Subjects -> EDUCATION (Total: 2548 journals)
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EDUCATION (2187 journals)                  1 2 3 4 5 6 7 8 | Last

Showing 1 - 200 of 857 Journals sorted alphabetically
#Tear : Revista de Educação, Ciência e Tecnologia     Open Access   (Followers: 5)
(Pensamiento), (palabra) y obra     Open Access   (Followers: 2)
21. Yüzyılda Eğitim Ve Toplum Eğitim Bilimleri Ve Sosyal Araştırmalar Dergisi     Open Access  
21st Century Pedagogy     Open Access   (Followers: 7)
@tic. revista d'innovació educativa     Open Access  
Abant İzzet Baysal Üniversitesi Eğitim Fakültesi Dergisi     Open Access   (Followers: 2)
ABDIMAS ALTRUIS : Jurnal Pengabdian Kepada Masyarakat     Open Access  
Abdimas Toddopuli : Jurnal Pengabdian Pada Masyarakat     Open Access   (Followers: 12)
About Campus     Hybrid Journal   (Followers: 9)
Academic Medicine     Hybrid Journal   (Followers: 75)
Academic Psychiatry     Full-text available via subscription   (Followers: 33)
Academic Questions     Hybrid Journal   (Followers: 9)
Academy of Educational Leadership Journal     Full-text available via subscription   (Followers: 65)
Academy of Management Learning and Education     Full-text available via subscription   (Followers: 65)
Accounting & Finance     Hybrid Journal   (Followers: 59)
Accounting Education: An International Journal     Hybrid Journal   (Followers: 23)
Açıköğretim Uygulamaları ve Araştırmaları Dergisi     Open Access  
ACM Transactions on Computing Education (TOCE)     Hybrid Journal   (Followers: 13)
Acta Científica : Ciências Humanas     Open Access   (Followers: 2)
Acta Didactica Norge     Open Access   (Followers: 2)
Acta Educationis Generalis     Open Access  
Acta Paedagogica Vilnensia     Open Access   (Followers: 1)
Acta Scientiarum. Education     Open Access  
Action in Teacher Education     Hybrid Journal   (Followers: 79)
Action Learning: Research and Practice     Hybrid Journal   (Followers: 44)
Action Research     Hybrid Journal   (Followers: 51)
Active Learning in Higher Education     Hybrid Journal   (Followers: 370)
Actualidades Pedagógicas     Open Access  
Adelphi series     Hybrid Journal   (Followers: 14)
Adiyaman University Journal of Educational Sciences     Open Access   (Followers: 1)
Administração Educacional     Open Access  
Administration & Society     Hybrid Journal   (Followers: 15)
Administrative Science Quarterly     Full-text available via subscription   (Followers: 247)
Adult Education Quarterly     Hybrid Journal   (Followers: 246)
Advanced Education     Open Access   (Followers: 16)
Advances in Building Education     Open Access   (Followers: 7)
Advances in Health Sciences Education     Hybrid Journal   (Followers: 36)
Advances in High Energy Physics     Open Access   (Followers: 25)
Advances in School Mental Health Promotion     Partially Free   (Followers: 12)
AERA Open     Open Access   (Followers: 11)
Africa Education Review     Hybrid Journal   (Followers: 30)
African Journal of Chemical Education     Open Access   (Followers: 5)
African Journal of Educational Studies in Mathematics and Sciences     Full-text available via subscription   (Followers: 10)
African Journal of Health Professions Education     Open Access   (Followers: 6)
African Journal of Research in Mathematics, Science and Technology Education     Hybrid Journal   (Followers: 11)
African Journal of Teacher Education     Open Access   (Followers: 1)
Agora     Full-text available via subscription   (Followers: 6)
AGORA Magazine     Open Access  
Ahi Evran Üniversitesi Kırşehir Eğitim Fakültesi Dergisi     Open Access  
Ahmad Dahlan Journal of English Studies     Open Access   (Followers: 3)
AIDS Education and Prevention     Full-text available via subscription   (Followers: 8)
Ainedidaktiikka     Open Access  
Akadémiai Értesítö     Full-text available via subscription  
Akademos     Open Access   (Followers: 1)
AKSIOMA Journal of Mathematics Education     Open Access   (Followers: 3)
AKSIOMATIK : Jurnal Penelitian Pendidikan dan Pembelajaran Matematika     Open Access   (Followers: 1)
Aksis : Jurnal Pendidikan Bahasa dan Sastra Indonesia     Open Access  
Al-Athfaal : Jurnal Ilmiah Pendidikan Anak Usia Dini     Open Access   (Followers: 3)
Al-Bahith Journal     Open Access   (Followers: 1)
Al-Fikrah     Open Access   (Followers: 4)
Al-Idarah : Jurnal Kependidikan Islam     Open Access  
Al-Jabar : Jurnal Pendidikan Matematika     Open Access   (Followers: 1)
Al-Mudarris : Journal of Education     Open Access   (Followers: 1)
Al-Tadris : Jurnal Pendidikan Bahasa Arab     Open Access  
Al-Tadzkiyyah : Jurnal Pendidikan Islam     Open Access  
Al-Tanzim : Jurnal Manajemen Pendidikan Islam     Open Access  
Al.Qadisiya journal for the Sciences of Physical Education     Open Access  
Alan Eğitimi Araştırmaları Dergisi     Open Access  
Alberta Journal of Educational Research     Full-text available via subscription   (Followers: 9)
Aldaba     Open Access   (Followers: 1)
Alexandria : Revista de Educação em Ciência e Tecnologia     Open Access  
Alotrop     Open Access  
Alsic : Apprentissage des Langues et Systèmes d'Information et de Communication     Open Access   (Followers: 17)
Alteridad     Open Access  
Amasya Universitesi Egitim Fakültesi Dergisi     Open Access  
Ambiente & Educação : Revista de Educação Ambiental     Open Access  
American Annals of the Deaf     Full-text available via subscription   (Followers: 19)
American Biology Teacher     Full-text available via subscription   (Followers: 14)
American Educational Research Journal     Hybrid Journal   (Followers: 237)
American Journal of Business Education     Open Access   (Followers: 16)
American Journal of Distance Education     Hybrid Journal   (Followers: 33)
American Journal of Education     Full-text available via subscription   (Followers: 282)
American Journal of Educational Research     Open Access   (Followers: 72)
American Journal of Health Education     Hybrid Journal   (Followers: 35)
American Journal of Physics     Full-text available via subscription   (Followers: 54)
American String Teacher     Full-text available via subscription   (Followers: 2)
Ana Dili Eğitimi Dergisi / Journal of Mother Tongue Education     Open Access  
Anadolu Journal Of Educational Sciences International     Open Access   (Followers: 1)
Anadolu University Journal of Education Faculty     Open Access  
ANALES de la Universidad Central del Ecuador     Open Access   (Followers: 4)
Anargya : Jurnal Ilmiah Pendidikan Matematika     Open Access   (Followers: 9)
Annales Universitatis Mariae Curie-Sklodowska, sectio N – Educatio Nova     Open Access  
Annali dell'Universita di Ferrara     Hybrid Journal  
Annals of Dyslexia     Hybrid Journal   (Followers: 11)
Annals of Modern Education     Full-text available via subscription   (Followers: 6)
Antistasis : An Open Educational Journal     Open Access   (Followers: 10)
Anuario Pilquen : Sección Divulgación Científica     Open Access  
Apertura. Revista de innovación educativa‏     Open Access   (Followers: 3)
Apex : New Zealand Journal of Gifted Children     Open Access   (Followers: 1)
Applied Environmental Education & Communication     Hybrid Journal   (Followers: 19)
Applied Measurement in Education     Hybrid Journal   (Followers: 11)
Aprender     Open Access  
AR-RIAYAH : Jurnal Pendidikan Dasar     Open Access  
Arabia     Open Access   (Followers: 1)
Arabiyatuna : Jurnal Bahasa Arab     Open Access  
Archivos de Ciencias de la Educación     Open Access   (Followers: 2)
Areté, Revista Digital del Doctorado en Educación de la Universidad Central de Venezuela     Open Access   (Followers: 1)
Arrancada     Open Access   (Followers: 1)
Ars Educandi     Open Access  
Art Design & Communication in Higher Education     Hybrid Journal   (Followers: 30)
Arte e Investigación     Open Access   (Followers: 1)
Arts and Humanities in Higher Education     Hybrid Journal   (Followers: 45)
Arts Education Policy Review     Hybrid Journal   (Followers: 7)
Artseduca : Revista electrónica de educación en las ARTES     Open Access   (Followers: 1)
ASEAN Journal of Education     Open Access   (Followers: 3)
ASHE Higher Education Reports     Hybrid Journal   (Followers: 21)
Asia Pacific Education Review     Hybrid Journal   (Followers: 12)
Asia Pacific Journal of Education     Hybrid Journal   (Followers: 24)
Asia-Pacific Education Researcher     Hybrid Journal   (Followers: 14)
Asia-Pacific Journal of Teacher Education     Hybrid Journal   (Followers: 27)
Asian Journal of Distance Education     Open Access   (Followers: 3)
Asian Journal of Education and Social Studies     Open Access   (Followers: 2)
Asian Journal of English Language Teaching     Full-text available via subscription   (Followers: 17)
Asian Journal of Legal Education     Full-text available via subscription   (Followers: 4)
Asian-Pacific Journal of Second and Foreign Language Education     Open Access   (Followers: 2)
ASp     Open Access   (Followers: 4)
Assessing Writing     Hybrid Journal   (Followers: 15)
Assessment & Evaluation in Higher Education     Hybrid Journal   (Followers: 246)
Assessment for Effective Intervention     Hybrid Journal   (Followers: 16)
Assessment in Education: Principles, Policy & Practice     Hybrid Journal   (Followers: 49)
Assessment Update     Hybrid Journal   (Followers: 5)
AStA Wirtschafts- und Sozialstatistisches Archiv     Hybrid Journal   (Followers: 5)
At-Ta'dib Jurnal Kependidikan Islam     Open Access  
At-Taqaddum     Open Access  
At-Turats     Open Access  
ATENA Didaktik     Open Access   (Followers: 5)
Atenas : Revista Científico Pedagógica     Open Access   (Followers: 1)
Athenea Digital     Open Access  
ATIKAN : Jurnal Kajian Pendidikan (Journal of Educational Studies)     Open Access  
Atthulab : Islamic Religion Teaching and Learning Journal     Open Access   (Followers: 1)
Aula Abierta     Open Access   (Followers: 2)
Aula de Encuentro     Open Access  
Australasian Journal of Educational Technology     Open Access   (Followers: 21)
Australasian Journal of Engineering Education     Hybrid Journal   (Followers: 2)
Australasian Journal of Gifted Education     Full-text available via subscription   (Followers: 7)
Australasian Marketing Journal (AMJ)     Hybrid Journal   (Followers: 4)
Australian Art Education     Full-text available via subscription   (Followers: 8)
Australian Educational Researcher     Hybrid Journal   (Followers: 31)
Australian Journal of Adult Learning     Full-text available via subscription   (Followers: 15)
Australian Journal of Career Development     Hybrid Journal   (Followers: 4)
Australian Journal of Dyslexia and Learning Difficulties     Full-text available via subscription   (Followers: 8)
Australian Journal of Education     Hybrid Journal   (Followers: 42)
Australian Journal of Environmental Education     Full-text available via subscription   (Followers: 10)
Australian Journal of Indigenous Education, The     Full-text available via subscription   (Followers: 11)
Australian Journal of Learning Difficulties     Hybrid Journal   (Followers: 5)
Australian Journal of Music Education     Full-text available via subscription   (Followers: 6)
Australian Journal of Public Administration     Hybrid Journal   (Followers: 478)
Australian Journal of Teacher Education     Open Access   (Followers: 28)
Australian Mathematics Teacher, The     Full-text available via subscription   (Followers: 7)
Australian Primary Mathematics Classroom     Full-text available via subscription   (Followers: 5)
Australian Screen Education Online     Full-text available via subscription   (Followers: 3)
Australian TAFE Teacher     Full-text available via subscription   (Followers: 4)
Australian Universities' Review, The     Full-text available via subscription   (Followers: 4)
Autism     Hybrid Journal   (Followers: 345)
Avaliação : Revista da Avaliação da Educação Superior (Campinas)     Open Access  
Azalea: Journal of Korean Literature & Culture     Full-text available via subscription   (Followers: 4)
Bahastra     Open Access  
Balkan Region Conference on Engineering and Business Education     Open Access   (Followers: 2)
Baltic Journal of Career Education and Management     Open Access   (Followers: 1)
Barn : Forskning om barn og barndom i Norden     Open Access   (Followers: 1)
Basastra : Jurnal Bahasa, Sastra, dan Pengajarannya     Open Access   (Followers: 1)
BC TEAL Journal     Open Access  
Becoming : Journal of the Georgia Middle School Association     Open Access   (Followers: 10)
Behavioural Sciences Undergraduate Journal     Open Access   (Followers: 5)
BELAJEA : Jurnal Pendidikan Islam     Open Access  
BELIA : Early Childhood Education Papers     Open Access   (Followers: 10)
BELT - Brazilian English Language Teaching Journal     Open Access   (Followers: 4)
Berkeley Review of Education     Open Access   (Followers: 9)
Biblioteca Escolar em Revista     Open Access  
Biblioteka i Edukacja     Open Access   (Followers: 4)
Bildung und Erziehung     Hybrid Journal   (Followers: 7)
Bio-Lectura     Open Access  
BIODIK : Jurnal Ilmiah Pendidikan Biologi     Open Access   (Followers: 1)
Bioedukasi : Jurnal Pendidikan Biologi FKIP UM Metro     Open Access   (Followers: 1)
Bioma : Jurnal Ilmiah Biologi     Open Access  
Biosaintifika : Journal of Biology & Biology Education     Open Access   (Followers: 9)
Biosfer : Jurnal Biologi dan Pendidikan Biologi     Open Access  
Biosfer : Jurnal Tadris Biologi     Open Access  
BISE : Jurnal Pendidikan Bisnis dan Ekonomi     Open Access   (Followers: 1)
Biuletyn Historii Wychowania     Open Access  
BMC Medical Education     Open Access   (Followers: 50)
BMJ Simulation & Technology Enhanced Learning     Hybrid Journal   (Followers: 12)
Boletim Cearense de Educação e História da Matemática     Open Access  
Boletim de Educação Matemática     Open Access  
Boletim Técnico do Senac     Open Access  
Bordón : Revista de Pedagogía     Open Access   (Followers: 1)
British (Jurnal Bahasa dan Sastra Inggris)     Open Access   (Followers: 1)
British Educational Research Journal     Hybrid Journal   (Followers: 253)
British Journal of Educational Studies     Hybrid Journal   (Followers: 205)
British Journal of Educational Technology     Hybrid Journal   (Followers: 205)

        1 2 3 4 5 6 7 8 | Last

Similar Journals
Journal Cover
Autism
Journal Prestige (SJR): 1.739
Citation Impact (citeScore): 4
Number of Followers: 345  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1362-3613 - ISSN (Online) 1461-7005
Published by Sage Publications Homepage  [1093 journals]
  • Explicit and implicit self-esteem in youth with autism spectrum disorders
    • Authors: Renske van der Cruijsen, Bianca E Boyer
      Abstract: Autism, Ahead of Print.
      Although the link between self-esteem and psychopathology has been well established, studies on self-esteem in individuals with autism spectrum disorder are lacking. In this study, we aimed to (1) compare explicit and implicit self-esteem of youth with autism spectrum disorder to typically developing peers and to (2) explore relationships of implicit-, explicit-, and discrepant self-esteem measures with co-occurring internalizing and externalizing problems in youth with autism spectrum disorder. For this purpose, 25 individuals with autism spectrum disorder and 24 individuals as age- and intelligence quotient–matched controls aged 8–16 years participated in this study. Results showed lower explicit self-esteem in autism spectrum disorder compared to typically developing youth and no differences in implicit self-esteem between groups. In youth with autism spectrum disorder, low explicit self-esteem was related to co-occurring depression symptoms, whereas lower implicit self-esteem was related to externalizing symptoms. These results show that youth with autism spectrum disorder are at risk for developing low explicit self-esteem, which appears to be related to often co-occurring internalizing symptoms. This emphasizes the need to focus more on self-esteem in assessment and treatment of youth with autism spectrum disorder.Lay abstractHaving a stable and good self-esteem is important for maintaining a good mental health. However, having low self-esteem is a risk factor for developing depressive, anxious, or uncooperative/aggressive symptoms. While many individuals with an autism spectrum disorder have these symptoms, there is a lack of studies on self-esteem in this group. We studied self-esteem of youth with autism spectrum disorder and the connection to their co-occurring symptoms. To do this, different self-esteem profiles were investigated, including explicit self-esteem (how someone says their self-esteem is after reflecting on it), implicit self-esteem (how someone’s self-esteem is on a task that does not give them time to reflect on it), and the difference between both (high explicit with low implicit self-esteem or low explicit with high implicit self-esteem). Our results show that youth with autism spectrum disorder report lower self-esteem than youth without autism spectrum disorder when they have reflected on it (explicit self-esteem). And parents of children with autism spectrum disorder report that their children have even lower self-esteem. Implicit self-esteem was the same for youth with and without autism spectrum disorder. Furthermore, we found that within youth with autism spectrum disorder, there was a negative relationship between explicit self-esteem and depressive symptoms, and between implicit self-esteem and externalizing behavior. Taken together, youth with autism spectrum disorder are at risk for developing low self-esteem and when they do they have a higher risk of developing co-occurring problems. Therefore we stress that it is important to measure and improve the self-esteem of youth with autism spectrum disorder, so they develop less co-occurring problems and have a higher quality of life.
      Citation: Autism
      PubDate: 2020-10-15T09:33:50Z
      DOI: 10.1177/1362361320961006
       
  • Autistic traits are related to worse performance in a volatile reward
           learning task despite adaptive learning rates
    • Authors: Judith Goris, Massimo Silvetti, Tom Verguts, Jan R Wiersema, Marcel Brass, Senne Braem
      Abstract: Autism, Ahead of Print.
      Recent theories propose that autism is characterized by an impairment in determining when to learn and when not. We investigated this by estimating learning rate in environments varying in volatility and uncertainty. Specifically, we correlated autistic traits (in 163 neurotypical participants) with modelled learning behaviour during probabilistic reward learning under the following three conditions: a Stationary Low Noise condition with stable reward contingencies, a Volatile condition with changing reward contingencies and a Stationary High Noise condition where reward probabilities for all options were 60%, resulting in an uncertain, noisy environment. Consistent with earlier findings, we found less optimal decision-making in the Volatile condition for participants with more autistic traits. However, we observed no correlations between underlying adjustments in learning rates and autistic traits, suggesting no impairment in updating learning rates in response to volatile versus noisy environments. Exploratory analyses indicated that impaired performance in the Volatile condition in participants with more autistic traits, was specific to trials with reward contingencies opposite to those initially learned, suggesting a primacy bias. We conclude that performance in volatile environments is lower in participants with more autistic traits, but this cannot be unambiguously attributed to difficulties with adjusting learning rates.Lay abstractRecent theories propose that autism is characterized by an impairment in determining when to learn and when not. Here, we investigated this hypothesis by estimating learning rates (i.e. the speed with which one learns) in three different environments that differed in rule stability and uncertainty. We found that neurotypical participants with more autistic traits performed worse in a volatile environment (with unstable rules), as they chose less often for the most rewarding option. Exploratory analyses indicated that performance was specifically worse when reward rules were opposite to those initially learned for participants with more autistic traits. However, there were no differences in the adjustment of learning rates between participants with more versus less autistic traits. Together, these results suggest that performance in volatile environments is lower in participants with more autistic traits, but that this performance difference cannot be unambiguously explained by an impairment in adjusting learning rates.
      Citation: Autism
      PubDate: 2020-10-08T09:11:01Z
      DOI: 10.1177/1362361320962237
       
  • How do core autism traits and associated symptoms relate to quality of
           life' Findings from the Longitudinal European Autism Project
    • Authors: Bethany FM Oakley, Julian Tillmann, Jumana Ahmad, Daisy Crawley, Antonia San José Cáceres, Rosemary Holt, Tony Charman, Tobias Banaschewski, Jan Buitelaar, Emily Simonoff, Declan Murphy, Eva Loth
      Abstract: Autism, Ahead of Print.
      Previous studies have reported reduced quality of life in autism. Improving quality of life for autistic people is, therefore, a key priority for clinical research and practice. However, the relative impact of core autism traits (e.g. social-communication difficulties), as compared to associated mental health symptoms (e.g. anxiety, depression) on quality of life remains poorly understood. This is despite at least 20%–50% of autistic individuals experiencing associated anxiety and/or depression symptoms. Hence, we measured subjective quality of life in 573 six to thirty-year-olds (autism spectrum disorder N = 344), using two widely validated questionnaires. Adults self-reported on the World Health Organization Quality of Life–Brief instrument. Parents of children/adolescents completed the Child Health and Illness Profile. We assessed individual variability across both measures and modelled associations between quality of life, core autism traits, anxiety, and depression symptoms. Across both age groups and quality of life measures, autistic individuals scored lower than comparison individuals, on average, particularly for physical health in adults (d = −1.24, 95% confidence interval: [−1.56, −0.93]) and school achievement for children/adolescents (d = −1.06, 95% confidence interval: [−1.29, −0.84]). However, a notable proportion of autistic individuals (36%–71% across quality of life domains) did not have reduced quality of life. Across ages and quality of life measures, severity of associated symptoms was significantly related to reduced quality of life on several domains, after accounting for core autism traits. Most notably, depression symptoms were related to reduced physical/psychological well-being in both adults (β ⩾ −0.34) and children/adolescents (β = −0.29, 95% confidence interval: [−0.36, −0.14]). For children/adolescents, anxiety symptoms (β ⩾ −0.28) and core social-communication difficulties (β ⩾ −0.22) were also related to subjective quality of life outcomes. Overall, findings indicate that not all autistic individuals experience reduced subjective quality of life. Variability in quality of life is significantly influenced by associated symptoms, across developmental stage. This may provide a tractable target for mental health services to improve quality of life for autistic individuals over the lifespan.Lay abstractPrevious studies suggest that some autistic individuals report lower satisfaction, or well-being, with different aspects of everyday life than those without autism. It is unclear whether this might be partly explained by symptoms of anxiety and/or depression, which affect at least 20%–50% of autistic people. In this study, we measured individual differences in well-being in 573 six to thirty-year-olds with and without a diagnosis of autism. We investigated whether individual differences in well-being were explained by autism traits (e.g. social-communication difficulties) and/or anxiety and depression symptoms. We showed that, though well-being was lower for some autistic individuals, compared to those without autism, many autistic individuals reported good well-being. Where well-being was reduced, this was particularly explained by depression symptoms, across all ages. For children/adolescents, anxiety and social-communication difficulties were also related to some aspects of well-being. Our study suggests that support and services for improving mental health, especially depression symptoms, may also improve broader outcomes for autistic people.
      Citation: Autism
      PubDate: 2020-10-07T07:07:13Z
      DOI: 10.1177/1362361320959959
       
