Potential Risk Factors for the Development of Self-Injurious Behavior among Infants at Risk for Autism Spectrum Disorder

Prevalence of self-injurious behavior (SIB) is as high as 50% among children with autism spectrum disorder (ASD). Identification of risk factors for the development of SIB is critical to early intervention and prevention. However, there is little empirical research utilizing a prospective design to identify early risk factors for SIB. The purpose of this study was to evaluate behavioral characteristics predicting SIB at age 2 years among 235 infants at high familial risk for ASD. Logistic regression results indicated that presence of SIB or proto-SIB and lower developmental functioning at age 12 months significantly predicted SIB at 24 months. A pattern of persistent SIB over this period was associated with a diagnosis of autism and poorer cognitive and adaptive outcomes.     

Identification of early self-injurious behaviour in young children with intellectual disability

Very little is known about the early stages of self-injurious behaviour (SIB) in young children with developmental disabilities, even though there has been a great deal of research into the prevalence, assessment and treatment of well-established SIB in older individuals. In the present initial study, teachers in special schools for children under 11 years of age with severe intellectual disability and/or autism were asked to identify children who were beginning to show early self-injury (the index group). These children were then matched to classroom controls (of the same ability level and mobility), and teachers were interviewed about the children's behaviours and skills. The index children showed significantly more potential SIB than the control group children, but there was overlap between the groups in terms of percentage duration of potential SIB, suggesting that teachers do not find it easy to identify children with 'early' SIB. The index children's skills and problem behaviours, their sensory impairments and degree of autism did not differ significantly from those of the control group. When all the children showing any potential SIB were pooled together, it transpired that developmental age and degree of mobility were significantly correlated with percentage duration of SIB, suggesting that these characteristics may be important risk markers. The index children were also observed at 3-month intervals at school over the following 18 months and self-injury clearly escalated for some of the index children, while it did not do so for others. Using regression analysis, increases in SIB were shown to be associated only with the degree of concern expressed about the child's behaviour at time 1 by the teacher, no other variables predicting increases in SIB.     

Effects of age and IQ on adaptive behavior domains for children with autism

Researchers have examined adaptive behavior in autism, but few studies have looked for different patterns of adaptive skills according to age and intelligence. Domain scores from the Vineland Adaptive Behavior Scale (VABS) were compared in relation to age and Performance IQ for 72 children and adolescents with autism and 37 nonautistic children and adolescents with mental retardation. Age and IQ were positively related to each of the Vineland domains. Children with autism had lower scores in the socialization domain. An interaction was present between Performance IQ and group: With increasing IQ, children with autism showed smaller increases in social functioning than children with mental retardation. A similar trend was present for daily living skills. Results suggest that (a) the relationship between the two groups' adaptive behavior profiles is stable from preschool age through adolescence, and (b) increasing IQ is associated with less of an increase in certain adaptive skills for children with autism.     

Daily living skills in children with autism spectrum disorder and intellectual disability: A comparative study from Turkey

BackgroundBetter daily living skills (DLS) are associated with increased independence and positive functional outcomes in Autism Spectrum Disorder (ASD).MethodThe present study aimed to investigate daily living skills (DLS) and the associated factors in 51 children with ASD and intellectual disability (ASD group) and 51 age- and gender-matched controls with intellectual disability (ID group). The severity of the autistic symptoms was measured with the clinician-rated Childhood Autism Rating Scale and the parent-reported Autism Behavior Checklist (ABC) in all children. The mothers also completed the Pediatric Quality of Life Inventory and the Basic DLS Questionnaire.ResultsThe ASD group scored lower than the comparison group in the total DLS score, personal hygiene, dressing, safety and interpersonal skills, despite being comparable in the parent-reported quality of life. Regression analysis of the whole sample demonstrated that the child’s age, intellectual level, speech level, autism symptom severity and the monthly household income were independent correlates of the total DLS. Exploratory analyses for each group revealed differential effects of these variables: in the ASD group; a higher speech level and monthly income, while in the ID group; an older age, a higher intellectual level and monthly income and a lower ABC score emerged as significant predictors of higher DLS.ConclusionsDeficient DLS in Turkish children with ASD, given their IQ, suggest that lower level of adaptive skills is inherent in ASD, rather than culture-specific to US and Western Europe.     

