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Autism
Journal Prestige (SJR): 1.739
Citation Impact (citeScore): 4
Number of Followers: 338  
 
Hybrid Journal Hybrid journal   * Containing 1 Open Access Open Access article(s) in this issue *
ISSN (Print) 1362-3613 - ISSN (Online) 1461-7005
Published by Sage Publications Homepage  [1090 journals]
  • Self-initiations in young children with autism during Pivotal Response
           Treatment with and without robot assistance
    • Authors: Manon WP De Korte, Iris van den Berk-Smeekens, Martine van Dongen-Boomsma, Iris J Oosterling, Jenny C Den Boer, Emilia I Barakova, Tino Lourens, Jan K Buitelaar, Jeffrey C Glennon, Wouter G Staal
      Abstract: Autism, Ahead of Print.
      The aim of this study was to investigate the effect of Pivotal Response Treatment versus robot-assisted Pivotal Response Treatment on self-initiations of children with autism spectrum disorder and to explore the relation between self-initiations and collateral gains in general social-communicative skills. Forty-four participants with autism spectrum disorder aged 3–8 years (Pivotal Response Treatment: n = 20, Pivotal Response Treatment + robot: n = 24), who were recruited as part of a larger randomized controlled trial (number NL4487/NTR4712, https://www.trialregister.nl/trial/4487), were included. Self-initiations were blindly coded, assessing video probes of all parent–child sessions using an event-recording system. General social-communicative skills were assessed with the parent- and teacher-rated Social Responsiveness Scale during intervention and at 3-month follow-up. Results using linear mixed-effects models showed overall gains in self-initiations during both Pivotal Response Treatment intervention groups (estimate = 0.43(0.15), 95% confidence interval (CI): 0.13–0.73), with larger gains in functional self-initiations in children receiving robot-assisted Pivotal Response Treatment (estimate = −0.27(0.12), 95% confidence interval: −0.50 to −0.04). Growth in self-initiations was related to higher parent-rated social awareness at follow-up compared with baseline in the total sample (r = −0.44, p = 0.011). The clinical implications of these findings, as well as directions for future research in the utility of Pivotal Response Treatment and robot assistance in autism spectrum disorder intervention, are discussed.Lay abstractThe initiation of social interaction is often defined as a core deficit of autism spectrum disorder. Optimizing these self-initiations is therefore a key component of Pivotal Response Treatment, an established intervention for children with autism spectrum disorder. However, little is known about the development of self-initiations during intervention and whether this development can be facilitated by robot assistance within Pivotal Response Treatment. The aim of this study was to (1) investigate the effect of Pivotal Response Treatment and robot-assisted Pivotal Response Treatment on self-initiations (functional and social) of young children with autism spectrum disorder over the course of intervention and (2) explore the relation between development in self-initiations and additional gains in general social-communicative skills. Forty-four children with autism spectrum disorder (aged 3–8 years) were included in this study. Self-initiations were assessed during parent–child interaction videos of therapy sessions and coded by raters who did not know which treatment (Pivotal Response Treatment or robot-assisted Pivotal Response Treatment) the child received. General social-communicative skills were assessed before start of the treatment, after 10 and 20 weeks of intervention and 3 months after the treatment was finalized. Results showed that self-initiations increased in both treatment groups, with the largest improvements in functional self-initiations in the group that received robot-assisted Pivotal Response Treatment. Increased self-initiations were related to higher parent-rated social awareness 3 months after finalizing the treatment.
      Citation: Autism
      PubDate: 2020-07-30T12:01:37Z
      DOI: 10.1177/1362361320935006
       
  • Identifying and measuring the common elements of naturalistic
           developmental behavioral interventions for autism spectrum disorder:
           Development of the NDBI-Fi
    • Authors: Kyle M Frost, Jessica Brian, Grace W Gengoux, Antonio Hardan, Sarah R Rieth, Aubyn Stahmer, Brooke Ingersoll
      Abstract: Autism, Ahead of Print.
      Naturalistic developmental behavioral interventions for young children with autism spectrum disorder share key elements. However, the extent of similarity and overlap in techniques among naturalistic developmental behavioral intervention models has not been quantified, and there is no standardized measure for assessing the implementation of their common elements. This article presents a multi-stage process which began with the development of a taxonomy of elements of naturalistic developmental behavioral interventions. Next, intervention experts identified the common elements of naturalistic developmental behavioral interventions using quantitative methods. An observational rating scheme of those common elements, the eight-item NDBI-Fi, was developed. Finally, preliminary analyses of the reliability and the validity of the NDBI-Fi were conducted using archival data from randomized controlled trials of caregiver-implemented naturalistic developmental behavioral interventions, including 87 post-intervention caregiver–child interaction videos from five sites, as well as 29 pre–post video pairs from two sites. Evaluation of the eight-item NDBI-Fi measure revealed promising psychometric properties, including evidence supporting adequate reliability, sensitivity to change, as well as concurrent, convergent, and discriminant validity. Results lend support to the utility of the NDBI-Fi as a measure of caregiver implementation of common elements across naturalistic developmental behavioral intervention models. With additional validation, this unique measure has the potential to advance intervention science in autism spectrum disorder by providing a tool which cuts across a class of evidence-based interventions.Lay abstractNaturalistic developmental behavioral interventions for young children with autism spectrum disorder share key elements. However, the extent of similarity between programs within this class of evidence-based interventions is unknown. There is also currently no tool that can be used to measure the implementation of their common elements. This article presents a multi-stage process which began with defining all intervention elements of naturalistic developmental behavioral interventions. Next, intervention experts identified the common elements of naturalistic developmental behavioral interventions using a survey. An observational rating scheme of those common elements, the eight-item NDBI-Fi, was developed. We evaluated the quality of the NDBI-Fi using videos from completed trials of caregiver-implemented naturalistic developmental behavioral interventions. Results showed that the NDBI-Fi measure has promise; it was sensitive to change, related to other similar measures, and demonstrated adequate agreement between raters. This unique measure has the potential to advance intervention science in autism spectrum disorder by providing a tool to measure the implementation of common elements across naturalistic developmental behavioral intervention models. Given that naturalistic developmental behavioral interventions have numerous shared strategies, this may ease clinicians’ uncertainty about choosing the “right” intervention package. It also suggests that there may not be a need for extensive training in more than one naturalistic developmental behavioral intervention. Future research should determine whether these common elements are part of other treatment approaches to better understand the quality of services children and families receive as part of usual care.
      Citation: Autism
      PubDate: 2020-07-30T12:01:07Z
      DOI: 10.1177/1362361320944011
       
  • The Dutch Sensory Perception Quotient-Short in adults with and without
           autism
    • Authors: Ricarda F Weiland, Tinca JC Polderman, Rosa A Hoekstra, Dirk JA Smit, Sander Begeer
      Abstract: Autism, Ahead of Print.
      Sensory symptoms were recently added to the diagnostic criteria of autism spectrum disorder and may be a mechanism underlying the broad phenotype of autism spectrum disorder. To measure sensory symptoms based on perceptual rather than affective, regulative, or attention components, the Sensory Perception Quotient (SPQ) measuring five modalities of sensory sensitivity has been developed. In this study, the Dutch translation of the abridged SPQ-Short was investigated in a large sample of adults with (n = 657) and without autism spectrum disorder (n = 585). Its hypothesized factor structure, combining modality specific and one modality-independent factor, was assessed in a hierarchical model. Results show that modality-specific subscales are indeed present in the short version. Furthermore, its reliability is high and comparable to the original English version. The autism spectrum disorder group reported higher sensory sensitivities than the comparison group, and women with autism spectrum disorder reported higher sensitivities compared with men with autism spectrum disorder. The SPQ-Short correlates with all Autism Quotient (AQ)-Short subscales, except for the “imagination” subscale. The SPQ-Short seems suitable to further explore the relationship between basic sensory sensitivities in autism spectrum disorder and their related symptoms such as over- and under-responsivity to sensory stimulation.Lay AbstractIndividuals on the autism spectrum often experience heightened or reduced sensory sensitivities. This feature was recently added to the diagnostic manual for autism (Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5)). To measure sensory sensitivities, the Sensory Perception Quotient (SPQ) has been developed. In this study, we tested whether a Dutch translation of the abridged SPQ-Short yields similar results as the original English version. We also tested whether this questionnaire can measure modality specific sensitivities. To this end, 657 adults with autism spectrum disorder and 585 adults without an autism spectrum disorder diagnosis filled out the Dutch SPQ-Short. The Dutch questionnaire data were very similar to the original English version: adults with autism spectrum disorder were more sensitive compared with adults without autism spectrum disorder. Women with autism spectrum disorder are more sensitive compared with men with autism spectrum disorder. Gender did not have an effect in the group without autism spectrum disorder. Individuals reporting higher sensory sensitivities also reported more autistic traits (such as lower social interests, or increased fascination for patterns). Finally, we found that the Dutch SPQ-Short is suited to measure modality-specific sensitivities. We conclude that the Dutch translation is a viable tool to measure sensory sensitivities in adults with and without autism spectrum disorder and can be used to further our understanding of differences in perception in people with or without autism spectrum disorder.
      Citation: Autism
      PubDate: 2020-07-28T10:26:27Z
      DOI: 10.1177/1362361320942085
       
  • A comparative feasibility study of two parent education and training
           programmes for autism spectrum disorder in a low-resource South African
           setting
    • Authors: John-Joe Dawson-Squibb, Petrus J de Vries
      Abstract: Autism, Ahead of Print.
      Despite the clear need for post-diagnostic parent/carer education and training in autism spectrum disorder, the evidence base is small, particularly in low-resource settings. Furthermore, few studies have examined the feasibility of intervention implementation. Here, we performed a comparative feasibility study of two Parent Education and Training programmes in a low-resource South African setting. EarlyBird/EarlyBird Plus, a UK-developed programme was compared to Autism Cares, a locally developed programme. The aims were to (1) examine acceptability, adaptation and perform limited efficacy testing and (2) use a multi-stakeholder panel and new autism spectrum disorder Parent Education and Training evaluation framework checklist to compare the programmes. A mixed-method, quasi-experimental design collected pre, post and 3-month follow-up data. Measures included standardised and custom-designed quantitative and qualitative data. In total, 18 parents participated in the EarlyBird/EarlyBird Plus programmes and 11 in Autism Cares. Strong parental acceptability for both programmes was found and adaptation suggestions were provided. Limited efficacy testing showed positive changes for parental stress, knowledge of autism spectrum disorder and child changes. The multi-stakeholder panel rated EarlyBird/EarlyBird Plus superior for next-step research based on implementation feasibility. Our findings contribute to the limited evidence base for autism spectrum disorder Parent Education and Training in low-resource environments and underline the need for evidence base of programmes to include not only intervention outcomes but also procedural and implementation outcomes.Lay AbstractAfter a diagnosis of autism, it is an important first step to give families information about autism and skills to help them support their child. These interventions are called Parent Education and Training programmes. Little is known about these programmes or if they can make a difference to families, particularly in countries with few autism resources. In this study, we compared two Parent Education and Training programmes in South Africa. EarlyBird/EarlyBird Plus was developed in the United Kingdom, and Autism Cares in South Africa. We wanted to know if parents found the programmes useful, and if any changes were required. We collected information from parents through questionnaires and interviews before and after the group. We also asked a panel of experts (including parents) to compare the programmes. In total, 18 parents attended the EarlyBird/EarlyBird Plus group and 11 attended the Autism Cares group. Parents found both programmes helpful and made suggestions for improvements. Parents showed less stress, more knowledge of autism, and saw improvements in their children. The expert panel rated EarlyBird/EarlyBird Plus as better because it was more supportive of parents and was seen as easier to run in the country. Our study showed that Parent Education and Training programmes are important, but that researchers must study not only the outcomes but also the implementation needs of these programmes.
      Citation: Autism
      PubDate: 2020-07-28T10:26:12Z
      DOI: 10.1177/1362361320942988
       
  • A systematic review and meta-analysis of parent-mediated intervention for
           children and adolescents with autism spectrum disorder in mainland China,
           Hong Kong, and Taiwan
    • Authors: Qing Liu, Wu-Ying Hsieh, Gaowei Chen
      Abstract: Autism, Ahead of Print.
      Parent-mediated intervention is a prominent approach to supplementing service insufficiency for the population with autism spectrum disorder, yet individuals from low-resource areas are largely under-represented among participants in the global parent-mediated intervention research. This systematic review and meta-analysis is the first to inspect the overall effects and research quality of parent-mediated interventions in mainland China, Hong Kong, and Taiwan. A total of 21 parent-mediated interventions were included in systematic review, and among them, 12 randomized controlled trials representing 964 children were analyzed in meta-synthesis. Overall, results of meta-analysis showed favorable effects of parent-mediated interventions with standardized mean difference ranging from 0.63 (social competence) to 1.00 (symptom severity) and averaged 0.76 across domains. However, the results should be interpreted with caution due to poor evidence quality as assessed in GRADE ratings. In terms of methodological quality, QualSyst evaluation showed that more than half (14/21) of the included studies were below satisfactory. Identified programs lack the capacity to be further disseminated in the Chinese societies due to the absence of solid theoretical foundations, the negligence of implementation outcomes, and the inadequacy of sophisticated cultural adaptations. This review reinforces the need for promotion and improvement of parent-mediated interventions in low-resource context (PROSPERO: CRD42019138723).Lay abstractThe ideal dosage for early intensive interventions for autism spectrum disorder has been suggested to be at least 25-hour per week to reach optimal effects. However, insufficient service use and unmet needs among families with children with autism spectrum disorder are frequently reported worldwide. Helping parents to develop strategies for interaction and management of behavior through parent training has been demonstrated to be a prominent way to supplementing service insufficiency for autism spectrum disorder, which is particularly crucial in less-resourced areas. This review included 21 parent-mediated intervention programs conducted in China, the most populated developing country. Among them, we were able to combine outcome information from 12 randomized controlled trials to increase confidence in the results. We also rated the quality of methodology and evidence for all included studies, which was taken into account in making conclusions. The included programs varied in the content, length, and delivery method of trainings. Although targeting different training outcomes, the majority of the studies aimed to help parents be more competent and responsive during interactions with their child in order to decrease symptom severity. Overall, results showed sufficient evidence that parent training did improve child outcomes as intended. However, the quality of more than half (14/21) of the included studies were below satisfactory. Identified programs lack the capacity to be further transported in the Chinese societies due to the lack of solid theoretical foundations, implementation manuals, and appropriate cultural adaptations. This review reinforces the need for promotion and improvement of parent-mediated interventions in low-resource context.
      Citation: Autism
      PubDate: 2020-07-28T10:25:42Z
      DOI: 10.1177/1362361320943380
       
  • Challenges, priorities, barriers to care, and stigma in families of people
           with autism: Similarities and differences among six Latin American
           countries
    • Authors: Cristiane Silvestre Paula, Sebastián Cukier, Graccielle Rodrigues Cunha, Matías Irarrázaval, Cecilia Montiel-Nava, Ricardo Garcia, Analia Rosoli, Daniel Valdez, Daniela Bordini, Andy Shih, Gabriela Garrido, Alexia Rattazzi
      Abstract: Autism, Ahead of Print.
      Lack of access to services and support is an important issue for people with autism, but in low- and middle-income countries there is a lack of data on this problem. The aims of this study were to describe the challenges and priorities, identify barriers to care, and map stigma among families of individuals with autism in Latin America. This survey was undertaken by the Red Espectro Autista Latinoamerica network, a coalition of researchers/clinicians from six Latin American countries; it comprised 2942 caregivers of children with autism from Brazil, Argentina, Chile, Uruguay, Venezuela, and the Dominican-Republic, who completed the Spanish/Portuguese version of the Caregiver Needs Survey. The survey showed that the main priorities were greater community awareness and improvements in education. The main barriers to care were waiting lists (50.2%), treatment costs (35.2%), and lack of specialized services (26.1%). Stigma experienced by families was frequent: one-third reported feeling discriminated against and helpless for having a child with autism, 48.8% reported some type of financial problem, 47.4% had to reduce work hours, and 35.5% had to stop working because of their child’s autism. This survey describes the main needs/challenges faced by individuals with autism in Latin America, helping to build data-driven strategies at a national/regional level.Lay abstractApproximately 6 million individuals with autism spectrum disorder live in Latin America. In order to strengthen autism spectrum disorder research collaborations and awareness in the region, the Latin American Autism Spectrum Network (Red Espectro Autista Latinoamerica) was constituted in 2015, comprising researchers and clinicians from the following six countries: Brazil Argentina, Chile, Uruguay, Venezuela, and the Dominican Republic. This first multisite study from the Red Espectro Autista Latinoamerica network aims to describe the challenges and priorities to identify barriers to care and to map stigma among families of individuals with autism spectrum disorder living in Latin America. A total of 2942 caregivers from these six countries completed an online survey showing that the main priorities were greater community awareness and improvements in the educational system for individuals with autism spectrum disorder. In addition to that, the main barriers to care were related to lack of structure, mainly waiting lists (50.2%), high treatment costs (35.2%), and lack of specialized services (26.1%). Stigma experienced by families was frequent: one third reported feeling discriminated against and helpless for having a child with autism spectrum disorder. Also, 48.8% of the caregivers declared financial problems, 47.4% of them had to cut down work hours, and 35.5% had to leave their jobs because of their child’s autism spectrum disorder. This is a pioneer study providing a description of the needs and challenges faced by families affected by autism spectrum disorder in Latin America, helping to build data-driven strategies at the national and regional levels.
      Citation: Autism
      PubDate: 2020-07-27T10:53:45Z
      DOI: 10.1177/1362361320940073
       
  • Parents’ perceptions and concerns about physical activity participation
           among adolescents with autism spectrum disorder
    • Authors: Susann Arnell, Kajsa Jerlinder, Lars-Olov Lundqvist
      Abstract: Autism, Ahead of Print.
      The parents of adolescents with autism spectrum disorder have a vital and proactive role in encouraging healthy physical activity habits, and they possess important knowledge about the adolescents’ needs when it comes to enhancing participation in physical activity. But promoting healthy physical activity habits in adolescents can be difficult. The purpose of this study was thus to describe parents’ perceptions of their adolescent child’s participation in physical activity and to describe the parental role in promoting such participation. Twenty-eight parents of adolescents aged 12–16 years with autism spectrum disorder were interviewed. The interviews were analyzed using an inductive content analysis approach. The parents described how challenging participation in physical activities could be for their adolescents. Despite this, they wanted to see their children participate more in physical activity but found the promotion of physical activity to be an overwhelming task that was difficult to cope with on their own. The results reveal a need for support and collaborative efforts among different actors to give these issues increased priority in order to promote the adolescents’ physical activity participation.Lay abstractWhat is already known about the topic' The parents of adolescents with autism spectrum disorder have a vital and proactive role in encouraging healthy physical activity habits. But promoting healthy physical activity habits in adolescents can be difficult. The purpose of this study was thus to describe the parental perceptions of their adolescent child’s participation in physical activity and to describe the parental role in promoting such participation. Twenty-eight parents of adolescents aged 12–16 years with autism spectrum disorder were interviewed.What this paper adds' The parents described how challenging participation in physical activities could be for their adolescents. Despite this, they wanted to see their children participate more in physical activity but found the promotion of physical activity to be an overwhelming task that was difficult to cope with on their own.Implications for practice, research, or policy. The results reveal a need for support and collaborative efforts among different actors to give these issues increased priority in order to promote the adolescents’ physical activity participation.
      Citation: Autism
      PubDate: 2020-07-25T11:12:02Z
      DOI: 10.1177/1362361320942092
       
  • Vision care among school-aged children with autism spectrum disorder in
           North America: Findings from the Autism Treatment Network Registry
           Call-Back Study
    • Authors: Olivia J Lindly, James Chan, Rachel M Fenning, Justin G Farmer, Ann M Neumeyer, Paul Wang, Mark Swanson, Robert A Parker, Karen A Kuhlthau
      Abstract: Autism, Ahead of Print.
      Children with autism spectrum disorder have a high risk of vision problems yet little is known about their vision care. This cross-sectional survey study, therefore, examined vision care among 351 children with autism spectrum disorder ages 6–17 years in the United States or Canada who were enrolled in the Autism Treatment Network Registry. Vision care variables were vision tested with pictures, shapes, or letters in the past 2 years; vision tested by an eye care practitioner (e.g. ophthalmologist, optometrist) in the past 2 years; prescribed corrective eyeglasses; and wore eyeglasses as recommended. Covariates included sociodemographic, child functioning, and family functioning variables. Multivariable models were fit for each vision care variable. Though 78% of children with autism spectrum disorder had their vision tested, only 57% had an eye care practitioner test their vision in the past 2 years. Among the 30% of children with autism spectrum disorder prescribed corrective eyeglasses, 78% wore their eyeglasses as recommended. Multivariable analysis results demonstrated statistically significant differences in vision care among children with autism spectrum disorder by parent education, household income, communication abilities, intellectual functioning, and caregiver strain. Overall, study results suggest many school-aged children with autism spectrum disorder do not receive recommended vision care and highlight potentially modifiable disparities in vision care.Lay AbstractChildren with autism are at high risk for vision problems, which may compound core social and behavioral symptoms if untreated. Despite recommendations for school-aged children with autism to receive routine vision testing by an eye care practitioner (ophthalmologist or optometrist), little is known about their vision care. This study, therefore, examined vision care among 351 children with autism ages 6–17 years in the United States or Canada who were enrolled in the Autism Treatment Network Registry. Parents were surveyed using the following vision care measures: (1) child’s vision was tested with pictures, shapes, or letters in the past 2 years; (2) child’s vision was tested by an eye care practitioner in the past 2 years; (3) child was prescribed corrective eyeglasses; and (4) child wore eyeglasses as recommended. Sociodemographic characteristics such as parent education level, child functioning characteristics such as child communication abilities, and family functioning characteristics such as caregiver strain were also assessed in relationship to vision care. Although 78% of children with autism had their vision tested, only 57% had an eye care practitioner test their vision in the past 2 years. Among the 30% of children with autism prescribed corrective eyeglasses, 78% wore their eyeglasses as recommended. Differences in vision care were additionally found among children with autism by parent education, household income, communication abilities, intellectual functioning, and caregiver strain. Overall, study results suggest many school-aged children with autism do not receive recommended vision care and highlight potentially modifiable disparities in vision care.
      Citation: Autism
      PubDate: 2020-07-22T04:48:55Z
      DOI: 10.1177/1362361320942091
       
  • Sex-related patterns of intrinsic functional connectivity in children and
           adolescents with autism spectrum disorders
    • Authors: Lindsay A Olson, Lisa E Mash, Annika Linke, Christopher H Fong, Ralph-Axel Müller, Inna Fishman
      Abstract: Autism, Ahead of Print.
      Although a growing literature highlights sex differences in autism spectrum disorder clinical presentation, less is known about female variants at the neural level. We investigated sex-related patterns of functional connectivity within and between functional networks in children and adolescents with autism spectrum disorders, compared to typically developing peers. Resting-state functional magnetic resonance imaging data for 141 children and adolescents (7–17 years) selected from an in-house sample and four sites contributing to the Autism Brain Imaging Database Exchange (ABIDE I and II) were submitted to group independent component analysis to generate resting-state functional networks. Functional connectivity was estimated by generating resting-state functional network correlation matrices, which were directly compared between males and females, and autism spectrum disorder and typically developing groups. Results revealed greater connectivity within the default mode network in typically developing girls as compared to typically developing boys, while no such sex effect was observed in the autism spectrum disorder group. Correlational analyses with clinical indices revealed a negative relationship between sensorimotor connectivity and history of early autism symptoms in girls, but not in boys with autism spectrum disorder. A lack of neurotypical sex differentiation in default mode network functional connectivity observed in boys and girls with autism spectrum disorder suggests that sex-related differences in network integration may be altered in autism spectrum disorder.Lay summaryWe investigated whether children and adolescents with autism spectrum disorders show sex-specific patterns of brain function (using functional magnetic resonance imaging) that are well documented in typically developing males and females. We found, unexpectedly, that boys and girls with autism do not differ in their brain functional connectivity, whereas typically developing boys and girls showed differences in a brain network involved in thinking about self and others (the default mode network). Results suggest that autism may be characterized by a lack of brain sex differentiation.
      Citation: Autism
      PubDate: 2020-07-21T07:26:00Z
      DOI: 10.1177/1362361320938194
       
