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Lee KS, Gau SSF, Tseng WL. Autistic Symptoms, Irritability, and Executive Dysfunctions: Symptom Dynamics from Multi-Network Models. J Autism Dev Disord 2024; 54:3078-3093. [PMID: 37453959 DOI: 10.1007/s10803-023-05981-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 07/18/2023]
Abstract
Socio-cognitive difficulties in individuals with autism spectrum disorder (ASD) are heterogenuous and often co-occur with irritability symptoms, such as angry/grouchy mood and temper outbursts. However, the specific relations between individual symptoms are not well-represented in conventional methods analyzing aggregated autistic symptoms and ASD diagnosis. Moreover, the cognitive-behavioral mechanisms linking ASD to irritability are largely unknown. This study investigated the dynamics between autistic (Social Responsiveness Scale) and irritability (Affective Reactivity Index) symptoms and executive functions (Cambridge Neuropsychological Test Automated Battery) in a sample of children and adolescents with ASD, their unaffected siblings, and neurotypical peers (N = 345, aged 6-18 years, 78.6% male). Three complementary networks across the entire sample were computed: (1) Gaussian graphical network estimating the conditional correlations between symptom nodes; (2) Relative importance network computing relative influence between symptoms; (3) Bayesian directed acyclic graph estimating predictive directionality between symptoms. Networks revealed numerous partial correlations within autistic (rs = .07-.56) and irritability (rs = .01-.45) symptoms and executive functions (rs = -.83 to .67) but weak connections between clusters. This segregated pattern converged in all directed and supplementary networks. Plausible predictive paths were found between social communication difficulties to autism mannerisms and between "angry frequently" to "lose temper easily." Autistic and irritability symptoms are two relatively independent families of symptoms. It is unlikely that executive dysfunctions explain elevated irritability in ASD. Findings underscore the need for researching other mood and cognitive-behavioral bridge symptoms, which may inform individualized treatments for co-occurring irritability in ASD.
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Grants
- R00 MH110570 NIMH NIH HHS
- R00MH110570 NIMH NIH HHS
- NSC98-3112-B-002-004 Ministry of Science and Technology, Taiwan
- NSC99-2627- B-002-015 Ministry of Science and Technology, Taiwan
- NSC100-2627-B-002-014 Ministry of Science and Technology, Taiwan
- NSC101-2627-B- 002-002 Ministry of Science and Technology, Taiwan
- NSC 101-2314-B-002-136-MY3 Ministry of Science and Technology, Taiwan
- NHRI-EX104-10404PI National Health Research Institute, Taiwan
- NHRI-EX105-10404PI National Health Research Institute, Taiwan
- NHRI-EX106-10404PI National Health Research Institute, Taiwan
- NHRI-EX107-10404PI National Health Research Institute, Taiwan
- NHRI-EX108-10404PI National Health Research Institute, Taiwan
- NHRI-EX110-11002PI National Health Research Institute, Taiwan
- NHRI-EX111-11002PI National Health Research Institute, Taiwan
- 10R81918- 03101R892103 AIM for Top University Excellent Research Project
- 102R892103 AIM for Top University Excellent Research Project
- R00MH110570 NIMH NIH HHS
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Affiliation(s)
- Ka Shu Lee
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital & College of Medicine, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan.
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
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Hirai M, Asada K, Kato T, Ikeda T, Hakuno Y, Ikeda A, Matsushima K, Awaya T, Okazaki S, Kato T, Funabiki Y, Murai T, Heike T, Hagiwara M, Yamagata T, Tomiwa K, Kimura R. Comparison of the Social Responsiveness Scale-2 among Individuals with Autism Spectrum Disorder and Williams Syndrome in Japan. J Autism Dev Disord 2024; 54:3176-3184. [PMID: 36167887 DOI: 10.1007/s10803-022-05740-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/28/2022]
Abstract
This study examined the similarities/differences between the social phenotypes of Williams syndrome (WS) and autism spectrum disorder (ASD). As cultural norms may affect symptom evaluation, this study administered the Social Responsiveness Scale-2 to Japanese individuals with WS (n = 78, 4.4-44.0 years) and ASD (n = 75, 4.7-55.4 years). The scores for Social Motivation and Social Communication were significantly more severe in the ASD than WS group. Overall, the similarities and differences between the social phenotypes of the syndromes were consistent with the findings of a recent study conducted in the UK, except for the social awareness subscale score. This highlights the importance of cross-cultural investigations of WS and ASD.
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Affiliation(s)
- Masahiro Hirai
- Department of Cognitive and Psychological Sciences, Graduate School of Informatics, Nagoya University, Furo-cho, Chikusa-ku, 464-8601, Nagoya, Japan.
- Center for Development of Advanced Medical Technology, Jichi Medical University, Tochigi, Japan.
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan.
| | - Kosuke Asada
- Faculty of Sociology, Toyo University, Tokyo, Japan
| | - Takeo Kato
- Department of Pediatrics, Shiga Medical Center for Children, Moriyama, Shiga, Japan
| | - Takahiro Ikeda
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Yoko Hakuno
- Global Research Institute, Keio University, Tokyo, Japan
| | - Ayaka Ikeda
- Department of Psychology, Senshu University, Kanagawa, Japan
| | - Kanae Matsushima
- Faculty of Rehabilitation, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tomonari Awaya
- Department of Anatomy and Developmental Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shin Okazaki
- Department of Pediatric Neurology, Osaka City General Hospital, Osaka, Japan
| | - Toshihiro Kato
- Faculty of Rehabilitation, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yasuko Funabiki
- Department of Cognitive and Behavioral Science, Graduate School of Human and Environmental Studies, Kyoto University, Kyoto, Japan
| | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshio Heike
- Department of Pediatrics, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Masatoshi Hagiwara
- Department of Anatomy and Developmental Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | - Ryo Kimura
- Department of Anatomy and Developmental Biology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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3
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Themistocleous CK, Andreou M, Peristeri E. Autism Detection in Children: Integrating Machine Learning and Natural Language Processing in Narrative Analysis. Behav Sci (Basel) 2024; 14:459. [PMID: 38920791 PMCID: PMC11200366 DOI: 10.3390/bs14060459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 06/27/2024] Open
Abstract
Despite the consensus that early identification leads to better outcomes for individuals with autism spectrum disorder (ASD), recent research reveals that the average age of diagnosis in the Greek population is approximately six years. However, this age of diagnosis is delayed by an additional two years for families from lower-income or minority backgrounds. These disparities result in adverse impacts on intervention outcomes, which are further burdened by the often time-consuming and labor-intensive language assessments for children with ASD. There is a crucial need for tools that increase access to early assessment and diagnosis that will be rigorous and objective. The current study leverages the capabilities of artificial intelligence to develop a reliable and practical model for distinguishing children with ASD from typically-developing peers based on their narrative and vocabulary skills. We applied natural language processing-based extraction techniques to automatically acquire language features (narrative and vocabulary skills) from storytelling in 68 children with ASD and 52 typically-developing children, and then trained machine learning models on the children's combined narrative and expressive vocabulary data to generate behavioral targets that effectively differentiate ASD from typically-developing children. According to the findings, the model could distinguish ASD from typically-developing children, achieving an accuracy of 96%. Specifically, out of the models used, hist gradient boosting and XGBoost showed slightly superior performance compared to the decision trees and gradient boosting models, particularly regarding accuracy and F1 score. These results bode well for the deployment of machine learning technology for children with ASD, especially those with limited access to early identification services.
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Affiliation(s)
| | - Maria Andreou
- Department of Speech and Language Therapy, University of Peloponnese, 24100 Kalamata, Greece
| | - Eleni Peristeri
- School of English, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
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Godoy-Giménez M, García-Pérez Á, Cañadas F, Estévez AF, Sayans-Jiménez P. The Broad Autism Phenotype-International Test (BAP-IT): A two-domain-based test for the assessment of the broad autism phenotype. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241228887. [PMID: 38366857 DOI: 10.1177/13623613241228887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
LAY ABSTRACT The broad autism phenotype refers to a group of behaviors related to autism spectrum disorder, but that appear to a lesser extent. Its assessment has been performed through outdated broad autism phenotype/autism spectrum disorder definitions and tests. To address this problem, this study presents the development of a new test, the Broad Autism Phenotype-International Test, a 20-item measure consisting of two dimensions, SOCIAL-BAP and RIRE-BAP, targeting the two-domain operationalization of autism spectrum disorder in Spain and the United Kingdom. Unlike the Broad Autism Phenotype Questionnaire, this test received empirical support as a quick and effective broad autism phenotype measure that can facilitate both broad autism phenotype/autism spectrum disorder research and interventions. This is the first step to studying the BAP in several Spanish and English-speaking countries.
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Cepanec M, Šimleša S. Item-Based Analysis of Some ADOS-2 Items with Typically Developing Participants Might help Improve Cross-Cultural Validity of ADOS-2. J Autism Dev Disord 2024; 54:109-120. [PMID: 36323993 DOI: 10.1007/s10803-022-05791-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
Most internationally recognized instruments for the screening and diagnosis of autism spectrum disorder have been developed in the USA, which calls into question the degree of their cultural adaptation to diverse populations. The aim of this study is to examine the characteristics of social communication in typically developing Croatian-speaking participants (N = 220) using ADOS-2-defined item-level normative values. Croatian subjects showed the expected ("typical") results in the domain of verbal communication, slightly atpical results in nonverbal communication (primarily gesture use), and more significant deviations in pragmatics (offering and asking for information), relative to the expectations of the ADOS-2. As ADOS-2 has become an important component of thorough ASD diagnostic evaluations worldwide, identifying methods for increasing the cross-cultural validity is essential.
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Affiliation(s)
- Maja Cepanec
- Child Communication Research Laboratory, Department of Speech and Language Pathology, Faculty of Education and Rehabilitation Sciences, University of Zagreb, Zagreb, Croatia.
| | - Sanja Šimleša
- Child Communication Research Laboratory, Department of Speech and Language Pathology, Faculty of Education and Rehabilitation Sciences, University of Zagreb, Zagreb, Croatia
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Ponzo S, May M, Tamayo-Elizalde M, Bailey K, Shand AJ, Bamford R, Multmeier J, Griessel I, Szulyovszky B, Blakey W, Valentine S, Plans D. App Characteristics and Accuracy Metrics of Available Digital Biomarkers for Autism: Scoping Review. JMIR Mhealth Uhealth 2023; 11:e52377. [PMID: 37976084 PMCID: PMC10692878 DOI: 10.2196/52377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Diagnostic delays in autism are common, with the time to diagnosis being up to 3 years from the onset of symptoms. Such delays have a proven detrimental effect on individuals and families going through the process. Digital health products, such as mobile apps, can help close this gap due to their scalability and ease of access. Further, mobile apps offer the opportunity to make the diagnostic process faster and more accurate by providing additional and timely information to clinicians undergoing autism assessments. OBJECTIVE The aim of this scoping review was to synthesize the available evidence about digital biomarker tools to aid clinicians, researchers in the autism field, and end users in making decisions as to their adoption within clinical and research settings. METHODS We conducted a structured literature search on databases and search engines to identify peer-reviewed studies and regulatory submissions that describe app characteristics, validation study details, and accuracy and validity metrics of commercial and research digital biomarker apps aimed at aiding the diagnosis of autism. RESULTS We identified 4 studies evaluating 4 products: 1 commercial and 3 research apps. The accuracy of the identified apps varied between 28% and 80.6%. Sensitivity and specificity also varied, ranging from 51.6% to 81.6% and 18.5% to 80.5%, respectively. Positive predictive value ranged from 20.3% to 76.6%, and negative predictive value fluctuated between 48.7% and 97.4%. Further, we found a lack of details around participants' demographics and, where these were reported, important imbalances in sex and ethnicity in the studies evaluating such products. Finally, evaluation methods as well as accuracy and validity metrics of available tools were not clearly reported in some cases and varied greatly across studies. Different comparators were also used, with some studies validating their tools against the Diagnostic and Statistical Manual of Mental Disorders criteria and others through self-reported measures. Further, while in most cases, 2 classes were used for algorithm validation purposes, 1 of the studies reported a third category (indeterminate). These discrepancies substantially impact the comparability and generalizability of the results, thus highlighting the need for standardized validation processes and the reporting of findings. CONCLUSIONS Despite their popularity, systematic evaluations and syntheses of the current state of the art of digital health products are lacking. Standardized and transparent evaluations of digital health tools in diverse populations are needed to assess their real-world usability and validity, as well as help researchers, clinicians, and end users safely adopt novel tools within clinical and research practices.
