Publisher: Sage Publications   (Total: 1089 journals)

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Showing 1 - 200 of 1089 Journals sorted alphabetically
AADE in Practice     Hybrid Journal   (Followers: 6)
Abstracts in Anthropology     Full-text available via subscription   (Followers: 24)
Academic Pathology     Open Access   (Followers: 5)
Accounting History     Hybrid Journal   (Followers: 17, SJR: 0.527, CiteScore: 1)
Acta Radiologica     Hybrid Journal   (Followers: 1, SJR: 0.754, CiteScore: 2)
Acta Radiologica Open     Open Access   (Followers: 2)
Acta Sociologica     Hybrid Journal   (Followers: 39, SJR: 0.939, CiteScore: 2)
Action Research     Hybrid Journal   (Followers: 51, SJR: 0.308, CiteScore: 1)
Active Learning in Higher Education     Hybrid Journal   (Followers: 362, SJR: 1.397, CiteScore: 2)
Adaptive Behavior     Hybrid Journal   (Followers: 9, SJR: 0.288, CiteScore: 1)
Administration & Society     Hybrid Journal   (Followers: 14, SJR: 0.675, CiteScore: 1)
Adoption & Fostering     Hybrid Journal   (Followers: 24, SJR: 0.313, CiteScore: 0)
Adsorption Science & Technology     Open Access   (Followers: 8, SJR: 0.258, CiteScore: 1)
Adult Education Quarterly     Hybrid Journal   (Followers: 239, SJR: 0.566, CiteScore: 2)
Adult Learning     Hybrid Journal   (Followers: 44)
Advances in Dental Research     Hybrid Journal   (Followers: 9, SJR: 1.791, CiteScore: 4)
Advances in Developing Human Resources     Hybrid Journal   (Followers: 31, SJR: 0.614, CiteScore: 2)
Advances in Mechanical Engineering     Open Access   (Followers: 136, SJR: 0.272, CiteScore: 1)
Advances in Methods and Practices in Psychological Science     Full-text available via subscription   (Followers: 11)
Advances in Structural Engineering     Full-text available via subscription   (Followers: 46, SJR: 0.599, CiteScore: 1)
Advances in Tumor Virology     Open Access   (Followers: 3, SJR: 0.108, CiteScore: 0)
AERA Open     Open Access   (Followers: 10)
Affilia     Hybrid Journal   (Followers: 5, SJR: 0.496, CiteScore: 1)
Agrarian South : J. of Political Economy     Hybrid Journal   (Followers: 2)
Air, Soil & Water Research     Open Access   (Followers: 13, SJR: 0.214, CiteScore: 1)
Alexandria : The J. of National and Intl. Library and Information Issues     Full-text available via subscription   (Followers: 67)
Allergy & Rhinology     Open Access   (Followers: 4)
AlterNative : An Intl. J. of Indigenous Peoples     Full-text available via subscription   (Followers: 12, SJR: 0.194, CiteScore: 0)
Alternative Law J.     Hybrid Journal   (Followers: 11, SJR: 0.176, CiteScore: 0)
Alternatives : Global, Local, Political     Hybrid Journal   (Followers: 12, SJR: 0.351, CiteScore: 1)
American Behavioral Scientist     Hybrid Journal   (Followers: 24, SJR: 0.982, CiteScore: 2)
American Economist     Hybrid Journal   (Followers: 8)
American Educational Research J.     Hybrid Journal   (Followers: 229, SJR: 2.913, CiteScore: 3)
American J. of Alzheimer's Disease and Other Dementias     Hybrid Journal   (Followers: 19, SJR: 0.67, CiteScore: 2)
American J. of Cosmetic Surgery     Hybrid Journal   (Followers: 8)
American J. of Evaluation     Hybrid Journal   (Followers: 17, SJR: 0.646, CiteScore: 2)
American J. of Health Promotion     Hybrid Journal   (Followers: 34, SJR: 0.807, CiteScore: 1)
American J. of Hospice and Palliative Medicine     Hybrid Journal   (Followers: 43, SJR: 0.65, CiteScore: 1)
American J. of Law & Medicine     Full-text available via subscription   (Followers: 12, SJR: 0.204, CiteScore: 1)
American J. of Lifestyle Medicine     Hybrid Journal   (Followers: 6, SJR: 0.431, CiteScore: 1)
American J. of Medical Quality     Hybrid Journal   (Followers: 12, SJR: 0.777, CiteScore: 1)
American J. of Men's Health     Open Access   (Followers: 9, SJR: 0.595, CiteScore: 2)
American J. of Rhinology and Allergy     Hybrid Journal   (Followers: 9, SJR: 0.972, CiteScore: 2)
American J. of Sports Medicine     Hybrid Journal   (Followers: 217, SJR: 3.949, CiteScore: 6)
American Politics Research     Hybrid Journal   (Followers: 33, SJR: 1.313, CiteScore: 1)
American Review of Public Administration     Hybrid Journal   (Followers: 21, SJR: 2.062, CiteScore: 2)
American Sociological Review     Hybrid Journal   (Followers: 333, SJR: 6.333, CiteScore: 6)
American String Teacher     Full-text available via subscription   (Followers: 2)
Analytical Chemistry Insights     Open Access   (Followers: 26, SJR: 0.224, CiteScore: 1)
Angiology     Hybrid Journal   (Followers: 3, SJR: 0.849, CiteScore: 2)
Animation     Hybrid Journal   (Followers: 14, SJR: 0.197, CiteScore: 0)
Annals of Clinical Biochemistry     Hybrid Journal   (Followers: 10, SJR: 0.634, CiteScore: 1)
Annals of Otology, Rhinology & Laryngology     Hybrid Journal   (Followers: 17, SJR: 0.807, CiteScore: 1)
Annals of Pharmacotherapy     Hybrid Journal   (Followers: 54, SJR: 1.096, CiteScore: 2)
Annals of the American Academy of Political and Social Science     Hybrid Journal   (Followers: 48, SJR: 1.225, CiteScore: 3)
Annals of the ICRP     Hybrid Journal   (Followers: 4, SJR: 0.548, CiteScore: 1)
Anthropocene Review     Hybrid Journal   (Followers: 8, SJR: 3.341, CiteScore: 7)
Anthropological Theory     Hybrid Journal   (Followers: 42, SJR: 0.739, CiteScore: 1)
Antitrust Bulletin     Hybrid Journal   (Followers: 11)
Antiviral Chemistry and Chemotherapy     Open Access   (Followers: 2, SJR: 0.635, CiteScore: 2)
Antyajaa : Indian J. of Women and Social Change     Hybrid Journal  
Applied Biosafety     Hybrid Journal   (Followers: 1, SJR: 0.131, CiteScore: 0)
Applied Psychological Measurement     Hybrid Journal   (Followers: 23, SJR: 1.17, CiteScore: 1)
Applied Spectroscopy     Full-text available via subscription   (Followers: 27, SJR: 0.489, CiteScore: 2)
Armed Forces & Society     Hybrid Journal   (Followers: 22, SJR: 0.29, CiteScore: 1)
Arts and Humanities in Higher Education     Hybrid Journal   (Followers: 42, SJR: 0.305, CiteScore: 1)
Asia Pacific Media Educator     Hybrid Journal   (Followers: 1, SJR: 0.23, CiteScore: 0)
Asia-Pacific J. of Management Research and Innovation     Full-text available via subscription   (Followers: 3)
Asia-Pacific J. of Public Health     Hybrid Journal   (Followers: 11, SJR: 0.558, CiteScore: 1)
Asian and Pacific Migration J.     Full-text available via subscription   (Followers: 9, SJR: 0.324, CiteScore: 1)
Asian Cardiovascular and Thoracic Annals     Hybrid Journal   (Followers: 2, SJR: 0.305, CiteScore: 0)
Asian J. of Comparative Politics     Hybrid Journal   (Followers: 5)
Asian J. of Legal Education     Full-text available via subscription   (Followers: 4)
Asian J. of Management Cases     Hybrid Journal   (Followers: 6, SJR: 0.101, CiteScore: 0)
ASN Neuro     Open Access   (Followers: 2, SJR: 1.534, CiteScore: 3)
Assessment     Hybrid Journal   (Followers: 17, SJR: 1.519, CiteScore: 3)
Assessment for Effective Intervention     Hybrid Journal   (Followers: 16, SJR: 0.578, CiteScore: 1)
Australasian Psychiatry     Hybrid Journal   (Followers: 18, SJR: 0.433, CiteScore: 1)
Australian & New Zealand J. of Psychiatry     Hybrid Journal   (Followers: 29, SJR: 1.801, CiteScore: 2)
Australian and New Zealand J. of Criminology     Hybrid Journal   (Followers: 533, SJR: 0.612, CiteScore: 1)
Australian J. of Career Development     Hybrid Journal   (Followers: 4)
Australian J. of Education     Hybrid Journal   (Followers: 42, SJR: 0.403, CiteScore: 1)
Australian J. of Management     Hybrid Journal   (Followers: 13, SJR: 0.497, CiteScore: 1)
Autism     Hybrid Journal   (Followers: 340, SJR: 1.739, CiteScore: 4)
Autism & Developmental Language Impairments     Open Access   (Followers: 12)
Behavior Modification     Hybrid Journal   (Followers: 12, SJR: 0.877, CiteScore: 2)
Behavioral and Cognitive Neuroscience Reviews     Hybrid Journal   (Followers: 26)
Bible Translator     Hybrid Journal   (Followers: 13)
Biblical Theology Bulletin     Hybrid Journal   (Followers: 19, SJR: 0.184, CiteScore: 0)
Big Data & Society     Open Access   (Followers: 52)
Biochemistry Insights     Open Access   (Followers: 7)
Bioinformatics and Biology Insights     Open Access   (Followers: 12, SJR: 1.141, CiteScore: 2)
Biological Research for Nursing     Hybrid Journal   (Followers: 7, SJR: 0.685, CiteScore: 2)
Biomarker Insights     Open Access   (Followers: 1, SJR: 0.81, CiteScore: 2)
Biomarkers in Cancer     Open Access   (Followers: 11)
Biomedical Engineering and Computational Biology     Open Access   (Followers: 13)
Biomedical Informatics Insights     Open Access   (Followers: 9)
Bioscope: South Asian Screen Studies     Hybrid Journal   (Followers: 3, SJR: 0.235, CiteScore: 0)
BMS: Bulletin of Sociological Methodology/Bulletin de Méthodologie Sociologique     Hybrid Journal   (Followers: 4, SJR: 0.226, CiteScore: 0)
Body & Society     Hybrid Journal   (Followers: 27, SJR: 1.531, CiteScore: 3)
Bone and Tissue Regeneration Insights     Open Access   (Followers: 2)
Brain and Neuroscience Advances     Open Access  
Breast Cancer : Basic and Clinical Research     Open Access   (Followers: 11, SJR: 0.823, CiteScore: 2)
British J. of Music Therapy     Hybrid Journal   (Followers: 8)
British J. of Occupational Therapy     Hybrid Journal   (Followers: 219, SJR: 0.323, CiteScore: 1)
British J. of Pain     Hybrid Journal   (Followers: 27, SJR: 0.579, CiteScore: 2)
British J. of Politics and Intl. Relations     Hybrid Journal   (Followers: 33, SJR: 0.91, CiteScore: 2)
British J. of Visual Impairment     Hybrid Journal   (Followers: 13, SJR: 0.337, CiteScore: 1)
British J.ism Review     Hybrid Journal   (Followers: 18)
BRQ Business Review Quarterly     Open Access   (Followers: 1)
Building Acoustics     Hybrid Journal   (Followers: 4, SJR: 0.215, CiteScore: 1)
Building Services Engineering Research & Technology     Hybrid Journal   (Followers: 3, SJR: 0.583, CiteScore: 1)
Bulletin of Science, Technology & Society     Hybrid Journal   (Followers: 8)
Business & Society     Hybrid Journal   (Followers: 13)
Business and Professional Communication Quarterly     Hybrid Journal   (Followers: 8, SJR: 0.348, CiteScore: 1)
Business Information Review     Hybrid Journal   (Followers: 17, SJR: 0.279, CiteScore: 0)
Business Perspectives and Research     Hybrid Journal   (Followers: 3)
Cahiers Élisabéthains     Hybrid Journal   (Followers: 1, SJR: 0.111, CiteScore: 0)
Calcutta Statistical Association Bulletin     Full-text available via subscription   (Followers: 1)
California Management Review     Hybrid Journal   (Followers: 32, SJR: 2.209, CiteScore: 4)
Canadian J. of Kidney Health and Disease     Open Access   (Followers: 6, SJR: 1.007, CiteScore: 2)
Canadian J. of Nursing Research (CJNR)     Hybrid Journal   (Followers: 13)
Canadian J. of Occupational Therapy     Hybrid Journal   (Followers: 142, SJR: 0.626, CiteScore: 1)
Canadian J. of Psychiatry     Hybrid Journal   (Followers: 27, SJR: 1.769, CiteScore: 3)
Canadian J. of School Psychology     Hybrid Journal   (Followers: 12, SJR: 0.266, CiteScore: 1)
Canadian Pharmacists J. / Revue des Pharmaciens du Canada     Hybrid Journal   (Followers: 3, SJR: 0.536, CiteScore: 1)
Cancer Control     Open Access   (Followers: 1)
Cancer Growth and Metastasis     Open Access   (Followers: 1)
Cancer Informatics     Open Access   (Followers: 4, SJR: 0.64, CiteScore: 1)
Capital and Class     Hybrid Journal   (Followers: 8, SJR: 0.282, CiteScore: 1)
Cardiac Cath Lab Director     Full-text available via subscription  
Cardiovascular and Thoracic Open     Open Access  
Career Development and Transition for Exceptional Individuals     Hybrid Journal   (Followers: 9, SJR: 0.44, CiteScore: 1)
Cartilage     Hybrid Journal   (Followers: 5, SJR: 0.889, CiteScore: 3)
Cell and Tissue Transplantation and Therapy     Open Access   (Followers: 2)
Cell Transplantation     Open Access   (Followers: 4, SJR: 1.023, CiteScore: 3)
Cephalalgia     Hybrid Journal   (Followers: 8, SJR: 1.581, CiteScore: 3)
Cephalalgia Reports     Open Access   (Followers: 2)
Child Language Teaching and Therapy     Hybrid Journal   (Followers: 35, SJR: 0.501, CiteScore: 1)
Child Maltreatment     Hybrid Journal   (Followers: 9, SJR: 1.22, CiteScore: 3)
Child Neurology Open     Open Access   (Followers: 5)
Childhood     Hybrid Journal   (Followers: 19, SJR: 0.894, CiteScore: 2)
Childhood Obesity and Nutrition     Open Access   (Followers: 11)
China Information     Hybrid Journal   (Followers: 7, SJR: 0.767, CiteScore: 2)
China Report     Hybrid Journal   (Followers: 10, SJR: 0.221, CiteScore: 0)
Chinese J. of Sociology     Full-text available via subscription   (Followers: 4)
Chronic Illness     Hybrid Journal   (Followers: 6, SJR: 0.672, CiteScore: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 9, SJR: 0.808, CiteScore: 2)
Chronic Stress     Open Access  
Citizenship, Social and Economics Education     Full-text available via subscription   (Followers: 6, SJR: 0.145, CiteScore: 0)
Cleft Palate-Craniofacial J.     Hybrid Journal   (Followers: 8, SJR: 0.757, CiteScore: 1)
Clin-Alert     Hybrid Journal   (Followers: 1)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 32, SJR: 0.49, CiteScore: 1)
Clinical and Translational Neuroscience     Open Access  
Clinical Case Studies     Hybrid Journal   (Followers: 3, SJR: 0.364, CiteScore: 1)
Clinical Child Psychology and Psychiatry     Hybrid Journal   (Followers: 45, SJR: 0.73, CiteScore: 2)
Clinical EEG and Neuroscience     Hybrid Journal   (Followers: 6, SJR: 0.552, CiteScore: 2)
Clinical Ethics     Hybrid Journal   (Followers: 10, SJR: 0.296, CiteScore: 1)
Clinical Medicine Insights : Arthritis and Musculoskeletal Disorders     Open Access   (Followers: 3, SJR: 0.537, CiteScore: 2)
Clinical Medicine Insights : Blood Disorders     Open Access   (SJR: 0.314, CiteScore: 2)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 6, SJR: 0.686, CiteScore: 2)
Clinical Medicine Insights : Case Reports     Open Access   (Followers: 1, SJR: 0.283, CiteScore: 1)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 3, SJR: 0.425, CiteScore: 2)
Clinical Medicine Insights : Ear, Nose and Throat     Open Access   (Followers: 1)
Clinical Medicine Insights : Endocrinology and Diabetes     Open Access   (Followers: 33, SJR: 0.63, CiteScore: 2)
Clinical Medicine Insights : Oncology     Open Access   (Followers: 3, SJR: 1.129, CiteScore: 3)
Clinical Medicine Insights : Pediatrics     Open Access   (Followers: 3)
Clinical Medicine Insights : Psychiatry     Open Access   (Followers: 10)
Clinical Medicine Insights : Reproductive Health     Open Access   (Followers: 2, SJR: 0.776, CiteScore: 0)
Clinical Medicine Insights : Therapeutics     Open Access   (Followers: 1, SJR: 0.172, CiteScore: 0)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 4)
Clinical Medicine Insights : Urology     Open Access   (Followers: 3)
Clinical Medicine Insights : Women's Health     Open Access   (Followers: 4)
Clinical Nursing Research     Hybrid Journal   (Followers: 31, SJR: 0.471, CiteScore: 1)
Clinical Pathology     Open Access   (Followers: 3)
Clinical Pediatrics     Hybrid Journal   (Followers: 22, SJR: 0.487, CiteScore: 1)
Clinical Psychological Science     Hybrid Journal   (Followers: 12, SJR: 3.281, CiteScore: 5)
Clinical Rehabilitation     Hybrid Journal   (Followers: 76, SJR: 1.322, CiteScore: 3)
Clinical Risk     Hybrid Journal   (Followers: 5, SJR: 0.133, CiteScore: 0)
Clinical Trials     Hybrid Journal   (Followers: 21, SJR: 2.399, CiteScore: 2)
Clothing and Textiles Research J.     Hybrid Journal   (Followers: 25, SJR: 0.36, CiteScore: 1)
Common Law World Review     Full-text available via subscription   (Followers: 18)
Communication & Sport     Hybrid Journal   (Followers: 8, SJR: 0.385, CiteScore: 1)
Communication and the Public     Hybrid Journal   (Followers: 1)
Communication Disorders Quarterly     Hybrid Journal   (Followers: 17, SJR: 0.458, CiteScore: 1)
Communication Research     Hybrid Journal   (Followers: 21, SJR: 2.171, CiteScore: 3)
Community College Review     Hybrid Journal   (Followers: 9, SJR: 1.451, CiteScore: 1)
Comparative Political Studies     Hybrid Journal   (Followers: 261, SJR: 3.772, CiteScore: 3)
Compensation & Benefits Review     Hybrid Journal   (Followers: 8)
Competition & Change     Hybrid Journal   (Followers: 11, SJR: 0.843, CiteScore: 2)
Competition and Regulation in Network Industries     Full-text available via subscription   (Followers: 8, SJR: 0.143, CiteScore: 0)
Concurrent Engineering     Hybrid Journal   (Followers: 3, SJR: 0.642, CiteScore: 2)
Conflict Management and Peace Science     Hybrid Journal   (Followers: 40, SJR: 2.441, CiteScore: 1)
Contemporary Drug Problems     Full-text available via subscription   (Followers: 3, SJR: 0.609, CiteScore: 2)
Contemporary Education Dialogue     Hybrid Journal   (Followers: 5, SJR: 0.102, CiteScore: 0)
Contemporary Issues in Early Childhood     Full-text available via subscription   (Followers: 8, SJR: 0.766, CiteScore: 1)
Contemporary Review of the Middle East     Full-text available via subscription   (Followers: 12)
Contemporary Sociology : A J. of Reviews     Full-text available via subscription   (Followers: 35, SJR: 0.195, CiteScore: 0)
Contemporary Voice of Dalit     Full-text available via subscription   (Followers: 1)
Contexts     Hybrid Journal   (Followers: 6)

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Similar Journals
Journal Cover
Autism
Journal Prestige (SJR): 1.739
Citation Impact (citeScore): 4
Number of Followers: 340  
 
Hybrid Journal Hybrid journal   * Containing 2 Open Access Open Access article(s) in this issue *
ISSN (Print) 1362-3613 - ISSN (Online) 1461-7005
Published by Sage Publications Homepage  [1089 journals]
  • Working toward a better understanding of the life experiences of women on
           the autism spectrum
    • Authors: Julie Lounds Taylor, Leann Smith DaWalt
      Pages: 1027 - 1030
      Abstract: Autism, Volume 24, Issue 5, Page 1027-1030, July 2020.

