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Neff RC, Stangis KA, Beniwal U, Hergenreder T, Ye B, Murphy GG. Cognitive behavioral phenotyping of DSCAM heterozygosity as a model for autism spectrum disorder. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.03.597158. [PMID: 38895491 PMCID: PMC11185729 DOI: 10.1101/2024.06.03.597158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
It is estimated that 1 in 36 children are affected by autism spectrum disorder (ASD) in the United States, which is nearly a twofold increase from a decade ago. Recent genetic studies have identified de novo loss-of-function (dnLoF) mutations in the Down Syndrome Cell Adhesion Molecule (DSCAM) as a strong risk factor for ASD. Previous research has shown that DSCAM ablation confers social interaction deficits and perseverative behaviors in mouse models. However, it remains unknown to what extent DSCAM underexpression captures the full range of behaviors, specifically cognitive phenotypes, presented in ASD. Here, we conducted a comprehensive cognitive behavioral phenotyping which revealed that loss of one copy of DSCAM , as in the DSCAM 2J +/- mice, displayed hyperactivity, increased anxiety, and motor coordination impairments. Additionally, hippocampal-dependent learning and memory was affected, including working memory, long-term memory, and contextual fear learning. Interestingly, implicit learning processes remained intact. Therefore, DSCAM LoF produces autistic-like behaviors that are similar to human cases of ASD. These findings further support a role for DSCAM dnLoF mutations in ASD and suggest DSCAM 2J +/- as a suitable model for ASD research. Summary Statement Autism spectrum disorder represents a growing patient population. Loss of one copy of the DSCAM gene provides a promising mouse model that reproduces autistic-like behaviors for research and therapeutic testing.
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Ahn YA, Moffitt JM, Tao Y, Custode S, Parlade M, Beaumont A, Cardona S, Hale M, Durocher J, Alessandri M, Shyu ML, Perry LK, Messinger DS. Objective Measurement of Social Gaze and Smile Behaviors in Children with Suspected Autism Spectrum Disorder During Administration of the Autism Diagnostic Observation Schedule, 2nd Edition. J Autism Dev Disord 2024; 54:2124-2137. [PMID: 37103660 DOI: 10.1007/s10803-023-05990-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 04/28/2023]
Abstract
Best practice for the assessment of autism spectrum disorder (ASD) symptom severity relies on clinician ratings of the Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2), but the association of these ratings with objective measures of children's social gaze and smiling is unknown. Sixty-six preschool-age children (49 boys, M = 39.97 months, SD = 10.58) with suspected ASD (61 confirmed ASD) were administered the ADOS-2 and provided social affect calibrated severity scores (SA CSS). Children's social gaze and smiling during the ADOS-2, captured with a camera contained in eyeglasses worn by the examiner and parent, were obtained via a computer vision processing pipeline. Children who gazed more at their parents (p = .04) and whose gaze at their parents involved more smiling (p = .02) received lower social affect severity scores, indicating fewer social affect symptoms, adjusted R2 = .15, p = .003.
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Affiliation(s)
- Yeojin A Ahn
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Yudong Tao
- Department of Electrical and Computer Engineering, University of Miami, Coral Gables, FL, USA
| | - Stephanie Custode
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Meaghan Parlade
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Amy Beaumont
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Sandra Cardona
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Melissa Hale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Jennifer Durocher
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Mei-Ling Shyu
- Department of Electrical and Computer Engineering, University of Miami, Coral Gables, FL, USA
| | - Lynn K Perry
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Daniel S Messinger
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
- Department of Electrical and Computer Engineering, University of Miami, Coral Gables, FL, USA.
- Departments of Pediatrics and Music Engineering, University of Miami, Coral Gables, FL, USA.
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., P.O. Box 248185, Coral Gables, FL, 33124, USA.
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Burnett LE, Koppensteiner P, Symonova O, Masson T, Vega-Zuniga T, Contreras X, Rülicke T, Shigemoto R, Novarino G, Joesch M. Shared behavioural impairments in visual perception and place avoidance across different autism models are driven by periaqueductal grey hypoexcitability in Setd5 haploinsufficient mice. PLoS Biol 2024; 22:e3002668. [PMID: 38857283 PMCID: PMC11216578 DOI: 10.1371/journal.pbio.3002668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 07/01/2024] [Accepted: 05/07/2024] [Indexed: 06/12/2024] Open
Abstract
Despite the diverse genetic origins of autism spectrum disorders (ASDs), affected individuals share strikingly similar and correlated behavioural traits that include perceptual and sensory processing challenges. Notably, the severity of these sensory symptoms is often predictive of the expression of other autistic traits. However, the origin of these perceptual deficits remains largely elusive. Here, we show a recurrent impairment in visual threat perception that is similarly impaired in 3 independent mouse models of ASD with different molecular aetiologies. Interestingly, this deficit is associated with reduced avoidance of threatening environments-a nonperceptual trait. Focusing on a common cause of ASDs, the Setd5 gene mutation, we define the molecular mechanism. We show that the perceptual impairment is caused by a potassium channel (Kv1)-mediated hypoexcitability in a subcortical node essential for the initiation of escape responses, the dorsal periaqueductal grey (dPAG). Targeted pharmacological Kv1 blockade rescued both perceptual and place avoidance deficits, causally linking seemingly unrelated trait deficits to the dPAG. Furthermore, we show that different molecular mechanisms converge on similar behavioural phenotypes by demonstrating that the autism models Cul3 and Ptchd1, despite having similar behavioural phenotypes, differ in their functional and molecular alteration. Our findings reveal a link between rapid perception controlled by subcortical pathways and appropriate learned interactions with the environment and define a nondevelopmental source of such deficits in ASD.
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Affiliation(s)
- Laura E. Burnett
- Institute of Science and Technology Austria, Klosterneuburg, Austria
| | | | - Olga Symonova
- Institute of Science and Technology Austria, Klosterneuburg, Austria
| | - Tomás Masson
- Institute of Science and Technology Austria, Klosterneuburg, Austria
| | - Tomas Vega-Zuniga
- Institute of Science and Technology Austria, Klosterneuburg, Austria
| | - Ximena Contreras
- Institute of Science and Technology Austria, Klosterneuburg, Austria
| | - Thomas Rülicke
- Department of Biomedical Sciences and Ludwig Boltzmann Institute for Hematology and Oncology, University of Veterinary Medicine, Vienna, Austria
| | - Ryuichi Shigemoto
- Institute of Science and Technology Austria, Klosterneuburg, Austria
| | - Gaia Novarino
- Institute of Science and Technology Austria, Klosterneuburg, Austria
| | - Maximilian Joesch
- Institute of Science and Technology Austria, Klosterneuburg, Austria
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4
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Northrup JB, Cortez KB, Mazefsky CA, Iverson JM. Expression and co-regulation of negative emotion in 18-month-olds at increased likelihood for autism with diverse developmental outcomes. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241233664. [PMID: 38407094 DOI: 10.1177/13623613241233664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
LAY ABSTRACT Managing negative emotion can be challenging for autistic individuals and their families from a young age. Parents help young children manage negative emotions by responding in comforting or supportive ways. Not much research has examined how negative emotions and parent responses to negative emotions are different in very young autistic children. This study used videotapes of 18-month-old toddlers and parents at home. We examined how much and how intensely toddlers expressed negative emotion in everyday situations, and how parents responded. Participants were younger siblings of autistic children, and we compared three groups-children that (1) later received an autism diagnosis; (2) had language delays but not autism; and (3) had no delays or autism. We found that autistic toddlers' negative emotion was more likely to be intense and to continue once it started compared with children without delays or autism. Language-delayed toddlers also showed some, but not all these differences. Parents responded similarly to negative emotions in all groups. When parents used strategies to help, it reduced the chances of the negative emotions continuing, although it may have been less helpful for autistic toddlers. This study shows that autistic children may express more intense and long-lasting negative emotions from an early age. It also shows that parents of autistic children are very responsive to their children's negative emotions, but these responses may not be as helpful to autistic children. While more research is needed, this study helps us understand how autistic toddlers may express and experience emotions differently.