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Affiliation(s)
- Sonia Ponzo
- Healios Limited, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Merle May
- Healios Limited, London, United Kingdom
| | | | | | - Alanna J Shand
- Healios Limited, London, United Kingdom
- Institute of Epidemiology and Healthcare, University College London, London, United Kingdom
| | | | | | | | | | - William Blakey
- Healios Limited, London, United Kingdom
- School of Computing, Engineering and Physical Sciences, University of the West of Scotland, Paisley, United Kingdom
| | | | - David Plans
- Healios Limited, London, United Kingdom
- Department of Psychology, Royal Holloway, University of London, London, United Kingdom
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7
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Lin W, Chan YH, Kiing JSH, Lim TSH, Chong SC, Kang YQ, Aishworiya R, Mulay KV, Tan MY. Restricted and repetitive behaviors and association with cognition and adaptive functioning in children with autism spectrum disorder in Singapore. Front Psychiatry 2023; 14:1249071. [PMID: 38034929 PMCID: PMC10687550 DOI: 10.3389/fpsyt.2023.1249071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Background One of the core features of autism spectrum disorder (ASD) is restricted, repetitive patterns of behavior, interests and activities (RRBs). RRBs are known to adversely affect cognition and adaptive functioning. We explored the relationship of RRBs with cognition and adaptive functioning in children with ASD in an Asian setting. Methods This cross-sectional study was conducted at a tertiary developmental pediatrics center in Singapore from September 2019 to October 2021. Parent-child dyads (parents and their children ≤7 years old diagnosed with ASD) were recruited. Parents completed the Repetitive Behavior Questionnaire-2 (RBQ-2), which reports total score and two subscales - Motor/Sensory Behaviors (RBQ-2 MS) and Rigidity/Routines/Preoccupation with Restricted Interests (RBQ-2 RRPRI). Standardized assessments included Mullen Scales of Early Learning (MSEL) and Vineland Adaptive Behavior Scales (VABS-II). Data analysis utilized descriptive statistics and Pearson's correlation. Results Parents of 113 children [75.2% male, mean (SD) age 5.0 (1.2) years] participated. Median (IQR) RBQ-2 score was 29.0 (11.0). Significant negative correlations (adjusted for age, gender and family history of ASD) were observed for total RBQ-2 scores with MSEL ELC scores (r = -0.248, n = 101, p = 0.014) and VABS-II ABC scores (r = -0.281, n = 88, p = 0.009). Specifically, these correlations of fair strength were seen only with the RBQ-2 MS subscale for both ELC (r = -0.321, n = 101, p = 0.001) and ABC (r = -0.3478, n = 88, p = 0.001). Conclusion In children with ASD, severity of RRBs correlated with adverse cognition and adaptive functioning measures in our study, consistent with Western literature. While our study does not show causality, it adds to literature serving as a foundation for further research for both clinicians and researchers to target RRBs in improving outcomes with children in ASD.
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Affiliation(s)
- Wanyun Lin
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jennifer S. H. Kiing
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tammy S. H. Lim
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shang Chee Chong
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ying Qi Kang
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ramkumar Aishworiya
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kalyani Vijayakumar Mulay
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mae Yue Tan
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Belcher HL, Uglik-Marucha N, Vitoratou S, Ford RM, Morein-Zamir S. Gender bias in autism screening: measurement invariance of different model frameworks of the Autism Spectrum Quotient. BJPsych Open 2023; 9:e173. [PMID: 37781848 PMCID: PMC10594186 DOI: 10.1192/bjo.2023.562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND The Autism Spectrum Quotient is a popular autism screening tool recommended for identifying potential cases of autism. However, many women with autism demonstrate a different presentation of traits to those currently captured by screening measures and assessment methods, such as the Autism Spectrum Quotient. AIMS Different models of the Autism Spectrum Quotient have been proposed in the literature, utilising different items from the original 50-item scale. Within good-fitting models, the current study aimed to explore whether these items assess autistic traits similarly across men and women. METHOD Seventeen Autism Spectrum Quotient models were identified from the literature. Using the responses of a large sample of adults from the UK general population (5246 women, 1830 men), confirmatory factor analysis was used to evaluate the fit of each model. Measurement invariance with respect to gender, adjusting for age, was explored in the 11 model frameworks that were found to have satisfactory fit to our data. RESULTS It emerged that only two items were gender invariant (non-biased), whereas for the remaining items, the probability of endorsement was influenced by gender. In particular, women had a higher probability of endorsing items relating to social skills and communication. CONCLUSIONS If the items of the Autism Spectrum Quotient indeed reflect autism-related traits, those items should be rephrased to ensure they do not present a gender-related bias. This is vital for ensuring more timely diagnoses and support for all people with autism.
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Affiliation(s)
- Hannah L. Belcher
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Nora Uglik-Marucha
- Psychometrics and Measurement Laboratory, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Silia Vitoratou
- Psychometrics and Measurement Laboratory, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Ruth M. Ford
- School of Psychology and Sports Science, Anglia Ruskin University, UK
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Rasga C, Santos JX, Café C, Oliveira A, Duque F, Posada M, Nunes A, Oliveira G, Vicente AM. Prevalence of Autism Spectrum Disorder in the Centro region of Portugal: a population based study of school age children within the ASDEU project. Front Psychiatry 2023; 14:1148184. [PMID: 37711428 PMCID: PMC10499322 DOI: 10.3389/fpsyt.2023.1148184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/10/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Accurate prevalence estimates for Autism Spectrum Disorder (ASD) are fundamental to adequately program medical and educational resources for children. However, estimates vary globally and across Europe, and it is therefore wise to conduct epidemiological studies in defined geo-cultural contexts. Methods We used a population screening approach to estimate the prevalence of ASD in the Centro region of Portugal, using a harmonized protocol as part of the Autism Spectrum Disorders in the European Union (ASDEU) project. Results The overall prevalence was estimated at 0.5% (95% CI 0.3-0.7), higher in schools with Autism Units (3.3%, 95%CI 2.7-3.9) than in regular schools (0.3%, 95% CI 0.1-0.5) or schools with Multiple Disability Units (0.3%, 95% CI 0.04-0.6). Discussion The results indicate that the diagnosis of ASD is followed by the most effective educational policies in Centro Region. The variability in prevalence estimates across the different regions from the ASDEU project, and globally, is discussed.
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Affiliation(s)
- Célia Rasga
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
- Faculty of Sciences, University of Lisboa, BioISI - Biosystems & Integrative Sciences Institute, Lisboa, Portugal
| | - João Xavier Santos
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
- Faculty of Sciences, University of Lisboa, BioISI - Biosystems & Integrative Sciences Institute, Lisboa, Portugal
| | - Cátia Café
- Unidade de Neurodesenvolvimento e Autismo, Serviço do Centro de Desenvolvimento da Criança, Centro de Investigação e Formação Clínica, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University Clinic of Pediatrics and Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Alexandra Oliveira
- Unidade de Neurodesenvolvimento e Autismo, Serviço do Centro de Desenvolvimento da Criança, Centro de Investigação e Formação Clínica, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University Clinic of Pediatrics and Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Frederico Duque
- Unidade de Neurodesenvolvimento e Autismo, Serviço do Centro de Desenvolvimento da Criança, Centro de Investigação e Formação Clínica, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University Clinic of Pediatrics and Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Manuel Posada
- Institute of Rare Diseases Research, IIER, Instituto de Salud Carlos III, ISCIII, Madrid, Spain
| | - Ana Nunes
- Faculty of Sciences, University of Lisboa, BioISI - Biosystems & Integrative Sciences Institute, Lisboa, Portugal
- Departamento de Física, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Guiomar Oliveira
- Unidade de Neurodesenvolvimento e Autismo, Serviço do Centro de Desenvolvimento da Criança, Centro de Investigação e Formação Clínica, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University Clinic of Pediatrics and Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
| | - Astrid Moura Vicente
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
- Faculty of Sciences, University of Lisboa, BioISI - Biosystems & Integrative Sciences Institute, Lisboa, Portugal
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Hussain A, John JR, Dissanayake C, Frost G, Girdler S, Karlov L, Masi A, Alach T, Eapen V. Sociocultural factors associated with detection of autism among culturally and linguistically diverse communities in Australia. BMC Pediatr 2023; 23:415. [PMID: 37612588 PMCID: PMC10463473 DOI: 10.1186/s12887-023-04236-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 08/08/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The age at which parents or caregivers first develop concerns about their child's development has significant implications on formal diagnosis and intervention. This study aims to determine the sociocultural factors that are associated with the age and type of first concern reported by parents of autistic children among culturally and linguistically diverse (CALD) communities in Australia. We also assessed whether sociocultural factors predict autism traits measured in terms of social affect (SA), restricted and repetitive behaviours (RRB), and calibrated severity scores (CSS). METHODS This study is a secondary data analysis of the data collected from six Autism Specific Early Learning and Care Centres (ASELCCs) as part of the Autism Co-operative Research Centre (CRC) program between 2015 and 2019. Data analysed in this study included a family history questionnaire with sociodemographic and sociocultural information, parent-reported age and type of first concern, and clinician/researcher administered Autism Diagnostic Observation Schedule - Second Edition (ADOS-2) which includes standardised domain-wise scores of social affect (SA) and restricted and repetitive behaviours (RRB) as well as calibrated severity scores (CSS), a measure of severity of autism. Primary analysis included multivariable linear regression models to examine the predictive influence of sociodemographic and sociocultural factors on the dependant variables of age of concern (AOC) and the autism traits (SA, RRB, and CSS). RESULTS The mean AOC in the sample was 18.18 months and the most common concerns were speech/language delay, limited social interaction, and hyperactivity/behavioural changes. The multivariable linear regression models showed factors such as increase in age of child, those from a CALD background, annual family income, sibling's autism diagnosis, and developmental concerns to be significantly associated with parental AOC. Additionally, we also found that increase in child's age and CALD status to be significant predictors of autism trait (RRB) and severity measured in terms of the CSS score. Further, females (compared to males) were associated with higher difficulties with social communication and interaction skills. CONCLUSION Understanding key factors that contribute to early identification of autism can help tailor awareness programs for parents and caregivers, whilst also informing the development of services focused on serving all CALD communities.
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Affiliation(s)
- Aniqa Hussain
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - James Rufus John
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Cheryl Dissanayake
- School of Psychology and Public Health, Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Grace Frost
- Autism Specific Early Learning and Care Centre, Prospect, South Australia, Australia
| | - Sonya Girdler
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Cooperative Research Centre for Living with Autism, Brisbane, Australia
| | - Lisa Karlov
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Anne Masi
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Tasha Alach
- Director of Therapy and Clinical Services, Autism Association of Western Australia Inc, Subiaco, WA, Australia
| | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia.
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
- Academic Unit of Child Psychiatry, South Western Sydney Local Health District, Liverpool Hospital, Sydney, NSW, Australia.
