Awareness and knowledge of autism and autism interventions: A general population survey

Recent figures show that autism spectrum disorder (ASD) affects at least 1 in 88 of the population, yet for years, international public awareness of ASD was limited. Over the past 5–10 years intense efforts have been made to raise autism awareness in the general population in countries such as UK and US. In this paper we report data from a large-scale general population survey (N = 1204) in which we assessed autism awareness, knowledge about autism, and perceptions about autism interventions in Northern Ireland. We found high levels of autism awareness, in fact over 80% of the sample were aware of ASD and over 60% of these respondents knew someone with ASD in their own family, circle of friends or work colleagues. Generally, knowledge of strengths and challenges faced by individuals with ASD was relatively accurate. However, perceptions of interventions and service provider responsibilities were vague and uncertain. Results show that local and international autism awareness campaigns have largely been successful and that the focus should shift towards disseminating accurate information regarding intervention and service provider responsibilities.     

Aggression in the general Swedish population, measured with a new self-rating inventory: The Aggression Questionnaire--revised Swedish version (AQ-RSV)

The aim of the present study was to develop a Swedish self-rating instrument for clinical aggression research based on the American Aggression Questionnaire (AQ), which measures physical aggression, verbal aggression, anger, and hostility. To test this adapted Aggression Questionnaire--revised Swedish version (AQ-RSV), it was mailed to 781 randomly selected individuals, aged 20-40 year. A total of 497 (64%) evaluable AQ-RSV inventories were obtained and analyzed statistically. Drop-out analysis showed that non-responders were most often male and significantly older than responders. Among the responders, AQ-RSV showed significant sex differences in all aggression subscales except Hostility. Aggression was found to vary with age, geographical region, and size of home community. The AQ and the AQ-RSV were comparable in correlations between the four aggression subscales and in alpha coefficients, which indicated considerable internal consistency. Development of the aggression-measuring instrument for Swedish conditions is important not only to study subtraits of aggression but to enable analyses of their relationships to neurobiological and psychiatric variables.     

Accuracy of the Mini-Mental Status Examination as a screening test for dementia in a Swedish elderly population

The aim of this study was to determine the accuracy of the Mini-Mental Status Examination (MMSE) as a screening test for dementia in an elderly Swedish population. All the inhabitants over 74 years of age in one area of Stockholm took the MMSE. The test was then compared to the clinical diagnosis of dementia. With a cut-off point of 23/24, the MMSE had a sensitivity of 87%, specificity of 92%, and positive predictive value (PPV) of 69%. Age, sex, and education did not substantially affect the specificity and the PPV, but had a slight effect on the sensitivity. The main causes of the false positives were somatic and psychiatric disorders. These results are in agreement with studies performed with similar methods and comparable populations.     

Joint attention development in toddlers with autism

Deficits in Joint Attention (JA) may be one of the earliest signs of Autism Spectrum Disorders (ASD). In this longitudinal study we investigated several types of JA behaviors at the age of 24 and 42 months, and their development over time. Eleven children with ASD, 10 children with other developmental disorders, and eight children without a developmental disorder participated. It was found that children with ASD showed significantly less JA at the age of 24 months. At this age, the various types of JA (Basic Joint Attention, Associated Joint Attention, Joint Visual Attention) were correlated with developmental level and number of autistic characteristics. However, at the age of 42 months, these associations were absent. Although children with ASD may show less JA at the age of 24 months compared to other groups of children, by the age of 42 months they reach about the same level of JA, except for joint visual attention. In fact, at both ages, children with ASD differed consistently only on JVA from the other groups. JVA may be a core component of an early screening device for ASD.     

Aggression in the general Swedish population,measured with a new self-rating inventory: The Aggression Questionnaire - revised Swedish version (AQ-RSV)

The aim of the present study was to develop a Swedish self-rating instrument for clinical aggression research based on the American Aggression Questionnaire (AQ), which measures physical aggression, verbal aggression, anger, and hostility. To test this adapted Aggression Questionnaire - revised Swedish version (AQ-RSV), it was mailed to 781 randomly selected individuals, aged 20-40 year. A total of 497 (64%) evaluable AQ-RSV inventories were obtained and analyzed statistically. Drop-out analysis showed that non-responders were most often male and significantly older than responders. Among the responders, AQ-RSV showed significant sex differences in all aggression subscales except Hostility. Aggression was found to vary with age, geographical region, and size of home community. The AQ and the AQ-RSV were comparable in correlations between the four aggression subscales and in alpha coefficients, which indicated considerable internal consistency. Development of the aggression-measuring instrument for Swedish conditions is important not only to study subtraits of aggression but to enable analyses of their relationships to neurobiological and psychiatric variables.     