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Ding N, Fu L, Qian L, Sun B, Li C, Gao H, Lei T, Ke X. The correlation between brain structure characteristics and emotion regulation ability in children at high risk of autism spectrum disorder. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02369-y. [PMID: 38402375 DOI: 10.1007/s00787-024-02369-y] [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] [Received: 08/14/2023] [Accepted: 01/08/2024] [Indexed: 02/26/2024]
Abstract
As indicated by longitudinal observation, autism has difficulty controlling emotions to a certain extent in early childhood, and most children's emotional and behavioral problems are further aggravated with the growth of age. This study aimed at exploring the correlation between white matter and white matter fiber bundle connectivity characteristics and their emotional regulation ability in children with autism using machine learning methods, which can lay an empirical basis for early clinical intervention of autism. Fifty-five high risk of autism spectrum disorder (HR-ASD) children and 52 typical development (TD) children were selected to complete the skull 3D-T1 structure and diffusion tensor imaging (DTI). The emotional regulation ability of the two groups was compared using the still-face paradigm (SFP). The classification and regression models of white matter characteristics and white matter fiber bundle connections of emotion regulation ability in the HR-ASD group were built based on the machine learning method. The volume of the right amygdala (R2 = 0.245) and the volume of the right hippocampus (R2 = 0.197) affected constructive emotion regulation strategies. FA (R2 = 0.32) and MD (R2 = 0.34) had the predictive effect on self-stimulating behaviour. White matter fiber bundle connection predicted constructive regulation strategies (positive edging R2 = 0.333, negative edging R2 = 0.334) and mother-seeking behaviors (positive edging R2 = 0.667, negative edging R2 = 0.363). The emotional regulation ability of HR-ASD children is significantly correlated with the connections of multiple white matter fiber bundles, which is a potential neuro-biomarker of emotional regulation ability.
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Affiliation(s)
- Ning Ding
- Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
- Qingdao Women and Children' s Hospital, Qingdao University, Qingdao, 266011, China
| | - Linyan Fu
- Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Lu Qian
- Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Bei Sun
- Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Chunyan Li
- Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Huiyun Gao
- Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Tianyu Lei
- Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xiaoyan Ke
- Child Mental Health Research Center, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China.
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Northrup JB, Mazefsky CA, Day TN. Valence and Intensity of Emotional Expression in Autistic and Non-Autistic Toddlers. J Autism Dev Disord 2024:10.1007/s10803-024-06268-8. [PMID: 38315319 PMCID: PMC11297193 DOI: 10.1007/s10803-024-06268-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE Differences in emotional experience and expression have long been recognized as common in the presentation of autism, yet research examining emotional expression in early childhood is limited, with mixed findings. Understanding emotional reactivity and expression in autism in early life is an essential step towards uncovering the mechanisms of these risks and identifying targets for intervention. METHODS The present study examined emotional expression in autistic (N = 17) and non-autistic (N = 20) toddlers (mean age = 25.27; SD = 1.88) during emotion elicitation tasks aimed at eliciting joy, frustration, and unease. Video recorded tasks were coded in ten second intervals for emotional valence and intensity, and the following variables were computed: proportion of time in positive, neutral, and negative affect; maximum intensity of positive and negative affect; and range of affect (i.e., most negative to most positive intensity). RESULTS Autistic toddlers spent more time in neutral facial expressions, less time displaying positive affect, and had somewhat less intense positive emotional expression than non-autistic peers. Small differences were apparent in intensity of negative affect expression, while no differences emerged in duration of time spent in negative affect. CONCLUSION Findings emphasize that differences may be more apparent in duration, rather than intensity of emotional expression, and that it may be particularly important to examine periods of "neutral" affect in young autistic children. Future research should consider the best ways to understand emotional reactivity in this population considering their unique interests, challenges, and communication styles.
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Affiliation(s)
- Jessie B Northrup
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Taylor N Day
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Sacrey LAR, Zwaigenbaum L, Brian JA, Smith IM, Armstrong V, Vaillancourt T, Schmidt LA. Behavioral and physiological differences during an emotion-evoking task in children at increased likelihood for autism spectrum disorder. Dev Psychopathol 2024; 36:404-414. [PMID: 36573373 DOI: 10.1017/s0954579422001286] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Literature examining emotional regulation in infants with autism spectrum disorder (ASD) has focused on parent report. We examined behavioral and physiological responses during an emotion-evoking task designed to elicit emotional states in infants. Infants at an increased likelihood for ASD (IL; have an older sibling with ASD; 96 not classified; 29 classified with ASD at age two) and low likelihood (LL; no family history of ASD; n = 61) completed the task at 6, 12, and 18 months. The main findings were (1) the IL-ASD group displayed higher levels of negative affect during toy removal and negative tasks compared to the IL non-ASD and LL groups, respectively, (2) the IL-ASD group spent more time looking at the baseline task compared to the other two groups, and (3) the IL-ASD group showed a greater increase in heart rate from baseline during the toy removal and negative tasks compared to the LL group. These results suggest that IL children who are classified as ASD at 24 months show differences in affect, gaze, and heart rate during an emotion-evoking task, with potential implications for understanding mechanisms related to emerging ASD.
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Affiliation(s)
- Lori-Ann R Sacrey
- Department of Pediatrics, University of Alberta/Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta/Autism Research Centre, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - Jessica A Brian
- Bloorview Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Isabel M Smith
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Autism Research Centre, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Vickie Armstrong
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
- Autism Research Centre, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Tracy Vaillancourt
- Department of Education and Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Louis A Schmidt
- Department of Psychology, McMaster University, Hamilton, Ontario, Canada
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Fasano RM, Mitsven SG, Custode SA, Sarker D, Bulotsky-Shearer RJ, Messinger DS, Perry LK. Automated measures of vocal interactions and engagement in inclusive preschool classrooms. Autism Res 2023; 16:1586-1599. [PMID: 37403878 DOI: 10.1002/aur.2980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 06/16/2023] [Indexed: 07/06/2023]
Abstract
Classroom engagement plays a crucial role in preschoolers' development, yet the correlates of engagement, especially among children with autism spectrum disorder (ASD) and developmental delays (DD), remains unknown. This study examines levels of engagement with classroom social partners and tasks among children in three groups ASD, DD, and typical development (TD). Here, we asked whether children's vocal interactions (vocalizations to and from peers and teachers) were associated with their classroom engagement with social partners (peers and teachers) and with tasks, and whether the association between classroom engagement and vocal interactions differed between children in the ASD group and their peers in the DD and TD groups. Automated measures of vocalizations and location quantified children's vocal interactions with peers and teachers over the course of the school year. Automated location and vocalization data were used to capture both (1) children's vocal output to specific peers and teachers, and (2) the vocal input they received from those peers and teachers. Participants were 72 3-5-year-olds (Mage = 48.6 months, SD = 7.0, 43% girls) and their teachers. Children in the ASD group displayed lower engagement with peers, teachers, and tasks than children in the TD group; they also showed lower engagement with peers than children in the DD group. Overall, children's own vocalizations were positively associated with engagement with social partners. Thus, although children in the ASD group tend to have lower engagement scores than children in the TD group, active participation in vocal interactions appears to support their classroom engagement with teachers and peers.
