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Waizbard-Bartov E, Fein D, Lord C, Amaral DG. Autism Severity and its Relationship to Disability. Focus (Am Psychiatr Publ) 2024; 22:252-262. [PMID: 38680979 PMCID: PMC11046712 DOI: 10.1176/appi.focus.24022007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Autism severity is currently defined and measured based exclusively on the severity levels of the two core symptom domains: social-communication and restricted or repetitive patterns of behaviors and interests. Autistic individuals, however, are often diagnosed with other medical, developmental, and psychological co-occurring conditions. These additional challenges such as intellectual disability, limited expressive and/or receptive language, and anxiety disorders, can have a tremendous impact on the day-to-day lives of autistic individuals, for both their adaptive functioning as well as their sense of wellbeing. Furthermore, the initial presentation of core symptoms and their likelihood of changing over time are influenced by the presence of such co-occurring conditions. In order to truly understand how a person's autism impacts their life, both core symptoms as well as other challenges should be considered. This approach was recently taken by The Lancet Commission on the future of care and clinical research in autism, which proposed the term "profound autism" for a subgroup of individuals presenting with high core symptom severity, co-occurring intellectual disability, and little or no language, who require extensive long-term care. Considering other individual factors such as daily living skills, specific support needs and environmental resources would also enhance the evaluation of disability in autistic individuals. As currently employed in the assessment of intellectual disability, a multidimensional approach to autism could provide a more comprehensive system for classification of impairment. At present, however, there is no formal way to designate the combined effect of these different aspects of autism on a person's life. A comprehensive outlook that acknowledges impairments, capabilities, co-occurring conditions, and environmental factors would be useful for identifying subgroups of individuals as well as for determining individual needs and strengths in clinical assessments. Lay Summary: The severity of a person's autism is currently defined based on the severity of their core autism symptoms: impaired social-communication and the presence of restricted or repetitive patterns of behaviors and interests. But autistic people often face additional challenges such as intellectual disability, epilepsy, and anxiety disorder, that considerably impact their everyday life, wellbeing, and the need for support. A more complete view of autism severity, one that includes core symptoms as well as additional challenges, could help identify meaningful sub-groups of autistic individuals and could be useful in clinical care. Appeared originally in Autism Res 2023; 16:685-696.
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Affiliation(s)
- Einat Waizbard-Bartov
- Department of Psychology, University of California Davis, Davis, California, USA (Waizbard-Bartov); The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA (Waizbard-Bartov, Amaral); Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA; Department of Pediatrics, University of Connecticut, Farmington, Connecticut, USA (Fein); Departments of Psychiatry and Human Development and Psychology, University of California, Los Angeles, California, USA (Lord)
| | - Deborah Fein
- Department of Psychology, University of California Davis, Davis, California, USA (Waizbard-Bartov); The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA (Waizbard-Bartov, Amaral); Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA; Department of Pediatrics, University of Connecticut, Farmington, Connecticut, USA (Fein); Departments of Psychiatry and Human Development and Psychology, University of California, Los Angeles, California, USA (Lord)
| | - Catherine Lord
- Department of Psychology, University of California Davis, Davis, California, USA (Waizbard-Bartov); The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA (Waizbard-Bartov, Amaral); Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA; Department of Pediatrics, University of Connecticut, Farmington, Connecticut, USA (Fein); Departments of Psychiatry and Human Development and Psychology, University of California, Los Angeles, California, USA (Lord)
| | - David G Amaral
- Department of Psychology, University of California Davis, Davis, California, USA (Waizbard-Bartov); The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA (Waizbard-Bartov, Amaral); Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA; Department of Pediatrics, University of Connecticut, Farmington, Connecticut, USA (Fein); Departments of Psychiatry and Human Development and Psychology, University of California, Los Angeles, California, USA (Lord)
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Fusaroli R, Weed E, Rocca R, Fein D, Naigles L. Repeat After Me? Both Children With and Without Autism Commonly Align Their Language With That of Their Caregivers. Cogn Sci 2023; 47:e13369. [PMID: 37905374 DOI: 10.1111/cogs.13369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 10/02/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023]
Abstract
Linguistic repetitions in children are conceptualized as negative in children with autism - echolalia, without communicative purpose - and positive in typically developing (TD) children - linguistic alignment involved in shared engagement, common ground and language acquisition. To investigate this apparent contradiction we analyzed spontaneous speech in 67 parent-child dyads from a longitudinal corpus (30 minutes of play activities at 6 visits over 2 years). We included 32 children with autism and 35 linguistically matched TD children (mean age at recruitment 32.76 and 20.27 months). We found a small number of exact repetitions in both groups (roughly 1% of utterances across visits), which increased over time in children with autism and decreased in the TD group. Partial repetitions were much more frequent: children reused caregivers' words at high rates regardless of diagnostic group (24% of utterances at first visit), and this increased in frequency (but not level) over time, faster for TD children (at final visit: 33% for autism, 40% for TD). The same happened for partial repetition of syntax and semantic alignment. However, chance alignment (as measured by surrogate pairs) also increased and findings for developmental changes were reliable only for syntactic and semantic alignment. Children with richer linguistic abilities also displayed a higher tendency to partially re-use their caregivers' language (alignment rates and semantic alignment). This highlights that all children commonly re-used the words, syntax, and topics of their caregivers, albeit with some quantitative differences, and that most repetition was at least potentially productive, with repeated language being re-contextualized and integrated with non-repeated language. The salience of echolalia in ASD might be partially explained by slight differences in frequency, amplified by lower semantic alignment, persistence over time, and expectations of echolalia. More in-depth qualitative and quantitative analyses of how repetitions are used and received in context are needed.
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Affiliation(s)
- Riccardo Fusaroli
- Department of Linguistics, Cognitive Science and Semiotics, School of Communication and Culture, Aarhus University
- Interacting Minds Center, School of Culture and Society, Aarhus University
- Linguistic Data Consortium, University of Pennsylvania
| | - Ethan Weed
- Department of Linguistics, Cognitive Science and Semiotics, School of Communication and Culture, Aarhus University
- Interacting Minds Center, School of Culture and Society, Aarhus University
| | - Roberta Rocca
- Department of Linguistics, Cognitive Science and Semiotics, School of Communication and Culture, Aarhus University
- Interacting Minds Center, School of Culture and Society, Aarhus University
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut
| | - Letitia Naigles
- Department of Psychological Sciences, University of Connecticut
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Waizbard-Bartov E, Fein D, Lord C, Amaral DG. Response to Mottron et al. (2023) and Woods et al. (2023). Autism Res 2023; 16:1660-1661. [PMID: 37584067 DOI: 10.1002/aur.2982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 08/17/2023]
Affiliation(s)
- Einat Waizbard-Bartov
- Department of Psychology, University of California Davis, Davis, California, USA
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
- Department of Pediatrics, University of Connecticut, Farmington, Connecticut, USA
| | - Catherine Lord
- Departments of Psychiatry and Human Development and Psychology, University of California, Los Angeles, California, USA
| | - David G Amaral
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA
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Majchrzak-Stiller B, Buchholz M, Peters I, Strotmann J, Möhrke J, Zelichowski L, Oehlke L, Quensel C, Fein D, Höhn P, Müller T, Uhl W, Braumann C. Oxathiazinane derivatives display both antineoplastic and antibacterial activity: a structure activity study. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04799-8. [PMID: 37171614 PMCID: PMC10374762 DOI: 10.1007/s00432-023-04799-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/15/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE The Oxathiazinane substance class is characterized by a high diversity of chemical structures yet to be fully investigated. Our research group recently proved that the 1.4.5-oxathiazine-4.4-dioxide, known as substance GP-2250, possesses antineoplastic properties as shown on pancreatic carcinoma. This current study aims to gain insights into the structure and activity relationship of a series of different Oxathiazinanes regarding their antineoplastic activity and the potential correlation with antibacterial activity. We investigated the newly synthesized Oxathiazinane derivatives: 2255, 2256, 2287, 2289, 2293 and 2296 in comparison to GP-2250. METHODS The antineoplastic effect was evaluated in different cancer entities (breast, skin, pancreas and colon cancer cell lines) by viability, proliferation, and cell migration assays in vitro. Disc diffusion tests were performed on various bacteria strains to examine the antibacterial potential. Additionally, reactive oxygen species (ROS) assays were conducted to investigate mechanistic aspects. RESULTS The substances GP-2250, 2293, 2289 and 2296 not only showed antineoplastic activity in four different cancer entities but also antibacterial effects, as tested on multiple bacteria strains including MRSA (Methicillin-resistant Staphylococcus aureus). Furthermore, these substances also induced high ROS levels up to 110% in the treated cancer cell lines compared to untreated control cells. These results indicate a correlation between an antineoplastic capacity and antibacterial properties of these derivatives. Both activities appear to be ROS driven. The Oxathiazinane derivatives 2255, 2256 and 2287 lacked both, antineoplastic and antibacterial activity. CONCLUSION Thus, a comparable structure activity relationship became apparent for both the antineoplastic and antibacterial activity.
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Affiliation(s)
- B Majchrzak-Stiller
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany.
| | - M Buchholz
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - I Peters
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - J Strotmann
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - J Möhrke
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - L Zelichowski
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - L Oehlke
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - C Quensel
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - D Fein
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - P Höhn
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - T Müller
- Geistlich Pharma AG, Wolhusen, Switzerland
| | - W Uhl
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - C Braumann
- Division of Molecular and Clinical Research, Department of General and Visceral Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
- Department of General, Visceral and Vascular Surgery, Evangelische Kliniken Gelsenkirchen, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Gelsenkirchen, Germany
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de Marchena A, Wieckowski AT, Algur Y, Williams LN, Fernandes S, Thomas RP, McClure LA, Dufek S, Fein D, Stahmer AC, Robins DL. Initial diagnostic impressions of trainees during autism evaluations: High specificity but low sensitivity. Autism Res 2023. [PMID: 37084079 DOI: 10.1002/aur.2933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
Reducing the age of first autism diagnosis facilitates access to critical early intervention services. A current "waitlist crisis" for autism diagnostic evaluation thus demands that we consider novel use of available clinical resources. Previous work has found that expert autism clinicians can identify autism in young children with high specificity after only a brief observation; rapid identification by non-experts remains untested. In the current study, 252 children ages 12-53 months presented for a comprehensive autism diagnostic evaluation. We found that junior clinicians in training to become autism specialists (n = 29) accurately determined whether or not a young child would be diagnosed with autism in the first five minutes of the clinic visit in 75% of cases. Specificity of brief observations was high (0.92), suggesting that brief observations may be an effective tool for triaging young children toward autism-specific interventions. In contrast, the lower negative predictive value (0.71) of brief observations, suggest that they should not be used to rule out autism. When trainees expressed more confidence in their initial impression, their impression was more likely to match the final diagnosis. These findings add to a body of literature showing that clinical observations of suspected autism should be taken seriously, but lack of clinician concern should not be used to rule out autism or overrule other indicators of likely autism, such as parent concern or a positive screening result.
