Child behavior checklist clinical scales discriminate referred youth with autism spectrum disorder: a preliminary study

Developmental coordination disorder subtypes also vary in the pattern of behavioral and emotional problems

Background

Behavioral and emotional problems in children with Developmental Coordination Disorder (DCD) are well documented. However, the heterogeneity of this group has been largely overlooked. Addressing this gap is important to develop individually-tailored interventions.

Aims

Our three aims were to assess: (i) behavioral and emotional problems in children with DCD; (ii) behavioral and emotional problems in subtypes of DCD, and (iii) the context-specificity of these problems (home/school).

Methods and procedure

Data were extracted from the medical records of a large sample of 93 children with DCD (79 boys, mean age 8.3) referred to a rehabilitation center. Behavioral and emotional problems were assessed with the Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF).

Outcomes and results

Two-third of the children presented with behavioral and emotional problems according to both parents and teachers. The subtypes with generalized motor problems were most affected, while the subtype with gross-motor problems was least affected. Children presented with more problems at home than at school.

Conclusion and implications

Given the frequent occurrence of behavioral and emotional problems, clinicians should tailor their interventions to these problems in DCD. Knowledge of subtypes can inform these decisions.

Age effects on autism heritability and etiological stability of autistic traits

BACKGROUND

Autism and autistic traits onset in childhood but persist into adulthood. Little is known about how genetic and environmental factors influence autism and autistic traits into adulthood. We aimed to determine age effects on the heritability of clinically diagnosed autism and the etiological stability of autistic traits from childhood to adulthood using twin methods.

METHODS

From 23,849 twin pairs in the Swedish Twin Register born between 1959 and 2010, we identified 485 individuals (1.01%, 31.5% female) with a clinical autism diagnosis. We estimated and compared the relative contribution of genetic, shared, and nonshared environmental influences to autism in childhood and adulthood. We further used multivariate twin analysis with four measurement points among 1,348 twin pairs in the longitudinal Twin Study of Child and Adolescent Development to assess the phenotypic and etiological stability of autistic traits - measured with three scales from the Child Behavior Checklist - from childhood to adulthood.

RESULTS

Autism heritability was comparable from childhood, (96% [95% CI, 76-99%]) to adulthood (87% [67-96%]). Autistic traits were moderately stable (phenotypic correlation = 0.35-0.61) from childhood to adulthood, and their heritability varied between 52 and 71%. We observed stable as well as newly emerging genetic influences on autistic traits from ages 8-9 to 19-20, and unique nonshared environmental influences at each age.

CONCLUSIONS

Genetic factors are important for autism and autistic traits in adulthood and separate genetic studies in adults are warranted.

Examining the association between prenatal cannabis exposure and child autism traits: A multi-cohort investigation in the environmental influences on child health outcome program

This study examined the association between prenatal cannabis exposure and autism spectrum disorder (ASD) diagnoses and traits. A total sample of 11,570 children (ages 1-18; 53% male; 25% Hispanic; 60% White) from 34 cohorts of the National Institutes of Health-funded environmental influences on child health outcomes consortium were included in analyses. Results from generalized linear mixed models replicated previous studies showing that associations between prenatal cannabis exposure and ASD traits in children are not significant when controlling for relevant covariates, particularly tobacco exposure. Child biological sex did not moderate the association between prenatal cannabis exposure and ASD. In a large sample and measuring ASD traits continuously, there was no evidence that prenatal cannabis exposure increases the risk for ASD. This work helps to clarify previous mixed findings by addressing concerns about statistical power and ASD measurement.

Behavioural and neuropsychological outcomes in children exposed in utero to maternal labour epidural analgesia

BACKGROUND

Recent studies report conflicting results regarding the relationship between labour epidural analgesia (LEA) in mothers and neurodevelopmental disorders in their offspring. We evaluated behavioural and neuropsychological test scores in children of mothers who used LEA.

METHODS

Children enrolled in the Raine Study from Western Australia and delivered vaginally from a singleton pregnancy between 1989 and 1992 were evaluated. Children exposed to LEA were compared with unexposed children. The primary outcome was the parent-reported Child Behaviour Checklist (CBCL) reporting total, internalising, and externalising behavioural problem scores at age 10 yr. Score differences, an increased risk of clinical deficit, and a dose-response based on the duration of LEA exposure were assessed. Secondary outcomes included language, motor function, cognition, and autistic traits.

RESULTS

Of 2180 children, 850 (39.0%) were exposed to LEA. After adjustment for covariates, exposed children had minimally increased CBCL total scores (+1.41 points; 95% confidence interval [CI] 0.09 to 2.73; P=0.037), but not internalising (+1.13 points; 95% CI -0.08 to 2.34; P=0.066) or externalising (+1.08 points; 95% CI -0.08 to 2.24; P=0.068) subscale subscores. Increased risk of clinical deficit was not observed for any CBCL score. For secondary outcomes, score differences were inconsistently observed in motor function and cognition. Increased exposure duration was not associated with worse scores in any outcomes.

CONCLUSIONS

Although LEA exposure was associated with slightly higher total behavioural scores, there was no difference in subscores, increased risk of clinical deficits, or dose-response relationship. These results argue against LEA exposure being associated with consistent, clinically significant neurodevelopmental deficits in children.

Psychometric Properties of the Child Behavior Checklist (CBCL) for Ages 6-18 to Identify Autism Spectrum Disorders (ASD) in a Turkish Parent Sample

The Child Behavior Checklist for ages 6-18 (CBCL/6-18) is broadly used for psycho-educational assessment in identifying children's behavior problems in special education and psychology. However, the usefulness of the CBCL/6-18 in a Turkish sample still needs to be investigated. The current study aimed to investigate the psychometric properties of the measures of the CBCL/6-18 within a sample of Turkish parents. The psychometric evaluation includes item calibration using the Partial Credit Model (PCM). We analyzed data from 548 parents who have children with autism spectrum disorder. According to the PCM calibration, the results suggested that the Internalizing, Externalizing, and Total Problem subscales were unidimensional and showed local independence successfully. All subscales demonstrated adequate reliability, indicating that the scale distinguishes between children with different behavior problems. The subscales had varying item step ordering, meaning that transitions from one category to second by parent ratings are relatively straightforward. Some items with easy-to-define behavior problems, for example, Item 42 (constipated), were more likely to be endorsed by parents. Consequently, the CBCL/6-18 has adequate psychometric properties for accurately assessing problem behaviors in children based on parent ratings.

In Memoriam: Professor Joseph Biederman's Contributions to Child and Adolescent Psychiatry

OBJECTIVE

To provide an overview of Joe Biederman's contributions to child and adolescent psychiatry.

METHOD

Nine colleagues described his contributions to: psychopharmacology, comorbidity and genetics, pediatric bipolar disorder, autism spectrum disorders, Tourette's and tic disorders, clinical and neuro biomarkers for pediatric mood disorders, executive functioning, and adult ADHD.

RESULTS

Joe Biederman left us with many concrete indicators of his contributions to child and adolescent psychiatry. He set up the world's first pediatric psychopharmacology clinic and clinical research program in child adolescent psychiatry. As a young faculty member he began a research program that led to many awards and eventual promotion to full professor at Harvard Medical School. He was for many years the most highly cited researcher in ADHD. He achieved this while maintaining a full clinical load and was widely respected for his clinical acumen.

CONCLUSION

The world is a better place because Joe Biederman was here.

