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  Subjects -> DISABILITY (Total: 114 journals)
Showing 1 - 200 of 310 Journals sorted alphabetically
Advances in Autism     Hybrid Journal   (Followers: 42)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Mental Health and Intellectual Disabilities     Hybrid Journal   (Followers: 89)
Advances in Mental Health and Learning Disabilities     Hybrid Journal   (Followers: 32)
Aequitas : Revue de Développement Humain, Handicap et Changement Social     Full-text available via subscription   (Followers: 10)
African Journal of Disability     Open Access   (Followers: 9)
Ageing & Society     Hybrid Journal   (Followers: 48)
ALTER - European Journal of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 13)
American Annals of the Deaf     Full-text available via subscription   (Followers: 19)
American Journal of Speech-Language Pathology     Full-text available via subscription   (Followers: 58)
American Journal on Intellectual and Developmental Disabilities     Full-text available via subscription   (Followers: 67)
Aphasiology     Hybrid Journal   (Followers: 61)
Assistive Technology: The Official Journal of RESNA     Hybrid Journal   (Followers: 22)
Audiology     Open Access   (Followers: 12)
Audiology - Communication Research     Open Access   (Followers: 12)
Audiology Research     Open Access   (Followers: 11)
Augmentative and Alternative Communication     Hybrid Journal   (Followers: 50)
Autism     Hybrid Journal   (Followers: 351)
Autism & Developmental Language Impairments     Open Access   (Followers: 16)
Autism in Adulthood     Hybrid Journal   (Followers: 9)
Autism Research     Hybrid Journal   (Followers: 58)
Autism's Own     Open Access   (Followers: 9)
British Journal of Learning Disabilities     Hybrid Journal   (Followers: 102)
British Journal of Special Education     Hybrid Journal   (Followers: 54)
British Journal of Visual Impairment     Hybrid Journal   (Followers: 14)
Canadian Journal of Disability Studies     Open Access   (Followers: 39)
Deafness & Education International     Hybrid Journal   (Followers: 6)
Developmental Disabilities Research Reviews     Hybrid Journal   (Followers: 27)
Disability & Rehabilitation     Hybrid Journal   (Followers: 85)
Disability & Society     Hybrid Journal   (Followers: 90)
Disability and Health Journal     Hybrid Journal   (Followers: 23)
Disability and Rehabilitation: Assistive Technology     Hybrid Journal   (Followers: 48)
Disability Compliance for Higher Education     Hybrid Journal   (Followers: 10)
Disability Studies Quarterly     Open Access   (Followers: 46)
Disability, CBR & Inclusive Development     Open Access   (Followers: 17)
Distúrbios da Comunicação     Open Access  
Early Popular Visual Culture     Hybrid Journal   (Followers: 5)
European Review of Aging and Physical Activity     Open Access   (Followers: 11)
Health Expectations     Open Access   (Followers: 16)
Hearing, Balance and Communication     Hybrid Journal   (Followers: 5)
Inclusion     Full-text available via subscription   (Followers: 21)
Indian Journal of Cerebral Palsy     Open Access   (Followers: 1)
Intellectual and Developmental Disabilities     Full-text available via subscription   (Followers: 43)
Intellectual Disability Australasia     Full-text available via subscription   (Followers: 13)
International Journal of Audiology     Hybrid Journal   (Followers: 20)
International Journal of Developmental Disabilities     Hybrid Journal   (Followers: 41)
International Journal of Disability Management Research     Full-text available via subscription   (Followers: 11)
International Journal of Language & Communication Disorders     Hybrid Journal   (Followers: 60)
International Journal of Orthopaedic and Trauma Nursing     Hybrid Journal   (Followers: 12)
International Journal of Technology Assessment in Health Care     Hybrid Journal   (Followers: 16)
International Journal on Disability and Human Development     Hybrid Journal   (Followers: 23)
Journal for Healthcare Quality     Hybrid Journal   (Followers: 28)
Journal of Accessibility and Design for All     Open Access   (Followers: 14)
Journal of Adult Protection, The     Hybrid Journal   (Followers: 16)
Journal of Aging and Health     Hybrid Journal   (Followers: 27)
Journal of Applied Research in Intellectual Disabilities     Hybrid Journal   (Followers: 53)
Journal of Assistive Technologies     Hybrid Journal   (Followers: 20)
Journal of Autism and Developmental Disorders     Hybrid Journal   (Followers: 94)
Journal of Deaf Studies and Deaf Education     Hybrid Journal   (Followers: 13)
Journal of Disability & Religion     Hybrid Journal   (Followers: 14)
Journal of Disability Policy Studies     Hybrid Journal   (Followers: 31)
Journal of Early Hearing Detection and Intervention     Open Access   (Followers: 7)
Journal of Elder Abuse & Neglect     Hybrid Journal   (Followers: 10)
Journal of Enabling Technologies     Hybrid Journal   (Followers: 11)
Journal of Gerontological Social Work     Hybrid Journal   (Followers: 15)
Journal of Integrated Care     Hybrid Journal   (Followers: 22)
Journal of Intellectual & Developmental Disability     Hybrid Journal   (Followers: 66)
Journal of Intellectual Disabilities     Hybrid Journal   (Followers: 40)
Journal of Intellectual Disabilities and Offending Behaviour     Hybrid Journal   (Followers: 55)
Journal of Intellectual Disability - Diagnosis and Treatment     Hybrid Journal   (Followers: 9)
Journal of Intellectual Disability Research     Hybrid Journal   (Followers: 71)
Journal of Learning Disabilities and Offending Behaviour     Hybrid Journal   (Followers: 28)
Journal of Literary & Cultural Disability Studies     Hybrid Journal   (Followers: 15)
Journal of Occupational Therapy, Schools, & Early Intervention     Hybrid Journal   (Followers: 56)
Journal of Policy and Practice In Intellectual Disabilities     Hybrid Journal   (Followers: 25)
Journal of Science Education for Students with Disabilities     Open Access   (Followers: 4)
Journal of Social Work in Disability & Rehabilitation     Hybrid Journal   (Followers: 20)
Journal of Speech, Language, and Hearing Research     Full-text available via subscription   (Followers: 95)
Journal of Spinal Cord Medicine     Hybrid Journal   (Followers: 5)
Learning Disabilities : A Multidisciplinary Journal     Full-text available via subscription   (Followers: 11)
Learning Disability Practice     Full-text available via subscription   (Followers: 26)
Mental Health Practice     Full-text available via subscription   (Followers: 24)
Music and Medicine     Hybrid Journal   (Followers: 2)
Physical & Occupational Therapy in Pediatrics     Hybrid Journal   (Followers: 70)
Physical Disabilities : Education and Related Services     Open Access   (Followers: 4)
Pró-Fono Revista de Atualização Científica     Open Access  
Public Policy and Aging Report     Hybrid Journal   (Followers: 2)
Quality in Ageing and Older Adults     Hybrid Journal   (Followers: 47)
Research and Practice in Intellectual and Developmental Disabilities     Hybrid Journal  
Revista Brasileira de Educação Especial     Open Access   (Followers: 1)
Revista Espaço     Open Access  
Revista Española de Discapacidad     Open Access  
Revista Médica Internacional sobre el Síndrome de Down     Full-text available via subscription   (Followers: 1)
Revue francophone de la déficience intellectuelle     Full-text available via subscription   (Followers: 1)
Scandinavian Journal of Disability Research     Open Access   (Followers: 27)
Sexuality and Disability     Hybrid Journal   (Followers: 18)
Siglo Cero. Revista Española sobre Discapacidad Intelectual     Open Access  
Sign Language Studies     Full-text available via subscription   (Followers: 7)
Social Care and Neurodisability     Hybrid Journal   (Followers: 7)
Society and Mental Health     Hybrid Journal   (Followers: 14)
Speech Communication     Hybrid Journal   (Followers: 16)
Stigma and Health     Full-text available via subscription  
Stress     Hybrid Journal   (Followers: 7)
Technical Aid to the Disabled Journal     Full-text available via subscription   (Followers: 1)
Technology and Disability     Hybrid Journal   (Followers: 28)
Tizard Learning Disability Review     Hybrid Journal   (Followers: 52)
Topics in Language Disorders     Hybrid Journal   (Followers: 14)
Visual Cognition     Hybrid Journal   (Followers: 13)
Visual Communication     Hybrid Journal   (Followers: 11)
Visual Communication Quarterly     Hybrid Journal   (Followers: 7)
Visual Studies     Hybrid Journal   (Followers: 5)
Working with Older People     Hybrid Journal   (Followers: 40)

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Similar Journals
Journal Cover
Autism
Journal Prestige (SJR): 1.739
Citation Impact (citeScore): 4
Number of Followers: 351  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1362-3613 - ISSN (Online) 1461-7005
Published by Sage Publications Homepage  [1141 journals]
  • ‘No idea of time’: Parents report differences in autistic children’s
           behaviour relating to time in a mixed-methods study
    • Authors: Daniel Poole, Emma Gowen, Ellen Poliakoff, Luke A Jones
      Abstract: Autism, Ahead of Print.
      An emerging body of research suggests that temporal processing may be disrupted in autistic children, although little is known about behaviours relating to time in daily life. In the present study, 113 parents of autistic and 201 parents of neurotypical children (aged 7–12 years) completed the It’s About Time questionnaire and open-ended questions about their child’s behaviour relating to time. The questionnaire scores were lower in the autistic compared with the neurotypical group, suggesting that behaviours are affected. Three key themes were identified using thematic analysis: autistic children had problems with temporal knowledge, learning about concepts relating to time, such as how to use the clock and language around time. There were differences in prospection with autistic children having more difficulties with how they thought about the future and prepared themselves for upcoming events. The final theme, monotropism, described how autistic children viewed their time as precious so they could maximise engagement in their interests. The present study indicates that behaviours relating to time can have a considerable impact on the daily lives of autistic children and their families. Further work exploring the development of temporal cognition in autism would be valuable for targeting effective educational and clinical support.Lay abstractMany everyday activities require us to organise our behaviours with respect to time. There is some evidence that autistic children have problems with how they perceive and understand time. However, little is currently known about this, or the ways in which behaviours related to time are impacted in daily life. In this study, 113 parents of autistic children and 201 parents of neurotypical children completed a questionnaire and open-ended questions about their child’s behaviour relating to time. Questionnaire scores were lower in the autistic group compared with neurotypicals, which suggests that behaviours relating to time are affected in autistic children. The open-ended responses further confirmed that the autistic children struggled with time and that this impacted on them and their family. Three key themes were identified. Theme 1: autistic children have problems with learning about concepts relating to time such as telling the time from a clock and using words to describe time (hours, minutes, etc.) appropriately. Theme 2: autistic children think about the future differently. Planning and working under time pressure were described as a problem. Theme 3: autistic children have strong interests which take up a lot of their attention and worrying about having sufficient time to pursue these interests causes anxiety. This research indicates that behaviours related to time can have a considerable impact on the lives of autistic children and that targeted support may be required.
      Citation: Autism
      PubDate: 2021-04-30T08:03:53Z
      DOI: 10.1177/13623613211010014
       
  • Depression in independent young adults on the autism spectrum: Demographic
           characteristics, service use, and barriers
    • Authors: Shuting Zheng, Ryan Adams, Julie Lounds Taylor, Florencia Pezzimenti, Somer L Bishop
      Abstract: Autism, Ahead of Print.
      Depression is a common problem for adults on the autism spectrum, but little is known about depression-related service receipt in this group. To understand depression diagnostic and treatment status better, we collected information on current depressive symptoms, depression diagnosis, and treatment status of 315 young adults with a childhood diagnosis of autism from the Simons Foundation Powering Autism Research for Knowledge registry. About two-thirds (65.4%) of the adults had been diagnosed with depression, and 46.7% currently met clinical cut-offs for depression on depressive symptoms measures. Among the currently depressed, the majority (83.0%) had a formal depression diagnosis. Despite being no more likely than males to be currently depressed, females (biological sex) were more likely to have received a depression diagnosis. As for depression treatment, 58.5% of currently depressed adults were currently being treated, and 68% had previously received treatment. Medication was the most common form of treatment, followed by individual therapy. Likelihood of receiving depression treatment was higher among those with a formal depression diagnosis and with higher levels of education. Adults reported several barriers to accessing treatment for depression, including financial and insurance issues, accessibility to appropriate care, and professionals’ lack of understanding about depression in autism.Lay abstractDepression is common among adults on the autism spectrum, but little is known about the extent to which these adults living in the community access diagnostic and treatment services for depression. To address this gap, we surveyed 315 adults on the autism spectrum on depression symptoms, diagnosis, and services. About half of the sample had scores on standard depression measures that suggested they were currently depressed (n = 147, 46.7%). Among the currently depressed, most of them had received a depression diagnosis from a professional. Depressed females were about 3.5 times more likely than depressed males to have a depression diagnosis. More than half of the currently depressed adults on the autism spectrum reported receiving depression treatment at the time of the study, while about two-thirds had previously received treatment. Those with a depression diagnosis were more likely to have received treatment, and those who had some education beyond high school were more likely to be currently receiving treatment. Financial and insurance issues were the most common barriers that adults reported in accessing treatment for depression.
      Citation: Autism
      PubDate: 2021-04-28T10:33:48Z
      DOI: 10.1177/13623613211008276
       
  • “This cage that I’m stuck inside”: Autistic adults’ perceptions of
           weight management, body weight, and body image
    • Authors: Sean Healy, Carly Pacanowski, Lauren Kennedy, Iva Obrusnikova
      Abstract: Autism, Ahead of Print.
      Personal beliefs and attitudes about body weight and body image are important determinants of weight management practices. To inform efforts to prevent and treat obesity among autistic adults, this study examined how autistic adults perceive weight management, body weight, and body image. Eleven adults participated in semi-structured interviews. Consistent with an interpretive paradigm, an interpretative phenomenological analysis methodology was employed, resulting in four themes: (a) Mental and physical health: direct and indirect interactions, (b) ASD traits and health-related behaviors, (c) Body dissatisfaction: Unrealistic ideals and misperceptions, and (d) Sources of information. This study’s findings have several implications for research and practice. First, participants viewed overweight and obesity as just one component of a holistic perspective of health. A dynamic, bidirectional relationship between mental health and physical health, including overweight/obesity was described, leading us to posit that the promotion of mental health is crucial for the promotion of overall health among autistic adults. Second, body dissatisfaction was pervasive among participants in this sample. This finding requires future research as it may be an important target for intervention, with relevance for mental health and weight management practices. Finally, interactions with medical professionals regarding weight management were perceived to be inadequate.Lay abstractOur beliefs and feelings about our bodies and our body weight influence our weight management behaviors, such as physical activity and eating behaviors. These beliefs and feelings are largely shaped by how we interact with, and compare ourselves to, people in our lives. Due to the social traits associated with autism, autistic adults may have different perceptions of body weight, body image, and weight management than neurotypical adults. To explore this, for the first time, we interviewed 11 autistic adults. The participants’ perceptions can be summarized in four findings. First, the participants viewed overweight and obesity as just one part of their overall health. Participants described how their mental health and physical health, including overweight/obesity, were closely connected. Second, some traits related to autism made weight management difficult; for example, eating and physical activity were negatively impacted by social anxiety, sensory sensitivity, obsessiveness, and a strong desire for routine. Third, participants were generally dissatisfied with how they looked. This was primarily due to a disconnect between how they felt their body looked and how it actually looked in real life. Other people, including on social media, also negatively influenced how they perceived themselves. Fourth, and finally, participants described how they got most of their weight management-related information online. Medical professionals were frequently described as being unprepared to provide them assistance related to weight management.
      Citation: Autism
      PubDate: 2021-04-28T10:32:07Z
      DOI: 10.1177/13623613211006989
       
  • Parent stress and coping trajectories in Hispanic and non-Hispanic
           families of children at risk of autism spectrum disorder
    • Authors: Emily J Hickey, Michelle Stransky, Jocelyn Kuhn, Jessica E Rosenberg, Howard J Cabral, Carol Weitzman, Sarabeth Broder-Fingert, Emily Feinberg
      Abstract: Autism, Ahead of Print.
      Significant disparities exist between Hispanic and non-Hispanic families in time-to-diagnosis among children identified as at risk of autism spectrum disorder; yet, little is known about parent experiences throughout the diagnostic process that may contribute to or help explain these disparities. The current study examined longitudinal trajectories of parenting stress, coping, and perceived family impact during the autism spectrum disorder diagnostic process among an ethnically and racially diverse low-income, urban sample, allowing for comparisons between Hispanic and non-Hispanic families. Hispanic families reported lower levels of parenting stress (χ2 = 5.35(1), p = 0.021), avoidant (χ2 = 9.66(1), p = 0.002) and approach (χ2 = 8.61(1), p = 0.003) coping, and negative family impact (χ2 = 5.39(1), p = 0.020) across time (main effects) compared with non-Hispanic families. Furthermore, there were differences in the change in use (Time Period × Ethnicity interaction effects) of both avoidant (χ2 = 10.80(3), p = 0.013) and approach (χ2 = 11.57(3), p = 0.009) coping, as well as negative family impact (χ2 = 9.81(3), p = 0.020), between Hispanic and non-Hispanic parents over time. These differences begin to shed light on the unique experiences of Hispanic parents. Because of the strengths that Hispanic families demonstrate, interventions that leverage those strengths and focus on education, empowerment, and resilience might be particularly beneficial for Hispanic families and may also better inform work to increase resilience in non-Hispanic families.Lay abstractLittle is known about parent experiences throughout the diagnostic process for autism or how these parent experiences may help explain the disparities that exist between Hispanic and non-Hispanic families in time-to-diagnosis among children identified as at risk for autism. The current study examined trajectories of parenting stress, coping, and perceived family impact over time, throughout the autism diagnostic process among Hispanic and non-Hispanic families. Hispanic families reported lower levels of parenting stress, coping, and negative family impact across time. Further, there were differences in the change in use of coping and the amount of negative family impact reported between Hispanic and non-Hispanic parents over time. These differences shed light on the unique experiences and strengths of Hispanic families demonstrate. Interventions that leverage those strengths and focus on education, empowerment, and resilience might be particularly beneficial for Hispanic families and may also better inform work to increase resilience.
      Citation: Autism
      PubDate: 2021-04-28T10:21:47Z
      DOI: 10.1177/13623613211001611
       
  • Comparison of mental health, well-being and parenting sense of competency
           among Australian and South-East Asian parents of autistic children
           accessing early intervention in Australia
    • Authors: Jodie Smith, Rhylee Sulek, Ifrah Abdullahi, Cherie C Green, Catherine A Bent, Cheryl Dissanayake, Kristelle Hudry
      Abstract: Autism, Ahead of Print.
      Parents from individualist cultures (those focused on autonomy of individuals; that is, Australian) may view their autistic children differently compared to parents from collectivist cultures (where community needs are valued over an individual’s, that is, South-East Asian cultures). As most research on autism and parenting has been undertaken in Western individualist cultures, knowledge of parenting beliefs and mental health within collectivist cultures is lacking. We compared the mental health, quality of life, well-being and parenting sense of competency between families raising an autistic child from two groups: 97 Australian parents and 58 parents from South-East Asian backgrounds. Children from both groups were receiving the same community-based early intervention. No group differences were found on the measures of mental health but, when compared to Australian parents, parents from South-East Asian backgrounds reported higher well-being and less impact on their quality of life resulting from their child’s autism-specific difficulties. Furthermore, a positive association between well-being and quality of life was only observed for South-East Asian parents. Hence, the views of, and responses to, disability for South-East Asian parents may act as a protective factor promoting well-being. This novel research indicates that culture plays a role in parenting autistic children and highlights the need to accurately capture cultural background information in research.Lay abstractWe know that parents of autistic children experience poorer mental health and lower well-being than parents of non-autistic children. We also know that poorer mental health among parents of autistic children has been observed across different cultures. Most research focuses on Western cultures, so we know little about parental mental health and well-being of parents from different cultural backgrounds; yet, it is likely that cultural background contributes to how parents view their child’s condition and respond to the diagnosis. Here, we compared mental health, quality of life and well-being between families raising an autistic child from Australian backgrounds to families from South-East Asian backgrounds. All children in the current study were receiving the same community-based early intervention. When compared to the general population, parents had poorer mental health overall, but there were no differences between the two groups of parents. However, parents from South-East Asian backgrounds reported higher well-being and fewer difficulties associated with their child’s autism. These findings suggest that cultural background likely influences not only parent’s view of, and response to, their child’s autism, but also their own sense of well-being. As researchers and clinicians working with families of autistic children, we should more explicitly consider family’s cultural background within our work.
      Citation: Autism
      PubDate: 2021-04-26T04:43:42Z
      DOI: 10.1177/13623613211010006
       
  • Baseline behaviour moderates movement skill intervention outcomes among
           young children with autism spectrum disorder
    • Authors: Emily Bremer, Meghann Lloyd
      Abstract: Autism, Ahead of Print.
      This study examined whether adaptive behaviour, emotional and behavioural challenges, and social skills, respectively, moderated the effect of a movement skill intervention on movement skills among preschool aged children with autism spectrum disorder. Twenty-seven participants with autism spectrum disorder (N = 13 experimental) between 3 and 5 years of age participated in a 12-week fundamental movement skill intervention. Movement skills were assessed at baseline and post-test. Adaptive behaviour, emotional and behavioural challenges, and social skills were assessed at baseline. A repeated-measures analysis of variance tested the group by time effect on movement skills. Three separate moderation analyses were then run to test the moderating effect of adaptive behaviour, emotional and behavioural challenges, and social skills, respectively, on the relationship between group assignment and movement skills at the post-test. The experimental group significantly improved their movement skills following the intervention (p = 0.02, ηp2=.19). The moderation analyses showed that adaptive behaviour (b(SE) = 0.86 (0.41), p < 0.05) and emotional and behavioural challenges (b(SE) = −1.5 (0.8), p = 0.06) at baseline moderated the association between group and post-test movement skills, when controlling for baseline movement skills. These findings may help caregivers and clinicians individualize treatment plans in regard to movement skill interventions for preschool-aged children with autism spectrum disorder.Lay abstractIt is common for children with autism spectrum disorder to experience delays in their movement skills. These skills are important for participation in play and physical activity. Previous research has found that movement skills can be improved with movement skill interventions. This study explored the behavioural factors of young children with autism spectrum disorder that make them most likely to improve their movement skills following a 12-week intervention. The study found that children with higher levels of adaptive behaviour and lower levels of emotional and behavioural challenges at the start of the intervention were more likely to have greater improvements in their movement skills following the intervention. These findings may help clinicians and caregivers plan which types of interventions are best suited for individual children with autism spectrum disorder.
      Citation: Autism
      PubDate: 2021-04-23T05:28:01Z
      DOI: 10.1177/13623613211009347
       
  • Early detection of young children at risk of autism spectrum disorder at
           well-baby clinics in the Netherlands: Perspectives of preventive care
           physicians
    • Authors: Michelle IJ Snijder, Shireen PT Kaijadoe, Maarten van ‘t Hof, Wietske A Ester, Jan K Buitelaar, Iris J Oosterling
      Abstract: Autism, Ahead of Print.
      To improve early detection of autism spectrum disorder in preventive care, a Dutch guideline was developed 5 years ago. The guideline provides preventive care physicians at well-baby clinics action-oriented advice and describes a step-by-step approach for children identified at an increased risk for autism spectrum disorder during general healthcare surveillance. This qualitative study evaluated the guideline adherence and studied barriers regarding early detection of autism spectrum disorder at well-baby clinics. Semi-structured interviews were undertaken with 12 preventive care physicians (one representative per province). Interviews were analyzed using grounded theory. It was found that the vast majority of participants did not follow-up general surveillance with an autism spectrum disorder–specific screener as prescribed by the guideline. Six barriers, to be divided in personal, guideline-related and external factors, were found regarding early detection of autism spectrum disorder and adherence to the guideline. The results of this study highlight the importance of an integrative approach, raising awareness of the benefits regarding early detection of autism spectrum disorder in preventive care, the need of continuous investment in easy and accessible training and active screening, and a closer collaboration between preventive care organizations and autism spectrum disorder experts.Lay To improve early detection of autism spectrum disorder in preventive care, a Dutch guideline was developed 5 years ago. The guideline provides preventive care physicians at well-baby clinics action-oriented advice and describes a step-by-step approach for children identified at an increased risk for autism spectrum disorder during general healthcare surveillance. The present qualitative study evaluated adherence to the guideline and studied barriers regarding early detection of autism spectrum disorder at well-baby clinics. Interviews were undertaken with 12 preventive care physicians (one representative per province). It was found that the vast majority of participants did not follow-up general surveillance with an autism spectrum disorder -specific screener as prescribed by the guideline. Six barriers (limited knowledge about autism spectrum disorder symptoms in infant and toddlerhood, professional attitude toward early detection, problems in discussing initial worries with parents, limited use of screening instruments, perceptions toward cultural and language differences and constraints regarding availability of healthcare services) were found. The results of this study highlight the importance of an integrative approach, raising awareness of the benefits regarding early detection of autism spectrum disorder in preventive care, the need of continuous investment in easy and accessible training and active screening, and a closer collaboration between preventive care organizations and autism spectrum disorder experts.
      Citation: Autism
      PubDate: 2021-04-22T12:09:42Z
      DOI: 10.1177/13623613211009345
       
  • Autism spectrum disorder prevalence and associated sociodemographic
           factors in the school population: EPINED study
    • Authors: Paula Morales Hidalgo, Núria Voltas Moreso, Josefa Canals Sans
      Abstract: Autism, Ahead of Print.
      The autism spectrum disorder prevalence data for southern Europe seem to be lower than international reports. The objective of the Neurodevelopmental Disorders Epidemiological Research Project was to estimate the prevalence of autism spectrum disorder in a representative school sample of Tarragona, Spain. Screening was performed through parents (N = 3727) and teachers (N = 6894), and 781 children were individually assessed. The overall estimated prevalence was 1.53% (1.78% in preschoolers; 1.30% in primary school children), being significantly higher than the 0.83% previously registered (0.92% and 0.74%, respectively). Respectively, 4.23% and 2.85% of the children showed subclinical autism spectrum disorder. Girls showed a significantly lower prevalence in all the conditions. Severity profiles were distributed as 46% mild, 47% moderate and 7% severe. A high ratio of males (90%) and children from Eastern Europe (16%) was found among severe autism spectrum disorder. Language therapy (51%) and psychological (65%) and educational supports (65%) were given to children with autism spectrum disorder. Pharmacological treatment was only found among school-aged children (37.5%). Public schools provided more educational support (72%) than private schools (36%). The heterogeneity of autism spectrum disorder makes it difficult to determine specific associated sociodemographic factors. The results confirmed a high prevalence of autism spectrum disorder in this province, suggesting a current under-diagnosis by public health services.Lay abstractAn increase in the prevalence of autism spectrum disorder has been reported around the world over the past decade. However, the prevalence data for southern Europe seem to be lower than international reports and notable methodological differences have been reported among studies. The objective of the Neurodevelopmental Disorders Epidemiological Research Project was to estimate the prevalence of autism spectrum disorder in a representative school sample of the province of Tarragona, Spain. The study included a screening procedure through parents (N = 3727) and teachers (N = 6894), and an individual assessment of children at risk and a comparison group (N = 781). The overall estimated prevalence in our sample was 1.53%, being significantly higher than the 0.83% previously registered diagnoses. A total of 3.31% of the children presented subclinical characteristics of autism spectrum disorder. Girls showed a significantly lower estimated prevalence in all the conditions. Severity profiles were distributed as 46% mild, 47% moderate and 7% severe. Psychological support (65%), educational support (65%) and language therapy (51%) were given to children with autism spectrum disorder. Pharmacological treatment was only found among school-aged children (37.5%). Public schools provided more educational supports (72%) than private schools (36%). The heterogeneity of autism spectrum disorder makes it difficult to determine specific associated sociodemographic factors. The results confirmed a high prevalence of autism spectrum disorder in the province, suggesting a current under-diagnosis in public health services. In view of the results, it is important to promote early diagnosis and intervention, especially in particular groups such as girls, children with intellectual disabilities and children from immigrant families.
      Citation: Autism
      PubDate: 2021-04-22T12:07:58Z
      DOI: 10.1177/13623613211007717
       
