Motor skill abilities in toddlers with autistic disorder,pervasive developmental disorder-not otherwise specified,and atypical development

Motor skills were assessed in 397 toddlers, and it was demonstrated that atypically developing toddlers exhibited significantly greater motor skill abilities than toddlers with autistic disorder. No significant difference on gross or fine motor skill abilities were found between atypically developing toddlers and toddlers with pervasive developmental disorder-not otherwise specified (PDD-NOS), or between toddlers with autistic disorder and toddlers with PDD-NOS. Gross and fine motor skills were found to be more impaired for toddlers with autistic disorder compared to the atypical development group. Furthermore, differences in gross or fine motor skills between the autistic disorder and the PDD-NOS group approached significance. Approximate effect sizes were also calculated. Implications of the results are also discussed.     

Feeding and sleep difficulties in toddlers with autism spectrum disorders

Children with autism spectrum disorders (ASD) present with a variety of comorbid difficulties, some of which relate to seemingly simply activities of daily living. Feeding and sleep difficulties are purportedly common within the ASD population, although the association between these problems and ASD symptomatology has rarely been addressed. The current study examined the feeding and sleep difficulties of 1747 toddlers who had a diagnosis of Autistic Disorder (n = 506), PDD-NOS (n = 522), or atypical development (n = 719) using the Baby and Infant Screen for Children with aUtIsm Traits-Part 2, a screening tool designed to identify comorbid difficulties of toddlers with ASD and/or atypical development. Individuals with Autistic Disorder were found to exhibit significantly more feeding and sleep difficulties than those with PDD-NOS, who in turn presented with more difficulties of this type than those with atypical development. While developmental quotient (DQ) was also related to feeding and sleep difficulties, DQ could not account for the differences between these groups.     

Anxiety and avoidance in infants and toddlers with autism spectrum disorders: Evidence for differing symptom severity and presentation

Little is known about the symptoms of anxiety in very young children with autism spectrum disorders, particularly comparisons between Autistic Disorder (AD) and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). In the current study, toddlers (i.e., 17–37 months of age) with diagnoses of either AD (N = 159) or PDD-NOS (N = 154) were compared to atypically developing toddlers who did not meet criteria for an autism spectrum disorder (N = 200). Results indicated an overall pattern whereby toddlers with AD had more severe anxious and avoidant symptoms than either toddlers with PDD-NOS or controls. Further, toddlers with PDD-NOS were significantly more severe than controls. Additional analyses examining specific differences between the groups on anxious and avoidant items were conducted as well. Overall, toddlers with AD appear to have more severe anxiety than either those with PDD-NOS or controls, who did not differ on many items.     

Exploring the Proposed DSM-5 Criteria in a Clinical Sample

The proposed DSM-5 criteria for Autism Spectrum Disorder (ASD) depart substantially from the previous DSM-IV criteria. In this file review study of 131 children aged 2-12, previously diagnosed with either Autistic Disorder or Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), 63?% met the new DSM-5 ASD criteria, including 81?% previously diagnosed with Autistic Disorder and only 17?% of those with PDD-NOS. The proportion of children meeting DSM-5 differed by IQ grouping as well, with higher rates in lower IQ groups. Children who did meet criteria for ASD had significantly lower levels of cognitive and adaptive skills and greater autism severity but were similar in age. These findings raise concerns that the new DSM-5 criteria may miss a number of children who would currently receive a diagnosis.     

Comparing Autism,PDD-NOS,and Other Developmental Disabilities on Parent-Reported Behavior Problems: Little Evidence for ASD Subtype Validity

Studies on the distinction between Autistic Disorder (AD) and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) have been inconclusive. This study examined the validity of PDD-NOS by comparing it to AD and other developmental disorders (DD) on parent-reported behavior problems. Fifty-four children with PDD-NOS were individually matched on age and non-verbal IQ to 54 children with AD and 54 children with DD. Groups were compared on select subscales of the Child Behavior Checklist. High rates of psychopathology were observed in both ASD groups. The only difference between PDD-NOS and AD groups was higher scores in the PDD-NOS group on two items measuring Anxiety/Depression. Cognitive functioning may be a more salient variable than subtype when studying psychopathology in individuals with ASDs.     