Relationships between sensory integration and the core symptoms of attention-deficit/hyperactivity disorder: the mediating effect of executive function

Attention-deficit/hyperactivity disorder (ADHD) is often accompanied by executive function deficits and functional alterations in sensory integration. The present study aimed to investigate the relationship between ADHD core symptoms, executive function, and sensory integration in children with ADHD. A total of 228 children with ADHD were recruited for our study. The Sensory Organization Test (SOT) and Child Sensory Integration Scale (CSIS) evaluated the sensory integration ability from lab-based and scaled-based perspectives, respectively. Three core components of executive functions (inhibition, working memory, and set-shifting) were assessed using both lab-based tests and the relevant factors from the behavior rating inventory of executive function (BRIEF). Partial correlation analysis was performed to explore the correlation of sensory integration with EF and ADHD core symptoms. Based on the observed significant correlation, bootstrap analyses were further conducted to explore the potential mediating effect of EF on the relationship between sensory integration and ADHD core symptoms. ADHD symptoms and EF were significantly correlated with CSIS scores; no factors were significantly correlated with SOT performance. In detail, the vestibular-balance score was negatively correlated with both inattention and hyperactivity/impulsivity symptoms, while the hyper-sensory and proprioception scores were negatively correlated with only inattention symptoms. For the scaled-based EF, vestibular-balance was negatively correlated with inhibition and working memory, and the hyper-sensory score was negatively correlated with shift factor. No correlation was found for the lab-based EF tests. The subsequent mediation analysis found that inhibition partially mediated the relationship between vestibular balance and hyperactivity/impulsivity symptoms. Working memory completely mediated the relationship between vestibular-balance, hyper-sensory, proprioception, and inattention symptoms. These results were well validated in an independent sample. Our present findings demonstrated that the functional alteration in basic sensory integration might be associated with impairments of executive functions and then lead to the behavioral expression of ADHD. The present findings might provide a new perspective to understand the occurrence of ADHD symptoms and potential precise intervention methods.

Association between maternal labour epidural analgesia and autistic traits in offspring

STUDY OBJECTIVE

Studies investigating associations between maternal epidural analgesia (MEA) and autism spectrum disorder (ASD) in the offspring are conflicting and lack prospective neurobehavioral follow-up assessments for autistic traits. We aim to prospectively investigate associations between MEA and autistic traits in the offspring.

DESIGN

Prospective neurobehavioral observational cohort study.

SETTING

Singaporean tertiary healthcare institutions.

PATIENTS

Participants recruited were singleton non-IVF children, >36 weeks gestation, delivered via normal vaginal delivery by mothers >18 years of age, delivered in Singapore from June 2009-September 2010 and followed up over 7 years.

INTERVENTIONS

Exposure to maternal epidural analgesia during delivery.

MEASUREMENTS

The primary outcome is an abnormal Social Responsiveness Scale (SRS) T score at 7 years (≥60 points). Secondary outcomes include the diagnosis of ASD and abnormal scores for autistic traits assessed via a neurobehavioral battery comprising: CBCL (child behavioural checklist), Q-CHAT (Quantitative Checklist for Autism in Toddlers), and Bayley-III. Multivariable analyses adjusting for maternal and offspring characteristics were performed.

MAIN RESULTS

704 out of 769 mother-child dyads recruited fulfilled the criteria for analysis. 365/704 mothers received MEA. The incidence of an abnormal SRS score at 7 years in offspring exposed to MEA was 19.9%, and 26.1% in non-exposed offspring (p = 0.154). Multivariable analysis did not demonstrate a significant association between MEA and abnormal SRS scores at 7 years (O.R.0.726, 95% C·I. 0.394-1.34, p = 0.305). After adjustment for maternal and fetal demographics, exposure to MEA was not significantly associated with an abnormal screen in all other tests for autistic traits. The clinical incidence of ASD was 1.76% in children without exposure to MEA, and 2.32% in children with MEA exposure (p = 0.506).

CONCLUSIONS

MEA is not significantly associated with the development of ASD and autistic traits in offspring, assessed over 7 years. Results should be taken into perspective given our wide confidence intervals and small cohort size.

Examining the clinical correlates of conduct disorder in youth with bipolar disorder

BACKGROUND

Conduct Disorder (CD) is highly comorbid with Bipolar Disorder (BP) and this comorbidity is associated with high morbidity and dysfunction. We sought to better understand the clinical characteristics and familiality of comorbid BP + CD by examining children with BP with and without co-morbid CD.

METHODS

357 subjects with BP were derived from two independent datasets of youth with and without BP. All subjects were evaluated with structured diagnostic interviews, the Child Behavior Checklist (CBCL), and neuropsychological testing. We stratified the sample of subjects with BP by the presence or absence of CD and compared the two groups on measures of psychopathology, school functioning, and neurocognitive functioning. First-degree relatives of subjects with BP +/- CD were compared on rates of psychopathology in relatives.

RESULTS

Subjects with BP + CD compared to BP without CD had significantly more impaired scores on the CBCL Aggressive Behavior (p < 0.001), Attention Problems (p = 0.002), Rule-Breaking Behavior (p < 0.001), Social Problems (p < 0.001), Withdrawn/Depressed clinical scales (p = 0.005), the Externalizing Problems (p < 0.001), and Total Problems composite scales(p < 0.001). Subjects with BP + CD had significantly higher rates of oppositional defiant disorder (ODD) (p = 0.002), any SUD (p < 0.001), and cigarette smoking (p = 0.001). First-degree relatives of subjects with BP + CD had significantly higher rates of CD/ODD/ASPD and cigarette smoking compared to first-degree relatives of subjects without CD.

LIMITATIONS

The generalization of our findings was limited due to a largely homogeneous sample and no CD only comparison group.

CONCLUSIONS

Given the deleterious outcomes associated with comorbid BP + CD, further efforts in identification and treatment are necessary.

Prenatal Antidepressant Exposures and Autism Spectrum Disorder or Traits: A Retrospective, Multi-Cohort Study

Prenatal antidepressant exposure has been associated with increased risk for neurodevelopmental disorders in childhood, including autism spectrum disorder (ASD). The current study utilized multi-cohort data from the Environmental influences on Child Health Outcomes (ECHO) program (N = 3129) to test for this association, and determine whether the association remained after adjusting for maternal prenatal depression and other potential confounders. Antidepressants and a subset of selective serotonin reuptake inhibitors (SSRIs) were examined in relation to binary (e.g., diagnostic) and continuous measures of ASD and ASD related traits (e.g., social difficulties, behavior problems) in children 1.5 to 12 years of age. Child sex was tested as an effect modifier. While prenatal antidepressant exposure was associated with ASD related traits in univariate analyses, these associations were statistically non-significant in models that adjusted for prenatal maternal depression and other maternal and child characteristics. Sex assigned at birth was not an effect modifier for the prenatal antidepressant and child ASD relationship. Overall, we found no association between prenatal antidepressant exposures and ASD diagnoses or traits. Discontinuation of antidepressants in pregnancy does not appear to be warranted on the basis of increased risk for offspring ASD.

The Development and Validation of a Subscale for the School-Age Child Behavior CheckList to Screen for Autism Spectrum Disorder

The first aim of this study was to construct/validate a subscale-with cut-offs considering gender/age differences-for the school-age Child Behavior CheckList (CBCL) to screen for Autism Spectrum Disorder (ASD) applying both data-driven (N = 1666) and clinician-expert (N = 15) approaches. Further, we compared these to previously established CBCL ASD profiles/subscales and DSM-oriented subscales. The second aim was to cross-validate results in two truly independent samples (N = 2445 and 886). Despite relatively low discriminative power of all subscales in the cross-validation samples, results indicated that the data-driven subscale had the best potential to screen for ASD and a similar screening potential as the DSM-oriented subscales. Given beneficial implications for pediatric/clinical practice, we encourage colleagues to continue the validation of this CBCL ASD subscale.

