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.     

Stereotypies and repetitive/restrictive behaviours in infants with autism and pervasive developmental disorder

Purpose: Autism Spectrum Disorders (ASD) are characterized by severe and debilitating symptoms including stereotyped and repetitive behaviours. Stereotypies and repetitive behaviours constitute core features of ASD and markedly impede attempts to remediate the disorder. Little previous research has examined characteristics of the core features of ASD in infants.

Method: In the present study, 760 infants with autism, PDD-NOS or no diagnosis of ASD but at risk for other developmental delays or physical disabilities were evaluated with respect to the nature and extent of their stereotyped and ritualistic behaviour using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT). A Kruskal-Wallis test with follow-up Mann-Whitney tests were employed to test for significant differences.

Results: Infants with autism evinced the highest amount of stereotypic behaviour, followed by those with PDD-NOS and atypical development. A sub-set of BISCUIT items could accurately predict diagnostic group membership.

Conclusions: These data suggest that many core features of ASD are distinct and can be reliably identified early in life. The potential early identification of these behavioural challenges could lead to earlier intervention practices and symptom alleviation for children in this population.     

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.     

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.     

The baby and infant screen for children with autism traits-part 2: The development of age-based cutoffs

Abstract

Objective: To create age-based scoring procedures for the BISCUIT-Part 2, an assessment measure of comorbid psychopathology in infants and toddlers aged 17–37 months.

Method: The standard deviation from the mean method was used to develop separate age-based cutoffs for those with an autism spectrum disorder (ASD) and those with non-ASD related developmental delays, using a sample of 2867 infants and toddlers and their parents.

Results: As age increased in those with ASD, higher cutoff scores were indicated. Less variation was seen in the cutoff scores established for those with non-ASD related delays.

Conclusion: The findings suggest that as children with ASD grow older, symptoms of comorbidity become more prevalent and easier to detect. The implications of these results, as well as possible areas of future research, are discussed.     

Nonverbal Communication Skills in Young Children with Autism

Objective The study was to examine nonverbal communication in young children with autism. Methods The participants were 23 young children with autism (mean CA = 32.79 months), 23 CA and MA-matched children with developmental delay and 22 18–20-month-old, and 22 13–15-month-old typically developing toddlers and infants. The abbreviated Early Social Communication Scales [Mundy et al. 1996, Early social communication scales (ESCS)] were used to test three types of nonverbal communicative skills, i.e., joint attention, requesting, and social interaction. Both frequency and proportion analyses were done in group comparisons. Results (1) Two- to three-year-old children with autism displayed deficits in joint attention ability, especially high-level skills. (2) The deficit in terms of frequency of communication was marked even compared with typically developing infants with younger mental age. (3) Young children with autism had different nonverbal communication profile compared with all three comparison groups. Conclusion Early social-communicative difficulties in autism involve early triadic communications involving joint attention and possibly dyadic turn-taking skills, which has implications for both early screening and early intervention.     

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.     

The effects of inattention/impulsivity and ASD symptom severity on social skills in toddlers

Objective: The aim of the current study was to examine the effects of symptom severity of ASD and symptom severity of inattention and impulsivity in toddlers to determine the potential impact on social skills.

Methods: A total of 240 toddlers diagnosed with ASD, ranging in age from 17–36 months, were included in this study. Parents or legal guardians were administered measures assessing for symptoms of ASD, symptoms of psychopathology and social skills.

Results: A significant interaction was found, indicating that toddlers with less severe symptoms of ASD and of inattention/impulsivity had better social skills. In contrast, toddlers with more severe symptoms of ASD and inattention/impulsivity had the most deficits in social skills.

Conclusion: These results further confirm that a multidimensional approach to assessment is needed and that comorbid psychopathology symptoms and social skills targets should be a focus of assessment and intervention.     

Autism spectrum disorders and motor skills: The effect on socialization as measured by the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT)

Purpose: To examine the effects of ASD diagnosis and motor skills on socialization in young children.