Challenging behaviors in toddlers diagnosed with autism spectrum disorders with the DSM-IV-TR and the proposed DSM-5 criteria

With publication of the DSM-5 slated for May 2013, it has been predicted that the new diagnostic criteria will cause a decrease in the prevalence of autism spectrum disorders (ASDs), seriously impacting children no longer meeting criteria for the disorder. A majority of individuals with ASD have behavior problems which are not considered core features of the disorder but are significantly impairing and often the focus of intervention. The aim of the current study was to investigate types of challenging behaviors in toddlers who may no longer meet diagnostic criteria for ASD using a psychometrically sound measure, the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) – Part 3. The study included 3339 toddlers, 501 who will retain ASD diagnosis according to the DSM-5; 439 who will no longer meet criteria, and a comparison group of 2399 toddlers referred for evaluation due to atypical development. Though toddlers diagnosed under the DSM-5 exhibited the most challenging behaviors, those who did not meet DSM-5 criteria exhibited significantly more challenging behaviors than the atypically developing toddlers. The effect of the changes in ASD diagnostic criteria on access to early behavioral interventions warrants careful consideration as the new DSM-5 criteria are adopted.     

The relationship between autism spectrum disorders and symptoms of conduct problems: The moderating effect of communication

Objective: To examine the relationship between ASD diagnosis (i.e. Autism, Pervasive Developmental Disorder–Not Otherwise Specified (PDD-NOS) and atypical developing control) and tantrum/conduct symptoms in infants and toddlers. Then examine the moderating role of communication.

Design: Analysis of Covariance was conducted for study 1 followed by hierarchical regression analyses for study 2.

Methods: The Baby and Infant Screen for Children with aUtIsm Traits, Part 2 was administered to the caregivers of 774 infants and toddlers.

Results: Those with autism exhibited the greatest tantrum/conduct symptoms followed by those with PDD-NOS and then atypical controls, F(3, 771)?=?94.42, p?=?0.003. Communication was not a significant moderator.

Conclusions: Those with Autistic Disorder exhibited greater symptoms of tantrum/conduct problems, which is consistent with previous research. It seems that the relationship with communication as a moderator may differ in young children as their language skills are still in the early stages of development.     

Agreement Among Four Diagnostic Instruments for Autism Spectrum Disorders in Toddlers

Autistic spectrum disorders (ASD) can be difficult to diagnose in toddlers. This study compared diagnostic measures (ADOS-G, ADI-R, CARS, and clinical judgment using DSM-IV criteria) applied to toddlers. Results indicated that the ADOS-G, CARS, and clinical judgment agreed with each other but not with the ADI-R. Many of the children classified with ASD by the other measures were not classified with autism by the ADI-R because they did not display enough repetitive behaviors and stereotyped interests. These results indicate that young children with ASD may not display repetitive behaviors and stereotyped interests, and for toddlers, the ADI-R would have a higher sensitivity if revised to include a diagnosis of PDD-NOS, for which the requirement of repetitive behaviors is less stringent.     