Behavioral problems in infants and young children with spinal muscular atrophy and their siblings: A cross-sectional study

INTRODUCTION

Older children and adults with spinal muscular atrophy (SMA) have been shown to have more anxiety, depression, and other behavioral problems in a few studies. But no similar studies have been performed in infants and young children with SMA.

METHOD

Behavioral co-morbidities of young children with SMA were compared with healthy and children with chronic non-neurological illness control group. Infant Behavior Questionnaire-Revised (IBQ-R) and parent-report version of chid behavior checklist (CBCL) were used for infants and preschool-age children respectively.

RESULTS

A total of 35 SMA children (age at symptom onset-5.9 ± 2.8 months, at enrolment-21.4 ± 7.1 months, 65% boys, 11, 19 and 5 were SMA 1, 2 and 3 respectively) and 24 siblings (38.6 ± 11.2 months, 71% boys) were enrolled. We also enrolled 15 children with nephrotic syndrome as age and gender matched control to SMA children in age-group 2-5 years (27.7 ± 9.1 months, 67% boys). In infants with SMA, the scale scores of IBQ-R were significantly higher for distress to limitation, fear, sadness, and falling reactivity/rate of recovery from distress (p = 0.005; 0.03; 0.001, and 0.04) and lower for soothability as compared to healthy control group (p = 0.04). Similarly, for the three dimensions of temperament computed from these 13 domains, the mean scale score for surgency/extraversion was lower and negative affectivity was higher (p = 0.04 and 0.03), in infants with SMA as compared to healthy controls. For preschool age group, the internalizing problem scores (p = 0.009 and 0.03) and stress problem scores (p = 0.002 and 0.04) were higher in the SMA group, as compared to both the healthy control group and diseased control group. While assessing the syndrome scale scores, the score was higher for emotionally reactive (p = 0.0002 and 0.01) and anxious domains (p < 0.0001 and p = 0.0002) compared to both healthy and diseased control groups.

CONCLUSION

Infants and young children with SMA suffer from increased internalizing problems like anxiety, depression and probably their healthy siblings are also at increased levels of stress, depicted by increased somatic complaints.

Math difficulties in attention deficit hyperactivity disorder do not originate from the visual number sense

There is ample evidence from literature and clinical practice indicating mathematical difficulties in individuals with ADHD, even when there is no concomitant diagnosis of developmental dyscalculia. What factors underlie these difficulties is still an open question. Research on dyscalculia and neurotypical development suggests visual perception of numerosity (the number sense) as a building block for math learning. Participants with lower numerosity estimation thresholds (higher precision) are often those with higher math capabilities. Strangely, the role of numerosity perception in math skills in ADHD has been neglected, leaving open the question whether math difficulties in ADHD also originate from a deficitary visual number sense. In the current study we psychophysically measured numerosity thresholds and accuracy in a sample of children/adolescents with ADHD, but not concomitant dyscalculia (N = 20, 8-16 years). Math abilities were also measured by tasks indexing different mathematical competences. Numerosity performance and math scores were then compared to those obtained from an age-matched control group (N = 20). Bayesian statistics indicated no difference between ADHD and controls on numerosity perception, despite many of the symbolic math tasks being impaired in participants with ADHD. Moreover, the math deficits showed by the group with ADHD remained substantial even when numerosity thresholds were statistically regressed out. Overall, these results indicate that math difficulties in ADHD are unlikely to originate from an impaired visual number sense.

Predictors of Functional School Outcome in Children With Pediatric Acquired Brain Injury

Objective

Among the variety of domains that may be impacted after pediatric acquired brain injury (pABI) are functional school outcomes. The purpose of this study was to identify demographic, medical, and psychological factors associated with impairments in functional school outcomes, defined as school absence, need of educational and psychological services, quality of life (QoL) in the school setting, and academic performance in children with pABI, with a specific emphasis on the significance of fatigue.

Materials and Method

We used baseline data from a randomized controlled trial. The sample consisted of seventy-six children aged 10 to 17 (M = 13 yrs) with pABI in the chronic phase (>1 year). All completed assessments of school-related QoL, academic performance, global functioning, fatigue, IQ, behavioral problems, and executive function.

Results

Fatigue, IQ, global functioning, behavioral problems, and sex emerged as potential predictors for functional school outcomes. Of note, overall fatigue emerged as the strongest potential predictor for parent-reported QoL in school (β = 0.548; p < 0.001) and self-reported QoL in school (β = 0.532; p < 0.001).

Conclusions

Following pABI, specific psychological, medical, and demographic factors are associated with functional school outcomes. Neither of the injury-related variables age at insult and time since insult were associated with functional school outcomes. Overall, our findings may suggest that a reintroduction to school with personalized accommodations tailored to the child's specific function and symptoms, such as fatigue, is recommended.

Association between frontal cortico-limbic white-matter microstructure and risk for pediatric depression

This study aimed to identify white-matter microstructural characteristics associated with risk for pediatric major depressive disorder (MDD) measured by the Child Behavior Checklist (CBCL) Anxiety/Depression scores. Children (N = 32) of both sexes, aged 6-12, underwent T1-weighted whole-head anatomical and diffusion-weighted imaging. Each participant's mean diffusion measure image was generated and thinned to create an alignment-invariant tract representation. Voxel-wise analysis on the resulting map was carried out in Track Based Spatial Statistics (TBSS) using general linear models by regressing the CBCL-Anxiety/Depression score against measures of diffusion tensor imaging (DTI). We also compared these results with prior DTI findings from the same children associated with CBCL-Emotion Dysregulation profile, an indicator for bipolar disorder. TBSS voxel-wise analysis showed a significant negative correlation between fractional anisotropy (FA) and CBCL-Anxiety/Depression scores localized in the right anterior cingulum and connected corpus callosal region. The negative FA correlations in these regions were greater in CBCL-Anxiety/ Depression scores compared to CBCL-Emotional Dysregulation scores. Reduced white-matter connectivity in the anterior cingulum and connected corpus callosal region may represent a biomarker of risk for pediatric MDD. These results may help identify brain differences associated with the development of MDD, and assist with earlier clinical identification of pediatric MDD.

Dual Language Learning Predicts Improved Executive Functioning in Youth with Autism

Previous findings show executive functioning advantages associated with dual language learning (DLL) among neurotypical individuals, yet few studies have investigated these effects in youth with autism spectrum disorder (ASD). The present study investigated effects of DLL and socioeconomic status (SES) on parent-reported executive functioning, verbal ability, and social-emotional functioning using a sample of DLL (n = 53) and monolingual (n = 106) youth with ASD without intellectual disability, matched on gender and full-scale IQ scores. After controlling for the effects of SES, results showed that monolingual youth had better outcomes on verbal ability, while DLL youth had fewer parent-reported problems with executive functioning and unusual behaviors. These findings indicate that bilingualism may mitigate executive functioning deficits in youth with ASD.

The child behavior checklist can aid in characterizing suspected comorbid psychopathology in clinically referred youth with ADHD

OBJECTIVE

To examine the utility of the Child Behavior Checklist (CBCL) to aid in the identification of comorbid psychopathological conditions affecting referred youth with suspected ADHD prior to the evaluation. The CBCL is an easy-to-use assessment tool that may provide invaluable information regarding the severity and characteristics of the presenting complaints.