  • Prenatal exposure to paternal smoking and likelihood for autism spectrum
           disorder
    • Authors: Bora Kim, Mina Ha, Young Shin Kim, Yun-Joo Koh, Shan Dong, Ho-Jang Kwon, Young-Suk Kim, Myung-Ho Lim, Ki-Chung Paik, Seung-Jin Yoo, Hosanna Kim, Patricia S Hong, Stephan J Sanders, Bennett L Leventhal
      Abstract: Autism, Ahead of Print.
      Genetics, environment, and their interactions impact autism spectrum disorder etiology. Smoking is a suspected autism spectrum disorder risk factor due to biological plausibility and high prevalence. Using two large epidemiological samples, we examined whether autism spectrum disorder was associated with prenatal paternal smoking in a Discovery sample (N = 10,245) and an independent Replication sample (N = 29,773). Paternal smoking was retrospectively assessed with questionnaires. Likelihood of having autism spectrum disorder was estimated with the Autism Spectrum Screening Questionnaire at three levels: low (
      Citation: Autism
      PubDate: 2021-04-21T04:58:13Z
      DOI: 10.1177/13623613211007319
       
  • Randomized pilot study of a special education advocacy program for
           Latinx/minority parents of children with autism spectrum disorder
    • Authors: Paul Luelmo, Connie Kasari
      Abstract: Autism, Ahead of Print.
      This study reports on a randomized controlled pilot intervention study examining the effectiveness and feasibility of a low-intensity (i.e. three sessions), low-cost, parent advocacy intervention. The intervention study employed community-partnered research methods and targeted a low-income community of mostly Latinx, immigrant-origin parents of children with autism spectrum disorder. The study was designed to test a parent-to-parent advocacy mentorship program in order to increase parent’s special education advocacy knowledge and empowerment. The educational intervention was delivered in Spanish to Spanish-speaking parents. Results indicated significantly increased in parent’s knowledge in the immediate intervention group, but this knowledge did not lead to greater sense of parent’s empowerment. Increases in knowledge about special education rights of their children are the first step toward advocating for services for their children. While parents from low-income, racial/ethnic minority backgrounds, particularly Latinx parents, can significantly increase their advocacy skills with a low-intensity, low-cost program, they may need more support in changing their self-perceptions of empowerment and advocacy.Lay abstractPersistent racial and ethnic disparities in obtaining an autism spectrum disorder diagnosis and services have been documented for Latinx children and other racial/ethnic minorities. This study reports on an educational intervention examining the effectiveness and feasibility of a low-intensity (i.e. three sessions), low-cost, parent advocacy for Latinx and other minority parents of children with autism. Results indicated significantly increased parental knowledge and in the immediate intervention group, but this knowledge did not lead to greater empowerment. While parents from low-income, racial/ethnic minority backgrounds, particularly Latinx parents, can significantly increase their advocacy skills with a low-intensity, low-cost program, they may need more support in changing their self-perceptions of empowerment and advocacy.
      Citation: Autism
      PubDate: 2021-04-17T04:50:06Z
      DOI: 10.1177/1362361321998561
       
  • The effect of early autism intervention on parental sense of efficacy in a
           randomized trial depends on the initial level of parent stress
    • Authors: Annette Estes, Paul Yoder, John McEachin, Gerhard Hellemann, Jeffrey Munson, Jessica Greenson, Marie Rocha, Elizabeth Gardner, Sally J Rogers
      Abstract: Autism, Ahead of Print.
      This study examined whether style or intensity of child-focused intervention had a secondary effect on parental sense of efficacy and whether these effects varied by baseline level of parent stress. We randomized 87 children with autism, age 13–30 months, into one of four conditions: 15 versus 25 intervention hours crossed with 12 months of Early Intensive Behavioral Intervention versus Early Start Denver Model. Baseline parent stress was the putative moderator. Parent sense of efficacy, collected at baseline and the end of treatment, was the dependent variable. Analyses used generalized linear mixed model with full information maximum likelihood estimation. We tested main effects and interactions involving time, treatment intensity and style, and baseline parent stress to test moderation effects. Changes in parent efficacy across 12 months were related to intervention intensity but not style; this effect was moderated by level of parent stress at baseline. Parents with higher stress at the beginning of a 1-year, home-based, comprehensive intervention program had a higher sense of parenting efficacy if their child received lower intensity intervention; parents with lower stress at baseline had a higher sense of efficacy if their child received higher intensity intervention.Lay abstractThis is a study of the secondary effects of interventions for young children with autism on their parents. Specifically, we were interested in the impact on parent’s sense of efficacy, or how confident and competent a parent feels about themselves as a parent. We tested three ideas: (1) that the style of the intervention, whether it was more or less structured and whether the parent had a more or less formal role, would impact a parent’s sense of efficacy; (2) that the intensity of the intervention, how many hours per week the intervention was delivered, would impact parental efficacy; and (3) that the parent’s level of stress prior to intervention would impact how intensity and style effected efficacy. We randomly assigned 87 children with autism, age 13–30 months, into one of four conditions: 15 versus 25 intervention hours crossed with two different styles of intervention. We used statistical tests to examine these ideas. We found that parental efficacy was related to intervention intensity but not style. Parents with higher stress at the beginning of a 1-year, home-based, comprehensive intervention program had a higher sense of parenting efficacy if their child received lower intensity intervention; parents with lower stress at baseline had a higher sense of efficacy if their child received higher intensity intervention. If a parent can emerge from the process of diagnosis and early intervention with an increased sense that they can make a difference in their child’s life (i.e. increased sense of efficacy), it may set the stage for meeting the long-term demands of parenting a child with autism.
      Citation: Autism
      PubDate: 2021-04-16T08:54:53Z
      DOI: 10.1177/13623613211005613
       
  • Autism-specific parenting self-efficacy: An examination of the role of
           parent-reported intervention involvement, satisfaction with
           intervention-related training, and caregiver burden
    • Authors: Jennifer Kurzrok, Eileen McBride, Ruth B Grossman
      Abstract: Autism, Ahead of Print.
      Parenting self-efficacy, described as the beliefs parents hold about their ability to successfully parent their children, has been shown to support parent and child well-being. Parents of children with autism spectrum disorder face disproportionately high levels of demand both as caregivers, and as partners in multiple, complex, intervention programs. This study examines the relationship between parents’ experiences with their child’s interventions—specifically their sense of involvement in treatment and satisfaction with intervention-related training—and their confidence in parenting a child with autism spectrum disorder, defined as autism-specific parenting self-efficacy. Participants (N = 438, 93% mothers of children with autism spectrum disorder aged 2–17 years) completed our novel autism-specific parenting self-efficacy scale and rated their experience of involvement in their child’s interventions and satisfaction with intervention-related training across a range of common autism spectrum disorder–related treatments. Respondents also completed a caregiver burden scale. Findings indicate that parents who report greater involvement in their child’s interventions, and note greater satisfaction with intervention-related training, also report greater autism-specific parenting self-efficacy. Parents who report greater financial and social burden report lower autism-specific parenting self-efficacy. We propose that these results are important in creating intervention experiences that foster parental self-efficacy through involvement, productive training experiences, and addressing parental burden.Lay abstractWhat is already known about the topic'Parents of children with autism experience enormous challenges managing the complex needs of caring for their children. This includes coordinating multiple and complex therapies and acting as partners in treatment. Parenting self-efficacy is the confidence a person has in their ability to manage the tasks that are part of raising a child. People who have more confidence, or greater parenting self-efficacy, often feel less stressed and are more able to manage the demands of family life. This is particularly important for parents with children who have autism spectrum disorder, since they experience more parenting pressures. Although a lot is known about parenting self-efficacy in parents of neurotypical children, we do not know enough about how to help parents of children with autism spectrum disorder develop greater parenting self-efficacy.What this paper adds'This study shows that parents gain a greater sense of parenting self-efficacy when they feel more involved in their child’s therapy and are more satisfied with the training they receive as part of these therapies. We also find that feeling pressure related to being a caregiver of a child with autism spectrum disorder can undermine autism-specific parenting self-efficacy. However, parents’ sense of confidence was not limited by the severity of their child’s symptoms.Implications for practice, research, or policyThe results suggest that there is an opportunity to help parents develop a greater sense of confidence in their ability to manage the complexities of raising a child with autism spectrum disorder by helping them feel more involved in treatment and by creating intervention-related training experiences that are more satisfying. Providers might also help by taking time to address the challenges and pressures that parents are experiencing, and helping them find ways to deal with these challenges. We suggest that there needs to be more research exploring how providers can best design interventions that support autism-specific parenting self-efficacy as a way of improving parental and child well-being.
      Citation: Autism
      PubDate: 2021-04-16T08:52:28Z
      DOI: 10.1177/1362361321990931
       
  • Psychometric properties of the Chinese Parent Version of the Autism
           Spectrum Rating Scale: Rasch analysis
    • Authors: Weili Yan, Richard J Siegert, Hao Zhou, Xiaobing Zou, Lijie Wu, Xuerong Luo, Tingyu Li, Yi Huang, Hongyan Guan, Xiang Chen, Meng Mao, Kun Xia, Lan Zhang, Erzhen Li, Chunpei Li, Xudong Zhang, Yuanfeng Zhou, Andy Shih, Eric Fombonne, Yi Zheng, Jisheng Han, Zhongsheng Sun, Yong-hui Jiang, Yi Wang
      Abstract: Autism, Ahead of Print.
      The recent adaptation of a Chinese parent version of the Autism Spectrum Rating Scale showed the Modified Chinese Autism Spectrum Rating Scale to be reliable and valid for use in China. The aim of this study was to test the Modified Chinese Autism Spectrum Rating Scale for fit to the Rasch model. We analysed data from a previous study of the Modified Chinese Autism Spectrum Rating Scale which comprised 1593 non-cases and 420 children diagnosed with autism spectrum disorder. We used super items based on groups of locally dependent items and item deletion when necessary to achieve good fit to the model for each of the three subscales identified by Zhou et al. and for the full 59-item Modified Chinese Autism Spectrum Rating Scale. The resulting conversion tables enable the use of genuine unidimensional, interval level scores for the total score and three subscales. Reliability was high with Person Separation Index values ranging from 0.83 to 0.89 for the three subscales and 0.79 for the total scale. In addition, we were able to identify a full-scale version of the Autism Spectrum Rating Scale and its three subscales that are all free of differential item functioning in relation to the five person factors recorded namely age, sex, caseness, relative and city. In future studies, the Teacher version of the Modified Chinese Autism Spectrum Rating Scale needs examination with Rasch analysis.Lay abstractThe Autism Spectrum Rating Scale is a behavioural rating scale completed by parents and teachers that is useful for identifying children with an autism spectrum disorder. The development of a modified Autism Spectrum Rating Scale suitable for use in China is important for the identification of children in China with an autism spectrum disorder. In this study, we examined the Modified Chinese Autism Spectrum Rating Scale using a statistical technique known as Rasch analysis. Rasch analysis tests whether the questionnaire meets the standards for modern scientific measurement. We used Rasch analysis to examine data from 2013 children in China including 420 diagnosed with an autism spectrum disorder who had been rated by a parent or grandparent. After removing a small number of items (questions), the Modified Chinese Autism Spectrum Rating Scale met the stringent criteria for Rasch measurement. The availability of a reliable and precise tool for assessing behaviours characteristic of an autism spectrum disorder in Chinese children will improve the identification and diagnosis of autism spectrum disorder in China, thus enabling better provision of support services.
      Citation: Autism
      PubDate: 2021-04-13T06:01:13Z
      DOI: 10.1177/13623613211004054
       
  • Ten weeks in: COVID-19-related distress in adults with autism spectrum
           disorder
    • Authors: Ryan E Adams, Shuting Zheng, Julie Lounds Taylor, Somer L Bishop
      Abstract: Autism, Ahead of Print.
      This study examined COVID-19-related distress among adults with autism spectrum disorder and its associations with demographic and mental health information. A sample of 275 adults (ages 18–35) in the United States, all capable of providing self-reports, was recruited from a large national registry. Adults completed online surveys of mental health symptoms just before COVID-19 was declared a pandemic. Two months later, they completed the same surveys of mental health symptoms, and also reported about distress they had experienced as a result of the COVID-19 pandemic. Nearly two-thirds (65.9%) endorsed some form of COVID-related distress with a little over half reporting any individual form of distress. Although depressive and anxiety symptoms did not change from Time 1 to Time 2 on average, higher levels of COVID-related distress was associated with an increase in depressive and anxiety symptoms between Time 1 and Time 2. In addition, women and those who reported higher anxiety symptoms before the pandemic were more likely to report some form of COVID-related distress. The findings suggest that as this global crisis continues to unfold, it will be critical to ensure that adults with autism spectrum disorder who were experiencing mental health challenges prior to the pandemic receive appropriate monitoring.Lay abstractThis study used data collected from 275 adults in the United States with autism spectrum disorder both before the pandemic and then 10 weeks into the pandemic to assess COVID-19-related distress and its impact. Two-thirds of those surveyed reported some type of distress related to the pandemic (i.e. difficulty coping or negative impact on emotional and mental health). While there were no changes in depressive and anxiety symptoms from prior to COVID-19 to 10 week later in the group as a whole, self-reported distress predicted increases in both anxiety and depression across the two timepoints. Furthermore, adults with higher levels of anxiety prior to the pandemic were more likely to report distress, and women were more likely to report a negative impact of the pandemic on their emotional and mental health. Findings highlight the importance of monitoring with adults with autism spectrum disorder to assess their need for mental health support, and providing ongoing support to those who already experience anxiety even before the pandemic.
      Citation: Autism
      PubDate: 2021-04-13T06:00:54Z
      DOI: 10.1177/13623613211005919
       
  • Intense connection and love: The experiences of autistic mothers
    • Authors: Amber-Sophie Dugdale, Andrew R Thompson, Alexandra Leedham, Nigel Beail, Megan Freeth
      Abstract: Autism, Ahead of Print.
      Knowledge of how parenthood is experienced by autistic women is currently poor. Nine autistic mothers to children aged 5–15 years completed semi-structured interviews, analysed using Interpretative Phenomenological Analysis. All mothers considered at least one of their children to also be autistic. Four superordinate themes emerged: 1. Autism fundamentally impacts parenting; 2. Battle for the right support; 3. Development and acceptance; and 4. The ups and downs of parenting. The themes demonstrate that while motherhood is largely a joyful experience for autistic mothers (Themes 1 and 4), it is associated with specific issues unlikely to be found in neurotypical motherhood (Theme 1), including negotiating misunderstandings from others (Theme 2). The need for self-care and self-acceptance was expressed (Theme 3) with parenting resulting in personal growth and adaptation (Theme 3). Feelings of intense connection and closeness were experienced (Theme 4), though managing children’s needs had a profound personal impact (Themes 2 and 4). The findings demonstrate that service-providers would benefit from training, ideally led by autistic individuals, on how autism presents in adulthood, masking, the potential for mismatching between emotional experience and facial expression, sensory needs (especially in pregnancy), and the double empathy problem (Theme 2). This study represents the first systematic in-depth analysis of the experiences of autistic mothers presented from their own perspectives.Lay abstractFor many women, adulthood involves becoming a mother. Knowledge of how motherhood is experienced by autistic women is currently poor. Poor knowledge has a range of negative consequences and can lead to inappropriate support. In this study, nine autistic women were interviewed about their experiences of motherhood. Seven of the nine mothers had an officially diagnosed autistic child, the final two mothers also suspected at least one of their children to be autistic. Systematic in-depth analysis of interview transcripts identified a range of common themes. Participants largely experienced motherhood as joyful, rewarding, and enjoyable, though managing children’s needs had a profound personal impact. Participants reflected on the need for self-care and self-acceptance, resulting in personal growth and adaptation. Participants also spoke of strong bonds, feelings of intense connection, and a range of shared experiences with their children. It was also clear that autistic motherhood is associated with a series of challenges unlikely to be experienced by non-autistic mothers, including the necessity of negotiating misunderstandings from others. The findings demonstrate that, generally, professionals need to be better educated on how autism presents in adulthood, including the fact that autistic women often engage in behaviour to mask their true self. Professionals need to know that there is potential for mismatching between emotional experience and facial expression, that autistic women have sensory needs (especially in pregnancy). Professionals frequently struggle to effectively take the needs and perspectives of autistic mothers into account, resulting in profoundly negative consequences for the mother.
      Citation: Autism
      PubDate: 2021-04-12T07:20:37Z
      DOI: 10.1177/13623613211005987
       
  • Using qualitative content analysis to understand the active ingredients of
           a parent-mediated naturalistic developmental behavioral intervention
    • Authors: Kyle M Frost, Kaylin Russell, Brooke Ingersoll
      Abstract: Autism, Ahead of Print.
      Although naturalistic developmental behavioral interventions have a sizable and growing evidence base for supporting the development of children on the autism spectrum, their active ingredients and mechanisms of change are not well understood. This study used qualitative content analysis to better understand the intervention process of a parent-mediated naturalistic developmental behavioral intervention. Caregivers completed weekly written reflection responses as they learned each intervention technique. These responses were coded, and code co-occurrences were examined to understand the relationship between implementation of specific intervention techniques and potential mechanisms of change according to caregiver observations. The responses were subsequently compared to a theoretical causal model derived from the intervention manual. Many responses were consistent with the intervention theory; however, some theoretical outcomes were not reported by caregivers, and caregivers described some potential mechanisms that were not explicitly stated in the intervention theory. Importantly, we found that individual techniques were associated with various mechanisms, suggesting that global measures of social communication may be insufficient for measuring context-dependent responses to individual intervention techniques. Our findings point to specific observable behaviors that may be useful targets of measurement in future experimental studies, and as indicators of treatment response in clinical settings. Overall, qualitative methods may be useful for understanding complex intervention processes.Lay abstractAlthough naturalistic developmental behavioral interventions are supported by research for supporting the development of children on the autism spectrum, how they work is not well understood. This study reviewed parent reflection comments in a systematic way to better how one such treatment worked, when delivered by caregivers. Caregivers completed weekly written reflection responses as they learned how to use the treatment techniques. We studied these responses to understand caregiver perspectives on how their children responded to the techniques. The responses were then compared to a theory of how the treatment works. Many responses were consistent with the treatment theory; however, others were not. We found that individual techniques were associated with different child responses, suggesting that general measures of social communication may not measure these specific short-term changes. Our findings point to specific behaviors that may be useful to measure in future research, or useful as indicators of treatment response in clinical practice settings. Overall, qualitative methods may be useful for understanding complex treatment processes.
      Citation: Autism
      PubDate: 2021-04-12T07:20:17Z
      DOI: 10.1177/13623613211003747
       
  • The untold perspective: Parents’ experiences of the autism spectrum
           disorder assessment process when the child did not receive a diagnosis
    • Authors: Lesley-Anne Bendik, Freya Spicer-White
      Abstract: Autism, Ahead of Print.
      This research explored parents’ lived experience of the autism spectrum disorder assessment process when a diagnosis was not received. Six mothers and one stepfather were interviewed and transcripts were analysed using interpretative phenomenological analysis. The identified themes: ‘My child is different’, The emotional and psychological journey and Understanding the outcome, illustrated issues encountered by parents during the assessment process and parenting a child with autistic-like characteristics but without a valid label. As a previously understudied area, clinical implications at the professional, service and policy level are discussed.Lay abstractAutism is diagnosed by a process of child assessment and parental interview. It has been well-documented by parents of children who received a diagnosis of autism, that the process can be lengthy and cause distress for families. Nevertheless, the outcome often compensated for the difficult assessment journey as it enables families to gain access to further information, support and intervention. However, less is known about the assessment process from parents who undertake the same process but at the end are told their child does not meet the diagnostic criteria, meaning no diagnosis is given. We interviewed six parents in North Wales, whose child did not receive a diagnostic of autism following an assessment. During the interview, parents were asked about their experience of the autism assessment process. We found that parents reflected on their experience according to three themes: (1) parents tried to navigate how they could make sense of their child being different despite not receiving a diagnosis; (2) parents referred to the assessment process as a journey, which encompassed many emotional and psychological components and (3) parents discussed what it was like to hear a non-diagnosis outcome, in terms of feeling relieved, confused and raising questions for the child’s future. These findings are important for professionals working in autism assessment services to help improve the assessment process for families, particularly when the assessment does not result in a diagnosis.
      Citation: Autism
      PubDate: 2021-04-12T07:19:57Z
      DOI: 10.1177/13623613211003741
       
  • Autism-Spectrum Quotient-Child and Autism-Spectrum Quotient-Adolescent in
           Chinese population: Screening autism spectrum disorder against
           attention-deficit/hyperactivity disorder and typically developing peers
    • Authors: Patsy PS Wong, Veronica CM Wai, Raymond WS Chan, Cecilia NW Leung, Patrick WL Leung
      Abstract: Autism, Ahead of Print.
      The Hong Kong Chinese version of the Autism-Spectrum Quotient-Child and Autism-Spectrum Quotient-Adolescent were examined for their psychometric properties and specificity on screening autism spectrum disorder against attention-deficit/hyperactivity disorder. This study recruited three groups of participants: typically developing children; children with autism spectrum disorder and children with attention-deficit/hyperactivity disorder. Both the Autism-Spectrum Quotient questionnaires demonstrated satisfactory psychometric properties in terms of internal consistency, test–retest reliability and area under receiver operating characteristics curve in discriminating the autism spectrum disorder group from the attention-deficit/hyperactivity disorder and typically developing groups, separately and jointly. The optimal cutoff scores for both the Autism-Spectrum Quotient questionnaires were identified to be 76, with satisfactory sensitivity and specificity, for differentiating the autism spectrum disorder group from the typically developing group and from the typically developing and attention-deficit/hyperactivity disorder groups combined. On the contrary, both Autism-Spectrum Quotient questionnaires could not effectively differentiate the attention-deficit/hyperactivity disorder group from the typically developing group, or in other words, they did not misclassify attention-deficit/hyperactivity disorder as autism spectrum disorder because of their phenotypic overlap in social difficulties. These findings supported that both the Autism-Spectrum Quotient questionnaires were not general measures of child and adolescent psychopathology, but could claim to be more specific measures of autism spectrum disorder, given their success in identifying the autism spectrum disorder group from the attention-deficit/hyperactivity disorder/typically developing groups, while failing to differentiate the latter two groups.Lay abstractThe Autism-Spectrum Quotient is a 50-item questionnaire developed to assess autistic symptoms in adults, adolescents and children. Its original version and others in different countries are known to be effective tools in identifying individuals with autism spectrum disorder. This study examined whether the Hong Kong Chinese versions of the Autism-Spectrum Quotient-Child and Autism-Spectrum Quotient-Adolescent were effective in identifying autism spectrum disorder children and adolescents. On top of comparing them with their typically developing peers, this study also included a group of children/adolescents with attention deficit/hyperactivity disorder, a disorder with similar social difficulties as autism spectrum disorder. Results showed that both the Autism-Spectrum Quotient questionnaires were effective in differentiating the autism spectrum disorder group from the typically developing and attention-deficit/hyperactivity disorder groups, separately and jointly. On the contrary, they could not identify the attention-deficit/hyperactivity disorder group from the typically developing group so that they were not misclassifying attention-deficit/hyperactivity disorder as autism spectrum disorder. These findings supported that both the Autism-Spectrum Quotient-Child and Autism-Spectrum Quotient-Adolescent were not general measures of child and adolescent psychopathology, but could claim to be specific measures of autism spectrum disorder. Such capability would enormously enhance their utility in clinical practice for identifying autism spectrum disorder children/adolescents from their typically developing peers and from those with attention-deficit/hyperactivity disorder. This is because, the latter is a common neurodevelopmental disorder frequently presented to child psychiatric clinics alongside with autism spectrum disorder.
      Citation: Autism
      PubDate: 2021-04-12T07:17:57Z
      DOI: 10.1177/13623613211003740
       
  • Short report on research trends during the COVID-19 pandemic and use of
           telehealth interventions and remote brain research in children with autism
           spectrum disorder
    • Authors: Wan-Chun Su, Sudha Srinivasan, Corina Cleffi, Anjana Bhat
      Abstract: Autism, Ahead of Print.
      Following the outbreak of the COVID-19 pandemic, the delivery of face-to-face (F2F) therapeutic interventions and neuroimaging assessments for children with autism spectrum disorder has been disrupted. To resume interventions and assessments, many services are now using telehealth-based online platforms. Using the Zoom conferencing platform, our research group has been providing creative play-based interventions to school-age children with autism spectrum disorder. The feedback on this telehealth intervention experience has been generally positive (mean satisfaction score: 4.4 on a 5-point Likert-type scoring range) and our preliminary data from six children with autism spectrum disorder suggest training-related improvements in gross motor, balance, and imitation skills. Despite the positive results, it remains to be explored if the effects of telehealth interventions are similar to those of F2F interventions. Neuroimaging techniques could provide objective measures of intervention effects. However, this will require researchers to resume neuroimaging research while adopting safe public health protocols to control the risk of COVID-19 transmission. In this short report, we summarize existing safety protocols for F2F neuroimaging research, our own experiences of safely conducting alternative, on-site and off-site neuroimaging data collection, as well as the potential opportunities of using online data sharing and low-cost, remote neuroimaging/electrophysiological techniques to continue brain research during the pandemic.Lay abstractThe COVID-19 pandemic has caused disruption in F2F healthcare delivery and neuroimaging research, especially when involving vulnerable populations such as children with autism spectrum disorder. Given the easy access to multiple video conferencing platforms, many healthcare services have moved to an online delivery format (i.e. telehealth). It is important to monitor the behavioral and neural effects of telehealth interventions and resume neuroimaging research while adopting public health safety protocols to control the risk of COVID-19 transmission. We summarize existing safety protocols and our own experience from in-person functional near-infrared spectroscopy neuroimaging data collection (on-site, at home, and in outdoor settings), as well as potential opportunities of using online data sharing and low-cost, remote neuroimaging/electrophysiological techniques to continue brain research during the pandemic.
      Citation: Autism
      PubDate: 2021-04-10T05:02:14Z
      DOI: 10.1177/13623613211004795
       