  • Facial emotion recognition in autistic adult females correlates with
           alexithymia, not autism
    • Authors: Louise Ola, Fiona Gullon-Scott
      Abstract: Autism, Ahead of Print.
      Research on predominantly male autistic samples has indicated that impairments in facial emotion recognition typically associated with autism spectrum conditions are instead due to co-occurring alexithymia. However, whether this could be demonstrated using more realistic facial emotion recognition stimuli and applied to autistic females was unclear. In all, 83 females diagnosed with autism spectrum condition completed online self-report measures of autism spectrum condition severity and alexithymia, and afacial emotion recognition deficit that assessed their ability to identify multimodal displays of complex emotions. Higher levels of alexithymia, but not autism spectrum condition severity, were associated with less accurate facial emotion recognition. Difficulty identifying one’s own feelings and externally oriented thinking were the components of alexithymia that were specifically related to facial emotion recognition accuracy. However, alexithymia (and autism spectrum condition severity) was not associated with speed of emotion processing. The findings are primarily discussed with the theoretical view that perceiving and experiencing emotions share the same neural networks, thus being able to recognise one’s own emotions may facilitate the ability to recognise others’. This study is in line with previous similar research on autistic males and suggests impairments in facial emotion recognition in autistic females should be attributed to co-occurring alexithymia.Lay abstractResearch with autistic males has indicated that difficulties in recognising facial expressions of emotion, commonly associated with autism spectrum conditions, may instead be due to co-occurring alexithymia (a condition involving lack of emotional awareness, difficulty describing feelings and difficulty distinguishing feelings from physical bodily sensations) and not to do with autism. We wanted to explore if this would be true for autistic females, as well as to use more realistic stimuli for emotional expression. In all, 83 females diagnosed with autism spectrum condition completed self-report measures of autism spectrum condition traits and alexithymia and completed a visual test that assessed their ability to identify multimodal displays of complex emotions. Higher levels of alexithymia, but not autism spectrum condition features, were associated with less accuracy in identifying emotions. Difficulty identifying one’s own feelings and externally oriented thinking were the components of alexithymia that were specifically related to facial emotion recognition accuracy. However, alexithymia (and levels of autism spectrum condition traits) was not associated with speed of emotion processing. We discuss the findings in terms of possible underlying mechanisms and the implications for our understanding of emotion processing and recognition in autism.
      Citation: Autism
      PubDate: 2020-07-21T07:25:44Z
      DOI: 10.1177/1362361320932727
       
  • Service use by youth with autism within a system-driven implementation of
           evidence-based practices in children’s mental health services
    • Authors: Nicole A Stadnick, Anna S Lau, Kelsey S Dickson, Keri Pesanti, Debbie Innes-Gomberg, Lauren Brookman-Frazee
      Abstract: Autism, Ahead of Print.
      Public mental health systems play an important role in caring for youth with autism spectrum disorder. Like other dually diagnosed populations, youth with autism spectrum disorder may receive services in the context of evidence-based practice implementation efforts within public mental health systems. Little is known about service use patterns within the context of system-driven implementations efforts for this population. This case–control study examined mental health service patterns of 2537 youth with autism spectrum disorder compared to 2537 matched peers receiving care in the Los Angeles County Department of Mental Health, the largest public mental health department in the United States, within the context of a system-driven implementation of multiple evidence-based practices. Although not the primary target of this implementation effort, youth with autism spectrum disorder were served when they met criteria for the services based on their presenting mental health symptoms. Comparative analyses using administrative claims data were conducted to examine differences in mental health utilization patterns and clinical characteristics. Findings revealed significant differences in the volume and duration of mental health services as well as differences in the service type and evidence-based practice delivered between youth with and without autism spectrum disorder. Results provide direction targeting implementation efforts for youth with autism spectrum disorder within a public mental health system care reform.
      Citation: Autism
      PubDate: 2020-07-18T08:47:11Z
      DOI: 10.1177/1362361320934230
       
  • Mentalising and conversation-following in autism
    • Authors: Hsuan-Chen Wu, Francesca Biondo, Ciara O’Mahony, Sarah White, Flora Thiebaut, Geraint Rees, Paul W Burgess
      Abstract: Autism, Ahead of Print.
      Some people with autism spectrum disorders have been observed to experience difficulties with making correct inferences in conversations in social situations. However, the nature and origin of their problem is rarely investigated. This study used manipulations of video stimuli to investigate two questions. The first question was whether it is the number of people involved in social situations, that is, the source of problems in following conversations, or whether it is the increased mentalising demands required to comprehend interactions between several people. The second question asked was whether the nature and pattern of the errors that autism spectrum disorder participants show are the same as typically developing people make when they make an error. In total, 43 typically developed adults and 30 adults diagnosed with autism spectrum disorder were studied. We found that it was the amount of mentalising required, rather than the number of people involved, which caused problems for people with autism spectrum disorder in following conversations. Furthermore, the autism spectrum disorder participants showed a more heterogeneous pattern of errors, showing less agreement among themselves than the typically developed group as to which test items were hardest. So, fully understanding the observed behaviour consequent upon weakness in mentalising ability in people with autism spectrum disorders requires consideration of factors other than mentalising.
      Citation: Autism
      PubDate: 2020-07-18T08:46:31Z
      DOI: 10.1177/1362361320935690
       
  • Autism spectrum disorder/Takiwātanga: An Integrated Data
           Infrastructure-based approach to autism spectrum disorder research in New
           Zealand
    • Authors: Nicholas Bowden, Hiran Thabrew, Jesse Kokaua, Richard Audas, Barry Milne, Kirsten Smiler, Hilary Stace, Barry Taylor, Sheree Gibb
      Abstract: Autism, Ahead of Print.
      New Zealand has few estimates of the prevalence of autism spectrum disorder and no national registry. The use of administrative data sources is expanding and could be useful in autism spectrum disorder research. However, the extent to which autism spectrum disorder can be captured in these data sources is unknown. In this study, we utilised three linked administrative health data sources from the Integrated Data Infrastructure to identify cases of autism spectrum disorder among New Zealand children and young people. We then investigated the extent to which a range of mental health, neurodevelopmental and related problems co-occur with autism spectrum disorder. In total, 9555 unique individuals aged 0–24 with autism spectrum disorder were identified. The identification rate for 8-year-olds was 1 in 102. Co-occurring mental health or related problems were noted in 68% of the autism spectrum disorder group. The most common co-occurring conditions were intellectual disability, disruptive behaviours and emotional problems. Although data from the Integrated Data Infrastructure may currently undercount cases of autism spectrum disorder, they could be useful for monitoring service and treatment-related trends, types of co-occurring conditions and for examining social outcomes. With further refinement, the Integrated Data Infrastructure could prove valuable for informing the national incidence and prevalence of autism spectrum disorder and the long-term effectiveness of clinical guidelines and interventions for this group.Lay abstractNew Zealand has few estimates of the prevalence autism spectrum disorder and no national registry or data set to identify and track cases. This hinders the ability to make informed, evidence-based decisions relating to autism spectrum disorder. In this study, we utilised linked health and non-health data to develop a method for identifying cases of autism spectrum disorder among children and young people in New Zealand. In addition, we examined rates of co-occurring mental health, neurodevelopmental and related conditions among this cohort and compared these to the general population. The method identified almost 10,000 children and young people with autism spectrum disorder in New Zealand. Co-occurring mental health or related problems were found in over 68% of this group (nearly seven times higher than the general population), and around half were identified with multiple co-occurring conditions. The most frequently identified conditions were intellectual disability, disruptive behaviours and emotional problems. We have developed a useful method for monitoring service and treatment-related trends, number and types of co-occurring conditions and examining social outcomes among individuals with autism spectrum disorder. While the method may underestimate the prevalence of autism spectrum disorder in New Zealand, it provides a significant step towards establishing a more comprehensive evidence base to inform autism spectrum disorder–related policy.
      Citation: Autism
      PubDate: 2020-07-17T09:07:17Z
      DOI: 10.1177/1362361320939329
       
  • Bilingualism in autism: Language learning profiles and social experiences
    • Authors: Bérengère G Digard, Antonella Sorace, Andrew Stanfield, Sue Fletcher-Watson
      Abstract: Autism, Ahead of Print.
      Bilingualism changes how people relate to others, and lead their lives. This is particularly relevant in autism, where social interaction presents challenges. Understanding the overlap between the social variations of bilingualism and autism could unveil new ways to support autistic people. This research aims to understand the language learning and social experiences of mono-, bi- and multilingual autistic people. A total of 297 autistic adults (mean age = 32.4 years) completed an online questionnaire including general demographic, language history and social life quality self-rating items. The sample included 89 monolingual English speakers, 98 bilinguals, and 110 multilinguals, with a wide range of language profiles. Regression models were used to analyse how bilingualism variables predicted social life quality ratings. In the full sample, age negatively predicted social life quality scores while the number of languages known positively predicted social life quality scores. In the multilingual subset, age negatively predicted social life quality scores, while third language proficiency positively predicted social life quality scores. This is the first study describing the language history and social experiences of a substantial sample of bilingual and multilingual autistic adults. It provides valuable insight into how autistic people can learn and use a new language, and how their bilingualism experiences shape their social life.Lay abstractBilingualism changes the way people relate to others. This is particularly interesting in the case of autism, where social interaction presents many challenges. A better understanding of the overlap between the social variations of bilingualism and autism could unveil new ways to support the social experiences of autistic people. This research aims to understand the language learning and social experiences of autistic people who speak one, two or more languages. A total of 297 autistic adults (aged between 16 and 80 years) completed an online questionnaire that included general demographic questions, social life quality self-rating questions, language history questions, and open questions about the respondents’ bilingualism experience. Respondents had a wide range of language experiences: there were 89 monolingual English speakers, 98 bilinguals, 110 respondents knew three languages or more, all with a wide range of abilities in their languages. In the full group, younger respondents were more satisfied with their social life, and respondents with many languages were more satisfied with their social life than respondents with few languages. In the multilingual group, younger respondents were more satisfied with their social life, and the more skilled in their third language the more satisfied with their social life. This is the first study describing the language history and social experiences of a large group of bilingual and multilingual autistic adults. It highlights how autistic people can encounter a new language, learn it and use it in their daily life, and how their bilingualism experiences shape their social life.
      Citation: Autism
      PubDate: 2020-07-17T09:06:37Z
      DOI: 10.1177/1362361320937845
       
  • The effect of school exposure and personal contact on attitudes towards
           bullying and autism in schools: A cohort study with a control group
    • Authors: Anna Cook, Jane Ogden, Naomi Winstone
      Abstract: Autism, Ahead of Print.
      Research shows that the attitudes of children and adolescents towards bullying are influenced by the school environment and their peer groups. Given the increased vulnerability to bullying for autistic children, this study explored whether neurotypical children’s attitudes towards bullying and autism varied according to school exposure and personal contact with autistic people. Survey data were collected at the beginning and end of the school year from 775 children aged 11–12 years, from six schools: three with specialist centres for autism and three without. Participants read vignettes depicting bullying scenarios then completed measures of their attitudes in relation to the vignette and towards autism. Children from centre schools showed a greater increase in prosocial emotions towards bullying. For children from non-centre schools, an interaction showed a decrease in prosocial emotions except in response to social exclusion of an autistic child. Increases in personal contact showed a greater increase in positive attitudes towards autistic people. Explanations draw on theories of inter-group contact and social-moral reasoning. Results highlight the need for contact both at a personal level and through attending a school with an inclusive autism provision to increase understanding, improve attitudes towards autism and reduce tolerance for bullying.Lay abstractAutistic children are more likely than non-autistic children to be bullied at school. This study therefore explored whether the kind of school setting and the level of personal contact with autistic people can affect children’s attitudes towards bullying and autism. Surveys were completed at the beginning and end of the school year by 775 children aged 11–12 years, from six schools: three with specialist centres for autistic children and three without. Participants read stories describing bullying situations, then provided their views in relation to the story and in relation to autism. Children in schools with centres increased their feelings of anger, pity, sadness and shame in response to the bullying situations. In contrast, children in schools with no centre showed less sociable responses to bullying, except in response to a story describing an autistic child, being excluded by classmates. Furthermore, children who increased the time they spent with autistic individuals over the course of the year showed a greater rise in positive attitudes towards autistic people. This highlights the need for both personal contact and an inclusive school environment, to improve attitudes towards autism and reduce tolerance for bullying.
      Citation: Autism
      PubDate: 2020-07-16T06:25:24Z
      DOI: 10.1177/1362361320937088
       
  • Continuing to look in the mirror: A review of neuroscientific evidence for
           the broken mirror hypothesis, EP-M model and STORM model of autism
           spectrum conditions
    • Authors: Luke Yates, Hannah Hobson
      Abstract: Autism, Ahead of Print.
      The mirror neuron system has been argued to be a key brain system responsible for action understanding and imitation. Subsequently, mirror neuron system dysfunction has therefore been proposed to explain the social deficits manifested within autism spectrum condition, an approach referred to as the broken mirror hypothesis. Despite excitement surrounding this hypothesis, extensive research has produced insufficient evidence to support the broken mirror hypothesis in its pure form, and instead two alternative models have been formulated: EP-M model and the social top-down response modulation (STORM) model. All models suggest some dysfunction regarding the mirror neuron system in autism spectrum condition, be that within the mirror neuron system itself or systems that regulate the mirror neuron system. This literature review compares these three models in regard to recent neuroscientific investigations. This review concludes that there is insufficient support for the broken mirror hypothesis, but converging evidence supports an integrated EP-M and STORM model.Lay abstractThe mirror neuron system has been argued to be a key brain system responsible for understanding the actions of others and for imitation. It has therefore been proposed that problems within this system could explain the social difficulties experienced by people with autism spectrum condition. This idea is referred to as the broken mirror hypothesis. However, research has produced insufficient evidence to support the broken mirror hypothesis in its original form. Therefore, two other models have been suggested: EP-M model and the social top-down response modulation (STORM) model. All models suggest something is different regarding the mirror neuron system in autism spectrum condition: either within the mirror neuron system itself or within the systems that control the activity of the mirror neuron system. This literature review compares these three models in regard to recent neuroscientific investigations. This review concludes that there is insufficient support for both the broken mirror hypothesis, but converging evidence supports an integrated EP-M and STORM model.
      Citation: Autism
      PubDate: 2020-07-16T06:23:40Z
      DOI: 10.1177/1362361320936945
       
  • Moral foundations theory in autism spectrum disorder: A qualitative
           investigation
    • Authors: Erin E Dempsey, Chris Moore, Annie E Richard, Isabel M Smith
      Abstract: Autism, Ahead of Print.
      Morality is important for how humans treat each other and non-human animals. Differences in moral reasoning have been found between autistic and neurotypical individuals. Research in this area has relied on accounts of moral psychology that suggest increasingly mature moral principles that develop from taking the perspectives of others. Yet, even autistic individuals, who sometimes differ in their ability to take others’ perspectives, make moral judgements that are similar to neurotypical individuals. Moral foundations theory suggests that moral psychology is not hierarchical but differs depending on culture. Moral foundations theory has not yet been investigated among autistic individuals. This qualitative study used interviews and qualitative analysis as a first attempt at understanding how moral foundations theory fits with autistic moral thinking. We found that all five moral foundations of moral foundations theory were represented in the interviews, yet certain foundations appeared more prominent than others. The autistic adults interviewed in our study discussed issues of care and fairness more than of loyalty, authority or purity when prompted to discuss moral transgressions. Future research should use quantitative methods to compare groups of autistic and neurotypical individuals to clarify similarities and differences in moral thinking between the groups.Lay abstractMorality is important for how humans treat each other and non-human animals. Differences in moral thinking have been found between autistic and neurotypical individuals. This research has relied on ways of thinking about moral psychology that suggest that mature morals develop as individuals learn to take the perspectives of others. Yet, even autistic individuals, who sometimes differ in their ability to take others’ perspectives, make moral judgements that are similar to neurotypical individuals. Moral foundations theory suggests that moral psychology is not hierarchical but differs depending on culture. This theory could therefore help make sense of similarities and differences in autistic and neurotypical moral thinking. Moral foundations theory has not yet been investigated among autistic individuals. In this study, we interviewed autistic adults as a first attempt at understanding how moral foundations theory fits with autistic moral thinking. We found that all five moral foundations of moral foundations theory were represented in the interviews, yet certain foundations appeared more prominent than others. The autistic adults interviewed in our study discussed issues of care and fairness more than of loyalty, authority or purity when prompted to discuss moral transgressions. Future research should use quantitative methods to compare groups of autistic and neurotypical individuals to clarify similarities and differences in moral thinking between the groups.
      Citation: Autism
      PubDate: 2020-07-15T03:03:54Z
      DOI: 10.1177/1362361320939331
       
  • Parent perceptions of participation in a parent-mediated
           communication-focussed intervention with their young child with autism
           spectrum disorder
    • Authors: Kathy Leadbitter, Wendy Macdonald, Carol Taylor, Karen Leneh Buckle
      Abstract: Autism, Ahead of Print.
      Paediatric Autism Communication Therapy is a parent-mediated, video-aided, communication-focussed intervention for young children with autism spectrum disorder. It has been shown in a UK randomised controlled trial to lead to improvements in parent–child communication and family quality of life, together with a sustained reduction in child autism symptom severity. This qualitative study examined parental perceptions of their participation in Paediatric Autism Communication Therapy within the context of the randomised controlled trial. Semi-structured interviews were carried out with 18 parents within 12 months of completion of the therapy. The thematic analysis provides insights into parents’ hopes, expectations, and learning processes when working with Paediatric Autism Communication Therapy therapists and carrying out daily practice in the home. Parents reported positive changes in their interaction and relationship with their child and improvements to their child’s communication and interaction. Some also highlighted poignant realisations and emotional challenges associated with taking part in this post-diagnostic therapy. Practical difficulties were also emphasised. Implications for the clinical practice of parent-mediated interventions with young children with autism spectrum disorder are discussed.Lay abstractPaediatric Autism Communication Therapy is an intervention for young children with autism spectrum disorder that focuses on parent–child communication. In Paediatric Autism Communication Therapy, the therapist and parent watch videos of the parent and child playing together. The therapist coaches the parent to carefully observe the child’s communication and to interact with their child in a more sensitive and responsive way. Parents are encouraged to use the strategies with their child at home. Paediatric Autism Communication Therapy has been shown to lead to long-term improvements in parent–child communication and family quality of life. This study aimed to explore parents’ perceptions of their participation in Paediatric Autism Communication Therapy. Interviews were carried out by an independent researcher with 18 parents. Parents discussed the learning processes they went through when working with Paediatric Autism Communication Therapy therapists and carrying out home practice. Some parents described initial doubts about the approach and hesitations about being videoed and analysing video material. In time, most parents came to really value the therapy and their relationship with the therapist. They reported positive changes in their interaction and relationship with their child and improvements to their child’s communication and interaction. Some also highlighted poignant realisations and emotional challenges associated with taking part in this post-diagnosis therapy. Practical difficulties were also emphasised, including the time commitment, accessibility of therapy venues and difficulties in occupying the child during therapist–parent discussion. Implications for the clinical practice of parent-mediated interventions are discussed.
      Citation: Autism
      PubDate: 2020-07-15T02:54:34Z
      DOI: 10.1177/1362361320936394
       
  • Integrating the Early Start Denver Model into Israeli community autism
           spectrum disorder preschools: Effectiveness and treatment response
           predictors
    • Authors: Yana Sinai-Gavrilov, Tali Gev, Irit Mor-Snir, Giacomo Vivanti, Ofer Golan
      Abstract: Autism, Ahead of Print.
      Early intensive intervention has been shown to significantly affect the development of children with autism spectrum disorder. However, the costly implementation of such interventions limits their wide dissemination in the community. This study examined an integration of the Early Start Denver Model into community preschool programs for children with autism spectrum disorder in Israel. Four community preschools implemented the preschool-based Early Start Denver Model and four implemented a multidisciplinary developmental intervention which is widely applied in Israeli community autism spectrum disorder preschools. Fifty-one children (aged 33–57 months) participated in the study. Twenty-six attended the preschool-based Early Start Denver Model preschools and twenty-five attended the multidisciplinary developmental intervention settings. Groups were comparable on age, developmental functioning, and socio-economic status. Compared to the multidisciplinary developmental intervention group, children in the preschool-based Early Start Denver Model treatment made greater gains on blinded measures of overall cognitive development, receptive and expressive language skills, as well as on parent- and teacher-reported adaptive communication and socialization abilities. In the preschool-based Early Start Denver Model group, children with lower symptom severity, higher adaptive functioning, and receptive language abilities at pre-treatment showed greater improvement. This study documents the successful integration of an Early Start Denver Model intervention into pre-existing community preschools, underlining the importance of disseminating evidence-based early intervention in community settings.Lay AbstractEarly intensive intervention has been shown to significantly affect the development of children with Autism. However, the costly implementation of such interventions limits their wide dissemination in the community. This study examined an integration of a research-supported early intensive intervention model called the Early Start Denver Model into community preschool programs for children with Autism in Israel. Four community preschools implemented the preschool-based Early Start Denver Model and four implemented the existing multidisciplinary developmental intervention which is widely applied in Israeli community preschools for children with autism. Fifty-one children (aged 33–57 months) participated in the study. Twenty-six attended the preschool-based Early Start Denver Model preschools and twenty-five attended the multidisciplinary developmental intervention preschools. Before the intervention began, groups were comparable on children’s age and developmental functioning and on families’ socio-economic status. Results showed that, compared to the multidisciplinary developmental intervention group, children in the preschool-based Early Start Denver Model treatment group made greater gains on measures of overall cognitive development, language skills, as well as on parent- and teacher-reported adaptive communication and socialization abilities. Children who had lower autism symptom severity, higher adaptive functioning and better language understanding abilities before taking part in the preschool-based Early Start Denver Model program showed greater improvements following it. This study documents the successful implementation of an intensive early intervention program in pre-existing community preschools, underlining the importance of the integration of research-supported intervention programs into community settings.
      Citation: Autism
      PubDate: 2020-07-14T11:58:09Z
      DOI: 10.1177/1362361320934221
       
  • Using phecode analysis to characterize co-occurring medical conditions in
           autism spectrum disorder
    • Authors: Michelle D Failla, Kyle L Schwartz, Shikha Chaganti, Laurie E Cutting, Bennett A Landman, Carissa J Cascio
      Abstract: Autism, Ahead of Print.
      Individuals with autism spectrum disorder experience a significant number of co-occurring medical conditions, yet little is known about these conditions beyond prevalence. Using large-scale de-identified medical records, we can use a novel phecode-based tool to characterize co-occurring conditions in autism spectrum disorder. We hypothesized that individuals with autism spectrum disorder experience an increased burden of co-occurring conditions as measured by presence, frequency, and duration of visits related to co-occurring conditions. Secondarily, we hypothesized that age at first encounter for autism spectrum disorder (early, 5) would be associated with different co-occurring conditions. The International Classification of Diseases, Ninth Revision, codes were extracted from a large anonymized electronic medical center database for 3097 individuals with autism spectrum disorder and 3097 matched controls. Co-occurring conditions were characterized using a novel tool (pyPheWAS) to examine presence, frequency, and duration of each condition. We identified several categories of co-occurring conditions in autism spectrum disorder: neurological (convulsions, sleep disorders); psychiatric (anxiety disorders, adjustment/conduct disorders), as well as constipation, hearing loss, and developmental delays. Our work confirms individuals with autism spectrum disorder are under a significant medical burden, with increased duration and frequency of visits associated with co-occurring conditions. Adequate management of these conditions could improve quality of life for individuals with autism spectrum disorder.Lay abstractPeople with autism spectrum disorder often have a number of other medical conditions in addition to autism. These can range from constipation to epilepsy. This study uses medical record data to understand how frequently and how long people with autism have to be seen by a medical professional for these other medical conditions. This study confirmed that people with autism often have a number of other medical conditions and that they have to go see a medical professional about those conditions often. We also looked to see if children diagnosed with autism after age 5 years might have different medical conditions compared to children diagnosed earlier. Children diagnosed later had more conditions like asthma, hearing loss, and mood disorders. This work describes how much medical care people with autism get for different medical conditions and the burden of seeking additional medical care for people with autism and their families.
      Citation: Autism
      PubDate: 2020-07-14T11:57:49Z
      DOI: 10.1177/1362361320934561
       