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Affiliation(s)
- Regina M Fasano
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Samantha G Mitsven
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | | | - Debasish Sarker
- Department of Physics, University of Miami, Coral Gables, Florida, USA
| | | | - Daniel S Messinger
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
- Departments of Pediatrics, Music Engineering, and Electrical and Computer Engineering, University of Miami, Coral Gables, Florida, USA
| | - Lynn K Perry
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
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Susko M, Armstrong VL, Brian JA, Bryson SE, Kushki A, Sacrey LAR, Zwaigenbaum L, Smith IM. Behavioural reactions to an emotion evoking task in infants at increased likelihood for autism spectrum disorder. Infant Behav Dev 2023; 72:101848. [PMID: 37307722 DOI: 10.1016/j.infbeh.2023.101848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/14/2023]
Abstract
Infants at increased likelihood for autism spectrum disorder (ASD) exhibit more negative affect and avoidance behaviour than typically developing infants, and children with ASD express fear differently than typically developing peers. We examined behavioural reactions to emotion-evoking stimuli in infants at increased familial likelihood for ASD. Participants included 55 increased likelihood (IL) infants (i.e., siblings of children diagnosed with ASD) and 27 typical likelihood (TL) infants (i.e., no family history of ASD). At 18 months, we showed infants two masks that commonly elicit fearful responses in older children and examined potential behavioural differences in approach, avoidance, 'freezing', crying, gaze aversion, and smiling. At 24 months, infants were assessed with the Toddler Module of the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2). Results of video-based coding showed that (1) IL infants exhibited more intense avoidance behaviour than TL infants in response to masks, and (2) intensity of avoidance and duration of freezing were positively correlated with ADOS-2 symptom severity scores. Findings suggest that differences in response to emotion-eliciting stimuli may predict later ASD symptoms. Such behavioural differences may inform early detection and intervention in ASD.
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Affiliation(s)
- Melissa Susko
- Autism Research Centre, IWK Health Centre, Halifax, NS, Canada; Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
| | | | - Jessica A Brian
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Susan E Bryson
- Autism Research Centre, IWK Health Centre, Halifax, NS, Canada; Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Azadeh Kushki
- Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, Toronto, ON, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | | | | | - Isabel M Smith
- Autism Research Centre, IWK Health Centre, Halifax, NS, Canada; Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
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Day TN, Northrup JB, Mazefsky CA. A PROMIS®ing New Measure for Quantifying Emotion Dysregulation in Toddlers and Preschoolers: Development of the Emotion Dysregulation Inventory-Young Child. J Autism Dev Disord 2023; 53:2261-2273. [PMID: 35403207 PMCID: PMC9550886 DOI: 10.1007/s10803-022-05536-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/27/2022]
Abstract
The Emotion Dysregulation Inventory (EDI) was designed and validated to quantify emotion dysregulation (ED) in school-age children, with a particular emphasis on capturing ED in youth with ASD. We saw a need to adapt the EDI for use in young children (ages 2-5) given early childhood is a formative time for emotion regulation development. The present study discusses the adaptation process for the EDI-Young Child (EDI-YC), including item refinement/generation and cognitive interviews (N = 10 with ASD), consistent with the Patient-Reported Outcomes Measurement Information System (PROMIS®) methodology. The item bank was piloted in a sample of 2-year-olds with and without ASD (N = 31), which provided initial support for the EDI-YC as a valid and reliable measure.
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Affiliation(s)
- Taylor N Day
- Department of Psychiatry, University of Pittsburgh School of Medicine, 101 N. Dithridge St, Suite #300, Pittsburgh, PA, USA
- Florida State University, Tallahassee, FL, USA
| | - Jessie B Northrup
- Department of Psychiatry, University of Pittsburgh School of Medicine, 101 N. Dithridge St, Suite #300, Pittsburgh, PA, USA
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, 101 N. Dithridge St, Suite #300, Pittsburgh, PA, USA.
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11
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Day TN, Mazefsky CA, Wetherby AM. Characterizing difficulties with emotion regulation in toddlers with autism spectrum disorder. RESEARCH IN AUTISM SPECTRUM DISORDERS 2022; 96:101992. [PMID: 36798961 PMCID: PMC9928168 DOI: 10.1016/j.rasd.2022.101992] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Difficulties with emotion regulation (ER) underlie emotional/behavioral challenges and co-occurring psychiatric symptoms in autism spectrum disorder (ASD), yet very little is known about the early development of emotion dysregulation. The present study aimed to identify differences in positive and negative emotional reactivity and regulation strategies in toddlers with and without ASD. Method Nine tasks from the Laboratory Temperament Assessment Battery (Lab-TAB) were completed with 37 toddlers with and without ASD (22-28 months). Video-recordings of these tasks were coded by research assistants using a behavioral coding scheme tapping facial, bodily, and vocal affect and the frequency of ER strategies. Mixed model analyses were performed to examine the mean affect and total regulation strategies across each task and t-tests were conducted to assess the types of ER strategies utilized. Results Toddlers with ASD showed significantly less positive affect and greater frustration compared to non-ASD toddlers; reactivity was comparable between the groups for fear. Both groups used ER strategies in a similar pattern across tasks, with the exception that toddlers with ASD more often engaged in distraction to regulate. Effects of age and developmental level are discussed. Conclusions Toddlers with ASD were robustly characterized by greater frustration and lower joy despite frequent and age appropriate attempts to regulate their emotions. This study provides preliminary evidence that observable indicators of emotion dysregulation are present by two years of age. Clinical implications and future research directions are discussed.