Behavioral and emotional profile and parental stress in preschool children with autism spectrum disorder

Parents of children with autism spectrum disorder (ASD) were shown to experience more stress than parents of typically developing peers, although little is known about risk factors predicting stress in this population. The aim of this study was to evaluate parental stress levels and behavioral and emotional problems in a sample of preschool children with ASD as compared to typically developing (TD) peers and to investigate the role of several factors, including the severity of autistic symptoms, adaptive skills, cognitive abilities and behavioral and emotional problems, on parental stress. Results confirmed that parents of children with ASD experience higher stress levels than parents of TD and that children with ASD show more behavioral and emotional problems than controls. Moreover, our results showed that behavioral and emotional problems are strong predictors of parental stress, while stress related to a parent–child dysfunctional relationship was associated with daily living and communication skills as well as cognitive abilities. Findings revealed different behavioral and emotional problems affecting parental stress in ASD and TD samples. No association between the severity of autism symptoms and parental stress was detected. These results suggest that dysfunctional behaviors in preschool children with ASD have a strong impact on parental stress, profoundly affecting the well-being of the entire family. Therefore, strategies aimed at the early detection and management of these behavioral and emotional problems are crucial in order to prevent parental stress and to develop the most appropriate treatment interventions.     

Who benefits from early intervention in autism spectrum disorders?

Research in autism spectrum disorders (ASD) described individual differences in response to intervention. This study explored child and parental characteristics at baseline that predict outcomes in adaptive skills and acquisition of cognitive gains. Seventy-eight children aged 15–35 months diagnosed with ASD by standardized diagnostic tools were included. Evaluations of verbal and non-verbal abilities, adaptive skills and autism severity were obtained at pre-intervention (T1) and after one year of intervention (T2). At T2, children improved significantly in their verbal ability and the severity of autism symptoms was reduced. Outcome in adaptive skills was best predicted by baseline verbal ability and maternal age. Better verbal ability especially in those with severe autism symptoms, and older maternal age predicted better adaptive skills outcome. T1 autism severity, child's age and maternal age and educational attainment best predicted cognitive gains. Less severe autism symptoms, younger child's age at start of intervention, older maternal age and higher maternal education predicted greater cognitive gains with intervention. The study suggests biological factors including age, language abilities and autism severity and environmental factors including maternal age and education, impact the ability to benefit from early intervention in ASD.     

Toward a Developmental Operational Definition of Autism

Traditional approaches to diagnosing autism emphasize delays in communication and socialization. Traditional diagnostic schemes typically list symptoms (e.g., lack of eye contact), but provide little guidance on how to incorporate information about developmental level in making a diagnosis. Because standardized measures of adaptive behavior can provide information about children's communication, socialization, and other behavior relative to their age, they may be useful tools for diagnosing autism. This study investigated the ability of the Vineland Adaptive Behavior Scales to identify children with autism. Vineland scores and measures of intellectual functioning were obtained for children with autism, PDDNOS, and other developmental disorders (DD). Discriminant function analyses indicated that the autism and combined nonautism (PDDNOS and DD) groups could be differentiated on the basis of socialization, daily living skills, and serious maladaptive behaviors. Socialization alone accounted for 48% of the variance in diagnosis. Using regression analyses derived from a large normative sample, adaptive behavior scores were predicted from chronological age (CA) and mental age (MA). Socialization scores in the autism group were substantially below the level predicted from CA or MA. An index derived from the ratio of actual to predicted socialization scores correctly classified 86% of both autism and nonautism cases. Findings suggest that comparison of obtained Vineland socialization scores to those predicted by CA or MA may be useful in clarifying the diagnosis of autism.     

