An Initial Psychometric Evaluation of the CBCL 6-18 in a Sample of Youth with Autism Spectrum Disorders

Similar names, different results: Consistency of the associations between prenatal exposure to phthalates and parent-ratings of behavior problems in preschool children

BACKGROUND

Environmental health research has reported mixed findings on the associations between prenatal exposure to phthalates and parent-ratings of child behavioral problems.

OBJECTIVE

We examined the consistency of the associations between prenatal urinary phthalate concentrations and child behavior scores across two standardized instruments - the Behavior Assessment System for Children-Second Edition (BASC-2) and the Child Behavior Checklist (CBCL) - using two analytical approaches used to correct for urine dilution.

METHOD

A sample of 351 mother-child pairs were selected from a prospective birth cohort of pregnant women enrolled between 2009 and 2012. Women provided spot urine samples during the second trimester of pregnancy, which were analyzed for levels of nine urinary phthalate metabolites. When their typically developing children were 3-4 years of age, mothers completed the BASC-2 and CBCL on the same day. Adjusted regression analyses examined the associations between maternal prenatal phthalate concentrations and child behavior scores on the BASC-2 and CBCL. To correct for urine dilution, primary regression analyses included urinary creatinine concentration as a separate independent variable (i.e., covariate). In the secondary regression analyses, creatinine-adjusted phthalate concentrations were used.

RESULTS

Primary logistic regression analyses that included urinary creatinine as a covariate showed that higher prenatal phthalate concentrations were related to increased odds of scores falling into the borderline or clinical range on the Hyperactivity, Aggression, Anxiety, Depression, Withdrawal, Externalizing Problems, Internalizing Problems, and Behavioral Symptoms Index scales on the BASC-2 (ORs from 1.39 to 2.07), but only the Anxious/Depressed and Externalizing Problems scales on the CBCL (ORs from 1.80 to 3.28). Primary linear regression analyses showed that higher prenatal phthalate concentrations were related to higher scores on the Externalizing Problems (β's = 0.16), Internalizing Problems (β's from 0.16 to 0.20), and Behavioral Symptoms Index (β's from 0.18 to 0.21) scales on the BASC-2, but not related to any CBCL scales. Sex-stratified analyses found that many associations were only significant for male children. Secondary analyses using creatinine-adjusted phthalate concentrations revealed that some of the associations from the primary analyses remained significant; however, a number of unique associations were observed.

CONCLUSION

Prenatal phthalate exposure was associated with preschool behavioral development; however, findings were not consistent for the BASC-2 and CBCL, especially related to the clinical/syndrome scales and Internalizing Problems scale. Further, many findings differed based on the analytical approach used to correct for urine dilution. Future work is needed to delineate the similarities and differences between similarly named child behavior constructs assessed by different neurodevelopmental assessments. Also, research is needed to better understand why and how different analytical approaches influence the reported associations between maternal prenatal phthalate concentrations and children's behavior problems.

Executive functioning, adaptive skills, emotional and behavioral profile: A comparison between autism spectrum disorder and phenylketonuria

INTRODUCTION

Influential theories maintain that some of Autism Spectrum Disorder (ASD) core symptoms may arise from deficits in executive functions (EF). EF deficits are also considered a neuropsychological marker of early treated individuals with phenylketonuria (PKU). Aims of this study were: to verify the occurrence and patterns of specific EF impairments in both clinical groups; to explore the coexistence of EF alterations with adaptive, behavioral and emotional problems in each clinical condition.

MATERIAL AND METHODS

We assessed EF, adaptive, behavioral and emotional profile in 21 participants with ASD, 15 early treated PKU individuals, comparable for age and IQ, and 14 controls, comparable for age to the clinical groups (age range: 7-14 years).

RESULTS

ASD and PKU participants presented two different, but partially overlapping patterns of EF impairment. While ASD participants showed a specific deficit in cognitive flexibility only, PKU individuals showed a more extensive impairment in EF with a weaker performance in two core EF domains (inhibition, cognitive flexibility) as compared to healthy controls. Psychological and adaptive profile was typical in PKU participants, while ASD participants experienced behavioral (externalizing symptoms), emotional (internalizing symptoms) and adaptive disorders (general, practical, social domains).

CONCLUSIONS

Present results support the view of a relative disengagement of adaptive and emotional-behavioral profile with respect to EF skills and suggest that other dysfunctions contribute to the multidimensional phenotype of ASD participants.

Respiratory sinus arrhythmia, parenting, and externalizing behavior in children with autism spectrum disorder

Children with autism spectrum disorder exhibit significant difficulties with emotion regulation. Respiratory sinus arrhythmia is a biomarker for processes related to emotion regulation, with higher baseline rates linked to beneficial outcomes. Although reduction in respiratory sinus arrhythmia in response to challenge can index adaptive processes in community samples, excessive withdrawal may suggest loss of regulatory control among children with clinical concerns. Psychophysiological risk for problems may be protected against or exacerbated by parenting environments more or less supportive of the development of children's regulatory competence. Respiratory sinus arrhythmia was examined in 61 children with autism spectrum disorder ages 6-10 years in relation to externalizing behavior, and parenting was considered as a moderator. Respiratory sinus arrhythmia was obtained during laboratory tasks, and positive parenting, negative parenting, and children's externalizing behaviors were each indexed through multiple methods. Respiratory sinus arrhythmia reactivity interacted with negative, but not positive parenting. Higher respiratory sinus arrhythmia reactivity was associated with more externalizing behavior under conditions of higher negative parenting, but with lower externalizing behavior at lower levels of negative parenting. Similarly, negative parenting was only associated with externalizing behaviors in the context of high child respiratory sinus arrhythmia reactivity. Implications for our understanding of emotion regulation in children with autism spectrum disorder, and for related interventions, are discussed.