METHODS

The sample included 332 youths consecutively referred to an ADHD program for the assessment of suspected ADHD. Parents completed the CBCL, parent-rated ADHD Self-Report Scale (ASRS), Social Responsiveness Scale (SRS), and Behavior Rating Inventory of Executive Function (BRIEF). Because of the established association between the CBCL Attention Problems scale and a structured diagnostic interview of ADHD, all youths analyzed had abnormal Attention Problems T-scores (≥60).

RESULTS

Seventy-six percent of youths with elevated Attention Problems T-scores had ≥3 additional abnormal CBCL scales, suggesting they were likely affected with multiple comorbid psychopathological conditions. Moreover, 44% had ≥1 CBCL clinical scale with a T-score more severe than their Attention Problems T-score, suggesting the putative comorbid condition was more severe than the ADHD symptoms. Additional CBCL scale elevations were associated with more severe functional impairments as assessed by the ASRS, SRS, BRIEF, and CBCL competence scales.

CONCLUSION

The CBCL obtained before the clinical assessment identified high rates of comorbid psychopathology in youths referred for the assessment of ADHD. It provided detailed information about the types and severity of suspected psychopathological conditions impacting a particular youth, which is critical to guide the assessing clinician on likely differing needs of the affected child.

Managing precocious puberty: A necessity for psychiatric evaluation

OBJECTIVE

Precocious puberty (PP) is one of the most common endocrine disorders in school-age girls. It has been reported that there is an increased tendency for psychiatric disorders for early maturing girls. The aim of this study was to determine the prevalence of psychiatric problems and to investigate depression and anxiety levels, and self-concept characteristics in girls with PP.

METHODS

Girls with PP (n = 41) and controls (n = 45) aged 7-11 years participated in this study. Psychiatric evaluations were conducted with semi-structured interviews. Behavioral and emotional problems were assessed using Child Behavior Check List and Teacher Report Form. Children's Depression Inventory, State-Trait Anxiety Inventory for Children and Piers-Harris Children's Self Concept Scale were administered, respectively.

RESULTS

Girls with PP had significantly more psychiatric diagnosis than controls (68.3 % vs 20 %, p < 0.001). PP group had significantly higher anxious-depressed, somatic complaints, social problems, aggresive behaviors and interestingly autistic traits. Increased symptom levels of depression and anxiety, and lower self-concept scores were also obtained from PP subjects.

CONCLUSIONS

PP is an independent predictor of psychiatric disorders. It is also associated with poorer psychiatric status, lower self esteem characteristics, and autistic traits. A multidisciplinary approach combining endocrinologic and psychiatric evaluations seem to be beneficial for the management of girls with PP.

Can the Child Behavior Checklist (CBCL) help characterize the types of psychopathologic conditions driving child psychiatry referrals?

Background:

Little is known about the scope of problems driving referrals to child and adolescent psychiatry services. Identifying the full range of mental disorders affecting a particular child can help triage the child to a clinician with the appropriate level of expertise. The Child Behavior Checklist (CBCL) is an easy-to-use assessment tool that may provide invaluable information regarding the severity of the presenting complaints and also aid in the referral process.

Objective:

To assess the utility of the CBCL to gain insights into the type of clinical problems driving referrals of youth to an outpatient pediatric psychiatry clinic.

Method:

The sample consisted of 418 newly referred youth 4-18 years of age of both sexes. Parents completed the CBCL assessing psychopathology and competence. Rates of patients with elevated T-scores on each scale were calculated for the whole group and stratified by sex and age (≤12 versus >12).

Results:

The CBCL identified high rates of psychopathology affecting referred youth. It also provided information on the type of suspected disorders affecting a particular child as well as their severity, critical information to guide likely differing clinical needs and therapeutic approaches. It also helped identify a high number of youth affected with multiple psychopathological conditions, likely to require a high level of clinical attention. Overall, males were significantly more impaired than females but there were no major differences between children and adolescents.

Conclusions:

The CBCL can aid in the identification of individual and comorbid mental disorders affecting youth seeking mental health services by providing specific information about the presence and the severity of specific suspected disorder. These findings have implications for prioritizing scarce resources in child mental health and for improved consideration of the complexity of clinical presentations to pediatric psychiatry programs of any type.

The Influence of Child-Related Factors on Caregiver Perceptions of Their Child's Sustained Participation in a Community Football Program: A Study of Children with and without Neurodevelopmental Disorders

This study evaluated the influence of activity preference and involvement on season completion in a community-based football program for children with and without neurodevelopmental disorders. Caregivers (n = 1428) of 1529 children aged 4 to 17 (M = 7.27, SD = 1.85), with (n = 175) and without (n = 1354) neurodevelopmental disorders who were currently participating or had previously participated in a group-based NAB AFL Auskick football program completed an online survey. The survey collected information on their child's completion of any attempted seasons of the football program, level of involvement during the sessions and preference for football over other sports and activities. Eighty percent of children with a neurodevelopmental diagnosis had completed all seasons of Auskick, compared with 93% of children without a neurodevelopmental diagnosis. Results indicated that children with neurodevelopmental disorders (n = 135) were 3.71 times less likely to complete a football season than their typically developing peers (n = 903). Higher levels of involvement during football sessions and greater preference for football were linked to a higher football season completion rate, irrespective of neurodevelopmental disability diagnosis. This study highlights the influence of child-related factors, in particular, preference and involvement, on children's sustained participation in community football programs, regardless of neurodevelopmental disability status.

A Combined Study on the Use of the Child Behavior Checklist 1½-5 for Identifying Autism Spectrum Disorders at 18 Months

The capacity of the Child Behavior Checklist 1½-5 (CBCL 1½-5) to identify children with autism spectrum disorder (ASD) at 18 months was tested on 37 children clinically referred for ASD and 46 children at elevated likelihood of developing ASD due to having an affected brother/sister. At 30 months the clinically referred children all received a confirmatory diagnosis, and 10 out of 46 siblings received a diagnosis of ASD. CBCL 1½-5 profiles were compared with a group of matched children with typical development (effect of cognitive level controlled for). The capacity of the CBCL 1½-5 DSM Oriented-Pervasive Developmental Problems scale to differentiate correctly between children diagnosed with ASD and children with typical development appeared dependent on group ascertainment methodology.

Clinical Subtypes in Children with Attention-Deficit Hyperactivity Disorder According to Their Child Behavior Checklist Profile

This study sought to identify subgroups of attention-deficit hyperactivity disorder (ADHD) defined by specific patterns of emotional and behavioral symptoms according to the parent-rated Child Behavior Checklist (CBCL). Our clinical sample comprised 314 children (aged 4 to 15 years) diagnosed with ADHD according to the DSM-5. In addition, comorbid psychiatric disorders, general functioning, and medication status were assessed. Cluster analysis was performed on the CBCL syndrome subscales and yielded a solution with four distinct subgroups. The "High internalizing/externalizing" group displayed an overlap between internalizing and externalizing problems in the CBCL profile. In addition, the "High internalizing/externalizing" group revealed a high rate of comorbid autism spectrum disorder and elevated autistic traits. The "Inattention and internalizing" group revealed a high rate of the predominantly inattentive presentation according to ADHD specifier from the DSM-5. The "Aggression and externalizing" group revealed a high rate of comorbid oppositional defiant disorder and conduct disorder. The "Less psychopathology" group scored low on all syndrome scales. Children with ADHD were subdivided into four distinct subgroups characterized by psychopathological patterns, with and without internalizing and externalizing problems. The overlap between internalizing and externalizing problems may be mediated with emotional dysregulation and associated neurobiological bases.