  • Alexithymic and autistic traits: Relevance for comorbid depression and
           social phobia in adults with and without autism spectrum disorder
    • Authors: Laura Albantakis, Marie-Luise Brandi, Imme Christina Zillekens, Lara Henco, Leonie Weindel, Hanna Thaler, Lena Schliephake, Bert Timmermans, Leonhard Schilbach
      Abstract: Autism, Ahead of Print.
      High alexithymic traits and psychiatric comorbidities such as depression and social phobia are frequently observed among adults with autism spectrum disorder. In this study, we tested whether alexithymic and/or autistic traits are risk factors for depressive and social phobic symptoms in adults with autism spectrum disorder (n = 122), patients with social interaction difficulties other than autism (n = 62), and neurotypical participants (n = 261). Multiple regression analyses of these three groups demonstrated that both traits explained considerable variance of depressive and social phobic symptoms. In adults with autism spectrum disorder, alexithymic traits were predictive of depressive symptoms, while autistic traits predicted social phobic symptoms. In patients with social interaction difficulties other than autism, alexithymic and autistic traits were identified as predictors of social phobic symptoms, while no variable predicted depressive symptoms. In neurotypicals, both alexithymic and autistic traits were predictive of depressive and social phobic symptoms. Our results, therefore, highlight the importance of assessing both alexithymic and autistic traits in patients with and without autism spectrum disorder for identifying comorbid psychopathology. Depending on the underlying core symptomatology, alexithymic and/or autistic traits increase the risk of depressive and social phobic symptoms calling for therapeutic strategies to prevent or at least reduce comorbid psychopathology.Lay abstractAdults with autism often develop mental health problems such as depression and social phobia. The reasons for this are still unclear. Many studies found that alexithymia plays an important role in mental health problems like depression. People with alexithymia have difficulties identifying and describing their emotions. Almost every second person with autism has alexithymia. Therefore, we explored in this study whether alexithymia is linked to worse mental health in autistic people. We looked at two common diagnoses, depression and social phobia. We found that alexithymia increased symptoms of depression, while autistic traits increased symptoms of social phobia. Our results suggest that alexithymia and autistic traits can increase the risk of mental health problems. An early assessment could help prevent mental health problems and improve quality of life.
      Citation: Autism
      PubDate: 2020-07-14T11:57:29Z
      DOI: 10.1177/1362361320936024
       
  • Speeded reasoning moderates the inverse relationship between autistic
           traits and emotion recognition
    • Authors: Alex Bertrams, Katja Schlegel
      Abstract: Autism, Ahead of Print.
      People with diagnosed autism or being high in autistic traits have been found to have difficulties with recognizing emotions from nonverbal expressions. In this study, we investigated whether speeded reasoning (reasoning performance under time pressure) moderates the inverse relationship between autistic traits and emotion recognition performance. We expected the negative correlation between autistic traits and emotion recognition to be less strong when speeded reasoning was high. The underlying assumption is that people high in autistic traits can compensate for their low intuition in recognizing emotions through quick analytical information processing. A paid online sample (N = 217) completed the 10-item version of the Autism Spectrum Quotient, two emotion recognition tests using videos with sound (Geneva Emotion Recognition Test) and pictures (Reading the Mind in the Eyes Test), and Baddeley’s Grammatical Reasoning Test to measure speeded reasoning. As expected, the inverse relationship between autistic traits and emotion recognition performance was less pronounced for individuals with high compared to low speeded reasoning ability. These results suggest that a high ability in making quick mental inferences may (partly) compensate for difficulties with intuitive emotion recognition related to autistic traits.Lay abstractAutistic people typically have difficulty recognizing other people’s emotions and to process nonverbal cues in an automatic, intuitive fashion. This usually also applies to people who—regardless of an official diagnosis of autism—achieve high values in autism questionnaires. However, some autistic people do not seem to have any problems with emotion recognition. One explanation may be that these individuals are able to compensate for their lack of intuitive or automatic processing through a quick conscious and deliberate analysis of the emotional cues in faces, voices, and body movements. On these grounds, we assumed that the higher autistic people’s ability to reason quickly (i.e. to make quick logical inferences), the fewer problems they should have with determining other people’s emotions. In our study, we asked workers on the crowdsourcing marketplace MTurk to complete a questionnaire about their autistic traits, to perform emotion recognition tests, and to complete a test of the ability to reason under time constraints. In our sample of 217 people, we found the expected pattern. Overall, those who had higher values in the autism questionnaire scored lower in the emotion recognition tests. However, when reasoning ability was taken into account, a more nuanced picture emerged: participants with high values both on the autism questionnaire and on the reasoning test recognized emotions as well as individuals with low autistic traits. Our results suggest that fast analytic information processing may help autistic people to compensate problems in recognizing others’ emotions.
      Citation: Autism
      PubDate: 2020-07-11T05:26:29Z
      DOI: 10.1177/1362361320937090
       
  • Peer engagement in toddlers with autism: Community implementation of
           dyadic and individual Joint Attention, Symbolic Play, Engagement, and
           Regulation intervention
    • Authors: Stephanie Y Shire, Wendy Shih, Suzanne Bracaglia, Maria Kodjoe, Connie Kasari
      Abstract: Autism, Ahead of Print.
      Center-based classroom community interventions create opportunities for young children with autism to connect with peers. Yet, there has been little examination of the peer interactions of toddlers with autism who experience core challenges in social communication and play skills that may create barriers to successful peer interactions. Classrooms of toddlers were randomized to an experimental social communication intervention including peers or to the standard individual (adult–child) social communication intervention. Both toddlers in peer and no peer conditions demonstrated significant gains in social communication and play. Toddlers with greater receptive language and combination and presymbolic play skills were most likely to demonstrate peer engagement.Lay AbstractAlthough young children may participate in education and intervention programs that take place in classrooms or groups, there is little information about how toddlers with special needs, and specifically toddlers with autism, are engaging with their peers. This study takes place in a public center-based early intervention program for toddlers with autism. Classrooms of toddlers were randomly assigned to an individual social communication intervention or the same intervention adapted to include a peer. Children in both groups made gains in social communication and play skills. Children who had the peer intervention were more engaged with peers when an adult was present, but not when the children were unsupported. This article adds information about early skills that may be important for children to master so that they have more success when trying to interact with their peers. These skills include understanding language (referred to as “receptive language” at 12 months or more) and play skills including building and stacking (referred to as “combination play”—for example, building with blocks or completing a puzzle) and extending familiar actions to themselves, others, and figures (referred to as “presymbolic play”—for example, putting a bottle to the doll or to themselves). Understanding which skills to target can help practitioners focus their instruction to build children’s skills toward connecting with peers through play.
      Citation: Autism
      PubDate: 2020-07-09T11:26:31Z
      DOI: 10.1177/1362361320935689
       
  • Perspective influences eye movements during real-life conversation:
           Mentalising about self versus others in autism
    • Authors: Mahsa Barzy, Heather J Ferguson, David M Williams
      Abstract: Autism, Ahead of Print.
      Social-communication is profoundly impaired among autistic individuals. Difficulties representing others’ mental states have been linked to modulations of gaze and speech, which have also been shown to be impaired in autism. Despite these observed impairments in ‘real-world’ communicative settings, research has mostly focused on lab-based experiments, where the language is highly structured. In a pre-registered experiment, we recorded eye movements and verbal responses while adults (N = 50) engaged in a real-life conversation. Using a novel approach, we also manipulated the perspective that participants adopted by asking them questions that were related to the self, a familiar other, or an unfamiliar other. Results replicated previous work, showing reduced attention to socially relevant information among autistic participants (i.e. less time looking at the experimenter’s face and more time looking around the background), compared to typically developing controls. Importantly, perspective modulated social attention in both groups; talking about an unfamiliar other reduced attention to potentially distracting or resource-demanding social information and increased looks to non-social background. Social attention did not differ between self and familiar other contexts, reflecting greater shared knowledge for familiar/similar others. Autistic participants spent more time looking at the background when talking about an unfamiliar other versus themselves. Future research should investigate the developmental trajectory of this effect and the cognitive mechanisms underlying it.Lay abstractPrevious lab-based studies suggest that autistic individuals are less attentive to social aspects of their environment. In our study, we recorded the eye movements of autistic and typically developing adults while they engaged in a real-life social interaction with a partner. Results showed that autistic adults were less likely than typically developing adults to look at the experimenter’s face, and instead were more likely to look at the background. Moreover, the perspective that was adopted in the conversation (talking about self versus others) modulated the patterns of eye movements in autistic and non-autistic adults. Overall, people spent less time looking at their conversation partner’s eyes and face and more time looking at the background, when talking about an unfamiliar other compared to when talking about themselves. This pattern was magnified among autistic adults. We conclude that allocating attention to social information during conversation is cognitively effortful, but this can be mitigated when talking about a topic that is familiar to them.
      Citation: Autism
      PubDate: 2020-07-09T11:24:11Z
      DOI: 10.1177/1362361320936820
       
  • Comparing the writing skills of autistic and nonautistic university
           students: A collaboration with autistic university students
    • Authors: Kristen Gillespie-Lynch, Emily Hotez, Matthew Zajic, Ariana Riccio, Danielle DeNigris, Bella Kofner, Dennis Bublitz, Naomi Gaggi, Kavi Luca
      Abstract: Autism, Ahead of Print.
      The writing skills of autistic university students have received very little empirical attention. Previous research has suggested that autistic people may struggle with writing, in part, due to challenges with Theory of Mind. However, other research indicates that Theory of Mind difficulties are far from universal in autism, varying across developmental and social contexts. Through a participatory research approach, autistic university students contributed to the current study examining the writing strengths and challenges of autistic (n = 25) and nonautistic (n = 25) university students. Autistic participants demonstrated more advanced writing skills, more perfectionistic attitudes about writing, and heightened nonverbal intelligence relative to nonautistic students. Autistic students did not exhibit reduced Theory of Mind skills. Although heightened nonverbal intelligence and being autistic were both initially predictive of writing quality, autism was no longer associated with writing quality after accounting for nonverbal intelligence. Findings suggest that autistic university students may often have enhanced cognitive and writing skills but may face challenges overcoming perfectionism. This research highlights the value of participatory collaborations with autistic students for identifying strengths that can help autistic students succeed in college.Lay abstractWe do not know very much about the writing skills of autistic university students. Studies with autistic children and teenagers show that some autistic young people have difficulties writing. Other autistic people are talented writers. In fact, some autistic people would rather write than speak. Good writers often imagine other people’s points of view when writing. Autistic people sometimes have difficulties understanding others’ points of view. Yet, autistic people often work much harder to understand others’ points of view than not-autistic people do. We collaborated with autistic university student researchers to see if autistic university students are better or worse at writing than nonautistic students. Autistic university students in our study were better writers than nonautistic students. Autistic students in our study had higher nonverbal intelligence than nonautistic students. Autistic students also put themselves under more pressure to write perfectly than nonautistic students did. Autistic students did not show any difficulties understanding other minds. This study shows that some autistic university students have stronger writing skills and higher intelligence than nonautistic university students. Yet, autistic students may be too hard on themselves about their writing. Fun activities that help students explore their ideas without pressure (like theater games) may help autistic students be less hard on their writing. Teachers can help autistic students express themselves through writing by encouraging them to write about their interests, by giving them enough time to write, and by letting them write using computers if they want to. This study shows that collaborations with autistic people can help us understand strengths that can help autistic people succeed.
      Citation: Autism
      PubDate: 2020-07-09T05:58:52Z
      DOI: 10.1177/1362361320929453
       
  • Comparing sleep patterns between children with autism spectrum disorder
           and children with typical development: A matched case–control study
    • Authors: Andy CY Tse, CCW Yu, Paul H Lee
      Abstract: Autism, Ahead of Print.
      Children with autism spectrum disorder are often reported to have more sleep deficits and poorer sleep quality compared with children with typical development. However, most previous studies have serious methodological limitations, such as varying sample sizes in the comparison groups, wide age range of participants, and body mass index not matched between participants. This study investigated whether sleep patterns differed between children with autism spectrum disorder and those with typical development using a carefully matched case–control design and incorporating both actigraphy and sleep log assessments. A total of 78 children diagnosed with autism spectrum disorder were matched with 78 typical development controls in this study. The matched variables included age, gender, and body mass index. The results showed that children with autism spectrum disorder had shorter sleep duration, reduced sleep efficiency, longer sleep-onset latency, and longer wake after sleep onset than children with typical development (ps 
      Citation: Autism
      PubDate: 2020-07-07T08:29:53Z
      DOI: 10.1177/1362361320936827
       
  • The role of staffing and classroom characteristics on preschool
           teachers’ use of one-to-one intervention with children with autism
    • Authors: Victor Lushin, Steven Marcus, Daphney Gaston, Rinad Beidas, Ashlee Lamson, Ilene Goy, Irina Godina, Joanne Rees, Rebecca Rivera, David Mandell
      Abstract: Autism, Ahead of Print.
      For preschool children with autism, individual behavioral interventions are among the best-tested treatments. However, they are rarely implemented in special education preschools. We observed one-to-one behavioral interventions formally and informally delivered by staff (N = 51) in 12 classrooms across three preschools for children with autism, aged 3–6 years, in a major US city. We estimated associations between the use of one-to-one intervention and classroom characteristics including staff-student ratio, professional role composition, and frequency of challenging child behaviors. A small number of classroom characteristics explained considerable portions of outcome variance: 23% for formally delivered one-to-one interventions and 41% for informally delivered interventions. The number of individually assigned personal care aides in the classroom was negatively correlated with less formal delivery of one-to-one intervention. Classroom challenging behavior was positively associated with formal delivery of one-to-one interventions. Interventionist’s professional roles and the number of children in the class accounted for the largest amounts of variance in informal intervention delivery. Staff training, clarifying professional roles, setting performance expectations for personal care aides and other classroom team members, and reducing class size may represent promising implementation targets. Findings suggest caution around task-shifting policies that transfer clinical functions from more highly trained to less highly trained staff.Lay abstractFor preschool children with autism, individual (one-to-one) behavioral interventions are among the best-tested treatments. However, they are rarely used in special education preschools. We observed formally and informally delivered one-to-one behavioral interventions use by classroom staff (n = 51) in 12 classrooms across three special education preschools for children with autism, aged 3–6 years, in a major US city. We estimated the associations between one-to-one intervention use and classroom characteristics including staff–student ratio, professional role composition, and frequency of challenging child behaviors. As a whole, the factors we examined were considerably important for both formally and informally delivered one-to-one interventions. The number of individually assigned personal care aides in the classroom was negatively associated with the use of formally delivered one-to-one intervention. Classroom challenging behavior was positively associated with use of formally delivered one-to-one interventions. Interventionist’s professional roles and the number of children in the class were most important for the use of informally delivered interventions. Staff training, clarifying professional roles, setting performance expectations for personal care aides and other classroom team members, and reducing class size may represent promising implementation targets. Findings suggest caution around task-shifting policies that transfer clinical functions from more highly trained to less highly trained staff.
      Citation: Autism
      PubDate: 2020-07-06T09:55:27Z
      DOI: 10.1177/1362361320932726
       
  • Multi-component communication intervention for children with autism: A
           randomized controlled trial
    • Authors: Lauren H Hampton, Ann P Kaiser, Elizabeth A Fuller
      Abstract: Autism, Ahead of Print.
      The objective of this study is to evaluate the effectiveness of a multi-component communication intervention on social communication for young children with autism. As many as half of children with autism are not yet talking by age 3, and up to a third of children with autism will remain minimally verbal past age 5. Spoken language outcomes are greatest when parents and clinicians are delivering language interventions to children with autism as compared to parents or clinicians alone. This study incorporates caregiver training, Discrete Trial Teaching, and JASP + EMT + SGD. A total of 68 children between ages 3 and 5 with autism, and their caregivers, participated in this study. Children were randomly assigned to the treatment or control group. Children in the treatment group received 36 sessions of the multi-component intervention in the clinic and at home. Children in both groups received a speech-generating device and the caregivers received an individualized training on how to program the speech-generating device. All participants were evaluated prior to intervention, immediately following intervention, and 4 months following intervention. Children in the intervention group demonstrated significantly greater joint attention than those in the control group immediately following intervention. Children in the intervention group, additionally, demonstrated greater social communication with their caregivers 4 months following intervention. This brief, multi-component intervention may be effective for improving social communication in young children with autism who are at risk for remaining minimally verbal. Future research is needed to understand for whom and under what conditions this intervention is most effective.Lay abstractThis study reports the results of a randomized trial for preverbal preschoolers with autism that demonstrates the effects of multiple intervention strategies including caregiver training. About 50% of children with autism are not talking by age 3 and up to 30% of children with autism will remain minimally verbal past age 5. Interventions delivered by clinicians and caregivers have the greatest effects on spoken language and may reduce the rate of those who remain minimally verbal. Sixty-eight children ages 3–5 with autism and their caregivers participated in this randomized trial comparing the communication intervention to a comparison group. A brief, multi-component, communication intervention (including a speech-generating device) for children with autism that addresses core deficits may be effective in improving joint attention skills immediately following intervention and social communication skills 4 months following intervention. Future research is needed to understand for whom and under what conditions this intervention is most effective.
      Citation: Autism
      PubDate: 2020-07-06T09:55:17Z
      DOI: 10.1177/1362361320934558
       
  • Temperament influences the relationship between symptom severity and
           adaptive functioning in children with autism spectrum disorder
    • Authors: Vivian Lee, Eric Duku, Lonnie Zwaigenbaum, Teresa Bennett, Peter Szatmari, Mayada Elsabbagh, Connor Kerns, Pat Mirenda, Isabel M Smith, Wendy J Ungar, Tracy Vaillancourt, Joanne Volden, Charlotte Waddell, Anat Zaidman-Zait, Ann Thompson, Stelios Georgiades
      Abstract: Autism, Ahead of Print.
      Temperament is a construct that is relatively stable over time but varies between individuals. Research suggests that children with autism spectrum disorder have a ‘reactive’ temperament profile when compared to peers with or without disabilities. However, our understanding of how temperament varies within children with autism and how it relates to child symptoms and outcomes is limited. This study aimed to (a) explore the variation of individual temperament traits within a sample of school-aged children with autism to determine whether subgroups of children with similar trait profiles emerge and (b) examine whether temperament influences the relationship between autism symptoms and adaptive functioning outcomes. Results revealed that children with autism can be classified empirically into two distinct profiles – ‘Even’ and ‘Reactive’ temperaments. Correlational and hierarchical regression analyses indicated that both temperament profiles and baseline symptom severity predicted adaptive functioning outcomes 1 year later. There was a significant interaction between temperament and symptom severity, suggesting temperament can influence the impact of increasing symptom severity on adaptive functioning skills in children with autism. Study findings highlight the importance of considering temperament in understanding the individual differences that influence the development of daily functioning and developmental outcomes in children with autism.Lay AbstractTemperament is often thought of as behavioural traits that are relatively stable over time but can vary between individuals. Children diagnosed with autism spectrum disorder are often characterized as having ‘reactive’ and ‘negative’ temperaments when compared to same-aged peers with or without disabilities, which can negatively impact the development of adaptive functioning skills but little is known about variations of temperament between individual children diagnosed with autism spectrum disorder. This study aimed to (a) explore the variation of individual temperament traits within a sample of school-aged children with autism spectrum disorder to determine whether subgroups with similar trait profiles emerge and (b) examine whether temperament influences the relationship between autism symptoms and adaptive functioning outcomes. Results from our dataset suggest that children diagnosed with autism spectrum disorder fit under two profiles: ‘even’ and ‘reactive’. Furthermore, our analysis shows that temperament can influence the impact of increasing symptom severity on adaptive functioning skills in children with autism spectrum disorder. Study findings highlight the importance of considering temperament when trying to understand the individual differences that influence the development of functioning and developmental outcomes in children with autism spectrum disorder.
      Citation: Autism
      PubDate: 2020-07-03T06:48:08Z
      DOI: 10.1177/1362361320933048
       
  • Short report: Evaluating the safety and usability of head-mounted virtual
           reality compared to monitor-displayed video for children with autism
           spectrum disorder
    • Authors: Mahan Malihi, Jenny Nguyen, Robyn E Cardy, Salina Eldon, Catharine Petta, Azadeh Kushki
      Abstract: Autism, Ahead of Print.
      Virtual reality provides a relatively inexpensive way to learn and repeatedly practice skills in personalized, controlled, and safe computer-generated settings. These systems are increasingly receiving attention as an innovative medium for delivering interventions to children with autism spectrum disorder. Although many virtual reality systems are commercially available and their use is increasing, little is known about the safety and usability of these systems for children with autism spectrum disorder. The aim of this study was a first step in addressing this gap. A convenience sample of 35 children with a diagnosis of autism spectrum disorder participated in an immersive head-mounted display virtual reality experience and a control condition (monitor-displayed video). Levels of anxiety and negative effects experienced were not significantly different between the two conditions. Participants reported significantly enhanced spatial presence (p = 0.003; d = 0.3) and naturalness (p = 0.002; d = 0.47) for the head-mounted display–virtual reality condition, and 74% of participants preferred using head-mounted display–virtual reality over monitor-displayed video. These findings provide preliminary evidence to support the safety and usability of head-mounted display–virtual reality for children with autism spectrum disorder. Future studies are needed to replicate the results in a larger sample, a range of virtual reality experiences, and in the context of long-term exposure.Lay abstractThis study investigated the safety and usability of a virtual reality experience for children with autism spectrum disorder in a laboratory setting. In our study, the negative effects of head-mounted display–virtual reality were similar to monitor-displayed video watching. At the same time, the participants indicated that the head-mounted display–virtual reality experience provided improved realism and sense of presence. This study is a first step in understanding the impact of head-mounted display on children with autism spectrum disorder.
      Citation: Autism
      PubDate: 2020-07-03T06:47:28Z
      DOI: 10.1177/1362361320934214
       
  • Short report: Social communication difficulties and restricted repetitive
           behaviors as predictors of anxiety in adults with autism spectrum disorder
           
    • Authors: Erika Kuzminskaite, Sander Begeer, Rosa A Hoekstra, Rachel Grove
      Abstract: Autism, Ahead of Print.
      Autism spectrum disorder and anxiety are highly comorbid conditions. Understanding the underlying traits of anxiety in autism spectrum disorder is crucial to prevent and treat it efficiently. Hence, this study determined whether social communication difficulties or restricted repetitive behaviors are stronger risk factors for anxiety symptoms in autistic adults in a large cohort. Data on 742 autistic adults from the Netherlands Autism Register were included in the study. Hierarchical regression was implemented to evaluate whether social communication difficulties (Autism-Spectrum Quotient social behavior factor) and restricted repetitive behaviors (Adult Routines Inventory) were predictive of anxiety (Hospital Anxiety and Depression Scale) controlling for age and sex. When considered together, restricted repetitive behaviors stood out as significant positive predictors of anxiety symptoms (lower-order restricted repetitive behaviors, β = 0.32, p  0.05). Non-social autistic traits are stronger predictors of anxiety symptoms than social traits in autistic adults. Increased attention to restricted repetitive behaviors should be given to improve current support programs for autistic adults with anxiety and to identify autistic individuals at risk.
      Citation: Autism
      PubDate: 2020-07-03T06:45:09Z
      DOI: 10.1177/1362361320934218
       
