their accuracy was estimated based on the other half of the sample. Each model was specified for the following milestones: Brushes teeth, Asks to use the toilet, Urinates in the toilet or potty, and Buttons large buttons. Results: This study aimed to find a suitable machine learning algorithm for milestone prediction/achievement for children with ASD using family/child socio-demographic characteristics. For, Brushes teeth, the three supervised machine learning models met or exceeded an accuracy of 95% with Logistic Regression, KNN, and ANN as the most robust socio-demographic predictors. For Asks to use toilet, 84.00% accuracy was achieved with the KNN and ANN models. For these models, the family socio-demographic predictors of "family expenditure" and "parents' age" accounted for most of the model variability. The last two parameters, Urinates in toilet or potty and Buttons large buttons had an accuracy of 91.00% and 76.00%, respectively, in ANN. Overall, the ANN had a higher accuracy (Above ~80% on average) among the other algorithms for all the parameters. Across the models and milestones, "family expenditure", "family size/ type", "living places" and "parent's age and occupation" were the most influential family/child socio-demographic factors. Conclusions: mCARE was successfully deployed in an LMIC (i.e., Bangladesh), allowing parents and care-practitioners a mechanism to share detailed information on child milestones achievement. Using advanced modeling techniques this study demonstrates how family/child socio-demographic elements can inform child milestone achievement. Specifically, families with fewer socio-demographic resources reported later milestone attainment. Developmental science theories highlight how family/systems can directly influence child development and this study provides a clear link between family resources and child developmental progress. Clinical implications for this work could include supporting the larger family system to improve child milestone achievement. Clinicaltrial: We took the IRB from Marquette University Institutional Review Board on July 9, 2020, with the protocol number HR-1803022959, and titled "MOBILE-BASED CARE FOR CHILDREN WITH AUTISM SPECTRUM DISORDER USING REMOTE EXPERIENCE SAMPLING METHOD (MCARE)" for recruiting a total of 316 subjects, of which we recruited 300. (Details description of participants in Methods section).
... In low-and middle-income countries, this rate is estimated to vary between 0.15% and 0.8%, whereas in a developing country such as Bangladesh this rate is reported to be 3% [9][10][11]. ASD symptoms gradually show up before 1 year of age, with nearly 80% of problems being identified by 2 years of age [12,13]. In particular, boys are affected 3 to 4 times more than girls with ASD [14]. ...
... Concerning parents' demography, educational level, occupation, family income and expenditures, number of siblings, and living area remain very important factors in the development of children with ASD [27][28][29][30]. Environmental factors such as the socioeconomic condition, neighborhood, and society's attitudes toward children with ASD are very significant [12,13]. Although genes increasing the risk for ASD in children are mostly prenatal [32], demography of parents remains very important [33], as it can affect the improvement of patients with ASD. ...
Preprint
Full-text available
BACKGROUND Care for children with autism spectrum disorder (ASD) can be challenging for families and medical care systems. This is especially true in Low-and-Middle-Income-countries (LMIC) like Bangladesh. To improve family-practitioner communication and developmental monitoring of children with ASD, [spell out] (mCARE) was developed. Within this study, mCARE was used to track child milestone achievement and family socio-demographic assets to inform mCARE feasibility/scalability and family-asset informed practitioner recommendations. OBJECTIVE The objectives of this paper are three-fold. First, document how mCARE can be used to monitor child milestone achievement. Second, demonstrate how advanced machine learning models can inform our understanding of milestone achievement in children with ASD. Third, describe family/child socio-demographic factors that are associated with earlier milestone achievement in children with ASD (across five machine learning models). METHODS Using mCARE collected data, this study assessed milestone achievement in 300 children with ASD from Bangladesh. In this study, we used four supervised machine learning (ML) algorithms (Decision Tree, Logistic Regression, k-Nearest Neighbors, Artificial Neural Network) and one unsupervised machine learning (K-means Clustering) to build models of milestone achievement based on family/child socio-demographic details. For analyses, the sample was randomly divided in half to train the ML models and then their accuracy was estimated based on the other half of the sample. Each model was specified for the following milestones: Brushes teeth, Asks to use the toilet, Urinates in the toilet or potty, and Buttons large buttons. RESULTS This study aimed to find a suitable machine learning algorithm for milestone prediction/achievement for children with ASD using family/child socio-demographic characteristics. For, Brushes teeth, the three supervised machine learning models met or exceeded an accuracy of 95% with Logistic Regression, KNN, and ANN as the most robust socio-demographic predictors. For Asks to use toilet, 84.00% accuracy was achieved with the KNN and ANN models. For these models, the family socio-demographic predictors of “family expenditure” and “parents’ age” accounted for most of the model variability. The last two parameters, Urinates in toilet or potty and Buttons large buttons had an accuracy of 91.00% and 76.00%, respectively, in ANN. Overall, the ANN had a higher accuracy (Above ~80% on average) among the other algorithms for all the parameters. Across the models and milestones, “family expenditure”, “family size/ type”, “living places” and “parent’s age and occupation” were the most influential family/child socio-demographic factors. CONCLUSIONS mCARE was successfully deployed in an LMIC (i.e., Bangladesh), allowing parents and care-practitioners a mechanism to share detailed information on child milestones achievement. Using advanced modeling techniques this study demonstrates how family/child socio-demographic elements can inform child milestone achievement. Specifically, families with fewer socio-demographic resources reported later milestone attainment. Developmental science theories highlight how family/systems can directly influence child development and this study provides a clear link between family resources and child developmental progress. Clinical implications for this work could include supporting the larger family system to improve child milestone achievement. CLINICALTRIAL We took the IRB from Marquette University Institutional Review Board on July 9, 2020, with the protocol number HR-1803022959, and titled “MOBILE-BASED CARE FOR CHILDREN WITH AUTISM SPECTRUM DISORDER USING REMOTE EXPERIENCE SAMPLING METHOD (MCARE)” for recruiting a total of 316 subjects, of which we recruited 300. (Details description of participants in Methods section)
... However, this finding should be considered with caution. While it contradicts some reports (De Giacomo & Fombonne, 1998;Young et al., 2003) where parents recall abnormalities dating to the first year of life, it is in line with Volkmar et al. (2005, p. 318) who suggest that some children who are later diagnosed with ASD may progress normally for a period of time, or may not manifest signs of the disorder in the first year of life and then gradually or rapidly lose the skills and begin to manifest the autistic symptomatology. Ozonoff et al. (2010) suggest that signs of autism emerge over the first year or so of life in many children with ASD, rather than being present from close to birth. ...
... Thus speech and language problems usually trigger parental concern of the Autistic disorder group (73.1%), while it is more rarely reported as first concern for Asperger or other disorder (40.0%). This finding is consistent with the literature (De Giacomo & Fombonne, 1998;Howlin & Asgharian, 1999;Howlin & Moore, 1997;Noterdaeme & Hutzelmeyer-Nickels, 2010) where speech and language problems are among the most common early symptoms to be noted by parents. Behavior problems and 'difficulties in education at school' are more prevalent in the Asperger or other disorder subgroup. ...
Article
Early diagnosis of autism spectrum disorder (ASD) is of paramount importance as it opens the road to early intervention, which is associated with better prognosis. However, early diagnosis is often delayed until preschool or school age. The purpose of the current retrospective study was to explore the age of recognition of first alarming symptoms in boys and girls as well as the age at diagnosis of different subtypes of ASD in a small sample. A total of 128 parents’ of children with ASDs were participated in the survey by completing a self-report questionnaire about early signs and symptoms that raised their concern. Parents of children with autism voiced concerns earlier and obtained diagnosis significantly earlier compared to parents of children with Asperger syndrome (p value <0.000). No significant difference (p value<0.05) has been detected between males and females in early manifestation of first signs and symptoms of ASD. The mean age at diagnosis was 3.8 years for autistic disorder, 6.2 years for children with Asperger syndrome and 6.4 years for other, e.g., PDD-NOS. The most commonly reported symptoms were speech and language problems (p value = 0.001) for children who were later diagnosed with autism, while behavior problems (p value = 0.046) as well as difficulties in education at school (p value = 0.013) for children with Asperger syndrome. The gap between early identification and diagnosis pinpoints the urgent need for national systematic early screening, the development of reliable and sensitive diagnostic instruments for infants and toddlers and heightened awareness of early signs of ASD among parents, teachers, and healthcare professionals and providers as well.
... ASD is a neurodevelopmental disorder characterized by persistent deficits in social communication and social interaction and by restricted and repetitive patterns of behavior, interests, or activities [16]. Although language difficulties are not a requisite for an ASD diagnosis, language delay is often the first issue raised by parents of children later diagnosed with ASD [17,18]. There is significant heterogeneity in the extent of language deficits that co-occur with ASD. ...
... All were native Hebrew-speaking children with Hebrewspeaking parents. The children in the ASD group had been previously diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders -DSM-5 [17] as high-functioning children with ASD by a multidisciplinary assessment team external to the research group. This is a legal procedure in Israel that determines entitlement to special education provision. ...