      Citation: Autism
      PubDate: 2020-06-22T07:14:52Z
      DOI: 10.1177/1362361320913754
      Issue No: Vol. 24, No. 5 (2020)
       
  • Temperament influences the relationship between symptom severity and
           adaptive functioning in children with autism spectrum disorder
    • Authors: Vivian Lee, Eric Duku, Lonnie Zwaigenbaum, Teresa Bennett, Peter Szatmari, Mayada Elsabbagh, Connor Kerns, Pat Mirenda, Isabel M Smith, Wendy J Ungar, Tracy Vaillancourt, Joanne Volden, Charlotte Waddell, Anat Zaidman-Zait, Ann Thompson, Stelios Georgiades
      Abstract: Autism, Ahead of Print.
      Temperament is a construct that is relatively stable over time but varies between individuals. Research suggests that children with autism spectrum disorder have a ‘reactive’ temperament profile when compared to peers with or without disabilities. However, our understanding of how temperament varies within children with autism and how it relates to child symptoms and outcomes is limited. This study aimed to (a) explore the variation of individual temperament traits within a sample of school-aged children with autism to determine whether subgroups of children with similar trait profiles emerge and (b) examine whether temperament influences the relationship between autism symptoms and adaptive functioning outcomes. Results revealed that children with autism can be classified empirically into two distinct profiles – ‘Even’ and ‘Reactive’ temperaments. Correlational and hierarchical regression analyses indicated that both temperament profiles and baseline symptom severity predicted adaptive functioning outcomes 1 year later. There was a significant interaction between temperament and symptom severity, suggesting temperament can influence the impact of increasing symptom severity on adaptive functioning skills in children with autism. Study findings highlight the importance of considering temperament in understanding the individual differences that influence the development of daily functioning and developmental outcomes in children with autism.Lay AbstractTemperament is often thought of as behavioural traits that are relatively stable over time but can vary between individuals. Children diagnosed with autism spectrum disorder are often characterized as having ‘reactive’ and ‘negative’ temperaments when compared to same-aged peers with or without disabilities, which can negatively impact the development of adaptive functioning skills but little is known about variations of temperament between individual children diagnosed with autism spectrum disorder. This study aimed to (a) explore the variation of individual temperament traits within a sample of school-aged children with autism spectrum disorder to determine whether subgroups with similar trait profiles emerge and (b) examine whether temperament influences the relationship between autism symptoms and adaptive functioning outcomes. Results from our dataset suggest that children diagnosed with autism spectrum disorder fit under two profiles: ‘even’ and ‘reactive’. Furthermore, our analysis shows that temperament can influence the impact of increasing symptom severity on adaptive functioning skills in children with autism spectrum disorder. Study findings highlight the importance of considering temperament when trying to understand the individual differences that influence the development of functioning and developmental outcomes in children with autism spectrum disorder.
      Citation: Autism
      PubDate: 2020-07-03T06:48:08Z
      DOI: 10.1177/1362361320933048
       
  • Short report: Evaluating the safety and usability of head-mounted virtual
           reality compared to monitor-displayed video for children with autism
           spectrum disorder
    • Authors: Mahan Malihi, Jenny Nguyen, Robyn E Cardy, Salina Eldon, Catharine Petta, Azadeh Kushki
      Abstract: Autism, Ahead of Print.
      Virtual reality provides a relatively inexpensive way to learn and repeatedly practice skills in personalized, controlled, and safe computer-generated settings. These systems are increasingly receiving attention as an innovative medium for delivering interventions to children with autism spectrum disorder. Although many virtual reality systems are commercially available and their use is increasing, little is known about the safety and usability of these systems for children with autism spectrum disorder. The aim of this study was a first step in addressing this gap. A convenience sample of 35 children with a diagnosis of autism spectrum disorder participated in an immersive head-mounted display virtual reality experience and a control condition (monitor-displayed video). Levels of anxiety and negative effects experienced were not significantly different between the two conditions. Participants reported significantly enhanced spatial presence (p = 0.003; d = 0.3) and naturalness (p = 0.002; d = 0.47) for the head-mounted display–virtual reality condition, and 74% of participants preferred using head-mounted display–virtual reality over monitor-displayed video. These findings provide preliminary evidence to support the safety and usability of head-mounted display–virtual reality for children with autism spectrum disorder. Future studies are needed to replicate the results in a larger sample, a range of virtual reality experiences, and in the context of long-term exposure.Lay abstractThis study investigated the safety and usability of a virtual reality experience for children with autism spectrum disorder in a laboratory setting. In our study, the negative effects of head-mounted display–virtual reality were similar to monitor-displayed video watching. At the same time, the participants indicated that the head-mounted display–virtual reality experience provided improved realism and sense of presence. This study is a first step in understanding the impact of head-mounted display on children with autism spectrum disorder.
      Citation: Autism
      PubDate: 2020-07-03T06:47:28Z
      DOI: 10.1177/1362361320934214
       
  • Short report: Social communication difficulties and restricted repetitive
           behaviors as predictors of anxiety in adults with autism spectrum disorder
           
    • Authors: Erika Kuzminskaite, Sander Begeer, Rosa A Hoekstra, Rachel Grove
      Abstract: Autism, Ahead of Print.
      Autism spectrum disorder and anxiety are highly comorbid conditions. Understanding the underlying traits of anxiety in autism spectrum disorder is crucial to prevent and treat it efficiently. Hence, this study determined whether social communication difficulties or restricted repetitive behaviors are stronger risk factors for anxiety symptoms in autistic adults in a large cohort. Data on 742 autistic adults from the Netherlands Autism Register were included in the study. Hierarchical regression was implemented to evaluate whether social communication difficulties (Autism-Spectrum Quotient social behavior factor) and restricted repetitive behaviors (Adult Routines Inventory) were predictive of anxiety (Hospital Anxiety and Depression Scale) controlling for age and sex. When considered together, restricted repetitive behaviors stood out as significant positive predictors of anxiety symptoms (lower-order restricted repetitive behaviors, β = 0.32, p  0.05). Non-social autistic traits are stronger predictors of anxiety symptoms than social traits in autistic adults. Increased attention to restricted repetitive behaviors should be given to improve current support programs for autistic adults with anxiety and to identify autistic individuals at risk.
      Citation: Autism
      PubDate: 2020-07-03T06:45:09Z
      DOI: 10.1177/1362361320934218
       
  • Factors associated with enrollment into a clinical trial of
           caregiver-implemented intervention for infants at risk for autism spectrum
           disorder
    • Authors: Jessica Bradshaw, Ashley Trumbull, Jennifer Stapel-Wax, Scott Gillespie, Nisha George, Celine Saulnier, Cheryl Klaiman, Juliann Woods, Nathan Call, Ami Klin, Amy Wetherby
      Abstract: Autism, Ahead of Print.
      Early intervention has been established as efficacious in addressing developmental delays in young children with autism spectrum disorder. Evidence that caregiver-implemented interventions are feasible and effective for young children with autism spectrum disorder is emerging, yet research suggests there are barriers to enrollment in clinical trials of these interventions for infants at risk for autism. This study identifies factors associated with enrollment in a clinical trial of a caregiver-implemented intervention for 12-month-old infants at risk for autism spectrum disorder. As part of a large longitudinal study, fifty-seven infants were deemed eligible for intervention based on several converging indicators of autism risk. Of these eligible infants, 44% declined enrollment in the intervention study. Examination of factors associated with families who declined enrollment compared to those who agreed to enroll revealed maternal full-time work status, household income, and distance to the clinic as significant predictors. In contrast, autism red flags and parental concern were not significantly associated with enrollment. These results highlight the need for more research on how parental understanding of, and willingness to act on, early social-communication delays impacts intervention study enrollment. Future research can then examine how to address these barriers to enrollment in caregiver-implemented intervention studies.Lay abstractEarly intervention helps to address developmental delays in young children with autism spectrum disorder. Yet, research suggests there are barriers to enrollment into research studies that test the effectiveness of these interventions for infants at risk. This study identifies family characteristics that were associated with agreement to enroll in a clinical trial of early intervention for 12-month-old infants at risk for autism spectrum disorder. As part of a large longitudinal study, infants were evaluated for early signs of autism spectrum disorder at 1 year of age. Of the fifty-seven infants who were showing signs of autism and deemed eligible for the early intervention trial, 44% declined enrollment. Results suggest that families were more likely to decline enrolling into the intervention study if the mother was working full time, the total household income was between US$60,000 and US$100,000, and they lived further from the clinic. In contrast, infant autism symptoms and parental concern at 12 months were not significantly associated with enrollment. These findings highlight the need for intervention studies that are more accessible to parents, for example, intervention that takes place in the home, in addition to more research on how parental understanding of, and willingness to act on, early social-communication delays impact intervention study enrollment. Future research can then examine how to address these barriers to enrollment in early intervention studies. Such findings will shed light on best practices for dissemination of early identification and intervention strategies.
      Citation: Autism
      PubDate: 2020-06-29T08:26:54Z
      DOI: 10.1177/1362361320928829
       
  • Healthcare service utilization and cost among transition-age youth with
           autism spectrum disorder and other special healthcare needs
    • Authors: Jennifer L Ames, Maria L Massolo, Meghan N Davignon, Yinge Qian, Lisa A Croen
      Abstract: Autism, Ahead of Print.
      Youth with autism spectrum disorder often have complex medical needs. Disruptions of healthcare during the transition from pediatric to adult healthcare may put youth with autism spectrum disorder at higher risk of medical emergencies and high medical costs. We conducted a study among transition-age youth (14–25 years old) receiving healthcare at Kaiser Permanente Northern California during 2014–2015. We examined the differences in healthcare utilization and costs among youth with autism spectrum disorder (n = 4123), attention deficit and hyperactivity disorder (n = 20,6015), diabetes mellitus (n = 2156), and general population controls (n = 20,615). Analyses were also stratified by age and sex. Youth with autism spectrum disorder had the highest utilization of outpatient primary care, mental health, and psychotropic medications and the lowest utilization of obstetrics/gynecology and urgent care. Costs for youth with autism spectrum disorder were higher than those for attention deficit and hyperactivity disorder and general population peers and lower than for diabetes mellitus. Utilization patterns varied by age. Transition-age youth with autism spectrum disorder generally utilize healthcare at higher rates relative to attention deficit and hyperactivity disorder and general population peers but at similar or lower rates than diabetes mellitus peers, indicating this group’s complex combination of psychiatric and medical healthcare needs. The relatively high utilization of psychiatric services and low utilization of women’s health services in transition-age youth with autism spectrum disorder may have implications for long-term health and warrants additional research.Lay abstractYouth with autism spectrum disorder often have complex medical needs. Disruptions of healthcare during the transition from pediatric to adult healthcare may put youth with autism spectrum disorder at higher risk of medical emergencies and high medical costs. To understand healthcare utilization during the transition years, we conducted a study among transition-age youth (14–25 years old) receiving healthcare at Kaiser Permanente Northern California during 2014–2015. We examined differences in healthcare utilization and costs among youth with autism spectrum disorder (n = 4123), attention deficit and hyperactivity disorder (n = 20,6015), diabetes mellitus (n = 2156), and general population controls (n = 20,615). Analyses were also stratified by age and sex. Youth with autism spectrum disorder had the highest utilization of outpatient primary care, mental health, and psychotropic medications and the lowest utilization of obstetrics/gynecology and urgent care. Costs for youth with autism spectrum disorder were higher than those for attention deficit and hyperactivity disorder and general population peers and lower than for diabetes mellitus. Healthcare utilization patterns varied by age. Transition-age youth with autism spectrum disorder generally used healthcare at higher rates relative to attention deficit and hyperactivity disorder and general population peers but at similar or lower rates than diabetes mellitus peers, indicating this group’s complex combination of psychiatric and medical healthcare needs. The relatively high utilization of psychiatric services and low utilization of women’s health services in transition-age youth with autism spectrum disorder may have implications for long-term health and warrants additional research.
      Citation: Autism
      PubDate: 2020-06-25T10:55:29Z
      DOI: 10.1177/1362361320931268
       
  • Memory enhancements from active control of learning in children with
           autism spectrum disorder
    • Authors: Valentina Fantasia, Douglas B. Markant, Giovanni Valeri, Nicholas Perri, Azzurra Ruggeri
      Abstract: Autism, Ahead of Print.
      Previous research with typically developing children and adults shows that active control of the learning experience leads to enhanced episodic memory, as compared with conditions lacking this control. The present study investigates whether similar advantages can be found in children with autism spectrum disorder. In this study, 6–12-year-old autistic children (N = 29) participated in a simple memory game on a touchscreen tablet, in which they were asked to remember 64 objects presented in four blocks of 16. In two of the blocks, children could decide the order and pacing of study (active condition), whereas in the other two blocks, they passively observed the active study decisions of a previous participant (yoked condition). We found that recognition memory was more accurate for objects studied in the active compared with the yoked condition, even after a week-long delay. The magnitude of the effect was comparable with that obtained in previous studies with typically developing children and adults, suggesting a robustness for the benefits of active learning that goes beyond what previously hypothesized, extending to special populations. We discuss how these findings may help develop pedagogical interventions that leverage the active learning approach to promote inclusive learning.Lay abstractResearch with adults and typically developing children has shown that being able to actively control their learning experience, that is, to decide what to learn, when, and at what pace, can boost learning in a variety of contexts. In particular, previous research has shown a robust advantage of active control for episodic memory as compared with conditions lacking this control. In this article, we explore the potential of active control to improve learning of 6- to 12-year-old children diagnosed with autism spectrum disorder. We presented them with a simple memory game on a touchscreen tablet, in which children were asked to recall as many of the presented objects as possible. For half of the objects, children could decide the order and pacing of study (active condition); for the other half, they passively observed the study decisions of a previous participant (yoked condition). We found that recognition memory was more accurate when children could actively control the order, pace, and frequency of the study experience, even after a week-long delay. We discuss how teachers and educators might promote active learning approaches in educational and pedagogical applications to support inclusive learning.
      Citation: Autism
      PubDate: 2020-06-24T01:06:08Z
      DOI: 10.1177/1362361320931244
       
  • A grounded theory of adoption and maintenance of physical activity among
           autistic adults
    • Authors: Andrew M Colombo-Dougovito, A Josephine Blagrave, Sean Healy
      Abstract: Autism, Ahead of Print.
      Background:Although a growing body of literature has explored the physical activity experiences from the perspective of children on the autism spectrum, the perspective of autistic adults remains largely unheard. Due to this absence of perspective, there exists limited knowledge of the appropriateness and generalizability of current models and theories of physical activity for this population.Methods:A constructivist grounded theory study was conducted to explore the experiences of adoption and maintenance of physical activity from the direct perspective of autistic adults. Autistic adults (n = 23) from the United States and the United Kingdom were recruited.Results:A total of 29 codes emerged from the coding process. These codes were formed into four broad categories: (1) individual attributes; (2) environmental factors; (3) social relationships; and (4) social experiences. The interconnectedness of these four categories was explored.Conclusions:The findings and presented model highlight the importance of building successful experiences for young children on the autism spectrum, so that they are more likely to continue physical activity into their adult life. Furthermore, findings emphasize the importance of creating noncompetitive, sensory-friendly physical activity experiences for autistic adults that offer flexibility in social engagement.Lay abstractLittle is known about how autistic adults experience physical activity. To begin to change this, we interviewed 23 autistic adults from the United State and the United Kingdom about their past and current experiences of physical activity participation. The interviewees told us about how their physical activity experiences were highly influenced by their individual strengths, the setting in which the activity took place, the presence of people to support their physical activities, and the sensory experiences they had while in physical activity. Through these interviews, we were able to create a model that represented the physical activity experiences discussed. Based on the model that emerged from this study, we recommend physical activity opportunities are made available that are noncompetitive, sensory-friendly, and that allow for participants to socialize as they prefer.
      Citation: Autism
      PubDate: 2020-06-24T01:06:00Z
      DOI: 10.1177/1362361320932444
       
  • The relationship between intolerance of uncertainty and anxiety in autism:
           A systematic literature review and meta-analysis
    • Authors: Richard Jenkinson, Elizabeth Milne, Andrew Thompson
      Abstract: Autism, Ahead of Print.
      The association between intolerance of uncertainty and anxiety has proved robust in neurotypical populations and has led to effective interventions targeting intolerance of uncertainty. The aim of this systematic review and meta-analysis was to investigate this association in autistic people, given the high prevalence of anxiety in this population and the limited effectiveness of therapies used currently to treat anxiety in autism. A protocol was published on the Prospero database (CRD42019125315), and electronic databases were searched using terms related to intolerance of uncertainty, anxiety and autism. Included in the systematic review were 12 studies, of which 10 were included in a meta-analysis. Results showed that anxiety and intolerance of uncertainty were consistently elevated in autistic participants. Examining the correlation between these two constructs, the meta-analysis revealed a large sample-weighted effect size, r = 0.62, 95% confidence interval = [0.52, 0.71], p 
      Citation: Autism
      PubDate: 2020-06-22T08:45:00Z
      DOI: 10.1177/1362361320932437
       
  • Service deserts and service oases: Utilizing geographic information
           systems to evaluate service availability for individuals with autism
           spectrum disorder
    • Authors: Amy Drahota, Richard Sadler, Christopher Hippensteel, Brooke Ingersoll, Lauren Bishop
      Abstract: Autism, Ahead of Print.
      Autism spectrum disorder and co-occurring symptoms often require lifelong services. However, access to autism spectrum disorder services is hindered by a lack of available autism spectrum disorder providers. We utilized geographic information systems methods to map autism spectrum disorder provider locations in Michigan. We hypothesized that (1) fewer providers would be located in less versus more populated areas; (2) neighborhoods with low versus high socioeconomic status would have fewer autism spectrum disorder providers; and (3) an interaction would be found between population and socioeconomic status such that neighborhoods with low socioeconomic status and high population would have few available autism spectrum disorder providers. We compiled a list of autism spectrum disorder providers in Michigan, geocoded the location of providers, and used network analysis to assess autism spectrum disorder service availability in relation to population distribution, socioeconomic disadvantage, urbanicity, and immobility. Hypotheses were supported. Individuals in rural neighborhoods had fewer available autism spectrum disorder providers than individuals in suburban and urban neighborhoods. In addition, neighborhoods with greater socioeconomic status disadvantage had fewer autism spectrum disorder providers available. Finally, statistically significant spatial disparities were found; wealthier suburbs had good provider availability while few providers were available in poorer, urban neighborhoods. Knowing autism spectrum disorder providers’ availability, and neighborhoods that are service deserts, presents the opportunity to utilize evidence-based dissemination and implementation strategies that promote increased autism spectrum disorder providers for underserved individuals.Lay abstractAutism spectrum disorder and co-occurring symptoms often require lifelong services. However, access to autism spectrum disorder services is hindered by a lack of available autism spectrum disorder providers. We utilized geographic information systems methods to map autism spectrum disorder provider locations in Michigan. We hypothesized that (1) fewer providers would be located in less versus more populated areas; (2) neighborhoods with low versus high socioeconomic status would have fewer autism spectrum disorder providers; and (3) an interaction would be found between population and socioeconomic status such that neighborhoods with low socioeconomic status and high population would have few available autism spectrum disorder providers. We compiled a list of autism spectrum disorder providers in Michigan, geocoded the location of providers, and used network analysis to assess autism spectrum disorder service availability in relation to population distribution, socioeconomic disadvantage, urbanicity, and immobility. Individuals in rural neighborhoods had fewer available autism spectrum disorder providers than individuals in suburban and urban neighborhoods. In addition, neighborhoods with greater socioeconomic status disadvantage had fewer autism spectrum disorder providers available. Finally, wealthier suburbs had good provider availability while few providers were available in poorer, urban neighborhoods. Knowing autism spectrum disorder providers’ availability, and neighborhoods that are particularly poorly serviced, presents the opportunity to utilize evidence-based dissemination and implementation strategies that promote increased autism spectrum disorder providers for underserved individuals.
      Citation: Autism
      PubDate: 2020-06-22T08:43:20Z
      DOI: 10.1177/1362361320931265
       
  • The face validity of an initial sub-typology of people with autism
           spectrum disorders detained in psychiatric hospitals
    • Authors: Magali Barnoux, Regi Alexander, Sabyasachi Bhaumik, John Devapriam, Connor Duggan, Lee Shepstone, Ekkehart Staufenberg, David Turner, Nichola Tyler, Essi Viding, Peter E Langdon
      Abstract: Autism, Ahead of Print.
      Autistic adults who have a history of committing crimes present a major problem for providers of services in terms of legal disposal options and possible interventions, and greater understanding of this group and their associated needs is required. For this reason, we aimed to investigate the face validity of a proposed sub-typology of autistic adults detained in secure psychiatric hospitals in the United Kingdom. Initially, a focus group was completed with psychiatrists, clinical psychologists, healthcare workers, family members and autistic adults who had been detained in hospital, leading to revisions of the sub-typology. Following this, a consensus rating exercise of 10 clinical vignettes based on this sub-typology with three rounds was completed with 15 psychiatrists and clinical psychologists; revisions to the vignettes to improve clarity were made following each round. The findings indicated that these subtypes possess face validity and raters were able to classify all 10 clinical case vignettes into the sub-typology, and percentage of agreement ranged from 96% to 100% for overall subtype classification. This study suggests that the further validity of the sub-typology should be investigated within a larger study, as these subtypes have the potential to directly inform the hospital care pathway such that length of stay can be minimised.Lay abstractAutistic adults who have a history of committing crimes pose challenges for the criminal justice system in terms of disposal and treatment. For this reason, we investigated the validity of a proposed sub-typology of autistic adults detained in secure psychiatric hospitals. Initially, we ran a focus group with psychiatrists, clinical psychologists, healthcare workers, family members and autistic adults who had been detained in hospital to consider a sub-typology of autistic adults who may come into contact with secure psychiatric hospitals. We asked 15 psychiatrists and clinical psychologists to rate 10 clinical vignettes based on our sub-typology with three rounds; revisions to the vignettes to improve clarity were made following each round. The findings indicated that these subtypes possess face validity and raters were able to classify all 10 clinical case vignettes into the sub-typology and percentage of agreement ranged from 96% to 100% for overall subtype classification. The findings suggested that the further validity of the sub-typology should be investigated within a larger study using a clinical sample. These subtypes may help inform treatment and care pathways within hospital.
      Citation: Autism
      PubDate: 2020-06-20T11:03:43Z
      DOI: 10.1177/1362361320929457
       