  • Anxiety in autistic individuals who speak few or no words: A qualitative
           study of parental experience and anxiety management
    • Authors: Joanne Tarver, Effie Pearson, Georgina Edwards, Aryana Shirazi, Liana Potter, Priya Malhi, Jane Waite
      Abstract: Autism, Ahead of Print.
      Anxiety is a common co-occurring condition in autism and impacts quality of life of autistic individuals and their families; autistic individuals who speak few or no words represent an under-researched group. This qualitative study aimed to understand more about parental recognition and management of anxiety in autistic individuals who speak few or no words. Semi-structured interviews were conducted with parents/carers of 17 autistic individuals (mage = 14.29) recruited from an existing participant database and social media adverts. Using thematic analysis, 15 themes were placed under three a-priori grand themes: parental recognition of anxiety; parental management of anxiety; and anxiety impact on the autistic individual and their family. Due to reduced verbal language use and overlap with other behaviours, parents described difficulties recognising anxiety in their child. However, they also described use of a number of management strategies, including some which overlap with components of evidence-based interventions for emotional and behavioural problems in autistic individuals (e.g. exposure/sensory calming). Despite this, parents reported that anxiety continues to have significant impact on quality of life. The findings of this study can help to inform the development of targeted intervention and assessment measures for anxiety in autistic individuals who speak few or no words.Lay abstractAnxiety is a common condition in autistic individuals, including those who also have an intellectual disability. Despite this, autistic individuals who have severe to profound intellectual disability, or use few or no words, are often excluded from autism research. There are also very few assessment tools and interventions with known effectiveness for autistic individuals with intellectual disability. In this study, we aimed to learn more about parent/carers experiences of recognising and managing anxiety in autistic individuals who use few or no words. We conducted semi-structured interviews with parents and carers to address three research questions: (1) what techniques and management strategies do parents describe for anxiety-related behaviour in their child; (2) how do communication difficulties impact parental understanding and management of anxiety provoking situations and behaviours; (3) what is the impact of anxiety-related behaviours on the quality of life of autistic individuals and their families' During the interviews, parents described difficulties recognising anxiety in their child, mostly due to reduced verbal language use and anxiety behaviours overlapping with other behaviours (e.g. autism characteristics). However, parents also described use of a number of management strategies, including some which overlap with components of evidence-based interventions for emotional and behavioural problems in autistic individuals (e.g. exposure/sensory calming). Despite this, parents reported that anxiety continues to have significant impact on quality of life. We will use the findings of this study to inform future research to develop assessment tools and interventions for anxiety in autistic individuals who use few or no words.
      Citation: Autism
      PubDate: 2020-10-01T08:55:51Z
      DOI: 10.1177/1362361320962366
       
  • Characteristics of toddlers with early versus later diagnosis of autism
           spectrum disorder
    • Authors: Lauren E Miller, Yael G Dai, Deborah A Fein, Diana L Robins
      Abstract: Autism, Ahead of Print.
      Autism spectrum disorder symptom emergence is heterogeneous, yet literature comparing young children diagnosed early versus later is relatively scant. Toddlers diagnosed with autism spectrum disorder between 12 and 18 months (n = 20), 19 and 24 months (n = 65), or 25 and 41 months (n = 27) were compared on demographics, developmental functioning, and symptoms. Later diagnosed children were more impaired than both younger groups on nonverbal reasoning, adaptive behavior, and autism spectrum disorder severity. Fine motor, receptive language, and social skills followed a linear pattern, with 25- to 41-month children more delayed than 19- to 24-month participants, who were more delayed than 12- to 18-month toddlers. Communication skills were similarly impaired across groups. Universal autism spectrum disorder screening before 18 months may detect toddlers when symptoms are milder and more amenable to intervention.Lay abstractThe emergence of autism symptoms in childhood is variable, with some children showing signs of autism spectrum disorder very early, and others not being identified until much later. Although most children in the United States are not diagnosed with autism spectrum disorder until preschool, at ages 3–4 years, symptoms can be reliably detected at 14 months. It is less certain how those toddlers diagnosed with autism spectrum disorder earlier versus later differ from each other clinically. This study revealed that young children diagnosed later in development, between ages 25 and 41 months, are more impaired on measures of cognitive, adaptive, and social functioning than their counterparts who are diagnosed with autism spectrum disorder earlier. All young children with autism spectrum disorder are impaired in communication to a similar degree, however. Universal autism screening at 18 months may identify toddlers with autism spectrum disorder when their symptoms are milder and more readily amenable to intervention. Repeated screening at 24 months is supported to detect those children missed by an earlier screening, who may be more severely affected. Caregivers should be encouraged to pursue diagnostic evaluation at an initial positive screening result to ensure timely diagnosis and treatment.
      Citation: Autism
      PubDate: 2020-09-26T11:29:57Z
      DOI: 10.1177/1362361320959507
       
  • Gastrointestinal problems are associated with increased repetitive
           behaviors but not social communication difficulties in young children with
           autism spectrum disorders
    • Authors: Payal Chakraborty, Kimberly L H Carpenter, Samantha Major, Megan Deaver, Saritha Vermeer, Brianna Herold, Lauren Franz, Jill Howard, Geraldine Dawson
      Abstract: Autism, Ahead of Print.
      Individuals with autism spectrum disorder are more likely than typically developing individuals to experience a range of gastrointestinal abnormalities, including chronic diarrhea, constipation, food sensitivities, and abdominal pain. These gastrointestinal symptoms have been associated with higher levels of irritability and aggressive behavior, but less is known about their relationship with core autism spectrum disorder symptoms. We investigated the relationship between autism spectrum disorder and gastrointestinal symptom severity while accounting for three associated behavioral symptom domains (Irritability, Aggressiveness, and Specific Fears), in a sample of 176 children (140 males and 36 females) ages 2–7 years old with autism spectrum disorder. Most participants had at least one reported gastrointestinal symptom (93.2%) and had more than one gastrointestinal symptom (88.1%). After accounting for each associated behavioral symptom domain, repetitive behaviors and stereotypies were positively associated with gastrointestinal symptom severity. Social and communication difficulties were not significantly associated with gastrointestinal symptom severity after accounting for associated behavioral symptoms. Our findings replicate a previously described association between irritability and aggression and gastrointestinal symptoms. Furthermore, gastrointestinal symptom severity is associated with repetitive behaviors, a subset of core autism spectrum disorder symptoms. This suggests that gastrointestinal symptoms may exacerbate repetitive behaviors, or vice versa, independent from other associated behavioral symptoms.Lay AbstractIndividuals with autism spectrum disorder are more likely than typically developing individuals to experience a range of gastrointestinal abnormalities, including chronic diarrhea, constipation, food sensitivities, and abdominal pain. These gastrointestinal symptoms have been associated with higher levels of irritability and aggressive behavior, but less is known about their relationship with core autism spectrum disorder symptoms. We investigated the relationship between autism spectrum disorder symptom severity and gastrointestinal symptoms while accounting for three associated behavioral symptom domains (Irritability, Aggressiveness, and Specific Fears), in a sample of 176 children (140 males and 36 females) ages 2–7 years old with autism spectrum disorder. A large majority (93.2%) of the sample had at least one reported gastrointestinal symptom, and most (88.1%) participants had more than one gastrointestinal symptom. Various types of gastrointestinal symptoms were reported; the most common symptoms reported were constipation, food limits, gas/bloating, and stomach pain. After accounting for each associated behavioral symptom domain, repetitive behaviors and stereotypies were significantly associated with gastrointestinal symptom severity. Increased severity of autism spectrum disorder symptoms was correlated with increased gastrointestinal symptom severity. Social and communication difficulties were not significantly associated with gastrointestinal symptom severity after accounting for associated behavioral symptoms. Our findings replicate a previously described association between irritability and aggression and gastrointestinal symptoms. Furthermore, we found that repetitive behaviors, but not social or communication symptoms, are associated with gastrointestinal symptom severity, even after accounting for associated behavioral symptoms. This suggests that gastrointestinal symptoms may exacerbate repetitive behaviors, or vice versa, independent from other associated behavioral symptoms.
      Citation: Autism
      PubDate: 2020-09-25T05:53:52Z
      DOI: 10.1177/1362361320959503
       
  • Inhibition in developmental disorders: A comparison of inhibition profiles
           between children with autism spectrum disorder,
           attention-deficit/hyperactivity disorder, and comorbid symptom
           presentation
    • Authors: Amanda Cremone-Caira, Katherine Trier, Victoria Sanchez, Brooke Kohn, Rachel Gilbert, Susan Faja
      Abstract: Autism, Ahead of Print.
      Thirty to 80% of children with autism spectrum disorder also have symptoms of attention-deficit hyperactivity disorder. Many children with autism spectrum disorder and attention-deficit hyperactivity disorder experience difficulties carrying out goal-directed behaviors, particularly when it comes to inhibiting responses. The aim of this study was to better understand the relative strengths and weaknesses across different measures of inhibition in children with autism spectrum disorder, attention-deficit hyperactivity disorder, autism spectrum disorder + attention-deficit hyperactivity disorder, and children who are typically developing. Inhibition of distracting information, motor responses, response speed, and selections with the potential for greater loss was measured in 155 school-aged children across these four groups. Results indicate that, for children with autism spectrum disorder + attention-deficit hyperactivity disorder, inhibition varied across the different outcomes assessed. Relative to typically developing children, children with autism spectrum disorder + attention-deficit hyperactivity disorder showed greater difficulty inhibiting behavioral responses. Conversely, inhibition of distracting information and strategic slowing of response speed differed between the children with autism spectrum disorder + attention-deficit hyperactivity disorder and those with either autism spectrum disorder or attention-deficit hyperactivity disorder. Avoidance of potential losses did not significantly differ between the four groups. The unique pattern of inhibition abilities shown in the autism spectrum disorder + attention-deficit hyperactivity disorder group suggests the need for special consideration in the context of targeted intervention.Lay AbstractMany children with autism spectrum disorder (ASD) also have symptoms of attention-deficit hyperactivity disorder (ADHD). Children with ASD and ADHD often experience difficulties with inhibition. This study had the goal of understanding inhibition in children with ASD, ADHD, ASD + ADHD, and children who are typically developing (TD) using tasks that measured several aspects of inhibition. Results indicate that children with ASD + ADHD had greater difficulty inhibiting behavioral responses than TD children. Children with ASD + ADHD also differed from children with ASD and with ADHD in their inhibition of distracting information and strategic slowing of response speed. The four groups did not differ in their avoidance of potential losses. Children with ASD + ADHD exhibit a unique profile of inhibition challenges suggesting they may benefit from targeted intervention matched to their abilities.
      Citation: Autism
      PubDate: 2020-09-25T05:53:33Z
      DOI: 10.1177/1362361320955107
       
  • How is autistic identity in adolescence influenced by parental disclosure
           decisions and perceptions of autism'
    • Authors: Ariana Riccio, Steven K Kapp, Allison Jordan, Anna Marie Dorelien, Kristen Gillespie-Lynch
      Abstract: Autism, Ahead of Print.
      A large body of literature examines parental interpretations of their child’s autism diagnosis. However, research examining intersections between parental disclosure of their child’s autism diagnosis to their child and their child’s identity development is lacking. The primary aim of this study was to analyze if parental decisions to disclose/withhold their child’s autism diagnosis influence adolescents’ perceptions of autism and identity development. Adolescent participants (n = 19) and their mothers, recruited from an informal educational program, completed in-person interviews and online questionnaires, respectively. Adolescents were told about their autism diagnosis in varying ways. Adolescents whose parents voluntarily disclosed their autism diagnosis to them described autism and themselves more positively than adolescents who did not experience voluntary disclosure. Although parents and teens showed similarities on a group level when defining autism, parents and children expressed diverse themes in their definitions of autism. Findings suggest that parents can help their children develop neurodiversity-aligned perspectives about autism by mindfully discussing autism with them early in their development.Lay abstractThere is a lot of research about how parents think about their child’s autism but we don’t know much about how parents talk with their kids about autism. How parents talk with their kids about autism may shape how kids see autism. A team of autistic and non-autistic people (including a mother of an autistic person) did a study. We wanted to know if how parents talk with their kids about autism shapes how their kids see autism. Nineteen teens from a summer camp did interviews and surveys. Their mothers did surveys. Teens learned about if they had autism in different ways. Some teens still didn’t know they were autistic. Teens whose moms chose to tell them about their autism talked about autism and themselves more positively than teens whose moms didn’t choose to talk with them about autism. Only teens whose moms chose to talk with them about autism described themselves as having social strengths. Teens had a harder time defining autism than moms. However, teens and moms talked about autism in similar ways. Our study shows that parents can help their kids see autism and themselves more positively by talking with their kids about autism early in development.
      Citation: Autism
      PubDate: 2020-09-24T08:59:31Z
      DOI: 10.1177/1362361320958214
       
  • Quantity and quality of empathic responding by autistic and non-autistic
           adolescent girls and boys
    • Authors: Carolien Rieffe, Rachel O’Connor, Anne Bülow, Danique Willems, Laura Hull, Felicity Sedgewick, Lex Stockmann, Els Blijd-Hoogewys
      Abstract: Autism, Ahead of Print.
      Empathy evokes support for the person in distress, and thus strengthening social cohesion. The question is to what extent empathic reactions can be observed in autistic adolescents and autistic girls in particular, since there is evidence that they have better social skills than boys, which might hinder their recognition as autistic. We examined 193 adolescents (autistic/non-autistic boys/girls) during an in vivo task in which the experimenter hurt herself. In line with our predictions, no group or gender differences appeared related to their attention for the event; yet autistic girls and boys showed less visible emotional arousal, indicative of less affective empathy. Autistic girls and boys reacted by comforting the experimenter equally often as their non-autistic peers, but autistic boys seemed to address the problem more often than any other group; while girls (autistic and non-autistic) more often addressed the emotion of the person in need. Our findings highlight that empathic behaviour – to some extent – seems similar between autistic and non-autistic boys and girls. However, differences exist, in terms of expressed emotional arousal and gender-specific comforting styles. Autistic girls’ higher levels of emotion-focused comforting could be explained by well-developed social skills, camouflaging, or emotional investment in relationships with others.Lay abstractEmpathy is an important feature to feel for another person, evoking social support for the person in distress, and thus strengthening social cohesion. The question is to what extent empathic reactions can also be observed in autistic adolescents and autistic girls in particular, since their often mentioned good social skills might prevent their direct social environment from recognizing their autism. We examined 194 adolescents (autistic and non-autistic boys and girls) during an in vivo task in which the experimenter pretended to hurt herself while closing a binder. All responses by the participants were videotaped and coded by two independent coders. In line with our predictions, no group or gender differences appeared related to their attention for the event; yet autistic girls and boys showed less visible emotional arousal, which could indicate less affective empathy (feeling for someone), or which could indicate that autistic adolescents know less well how to show empathy. Autistic girls and boys reacted by comforting the experimenter equally often as their non-autistic peers, but autistic boys addressed the problem more often than any other group, while girls (autistic and non-autistic) more often addressed the emotion of the person in need. Our findings highlight that empathic behaviour is remarkably similar between autistic and non-autistic boys and girls. Indeed, only subtle differences exist, in terms of expressed emotional arousal and gender-specific comforting styles. Autistic girls’ higher levels of emotion-focused comforting could be explained by well-developed social skills, camouflaging, or emotional investment in relationships with others.
      Citation: Autism
      PubDate: 2020-09-24T08:58:12Z
      DOI: 10.1177/1362361320956422
       
  • Development and preliminary validation of a depressive symptomatology
           detection scale among children and adolescents on the autism spectrum
    • Authors: Lucie Bellalou, Naomi Downes, Emilie Cappe
      Abstract: Autism, Ahead of Print.
      High rates of depressive disorders are reported among young people on the autism spectrum. This condition is generally assessed using measures validated for typically developing young people. Tools adapted to children on the autism spectrum are not tailored to detect Major Depressive Disorder, nor have they been used among samples with an intellectual disability. To fill this gap, this article builds a novel Scale for evaluating depressive symptoms among youth on the autism spectrum (Echelle d’évaluation de la symptomatology dépressive spécifique à l’autisme) and evaluates its performance using a sample of 153 young people on the autism spectrum in France. The Echelle d’évaluation de la symptomatology dépressive spécifique à l’autisme was completed by parents of children and adolescents (aged 3–17 years) via an interview with a psychologist. The Echelle d’évaluation de la symptomatology dépressive spécifique à l’autisme has very good internal consistency, as well as good content validity. The scale is composed of two factors: (1) behavioral changes and (2) emotional and cognitive changes. Future studies should replicate this validation study with a larger sample size and investigate interrater reliability. Overall, results suggest preliminary support for using the Echelle d’évaluation de la symptomatology dépressive spécifique à l’autisme among youth on the autism spectrum.Lay abstractMany individuals on the autism spectrum experience depressive symptoms. These symptoms contribute to poor quality of life and may have a more negative impact than core autistic features. However, identifying depressive symptoms among individuals on the spectrum is a real challenge. In this study, we investigate the psychometric qualities of a French scale for evaluating depressive symptoms among youth on the autism spectrum. Participants were 153 autistic children and adolescents aged between 3 and 17 years. The majority of the sample was male (73.86%). One of their parents completed the scale for evaluating depressive symptoms among youth on the autism spectrum during an interview with a psychologist. Overall, the findings indicate the scale may be reliably used with children and adolescents on the autism spectrum. Experts deemed the items as being representative of depressive symptoms. The scale is composed of two factors: behavioral changes on one hand and cognitive and emotional changes on the other. The results are encouraging and show the scale is a promising instrument for assessing Major Depressive Disorder symptomatology among youth on the spectrum. Future studies should focus on testing this scale among adults and developing an auto-evaluative section.
      Citation: Autism
      PubDate: 2020-09-21T07:25:45Z
      DOI: 10.1177/1362361320958209
       
  • ‘I just rolled up my sleeves’: Mothers’ perspectives on raising
           girls on the autism spectrum
    • Authors: Karen Fowler, Cliodhna O’Connor
      Abstract: Autism, Ahead of Print.
      Little previous research has elucidated the everyday experiences of autistic girls or their families. This study used qualitative in-depth interviews to explore mothers’ experiences of the diagnosis, presentation and impact of caring for a daughter with autism. Nineteen women with autistic daughters (aged between 7 and 18) participated in the research, which took place in Ireland. Thematic analysis identified six themes: What’s Going On'; Road to Acceptance; Beyond the Stigma of Autism; Autism: Like a Girl; Mothers Holding It All Together; and Mothers Roll Up Their Sleeves. The analysis suggests that the path of autism in girls in Ireland is marked by diagnostic delays, social stigma, interpersonal difficulties, mental health comorbidities and parental stress. However, these challenges were offset by the resilience of mothers, buttressed by pride in their daughters and support from other women. Results will inform the development of policy and practice that is sensitive to the lived realities of autistic girls and their families.Lay abstractAutism in boys has been well researched but very little is known about the everyday experiences of autistic girls or their families. Mothers’ views and insights can be very helpful in increasing knowledge around the unique demands of raising a daughter with autism. This study conducted interviews with Irish mothers to examine their own experiences regarding (a) getting an autism diagnosis for their daughter, (b) their daughters’ personal characteristics and (c) the impact of caring for a daughter with autism. The study suggests that the route to an autism diagnosis for girls in Ireland is made more difficult by delays and missed diagnoses, and often followed by inadequate supports. Mothers described autistic girls as presenting with social challenges and mental health difficulties. Many mothers experienced judgement from other parents and family members, acute stress and mental health struggles. However, these challenges were offset by mothers’ resilience, pride in their daughters and support from other women. The findings of this study highlight the importance of specific support for autistic girls and their families.
      Citation: Autism
      PubDate: 2020-09-15T09:52:54Z
      DOI: 10.1177/1362361320956876
       
