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Gentles SJ, Ng-Cordell EC, Hunsche MC, McVey AJ, Bednar ED, DeGroote MG, Chen YJ, Duku E, Kerns CM, Banfield L, Szatmari P, Georgiades S. Trajectory research in children with an autism diagnosis: A scoping review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:540-564. [PMID: 37194194 PMCID: PMC10913344 DOI: 10.1177/13623613231170280] [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] [Indexed: 05/18/2023]
Abstract
LAY ABSTRACT The types of outcomes studied in children on the autism spectrum include clinical characteristics, such as social functioning, communication, language, or autism symptoms. Research that measures these outcomes at multiple timepoints is useful to improve our understanding of what to expect as children develop. In trajectory studies, researchers assess outcomes at three or more timepoints. This method has advantages over two-timepoint studies because it allows researchers to describe changes in the speed of development, such as accelerations, plateaus, or slowdowns. We identified and reviewed 103 published trajectory studies in children (to age 18 years) with an autism diagnosis. Importantly, we did not include studies of treatments or their effects, nor did we summarize the results of studies. Instead, this review summarizes the characteristics of the available published research, including the methods used, the many different outcomes that have been studied over time and the ages over which they have been studied. This summary may be of interest to autistic people and caregivers (parents) who want to know about the existence of research that provides answers about what to expect during an autistic child's development. We have recommended that future trajectory research efforts try to make up for the lack of studies from low- and middle-income countries; that more attention is given to the following outcomes that are meaningful to caregivers and autistic people; and to try to fill in the age gaps where more outcome-specific data are needed.
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2
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Huang CY, Chen KS, Lee KY, Lin CH, Chen KL. Different autism measures targeting different severity levels in children with autism spectrum disorder. Eur Arch Psychiatry Clin Neurosci 2024; 274:27-33. [PMID: 37624379 DOI: 10.1007/s00406-023-01673-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
The Childhood Autism Rating Scale™, Second Edition (CARS™-2) and Social Responsiveness Scale™, Second Edition (SRS™-2) are two measures for identifying autism symptoms. The CARS™-2 has two versions: Standard (CARS-ST) and High-Functioning (CARS-HF). To better understand their properties, this study aimed to investigate: (1) the associations among the CARS-ST, CARS-HF and the SRS™-2, and (2) the severity consistency between the CARS-ST and the CARS-HF. A sample of 125 children with autism spectrum disorder was recruited (mean age: 80.98 months, SD = 16.08). Based on Verbal Comprehension Index (VCI), children were divided into two groups: low severity level of autism spectrum disorder (LSL-ASD: VCI ≥ 80) and high severity level of autism spectrum disorder (HSL-ASD: VCI < 80). All children were evaluated with the CARS-ST and the SRS™-2, and the HF group, with the CARS-HF as well. In the LSL group, the CARS-ST and the CARS-HF had high correlation (r = 0.852, p < .001). Both versions had small to moderate correlations with the SRS™-2 (r = 0.130-0.491). In the HSL group, no significant correlations were found between the CARS-ST and SRS™-2 (p > .05). The CARS-HF and the CARS-ST had low severity consistency (Kappa = 0.376, p < .01). The CARS-ST and the CARS-HF had high correlations but low severity consistency. Different correlation patterns were found between the CARS™-2 and the SRS™-2 in the LSL and HSL groups. The results should help clinicians better understand the properties of the measures and choose appropriate measures when assessing autism symptoms.
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Affiliation(s)
- Chien-Yu Huang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Shu Chen
- Department of Child & Adolescent Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Kuan-Ying Lee
- Department of Child and Adolescent Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan
| | - Chien-Ho Lin
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
| | - Kuan-Lin Chen
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No. 1 University Road, Tainan City, 701, Taiwan.
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Montazeri F, Buitelaar JK, Oosterling IJ, de Bildt A, Anderson GM. Network Structure of Autism Spectrum Disorder Behaviors and Its Evolution in Preschool Children: Insights from a New Longitudinal Network Analysis Method. J Autism Dev Disord 2023; 53:4293-4307. [PMID: 36066728 DOI: 10.1007/s10803-022-05723-8] [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] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
Network modeling of the social, communication and restrictive/repetitive behaviors (RRBs) included in the definition of Autism Spectrum Disorder was performed. The Autism Diagnostic Interview-Revised (ADI-R) assessed behaviors in 139 pre-school cases at two cross-sections that averaged 34.8 months apart. Cross-sectional networks were based on the correlation matrix of the ADI-R behavioral items and the "bootCross" method was developed and enabled the estimation of a longitudinal network. At both stages, RRB items/nodes formed a consistent peripheral cluster, while social and communication nodes formed a core cluster that diverged with time. These differences in the nature and evolution of the RRB and socio-communicative dimensions indicate that their inter-behavior dynamics are very different. The most central behaviors across stages are proposed as prime targets for efficient therapeutic intervention.
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Affiliation(s)
- Farhad Montazeri
- Child Study Center, Yale University School of Medicine, 230 S. Frontage Rd, New Haven, CT, USA.
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Iris J Oosterling
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Annelies de Bildt
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Lübeckweg 2, NL-9723 HE, Groningen, The Netherlands
- Accare, Child Study Center, Groningen, The Netherlands
| | - George M Anderson
- Child Study Center, Yale University School of Medicine, 230 S. Frontage Rd, New Haven, CT, USA
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Fountain C, Winter AS, Cheslack-Postava K, Bearman PS. Developmental Trajectories of Autism. Pediatrics 2023; 152:e2022058674. [PMID: 37615073 PMCID: PMC10551845 DOI: 10.1542/peds.2022-058674] [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] [Accepted: 06/07/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVES The goal of this study was to describe the typical, longitudinal, developmental trajectories of communication and social functioning in individuals with autism spectrum disorder from childhood through adulthood and to determine the correlates of these trajectories. METHODS Children with autism spectrum disorder who were born in California from 1992 through 2016 and enrolled with the California Department of Developmental Services were identified. Subjects with <4 evaluations in the database were excluded, resulting in a sample of 71 285 individuals. Score sequences were constructed based on evaluative items for communication and social functioning. Typical trajectories were identified using group-based latent trajectory modeling, and logistic regression was used to determine the odds of classification into a social adolescent decline trajectory by individual-, family-, and zip code-level factors. RESULTS Six typical patterns of communication functioning and 7 typical patterns of social functioning were identified. Whereas the majority of autistic individuals exhibit improved communication functioning as they age, the majority of individuals exhibit steady social functioning. A small group of individuals (5.0%) exhibits high social functioning in childhood that declines in adolescence. Membership in this adolescent decline group is associated with maternal non-Hispanic white race and ethnicity, female sex, moderate levels of maternal education, lower zip code-level median home values and population density, and higher zip code-level inequality. CONCLUSIONS Most autistic individuals show improved communication and social functioning as they age, but not all do. Trajectory group membership is correlated with socioeconomic status. Future research should investigate what drives these correlations.
