WISC-R and Vineland Adaptive Behavior Scale scores in autistic children

Using adaptive behavior scores to convey level of functioning in children with autism spectrum disorder: Evidence from the Study to Explore Early Development

LAY ABSTRACT

Autistic people are often described as "low-" or "high-functioning" based on their scores on cognitive tests. These terms are common in publications and in everyday communication. However, recent research and feedback from the autistic community suggests that relying on cognitive ability alone to describe functioning may miss meaningful differences in the abilities of autistic children and adults and in the kinds of support they may need. Additional methods are needed to describe "functioning" in autistic children. We examined whether scores from a test measuring adaptive behaviors would provide information on the functional abilities of children with autism that is different from cognitive ability and autism symptom severity. Adaptive behaviors include age-appropriate skills that allow people to function in their everyday lives and social interactions. We found that a large amount of the variation in adaptive behavior scores was not explained by cognitive development, autism symptom severity, and behavioral and emotional problems. In addition, there was a wide range of adaptive ability levels in children with autism in our study, including in those with low, average, or high cognitive scores. Our results suggest that adaptive behavior scores could provide useful information about the strengths and support needs of autistic children above and beyond measures of cognitive ability and autism symptom severity. Adaptive behavior scores provide important information on the needs of autistic people.

Behavior Problems and Social Competence in Fragile X Syndrome: A Systematic Review

Fragile X syndrome (FXS) causes intellectual disability and is the known leading cause of autism. Common problems in FXS include behavior and social problems. Along with syndromic characteristics and autism comorbidity, environmental factors might influence these difficulties. This systematic review focuses on the last 20 years of studies concerning behavior and social problems in FXS, considering environmental and personal variables that might influence both problems. Three databases were reviewed, leading to fifty-one studies meeting the inclusion criteria. Attention deficit hyperactivity disorder (ADHD) problems remain the greatest behavior problems, with behavioral problems and social competence being stable during the 20 years. Some developmental trajectories might have changed due to higher methodological control, such as aggressive behavior and attention problems. The socialization trajectory from childhood to adolescence remains unclear. Comorbidity with autism in individuals with FXS increased behavior problems and worsened social competence profiles. At the same time, comparisons between individuals with comorbid FXS and autism and individuals with autism might help define the comorbid phenotype. Environmental factors and parental characteristics influenced behavior problems and social competence. Higher methodological control is needed in studies including autism symptomatology and parental characteristics. More studies comparing autism in FXS with idiopathic autism are needed to discern differences between conditions.

Use of the Vineland-3, a measure of adaptive functioning, in CLN3

Progressive vision loss and neurocognitive impairment are early and frequent presentations in CLN3 disease. This highlights neurodevelopmental functioning as critical to the disease, but limits the neuropsychological test repertoire. We evaluated the convergent validity of the Vineland Adaptive Behavior Scales as a potential outcome measure. In a prospective observational study of 22 individuals (female:male 11:11; 6-20 years-old) with a molecular diagnosis of CLN3, we used generalized linear models and Spearman correlations to quantify the relationship of the adaptive behavior composite (ABC) standard score with established outcomes of verbal IQ (VIQ) and disease severity (Unified Batten Disease Rating Scale, UBDRS) scores. We analyzed ABC changes in 1-year follow-up data in a subset of the same cohort (n = 17). The ABC and VIQ, both standard scores, exhibited a strong positive correlation in cross-sectional data (r = 0.81). ABC and UBDRS scores were strongly and positively correlated in cross-sectional data (r_range  = 0.87-0.93). Participants' ABC scores decreased slightly over the 1-year follow-up period (mean change, 95% CI: -5.23, -2.16). The convergent validity of the Vineland-3 for use in CLN3 is supported by its relationships with the established outcomes of VIQ and UBDRS. Future longitudinal research, including replication in other cohorts and evaluation of sensitivity to change, will be important to establish utility of the Vineland-3 for monitoring change in CLN3.

