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Dwyer P, Sillas A, Prieto M, Camp E, Nordahl CW, Rivera SM. Hyper-focus, sticky attention, and springy attention in young autistic children: Associations with sensory behaviors and cognitive ability. Autism Res 2024. [PMID: 38840328 DOI: 10.1002/aur.3174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
The autistic-developed monotropism account suggests that atypical, domain-general attentional hyper-focus on interests is a central aspect of autism, but domain-general attention differences in autism can manifest differently. Prior research suggests autistic children are often slow to disengage attention from stimuli-a pattern often called "sticky attention"-and that they can show reduced novelty preference. These attentional patterns could influence sensory experiences and learning. We used eye-tracking to investigate novelty preference and "sticky attention" in young autistic children; we also examined whether attentional patterns were related to cognitive abilities and caregiver-reported sensory responsiveness. A total of 46 autistic and 28 nonautistic participants, aged between 2 and 4 years, provided usable data. We found no evidence that autistic children exhibited greater "sticky attention" than nonautistics, but "sticky attention" in autism was associated with more caregiver-reported sensory hyper-responsiveness, seeking/interests, and enhanced perception. Autistic children also nonsignificantly trended toward exhibiting reduced novelty preference. Unexpectedly, the time-course of this trending novelty preference difference implied it was not driven by reduced orienting to novelty, but increased returning to already-familiarized stimuli: what we call "springy attention." Exploratory analyses of data from the attentional disengagement task suggest autistic participants may have exhibited greater "springy attention," though further research with paradigms optimized for measuring this construct should confirm this. Importantly, "springy attention" was robustly related to reduced cognitive abilities and greater caregiver-reported hypo-responsiveness. Thus, this study illuminates two distinct domain-general attentional patterns, each with distinct correlates in young autistic children, which could have important implications for understanding autistic children's learning, development, and experiences.
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Affiliation(s)
- Patrick Dwyer
- Center for Mind and Brain, University of California, Davis, Davis, California, USA
- Department of Psychology, University of California, Davis, Davis, California, USA
- MIND Institute, UC Davis Health, Sacramento, California, USA
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Andre Sillas
- Center for Mind and Brain, University of California, Davis, Davis, California, USA
| | - Melanie Prieto
- Center for Mind and Brain, University of California, Davis, Davis, California, USA
- Department of Psychology, University of California, Santa Cruz, California, USA
| | - Emily Camp
- Center for Mind and Brain, University of California, Davis, Davis, California, USA
- Department of Psychology, University of California, Davis, Davis, California, USA
| | - Christine Wu Nordahl
- MIND Institute, UC Davis Health, Sacramento, California, USA
- Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA, USA
| | - Susan M Rivera
- Center for Mind and Brain, University of California, Davis, Davis, California, USA
- Department of Psychology, University of California, Davis, Davis, California, USA
- MIND Institute, UC Davis Health, Sacramento, California, USA
- Department of Psychology, University of Maryland, College Park, Maryland, USA
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2
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Levine MA, Chen H, Wodka EL, Caffo BS, Ewen JB. Autism Symptom Presentation and Hierarchical Models of Intelligence. J Autism Dev Disord 2024:10.1007/s10803-024-06411-5. [PMID: 38833030 DOI: 10.1007/s10803-024-06411-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND There is a substantial history studying the relationship between general intelligence and the core symptoms of autism. However, a gap in knowledge is how dimensional autism symptomatology associates with different components of clinically-relevant hierarchical models of intelligence. METHOD We examined correlations between autism diagnostic symptom magnitude (Autism Diagnostic Observational Schedule; ADOS) and a hierarchical statistical model of intelligence. One autistic cohort was tested on the fourth edition of Wechsler Intelligence Scale for Children (WISC-IV; N = 131), and another on the fifth edition (WISC-V; N = 83). We anticipated a convergent pattern of results between cohorts. RESULTS On WISC-IV, ADOS scores were correlated significantly with g and three out of four intermediate factor scores, which was a broader pattern of correlations than anticipated from the literature. In the WISC-V cohort, only one intermediate factor correlated significantly with the ADOS; correlations with g and the other intermediate factors were less statistically certain. ADOS-factor correlations were larger in the WISC-IV than WISC-V cohort; this difference was significant at the 90% level. CONCLUSIONS WISC-IV shows dimensional relationships with ADOS at multiple points in the hierarchical model of intelligence. Moreover, the current results provide evidence that relationship between core autism symptomatology and the construct of general intelligence may depend on how intelligence is measured. Known cohort effects in the relationship between categorical autism diagnosis and general intelligence have previously been attributed to changes in autism diagnostic practices. To our knowledge, this is the first evidence that differing versions of IQ tests may be implicated.
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Affiliation(s)
- Michael A Levine
- Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Huan Chen
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ericka L Wodka
- Center for Autism Service, Science and Innovation, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian S Caffo
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joshua B Ewen
- Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA.
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Division of Developmental & Behavioral Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Box 119, Chicago, IL, 60611, USA.
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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3
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Andrews DS, Diers K, Lee JK, Harvey DJ, Heath B, Cordero D, Rogers SJ, Reuter M, Solomon M, Amaral DG, Nordahl CW. Sex differences in trajectories of cortical development in autistic children from 2-13 years of age. Mol Psychiatry 2024:10.1038/s41380-024-02592-8. [PMID: 38755243 DOI: 10.1038/s41380-024-02592-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024]
Abstract
Previous studies have reported alterations in cortical thickness in autism. However, few have included enough autistic females to determine if there are sex specific differences in cortical structure in autism. This longitudinal study aimed to investigate autistic sex differences in cortical thickness and trajectory of cortical thinning across childhood. Participants included 290 autistic (88 females) and 139 nonautistic (60 females) individuals assessed at up to 4 timepoints spanning ~2-13 years of age (918 total MRI timepoints). Estimates of cortical thickness in early and late childhood as well as the trajectory of cortical thinning were modeled using spatiotemporal linear mixed effects models of age-by-sex-by-diagnosis. Additionally, the spatial correspondence between cortical maps of sex-by-diagnosis differences and neurotypical sex differences were evaluated. Relative to their nonautistic peers, autistic females had more extensive cortical differences than autistic males. These differences involved multiple functional networks, and were mainly characterized by thicker cortex at ~3 years of age and faster cortical thinning in autistic females. Cortical regions in which autistic alterations were different between the sexes significantly overlapped with regions that differed by sex in neurotypical development. Autistic females and males demonstrated some shared differences in cortical thickness and rate of cortical thinning across childhood relative to their nonautistic peers, however these areas were relatively small compared to the widespread differences observed across the sexes. These results support evidence of sex-specific neurobiology in autism and suggest that processes that regulate sex differentiation in the neurotypical brain contribute to sex differences in the etiology of autism.
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Affiliation(s)
- Derek S Andrews
- Department of Psychiatry & Behavioral Sciences, the MIND Institute, University of California, Davis, CA, USA.
| | - Kersten Diers
- AI in Medical Imaging, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Joshua K Lee
- Department of Psychiatry & Behavioral Sciences, the MIND Institute, University of California, Davis, CA, USA
| | - Danielle J Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California, University of California, Davis, CA, USA
| | - Brianna Heath
- Department of Psychiatry & Behavioral Sciences, the MIND Institute, University of California, Davis, CA, USA
| | - Devani Cordero
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Sally J Rogers
- Department of Psychiatry & Behavioral Sciences, the MIND Institute, University of California, Davis, CA, USA
| | - Martin Reuter
- AI in Medical Imaging, German Center for Neurodegenerative Diseases, Bonn, Germany
- A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Marjorie Solomon
- Department of Psychiatry & Behavioral Sciences, the MIND Institute, University of California, Davis, CA, USA
| | - David G Amaral
- Department of Psychiatry & Behavioral Sciences, the MIND Institute, University of California, Davis, CA, USA
| | - Christine Wu Nordahl
- Department of Psychiatry & Behavioral Sciences, the MIND Institute, University of California, Davis, CA, USA
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4
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Waizbard-Bartov E, Ferrer E, Heath B, Andrews DS, Rogers S, Kerns CM, Wu Nordahl C, Solomon M, Amaral DG. Changes in the severity of autism symptom domains are related to mental health challenges during middle childhood. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1216-1230. [PMID: 37691349 PMCID: PMC10924781 DOI: 10.1177/13623613231195108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
LAY ABSTRACT For many autistic children, the severity of their autism symptoms changes during middle childhood. We studied whether these changes are associated with the emergence of other mental health challenges such as anxiety and attention-deficit hyperactivity disorder. Children who had increased social-communication challenges had more anxiety and attention-deficit hyperactivity disorder symptoms and disruptive behavior problems than other children. Children who decreased their restricted and repetitive behaviors, on the contrary, had more anxiety. We discuss why these changes in autism symptoms may lead to increases in other mental health concerns.
