The diagnosis conundrum: Comparison of crowdsourced and expert assessments of toddlers with high and low risk of autism spectrum disorder

Caregiver Perceptions of Social Communication and Interaction: Development and Validation of the SCIPS

Social communication and interaction (SC/I) skill quality may be influenced by cultural values, norms, and expectations. Because difficulties in SC/I is a core criterion for identifying autism and is a frequent construct of interest in autism research, a measure designed to capture cross-cultural differences in the perspectives of SC/I skills is warranted. To address this need we developed and validated the Social Communication and Interaction Perceptions Scale (SCIPS), a caregiver report measure for children ages 6-18 years, that measures both frequency and perceived importance of various SC/I skills. Results from 401 diverse caregiver participants showed that for both domains (i.e., Frequency and Importance) the SCIPS has good reliability (α = 0.88-0.95) and two factors that examine basic and advanced aspects of SC/I skills. Findings support the use of the SCIPS as a measure of caregiver perspectives of SC/I skills in clinical and research contexts.

Separate scoring algorithms for specific identification priorities optimize the screening properties of the Screening Tool for Autism in Toddlers (STAT)

The Screening Tool for Autism in Toddlers (STAT) is a validated stage-2 autism spectrum disorder (ASD) screening measure that takes 20 minutes to administer and comprises 12 play-based items that are scored according to specific criteria. This study examines an expanded version (STAT-E) that includes the examiner's subjective ratings of children's social engagement (SE) and atypical behaviors (AB) in the scoring algorithm. The sample comprised 238 children who were 24-35 months old. The STAT-E assessors had limited ASD experience to mimic its use by community-based non-specialists, and were trained using a scalable web-based platform. A diagnostic evaluation was completed by clinical experts who were blind to the STAT-E results. Logistic regression, ROC curves, and classification matrices and metrics were used to determine the screening properties of STAT-E when scored using the original STAT scoring algorithm versus a new algorithm that included the SE and AB ratings. Inclusion of the SE and AB ratings improved positive risk classification appreciably, while the specificity declined. These results suggest that the STAT-E using the original STAT scoring algorithm optimizes specificity, while the STAT-E scoring algorithm with the two new ratings optimizes the positive risk classification. Using multiple scoring algorithms on the STAT may provide improved screening accuracy for diverse contexts, and a scalable web-based tutorial may be a pathway for increasing the number of community providers who can administer the STAT and contribute toward increased rates of autism screening.

The Gap Between Cognition and Adaptive Behavior in Students with Autism Spectrum Disorder: Implications for Social Anxiety and the Moderating Effect of Autism Traits

The gap between cognitive ability and adaptive behavior has been thought to enhance psychopathology among people with autism, particularly among those without intellectual disability. We examined this association by exploring the gap between cognitive understanding of social behavior and socially adaptive behavior, and its impact on social anxiety symptoms, obsessive-compulsive symptoms, and depressive symptoms, among 53 university students with autism (without intellectual disability). A higher cognition-social adaptation discrepancy was associated with more social anxiety, but this effect was moderated by autistic trait (AT) levels; a greater gap was associated with more avoidance symptoms of social anxiety only among students with high AT. Cognitive flexibility and prosocial behavior may mitigate the effects of AT. Potential implications and interventions are discussed.