Siblings of children with autism: Predictors of adjustment

As the prevalence of autism increases, so does the need to examine the effects of autism on family members of children with autism. The current study evaluated possible predictors of adjustment in siblings of children with autism. Aspects of the parents’ functioning as caregivers for a child with autism were examined to determine whether they predicted the adjustment of the child's sibling. Two hundred caregivers of 4–10-year-old children with autism who had at least one sibling without autism participated by filling out questionnaires online. Parental satisfaction with the role of caregiver for the child with autism was negatively correlated with difficulties in sibling adjustment, and it was the only significant predictor of sibling adjustment in a hierarchical regression analysis. Parental stress and parental self-efficacy were not unique contributors to sibling adjustment when other parental variables were considered. No significant relationship was found between parental therapy involvement and sibling adjustment, or between parental educational involvement and sibling adjustment. The lack of parental involvement as a predictor of sibling adjustment adds new findings to the current literature, which had found such a relationship in a previous study with a smaller sample.     

Factors associated with parental stress and satisfaction during the process of diagnosis of children with Autism Spectrum Disorders

Diagnosis of Autism Spectrum Disorders (ASD) is complex and parents worldwide often experience difficulties and frustration during the diagnostic process. This study examined the duration of the diagnostic period, the number of professionals consulted, the relationship with the professional(s) and the perceived helpfulness of information provided in relation to how they impact on parental satisfaction and stress during the diagnostic process. The study also obtained professional perspectives regarding current diagnostic practices to understand aspects of the process which may be helpful in increasing professional confidence in diagnosing ASD. One hundred and two parents of 2-17 years old children and young people with ASD recruited from ASD special schools, intervention centres and hospitals in Singapore completed a survey, which included information on various aspects of the diagnostic process and measures of autism severity, parental stress and satisfaction. Seventeen professionals completed a similar survey. Parents from higher educational and socioeconomic backgrounds were more likely to raise concerns about their child's development at an earlier age. Higher parental stress was associated with more professionals consulted and lower perceived collaboration with professionals. Higher parental satisfaction was associated with higher perceived collaboration with professionals, higher perceived helpfulness of received information, lower severity of child ASD symptoms and lower levels of stress. Findings are discussed in relation to clinical practice guidelines and existing literature on the process and impact of diagnosis on families.     

Adherence to Behavioral and Medical Treatment Recommendations by Parents of Children with Autism Spectrum Disorders

The extent to which parents of children with intellectual or developmental disabilities are adherent to prescribed treatments has not been investigated. In this treatment adherence study, parents (n = 220) of children with autism spectrum disorders were surveyed regarding implementation of recommended treatments to manage problem behavior of their children living at home. Overall adherence to medical treatment recommendations was significantly greater than adherence to behavioral treatment recommendations (p < .002). Of the behavioral treatment recommendations, parents reported greater adherence to reinforcement (81.7%) than punishment (68.9%). Child diagnosis (p < .002) and the diagnosis × marital status interaction (p < .05) were significantly associated with reported adherence to behavioral and medical treatment, respectively. Results are discussed in light of the need to address adherence enhancement and measurement methods. Portions of this work were presented at the Annual Gatlinburg Conference on Research and Theory in Intellectual and Developmental Disabilities, San Diego, CA, March 2008.     

Early Social and Emotional Communication in the Infant Siblings of Children with Autism Spectrum Disorders: An Examination of the Broad Phenotype

Infants with older siblings with Autism Spectrum Disorders (ASD-sibs) are at risk for socioemotional difficulties. ASD-sibs were compared to infants with typically developing older siblings (TD-sibs) using the face-to-face/still-face (FFSF) at 6 months and the Early Social Communication Scale (ESCS) at 8, 10, 12, 15, and/or 18 months. ASD-sibs smiled for a lower proportion of the FFSF than TD-sibs and lacked emotional continuity between episodes. With respect to TD-sibs, ASD-sibs engaged in lower rates of initiating joint attention at 15 months, lower rates of higher-level behavioral requests at 12 months, and responded to fewer joint attention bids at 18 months. The results suggest subtle, inconsistent, but multi-faceted deficits in emotional expression and referential communication in infants at-risk for ASDs.     

