What symptoms predict the diagnosis of autism or PDD-NOS in infants and toddlers with developmental delays using the Baby and Infant Screen for aUtIsm Traits

Purpose: Autism Spectrum Disorders (ASD) are characterized by life-long and severe symptoms such as stereotypies, social skills deficits and language delays. Previous research has demonstrated that children who receive early intensive behavioural intervention have a better prognosis than those who do not receive services. It is for this reason that assessments designed specifically for early identification of ASD are of paramount important.

Method: In Study 1, 957 infants with autism, PDD-NOS and atypical development were evaluated using an assessment screener for ASD traits, the Baby and Infant Screen for aUtIsm Traits (BISCUIT). In Study 2, only those with an autism or PDD-NOS diagnosis were evaluated.

Results: The BISCUIT was found to have an excellent overall classification rate for children in the target population. A sub-set of BISCUIT items was found that distinguished children with ASD from atypically developing children. Items were also found which could accurately predict autism vs PDD-NOS diagnosis.

Conclusions: These data suggest that the core features of ASD are distinct and can be identified early in life. Furthermore, the presence of specific core behaviours can allow for a more accurate clinical and diagnostic picture for young children with autism or PDD-NOS vs general developmental delays.     

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.     

The relationship between race and challenging behaviours in infants and toddlers with autistic disorder and pervasive developmental disorder–not otherwise specified

Objective: To examine the contributions of race and diagnostic category to endorsement rates of challenging behaviours in infants and toddlers with autism, PDD-NOS and atypical development without ASD, using the Baby and Infant Screen for Children with aUtIsm Traits, Part-3 (BISCUIT Part-3).

Design: Multivariate analyses of variance (MANOVAs) on each sub-scale of the BISCUIT Part-3. Follow-up univariate analyses and post-hoc tests as needed.

Methods: Scores on the BISCUIT Part-3 were compared for 453 Caucasian and 409 African-American infants and toddlers, grouped by race and diagnosis.

Results: Significant differences between races were found on five out of 10 aggressive behaviours, while no significant differences were found on self-injurious or stereotypic behaviours. Significant differences between diagnostic groups were found on all behaviours.

Conclusion: Cultural factors should be taken into account when examining challenging behaviours in infants and toddlers with ASD.     

Effects of symptoms of co-morbid psychopathology on challenging behaviours among infants and toddlers with Autistic Disorder and PDD-NOS as assessed with the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT)

Purpose: To examine whether level of symptoms of co-morbid psychopathology exacerbated challenging behaviours in young children with autism spectrum disorders (ASD).

Method: Using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT)–Part 2 which measures co-morbid symptoms and the BISCUIT- Part 3 which examines challenging behaviours, 362 infants and toddlers with ASD were evaluated.

Results: Findings showed that participants scoring high on symptoms of Avoidance and Tantrum/Conduct problems had greater rates of aggressive/destructive behaviours, self-injurious behaviours (SIB) and stereotypies compared to those with low scores. Participants with high levels of Inattention/Impulsivity or Eat/Sleep concerns, compared to those with low levels, demonstrated greater aggressive/destructive behaviour and stereotypies. For symptoms of Anxiety/Repetitive Behaviours, participants with high scores displayed greater levels of stereotypies.

Conclusions: Symptoms of co-morbid psychopathology are present at a very early age for children with ASD and elevated levels of these symptoms may exacerbate challenging behaviours.     

Stereotyped behaviours in children with autism spectrum disorders and atypical development as measured by the BPI-01

Objective: As repetitive behaviours in children with autism spectrum disorders (ASDs) can significantly interfere with one's daily functioning, continued research on these behaviours is needed.

Methods: This study examined the occurrence of repetitive motor movements in toddlers (17–37 months) with ASD and atypical development and the relationship between stereotypies and sensory impairment.

Results: Children with ASD (n?=?13) exhibited significantly more repetitive behaviours than the non-ASD group (n?=?12). Greater percentages of endorsement were evident for the ASD group on nearly all items of the Behaviour Problems Inventory-01 (BPI-01) Stereotypy subscale. More repetitive behaviours tended to co-occur with other stereotypies for the ASD group. A moderate correlation was found between stereotypy severity and sensory deficits.

Conclusion: These findings suggest that stereotyped behaviours can be identified at very young ages, negatively affect the behavioural presentation of those with ASDs and should be considered when developing treatment plans.     