Article
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Objectives: This study aims to investigate the ability of high-functioning children with autism spectrum disorder and normal language (ALN) to learn artificial words, and to investigate their ability to use their knowledge of morphophonological patterns for this learning. Methods: Children with ALN and typically developing (TD) children, matched for cognitive and language measures, learned 8 artificial Hebrew words during two daily practice sessions by means of identification and naming tasks. Half the words were constructed from existing morphophonological patterns, and the other half were constructed from pseudo-morphophonological patterns. The two types of words allowed the investigation of the participants' ability to use their knowledge of morphophonological patterns (morpholexical processes) for word learning. Both accuracy and speed were measured. Results: The ALN group improved incrementally at a rate (slope) similar to that of the TD group in identifying and naming the artificial words, in both accuracy and speed. However, the ALN group were slower than their TD peers in learning to identify the artificial words. Both groups demonstrated higher accuracy and faster speed in both tasks in learning the artificial words with existing morphophonological patterns than those with pseudo-patterns. However, this gap was smaller in the ALN group in the accuracy of naming and marginal in speed of identification. Conclusions: Children with ALN possess a lexical learning mechanism that is qualitatively not atypical but may be less efficient than that of their TD peers, including exploiting knowledge of morphophonological patterns - where such patterns exist - for word learning.
... Drissa Traore were found to be culturally inappropriate in the Malian context [12]. Timely ASD diagnosis requires early detection, which depends on parental recognition of developmental abnormalities [13]. In the U.S, parental concerns of childhood developmental abnormalities have been shown to in uence early or late ASD screening and diagnosis as well as the overall well-being of autistic children [14,15]. ...
... Parents with both high socio-economic status (S.E.S) and high education level tend to be more concerned about their child developmental than those with low S.E.S and education level. They may easily access healthcare for ASD screening, monitoring and surveillance [12,13,18]. ...
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Background In Mali, the health facility-based prevalence of autism spectrum disorders (ASD) in Mali was 4.5% (105/2,343) and the age of first medical visit for autistic children was around 7 years old in 2018. Parental recognition of developmental abnormalities initiates the early autism detection and diagnosis. We aimed to assess the feasibility of a main study to associate parental concerns with early first medical visits and subsequent ASD diagnostic in Mali.Methods We conducted a pilot study from November 2017 to July 2019. We surveyed 57 parents of autistic children aged 3-14 years old.ResultsParents were concerned over verbal communication in 54.1% and reciprocal social interaction in 43.8%. Children with ASD had their first medical visit after 18 months old in 66.7%, ≥ two medical visits in 87.7%, and were identified after 36 months old in 76.8%.Conclusion Parental concerns were not significantly associated with early first medical visit and ASD identification. This pilot study will help in the design of larger studies on the same topic in Mali.
... The finding that early deficits in communication are predictive of early diagnosis is consistent with earlier studies which found that problems with verbal and nonverbal communication, rather than abnormal social interactions or presence of restricted/repetitive behaviors, are key for early detection of ASD [27]. Using, to our knowledge, one of the biggest sample to date, we replicated the finding from a number of studies that parental concerns about child's communication are the earliest signs of an underlying ASD [34][35][36]. As we noted earlier, the most likely explanation for this finding is that these symptoms index what parents expect of normal development in the home in the first 2 years of life. ...
Article
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Background The objective of this study is to gain new insights into the relationship between clinical signs and age at diagnosis. Method We utilize a new, large, online survey of 1743 parents of children diagnosed with ASD, and use multiple statistical approaches. These include regression analysis, factor analysis, and machine learning (regression tree). Results We find that clinical signs that most strongly predict early diagnosis are not necessarily specific to autism, but rather those that initiate the process that eventually leads to an ASD diagnosis. Given the high correlations between symptoms, only a few signs are found to be important in predicting early diagnosis. For several clinical signs we find that their presence and intensity are positively correlated with delayed diagnosis (e.g., tantrums and aggression). Even though our data are drawn from parents’ retrospective accounts, we provide evidence that parental recall bias and/or hindsight bias did not play a significant role in shaping our results. Conclusion In the subset of children without early deficits in communication, diagnosis is delayed, and this might be improved if more attention will be given to clinical signs that are not necessarily considered as ASD symptoms. Our findings also suggest that careful attention should be paid to children showing excessive tantrums or aggression, as these behaviors may interfere with an early ASD diagnoses.
... Autism in its prototypical form is usually detected by parents around the middle of the second year of life [14,15] through a set of mainly socio-communicative signs (decreased response to name, social synchrony, oriented smiling, initiative and response to joint attention, imitation, and eye contact) and language signs (absence of language development or loss of the few words already acquired by the child. ...
Preprint
What does the way autistics bypass, learn, and eventually master language tell us about human linguistic ability? Here, we argue that non-social acquisition of language, in addition to representing a strong argument for nativist models of human language, may be encompassed within the human-specific orientation and mastery of complex embedded structures, of which language represents one realization. Non-social language learning could thus represent the extension of available linguistic, and non-linguistic material processed by human genetic constraints, allowing language acquisition. This deviation from typical developmental language acquisition may ultimately allow access to language, sometimes in its most elaborate forms, and also explains the possibility of the absence of its development when applied to primarily non-linguistic structured material. However, such enlargement of material-specificity does not cast doubts about its human nature. Regardless of the adaptive success or failure of non-social language learning, it is up to science, legal policies, and ethical principles to strive to maintain autism as a human potentiality to further foster our vision of a plural society.
... The social attention and communication study (SACS) is a useful and valid clinicianrated checklist for age-specific risk behaviors in ASD, which can be implemented in children younger than 24 months (Barbaro & Dissanayake, 2010). However, this age restriction may limit the applicability of the instrument because parents in communities with a lower cultural awareness regarding ASD may not be aware of the ASD-related behaviors until much later in their child's development (De Giacomo & Fombonne, 1998;Qian et al., 2012). ...
Article
This study validates behavior development screening for toddlers (BeDevel), which utilizes a combination of short caregiver interviews (BeDevel‐I) and semistructured play observations (BeDevel‐P). The data of 431 toddlers (male 66.2%; mean age (SD) = 29.11 (8.59) months; ASD, n = 201; developmental delay, n = 46; typically developing, n = 184), aged 18 ~ 42 months, were included in the validation of BeDevel. The best clinical estimate diagnosis, screening rate, validity, sensitivity, and reliability of BeDevel were determined based on data cross‐sectionally collected using BeDevel and existing diagnostic/screening instruments: autism diagnostic observation schedule (ADOS), autism diagnostic interview (ADI‐R), Vineland adaptive behavior scales‐II (VABS‐II), social response scales (SRS), sequenced language scale for infants (SELSI), Korean childhood autism rating scale (K‐CARS), and Korean social communication questionnaire (K‐SCQ). The k values of BeDevel‐I and BeDevel‐P were 0.055 ~ 0.732 and 0.291 ~ 0.752, respectively. Items related to social referencing in BeDevel‐P had a particularly high diagnostic validity (k = 0.483 ~ 0.684). Reliabilities of BeDevel‐I and BeDevel‐P were sufficient (Cronbach's alpha = 0.86 ~ 0.88 and 0.92 ~ 0.95, respectively). BeDevel‐I and BeDevel‐P showed high sensitivity (BeDevel‐I: 85.00 ~ 89.29%; BeDevel‐P: 85.00 ~ 91.75%), specificity (BeDevel‐I: 77.55 ~ 89.55%; BeDevel‐P: 85.09 ~ 97.01%), PPV (BeDevel‐I: 70.83 ~ 88.54%; BeDevel‐P: 81.52 ~ 94.68%), and NPV (BeDevel‐I: 76.00 ~ 95.24%; BeDevel‐P: 84.62 ~ 95.45%). The agreement between the composite BeDevel score and ADOS, ADI‐R, K‐CARS, and K‐SCQ was >67.6% (range = 67.6 ~ 90.8%). Combining a short caregiver interview and direct play observation is a valid and reliable screening process. More studies on social referencing as an important early marker are needed. BeDevel can be utilized as a secondary screening instrument before diagnostic confirmation in clinical and community settings. Lay summary BeDevel, which consists of a short caregiver interview and direct play observation, is a valid and reliable screening instrument for autism spectrum disorder (ASD). We suggest that BeDevel can be utilized as a secondary instrument before administering diagnostic assessments in clinical and community settings. More studies examining social referencing as a potential behavioral marker of ASD are needed.
... El porcentaje de padres que reconocen alguna alteración del desarrollo antes de la edad de 1 año (18,2%) y antes de la edad de dos años (59%) también es menor a lo observado en otros estudios. Publicaciones, provenientes de diferentes diseños y poblaciones de estudio, informan un promedio de rango de edad de las primeras preocupaciones entre 14 y 24 meses, con aproximadamente un tercio de los padres reportando primeras preocupaciones a la edad de un año, y tres cuartos a los 2 años 11,[22][23][24][25][26][27][28] . El retraso en el reconocimiento de las dificultades, observado en esta muestra, señalaría una menor conciencia de los hitos del desarrollo temprano en el área social y emocional, específicamente de los signos de alerta de autismo, comparativamente con otros logros del desarrollo como son los hitos el desarrollo motor. ...