Analysis of unsupported gait in toddlers with autism

Aims: A number of studies have suggested the importance of motor development in autism. Motor development has been considered a possible bio-marker of autism since it does not depend on either social or linguistic development. In this study, using retrospective video analysis we investigated the first unsupported gait in toddlers with autism. Methods: Fifty-five toddlers, belonging to three groups were recruited: toddlers with autistic disorder (AD, n = 20, age 14.2 mo, sd 1.4 mo) and as comparison groups: typically developing toddlers (TD, n = 20, age 12.9 mo, sd 1.1 mo) and toddlers with non-autistic developmental delays of mixed aetiology (DD, n = 15, age 13.1 mo, sd 0.8 mo). The Walking Observation Scale (WOS) and the Positional Pattern for Symmetry during Walking (PPSW) were used to gather data on the first unsupported gait. The WOS includes 11 items that analyze gait through three axes: foot movements; arm movements; general movements while the PPSW analyses static and dynamical symmetry during gait. Results: Our results have identified significant differences in gait patterns among the group of toddlers with AD as opposed to the control groups. Significant differences between AD and the two control groups were found for both WOS (p < .001) and PPSW (p < .001). Conclusion: The specificity of motor disturbances we have identified in autism (postural asymmetry) is consistent with previous findings that implicated cerebellar involvement in the motor symptoms of autism.     

The impact of familial autism diagnoses on autism symptomatology in infants and toddlers

Debate regarding the etiology of Autism Spectrum Disorders (ASD) is on the rise with numerous theories being put forth. Currently, the theory with the most empirical support is the interaction of multiple genes. Many studies have provided evidence that as the incidence of ASD increases so do genetic similarities. However, very little research has focused on the presentation of ASD symptomatology in those individuals with or without ASD diagnoses who have biological relatives with or without ASD diagnoses. The aim of the current study was to first examine the percentage of toddlers with and without ASD who had biological relatives with ASD. Next, the impact familial ASD had on ASD symptomatology within infants and toddlers with and without diagnoses of ASD was investigated. In the first study, 438 toddlers with an ASD diagnosis and 1,071 who were atypically developing without an ASD diagnosis were examined. A greater percentage of toddlers with ASD were noted to have a biological relative with an identified ASD in comparison to atypically developing toddlers. In the second study, no significant differences emerged between groups dependent on familial ASD of symptoms of autism as measured by the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT). As such, despite previous research indicating a strong genetic link to ASD, this link is undoubtedly complex and not necessarily related to ASD symptomatology. Suggestions for further research are provided.     

Interventions for toddlers with autism spectrum disorder: A meta-analysis of single-subject experimental studies

BackgroundProgress in diagnostic assessment made it possible to diagnose ASD at a young age. Concurrently, intervention research for toddlers with ASD has increased since the past decade.MethodIn this study, we report on a five-level meta-analysis of 34 single-subject experimental studies, intended to offer a better insight into what types of interventions are effective for toddlers under the age of three with or at risk for ASD.ResultsThe analysis revealed a significant positive overall effect size. We found that interventions at home were significantly more effective compared to those in other settings. Other significant moderators regarding intervention characteristics were the agent of intervention and duration in weeks. No moderator effects of study and child characteristics were found.ConclusionsOn average, interventions for toddlers with or at risk for ASD are successful.     