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Affiliation(s)
- Christine Fountain
- Department of Anthropology & Sociology, Fordham
University, New York, NY
| | - Alix S. Winter
- Interdisciplinary Center for Innovative Theory and
Empirics, Columbia University, New York, NY
| | | | - Peter S. Bearman
- Interdisciplinary Center for Innovative Theory and
Empirics, Columbia University, New York, NY
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5
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Montagner PSS, Medeiros W, da Silva LCR, Borges CN, Brasil-Neto J, de Deus Silva Barbosa V, Caixeta FV, Malcher-Lopes R. Individually tailored dosage regimen of full-spectrum Cannabis extracts for autistic core and comorbid symptoms: a real-life report of multi-symptomatic benefits. Front Psychiatry 2023; 14:1210155. [PMID: 37671290 PMCID: PMC10475955 DOI: 10.3389/fpsyt.2023.1210155] [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: 04/25/2023] [Accepted: 07/24/2023] [Indexed: 09/07/2023] Open
Abstract
Autism Spectrum Disorders (ASD) may significantly impact the well-being of patients and their families. The therapeutic use of cannabis for ASD has gained interest due to its promising results and low side effects, but a consensus on treatment guidelines is lacking. In this study, we conducted a retrospective analysis of 20 patients with autistic symptoms who were treated with full-spectrum cannabis extracts (FCEs) in a response-based, individually-tailored dosage regimen. The daily dosage and relative proportions of cannabidiol (CBD) and tetrahydrocannabinol (THC) were adjusted based on treatment results following periodic clinical evaluation. Most patients (80%) were treated for a minimum of 6 months. We have used a novel, detailed online patient- or caregiver-reported outcome survey that inquired about core and comorbid symptoms, and quality of life. We also reviewed patients' clinical files, and no individual condition within the autistic spectrum was excluded. This real-life approach enabled us to gain a clearer appraisal of the ample scope of benefits that FCEs can provide for ASD patients and their families. Eighteen patients started with a CBD-rich FCE titrating protocol, and in three of them, the CBD-rich (CBD-dominant) FCE was gradually complemented with low doses of a THC-rich (THC-dominant) FCE based on observed effects. Two other patients have used throughout treatment a blend of two FCEs, one CBD-rich and the other THC-rich. The outcomes were mainly positive for most symptoms, and only one patient from each of the two above-mentioned situations displayed important side effects one who has used only CBD-rich FCE throughout the treatment, and another who has used a blend of CBD-Rich and THC-rich FCEs. Therefore, after FCE treatment, 18 out of 20 patients showed improvement in most core and comorbid symptoms of autism, and in quality of life for patients and their families. For them, side effects were mild and infrequent. Additionally, we show, for the first time, that allotriophagy (Pica) can be treated by FCEs. Other medications were reduced or completely discontinued in most cases. Based on our findings, we propose guidelines for individually tailored dosage regimens that may be adapted to locally available qualified FCEs and guide further clinical trials.
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Affiliation(s)
| | - Wesley Medeiros
- Laboratory of Neuroscience and Behavior, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brasília, Brazil
| | - Leandro Cruz Ramires da Silva
- Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Brazilian Association of Medical Cannabis Patients, Ama-Me, Belo Horizonte, Brazil
| | - Clarissa Nogueira Borges
- Specialized Educational Care Division for Gifted Students of the Department of Education of the Federal District, Brasília, Brazil
| | | | - Vinícius de Deus Silva Barbosa
- Medical Cannabis Center–Syrian-Lebanese Hospital, São Paulo, Brazil
- National Association for Inclusion of the Autistic People, São Paulo, Brazil
| | - Fabio V. Caixeta
- Laboratory of Neuroscience and Behavior, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brasília, Brazil
| | - Renato Malcher-Lopes
- Laboratory of Neuroscience and Behavior, Department of Physiological Sciences, Institute of Biological Sciences, University of Brasilia, Brasília, Brazil
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Advancing research on early autism through an integrated risk and resilience perspective. Dev Psychopathol 2023; 35:44-61. [PMID: 35379370 DOI: 10.1017/s0954579421001437] [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: 11/05/2022]
Abstract
To date, a deficit-oriented approach dominates autism spectrum disorder (ASD) research, including studies of infant siblings of children with ASD at high risk (HR) for the disabilities associated with this disorder. Despite scientific advances regarding early ASD-related risk, there remains little systematic investigation of positive development, limiting the scope of research and quite possibly a deeper understanding of pathways toward and away from ASD-related impairments. In this paper, we argue that integrating a resilience framework into early ASD research has the potential to enhance knowledge on prodromal course, phenotypic heterogeneity, and developmental processes of risk and adaptation. We delineate a developmental systems resilience framework with particular reference to HR infants. To illustrate the utility of a resilience perspective, we consider the "female protective effect" and other evidence of adaptation in the face of ASD-related risk. We suggest that a resilience framework invites focal questions about the nature, timing, levels, interactions, and mechanisms by which positive adaptation occurs in relation to risk and developmental pathways toward and away from ASD-related difficulties. We conclude with recommendations for future research, including more focus on adaptive development and multisystem processes, pathways away from disorder, and reconsideration of extant evidence within an integrated risk-and-resilience framework.
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7
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Ilan M, Faroy M, Zachor D, Manelis L, Waissengreen D, Michaelovski A, Avni I, Menashe I, Koller J, Dinstein I, Meiri G. Children with autism exhibit similar longitudinal changes in core symptoms when placed in special or mainstream education settings. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023:13623613221142394. [PMID: 36632654 PMCID: PMC10375002 DOI: 10.1177/13623613221142394] [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: 01/13/2023]
Abstract
LAY ABSTRACT Today, children with autism spectrum disorder (ASD) are placed in mainstream or special education settings somewhat arbitrarily with no clear clinical recommendations. Here, we compared changes in core ASD symptoms, as measured by the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) clinical assessment, across ASD preschool children placed in special or mainstream education. Longitudinal changes in ADOS-2 scores did not differ significantly across settings over a 1- to 2-year period. While some children improved in core ASD symptoms, others deteriorated in both settings. This highlights the need to identify specific criteria for establishing meaningful placement recommendations.
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Affiliation(s)
- Michal Ilan
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel
| | - Michal Faroy
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel.,The Academic College of Tel Aviv-Yaffo, Israel
| | | | - Liora Manelis
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel
| | - Danel Waissengreen
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel
| | | | - Inbar Avni
- Ben-Gurion University of the Negev, Israel
| | | | | | | | - Gal Meiri
- Ben-Gurion University of the Negev, Israel.,Soroka University Medical Center, Israel
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8
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Pickles A, Wright N, Bedford R, Steiman M, Duku E, Bennett T, Georgiades S, Kerns CM, Mirenda P, Smith IM, Ungar WJ, Vaillancourt T, Waddell C, Zaidman‐Zait A, Zwaigenbaum L, Szatmari P, Elsabbagh M. Predictors of language regression and its association with subsequent communication development in children with autism. J Child Psychol Psychiatry 2022; 63:1243-1251. [PMID: 35098539 PMCID: PMC9786608 DOI: 10.1111/jcpp.13565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Language regression, broadly defined as the loss of acquired language skills in early childhood, is a distinctive feature of autism. Little is known about the factors underlying regression or the prognosis of children who exhibit regression. We examine potential predictors of language regression and test its association with language development in a prospective longitudinal sample of children with autism spectrum disorder (ASD) from diagnosis to age 10 years. METHODS We analysed data from Pathways in ASD, a prospective longitudinal study of 421 children enrolled around the time of an autism diagnosis between 2 and 5 years. Autism Diagnostic Interview-Revised data were available for 408 children, of whom 90 (22%) were classified as having language regression. RESULTS Demographic and other health factors including caregiver education, family income, child sex, reported seizures, and age of enrolment did not differ between children with and without language regression. Children with language regression walked earlier and attained first words sooner than those without regression. However, both groups attained phrase speech at comparable ages. Those with regression exhibited greater delays in expressive and receptive communication over the follow-up period, although this effect was attenuated when accounting for baseline differences in motor and cognitive ability. Overall, those with language regression continued to exhibit expressive but not receptive communication delay compared to those without regression. Communication trajectories were heterogeneous to age 10 years, irrespective of regression status. CONCLUSIONS Although language regression can be alarming, our findings confirm that its occurrence does not necessarily foreshadow worse developmental outcomes relative to those without regression. Although a discrepancy in age-equivalent communication skills may persist, this can be expected to be of less practical importance with rising average levels of skills. Future studies need to account for the significant variability in language trajectories by considering factors beyond developmental regression.