  • Person-oriented ethics for autism research: Creating best practices
           through engagement with autism and autistic communities
    • Authors: M Ariel Cascio, Jonathan A Weiss, Eric Racine
      Abstract: Autism, Ahead of Print.
      Research ethics is an important part of any study. Ethics goes beyond ethics committee approval and consent documents. It addresses broader issues of respect, inclusion, and empowerment in the everyday context of research. This article focuses on everyday aspects of research ethics for studies involving autistic participants. It draws on a review of the literature and a process of ethical deliberation involving a task force of researchers, professionals, autistic self-advocates, and parents. These methods led to the creation of suggestions for researchers. This article describes the community engagement process, briefly presents the task force suggestions, and provides more detailed discussion of select items for illustration. Suggestions are organized around five “person-oriented research ethics” guideposts: (1) individualization (e.g. providing individualized support for participants), (2) acknowledgment of lived world (e.g. acknowledging barriers to care that impact research ethics), (3) empowerment in decision-making (e.g. creating accessible consent processes that address specific communication needs), (4) respect for holistic personhood (e.g. addressing sensory and processing needs and strengths), and (5) focus on researcher–participant relationships (e.g. involving autistic people in ways other than research participants, including but not limited to via participatory research). This project highlights the value of researcher–community partnerships in discussions about research ethics.Lay abstractResearch ethics means issues that concern the welfare and wellbeing of people who take part in research. It is important in all scientific studies. Ethics helps people who do research treat people who take part in research fairly and with respect. This article is about day-to-day ethics when autistic people take part in research. We present tips for researchers who want to do this type of study.We used two methods to create these tips. First, we wanted to know what other people said about this topic. We used a literature review to find out. Second, we wanted to know what autistic people, parents, and professionals thought, and had a working group meet to discuss it. The working group provided advice that researchers could consider around day-to-day ethics in research. This article talks about these methods and advice. The advice fits into five big groups:Tailor the research process for the unique needs of each person.Think about the world in which people who take part in research live.Make it easier for people to make their own choices.Value what people who take part in research have to share and consider their needs and strengths.Think about how researchers and people who take part in research work together.This project shows why it is useful for researchers and communities to talk about research ethics together.
      Citation: Autism
      PubDate: 2020-06-18T12:02:12Z
      DOI: 10.1177/1362361320918763
       
  • The health of college students on the autism spectrum as compared to their
           neurotypical peers
    • Authors: Jane D McLeod, Amelia Hawbaker, Emily Meanwell
      Abstract: Autism, Ahead of Print.
      Data from an online survey of undergraduate students at 14 colleges and universities were used to estimate the association of autism with six physical and mental health outcomes, accounting for comorbidity with other disabilities (learning disability, attention deficit hyperactivity disorder, sensory impairment, mobility impairment, mental health disorder, or other disabilities). Autism status was determined based on registration for disability accommodations based on autism and/or self-reports of an autism diagnosis. Health outcomes included self-rated physical health, self-rated mental health, depressive symptoms, symptoms of anxiety, sleep deprivation, and binge drinking. Students with autism reported poorer self-rated physical and mental health, more depressive symptoms, and more symptoms of anxiety than other students, even in the presence of controls for other disabilities. Students with autism also reported a lower likelihood of sleep deprivation and binge drinking than other students. Our results extend previous research on the health correlates of autism by considering additional indicators of health and by incorporating a direct comparison to neurotypical students. They encourage consideration of how health services for students with autism can be improved, especially for mental health problems, and argue for integrated support services that address the full constellation of physical and mental health challenges that students on the spectrum experience.Lay abstractStudies have shown that children and older adults on the autism spectrum experience more physical and mental health problems than their neurotypical peers. Less is known about the physical and mental health of college students on the spectrum. Studying college students is important because young adults on the spectrum are enrolling in college at increasing rates and because health problems can be a barrier to succeeding in college. We collected data from 2820 students at 14 colleges and universities using an online survey, some of whom had registered for accommodations based on autism and others of whom had not. We used the data to compare the physical and mental health of students on the spectrum to their neurotypical peers. Because students with autism often report other disabilities that also affect health, we accounted for whether they experienced a learning disability, attention deficit hyperactivity disorder, sensory impairment, mobility impairment, mental health disorder, or any other disabilities. We assessed health using self-reports of how healthy they were physically and mentally, and reports of depressive symptoms, symptoms of anxiety, sleep deprivation, and binge drinking. We found that students with autism reported poorer physical and mental health, more depressive symptoms, and more symptoms of anxiety even after taking into account other disabilities they may have experienced. They were also less likely to report sleep deprivation and binge drinking. Our results argue for developing specialized services to address the physical and mental health challenges of college students on the spectrum.
      Citation: Autism
      PubDate: 2020-06-18T12:00:52Z
      DOI: 10.1177/1362361320926070
       
  • Transitioning youth with autism spectrum disorders and other special
           health care needs into adult primary care: A provider survey
    • Authors: Jennifer L Ames, Maria L Massolo, Meghan N Davignon, Yinge Qian, Hilda J Cerros, Lisa A Croen
      Abstract: Autism, Ahead of Print.
      Health care continuity during the transition from pediatric to adult care is critical to helping individuals with autism spectrum disorders manage complex medical and psychiatric co-morbidities that start in childhood and evolve with age. We conducted a brief online survey of pediatric and adult providers at Kaiser Permanente Northern California, a large integrated health care delivery system, to assess departmental policies and personal approaches to transitioning patients with special health care needs, including autism spectrum disorders. A total of 354 pediatric (43% response rate) and 715 adult providers (30% response rate) completed the survey. A large majority of departments did not have transition policies in place. Many providers in both primary care and mental health did not provide transition resources, review legal changes, use standardized assessment tools, or communicate with the next/previous provider. Transition planning was usually delayed until age 17 or later. Most providers did not have consistent approaches to the transition of care for youth with special health care needs and may be inadequately prepared to handle the process for patients with autism spectrum disorders. As the population of transition-age youth with autism spectrum disorders continues to grow, there is urgent need to understand how to best implement transition policies that promote early communication between providers and families and track outcomes among transitioning patients with special health care needs.Lay AbstractThe transition from pediatric to adult care is a critical inflection point for the long-term health of youth with autism spectrum disorders and other special health care needs. However, for many patients, their caregivers, and providers, the transition lacks coordination. This survey study demonstrates that pediatric and adult providers struggle to implement many components of transition best practices for youth with autism and other chronic conditions, highlighting the urgent need for enhanced medical coordination and additional transition training and resources.
      Citation: Autism
      PubDate: 2020-06-18T12:00:12Z
      DOI: 10.1177/1362361320926318
       
  • Measuring change in facial emotion recognition in individuals with autism
           spectrum disorder: A systematic review
    • Authors: Andrea Trubanova Wieckowski, L Taylor Flynn, J Anthony Richey, Denis Gracanin, Susan W White
      Abstract: Autism, Ahead of Print.
      Children and adults with autism spectrum disorder are less accurate in facial emotion recognition, which is thought to contribute to impairment in social functioning. Although many interventions have been developed to improve facial emotion recognition, there is no consensus on how to best measure facial emotion recognition in people with autism spectrum disorder. This lack of agreement has led to wide variability in how facial emotion recognition is measured and, subsequently, inconsistent findings related to impact of intervention targeting facial emotion recognition impairment. The purpose of this review is to synthesize the extant research on measurement of facial emotion recognition in the context of treatment. We conducted an electronic database search to identify relevant, peer-reviewed articles published between January 1998 and November 2019 to identify studies evaluating change in facial emotion recognition in autism spectrum disorder. Sixty-five studies met inclusion criteria, utilizing a total of 36 different assessment measures for facial emotion recognition in individuals with autism spectrum disorder. Only six of the measures were used in multiple studies conducted by different investigative teams. The outcomes of the studies are reported and summarized with the goal of informing future research.Lay AbstractChildren and adults with autism spectrum disorder show difficulty recognizing facial emotions in others, which makes social interaction challenging. While there are many treatments developed to improve facial emotion recognition, there is no agreement on the best way to measure such abilities in individuals with autism spectrum disorder. The purpose of this review is to examine studies that were published between January 1998 and November 2019 and have measured change in facial emotion recognition to evaluate the effectiveness of different treatments. Our search yielded 65 studies, and within these studies, 36 different measures were used to evaluate facial emotion recognition in individuals with autism spectrum disorder. Only six of these measures, however, were used in different studies and by different investigators. In this review, we summarize the different measures and outcomes of the studies, in order to identify promising assessment tools and inform future research.
      Citation: Autism
      PubDate: 2020-06-18T11:58:32Z
      DOI: 10.1177/1362361320925334
       
  • Inclusion, acceptance, shame and isolation: Attitudes to autism in
           Aboriginal and Torres Strait Islander communities in Australia
    • Authors: Rozanna Lilley, Mikala Sedgwick, Elizabeth Pellicano
      Abstract: Autism, Ahead of Print.
      This is the first qualitative study to investigate experiences of, and attitudes towards, autism in Aboriginal and Torres Strait Islander communities in Australia. Understanding the complexity of these attitudes is crucial because they influence the recognition of autism as well as the ways in which individuals and families are supported. Twelve families with 16 autistic children living in diverse regions of Australia participated in a semi-structured interview. The interviews were thematically analysed using the six-step process outlined by Braun and Clarke. The analysis identified a marked tension in participants’ accounts. On the one hand, participants described negative feelings, including shame associated with atypical behaviour, stigmatisation and the social isolation of families, which potentially point towards under-identification or misdiagnosis. On the other hand, they also described inclusive attitudes, including ‘looking after each other’ and a growing acceptance of autistic differences. This positive model of support for and acceptance of autistic children and their families may well contribute to good outcomes for autistic children and adults in Aboriginal and Torres Strait Islander communities. More research is needed on cross-cultural and pluralistic understandings of autism, parental perceptions and family experience.Lay AbstractThere has been almost no research done about autism in Aboriginal and Torres Strait Islander communities in Australia. This article is the first detailed report on attitudes to autism in these communities. Understanding attitudes to autism is important because they influence whether or not children are diagnosed, as well as the kinds of support autistic people are getting. Twelve families who lived in different parts of Australia were interviewed. They told us that there is a range of attitudes to autism in Aboriginal and Torres Strait Islander communities. These include negative ideas such as sometimes feeling shame associated with children’s unusual behaviour, as well as feeling stigmatised and socially isolated. The negative attitudes reported may mean that some children are missing out on an autism diagnosis or being wrongly diagnosed with a different condition in these communities. They also included positive ideas such as the importance of looking after each other and of accepting autistic people and their differences. We can all learn from these positive attitudes. It will be interesting to know in future projects whether these accepting attitudes lead to better outcomes for autistic children and adults in these communities. This research helps us to understand how autism is thought about in different cultures and how attitudes impact diagnosis and support. It will also help people to plan supports that reflect what Aboriginal and Torres Strait Islander families actually want and need.
      Citation: Autism
      PubDate: 2020-06-12T10:24:37Z
      DOI: 10.1177/1362361320928830
       
  • Atypical visual-auditory predictive coding in autism spectrum disorder:
           Electrophysiological evidence from stimulus omissions
    • Authors: Thijs van Laarhoven, Jeroen J Stekelenburg, Mart LJM Eussen, Jean Vroomen
      Abstract: Autism, Ahead of Print.
      Autism spectrum disorder is a pervasive neurodevelopmental disorder that has been linked to a range of perceptual processing alterations, including hypo- and hyperresponsiveness to sensory stimulation. A recently proposed theory that attempts to account for these symptoms, states that autistic individuals have a decreased ability to anticipate upcoming sensory stimulation due to overly precise internal prediction models. Here, we tested this hypothesis by comparing the electrophysiological markers of prediction errors in auditory prediction by vision between a group of autistic individuals and a group of age-matched individuals with typical development. Between-group differences in prediction error signaling were assessed by comparing event-related potentials evoked by unexpected auditory omissions in a sequence of audiovisual recordings of a handclap in which the visual motion reliably predicted the onset and content of the sound. Unexpected auditory omissions induced an increased early negative omission response in the autism spectrum disorder group, indicating that violations of the prediction model produced larger prediction errors in the autism spectrum disorder group compared to the typical development group. The current results show that autistic individuals have alterations in visual-auditory predictive coding, and support the notion of impaired predictive coding as a core deficit underlying atypical sensory perception in autism spectrum disorder.Lay abstractMany autistic individuals experience difficulties in processing sensory information (e.g. increased sensitivity to sound). Here we show that these difficulties may be related to an inability to process unexpected sensory stimulation. In this study, 29 older adolescents and young adults with autism and 29 age-matched individuals with typical development participated in an electroencephalography study. The electroencephalography study measured the participants’ brain activity during unexpected silences in a sequence of videos of a handclap. The results showed that the brain activity of autistic individuals during these silences was increased compared to individuals with typical development. This increased activity indicates that autistic individuals may have difficulties in processing unexpected incoming sensory information, and might explain why autistic individuals are often overwhelmed by sensory stimulation. Our findings contribute to a better understanding of the neural mechanisms underlying the different sensory perception experienced by autistic individuals.
      Citation: Autism
      PubDate: 2020-06-10T10:57:31Z
      DOI: 10.1177/1362361320926061
       
  • Twitter usage about autism spectrum disorder
    • Authors: Monica L Bellon-Harn, Jianyuan Ni, Vinaya Manchaiah
      Abstract: Autism, Ahead of Print.
      Stakeholders within autism spectrum disorder communities use Twitter for specific purposes. The goal of this study was to characterize patterns and themes of tweet content and sentiment and intercommunications between users sending and retweeting content to their respective user networks. The study used cross-sectional analysis of data generated from Twitter. Twitter content, sentiment, users, and community networks were examined from a sample of tweets with the highest Twitter reach and the lowest Twitter reach. Results indicate that Twitter content from both samples was primarily related to empowerment and support. Differences between the number of tweets originating from an individual in the lowest reach sample (i.e. 41%) as compared to the individuals in the highest reach sample (i.e. 18%) were noted. The number of users belonging to an advocacy subcommunity was substantially larger than a clinical and research subcommunity. Results provide insight into the presuppositions of individuals with autism spectrum disorder, their families and significant others, and other stakeholders.
      Citation: Autism
      PubDate: 2020-06-07T06:34:37Z
      DOI: 10.1177/1362361320923173
       
  • Attributions, causal beliefs, and help-seeking behavior of parents of
           children with autism spectrum disorder and sleep problems
    • Authors: Laurie McLay, Sarah G Hansen, Amarie Carnett, Karyn G France, Neville M Blampied
      Abstract: Autism, Ahead of Print.
      Sleep problems in children with autism spectrum disorder are prevalent and persistent but also treatable. Little is known about how and why parents of such children seek help for sleep disturbance. Via an online survey (n = 244 respondents), we gathered information about parents’ attributions about children’s sleep problems and beliefs about causes and on sources of information about, and their decisions regarding, help-seeking. Eighty-two percent of parents reported seeking some kind of help for their child’s sleep disturbance, and the average parent had tried six different treatment strategies, most commonly medical. Alignment of parents’ treatment choices with empirical evidence about treatment efficacy was poor, but belief in effectiveness was closely related to frequency of use of a treatment. In a Principal Components Analysis, parental attributions loaded on two factors: one which suggests the sleep problems are viewed as intrinsic to autism and stable (factor one) and the other as located within the child, stable, and treatment resistant (factor two). These findings have important implications for parental education and clinical practice in the treatment of sleep problems in children with autism spectrum disorder.Lay abstractSleep problems are commonly reported among parents of children with autism spectrum disorder (ASD). Without effective treatment, such problems are unlikely to resolve. To date, we know very little about how and why parents of children with ASD seek help for sleep disturbance. Via an online survey, we gathered information about how parents make sense of their children’s sleep problems, beliefs about their causes, sources of information, and help-seeking behavior. The analysis of responses from 244 parents revealed that parents commonly view sleep problems (a) as a consequence of their child’s ASD, and unlikely to change over time (stable), and (b) as located within the child (intrinsic), stable over time, and difficult to treat. Despite this, parents also rated sleep problems as being important to treat. Eighty-two percent of parents surveyed reported seeking some kind of help for their child’s sleep disturbance, and the average parent had tried six different treatment strategies, most commonly medical approaches (e.g. melatonin). The alignment between parents’ treatment choices and those strategies that are supported by research was poor, but belief in the effectiveness of treatments was closely related to how often the treatment was used. These findings have important implications for parental education and clinical practice in the treatment of sleep problems in children with ASD.
      Citation: Autism
      PubDate: 2020-06-07T06:31:57Z
      DOI: 10.1177/1362361320924216
       
  • Tell me where it is: Selective difficulties in spatial language on the
           autism spectrum
    • Authors: Agata Bochynska, Kenny R. Coventry, Valentin Vulchanov, Mila Vulchanova
      Abstract: Autism, Ahead of Print.
      Proficient use of spatial terms such as under, to the left of or in front of is a central component of daily communication and is important in the development of language and spatial cognition. Here we examine spatial language abilities in intellectually high-functioning individuals with autism spectrum disorder, an area previously overlooked in autism research. Twenty-five high-functioning individuals with ASD and 25 typically developing controls, matched for chronological age and cognitive abilities, completed a novel battery tapping a broad range of spatial language abilities. We report selective difficulties in the production of spatial terms and spatial description recall in high-functioning ASD. Overall verbal abilities did not account for the observed group differences. Crucially, however, the intensity of autism spectrum traits predicted individual performance in both spatial language production and spatial description recall. We discuss the theoretical implications of these findings and explore their significance for both clinical practice and intervention.Lay abstractHow we think and talk about space is an essential ability, necessary for understanding the world around us. We recruit spatial thinking every day when finding our way or using tools but also in more advanced tasks, such as reading complex graphs or maps. We do so also in daily communication when we use spatial language, terms such as under, over, to the left of or in front of, and when we give instructions. Spatial terms appear in children’s early vocabularies and continue to develop until late childhood or even early adolescence. Because spatial language develops over many years, some spatial terms are mastered very early, whereas others take longer to acquire. In the current set of studies, we tested how intellectually high-functioning children and adults on the autism spectrum use and understand these early- and late-acquired spatial terms in comparison to typically developing age-matched individuals. We found that children and adults on the autism spectrum experience difficulties with the use of some spatial terms (e.g. near and far or out of and down off) but not with others, which are acquired early (e.g. in and on or over and under). We also found that remembering spatial terms from short stories was more difficult for the individuals on the autism spectrum compared with typically developing individuals. These results reveal difficulties that can profoundly affect everyday communication of children and adults on the autism spectrum but also open new directions of research on language development in autism spectrum disorders.
      Citation: Autism
      PubDate: 2020-06-05T06:31:23Z
      DOI: 10.1177/1362361320921040
       
  • “Chasing hope”: Parents’ perspectives on complementary and
           alternative interventions for children with autism in Kazakhstan
    • Authors: Sofiya An, Akbota Kanderzhanova, Assel Akhmetova, Faye Foster, Chee Kai Chan
      Abstract: Autism, Ahead of Print.
      In post-Soviet Kazakhstan, the system of care for children with autism has been transforming over the past three decades. There is little known about the use of complementary and alternative medicine by families raising autistic children in the post-Soviet region. An exploratory qualitative focus group design was employed to study parents’ experiences of using complementary and alternative medicine focusing on the perceived factors driving the utilization of complementary and alternative medicine by families of autistic children and the availability of complementary and alternative medicine. Six focus groups were conducted in five cities of diverse geographical locations in Kazakhstan. Data were analyzed using a framework analysis. Two overarching themes and subthemes are developed. The first “unmet needs” relates to predisposing factors that motivate parents to complementary and alternative medicine uptake and the second “chasing hope” relates to enabling factors that facilitate parents’ uptake of complementary and alternative medicines. In summary, parents of autism spectrum disorder children in Kazakhstan face multiple challenges when seeking treatment for their children’s condition and implement whatever complementary and alternative medicine interventions available. A decision to use, and the choice of intervention, mainly comes from perceptions of having no other choice rather than from rational decisions based on efficacy of complementary and alternative medicines. This study provides the first empirical conceptualization of parents’ motives for choosing complementary and alternative medicine in Kazakhstan.Lay abstractThe article reports the findings of a qualitative research study on how and why parents of autistic children in Kazakhstan utilize complementary and alternative medicine. We found that parents turn to complementary and alternative medicine because of the lack of professional care options available to them and in pursuit for hope and opportunities for their children with ASD.
      Citation: Autism
      PubDate: 2020-06-05T06:28:22Z
      DOI: 10.1177/1362361320923494
       
  • Atypical social communication is associated with positive initial
           impressions among peers with autism spectrum disorder
    • Authors: Jessica E Granieri, Morgan L McNair, Alan H Gerber, Rebecca F Reifler, Matthew D Lerner
      Abstract: Autism, Ahead of Print.
      Atypical social communication is a key indicator of autism spectrum disorder and has long been presumed to interfere with friendship formation and first impressions among typically developing youth. However, emerging literature suggests that such atypicalities may function differently among groups of peers with autism spectrum disorder. The current study aimed to investigate the relationship between atypical social communication patterns and first impression sociometric ratings by peers in groups of youth with autism spectrum disorder. Findings suggest that, contrary to typically developing individuals, several forms of atypical communication among youth with autism spectrum disorder are associated with more positive first impressions by others with autism spectrum disorder. This suggests that interventions designed to increase friendships among youth with autism spectrum disorder may benefit from reframing their approach to addressing atypical social communication.
      Citation: Autism
      PubDate: 2020-06-05T06:23:23Z
      DOI: 10.1177/1362361320924906
       
  • Prediction of social behavior in autism spectrum disorders: Explicit
           versus implicit social cognition
    • Authors: Cara M Keifer, Amori Yee Mikami, James P Morris, Erin J Libsack, Matthew D Lerner
      Abstract: Autism, Ahead of Print.
      Deficient social communication and interaction behaviors are a hallmark feature of individuals with autism spectrum disorder. These social communication and interaction deficits potentially stem from problems with explicit social cognition (i.e. processes that are controlled and largely conscious) as well as with implicit social cognition (i.e. processes that are fast, spontaneous, and primarily unconscious). This study aimed to investigate the relative contributions of implicit and explicit social cognition factors as predictors of multi-informant measures of social communication and interaction behaviors in a sample of 34 youth with clinical diagnoses of autism spectrum disorder. Behavioral, cognitive, and electrophysiological indices of implicit and explicit social cognition were entered into partial least squares regression models designed to identify latent factors that optimally predict parent-report, observer-coded, and clinician-rated social communication, and interaction outcomes. Results indicated that while both implicit and explicit social cognition factors optimally predicted outcomes, implicit social cognition factors were relatively more predictive. Findings have important implications for the conceptualization and measurement of social functioning as well as the development of targeted social interventions in autism spectrum disorder populations.Lay abstractDifficulties with social communication and interaction are a hallmark feature of autism spectrum disorder. These difficulties may be the result of problems with explicit social cognition (effortful and largely conscious processes) such as learning and recalling social norms or rules. Alternatively, social deficits may stem from problems with implicit social cognition (rapid and largely unconscious processes) such as the efficient integration of social information. The goal of this study was to determine how problems in explicit and implicit social cognition relate to social behavior in 34 youth with autism spectrum disorder. We measured aspects of implicit and explicit social cognition abilities in the laboratory using behavioral, cognitive, and brain (electrophysiological) measures. We then used those measures to predict “real-world” social behavior as reported by parents, clinicians, and independent observers. Results showed that overall better aspects of implicit and explicit social cognition predicted more competent social behavior. In addition, the ability to fluidly integrate social information (implicit social cognition) was more frequently related to competent social behavior that merely knowing what to do in social situations (explicit social cognition). These findings may help with the development of interventions focusing on improving social deficits.
      Citation: Autism
      PubDate: 2020-06-02T09:55:54Z
      DOI: 10.1177/1362361320922058
       