Subclassification of children with autism and pervasive developmental disorder: A questionnaire based on Wing's Subgrouping scheme

A questionnaire (the Wing Subgroups Questionnaire, or WSQ) for subclassifying children with autism into one of Wing's three hypothesized subgroups was developed, and the validity of this measure was assessed. Forty parents of children with autism or pervasive developmental disorder not otherwise specified (PDDNOS) completed the questionnaire. Results indicated that the questionnaire has adequate external criterion-referenced validity with similar subgroup ratings made by clinicians, and good internal consistency. Furthermore, results revealed three distinct and separate subgroups corresponding to Wing's subclassification scheme. Other analyses suggested that Wing assignment based on the WSQ was independent of chronological age and age equivalents for social and daily living skills, but not independent of diagnosis of autism vs. PDDNOS, IQ, severity of autism, sex, receptive language mental age, and age equivalents for communication skills. Finally, a discriminant analysis indicated that, of all the dependent variables examined in the present study, the clinicians' Wing assignment was the best predictor of Wing assignment based on the parent-completed WSQ. These findings provide support for Wing's classification system, and suggest that the WSQ is a valid and useful tool for subclassifying individuals with autism.This article fulfilled part of the first author's requirements for a Master's degree in clinical child psychology at the University of Washington. The authors acknowledge funding from the NINDS (NS26678) awarded to Geraldine Dawson. We gratefully acknowledge the assistance of the parents who participated in this study, as well as the help of Thy Nguyen and Shirley Harrell in the data entry, and of Laura Grofer, Art Lewy, Gary Mesibov, Julie Osterling, and Craig Mason in other aspects of the study's completion.     

Sleep disruption as a correlate to cognitive and adaptive behavior problems in autism spectrum disorders

Sleep problems associated with autism spectrum disorders (ASD) have been well documented, but less is known about the effects of sleep problems on day-time cognitive and adaptive performance in this population. Children diagnosed with autism or pervasive developmental disorder-not otherwise specified (PDD-NOS) (N = 335) from 1 to 10 years of age (M = 5.5 years) were evaluated for the relationships of Behavioral Evaluation of Disorders of Sleep (BEDS; Schreck, 1998) scores to measures of intelligence and adaptive behavior. Results suggested that children who slept fewer hours per night had lower overall intelligence, verbal skills, overall adaptive functioning, daily living skills, socialization skills, and motor development. Children who slept fewer hours at night with waking during the night had more communication problems. Breathing related sleep problems and fewer hours of sleep related most often to problems with perceptual tasks. The results indicate that quality of sleep--especially sleep duration--may be related to problems with day-time cognitive and adaptive functioning in children with autism and PDD-NOS. However, future research must be conducted to further understand these relationships.     

Differences in adaptive functioning among people with autism or mental retardation

This report describes differences in motoric and instrumental activity of daily living skills (MADLs and IADLs) between 1,442 people with autism and 24,048 people with mental retardation, using data from an adaptive behavior measure. Comparisons were made using groups defined by age (5–12, 13–21, and 21–35 years) and intellectual level. Diagnoses of record were confirmed through group analyses of rates of problem behaviors consistent with autism and comparison to an independent data base. Findings suggest that at ages 5–12 the skills of children with autism are more developed than those of children with mental retardation matched by age and intellectual level. However, in the older groups these differences diminish, and with increasing age (21–35 years) more developed instrumental skills are observed for people with mental retardation.     

The relationship of motor skills and adaptive behavior skills in young children with autism spectrum disorders

ObjectiveTo determine the relationship of motor skills and adaptive behavior skills in young children with autism.DesignA multiple regression analysis tested the relationship of motor skills on the adaptive behavior composite, daily living, adaptive social and adaptive communicative skills holding constant age, non-verbal problem solving, and calibrated autism severity.SettingMajority of the data collected took place in an autism clinic.ParticipantsA cohort of 233 young children with ASD (n = 172), PDD-NOS (n = 22) and non-ASD (developmental delay, n = 39) between the ages of 14–49 months were recruited from early intervention studies and clinical referrals. Children with non-ASD (developmental delay) were included in this study to provide a range of scores indicted through calibrated autism severity.InterventionsNot applicable.Main outcome measuresThe primary outcome measures in this study were adaptive behavior skills.ResultsFine motor skills significantly predicted all adaptive behavior skills (p < 0.01). Gross motor skills were predictive of daily living skills (p < 0.05). Children with weaker motor skills displayed greater deficits in adaptive behavior skills.ConclusionsThe fine and gross motor skills are significantly related to adaptive behavior skills in young children with autism spectrum disorder. There is more to focus on and new avenues to explore in the realm of discovering how to implement early intervention and rehabilitation for young children with autism and motor skills need to be a part of the discussion.     

