Parent and Teacher Concordance of Child Outcomes for Youth with Autism Spectrum Disorder

Children's and Parents' Factors That Affect Parenting Stress in Preschool Children With Developmental Disabilities or Typical Development

OBJECTIVE

This study compared parenting stress in preschool children with developmental disabilities (DD) or typical development (TD). We also investigated children's factors that affect parenting stress.

METHODS

A total of 196 preschool children participated in the study (aged 54.8±9.2 months). There were 79 children with DD (59 with autism spectrum disorder, 61 with intellectual disability, 12 with language disorder) and 117 with TD. The high parenting stress and the low parenting stress groups were divided based on the Total Stress of Korean Parenting Stress Index Fourth Edition (K-PSI-4) with an 85-percentile cutoff score. Pearson's correlation analysis was conducted to calculate the correlation between K-PSI-4 and the children's or parents' measures.

RESULTS

The difference in parenting stress between DD and TD was significant in the Total Stress of K-PSI-4 (p<0.001). The Total Stress scale of K-PSI-4 represented a modest to strong correlation with cognitive development, adaptive functioning, social communication, and behavioral problems in children with DD. Our results showed that caregivers of children with DD reported higher parenting stress than those with TD. Parenting stress was strongly associated with cognitive development, adaptive functioning, social communication, and behavioral problems in children with DD. Among the children's factors, especially social communication, attention problems, and aggressive behavior had association with caregivers' higher parenting stress.

CONCLUSION

These findings suggest the need for early intervention for parenting stress in caregivers by assessing child characteristics, including social cognition, awareness, communication, and inattention and hyperactivity, in the evaluation of children with DD.

Teacher- and parent-reported trajectories of maladaptive behaviors among individuals with autism and non-spectrum delays

People with autism spectrum disorder (ASD) and non-spectrum developmental delays frequently exhibit maladaptive behaviors throughout the lifespan, which can have pervasive effects on quality of life. Maladaptive behaviors have been shown to change over time as a function of various individual-level factors (e.g., cognitive ability), yet research is primarily limited to parent-reported measures. To expand upon this work, the present study aimed to examine trajectories of teacher- and parent-reported maladaptive behaviors (i.e., hyperactivity, irritability, social withdrawal) and to test whether individual-level predictors (e.g., autism features, verbal intelligence quotient) and school-related predictors (e.g., teacher type, student-adult ratio, personal aide, school type) impact these trajectories among 165 individuals with ASD or non-spectrum delays from ages 9 to 18. Multilevel models revealed that, according to both teacher and parent report, participants showed the greatest improvement in hyperactivity, less but still notable improvement in irritability, and stable levels of social withdrawal over time. Higher verbal ability and fewer ASD features, in addition to mainstream school placement, emerged as important individual- and school-related differences associated with fewer maladaptive behaviors over time. The multi-informant perspective and longitudinal design provide novel insight into the manifestations of these maladaptive behaviors across different contexts and across time. Findings highlight the consistency of teacher- and parent-reported trajectories over time and further emphasize the importance of targeting maladaptive behaviors using a multisystem intervention approach in both school and home contexts.

Adaptation of autism spectrum screening questionnaire (ASSQ) for use in Georgian school settings

Purpose

Even though 95% of children with neurodevelopmental disorders, including autism spectrum disorder (ASD), live in low- and middle-income countries, there is a dearth of studies from these countries, including the Republic of Georgia. Several ASD screening tools are available, but few are validated for use in Georgian or other smaller countries. This study aims to adapt and validate the autism spectrum screening questionnaire (ASSQ) for use in Georgia.

Design/methodology/approach

The ASSQ was administered for all third-grade students in 402 schools in the five main Georgian cities, n = 27,336. Prior to use, the 27-item ASSQ was translated, back-translated and adapted for use in Georgia. A total of 16,556 students (approximately 61%) were assessed by a parent and/or teacher. Optimal cutoff scores were estimated. Randomly chosen children who screened positive (n = 173) and negative (n = 127) were offered comprehensive assessment using standardized diagnostic procedures.

