Early Adaptive Functioning Trajectories in Preschoolers With Autism Spectrum Disorders

Adaptive Functioning Across Contexts: A Comparison of Parent and Self-Reported Ratings in Autistic and Non-Autistic Youth

Multi-informants are essential for capturing the full range of adaptive functioning abilities necessary for daily living and independence. However, discrepancies within parent-child dyads, specifically comparing parent-reports to child self-reports, can cloud interpretation from assessments and hinder support planning. This study examines discrepancies in parent-youth perceptions of adaptive functioning, focusing on the social domain, and investigates associations among parents, youth, and independent ratings, considering factors like IQ, autism severity, and parental education. The study included 132 individuals (66 autistic, 66 non-autistic) aged 16-24 years. Adaptive functioning was measured using the Adaptive Behavior Assessment System-3 across the conceptual, practical, and social domains. Agreement between reporters was assessed using paired-sample t-tests, intraclass-correlations, and Bland-Altman plots. Spearman's correlations examined associations between raters, while the effects of IQ, autism severity, and parental education on discrepancies were analyzed using linear regression. Autistic self- and parent-reports showed lower adaptive functioning than non-autistic dyads. Autistic youth reported higher social and less practical adaptive skills compared to parents. Autistic self-reports in the social domain correlated significantly with independent assessment. Increased autistic symptoms were associated with greater parent-child discrepancies. This study underscores the importance of multi-informant assessments to understand the full range of adaptive functioning in autistic individuals. Discrepancies in social and practical domains highlight the need for both perspectives, because parents may not observe all behaviors and may overlook autistic individuals' perception of support needs in the practical domain. Understanding these differences is crucial for improving supports planning and enhancing quality of life for autistic individuals.

Atypical audio-visual neural synchrony and speech processing in early autism

BACKGROUND

Children with Autism Spectrum disorder (ASD) often exhibit communication difficulties that may stem from basic auditory temporal integration impairment but also be aggravated by an audio-visual integration deficit, resulting in a lack of interest in face-to-face communication. This study addresses whether speech processing anomalies in young autistic children (mean age 3.09-year-old) are associated with alterations of audio-visual temporal integration.

METHODS

We used high-density electroencephalography (HD-EEG) and eye tracking to record brain activity and gaze patterns in 31 children with ASD (6 females) and 33 typically developing (TD) children (11 females), while they watched cartoon videos. Neural responses to temporal audio-visual stimuli were analyzed using Temporal Response Functions model and phase analyses for audiovisual temporal coordination.

RESULTS

The reconstructability of speech signals from auditory responses was reduced in children with ASD compared to TD, but despite more restricted gaze patterns in ASD it was similar for visual responses in both groups. Speech reception was most strongly affected when visual speech information was also present, an interference that was not seen in TD children. These differences were associated with a broader phase angle distribution (exceeding pi/2) in the EEG theta range in children with ASD, signaling reduced reliability of audio-visual temporal alignment.

CONCLUSION

These findings show that speech processing anomalies in ASD do not stand alone and that they are associated already at a very early development stage with audio-visual imbalance with poor auditory response encoding and disrupted audio-visual temporal coordination.

Early trajectories and moderators of autistic language profiles: A longitudinal study in preschoolers

LAY ABSTRACT

Language development can greatly vary among autistic children. Children who struggle with language acquisition often face many challenges and experience lower quality of life. However, little is known about the early language trajectories of autistic preschoolers and their moderators. Autistic language can be stratified into three profiles. Language unimpaired experience little to no language difficulties; language impaired show significant difficulties in language; minimally verbal never develop functional language. In this study, we used a longitudinal sample of preschoolers with autism and with typical development (aged 1.5-5.7 years). We replicated the three language profiles through a data-driven approach. We also found that different factors modulated the language outcome within each group. For instance, non-verbal cognition at age 2.4 moderated the participants' attribution to each language profile. Moreover, early intervention moderated verbal outcome in the language impaired profile. In conclusion, we provided a detailed description of how autistic preschoolers acquire language, and what factors might influence their trajectories. Our findings could inspire more personalized intervention for early autistic language difficulties.

Phenotyping variability in early socio-communicative skills in young children with autism and its influence on later development

Children with autism spectrum disorder (ASD) often face challenges in early social communication skills, prompting the need for a detailed exploration of specific behaviors and their impact on cognitive and adaptive functioning. This study aims to address this gap by examining the developmental trajectories of early social communication skills in preschoolers with ASD aged 18-60 months, comparing them to age-matched typically developing (TD) children. Utilizing the early social communication scales (ESCS), the research employs a longitudinal design to capture changes over time. We apply a principal component analysis (PCA) to ESCS variables to identify underlying components, and cluster analysis to identify subgroups based on preverbal communication profiles. The results reveal consistent differences in early social communication skills between ASD and TD children, with ASD children exhibiting reduced skills. PCA identifies two components, distinguishing objects-directed behaviors and social interaction-directed behaviors. Cluster analysis identifies three subgroups of autistic children, each displaying specific communication profiles associated with distinct cognitive and adaptive functioning trajectories. In conclusion, this study provides a nuanced understanding of early social communication development in ASD, emphasizing the importance of low-level behaviors. The identification of subgroups and their unique trajectories contributes to a more comprehensive understanding of ASD heterogeneity. These findings underscore the significance of early diagnosis, focusing on specific behaviors predicting cognitive and adaptive functioning outcomes. The study encourages further research to explore the sequential development of these skills, offering valuable insights for interventions and support strategies.

Feasibility and Preliminary Evaluation of Theory-Based Training Program on Daily Living Skills Among Children With Autism Spectrum Disorder: Findings From Rural Regions in Egypt

BACKGROUND

One of the most crucial objectives in the education and treatment of young children with autism spectrum disorder (ASD) is independence in daily living skills (DLS). Therefore, as a child with ASD condition grows, measures of everyday functioning including adaptive behaviors should be more regularly monitored and regulated.

AIM

The primary aim of this study was to evaluate the feasibility of a developed theory-based training program and its preliminary effectiveness on the acquisition of DLS among school-age children with ASD.