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Affiliation(s)
- Ashley de Marchena
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Yasemin Algur
- Department of Epidemiology & Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Lashae N Williams
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Sherira Fernandes
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Rebecca P Thomas
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Leslie A McClure
- Department of Epidemiology & Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Sarah Dufek
- Department of Psychiatry and Behavioral Sciences, University of California, Davis MIND Institute, Sacramento, California, USA
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Aubyn C Stahmer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis MIND Institute, Sacramento, California, USA
| | - Diana L Robins
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
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Abstract
Autism severity is currently defined and measured based exclusively on the severity levels of the two core symptom domains: social-communication and restricted or repetitive patterns of behaviors and interests. Autistic individuals, however, are often diagnosed with other medical, developmental, and psychological co-occurring conditions. These additional challenges such as intellectual disability, limited expressive and/or receptive language, and anxiety disorders, can have a tremendous impact on the day-to-day lives of autistic individuals, for both their adaptive functioning as well as their sense of wellbeing. Furthermore, the initial presentation of core symptoms and their likelihood of changing over time are influenced by the presence of such co-occurring conditions. In order to truly understand how a person's autism impacts their life, both core symptoms as well as other challenges should be considered. This approach was recently taken byThe Lancet Commission on the future of care and clinical research in autism, which proposed the term "profound autism" for a subgroup of individuals presenting with high core symptom severity, co-occurring intellectual disability, and little or no language, who require extensive long-term care. Considering other individual factors such as daily living skills, specific support needs and environmental resources would also enhance the evaluation of disability in autistic individuals. As currently employed in the assessment of intellectual disability, a multidimensional approach to autism could provide a more comprehensive system for classification of impairment. At present, however, there is no formal way to designate the combined effect of these different aspects of autism on a person's life. A comprehensive outlook that acknowledges impairments, capabilities, co-occurring conditions, and environmental factors would be useful for identifying subgroups of individuals as well as for determining individual needs and strengths in clinical assessments.
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Affiliation(s)
- Einat Waizbard-Bartov
- Department of Psychology, University of California Davis, Davis, California, USA
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
- Department of Pediatrics, University of Connecticut, Farmington, Connecticut, USA
| | - Catherine Lord
- Departments of Psychiatry and Human Development and Psychology, University of California, Los Angeles, California, USA
| | - David G. Amaral
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA
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Fusaroli R, Weed E, Rocca R, Fein D, Naigles L. Caregiver linguistic alignment to autistic and typically developing children: A natural language processing approach illuminates the interactive components of language development. Cognition 2023; 236:105422. [PMID: 36871399 DOI: 10.1016/j.cognition.2023.105422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/13/2022] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Language development is a highly interactive activity. However, most research on linguistic environment has focused on the quantity and complexity of linguistic input to children, with current models showing that complexity facilitates language in both typically developing (TD) and autistic children. AIMS After reviewing existing work on caregiver engagement of children's utterances, we aim to operationalize such engagement with automated measures of linguistic alignment, thereby providing scalable tools to assess caregivers' active reuse of their children's language. By assessing the presence of alignment, its sensitivity to the child's individual differences and how well it predicts language development beyond current models across the two groups, we showcase the usefulness of the approach and provide initial empirical foundations for further conceptual and empirical investigations. METHODS We measure lexical, syntactic and semantic types of caregiver alignment in a longitudinal corpus involving 32 adult-autistic child and 35 adult-TD child dyads, with children between 2 and 5 years of age. We assess the extent to which caregivers repeat their children's words, syntax, and semantics, and whether these repetitions predict language development beyond more standard predictors. RESULTS Caregivers tend to re-use their child's language in a way that is related to the child's individual, primarily linguistic, differences. Caregivers' alignment provides unique information improving our ability to predict future language development in both typical and autistic children. CONCLUSIONS We provide evidence that language development also relies on interactive conversational processes, previously understudied. We share carefully detailed methods, and open-source scripts so as to systematically extend our approach to new contexts and languages.
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Affiliation(s)
- Riccardo Fusaroli
- Department of Linguistics, Cognitive Science and Semiotics, School of Communication and Culture, Aarhus University, Jens Chr Skous vej 2, 8000 Aarhus, Denmark; Interacting Minds Center, School of Culture and Society, Aarhus University, Jens Chr Skous vej 4, 8000 Aarhus, Denmark; Linguistic Data Consortium, University of Pennsylvania, 3600 Market St, Suite 810, Philadelphia, PA 19104-2653, USA.
| | - Ethan Weed
- Department of Linguistics, Cognitive Science and Semiotics, School of Communication and Culture, Aarhus University, Jens Chr Skous vej 2, 8000 Aarhus, Denmark; Interacting Minds Center, School of Culture and Society, Aarhus University, Jens Chr Skous vej 4, 8000 Aarhus, Denmark
| | - Roberta Rocca
- Department of Linguistics, Cognitive Science and Semiotics, School of Communication and Culture, Aarhus University, Jens Chr Skous vej 2, 8000 Aarhus, Denmark; Interacting Minds Center, School of Culture and Society, Aarhus University, Jens Chr Skous vej 4, 8000 Aarhus, Denmark
| | - Deborah Fein
- Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 0629-1020, USA
| | - Letitia Naigles
- Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 0629-1020, USA
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Abstract
This paper addresses the hypothesis that autism spectrum disorder features follow multiple long-term developmental trajectories, including an absence of symptoms that were present in childhood, by the time of adolescence. In early work on this topic, this circumstance was called an 'optimal outcome'. To better reflect the reality of multiple excellent outcomes regardless of whether autism spectrum disorder features are present or absent, including autonomy, daily living skills, communication skills, and relationships and employment/activities outside the home, the terminology 'loss of autism diagnosis' (LAD) has been proposed as a substitute. The paper also contextualizes an LAD outcome within research, practice and advocacy.
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Affiliation(s)
- Inge-Marie Eigsti
- University of Connecticut; Department of Psychological Sciences; 406 Babbidge Road; Storrs, CT 06269; USA
- CT Institute for the Brain and Cognitive Sciences, Storrs, CT, USA
| | - Deborah Fein
- University of Connecticut; Department of Psychological Sciences; 406 Babbidge Road; Storrs, CT 06269; USA
- Department of Pediatrics, University of Connecticut, Farmington, CT, USA
| | - Caroline Larson
- University of Connecticut; Department of Psychological Sciences; 406 Babbidge Road; Storrs, CT 06269; USA
- CT Institute for the Brain and Cognitive Sciences, Storrs, CT, USA
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Williams LN, Wieckowski AT, Dieckhaus MFS, Dai YG, Zhang F, Dumont-Mathieu T, Barton M, Fein D, Robins DL. Primary Care Clinician and Child Characteristics Impacting Autism Surveillance. Brain Sci 2022; 13:brainsci13010018. [PMID: 36672000 PMCID: PMC9855901 DOI: 10.3390/brainsci13010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Early detection of autism provides access to early intervention and subsequently fewer lifelong challenges. However, disparities in screening have been associated with socioeconomic status (SES) and race, and disparities in surveillance have been associated with clinician knowledge and beliefs about autism identification. The present study examines associations between demographic variables and clinician beliefs, and agreement between screening results and clinician surveillance. Surveillance included activities used by the primary care clinicians (PCCs) to assess risk for autism. PCCs reported their beliefs about autism screening and identification, their sex, race, years in practice, and racial distribution of their patient population. Children's demographic information was also collected. PCCs identified children as having, or not having, an increased likelihood of autism, and parents of children completed an autism screener. Agreement between screening and surveillance results were examined across PCC, practice, and child demographics. Higher confidence in autism knowledge and screening resources, female PCC sex, and majority White practice patient demographics all predicted agreement between screening and surveillance. Female child sex and higher maternal education also predicted agreement between screening and surveillance. These findings highlight the importance of PCC screening beliefs and child and PCC demographics on the autism identification process.
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Affiliation(s)
- Lashae N. Williams
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA 19104, USA
- Correspondence:
| | | | - Mary F. S. Dieckhaus
- Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Yael G. Dai
- Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Fengqing Zhang
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA 19104, USA
| | - Thyde Dumont-Mathieu
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT 06032, USA
| | - Marianne Barton
- Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, CT 06269, USA
| | - Diana L. Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA 19104, USA
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Affiliation(s)
- Inge-Marie Eigsti
- University of Connecticut; Department of Psychological
Sciences; 406 Babbidge Road; Storrs, CT 06269; USA
| | - Teresa Girolamo
- University of Connecticut; Department of Psychological
Sciences; 406 Babbidge Road; Storrs, CT 06269; USA
| | - Deborah Fein
- University of Connecticut; Department of Psychological
Sciences; 406 Babbidge Road; Storrs, CT 06269; USA
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Yamane N, Snow AD, Fein D, Naigles L, Goldman S. Brief report: Parent-guided movements during play with children with autism spectrum disorder. Res Autism Spectr Disord 2022; 94:101968. [PMID: 36329719 PMCID: PMC9629284 DOI: 10.1016/j.rasd.2022.101968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Children with autism spectrum disorder (ASD) demonstrate social and communication impairments from an early age. While researchers have long investigated parenting behaviors in relation to children's social and communication development, fewer studies have examined the relevance of movement-based parenting behaviors to facilitating communication and social engagement with young children. The present study aimed to investigate: (1) parent-guided movements (PGMs) within dyads of parents and typically developing (TD) children and children with ASD; and (2) children's ASD diagnostic and receptive language scores as predictors of PGM frequency. METHOD Video-recorded play interactions of 33 TD dyads (mean age: 20.4 months) and 31 dyads with ASD (mean age: 32.6 months) were matched on child's expressive language. Data were obtained from a longitudinal study on developmental language trajectories in ASD and coded for PGMs. RESULTS Overall, parents of children with ASD initiated PGMs more frequently than parents of TD children during play (U = 269.00, z = - 3.58, p < 0.001). PGM frequency was predicted by children's ADOS scores (X 2 = 5.46, p = 0.02, OR = 1.26, 95% CI [1.04, 1.54]) and receptive language (X 2 = 4.15, p = 0.04, OR = 5.43, 95% CI [1.10, 27.67]). CONCLUSIONS Findings suggest that parents of children with ASD and low receptive language may utilize more movement-based strategies to compensate for their children's impaired social engagement and verbal comprehension. This study offers insight on a particular movement-based modality characterizing ASD dyads that can be used as a measure in parent-mediated interventions.