Findings

Data from 15,510 parents- and 13,517 teachers-administered ASSQ revealed statistically significant differences in median and cutoff scores between parents and teachers: 7 versus 4 and 9 versus 6, respectively. Cutoff score = 14, on either parent or teacher ASSQ, had sensitivity of 0.94, indicating that it can be used in school settings.

Originality/value

The Georgian adaptation of the ASSQ creates opportunity for further ASD research, while also providing a valid screening tool for clinicians. Data from Georgia will add to the growing understanding of the broader ASD phenotype.

Sibling Influences on Trajectories of Maladaptive Behaviors in Autism

Siblings play an important role in the behavioral trajectories of individuals with autism spectrum disorder (ASD). While having siblings has been associated with positive outcomes in ASD, including stronger adaptive functioning, social and non-verbal communication, and theory of mind, little is known about the impact of siblings on more negative outcomes, such as maladaptive behaviors. To address this gap, the present longitudinal study tested sibling predictors of trajectories of maladaptive behaviors (e.g., teacher- and parent-reported hyperactivity, irritability, and social withdrawal) from childhood through early adulthood among individuals with ASD and non-spectrum delays. Multilevel models revealed that, while the mere presence of a sibling did not impact maladaptive behavior trajectories apart from teacher-reported hyperactivity, the diagnostic profile of the sibling (e.g., emotional/behavioral disorder, ASD, medical condition) emerged as an important predictor. Specifically, although findings varied across teacher and parent reports, more hyperactivity and irritability across time was identified when the sibling had diagnoses of an emotional/behavioral disorder, ASD, and/or a medical condition. Overall, this study provides novel insight into the broader family-level factors that influence the presentation of maladaptive behaviors across time and across contexts.

What is the concordance between parent- and education professional-reported adaptive functioning in autistic children using the VABS-II?

Adaptive functioning of autistic children is traditionally measured through informant-report, often from parents. Behaviour varies across settings though, and context-specific reports should be considered. Limited and inconsistent results show low parent-education professional concordance, but no research has yet explored item level response variation. We investigated Vineland Adaptive Behaviour Scales-II concordance using 233 lower ability autistic children from the PACT-G sample. Domain and item level agreement was low, but better on objectively measured behaviours. Higher child nonverbal ability improved concordance. Where disagreements occurred, education professionals identified emergent skills more and parents were more likely to rate present/absent. Parents and education professionals view the adaptive abilities of autistic children differently and both should be considered when developing personalised interventions and support.

An Evaluation of Parent and Teacher Discrepancies on an Adaptive Behavior Measure for Youth with Autism Spectrum Disorder, Intellectual Disability, and Global Developmental Delay

Comprehensive evaluations include data from multiple informants, but discrepancies occur on adaptive skill measures of youth with autism spectrum disorder (ASD) and intellectual disabilities (ID). This study investigated discrepancies between parent-teacher ratings on a measure of adaptive behavior [Adaptive Behavior Assessment System, Third Edition (ABAS-3)] in a clinical sample of 115 youth. Agreement between informants was determined and then discrepancies were identified using paired-sample t-tests for the whole sample and subsamples. Factors associated with parent-teacher discrepancies were investigated including age, diagnoses, IQ, autism symptomology, and parent education. Parent-teacher scores were moderately correlated for the ABAS-3 composite and domains. Teachers rated youth with ASD and ID as having higher adaptive skills. Autism symptomology significantly predicted discrepancies between informants on the ABAS-3.

Mobile App for Parental Empowerment for Caregivers of Children With Autism Spectrum Disorders: Prospective Open Trial

BACKGROUND

Conflicting data emerge from literature regarding the actual use of smartphone apps in medicine; some considered the introduction of smartphone apps in medicine to be a breakthrough, while others suggested that, in real-life, the use of smartphone apps in medicine is disappointingly low. Yet, digital tools become more present in medicine daily. To empower parents of a child with autism spectrum disorder, we developed the Smartautism smartphone app, which asks questions and provides feedback, using a screen with simple curves.

OBJECTIVE

The purpose of this study was to evaluate usage of the app by caregivers of individuals with autism spectrum disorders.

METHODS

We conducted a prospective longitudinal exploratory open study with families that have a child with autism spectrum disorder. Data were recorded over a period of 6 months, and the outcome criteria were (1) overall response rates for a feedback screen and qualitative questionnaires, and (2) response rates by degree of completion and by user interest, based on attrition.