METHODS

A preliminary experimental research design (pre- and post-evaluation) was conducted from the beginning of May to the end of July 2023 on 31 children with ASD. The socio-economic status scale, Vineland Adaptive Behavior Scale, and Gilliam Autism Rating Scale were administered before and after a theory-based DLS training program.

RESULTS

There was a significant difference in the DLS and motor functioning before and after the implementation of the training program (p < .001 and p = .021, respectively). In addition, there was a significant difference in the total score of autistic severity before and after the implementation of the training program (p < .001).

CONCLUSION

The promising outcomes of the study indicate the need for further testing and expansion of this intervention. These findings contribute to the growing body of evidence highlighting the significance of DLS training program in the comprehensive treatment approach for children with ASD. Consequently, proposing DLS training programs as a cost-effective and efficient nursing intervention is warranted.

Cognitive-adaptive Functioning Gap and Mediating Factors that Impact Adaptive Functioning in Chinese Preschool-aged Children with Autism Spectrum Disorder

This study aimed to investigate the gap between adaptive functioning and cognitive functioning, especially verbal and nonverbal intelligence quotient (IQ) in Chinese children with ASD. We systematically explored cognitive functioning, ASD severity, early signs of developmental abnormalities, and socioeconomic factors as mediating factors of adaptive functioning. We enrolled 151 children (age: 2.5?6 years) with ASD and categorized them into one group with IQ ≥ 70 and another with IQ < 70. The two groups were calibrated for age, age at diagnosis, and IQ, and the relationship of adaptive skills with vocabulary acquisition index (VAI) and nonverbal index (NVI) were separately analyzed. Results show that the gap between IQ and adaptive functioning was significant in children with ASD having IQ ≥ 70, with both VAI and NVI showing statistically significant differences (all P < 0.001). VAI correlated positively with scores for overall adaptive skills and specific domains, whereas NVI had no significant correlations with adaptive skill scores. Age of first walking unaided had an independent positive correlation (all P < 0.05) with scores of adaptive skills and specific domains. IQ-adaptive functioning gap is significant in children with ASD having IQ ≥ 70, suggesting that defining "high-functioning autism" merely on the basis of IQ is not appropriate. Verbal IQ and early signs of motor development are specific and possible predictors of adaptive functioning in children with ASD, respectively.

Development and Psychometric Examination of a New Social Competence Outcome Measure for Children with Autism Spectrum Disorder: The Observational Social Competence Assessment

Current assessments of social competence for children with autism spectrum disorder (ASD) are mostly designed for screening or diagnosis, not for measuring outcomes. This study aimed to develop a professional-administrated outcome measure, the Observational Social Competence Assessment (OSCA), and examine its psychometric properties. The OSCA was constructed based on a multidimensional view of social competence (i.e., social skill elements, social reciprocity, and social adjustment). For psychometric evaluation, 89 children with ASD between 3 and 12 years (mean = 70.69 months, SD = 15.31) were assessed with the OSCA and with assessments of ASD symptoms, verbal comprehension ability, and adaptive function. The results show that the OSCA has good internal consistency (Cronbach's α = 0.820-0.954), test-retest reliability (intraclass correlation coefficients [ICC] = 0.917-0.960), and inter-rater reliability (ICC = 0.905-0.974). The OSCA also has good convergent (r = 0.508-0.703, p < 0.01) and divergent validity (r = 0.105, p = 0.496), as well as good responsiveness to changes in the social adjustment dimension (Cohen's d = 1.26 and standardized response mean [SRM] = 1.92). Conclusively, these results show that the OSCA is sufficiently reliable, valid and responsive to be applied as an outcome measure of social competence in children with ASD.

The Association Between Autism Symptomatology and Adaptive Functioning Over Six Months: Findings from the Pilot Phase of the PARC Study

PURPOSE

In the context of developmental trajectories, the association between adaptive functioning and core autism symptomatology remains unclear. The current study examines the associations of adaptive behavior with autism symptom sub-domains and with different facets of symptom expression.

METHODS

Participants include 36 children with a recent diagnosis of autism (33 males; mean age = 56.4 months; SD = 9 months). Families were recruited in the context of the Pediatric Autism Research Cohort (PARC) project. Parents filled out questionnaires at two time points, six months apart, regarding their child's autism symptoms and adaptive functioning. The longitudinal relationship between adaptive functioning and autism symptoms was investigated using Mixed Linear Model analyses: one assessing the relationship between general symptom levels and adaptive functioning, and another examining the associations between symptom frequency and impact with adaptive functioning. We conducted Pearson correlation tests at both time points to assess the associations between symptom sub-domains and adaptive functioning.

RESULTS

Findings showed that higher autism symptoms associated with lower adaptive behavior skills, and that this association remained stable over time. Autism impact scores did not significantly relate to adaptive skills, as opposed to frequency scores. Associations between adaptive functioning and autism symptom sub-domains strengthened over time.

CONCLUSION

These findings suggest that adaptive functioning is associated with parent-report autism symptomatology, and that this association changes and, on average, becomes stronger over time. Findings may indicate that frequency and impact of symptoms have differential roles in the development of adaptive skills and are worthy of further exploration.

Using adaptive behavior scores to convey level of functioning in children with autism spectrum disorder: Evidence from the Study to Explore Early Development

LAY ABSTRACT

Autistic people are often described as "low-" or "high-functioning" based on their scores on cognitive tests. These terms are common in publications and in everyday communication. However, recent research and feedback from the autistic community suggests that relying on cognitive ability alone to describe functioning may miss meaningful differences in the abilities of autistic children and adults and in the kinds of support they may need. Additional methods are needed to describe "functioning" in autistic children. We examined whether scores from a test measuring adaptive behaviors would provide information on the functional abilities of children with autism that is different from cognitive ability and autism symptom severity. Adaptive behaviors include age-appropriate skills that allow people to function in their everyday lives and social interactions. We found that a large amount of the variation in adaptive behavior scores was not explained by cognitive development, autism symptom severity, and behavioral and emotional problems. In addition, there was a wide range of adaptive ability levels in children with autism in our study, including in those with low, average, or high cognitive scores. Our results suggest that adaptive behavior scores could provide useful information about the strengths and support needs of autistic children above and beyond measures of cognitive ability and autism symptom severity. Adaptive behavior scores provide important information on the needs of autistic people.