Factor structure and diagnostic fidelity of the Baby and Infant Screen for Children with aUtIsm Traits–Part 1 (BISCUIT–part 1)

Objective: Due to the effectiveness of early intervention on the outcome of individuals with ASD, there is a race to identify children with ASD at younger ages. The Baby and Infant Screen for Children with aUtIsm Traits–Part 1 (BISCUIT–Part 1) is a new assessment tool designed to assess symptoms of ASD in children between the ages of 17–37 months. The aim of this study was to identify the factor structure of BISCUIT–Part 1 and investigate group differences with regards to these factors.

Methods: Participants (n = 1287) were enrolled in a state-funded early intervention programme for children at-risk for a developmental disability. The BISCUIT was administered to a parent or other significant caregiver along with other developmental measures as part of the assessment protocol for the early intervention programme.

Results: The exploratory factor analysis yielded a three-factor solution consistent with symptom clusters characteristic of ASD. Furthermore, participants diagnosed with ASD exhibited significantly higher scores on the factors of the BISCUIT–Part 1, compared to toddlers without a diagnosis of ASD.

Conclusion: The BISCUIT–Part 1 shows promise in aiding clinicians in the diagnosis of ASD in infants and toddlers.     

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.     

Repetitive/restricted behaviours and interests in children with cerebral palsy and autism spectrum disorder

Objective: To inspect the presence and severity of deficits in restricted and/or repetitive behaviours and interests (RRBIs) in children with cerebral palsy (CP) and autism spectrum disorders (ASDs).

Methods: Children studied (18–35 months of age) belonged to one of three diagnostic groups: children with CP and autism (n?=?11), children with CP and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS; n?=?10) and children with a sole diagnosis of CP (n?=?15). A one-way, between subjects ANOVA was conducted on the Repetitive Behaviour/Restricted Interests domain of the Baby and Infant Screen for aUtIsm Traits-Part 1 (BISCUIT-Part 1) and followed up with post-hoc tests. Percentage endorsements were also calculated for each item of this domain.

Results: Children with CP?+?autism had significantly greater impairment. No significant differences were found between the CP?+?PDD-NOS and the CP alone groups.

Conclusion: The implications of these findings are discussed.     

Prospective study of autism phenomenology and the behavioural phenotype of Phelan–McDermid syndrome: comparison to fragile X syndrome,Down syndrome and idiopathic autism spectrum disorder

Background

The limited behavioural phenotype literature on Phelan–McDermid syndrome (PMS) indicates atypically high levels of activity, impulsivity and autism spectrum disorder (ASD) behaviours. Divergent profiles of ASD in PMS are also reported, with some studies demonstrating similarities to idiopathic ASD and others indicating an uneven profile of social and communication impairments and repetitive behaviours. An evaluation of the behavioural phenotype of PMS and the prevalence and phenomenology of ASD is warranted, particularly given the causal involvement of the SHANK3 gene in the aetiology of PMS.

Methods

Carers of individuals with PMS (N = 30; mean age = 10.55, SD = 7.08) completed questionnaires relating to impulsivity, overactivity, mood, interest and pleasure, repetitive behaviour and ASD phenomenology. These data were compared to data from matched samples of individuals with fragile X and Down syndromes and idiopathic ASD. In order to evaluate the profile of ASD phenomenology in PMS, two comparisons were made: first, including the total sample with PMS, and second, including only those who met the threshold indicative of autism on an ASD screening measure.

Results

The results revealed lower mood in individuals with PMS, but no differences in impulsivity and overactivity. Compulsive and routine-driven repetitive behaviours were less common in the total sample with PMS; however, motor-based stereotyped behaviours were more common. ASD phenomenology was highly prevalent, with 87% of the sample meeting the cutoff score for ASD and 57% meeting the cutoff for autism. The profile of ASD phenomenology in the total sample with PMS differed from those with idiopathic ASD across impairments in communication and social interaction and repetitive behaviour. However, the profile of those who met the threshold for autism was commensurate to those with idiopathic ASD.

Conclusions

ASD phenomenology is common within PMS. Whilst the total sample may display an atypical profile of ASD behaviour, the profile in those who met the threshold for autism was very similar to those with idiopathic ASD. These results are discussed in relation to the wider behavioural phenotype and the emerging evidence of an autism endophenotype in PMS.

     

Autism severity as a predictor of inattention and impulsivity in toddlers

Abstract

Objective: Evaluate how severity of autism spectrum disorder (ASD) symptoms predicts attention-deficit/hyperactivity disorder (ADHD) symptoms in atypically developing toddlers.