  • Overcoming hurdles to intervention studies with autistic children with
           profound communication difficulties and their families
    • Authors: Ailbhe McKinney, Emma JL Weisblatt, Kathryn L Hotson, Zahra Bilal Ahmed, Claudia Dias, Dorit BenShalom, Juliet Foster, Suzanne Murphy, Sofía S Villar, Matthew K Belmonte
      Abstract: Autism, Ahead of Print.
      Autistic children and adults who are non-verbal/minimally verbal or have an intellectual disability have often been excluded from Autism Spectrum Disorder research. Historical, practical and theoretical reasons for this exclusion continue to deter some researchers from work with this underserved population. We discuss why these reasons are neither convincing nor ethical, and provide strategies for dealing with practical issues. As part of a randomised controlled trial of an intervention for children with profound autism, we reflected as a multi-disciplinary team on what we had learnt from these children, their families and each other. We provide 10 strategies to overcome what appeared initially to be barriers to collecting data with this population. These hurdles and our solutions are organised by theme: interacting physically with children, how to play and test, navigating difficult behaviours, selecting suitable outcome measures, relating with parents, managing siblings, involving stakeholders, timing interactions, the clinician’s role in managing expectations, and recruitment. The aim of this article is to provide researchers with the tools to feel motivated to conduct research with children with profound autism and their families, a difficult but worthwhile endeavour. Many of these lessons also apply to conducting research with non-autistic children with intellectual disabilities.Lay abstractAutistic children who speak few or no words or who have an intellectual disability are the most in need of new understandings and treatments, but the most often left out of the research that can bring these benefits. Researchers perceive difficulties around compliance with instructions, testing, challenging behaviours and family stress. Although research with these children can indeed be difficult, their continuing exclusion is unethical and unacceptable. Drawing on our experiences testing a possible treatment for children with profound autism, we provide 10 practical guidelines related to (1) interacting physically, (2) combining play and testing, (3) responding to challenging behaviour, (4) finding suitable tests, (5) relationships with parents, (6) relationships with siblings, (7) involving stakeholders, (8) planning the testing times, (9) the role of the clinical supervisor and (10) recruiting and retaining participants. We hope that these guidelines will prepare and embolden other research teams to work with profoundly autistic children, ending their historical exclusion from research. These guidelines also could be useful for conducting research with children with intellectual disabilities.
      Citation: Autism
      PubDate: 2021-04-08T04:44:39Z
      DOI: 10.1177/1362361321998916
       
  • Intrinsic hippocampal functional connectivity underlying rigid memory in
           children and adolescents with autism spectrum disorder: A case–control
           study
    • Authors: Teruo Hashimoto, Susumu Yokota, Yutaka Matsuzaki, Ryuta Kawashima
      Abstract: Autism, Ahead of Print.
      Atypical learning and memory in early life can promote atypical behaviors in later life. Less relational learning and inflexible retrieval in childhood may enhance restricted and repeated behaviors in patients with autism spectrum disorder. The purpose of this study was to elucidate the mechanisms of atypical memory in children with autism spectrum disorder. We conducted picture–name pair learning and delayed-recognition tests with two groups: one group with high-functioning autism spectrum disorder children (aged 7–16, n = 41) and one group with typically developing children (n = 82) that matched the first group’s age, sex, and IQ. We assessed correlations between successful recognition scores and seed-to-whole-brain resting-state functional connectivity. Although both learning and retrieval performances were comparable between the two groups, we observed slightly lower category learning and significantly fewer memory gains in the autism spectrum disorder group than in the typically developing group. The right canonical anterior hippocampal network was involved in successful memory in youths with typically developing, while other memory systems may be involved in successful memory in youths with autism spectrum disorder. Context-independent and less relational memory processing may be associated with fewer memory gains in autism spectrum disorder. These atypical memory characteristics in autism spectrum disorder may accentuate their inflexible behaviors in some situations.Lay abstractAtypical learning and memory in early life can promote atypical behaviors in later life. Specifically, less relational learning and inflexible retrieval in childhood may enhance restricted and repeated behaviors in patients with autism spectrum disorder. The purpose of this study was to elucidate the mechanisms of atypical memory in children with autism spectrum disorder. We conducted picture–name pair learning and delayed-recognition tests with two groups of youths: one group with high-functioning autism spectrum disorder children (aged 7–16, n = 41) and one group with typically developing children (n = 82) that matched the first group’s age, sex, and full-scale IQ. We examined correlations between successful recognition scores and neural connectivity during resting in the magnetic resonance imaging scanner without thinking about anything. Although both learning and retrieval performances were comparable between the two groups, we observed significantly fewer memory gains in the autism spectrum disorder group than in the typically developing group. The memory network was involved in successful memory retrieval in youths with typically developing, while the other memory systems that do not depend to a great degree on networks may be involved in successful memory in youths with autism spectrum disorder. Context-independent and less relational memory processing may be associated with fewer memory gains in autism spectrum disorder. In other words, autism spectrum disorder youths might benefit from non-relational memory. These atypical memory characteristics in autism spectrum disorder may exaggerate their inflexible behaviors in some situations, or—vice versa—their atypical behaviors may result in rigid and less connected memories.
      Citation: Autism
      PubDate: 2021-03-29T05:41:34Z
      DOI: 10.1177/13623613211004058
       
  • Characterizing therapist delivery of evidence-based intervention
           strategies in publicly funded mental health services for children with
           autism spectrum disorder: Differentiating practice patterns in usual care
           and AIM HI delivery
    • Authors: Eliana Hurwich-Reiss, Colby Chlebowski, Teresa Lind, Kassandra Martinez, Karin M Best, Lauren Brookman-Frazee
      Abstract: Autism, Ahead of Print.
      This study identified patterns of therapist delivery of evidence-based intervention strategies with children with autism spectrum disorder within publicly funded mental health services and compared patterns for therapists delivering usual care to those trained in AIM HI (“An Individualized Mental Health Intervention for ASD”). Data were drawn from a randomized community effectiveness trial and included a subsample of 159 therapists (86% female) providing outpatient or school-based psychotherapy. Therapist strategies were measured via observational coding of psychotherapy session recordings. Exploratory factor analysis used to examine patterns of strategy delivery showed that among therapists in the usual care condition, strategies loaded onto the single factor, General Strategies, whereas for therapists in the AIM HI training condition, strategies grouped onto two factors, Autism Engagement Strategies and Active Teaching Strategies. Among usual care therapists, General Strategies were associated with an increase in child behavior problems, whereas for AIM HI therapists, Active Teaching Strategies were associated with reductions in child behavior problems over 18 months. Results support the effectiveness of training therapists in evidence-based interventions to increase the specificity of strategies delivered to children with autism spectrum disorder served in publicly funded mental health settings. Findings also support the use of active teaching strategies in reducing challenging behaviors.Lay abstractThis study was conducted to identify patterns of therapist delivery of evidence-based intervention strategies with children with autism spectrum disorder receiving publicly funded mental health services and compare strategy use for therapists delivering usual care to those trained to deliver AIM HI (“An Individualized Mental Health Intervention for ASD”), an intervention designed to reduce challenging behaviors in children with autism spectrum disorder. For therapists trained in AIM HI, intervention strategies grouped onto two factors, Autism Engagement Strategies and Active Teaching Strategies, while strategies used by usual care therapists grouped onto a broader single factor, General Strategies. Among usual care therapists, General Strategies were related to an increase in child behavior problems, whereas for AIM HI therapists, Active Teaching Strategies were related with reductions in child behavior problems over 18 months. Findings support the use of active teaching strategies in reducing challenging behaviors in children with autism spectrum disorder and provide support for the effectiveness of training therapists in evidence-based interventions to promote the delivery of targeted, specific intervention strategies to children with autism spectrum disorder in mental health services.
      Citation: Autism
      PubDate: 2021-03-29T05:38:55Z
      DOI: 10.1177/13623613211001614
       
  • Another step to school inclusion: Development and validation of the
           Children’s Attitudes Toward Autism Questionnaire
    • Authors: Cyrielle Derguy, Benoite Aubé, Odile Rohmer, Federica Marotta, Déborah Loyal
      Abstract: Autism, Ahead of Print.
      Negatives attitudes toward children with autism are an important barrier to school inclusion. Despite the increasing amount of research, no psychometrically sound scale reliably measures these attitudes in young students. Our aim was to develop and validate a tool (Children’s Attitudes Toward Autism Questionnaire) to evaluate attitudes (three dimensions) of students in elementary school toward peers with autism. Elementary school students (N = 204) completed the Children’s Attitudes Toward Autism Questionnaire and two other scales assessing behavioral intentions toward peers with mental disability (Shared Activities Questionnaire-B) and familiarity with disability and autism. The confirmatory factor analysis first showed a satisfactory model fit (χ2/df = 3.65, root mean square error of approximation = 0.114, adjusted goodness of fit index = 0.970, standardized root mean square residual = 0.067, comparative fit index = 0.967, and non-normed fit index = 0.963) and internal consistency for each dimension was good (>0.70). Second, attitudes were more positive in girls, older children, and children familiar with disability (but not with autism). The behavioral dimension of the Children’s Attitudes Toward Autism Questionnaire had the strongest association with the Shared Activities Questionnaire-B. The Children’s Attitudes Toward Autism Questionnaire is the first scale (1) to assess the three dimensions of attitudes toward autism (2) among children (from the age of 6 years old) and (3) to show good psychometric quality. With the Children’s Attitudes Toward Autism Questionnaire, researchers can reliably measure children’s attitudes toward peers with autism, which is especially necessary when evaluating the effectiveness of much-needed anti-stigma programs.Lay abstractResearch has shown that negative attitudes toward a different child can appear very early in development. Unfortunately, these negative attitudes are one of the most important barriers to the school inclusion of children with autism. Despite the increasing amount of research, no tool reliably measures these attitudes among young students. The objective of this study was to develop and validate a questionnaire (Children’s Attitudes Toward Autism Questionnaire) to evaluate attitudes of students in elementary school toward their peers with autism. Elementary school students (N = 204) completed the Children’s Attitudes Toward Autism Questionnaire and two other scales assessing behavioral intentions toward peers with a mental disability (Shared Activities Questionnaire-B) and familiarity with disability and autism. Results first showed that the Children’s Attitudes Toward Autism Questionnaire reliably measured the concept of attitude through three sub-dimensions (namely, the cognitive, affective, and behavioral dimensions). Second, analyses confirmed that the Children’s Attitudes Toward Autism Questionnaire corresponds with previous knowledge on this topic, namely, that attitudes were more positive in girls, older children, and children familiar with disability. In conclusion, the Children’s Attitudes Toward Autism Questionnaire is the first scale (1) to assess all the dimensions of attitudes toward autism among elementary school children (from the age of 6 years old) and (2) to show theoretical and statistical relevance. From now on, the Children’s Attitudes Toward Autism Questionnaire can be used to assess attitudes of young children toward their peers with autism. This is an important step forward, in particular for evaluating the effects of anti-stigma programs that are increasingly implemented in schools.
      Citation: Autism
      PubDate: 2021-03-27T10:58:20Z
      DOI: 10.1177/13623613211000163
       
  • DSM-5 symptom expression in toddlers
    • Authors: Kirsty L Coulter, Marianne L Barton, Diana L Robins, Wendy L Stone, Deborah A Fein
      Abstract: Autism, Ahead of Print.
      Although the early behaviors associated with autism spectrum disorder have been well characterized, many behaviors are also commonly observed in young children with other developmental delays and even in those with typical development. Therefore, consideration must be given to whether a child demonstrates sufficient autism spectrum disorder symptoms to warrant this diagnosis. Using the Toddler Autism Symptom Inventory, we examined caregiver endorsement of specific behaviors in three groups of toddlers referred for autism spectrum disorder risk: those who received a best-estimate diagnosis of autism spectrum disorder, those with another developmental disorder, and those who showed slight or no developmental delays and did not meet criteria for any disorder. The results revealed significant differences in symptoms among the three diagnostic groups, as well as low frequency of some DSM-5, ASD criteria, especially insistence on sameness, for those with ASD. These findings have important implications for applying the DSM-5, diagnostic criteria to toddlers.Lay abstractChildren with autism show more social-communication symptoms and repetitive behaviors than children with typical development or those diagnosed with other developmental disorders; however, non-autistic children often show some behaviors that are associated with autism. We compared the behavioral reports from caregivers of children in these three groups to identify the behaviors that were specific to autism. Children with autism were found to show more of these behaviors, and behaviors that are particularly indicative of autism were identified. These behaviors included social symptoms (approaching others to interact, showing things, looking back while showing, responding to an approaching child, spontaneous imitation) and repetitive behavior symptoms (specific, inflexible play, unusual body movements, strong specific interest, carrying around an unusual object, sensory seeking, and sensory hyper-reactivity).These findings may aid professionals in determining the most appropriate diagnosis for a child between the ages of 12 and 36 months.
      Citation: Autism
      PubDate: 2021-03-27T10:54:33Z
      DOI: 10.1177/13623613211000160
       
  • Social-communicative gestures at baseline predict verbal and nonverbal
           gains for children with autism receiving the Early Start Denver Model
    • Authors: Dominik Laister, Magdalena Stammler, Giacomo Vivanti, Daniel Holzinger
      Abstract: Autism, Ahead of Print.
      In children with autism spectrum disorder, atypical gesture use is a core deficit with consequences for social learning, social interaction, and language development. Little is known about the relevance of early gesture use in predicting developmental outcomes of children receiving early interventions targeting social-communicative behaviors such as the Early Start Denver Model. We found that the parent-rated “Gestural Approach Behavior” subscale of the Pervasive Developmental Disorder Behavior Inventory was predictively associated with developmental changes after 1 year of intervention as assessed by the Mullen Scales of Early Learning. This subscale was as strong a predictor as the Mullen nonverbal development quotient before intervention. Our findings suggest that children who use more gestures for social communication might be better equipped to respond to the learning opportunities offered by the Early Start Denver Model.Lay abstractAlthough there is growing evidence of the effectiveness and importance of certain early intervention programs for children with autism spectrum disorders, little is known about predictive information before intervention to search for the most accurate therapeutic approach for the individual child and his family. In children with autism spectrum disorder, atypical gesture use is one core deficit with consequences for the development of social interaction and language, but there is little knowledge about the relevance of early gesture use in predicting developmental outcomes of children receiving early interventions targeting social-communicative behaviors such as the Early Start Denver Model. In this study, we found that the parent-rated “Gestural Approach Behavior” subscale of the Pervasive Developmental Disorder Behavior Inventory was predictively associated with clinically assessed developmental changes after 1 year of intervention. This subscale was as strong a predictor as nonverbal development before intervention. Our findings suggest that children who use more gestures in daily life might be better equipped to respond to learning opportunities offered by early interventions targeting social communication strategies such as the Early Start Denver Model. Furthermore, we conclude that the parent-rated questionnaire might be a valuable and economic set of questions with high relevance for clinical assessments.
      Citation: Autism
      PubDate: 2021-03-27T10:52:34Z
      DOI: 10.1177/1362361321999905
       
  • Short report: Patterns of US federal autism research funding during
           2017–2019
    • Authors: Lauren Harris, Daniel Gilmore, Anne Longo, Brittany N Hand
      Abstract: Autism, Ahead of Print.
      In 2017, the Interagency Autism Coordinating Committee, a federal advisory panel consisting of autism researchers and community members, recommended that funders of autism research prioritize research projects on: (1) treatments/interventions, (2) evidence-based services, and (3) lifespan issues. We sought to describe research funding since this recommendation was made. We searched the databases of the three largest federal funders of autism research in the United States (National Institutes of Health, Department of Education, and Centers for Disease Control and Prevention) for grants awarded during 2017–2019. We categorized grants as follows: autism screening and diagnosis, biology, risk factors, treatments and interventions, services, lifespan issues, or infrastructure and surveillance. We found that funding patterns remained largely consistent during 2017–2019. Biological research received a relative majority of funding (32.59%), followed by treatments and interventions (22.87%). While given higher funding priority by the Interagency Autism Coordinating Committee’s recent budget recommendation, fewer funds were awarded to research areas like services (5.02%) and lifespan issues (2.51%), indicating a misalignment between funding patterns and the Interagency Autism Coordinating Committee budget recommendation. These findings emphasize the need for autism research funding to align with the Interagency Autism Coordinating Committee budget recommendations to best meet the needs of the autism community, particularly autistic younger, middle-aged, and older adults.Lay abstractIn 2017, an advisory board consisting of autism researchers and community members recommended that funders of autism research prioritize research projects on: (1) treatments/interventions, (2) evidence-based services, and (3) lifespan issues. To describe funding in these areas since this recommendation was made, we searched the databases of the three largest federal funders of autism research in the United States. We found that the largest portion of federal funding during 2017–2019 was awarded to research on the biology of autism (32.59%) and treatments and interventions for autism (22.87%). Less funds were awarded to research areas that are high funding priorities by the Interagency Autism Coordinating Committee budget recommendation including services (5.02%) and lifespan issues (2.51%). Our findings emphasize that autism research funding is not consistent with the Interagency Autism Coordinating Committee budget recommendation to increase funding particularly to services and lifespan issues. We recommend that funding patterns should shift to better align with these priorities so that autism research may better serve the needs of the autism community.
      Citation: Autism
      PubDate: 2021-03-26T05:25:03Z
      DOI: 10.1177/13623613211003430
       
  • Training the social brain: Clinical and neural effects of an 8-week
           real-time functional magnetic resonance imaging neurofeedback Phase IIa
           Clinical Trial in Autism
    • Authors: Bruno Direito, Susana Mouga, Alexandre Sayal, Marco Simões, Hugo Quental, Inês Bernardino, Rebecca Playle, Rachel McNamara, David EJ Linden, Guiomar Oliveira, Miguel Castelo Branco
      Abstract: Autism, Ahead of Print.
      Autism spectrum disorder is characterized by abnormal function in core social brain regions. Here, we demonstrate the feasibility of real-time functional magnetic resonance imaging volitional neurofeedback. Following up the demonstration of neuromodulation in healthy participants, in this repeated-measure design clinical trial, 15 autism spectrum disorder patients were enrolled in a 5-session training program of real-time functional magnetic resonance imaging neurofeedback targeting facial emotion expressions processing, using the posterior superior temporal sulcus as region-of-interest. Participants were able to modulate brain activity in this region-of-interest, over multiple sessions. Moreover, we identified the relevant clinical and neural effects, as documented by whole-brain neuroimaging results and neuropsychological measures, including emotion recognition of fear, immediately after the intervention and persisting after 6 months. Neuromodulation profiles demonstrated subject-specificity for happy, sad, and neutral facial expressions, an unsurprising variable pattern in autism spectrum disorder. Modulation occurred in negative or positive directions, even for neutral faces, in line with their often-perceived ambiguity in autism spectrum disorder. Striatal regions (associated with success/failure of neuromodulation), saliency (insula/anterior cingulate cortex), and emotional control (medial prefrontal cortex) networks were recruited during neuromodulation. Recruitment of the operant learning network is consistent with participants’ engagement. Compliance, immediate intervention benefits, and their persistence after 6 months pave the way for a future Phase IIb/III, randomized controlled clinical trial, with a larger sample that will allow to conclude on clinical benefits from neurofeedback training in autism spectrum disorder (NCT02440451).Lay abstractNeurofeedback is an emerging therapeutic approach in neuropsychiatric disorders. Its potential application in autism spectrum disorder remains to be tested. Here, we demonstrate the feasibility of real-time functional magnetic resonance imaging volitional neurofeedback in targeting social brain regions in autism spectrum disorder. In this clinical trial, autism spectrum disorder patients were enrolled in a program with five training sessions of neurofeedback. Participants were able to control their own brain activity in this social brain region, with positive clinical and neural effects. Larger, controlled, and blinded clinical studies will be required to confirm the benefits.
      Citation: Autism
      PubDate: 2021-03-26T05:23:44Z
      DOI: 10.1177/13623613211002052
       
  • Dog training intervention improves adaptive social communication skills in
           young children with autism spectrum disorder: A controlled crossover study
           
    • Authors: Esther Ben-Itzchak, Ditza A Zachor
      Abstract: Autism, Ahead of Print.
      Controlled studies examining canine therapy in autism spectrum disorder are scarce. This study examined the effectiveness of a “Dog Training Intervention” on adaptive skills, autism severity, and anxiety using a controlled crossover design. Seventy-three participants diagnosed with autism spectrum disorder (Mage = 4:10 ± 1:0) were divided into two groups that received the dog training intervention during half of the school year in addition to standard-of-care interventions. The dog training intervention, in which the children were taught how to interact with and train dogs, was given twice weekly for 4 months within autism spectrum disorder–specific special education school. Those receiving the dog training intervention first showed significantly increased adaptive social and communication skills compared to the controls, and the gains were maintained after the dog training intervention. Belonging to the first dog training intervention group, higher pre-intervention adaptive skills, higher baseline cognitive ability, and less severe autism severity predicted better adaptive social and communication skills. The controls improved in adaptive skills only during their receipt of dog training intervention after crossover. The positive impact on social communication skills suggests that dog training may serve as an effective model for establishing social interaction. Dog training intervention appears to be an effective adjunct treatment to interventions provided in special education schools for children with autism spectrum disorder.Lay abstractThere is some evidence that using therapy dogs for children with autism spectrum disorder generally results in improved social communication skills and reduced behavioral problems. However, well-controlled studies that examine its effectiveness are scarce. This study examined the effectiveness of a “Dog Training Intervention.” The study included 73 participants diagnosed with autism spectrum disorder (61 males, 12 females) with age range of 2:10–7:6 years (M = 4:10 ± 1:0) who attend autism spectrum disorder–specific special education schools. The study population was divided into two groups. Each group received the dog training intervention during one part of the school year (first half or second half) in addition to the standard interventions provided by the special education school settings. The dog training intervention was given twice weekly for 4 months within the school setting. The group that received the dog training intervention first showed a significant increase in adaptive social and communication skills in comparison to the second group that did not receive the intervention in this period. This improvement was maintained after the dog training intervention. The second group, which received intervention at the second half of the year, showed improvement in communication and socialization adaptive skills only during the period in which they received the dog training intervention. The positive impact on social communication adaptive skills of the dog training intervention among young children with autism spectrum disorder suggests that dogs may serve as an effective model for establishing social interaction. Dog training intervention appears to be an effective adjunct treatment to the interventions provided in special education schools for young children with autism spectrum disorder.
      Citation: Autism
      PubDate: 2021-03-23T05:01:13Z
      DOI: 10.1177/13623613211000501
       
  • County-level variation in geographic access to Board Certified Behavior
           Analysts among children with Autism Spectrum Disorder in the United States
           
    • Authors: Marissa E Yingling, Matthew H Ruther, Erick M Dubuque, David S Mandell
      Abstract: Autism, Ahead of Print.
      This study examined variation in geographic access to Board Certified Behavior Analysts for children with autism spectrum disorder. Between March and May 2019, we integrated public data from the U.S. Department of Education’s Civil Rights Data Collection, Behavior Analyst Certification Board’s certificant registry, and U.S. Census. The study sample included all U.S. counties and county equivalents in 48 states and D.C. (N = 3108). Using geographic information systems software, we assigned Board Certified Behavior Analysts to counties based on their residence, allocated children via school districts to counties, and generated per capita autism spectrum disorder/Board Certified Behavior Analyst ratios. We calculated the Getis-Ord G* statistics for each county and each ratio and compared counties in high-ratio clusters with counties in low-ratio clusters by socioeconomic variables. More than half of all counties had no Board Certified Behavior Analysts. Counties in the highest accessibility category had ⩽17.1 children with autism spectrum disorder per Board Certified Behavior Analyst (n = 770), while counties in the lowest accessibility category had ⩾137.1 children with autism spectrum disorder per Board Certified Behavior Analyst (n = 12). In all, 55 of the 129 counties with the highest autism spectrum disorder prevalence had no Board Certified Behavior Analysts. Higher accessibility counties were wealthier and had smaller uninsured populations. To improve geographic access, we must identify factors driving unequal distribution that can inform provider recruitment and retention efforts in underserved areas.Lay abstractThis study looked at whether access to Board Certified Behavior Analysts for children with autism spectrum disorder is different between U.S. counties. The study included all U.S. counties and county equivalents in 48 states and D.C. (N = 3108). Between March and May 2019, we combined data from the U.S. Department of Education’s Civil Rights Data Collection, Behavior Analyst Certification Board’s certificant registry, and U.S. Census. We assigned Board Certified Behavior Analysts to counties based on their address, matched children in school districts to counties, and determined how many children with autism spectrum disorder there were in a county compared with how many Board Certified Behavior Analysts there were in a county. The results show uneven numbers of Board Certified Behavior Analysts between U.S. counties. More than half of all counties had no Board Certified Behavior Analysts. National maps illustrate clusters of high and low accessibility to Board Certified Behavior Analysts. To improve access to Board Certified Behavior Analysts in underserved areas, we must identify what contributes to the differences in access.
      Citation: Autism
      PubDate: 2021-03-20T04:34:45Z
      DOI: 10.1177/13623613211002051
       
  • Attentional shifting differences in autism: Domain general, domain
           specific or both'
    • Authors: Simona Skripkauskaite, Lance Slade, Jennifer Mayer
      Abstract: Autism, Ahead of Print.
      Atypical attention is considered to have an important role in the development of autism. Yet, it remains unclear whether these attentional difficulties are specific to the social domain. This study aimed to examine attentional orienting in autistic and non-autistic adults from and to non-social and social stimuli. We utilised a modified gap–overlap task with schematic images (Experiment 1: autistic = 27 and non-autistic = 26) and photographs (Experiment 2: autistic = 18 and non-autistic = 17). Eye-tracking data (i.e. saccadic latencies) were then compared across condition and type of stimulus (social or non-social) using multilevel modelling. Autistic adults exhibited mostly typical gap and overlap effects, as well as a bias towards social stimuli. Yet, autistic participants benefitted from exogenous disengagement when orienting to social information more than non-autistic participants. Neither a domain general nor social domain–specific account for attentional atypicalities in autism was supported separately. Yet, subtle combined domain differences were revealed in the gap condition.Lay abstractPrevious research has shown that autistic individuals look at other people less and orient to them more slowly than others. Yet, it is still unclear if this represents general visual differences (e.g. slower looking at any new information, social or not) or a uniquely social difference (e.g. only slower looking to humans but not objects). Here, we aimed to examine how quickly autistic and non-autistic adults look to and away from social (i.e. faces) and non-social information (i.e. squares and houses). We used an attentional shifting task with two images where sometimes the first image disappears before the new image appears (makes it easier to notice the new image) and other times it stays on the screen when the new image appears. In Experiment 1, we showed schematic faces and squares to 27 autistic and 26 non-autistic adults, and in Experiment 2, we showed photographs of faces and houses to 18 autistic and 17 non-autistic adults. In general, autistic adults looked at the new non-social or social images similarly to non-autistic adults. Yet, only autistic adults looked at new social information faster when the first image disappeared before the new image appeared. This shows that autistic individuals may find it easier to notice new social information if their attention is not already occupied.
      Citation: Autism
      PubDate: 2021-03-20T04:32:36Z
      DOI: 10.1177/13623613211001619
       