Sympathetic-Parasympathetic Interaction and Externalizing Problems in Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) exhibit significant difficulties with emotion regulation and reactivity, which may be linked to underlying psychophysiology. The present study examined associations between autonomic nervous system activity and individual differences in externalizing behavior problems in children with ASD. A multisystem approach was adopted to consider the interplay between markers of sympathetic (electrodermal reactivity-EDA-R) and parasympathetic reactivity (respiratory sinus arrhythmia reactivity-RSA-R) in relation to behavioral challenges. Fifty-two children with ASD ages 6-10 years contributed complete psychophysiological data. Measures of EDA-R and RSA-R (RSA withdrawal) were obtained in response to a laboratory challenge task and parents reported on child externalizing behavior problems using a standardized questionnaire and a structured clinical interview. An equifinality model was supported, with two distinct psychophysiological pathways linked to heightened externalizing behavior problems. Greater RSA-R was associated with more externalizing problems in the context of higher levels of EDA-R, and lower EDA-R was associated with increased externalizing problems at lower levels of RSA-R. Findings underscore the importance of considering the role of psychophysiology in the unfolding of comorbid externalizing problems in children with ASD. Potential implications for tailoring coregulatory supports are discussed. Autism Res 2019, 12: 1805-1816. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Children with autism spectrum disorder (ASD) exhibit elevated rates of challenging behavior. This study identified specific psychophysiological profiles (low sympathetic-low parasympathetic reactivity, and high sympathetic-high parasympathetic reactivity) that may place these children at greater risk for behavior problems. Findings have implications for better understanding behavioral challenges in children with ASD, and for tailoring supports to address underlying psychophysiology.

Description of Criterion Validity of the Autism Spectrum Rating Scales 6-18 Parent Report: Initial Exploration in a Large Community Sample

Research regarding psychometric properties of autism spectrum disorder questionnaires is lacking. This study explored the criterion validity of the ASRS 6-18 parent report (ASRS-6-18-P) in a large, well-characterized, real-world clinical sample of 422 children ([Formula: see text] autism [AUT] n = 139; non-autism [NOT] n = 283) evaluated with the Autism Diagnostic Observation Schedule-2, a gold-standard measure. Significant mean differences were observed for DSM-5, social, and unusual behaviors. Total, DSM-5, social, and unusual behaviors demonstrated significant correlations with ADOS-2 comparison scores (modules 1-3), but not with module 4 (raw) scores. DSM-5 and Unusual Behaviors demonstrated significant but poor AUCs (0.60). Findings with/without covariates (IQ/age) were overall similar. Sensitivity and specificity could not be optimized. The suggested cutpoint (T-score = 60) demonstrated unacceptably high false positive rates (> 76.33%). While findings suggest limited diagnostic utility of the ASRS-6-18-P, the sample's complex psychiatric presentation and measurement error inherent in cutoff score application should be considered when generalizing results. Further research is recommended.

Parental criticism and behavior problems in children with autism spectrum disorder

Associations between parent critical attitudes (a component of the Expressed Emotion construct) and behavior problems have been relatively well established in adolescents and young adults with autism spectrum disorder, but use of systems adapted for children with autism spectrum disorder and additional investigations with younger samples are needed. This study examined parental criticism, derived from a population-specific coding system, as related to behavior problems in children with autism spectrum disorder between the ages of 4 and 11 years, and considered parental warmth and children's psychophysiological reactivity as statistical moderators of these associations. In all, 40 children with autism spectrum disorder and their primary caregivers attended a visit involving collection of child electrodermal activity, parent-child interaction, a parent interview from which critical attitudes and warmth were coded, and parent report of child behavior problems. Criticism was directly related to higher child externalizing but not internalizing problems. Parental criticism interacted with warmth in the prediction of internalizing problems such that criticism was only associated with more problems in the context of moderate but not high warmth. Criticism was positively associated with externalizing problems under conditions of moderate and high, but not low, child electrodermal activity reactivity. Implications for conceptualizations of parental criticism in autism spectrum disorder, for understanding comorbid behavior problems in this population, and for intervention are discussed.

Differences in profiles of emotional behavioral problems across instruments in verbal versus minimally verbal children with autism spectrum disorder

There has been increasing attention to the assessment of minimally verbal (MV) children with autism spectrum disorder (ASD). Previous research has begun to examine the relationship between verbal abilities and emotional and behavioral problems (EBP). The current study compared parent-reported EBP in children of differing language levels on two instruments commonly used in ASD research and clinical practice, the Child Behavior Checklist (CBCL) and Aberrant Behavior Checklist (ABC). The study consisted of 1,937 6-18 years old children with ASD from the Simons Simplex Collection. Children were divided into three language groups, by ADOS module (Module 1 = MV, 2 = phrase speech (PS), and 3 = verbally fluent (VF)) and then compared on CBCL and ABC subscales. The ABC and CBCL showed different patterns of elevations across the language groups. MV children were reported to have more impairment than VF children on the ABC irritability, lethargy, and hyperactivity scales. Children with less language (MV and PS) exhibited less impairment on the CBCL internalizing domain than VF children, but did not differ on the externalizing domain. Post hoc comparisons showed that internalizing differences were driven by fewer children with less language exhibiting clinically elevated anxious/depressed scores compared to VF children. The present study underscores the significance of considering language when assessing EBP. Results have implications for the psychiatric screening of children with ASD, particularly those with language impairments. Researchers should exercise caution when applying EBP instruments designed for use with different populations and purposes to broad samples of children. Autism Res 2019, 12: 1367-1375. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Some emotional and behavioral problem (EBP) scales include items that may be inappropriate for children with ASD and limited language. The present study found that there was a tendency for children with language impairment to have lower internalizing scores on the Child Behavior Checklist, but higher scores lethargy and irritability scores on the Aberrant Behavior Checklist, relative to verbally fluent children. This suggests that each of these instruments may underestimate EBPs in certain subsets of children.