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Peristeri E, Andreou M. Intellectual development in young children with autism spectrum disorders: A longitudinal study. Autism Res 2024; 17:543-554. [PMID: 38183366 DOI: 10.1002/aur.3089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/14/2023] [Indexed: 01/08/2024]
Abstract
Intelligence profiles in autism have been characterized by great variability. The questions of how autistic children's intelligence changes over time, and what factors influence these changes deserve study as part of efforts to document child autism profiles, but also because the relationship between intellectual functioning and children's background characteristics is poorly understood, particularly in a longitudinal context. A total of 39 autistic children and 39 age-matched neurotypical children (5-9 years old) completed two IQ assessments at preschool age and up to 4 years later. Repeated-measures analyses assessed longitudinal changes in the children's verbal (VIQ), performance (PIQ), and full-scale IQ (FSIQ) at group level. We further sought to identify clusters with distinct profiles in each group by adopting an unsupervised K-means clustering approach, and detect possible between-subgroup differences in terms of children's socioeconomic status and autism severity. The largest cluster in the autistic group was composed of children whose PIQ significantly dropped at follow-up, while the second largest cluster improved in all quotients; the smallest cluster, wherein children had more highly educated mothers than the rest of the clusters, was characterized by large improvement in VIQ. For the neurotypical children, there was a two-cluster division; the majority of them improved in the three quotients, while very few dropped in PIQ at follow-up. The relation between socioeconomic status and IQ changes was significant for both groups. The findings demonstrate both the complexity of intelligence changes in autism and the need to view this complexity through the lens of the children's socioeconomic diversity.
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Affiliation(s)
- Eleni Peristeri
- Department of Theoretical and Applied Linguistics, School of English, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Andreou
- Department of Speech and Language Therapy, University of Peloponnese, Kalamata, Greece
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Girard D, Courchesne V, Cimon-Paquet C, Jacques C, Soulières I. Visual abilities and exploration behaviors as predictors of intelligence in autistic children from preschool to school age. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2446-2464. [PMID: 37113016 DOI: 10.1177/13623613231166189] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
LAY ABSTRACT At the time of diagnosis, parents of autistic children frequently wonder what the future holds for their children in terms of intellectual development. It remains however difficult to answer this question at such a young age. Indeed, while early precursors of intelligence are well known for children following a typical development, these precursors remain to be identified for autistic children. Some theoretical models of intelligence suggest that perceptual abilities or behaviors, as seen early in autistic cognitive development, could be early indicators of intelligence. However, research examining the relation between early perceptual predictors and autistic intelligence over time is needed. This article is the first to consider a variety of early perceptual abilities and behaviors as precursors/predictors of intelligence at school age in autistic children. We showed that better performance in perceptual tasks at preschool age predicted better intellectual abilities measured later in autistic children. Importantly, our sample of autistic children represented the whole spectrum, including children with few to no spoken words, who are an important proportion of autistic preschoolers. While early perceptual abilities and behaviors may not substitute for a formal intellectual assessment, our results support that these indices may help estimate later intellectual level in autistic children. Perceptual abilities have the advantage to be easy to observe at preschool age and seem to fit the cognitive style of autistic children. Assessment methods could probably gain from including and focusing more on the perceptual strengths of autistic children.
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Affiliation(s)
- Dominique Girard
- Autism Research Group, CIUSSS-NIM, Hôpital en santé mentale Rivière-des-Prairies, Montreal, Canada
| | - Valérie Courchesne
- Autism Research Group, CIUSSS-NIM, Hôpital en santé mentale Rivière-des-Prairies, Montreal, Canada
| | | | - Claudine Jacques
- Department of psychoedcation and psychology, Université du Québec en Outaouais, Canada
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Tsiplova K, Ungar WJ. Why it is so challenging to perform economic evaluations of interventions in autism and what to do about it. Autism Res 2023; 16:2061-2070. [PMID: 37606004 DOI: 10.1002/aur.3014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/29/2023] [Indexed: 08/23/2023]
Abstract
Economic evaluation is used to determine the optimal provision of services and programs under budget constraints and to inform public and private payer funding decisions. To maximize value-for-money in the design and delivery of programs and services for persons with autism spectrum disorder (ASD), it's essential to generate high-quality economic evidence to inform budget allocation. There is a paucity however, of economic evaluations of interventions for ASD. This is due in part to challenges in conducting economic evaluations in this population and the lack of guidance on suitable approaches. These challenges are related to the inherent heterogeneity of the autistic population; establishing short- and long-term effectiveness; measurement of costs and the availability of valid instruments for collecting economic data; the appropriateness of outcomes for use in economic evaluation; and achieving statistical power. This commentary addresses a lack of awareness and needed guidance on these issues by discussing the challenges and providing recommendations for how economic evaluations in ASD could be improved to generate high-quality evidence for program funding decision-making.
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Affiliation(s)
- Kate Tsiplova
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Wendy J Ungar
- Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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8
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Fountain C, Winter AS, Cheslack-Postava K, Bearman PS. Developmental Trajectories of Autism. Pediatrics 2023; 152:e2022058674. [PMID: 37615073 PMCID: PMC10551845 DOI: 10.1542/peds.2022-058674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVES The goal of this study was to describe the typical, longitudinal, developmental trajectories of communication and social functioning in individuals with autism spectrum disorder from childhood through adulthood and to determine the correlates of these trajectories. METHODS Children with autism spectrum disorder who were born in California from 1992 through 2016 and enrolled with the California Department of Developmental Services were identified. Subjects with <4 evaluations in the database were excluded, resulting in a sample of 71 285 individuals. Score sequences were constructed based on evaluative items for communication and social functioning. Typical trajectories were identified using group-based latent trajectory modeling, and logistic regression was used to determine the odds of classification into a social adolescent decline trajectory by individual-, family-, and zip code-level factors. RESULTS Six typical patterns of communication functioning and 7 typical patterns of social functioning were identified. Whereas the majority of autistic individuals exhibit improved communication functioning as they age, the majority of individuals exhibit steady social functioning. A small group of individuals (5.0%) exhibits high social functioning in childhood that declines in adolescence. Membership in this adolescent decline group is associated with maternal non-Hispanic white race and ethnicity, female sex, moderate levels of maternal education, lower zip code-level median home values and population density, and higher zip code-level inequality. CONCLUSIONS Most autistic individuals show improved communication and social functioning as they age, but not all do. Trajectory group membership is correlated with socioeconomic status. Future research should investigate what drives these correlations.
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Affiliation(s)
- Christine Fountain
- Department of Anthropology & Sociology, Fordham
University, New York, NY
| | - Alix S. Winter
- Interdisciplinary Center for Innovative Theory and
Empirics, Columbia University, New York, NY
| | | | - Peter S. Bearman
- Interdisciplinary Center for Innovative Theory and
Empirics, Columbia University, New York, NY
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Solomon M, Cho A(B, Iosif A, Heath B, Srivastav A, Wu Nordahl C, Ferrer E, Amaral D. IQ trajectories in autistic children through preadolescence. JCPP ADVANCES 2023; 3:e12127. [PMID: 37397281 PMCID: PMC10241474 DOI: 10.1002/jcv2.12127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/10/2022] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND We extended our study of trajectories of intellectual development of autistic individuals in early (mean age 3 years; T1), and middle childhood (mean age 5 years, 7 months; T2) into later middle childhood/preadolescence (mean age 11 years, 6 months; T3) in the longitudinal Autism Phenome Project cohort. Participants included 373 autistic children (115 females). METHODS Multivariate latent class growth analysis was used to identify distinct IQ trajectory subgroups. Baseline and developmental course group differences and predictors of trajectory membership were assessed using linear mixed effects models with repeated measures with pairwise testing, multinomial logistic regression models, and sensitivity analyses. RESULTS We isolated three IQ trajectories between T1 and T3 for autistic youth that were similar to those found in our prior work. These included a group with persistent intellectual disability (ID; 45%), a group with substantial increases in IQ (CHG; 39%), and a group with persistently average or above IQs (P-High; 16%). By T3, the groups did not differ in ADOS-2 calibrated severity scores (CSS), and there were no group differences between Vineland (VABS) communication scores in CHG and P-High. T1-T3 externalizing behaviors declined significantly for CHG, however, there were no significant T3 group differences between internalizing or externalizing symptoms. T1 correlates for CHG and P-High versus ID group membership included higher VABS communication and lower ADOS-2 CSS. A T1 to T2 increase in VABS communication scores and a decline in externalizing predicted CHG versus ID group membership at T3, while T1 to T2 improvement in VABS communication and reduction in ADOS-2 CSS predicted P-High versus ID group membership. CONCLUSIONS Autistic youth exhibit consistent IQ developmental trajectories from early childhood through preadolescence. Factors associated with trajectory group membership may provide clues about prognosis, and the need for treatments that improve adaptive communication and externalizing symptoms.