  • Factors associated with enrollment into a clinical trial of
           caregiver-implemented intervention for infants at risk for autism spectrum
           disorder
    • Authors: Jessica Bradshaw, Ashley Trumbull, Jennifer Stapel-Wax, Scott Gillespie, Nisha George, Celine Saulnier, Cheryl Klaiman, Juliann Woods, Nathan Call, Ami Klin, Amy Wetherby
      Abstract: Autism, Ahead of Print.
      Early intervention has been established as efficacious in addressing developmental delays in young children with autism spectrum disorder. Evidence that caregiver-implemented interventions are feasible and effective for young children with autism spectrum disorder is emerging, yet research suggests there are barriers to enrollment in clinical trials of these interventions for infants at risk for autism. This study identifies factors associated with enrollment in a clinical trial of a caregiver-implemented intervention for 12-month-old infants at risk for autism spectrum disorder. As part of a large longitudinal study, fifty-seven infants were deemed eligible for intervention based on several converging indicators of autism risk. Of these eligible infants, 44% declined enrollment in the intervention study. Examination of factors associated with families who declined enrollment compared to those who agreed to enroll revealed maternal full-time work status, household income, and distance to the clinic as significant predictors. In contrast, autism red flags and parental concern were not significantly associated with enrollment. These results highlight the need for more research on how parental understanding of, and willingness to act on, early social-communication delays impacts intervention study enrollment. Future research can then examine how to address these barriers to enrollment in caregiver-implemented intervention studies.Lay abstractEarly intervention helps to address developmental delays in young children with autism spectrum disorder. Yet, research suggests there are barriers to enrollment into research studies that test the effectiveness of these interventions for infants at risk. This study identifies family characteristics that were associated with agreement to enroll in a clinical trial of early intervention for 12-month-old infants at risk for autism spectrum disorder. As part of a large longitudinal study, infants were evaluated for early signs of autism spectrum disorder at 1 year of age. Of the fifty-seven infants who were showing signs of autism and deemed eligible for the early intervention trial, 44% declined enrollment. Results suggest that families were more likely to decline enrolling into the intervention study if the mother was working full time, the total household income was between US$60,000 and US$100,000, and they lived further from the clinic. In contrast, infant autism symptoms and parental concern at 12 months were not significantly associated with enrollment. These findings highlight the need for intervention studies that are more accessible to parents, for example, intervention that takes place in the home, in addition to more research on how parental understanding of, and willingness to act on, early social-communication delays impact intervention study enrollment. Future research can then examine how to address these barriers to enrollment in early intervention studies. Such findings will shed light on best practices for dissemination of early identification and intervention strategies.
      Citation: Autism
      PubDate: 2020-06-29T08:26:54Z
      DOI: 10.1177/1362361320928829
       
  • Healthcare service utilization and cost among transition-age youth with
           autism spectrum disorder and other special healthcare needs
    • Authors: Jennifer L Ames, Maria L Massolo, Meghan N Davignon, Yinge Qian, Lisa A Croen
      Abstract: Autism, Ahead of Print.
      Youth with autism spectrum disorder often have complex medical needs. Disruptions of healthcare during the transition from pediatric to adult healthcare may put youth with autism spectrum disorder at higher risk of medical emergencies and high medical costs. We conducted a study among transition-age youth (14–25 years old) receiving healthcare at Kaiser Permanente Northern California during 2014–2015. We examined the differences in healthcare utilization and costs among youth with autism spectrum disorder (n = 4123), attention deficit and hyperactivity disorder (n = 20,6015), diabetes mellitus (n = 2156), and general population controls (n = 20,615). Analyses were also stratified by age and sex. Youth with autism spectrum disorder had the highest utilization of outpatient primary care, mental health, and psychotropic medications and the lowest utilization of obstetrics/gynecology and urgent care. Costs for youth with autism spectrum disorder were higher than those for attention deficit and hyperactivity disorder and general population peers and lower than for diabetes mellitus. Utilization patterns varied by age. Transition-age youth with autism spectrum disorder generally utilize healthcare at higher rates relative to attention deficit and hyperactivity disorder and general population peers but at similar or lower rates than diabetes mellitus peers, indicating this group’s complex combination of psychiatric and medical healthcare needs. The relatively high utilization of psychiatric services and low utilization of women’s health services in transition-age youth with autism spectrum disorder may have implications for long-term health and warrants additional research.Lay abstractYouth with autism spectrum disorder often have complex medical needs. Disruptions of healthcare during the transition from pediatric to adult healthcare may put youth with autism spectrum disorder at higher risk of medical emergencies and high medical costs. To understand healthcare utilization during the transition years, we conducted a study among transition-age youth (14–25 years old) receiving healthcare at Kaiser Permanente Northern California during 2014–2015. We examined differences in healthcare utilization and costs among youth with autism spectrum disorder (n = 4123), attention deficit and hyperactivity disorder (n = 20,6015), diabetes mellitus (n = 2156), and general population controls (n = 20,615). Analyses were also stratified by age and sex. Youth with autism spectrum disorder had the highest utilization of outpatient primary care, mental health, and psychotropic medications and the lowest utilization of obstetrics/gynecology and urgent care. Costs for youth with autism spectrum disorder were higher than those for attention deficit and hyperactivity disorder and general population peers and lower than for diabetes mellitus. Healthcare utilization patterns varied by age. Transition-age youth with autism spectrum disorder generally used healthcare at higher rates relative to attention deficit and hyperactivity disorder and general population peers but at similar or lower rates than diabetes mellitus peers, indicating this group’s complex combination of psychiatric and medical healthcare needs. The relatively high utilization of psychiatric services and low utilization of women’s health services in transition-age youth with autism spectrum disorder may have implications for long-term health and warrants additional research.
      Citation: Autism
      PubDate: 2020-06-25T10:55:29Z
      DOI: 10.1177/1362361320931268
       
  • Memory enhancements from active control of learning in children with
           autism spectrum disorder
    • Authors: Valentina Fantasia, Douglas B. Markant, Giovanni Valeri, Nicholas Perri, Azzurra Ruggeri
      Abstract: Autism, Ahead of Print.
      Previous research with typically developing children and adults shows that active control of the learning experience leads to enhanced episodic memory, as compared with conditions lacking this control. The present study investigates whether similar advantages can be found in children with autism spectrum disorder. In this study, 6–12-year-old autistic children (N = 29) participated in a simple memory game on a touchscreen tablet, in which they were asked to remember 64 objects presented in four blocks of 16. In two of the blocks, children could decide the order and pacing of study (active condition), whereas in the other two blocks, they passively observed the active study decisions of a previous participant (yoked condition). We found that recognition memory was more accurate for objects studied in the active compared with the yoked condition, even after a week-long delay. The magnitude of the effect was comparable with that obtained in previous studies with typically developing children and adults, suggesting a robustness for the benefits of active learning that goes beyond what previously hypothesized, extending to special populations. We discuss how these findings may help develop pedagogical interventions that leverage the active learning approach to promote inclusive learning.Lay abstractResearch with adults and typically developing children has shown that being able to actively control their learning experience, that is, to decide what to learn, when, and at what pace, can boost learning in a variety of contexts. In particular, previous research has shown a robust advantage of active control for episodic memory as compared with conditions lacking this control. In this article, we explore the potential of active control to improve learning of 6- to 12-year-old children diagnosed with autism spectrum disorder. We presented them with a simple memory game on a touchscreen tablet, in which children were asked to recall as many of the presented objects as possible. For half of the objects, children could decide the order and pacing of study (active condition); for the other half, they passively observed the study decisions of a previous participant (yoked condition). We found that recognition memory was more accurate when children could actively control the order, pace, and frequency of the study experience, even after a week-long delay. We discuss how teachers and educators might promote active learning approaches in educational and pedagogical applications to support inclusive learning.
      Citation: Autism
      PubDate: 2020-06-24T01:06:08Z
      DOI: 10.1177/1362361320931244
       
  • A grounded theory of adoption and maintenance of physical activity among
           autistic adults
    • Authors: Andrew M Colombo-Dougovito, A Josephine Blagrave, Sean Healy
      Abstract: Autism, Ahead of Print.
      Background:Although a growing body of literature has explored the physical activity experiences from the perspective of children on the autism spectrum, the perspective of autistic adults remains largely unheard. Due to this absence of perspective, there exists limited knowledge of the appropriateness and generalizability of current models and theories of physical activity for this population.Methods:A constructivist grounded theory study was conducted to explore the experiences of adoption and maintenance of physical activity from the direct perspective of autistic adults. Autistic adults (n = 23) from the United States and the United Kingdom were recruited.Results:A total of 29 codes emerged from the coding process. These codes were formed into four broad categories: (1) individual attributes; (2) environmental factors; (3) social relationships; and (4) social experiences. The interconnectedness of these four categories was explored.Conclusions:The findings and presented model highlight the importance of building successful experiences for young children on the autism spectrum, so that they are more likely to continue physical activity into their adult life. Furthermore, findings emphasize the importance of creating noncompetitive, sensory-friendly physical activity experiences for autistic adults that offer flexibility in social engagement.Lay abstractLittle is known about how autistic adults experience physical activity. To begin to change this, we interviewed 23 autistic adults from the United State and the United Kingdom about their past and current experiences of physical activity participation. The interviewees told us about how their physical activity experiences were highly influenced by their individual strengths, the setting in which the activity took place, the presence of people to support their physical activities, and the sensory experiences they had while in physical activity. Through these interviews, we were able to create a model that represented the physical activity experiences discussed. Based on the model that emerged from this study, we recommend physical activity opportunities are made available that are noncompetitive, sensory-friendly, and that allow for participants to socialize as they prefer.
      Citation: Autism
      PubDate: 2020-06-24T01:06:00Z
      DOI: 10.1177/1362361320932444
       
  • The relationship between intolerance of uncertainty and anxiety in autism:
           A systematic literature review and meta-analysis
    • Authors: Richard Jenkinson, Elizabeth Milne, Andrew Thompson
      Abstract: Autism, Ahead of Print.
      The association between intolerance of uncertainty and anxiety has proved robust in neurotypical populations and has led to effective interventions targeting intolerance of uncertainty. The aim of this systematic review and meta-analysis was to investigate this association in autistic people, given the high prevalence of anxiety in this population and the limited effectiveness of therapies used currently to treat anxiety in autism. A protocol was published on the Prospero database (CRD42019125315), and electronic databases were searched using terms related to intolerance of uncertainty, anxiety and autism. Included in the systematic review were 12 studies, of which 10 were included in a meta-analysis. Results showed that anxiety and intolerance of uncertainty were consistently elevated in autistic participants. Examining the correlation between these two constructs, the meta-analysis revealed a large sample-weighted effect size, r = 0.62, 95% confidence interval = [0.52, 0.71], p 
      Citation: Autism
      PubDate: 2020-06-22T08:45:00Z
      DOI: 10.1177/1362361320932437
       
  • Service deserts and service oases: Utilizing geographic information
           systems to evaluate service availability for individuals with autism
           spectrum disorder
    • Authors: Amy Drahota, Richard Sadler, Christopher Hippensteel, Brooke Ingersoll, Lauren Bishop
      Abstract: Autism, Ahead of Print.
      Autism spectrum disorder and co-occurring symptoms often require lifelong services. However, access to autism spectrum disorder services is hindered by a lack of available autism spectrum disorder providers. We utilized geographic information systems methods to map autism spectrum disorder provider locations in Michigan. We hypothesized that (1) fewer providers would be located in less versus more populated areas; (2) neighborhoods with low versus high socioeconomic status would have fewer autism spectrum disorder providers; and (3) an interaction would be found between population and socioeconomic status such that neighborhoods with low socioeconomic status and high population would have few available autism spectrum disorder providers. We compiled a list of autism spectrum disorder providers in Michigan, geocoded the location of providers, and used network analysis to assess autism spectrum disorder service availability in relation to population distribution, socioeconomic disadvantage, urbanicity, and immobility. Hypotheses were supported. Individuals in rural neighborhoods had fewer available autism spectrum disorder providers than individuals in suburban and urban neighborhoods. In addition, neighborhoods with greater socioeconomic status disadvantage had fewer autism spectrum disorder providers available. Finally, statistically significant spatial disparities were found; wealthier suburbs had good provider availability while few providers were available in poorer, urban neighborhoods. Knowing autism spectrum disorder providers’ availability, and neighborhoods that are service deserts, presents the opportunity to utilize evidence-based dissemination and implementation strategies that promote increased autism spectrum disorder providers for underserved individuals.Lay abstractAutism spectrum disorder and co-occurring symptoms often require lifelong services. However, access to autism spectrum disorder services is hindered by a lack of available autism spectrum disorder providers. We utilized geographic information systems methods to map autism spectrum disorder provider locations in Michigan. We hypothesized that (1) fewer providers would be located in less versus more populated areas; (2) neighborhoods with low versus high socioeconomic status would have fewer autism spectrum disorder providers; and (3) an interaction would be found between population and socioeconomic status such that neighborhoods with low socioeconomic status and high population would have few available autism spectrum disorder providers. We compiled a list of autism spectrum disorder providers in Michigan, geocoded the location of providers, and used network analysis to assess autism spectrum disorder service availability in relation to population distribution, socioeconomic disadvantage, urbanicity, and immobility. Individuals in rural neighborhoods had fewer available autism spectrum disorder providers than individuals in suburban and urban neighborhoods. In addition, neighborhoods with greater socioeconomic status disadvantage had fewer autism spectrum disorder providers available. Finally, wealthier suburbs had good provider availability while few providers were available in poorer, urban neighborhoods. Knowing autism spectrum disorder providers’ availability, and neighborhoods that are particularly poorly serviced, presents the opportunity to utilize evidence-based dissemination and implementation strategies that promote increased autism spectrum disorder providers for underserved individuals.
      Citation: Autism
      PubDate: 2020-06-22T08:43:20Z
      DOI: 10.1177/1362361320931265
       
  • The face validity of an initial sub-typology of people with autism
           spectrum disorders detained in psychiatric hospitals
    • Authors: Magali Barnoux, Regi Alexander, Sabyasachi Bhaumik, John Devapriam, Connor Duggan, Lee Shepstone, Ekkehart Staufenberg, David Turner, Nichola Tyler, Essi Viding, Peter E Langdon
      Abstract: Autism, Ahead of Print.
      Autistic adults who have a history of committing crimes present a major problem for providers of services in terms of legal disposal options and possible interventions, and greater understanding of this group and their associated needs is required. For this reason, we aimed to investigate the face validity of a proposed sub-typology of autistic adults detained in secure psychiatric hospitals in the United Kingdom. Initially, a focus group was completed with psychiatrists, clinical psychologists, healthcare workers, family members and autistic adults who had been detained in hospital, leading to revisions of the sub-typology. Following this, a consensus rating exercise of 10 clinical vignettes based on this sub-typology with three rounds was completed with 15 psychiatrists and clinical psychologists; revisions to the vignettes to improve clarity were made following each round. The findings indicated that these subtypes possess face validity and raters were able to classify all 10 clinical case vignettes into the sub-typology, and percentage of agreement ranged from 96% to 100% for overall subtype classification. This study suggests that the further validity of the sub-typology should be investigated within a larger study, as these subtypes have the potential to directly inform the hospital care pathway such that length of stay can be minimised.Lay abstractAutistic adults who have a history of committing crimes pose challenges for the criminal justice system in terms of disposal and treatment. For this reason, we investigated the validity of a proposed sub-typology of autistic adults detained in secure psychiatric hospitals. Initially, we ran a focus group with psychiatrists, clinical psychologists, healthcare workers, family members and autistic adults who had been detained in hospital to consider a sub-typology of autistic adults who may come into contact with secure psychiatric hospitals. We asked 15 psychiatrists and clinical psychologists to rate 10 clinical vignettes based on our sub-typology with three rounds; revisions to the vignettes to improve clarity were made following each round. The findings indicated that these subtypes possess face validity and raters were able to classify all 10 clinical case vignettes into the sub-typology and percentage of agreement ranged from 96% to 100% for overall subtype classification. The findings suggested that the further validity of the sub-typology should be investigated within a larger study using a clinical sample. These subtypes may help inform treatment and care pathways within hospital.
      Citation: Autism
      PubDate: 2020-06-20T11:03:43Z
      DOI: 10.1177/1362361320929457
       
  • Person-oriented ethics for autism research: Creating best practices
           through engagement with autism and autistic communities
    • Authors: M Ariel Cascio, Jonathan A Weiss, Eric Racine
      Abstract: Autism, Ahead of Print.
      Research ethics is an important part of any study. Ethics goes beyond ethics committee approval and consent documents. It addresses broader issues of respect, inclusion, and empowerment in the everyday context of research. This article focuses on everyday aspects of research ethics for studies involving autistic participants. It draws on a review of the literature and a process of ethical deliberation involving a task force of researchers, professionals, autistic self-advocates, and parents. These methods led to the creation of suggestions for researchers. This article describes the community engagement process, briefly presents the task force suggestions, and provides more detailed discussion of select items for illustration. Suggestions are organized around five “person-oriented research ethics” guideposts: (1) individualization (e.g. providing individualized support for participants), (2) acknowledgment of lived world (e.g. acknowledging barriers to care that impact research ethics), (3) empowerment in decision-making (e.g. creating accessible consent processes that address specific communication needs), (4) respect for holistic personhood (e.g. addressing sensory and processing needs and strengths), and (5) focus on researcher–participant relationships (e.g. involving autistic people in ways other than research participants, including but not limited to via participatory research). This project highlights the value of researcher–community partnerships in discussions about research ethics.Lay abstractResearch ethics means issues that concern the welfare and wellbeing of people who take part in research. It is important in all scientific studies. Ethics helps people who do research treat people who take part in research fairly and with respect. This article is about day-to-day ethics when autistic people take part in research. We present tips for researchers who want to do this type of study.We used two methods to create these tips. First, we wanted to know what other people said about this topic. We used a literature review to find out. Second, we wanted to know what autistic people, parents, and professionals thought, and had a working group meet to discuss it. The working group provided advice that researchers could consider around day-to-day ethics in research. This article talks about these methods and advice. The advice fits into five big groups:Tailor the research process for the unique needs of each person.Think about the world in which people who take part in research live.Make it easier for people to make their own choices.Value what people who take part in research have to share and consider their needs and strengths.Think about how researchers and people who take part in research work together.This project shows why it is useful for researchers and communities to talk about research ethics together.
      Citation: Autism
      PubDate: 2020-06-18T12:02:12Z
      DOI: 10.1177/1362361320918763
       
  • The health of college students on the autism spectrum as compared to their
           neurotypical peers
    • Authors: Jane D McLeod, Amelia Hawbaker, Emily Meanwell
      Abstract: Autism, Ahead of Print.
      Data from an online survey of undergraduate students at 14 colleges and universities were used to estimate the association of autism with six physical and mental health outcomes, accounting for comorbidity with other disabilities (learning disability, attention deficit hyperactivity disorder, sensory impairment, mobility impairment, mental health disorder, or other disabilities). Autism status was determined based on registration for disability accommodations based on autism and/or self-reports of an autism diagnosis. Health outcomes included self-rated physical health, self-rated mental health, depressive symptoms, symptoms of anxiety, sleep deprivation, and binge drinking. Students with autism reported poorer self-rated physical and mental health, more depressive symptoms, and more symptoms of anxiety than other students, even in the presence of controls for other disabilities. Students with autism also reported a lower likelihood of sleep deprivation and binge drinking than other students. Our results extend previous research on the health correlates of autism by considering additional indicators of health and by incorporating a direct comparison to neurotypical students. They encourage consideration of how health services for students with autism can be improved, especially for mental health problems, and argue for integrated support services that address the full constellation of physical and mental health challenges that students on the spectrum experience.Lay abstractStudies have shown that children and older adults on the autism spectrum experience more physical and mental health problems than their neurotypical peers. Less is known about the physical and mental health of college students on the spectrum. Studying college students is important because young adults on the spectrum are enrolling in college at increasing rates and because health problems can be a barrier to succeeding in college. We collected data from 2820 students at 14 colleges and universities using an online survey, some of whom had registered for accommodations based on autism and others of whom had not. We used the data to compare the physical and mental health of students on the spectrum to their neurotypical peers. Because students with autism often report other disabilities that also affect health, we accounted for whether they experienced a learning disability, attention deficit hyperactivity disorder, sensory impairment, mobility impairment, mental health disorder, or any other disabilities. We assessed health using self-reports of how healthy they were physically and mentally, and reports of depressive symptoms, symptoms of anxiety, sleep deprivation, and binge drinking. We found that students with autism reported poorer physical and mental health, more depressive symptoms, and more symptoms of anxiety even after taking into account other disabilities they may have experienced. They were also less likely to report sleep deprivation and binge drinking. Our results argue for developing specialized services to address the physical and mental health challenges of college students on the spectrum.
      Citation: Autism
      PubDate: 2020-06-18T12:00:52Z
      DOI: 10.1177/1362361320926070
       
  • Transitioning youth with autism spectrum disorders and other special
           health care needs into adult primary care: A provider survey
    • Authors: Jennifer L Ames, Maria L Massolo, Meghan N Davignon, Yinge Qian, Hilda J Cerros, Lisa A Croen
      Abstract: Autism, Ahead of Print.
      Health care continuity during the transition from pediatric to adult care is critical to helping individuals with autism spectrum disorders manage complex medical and psychiatric co-morbidities that start in childhood and evolve with age. We conducted a brief online survey of pediatric and adult providers at Kaiser Permanente Northern California, a large integrated health care delivery system, to assess departmental policies and personal approaches to transitioning patients with special health care needs, including autism spectrum disorders. A total of 354 pediatric (43% response rate) and 715 adult providers (30% response rate) completed the survey. A large majority of departments did not have transition policies in place. Many providers in both primary care and mental health did not provide transition resources, review legal changes, use standardized assessment tools, or communicate with the next/previous provider. Transition planning was usually delayed until age 17 or later. Most providers did not have consistent approaches to the transition of care for youth with special health care needs and may be inadequately prepared to handle the process for patients with autism spectrum disorders. As the population of transition-age youth with autism spectrum disorders continues to grow, there is urgent need to understand how to best implement transition policies that promote early communication between providers and families and track outcomes among transitioning patients with special health care needs.Lay AbstractThe transition from pediatric to adult care is a critical inflection point for the long-term health of youth with autism spectrum disorders and other special health care needs. However, for many patients, their caregivers, and providers, the transition lacks coordination. This survey study demonstrates that pediatric and adult providers struggle to implement many components of transition best practices for youth with autism and other chronic conditions, highlighting the urgent need for enhanced medical coordination and additional transition training and resources.
      Citation: Autism
      PubDate: 2020-06-18T12:00:12Z
      DOI: 10.1177/1362361320926318
       