  • Physical activity participation among adolescents with autism spectrum
           disorder
    • Authors: Patrick Jachyra, Rebecca Renwick, Brenda Gladstone, Evdokia Anagnostou, Barbara E Gibson
      Abstract: Autism, Ahead of Print.
      Adolescents with autism spectrum disorder are less physically active compared with their age-related peers. Despite the many benefits of physical activity, little is known about why they are predominantly inactive. To date, research has rarely included adolescent’s perspectives, and little is known about how wider social, systemic, and policy forces shape physical activity. The purpose of this study was to explore the perceptions, meanings, and role of physical activity in the lives of adolescents with autism spectrum disorder, and draw on their experiences to examine how social and cultural processes shaped their participation. Ten adolescent boys with autism spectrum disorder created individual digital stories, and participated in two interviews. Thematic analysis was informed by a critical social science approach. The results highlight that bullying, challenges in community programs, and the prioritization of therapeutic interventions limited participation. Participation was maximized when physical activity generated meaning, purpose, a sense of identity, and affective pleasures. The study findings illuminate the complexity of physical activity participation which has not previously been described in the literature. The findings suggest potential value in promoting the affective pleasures of movement, along with facilitating social and systemic pathways to enhance physical activity participation.Lay abstractAdolescents with autism spectrum disorder are less likely to be physically active compared to their age-related peers. Despite the lower levels of physical activity observed among adolescents with autism spectrum disorder, it is unknown why they are predominantly inactive. Much of the research so far has focused on understanding how biological aspects influence physical activity participation. But there is little research that has examined how social and cultural components influence their physical activity participation. There is also little research that has sought the perspectives and experiences of adolescents with autism spectrum disorder. In this study, 10 adolescent boys with autism spectrum disorder created a digital story, and also participated in two face-to-face interviews. The purpose of the study was to examine how individual, social, and cultural forces influenced physical activity participation. Analysis of the data highlight that bullying, challenges in community programs, and the prioritization of therapeutic interventions limited participation. On the contrary, participants were more likely to be active when physical activity generated meaning, purpose, a sense of identity, and affective pleasures. The findings add new knowledge suggesting that adolescents with autism spectrum disorder are not simply unmotivated. Rather, physical activity participation was shaped by wider social experiences, norms, values, and practices in which they were immersed. The findings suggest a need for directed efforts to create policies and practices which are individualized and reflective of the needs and abilities of adolescents with autism spectrum disorder to promote physical activity participation and potentially enhance physical health and wellbeing.
      Citation: Autism
      PubDate: 2020-09-14T07:45:22Z
      DOI: 10.1177/1362361320949344
       
  • Improving autism and developmental screening and referral in US primary
           care practices serving Latinos
    • Authors: Katharine E Zuckerman, Alison E Chavez, Laura Wilson, Katie Unger, Colleen Reuland, Katrina Ramsey, Margaret King, Julie Scholz, Eric Fombonne
      Abstract: Autism, Ahead of Print.
      Improving autism spectrum disorder screening and referral in primary care may reduce autism spectrum disorder disparities for Latino children. The REAL-START intervention aimed to increase primary care provider adherence to autism spectrum disorder and developmental screening guidelines, and to increase Early Intervention referral for children at developmental risk in primary care clinics serving Latinos. This quasi-experimental study enrolled six Oregon primary care clinics. Clinic staff attended one initial and three follow-up trainings. Trainings addressed screening, billing, referral, and follow-up issues specific to Latinos. Clinic leaders met with a quality improvement facilitator to review performance. Medical record review measured screening and referral at 18- and 24-month well-child visits at baseline and 3, 6, 9, and 12 months. State Early Intervention database queries assessed Early Intervention eligibility. Overall, 2224 well-child visits were assessed (39% Latino). Clinics improved rates of autism spectrum disorder screening from 70% to 94% and general developmental screening from 62% to 95%. Adherence to screening guidelines increased from 46% to 91%. Proportion of children referred to Early Intervention for unchanged, but total referrals increased and age range of referred children broadened. Time to Early Intervention evaluation was slightly shorter among screening-age children. REAL-START may improve screening and referral for autism spectrum disorder and developmental delay in Latino communities.Lay abstractLatino children experience delays in access to diagnosis and treatment of autism spectrum disorder. Primary care–based screening of all children for autism spectrum disorder and referring them for services may reduce racial/ethnic differences and improve care. REAL-START, a yearlong screening intervention, was effective in increasing screening for autism spectrum disorder and general developmental delays, increasing therapy referrals, and shortening time for developmental assessment in primary care clinics with Latino patients.
      Citation: Autism
      PubDate: 2020-09-14T07:45:02Z
      DOI: 10.1177/1362361320957461
       
  • A commentary on interpreting the United States preventive services task
           force autism screening recommendation statement
    • Authors: Emily Hickey, R Christopher Sheldrick, Jocelyn Kuhn, Sarabeth Broder-Fingert
      Abstract: Autism, Ahead of Print.
      In 2016, the US Preventive Services Task Force concluded that there was “insufficient” (“I” statement) evidence to support universal primary care screening for autism spectrum disorder. The statement led to controversy among research and clinical communities. Although a number of papers have since been published arguing for the potential benefit of autism spectrum disorder screening, none adequately address the potential harms of autism spectrum disorder screening. This evidence gap may relate to confusion regarding how the US Preventive Services Task Force conceptualizes and evaluates potential harm. In this commentary, we explore how the US Preventive Services Task Force operationalizes harm and discuss how the potential for harm was described in the “I” statement on autism spectrum disorder screening. This information can serve as a guide for investigators working to study the benefits and harms of autism spectrum disorder screening in order to fill the research gaps cited by the US Preventive Services Task Force report. Finally, we recommend future research directions for exploring harms of autism spectrum disorder screening, filling cited research gaps, and ultimately ensuring that the benefits of autism spectrum disorder screening truly outweigh the harms for all children and their families.
      Citation: Autism
      PubDate: 2020-09-14T07:44:43Z
      DOI: 10.1177/1362361320957463
       
  • Cross-lagged model of bullying victimization and mental health problems in
           children with autism in middle to older childhood
    • Authors: Geovanna Rodriguez, Kim Drastal, Sigan L Hartley
      Abstract: Autism, Ahead of Print.
      Youth with autism spectrum conditions have been shown to be at an increased risk for bullying victimization. The overall aim of this study was to identify factors associated with increased risk for bullying victimization in youth with autism during middle childhood to early adolescence (aged 5–12 years) and to explore the potential time-ordered associations between bullying victimization and mental health problems 12 months later. The average age of the youth with autism was 7.90 years (SD = 2.33), 86% were male, 34.6% had an intellectual disability, and 84% were White, non-Hispanic. Youth with autism who experienced bullying victimization (vs no victimization) were older in age, had more severe autism symptoms, and higher levels of internalizing and externalizing mental health problems at study onset. Using two cross-lagged structural equation models, the associations between maternal report of youth bullying victimization and teacher report of youth mental health problems using two waves of data were tested. Internalizing and externalizing mental health problems at Time 1 did not relate to change in likelihood of being bullied 1 year later. In contrast, bullying victimization at Time 1 was associated with an increase in internalizing mental health problems (β = 0.24, p 
      Citation: Autism
      PubDate: 2020-09-12T07:37:45Z
      DOI: 10.1177/1362361320947513
       
  • The role of early social motivation in explaining variability in
           functional language in toddlers with autism spectrum disorder
    • Authors: Pumpki L Su, Sally J Rogers, Annette Estes, Paul Yoder
      Abstract: Autism, Ahead of Print.
      This study examined an insufficiently studied predictor of functional language, social motivation, in a group of 87 young children with autism spectrum disorder. Participants (age 14–31 months at the start of the study) were assessed at four times over 24 months. We tested total and indirect associations between early social motivation and later expressive language to understand the behavioral mechanisms by which social motivation might affect functional language development. Results from this study show that early social motivation predicts functional language 2 years later in young children with autism spectrum disorder. In addition, this positive longitudinal association is serially mediated by intentional communication and then receptive language. These findings are consistent with the elicited bootstrapping hypothesis which proposes that children with relatively stronger social motivation produce more intentional communication. This, in turn, elicits others’ linguistic input which impels receptive language development. This process eventually results in relatively increased expressive language development.Lay abstractAbout one-third of children with autism spectrum disorder never develop the language that they need in different day-to-day situations. Identifying potential factors that can predict later language development is crucial to understanding why some children with autism spectrum disorder successfully develop language while others do not. This study sought to investigate one of the understudied predictors of language development, social motivation, and to test theories for why this association may occur. Testing the theories requires that we measure children’s ability to deliberately and directly communicate with others (i.e. intentional communication) and children’s language understanding between the measures of social motivation and later expressive language. We tested 87 children with autism spectrum disorder, aged 14–31 months, at four times over 24 months. We found that children with relatively stronger social motivation had relatively better language use 2 years later. This positive link was partly due to a child’s ability to produce intentional communication and to understand language. Although we did not measure parents’ talking to their children, a theory that inspired this study suggests that children who use frequent intentional communication probably motivate others to talk with them frequently, which facilitates children’s language understanding which leads to the development of expressive language. This theory, if confirmed to be true, can provide guidance for parents who want to help their children learn to talk. Parents could look for intentional communication from their children and respond by talking to their children. Effective intervention on both parent and child targets will likely enhance treatment efficacy. Future work is needed to test these ideas.
      Citation: Autism
      PubDate: 2020-09-12T07:37:16Z
      DOI: 10.1177/1362361320953260
       
  • Health status of Medicare-enrolled autistic older adults with and without
           co-occurring intellectual disability: An analysis of inpatient and
           institutional outpatient medical claims
    • Authors: Daniel Gilmore, Lauren Harris, Anne Longo, Brittany N Hand
      Abstract: Autism, Ahead of Print.
      Little is known about the extent to which the healthcare needs of autistic older adults with intellectual disability differ from autistic older adults without intellectual disability. We conducted a cross-sectional retrospective cohort study of Medicare claims data from 2016 to 2017 to compare the prevalence of physical and mental health conditions among autistic older adults (age 65+ years) with intellectual disability (N = 2054) to autistic older adults without intellectual disability (N = 2631). Medicare claims data consisted of records from inpatient hospitalizations and institutional outpatient visits (i.e. visits to hospital outpatient departments, rural health clinics, renal dialysis facilities, outpatient rehabilitation facilities, Federally Qualified Health Centers, and community mental health centers). Examination of the largest between-group differences revealed that autistic older adults with intellectual disability had 350% greater odds of epilepsy (odds ratio = 4.5, 95% confidence interval = 3.9–5.2), 170% greater odds of osteoporosis (odds ratio = 2.7, 95% confidence interval = 2.3–3.2), and 100% greater odds of gastrointestinal conditions (odds ratio = 2.0, 95% confidence interval = 1.8–2.2) but 80% lower odds of attention deficit disorders (odds ratio = 0.2, 95% confidence interval = 0.1–0.3), 70% lower odds of substance use disorders (odds ratio = 0.3, 95% confidence interval = 0.2–0.4), and 60% lower odds of suicidal ideation or intentional self-injury (odds ratio = 0.4, 95% confidence interval = 0.3–0.6). These findings highlight the importance of developing tailored health management strategies for the autistic older adult population as a function of intellectual disability status.Lay abstractLittle is known about the extent to which the healthcare needs of autistic older adults with intellectual disability differ from autistic older adults without intellectual disability. Our study is the first, to our knowledge, to use US national data to compare physical and mental health conditions among autistic older adults with and without intellectual disability. The data analyzed in this study consisted of records from inpatient hospitalizations as well as “institutional outpatient” healthcare visits, which include visits to hospital outpatient departments, rural health clinics, renal dialysis facilities, outpatient rehabilitation facilities, Federally Qualified Health Centers, and community mental health centers. Autistic older adults with intellectual disability were significantly more likely to have thyroid disorders, epilepsy, respiratory infections, gastrointestinal conditions, osteoporosis, cognitive disorders, and schizophrenia/psychotic disorders. In contrast, autistic older adults without intellectual disability were significantly more likely to have obesity, diabetes, high blood pressure, cerebrovascular disease, chronic obstructive pulmonary disease, arthritis, back conditions, attention deficit disorders, substance use disorders, and suicidal ideation or intentional self-injury. These findings highlight the importance of developing distinct, tailored health management strategies for the autistic older adults with and without intellectual disability.
      Citation: Autism
      PubDate: 2020-09-10T06:17:54Z
      DOI: 10.1177/1362361320955109
       
  • Specialized primary care medical home: A positive impact on continuity of
           care among autistic adults
    • Authors: Brittany N Hand, Daniel L Coury, Susan White, Amy R Darragh, Susan Moffatt-Bruce, Lauren Harris, Anne Longo, Jennifer H Garvin
      Abstract: Autism, Ahead of Print.
      While the medical home has proven effective at improving continuity of care among other populations, there is a paucity of literature testing the effectiveness of medical homes in serving the healthcare needs of autistic adults. We conducted a retrospective cohort study to compare the continuity of care of autistic adult patients at a specialized primary care medical home designed to remove barriers to care for autistic adults, called the Center for Autism Services and Transition (CAST), to propensity score matched national samples of autistic adults with private insurance or Medicare. The unadjusted median Bice–Boxerman continuity of care index was 0.6 (interquartile range = 0.4–1.0) for CAST patients, 0.5 (interquartile range = 0.3–1.0) for Medicare beneficiaries, and 0.6 (interquartile range = 0.4–1.0) for privately insured autistic adults. In multivariable models controlling for demographic characteristics, on average, CAST patients had continuity of care indices that were 10% higher than national samples of autistic adult Medicare beneficiaries (p 
      Citation: Autism
      PubDate: 2020-09-10T06:17:14Z
      DOI: 10.1177/1362361320953967
       
  • Increased prevalence of non-communicable physical health conditions among
           autistic adults
    • Authors: Elizabeth Weir, Carrie Allison, Varun Warrier, Simon Baron-Cohen
      Abstract: Autism, Ahead of Print.
      Autistic individuals may be at risk of premature mortality, and physical health comorbidity increases this risk; however, most studies fail to include older autistic adults or consider lifestyle-related factors that affect health. We developed an anonymous, online physical health survey. The final sample included n = 2368 individuals (mean age = 41.42), and of these, n = 1156 were autistic individuals (mean age = 40.98). We utilized three sex-stratified statistical models to determine the prevalence of cancer, cardiovascular conditions, respiratory conditions, and diabetes. All three models indicate that autistic females are more likely to have cardiovascular conditions, respiratory conditions, asthma, low blood pressure, arrhythmias, and prediabetes than non-autistic females, and autistic males are more likely to have arrhythmias than non-autistic males; these results suggest that autistic individuals carry increased risks for these conditions when compared to the general population, even after controlling for age, ethnicity, education level, body mass index, smoking, and alcohol use. Further, these risks may differ depending on biological sex for autistic individuals. Autistic adults, and particularly autistic females, have greater and wider-ranging risks than previously thought, even after controlling for demographic and lifestyle-related factors. Although this is a large sample of autistic adults across the lifespan, future research should employ larger, population-based samples to confirm these findings.Lay abstractPrevious research indicates autistic individuals die at a younger age than others and that this is possibly due in part to chronic physical health conditions. The present study used an anonymous, online survey to determine how common certain physical health conditions are among autistic adults, compared with non-autistic adults. We found autistic adults are more likely to develop heart conditions, lung conditions, and diabetes than non-autistic adults. Autistic females may be at higher risk of developing certain conditions (including respiratory conditions, asthma, and prediabetes) than autistic males. Finally, autistic individuals have increased health risks even when considering lifestyle factors (such as smoking, alcohol, and body mass index). This is still a relatively small study, and future research needs to confirm these findings and identify why these risks exist.
      Citation: Autism
      PubDate: 2020-09-10T06:16:14Z
      DOI: 10.1177/1362361320953652
       
  • Neurological disorders in autism: A systematic review and meta-analysis
    • Authors: Pei-Yin Pan, Sven Bölte, Preet Kaur, Sadia Jamil, Ulf Jonsson
      Abstract: Autism, Ahead of Print.
      The etiological significance of neurological disorders in autism is debated, but it is clear that they complicate support provision and clinical management, and can have negative impact on outcomes. This systematic review and meta-analysis explored the full range of co-occurring neurological disorders in autism. We estimated the odds of having neurological complications compared to the general population and other neurodevelopmental conditions, as well as the overall prevalence of different neurological disorders. Seventy-nine articles were eligible for the systematic review, including 28 case-control studies, 43 prevalence studies, and 8 cohort studies. Findings were heterogeneous across studies. Overall, autistic individuals were significantly more likely than the general population to exhibit epilepsy, macrocephaly, hydrocephalus, cerebral palsy, migraine/headache, and congenital abnormalities of the nervous system, with prevalence estimates ranging from 1.1% (0%–3.3%; hydrocephalus) to 14.2% (11.3%–17.2%; epilepsy). Epilepsy was also more common in autism than in attention-deficit/hyperactivity disorder (odds ratio [95% confidence interval] = 4.06 [2.81–5.88]). Findings indicate that awareness of neurological disorders and neurological check-ups are indicated in autism to ensure adequate physical health care and support. Prospective studies of neurological disorders in children diagnosed with or at risk of autism might further enhance our understanding of causal pathways.Lay abstractNeurological disorders, such as epilepsy and cerebral palsy, have been reported to occur among individuals with autism beyond chance and may have an impact on daily living across the lifespan. Although there has been research investigating neurological disorders in autism, the findings are not always conclusive. Previous summaries of existing studies have not evaluated the full range of neurological disorders. This study aimed to comprehensively explore the neurological problems appearing in autism to provide updated information that is needed for better healthcare and support in this population. We looked at already published studies focusing on risk or frequency of neurological disorders in autism. Our results suggest that individuals with autism are more likely than the general population to have a range of neurological disorders, including epilepsy, macrocephaly, hydrocephalus, cerebral palsy, migraine/headache, and inborn abnormalities of the nervous system. In order to provide individualized healthcare and support of high quality to individuals diagnosed with autism, health care professionals and other support providers need to be attentive to neurological complications. To further improve our understanding about the link between autism and neurological disorders, future research should follow the neurological health of children who are diagnosed with or are at increased likelihood of autism.
      Citation: Autism
      PubDate: 2020-09-10T06:15:15Z
      DOI: 10.1177/1362361320951370
       
  • Parental perspectives of functioning in their children with autism
           spectrum disorder: A global scoping review
    • Authors: Marisa Viljoen, Soheil Mahdi, James Shelly, Petrus J de Vries
      Abstract: Autism, Ahead of Print.
      No reviews to date have summarized the views of parents on the functional challenges and/or strengths of their children with autism spectrum disorder. We set out to perform a scoping review aiming (a) to identify and collate global results to provide a broad description of parental perspective of functioning research and (b) to summarize these using the International Classification of Functioning Disability and Health–Child and Youth version framework. The International Classification of Functioning Disability and Health provides a language to describe the functional skills of an individual with a health condition in terms of their body structures, body functions, activities and participation, their environmental and personal factors. Given the influence that context has on functioning, and the potential impact of economic status on availability of resources, we were specifically interested to compare perspectives from high-income countries and low-/middle-income countries. Two researchers conducted a comprehensive search of English peer-reviewed studies published between 1990 and June 2016. Articles were accessed and summarized using thematic analysis. Meaningful phrases were extracted from key findings and linked to second-level International Classification of Functioning Disability and Health–Child and Youth categories following international linking rules. Thirty-three studies were identified of which only six originated from low/middle-income countries (n = 6/33, 18%). Two studies compared perspectives from low-/middle-income countries and high-income countries (n = 2/33, 6%). Functional themes from high-income countries included a range across the International Classification of Functioning Disability and Health–Child and Youth bio-psychosocial framework while functional themes from low-/middle-income countries were predominantly focused on environmental factors. We propose further research should consider a systematic comparison of high-income and low/middle-income countries across functional categories to get a more accurate impression of the impact of context on functioning.Lay abstractNo paper to date has summarized parents’ views on the functional challenges and/or strengths of their children with autism spectrum disorder. In this review we set out to perform a scoping review aiming to (a) find and compare existing research from around the globe on parental perception of functioning and (b) summarize results from these papers using the International Classification of Functioning Disability and Health–Child and Youth version framework. Since we know that the place and circumstances we live in can have a significant influence on our functioning in daily life, we were specifically interested in comparing perceptions from high-income countries and low-/middle-income countries. Two researchers conducted a comprehensive search of English studies published between 1990 and June 2016. Papers were summarized and key findings were linked to International Classification of Functioning Disability and Health–Child and Youth categories. Thirty-three studies were identified, of which most were conducted in high-income countries (n = 25/33, 76%) with only six studies in low/middle-income countries (n = 6/33, 18%). Two studies compared views from low/middle-income and high-income countries (n = 2/33, 6%). Functional themes from high-income countries included a range across the International Classification of Functioning Disability and Health–Child and Youth framework while functional themes from low-/middle-income countries were mostly focused on environmental factors. It was difficult to directly compare studies from low/middle-income and high-income countries because they investigated and discussed such different parts of functioning. We suggest that future research should use an approach that will allow researchers to directly compare functional categories in order to get a more accurate impression of the impact of context on functioning.
      Citation: Autism
      PubDate: 2020-08-31T04:38:38Z
      DOI: 10.1177/1362361320950055
       
  • Disparities in autism spectrum disorder diagnoses among 8-year-old
           children in Colorado: Who are we missing'
    • Authors: Trenesha L Hill, Tiffany C White, Bruno J Anthony, Judy Reaven, Bryn Harris, Nuri Reyes, Laura G Anthony
      Abstract: Autism, Ahead of Print.
      There is often a large time gap between caregivers’ initial concerns and the diagnosis of autism spectrum disorder. The current study aimed to identify factors associated with missed or delayed autism spectrum disorder diagnoses among children in Colorado. In a surveillance-based sample of 8-year-old children with autism spectrum disorder (N = 572), we examined differences between children who were identified with autism spectrum disorder by a community provider and/or were eligible for special education services under an autism eligibility (documented diagnosis) and children who were first identified with autism spectrum disorder through a systematic record review (newly identified). Compared to documented diagnosis children, newly identified children were more likely to be female, aggressive, and argumentative. They were less likely to have had a developmental regression, sleep abnormalities, or an autism screener or diagnostic measure in their records. Newly identified children also had a poorer quality of information in their records. Furthermore, among documented diagnosis children, variations in clinical presentations were associated with significantly different mean ages at autism spectrum disorder diagnosis; children who showed early delays, motor abnormalities, hyperactivity and attention deficits, and odd responses to sensory stimuli received a diagnosis much earlier than documented diagnosis children with other clinical presentations.Lay abstractAlthough autism can be reliably diagnosed as early as 2 years of age, many children are not diagnosed with autism until much later. We analyzed data to determine why many of the 8-year-old children who resided in Colorado and were identified as having autism through a review of their health and/or educational records did not have a documented clinical diagnosis of autism and were not eligible for special education services under an autism eligibility. We found that children who did not have a documented clinical diagnosis of autism and were not eligible for special education services under an autism eligibility were more likely to be female, aggressive, and argumentative. They had a poorer quality of information in their records and were less likely to have had a developmental regression, sleep problems, or an autism screener or diagnostic measure in their records. These results suggest that the symptoms characteristic of autism among this group of children may have been attributed to another disorder and that clinicians may be able to recognize autism more readily in children with more functional impairment and those who experience a developmental regression. We also discovered that differences in symptom presentations among children who had a documented clinical diagnosis of autism and/or were eligible for special education services under an autism eligibility were associated with different ages at autism diagnosis.
      Citation: Autism
      PubDate: 2020-08-29T06:34:35Z
      DOI: 10.1177/1362361320950058
       