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Affiliation(s)
- Natasha Yamane
- Columbia University Irving Medical Center, Department of Neurology, G.H. Sergievsky Center, New York, NY, USA
| | - Arielle D. Snow
- Columbia University Irving Medical Center, Department of Neurology, G.H. Sergievsky Center, New York, NY, USA
| | - Deborah Fein
- University of Connecticut, Department of Psychological Sciences, Storrs, CT, USA
| | - Letitia Naigles
- University of Connecticut, Department of Psychological Sciences, Storrs, CT, USA
| | - Sylvie Goldman
- Columbia University Irving Medical Center, Department of Neurology, Divisions of Child Neurology and Cognitive Neuroscience, New York, NY, USA
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Larson C, Rivera-Figueroa K, Thomas HR, Fein D, Stevens MC, Eigsti IM. Structural language impairment in Autism Spectrum Disorder versus Loss of Autism Diagnosis: Behavioral and neural characteristics. Neuroimage Clin 2022; 34:103043. [PMID: 35567947 PMCID: PMC9112023 DOI: 10.1016/j.nicl.2022.103043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/14/2022] [Accepted: 05/08/2022] [Indexed: 02/02/2023]
Abstract
This study probed for structural language impairment using behavioral and functional neuroimaging methods in individuals with Autism Spectrum Disorder (ASD) and those diagnosed with ASD in childhood who no longer meet criteria for ASD, referred to as Loss of Autism Diagnosis (LAD1). Participants were drawn from Fein et al. (2013): ASD (n = 35), LAD (n = 31), and Neurotypical (NT; n = 34). Criteria for structural language impairment were: Scores ≤ 82 on Clinical Evaluation of Language Fundamentals-4 (CELF) Core Language, an omnibus measure of language; and scores ≤ 7 on CELF Recalling Sentences, a clinical marker of structural language impairment. Task-based fMRI examined lateralization of significantly activated language-related brain regions in groups with structural language impairment (LI2) versus normal-range language (LN3), collapsed across ASD, LAD1, and NT status. Results showed no ASD versus LAD group differences in the proportion of participants with structural language impairment according to either metric (Recalling Sentences or Core Language). Functional MRI results indicated greater left hemisphere lateralization within significantly activated regions in the LI2 group. Structural language abilities were not meaningfully associated with either social abilities or lifetime ADHD symptoms in LI2 subgroups, further suggesting the presence of structural language impairment. Findings indicate the presence of persistent structural language difficulty even in the absence of ASD symptoms in some individuals within the LAD1 group and unique patterns of language-related neural specialization for language function in LI2 relative to LN3.
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Affiliation(s)
- Caroline Larson
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA,CT Institute for the Brain and Cognitive Sciences, Storrs, CT, USA,Corresponding author at: Department of Psychological Sciences, Unit 1020, 406 Babbidge Rd, Storrs, CT 06269, USA.
| | | | - Hannah R. Thomas
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA,Department of Pediatrics, University of Connecticut, Farmington, CT, USA
| | - Michael C. Stevens
- Olin Neuropsychiatry Research Center at the Institute of Living, Hartford, CT, USA,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Inge-Marie Eigsti
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA,CT Institute for the Brain and Cognitive Sciences, Storrs, CT, USA
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13
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Fein D, Eigsti IM, Barton M. Response to "A radical change in our autism research strategy is needed: Back to prototypes" by Mottron et al. (2021). Autism Res 2021; 14:2237-2238. [PMID: 34423923 PMCID: PMC8549012 DOI: 10.1002/aur.2596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 02/02/2023]
Affiliation(s)
| | - Inge-Marie Eigsti
- Director, Connecticut Autism and Language Lab (CALL), University of
Connecticut,Co-Director, Cognitive Neuroscience of Communication T32 training
program
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14
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Wieckowski AT, de Marchena A, Algur Y, Nichols L, Fernandes S, Thomas RP, McClure LA, Dufek S, Fein D, Adamson LB, Stahmer A, Robins DL. The first five minutes: Initial impressions during autism spectrum disorder diagnostic evaluations in young children. Autism Res 2021; 14:1923-1934. [PMID: 34021728 PMCID: PMC8480227 DOI: 10.1002/aur.2536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/13/2021] [Accepted: 05/04/2021] [Indexed: 11/09/2022]
Abstract
Diagnosticians report that autism spectrum disorder (ASD) is immediately apparent in some, but not all, children ultimately diagnosed. Clinicians' initial diagnostic impressions have implications for ASD early detection, yet the literature raises questions about their accuracy. This study explores diagnostic impressions of ASD specialists made within the first 5 minutes of meeting a young child and investigates factors associated with the match between initial impressions and final diagnoses. Participants were children (n = 294, aged 12-53 months) referred for an ASD evaluation as part of multi-site ASD screening studies. After 5 minutes observing each child, clinicians with expertise diagnosing ASD recorded if they thought the child would meet criteria for ASD following a complete evaluation, and recorded their confidence in this impression. Clinicians' initial impressions matched the final diagnosis in 81% of cases. Ninety-two percent of cases initially thought to have ASD met criteria following a full evaluation; however, 24% of cases initially thought not to have ASD also met criteria, suggesting a high miss rate. Clinicians were generally confident in their initial impressions, reporting highest confidence for children initially thought correctly not to have ASD. ASD behavioral presentation, but not demographic characteristics or developmental level, were associated with matching initial impression and final diagnosis, and confidence. Brief observations indicating ASD should trigger referral to intervention services, but are likely to under-detect positive cases and should not be used to rule out ASD, highlighting the need to incorporate information beyond initial clinical impression. LAY SUMMARY: When children come in for an autism evaluation, clinicians often form early impressions-before doing any formal testing-about whether the child has autism. We studied how often these early impressions match the final diagnosis, and found that clinicians could not easily rule out autism (many children who initially appeared not to have autism were ultimately diagnosed), but were generally accurate ruling in autism (when a child appeared to have autism within 5 minutes, they were almost always so diagnosed).
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Affiliation(s)
| | - Ashley de Marchena
- Department of Behavioral and Social Sciences, University of the Sciences, Philadelphia, Pennsylvania, USA
| | - Yasemin Algur
- Department of Epidemiology & Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Lashae Nichols
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Sherira Fernandes
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | - Rebecca P Thomas
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Leslie A McClure
- Department of Epidemiology & Biostatistics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Sarah Dufek
- Department of Psychiatry and Behavioral Sciences, University of California, Davis MIND Institute, Sacramento, California, USA
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Lauren B Adamson
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA
| | - Aubyn Stahmer
- Department of Psychiatry and Behavioral Sciences, University of California, Davis MIND Institute, Sacramento, California, USA
| | - Diana L Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
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15
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Duvall S, Armstrong K, Shahabuddin A, Grantz C, Fein D, Lord C. A road map for identifying autism spectrum disorder: recognizing and evaluating characteristics that should raise red or "pink" flags to guide accurate differential diagnosis. Clin Neuropsychol 2021; 36:1172-1207. [PMID: 34121610 DOI: 10.1080/13854046.2021.1921276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective: Given the high population prevalence of Autism Spectrum Disorder (ASD) and overlapping symptoms with medically complex groups, ASD is a common rule out diagnosis for neuropsychologists even when not identified in the referral or initial presenting concerns. This paper presents practical guidance to support neuropsychologists in their ability to accurately assess, diagnose, and/or rule out ASD, especially in patients with more subtle presentations. Method: This paper combines clinical experience and empirical literature to highlight important assessment measures and related considerations, differential diagnostic considerations, common misconceptions about ASD and person/family characteristics, as well as variability in presentation and comorbidities that can obscure the diagnosis. Characteristics that may be considered "red flags" (clearly diagnostic, classic symptoms) and "pink flags" (associated features and symptoms that are suggestive of ASD but not quite definitive and that may overlap with symptoms seen in other neurodevelopmental or psychiatric diagnoses) will be discussed. Conclusions: Neuropsychologists in all clinical settings should be able to effectively screen for and/or diagnose ASD, even when its presentation is more subtle and/or when symptoms are masked by patient strengths in a way that makes their clinical presentation less obvious. Practical strategies for communicating the diagnosis and next steps/recommendations for interventions are reviewed.
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Affiliation(s)
- Susanne Duvall
- Department of Pediatrics & Psychiatry, Institute on Development and Disability, Oregon Health & Science University, Portland, OR, USA
| | | | - Ambreen Shahabuddin
- Department of Pediatrics & Psychiatry, Institute on Development and Disability, Oregon Health & Science University, Portland, OR, USA
| | - Caroline Grantz
- Department of Psychiatry, University of California Los Angeles, Los Angeles, CA, USA
| | - Deborah Fein
- Departments of Psychological Sciences and Pediatrics, University of Connecticut, Storrs, CT, USA
| | - Catherine Lord
- Department of Psychiatry and Education, Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA, USA
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16
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Lofters J, Flemming N, Gayle L, Simmonds RK, Adedoyin O, Brijmohan S, Fein D. Pre-Eclampsia Strikes: Could It Be Related This Gland? J Endocr Soc 2021. [PMCID: PMC8090094 DOI: 10.1210/jendso/bvab048.1594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Primary hyperparathyroidism (PHPT) is rarely diagnosed in pregnancy and if left untreated has the potential to lead to serious maternal and neonatal complications. We describe a case of PHPT with associated complicated pre-eclampsia. Clinical Case29-year-old primigravida admitted at 33 + 6 weeks with fatigue, 10lbs weight gain and elevated BP. Labs revealed potassium 2.9 (3.5-5.2mmol/L), corrected serum calcium (Ca)11.62 (8.4-10.2mg/dL), ionized calcium 1.69 (1.15-1.33mmol/L), PTH 163.9 (15-65pg/mL) and vitamin D 24.6 (30-100ng/mL). Other labs were normal. Urine studies showed 315mg/24h proteinuria and urine calcium of 129.5 mg/24hrs (100-300mg/24hrs). She was started on magnesium sulphate along with labetalol for BP control, given betamethasone for stimulation of fetal lung maturity as well as potassium repletion. Hypercalcemia (HCa) was initially managed with fluids and Lasix intravenously. At 34 + 2 weeks she developed SOB, orthopnea, headaches with new 9lbs weight gain over 5 days and sustained BP elevation. Urgent C-section was done for pre-eclampsia with severe features. Post-operatively, she suffered from postpartum hemorrhage, managed with transfusion of packed red cells and transient placement of a Bakri balloon. Her HCa worsened with Ca 12.56 and cinacalcet was started after delivery. This coincided with gradual improvement of her BP and Ca to 10.8. She declined additional work-up and was discharged in stable condition. Clinical LessonPHPT often goes undiagnosed in pregnancy, with symptoms of fatigue and constipation mimicking common complaints of pregnancy. Studies have also suggested that up to 25% of patients with PHPT during pregnancy present with hypertension and pre-eclampsia and that there is an association between preeclampsia and the presence of parathyroid adenomas. The pathophysiology is unclear but is thought to be due to endothelial dysfunction triggered by hypercalcemia as well as abnormal placentation. No clear guidelines exist for the management of PHPT during pregnancy, with observation and rehydration being the preferred initial options. The use of cinacalcet as well as curative surgical parathyroidectomy when Ca levels persist >11 in the second trimester have also been described. Our patient presented similarly, with severe pre-eclampsia needing urgent C-section, further complicated by persistent severe HCa. Early diagnosis of PHPT, along with treatment including cinacalcet improved her Ca. It is therefore important that PHPT be considered in patients presenting like ours, progressing to severe pre-eclampsia as early reduction of serum calcium may reduce morbidity and mortality. ReferencesMcCarthy, A., Howarth, S., Khoo, S., Hale, J., Oddy, S., Halsall, D., ... & Samyraju, M. (2019). Management of primary hyperparathyroidism in pregnancy: a case series. Endocrinology, diabetes & metabolism case reports, 2019(1).