Individualized Parent-Mediated Behavioral Treatment for Challenging Behavior: A Program Description

Past research suggests behavioral treatments are effective for challenging behavior in children and young adults with neurodevelopmental disorders, such as autism spectrum disorder (ASD). However, access to these services can be limited and require substantial resources. To address this issue, the current study provides a programmatic description of an individualized parent-mediated service model targeting moderate challenging behavior. In the program, therapists coached parents to implement functional analyses and individualized function-based treatment packages. Forty-one families of children and young adults with neurodevelopmental disorders participated. Most clients (75.6%) met all admission treatment goals and parents reported significant decreases in frequency and severity of challenging behaviors at discharge. Parents also reported less stress at discharge. Outcomes of the study suggest this parent-mediated treatment model is a viable option to treating moderate challenging behavior in children and young adults with intellectual and developmental disorders.

Speech Reception in Young Children with Autism Is Selectively Indexed by a Neural Oscillation Coupling Anomaly

Communication difficulties are one of the core criteria in diagnosing autism spectrum disorder (ASD), and are often characterized by speech reception difficulties, whose biological underpinnings are not yet identified. This deficit could denote atypical neuronal ensemble activity, as reflected by neural oscillations. Atypical cross-frequency oscillation coupling, in particular, could disrupt the joint tracking and prediction of dynamic acoustic stimuli, a dual process that is essential for speech comprehension. Whether such oscillatory anomalies already exist in very young children with ASD, and with what specificity they relate to individual language reception capacity is unknown. We collected neural activity data using electroencephalography (EEG) in 64 very young children with and without ASD (mean age 3; 17 females, 47 males) while they were exposed to naturalistic-continuous speech. EEG power of frequency bands typically associated with phrase-level chunking (δ, 1-3 Hz), phonemic encoding (low-γ, 25-35 Hz), and top-down control (β, 12-20 Hz) were markedly reduced in ASD relative to typically developing (TD) children. Speech neural tracking by δ and θ (4-8 Hz) oscillations was also weaker in ASD compared with TD children. After controlling gaze-pattern differences, we found that the classical θ/γ coupling was replaced by an atypical β/γ coupling in children with ASD. This anomaly was the single most specific predictor of individual speech reception difficulties in ASD children. These findings suggest that early interventions (e.g., neurostimulation) targeting the disruption of β/γ coupling and the upregulation of θ/γ coupling could improve speech processing coordination in young children with ASD and help them engage in oral interactions.SIGNIFICANCE STATEMENT Very young children already present marked alterations of neural oscillatory activity in response to natural speech at the time of autism spectrum disorder (ASD) diagnosis. Hierarchical processing of phonemic-range and syllabic-range information (θ/γ coupling) is disrupted in ASD children. Abnormal bottom-up (low-γ) and top-down (low-β) coordination specifically predicts speech reception deficits in very young ASD children, and no other cognitive deficit.

Pathways to peer interaction in ASD and TD through individual and dyadic joint-action motor abilities

Purpose

Any social engagement, especially with peers, requires children's effective activation of social and motor mechanisms. Children and adolescents with autism spectrum disorder (ASD) often display dysfunctions both in individual motor functioning (e.g., fine/gross) and in dyadic joint action (JA), where two partners coordinate movement toward a shared goal. Yet, these mechanisms' contribution to peer interaction has been underexplored.

Method

This study examined the contribution of individual motor functioning and JA performance to peer interaction (cooperation, attentiveness, social engagement, and dyadic quality), while comparing children and adolescents' (youngsters) with ASD versus those with typical development (TD).

Results

Results indicated more competent peer interaction in TD than in ASD. Interestingly, only the ASD group showed significant maturation with age for social engagement and dyadic interaction quality, calls for further examination of developmental trajectories. However, even the oldest participants with ASD continued to lag behind the youngest TD group. Also, findings indicated that better individual motor functioning and JA performance explained better peer interactive competence; yet, the contribution of individual motor functioning to social cooperation and dyadic quality was moderated by JA performance. Thus, youngsters' individual motor system was found to be an important contributor to peer interaction in those with low to moderate JA coordination capabilities, but not for those with high JA.

Conclusion

Results emphasize possible distinct contributions of each motor mechanism and their interaction for facilitating social interaction, hence, encouraging incorporation of individual and dyadic motor skills explicitly into social interaction interventions for youngsters ASD.

Altered developmental trajectories of verbal learning skills in 22q11.2DS: associations with hippocampal development and psychosis

BACKGROUND

The cognitive profile in 22q11.2 deletion syndrome (22q11.2DS) is often characterized by a discrepancy between nonverbal vs. verbal reasoning skills, in favor of the latter skills. This dissociation has also been observed in memory, with verbal learning skills described as a relative strength. Yet the development of these skills is still to be investigated. We thus aimed to explore verbal learning longitudinally. Furthermore, we explored verbal learning and its respective associations with hippocampal alterations and psychosis, which remain largely unknown despite their high prevalence in 22q11.2DS.

METHODS

In total, 332 individuals (173 with 22q11.2DS) aged 5-30 years completed a verbal-paired associates task. Mixed-models regression analyses were conducted to explore developmental trajectories with threefold objectives. First, verbal learning and retention trajectories were compared between 22q11.2DS vs. HC. Second, we examined hippocampal volume development in 22q11.2DS participants with lower vs. higher verbal learning performance. Third, we explored verbal learning trajectories in 22q11.2DS participants with vs. without positive psychotic symptoms and with vs. without a psychotic spectrum disorder (PSD).

RESULTS

Our findings first reveal lower verbal learning performance in 22q11.2DS, with a developmental plateau emerging from adolescence. Second, participants with lower verbal learning scores displayed a reduced left hippocampal tail volume. Third, participants with PSD showed a deterioration of verbal learning performance, independently of verbal reasoning skills.

CONCLUSION

Our study challenges the current view of preserved verbal learning skills in 22q11.2DS and highlights associations with specific hippocampal alterations. We further identify verbal learning as a novel cognitive marker for psychosis in 22q11.2DS.