Imputing cognitive impairment in SPARK, a large autism cohort

Diverse large cohorts are necessary for dissecting subtypes of autism, and intellectual disability is one of the most robust endophenotypes for analysis. However, current cognitive assessment methods are not feasible at scale. We developed five commonly used machine learning models to predict cognitive impairment (FSIQ<80 and FSIQ<70) and FSIQ scores among 521 children with autism using parent-reported online surveys in SPARK, and evaluated them in an independent set (n = 1346) with a missing data rate up to 70%. We assessed accuracy, sensitivity, and specificity by comparing predicted cognitive levels against clinical IQ data. The elastic-net model has good performance (AUC = 0.876, sensitivity = 0.772, specificity = 0.803) using 129 predictive features to impute cognitive impairment (FSIQ<80). Top-ranked predictive features included parent-reported language and cognitive levels, age at autism diagnosis, and history of services. Prediction of FSIQ<70 and FSIQ scores also showed good performance. We show cognitive levels can be imputed with high accuracy for children with autism, using commonly collected parent-reported data and standardized surveys. The current model offers a method for large-scale autism studies seeking estimates of cognitive ability when standardized psychometric testing is not feasible. LAY SUMMARY: Children with autism who have more severe learning challenges or cognitive impairment have different needs that are important to consider in research studies. When children in our study were missing standardized cognitive testing scores, we were able to use machine learning with other information to correctly "guess" when they have cognitive impairment about 80% of the time. We can use this information in research in the future to develop more appropriate treatments for children with autism and cognitive impairment.

Randomized controlled trial of sulforaphane and metabolite discovery in children with Autism Spectrum Disorder

Background

Sulforaphane (SF), an isothiocyanate in broccoli, has potential benefits relevant to autism spectrum disorder (ASD) through its effects on several metabolic and immunologic pathways. Previous clinical trials of oral SF demonstrated positive clinical effects on behavior in young men and changes in urinary metabolomics in children with ASD.

Methods

We conducted a 15-week randomized parallel double-blind placebo-controlled clinical trial with 15-week open-label treatment and 6-week no-treatment extensions in 57 children, ages 3–12 years, with ASD over 36 weeks. Twenty-eight were assigned SF and 29 received placebo (PL). Clinical effects, safety and tolerability of SF were measured as were biomarkers to elucidate mechanisms of action of SF in ASD.

Results

Data from 22 children taking SF and 23 on PL were analyzed. Treatment effects on the primary outcome measure, the Ohio Autism Clinical Impressions Scale (OACIS), in the general level of autism were not significant between SF and PL groups at 7 and 15 weeks. The effect sizes on the OACIS were non-statistically significant but positive, suggesting a possible trend toward greater improvement in those on treatment with SF (Cohen’s d 0.21; 95% CI − 0.46, 0.88 and 0.10; 95% CI − 0.52, 0.72, respectively). Both groups improved in all subscales when on SF during the open-label phase. Caregiver ratings on secondary outcome measures improved significantly on the Aberrant Behavior Checklist (ABC) at 15 weeks (Cohen’s d − 0.96; 95% CI − 1.73, − 0.15), but not on the Social Responsiveness Scale-2 (SRS-2). Ratings on the ABC and SRS-2 improved with a non-randomized analysis of the length of exposure to SF, compared to the pre-treatment baseline (p < 0.001). There were significant changes with SF compared to PL in biomarkers of glutathione redox status, mitochondrial respiration, inflammatory markers and heat shock proteins. Clinical laboratory studies confirmed product safety. SF was very well tolerated and side effects of treatment, none serious, included rare insomnia, irritability and intolerance of the taste and smell.

Limitations

The sample size was limited to 45 children with ASD and we did not impute missing data. We were unable to document significant changes in clinical assessments during clinical visits in those taking SF compared to PL. The clinical results were confounded by placebo effects during the open-label phase.

Conclusions

SF led to small yet non-statistically significant changes in the total and all subscale scores of the primary outcome measure, while for secondary outcome measures, caregivers’ assessments of children taking SF showed statistically significant improvements compared to those taking PL on the ABC but not the SRS-2. Clinical effects of SF were less notable in children compared to our previous trial of a SF-rich preparation in young men with ASD. Several of the effects of SF on biomarkers correlated to clinical improvements. SF was very well tolerated and safe and effective based on our secondary clinical measures.

Trial registration: This study was prospectively registered at clinicaltrials.gov (NCT02561481) on September 28, 2015. Funding was provided by the U.S. Department of Defense.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13229-021-00447-5.