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Affiliation(s)
- Taylor N. Day
- Florida State University, Department of Psychology, Tallahassee, FL, USA
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - Carla A. Mazefsky
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - Amy M. Wetherby
- Florida State University College of Medicine, Department of Clinical Sciences, Tallahassee, FL, USA
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Powell K, Macari S, Brennan-Wydra E, Feiner H, Butler M, Goncalves Fortes D, Boxberger A, Torres-Viso M, Morgan C, Lyons M, Chawarska K. Elevated symptoms of executive dysfunction predict lower adaptive functioning in 3-year-olds with autism spectrum disorder. Autism Res 2022; 15:1336-1347. [PMID: 35388596 PMCID: PMC9253075 DOI: 10.1002/aur.2715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 11/06/2022]
Abstract
Executive functioning (EF) deficits co-occur frequently with autism spectrum disorder (ASD) and have a long-term detrimental impact on quality of life of children and their families. Timely identification of risk for EF vulnerabilities may hasten access to early intervention and alleviate their long-term consequences. This study examines (1) if EF deficits are elevated in toddlers with ASD compared to nonautistic siblings of children with ASD, typically developing (TYP) toddlers, and toddlers with atypical developmental presentation; and (2) if EF deficits have a detrimental effect on adaptive functioning in ASD. Participants were recruited between September 2014 and October 2019 and included 73 toddlers with ASD, 33 nonautistic siblings of children with ASD, 35 toddlers with atypical development, and 28 TYP toddlers matched on chronological age (M = 39.01 months, SD = 3.11). EF deficits were measured using the BRIEF-P; adaptive skills were measured using the VABS-II. Whenever appropriate, analyses were controlled for MSEL verbal and nonverbal developmental quotient, ADOS-2 autism severity scores, and sex. Analyses revealed that toddlers with ASD exhibited elevated BRIEF-P scores across all domains compared to each of the three comparison groups. Higher BRIEF-P scores were associated with lower adaptive social, communication, and daily living skills while controlling for symptom severity, verbal and nonverbal functioning, and sex. In conclusion, marked vulnerabilities in EF are already present in 3-year-old toddlers with ASD and are predictive of the level of adaptive functioning in ASD. EF vulnerabilities in toddlers should be targeted for intervention to improve long-term outcomes in ASD. LAY SUMMARY: Many children with autism experience vulnerabilities in executive functioning (EF), which may include challenges with inhibition, working memory, cognitive flexibility, and planning. The study shows that these vulnerabilities can already be detected at age three and that their presence is linked with lower social, communication, and daily living skills. Screening children with ASD for EF challenges and helping those who have difficulties may improve their long-term outcomes.
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Affiliation(s)
- Kelly Powell
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Suzanne Macari
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Emma Brennan-Wydra
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Hannah Feiner
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Maureen Butler
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Diogo Goncalves Fortes
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Alexandra Boxberger
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Mariana Torres-Viso
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Chelsea Morgan
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Megan Lyons
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
| | - Katarzyna Chawarska
- Yale University School of Medicine, Yale Child Study Center, New Haven, Connecticut, USA
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13
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Jacques C, Courchesne V, Mineau S, Dawson M, Mottron L. Positive, negative, neutral-or unknown? The perceived valence of emotions expressed by young autistic children in a novel context suited to autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1833-1848. [PMID: 35168392 PMCID: PMC9483191 DOI: 10.1177/13623613211068221] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Starting early in life, autistics are characterized as having atypical facial expressions, as well as decreased positive and increased negative affect. The literature on autistic facial expressions remains small, however, with disparate methods and results suggesting limited understanding of common autistic emotions. Furthermore, unlike non-autistics’ emotions, autistics’ emotions have been assessed without considering this population’s characteristics. In this study, the valence of young children’s facial expressions was thus rated as positive, negative, neutral, or “unknown”—a term for perceived emotions observers do not understand. Facial expressions were assessed using the Montreal Stimulating Play Situation, a context incorporating potential autistic interests. Comparing 37 autistic and 39 typical young (27–56 months) age-matched children, we found no group differences in expressed positive, negative, and neutral emotions. We did find differences in unknown emotions, which were unique to the autistic group. Preliminary data also showed that autistic children’s repetitive behaviors co-occurred with positive, neutral, and unknown emotions, but not with negative emotions. In a novel context that considers their characteristics, we did not find decreased positive or increased negative emotions in young autistic children. Instead, they uniquely expressed emotions perceived as unknown, showing the need to improve our understanding of their full emotional repertoire.
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Affiliation(s)
- Claudine Jacques
- Université du Québec en Outaouais, Canada.,CIUSSS du Nord-de-l'Île-de-Montréal, Canada
| | | | | | | | - Laurent Mottron
- CIUSSS du Nord-de-l'Île-de-Montréal, Canada.,Université de Montréal, Canada
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14
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Zaharia A, Noir-Kahlo K, Bressoud N, Sander D, Dukes D, Samson AC. Proof of Concept: A Brief Psycho-Educational Training Program to Increase the Use of Positive Emotion Regulation Strategies in Individuals With Autism Spectrum Disorder. Front Psychol 2021; 12:705937. [PMID: 34790142 PMCID: PMC8591291 DOI: 10.3389/fpsyg.2021.705937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
Attenuated positive emotions and difficulties in regulating emotions are frequently observed in individuals with autism spectrum disorders (ASD) and are linked to increased risk of affective disorders, problematic behaviors, and impaired socio-emotional functioning. As such, interventions specifically focused on positive emotion regulation (ER) skills could be very valuable for individuals with ASD, their caregivers, and therapists. However, the field of positive ER in ASD is under-researched. The present study aimed at testing the practical potential and the preliminary effects of a brief novel psycho-educational training program on positive ER for individuals with ASD. Thirty male participants with ASD (aged 10-35years; N training=14, N waitlist=16) underwent a three-session program on the use of adaptive positive ER strategies (i.e., attentional deployment, cognitive change, and response modulation). Participants rated the program as easy to understand, interesting, pleasant, and likable. No dropouts or adverse effects were observed. The training group showed a significant increase in the self-reported use of the ER strategies compared to the waitlist group. The increase in the use of ER strategies maintained up to 7 weeks in the overall sample. Having reached high satisfaction rates and the intended effects in this proof of concept study, this novel program represents a promising tool to support ER. Future research should next investigate the efficacy of the intervention on day-to-day emotional experience and wellbeing. Clinical Trial Registration: ClinicalTrials.gov # NCT02898298.
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Affiliation(s)
- Alexandra Zaharia
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland.,Faculty of Psychology, UniDistance Suisse, Brig, Switzerland.,Institute of Special Education, University of Fribourg, Fribourg, Switzerland
| | - Katharina Noir-Kahlo
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland.,Réseau Fribourgeois de Santé Mentale, Fribourg, Switzerland
| | - Nicolas Bressoud
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland.,Institute of Special Education, University of Fribourg, Fribourg, Switzerland.,Haute École Pédagogique du Valais, Saint-Maurice, Switzerland
| | - David Sander
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland.,Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Daniel Dukes
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland.,Institute of Special Education, University of Fribourg, Fribourg, Switzerland
| | - Andrea C Samson
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland.,Faculty of Psychology, UniDistance Suisse, Brig, Switzerland.,Institute of Special Education, University of Fribourg, Fribourg, Switzerland
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15
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Northrup JB, Patterson MT, Mazefsky CA. Predictors of Severity and Change in Emotion Dysregulation among Children and Adolescents with ASD. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021; 50:708-729. [PMID: 34369833 DOI: 10.1080/15374416.2021.1955369] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Emotion dysregulation problems are prevalent and disruptive for many with autism spectrum disorder (ASD). This study compared severity and perceived change in emotion dysregulation in youth with and without ASD and probed correlates of emotion dysregulation (including possible two-way interactions) among youth with ASD. METHOD Participants were drawn from two large online samples (mean age = 12; range: 6-17) with (N = 1323) and without (N = 921) ASD. The study used the Emotion Dysregulation Inventory (EDI), a parent-report measure designed for youth with ASD. The EDI asks parents about current severity and perceived change (i.e. how current severity compares to lifetime severity) in emotion dysregulation, and includes two factors: Reactivity (rapidly escalating, intense negative affect) and Dysphoria (poorly upregulated positive affect, general unease). RESULTS Results indicated that youth with ASD had greater Reactivity severity and also greater positive change in Reactivity than non-ASD peers. Furthermore, differences between youth with and without ASD in the relationship between Reactivity and Dysphoria suggest a distinct profile of emotion dysregulation in ASD. Within the ASD sample, age and severity of stereotyped behavior predicted Reactivity and Dysphoria severity and Reactivity change. Female gender, lower parent education, and fluent verbal ability were additional predictors of increased Reactivity severity, while intellectual disability predicted lower Dysphoria severity. CONCLUSIONS This study provides new insight into predictors of emotion dysregulation in youth with ASD and represents a first step toward identifying which children with ASD may be most vulnerable to severe emotion dysregulation problems.