  • Dropping out and moving on: A qualitative study of autistic people’s
           experiences of university
    • Authors: Eilidh Cage, Jack Howes
      Abstract: Autism, Ahead of Print.
      Autistic people are at high risk of dropping out of university, but little research has examined this issue. Fourteen autistic people participated in semi-structured interviews examining their experiences at university and the reasons they had dropped out. Thematic analysis identified patterns in participants’ responses. Themes were categorised as systemic issues, challenges within university or life after dropping out. Systemic issues centred around accessing diagnosis, autism understanding, mental health and outsider status. Challenges at university included culture shock, becoming disengaged, lack of proactive support and perceived inevitability of dropping out. Finally, life after dropping out was characterised by processing of trauma and shame, and realisation of doing ‘what’s right for you’. Together, these themes suggest that many improvements could be made at universities, such as more proactive support and creating more accessible environments. Societal-level change is also needed to improve educational opportunities for autistic people.Lay abstractMany autistic people now go to university, but many of them also drop out of their studies. In fact, it is believed that autistic people are at higher risk of dropping out, but little research has been done to understand why this is happening. This research used interviews to take an in-depth look at 14 autistic people’s experiences of dropping out of university. All the things the participants talked about were examined closely by the researchers who identified common themes in what the participants discussed. The first set of themes captured some overarching issues faced by autistic people, such as difficulties with getting diagnosed, a lack of autism understanding, mental health challenges and feeling like an outsider. The next themes were organised within challenges faced at university, including a feeling of culture shock, becoming disengaged from one’s studies, a lack of proactive support from their university and a feeling that dropping out became inevitable. Finally, there were themes about life after dropping out, which involved a sense that the experience at university had been traumatic and shameful, but they believed people had to do what is right for them. All of these themes suggest that universities need to be better at supporting autistic people when they first come to university, and that they should actively offer clear support throughout and try and make the university environment more accessible for everyone, to ensure more autistic people have a positive university experience.
      Citation: Autism
      PubDate: 2020-06-01T06:39:15Z
      DOI: 10.1177/1362361320918750
       
  • Reliability and validity of the Pediatric Anxiety Rating Scale modified
           for autism spectrum disorder
    • Authors: Brenna B Maddox, Luc Lecavalier, Judith S Miller, Jill Pritchett, Jill Hollway, Susan W White, Scott Gillespie, Andrea N Evans, Robert T Schultz, John D Herrington, Karen Bearss, Lawrence Scahill
      Abstract: Autism, Ahead of Print.
      Anxiety often co-occurs with autism spectrum disorder, yet there are few valid and reliable instruments for measuring anxiety in youth with autism spectrum disorder. This article describes the modification of the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder and systematic psychometric evaluation in a well-characterized sample of 116 youth (age: 5–17 years) with autism spectrum disorder and a range of anxiety symptoms. The clinician-administered-Pediatric Anxiety Rating Scale for youth with autism spectrum disorder was modified with input from parents of children with autism spectrum disorder and an expert panel. Unlike many other anxiety measures, the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder is more focused on behavioral manifestations of anxiety versus verbal expression. Results provide preliminary support for the psychometric properties of the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder. The internal consistency of the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder was 0.90. The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder was strongly correlated with parent-report anxiety measures (rs = 0.62–0.68), supporting convergent validity. In support of divergent validity, correlations between the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder and parent ratings of autism spectrum disorder symptoms, social withdrawal, stereotypy, hyperactivity, inappropriate speech, and repetitive behaviors were low (rs = 0.13–0.32). The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder was moderately correlated with parent-reported irritability (r = 0.52). The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder showed good test-retest reliability (intraclass correlation coefficient = 0.75–0.82) and inter-rater reliability (ICCs = 0.70–0.92). Overall, results support the use of the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder for assessing anxiety in youth with autism spectrum disorder.Lay AbstractMany youth with autism spectrum disorder have anxiety, but it can be difficult to assess anxiety with existing measures. We modified the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder and tested the new measure in a group of 116 youth (age: 5–17 years) with autism spectrum disorder. The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder is an interview that a clinician usually completes with the child and parent together. We modified the interview questions and scoring instructions based on feedback from parents of children with autism spectrum disorder and from a panel of experts in autism spectrum disorder and anxiety. Unlike many other anxiety measures, the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder relies less on a child’s verbal expression of anxiety and more on signs that a parent can easily observe. Training clinicians to administer and score the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder was uncomplicated, and raters showed excellent agreement on video-recorded interviews. Youth who were not currently in treatment for anxiety had stable Pediatric Anxiety Rating Scale for youth with autism spectrum disorder scores with repeat measurement over a 1-month period. The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder is a useful clinician-rated measure of anxiety in youth with autism spectrum disorder and fills a gap for assessing anxiety in this population.
      Citation: Autism
      PubDate: 2020-06-01T06:37:15Z
      DOI: 10.1177/1362361320922682
       
  • Examining the relationship between parent physical activity support
           behaviour and physical activity among children and youth with autism
           spectrum disorder
    • Authors: Denver M Brown, Kelly P Arbour-Nicitopoulos, Kathleen A Martin Ginis, Amy E Latimer-Cheung, Rebecca L Bassett-Gunter
      Abstract: Autism, Ahead of Print.
      Children and youth with autism spectrum disorder engage in less physical activity than neurotypically developing peers. This may be due to factors associated with autism spectrum disorder at the individual and environmental level that can make physical activity participation more challenging. Parent support is a known determinant of physical activity among children and youth; however, limited research has explored the relationship between parent physical activity support behaviour and child physical activity behaviour within the autism spectrum disorder population. Guided by the multi-process action control framework, this study examined the relationship between parent physical activity support behaviour and physical activity levels of children and youth with autism spectrum disorder. Parents (n = 201) of school-aged children and youth with autism spectrum disorder completed measures of parent physical activity support (intentions, behavioural regulation, support behaviour), as well as their child’s physical activity behaviour. Congruent with the multi-process action control model, intentions to provide physical activity support were significantly associated with parent physical activity support behaviour. Behavioural regulation of physical activity support mediated this relationship, which in turn significantly predicted child physical activity behaviour. Findings suggest parents play an instrumental role in the physical activity behaviour of children and youth with autism spectrum disorder. Family-level interventions targeting parents’ behavioural regulation strategies to provide physical activity support may be an effective strategy to increase physical activity in children and youth with autism spectrum disorder.Lay abstractChildren and youth with autism spectrum disorder engage in less physical activity than neurotypically developing peers. This may be due to factors associated with autism spectrum disorder at the individual and environmental level that can make physical activity participation more challenging. Parent support is a known determinant of physical activity among children and youth; however, limited research has explored the relationship between parent physical activity support behaviour and child physical activity behaviour within the autism spectrum disorder population. The purpose of this study was to examine the relationship between parent physical activity support behaviour and physical activity levels of children and youth with autism spectrum disorder. Parents (n = 201) of school-aged children and youth with autism spectrum disorder completed measures of parent physical activity support (intentions, behavioural regulation, support behaviour), as well as their child’s physical activity behaviour. The results showed that parent’s intentions to provide physical activity support were associated with their support behaviour for their child’s physical activity (e.g. encouragement, being active together). Parents who followed through with their intentions to provide support reported using behavioural regulation strategies such as goal setting and planning more often. Finally, the results showed parent physical activity support behaviour was positively associated with child physical activity behaviour. Findings suggest parents play an instrumental role in the physical activity behaviour of children and youth with autism spectrum disorder. Family-level interventions targeting parents’ behavioural regulation strategies to provide physical activity support may be an effective strategy to increase physical activity in children and youth with autism spectrum disorder.
      Citation: Autism
      PubDate: 2020-06-01T06:35:32Z
      DOI: 10.1177/1362361320922658
       
  • Making sense of the perceptual capacities in autistic and non-autistic
           adults
    • Authors: Jana Brinkert, Anna Remington
      Abstract: Autism, Ahead of Print.
      Recent studies highlighted that autistic individuals show increased perceptual capacity – the ability to process more information at any one time. This study examined whether there is a link between this increased perceptual capacity and the sensory hypersensitivity that many autistic people experience on a daily basis. In total, 38 autistic and 66 non-autistic adults filled in sensory questionnaires and performed an auditory load task, which assessed perceptual capacity. Results showed that higher levels of auditory perceptual capacity were correlated with higher levels of sensory sensitivities. We identified two clusters in the sample: one group of individuals with hyposensitivity and a decreased perceptual capacity (n = 42) and a cluster with an increased perceptual capacity and hypersensitivity (n = 47). Understanding this relationship may offer the opportunity to develop more effective techniques to ameliorate the often debilitating consequences of sensory hypersensitivity and over-arousal. Interestingly, this association between perceptual capacity and sensory sensitivities was seen for both groups; no significant association was found between perceptual capacity and level of autistic traits. As such, the findings may extend to other conditions with sensory atypicalities, such as attention-deficit hyperactivity disorder or Williams syndrome. The practical implications of the results for many aspects of daily life, education and employment are discussed.Lay abstractPerceptual capacity refers to the amount of information that we can pay attention to at any one time. Research has shown that autistic people have a higher perceptual capacity, which means they can take in more information than non-autistic people can. This can be useful in certain situations, for instance, hearing approaching cars or noticing small details. However, in other situations, a higher perceptual capacity may result in more distraction. This study looked at whether having this increased perceptual capacity is linked to being very sensitive to sensory information (lights, sounds, touch, taste and smell) – something that many autistic people experience on a daily basis. Being very sensitive to these things can make it hard to interact with the world around us, so it is important to know more about what causes the sensitivity. To explore this, 38 autistic and 66 non-autistic adults completed a computer task that measured perceptual capacity and filled in a questionnaire about how sensitive they were to sensory information. We found that perceptual capacity was related to sensory symptoms for both autistic and non-autistic participants; people who had a larger perceptual capacity showed more sensitivity, while people who had a lower perceptual capacity showed reduced sensory sensitivity. This information can hopefully be used to improve the way in which we can support people who experience unpleasant sensory sensitivity.
      Citation: Autism
      PubDate: 2020-06-01T06:33:35Z
      DOI: 10.1177/1362361320922640
       
  • Head circumference trends in autism between 0 and 100 months
    • Authors: Joel Crucitti, Christian Hyde, Peter G Enticott, Mark A Stokes
      Abstract: Autism, Ahead of Print.
      Meta-analyses of head circumference in autistic individuals exist; however, simple meta-analytic approaches are limited. Consequently, we gathered head circumference raw data of autistic (N = 2381) and typically developing participants (N = 994) by re-analysing the data from previously published studies together. The present study found no mean difference between head circumference of autistic and typically developing individuals, although simple effect analyses revealed smaller mean head circumference in autistic than typically developing females aged 12–17 months. However, compared to controls, the frequency of extreme head circumference in autistic males was greater at birth and between 60 and 100 months. In addition, the frequency of extremely small head circumference between 6 and 11 months, and extremely large head circumference between 12 and 17 months, was greater in autistic than typically developing males. For autistic females, compared to controls, extreme head circumference was more frequent between 36 and 59 months and less frequent at birth. We conclude that it is imperative to consider the effects of age and sex when investigating the relationship between autism diagnosis and head circumference. This variance was more effectively described via the approach of the present study than previous meta-analytic approaches.Lay abstractSummaries of studies that have measured head size in those with autism, known as meta-analyses, currently exist. However, this approach does not adequately explain extreme cases (such as those with extremely small, or extremely large, head size). Because of this, we obtained all available published data measuring head size (12 studies). The data from each study were then combined to make a larger dataset. We found that females with autism aged 12–17 months had, on average, smaller head sizes. Otherwise, average head size was not atypical in autism. However, we found that males with autism were more likely to have extreme head sizes at birth and between 60 and 100 months, a small head between 6 and 11 months, and a large head between 12 and 17 months. Females with autism were more likely to have extreme head sizes between 36 and 59 months and were less likely at birth. Our approach was able to measure the influence of age and biological sex on head size in autism, as well as the frequency of extreme cases of head size in autism. These results add to what we already know about head size in autism.
      Citation: Autism
      PubDate: 2020-06-01T06:31:15Z
      DOI: 10.1177/1362361320921037
       
  • Impact of a digital Modified Checklist for Autism in Toddlers–Revised on
           likelihood and age of autism diagnosis and referral for developmental
           evaluation
    • Authors: Samantha Major, Kathleen Campbell, Steven Espinosa, Jeffrey P Baker, Kimberly LH Carpenter, Guillermo Sapiro, Saritha Vermeer, Geraldine Dawson
      Abstract: Autism, Ahead of Print.
      The present study is a single-site quality improvement project within pediatric primary care involving the implementation of a digital version of the Modified Checklist for Autism in Toddlers–Revised. We evaluated the impact of the digital screener on the likelihood of physician referral for a developmental evaluation or autism diagnosis, and the age of the patients at the time of the event. Patients were children 16–30  months old seen for 18 and 24 months’ well-child visits (1279 encounters), who screened positive for risk for autism spectrum disorder on the Modified Checklist for Autism in Toddlers–Revised without a previously documented autism spectrum disorder diagnosis. Comparisons were made between a cohort of children screened with the paper and pencil version of the Modified Checklist for Autism in Toddlers–Revised before the digital version was implemented and a cohort of children screened during the intervention period. Patients were followed until 48 months and referrals were obtained from electronic health records. Patients screened with the digital Modified Checklist for Autism in Toddlers–Revised were five times more likely to be referred for a developmental evaluation. The automatic scoring, risk assessment, and referral decision support features helped to improve screening outcomes. In this clinic, process change to a digital screening method with automatic guidance for next steps improved adherence to evidence-based clinical care.Lay abstractThis was a project in primary care for young children (1–2 years old). We tested a parent questionnaire on a tablet. This tablet questionnaire asked questions to see whether the child may have autism. We compared the paper and pencil version of the questionnaire to the tablet questionnaire. We read the medical charts for the children until they were 4 years old to see whether they ended up having autism. We found that doctors were more likely to recommend an autism evaluation when a parent used the tablet questionnaire. We think that the tablet’s automatic scoring feature helped the doctors. We also think that the doctors benefited from the advice the tablet gave them.
      Citation: Autism
      PubDate: 2020-05-29T06:25:15Z
      DOI: 10.1177/1362361320916656
       
  • Implementing early intensive behavioral intervention in community settings
    • Authors: Joshua B Plavnick, M Y Savana Bak, Sarah M Avendaño, Ana D Dueñas, Matthew T Brodhead, Emma S Sipila
      Abstract: Autism, Ahead of Print.
      Although research shows early intensive behavioral intervention is efficacious when delivered in university or private intervention centers, little is known about effectiveness or feasibility of disseminating early intensive behavioral intervention to larger communities. The Michigan State University Early Learning Institute was developed to address gaps in distribution of early intensive behavioral intervention to community settings, with an emphasis of serving children and families on Medicaid. This short report describes the Early Learning Institute’s approach and preliminary utilization data among Medicaid families. Results suggest the model has potential for dissemination within community settings and promote utilization among Medicaid children.Lay abstractAlthough research shows early intensive behavioral intervention can be very beneficial for children with autism spectrum disorder when delivered in university or private intervention centers, little is known about the best way to provide early intensive behavioral intervention within the broader community. The Michigan State University Early Learning Institute was developed to address challenges with providing early intensive behavioral intervention in community settings, with an emphasis on serving children and families on Medicaid. This short report describes the approach taken by the Early Learning Institute and reports data regarding enrollment and utilization among Medicaid families. Results suggest the model has potential to be used within community settings and that children on Medicaid are likely to consistently attend their treatment sessions.
      Citation: Autism
      PubDate: 2020-05-20T09:42:27Z
      DOI: 10.1177/1362361320919243
       
  • Work, living, and the pursuit of happiness: Vocational and psychosocial
           outcomes for young adults with autism
    • Authors: Catherine Lord, James B McCauley, Lauren A Pepa, Marisela Huerta, Andrew Pickles
      Abstract: Autism, Ahead of Print.
      Longitudinal data on the functioning of adults referred for possible autism as children are sparse and possibly different from datasets consisting of adult clinical referrals. A total of 123 young adults, mean age of 26, referred for neurodevelopmental disorders in early childhood were categorized into three outcome groups: autism spectrum disorder (ASD) diagnosis at some point and current intelligence quotient (IQ) ⩾ 70 (Ever ASD-Higher IQ), ever ASD and current IQ 
      Citation: Autism
      PubDate: 2020-05-20T09:36:27Z
      DOI: 10.1177/1362361320919246
       
  • Does implementing a new intervention disrupt use of existing
           evidence-based autism interventions'
    • Authors: Melanie Pellecchia, Rinad S Beidas, Gwendolyn Lawson, Nathaniel J Williams, Max Seidman, John R Kimberly, Carolyn C Cannuscio, David S Mandell
      Abstract: Autism, Ahead of Print.
      This study examines how the introduction of TeachTown:Basics, a computer-assisted intervention for students with autism spectrum disorder, influenced teachers’ use of other evidence-based practices. In a randomized controlled trial that enrolled 73 teachers nested within 58 schools, we used three-level hierarchical linear models to evaluate changes in teachers’ use of evidence-based practices across the school year for those who received TeachTown:Basics versus those assigned to control. Both groups received training and implementation support to deliver three well-established evidence-based practices for autism spectrum disorder. Qualitative interviews were conducted with 25 teachers who used TeachTown:Basics to better understand their experience. Compared with teachers in the control group, teachers in the TeachTown:Basics group reported significantly less growth over the 9-month period in their use of evidence-based practices that require one-to-one instruction (ps 
      Citation: Autism
      PubDate: 2020-05-20T09:33:27Z
      DOI: 10.1177/1362361320919248
       
  • Autistic peer-to-peer information transfer is highly effective
    • Authors: Catherine J Crompton, Danielle Ropar, Claire VM Evans-Williams, Emma G Flynn, Sue Fletcher-Watson
      Abstract: Autism, Ahead of Print.
      Effective information transfer requires social communication skills. As autism is clinically defined by social communication deficits, it may be expected that information transfer between autistic people would be particularly deficient. However, the Double Empathy theory would suggest that communication difficulties arise from a mismatch in neurotype; and thus information transfer between autistic people may be more successful than information transfer between an autistic and a non-autistic person. We investigate this by examining information transfer between autistic adults, non-autistic adults and mixed autistic-with-non-autistic pairs. Initial participants were told a story which they recounted to a second participant, who recounted the story to a third participant and so on, along a ‘diffusion chain’ of eight participants (n = 72). We found a significantly steeper decline in detail retention in the mixed chains, while autistic chains did not significantly differ from non-autistic chains. Participant rapport ratings revealed significantly lower scores for mixed chains. These results challenge the diagnostic criterion that autistic people lack the skills to interact successfully. Rather, autistic people effectively share information with each other. Information transfer selectively degrades more quickly in mixed pairs, in parallel with a reduction in rapport.Lay abstractSharing information with other people relies on the ability to communicate well. Autism is defined clinically by deficits in social communication. It may therefore be expected that autistic people find it difficult to share information with other people. We wanted to find out whether this was the case, and whether it was different when autistic people were sharing information with other autistic people or with non-autistic people. We recruited nine groups, each with eight people. In three of the groups, everyone was autistic; in three of the groups, everyone was non-autistic; and three of the groups were mixed groups where half the group was autistic and half the group was non-autistic. We told one person in each group a story and asked them to share it with another person, and for that person to share it again and so on, until everyone in the group had heard the story. We then looked at how many details of the story had been shared at each stage. We found that autistic people share information with other autistic people as well as non-autistic people do with other non-autistic people. However, when there are mixed groups of autistic and non-autistic people, much less information is shared. Participants were also asked how they felt they had got on with the other person in the interaction. The people in the mixed groups also experienced lower rapport with the person they were sharing the story with. This finding is important as it shows that autistic people have the skills to share information well with one another and experience good rapport, and that there are selective problems when autistic and non-autistic people are interacting.
      Citation: Autism
      PubDate: 2020-05-20T09:29:46Z
      DOI: 10.1177/1362361320919286
       
  • The hidden inequalities of COVID-19
    • Authors: Elizabeth Pellicano, Marc Stears
      Abstract: Autism, Ahead of Print.