Method: Parents/caregivers of 2300 atypically developing toddlers’ ages 18–37 months were assessed about their children’s behaviours using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) Part 1 and the inattention/impulsivity subscale of the BISCUIT-Part 2.

Results: ASD symptom severity was positively and significantly correlated with inattention/impulsivity, indicating that children with more severe symptoms of ASD tended to have higher scores on the measure of inattention/impulsivity, R²?=?0.49, F (1, 2298)?=?2234.72, p?<?0.001. Additionally, ASD symptom severity significantly predicted inattention/impulsivity, β?=?0.70, t (2298)?=?47.27, p?<?0.001.

Conclusions: ASD symptom severity predicts rates of ADHD symptoms in atypically developing toddlers. The implications of these findings are discussed in the context of other research.     

Specifying PDD-NOS: a comparison of PDD-NOS, Asperger syndrome, and autism

OBJECTIVE: To describe the clinical characteristics of children given a diagnosis of pervasive developmental disorder-not otherwise specified (PDD-NOS) by expert clinicians and to compare these to the clinical characteristics of children given a diagnosis of autism and Asperger syndrome (AS). METHOD: Two hundred sixteen children with autism, 33 with AS, and 21 with PDD-NOS were compared on measures of level of functioning (communication, daily living and social skills, IQ, and age of acquisition of language) and on various symptoms of autism (impaired communication and reciprocal social interaction and a preference for repetitive and stereotyped activities). RESULTS: In terms of level of functioning measures, the PDD-NOS children had scores that were between those of the children with autism and those of the children with AS. In contrast, the PDD-NOS group had fewer autistic symptoms, especially repetitive stereotyped behaviors, than both the autism and AS groups (chi2 = 11.06, p =.004). Children with PDD-NOS could be placed into one of three subgroups: a high-functioning group (24%) who resembled AS but had transient language delay or mild cognitive impairment; a subgroup resembling autism (24%) but who had late age of onset or too severe cognitive delays or were too young to potentially meet the full diagnostic criteria for autism; and a group (52%) not fulfilling the criteria for autism because of fewer stereotyped and repetitive behaviors. CONCLUSIONS: With some revision to current diagnostic criteria, a more homogenous atypical group with significant impairments in social-communication but fewer repetitive behaviors can be differentiated from the more nonspecific PDD-NOS group. This differentiation may lead to better reliability in diagnosis and to further progress in studies of etiology.     

The relationship between parents’ first concerns and symptoms of autism spectrum disorders

Objective: To examine the relationship between parents’ first concerns and early Autism Spectrum Disorder (ASD) symptoms.

Methods: Symptoms of ASD were compared in 1393 toddlers with and without a diagnosis of an ASD, based on the area of parents’ first concerns. Communication and behaviour problems were examined in the current study, as they are the most frequently reported first concerns in the literature. A series of one-way, between-subjects ANOVAs were conducted on each sub-scale of the BISCUIT Part-1.

Results: Symptoms of Autism Spectrum Disorders (ASD) significant differences were found between most groups on all sub-scales. On the Socialization/Non-verbal Communication and Repetitive Behaviour/Restricted Interest sub-scales, those with ASD and behaviour concerns had the highest scores. On the Communication sub-scale, those with ASD and communication concerns had the highest scores.

Conclusions: A significant relationship exists between early ASD symptoms and area of first concern. The implications of these results are discussed.     

Cutoffs, norms, and patterns of comorbid difficulties in children with an ASD on the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT-Part 2)

Diagnosing autism and PDD-NOS at very early ages has become a major priority in the field of mental health. More recently, researchers have also come to realize the importance of identifying co-occurring conditions of psychopathology in this population. In the present study, 309 children between 17 and 37 months of age who had been identified as having either autism or PDD-NOS were screened for comorbid psychopathology. Using the psychopathology scale of the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT-Part 2), norms and cutoff scores for various forms of psychopathology (e.g., conduct problems, inattention, impulsivity, avoidance, anxiety, eating and sleep problems) were established. Additionally, frequency of items across factors was compared for autism, PDD-NOS and on atypically developing group of children without an autism spectrum disorder (ASD) (n = 460). All five disorders (tantrum, conduct behavior, inattentive/impulsive, avoidant behavior, anxiety/repetitive and eating problems/sleep) were more common in the autism group. Differences in the two groups were particularly striking for the anxiety/repetitive behavior and inattention/impulsivity factors. Implications of these findings are discussed.     

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.     

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.     

Externalizing and tantrum behaviours in children with ASD and ADHD compared to children with ADHD

Objective: Compare rates of externalizing in children with autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) symptoms to children with ADHD.