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Affiliation(s)
- Marjorie Solomon
- Department of Psychiatry and Behavioral SciencesUniversity of California‐DavisSacramentoCaliforniaUSA
- Imaging Research CenterSacramentoCaliforniaUSA
- MIND InstituteSacramentoCaliforniaUSA
| | - An‐Chuen (Billy) Cho
- Department of Psychiatry and Behavioral SciencesUniversity of California‐DavisSacramentoCaliforniaUSA
- MIND InstituteSacramentoCaliforniaUSA
| | - Ana‐Maria Iosif
- Department of Public Health SciencesUniversity of California‐DavisDavisCaliforniaUSA
| | - Brianna Heath
- Department of Psychiatry and Behavioral SciencesUniversity of California‐DavisSacramentoCaliforniaUSA
- MIND InstituteSacramentoCaliforniaUSA
| | - Apurv Srivastav
- Department of Public Health SciencesUniversity of California‐DavisDavisCaliforniaUSA
| | - Christine Wu Nordahl
- Department of Psychiatry and Behavioral SciencesUniversity of California‐DavisSacramentoCaliforniaUSA
- MIND InstituteSacramentoCaliforniaUSA
| | - Emilio Ferrer
- Department of PsychologyUniversity of California‐DavisDavisCaliforniaUSA
| | - David Amaral
- Department of Psychiatry and Behavioral SciencesUniversity of California‐DavisSacramentoCaliforniaUSA
- MIND InstituteSacramentoCaliforniaUSA
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Ji Y, Ji Y, Zhu HL, Cheng SM, Zou XB, Zhu FL. Examine sex differences in autism spectrum disorder in school-aged children and adolescents with fluent language. Front Psychiatry 2023; 14:1151596. [PMID: 37091718 PMCID: PMC10117662 DOI: 10.3389/fpsyt.2023.1151596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/13/2023] [Indexed: 04/25/2023] Open
Abstract
There are noteworthy sex disparities in the prevalence of autism spectrum disorders (ASD), while findings regarding the sex differences in core symptoms are inconsistent. There are few relevant studies on sex differences in mainland China. This study was dedicated to a deeper understanding of the impact of sex differences on the clinical presentation of ASD with fluent language. We retrospectively studied 301 children with ASD (58 females) and utilized raw scores from the ADI-R and ADOS and the intelligence quotient (IQ) to measure symptomatology. Based on the Full-Scale IQ (FS-IQ), a binary split of average, above-average IQ (high-IQ), and below-average IQ (low IQ) occurs at 85. Across the entire sample, males and females are comparable in the FS-IQ, while males scored higher in the Perceptual Reasoning Index (PRI) (F = 7.812, p = 0.006). ADI-R did not find any statistically significant sex differences in the diagnostic cutoff score satisfaction or the raw domain scores. While a significant effect of sex on ADOS social affect domain scores was found in the total sample [λ = 0.970, partial η2 = 0.030, F (3,295) = 3.019, p = 0.030]. Tests of between-subjects effects revealed that males scored higher than females mainly in the ADOS reciprocal social interaction subcategory (partial η2 = 0.022, F = 6.563, p = 0.011). Stratified analysis revealed that the effect of sex on ADOS reciprocal social interaction subcategory scores only significant in the low-IQ children with ASD (partial η2 = 0.092, F = 10.088, p = 0.002). In general, overall cognitive functioning is similar across males and females with ASD, while males have a higher perceptual reasoning ability. Females with ASD are more likely to have comorbid intellectual impairment than males, and they could require additional intervention support. Autistic children with low IQs are more likely to exhibit sex differences in their core symptoms than children with high IQs. Intelligence plays a key role in sex-based differences in the core symptoms of ASD.
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11
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Lee JK, Cho ACB, Andrews DS, Ozonoff S, Rogers SJ, Amaral DG, Solomon M, Nordahl CW. Default mode and fronto-parietal network associations with IQ development across childhood in autism. J Neurodev Disord 2022; 14:51. [PMID: 36109700 PMCID: PMC9479280 DOI: 10.1186/s11689-022-09460-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Intellectual disability affects approximately one third of individuals with autism spectrum disorder (autism). Yet, a major unresolved neurobiological question is what differentiates autistic individuals with and without intellectual disability. Intelligence quotients (IQs) are highly variable during childhood. We previously identified three subgroups of autistic children with different trajectories of intellectual development from early (2–3½ years) to middle childhood (9–12 years): (a) persistently high: individuals whose IQs remained in the normal range; (b) persistently low: individuals whose IQs remained in the range of intellectual disability (IQ < 70); and (c) changers: individuals whose IQs began in the range of intellectual disability but increased to the normal IQ range. The frontoparietal (FPN) and default mode (DMN) networks have established links to intellectual functioning. Here, we tested whether brain regions within the FPN and DMN differed volumetrically between these IQ trajectory groups in early childhood. Methods We conducted multivariate distance matrix regression to examine the brain regions within the FPN (11 regions x 2 hemispheres) and the DMN (12 regions x 2 hemispheres) in 48 persistently high (18 female), 108 persistently low (32 female), and 109 changers (39 female) using structural MRI acquired at baseline. FPN and DMN regions were defined using networks identified in Smith et al. (Proc Natl Acad Sci U S A 106:13040–5, 2009). IQ trajectory groups were defined by IQ measurements from up to three time points spanning early to middle childhood (mean age time 1: 3.2 years; time 2: 5.4 years; time 3: 11.3 years). Results The changers group exhibited volumetric differences in the DMN compared to both the persistently low and persistently high groups at time 1. However, the persistently high group did not differ from the persistently low group, suggesting that DMN structure may be an early predictor for change in IQ trajectory. In contrast, the persistently high group exhibited differences in the FPN compared to both the persistently low and changers groups, suggesting differences related more to concurrent IQ and the absence of intellectual disability. Conclusions Within autism, volumetric differences of brain regions within the DMN in early childhood may differentiate individuals with persistently low IQ from those with low IQ that improves through childhood. Structural differences in brain networks between these three IQ-based subgroups highlight distinct neural underpinnings of these autism sub-phenotypes. Supplementary Information The online version contains supplementary material available at 10.1186/s11689-022-09460-y.
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12
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Weitlauf AS, Broderick N, Alacia Stainbrook J, Slaughter JC, Taylor JL, Herrington CG, Nicholson AG, Santulli M, Dorris K, Garrett LJ, Hopton M, Kinsman A, Morton M, Vogel A, Dykens EM, Pablo Juárez A, Warren ZE. A Longitudinal RCT of P-ESDM With and Without Parental Mindfulness Based Stress Reduction: Impact on Child Outcomes. J Autism Dev Disord 2022; 52:5403-5413. [PMID: 35040001 PMCID: PMC9289080 DOI: 10.1007/s10803-021-05399-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
This randomized controlled trial (NCT03889821) examined Mindfulness Based Stress Reduction (MBSR) in conjunction with the Parent-implemented Early Start Denver Model (P-ESDM). A previous report described improved metrics of parental distress (Weitlauf et al. in Pediatrics 145(Supplement 1):S81-S92, 2020). This manuscript examines child outcomes. 63 children with ASD (< 36 months) and their parents received 12 P-ESDM sessions. Half of parents also received MBSR. Longitudinal examination of whole sample means revealed modest improvements in autism severity, cognitive, and adaptive skills. There was not a significant time × group interaction for children whose parents received MBSR. Future work should examine more proximal markers of child or dyadic change to enhance understanding of the impact of providing direct treatment for parents as part of early intervention initiatives.
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Affiliation(s)
- Amy S Weitlauf
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Neill Broderick
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Alacia Stainbrook
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA
| | - Julie Lounds Taylor
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Amy G Nicholson
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Madeline Santulli
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristin Dorris
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Michelle Hopton
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amy Kinsman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mary Morton
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ashley Vogel
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elisabeth M Dykens
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - A Pablo Juárez
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
| | - Zachary E Warren
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
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13
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Prigge MBD, Bigler ED, Lange N, Morgan J, Froehlich A, Freeman A, Kellett K, Kane KL, King CK, Taylor J, Dean DC, King JB, Anderson JS, Zielinski BA, Alexander AL, Lainhart JE. Longitudinal Stability of Intellectual Functioning in Autism Spectrum Disorder: From Age 3 Through Mid-adulthood. J Autism Dev Disord 2022; 52:4490-4504. [PMID: 34677753 PMCID: PMC9090201 DOI: 10.1007/s10803-021-05227-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 12/02/2022]
Abstract
Intelligence (IQ) scores are used in educational and vocational planning for individuals with autism spectrum disorder (ASD) yet little is known about the stability of IQ throughout development. We examined longitudinal age-related IQ stability in 119 individuals with ASD (3-36 years of age at first visit) and 128 typically developing controls. Intelligence measures were collected over a 20-year period. In ASD, Full Scale (FSIQ) and Verbal (VIQ) Intelligence started lower in childhood and increased at a greater rate with age relative to the control group. By early adulthood, VIQ and working memory stabilized, whereas nonverbal and perceptual scores continued to change. Our results suggest that in individuals with ASD, IQ estimates may be dynamic in childhood and young adulthood.
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Affiliation(s)
- Molly B D Prigge
- Department of Radiology and Imaging Sciences, Radiology Research, University of Utah, 729 Arapeen Drive, Salt Lake City, UT, 84108, USA.
| | - Erin D Bigler
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT, USA
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
- Department of Neurology, University of California-Davis, Davis, CA, USA
| | - Nicholas Lange
- Department of Psychiatry, Harvard School of Medicine, Boston, MA, USA
| | - Jubel Morgan
- Department of Radiology and Imaging Sciences, Radiology Research, University of Utah, 729 Arapeen Drive, Salt Lake City, UT, 84108, USA
| | - Alyson Froehlich
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Abigail Freeman
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristina Kellett
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Karen L Kane
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Carolyn K King
- Department of Radiology and Imaging Sciences, Radiology Research, University of Utah, 729 Arapeen Drive, Salt Lake City, UT, 84108, USA
| | - June Taylor
- Department of Radiology and Imaging Sciences, Radiology Research, University of Utah, 729 Arapeen Drive, Salt Lake City, UT, 84108, USA
| | - Douglas C Dean
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Jace B King
- Department of Radiology and Imaging Sciences, Radiology Research, University of Utah, 729 Arapeen Drive, Salt Lake City, UT, 84108, USA
| | - Jeff S Anderson
- Department of Radiology and Imaging Sciences, Radiology Research, University of Utah, 729 Arapeen Drive, Salt Lake City, UT, 84108, USA
| | - Brandon A Zielinski
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Andrew L Alexander
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Janet E Lainhart
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
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14
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Billeiter KB, Froiland JM, Allen JP, Hajovsky DB. Neurodiversity and Intelligence: Evaluating the Flynn Effect in Children with Autism Spectrum Disorder. Child Psychiatry Hum Dev 2022; 53:919-927. [PMID: 33939111 DOI: 10.1007/s10578-021-01175-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
The Flynn Effect (FE) among child and adolescent populations indicates that intelligence scores improve by about three points per decade. Using nine years of data from the National Database for Autism Research, this study examined whether general intelligence changed significantly for nine cohorts with autism spectrum disorder (ASD; N = 671). Analyses demonstrated a downward trend such that Cohen's d from 1998 to 2006 was - 0.27. The mean IQ is 92.74 for years 1-3, 91.54 for years 4-6, and 87.34 for years 7-9, indicating a reverse FE of 5.4 points per decade. A linear regression revealed a significant negative FE comparable to the positive effect of age on IQ among those with ASD. Implications for research, practice, and law are discussed.