Parental Perspectives on Psychiatric Comorbidity in Preschoolers With Autism Spectrum Disorders Receiving Publicly Funded Mental Health Services

An increased prevalence of psychiatric comorbidity (PC) in individuals with Autism Spectrum Disorders (ASD) is consistently reported. While several studies have examined PC in school-aged children, adolescents and adults with ASD, investigations on PC in preschoolers are less common. In this study, we explore the prevalence and the type of PC in a sample of 989 preschoolers with ASD through the DSM-Oriented Scales (DOS) of the Child Behavior Checklist (CBCL 1½-5) and their possible links with the core features of ASD and cognitive functioning. Results indicated that 37.8% of the sample had at least one PC in addition to ASD; these subjects displayed significantly higher Total score (p = 0.02) and Social Affect score (p = 0.003) on the ADOS-based calibrated severity scores (CSS), as well as lower (p ≤ 0.0001) performance IQ (pIQ) compared to ASD individuals without PC. As far as the specific DOS, Affective Problems (AP) were detected in 23.4% of the whole sample, ADHD Problems (ADHD) in 17.3%, Anxiety Problems (AXP) in 16.7%, and Oppositional Problems (OP) in 7.9%. These different comorbidities were isolated in 195 subjects (Mono-comorbid group: 19.7% of the whole sample), while 179 subjects (18.1% of the whole sample) had two or more types of PC (Multi-comorbid group). One-way ANOVA revealed that subjects with multi-comorbidity have statistically significant lower pIQ and higher Total score and Social Affect score on CSS-ADOS. Specific differences for each type of comorbidity and gender differences were also discussed. Taken together, results indicate a considerable presence of PC in preschoolers with ASD that should be accurately considered during the assessment and diagnosis process in order to plan a tailored intervention based not only on core symptoms of ASD, but also on comorbid psychiatric condition since preschool age.

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

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

Autism spectrum disorder traits in typically developing emerging adults and associated parenting: A person-centered approach

Research on parenting children with autism spectrum disorder (ASD) indicates these children receive parenting tailored to their condition. However, little is known about ASD in adulthood, especially in emerging adults at college, and how they are parented. The current study examined how emerging adults in a non-clinical typically-developing sample differed in their current perceptions of parenting as a function of ASD traits. Participants completed questionnaires about their current perceptions of parenting and self-reported ASD traits. Parenting characteristics assessed included parenting style, discipline, parent-child relationship quality, and parental distress. Results indicated that higher levels of self-reported ASD traits were associated with increasingly ineffective parenting characteristics including lower authoritative style, harsher discipline, poorer parent-child relationship quality (e.g., lower involvement), and higher parental distress. Researchers are encouraged to extend ASD research into adulthood by validating diagnostic methods with adults and investigating processes in adulthood that have been well-established in the childhood ASD literature.

Psychometric Properties of the Spence Children's Anxiety Scale: Parent Report in Children with Autism Spectrum Disorder

Although anxiety is frequently reported in children with autism spectrum disorder (ASD), existing anxiety scales are often psychometrically inappropriate for this population. This study examined the internal structure, reliability, convergent and discriminant validity of the Spence Children's Anxiety Scale-Parent Report (SCAS-P; Spence 1999) in 238 school-aged children with ASD. While confirmatory factor analysis did not support the original six-correlated-factor structure, structural support as well as acceptable internal consistency and convergent validity was found for Generalized Anxiety, Separation Anxiety, Panic, and Agoraphobia subscales. Use of the SCAS-P in its original form for assessment in children with ASD was not supported. However, four subscales showed viability, and may benefit re-analyses of existing SCAS-P data and future scale adaptations for research and clinical purposes.

Sympathetic Under-Arousal and Externalizing Behavior Problems in Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) commonly exhibit co-occurring externalizing behavior problems, which can impede learning opportunities and contribute significantly to caregiver stress. Substantial theory and research has linked under-arousal of the sympathetic nervous system to increased externalizing problems in children without ASD, but under-arousal has not been considered as an explanatory mechanism for individual differences among children with ASD. We tested the notion that lower electrodermal activity (EDA) would predict more externalizing problems in children with ASD, and considered the degree to which parent co-regulatory support could buffer this risk. Forty children with ASD between the ages of 4 and 11 years and their primary caregivers participated in a laboratory visit that included various play, compliance, and problem-solving regulatory tasks. EDA was measured through wireless wrist sensors, parental scaffolding was observed during a dyadic problem-solving task, and parents rated their children's externalizing behavior problems. As predicted, low EDA during the compliance-oriented tasks directly predicted higher child externalizing problems. Parental scaffolding moderated the link between under-arousal during the problem-solving regulatory tasks and externalizing problems such that the relation was observed in the context of low, but not high, support. Implications for relevant theories (e.g., fearlessness theory, stimulation-seeking theory) are discussed, and the potential for psychophysiological patterns to inform intervention with these children is considered.

Review and evaluation of patient-centered psychosocial assessments for children with central precocious puberty or early puberty

The objective of this study was to assess the current use of patient-centered psychosocial assessments for the evaluation of children with central precocious puberty (CPP). Studies evaluating the psychosocial impact of CPP were identified through searches of the PubMed and Cochrane Library databases, ClinicalTrials.gov, a drug prescribing information database, and regulatory websites. Studies were screened using prespecified inclusion and exclusion criteria. Potentially relevant patient-centered outcome assessments (including patient-, parent- or observer-reported measures) used in the identified studies were evaluated in detail for their relevance in CPP. Of the 467 studies identified, 15 met the inclusion criteria. Frequently assessed concepts included depression and anxiety, behavior and behavioral problems, body image and self-esteem and personality type/characteristics. Among the assessments used in the identified studies, the Child Behavior Checklist, Pediatric Quality of Life Inventory (PedsQL), SF-10 for Children and Child Health Questionnaire were comprehensively evaluated. The PedsQL showed promise as a patient-centered outcome measure in CPP. Although there is a lack of validated tools measuring psychosocial health and health-related quality of life in patients with CPP, the PedsQL captures issues seen in this patient population and is relatively easy to administer. Further studies using this and other tools in children with CPP are needed.

Predictors of Parent-Teacher Agreement in Youth with Autism Spectrum Disorder and Their Typically Developing Siblings

This study evaluated the magnitude of informant agreement and predictors of agreement on behavior and emotional problems and autism symptoms in 403 children with autism and their typically developing siblings. Parent-teacher agreement was investigated on the Child Behavior Checklist (CBCL) and Social Responsiveness Scale (SRS). Agreement between parents and teachers fell in the low to moderate range. Multiple demographic and clinical variables were considered as predictors, and only some measures of parent broad autism traits were associated with informant agreement. Parent report on the SRS was a positive predictor of agreement, while teacher report was a negative predictor. Parent report on the CBCL emerged as a positive predictor of agreement, while teacher report emerged as a negative predictor.