Correlates of daily functioning in older adults with autism spectrum disorder

Objectives: Studies of adults with autism spectrum disorder (ASD) have demonstrated poor outcomes related to independence and everyday living skills compared to the general population. In a sample of 74 adults with ASD who require a high level of support we sought to identify correlates of daily functioning.Methods: We administered questionnaires to residential staff and identified participants' independence level in basic and instrumental activities of daily living.Results: There was no association of age with daily functioning. Higher daily functioning was associated with a better general medical health rating. Functional independence was greater in participants with IQ range of 55 to 65 compared to those with IQ below 55. Language difficulties and behavioral disturbances were not significantly correlated with independence in daily living skills. In this sample, individual had held a median of three different types of jobs in supported employment.Conclusion: Daily functioning in adults with autism generally does not decline with age, but because this was cross-sectional data, this requires further confirmation. Community programs designed for adults with ASD who require a high level of support should focus on overall medical health and promotion of daily living skill building.

Tools for the assessment of neuropsychomotor profile in the rehabilitation of children with central nervous system tumor: a systematic review

Objective:

This study reviews the scientific literature to identify and describe which assessment tools (ATs) are used in pediatric oncology and neuro-oncology rehabilitation and which development neuropsychomotor (DNPM) ATs were built for children with central nervous system (CNS) tumors.

Methods:

A systematic review was performed searching PubMed, CINAHL, PEDro, Science Direct, and Catalog of National Institute of Tumors databases and specialized journals. The search covered 7 years (2010–2017) and used relevant keywords in different combinations. A further search was carried out on DNPM rehabilitation manuals and academic thesis.

Results:

The review retrieved 35 eligible articles containing 63 ATs. The most common ATs were the Behavioral Rating Inventory of Executive Function (BRIEF) and the Wechsler Intelligence Scale for Children (WISC). Most of the ATs covered a single area of child development among behavioral/psychological, cognitive, and motor areas. A total of 159 ATs were found in manuals and thesis, and only 17 of them were already identified in the journal search. None of the ATs identified in both searches had been specifically developed for children with CNS tumor.

Conclusion:

The results highlight the need to develop and validate a global multidimensional AT for children with CNS tumor, overcoming the fragmentation of the assessment procedures and promoting standardized rehabilitation protocols.

Improving social functioning and challenging behaviors in adolescents with ASD and significant ID: A randomized pilot feasibility trial of reciprocal imitation training in a residential setting

There is a lack of effective social interventions for youths with ASD and co-morbid intellectual disability (ID). A previous single-case design study indicated that reciprocal imitation training (RIT) may improve social interaction and challenging behavior in this population. The current pilot study examined the feasibility of conducting an RCT to investigate the effectiveness of RIT for improving social functioning and challenging behaviors in 20 adolescents with ASD and severe ID in a residential program. The assessment protocol was feasible. RIT was well-tolerated by the adolescents and implemented with fidelity by teaching staff. Preliminary findings indicate that treatment had moderate to large effects on social functioning and challenging behavior, with mixed findings for imitation skills. A larger RCT of RIT for this population is feasible and warranted.

Adaptive profiles in autism and other neurodevelopmental disorders

We investigated the influence of specific autism spectrum disorder (ASD) deficits in learning adaptive behaviour, besides intelligence quotient (IQ). Participated 217 school-aged: ASD (N = 115), and other neurodevelopmental disorders (OND) groups (N = 102) matched by Full-Scale IQ. We compared standard scores of Vineland Adaptive Behaviour Scale (VABS) in communication, daily living skills, socialization and adaptive behaviour composite. Pearson-correlation analysis was performed between each domain of VABS and Full-Scale, Verbal and Performance IQ, and chronological age (CA). Results indicated that impairment in adaptive behaviour within the domain of socialization skills remains a distinctive factor of ASD versus OND, independently of intellectual disability (ID). Co-occurring ID result in further debilitating effects on overall functioning, especially in ASD. CA is negatively associated with VABS scores.

Indicators of intellectual disabilities in young children with autism spectrum disorders

No agreement has been reached yet on the co-occurrence of Intellectual Disability (ID) and Autism Spectrum Disorders (ASD) in young children. This study describes the clinical profiles of 253 children with ASD between 30 and 65 months old, on IQ and adaptive behaviors, prior to their entry in an early behavioral intervention program. Results showed that 36.8% of the children met the criteria for ID, with 60.2% of these in the mild range (IQ 50-69) and 39.8% in the moderate range (IQ 35-49). ID profiles were similar for boys and girls. Intellectual and adaptive behavior profiles are described as well as their links to various socioeconomic factors.