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Affiliation(s)
- Jason Lofters
- Englewood Hospital and Medical Center, Englewood, NJ, USA
| | - Nia Flemming
- Englewood Hospital and Medical Center, Englewood, NJ, USA
| | - Latoya Gayle
- Englewood Hospital and Medical Center, Englewood, NJ, USA
| | | | | | | | - Deborah Fein
- Englewood Hospital and Medical Center, Englewood, NJ, USA
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17
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McClure LA, Lee NL, Sand K, Vivanti G, Fein D, Stahmer A, Robins DL. Connecting the Dots: a cluster-randomized clinical trial integrating standardized autism spectrum disorders screening, high-quality treatment, and long-term outcomes. Trials 2021; 22:319. [PMID: 33934719 PMCID: PMC8091523 DOI: 10.1186/s13063-021-05286-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/22/2021] [Indexed: 11/19/2022] Open
Abstract
Background Autism spectrum disorder (ASD) affects one in 54 children in the United States of America, and supporting people with ASD across the lifespan presents challenges that impact individuals, families, and communities and can be quite costly. The American Academy of Pediatrics has issued recommendations for routine ASD screening at 18 and 24 months, but some research suggests that few pediatricians perform high-fidelity, standardized screening universally. Furthermore, the United States Preventive Services Task Force (USPSTF) found insufficient evidence to recommend for or against universal ASD screening. The objective of this study is to test the hypothesis that children with ASD who have high fidelity; standardized screening will achieve superior outcomes at 5 years of age compared to children receiving usual care ASD detection strategies. Methods This is a cluster-randomized, controlled clinical trial in 3 sites in the USA. Pediatric practices will be randomized to implement universal, standardized, high-fidelity toddler screening or usual care, with randomization stratified by the practice size. The study will enroll 3450 children, approximately half in each group. From this sample, we anticipate 100 children to be diagnosed with ASD. Children in both groups receiving an ASD diagnosis will be administered the Early Start Denver Model, an evidence-based early intervention addressing social, communication, and cognitive functioning. Treatment will last for 1 year, with up to 20 h per week of therapy for children with ASD. Results Primary outcomes measured at baseline, following treatment, and at 4 and 5 years of age include ASD symptom severity (Brief Observation of Social Communication Change (BOSCC)) and cognitive functioning (Mullen Scales of Early Learning (MSEL) and Differential Abilities Scale-II (DAS-II)). Secondary outcomes in children include measures of adaptive functioning, ASD symptoms, and kindergarten readiness; secondary analyses will also examine stress and empowerment among parents. Several novel exploratory measures will be included as well. The study will utilize a modified intention-to-treat analysis. Conclusions This trial will evaluate the impact of universal, standardized, high-fidelity screening for ASD among children at 18 months of age, with a goal of providing evidence to support this strategy to detect ASD in toddlers in order to start treatment as young as possible and maximize outcomes. Ethics and dissemination This study was approved by the Institutional Review Board at Drexel University (IRB protocol: 1607004653). All findings will be provided by the principal investigator via email; data will be available through the NIMH Data Archive (https://nda.nih.gov/). Trial registration ClinicalTrials.gov NCT03333629. Registered on November 7, 2017 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05286-6.
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Affiliation(s)
- Leslie A McClure
- Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA.
| | - Nora L Lee
- Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Katherine Sand
- AJ Drexel Autism Institute, Drexel University, 3020 Market Street, Philadelphia, PA, 19104, USA
| | - Giacomo Vivanti
- AJ Drexel Autism Institute, Drexel University, 3020 Market Street, Philadelphia, PA, 19104, USA
| | - Deborah Fein
- University of Connecticut, 406 Babbidge Rd, Storrs, CT, 06268, USA
| | - Aubyn Stahmer
- University of California, Davis, 2825 50th St, Sacramento, CA, 95819, USA
| | - Diana L Robins
- AJ Drexel Autism Institute, Drexel University, 3020 Market Street, Philadelphia, PA, 19104, USA
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18
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Abstract
Categorical induction abilities are robust in typically developing (TD) preschoolers, while children with Autism Spectrum Disorders (ASD) frequently perform inconsistently on tasks asking for the transference of traits from a known category member to a new example based on shared category membership. Here, TD five-year-olds and six-year-olds with ASD participated in a categorical induction task; the TD children performed significantly better and more consistently than the children with ASD. Concurrent verbal and nonverbal tests were not significant correlates; however, the TD children's shape bias performance at two years of age was significantly positively predictive of categorical induction performance at age five. The shape bias, the tendency to extend a novel label to other objects of the same shape during word learning, appears linked with categorical induction ability in TD children, suggesting a common underlying skill and consistent developmental trajectory. Word learning and categorical induction appear uncoupled in children with ASD.
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Affiliation(s)
- Lisa Tecoulesco
- Department of Psychological Sciences, University of Connecticut, Storrs, CT06269USA
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, CT06269USA
| | - Letitia R Naigles
- Department of Psychological Sciences, University of Connecticut, Storrs, CT06269USA
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19
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Abbruzzese LD, Yamane N, Fein D, Naigles L, Goldman S. Assessing Child Postural Variability: Development, Feasibility, and Reliability of a Video Coding System. Phys Occup Ther Pediatr 2021; 41:314-325. [PMID: 33063576 DOI: 10.1080/01942638.2020.1833272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS Postural variability is central to children's locomotion, motor control, and environmental exploration, and lacks standardized methods for systematic assessment. The purpose of this study was to develop and evaluate the feasibility and interrater reliability of Child Posture Variability Coding (CPVC), a method of quantifying postural variability in young children. METHOD Videos of parent-child play interactions obtained from a longitudinal study investigating language acquisition in typically developing (TD) children and children with autism spectrum disorder (ASD) were used to develop 33 codes for children's voluntary changes in static and dynamic postures. Interrater reliability was calculated for three raters who independently coded 10 randomly selected videos of children aged 23 to 48 months (TD: n = 5, median = 35, IQR = 12.5; ASD: n = 5, median = 35, IQR = 6.75). RESULTS Overall, CPVC demonstrated excellent interrater reliability (Krippendorff's α > 0.90). Among all codes developed, five codes (i.e., sit-half, sit-other, crawl, cruise, and supported walk) were not observed by any coders in the sample, but were kept in the coding scheme to reflect normal developmental milestones. CONCLUSIONS CPVC is a reliable, feasible method of quantifying postural variability in young children with and without neurodevelopmental disorders in naturalistic contexts.
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Affiliation(s)
- Laurel Daniels Abbruzzese
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Natasha Yamane
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - Deborah Fein
- Department of Psychology, University of Connecticut, Storrs, Connecticut, USA
| | - Letitia Naigles
- Department of Psychology, University of Connecticut, Storrs, Connecticut, USA
| | - Sylvie Goldman
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
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20
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Fein D. Proposed brief diagnostic observational scale for autism spectrum disorder. Dev Med Child Neurol 2020; 62:772. [PMID: 32222044 DOI: 10.1111/dmcn.14531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Deborah Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA.,Department of Pediatrics, University of Connecticut, Farmington, CT, USA
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21
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Moulton E, Bradbury K, Barton M, Fein D. Factor Analysis of the Childhood Autism Rating Scale in a Sample of Two Year Olds with an Autism Spectrum Disorder. J Autism Dev Disord 2019; 49:2733-2746. [PMID: 27743321 DOI: 10.1007/s10803-016-2936-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The Childhood Autism Rating Scale (CARS), (Schopler et al. in J Autism Dev Disord 10(1):91-103, 1980) is a 15-item observation-based rating scale that yields a total score reflective of autism symptom severity. This study investigated the factor structure of the CARS in a sample of 2-year-old children with DSM-IV-TR (American Psychiatric Association in Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Publishing, Washington, 2000) diagnoses of AD or PDD-NOS. Following a preliminary internal cross-validation, principal axis factor analysis was completed (N = 282). The results indicate a three-factor solution: Social Communication, Stereotyped Behaviors and Sensory Sensitivities, and Emotional Reactivity. The factors are meaningful, with the first two reflective of DSM-5 symptom domains. This study supports the continued relevance of the CARS in ASD assessment, and extends its utility in 2-year-old children.
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Affiliation(s)
- Emily Moulton
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA.
| | - Kathryn Bradbury
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Marianne Barton
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
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22
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Jashar DT, Fein D, Berry LN, Burke JD, Miller LE, Barton ML, Dumont-Mathieu T. Parental Perceptions of a Comprehensive Diagnostic Evaluation for Toddlers at Risk for Autism Spectrum Disorder. J Autism Dev Disord 2019; 49:1763-1777. [PMID: 30607783 DOI: 10.1007/s10803-018-3851-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Parent satisfaction with neurodevelopmental evaluations may influence the pursuit of intervention. Parent satisfaction with a neurodevelopmental evaluation for toddlers at risk for autism (n = 257; 128 with autism) was examined using the Post-Evaluation Satisfaction Questionnaire, which collected quantitative and qualitative information. Fewer ethnic/racial minority than non-minority parents returned the questionnaire. Factor analysis indicated a one-factor model, Total score, which did not differ significantly by diagnosis, autism severity, child's cognitive or adaptive delay, family race/ethnicity, maternal education, family annual income, or parental stress. Examination of 24 individual items showed a race/ethnicity difference for only one item; minority parents scored the evaluation as meeting their needs less. Qualitative data stressed the importance of fully explaining diagnoses/recommendations and providing direct and clear feedback.
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Affiliation(s)
- Dasal Tenzin Jashar
- University of Minnesota, Minneapolis, MN, USA. .,Kennedy Krieger Institute, 1750 E. Fairmount Avenue, Baltimore, MD, 21231, USA.
| | - Deborah Fein
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
| | - Leandra N Berry
- Department of Pediatrics, Baylor College of Medicine, 8080 North Stadium Drive, Suite 180, Houston, TX, 77054, USA
| | - Jeffrey D Burke
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
| | - Lauren E Miller
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
| | - Marianne L Barton
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
| | - Thyde Dumont-Mathieu
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
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23
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Fusaroli R, Weed E, Fein D, Naigles L. Hearing me hearing you: Reciprocal effects between child and parent language in autism and typical development. Cognition 2019; 183:1-18. [PMID: 30396129 PMCID: PMC6322977 DOI: 10.1016/j.cognition.2018.10.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 09/04/2018] [Accepted: 10/27/2018] [Indexed: 01/06/2023]
Abstract
Language development in typically developing children (TD) has traditionally been investigated in relation to environmental factors, while language in children with autism spectrum disorder (ASD) has primarily been related to child-based factors. We employ a longitudinal corpus of 32 preschoolers with ASD and 35 linguistically matched TD peers recorded over 6 visits (ranging between 2 and 5 years of age) to investigate the relative importance of child-based and environmental factors in language development for both populations. We also investigate the reciprocal interaction between children's response to parents' input, and parents' response to children's production. We report six major findings. (1) Children's production of word types, tokens, and MLU increased across visits, and were predicted by their Expressive Language (EL) (positively) and diagnosis (negatively) from Visit 1. (2) Parents' production also increased across visits, and was predicted by their child's nonverbal cognition (positively) and diagnosis (negatively) from Visit 1. (3) At all visits and across groups, children and parents matched each other in lexical and syntactic production; (4) Parents who produced longer MLUs during a given visit had children who produced more word types and tokens, and had longer MLUs, at the subsequent visit. (5) When both child EL at Visit 1 and parent MLU were included in the model, both contributed significantly to future child language; however, EL accounted for a greater proportion of the variance. (6) Finally, children's speech significantly predicted parent speech at the next visit. Taken together, these results draw more attention to the importance of child-based factors in the early language development of TD children, and to the importance of parental language factors in the early language development of children with ASD.