  • Correlates of adaptive skills in children with autism spectrum disorder
    • Authors: Ramkumar Aishworiya, Tze Jui Goh, Min Sung, Stacey Kiat Hong Tay
      Abstract: Autism, Ahead of Print.
      This study aimed to identify potential modifiable factors prior to early intervention that are associated with better adaptive skills in children with autism spectrum disorder. This cross-sectional study recruited patients with autism spectrum disorder, aged 5–12 years from two tertiary developmental programmes in Singapore. Demographics, family socio-economic status and early intervention details were collected. The primary outcome was the Vineland Adaptive Behaviour Scales Adaptive Behaviour Composite score. Multivariate linear regression analysis was done. The sample (N = 193) comprised 84% males with a mean age of 6 years and 7 months. Mean age at diagnosis was 35.5 months and mean Vineland Adaptive Behaviour Scales Adaptive Behaviour Composite standard score was 76.5. Mean waiting time for early intervention was 6.2 months with a mean intensity of 8.0 h/week. Waiting time for early intervention was a negative correlate of the Vineland Adaptive Behaviour Scales Adaptive Behaviour Composite score after controlling for other variables (β = −0.74, p = 0.04). Significant correlates also included paternal education (β = 5.44, p = 0.03) and the presence of financial difficulties in the family (β = −5.98, p = 0.04). Waiting time for early intervention is a modifiable risk factor that may be addressed during service planning to potentially improve adaptive skills in autism spectrum disorder. Children from low socio-economic status families may be at risk for poor functional skills and will benefit from targeted intervention plans.Lay abstractDespite improving services and care for individuals with autism spectrum disorder, functional outcomes such as daily living skills tend to be suboptimal for many. This study wanted to identify modifiable early intervention factors that are associated with better outcomes and possible high-risk groups of children who are at risk of poorer outcomes. Participants included 193 children aged between 5 and 12 years of age whose parents provided information on their family background and early intervention characteristics. These children also had their adaptive behaviour skills examined by formal testing. Results indicated that shorter wait time for early intervention was associated with better adaptive behaviour scores. Children from families with financial difficulties and lower paternal education were also at risk of poorer adaptive skills. Designing services for children with autism such that wait times to enter early intervention services are minimised following initial diagnosis can improve their eventual functional outcomes. Changes in healthcare policy to allow expedited entry or targeted intervention to children from low socio-economic status families can also enhance their eventual adaptive skill gains.
      Citation: Autism
      PubDate: 2021-03-17T05:21:34Z
      DOI: 10.1177/1362361321997287
       
  • Recognition of affective prosody in autism spectrum conditions: A
           systematic review and meta-analysis
    • Authors: Minyue Zhang, Suyun Xu, Yu Chen, Yi Lin, Hongwei Ding, Yang Zhang
      Abstract: Autism, Ahead of Print.
      Affective prosody recognition is an important area of research in autism spectrum conditions where difficulties in social cognition have been frequently observed. To probe into the mixed results reported in the literature, we conducted a systematic review with meta-analysis and examined potential factors that could explain the inconsistent results. Our literature search included six electronic databases for studies that compared the affective prosody recognition performance in individuals with autism spectrum condition with typically developing participants, which yielded 23 papers eligible for quantitative synthesis. Using a random-effects model, we obtained a moderate-to-large pooled effect (Hedges’ g = −0.63) for the overall affective prosody recognition performance of autism spectrum condition participants, which, however, reduced substantially (to −0.26) and became non-significant after the correction for publication bias. The number of answer codes was found to be a significant moderator for the effect estimate, whereas the number of speakers was not. Moreover, the magnitude of the pooled effect estimate varied across emotions. The findings suggested moderate differences in affective prosody recognition ability between autism spectrum condition and typically developing individuals, which reduced to marginal difficulties for autism spectrum condition when the impact of publication bias was taken into account. Diversity in the number of answer codes could have differential effects on affective prosody recognition performance in autism spectrum condition, which varied across emotions. The present review and meta-analysis demonstrated the insufficiency of research on affective prosody recognition in autism spectrum condition, highlighting a need for further exploration of the contributors and underlying mechanisms for specific affective prosody recognition difficulties.Lay abstractDifferences in understanding others’ emotions and attitudes through features in speech (e.g. intonation) have been observed in individuals with autism spectrum conditions, which contribute greatly to their social communication challenges. However, some studies reported that individuals with autism spectrum condition performed comparably to typically developing individuals on affective prosody recognition. Here, we provide a comprehensive review with statistical analysis of 23 existing studies on this topic to examine potential factors that could explain the discrepancies. Compared with typically developing individuals, autism spectrum condition participants generally appeared to encounter more difficulties in affective prosody recognition. But this finding was likely due to the tendency of the existing research to overly focus on deficits in autism. The affective prosody recognition performance in individuals with autism spectrum condition was closely related to the number of answer options offered to them. Moreover, the degree of difficulty in affective prosody recognition encountered by individuals with autism spectrum condition varied across emotions. The findings of this systematic review highlighted the need for further research on affective prosody recognition in autism (e.g. studies that include tonal language speakers and autism spectrum condition individuals with lower cognitive or verbal abilities).
      Citation: Autism
      PubDate: 2021-03-16T04:55:19Z
      DOI: 10.1177/1362361321995725
       
  • ‘You don’t look autistic’: A qualitative exploration of women’s
           experiences of being the ‘autistic other’
    • Authors: Kate Seers, Rachel C Hogg
      Abstract: Autism, Ahead of Print.
      There is currently a paucity of literature exploring the experiences of women on the autism spectrum. It is imperative research is conducted to capture the experiences of women on the autism spectrum and ensure appropriate support is provided to this cohort. Drawing upon a social constructionist framework, this qualitative research study sought to understand how psychological and socio-cultural constructions of autism spectrum condition and gender influence the well-being of women on the autism spectrum. Eight participants engaged in a semi-structured interview, with thematic analysis conducted to demonstrate the impact of gender roles and social expectations on the women’s identity and autism spectrum condition expression. The research highlighted the changing understandings of autism spectrum condition across a woman’s lifespan and the process and impact of resisting hegemonic autism spectrum condition categorisation. The findings demonstrate that social constructions of gender and stereotypical understandings of autism spectrum condition, which prioritise a deficit, medical model, have significant consequences for women’s well-being and subjectivity. The women experienced challenging formative years, but with diagnosis and the evolution and acceptance of their identities, they were able to resist negative narratives of autism spectrum condition, embrace their strengths and develop adaptive coping strategies. It is hoped this article generates insights for societal and clinical recognition to better support women on the autism spectrum.Lay abstractMost autism spectrum condition research addresses the neurological and biological causes of autism spectrum condition, focusing upon deficits associated with autism spectrum condition and behavioural interventions designed to minimise these deficits. Little is known about the lived experiences of adult women on the autism spectrum and how they navigate social expectations around gender, autism spectrum condition and gendered understandings of autism spectrum condition. The lived experiences of eight women on the AS will be shared here, with attention to how gendered expectations influence women’s experiences of autism spectrum condition, their sense of self and well-being. Findings showed these women struggled to reconcile the expectations of others, particularly early in life. The women had difficultly conforming to stereotypical ideals of femininity, yet as they aged, they felt less need to conform, valuing their unique style and behaviours. The women also rejected deficit-oriented descriptions of autism spectrum condition generated by the medical community, preferring to focus on their strengths and unique characteristics. It is hoped this article helps psychologists and the wider community to understand and meet the needs of women on the AS.
      Citation: Autism
      PubDate: 2021-03-16T04:49:19Z
      DOI: 10.1177/1362361321993722
       
  • The gap between IQ and adaptive functioning in autism spectrum disorder:
           Disentangling diagnostic and sex differences
    • Authors: Goldie A McQuaid, Kevin A Pelphrey, Susan Y Bookheimer, Mirella Dapretto, Sara J Webb, Raphael A Bernier, James C McPartland, John D Van Horn, Gregory L Wallace
      Abstract: Autism, Ahead of Print.
      Adaptive functioning, or the suite of skills essential for real-world, day-to-day functioning, includes daily living, communication, and socialization abilities. Even in the absence of co-occurring intellectual disability (IQ  70) ASD (females = 75, males = 102), and 178 typically developing (TD) (females = 87, males = 91) youth, aged 8–17 years. We examined whether each group evidenced a gap between full-scale IQ and adaptive skills and its associations with age. ASD youth evinced significantly lower adaptive skills and a significantly greater IQ-adaptive functioning gap than their same-sex TD peers. In this cross-sectional sample, the increase in the IQ-adaptive functioning gap with age was of similar magnitude for ASD males and females, but only reached statistical significance in males. We discuss unique implications the profound IQ-socialization skills gap in particular may have for ASD females.Lay abstractAdaptive functioning refers to skills that are vital to success in day-to-day life, including daily living (e.g. grocery shopping, food preparation, transportation use), communication (e.g. verbal expression of needs), and socialization skills (e.g. interpersonal skills, including expressing and recognizing emotions, and understanding turn-taking in conversation). Among autistic individuals without intellectual disability, adaptive functioning is not commensurate with intellectual ability (IQ), and instead a gap exists between these individuals’ intellectual ability and their adaptive skills. Further, these autistic individuals show a widening of this gap with increasing age. Existing studies of the gap between IQ and adaptive functioning have studied predominantly male samples. Thus, we do not know if the gap also exists in autistic females. We therefore looked at adaptive functioning and the gap between IQ and adaptive functioning in a large sample of autistic girls and boys without intellectual disability. To disentangle effects of group (autistic vs typically developing) from effects of sex (girls vs boys), we compared autistic girls and boys to one another as well as to their same-sex typically developing peers. Analyses took into consideration differences in IQ between autistic and typically developing youth. We found autistic girls, like autistic boys, show lower adaptive functioning than their same-sex typically developing peers. Results underscore the need to evaluate adaptive functioning in autistic individuals without intellectual disability and to provide necessary supports. The large gap between intellectual ability and socialization skills, in particular, may be of critical importance in improving our understanding of outcomes and mental health difficulties among autistic females.
      Citation: Autism
      PubDate: 2021-03-15T07:29:31Z
      DOI: 10.1177/1362361321995620
       
  • Associations between social camouflaging and internalizing symptoms in
           autistic and non-autistic adolescents
    • Authors: Courtney J Bernardin, Timothy Lewis, Debora Bell, Stephen Kanne
      Abstract: Autism, Ahead of Print.
      Autistic individuals experience higher rates of psychiatric comorbidities than their peers. Camouflaging, the process through which individuals hide autistic traits, can be detrimental to mental health. This may be particularly true for autistic females, although research on sex differences in the relationship between camouflaging and mental health has focused on adults. The purpose of this study was to extend previous research on camouflaging and mental health through examining age, sex, autism diagnosis, and camouflaging as predictors of depression, anxiety, and stress levels in autistic and non-autistic adolescents. One hundred forty adolescents ages 13–18 years (62 non-autistic, 58 female) completed an online survey including measures of camouflaging, autistic traits, and internalizing symptoms. Hierarchical linear regression was used to examine age, sex, diagnosis, and camouflaging as predictors of internalizing symptoms. Findings suggest that level of camouflaging is an important predictor of depression, anxiety, and stress in autistic and non-autistic adolescents and that camouflaging may be particularly distressing for females, regardless of diagnosis. These findings inform our understanding of camouflaging and its consequences and point to future directions for support for autistic and non-autistic adolescents. Clinicians may consider interventions targeting social skills, self-acceptance, and self-esteem to reduce possible negative effects of camouflaging.Lay abstractAutistic individuals have more mental health difficulties than non-autistic individuals. It is important to understand why this might be. Research has shown that camouflaging, or strategies used to hide autistic traits, might contribute to mental health difficulties in autistic adults. We examined whether this was also the case for autistic adolescents. This study included 140 adolescents ages 13–18 years (62 non-autistic, 58 female). All participants answered questions about camouflaging, autistic traits, and mental health difficulties. We found that autistic and non-autistic adolescents who reported higher levels of camouflaging also reported higher levels of depression, anxiety, and stress. We also found that camouflaging might be particularly stressful for females. These findings improve our understanding of camouflaging during adolescence and point to potential ways to support autistic adolescents, such as help with social skills, self-acceptance, and self-esteem. The findings also support the importance of increasing autism acceptance in the general population.
      Citation: Autism
      PubDate: 2021-03-12T11:20:57Z
      DOI: 10.1177/1362361321997284
       
  • Autistic differences in the temporal dynamics of social attention
    • Authors: Nicholas Hedger, Bhismadev Chakrabarti
      Abstract: Autism, Ahead of Print.
      Individuals with autism spectrum disorders typically exhibit reduced visual attention towards social stimuli relative to neurotypical individuals. Importantly, however, attention is not a static process, and it remains unclear how such effects may manifest over time. Exploring these momentary changes in gaze behaviour can more clearly illustrate how individuals respond to social stimuli and provide insight into the mechanisms underlying reduced social attention in autism spectrum disorder. Using a simple passive eye-tracking task with competing presentations of social and nonsocial stimuli, we examine the different ways in which attention to social stimuli evolves over time in neurotypical adults and adults with and autism spectrum disorders. Our temporal modelling of gaze behaviour revealed divergent temporal profiles of social attention in neurotypical and observers with autism. Neurotypical data showed an initial increase in social attention, a ‘decay’ and subsequent ‘recovery’ after prolonged viewing. By contrast, in individuals with autism spectrum disorder, social attention decayed over time in a linear fashion without recovery after prolonged viewing. We speculate that the ‘gaze cascade’ effect that maintains selection of social stimuli in neurotypical observers is disrupted in individuals with high autistic traits. Considering these temporal components of gaze behaviour may enhance behavioural phenotypes and theories of social attention in autism spectrum disorder.Lay abstractOne behaviour often observed in individuals with autism is that they tend to look less towards social stimuli relative to neurotypical individuals. For instance, many eye-tracking studies have shown that individuals with autism will look less towards people and more towards objects in scenes. However, we currently know very little about how these behaviours change over time. Tracking these moment-to-moment changes in looking behaviour in individuals with autism can more clearly illustrate how they respond to social stimuli. In this study, adults with and without autism were presented with displays of social and non-social stimuli, while looking behaviours were measured by eye-tracking. We found large differences in how the two groups looked towards social stimuli over time. Neurotypical individuals initially showed a high probability of looking towards social stimuli, then a decline in probability, and a subsequent increase in probability after prolonged viewing. By contrast, individuals with autism showed an initial increase in probability, followed by a continuous decline in probability that did not recover. This pattern of results may indicate that individuals with autism exhibit reduced responsivity to the reward value of social stimuli. Moreover, our data suggest that exploring the temporal nature of gaze behaviours can lead to more precise explanatory theories of attention in autism.
      Citation: Autism
      PubDate: 2021-03-12T05:26:44Z
      DOI: 10.1177/1362361321998573
       
  • Parenting stress in autism spectrum disorder may account for discrepancies
           in parent and clinician ratings of child functioning
    • Authors: Jessica M Schwartzman, Antonio Y Hardan, Grace W Gengoux
      Abstract: Autism, Ahead of Print.
      Elevated parenting stress among parents of children with autism spectrum disorder is well-documented; however, there is limited information about variability in parenting stress and relationships with parent ratings of child functioning. The aim of this study was to explore profiles of parenting stress among 100 parents of young children with autism spectrum disorder enrolled in two clinical trials and potential relationships between parenting stress and parent ratings of child functioning at the baseline timepoint. Secondary aims examined differential patterns of association between parenting stress profiles and parent versus clinician ratings of child functioning. A k-means cluster analysis yielded three different profiles of parenting stress (normal, elevated, and clinically significant) using scores on the Parenting Stress Index–Short Form. One-way analyses of variance revealed differential patterns of parent ratings across the three parenting stress profiles on certain domains of child functioning (e.g. problem behaviors and social impairment) and family empowerment, but similar ratings of child receptive and expressive language abilities. Clinicians blinded to study conditions also rated child functioning, but clinician ratings did not differ by parenting stress profile. Findings emphasize the importance of identifying parenting stress profiles and understanding their relationship with parent ratings, with implications for interpreting parent-report measures and measuring child response in treatment trials.Lay abstractElevated parenting stress among parents of children with autism spectrum disorder is well-documented; however, there is limited information about differences in parenting stress and potential relationships with parent ratings of child functioning. The aim of this study was to explore profiles of parenting stress among 100 parents of young children with autism spectrum disorder enrolled in two clinical trials and to explore relationships between parenting stress level and parent ratings of child functioning before treatment. Secondary aims examined differential patterns of association between parenting stress profiles and parent versus clinician ratings of child functioning. We show that stress may influence parent ratings of certain child behaviors (e.g. problem behaviors) and not others (e.g. language), yet clinician ratings of these same children do not differ. This new understanding of parenting stress has implications for parent-rated measures, tracking treatment outcome, and the design of clinical trials.
      Citation: Autism
      PubDate: 2021-03-11T06:34:15Z
      DOI: 10.1177/1362361321998560
       
  • A multimethod approach to assessing motor skills in boys and girls with
           autism spectrum disorder
    • Authors: Alessandro Crippa, Francesco Craig, Silvia Busti Ceccarelli, Maddalena Mauri, Silvia Grazioli, Nicoletta Scionti, Alice Cremascoli, Camilla Ferrante, Chiara Visioli, Gian Marco Marzocchi, Massimo Molteni, Maria Nobile
      Abstract: Autism, Ahead of Print.
      Motor abnormalities are highly prevalent in children with autism spectrum disorder and are strongly predictive of adaptive functioning. Despite the documented sex bias in the prevalence of the disorder, the impact of sex differences on motor abnormalities has been overlooked. The goal of this study was to investigate differences in the motor profile of boys and girls with autism spectrum disorder aged 3–11 years using a multimethod approach. Ninety-eight children with autism spectrum disorder and 98 typically developing children were assessed using the Movement Assessment Battery for Children 2, the Developmental Coordination Disorder Questionnaire, and the kinematic analysis of a reach-to-drop task. Results from principal components analysis on reach-to-drop-dependent measures indicated four components, accounting for kinematic parameters of the motor task. Irrespective of sex, children with autism spectrum disorder showed worse scores on Movement Assessment Battery for Children 2 and Developmental Coordination Disorder Questionnaire subscales than typically developing children. Interestingly, a diagnosis-by-sex interaction was found on a kinematic feature measured in the last part of the movement, with girls with autism spectrum disorder presenting altered motor anticipation. Although preliminary, these findings suggested that sex-related nuances in motor functioning of children with autism spectrum disorder could be insufficiently captured by existing motor measures.Lay abstractMotor peculiarities are often reported in children with autism spectrum disorder and may predict subsequent adaptive functioning and quality of life. Although the sex bias in the prevalence of the disorder is well documented, little is known about differences in motor profile in males and females with autism spectrum disorder. Our goal was to study differences in motor functioning of boys and girls with autism spectrum disorder aged 3–11 years compared with typically developing children. Their motor performances were evaluated using a multimethod approach, including standardized motor tests, caregiver reports, and a detailed motion capture analysis of a simple reach-to-drop movement. We found that, irrespective of sex, children with autism spectrum disorder had worse scores than typically developing children on standardized tests and on caregiver reports. Interestingly, girls with autism spectrum disorder, but not boys, presented altered motor anticipation in reach-to-drop. Our findings emphasize the need for more sex-specific assessment of motor function in autism spectrum disorder.
      Citation: Autism
      PubDate: 2021-03-03T04:25:34Z
      DOI: 10.1177/1362361321995634
       
  • Feeding and eating problems in children and adolescents with autism: A
           scoping review
    • Authors: Jessica Baraskewich, Kristin M von Ranson, Adam McCrimmon, Carly A McMorris
      Abstract: Autism, Ahead of Print.
      Feeding problems, such as picky eating and food avoidance, are common in youth with autism. Other feeding and eating problems (e.g. disordered eating, fear of trying new foods, and insistence on specific food presentation) are also common in this population. This scoping review describes the nature and extent of feeding and eating problems in autistic youth and reports characteristics of autistic youth who experience such issues. Thirty-four studies were included in the current review, with almost all studies (91%) investigating feeding problems. Only 9% of studies examined concern with weight, shape, and/or body image, but several authors noted that disordered eating attitudes and behaviors may occur more frequently in those with autism than their peers without autism. No common individual characteristics (e.g. cognitive functioning and autism symptom severity) were identified for youth who experience feeding or eating problems. Although differentiating “feeding” from “eating” problems is critical for accurate identification and treatment of these issues, the existing literature has failed to do so. We propose that in future research “eating problems” be used when behaviors involve preoccupation with food, eating, or body image, and “feeding problems” be used when such preoccupation is absent.Lay abstractFeeding problems, such as picky eating and food avoidance, are common in youth with autism. Other, broader difficulties with feeding and eating (eating disorder symptoms such as restricting food intake or preoccupation with body shape or weight and insistence on specific food presentation) are also common in autistic individuals. Here, we describe the nature and extent of feeding and eating problems in youth with autism. We found no common characteristics (such as severity of autism symptoms) that best describe autistic youth who experience problems with feeding or eating. Almost all studies we reviewed focused on problems with feeding (selective or picky eating), and only a few studies focused on eating disorder symptoms (concern with weight, shape, and/or body image). However, some researchers reported that eating disorder symptoms may occur more often in autistic individuals compared to their peers without autism. Many studies used the terms “feeding” and “eating” problems interchangeably, but understanding the difference between these problems is important for researchers to be consistent, as well as for proper identification and treatment. We suggest future researchers use “eating problems” when behaviors involve preoccupation with food, eating, or body image, and “feeding problems” when this preoccupation is absent. We highlight the importance of understanding whether feeding or eating problems are separate from autism traits, and the role of caregivers and other adults in the child’s treatment. Considerations for health-care providers to assist with diagnosis and treatment are also provided.
      Citation: Autism
      PubDate: 2021-03-03T04:22:55Z
      DOI: 10.1177/1362361321995631
       
  • A co-twin-control study of altered sensory processing in autism
    • Authors: Janina Neufeld, Mark J Taylor, Karl Lundin Remnélius, Johan Isaksson, Paul Lichtenstein, Sven Bölte
      Abstract: Autism, Ahead of Print.
      Autism spectrum disorder is associated with sensory processing alterations, such as sensory hyper- and hypo-responsiveness. Twin studies are scarce in this field, but they are necessary in order to disentangle the genetic and environmental contributions to this association. Furthermore, it is unclear how different neurodevelopmental/psychiatric conditions contribute to altering sensory processing. We investigated the association between autistic traits/autism spectrum disorder diagnosis and sensory processing alterations in twins (N = 269), using the adult/adolescent sensory profile, which differentiates four sub-domains: Low Registration, Sensation Seeking, Sensory Sensitivity, and Sensation Avoiding. While the associations between autistic traits and Low Registration and Sensation Avoiding persisted within monozygotic (genetically identical) twins, Sensory Sensitivity was only associated with autistic traits within dizygotic twins. In multivariate analyses with different neurodevelopmental/psychiatric diagnoses as predictor variables, autism spectrum disorder and attention deficit hyperactivity disorder were the strongest predictors for two adult/adolescent sensory profile sub-domains each. The results suggest that the association between autistic traits and Sensory Sensitivity is influenced by genetics while non-shared environmental factors influence the associations between autistic traits and Low Registration and Sensation Avoiding. They further indicate that altered sensory processing is not specific to autism spectrum disorder, while autism spectrum disorder is a strong predictor of certain sensory processing alterations, even when controlling for other (comorbid) neurodevelopmental/psychiatric conditions.Lay abstractIndividuals diagnosed with autism often describe that they process sensory information differently from others, and many experience sensory issues as problematic. For instance, an increased sensitivity to smells or sounds can make participating in social settings challenging. While sensory issues are now part of the diagnostic criteria for autism, they also co-occur with other psychiatric diagnoses such as attention deficit hyperactivity disorder and anxiety disorders. It is unclear to what extent the relationship between autism and alterations in sensory processing are due to genetics or environment. In addition, more research is needed on how autism, as compared to other diagnoses, is associated with sensory issues. Using a twin study, we found that genetic factors influenced self-reported reactivity to sensory stimuli in autism while environmental factors influenced other sensory issues (e.g. difficulties in detecting or differentiating sensory input). Hence, sensory hyper-reactivity might be an early onset core feature of autism, while other domains of alterations in sensory processing might develop later, influenced by the environment. Moreover, autism was more strongly associated with sensory issues related to increased sensitivity/reactivity as compared to other psychiatric diagnoses. However, attention deficit hyperactivity disorder was more strongly related to deficits in detecting/differentiating sensory stimuli and with an increased drive to seek sensory input. Our results indicate that sensory issues are not specific to autism, but that some aspects of altered sensory processing are more relevant for autism than for other diagnoses.
      Citation: Autism
      PubDate: 2021-03-01T12:49:51Z
      DOI: 10.1177/1362361321991255
       
  • Autistic adults’ subjective experiences of hoarding and
           self-injurious behaviors
    • Authors: Yael Goldfarb, Osnat Zafrani, Darren Hedley, Maya Yaari, Eynat Gal
      Abstract: Autism, Ahead of Print.
      Restrictive and Repetitive Behaviors and Interests represent a core feature of autism since the earliest conceptualization of the condition. Related behaviors, such as hoarding and self-injurious behaviors, are under-researched in adulthood, resulting in limited knowledge about their various manifestation through the life span. This study expands our understanding of hoarding and self-injurious behaviors through subjective experiences shared by autistic adults. Ten adults with an autism diagnosis (aged 18–55 years, five females) participated in semi-structured, in-depth interviews. Thematic analysis identified a cluster of behaviors related to hoarding and self-injurious behaviors. Further analysis sub-categorized each theme according to the underlying purpose of the behavior. Hoarding behaviors were motivated by (1) a need for emotional aids, (2) disposing difficulties, and (3) collecting items related to special interests. Reasons for engaging in self-injurious behaviors were (1) an urge for sensory stimulation and (2) emotional regulation purposes. Discussion focuses on the underlying motives of the participants for engaging in these behaviors, in respect to current research knowledge. Relations to the general construct of Restrictive and Repetitive Behaviors and Interests are discussed along with implications for research and practice.Lay abstractHoarding and self-injurious behaviors are relatively common in autism, but knowledge about their expressions in adulthood is scarce. Through interviews collecting subjective experiences of autistic adults, these behaviors were explored, and categorized to their underlying purposes. Findings portray the occurrence of these behaviors in the lives of autistic adults, their self-regulatory purposes, and their relationship to other behaviors in the domain of Restrictive and Repetitive Behaviors and Interests.
      Citation: Autism
      PubDate: 2021-02-26T05:03:52Z
      DOI: 10.1177/1362361321992640
       