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Affiliation(s)
| | - John Mark Froiland
- Department of Educational Studies, Purdue University, West Lafayette, IN, USA
| | - Justin P Allen
- Department of Psychology, Sam Houston State University, Huntsville, TX, USA
| | - Daniel B Hajovsky
- Division of Counseling and Psychology in Education, University of South Dakota, Vermillion, SD, USA
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15
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Brignell A, Harwood RC, May T, Woolfenden S, Montgomery A, Iorio A, Williams K. Overall prognosis of preschool autism spectrum disorder diagnoses. Cochrane Database Syst Rev 2022; 9:CD012749. [PMID: 36169177 PMCID: PMC9516883 DOI: 10.1002/14651858.cd012749.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Autism spectrum disorder is a neurodevelopmental disorder characterised by social communication difficulties, restricted interests and repetitive behaviours. The clinical pathway for children with a diagnosis of autism spectrum disorder is varied, and current research suggests some children may not continue to meet diagnostic criteria over time. OBJECTIVES The primary objective of this review was to synthesise the available evidence on the proportion of preschool children who have a diagnosis of autism spectrum disorder at baseline (diagnosed before six years of age) who continue to meet diagnostic criteria at follow-up one or more years later (up to 19 years of age). SEARCH METHODS We searched MEDLINE, Embase, PsycINFO, and eight other databases in October 2017 and ran top-up searches up to July 2021. We also searched reference lists of relevant systematic reviews. SELECTION CRITERIA Two review authors independently assessed prospective and retrospective follow-up studies that used the same measure and process within studies to diagnose autism spectrum disorder at baseline and follow-up. Studies were required to have at least one year of follow-up and contain at least 10 participants. Participants were all aged less than six years at baseline assessment and followed up before 19 years of age. DATA COLLECTION AND ANALYSIS We extracted data on study characteristics and the proportion of children diagnosed with autism spectrum disorder at baseline and follow-up. We also collected information on change in scores on measures that assess the dimensions of autism spectrum disorder (i.e. social communication and restricted interests and repetitive behaviours). Two review authors independently extracted data on study characteristics and assessed risk of bias using a modified quality in prognosis studies (QUIPS) tool. We conducted a random-effects meta-analysis or narrative synthesis, depending on the type of data available. We also conducted prognostic factor analyses to explore factors that may predict diagnostic outcome. MAIN RESULTS In total, 49 studies met our inclusion criteria and 42 of these (11,740 participants) had data that could be extracted. Of the 42 studies, 25 (60%) were conducted in North America, 13 (31%) were conducted in Europe and the UK, and four (10%) in Asia. Most (52%) studies were published before 2014. The mean age of the participants was 3.19 years (range 1.13 to 5.0 years) at baseline and 6.12 years (range 3.0 to 12.14 years) at follow-up. The mean length of follow-up was 2.86 years (range 1.0 to 12.41 years). The majority of the children were boys (81%), and just over half (60%) of the studies primarily included participants with intellectual disability (intelligence quotient < 70). The mean sample size was 272 (range 10 to 8564). Sixty-nine per cent of studies used one diagnostic assessment tool, 24% used two tools and 7% used three or more tools. Diagnosis was decided by a multidisciplinary team in 41% of studies. No data were available for the outcomes of social communication and restricted and repetitive behaviours and interests. Of the 42 studies with available data, we were able to synthesise data from 34 studies (69% of all included studies; n = 11,129) in a meta-analysis. In summary, 92% (95% confidence interval 89% to 95%) of participants continued to meet diagnostic criteria for autism spectrum disorder from baseline to follow-up one or more years later; however, the quality of the evidence was judged as low due to study limitations and inconsistency. The majority of the included studies (95%) were rated at high risk of bias. We were unable to explore the outcomes of change in social communication and restricted and repetitive behaviour and interests between baseline and follow-up as none of the included studies provided separate domain scores at baseline and follow-up. Details on conflict of interest were reported in 24 studies. Funding support was reported by 30 studies, 12 studies omitted details on funding sources and two studies reported no funding support. Declared funding sources were categorised as government, university or non-government organisation or charity groups. We considered it unlikely funding sources would have significantly influenced the outcomes, given the nature of prognosis studies. AUTHORS' CONCLUSIONS Overall, we found that nine out of 10 children who were diagnosed with autism spectrum disorder before six years of age continued to meet diagnostic criteria for autism spectrum disorder a year or more later, however the evidence was uncertain. Confidence in the evidence was rated low using GRADE, due to heterogeneity and risk of bias, and there were few studies that included children diagnosed using a current classification system, such as the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the eleventh revision of the International Classification of Diseases (ICD-11). Future studies that are well-designed, prospective and specifically assess prognosis of autism spectrum disorder diagnoses are needed. These studies should also include contemporary diagnostic assessment methods across a broad range of participants and investigate a range of relevant prognostic factors.
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Affiliation(s)
- Amanda Brignell
- Department of Paediatrics, Monash University, Clayton, Australia
- Speech and language, Murdoch Children's Research Institute, Parkville, Australia
- Department of Speech Pathology, Australian Catholic University, Fitzroy, Australia
- Developmental Paediatrics, Monash Children's Hospital, Clayton, Australia
| | | | - Tamara May
- Department of Paediatrics, Monash University, Clayton, Australia
| | - Susan Woolfenden
- Community Child Health, Sydney Children's Hospital Network, Randwick, Australia
- School of Women's & Children's Health, UNSW Medicine, UNSW Sydney, Kensington, Australia
| | - Alicia Montgomery
- Community Child Health, Sydney Children's Hospital Network, Randwick, Australia
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Canada
| | - Katrina Williams
- Department of Paediatrics, Monash University, Clayton, Australia
- Developmental Paediatrics, Monash Children's Hospital, Clayton, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia
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16
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Brefort E, Saint-Georges-Chaumet Y, Cohen D, Saint-Georges C. Two-year follow-up of 90 children with autism spectrum disorder receiving intensive developmental play therapy (3i method). BMC Pediatr 2022; 22:373. [PMID: 35764975 PMCID: PMC9238102 DOI: 10.1186/s12887-022-03431-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 06/13/2022] [Indexed: 12/27/2022] Open
Abstract
Background The Intensive, Interactive, and Individual (3i) intervention approach aims to decrease the severity of autism spectrum disorder (ASD) using intensive developmental play therapy (3i). We performed a retrospective study of 90 children who were enrolled for 2 years in the 3i approach to assess changes and predictors of changes in ASD severity at follow-up (FU). Methods The ASD severity of all patients (N = 119) who began 3i intervention between 2013 and 2018 was systematically measured using the childhood autism rating scale (CARS) and autism diagnosis interview-revised (ADI-R). Among them, 90 patients (mean age 5.6 ± 3.7 years) had a second assessment at the 2 year FU. CARS and ADI-R scores after 2 years of 3i intervention were compared to baseline scores using paired student’s t-tests. We used multiple linear regression models to assess the weight of baseline variables (e.g., age, oral language, sex, treatment intensity) on changes at the 2 year FU. Results Mean CARS and ADI-R subscores (interaction, communication, repetitive behaviour) decreased significantly by 20, 41, 27.5 and 25%, respectively (effect sizes: d > 0.8). Moreover, 55 and 46.7% of participants switched to a lower category of ASD severity based on the CARS scale and ADI-R interview, respectively. Multiple linear models showed that (i) a higher treatment intensity (more than 30 h per week) was significantly associated with a greater decrease (improvement) in the ADI-R interaction score; (ii) patients categorized as verbal subjects at baseline were associated with a better outcome, as ascertained by the CARS, ADI-R interaction and ADI-R communication scores; and (iii) older patients were significantly associated with a greater decrease in the ADI-R interaction score. However, we found no impact of sex, severity of ASD or comorbidities at baseline. Conclusion This study performed on 90 children suggests that 3i therapy may allow for a significant reduction in ASD severity with improvements in interaction, communication, and repetitive behaviours. A study using a control group is required to assess the efficacy of 3i play therapy compared to other interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03431-x.
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Affiliation(s)
| | | | - David Cohen
- Department of Child and Adolescent Psychiatry, Hôpital de la Pitié-Salpêtrière, Sorbonne University, 75013, Paris, France.,Institut des Systèmes Intelligents et de Robotiques, CNRS UMR 7222, Sorbonne University, Paris, France
| | - Catherine Saint-Georges
- Department of Child and Adolescent Psychiatry, Hôpital de la Pitié-Salpêtrière, Sorbonne University, 75013, Paris, France. .,Institut des Systèmes Intelligents et de Robotiques, CNRS UMR 7222, Sorbonne University, Paris, France.