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Affiliation(s)
- Andrew Pickles
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Nicola Wright
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | | | - Mandy Steiman
- Azrieli Centre for Autism ResearchMontreal Neurological HospitalMcGill UniversityMontrealQCCanada
| | | | | | | | | | - Pat Mirenda
- University of British ColumbiaVancouverBCCanada
| | | | - Wendy J. Ungar
- Hospital for Sick Children Research InstituteUniversity of TorontoTorontoONCanada
| | | | | | | | | | - Peter Szatmari
- Hospital for Sick Children Research InstituteUniversity of TorontoTorontoONCanada
| | - Mayada Elsabbagh
- Azrieli Centre for Autism ResearchMontreal Neurological HospitalMcGill UniversityMontrealQCCanada
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9
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Sex- and age-related differences in autistic behaviours in children with neurofibromatosis type 1. J Autism Dev Disord 2022:10.1007/s10803-022-05571-6. [PMID: 35445370 DOI: 10.1007/s10803-022-05571-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
Abstract
This study investigated sex and age differences in autistic behaviours in children with neurofibromatosis type 1 (NF1) who scored within the clinical range on the Social Responsiveness Scale - Second Edition (T score ≥ 60). Thirty-four males and 28 females (3-16 years) were assessed with the Autism Diagnostic Observation Schedule - Second Edition and Autism Diagnostic Interview - Revised. Across both measures, males exhibited greater social communication deficits relative to females. Age-related abatement of social communication difficulties was observed for males but not females. Conversely, no sex differences were found for restricted/repetitive behaviours, which were stable over time for both males and females. The findings are discussed within the context of broader neurodevelopmental considerations that are common in NF1.
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10
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Fombonne E, Croen LA, Bulkley JE, Varga AM, Daida YG, Hatch BA, Dickerson JF, Lynch FL. Emotional and Behavioral Problems in Youth with Autism: High Prevalence and Impact on Functioning. J Dev Behav Pediatr 2022; 43:140-148. [PMID: 34693924 PMCID: PMC9021329 DOI: 10.1097/dbp.0000000000001028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Emotional and behavioral problems (EBPs) may co-occur with autism spectrum disorder (ASD) and impair children's functioning beyond autism symptomatology. We compared the prevalence of EBPs in youths with or without ASD and evaluated their unique contribution to impairment in ASD. METHODS We surveyed 1267 children (79.4% boys, mean age: 9.2 years, range: 3-17) recruited at 3 sites in Kaiser Permanente and OCHIN primary care clinical networks, with confirmed International Classification of Diseases-10th ed. diagnosis of ASD (N = 564), asthma (N = 468), or neither (N = 429). Children from the 2 comparison groups were age-matched and sex-matched to the ASD group. EBPs and impairment were measured by the Strengths and Difficulties Questionnaire and autism symptomatology by the Social Responsiveness Scale in the ASD group only. RESULTS EBPs and impairment mean scores were significantly (p < 0.001) higher in participants with ASD compared with children from the 2 comparison groups, across sexes and age groups, with no significant difference between the asthma and control groups. Among children with ASD, both EBPs and autistic symptoms were significantly correlated with impairment (r = 0.64 and r = 0.65, respectively) and explained a significant proportion of impairment variance (R2 = 0.525; p < 0.001) in multiple linear regression. In the relative importance analysis, EBPs and autistic symptoms explained comparable proportions of impairment variance (46% and 52%, respectively) with no significant difference between their relative weights (mean difference: 0.03; 95% confidence interval: -0.049 to 0.114). CONCLUSION Among youth with ASD, high levels of EBPs impair daily functioning as much as autistic symptoms. Systematic detection and management of EBPs may improve functioning and outcomes in youth with ASD.
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Affiliation(s)
| | | | - Joanna E. Bulkley
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | | | - Yihe G. Daida
- Center for Integrated Health Care Research, Kaiser Permanente, Honolulu, HI
| | - Brigit A. Hatch
- Oregon Health & Science University, Portland, OR
- OCHIN, Inc., Portland, OR
| | - John F. Dickerson
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Frances L. Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR
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11
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Wiggins LD, Tian LH, Rubenstein E, Schieve L, Daniels J, Pazol K, DiGuiseppi C, Barger B, Moody E, Rosenberg S, Bradley C, Hsu M, Rosenberg CR, Christensen D, Crume T, Pandey J, Levy SE. Features that best define the heterogeneity and homogeneity of autism in preschool-age children: A multisite case-control analysis replicated across two independent samples. Autism Res 2022; 15:539-550. [PMID: 34967132 PMCID: PMC9048225 DOI: 10.1002/aur.2663] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/15/2021] [Accepted: 12/09/2021] [Indexed: 11/12/2022]
Abstract
The heterogeneous nature of children with symptoms of autism spectrum disorder (ASD) makes it difficult to identify risk factors and effective treatment options. We sought to identify behavioral and developmental features that best define the heterogeneity and homogeneity in 2-5-year-old children classified with ASD and subthreshold ASD characteristics. Children were enrolled in a multisite case-control study of ASD. Detailed behavioral and developmental data were gathered by maternal telephone interview, parent-administered questionnaires, child cognitive evaluation, and ASD diagnostic measures. Participants with a positive ASD screen score or prior ASD diagnosis were referred for comprehensive evaluation. Children in the ASD group met study criteria based on this evaluation; children who did not meet study criteria were categorized as having subthreshold ASD characteristics. There were 1480 children classified as ASD (81.6% boys) and 594 children classified as having subthreshold ASD characteristics (70.2% boys) in the sample. Factors associated with dysregulation (e.g., aggression, anxiety/depression, sleep problems) followed by developmental abilities (e.g., expressive and receptive language skills) most contributed to heterogeneity in both groups of children. Atypical sensory response contributed to homogeneity in children classified as ASD but not those with subthreshold characteristics. These findings suggest that dysregulation and developmental abilities are clinical features that can impact functioning in children with ASD and other DD, and that documenting these features in pediatric records may help meet the needs of the individual child. Sensory dysfunction could be considered a core feature of ASD and thus used to inform more targeted screening, evaluation, treatment, and research efforts. LAY SUMMARY: The diverse nature of autism spectrum disorder (ASD) makes it difficult to find risk factors and treatment options. We identified the most dissimilar and most similar symptom(s) in children classified as ASD and as having subthreshold ASD characteristics. Factors associated with dysregulation and developmental abilities contributed to diversity in both groups of children. Sensory dysfunction was the most common symptom in children with ASD but not those with subthreshold characteristics. Findings can inform clinical practice and research.
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Affiliation(s)
- Lisa D. Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lin H. Tian
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric Rubenstein
- Department of Epidemiology, Boston University, Boston, Massachusetts, USA
| | - Laura Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julie Daniels
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Karen Pazol
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Brian Barger
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Eric Moody
- Institute for Disabilities, University of Wyoming, Laramie, Wyoming, USA
| | - Steven Rosenberg
- Anschutz Medical Campus, University of Colorado, Boulder, Colorado, USA
| | - Chyrise Bradley
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Melanie Hsu
- The Autism Research Program, Kaiser Permanente Northern California, Oakland, California, USA
| | | | - Deborah Christensen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tessa Crume
- Anschutz Medical Campus, University of Colorado, Boulder, Colorado, USA
| | - Juhi Pandey
- Center for Autism Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Susan E. Levy
- Center for Autism Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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12
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Waizbard-Bartov E, Ferrer E, Heath B, Rogers SJ, Nordahl CW, Solomon M, Amaral DG. Identifying autism symptom severity trajectories across childhood. Autism Res 2022; 15:687-701. [PMID: 35084115 DOI: 10.1002/aur.2674] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/03/2022] [Accepted: 01/09/2022] [Indexed: 12/25/2022]
Abstract
An individual's autism symptom severity level can change across childhood. The prevalence and direction of change, however, are still not well understood. Nor are the characteristics of children that experience change. Symptom severity trajectories were evaluated from early to middle childhood (approximately ages 3-11) for 182 autistic children. Symptom severity change was evaluated using individual change scores and the Reliable Change Index. Fifty-one percent of participants experienced symptom severity change: 27% of children decreased in severity, 24% increased and 49% were stable. Symptom severity decreases were more common during early childhood. Severity increases occurred at both early and middle childhood but increase in social affect severity was especially prominent during middle childhood. Most children experienced significant change during only one period and remained stable during the other. Girls decreased more and increased less in symptom severity than boys. Children that increased in severity decreased in adaptive functioning across childhood. Exploratory analyses indicated that a decrease in severity was associated with higher parental education level and older parental age at the time of the child's birth. Conversely, increase in autism severity was associated with lower parental education level and younger parental age at the child's birth. These findings extend recent observations that symptom severity change is more likely than previously appreciated. An understanding of the role of both biological and sociodemographic factors in determining a child's symptom trajectory may factor into future decisions on allocation and type of interventions distributed to young autistic children. LAY SUMMARY: We studied whether a child's autism severity changed from initial diagnosis until middle childhood (ages 3-11). We found that 27% of the children decreased in severity, 24% increased and the rest stayed the same. Symptom severity decreases were more common during early childhood while severity increases were more prominent during middle childhood. We also found that girls were more likely to decrease than boys. Whether a child decreased or increased is related, in part, to parental characteristics.