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Affiliation(s)
- Riccardo Fusaroli
- Institute of Communication and Culture, Aarhus University, Jens Chr. Skous Vej 2, 8000 Aarhus, Denmark; The Interacting Minds Centre, Aarhus University, Jens Chr. Skous Vej 4, 8000 Aarhus, Denmark.
| | - Ethan Weed
- Institute of Communication and Culture, Aarhus University, Jens Chr. Skous Vej 2, 8000 Aarhus, Denmark; The Interacting Minds Centre, Aarhus University, Jens Chr. Skous Vej 4, 8000 Aarhus, Denmark
| | - Deborah Fein
- Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269-1020, United States
| | - Letitia Naigles
- Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269-1020, United States
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24
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Ramsey RK, Nichols L, Ludwig NN, Fein D, Adamson LB, Robins DL. Brief Report: Sex Differences in Parental Concerns for Toddlers with Autism Risk. J Autism Dev Disord 2018; 48:4063-4069. [PMID: 29700708 DOI: 10.1007/s10803-018-3583-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Research on sex differences in autism spectrum disorder (ASD) suggests both higher prevalence and a more easily observable presentation of core ASD symptomology in males, which may lead to sex differences in parental concerns. The current study examined whether sex and diagnosis relate to the timing, number, and types of pre-diagnosis concerns for 669 (Nmale = 468) toddlers who screened at risk for ASD. No sex differences in parents' concerns emerged for toddlers diagnosed with ASD; however, in the overall at-risk sample, parents of boys endorsed ASD symptoms, including restricted and repetitive behaviors, more than parents of girls. Future research should examine why sex differences in pre-diagnosis concerns emerge and how they might impact early diagnosis for at-risk boys versus girls.
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Affiliation(s)
- Riane K Ramsey
- Department of Psychology, Georgia State University, P. O. Box 5010, Atlanta, GA, 30302-5010, USA.
| | - Lashae Nichols
- Department of Psychology, Georgia State University, P. O. Box 5010, Atlanta, GA, 30302-5010, USA.,Center for Autism and Related Disabilities, University of Miami, Miami, FL, USA
| | - Natasha N Ludwig
- Department of Psychology, Georgia State University, P. O. Box 5010, Atlanta, GA, 30302-5010, USA.,Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
| | - Lauren B Adamson
- Department of Psychology, Georgia State University, P. O. Box 5010, Atlanta, GA, 30302-5010, USA
| | - Diana L Robins
- AJ Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
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25
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Fein D. Jill Boucher: Autism Spectrum Disorder (2nd ed.). J Autism Dev Disord 2018. [DOI: 10.1007/s10803-018-3547-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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Suh J, Orinstein A, Barton M, Chen CM, Eigsti IM, Ramirez-Esparza N, Fein D. Ratings of Broader Autism Phenotype and Personality Traits in Optimal Outcomes from Autism Spectrum Disorder. J Autism Dev Disord 2017; 46:3505-3518. [PMID: 27538964 DOI: 10.1007/s10803-016-2868-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The study examines whether "optimal outcome" (OO) children, despite no longer meeting diagnostic criteria for Autism Spectrum Disorder (ASD), exhibit personality traits often found in those with ASD. Nine zero acquaintance raters evaluated Broader Autism Phenotype (BAP) and Big Five personality traits of 22 OO individuals, 27 high functioning individuals with ASD (HFA), and 23 typically developing (TD) peers. HFA children displayed higher ratings than their peers on all BAP traits. OO were indistinguishable from TD, with the exception of greater extraversion (e.g., increased talkativeness), a potential tendency to be less emotionally stable, and pragmatic language deficits such as getting sidetracked in conversation. Overall, OO individuals are not showing BAP characteristics, but may be subject to other mild ADHD-like characteristics.
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Affiliation(s)
- Joyce Suh
- Department of Psychology, University of Connecticut, Storrs, CT, USA. .,Department of Neuropsychology, Kennedy Krieger Institute/Johns Hopkins School of Medicine, 1750 East Fairmount Avenue, Baltimore, MD, 21231, USA.
| | - Alyssa Orinstein
- Department of Psychology, University of Connecticut, Storrs, CT, USA.,Developmental Medicine Center, Boston Children's Hospital, Boston, MA, USA
| | - Marianne Barton
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Chi-Ming Chen
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Inge-Marie Eigsti
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | | | - Deborah Fein
- Department of Psychology, University of Connecticut, Storrs, CT, USA.,Department of Pediatrics, University of Connecticut, Farmington, CT, USA
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27
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Jashar DT, Brennan LA, Barton ML, Fein D. Cognitive and Adaptive Skills in Toddlers Who Meet Criteria for Autism in DSM-IV but not DSM-5. J Autism Dev Disord 2017; 46:3667-3677. [PMID: 27628939 DOI: 10.1007/s10803-016-2901-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The current study compared adaptive and cognitive skills, and autism severity of toddlers with an autism spectrum disorder (ASD) diagnosis under DSM-IV but not DSM-5 criteria (DSM-IV only group) to those who met autism criteria under both diagnostic systems (DSM-5 group) and to those without ASD (non-ASD group). The toddlers in the DSM-IV only group were less delayed on various domains of adaptive (Communication, Socialization) and cognitive (Expressive and Receptive language, Fine Motor, Visual Reception) skills, and had less severe symptoms of ASD than the DSM-5 group. Thus, they might have the best potential for successful intervention. The DSM-IV only group did not differ from the non-ASD group in any adaptive or cognitive skills except for socialization skills, the hallmark of ASD.
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Affiliation(s)
- Dasal Tenzin Jashar
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA.
| | - Laura A Brennan
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
| | - Marianne L Barton
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
| | - Deborah Fein
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA
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28
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Jyotishi M, Fein D, Naigles L. Investigating the Grammatical and Pragmatic Origins of Wh-Questions in Children with Autism Spectrum Disorders. Front Psychol 2017; 8:319. [PMID: 28344564 PMCID: PMC5344911 DOI: 10.3389/fpsyg.2017.00319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/20/2017] [Indexed: 11/16/2022] Open
Abstract
Compared to typically developing children, children with autism (ASD) show delayed production of wh-questions. It is currently controversial the degree to which such deficits derive from social-pragmatic requirements and/or because these are complex grammatical structures. The current study employed the intermodal preferential looking (IPL) paradigm, which reduces social-pragmatic demands. The IPL paradigm can help distinguish these proposals, as successful comprehension promotes the “pragmatics-origins” argument whereas comprehension difficulties would implicate a “grammatical-origins” argument. Additionally, we tested both the linguistic and social explanations by assessing the contributions of children's early grammatical knowledge (i.e., SVO word order) and their social-pragmatic scores on the Vineland to their later wh-question comprehension. Fourteen children with ASD and 17 TD children, matched on language level, were visited in their homes at 4-month intervals. Comprehension of wh-questions and SVO word order were tested via IPL: the wh-question video showed a costumed horse and bird serving as agents or patients of familiar transitive actions. During the test trials, they were displayed side by side with directing audios (e.g., “What did the horse tickle?”, “What hugged the bird?”, “Where is the horse/bird?”). Children's eye movements were coded offline; the DV was their percent looking to the named item during test. To show comprehension, children should look longer at the named item during a where-question than during a subject-wh or object-wh question. Results indicated that TD children comprehended both subject and object wh-questions at 32 months of age. Comprehension of object-wh questions emerged chronologically later in children with ASD compared to their TD peers, but at similar levels of language. Moreover, performance on word order and social-pragmatic scores independently predicted both groups' later performance on wh-question comprehension. Our findings indicate that both grammar and social-pragmatics are implicated in the comprehension of wh-questions. The “grammatical-origins” argument is supported because the ASD group did not reveal earlier and stable comprehension of wh-questions; furthermore, their performance on SVO word order predicted their later success in linguistic processing of wh-questions. The “pragmatic-origins” argument is also supported because children's earlier socialization and communication scores strongly predicted their successful performance on wh-question comprehension.
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Affiliation(s)
- Manya Jyotishi
- Department of Psychological Sciences, University of Connecticut Storrs, CT, USA
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut Storrs, CT, USA
| | - Letitia Naigles
- Department of Psychological Sciences, University of Connecticut Storrs, CT, USA
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29
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Brennan L, Fein D, Como A, Rathwell IC, Chen CM. Use of the Modified Checklist for Autism, Revised with Follow Up-Albanian to Screen for ASD in Albania. J Autism Dev Disord 2016; 46:3392-3407. [PMID: 27491423 PMCID: PMC5074853 DOI: 10.1007/s10803-016-2875-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The Modified Checklist for Autism in Toddlers Revised-Albanian screener (M-CHAT-R-A) was used to screen 2594 toddlers, aged 16-30 months, at well-child visits. Two hundred fifty-three (9.75 %) screened positive; follow up on failed items were conducted by phone with 127 (50 %); the remainder were lost to follow-up. Twenty-six toddlers (21 %) continued to screen positive; 19 received full evaluations, which assessed for ASD with the Autism Diagnostic Observation Schedule and developmental delays with the Parents Assessment of Developmental Status-Developmental Milestones. All evaluated children had significant delays; 17 of the 19 met criteria for Autism/ASD. Removal of three items improved performance. Although Albania and the US are quite different in culture and language, key features of ASD appeared very similar.