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Affiliation(s)
- Jessie B Northrup
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Mark T Patterson
- Department of Social and Decision Sciences, Carnegie Mellon University
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine
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16
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Kanagaraj S, Devishrree S, Swetha J, Priya BK, Sankar S, Cherian J, Gopal CR, Karthikeyan S. Autism and Emotion: A Narrative Review. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2021. [DOI: 10.1055/s-0041-1736277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractAutism spectrum disorder (ASD) includes a variety of childhood-onset and lifelong neurodevelopmental condition with an enduring impact on multiple domains of functioning characterized by persistent deficits in social communication, restricted and repetitive behavior interest, and activities. They often find it hard to recognize and control emotions but their emotional expression can be improved by various intervention techniques that in turn can help them understand and respond more appropriately to other people. Problems in the area on emotional reciprocity among individual with ASD involve recognizing, understanding, expressing, and regulating emotions. Their ability in emotional reciprocity is often improved with a comprehensive treatment approach, especially by focused emotional enhancement intervention. In this review, we followed the standard IMRAD (Introduction, Methods, Results, and Discussion) structure to critically examine the condition of autism and its relation with genetic mechanism, and how theories of emotion and theory of mind associated with persons with ASD, some of the widely used assessment tools and future research direction in the emotional development of individuals diagnosed with ASD by using the narrative review method. Records collected through research databases such as Scopus, PubMed, Web of Science, Medline, EBSCO and published books with ISBN (International Standard Book Number), and published test manuals were evaluated in-depth and summarized based on the subtopic of the proposed title. A critical theoretical analysis of the genetic mechanism of emotions, theories of emotions, and theory of mind was explained in connection with ASD.
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Affiliation(s)
- Sagayaraj Kanagaraj
- Department of Counseling Psychology, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, Tamil Nadu, India
| | - S. Devishrree
- Department of Clinical Psychology, National Institute for Empowerment of Persons with Multiple Disabilities (Divyangjan), East Coast Road, Chennai, Tamil Nadu, India
| | - J. Swetha
- Department of Rehabilitation Psychology, National Institute for Empowerment of Persons with Intellectual Disabilities (Divyangjan), Manovikas Nagar, Secunderabad, Telangana, India
| | - B. Krishna Priya
- Department of Counseling Psychology, University of Madras, Chennai, Tamil Nadu, India
| | - Srivarshini Sankar
- School of Biosciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Jincy Cherian
- Department of Psychology, Dayalbagh Educational Institute, Agra, Uttar Pradesh, India
| | - C.N. Ram Gopal
- Department of Counseling Psychology, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, Tamil Nadu, India
| | - S. Karthikeyan
- Department of Clinical Psychology, National Institute for Empowerment of Persons with Multiple Disabilities (Divyangjan), East Coast Road, Chennai, Tamil Nadu, India
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17
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Ding N, Gao H, Jiang J, Zhai M, Shao H, Fu L, Li C, Ren Y, Li Y, Feng M, Cui X, Qiu N, Jin P, Ke X. The characteristics and factors of the internalizing and externalizing behaviours of children at high risk for autism spectrum disorder. BMC Psychiatry 2021; 21:523. [PMID: 34686160 PMCID: PMC8532264 DOI: 10.1186/s12888-021-03479-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The behavioral characteristics of children with autism spectrum disorder (ASD) are not only affected by their disease, but also by their parenting environment. HR-ASD has the risk of developing internalization and externalization problems. How the early development of these behavioral problems is affected by parent-child interaction is worth exploring. We tested whether parent-child interactions and parenting characteristics were associated with behavioural problems during the infant periods. METHODS This study collected data from 91 infants at high risk for ASD and 68 matched typically developing (TD) infants, about their internalizing and externalizing behavioural problems and engagement states (i.e. positive, negative, and parent-child interactions), using free play paradigm. Parent measures were assessed using the Broad Autism Phenotypic Questionnaire (BAPQ) and Parenting Stress Index Short Form (PSI-SF) questionnaire. The core symptoms of ASD were assessed using the the Autism Diagnostic Observational Schedule (ADOS). RESULTS During free play, infants in the HR-ASD group showed more internalizing (P < 0.001) and externalizing (P < 0.05) behaviours and less positive engagement (P < 0.01) than the TD group. In the regression analysis, we found that parenting stress had an impact on the infants' externalizing behaviours (△R2 = 0.215). Parent negative engagement had an impact on the infants' internalizing behaviours (△R2 = 0.451). CONCLUSIONS The present study revealed that children at high risk for ASD exhibited more severe internalizing and externalizing behavioural problems than TD group. The parent negative engagement is associated with behavioural problems. The findings on the contribution of parents' factors to behavioural problems suggests that the parenting stress and parent-child interactions are important factors for mitigating behavioural problems.
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Affiliation(s)
- Ning Ding
- Nanjing Brain Hospital, Affiliated with Nanjing Medical University, Child Mental Health Research Center, Nanjing, 210029, China
| | - Huiyun Gao
- Nanjing Brain Hospital, Affiliated with Nanjing Medical University, Child Mental Health Research Center, Nanjing, 210029, China
| | - Jiying Jiang
- Nanjing Brain Hospital, Affiliated with Nanjing Medical University, Child Mental Health Research Center, Nanjing, 210029, China
| | - Mengyao Zhai
- Nanjing Brain Hospital, Affiliated with Nanjing Medical University, Child Mental Health Research Center, Nanjing, 210029, China
| | - Huan Shao
- Nanjing Brain Hospital, Affiliated with Nanjing Medical University, Child Mental Health Research Center, Nanjing, 210029, China
| | - Linyan Fu
- Nanjing Brain Hospital, Affiliated with Nanjing Medical University, Child Mental Health Research Center, Nanjing, 210029, China
| | - Chunyan Li
- Nanjing Brain Hospital, Affiliated with Nanjing Medical University, Child Mental Health Research Center, Nanjing, 210029, China
| | - Yanling Ren
- Nanjing Brain Hospital, Affiliated with Nanjing Medical University, Child Mental Health Research Center, Nanjing, 210029, China
| | - Yu Li
- Nanjing Brain Hospital, Affiliated with Nanjing Medical University, Child Mental Health Research Center, Nanjing, 210029, China
| | - Min Feng
- Nanjing Brain Hospital, Affiliated with Nanjing Medical University, Child Mental Health Research Center, Nanjing, 210029, China
| | - Xiwen Cui
- Nanjing Brain Hospital, Affiliated with Nanjing Medical University, Child Mental Health Research Center, Nanjing, 210029, China
| | - Nana Qiu
- Nanjing Brain Hospital, Affiliated with Nanjing Medical University, Child Mental Health Research Center, Nanjing, 210029, China
| | - Peiying Jin
- Nanjing Brain Hospital, Affiliated with Nanjing Medical University, Child Mental Health Research Center, Nanjing, 210029, China
| | - Xiaoyan Ke
- Nanjing Brain Hospital, Affiliated with Nanjing Medical University, Child Mental Health Research Center, Nanjing, 210029, China.