Attention-deficit hyperactivity disorder symptoms in a clinic sample of children and adolescents with pervasive developmental disorders

OBJECTIVES: The aims of this systematic chart review were to determine the frequency of attention-deficit/hyperactivity disorder (ADHD) in a clinic sample of children and adolescents with autism spectrum disorders (ASD), to compare ADHD symptoms in children with Autistic Disorder, Asperger's Disorder, and pervasive developmental disorders-not otherwise specified (PDD-NOS), to compare ADHD symptoms in individuals with and without ADHD-related chief complaints, and to determine the correlation between ADHD Rating Scale (ADHD RS) scores and age. METHOD: This systematic chart review examined data from children and adolescents who were consecutively referred to a university-based autism psychopharmacology program. All individuals were diagnosed by semistructured interview for ASD and ADHD, and ADHD symptoms were assessed using ADHD RS scores. RESULTS: Of 83 children, 78% fulfilled Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for ADHD and exceeded the 93rd percentile norm for the ADHD RS. Hyperactivity-impulsivity scores were significantly greater in individuals with autism than those with other ASDs. DSM-IV ADHD diagnosis was represented equally in individuals with and without ADHD as their chief complaints. ADHD RS hyperactivity-impulsivity and total scores were negatively correlated with age. CONCLUSION: ADHD symptoms are pervasive in clinically referred children and adolescents with ASD.     

The moderating effects of intellectual development on core symptoms of autism and PDD-NOS in toddlers and infants

Little research has been conducted on whether deficits in developmental functioning affect the range of core symptoms for autism spectrum disorders (ASD). This study represents a first attempt to determine whether developmental level has an effect on the expression of ASD symptoms in infants and toddlers. Eight hundred and fifty-three infants were evaluated with respect to the nature and extent of their ASD symptoms and developmental functioning. Young children with autism displayed a higher number of symptoms than those with PDD-NOS on all three domains of impairment (social, communication, repetitive behaviors). As expected, children without an ASD evinced far fewer symptoms than both these groups. Developmental level was not found to be a moderator for expression of ASD symptoms for the entire sample, or individual diagnostic groups. Higher developmental level was associated with lower severity of evinced ASD symptoms in the sample.     

An examination of the relationship between communication and socialization deficits in children with autism and PDD-NOS

Autism Spectrum Disorders (ASDs) are characterized by pervasive impairments in repetitive behaviors or interests, communication, and socialization. As the onset of these features occurs at a very young age, early detection is of the utmost importance. In an attempt to better clarify the behavioral presentation of communication and socialization deficits to aid in early assessment and intervention, impairments in these areas were examined among infants and toddlers (17-36 months) with Autistic Disorder (AD), Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), and non-ASD related developmental delay. The Baby and Infant Screen for Children with aUtIsm Traits-Part1 (BISCUIT-Part1) and the Battelle Developmental Inventory, 2nd Edition (BDI-2) were utilized to examine communication and socialization levels, respectively, among these groups. All groups significantly differed on level of socialization impairment with the Autism group displaying the greatest impairment and the non-ASD related developmental delay group evincing the least impairment. In regards to communication deficits, the non-ASD related developmentally delayed group differed significantly in comparison to the Autism and PDD-NOS groups; however, no significant differences were found between children with AD and PDD-NOS. While communication and socialization impairments were found to significantly correlate for all participants with the exception of those with PDD-NOS, these correlations were not found to significantly differ from one another across groups. The implications, limitations, and future directions of these results are discussed.     

Altered chemical metabolites in the amygdala-hippocampus region contribute to autistic symptoms of autism spectrum disorders.

BACKGROUND: Although several previous studies have been conducted, the neural basis of autism spectrum disorder (ASD) is poorly understood. The objective of the present study was to determine whether individuals with ASD have altered brain chemical metabolites and whether such alterations are related to their autistic symptoms. METHODS: N-acetylaspartate (NAA)/creatine (Cr) and choline/Cr ratios in the right medial temporal lobe (MTL), medial prefrontal cortex, and cerebellar vermis were measured in 38 individuals with ASD (mean age = 12.9 years), including 12 with autism, 15 with Asperger's Disorder, and 11 with pervasive developmental disorder not otherwise specified (PDD-NOS), and 16 matched healthy control subjects (mean age = 11.5 years) with proton magnetic resonance spectroscopy. Autistic symptoms were assessed by the Childhood Autistic Rating Scale-Tokyo Version. RESULTS: There was a significant group difference for NAA/Cr ratio in the right MTL between the autism, Asperger's Disorder, PDD-NOS, and control groups (p < .001), and the autism group had a significantly lower NAA/Cr ratio compared with the PDD-NOS (p < .001) and control (p < .001) groups. In the ASD group, there was a significant negative correlation between NAA/Cr ratio in the right MTL and their Childhood Autistic Rating Scale-Tokyo Version total scores (r = -.44, p = .01) and subscales of emotional response (r = -.38, p = .02) and listening response (r = -.54, p = .001). CONCLUSIONS: The results of the present study suggest that subjects with ASD have abnormalities of neural integrity in the amygdala-hippocampus region that are related to their severity and social impairments.     