Adaptive behavior in toddlers under two with autism spectrum disorders

The Vineland Adaptive Behavior Scale was administered to 54 children diagnosed with autism spectrum disorder (ASD) before age 2, and a matching group of 18 toddlers with developmental delay (DD). The group with ASD was more impaired on all scales of the Vineland than DD peers. When 18 ASD/DD pairs very closely matched on age, verbal and nonverbal development were selected, differences were found only on Vineland Receptive Communication and Daily Living. Correlation analyses to explore connection of these areas of difference with cognition and autistic symptoms suggested that Vineland Daily Living scores were significantly correlated with nonverbal ability and with ADOS total algorithm scores. Vineland Receptive Communication scores correlated significantly only with ADOS total algorithms. The clinical implications of these findings are discussed.

Early-emerging social adaptive skills in toddlers with autism spectrum disorders: an item analysis

Individuals with ASD have significant impairments in adaptive skills, particularly adaptive socialization skills. The present study examined the extent to which 20 items from the Vineland Adaptive Behavior Scales-Socialization Domain differentiated between ASD and developmentally delayed (DD) groups. Participants included 108 toddlers with ASD or DD under the age of 3 years. Nine of the 20 items significantly distinguished the groups. The ASD group demonstrated significantly weaker socialization skills, including deficits in basic social behaviors. The results support the notion that (a) socialization deficits in ASD impact foundational social skills typically emerging in the first year of life, (b) examination of specific social adaptive behaviors contribute to differential diagnosis, and (c) foundational social behaviors should be targeted for intervention.

Language and communication skills in preschool children with autism spectrum disorders: contribution of cognition, severity of autism symptoms, and adaptive functioning to the variability

This study examined the contribution of cognitive function, severity of autism, and adaptive functioning to the variability in language and communication skills in 129 preschool children (aged 24-63 months) with autism spectrum disorder (ASD). Participants were selected from a representative research cohort of 208 preschool children on the basis of caregiver completion of the MacArthur-Bates Communicative Development Inventories (CDI). The children were classified into three cognitive groups: (a) Normal intelligence; (b) Developmental delay; and (c) Intellectual disability. Autism symptom severity was measured by the Autistic Behavior Checklist (ABC), and adaptive functioning by the Daily Living Skills (DLS) and Socialization (Soc) subscales from the Vineland Adaptive Behavior Scales. For each of five CDI variables (Phrases understood, Words understood, Words produced, Gestures and actions, and Language use), the contribution of cognition, severity of autism symptoms, and adaptive functioning to the variability was examined. Cognition and age explained about half or more of the variance in the four verbal language CDI variables, but only about one fourth of the variance in the non-verbal communication variable Gestures and actions. Severity of autism symptoms and the two adaptive measures (DLS and Soc) each only accounted for a few percent more of the variance in the four CDI language variables; however, for Gestures and actions, an additional 11-21% of the variance was accounted for. In conclusion, for children with ASD, receptive and expressive language is mainly related to cognitive level, whereas non-verbal communication skills seem to also be related to severity of autism symptoms and adaptive functioning.

Adaptive and maladaptive behavior in children with Smith-Magenis Syndrome

Children with Smith-Magenis Syndrome (SMS) exhibit deficits in adaptive behavior but systematic studies using objective measures are lacking. This descriptive study assessed adaptive functioning in 19 children with SMS using the Vineland Adaptive Behavior Scales (VABS). Maladaptive behavior was examined through parent questionnaires and the Childhood Autism Rating Scale. Cognitive functioning was evaluated with an age-appropriate test. Children scored below average on VABS Communication, Daily Living Skills, and Socialization scales. Learning problems and hyperactivity scales on the Conner's Parent Rating Scale were elevated, and girls were more impulsive than boys. Stereotypic and self-injurious behaviors were present in all children. Cognitive functioning was delayed and consistent with communication and daily living skills, while socialization scores were higher than IQ.

Spatial cognition in autism spectrum disorders: superior, impaired, or just intact?