Autistic spectrum disorder symptoms in children and adolescents with attention-deficit/hyperactivity disorder: a meta-analytical review

BACKGROUND

Research identifies highly variable prevalence estimates for autism spectrum disorder (ASD) in children and adolescents with attention deficit hyperactivity disorder (ADHD), particularly between community and clinical samples, warranting quantitative meta-analyses to investigate the true prevalence of ASD in children and adolescents with ADHD.

METHODS

Studies were identified through a systematic literature search of PsycINFO, MEDLINE and Web of Science through January 2018. Twenty-two publications met inclusion criteria (total N = 61 985). Two random effects meta-analyses were conducted: (1) to identify the proportion of children and adolescents with ADHD that met criteria for ASD; and (2) to compare the severity of dimensionally-measured ASD symptomology in children and adolescents with and without ADHD.

RESULTS

The overall pooled effect for children and adolescents with ADHD who met threshold for ASD was 21%. There was no significant difference between community samples (19%) and clinical samples (24%) or between US studies v. those from other countries. Children and adolescents with ADHD had substantially more dimensionally-measured ASD traits compared with those who did not have ADHD (d = 1.23).

CONCLUSION

The findings provide further evidence that ADHD and ASD are associated in nature. Clinical and research implications are discussed.

School-age social behavior and pragmatic language ability in children with prenatal serotonin reuptake inhibitor exposure

Studies examining associations between fetal serotonin reuptake inhibitor (SRI) exposure and child autism spectrum disorder (ASD) diagnoses or delayed language remain mixed and rarely prospectively follow children or employ gold-standard assessments. We prospectively followed a cohort of mother-child dyads from pregnancy through early elementary school (N = 178), and obtained maternal and alternate-caregiver ratings of behaviors related to ASD (N = 137), as well as direct, gold-standard assessments of child ASD symptoms and pragmatic language among dyads who experienced prenatal depression and either took SRIs or were medication free during pregnancy (N = 44). Prenatal SRI exposure was related to maternal ratings of ASD-related behaviors (β = 0.24 95% confidence interval; CI [0.07, 0.48]), and, among boys, alternative caregiver ratings (males-only β = 0.28 95% CI [0.02, 0.55], females-only β = -0.21 95% CI [-0.63, 0.08]). However, results of our direct assessments suggest an association between SRI exposure and reduced pragmatic language scores (β = -0.27, 95% CI [-0.53, -0.01], but not ASD (Autism Diagnostic Observation Schedule β = 0.14 95% CI [-0.15, 0.41]; Social Responsiveness Scale β = 0.08 95% CI [-0.25, 0.40]). These discrepancies point to issues regarding how ASD is assessed, and the possibility that SRIs may be more strongly associated with language or other broader behaviors that coincide with ASD. Larger prospective studies that incorporate thorough, gold-standard assessments of ASD, language, and other ASD-related behaviors are needed.

Measuring treatment outcome in children with developmental coordination disorder; responsiveness of six outcome measures

Purpose: Although measuring outcome of rehabilitation in children with Developmental Coordination Disorder is considered important no consensus exists on which instruments to use. An important attribute of a measurement instrument would be that it is sensitive to clinical changes. The aim of this prospective, observational study was therefore to investigate the responsiveness of six potentially suitable instruments.Methods: Forty-one children (34 boys, median age 7.8 years, Inter Quartile Range: 7.2-9.2) receiving multidisciplinary rehabilitation treatment for Developmental Coordination Disorder were included (mean treatment time: 32.8 h, Standard Deviation 7.3). The following instruments were applied before and after rehabilitation: Movement-Asessment-Battery-Children-2 (MABC-2), Canadian Occupational Performance Measure (COPM), Systematic detection writing problems (SOS-2-NL), DCD-daily, Behaviour Rating Inventory of Executive Function (BRIEF), and TNO-AZL children's Quality of Life questionnaire (TACQOL)). Change-scores (paired t-test/Wilcoxon-test) and responsiveness (Effect-sizes and Standardized-Response-Means) were calculated.Results: Significant differences over time were found for the Canadian Occupational Performance Measure, DCDdaily and Movement-Asessment-Battery-Children-2 (p < 0.05). The responsiveness of these instruments was moderate-high (Canadian Occupational Performance Measure-performance Effect-Size:1.70/Standardized-Response-Mean:1.81, Canadian Occupational Performance Measure-satisfaction Effect-Size:1.65/Standardized-Response-Mean 1.53; DCDdaily-total-score Effect-Size:0.40/Standardized-Response-Mean:0.62, DCDdaily-Quality-score Effect-Size:0.74/Standardized-Response-Mean:0.89, DCDdaily-time-score Effect-Size:0.21/Standardized-Response-Mean:0.43; MABC-2-total-score Effect-Size:0.42/Standardized-Response-Mean:0.43, MABC-2-Ball-skills-score Effect-Size:0.33/Standardized-Response-Mean:0.36). Systematic detection of writing problems (SOS-2-NL), Behaviour Rating Inventory of Executive Function (BRIEF) and TNO-AZL children's Quality of Life questionnaire (TACQOL) were not responsive to change.Conclusion: Although the Movement-Asessment-Battery-Children-2 test is the most widely used instrument when measuring rehabilitation outcome in Developmental Coordination Disorder, the Canadian Occupational Performance Measure and DCDdaily seem to be more responsive and constitute a valuable addition.Implications for rehabilitationCurrently, there is no consensus on the preferred measurement instruments to evaluate the outcomes of rehabilitation in children with Developmental Coordination Disorder.The responsiveness of the Canadian Occupational Performance Measure (COPM) was found to be large, of the DCDdaily moderate to large, and of the Movement-Assessment-Battery-Children-2 (MABC-2) small, whereas the systematic detection of writing problems (SOS-2-NL; Systematisch Opsporing Schrijfproblemen-2-NL), Behavior Rating Inventory of Executive Functioning (BRIEF) and TNO-AZL Questionnaire for Children's Health-Related Quality of Life (TACQOL) were not responsive to change.Although the Movement-Assessment-Battery-Children-2 (MABC-2) is commonly used in Developmental Coordination Disorder rehabilitation, applying the Canadian Occupational Performance Measure (COPM) and DCDdaily should be considered, as these instruments were more sensitive to clinical changes.

Predictive utility of autistic traits in youth with ADHD: a controlled 10-year longitudinal follow-up study

The objective of this study was to investigate the stability and predictive utility of autistic traits (ATs) in youth with attention-deficit/hyperactivity disorder (ADHD). Participants were referred youth with and without ADHD, without a diagnosis of autism spectrum disorder, and their siblings, derived from identically designed longitudinal case-control family studies of boys and girls with ADHD. Subjects were assessed with structured diagnostic interviews and measures of social, cognitive, and educational functioning. The presence of ATs at baseline was operationalized using a unique profile of the Child Behavior Checklist (CBCL) consisting of an aggregate T score of ≥ 195 on the Withdrawn, Social, and Thought Problems subscales (CBCL-AT profile). At the follow-up, 83% of the ADHD youth with a positive AT profile at baseline continued to have a positive CBCL-AT profile. The presence of a positive CBCL-AT profile at baseline in youth with ADHD heralded a more compromised course characterized by a greater burden of psychopathology that emerged at an earlier age, along with poorer interpersonal, educational, and neurocognitive outcomes. Findings indicate a high level of persisting ATs in ADHD youth over time, as indexed through the CBCL-AT profile, and the presence of this profile prognosticates a compromised course in adult life in multiple domains of functioning.