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17
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Wolff N, Eberlein M, Stroth S, Poustka L, Roepke S, Kamp-Becker I, Roessner V. Abilities and Disabilities-Applying Machine Learning to Disentangle the Role of Intelligence in Diagnosing Autism Spectrum Disorders. Front Psychiatry 2022; 13:826043. [PMID: 35308891 PMCID: PMC8927055 DOI: 10.3389/fpsyt.2022.826043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/10/2022] [Indexed: 12/25/2022] Open
Abstract
Objective Although autism spectrum disorder (ASD) is a relatively common, well-known but heterogeneous neuropsychiatric disorder, specific knowledge about characteristics of this heterogeneity is scarce. There is consensus that IQ contributes to this heterogeneity as well as complicates diagnostics and treatment planning. In this study, we assessed the accuracy of the Autism Diagnostic Observation Schedule (ADOS/2) in the whole and IQ-defined subsamples, and analyzed if the ADOS/2 accuracy may be increased by the application of machine learning (ML) algorithms that processed additional information including the IQ level. Methods The study included 1,084 individuals: 440 individuals with ASD (with a mean IQ level of 3.3 ± 1.5) and 644 individuals without ASD (with a mean IQ level of 3.2 ± 1.2). We applied and analyzed Random Forest (RF) and Decision Tree (DT) to the ADOS/2 data, compared their accuracy to ADOS/2 cutoff algorithms, and examined most relevant items to distinguish between ASD and Non-ASD. In sum, we included 49 individual features, independently of the applied ADOS module. Results In DT analyses, we observed that for the decision ASD/Non-ASD, solely one to four items are sufficient to differentiate between groups with high accuracy. In addition, in sub-cohorts of individuals with (a) below (IQ level ≥4)/ID and (b) above average intelligence (IQ level ≤ 2), the ADOS/2 cutoff showed reduced accuracy. This reduced accuracy results in (a) a three times higher risk of false-positive diagnoses or (b) a 1.7 higher risk for false-negative diagnoses; both errors could be significantly decreased by the application of the alternative ML algorithms. Conclusions Using ML algorithms showed that a small set of ADOS/2 items could help clinicians to more accurately detect ASD in clinical practice across all IQ levels and to increase diagnostic accuracy especially in individuals with below and above average IQ level.
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Affiliation(s)
- Nicole Wolff
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Matthias Eberlein
- Institute of Circuits and Systems, Faculty of Electrical and Computer Engineering, Technische Universität Dresden, Dresden, Germany
| | - Sanna Stroth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University, Marburg, Germany
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Stefan Roepke
- Department of Psychiatry, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Inge Kamp-Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University, Marburg, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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18
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Nordahl CW, Andrews DS, Dwyer P, Waizbard-Bartov E, Restrepo B, Lee JK, Heath B, Saron C, Rivera SM, Solomon M, Ashwood P, Amaral DG. The Autism Phenome Project: Toward Identifying Clinically Meaningful Subgroups of Autism. Front Neurosci 2022; 15:786220. [PMID: 35110990 PMCID: PMC8801875 DOI: 10.3389/fnins.2021.786220] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/20/2021] [Indexed: 12/23/2022] Open
Abstract
One of the most universally accepted facts about autism is that it is heterogenous. Individuals diagnosed with autism spectrum disorder have a wide range of behavioral presentations and a variety of co-occurring medical and mental health conditions. The identification of more homogenous subgroups is likely to lead to a better understanding of etiologies as well as more targeted interventions and treatments. In 2006, we initiated the UC Davis MIND Institute Autism Phenome Project (APP) with the overarching goal of identifying clinically meaningful subtypes of autism. This ongoing longitudinal multidisciplinary study now includes over 400 children and involves comprehensive medical, behavioral, and neuroimaging assessments from early childhood through adolescence (2-19 years of age). We have employed several strategies to identify sub-populations within autistic individuals: subgrouping by neural, biological, behavioral or clinical characteristics as well as by developmental trajectories. In this Mini Review, we summarize findings to date from the APP cohort and describe progress made toward identifying meaningful subgroups of autism.
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Affiliation(s)
- Christine Wu Nordahl
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Derek Sayre Andrews
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Patrick Dwyer
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States
- Department of Psychology, University of California, Davis, Davis, CA, United States
| | - Einat Waizbard-Bartov
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Bibiana Restrepo
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Pediatrics, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Joshua K. Lee
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Brianna Heath
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Clifford Saron
- MIND Institute, University of California, Davis, Davis, CA, United States
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States
| | - Susan M. Rivera
- MIND Institute, University of California, Davis, Davis, CA, United States
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States
- Department of Psychology, University of California, Davis, Davis, CA, United States
| | - Marjorie Solomon
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Paul Ashwood
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Medical Microbiology and Immunology, School of Medicine, University of California, Davis, Davis, CA, United States
| | - David G. Amaral
- MIND Institute, University of California, Davis, Davis, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, Davis, Davis, CA, United States
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19
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Fennell LCP, Johnson SA. Examination of professional biases about autism: how can we do better? Clin Neuropsychol 2021; 36:1094-1115. [PMID: 34369298 DOI: 10.1080/13854046.2021.1958922] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This paper lends a critical eye to six common assumptions/biases about autism that may influence neuropsychologists in their clinical work. These biases are based on research as well as the historical roots of the study of autism. Our goal is to encourage curiosity and reflection on these biases in order to improve neuropsychological service delivery for people on the autism spectrum. Methods: We argue that psychologists should strive to understand the function of behaviours observed with autism in order to offer helpful supports. We explore the assertions that autism is not a dichotomous or linear construct and that the use of high and low functioning descriptors are not useful nor appreciated by the autism community. We discuss the widely held beliefs that individuals on the autism spectrum lack theory of mind, empathy and social motivation. Importantly, people on the autism spectrum are telling us that the dialogue about them around theory of mind and empathy is a human rights issue. Finally, we discuss the role of standardized testing. Conclusions: Through an exploration of research literature, the writings of scholars and advocates on the autism spectrum, and personal, clinical and research experience we encourage our profession to take a leadership role in examining biases and changing the clinical and research landscape so that it better reflects respectful discourse for individuals on the autism spectrum. This is critical to reduce the stigma that continues to be associated with autism and has a negative affect on mental health and quality of life.
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Affiliation(s)
- Louise C P Fennell
- Department of Psychology, University of Victoria, Victoria, Canada.,Private Practice of Psychologist Louise Fennell, Victoria, Canada
| | - Shannon A Johnson
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
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20
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Habayeb S, Kenworthy L, De La Torre A, Ratto A. Still Left Behind: Fewer Black School-Aged Youth Receive ASD Diagnoses Compared to White Youth. J Autism Dev Disord 2021; 52:2274-2283. [PMID: 34089141 DOI: 10.1007/s10803-021-05118-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 01/21/2023]
Abstract
Prior research suggests that Black children are at risk for delays in diagnosis of autism, but factors that influence diagnostic timing across races remain unclear. This study analyzed data from Black and White children who received a first-time autism diagnosis at a specialty clinic. Black youth were under-represented in the group who received a first diagnosis in middle/late childhood (i.e., after age six). Receiving a diagnosis later in childhood was related to higher IQ (trend level) and more internalizing problems for White children whereas it was related to lower IQ (trend level) and higher ASD symptom intensity for Black children. Findings suggest racial disparities in early identification of autism may be diminishing but persist among those diagnosed later in childhood..
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Affiliation(s)
- Serene Habayeb
- Department of Psychology and Behavioral Health, Children's National Hospital, 111 Michigan Ave NW, Washington, District of Columbia, 20010, USA.
- Center for Autism Spectrum Disorder, Children's National Hospital, 15245 Shady Grove Rd. Suite 350, Rockville, Maryland, 20850, USA.
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorder, Children's National Hospital, 15245 Shady Grove Rd. Suite 350, Rockville, Maryland, 20850, USA
| | - Andrea De La Torre
- Center for Autism Spectrum Disorder, Children's National Hospital, 15245 Shady Grove Rd. Suite 350, Rockville, Maryland, 20850, USA
- Department of Psychology, University of Baltimore, 1420 N Charles Street, Baltimore, Maryland, 21201, USA
| | - Allison Ratto
- Center for Autism Spectrum Disorder, Children's National Hospital, 15245 Shady Grove Rd. Suite 350, Rockville, Maryland, 20850, USA
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21
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Agelink van Rentergem JA, Deserno MK, Geurts HM. Validation strategies for subtypes in psychiatry: A systematic review of research on autism spectrum disorder. Clin Psychol Rev 2021; 87:102033. [PMID: 33962352 DOI: 10.1016/j.cpr.2021.102033] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 02/14/2021] [Accepted: 04/14/2021] [Indexed: 12/11/2022]
Abstract
Heterogeneity within autism spectrum disorder (ASD) is recognized as a challenge to both biological and psychological research, as well as clinical practice. To reduce unexplained heterogeneity, subtyping techniques are often used to establish more homogeneous subtypes based on metrics of similarity and dissimilarity between people. We review the ASD literature to create a systematic overview of the subtyping procedures and subtype validation techniques that are used in this field. We conducted a systematic review of 156 articles (2001-June 2020) that subtyped participants (range N of studies = 17-20,658), of which some or all had an ASD diagnosis. We found a large diversity in (parametric and non-parametric) methods and (biological, psychological, demographic) variables used to establish subtypes. The majority of studies validated their subtype results using variables that were measured concurrently, but were not included in the subtyping procedure. Other investigations into subtypes' validity were rarer. In order to advance clinical research and the theoretical and clinical usefulness of identified subtypes, we propose a structured approach and present the SUbtyping VAlidation Checklist (SUVAC), a checklist for validating subtyping results.