The profile of spatial ability is of interest across autism spectrum disorders (ASD) because of reported spatial strengths in ASD and due to the recent association of Asperger's syndrome with Nonverbal Learning Disability. Spatial functions were examined in relation to two cognitive theories in autism: the central coherence and executive function (EF) theories. Performance on spatial tasks, EFs, and global/local processing was compared in children with ASD and controls. While the ASD group had faster reaction times on the Embedded Figures task, spatial performance was intact, but not superior, on other tasks. There was no evidence for impairments in EF or in processing global/local information, therefore contradicting these two theories. The implications of these results for these two theories are discussed.

Risperidone and adaptive behavior in children with autism

OBJECTIVE

To evaluate the impact of risperidone on adaptive behavior in children with autistic disorder who have serious behavior problems and to examine different methods of scoring the Vineland Adaptive Behavior Scales to measure change.

METHOD

Forty-eight children (5 years to 16 years, 5 months) who showed behavioral improvement during acute treatment with risperidone were followed for 6 months and assessed with the Vineland Scales.

RESULTS

Raw scores, age-equivalents, and special norm percentile scores all showed significant increases in adaptive behavior in the areas of communication, daily living skills, and socialization (p <.01). During a period of 6 to 8 months, children gained an average of 7.8 age-equivalent months in the area of socialization, a > 6% improvement beyond what would be expected based on baseline growth rates.

CONCLUSIONS

Although limited by the absence of a control group, these results suggest that risperidone may improve adaptive skills in children with autistic disorder accompanied by serious behavioral problems. Vineland age-equivalent scores appear to be most useful in assessing change with treatment over time.

Adaptive functioning and behaviour problems in relation to level of education in children and adolescents with intellectual disability

BACKGROUND

The interrelationship between adaptive functioning, behaviour problems and level of special education was studied in 186 children with IQs ranging from 61 to 70. The objective was to increase the insight into the contribution of adaptive functioning and general and autistic behaviour problems to the level of education in children with intellectual disability (ID).

METHODS

Children from two levels of special education in the Netherlands were compared with respect to adaptive functioning [Vineland Adaptive Behavior Scales (VABS)], general behaviour problems [Child Behavior Checklist (CBCL)] and autistic behaviour problems [Autism Behavior Checklist (ABC)]. The effect of behaviour problems on adaptive functioning, and the causal relationships between behaviour problems, adaptive functioning and level of education were investigated.

RESULTS

Children in schools for mild learning problems had higher VABS scores, and lower CBCL and ABC scores. The ABC had a significant effect on the total age equivalent of the VABS in schools for severe learning problems, the CBCL in schools for mild learning problems. A direct effect of the ABC and CBCL total scores on the VABS age equivalent was found, together with a direct effect of the VABS age equivalent on level of education and therefore an indirect effect of ABC and CBCL on level of education.

CONCLUSIONS

In the children with the highest level of mild ID, adaptive functioning seems to be the most important factor that directly influences the level of education that a child attends. Autistic and general behaviour problems directly influence the level of adaptive functioning. Especially, autistic problems seem to have such a restrictive effect on the level of adaptive functioning that children do not reach the level of education that would be expected based on IQ. Clinical implications are discussed.

Patterns of development in young children with autism

OBJECTIVE

To determine the extent to which the developmental profile of children less than 4 years can help in distinguishing children with autism from children with developmental delay.

METHODS

Subjects were 32 children with autism as per the DSM IV criteria and 32 children with developmental delay matched on chronological and academic age. The Developmental Profile II was used to assess the developmental functioning in five domains including physical, social, self help, academic, and communication.

RESULTS

The two groups showed significantly different developmental profiles and these differences were accounted for mainly by significantly lower social skills and superior motor skills in the autistic group as compared to the developmentally delayed group.

CONCLUSION

Developmental Profile II may help in distinguishing young children with autistic disorder from non-autistic children with comparable developmental delays.

Autism in infancy and early childhood

Although initially described as an inborn disorder of affective contact, information on autism as it exists in infants has been limited. Delays in diagnosis, lack of information about the condition, and reliance on retrospective research strategies have been problematic. An awareness of the increased risk for siblings is now allowing the development of new, prospective approaches. Consistent with Kanner's original hypothesis, the available information strongly suggests a fundamental difficulty in the earliest social processes, which, in turn, impacts many other areas of development. New approaches to screening have lowered the age of initial diagnosis; this presents new challenges for early intervention. Directions for future research are highlighted.