Being on Your Own or Feeling Lonely? Loneliness and Other Social Variables in Youths with Autism Spectrum Disorders

A cross-sectional study was conducted to examine loneliness and its correlates in children (7 to 11 years) and adolescents (12 to 18 years) with autism spectrum disorders (ASD, n = 73) and control groups of clinically referred (ADHD, n = 76) and non-clinical (n = 106) youths. Youths completed questionnaires on loneliness and desire for social interaction, while parents and teachers filled out scales on other aspects of children's social functioning. Results indicated that only at an adolescent age, the ASD group reported higher levels of loneliness than the control groups. Further, the ASD group generally expressed relatively low levels of desire for social interaction, although these youths displayed a similar increase in the wish to belong during adolescence as participants in the control groups. Finally, the ASD group exhibited lower levels of social competence and social skills and higher levels of social problems and social anxiety than the control groups, and in all groups these social variables correlated in a theoretically meaningful with loneliness.

The Social Aptitudes Scale: looking at both "ends" of the social functioning dimension

PURPOSE

Dimensional approaches are likely to advance understanding of human behaviors and emotions. Nevertheless, it is unclear whether instruments in psychiatry capture variability at the full spectrum of these dimensions. We aimed to investigate this issue for two scales assessing distinct aspects of social functioning: the Social Aptitudes Scale (SAS), a "bidirectional" scale constructed to investigate both "ends" of social functioning; and the social Child Behavior Checklist (CBCL-social), a "unidirectional" scale constructed to assess social problems.

METHODS

We investigated 2512 children and adolescents aged 6-14. Item response theory was used to investigate on which range of the trait each scale captures information. We performed quantile regressions to investigate if correlations between SAS and CBCL-social vary within different levels of social aptitudes dimension and multiple logistic regressions to investigate associations with negative and positive clinical outcomes.

RESULTS

SAS was able to provide information on the full range of social aptitudes, whereas CBCL-social provided information on subjects with high levels of social problems. Quantile regressions showed SAS and CBCL-social have higher correlations for subjects with low social aptitudes and non-significant correlations for subjects with high social aptitudes. Multiple logistic regressions showed that SAS was able to provide independent clinical predictions even after adjusting for CBCL-social scores.

CONCLUSIONS

Our results provide further validity to SAS and exemplify the potential of "bidirectional" scales to dimensional assessment, allowing a better understanding of variations that occur in the population and providing information for children with typical and atypical development.

Utility of the CBCL DSM-Oriented Scales in Assessing Emotional Disorders in Youth with Autism

BACKGROUND

Youth with autism spectrum disorder (ASD) are at risk for one or more emotional disorders (ED) including depressive and anxiety conditions. DSM-5 diagnostic guidelines indicate that co-occurring ED must be specified when present (APA, 2013). While ED may be evaluated for during initial diagnostic assessment, routine monitoring and screening is needed to identify emerging ED in later childhood and adolescence, a period of high risk.

METHOD

Confirmatory factor analysis, convergent and divergent validity analyses, criterion-related validity, and diagnostic accuracy analyses of the CBCL's Affective Problems and Anxiety Problems DSM Oriented Scales was completed on 93 well-characterized youth, ages 6 to 18 years with ASD (6:1 M:F), with and without intellectual impairment. These youth were from predominately white, middle-class backgrounds.

RESULTS

Each scale measured a single construct reliably (depressive and anxiety disorders), neither scale measured symptoms of ASD, and youth with a depressive disorder had other ED co-morbidities.

CONCLUSIONS

Findings demonstrate the DSM Oriented Affective and Anxiety Problem Scales can be used to screen for depression and anxiety in youth with ASD. Replication is needed with various subgroups representing gender, age, developmental level, autism, and mental health severity differences, and with groups across a broader set of demographics.

Parenting for Autism, Language, And Communication Evaluation Study (PALACES): protocol for a pilot randomised controlled trial

INTRODUCTION

Children with autistic spectrum disorder (ASD) often have associated behavioural difficulties that can present a challenge for parents and parenting. There are several effective social learning theory-based parenting programmes for dealing with behavioural difficulties, including the Incredible Years (IY) parent programmes. However, these programmes typically do not specifically target parents of children with ASD. Recently, a new addition to the IY suite of programmes known as the IY Autistic Spectrum and Language Delays (IY-ASLD) parent programme was developed. The main aims of the present study are to examine the feasibility of delivering this programme within child health services and to provide initial evidence for effectiveness and economic costs.

METHODS AND ANALYSIS

The Parenting for Autism, Language, And Communication Evaluation Study (PALACES) trial is a pragmatic, multicentre, pilot randomised controlled trial comparing the IY-ASLD programme with a wait-list control condition. 72 parents of children with ASD (aged 3-8 years) will be randomly allocated to either the intervention or control condition. Data will be collected prior to randomisation and 6 months postrandomisation for all families. Families in the intervention condition only will also be followed up at 12 and 18 months postrandomisation. This study will provide initial evidence of effectiveness for the newly developed IY-ASLD parenting programme. It will also add to the limited economic evidence for an intervention targeting parents of children with ASD and provide longer term data, an important component for evaluations of parenting programmes.

ETHICS AND DISSEMINATION

Approval for the study was granted by the Research Ethics Committee at the School of Psychology, Bangor University (reference number: 2016-15768) and the North Wales Research Ethics Committee, UK (reference number: 16/WA/0224). The findings will be disseminated through research conferences and peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ISRCTN57070414; Pre-results.