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Affiliation(s)
- Joost A Agelink van Rentergem
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Dutch Autism & ADHD Research Center, the Netherlands.
| | - Marie K Deserno
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Dutch Autism & ADHD Research Center, the Netherlands
| | - Hilde M Geurts
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Dutch Autism & ADHD Research Center, the Netherlands; Dr. Leo Kannerhuis, the Netherlands
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22
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Horinouchi T, Maeyama K, Nagai M, Mizobuchi M, Takagi Y, Okada Y, Kato T, Nishimura M, Kawasaki Y, Yoshioka M, Takada S, Matsumoto H, Nakamachi Y, Saegusa J, Fukushima S, Fujioka K, Tomioka K, Nagase H, Nozu K, Iijima K, Nishimura N. Genetic Analysis of UGT1A1 Polymorphisms Using Preserved Dried Umbilical Cord for Assessing the Potential of Neonatal Jaundice as a Risk Factor for Autism Spectrum Disorder in Children. J Autism Dev Disord 2021; 52:483-489. [PMID: 33730321 DOI: 10.1007/s10803-021-04941-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 12/27/2022]
Abstract
Neonatal jaundice has been suggested as a perinatal risk factor for autism spectrum disorder (ASD). We examined UGT1A1 polymorphisms to assess the potential of neonatal jaundice as a risk factor for ASD in children by using DNA extracted from preserved umbilical cord. In total, 79 children with ASD were genotyped for UGT1A1*28 (c.-41-40dup), UGT1A1*6 (c.211 G > A), and UGT1A1*27 (c.686 C > A). The allele frequency of UGT1A1*6 (OR = 1.34, p = 0.26) and UGT1A1*28 (OR = 0.80, p = 0.54) and the prevalence of UGT1A1*28/*6 diplotypes did not differ significantly from those in the control population. No UGT1A1*27 allele was detected in the subjects. ASD symptom assessment scores were not associated with UGT1A1*28/*6/*27 genotypes or UGT1A1*28/*6 diplotypes. These results suggest that neonatal jaundice is not significantly associated with ASD.
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Affiliation(s)
- Tomoko Horinouchi
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kaori Maeyama
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
- Palmore Hospital, Kobe, Japan
| | - Masashi Nagai
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Metabolic Endocrinology, Kobe Children's Hospital, Kobe, Japan
| | - Masami Mizobuchi
- Department of Developmental Pediatrics, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Yasuko Takagi
- General Pediatric and Rehabilitation Center for the Disabled, Kobe, Japan
| | - Yuka Okada
- Eastern Pediatric and Rehabilitation Center for the Disabled, Kobe, Japan
| | - Takeshi Kato
- Western Pediatric and Rehabilitation Center for the Disabled, Kobe, Japan
| | | | | | - Mieko Yoshioka
- General Pediatric and Rehabilitation Center for the Disabled, Kobe, Japan
| | - Satoshi Takada
- General Pediatric and Rehabilitation Center for the Disabled, Kobe, Japan
| | | | - Yuji Nakamachi
- Division of Clinical Laboratory, Kobe University Hospital, Kobe, Japan
| | - Jun Saegusa
- Division of Clinical Laboratory, Kobe University Hospital, Kobe, Japan
| | - Sachiyo Fukushima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumichi Fujioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumi Tomioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Nagase
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriyuki Nishimura
- Department of Public Health, Kobe University Graduate School of Health Science, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan.
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McIntyre NS, Tomaszewski B, Hume KA, Odom SL. Stability of Literacy Profiles of Adolescents With Autism Spectrum Disorder and Associations With Stakeholder Perceptions of Appropriate High School Support Needs. Lang Speech Hear Serv Sch 2021; 52:209-224. [PMID: 33464986 DOI: 10.1044/2020_lshss-20-00016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose For many individuals with autism spectrum disorder (ASD), postsecondary outcomes are poor. This may be due to insufficient academic supports, particularly with regard to literacy skills, during high school. More information is needed about skill profiles so that we can better differentiate support for students with varying social, communication, cognitive, and academic proficiency levels. This study was designed to (a) identify unique literacy profiles of high school students with ASD, (b) assess profile stability over time, (c) identify predictors of profile membership, and (d) analyze stakeholder reports of required school support intensity. Method Participants were a diverse sample of high school students with ASD, 14-21 years old (N = 544), their parents, and their teachers who participated in a randomized controlled trial of a comprehensive treatment model for high school students with ASD. Standardized measures were administered to assess nonverbal IQ, autism symptomatology, language/adaptive communication, reading comprehension, academic knowledge, and parent/teacher report of school support needs intensity. Latent transition analysis was conducted to examine sample heterogeneity and to explore the stability of the profiles. Associations between profiles and reports of support intensity were examined. Results Four literacy profiles were identified that were stable over 2 years: Emergent Literacy/Comprehensive Support, Low Literacy/Intensive Support, Average Literacy/Moderate Support, and Average Literacy/Limited Support. Parent and teacher reports of school support intensity generally aligned with the profiles. Conclusions These analyses provide insight into the diverse literacy and support needs in ASD. Implications for practice and the role of speech-language pathologists in assessment and intervention are discussed. Supplemental Material https://doi.org/10.23641/asha.13495119.
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Waizbard-Bartov E, Ferrer E, Young GS, Heath B, Rogers S, Wu Nordahl C, Solomon M, Amaral DG. Trajectories of Autism Symptom Severity Change During Early Childhood. J Autism Dev Disord 2021; 51:227-242. [PMID: 32410098 PMCID: PMC7810617 DOI: 10.1007/s10803-020-04526-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Autism symptom severity change was evaluated during early childhood in 125 children diagnosed with autism spectrum disorder (ASD). Children were assessed at approximately 3 and 6 years of age for autism symptom severity, IQ and adaptive functioning. Each child was assigned a change score, representing the difference between ADOS Calibrated Severity Scores (CSS) at the two ages. A Decreased Severity Group (28.8%) decreased by 2 or more points; a Stable Severity Group (54.4%) changed by 1 point or less; and an Increased Severity Group (16.8%) increased by 2 or more points. Girls tended to decrease in severity more than boys and increase in severity less than boys. There was no clear relationship between intervention history and membership in the groups.
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Affiliation(s)
- Einat Waizbard-Bartov
- Department of Psychology, University of California Davis, Davis, CA, USA
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Emilio Ferrer
- Department of Psychology, University of California Davis, Davis, CA, USA
| | - Gregory S Young
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Brianna Heath
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Sally Rogers
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Christine Wu Nordahl
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - Marjorie Solomon
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - David G Amaral
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA.
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25
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Shan L, Feng JY, Wang TT, Xu ZD, Jia FY. Prevalence and Developmental Profiles of Autism Spectrum Disorders in Children With Global Developmental Delay. Front Psychiatry 2021; 12:794238. [PMID: 35115968 PMCID: PMC8803654 DOI: 10.3389/fpsyt.2021.794238] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/22/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Previous studies have mostly explored the comorbidities of Global developmental delay (GDD) in children with Autism Spectrum Disorders (ASD) from the perspective of ASD. The study focus on the perspective of GDD to investigate the prevalence and developmental profiles of ASD in GDD and to explore the correlation between the developmental level and symptoms of autism. METHODS Clinical data of 521 children with GDD aged from 24 to 60 months were retrospectively analyzed. Analyses were performed first for the whole sample and then subdivided into two subgroups (GDD+ASD-, GDD+ASD+) according to whether had ASD. Symptoms of autism were evaluated by the Autism Behavior Checklist and the Childhood Autism Rating Scale. The Chinese version of the Gesell Developmental Schedules was used to evaluate the level of children's mental development. RESULT The prevalence of ASD in children with GDD was 62.3%. The total average developmental quotient (DQ) of GDD was mildly deficient and was negatively correlated with symptoms of autism (p < 0.05); language ability was severe and extremely severe deficient (P < 0.05). GDD+ASD- group and GDD+ASD+ group have some common points as well as differences in the developmental features. The language delay of children in both subgroups was the most obviously defected, thereafter followed by the item of personal social activity. In the GDD+ASD+ group, the DQ of gross motor skills>fine motor skills>adaptability (p < 0.05). There were no significant differences among the DQ of gross motor skills, fine motor skills and adaptability in GDD+ASD- group (p > 0.05). The GDD+ASD-group had better adaptability, fine motor skills, language ability, personal social activity than that of the GDD+ASD+ group, but the gross motor skills in GDD+ASD- group were worse (p < 0.05). CONCLUSION GDD children have a high proportion of comorbid ASD, and GDD children with poorer developmental levels are more likely to have ASD symptoms. Development profiles in both GDD+ASD- children and GDD+ASD+ children have common features but there are also differences. GDD+ASD+ group is worse than GDD+ASD- group in terms of the overall development level.