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Affiliation(s)
- Einat Waizbard-Bartov
- Department of Psychology, University of California Davis, Davis, California, USA.,The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA
| | - Emilio Ferrer
- Department of Psychology, University of California Davis, Davis, California, USA
| | - Brianna Heath
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA
| | - Sally J Rogers
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA
| | - Christine Wu Nordahl
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA
| | - Marjorie Solomon
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA
| | - David G Amaral
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA
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13
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Abstract
Over the past four decades there have been significant advances in our understanding of autism, yet services for autistic adults continue to lag far behind those for children, and prospects for employment and independent living remain poor. Adult outcomes also vary widely and while cognitive and language abilities are important prognostic indicators, the influence of social, emotional, familial and many other factors remains uncertain. For this special issue marking the 40th anniversary of DSM-III, the present paper describes the changing perspectives of autism in adulthood that have occurred over this period, explores individual and wider environmental factors related to outcome, and suggests ways in which services need to be changed to improve the future for adults living with autism.
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Affiliation(s)
- Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.
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14
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Riglin L, Wootton RE, Thapar AK, Livingston LA, Langley K, Collishaw S, Tagg J, Smith GD, Stergiakouli E, Tilling K, Thapar A. Variable Emergence of Autism Spectrum Disorder Symptoms From Childhood to Early Adulthood. Am J Psychiatry 2021; 178:752-760. [PMID: 33900814 PMCID: PMC7611492 DOI: 10.1176/appi.ajp.2020.20071119] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Autism spectrum disorder (ASD) is currently considered an early-onset neurodevelopmental condition. Follow-up studies of clinic-ascertained autism suggest that autistic symptoms typically decline with age, although symptom improvement is limited for some. To date there have been no population-based prospective studies investigating the natural history of autistic symptoms from childhood to adulthood. The aim of this study was to characterize the development and heterogeneity of autistic symptoms in a population-based cohort from childhood to age 25. METHODS Data were analyzed in a prospective U.K. population-based cohort (ALSPAC). Trajectories were derived using five assessments of the parent-rated Social and Communication Disorders Checklist (SCDC) spanning ages 7-25. Additional measures were used to validate symptom trajectories. RESULTS Three distinct SCDC symptom trajectory classes were identified: low (88.5%), declining (5.0%), and late-emerging (6.5%). Both the declining and late-emerging trajectory classes were associated with child and adult ASD measures, low IQ, communication problems, peer problems, and worse adult functioning compared with the low trajectory class. Male sex was associated with a higher likelihood of being in the declining trajectory class (odds ratio=2.84, 95% CI=2.19, 3.69). This sex difference was not observed in the late-emerging class (odds ratio=1.00, 95% CI=0.80, 1.24) compared with the low trajectory class. CONCLUSIONS ASD symptom levels that emerged early tended to decline across development, although impairment was still present in adulthood for some. For others, autistic symptoms emerged across adolescence and adulthood. This challenges our current understanding that ASD symptoms inevitably first manifest early in development.
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Affiliation(s)
- Lucy Riglin
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - Robyn E Wootton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Ajay K Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | | | - Kate Langley
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK,School of Psychology, Cardiff University, UK
| | - Stephan Collishaw
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - Jack Tagg
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | | | - Evie Stergiakouli
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Kate Tilling
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK,Corresponding author. Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff, CF24 4HQ. Tel: +442920688478.
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15
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Agelink van Rentergem JA, Deserno MK, Geurts HM. Validation strategies for subtypes in psychiatry: A systematic review of research on autism spectrum disorder. Clin Psychol Rev 2021; 87:102033. [PMID: 33962352 DOI: 10.1016/j.cpr.2021.102033] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 02/14/2021] [Accepted: 04/14/2021] [Indexed: 12/11/2022]
Abstract
Heterogeneity within autism spectrum disorder (ASD) is recognized as a challenge to both biological and psychological research, as well as clinical practice. To reduce unexplained heterogeneity, subtyping techniques are often used to establish more homogeneous subtypes based on metrics of similarity and dissimilarity between people. We review the ASD literature to create a systematic overview of the subtyping procedures and subtype validation techniques that are used in this field. We conducted a systematic review of 156 articles (2001-June 2020) that subtyped participants (range N of studies = 17-20,658), of which some or all had an ASD diagnosis. We found a large diversity in (parametric and non-parametric) methods and (biological, psychological, demographic) variables used to establish subtypes. The majority of studies validated their subtype results using variables that were measured concurrently, but were not included in the subtyping procedure. Other investigations into subtypes' validity were rarer. In order to advance clinical research and the theoretical and clinical usefulness of identified subtypes, we propose a structured approach and present the SUbtyping VAlidation Checklist (SUVAC), a checklist for validating subtyping results.
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Affiliation(s)
- Joost A Agelink van Rentergem
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Dutch Autism & ADHD Research Center, the Netherlands.
| | - Marie K Deserno
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Dutch Autism & ADHD Research Center, the Netherlands
| | - Hilde M Geurts
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Dutch Autism & ADHD Research Center, the Netherlands; Dr. Leo Kannerhuis, the Netherlands
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16
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Szatmari P, Cost KT, Duku E, Bennett T, Elsabbagh M, Georgiades S, Kerns C, Mirenda P, Smith IM, Ungar WJ, Vaillancourt T, Waddell C, Zaidman-Zait A, Zwaigenbaum L. Association of Child and Family Attributes With Outcomes in Children With Autism. JAMA Netw Open 2021; 4:e212530. [PMID: 33779740 PMCID: PMC8008283 DOI: 10.1001/jamanetworkopen.2021.2530] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE The prevalence and attributes of positive outcomes (or doing well) among children with autism spectrum disorder (ASD) in midchildhood are not well known. OBJECTIVE To estimate the prevalence of doing well according to metrics of proficiency and growth and to investigate the extent to which significant associations exist between child- and family-level variables and doing well. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study included children with ASD from regional clinics across Canada. Participants were sampled 3 times between ages 2 and 4.9 years (T1) and twice in follow-up into middle childhood (T2). Data were analyzed March 2018 through January 2020. EXPOSURES Language and IQ assessments at first sample; household income, parent coping, and family functioning. MAIN OUTCOMES AND MEASURES Key outcome domains of developmental health included measures of socialization, communication, independent living skills, and measures of internalizing and externalizing behaviors. Thresholds for doing well in these domains by either proficiency or growth were established. The extent to which language, IQ, household income, parent coping, and family functioning were associated with assessed outcomes was determined by logistic regression. The association between outcomes and concurrent Autism Diagnostic Observation Schedule (ADOS) classification scores was also estimated. RESULTS In a total cohort of 272 children (234 [86.0%] boys; mean [SD] age, 10.76 [0.26] years), approximately 78.8% (95% CI, 73.2%-84.4%) of the sample were estimated to be doing well by either metric on at least 1 domain, and 23.6% (95% CI, 17.7%-29.4%) were doing well in 4 or 5 domains. It was possible to be doing well by either proficiency or growth and still meet ADOS criteria for ASD. For the growth metric, between 61.5% (95% CI, 40.7%-79.1%) and 79.6% (95% CI, 66.0%-88.9%) of participants had ADOS scores of 4 or greater; for the proficiency metric, between 63.8% (95% CI, 48.4%-76.9%) and 75.8% (95% CI, 63.0%-85.4%) had scores of 4 or greater. Doing well by either metric for all domains was associated with T1 scores on that outcome domain (eg, T1 daily living skills associated with doing well at T2 daily living by the proficiency metric as measured by the Vineland Adaptive Behavior Scales-Second Edition daily living skills scale [202 participants]: β = 0.07; OR, 1.07; 95% CI, 1.03-1.11; P < .001). Doing well in socialization by the growth metric was also associated with better T1 language skills scores (202 participants) (β = 0.04; OR, 1.04; 95% CI, 1.00-1.07, P = .04). Doing well in externalizing by the growth metric was also associated with higher household income at T1 (178 participants) (β = 0.10; OR, 1.10; 95% CI, 1.06-1.15; P < .001). Better family functioning at T1 was associated with doing well on both socialization and externalizing by proficiency metric and on internalizing by growth metric (socialization by proficiency [202 participants]: β = -1.01; OR, 0.36; 95% CI, 0.14-0.93; P = .04; externalizing by proficiency [178 participants]: β = 1.00; OR, 0.37; 95% CI, 0.16-0.82; P = .02; internalizing by growth [178 participants]: β = -1.03; OR, 0.36; 95% CI, 0.16-0.79; P = .01). CONCLUSIONS AND RELEVANCE This cohort study found that a substantial proportion of children with ASD were doing well by middle childhood in at least 1 key domain of developmental health, and that doing well was possible even in the context of continuing to meet criteria for ASD. These results support a strengths-based approach to treatment planning that should include robust support for families to increase the potential likelihood of doing well later in life.