Anxiety Disorders Interview Schedule-Autism Addendum: Reliability and Validity in Children With Autism Spectrum Disorder

Assessing anxiety in autism spectrum disorder (ASD) is inherently challenging due to overlapping (e.g., social avoidance) and ambiguous symptoms (e.g., fears of change). An ASD addendum to the Anxiety Disorders Interview Schedule-Child/Parent, Parent Version (ADIS/ASA) was developed to provide a systematic approach for differentiating traditional anxiety disorders from symptoms of ASD and more ambiguous, ASD-related anxiety symptoms. Interrater reliability and convergent and discriminant validity were examined in a sample of 69 youth with ASD (8-13 years, 75% male, IQ = 68-143) seeking treatment for anxiety. The parents of participants completed the ADIS/ASA and a battery of behavioral measures. A second rater independently observed and scored recordings of the original interviews. Findings suggest reliable measurement of comorbid (intraclass correlation = 0.85-0.98, κ = 0.67-0.91) as well as ambiguous anxiety-like symptoms (intraclass correlation = 0.87-95, κ = 0.77-0.90) in children with ASD. Convergent and discriminant validity were supported for the traditional anxiety symptoms on the ADIS/ASA, whereas convergent and discriminant validity were partially supported for the ambiguous anxiety-like symptoms. Results provide evidence for the reliability and validity of the ADIS/ASA as a measure of traditional anxiety categories in youth with ASD, with partial support for the validity of the ambiguous anxiety-like categories. Unlike other measures, the ADIS/ASA differentiates comorbid anxiety disorders from overlapping and ambiguous anxiety-like symptoms in ASD, allowing for more precise measurement and clinical conceptualization. Ambiguous anxiety-like symptoms appear phenomenologically distinct from comorbid anxiety disorders and may reflect either symptoms of ASD or a novel variant of anxiety in ASD.

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

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

Factors influencing the probability of a diagnosis of autism spectrum disorder in girls versus boys

In order to shed more light on why referred girls are less likely to be diagnosed with autism spectrum disorder than boys, this study examined whether behavioral characteristics influence the probability of an autism spectrum disorder diagnosis differently in girls versus boys derived from a multicenter sample of consecutively referred children aged 2.5-10 years. Based on information from the short version of the Developmental, Dimensional and Diagnostic Interview and the Autism Diagnostic Observation Schedule, 130 children (106 boys and 24 girls) received a diagnosis of autism spectrum disorder according to Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) criteria and 101 children (61 boys and 40 girls) did not. Higher overall levels of parent-reported repetitive and restricted behavior symptoms were less predictive of an autism spectrum disorder diagnosis in girls than in boys (odds ratio interaction = 0.41, 95% confidence interval = 0.18-0.92, p = 0.03). In contrast, higher overall levels of parent-reported emotional and behavioral problems increased the probability of an autism spectrum disorder diagnosis more in girls than in boys (odds ratio interaction = 2.44, 95% confidence interval = 1.13-5.29, p = 0.02). No differences were found between girls and boys in the prediction of an autism spectrum disorder diagnosis by overall autistic impairment, sensory symptoms, and cognitive functioning. These findings provide insight into possible explanations for the assumed underidentification of autism spectrum disorder in girls in the clinic.

Caregiving for youth with co-occurring developmental disabilities and behavioral health issues when caregivers face additional health-related stressors: Analysis of risk and protective factors from a national sample

BACKGROUND

Family caregivers of youth with DD and behavioral health issues experience the highest level of caregiving strain. Many must also deal with their own or another family member's chronic health condition, which may place them at additional risk for poor outcomes.

AIMS

(1) Provide a "snapshot" of DD family caregivers based on a national sample; (2) identify risk and protective factors among groups of DD caregivers with graduated levels of health-related stressors; (3) examine the impact of risk and protective factors on strain for DD caregivers.

METHODS AND PROCEDURES

We conducted a secondary analysis of data from N=600 DD caregivers recruited through sites across the United States. Risk and protective factors were compared among three groups of caregivers at study enrollment: (1) those focused on providing care for the target youth with DD, without additional health-related stressors with which to contend; (2) those contending with minor additional health-related stressors; and, (3) those contending with major additional health-related stressors. Predictors of caregiving strain at six months post-enrollment were identified.

RESULTS

52% of the overall sample was unemployed and 71% were living at or below poverty. Differences were found among groups on a variety of risk and protective factors. With some exceptions, predictors of caregiving strain were similar to non-DD populations.

CONCLUSIONS AND IMPLICATIONS

This study provides valuable information about a population of caregivers who are highly vulnerable to poor outcomes. Findings highlight the importance of considering the needs, strengths, and outcomes of family caregivers.

Usefulness of CBCL/6-18 to evaluate emotional and behavioral problems in Indonesian autism spectrum disorder children

BACKGROUND

The Child Behavior Checklist (CBCL) has been widely utilized to estimate emotional and behavioral problems in children in the USA and Europe. Although the Indonesian version of the CBCL/6-18 was proven to have good validity and internal consistency in children with typical development (TD) in Indonesia, it has not been utilized for children with autism spectrum disorder (ASD). The purpose of this study was therefore to investigate the usefulness of CBCL/6-18 for detecting emotional and behavioral problems in Indonesian ASD children.

METHODS

One hundred and eight mothers of children with ASD and with TD were enrolled in this study. The diagnosis of ASD in Indonesia was made by expert child neurologists based on DSM-IV-TR. Mothers of children aged 6-18 years completed the Indonesian version of the CBCL.

RESULTS

The scores of total problems, internalizing, and externalizing were significantly higher in the ASD group than the TD group. Children with ASD scored significantly higher in seven of the eight CBCL subscales (except somatic complaints) compared with TD children.

CONCLUSIONS

The CBCL/6-18 Indonesian version could be considered as a useful tool for detecting emotional and behavioral problems in children with ASD in Indonesia in Muslim populations.

Trajectories of internalizing and externalizing symptoms among adults with autism spectrum disorders

Individuals with autism spectrum disorder (ASD) experience higher rates of psychopathology than their typically developing peers or peers with other intellectual or developmental disabilities. Little is known about the developmental course of psychiatric symptoms such as internalizing and externalizing behaviors in this population. Individual characteristics and aspects of the family environment may explain variability in outcomes for adults with ASD. The present study extends our current understanding of psychopathology among individuals with ASD by examining group-based trajectories of internalizing and externalizing symptoms in adulthood. Overall, the results showed that symptoms became less severe over time. Distinct patterns of change in psychopathology were observed and associated with differential profiles of psychotropic medication use, comorbid mental health diagnoses, and residential placement. The likelihood of following each developmental trajectory was estimated based on characteristics of the adults with ASD (gender, adaptive behavior, and autistic symptoms) and maternal expressed emotion (criticism and warmth). Maternal criticism and warmth were identified as key risk and protective factors, respectively, with important implications for future research and intervention for individuals with ASD.