Adaptive behaviors and related factors in children and adolescents with autism spectrum disorder: Report from ELENA cohort

There are strong individual differences in adaptive behaviors (AB) in autism spectrum disorder (ASD) with conflicting results in literature about specific patterns and related factors. The present study aims to describe AB and identify related factors in terms of clinical and socio-familial characteristics in 875 children and adolescents with ASD in the multiregional ELENA cohort in France. Results showed that AB in children and adolescents with ASD were lower than in typically developing subjects, regardless of age group. AB were associated with clinical (gender, age at diagnosis, IQ, ASD severity, psychiatric comorbidities, motor and language skills, challenging behaviors), interventional (school attendance, special interventions) and familial characteristics (age, educational and socio-economic status of parents, household status, number of siblings). There is a need of interventions focusing on improvement of AB, tailored to children's characteristics.

Prosodic signatures of ASD severity and developmental delay in preschoolers

Atypical prosody in speech production is a core feature of Autism Spectrum Disorder (ASD) that can impact everyday life communication. Because the ability to modulate prosody develops around the age of speech acquisition, it might be affected by ASD symptoms and developmental delays that emerge at the same period. Here, we investigated the existence of a prosodic signature of developmental level and ASD symptom severity in a sample of 74 autistic preschoolers. We first developed an original diarization pipeline to extract preschoolers' vocalizations from recordings of naturalistic social interactions. Using this novel approach, we then found a robust voice quality signature of ASD developmental difficulties in preschoolers. Furthermore, some prosodic measures were associated with one year later outcome in participants who had not acquired speech yet. Altogether, our results highlight the potential benefits of automatized diarization algorithms and prosodic metrics for digital phenotyping in psychiatry, helping clinicians establish early diagnosis and prognosis.

Global trends and hotspots in the digital therapeutics of autism spectrum disorders: a bibliometric analysis from 2002 to 2022

Introduction

Autism spectrum disorder (ASD) is a severe neurodevelopmental disorder that has become a major cause of disability in children. Digital therapeutics (DTx) delivers evidence-based therapeutic interventions to patients that are driven by software to prevent, manage, or treat a medical disorder or disease. This study objectively analyzed the current research status of global DTx in ASD from 2002 to 2022, aiming to explore the current global research status and trends in the field.

Methods

The Web of Science database was searched for articles about DTx in ASD from January 2002 to October 2022. CiteSpace was used to analyze the co-occurrence of keywords in literature, partnerships between authors, institutions, and countries, the sudden occurrence of keywords, clustering of keywords over time, and analysis of references, cited authors, and cited journals.

Results

A total of 509 articles were included. The most productive country and institution were the United States and Vanderbilt University. The largest contributing authors were Warren, Zachary, and Sarkar, Nilanjan. The most-cited journal was the Journal of Autism and Developmental Disorders. The most-cited and co-cited articles were Brian Scarselati (Robots for Use in Autism Research, 2012) and Ralph Adolphs (Abnormal processing of social information from faces in autism, 2001). "Artificial Intelligence," "machine learning," "Virtual Reality," and "eye tracking" were common new and cutting-edge trends in research on DTx in ASD.

Discussion

The use of DTx in ASD is developing rapidly and gaining the attention of researchers worldwide. The publications in this field have increased year by year, mainly concentrated in the developed countries, especially in the United States. Both Vanderbilt University and Yale University are very important institutions in the field. The researcher from Vanderbilt University, Warren and Zachary, his dynamics or achievements in the field is also more worth our attention. The application of new technologies such as virtual reality, machine learning, and eye-tracking in this field has driven the development of DTx on ASD and is currently a popular research topic. More cross-regional and cross-disciplinary collaborations are recommended to advance the development and availability of DTx.

IQ trajectories in autistic children through preadolescence

Background

We extended our study of trajectories of intellectual development of autistic individuals in early (mean age 3 years; T1), and middle childhood (mean age 5 years, 7 months; T2) into later middle childhood/preadolescence (mean age 11 years, 6 months; T3) in the longitudinal Autism Phenome Project cohort. Participants included 373 autistic children (115 females).

Methods

Multivariate latent class growth analysis was used to identify distinct IQ trajectory subgroups. Baseline and developmental course group differences and predictors of trajectory membership were assessed using linear mixed effects models with repeated measures with pairwise testing, multinomial logistic regression models, and sensitivity analyses.

Results

We isolated three IQ trajectories between T1 and T3 for autistic youth that were similar to those found in our prior work. These included a group with persistent intellectual disability (ID; 45%), a group with substantial increases in IQ (CHG; 39%), and a group with persistently average or above IQs (P-High; 16%). By T3, the groups did not differ in ADOS-2 calibrated severity scores (CSS), and there were no group differences between Vineland (VABS) communication scores in CHG and P-High. T1-T3 externalizing behaviors declined significantly for CHG, however, there were no significant T3 group differences between internalizing or externalizing symptoms. T1 correlates for CHG and P-High versus ID group membership included higher VABS communication and lower ADOS-2 CSS. A T1 to T2 increase in VABS communication scores and a decline in externalizing predicted CHG versus ID group membership at T3, while T1 to T2 improvement in VABS communication and reduction in ADOS-2 CSS predicted P-High versus ID group membership.

Conclusions

Autistic youth exhibit consistent IQ developmental trajectories from early childhood through preadolescence. Factors associated with trajectory group membership may provide clues about prognosis, and the need for treatments that improve adaptive communication and externalizing symptoms.

Exploring developmental trajectories throughout adolescence of children with autism spectrum disorder without intellectual disability

Characterizing the developmental trajectories of children with autism spectrum disorder (ASD) throughout adolescence and across different domains of functioning offers opportunities to improve long-term outcomes. This prospective study explored, for the first time, the evolution of children with ASD-without intellectual disability (ID) in terms of socio-adaptative skills, learning behaviors, executive functioning (EF), and internalizing/externalizing problems, compared to typically developing (TD) peers. Forty-five children with ASD-without ID and 37 matched TD children (aged 7-11) were assessed at baseline and after 5 years. Parents and teachers completed measures on theory of mind (ToM), socialization, daily living skills, learning style, EF, and emotional/behavioural difficulties at both time points. On all the domains assessed, the ASD group performed significantly worse than the TD group, both in childhood and adolescence. Specific changes were noted between baseline and follow-up assessment on adaptive skills, prosocial behavior, emotional control, inhibit, working memory and monitoring. Group membership (ASD/TD) was influenced by peer relationships and inhibit EF variables. These findings have implications for clinical and school settings.