Article
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Introducción: Los Trastornos del Espectro Autista (TEA) son desórdenes del neurodesarrollo de prevalencia en aumento. Las personas TEA tienen múltiples necesidades de salud, educación y comunitarias. En Chile existe escasa información al respecto. Objetivo: Conocer características demográficas, clínicas, primeras preocupaciones de sus cuidadores y la edad de diagnóstico de personas TEA. Pacientes y Método: Participaron padres/cuidadores de personas TEA, quienes respondieron la Encuesta de Ne cesidades de Cuidadores, desarrollada por Autism Speaks para este propósito específico y traducida al español. La encuesta comprende 4 secciones: información demográfica, características de la persona TEA, utilización pasada y presente de Servicios de Salud y Educación y percepciones de Padres/Cui dadores en cuanto a satisfacción, impacto, estigma, y calidad de vida. Aquí se reporta información proveniente de las dos primeras secciones. Resultados: Participaron 291 cuidadores (86% madres) de 291 personas TEA, 89% varones, de entre 1-40 años (X: 10,4 DE: 6,1). La edad promedio de primeras preocupaciones fue 29,2 m (DE: 23,8) y las principales fueron: dificultades en interacción (79,4%), respuesta inusual a estímulos sensoriales (69,8%), dificultades de comportamiento (65,3%), gestos/ movimientos inusuales (64,3%), falta de contacto visual (63,6%). La edad promedio de diagnóstico fue 58 m (DE: 36,5), con retraso promedio del diagnóstico de 29 m. El diagnóstico fue realizado por neurólogos pediátricos (44,7%), psiquiatras infantiles (19,2%), pediatras (5,5%). Las comorbilidades más frecuentes fueron compromiso de lenguaje, déficit cognitivo y problemas conductuales. Con clusiones: La tardía edad de diagnóstico y la gran brecha entre edad de primeras preocupaciones y diagnóstico de TEA representan una pérdida crítica de oportunidades de tratamiento, lo que puede poner en riesgo las posibilidades de un mejor pronóstico futuro.
... Delay in language development constitutes one of the first predictive factors of ASD in childhood [37]. Non-normotypical linguistic development, according to many researchers, is interpreted based on structural-functional differences in temporal areas of the brain. ...
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Autistic Spectrum Disorders (ASD) is an umbrella term that describes a range of common neurodevelopmental disorders affecting approximately 1% of the population. ASD are characterized by multilateral shortages, such as difficulties in communication and social interaction, repetitive, stereotypical behaviors and a limited scope of interests, mobility problems and disorders of language development, as well. These deficits do not follow the norm; on the contrary, great differentiation in their profiles and severity is observed between different people. ASD have, to a great degree, a hereditary, genetic basis however up to a decade ago, the researchers focusing on their neurobiological background were few. The present review study is an attempt to shed light on the neurobiological pathway of Autism Spectrum Disorder. The last decade, there has been an intense research emphasizing on the polymorphous patterns of neurobiological mutations present in ASD. The findings pertain to such diverse differences compared to the neurotypical population in the neural, structural-functional, molecular, endocrine, electrophysiological and genetic levels and also in the connectivity and neurotransmission levels, that many investigators are led to a hypothesis of a radically different brain organization [1-3]. Based on the neurobiological findings, we are now able to explain about 10%-20% of ASD cases. In the following sections, detailed descriptions of the neurobiological differences of individuals with ASD are given compared to the neurotypical population at various levels and their association with the cognitive and behavioral profile of the observed deficits. One of the first confirmed findings is regarding the non-normotypical brain over-development of people with ASD during childhood. The majority of studies were conducted on infants or children aged one year or over, for the duration of their childhood. Thus, researchers hypothesize that this over-development might be related to the first clinical symptoms of autism, cognitive and behavioral, observed at this age [4]. For example, in a recent study, Hazlett et al. examined the growth rate of cerebral volume (white and gray matter) and cortical thickness in children aged two years [5]. They also performed a repeat measurement two years later. The results showed that children with ASD had approximately 9% greater gray and white matter volume compared to the control group at both time points, while they did not differ in cortical thickness. Despite this difference, the rate of brain development was the same between the groups, as was indicated by the lack of intergroup differences in cerebral volume between the two time points, which according to the researchers is due to an increased growth rate before the age of two. The study by Schumann et al. resulted in similar findings, the difference being that the size and growth rate of gray matter were greater in the anterior areas of the brain (frontal, temporal, parietal) compared to the posterior areas [6]. Moreover, non-normotypical over-development was mainly observed in the temporal regions. In addition, in a rare recent study, Calderoni et al. investigated the brain volume of various structures in a group consisting entirely of girls with ASD (2 to 7 years old) and a matched control group [7]. The findings showed a 5% greater overall size of intracranial structures in girls with ASD compared to the control group, and a particularly noticeable enlargement in gray matter in the superior frontal gyrus bilaterally and in the right temporo-Review Article iMedPub Journals www.imedpub.com
... Although language impairments are not a core criterion for ASD, they are a very common feature and play a central role in specifying an individual's unique presentation (American Psychiatric Association, 2013). Professional assessments are often motivated by parental concerns about delayed language acquisition (De Giacomo & Fombonne, 1998), and a significant sub-group are minimally verbal throughout their lifetime (Pickles, Anderson, & Lord, 2014). These individuals often present with complex communication needs and intellectual disabilities that impact their cognitive development and independence (Fernell, Eriksson, & Gillberg, 2013). ...
... their child in the first place (Dahlgren & Gillberg, 1989;De Giacomo & Fombonne, 1998). Thus, children with ASD are often identified due to their delay in language milestones. ...
Article
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Language skills as well as general cognitive skills show a considerable variation in children with autism spectrum disorder (ASD). In previous studies, at least three profiles based on these skills have been suggested; autism with language and non-verbal cognitive skills within the average/normal range (ALN), autism with language disorder (ALD) without concurrent non-verbal cognitive disability, and autism with language disorder and cognitive disability, i.e. autism with a more general delay (AGD). The aim of the present longitudinal case study is to illustrate these three groups more thorough by presenting the developmental trajectories of children belonging to each profile. Six children were chosen based on their language and cognitive profiles from the first age 3-year assessment. They came from a larger group of children with ASD identified by autism screening at child health-care centres at age 2.5 years. These six children represent one boy and one girl from each of the three subgroups ALN, ALD and AGD, and were assessed a second time at age 5 and a third time at age 8 years, regarding expressive and receptive language skills, autistic severity and non-verbal cognitive skills. Although preliminary, our results indicate a rather stable developmental trajectory from age 3 to 8 years characterising children with autism based on language and non-verbal cognitive functioning. Thus, in order to help intervention planning and increase predictions of outcome, it seems important to specify both linguistic and cognitive level already at the first assessment in children with ASD.
... Although autism spectrum disorder (ASD) usually is not diagnosed until age 4 years, 1 parents' retrospective concerns indicate that symptoms may emerge earlier, often within the first year of life. 2 This lag time can increase parental anxiety and delay access to ASD interventions and family support. Given evidence that early intervention can positively affect children [3][4][5] and families, 6 improving our ability to identify the earliest signs of ASD can promote access to early intervention and maximize developmental gains. ...
Article
Aim To examine parental concerns about children at increased familial risk (i.e. high risk) of developing autism spectrum disorder (ASD) in early infancy. Method ASD-related and general parental concerns were prospectively collected for 76 infants at ages 1.5, 3, 6, 9, 12, and 18 months. Outcome classification was determined at 36 months. Analyses included generalized linear mixed models and qualitative evaluation of parental concerns in relation to risk status (high vs low risk) and outcome classification within the high-risk group (atypically developing vs typically developing) over time. Results Most parents had no concerns at 1.5 (high risk 71%, low risk 87%) and 3 months (high risk 77%, low risk 86%). Beginning at 6 months, parents of high-risk infants reported more ASD-related (p<0.001) and general concerns (p=0.003) than parents of low-risk infants. Beginning at 12 months, parents of high-risk atypically developing infants reported more ASD-related concerns than parents of high-risk typically developing infants (p=0.013). Interpretation Clinicians should elicit parental concerns and provide support, as parents are worried about their high-risk infants by age 6 months. Additionally, parents’ abilities to identify concerns that are suggestive of ASD by age 12 months may aid in earlier screening and intervention.
... Yet, current evidence suggests little progress toward earlier diagnoses (Brett, Warnell, McConachie, & Parr, 2014), with recent US (Baio et al., 2018;Christensen et al., 2016) and UK (Brett et al., 2014) studies reporting a mean age of diagnosis at around 4-5 years. Recognizing that many parents identify developmental concerns much earlier (De Giacomo & Fombonne, 1998;Sacrey et al., 2015), there remains considerable opportunity to shorten the stressful "diagnostic odyssey" that many families experience (Goin-Kochel, Mackintosh, & Myers, 2006;Wiggins, Baio, & Rice, 2006;Zwaigenbaum & Penner, 2018). ...
Article
The objectives were to characterize behavioral signs of autism spectrum disorder (ASD) in younger siblings of diagnosed children (high-risk; HR) and examine classification features of the Autism Observation Scale for Infants (AOSI). Participants (501 HR and 180 low-risk [LR]) were assessed between 6 and 18 months using the AOSI and at age 3 for ASD diagnoses. Total AOSI scores differentiated HR infants later diagnosed with ASD starting at 12 months. ROC analyses identified 12- and 18-month cutoff scores associated with 0.52 sensitivity and 0.74 specificity and 0.73 sensitivity and 0.65 specificity, respectively. Although classification accuracy does not support use as a standalone screen, the AOSI identifies features associated with ASD starting at 6 months and differentiates HR infants with ASD by 12 months.