Mental health literacy of autism spectrum disorders in the Japanese general population

Objective  We aimed to clarify the public’s mental health literacy of autism spectrum disorders (ASD). Methods  Using a vignette of a young child, 500 Japanese participants were asked their perspectives, such as causes and appropriate coping strategies. For each response from those respondents who correctly identified the child as having autism, we tested the effects of sex and generation. Results  Two hundred twenty-nine respondents (45.8%) correctly identified the child as having autism. Significantly (P < 0.05) more females planned practical coping strategies such as contacting public agencies, whereas males had relatively more irrelevant perceptions, for example, significantly more males attributed ASD to social environment. Significantly more young respondents expected psychiatric treatments such as antipsychotic administration to be effective, and more seniors estimated low that the prevalence is approximately 0.01% or less. Conclusions  The mental health literacy of ASD among the Japanese public appears to be acceptable but there is still much room for improvement. Females showed more accurate knowledge, possibly reflecting gender roles. Some young people are not likely to know of the impact of psychiatric treatment, and seniors appear to be unaware of the current broadened recognition of ASD. Continued efforts to disseminate accurate information are required, particularly among males.     

Trends and topics in Early Intensive Behavioral Interventions for toddlers with autism

The use of applied behavior analysis (ABA) to treat persons with autism goes back several decades. Many specific target behaviors and intervention strategies have been developed. In the last two decades the most heavily studied of these methods has been Early Intensive Behavioral Interventions (EIBI). This package of ABA methods is unique in two ways. First, a broad range of target behaviors are trained for 20–40 h per week. This training is much more treatment per week than what is described in most ABA studies. Second, the children treated are typically 2–3 years of age, which is younger than for most ABA research. Reviews of EIBI have typically focused on the efficacy of the methods. These are important, but at present we argue that these methods are effective. This paper is different in that it looks at current trends such as generalization, parent training, factors that mitigate against effective treatment and the need for follow-up and booster treatment.     

Current state of autism knowledge in the general population of the United States

BackgroundThe increasing prevalence of autism warrants increased knowledge for laypersons who engage with autistic individuals . However, limited research has been conducted on the general population’s knowledge of autism.MethodThe present study describes the current level of autism knowledge among a general population sample in the United States (N = 318) using the Autism Spectrum Knowledge Scale, General Population version (ASKSG; McClain et al., 2019).ResultsParticipants in our study were more knowledgeable about the symptoms and behaviors associated with autism than the etiology, prevalence, and assessment procedures.ConclusionsThe lack of knowledge in the general population surrounding autism necessitates further efforts to increase public awareness.     

Factors associated with self-reported need for treatment of sleeping difficulties: a survey of the general Swedish population

ObjectiveThis study aims to investigate factors associated with the self-reported need for treatment of sleeping difficulties in the general population.MethodsThis study consisted of a cross-sectional telephone survey of 1550 people randomly selected from the total population of Sweden. The survey, conducted by the Swedish national statistics agency, Statistics Sweden, was completed by 1115 people aged 18–85 years. Participants were asked about sleep patterns, daytime symptoms, physical and mental health disorders, use of prescribed hypnotics, help-seeking behaviors, and sociodemographic characteristics. They were also asked whether they thought they needed treatment for sleeping difficulties.ResultsA total of 12.5% of the participants reported a need for treatment because of sleeping difficulties. Significantly more women than men reported such a need (OR 1.46, 95% CI 1.02–2.10). Additionally, in univariate analyses, older age (age 60–69), sick leave, retirement, and unemployment were associated with a self-reported need for treatment, as were several sleep complaints, daytime symptoms, and physical and mental health disorders. A logistic regression model showed that difficulty initiating sleep (OR 6.29, 95% CI 3.67–10.78) was the factor most strongly associated with a self-reported need for treatment for sleeping difficulties. Other important factors were nonrestorative sleep (OR 3.70, 95% CI 2.05–6.69), mental health disorders (OR 3.01, 95% CI 1.59–5.67), and fatigue (OR 2.95, 95% CI 1.53–5.68).ConclusionsThere was considerable self-reported need for treatment for sleeping difficulties in the population. Difficulty initiating sleep was the factor most strongly associated with this need, followed by nonrestorative sleep, mental health disorders, and fatigue.     

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.     