Executive functions in daily living skills: A study in adults with autism spectrum disorder

Introduction

Adults with autism and adults with schizophrenia show difficulties in adaptive skills, especially those related to daily functioning. Some studies suggest that adaptive skills are associated with deficits in executive functions (EF), while others indicate that intelligence quotient (IQ) might also play a role. Literature suggests that autistic symptoms further affect adaptive skills. The interest of the current study, therefore, was to explore to what extent IQ, EFs as well as core autistic symptoms predict adaptive skills.

Methods

To do this, 25 controls, 24 adults with autism, and 12 with schizophrenia were assessed on IQ (Wechsler Adult Intelligence Scale), and executive functioning. The EF was measured with neuropsychological tasks (inhibition, updating, and task switching) and with the Dysexecutive-Spanish Questionnaire (DEX-Sp) which assessed everyday life EF problems. Core ASD symptoms were measured using the Autism Diagnostic Observation Schedule, the Autism Spectrum Quotient-Short version (AQ-S), and the Repetitive Behavior Questionnaire - 3 (RBQ-3).

Results

The results indicated EF difficulties in both, autism and schizophrenia. The IQ explained a high percentage of the variance found in adaptive skills, but only in the autism group. We can conclude, therefore, that high IQ is associated with low adaptive skills levels and EFs affect adaptive functioning in people with autism; however, this does not explain the difficulties in adaptive functioning in the schizophrenia group. Core features of autism assessed with self-report questionnaires (but not the ADOS-2) predicted low scores on the adaptive skills, only in the autism group.

Discussion

Both EF measures predicted adaptive skills scores in autism, but not in schizophrenia. Our results suggest that different factors affect the adaptive functioning in each disorder. For instance, the EFs should be a central focus for improvement, especially for individuals with autism.

Measuring social orienting in preschoolers with autism spectrum disorder using cartoons stimuli

Altered social orienting (SO) was proposed as the primary source of socio-communicative difficulties in autism spectrum disorder (ASD). Eye-tracking studies generally confirm a decreased SO in ASD population. However, SO has been scarcely investigated using minimally social stimuli such as cartoons. The extent to which SO might be decreased when watching cartoons is therefore unknown. Yet, it could allow for malleable and child-friendly paradigms that could be sensitive to early atypical visual preference. In this study, 90 preschoolers with ASD (age = 3.19 ± 0 .88) and 20 TD (age = 2.95 ± 1.26) watched two eye-tracking preference tasks. One Realistic task, displaying children dancing versus geometric shapes moving repetitively and a Cartoon task, displaying social and non-social cartoon stimuli with similar movements. We measured SO percentage along with refined visual exploration parameters and compared those of ASD children to TDs. In addition, we investigated their relations with behavioral measures such as symptom severity, developmental and adaptive levels. We evidenced a decreased SO percentage in ASD compared to TD children when watching the Realistic task but not the Cartoon task. We did not identify any other between groups differences. However, we identified several correlations between eye-tracking measures and developmental as well as adaptive measures within the Cartoon task. Together, our results support a preferential orientation of children with autism towards repetitively moving shapes but no decreased SO when measured with minimally social stimuli. Nonetheless, when investigating finer visual exploration parameters, even socially simple stimuli elicited atypical gaze patterns related to early developmental delay.

Differences and Similarities in Adaptive Functioning between Children with Autism Spectrum Disorder and Williams-Beuren Syndrome: A Longitudinal Study

Background: The last decade has seen a growing number of comparative studies on adaptive profiles between individuals with autism spectrum disorder (ASD) and Williams–Beuren syndrome (WBS), showing shared and syndrome-specific adaptive trajectories. Studies have revealed similarities in global adaptive profiles across conditions, while some differences have been found in preschoolers on the specific sub-domains of communication and socialization. However, the majority of studies that have focused on the differences in adaptive functioning across these two conditions used a cross-sectional design. To the best of our knowledge, there are no studies exploring the differences and similarities of adaptive functioning over time. Methods: We compared longitudinal data of adaptive functioning measured by Vineland Adaptive Behavior Scales (VABS) between two samples of children and adolescents with ASD and WBS, matched for chronological age and cognitive/developmental level at the time of the first evaluation. Results and Conclusions: We did not find any difference on the global adaptive level, both at the first evaluation and over time. However, significant differences emerged on the socialization and communication levels at the time of recruitment. Longitudinal data show that only the socialization domain remains different over time, with individuals with WBS having better functioning than those with ASD. The results on shared and distinct patterns of adaptive functioning between disorders are discussed from a developmental perspective, thus contributing to the implementation of age-specific interventions.

Using the Assessment of Motor and Process Skills and the Pediatric Evaluation of Disability Inventory to Assess Self-Care Performance Among Preschool Children With Autism Spectrum Disorder

IMPORTANCE

Caregiver rating scales often give an unclear picture of the actual self-care performance of preschool children with autism spectrum disorder (ASD).

OBJECTIVE

To assess self-care performance among preschool children with ASD using two standardized instruments.

DESIGN

Cross-sectional study.

SETTING

Clinics, hospitals, and early intervention centers in Tainan, Taiwan.

PARTICIPANTS

Sixty children with ASD (ages 48-71 mo). Outcomes and Measures: The Standard Version of the Childhood Autism Rating Scale-Second Edition, the Assessment of Motor and Process Skills (AMPS), and the Chinese version of the Pediatric Evaluation of Disability Inventory (PEDI-C).

RESULTS

About 53.3% of children with ASD scored below 1.5 logits for AMPS motor skills and below 1 logit for AMPS process skills, indicating difficulties performing activities of daily living tasks. The average PEDI-C self-care normative standard scores were moderately low (between -1 and -2 SDs), indicating poor self-care performance. The correlations between the two measures were also low (rs = .27-.44). Overall, the results for 36 children were consistent with AMPS and PEDI-C scores; however, those for 24 children (40.0%) were discrepant.