      Citation: Autism
      PubDate: 2020-05-19T06:58:38Z
      DOI: 10.1177/1362361320927590
       
  • Considering efficacy and effectiveness trials of cognitive behavioral
           therapy among youth with autism: A systematic review
    • Authors: Johanna K Lake, Paula Tablon Modica, Victoria Chan, Jonathan A Weiss
      Abstract: Autism, Ahead of Print.
      Cognitive behavioral therapy is a widely studied and commonly used psychosocial intervention for treating emotional problems in individuals with autism. To date, most studies of cognitive behavioral therapy and autism have focused on efficacy. Effectiveness trials, by contrast, measure whether an intervention produces particular results under “real-world” clinical conditions. We conducted a systematic review of cognitive behavioral therapy interventions targeting affective disorders among youth with autism and (a) classified studies as either efficacy or effectiveness trials and (b) coded how the effectiveness trials reflect the implementation characteristics outlined in the Framework of Dissemination in Health Services Intervention Research. The systematic search yielded 2959 articles, with 33 studies meeting inclusion criteria. Thirteen studies were categorized as effectiveness and 20 as efficacy. We discuss how the effectiveness studies considered elements of the implementation framework and provide recommendations for future studies, including greater consideration and measurement of adoption and sustainability processes, as well as organizational- and system-level outcomes. Results shed light on our understanding of the effectiveness of cognitive behavioral therapy in routine clinical practice, how an implementation framework can be used to guide and improve effectiveness studies, and identify barriers, facilitators, and gaps in the implementation process.Lay abstractCognitive behavioral therapy is a common treatment for emotional problems in people with autism. Most studies of cognitive behavioral therapy and autism have focused on efficacy, meaning whether a treatment produces results under “ideal” conditions, like a lab or research setting. Effectiveness trials, by contrast, investigate whether a treatment produces results under “real-world” conditions, like a community setting (e.g. hospital, community mental health center, school). There can be challenges in bringing a cognitive behavioral therapy treatment out of a lab or research setting into the community, and the field of implementation science uses frameworks to help guide researchers in this process. In this study, we reviewed efficacy and effectiveness studies of cognitive behavioral therapy treatments for emotional problems (e.g. anxiety, depression) in children and youth with autism. Our search found 2959 articles, with 33 studies meeting our criteria. In total, 13 studies were labelled as effectiveness and 20 as efficacy. We discuss how the effectiveness studies used characteristics of an implementation science framework, such as studying how individuals learn about the treatment, accept or reject it, how it is used in the community over time, and any changes that happened to the individual or the organization (e.g. hospital, school, community mental health center) because of it. Results help us better understand the use of cognitive behavioral therapy in the community, including how a framework can be used to improve effectiveness studies.
      Citation: Autism
      PubDate: 2020-05-19T06:57:58Z
      DOI: 10.1177/1362361320918754
       
  • Types and correlates of school non-attendance in students with autism
           spectrum disorders
    • Authors: Vasiliki Totsika, Richard P Hastings, Yoko Dutton, Alison Worsley, Glenn Melvin, Kylie Gray, Bruce Tonge, David Heyne
      Abstract: Autism, Ahead of Print.
      School non-attendance in autism spectrum disorders has received very little attention to date. The study aimed to provide a comprehensive description of school non-attendance in students with autism spectrum disorders. Through an online survey, parents of 486 children (mean age: 11 years) reported on school attendance over 1 month and reasons for instances of non-attendance. On average, students missed 5 days of school of a possible 23 days. Persistent non-attendance (absent on 10%+ of available sessions) occurred among 43% of students. School non-attendance was associated with child older age, not living in a two-parent household, parental unemployment and, especially, attending a mainstream school. School refusal accounted for 43% of non-attendance. School exclusion and school withdrawal each accounted for 9% of absences. Truancy was almost non-existent. Non-problematic absenteeism (mostly related to medical appointments and illness) accounted for 32% of absences. Non-problematic absenteeism was more likely among those with intellectual disability, school refusal was more likely among older students and school exclusion was more likely among students from single-parent, unemployed and well-educated households. Findings suggest that school non-attendance in autism spectrum disorders is a significant issue, and that it is important to capture detail about attendance patterns and reasons for school non-attendance.Lay abstractOur study aimed to describe school non-attendance in students with autism. We conducted an online survey. Parents of 486 students (mean age: 11 years) indicated which days their child had missed school (over a period of 1 month). If the child had missed a day, the parent was asked to select a reason from a list of 15 possible reasons (this is a measure of types of school non-attendance called SNACK (School Non-Attendance ChecKlist; Heyne et al., 2019)). On average, students missed 5 days of school of a possible 23 days. Missing over 10% of school is known as persistent absence, and in our study, 43% of students experienced persistent absence. Older students, who attended mainstream schools, who did not live in a two-parent household and whose caregiver was unemployed were more likely to miss school. Looking at the reasons for absence, school refusal was the most frequent reason, accounting for 43% of absences. Nine percent of absence was due to school exclusion. Nine percent of absence was due to school withdrawal. Truancy was almost non-existent. A final reason describes non-problematic absence that is mostly due to medical appointments and illness. This type of absence accounted for 32% of absences in our study, and it was more likely in student with intellectual disability. School refusal was more likely among older students. School exclusion was more likely among students from single-parent, unemployed and well-educated households. Findings from this study help us to understand better the difficulties students with autism experience attending school.
      Citation: Autism
      PubDate: 2020-05-18T11:06:06Z
      DOI: 10.1177/1362361320916967
       
  • Motor atypicalities in infancy are associated with general developmental
           level at 2 years, but not autistic symptoms
    • Authors: Sheila Achermann, Pär Nyström, Sven Bölte, Terje Falck-Ytter
      Abstract: Autism, Ahead of Print.
      Atypical motor development has frequently been reported in infants at elevated likelihood for autism spectrum disorder. However, no previous study has used detailed motion capture technology to compare infant siblings of children with autism spectrum disorder and infant siblings with no familial history of autism spectrum disorder. We investigated reaching movements during an interceptive action task in 10-month-old infants using kinematic data with high spatiotemporal resolution. The results indicated that several measures were different in infants at elevated likelihood. However, longitudinal analyses revealed that while specific infant motor measures (e.g. number of movement units) were related to broad measures of general developmental level in toddlerhood, the associations with later autism spectrum disorder symptomatology were not significant. These findings confirm that some aspects of motor functioning are atypical in infants at elevated likelihood for autism spectrum disorder, but provide no support for the view that these issues are specifically linked to autism spectrum disorder symptoms, but may rather reflect neurodevelopment more generally.Lay abstractAtypicalities in motor functioning are often observed in later born infant siblings of children with autism spectrum disorder. The goal of our study was to investigate motor functioning in infants with and without familial history of autism spectrum disorder. Specifically, we investigated how infants catch a ball that is rolling toward them following a non-straight path, a task that requires both efficient planning and execution. Their performance was measured using detailed three-dimensional motion capture technology. We found that several early motor functioning measures were different in infants with an older autistic sibling compared to controls. However, these early motor measures were not related to autistic symptoms at the age of 2 years. Instead, we found that some of the early motor measures were related to their subsequent non-social, general development. The findings of our study help us understand motor functioning early in life and how motor functioning is related to other aspects of development.
      Citation: Autism
      PubDate: 2020-05-16T06:16:11Z
      DOI: 10.1177/1362361320918745
       
  • Interventions to address health outcomes among autistic adults: A
           systematic review
    • Authors: Teal W Benevides, Stephen M Shore, May-Lynn Andresen, Reid Caplan, Barb Cook, Dena L Gassner, Jasmine M Erves, Taylor M Hazlewood, M Caroline King, Lisa Morgan, Lauren E Murphy, Yenn Purkis, Brigid Rankowski, Sarah M Rutledge, Savannah P Welch, Karl Wittig
      Abstract: Autism, Ahead of Print.
      Research has shown that autistic adults have poor health outcomes. We conducted a systematic review to identify existing interventions to address health outcomes for autistic adults and to determine whether these interventions address the priorities of the autistic community. We searched PubMed for articles that included an intervention, a primary health outcome measured at the individual (not system) level, and a sample population of at least 50% autistic adults. Studies were excluded if they were not peer-reviewed, had a focus on caregivers, were expert opinions on specific interventions, untested protocols, or interventions without a primary health outcome. Out of the 778 articles reviewed, 19 were found to meet the stated criteria. Based on the evidence gathered, two were considered emerging evidence-based approaches: cognitive behavioral approaches and mindfulness. The remaining interventions included in the review did not have sufficient evidence to support current use with this population. The majority of the studies included samples of young autistic adults, primarily male, without an intellectual disability. Anxiety, quality of life, depression, and behavioral issues were among the health outcomes measured in the final included articles. More research on preferred interventions with prioritized health outcomes of the autistic adult population is needed.Lay abstractAutistic adults have more health problems then their same-aged peers. Yet little research has been conducted that focuses on addressing these health problems. In order to guide future research, it is important to know what intervention studies have been done to improve health outcomes among autistic adults. The project team and student assistants read studies that were published between 2007 and 2018 in the online research database, PubMed. We looked for studies published in English, which were peer-reviewed and included (1) an intervention, (2) an outcome that was related to health, and (3) a study group that included autistic adults. We did not include studies that had outcomes about employment (unless there was a health outcome), studies about caregivers or caregiving, or expert opinions about interventions. Of 778 reviewed articles, 19 studies met all of the criteria above. Within these studies, two approaches were found to have emerging evidence for their use in autistic adults: cognitive behavioral interventions and mindfulness-based approaches for improved mental health outcomes. The remaining intervention approaches did not have enough articles to support their use. Many of the outcomes were about reduced symptoms of co-occurring mental health diagnoses (e.g. reduced anxiety, depression). Most of the participants in these studies were male and did not have intellectual disability. Most study participants were adults younger than 40. There are not many intervention studies that address health outcomes among autistic adults. More research is needed on interventions which are desired by the adult autism community and address preferred health outcomes such as increased quality of life or well-being.
      Citation: Autism
      PubDate: 2020-05-11T09:15:59Z
      DOI: 10.1177/1362361320913664
       
  • Determinants of an autism spectrum disorder diagnosis in childhood and
           adolescence: Evidence from the UK Millennium Cohort Study
    • Authors: Mariko Hosozawa, Amanda Sacker, William Mandy, Emily Midouhas, Eirini Flouri, Noriko Cable
      Abstract: Autism, Ahead of Print.
      This study aimed to identify determinants of a late autism spectrum disorder diagnosis, including diagnoses made ‘very late’ (i.e., in adolescence), using the Millennium Cohort Study, a nationally representative population-based cohort in the United Kingdom. Children diagnosed with autism spectrum disorder by age 14 (N = 581) were included and grouped by the parent-reported timing of diagnosis: before school (up to age 5), during primary school (age 5–11) and during secondary school (age 11–14). Predictors of diagnostic timing, at the child, family and school levels, were investigated using multinomial logistic regression. Most (79%) children with autism spectrum disorder were diagnosed after school entry, and 28% were not diagnosed until secondary school. Among those not diagnosed until secondary school, 75% had been identified at age 5 years by a parent and/or teacher as having socio-behavioural difficulties. Being diagnosed after starting school was predicted by living in poverty (adjusted relative risk ratio: primary = 1.90, 95% confidence interval: 1.03–3.53; secondary = 2.15, 1.05–4.42) and/or having no initial parental concerns (primary = 0.32, 0.15–0.70; secondary = 0.19, 0.09–0.43). Having typical-range intelligence also predicted diagnosis during secondary school. The result indicates that those without cognitive delays and poorer children were at risk of ‘very late’ (i.e. adolescent) diagnosis. Strategies to promote earlier identification, targeting age at primary school entry, could help those more likely to be diagnosed late.Lay abstractDespite policy emphasis on early identification, many children with autism spectrum disorder are diagnosed late, with some being diagnosed as late as in adolescence. However, evidence on what determines the timing of autism spectrum disorder diagnosis including children diagnosed in adolescence is lacking. Understanding these determinants, particularly in those diagnosed later than is ideal, can inform the development of effective strategies to improve earlier identification of autism spectrum disorder. This study used a nationally representative population-based cohort in the United Kingdom to explore child, family and school level predictors of timing of autism spectrum disorder diagnosis. In the United Kingdom, 79% of the children with autism spectrum disorder were diagnosed after entering primary school and 28% during secondary school. Among those not diagnosed until secondary school, 75% had shown social difficulties noticed by parents and/or teachers at age 5 years. The results suggest that healthcare providers should be aware that, even for universal systems of care, those living in poverty and having higher intelligence are most likely to miss out on a timely diagnosis. Strategies to promote earlier identification among school-aged children, including targeting primary school entry age (i.e. around age 5) and that encouraging referrals for a formal assessment at the first report of concerns over the child’s social development may benefit those children who would otherwise be diagnosed later.
      Citation: Autism
      PubDate: 2020-05-05T10:29:23Z
      DOI: 10.1177/1362361320913671
       
  • The link between autism spectrum disorder and gut microbiota: A scoping
           review
    • Authors: Amanda Nitschke, Raywat Deonandan, Anne TM Konkle
      Abstract: Autism, Ahead of Print.
      Gut dysfunction and microbial dysbiosis comorbidities are of particular interest in recent autism research, as gastrointestinal distress is present in up to 90% of autism spectrum disorder cases and therefore may play a key role in the pathogenesis of this disorder. This scoping review aims to integrate the results of studies conducted in the past 6 years examining the association between gut microbiota and autism spectrum disorder, specifically with regard to the characterization of autism spectrum disorder microbiota and potential therapeutic interventions. Studies related to the gastrointestinal microbiome of subjects with autism spectrum disorder were identified through PubMed, SCOPUS, PsycInfo, and Google Scholar databases. Studies were screened and selected based on defined inclusion and exclusion criteria; 19 studies were included. Research continues to report differences between microbiota of individuals with autism spectrum disorder and controls; however, the types and abundances of bacteria present remain inconsistent. Promising treatment interventions for autism spectrum disorder, including special diets, dietary supplementation, and of particular interest, microbiota transfer therapy, are also being explored. Research regarding the link between gut microbiota and autism spectrum disorder renders exciting results; however, it is still in its infancy of investigation. Rigorous methodologies are required to support and strengthen the reliability of existing results, and to further our understanding of the pathogenesis of autism spectrum disorder.Lay abstractGastrointestinal distress and gut microbial imbalances are commonly found in children with autism spectrum disorder, and therefore may play a key role in the development of the disorder. This scoping review aimed to examine the extent, range and nature of research conducted in the past 6 years that focused on furthering our understanding of autism spectrum disorder and its association with gut microbiota. A literature review was performed with predetermined key words. Studies were screened and selected based on defined inclusion and exclusion criteria. A total of 19 studies were included for final analysis. While there are continuous reports of differences in gut microbiota between autism spectrum disorder and neurotypical individuals, knowledge about the consistency in the presence and abundance of bacterial species, as well as metabolites, remains deficient. Treatments such as special diets, vitamin, prebiotic, probiotic, and microbiota transfer therapy show promising therapeutic potential, yet are in their infancy of investigation. Overall, further research with rigorous methodologies is required to support and strengthen the reliability of existing findings. Future research should aim to increase sample sizes, eliminate biases, and subgroup autism spectrum disorder groups to help accommodate for inter-individual variation. As increasing evidence of a unique autism spectrum disorder microbiome and metabolome is acquired, autism spectrum disorder-specific biomarkers can be identified. These biomarkers have great implications in terms of elucidating the molecular mechanisms of autism spectrum disorder, preventing the onset of autism spectrum disorder, and improving treatments for individuals with autism spectrum disorder.
      Citation: Autism
      PubDate: 2020-04-28T09:01:59Z
      DOI: 10.1177/1362361320913364
       
  • When the mask comes off: Mothers’ experiences of parenting a daughter
           with autism spectrum condition
    • Authors: James Anderson, Charles Marley, Karri Gillespie-Smith, Leonie Carter, Ken MacMahon
      Abstract: Autism, Ahead of Print.
      There is limited knowledge and research on the experiences of having a daughter with autism spectrum condition from a mother’s perspective. This study aims to explore the experiences of mothers who care for a daughter with autism spectrum condition, with a particular focus on female autism spectrum condition presentation. Ten mothers of daughters with autism spectrum condition took part in a semi-structured interview. Interpretative phenomenological analysis was used to analyse the data. Five superordinate themes emerged: ‘Girls have autism too’, ‘She’s a chameleon’, ‘The impact of the diagnosis’, ‘Impact on mums’ and ‘Day-to-day life’. These findings add to our knowledge of how female autism spectrum condition presents and of the experiences directly related to being the mother of a daughter with autism spectrum condition. The findings have implications for clinicians that carry out autism spectrum condition assessments and provide insights into areas where additional support can be provided to mothers and daughters.Lay abstractParents of children with autism spectrum condition report increased stress and difficulties compared with parents of typically developing children. Our knowledge and understanding of how autism spectrum condition presents in autistic females is currently limited and parents of this population may experience challenges when raising their daughter. Given that mothers are often the main caregiver of a child with autism spectrum condition, they may have useful insights into the experiences of parenting a daughter with autism spectrum condition. Therefore, a qualitative study was undertaken to explore what mothers’ experiences are of parenting a daughter with autism spectrum condition. Semi-structured interviews were conducted with 10 mothers of daughters with autism spectrum condition. The interviews were analysed using interpretative phenomenological analysis. Five main themes emerged from the qualitative study (‘Girls have autism too’, ‘She’s a chameleon’, ‘The impact of the diagnosis’, ‘Impact on mums’ and ‘Day-to-day life’). The findings of this study expand our current knowledge of the experiences and challenges faced by mothers raising a daughter with autism spectrum condition. Mothers hold a vast amount of knowledge on their daughters’ autism spectrum condition which could inform the diagnostic process and clinical practice. Considering these results, it is important that clinicians support mothers and the family system around children with an autism spectrum condition diagnosis.
      Citation: Autism
      PubDate: 2020-04-27T03:03:32Z
      DOI: 10.1177/1362361320913668
       
  • Public knowledge and stigma of autism spectrum disorder: Comparing China
           with the United States
    • Authors: Luodi Yu, Sheri Stronach, Ashley J Harrison
      Abstract: Autism, Ahead of Print.
      Autism spectrum disorder in China differs considerably from autism spectrum disorder in the West in terms of prevalence estimates, education opportunities, and life outcomes of autistic people. The lack of autism spectrum disorder awareness could be a key factor underlying the disparities. To date, there has been no evaluation of autism spectrum disorder knowledge among the general public of China. Using the Autism Stigma and Knowledge Questionnaire developed for use in diverse cultural contexts, this study uncovered profoundly different public views about autism spectrum disorder in China compared with the United States. Determined by cognitive diagnosis modeling, 86%–91% of the surveyed U.S. citizens (N = 1127) achieved adequate autism spectrum disorder knowledge in diagnosis/symptoms, etiology, and treatment, whereas for the Chinese citizens (N = 1254) the percentages were only 57%–65%. Moreover, 14% of the participants from the United States were classified to endorse autism spectrum disorder stigma; in comparison, 38% of the Chinese participants endorsed autism spectrum disorder stigma. The Chinese citizens displayed knowledge deficits primarily in the areas of autism spectrum disorder core symptoms, comorbid intellectual impairment, and prognosis. Sociodemographic factors associated with the Chinese citizen’s misconceptions included gender, ethnicity, social economic factors, among others. These results have important implications for increasing public awareness and promoting community participation for autistic individuals in China.Lay abstractASD in China differs considerably from ASD in the West in terms of prevalence estimates, education opportunities and life outcomes of autistic people. The lack of ASD awareness could be a key factor underlying these disparities. We asked 1127 U.S. citizens and 1254 Chinese citizens about their autism knowledge using the Autism Stigma and Knowledge Questionnaire (ASK-Q).The results indicated profoundly different public views about ASD in China compared to the U.S. Specifically, only 57%-65% of the Chinese citizens demonstrated adequate ASD knowledge compared to 86%-91% in the U.S. citizens. Fourteen percent of the U.S. citizens were shown to hold stigma beliefs towards ASD; in comparison, 38% of the Chinese citizens indicated ASD stigma. The Chinese citizens displayed misconceptions about ASD related to symptoms, causes, and possible long-term outcomes. In China but not in the U.S., male citizens and citizens with lower social economic status were more likely to have misconceptions about ASD than others were. The findings of this research can help increase public awareness about ASD and create a more inclusive environment for autistic people in China.
      Citation: Autism
      PubDate: 2020-04-27T03:01:53Z
      DOI: 10.1177/1362361319900839
       
  • A qualitative study on perspective of parents of children with autism on
           the nature of parent–professional relationship in Kerala, India
    • Authors: Rajani Ramachandran
      Abstract: Autism, Ahead of Print.
      This study explored the nature of relationship between parents of children with autism and professionals who provide therapy-based service for autism in Kerala, India. Thematic analysis of semi-structured interview with 21 parents of children with autism whose age ranged between 5.8 and 17.3 years helped identify three themes related to the nature of parent–professional relationship—information, responsibility, and personal growth. There was a dearth of scheduled, in-depth, and personalized one-on-one interaction between the parent and the professional. Though parents were involved hands on in their child’s training under professional direction, they remained mere information providers in decision making. The parent–professional relationship did not nurture parent’s self efficacy. This led to parents feeling inadequate to provide for their child’s developmental needs and being apprehensive about adulthood. The customary nature of parent–professional relationship observed may be a reflection of the collectivist culture in India. The need for parent-mediated interventions and for it to focus on enabling parents to break cultural barriers that might be holding them back from partnering with professionals on equal terms is discussed.Lay AbstractThis study explored the nature of relationship between parents of children with autism and professionals who provide therapy-based services for autism in Kerala, India. Given the shortage of professionally qualified therapists and educators (particularly in the case of autism) in low- and medium-income countries, parent-mediated interventions where professionals and parents work as partners are recommended as an effective means to meet the demand. However, for parent-mediated interventions to be effective, we first need to understand the customary nature of parent–professional relationship and develop the intervention accordingly. It is within this context that parents of 21 children with autism whose age ranged between 5.8 and 17.3 years were interviewed in order to understand the customary nature of parent–professional relationship. There was a dearth of scheduled, in-depth, and personalized one-on-one interaction between the parent and the professional. Though parents were involved hands on in their child’s training under professional direction, they remained mere information providers in decision making. The parent–professional relationship did not nurture parent’s self efficacy. This led to parents feeling inadequate to provide for their child’s developmental needs and being apprehensive about adulthood. The customary nature of parent–professional relationship observed may be a reflection of the collectivist culture in India. The findings suggest that parent-mediated interventions will need to focus on enabling parents to break cultural barriers that might be holding them back from partnering with professionals as equals.
      Citation: Autism
      PubDate: 2020-04-24T10:44:30Z
      DOI: 10.1177/1362361320912156
       