The relationship between autism spectrum disorders and anxiety: The moderating effect of communication

Communication skills have been shown to have differing effects on levels of anxiety depending on whether or not a child has an autism spectrum disorder (ASD) or is typically developing. This article examined whether or not communication deficits differentially affect children with ASD compared to those without ASD. Ninety-nine children with autistic disorder (n = 33), Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS; n = 33), and no diagnosis (n = 33) were examined using the Autism Spectrum Disorders Diagnostic for Children and Comorbidity for Children scales to determine their level of anxiety and degree of communication deficits. Results indicated that anxiety decreased as communication deficits increased for those with autistic disorder compared to those with PDD-NOS or no diagnosis; however, for those with PDD-NOS anxiety increased as communication deficits increased compared to those with no diagnosis. The importance and differential impact of communication deficits on anxiety for different groups is highlighted.     

The effect of Autism Spectrum Disorders on adaptive independent living skills in adults with severe intellectual disability

Autism Spectrum Disorders are a class of conditions categorized by communication problems, ritualistic behaviors, and deficits in social behaviors. While evidence supporting a genetic component of Autism Spectrum Disorders (ASDs) is strong, no specific genetic marker has been identified. Thus, professionals have had to utilize intelligence tests and measures of adaptive functioning to aid in the diagnosis of individuals with ASD. The present study aimed to isolate specific differences in adaptive functioning in adults with ASD. Two hundred and thirty-four adults with ASD (Autism Spectrum Disorder) or Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) and intellectual disabilities (IDs) were evaluated with respect to the nature and extent of their independent living skill functioning. The implications of these data for more fully describing and diagnosing autism and PDD-NOS in adults are discussed.     

The relationship of comorbid anxiety symptom severity and challenging behaviors in infants and toddlers with autism spectrum disorder

The rates of comorbid anxiety as well as the presentation of challenging behaviors are elevated within the autism spectrum disorder (ASD) population. The current study utilizes the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) to explore the relationship of anxiety/repetitive behavior symptom severity and challenging behaviors in infants and toddlers with ASD. Children with ASD who evinced more severe impairment associated with anxiety/repetitive behavior (n = 94) demonstrated higher rates of overall challenging behaviors than those with ASD who evinced no to minimal anxiety impairment (n = 291). Specifically, a comparison of individual challenging behavior items indicated that the infants and toddlers with moderate to severe anxiety impairment exhibited more significant challenging behaviors under the domains of aggression/destruction, stereotypies, and self-injurious behavior than children with no to minimal impairment. This study adds to the literature evidencing an exacerbation of challenging behaviors by comorbid psychopathology in individuals with ASD. Clinical implications of these results are discussed.     

An examination of challenging behaviors in autistic disorder versus pervasive developmental disorder not otherwise specified: Significant differences and gender effects

Children with Autism Spectrum Disorders (ASDs) are well-known for engagement in challenging behaviors. Unfortunately, due to its absence as a criterion for diagnosis in the DSM-IV-TR, little attention has been paid to the endorsement rates of such behaviors. However, a recently developed measure to assist in the diagnosis of infants and toddlers with autism and PDD-NOS - the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) - has included a section designated for just this reason. This study used the BISCUIT to assess for significant differences in the endorsement rates of challenging behaviors between infants and toddlers with autism versus PDD-NOS as well as for significant differences between genders. There were significant differences between the diagnostic groups in endorsement rates of challenging behaviors as a whole, as well as among many specific behavior items. No significant differences between genders in endorsement rates of challenging behaviors were found. The implications of these findings are discussed.     