  • Development and psychometric testing of the AASPIRE Adult Autism
           Healthcare Provider Self-Efficacy Scale
    • Authors: Christina Nicolaidis, Gavin Schnider, Junghee Lee, Dora M Raymaker, Steven K Kapp, Lisa A Croen, Anna Urbanowicz, Joelle Maslak
      Abstract: Autism, Ahead of Print.
      Our objective was to develop a measure of healthcare providers’ self-efficacy in providing healthcare to autistic adults and to better understand their training needs. We used a community-based participatory research approach with academic researchers, autistic adults, supporters, and healthcare providers. We developed a one-page questionnaire which included the new 6-item self-efficacy scale, two items on how challenging and rewarding it is to provide care to autistic adults, and seven items on provider characteristics. We surveyed 143 healthcare providers from eight primary care clinics in Oregon and California, United States. Preliminary psychometric testing found the Academic Autism Spectrum Partnership in Research and Education (AASPIRE) Adult Autism Healthcare Provider Self-Efficacy Scale to have good internal consistency reliability (Cronbach’s alpha 0.87) and consist of a single factor. A priori hypothesis testing found correlations in the expected directions. Only a minority of providers reported high confidence in communicating with patients (25%); performing physical exams or procedures (43%); accurately diagnosing and treating other medical issues (40%); helping patients stay calm and comfortable during visits (38%); identifying accommodation needs (14%); and making necessary accommodations (16%). While providers need training across all aspects of care related to autism in adulthood, interventions should pay particular attention to helping providers communicate with patients and identify and make accommodations.Lay abstractThe adult healthcare system is ill-prepared to provide high-quality care to autistic adults. Lack of provider training may contribute to the problem, but there are few previously tested survey instruments to guide provider training efforts. Our objective was to develop and test a measure of healthcare providers’ confidence (or “self-efficacy”) in providing healthcare to autistic adults and to use it to better understand their training needs. We used a community-based participatory research (CBPR) approach, in partnership with academic researchers, autistic adults, supporters, and healthcare providers, throughout the project. We developed a one-page questionnaire and surveyed 143 primary care providers from eight primary care clinics in Oregon and California, United States. Preliminary testing of the AASPIRE Adult Autism Healthcare Provider Self-Efficacy Scale suggests that the measure is reliable and valid. Using this scale, we found only a minority of providers reported high confidence in communicating with patients (25%); performing physical exams or procedures (43%); accurately diagnosing and treating other medical issues (40%); helping patients stay calm and comfortable during visits (38%); identifying accommodation needs (14%); and making necessary accommodations (16%). While providers need training across all aspects of care related to autism in adulthood, interventions should pay particular attention to helping providers communicate with patients, and identify and make necessary accommodations. Future research is needed to further validate this scale and to understand how to meet providers’ training needs most effectively.
      Citation: Autism
      PubDate: 2020-08-29T06:33:35Z
      DOI: 10.1177/1362361320949734
       
  • Improving visual perspective-taking performance in children with autism
           spectrum conditions: Effects of embodied self-rotation and object-based
           mental rotation strategies
    • Authors: Pingping Ni, Lingfeng Xue, Jiajing Cai, Minjie Wen, Jie He
      Abstract: Autism, Ahead of Print.
      Visual perspective-taking is the ability to perceive the world from another person’s perspective, and research on visual perspective-taking ability in children with autism spectrum conditions yielded inconsistent results. To solve a visual perspective-taking task, people can mentally rotate themselves to another person’s location (embodied self-rotation strategy) or else rotate the object toward themselves (object-based mental rotation strategy). Previous interventions for autistic individuals have mainly focused on embodied self-rotation strategy, the visual perspective-taking mechanism in neurotypicals. This study examined the effects of both embodied self-rotation and object-based mental rotation strategies in improving visual perspective-taking performance in 34 autistic children and 34 ability-matched neurotypical children. All children completed three tasks: one measuring baseline visual perspective-taking performance, while the other two measuring visual perspective-taking performance after instructions in embodied self-rotation and object-based mental rotation strategies. The results indicated that autistic children had difficulty in baseline visual perspective-taking tasks. After a brief strategy learning period, autistic children benefited similarly from both embodied self-rotation and object-based mental rotation instructions, suggesting that there are various possible ways to improving autistic children’s perspective taking, and that further interventions for autistic children could consider combining different strategies that better suit their autistic traits.Lay abstractWhen answering how the same object might appear to others in different locations, people can provide answers by mentally putting themselves into another person’s location using the embodied self-rotation strategy or by rotating the target object toward themselves using the object-based mental rotation strategy. In this study, after learning the embodied self-rotation or object-based mental rotation strategies, autistic children improved their visual perspective-taking performance, which is believed to be impaired or delayed in autistic individuals. We recruited 34 autistic children and an equal number of ability-matched typical children and examined their visual perspective-taking performance at baseline and after learning the embodied self-rotation and object-based mental rotation strategies. As previous visual perspective-taking and other social cognition interventions for autistic individuals have primarily focused on the embodied self-rotation strategy, showing moderate effectiveness and limited generalizability, we explored the effects of both embodied self-rotation and object-based mental rotation strategies for improving perspective-taking performance and discussed their implications in this study. The results showed that autistic children had a lower performance at baseline compared with typical children; however, they were still sensitive to both embodied self-rotation and object-based mental rotation strategies. Unlike typical children, who gained more from the embodied self-rotation strategy, autistic children benefited similarly from the two strategies. This suggests that there are multiple ways to helping autistic children overcome their difficulty in perspective-taking tasks. Future interventions for autistic children could consider combining various strategies that better suit their autistic traits.
      Citation: Autism
      PubDate: 2020-08-28T06:08:21Z
      DOI: 10.1177/1362361320949352
       
  • Effects of being watched on eye gaze and facial displays of typical and
           autistic individuals during conversation
    • Authors: Roser Cañigueral, Jamie A Ward, Antonia F de C Hamilton
      Abstract: Autism, Ahead of Print.
      Communication with others relies on coordinated exchanges of social signals, such as eye gaze and facial displays. However, this can only happen when partners are able to see each other. Although previous studies report that autistic individuals have difficulties in planning eye gaze and making facial displays during conversation, evidence from real-life dyadic tasks is scarce and mixed. Across two studies, here we investigate how eye gaze and facial displays of typical and high-functioning autistic individuals are modulated by the belief in being seen and potential to show true gaze direction. Participants were recorded with an eye-tracking and video-camera system while they completed a structured Q&A task with a confederate under three social contexts: pre-recorded video, video-call and face-to-face. Typical participants gazed less to the confederate and produced more facial displays when they were being watched and when they were speaking. Contrary to our hypotheses, eye gaze and facial motion patterns in autistic participants were overall similar to the typical group. This suggests that high-functioning autistic participants are able to use eye gaze and facial displays as social signals. Future studies will need to investigate to what extent this reflects spontaneous behaviour or the use of compensation strategies.Lay abstractWhen we are communicating with other people, we exchange a variety of social signals through eye gaze and facial expressions. However, coordinated exchanges of these social signals can only happen when people involved in the interaction are able to see each other. Although previous studies report that autistic individuals have difficulties in using eye gaze and facial expressions during social interactions, evidence from tasks that involve real face-to-face conversations is scarce and mixed. Here, we investigate how eye gaze and facial expressions of typical and high-functioning autistic individuals are modulated by the belief in being seen by another person, and by being in a face-to-face interaction. Participants were recorded with an eye-tracking and video-camera system while they completed a structured Q&A task with a confederate under three social contexts: pre-recorded video (no belief in being seen, no face-to-face), video-call (belief in being seen, no face-to-face) and face-to-face (belief in being seen and face-to-face). Typical participants gazed less to the confederate and made more facial expressions when they were being watched and when they were speaking. Contrary to our hypotheses, eye gaze and facial expression patterns in autistic participants were overall similar to the typical group. This suggests that high-functioning autistic participants are able to use eye gaze and facial expressions as social signals. Future studies will need to investigate to what extent this reflects spontaneous behaviour or the use of compensation strategies.
      Citation: Autism
      PubDate: 2020-08-28T06:08:10Z
      DOI: 10.1177/1362361320951691
       
  • ‘I’m not just a guinea pig’: Academic and community perceptions of
           participatory autism research
    • Authors: Jacquiline den Houting, Julianne Higgins, Kathy Isaacs, Joanne Mahony, Elizabeth Pellicano
      Abstract: Autism, Ahead of Print.
      Despite calls for increased community engagement in autism research, the published evidence base suggests that participatory autism research remains rare. This study examined the extent and nature of community engagement in Australian research projects commissioned by the Autism CRC. Data were gathered using an online survey, comprising quantitative scale items and qualitative free-text responses, which was completed by 64 academic partners and 15 community partners. Quantitative findings indicated that autism research stakeholders in Australia are largely supportive of community engagement in research and have had positive experiences of participatory research. These findings were not wholly corroborated by the qualitative findings, however, which suggested that participants lacked understanding of participatory research, and held attitudes that may hinder the conduct of successful participatory research. Systemic issues within research settings were also perceived to impede community engagement in research. Both academic and community partners would benefit from better understanding of participatory research approaches, paired with practical and epistemological shifts at the systemic level, to ensure that future community engagement in autism research is respectful, equitable and beneficial to all stakeholders.Lay abstractParticipatory research means working together (engaging) with the community that is affected by research to make decisions about that research. Participatory research is common in some fields, but it is still rare in autism research. In this study, we wanted to find out how Australian autism researchers and community members feel about participatory research. We worked with an Autistic Advisory Group to design this study, understand the results and write this article. We asked 127 people, all working on research from the Cooperative Research Centre for Living with Autism, to complete an online survey about participatory research. The survey included some questions that were answered on rating scales, and some where participants wrote their own answers. Seventy-nine people (64 researchers and 15 community members) completed most or all of the survey. The rating scales showed that most participants (82%) supported moderate or extensive community engagement in research, and most participants (72%) thought there should be more community engagement in autism research. In general, the participants rated their experiences of participatory research positively. Using the participants’ own written answers, we found four main ideas: (1) participatory research is important, but difficult; (2) many people do not fully understand what participatory research is; (3) academics and community members do not work together as = and (4) research systems are not designed for participatory research. Our results suggest that autism researchers and community members want to do more participatory research, but they might need training, support and funding to do participatory research well.
      Citation: Autism
      PubDate: 2020-08-28T06:08:01Z
      DOI: 10.1177/1362361320951696
       
  • Construct validity of the First-Year Inventory (FYI Version 2.0) in
           12-month-olds at high-risk for Autism Spectrum Disorder
    • Authors: Helen Y Lee, Cheryl Vigen, Lonnie Zwaigenbaum, Isabel M Smith, Jessica Brian, Linda R. Watson, Elizabeth R. Crais, Grace T Baranek
      Abstract: Autism, Ahead of Print.
      This study examines the construct validity of the First-Year Inventory 2.0 with respect to other established instruments in a sample of high-risk infant siblings of children with Autism Spectrum Disorder. The First-Year Inventory 2.0 is a parent-report screening instrument designed to identify 12-month-old infants at risk for an eventual diagnosis of Autism Spectrum Disorder and consists of two domains: Social-Communication and Sensory-Regulatory. Although the First-Year Inventory 2.0’s screening psychometrics have been examined, its construct validity has not been investigated. In a sample of 112 high-risk 12-month-olds, we examined the First-Year Inventory 2.0’s associations with the Autism Observation Scale for Infants, an observer-based Autism Spectrum Disorder screener, and with other developmental instruments measuring similar areas in social communication and regulatory functioning in young children. Findings generally supported the First-Year Inventory 2.0 associations with other instruments in expected ways. The First-Year Inventory 2.0 Social-Communication domain was notably associated with the Autism Observation Scale for Infant’s total score and with language and communication domains of the Vineland and the Mullen. The Sensory-Regulatory domain showed minimal associations with other instruments that only had a few sensory items. Considering different objectives and strengths of assessments, researchers and clinicians are encouraged to utilize a variety of instruments in a comprehensive evaluation of a child.Lay abstractThe First-Year Inventory 2.0 is a parent-report screening instrument designed to identify 12-month-old infants at risk for an eventual diagnosis of Autism Spectrum Disorder. This instrument focuses on Social-Communication and Sensory-Regulatory areas of infant behavior. Although the First-Year Inventory 2.0 screening performance has been previously studied, its validity has not been examined. Establishing validity of an instrument is important because it supports the effectiveness and the reliability of the instrument. In this study, we examined relationship between the First-Year Inventory 2.0 (Social-Communication and Sensory-Regulatory areas) and other instruments that measure similar areas of infant behavior in a sample of high-risk infant siblings of children with Autism Spectrum Disorder. These other instruments share some common aims and theoretical areas with the First-Year Inventory 2.0: the Autism Observation Scale for Infants, the Mullen Scales of Early Learning, the Vineland Adaptive Behavior Scales-II, and the Infant Behavior Questionnaire. Findings generally supported the validity of the First-Year Inventory 2.0 with other instruments. In particular, the Social-Communication area of the First-Year Inventory 2.0 showed greater commonality with other instruments than in the Sensory-Regulatory area. The Sensory-Regulatory area seemed to be a unique feature of the First-Year Inventory 2.0 instrument. Considering different aims and strengths of assessments, researchers and clinicians are encouraged to utilize a variety of instruments in a comprehensive evaluation of a child.
      Citation: Autism
      PubDate: 2020-08-27T07:48:23Z
      DOI: 10.1177/1362361320947325
       
  • Eye contact perception in high-functioning adults with autism spectrum
           disorder
    • Authors: Shota Uono, Sayaka Yoshimura, Motomi Toichi
      Abstract: Autism, Ahead of Print.
      The present study investigated how the eye contact perception of ingroup and outgroup faces by Japanese adults with high-functioning autism spectrum disorder differed from that of age-, sex-, and IQ-matched typically developing individuals. The autism spectrum disorder and typically developing individuals were equally likely to perceive subtly averted gazes as self-directed gazes. In both groups, the frequency with which self-directed gazes were perceived decreased as gaze aversion increased. In general, individuals with autism spectrum disorder were equally capable of perceiving a self-directed gaze as typically developing individuals. However, typically developing individuals, but not individuals with autism spectrum disorder, were more likely to perceive self-directed gazes from ingroup faces than from outgroup faces. Stimuli ratings revealed that individuals with autism spectrum disorder, but not those with typically developing, gave higher warmth ratings to ingroup faces with averted gazes and outgroup faces with direct gazes compared to other types of face stimuli, suggesting atypical affective experiences in response to ingroup and outgroup faces in autism spectrum disorder. These results suggest that individuals with autism spectrum disorder did not show an ingroup bias for the perception of a self-directed gaze, and raise the possibility that an atypical emotional experience contributes to the diminished ingroup bias for the perception of a self-directed gaze.Lay abstractThe detection of a self-directed gaze is often the starting point for social interactions and a person who feels as if they are being watched can prepare to respond to others’ actions irrespective of the real gaze direction because the other person may likely be motivated to approach. Although many studies demonstrated that individuals with autism spectrum disorder have difficulty discriminating gaze direction, it remains unclear how the perception of self-directed gaze by individuals with autism spectrum disorder differs from that of age-, sex-, and IQ-matched typically developing individuals. Participants observed faces with various gaze directions and answered whether the person in the photograph was looking at them or not. Individuals with and without autism spectrum disorder were just as likely to perceive subtle averted gazes as self-directed gazes. The frequency of perceiving a self-directed gaze decreased as gaze aversion increased in both groups and, in general, individuals with autism spectrum disorder showed a comparable ability to perceive a self-directed gaze as that of typically developing individuals. Interestingly, considering face membership of photographs (ingroup or outgroup faces), typically developing individuals, but not individuals with autism spectrum disorder, were more likely to perceive self-directed gazes from ingroup faces than from outgroup faces. However, individuals with autism spectrum disorder had different affective experiences in response to ingroup and outgroup faces. These results suggest that individuals with autism spectrum disorder did not show an ingroup bias for the perception of a self-directed gaze, and raise a possibility that an atypical emotional experience contributes to the diminished ingroup bias.
      Citation: Autism
      PubDate: 2020-08-27T07:48:09Z
      DOI: 10.1177/1362361320949721
       
  • Knowing me, knowing you: Spontaneous use of mentalistic language for self
           and other in autism
    • Authors: Alexandra Zinck, Uta Frith, Peter Schönknecht, Sarah White
      Abstract: Autism, Ahead of Print.
      Recent studies on mentalizing have shown that autistic individuals who pass explicit mentalizing tasks may still have difficulties with implicit mentalizing tasks. This study explores implicit mentalizing by examining spontaneous speech that is likely to contain mentalistic expressions. The spontaneous production of meta-statements provides a clear measure for implicit mentalizing that is unlikely to be learned through experience. We examined the self- and other-descriptions of highly verbally able autistic and non-autistic adults in terms of their spontaneous use of mentalistic language and meta-representational utterances through quantitative and qualitative analysis. We devised a hierarchical coding system that allowed us to study the types of statements produced in comparable conditions for the self and for a familiar other. The descriptions of autistic participants revealed less mentalistic content relating to psychological traits and meta-statements. References to physical traits were similar between groups. Within each group, participants produced a similar pattern of types of mental utterance across ‘self’ and ‘other’ conditions. This suggests that autistic individuals show a unique pattern of mental-state-representation for both self and other. Meta-statements add a degree of complexity to self- and other-descriptions and to the understanding of mental states; their reduction in autism provides evidence for implicit mentalizing difficulties.Lay abstractAutistic people can have difficulties in understanding non-autistic people’s mental states such as beliefs, emotions and intentions. Although autistic adults may learn to overcome difficulties in understanding of explicit (overt) mental states, they may nevertheless struggle with implicit (indirect) understanding of mental states. This study explores how spontaneous language is used in order to specifically point to this implicit (indirect) understanding of mental states. In particular, our study compares the spontaneous statements that were used in descriptions of oneself and a familiar other person. Here, we found that autistic and non-autistic adults were comparable in the number of statements about physical traits they made. In contrast, non-autistic adults made more statements about mentalistic traits (about the mental including psychological traits, relationship traits and statements reflecting about these) both for the self and the other. Non-autistic and autistic adults showed no difference in the number of statements about relationships but in the number of statements about psychological traits and especially in the statements reflecting on these. Each group showed a similar pattern of kinds of statements for the self and for the other person. This suggests that autistic individuals show the same unique pattern of description in mentalistic terms for the self and another person. This study also indicates that investigating spontaneous use of language, especially for statements reflecting about mental states, enables us to look into difficulties with implicit (indirect) understanding of mental states.
      Citation: Autism
      PubDate: 2020-08-27T07:47:50Z
      DOI: 10.1177/1362361320951017
       
  • Assessment of Sesame Street online autism resources: Impacts on parental
           implicit and explicit attitudes toward children with autism
    • Authors: Cheryl L Dickter, Joshua A Burk, Laura Gutermuth Anthony, Hillary A Robertson, Alyssa Verbalis, Sydney Seese, Yetta Myrick, Bruno J Anthony
      Abstract: Autism, Ahead of Print.
      The current study sought to characterize implicit bias toward children with autism and examine whether viewing educational materials about autism would change attitudes toward children with autism. A website developed by Sesame Street containing information about autism and resources for families was distributed to parents of children with autism (n = 473) and parents of children without autism (n = 707). Pre- and post-test measures of implicit bias toward children with autism; explicit attitudes and knowledge about autism; and parenting confidence, strain, and stigma were completed before and after the website was presented. Results indicated that parents of children with autism showed less implicit bias compared with those of non-autistic children during the pre-test, but the groups did not differ at the post-test. Parents without autistic children and those with more negative explicit attitudes showed a greater reduction in implicit bias from the pre- to the post-test. In addition, for parents of children with autism, a more positive change in explicit attitudes and increased knowledge from the pre- to the post-test was associated with more empowerment at the post-test. Together, our findings suggest that the online educational resources can reduce implicit bias against children with autism and help mitigate some of the psychological issues associated with parenting children with autism.
      Citation: Autism
      PubDate: 2020-08-26T05:45:54Z
      DOI: 10.1177/1362361320949346
       