... Parents with both high socio-economic status (S.E.S) and high education level tend to be more concerned about their child developmental than those with low S.E.S and education level. They may easily access healthcare for ASD screening, monitoring and surveillance [12,13,18]. ...
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Background: In Mali, the health facility-based prevalence of autism spectrum disorders (ASD) in Mali was 4.5% (105/2,343) and the age of first medical visit for autistic children was around 7 years old in 2018. Parental recognition of developmental abnormalities initiates the early autism detection and diagnosis. In this pilot study, our aim was to investigate if parental concerns were associated with early first medical visits and subsequent ASD diagnostic in Mali. Methods: We conducted a pilot study from November 2017 to July 2019. We surveyed 57 parents of autistic children aged 3-14 years old. Results: Parents were concerned over verbal communication in 54.1% and reciprocal social interaction in 43.8%. Children with ASD had their first medical visit after 18 months old in 66.7%, ≥ two medical visits in 87.7%, and were identified after 36 months old in 76.8%. Conclusion: Parental concerns were not significantly associated with early first medical visit and ASD identification. This pilot study will help in the design of larger studies on the same topic in Mali.
... Hence, especially in single-child families, children may not show obvious symptoms of ASD at home. With family size trending downward, recognizing signs of ASD in their young children is a major challenge for more and more parents (De Giacomo & Fombonne, 1998;Zwaigenbaum et al., 2005). It would be helpful to supplement parent reports (based on existing instruments such as Autism Behavior Checklist, Volkmar et al., 1988; Developmental Behavior Checklist-Early Screen, Gray & Tonge, 2005; Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F), Robins et al., 2014;Pervasive Developmental Disorder Screening Test-II, Siegel, 2004) with other sources of information. ...
Article
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Lay abstract: With professional training and regular opportunities to observe children interacting with their peers, preschool teachers are in a good position to notice children's autism spectrum disorder symptomatology. Yet even when a preschool teacher suspects that a child may have autism spectrum disorder, fear of false alarm may hold the teacher back from alerting the parents, let alone suggesting them to consider clinical assessment for the child. A valid and convenient screening tool can help preschool teachers make more informed and hence more confident judgment. We set out to develop a screening tool that capitalizes on peer interaction as a naturalistic "stress test" to identify children more likely than their peers to have autism spectrum disorder. A total of 304 3- to 4-year-olds were observed at school with an 84-item preliminary checklist; data-driven item reduction yielded a 13-item Classroom Observation Scale. The Classroom Observation Scale scores correlated significantly with Autism Diagnostic Observation Schedule-2 scores. To validate the scale, another 322 2- to 4-year-olds were screened using the Classroom Observation Scale. The screen-positive children and randomly selected typically developing peers were assessed for autism spectrum disorder 1.5 years later. The Classroom Observation Scale as used by teachers and researchers near preschool onset predicted autism spectrum disorder diagnoses 1.5 years later. This user-friendly 13-item Classroom Observation Scale enables teachers and healthcare workers with little or no clinical training to identify, with reliable and valid results, preschoolers more likely than their peers to have autism spectrum disorder.
... Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder characterized by social communication deficits and patterns of restricted and repetitive behavior. The average age of first words for individuals with ASD is approximately 36 months, in contrast to the expected onset at around 18 months, making expressive language delay the most common reason parents of individuals with ASD seek diagnostic and clinical services (De Giacomo and Fombonne 1998;Franchini et al. 2018). Individuals with ASD who have few to no functional words are considered minimally verbal Koegel et al. 2020) and an estimated 30% of individuals with ASD are classified as such during adulthood (Tager-Flusberg and Kasari 2013; Rose et al. 2016). ...
Article
About 30% of adults with autism are minimally verbal. Past research suggested that after age five, few gain verbal fluency, but studies have rarely investigated whether family environmental factors contribute to the acquisition of verbal fluency. The present study utilized data from the Autism Diagnostic Interview-Revised to compare changes in verbal fluency for 404 individuals with autism from childhood to adolescence and adulthood. Socioeconomic factors were examined across fluency groups (i.e., those who did/did not achieve verbal fluency). Findings indicated that fully 60% of those who were minimally verbal in early childhood acquired verbal fluency in adolescence and adulthood. Parent socioeconomic status differed across fluency groups, suggesting the importance of environmental factors for individual development.
... Previous researches suggest that in young children with ASD, verbal development is predicted by both verbal and nonverbal skills such as joint attention, play development, imitation and motor skills (which remain under-developed) (Paul et al., 2008;Thurm et al., 2007;Charman et al. 2003;Charman et al. 2005;Weismer et al., 2010;Manwaring et al., 2017;Stone & Yoder 2001). Usually delayed language milestones concern the parents to seek clinical consultation (Bolton et al., 2012;De Giacomo & Fombonne, 1998;Richards et al., 2016). Verbal communication impairment involves difficultly in initiating and sustaining a conversation such that even normal conversations like the exchange of ideas become challenging for them. ...
Chapter
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Autism spectrum disorder (ASD), a neurodevelopmental disorder, manifests as impairment in social communication an interaction with restrictive and repetitive patterns of behaviour. Yoga therapy, a mind-body intervention, employs a multi-dimensional approach to reduce psychological distress and bring balance and harmony at the levels of body, breath and mind through physical postures, breathing practices, chanting, and relaxation techniques, respectively, thus enhancing overall well-being. Various yoga studies have shown promise in improving symptoms of ASD by improvement in sensory processing, gross motor skills, balance and coordination, cognition, imitation skills, and the ability to connect in relationships. This chapter aims to provide an overview of the potential role of Yoga therapy in the management of ASDs with emphasis on future standardized yoga trials with robust methodology and long-term follow-ups to establish the clinical utility of Yoga therapy for the same. Also, a tentative yoga lifestyle module for ASD with necessary contra-indications and practical tips has been provided.
... Interestingly, social impairment was the most prominent early indicator of autism that participants identified with. The symptoms described by the participants in this study are in line with the findings of other studies which describe such difficulties as being early concerns of parents of children who were later diagnosed with autism (De Giacomo & Fombonne, 1998;Welton, 2004;Young et al., 2003;Zeleke et al., 2017). This suggests that some of the delays in identifying early symptomatic features described by the participants may reflect parents' and professionals' difficulty in understanding them, rather than the absence of symptoms per se. ...
Article
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Autism Spectrum Disorder (ASD) is a pervasive neurodevelopmental disorder associated with qualitative impairments in social interaction, social communication and restricted, repetitive behaviour (American Psychiatric Association, 2013). Symptoms of ASD are first evident in infancy and childhood. However, individuals presenting with less overt ASD symptomatology may only be diagnosed in adulthood, when the expectation of independence and productivity results in a growing crisis for the individual. This study applied an exploratory qualitative research design to explore first-hand experiences of ten adult males (25 years and above) who were diagnosed with autism during their adulthood. Purposive sampling was used to select participants through the Neurodiversity Centre, Cape Town, South Africa. In-depth one-on-one interviews, guided by a semi-structured interview schedule were conducted. The thematic analysis technique and NVivo 12 qualitative analysis software were used to organise the data and identify themes. Three key themes emerged: failure to diagnose ASD in childhood despite signs and symptoms, ramifications of missed/misdiagnosis in childhood and adulthood on psychological well-being and the impact of receiving a diagnosis of ASD in adulthood. Missed/misdiagnosis had serious implications for psychological well-being throughout childhood and into adulthood. Late diagnosis resulted in missed opportunities for early intervention to address impairments associated with ASD. Receiving a diagnosis provided an explanation for long standing difficulties, offered a way forward in terms of developing coping strategies and allowed for self-acceptance. The implications of these findings for the development of better early screening and assessment for ASD are discussed and future research pathways suggested.
... Language difficulties associated with autism or fragile X syndrome Delays in language development are common in young children with autism or FXS (De Giacomo and Fombonne, 1998;McDuffie et al., 2017) and are often observed well beyond early childhood (Hartley et al., 2011;Howlin et al., 2014). For individuals with autism, language delays are often noticed early in development (Tager-Flusberg et al., 2009;Boucher, 2012;Talbott et al., 2015). ...
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Early development marks a period of rapid learning facilitated by children’s natural curiosity about the people around them. In children with typical development, these early social attentional preferences set the foundation for learning about and from the surrounding world of people. Much of this learning happens using joint attention, the ability to coordinate attention between people and objects of mutual interest. It is well documented that decreased gaze use is commonly observed in individuals with autism and individuals with fragile X syndrome (FXS). Despite the growing body of research comparing phenotypic similarities between individuals with autism and individuals with FXS, no studies have directly compared joint attention performance between these groups. In the present study, we considered the similarities and differences in joint attention between preschool-aged boys with autism or FXS, and the relation between joint attention, language, and other phenotypic characteristics known to differ between boys with autism and boys with FXS. Although joint attention appeared similar, between-group differences emerged when controlling for the influence of age, non-verbal IQ, and autism symptom severity. Differences were also observed when considering how joint attention performance related to other aspects of the phenotype. For example, strong positive associations were observed between joint attention and language performance in boys with autism but not boys with FXS, even after controlling for non-verbal IQ. In contrast, the negative association between joint attention and anxiety symptom severity was significant and stronger in boys with FXS than in autism. These data offer preliminary insights into the similarities and differences between the autism and FXS phenotypes.