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Affiliation(s)
- Laura Brennan
- Dept. of Psychology, University of Connecticut, Storrs, CT
| | - Deborah Fein
- Depts. of Psychology and Pediatrics, University of Connecticut, Storrs, CT, tel: 413-519-1324, fax: 860-486-2760
| | - Ariel Como
- Tirana Medical University, Medical Director, “Domenick Scaglione” Regional Center for Autism, Tirana, Albania
| | | | - Chi-Ming Chen
- Department of Psychology, University of Connecticut, Storrs, CT
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30
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Robins DL, Adamson LB, Barton M, Connell JE, Dumont-Mathieu T, Dworkin PH, Fein D, Greenstein MA, Hsu HW, Kerns C, Newschaffer C, Plumb J, Shattuck P, Turchi R, Vivanti G. Universal Autism Screening for Toddlers: Recommendations at Odds. J Autism Dev Disord 2016; 46:1880-2. [PMID: 26820633 DOI: 10.1007/s10803-016-2697-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Diana L Robins
- AJ Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA.
| | - Lauren B Adamson
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Marianne Barton
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - James E Connell
- AJ Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Thyde Dumont-Mathieu
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA.,Division of Developmental-Rehabilitation Medicine, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Paul H Dworkin
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA.,Office for Community Child Health and Help Me Grow National Center, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Deborah Fein
- Department of Psychology, University of Connecticut, Storrs, CT, USA.,Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Mark A Greenstein
- Divisions of Developmental-Behavioral Pediatrics and Clinical Genetics, Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Ho-Wen Hsu
- New England Newborn Screening Program, University of Massachussetts Medical School, Worcester, MA, USA
| | - Connor Kerns
- AJ Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Craig Newschaffer
- AJ Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Jennifer Plumb
- AJ Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Paul Shattuck
- AJ Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA
| | - Renee Turchi
- Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.,Center for Children and Youth with Special Health Care Needs at St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Giacomo Vivanti
- AJ Drexel Autism Institute, Drexel University, 3020 Market Street, Suite 560, Philadelphia, PA, 19104, USA.,Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Australia
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31
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Ellawadi AB, Fein D, Naigles LR. Category structure and processing in 6-year-old children with autism. Autism Res 2016; 10:327-336. [DOI: 10.1002/aur.1652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 03/04/2016] [Accepted: 05/11/2016] [Indexed: 11/05/2022]
Affiliation(s)
| | - Deborah Fein
- Department of Psychology; University of Connecticut; Storrs Connecticut
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32
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Naigles LR, Cheng M, Rattansone NX, Tek S, Khetrapal N, Fein D, Demuth K. "You're telling me!" The Prevalence and Predictors of Pronoun Reversals in Children with Autism Spectrum Disorders and Typical Development. Res Autism Spectr Disord 2016; 27:11-20. [PMID: 27103941 PMCID: PMC4834724 DOI: 10.1016/j.rasd.2016.03.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Social and linguistic explanations have been proposed for pronoun reversals in young typically developing (TD) children and those with autism spectrum disorders (ASD). The current study breaks new ground in investigating both explanations, comparing 18 TD toddlers and 15 children with ASD at similar language levels. Spontaneous speech was sampled every four months for six visits. Vocabulary and joint attention were also measured. Both groups produced pronoun reversals at low rates. The ASD group produced somewhat more reversals than the TD group, overall and at multiple visits. In the ASD group, early language and joint attention scores contributed significantly and independently to the incidence of reversal. Both linguistic and social factors seem implicated; moreover, reversals seem to occur when children's language and social abilities develop asynchronously. These findings can help clinicians devise both linguistic and social interventions for the relevant children.
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Affiliation(s)
| | | | - Nan Xu Rattansone
- Department of Linguistics, 5th floor, Building C5A Room 508, Macquarie University, Balaclava Road, North Ryde, NSW 2109, Australia
| | - Saime Tek
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT 06269-1020
| | - Neha Khetrapal
- Department of Linguistics, 5th floor, Building C5A Room 508, Macquarie University, Balaclava Road, North Ryde, NSW 2109, Australia
| | - Deborah Fein
- Department of Psychology, 406 Babbidge Road, University of Connecticut, Storrs, CT 06269-1020
| | - Katherine Demuth
- Department of Linguistics, 5th floor, Building C5A Room 508, Macquarie University, Balaclava Road, North Ryde, NSW 2109, Australia
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33
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Canfield AR, Eigsti IM, de Marchena A, Fein D. Story Goodness in Adolescents With Autism Spectrum Disorder (ASD) and in Optimal Outcomes From ASD. J Speech Lang Hear Res 2016; 59:533-45. [PMID: 27280731 PMCID: PMC4972015 DOI: 10.1044/2015_jslhr-l-15-0022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 06/03/2015] [Accepted: 10/14/2015] [Indexed: 05/25/2023]
Abstract
PURPOSE This study examined narrative quality of adolescents with autism spectrum disorder (ASD) using a well-studied "story goodness" coding system. METHOD Narrative samples were analyzed for distinct aspects of story goodness and rated by naïve readers on dimensions of story goodness, accuracy, cohesiveness, and oddness. Adolescents with high-functioning ASD were compared with adolescents with typical development (TD; n = 15 per group). A second study compared narratives from adolescents across three groups: ASD, TD, and youths with "optimal outcomes," who were diagnosed with ASD early in development but no longer meet criteria for ASD and have typical behavioral functioning. RESULTS In both studies, the ASD group's narratives had lower composite quality scores compared with peers with typical development. In Study 2, narratives from the optimal outcomes group were intermediate in scores and did not differ significantly from those of either other group. However, naïve raters were able to detect qualitative narrative differences across groups. CONCLUSIONS Findings indicate that pragmatic deficits in ASD are salient and could have clinical relevance. Furthermore, results indicate subtle differences in pragmatic language skills for individuals with optimal outcomes despite otherwise typical language skills in other domains. These results highlight the need for clinical interventions tailored to the specific deficits of these populations.
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Affiliation(s)
| | | | - Ashley de Marchena
- Center for Autism Research, Intellectual and Developmental Disabilities Research Center, The Children's Hospital of Philadelphia, PA
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34
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Affiliation(s)
- Deborah Fein
- Departments of Psychology and Pediatrics, University of Connecticut, Storrs, CT, USA
| | - Diana Robins
- AJ Drexel Autism Institute, Drexel Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Marianne Barton
- Department of Psychology, University of Connecticut, Storrs, CT, USA
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35
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Zwaigenbaum L, Bauman ML, Choueiri R, Fein D, Kasari C, Pierce K, Stone WL, Yirmiya N, Estes A, Hansen RL, McPartland JC, Natowicz MR, Buie T, Carter A, Davis PA, Granpeesheh D, Mailloux Z, Newschaffer C, Robins D, Smith Roley S, Wagner S, Wetherby A. Early Identification and Interventions for Autism Spectrum Disorder: Executive Summary. Pediatrics 2015; 136 Suppl 1:S1-9. [PMID: 26430167 PMCID: PMC9923899 DOI: 10.1542/peds.2014-3667b] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada;
| | - Margaret L. Bauman
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Roula Choueiri
- Division of Developmental and Behavioral Pediatrics, University of Massachusetts Memorial Children’s Medical Center, Worcester, Massachusetts
| | - Deborah Fein
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Connie Kasari
- Graduate School of Education & Information Studies, University of California Los Angeles, Los Angeles, California
| | - Karen Pierce
- Department of Neurosciences, University of California San Diego, La Jolla, California
| | | | - Nurit Yirmiya
- Department of Psychology, Hebrew University of Jerusalem Mount Scopus, Jerusalem, Israel
| | - Annette Estes
- Speech and Hearing Sciences, University of Washington, Seattle, Washington
| | - Robin L. Hansen
- Department of Pediatrics, University of California Davis MIND Institute, Sacramento, California
| | | | | | - Timothy Buie
- Harvard Medical School and Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Alice Carter
- Department of Psychology, University of Massachusetts, Boston, Massachusetts
| | | | | | - Zoe Mailloux
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Craig Newschaffer
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Diana Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Susanne Smith Roley
- USC Mrs T.H. Chan Division of Occupational Science and Occupational Therapy, Los Angeles, California
| | - Sheldon Wagner
- Behavioral Development & Educational Services, New Bedford, Massachusetts; and
| | - Amy Wetherby
- Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida
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36
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Zwaigenbaum L, Bauman ML, Fein D, Pierce K, Buie T, Davis PA, Newschaffer C, Robins DL, Wetherby A, Choueiri R, Kasari C, Stone WL, Yirmiya N, Estes A, Hansen RL, McPartland JC, Natowicz MR, Carter A, Granpeesheh D, Mailloux Z, Smith Roley S, Wagner S. Early Screening of Autism Spectrum Disorder: Recommendations for Practice and Research. Pediatrics 2015; 136 Suppl 1:S41-59. [PMID: 26430169 PMCID: PMC9923900 DOI: 10.1542/peds.2014-3667d] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This article reviews current evidence for autism spectrum disorder (ASD) screening based on peer-reviewed articles published to December 2013. Screening provides a standardized process to ensure that children are systematically monitored for early signs of ASD to promote earlier diagnosis. The current review indicates that screening in children aged 18 to 24 months can assist in early detection, consistent with current American Academy of Pediatrics' recommendations. We identify ASD-specific and broadband screening tools that have been evaluated in large community samples which show particular promise in terms of accurate classification and clinical utility. We also suggest strategies to help overcome challenges to implementing ASD screening in community practice, as well as priorities for future research.
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Affiliation(s)
- Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada;
| | - Margaret L. Bauman
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Deborah Fein
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Karen Pierce
- Department of Neurosciences, University of California San Diego, La Jolla, California
| | - Timothy Buie
- Harvard Medical School and Massachusetts General Hospital for Children, Boston, Massachusetts
| | | | - Craig Newschaffer
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Diana L. Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Amy Wetherby
- Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida
| | - Roula Choueiri
- Division of Developmental and Behavioral Pediatrics, University of Massachusetts Memorial Children’s Medical Center, Worcester, Massachusetts
| | - Connie Kasari
- Graduate School of Education & Information Studies, University of California Los Angeles, Los Angeles, California
| | | | - Nurit Yirmiya
- Department of Psychology, Hebrew University of Jerusalem Mount Scopus, Jerusalem, Israel
| | - Annette Estes
- Speech and Hearing Sciences, University of Washington, Seattle, Washington
| | - Robin L. Hansen
- Department of Pediatrics, University of California Davis MIND Institute, Sacramento, California
| | | | | | - Alice Carter
- Department of Psychology, University of Massachusetts, Boston, Massachusetts
| | | | - Zoe Mailloux
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Susanne Smith Roley
- USC Mrs T.H. Chan Division of Occupational Science and Occupational Therapy, Los Angeles, California; and
| | - Sheldon Wagner
- Behavioral Development & Educational Services, New Bedford, Massachusetts
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37
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Zwaigenbaum L, Bauman ML, Choueiri R, Kasari C, Carter A, Granpeesheh D, Mailloux Z, Smith Roley S, Wagner S, Fein D, Pierce K, Buie T, Davis PA, Newschaffer C, Robins D, Wetherby A, Stone WL, Yirmiya N, Estes A, Hansen RL, McPartland JC, Natowicz MR. Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research. Pediatrics 2015; 136 Suppl 1:S60-81. [PMID: 26430170 PMCID: PMC9923898 DOI: 10.1542/peds.2014-3667e] [Citation(s) in RCA: 316] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This article reviews current evidence for autism spectrum disorder (ASD) interventions for children aged <3 years, based on peer-reviewed articles published up to December 2013. Several groups have adapted treatments initially designed for older, preschool-aged children with ASD, integrating best practice in behavioral teaching methods into a developmental framework based on current scientific understanding of how infants and toddlers learn. The central role of parents has been emphasized, and interventions are designed to incorporate learning opportunities into everyday activities, capitalize on "teachable moments," and facilitate the generalization of skills beyond the familiar home setting. Our review identified several comprehensive and targeted treatment models with evidence of clear benefits. Although some trials were limited to 8- to 12-week outcome data, enhanced outcomes associated with some interventions were evaluated over periods as long as 2 years. Based on this review, recommendations are proposed for clinical practice and future research.