Methods: Two samples were used: gross motor skills sample (n?=?408) and fine motor skills sample (n?=?402). The Battelle Developmental Inventory–Second Edition assessed motor skills, while the Baby and Infant Screen for Children with aUtIsm Traits, Part 1 assessed socialization.

Results: A main effect of diagnosis was found for both samples on socialization such that those with autism exhibited the most severe deficits followed by those with PDD-NOS and then atypically developing children. There was a main effect for gross motor skills, with high gross motor skills showing less social impairment. The interaction term was only significant in regards to fine motor skills.

Conclusions: The individual effects of ASD diagnosis and motor impairment as well as the interaction have implications for the assessment and treatment in these individuals.     

Factors related to parental age of first concern in toddlers with autism spectrum disorder

Purpose: The age of first concern (AOC) of parents of children with autism spectrum disorders (ASD) has substantial implications for early diagnosis and intervention. The current study sought to determine the average AOC, what types of first concerns are most common, and what factors predict earlier AOC in toddlers with ASD. Methods: This study analyzed the predictive influence of the type of concern, symptom severity, medical diagnoses, and other independent variables on AOC among toddlers with ASD using multiple regressions. Results: The mean AOC was found to be 13.97 months (SD = 7.86). The most commonly reported first concern was speech/language. First concerns related to communication, speech/language predicted later AOC, while motor concerns predicted earlier AOC. Conclusions: Concerns that are more closely related to social communication deficits characteristic of ASD predicted later AOC. The implications of these findings on screening/assessment and intervention are discussed.     

Autism spectrum disorder severity as a predictor of Battelle Developmental Inventory – Second Edition (BDI-2) scores in toddlers

Objective: The study aimed to evaluate the relationship between the severity of autism spectrum disorder (ASD) symptomology and scores on the Battelle Developmental Inventory, Second Edition (BDI-2) in toddlers (n?=?325).

Methods: Total scores on the BDI-2 and individual domain scores were examined to explore the relationship between severity of ASD and developmental quotient, impairment in personal-social skills, adaptive functioning, cognition, and communication.

Results: Regression analyses controlled for the impact of age and IQ on results, indicating that higher autism severity scores were associated with overall greater impairment and in the total scores and the individual domains of the BDI-2. The domains were found to be differentially affected by severity of ASD.

Conclusion: These findings suggest severity of ASD may influence symptom presentation. Clinical implications of study findings are discussed.     

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 effects of developmental quotient and diagnostic criteria on challenging behaviors in toddlers with developmental disabilities

Previous research has found that individuals with intellectual disability and/or autism spectrum disorder (ASD), and those with greater symptom severity within these diagnoses, show higher rates of aggressive/destructive behavior, stereotypic behavior, and self-injurious behavior. In this exploratory cross-sectional study, toddlers at-risk for a developmental disorder (n=1509) ranging from 17 to 36 months fell into one of three diagnostic categories: Autistic Disorder, Pervasive Developmental Disorder-Not Otherwise Specified [PDD-NOS], and atypically developing - no ASD diagnosis. Mental health professionals from EarlySteps, Louisiana's Early Intervention System, interviewed parents and guardians using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) -Part 3 (Matson, Boisjoli, & Wilkins, 2007) to obtain measures of challenging behaviors and the Battelle Developmental Inventory, 2nd Edition (BDI-2) (Newborg, 2005) to obtain developmental quotients (DQ). Toddlers diagnosed with Autistic Disorder or PDD-NOS showed a positive relationship between total DQ and challenging behavior; whereas, atypically developing toddlers with no ASD diagnosis showed a more adaptive, negative relationship. The DQ domains that were most influential on challenging behaviors varied by diagnosis, with communication and motor domains playing greater roles for toddlers with Autistic Disorder or PDD-NOS, and personal-social and cognitive domains playing greater roles for atypically developing toddlers with no ASD diagnosis.     