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18
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Sacrey LAR, Zwaigenbaum L, Brian JA, Smith IM, Armstrong V, Raza S, Vaillancourt T, Schmidt LA. Affect and gaze responses during an Emotion-Evoking Task in infants at an increased likelihood for autism spectrum disorder. Mol Autism 2021; 12:63. [PMID: 34615540 PMCID: PMC8493694 DOI: 10.1186/s13229-021-00468-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 09/06/2021] [Indexed: 12/04/2022] Open
Abstract
Background The majority of research examining emotional difficulties in autism spectrum disorder (ASD) prior to age 2 relies on parent report. Methods We examined behavioral responses (affect and gaze) during emotionally salient tasks designed to elicit mildly positive and negative emotional states in infants. At 12 and 18 months, infants at an increased likelihood for an ASD diagnosis (IL; have an older sibling with ASD; n = 60) and low likelihood (LL; no family history of ASD; n = 21) completed the Emotion-Evoking (EE) Task and parents completed the Infant Behavior Questionnaire-Revised (IBQ-R). All children received an Autism Diagnostic Observation Scale—second Edition assessment for ASD symptomatology at 24 months. Results The main findings were (1) the IL group displayed higher rates of negative affect and spent less time looking at the task objects compared to the LL group, and (2) affect and gaze scores at 12 and 18 months, but not scores on the IBQ-R, predicted ASD symptoms at 24 months. Limitations The data were drawn from an IL sample and may not be generalizable to the general ASD population, and the children were not followed to determine a diagnosis of ASD. Conclusion These results suggest that behavioral responses can provide important information that complements parent reports of emotional regulation in IL infants as early as 12 months of age. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-021-00468-0.
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Affiliation(s)
- Lori-Ann R Sacrey
- Department of Pediatrics, Autism Research Centre - E209, Glenrose Rehabilitation Hospital, University of Alberta, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada.
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, Autism Research Centre - E209, Glenrose Rehabilitation Hospital, University of Alberta, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada
| | - Jessica A Brian
- Bloorview Research Institute, University of Toronto, Toronto, ON, Canada
| | - Isabel M Smith
- IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | | | - Sarah Raza
- Department of Pediatrics, Autism Research Centre - E209, Glenrose Rehabilitation Hospital, University of Alberta, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada
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19
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Macari S, Chen X, Brunissen L, Yhang E, Brennan-Wydra E, Vernetti A, Volkmar F, Chang J, Chawarska K. Puppets facilitate attention to social cues in children with ASD. Autism Res 2021; 14:1975-1985. [PMID: 34350712 PMCID: PMC8434944 DOI: 10.1002/aur.2552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/09/2021] [Accepted: 05/18/2021] [Indexed: 11/06/2022]
Abstract
Diminished visual attention to faces of social partners represents one of the early characteristics of autism spectrum disorder (ASD). Here we examine if the introduction of puppets as social partners alters attention to speakers' faces in young children with ASD and typically developing (TD) controls. Children with ASD (N = 37; Mage = 49.44 months) and TD (N = 27; Mage = 40.66 months) viewed a video depicting a puppet and a human engaged in a conversation. Dwell time on these faces was analyzed as a function of group and speaker's identity. Unlike TD controls, the ASD group exhibited limited visual attention to and chance-level visual preference for the human speaker. However, attention to and preference for the puppet speaker's face was greater than chance and comparable across the two groups. While there was a strong association between low human speaker preference and high autism severity, no association with autism severity was found for puppet speaker preference. Unlike humans, expressive and verbal puppets attracted the attention of children with ASD at levels comparable to that of TD controls. Considering that puppets can engage in reciprocal interactions and deliver simplified, salient social-communicative cues, they may facilitate therapeutic efforts in children with ASD. LAY SUMMARY: While studies have shown support for therapeutic uses of robots with children with autism, other similar agents such as puppets remain to be explored. When shown a video of a conversation between a puppet and a person, young children with ASD paid as much attention to the puppet's face as typically-developing (TD) children. Since puppets can engage in back-and-forth interactions and model social interactions and communication, they may play a promising role in therapeutic efforts for young children with ASD.
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Affiliation(s)
- Suzanne Macari
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Xinyuan Chen
- Department of Statistics and Data Science, Yale University, New Haven, Connecticut, USA
| | - Ludivine Brunissen
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Eukyung Yhang
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Emma Brennan-Wydra
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Angelina Vernetti
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Fred Volkmar
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Joseph Chang
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Statistics and Data Science, Yale University, New Haven, Connecticut, USA
| | - Katarzyna Chawarska
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
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20
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Konke LA, Forslund T, Nilsson-Jobs E, Nyström P, Falck-Ytter T, Brocki K. How Does Temperament in Toddlers at Elevated Likelihood for Autism Relate to Symptoms of Autism and ADHD at Three Years of Age? J Autism Dev Disord 2021; 52:995-1006. [PMID: 33852084 PMCID: PMC8854311 DOI: 10.1007/s10803-021-05001-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 12/28/2022]
Abstract
The current study investigated longitudinal associations between parent-rated temperament, observed exuberance and accelerometer activity level at 18-months and symptoms of ASD and ADHD at 36-months in a sample of 54 children at elevated likelihood for ASD. For the specific parent-rated temperament scales, most observed significant associations appeared to be specific for either ASD or ADHD symptoms. Indeed, by controlling for overlapping symptoms a different pattern of associations emerged. These results illustrate how temperamental measures may signal risk for later ASD versus ADHD symptomatology in infants at elevated likelihood for ASD. In addition, they indicate the potential of adopting a broader view on neurodevelopmental disorders by investigating not only ASD traits, but also co-occurring disorders such as ADHD in samples of elevated likelihood for ASD.
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Affiliation(s)
| | - Tommie Forslund
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden.,Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Pär Nyström
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden
| | - Terje Falck-Ytter
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden.,Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden.,Swedish Collegium for Advanced Study (SCAS), Uppsala, Sweden
| | - Karin Brocki
- Department of Psychology, Uppsala University, Box 1225, 751 42, Uppsala, Sweden.