  • Intermittent theta burst stimulation over the posterior superior temporal
           sulcus for children with autism spectrum disorder: A 4-week randomized
           blinded controlled trial followed by another 4-week open-label
           intervention
    • Authors: Hsing-Chang Ni, Yi-Lung Chen, Yi-Ping Chao, Chen-Te Wu, Yu-Yu Wu, Sophie Hsin-Yi Liang, Wei-Chih Chin, Tai-Li Chou, Susan Shur-Fen Gau, Ying-Zu Huang, Hsiang-Yuan Lin
      Abstract: Autism, Ahead of Print.
      The posterior superior temporal sulcus is a potential therapeutic target of brain stimulation for autism spectrum disorder. We conducted a 4-week randomized, single-blind parallel sham-controlled trial, followed by additional 4-week open-label intervention to evaluate the feasibility and efficacy regarding intermittent theta burst stimulation over the bilateral posterior superior temporal sulcus in autism spectrum disorder. In total, 78 intellectually able children and adolescents were randomized to the active (n = 40) and sham groups (n = 38). During the first 4 weeks, the active group received two-session/week intermittent theta burst stimulation, whereas the sham group received the same number of sham stimulation. After unblinding, both groups received eight-session real stimulation over the additional 4 weeks. In total, 91% participants completed the protocol with mild and transitory side-effects. There was no significant group-by-time interaction for active versus sham group on clinical symptoms and social cognitive performances in the first 4 weeks. The within-group analysis revealed 8 weeks (including a 4-week blind trial and a 4-week open-label intervention) of intermittent theta burst stimulation achieved greater efficacy than 4-week interventions. Participants with higher intelligence, better social cognitive performances, alongside less attention-deficit hyperactivity disorder severity at baseline, were more likely to be responders. Our study demonstrated the feasibility of long-term intermittent theta burst stimulation over the posterior superior temporal sulcus in children and adolescents with autism spectrum disorder. However, the findings from the first 4-week blind trial do not support the therapeutic efficacy of intermittent theta burst stimulation over the posterior superior temporal sulcus on the clinical symptoms and cognitive performance of social impairment, given the current stimulation protocol. The exploratory analyses suggest that the therapeutic efficacy might be moderated by several individual characteristics and more intermittent theta burst stimulation sessions.Lay abstractIntermittent theta burst stimulation is a varied form of repetitive transcranial magnetic non-invasive brain stimulation technique used to treat several neurological and psychiatric disorders. Its feasibility and therapeutic effects on the bilateral posterior superior temporal sulcus in children with autism are unknown. We conducted a single-blind, sham-controlled parallel randomized clinical trial in a hitherto largest sample of intellectually able children with autism (N = 78). Participants randomized to the active group received two-session/week intermittent theta burst stimulation for continuous 8 weeks. Those in the sham group received two-session/week sham stimulations in the first 4 weeks and then active intervention for the following 4 weeks after unblinding. First, we found that continuous 8-week intermittent theta burst stimulation on the bilateral posterior superior temporal sulcus in children with autism is safe and tolerable. Second, we found that 8-week intermittent theta burst stimulation produced greater therapeutic efficacy, although we did not find any significant effects of 4-week intermittent theta burst stimulation on core symptoms and social cognitive performances in autism. Further analysis revealed that participants with higher intelligence and better social cognitive performance, alongside less attention-deficit hyperactivity disorder severity at baseline, were more likely to be responders. This study identified that the factors contribute to responders and the results suggest that longer courses of non-invasive brain stimulation may be needed to produce therapeutic benefits in autism, with consideration of heterogeneous responses.
      Citation: Autism
      PubDate: 2021-02-26T05:01:24Z
      DOI: 10.1177/1362361321990534
       
  • Naturalistic evaluation of preschoolers’ spontaneous interactions: The
           Autism Peer Interaction Observation Scale
    • Authors: Nirit Bauminger-Zviely, Analia Shefer
      Abstract: Autism, Ahead of Print.
      Peer interaction can be challenging in autism spectrum disorder, but naturalistic peer-observation scales for preschoolers are scarce. This study examined psychometric qualities of the newly developed Autism Peer Interaction Observation Scale. We tested the Autism Peer Interaction Observation Scale to (a) characterize peer interactions of preschoolers with autism spectrum disorder who were cognitively able versus typical age-mates, (b) explore each group’s hierarchical pattern of peer interaction behaviors, and (c) identify Autism Peer Interaction Observation Scale’s links with standard reports for assessing social-communication functioning (Vineland Behavior Scales, 2nd ed.), social impairment (Social Responsiveness Scale, 2nd ed.), autism severity (Autism Diagnostic Observation Schedule, 2nd ed.), and intelligence quotient (Mullen) in the cognitively able preschoolers with autism spectrum disorder group. Participants comprised 85 preschoolers (50 cognitively able preschoolers with autism spectrum disorder, intelligence quotient > 75; 35 typical). Groups were matched for age, intelligence quotient, and maternal education. Significant group differences emerged on all Autism Peer Interaction Observation Scale categories, in favor of typical. In cognitively able preschoolers with autism spectrum disorder, correlation analyses indicated that more typical peer relations on Autism Peer Interaction Observation Scale were linked with better adaptive and socialization skills (Vineland Behavior Scales, 2nd ed.) and fewer social atypicalities (Social Responsiveness Scale, 2nd ed.). Higher intelligence quotient scores were linked with better Autism Peer Interaction Observation Scale social-communication functioning. Only a few Autism Peer Interaction Observation Scale social-communication categories significantly correlated with the Autism Diagnostic Observation Schedule, 2nd ed. Findings highlight the Autism Peer Interaction Observation Scale as differentiating between groups and providing knowledge about peer interaction in natural settings. This new tool can help personalize social-communication programs and evaluations of early intervention outcomes.Lay abstractPeer interaction can be challenging in autism spectrum disorder, but naturalistic peer-observation scales for preschoolers are limited. This study examined the newly developed Autism Peer Interaction Observation Scale, with 17 subcategories, which evaluate naturalistic peer interaction processes in preschoolers with autism spectrum disorder and typical development. We tested the Autism Peer Interaction Observation Scale to (a) characterize peer interactions of preschoolers with autism spectrum disorder who were cognitively able versus typical age-mates, (b) explore each group’s hierarchical pattern of peer interaction behaviors, and (c) identify Autism Peer Interaction Observation Scale’s links with standard reports for assessing social-communication functioning (Vineland Behavior Scales, 2nd ed.), social impairment (Social Responsiveness Scale, 2nd ed.), autism severity (Autism Diagnostic Observation Schedule, 2nd ed.), and intelligence quotient (Mullen) in the cognitively able preschoolers with autism spectrum disorder group. Participants comprised 85 preschoolers (50 cognitively able preschoolers with autism spectrum disorder, intelligence quotient > 75; 35 typical). Groups were matched according to age, intelligence quotient, and maternal education. Significant group differences emerged on all Autism Peer Interaction Observation Scale categories, with the typical group showing better social-communication functioning as compared to the cognitively able preschoolers with autism spectrum disorder group. Also, in cognitively able preschoolers with autism spectrum disorder that observed as demonstrating more typical peer relations on the Autism Peer Interaction Observation Scale showed better adaptive and socialization skills on the Vineland (Vineland Behavior Scales, 2nd ed.) and fewer social atypicalities on the Social Responsiveness Scale, 2nd ed. Higher intelligence quotient scores were linked with better observed social-communication functioning (on Autism Peer Interaction Observation Scale). Few Autism Peer Interaction Observation Scale social-communicative categories significantly correlated with the Autism Diagnostic Observation Schedule, 2nd ed. Findings highlight the Autism Peer Interaction Observation Scale as differentiating the two preschooler groups and providing additional knowledge about socially communicative peer interaction in natural settings. This new tool can help personalize social-communication programs and evaluations of early intervention outcomes, thereby leading to a fuller picture of these young children’s functioning.
      Citation: Autism
      PubDate: 2021-02-25T04:41:40Z
      DOI: 10.1177/1362361321989919
       
  • Do animated triangles reveal a marked difficulty among autistic people
           with reading minds'
    • Authors: Alexander C Wilson
      Abstract: Autism, Ahead of Print.
      This meta-analysis tested whether autistic people show a marked, isolated difficulty with mentalising when assessed using the Frith -Happé Animations, an advanced test of mentalising (or ‘theory of mind’). Effect sizes were aggregated in multivariate meta-analysis from 33 papers reporting data for over 3000 autistic and non-autistic people. Relative to non-autistic individuals, autistic people underperformed, with a small effect size on the non-mentalising control conditions and a medium effect size on the mentalising condition. This indicates that studies have reliably found mentalising to be an area of challenge for autistic people, although the group differences were not large. It remains to be seen how important mentalising difficulties are in accounting for the social difficulties diagnostic of autism. As autistic people underperformed on the control conditions as well as the mentalising condition, it is likely that group differences on the test are partly due to domain-general information processing differences. Finally, there was evidence of publication bias, suggesting that true effects on the Frith -Happé Animations may be somewhat smaller than reported in the literature.Lay abstractAutistic people are thought to have difficulty with mentalising (our drive to track and understand the minds of other people). Mentalising is often measured by the Frith -Happé Animations task, where individuals need to interpret the interactions of abstract shapes. This review article collated results from over 3000 people to assess how autistic people performed on the task. Analysis showed that autistic people tended to underperform compared to non-autistic people on the task, although the scale of the difference was moderate rather than large. Also, autistic people showed some difficulty with the non-mentalising as well as mentalising aspects of the task. These results raise questions about the scale and specificity of mentalising difficulties in autism. It also remains unclear how well mentalising difficulties account for the social challenges diagnostic of autism.
      Citation: Autism
      PubDate: 2021-02-23T09:04:24Z
      DOI: 10.1177/1362361321989152
       
  • Camouflaging in an everyday social context: An interpersonal recall study
    • Authors: Julia Cook, Laura Crane, Laura Bourne, Laura Hull, William Mandy
      Abstract: Autism, Ahead of Print.
      Camouflaging is a social phenomenon operating within everyday social interactions of autistic and non-autistic people. The current study explored autistic adults’ camouflaging in an everyday social context via interpersonal process recall methodology (Kegan, 1969). A total of 17 autistic adults (8 females, 6 males and 3 agender/gender-neutral individuals) participated in a 10-min controlled social task designed to replicate a common day-to-day social situation. Participants then watched a video of their interaction with a researcher, actively identifying instances of camouflaging and discussing their experiences of camouflaging. Using thematic analysis, four themes were generated: (1) a strong desire for, yet uncertainty in, securing social acceptance and connection; (2) camouflaging, developed over time, as a means to achieve social acceptance and connection; (3) experiencing intrapersonal and interpersonal camouflaging consequences during social interactions; and (4) authentic socialising as an alternative to camouflaging. These findings are discussed with reference to the existing literature on stigma management outside the field of autism.Lay abstractMany autistic people report that, despite personal costs, they use strategies to hide their autistic characteristics or appear non-autistic at work, school or university, when speaking with health professionals, or while socialising with certain friends and family members. These strategies are often referred to as camouflaging. This study explores camouflaging during everyday social interactions. A total of 17 autistic adults were filmed taking part in a common everyday social situation – a conversation with a stranger. They then watched the video of this conversation with a researcher and answered questions about camouflaging. These autistic people told us that they (1) had a strong desire to socialise with and be valued by other people but, because of negative past experiences, they often felt unsure about their ability to do so; (2) used camouflaging to help them to socialise and be valued by others; (3) experienced negative consequences when camouflaging (e.g. fatigue, anxiety and difficulties in friendships); and (4) sometimes socialised in more autistic ways instead of camouflaging. This study shows us how autistic people often change their behaviour because of the way they are treated by nonautistic people and that autistic people may benefit from programmes that help them to socialise in more authentically autistic ways, but only if their autistic social behaviour is met with understanding and acceptance from non-autistic people.
      Citation: Autism
      PubDate: 2021-02-20T05:15:11Z
      DOI: 10.1177/1362361321992641
       
  • Adults with autism spectrum disorder show atypical patterns of thoughts
           and feelings during rest
    • Authors: Sonja Simpraga, Ricarda F Weiland, Huibert D Mansvelder, Tinca JC Polderman, Sander Begeer, Dirk JA Smit, Klaus Linkenkaer-Hansen
      Abstract: Autism, Ahead of Print.
      Mind wandering constitutes a major part of everyday experience and is inherently related to how we feel and identify ourselves. Thus, probing the character and content of thoughts and feelings experienced during mind-wandering episodes could lead to a better understanding of the human mind in health and disease. How mind wandering and spontaneous thought processes are affected in disorders such as autism is poorly understood. Here, we used the eyes-closed rest condition to stimulate mind wandering and quantified the subjective experiences using the Amsterdam Resting-State Questionnaire—which quantifies subjective psychological states of resting-state cognition across 10 domains—in 88 adults with autism spectrum disorder and 90 controls. We observed an atypical pattern of both thoughts and feelings in the autism spectrum disorder cohort, specifically in the domains of Theory of Mind, Comfort, and Discontinuity of Mind. We propose that the use of the Amsterdam Resting-State Questionnaire as a standardized cognitive instrument could advance our understanding of thoughts and feelings in autism spectrum disorder as well as in a wide variety of other brain disorders and how these may change due to therapeutic interventions.Lay abstractEveryone knows the feeling of letting one’s mind wander freely in a quiet moment. The thoughts and feelings experienced in those moments have been shown to influence our well-being—and vice versa. In this study, we looked at which thoughts and feelings are being experienced by adults with autism spectrum disorder and compared them to adults without autism spectrum disorder. In total, 88 adults with autism spectrum disorder and 90 adults without autism spectrum disorder were asked to rest for 5 min with their eyes closed and let their mind wander. Directly after, they filled in the Amsterdam Resting-State Questionnaire, which probes what participants were feeling and thinking during the period of rest. We found that adults with autism spectrum disorder tend to think less about others, felt less comfortable, and had more disrupted thoughts during the rest compared to adults without autism spectrum disorder. Interestingly, autism spectrum disorder participants reporting lower levels of comfort during the rest also reported more autism spectrum disorder symptoms, specifically in social behaviors and skills, attention switching, and imagination. We propose to use the eyes-closed rest condition in combination with the Amsterdam Resting-State Questionnaire more widely to shed light on aberrant thoughts and feelings in brain disorders and to study the effect of therapeutic interventions.
      Citation: Autism
      PubDate: 2021-02-20T05:14:42Z
      DOI: 10.1177/1362361321990928
       
  • ‘It’s not that they don’t want to access the support . . . it’s
           the impact of the autism’: The experience of eating disorder services
           from the perspective of autistic women, parents and healthcare
           professionals
    • Authors: Charli Babb, Janina Brede, Catherine R G Jones, Mair Elliott, Cathy Zanker, Kate Tchanturia, Lucy Serpell, Will Mandy, John R E Fox
      Abstract: Autism, Ahead of Print.
      This study explores autistic women’s experiences of eating disorder services. Estimates suggest that 20%–30% of women in treatment for anorexia nervosa display diagnostic features characteristic of autism. Research suggests that autistic individuals’ needs are not being met by standard anorexia nervosa treatments. In the current study, in-depth interviews were conducted with 15 autistic women with experience of anorexia nervosa, 12 parents of autistic women with anorexia nervosa, and 11 eating disorder healthcare professionals. Using thematic analysis, three overarching themes were identified: misunderstanding autism and autistic traits, one treatment does not fit all, and improving accessibility and engagement within services. We found that there were diverse barriers facing autistic women when in treatment for anorexia nervosa, and these were accentuated by a lack of autism understanding within eating disorder services. Future research should focus on developing interventions that are tailored to the specific needs of autistic individuals with anorexia nervosa.Lay This study explores autistic women’s experiences of eating disorder services. About 20%–30% of people with anorexia nervosa are also autistic, and current treatments seem not to work as well for them. We interviewed 15 autistic women with experience of anorexia nervosa, 12 parents of autistic women with anorexia nervosa, and 11 healthcare professionals working in eating disorder services. We asked autistic women and parents about their experiences of eating disorder services, and we asked healthcare professionals about their experiences treating autistic women with anorexia nervosa. Participants’ views were represented by three overall themes: misunderstanding autism and autistic traits, one treatment does not fit all, and improving accessibility and engagement within services. We found that autistic women face many barriers when in treatment for anorexia nervosa, often because of a lack of autism understanding within eating disorder services. Future research should look at developing anorexia nervosa treatments that can specifically help autistic individuals.
      Citation: Autism
      PubDate: 2021-02-16T05:02:28Z
      DOI: 10.1177/1362361321991257
       
  • Exploring an e-learning community’s response to the language and
           terminology use in autism from two massive open online courses on autism
           education and technology use
    • Authors: Jiedi Lei, Lauren Jones, Mark Brosnan
      Abstract: Autism, Ahead of Print.
      Prior research has identified the divergence across different stakeholder groups in the semantic choice of language when describing autism, as members of the autism and autistic community preferred to use identity-first language (autistic person), whereas professionals were more likely to use person-first language (person with autism). This study explored 803 e-learners’ responses from their comments across two massive open online courses on autism education held between 2017 and 2019. Comments from members of the autistic and autism community and professionals were analysed together using thematic analysis, to identify shared opinions on what, why and how language should be used when describing autism across stakeholder groups. Learners agreed that autistic individuals should guide others on which terminology to use when describing autism and that the diagnostic label is a way to facilitate understanding across stakeholder groups and help the individual gain access to support. Semantic language choices may matter less as long as the person’s difficulties are clearly acknowledged, with adaptations made to meet their specific needs. Adding to a growing body of literature on terminology use in autism research and practice, we highlight that consideration for semantic choice of language use should focus on communicating an individual’s strengths and differences.Lay abstractWithin the neurodiversity movement, one recent divergence is in the semantic choice of language when describing autism, as members of the autism and autistic community preferred to use identity-first language (autistic person), whereas professionals were more likely to use person-first language (person with autism). This study explored 803 e-learners’ responses from their comments across two massive open online courses on autism education held between 2017 and 2019. Learners agreed that autistic individuals should guide others on which terminology to use when describing autism, and although identity-first language acknowledges autism as part of an individual’s identity, it can also conjure up negative stereotypes and be stigmatising. Although family, friends and professionals highlighted that the diagnostic label is a way to facilitate understanding across stakeholder groups and help autistic individuals gain access to support, autistic self-advocates found the process of disclosing autism as a form of disability to conflict with their sense of identity, and broader terms such as ‘autism spectrum’ failed to capture individual strengths and weaknesses. Semantic language choices may matter less as long as the person’s difficulties are clearly acknowledged, with adaptations made to meet their specific needs. Adding to a growing body of literature on terminology use in autism research and practice, we highlight that language used when describing autism should follow the autistic individual’s lead, with the primary focus on communicating an individual’s strengths and difficulties, to foster a sense of positive autism identity and inclusivity, and enable access to appropriate support.
      Citation: Autism
      PubDate: 2021-02-11T09:43:11Z
      DOI: 10.1177/1362361320987963
       
  • Examining frequent emergency department use among children and adolescents
           with autism spectrum disorder
    • Authors: Judith Beverly, Theodoros Giannouchos, Timothy Callaghan
      Abstract: Autism, Ahead of Print.
      We analyze the 2011–2016 Healthcare Cost and Utilization Project State Emergency Department Databases and State Inpatient Databases for all emergency department visits by children and adolescents in New York to estimate the association between autism spectrum disorder and frequent emergency department utilization. Our study included 5.9 million individuals with 9.1 million emergency department visits. Of those, 31,682 had autism spectrum disorder (0.5%) accounting for 66,053 (0.7%) emergency department visits. Individuals with autism spectrum disorder had on average 0.6 more emergency department visits per year, were more likely to exhibit frequent emergency department use (⩾4, ⩾6, ⩾8, and ⩾10 emergency department visits/year), and had larger shares of comorbidities and diagnoses related to attention-deficit/hyperactivity disorder, intellectual disability, and epilepsy. These findings highlight the need for patient and family-centered care interventions and emergency department staff education initiatives.Lay abstractThis study used data for 5.9 million individuals with 9.1 million emergency department visits from all hospitals in the state of New York to explore frequent emergency department use between children and adolescents with autism spectrum disorders and those without autism spectrum disorders. We found that children and adolescents with autism spectrum disorders had larger shares of comorbidities and diagnoses related to attention-deficit/hyperactivity disorder, intellectual disability, and epilepsy. Children and adolescents with autism spectrum disorders were also more likely to utilize emergency departments and to exhibit frequent use. These results emphasize the need for using family-centered care to improve the care experiences of children and youth with autism spectrum disorders and their families. In addition, the education of emergency department staff of processes and practices as it relates to delivery of care and the care experience.
      Citation: Autism
      PubDate: 2021-02-11T06:00:58Z
      DOI: 10.1177/1362361321990925
       
  • Virtual interview training for autistic transition age youth: A randomized
           controlled feasibility and effectiveness trial
    • Authors: Matthew J Smith, Kari Sherwood, Brittany Ross, Justin D Smith, Leann DaWalt, Lauren Bishop, Laura Humm, Jeff Elkins, Chris Steacy
      Abstract: Autism, Ahead of Print.
      Autistic transition age youth struggle with obtaining employment, and interviewing is a critical barrier to getting a job. We adapted an efficacious virtual reality job interview intervention to meet the needs of autistic transition age youth, called the Virtual Interview Training for Transition Age Youth. This study evaluated whether Virtual Interview Training for Transition Age Youth can be feasibly delivered in high school special education settings and whether Virtual Interview Training for Transition Age Youth improves job interview skills, job interview self-efficacy, job interview anxiety, and access to employment. Forty-eight autistic transition age youth received school-based pre-employment services as usual with Virtual Interview Training for Transition Age Youth, while 23 autistic transition age youth received services as usual only. Local teachers trained and supervised autistic transition age youth using Virtual Interview Training for Transition Age Youth. Participants reported Virtual Interview Training for Transition Age Youth was highly acceptable. Participants receiving services as usual and Virtual Interview Training for Transition Age Youth, compared to participants receiving services as usual only, had better job interview skills and lower job interview anxiety as well as greater access to jobs. Overall, Virtual Interview Training for Transition Age Youth appears to be effective at teaching job interview skills that are associated with accessing competitive jobs. Moreover, youth enjoyed Virtual Interview Training for Transition Age Youth and teachers feasibly implemented the tool within special education pre-employment transition services. Future research needs to better understand how autistic transition age youth from culturally diverse backgrounds and different social, behavioral, or mental health challenges may respond to Virtual Interview Training for Transition Age Youth.Lay abstractAutistic transition age youth struggle with obtaining employment, and interviewing is a critical barrier to getting a job. We adapted an efficacious virtual reality job interview intervention to meet the needs of autistic transition age youth, called the Virtual Interview Training for Transition Age Youth. This study evaluated whether Virtual Interview Training for Transition Age Youth can be feasibly delivered in high school special education settings and whether Virtual Interview Training for Transition Age Youth improves job interview skills, job interview self-efficacy, job interview anxiety, and access to employment. Forty-eight autistic transition age youth received school-based pre-employment services as usual with Virtual Interview Training for Transition Age Youth, while 23 autistic transition age youth received services as usual only. Local teachers trained and supervised autistic transition age youth using Virtual Interview Training for Transition Age Youth. Participants reported Virtual Interview Training for Transition Age Youth was highly acceptable. Participants receiving services as usual and Virtual Interview Training for Transition Age Youth, compared to participants receiving services as usual only, had better job interview skills and lower job interview anxiety as well as greater access to jobs. Overall, Virtual Interview Training for Transition Age Youth appears to be effective at teaching job interview skills that are associated with accessing competitive jobs. Moreover, youth enjoyed Virtual Interview Training for Transition Age Youth and teachers feasibly implemented the tool within special education pre-employment transition services. Future research needs to better understand how autistic transition age youth from culturally diverse backgrounds and different social, behavioral, or mental health challenges may respond to Virtual Interview Training for Transition Age Youth.
      Citation: Autism
      PubDate: 2021-02-11T05:58:38Z
      DOI: 10.1177/1362361321989928
       
  • A mixed methods exploration of community providers’ perceived barriers
           and facilitators to the use of parent training with Medicaid-enrolled
           clients with autism
    • Authors: Diondra Straiton, Barb Groom, Brooke Ingersoll
      Abstract: Autism, Ahead of Print.
      This mixed methods analysis examined provider perspectives on barriers and facilitators to parent training use with Medicaid-enrolled clients. Provider survey data were analyzed using hierarchical linear regression models and thematic analysis was used to analyze follow-up interviews with providers. Qualitative themes were developed inductively from interview transcripts without preconceived hypotheses. Barriers and facilitators were identified at the family-, provider-, and organization-level. Family-level barriers were the only barriers to uniquely predict parent training extensiveness (β = −0.27, p = 0.007), which is a composite measure of parent training frequency and quality. No facilitators uniquely predicted extensiveness, but provider skills and professional training experiences marginally predicted extensiveness (ps 
      Citation: Autism
      PubDate: 2021-02-09T05:08:23Z
      DOI: 10.1177/1362361321989911
       
  • Understanding the role of self-determination in shaping university
           experiences for autistic and typically developing students in the United
           Kingdom
    • Authors: Jiedi Lei, Ailsa Russell
      Abstract: Autism, Ahead of Print.
      With more autistic students enrolling in higher education, little is known about how autistic students can actively and effectively shape their own university experience through self-determination. This study explores how both autistic (n = 18) and typically developing students and recent graduates (n = 18) perceive their self-determination during their transition into, through and out of university in the United Kingdom. Students reported many shared and unique aspects of autonomy, competence and relatedness underlying self-determination. Many autistic students also discussed autism-related strengths facilitating academic pursuit at university, though found coping with transitional changes more difficult than typically developing students. Using strength-based approaches to help autistic students to actively adapt to routine changes might facilitate their self-determination during transition to university.Lay abstractPrior research suggests that autistic students in higher education might struggle with developing autonomy, competence and establish relatedness due to their executive functioning and social communication difficulties. We interviewed 18 autistic and 18 typically developing students to explore how students perceived themselves to be in control of their university experience. Both groups provided anecdotal examples that supported similar perceptions of self-determination in shaping the academic, daily living and socialisation aspects of university life. Autistic students reflected on their cognitive strengths such as attention to detail, persistence and ability to tailor their academic studies towards their interest. Varying degrees of sociability were noted, with some autistic students preferring to focus their self-determination efforts on academic success, while others treasured the novel social experiences including peer support and friendship at university. Compared to greater flexibility endorsed by typically developing students, autistic students perceived establishing a routine at university to be a necessity and were self-determined in maintaining stability amid a sea of change. Recognising strengths and self-determination efforts in autistic students can help stakeholders support their personal development towards independent living and self-sufficiency in adulthood and to successfully transition into, through and out of university.
      Citation: Autism
      PubDate: 2021-02-04T04:50:58Z
      DOI: 10.1177/1362361320984897
       