... Autism in its prototypical form is usually detected by parents around the middle of the second year of life through a set of mainly socio-communicative signs (decreased response to name, social synchrony, oriented smiling, initiative and response to joint attention, imitation, and eye contact) and language signs (absence of language development or loss of the few words already acquired by the child) [44,45]. ...
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What does the way autistics bypass, learn, and eventually master language tell us about humans’ genetically encoded linguistic ability? In this theoretical review, we argue that autistic non-social acquisition of language, as well as autistic savant abilities, provide a strong argument for an innate, human-specific orientation toward (and mastery of) complex embedded structures. Autistic non-social language learning may represent a widening of the material processed during development beyond oral language. Structure detection and manipulation and generative production of non-linguistic embedded and chained material (savant abilities in calendar calculation, musical composition and interpretation, three-dimensional drawing) may thus represent an application of such innate mechanisms to non-standard materials. Typical language learning through exposure to the child’s mother tongue may represent but one of many possible achievements of the same capacity. The deviation from typical language development in autism may ultimately allow access to oral language, sometimes in its most elaborate forms, but also explains the possibility of the absence of its development when applied exclusively to non-linguistic structured material. Such an extension of human capacities beyond, or in parallel to, their usual limits call into question what we consider to be specific or expected in humans and, therefore, does not necessarily represent a genetic “error”. Regardless of the adaptive success or failure of non-social language learning, it is up to science and ethical principles to strive to maintain autism as a human potentiality to further foster our vision of a plural society.
... The description of behaviors presented in the questionnaire was inspired by 18 behaviors related to social communication and play described in the literature (Barbaro and Dissanayake, 2009;Robins et al., 2009;Barbaro et al., 2011) and available in Spanish (Albores-Gallo et al., 2012). In order to present a wide range of autism-related behaviors, the questionnaire also included one item related to expressive language delay, reported as one of the first signs alerting parents in different cultures (De Giacomo and Fombonne, 1998;Daley, 2004). Two questions about challenging behaviors that can be present in some young children developing with ASD (Matson et al., 2010(Matson et al., , 2011 were also included. ...
Article
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The identification and diagnosis of children with autism currently rely on behavioral presentation and developmental history. Cultural norms and other socio-demographic factors can influence what is expected or non-expected behaviors in a developing child. Perceptions, beliefs, and causal attribution of early signs can influence families’ help-search behaviors. Lack of recognition of autism’s first manifestations can critically delay the age of diagnosis, the provision of informed guidance to families, and the implementation of adapted interventions during the critical period of early development. Furthermore, a lack of understanding of early signs as the manifestations of a developmental condition may increase stigma and non-conventional explanations. Still, cultural and socio-demographic factors are largely understudied, particularly in low-and middle-income settings. Based on the hypothesis that non-specialists such as family members and friends are one of the first sources of referral in Latin American contexts, we aimed to study the general population’s perceptions and the explanatory causes of autism’s early signs. One-hundred-and-eighty-three Ecuadorian adults responded to a questionnaire developed for this study, describing sixteen ASD-related behaviors. Results indicated that, with the exemption of language impairment and self-injurious behaviors, a substantial proportion of participants did not endorse many behaviors as “concerning and requiring professional attention.” Also, language impairment was the only behavior identified as related to a developmental disorder. Additionally, most participants attributed the majority of behaviors listed in the questionnaire to causes unrelated to ASD, such as child personality. We discuss the impact of those findings in clinical practice and on awareness programs.
... While social communication is universally impaired in this population, there is considerable variation in structural language abilities, i.e., lexicon, syntax (Eigsti et al., 2011;Ellis Weismer and Kover, 2015;Koegel et al., 2020). Early language/communication delays are among the initial red flags for ASD (NICHD, 2021) and are often one of the first concerns noted by parents (De Giacomo and Fombonne, 1998;Eigsti et al., 2011). Importantly, early language abilities predict broader outcomes for children with ASD, including response to treatment and cognitive outcomes (Stone and Yoder, 2001;Szatmari et al., 2003;Eigsti et al., 2011). ...
Article
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Language delay is often one of the first concerns of parents of toddlers with autism spectrum disorder (ASD), and early language abilities predict broader outcomes for children on the autism spectrum. Yet, mechanisms underlying language deficits in autistic children remain underspecified. One prominent component of linguistic behavior is the use of predictions or expectations during learning and processing. Several researcher teams have posited prediction deficit accounts of ASD. The basic assumption of the prediction accounts is that information is processed by making predictions and testing violations against expectations (prediction errors). Flexible (neurotypical) brains attribute differential weights to prediction errors to determine when new learning is appropriate, while autistic individuals are thought to assign disproportionate weight to prediction errors. According to some views, these prediction deficits are hypothesized to lead to higher levels of perceived novelty, resulting in “hyperplasticity” of learning based on the most recent input. In this article, we adopt the perspective that it would be useful to investigate whether language deficits in children with ASD can be attributed to atypical domain-general prediction processes.
... Early in the second year of life, parental concerns may include behaviors that are not specific to ASD (motor atypicalities, passivity, emotional functioning, hyperactivity, and sleep problems) [46]. In the second and third year of life, the area that raises particular concerns is communication [47][48][49]. According to a study by Vostanis and colleagues [50], at 12 to 18 months of age, play behaviors and a lack of referential gestures in-between were the best predictors of a later ASD diagnosis. ...
Article
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This study aimed to assess some early symptoms of autism spectrum disorders (ASD) measured by a screening tool developed for an early detection of ASD. We investigated if the early symptoms were associated with toddlers’ age, gender or ASD familial risk status. We used the Polish version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT) to assess 1024 children aged 16 to 36 months. The sample included four groups of participants: typically developing toddlers, toddlers with parent-reported ASD-specific concerns, toddlers at risk for autism due to having an older sibling with ASD, and toddlers with a developmental delay. We found that mean Q-CHAT scores were significantly higher in boys than in girls. We did not find any associations between Q-CHAT scores and age. We observed that toddlers with a familial risk for ASD and those with a developmental delay scored significantly higher than controls. We collated these results with previous studies that used the Q-CHAT and other instruments.
... Caregivers' readiness to navigate the diagnostic process impacts the timeline between the age of first concern and age of diagnosis, as a caregiver's engagement in pursuing services depends on their understanding of autism and readiness to seek services GARDNER ET AL. | 3 (Gentles et al., 2020). Research indicates delayed language and communication skills are generally the first developmental concerns noted by caregivers of children later diagnosed with autism (De Giacomo & Fombonne, 1998;Kozlowski et al., 2011). Complicating factors that affect ASD diagnosis include gender, verbal IQ (McDonnell et al., 2020), race, ethnicity, and socioeconomic status (Maenner et al., 2020). ...
Article
Providing high-quality services to autistic students and their caregivers requires interprofessional collaboration. This paper highlights the importance of collaboration between clinical and school settings to promote integrated and comprehensive care for autistic students and their caregivers. First, we present how autistic students are identified and diagnosed in school and clinical settings, with particular attention to how these processes impact access to services. Next, we present interprofessional collabora-tive practice (IPC) as a framework to facilitate increased collaboration between school and clinical providers working with autistic students. Key tenets of IPC that address barriers to collaboration and several examples of IPC are outlined. To assure readiness to engage in collaborative practice, we discuss graduate interprofessional education (IPE) as a means to train emerging professionals in IPC for autistic students. Finally, we highlight several examples of IPE training programs specific to autism and related developmental disabilities. K E Y W O R D S assessment, autism, interprofessional collaborative practice, interprofessional education Psychology in the Schools. 2022;1-11. wileyonlinelibrary.com/journal/pits | 1 This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
... Particularly, as expected, the most represented disorder was CD, identified as main diagnosis in 60% of the cases and mostly represented by language disorder (with both expressive and receptive functions compromised), as demonstrated above, one of the most common reasons for suspecting ASD is a delay in language development. 32 The other two other clinical categories diagnoses were identified in lower percentage of cases and were represent by "mild intellectual disability" (24%) and externalizing problems (16%), mostly represented by "attention deficit disorder with hyperactivity". These results are consistent with the finding that child's language delay and/or deficit in social communication are the main warning signs for ASD, followed in the order by opposition, hyperactivity, lack of attention, and delay in reaching motor milestones, among others. ...
Article
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Background: Children with autism spectrum disorder (ASD) share some symptoms with children with other neurodevelopmental disorders (ie, intellectual disability or communication disorders or language disorders). These similarities can make difficult to obtain an accurate diagnosis, which is essential to give targeted treatments to the patients. We aim to verify in our study if children with autistic traits who undergo to Autism Diagnostic Observation Schedule had specific clinical diagnosis. Patients and methods: We selected 73 children tested with ADOS-G or ADOS-2, for the presence of autistic symptoms. The whole sample did not reach the cut-off of ADOS and did not receive the ASD diagnosis, according to DSM-5. Results: Results of this study showed that in order of frequency and early diagnosis, communication disorders (CD), mild intellectual disability (mID) and the attention deficit hyperactivity disorders (ADHD) represent the most common final clinical diagnosis in children with autistic traits. Conclusion: Our results showed as the CD was the common diagnosis of these children and that often associated with younger age. Moreover, analyses of ADOS domains and the difference of individual items between groups did not show the capacity to differentiate between different neurodevelopmental disorders in terms of differential diagnosis, and this confirms the need for integrating multiple sources of information during the diagnostic process.