  • Telehealth cognitive behavioral therapy for insomnia in children with
           autism spectrum disorder: A pilot examining feasibility, satisfaction, and
           preliminary findings
    • Authors: Christina S McCrae, Wai Sze Chan, Ashley F Curtis, Neetu Nair, Chelsea B Deroche, Melissa Munoz, Stephanie Takamatsu, Deija McLean, Mattina Davenport, Julie E Muckerman, Nicole Takahashi, Dillon McCann, Kevin McGovney, Pradeep Sahota, Micah O Mazurek
      Abstract: Autism, Ahead of Print.
      Insomnia is common in children with autism. Cognitive behavioral treatment for childhood insomnia may improve sleep and functioning in children with autism and their parents, but delivery involving multiple office visits limits accessibility. This single-arm pilot study tested telehealth delivery of eight-session cognitive behavioral treatment for childhood insomnia in 17 children (6–12 years) with autism spectrum disorder and insomnia and their parent(s). Treatment integrity was assessed each session (delivery, by therapist; receipt, participant understanding; and enactment, home practice). Treatment satisfaction was assessed after treatment. Children and parents wore actigraphs and completed electronic diaries for 2 weeks, children completed 5-min Holter Monitoring (assessed heart rate variability, physiological arousal indicator), and parents completed Aberrant Behavior Checklist before and after 1 month. Average integrity scores were high (98%, delivery; 93%, receipt; and 82%, enactment). Parents found cognitive behavioral treatment for childhood insomnia helpful, age-appropriate, and autism-friendly. Paired-samples t-tests (family-wise error controlled) indicated telehealth cognitive behavioral treatment for childhood insomnia improved child and parent sleep (objective and subjective) and functioning (child—decreased irritability, lethargy, stereotypy, hyperactivity; parent—decreased fatigue). At 1 month, inappropriate speech also decreased, but hyperactivity was no longer decreased. Other gains were maintained. Most children demonstrated reduced arousal following treatment. This pilot shows telehealth cognitive behavioral treatment for childhood insomnia is feasible and may improve child and parent sleep, child behavior and arousal, and parent fatigue. A randomized controlled trial of telehealth cognitive behavioral treatment for childhood insomnia for children with autism is needed.Lay abstractInsomnia is common in children with autism. Cognitive behavioral treatment for childhood insomnia (CBT-CI) may improve sleep and functioning in children with autism and their parents, but typical delivery involving multiple office visits can make it difficult for some children to get this treatment. This pilot study tested telehealth delivery of CBT-CI using computers, which allowed children and their parents to get the treatment at home. This pilot shows therapists that parents and children were able to use telehealth CBT-CI to improve child and parent sleep, child behavior and arousal, and parent fatigue. Parents found telehealth CBT-CI helpful, age-appropriate, and autism-friendly. Telehealth CBT-CI holds promise for treating insomnia in school-aged children with autism and deserves further testing.
      Citation: Autism
      PubDate: 2020-08-25T08:32:46Z
      DOI: 10.1177/1362361320949078
       
  • Production and comprehension of pronouns in individuals with autism: A
           meta-analysis and systematic review
    • Authors: Elizabeth G Finnegan, Kristie Asaro-Saddler, Matthew C Zajic
      Abstract: Autism, Ahead of Print.
      This study compared pronoun use in individuals with autism to their typically developing peers via meta-analysis and systematic review of 20 selected articles to examine differences in overall pronoun usage as well as in personal, ambiguous, possessive, reflexive, and clitic pronoun usage. Summary effects indicated significant differences between individuals with autism and their typically developing peers in the use of pronouns overall as well as in ambiguous, clitic, and reflexive pronoun usage, but not in personal and possessive pronoun usage. Results indicate wide variation in the way individuals with autism use pronouns, and individual outcomes appeared to be moderated by multiple factors, including cognitive ability, first language, and overall language development. Implications and recommendations for assessment and intervention practices are discussed.Lay abstractThis research compared pronoun use in individuals with autism and typically developing peers. Meta-analysis and systematic review of 20 selected articles were used to determine whether significant differences existed in the use of pronouns overall as well as in personal, ambiguous, possessive, reflexive, and clitic pronoun usage. Summary effects indicated significant differences between individuals with autism and their typically developing peers in the use of pronouns overall as well as in ambiguous, clitic, and reflexive pronoun usage, but not in personal and possessive pronoun usage. Results indicate wide variation in the way individuals with autism use pronouns. Since individual outcomes appear to be moderated by multiple factors, including cognitive ability, first language, and overall language development, it is recommended these be considered in assessment and treatment.
      Citation: Autism
      PubDate: 2020-08-25T08:27:43Z
      DOI: 10.1177/1362361320949103
       
  • Mortality in 787,666 school pupils with and without autism: A cohort study
    • Authors: Gillian S Smith, Michael Fleming, Deborah Kinnear, Angela Henderson, Jill P Pell, Craig Melville, Sally-Ann Cooper
      Abstract: Autism, Ahead of Print.
      Studies on children and adults combined suggest higher mortality rates for autistic than other people, but few report mortality rates for autistic children. In addition, past studies may not be representative of the current generation of children diagnosed with autism. We examined mortality in children using data from Scotland’s annual pupil census, linked to National Records of Scotland deaths register, between 2008 and 2015. In total, 9754 (1.2%) of 787,666 pupils had autism. They were more likely to live in neighbourhoods of greater deprivation and receive free school meals. Six autistic pupils died; crude mortality rate 15.8/100,000 person-years (95% CI = 7.1–35.1), compared with 458 other pupils; crude mortality rate 12.5/100,000 person-years (95% CI = 11.4–13.7). The indirectly standardised mortality ratio was 1.1 (95% CI = 0.5–2.5). In the autistic pupils, the most common causes of death were nervous system diseases, for example, epilepsy. Avoidable causes were common. In the comparison group, external causes and cancers were the most common causes of death. We cautiously conclude that mortality in the current generation of autistic children is no higher than for other children, perhaps due to recent widening of criteria for autism spectrum diagnosis, but some deaths could have been avoided by better care.Lay abstractThere are few studies on the deaths of children and young people with autism; some studies on children and adults combined suggest that those with autism may have higher death rates than other people. More children are diagnosed with autism than in the past, suggesting that there are now more children with milder autism who have the diagnosis than in the past, so studies in the past might not apply to the current generation of children and young people diagnosed with autism. We examined the rates of death in children and young people in Scotland using recorded information in Scotland’s annual pupil census, linked to the National Records of Scotland deaths register, between 2008 and 2015. In total, 9754 (1.2%) out of 787,666 pupils had autism. Six pupils with autism died in the study period, compared with 458 other pupils. This was equivalent to 16 per 100,000 for pupils with autism and 13 per 100,000 pupils without autism; hence, the rate of death was very similar. In the pupils with autism, the most common causes of death were diseases of the nervous system, whereas they were from external causes in the comparison pupils. The autism group had some deaths due to epilepsy which might have been prevented by good quality care. We cautiously conclude that the death rate in the current generation of children and young adults with autism is no higher than for other children, but that even in this high-income country, some deaths could be prevented by high quality care.
      Citation: Autism
      PubDate: 2020-08-24T08:31:49Z
      DOI: 10.1177/1362361320944037
       
  • For which younger siblings of children with autism spectrum disorder does
           parent-mediated intervention work'
    • Authors: Paul J Yoder, Wendy L Stone, Sarah R Edmunds
      Abstract: Autism, Ahead of Print.
      In this second of two primary papers, we examined moderators of treatment effects for younger siblings of children with autism spectrum disorders whose parents were taught to use a parent-implemented intervention called “Improving Parents As Communication Teachers”. Investigators randomized 97 high-risk siblings and their primary parent to either the Improving Parents As Communication Teachers or control group, used intent-to-treat analysis, and used assessors and coders who were blinded to group assignment. We hypothesized that a cumulative risk score (incorporating younger siblings’ sex, multiplex status, and behavioral risk) would moderate the effect of Improving Parents As Communication Teachers on younger siblings’ proximal skills related to their continuously measured communication challenges. Pre-intervention level of parents’ depressive symptoms was the proposed moderator of Improving Parents As Communication Teachers on parenting-related stress and parenting efficacy. In high-risk siblings with no additional risk factors (i.e. girls with only one older sibling with autism spectrum disorder and who score at low risk on an autism spectrum disorder screen), parental receipt of Improving Parents As Communication Teachers training had indirect effects on children’s expressive language ability or autism spectrum disorder diagnosis through earlier effects on high-risk siblings’ intentional communication or expressive vocabulary. “Improving Parents As Communication Teachers” intervention did not show moderated or total effects on parenting-related stress or parenting efficacy.Lay AbstractIn this second of two primary papers, we examined two pre-intervention characteristics that might describe for whom a parent-implemented intervention, “Improving Parents As Communication Teachers,” worked. Investigators randomized 97 high-risk siblings and their primary parent to either the Improving Parents As Communication Teachers or control group, used intent-to-treat analysis, and used assessors and coders who were blinded to group assignment. We predicted that a combined risk score (incorporating young siblings’ sex, multiplex status, and behavioral risk) would describe the subgroup for whom Improving Parents As Communication Teachers affected the targeted skills related to reducing communication challenges. We also predicted that pre-intervention level of parents’ depressive symptoms would describe the parents whose parenting stress and effectiveness as parents would be improved by learning to use Improving Parents As Communication Teachers. In girls with only one older sibling with autism spectrum disorder and who scored at low risk on an autism spectrum disorder screen, parental receipt of Improving Parents As Communication Teachers training had an indirect effect on children’s expressive language ability or autism spectrum disorder diagnosis through earlier effects on high-risk siblings’ intentional communication or expressive vocabulary. We did not confirm our prediction regarding Improving Parents As Communication Teachers’ effect on parenting-related stress or sense of parenting effectiveness.
      Citation: Autism
      PubDate: 2020-08-19T04:26:39Z
      DOI: 10.1177/1362361320943373
       
  • Parent utilization of ImPACT intervention strategies is a mediator of
           proximal then distal social communication outcomes in younger siblings of
           children with ASD
    • Authors: Paul J Yoder, Wendy L Stone, Sarah R Edmunds
      Abstract: Autism, Ahead of Print.
      Younger siblings of children with autism spectrum disorders (HR-Sibs) are at elevated risk for social communication deficits and language delays. One way to mitigate this risk early, before these deficits and delays become clear or impairing, may be to equip parents to use the strategies taught through the Improving Parents as Communication Teachers (ImPACT) intervention. In this randomized control trial, 97 HR-Sibs (mean age 14 months) and their primary caregiver were randomized to either ImPACT or a business-as-usual control group. Our a priori, preregistered hypothesis was that parents’ participation in ImPACT training would indirectly attenuate younger siblings’ social communication challenges 9 months later by sequentially increasing parents’ use of ImPACT strategies immediately after the intervention phase and by improving children’s midpoint proximal skills (e.g. motor imitation or intentional communication). Results supported this prediction.Lay abstractLater born siblings of children with autism spectrum disorders (ASD) are at elevated risk for language delay or ASD. One way to manage this risk may be for parents to use techniques taught in Improving Parents as Communication Teachers (ImPACT) with the younger siblings during the period in which language delay and ASD may be too subtle to be diagnosed. ImPACT targets children’s play, imitation, and communication skills. Improvement in these skills may reduce the severity of language delays and social communication deficits associated with ASD. In this study, 97 younger siblings of children with ASD and their primary parents were randomly assigned to ImPACT or a control group. We measured whether parents used ImPACT teaching strategies and whether children used the skills that ImPACT targets. We also measured children’s later language ability and social communication skills. The results confirmed our predictions that parents’ use of ImPACT strategies improves language ability by improving children’s motor imitation and communication skills. Use of ImPACT also had a positive effect on children’s language delay and ASD symptoms, supporting the clinical value of the findings. The study’s methodological strengths make this one of the most rigorous tests of ImPACT and supports one way to manage the risk of language delay and ASD in younger siblings of children with ASD.
      Citation: Autism
      PubDate: 2020-08-19T04:26:24Z
      DOI: 10.1177/1362361320946883
       
  • Timing of diagnosis, depression and self-harm in adolescents with autism
           spectrum disorder
    • Authors: Mariko Hosozawa, Amanda Sacker, Noriko Cable
      Abstract: Autism, Ahead of Print.
      This exploratory study aimed to explore the association between depression and self-harming behaviour in adolescence and the timing of diagnosis for autism spectrum disorder. We analysed data on 11,320 14 year olds, including 396 children with autism spectrum disorder, from the UK Millennium Cohort Study. Exposures were the timing of diagnosis for autism spectrum disorder confirmed by parental report at ages 5, 7, 11 and 14. Outcomes were depression measured by the Short Mood and Feelings Questionnaire (scores ⩾12) and self-report of self-harming behaviour, both assessed at age 14. Data were analysed using multivariable regression analysis. 91% of the autism spectrum disorder group had within-typical-range cognitive ability. After adjusting for child and family confounders, there was a positive linear trend between diagnostic age and depression, with children diagnosed between ages 7 and 11 and children diagnosed after age 11 showing increased symptoms (odds ratio = 2.21 and 3.58, respectively). A similar trend was observed for self-harming behaviour, with children diagnosed after age 11 showing the strongest association (odds ratio = 3.16). These results suggest the importance of earlier diagnosis in preventing secondary mental health problems in this population, particularly among those without cognitive delays. Further studies replicating across a wider intellectual spectrum and clarifying the underlying mechanism are warranted.Lay AbstractChildren with autism spectrum disorder are at increased risk of depression and self-harming behaviours. The question of whether timing of diagnosis of autism spectrum disorder is associated with these consequences in adolescence has not yet been studied. This exploratory study aimed to explore the association between depression and self-harming behaviour in adolescence and the parent-reported timing of diagnosis for autism spectrum disorder using a large population-based cohort in the United Kingdom. Most of the children with autism spectrum disorder in our study had within-typical-range cognitive ability. We found a linear association between timing of autism spectrum disorder diagnosis and depression and self-harming behaviour in adolescence; later diagnosis of autism spectrum disorder, particularly diagnosis in adolescence, was associated with the increased risk of self-reported depressive symptoms and self-harming behaviour in adolescence among children with autism spectrum disorder. Our findings, albeit observational, suggest that interventions targeting the earlier diagnosis of autism spectrum disorder and approaches to improve person–environment fit may help prevent secondary mental health problems in this population, particularly among those without cognitive delays and those diagnosed late. Further studies replicating across a wider intellectual spectrum and clarifying the underlying mechanism are warranted.
      Citation: Autism
      PubDate: 2020-08-08T09:03:55Z
      DOI: 10.1177/1362361320945540
       
  • Epilepsy in adulthood: Prevalence, incidence, and associated antiepileptic
           drug use in autistic adults in a state Medicaid system
    • Authors: Lauren Bishop, Kiley J McLean, Eric Rubenstein
      Abstract: Autism, Ahead of Print.
      Although epilepsy commonly presents with autism in children, it is currently unknown whether established estimates represent the prevalence and incidence of epilepsy in autistic adults. Our objective was to use population-level Medicaid data to determine prevalence, incidence, and antiepileptic drug use associated with epilepsy in a unique population of autistic adults aged 21+ with (N = 2738) and without (N = 4775) intellectual disability and to compare results to adults with intellectual disability alone (N = 18,429). We found that 34.6% of autistic adults with intellectual disability and 11.1% of autistic adults without intellectual disability had epilepsy, compared to 27.0% of adults with intellectual disability alone. New incidence of epilepsy was 23.6 incident cases per 1000 person years (95% confidence interval: 21.3, 26.2) in autistic adults with intellectual disability, 7.7 incident cases per 1000 person years (95% confidence interval: 6.6, 8.9) in autistic adults without intellectual disability, and 15.9 incident cases per 1000 person years (95% confidence interval: 15.2, 16.7) in adults with intellectual disability alone. Female sex and intellectual disability were associated with increased risk of prevalent and incident epilepsy in autistic adults. Findings underscore the importance of treating prevalent epilepsy and screening and preventing incident epilepsy in autistic adults as they age.Lay abstractEpilepsy is more common in autistic children compared to children without autism, but we do not have good estimates of how many autistic adults have epilepsy. We used data from a full population of 7513 autistic adults who received Medicaid in Wisconsin to figure out the proportion of autistic adults who have epilepsy, as compared to 18,429 adults with intellectual disability. We also wanted to assess how often epilepsy is first diagnosed in adulthood. Finally, we wanted to see whether antiepileptic drugs are being used to treat epilepsy in autistic adults. We found that 34.6% of autistic adults with intellectual disability and 11.1% of autistic adults without intellectual disability had epilepsy, compared to 27.0% of adults with intellectual disability alone. Autistic women and autistic adults with intellectual disability were more likely than autistic men and autistic adults without intellectual disability to have both previous and new diagnoses of epilepsy. Finally, we found that antiepileptic medications are commonly prescribed to autistic people who do not have epilepsy potentially to treat mental health conditions or behavior problems, and that antiepileptic medications are not always prescribed to autistic people with epilepsy even though they are indicated as a first-line epilepsy treatment. The findings of this study highlight the need to effectively treat and prevent epilepsy in autistic adults.
      Citation: Autism
      PubDate: 2020-08-06T04:51:44Z
      DOI: 10.1177/1362361320942982
       
  • Parent-identified strengths of autistic youth
    • Authors: Nick Warren, Bridges Eatchel, Anne V Kirby, Marissa Diener, Cheryl Wright, Valerie D’Astous
      Abstract: Autism, Ahead of Print.
      There is a need for strengths-based intervention approaches for autistic youth during the transition to adulthood. In the current study, we explored parent perspectives about youth strengths during adolescence. We combined data from three studies which included semi-structured interviews about parents’ perspectives on preparing for adulthood with autistic youth. Total participants included 39 parents of 41 autistic youth (ages 12–19 years, 88% male). Parents of autistic youth described many strengths of their children in the context of conversations about the transition to adulthood. Thematic analysis revealed three subthemes under the broad theme of parental perceptions of strengths: diverse strengths and skills, strengths counterbalanced by challenges, and strengths with supports. Diverse strengths and skills were further categorized using content analysis and included intelligence, creativity, physical abilities, and self-care skills, which notably include some areas often perceived as weaknesses for autistic people. The findings demonstrate that parents are an important source of information about youth strengths during transition planning processes. Understanding the types of strengths that parents observe in their autistic sons and daughters can help inform the development of strengths-based interventions capable of supporting the transition to adulthood.Lay abstractAutism is a condition frequently characterized by social and communication challenges. Because most research focuses on understanding and reducing challenges, less is known about the strengths of autistic individuals. This is especially true of those who are transitioning into adulthood. We designed this research study to provide information about how parents perceive the strengths of their autistic adolescent children prior to the transition. We reviewed 39 parent interviews from previous research about how they prepare their autistic sons and daughters for adulthood. Without prompting, parents identified many strengths of their autistic children. Diverse strengths and skills they identified included intelligence, creativity, physical abilities, and self-care skills. These strengths are interesting, as they cover traits that are often thought of as areas of difficulty for autistic youth. However, parents also talked about strengths alongside challenges, and how specific supports would be needed to help their sons and daughters fully realize their strengths. These findings are important, as they help us know more about the strengths of autistic youth and how strengths can be supported when preparing for adulthood. Our findings also help reveal strengths that are particularly apparent during the transition to adulthood.
      Citation: Autism
      PubDate: 2020-08-06T04:51:44Z
      DOI: 10.1177/1362361320945556
       
  • Increased emotional eating behaviors in children with autism: Sex
           differences and links with dietary variety
    • Authors: Gregory L Wallace, Emily Richard, Alexandra Wolff, Monica Nadeau, Nancy Zucker
      Abstract: Autism, Ahead of Print.
      Although food selectivity and so-called “picky” eating are well documented in autism spectrum disorder, emotion-linked eating has rarely been investigated. This study examined emotion-linked over- and under-eating based on parent ratings of these behaviors in 4- to 17-year-old children with autism spectrum disorder (n = 190) as compared to same-age typically developing children (n = 119). Children with autism spectrum disorder were rated as exhibiting both more emotional over-eating and more emotional under-eating behaviors than their typically developing peers. Furthermore, while sex differences in these emotional eating behaviors were not observed in the typically developing children, girls with autism spectrum disorder were rated as experiencing more emotional over-eating behaviors than boys with autism spectrum disorder. Finally, among all children with autism spectrum disorder, emotional over-eating was linked with increased consumption of sweet foods and decreased consumption of vegetables. These findings have implications for better understanding eating habits in children with autism spectrum disorder and suggest that emotional eating behaviors might have both immediate and downstream health impacts.Lay abstractAlthough “picky” eating is well documented in autism spectrum disorder, emotional eating has rarely been investigated. This study examined emotional over- and under-eating based on parent ratings of these behaviors in 4- to 17-year-old children with autism spectrum disorder (n = 190) as compared to same-age typically developing children (n = 119). Children with autism spectrum disorder were rated as exhibiting both more emotional over-eating and more emotional under-eating behaviors than their typically developing peers. Furthermore, while sex differences in these emotional eating behaviors were not observed in the typically developing children, girls with autism spectrum disorder were rated as experiencing more emotional over-eating behaviors than boys with autism spectrum disorder. Finally, among all children with autism spectrum disorder, emotional over-eating was linked with increased consumption of sweet foods and decreased consumption of vegetables. These findings have implications for better understanding eating habits in children with autism spectrum disorder and suggest that emotional eating behaviors might have both immediate and downstream health impacts.
      Citation: Autism
      PubDate: 2020-08-01T08:14:08Z
      DOI: 10.1177/1362361320942087
       