Method: Parents/caregivers of 85 children with ASD and/or ADHD were surveyed about their children's behaviours using the Autism Spectrum Disorders-Comorbidity for Children and the Autism Spectrum Disorders-Behaviour Problem for Children.

Results: Specific main effects analyses were then conducted. Children with ASD exhibited a higher number of externalizing (F(1,?83)?=?83.34, p?<?0.001) and tantrum behaviours (F(1,83)?=?781.86, p?<?0.001) than children without ASD.

Conclusions: ASD exacerbates the externalizing symptoms of ADHD during childhood. This study adds to the literature on the importance of assessing for a wide-range of possible behaviour problems in children presenting with ADHD symptomatology. The implications of these findings are discussed in the context of other research.     

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.     

Variability in adaptive behaviour in young children with autism spectrum disorder

ABSTRACT

Background Understanding adaptive behaviour variability in children with autism spectrum disorder (ASD) may have important implications for early intervention. The purpose of this study was to explore whether autism symptom severity and caregiver depression affected adaptive behaviour in young children with ASD.

Method Data were collected from 60 primary caregivers of children aged 2–6 years with ASD. A factorial multivariate analysis of covariance was conducted to investigate if different levels of autism symptom severity and caregiver depression affected communication, socialisation, and daily living skills, after controlling for child age.

Results Findings suggest that only autism symptom severity accounted for significant variance in adaptive behaviour, with socialisation being most impacted. Although more than half of the caregivers reported heightened depressive symptoms, caregiver depression was not related to adaptive behaviour.

Conclusions Findings highlight the level of functional impairment that young children with ASD experience in relation to autism symptom severity.     

Measurement of restricted and repetitive behaviour in children with autism spectrum disorder: Selecting a questionnaire or interview

Assessment of children's restricted and repetitive behaviours offers potential opportunities to improve early diagnosis of autism spectrum disorder (ASD) and timely access to interventions and support. To facilitate this requires understanding of the phenomenology of repetitive behaviours in ASD, including differentiating behaviours seen in ASD from other populations such as young typically developing and developmentally delayed children. A key factor in achieving understanding is valid and reliable measurement.This review considers the issues in conceptualisation of repetitive behaviours which should guide the choice of measurement tool, including definition of subtypes of repetitive behaviours, associations with age and ability, and categorisation of frequency and severity. The resulting conclusions about the requirements for measurement are applied within a systematic review of quantitative interview and questionnaire measures of repetitive behaviour used with children with ASD. The conclusions of the review lead to recommendations for existing and future research on restricted and repetitive behaviours in ASD.     

Impaired Error Monitoring and Correction Function in Autism

Introduction. Error monitoring and correction is one of the executive functions and is important for effective goal-directed behavior. Deficient executive functioning, including reduced error monitoring ability, is one of the typical features of such neurodevelopmental disorders as autism, probably related to perseverative responding, stereotyped repetitive behaviors, and an inability to accurately monitor ongoing behavior. Our prior studies of behavioral and event-related potential measures during performance on visual oddball tasks in high-functioning autistic (HFA) children showed that despite only minor differences in reaction times (RTs) HFA children committed significantly more errors.

Method. This study investigated error monitoring in children with autism spectrum disorder (ASD) with response-locked event-related potentials—the error-related negativity (ERN) and error-related positivity (Pe) recorded at fronto-central sites. The ERN reflects early error detection processes, whereas the Pe has been associated with later conscious error evaluation and attention reallocation. RTs in correct trials and posterror slowing in RTs were measured. In this study 14 participants with ASD and 14 age- and IQ-matched controls received a three-category visual oddball task with novel distracters.

Results. ERN had a lower amplitude and longer latency in the ASD group but was localized in the caudal part of anterior cingulate cortex in both groups. The Pe component was significantly prolonged in the ASD group but did not reach significance in amplitude differences compared to controls. We found significant posterror slowing in RTs in controls and posterror acceleration in RTs in the ASD group.

Conclusion. The reduced ERN and altered Pe along with a lack of posterror RT slowing in autism might be interpreted as insensitivity in the detection and monitoring of response errors and a reduced ability of execute corrective actions. This might result in reduced error awareness and failure in adjustment when dealing with situations where erroneous responses may occur. This deficit might be manifested in the perseverative behaviors often seen in individuals with ASD. The results are discussed in terms of a general impairment in self-monitoring and other executive functions underlying behavioral and social disturbances in ASD.