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11
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Romagnano V, Sokolov AN, Fallgatter AJ, Pavlova MA. Do subtle cultural differences sculpt face pareidolia? SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:28. [PMID: 37142598 PMCID: PMC10160123 DOI: 10.1038/s41537-023-00355-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/10/2023] [Indexed: 05/06/2023]
Abstract
Face tuning to non-face images such as shadows or grilled toasts is termed face pareidolia. Face-pareidolia images represent a valuable tool for investigation of social cognition in mental disorders. Here we examined (i) whether, and, if so, how face pareidolia is affected by subtle cultural differences; and (ii) whether this impact is modulated by gender. With this purpose in mind, females and males from Northern Italy were administered a set of Face-n-Thing images, photographs of objects such as houses or waves to a varying degree resembling a face. Participants were presented with pareidolia images with canonical upright orientation and display inversion that heavily affects face pareidolia. In a two-alternative forced-choice paradigm, beholders had to indicate whether each image resembled a face. The outcome was compared with the findings obtained in the Southwest of Germany. With upright orientation, neither cultural background nor gender affected face pareidolia. As expected, display inversion generally mired face pareidolia. Yet, while display inversion led to a drastic reduction of face impression in German males as compared to females, in Italians, no gender differences were found. In a nutshell, subtle cultural differences do not sculpt face pareidolia, but instead affect face impression in a gender-specific way under unusual viewing conditions. Clarification of the origins of these effects requires tailored brain imaging work. Implications for transcultural psychiatry, in particular, for schizophrenia research, are highlighted and discussed.
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Affiliation(s)
- Valentina Romagnano
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Medical School and University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Alexander N Sokolov
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Medical School and University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Medical School and University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Marina A Pavlova
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), Medical School and University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany.
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12
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Eapen V, Karlov L, John JR, Beneytez C, Grimes PZ, Kang YQ, Mardare I, Minca DG, Voicu L, Malek KA, Ramkumar A, Stefanik K, Gyori M, Volgyesi-Molnar M. Quality of life in parents of autistic children: A transcultural perspective. Front Psychol 2023; 14:1022094. [PMID: 36910746 PMCID: PMC9996029 DOI: 10.3389/fpsyg.2023.1022094] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction The concepts of health, illness, and disability as well as the perceptions of autism and quality of life (QoL) vary greatly across cultures and across time. This study sought to explore the interplay of culture on QoL and impact on parents caring for autistic children. Methods We used a transcultural dataset from seven countries (Australia, Hungary, Malaysia, Romania, Singapore, Spain, and the United Kingdom) with participating parents/carers reporting on the Quality of Life in Autism (QoLA) questionnaire. The QoLA questionnaire is a validated measure of QoL for parents of autistic children, with Part A subscale measuring parental QoL and part B subscale assessing the parental impact of the child's autism spectrum disorder (ASD) symptoms or features. We used the Quade's ranked analysis of covariance to determine significant differences between the countries in relation to QoLA Part A and Part B scores while adjusting for baseline differences using covariates such as parents' gender, child's age, and gender. Additionally, a post-hoc analysis with Bonferroni correction was also conducted to examine multiple pairwise comparisons. Results and conclusion We found that while the effect of features of ASD (Part B subscale) stayed strongly comparable between cultures, the self-reported parental QoL was most likely determined by different aspects of culture in different countries. It is concluded that while the ASD symptoms or features appear to affect parents in the same way across different countries, the parental QoL may be a culturally informed construct.
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Affiliation(s)
- Valsamma Eapen
- Discipline of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Lisa Karlov
- Discipline of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - James Rufus John
- Discipline of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Carmen Beneytez
- Equipo Especifico Alteraciones Graves del Desarrollo, Consejería de Educación de Madrid, Madrid, Spain
| | - Poppy Z. Grimes
- Swalcliffe Park School CIO, Oxfordshire, United Kingdom
- Centre for Clinical Brain Sciences, Division of Psychiatry, University of Edinburgh, Edinburgh, United Kingdom
| | - Ying Qi Kang
- Department of Paediatrics, Khoo Teck Puat-National University Children’s Medical Institute (KTP-NUCMI), National University Hospital, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ileana Mardare
- Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Dana Galieta Minca
- Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Laura Voicu
- Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Khasnur Abd Malek
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Malaysia
| | - Aishworiya Ramkumar
- Department of Paediatrics, Khoo Teck Puat-National University Children’s Medical Institute (KTP-NUCMI), National University Hospital, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Krisztina Stefanik
- Institute of Special Needs Education for People with Atypical Behavior and Cognition, ELTE University Budapest, Budapest, Hungary
- HAS-ELTE ‘Autism in Education’ Research Group, Budapest, Hungary
| | - Miklos Gyori
- HAS-ELTE ‘Autism in Education’ Research Group, Budapest, Hungary
- Institute for the Psychology of Special Needs, ELTE University, Budapest, Hungary
| | - Marta Volgyesi-Molnar
- HAS-ELTE ‘Autism in Education’ Research Group, Budapest, Hungary
- Institute for the Psychology of Special Needs, ELTE University, Budapest, Hungary
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Leung CNW, Leung CSY, Chan RWS, Leung PWL. Can the UK AQ-10 be applicable to Chinese samples with autism spectrum disorder in Hong Kong? Cross-cultural similarities and differences. Autism Res 2023; 16:302-314. [PMID: 36333966 DOI: 10.1002/aur.2847] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/25/2022] [Indexed: 11/08/2022]
Abstract
The current study aimed at testing and developing alternative short versions of autism spectrum quotient (AQ-10) (adult [self-report], adult [parent-report], adolescent, and child versions) for use in Hong Kong. First, the various versions of AQ-10 developed in the United Kingdom (the AQ-10-UK) were applied to Hong Kong Chinese samples and demonstrated satisfactory discriminative power (AUCs 0.77-0.94). Second, the Hong Kong Chinese versions of AQ-10 (AQ-10-HK) were developed, using the same methodology as in the original UK study. There were some changes in the choice of items and cut-offs. The AQ-10-HK demonstrated slightly greater discriminative power (AUCs 0.88-0.97) to that of the AQ-10-UK, but the differences in AUCs were not statistically significant. Compared to the corresponding full-length versions, both the UK and HK short forms did not seem to lose any significant discriminative power. Yet, the various versions of AQ, be they the full-length or AQ-10, appeared to consistently exhibit slightly smaller AUCs with the Hong Kong Chinese samples than with the UK samples. So, this study found both cross-cultural similarities and differences. The AQ-10-HK was recommended for local practice to maximize the advantage gained. Yet, for international multi-site research collaboration, involving the UK and HK, the original AQ-10-UK can be used for direct comparison of data.
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Affiliation(s)
| | - Cindy Sin Yu Leung
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong
| | | | - Patrick W L Leung
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong
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Mounzer W, Stenhoff DM, Alkhateeb JM, Al Khatib AJ. A follow-up study of early intensive behavioral intervention program for children with Autism in Syria. Sci Rep 2023; 13:70. [PMID: 36593287 PMCID: PMC9807639 DOI: 10.1038/s41598-022-27198-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
We examined the sustained effects of early intensive behavioral intervention (EIBI) on 66 children with autism spectrum disorder who participated in the Future Center's EIBI program. Children were assessed using the childhood autism rating scale (CARS), autism behavior checklist (ABC), and adaptive behavior scale (ABS-Arabic) 3 years after leaving the program. Continued positive effects were observed in several areas, including adaptive behavior and autism symptoms. However, participants' social skills might have declined on the ABS-Arabic after service withdrawal. Additionally, a significant negative association (p < .001) was found between participants' performance on the CARS and the number of weekly trials. This is encouraging, given the lack of EIBI services and regional instability. Future research should increase the sample size and use a more rigorous design.
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Affiliation(s)
- Wissam Mounzer
- grid.8192.20000 0001 2353 3326Department of Psychology, Damascus University, Damascus, Syria ,grid.10548.380000 0004 1936 9377Present Address: Department of Special Education, Stockholm University, Stockholm, Sweden
| | - Donald M. Stenhoff
- grid.215654.10000 0001 2151 2636Department of Psychology, Arizona State University, Tempe, AZ USA
| | - Jamal M. Alkhateeb
- grid.9670.80000 0001 2174 4509Department of Special Education, The University of Jordan, Amman, Jordan
| | - Amal J. Al Khatib
- grid.33801.390000 0004 0528 1681Department of Early Childhood Education, Queen Rania Faculty for Childhood, Hashemite University, Zarqa, Jordan
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Kim SY, Oh M, Bong G, Song DY, Yoon NH, Kim JH, Yoo HJ. Diagnostic validity of Autism Diagnostic Observation Schedule, second edition (K-ADOS-2) in the Korean population. Mol Autism 2022; 13:30. [PMID: 35773721 PMCID: PMC9245227 DOI: 10.1186/s13229-022-00506-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/31/2022] [Indexed: 11/22/2022] Open
Abstract
Background Although the Korean version of the Autism Diagnostic Observation Schedule-2 (K-ADOS‐2) is widely being used to diagnose autism spectrum disorder (ASD) in South Korea, no previous study has examined the validity and reliability of all modules of K-ADOS-2 across a wide age range, particularly older children, adolescents, and adults. Method Data from 2,158 participants were included (mean age = 79.7 months; 73.6% male): 1473 participants with ASD and 685 participants without ASD (Toddler Module, n = 289; Module 1, n = 642; Module 2 n = 574; Module 3 n = 411; Module 4, n = 242). Participants completed a battery of tests, including the K-ADOS or K-ADOS-2 and other existing diagnostic instruments. Sensitivity, specificity, area under the receiver operating characteristic (ROC) curve, positive predictive value (PPV), negative predictive value (NPV), Cohen’s kappa (k), and agreement with existing diagnostic instruments were computed. Cronbach’s α values were also calculated. Results All developmental cells of the K-ADOS-2 showed sufficient ranges of sensitivity 85.4–100.0%; specificity, 80.4–96.8%; area under the ROC curve, .90-.97; PPV, 77.8–99.3%; NPV, 80.6–100.0%; and k values, .83–.92. The kappa agreements of developmental cells with existing diagnostic instruments ranged from .20 to .90. Cronbach’s α values ranged from .82 to .91 across all developmental cells. Limitation The best-estimate clinical diagnoses made in this study were not independent of the K-ADOS-2 scores. Some modules did not include balanced numbers of participants in terms of gender and diagnostic status. Conclusion The K-ADOS-2 is a valid and reliable instrument in diagnosing ASD in South Korea. Future studies exploring the effectiveness of the K-ADOS-2 in capturing restricted, repetitive behaviors and differentiating ASD from other developmental disabilities are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-022-00506-5.
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Affiliation(s)
- So Yoon Kim
- Teacher Education, Duksung Women's University, Seoul, South Korea
| | - Miae Oh
- Department of Psychiatry, Kyung Hee University Hospital, Seoul, South Korea
| | - Guiyoung Bong
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi, 463-707, South Korea
| | - Da-Yea Song
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi, 463-707, South Korea
| | - Nan-He Yoon
- Division of Social Welfare and Health Administration, Wonkwang University, Iksan, South Korea
| | - Joo Hyun Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi, 463-707, South Korea
| | - Hee Jeong Yoo
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-ro, Bundang-gu, Seongnam, Gyeonggi, 463-707, South Korea. .,Seoul National University College of Medicine, Seoul, South Korea.