Deficient brainstem encoding of pitch in children with Autism Spectrum Disorders

OBJECTIVE: Deficient prosody is a hallmark of the pragmatic (socially contextualized) language impairment in Autism Spectrum Disorders (ASD). Prosody communicates emotion and intention and is conveyed through acoustic cues such as pitch contour. Thus, the objective of this study was to examine the subcortical representations of prosodic speech in children with ASD. METHODS: Using passively evoked brainstem responses to speech syllables with descending and ascending pitch contours, we examined sensory encoding of pitch in children with ASD who had normal intelligence and hearing and were age-matched with typically developing (TD) control children. RESULTS: We found that some children on the autism spectrum show deficient pitch tracking (evidenced by increased Frequency and Slope Errors and reduced phase locking) compared with TD children. CONCLUSIONS: This is the first demonstration of subcortical involvement in prosody encoding deficits in this population of children. SIGNIFICANCE: Our findings may have implications for diagnostic and remediation strategies in a subset of children with ASD and open up an avenue for future investigations.     

Treatment of Seizure Disorders and EEG Abnormalities in Children with Autism Spectrum Disorders

The treatment of seizure disorders EEG epileptiform abnormalities without epilepsy in children with autism spectrum disorders (ASD) is considered within the context of the relationship of epilepsy and epileptiform disorders to language, behavior, and cognition. There is an increased prevalence of both epilepsy and abnormal potentially epileptogenic activity in children with ASD. Anecdotal evidence suggests that the use of anticonvulsants to treat epileptiform discharges thought to be producing dysfunction in selected aspects of cognition, language, or behavior makes a positive difference in a subgroup of children with ASD, but there is inadequate evidence on which to base specific recommendations. There is, at present, no scientific justification for considering epilepsy surgery in children with ASD in the absence of intractable clinical seizures.     

The relationship between Health-Related Quality of Life and sleep problems in children with Autism Spectrum Disorders

Although children with Autism Spectrum Disorders (ASD) are thought to experience sleep problems at a much higher rate than typically developing peers, the relationship between sleep disturbance and Health-Related Quality of Life (HRQoL) has not been explored within this pediatric population. Further, little is understood about the HRQoL of children with ASD in general. This study assessed the HRQoL and sleep health of a sample of children with ASD and investigated the relationship between HRQoL and overall sleep problems within the context of key clinical characteristics. Study participants included 86 parents of children with ASD between the ages of 4 and 12 years. Subjects were recruited from 3 autism specialty clinics at large academic medical centers and asked to proxy-report on their children's HRQoL and sleep habits. Adjusted regression models showed a consistent negative relationship between sleep disturbance and HRQoL, with greater overall sleep problems being associated with poorer total, physical, and psychosocial HRQoL. Sleep duration and sleep anxiety were also found to be negatively associated with HRQoL. These findings suggest that treatments that are effective in treating sleep disturbances may improve children's HRQoL.     

Parenting dimensions in mothers and fathers of children with Autism Spectrum Disorders

Rearing a child with Autism Spectrum Disorder (ASD) is a unique challenge for both parents. Previous studies addressed how mothers are affected by the challenges of raising a child with ASD, mostly in terms of stress pattern. In this study, we focused on comparisons between mothers and fathers of children with ASD in parental stress, attitude and mental health. We examined 99 parents of children with ASD using the Parenting Stress Index-Short Form, the Parental Style Questionnaire, the Self-Perceptions of the Parental Role and the Symptom Checklist-90-Revised. The results revealed the gender differences in the parental attitude and mental health. Mothers reported that they engaged in more social behaviors with their children than fathers. In addition mothers reported higher level of depression than fathers. No difference among parents emerged in the Parenting Stress Index-Short Form. The results of a multiple regression analysis revealed that parenting distress is associated with depression, balance of parents’ diverse roles in their life and dysfunctional interaction between parents and children. These findings highlight both similarities and differences between mothers and fathers of children with ASD and the existence of a relationship between parental stress, mental health and attitude. Results suggest the importance of developing specific intervention programs which incorporate these fundamental parenting domains.     

Regression, Developmental Trajectory and Associated Problems in Disorders in the Autism Spectrum: The SNAP Study

We report rates of regression and associated findings in a population derived group of 255 children aged 9–14 years, participating in a prevalence study of autism spectrum disorders (ASD); 53 with narrowly defined autism, 105 with broader ASD and 97 with non-ASD neurodevelopmental problems, drawn from those with special educational needs within a population of 56,946 children. Language regression was reported in 30% with narrowly defined autism, 8% with broader ASD and less than 3% with developmental problems without ASD. A smaller group of children were identified who underwent a less clear setback. Regression was associated with higher rates of autistic symptoms and a deviation in developmental trajectory. Regression was not associated with epilepsy or gastrointestinal problems.     