... Other findings underline that most common parental concerns are speech and language development, followed by an abnormal socio-emotional response, and a medical problem or delay in developmental milestones (17). Speechlanguage therapy is the most commonly identified intervention provided for children with ASD (18). ...
Article
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Background: Autism spectrum disorder (ASD) is a developmental disability, which is a biologically based neurodevelopmental disorder that affects a child’s social interaction and communication skills. Core deficits are identified in two domains: social communication/interaction and restrictive, repetitive patterns of behavior. Children and youth with ASD have service needs in behavioral, educational, health, leisure, family support, and other areas. Autism is a set of heterogeneous neurodevelopmental conditions, characterized by inability to acquire social skills, repetitive behaviors and failure of speech and nonverbal communication development. Objective: To examine frequency, correlation and predictivity of communication and language skills of autistic spectrum disorders (ASD) children and their parents’ emotions. Methods: The sample consisted of 80 participants who are parents of children with ASD. The study was performed using a questionnaire made out for this research. Three groups of variables were analyzed: parental emotions variables; child’s communication variables, child’s language variables. Statistical analysis was performed by SPSS, and included basic statistical parameters and multiple regression analysis. Results: The most common ways of communicate for children with ASD are: Allowing to cuddle; Recognizes familiar faces; and Makes it known when he needs help or wants an item. The most common language forms of children ASD are: Following simple instructions; Understanding connected words/phrases; Pronouncing single words; and Looking at when called by name. Parents of children with ASD expressed the greatest agreement with the following statements: “My child is more demanding than most other children”; “It seems to me that my child is very sensitive and easily upset”; “My child can’t do much of what he’s expected to know to do”, and “I often lack energy.” Conclusion: Parents of children with ASD proved that their children have significant delays in communication and language. Developed communication and language skills of the child with ASD are valid predictors of parents’ emotions/attitudes. Speech and language therapy work focused on developing the ASD child’s communication and language skills can be expected to improve parents’ emotions/attitudes. Keywords: caretaker’s attitudes, speech and language pathology.
... Early detection of ASD has been proposed to improve outcome, and efforts have been undertaken to lower the age at which a diagnosis of ASD is made through screening, and broad-based developmental surveillance as well as ASD directed screening have been used (Broder-Fingert et al., 2018). Previous studies have shown that parents to children with ASD often identify a possible ASD in their child at an age as early as 12-18 months (De Giacomo & Fombonne, 1998;Wimpory et al., 2000). However, their concern is often not taken seriously by Health care professionals (Ryan & Salisbury, 2012). ...
Article
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One-hundred twenty-four pre-school children referred for assessment to a neuropsychiatric team were included in this study of the Autism Behavior Checklist (ABC), ESSENCE-Q, and Conners Abbreviated Parent-Teacher Rating Scale (CAPRS). All three questionnaires showed a good correlation towards severity of symptoms in ASD. The ABC questionnaire was, as has been shown in earlier research less accurate in identifying individuals with ASD having an IQ within the normal range. However the ESSENCE-Q, and the CAPRS proved to identify children with difficulties needing further assessment regardless of intellectual ability. The CAPRS showed a good correlation to severity in ASD indicating difficulties in the regulation of activity and behavior likely to be connected to ASD in pre-school children.
... Children with autism spectrum disorder (ASD) exhibit difficulty learning language with wide variation in the nature and degree of these difficulties (Kjelgaard & Tager-Flusberg, 2001;Lord et al., 2004;Tager-Flusberg et al., 2005;Thurm et al., 2007). Concerns with communication are often one of the first developmental concerns that caregivers of children later diagnosed with ASD express (De Giacomo, & Fombonne, 1998;Howlin & Moore, 1997;Kozlowski et al., 2011). Such concerns are consistent with the observed areas of need in prelinguistic skills of children with ASD (e.g., joint attention, canonical babbling; Mundy et al., 1986;Patten et al., 2014;Sigman & Ruskin, 1999). ...
Article
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We conducted a systematic review to identify randomized controlled trials (RCTs) and single case research design (SCRD) studies of children with autism spectrum disorder that evaluate the effectiveness of responsivity intervention techniques for improving prelinguistic and/or language outcomes. Mean effect sizes were moderate and large for RCTs (33 studies; g = 0.36, 95% CI [0.21, 0.51]) and SCRD (34 studies; between-case standardized mean difference = 1.20, 95% CI [0.87, 1.54]) studies, respectively. Visual analysis (37 studies) revealed strong evidence of a functional relation for 45% of the opportunities and no evidence for 53%. Analyses of moderator effects and study quality are presented. Findings provide support for responsivity intervention strategies with more robust support for context-bound outcomes than more generalized outcomes.
... Our two main findings add to the literature by demonstrating distinct profiles of vocalizations in infants at high familial risk of ASD that do and do not develop the condition. Given that language delays are one of the first concerns reported by parents of children who are later diagnosed with ASD (De Giacomo & Fombonne, 1998;Kozlowski et al., 2011), and early intervention focused on communication deficits in ASD is effective (Green et al., 2013;Kasari et al., 2014;Yoder et al., 2021) and improves outcomes in a variety of areas such as social skills (Landa, 2007;Zwaigenbaum et al., 2007), identifying distinctive vocalization patterns before age two has significant potential for lowering the age of diagnosis, guiding early intervention, and optimizing longterm functioning for children and families. ...
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Infant vocalizations are early‐emerging communicative markers shown to be atypical in autism spectrum disorder (ASD), but few longitudinal, prospective studies exist. In this study, 23,850 infant vocalizations from infants at low (LR)‐ and high (HR)‐risk for ASD (HR‐ASD = 23, female = 3; HR‐Neg = 35, female = 13; LR = 32, female = 10; 80% White; collected from 2007 to 2017 near Philadelphia) were analyzed at 6, 12, and 24 months. At 12 months, HR‐ASD infants produced fewer vocalizations than HR‐Neg infants. From 6 to 24 months, HR‐Neg infants demonstrated steeper vocalization growth compared to HR‐ASD and LR infants. Finally, among HR infants, vocalizing at 12 months was associated with language, social phenotype, and diagnosis at age 2. Infant vocalizing is an objective behavioral marker that could facilitate earlier detection of ASD.
... Moreover, several of these items represent some of the earliest behavioral symptoms in ASD. For example, studies have found that some of the signs that are often noticed and reported first by parents include repetitive interests and behaviors, atypical social emotional responses, and extremes of behavioral activity (4,48,49). Furthermore, several studies that examined and coded family home videos found differences in repetitive behaviors, social behaviors, and sensory oriented behaviors between those with ASD and typically developing children; these differences were detectable as early as 12 monthsold (50,51). Therefore, in addition to the contributing items of the ASSC scale representing many of the typical symptoms of ASD, research has found that they are also some of the most commonly reported initial concerns. ...
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Autism Spectrum Disorder (ASD) is a complex childhood onset neurodevelopmental disorder that has become the fastest growing developmental disability. Due to the increased demand for diagnostic assessments and subsequent increased wait times, standardized screening as part of regular clinical practice is needed. More specifically, there is an important need for the development of a more streamlined screening tool within an existing assessment system to identify those at greatest risk of having ASD. The current study utilized data from ~17,000 assessments obtained within the province of Ontario, based on the interRAI Child and Youth Mental Health (ChYMH) and Child and Youth Mental Health and Developmental Disability (ChYMH-DD), to develop a scale to identify children who have a higher likelihood of having autism. The scale was then tested on a trial population with data from the interRAI Early Years instrument. Further analyses examined the predictive validity of the scale. The Autism Spectrum Screening Checklist (ASSC) was found to be a good predictor of ASD with a sensitivity of 0.73 and specificity of 0.62, at the recommended cut-point of 2+. The results were consistent across several age ranges, specifically from 2 to 21 years of age. The ASSC scale provides an initial screen to help identify children and youth at heightened risk for autism within larger populations being assessed as part of routine practice. The main goal for the development and implementation of the ASSC scale is to harness the power of the existing interRAI assessment system to provide a more efficient, effective screening and referral process. This will ultimately help improve patient outcomes through needs-based care.
... Autism in its prototypical form is usually detected by parents around the middle of the second year of life through a set of mainly socio-communicative signs (decreased response to name, social synchrony, oriented smiling, initiative and response to joint attention, imitation, and eye contact) and language signs (absence of language development or loss of the few words already acquired by the child) [44,45]. ...