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Bard KA, Keller H, Ross KM, Hewlett B, Butler L, Boysen ST, Matsuzawa T. Joint Attention in Human and Chimpanzee Infants in Varied Socio-Ecological Contexts. Monogr Soc Res Child Dev 2022; 86:7-217. [PMID: 35355281 DOI: 10.1111/mono.12435] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Joint attention (JA) is an early manifestation of social cognition, commonly described as interactions in which an infant looks or gestures to an adult female to share attention about an object, within a positive emotional atmosphere. We label this description the JA phenotype. We argue that characterizing JA in this way reflects unexamined assumptions which are, in part, due to past developmental researchers' primary focus on western, middle-class infants and families. We describe a range of cultural variations in caregiving practices, socialization goals, and parenting ethnotheories as an essential initial step in viewing joint attention within inclusive and contextualized perspectives. We begin the process of conducting a decolonized study of JA by considering the core construct of joint attention (i.e., triadic connectedness) and adopting culturally inclusive definitions (labeled joint engagement [JE]). Our JE definitions allow for attention and engagement to be expressed in visual and tactile modalities (e.g., for infants experiencing distal or proximal caregiving), with various social partners (e.g., peers, older siblings, mothers), with a range of shared topics (e.g., representing diverse socialization goals, and socio-ecologies with and without toys), and with a range of emotional tone (e.g., for infants living in cultures valuing calmness and low arousal, and those valuing exuberance). Our definition of JE includes initiations from either partner (to include priorities for adult-led or child-led interactions). Our next foundational step is making an ecological commitment to naturalistic observations (Dahl, 2017, Child Dev Perspect, 11(2), 79-84): We measure JE while infants interact within their own physical and social ecologies. This commitment allows us to describe JE as it occurs in everyday contexts, without constraints imposed by researchers. Next, we sample multiple groups of infants drawn from diverse socio-ecological settings. Moreover, we include diverse samples of chimpanzee infants to compare with diverse samples of human infants, to investigate the extent to which JE is unique to humans, and to document diversity both within and between species. We sampled human infants living in three diverse settings. U.K. infants (n = 8) were from western, middle-class families living near universities in the south of England. Nso infants (n = 12) were from communities of subsistence farmers in Cameroon, Africa. Aka infants (n = 10) were from foraging communities in the tropical rain forests of Central African Republic, Africa. We coded behavioral details of JE from videotaped observations (taken between 2004 and 2010). JE occurred in the majority of coded intervals (Mdn = 68%), supporting a conclusion that JE is normative for human infants. The JA phenotype, in contrast, was infrequent, and significantly more common in the U.K. (Mdn = 10%) than the other groups (Mdn < 3%). We found significant within-species diversity in JE phenotypes (i.e., configurations of predominant forms of JE characteristics). We conclude that triadic connectedness is very common in human infants, but there is significant contextualization of behavioral forms of JE. We also studied chimpanzee infants living in diverse socio-ecologies. The PRI/Zoo chimpanzee infants (n = 7) were from captive, stable groups of mixed ages and sexes, and included 4 infants from the Chester Zoo, U.K. and 3 from the Primate Research Institute, Kyoto University, Japan. The Gombe chimpanzee infants (n = 12) were living in a dynamically changing, wild community in the Gombe National Park, Tanzania, Africa. Additionally, we include two Home chimpanzee infants who were reared from birth by a female scientist, in the combined U.S., middle-class contexts of home and university cognition laboratory. JE was coded from videotaped observations (taken between 1993 and 2006). JE occurred during the majority of coded intervals (Mdn = 64%), consistent with the position that JE is normative for chimpanzee infants. The JA phenotype, in contrast, was rare, but more commonly observed in the two Home chimpanzee infants (in 8% and 2% of intervals) than in other chimpanzee groups (Mdns = 0%). We found within-species diversity in the configurations comprising the JE phenotypes. We conclude that triadic connectedness is very common in chimpanzee infants, but behavioral forms of joint engagement are contextualized. We compared JE across species, and found no species-uniqueness in behavioral forms, JE characteristics, or JE phenotypes. Both human and chimpanzee infants develop contextualized social cognition. Within-species diversity is embraced when triadic connectedness is described with culturally inclusive definitions. In contrast, restricting definitions to the JA phenotype privileges a behavioral form most valued in western, middle-class socio-ecologies, irrespective of whether the interactions involve human or chimpanzee infants. Our study presents a model for how to decolonize an important topic in developmental psychology. Decolonization is accomplished by defining the phenomenon inclusively, embracing diversity in sampling, challenging claims of human-uniqueness, and having an ecological commitment to observe infant social cognition as it occurs within everyday socio-ecological contexts. It is essential that evolutionary and developmental theories of social cognition are re-built on more inclusive and decolonized empirical foundations.
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Affiliation(s)
- Kim A Bard
- Department of Psychology, University of Portsmouth
| | - Heidi Keller
- Department of Human Sciences, Osnabrück University
| | | | - Barry Hewlett
- Department of Anthropology, Washington State University, Vancouver
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Godoy-Giménez M, González-Rodríguez A, Estévez AF, Cañadas F, Sayans-Jiménez P. Applying a Rasch model to the Broad Autism Phenotype Questionnaire: item severity analysis and differential test functioning of the English and Spanish versions. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02789-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AbstractThe broad autism phenotype (BAP) represents the elevated but nonclinical levels of autism-related expressions expanding them beyond the disorder threshold towards the general population and it is assessed worldwide using the Broad Autism Phenotype Questionnaire. In this study, we applied a Rasch item response approach to the Spanish and the English BAPQ versions. This approach allows us to test the proper functioning of each version, estimate which BAP behaviours are more likeable at different levels of severity, and study whether BAPQ item’s severities and orders could be considered equivalent between both versions. A Spanish community sample of 970 participants and an English of 533 ones completed either the Spanish or the English version of the BAPQ. The results revealed a lack of unidimensionality of the Pragmatic Language subscale in both tests and the Rigid subscale in the English version. Both Aloof subscale versions and the Spanish Rigid demonstrated adequate properties but with several items showing differential functioning in the case of Aloof. We conclude by highlighting the necessity of BAP measurements paralleling the current autism spectrum disorder structure, following the severity-dimensional conceptualization (behaviours are continuously distributed according to their severity), and suitable for being adapted to different languages.
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Niedźwiecka A, Pisula E. Symptoms of Autism Spectrum Disorders Measured by the Qualitative Checklist for Autism in Toddlers in a Large Sample of Polish Toddlers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3072. [PMID: 35270764 PMCID: PMC8910243 DOI: 10.3390/ijerph19053072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 12/10/2022]
Abstract
This study aimed to assess some early symptoms of autism spectrum disorders (ASD) measured by a screening tool developed for an early detection of ASD. We investigated if the early symptoms were associated with toddlers' age, gender or ASD familial risk status. We used the Polish version of the Quantitative Checklist for Autism in Toddlers (Q-CHAT) to assess 1024 children aged 16 to 36 months. The sample included four groups of participants: typically developing toddlers, toddlers with parent-reported ASD-specific concerns, toddlers at risk for autism due to having an older sibling with ASD, and toddlers with a developmental delay. We found that mean Q-CHAT scores were significantly higher in boys than in girls. We did not find any associations between Q-CHAT scores and age. We observed that toddlers with a familial risk for ASD and those with a developmental delay scored significantly higher than controls. We collated these results with previous studies that used the Q-CHAT and other instruments.
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Affiliation(s)
- Alicja Niedźwiecka
- Department of Health and Rehabilitation Psychology, Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183 Warsaw, Poland;
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Golson ME, Ficklin E, Haverkamp CR, McClain MB, Harris B. Cultural differences in social communication and interaction: A gap in autism research. Autism Res 2021; 15:208-214. [PMID: 34936220 DOI: 10.1002/aur.2657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/30/2021] [Accepted: 12/09/2021] [Indexed: 11/07/2022]
Abstract
Social communication and interaction deficits are a diagnostic criteria of autism and integral to practitioner and researcher conceptualization. Culture is an influential factor in expectations for, and demonstration of, social communication and interaction skills, but there is limited research published in autism journals on this topic. This paucity of autism research examining cultural factors related to social communication and interaction may contribute to known identification disparities for racial and ethnic populations minoritized by systemic factors and research bias. We call for increased commitment from researchers to recruit racially and ethnically minoritized participants, prioritize investigating cultural expectations and perceptions of social communication and interaction, and evaluate measures related to social communication for cultural and linguistic responsivity. LAY SUMMARY: A diagnosis of autism requires the presence of deficits in social communication and interaction. Examples of these behaviors and skills include holding a back-and-forth conversation, the use of nonverbal communicative behaviors (e.g., gestures), and developing and maintaining social relationships. Culture influences the expectations for, and presentation of, these behaviors. However, research on this topic is lacking. Conducting more research related to culture and social communication could help reduce the disparities in autism identification across racially and ethnically minoritized populations.
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Affiliation(s)
- Megan E Golson
- Department of Psychology, Utah State University, Logan, Utah, USA
| | - Erica Ficklin
- Department of Psychology, Utah State University, Logan, Utah, USA
| | | | | | - Bryn Harris
- University of Colorado Denver, Denver, Colorado, USA
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Giannotti M, Bonatti SM, Tanaka S, Kojima H, de Falco S. Parenting Stress and Social Style in Mothers and Fathers of Children with Autism Spectrum Disorder: A Cross-Cultural Investigation in Italy and Japan. Brain Sci 2021; 11:1419. [PMID: 34827418 PMCID: PMC8615867 DOI: 10.3390/brainsci11111419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
Parents of children with autism spectrum disorder (ASD) face unique challenges, which may affect parenting functioning. However, little is known about gender and cultural variations in parenting stress and styles in these families. The aims of this study were to investigate: (1a) the differences in parenting stress and (1b) social style between Italian and Japanese mothers and fathers of children with ASD; (2) the predictive role of culture, sociodemographic, and child's characteristics on parenting stress; (3) the predictors of the social parenting style, including parenting stress dimensions. The study involved 92 Italians and 89 Japanese parents of school-age children (5-12 years) with ASD who completed the Parenting Stress Index and the Parenting Style Questionnaire. Results revealed that Japanese parents showed higher parenting stress and less engagement in social style than Italians. Across cultures, mothers used more social style than fathers. Being Japanese and having a child with greater ASD severity predicted higher levels of parenting stress. We also found that country, parent's gender, and stress related to the dysfunctional interaction were significant predictors of parenting social style. Our findings highlight the importance of a cross-cultural approach to better understand the experiences and needs of mothers and fathers of children with ASD.
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Affiliation(s)
- Michele Giannotti
- Laboratory of Observation, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38122 Trento, Italy; (S.M.B.); (S.d.F.)
| | - Sophia Marlene Bonatti
- Laboratory of Observation, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38122 Trento, Italy; (S.M.B.); (S.d.F.)
| | - Sanae Tanaka
- Research Center for Child Mental Development, Kanazawa University, Kanazawa 920-0925, Japan; (S.T.); (H.K.)
| | - Haruyuki Kojima
- Research Center for Child Mental Development, Kanazawa University, Kanazawa 920-0925, Japan; (S.T.); (H.K.)
- Faculty of Human Sciences, Kanazawa University, Kanazawa 920-1192, Japan
| | - Simona de Falco
- Laboratory of Observation, Diagnosis and Education (ODFLab), Department of Psychology and Cognitive Science, University of Trento, 38122 Trento, Italy; (S.M.B.); (S.d.F.)