The association between familial ASD diagnosis,autism symptomatology and developmental functioning in young children

Few studies have directly compared individuals with and without a relative diagnosed with ASD on various domains. The present study aimed to examine the relationship between familial ASD diagnosis and the exhibition of ASD symptoms in young children with and without ASD diagnoses. Participants included 8353 children aged 17–37 months old and their families. They were divided into four groups based on individual and family diagnosis, then compared on autism symptomatology and developmental domains. No differences were found between ASD groups on overall scores and each of the factor domains, indicating no association between family ASD diagnosis and ASD symptomatology or developmental functioning. Disparate results were found for atypically developing groups with and without relatives diagnosed with ASD. Implications of these results are discussed.     

Social and communication behaviours in infants and toddlers with autism and pervasive developmental disorder-not otherwise specified

Purpose: Autism Spectrum Disorders (ASD) are a group of conditions characterized by symptoms that onset in early childhood. Deficits in social skills and communication are two of the core features of ASD and, if not remediated, can lead to poor long-term outcomes. Few researchers have examined characteristics of social skills and communication in infants with ASD.

Method: The social skills and communicative ability of 886 infants and toddlers 17–37 months of age with autism, PDD-NOS or ‘at risk’ for other developmental delays were evaluated using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT). A Kruskal-Wallis test with follow-up Mann-Whitney tests were used to test for significance.

Results: Infants and toddlers with autism, followed by PDD-NOS, had greater social and communication deficits than children ‘at risk’ for developmental delays. Items which distinguished between these diagnostic groups were determined.

Conclusions: Outcomes suggest that social and communication deficits can be identified at early ages in a population of developmentally delayed toddlers. Implications are that pinpointing emerging social and communicative autistic traits earlier will allow for more accurate assessment and diagnosis in infants with ASD. This translates into earlier intervention and more effective treatment practices.     

Multi-site Study of the Childhood Autism Rating Scale (CARS) in Five Clinical Groups of Young Children

This study examined several questions pertaining to the Childhood Autism Rating Scale (CARS) in a sample of 274 preschool children (aged 2–6 years) clinically diagnosed as falling in one of five groups: Autistic Disorder, PDD-NOS, MR, Delayed, and Other. In addition to diagnosis and the CARS, all children were given standardized cognitive and adaptive behavior measures. Results indicated high concordance between the CARS and clinical diagnosis using DSM-IV (including excellent sensitivity and specificity). There was a moderate negative correlation of CARS scores and developmental level (both cognitive and adaptive), indicating significant shared variance. There were significant and sensible differences in mean CARS score for different diagnostic groups, including a substantial difference between the Autistic Disorder and PDD-NOS groups.     

The relationship between race and comorbid symptoms in infants and toddlers with autism spectrum disorder

Researchers have indicated that persons with autism spectrum disorder (ASD) population evince higher rates of comorbid symptoms. While the relationship between comorbid symptoms and factors such as autism symptom severity, IQ level, age, communication abilities, and degree of social impairment were previously examined, there has been limited research on the effect of race in this area. The current study examined the potential role of race in comorbid symptoms in toddlers with ASD and atypically developing toddlers without a diagnosis of ASD using The Baby and Infant Screen for Children with aUtIsm Traits – Part 2 (BISCUIT-Part 2). Based on the current findings, African-American toddlers evinced higher rates of comorbid symptoms than Caucasian toddlers and toddlers of other races. In addition, toddlers with ASD evinced higher rates of comorbid symptoms than atypically developing toddlers without a diagnosis of ASD. Implications regarding these findings are discussed.