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Affiliation(s)
- Peter Szatmari
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Eric Duku
- McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Pat Mirenda
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Wendy J. Ungar
- The Hospital for Sick Children, Toronto, Ontario, Canada
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17
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Vanegas SB. Examining factors related to the age of diagnosis of children with autism spectrum disorder from immigrant and non-immigrant backgrounds in a diverse clinical sample. Autism Res 2021; 14:1260-1270. [PMID: 33624946 DOI: 10.1002/aur.2489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/10/2021] [Indexed: 11/07/2022]
Abstract
A timely diagnosis of autism spectrum disorder (ASD) is important for children as that may help inform the best services and supports needed for optimal outcomes. However, disparities in the identification of ASD have been consistently documented for racial/ethnic minority and immigrant populations. The majority of studies of immigrant populations have focused on the qualitative experience of ASD, however, greater knowledge about the predictors of the age of initial ASD diagnosis is needed. This study examined the child, maternal, and family-level factors that predicted the age of initial ASD diagnosis in a diverse clinical sample through a retrospective medical record review. Medical records of clinical evaluations conducted between 2004 and 2014 were reviewed for children with ASD born to immigrant and non-immigrant mothers. Regression analyses found that for both groups of children with ASD, using verbal language to communicate and having another diagnosis (attention-deficit/hyperactivity disorder or another condition) predicted an older age of initial ASD diagnosis. For children with ASD born to immigrant mothers, residing in a multilingual household was associated with a younger age of diagnosis. These results highlight the complexities of an ASD diagnosis among diverse children and families, particularly among immigrant communities. LAY SUMMARY: This research looked at predictors of when children received their first autism spectrum disorder diagnosis across children born to immigrant mothers and children born to U.S.-born mothers. Living in a multilingual home was related to a younger age of diagnosis for children of immigrant mothers; being verbal and having another diagnosis was related to an older age of diagnosis for both groups of children. This highlights the need to improve diagnostic services for diverse children.
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Affiliation(s)
- Sandra B Vanegas
- School of Social Work, Texas State University, San Marcos, Texas, USA
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18
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Atypical Development of Attentional Control Associates with Later Adaptive Functioning, Autism and ADHD Traits. J Autism Dev Disord 2020; 50:4085-4105. [PMID: 32221749 PMCID: PMC7557503 DOI: 10.1007/s10803-020-04465-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Autism is frequently associated with difficulties with top-down attentional control, which impact on individuals’ mental health and quality of life. The developmental processes involved in these attentional difficulties are not well understood. Using a data-driven approach, 2 samples (N = 294 and 412) of infants at elevated and typical likelihood of autism were grouped according to profiles of parent report of attention at 10, 15 and 25 months. In contrast to the normative profile of increases in attentional control scores between infancy and toddlerhood, a minority (7–9%) showed plateauing attentional control scores between 10 and 25 months. Consistent with pre-registered hypotheses, plateaued growth of attentional control was associated with elevated autism and ADHD traits, and lower adaptive functioning at age 3 years.
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19
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Shulman C, Esler A, Morrier MJ, Rice CE. Diagnosis of Autism Spectrum Disorder Across the Lifespan. Psychiatr Clin North Am 2020; 43:583-603. [PMID: 33126997 DOI: 10.1016/j.psc.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Although autism spectrum disorder (ASD) is one of the most common neurodevelopmental disorders it is also one of the most heterogeneous conditions, making identification and diagnosis complex. The importance of a stable and consistent diagnosis cannot be overstated. An accurate diagnosis is the basis for understanding the individual and establishing an individualized treatment plan. We present those elements that should be included in any assessment for ASD and describe the ways in which ASD typically manifests itself at various developmental stages. The implications and challenges for assessment at different ages and levels of functioning are discussed.
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Affiliation(s)
- Cory Shulman
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, 91905, Israel.
| | - Amy Esler
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota 2540 Riverside Ave S., RPB 550, Minneapolis, MN 55454, USA
| | - Michael J Morrier
- Emory Autism Center, 1551 Shoup Court, Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Decatur, GA 30033, USA
| | - Catherine E Rice
- Emory Autism Center, 1551 Shoup Court, Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Decatur, GA 30033, USA
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20
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Shulman C, Rice CE, Morrier MJ, Esler A. The Role of Diagnostic Instruments in Dual and Differential Diagnosis in Autism Spectrum Disorder Across the Lifespan. Psychiatr Clin North Am 2020; 43:605-628. [PMID: 33126998 DOI: 10.1016/j.psc.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The heterogeneity inherent in autism spectrum disorder (ASD) makes the identification and diagnosis of ASD complex. We survey a large number of diagnostic tools, including screeners and tools designed for in-depth assessment. We also discuss the challenges presented by overlapping symptomatology between ASD and other disorders and the need to determine whether a diagnosis of ASD or another diagnosis best explains the individual's symptoms. We conclude with a call to action for the next steps necessary for meeting the diagnostic challenges presented here to improve the diagnostic process and to help understand each individual's particular ASD profile.
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Affiliation(s)
- Cory Shulman
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, 91905, Israel.
| | - Catherine E Rice
- Emory Autism Center, 1551 Shoup Court, Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Decatur, GA 30033, USA
| | - Michael J Morrier
- Emory Autism Center, 1551 Shoup Court, Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Decatur, GA 30033, USA
| | - Amy Esler
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota 2540 Riverside Ave S., RPB 550, Minneapolis, MN 55454, USA
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21
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Lord C, McCauley JB, Pepa LA, Huerta M, Pickles A. Work, living, and the pursuit of happiness: Vocational and psychosocial outcomes for young adults with autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1691-1703. [PMID: 32431163 PMCID: PMC7541415 DOI: 10.1177/1362361320919246] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT It is important to better understand how adults with autism are functioning in adulthood. Studies that have tracked individuals across the lifespan can help identify developmental factors influence differences in adult outcomes. The present study examines the independence, well-being, and functioning of 123 adults that have been closely followed since early childhood. Autism diagnosis and cognitive assessments were given frequently throughout childhood and during adulthood. We examined differences between adults who had received an autism diagnosis at some point with higher cognitive abilities (Ever ASD-High IQ) and lower cognitive abilities (Ever ASD-Low IQ), as well as adults who never received a diagnosis of autism in the course of the study (Never ASD). We found that autistic features specifically related to adaptive skills and friendships, and verbal intelligence related to work outcomes. In many ways, the Never ASD group had similar outcomes compared to the ASD groups. However, adults with ASD tended to have lower well-being and fewer positive emotions. Families played a major role in supporting adults with and without ASD at all intellectual levels. The findings suggest that realistic ways of increasing independence need to be developed by working with adults and their families, while acknowledging the contribution of individual differences in mental health, intelligence and autism symptoms across neurodevelopmental disorders.