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21
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Williams ZJ, Suzman E, Woynaroski TG. Prevalence of Decreased Sound Tolerance (Hyperacusis) in Individuals With Autism Spectrum Disorder: A Meta-Analysis. Ear Hear 2021; 42:1137-1150. [PMID: 33577214 PMCID: PMC8349927 DOI: 10.1097/aud.0000000000001005] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Hyperacusis, defined as decreased tolerance to sound at levels that would not trouble most individuals, is frequently observed in individuals with autism spectrum disorder (ASD). Despite the functional impairment attributable to hyperacusis, little is known about its prevalence or natural history in the ASD population. The objective of this study was to conduct a systematic review and meta-analysis estimating the current and lifetime prevalence of hyperacusis in children, adolescents, and adults with ASD. By precisely estimating the burden of hyperacusis in the ASD population, the present study aims to enhance recognition of this particular symptom of ASD and highlight the need for additional research into the causes, prevention, and treatment of hyperacusis in persons on the spectrum. DESIGN We searched PubMed and ProQuest to identify peer-reviewed articles published in English after January 1993. We additionally performed targeted searches of Google Scholar and the gray literature, including studies published through May 2020. Eligible studies included at least 20 individuals with diagnosed ASD of any age and reported data from which the proportion of ASD individuals with current and/or lifetime hyperacusis could be derived. To account for multiple prevalence estimates derived from the same samples, we utilized three-level Bayesian random-effects meta-analyses to estimate the current and lifetime prevalence of hyperacusis. Bayesian meta-regression was used to assess potential moderators of current hyperacusis prevalence. To reduce heterogeneity due to varying definitions of hyperacusis, we performed a sensitivity analysis on the subset of studies that ascertained hyperacusis status using the Autism Diagnostic Interview-Revised (ADI-R), a structured parent interview. RESULTS A total of 7783 nonduplicate articles were screened, of which 67 were included in the review and synthesis. Hyperacusis status was ascertained in multiple ways across studies, with 60 articles employing interviews or questionnaires and seven using behavioral observations or objective measures. The mean (range) age of samples in the included studies was 7.88 years (1.00 to 34.89 years). The meta-analysis of interview/questionnaire measures (k(3) = 103, nASD = 13,093) estimated the current and lifetime prevalence of hyperacusis in ASD to be 41.42% (95% CrI, 37.23 to 45.84%) and 60.58% (50.37 to 69.76%), respectively. A sensitivity analysis restricted to prevalence estimates derived from the ADI-R (k(3) = 25, nASD = 5028) produced similar values. The estimate of current hyperacusis prevalence using objective/observational measures (k(3) = 8, nASD = 488) was 27.30% (14.92 to 46.31%). Heterogeneity in the full sample of interview/questionnaire measures was substantial but not significantly explained by any tested moderator. However, prevalence increased sharply with increasing age in studies using the ADI-R (BF10 = 93.10, R2Het = 0.692). CONCLUSIONS In this meta-analysis, we found a high prevalence of current and lifetime hyperacusis in individuals with ASD, with a majority of individuals on the autism spectrum experiencing hyperacusis at some point in their lives. The high prevalence of hyperacusis in individuals with ASD across the lifespan highlights the need for further research on sound tolerance in this population and the development of services and/or interventions to reduce the burden of this common symptom.
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Affiliation(s)
- Zachary J. Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN
| | - Evan Suzman
- Graduate Program in Biomedical Sciences, Vanderbilt University, Nashville, TN
| | - Tiffany G. Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN
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22
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Symptoms of Autism, Comorbid Mental Health Conditions and Challenging Behaviors among Toddlers with Down Syndrome at Low Risk for ASD-Characterization Using the BISCUIT-Parts 1-3. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010684. [PMID: 34682430 PMCID: PMC8535697 DOI: 10.3390/ijerph182010684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/29/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022]
Abstract
Background: Autism spectrum disorder (ASD) may coexist with Down syndrome (DS). Most studies on this topic involve school-age children, adolescents, or adults with DS. This study looked at ASD symptoms, other mental health problems, and challenging behaviors in toddlers with DS at low risk of ASD. Methods: We used screening tools for autism in toddlers; BISCUIT–Parts 1–3 and Q-CHAT. We compared four groups of children aged 17–37 months: DS, ASD, Atypical Development (AD), and Typically Developing (TD). Results: Children with DS showed lower symptoms of ASD than children with ASD (without DS) and higher than TD children, except for repetitive behaviors/restricted interests. For comorbid mental health problems and difficult behaviors, children with DS scored lower than children with ASD. There were no differences between children with DS and TD children in this regard. Conclusions: The study results indicate that BISCUIT–Parts 1–3 are valid instruments to differentiate toddlers with DS from toddlers with ASD. However, they also show that toddlers with DS at low ASD risk are a very heterogeneous group when the ASD symptoms are considered. Autistic characteristics should be taken into account in supporting young children with this genetic condition.
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23
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Tsirgiotis JM, Young RL, Weber N. Sex/Gender Differences in CARS2 and GARS-3 Item Scores: Evidence of Phenotypic Differences Between Males and Females with ASD. J Autism Dev Disord 2021; 52:3958-3976. [PMID: 34533659 DOI: 10.1007/s10803-021-05286-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/26/2022]
Abstract
Growing evidence suggests that autistic females are more likely to be diagnostically overlooked than males, perhaps due to differences in ASD presentations (van Wijngaarden-Cremers in JAMA 44:627-635, 2014). To investigate specific behaviours in which differences lie, we analysed profiles of 777 children using the Childhood Autism Rating Scale (Scholper in JAMA 29:489-493, 2010) or Gilliam Autism Rating Scale (Gilliam, 2014). Males demonstrated greater difficulty in six CARS2-ST items and seven behaviours on the GARS-3, mostly reflecting restricted and repetitive behaviours. Across all instruments, the only area in which females showed greater difficulty was fear or nervousness (CARS2-ST). No meaningful differences emerged from the CARS2-HF analysis. Where males showed greater difficulty, females were more likely to present with developmentally typical behaviour.
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Affiliation(s)
- Joanna M Tsirgiotis
- Flinders University, Sturt Road, Bedford Park, Adelaide, SA, 5062, Australia
| | - Robyn L Young
- Flinders University, Sturt Road, Bedford Park, Adelaide, SA, 5062, Australia.
| | - Nathan Weber
- Flinders University, Sturt Road, Bedford Park, Adelaide, SA, 5062, Australia
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24
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Stevanovic D, Costanzo F, Fucà E, Valeri G, Vicari S, Robins DL, Samms-Vaughan M, Ozek Erkuran H, Yaylaci F, Deshpande SN, Deshmukh V, Arora NK, Albores-Gallo L, García-López C, Gatica-Bahamonde G, Gabunia M, Zirakashvili M, Machado FP, Radan M, Samadi SA, Toh TH, Gayle W, Brennan L, Zorcec T, Auza A, de Jonge M, Shoqirat N, Marini A, Knez R. Measurement invariance of the Childhood Autism Rating Scale (CARS) across six countries. Autism Res 2021; 14:2544-2554. [PMID: 34346193 DOI: 10.1002/aur.2586] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 11/07/2022]
Abstract
The Childhood Autism Rating Scale (CARS) is a simple and inexpensive tool for Autism spectrum disorder (ASD) assessments, with evidenced psychometric data from different countries. However, it is still unclear whether ASD symptoms are measured the same way across different societies and world regions with this tool, since data on its cross-cultural validity are lacking. This study evaluated the cross-cultural measurement invariance of the CARS among children with ASD from six countries, for whom data were aggregated from previous studies in India (n = 101), Jamaica (n = 139), Mexico (n = 72), Spain (n = 99), Turkey (n = 150), and the United States of America (n = 186). We analyzed the approximate measurement invariance based on Bayesian structural equation modeling. The model did not fit the data and its measurement invariance did not hold, with all items found non-invariant across the countries. Items related to social communication and interaction (i.e., relating to people, imitation, emotional response, and verbal and nonverbal communication) displayed lower levels of cross-country non-invariance compared to items about stereotyped behaviors/sensory sensitivity (i.e., body and object use, adaptation to change, or taste, smell, and touch response). This study found that the CARS may not provide cross-culturally valid ASD assessments. Thus, cross-cultural comparisons with the CARS should consider first which items operate differently across samples of interest, since its cross-cultural measurement non-invariance could be a source of cross-cultural variability in ASD presentations. Additional studies are needed before drawing valid recommendations in relation to the cultural sensitivity of particular items.
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Affiliation(s)
- Dejan Stevanovic
- Department of Psychiatry, Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Floriana Costanzo
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Elisa Fucà
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giovanni Valeri
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Stefano Vicari
- Child and Adolescent Neuropsychiatry Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Diana L Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Handan Ozek Erkuran
- Child and Adolescent Psychiatry Unit, Dr Behcet Uz Children's Research and Training Hospital, Izmir, Turkey
| | - Ferhat Yaylaci
- Child Psychiatry Unit, Bursa Dortcelik Children's Hospital, Bursa, Turkey
| | - Smita N Deshpande
- Department of Psychiatry, Centre of Excellence in Mental health, Atal Bihari Vajpayee Institute of Medical Sciences; Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | | | | | - Lilia Albores-Gallo
- Research Division, Hospital Psiquiátrico Infantil "Dr. Juan N. Navarro," Secretaría de Salud, Mexico City, Mexico
| | | | | | | | | | | | - Miruna Radan
- National Institute for Maternal and Child Health, Bucharest, Romania
| | - Sayyed Ali Samadi
- Institute of Nursing and Health Research, University of Ulster, Coleraine, UK
| | - Teck-Hock Toh
- Clinical Research Centre & Department of Pediatrics, Sibu Hospital, Ministry of Health Malaysia, Sibu, Malaysia
| | - Windham Gayle
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, California, USA
| | | | - Tatjana Zorcec
- Developmental Department, University Children's Hospital, Skopje, Macedonia
| | - Alejandra Auza
- Language and Cognition Laboratory, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Maretha de Jonge
- Faculty of Social Science, Education and Child Studies, Clinical Neuroscience and Developmental Disorders, Leiden University, Leiden, The Netherlands
| | | | | | - Rajna Knez
- Department of Women's and Children's Health, Skaraborgs Hospital, Skövde, Sweden.,Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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25
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Fombonne E, MacFarlane H, Salem AC. Epidemiological surveys of ASD: advances and remaining challenges. J Autism Dev Disord 2021; 51:4271-4290. [PMID: 33864555 DOI: 10.1007/s10803-021-05005-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 12/25/2022]
Abstract
Recent worldwide epidemiological surveys of autism conducted in 37 countries are reviewed; the median prevalence of autism is .97% in 26 high-income countries. Methodological advances and remaining challenges in designing and executing surveys are discussed, including the effects on prevalence of variable case definitions and nosography, of reliance on parental reports only, case ascertainment through mainstream school surveys, innovative approaches to screen school samples more efficiently, and consideration of age in interpreting surveys. Directions for the future of autism epidemiology are discussed, including the need to systematically examine cross-cultural variation in phenotypic expression and developing surveillance programs.
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Affiliation(s)
- Eric Fombonne
- Department of Psychiatry, Oregon Health & Science University, Mail code: GH254 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Heather MacFarlane
- Department of Psychiatry, Oregon Health & Science University, Mail code: GH254 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Alexandra C Salem
- Department of Psychiatry, Oregon Health & Science University, Mail code: GH254 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
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26
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Bong G, Kim SY, Song DY, Kim JH, Hong Y, Yoon NH, Sunwoo H, Jang JY, Oh M, Kim JM, Lee KS, Jung S, Choi CW, Ryu JS, Yoo HJ. Short caregiver interview and play observation for early screening of autism spectrum disorder: Behavior development screening for toddlers (BeDevel). Autism Res 2021; 14:1472-1483. [PMID: 33792202 DOI: 10.1002/aur.2510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/22/2020] [Accepted: 03/15/2021] [Indexed: 11/05/2022]
Abstract
This study validates behavior development screening for toddlers (BeDevel), which utilizes a combination of short caregiver interviews (BeDevel-I) and semistructured play observations (BeDevel-P). The data of 431 toddlers (male 66.2%; mean age (SD) = 29.11 (8.59) months; ASD, n = 201; developmental delay, n = 46; typically developing, n = 184), aged 18 ~ 42 months, were included in the validation of BeDevel. The best clinical estimate diagnosis, screening rate, validity, sensitivity, and reliability of BeDevel were determined based on data cross-sectionally collected using BeDevel and existing diagnostic/screening instruments: autism diagnostic observation schedule (ADOS), autism diagnostic interview (ADI-R), Vineland adaptive behavior scales-II (VABS-II), social response scales (SRS), sequenced language scale for infants (SELSI), Korean childhood autism rating scale (K-CARS), and Korean social communication questionnaire (K-SCQ). The k values of BeDevel-I and BeDevel-P were 0.055 ~ 0.732 and 0.291 ~ 0.752, respectively. Items related to social referencing in BeDevel-P had a particularly high diagnostic validity (k = 0.483 ~ 0.684). Reliabilities of BeDevel-I and BeDevel-P were sufficient (Cronbach's alpha = 0.86 ~ 0.88 and 0.92 ~ 0.95, respectively). BeDevel-I and BeDevel-P showed high sensitivity (BeDevel-I: 85.00 ~ 89.29%; BeDevel-P: 85.00 ~ 91.75%), specificity (BeDevel-I: 77.55 ~ 89.55%; BeDevel-P: 85.09 ~ 97.01%), PPV (BeDevel-I: 70.83 ~ 88.54%; BeDevel-P: 81.52 ~ 94.68%), and NPV (BeDevel-I: 76.00 ~ 95.24%; BeDevel-P: 84.62 ~ 95.45%). The agreement between the composite BeDevel score and ADOS, ADI-R, K-CARS, and K-SCQ was >67.6% (range = 67.6 ~ 90.8%). Combining a short caregiver interview and direct play observation is a valid and reliable screening process. More studies on social referencing as an important early marker are needed. BeDevel can be utilized as a secondary screening instrument before diagnostic confirmation in clinical and community settings. LAY SUMMARY: BeDevel, which consists of a short caregiver interview and direct play observation, is a valid and reliable screening instrument for autism spectrum disorder (ASD). We suggest that BeDevel can be utilized as a secondary instrument before administering diagnostic assessments in clinical and community settings. More studies examining social referencing as a potential behavioral marker of ASD are needed.