Superior Disembedding Performance of High-Functioning Individuals with Autism Spectrum Disorders and Their Parents: The Need for Subtle Measures

We assessed the disembedding performance on the Embedded Figures Test (EFT) of high-functioning subjects with autism or autism spectrum disorders from multi-incidence families and the performance of their parents. The individuals with autism spectrum disorders were significantly faster than matched controls in locating the shape, but their parents were not faster than a control group of parents. However, both the individuals with autism spectrum disorders and their fathers made significantly fewer incorrect attempts before finding the right shape than matched controls. These results suggest that the number of incorrect attempts is a more subtle measure than accuracy or response time for assessing superior disembedding skills and therefore may be useful in the assessment of individuals with autism spectrum disorders.     

Correlating derived relational responding with linguistic and cognitive ability in children with Autism Spectrum Disorders

Many children with Autism Spectrum Disorders (ASD) show substantial deficits in linguistic and cognitive ability. When considered from the perspective of Relational Frame Theory (RFT), it is possible that these deficits are rooted in a deficiency in the capacity to derive relations. One key aim of the Training and Assessment of Relational Precursors and Abilities (TARPA) protocol is to assess derived relational responding. A number of previous studies have shown correlations between TARPA performance and linguistic ability in children with ASD. The current study has extended this work by (i) showing correlations between TARPA performance and cognitive as well as linguistic ability in a larger (n = 35) sample of children with ASD; (ii) providing evidence of TARPA test–retest reliability; (iii) providing additional evidence indicating differences in visual and auditory performance in children with ASD.     

Reading the mind in the face and voice in parents of children with Autism Spectrum Disorders

One core feature of Autism Spectrum Disorders (ASD) is impairment in social functioning and inferring mental states and emotions referred to theory of mind (TOM). The “Broad Autism Phenotype” (BAP) proposes that defining features of autism express in milder form among first degree relatives of these patients. Theory of mind deficits has been examined using advanced TOM tasks such as “Reading the Mind in the Eyes”. This study has furthered previous findings using another test designed to tap higher TOM abilities named “Mind Reading in the Voice”. The objective of this study is to examine theory of mind abilities from two main communicative sources in parents of children with ASD in contrast to two groups, one clinical and one non-clinical. Forty-eight parents of individuals with autism, 31 parents of individuals with Down syndrome and 30 parents of typically developed children were administered two tests of mind-reading. Analysis revealed that although there is not a significant difference between three groups’ performance in “Mind Reading from Eyes”, parents of children with ASD have significantly lower performance in “Mind Reading from Voice”. It can be concluded that TOM deficits in parents of children with ASD are not restricted to inferring mental states form eyes and deficits in mind-reading from voice could also be a part of BAP.     

Brief Report: Adults with Mild Autism Spectrum Disorders (ASD): Scores on the Autism Spectrum Quotient (AQ) and Comorbid Psychopathology

While knowledge about symptom presentation of adults with mild ASD, including comorbid psychopathology, is limited, referral of adults with suspected mild PDD is increasing. We report on pilot research investigating whether patients diagnosed with mild ASD (n = 15) and patients who were not diagnosed with ASD (n = 21) differed in terms of (a) AQ scores and (b) Axis I and II disorders, assessed by the SCAN and the IPDE. Additionally, AQ scores were compared with those from non-ASD patients referred to a general outpatient clinic (n = 369). The results showed very few differences between ASD patients and non-ASD patients. Self-report may not differentiate mild ASD patients from non-ASD patients and Axis I and II disorders seem equally prevalent among these two groups.     

Reliability and validity of the Psychoeducational Profile-third edition Caregiver Report in children with Autism Spectrum Disorders

The aim of this study was to examine the internal consistency, inter-respondent reliability, and convergent and divergent validity of the Psychoeducational Profile-third edition Caregiver Report (PEP3-CR) in children with Autism Spectrum Disorders (ASD). We examined the internal consistency on 66 mothers of children with ASD who completed the PEP3-CR. Inter-respondent reliability was examined on 46 pairs of mothers and fathers who completed the PEP3-CR independently within one week. Moreover, 64 children were administered the Psychoeducational Profile-third edition Performance Test (PEP3-PT) and 20 children and their parents were administered the Childhood Autism Rating Scale (CARS) and the Vineland Adaptive Behavior Scale (VABS) to examine the convergent and divergent validity of the PEP3-CR. The Cronbach's alpha of the PEP3-CR subtests, ranging from 0.83 to 0.85, indicated sufficient internal consistency. The intra-class correlation coefficient (ICC) of the two parents, ranging from 0.66 to 0.79, indicated moderate inter-respondent reliability. The correlations between the PEP3-PT, CARS, VABS and the PEP3-CR supported the convergent and divergent validity of the PEP3-CR. Therefore, the PEP3-CR is a reliable and valid caregiver report for assessing adaptive functioning and autistic behaviors in children with ASD.     