  • Exploring the health of families with a child with autism
    • Authors: Sarah L Smith, Hannah B McQuade
      Abstract: Autism, Ahead of Print.
      Families provide a critical context for the overall growth and development of a child. The health of a family is foundational to the everyday life in which a child and family can flourish. For families raising a child with autism, the chronic, intense nature of everyday life threatens family health in part due to increased parental stress and potential centralization of the child with autism in family functioning. The present study sought to understand how families of children with autism perceived and experienced their own family health and to identify what factors and processes families identified as contributing to their health. Researchers conducted semi-structured interviews with 16 families with a child with autism ages 2-17. Interviews occurred in person and with all members present to the extent possible. Sixteen mothers, eight fathers, and 32 children (18 with autism) participated. Interviews were audiorecorded and transcribed verbatim. Researchers analyzed data using inductive content analyses to generate results. Findings suggest families experience family health as a journey grounded within family identity and marked by five themes: connection, balance, the centralization of autism, stress, and support systems. Findings contribute relevant considerations for service providers working to support children with autism and their families.Lay abstractFamilies are important for the overall growth and development of a child. The health of a family is foundational to the everyday life in which a child and family can blossom. Families with a child with autism have a family life that has challenges for many reasons including that parents can be stressed from trying to figure out how to be a good parent for their child with autism. We wanted to know two things: (1) what is family health for families of a child with autism and (2) what affects families trying to be their healthiest. We wanted to know the answers to these questions from families themselves, including parents (not just moms) and children, because they are the best experts. We talked to 16 families including 16 mothers, 8 fathers, and 32 children (18 with autism). Families shared that being a healthy family was a journey with ups and downs and that families were not always perfect. It helped when families knew about themselves as a family such as knowing what they liked and did not like to do, and knowing what the different people in the family needed. Families said that what affected their family’s health was being together, keeping their days not too busy, stress, autism itself, having helpers like friends, grandparents, therapists, and having money to pay for services. We hope that knowing these answers will guide service providers of people with autism to think about healthy families.
      Citation: Autism
      PubDate: 2021-01-28T09:51:40Z
      DOI: 10.1177/1362361320986354
       
  • Mental health, broad autism phenotype and psychological inflexibility in
           mothers of young children with autism spectrum disorder in Australia: A
           cross-sectional survey
    • Authors: Kavindri Kulasinghe, Koa Whittingham, Amy E Mitchell
      Abstract: Autism, Ahead of Print.
      Mothers of children with autism spectrum disorder are more likely to have features of the broad autism phenotype and adverse mental health outcomes. The broad autism phenotype can contribute to poorer mental health; however, the mechanism behind this relationship remains uncertain. This study investigated both the predictors of mental health and the relationship between the broad autism phenotype and mental health symptoms in mothers of children with autism spectrum disorder. This cross-sectional survey recruited 232 Australian mothers (⩾18 years) of children with autism spectrum disorder (0–10 years) and assessed maternal broad autism phenotype, mental health, adult attachment style, degree of social support and parenting experience. Hierarchical multiple regressions, t-tests, correlations and mediation analyses were conducted. Psychological inflexibility was the greatest unique predictor of anxious, depressive and stress symptomatology. Challenging parenting experiences predicted depressive, anxious and stress symptomatology while the broad autism phenotype also uniquely predicted anxious symptoms. Both psychological inflexibility and challenging parenting experiences were significant mediators of the relationships between the broad autism phenotype and depressive symptoms and between the broad autism phenotype and anxiety. Psychological inflexibility alone mediated the relationship between the broad autism phenotype and stress. Targeting psychological inflexibility and supporting parenting are promising avenues for future interventions to support the mental health of mothers of young children with autism spectrum disorder.Lay abstractMothers of children with autism tend to have poorer mental health outcomes compared to most mothers. Lack of social support, parenting challenges and relationship difficulties are more common for mothers of children with autism and can all affect maternal mental health. Mothers of children with autism are also more likely to have some autistic features, called the broad autism phenotype, that can contribute to poorer mental health; however, how these factors relate to one another are unclear. This study found that mothers who were less flexible in their thinking and behaviour and had more difficult parenting experiences tended to have poorer mental health. Mothers with more autistic features were less flexible in their thinking and behaviour, which, in turn, was linked to greater symptoms of depression, anxiety and stress. Mothers with greater autistic features also reported more difficult parenting experiences, which was in turn linked with greater symptoms of anxiety and depression. This study suggests that supporting mothers of young children with autism to manage parenting challenges and become more flexible with their thinking and behaviour could help to improve their mental health.
      Citation: Autism
      PubDate: 2021-01-28T09:50:44Z
      DOI: 10.1177/1362361320984625
       
  • Are there anthropometric and body composition differences between children
           with autism spectrum disorder and children with typical development'
           Analysis by age and spectrum severity in a school population
    • Authors: Patricia Esteban-Figuerola, Paula Morales-Hidalgo, Victoria Arija-Val, Josefa Canals-Sans
      Abstract: Autism, Ahead of Print.
      Overweight and obesity have been reported to be more prevalent in populations with autism spectrum disorder than in children with typical development. The aim of this study was to compare the anthropometric status of children with autism spectrum disorder (diagnosed and subclinical) and children with typical development and analyse which variables can affect the anthropometric and health status of children with autism spectrum disorder. We present a two-phase epidemiological study in a school population of two age groups which assesses autism spectrum disorder diagnosis, anthropometric data and bioelectrical impedance analysis. From an initial sample of 3,713 children, 79 with autism spectrum disorder, 42 with subclinical autism spectrum disorder and 350 with typical development participated in the study. Pre-schoolers with autism spectrum disorder were taller than pre-schoolers with typical development. School-age children with autism spectrum disorder showed a significantly higher body mass index and rate of overweight/obesity than children with typical development (63.4% vs 46.3%). No significant differences were found for bioelectrical impedance analysis, but school-age children with autism spectrum disorder showed a significantly higher waist circumference, waist/height ratio and cardiovascular risk than children with typical development. The quality of the diet was lower in children with autism spectrum disorder than in children with typical development. Multiple regression analyses showed that having autism spectrum disorder and internalizing psychological problems were associated with waist/height ratio and high cardiovascular risk in school-age children.Lay abstractThis study makes a comparison between the growth status of pre-school and school-age children with autism spectrum disorder and typical development children. Pre-schoolers with autism spectrum disorder were taller than children with typical development. School-age children with autism spectrum disorder were more overweight/obese, had more body fat and a greater waist circumference and waist/height ratio than children with typical development. The presence of autism spectrum disorder and internalizing problems was associated with cardiovascular risk in school-age children.
      Citation: Autism
      PubDate: 2021-01-25T09:14:06Z
      DOI: 10.1177/1362361320987724
       
  • Self-reported community participation experiences and preferences of
           autistic adults
    • Authors: Lindsay L Shea, Katherine Verstreate, Stacy Nonnemacher, Wei Wong, Mark S Salzer
      Abstract: Autism, Ahead of Print.
      Community participation is essential to overall health and well-being. However, research on the community participation experiences and preferences of autistic adults is lacking. Results from a large, mid-Atlantic statewide needs assessment survey found that a number of activities that include social interactions or are focused on meeting daily needs are important to autistic adults and that they participate in these activities to varying degrees. Going shopping at a grocery store was the most common community activity reported and also rated as important by the largest proportion of respondents. Autistic adults with a co-occurring intellectual disability participated in fewer activities and reported fewer activities as important. Sufficiency, the extent to which each individual was satisfied with their level of participation in important activities, was greater for autistic adults with higher incomes and lower for autistic adults who lived independently or had co-occurring psychiatric diagnoses. Breadth, or the number of important activities participated in during the past month, was lowest for autistic adults living in facilities and those with co-occurring psychiatric diagnoses, and higher for adults with self-reported service needs. As new community participation requirements for Medicaid roll out across the United States, autistic adults can provide critical feedback to inform policy and practice.Lay abstractAlthough participation in communities is a key component of health and well-being, little research has explored community participation among autistic adults. A better understanding of preferences and access to various community activities among autistic adults provides intervention and policy directions in a critical area. This study reports responses from one of the largest groups of autistic adults surveyed to date. Participants reported their valued activities, number of days they participated in each activity during the previous month, and the extent to which they perceived their participation to be sufficient. Grocery shopping was the most common community activity, and most important. A wide range of activities were participated in during the previous month and more than half of the autistic adults reported that most activities were important. Autistic adults with a co-occurring intellectual disability participated in fewer activities and said that fewer activities were important. Sufficiency, or the degree to which an individual felt they participated enough in important activities, was greater for autistic adults with higher incomes and lower for autistic adults who lived independently or had co-occurring psychiatric diagnoses. Breadth of participation, or the number of important types of participation in the past month, was lower for autistic adults residing in supported living facilities and for autistic adults with co-occurring psychiatric diagnoses. Breadth was greater for autistic adults with self-reported service needs. Our study findings offer important information to guide implementation of new federal requirements aimed at promoting greater community participation among individuals covered by Medicaid.
      Citation: Autism
      PubDate: 2021-01-25T01:02:52Z
      DOI: 10.1177/1362361320987682
       
  • Cross-cultural perspectives on the meaning of family quality of life:
           Comparing Korean immigrant families and Canadian families of children with
           autism spectrum disorder
    • Authors: Vanessa C. Fong, Emily Gardiner, Grace Iarocci
      Abstract: Autism, Ahead of Print.
      This study sought to examine and compare conceptualizations and descriptions of family quality of life, from the perspectives of Korean immigrant and Canadian families of children with autism spectrum disorder. Thematic analysis of semi-structured interviews from 13 Korean immigrant parents and 12 Canadian parents of children with autism living in BC, Canada was conducted. For Korean immigrant families, three themes were identified: family cohesiveness, value orientation, and acceptance from society. For Canadian families, themes comprising family interactions, support, emotional well-being, individual characteristics, and comparisons to other families were essential elements in defining their family quality of life. Findings highlight how cultural values and differences may translate into different conceptualizations of family quality of life and underscore the need for cross-cultural and diverse perspectives in the study and development of future assessment tools.Lay abstractThe purpose of this study was to compare Korean immigrant families and Canadian families of children with autism in their perceptions and definitions of family quality of life. Interviews were done with 13 Korean immigrant parents and 12 Canadian parents of children with autism living in BC, Canada. For Korean immigrant families, three themes were identified: family cohesiveness, value orientation, and acceptance from society. For Canadian families, themes comprising family interactions, support, emotional well-being, individual characteristics, and comparisons to other families were essential elements in defining their family quality of life. The findings emphasize how differences in culture may impact how we understand and assess family functioning and quality of life. If research informing the development of these tools lacks cross-cultural perspectives, service providers and professionals may fail to address these families’ unique needs.
      Citation: Autism
      PubDate: 2021-01-23T04:57:56Z
      DOI: 10.1177/1362361321989221
       
  • Reduced differentiation of emotion-associated bodily sensations in autism
    • Authors: Eleanor R Palser, Alejandro Galvez-Pol, Clare E Palmer, Ricci Hannah, Aikaterini Fotopoulou, Elizabeth Pellicano, James M Kilner
      Abstract: Autism, Ahead of Print.
      Differences in understanding emotion in autism are well-documented, although far more research has considered how being autistic impacts an understanding of other people’s emotions, compared to their own. In neurotypical adults and children, many emotions are associated with distinct bodily maps of experienced sensation, and the ability to report these maps is significantly related to the awareness of interoceptive signals. Here, in 100 children who either carry a clinical diagnosis of autism (n = 45) or who have no history of autism (n = 55), we investigated potential differences in differentiation across autistic children’s bodily maps of emotion, as well as how such differentiation relates to the processing of interoceptive signals. As such, we measured objective interoceptive performance using the heartbeat-counting task, and participants’ subjective experience of interoceptive signals using the child version of the Body Perception Questionnaire. We found less differentiation in the bodily maps of emotion in autistic children, but no association with either objective or subjective interoceptive processing. These findings suggest that, in addition to previously reported differences in detecting others’ emotional states, autistic children have a less differentiated bodily experience of emotion. This does not, however, relate to differences in interoceptive perception as measured here.Lay abstractMore research has been conducted on how autistic people understand and interpret other people’s emotions, than on how autistic people experience their own emotions. The experience of emotion is important however, because it can relate to difficulties like anxiety and depression, which are common in autism. In neurotypical adults and children, different emotions have been associated with unique maps of activity patterns in the body. Whether these maps of emotion are comparable in autism is currently unknown. Here, we asked 100 children and adolescents, 45 of whom were autistic, to color in outlines of the body to indicate how they experienced seven emotions. Autistic adults and children sometimes report differences in how they experience their internal bodily states, termed interoception, and so we also investigated how this related to the bodily maps of emotion. In this study, the autistic children and adolescents had comparable interoception to the non-autistic children and adolescents, but there was less variability in their maps of emotion. In other words, they showed more similar patterns of activity across the different emotions. This was not related to interoception, however. This work suggests that there are differences in how autistic people experience emotion that are not explained by differences in interoception. In neurotypical people, less variability in emotional experiences is linked to anxiety and depression, and future work should seek to understand if this is a contributing factor to the increased prevalence of these difficulties in autism.
      Citation: Autism
      PubDate: 2021-01-23T04:54:15Z
      DOI: 10.1177/1362361320987950
       
  • Effects of autism acceptance training on explicit and implicit biases
           toward autism
    • Authors: Desiree R Jones, Kilee M DeBrabander, Noah J Sasson
      Abstract: Autism, Ahead of Print.
      Non-autistic adults often hold explicit and implicit biases toward autism that contribute to personal and professional challenges for autistic people. Although previous research indicates that non-autistic adults with higher autism knowledge and familiarity express more inclusionary attitudes, it remains unclear whether training programs designed to promote autism acceptance and understanding affect subsequent implicit and explicit biases toward autism. In this study, non-autistic adults (N = 238) completed an autism acceptance training featuring factual information and engaging first-person narratives, a general mental health training not mentioning autism, or a no-training control, then responded to surveys assessing their autism knowledge, stigma, and impressions of autistic adults, and completed a novel implicit association task about autism. Non-autistic adults in the autism acceptance training condition reported more positive impressions of autistic adults, demonstrated fewer misconceptions and lower stigma about autism, endorsed higher expectations of autistic abilities, and expressed greater social interest in hypothetical and real autistic people. However, training had no effect on implicit biases, with non-autistic adults associating autism-related labels with unpleasant personal attributes regardless of training condition. These findings suggest that the autism acceptance training program in this study, designed to increase autism knowledge and familiarity among non-autistic people, holds promise for reducing explicit but not implicit biases toward autism.Lay abstractAutistic adults face prejudice from non-autistic people. They are often judged unfairly and left out of social activities because of their differences. This can make it difficult for autistic people to make friends and find jobs. Some training programs have tried to teach autistic people to act more like non-autistic people to help them gain acceptance. Fewer have focused on teaching non-autistic people how to be more autism friendly. In this study, we used a short training video that teaches people about autism. The video was created with the help of autistic adults and included clips of real autistic people. We found that non-autistic people who watched this video had better knowledge about autism and showed more autism-friendly attitudes than those who watched a video about mental health or those who did not watch any video. They were more open to having a relationship with an autistic person and had more positive beliefs about autism. However, our video did not affect people’s unconscious attitudes about autism. People in our study connected autism with unpleasant traits, even if they had watched the autism training video. This suggests that teaching non-autistic people about autism may promote more autism-friendly attitudes, but some beliefs may be harder to change.
      Citation: Autism
      PubDate: 2021-01-21T07:13:07Z
      DOI: 10.1177/1362361320984896
       
  • Can pictorial narration offer a solution to teacher training on the
           effective inclusion of students with autism spectrum disorder in
           low-resource settings' Investigation on knowledge and stigma change
    • Authors: Hui Min Low, Tze Peng Wong, Lay Wah Lee, Somchay Makesavanh, Bountheing Vongsouangtham, Vikate Phannalath, Aznan Che Ahmad, Ann Sien Sut Lee
      Abstract: Autism, Ahead of Print.
      The main aim of this article is to explore whether pictorial narration could offer a solution to teacher training on the effective inclusion of students with autism spectrum disorder in a low-resource context in the Lao People’s Democratic Republic. For this purpose, pre- and post-training knowledge data were collected from 87 Laotian teachers who participated in teacher training using a pictorial narrative e-module called The Story of KhamdyTM. The teacher training included a half-day orientation workshop, followed by 4 weeks of online learning. Statistically significant improvement in autism spectrum disorder knowledge and reduction in autism spectrum disorder stigma was recorded for the teachers after completing the teacher training. The findings on social validity pointed to high acceptance toward the pictorial narrative method and the content designed for the purpose of this training. The teachers’ acceptance of the training method was found to have positive effects on their knowledge changes in the diagnosis and etiology aspects of autism spectrum disorder knowledge. The findings supported the use of a pictorial narration approach in imparting knowledge about inclusive education and autism spectrum disorder to teachers in a least developed country. The findings offered insights to explain the knowledge change and stigma reduction recorded.Lay abstractIn this study, we explored whether pictorial narration could offer a solution to teacher training on effective inclusion of students with autism spectrum disorder in the Lao People’s Democratic Republic. For this purpose, pre- and post-training knowledge data were collected from 87 Laotian teachers who participated in teacher training using a pictorial narrative e-module called The Story of KhamdyTM. The teachers’ knowledge test results and feedback were analyzed. The findings indicated that teachers’ acceptance toward the training method had positive effects on their knowledge changes and supported the use of a pictorial narration approach in imparting knowledge about inclusive education and autism spectrum disorder to teachers in a least developed country.
      Citation: Autism
      PubDate: 2021-01-20T05:06:37Z
      DOI: 10.1177/1362361320984899
       
  • End-user perspectives on the development of an online intervention for
           parents of children on the autism spectrum
    • Authors: Susannah Hermaszewska, Jacqueline Sin
      Abstract: Autism, Ahead of Print.
      Strong evidence suggests that parents of children on the autism spectrum face increased stressors to their physical and mental wellbeing due to the demands of caregiving and paucity of support. The disparity between the services currently offered and unmet needs indicates that accessible and flexible support through online delivery is needed for parents. This study presents the ideas and perspectives collected from five focus groups of 17 parents of autistic children, on the optimal content and implementation strategy of an online intervention. Using thematic framework analysis, we derived themes under the categories: the need for online interventions; content and design; and implementation. Parents supported the development of a multicomponent online intervention which combines psychoeducation with peer-support and access to healthcare professionals.Lay abstractParent caregivers play an essential role in the lives of individuals on the autism spectrum. The demands of caregiving can have negative effects on the mental and physical wellbeing of parents. Different types of formal support have been developed to help parents to cope with caregiving; however, many parents struggle to access services due to limited availability and busy schedules. The Internet could offer parents more accessible and flexible support. We asked 17 parents what content they would like to include in an online resource. Parents told us about their experiences trying to access and use existing formal support and websites. They overwhelmingly supported the development of an online resource informed by their suggestions. Parents emphasised the need for easier access to information through educational components and direct access to healthcare professionals online. Parents also wanted help with finding existing services and reliable, locally relevant information. Parents stressed the need for a safe environment to meet and chat with other parents online. This research forms the first stage in the development process of an online health resource for parents.
      Citation: Autism
      PubDate: 2021-01-11T09:47:59Z
      DOI: 10.1177/1362361320984895
       
  • Enhancing developmental–behavioral pediatric rotations by teaching
           residents how to evaluate autism in primary care
    • Authors: Jeffrey F Hine, Liliana Wagner, Rachel Goode, Verity Rodrigues, Julie Lounds Taylor, Amy Weitlauf, Zachary E Warren
      Abstract: Autism, Ahead of Print.
      Most pediatric residency programs do not provide adequate practical experiences for residents in autism-related care, with a specific dearth of training in diagnostic processes. Without this training, residents enter the primary care workforce with uncertainty surrounding implementation of standard-of-care recommendations for children with autism. Our curriculum was designed to improve upon previously passive shadowing experiences within our developmental–behavioral pediatric rotation by integrating hands-on training in within-practice diagnostic identification and care coordination. In addition to multiple web-based learning activities (including a tutorial teaching administration of an interactive assessment tool), residents were required to actively participate in autism evaluations under supervision of an attending provider. Data were collected to assess feasibility of curricular changes as well as increased comfort level across recommended practice behaviors. Regarding feasibility, 95% of residents completed training components and pre-/post-ratings indicated significant increases in comfort in identifying symptoms/risk for autism, providing feedback about diagnostic decision, and effectively connecting families with services. Outcomes suggest feasibility of model and significantly increased resident comfort level across a range of recommended practice behaviors. This project reflects a first step in advancing incorporation of autism training into pediatric residency programs.Lay abstractMost physician preparation programs do not provide enough practical experiences in autism-related care. This is especially true for how to assess for and diagnose autism. Without this training, many pediatricians are not well prepared to implement appropriate care for children with autism and their families. We designed a curriculum to improve training for medical residents that involved explicit hands-on training in diagnostic identification and care coordination for toddlers at risk for autism. We collected data to assess whether our enhanced curriculum led to increased comfort level across recommended practice behaviors. Almost all the residents were able to complete the training within their rotation and our surveys indicated significant increases in residents feeling more comfortable identifying symptoms of autism, providing feedback about diagnostic decisions, and effectively connecting families with services. A significant majority of residents considered it appropriate or very appropriate for children to receive a diagnosis solely from a primary care provider. Our results suggest feasibility of the enhanced model, and this project reflects the first step in advancing incorporation of autism training into pediatric residency programs.
      Citation: Autism
      PubDate: 2021-01-06T05:12:40Z
      DOI: 10.1177/1362361320984313
       
  • “We believe in good jobs, fair jobs, dignifying jobs that give you a
           good sense of identity”: Career and job guidance counseling in autism
    • Authors: Sven Bölte
      First page: 857
      Abstract: Autism, Ahead of Print.

      Citation: Autism
      PubDate: 2021-02-08T06:53:19Z
      DOI: 10.1177/1362361321990325
       
  • Core experiences of parents of children with autism during the COVID-19
           pandemic lockdown
    • Authors: Itay Tokatly Latzer, Yael Leitner, Orit Karnieli-Miller
      First page: 1047
      Abstract: Autism, Ahead of Print.
      The lockdown that was imposed by governments as part of the attempt to contain the COVID-19 pandemic included extreme measures, such as home confinement and the shutting down of special education systems. Our aim was to learn about the core experiences of parents of children with autism during this significant life disturbance. Thirty-one parents of 25 children with autism participated in semi-structured telephone interviews which were transcribed verbatim and underwent a qualitative, immersion/crystallization analysis. The analysis was conducted in an iterative consensus-building process to identify parents’ experiences, concerns, challenges, coping strategies, and perceived needs during the lockdown. The main themes that emerged related to the various parental concerns; the major difficulties encountered during this unique time, the functional, social, and behavioral implications the lockdown had on these children; and the manner in which the parents coped as an indication of their resourcefulness and outlook. Our findings broaden the insight into the underlying elements of the hardships and gains experienced by children with autism and their parents in times of significant life adversity. Programs in such times should be directed at supporting and guiding parents on how to better accommodate to the situation, thereby optimizing their coping strategies and resilience.Lay abstractThe lockdown and home isolation due to the COVID-19 pandemic led to significant transformation in lifestyles. Being a parent in this situation was not easy for anyone, much less for parents of children with special needs. The shutting down of special education systems meant that parents lost a vital support network and had to be the sole full-time caregivers despite often lacking the skills to cope with this new and daunting situation. We interviewed parents and learned that the main difficulties faced by homebound autistic children stemmed from the change in routine, lack of special education services, limited physical space, and food- and sleep-related issues. Some children experienced worsening in behavioral, social, and developmental domains, yet others seemed to not only overcome the challenges of changing conditions but even benefit from them. The children’s success or failure was directly related to how their parents coped. The key factors that enabled successful coping were the parents’ ability to accommodate to the child’s needs, their own creativeness and resourcefulness, and a generally positive outlook. The results of this analysis revealed that the best way to benefit autistic children caught up in drastic changes in their routine lifestyle is to invest in a strong support system for their parents.
      Citation: Autism
      PubDate: 2021-01-13T05:29:32Z
      DOI: 10.1177/1362361320984317
       
  • Physical activity and screen time among youth with autism: A longitudinal
           analysis from 9 to 18 years
    • Authors: J Dahlgren, S Healy, M MacDonald, J Geldhof, K Palmiere, JA Haegele
      First page: 1090
      Abstract: Autism, Ahead of Print.
      To date, studies using cross-sectional methodologies make up a majority of the literature surrounding children with autism spectrum disorders and participation in physical activity and screen time. Longitudinal studies are needed to examine how physical activity and screen time behaviors co-develop for children with and without an autism spectrum disorder. To address this research gap, this study compared how physical activity and screen time levels changed over time (9 to 18 years of age) between youth with autism spectrum disorder and youth with neurotypical development. Data on the levels of moderate-to-vigorous physical activity, light physical activity, television-, and video game-based screen time, collected as a part of the “Growing up in Ireland” study, were compared between youth with autism spectrum disorder and a propensity-matched sample of youth with neurotypical development (n = 88 per group; 176 in total). Robust regression analyses indicated that children with autism spectrum disorder became less active over time compared to children with neurotypical development and that video game screen time also differed significantly between the groups when children were 9 years old. These findings elucidate important disparities present between these groups of children during pivotal developmental times.Lay abstractTo date, studies using cross-sectional methodologies make up a majority of the literature surrounding children with autism spectrum disorders and participation in physical activity and screen time. Longitudinal studies are needed to examine how physical activity and screen time behaviors co-develop for children with and without an autism spectrum disorder. To address this research gap, this study compared how physical activity and screen time levels changed over time (from 9 to 18 years of age) between youth with autism spectrum disorder and youth with neurotypical development. Data on the levels of moderate-to-vigorous physical activity, light physical activity, television-, and video game-based screen time, collected as a part of the “Growing up in Ireland” study, were compared between youth with autism spectrum disorder and a propensity-matched sample of youth with neurotypical development (n = 88 per group; 176 in total). Robust regression analyses indicated that children with autism spectrum disorder became less active over time compared to children with neurotypical development and that video game screen time also differed significantly between the groups when children were 9 years old. These findings elucidate important disparities present between these groups of children during pivotal developmental times.
      Citation: Autism
      PubDate: 2021-01-07T08:57:47Z
      DOI: 10.1177/1362361320981314
       