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Affiliation(s)
- Ling Shan
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Jun-Yan Feng
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Tian-Tian Wang
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Jilin University, Changchun, China
| | - Zhi-Da Xu
- Department of Psychiatry, GGz Centraal, Amersfoort, Netherlands
| | - Fei-Yong Jia
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Jilin University, Changchun, China
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26
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Como DH, Stein Duker LI, Polido JC, Cermak SA. Oral Health and Autism Spectrum Disorders: A Unique Collaboration between Dentistry and Occupational Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E135. [PMID: 33375475 PMCID: PMC7795681 DOI: 10.3390/ijerph18010135] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 12/16/2022]
Abstract
Children with autism spectrum disorders (ASD) are at risk for oral health disparities. With the dramatic rise in ASD prevalence to 1 in 54 children, it is likely that an increasing number of dental practitioners will encounter or be asked to treat children with ASD. This paper reviews explanations related to the increasing prevalence of ASD, provides reasons why children with ASD are at increased risk for poor oral health, and discusses unique interprofessional collaborations between dental practitioners and occupational therapists. Occupational therapists and dentists can work together to plan modifications to the dental environment or adapt dental protocols to reduce some of the barriers encountered by those with ASD, provide desensitization strategies before the clinic visit, or help a child with emotional regulation during clinical treatments.
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Affiliation(s)
- Dominique H. Como
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (L.I.S.D.); (S.A.C.)
| | - Leah I. Stein Duker
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (L.I.S.D.); (S.A.C.)
| | - José C. Polido
- Children’s Hospital Los Angeles and Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA;
| | - Sharon A. Cermak
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA; (L.I.S.D.); (S.A.C.)
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27
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Lord C, McCauley JB, Pepa LA, Huerta M, Pickles A. Work, living, and the pursuit of happiness: Vocational and psychosocial outcomes for young adults with autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1691-1703. [PMID: 32431163 PMCID: PMC7541415 DOI: 10.1177/1362361320919246] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT It is important to better understand how adults with autism are functioning in adulthood. Studies that have tracked individuals across the lifespan can help identify developmental factors influence differences in adult outcomes. The present study examines the independence, well-being, and functioning of 123 adults that have been closely followed since early childhood. Autism diagnosis and cognitive assessments were given frequently throughout childhood and during adulthood. We examined differences between adults who had received an autism diagnosis at some point with higher cognitive abilities (Ever ASD-High IQ) and lower cognitive abilities (Ever ASD-Low IQ), as well as adults who never received a diagnosis of autism in the course of the study (Never ASD). We found that autistic features specifically related to adaptive skills and friendships, and verbal intelligence related to work outcomes. In many ways, the Never ASD group had similar outcomes compared to the ASD groups. However, adults with ASD tended to have lower well-being and fewer positive emotions. Families played a major role in supporting adults with and without ASD at all intellectual levels. The findings suggest that realistic ways of increasing independence need to be developed by working with adults and their families, while acknowledging the contribution of individual differences in mental health, intelligence and autism symptoms across neurodevelopmental disorders.
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28
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Rodgers M, Marshall D, Simmonds M, Le Couteur A, Biswas M, Wright K, Rai D, Palmer S, Stewart L, Hodgson R. Interventions based on early intensive applied behaviour analysis for autistic children: a systematic review and cost-effectiveness analysis. Health Technol Assess 2020; 24:1-306. [PMID: 32686642 PMCID: PMC7397479 DOI: 10.3310/hta24350] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Early intensive applied behaviour analysis-based interventions are intensive interventions for autistic children that are often delivered on a one-to-one basis for 20-50 hours per week. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of early intensive applied behaviour analysis-based interventions for autistic children, based on current evidence. METHODS A systematic review and individual participant data meta-analysis were conducted to evaluate the clinical effectiveness of an early intensive applied behaviour analysis-based intervention for autistic children. An economic analysis included a review of existing analyses and the development of a new model. RESULTS Twenty studies were included in the clinical review. Individual participant data were retrieved from 15 of these studies. Results favoured the interventions when assessing adaptive behaviour after 2 years compared with treatment as usual/eclectic interventions (mean difference 7.00, 95% confidence interval 1.95 to 12.06). In analyses of cognitive ability (intelligence quotient), results favoured the interventions by approximately 10 points after 1 year (mean difference 9.16, 95% confidence interval 4.38 to 13.93) and 2 years (mean difference 14.13, 95% confidence interval 9.16 to 19.10). Evidence for other outcomes was limited and meta-analyses were generally inconclusive. There was no evidence that the effect of the interventions varied with characteristics of the children, but data were limited. Adopting a £30,000 per quality-adjusted life-year threshold, the results of the cost-effectiveness analysis indicate that early intensive applied behaviour analysis-based interventions would need to generate larger benefits or cost savings to be cost-effective. Adopting a public sector perspective and making pessimistic assumptions about long-term effects, the incremental cost-effectiveness ratio for early intensive applied behaviour analysis-based therapy compared with treatment as usual is £189,122 per quality-adjusted life-year. When optimistic assumptions are made, the incremental cost-effectiveness ratio is £46,768 per quality-adjusted life-year. Scenario analyses indicated that these interventions can potentially be cost-effective if long-term improvements persist into adulthood, or if they have significant impact on educational placement. Care should be taken when interpreting these scenarios owing to the limited data. LIMITATIONS All included studies were at risk of bias, there was substantial heterogeneity and effects varied considerably across studies. The effect of intervention on autism symptom severity, language development and school placement remains uncertain because of the limited data. The long-term effects are unclear owing to a lack of follow-up data. CONCLUSIONS This review found limited evidence that early intensive applied behaviour analysis-based interventions may improve cognitive ability and adaptive behaviour, but the long-term impact of the interventions remains unknown. The economic analysis is constrained by the limited effectiveness evidence, but suggests that these interventions are unlikely to be cost-effective unless clear long-term benefits, or a substantial change in which schools children attend, can be identified. FUTURE WORK Further studies into the effectiveness of early intensive applied behaviour analysis-based interventions may be warranted if they include well-defined, alternative interventions as comparators and collect relevant outcomes. Consideration should be given to future studies that not only address whether or not early intensive applied behaviour analysis-based interventions are clinically effective, but also aim to identify which components of early intensive applied behaviour analysis-based interventions might drive effectiveness. STUDY REGISTRATION This study is registered as PROSPERO CRD42017068303. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 35. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Mark Rodgers
- Centre for Reviews and Dissemination, University of York, York, UK
| | - David Marshall
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Mark Simmonds
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Ann Le Couteur
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mousumi Biswas
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Dheeraj Rai
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | - Lesley Stewart
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Robert Hodgson
- Centre for Reviews and Dissemination, University of York, York, UK
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Zaidman-Zait A, Mirenda P, Szatmari P, Duku E, Smith IM, Zwaigenbaum L, Vaillancourt T, Kerns C, Volden J, Waddell C, Bennett T, Georgiades S, Ungar WJ, Elsabbagh M. Profiles and Predictors of Academic and Social School Functioning among Children with Autism Spectrum Disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:656-668. [DOI: 10.1080/15374416.2020.1750021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Anat Zaidman-Zait
- Department of School Counseling and Special Education, Tel Aviv University
| | - Pat Mirenda
- Department of Educational and Counselling Psychology and Special Education, University of British Columbia
| | - Peter Szatmari
- Centre for Addiction and Mental Health, University of Toronto
| | - Eric Duku
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University
| | | | | | | | - Connor Kerns
- Department of Educational and Counselling Psychology and Special Education, University of British Columbia
| | - Joanne Volden
- Faculty of Rehabilitation Medicine, University of Alberta
| | - Charlotte Waddell
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University
| | - Teresa Bennett
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University
| | - Stelios Georgiades
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University
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30
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Bacon EC, Moore A, Lee Q, Carter Barnes C, Courchesne E, Pierce K. Identifying prognostic markers in autism spectrum disorder using eye tracking. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:658-669. [PMID: 31647314 PMCID: PMC7166165 DOI: 10.1177/1362361319878578] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
While many children with autism spectrum disorder are now detected at young ages given the rise in screening and general awareness, little is known regarding the prognosis of early detected children. The brain is shaped by experience-dependent mechanisms; thus, what a child pays attention to plays a pivotal role in shaping brain development. Eye tracking can provide an index of a child's visual attention and, as such, holds promise as a technology for revealing prognostic markers. In this, 49 children aged 1-3 years with autism spectrum disorder participated in an eye-tracking test, the GeoPref Test, that revealed preference for social versus nonsocial images. Next, children participated in a comprehensive test battery 5-9 years following the initial GeoPref Test. Statistical tests examined whether early age eye tracking predicted later school-age outcomes in symptom severity, social functioning, adaptive behavior, joint attention, and IQ. Results indicated that toddlers with higher preference for geometric images demonstrated greater symptom severity and fewer gaze shifts at school age. This relationship was not found in relation to IQ or adaptive behavior. Overall, the GeoPref Test holds promise as a symptom severity prognostic tool; further development of eye-tracking paradigms may enhance prognostic power and prove valuable in validating treatment progress.