Classical galactosemia: neuropsychological and psychosocial functioning beyond intellectual abilities

Background

Despite early diagnosis and treatment, Classical Galactosemia (CG) patients frequently develop long-term complications, such as cognitive impairment. Available literature primarily reports on general intellectual abilities and shows a substantially lower Full Scale Intelligence Quotient (FSIQ) in CG patients than in the general population. Both problems in social functioning as well as internalizing problems are often reported in CG patients. The combination of intelligence, cognitive functioning, behavior and social functioning has not been studied systematically in CG patients.

Methods

To determine if CG patients demonstrate a specific neuropsychological and psychosocial profile, we investigated intelligence, functioning on multiple cognitive domains, behavior and social functioning with a comprehensive neuropsychological test battery and questionnaires (self- and proxy-reported).

Results

The data of 48 patients, aged 4–47 years are reported. FSIQ ranged from 45 to 103 (mean 77 ± 14). A negative correlation between age and FSIQ was demonstrated (p = 0.037) which resulted directly from the inclusion of four young ‘milder’ patients detected by newborn screening (NBS) with an expected better clinical outcome. Compared to normative data, patients had significantly lower but highly variable scores on all cognitive domains, especially on tests requiring mental speed. In the context of the FSIQ, 43% of the cognitive test results exceeded IQ based expectations. Overall, the patients’ scores on social functioning were in the normal range but internalizing problems were frequently reported. In our cohort, an early initiation of dietary treatment due to NBS or family screening did not result in a more favorable neuropsychological outcome.

Conclusions

In this study, we demonstrated that as a cohort, CG patients have a below average intelligence and impaired cognitive functioning without a distinctive neuropsychological profile. The effect of age on neurocognitive functioning should be assessed in longitudinal studies. Social functioning was not impaired, but patients may be at risk for internalizing problems. Considering the large variability in cognitive, behavioral and social functioning and the finding that cognitive outcomes may exceed IQ based expectations, an individual evaluation and follow-up is warranted in all CG patients to ensure timely support if needed.

Impaired social functioning in children with narcolepsy

Study Objectives

To explore impairments in social functioning in children with narcolepsy compared to healthy children.

Methods

Parents of 53 pediatric patients with narcolepsy type 1 and 64 matched healthy children completed the Social Responsiveness Scale (SRS) and the Child Behavior Checklist 6-18 (CBCL 6-18).

Results

Patients scored significantly higher on the total score of the SRS (median 56, interquartile range [IQR] 23.5) compared to controls (median 44.5, IQR 8.5, U = 797.0, p < 0.001). Patients also scored higher on the sum of the CBCL 6-18 subscales indicative of social functioning (Withdrawn/Depressed, Social Problems, and Thought Problems; median 183, IQR 30.5) compared to controls (median 155, IQR 13, U = 500.0, p < 0.001). A total of 24 patients (45.3%) reported at least mild-to-moderate difficulties in social functioning compared to seven controls (10.9%, χ2 = 17.165, p < 0.001). Eleven patients (20.8%) and only one control (1.6%) had T scores above 75, which points to severely impaired social functioning (χ2 = 11.602, p = 0.001). Within the patient group, girls reported mild-to-moderate difficulties in social functioning significantly more often compared to boys on the SRS (77.8% versus 28.6%, χ2 = 17.560, p < 0.001).

Conclusions

Impaired social functioning is common in children with narcolepsy type 1, especially in girls. Questionnaires such as the SRS and the CBCL 6-18 may help in early detection of social problems in pediatric narcolepsy. Recognition of these problems could be valuable in the management of young people with narcolepsy.

Psychotic symptoms in 16p11.2 copy-number variant carriers

16p11.2 copy-number variation (CNV) is implicated in neurodevelopmental disorders, with the duplication and deletion associated with autism spectrum disorder (ASD) and the duplication associated with schizophrenia (SCZ). The 16p11.2 CNV may therefore provide insight into the relationship between ASD and SCZ, distinct disorders that co-occur at an elevated rate, and are difficult to distinguish from each other and from common co-occurring diagnoses such as obsessive compulsive disorder (OCD), itself a potential risk factor for SCZ. As psychotic symptoms are core to SCZ but distinct from ASD, we sought to examine their predictors in a population (n = 546) of 16p11.2 CNV carriers and their noncarrier siblings recruited by the Simons Variation in Individuals Project. We hypothesized that psychotic symptoms would be most common in duplication carriers followed by deletion carriers and noncarriers, that an ASD diagnosis would predict psychotic symptoms among CNV carriers, and that OCD symptoms would predict psychotic symptoms among all participants. Using data collected across multiple measures, we identified 19 participants with psychotic symptoms. Logistic regression models adjusting for biological sex, age, and IQ found that 16p11.2 duplication and ASD diagnosis predicted psychotic symptom presence. Our findings suggest that the association between 16p11.2 duplication and psychotic symptoms is independent of ASD diagnosis and that ASD diagnosis and psychotic symptoms may be associated in 16p11.2 CNV carriers. Autism Res 2020, 13: 187-198. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Either deletion or duplication at chromosome 16p11.2 raises the risk of autism spectrum disorder, and duplication, but not deletion, has been reported in schizophrenia (SCZ). In a sample of 16p11.2 deletion and duplication carriers, we found that having the duplication or having an autism diagnosis may increase the risk of psychosis, a key feature of SCZ.

Assessment of Psychopathological Comorbidities in Children and Adolescents With Autism Spectrum Disorder Using the Child Behavior Checklist

Autism spectrum disorder (ASD) is characterized by psychiatric and behavioral comorbidities. The Child Behavior Checklist (CBCL) provides valid and well-established measures of emotional, behavioral, and social problems in children and adolescents. The aim of the present study was to verify whether emotional, behavioral, and social problems were modulated by ASD symptom severity, cognitive development, gender, and age by analyzing the CBCL in a large group of children and adolescents with ASD. The results show that around 30% of participants with ASD exhibited internalizing problems and only 6% externalizing problems, with males exhibiting more internalizing problems than females. No correlation was found between CBCL scores and indices of ASD severity. However, higher CBCL Total Problems scores were found in older children and in children with lower cognitive abilities. The detection of behavioral and emotional problems allows children with ASD to undergo specific and individualized treatment that takes into account their psychopathological problems.

Effects of iron supplementation of low-birth-weight infants on cognition and behavior at 7 years: a randomized controlled trial

BackgroundLow-birth-weight infants (LBW) are at an increased risk of iron deficiency that has been associated with impaired neurodevelopment. We hypothesized that iron supplementation of LBW infants improves cognitive scores and reduces behavioral problems until school age.MethodsWe randomized 285 marginally LBW (2,000-2,500 g) infants to receive 0, 1, or 2 mg/kg/day of iron supplements from 6 weeks to 6 months of age. At 7 years of age, 205 participants were assessed regarding cognition using Wechsler Intelligence Scale for Children (WISC-IV) and behavior using the parental questionnaires Child Behavior Checklist (CBCL) and Five to Fifteen (FTF).ResultsThere were no significant differences between the intervention groups in WISC-IV or FTF. However, the CBCL scores for externalizing problems were significantly different, in favor of supplemented children (P=0.045). When combining the supplemented groups, they had significantly lower scores for externalizing behavior compared with placebo (median (interquartile range): 44 [34;51] vs. 48.5 [41;56] P=0.013), and their risk ratio (95% confidence interval) for a total behavioral score above the cutoff for clinical problems was 0.31 (0.09-1.0), P=0.054.ConclusionLower scores of externalizing behavior in supplemented children support our previous findings at 3 years, and suggest that iron supplementation may have long-lasting effects on behavioral functions.