  • How do children and youth with autism spectrum disorder self-report on
           behavior' A study of the validity indexes on the Behavior Assessment
           System for Children, Second Edition, self-report of personality
    • Authors: Reyhane Bakhtiari, Sarah M Hutchison, Grace Iarocci
      First page: 1100
      Abstract: Autism, Ahead of Print.
      Self-report measures offer a unique source of information in the assessment and intervention of individuals with autism spectrum disorder. However, it is not known if children with autism spectrum disorder can answer self-report questionnaires accurately and consistently. As a step to address this issue, we examined validity indexes of the Behavior Assessment System for Children, Second Edition, self-report of personality in 139 children and adolescents with and without autism spectrum disorder aged 8–17 years. There were no significant differences between groups on parents’ education, first language spoken at home, intelligence quotient, and age. We examined the influence of diagnosis of autism spectrum disorder, age group, intelligence quotient, and attention problems on the self-report of personality validity indexes (indicators of overly negative or positive, random, inattentive or inconsistent responses). The findings suggest that participants with autism spectrum disorder were more likely to show at least one validity caution on their self-report of personality as compared to their matched typically developing peers. However, this difference might be a result of comorbid attention problems, rather than having a diagnosis of autism spectrum disorder. The diagnosis of autism spectrum disorder was not a significant predictor of the validity indexes. Participants, with and without autism spectrum disorder, with fewer attention problem ratings, higher intelligence quotient scores, and adolescents compared to children showed better validity outcomes.Lay abstractUsing self-report questionnaires is an important method in the assessment and treatment of children with autism. Self-reports can provide unique information about children’s feelings and thoughts that is not available through other methods such as parent-reports. However, many clinicians are not sure whether children with autism can provide accurate self-reports. To study this, we examined 139 children and youth with and without autism aged 8–17 years. We looked at the effect of having autism, as well as other factors such as age, intelligence quotient, and attention problems on the validity of self-reports in these children. We examined if the children gave overly negative or positive answers and if they responded to the questions randomly or without paying attention. We found that children with autism can provide acceptable self-reports. However, they have more validity problems compared to their peers without autism. Our findings showed that this difference might be related to having attention problems in addition to autism, rather than having autism by itself. Children, with and without autism spectrum disorder, with fewer attention problems and higher intelligence quotient scores and those in the older age group, showed better validity. This article suggests that clinicians can use self-report measures for children with autism, but they should pay attention to important factors such as children’s intelligence quotient and attention problems.
      Citation: Autism
      PubDate: 2021-01-28T09:50:21Z
      DOI: 10.1177/1362361320984601
       
  • Health characteristics of reproductive-aged autistic women in Ontario: A
           population-based, cross-sectional study
    • Authors: Ami Tint, Hilary K Brown, Simon Chen, Meng-Chuan Lai, Lesley A Tarasoff, Simone N Vigod, Susan Parish, Susan M Havercamp, Yona Lunsky
      First page: 1114
      Abstract: Autism, Ahead of Print.
      While an increasing number of girls and women are being identified with autism, we know little about the health of reproductive-aged autistic women. Our objectives were to (1) describe health characteristics of reproductive-aged autistic women who could potentially become pregnant and (2) compare these characteristics with those of non-autistic women. We conducted a population-based cross-sectional study using 2017–2018 administrative health data from Ontario, Canada. A total of 6,870 fifteen- to 44-year-old autistic women were identified and compared with 2,686,160 non-autistic women. Variables of interest included social determinants of health (neighborhood income, residential instability, material deprivation, rurality), health (co-occurring medical and psychiatric conditions, use of potentially teratogenic medications, history of assault), and health care factors (continuity of primary care). Overall, reproductive-aged autistic women had poorer health compared with non-autistic women, including increased rates of material deprivation, chronic medical conditions, psychiatric conditions, use of potentially teratogenic medications, and history of assault. These findings highlight the need for health interventions tailored to the needs of reproductive-aged autistic women.Lay abstractWhile an increasing number of girls and women are being identified with autism, we know little about reproductive-aged autistic women’s health. This study used administrative data from Ontario, Canada, to compare the health of reproductive-aged autistic women with non-autistic women. Overall, reproductive-aged autistic women had poorer health compared with non-autistic women, including increased rates of material deprivation, chronic medical conditions, psychiatric conditions, history of assault, and use of potentially teratogenic medications (i.e. drugs that can be harmful to the development of an embryo or fetus). These findings suggest that there is a need for health interventions tailored to the needs of reproductive-aged autistic women.
      Citation: Autism
      PubDate: 2021-01-20T05:02:37Z
      DOI: 10.1177/1362361320982819
       
  • Differential predictors of well-being versus mental health among parents
           of pre-schoolers with autism
    • Authors: Cherie C Green, Jodie Smith, Catherine A Bent, Lacey Chetcuti, Rhylee Sulek, Mirko Uljarević, Kristelle Hudry
      First page: 1125
      Abstract: Autism, Ahead of Print.
      Extensive research has shown elevated mental health difficulties among parents of children with autism compared to other parents. Although several studies have explored factors related to mental health among parents of children with autism, the factors that influence and promote well-being remain poorly characterised. Parents of young, newly diagnosed autistic children may also be particularly vulnerable to stressors that impact mental health and well-being. We examined child-, parent-, and family/socioeconomic factors associated with concurrent mental health and well-being among 136 parents of young children with autism, aged 13–48 months. Parental mental health was predicted by both trait negative emotionality and reported child autism symptoms, while well-being was predicted by parent factors alone, including trait extraversion and mindfulness. Broader child characteristics and family/socioeconomic contextual factors made no significant contribution in regression models. While the mental health and well-being of parents with young autistic children are associated with one another, unique predictors seem to exist. That well-being was uniquely predicted by a modifiable parent characteristic – mindfulness – suggests the potential for early supports to bring direct benefits for parents, in the context of raising a young child with autism.Lay abstractRaising a child with autism has been linked to mental health difficulties. Poor parental mental health is likely influenced by various factors – including child-, parent-, and family/socioeconomic characteristics. However, little is known about what influences and promotes well-being (as opposed to mental health) among parents of young, newly diagnosed autistic children who may be particularly vulnerable. We examined child-, parent-, and family/socioeconomic factors associated with each of mental health and well-being in a sample of 136 parents of pre-school-aged children. Parental mental health was linked to both child- (i.e. autism symptom severity) and parent-related factors (i.e. personality traits reflecting a tendency to experience negative emotions). By contrast, in additional to mental health difficulties, which were linked to well-being, only other parent-related characteristics (and not child characteristics) were related to well-being. These included personality traits reflecting a tendency to be more extraverted/sociable, and also mindfulness. Other child-related and family/socioeconomic context factors (including household income, parental education level) were not linked to parental mental health or well-being in this sample. These results support the idea that poorer mental health and well-being are not simply the opposite of one another. That is, while these two factors were related, they were linked to different personal characteristics. Perhaps most importantly, the link between well-being and mindfulness – a personal characteristic that parents can improve – suggests mindfulness-based interventions may be helpful in directly supporting parental well-being in the context of raising a young child with autism.
      Citation: Autism
      PubDate: 2021-01-21T07:11:46Z
      DOI: 10.1177/1362361320984315
       
  • Intensive behavioural interventions based on applied behaviour analysis
           for young children with autism: An international collaborative individual
           participant data meta-analysis
    • Authors: Mark Rodgers, Mark Simmonds, David Marshall, Robert Hodgson, Lesley A Stewart, Dheeraj Rai, Kath Wright, Esther Ben-Itzchak, Svein Eikeseth, Sigmund Eldevik, Hanna Kovshoff, Iliana Magiati, Lisa A Osborne, Phil Reed, Giacomo Vivanti, Ditza Zachor, Ann Le Couteur
      First page: 1137
      Abstract: Autism, Ahead of Print.
      This individual participant data meta-analysis is the most intensive possible evaluation of the effectiveness of early intensive applied behaviour analysis–based interventions for pre-school autistic children compared with treatment as usual/eclectic interventions. Data from 491 participants (originally collected in 10 studies) were included. Children receiving early intensive applied behaviour analysis–based interventions improved more on the Vineland adaptive behaviour scale (MD = 7.00; 95% confidence interval = 1.95–12.06) and cognitive ability (intelligence quotient) (MD = 14.13; 95% confidence interval = 9.16–19.10) relative to comparators at 2 years; though effects varied considerably across studies. Evidence for other outcomes was inconclusive due to insufficient evidence and there were few data on longer-term effects. All studies were at risk of bias across several domains, often due to the lack of randomisation or blinding of outcome assessors. Given the emerging evidence of modest, albeit short term, effects of a range of pre-school autism interventions and the limitations of the quality of evaluation studies to date, future research should investigate which supports and interventions are most effective for children and families prioritising outcomes measures that are meaningful for the autism community and longer-term follow-up. Further systematic reviews of the existing evidence are unlikely to add to the findings presented here.Lay abstractEarly intensive applied behaviour analysis–based interventions are designed to support young autistic children’s learning and development. Unfortunately, the available evidence about the effectiveness of these interventions remains unclear. Several reviews have focused on the published findings rather than contacting the authors to collect and analyse data about the individual participants in the original studies. Also, most of the studies were carried out by groups involved in delivering the interventions leading to the potential bias in interpreting the results. Our research team (supported by an international advisory group) carried out an independent individual patient data review by collecting the original participant data from the authors of the studies, to examine the effectiveness of these interventions. The results suggested that early intensive applied behaviour analysis–based interventions might lead to some changes in children’s cognitive ability (intelligence quotient) and everyday life skills after 2 years, compared with standard treatments. However, all the studies had problems with the way they were designed. Also, few of the studies looked at outcomes that have been described as most important to autistic people or followed children beyond 2 years. We think that further systematic reviews of the existing evidence are unlikely to add to the findings of our review. Furthermore, we recommend that future research should investigate which types of supports and interventions are most effective for children and families, prioritising outcomes measures that are meaningful for the autism community and include, wherever possible, longer-term follow-up.
      Citation: Autism
      PubDate: 2021-01-23T04:37:15Z
      DOI: 10.1177/1362361320985680
       
  • Short report: Autistic parents’ views and experiences of talking about
           autism with their autistic children
    • Authors: Laura Crane, Lok Man Lui, Jade Davies, Elizabeth Pellicano
      First page: 1161
      Abstract: Autism, Ahead of Print.
      Little is known about how parents talk about autism with their autistic children, particularly among families in which both a parent and child are autistic. Using an online survey, we gathered quantitative and qualitative data from 34 autistic parents (most of whom had told their children about their diagnosis) to address this knowledge gap. There was considerable overlap between the views and experiences of the autistic parents in this study and the largely non-autistic parent samples in previous research. Specifically, parents emphasised the importance of being open and honest about the diagnosis, disclosing the diagnosis as early as possible, individualising discussions to children’s needs and framing the diagnosis positively. There were, however, areas in which the views and experiences of the current sample differed from previous research on non-autistic samples. First, our sample of autistic parents outlined the benefits of their own experiential expertise, which they felt resulted in heightened understanding and empathy with their children. Second, our sample tended not to express concerns about disclosure potentially having a negative impact. Finally, our participants did not express a want or need for professional support with disclosure. Instead, they reported feeling well equipped to support their children using their own knowledge and lived experience.Lay abstractPrevious research examining how parents talk about autism with their children has tended to focus on parents who are not autistic themselves. We collected information on this topic from 34 autistic parents of autistic children (most of whom had told their children about their diagnosis). We found similarities, but also differences, between the views and experiences of autistic parents in this research and those reported in previous research (in studies of largely non-autistic parents). Similarities include the following: it is important to be open and honest about the diagnosis; the diagnosis should be introduced/discussed as early as possible; discussions should be tailored to each individual child’s needs; and we should not overlook the challenges associated with autism, but it is important to focus on positive aspects too. Differences include the following: autistic parents used personal experiences in conversations about autism, which was felt to result in increased understanding and empathy with their children; autistic parents overwhelmingly focused on more positive aspects of an autism diagnosis; our sample did not express concerns that discussions could have negative consequences too (e.g. making children more anxious); and autistic parents did not want or need professional support to talk about autism with their children (instead, they felt confident in using their own knowledge/experiences to guide discussions).
      Citation: Autism
      PubDate: 2021-01-05T04:37:13Z
      DOI: 10.1177/1362361320981317
       
  • Age at autism spectrum disorder diagnosis: A systematic review and
           meta-analysis from 2012 to 2019
    • Authors: Maarten van ’t Hof, Chanel Tisseur, Ina van Berckelear-Onnes, Annemyn van Nieuwenhuyzen, Amy M Daniels, Mathijs Deen, Hans W Hoek, Wietske A Ester
      First page: 862
      Abstract: Autism, Ahead of Print.
      Between 1990 and 2012, the global mean age at diagnosis of autism spectrum disorder ranged from 38 to 120 months. Measures have since been introduced to reduce the age at autism spectrum disorder diagnosis, but the current global mean age is unknown. This review and meta-analysis report the average age at diagnosis from studies published between 2012 and 2019. We initially identified 1150 articles, including 56 studies that reported the mean or median age at diagnosis across 40 countries (n = 120,540 individuals with autism spectrum disorder). Meta-analysis results (on 35 studies, including 55 cohorts from 35 countries, n = 66,966 individuals with autism spectrum disorder) found a current mean age at diagnosis of 60.48 months (range: 30.90–234.57 months). The subgroup analysis for studies that only included children aged ⩽10 years (nine studies, including 26 cohorts from 23 countries, n = 18,134 children with autism spectrum disorder) showed a mean age at diagnosis of 43.18 months (range: 30.90–74.70 months). Numerous factors may influence age at diagnosis and were reported by 46 studies, often with conflicting or inconclusive findings. Our study is the first to ascertain the global average age at autism spectrum disorder diagnosis from a meta-analysis. Continued efforts to lower the average age at autism spectrum disorder diagnosis are needed.Lay abstractWe currently assume that the global mean age at diagnosis of autism spectrum disorder ranges from 38 to 120 months. However, this range is based on studies from 1991 to 2012 and measures have since been introduced to reduce the age at autism spectrum disorder diagnosis. We performed a systematic review and meta-analysis (statistical analysis that combines the results of multiple scientific studies) for studies published between 2012 and 2019 to evaluate the current age at autism spectrum disorder diagnosis. We included 56 studies that reported the age at diagnosis for 40 countries (containing 120,540 individuals with autism spectrum disorder). Results showed the current mean age at diagnosis to be 60.48 months (range: 30.90–234.57 months) and 43.18 months (range: 30.90–74.70 months) for studies that only included children aged ⩽10 years. Numerous factors that may influence age at diagnosis (e.g. type of autism spectrum disorder diagnosis, additional diagnoses and gender) were reported by 46 studies, often with conflicting or inconclusive results. Our study is the first to determine the global average age at autism spectrum disorder diagnosis from a meta-analysis. Although progress is being made in the earlier detection of autism spectrum disorder, it requires our constant attention.
      Citation: Autism
      PubDate: 2020-11-20T05:56:12Z
      DOI: 10.1177/1362361320971107
       
  • The effectiveness of physical activity interventions on communication and
           social functioning in autistic children and adolescents: A meta-analysis
           of controlled trials
    • Authors: John SY Chan, Kanfeng Deng, Jin H Yan
      First page: 874
      Abstract: Autism, Ahead of Print.
      Difficulty with communication and social functioning are two outstanding core symptoms of autism spectrum disorder, and physical activity has long been suggested to improve autism spectrum disorder symptoms. In this meta-analysis of controlled trials, we examined the effects of physical activity interventions compared to controls on communication and social functioning in autistic children and adolescents. Included studies are published articles in English with autism spectrum disorder participants younger than 18 years. Literature search was conducted on MEDLINE, Embase, CINAHL, and related databases through 6 May 2020. Quality of study was assessed with the Cochrane risk-of-bias tool regarding randomization, allocation concealment, blinding, attrition, and selective reporting. We included 12 controlled trials (N = 350) with communication outcomes (k = 8) and/or social functioning outcomes (k = 11). Results show small to moderate intervention benefits on communication (standardized mean change = 0.27, 95% confidence interval (0.06, 0.48)) and social functioning (standardized mean change = 0.39, 95% confidence interval (0.15, 0.63)), but the result for social functioning may be susceptible to publication bias. Better intervention outcomes are observed in younger participants, suggesting the importance of early participation. This study shows the benefits of physical activity interventions, and they could be considered a cost-effective means for autism spectrum disorder management in the future.Lay abstractDifficulty with communication and social functioning are two outstanding core symptoms of autism spectrum disorder, while there is no efficacious pharmacologic treatment available to deal with them. Traditional behavioral therapies usually require specialist therapist and be conducted in specific settings, increasing burdens on families and individuals with autism. Physical activity has long been found to promote physical and mental well-beings, and it is more affordable and versatile than traditional therapies. There is preliminary support for the use of physical activity interventions to improve communication and social functioning in individuals with autism. In this study, we quantitatively aggregate data from existing controlled trials to provide an up-to-date inquiry into the effectiveness of physical activity interventions on communication and social functioning in autistic children and adolescents. We included 12 trials involving 350 participants (8 trials reported communication outcomes and 11 trials reported social functioning outcomes) and found small to moderate benefits on communication and social functioning. Further analyses showed that the benefit of physical activity interventions is greater in younger participants. Results of this study suggest that physical activity interventions are effective to improve communication and social functioning in autistic children and adolescents, and early participation in the interventions can be more beneficial. Given their affordability, versatility, and efficacy, physical activity interventions could be considered a cost-effective option for autism spectrum disorder management in the future.
      Citation: Autism
      PubDate: 2020-12-12T07:23:51Z
      DOI: 10.1177/1362361320977645
       
  • Altered DNA methylation in a severe subtype of idiopathic autism: Evidence
           for sex differences in affected metabolic pathways
    • Authors: Valerie W Hu, Yi Hong, Minyi Xu, Henry T Shu
      First page: 887
      Abstract: Autism, Ahead of Print.
      Although differences in DNA methylation have been associated with both syndromic and idiopathic autism, differential methylation has not been examined previously with respect to sex differences. The goals of this study were to (1) identify differences in the DNA methylation profiles of lymphoblastoid cell lines derived from a subgroup of severely affected individuals with idiopathic autism and their respective sex-matched siblings, (2) describe autism spectrum disorder–relevant pathways and functions that may be impacted by differentially methylated genes, and (3) investigate sex-dependent differences in methylation patterns and signaling pathways. Our results revealed significant differences in DNA methylation in cells from individuals with idiopathic autism spectrum disorders and from their unaffected sex-matched siblings. The samples were divided either by sex or by separation into discovery and validation groups. The genes in differentially methylated regions were statistically enriched in autism susceptibility genes and canonical pathways commonly associated with autism spectrum disorders, including synaptogenesis, semaphorin, and mammalian target of rapamycin signaling pathways. Differentially methylated region–associated genes in females were additionally associated with pathways that implicate mitochondrial dysfunction and metabolic disorders that may offer some protection against autism spectrum disorders. Further investigations of sex differences are required to develop a fuller understanding of the pathobiology, gene regulatory mechanisms, and differential susceptibility of males and females toward autism spectrum disorders.Lay abstractThis study investigates altered DNA methylation that may contribute to autism spectrum disorders. DNA methylation is an epigenetic mechanism for regulating the level at which genes are expressed, and is thus complementary to genetics and gene expression analyses which look at the variations in gene structure and gene products in cells. Here, we identify DNA methylation differences between autistic and sex-matched non-autistic siblings, focusing on a subgroup of severely affected individuals with language impairment to reduce the clinical heterogeneity among the cases. Our results show significant differentially methylated genes between the sibling groups that are enriched in autism risk genes as well as in signaling and biochemical pathways previously associated with the pathobiology of autism spectrum disorders. Moreover, we show for the first time that these differences are in part sex dependent, with differentially methylated genes in females associated with pathways that implicate mitochondrial dysfunction and metabolic disorders that may offer some protection to females against autism spectrum disorders. Further investigations of sex differences are required to develop a fuller understanding of the pathobiology, gene regulatory mechanisms, and differential susceptibility of males and females toward autism spectrum disorders.
      Citation: Autism
      PubDate: 2020-12-01T06:29:26Z
      DOI: 10.1177/1362361320971085
       
  • T-STAT for detecting autism spectrum disorder in toddlers aged
           18–24 months
    • Authors: Chin-Chin Wu, Chung-Hsin Chiang, Ching-Lin Chu, Lai-Sang Iao, Yuh-Ming Hou
      First page: 911
      Abstract: Autism, Ahead of Print.
      Two studies were conducted to examine the use of the Taiwanese version of the Screening Tool for Autism in Two-Year-Olds for detecting autism spectrum disorder in toddlers aged 18–24 months. Study 1 used receiver operating characteristics to select a cutoff score for the Taiwanese version of the Screening Tool for Autism in Two-Year-Olds. It involved two groups of 16 toddlers each, one group with toddlers having autism spectrum disorder and the other group with chronological and mental age-matched toddlers with developmental delay. The result suggested that a cutoff of 2.50 would yield high sensitivity and specificity. In Study 2, we recruited 136 toddlers—30 with autism spectrum disorder, 33 with mild-autism spectrum disorder, and 73 with developmental delay. Using 2.50 as the cutoff score, the concurrent agreement between Taiwanese version of the Screening Tool for Autism in Two-Year-Olds risk and clinical diagnosis and Autism Diagnostic Observation Schedule yielded high sensitivity and specificity. The results of this study indicated that the Taiwanese version of the Screening Tool for Autism in Two-Year-Olds can be used as a Level 2 autism-specific screening tool for the 18–24 months age group.Lay abstractThe benefits of early intervention for young children with autism spectrum disorder highlight the importance of early diagnosis. Reliable diagnoses of autism spectrum disorder can be made before 24 months of age. However, many children are diagnosed with autism spectrum disorder at a later age. Delayed diagnosis can occur for children with less severe symptoms and lead to missed opportunities for early intervention. This current study was executed to examine the Taiwanese version of the Screening Tool for Autism in Two-Year-Olds in detecting autism spectrum disorder in toddlers between 18 and 24 months of age. One strength of this study was the inclusion of toddlers with autism spectrum disorder or mild-autism spectrum disorder using the strict and relaxed Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria for autism spectrum disorder simultaneously. The results of this study supported that diagnosis of toddlers with autism spectrum disorder could be made reliable before 24 months of age. And the Taiwanese version of the Screening Tool for Autism in Two-Year-Olds was a Level 2 autism-specific screening tool for toddlers aged from 18 to 24 months in Taiwan.
      Citation: Autism
      PubDate: 2020-11-28T05:07:03Z
      DOI: 10.1177/1362361320972300
       
  • Generosity of state insurance mandates and growth in the workforce for
           autism spectrum disorder
    • Authors: Ryan K McBain, Jonathan H Cantor, Aaron Kofner, Timothy Callaghan, Bradley D Stein, Hao Yu
      First page: 921
      Abstract: Autism, Ahead of Print.
      All 50 US states have enacted mandates requiring insurers to cover autism-related services. We assessed whether and to what extent variation in generosity of state insurance mandates has been associated with rate of growth in the health workforce for children with autism spectrum disorder: including board-certified behavioral analysts, child psychiatrists, and pediatricians. Drawing data from the National Conference of State Legislatures and Area Health Resource Files, we evaluated eight mandate policy features, utilizing a fixed-effect longitudinal regression framework to examine their relationships with workforce growth during a 15-year period (2003–2017) over which 44 states enacted a mandate. Aspects of mandate generosity included ages covered, spending caps, and types of services covered. We found that mandate generosity was closely associated with the magnitude of increase in supply of board-certified behavioral analysts and—to a lesser extent—child psychiatrists. States with the most generous mandates would be expected to have 39% more board-certified behavioral analysts and 17% more child psychiatrists in 2017, compared to states with least generous mandates. We found no association between mandate generosity and supply of pediatricians. Collectively, our results suggest that the degree of generosity afforded by mandates may be as important as the passage of mandate legislation itself for encouraging workforce growth.Lay abstractTo improve access to health services for children with autism spectrum disorder, US states have passed laws requiring health insurers to cover autism-related care, commonly known as state insurance mandates. However, the features of mandates differ across states, with some state laws containing very generous provisions and others containing very restrictive provisions such as whether the mandates include children aged above 12 years, whether there is a limit on spending, and whether there are restrictions on the types of services covered. This study examined the relationship between generosity of mandates and growth in the health workforce between 2003 and 2017, a period during which 44 states passed mandates. We found that states that enacted more generous mandates experienced significantly more growth in board-certified behavioral analysts who provide behavioral therapy as well as more growth in child psychiatrists. We did not find differences in the growth of pediatricians, which is a less specialized segment of the workforce. Our findings were consistent across eight different mandate features and suggest that the content of legislation may be as important as whether or not legislation has been passed in terms of encouraging growth in the supply of services for children with autism spectrum disorder.
      Citation: Autism
      PubDate: 2020-12-04T10:14:45Z
      DOI: 10.1177/1362361320976744
       
  • Autism screening and conditional cash transfers in Chile: Using the
           Quantitative Checklist (Q-CHAT) for early autism detection in a low
           resource setting
    • Authors: Andres Roman-Urrestarazu, Carolina Yáñez, Claudia López-Garí, Constanza Elgueta, Carrie Allison, Carol Brayne, Mónica Troncoso, Simon Baron-Cohen
      First page: 932
      Abstract: Autism, Ahead of Print.
      Diagnosis of Autism Spectrum Conditions (ASC) can be an extended procedure since ASC tend to both vary greatly across individual symptoms and diagnostic pathways with serious challenges to opportune access and diagnosis in low resource settings. We adapted the Q-CHAT-25 for use in a routine health check-ups programme at Chilean primary health clinics by developing a 10-item version of this questionnaire recruiting n = 287 (F: 112/M: 175) participants (Controls: n = 125, F: 58/M: 67; Developmental Delay: n = 149, F: 53/M: 96; Autism Spectrum Conditions: n = 13, F: 1/M: 12). Our findings show that the Q-CHAT-10 can be successfully applied in health-check programmes. The results for the Q-CHAT-10 show high internal consistency (Cronbach’s α: 0.85) and good overall performance, significantly correlating (r = 0.79, p 
      Citation: Autism
      PubDate: 2020-12-17T04:58:48Z
      DOI: 10.1177/1362361320972277
       
  • Family navigation to increase evaluation for autism spectrum disorder in
           toddlers: Screening and Linkage to Services for Autism pragmatic
           randomized trial
    • Authors: Carolyn DiGuiseppi, Steven A Rosenberg, Margaret A Tomcho, Kathryn Colborn, Kristina Hightshoe, Silvia Gutiérrez-Raghunath, Jeanette M Cordova, Jodi K Dooling-Litfin, Cordelia Robinson Rosenberg
      First page: 946
      Abstract: Autism, Ahead of Print.
      The Screening and Linkage to Services for Autism pragmatic trial examined the effect of family navigation on referral and evaluation for autism spectrum disorder in an urban healthcare system serving low-income families. Children aged 16–30 months with initial scores ⩾3 on the Modified Checklist for Autism in Toddlers–Revised with Follow-up (M-CHAT-R/F) were randomized to usual care (n = 133) or navigation if indicated (n = 142). Bilingual, bicultural autism family navigators offered navigation to intervention-group families if the completed M-CHAT-R/F indicated the need for autism spectrum disorder diagnostic evaluation. Autism family navigators also assisted families to arrange for completion of the M-CHAT-R/F interview if not done, and then offered navigation if indicated. Of 49 families for whom navigation was indicated, 45% received navigation, including care coordination, education, and practical support. In intention-to-treat analyses, the intervention did not increase referrals for evaluation but more than doubled completed autism spectrum disorder diagnostic evaluations. Intervention children were also more likely to complete the M-CHAT-R/F interview with fidelity. Research is needed to identify effective methods to improve uptake of family navigation. Family navigation may be an important tool for reducing systemic inequalities in the early identification and treatment of young children with autism spectrum disorder (ClinicalTrials.gov, https://clinicaltrials.gov/; NCT02374541).Lay abstractYoung children with autism spectrum disorder can benefit from early detection and intervention to moderate autism spectrum disorder’s effect on their development. Routine screening with standardized instruments facilitates early identification. However, many screen-positive children do not receive referrals for evaluation, complete diagnostic evaluations, or engage in services. This is especially true for children of color and those from less educated or low-income families. The Screening and Linkage to Services for Autism trial evaluated the effect of family navigation on referral and evaluation for autism spectrum disorder in screen-positive toddlers. The trial was conducted in an urban, low-income population. It was designed to test “real-world” implementation of family navigation. We randomly assigned 275 children aged 16–30 months with an initial positive autism spectrum disorder screen to receive navigation if indicated or usual care. Navigation increased the number of at-risk toddlers who were evaluated for autism spectrum disorder. It also improved the quality of autism spectrum disorder screening in primary care clinics. However, many children failed to receive indicated referrals for evaluation. Navigation did not improve referral rates. Furthermore, nearly half of families who were potentially eligible for navigation could not be contacted. Other ways of structuring the navigation program may be necessary to improve families’ access to and acceptance of navigation, especially in the setting of financial, cultural, and linguistic barriers. Our trial nevertheless showed that family navigation may be an important tool for reducing systemic inequalities in the early identification and treatment of young children with autism spectrum disorder.
      Citation: Autism
      PubDate: 2020-11-28T05:07:29Z
      DOI: 10.1177/1362361320974175
       