Autism Spectrum Disorder Symptoms and Comorbidity in Emerging Adults

Autism spectrum disorder (ASD) continues to grow in prevalence each passing year. As more children are diagnosed, it makes sense that the emerging adult and adult population with ASD also will continue to grow. Although the body of research is quite large for children with ASD, the literature for emerging adults with ASD is sparse in comparison. The current study aimed to extend existing literature further by beginning to explore the realm of emerging adulthood. Specifically, the study investigated the presence of comorbid psychiatric symptoms in emerging adults who also presented with ASD symptoms as measured by the Adult Self-Report (Rescorla and Achenbach in The Achenbach System of Empirically Based Assessment (ASEBA) for ages 18 to 90 years. The use of psychological testing for treatment planning and outcomes assessment: volume 3: instruments for adults, 3rd edn. Lawrence Erlbaum Associates, Mahwah, pp 115-152, 2004). Emerging adults were categorized as having normal, mild, moderate, or severe levels of ASD symptoms and were compared for the presence of comorbid psychiatric symptoms. Overall, results suggested that emerging adults who presented with greater ASD symptom severity were more likely to experience the presence of additional comorbid symptoms.

Medical and Behavioral Correlates of Depression History in Children and Adolescents With Autism Spectrum Disorder

BACKGROUND AND OBJECTIVES

Depression is commonly associated with autism spectrum disorder (ASD) across the life span. We sought to identify medical and behavioral problems associated with a history of a parent-reported diagnosis of depression in a large sample of school-aged children and adolescents with ASD.

METHODS

A sample of 1272 participants (aged 6-17 years; mean [SD]: 9.56 [2.79] years) from the Autism Speaks Autism Treatment Network consortium were divided into "ever-depressed" (n = 89) and "nondepressed" (n = 1183) groups on the basis of caregiver endorsement of children's current or previous diagnoses of depression.

RESULTS

In total, 7.0% of children with ASD (4.8% of those aged 6-12 years and 20.2% of those aged 13-17 years) were reported to have a history of a depression diagnosis. Positive depression history was associated with greater chronological age, higher IQ, and Asperger disorder diagnosis. After controlling for age, IQ, and within-spectrum categorical diagnosis, the ever-depressed group exhibited significantly greater rates of seizure disorders (odds ratio = 2.64) and gastrointestinal problems (odds ratio = 2.59) and trend-level differences in aggression, somatic complaints, and social impairments. The groups did not differ in autism severity, repetitive behaviors, sleep problems, eating problems, self-injurious behavior, or current intervention use.

CONCLUSIONS

Co-occurring depression is a particularly common problem in higher-functioning older children within the Autism Treatment Network. Our findings indicate that children with ASD and a history of a depression diagnosis are more likely to also have co-occurring medical problems, although the presence and direction of causality is unclear.

Systematic Review of the Measurement Properties of Tools Used to Measure Behaviour Problems in Young Children with Autism

Background

Behaviour problems are common in young children with autism spectrum disorder (ASD). There are many different tools used to measure behavior problems but little is known about their validity for the population.

Objectives

To evaluate the measurement properties of behaviour problems tools used in evaluation of intervention or observational research studies with children with ASD up to the age of six years.

Methods

Behaviour measurement tools were identified as part of a larger, two stage, systematic review. First, sixteen major electronic databases, as well as grey literature and research registers were searched, and tools used listed and categorized. Second, using methodological filters, we searched for articles examining the measurement properties of the tools in use with young children with ASD in ERIC, MEDLINE, EMBASE, CINAHL, and PsycINFO. The quality of these papers was then evaluated using the COSMIN checklist.

Results

We identified twelve tools which had been used to measure behaviour problems in young children with ASD, and fifteen studies which investigated the measurement properties of six of these tools. There was no evidence available for the remaining six tools. Two questionnaires were found to be the most robust in their measurement properties, the Child Behavior Checklist and the Home Situations Questionnaire—Pervasive Developmental Disorders version.

Conclusions

We found patchy evidence on reliability and validity, for only a few of the tools used to measure behaviour problems in young children with ASD. More systematic research is required on measurement properties of tools for use in this population, in particular to establish responsiveness to change which is essential in measurement of outcomes of intervention.

PROSPERO Registration Number

CRD42012002223

Comparison of Fecal Microbiota in Children with Autism Spectrum Disorders and Neurotypical Siblings in the Simons Simplex Collection

In order to assess potential associations between autism spectrum disorder (ASD) phenotype, functional GI disorders and fecal microbiota, we recruited simplex families, which had only a single ASD proband and neurotypical (NT) siblings, through the Simons Simplex Community at the Interactive Autism Network (SSC@IAN). Fecal samples and metadata related to functional GI disorders and diet were collected from ASD probands and NT siblings of ASD probands (age 7-14). Functional gastrointestinal disorders (FGID) were assessed using the parent-completed ROME III questionnaire for pediatric FGIDs, and problem behaviors were assessed using the Child Behavior Check List (CBCL). Targeted quantitative polymerase chain reaction (qPCR) assays were conducted on selected taxa implicated in ASD, including Sutterella spp., Bacteroidetes spp. and Prevotella spp. Illumina sequencing of the V1V2 and the V1V3 regions of the bacterial 16S rRNA genes from fecal DNA was performed to an average depth of 208,000 and 107,000 high-quality reads respectively. Twenty-five of 59 ASD children and 13 of 44 NT siblings met ROME III criteria for at least one FGID. Functional constipation was more prevalent in ASD (17 of 59) compared to NT siblings (6 of 44, P = 0.035). The mean CBCL scores in NT siblings with FGID, ASD children with FGID and ASD without FGID were comparably higher (58-62 vs. 44, P < 0.0001) when compared to NT children without FGID. There was no significant difference in macronutrient intake between ASD and NT siblings. There was no significant difference in ASD severity scores between ASD children with and without FGID. No significant difference in diversity or overall microbial composition was detected between ASD children with NT siblings. Exploratory analysis of the 16S rRNA sequencing data, however, identified several low abundance taxa binned at the genus level that were associated with ASD and/or first order ASD*FGID interactions (FDR <0.1).