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22
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Hickey EJ, Bolt D, Rodriguez G, Hartley SL. Bidirectional Relations between Parent Warmth and Criticism and the Symptoms and Behavior Problems of Children with Autism. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:865-879. [PMID: 32170525 PMCID: PMC7242134 DOI: 10.1007/s10802-020-00628-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Family research in the field of ASD has focused on describing the impact of child challenges on parents, usually mothers, and given little attention to the ways in which mothers and fathers reciprocally influence the development of the child with ASD. The current study examined the direction of effects between the emotional quality of the mother-child and father-child relationships and the child's severity of ASD symptoms and emotional and behavioral problems across three time points spanning 2 years. Using parent Five Minute Speech Samples and teacher ratings of the severity of the child's ASD symptoms and emotional and behavioral problems, four cross-lagged structural equation models were employed to test bidirectional effects between parent warmth and criticism and child ASD symptoms and emotional and behavioral problems across three waves of data (approximately 12 months apart) in 159 families who had a child with ASD (initially aged 6 to 13 years). Mothers and fathers had an average age of 39.53 (SD=5.55) and 41.66 years (SD=6.19). Children with ASD were predominately male (86.2%) and white, non-Hispanic (76.7%). Crossed-lagged model results indicated bidirectional effects for both mothers and fathers. Warmth in the mother-child relationship and father-child relationship impacted child functioning at earlier time points. In the opposite direction, child functioning impacted father warmth and mother criticism at later time points. Findings indicate that the emotional quality of the parent-child relationships are bidirectionally related to the symptoms and emotional and behavioral problems of children with ASD. Important implications for supporting families are discussed.
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Affiliation(s)
- Emily J Hickey
- General Academic Pediatrics, Boston Medical Center, Boston, MA, USA.
| | - Daniel Bolt
- Educational Psychology, Department University of Wisconsin-Madison, Madison, WI, USA
| | - Geovanna Rodriguez
- Special Education and Clinical Sciences, University of Oregon, Eugene, OR, 97403, USA
| | - Sigan L Hartley
- Human Development and Family Studies Department, University of Wisconsin-Madison, Madison, WI, USA
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23
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Koegel LK, Bryan KM, Su PL, Vaidya M, Camarata S. Parent Education in Studies With Nonverbal and Minimally Verbal Participants With Autism Spectrum Disorder: A Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:890-902. [PMID: 32243190 DOI: 10.1044/2019_ajslp-19-00007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The purpose of this systematic review was to identify parent education procedures implemented in intervention studies focused on expressive verbal communication for nonverbal (NV) or minimally verbal (MV) children with autism spectrum disorder (ASD). Parent education has been shown to be an essential component in the habilitation of individuals with ASD. Parents of individuals with ASD who are NV or MV may particularly benefit from parent education in order to provide opportunities for communication and to support their children across the life span. Method ProQuest databases were searched between the years of 1960 and 2018 to identify articles that targeted verbal communication in MV and NV individuals with ASD. A total of 1,231 were evaluated to assess whether parent education was implemented. We found 36 studies that included a parent education component. These were reviewed with regard to (a) the number of participants and participants' ages, (b) the parent education program provided, (c) the format of the parent education, (d) the duration of the parent education, (e) the measurement of parent education, and (f) the parent fidelity of implementation scores. Results The results of this analysis showed that very few studies have included a parent education component, descriptions of the parent education programs are unclear in most studies, and few studies have scored the parents' implementation of the intervention. Conclusions Currently, there is great variability in parent education programs in regard to participant age, hours provided, fidelity of implementation, format of parent education, and type of treatment used. Suggestions are made to provide both a more comprehensive description and consistent measurement of parent education programs.
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Affiliation(s)
- Lynn Kern Koegel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
| | | | - Pumpki Lei Su
- Vanderbilt University School of Medicine, Nashville, TN
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24
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The Role of Diagnostic Instruments in Dual and Differential Diagnosis in Autism Spectrum Disorder Across the Lifespan. Child Adolesc Psychiatr Clin N Am 2020; 29:275-299. [PMID: 32169263 DOI: 10.1016/j.chc.2020.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The heterogeneity inherent in autism spectrum disorder (ASD) makes the identification and diagnosis of ASD complex. We survey a large number of diagnostic tools, including screeners and tools designed for in-depth assessment. We also discuss the challenges presented by overlapping symptomatology between ASD and other disorders and the need to determine whether a diagnosis of ASD or another diagnosis best explains the individual's symptoms. We conclude with a call to action for the next steps necessary for meeting the diagnostic challenges presented here to improve the diagnostic process and to help understand each individual's particular ASD profile.
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25
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Shulman C, Esler A, Morrier MJ, Rice CE. Diagnosis of Autism Spectrum Disorder Across the Lifespan. Child Adolesc Psychiatr Clin N Am 2020; 29:253-273. [PMID: 32169262 DOI: 10.1016/j.chc.2020.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Although autism spectrum disorder (ASD) is one of the most common neurodevelopmental disorders it is also one of the most heterogeneous conditions, making identification and diagnosis complex. The importance of a stable and consistent diagnosis cannot be overstated. An accurate diagnosis is the basis for understanding the individual and establishing an individualized treatment plan. We present those elements that should be included in any assessment for ASD and describe the ways in which ASD typically manifests itself at various developmental stages. The implications and challenges for assessment at different ages and levels of functioning are discussed.
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Affiliation(s)
- Cory Shulman
- The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, 91905, Israel.
| | - Amy Esler
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota 2540 Riverside Ave S., RPB 550, Minneapolis, MN 55454, USA
| | - Michael J Morrier
- Emory Autism Center, 1551 Shoup Court, Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Decatur, GA 30033, USA
| | - Catherine E Rice
- Emory Autism Center, 1551 Shoup Court, Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Decatur, GA 30033, USA
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Abstract
Autism spectrum disorder (referred to here as autism) is one of several overlapping neurodevelopmental conditions that have variable impacts on different individuals. This variability results from dynamic interactions between biological and non-biological risk factors, which result in increasing differentiation between individuals over time. Although this differentiation continues well into adulthood, the infancy period is when the brain and behavior develop rapidly, and when the first signs and symptoms of autism emerge. This review discusses advances in our understanding of the causal pathways leading to autism and overlapping neurodevelopmental conditions. Research is also mapping trajectories of brain and behavioral development for some risk groups, namely later born siblings of children with autism and/or infants referred because of developmental concerns. This knowledge has been useful in improving early identification and establishing the feasibility of targeted interventions for infant risk groups before symptoms arise. However, key knowledge gaps remain, such as the discovery of protective factors (biological or environmental) that may mitigate the impact of risk. Also, the dynamic mechanisms that underlie the associations between risk factors and outcomes need further research. These include the processes of resilience, which may explain why some individuals at risk for autism achieve better than expected outcomes. Bridging these knowledge gaps would help to provide tools for early identification and intervention that reflect dynamic developmental pathways from risk to outcomes.
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Affiliation(s)
- Mayada Elsabbagh
- Montreal Neurological Institute, Azrieli Centre for Autism Research, McGill University, Montreal, Canada
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Abstract
UNLABELLED Many predisposing factors to caries are present in autism, however, it is unlikely that autistic patients exhibit higher caries indexes than the rest of the population. OBJECTIVE To evaluate salivary factors related to caries in autistic patients. STUDY DESIGN 34 autistics and 34 controls aged between 4-13 years old were included. Decayed, missing, and filled teeth (DMFT) index and oral hygiene simplified index (IHO-S) were assessed, as well as, pH, total proteins, phosphate, calcium and IgA in saliva. All data were analyzed by chi2 and Student t tests for independent samples. P values<0.05 were considered statistically significant. RESULTS Autistic patients showed less caries than controls (p≤0.001), DMFT was 1±1 and 3±2 respectively (p≤0.001). In relation to IHO-S, values increased (p=0.008) in autistic patients (2.25±0.78) compared to controls (1.79±0.59), however Salivary ph means were similar (7.20±0.48 and 7.27±0.34 respectively). Decreased calcium levels (p=0.013) were observed in autistics (0.621±0.35 mmol/L) compared to controls (0.89±0.51 mmol/L), but phosphate levels were similar (6.17±4.22 M, 5.51±4.86 M respectively). When total proteins of saliva were assessed, autistics showed a slight increment (2.65±1.81 mg/mL) compared to controls (2.24±1.27 mg/mL) and zymography showed a higher proteolytic activity in autistic children. Finally, IgA concentration reached 116.55±90.97 μg/mL in autistics and 161.61 ± 193.37μg/mL (p=0.527) in the control group. CONCLUSIONS Even though patients with autism exhibited a poorer oral hygiene, caries indexes were lower, calcium levels in saliva were found to be lesser and phosphate levels higher.