  • Vision care among school-aged children with autism spectrum disorder in
           North America: Findings from the Autism Treatment Network Registry
           Call-Back Study
    • Authors: Olivia J Lindly, James Chan, Rachel M Fenning, Justin G Farmer, Ann M Neumeyer, Paul Wang, Mark Swanson, Robert A Parker, Karen A Kuhlthau
      Abstract: Autism, Ahead of Print.
      Children with autism spectrum disorder have a high risk of vision problems yet little is known about their vision care. This cross-sectional survey study, therefore, examined vision care among 351 children with autism spectrum disorder ages 6–17 years in the United States or Canada who were enrolled in the Autism Treatment Network Registry. Vision care variables were vision tested with pictures, shapes, or letters in the past 2 years; vision tested by an eye care practitioner (e.g. ophthalmologist, optometrist) in the past 2 years; prescribed corrective eyeglasses; and wore eyeglasses as recommended. Covariates included sociodemographic, child functioning, and family functioning variables. Multivariable models were fit for each vision care variable. Though 78% of children with autism spectrum disorder had their vision tested, only 57% had an eye care practitioner test their vision in the past 2 years. Among the 30% of children with autism spectrum disorder prescribed corrective eyeglasses, 78% wore their eyeglasses as recommended. Multivariable analysis results demonstrated statistically significant differences in vision care among children with autism spectrum disorder by parent education, household income, communication abilities, intellectual functioning, and caregiver strain. Overall, study results suggest many school-aged children with autism spectrum disorder do not receive recommended vision care and highlight potentially modifiable disparities in vision care.Lay AbstractChildren with autism are at high risk for vision problems, which may compound core social and behavioral symptoms if untreated. Despite recommendations for school-aged children with autism to receive routine vision testing by an eye care practitioner (ophthalmologist or optometrist), little is known about their vision care. This study, therefore, examined vision care among 351 children with autism ages 6–17 years in the United States or Canada who were enrolled in the Autism Treatment Network Registry. Parents were surveyed using the following vision care measures: (1) child’s vision was tested with pictures, shapes, or letters in the past 2 years; (2) child’s vision was tested by an eye care practitioner in the past 2 years; (3) child was prescribed corrective eyeglasses; and (4) child wore eyeglasses as recommended. Sociodemographic characteristics such as parent education level, child functioning characteristics such as child communication abilities, and family functioning characteristics such as caregiver strain were also assessed in relationship to vision care. Although 78% of children with autism had their vision tested, only 57% had an eye care practitioner test their vision in the past 2 years. Among the 30% of children with autism prescribed corrective eyeglasses, 78% wore their eyeglasses as recommended. Differences in vision care were additionally found among children with autism by parent education, household income, communication abilities, intellectual functioning, and caregiver strain. Overall, study results suggest many school-aged children with autism do not receive recommended vision care and highlight potentially modifiable disparities in vision care.
      Citation: Autism
      PubDate: 2020-07-22T04:48:55Z
      DOI: 10.1177/1362361320942091
       
  • Using phecode analysis to characterize co-occurring medical conditions in
           autism spectrum disorder
    • Authors: Michelle D Failla, Kyle L Schwartz, Shikha Chaganti, Laurie E Cutting, Bennett A Landman, Carissa J Cascio
      Abstract: Autism, Ahead of Print.
      Individuals with autism spectrum disorder experience a significant number of co-occurring medical conditions, yet little is known about these conditions beyond prevalence. Using large-scale de-identified medical records, we can use a novel phecode-based tool to characterize co-occurring conditions in autism spectrum disorder. We hypothesized that individuals with autism spectrum disorder experience an increased burden of co-occurring conditions as measured by presence, frequency, and duration of visits related to co-occurring conditions. Secondarily, we hypothesized that age at first encounter for autism spectrum disorder (early, 5) would be associated with different co-occurring conditions. The International Classification of Diseases, Ninth Revision, codes were extracted from a large anonymized electronic medical center database for 3097 individuals with autism spectrum disorder and 3097 matched controls. Co-occurring conditions were characterized using a novel tool (pyPheWAS) to examine presence, frequency, and duration of each condition. We identified several categories of co-occurring conditions in autism spectrum disorder: neurological (convulsions, sleep disorders); psychiatric (anxiety disorders, adjustment/conduct disorders), as well as constipation, hearing loss, and developmental delays. Our work confirms individuals with autism spectrum disorder are under a significant medical burden, with increased duration and frequency of visits associated with co-occurring conditions. Adequate management of these conditions could improve quality of life for individuals with autism spectrum disorder.Lay abstractPeople with autism spectrum disorder often have a number of other medical conditions in addition to autism. These can range from constipation to epilepsy. This study uses medical record data to understand how frequently and how long people with autism have to be seen by a medical professional for these other medical conditions. This study confirmed that people with autism often have a number of other medical conditions and that they have to go see a medical professional about those conditions often. We also looked to see if children diagnosed with autism after age 5 years might have different medical conditions compared to children diagnosed earlier. Children diagnosed later had more conditions like asthma, hearing loss, and mood disorders. This work describes how much medical care people with autism get for different medical conditions and the burden of seeking additional medical care for people with autism and their families.
      Citation: Autism
      PubDate: 2020-07-14T11:57:49Z
      DOI: 10.1177/1362361320934561
       
  • 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
       
  • 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 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
       
  • The relationship between intolerance of uncertainty and anxiety in autism:
           A systematic literature review and meta-analysis
    • Authors: Richard Jenkinson, Elizabeth Milne, Andrew Thompson
      First page: 1933
      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
       
  • Continuing to look in the mirror: A review of neuroscientific evidence for
           the broken mirror hypothesis, EP-M model and STORM model of autism
           spectrum conditions
    • Authors: Luke Yates, Hannah Hobson
      First page: 1945
      Abstract: Autism, Ahead of Print.
      The mirror neuron system has been argued to be a key brain system responsible for action understanding and imitation. Subsequently, mirror neuron system dysfunction has therefore been proposed to explain the social deficits manifested within autism spectrum condition, an approach referred to as the broken mirror hypothesis. Despite excitement surrounding this hypothesis, extensive research has produced insufficient evidence to support the broken mirror hypothesis in its pure form, and instead two alternative models have been formulated: EP-M model and the social top-down response modulation (STORM) model. All models suggest some dysfunction regarding the mirror neuron system in autism spectrum condition, be that within the mirror neuron system itself or systems that regulate the mirror neuron system. This literature review compares these three models in regard to recent neuroscientific investigations. This review concludes that there is insufficient support for the broken mirror hypothesis, but converging evidence supports an integrated EP-M and STORM model.Lay abstractThe mirror neuron system has been argued to be a key brain system responsible for understanding the actions of others and for imitation. It has therefore been proposed that problems within this system could explain the social difficulties experienced by people with autism spectrum condition. This idea is referred to as the broken mirror hypothesis. However, research has produced insufficient evidence to support the broken mirror hypothesis in its original form. Therefore, two other models have been suggested: EP-M model and the social top-down response modulation (STORM) model. All models suggest something is different regarding the mirror neuron system in autism spectrum condition: either within the mirror neuron system itself or within the systems that control the activity of the mirror neuron system. This literature review compares these three models in regard to recent neuroscientific investigations. This review concludes that there is insufficient support for both the broken mirror hypothesis, but converging evidence supports an integrated EP-M and STORM model.
      Citation: Autism
      PubDate: 2020-07-16T06:23:40Z
      DOI: 10.1177/1362361320936945
       
  • A systematic review and meta-analysis of parent-mediated intervention for
           children and adolescents with autism spectrum disorder in mainland China,
           Hong Kong, and Taiwan
    • Authors: Qing Liu, Wu-Ying Hsieh, Gaowei Chen
      First page: 1960
      Abstract: Autism, Ahead of Print.
      Parent-mediated intervention is a prominent approach to supplementing service insufficiency for the population with autism spectrum disorder, yet individuals from low-resource areas are largely under-represented among participants in the global parent-mediated intervention research. This systematic review and meta-analysis is the first to inspect the overall effects and research quality of parent-mediated interventions in mainland China, Hong Kong, and Taiwan. A total of 21 parent-mediated interventions were included in systematic review, and among them, 12 randomized controlled trials representing 964 children were analyzed in meta-synthesis. Overall, results of meta-analysis showed favorable effects of parent-mediated interventions with standardized mean difference ranging from 0.63 (social competence) to 1.00 (symptom severity) and averaged 0.76 across domains. However, the results should be interpreted with caution due to poor evidence quality as assessed in GRADE ratings. In terms of methodological quality, QualSyst evaluation showed that more than half (14/21) of the included studies were below satisfactory. Identified programs lack the capacity to be further disseminated in the Chinese societies due to the absence of solid theoretical foundations, the negligence of implementation outcomes, and the inadequacy of sophisticated cultural adaptations. This review reinforces the need for promotion and improvement of parent-mediated interventions in low-resource context (PROSPERO: CRD42019138723).Lay abstractThe ideal dosage for early intensive interventions for autism spectrum disorder has been suggested to be at least 25-hour per week to reach optimal effects. However, insufficient service use and unmet needs among families with children with autism spectrum disorder are frequently reported worldwide. Helping parents to develop strategies for interaction and management of behavior through parent training has been demonstrated to be a prominent way to supplementing service insufficiency for autism spectrum disorder, which is particularly crucial in less-resourced areas. This review included 21 parent-mediated intervention programs conducted in China, the most populated developing country. Among them, we were able to combine outcome information from 12 randomized controlled trials to increase confidence in the results. We also rated the quality of methodology and evidence for all included studies, which was taken into account in making conclusions. The included programs varied in the content, length, and delivery method of trainings. Although targeting different training outcomes, the majority of the studies aimed to help parents be more competent and responsive during interactions with their child in order to decrease symptom severity. Overall, results showed sufficient evidence that parent training did improve child outcomes as intended. However, the quality of more than half (14/21) of the included studies were below satisfactory. Identified programs lack the capacity to be further transported in the Chinese societies due to the lack of solid theoretical foundations, implementation manuals, and appropriate cultural adaptations. This review reinforces the need for promotion and improvement of parent-mediated interventions in low-resource context.
      Citation: Autism
      PubDate: 2020-07-28T10:25:42Z
      DOI: 10.1177/1362361320943380
       
  • Mentalising and conversation-following in autism
    • Authors: Hsuan-Chen Wu, Francesca Biondo, Ciara O’Mahony, Sarah White, Flora Thiebaut, Geraint Rees, Paul W Burgess
      First page: 1980
      Abstract: Autism, Ahead of Print.
      Some people with autism spectrum disorders have been observed to experience difficulties with making correct inferences in conversations in social situations. However, the nature and origin of their problem is rarely investigated. This study used manipulations of video stimuli to investigate two questions. The first question was whether it is the number of people involved in social situations, that is, the source of problems in following conversations, or whether it is the increased mentalising demands required to comprehend interactions between several people. The second question asked was whether the nature and pattern of the errors that autism spectrum disorder participants show are the same as typically developing people make when they make an error. In total, 43 typically developed adults and 30 adults diagnosed with autism spectrum disorder were studied. We found that it was the amount of mentalising required, rather than the number of people involved, which caused problems for people with autism spectrum disorder in following conversations. Furthermore, the autism spectrum disorder participants showed a more heterogeneous pattern of errors, showing less agreement among themselves than the typically developed group as to which test items were hardest. So, fully understanding the observed behaviour consequent upon weakness in mentalising ability in people with autism spectrum disorders requires consideration of factors other than mentalising.
      Citation: Autism
      PubDate: 2020-07-18T08:46:31Z
      DOI: 10.1177/1362361320935690
       
  • 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
      First page: 1995
      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
       
  • 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
      First page: 2008
      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
       
  • Facial emotion recognition in autistic adult females correlates with
           alexithymia, not autism
    • Authors: Louise Ola, Fiona Gullon-Scott
      First page: 2021
      Abstract: Autism, Ahead of Print.
      Research on predominantly male autistic samples has indicated that impairments in facial emotion recognition typically associated with autism spectrum conditions are instead due to co-occurring alexithymia. However, whether this could be demonstrated using more realistic facial emotion recognition stimuli and applied to autistic females was unclear. In all, 83 females diagnosed with autism spectrum condition completed online self-report measures of autism spectrum condition severity and alexithymia, and afacial emotion recognition deficit that assessed their ability to identify multimodal displays of complex emotions. Higher levels of alexithymia, but not autism spectrum condition severity, were associated with less accurate facial emotion recognition. Difficulty identifying one’s own feelings and externally oriented thinking were the components of alexithymia that were specifically related to facial emotion recognition accuracy. However, alexithymia (and autism spectrum condition severity) was not associated with speed of emotion processing. The findings are primarily discussed with the theoretical view that perceiving and experiencing emotions share the same neural networks, thus being able to recognise one’s own emotions may facilitate the ability to recognise others’. This study is in line with previous similar research on autistic males and suggests impairments in facial emotion recognition in autistic females should be attributed to co-occurring alexithymia.Lay abstractResearch with autistic males has indicated that difficulties in recognising facial expressions of emotion, commonly associated with autism spectrum conditions, may instead be due to co-occurring alexithymia (a condition involving lack of emotional awareness, difficulty describing feelings and difficulty distinguishing feelings from physical bodily sensations) and not to do with autism. We wanted to explore if this would be true for autistic females, as well as to use more realistic stimuli for emotional expression. In all, 83 females diagnosed with autism spectrum condition completed self-report measures of autism spectrum condition traits and alexithymia and completed a visual test that assessed their ability to identify multimodal displays of complex emotions. Higher levels of alexithymia, but not autism spectrum condition features, were associated with less accuracy in identifying emotions. Difficulty identifying one’s own feelings and externally oriented thinking were the components of alexithymia that were specifically related to facial emotion recognition accuracy. However, alexithymia (and levels of autism spectrum condition traits) was not associated with speed of emotion processing. We discuss the findings in terms of possible underlying mechanisms and the implications for our understanding of emotion processing and recognition in autism.
      Citation: Autism
      PubDate: 2020-07-21T07:25:44Z
      DOI: 10.1177/1362361320932727
       
  • The role of staffing and classroom characteristics on preschool
           teachers’ use of one-to-one intervention with children with autism
    • Authors: Victor Lushin, Steven Marcus, Daphney Gaston, Rinad Beidas, Ashlee Lamson, Ilene Goy, Irina Godina, Joanne Rees, Rebecca Rivera, David Mandell
      First page: 2035
      Abstract: Autism, Ahead of Print.
      For preschool children with autism, individual behavioral interventions are among the best-tested treatments. However, they are rarely implemented in special education preschools. We observed one-to-one behavioral interventions formally and informally delivered by staff (N = 51) in 12 classrooms across three preschools for children with autism, aged 3–6 years, in a major US city. We estimated associations between the use of one-to-one intervention and classroom characteristics including staff-student ratio, professional role composition, and frequency of challenging child behaviors. A small number of classroom characteristics explained considerable portions of outcome variance: 23% for formally delivered one-to-one interventions and 41% for informally delivered interventions. The number of individually assigned personal care aides in the classroom was negatively correlated with less formal delivery of one-to-one intervention. Classroom challenging behavior was positively associated with formal delivery of one-to-one interventions. Interventionist’s professional roles and the number of children in the class accounted for the largest amounts of variance in informal intervention delivery. Staff training, clarifying professional roles, setting performance expectations for personal care aides and other classroom team members, and reducing class size may represent promising implementation targets. Findings suggest caution around task-shifting policies that transfer clinical functions from more highly trained to less highly trained staff.Lay abstractFor preschool children with autism, individual (one-to-one) behavioral interventions are among the best-tested treatments. However, they are rarely used in special education preschools. We observed formally and informally delivered one-to-one behavioral interventions use by classroom staff (n = 51) in 12 classrooms across three special education preschools for children with autism, aged 3–6 years, in a major US city. We estimated the associations between one-to-one intervention use and classroom characteristics including staff–student ratio, professional role composition, and frequency of challenging child behaviors. As a whole, the factors we examined were considerably important for both formally and informally delivered one-to-one interventions. The number of individually assigned personal care aides in the classroom was negatively associated with the use of formally delivered one-to-one intervention. Classroom challenging behavior was positively associated with use of formally delivered one-to-one interventions. Interventionist’s professional roles and the number of children in the class were most important for the use of informally delivered interventions. Staff training, clarifying professional roles, setting performance expectations for personal care aides and other classroom team members, and reducing class size may represent promising implementation targets. Findings suggest caution around task-shifting policies that transfer clinical functions from more highly trained to less highly trained staff.
      Citation: Autism
      PubDate: 2020-07-06T09:55:27Z
      DOI: 10.1177/1362361320932726
       
  • Alexithymic and autistic traits: Relevance for comorbid depression and
           social phobia in adults with and without autism spectrum disorder
    • Authors: Laura Albantakis, Marie-Luise Brandi, Imme Christina Zillekens, Lara Henco, Leonie Weindel, Hanna Thaler, Lena Schliephake, Bert Timmermans, Leonhard Schilbach
      First page: 2046
      Abstract: Autism, Ahead of Print.
      High alexithymic traits and psychiatric comorbidities such as depression and social phobia are frequently observed among adults with autism spectrum disorder. In this study, we tested whether alexithymic and/or autistic traits are risk factors for depressive and social phobic symptoms in adults with autism spectrum disorder (n = 122), patients with social interaction difficulties other than autism (n = 62), and neurotypical participants (n = 261). Multiple regression analyses of these three groups demonstrated that both traits explained considerable variance of depressive and social phobic symptoms. In adults with autism spectrum disorder, alexithymic traits were predictive of depressive symptoms, while autistic traits predicted social phobic symptoms. In patients with social interaction difficulties other than autism, alexithymic and autistic traits were identified as predictors of social phobic symptoms, while no variable predicted depressive symptoms. In neurotypicals, both alexithymic and autistic traits were predictive of depressive and social phobic symptoms. Our results, therefore, highlight the importance of assessing both alexithymic and autistic traits in patients with and without autism spectrum disorder for identifying comorbid psychopathology. Depending on the underlying core symptomatology, alexithymic and/or autistic traits increase the risk of depressive and social phobic symptoms calling for therapeutic strategies to prevent or at least reduce comorbid psychopathology.Lay abstractAdults with autism often develop mental health problems such as depression and social phobia. The reasons for this are still unclear. Many studies found that alexithymia plays an important role in mental health problems like depression. People with alexithymia have difficulties identifying and describing their emotions. Almost every second person with autism has alexithymia. Therefore, we explored in this study whether alexithymia is linked to worse mental health in autistic people. We looked at two common diagnoses, depression and social phobia. We found that alexithymia increased symptoms of depression, while autistic traits increased symptoms of social phobia. Our results suggest that alexithymia and autistic traits can increase the risk of mental health problems. An early assessment could help prevent mental health problems and improve quality of life.
      Citation: Autism
      PubDate: 2020-07-14T11:57:29Z
      DOI: 10.1177/1362361320936024
       
  • 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
      First page: 2057
      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
       
  • The Dutch Sensory Perception Quotient-Short in adults with and without
           autism
    • Authors: Ricarda F Weiland, Tinca JC Polderman, Rosa A Hoekstra, Dirk JA Smit, Sander Begeer
      First page: 2071
      Abstract: Autism, Ahead of Print.
      Sensory symptoms were recently added to the diagnostic criteria of autism spectrum disorder and may be a mechanism underlying the broad phenotype of autism spectrum disorder. To measure sensory symptoms based on perceptual rather than affective, regulative, or attention components, the Sensory Perception Quotient (SPQ) measuring five modalities of sensory sensitivity has been developed. In this study, the Dutch translation of the abridged SPQ-Short was investigated in a large sample of adults with (n = 657) and without autism spectrum disorder (n = 585). Its hypothesized factor structure, combining modality specific and one modality-independent factor, was assessed in a hierarchical model. Results show that modality-specific subscales are indeed present in the short version. Furthermore, its reliability is high and comparable to the original English version. The autism spectrum disorder group reported higher sensory sensitivities than the comparison group, and women with autism spectrum disorder reported higher sensitivities compared with men with autism spectrum disorder. The SPQ-Short correlates with all Autism Quotient (AQ)-Short subscales, except for the “imagination” subscale. The SPQ-Short seems suitable to further explore the relationship between basic sensory sensitivities in autism spectrum disorder and their related symptoms such as over- and under-responsivity to sensory stimulation.Lay AbstractIndividuals on the autism spectrum often experience heightened or reduced sensory sensitivities. This feature was recently added to the diagnostic manual for autism (Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5)). To measure sensory sensitivities, the Sensory Perception Quotient (SPQ) has been developed. In this study, we tested whether a Dutch translation of the abridged SPQ-Short yields similar results as the original English version. We also tested whether this questionnaire can measure modality specific sensitivities. To this end, 657 adults with autism spectrum disorder and 585 adults without an autism spectrum disorder diagnosis filled out the Dutch SPQ-Short. The Dutch questionnaire data were very similar to the original English version: adults with autism spectrum disorder were more sensitive compared with adults without autism spectrum disorder. Women with autism spectrum disorder are more sensitive compared with men with autism spectrum disorder. Gender did not have an effect in the group without autism spectrum disorder. Individuals reporting higher sensory sensitivities also reported more autistic traits (such as lower social interests, or increased fascination for patterns). Finally, we found that the Dutch SPQ-Short is suited to measure modality-specific sensitivities. We conclude that the Dutch translation is a viable tool to measure sensory sensitivities in adults with and without autism spectrum disorder and can be used to further our understanding of differences in perception in people with or without autism spectrum disorder.
      Citation: Autism
      PubDate: 2020-07-28T10:26:27Z
      DOI: 10.1177/1362361320942085
       