ESAT and M-CHAT as screening instruments for autism spectrum disorders at 18 months in the general population: issues of overlap and association with clinical referrals

The Modified Checklist for Autism in Toddlers (M-CHAT) and the Early Screening of Autistic Traits (ESAT) were designed to screen for autism spectrum disorders in very young children. The aim of this study was to explore proportions of children that screened positive on the ESAT or the M-CHAT and to investigate if screening positive on the ESAT and M-CHAT is associated with clinical referral by 18 months and other aspects of children’s development, health, and behavior. In this study, the mothers of 12,948 18-month-old children returned a questionnaire consisting of items from the ESAT and M-CHAT, plus questions about clinical and developmental characteristics. The M-CHAT identified more screen-positive children than the ESAT, but the ESAT was associated with more clinical referrals and tended to identify more children with medical, language, and behavioral problems. A post hoc analysis of combining the two instruments found this to be more effective than the individual instruments alone in identifying children referred to clinical services at 18 months. Further analysis at the level of single items is warranted to improve these screening instruments.     

Prevalence of autism spectrum disorders in toddlers receiving early intervention services

The prevalence of autism spectrum disorders (ASD) continues to be a source of debate among researchers and clinicians. Prevalence studies are of the utmost importance in order to obtain an accurate picture of the true prevalence rate of ASD and because these rates continue to be on the rise. To date, studies examining prevalence rates have utilized community or clinical populations. Therefore, the aim of the current study was to utilize a sample of toddlers at risk for or currently diagnosed with a developmental delay (N = 2027) to determine the prevalence rate in this young population. As anticipated, the prevalence rates of ASD were much higher in this at risk sample of toddlers compared to rates reported in community or clinical samples. In addition, gender differences in prevalence rates emerged. However, the differences between these rates were not as pronounced as in other previously studied populations. These results underscore the necessity to routinely assess toddlers for the presence of symptoms of ASD who are already receiving early intervention services for other developmental delays.     

Defining characteristics for young children meeting cutoff on the modified checklist for autism in toddlers

Early diagnosis of Autism Spectrum Disorders (ASDs) is crucial so that early intervention services, which have been found to best alleviate symptoms of ASD in children, can be implemented. Currently, the Modified Checklist for Autism in Toddlers (M-CHAT) and the Baby and Infant Screen for Children with aUtIsm Traits-Part 1 (BISCUIT-Part 1) are the most widely researched ASD measures in early childhood. However, the M-CHAT provides many false positive results as it is solely used as a screening instrument as opposed to a diagnostic measure, while the BISCUIT-Part 1 appears to have more diagnostic fidelity. The current study examined 243 toddlers who failed the M-CHAT screener and were therefore referred for further evaluation. Upon further evaluation, 141 of the toddlers were diagnosed with an ASD while the remaining 102 were not. Characteristics differentiating these two groups on the M-CHAT, BISCUIT-Part 1, and Battelle Developmental Inventory, Second Edition (BDI-II) were examined with analyses supporting the hypotheses that children in the ASD group had higher M-CHAT and BISCUIT-Part 1 scores in conjunction with lower BDI-II scores. Based on these results, the incremental predictive validity of the M-CHAT was assessed; the BISCUIT-Part 1 was found to be more accurate in arriving at ASD diagnoses. The implications of these findings are discussed.     

Assessing progress and outcome of early intensive behavioral intervention for toddlers with autism

Intensive behavioral intervention for young children diagnosed with autism can produce large gains in social, cognitive, and language development. Although several studies have identified behaviors that are possible indicators of best outcome, changes in performance are typically measured using norm-referenced standardized scores referencing overall functioning level rather than via repeated observational measures of autism-specific deficits (i.e., social behavior). In the current study, 83 children with autism (CWA), aged 1, 2 and 3 years, and 58 same-aged typically developing children (TDC) were directly observed in the areas of cognitive skills, joint attention (JA), play, and stereotypic behavior using a measure called the Early Skills Assessment Tool (ESAT; MacDonald et al., 2006). CWA were assessed at entry into an EIBI program and again after 1 year of treatment. Changes in performance were compared pre- and post-treatment as well as to the normative data by age. Results indicate significant gains on the ESAT across all age groups with the greatest gains seen in the children who entered treatment prior to their second birthday. Increases were seen on direct measures of JA, play, imitation and language while decreases were seen in stereotypy regardless of level of performance at entry into EIBI. The ESAT, a direct measurement tool, served as a sensitive tool to measure changes in autism symptomatology following EIBI treatment.