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Autism Spectrum Disorders and ADHD: Overlapping Phenomenology, Diagnostic Issues, and Treatment Considerations. Curr Psychiatry Rep 2019; 21:34. [PMID: 30903299 DOI: 10.1007/s11920-019-1020-5] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) are both increasing in prevalence and commonly co-occur with each other. The goal of this review is to outline what has been published recently on the topics of ASD, ADHD, and the comorbid state (ASD+ADHD) with a particular focus on shared phenomenology, differential diagnosis, and treatment considerations. RECENT FINDINGS ASD and ADHD have shared genetic heritability and are both associated with shared impairments in social functioning and executive functioning. Quantitative and qualitative differences exist, however, in the phenotypic presentations of the impairments which characterize ASD and ADHD. For ASD interventions to be maximally efficacious, comorbid ADHD needs to be considered (and vice versa). The research on ASD and ADHD suggests some overlap between the two disorders yet enough differences to indicate that these conditions are sufficiently distinct to warrant separate diagnostic categories.
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Colombi C, Vivanti G, Rogers S. Evidenced-Based Practices. HANDBOOK OF INTERDISCIPLINARY TREATMENTS FOR AUTISM SPECTRUM DISORDER 2019. [DOI: 10.1007/978-3-030-13027-5_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Muratori F, Turi M, Prosperi M, Narzisi A, Valeri G, Guerrera S, Santocchi E, Apicella F, Lattarulo C, Calderoni S, Vicari S. Parental Perspectives on Psychiatric Comorbidity in Preschoolers With Autism Spectrum Disorders Receiving Publicly Funded Mental Health Services. Front Psychiatry 2019; 10:107. [PMID: 30914976 PMCID: PMC6422880 DOI: 10.3389/fpsyt.2019.00107] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/13/2019] [Indexed: 11/26/2022] Open
Abstract
An increased prevalence of psychiatric comorbidity (PC) in individuals with Autism Spectrum Disorders (ASD) is consistently reported. While several studies have examined PC in school-aged children, adolescents and adults with ASD, investigations on PC in preschoolers are less common. In this study, we explore the prevalence and the type of PC in a sample of 989 preschoolers with ASD through the DSM-Oriented Scales (DOS) of the Child Behavior Checklist (CBCL 1½-5) and their possible links with the core features of ASD and cognitive functioning. Results indicated that 37.8% of the sample had at least one PC in addition to ASD; these subjects displayed significantly higher Total score (p = 0.02) and Social Affect score (p = 0.003) on the ADOS-based calibrated severity scores (CSS), as well as lower (p ≤ 0.0001) performance IQ (pIQ) compared to ASD individuals without PC. As far as the specific DOS, Affective Problems (AP) were detected in 23.4% of the whole sample, ADHD Problems (ADHD) in 17.3%, Anxiety Problems (AXP) in 16.7%, and Oppositional Problems (OP) in 7.9%. These different comorbidities were isolated in 195 subjects (Mono-comorbid group: 19.7% of the whole sample), while 179 subjects (18.1% of the whole sample) had two or more types of PC (Multi-comorbid group). One-way ANOVA revealed that subjects with multi-comorbidity have statistically significant lower pIQ and higher Total score and Social Affect score on CSS-ADOS. Specific differences for each type of comorbidity and gender differences were also discussed. Taken together, results indicate a considerable presence of PC in preschoolers with ASD that should be accurately considered during the assessment and diagnosis process in order to plan a tailored intervention based not only on core symptoms of ASD, but also on comorbid psychiatric condition since preschool age.
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Affiliation(s)
- Filippo Muratori
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Turi
- Fondazione Stella Maris Mediterraneo, Potenza, Italy
| | - Margherita Prosperi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonio Narzisi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Giovanni Valeri
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Silvia Guerrera
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Elisa Santocchi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Fabio Apicella
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | | | - Sara Calderoni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
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Kim SH, Bal VH, Benrey N, Choi YB, Guthrie W, Colombi C, Lord C. Variability in Autism Symptom Trajectories Using Repeated Observations From 14 to 36 Months of Age. J Am Acad Child Adolesc Psychiatry 2018; 57:837-848.e2. [PMID: 30392625 PMCID: PMC6636833 DOI: 10.1016/j.jaac.2018.05.026] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/15/2018] [Accepted: 06/22/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE This study examined variability in autism symptom trajectories in toddlers referred for possible autism spectrum disorder (ASD) who had frequent observations from 14 to 36 months of age. METHOD In total, 912 observations of the Autism Diagnostic Observation Schedule (ADOS) were obtained from 149 children (103 with ASD) followed from 14 to 36 months of age. As a follow-up to a previous analysis of ADOS algorithm scores, a different analytic approach (Proc Traj) was implemented to identify several courses of symptom trajectories using ADOS Calibrated Severity Scores in a larger sample. Proc Traj is a statistical method that clusters individuals into separate groups based on different growth trajectories. Changes in symptom severity based on individual ADOS items also were examined. RESULTS Trajectory analysis of overall symptom severity identified 4 clusters (non-spectrum ∼25%; worsening ∼27%; moderately-improving ∼25%; severe-persistent ∼23%). Trajectory clusters varied significantly in the proportions of confirmatory ASD diagnosis, level of baseline and final verbal and nonverbal abilities, and symptom severity. For the moderately-improving group, social communication improved, whereas restricted and repetitive behaviors were stable over time. Language and verbal and nonverbal communication improved for many children, but several social affect and restricted and repetitive behavior symptoms remained stable or worsened. CONCLUSION Significant variability in symptom trajectories was observed among toddlers referred for possible ASD. Changes in social and restricted and repetitive behavior domain scores did not always co-occur. Similarly, item-level trajectories did not always align with trajectories of overall severity scores. These findings highlight the importance of monitoring individual symptoms within broader symptom domains when conducting repeated assessments for young children with suspected ASD.
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Affiliation(s)
- So Hyun Kim
- Center for Autism and the Developing Brain, Weill Cornell Medicine, White Plains, NY.
| | - Vanessa H. Bal
- Weill Institute for Neurosciences, University of California, San Francisco
| | - Nurit Benrey
- Center for Autism and the Developing Brain, Weill Cornell Medicine, White Plains, NY
| | - Yeo Bi Choi
- Center for Autism and the Developing Brain, Weill Cornell Medicine, White Plains, NY
| | - Whitney Guthrie
- Center for Autism Research, Children’s Hospital of Philadelphia, PA
| | | | - Catherine Lord
- Center for Autism and the Developing Brain, Weill Cornell Medicine, White Plains, NY
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Bornstein MH, Hahn CS, Putnick DL, Pearson RM. Stability of core language skill from infancy to adolescence in typical and atypical development. SCIENCE ADVANCES 2018; 4:eaat7422. [PMID: 30474055 PMCID: PMC6248911 DOI: 10.1126/sciadv.aat7422] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/24/2018] [Indexed: 05/15/2023]
Abstract
Command of language is a fundamental life skill, a cornerstone of cognitive and socioemotional development, and a necessary ingredient for successful functioning in society. We used 15-year prospective longitudinal data from the Avon Longitudinal Study of Parents and Children to evaluate two types of stability of core language skill in 5036 typically developing and 1056 atypically developing (preterm, dyslexic, autistic, and hearing impaired) children in a multiage, multidomain, multimeasure, multireporter framework. A single core language skill was extracted from multiple measures at multiple ages, and this skill proved stable from infancy to adolescence in all groups, even accounting for child nonverbal intelligence and sociability and maternal age and education. Language skill is a highly conserved and robust individual-differences characteristic. Lagging language skills, a risk factor in child development, would profitably be addressed early in life.