  • Integrating the Early Start Denver Model into Israeli community autism
           spectrum disorder preschools: Effectiveness and treatment response
           predictors
    • Authors: Yana Sinai-Gavrilov, Tali Gev, Irit Mor-Snir, Giacomo Vivanti, Ofer Golan
      First page: 2081
      Abstract: Autism, Ahead of Print.
      Early intensive intervention has been shown to significantly affect the development of children with autism spectrum disorder. However, the costly implementation of such interventions limits their wide dissemination in the community. This study examined an integration of the Early Start Denver Model into community preschool programs for children with autism spectrum disorder in Israel. Four community preschools implemented the preschool-based Early Start Denver Model and four implemented a multidisciplinary developmental intervention which is widely applied in Israeli community autism spectrum disorder preschools. Fifty-one children (aged 33–57 months) participated in the study. Twenty-six attended the preschool-based Early Start Denver Model preschools and twenty-five attended the multidisciplinary developmental intervention settings. Groups were comparable on age, developmental functioning, and socio-economic status. Compared to the multidisciplinary developmental intervention group, children in the preschool-based Early Start Denver Model treatment made greater gains on blinded measures of overall cognitive development, receptive and expressive language skills, as well as on parent- and teacher-reported adaptive communication and socialization abilities. In the preschool-based Early Start Denver Model group, children with lower symptom severity, higher adaptive functioning, and receptive language abilities at pre-treatment showed greater improvement. This study documents the successful integration of an Early Start Denver Model intervention into pre-existing community preschools, underlining the importance of disseminating evidence-based early intervention in community settings.Lay AbstractEarly intensive intervention has been shown to significantly affect the development of children with Autism. However, the costly implementation of such interventions limits their wide dissemination in the community. This study examined an integration of a research-supported early intensive intervention model called the Early Start Denver Model into community preschool programs for children with Autism in Israel. Four community preschools implemented the preschool-based Early Start Denver Model and four implemented the existing multidisciplinary developmental intervention which is widely applied in Israeli community preschools for children with autism. Fifty-one children (aged 33–57 months) participated in the study. Twenty-six attended the preschool-based Early Start Denver Model preschools and twenty-five attended the multidisciplinary developmental intervention preschools. Before the intervention began, groups were comparable on children’s age and developmental functioning and on families’ socio-economic status. Results showed that, compared to the multidisciplinary developmental intervention group, children in the preschool-based Early Start Denver Model treatment group made greater gains on measures of overall cognitive development, language skills, as well as on parent- and teacher-reported adaptive communication and socialization abilities. Children who had lower autism symptom severity, higher adaptive functioning and better language understanding abilities before taking part in the preschool-based Early Start Denver Model program showed greater improvements following it. This study documents the successful implementation of an intensive early intervention program in pre-existing community preschools, underlining the importance of the integration of research-supported intervention programs into community settings.
      Citation: Autism
      PubDate: 2020-07-14T11:58:09Z
      DOI: 10.1177/1362361320934221
       
  • Service use by youth with autism within a system-driven implementation of
           evidence-based practices in children’s mental health services
    • Authors: Nicole A Stadnick, Anna S Lau, Kelsey S Dickson, Keri Pesanti, Debbie Innes-Gomberg, Lauren Brookman-Frazee
      First page: 2094
      Abstract: Autism, Ahead of Print.
      Public mental health systems play an important role in caring for youth with autism spectrum disorder. Like other dually diagnosed populations, youth with autism spectrum disorder may receive services in the context of evidence-based practice implementation efforts within public mental health systems. Little is known about service use patterns within the context of system-driven implementations efforts for this population. This case–control study examined mental health service patterns of 2537 youth with autism spectrum disorder compared to 2537 matched peers receiving care in the Los Angeles County Department of Mental Health, the largest public mental health department in the United States, within the context of a system-driven implementation of multiple evidence-based practices. Although not the primary target of this implementation effort, youth with autism spectrum disorder were served when they met criteria for the services based on their presenting mental health symptoms. Comparative analyses using administrative claims data were conducted to examine differences in mental health utilization patterns and clinical characteristics. Findings revealed significant differences in the volume and duration of mental health services as well as differences in the service type and evidence-based practice delivered between youth with and without autism spectrum disorder. Results provide direction targeting implementation efforts for youth with autism spectrum disorder within a public mental health system care reform.
      Citation: Autism
      PubDate: 2020-07-18T08:47:11Z
      DOI: 10.1177/1362361320934230
       
  • Multi-component communication intervention for children with autism: A
           randomized controlled trial
    • Authors: Lauren H Hampton, Ann P Kaiser, Elizabeth A Fuller
      First page: 2104
      Abstract: Autism, Ahead of Print.
      The objective of this study is to evaluate the effectiveness of a multi-component communication intervention on social communication for young children with autism. As many as half of children with autism are not yet talking by age 3, and up to a third of children with autism will remain minimally verbal past age 5. Spoken language outcomes are greatest when parents and clinicians are delivering language interventions to children with autism as compared to parents or clinicians alone. This study incorporates caregiver training, Discrete Trial Teaching, and JASP + EMT + SGD. A total of 68 children between ages 3 and 5 with autism, and their caregivers, participated in this study. Children were randomly assigned to the treatment or control group. Children in the treatment group received 36 sessions of the multi-component intervention in the clinic and at home. Children in both groups received a speech-generating device and the caregivers received an individualized training on how to program the speech-generating device. All participants were evaluated prior to intervention, immediately following intervention, and 4 months following intervention. Children in the intervention group demonstrated significantly greater joint attention than those in the control group immediately following intervention. Children in the intervention group, additionally, demonstrated greater social communication with their caregivers 4 months following intervention. This brief, multi-component intervention may be effective for improving social communication in young children with autism who are at risk for remaining minimally verbal. Future research is needed to understand for whom and under what conditions this intervention is most effective.Lay abstractThis study reports the results of a randomized trial for preverbal preschoolers with autism that demonstrates the effects of multiple intervention strategies including caregiver training. About 50% of children with autism are not talking by age 3 and up to 30% of children with autism will remain minimally verbal past age 5. Interventions delivered by clinicians and caregivers have the greatest effects on spoken language and may reduce the rate of those who remain minimally verbal. Sixty-eight children ages 3–5 with autism and their caregivers participated in this randomized trial comparing the communication intervention to a comparison group. A brief, multi-component, communication intervention (including a speech-generating device) for children with autism that addresses core deficits may be effective in improving joint attention skills immediately following intervention and social communication skills 4 months following intervention. Future research is needed to understand for whom and under what conditions this intervention is most effective.
      Citation: Autism
      PubDate: 2020-07-06T09:55:17Z
      DOI: 10.1177/1362361320934558
       
  • Self-initiations in young children with autism during Pivotal Response
           Treatment with and without robot assistance
    • Authors: Manon WP De Korte, Iris van den Berk-Smeekens, Martine van Dongen-Boomsma, Iris J Oosterling, Jenny C Den Boer, Emilia I Barakova, Tino Lourens, Jan K Buitelaar, Jeffrey C Glennon, Wouter G Staal
      First page: 2117
      Abstract: Autism, Ahead of Print.
      The aim of this study was to investigate the effect of Pivotal Response Treatment versus robot-assisted Pivotal Response Treatment on self-initiations of children with autism spectrum disorder and to explore the relation between self-initiations and collateral gains in general social-communicative skills. Forty-four participants with autism spectrum disorder aged 3–8 years (Pivotal Response Treatment: n = 20, Pivotal Response Treatment + robot: n = 24), who were recruited as part of a larger randomized controlled trial (number NL4487/NTR4712, https://www.trialregister.nl/trial/4487), were included. Self-initiations were blindly coded, assessing video probes of all parent–child sessions using an event-recording system. General social-communicative skills were assessed with the parent- and teacher-rated Social Responsiveness Scale during intervention and at 3-month follow-up. Results using linear mixed-effects models showed overall gains in self-initiations during both Pivotal Response Treatment intervention groups (estimate = 0.43(0.15), 95% confidence interval (CI): 0.13–0.73), with larger gains in functional self-initiations in children receiving robot-assisted Pivotal Response Treatment (estimate = −0.27(0.12), 95% confidence interval: −0.50 to −0.04). Growth in self-initiations was related to higher parent-rated social awareness at follow-up compared with baseline in the total sample (r = −0.44, p = 0.011). The clinical implications of these findings, as well as directions for future research in the utility of Pivotal Response Treatment and robot assistance in autism spectrum disorder intervention, are discussed.Lay abstractThe initiation of social interaction is often defined as a core deficit of autism spectrum disorder. Optimizing these self-initiations is therefore a key component of Pivotal Response Treatment, an established intervention for children with autism spectrum disorder. However, little is known about the development of self-initiations during intervention and whether this development can be facilitated by robot assistance within Pivotal Response Treatment. The aim of this study was to (1) investigate the effect of Pivotal Response Treatment and robot-assisted Pivotal Response Treatment on self-initiations (functional and social) of young children with autism spectrum disorder over the course of intervention and (2) explore the relation between development in self-initiations and additional gains in general social-communicative skills. Forty-four children with autism spectrum disorder (aged 3–8 years) were included in this study. Self-initiations were assessed during parent–child interaction videos of therapy sessions and coded by raters who did not know which treatment (Pivotal Response Treatment or robot-assisted Pivotal Response Treatment) the child received. General social-communicative skills were assessed before start of the treatment, after 10 and 20 weeks of intervention and 3 months after the treatment was finalized. Results showed that self-initiations increased in both treatment groups, with the largest improvements in functional self-initiations in the group that received robot-assisted Pivotal Response Treatment. Increased self-initiations were related to higher parent-rated social awareness 3 months after finalizing the treatment.
      Citation: Autism
      PubDate: 2020-07-30T12:01:37Z
      DOI: 10.1177/1362361320935006
       
  • Parent perceptions of participation in a parent-mediated
           communication-focussed intervention with their young child with autism
           spectrum disorder
    • Authors: Kathy Leadbitter, Wendy Macdonald, Carol Taylor, Karen Leneh Buckle
      First page: 2129
      Abstract: Autism, Ahead of Print.
      Paediatric Autism Communication Therapy is a parent-mediated, video-aided, communication-focussed intervention for young children with autism spectrum disorder. It has been shown in a UK randomised controlled trial to lead to improvements in parent–child communication and family quality of life, together with a sustained reduction in child autism symptom severity. This qualitative study examined parental perceptions of their participation in Paediatric Autism Communication Therapy within the context of the randomised controlled trial. Semi-structured interviews were carried out with 18 parents within 12 months of completion of the therapy. The thematic analysis provides insights into parents’ hopes, expectations, and learning processes when working with Paediatric Autism Communication Therapy therapists and carrying out daily practice in the home. Parents reported positive changes in their interaction and relationship with their child and improvements to their child’s communication and interaction. Some also highlighted poignant realisations and emotional challenges associated with taking part in this post-diagnostic therapy. Practical difficulties were also emphasised. Implications for the clinical practice of parent-mediated interventions with young children with autism spectrum disorder are discussed.Lay abstractPaediatric Autism Communication Therapy is an intervention for young children with autism spectrum disorder that focuses on parent–child communication. In Paediatric Autism Communication Therapy, the therapist and parent watch videos of the parent and child playing together. The therapist coaches the parent to carefully observe the child’s communication and to interact with their child in a more sensitive and responsive way. Parents are encouraged to use the strategies with their child at home. Paediatric Autism Communication Therapy has been shown to lead to long-term improvements in parent–child communication and family quality of life. This study aimed to explore parents’ perceptions of their participation in Paediatric Autism Communication Therapy. Interviews were carried out by an independent researcher with 18 parents. Parents discussed the learning processes they went through when working with Paediatric Autism Communication Therapy therapists and carrying out home practice. Some parents described initial doubts about the approach and hesitations about being videoed and analysing video material. In time, most parents came to really value the therapy and their relationship with the therapist. They reported positive changes in their interaction and relationship with their child and improvements to their child’s communication and interaction. Some also highlighted poignant realisations and emotional challenges associated with taking part in this post-diagnosis therapy. Practical difficulties were also emphasised, including the time commitment, accessibility of therapy venues and difficulties in occupying the child during therapist–parent discussion. Implications for the clinical practice of parent-mediated interventions are discussed.
      Citation: Autism
      PubDate: 2020-07-15T02:54:34Z
      DOI: 10.1177/1362361320936394
       
  • Peer engagement in toddlers with autism: Community implementation of
           dyadic and individual Joint Attention, Symbolic Play, Engagement, and
           Regulation intervention
    • Authors: Stephanie Y Shire, Wendy Shih, Suzanne Bracaglia, Maria Kodjoe, Connie Kasari
      First page: 2142
      Abstract: Autism, Ahead of Print.
      Center-based classroom community interventions create opportunities for young children with autism to connect with peers. Yet, there has been little examination of the peer interactions of toddlers with autism who experience core challenges in social communication and play skills that may create barriers to successful peer interactions. Classrooms of toddlers were randomized to an experimental social communication intervention including peers or to the standard individual (adult–child) social communication intervention. Both toddlers in peer and no peer conditions demonstrated significant gains in social communication and play. Toddlers with greater receptive language and combination and presymbolic play skills were most likely to demonstrate peer engagement.Lay AbstractAlthough young children may participate in education and intervention programs that take place in classrooms or groups, there is little information about how toddlers with special needs, and specifically toddlers with autism, are engaging with their peers. This study takes place in a public center-based early intervention program for toddlers with autism. Classrooms of toddlers were randomly assigned to an individual social communication intervention or the same intervention adapted to include a peer. Children in both groups made gains in social communication and play skills. Children who had the peer intervention were more engaged with peers when an adult was present, but not when the children were unsupported. This article adds information about early skills that may be important for children to master so that they have more success when trying to interact with their peers. These skills include understanding language (referred to as “receptive language” at 12 months or more) and play skills including building and stacking (referred to as “combination play”—for example, building with blocks or completing a puzzle) and extending familiar actions to themselves, others, and figures (referred to as “presymbolic play”—for example, putting a bottle to the doll or to themselves). Understanding which skills to target can help practitioners focus their instruction to build children’s skills toward connecting with peers through play.
      Citation: Autism
      PubDate: 2020-07-09T11:26:31Z
      DOI: 10.1177/1362361320935689
       
  • Perspective influences eye movements during real-life conversation:
           Mentalising about self versus others in autism
    • Authors: Mahsa Barzy, Heather J Ferguson, David M Williams
      First page: 2153
      Abstract: Autism, Ahead of Print.
      Social-communication is profoundly impaired among autistic individuals. Difficulties representing others’ mental states have been linked to modulations of gaze and speech, which have also been shown to be impaired in autism. Despite these observed impairments in ‘real-world’ communicative settings, research has mostly focused on lab-based experiments, where the language is highly structured. In a pre-registered experiment, we recorded eye movements and verbal responses while adults (N = 50) engaged in a real-life conversation. Using a novel approach, we also manipulated the perspective that participants adopted by asking them questions that were related to the self, a familiar other, or an unfamiliar other. Results replicated previous work, showing reduced attention to socially relevant information among autistic participants (i.e. less time looking at the experimenter’s face and more time looking around the background), compared to typically developing controls. Importantly, perspective modulated social attention in both groups; talking about an unfamiliar other reduced attention to potentially distracting or resource-demanding social information and increased looks to non-social background. Social attention did not differ between self and familiar other contexts, reflecting greater shared knowledge for familiar/similar others. Autistic participants spent more time looking at the background when talking about an unfamiliar other versus themselves. Future research should investigate the developmental trajectory of this effect and the cognitive mechanisms underlying it.Lay abstractPrevious lab-based studies suggest that autistic individuals are less attentive to social aspects of their environment. In our study, we recorded the eye movements of autistic and typically developing adults while they engaged in a real-life social interaction with a partner. Results showed that autistic adults were less likely than typically developing adults to look at the experimenter’s face, and instead were more likely to look at the background. Moreover, the perspective that was adopted in the conversation (talking about self versus others) modulated the patterns of eye movements in autistic and non-autistic adults. Overall, people spent less time looking at their conversation partner’s eyes and face and more time looking at the background, when talking about an unfamiliar other compared to when talking about themselves. This pattern was magnified among autistic adults. We conclude that allocating attention to social information during conversation is cognitively effortful, but this can be mitigated when talking about a topic that is familiar to them.
      Citation: Autism
      PubDate: 2020-07-09T11:24:11Z
      DOI: 10.1177/1362361320936820
       
  • Bilingualism in autism: Language learning profiles and social experiences
    • Authors: Bérengère G Digard, Antonella Sorace, Andrew Stanfield, Sue Fletcher-Watson
      First page: 2166
      Abstract: Autism, Ahead of Print.
      Bilingualism changes how people relate to others, and lead their lives. This is particularly relevant in autism, where social interaction presents challenges. Understanding the overlap between the social variations of bilingualism and autism could unveil new ways to support autistic people. This research aims to understand the language learning and social experiences of mono-, bi- and multilingual autistic people. A total of 297 autistic adults (mean age = 32.4 years) completed an online questionnaire including general demographic, language history and social life quality self-rating items. The sample included 89 monolingual English speakers, 98 bilinguals, and 110 multilinguals, with a wide range of language profiles. Regression models were used to analyse how bilingualism variables predicted social life quality ratings. In the full sample, age negatively predicted social life quality scores while the number of languages known positively predicted social life quality scores. In the multilingual subset, age negatively predicted social life quality scores, while third language proficiency positively predicted social life quality scores. This is the first study describing the language history and social experiences of a substantial sample of bilingual and multilingual autistic adults. It provides valuable insight into how autistic people can learn and use a new language, and how their bilingualism experiences shape their social life.Lay abstractBilingualism changes the way people relate to others. This is particularly interesting in the case of autism, where social interaction presents many challenges. A better understanding of the overlap between the social variations of bilingualism and autism could unveil new ways to support the social experiences of autistic people. This research aims to understand the language learning and social experiences of autistic people who speak one, two or more languages. A total of 297 autistic adults (aged between 16 and 80 years) completed an online questionnaire that included general demographic questions, social life quality self-rating questions, language history questions, and open questions about the respondents’ bilingualism experience. Respondents had a wide range of language experiences: there were 89 monolingual English speakers, 98 bilinguals, 110 respondents knew three languages or more, all with a wide range of abilities in their languages. In the full group, younger respondents were more satisfied with their social life, and respondents with many languages were more satisfied with their social life than respondents with few languages. In the multilingual group, younger respondents were more satisfied with their social life, and the more skilled in their third language the more satisfied with their social life. This is the first study describing the language history and social experiences of a large group of bilingual and multilingual autistic adults. It highlights how autistic people can encounter a new language, learn it and use it in their daily life, and how their bilingualism experiences shape their social life.
      Citation: Autism
      PubDate: 2020-07-17T09:06:37Z
      DOI: 10.1177/1362361320937845
       
  • The effect of school exposure and personal contact on attitudes towards
           bullying and autism in schools: A cohort study with a control group
    • Authors: Anna Cook, Jane Ogden, Naomi Winstone
      First page: 2178
      Abstract: Autism, Ahead of Print.
      Research shows that the attitudes of children and adolescents towards bullying are influenced by the school environment and their peer groups. Given the increased vulnerability to bullying for autistic children, this study explored whether neurotypical children’s attitudes towards bullying and autism varied according to school exposure and personal contact with autistic people. Survey data were collected at the beginning and end of the school year from 775 children aged 11–12 years, from six schools: three with specialist centres for autism and three without. Participants read vignettes depicting bullying scenarios then completed measures of their attitudes in relation to the vignette and towards autism. Children from centre schools showed a greater increase in prosocial emotions towards bullying. For children from non-centre schools, an interaction showed a decrease in prosocial emotions except in response to social exclusion of an autistic child. Increases in personal contact showed a greater increase in positive attitudes towards autistic people. Explanations draw on theories of inter-group contact and social-moral reasoning. Results highlight the need for contact both at a personal level and through attending a school with an inclusive autism provision to increase understanding, improve attitudes towards autism and reduce tolerance for bullying.Lay abstractAutistic children are more likely than non-autistic children to be bullied at school. This study therefore explored whether the kind of school setting and the level of personal contact with autistic people can affect children’s attitudes towards bullying and autism. Surveys were completed at the beginning and end of the school year by 775 children aged 11–12 years, from six schools: three with specialist centres for autistic children and three without. Participants read stories describing bullying situations, then provided their views in relation to the story and in relation to autism. Children in schools with centres increased their feelings of anger, pity, sadness and shame in response to the bullying situations. In contrast, children in schools with no centre showed less sociable responses to bullying, except in response to a story describing an autistic child, being excluded by classmates. Furthermore, children who increased the time they spent with autistic individuals over the course of the year showed a greater rise in positive attitudes towards autistic people. This highlights the need for both personal contact and an inclusive school environment, to improve attitudes towards autism and reduce tolerance for bullying.
      Citation: Autism
      PubDate: 2020-07-16T06:25:24Z
      DOI: 10.1177/1362361320937088
       
  • Sex-related patterns of intrinsic functional connectivity in children and
           adolescents with autism spectrum disorders
    • Authors: Lindsay A Olson, Lisa E Mash, Annika Linke, Christopher H Fong, Ralph-Axel Müller, Inna Fishman
      First page: 2190
      Abstract: Autism, Ahead of Print.
      Although a growing literature highlights sex differences in autism spectrum disorder clinical presentation, less is known about female variants at the neural level. We investigated sex-related patterns of functional connectivity within and between functional networks in children and adolescents with autism spectrum disorders, compared to typically developing peers. Resting-state functional magnetic resonance imaging data for 141 children and adolescents (7–17 years) selected from an in-house sample and four sites contributing to the Autism Brain Imaging Database Exchange (ABIDE I and II) were submitted to group independent component analysis to generate resting-state functional networks. Functional connectivity was estimated by generating resting-state functional network correlation matrices, which were directly compared between males and females, and autism spectrum disorder and typically developing groups. Results revealed greater connectivity within the default mode network in typically developing girls as compared to typically developing boys, while no such sex effect was observed in the autism spectrum disorder group. Correlational analyses with clinical indices revealed a negative relationship between sensorimotor connectivity and history of early autism symptoms in girls, but not in boys with autism spectrum disorder. A lack of neurotypical sex differentiation in default mode network functional connectivity observed in boys and girls with autism spectrum disorder suggests that sex-related differences in network integration may be altered in autism spectrum disorder.Lay summaryWe investigated whether children and adolescents with autism spectrum disorders show sex-specific patterns of brain function (using functional magnetic resonance imaging) that are well documented in typically developing males and females. We found, unexpectedly, that boys and girls with autism do not differ in their brain functional connectivity, whereas typically developing boys and girls showed differences in a brain network involved in thinking about self and others (the default mode network). Results suggest that autism may be characterized by a lack of brain sex differentiation.
      Citation: Autism
      PubDate: 2020-07-21T07:26:00Z
      DOI: 10.1177/1362361320938194
       