  • Interviewing autistic adults: Adaptations to support recall in police,
           employment, and healthcare interviews
    • Authors: Jade Eloise Norris, Laura Crane, Katie Maras
      Abstract: Autism, Ahead of Print.
      Recalling specific past experiences is critical for most formal social interactions, including when being interviewed for employment, as a witness or defendant in the criminal justice system, or as a patient during a clinical consultation. Such interviews can be difficult for autistic adults under standard open questioning, yet applied research into effective methods to facilitate autistic adults’ recall is only recently beginning to emerge. The current study tested the efficacy of different prompting techniques to support autistic adults’ recall of specific personal memories; 30 autistic and 30 typically developing adults (intelligence quotients > 85) were asked to recall specific instances from their past, relevant to criminal justice system, healthcare, and employment interviews. Questions comprised ‘open questions’, ‘semantic prompting’ (where semantic knowledge was used to prompt specific episodic retrieval) and ‘visual–verbal prompting’ (a pie-diagram with prompts to recall specific details, for example, who, what, and where). Half the participants received the questions in advance. Consistent with previous research, autistic participants reported memories with reduced specificity. For both groups, visual–verbal prompting support improved specificity and episodic relevance, while semantic prompting also aided recall for employment questions (but not health or criminal justice system). Findings offer new practical insight for interviewers to facilitate communication with typically developing and autistic adults.Lay abstractDuring many types of interviews (e.g. in employment, with the police, and in healthcare), we need to recall detailed memories of specific events, which can be difficult for autistic people in response to commonly used questions. This is especially because these tend to be open questions (i.e. very broad). Autistic people have disproportionately high rates of physical and mental health conditions, are more likely to interact with police, and are the most underemployed disability group. However, interviewers are often unsure about how to adapt their communication for autistic people.Our research tested whether different types of prompts enabled autistic people to recall specific memories (memories of a single event within one day). Participants were asked about situations relating to witnessing a crime (e.g. at the bank), physical or mental health scenarios and employment interviews (e.g. a time you’ve met a deadline).We tested the following:Open questions: basic questions only (e.g. ‘tell me about a time you went to the cinema’),Semantic prompting: a general prompt (e.g. ‘do you enjoy going to the cinema'’) before asking for a specific instance (‘tell me about a time you went to the cinema'’),Visual–verbal prompting: asking participants to recall when it happened, who was there, the actions that occurred, the setting, and any objects.With visual–verbal prompting, autistic and typically developing participants’ memories were more specific and detailed. Semantic prompting was also effective for employment questions. Our study shows that autistic people can recall specific memories when they are appropriately prompted. Visual–verbal prompting may be effective across different situations.
      Citation: Autism
      PubDate: 2020-03-23T01:58:00Z
      DOI: 10.1177/1362361320909174
       
  • Randomized controlled trial of a sibling support group: Mental health
           outcomes for siblings of children with autism
    • Authors: Emily A Jones, Theresa Fiani, Jennifer L Stewart, Nicole Neil, Susan McHugh, Daniel M Fienup
      Abstract: Autism, Ahead of Print.
      Typically developing siblings of a child with autism spectrum disorder may be at increased risk of mental health difficulties. A support group is one approach to improve mental health outcomes for typically developing siblings. During support groups, typically developing siblings discuss their feelings, learn coping strategies and problem-solving skills, and develop a peer network. We conducted a randomized controlled trial comparing a support group to an attention-only social control group. Some areas of mental health improved. Autism spectrum disorder symptom severity in the sibling with autism spectrum disorder moderated effects. Findings suggest continuing to examine what areas of mental health and adjustment are improved with support groups and subgroups of typically developing siblings for whom support groups might be particularly effective.Lay abstractTypically developing siblings of a child with autism spectrum disorder may show mental health difficulties. A support group is one approach to help typically developing siblings. During support groups, typically developing siblings discuss their feelings, learn coping strategies and problem-solving skills, and develop a peer network. We compared a support group to participation in a similar group without a focus on the sibling with autism spectrum disorder. Some areas of mental health improved. Improvements were also impacted by autism spectrum disorder symptom severity in the sibling with autism spectrum disorder. Findings suggest continuing to examine how support groups can help typically developing siblings and for which siblings support groups might be particularly effective.
      Citation: Autism
      PubDate: 2020-03-14T05:05:35Z
      DOI: 10.1177/1362361320908979
       
  • The Witness-Aimed First Account (WAFA): A new technique for interviewing
           autistic witnesses and victims
    • Authors: Katie Maras, Coral Dando, Heather Stephenson, Anna Lambrechts, Sophie Anns, Sebastian Gaigg
      Abstract: Autism, Ahead of Print.
      Autistic people experience social communication difficulties alongside specific memory difficulties that can impact their ability to recall episodic events. Police interviewing techniques do not take account of these differences, and so are often ineffective. Here we introduce a novel Witness-Aimed First Account interview technique, designed to better support autistic witnesses by diminishing socio-cognitive and executive demands through encouraging participants to generate and direct their own discrete, parameter-bound event topics, before freely recalling information within each parameter-bound topic. Since witnessed events are rarely cohesive stories with a logical chain of events, we also explored witnesses’ recall when the narrative structure of the to-be-remembered event was lost. Thirty-three autistic and 30 typically developing participants were interviewed about their memory for two videos depicting criminal events. Clip segments of one video were ‘scrambled’, disrupting the event’s narrative structure; the other video was watched intact. Although both autistic and typically developing witnesses recalled fewer details with less accuracy from the scrambled video, Witness-Aimed First Account interviews resulted in more detailed and accurate recall from autistic and typically developing witnesses, for both scrambled and unscrambled videos. The Witness-Aimed First Account technique may be a useful tool to improve autistic and typically developing witnesses’ accounts within a legally appropriate, non-leading framework.Lay abstractAutistic people may be more likely to be interviewed by police as a victim/witness, yet they experience social communication difficulties alongside specific memory difficulties that can impact their ability to recall information from memory. Police interviewing techniques do not take account of these differences, and so are often ineffective. We developed a new technique for interviewing autistic witnesses, referred to a Witness-Aimed First Account, which was designed to better support differences in the way that autistic witnesses process information in memory. The Witness-Aimed First Account technique encourages witnesses to first segment the witnessed event into discrete, parameter-bound event topics, which are then displayed on post-it notes while the witness goes onto freely recall as much information as they can from within each parameter-bound topic in turn. Since witnessed events are rarely cohesive stories with a logical chain of events, we also explored autistic and non-autistic witnesses’ recall when the events were witnessed in a random (nonsensical) order. Thirty-three autistic and 30 typically developing participants were interviewed about their memory for two videos depicting criminal events. Clip segments of one video were ‘scrambled’, disrupting the event’s narrative structure; the other video was watched intact. Although both autistic and non-autistic witnesses recalled fewer details with less accuracy from the scrambled video, Witness-Aimed First Account interviews resulted in more detailed and accurate recall from both autistic and non-autistic witnesses, for both scrambled and unscrambled videos. The Witness-Aimed First Account technique may be a useful tool to improve witnesses’ accounts within a legally appropriate, non-leading framework.
      Citation: Autism
      PubDate: 2020-03-14T05:04:15Z
      DOI: 10.1177/1362361320908986
       
  • How accurate are autistic adults and those high in autistic traits at
           making face-to-face line-of-sight judgements'
    • Authors: Megan Freeth, Emma Morgan, Patricia Bugembe, Aaron Brown
      Abstract: Autism, Ahead of Print.
      Being able to follow the direction of another person’s line-of-sight facilitates social communication. To date, much research on the processes involved in social communication has been conducted using computer-based tasks that lack ecological validity. The current paradigm assesses how accurately participants can follow a social partner’s line-of-sight in a face-to-face scenario. In Study 1, autistic and neurotypical adults were asked to identify which location, on a grid of 36 potential locations, the experimenter was looking at on a series of discrete trials. All participants (both autistic and neurotypical) were able to effectively make line-of-sight judgements, scoring significantly above chance. Participants were also just as effective at making these judgements from either a brief, 1s, glance or from a prolonged, 5s, stare. However, at the group level, autistic participants were significantly less accurate than neurotypical participants overall. In Study 2, potential variation in performance along the broad autism phenotype was considered using the same paradigm. Bayesian analyses demonstrated that line-of-sight judgement accuracy was not related to the amount of autistic traits. Overall, these findings advance the understanding of the mechanistic processes of social communication in relation to autism and autistic traits in a face-to-face setting.Lay abstractIn order to effectively understand and consider what others are talking about, we sometimes need to follow their line-of-sight to the location at which they are looking, as this can provide important contextual information regarding what they are saying. If we are not able to follow other people’s line-of-sight, this could result in social communication difficulties. Here we tested how effectively autistic and neurotypical adults are at following a social partner’s line-of-sight during a face-to-face task. In a first study, completed by 14 autistic adult participants of average to above-average verbal ability and 14 neurotypical adult participants, we found that all participants were able to effectively follow the social partner’s line-of-sight. We also found that participants tended to be as effective at making these judgements from both a brief, 1s, glance or a long, 5s, stare. However, autistic adults were less accurate, on average, than neurotypical adults overall. In a second study, a separate group of 65 neurotypical adults completed the same line-of-sight judgement task to investigate whether task performance was related to individual variation in self-reported autistic traits. This found that the amount of self-reported autistic traits was not at all related to people’s ability to accurately make line-of-sight judgements. This research isolates and furthers our understanding of an important component part of the social communication process and assesses it in a real-world context.
      Citation: Autism
      PubDate: 2020-03-14T05:02:15Z
      DOI: 10.1177/1362361320909176
       
  • Facilitating sensorimotor integration via blocked practice underpins
           imitation learning of atypical biological kinematics in autism spectrum
           disorder
    • Authors: Nathan C Foster, Simon J Bennett, Joe Causer, Digby Elliott, Geoffrey Bird, Spencer J Hayes
      Abstract: Autism, Ahead of Print.
      The reduced efficacy of voluntary imitation in autism is suggested to be underpinned by differences in sensorimotor processing. We examined whether the imitation of novel atypical biological kinematics by autistic adults is enhanced by imitating a model in a predictable blocked practice trial order. This practice structure is expected to facilitate trial-to-trial sensorimotor processing, integration and encoding of biological kinematics. The results showed that neurotypical participants were generally more effective at imitating the biological kinematics across all experimental phases. Importantly, and compared to a pre-test where imitation was performed in a randomised (unpredictable) trial order, the autistic participants learned to imitate the atypical kinematics more effectively following an acquisition phase of repeatedly imitating the same model during blocked practice. Data from the post-test showed that autistic participants remained effective at imitating the atypical biological kinematics when the models were subsequently presented in a randomised trial order. These findings show that the reduced efficacy of voluntary imitation in autism can be enhanced during learning by facilitating trial-to-trial processing and integration of sensorimotor information using blocked practice.Lay AbstractAutistic people sometimes find it difficult to copy another person’s movement accurately, especially if the movement is unfamiliar or novel (e.g. to use chop sticks). In this study, we found that autistic people were generally less accurate at copying a novel movement than non-autistic people. However, by making a small adjustment and asking people to copy this movement for a set number of attempts in a predictable manner, we showed that autistic people did successfully learn to copy a new movement. This is a very important finding for autistic people because rather than thinking they cannot copy new movements, all that needs to be considered is for parents/guardians, teachers and/or support workers to make a small adjustment so that learning occurs in a predictable manner for new skills to be successfully acquired through copying. The implications from this study are wide-ranging as copying (imitation) and motor learning are important developmental processes for autistic infants and children to acquire in order to interact within the world. Therefore, practising these behaviours in the most effective way can certainly help the developmental pathway.
      Citation: Autism
      PubDate: 2020-03-14T04:54:55Z
      DOI: 10.1177/1362361320908104
       
  • Contextual determinants of parental reflective functioning: Children with
           autism versus their typically developing siblings
    • Authors: Yael Enav, Dana Erhard-Weiss, Amit Goldenberg, Marguerite Knudston, Antonio Y Hardan, James J Gross
      Abstract: Autism, Ahead of Print.
      Parental reflective functioning is defined as holding in mind one’s child’s thoughts, feelings, beliefs, and intentions and reflecting on how these mental states may be affecting the child’s behavior. Although parental reflective functioning is often treated as a stable feature of the parent, there is growing appreciation that it may be shaped by the context in which the parent is operating. In this study, we examined parental reflective functioning using the Parental Developmental Interview when parents were talking about their interactions with their child with autism versus the child’s typically developing siblings. Our sample included 30 parents who had a child between the ages of 3 and 18 years with a clinical diagnosis of autism spectrum disorder and at least one typically developing child. Findings indicated that parents exhibited significantly higher reflective functioning when interacting with their child with autism spectrum disorder versus the typically developing siblings, and the difference was moderated by parental self-efficacy. The evidence for a disparity in parental reflective functioning between children with autism spectrum disorder and their typically developing siblings (especially for parents with low parental self-efficacy) warrants further investigations that might lead to the development of effective interventions.Lay AbstractIn this study, we examined parental reflective functioning using the Parental Developmental Interview when parents were talking about their interactions with their child with autism versus the child’s typically developing siblings. Our sample included 30 parents who had a child between the ages of 3 and 18 years with a clinical diagnosis of autism spectrum disorder and at least one typically developing child. Findings indicated that parents exhibited significantly higher reflective functioning when interacting with their child with autism spectrum disorder versus the typically developing siblings, and the difference was moderated by parental self-efficacy.
      Citation: Autism
      PubDate: 2020-03-14T04:51:15Z
      DOI: 10.1177/1362361320908096
       
  • Factor structure and psychometric properties of the brief
           Connor–Davidson Resilience Scale for adults on the autism spectrum
    • Authors: Ye In (Jane) Hwang, Samuel Arnold, Julian Trollor, Mirko Uljarević
      Abstract: Autism, Ahead of Print.
      Resilience is an increasingly popular concept in literature as a protective factor against mental ill-health. While elevated rates of anxiety and mood disorders occur in adults on the autism spectrum, there is a gap in literature investigating the application of resilience to this population. This brief report examined the factor structure and psychometric properties of the 10-item Connor–Davidson Resilience Scale in a sample of 95 autistic adults (Mage = 44). Our findings provide evidence for a unidimensional structure and robust psychometric properties of the scale in an autistic population, in line with factorial studies involving the general population.Lay AbstractAdults on the autism spectrum experience high rates of anxiety and depression, and may be particularly vulnerable to difficult and traumatic life experiences, which may contribute to the development and maintenance of these conditions. Resilience is an increasingly popular concept in research, which describes the ability to ‘bounce back’ following difficult emotional experiences, and the flexibility to adapt to stressful and demanding situations. The Connor–Davidson Resilience Scale has been used predominantly in studies involving non-autistic adults to measure resilience. While resilience is a potentially important concept for autistic adults, the suitability of the 10-item version of the Connor–Davidson Resilience Scale for use with adults on the spectrum has not yet been studied. In this short report, we investigate whether the Connor–Davidson Resilience Scale 10 is a valid measure to use with this population, and its relationship with other measures of mental well- or ill-being. Participants were 95 autistic adults with a mean age of 44 (63% female) who completed measures of resilience, autism symptoms, depression, anxiety and mental wellbeing. Overall, the findings indicate that the Connor–Davidson Resilience Scale 10 may be reliably used with autistic adults to measure trait resilience, which is associated with positive wellbeing and may serve as a protective factor from negative mental wellbeing. Future studies may use the Connor–Davidson Resilience Scale 10 to investigate resilience as a protective factor from negative mental health outcomes in response to traumatic and adverse emotional events for which autistic individuals may be particularly susceptible.
      Citation: Autism
      PubDate: 2020-03-14T04:48:55Z
      DOI: 10.1177/1362361320908095
       
  • ‘I never realised everybody felt as happy as I do when I am around
           autistic people’: A thematic analysis of autistic adults’
           relationships with autistic and neurotypical friends and family
    • Authors: Catherine J Crompton, Sonny Hallett, Danielle Ropar, Emma Flynn, Sue Fletcher-Watson
      Abstract: Autism, Ahead of Print.
      Many autistic people are motivated to have friends, relationships and close family bonds, despite the clinical characterisation of autism as a condition negatively affecting social interaction. Many first-hand accounts of autistic people describe feelings of comfort and ease specifically with other autistic people. This qualitative research explored and contrasted autistic experiences of spending social time with neurotypical and autistic friends and family. In total, 12 autistic adults (10 females, aged 21–51) completed semi-structured interviews focused on time spent with friends and family; positive and negative aspects of time spent with neurotypical and autistic friends and family; and feelings during and after spending time together. Three themes were identified: cross-neurotype understanding, minority status and belonging. Investigation of these themes reveals the benefits of autistic people creating and maintaining social relationships with other autistic people, in a more systematic way than previous individual reports. They highlight the need for autistic-led social opportunities and indicate benefits of informal peer support for autistic adults.Lay abstractAlthough autistic people may struggle to interact with others, many autistic people have said they find interacting with other autistic people more comfortable. To find out whether this was a common experience, we did hour-long interviews with 12 autistic adults. We asked them questions about how it feels when spending time with their friends and family, and whether it felt different depending on whether the friends and family were autistic or neurotypical. We analysed the interviews and found three common themes in what our participants said. First, they found spending with other autistic people easier and more comfortable than spending time with neurotypical people, and felt they were better understood by other autistic people. Second, autistic people often felt they were in a social minority, and in order to spend time with neurotypical friends and family, they had to conform with what the neurotypical people wanted and were used to. Third, autistic people felt like they belonged with other autistic people and that they could be themselves around them. These findings show that having time with autistic friends and family can be very beneficial for autistic people and played an important role in a happy social life.
      Citation: Autism
      PubDate: 2020-03-07T09:53:29Z
      DOI: 10.1177/1362361320908976
       
  • Diagnosis of autism in adulthood: A scoping review
    • Authors: Yunhe Huang, Samuel RC Arnold, Kitty-Rose Foley, Julian N Trollor
      Abstract: Autism, Ahead of Print.
      More adults are undergoing autism assessment due to recent changes in awareness, diagnostic criteria and professional practices. This scoping review aimed to summarise research on autism diagnosis in adulthood and identify any gaps for future study. The authors searched for studies involving first-time assessment and diagnosis of autism in adults, which identified 82 studies from 13 countries using various methodologies. Six themes of (1) prevalence, (2) diagnostic pathways and processes, (3) gender, (4) psychosocial characteristics, (5) co-occurring conditions and (6) experiences of diagnosis were identified across the studies. Findings suggest that receiving an autism diagnosis has a significant emotional impact on adults, but accessibility and processes are inconsistent, and formal support services are lacking. More research is needed on autism diagnosis in adults with intellectual disability, consequences of the timing of diagnosis, and support after diagnosis.Lay abstractMore adults are getting assessed for possible autism. Here, we give an overview on what is already known about autism diagnosis in adulthood and find areas that need more research. We divided results from the studies we found into six topics of (1) rates of autism in different groups; (2) the process of getting an autism diagnosis in adulthood; (3) gender; (4) personality traits, abilities and behaviours of diagnosed adults; (5) mental and physical health conditions that occur together with autism; and (6) how adults think and feel about being assessed and diagnosed. We found that adults often have strong emotions after being diagnosed, the process of getting a diagnosis can be unclear and different for everyone, and not many support services are available for adults. More research on diagnosing adults with intellectual disability, differences between early and late-diagnosed adults, and support after diagnosis would be useful.
      Citation: Autism
      PubDate: 2020-02-28T08:58:51Z
      DOI: 10.1177/1362361320903128
       
  • An association of intrapartum synthetic oxytocin dosing and the odds of
           developing autism

         This is an Open Access Article Open Access Article

    • Authors: Stephen M Soltys, Jill Rose Scherbel, Joseph R Kurian, Todd Diebold, Teresa Wilson, Lindsay Hedden, Kathleen Groesch, Paula L Diaz-Sylvester, Albert Botchway, Pamela Campbell, Julio Ricardo Loret de Mola
      Abstract: Autism, Ahead of Print.
      A case-control study was performed to determine whether an association exists between exposure to synthetic oxytocin and a subsequent autism spectrum disorder diagnosis; 171 children under age 18 meeting Diagnostic and Statistical Manual of Mental Disorders (5th ed.) autism spectrum disorder criteria were compared to 171 children without autism spectrum disorder diagnosis matched by gender, birth year, gestational age, and maternal age at birth. A conditional logistic regression model was used to examine the association of clinical variables and autism spectrum disorder. Significantly elevated odds ratios for autism spectrum disorder were associated with first-time Cesarean section (odds ratio = 2.56), but not a repeat Cesarean section. Odds ratios were also significantly elevated for subjects whose mother’s body mass index was 35 or higher at birth (odds ratio = 2.34) and subjects in which the reason for delivery was categorized as “fetal indication” (odds ratio = 2.00). When controlling for these and other variables, the odds of developing autism spectrum disorder were significantly elevated in males with long duration of exposure (odds ratio = 3.48) and high cumulative dose of synthetic oxytocin (odds ratio = 2.79). No significant associations of synthetic oxytocin dosing and autism spectrum disorder were noted in female subjects. The association of elevated autism spectrum disorder odds found with high duration and high cumulative dose synthetic oxytocin in male subjects suggests the need for further investigation to fully elucidate any cause and effect relationship.Lay abstractOxytocin is a hormone naturally produced in the human body that can make the womb (uterus) contract during labor. Manufactured oxytocin is frequently given to mothers in labor to strengthen the contractions or in some cases to start labor. This study compared children with a diagnosis of autism and children without autism to see whether children with autism received more oxytocin during labor. The odds of a child having an autism diagnosis were significantly higher if the delivery was a first-time Cesarean section, if the mother had a body mass index of 35 or higher, or if the reason for delivery were a range of fetal problems that made delivery necessary. It was found that boys who were exposed to oxytocin for longer periods of time during labor and received higher total doses of oxytocin had significantly higher odds of developing autism. There were no significant associations of oxytocin dosing and autism noted in female children. As this is the first study to look at any relationship between the dose of oxytocin received during labor and the odds of developing autism, further study needs to be done to determine whether there is any cause and effect relationship. Thus, at this time, there is no recommended change in clinical practice.
      Citation: Autism
      PubDate: 2020-02-14T09:06:14Z
      DOI: 10.1177/1362361320902903
       