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Affiliation(s)
- Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada;
| | - Margaret L. Bauman
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Roula Choueiri
- Division of Developmental and Behavioral Pediatrics, University of Massachusetts Memorial Children’s Medical Center, Worcester, Massachusetts
| | - Connie Kasari
- Graduate School of Education & Information Studies, University of California Los Angeles, Los Angeles, California
| | - Alice Carter
- Department of Psychology, University of Massachusetts, Boston, Massachusetts
| | | | - Zoe Mailloux
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Susanne Smith Roley
- USC Mrs T.H. Chan Division of Occupational Science and Occupational Therapy, Los Angeles, California
| | - Sheldon Wagner
- Behavioral Development & Educational Services, New Bedford, Massachusetts
| | - Deborah Fein
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Karen Pierce
- Department of Neurosciences, University of California San Diego, La Jolla, California
| | - Timothy Buie
- Harvard Medical School and Massachusetts General Hospital for Children, Boston, Massachusetts
| | | | - Craig Newschaffer
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Diana Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Amy Wetherby
- Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida
| | | | - Nurit Yirmiya
- Department of Psychology, Hebrew University of Jerusalem Mount Scopus, Jerusalem, Israel
| | - Annette Estes
- Speech and Hearing Sciences, University of Washington, Seattle, Washington
| | - Robin L. Hansen
- Department of Pediatrics, University of California Davis MIND Institute, Sacramento, California
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Zwaigenbaum L, Bauman ML, Stone WL, Yirmiya N, Estes A, Hansen RL, McPartland JC, Natowicz MR, Choueiri R, Fein D, Kasari C, Pierce K, Buie T, Carter A, Davis PA, Granpeesheh D, Mailloux Z, Newschaffer C, Robins D, Roley SS, Wagner S, Wetherby A. Early Identification of Autism Spectrum Disorder: Recommendations for Practice and Research. Pediatrics 2015; 136 Suppl 1:S10-40. [PMID: 26430168 PMCID: PMC9923897 DOI: 10.1542/peds.2014-3667c] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Early identification of autism spectrum disorder (ASD) is essential to ensure that children can access specialized evidence-based interventions that can help to optimize long-term outcomes. Early identification also helps shorten the stressful "diagnostic odyssey" that many families experience before diagnosis. There have been important advances in research into the early development of ASDs, incorporating prospective designs and new technologies aimed at more precisely delineating the early emergence of ASD. Thus, an updated review of the state of the science of early identification of ASD was needed to inform best practice. These issues were the focus of a multidisciplinary panel of clinical practitioners and researchers who completed a literature review and reached consensus on current evidence addressing the question "What are the earliest signs and symptoms of ASD in children aged ≤24 months that can be used for early identification?" Summary statements address current knowledge on early signs of ASD, potential contributions and limitations of prospective research with high-risk infants, and priorities for promoting the incorporation of this knowledge into clinical practice and future research.
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Affiliation(s)
- Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada;
| | - Margaret L. Bauman
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | | | - Nurit Yirmiya
- Department of Psychology, Hebrew University of Jerusalem Mount Scopus, Jerusalem, Israel
| | - Annette Estes
- Speech and Hearing Sciences, University of Washington, Seattle, Washington
| | - Robin L. Hansen
- Department of Pediatrics, University of California Davis MIND Institute, Sacramento, California
| | | | | | - Roula Choueiri
- Division of Developmental and Behavioral Pediatrics, University of Massachusetts Memorial Children’s Medical Center, Worcester, Massachusetts
| | - Deborah Fein
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Connie Kasari
- Graduate School of Education & Information Studies, University of California Los Angeles, Los Angeles, California
| | - Karen Pierce
- Department of Neurosciences, University of California San Diego, La Jolla, California
| | - Timothy Buie
- Harvard Medical School and Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Alice Carter
- Department of Psychology, University of Massachusetts, Boston, Massachusetts
| | | | | | - Zoe Mailloux
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Craig Newschaffer
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Diana Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
| | - Susanne Smith Roley
- USC Mrs T.H. Chan Division of Occupational Science and Occupational Therapy, Los Angeles, California
| | - Sheldon Wagner
- Behavioral Development & Educational Services, New Bedford, Massachusetts; and
| | - Amy Wetherby
- Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida
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Potrzeba ER, Fein D, Naigles L. Investigating the shape bias in typically developing children and children with autism spectrum disorders. Front Psychol 2015; 6:446. [PMID: 25954219 PMCID: PMC4404809 DOI: 10.3389/fpsyg.2015.00446] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/29/2015] [Indexed: 11/16/2022] Open
Abstract
Young typically developing (TD) children have been observed to utilize word learning strategies such as the noun bias and shape bias; these improve their efficiency in acquiring and categorizing novel terms. Children using the shape bias extend object labels to new objects of the same shape; thus, the shape bias prompts the categorization of object words based on the global characteristic of shape over local, discrete details. Individuals with autism spectrum disorders (ASDs) frequently attend to minor details of objects rather than their global structure. Therefore, children with ASD may not use shape bias to acquire new words. Previous research with children with ASD has provided evidence that they parallel TD children in showing a noun bias, but not a shape bias (Tek et al., 2008). However, this sample was small and individual and item differences were not investigated in depth. In an extension of Tek et al. (2008) with twice the sample size and a wider developmental timespan, we tested 32 children with ASD and 35 TD children in a longitudinal study across 20 months using the intermodal preferential looking paradigm. Children saw five triads of novel objects (target, shape-match, color-match) in both NoName and Name trials; those who looked longer at the shape-match during the Name trials than the NoName trials demonstrated a shape bias. The TD group showed a significant shape bias at all visits, beginning at 20 months of age while the language-matched ASD group did not show a significant shape bias at any visit. Within the ASD group, though, some children did show a shape bias; these children had larger vocabularies concurrently and longitudinally. Degree of shape bias elicitation varied by item, but did not seem related to perceptual complexity. We conclude that shape does not appear to be an organizing factor for word learning by children with ASD.
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Affiliation(s)
- Emily R Potrzeba
- Department of Psychology, University of Connecticut Storrs, CT, USA ; Department of Allied Health Sciences, University of North Carolina Chapel Hill NC, USA
| | - Deborah Fein
- Department of Psychology, University of Connecticut Storrs, CT, USA
| | - Letitia Naigles
- Department of Psychology, University of Connecticut Storrs, CT, USA
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Tovar AT, Fein D, Naigles LR. Grammatical aspect is a strength in the language comprehension of young children with autism spectrum disorder. J Speech Lang Hear Res 2015; 58:301-310. [PMID: 25421384 PMCID: PMC4398577 DOI: 10.1044/2014_jslhr-l-13-0257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 04/18/2014] [Accepted: 10/01/2014] [Indexed: 06/02/2023]
Abstract
PURPOSE The comprehension of tense/aspect morphology by children with autism spectrum disorder (ASD) was assessed via Intermodal Preferential Looking (IPL) to determine whether this population's difficulties with producing these morphemes extended to their comprehension. METHOD Four-year-old participants were assessed twice, 4 months apart. They viewed a video that presented side-by-side ongoing and completed events paired with familiar verbs with past tense and progressive morphology. Their eye movements were recorded and coded offline; the IPL measures included percentage of looking time at, and latency of first look to, the matching scene. Spontaneous speech samples were also obtained and coded for number of words, past tense, and progressive inflections. RESULTS Relative to their baseline preferences, these 4-year-old children with ASD looked more quickly to and longer at the matching scene for both morphemes. Children who produced more words, including progressive and past morphemes, and those who performed better on standardized language assessments demonstrated better comprehension of -ing. CONCLUSIONS Overall, these children with ASD demonstrated consistent comprehension of grammatical aspect morphology; moreover, their degree of comprehension was found to correlate with spontaneous production and standardized test scores.
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Goodwin A, Fein D, Naigles L. The role of maternal input in the development of wh-question comprehension in autism and typical development. J Child Lang 2015; 42:32-63. [PMID: 24461930 DOI: 10.1017/s0305000913000524] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Social deficits have been implicated in the language delays and deficits of children with autism (ASD); thus, the extent to which these children use language input in social contexts similarly to typically developing (TD) children is unknown. The current study investigated how caregiver input influenced the development of wh-question comprehension in TD children and language-matched preschoolers with ASD. Children were visited at four-month intervals over 1.5 years; mother-child play sessions at visits 1-2 were coded for maternal wh-question use. At visits 3-5 children watched videos in the Intermodal Preferential Looking paradigm, to assess their comprehension of subject and object wh-questions. Mothers' use of wh-questions with verbs and complex wh-questions positively predicted wh-question comprehension in the TD group; in contrast, mothers' use of wh-questions with 'be' as the main verb negatively predicted wh-question comprehension in the ASD group. Thus, TD children and children with ASD appear to use their linguistic input differently.
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Abstract
Symptoms of autism spectrum disorders may appear as early as 6 months, but parent concern, which can precipitate evaluation, often lags significantly. The presence of typical or atypical older siblings can change parents' sensitivity to departures from typical development. This study investigated type and age of parent's first concerns in toddlers with autism spectrum disorder, prior to diagnosis. Participants had (1) at least one older sibling with autism spectrum disorder (Sibs-ASD); (2) only typically developing older siblings (Sibs-TD), or (3) were only/oldest (No-Sibs). Specific autism spectrum disorder diagnoses and symptom severity were similar among groups. Developmentally, No-Sibs showed the largest delays, followed by Sibs-TD, followed by Sibs-ASD. Mean age of first concern was 16 months for No-Sibs, 14 months for Sibs-TD, and 10 months for Sibs-ASD. Age of first concern differed significantly by group, even after controlling for mother's age and education. Concern about language was prevalent in all groups. Thus, the presence of an older child with typical or, especially, atypical development was associated with earlier concerns for the affected child, despite milder developmental delays. These findings underscore the importance of encouraging parents to report concerns to pediatricians, routine standardized screening for autism spectrum disorder, and the need for pediatrician vigilance, especially for only or oldest children.
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Troyb E, Orinstein A, Tyson K, Eigsti IM, Naigles L, Fein D. Restricted and repetitive behaviors in individuals with a history of ASDs who have achieved optimal outcomes. J Autism Dev Disord 2014; 44:3168-84. [PMID: 25030967 PMCID: PMC4224622 DOI: 10.1007/s10803-014-2182-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Studies of autism spectrum disorders (ASDs) suggest that restricted and repetitive behaviors (RRBs) are particularly difficult to remediate. We examined present and past RRBs in 34 individuals who achieved optimal outcomes (OOs; lost their ASD diagnosis), 45 high-functioning individuals with ASD (HFA) and 34 typically developing (TD) peers. The OO group exhibited minimal residual RRBs at the time of the study. All OO participants were reported to have at least one RRB in early childhood and almost 90 % met the RRB cutoff for ASD in early childhood, but RRBs were not more present in the OO than the TD group at the time of the study. History of RRBs in the HFA and OO groups differed only in oversensitivity to noise and insistence on sameness. Reports of current behavior indicated that RRB's had almost totally disappeared in the OO group. Thus, although RRB's were present in the OO group in childhood, they resolved along with social and communication deficits.