Receiver operating characteristic curve analysis of the Child Behavior Checklist and Teacher's Report Form for assessing autism spectrum disorder in preschool-aged children

BACKGROUND

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social, behavioral, and communication impairments with an estimated prevalence of 1 in 68 school-aged children. There is a need for objective and easily applicable instruments for early identification of autistic children to enable initiation of early interventions during a very sensitive period of brain development and, consequently, optimize prognosis. Here, we tested the utility of the Child Behavior Checklist (CBCL) and the Caregiver-Teacher's Report Form (C-TRF) scales for assessing ASD in Brazil, where ASD screening research is emergent.

SUBJECTS AND METHODS

A total of 70 children (2-5 years old, both sexes) were enrolled, including an ASD group (n=39) and a non-ASD control group (n=31). The preschool versions of the CBCL and C-TRF were applied. The CBCL and C-TRF results were compared between the ASD and non-ASD control groups with Mann-Whitney U tests and receiver operating characteristic analyses.

RESULTS

The CBCL and C-TRF were found to have moderate accuracy for the dimensions withdrawn and autism spectrum problems, and to correlate with each other.

CONCLUSION

The CBCL and C-TRF may aid in early ASD detection.

Severity of Autism Symptoms and Degree of Attentional Difficulties Predicts Emotional and Behavioral Problems in Children with High-Functioning Autism; a Two-Year Follow-up Study

Children with autism often struggle with emotional and behavioral problems (EBP). This study investigated whether level of autism symptoms, attention problems or verbal IQ at baseline can predict EBP 2 years later in children with High-Functioning Autism (HFA). Thirty-four participants with HFA and 45 typically developing children (TD) (ages 9-16) were assessed with parent ratings of EBP, autism symptoms, attention problems, and a test of verbal IQ. The amount of autism symptoms and degree of attention problems at baseline significantly predicted EBP at follow-up, whereas verbal IQ did not. The findings from this study emphasize the importance of assessing and understanding the consequences of autism symptoms and attention problems when treating EBP in children with HFA. Furthermore, interventions aimed at improving ASD symptoms may positively affect the prevalence of EBP in children with HFA.

The Screen for Child Anxiety-Related Emotional Disorders Is Sensitive but Not Specific in Identifying Anxiety in Children with High-Functioning Autism Spectrum Disorder: A Pilot Comparison to the Achenbach System of Empirically Based Assessment Scales

Validated brief screening instruments are needed to improve the detection of anxiety disorders in autism spectrum disorder (ASD). The Screen for Child Anxiety-Related Emotional Disorders (SCARED), a 41-item parent- and self-reported scale measuring anxiety, was compared to the Achenbach System of Empirically Based Assessment (ASEBA) scales. One hundred participants with a clinical diagnosis of high-functioning ASD, aged 8-18 years, and their parents completed the above scales. We hypothesized that the SCARED would be useful in screening for anxiety and its results for total scores of anxiety would converge with ASEBA syndrome scales for anxiety and internalizing disorders. Significant correlations were shown between the SCARED and the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) across a broad spectrum of scales. The CBCL syndrome scale for anxious/depressed showed the highest correlation and predicted anxiety scores on the SCARED. While many of the YSR scales significantly correlated with child ratings of anxiety, none of the scales predicted the SCARED child scores. Differences in self and parent reports suggest that parents interpret externalizing behaviors as signs of anxiety in ASD, whereas youth may describe internalized symptoms as anxiety. Females were more likely to self-report anxiety than males. Results support the use of the SCARED as a screening tool for anxiety in high-functioning ASD, but it should be supplemented with other tools to increase the specificity of its results.

Screening for ASD with the Korean CBCL/1½-5

To test the Child Behavior Checklist's (CBCL/1½-5) ability to screen for autism spectrum disorders (ASD), we studied Korean preschoolers: 46 with ASD, 111 with developmental delay (DD), 71 with other psychiatric disorders (OPD), and 228 non-referred (NR). The ASD group scored significantly higher than the other groups on the Withdrawn and DSM-Pervasive Developmental Problems (DSM-PDP) scales as well as attaining higher scores (p < .001) on seven items reflecting ASD. With a T ≥ 65 cutpoint on the DSM-PDP scale, sensitivity was 80 % for identifying ASD relative to the other three groups, but specificity varied across groups: NR = 87 %, OPD = 55 %, DD = 60 %, replicating in a non-Western sample results from previous studies. Results suggested that the CBCL/1½-5 performs best in Level 1 screening, namely differentiating children with ASD from children in the general population.

Screening and direct assessment methodology to determine the prevalence of autism spectrum disorders

PURPOSE

Findings from the Centers for Disease Control and Prevention-sponsored Autism and Developmental Disabilities Monitoring (ADDM) network suggest a growing prevalence of autism spectrum disorders (ASDs). The rigorous ADDM record review methodology has provided valuable insight into the epidemiology of autism spectrum disorder (ASD), but recent studies using alternative methods have reported significantly higher prevalence estimates. The South Carolina Children's Educational Surveillance Study (SUCCESS) was designed to determine ASD prevalence via population-based screening and direct assessment and to compare prevalence results to ADDM and administrative prevalence counts. This article provides an overview of the methods used for this study.

METHODS

SUCCESS involved a novel (first in the United States) population-based screening approach combined with direct assessment to determine ASD prevalence.

RESULTS

SUCCESS results will be compared to those obtained via records-based surveillance (ADDM) and administrative counts in the same population of children. This article describes the methods for developing and implementing SUCCESS and rationale for major decisions. Procedures used to maximize participation and accurately determine case status are discussed. Study results will be available in 2016.

CONCLUSIONS

Accurate reporting of ASD prevalence is important to researchers, health care providers, policy makers, and families. This study will clarify the findings of various methods used to estimate ASD prevalence.

Are Non-intellectually Disabled Black Youth with ASD Less Impaired on Parent Report than Their White Peers?

There is a lack of research examining differences in functioning in autism spectrum disorder (ASD) across ethnicity, particularly among those without intellectual disability (ID). This study investigated ethnic differences in parent-reported impairment in executive function, adaptive behavior, and social-emotional functioning. White and Black youth (n = 64; ages 6-17) with ASD without ID were compared on each of these domains. Black youth had significantly lower levels of impairment on all three domains. Findings may reflect better daily functioning among Black youth with ASD and/or cultural differences in parent response to questionnaires. Regardless, these findings raise concern about the sensitivity of commonly used measures for Black children with ASD and the impact of culture on daily functioning and symptom manifestation.