Systematic review of tools to measure outcomes for young children with autism spectrum disorder

BACKGROUND

The needs of children with autism spectrum disorder (ASD) are complex and this is reflected in the number and diversity of outcomes assessed and measurement tools used to collect evidence about children's progress. Relevant outcomes include improvement in core ASD impairments, such as communication, social awareness, sensory sensitivities and repetitiveness; skills such as social functioning and play; participation outcomes such as social inclusion; and parent and family impact.

OBJECTIVES

To examine the measurement properties of tools used to measure progress and outcomes in children with ASD up to the age of 6 years. To identify outcome areas regarded as important by people with ASD and parents.

METHODS

The MeASURe (Measurement in Autism Spectrum disorder Under Review) research collaboration included ASD experts and review methodologists. We undertook systematic review of tools used in ASD early intervention and observational studies from 1992 to 2013; systematic review, using the COSMIN checklist (Consensus-based Standards for the selection of health Measurement Instruments) of papers addressing the measurement properties of identified tools in children with ASD; and synthesis of evidence and gaps. The review design and process was informed throughout by consultation with stakeholders including parents, young people with ASD, clinicians and researchers.

RESULTS

The conceptual framework developed for the review was drawn from the International Classification of Functioning, Disability and Health, including the domains 'Impairments', 'Activity Level Indicators', 'Participation', and 'Family Measures'. In review 1, 10,154 papers were sifted - 3091 by full text - and data extracted from 184; in total, 131 tools were identified, excluding observational coding, study-specific measures and those not in English. In review 2, 2665 papers were sifted and data concerning measurement properties of 57 (43%) tools were extracted from 128 papers. Evidence for the measurement properties of the reviewed tools was combined with information about their accessibility and presentation. Twelve tools were identified as having the strongest supporting evidence, the majority measuring autism characteristics and problem behaviour. The patchy evidence and limited scope of outcomes measured mean these tools do not constitute a 'recommended battery' for use. In particular, there is little evidence that the identified tools would be good at detecting change in intervention studies. The obvious gaps in available outcome measurement include well-being and participation outcomes for children, and family quality-of-life outcomes, domains particularly valued by our informants (young people with ASD and parents).

CONCLUSIONS

This is the first systematic review of the quality and appropriateness of tools designed to monitor progress and outcomes of young children with ASD. Although it was not possible to recommend fully robust tools at this stage, the review consolidates what is known about the field and will act as a benchmark for future developments. With input from parents and other stakeholders, recommendations are made about priority targets for research.

FUTURE WORK

Priorities include development of a tool to measure child quality of life in ASD, and validation of a potential primary outcome tool for trials of early social communication intervention.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42012002223.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Depressive and anxiety symptom trajectories from school age through young adulthood in samples with autism spectrum disorder and developmental delay

OBJECTIVE

The objectives of this study were to model growth in anxiety and depressive symptoms from late school age through young adulthood in individuals with autism spectrum disorder (ASD) and controls with developmental delay (DD), and to assess relationships among internalizing growth patterns, participant characteristics, baseline predictors, and distal outcomes.

METHOD

Data were collected between ages 6 and 24 years in 165 participants (n = 109 with ASD; n = 56 with nonspectrum DD), most of whom received diagnostic evaluations in both childhood and early adulthood. Questionnaires were collected approximately every 3 to 6 months between ages 9 and 24 years. Parent-rated Child Behavior Checklist (CBCL), Adult Behavior Checklist (ABCL), and Developmental Behaviour Checklist anxiety- and depression-related subscale distributions were modeled with mixed-effects Poisson models, covarying diagnosis, age, verbal IQ (VIQ), gender, and significant 2- and 3-way interactions.

RESULTS

Anxiety was positively associated with VIQ, and controlling for VIQ, both anxiety and depressive symptoms were greater in ASD than nonspectrum participants. Female gender predicted greater increases over time in anxiety and depressive symptoms for both diagnostic groups. Lower maternal education was associated with increasing internalizing symptoms in a subset of less verbal individuals with ASD. In exploratory post hoc analyses, internalizing symptoms were associated with poorer emotional regulation in school age, and with lower life satisfaction and greater social difficulties in early adulthood.

CONCLUSION

Findings support previous claims that individuals with ASD are at particular risk for affect- and anxiety-specific problems. Although symptom levels in females increase at a faster rate throughout adolescence, males with ASD appear to have elevated levels of depressive symptoms in school age that are maintained into young adulthood.

Development of a New Attention Rating Scale for Children With Intellectual Disability: The Scale of Attention in Intellectual Disability (SAID)

Difficulties with attention, impulsivity, and hyperactivity are thought to be as common among children with intellectual disability (ID) as they are in children without ID. Despite this, there is a lack of scales to specifically assess ADHD symptomatology in children and adolescents with ID. This article describes the development and evaluation of a teacher-completed measure; the Scale of Attention in Intellectual Disability (SAID). A community survey of 176 teachers of children 5-13 years of age, with ID at all levels of impairment indicated that the T-SAID is a reliable and valid measure. Integrating this scale with neuropsychological and clinical research holds exciting promise for enhancing our understanding of the nature of attention difficulties within populations with ID.

Sleep problems in children with autism spectrum disorder: examining the contributions of sensory over-responsivity and anxiety

OBJECTIVES

Children with autism spectrum disorder (ASD) are at high risk for sleep problems. Previous research suggests that sensory problems and anxiety may be related to the development and maintenance of sleep problems in children with ASD. However, the relationships among these co-occurring conditions have not been previously studied. The current study examined the interrelations of these symptoms in a large well-characterized sample of children and adolescents with ASD.

METHODS

The current study examined the relationships among sleep problems, sensory over-responsivity, and anxiety in 1347 children enrolled in the Autism Speaks Autism Treatment Network. The primary measures included the Children's Sleep Habits Questionnaire, the Child Behavior Checklist, and the Short Sensory Profile.