Entwicklungsverlauf im 2. und 3. Lebensjahrzehnt bei 18 Patienten mit Kanner-Autismus

The course of development of 18 patients with Kanner autism (mean age 28 years) in their second and third decades was explored and recorded with respect to factors affecting social competence in adulthood. To validate the diagnosis, we used the Childhood Autism Rating Scale. A version of the Vineland Adaptive Behavior Scales was employed to assess social adaptation. On average, the individuals showed socially adaptive skills that are typical for healthy children at the age of 4 years and 3 months. Of the autistic persons, 72% showed a characteristic pattern: scoring highest in daily living skills and lowest in social skills, especially in interpersonal relationships, where they performed at an average age equivalent of only 2 years and 7 months.     

The behavioral consequences of exposure to antiepileptic drugs in utero

The aim of the study was to examine the behavior of 242 children, aged between 6 and 16 years, born to mothers with epilepsy. Exposure to sodium valproate (VPA) in utero was associated with high levels of parental stress induced by the child's maladaptive behavior. These children were also poorer for daily living skills and skills relating to socialization. The outcomes on both measures were strongly affected by the Full Scale IQ (FSIQ) of the child; however, no significant differences were found between the groups and therefore this pattern of results cannot simply be attributed to a lower FSIQ. The results of this study suggest that exposure to VPA in utero and the presence of a lowered FSIQ are risk factors for the development of poorer adaptive behavior and a higher rate of maladaptive behaviors.     

Early language milestones predict later language,but not autism symptoms in higher functioning children with autism spectrum disorders

Language ability is a known predictor of outcome in children with autism but plays a more controversial role for higher functioning children with autism spectrum disorders (ASD). We studied the relationship between early language milestones and later structural language, adaptive functioning and autism symptoms in a sample of 76 children (mean age = 9.1 years) with an ASD, using two different language milestones: first phrase by 24 or 36 months. After controlling for age and nonverbal abilities, retrospectively reported early language milestones were predictive of later structural language abilities, measured by a sentence repetition task, and adaptive communication skills, but not autism symptoms or adaptive social skills. Acquisition of phrase speech by 24 months was sensitive to language and communication impairments in our ASD group, the majority (84%) of which had already acquired phrase speech by 36 months of age. Early available and easily collectable milestone data may be a useful marker of later language performance even in higher functioning, verbal children on the autism spectrum. When a detailed assessment of language is not possible, data on early milestones may be useful for identifying children at-risk in clinical settings and for language phenotyping in the laboratory.     

Handicaps and the development of skills between childhood and early adolescence in young people with severe intellectual disabilities

Background While a number of studies have examined the development of skills in children with intellectual disabilities (ID), most have been cross-sectional, most have been concerned with particular syndromes such as Down's syndrome or autism and few have attempted to identify factors associated with improvements in skills. Methods From a sample of 111 children with severe ID who had been identified from the registers of six special schools at 4–11 years of age, 82 were traced and reassessed 5 years later at the age of 11–17 years. On both occasions, information on the children's handicaps and skills was collected by interviewing their main carers using a shortened version of the Vineland Adaptive Behaviour Scales and the Disability Assessment Schedule. Results and conclusions There were small but statistically significant improvements in Vineland age-equivalent communication and daily living skills scores, but not in Vineland Socialization scores, over the 5-year period of follow-up. This pattern of improvement was observed in most aetiological subgroups. Improvement in skills was greatest in younger children, and was associated with reductions in behaviour problems and in levels of parental stress. In spite of the improvements in age-equivalent scores, Vineland standard scores showed significant declines over the same period of time, indicating that the improvements observed were smaller than would be expected in a general population sample of children of the same age. The dangers of using standard scores or quotients to quantify the level of functioning of children with severe ID are highlighted.     

Developmental Trajectories of Adaptive Behaviors from Early Childhood to Adolescence in a Cohort of 152 Children with Autism Spectrum Disorders

This study examines change in 152 children over an almost 10-year period (T1: 4.9 (± 1.3) years; T2: 8.1 (± 1.3) years; T3: 15(± 1.6) years) using a group-based, semi-parametric method in order to identify distinct developmental trajectories. Important deficits remain at adolescence in the adaptive abilities of children with Autism spectrum disorders, but changes in adaptive skills show two distinct growth rates. The univariate analysis reveals that low growth trajectories for both social and communication outcome are associated with the following characteristics at age 5: low cognitive and language skills, presence of epilepsy, and severity of autism. The multivariate analysis confirms that risk factors at age 5, were low language and severity of autism for both social and communication outcomes 10 years later, and that hours of early intervention was protective factor for communication.     