CONCLUSIONS AND RELEVANCE

These findings have implications for how preschool children with ASD perform their self-care activities and suggest that more than half of preschool children with ASD have a need for occupational therapy interventions that target self-care skills. Occupational therapy practitioners can work with preschool children with ASD and their families to help them improve their self-care performance. What This Article Adds: Many children with ASD need occupational therapy interventions that target self-care skills. Both the AMPS and the PEDI-C provide valuable information from different perspectives on the self-care performance of preschool children with ASD.

Trajectories of imitation skills in preschoolers with autism spectrum disorders

Background

Imitation skills play a crucial role in social cognitive development from early childhood. Many studies have shown a deficit in imitation skills in children with autism spectrum disorders (ASD). Little is known about the development of imitation behaviors in children with ASD. This study aims to measure the trajectories of early imitation skills in preschoolers with ASD and how these skills impact other areas of early development.

Methods

For this purpose, we assessed imitation, language, and cognition skills in 177 children with ASD and 43 typically developing children (TD) aged 2 to 5 years old, 126 of which were followed longitudinally, yielding a total of 396 time points.

Results

Our results confirmed the presence of an early imitation deficit in toddlers with ASD compared to TD children. The study of the trajectories showed that these difficulties were marked at the age of 2 years and gradually decreased until the age of 5 years old. Imitation skills were strongly linked with cognitive and language skills and level of symptoms in our ASD group at baseline. Moreover, the imitation skills at baseline were predictive of the language gains a year later in our ASD group. Using a data-driven clustering method, we delineated different developmental trajectories of imitation skills within the ASD group.

Conclusions

The clinical implications of the findings are discussed, particularly the impact of an early imitation deficit on other areas of competence of the young child.

Supplementary Information

The online version contains supplementary material available at 10.1186/s11689-021-09412-y.

Distinct Patterns of Cognitive Outcome in Young Children With Autism Spectrum Disorder Receiving the Early Start Denver Model

Evidence-based, early intervention significantly improves developmental outcome in young children with autism. Nonetheless, there is high interindividual heterogeneity in developmental trajectories during the therapy. It is established that starting intervention as early as possible results in better developmental outcomes. But except for younger age at start, there is no clear consensus about behavioral characteristics that could provide a reliable individual prediction of a child's developmental outcome after receiving an early intervention. In this study, we analyze developmental trajectories of preschoolers with autism who received 2 years of intervention using the Early Start Denver Model (ESDM) approach in Geneva, Switzerland in an individual setting (n = 55, aged 28.7 ± 5.1 months with a range of 15-42). Our aim was to identify early predictors of response to intervention. We applied a cluster analysis to distinguish between 3 groups based on their cognitive level at intake, and rates of cognitive change over the course of intervention. The first group of children only had a mild cognitive delay at intake and nearly no cognitive delay by the end of intervention (Higher Cognitive at baseline: HC). The children in the two other groups all presented with severe cognitive delay at baseline. However, they had two very different patterns of response to intervention. The majority significantly improved developmental scores over the course of intervention (Optimal Responders: OptR) whereas a minority of children showed only modest improvement (Minimal Responders: MinR). Further analyses showed that children who ended up having an optimal 2-year intervention outcome (OptR) were characterized by higher adaptive functioning at baseline combined with rapid developmental improvement during the first 6 months of intervention. Inversely, less significant progress by the sixth month of intervention was associated with a less optimal response to treatment (MinR).

Using 2D video-based pose estimation for automated prediction of autism spectrum disorders in young children

Clinical research in autism has recently witnessed promising digital phenotyping results, mainly focused on single feature extraction, such as gaze, head turn on name-calling or visual tracking of the moving object. The main drawback of these studies is the focus on relatively isolated behaviors elicited by largely controlled prompts. We recognize that while the diagnosis process understands the indexing of the specific behaviors, ASD also comes with broad impairments that often transcend single behavioral acts. For instance, the atypical nonverbal behaviors manifest through global patterns of atypical postures and movements, fewer gestures used and often decoupled from visual contact, facial affect, speech. Here, we tested the hypothesis that a deep neural network trained on the non-verbal aspects of social interaction can effectively differentiate between children with ASD and their typically developing peers. Our model achieves an accuracy of 80.9% (F1 score: 0.818; precision: 0.784; recall: 0.854) with the prediction probability positively correlated to the overall level of symptoms of autism in social affect and repetitive and restricted behaviors domain. Provided the non-invasive and affordable nature of computer vision, our approach carries reasonable promises that a reliable machine-learning-based ASD screening may become a reality not too far in the future.

Searching for What Really Matters: A Thematic Analysis of Quality of Life among Preschool Children on the Autism Spectrum

Quality of life (QoL) is an essential measure when assessing health interventions. Most early interventions for preschool children on the spectrum evaluate the effects on autism symptoms. However, researchers increasingly believe that good interventions should also improve the QoL of these children. Domains of QoL among preschool children on the autism spectrum have not previously been researched. We interviewed adults on the spectrum to explore early childhood experiences that made their lives satisfying. Our data revealed four major themes: interests, environmental regularity, sensory differences and social interactions. This study provides the first insights on aspects of life important to pre-schoolers on the spectrum. Findings will contribute to developing items for a measure of QoL among this population.

Long-term effects of early treatment with SSRIs on cognition and brain development in individuals with 22q11.2 deletion syndrome

Cognitive deficits in individuals at risk of psychosis represent a significant challenge for research, as current strategies for symptomatic treatment are often ineffective. Recent studies showed that atypical cognitive development predicts the occurrence of psychotic symptoms. Additionally, abnormal brain development is known to predate clinical manifestations of psychosis. Therefore, critical developmental stages may be the best period for early interventions expected to prevent cognitive decline and protect brain maturation. However, it is challenging to identify and treat individuals at risk of psychosis in the general population before the onset of the first psychotic symptoms. 22q11.2 deletion syndrome (22q11DS), the neurogenetic disorder with the highest genetic risk for schizophrenia, provides the opportunity to prospectively study the development of subjects at risk for psychosis. In this retrospective cohort study, we aimed to establish if early treatment with SSRIs in children and adolescents with 22q11DS was associated with long-term effects on cognition and brain development. We included 98 participants with a confirmed diagnosis of 22q11DS followed up 2-4 times (age range: 10-32). Thirty subjects without psychiatric disorders never received psychotropic medications, thirty had psychotic symptoms but were not treated with SSRIs, and 38 received SSRIs treatment. An increase in IQ scores characterized the developmental trajectories of participants receiving treatment with SSRIs, even those with psychotic symptoms. The thickness of frontal regions and hippocampal volume were also relatively increased. The magnitude of the outcomes was inversely correlated to the age at the onset of the treatment. We provide preliminary evidence that early long-term treatment with SSRIs may attenuate the cognitive decline associated with psychosis in 22q11DS and developmental brain abnormalities.