  • Measuring change in facial emotion recognition in individuals with autism
           spectrum disorder: A systematic review
    • Authors: Andrea Trubanova Wieckowski, L Taylor Flynn, J Anthony Richey, Denis Gracanin, Susan W White
      Abstract: Autism, Ahead of Print.
      Children and adults with autism spectrum disorder are less accurate in facial emotion recognition, which is thought to contribute to impairment in social functioning. Although many interventions have been developed to improve facial emotion recognition, there is no consensus on how to best measure facial emotion recognition in people with autism spectrum disorder. This lack of agreement has led to wide variability in how facial emotion recognition is measured and, subsequently, inconsistent findings related to impact of intervention targeting facial emotion recognition impairment. The purpose of this review is to synthesize the extant research on measurement of facial emotion recognition in the context of treatment. We conducted an electronic database search to identify relevant, peer-reviewed articles published between January 1998 and November 2019 to identify studies evaluating change in facial emotion recognition in autism spectrum disorder. Sixty-five studies met inclusion criteria, utilizing a total of 36 different assessment measures for facial emotion recognition in individuals with autism spectrum disorder. Only six of the measures were used in multiple studies conducted by different investigative teams. The outcomes of the studies are reported and summarized with the goal of informing future research.Lay AbstractChildren and adults with autism spectrum disorder show difficulty recognizing facial emotions in others, which makes social interaction challenging. While there are many treatments developed to improve facial emotion recognition, there is no agreement on the best way to measure such abilities in individuals with autism spectrum disorder. The purpose of this review is to examine studies that were published between January 1998 and November 2019 and have measured change in facial emotion recognition to evaluate the effectiveness of different treatments. Our search yielded 65 studies, and within these studies, 36 different measures were used to evaluate facial emotion recognition in individuals with autism spectrum disorder. Only six of these measures, however, were used in different studies and by different investigators. In this review, we summarize the different measures and outcomes of the studies, in order to identify promising assessment tools and inform future research.
      Citation: Autism
      PubDate: 2020-06-18T11:58:32Z
      DOI: 10.1177/1362361320925334
       
  • Inclusion, acceptance, shame and isolation: Attitudes to autism in
           Aboriginal and Torres Strait Islander communities in Australia
    • Authors: Rozanna Lilley, Mikala Sedgwick, Elizabeth Pellicano
      Abstract: Autism, Ahead of Print.
      This is the first qualitative study to investigate experiences of, and attitudes towards, autism in Aboriginal and Torres Strait Islander communities in Australia. Understanding the complexity of these attitudes is crucial because they influence the recognition of autism as well as the ways in which individuals and families are supported. Twelve families with 16 autistic children living in diverse regions of Australia participated in a semi-structured interview. The interviews were thematically analysed using the six-step process outlined by Braun and Clarke. The analysis identified a marked tension in participants’ accounts. On the one hand, participants described negative feelings, including shame associated with atypical behaviour, stigmatisation and the social isolation of families, which potentially point towards under-identification or misdiagnosis. On the other hand, they also described inclusive attitudes, including ‘looking after each other’ and a growing acceptance of autistic differences. This positive model of support for and acceptance of autistic children and their families may well contribute to good outcomes for autistic children and adults in Aboriginal and Torres Strait Islander communities. More research is needed on cross-cultural and pluralistic understandings of autism, parental perceptions and family experience.Lay AbstractThere has been almost no research done about autism in Aboriginal and Torres Strait Islander communities in Australia. This article is the first detailed report on attitudes to autism in these communities. Understanding attitudes to autism is important because they influence whether or not children are diagnosed, as well as the kinds of support autistic people are getting. Twelve families who lived in different parts of Australia were interviewed. They told us that there is a range of attitudes to autism in Aboriginal and Torres Strait Islander communities. These include negative ideas such as sometimes feeling shame associated with children’s unusual behaviour, as well as feeling stigmatised and socially isolated. The negative attitudes reported may mean that some children are missing out on an autism diagnosis or being wrongly diagnosed with a different condition in these communities. They also included positive ideas such as the importance of looking after each other and of accepting autistic people and their differences. We can all learn from these positive attitudes. It will be interesting to know in future projects whether these accepting attitudes lead to better outcomes for autistic children and adults in these communities. This research helps us to understand how autism is thought about in different cultures and how attitudes impact diagnosis and support. It will also help people to plan supports that reflect what Aboriginal and Torres Strait Islander families actually want and need.
      Citation: Autism
      PubDate: 2020-06-12T10:24:37Z
      DOI: 10.1177/1362361320928830
       
  • Atypical visual-auditory predictive coding in autism spectrum disorder:
           Electrophysiological evidence from stimulus omissions
    • Authors: Thijs van Laarhoven, Jeroen J Stekelenburg, Mart LJM Eussen, Jean Vroomen
      Abstract: Autism, Ahead of Print.
      Autism spectrum disorder is a pervasive neurodevelopmental disorder that has been linked to a range of perceptual processing alterations, including hypo- and hyperresponsiveness to sensory stimulation. A recently proposed theory that attempts to account for these symptoms, states that autistic individuals have a decreased ability to anticipate upcoming sensory stimulation due to overly precise internal prediction models. Here, we tested this hypothesis by comparing the electrophysiological markers of prediction errors in auditory prediction by vision between a group of autistic individuals and a group of age-matched individuals with typical development. Between-group differences in prediction error signaling were assessed by comparing event-related potentials evoked by unexpected auditory omissions in a sequence of audiovisual recordings of a handclap in which the visual motion reliably predicted the onset and content of the sound. Unexpected auditory omissions induced an increased early negative omission response in the autism spectrum disorder group, indicating that violations of the prediction model produced larger prediction errors in the autism spectrum disorder group compared to the typical development group. The current results show that autistic individuals have alterations in visual-auditory predictive coding, and support the notion of impaired predictive coding as a core deficit underlying atypical sensory perception in autism spectrum disorder.Lay abstractMany autistic individuals experience difficulties in processing sensory information (e.g. increased sensitivity to sound). Here we show that these difficulties may be related to an inability to process unexpected sensory stimulation. In this study, 29 older adolescents and young adults with autism and 29 age-matched individuals with typical development participated in an electroencephalography study. The electroencephalography study measured the participants’ brain activity during unexpected silences in a sequence of videos of a handclap. The results showed that the brain activity of autistic individuals during these silences was increased compared to individuals with typical development. This increased activity indicates that autistic individuals may have difficulties in processing unexpected incoming sensory information, and might explain why autistic individuals are often overwhelmed by sensory stimulation. Our findings contribute to a better understanding of the neural mechanisms underlying the different sensory perception experienced by autistic individuals.
      Citation: Autism
      PubDate: 2020-06-10T10:57:31Z
      DOI: 10.1177/1362361320926061
       
  • Twitter usage about autism spectrum disorder
    • Authors: Monica L Bellon-Harn, Jianyuan Ni, Vinaya Manchaiah
      Abstract: Autism, Ahead of Print.
      Stakeholders within autism spectrum disorder communities use Twitter for specific purposes. The goal of this study was to characterize patterns and themes of tweet content and sentiment and intercommunications between users sending and retweeting content to their respective user networks. The study used cross-sectional analysis of data generated from Twitter. Twitter content, sentiment, users, and community networks were examined from a sample of tweets with the highest Twitter reach and the lowest Twitter reach. Results indicate that Twitter content from both samples was primarily related to empowerment and support. Differences between the number of tweets originating from an individual in the lowest reach sample (i.e. 41%) as compared to the individuals in the highest reach sample (i.e. 18%) were noted. The number of users belonging to an advocacy subcommunity was substantially larger than a clinical and research subcommunity. Results provide insight into the presuppositions of individuals with autism spectrum disorder, their families and significant others, and other stakeholders.
      Citation: Autism
      PubDate: 2020-06-07T06:34:37Z
      DOI: 10.1177/1362361320923173
       
  • Attributions, causal beliefs, and help-seeking behavior of parents of
           children with autism spectrum disorder and sleep problems
    • Authors: Laurie McLay, Sarah G Hansen, Amarie Carnett, Karyn G France, Neville M Blampied
      Abstract: Autism, Ahead of Print.
      Sleep problems in children with autism spectrum disorder are prevalent and persistent but also treatable. Little is known about how and why parents of such children seek help for sleep disturbance. Via an online survey (n = 244 respondents), we gathered information about parents’ attributions about children’s sleep problems and beliefs about causes and on sources of information about, and their decisions regarding, help-seeking. Eighty-two percent of parents reported seeking some kind of help for their child’s sleep disturbance, and the average parent had tried six different treatment strategies, most commonly medical. Alignment of parents’ treatment choices with empirical evidence about treatment efficacy was poor, but belief in effectiveness was closely related to frequency of use of a treatment. In a Principal Components Analysis, parental attributions loaded on two factors: one which suggests the sleep problems are viewed as intrinsic to autism and stable (factor one) and the other as located within the child, stable, and treatment resistant (factor two). These findings have important implications for parental education and clinical practice in the treatment of sleep problems in children with autism spectrum disorder.Lay abstractSleep problems are commonly reported among parents of children with autism spectrum disorder (ASD). Without effective treatment, such problems are unlikely to resolve. To date, we know very little about how and why parents of children with ASD seek help for sleep disturbance. Via an online survey, we gathered information about how parents make sense of their children’s sleep problems, beliefs about their causes, sources of information, and help-seeking behavior. The analysis of responses from 244 parents revealed that parents commonly view sleep problems (a) as a consequence of their child’s ASD, and unlikely to change over time (stable), and (b) as located within the child (intrinsic), stable over time, and difficult to treat. Despite this, parents also rated sleep problems as being important to treat. Eighty-two percent of parents surveyed reported seeking some kind of help for their child’s sleep disturbance, and the average parent had tried six different treatment strategies, most commonly medical approaches (e.g. melatonin). The alignment between parents’ treatment choices and those strategies that are supported by research was poor, but belief in the effectiveness of treatments was closely related to how often the treatment was used. These findings have important implications for parental education and clinical practice in the treatment of sleep problems in children with ASD.
      Citation: Autism
      PubDate: 2020-06-07T06:31:57Z
      DOI: 10.1177/1362361320924216
       
  • Tell me where it is: Selective difficulties in spatial language on the
           autism spectrum
    • Authors: Agata Bochynska, Kenny R. Coventry, Valentin Vulchanov, Mila Vulchanova
      Abstract: Autism, Ahead of Print.
      Proficient use of spatial terms such as under, to the left of or in front of is a central component of daily communication and is important in the development of language and spatial cognition. Here we examine spatial language abilities in intellectually high-functioning individuals with autism spectrum disorder, an area previously overlooked in autism research. Twenty-five high-functioning individuals with ASD and 25 typically developing controls, matched for chronological age and cognitive abilities, completed a novel battery tapping a broad range of spatial language abilities. We report selective difficulties in the production of spatial terms and spatial description recall in high-functioning ASD. Overall verbal abilities did not account for the observed group differences. Crucially, however, the intensity of autism spectrum traits predicted individual performance in both spatial language production and spatial description recall. We discuss the theoretical implications of these findings and explore their significance for both clinical practice and intervention.Lay abstractHow we think and talk about space is an essential ability, necessary for understanding the world around us. We recruit spatial thinking every day when finding our way or using tools but also in more advanced tasks, such as reading complex graphs or maps. We do so also in daily communication when we use spatial language, terms such as under, over, to the left of or in front of, and when we give instructions. Spatial terms appear in children’s early vocabularies and continue to develop until late childhood or even early adolescence. Because spatial language develops over many years, some spatial terms are mastered very early, whereas others take longer to acquire. In the current set of studies, we tested how intellectually high-functioning children and adults on the autism spectrum use and understand these early- and late-acquired spatial terms in comparison to typically developing age-matched individuals. We found that children and adults on the autism spectrum experience difficulties with the use of some spatial terms (e.g. near and far or out of and down off) but not with others, which are acquired early (e.g. in and on or over and under). We also found that remembering spatial terms from short stories was more difficult for the individuals on the autism spectrum compared with typically developing individuals. These results reveal difficulties that can profoundly affect everyday communication of children and adults on the autism spectrum but also open new directions of research on language development in autism spectrum disorders.
      Citation: Autism
      PubDate: 2020-06-05T06:31:23Z
      DOI: 10.1177/1362361320921040
       
  • “Chasing hope”: Parents’ perspectives on complementary and
           alternative interventions for children with autism in Kazakhstan
    • Authors: Sofiya An, Akbota Kanderzhanova, Assel Akhmetova, Faye Foster, Chee Kai Chan
      Abstract: Autism, Ahead of Print.
      In post-Soviet Kazakhstan, the system of care for children with autism has been transforming over the past three decades. There is little known about the use of complementary and alternative medicine by families raising autistic children in the post-Soviet region. An exploratory qualitative focus group design was employed to study parents’ experiences of using complementary and alternative medicine focusing on the perceived factors driving the utilization of complementary and alternative medicine by families of autistic children and the availability of complementary and alternative medicine. Six focus groups were conducted in five cities of diverse geographical locations in Kazakhstan. Data were analyzed using a framework analysis. Two overarching themes and subthemes are developed. The first “unmet needs” relates to predisposing factors that motivate parents to complementary and alternative medicine uptake and the second “chasing hope” relates to enabling factors that facilitate parents’ uptake of complementary and alternative medicines. In summary, parents of autism spectrum disorder children in Kazakhstan face multiple challenges when seeking treatment for their children’s condition and implement whatever complementary and alternative medicine interventions available. A decision to use, and the choice of intervention, mainly comes from perceptions of having no other choice rather than from rational decisions based on efficacy of complementary and alternative medicines. This study provides the first empirical conceptualization of parents’ motives for choosing complementary and alternative medicine in Kazakhstan.Lay abstractThe article reports the findings of a qualitative research study on how and why parents of autistic children in Kazakhstan utilize complementary and alternative medicine. We found that parents turn to complementary and alternative medicine because of the lack of professional care options available to them and in pursuit for hope and opportunities for their children with ASD.
      Citation: Autism
      PubDate: 2020-06-05T06:28:22Z
      DOI: 10.1177/1362361320923494
       
  • Atypical social communication is associated with positive initial
           impressions among peers with autism spectrum disorder
    • Authors: Jessica E Granieri, Morgan L McNair, Alan H Gerber, Rebecca F Reifler, Matthew D Lerner
      Abstract: Autism, Ahead of Print.
      Atypical social communication is a key indicator of autism spectrum disorder and has long been presumed to interfere with friendship formation and first impressions among typically developing youth. However, emerging literature suggests that such atypicalities may function differently among groups of peers with autism spectrum disorder. The current study aimed to investigate the relationship between atypical social communication patterns and first impression sociometric ratings by peers in groups of youth with autism spectrum disorder. Findings suggest that, contrary to typically developing individuals, several forms of atypical communication among youth with autism spectrum disorder are associated with more positive first impressions by others with autism spectrum disorder. This suggests that interventions designed to increase friendships among youth with autism spectrum disorder may benefit from reframing their approach to addressing atypical social communication.
      Citation: Autism
      PubDate: 2020-06-05T06:23:23Z
      DOI: 10.1177/1362361320924906
       
  • Prediction of social behavior in autism spectrum disorders: Explicit
           versus implicit social cognition
    • Authors: Cara M Keifer, Amori Yee Mikami, James P Morris, Erin J Libsack, Matthew D Lerner
      Abstract: Autism, Ahead of Print.
      Deficient social communication and interaction behaviors are a hallmark feature of individuals with autism spectrum disorder. These social communication and interaction deficits potentially stem from problems with explicit social cognition (i.e. processes that are controlled and largely conscious) as well as with implicit social cognition (i.e. processes that are fast, spontaneous, and primarily unconscious). This study aimed to investigate the relative contributions of implicit and explicit social cognition factors as predictors of multi-informant measures of social communication and interaction behaviors in a sample of 34 youth with clinical diagnoses of autism spectrum disorder. Behavioral, cognitive, and electrophysiological indices of implicit and explicit social cognition were entered into partial least squares regression models designed to identify latent factors that optimally predict parent-report, observer-coded, and clinician-rated social communication, and interaction outcomes. Results indicated that while both implicit and explicit social cognition factors optimally predicted outcomes, implicit social cognition factors were relatively more predictive. Findings have important implications for the conceptualization and measurement of social functioning as well as the development of targeted social interventions in autism spectrum disorder populations.Lay abstractDifficulties with social communication and interaction are a hallmark feature of autism spectrum disorder. These difficulties may be the result of problems with explicit social cognition (effortful and largely conscious processes) such as learning and recalling social norms or rules. Alternatively, social deficits may stem from problems with implicit social cognition (rapid and largely unconscious processes) such as the efficient integration of social information. The goal of this study was to determine how problems in explicit and implicit social cognition relate to social behavior in 34 youth with autism spectrum disorder. We measured aspects of implicit and explicit social cognition abilities in the laboratory using behavioral, cognitive, and brain (electrophysiological) measures. We then used those measures to predict “real-world” social behavior as reported by parents, clinicians, and independent observers. Results showed that overall better aspects of implicit and explicit social cognition predicted more competent social behavior. In addition, the ability to fluidly integrate social information (implicit social cognition) was more frequently related to competent social behavior that merely knowing what to do in social situations (explicit social cognition). These findings may help with the development of interventions focusing on improving social deficits.
      Citation: Autism
      PubDate: 2020-06-02T09:55:54Z
      DOI: 10.1177/1362361320922058
       
  • Dropping out and moving on: A qualitative study of autistic people’s
           experiences of university
    • Authors: Eilidh Cage, Jack Howes
      Abstract: Autism, Ahead of Print.
      Autistic people are at high risk of dropping out of university, but little research has examined this issue. Fourteen autistic people participated in semi-structured interviews examining their experiences at university and the reasons they had dropped out. Thematic analysis identified patterns in participants’ responses. Themes were categorised as systemic issues, challenges within university or life after dropping out. Systemic issues centred around accessing diagnosis, autism understanding, mental health and outsider status. Challenges at university included culture shock, becoming disengaged, lack of proactive support and perceived inevitability of dropping out. Finally, life after dropping out was characterised by processing of trauma and shame, and realisation of doing ‘what’s right for you’. Together, these themes suggest that many improvements could be made at universities, such as more proactive support and creating more accessible environments. Societal-level change is also needed to improve educational opportunities for autistic people.Lay abstractMany autistic people now go to university, but many of them also drop out of their studies. In fact, it is believed that autistic people are at higher risk of dropping out, but little research has been done to understand why this is happening. This research used interviews to take an in-depth look at 14 autistic people’s experiences of dropping out of university. All the things the participants talked about were examined closely by the researchers who identified common themes in what the participants discussed. The first set of themes captured some overarching issues faced by autistic people, such as difficulties with getting diagnosed, a lack of autism understanding, mental health challenges and feeling like an outsider. The next themes were organised within challenges faced at university, including a feeling of culture shock, becoming disengaged from one’s studies, a lack of proactive support from their university and a feeling that dropping out became inevitable. Finally, there were themes about life after dropping out, which involved a sense that the experience at university had been traumatic and shameful, but they believed people had to do what is right for them. All of these themes suggest that universities need to be better at supporting autistic people when they first come to university, and that they should actively offer clear support throughout and try and make the university environment more accessible for everyone, to ensure more autistic people have a positive university experience.
      Citation: Autism
      PubDate: 2020-06-01T06:39:15Z
      DOI: 10.1177/1362361320918750
       
  • Reliability and validity of the Pediatric Anxiety Rating Scale modified
           for autism spectrum disorder
    • Authors: Brenna B Maddox, Luc Lecavalier, Judith S Miller, Jill Pritchett, Jill Hollway, Susan W White, Scott Gillespie, Andrea N Evans, Robert T Schultz, John D Herrington, Karen Bearss, Lawrence Scahill
      Abstract: Autism, Ahead of Print.
      Anxiety often co-occurs with autism spectrum disorder, yet there are few valid and reliable instruments for measuring anxiety in youth with autism spectrum disorder. This article describes the modification of the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder and systematic psychometric evaluation in a well-characterized sample of 116 youth (age: 5–17 years) with autism spectrum disorder and a range of anxiety symptoms. The clinician-administered-Pediatric Anxiety Rating Scale for youth with autism spectrum disorder was modified with input from parents of children with autism spectrum disorder and an expert panel. Unlike many other anxiety measures, the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder is more focused on behavioral manifestations of anxiety versus verbal expression. Results provide preliminary support for the psychometric properties of the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder. The internal consistency of the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder was 0.90. The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder was strongly correlated with parent-report anxiety measures (rs = 0.62–0.68), supporting convergent validity. In support of divergent validity, correlations between the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder and parent ratings of autism spectrum disorder symptoms, social withdrawal, stereotypy, hyperactivity, inappropriate speech, and repetitive behaviors were low (rs = 0.13–0.32). The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder was moderately correlated with parent-reported irritability (r = 0.52). The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder showed good test-retest reliability (intraclass correlation coefficient = 0.75–0.82) and inter-rater reliability (ICCs = 0.70–0.92). Overall, results support the use of the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder for assessing anxiety in youth with autism spectrum disorder.Lay AbstractMany youth with autism spectrum disorder have anxiety, but it can be difficult to assess anxiety with existing measures. We modified the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder and tested the new measure in a group of 116 youth (age: 5–17 years) with autism spectrum disorder. The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder is an interview that a clinician usually completes with the child and parent together. We modified the interview questions and scoring instructions based on feedback from parents of children with autism spectrum disorder and from a panel of experts in autism spectrum disorder and anxiety. Unlike many other anxiety measures, the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder relies less on a child’s verbal expression of anxiety and more on signs that a parent can easily observe. Training clinicians to administer and score the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder was uncomplicated, and raters showed excellent agreement on video-recorded interviews. Youth who were not currently in treatment for anxiety had stable Pediatric Anxiety Rating Scale for youth with autism spectrum disorder scores with repeat measurement over a 1-month period. The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder is a useful clinician-rated measure of anxiety in youth with autism spectrum disorder and fills a gap for assessing anxiety in this population.
      Citation: Autism
      PubDate: 2020-06-01T06:37:15Z
      DOI: 10.1177/1362361320922682
       
  • Examining the relationship between parent physical activity support
           behaviour and physical activity among children and youth with autism
           spectrum disorder
    • Authors: Denver M Brown, Kelly P Arbour-Nicitopoulos, Kathleen A Martin Ginis, Amy E Latimer-Cheung, Rebecca L Bassett-Gunter
      Abstract: Autism, Ahead of Print.
      Children and youth with autism spectrum disorder engage in less physical activity than neurotypically developing peers. This may be due to factors associated with autism spectrum disorder at the individual and environmental level that can make physical activity participation more challenging. Parent support is a known determinant of physical activity among children and youth; however, limited research has explored the relationship between parent physical activity support behaviour and child physical activity behaviour within the autism spectrum disorder population. Guided by the multi-process action control framework, this study examined the relationship between parent physical activity support behaviour and physical activity levels of children and youth with autism spectrum disorder. Parents (n = 201) of school-aged children and youth with autism spectrum disorder completed measures of parent physical activity support (intentions, behavioural regulation, support behaviour), as well as their child’s physical activity behaviour. Congruent with the multi-process action control model, intentions to provide physical activity support were significantly associated with parent physical activity support behaviour. Behavioural regulation of physical activity support mediated this relationship, which in turn significantly predicted child physical activity behaviour. Findings suggest parents play an instrumental role in the physical activity behaviour of children and youth with autism spectrum disorder. Family-level interventions targeting parents’ behavioural regulation strategies to provide physical activity support may be an effective strategy to increase physical activity in children and youth with autism spectrum disorder.Lay abstractChildren and youth with autism spectrum disorder engage in less physical activity than neurotypically developing peers. This may be due to factors associated with autism spectrum disorder at the individual and environmental level that can make physical activity participation more challenging. Parent support is a known determinant of physical activity among children and youth; however, limited research has explored the relationship between parent physical activity support behaviour and child physical activity behaviour within the autism spectrum disorder population. The purpose of this study was to examine the relationship between parent physical activity support behaviour and physical activity levels of children and youth with autism spectrum disorder. Parents (n = 201) of school-aged children and youth with autism spectrum disorder completed measures of parent physical activity support (intentions, behavioural regulation, support behaviour), as well as their child’s physical activity behaviour. The results showed that parent’s intentions to provide physical activity support were associated with their support behaviour for their child’s physical activity (e.g. encouragement, being active together). Parents who followed through with their intentions to provide support reported using behavioural regulation strategies such as goal setting and planning more often. Finally, the results showed parent physical activity support behaviour was positively associated with child physical activity behaviour. Findings suggest parents play an instrumental role in the physical activity behaviour of children and youth with autism spectrum disorder. Family-level interventions targeting parents’ behavioural regulation strategies to provide physical activity support may be an effective strategy to increase physical activity in children and youth with autism spectrum disorder.
      Citation: Autism
      PubDate: 2020-06-01T06:35:32Z
      DOI: 10.1177/1362361320922658
       