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Affiliation(s)
- Guiyoung Bong
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - So Yoon Kim
- Department in Teacher Education, Duksung Women's University, Seoul, South Korea
| | - Da-Yea Song
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Heun Kim
- Department of Psychology, University of Alabama Birmingham, Birmingham, Alabama, USA
| | | | - Nan-He Yoon
- Department of Health Administration, Hanyang Cyber University, South Korea
| | - Hyunjung Sunwoo
- Department of Clinical Psychology, Junior mind clinic Didim, Hwaseong, South Korea
| | - Jeong Yun Jang
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Miae Oh
- Department of Psychiatry, Kyung Hee University Hospital, Seoul, South Korea
| | - Jong Myeong Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyung-Sook Lee
- Department of Rehabilitation, Hanshin University, Kyeonggi, South Korea.,Sewon Infant Child Development Center, Seoul, South Korea
| | - Seokjin Jung
- Sewon Infant Child Development Center, Seoul, South Korea
| | - Chang Won Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hee Jeong Yoo
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
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27
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Longitudinal Social and Communication Outcomes in Children with Autism Raised in Bi/Multilingual Environments. J Autism Dev Disord 2021; 52:339-348. [PMID: 33689091 DOI: 10.1007/s10803-021-04940-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Abstract
Globally, there are more bilingual speakers than monolingual speakers; however, scant research evidence exists regarding social communication development and outcomes for bilingual children with autism spectrum disorder (ASD). A stronger evidence base will facilitate health professionals and educators providing accurate recommendations regarding language use. This study employed a longitudinal cohort design to compare social and communication skills, at baseline and over 12 months, for 60 monolingual and 60 bilingual children with ASD receiving community based early intervention. We found few differences at intake, and no difference in the magnitude of change over 12 months for this cohort. Findings support the notion that there is no basis on which to discourage home language use with bilingual children with ASD.
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28
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Oh M, Song DY, Bong G, Yoon NH, Kim SY, Kim JH, Kim J, Yoo HJ. Validating the Autism Diagnostic Interview-Revised in the Korean Population. Psychiatry Investig 2021; 18:196-204. [PMID: 33735550 PMCID: PMC8016687 DOI: 10.30773/pi.2020.0337] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/15/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE This study aimed to examine the validity of the Korean version of the Autism Diagnostic Interview-Revised (K-ADI-R) and determine its efficacy in identifying individuals with autism spectrum disorder (ASD). METHODS Data were pooled from several past and ongoing studies as well as clinical records acquired at Seoul National University Bundang Hospital from 2008 to 2017. The K-ADI-R were administered and scored by trained research reliable examiners. Measurements to investigate the validity of the K-ADI-R was through sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and Cohen's kappa. RESULTS A total of 1,271 (age 88.9±62.42 months, male=927) participants were included. The K-ADI-R yielded strong psychometric properties with high sensitivity (86.06-99.27%), specificity (84.75-99.55%), PPV (92.33-99.72%), and NPV (79.43-98.64%). There were significant differences in item scores across the K-ADI-R diagnostic algorithm regardless of age and sex (p<0.001). Agreement between the K-ADI-R and other ASD related measurements ranged between levels of good to excellent. CONCLUSION Despite language or cultural boundaries, the K-ADI-R demonstrated high levels of sensitivity, specificity, PPV, and NPV within a wide range of participants; hence, suggesting promising usage as a valuable diagnostic instrument for individuals with ASD.
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Affiliation(s)
- Miae Oh
- Department of Psychiatry, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Da-Yea Song
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Guiyoung Bong
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Nan-He Yoon
- Department of Health Administration, Hanyang Cyber University, Seoul, Republic of Korea
| | - So Yoon Kim
- Teacher Education, Duksung Women's University, Seoul, Republic of Korea
| | - Joo-Hyun Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jongmyeong Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hee Jeong Yoo
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Seoul National University College of Medicine, Seoul, Republic of Korea
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29
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Zeleke WA, Hughes TL, Kanyongo G. Assessing the Effectiveness of Professional Development Training on Autism and Culturally Responsive Practice for Educators and Practitioners in Ethiopia. Front Psychiatry 2021; 11:583674. [PMID: 33708144 PMCID: PMC7940830 DOI: 10.3389/fpsyt.2020.583674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022] Open
Abstract
This study examines the effect of professional development training on educators' and practitioners' knowledge of Autism and the use of culturally responsive practices. Using a single group, pre-post design, data was gathered from 34 educators and health professionals (i.e., teachers, counselors, psychologists, therapists, therapeutic care workers, social workers, and nurses) in Ethiopia. A week-long training covering ASDs and culturally responsive evidence-based training was provided to participants. Results showed significant improvement in participants' knowledge about ASD symptoms, nature, characteristics, as well as intervention selection. Participants' use of culturally informed approaches, in their area of professional service, showed a high level of participants' knowledge and low-level use of culturally responsive practices, policies, and procedures. Recommendations for addressing cultural factors impacting the diagnosis and treatment-seeking approaches to ASD in Africa are provided.
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Affiliation(s)
- Waganesh A. Zeleke
- Department of Counseling, Psychology and Special Education, Duquesne University, Pittsburgh, PA, United States
| | - Tammy L. Hughes
- Department of Counseling, Psychology and Special Education, Duquesne University, Pittsburgh, PA, United States
| | - Gibbs Kanyongo
- Department of Educational Foundations and Leadership, Duquesne University, Pittsburgh, PA, United States
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30
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De Giacomo A, Craig F, Palermo G, Coppola A, Margari M, Campanozzi S, Margari L, Turi M. Differential Diagnosis in Children with Autistic Symptoms and Subthreshold ADOS Total Score: An Observational Study. Neuropsychiatr Dis Treat 2021; 17:2163-2172. [PMID: 34262276 PMCID: PMC8274229 DOI: 10.2147/ndt.s300452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Children with autism spectrum disorder (ASD) share some symptoms with children with other neurodevelopmental disorders (ie, intellectual disability or communication disorders or language disorders). These similarities can make difficult to obtain an accurate diagnosis, which is essential to give targeted treatments to the patients. We aim to verify in our study if children with autistic traits who undergo to Autism Diagnostic Observation Schedule had specific clinical diagnosis. PATIENTS AND METHODS We selected 73 children tested with ADOS-G or ADOS-2, for the presence of autistic symptoms. The whole sample did not reach the cut-off of ADOS and did not receive the ASD diagnosis, according to DSM-5. RESULTS Results of this study showed that in order of frequency and early diagnosis, communication disorders (CD), mild intellectual disability (mID) and the attention deficit hyperactivity disorders (ADHD) represent the most common final clinical diagnosis in children with autistic traits. CONCLUSION Our results showed as the CD was the common diagnosis of these children and that often associated with younger age. Moreover, analyses of ADOS domains and the difference of individual items between groups did not show the capacity to differentiate between different neurodevelopmental disorders in terms of differential diagnosis, and this confirms the need for integrating multiple sources of information during the diagnostic process.
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Affiliation(s)
- Andrea De Giacomo
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Craig
- Department of Cultures, Education and Society, University of Calabria, Rende, Italy
| | | | - Annamaria Coppola
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Mariella Margari
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Stella Campanozzi
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Lucia Margari
- Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Marco Turi
- Fondazione Stella Maris Mediterraneo, Potenza, Italy
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Rescorla LA, Adams A, Ivanova MY. The CBCL/1½-5's DSM-ASD Scale: Confirmatory Factor Analyses Across 24 Societies. J Autism Dev Disord 2020; 50:3326-3340. [PMID: 31559509 DOI: 10.1007/s10803-019-04189-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Previous research supports the CBCL/1½-5's DSM-ASD scale (and its precursor, the DSM-PDP scale) as a Level 1 ASD screener. Confirmatory factor analyses (CFAs) with data from population samples in 24 societies (N = 19,850) indicated good measurement invariance across societies, especially for configural and metric invariance. Items 4. 25, 67, 80, and 98 may be especially good discriminators of ASD because they have tend to have low base rates, strong loadings on the ASD latent construct, and the best measurement invariance across societies. Further research is needed to test the discriminative power of these items in predicting ASD, but our strong measurement findings support the international psychometric robustness of the CBCL/1½-5's DSM-ASD scale.
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Affiliation(s)
- Leslie A Rescorla
- Department of Psychology, Bryn Mawr College, 101 N. Merion Avenue, Bryn Mawr, PA, 19010, USA.
| | - Allison Adams
- Department of Psychology, Bryn Mawr College, 101 N. Merion Avenue, Bryn Mawr, PA, 19010, USA
| | - Masha Y Ivanova
- University of Vermont, 1 S. Prospect Street, Burlington, VT, 05401, USA
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Virolainen S, Hussien W, Dalibalta S. Autism spectrum disorder in the United Arab Emirates: potential environmental links. REVIEWS ON ENVIRONMENTAL HEALTH 2020; 35:359-369. [PMID: 32663174 DOI: 10.1515/reveh-2020-0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Abstract
Autism spectrum disorder (ASD) has been experiencing an increase in global prevalence in recent decades. While many factors could account for this reality, certain environmental links have been shown to contribute to ASD development and etiology. The Middle East has had relatively little published research on ASD etiology although statistics indicate that ASD affects 1 in 146 births in the United Arab Emirates (UAE). This review therefore aims to examine potential causes of ASD within the UAE specifically, focusing on environmental links that may contribute to the rise in ASD cases in this population. Significantly, suboptimal breastfeeding practices, high levels of vitamin D deficiency, increased exposure to pollution, pesticides and heavy metals within the UAE may all be potentially important contributing factors to ASD in this population. Our findings support the notion that there are key links between various environmental factors and ASD prevalence in the UAE. The lack of knowledge and much research on ASD within the UAE deeply necessitates further studies on its etiology as it poses a serious public health challenge in the region and globally.