Impact of containment and mitigation measures on children and youth with ASD during the COVID-19 pandemic: Report from the ELENA cohort

BACKGROUND

Containment, involving separation and restriction of movement of people due to the COVID-19 pandemic, and mitigation, also referred to as lockdown, involving closure of schools, universities and public venues, has had a profound impact on people's lives globally. The study focuses on the effects of containment and mitigation measures, on the behavior of children and youth (CaY) with Autism Spectrum Disorders (ASD). The study primary aim was to examine the impact of these urgent measures on the behaviors, communication, sleep, and nutritional status of the CaY. A secondary aim was to explore risk and protective factors on behavior change including sociodemographic variables, living conditions, ASD symptom severity and continuity of interventions.

METHODS

The study sample consisted of 239 ASD subjects, 2-21 years of age, enrolled in the ELENA cohort in France at Stage 3 confinement and mitigation measures announced on March 16, 2020. A parent informant completed the COVID-19 questionnaire.

RESULTS

Of the domains examined, challenging behaviors, communicative skills and sleep had the greatest impact; in terms of risk and protective factors, subject age, ASD severity, single parenthood, daily living skills, and intervention continuity were most likely to impact behaviors; living conditions were not linked to behavior change.

CONCLUSIONS

The findings highlight the topography of behavioral change in CaY with ASD following institution of containment and mitigation measures during the COVID-19 pandemic and help identify risk and protective factors to help better address needs and tailor interventions in the future.

Brief Report: Health-Related Quality of Life in Preschoolers with Autism Spectrum Disorder is Related to Diagnostic Age and Autistic Symptom Severity

We conducted a cross-sectional study to explore whether clinical characteristics and autism diagnostic-traits severity are associated with caregiver-reported impairment of health-related quality of life (Pediatric Quality of Life Inventory Generic Core Scales, Fourth Edition) in 93 Chilean toddlers (age: 2-4 years) with autism spectrum disorder. Median total scale, physical health, and psychosocial health scores were 76 (IQR 70-81), 88 (IQR 81-94), and 71 (IQR 62-79), respectively. In multiple-regression analysis, diagnostic age (β = 0.219; p 0.021) and Calibrated Severity Score of Autism Diagnostic Observation Schedule, second edition (β = - 0.434; p < 0.001) were independently correlated to the total scale score. Lower age and higher autistic traits severity at diagnosis are correlated with worse well-being perception by caregivers.

Predictors of Treatment Outcome in Preschoolers with Autism Spectrum Disorder: An Observational Study in the Greater Geneva Area, Switzerland

This study aims to identify predictors of treatment outcome in young children with ASD within a European context, where service provision of intervention remains sporadic. We investigated whether a child's age at baseline, intensity of the intervention provided, type of intervention, child's level of social orienting and cognitive skills at baseline predicted changes in autistic symptoms and cognitive development after 1 year of intervention, in a sample of 60 children with ASD. Our results strongly support early and intensive intervention. We also observed that lower cognitive skills at baseline were related to greater cognitive gains. Finally, we show that a child's interest in social stimuli may contribute to intervention outcome.

Comparison of Adaptive Functioning in Children with Williams Beuren Syndrome and Autism Spectrum Disorder: A Cross-Syndrome Study

Williams Beuren syndrome (WBS) and autism spectrum disorder (ASD) have been long considered as "polar opposite" disorders. Although children with WBS appears to be hypersociable, recent researches have revealed difficulties in socio-communicative skills such as shared attention, showing or giving objects, social relationships comprehension, pragmatic use of language, and emotion's recognition. The aim of this cross-syndrome study is to compare clinician-report adaptive profiles of two wide developmental range children by means of Vineland Adaptive Behavior Scales-Interview Edition, Survey Form. Eighty individuals, 40 with WBS and 40 with ASD (31 preschoolers and 49 scholars) with ASD and WBS matched for chronological age and developmental/cognitive level were recruited. Analysis of domains and subdomains have been reported. Results showed no significant difference in global adaptive level between WBS and ASD in both preschooler and scholar children. Communication domain significantly differ in preschoolers (higher in WBS children), but not in scholars. Expressive subdomain significantly differ in both preschoolers and scholars (higher in WBS children). Play and Leisure subdomain significantly differ in scholars (higher in WBS children), but not in preschoolers. Our results support hypothesis on a shared global adaptive impairment in children with WBS and ASD, by extending this findings to scholar-age children. Analysis of domains and subdomains differences highlight the need for interventions targeting social-pragmatic skills since first years of life. Differences in preschoolers and scholars adaptive profiles could be explained through a developmental perspective. LAY SUMMARY: Little is known about differences in adaptive profiles between Williams Beuren syndrome and autism spectrum disorder. Our results show similarities in global adaptive level and difference in communication level. Furthermore, expressive skills seem to be higher in Williams Beuren Syndrome. Autism Res 2021, 14: 748-758. © 2020 International Society for Autism Research and Wiley Periodicals LLC.

Relationship Between the Performance of Self-Care and Visual Perception Among Young Children With Autism Spectrum Disorder and Typical Developing Children

Studies investigating the performance of self-care and visual perception in young children with autism spectrum disorder (ASD) are limited. The relationship between self-care performance and visual perception ability in young children with ASD is not yet clearly understood. Here, self-care performance was evaluated by the caregivers and therapists of children with ASD. The differences in self-care performance and visual perception ability were investigated in 66 children with ASD and 66 typically developing (TD) children between the ages of 48-83 months. The relationships between self-care and visual perception were tested in both two groups. The Assessment of Motor and Process Skills (AMPS) and the Chinese version of the Pediatric Evaluation of Disability Inventory (PEDI-C) were used to assess the children's self-care performance. The Test of Visual Perceptual Skills-Third Edition (TVPS-3) and the Developmental Test of Visual Perception-Third Edition (DTVP-3) were used to evaluate visual perception ability. Young children with ASD obtained significantly lower scores for self-care performance (AMPS and PEDI-C) and visual perception ability (TVPS-3 and DTVP) compared with TD children. Additionally, positive correlations were found between self-care performance and visual perception ability in young children with ASD. The results provide a valuable contribution to our understanding about self-care and visual perception performance of young children with ASD. The findings of this research highlight the need for pediatric practitioners to include self-care and visual-motor integration evaluations for young children with ASD. LAY SUMMARY: Young children with ASD obtained significantly lower scores for self-care performance and visual perception ability compared with TD children. Positive correlations were found between self-care performance and visual perception ability in young children with ASD. The results provide a valuable contribution to our understanding about self-care and visual perception performance of young children with ASD.