RESULTS

Participants (n=65) had a very high intent to use the app during the 6-month period (3698/3900 instances, 94.8%); however, secondary analysis showed that only 46% of participants (30/65) had constant response rates over 50%. Interestingly, these users were characterized by higher use and satisfaction with the feedback screen when compared to low (P<.001) and moderate (P=.007) users.

CONCLUSIONS

We found that real or perceived utility is an important incentive for parents who use empowerment smartphone apps.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2016-012135.

Which Factors Influence Teacher Report of Adaptive Functioning in Autistic Children?

A wealth of parent-report research shows adaptive functioning difficulties in autistic children, with parent-report influenced by a number of child factors. Adaptive functioning in autistic children is known to vary across settings; however, no research has yet explored factors influencing education professional-report. This study investigated the rate and profile of impairment, and child factors influencing education professional-reported adaptive skills in 248 autistic children. Twelve children were < 3 years (min age for available normative data on the adaptive function measure), so were removed from the analyses. Results replicated parent-literature; adaptive skills were negatively associated with age and informant-reported autism severity, and positively associated with nonverbal ability and expressive language. Adaptive functioning is important for real-world outcomes, e.g. educational attainment, independence, and support needs. Improving our understanding of adaptive functioning in the education context may support opportunities for shared learning and enhance personalised support .

Concordance between Community Supervisor and Provider Ratings of Fidelity: Examination of Multi-Level Predictors and Outcomes

Fidelity is conceptualized as a key mechanism impacting treatment outcomes, yet community examination of fidelity is limited, partly due to limited feasible training methods and tools. Provider-report tools represent a feasible method for improving routine fidelity monitoring. Additional work examining the effectiveness of these methods and concordance with other fidelity sources is needed. Further, provider and client factors impact both intervention implementation and concordance, but their impact on fidelity measurement is poorly understood. Using a train-the-trainer methodology, we examine concordance between three methods of assessing fidelity (trained independent coders, supervisor evaluation and provider self-report) using a fidelity assessment tool adapted for community use. Multilevel models examined predictors (provider- and child- level factors) and outcomes (provider average fidelity) of concordance. Results suggest supervisors and providers are able to use the fidelity tool, but demonstrated variable concordance, with higher concordance with trained coders for supervisors than providers. Provider credentials and child language were marginally predictive of rater concordance. Higher supervisor accuracy was associated with higher provider fidelity. Findings inform broader efforts to improve the development and implementation of feasible fidelity tools for routine use in community settings and highlight multi-level factors impacting the adoption and implementation of such tools.

Parent-Child Concordance on the Pubertal Development Scale in Typically Developing and Autistic Youth

BACKGROUND

Characterizing puberty in autism spectrum disorder (ASD) is critical given the direct impacts of pubertal progression on neural, cognitive, and physical maturation. Limited information is available about the utility and parent-child concordance of the self-report and parent-report Pubertal Development Scale (PDS) in ASD, an economical and easily administered measure.

METHOD

The primary aim of this study was to examine the concordance between self-report and parent-report PDS ratings in autistic males and females ages 8-17y compared to typically developing (TD) youth, including using the PDS to derive informant-based estimates of adrenal and gonadal development. We hypothesized that there would be greater parent-youth discrepancies in pubertal ratings among autistic males. Our second aim was exploratory; we examined whether individual characteristics impact PDS concordance and hypothesized that lower intellectual and adaptive skills, higher autistic traits, and reduced self-awareness/monitoring would correlate with lower concordance.

RESULTS

There were no significant diagnostic group differences in parent-youth concordance for overall PDS scores among males and females. Autistic males had significantly lower inter-item agreement with their parents than TD males and had lower agreement for both adrenal and gonadal aspects of pubertal maturation (adrenal κ=.48; gonadal κ=.55).

CONCLUSIONS

The PDS is a feasible measure in ASD. Greater parent-youth discrepancies in autistic males may be due to reduced parental awareness or reduced insight into pubertal maturation among autistic males. Future research is needed to further elucidate individual and/or environmental characteristics that influence youth- and parent-reported PDS scores, including differences in self-perception and insight.