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Affiliation(s)
- Marc H. Bornstein
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- Institute for Fiscal Studies, London, UK
| | - Chun-Shin Hahn
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Diane L. Putnick
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Rebecca M. Pearson
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Baghdadli A, Michelon C, Pernon E, Picot MC, Miot S, Sonié S, Rattaz C, Mottron L. Adaptive trajectories and early risk factors in the autism spectrum: A 15-year prospective study. Autism Res 2018; 11:1455-1467. [PMID: 30270526 DOI: 10.1002/aur.2022] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 08/01/2018] [Accepted: 08/18/2018] [Indexed: 12/22/2022]
Abstract
Little is known about long-term outcomes. We investigate the adaptive trajectories and their risk factors in ASD. Data were obtained from 281 children prospectively followed untill adulthood. The final sample consisted of 106 individuals. Vineland scores were collected at baseline (T1), 3 (T2), 10 (T3), and 15 (T4) years later. A group-based method was used to identify homogeneous patterns of adaptive skills trajectories. Results show that among the children initially categorized as autistic, 82.6% remained over the ADOS diagnostic threshold, 11.9% converted to atypical autism, and 5.4% fell under the ADOS threshold. Most atypical autism diagnoses were unstable. Most (81.7%) autistic participants had an ID at inclusion. At T1, 59.3% were nonverbal, but only 39% at T4. Most changes occurred between 4 and 8 years of age. Approximately 25% of participants exhibited a "high" growth trajectory, in which progress continues throughout adolescence, and 75% a "low" growth trajectory, characterized by greater autistic symptoms, intellectual disability, and lower language abilities reflected by high CARS scores, low apparent DQ, and speech difficulties, which mostly, but not always, predicted low trajectories. Our findings suggest that the adaptive prognosis of autism is mostly poor in this cohort, biased toward intellectual disability. However, changes in diagnostic, speech, and adaptive status are not uncommon, even for indivduals with low measured intelligence or apparent intellectual disability, and are sometimes difficult to predict. Autism Research 2018, 11: 1455-1467. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Most autism diagnoses given before 5 years of age are stable to adulthood, but one-fifth of individuals are no longer considered to be autistic, even in a cohort biased toward apparent intellectual disability. Conversely, atypical autism diagnoses are mostly unstable. One-third of children who are nonverbal at 5 years are verbal within 15 years, mostly before 8 years of age. Concerning adaptive behavior outcomes, only one-fourth of children exhibit a high-growth trajectory through at least 15 years.
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Affiliation(s)
- Amaria Baghdadli
- Centre Ressources Autisme, University Hospital, Montpellier, France.,Centre de Recherche en Épidémiologie et Santé des Populations, U1178, INSERM, Paris, France
| | - Cécile Michelon
- Centre Ressources Autisme, University Hospital, Montpellier, France
| | - Eric Pernon
- Centre Ressources Autisme, University Hospital, Montpellier, France
| | | | - Stéphanie Miot
- Centre Ressources Autisme, University Hospital, Montpellier, France.,Centre de Recherche en Épidémiologie et Santé des Populations, U1178, INSERM, Paris, France
| | - Sandrine Sonié
- Centre Ressources Autisme, Centre de Recherche en Neurosciences de Lyon, CNRS UMR 5292, Le Vinatier, Lyon, France
| | - Cécile Rattaz
- Centre Ressources Autisme, University Hospital, Montpellier, France
| | - Laurent Mottron
- Hôpital Rivière des Prairies & CIUSSS du Nord, Université de Montréal, 7070 Bvd Perras, H1E1A4, Montréal, Quebec, Canada
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A Longitudinal Study of Children Diagnosed with Autism Spectrum Disorder Before Age Three: School Services at Three Points Time for Three Levels of Outcome Disability. J Autism Dev Disord 2018; 48:3747-3760. [PMID: 29948529 DOI: 10.1007/s10803-018-3606-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This study follows 70 children determined to have Autism Spectrum Disorder (ASD) before age three (Time 1). Parents filled out questionnaires and standardized measures about their child when he/she was school-aged (Time 2), including information about their children's preschool, kindergarten, and grade school educational settings. At Time 2, the researchers placed children in three diagnostic groups of No ASD, ASD-Higher Functioning, and ASD-Lower Functioning. Retrospective results showed that most children were receiving intensive services at the preschool level. In kindergarten, there was some divergence among the three groups, with more intensive services continuing for the ASD groups. At school age, classroom placement and services reflected service patterns that were consistent with these three levels of disability.
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35
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Solomon M, Iosif AM, Reinhardt VP, Libero L, Nordahl C, Ozonoff S, Rogers SJ, Amaral DG. What will my child's future hold? phenotypes of intellectual development in 2-8-year-olds with autism spectrum disorder. Autism Res 2018; 11:121-132. [PMID: 29076255 PMCID: PMC5961488 DOI: 10.1002/aur.1884] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/21/2017] [Accepted: 10/03/2017] [Indexed: 11/11/2022]
Abstract
We examined phenotypes of autism spectrum disorder (ASD) based on trajectories of intellectual development from early (ages 2-3 ½) to middle (ages 5-8) childhood in a recent clinically ascertained cohort. Participants included 102 children (82 males) initially diagnosed with ASD from the Autism Phenome Project longitudinal sample. Latent class growth analysis was used to identify distinct IQ trajectories. Baseline and developmental course differences among groups were assessed using univariate techniques and repeated measures regression models, respectively. A four class model best represented the data. Using the highest posterior probability, participants were assigned to High Challenges (25.5%), Stable Low (17.6%), Changers (35.3%), and Lesser Challenges (21.6%) groups. The High Challenges and Stable Low groups exhibited persistently low IQ, although, the High Challenges group experienced declines while the Stable Low group's scores remained more constant. Changers showed IQ improvement of > 2 standard deviations. The Lesser Challenges group had IQs in the average range at both times that were about 1 standard deviation higher at T2. In summation, 75% of the participants experienced some relative improvements in intellectual and/or other areas of functioning between ages 2 and 8 years. The Changers group demonstrated the most significant IQ change that was accompanied by adaptive communication improvement and declining externalizing symptoms. Only the Lesser Challenges group showed a significant reduction in ASD symptom severity, such that by age 8, 14% of them no longer met ADOS-2 criteria for ASD. All groups showed reductions in internalizing symptoms. Intervention history was not associated with group status. Autism Res 2018, 11: 121-132. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY We examined how the IQs of children with autism spectrum disorder change between ages 2 and 8, and identified four patterns. Two groups exhibited persistently lower IQs. One group showed IQ increases of greater than 30 points with improved communicate abilities and declining disruptive behaviors. The final group had IQs in the average or better range at both time points, and 14% of them lost their diagnoses. Over half of the children experienced improved intellectual functioning between ages 2 and 8, whereas about 25% showed declines. Findings were not associated with intervention history.
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Affiliation(s)
- Marjorie Solomon
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA
- MIND Institute, University of California-Davis, Davis, CA
- Imaging Research Center, University of California-Davis, Davis, CA
| | - Ana-Maria Iosif
- Department of Public Health Sciences, University of California-Davis, Davis, CA
| | - Vanessa P. Reinhardt
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA
- MIND Institute, University of California-Davis, Davis, CA
| | - Lauren Libero
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA
- MIND Institute, University of California-Davis, Davis, CA
| | - Christine Nordahl
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA
- MIND Institute, University of California-Davis, Davis, CA
| | - Sally Ozonoff
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA
- MIND Institute, University of California-Davis, Davis, CA
| | - Sally J. Rogers
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA
- MIND Institute, University of California-Davis, Davis, CA
| | - David G. Amaral
- Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA
- MIND Institute, University of California-Davis, Davis, CA
- Center for Neuroscience, University of California-Davis, Davis, CA
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Szatmari P. Complexity and Parsimony in Natural History Studies of Children With Autism Spectrum Disorder. J Am Acad Child Adolesc Psychiatry 2017; 56:636-638. [PMID: 28735691 DOI: 10.1016/j.jaac.2017.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
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