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31
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Kaneko S, Kato TA, Makinodan M, Komori T, Ishida R, Kishimoto N, Takahashi M, Yasuda Y, Hashimoto R, Iwasaka H, Tanaka A, Uchida Y, Kanba S, Kishimoto T. The Self-Construal Scale: A Potential Tool for Predicting Subjective Well-Being of Individuals With Autism Spectrum Disorder. Autism Res 2019; 13:947-958. [PMID: 31793248 DOI: 10.1002/aur.2242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/13/2019] [Accepted: 11/02/2019] [Indexed: 12/18/2022]
Abstract
Despite accumulating evidence that culture shapes the symptoms of autism spectrum disorder (ASD), no studies have yet applied the Self-Construal Scale to individuals with ASD. We compared the self-construals (measured using the Self-Construal Scale) of 31 high-functioning Japanese individuals with ASD with those of 60 typically developing (TD) individuals. We also examined how the self-construals of individuals with ASD related to their intelligence quotient, adverse childhood experiences, attention deficit hyperactivity disorder, ASD symptoms during adulthood and preschool years, and subjective well-being. Individuals with ASD were more likely to display independent self-construals than were TD individuals; unexpectedly, however, a substantial proportion of individuals with ASD (43.8%) displayed relatively interdependent self-construals. Among individuals with ASD, self-construals were significantly associated with ASD symptoms during preschool years, and with satisfaction of the need for autonomy and frustration of the need for relatedness. Evaluating self-construals can help predict the subjective well-being of high-functioning individuals with ASD. Moreover, the Self-Construal Scale may be useful for understanding the heterogeneous phenotypes of ASD, based on its association with autistic symptoms during preschool years, suggesting that the scale is a potential tool to develop efficient interventions for high-functioning individuals with ASD. Autism Res 2020, 13: 947-958. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Autism Spectrum Disorders (ASD) are a group of disorders presenting a variety of symptoms and biological origins that can complicate choosing an intervention best suited for improving well-being. Results indicate that a self-construal scale could help understand individuals with high-functioning ASD by independent and interdependent self-construals that are associated with ASD symptoms during preschool years and adult subjective well-being. Our findings suggest that this scale can help understand ASD and select appropriate interventions.
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Affiliation(s)
- Sachie Kaneko
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Kokoro Research Center, Kyoto University, Kyoto, Japan.,Psychiatric Hospital Heartland Shigisan, Sango, Japan
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Manabu Makinodan
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Takashi Komori
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Rio Ishida
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Naoko Kishimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Masato Takahashi
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Yuka Yasuda
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan.,Life Grow Brilliant Mental Clinic, Medical Corporation Foster, Osaka, Japan.,Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.,Osaka University, Suita, Japan
| | | | - Ayumi Tanaka
- Department of Psychology, Doshisha University, Kyoto, Japan
| | - Yukiko Uchida
- Kokoro Research Center, Kyoto University, Kyoto, Japan
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshifumi Kishimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
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32
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Amaral DG, Anderson GM, Bailey A, Bernier R, Bishop S, Blatt G, Canal-Bedia R, Charman T, Dawson G, de Vries PJ, Dicicco-Bloom E, Dissanayake C, Kamio Y, Kana R, Khan NZ, Knoll A, Kooy F, Lainhart J, Levitt P, Loveland K, Minshew N, Mueller RA, Murphy D, Mundy P, Palencia S, Pinto-Martin J, Rattazzi A, Rogers S, Stone WL, Webb SJ, Whitehouse A. Gaps in Current Autism Research: The Thoughts of the Autism Research Editorial Board and Associate Editors. Autism Res 2019; 12:700-714. [PMID: 31025542 DOI: 10.1002/aur.2101] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 12/20/2022]
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33
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Cohen E, Houtrow A. Disability Is Not Delay: Precision Communication about Intellectual Disability. J Pediatr 2019; 207:241-243. [PMID: 30679053 DOI: 10.1016/j.jpeds.2018.12.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/05/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Eyal Cohen
- Department of Pediatrics and Child Health Evaluative Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Amy Houtrow
- Departments of Physical Medicine and Rehabilitation and Pediatrics, University of Pittsburgh, Pittsburgh, PA
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Muratori F, Turi M, Prosperi M, Narzisi A, Valeri G, Guerrera S, Santocchi E, Apicella F, Lattarulo C, Calderoni S, Vicari S. Parental Perspectives on Psychiatric Comorbidity in Preschoolers With Autism Spectrum Disorders Receiving Publicly Funded Mental Health Services. Front Psychiatry 2019; 10:107. [PMID: 30914976 PMCID: PMC6422880 DOI: 10.3389/fpsyt.2019.00107] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/13/2019] [Indexed: 11/26/2022] Open
Abstract
An increased prevalence of psychiatric comorbidity (PC) in individuals with Autism Spectrum Disorders (ASD) is consistently reported. While several studies have examined PC in school-aged children, adolescents and adults with ASD, investigations on PC in preschoolers are less common. In this study, we explore the prevalence and the type of PC in a sample of 989 preschoolers with ASD through the DSM-Oriented Scales (DOS) of the Child Behavior Checklist (CBCL 1½-5) and their possible links with the core features of ASD and cognitive functioning. Results indicated that 37.8% of the sample had at least one PC in addition to ASD; these subjects displayed significantly higher Total score (p = 0.02) and Social Affect score (p = 0.003) on the ADOS-based calibrated severity scores (CSS), as well as lower (p ≤ 0.0001) performance IQ (pIQ) compared to ASD individuals without PC. As far as the specific DOS, Affective Problems (AP) were detected in 23.4% of the whole sample, ADHD Problems (ADHD) in 17.3%, Anxiety Problems (AXP) in 16.7%, and Oppositional Problems (OP) in 7.9%. These different comorbidities were isolated in 195 subjects (Mono-comorbid group: 19.7% of the whole sample), while 179 subjects (18.1% of the whole sample) had two or more types of PC (Multi-comorbid group). One-way ANOVA revealed that subjects with multi-comorbidity have statistically significant lower pIQ and higher Total score and Social Affect score on CSS-ADOS. Specific differences for each type of comorbidity and gender differences were also discussed. Taken together, results indicate a considerable presence of PC in preschoolers with ASD that should be accurately considered during the assessment and diagnosis process in order to plan a tailored intervention based not only on core symptoms of ASD, but also on comorbid psychiatric condition since preschool age.
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Affiliation(s)
- Filippo Muratori
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Turi
- Fondazione Stella Maris Mediterraneo, Potenza, Italy
| | - Margherita Prosperi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonio Narzisi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Giovanni Valeri
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Silvia Guerrera
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Elisa Santocchi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Fabio Apicella
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | | | - Sara Calderoni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
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Barnett W, Halligan S, Heron J, Fraser A, Koen N, Zar HJ, Donald KA, Stein DJ. Maltreatment in childhood and intimate partner violence: A latent class growth analysis in a South African pregnancy cohort. CHILD ABUSE & NEGLECT 2018; 86:336-348. [PMID: 30241702 PMCID: PMC6297167 DOI: 10.1016/j.chiabu.2018.08.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 08/21/2018] [Accepted: 08/29/2018] [Indexed: 05/22/2023]
Abstract
Intimate partner violence (IPV) is a significant global problem, prevalent in low and middle-income countries (LMICs). IPV is particularly problematic during the perinatal and early postnatal period, where it is linked with negative maternal and child health outcomes. There has been little examination of profiles of IPV and early life adversity in LMIC contexts. We aimed to characterize longitudinal IPV and to investigate maternal maltreatment in childhood as a predictor of IPV exposure during pregnancy and postnatally in a low resource setting. This study was nested in the Drakenstein Child Health Study, a longitudinal birth cohort. Maternal IPV (emotional, physical and sexual) was measured at six timepoints from pregnancy to two years postpartum (n = 832); sociodemographic variables and maternal maltreatment in childhood were measured antenatally at 28-32 weeks' gestation. Associations between maternal maltreatment in childhood and IPV latent class membership (to identify patterns of maternal IPV exposure) were estimated using multinomial and logistic regression. We observed high levels of maternal maltreatment during childhood (34%) and IPV during pregnancy (33%). In latent class analysis separating by IPV sub-type, two latent classes of no/low and moderate sexual IPV and three classes of low, moderate, and high emotional and physical IPV (separately) were detected. In combined latent class analysis, including all IPV sub-types together, a low, moderate and high exposure class emerged as well as a high antenatal/decreasing postnatal class. Moderate and high classes for all IPV sub-types and combined analysis showed stable intensity profiles. Maternal childhood sexual abuse, physical abuse and neglect, and emotional abuse predicted membership in high IPV classes, across all domains of IPV (aORs between 1.99 and 5.86). Maternal maltreatment in childhood was associated with increased probability of experiencing high or moderate intensity IPV during and around pregnancy; emotional neglect was associated with decreasing IPV class for combined model. Intervening early to disrupt this cycle of abuse is critical to two generations.
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Affiliation(s)
- Whitney Barnett
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Medical Research Council Unit on Child & Adolescent Health, University of Cape Town, South Africa.
| | - Sarah Halligan
- Department of Psychology, Bath University, United Kingdom
| | - Jon Heron
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Abigail Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom; MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
| | - Nastassja Koen
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa; South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Medical Research Council Unit on Child & Adolescent Health, University of Cape Town, South Africa
| | - Kirsty A Donald
- Division of Developmental Paediatrics, Department of Paediatrics & Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa; South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
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36
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A Longitudinal Study of Children Diagnosed with Autism Spectrum Disorder Before Age Three: School Services at Three Points Time for Three Levels of Outcome Disability. J Autism Dev Disord 2018; 48:3747-3760. [PMID: 29948529 DOI: 10.1007/s10803-018-3606-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This study follows 70 children determined to have Autism Spectrum Disorder (ASD) before age three (Time 1). Parents filled out questionnaires and standardized measures about their child when he/she was school-aged (Time 2), including information about their children's preschool, kindergarten, and grade school educational settings. At Time 2, the researchers placed children in three diagnostic groups of No ASD, ASD-Higher Functioning, and ASD-Lower Functioning. Retrospective results showed that most children were receiving intensive services at the preschool level. In kindergarten, there was some divergence among the three groups, with more intensive services continuing for the ASD groups. At school age, classroom placement and services reflected service patterns that were consistent with these three levels of disability.
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