  • Making sense of the perceptual capacities in autistic and non-autistic
           adults
    • Authors: Jana Brinkert, Anna Remington
      Abstract: Autism, Ahead of Print.
      Recent studies highlighted that autistic individuals show increased perceptual capacity – the ability to process more information at any one time. This study examined whether there is a link between this increased perceptual capacity and the sensory hypersensitivity that many autistic people experience on a daily basis. In total, 38 autistic and 66 non-autistic adults filled in sensory questionnaires and performed an auditory load task, which assessed perceptual capacity. Results showed that higher levels of auditory perceptual capacity were correlated with higher levels of sensory sensitivities. We identified two clusters in the sample: one group of individuals with hyposensitivity and a decreased perceptual capacity (n = 42) and a cluster with an increased perceptual capacity and hypersensitivity (n = 47). Understanding this relationship may offer the opportunity to develop more effective techniques to ameliorate the often debilitating consequences of sensory hypersensitivity and over-arousal. Interestingly, this association between perceptual capacity and sensory sensitivities was seen for both groups; no significant association was found between perceptual capacity and level of autistic traits. As such, the findings may extend to other conditions with sensory atypicalities, such as attention-deficit hyperactivity disorder or Williams syndrome. The practical implications of the results for many aspects of daily life, education and employment are discussed.Lay abstractPerceptual capacity refers to the amount of information that we can pay attention to at any one time. Research has shown that autistic people have a higher perceptual capacity, which means they can take in more information than non-autistic people can. This can be useful in certain situations, for instance, hearing approaching cars or noticing small details. However, in other situations, a higher perceptual capacity may result in more distraction. This study looked at whether having this increased perceptual capacity is linked to being very sensitive to sensory information (lights, sounds, touch, taste and smell) – something that many autistic people experience on a daily basis. Being very sensitive to these things can make it hard to interact with the world around us, so it is important to know more about what causes the sensitivity. To explore this, 38 autistic and 66 non-autistic adults completed a computer task that measured perceptual capacity and filled in a questionnaire about how sensitive they were to sensory information. We found that perceptual capacity was related to sensory symptoms for both autistic and non-autistic participants; people who had a larger perceptual capacity showed more sensitivity, while people who had a lower perceptual capacity showed reduced sensory sensitivity. This information can hopefully be used to improve the way in which we can support people who experience unpleasant sensory sensitivity.
      Citation: Autism
      PubDate: 2020-06-01T06:33:35Z
      DOI: 10.1177/1362361320922640
       
  • Head circumference trends in autism between 0 and 100 months
    • Authors: Joel Crucitti, Christian Hyde, Peter G Enticott, Mark A Stokes
      Abstract: Autism, Ahead of Print.
      Meta-analyses of head circumference in autistic individuals exist; however, simple meta-analytic approaches are limited. Consequently, we gathered head circumference raw data of autistic (N = 2381) and typically developing participants (N = 994) by re-analysing the data from previously published studies together. The present study found no mean difference between head circumference of autistic and typically developing individuals, although simple effect analyses revealed smaller mean head circumference in autistic than typically developing females aged 12–17 months. However, compared to controls, the frequency of extreme head circumference in autistic males was greater at birth and between 60 and 100 months. In addition, the frequency of extremely small head circumference between 6 and 11 months, and extremely large head circumference between 12 and 17 months, was greater in autistic than typically developing males. For autistic females, compared to controls, extreme head circumference was more frequent between 36 and 59 months and less frequent at birth. We conclude that it is imperative to consider the effects of age and sex when investigating the relationship between autism diagnosis and head circumference. This variance was more effectively described via the approach of the present study than previous meta-analytic approaches.Lay abstractSummaries of studies that have measured head size in those with autism, known as meta-analyses, currently exist. However, this approach does not adequately explain extreme cases (such as those with extremely small, or extremely large, head size). Because of this, we obtained all available published data measuring head size (12 studies). The data from each study were then combined to make a larger dataset. We found that females with autism aged 12–17 months had, on average, smaller head sizes. Otherwise, average head size was not atypical in autism. However, we found that males with autism were more likely to have extreme head sizes at birth and between 60 and 100 months, a small head between 6 and 11 months, and a large head between 12 and 17 months. Females with autism were more likely to have extreme head sizes between 36 and 59 months and were less likely at birth. Our approach was able to measure the influence of age and biological sex on head size in autism, as well as the frequency of extreme cases of head size in autism. These results add to what we already know about head size in autism.
      Citation: Autism
      PubDate: 2020-06-01T06:31:15Z
      DOI: 10.1177/1362361320921037
       
  • Impact of a digital Modified Checklist for Autism in Toddlers–Revised on
           likelihood and age of autism diagnosis and referral for developmental
           evaluation
    • Authors: Samantha Major, Kathleen Campbell, Steven Espinosa, Jeffrey P Baker, Kimberly LH Carpenter, Guillermo Sapiro, Saritha Vermeer, Geraldine Dawson
      Abstract: Autism, Ahead of Print.
      The present study is a single-site quality improvement project within pediatric primary care involving the implementation of a digital version of the Modified Checklist for Autism in Toddlers–Revised. We evaluated the impact of the digital screener on the likelihood of physician referral for a developmental evaluation or autism diagnosis, and the age of the patients at the time of the event. Patients were children 16–30  months old seen for 18 and 24 months’ well-child visits (1279 encounters), who screened positive for risk for autism spectrum disorder on the Modified Checklist for Autism in Toddlers–Revised without a previously documented autism spectrum disorder diagnosis. Comparisons were made between a cohort of children screened with the paper and pencil version of the Modified Checklist for Autism in Toddlers–Revised before the digital version was implemented and a cohort of children screened during the intervention period. Patients were followed until 48 months and referrals were obtained from electronic health records. Patients screened with the digital Modified Checklist for Autism in Toddlers–Revised were five times more likely to be referred for a developmental evaluation. The automatic scoring, risk assessment, and referral decision support features helped to improve screening outcomes. In this clinic, process change to a digital screening method with automatic guidance for next steps improved adherence to evidence-based clinical care.Lay abstractThis was a project in primary care for young children (1–2 years old). We tested a parent questionnaire on a tablet. This tablet questionnaire asked questions to see whether the child may have autism. We compared the paper and pencil version of the questionnaire to the tablet questionnaire. We read the medical charts for the children until they were 4 years old to see whether they ended up having autism. We found that doctors were more likely to recommend an autism evaluation when a parent used the tablet questionnaire. We think that the tablet’s automatic scoring feature helped the doctors. We also think that the doctors benefited from the advice the tablet gave them.
      Citation: Autism
      PubDate: 2020-05-29T06:25:15Z
      DOI: 10.1177/1362361320916656
       
  • Implementing early intensive behavioral intervention in community settings
    • Authors: Joshua B Plavnick, M Y Savana Bak, Sarah M Avendaño, Ana D Dueñas, Matthew T Brodhead, Emma S Sipila
      Abstract: Autism, Ahead of Print.
      Although research shows early intensive behavioral intervention is efficacious when delivered in university or private intervention centers, little is known about effectiveness or feasibility of disseminating early intensive behavioral intervention to larger communities. The Michigan State University Early Learning Institute was developed to address gaps in distribution of early intensive behavioral intervention to community settings, with an emphasis of serving children and families on Medicaid. This short report describes the Early Learning Institute’s approach and preliminary utilization data among Medicaid families. Results suggest the model has potential for dissemination within community settings and promote utilization among Medicaid children.Lay abstractAlthough research shows early intensive behavioral intervention can be very beneficial for children with autism spectrum disorder when delivered in university or private intervention centers, little is known about the best way to provide early intensive behavioral intervention within the broader community. The Michigan State University Early Learning Institute was developed to address challenges with providing early intensive behavioral intervention in community settings, with an emphasis on serving children and families on Medicaid. This short report describes the approach taken by the Early Learning Institute and reports data regarding enrollment and utilization among Medicaid families. Results suggest the model has potential to be used within community settings and that children on Medicaid are likely to consistently attend their treatment sessions.
      Citation: Autism
      PubDate: 2020-05-20T09:42:27Z
      DOI: 10.1177/1362361320919243
       
  • Work, living, and the pursuit of happiness: Vocational and psychosocial
           outcomes for young adults with autism
    • Authors: Catherine Lord, James B McCauley, Lauren A Pepa, Marisela Huerta, Andrew Pickles
      Abstract: Autism, Ahead of Print.
      Longitudinal data on the functioning of adults referred for possible autism as children are sparse and possibly different from datasets consisting of adult clinical referrals. A total of 123 young adults, mean age of 26, referred for neurodevelopmental disorders in early childhood were categorized into three outcome groups: autism spectrum disorder (ASD) diagnosis at some point and current intelligence quotient (IQ) ⩾ 70 (Ever ASD-Higher IQ), ever ASD and current IQ 
      Citation: Autism
      PubDate: 2020-05-20T09:36:27Z
      DOI: 10.1177/1362361320919246
       
  • Does implementing a new intervention disrupt use of existing
           evidence-based autism interventions'
    • Authors: Melanie Pellecchia, Rinad S Beidas, Gwendolyn Lawson, Nathaniel J Williams, Max Seidman, John R Kimberly, Carolyn C Cannuscio, David S Mandell
      Abstract: Autism, Ahead of Print.
      This study examines how the introduction of TeachTown:Basics, a computer-assisted intervention for students with autism spectrum disorder, influenced teachers’ use of other evidence-based practices. In a randomized controlled trial that enrolled 73 teachers nested within 58 schools, we used three-level hierarchical linear models to evaluate changes in teachers’ use of evidence-based practices across the school year for those who received TeachTown:Basics versus those assigned to control. Both groups received training and implementation support to deliver three well-established evidence-based practices for autism spectrum disorder. Qualitative interviews were conducted with 25 teachers who used TeachTown:Basics to better understand their experience. Compared with teachers in the control group, teachers in the TeachTown:Basics group reported significantly less growth over the 9-month period in their use of evidence-based practices that require one-to-one instruction (ps 
      Citation: Autism
      PubDate: 2020-05-20T09:33:27Z
      DOI: 10.1177/1362361320919248
       
  • Autistic peer-to-peer information transfer is highly effective
    • Authors: Catherine J Crompton, Danielle Ropar, Claire VM Evans-Williams, Emma G Flynn, Sue Fletcher-Watson
      Abstract: Autism, Ahead of Print.
      Effective information transfer requires social communication skills. As autism is clinically defined by social communication deficits, it may be expected that information transfer between autistic people would be particularly deficient. However, the Double Empathy theory would suggest that communication difficulties arise from a mismatch in neurotype; and thus information transfer between autistic people may be more successful than information transfer between an autistic and a non-autistic person. We investigate this by examining information transfer between autistic adults, non-autistic adults and mixed autistic-with-non-autistic pairs. Initial participants were told a story which they recounted to a second participant, who recounted the story to a third participant and so on, along a ‘diffusion chain’ of eight participants (n = 72). We found a significantly steeper decline in detail retention in the mixed chains, while autistic chains did not significantly differ from non-autistic chains. Participant rapport ratings revealed significantly lower scores for mixed chains. These results challenge the diagnostic criterion that autistic people lack the skills to interact successfully. Rather, autistic people effectively share information with each other. Information transfer selectively degrades more quickly in mixed pairs, in parallel with a reduction in rapport.Lay abstractSharing information with other people relies on the ability to communicate well. Autism is defined clinically by deficits in social communication. It may therefore be expected that autistic people find it difficult to share information with other people. We wanted to find out whether this was the case, and whether it was different when autistic people were sharing information with other autistic people or with non-autistic people. We recruited nine groups, each with eight people. In three of the groups, everyone was autistic; in three of the groups, everyone was non-autistic; and three of the groups were mixed groups where half the group was autistic and half the group was non-autistic. We told one person in each group a story and asked them to share it with another person, and for that person to share it again and so on, until everyone in the group had heard the story. We then looked at how many details of the story had been shared at each stage. We found that autistic people share information with other autistic people as well as non-autistic people do with other non-autistic people. However, when there are mixed groups of autistic and non-autistic people, much less information is shared. Participants were also asked how they felt they had got on with the other person in the interaction. The people in the mixed groups also experienced lower rapport with the person they were sharing the story with. This finding is important as it shows that autistic people have the skills to share information well with one another and experience good rapport, and that there are selective problems when autistic and non-autistic people are interacting.
      Citation: Autism
      PubDate: 2020-05-20T09:29:46Z
      DOI: 10.1177/1362361320919286
       
  • Considering efficacy and effectiveness trials of cognitive behavioral
           therapy among youth with autism: A systematic review
    • Authors: Johanna K Lake, Paula Tablon Modica, Victoria Chan, Jonathan A Weiss
      Abstract: Autism, Ahead of Print.
      Cognitive behavioral therapy is a widely studied and commonly used psychosocial intervention for treating emotional problems in individuals with autism. To date, most studies of cognitive behavioral therapy and autism have focused on efficacy. Effectiveness trials, by contrast, measure whether an intervention produces particular results under “real-world” clinical conditions. We conducted a systematic review of cognitive behavioral therapy interventions targeting affective disorders among youth with autism and (a) classified studies as either efficacy or effectiveness trials and (b) coded how the effectiveness trials reflect the implementation characteristics outlined in the Framework of Dissemination in Health Services Intervention Research. The systematic search yielded 2959 articles, with 33 studies meeting inclusion criteria. Thirteen studies were categorized as effectiveness and 20 as efficacy. We discuss how the effectiveness studies considered elements of the implementation framework and provide recommendations for future studies, including greater consideration and measurement of adoption and sustainability processes, as well as organizational- and system-level outcomes. Results shed light on our understanding of the effectiveness of cognitive behavioral therapy in routine clinical practice, how an implementation framework can be used to guide and improve effectiveness studies, and identify barriers, facilitators, and gaps in the implementation process.Lay abstractCognitive behavioral therapy is a common treatment for emotional problems in people with autism. Most studies of cognitive behavioral therapy and autism have focused on efficacy, meaning whether a treatment produces results under “ideal” conditions, like a lab or research setting. Effectiveness trials, by contrast, investigate whether a treatment produces results under “real-world” conditions, like a community setting (e.g. hospital, community mental health center, school). There can be challenges in bringing a cognitive behavioral therapy treatment out of a lab or research setting into the community, and the field of implementation science uses frameworks to help guide researchers in this process. In this study, we reviewed efficacy and effectiveness studies of cognitive behavioral therapy treatments for emotional problems (e.g. anxiety, depression) in children and youth with autism. Our search found 2959 articles, with 33 studies meeting our criteria. In total, 13 studies were labelled as effectiveness and 20 as efficacy. We discuss how the effectiveness studies used characteristics of an implementation science framework, such as studying how individuals learn about the treatment, accept or reject it, how it is used in the community over time, and any changes that happened to the individual or the organization (e.g. hospital, school, community mental health center) because of it. Results help us better understand the use of cognitive behavioral therapy in the community, including how a framework can be used to improve effectiveness studies.
      Citation: Autism
      PubDate: 2020-05-19T06:57:58Z
      DOI: 10.1177/1362361320918754
       
  • Types and correlates of school non-attendance in students with autism
           spectrum disorders
    • Authors: Vasiliki Totsika, Richard P Hastings, Yoko Dutton, Alison Worsley, Glenn Melvin, Kylie Gray, Bruce Tonge, David Heyne
      Abstract: Autism, Ahead of Print.
      School non-attendance in autism spectrum disorders has received very little attention to date. The study aimed to provide a comprehensive description of school non-attendance in students with autism spectrum disorders. Through an online survey, parents of 486 children (mean age: 11 years) reported on school attendance over 1 month and reasons for instances of non-attendance. On average, students missed 5 days of school of a possible 23 days. Persistent non-attendance (absent on 10%+ of available sessions) occurred among 43% of students. School non-attendance was associated with child older age, not living in a two-parent household, parental unemployment and, especially, attending a mainstream school. School refusal accounted for 43% of non-attendance. School exclusion and school withdrawal each accounted for 9% of absences. Truancy was almost non-existent. Non-problematic absenteeism (mostly related to medical appointments and illness) accounted for 32% of absences. Non-problematic absenteeism was more likely among those with intellectual disability, school refusal was more likely among older students and school exclusion was more likely among students from single-parent, unemployed and well-educated households. Findings suggest that school non-attendance in autism spectrum disorders is a significant issue, and that it is important to capture detail about attendance patterns and reasons for school non-attendance.Lay abstractOur study aimed to describe school non-attendance in students with autism. We conducted an online survey. Parents of 486 students (mean age: 11 years) indicated which days their child had missed school (over a period of 1 month). If the child had missed a day, the parent was asked to select a reason from a list of 15 possible reasons (this is a measure of types of school non-attendance called SNACK (School Non-Attendance ChecKlist; Heyne et al., 2019)). On average, students missed 5 days of school of a possible 23 days. Missing over 10% of school is known as persistent absence, and in our study, 43% of students experienced persistent absence. Older students, who attended mainstream schools, who did not live in a two-parent household and whose caregiver was unemployed were more likely to miss school. Looking at the reasons for absence, school refusal was the most frequent reason, accounting for 43% of absences. Nine percent of absence was due to school exclusion. Nine percent of absence was due to school withdrawal. Truancy was almost non-existent. A final reason describes non-problematic absence that is mostly due to medical appointments and illness. This type of absence accounted for 32% of absences in our study, and it was more likely in student with intellectual disability. School refusal was more likely among older students. School exclusion was more likely among students from single-parent, unemployed and well-educated households. Findings from this study help us to understand better the difficulties students with autism experience attending school.
      Citation: Autism
      PubDate: 2020-05-18T11:06:06Z
      DOI: 10.1177/1362361320916967
       
  • Motor atypicalities in infancy are associated with general developmental
           level at 2 years, but not autistic symptoms
    • Authors: Sheila Achermann, Pär Nyström, Sven Bölte, Terje Falck-Ytter
      Abstract: Autism, Ahead of Print.
      Atypical motor development has frequently been reported in infants at elevated likelihood for autism spectrum disorder. However, no previous study has used detailed motion capture technology to compare infant siblings of children with autism spectrum disorder and infant siblings with no familial history of autism spectrum disorder. We investigated reaching movements during an interceptive action task in 10-month-old infants using kinematic data with high spatiotemporal resolution. The results indicated that several measures were different in infants at elevated likelihood. However, longitudinal analyses revealed that while specific infant motor measures (e.g. number of movement units) were related to broad measures of general developmental level in toddlerhood, the associations with later autism spectrum disorder symptomatology were not significant. These findings confirm that some aspects of motor functioning are atypical in infants at elevated likelihood for autism spectrum disorder, but provide no support for the view that these issues are specifically linked to autism spectrum disorder symptoms, but may rather reflect neurodevelopment more generally.Lay abstractAtypicalities in motor functioning are often observed in later born infant siblings of children with autism spectrum disorder. The goal of our study was to investigate motor functioning in infants with and without familial history of autism spectrum disorder. Specifically, we investigated how infants catch a ball that is rolling toward them following a non-straight path, a task that requires both efficient planning and execution. Their performance was measured using detailed three-dimensional motion capture technology. We found that several early motor functioning measures were different in infants with an older autistic sibling compared to controls. However, these early motor measures were not related to autistic symptoms at the age of 2 years. Instead, we found that some of the early motor measures were related to their subsequent non-social, general development. The findings of our study help us understand motor functioning early in life and how motor functioning is related to other aspects of development.
      Citation: Autism
      PubDate: 2020-05-16T06:16:11Z
      DOI: 10.1177/1362361320918745
       
  • The hidden inequalities of COVID-19
    • Authors: Elizabeth Pellicano, Marc Stears
      First page: 1309
      Abstract: Autism, Ahead of Print.