  • Moral foundations theory in autism spectrum disorder: A qualitative
           investigation
    • Authors: Erin E Dempsey, Chris Moore, Annie E Richard, Isabel M Smith
      First page: 2202
      Abstract: Autism, Ahead of Print.
      Morality is important for how humans treat each other and non-human animals. Differences in moral reasoning have been found between autistic and neurotypical individuals. Research in this area has relied on accounts of moral psychology that suggest increasingly mature moral principles that develop from taking the perspectives of others. Yet, even autistic individuals, who sometimes differ in their ability to take others’ perspectives, make moral judgements that are similar to neurotypical individuals. Moral foundations theory suggests that moral psychology is not hierarchical but differs depending on culture. Moral foundations theory has not yet been investigated among autistic individuals. This qualitative study used interviews and qualitative analysis as a first attempt at understanding how moral foundations theory fits with autistic moral thinking. We found that all five moral foundations of moral foundations theory were represented in the interviews, yet certain foundations appeared more prominent than others. The autistic adults interviewed in our study discussed issues of care and fairness more than of loyalty, authority or purity when prompted to discuss moral transgressions. Future research should use quantitative methods to compare groups of autistic and neurotypical individuals to clarify similarities and differences in moral thinking between the groups.Lay abstractMorality is important for how humans treat each other and non-human animals. Differences in moral thinking have been found between autistic and neurotypical individuals. This research has relied on ways of thinking about moral psychology that suggest that mature morals develop as individuals learn to take the perspectives of others. Yet, even autistic individuals, who sometimes differ in their ability to take others’ perspectives, make moral judgements that are similar to neurotypical individuals. Moral foundations theory suggests that moral psychology is not hierarchical but differs depending on culture. This theory could therefore help make sense of similarities and differences in autistic and neurotypical moral thinking. Moral foundations theory has not yet been investigated among autistic individuals. In this study, we interviewed autistic adults as a first attempt at understanding how moral foundations theory fits with autistic moral thinking. We found that all five moral foundations of moral foundations theory were represented in the interviews, yet certain foundations appeared more prominent than others. The autistic adults interviewed in our study discussed issues of care and fairness more than of loyalty, authority or purity when prompted to discuss moral transgressions. Future research should use quantitative methods to compare groups of autistic and neurotypical individuals to clarify similarities and differences in moral thinking between the groups.
      Citation: Autism
      PubDate: 2020-07-15T03:03:54Z
      DOI: 10.1177/1362361320939331
       
  • Autism spectrum disorder/Takiwātanga: An Integrated Data
           Infrastructure-based approach to autism spectrum disorder research in New
           Zealand
    • Authors: Nicholas Bowden, Hiran Thabrew, Jesse Kokaua, Richard Audas, Barry Milne, Kirsten Smiler, Hilary Stace, Barry Taylor, Sheree Gibb
      First page: 2213
      Abstract: Autism, Ahead of Print.
      New Zealand has few estimates of the prevalence of autism spectrum disorder and no national registry. The use of administrative data sources is expanding and could be useful in autism spectrum disorder research. However, the extent to which autism spectrum disorder can be captured in these data sources is unknown. In this study, we utilised three linked administrative health data sources from the Integrated Data Infrastructure to identify cases of autism spectrum disorder among New Zealand children and young people. We then investigated the extent to which a range of mental health, neurodevelopmental and related problems co-occur with autism spectrum disorder. In total, 9555 unique individuals aged 0–24 with autism spectrum disorder were identified. The identification rate for 8-year-olds was 1 in 102. Co-occurring mental health or related problems were noted in 68% of the autism spectrum disorder group. The most common co-occurring conditions were intellectual disability, disruptive behaviours and emotional problems. Although data from the Integrated Data Infrastructure may currently undercount cases of autism spectrum disorder, they could be useful for monitoring service and treatment-related trends, types of co-occurring conditions and for examining social outcomes. With further refinement, the Integrated Data Infrastructure could prove valuable for informing the national incidence and prevalence of autism spectrum disorder and the long-term effectiveness of clinical guidelines and interventions for this group.Lay abstractNew Zealand has few estimates of the prevalence autism spectrum disorder and no national registry or data set to identify and track cases. This hinders the ability to make informed, evidence-based decisions relating to autism spectrum disorder. In this study, we utilised linked health and non-health data to develop a method for identifying cases of autism spectrum disorder among children and young people in New Zealand. In addition, we examined rates of co-occurring mental health, neurodevelopmental and related conditions among this cohort and compared these to the general population. The method identified almost 10,000 children and young people with autism spectrum disorder in New Zealand. Co-occurring mental health or related problems were found in over 68% of this group (nearly seven times higher than the general population), and around half were identified with multiple co-occurring conditions. The most frequently identified conditions were intellectual disability, disruptive behaviours and emotional problems. We have developed a useful method for monitoring service and treatment-related trends, number and types of co-occurring conditions and examining social outcomes among individuals with autism spectrum disorder. While the method may underestimate the prevalence of autism spectrum disorder in New Zealand, it provides a significant step towards establishing a more comprehensive evidence base to inform autism spectrum disorder–related policy.
      Citation: Autism
      PubDate: 2020-07-17T09:07:17Z
      DOI: 10.1177/1362361320939329
       
  • Challenges, priorities, barriers to care, and stigma in families of people
           with autism: Similarities and differences among six Latin American
           countries
    • Authors: Cristiane Silvestre Paula, Sebastián Cukier, Graccielle Rodrigues Cunha, Matías Irarrázaval, Cecilia Montiel-Nava, Ricardo Garcia, Analia Rosoli, Daniel Valdez, Daniela Bordini, Andy Shih, Gabriela Garrido, Alexia Rattazzi
      First page: 2228
      Abstract: Autism, Ahead of Print.
      Lack of access to services and support is an important issue for people with autism, but in low- and middle-income countries there is a lack of data on this problem. The aims of this study were to describe the challenges and priorities, identify barriers to care, and map stigma among families of individuals with autism in Latin America. This survey was undertaken by the Red Espectro Autista Latinoamerica network, a coalition of researchers/clinicians from six Latin American countries; it comprised 2942 caregivers of children with autism from Brazil, Argentina, Chile, Uruguay, Venezuela, and the Dominican-Republic, who completed the Spanish/Portuguese version of the Caregiver Needs Survey. The survey showed that the main priorities were greater community awareness and improvements in education. The main barriers to care were waiting lists (50.2%), treatment costs (35.2%), and lack of specialized services (26.1%). Stigma experienced by families was frequent: one-third reported feeling discriminated against and helpless for having a child with autism, 48.8% reported some type of financial problem, 47.4% had to reduce work hours, and 35.5% had to stop working because of their child’s autism. This survey describes the main needs/challenges faced by individuals with autism in Latin America, helping to build data-driven strategies at a national/regional level.Lay abstractApproximately 6 million individuals with autism spectrum disorder live in Latin America. In order to strengthen autism spectrum disorder research collaborations and awareness in the region, the Latin American Autism Spectrum Network (Red Espectro Autista Latinoamerica) was constituted in 2015, comprising researchers and clinicians from the following six countries: Brazil Argentina, Chile, Uruguay, Venezuela, and the Dominican Republic. This first multisite study from the Red Espectro Autista Latinoamerica network aims to describe the challenges and priorities to identify barriers to care and to map stigma among families of individuals with autism spectrum disorder living in Latin America. A total of 2942 caregivers from these six countries completed an online survey showing that the main priorities were greater community awareness and improvements in the educational system for individuals with autism spectrum disorder. In addition to that, the main barriers to care were related to lack of structure, mainly waiting lists (50.2%), high treatment costs (35.2%), and lack of specialized services (26.1%). Stigma experienced by families was frequent: one third reported feeling discriminated against and helpless for having a child with autism spectrum disorder. Also, 48.8% of the caregivers declared financial problems, 47.4% of them had to cut down work hours, and 35.5% had to leave their jobs because of their child’s autism spectrum disorder. This is a pioneer study providing a description of the needs and challenges faced by families affected by autism spectrum disorder in Latin America, helping to build data-driven strategies at the national and regional levels.
      Citation: Autism
      PubDate: 2020-07-27T10:53:45Z
      DOI: 10.1177/1362361320940073
       
  • Parents’ perceptions and concerns about physical activity participation
           among adolescents with autism spectrum disorder
    • Authors: Susann Arnell, Kajsa Jerlinder, Lars-Olov Lundqvist
      First page: 2243
      Abstract: Autism, Ahead of Print.
      The parents of adolescents with autism spectrum disorder have a vital and proactive role in encouraging healthy physical activity habits, and they possess important knowledge about the adolescents’ needs when it comes to enhancing participation in physical activity. But promoting healthy physical activity habits in adolescents can be difficult. The purpose of this study was thus to describe parents’ perceptions of their adolescent child’s participation in physical activity and to describe the parental role in promoting such participation. Twenty-eight parents of adolescents aged 12–16 years with autism spectrum disorder were interviewed. The interviews were analyzed using an inductive content analysis approach. The parents described how challenging participation in physical activities could be for their adolescents. Despite this, they wanted to see their children participate more in physical activity but found the promotion of physical activity to be an overwhelming task that was difficult to cope with on their own. The results reveal a need for support and collaborative efforts among different actors to give these issues increased priority in order to promote the adolescents’ physical activity participation.Lay abstractWhat is already known about the topic' The parents of adolescents with autism spectrum disorder have a vital and proactive role in encouraging healthy physical activity habits. But promoting healthy physical activity habits in adolescents can be difficult. The purpose of this study was thus to describe the parental perceptions of their adolescent child’s participation in physical activity and to describe the parental role in promoting such participation. Twenty-eight parents of adolescents aged 12–16 years with autism spectrum disorder were interviewed.What this paper adds' The parents described how challenging participation in physical activities could be for their adolescents. Despite this, they wanted to see their children participate more in physical activity but found the promotion of physical activity to be an overwhelming task that was difficult to cope with on their own.Implications for practice, research, or policy. The results reveal a need for support and collaborative efforts among different actors to give these issues increased priority in order to promote the adolescents’ physical activity participation.
      Citation: Autism
      PubDate: 2020-07-25T11:12:02Z
      DOI: 10.1177/1362361320942092
       
  • Assessing the convergence of self-report and informant measures for adults
           with autism spectrum disorder
    • Authors: Rachel K Sandercock, Elena M Lamarche, Mark R Klinger, Laura G Klinger
      First page: 2256
      Abstract: Autism, Ahead of Print.
      Self-report measures are widely used for research and clinical assessment of adults with autism spectrum disorder. However, there has been little research examining the convergence of self- and informant-report in this population. This study examined agreement between 40 pairs of adults with autism spectrum disorder and their caregivers on measures of symptom severity, daily living skills, quality of life, and unmet service needs. In addition, this study examined the predictive value of each reporter for objective independent living and employment outcomes. Caregiver and self-report scores were significantly positively correlated on all measures (all r’s>0.50). Results indicated that there were significant differences between reporter ratings of daily living skills, quality of life, and unmet service needs, but no significant differences between ratings of symptom severity. Combining caregiver-report and self-report measures provided significantly higher predictive value of objective outcomes than measures from a single reporter. These findings indicate that both informants provide valuable information and adults with autism spectrum disorder should be included in reporting on their own symptoms and experiences. Given that two reporters together were more predictive of objective outcomes; however, a multi-informant assessment may be the most comprehensive approach for evaluating current functioning and identifying service needs in this population.Lay AbstractSelf-report measures are frequently used for research and clinical assessments of adults with autism spectrum disorder. However, there has been little research examining agreement between self-report and informant-report in this population. Valid self-report measures are essential for conducting research with and providing high quality clinical services for adults with autism spectrum disorder. This study collected measures from 40 pairs of adults with autism spectrum disorder and their caregivers on measures of symptom severity, daily living skills, quality of life, and unmet service needs. Caregiver and self-report responses were highly associated with one another on all measures, though there were significant gaps between scores on the measures of daily living skills and quality of life. It is also important to understand how each informant’s responses relate to outcomes in the areas of employment and independent living. Using self-report and caregiver-report together better predicted outcomes for the adult with autism spectrum disorder than scores from either individual reporter alone. These findings show that there is unique and valuable information provided by both adults with autism spectrum disorder and their caregivers; a multi-informant approach is important for obtaining the most comprehensive picture of current functioning, identifying unmet service needs, and creating treatment plans. This research also highlights the importance of including and prioritizing self-report perspectives in shaping service planning.
      Citation: Autism
      PubDate: 2020-08-03T05:56:27Z
      DOI: 10.1177/1362361320942981
       
  • A comparative feasibility study of two parent education and training
           programmes for autism spectrum disorder in a low-resource South African
           setting
    • Authors: John-Joe Dawson-Squibb, Petrus J de Vries
      First page: 2269
      Abstract: Autism, Ahead of Print.
      Despite the clear need for post-diagnostic parent/carer education and training in autism spectrum disorder, the evidence base is small, particularly in low-resource settings. Furthermore, few studies have examined the feasibility of intervention implementation. Here, we performed a comparative feasibility study of two Parent Education and Training programmes in a low-resource South African setting. EarlyBird/EarlyBird Plus, a UK-developed programme was compared to Autism Cares, a locally developed programme. The aims were to (1) examine acceptability, adaptation and perform limited efficacy testing and (2) use a multi-stakeholder panel and new autism spectrum disorder Parent Education and Training evaluation framework checklist to compare the programmes. A mixed-method, quasi-experimental design collected pre, post and 3-month follow-up data. Measures included standardised and custom-designed quantitative and qualitative data. In total, 18 parents participated in the EarlyBird/EarlyBird Plus programmes and 11 in Autism Cares. Strong parental acceptability for both programmes was found and adaptation suggestions were provided. Limited efficacy testing showed positive changes for parental stress, knowledge of autism spectrum disorder and child changes. The multi-stakeholder panel rated EarlyBird/EarlyBird Plus superior for next-step research based on implementation feasibility. Our findings contribute to the limited evidence base for autism spectrum disorder Parent Education and Training in low-resource environments and underline the need for evidence base of programmes to include not only intervention outcomes but also procedural and implementation outcomes.Lay AbstractAfter a diagnosis of autism, it is an important first step to give families information about autism and skills to help them support their child. These interventions are called Parent Education and Training programmes. Little is known about these programmes or if they can make a difference to families, particularly in countries with few autism resources. In this study, we compared two Parent Education and Training programmes in South Africa. EarlyBird/EarlyBird Plus was developed in the United Kingdom, and Autism Cares in South Africa. We wanted to know if parents found the programmes useful, and if any changes were required. We collected information from parents through questionnaires and interviews before and after the group. We also asked a panel of experts (including parents) to compare the programmes. In total, 18 parents attended the EarlyBird/EarlyBird Plus group and 11 attended the Autism Cares group. Parents found both programmes helpful and made suggestions for improvements. Parents showed less stress, more knowledge of autism, and saw improvements in their children. The expert panel rated EarlyBird/EarlyBird Plus as better because it was more supportive of parents and was seen as easier to run in the country. Our study showed that Parent Education and Training programmes are important, but that researchers must study not only the outcomes but also the implementation needs of these programmes.
      Citation: Autism
      PubDate: 2020-07-28T10:26:12Z
      DOI: 10.1177/1362361320942988
       
  • Identifying and measuring the common elements of naturalistic
           developmental behavioral interventions for autism spectrum disorder:
           Development of the NDBI-Fi
    • Authors: Kyle M Frost, Jessica Brian, Grace W Gengoux, Antonio Hardan, Sarah R Rieth, Aubyn Stahmer, Brooke Ingersoll
      First page: 2285
      Abstract: Autism, Ahead of Print.
      Naturalistic developmental behavioral interventions for young children with autism spectrum disorder share key elements. However, the extent of similarity and overlap in techniques among naturalistic developmental behavioral intervention models has not been quantified, and there is no standardized measure for assessing the implementation of their common elements. This article presents a multi-stage process which began with the development of a taxonomy of elements of naturalistic developmental behavioral interventions. Next, intervention experts identified the common elements of naturalistic developmental behavioral interventions using quantitative methods. An observational rating scheme of those common elements, the eight-item NDBI-Fi, was developed. Finally, preliminary analyses of the reliability and the validity of the NDBI-Fi were conducted using archival data from randomized controlled trials of caregiver-implemented naturalistic developmental behavioral interventions, including 87 post-intervention caregiver–child interaction videos from five sites, as well as 29 pre–post video pairs from two sites. Evaluation of the eight-item NDBI-Fi measure revealed promising psychometric properties, including evidence supporting adequate reliability, sensitivity to change, as well as concurrent, convergent, and discriminant validity. Results lend support to the utility of the NDBI-Fi as a measure of caregiver implementation of common elements across naturalistic developmental behavioral intervention models. With additional validation, this unique measure has the potential to advance intervention science in autism spectrum disorder by providing a tool which cuts across a class of evidence-based interventions.Lay abstractNaturalistic developmental behavioral interventions for young children with autism spectrum disorder share key elements. However, the extent of similarity between programs within this class of evidence-based interventions is unknown. There is also currently no tool that can be used to measure the implementation of their common elements. This article presents a multi-stage process which began with defining all intervention elements of naturalistic developmental behavioral interventions. Next, intervention experts identified the common elements of naturalistic developmental behavioral interventions using a survey. An observational rating scheme of those common elements, the eight-item NDBI-Fi, was developed. We evaluated the quality of the NDBI-Fi using videos from completed trials of caregiver-implemented naturalistic developmental behavioral interventions. Results showed that the NDBI-Fi measure has promise; it was sensitive to change, related to other similar measures, and demonstrated adequate agreement between raters. This unique measure has the potential to advance intervention science in autism spectrum disorder by providing a tool to measure the implementation of common elements across naturalistic developmental behavioral intervention models. Given that naturalistic developmental behavioral interventions have numerous shared strategies, this may ease clinicians’ uncertainty about choosing the “right” intervention package. It also suggests that there may not be a need for extensive training in more than one naturalistic developmental behavioral intervention. Future research should determine whether these common elements are part of other treatment approaches to better understand the quality of services children and families receive as part of usual care.
      Citation: Autism
      PubDate: 2020-07-30T12:01:07Z
      DOI: 10.1177/1362361320944011
       
  • Comparing sleep patterns between children with autism spectrum disorder
           and children with typical development: A matched case–control study
    • Authors: Andy CY Tse, CCW Yu, Paul H Lee
      First page: 2298
      Abstract: Autism, Ahead of Print.
      Children with autism spectrum disorder are often reported to have more sleep deficits and poorer sleep quality compared with children with typical development. However, most previous studies have serious methodological limitations, such as varying sample sizes in the comparison groups, wide age range of participants, and body mass index not matched between participants. This study investigated whether sleep patterns differed between children with autism spectrum disorder and those with typical development using a carefully matched case–control design and incorporating both actigraphy and sleep log assessments. A total of 78 children diagnosed with autism spectrum disorder were matched with 78 typical development controls in this study. The matched variables included age, gender, and body mass index. The results showed that children with autism spectrum disorder had shorter sleep duration, reduced sleep efficiency, longer sleep-onset latency, and longer wake after sleep onset than children with typical development (ps 
      Citation: Autism
      PubDate: 2020-07-07T08:29:53Z
      DOI: 10.1177/1362361320936827
       
  • Speeded reasoning moderates the inverse relationship between autistic
           traits and emotion recognition
    • Authors: Alex Bertrams, Katja Schlegel
      First page: 2304
      Abstract: Autism, Ahead of Print.
      People with diagnosed autism or being high in autistic traits have been found to have difficulties with recognizing emotions from nonverbal expressions. In this study, we investigated whether speeded reasoning (reasoning performance under time pressure) moderates the inverse relationship between autistic traits and emotion recognition performance. We expected the negative correlation between autistic traits and emotion recognition to be less strong when speeded reasoning was high. The underlying assumption is that people high in autistic traits can compensate for their low intuition in recognizing emotions through quick analytical information processing. A paid online sample (N = 217) completed the 10-item version of the Autism Spectrum Quotient, two emotion recognition tests using videos with sound (Geneva Emotion Recognition Test) and pictures (Reading the Mind in the Eyes Test), and Baddeley’s Grammatical Reasoning Test to measure speeded reasoning. As expected, the inverse relationship between autistic traits and emotion recognition performance was less pronounced for individuals with high compared to low speeded reasoning ability. These results suggest that a high ability in making quick mental inferences may (partly) compensate for difficulties with intuitive emotion recognition related to autistic traits.Lay abstractAutistic people typically have difficulty recognizing other people’s emotions and to process nonverbal cues in an automatic, intuitive fashion. This usually also applies to people who—regardless of an official diagnosis of autism—achieve high values in autism questionnaires. However, some autistic people do not seem to have any problems with emotion recognition. One explanation may be that these individuals are able to compensate for their lack of intuitive or automatic processing through a quick conscious and deliberate analysis of the emotional cues in faces, voices, and body movements. On these grounds, we assumed that the higher autistic people’s ability to reason quickly (i.e. to make quick logical inferences), the fewer problems they should have with determining other people’s emotions. In our study, we asked workers on the crowdsourcing marketplace MTurk to complete a questionnaire about their autistic traits, to perform emotion recognition tests, and to complete a test of the ability to reason under time constraints. In our sample of 217 people, we found the expected pattern. Overall, those who had higher values in the autism questionnaire scored lower in the emotion recognition tests. However, when reasoning ability was taken into account, a more nuanced picture emerged: participants with high values both on the autism questionnaire and on the reasoning test recognized emotions as well as individuals with low autistic traits. Our results suggest that fast analytic information processing may help autistic people to compensate problems in recognizing others’ emotions.
      Citation: Autism
      PubDate: 2020-07-11T05:26:29Z
      DOI: 10.1177/1362361320937090
       
 
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