RESULTS

In bivariate correlations and multivariate path analyses, anxiety was associated with all types of sleep problems (ie, bedtime resistance, sleep-onset delay, sleep duration, sleep anxiety, and night wakings; p < 0.01 to p < 0.001; small to medium effect sizes). Sensory over-responsivity (SOR) was correlated with all sleep problems in bivariate analyses (p < 0.01 to p < 0.001; small effect sizes). In multivariate path models, SOR remained significantly associated with all sleep problems except night awakenings for older children, while SOR was no longer significantly associated with bedtime resistance or sleep anxiety for younger children.

CONCLUSIONS

Children with ASD who have anxiety and SOR may be particularly predisposed to sleep problems. These findings suggest that some children with ASD and sleep disturbance may have difficulties with hyperarousal. Future research using physiological measures of arousal and objective measures of sleep are needed.

Methodological considerations when assessing restricted and repetitive behaviors and aggression

Methodological issues impacting the relationship between aggression and restricted, repetitive, and stereotyped behaviors and interests (RRSBI) were examined in 2648 children and adolescents with autism spectrum disorders (ASD) using a multi-method, multi-informant analysis model to assess the effects of informant, assessment method, and aggression phenotype. Overall, a significant, but small relationship was found between RRSBI and aggression (p < .05). There was significant heterogeneity of estimates with large effect sizes observed when utilizing teacher report and a broad phenotype of aggression. Variance in estimates was attributed to differences in informant and assessment method with two times greater effect attributed to informant. Results suggest strategies to optimize future investigations of the relationship between RRSBI and aggression. Findings also provide the opportunity for the development of targeted interventions for aggression in youth with ASD.

Age at first autism spectrum disorder diagnosis: the role of birth cohort, demographic factors, and clinical features

OBJECTIVE

This study sought to identify factors that may be associated with delays in autism spectrum disorder (ASD) diagnosis, including birth cohort, sociodemographic characteristics, and clinical features.

METHODS

Participants included 1716 children and adolescents with ASD enrolled in the Autism Speaks Autism Treatment Network (AS-ATN) between the years 2008 and 2011. Data were collected at enrollment using AS-ATN parent- and clinician-report forms and standardized measures of I.Q., ASD symptoms, adaptive function, and psychiatric symptoms.

RESULTS

Age at first ASD diagnosis was positively correlated with current age, suggesting a birth cohort effect. Sociodemographic and clinical features were also associated with age at diagnosis, even after controlling for current age. Hierarchical linear regression results showed that older current age, lower socioeconomic status (SES), higher I.Q. score, and lower levels of autism symptoms were associated with later age at initial diagnosis. There was also a significant interaction between current age and I.Q., with higher functioning children being diagnosed at younger ages than in previous years.

CONCLUSIONS

Early diagnosis of ASD is critically important for improving access to interventions; however, many children experience diagnostic delays. In this sample, children from the most recent birth cohorts were diagnosed earlier, suggesting that early signs of ASD are being increasingly recognized. However, socioeconomic barriers to diagnosis still seem to exist. Children with less severe ASD symptoms and with higher I.Q. are also diagnosed at later ages. Efforts are still needed to reduce diagnostic disparities for families of low SES and to improve early recognition of more subtle symptoms.

Validity Study of the CBCL 6-18 for the Assessment of Emotional Problems in Youth With ASD

Youth with autism spectrum disorder (ASD) often present with emotional problems such as anxiety and depression (American Psychiatric Association, 2013). A recent study of the Child Behavior Checklist 6-18 (CBCL; Achenbach & Rescorla, 2001) indicated good sensitivity but relatively low specificity for identifying emotional problems in youth with ASD. The current study examined the extent to which variance in the CBCL's Anxious/Depressed, Withdrawn/Depressed, Internalizing Domain, and Total Problems scales was accounted for by symptoms of emotional problems relative to ASD symptoms. Correlation and multiple regression analyses indicated that these scales measured anxiety and depression but a small statistically significant proportion of variance in Total Problems scores was also accounted for by ASD symptoms. Results contribute to the emerging evidence base for the inclusion of the CBCL in assessment protocols for assessing emotional and behavioral problems in youth with ASD.

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

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

Understanding the gap between cognitive abilities and daily living skills in adolescents with autism spectrum disorders with average intelligence

Daily living skills standard scores on the Vineland Adaptive Behavior Scales-2nd edition were examined in 417 adolescents from the Simons Simplex Collection. All participants had at least average intelligence and a diagnosis of autism spectrum disorder. Descriptive statistics and binary logistic regressions were used to examine the prevalence and predictors of a "daily living skills deficit," defined as below average daily living skills in the context of average intelligence quotient. Approximately half of the adolescents were identified as having a daily living skills deficit. Autism symptomatology, intelligence quotient, maternal education, age, and sex accounted for only 10% of the variance in predicting a daily living skills deficit. Identifying factors associated with better or worse daily living skills may help shed light on the variability in adult outcome in individuals with autism spectrum disorder with average intelligence.

Anxiety, sensory over-responsivity, and gastrointestinal problems in children with autism spectrum disorders

Children with autism spectrum disorders (ASD) experience high rates of anxiety, sensory processing problems, and gastrointestinal (GI) problems; however, the associations among these symptoms in children with ASD have not been previously examined. The current study examined bivariate and multivariate relations among anxiety, sensory over-responsivity, and chronic GI problems in a sample of 2,973 children with ASD enrolled in the Autism Treatment Network (ages 2-17 years, 81.6 % male). Twenty-four percent of the sample experienced at least one type of chronic GI problem (constipation, abdominal pain, bloating, diarrhea, and/or nausea lasting three or more months). Children with each type of GI problem had significantly higher rates of both anxiety and sensory over-responsivity. Sensory over-responsivity and anxiety were highly associated, and each provided unique contributions to the prediction of chronic GI problems in logistic regression analyses. The results indicate that anxiety, sensory over-responsivity and GI problems are possibly interrelated phenomenon for children with ASD, and may have common underlying mechanisms.