  • Effects of pivotal response treatment on reciprocal vocal contingency in a
           randomized controlled trial of children with autism spectrum disorder
    • Authors: Jena McDaniel, Paul Yoder, Madison Crandall, Maria Estefania Millan, Christina Mich Ardel, Grace W Gengoux, Antonio Y Hardan
      Abstract: Autism, Ahead of Print.
      A pivotal response treatment package consisting of clinician-delivered and parent-implemented strategies was recently found to be effective in improving language and social communication deficits in children with autism spectrum disorder. Reciprocal vocal contingency, an automated measure of vocal reciprocity, may provide stronger and complementary evidence of the effects of the pivotal response treatment package. Reciprocal vocal contingency is derived through an automated process from daylong audio samples from the child’s natural environment. Therefore, reciprocal vocal contingency is at lower risk for detection bias than parent report and brief parent–child interaction measures. Although differences were non-significant at baseline and after 12 weeks of intervention for the 48 children with autism spectrum disorder who were randomly assigned to the pivotal response treatment package or a delayed treatment control group, the pivotal response treatment package group had higher ranked reciprocal vocal contingency scores than the control group after 24 weeks (U = 125, p = .04). These findings are consistent with results from parent report and parent–child interaction measures obtained during the trial. The participants in the pivotal response treatment package exhibited greater vocal responsiveness to adult vocal responses to their vocalizations than the control group. Findings support the effectiveness of the pivotal response treatment package on vocal reciprocity of children with autism spectrum disorder, which may be a pivotal skill for language development.Lay abstractA recent randomized controlled trial found that children with autism spectrum disorder who received a pivotal response treatment package showed improved language and social communication skills following the intervention. The pivotal response treatment package includes clinician-delivered and parent-implemented strategies. Reciprocal vocal contingency is an automated measure of vocal reciprocity derived from daylong audio samples from the child’s natural environment. It may provide stronger and complementary evidence of the effects of the pivotal response treatment package because it is at lower risk for detection bias than parent report and brief parent–child interaction measures. The current study compared reciprocal vocal contingency for 24 children with autism spectrum disorder in the pivotal response treatment package group and 24 children with autism spectrum disorder in the control group. The pivotal response treatment package group received 24 weeks of the pivotal response treatment package intervention. The control group received their usual intervention services during that time. The groups did not differ in reciprocal vocal contingency when the intervention started or after 12 weeks of intervention. However, after 24 weeks the pivotal response treatment package group had higher ranked reciprocal vocal contingency scores than the control group. These findings are consistent with results from parent report and parent–child interaction measures obtained during the trial. The participants in the pivotal response treatment package exhibited greater vocal responsiveness to adult vocal responses to their vocalizations than the control group. Findings support the effectiveness of the pivotal response treatment package on vocal reciprocity of children with autism spectrum disorder, which may be a pivotal skill for language development.
      Citation: Autism
      PubDate: 2020-02-14T09:05:34Z
      DOI: 10.1177/1362361320903138
       
  • Looking or talking: Visual attention and verbal engagement during shared
           book reading of preschool children on the autism spectrum
    • Authors: Rachelle Wicks, Jessica Paynter, Marleen F Westerveld
      Abstract: Autism, Ahead of Print.
      Visual attention and active engagement during shared book reading are important for facilitating emergent literacy learning during the preschool years. Children on the autism spectrum often show difficulties in language and literacy development, yet research investigating potential indicators of shared book reading engagement, including visual attention and verbal engagement, for this group of preschoolers is currently limited. To better understand the relationship between children’s visual attention and verbal engagement during shared book reading, parent shared book reading behaviors, and children’s emergent literacy skills (e.g. receptive vocabulary and letter-name knowledge), we observed 40 preschoolers on the spectrum and their parents sharing an unfamiliar storybook. Videos of the shared book reading interactions were transcribed and coded for child and parent behaviors using observational coding schemes. Strong significant associations were found between children’s visual attention, verbal engagement, and parents’ use of questions and/or prompts during the shared book reading interaction. Contrary to expectations, children’s visual attention was not related to their emergent literacy skills. Overall, our findings emphasize the interplay between parent behaviors and how preschoolers on the spectrum engage in this important literacy-related context and provide directions for future research.Lay abstractChildren who have an autism diagnosis often have trouble learning to talk and read. These difficulties become noticeable before children start school and may be linked to lower attention and engagement in literacy-related activities such as sharing storybooks with their parents. To date, few researchers have looked at possible ways to measure how children on the autism spectrum engage during shared storybook reading, for example, where children look or how much they talk, and how this may be related to their letter-name knowledge and their vocabulary knowledge. In this study, we analyzed videos of 40 preschoolers on the spectrum and their parents sharing an unfamiliar storybook. We wanted to see whether where children looked (i.e. toward the storybook, their parent, or elsewhere) and how much they talked were related to what their parents did (e.g. ask questions or provide prompts) and/or children’s letter-name knowledge and vocabulary. The videos were coded for different child and parent behaviors. We found that where children looked and how much they talked were strongly related to each other and what parents did during the shared book reading interaction, particularly asking questions and using prompts. In contrast to what we expected, where children looked was not related to children’s letter or vocabulary knowledge. Overall, results of the study draw attention to the connection between what parents do and what preschoolers on the spectrum do when sharing storybooks and provide directions for future research.
      Citation: Autism
      PubDate: 2020-02-13T05:56:48Z
      DOI: 10.1177/1362361319900594
       
  • Sluggish cognitive tempo: An examination of clinical correlates for adults
           with autism
    • Authors: Alexis M Brewe, Grace Lee Simmons, Nicole N Capriola-Hall, Susan W White
      Abstract: Autism, Ahead of Print.
      Adults with autism spectrum disorder often experience co-occurring mental health problems such as attention-deficit/hyperactivity-disorder, as well as impairments in executive function. Sluggish cognitive tempo, a cluster of behaviors including slow processing, daydreaming, and mental fogginess, has been shown to be associated with attention-deficit/hyperactivity-disorder. This study was designed to assess sluggish cognitive tempo in young adults with autism spectrum disorder. Specifically, we sought to establish a preliminary estimate of clinically significant sluggish cognitive tempo symptoms and to better understand its phenomenology and associations with executive function and psychiatric symptoms in the context of autism spectrum disorder. Young adults with autism spectrum disorder (n = 57; age 16–25 years; 84.2% male) completed a laboratory-based executive function task, and parents and participants completed measures of the participants’ sluggish cognitive tempo, attention-deficit/hyperactivity-disorder, depression, and anxiety symptoms. Nearly one-third of the sample exhibited clinically impairing levels of sluggish cognitive tempo. Although sluggish cognitive tempo and attention-deficit/hyperactivity-disorder symptoms were significantly correlated, findings suggest the constructs are distinct. Results also suggest that increased sluggish cognitive tempo is related to executive function impairment and depression, but not anxiety symptoms. Considerations for assessment and long-term impacts of sluggish cognitive tempo for adults with autism spectrum disorder are discussed.Lay abstractAdults with autism spectrum disorder often experience a range of co-occurring mental health problems such as attention-deficit/hyperactivity-disorder, as well as difficulties with executive function. Sluggish cognitive tempo, a cluster of behaviors including slow processing, daydreaming, and mental fogginess, has been shown to be associated with attention-deficit/hyperactivity-disorder, and limited research has suggested that individuals with autism spectrum disorder may experience sluggish cognitive tempo. We examined co-occurring mental health problems and executive function in 57 young adults with autism spectrum disorder, aged 16–25 years to better understand sluggish cognitive tempo in autism spectrum disorder. Parents of the young adults answered questions about their children’s sluggish cognitive tempo, attention-deficit/hyperactivity-disorder, depression, and anxiety symptoms, and the young adults completed tests of their executive function. Results demonstrated that nearly one-third of the sample exhibited clinically impairing levels of sluggish cognitive tempo. Although sluggish cognitive tempo and attention-deficit/hyperactivity-disorder symptoms were related, our findings suggest they are not the same constructs. Increased sluggish cognitive tempo is related to more difficulties with executive function and increased depression, but not anxiety symptoms. Results demonstrate that sluggish cognitive tempo may pose heightened difficulties for adults with autism spectrum disorder, making it an important construct to continue studying. Considerations for assessment and long-term impacts of sluggish cognitive tempo for adults with autism spectrum disorder are discussed.
      Citation: Autism
      PubDate: 2020-02-07T09:41:48Z
      DOI: 10.1177/1362361319900422
       
  • A framework of evidence-based practice for digital support, co-developed
           with and for the autism community
    • Authors: Vanessa Zervogianni, Sue Fletcher-Watson, Gerardo Herrera, Matthew Goodwin, Patricia Pérez-Fuster, Mark Brosnan, Ouriel Grynszpan
      Abstract: Autism, Ahead of Print.
      A wide array of digital supports (such as apps) have been developed for the autism community, many of which have little or no evidence to support their effectiveness. A Delphi study methodology was used to develop a consensus on what constitutes good evidence for digital supports among the broader autism community, including autistic people and their families, as well as autism-related professionals and researchers. A four-phase Delphi study consultation with 27 panel members resulted in agreement on three categories for which evidence is required: reliability, engagement and effectiveness of the technology. Consensus was also reached on four key sources of evidence for these three categories: hands-on experience, academic sources, expert views and online reviews. These were differentially weighted as sources of evidence within these three categories.Lay abstractDigital supports are any type of technologies that have been intentionally developed to improve daily living in some way. A wide array of digital supports (such as apps) have been developed for the autism community specifically, but there is little or no evidence of whether they work or not. This study sought to identify what types of evidence the autistic community valued and wanted to see provided to enable an informed choice to be made regarding digital supports. A consensus was developed between autistic people and their families, practitioners (such as therapists and teachers) as well as researchers, to identify the core aspects of evidence that everyone agreed were useful. In all, 27 people reached agreement on three categories for which evidence is required: reliability, engagement and the effectiveness of the technology. Consensus was also reached on four key sources of evidence for these three categories: hands-on experience, academic sources, expert views and online reviews. The resulting framework allows for any technology to be evaluated for the level of evidence identifying how effective it is. The framework can be used by autistic people, their families, practitioners and researchers to ensure that decisions concerning the provision of support for autistic people is informed by evidence, that is, ‘evidence-based practice’.
      Citation: Autism
      PubDate: 2020-02-06T11:20:43Z
      DOI: 10.1177/1362361319898331
       
  • ‘When my autism broke’: A qualitative study spotlighting
           autistic voices on menopause
    • Authors: Rachel L Moseley, Tanya Druce, Julie M Turner-Cobb
      Abstract: Autism, Ahead of Print.
      Autistic women often struggle with the onset of menstruation, a key transition point in the female reproductive lifespan. Presently, there is no research investigating how autistic people navigate the menopausal transition, and whether it poses additional challenges in addition to those already faced by neurotypical women. As a preliminary participatory study in this area, we conducted an online focus group with seven autistic individuals, aged 49–63 years (median = 64.5 years) and assigned female at birth, to explore the state of knowledge about the menopause in autism, difficulties the menopause might bring, support that might be needed, and what questions require scientific investigation. Thematic analysis of the discussion generated three themes: (a) lack of knowledge and understanding; (b) cracking the mask and adaptive functioning; and (c) finding support. Themes suggested a lack of professional knowledge, understanding and communication about menopause for autistic people, and an absence of support. Menopause was discussed as heightening pre-existing and generating new cognitive, social, emotional and sensory difficulties. This study illustrates the need for greater focus of attention towards how autistic people cope with the major life transition of menopause.Lay abstractAutistic girls are known to struggle with the onset of menstruation, reporting that during their period, sensory sensitivities are heightened, it becomes more difficult to think clearly and control their emotions and they struggle more with everyday life and self-care. Yet surprisingly, nothing is known about how autistic women handle the menopausal transition in midlife. In non-autistic women, the menopause brings many physical changes and challenging symptoms from hot flushes to feeling more anxious and depressed. Because autistic women are already vulnerable to suicide, poor physical and mental health, and because they may already struggle with planning, controlling their emotions and coping with change, the menopause may be an especially challenging time. Yet, not one single study exists on the menopause in autism, so we conducted an online discussion (focus group) with seven autistic women. They confirmed that very little is known about menopause in autistic people, very little support is available and that menopause might be especially difficult for autistic people. Autism-related difficulties (including sensory sensitivity, socializing with others and communicating needs) were reported to worsen during the menopause, often so dramatically that some participants suggested they found it impossible to continue to mask their struggles. Participants also reported having extreme meltdowns, experiencing anxiety and depression, and feeling suicidal. This study highlights how important it is that professionals pay attention to menopause in autism, and discusses future research directions.
      Citation: Autism
      PubDate: 2020-01-31T11:23:51Z
      DOI: 10.1177/1362361319901184
       
  • Indigenous Australians with autism: A scoping review
         This is an Open Access Article Open Access Article

    • Authors: Benjamin Bailey, Joanne Arciuli
      First page: 1031
      Abstract: Autism, Ahead of Print.
      Aboriginal and Torres Strait Islander people with autism spectrum disorder, used interchangeably with the term autism, are among the most marginalised people in Australian society. This review maps out existing and emerging themes in the research involving Indigenous Australians with autism based on a search of the peer-reviewed and grey literature. Our search identified 1457 potentially relevant publications. Of these, 19 publications met our inclusion criteria and focused on autism spectrum disorder diagnosis and prevalence, as well as carer and service provider perspectives on autism, and autism support services for Indigenous Australians. We were able to access 17 publications: 12 journal articles, 3 conference presentations, 1 resource booklet and 1 dissertation. Findings suggest similar prevalence rates for autism among Indigenous and non-Indigenous Australians, although some Aboriginal and Torres Strait Islander people with autism may not receive a diagnosis or may be misdiagnosed. Research on the perspectives of Aboriginal and Torres Strait Islander carers and Indigenous and non-Indigenous service providers is discussed in relation to Indigenous perspectives on autism, as well as barriers and strategies to improve access to diagnosis and support services. Although not the focus of our review, we briefly mention studies of Indigenous people with autism in countries other than Australia.Lay AbstractAboriginal and Torres Strait Islander people with developmental disabilities such as autism are among the most marginalised people in Australian society. We reviewed research involving Indigenous Australians with autism based on a search of the peer-reviewed and grey literature. Our search identified 1457 potentially relevant publications. Of these, 19 publications were in line with our main areas of inquiry: autism spectrum disorder diagnosis and prevalence, carer and service provider perspectives on autism, and autism support services. These included 12 journal publications, 3 conference presentations, 1 resource booklet and 1 thesis dissertation. Findings suggest similar prevalence rates for autism among Indigenous and non-Indigenous Australians, although some Aboriginal and Torres Strait Islander people with autism may not receive a diagnosis or may be misdiagnosed. We also discuss research on the perspectives of Aboriginal and Torres Strait Islander carers and Indigenous and non-Indigenous service providers, as well as barriers and strategies for improving access to diagnosis and support services.
      Citation: Autism
      PubDate: 2020-01-13T09:00:01Z
      DOI: 10.1177/1362361319894829
       
  • Oral health status of children and adolescents with autism spectrum
           disorder: A systematic review of case-control studies and meta-analysis
    • Authors: Phoebe PY Lam, Rennan Du, Simin Peng, Colman PJ McGrath, Cynthia KY Yiu
      First page: 1047
      Abstract: Autism, Ahead of Print.
      Children and adolescents with autism spectrum disorder are thought to be more vulnerable to oral diseases than typically developing individuals due to cariogenic dietary habits, self-injurious behaviors, and increased barriers to dental care services. This review aimed to summarize current evidence comparing the oral health status of people diagnosed with and without autism spectrum disorder. Study selection and screening, data extraction, risk of bias assessment, and quality-of-evidence evaluation was conducted using the Grading of Recommendations Assessment Development and Evaluation approach and performed independently by two reviewers. A total of 16 studies were found eligible for qualitative synthesis and 15 were included in quantitative analysis. When comparing children and adolescents diagnosed with and without autism spectrum disorder, significantly higher prevalence of bruxism was identified. Individuals diagnosed with autism spectrum disorder were also found to have significantly lower salivary pH. However, no statistically significant differences in terms of caries prevalence and severity, oral hygiene and periodontal status, prevalence of malocclusion, dental traumatic injuries, as well as salivary flow rate and buffering capacity were found. The quality of evidence of each outcome was graded as very low mainly due to the overall high risk of bias, considerable heterogeneity, and imprecision.Lay AbstractChildren and adolescents diagnosed with Autism Spectrum Disorder (ASD) are thought to be more vulnerable to oral diseases than typically-developing individuals. This is due to their increased barriers to dental care services, self-harm behaviors and dietary habits that may favor tooth decay. In this review, we summarized the current evidence comparing the oral health status of children and adolescents diagnosed with and without ASD.After a systematic search in the literature, we found that the salivary pH of individuals diagnosed with ASD was significantly lower, but the results were not clinically significant that can increase their risks to tooth decay. We also found weak evidence suggesting a higher percentage of children and adolescents diagnosed with ASD having the habit of tooth grinding compared with their neurotypical counterparts. When comparing salivary flow rate, tooth decay, gum diseases, tooth malalignment and tooth trauma; no significant differences were found between the two groups.The findings did not suggest ASD as a predisposing factor to oral diseases: other factors including sugary diet and inadequate oral hygiene may play a more important role. We also call for further research to establish more concrete association between ASD and oral diseases.
      Citation: Autism
      PubDate: 2020-01-14T05:59:01Z
      DOI: 10.1177/1362361319877337
       
  • Stakeholder perspectives on transition planning, implementation, and
           outcomes for students with autism spectrum disorder
    • Authors: Claire Snell-Rood, Lisa Ruble, Harold Kleinert, John H McGrew, Medina Adams, Alexis Rodgers, Jaye Odom, Wing Hang Wong, Yue Yu
      First page: 1164
      Abstract: Autism, Ahead of Print.
      Little is known about factors impacting poor post-school outcomes for transition-age students with autism spectrum disorder. Guided by the Exploration, Preparation, Implementation, and Sustainment implementation science framework, we sought to better understand the interdependent impacts of policy, organizational, provider, and individual factors that shape the transition planning process in schools, and the subsequent process through which transition plans are implemented as youth access services and gain employment after school. We conducted focus groups with individuals with autism spectrum disorder, parents, classroom teachers, school administrators, adult service providers, and state policymakers (10 groups, N = 40). Participants described how core tenets of the individualized education planning process were not reliably implemented: planning was characterized by inappropriate goal-setting, ineffective communication, and inadequate involvement of all decision-makers needed to inform planning. After school, youth struggled to access the services stipulated in their transition plans due to inadequate planning, overburdened services, and insufficient accountability for adult service providers. Finally, a failure to include appropriate skill-building and insufficient interagency and community relationships limited efforts to gain and maintain employment. Diverse stakeholder perspectives illuminate the need for implementation efforts to target the provider, organizational, and policy levels to improve transition outcomes for individuals with autism spectrum disorder.Lay abstractLittle is known about factors impacting poor post-school outcomes for transition-age students with autism spectrum disorder. Guided by an implementation science framework that takes into account the multiple factors that influence transition outcomes, we sought to better understand the interdependent impacts of policy, organizational, provider, and individual factors that shape the transition planning process in schools, and the subsequent process through which transition plans are implemented as youth with autism spectrum disorder access services and gain employment after school. We conducted focus groups with individuals with autism spectrum disorder, parents, classroom teachers, school administrators, adult service providers, and state policymakers (10 groups, N = 40). Participants described how core tenets of the individualized education planning process were not reliably implemented: planning was described by inappropriate goal-setting, ineffective communication, and inadequate involvement of all decision-makers needed to inform planning. After school, youth struggled to access the services specified in their transition plans due to inadequate planning, overburdened services, and insufficient accountability for adult service providers. Finally, a failure to include appropriate skill-building and insufficient interagency and community relationships limited efforts to gain and maintain employment. Diverse stakeholder perspectives illuminate the need for implementation efforts to target the provider, organizational, and policy levels to improve transition outcomes for individuals with autism spectrum disorder.
      Citation: Autism
      PubDate: 2020-01-20T11:14:42Z
      DOI: 10.1177/1362361319894827
       
  • Factually based autism awareness campaigns may not always be effective in
           changing attitudes towards autism: Evidence from British and South Korean
           nursing students
    • Authors: Saoirse Mac Cárthaigh, Beatriz López
      First page: 1177
      Abstract: Autism, Ahead of Print.
      This study explored the relationship between autism knowledge, autistic traits, frequency of contact with autistic people and attitudes towards these individuals in British and South Korean student nurses and whether these relationships were affected by the presence of autistic traits. In total, 331 participants (156 South Korean and 175 British) completed self-report measures of autism knowledge, attitudes towards autistic people, frequency of contact with these individuals and autistic traits. Although British participants demonstrated greater knowledge and more favourable attitudes, significant knowledge deficiencies were noted in both groups. Among British participants, knowledge was found to be a significant, but a very marginal, predictor of attitudes, whereas neither knowledge nor frequency of contact were predictive of attitudes among South Korean participants. Contrary to previous research findings, cultural differences in the presence of autistic traits were not noted, nor were these traits found to correlate with attitudes towards autistic people. The findings suggest that awareness initiatives which aim to address attitudes towards autism need more than simply increasing factual knowledge. More importantly, the results suggest that Western-developed autism awareness initiatives may be ineffectual if cultural idiosyncrasies are not considered.Lay abstractThis study explored the relationship between autism knowledge, autistic traits, frequency of contact with autistic people and attitudes towards these individuals in British and South Korean student nurses and whether these relationships were affected by the presence of autistic traits. In total, 331 participants (156 South Korean and 175 British) completed self-report measures of autism knowledge, attitudes towards autistic people, frequency of contact with these individuals and autistic traits. Although British participants demonstrated greater knowledge and more favourable attitudes, significant knowledge gaps were noted in both groups. Among British participants, knowledge was found to be only a marginal predictor of attitudes, whereas neither knowledge nor frequency of contact were predictive of attitudes among South Korean participants. Contrary to previous research findings, cultural differences in the presence of autistic traits were not noted, nor were these traits found to be related to attitudes towards autistic people. The findings suggest that awareness initiatives which aim to address attitudes towards autism need more than simply increasing factual knowledge. More importantly, the results suggest that Western-developed autism awareness initiatives may be ineffectual if cultural differences are not considered.
      Citation: Autism
      PubDate: 2020-01-20T11:11:42Z
      DOI: 10.1177/1362361319898362
       