Parental recognition of developmental abnormalities in autism

 In order to identify factors associated with the early detection and referral of children with pervasive developmental disorders, a sample of 82 consecutive referrals to an outpatient diagnostic service was studied. All children were thoroughly assessed with the Autism Diagnostic Interview (ADI), standardized psychological tests and direct observations. Data from the ADI on the first symptoms to arouse parental concern and on the first professional advice sought were analyzed. The mean age of children was 19.1 months (SD=9.4) when the parents first became concerned, and the first professional advice was sought when children were 24.1 months old (SD=11.7). The most common parental concerns were for speech and language development, followed by abnormal socio-emotional response, and medical problem or delay in milestone. In both bivariate and multiple regression analyses, the mean age of children at first parental concern and professional advice was significantly lower in the presence of mental retardation in the child, of an older sibling in the family, and of first parental concerns for medical problem/delay in milestone. More specific autistic behaviours, child’s gender, social class and place of residence did not influence the age of recognition of the disorder in this sample. Health visitors and general practitioners were the first professionals contacted by parents. The implications of these findings for early detection and diagnosis of autism are discussed. Received: 11 August 1997 Accepted: 18 November 1997     

Effects of Cognitive Behavioral Therapy on Daily Living Skills in Children with High-Functioning Autism and Concurrent Anxiety Disorders

CBT is a promising treatment for children with autism spectrum disorders (ASD) and focuses, in part, on children’s independence and self-help skills. In a trial of CBT for anxiety in ASD (Wood et al. in J Child Psychol Psychiatry 50:224–234, 2009), children’s daily living skills and related parental intrusiveness were assessed. Forty children with ASD (7–11 years) and their primary caregiver were randomly assigned to an immediate treatment (IT; n = 17) or 3-month waitlist (WL; n = 23) condition. In comparison to WL, IT parents reported increases in children’s total and personal daily living skills, and reduced involvement in their children’s private daily routines. Reductions correlated with reduced anxiety severity. These results provide preliminary evidence that CBT may yield increased independence and daily living skills among children with ASD.     

Symptoms of ADHD and their correlates in children with intellectual disabilities

Existing research suggests that children with intellectual disabilities are at increased risk for ADHD, and that the symptoms of the disorder might successfully be treated with stimulant drugs. However, there has been little exploration of ADHD symptoms and their correlates in children with intellectual disabilities. Analyses of three samples of children with intellectual disabilities are presented (total N=338). Correlational analyses showed that younger children, and those with a diagnosis of Autism were rated as having more ADHD/hyperactivity symptoms. There was little evidence of a sex difference, and no strong associations with domains of adaptive behavior (socialization, communication, and daily living skills). However, there was a small but significant negative association between mental age and ratings of symptoms. Finally, an increased prevalence of ADHD/hyperactivity symptoms was confirmed in the children with intellectual disabilities compared to their siblings. This effect remained after controlling for chronological and mental age differences between the siblings. These findings support those from previous research and suggest that ADHD/Hyperkinesis may be a valid psychiatric diagnosis for children with intellectual disabilities. However, a great deal more research is needed to explore the phenomenology of ADHD in intellectual disability and to develop an evidence base for psychosocial intervention.     

Risk Factors Associated with Self-Injurious Behaviors in Children and Adolescents with Autism Spectrum Disorders

While self-injurious behaviors (SIB) can cause significant morbidity for children with autism spectrum disorders (ASD), little is known about its associated risk factors. We assessed 7 factors that may influence self-injury in a large cohort of children with ASD: (a) atypical sensory processing; (b) impaired cognitive ability; (c) abnormal functional communication; (d) abnormal social functioning; (e) age; (f) the need for sameness; (g) rituals and compulsions. Half (52.3%, n?=?126) of the children (n?=?241, aged 2–19?years) demonstrated SIB. Abnormal sensory processing was the strongest single predictor of self-injury followed by sameness, impaired cognitive ability and social functioning. Since atypical sensory processing and sameness have a greater relative impact on SIB, treatment approaches that focus on these factors may be beneficial in reducing self-harm in children with ASD.