The Psychometric Properties of the Vineland Adaptive Behavior Scales in Children and Adolescents with Mental Retardation

The psychometric properties of the Vineland Adaptive Behavior Scales Survey Form were studied in a total population of children and adolescents with MR, and in the specific levels of functioning (n=826, age 4-18 years). The original division into (sub)domains, as assigned by the authors, was replicated in the total population and in the mild and moderate levels of functioning. In the severe and profound levels of functioning the structure was less well recognized. The reliability of the instrument proved to be good in the total population and the subgroups. The construct validity was high in all groups. The implications of these findings are discussed with respect to the usefulness of the Vineland for the population with MR.

The relation between general cognitive level and adaptive behavior domains in individuals with autism with and without co-morbid mental retardation

This study examined the association between adaptive behavior and general cognitive level in individuals with autism or PDD-NOS with and without comorbid mental retardation. Data from the screening version of the Vineland Adaptive Scales and the Wechsler Intelligence Scales were analysed in a sample of 67 subjects. While in the higher functioning individuals (IQ > 70, n = 34) IQ and adaptive behavior level differed significantly, performances were fairly comparable in subjects showing lower cognitive functioning (IQ < 70, n = 33). Regression models revealed a higher correlation between IQ and single adaptive behavior domains in the non-mentally retarded participants, with the domain Communication reaching the highest predictive power of the single adaptive behavior areas. Findings indicate, the relationship between adaptive and cognitive function in autistic disorders is mediated by the presence of a qualitative reduction of intelligence. Methodological limitations of the study are discussed.

Predictors and correlates of adaptive functioning in children with developmental disorders

Autism is a developmental disorder marked by impairments in socialization, communication, and perseverative behavior and is associated with cognitive impairment and deficits in adaptive functioning. Research has consistently demonstrated that children with autism have deficits in adaptive functioning more severe than their cognitive deficits. This study investigates the correlates and predictors of adaptive functioning as measured by the Vineland Adaptive Behavior Scales in high- and low-functioning children with autism and their age and nonverbal IQ matched controls. Thirty-five 9-year-old children with high-functioning autism (HAD) were compared with 31 age-matched children with developmental language disorder (DLD), and 40 9-year-old children with low-functioning autism (LAD) were compared with 17 age-matched children with low IQ on adaptive functioning, IQ, autistic symptomology, and tests of language and verbal memory. Results indicate that both groups with autism were significantly impaired compared to their matched controls on Socialization and Daily Living, but not Communication and that these impairments were more pronounced in the HAD group than in the LAD group. Adaptive behavior was strongly correlated with autistic symptomology only in the HAD group. Regression analyses indicated that IQ was strongly predictive of adaptive behavior in both low-functioning groups, but tests of language and verbal memory predicted adaptive behavior in the higher functioning groups. Results suggest that IQ may act as a limiting factor for lower functioning children but higher functioning children are impaired by specific deficits, including autistic symptomology and impaired language and verbal memory.

Toward a developmental operational definition of autism

Traditional approaches to diagnosing autism emphasize delays in communication and socialization. Traditional diagnostic schemes typically list symptoms (e.g., lack of eye contact), but provide little guidance on how to incorporate information about developmental level in making a diagnosis. Because standardized measures of adaptive behavior can provide information about children's communication, socialization, and other behavior relative to their age, they may be useful tools for diagnosing autism. This study investigated the ability of the Vineland Adaptive Behavior Scales to identify children with autism. Vineland scores and measures of intellectual functioning were obtained for children with autism, PDDNOS, and other developmental disorders (DD). Discriminant function analyses indicated that the autism and combined nonautism (PDDNOS and DD) groups could be differentiated on the basis of socialization, daily living skills, and serious maladaptive behaviors. Socialization alone accounted for 48% of the variance in diagnosis. Using regression analyses derived from a large normative sample, adaptive behavior scores were predicted from chronological age (CA) and mental age (MA). Socialization scores in the autism group were substantially below the level predicted from CA or MA. An index derived from the ratio of actual to predicted socialization scores correctly classified 86% of both autism and nonautism cases. Findings suggest that comparison of obtained Vineland socialization scores to those predicted by CA or MA may be useful in clarifying the diagnosis of autism.