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Affiliation(s)
| | - Wejdan Hussien
- Department of Biology, Chemistry & Environmental Sciences, American University of Sharjah, P.O. Box 26666, Sharjah, United Arab Emirates
| | - Sarah Dalibalta
- Department of Biology, Chemistry & Environmental Sciences, American University of Sharjah, P.O. Box 26666, Sharjah, United Arab Emirates
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Jayanath S, Ozonoff S. First Parental Concerns and Age at Diagnosis of Autism Spectrum Disorder: A Retrospective Review from Malaysia. Malays J Med Sci 2020; 27:78-89. [PMID: 33154704 PMCID: PMC7605832 DOI: 10.21315/mjms2020.27.5.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 08/04/2020] [Indexed: 01/10/2023] Open
Abstract
Background Autism spectrum disorder (ASD) is a neurodevelopmental disorder. This is the first study to examine first parental concerns in ASD in Malaysia. We examined: i) age and type of first parental concerns (AOC); ii) association between AOC and severity; iii) time lag between AOC and diagnosis; and iv) factors associated with diagnostic delay. Methods Medical records of 366 patients (aged 1–18 years) with ASD, at the Developmental Paediatrics Clinic of University of Malaya Medical Centre (UMMC), Kuala Lumpur, were reviewed for this 16-month retrospective cohort study. A validated coding system was used for initial parent concerns. Severity was classified via the Diagnostic and Statistical Manual of Mental Disorders-5th edition (DSM-5) criteria. Time lag between AOC and age at diagnosis (AOD) was calculated. Potential predictors of delayed diagnosis were extracted. Results Three-quarters (75.1%) of parents had concerns by 36 months. Speech/language/communication concerns were most frequent (60.1%). Number of first concerns was significantly correlated with severity (social communication/interaction, SCI [P = 0.019] and restricted, repetitive patterns of behaviours and/or interests/activities, RRB [P < 0.001]). AOC and AOD were significantly negatively correlated with SCI and RRB (P < 0.001). Medians; AOC: 24 months, AOD: 46 months and time lag: 17 months. Higher initial screen time was associated with diagnostic delay (P = 0.031). Conclusion First parental concerns and AOD were comparable to studies across countries. Speech/communication delays may represent universal first parental recognition of ASD.
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Affiliation(s)
- Subhashini Jayanath
- Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sally Ozonoff
- Department of Psychiatry and Behavioral Sciences, UC Davis MIND Institute, Sacramento, USA
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McClain MB, Harris B, Schwartz SE, Golson ME. Differential Item and Test Functioning of the Autism Spectrum Rating Scales: A Follow-Up Evaluation in a Diverse, Nonclinical Sample. JOURNAL OF PSYCHOEDUCATIONAL ASSESSMENT 2020. [DOI: 10.1177/0734282920945529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although the racial/ethnic demographics in the United States are changing, few studies evaluate the cultural and linguistic responsiveness of commonly used autism spectrum disorder screening and diagnostic assessment measures. The purpose of this study is to evaluate item and test functioning of the Autism Spectrum Rating Scales (ASRS) in a sample of racially/ethnically diverse parents of children (nonclinical) between the ages of 6–18 ( N = 806). This study is a follow-up to a prior publication examining the factor structure of the ASRS among a similar sample. The present study furthers the examination of measurement invariance of the ASRS in racially/ethnically diverse populations by conducting differential item functioning and differential test functioning with a larger sample. Results indicate test-level invariance; however, five items are noninvariant across parent reporters from different racial/ethnic groups. Implications for practice and directions for future research are discussed.
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Affiliation(s)
| | - Bryn Harris
- University of Colorado Denver, Denver, CO, USA
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Garcia Primo P, Weber C, Posada de la Paz M, Fellinger J, Dirmhirn A, Holzinger D. Explaining Age at Autism Spectrum Diagnosis in Children with Migrant and Non-Migrant Background in Austria. Brain Sci 2020; 10:brainsci10070448. [PMID: 32674382 PMCID: PMC7407505 DOI: 10.3390/brainsci10070448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/31/2022] Open
Abstract
This study explored (i) differences in age at Autism Spectrum Disorder (ASD) diagnosis between children with and without a migrant background in the main diagnostic centre for ASD in Upper Austria (ii) factors related to the age at diagnosis and (iii) whether specific factors differed between the two groups. A retrospective chart analysis included all children who received their first diagnosis before the age of 10 years (n = 211) between 2013 and 2018. Children with a migrant background were diagnosed 13 months earlier than those without (r = 0.278, p < 0.001), and had more severe delays in language, more severe autism, no Asperger’s syndrome, lower parental educational level and more frequent referrals by paediatricians. For the total sample, expressive language delay, severity of restricted and repetitive behaviours, higher nonverbal development, and paediatric referrals explained earlier diagnoses. There was a stronger effect of parental education and weaker effect of language impairment on age at ASD diagnosis in children with a migrant background. In conclusion, no delay in diagnosing ASD in children with a migrant background in a country with universal health care and an established system of paediatric developmental surveillance was found. Awareness of ASD, including Asperger’s syndrome, should be raised among families and healthcare professionals.
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Affiliation(s)
- Patricia Garcia Primo
- Research Institute of Developmental Medicine, Johannes Kepler University, 4020 Linz, Austria; (P.G.P.); (C.W.); (J.F.); (D.H.)
| | - Christoph Weber
- Research Institute of Developmental Medicine, Johannes Kepler University, 4020 Linz, Austria; (P.G.P.); (C.W.); (J.F.); (D.H.)
- Department for Inclusive Education, University of Education Upper Austria, 4020 Linz, Austria
| | - Manuel Posada de la Paz
- Institute of Rare Diseases Research (IIER) & CIBERER, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence:
| | - Johannes Fellinger
- Research Institute of Developmental Medicine, Johannes Kepler University, 4020 Linz, Austria; (P.G.P.); (C.W.); (J.F.); (D.H.)
- Institut für Sinnes- und Sprachneurologie, Konventhospital Barmherzige Brüder, 4020 Linz, Austria;
- Division of Social Psychiatry, Medical University of Vienna, 1010 Vienna, Austria
| | - Anna Dirmhirn
- Institut für Sinnes- und Sprachneurologie, Konventhospital Barmherzige Brüder, 4020 Linz, Austria;
| | - Daniel Holzinger
- Research Institute of Developmental Medicine, Johannes Kepler University, 4020 Linz, Austria; (P.G.P.); (C.W.); (J.F.); (D.H.)
- Institut für Sinnes- und Sprachneurologie, Konventhospital Barmherzige Brüder, 4020 Linz, Austria;
- Institute of Linguistics, Karl-Franzens University of Graz, 8010 Graz, Austria
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Autism Spectrum Disorders in Greece: Nationwide Prevalence in 10-11 Year-Old Children and Regional Disparities. J Clin Med 2020; 9:jcm9072163. [PMID: 32650567 PMCID: PMC7408756 DOI: 10.3390/jcm9072163] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 12/21/2022] Open
Abstract
Autism spectrum disorders (ASD) constitute a public health concern with increasing prevalence worldwide. We aimed to estimate prevalence and age at diagnosis in Greece, where no large-scale prevalence study has ever been conducted. Aggregate data were collected on ASD diagnoses by gender and calendar year of diagnosis up to 2019, for children born in 2008 and 2009, from the Centers for Educational and Counseling Support, which evaluate children to receive special educational support in school. Coverage was 87.1% of centers and 88.1% of schoolchildren born in 2008–9. ASD prevalence overall was 1.15% (1.83% males, 0.44% females; ratio 4.14:1), ranging from 0.59% to 1.50% in Greece’s 13 regions. In five regions, prevalence differed significantly between centers. Overall, only 3.8% of diagnoses were made before the fourth year after birth and 42.7% before the sixth year, with considerable variation between regions. Approximate mean age at diagnosis was six years and one month, and about three months earlier for girls than for boys. Our results provide evidence-based information to guide service planning and development at national and regional levels. Particular attention should be paid to smoothing out inequalities regarding service accessibility and provision. Emphasis should be given to earlier identification and diagnosis of ASD.
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de Leeuw A, Happé F, Hoekstra RA. A Conceptual Framework for Understanding the Cultural and Contextual Factors on Autism Across the Globe. Autism Res 2020; 13:1029-1050. [PMID: 32083402 PMCID: PMC7614360 DOI: 10.1002/aur.2276] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/02/2020] [Accepted: 01/24/2020] [Indexed: 12/14/2022]
Abstract
Autism research is heavily skewed toward western high-income countries. Culturally appropriate screening and diagnostic instruments for autism are lacking in most low- and middle-income settings where the majority of the global autism population lives. To date, a clear overview of the possible cultural and contextual factors that may affect the process of identifying and diagnosing individuals with autism spectrum disorders (ASD) is missing. This study aims to outline these factors by proposing a conceptual framework. A multidisciplinary review approach was applied to inform the development of the conceptual framework, combining a systematic review of the relevant autism research literature with a wider literature search spanning key texts in global mental health, cultural psychiatry, cross-cultural psychology, and intellectual disability research. The resulting conceptual framework considers the identification, help-seeking, and diagnostic process at four interrelated levels: (a) the expression; (b) recognition; (c) interpretation; and (d) reporting of autism symptoms, and describes the cultural and contextual factors associated with each of these levels, including cultural norms of typical and atypical behavior, culture-specific approaches to parenting, mental health literacy, cultural beliefs, attitudes and stigma, as well as the affordability, availability, accessibility, and acceptability of services. This framework, mapping out the cultural and contextual factors that can affect the identification, help-seeking, and diagnosis of ASD may function as a springboard for the development of culturally appropriate autism screening and diagnostic instruments, and inform future cross-cultural autism research directions. The framework also has relevance for clinicians and policy makers aiming to improve support for underserved autism populations worldwide. Autism Res 2020, 13: 1029-1050. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The vast majority of autism research is conducted in western high-income settings. We therefore know relatively little of how culture and context can affect the identification, help-seeking, and diagnosis of autism across the globe. This study synthesizes what is known from the autism research literature and a broader literature and maps out how culture and context may affect (a) the expression, (b) recognition, (c) interpretation, and (d) reporting of autism symptoms.
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Affiliation(s)
- Anne de Leeuw
- Amsterdam University Medical Centre, location VUmc, Amsterdam, The Netherlands
| | - Francesca Happé
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Rosa A Hoekstra
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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Htut M, Ho E, Wiles J. A Study of Asian Children Who are Diagnosed with Autism Spectrum Disorder and Available Support Services in Auckland, New Zealand. J Autism Dev Disord 2020; 50:1855-1865. [DOI: 10.1007/s10803-019-03936-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lee KS, Jung SJ, Yoo HJ, Shin YW, Cho YI. Validity and Reliability of the Behavior Development Screening for Toddlers-Questionnaire/Parents(BeDevel-Q/P): A Korean Autism Screening Instrument for Infants aged 24-35 Months. Psychiatry Investig 2020; 17:47-54. [PMID: 31995971 PMCID: PMC6992850 DOI: 10.30773/pi.2018.0271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 09/29/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study tested the validity and reliability of the Behavior Development Screening for Toddlers-Questionnaire-Parents (BeDevel-Q/P), a new autism spectrum disorder (ASD) screening instrument being developed in South Korea. The parents of 24-35-month-old infants were recruited to complete the questionnaire. METHODS The participants were 791 infants aged 24-35 months. There were 623 typically developing infants, 88 infants with ASD, and 80 developmentally delayed infants. For test-retest, the participants were surveyed every 1-4 weeks. Participants were recruited nationwide. Subjects' parents completed the BeDevel-Q/P and concurrent validity questionnaires. The data were used for statistical analysis. RESULTS A total of 24 items consisting of 16 items from factor 1 (F1), 6 items from factor 2 (F2), and 2 items from factor 3 (F3), were selected for the final BeDevel-Q/P items. CONCLUSION The factors of the screening instrument developed in this study were analyzed, and three factors were extracted, confirming the theoretical foundation of the BeDevel-Q for the parents of 24-35-month-old infants.