  • Characterizing the early vocabulary profiles of preverbal and minimally
           verbal children with autism spectrum disorder
    • Authors: Eileen Haebig, Eva Jiménez, Christopher R Cox, Thomas T Hills
      First page: 958
      Abstract: Autism, Ahead of Print.
      Children with autism spectrum disorder often have significant language delays. But do they learn language differently than neurotypical toddlers' We compared the lexical skills of 64 preverbal and minimally verbal children with autism spectrum disorder to 461 vocabulary-size-matched typically developing toddlers. We also examined social features of verb knowledge using a novel collection of social ratings. Children with autism spectrum disorder produced proportionally more verbs than typically developing toddlers. Children with autism spectrum disorder produced proportionally more action and food words, while typically developing toddlers produced proportionally more animal, people words, and animal sounds and sound effects. Children with autism spectrum disorder also produced “mommy” and “daddy” at lower rates. We discuss how these differences may reflect an association between lexical development and weaknesses in social communication.Lay abstractAlthough preverbal and minimally verbal children with autism spectrum disorder represent a significant portion of the autism spectrum disorder population, we have a limited understanding of and characterization of them. Although it is a given that their lexical profiles contain fewer words, it is important to determine whether (a) the words preverbal and minimally verbal children with autism spectrum disorder produce are similar to the first words typically developing children produce or (b) there are unique features of the limited words that preverbal and minimally verbal children with autism spectrum disorder produce. The current study compared the early word profiles of preverbal and minimally verbal children with autism spectrum disorder to vocabulary-matched typically developing toddlers. Children with autism spectrum disorder produced proportionally more verbs than typically developing toddlers. Also, children with autism spectrum disorder produced proportionally more action and food words, while typically developing toddlers produced proportionally more animal words, animal sounds and sound effects, and people words. Children with autism spectrum disorder also produced “mommy” and “daddy” at lower rates. Our findings identified several areas of overlap in early word learning; however, our findings also point to differences that may be connected to core weaknesses in social communication (i.e. people words). The findings highlight words and categories that could serve as useful targets for communication intervention with preverbal and minimally verbal children with autism spectrum disorder.
      Citation: Autism
      PubDate: 2020-11-28T05:07:59Z
      DOI: 10.1177/1362361320973799
       
  • Factors related to parental therapeutic self-efficacy in a parent-mediated
           intervention for children with autism spectrum disorder: A mixed methods
           study
    • Authors: Kaylin M Russell, Brooke Ingersoll
      First page: 971
      Abstract: Autism, Ahead of Print.
      Parental self-efficacy, parents’ beliefs in their ability to successfully parent their child, plays an important role in family outcomes when a child has autism spectrum disorder. It is important to consider therapeutic self-efficacy, one’s feelings of self-efficacy regarding their implementation of an intervention, within parent-mediated interventions. The goal of this mixed methods study was to better understand factors that relate to parents’ therapeutic self-efficacy when implementing a telehealth-based parent-mediated intervention. Participants were 51 parents of children with autism spectrum disorder between 17 and 83 months old. Parents reported generally high therapeutic self-efficacy, and global parental self-efficacy was significantly related therapeutic self-efficacy. Thematic analysis of parents’ written reflections of the intervention’s lessons identified four themes that related to therapeutic self-efficacy: the importance of a good fit between the child’s skills and the intervention, the importance of a good fit between the parent’s interaction style and the intervention, environmental factors support intervention use, and the importance of the child’s response to the intervention. Several themes differed for parents with higher and lower therapeutic self-efficacy. Findings suggest that global parental self-efficacy plays an important role in parental therapeutic self-efficacy in parent-mediated interventions. Coaches should specifically ask about the child’s skills, parent’s interaction style, environmental challenges, and child’s response as they support parents in learning.Lay abstractParental self-efficacy refers to parents’ beliefs in their ability to successfully parent their child. Parental self-efficacy plays an important role in family outcomes when a child has autism spectrum disorder. It is important to consider therapeutic self-efficacy, one’s feelings of self-efficacy regarding their implementation of an intervention, within parent-mediated interventions. The goal of this mixed methods study was to better understand factors that relate to parents’ therapeutic self-efficacy when using a telehealth-based parent-mediated intervention. Participants were 51 parents of children with autism spectrum disorder between 17 and 83 months old. Parents had generally high therapeutic self-efficacy, and global parental self-efficacy was significantly related therapeutic self-efficacy. Parents’ written reflections revealed four themes that related to their therapeutic self-efficacy: the importance of a good fit between the child’s skills and the intervention, the importance of a good fit between the parent’s interaction style and the intervention, environmental factors support intervention use, and the importance of the child’s response to the intervention. Several themes differed for parents with higher and lower therapeutic self-efficacy. Findings suggest that global parental self-efficacy plays an important role in parental therapeutic self-efficacy in parent-mediated interventions. To support parents in learning, coaches should ask about the child’s skills, parent’s interaction style, environmental challenges, and child’s response.
      Citation: Autism
      PubDate: 2020-11-28T05:07:49Z
      DOI: 10.1177/1362361320974233
       
  • Embedding school cultures and climates that promote evidence-based
           practice implementation for youth with autism: A qualitative study
    • Authors: Nathaniel J Williams, Lindsay Frederick, Alix Ching, David Mandell, Christina Kang-Yi, Jill Locke
      First page: 982
      Abstract: Autism, Ahead of Print.
      Schools play a major role in delivering behavioral health services to autistic youth. School culture and climate are strong predictors of the extent to which these services incorporate evidence-based practices; however, little is known about how school leaders shape culture and climate. Drawing on the concept of culture and climate embedding mechanisms, we conducted a qualitative study to understand the ways in which school principals embed cultures and climates that support effective implementation of evidence-based practices for youth with autism. Semi-structured interviews with 32 teachers in schools that implemented three closely related evidence-based practices for youth with autism (discrete trial training, pivotal response training, and visual schedules) explored teachers’ experiences regarding (a) implementation of the three evidence-based practices, (b) perceptions of school culture and climate, and (c) principals’ behaviors, practices, and decisions that supported or detracted from the aspects of culture and climate that supported successful implementation. Thematic analysis detailed seven mechanisms that principals used to embed cultures and climates that shaped evidence-based practice implementation. These mechanisms represent actionable targets for school leaders and inform strategies to improve the implementation of evidence-based practices for youth with autism in schools.Lay abstractSchools play a major role in providing services to youth with autism; however, not all schools use evidence-based practices, defined as interventions that are proven to improve youth well-being through rigorous research. School culture and climate are strong predictors of whether or not a school uses evidence-based practices; however, little is known about how principals can create school cultures and climates that support the use of these practices. This study interviewed 32 teachers in elementary schools that implemented three closely related evidence-based practices for youth with autism to better understand how principals create school cultures and climates that support effective services. Analysis of the teachers’ responses identified seven strategies principals can use to create school cultures and climates that support the implementation of effective practices for youth with autism. The strategies include the following: (a) support teachers to obtain professional development focused on autism, (b) align performance expectations and evaluations with the needs of students with autism and evidence-based practice delivery, (c) allocate resources to ensure adequate staff, materials, and training are available to implement evidence-based practices, (d) be open and flexible to allow teachers to use the building and resources as needed to meet students’ needs, (e) provide direct assistance, feedback, and coaching to troubleshoot challenges or involve outside experts to do so, (f) openly value the work of special education teachers and provide recognition to those who develop expertise in evidence-based practices, and (g) look for opportunities to integrate special and general education teachers and students to foster a truly inclusive climate.
      Citation: Autism
      PubDate: 2020-12-12T07:24:20Z
      DOI: 10.1177/1362361320974509
       
  • Evaluating the effects of a yoga-based program integrated with third-wave
           cognitive behavioral therapy components on self-regulation in children on
           the autism spectrum: A pilot randomized controlled trial
    • Authors: Radhika Tanksale, Kate Sofronoff, Jeanie Sheffield, John Gilmour
      First page: 995
      Abstract: Autism, Ahead of Print.
      Research using mind–body practices in autism is limited but suggests a trend for ruminative reduction and improved behavioral–emotional outcomes. Following random assignment (N = 67), effects of a weekly six-session pilot yoga-based group program combined with third-wave cognitive behavioral therapy elements on self-regulation for children on the autism spectrum (aged 8–12 years) was assessed. The primary outcome was executive functions. Secondary outcomes were sleep, anxiety, and emotion awareness. After attrition, assessment results from participants in the intervention (n = 31) and the waitlist conditions (n = 30) completed at baseline, post-intervention, and 6-week follow-up were evaluated. For the intervention group, the between-group mean score differences suggest a decrease in parent-reported global executive difficulties from baseline to post-intervention (−2.61; 95% confidence interval −5.13 to −0.09, p = 0.047, d = −0.39) and baseline to follow-up (−4.17; 95% confidence interval −6.72 to −1.62, p = 0.017, d = −0.59) with small-to-medium effect sizes. Small-to-medium effects were found for a few parent-reported children’s sleep issues, child-reported aspects of emotion awareness, and performance anxiety. Non-significant findings are discussed in this article. Preliminary findings suggest mixed results and should be interpreted cautiously. The yoga-informed program may complement existing treatments and will benefit from ongoing evaluation.Lay abstractChildren on the autism spectrum may experience difficulties with the regulation of attention, thoughts, emotions, and behavior, understanding, and expressing their emotions appropriately, as well as anxiety, and sleep. In autism research, contemplative practices that work through both body and mind have shown tentatively promising results. However, there are limited studies on this topic, and the use of yoga to facilitate executive control has not been researched yet. The Incredible Explorers (6-week program), a yoga-informed intervention program for children (8–12 years), was developed to understand whether, for children on the autism spectrum, the training could improve the ability to self-regulate, reduce anxiety and sleep problems, and increase awareness of emotions. In our sample, 61 children with one of their parents completed the program. Half of the group received the intervention, and the other half had to wait until the yoga group completed their trial. The participants were asked to give their feedback immediately after program completion and at 6-week follow-up. Compared to the group that was waiting to receive the intervention, parents in the yoga group reported significant gains for their children in regulating their overall executive control immediately after the session and again at follow-up. The parents reported a reduction in some of the sleep problems post-treatment. Children indicated an improved ability to communicate their feelings and willingness to analyze their emotions post-intervention. However, the study had several shortcomings and given that this was the first trial of the program, the results need to be interpreted with caution. Further research is recommended.
      Citation: Autism
      PubDate: 2020-11-26T05:24:38Z
      DOI: 10.1177/1362361320974841
       
  • Identifying children with autism spectrum disorders in Iran using the
           Autism Diagnostic Interview–Revised
    • Authors: Sayyed Ali Samadi, Roy McConkey, Ameneh Mahmoodizadeh
      First page: 1009
      Abstract: Autism, Ahead of Print.
      The assessment instruments for diagnosing children with autism spectrum disorder have been developed mostly in affluent, English-speaking countries. Among the most popular has been the Autism Diagnostic Interview–Revised. This article reports its use in Iran with the dual aims of confirming the factor structure of the revised Autism Diagnostic Interview when used to assess Iranian children for autism spectrum disorder and to identify the algorithms that best distinguish children with autism spectrum disorder from those who are developing typically and from those with intellectual disability. Study 1 contrasted the Autism Diagnostic Interview–Revised ratings given to 420 children with autism spectrum disorder from those of 110 typically developing children. In Study 2, the Autism Diagnostic Interview–Revised ratings of 720 children with autism spectrum disorder were compared with those of 172 children with intellectual disability, and from those with intellectual disability. Exploratory factor analyses identified one main factor that merged the social interaction and communication items of Autism Diagnostic Interview–Revised, but replicated the repetitive behaviour and verbal factors. Receiver operating characteristic analyses identified suitable cut-off points on the revised factor scores. Also, the age at which symptoms became apparent increased the sensitivity of the algorithm in distinguishing children with autism spectrum disorder from those with intellectual disability. These findings are in line with the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), recommendations and suggest a commonality in autism spectrum disorder presentations across different nations. The methodology used in this research could guide similar adaptations of assessment instruments for use in other cultures.Lay abstractThe diagnosis of autism spectrum disorder is a challenging task. Most of the current assessment scales have been developed in the West. The present study examines the applicability of one of the most used scales (the Autism Diagnostic Interview–Revised) in a Middle-Eastern culture. Two studies were undertaken. In the first, the Autism Diagnostic Interview–Revised ratings given to 420 children with autism spectrum disorder, aged 4–11 years, and 110 typically developing children were contrasted. In Study 2, the Autism Diagnostic Interview–Revised ratings of 720 children with autism spectrum disorder were compared with those of 172 children with intellectual disabilities to find out whether the Autism Diagnostic Interview–Revised scale would discriminate between these two types of developmental disabilities. The studies confirmed the acceptability of the scale to Iranian parents and assessors. However, the summary scores used to determine whether a child was likely to have autism spectrum disorder were recalculated on the two domains of social communication and repetitive behaviours, which were identified in the statistical analyses that are recommended for the evaluation of assessment scales. Thus the translated scale with the modified domain scoring proved very suitable for identifying Iranian children with autism spectrum disorder. Having a common tool such as Autism Diagnostic Interview–Revised will strengthen the opportunities to undertake cross-cultural research into the impact of autism spectrum disorder on the child and families.
      Citation: Autism
      PubDate: 2020-11-28T05:08:09Z
      DOI: 10.1177/1362361320974558
       
  • Functional gender differences in autism: An international,
           multidisciplinary expert survey using the International Classification of
           Functioning, Disability, and Health model
    • Authors: Karl Lundin, Soheil Mahdi, Johan Isaksson, Sven Bölte
      First page: 1020
      Abstract: Autism, Ahead of Print.
      Few studies have addressed gender differences in autism in relation to functioning and across cultures. We aimed to explore functional gender differences in autism from a multidisciplinary, global perspective using the International Classification of Functioning, Disability, and Health. Perceptions among professionals in high-income countries and middle-income countries were examined based on qualitative survey data from N = 225 professionals. Of these, n = 131 professionals provided information on functional gender differences in autism. Thirty-two professionals reported perceiving no gender differences. Remaining respondents (n = 99)—representing 31 countries, all World Health Organization regions, and 10 different professions—were included in a content analysis on functional gender differences, which generated three main categories and 13 subcategories. The subcategories were subsequently linked to International Classification of Functioning, Disability, and Health categories. Autistic males were described as displaying more externalizing behaviors, and females as having more internalizing problems and being more socially motivated. Thirty-two International Classification of Functioning, Disability, and Health categories were identified, of which 31 were covered by the comprehensive Core Set for autism. Gender differences in core symptoms and co-existing problems were acknowledged by professionals from both high-income countries and middle-income countries, while differences in social behaviors, including camouflaging, were more frequently described by experts from high-income countries.Lay abstractIn this study, we explored if professionals working with autistic people in different regions of the world perceive differences between females and males diagnosed with the condition. A total of 131 professionals responded to a survey that included an open question about gender differences in autism. Of these, 32 responded that they do not perceive gender differences in autism. The information provided by the other 99 experts was analyzed to identify common patterns. Three main differences were found, (1) Matching the clinical conceptualization of autism where professionals described differences in core symptoms of autism, and that autistic females were less similar to the conceptualization of autism. In (2) Co-existing problems, professionals described that autistic males display more apparent problems including hyperactivity, while autistic females were perceived as having more internalizing issues such as anxiety and eating disorders. In the last category, (3) Navigating the social environment, experts perceived autistic females as more socially motivated, and more inclined to camouflage social difficulties, making their challenges less evident. Professionals also perceived differences in the social environment, for example, that autistic girls receive more support from their peers while autistic boys are more often bullied. Our results suggest that professionals working in different parts of the world acknowledge gender differences in autism, but also that there might be some regional differences. Finally, we found that gender differences reported by the international professionals could largely be assessed with a shortened version of the International Classification of Functioning by the World Health Organization, specifically developed for autism.
      Citation: Autism
      PubDate: 2020-12-03T06:33:29Z
      DOI: 10.1177/1362361320975311
       
  • Qualification for upper secondary education in individuals with autism
           without intellectual disability: Total population study, Stockholm, Sweden
           
    • Authors: Isidora Stark, Peiwen Liao, Cecilia Magnusson, Michael Lundberg¹, Dheeraj Rai, Anton Lager, Selma Idring Nordström
      First page: 1036
      Abstract: Autism, Ahead of Print.
      This study used the Stockholm Youth Cohort, a total population cohort (N = 364,957), to describe patterns and predictors of qualification for upper secondary education, defined by passing graduation grades in core compulsory school subjects in contemporary young individuals diagnosed with autism spectrum disorders without intellectual disability (n = 6138). At the expected age for graduation, 16 years, 29% (adjusted rate difference 95% confidence interval (28.0–30.0)) fewer autistic than non-autistic individuals were qualified for upper secondary education (57% and 86%, respectively). Comorbid attention-deficit hyperactivity disorder further increased this difference. Within the group of autistic students without intellectual disability, female sex and lower family income were associated with non-qualification for upper secondary education. The proportion of students with autism without intellectual disability who qualified for upper secondary education increased at age 20. These findings underline the need for improved support for students with a diagnosis of autism without intellectual disability in mainstream education.Lay abstractObtaining a quality education is important for any individual’s chances of leading a healthy and thriving life. Currently, educational policies in many countries underscore the rights of students with autism to be educated in mainstream schools. While there is some knowledge on school outcomes among students with autism from older studies, little is known about rates of qualification for upper secondary education among children with autism in mainstream schools today. This lack of knowledge is problematic since autism is diagnosed more widely, and prior evidence may not be relevant for individuals with autism and their families today. Using Swedish registers, we therefore examined this in a study including all children and young people in Stockholm County in 2001 through 2011. We found that about two thirds of children with autism without intellectual disability qualified for upper secondary education at the expected age, in comparison with about nine in ten among typically developing peers. We also found that girls with autism had further difficulties obtaining such qualification than boys and that those who were additionally diagnosed with attention-deficit hyperactivity disorder were particularly at risk of non-qualification. Finally, students with autism without intellectual disability had a greater chance of completing compulsory education if given an extended period to graduate. These findings underline the need for supportive interventions for children with autism during compulsory school. They may also challenge the inclusive education policy adopted by majority of western countries, at least in the wake of addressing special needs in mainstream schooling.
      Citation: Autism
      PubDate: 2020-11-28T05:08:30Z
      DOI: 10.1177/1362361320975929
       
  • Ameliorating the disadvantage for autistic job seekers: An initial
           evaluation of adapted employment interview questions
    • Authors: Katie Maras, Jade Eloise Norris, Jemma Nicholson, Brett Heasman, Anna Remington, Laura Crane
      First page: 1060
      Abstract: Autism, Ahead of Print.
      Despite possessing valuable skills, social communication differences mean that autistic people are frequently disadvantaged in job interviews. We examined how autistic and non-autistic adults compared on standard (unmodified) job interview questions, and then used these findings to develop and evaluate supportive adaptations to questions. Fifty adults (25 autistic, 25 non-autistic) took part in two mock job interviews. Interview 1 provided a baseline measure of performance when answering typical, unmodified interview questions. Employment experts (unaware of participants’ autism diagnoses) rated all interviewees on question-specific performance and overall impressions and then provided feedback about how interviewees could improve and how questions could be adapted to facilitate this. Interviewees also provided feedback about the interview process from their perspective. Adaptations to the questions were developed, with Interview 2 taking place approximately 6 months later. Results demonstrated that, in Interview 1, employment experts rated autistic interviewees less favourably than nonautistic interviewees. Ratings of both autistic and non-autistic participants’ answers improved in Interview 2, but particularly for autistic interviewees (such that differences between autistic and non-autistic interviewees’ performance reduced in Interview 2). Employers should be aware that adaptations to job interview questions are critical to level the playing field for autistic candidates.Lay abstractDespite possessing valuable skills, differences in the way that autistic people understand and respond to others in social situations mean that they are frequently disadvantaged in job interviews. We examined how autistic and non-autistic adults compared on standard (unmodified) job interview questions, and then used these findings to develop and evaluate supportive adaptations to questions. Fifty adults (25 autistic, 25 non-autistic) took part in two mock job interviews. Interview 1 provided a baseline measure of performance when answering typical, unmodified interview questions. Employment experts (unaware of participants’ autism diagnoses) rated all interviewees on their responses to each question and their overall impressions of them and then provided feedback about how interviewees could improve and how questions could be adapted to facilitate this. Interviewees also provided feedback about the interview process, from their perspective. Adaptations to the questions were developed, with Interview 2 taking place approximately 6 months later. Results demonstrated that, in Interview 1, employment experts rated autistic interviewees less favourably than non-autistic interviewees. Ratings of both autistic and non-autistic participants’ answers improved in Interview 2, but particularly for autistic interviewees (such that differences between autistic and non-autistic interviewees’ performance reduced in Interview 2). Employers should be aware that adaptations to job interview questions are critical to level the playing field for autistic candidates.
      Citation: Autism
      PubDate: 2020-12-19T06:02:36Z
      DOI: 10.1177/1362361320981319
       
  • Autism in the Western Cape province of South Africa: Rates,
           socio-demographics, disability and educational characteristics in one
           million school children
    • Authors: Sarosha Pillay, Madeleine Duncan, Petrus J de Vries
      First page: 1076
      Abstract: Autism, Ahead of Print.
      The prevalence of autism spectrum disorder in South Africa is unknown and, to date, very little research has been performed within school systems that could inform the rates, distribution and profile of needs of children with autism spectrum disorder in education. We performed a comprehensive database search of all children with autism spectrum disorder in the formal education system in the Western Cape province of South Africa and compared the findings with population demographic expectations of the province. From a population of 1,154,353 children attending schools in the province, a total of 940 children with a diagnosis of autism spectrum disorder were identified, representing a rate of 0.08%. The male: female ratio was 5.5:1. There was a significant difference in the self-reported racial and language composition of the autism spectrum disorder sample compared with the Western Cape demographics where a higher proportion of children with autism spectrum disorder were from White racial groups and English-speaking homes. Eighty-nine percent of children with autism spectrum disorder were in Special Schools and only 10% were in Ordinary/Mainstream Schools. Most of the children (83%) attended schools in the City of Cape Town and only 17% in rural areas. Co-occurring intellectual disability was reported in 22.2% of the population, attention-deficit/hyperactivity disorder in 2.6% and epilepsy in 0.7%. Data showed a 76.03% increase in autism spectrum disorder in schools between 2012 and 2016, with an average increase of 15.18% per year. Findings suggested an under-representation of autism spectrum disorder in schools and an under-identification of co-occurring conditions. Results indicate that despite being one of the better-resourced provinces in South Africa, the Western Cape is not equipped to identify and meet the culturally and linguistically diverse needs of its communities. We propose strengthening of educational systems for children with autism spectrum disorder in the Western Cape, and similar investigations in other South African provinces.Lay abstractThere is very little information about autism spectrum disorder in South Africa and not much is known about children with autism spectrum disorder and their educational needs. In this study, we searched for all children with autism spectrum disorder attending schools in the Western Cape province of South Africa and compared our findings with the profile of people living in the province. We found fewer children with autism spectrum disorder in schools than expected (0.08%) and co-occurring conditions (intellectual disability = 22.2%, attention-deficit/hyperactivity disorder = 2.6% and epilepsy = 0.7%) were reported at lower rates. More children were from White racial groups and from English-speaking homes compared with the Western Cape population demographics. Most of the children (89%) attended schools for children with Special Educational Needs and only 10% were in Ordinary/Mainstream schools. Eighty-three percent attended schools in urban areas and 17% in rural areas. There was a 76.03% increase in children with autism spectrum disorder in schools between 2012 and 2016. Our findings support the need for better identification and reporting of children with autism spectrum disorder in the education system. We propose urgent review and strengthening of education systems for children with autism spectrum disorder in the Western Cape province and in other parts of South Africa.
      Citation: Autism
      PubDate: 2020-12-18T07:52:06Z
      DOI: 10.1177/1362361320978042
       
  • Short report: Development and utility of the Family-Centered Autism
           Navigation interview
    • Authors: Kris Pizur-Barnekow, Amy C Lang, Brian Barger
      First page: 1154
      Abstract: Autism, Ahead of Print.
      Navigating various systems, resources, and supports available for families of children with autism spectrum disorder is challenging. Family navigation is a potentially important support system for families of children with autism spectrum disorder. Family navigators are professionals who engage with families to enhance access to early identification and intervention services via shared navigation plans that help meet the family’s priorities and goals when navigating systems of support. Systematic processes and tools facilitating the development of a shared navigation plan with families following diagnosis are currently limited. This short report describes product development of the Family-Centered Autism Navigation using quality improvement methods including Lean Launch and qualitative methodology.Lay abstractWhen a parent learns of their child’s autism diagnosis, they may be overwhelmed, confused, and frustrated. Family navigation services are designed to improve access to care. While these services are a promising intervention to enhance well-being and developmental outcomes, there are limited tools that can systematically facilitate the development of a shared navigation plan that prioritizes the concerns of the family. The Family-Centered Autism Navigation semi-structured interview guide is designed for family navigators to triage and prioritize caregiver’s needs to coordinate and navigate systems of care after learning of their child’s autism spectrum disorder diagnosis. The goals of the Family-Centered Autism Navigation interview are to (1) identify family and child strengths; (2) identify family/caregiver concerns regarding navigation of services and systems following their child’s diagnosis of autism; (3) measure change in caregiver knowledge, ability and skill as it relates to understanding, remembering, and evaluating information they receive; and (4) assist with the development of a shared navigation plan. When using the Family-Centered Autism Navigation guide, family navigators and caregivers co-create a family-centered, prioritized action plan that supports and prepares caregivers as they navigate systems of care. This short report describes the development process of the Family-Centered Autism Navigation semi-structured interview guide. We utilized brief interviews (n = 42), expert feedback (n = 13), and quality improvement strategies (n = 2 family navigators) to develop the questions and determine the usability of the Family-Centered Autism Navigation interview in practice.
      Citation: Autism
      PubDate: 2020-11-26T05:25:38Z
      DOI: 10.1177/1362361320972890
       
 
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