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What does the way that autistic individuals bypass, learn, and eventually master language tell us about humans’ genetically encoded linguistic ability? In this theoretical review, we argue that autistic non-social acquisition of language and autistic savant abilities provide a strong argument for an innate, human-specific orientation towards (and mastery of) complex embedded structures. Autistic non-social language learning may represent a widening of the material processed during development beyond oral language. The structure detection and manipulation and generative production of non-linguistic embedded and chained material (savant abilities in calendar calculation, musical composition, musical interpretation, and three-dimensional drawing) may thus represent an application of such innate mechanisms to non-standard materials. Typical language learning through exposure to the child’s mother tongue may represent but one of many possible achievements of the same capacity. The deviation from typical language development in autism may ultimately allow access to oral language, sometimes in its most elaborate forms, and also explain the possibility of the absence of its development when applied exclusively to non-linguistic structured material. Such an extension of human capacities beyond or in parallel to their usual limits call into question what we consider to be specific or expected in humans and therefore does not necessarily represent a genetic “error”. Regardless of the adaptive success or failure of non-social language learning, it is the duty of science and ethical principles to strive to maintain autism as a human potentiality to further foster our vision of a plural society.
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Purpose This article examines the need for increased research into the prelinguistic trajectory of childhood apraxia of speech (CAS). We discuss the significant gains made in the early identification of disorders such as autism spectrum disorder, fragile X syndrome, and Rett syndrome that have resulted through the study of early (i.e., prelinguistic) developmental behaviors of infants and toddlers at risk for these disorders. We suggest that notable gains in understanding CAS could be made by increasing investigative focus on infants and toddlers later diagnosed with CAS or who are at risk for it (i.e., have an older sibling diagnosed with the disorder). Conclusions Currently, there are few studies to guide clinical decision making for infants and toddlers who may have CAS. To address this gap, we present a call to action with recommendations for researchers and clinicians. We recommend more retrospective investigative designs be conducted, inclusive of retrospective parent questionnaires and retrospective home video analysis, as well as prospective longitudinal studies of at-risk infants. We suggest that studies not be limited to exploring an affected infant's vocal output, but that efforts be made to acquire a broad view of an affected infant's early developmental trajectory (e.g., social skills, eye gaze, and imitative skills). A more comprehensive understanding of CAS will guide clinicians not only in identification of the disorder but will inform treatment decisions as well.
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Aims: The purpose of this study was to examine the nature of phonological processing in individuals with autism spectrum disorder (ASD) as it pertains to their nonverbal cognitive and linguistic abilities. Methods: Twenty-one participants between the ages of 9 and 21 years were administered a nonverbal cognitive assessment (Raven test), a language measure that requires receptive and expressive knowledge of semantics, syntax and morphology, as well as the integration across these language domains (CELF-4), and a measure of phonological processing (CTOPP). Results: Results show that performance on nonword repetition (NWR) that reflects an aspect of phonological memory was significantly low, whereas performance on phoneme reversal, phoneme elision, blending words and memory for digits was within the normal range. Hierarchical regressions with age, nonverbal intelligence (Raven test) and receptive language (CELF) as predictors showed that for NWR and phoneme elision the receptive part of the CELF was the main significant -predictor, after controlling for age. For phoneme reversal and memory for digits, however, the Raven score was the significant predictor, suggesting that cognitive nonverbal ability is the main factor explaining variability in these tasks. Conclusions: A deficit in phonological memory characterizes individuals in the autistic population. This deficit may influence language acquisition in this population consistent with other populations of children with language impairments. Other tasks of phonological awareness, however, might be preserved especially when they do not involve memory for long phonological sequences and when the cognitive abilities are within the norm.
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Background: The objective of this study is to gain new insights into the relationship between clinical signs and age at diagnosis. Method: We utilize a new, large, online survey of parents of children diagnosed with ASD, and use multiple statistical approaches. Results: We find that clinical signs that most strongly predict early diagnosis are not necessarily specific to autism, but rather those that initiate the process that eventually leads to an ASD diagnosis. Given the high correlations between symptoms, only a few signs are found to be important in predicting early diagnosis. For several clinical signs we find that their presence and intensity are positively correlated with delayed diagnosis (e.g., tantrums and aggression). Even though our data are drawn from parents’ retrospective accounts, we provide evidence that parental recall bias and/or hindsight bias did not play a significant role in shaping our results. Conclusion: In the subset of children without early deficits in communication, diagnosis is delayed, and this might be improved if more attention will be given to clinical signs that are not necessarily considered as ASD symptoms. Our findings also suggest that careful attention should be paid to children showing excessive tantrums or aggression, as these behaviors may interfere with an early ASD diagnoses.
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Twice-exceptional individuals are those who have high cognitive ability in one or more areas, but also have a diagnosed disability. The needs of these individuals likely differ from those with high cognitive ability without a disability and those who solely have a disability. Intervening early can offer exceptional benefits for twice-exceptional individuals, but this has proved challenging due to the high cognitive abilities masking disabilities. This study explores if parent-reported developmental milestones can predict the number of disabilities diagnosed for an individual, including Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), and Specific Learning Disorder (SLD). Using a clinical sample of about 1,300 individuals, we used a Bayesian cumulative logistic model to explore if developmental milestones can predict the number of diagnoses after controlling for IQ and age. Study results showed that when an individual began to count and read informed predictions for the number of future diagnoses in the clinical sample. Implications for future study and practitioners are discussed in further detail.
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Decades of research indicate that autism spectrum disorder (ASD) is a lifelong disorder that ranges in severity across individuals. Though the central diagnostic components of the disorder center on social communication and restrictive and repetitive behaviors, ASD may influence many other features of an individual's life. This article includes an overview of the disorder and diagnostic process. We provide an in-depth look at various domains that may intersect with ASD including social and language development, play and leisure, wellness, and adolescence and adulthood. Characteristics of contemporary services are highlighted including an emphasis on personalization, integration of the individual's strengths, and connection to family and cultural values.
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Background: The objective of this study is to gain new insights into the relationship between clinical signs and age at diagnosis. Method: We utilize a new, large, online survey of 1743 parents of children diagnosed with ASD, and use multiple statistical approaches. These include regression analysis, factor analysis, and machine learning (regression tree). Results: We find that clinical signs that most strongly predict early diagnosis are not necessarily specific to autism, but rather those that initiate the process that eventually leads to an ASD diagnosis. Given the high correlations between symptoms, only a few signs are found to be important in predicting early diagnosis. For several clinical signs we find that their presence and intensity are positively correlated with delayed diagnosis (e.g., tantrums and aggression). Even though our data are drawn from parents’ retrospective accounts, we provide evidence that parental recall bias and/or hindsight bias did not play a significant role in shaping our results. Conclusion: In the subset of children without early deficits in communication, diagnosis is delayed, and this might be improved if more attention will be given to clinical signs that are not necessarily considered as ASD symptoms. Our findings also suggest that careful attention should be paid to children showing excessive tantrums or aggression, as these behaviors may interfere with an early ASD diagnoses.
Chapter
Across the globe, autism operates within a rapidly changing environment, and as a society, we are frequently exposed to messages about new discoveries or ideas about it. The media regularly reports stories about autism, proffering ideas about diagnosing and treating autistic children (e.g., see, Falco, 2009, for an example of this). Indeed, there has been extensive media coverage of autism, meaning that this condition has gone from being almost invisible to the public eye – now dominating a range of contexts and disciplines (Karim, 2017). The increased visibility of autism has prompted a surge in the attention given to discussing and studying autism. This increased awareness and spotlight on autism has resulted in a growing body of research focused on examining the aetiology, neurophysiology, genetics believed to underpin autism, as well as the behaviours of autistic individuals and programs of intervention. Many scholars have suggested that this increase in attention is a great and important stride forward for autistic people, their families, and the broader communities. However, the increased visibility of autism has also created challenges, critiques, and broad explorations of the very meaning(s) of the condition, the implications of it, the discourses that shroud it, and the location of autism within the field of mental health and disability studies (Lester & O’Reilly, 2016).
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Purpose Parents of children on the autism spectrum enrolled in early intervention often receive coaching to address both social communication and disruptive behavior, which are the two most frequently reported concerns by parents. Intervention techniques for both are often recommended to be implemented across daily routines and require the parents to learn new ways of interacting with their child. A sequential approach to instructing parents in these key intervention targets may reduce burden and increase adherence. Method This multiple-baseline design pilot study included three mother–child dyads who received instruction in a disruptive behavior intervention immediately following a social communication intervention. Maternal maintenance of social communication strategies and child disruptive behaviors were measured during probes throughout the study. Results Results indicate that although mothers readily learned to implement the techniques, fidelity of implementing social communication strategies declined after introduction of the positive behavior support strategies. Conclusions A sequenced approach to parent-mediated intervention is feasible and acceptable. Clinical implications and future directions are discussed. Supplemental Material https://doi.org/10.23641/asha.19528978
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Screening for early signs of autism spectrum disorder (ASD) (before 36 months of age) allows an early diagnosis and early intervention programs that provide better developmental opportunities for the child. The objective of this chapter is to increase the knowledge about early signs of ASD enabling their early detection. The method used was a literature review of the early warning signs of autism spectrum disorder in children between 24 and 36 months of age in the domains that characterize this disorder.
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Results from ROC curves of items from two scales, the Autism Diagnostic Interview (ADI) and Autism Diagnostic Interview-Revised (ADI-R), operationalizing DSM-IV criteria for autism are presented for 319 autistic and 113 other subjects from 8 international autism centers. Analyses indicate that multiple items were necessary to attain adequate sensitivity and specificity if samples with varying levels of language were considered separately. Although considering only current behavior was generally sufficient when a combination cutoff and additive model was employed, predictive power was highest when history was taken into account. A single set of criteria, as operationalized by individually structured questions in the ADI/ADI-R, was effective in differentiating autism from mental handicap and language impairment in subjects with a range of chronological ages and developmental levels.