The Role of Executive Functioning in Predicting Social Competence in Children with and without Autism Spectrum Disorder

All children with autism spectrum disorder (ASD) experience social difficulties but they differ with regard to the type and severity of their challenges. Potentially powerful interventions targeting social skills in children with ASD may have limited effectiveness if they are not tailored to the child's specific needs. One factor that may influence social competence is executive functioning (EF). EF may impact social competence by facilitating higher-order strategies such as emotional and cognitive regulation which are necessary for social interactions. Participants included 132 children and adolescents, aged 7-13, including 77 with ASD (M = 10.11, SD = 1.94), and 55 without ASD (M = 9.54, SD = 1.67). Caregivers completed the Behavior Rating Inventory of Executive Functioning, Version 2 (BRIEF-2) Parent Form, assessing everyday EF skills, and the Multidimensional Social Competence Scale (MSCS). Hierarchical multiple regression analyses were conducted separately for the group without ASD and the group with ASD, with MSCS entered as the dependent variables and EF indices and scales of the BRIEF-2 as the main predictor variables. EF deficits in emotional control predicted poor emotion regulation for both children with and without ASD. For the group without ASD, better emotional control and initiation skills predicted empathic concern and social knowledge, respectively. Challenges in self-monitoring significantly predicted difficulties with social inferencing and social knowledge for children with ASD. The findings highlight the importance of targeting specific EF skills that contribute to various aspects of social competence to increase the effectiveness of interventions for children with ASD. Autism Res 2020, 13: 1856-1866. © 2020 International Society for Autism Research and Wiley Periodicals LLC LAY SUMMARY: We examined whether parents' ratings of their children's higher-order thinking skills (e.g., paying attention, organizing and planning, initiating tasks, regulating emotions, self-monitoring) predicted social competence among children with and without autism spectrum disorder (ASD). For children without ASD, emotional control and initiation skills were strongly linked to their displays of empathy and social knowledge, respectively. For children with ASD, their abilities to be aware of their own behaviors and its impact on others were strongly related to their ability to interpret social cues and their social knowledge. For both groups, the ability to regulate their emotions were important predictors of their ability to modulate their emotions in social contexts.

Informant Discrepancies in the Assessment of Adaptive Behavior of Children with Autism Spectrum Disorder

This study examined informant discrepancies for parent and teacher adaptive behavior ratings of 103 children, ages 6-12 years, with ASD (without intellectual disability). Scores on the Adaptive Behavior Assessment System, third edition (Harrison and Oakland, Western Psychological Services, Los Angeles, 2015) General Adaptive Composite (GAC) and practical, social, and conceptual domains were examined for mean differences, level of agreement, and moderators of difference scores between informant groups. Teacher scores were significantly higher (indicating better functioning) than parents for the GAC and practical domain. Parent and teacher scores were moderately correlated and Bland-Altman plots and regression analyses revealed no systematic differences in parent-teacher agreement across the range of scores. None of the tested variables moderated the parent-teacher difference scores. Implications for clinical practice are discussed.

We're not all cut from the same cloth: TAILORing treatments for children with chronic conditions

Background

Finding the optimal treatment for a chronic condition can be a complex and lengthy endeavor for both the patient and the clinician. To address this challenge, we developed an “N-of-1” quality improvement infrastructure to aid providers and patients in personalized treatment decision-making using systematic assessment of patient-reported outcomes during routine care.

Methods

Using the REDCap data management infrastructure, we implemented three pediatric pilots of the Treatment Assessments in the Individual Leading to Optimal Regimens (TAILOR) tool, including children receiving early intervention, children with attention deficit hyperactivity disorder, and children with challenging behaviors in the classroom setting. This retrospective review of data summarizes utilization and satisfaction data during our pilot experience with the tool.

Results

The three pilots included a combined total of 109 children and 39 healthcare providers, with 67 parents and 77 teachers invited to share data using brief surveys administered using TAILOR. Overall survey response rates ranged from 38% to 84% across the three pilots, with response rates notably higher among teachers as compared with parents. Satisfaction data indicated positive impressions of the tool’s utility.

Discussion

These experiences show the utility of the TAILOR framework for supporting collection and incorporation of patient-reported outcomes into the care of individuals with chronic conditions.