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Affiliation(s)
- Kyung Sook Lee
- Department of Rehabilitation, Hanshin University, Osan, Republic of Korea
| | - Suk Jin Jung
- Sewon Infant & Child Development Center, Seoul, Republic of Korea
| | - Hee Jeong Yoo
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yong Woo Shin
- Department of Psychology, Sungshin University, Seoul, Republic of Korea
| | - Young Il Cho
- Department of Psychology, Sungshin University, Seoul, Republic of Korea
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Abstract
The article presents findings from the validation of the Polish version of the Short Sensory Profile, 2nd edition (SSP-2-PL).A total of 1230 participants were recruited: 310 diagnosed with autism spectrum disorder (ASD), 264 with nonspectrum neurodevelopmental disorders, and 656 typically developing (TD). The reliability and validity of the questionnaire were estimated using several methods, including internal consistency, test-retest, and factor analysis.Exploratory factor analysis identified a unidimensional solution in both the TD and ASD groups. The structure of SSP-2 seems to be homogeneous; therefore, the findings support the validity of calculating the SSP-2 overall score. Cronbach alphas and intraclass correlation coefficients exceeded 0.90 for overall total in all study groups. The Social Communication Questionnaire total score correlated moderately with SSP-2 scores. A 1-way analysis of variance yielded statistically significant differences at P < .001 between groups on all scales/quadrants and the overall score. Our results indicate greater severity of sensory processing problems among children with ASD and non-ASD disorders than among TD peers. Among children with ASD, 85% experienced problems with sensory processing. Scores in SSP-2-PL were not affected by the children's age, gender, informant, and informant's level of education.To the best of our knowledge, this is the 1st study on non-English participants using a revised version of the SSP-2. The results confirm the prevalence of sensory processing problems among children with neurodevelopmental disorders, especially with ASD. SSP-2-PL has high reliability in terms of both internal consistency and stability of scores. The results suggest that SSP-2 overall score could be used for screening purposes, namely to identify sensory processing and behavioral problems combined into one factor. Further analyzes of the SSP-2 factor structure are needed to confirm the findings of the present study.
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Niedźwiecka A, Domasiewicz Z, Kawa R, Tomalski P, Pisula E. Sensory processing in toddlers with autism spectrum disorders. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2019. [DOI: 10.1080/17405629.2019.1676715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Alicja Niedźwiecka
- Department of Health and Rehabilitation Psychology, Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | | | - Rafał Kawa
- Department of Health and Rehabilitation Psychology, Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Przemysław Tomalski
- Developmental Psychology Unit, Faculty of Psychology, University of Warsaw, Warsaw, Poland
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Ewa Pisula
- Department of Health and Rehabilitation Psychology, Faculty of Psychology, University of Warsaw, Warsaw, Poland
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Kašćelan D, Katsos N, Gibson JL. Relations Between Bilingualism and Autistic-Like Traits in a General Population Sample of Primary School Children. J Autism Dev Disord 2019; 49:2509-2523. [PMID: 30976960 PMCID: PMC6546658 DOI: 10.1007/s10803-019-03994-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Some evidence suggests that bilingualism improves communication and cognitive skills which are often impaired in autism. However, diagnosing autism in bilinguals may suffer a cultural bias, which can affect the investigation of bilingualism and autism. Therefore, the current study investigates relations between autistic-like traits (ALTs) and bilingualism in a general population sample of 394 children (M age = 8;3). Within the high-scoring group on the ALT measure, monolinguals had significantly higher ALT scores than bilinguals. There were no differences between monolinguals and bilinguals in the low-scoring group. Across the whole sample, age and structural language skills accounted for 35% variance in ALTs, while bilingualism had no effect on ALTs. Furthermore, structural language skills explained more variance in ALTs among bilinguals than among monolinguals.
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Affiliation(s)
- Draško Kašćelan
- Faculty of Modern and Medieval Languages, University of Cambridge, Raised Faculty Building, Sidgwick Avenue, Cambridge, CB3 9DA, UK.
| | - Napoleon Katsos
- Faculty of Modern and Medieval Languages, University of Cambridge, Raised Faculty Building, Sidgwick Avenue, Cambridge, CB3 9DA, UK
| | - Jenny L Gibson
- Faculty of Education, University of Cambridge, 184 Hills Road, Cambridge, CB2 8PQ, UK
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Al Khateeb JM, Kaczmarek L, Al Hadidi MS. Parents’ perceptions of raising children with autism spectrum disorders in the United States and Arab countries: A comparative review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:1645-1654. [DOI: 10.1177/1362361319833929] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Four databases were searched to identify studies published by Arab researchers on parents’ perceptions of autism spectrum disorder and studies conducted by US researchers and published in systematic reviews of this topic. The electronic search resulted in 14 studies published by Arab researchers and 55 studies published by US researchers. The results showed that autism spectrum disorder has many of the same effects on Arab and American families. Six major areas were identified in the results. Financial difficulties associated with raising children with autism spectrum disorder were mentioned more in Arab studies than in US studies. Arab studies had more emphasis on gender than US studies. The results related to quality of life of parents of children with autism spectrum disorder in Arab studies were equivocal. US studies included comparisons with families without a child with autism spectrum disorder, and addressed factors that were associated with quality of life indicators. More health, educational, and social services were available in United States than in Arab countries, but some frustration was reported by US parents in obtaining appropriate services in some studies. A higher percentage of Arab studies mentioned the role of religious faith than US studies. Finally, social stigma was evidenced in both cultures, but not much research was available.
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Moseley RL, Hitchiner R, Kirkby JA. Self-reported sex differences in high-functioning adults with autism: a meta-analysis. Mol Autism 2018; 9:33. [PMID: 29796237 PMCID: PMC5960195 DOI: 10.1186/s13229-018-0216-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 04/30/2018] [Indexed: 12/21/2022] Open
Abstract
Background Sex differences in autistic symptomatology are believed to contribute to the mis- and missed diagnosis of many girls and women with an autism spectrum condition (ASC). Whilst recent years have seen the emergence of clinical and empirical reports delineating the profile of young autistic girls, recognition of sex differences in symptomatology in adulthood is far more limited. Methods We chose here to focus on symptomatology as reported using a screening instrument, the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R). In a meta-analysis, we pooled and analysed RAADS-R data from a number of experimental groups. Analysis of variance (ANOVA) searched for the presence of main effects of Sex and Diagnosis and for interactions between these factors in our sample of autistic and non-autistic adults. Results In social relatedness and circumscribed interests, main effects of Diagnosis revealed that as expected, autistic adults reported significantly greater lifetime prevalence of symptoms in these domains; an effect of Sex, in circumscribed interests, also suggested that males generally reported more prevalent symptoms than females. An interaction of Sex and Diagnosis in language symptomatology revealed that a normative sex difference in language difficulties was attenuated in autism. An interaction of Sex and Diagnosis in the sensorimotor domain revealed the opposite picture: a lack of sex differences between typically developing men and women and a greater prevalence of sensorimotor symptoms in autistic women than autistic men. Conclusions We discuss the literature on childhood sex differences in relation to those which emerged in our adult sample. Where childhood sex differences fail to persist in adulthood, several interpretations exist, and we discuss, for example, an inherent sampling bias that may mean that only autistic women most similar to the male presentation are diagnosed. The finding that sensorimotor symptomatology is more highly reported by autistic women is a finding requiring objective confirmation, given its potential importance in diagnosis. Electronic supplementary material The online version of this article (10.1186/s13229-018-0216-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R L Moseley
- Department of Psychology, Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB UK
| | - R Hitchiner
- Department of Psychology, Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB UK
| | - J A Kirkby
- Department of Psychology, Bournemouth University, Fern Barrow, Poole, Dorset, BH12 5BB UK
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Restricted and Repetitive Behaviors in Autism Spectrum Disorder: a Review of Associated Features and Presentation Across Clinical Populations. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018. [DOI: 10.1007/s40474-018-0139-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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46
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Miyasaka M, Kajimura S, Nomura M. Biases in Understanding Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder in Japan. Front Psychol 2018. [PMID: 29541049 PMCID: PMC5836146 DOI: 10.3389/fpsyg.2018.00244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Recent research has shown high rates of comorbidity between attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) and difficulties regarding differential diagnosis. Unlike those in Western countries, the Japanese ADHD prevalence rate is lower relative to that of ASD. This inconsistency could have occurred because of cultural diversities among professionals such as physicians. However, little is known about attitudes toward ADHD and ASD in non-Western cultural contexts. We conducted two experiments to identify biases in ASD and ADHD assessment. In Study 1, we examined attitudes toward these disorders in medical doctors and mental health professionals, using a web-based questionnaire. In Study 2, medical doctors and clinical psychologists assessed four fictional cases based on criteria for ADHD, ASD, oppositional defiant disorder, and disinhibited social engagement disorder (DSED). Diagnosis of ASD was considered more difficult relative to that of ADHD. Most participants assessed the fictional DSED case as ASD, rather than DSED or ADHD. The results provide evidence that Japanese professionals are more likely to attribute children’s behavioral problems to ASD, relative to other disorders. Therefore, Japanese therapists could be more sensitive to and likely to diagnose ASD, relative to therapists in other countries. These findings suggest that cultural biases could influence clinicians’ diagnosis of ADHD and ASD.
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Affiliation(s)
- Mami Miyasaka
- Department of Cognitive Psychology in Education, Graduate School of Education, Kyoto University, Kyoto, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Shogo Kajimura
- Japan Society for the Promotion of Science, Tokyo, Japan.,Brain Science Institute, Tamagawa University, Tokyo, Japan
| | - Michio Nomura
- Department of Cognitive Psychology in Education, Graduate School of Education, Kyoto University, Kyoto, Japan
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do Egito JHT, Ferreira GMR, Gonçalves MI, Osório AAC. Brief Report: Factor Analysis of the Brazilian Version of the Adult Autism Spectrum Quotient. J Autism Dev Disord 2017; 48:1847-1853. [DOI: 10.1007/s10803-017-3424-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chojnicka I, Pisula E. Adaptation and Validation of the ADOS-2, Polish Version. Front Psychol 2017; 8:1916. [PMID: 29163293 PMCID: PMC5681938 DOI: 10.3389/fpsyg.2017.01916] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 10/16/2017] [Indexed: 11/13/2022] Open
Abstract
Autism Diagnostic Observation Schedule (ADOS) is one of the most popular instruments used world-widely in the diagnosis of autism spectrum disorders (ASD). Unfortunately, there are only a few studies of the psychometric properties of non-English language versions of this instrument and none of the adaptation of its second edition (ADOS-2). The objective of this study was to verify the psychometric properties of the Polish version of the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2-PL). The authors recruited 401 participants: 193 with ASDs (ASD group) and 78 with non-spectrum disorders, plus 130 typically developing participants (control group). ADOS-2-PL was found to have high interrater reliability, internal consistency and test-retest reliability. Confirmatory factor analysis confirmed a good fit of the Polish data to the two-factor model of ADOS-2. As no significant differences were found between participants with childhood autism and other ASDs, only one cut-off was established for Modules 1-4. The sensitivity, specificity and positive predictive value of ADOS-2-PL are high: sensitivity was over 90% (only for the "Older with some words" algorithm in the Toddler Module the sensitivity was 71% and "Aged 5 years or older" algorithm in Module 2 sensitivity was 84%), specificity was above 80% (with the exception of the Module 4 and Module 2 "Aged 5 years or older" algorithm where it was above 70%). The results support the use of ADOS-2-PL in clinical practice and scientific research. To the best of our knowledge, there have been no reports to date about adaptations of ADOS-2 and the psychometric properties of non-English language versions. As such, this constitutes the first attempt at adapting ADOS-2, and its results could be of interest for researchers outside of Poland.
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Affiliation(s)
| | - Ewa Pisula
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
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Harrison AJ, Long KA, Tommet DC, Jones RN. Examining the Role of Race, Ethnicity, and Gender on Social and Behavioral Ratings Within the Autism Diagnostic Observation Schedule. J Autism Dev Disord 2017; 47:2770-2782. [DOI: 10.1007/s10803-017-3176-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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