Early development, temperament, and functional impairment in autism and fragile X syndrome

We compared the developmental status, functional abilities, and temperament of 31 young boys with fragile X syndrome (FXS) who did not have autism, matched on chronological age, gender, and race, with 31 boys with autism but no FXS. Children with autism exhibited a more variable profile of development in comparison with a relatively flat profile for children with FXS. Children with autism were significantly more delayed in social skills and were rated by observers as exhibiting a greater degree of impairment in cognitive, communication, and social skills. On temperament ratings, both groups were slower to adapt, less persistent, and more withdrawing than the reference group. Boys with FXS were rated as more active than the referent group, whereas boys with autism were rated as less intense, more distractible, having a higher threshold for response, and less rhythmic than the reference group. A smaller three-group analysis compared boys with FXS, boys with autism, and boys with both FXS and autism. Children with both autism and FXS were substantially more delayed than children with autism or FXS alone.

Vineland Adaptive Behavior Scale scores as a function of age and initial IQ in 210 autistic children

Human growth modeling statistics were utilized to examine how Vineland Adaptive Behavior Scale (VABS) scores changed in individuals with autistic disorder as a function of both age and initial IQ. Results revealed that subjects improved with age in all domains. The rate of growth in Communication and Daily Living Skills was related to initial IQ while rate of growth in Social Skills was not. Results should provide hope for parents and further support for the importance of functional social-communication skills in the treatment of autism.

A comparison of social skills in adults with autistic disorder, pervasive developmental disorder not otherwise specified, and mental retardation

We examined the social skills of adults with autism, PDDNOS, and mental retardation. All participants were diagnosed with profound mental retardation. Participants in the autism and PDDNOS groups had been previously diagnosed using the Childhood Autism Rating Scale (CARS) and record review. These diagnoses were confirmed by readministering the CARS by one author and an independent rater. Social skills were assessed by using the Vineland Adaptive Behavior Scales and the Matson Evaluation of Social Skills in the Severely Retarded. Significant differences between the autism and mental retardation groups were found on both measures. The PDDNOS group demonstrated better positive nonverbal social skills than the autism group but not the mental retardation group. Special treatment needs of institutionalized adults with autism appear warranted along with a need to clarify further the differences between PDDNOS and mental retardation.

The Vineland Adaptive Behavior Scales: supplementary norms for individuals with autism

Vineland Adaptive Behavior Scales Special Population norms are presented for four groups of individuals with autism: (a) mute children under 10 years of age; (b) children with at least some verbal skills under 10 years of age; (c) mute individuals who are 10 years of age or older; and (d) individuals with at least some verbal skills who are 10 years of age or older. The sample included 684 autistic individuals ascertained from cases referred for the DSM-IV autism/PDD field trial collaborative study and five university sites with expertise in autism. Young children had higher standard scores than older individuals across all Vineland domains. In the Communication domain, younger verbal children were least impaired, older mute individuals most impaired, and younger mute and older verbal individuals in the midrange. Verbal individuals achieved higher scores in Daily Living Skills than mute individuals. The expected profile of a relative weakness in Socialization and relative strength in Daily Living Skills was obtained with age-equivalent but not standard scores. Results high-light the importance of employing Vineland special population norms as well as national norms when evaluating individuals with autism.

Adaptive and intellectual functioning in autistic and nonautistic retarded children

This study examined the relationship between adaptive functioning on the Vineland Adaptive Behaviour Scale (VABS) and intellectual functioning on the Stanford-Binet Intelligence Scale, 4th edition (SB-IV) in autistic children and nonautistic retarded children of comparable CA and SB-IV composite score (IQ). The autistic group had lower scores than the retarded group in VABS adaptive composite, Socialization domain, and Communication domain, and SB-IV Verbal Reasoning area. VABS domain scores yielded higher classification rates than the SB-IV area scores in discriminating the two groups. Correlations between the two measures were much higher for the autistic group than for the retarded group. Results support the conclusion that the cognitive impairment in autism is reflected in greater impairment in adaptive behaviors than in mental retardation without autism.

Vineland Adaptive Behavior Scales as a summary of functional outcome of extremely low-birthweight children

This study reports moderate to high Pearson correlations between Vineland Adaptive Behavior Scale (VABS) subscale and total scores and a variety of cognitive, academic and motor performance tests on a population of extremely low-birthweight infants assessed at eight years of age. The subscales describe adaptive behaviour in daily living, communication, motor function and socialization, as well as an adaptive behaviour composite score. Because it can provide a norm-referenced description of functional outcomes and can be used to assess all children regardless of disability, the authors believe that the VABS should be applied uniformly by all groups reporting school-age outcome of neonatal intensive-care populations.