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Autism is currently detected only at about three years of age. This study aimed to establish if detection of autism was possible at 18 months of age. We screened 41 18-month-old toddlers who were at high genetic risk for developing autism, and 50 randomly selected 18-month-olds, using a new instrument, the CHAT, administered by GPs or health visitors. More than 80% of the randomly selected 18-month-old toddlers passed on all items, and none failed on more than one of pretend play, protodeclarative pointing, joint-attention, social interest, and social play. Four children in the high-risk group failed on two or more of these five key types of behaviour. At follow-up at 30 months of age, the 87 children who had passed four or more of these key types of behaviour at 18 months of age had continued to develop normally. The four toddlers who had failed on two or more of these key types of behaviour at 18 months received a diagnosis of autism by 30 months.
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Preliminary analyses of 12 home movies taken by parents before the recognition of autistic disorders of their own child confirm the major value of this method for describing early signs: anomalies of eye contact, deficient variability of emotional expression, defect of attention and initiation of communication, motor abnormalities, etc. The possibilities of subsequently using these documents in a research context are described: behavior assignment with a rating scale, comparative analysis with movies of normal children, blind examination, and scoring by investigators not informed of the diagnosis.
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To estimate the prevalence of autism, to assess the strength of its association with specific medical disorders, and to test for a secular increase in its incidence. An epidemiological survey was conducted among 325,347 French children born between 1976 and 1985 and living in three different French départements. Diagnosis, educational level, and associated medical conditions were abstracted from the records of children known to local educational authorities. Data were also pooled with those from another similar survey. One hundred seventy-four children (mean age: 11.6 years) with autism were identified. The prevalence rate was 5.35/10,000 (16.3/10,000 if other pervasive developmental disorders are included), with no difference according to geographical area or social class. Rates of medical conditions were as follows: 1.1% for tuberous sclerosis, 2.9% for chromosomal abnormalities including fragile X, 2.9% for cerebral palsy, 4.6% for sensory impairments, 0.6% for neurofibromatosis, 0.6% for congenital rubella, and 1.7% for Down syndrome. In the combined sample of 328 children with autism, the level and pattern of medical correlates were comparable, with tuberous sclerosis having a consistently strong association with autism. Prevalence rates were similar in successive birth cohorts. Medical disorders (excluding epilepsy and sensory impairments) accounted for fewer than 10% of the cases of autism. No secular increase in the prevalence of autism was found.
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In a readable and highly accessible ethnographic account that is shaped by the stories of families and the voices of parents, De Wolfe examines how parents of children with autism navigate the educational and medical systems, understand their own and their children's bodies, and support and educate one another.
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The authors examined infant hearing and vision screening tests for a group of children subsequently diagnosed as autistic and compared them with a group of children suffering from non-specific developmental delay, as well as with a random sample of records. Four categories (motor, vision, hearing and language, social) were investigated at three ages: six, 12 and 18 months. The random sample group had a low incidence of reported problems at all ages. The learning-disabled group had a sharp increase in reported abnormalities in all categories at 12 months. The autistic group had a selective increase in the social category alone at 18 months.
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Coded home videotapes of 11 autistic and 11 normally developing children's first year birthday parties for social, affective, joint attention, and communicative behaviors and for specific autistic symptoms. Autistic children displayed significantly fewer social and joint attention behaviors and significantly more autistic symptoms. In combination, four behaviors correctly classified 10 of 11 autistic children and 10 of 11 normal children. These behaviors consisted of pointing, showing objects, looking at others, and orienting to name.
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A sample of 43 autistic and developmentally impaired adolescents were assessed with the Autism Diagnostic Interview (ADI), DSM-III-R criteria, and the clinician's diagnosis. DSM-III-R criteria for autism have low specificity and agree poorly with the other two definitions. Detailed results of the ADI are provided that confirm the usefulness and discriminant validity of this semi-structured diagnostic interview in a sample of very retarded autistic subjects.
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Data from 39 young children with autism or other pervasive developmental disorders were examined to determine the relevance of the age of social symptom onset and language symptom onset to other developmental variables. Contrary to the authors' hypotheses, earlier onset of social symptoms was not indicative of a greater severity of autistic symptoms, retardation, or incidence of insecure attachments. Early speech loss was associated with lower IQ, greater social deficits, and poorer language development, while the presence of useful speech at age 2 was related to better functioning in multiple domains. Thus, language functions, rather than the social behaviors examined, carried the greatest predictive power regarding short-term outcomes.
A population sample of autistic children (n = 26) were compared retrospectively with age- and sex-matched mentally retarded children (n = 20) and age- and sex-matched population-representative children (n = 25) on a 130-item questionnaire to the mother concerning characteristic features of the child's behaviour in the first 2 years of life. Thirteen items discriminated clearly between the groups. The results are discussed in the context of early screening for autism.
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We examined the distribution of ages of onset of autism and related communication handicaps and assessed factors related to age of onset. Subjects were approximately 1,800 children seen at Division TEACCH (Treatment and Education of Autistic and related Communication handicapped CHildren) since 1970. Exact numbers of subjects varied with different analyses due to missing data. Data were gathered through direct assessment, interview, and questionnaire. Seventy-six percent of autistic children were identified by parents by 24 months of age, and 94% by 36 months. Families reporting early onset tended to seek help sooner and to be seen by TEACCH sooner. Early onset was most clearly related to severity as measured by IQ and ratings on the Childhood Autism Rating Scale (Schopler, Reichler, & Renner, 1986). The findings support the treatment of age of onset of autism by DSM-III-R (American Psychiatric Association, 1987).
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In DSM-III, pervasive developmental disorder is divided into two major categories: infantile autism and childhood onset pervasive developmental disorder. The criteria differ, primarily, in the age of onset. The authors studied 129 patients who had received diagnoses of pervasive developmental disorder or a related disorder and found only five cases of apparent childhood onset pervasive developmental disorder. These five patients were behaviorally indistinguishable from those with other diagnoses. Practically, age of onset may be more appropriately termed "age of recognition," and its use as a major diagnostic criterion for such disorders may not be justified.
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Describes the Autism Diagnostic Interview-Revised (ADI-R), a revision of the Autism Diagnostic Interview, a semistructured, investigator-based interview for caregivers of children and adults for whom autism or pervasive developmental disorders is a possible diagnosis. The revised interview has been reorganized, shortened, modified to be appropriate for children with mental ages from about 18 months into adulthood and linked to ICD-10 and DSM-IV criteria. Psychometric data are presented for a sample of preschool children.
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Autism is a condition that generally results in lifelong disability and dependence. This paper briefly reviews findings from comprehensive early intervention studies published in peer-reviewed journals and formulates major questions that need to be answered for the field to establish efficacious, accessible treatment for very young children with autism. At least six comprehensive treatment programs designed to stimulate widespread changes in young children with autism have published positive outcome data in peer-reviewed journals. Highlights of the findings of these six studies appear in Table I. It is important to point out that none of these studies used the most rigorous experimental designs, involving random assignments of children to groups and the use of evaluators blind to all aspects of the study. The studies differed in many ways, including different curricula, different settings and ratios, different ages and functioning levels, different ways of measuring progress, and different kinds of comparison groups or strategies for looking at change. However, many commonalities occurred in the results of the six studies. All the studies reported (a) significant acceleration of developmental rates, resulting in significant IQ gains; (b) significant language gains in the treated children; (c) improved social behavior and decreased symptoms of autism. Furthermore, these gains were accomplished, for most programs, within 1 to 2 years of intensive preschool intervention. The majority of treated children (73%) had useful speech by the end of the intervention period (generally age 5). Although only two studies had a longitudinal component, both indicated that the children maintained their gains for years after the intervention program ended.
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The relationship between reproductive factors and risk of lymphoid neoplasms was investigated in a hospital-based case-control study conducted in northern Italy on women with histologically confirmed incident Hodgkin's disease (HD) (n = 68), non-Hodgkin's lymphomas (NHL) (n = 180) and multiple myelomas (MM) (n = 71), and 448 controls admitted to hospitals, for acute, non-neoplastic, non-immunological and non-gynecological conditions. The odds ratios (OR) of HD were 0.6 for > or = 3 pregnancies compared to nulligravidae, and 0.5 for > or = 1 total (spontaneous and induced) abortions compared to women reporting no abortions. Compared to nulliparae, the OR of HD was 0.9 in parae and 0.3 in those with first birth when aged < 20 years. The OR of NHL and MM in relation to number of pregnancies, abortions and births, age at first birth and time since last birth were close to unity. Results were similar for the relation between reproductive factors and HD in women younger than 50 years. The OR of NHL was above unity (OR 2.2, 95% CI 1.0 to 4.9) for women aged < 50 years reporting one or more pregnancies as compared to nulliparae, and for women reporting the last birth since less than 10 years (OR 2.9, 95% CI 1.1 to 7.4). Early events in pregnancy, including changes in immunological status, rather than exposure to female sex hormones are likely mechanisms for the protection of pregnancies and abortions on the risk of HD.
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