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21
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Chetcuti L, Uljarević M, Ellis-Davies K, Hardan AY, Whitehouse AJO, Hedley D, Putnam S, Hudry K, Prior MR. Temperament in individuals with Autism Spectrum Disorder: A systematic review. Clin Psychol Rev 2021; 85:101984. [PMID: 33607568 DOI: 10.1016/j.cpr.2021.101984] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 01/09/2023]
Abstract
The study of temperament in Autism Spectrum Disorder (ASD) has the potential to provide insight regarding variability in the onset, nature, and course of both core and co-morbid symptoms. The aim of this systematic review was to integrate existing findings concerning temperament in the context of ASD. Searches of Medline, PsychInfo and Scopus databases identified 64 relevant studies. As a group, children and adolescents with ASD appear to be temperamentally different from both typically developing and other clinical non-ASD groups, characterized by higher negative affectivity, lower surgency, and lower effortful control at a higher-order level. Consistent with research on typically developing children, correlational findings and emerging longitudinal evidence suggests that lower effortful control and higher negative affect are associated with increased internalizing and externalizing problems in ASD samples. Longitudinal studies suggest there may be temperamental differences between high familial risk infants who do and do not develop ASD from as early as 6-months of age. Limitations of existing research are highlighted, and possible directions for future research to capitalize on the potential afforded through the study of temperament in relation to ASD are discussed.
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Affiliation(s)
- Lacey Chetcuti
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Mirko Uljarević
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia; Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, Stanford Autism Center, School of Medicine, Stanford University, USA.
| | | | - Antonio Y Hardan
- Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, Stanford Autism Center, School of Medicine, Stanford University, USA
| | | | - Darren Hedley
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Samuel Putnam
- Department of Psychology, Bowdoin College, United States
| | - Kristelle Hudry
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Margot R Prior
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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22
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Manolova H, Hristova M, Staykova S. The Importance of Early Psychological Assessment for Differential Diagnosis and Detection of Comorbidity in Children With Autism Spectrum Disorder. Front Psychiatry 2021; 12:671744. [PMID: 34054622 PMCID: PMC8149738 DOI: 10.3389/fpsyt.2021.671744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Harieta Manolova
- Department of Psychiatry and Medical Psychology, Medical University - Sofia, Sofia, Bulgaria
| | - Mihaela Hristova
- Department of Psychiatry and Medical Psychology, Medical University - Sofia, Sofia, Bulgaria
| | - Svetla Staykova
- Department of Psychiatry and Medical Psychology, Medical University - Sofia, Sofia, Bulgaria
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23
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Macari SL, Vernetti A, Chawarska K. Attend Less, Fear More: Elevated Distress to Social Threat in Toddlers With Autism Spectrum Disorder. Autism Res 2020; 14:1025-1036. [PMID: 33283976 DOI: 10.1002/aur.2448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/01/2020] [Accepted: 11/21/2020] [Indexed: 01/10/2023]
Abstract
Differential emotional reactivity to social and nonsocial stimuli has been hypothesized but rarely examined empirically in ASD despite its potential importance for development of social motivation, cognition, and comorbid psychopathology. This study examined emotional reactivity, regulation, and attention to social and nonsocial threat in toddlers with ASD (n = 42, Mage : 22 months) and typically developing (TD) toddlers (n = 22, Mage : 23 months), and their mutual associations with autism symptom severity. Participants were exposed to social (stranger), nonsocial (mechanical objects), and ambiguous (masks) threats, and their intensity of distress (iDistress), attention to threat (Attention), and presence of emotion regulation (ER) strategies were measured. Autism symptom severity was quantified using the Autism Diagnostic Observation Schedule-2. In response to social threat, toddlers with ASD exhibited elevated iDistress (P < 0.038) but lower Attention (P < 0.002) and a wider variety of ER strategies (P < 0.040) compared to TD controls, though their ER strategies were less likely to be social. However, nonsocial and ambiguous threat elicited lower iDistress in ASD than in TD toddlers (P = 0.012 and P = 0.034, respectively), but comparable Attention and ER strategy use. Autism severity was not associated with iDistress. The study demonstrates elevated emotional salience but diminished attentional salience of social threat in ASD. A failure to attend adequately to social threats may restrict opportunities to appraise their threat value and engender often observed in ASD negative emotional responses to novel social situations. Early atypical emotional reactivity may independently contribute to the shaping of complex autism phenotypes and may be linked with later emerging affective and behavioral symptoms. LAY SUMMARY: Compared to typically developing toddlers, toddlers with ASD show diminished attention yet enhanced distress in response to social threat. Poor attention to potential social threat may limit opportunities to assess its threat value and thus contribute to often observed negative emotional responses to novel social situations. Identifying the precursors of atypical emotional reactivity in infancy and its links with later psychopathology will inform about novel treatment targets and mechanisms of change in the early stages of ASD. Autism Res 2021, 14: 1025-1036. © 2020 International Society for Autism Research, Wiley Periodicals, LLC.
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Affiliation(s)
- Suzanne L Macari
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, 06511, USA
| | - Angelina Vernetti
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, 06511, USA
| | - Katarzyna Chawarska
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, 06511, USA
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Vernetti A, Shic F, Boccanfuso L, Macari S, Kane-Grade F, Milgramm A, Hilton E, Heymann P, Goodwin MS, Chawarska K. Atypical Emotional Electrodermal Activity in Toddlers with Autism Spectrum Disorder. Autism Res 2020; 13:1476-1488. [PMID: 32896980 PMCID: PMC10081486 DOI: 10.1002/aur.2374] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 07/19/2020] [Accepted: 07/23/2020] [Indexed: 01/22/2023]
Abstract
Past studies in autism spectrum disorder (ASD) indicate atypical peripheral physiological arousal. However, the conditions under which these atypicalities arise and their link with behavioral emotional expressions and core ASD symptoms remain uncertain. Given the importance of physiological arousal in affective, learning, and cognitive processes, the current study examined changes in skin conductance level (ΔSCL) in 41 toddlers with ASD (mean age: 22.7 months, SD: 2.9) and 32 age-matched toddlers with typical development (TD) (mean age: 21.6 months, SD: 3.6) in response to probes designed to induce anger, joy, and fear emotions. The magnitude of ΔSCL was comparable during anger (P = 0.206, d = 0.30) and joy (P = 0.996, d = 0.01) conditions, but significantly lower during the fear condition (P = 0.001, d = 0.83) in toddlers with ASD compared to TD peers. In the combined samples, ΔSCL positively correlated with intensity of behavioral emotional expressivity during the anger (r[71] = 0.36, P = 0.002) and fear (r[68] = 0.32, P = 0.007) conditions, but not in the joy (r[69] = -0.15, P = 0.226) condition. Finally, ΔSCL did not associate with autism symptom severity in any emotion-eliciting condition in the ASD group. Toddlers with ASD displayed attenuated ΔSCL to situations aimed at eliciting fear, which may forecast the emergence of highly prevalent internalizing and externalizing problems in this population. The study putatively identifies ΔSCL as a dimension not associated with severity of autism but with behavioral responses in negatively emotionally challenging events and provides support for the feasibility, validity, and incipient utility of examining ΔSCL in response to emotional challenges in very young children. LAY SUMMARY: Physiological arousal was measured in toddlers with autism exposed to frustrating, pleasant, and threatening tasks. Compared to typically developing peers, toddlers with autism showed comparable arousal responses to frustrating and pleasant events, but lower responses to threatening events. Importantly, physiological arousal and behavioral expressions were aligned during frustrating and threatening events, inviting exploration of physiological arousal to measure responses to emotional challenges. Furthermore, this study advances the understanding of precursors to emotional and behavioral problems common in older children with autism. Autism Res 2020, 13: 1476-1488. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Angelina Vernetti
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Frederick Shic
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA.,Seattle Children's Research Institute, Seattle, Washington, USA.,Division of General Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Suzanne Macari
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Finola Kane-Grade
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Anna Milgramm
- Center for Autism and Related Disabilities, University at Albany, SUNY, New York City, New York, USA
| | - Emily Hilton
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Perrine Heymann
- Early Childhood Behavior Lab, Florida International University, Miami, Florida, USA
| | - Matthew S Goodwin
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Katarzyna Chawarska
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
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Mallise CA, Lane AE, Woolard AJ, Whalen OM, Murphy VE, Karayanidis F, Campbell LE. The temperament features associated with autism spectrum disorder in childhood: A systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 104:103711. [PMID: 32599501 DOI: 10.1016/j.ridd.2020.103711] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 03/14/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Temperament is an important construct that shapes child development. Temperament is suggested to present differently in different groups, such as children with neurodevelopmental disorders. However, it is not known whether there are specific temperament features associated with Autism Spectrum Disorder (ASD). AIM This systematic review aimed to synthesise extant literature to determine whether there are temperament features associated with ASD in infancy, toddlerhood and childhood. METHODS AND PROCEDURES Following the PRISMA guidelines for systematic reviews, we searched PsycINFO, CINAHL, Academic Search Ultimate and ProQuest for all available articles from database conception until January 2020. The Joanna Briggs Institute Critical Appraisal checklists were used to assess the methodological quality of included articles. OUTCOMES AND RESULTS Twenty-six articles met the selection criteria: (1) reported on the temperament of children (0-12 years of age) diagnosed with ASD, (2) peer-reviewed; and (3) published in English. Articles varied in overall methodological quality. Infants later diagnosed with ASD were found to more frequently be described as having 'easy' temperament features in early infancy, compared to typically developing infants and infants with developmental concerns but not ASD. Once diagnosed, children with ASD were reported to, as a group, display more negative affect, less extraversion and less effortful control than typically developing children. CONCLUSIONS AND IMPLICATIONS The literature suggests that more challenging temperament features are associated with ASD in childhood, but less is known about within group variability. Overall, this review highlights the need for further investigation into the variability of temperament in children with ASD.