Is fragile X syndrome a pervasive developmental disability? Cognitive ability and adaptive behavior in males with the full mutation

In addition to mental retardation (MR), fragile X [fra(X)] syndrome has been associated with various psychopathologies, although it appears that the link is secondary to MR. It has been proposed that individuals with the full mutation be classified as a subcategory of pervasive developmental disorders (PDD). If fra(X) males are to be categorized as PDD, how do they compare with other types of developmental disabilities? We examined 27 fra(X) males aged 3-14 years, from 4 sites in North America. Measures of cognitive abilities were obtained from the Stanford-Binet Fourth Edition (SBFE), while levels of adaptive behavior were evaluated using the Vineland Adaptive Behavior Scales (VABS). Control subjects were sex-, age-, and IQ matched children and adolescents ascertained from the Developmental Evaluation Clinic (DEC) at Kings County Hospital. At the DEC, control subjects were diagnosed as either MR (n = 43) or autistic disorder (AD; n = 22). To compare subjects' adaptive behavior (SQ) with their cognitive abilities (IQ), a ratio of [(SQ/IQ) x 100] was computed. Results graphed as cumulative distribution functions (cdf) revealed that the cdf for AD males, who by definition are socially impaired, was positioned to the left of the cdf for MR controls, as expected. Mean ratio for AD males (70) was lower than for MR males (84). On the other hand, the cdf for fra(X) males was positioned far to the right of either AD or MR controls (mean ratio = 125). Statistical tests showed that SQ of fra(X) males was significantly higher than controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Cognitive shifting as a predictor of progress in social understanding in high-functioning adolescents with autism: a prospective study

Although striking and pervasive failure of social understanding is commonly viewed as a major defining characteristic of people with autism, few follow-up reports were published that have focused on improvement of social intelligence. In this prospective study in which 17 high-functioning adolescents with autism were involved, cognitive shifting as measured by card sorting tests, unlike overall intelligence, was shown to be the only significant factor in predicting progress in social understanding as assessed by social comprehension tests. A pretest-posttest design was used. During the 2-year follow-up all the subjects were in residential care and enrolled in educational curricula focusing on the development of social intelligence, living, and vocational skills.

Quantifying social development in autism

OBJECTIVE

This study was concerned with the development of quantitative measures of social development in autism.

METHOD

Multiple regression equations predicting social, communicative, and daily living skills on the Vineland Adaptive Behavior Scales were derived from a large, normative sample and applied to groups of autistic and nonautistic, developmentally disordered children. Predictive models included either mental or chronological age and other relevant variables.

RESULTS

Social skills in the autistic group were more than two standard deviations below those predicted by their mental age; an index derived from the ratio of actual to predicted social skills correctly classified 94% of the autistic and 92% of the nonautistic, developmentally disordered cases.

CONCLUSIONS

The findings are consistent with the idea that social disturbance is central in the definition of autism. The approach used in this study has potential advantages for providing more precise measures of social development in autism.

Autistic social dysfunction: some limitations of the theory of mind hypothesis

This study examined the extent to which the social disabilities found in autism can be accounted for by the "Theory of Mind" hypothesis. Items related to social development from the Vineland Adaptive Behavior Scales were administered to 29 CA-, MA- and IQ-matched pairs of young autistic and non-autistic, developmentally disabled children. These items were evaluated in relation to expected ages of acquisition based on the Vineland standardization database. Our results indicate that the social dysfunction in autism affects very basic and early emerging social behaviors which are typically present prior to the time at which even the earliest precursors of a theory of mind apparently emerge.

A comparative evaluation of adaptive behavior in children and adolescents with autism, Down syndrome, and normal development

The adaptive behaviors of 20 autistic, 20 Down syndrome, and 20 developmentally normal children were compared using the Vineland Adaptive Behavior Scale. Unlike previous studies, we included a comparison group of very young normally developing children and matched subjects on overall adaptive behavior as well as several pertinent demographic characteristics. Findings revealed that, relative to children with Down syndrome or normal development, autistic children displayed significant and pervasive deficits in the acquisition of adaptive social skills, and greater variability in adaptive skills. These findings underscore the need to longitudinally assess the development of socialization in autistic children and further highlight the utility of the Vineland in operationally defining the nature of social dysfunction in autistic children.