Developmental Trajectories of Adaptive Behavior From Toddlerhood to Middle Childhood in Autism Spectrum Disorder

Longitudinal growth modeling was utilized to examine adaptive behavior over eight years across the three time points (i.e., ages 2-10). Seventy-six parents completed the Vineland Adaptive Behavior Scales interviews of adaptive behavior. Child participants completed standardized developmental testing and an executive function task in toddlerhood and the Autism Diagnostic Observation Schedule across all time points. Growth models were specified for communication, daily living skills, and socialization domains of adaptive behavior. Mental age in toddlerhood was a significant predictor of trajectories of communication, daily living skills, and socialization. Executive function and autism severity were significant predictors of socialization. Findings suggest executive function as a potential target for promoting the growth of adaptive behavior skills in addition to autism symptomology.

Mortality in individuals with autism spectrum disorder: Predictors over a 20-year period

Research has shown that individuals with autism spectrum disorder have higher rates of health problems throughout childhood, adolescence, and adulthood, and that this may result in elevated risk of early mortality. This study reported the rate, timing, and causes of death in a large community-based cohort of adolescents and adults with autism spectrum disorder (n = 406) over a 20-year period (1998-2018) and identified predictors of mortality. Over this period, 6.4% of individuals died at an average age of 39 years. Causes of death included chronic conditions (such as cancer and heart disease), accidents (such as choking on food and accidental poisoning), and health complications due to medication side effects. Even after controlling for age and health status, significant predictors of mortality were early childhood levels of impairments in social reciprocity and high levels of functional impairments at the start of the study period. The results suggest the importance of social engagement and functional self-sufficiency across the life course, as well as adequate access to health care for individuals with autism spectrum disorder.

Sensory Processing Issues and Their Association with Social Difficulties in Children with Autism Spectrum Disorders

Sensory processing issues have been frequently reported in individuals with Autism Spectrum Disorders (ASD), but their relationship with social and overall adaptive functioning has not been extensively characterized to date. Here, we investigate how sensory processing atypicalities relate with deficits in social skills, impaired social cognition, and general adaptive functioning in a group of preschoolers with ASD. Sixty-four children with ASD aged 3 to 6 were included in this study, along with 36 age-matched typically-developing (TD) peers. Parent-reported measures of sensory processing, social difficulties and overall adaptive functioning were collected for all children. We also obtained precise measures of social attention deployment using a custom-design eye-tracking task depicting naturalistic social scenes. Within the group of children with ASD, higher intensities of sensory issues were associated with more prominent social difficulties and lower adaptive functioning. We also found that children with ASD who had more sensory issues showed visual exploration patterns of social scenes that strongly deviated from the one seen in the TD group. The association of sensory processing atypicalities with "higher-order" functional domains such as social and adaptive functioning in children with ASD stresses the importance of further research on sensory symptoms in autism.

[Formula: see text] Long-term verbal memory deficit and associated hippocampal alterations in 22q11.2 deletion syndrome

Chromosome 22q11.2 deletion syndrome (22q11.2DS) is a genetic disease associated with an increased risk for schizophrenia and a specific cognitive profile. In this paper, we challenge the current view of spared verbal memory in 22q11.2DS by investigating verbal memory consolidation processes over an extended time span to further qualify the neuropsychological profile. Our hypotheses are based on brain anomalies of the medial temporal lobes consistently reported in this syndrome.Eighty-four participants (45 with 22q11.2DS), aged 8-24 years old, completed a verbal episodic memory task to investigate long-term memory on four different time delays. We compared trajectories of forgetting between groups (22q11.2DS vs. controls) and analyzed performance inside the 22q11.2DS sample through cluster analyses. Potential links between memory performance and volume of the hippocampal subfields were examined.We showed accelerated long-term forgetting (ALF) in the 22q11.2DS group, visible after a delay of one day. Using mixed models, we showed significant differences in the shape of memory trajectories between subgroups of participants with 22q11.2DS. These sub-groups differed in terms of memory recognition, intellectual functioning, positive psychotic symptoms and grey matter volume of hippocampal subfields but not in terms of age.In conclusion, by investigating memory processes on longer delays than standardized memory tasks, we identified deficits in long-term memory consolidation leading to ALF in 22q11.2DS. Nevertheless, we showed that a subgroup of patients had larger memory consolidation deficit associated with lower intellectual functioning, higher rates of positive psychotic symptoms and hippocampal alterations.

Neurodevelopmental Disorders Affecting Sociability: Recent Research Advances and Future Directions in Autism Spectrum Disorder and Williams Syndrome

PURPOSE OF REVIEW

In this review, we summarize current knowledge and hypotheses on the nature of social abnormalities in autism spectrum disorder (ASD) and Williams syndrome (WS).

RECENT FINDINGS

Social phenotypes in ASD and WS appear to reflect analogous disruptions in social cognition, and distinct patterns of social motivation, which appears to be reduced in ASD and enhanced in WS. These abnormalities likely originate from heterogeneous vulnerabilities that disrupt the interplay between domain-general and social domain-specific cognitive and motivational processes during early development. Causal pathways remain unclear. Advances and research gaps in our understanding of the social phenotypes in ASD and WS highlight the importance of (1) parsing the construct of sociability, (2) adopting a developmental perspective, (3) including samples that are representative of the spectrum of severity within ASD and WS in neuroscientific research, and (4) adopting transdiagnostic treatment approaches to target shared areas of impairment across diagnostic boundaries.