Parental Recognition of Developmental Problems in Toddlers with Autism Spectrum Disorders

Symptoms of Autism Spectrum Disorders (ASD) begin to manifest during the first 2 years; there is limited evidence regarding type and timing of symptom onset. We examined factors related to parental age of recognition (AOR) of early abnormalities and the association between AOR and diagnosis and levels of functioning at 2 and 4 years in 75 toddlers with ASD. Results suggest significant differences between autism and PDD-NOS in the AOR and type of first concerns. Early social and motor delays as well as maternal age was associated with AOR. Later AOR was associated with poorer social-communicative and nonverbal cognitive functioning at 2 and 4. The findings are discussed in a context of identifying distinct developmental trajectories within the autism spectrum.     

A comparison of social skills profiles in intellectually disabled adults with and without ASD

The purpose of this study was to systematically examine the social-skills profiles among adults with autism spectrum disorders (ASD) and intellectual disability (ID). Using one-way multivariate analysis of variance (MANOVA), three groups (autism, pervasive developmental disorder-not otherwise specified [PDD-NOS], and ID only) were compared on seven global measures of social behavior. There were 72 individuals in each group matched on level of ID, verbal ability, age, and gender. Distinctions were noted in the areas of positive social behaviors and negative nonverbal social behaviors. Those with autism displayed the greatest deficits in these areas, followed by those with PDD-NOS. The results support the notions that social impairment remains a distinct feature of ASD in adults with ID, that autism and PDD-NOS are two conditions on the same spectrum, and that this spectrum is relevant for adults with ID. Implications of the results and directions for future research are discussed.     

DSM-5 criteria for autism spectrum disorder maximizes diagnostic sensitivity and specificity in preschool children

Purpose

The criteria for autism spectrum disorder (ASD) were revised in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The objective of this study was to compare the sensitivity and specificity of DSM-IV-Text Revision (DSM-IV-TR) and DSM-5 definitions of ASD in a community-based sample of preschool children.

Methods

Children between 2 and 5 years of age were enrolled in the Study to Explore Early Development-Phase 2 (SEED2) and received a comprehensive developmental evaluation. The clinician(s) who evaluated the child completed two diagnostic checklists that indicated the presence and severity of DSM-IV-TR and DSM-5 criteria. Definitions for DSM-5 ASD, DSM-IV-TR autistic disorder, and DSM-IV-TR Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) were created from the diagnostic checklists.

Results

773 children met SEED2 criteria for ASD and 288 met criteria for another developmental disorder (DD). Agreement between DSM-5 and DSM-IV-TR definitions of ASD were good for autistic disorder (0.78) and moderate for PDD-NOS (0.57 and 0.59). Children who met DSM-IV-TR autistic disorder but not DSM-5 ASD (n = 71) were more likely to have mild ASD symptoms, or symptoms accounted for by another disorder. Children who met PDD-NOS but not DSM-5 ASD (n = 66), or vice versa (n = 120) were less likely to have intellectual disability and more likely to be female. Sensitivity and specificity were best balanced with DSM-5 ASD criteria (0.95 and 0.78, respectively).

Conclusions

The DSM-5 definition of ASD maximizes diagnostic sensitivity and specificity in the SEED2 sample. These findings support the DSM-5 conceptualization of ASD in preschool children.

     

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.     

Rehabilitation issues in Landau–Kleffner Syndrome

Abstract

Objective: Attention-deficit hyperactivity disorder (ADHD) has been linked to deficits in socialization and communication, similar to those observed in children with ASD. In the present study, we examine the differences in developmental quotient and subscale scores between children with ASD and children with ADHD.

Methods: We compared the developmental scores in a sample of 2990 children who presented to an early intervention program, who met criteria for ASD, inattentive ADHD, hyperactive/impulsive ADHD, combined ASD/ADHD, or are at risk for developmental disorders.

Results: The overall developmental quotient did not significantly differ between those in the ADHD inattentive and hyperactive subtype groups. Adaptive skills differed most greatly between the ASD groups and the ADHD/atypically-developing groups.

Conclusion: The present study represents a first step towards understanding the relationship of ADHD to ASD in early childhood. Young children with ASD symptoms are more greatly impaired than those with symptoms of ADHD.     

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.