      Citation: Autism
      PubDate: 2020-05-19T06:58:38Z
      DOI: 10.1177/1362361320927590
       
  • Diagnosis of autism in adulthood: A scoping review
    • Authors: Yunhe Huang, Samuel RC Arnold, Kitty-Rose Foley, Julian N Trollor
      First page: 1311
      Abstract: Autism, Ahead of Print.
      More adults are undergoing autism assessment due to recent changes in awareness, diagnostic criteria and professional practices. This scoping review aimed to summarise research on autism diagnosis in adulthood and identify any gaps for future study. The authors searched for studies involving first-time assessment and diagnosis of autism in adults, which identified 82 studies from 13 countries using various methodologies. Six themes of (1) prevalence, (2) diagnostic pathways and processes, (3) gender, (4) psychosocial characteristics, (5) co-occurring conditions and (6) experiences of diagnosis were identified across the studies. Findings suggest that receiving an autism diagnosis has a significant emotional impact on adults, but accessibility and processes are inconsistent, and formal support services are lacking. More research is needed on autism diagnosis in adults with intellectual disability, consequences of the timing of diagnosis, and support after diagnosis.Lay abstractMore adults are getting assessed for possible autism. Here, we give an overview on what is already known about autism diagnosis in adulthood and find areas that need more research. We divided results from the studies we found into six topics of (1) rates of autism in different groups; (2) the process of getting an autism diagnosis in adulthood; (3) gender; (4) personality traits, abilities and behaviours of diagnosed adults; (5) mental and physical health conditions that occur together with autism; and (6) how adults think and feel about being assessed and diagnosed. We found that adults often have strong emotions after being diagnosed, the process of getting a diagnosis can be unclear and different for everyone, and not many support services are available for adults. More research on diagnosing adults with intellectual disability, differences between early and late-diagnosed adults, and support after diagnosis would be useful.
      Citation: Autism
      PubDate: 2020-02-28T08:58:51Z
      DOI: 10.1177/1362361320903128
       
  • The link between autism spectrum disorder and gut microbiota: A scoping
           review
    • Authors: Amanda Nitschke, Raywat Deonandan, Anne TM Konkle
      First page: 1328
      Abstract: Autism, Ahead of Print.
      Gut dysfunction and microbial dysbiosis comorbidities are of particular interest in recent autism research, as gastrointestinal distress is present in up to 90% of autism spectrum disorder cases and therefore may play a key role in the pathogenesis of this disorder. This scoping review aims to integrate the results of studies conducted in the past 6 years examining the association between gut microbiota and autism spectrum disorder, specifically with regard to the characterization of autism spectrum disorder microbiota and potential therapeutic interventions. Studies related to the gastrointestinal microbiome of subjects with autism spectrum disorder were identified through PubMed, SCOPUS, PsycInfo, and Google Scholar databases. Studies were screened and selected based on defined inclusion and exclusion criteria; 19 studies were included. Research continues to report differences between microbiota of individuals with autism spectrum disorder and controls; however, the types and abundances of bacteria present remain inconsistent. Promising treatment interventions for autism spectrum disorder, including special diets, dietary supplementation, and of particular interest, microbiota transfer therapy, are also being explored. Research regarding the link between gut microbiota and autism spectrum disorder renders exciting results; however, it is still in its infancy of investigation. Rigorous methodologies are required to support and strengthen the reliability of existing results, and to further our understanding of the pathogenesis of autism spectrum disorder.Lay abstractGastrointestinal distress and gut microbial imbalances are commonly found in children with autism spectrum disorder, and therefore may play a key role in the development of the disorder. This scoping review aimed to examine the extent, range and nature of research conducted in the past 6 years that focused on furthering our understanding of autism spectrum disorder and its association with gut microbiota. A literature review was performed with predetermined key words. Studies were screened and selected based on defined inclusion and exclusion criteria. A total of 19 studies were included for final analysis. While there are continuous reports of differences in gut microbiota between autism spectrum disorder and neurotypical individuals, knowledge about the consistency in the presence and abundance of bacterial species, as well as metabolites, remains deficient. Treatments such as special diets, vitamin, prebiotic, probiotic, and microbiota transfer therapy show promising therapeutic potential, yet are in their infancy of investigation. Overall, further research with rigorous methodologies is required to support and strengthen the reliability of existing findings. Future research should aim to increase sample sizes, eliminate biases, and subgroup autism spectrum disorder groups to help accommodate for inter-individual variation. As increasing evidence of a unique autism spectrum disorder microbiome and metabolome is acquired, autism spectrum disorder-specific biomarkers can be identified. These biomarkers have great implications in terms of elucidating the molecular mechanisms of autism spectrum disorder, preventing the onset of autism spectrum disorder, and improving treatments for individuals with autism spectrum disorder.
      Citation: Autism
      PubDate: 2020-04-28T09:01:59Z
      DOI: 10.1177/1362361320913364
       
  • Interventions to address health outcomes among autistic adults: A
           systematic review
    • Authors: Teal W Benevides, Stephen M Shore, May-Lynn Andresen, Reid Caplan, Barb Cook, Dena L Gassner, Jasmine M Erves, Taylor M Hazlewood, M Caroline King, Lisa Morgan, Lauren E Murphy, Yenn Purkis, Brigid Rankowski, Sarah M Rutledge, Savannah P Welch, Karl Wittig
      First page: 1345
      Abstract: Autism, Ahead of Print.
      Research has shown that autistic adults have poor health outcomes. We conducted a systematic review to identify existing interventions to address health outcomes for autistic adults and to determine whether these interventions address the priorities of the autistic community. We searched PubMed for articles that included an intervention, a primary health outcome measured at the individual (not system) level, and a sample population of at least 50% autistic adults. Studies were excluded if they were not peer-reviewed, had a focus on caregivers, were expert opinions on specific interventions, untested protocols, or interventions without a primary health outcome. Out of the 778 articles reviewed, 19 were found to meet the stated criteria. Based on the evidence gathered, two were considered emerging evidence-based approaches: cognitive behavioral approaches and mindfulness. The remaining interventions included in the review did not have sufficient evidence to support current use with this population. The majority of the studies included samples of young autistic adults, primarily male, without an intellectual disability. Anxiety, quality of life, depression, and behavioral issues were among the health outcomes measured in the final included articles. More research on preferred interventions with prioritized health outcomes of the autistic adult population is needed.Lay abstractAutistic adults have more health problems then their same-aged peers. Yet little research has been conducted that focuses on addressing these health problems. In order to guide future research, it is important to know what intervention studies have been done to improve health outcomes among autistic adults. The project team and student assistants read studies that were published between 2007 and 2018 in the online research database, PubMed. We looked for studies published in English, which were peer-reviewed and included (1) an intervention, (2) an outcome that was related to health, and (3) a study group that included autistic adults. We did not include studies that had outcomes about employment (unless there was a health outcome), studies about caregivers or caregiving, or expert opinions about interventions. Of 778 reviewed articles, 19 studies met all of the criteria above. Within these studies, two approaches were found to have emerging evidence for their use in autistic adults: cognitive behavioral interventions and mindfulness-based approaches for improved mental health outcomes. The remaining intervention approaches did not have enough articles to support their use. Many of the outcomes were about reduced symptoms of co-occurring mental health diagnoses (e.g. reduced anxiety, depression). Most of the participants in these studies were male and did not have intellectual disability. Most study participants were adults younger than 40. There are not many intervention studies that address health outcomes among autistic adults. More research is needed on interventions which are desired by the adult autism community and address preferred health outcomes such as increased quality of life or well-being.
      Citation: Autism
      PubDate: 2020-05-11T09:15:59Z
      DOI: 10.1177/1362361320913664
       
  • Sluggish cognitive tempo: An examination of clinical correlates for adults
           with autism
    • Authors: Alexis M Brewe, Grace Lee Simmons, Nicole N Capriola-Hall, Susan W White
      First page: 1373
      Abstract: Autism, Ahead of Print.
      Adults with autism spectrum disorder often experience co-occurring mental health problems such as attention-deficit/hyperactivity-disorder, as well as impairments in executive function. Sluggish cognitive tempo, a cluster of behaviors including slow processing, daydreaming, and mental fogginess, has been shown to be associated with attention-deficit/hyperactivity-disorder. This study was designed to assess sluggish cognitive tempo in young adults with autism spectrum disorder. Specifically, we sought to establish a preliminary estimate of clinically significant sluggish cognitive tempo symptoms and to better understand its phenomenology and associations with executive function and psychiatric symptoms in the context of autism spectrum disorder. Young adults with autism spectrum disorder (n = 57; age 16–25 years; 84.2% male) completed a laboratory-based executive function task, and parents and participants completed measures of the participants’ sluggish cognitive tempo, attention-deficit/hyperactivity-disorder, depression, and anxiety symptoms. Nearly one-third of the sample exhibited clinically impairing levels of sluggish cognitive tempo. Although sluggish cognitive tempo and attention-deficit/hyperactivity-disorder symptoms were significantly correlated, findings suggest the constructs are distinct. Results also suggest that increased sluggish cognitive tempo is related to executive function impairment and depression, but not anxiety symptoms. Considerations for assessment and long-term impacts of sluggish cognitive tempo for adults with autism spectrum disorder are discussed.Lay abstractAdults with autism spectrum disorder often experience a range of co-occurring mental health problems such as attention-deficit/hyperactivity-disorder, as well as difficulties with executive function. Sluggish cognitive tempo, a cluster of behaviors including slow processing, daydreaming, and mental fogginess, has been shown to be associated with attention-deficit/hyperactivity-disorder, and limited research has suggested that individuals with autism spectrum disorder may experience sluggish cognitive tempo. We examined co-occurring mental health problems and executive function in 57 young adults with autism spectrum disorder, aged 16–25 years to better understand sluggish cognitive tempo in autism spectrum disorder. Parents of the young adults answered questions about their children’s sluggish cognitive tempo, attention-deficit/hyperactivity-disorder, depression, and anxiety symptoms, and the young adults completed tests of their executive function. Results demonstrated that nearly one-third of the sample exhibited clinically impairing levels of sluggish cognitive tempo. Although sluggish cognitive tempo and attention-deficit/hyperactivity-disorder symptoms were related, our findings suggest they are not the same constructs. Increased sluggish cognitive tempo is related to more difficulties with executive function and increased depression, but not anxiety symptoms. Results demonstrate that sluggish cognitive tempo may pose heightened difficulties for adults with autism spectrum disorder, making it an important construct to continue studying. Considerations for assessment and long-term impacts of sluggish cognitive tempo for adults with autism spectrum disorder are discussed.
      Citation: Autism
      PubDate: 2020-02-07T09:41:48Z
      DOI: 10.1177/1362361319900422
       
  • Looking or talking: Visual attention and verbal engagement during shared
           book reading of preschool children on the autism spectrum
    • Authors: Rachelle Wicks, Jessica Paynter, Marleen F Westerveld
      First page: 1384
      Abstract: Autism, Ahead of Print.
      Visual attention and active engagement during shared book reading are important for facilitating emergent literacy learning during the preschool years. Children on the autism spectrum often show difficulties in language and literacy development, yet research investigating potential indicators of shared book reading engagement, including visual attention and verbal engagement, for this group of preschoolers is currently limited. To better understand the relationship between children’s visual attention and verbal engagement during shared book reading, parent shared book reading behaviors, and children’s emergent literacy skills (e.g. receptive vocabulary and letter-name knowledge), we observed 40 preschoolers on the spectrum and their parents sharing an unfamiliar storybook. Videos of the shared book reading interactions were transcribed and coded for child and parent behaviors using observational coding schemes. Strong significant associations were found between children’s visual attention, verbal engagement, and parents’ use of questions and/or prompts during the shared book reading interaction. Contrary to expectations, children’s visual attention was not related to their emergent literacy skills. Overall, our findings emphasize the interplay between parent behaviors and how preschoolers on the spectrum engage in this important literacy-related context and provide directions for future research.Lay abstractChildren who have an autism diagnosis often have trouble learning to talk and read. These difficulties become noticeable before children start school and may be linked to lower attention and engagement in literacy-related activities such as sharing storybooks with their parents. To date, few researchers have looked at possible ways to measure how children on the autism spectrum engage during shared storybook reading, for example, where children look or how much they talk, and how this may be related to their letter-name knowledge and their vocabulary knowledge. In this study, we analyzed videos of 40 preschoolers on the spectrum and their parents sharing an unfamiliar storybook. We wanted to see whether where children looked (i.e. toward the storybook, their parent, or elsewhere) and how much they talked were related to what their parents did (e.g. ask questions or provide prompts) and/or children’s letter-name knowledge and vocabulary. The videos were coded for different child and parent behaviors. We found that where children looked and how much they talked were strongly related to each other and what parents did during the shared book reading interaction, particularly asking questions and using prompts. In contrast to what we expected, where children looked was not related to children’s letter or vocabulary knowledge. Overall, results of the study draw attention to the connection between what parents do and what preschoolers on the spectrum do when sharing storybooks and provide directions for future research.
      Citation: Autism
      PubDate: 2020-02-13T05:56:48Z
      DOI: 10.1177/1362361319900594
       
  • An association of intrapartum synthetic oxytocin dosing and the odds of
           developing autism

         This is an Open Access Article Open Access Article

    • Authors: Stephen M Soltys, Jill Rose Scherbel, Joseph R Kurian, Todd Diebold, Teresa Wilson, Lindsay Hedden, Kathleen Groesch, Paula L Diaz-Sylvester, Albert Botchway, Pamela Campbell, Julio Ricardo Loret de Mola
      First page: 1400
      Abstract: Autism, Ahead of Print.
      A case-control study was performed to determine whether an association exists between exposure to synthetic oxytocin and a subsequent autism spectrum disorder diagnosis; 171 children under age 18 meeting Diagnostic and Statistical Manual of Mental Disorders (5th ed.) autism spectrum disorder criteria were compared to 171 children without autism spectrum disorder diagnosis matched by gender, birth year, gestational age, and maternal age at birth. A conditional logistic regression model was used to examine the association of clinical variables and autism spectrum disorder. Significantly elevated odds ratios for autism spectrum disorder were associated with first-time Cesarean section (odds ratio = 2.56), but not a repeat Cesarean section. Odds ratios were also significantly elevated for subjects whose mother’s body mass index was 35 or higher at birth (odds ratio = 2.34) and subjects in which the reason for delivery was categorized as “fetal indication” (odds ratio = 2.00). When controlling for these and other variables, the odds of developing autism spectrum disorder were significantly elevated in males with long duration of exposure (odds ratio = 3.48) and high cumulative dose of synthetic oxytocin (odds ratio = 2.79). No significant associations of synthetic oxytocin dosing and autism spectrum disorder were noted in female subjects. The association of elevated autism spectrum disorder odds found with high duration and high cumulative dose synthetic oxytocin in male subjects suggests the need for further investigation to fully elucidate any cause and effect relationship.Lay abstractOxytocin is a hormone naturally produced in the human body that can make the womb (uterus) contract during labor. Manufactured oxytocin is frequently given to mothers in labor to strengthen the contractions or in some cases to start labor. This study compared children with a diagnosis of autism and children without autism to see whether children with autism received more oxytocin during labor. The odds of a child having an autism diagnosis were significantly higher if the delivery was a first-time Cesarean section, if the mother had a body mass index of 35 or higher, or if the reason for delivery were a range of fetal problems that made delivery necessary. It was found that boys who were exposed to oxytocin for longer periods of time during labor and received higher total doses of oxytocin had significantly higher odds of developing autism. There were no significant associations of oxytocin dosing and autism noted in female children. As this is the first study to look at any relationship between the dose of oxytocin received during labor and the odds of developing autism, further study needs to be done to determine whether there is any cause and effect relationship. Thus, at this time, there is no recommended change in clinical practice.
      Citation: Autism
      PubDate: 2020-02-14T09:06:14Z
      DOI: 10.1177/1362361320902903
       
  • A framework of evidence-based practice for digital support, co-developed
           with and for the autism community
    • Authors: Vanessa Zervogianni, Sue Fletcher-Watson, Gerardo Herrera, Matthew Goodwin, Patricia Pérez-Fuster, Mark Brosnan, Ouriel Grynszpan
      First page: 1411
      Abstract: Autism, Ahead of Print.
      A wide array of digital supports (such as apps) have been developed for the autism community, many of which have little or no evidence to support their effectiveness. A Delphi study methodology was used to develop a consensus on what constitutes good evidence for digital supports among the broader autism community, including autistic people and their families, as well as autism-related professionals and researchers. A four-phase Delphi study consultation with 27 panel members resulted in agreement on three categories for which evidence is required: reliability, engagement and effectiveness of the technology. Consensus was also reached on four key sources of evidence for these three categories: hands-on experience, academic sources, expert views and online reviews. These were differentially weighted as sources of evidence within these three categories.Lay abstractDigital supports are any type of technologies that have been intentionally developed to improve daily living in some way. A wide array of digital supports (such as apps) have been developed for the autism community specifically, but there is little or no evidence of whether they work or not. This study sought to identify what types of evidence the autistic community valued and wanted to see provided to enable an informed choice to be made regarding digital supports. A consensus was developed between autistic people and their families, practitioners (such as therapists and teachers) as well as researchers, to identify the core aspects of evidence that everyone agreed were useful. In all, 27 people reached agreement on three categories for which evidence is required: reliability, engagement and the effectiveness of the technology. Consensus was also reached on four key sources of evidence for these three categories: hands-on experience, academic sources, expert views and online reviews. The resulting framework allows for any technology to be evaluated for the level of evidence identifying how effective it is. The framework can be used by autistic people, their families, practitioners and researchers to ensure that decisions concerning the provision of support for autistic people is informed by evidence, that is, ‘evidence-based practice’.
      Citation: Autism
      PubDate: 2020-02-06T11:20:43Z
      DOI: 10.1177/1362361319898331
       
  • ‘When my autism broke’: A qualitative study spotlighting
           autistic voices on menopause
    • Authors: Rachel L Moseley, Tanya Druce, Julie M Turner-Cobb
      First page: 1423
      Abstract: Autism, Ahead of Print.
      Autistic women often struggle with the onset of menstruation, a key transition point in the female reproductive lifespan. Presently, there is no research investigating how autistic people navigate the menopausal transition, and whether it poses additional challenges in addition to those already faced by neurotypical women. As a preliminary participatory study in this area, we conducted an online focus group with seven autistic individuals, aged 49–63 years (median = 64.5 years) and assigned female at birth, to explore the state of knowledge about the menopause in autism, difficulties the menopause might bring, support that might be needed, and what questions require scientific investigation. Thematic analysis of the discussion generated three themes: (a) lack of knowledge and understanding; (b) cracking the mask and adaptive functioning; and (c) finding support. Themes suggested a lack of professional knowledge, understanding and communication about menopause for autistic people, and an absence of support. Menopause was discussed as heightening pre-existing and generating new cognitive, social, emotional and sensory difficulties. This study illustrates the need for greater focus of attention towards how autistic people cope with the major life transition of menopause.Lay abstractAutistic girls are known to struggle with the onset of menstruation, reporting that during their period, sensory sensitivities are heightened, it becomes more difficult to think clearly and control their emotions and they struggle more with everyday life and self-care. Yet surprisingly, nothing is known about how autistic women handle the menopausal transition in midlife. In non-autistic women, the menopause brings many physical changes and challenging symptoms from hot flushes to feeling more anxious and depressed. Because autistic women are already vulnerable to suicide, poor physical and mental health, and because they may already struggle with planning, controlling their emotions and coping with change, the menopause may be an especially challenging time. Yet, not one single study exists on the menopause in autism, so we conducted an online discussion (focus group) with seven autistic women. They confirmed that very little is known about menopause in autistic people, very little support is available and that menopause might be especially difficult for autistic people. Autism-related difficulties (including sensory sensitivity, socializing with others and communicating needs) were reported to worsen during the menopause, often so dramatically that some participants suggested they found it impossible to continue to mask their struggles. Participants also reported having extreme meltdowns, experiencing anxiety and depression, and feeling suicidal. This study highlights how important it is that professionals pay attention to menopause in autism, and discusses future research directions.
      Citation: Autism
      PubDate: 2020-01-31T11:23:51Z
      DOI: 10.1177/1362361319901184
       
  • ‘I never realised everybody felt as happy as I do when I am around
           autistic people’: A thematic analysis of autistic adults’
           relationships with autistic and neurotypical friends and family
    • Authors: Catherine J Crompton, Sonny Hallett, Danielle Ropar, Emma Flynn, Sue Fletcher-Watson
      First page: 1438
      Abstract: Autism, Ahead of Print.
      Many autistic people are motivated to have friends, relationships and close family bonds, despite the clinical characterisation of autism as a condition negatively affecting social interaction. Many first-hand accounts of autistic people describe feelings of comfort and ease specifically with other autistic people. This qualitative research explored and contrasted autistic experiences of spending social time with neurotypical and autistic friends and family. In total, 12 autistic adults (10 females, aged 21–51) completed semi-structured interviews focused on time spent with friends and family; positive and negative aspects of time spent with neurotypical and autistic friends and family; and feelings during and after spending time together. Three themes were identified: cross-neurotype understanding, minority status and belonging. Investigation of these themes reveals the benefits of autistic people creating and maintaining social relationships with other autistic people, in a more systematic way than previous individual reports. They highlight the need for autistic-led social opportunities and indicate benefits of informal peer support for autistic adults.Lay abstractAlthough autistic people may struggle to interact with others, many autistic people have said they find interacting with other autistic people more comfortable. To find out whether this was a common experience, we did hour-long interviews with 12 autistic adults. We asked them questions about how it feels when spending time with their friends and family, and whether it felt different depending on whether the friends and family were autistic or neurotypical. We analysed the interviews and found three common themes in what our participants said. First, they found spending with other autistic people easier and more comfortable than spending time with neurotypical people, and felt they were better understood by other autistic people. Second, autistic people often felt they were in a social minority, and in order to spend time with neurotypical friends and family, they had to conform with what the neurotypical people wanted and were used to. Third, autistic people felt like they belonged with other autistic people and that they could be themselves around them. These findings show that having time with autistic friends and family can be very beneficial for autistic people and played an important role in a happy social life.
      Citation: Autism
      PubDate: 2020-03-07T09:53:29Z
      DOI: 10.1177/1362361320908976
       
  • The Witness-Aimed First Account (WAFA): A new technique for interviewing
           autistic witnesses and victims
    • Authors: Katie Maras, Coral Dando, Heather Stephenson, Anna Lambrechts, Sophie Anns, Sebastian Gaigg
      First page: 1449
      Abstract: Autism, Ahead of Print.
      Autistic people experience social communication difficulties alongside specific memory difficulties that can impact their ability to recall episodic events. Police interviewing techniques do not take account of these differences, and so are often ineffective. Here we introduce a novel Witness-Aimed First Account interview technique, designed to better support autistic witnesses by diminishing socio-cognitive and executive demands through encouraging participants to generate and direct their own discrete, parameter-bound event topics, before freely recalling information within each parameter-bound topic. Since witnessed events are rarely cohesive stories with a logical chain of events, we also explored witnesses’ recall when the narrative structure of the to-be-remembered event was lost. Thirty-three autistic and 30 typically developing participants were interviewed about their memory for two videos depicting criminal events. Clip segments of one video were ‘scrambled’, disrupting the event’s narrative structure; the other video was watched intact. Although both autistic and typically developing witnesses recalled fewer details with less accuracy from the scrambled video, Witness-Aimed First Account interviews resulted in more detailed and accurate recall from autistic and typically developing witnesses, for both scrambled and unscrambled videos. The Witness-Aimed First Account technique may be a useful tool to improve autistic and typically developing witnesses’ accounts within a legally appropriate, non-leading framework.Lay abstractAutistic people may be more likely to be interviewed by police as a victim/witness, yet they experience social communication difficulties alongside specific memory difficulties that can impact their ability to recall information from memory. Police interviewing techniques do not take account of these differences, and so are often ineffective. We developed a new technique for interviewing autistic witnesses, referred to a Witness-Aimed First Account, which was designed to better support differences in the way that autistic witnesses process information in memory. The Witness-Aimed First Account technique encourages witnesses to first segment the witnessed event into discrete, parameter-bound event topics, which are then displayed on post-it notes while the witness goes onto freely recall as much information as they can from within each parameter-bound topic in turn. Since witnessed events are rarely cohesive stories with a logical chain of events, we also explored autistic and non-autistic witnesses’ recall when the events were witnessed in a random (nonsensical) order. Thirty-three autistic and 30 typically developing participants were interviewed about their memory for two videos depicting criminal events. Clip segments of one video were ‘scrambled’, disrupting the event’s narrative structure; the other video was watched intact. Although both autistic and non-autistic witnesses recalled fewer details with less accuracy from the scrambled video, Witness-Aimed First Account interviews resulted in more detailed and accurate recall from both autistic and non-autistic witnesses, for both scrambled and unscrambled videos. The Witness-Aimed First Account technique may be a useful tool to improve witnesses’ accounts within a legally appropriate, non-leading framework.
      Citation: Autism
      PubDate: 2020-03-14T05:04:15Z
      DOI: 10.1177/1362361320908986
       
  • Randomized controlled trial of a sibling support group: Mental health
           outcomes for siblings of children with autism
    • Authors: Emily A Jones, Theresa Fiani, Jennifer L Stewart, Nicole Neil, Susan McHugh, Daniel M Fienup
      First page: 1468
      Abstract: Autism, Ahead of Print.
      Typically developing siblings of a child with autism spectrum disorder may be at increased risk of mental health difficulties. A support group is one approach to improve mental health outcomes for typically developing siblings. During support groups, typically developing siblings discuss their feelings, learn coping strategies and problem-solving skills, and develop a peer network. We conducted a randomized controlled trial comparing a support group to an attention-only social control group. Some areas of mental health improved. Autism spectrum disorder symptom severity in the sibling with autism spectrum disorder moderated effects. Findings suggest continuing to examine what areas of mental health and adjustment are improved with support groups and subgroups of typically developing siblings for whom support groups might be particularly effective.Lay abstractTypically developing siblings of a child with autism spectrum disorder may show mental health difficulties. A support group is one approach to help typically developing siblings. During support groups, typically developing siblings discuss their feelings, learn coping strategies and problem-solving skills, and develop a peer network. We compared a support group to participation in a similar group without a focus on the sibling with autism spectrum disorder. Some areas of mental health improved. Improvements were also impacted by autism spectrum disorder symptom severity in the sibling with autism spectrum disorder. Findings suggest continuing to examine how support groups can help typically developing siblings and for which siblings support groups might be particularly effective.
      Citation: Autism
      PubDate: 2020-03-14T05:05:35Z
      DOI: 10.1177/1362361320908979
       