Multi-informant Ratings of Psychiatric Symptom Severity in Children with Autism Spectrum Disorders: The Importance of Environmental Context

The present study examines co-occurring psychiatric syndromes in a well-characterized sample of youths with autism spectrum disorders (ASD; n = 177) and their siblings (n = 148), reported independently by parents and teachers. In ASD, parents reported substantial comorbidity with affective (26%), anxiety (25%), attentional (25%), conduct (16%), oppositional (15%), and somatic problems (6%). Teachers reported a much lower prevalence. Autistic severity scores for children with ASD exhibited moderate correlations with general psychopathology within- but not across-informants, whereas, sibling correlations were significant both within- and across-informants. Results support the role of environmental context in psychiatric symptom expression in children affected by autism and suggest that informant discrepancies may more provide critical cues for these children via specific environmental modifications.     

The effects of coping style,social support,and behavioral problems on the well-being of mothers of children with Autism Spectrum Disorders in Lebanon

The present study examined the effects of coping styles, social support, and child's behavioral symptoms on the well-being of 65 mothers of children with Autism Spectrum Disorders (ASD) in Lebanon. Comparisons to the well-being of 98 mothers of typically developing children were also drawn. Regression analyses showed that disengagement and distraction coping predicted poor well-being, whereas cognitive reframing showed a correlation with better well-being levels. A significant correlation was found between child's behavioral problems and maternal well-being. T-test analyses revealed that mothers of children with ASD differed in terms of coping styles used. Additionally, mothers of children with ASD showed lower levels of perceived social support. Well-being was significantly better for mothers of typically developing children. Study limitations and implications are discussed.     

Factor Analysis of the Aberrant Behavior Checklist in Individuals with Autism Spectrum Disorders

Exploratory factor analysis (varimax and promax rotations) of the aberrant behavior checklist-community version (ABC) in 275 individuals with Autism spectrum disorder (ASD) identified four- and five-factor solutions which accounted for >70% of the variance. Confirmatory factor analysis (Lisrel 8.7) revealed indices of moderate fit for the five-factor solution. Our results suggest that the factor structure of the ABC is robust within an ASD sample. Both solutions yielded a three items self-injury factor. Stratifying on this factor, we identified significant differences between the high- and low-self injury groups on ABC subscales. The emergence of a self-injury factor, while not suggestive of a new subscale, warrants further exploration as a tool that could help dissect relevant neurobiobehavioral groups in ASD.     

Local processing and social skills in children with Autism Spectrum Disorders: The role of anxiety and cognitive functioning

The present study examined the relations between anxiety, cognitive functioning, local processing, and social skills in a group of 102 children diagnosed with an Autism Spectrum Disorder. The results indicated that children diagnosed with Asperger's Disorder had significantly higher cognitive functioning and enhanced local processing (i.e., Block Design scores) compared to those diagnosed with Autistic Disorder or PDD-NOS. Regression analyses results showed that anxiety and cognitive functioning moderated the association between local processing and social skills. For children with low cognitive functioning and high anxiety, greater local processing was associated with poorer social skills than those with high cognitive functioning, high anxiety, and greater local processing. For children with high cognitive functioning and high anxiety, enhanced local processing was associated with better social skills than those with high cognitive functioning and reduced local processing. Implications of these findings are discussed.     

The Modified Checklist for Autism in Toddlers: A Follow-up Study Investigating the Early Detection of Autism Spectrum Disorders

Autism spectrum disorders (ASD) often go undetected in toddlers. The Modified Checklist for Autism in Toddlers (M-CHAT) was used to screen 3,793 children aged 16–30 months from low- and high-risk sources; screen positive cases were diagnostically evaluated. Re-screening was performed on 1,416 children aged 42–54 months. Time1 Positive Predictive Value (PPV) was .36 for the initial screening and .74 for the screening plus follow-up telephone interview; values were similar for Time2 PPV. When separating referral sources, PPV was low for the low-risk sample but acceptable with the follow-up telephone interview. Children with ASD from the low-risk and high-risk samples were highly similar. Results indicate that the M-CHAT continues to be a promising instrument for the early detection of ASD.