  • Maternal polyunsaturated fatty acids and risk for autism spectrum disorder
           in the MARBLES high-risk study
    • Authors: Yunru Huang, Ana-Maria Iosif, Robin L Hansen, Rebecca J Schmidt
      First page: 1191
      Abstract: Autism, Ahead of Print.
      Prior research studies suggest that maternal polyunsaturated fatty acids could have protective effects on neurodevelopmental outcomes. The objective of this study was to examine associations between maternal polyunsaturated fatty acid intake during pregnancy and risk for autism spectrum disorder and other non-typical development in a prospective cohort. Eligible women already had a child with autism spectrum disorder and were planning a pregnancy or were pregnant with another child. Children were clinically assessed longitudinally and diagnosed at 36 months. Maternal polyunsaturated fatty acid intake during pregnancy was estimated using food frequency questionnaires. Maternal third-trimester plasma polyunsaturated fatty acid concentration was measured by gas chromatography. In all, 258 mother–child pairs were included. Mothers consuming more total omega-3 in the second half of pregnancy were 40% less likely to have children with autism spectrum disorder (relative risk = 0.6, 95% confidence interval: 0.3–0.98). No significant associations were observed between maternal third-trimester plasma polyunsaturated fatty acid subtype concentrations and risk of autism spectrum disorder. However, higher plasma eicosapentaenoic acid and docosahexaenoic acid concentrations were associated with lower non-typical development risk (relative risk ranging from 0.47 to 0.88). This study provides suggestive evidence of associations between risk of autism spectrum disorder in the children and maternal omega-3 intake in late pregnancy but not with third-trimester plasma polyunsaturated fatty acids. Further research is needed to evaluate these potential relationships.Lay abstractPrior studies suggest that maternal polyunsaturated fatty acids intake during pregnancy may have protective effects on autism spectrum disorder in their children. However, they did not examine detailed timing of maternal polyunsaturated fatty acid intake during pregnancy, nor did they evaluate plasma concentrations. This study investigates whether maternal polyunsaturated fatty acids in defined time windows of pregnancy, assessed by both questionnaires and biomarkers, are associated with risk of autism spectrum disorder and other non-typical development in the children. Food frequency questionnaires were used to estimate maternal polyunsaturated fatty acid intake during the first and second half of pregnancy. Gas chromatography measured maternal plasma polyunsaturated fatty acid concentrations in the third trimester. In all, 258 mother–child pairs from a prospective cohort were included. All mothers already had a child with autism spectrum disorder and were planning a pregnancy or pregnant with another child. Children were clinically assessed longitudinally and diagnosed at 36 months. For polyunsaturated fatty acid intake from questionnaires, we only found mothers consuming more omega-3 in the second half of pregnancy were 40% less likely to have children with autism spectrum disorder. For polyunsaturated fatty acid concentrations in the third-trimester plasma, we did not observe any statistical significance in relation to the risk of autism spectrum disorder. However, our study confirmed associations from previous studies between higher maternal docosahexaenoic acid and eicosapentaenoic acid plasma concentrations in the late pregnancy and reduced risk for non-typical development. This study markedly advanced understandings of whether and when maternal polyunsaturated fatty acid intake influences risk for autism spectrum disorder and sets the stage for prevention at the behavioral and educational level.
      Citation: Autism
      PubDate: 2020-01-21T09:27:01Z
      DOI: 10.1177/1362361319877792
       
  • Characterizing intrinsic functional connectivity in relation to impaired
           self-regulation in intellectually able male youth with autism spectrum
           disorder
    • Authors: Hsiang-Yuan Lin, Hsing-Chang Ni, Wen-Yih Isaac Tseng, Susan Shur-Fen Gau
      First page: 1201
      Abstract: Autism, Ahead of Print.
      While a considerable number of youth with autism spectrum disorder exhibit impaired self-regulation (dysregulation), little is known about the neural correlates of dysregulation in autism spectrum disorder. In a sample of intellectually able boys with autism spectrum disorder (further categorized as those with and without dysregulation) and typically developing boys (aged 7–17 years), we conducted a multivariate connectome-wide association study to examine the intrinsic functional connectivity with resting-state functional magnetic resonance imaging. Dysregulation was defined by the sum of Attention, Aggression, and Anxiety/Depression subscales on the Child Behavior Checklist. We identified that both categorical and dimensional neural correlates of dysregulation in youth with autism spectrum disorder involved atypical connectivity among the components of multiple brain networks, especially between those subserving sensorimotor processing and salience encoding, beyond higher-level cognitive control circuitries. Interaction within the attention network might serve as autism spectrum disorder–specific neural correlates underpinning dysregulation. Our results highlight that the inter-individual variability in dysregulation might contribute to the inconsistency in the neuroimaging literature of autism spectrum disorder. Collectively, the present findings provide evidence to suggest that dysregulation might be considered as both categorical and dimensional moderators to parse heterogeneity of autism spectrum disorder.Lay AbstractImpaired self-regulation (i.e., dysregulation in affective, behavioral, and cognitive control), is commonly present in young people with autism spectrum disorder (ASD). However, little is known about what is happening in people’s brains when self-regulation is impaired in young people with ASD. We used a technique called functional MRI (which measures brain activity by detecting changes associated with blood flow) at a resting state (when participants are not asked to do anything) to research this in intellectually able young people with ASD. We found that brains with more connections, especially between regions involved in sensorimotor processing and regions involved in the processes that enable peoples to focus their attention on the most pertinent features from the sensory environment (salience processing), were related to more impaired self-regulation in young people with and without ASD. We also found that impaired self-regulation was related to increased communication within the brain system involved in voluntary orienting attention to a sensory cue (the dorsal attention network) in young people with ASD. These results highlight how different people have different degrees of dysregulation, which has been largely overlooked in the earlier brain imaging reports on ASD. This might contribute to understanding some of the inconsistencies in the existing published literature on this topic.
      Citation: Autism
      PubDate: 2020-01-21T09:23:20Z
      DOI: 10.1177/1362361319888104
       
  • Does phonetic repertoire in minimally verbal autistic preschoolers predict
           the severity of later expressive language impairment'
    • Authors: Jo Saul, Courtenay Norbury
      First page: 1217
      Abstract: Autism, Ahead of Print.
      Trajectories of expressive language development are highly heterogeneous in autism. Yoder et al. found that parental responsiveness, child response to joint attention, child communicative intent and consonant inventory were unique predictors of expressive language growth in minimally verbal preschoolers 16 months later (n = 87). This study applied these predictors to an independent sample, over a 12-month period (n = 27). A broader measure of phonetic repertoire, combining reported, elicited and observed speech sounds, was included to further understand the contribution of speech production skills. Expressive language growth was highly variable: 65% remained minimally verbal at mean age 5;2, while 7% gained over 340 words. Contrary to expectations, communicative intent, parent responsiveness and response to joint attention were not found to predict expressive language growth or outcome. In contrast, both consonant inventory and phonetic repertoire were significant predictors (adjusted R2 = 0.29 and 0.45). These results underscore the contribution of speech production abilities to expressive language development in this population, which may reflect an additional deficit rather than a consequence of core autism symptoms. Future work should include those with the most persistently limited expressive language, so that findings can be generalized and additional barriers to communication identified and addressed.Lay abstractWhat is already known about the topic'Language skills vary enormously in autism: while some autistic individuals can engage in sophisticated conversations, many remain minimally verbal, meaning they use few or no words regularly for communication. We do not know what causes this variation, but we do know that certain child and family characteristics can be measured when a child is young, and this information can improve our prediction of how expressive language might develop over time.What this article adds'We examined four characteristics, which have already been found to predict language development in young minimally verbal autistic children. We followed the expressive language progress of 27 minimally verbal children, aged three to five, for a year. One-third no longer met the minimally verbal criteria at the end of the study. In this sample, only one factor predicted language progress, which was the child’s initial speech skills (the number of different speech sounds that the child made during an interaction). This finding adds to the evidence that speech skills contribute to language development in autism. In some cases, persistent and severe expressive language difficulties may reflect an additional deficit in speech production, rather than a consequence of core autism features.Implications for practice, research or policyOur findings suggest that there are factors other than social skills that influence language development in autism. Careful assessment of speech production should be considered when language does not develop as expected. Future research should evaluate speech skills interventions for minimally verbal autistic individuals, as well as promoting the use of alternative communication systems.
      Citation: Autism
      PubDate: 2020-01-21T09:17:20Z
      DOI: 10.1177/1362361319898560
       
  • Social language opportunities for preschoolers with autism: Insights from
           audio recordings in urban classrooms
    • Authors: Emily F Ferguson, Allison S Nahmias, Samantha Crabbe, Talia Liu, David S Mandell, Julia Parish-Morris
      First page: 1232
      Abstract: Autism, Ahead of Print.
      Many children diagnosed with autism spectrum disorder who receive early intervention reap developmental benefits, but little is known about characteristics of early intervention placements in the community that optimize individual growth. The extent to which children hear and use language, in particular, may contribute significantly to developmental outcomes. We analyzed natural language production and exposure to language in preschoolers on the autism spectrum across three classroom compositions: autism only, mixed disability, and inclusion. Autistic children in inclusion classrooms produced more speech, received significantly more verbal input from their peers, and were exposed to a similar amount of teacher talk compared to children in autism only or mixed disability classrooms. These findings shed preliminary light on the linguistic environment of early intervention placements in the community, along with the characteristics of children placed in early intervention settings that may influence their language exposure from peers and teachers. Natural language sampling is a promising method for capturing language exposure in early intervention settings and providing context for understanding developmental outcomes resulting from early intervention.Lay abstractEarly intervention is important for preschoolers on the autism spectrum, but little is known about early intervention classrooms in the community. This study found that children with better language skills and lower autism severity have more verbal interactions with their classmates, especially in classrooms with typically developing peers (inclusion settings). Findings suggest that natural language sampling is a useful method for characterizing autistic children and their early intervention settings. In addition, natural language sampling may have important implications for understanding individual opportunities for development in community early intervention settings.
      Citation: Autism
      PubDate: 2020-01-22T08:41:47Z
      DOI: 10.1177/1362361319894835
       
  • “Different but connected”: Participatory action research using
           Photovoice to explore well-being in autistic young adults
    • Authors: Gary Yu Hin Lam, Emily Holden, Megan Fitzpatrick, Linda Raffaele Mendez, Karen Berkman
      First page: 1246
      Abstract: Autism, Ahead of Print.
      Past research has largely focused on the negative aspects of well-being of autistic young adults during the post-school transition. Research that meaningfully includes autistic individuals and captures their perspectives of positive well-being is essential for stakeholders to better understand how to provide services that respond to the needs and wants of the autistic community. In the current study, 14 autistic young adults in a post-school transition program participated in a Photovoice project and used photos to express their ideas about well-being. A participatory action research approach was used to support participants’ active engagement in the research processes and to encourage meaningful expression of their first-person perspectives. Results revealed an account of well-being reflecting expressions of individuality and growth, the significance of having close relationships, and a sense of connection with the community. This study has implications for research and practice that promotes well-being among the autistic community using approaches that are ethically informed and inclusive of autistic voices.Lay abstractPast research has mainly focused on autistic people’s deficits and poor outcomes compared to other groups of people. Little is known about their positive life experiences, and how to support them to achieve a higher quality of life. It is important to include autistic individuals in research so that they can influence how their voices are represented in a meaningful way and how the research results will be useful to them. In this study, a university researcher collaborated with 14 autistic young adults in a post-school transition program to design and run the research, collect and analyze the data, and use the results to create a presentation to the community. Specifically, the participants took photos in daily life and discussed their ideas about what a good life means to them. Results showed that these young adults described themselves as uniquely and different, but they were eager to learn and adapt. They also valued their relationships with their families, friends, and animals around them, as well as the community at large. This research shows that autistic individuals have important perspectives to share and knowledge to contribute when they are given the opportunities to participate in different aspects of research. The findings will be useful in developing services and influencing policies that promote well-being among autistic adults.
      Citation: Autism
      PubDate: 2020-01-23T06:58:45Z
      DOI: 10.1177/1362361319898961
       
  • Challenges and contributors to self-efficacy for caregivers of toddlers
           with autism
    • Authors: Hannah H Schertz, Jessica Nina Lester, Emine Erden, Selin Safran, Penny Githens
      First page: 1260
      Abstract: Autism, Ahead of Print.
      In this qualitative study, 11 mothers of toddlers with autism participated in interviews to investigate how they perceived their roles and their competency to support toddlers’ social learning in the context of both professional-implemented and parent-mediated early intervention models. The authors conducted a thematic analysis with multiple layers of independent coding. Four resulting themes highlighted challenges and contributors to parent self-efficacy. First, related to child characteristics, challenges were most prominent in the early period as participants adjusted to the diagnosis and reached to connect when social difficulties emerged. Second, having a peripheral role in early intervention challenged participants’ confidence in their abilities, while receiving guidance to assume an active leadership role supported their sense of efficacy for facilitating toddlers’ social learning. In a third theme, participants described specific and general examples of their expertise. Fourth, participants considered the transactional context of parent–child interaction and largely viewed their toddlers’ independent wills, natures, and preferences as strengths upon which to build social engagement. The results support the need for early interventionists to promote and leverage family capacity for facilitating toddler learning as social challenges begin to appear for toddlers with autism.Lay AbstractParent-participatory early intervention practices are linked to parents’ positive views of their own and their children’s capabilities, beliefs that are associated with a range of parent and child outcomes. A qualitative study was conducted with 11 mothers of toddlers with autism who had experience with both professionally directed and parent-mediated early intervention. Participants were interviewed to explore their perspectives on their roles in relation to professionals and on how they viewed their ability to support their toddlers’ social learning. An in-depth analysis of the transcribed interviews resulted in four themes. First, in the early stages, participants experienced challenges to their self-efficacy as they adjusted to the diagnosis and reached to connect with their child when social challenges emerged. Second, participants’ views of their capability were stronger when they were provided with background knowledge enabling them to take the lead in guiding their children’s learning than when professionals modeled predetermined intervention strategies for them to copy. Third, participants provided specific examples of their expertise to support their toddlers’ social learning and viewed their close parent–child relationship and intimate knowledge of their children as valuable to the intervention. Fourth, participants voiced respect for their toddlers’ natures and preferences, positioning them to build on their toddlers’ strengths in everyday interactions. The results support the need for early intervention providers to promote and leverage family capacity for facilitating toddler learning as social challenges begin to appear for toddlers with autism.
      Citation: Autism
      PubDate: 2020-01-23T06:56:19Z
      DOI: 10.1177/1362361319899761
       
  • Facilitators’ perspectives on a psychoeducational program for
           parents of an autistic child
    • Authors: Candice Decroocq, Thierry Soulas, Jérôme Lichtlé, Carol Sankey, Aaron Engelberg, Emilie Cappe
      First page: 1273
      Abstract: Autism, Ahead of Print.
      The recent increase of diagnosed cases of autism spectrum disorders has led to a considerable rise in the demands for autism-related services and interventions. Parents express the need to access relevant information about their child’s difference, and parent support interventions appear to respond effectively to this demand, as they are knowledge-focused and offer indirect support to the child. The aim of this study was to capture the subjective experience of facilitators who implemented a psychoeducational program called Beyond PDD: Parental Skills within My Reach. Structured interviews of the facilitators (N = 18) provided insight on institutional support, issues related to the program itself, required and/or recommended professional background, personal experience and competences, and difficulties linked to recruitment and research criteria. Recommendations aiming to enhance program implementation and delivery were then created using facilitators’ feedback on these aspects.Lay abstractThe recent increase of diagnosed cases of autism spectrum disorders has led to a considerable rise in the demands for autism-related services and interventions. Caring for an autistic child can be perceived as an enrichment, which coexists with stress in parents. Parents express the need to access relevant information about their child’s difference, and parent support interventions appear to respond effectively to this demand, as they are knowledge-focused and offer indirect support to the child. The aim of this study was to capture the subjective experience of facilitators who implemented a psychoeducational program called Beyond PDD: Parental Skills within My Reach. This program is based on the acknowledged fact that parents of autistic children play a central role in their child’s development. Its main goal is to help parents of autistic children under the age of 8 to identify, develop, and update their parenting competences. This program broaches different topics: (1) specific features of an autistic child, (2) post-diagnostic parental adjustment, (3) communication and social relationships, (4) importance of providing the child with a structured environment, and (5) parental emotions and perceptions that impact everyday life. Structured interviews of the facilitators provided insight on institutional support, issues related to the program itself, required and/or recommended professional background, personal experience and competences, and difficulties linked to recruitment and research criteria. Recommendations aiming to enhance program implementation and delivery were then created using facilitators’ feedback on these aspects.
      Citation: Autism
      PubDate: 2020-01-23T06:56:05Z
      DOI: 10.1177/1362361319899766
       
  • Emergent life events in the delivery of a caregiver-mediated
           evidence-based intervention for children with autism spectrum disorder in
           publicly funded mental health services
    • Authors: Teresa Lind, Anna S Lau, Christopher Gomez, Adriana Rodriguez, Karen Guan, Colby Chlebowski, Aimee Zhang, Bruce Chorpita, Lauren Brookman-Frazee
      First page: 1286
      Abstract: Autism, Ahead of Print.
      Mental health clinicians often report significant challenges when delivering evidence-based interventions in community settings, particularly when unexpected client stressors (or emergent life events) interfere with the therapy process. The current study sought to extend the study of emergent life events to children with autism spectrum disorder by examining the occurrence and impact of emergent life events in the context of a collaborative, caregiver-mediated intervention for reducing challenging behaviors in children with autism spectrum disorder, An Individualized Mental Health Intervention for ASD (AIM HI). Participants included 38 child–clinician dyads enrolled in a community effectiveness trial of An Individualized Mental Health Intervention for ASD. Video recordings of 100 therapy sessions were coded for caregiver-reported emergent life events and clinician adherence to the Individualized Mental Health Intervention for ASD protocol. Results indicated that mild to severe emergent life events were reported in 36% of sessions, and were reported for 58% of children at some point during treatment. Greater number of child comorbid diagnoses and less clinician experience were both significantly associated with a higher number of caregiver-reported emergent life events. There was no significant link between emergent life events and clinician adherence to the Individualized Mental Health Intervention for ASD protocol. Findings offer implications for evidence-based intervention implementation, particularly the importance of incorporating clinician training in addressing complex presentations and crises in the context of evidence-based interventions.Lay abstractMental health clinicians often report significant challenges when delivering evidence-based interventions (EBI) in community settings, particularly when unexpected client stressors (or emergent life events; ELEs) interfere with the therapy process. The current study sought to extend the study of ELEs to children with Autism Spectrum Disorder (ASD) by examining the occurrence and impact of ELEs in the context of a collaborative, caregiver-mediated intervention for reducing challenging behaviors in children with ASD. This intervention was An Individualized Mental Health Intervention for children with ASD (referred to as AIM HI). Participants included 38 clinicians and child clients who were enrolled in a community effectiveness trial of AIM HI. Video recordings of 100 therapy sessions were coded for caregiver-reported ELEs and also how well clinicians adhered to the AIM HI protocol. Results indicated that mild to severe ELEs were reported in 36% of therapy sessions, and were reported for 58% of children at some point during the intervention. Children who had a greater number of diagnoses (in addition to the autism diagnosis) tended to have more ELEs. In addition, clinicians with less years of experience tended to have sessions with more ELEs. There was no significant link between ELEs and how well clinicians adhered to the AIM HI protocol. Findings offer implications for the implementation of EBI, particularly the importance of incorporating clinician training in addressing complex presentations and crises in the context of EBIs.
      Citation: Autism
      PubDate: 2020-01-31T11:33:12Z
      DOI: 10.1177/1362361319881084
       
  • Preliminary clinical outcomes of a short-term low-intensity Early Start
           Denver Model implemented in the Taiwanese public health system
    • Authors: Tzu-Ling Lin, Chung-Hsin Chiang, Suk Yin Ho, Hsin-Chi Wu, Ching-Ching Wong
      First page: 1300
      Abstract: Autism, Ahead of Print.
      The Early Start Denver Model is an evidence-based, comprehensive naturalistic developmental behavioral intervention. Randomized controlled studies indicate that long-term, high-intensity Early Start Denver Model in home-based settings can positively impact the clinical outcomes of young children with autism spectrum disorder. However, it is difficult to deliver high-intensity early intervention in an under-resourced country such as Taiwan. This study evaluated the effects of implementing the Early Start Denver Model with adaptations (including low intensity, shorter duration, and delivery in general hospitals by multidisciplinary professionals) within the Taiwanese public health system. A pre- and post-intervention study was conducted. Sixteen children with autism spectrum disorder (mean age of 33.5 months) received 6 months of one-on-one Early Start Denver Model intervention (approximately 8 h per week). The children showed significant post-intervention improvements in language and overall cognitive functioning and reduced symptom severity in communication and play. This study suggests that delivering the Early Start Denver Model in community-based hospitals may be an effective intervention, with a wider reach, for young children with autism spectrum disorder in Taiwan. The next steps in Taiwan are to incorporate a control group and assess the long-term effects of the adapted Taiwanese Early Start Denver Model program.Lay AbstractThe Early Start Denver Model is a comprehensive naturalistic developmental behavioral intervention for young children with autism spectrum disorder. Rigorous studies indicate that long-term, high-intensity Early Start Denver Model in home-based settings can help young children with autism spectrum disorder have great progress in language, cognitive development, and adaptive skills and reduce overall symptom severity. In accordance with the current limitations in resourcing for early intervention in Taiwan, this study evaluated the effects of implementing the Early Start Denver Model in the Taiwanese public health system with some adaptations, including lower intensity, shorter duration, and delivery in general hospitals. A total of 16 children with autism spectrum disorder, aged between 25 and 46 months, received approximately 8 h per week one-on-one Early Start Denver Model intervention. After 6 months of intervention, the children showed great improvements in language and overall cognitive functioning and reduced symptom severity in communication and play. This study suggests that directly delivering the Early Start Denver Model in community-based hospitals may be an effective intervention, which can make more young children with autism spectrum disorder in Taiwan access the Early Start Denver Model service.
      Citation: Autism
      PubDate: 2020-01-08T10:24:18Z
      DOI: 10.1177/1362361319897179
       
 
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