  • How accurate are autistic adults and those high in autistic traits at
           making face-to-face line-of-sight judgements'
    • Authors: Megan Freeth, Emma Morgan, Patricia Bugembe, Aaron Brown
      First page: 1482
      Abstract: Autism, Ahead of Print.
      Being able to follow the direction of another person’s line-of-sight facilitates social communication. To date, much research on the processes involved in social communication has been conducted using computer-based tasks that lack ecological validity. The current paradigm assesses how accurately participants can follow a social partner’s line-of-sight in a face-to-face scenario. In Study 1, autistic and neurotypical adults were asked to identify which location, on a grid of 36 potential locations, the experimenter was looking at on a series of discrete trials. All participants (both autistic and neurotypical) were able to effectively make line-of-sight judgements, scoring significantly above chance. Participants were also just as effective at making these judgements from either a brief, 1s, glance or from a prolonged, 5s, stare. However, at the group level, autistic participants were significantly less accurate than neurotypical participants overall. In Study 2, potential variation in performance along the broad autism phenotype was considered using the same paradigm. Bayesian analyses demonstrated that line-of-sight judgement accuracy was not related to the amount of autistic traits. Overall, these findings advance the understanding of the mechanistic processes of social communication in relation to autism and autistic traits in a face-to-face setting.Lay abstractIn order to effectively understand and consider what others are talking about, we sometimes need to follow their line-of-sight to the location at which they are looking, as this can provide important contextual information regarding what they are saying. If we are not able to follow other people’s line-of-sight, this could result in social communication difficulties. Here we tested how effectively autistic and neurotypical adults are at following a social partner’s line-of-sight during a face-to-face task. In a first study, completed by 14 autistic adult participants of average to above-average verbal ability and 14 neurotypical adult participants, we found that all participants were able to effectively follow the social partner’s line-of-sight. We also found that participants tended to be as effective at making these judgements from both a brief, 1s, glance or a long, 5s, stare. However, autistic adults were less accurate, on average, than neurotypical adults overall. In a second study, a separate group of 65 neurotypical adults completed the same line-of-sight judgement task to investigate whether task performance was related to individual variation in self-reported autistic traits. This found that the amount of self-reported autistic traits was not at all related to people’s ability to accurately make line-of-sight judgements. This research isolates and furthers our understanding of an important component part of the social communication process and assesses it in a real-world context.
      Citation: Autism
      PubDate: 2020-03-14T05:02:15Z
      DOI: 10.1177/1362361320909176
       
  • Facilitating sensorimotor integration via blocked practice underpins
           imitation learning of atypical biological kinematics in autism spectrum
           disorder
    • Authors: Nathan C Foster, Simon J Bennett, Joe Causer, Digby Elliott, Geoffrey Bird, Spencer J Hayes
      First page: 1494
      Abstract: Autism, Ahead of Print.
      The reduced efficacy of voluntary imitation in autism is suggested to be underpinned by differences in sensorimotor processing. We examined whether the imitation of novel atypical biological kinematics by autistic adults is enhanced by imitating a model in a predictable blocked practice trial order. This practice structure is expected to facilitate trial-to-trial sensorimotor processing, integration and encoding of biological kinematics. The results showed that neurotypical participants were generally more effective at imitating the biological kinematics across all experimental phases. Importantly, and compared to a pre-test where imitation was performed in a randomised (unpredictable) trial order, the autistic participants learned to imitate the atypical kinematics more effectively following an acquisition phase of repeatedly imitating the same model during blocked practice. Data from the post-test showed that autistic participants remained effective at imitating the atypical biological kinematics when the models were subsequently presented in a randomised trial order. These findings show that the reduced efficacy of voluntary imitation in autism can be enhanced during learning by facilitating trial-to-trial processing and integration of sensorimotor information using blocked practice.Lay AbstractAutistic people sometimes find it difficult to copy another person’s movement accurately, especially if the movement is unfamiliar or novel (e.g. to use chop sticks). In this study, we found that autistic people were generally less accurate at copying a novel movement than non-autistic people. However, by making a small adjustment and asking people to copy this movement for a set number of attempts in a predictable manner, we showed that autistic people did successfully learn to copy a new movement. This is a very important finding for autistic people because rather than thinking they cannot copy new movements, all that needs to be considered is for parents/guardians, teachers and/or support workers to make a small adjustment so that learning occurs in a predictable manner for new skills to be successfully acquired through copying. The implications from this study are wide-ranging as copying (imitation) and motor learning are important developmental processes for autistic infants and children to acquire in order to interact within the world. Therefore, practising these behaviours in the most effective way can certainly help the developmental pathway.
      Citation: Autism
      PubDate: 2020-03-14T04:54:55Z
      DOI: 10.1177/1362361320908104
       
  • Interviewing autistic adults: Adaptations to support recall in police,
           employment, and healthcare interviews
    • Authors: Jade Eloise Norris, Laura Crane, Katie Maras
      First page: 1506
      Abstract: Autism, Ahead of Print.
      Recalling specific past experiences is critical for most formal social interactions, including when being interviewed for employment, as a witness or defendant in the criminal justice system, or as a patient during a clinical consultation. Such interviews can be difficult for autistic adults under standard open questioning, yet applied research into effective methods to facilitate autistic adults’ recall is only recently beginning to emerge. The current study tested the efficacy of different prompting techniques to support autistic adults’ recall of specific personal memories; 30 autistic and 30 typically developing adults (intelligence quotients > 85) were asked to recall specific instances from their past, relevant to criminal justice system, healthcare, and employment interviews. Questions comprised ‘open questions’, ‘semantic prompting’ (where semantic knowledge was used to prompt specific episodic retrieval) and ‘visual–verbal prompting’ (a pie-diagram with prompts to recall specific details, for example, who, what, and where). Half the participants received the questions in advance. Consistent with previous research, autistic participants reported memories with reduced specificity. For both groups, visual–verbal prompting support improved specificity and episodic relevance, while semantic prompting also aided recall for employment questions (but not health or criminal justice system). Findings offer new practical insight for interviewers to facilitate communication with typically developing and autistic adults.Lay abstractDuring many types of interviews (e.g. in employment, with the police, and in healthcare), we need to recall detailed memories of specific events, which can be difficult for autistic people in response to commonly used questions. This is especially because these tend to be open questions (i.e. very broad). Autistic people have disproportionately high rates of physical and mental health conditions, are more likely to interact with police, and are the most underemployed disability group. However, interviewers are often unsure about how to adapt their communication for autistic people.Our research tested whether different types of prompts enabled autistic people to recall specific memories (memories of a single event within one day). Participants were asked about situations relating to witnessing a crime (e.g. at the bank), physical or mental health scenarios and employment interviews (e.g. a time you’ve met a deadline).We tested the following:Open questions: basic questions only (e.g. ‘tell me about a time you went to the cinema’),Semantic prompting: a general prompt (e.g. ‘do you enjoy going to the cinema'’) before asking for a specific instance (‘tell me about a time you went to the cinema'’),Visual–verbal prompting: asking participants to recall when it happened, who was there, the actions that occurred, the setting, and any objects.With visual–verbal prompting, autistic and typically developing participants’ memories were more specific and detailed. Semantic prompting was also effective for employment questions. Our study shows that autistic people can recall specific memories when they are appropriately prompted. Visual–verbal prompting may be effective across different situations.
      Citation: Autism
      PubDate: 2020-03-23T01:58:00Z
      DOI: 10.1177/1362361320909174
       
  • A qualitative study on perspective of parents of children with autism on
           the nature of parent–professional relationship in Kerala, India
    • Authors: Rajani Ramachandran
      First page: 1521
      Abstract: Autism, Ahead of Print.
      This study explored the nature of relationship between parents of children with autism and professionals who provide therapy-based service for autism in Kerala, India. Thematic analysis of semi-structured interview with 21 parents of children with autism whose age ranged between 5.8 and 17.3 years helped identify three themes related to the nature of parent–professional relationship—information, responsibility, and personal growth. There was a dearth of scheduled, in-depth, and personalized one-on-one interaction between the parent and the professional. Though parents were involved hands on in their child’s training under professional direction, they remained mere information providers in decision making. The parent–professional relationship did not nurture parent’s self efficacy. This led to parents feeling inadequate to provide for their child’s developmental needs and being apprehensive about adulthood. The customary nature of parent–professional relationship observed may be a reflection of the collectivist culture in India. The need for parent-mediated interventions and for it to focus on enabling parents to break cultural barriers that might be holding them back from partnering with professionals on equal terms is discussed.Lay AbstractThis study explored the nature of relationship between parents of children with autism and professionals who provide therapy-based services for autism in Kerala, India. Given the shortage of professionally qualified therapists and educators (particularly in the case of autism) in low- and medium-income countries, parent-mediated interventions where professionals and parents work as partners are recommended as an effective means to meet the demand. However, for parent-mediated interventions to be effective, we first need to understand the customary nature of parent–professional relationship and develop the intervention accordingly. It is within this context that parents of 21 children with autism whose age ranged between 5.8 and 17.3 years were interviewed in order to understand the customary nature of parent–professional relationship. There was a dearth of scheduled, in-depth, and personalized one-on-one interaction between the parent and the professional. Though parents were involved hands on in their child’s training under professional direction, they remained mere information providers in decision making. The parent–professional relationship did not nurture parent’s self efficacy. This led to parents feeling inadequate to provide for their child’s developmental needs and being apprehensive about adulthood. The customary nature of parent–professional relationship observed may be a reflection of the collectivist culture in India. The findings suggest that parent-mediated interventions will need to focus on enabling parents to break cultural barriers that might be holding them back from partnering with professionals as equals.
      Citation: Autism
      PubDate: 2020-04-24T10:44:30Z
      DOI: 10.1177/1362361320912156
       
  • Public knowledge and stigma of autism spectrum disorder: Comparing China
           with the United States
    • Authors: Luodi Yu, Sheri Stronach, Ashley J Harrison
      First page: 1531
      Abstract: Autism, Ahead of Print.
      Autism spectrum disorder in China differs considerably from autism spectrum disorder in the West in terms of prevalence estimates, education opportunities, and life outcomes of autistic people. The lack of autism spectrum disorder awareness could be a key factor underlying the disparities. To date, there has been no evaluation of autism spectrum disorder knowledge among the general public of China. Using the Autism Stigma and Knowledge Questionnaire developed for use in diverse cultural contexts, this study uncovered profoundly different public views about autism spectrum disorder in China compared with the United States. Determined by cognitive diagnosis modeling, 86%–91% of the surveyed U.S. citizens (N = 1127) achieved adequate autism spectrum disorder knowledge in diagnosis/symptoms, etiology, and treatment, whereas for the Chinese citizens (N = 1254) the percentages were only 57%–65%. Moreover, 14% of the participants from the United States were classified to endorse autism spectrum disorder stigma; in comparison, 38% of the Chinese participants endorsed autism spectrum disorder stigma. The Chinese citizens displayed knowledge deficits primarily in the areas of autism spectrum disorder core symptoms, comorbid intellectual impairment, and prognosis. Sociodemographic factors associated with the Chinese citizen’s misconceptions included gender, ethnicity, social economic factors, among others. These results have important implications for increasing public awareness and promoting community participation for autistic individuals in China.Lay abstractASD in China differs considerably from ASD in the West in terms of prevalence estimates, education opportunities and life outcomes of autistic people. The lack of ASD awareness could be a key factor underlying these disparities. We asked 1127 U.S. citizens and 1254 Chinese citizens about their autism knowledge using the Autism Stigma and Knowledge Questionnaire (ASK-Q).The results indicated profoundly different public views about ASD in China compared to the U.S. Specifically, only 57%-65% of the Chinese citizens demonstrated adequate ASD knowledge compared to 86%-91% in the U.S. citizens. Fourteen percent of the U.S. citizens were shown to hold stigma beliefs towards ASD; in comparison, 38% of the Chinese citizens indicated ASD stigma. The Chinese citizens displayed misconceptions about ASD related to symptoms, causes, and possible long-term outcomes. In China but not in the U.S., male citizens and citizens with lower social economic status were more likely to have misconceptions about ASD than others were. The findings of this research can help increase public awareness about ASD and create a more inclusive environment for autistic people in China.
      Citation: Autism
      PubDate: 2020-04-27T03:01:53Z
      DOI: 10.1177/1362361319900839
       
  • When the mask comes off: Mothers’ experiences of parenting a daughter
           with autism spectrum condition
    • Authors: James Anderson, Charles Marley, Karri Gillespie-Smith, Leonie Carter, Ken MacMahon
      First page: 1546
      Abstract: Autism, Ahead of Print.
      There is limited knowledge and research on the experiences of having a daughter with autism spectrum condition from a mother’s perspective. This study aims to explore the experiences of mothers who care for a daughter with autism spectrum condition, with a particular focus on female autism spectrum condition presentation. Ten mothers of daughters with autism spectrum condition took part in a semi-structured interview. Interpretative phenomenological analysis was used to analyse the data. Five superordinate themes emerged: ‘Girls have autism too’, ‘She’s a chameleon’, ‘The impact of the diagnosis’, ‘Impact on mums’ and ‘Day-to-day life’. These findings add to our knowledge of how female autism spectrum condition presents and of the experiences directly related to being the mother of a daughter with autism spectrum condition. The findings have implications for clinicians that carry out autism spectrum condition assessments and provide insights into areas where additional support can be provided to mothers and daughters.Lay abstractParents of children with autism spectrum condition report increased stress and difficulties compared with parents of typically developing children. Our knowledge and understanding of how autism spectrum condition presents in autistic females is currently limited and parents of this population may experience challenges when raising their daughter. Given that mothers are often the main caregiver of a child with autism spectrum condition, they may have useful insights into the experiences of parenting a daughter with autism spectrum condition. Therefore, a qualitative study was undertaken to explore what mothers’ experiences are of parenting a daughter with autism spectrum condition. Semi-structured interviews were conducted with 10 mothers of daughters with autism spectrum condition. The interviews were analysed using interpretative phenomenological analysis. Five main themes emerged from the qualitative study (‘Girls have autism too’, ‘She’s a chameleon’, ‘The impact of the diagnosis’, ‘Impact on mums’ and ‘Day-to-day life’). The findings of this study expand our current knowledge of the experiences and challenges faced by mothers raising a daughter with autism spectrum condition. Mothers hold a vast amount of knowledge on their daughters’ autism spectrum condition which could inform the diagnostic process and clinical practice. Considering these results, it is important that clinicians support mothers and the family system around children with an autism spectrum condition diagnosis.
      Citation: Autism
      PubDate: 2020-04-27T03:03:32Z
      DOI: 10.1177/1362361320913668
       
  • Determinants of an autism spectrum disorder diagnosis in childhood and
           adolescence: Evidence from the UK Millennium Cohort Study
    • Authors: Mariko Hosozawa, Amanda Sacker, William Mandy, Emily Midouhas, Eirini Flouri, Noriko Cable
      First page: 1557
      Abstract: Autism, Ahead of Print.
      This study aimed to identify determinants of a late autism spectrum disorder diagnosis, including diagnoses made ‘very late’ (i.e., in adolescence), using the Millennium Cohort Study, a nationally representative population-based cohort in the United Kingdom. Children diagnosed with autism spectrum disorder by age 14 (N = 581) were included and grouped by the parent-reported timing of diagnosis: before school (up to age 5), during primary school (age 5–11) and during secondary school (age 11–14). Predictors of diagnostic timing, at the child, family and school levels, were investigated using multinomial logistic regression. Most (79%) children with autism spectrum disorder were diagnosed after school entry, and 28% were not diagnosed until secondary school. Among those not diagnosed until secondary school, 75% had been identified at age 5 years by a parent and/or teacher as having socio-behavioural difficulties. Being diagnosed after starting school was predicted by living in poverty (adjusted relative risk ratio: primary = 1.90, 95% confidence interval: 1.03–3.53; secondary = 2.15, 1.05–4.42) and/or having no initial parental concerns (primary = 0.32, 0.15–0.70; secondary = 0.19, 0.09–0.43). Having typical-range intelligence also predicted diagnosis during secondary school. The result indicates that those without cognitive delays and poorer children were at risk of ‘very late’ (i.e. adolescent) diagnosis. Strategies to promote earlier identification, targeting age at primary school entry, could help those more likely to be diagnosed late.Lay abstractDespite policy emphasis on early identification, many children with autism spectrum disorder are diagnosed late, with some being diagnosed as late as in adolescence. However, evidence on what determines the timing of autism spectrum disorder diagnosis including children diagnosed in adolescence is lacking. Understanding these determinants, particularly in those diagnosed later than is ideal, can inform the development of effective strategies to improve earlier identification of autism spectrum disorder. This study used a nationally representative population-based cohort in the United Kingdom to explore child, family and school level predictors of timing of autism spectrum disorder diagnosis. In the United Kingdom, 79% of the children with autism spectrum disorder were diagnosed after entering primary school and 28% during secondary school. Among those not diagnosed until secondary school, 75% had shown social difficulties noticed by parents and/or teachers at age 5 years. The results suggest that healthcare providers should be aware that, even for universal systems of care, those living in poverty and having higher intelligence are most likely to miss out on a timely diagnosis. Strategies to promote earlier identification among school-aged children, including targeting primary school entry age (i.e. around age 5) and that encouraging referrals for a formal assessment at the first report of concerns over the child’s social development may benefit those children who would otherwise be diagnosed later.
      Citation: Autism
      PubDate: 2020-05-05T10:29:23Z
      DOI: 10.1177/1362361320913671
       
  • Effects of pivotal response treatment on reciprocal vocal contingency in a
           randomized controlled trial of children with autism spectrum disorder
    • Authors: Jena McDaniel, Paul Yoder, Madison Crandall, Maria Estefania Millan, Christina Mich Ardel, Grace W Gengoux, Antonio Y Hardan
      First page: 1566
      Abstract: Autism, Ahead of Print.
      A pivotal response treatment package consisting of clinician-delivered and parent-implemented strategies was recently found to be effective in improving language and social communication deficits in children with autism spectrum disorder. Reciprocal vocal contingency, an automated measure of vocal reciprocity, may provide stronger and complementary evidence of the effects of the pivotal response treatment package. Reciprocal vocal contingency is derived through an automated process from daylong audio samples from the child’s natural environment. Therefore, reciprocal vocal contingency is at lower risk for detection bias than parent report and brief parent–child interaction measures. Although differences were non-significant at baseline and after 12 weeks of intervention for the 48 children with autism spectrum disorder who were randomly assigned to the pivotal response treatment package or a delayed treatment control group, the pivotal response treatment package group had higher ranked reciprocal vocal contingency scores than the control group after 24 weeks (U = 125, p = .04). These findings are consistent with results from parent report and parent–child interaction measures obtained during the trial. The participants in the pivotal response treatment package exhibited greater vocal responsiveness to adult vocal responses to their vocalizations than the control group. Findings support the effectiveness of the pivotal response treatment package on vocal reciprocity of children with autism spectrum disorder, which may be a pivotal skill for language development.Lay abstractA recent randomized controlled trial found that children with autism spectrum disorder who received a pivotal response treatment package showed improved language and social communication skills following the intervention. The pivotal response treatment package includes clinician-delivered and parent-implemented strategies. Reciprocal vocal contingency is an automated measure of vocal reciprocity derived from daylong audio samples from the child’s natural environment. It may provide stronger and complementary evidence of the effects of the pivotal response treatment package because it is at lower risk for detection bias than parent report and brief parent–child interaction measures. The current study compared reciprocal vocal contingency for 24 children with autism spectrum disorder in the pivotal response treatment package group and 24 children with autism spectrum disorder in the control group. The pivotal response treatment package group received 24 weeks of the pivotal response treatment package intervention. The control group received their usual intervention services during that time. The groups did not differ in reciprocal vocal contingency when the intervention started or after 12 weeks of intervention. However, after 24 weeks the pivotal response treatment package group had higher ranked reciprocal vocal contingency scores than the control group. These findings are consistent with results from parent report and parent–child interaction measures obtained during the trial. The participants in the pivotal response treatment package exhibited greater vocal responsiveness to adult vocal responses to their vocalizations than the control group. Findings support the effectiveness of the pivotal response treatment package on vocal reciprocity of children with autism spectrum disorder, which may be a pivotal skill for language development.
      Citation: Autism
      PubDate: 2020-02-14T09:05:34Z
      DOI: 10.1177/1362361320903138
       
  • Factor structure and psychometric properties of the brief
           Connor–Davidson Resilience Scale for adults on the autism spectrum
    • Authors: Ye In (Jane) Hwang, Samuel Arnold, Julian Trollor, Mirko Uljarević
      First page: 1572
      Abstract: Autism, Ahead of Print.
      Resilience is an increasingly popular concept in literature as a protective factor against mental ill-health. While elevated rates of anxiety and mood disorders occur in adults on the autism spectrum, there is a gap in literature investigating the application of resilience to this population. This brief report examined the factor structure and psychometric properties of the 10-item Connor–Davidson Resilience Scale in a sample of 95 autistic adults (Mage = 44). Our findings provide evidence for a unidimensional structure and robust psychometric properties of the scale in an autistic population, in line with factorial studies involving the general population.Lay AbstractAdults on the autism spectrum experience high rates of anxiety and depression, and may be particularly vulnerable to difficult and traumatic life experiences, which may contribute to the development and maintenance of these conditions. Resilience is an increasingly popular concept in research, which describes the ability to ‘bounce back’ following difficult emotional experiences, and the flexibility to adapt to stressful and demanding situations. The Connor–Davidson Resilience Scale has been used predominantly in studies involving non-autistic adults to measure resilience. While resilience is a potentially important concept for autistic adults, the suitability of the 10-item version of the Connor–Davidson Resilience Scale for use with adults on the spectrum has not yet been studied. In this short report, we investigate whether the Connor–Davidson Resilience Scale 10 is a valid measure to use with this population, and its relationship with other measures of mental well- or ill-being. Participants were 95 autistic adults with a mean age of 44 (63% female) who completed measures of resilience, autism symptoms, depression, anxiety and mental wellbeing. Overall, the findings indicate that the Connor–Davidson Resilience Scale 10 may be reliably used with autistic adults to measure trait resilience, which is associated with positive wellbeing and may serve as a protective factor from negative mental wellbeing. Future studies may use the Connor–Davidson Resilience Scale 10 to investigate resilience as a protective factor from negative mental health outcomes in response to traumatic and adverse emotional events for which autistic individuals may be particularly susceptible.
      Citation: Autism
      PubDate: 2020-03-14T04:48:55Z
      DOI: 10.1177/1362361320908095
       
  • Contextual determinants of parental reflective functioning: Children with
           autism versus their typically developing siblings
    • Authors: Yael Enav, Dana Erhard-Weiss, Amit Goldenberg, Marguerite Knudston, Antonio Y Hardan, James J Gross
      First page: 1578
      Abstract: Autism, Ahead of Print.
      Parental reflective functioning is defined as holding in mind one’s child’s thoughts, feelings, beliefs, and intentions and reflecting on how these mental states may be affecting the child’s behavior. Although parental reflective functioning is often treated as a stable feature of the parent, there is growing appreciation that it may be shaped by the context in which the parent is operating. In this study, we examined parental reflective functioning using the Parental Developmental Interview when parents were talking about their interactions with their child with autism versus the child’s typically developing siblings. Our sample included 30 parents who had a child between the ages of 3 and 18 years with a clinical diagnosis of autism spectrum disorder and at least one typically developing child. Findings indicated that parents exhibited significantly higher reflective functioning when interacting with their child with autism spectrum disorder versus the typically developing siblings, and the difference was moderated by parental self-efficacy. The evidence for a disparity in parental reflective functioning between children with autism spectrum disorder and their typically developing siblings (especially for parents with low parental self-efficacy) warrants further investigations that might lead to the development of effective interventions.Lay AbstractIn this study, we examined parental reflective functioning using the Parental Developmental Interview when parents were talking about their interactions with their child with autism versus the child’s typically developing siblings. Our sample included 30 parents who had a child between the ages of 3 and 18 years with a clinical diagnosis of autism spectrum disorder and at least one typically developing child. Findings indicated that parents exhibited significantly higher reflective functioning when interacting with their child with autism spectrum disorder versus the typically developing siblings, and the difference was moderated by parental self-efficacy.
      Citation: Autism
      PubDate: 2020-03-14T04:51:15Z
      DOI: 10.1177/1362361320908096
       
 
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