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Affiliation(s)
- Carly A Mallise
- School of Psychology, University of Newcastle, Callaghan, Australia; Priority Research Centre GrowUpWell®, University of Newcastle, Australia
| | - Alison E Lane
- Priority Research Centre GrowUpWell®, University of Newcastle, Australia; School of Health Sciences, University of Newcastle, Callaghan, Australia
| | - Alix J Woolard
- School of Psychology, University of Newcastle, Callaghan, Australia; Priority Research Centre GrowUpWell®, University of Newcastle, Australia
| | - Olivia M Whalen
- School of Psychology, University of Newcastle, Callaghan, Australia; Priority Research Centre GrowUpWell®, University of Newcastle, Australia
| | - Vanessa E Murphy
- Priority Research Centre GrowUpWell®, University of Newcastle, Australia; VIVA (Viruses, Infections/Immunity, Vaccines and Asthma) Research Group, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Frini Karayanidis
- School of Psychology, University of Newcastle, Callaghan, Australia; Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Australia
| | - Linda E Campbell
- School of Psychology, University of Newcastle, Callaghan, Australia; Priority Research Centre GrowUpWell®, University of Newcastle, Australia.
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Northrup JB, Goodwin M, Montrenes J, Vezzoli J, Golt J, Peura CB, Siegel M, Mazefsky C. Observed emotional reactivity in response to frustration tasks in psychiatrically hospitalized youth with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:968-982. [PMID: 32169018 DOI: 10.1177/1362361320908108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Large emotional reactions (e.g. outbursts, tantrums) can be common and distressing in the lives of individuals with autism spectrum disorder and their families. Most previous research that has examined these types of emotional responses have used questionnaire data or focused only on young children. In addition, very little research has included individuals across a large range of intellectual and functional abilities or individuals with more severe emotional and/or behavioral difficulties. This study examined emotional reactions to frustrating tasks in 6-21-year-olds with autism spectrum disorder who were psychiatrically hospitalized due to emotional and/or behavioral difficulties. We describe change in the amount, intensity, duration, and range of emotional reactions that the participants displayed from a neutral activity to the frustrating tasks and then to a neutral recovery period. We also examined associations between characteristics of the participants and these emotional reactions. We found that younger children displayed more negative emotions across the neutral and frustrating tasks; however, age did not relate to how big their reactions to frustration were. Furthermore, we found that individuals with fewer adaptive skills (i.e. age-appropriate life skills) and minimally verbal individuals had bigger reactions and recovered less following the frustration tasks. The results highlight the importance of examining emotional reactions in individuals with lower verbal and adaptive abilities and for interventions to consider the connection between verbal and adaptive skills and emotional reactions.
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Affiliation(s)
| | | | | | | | - Josh Golt
- University of Pittsburgh, USA.,The University of Alabama, USA
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Reyes N, Walsh C, Soke N, Hepburn S. Changes in temperament over time in young children with autism spectrum disorder and other developmental delays: a follow-up comparison study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:1248-1261. [PMID: 31169961 DOI: 10.1111/jir.12648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Although in the last decade some research has emerged on temperament in autism spectrum disorder (ASD), this research has primarily focused on the differences between children with ASD and their typically developing peers rather than the stability or change in temperament in this population. Thus, the goal of this study was to examine temperament over time in children with ASD, developmental delays (DD) and typical development (TD). Temperament differences were also compared among the three groups. METHODS To accomplish this, parents rated children's temperament at Time 1 (T1) and Time 2 (T2) using the Carey Temperament Scales (CTS). RESULTS Results from the study showed that at T1, parents of children with ASD rated their children as more withdrawn (i.e. approach), and emotionally negative (i.e. mood), and less distractible and adaptable than parents of children with TD and DD. Also, children with ASD were rated as more intense and children with DD as less distractible than their TD peers. Similarly, at T2, children with ASD were rated more withdrawn, and emotionally negative, and less persistent, rhythmic, adaptable and distractible than children with TD and DD. Also, children with ASD were rated as more active than their DD peers. Regarding stability, parent ratings of temperament appeared stable over time in the TD group, but ratings varied substantially in the ASD or DD groups. That is, for the ASD group, activity and approach at T1 were significantly associated with their corresponding dimensions at T2. However, for the TD group, rhythmicity, approach, intensity and mood at T1 were significantly associated with those dimensions at T2. No associations were found in the DD group. Regarding change, parents reported change in rhythmicity, persistence and threshold between T1 and T2 in the ASD group. Similarly, parents reported change in rhythmicity, approach and threshold between T1 and T2 in the DD group. Lastly, parents of TD children reported change in adaptability, persistence and distractibility between T1 and T2. CONCLUSIONS These findings are novel in that children with ASD appear to have less stable temperament profile and different change patterns than children with TD or DD. Similar to previous research, children with ASD were described by their parents as experiencing more temperamental difficulties.
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Affiliation(s)
- N Reyes
- Department of Pediatrics, University of Colorado, Aurora, CO, USA
- Department of Psychiatry, University of Colorado, Aurora, CO, USA
| | - C Walsh
- Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | - N Soke
- Department of Psychiatry, University of Colorado, Aurora, CO, USA
| | - S Hepburn
- Department of Psychiatry, University of Colorado, Aurora, CO, USA
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