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Affiliation(s)
- Eva Troyb
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA,
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44
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Tyson K, Kelley E, Fein D, Orinstein A, Troyb E, Barton M, Eigsti IM, Naigles L, Schultz RT, Stevens M, Helt M, Rosenthal M. Language and verbal memory in individuals with a history of autism spectrum disorders who have achieved optimal outcomes. J Autism Dev Disord 2014; 44:648-63. [PMID: 23982487 DOI: 10.1007/s10803-013-1921-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Some individuals who lose their autism spectrum disorder diagnosis may continue to display subtle weaknesses in language. We examined language and verbal memory in 44 individuals with high-functioning autism (HFA), 34 individuals with "optimal outcomes" (OO) and 34 individuals with typical development (TD). The OO group scored in the average range or above on all measures and showed few differences from the TD group. The HFA group performed within the average range but showed significantly lower mean performance than the other groups on multiple language measures, even when controlling for verbal IQ. Results also indicate that OO individuals show strong language abilities in all areas tested, but that their language may show greater reliance on verbal memory.
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Affiliation(s)
- Katherine Tyson
- Department of Psychology, University of Connecticut, Storrs, CT, USA,
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45
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Tek S, Mesite L, Fein D, Naigles L. Longitudinal analyses of expressive language development reveal two distinct language profiles among young children with autism spectrum disorders. J Autism Dev Disord 2014; 44:75-89. [PMID: 23719855 DOI: 10.1007/s10803-013-1853-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although children with autism spectrum disorders (ASD) show significant variation in language skills, research on what type(s) of language profiles they demonstrate has been limited. Using growth-curve analyses, we investigated how different groups of young children with ASD show increases in the size of their lexicon, morpho-syntactic production as measured by Brown's 14 grammatical morphemes, and wh-question complexity, compared to TD children, across six time points. Children with ASD who had higher verbal skills were comparable to TD children on most language measures, whereas the children with ASD who had low verbal skills had flatter trajectories in most language measures. Thus, two distinct language profiles emerged for children with ASD.
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Affiliation(s)
- Saime Tek
- Psychology Department, Bilkent University, Bilkent, 06800, Ankara, Turkey,
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Herlihy LE, Brooks B, Dumont-Mathieu T, Barton ML, Fein D, Chen CM, Robins DL. Standardized screening facilitates timely diagnosis of autism spectrum disorders in a diverse sample of low-risk toddlers. J Dev Behav Pediatr 2014; 35:85-92. [PMID: 24509053 PMCID: PMC4388145 DOI: 10.1097/dbp.0000000000000014] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Routine, standardized screening for autism spectrum disorder (ASD) has been hypothesized to reduce known racial/ethnic and socioeconomic status (SES) disparities in age of first diagnosis. This study explored demographic differences in toddlers' age and performance on developmental measures at the time of ASD assessment. METHOD Toddlers (16-39 months at evaluation) who screened at-risk for developmental delay on the Modified Checklist for Autism in Toddlers (M-CHAT) or M-CHAT-Revised (M-CHAT-R) and follow-up interview participated in a diagnostic assessment. Of these, 44.7% were racial/ethnic minorities and 53.5% were non-minorities. Child race/ethnicity, years of maternal education (MEd), and household yearly income (YI) were parent-reported. RESULTS Small but significant correlations were observed between MEd or YI and evaluation age and adaptive communication, socialization, and motor scores. Controlling for MEd and YI, minority racial/ethnic group did not predict child's performance on most measures and did not predict likelihood of ASD diagnosis. Differences in age at evaluation and receptive language skills were small effects. CONCLUSION Significant but small effects emerged for SES and minority status on toddlers' age at evaluation and parent-reported adaptive skills, but these did not predict ASD diagnosis. The small magnitude of these effects suggests that routine, standardized screening for ASD in toddlers and timely access to diagnostic evaluation can reduce disparities in age at diagnosis and possibly reduce racial/ethnic disparities in access to services for ASD and other developmental delays.
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Affiliation(s)
- Lauren E. Herlihy
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Bianca Brooks
- Departments of Clinical Psychology and Neuroscience, Georgia State University, Atlanta, Georgia
| | | | - Marianne L. Barton
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Deborah Fein
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Chi-Ming Chen
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - Diana L. Robins
- Departments of Clinical Psychology and Neuroscience, Georgia State University, Atlanta, Georgia
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Robins DL, Casagrande K, Barton M, Chen CMA, Dumont-Mathieu T, Fein D. Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics 2014; 133:37-45. [PMID: 24366990 PMCID: PMC3876182 DOI: 10.1542/peds.2013-1813] [Citation(s) in RCA: 488] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE This study validates the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F), a screening tool for low-risk toddlers, and demonstrates improved utility compared with the original M-CHAT. METHODS Toddlers (N = 16,071) were screened during 18- and 24-month well-child care visits in metropolitan Atlanta and Connecticut. Parents of toddlers at risk on M-CHAT-R completed follow-up; those who continued to show risk were evaluated. RESULTS The reliability and validity of the M-CHAT-R/F were demonstrated, and optimal scoring was determined by using receiver operating characteristic curves. Children whose total score was ≥ 3 initially and ≥ 2 after follow-up had a 47.5% risk of being diagnosed with autism spectrum disorder (ASD; confidence interval [95% CI]: 0.41-0.54) and a 94.6% risk of any developmental delay or concern (95% CI: 0.92-0.98). Total score was more effective than alternative scores. An algorithm based on 3 risk levels is recommended to maximize clinical utility and to reduce age of diagnosis and onset of early intervention. The M-CHAT-R detects ASD at a higher rate compared with the M-CHAT while also reducing the number of children needing the follow-up. Children in the current study were diagnosed 2 years younger than the national median age of diagnosis. CONCLUSIONS The M-CHAT-R/F detects many cases of ASD in toddlers; physicians using the 2-stage screener can be confident that most screen-positive cases warrant evaluation and referral for early intervention. Widespread implementation of universal screening can lower the age of ASD diagnosis by 2 years compared with recent surveillance findings, increasing time available for early intervention.
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Affiliation(s)
- Diana L. Robins
- Department of Psychology,,Neuroscience Institute, Georgia State University, Atlanta, Georgia; and
| | | | | | | | - Thyde Dumont-Mathieu
- Department of Psychology,,Department of Pediatrics, University of Connecticut, Storrs, Connecticut
| | - Deborah Fein
- Department of Psychology,,Department of Pediatrics, University of Connecticut, Storrs, Connecticut
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Troyb E, Orinstein A, Tyson K, Helt M, Eigsti IM, Stevens M, Fein D. Academic abilities in children and adolescents with a history of autism spectrum disorders who have achieved optimal outcomes. Autism 2013; 18:233-43. [PMID: 24096312 DOI: 10.1177/1362361312473519] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examines the academic abilities of children and adolescents who were once diagnosed with an autism spectrum disorder, but who no longer meet diagnostic criteria for this disorder. These individuals have achieved social and language skills within the average range for their ages, receive little or no school support, and are referred to as having achieved "optimal outcomes." Performance of 32 individuals who achieved optimal outcomes, 41 high-functioning individuals with a current autism spectrum disorder diagnosis (high-functioning autism), and 34 typically developing peers was compared on measures of decoding, reading comprehension, mathematical problem solving, and written expression. Groups were matched on age, sex, and nonverbal IQ; however, the high-functioning autism group scored significantly lower than the optimal outcome and typically developing groups on verbal IQ. All three groups performed in the average range on all subtests measured, and no significant differences were found in performance of the optimal outcome and typically developing groups. The high-functioning autism group scored significantly lower on subtests of reading comprehension and mathematical problem solving than the optimal outcome group. These findings suggest that the academic abilities of individuals who achieved optimal outcomes are similar to those of their typically developing peers, even in areas where individuals who have retained their autism spectrum disorder diagnoses exhibit some ongoing difficulty.
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Troyb E, Rosenthal M, Eigsti IM, Kelley E, Tyson K, Orinstein A, Barton M, Fein D. Executive functioning in individuals with a history of ASDs who have achieved optimal outcomes. Child Neuropsychol 2013; 20:378-97. [PMID: 23731181 DOI: 10.1080/09297049.2013.799644] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Executive functioning (EF) is examined among children and adolescents once diagnosed with an autism spectrum disorder (ASD), but who no longer meet diagnostic criteria. These individuals have average social and language skills, receive minimal school support and are considered to have achieved "optimal outcomes" (OOs). Since residual impairments in these individuals might be expected in deficits central to autism, and in developmentally advanced skills, EF was examined in 34 individuals who achieved OOs, 43 individuals with high-functioning autism (HFA), and 34 typically developing (TD) peers. Groups were matched on age (M = 13.49), gender, and nonverbal IQ (NVIQ) but differed on verbal IQ (VIQ; HFA < TD, OO). On direct assessment, all three groups demonstrated average EF; however, the OO and HFA groups exhibited more impulsivity and less efficient planning and problem-solving than the TD group, and more HFA participants exhibited below average inhibition than did OO and TD participants. Parent-report measures revealed average EF among the OO and TD groups; however, the OO group exhibited more difficulty than the TD group on set-shifting and working memory. HFA participants demonstrated more difficulty on all parent-reported EF domains, with a clinical impairment in attention-shifting. Results suggest that EF in OO appears to be within the average range, even for functions that were impaired among individuals with HFA. Despite their average performance, however, the OO and TD groups differed on measures of impulsivity, set-shifting, problem-solving, working memory, and planning, suggesting that the OO group does not have the above-average EF scores of the TD group despite their high-average IQs.
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Affiliation(s)
- Eva Troyb
- a Department of Psychology , University of Connecticut , Storrs , Connecticut , USA
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Abstract
OBJECTIVE The purpose of the study was to examine use of the Modified Checklist for Autism in Toddlers (M-CHAT) as an autism-specific screening instrument in a large, geographically diverse pediatrics-based sample. METHODS The M-CHAT and the M-CHAT Follow-Up (M-CHAT/F) were used to screen 18,989 toddlers at pediatric well-child visits in 2 US geographic regions. Pediatricians directly referred children to ascertain potential missed screening cases. Screen-positive children received the M-CHAT/F; children who continued to screen positive after the M-CHAT/F received a diagnostic evaluation. RESULTS Results indicated that 54% of children who screened positive on the M-CHAT and M-CHAT/F presented with an autism spectrum disorder (ASD), and 98% presented with clinically significant developmental concerns warranting intervention. An M-CHAT total score cutoff of ≥3 identifies nearly all screen-positive cases, and for ease of scoring the use of only the M-CHAT total score cutoff is recommended. An M-CHAT total score of 7 serves as an appropriate clinical cutoff, and providers can bypass the M-CHAT/F and refer immediately to evaluation and intervention if a child obtains a score of ≥7. CONCLUSIONS This study provides empirical support for the utility of population screening for ASD with the use of the M-CHAT in a primary care setting. Results suggest that the M-CHAT continues to be an effective screening instrument for ASD when the 2-step screening process is used. The M-CHAT is widely used at pediatric offices, and this study provides updated results to facilitate use and scoring of the M-CHAT by clinical providers.
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Affiliation(s)
- Colby Chlebowski
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA.
| | - Diana L. Robins
- Department of Psychology, Georgia State University, Atlanta, Georgia
| | | | - Deborah Fein
- Departments of Psychology and,Pediatrics, University of Connecticut, Storrs, Connecticut
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