Utility of the Child Behavior Checklist as a Screener for Autism Spectrum Disorder

The Child Behavior Checklist (CBCL) has been proposed for screening of autism spectrum disorders (ASD) in clinical settings. Given the already widespread use of the CBCL, this could have great implications for clinical practice. This study examined the utility of CBCL profiles in differentiating children with ASD from children with other clinical disorders. Participants were 226 children with ASD and 163 children with attention-deficit/hyperactivity disorder, intellectual disability, language disorders, or emotional disorders, aged 2-13 years. Diagnosis was based on comprehensive clinical evaluation including well-validated diagnostic instruments for ASD and cognitive testing. Discriminative validity of CBCL profiles proposed for ASD screening was examined with area under the curve (AUC) scores, sensitivity, and specificity. The CBCL profiles showed low discriminative accuracy for ASD (AUC 0.59-0.70). Meeting cutoffs proposed for ASD was associated with general emotional/behavioral problems (EBP; mood problems/aggressive behavior), both in children with and without ASD. Cutoff adjustment depending on EBP-level was associated with improved discriminative accuracy for school-age children. However, the rate of false positives remained high in children with clinical levels of EBP. The results indicate that use of the CBCL profiles for ASD-specific screening would likely result in a large number of misclassifications. Although taking EBP-level into account was associated with improved discriminative accuracy for ASD, acceptable specificity could only be achieved for school-age children with below clinical levels of EBP. Further research should explore the potential of using the EBP adjustment strategy to improve the screening efficiency of other more ASD-specific instruments.

Relations between emotional and social functioning in children with anxiety disorders

The current study investigated concurrent relations between emotional and social functioning in youth with anxiety disorders using a multi-reporter (i.e., children, parents, teachers) assessment strategy. Ninety youth (M age = 8.98 years, SD = 1.68) with a primary diagnosis of generalized anxiety disorder, social phobia, and/or separation anxiety disorder, and a parent participated. Regression analyses indicated that positive affect and emotion regulation coping were related to adaptive measures of social functioning, whereas positive affect, negative affect, reluctance to share emotional experiences with peers, and lability/negativity were related to maladaptive measures of social functioning in the expected directions. For youth high in lability/negativity and low in emotion regulation coping, the relationship between diagnostic severity and social problems was exacerbated. This research contributes to our understanding of the interplay of social and emotional variables and suggests that efforts to facilitate child emotional functioning may improve social functioning for anxious youth, or vice versa.

Exploring the agreement between questionnaire information and DSM-IV diagnoses of comorbid psychopathology in children with autism spectrum disorders

Autism spectrum disorders are often comorbid with other psychiatric symptoms and disorders. However, identifying psychiatric comorbidity in children with autism spectrum disorders is challenging. We explored how a questionnaire, the Child Behavior Check List, agreed with a Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV)-based semi-structured interview, the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children (Kiddie-SADS). The sample comprised 55 children and adolescents (age 6 to 18 years) with autism spectrum disorders, including the main autism spectrum disorder subgroups and the broad range of cognitive and language functioning. High rate of psychopathology was found both through questionnaire and interview assessment. Using predefined Child Behavior Check List cutoffs, we found good agreement between the Child Behavior Check List and the Kiddie-SADS for identifying attention deficit/hyperactivity disorder, depressive disorders, and oppositional defiant disorder. However, overall the specificity of the Child Behavior Check List was low. The Child Behavior Check List was not useful for identifying anxiety disorders. The Child Behavior Check List may capture core symptoms of autism spectrum disorders as well as comorbid psychopathology, and clinicians should be aware that the Child Behavior Check List may be unspecific when used in children and adolescents with autism spectrum disorders.

Autistic traits in children with and without ADHD

OBJECTIVE

To assess the implications of autistic traits (ATs) in youth with attention-deficit/hyperactivity disorder (ADHD) without a diagnosis of autism.

METHODS

Participants were youth with (n = 242) and without (n = 227) ADHD and controls without ADHD in whom a diagnosis of autism was exclusionary. Assessment included measures of psychiatric, psychosocial, educational, and cognitive functioning. ATs were operationalized by using the withdrawn + social + thought problems T scores from the Child Behavior Checklist.

RESULTS

A positive AT profile was significantly overrepresented among ADHD children versus controls (18% vs 0.87%; P < .001). ADHD children with the AT profile were significantly more impaired than control subjects in psychopathology, interpersonal, school, family, and cognitive domains.

CONCLUSIONS

A substantial minority of ADHD children manifests ATs, and those exhibiting ATs have greater severity of illness and dysfunction.

Child Behavior Check List 1½-5 as a tool to identify toddlers with autism spectrum disorders: a case-control study

Tools to identify toddlers with autism in clinical settings have been recently developed. This study evaluated the sensitivity and specificity of the Child Behavior Check List 1½-5 (CBCL 1½-5) in the detection of toddlers subsequently diagnosed with an Autism Spectrum Disorder (ASD), ages 18-36 months. The CBCL of 47 children with ASD were compared to the CBCL of 47 toddlers with Other Psychiatric Disorders (OPD) as well as the CBCL of 47 toddlers with Typical Development (TD) in a case control study. One-way analysis of variance (ANOVA) and logistic regression with odds ratio (OR) analyses were performed. In order to establish the optimal threshold able to discriminate children with ASD from children with OPD and TD, Receiver Operating Characteristic (ROC) analyses were performed. One-way ANOVA revealed significant differences between the three groups. Logistic regression analysis showed that the Withdrawn and the Pervasive Developmental Problems (PDP) subscales can recognize toddlers subsequently identified as ASD from both children with TD (p<0.001) and OPD (p<0.001). ROC analyses showed very high sensitivity and specificity for the PDP (0.98 and 0.91) and Withdrawn (0.92 and 0.97) subscales when ASD was compared to TD. Sensitivity and specificity of Withdrawn (0.90 and 0.83) and PDP (0.85 and 0.83) remained high when comparing ASD versus OPD. In conclusion, the CBCL 1½-5 seemed to be able to identify toddlers subsequently diagnosed with ASD from children with TD and OPD. Its high sensitivity and specificity, coupled with its efficiency in terms of time and cost, suggest this broadband tool should be tested in a pilot screening survey of toddlers in the general population.

Diagnosing autism in neurobiological research studies

Autism spectrum disorder (ASD) is by definition a complex and heterogeneous disorder. Variation in factors such as developmental level, language ability and IQ further complicate the presentation of symptoms. Clinical research and basic science must continue to inform each other's questions to help address the heterogeneity inherent to the disorder. This review uses a clinical perspective to outline the common tools and best practices for diagnosing and characterizing ASD in a research setting. We discuss considerations for classifying research populations, including language ability and IQ and examine the advantages and disadvantages of different psychometric measurements. Ultimately, the contribution of multiple sources of data representing different perspectives is crucial for interpreting and understanding the ASD phenotype.

Using the Child Behavior Checklist and the Teacher's Report Form for identification of children with autism spectrum disorders

This study evaluated the ability of the Child Behavior Checklist and the Teacher's Report Form to identify children with autism spectrum disorders (ASD), using a sample of children with ASD (n = 458), referred children without ASD (n = 1109) and children from the general population (n = 999). A ten items ASD scale was constructed using half of the sample and the ability of this scale to discriminate between children with ASD and the other children was tested for the CBCL and the TRF separately and together in the other half of the sample. Using a cut-off score of 8 the combined CBCL/TRF ASD scale demonstrated high predictive values (NPV 95%, PPV 73%) in identifying children with ASD and children in the general population sample. This might be an acceptable percentage of false positives in general screening, considering the chance that these children might have other behavioural, emotional, and developmental problems which also need psychiatric evaluation. In the referred population, using a cut-off of 13, PPV was 49% and NPV was 85%. The high NPV indicates that in a referred population the scale is especially good at identifying children who do not need evaluation with a more ASD-specific instrument.