The relationship between ethnicity and age of first concern in toddlers with autism spectrum disorder

The current study examined the relationship between ethnicity and the age at which parents first become concerned about their children's development in 1478 toddlers with autism spectrum disorder (ASD) and atypical development. Based on the current findings, there were no racial/ethnic differences in age of parent's first concerns. Caregivers of toddlers with ASD first developed concerns around the same time independent of which ethnic groups they belong to. In addition, the age of caregivers’ first concerns was significantly younger for those with ASD compared to those who are atypically developing without an ASD diagnosis. Implications regarding these findings are discussed.     

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.     

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.     

The relationship between cognitive development and conduct problems in young children with autism spectrum disorder

Individuals with ASD often demonstrate elevated rates of challenging behaviors, such as tantrums, aggression, and property destruction. The current study examined the relationship between cognitive abilities and conduct problem behaviors in 263 children aged 18 to 39 months. Cognitive development was measured utilizing the cognitive developmental quotient (DQ) on the Battelle Developmental Inventory, Second Edition (BDI-2). Participants were separated into two groups: (1) low cognitive DQ group (cognitive DQ less than or equal to 70), and (2) typical cognitive DQ group (cognitive DQ greater than 70). Conduct problems were assessed using the Tantrum/Conduct Behavior subscale of the Baby and Infant Screen for Children with aUtIsm Traits, Part 2 (BISCUIT-Part 2). Higher rates of overall conduct problem behaviors were observed in young children with ASD and typical cognitive development relative to children with low cognitive development. Comparisons of specific conduct behaviors indicated cognitive ability may be associated with particular presentations of conduct problems. Implications are discussed.     

The effect of cognitive skills and autism spectrum disorder on stereotyped behaviors in infants and toddlers

Stereotyped behaviors are prominent in both the ASD and ID populations; stereotypies can impede social skill acquisition, interfere with learning, and adversely affect an individual's quality of life. The current study explored the effect of cognitive skills and autism spectrum disorder (ASD) on the rate of stereotypies in 2019 children aged 17–39 months. Cognitive abilities were assessed using the cognitive developmental quotient (DQ) on the Battelle Developmental Inventory, Second Edition (BDI-2); two levels of cognitive skill were used: (1) low (cognitive DQ less than or equal to 70), and (2) typical (cognitive DQ greater than 70). Stereotypies were examined utilizing the Baby and Infant Screen for Children with aUtIsm Traits, Part 3 (BISCUIT-Part 3). Children with ASD were found to have greater rates of overall stereotyped behaviors compared to children with atypical development, regardless of cognitive level; however, children with ASD and typical cognitive ability evinced the highest rate of stereotypies. An examination of specific stereotyped behaviors (i.e., unusual play with objects, repeated and unusual vocalizations, repeated and unusual body movements) revealed disparate results. Research and clinical implications regarding these findings are discussed.     

Gender effects on challenging behaviors in children with autism spectrum disorders

Challenging behaviors are extremely prevalent within the autism spectrum disorder (ASD) population. To date, numerous factors affecting the rates of challenging behaviors within the ASD population have been examined including age, gender, ethnicity, and intellectual functioning. Controversy has arisen in regard to the effect of gender on challenging behaviors rates in individuals with ASD with some researchers finding differences while others do not. The aim of the current study was to examine the gender effects of children and adolescents with ASD on challenging behavior rates in an effort to assist in clarifying this relationship. Three hundred ninety-one children ages 2 through 17 years participated in the current study and were assigned to one of four groups: male with ASD, male without ASD, female with ASD, and female without ASD. Differences in rates of challenging behaviors between the groups were examined using the Autism Spectrum Disorder-Behavior Problems for Children. Overall, gender was not found to have an effect on the rates of challenging behaviors among children and adolescents with or without ASD. The implications of this finding are discussed along with possible future avenues of investigation.     

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

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

Challenging behaviors in toddlers diagnosed with autism spectrum disorders with the DSM-IV-TR and the proposed DSM-5 criteria

With publication of the DSM-5 slated for May 2013, it has been predicted that the new diagnostic criteria will cause a decrease in the prevalence of autism spectrum disorders (ASDs), seriously impacting children no longer meeting criteria for the disorder. A majority of individuals with ASD have behavior problems which are not considered core features of the disorder but are significantly impairing and often the focus of intervention. The aim of the current study was to investigate types of challenging behaviors in toddlers who may no longer meet diagnostic criteria for ASD using a psychometrically sound measure, the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT) – Part 3. The study included 3339 toddlers, 501 who will retain ASD diagnosis according to the DSM-5; 439 who will no longer meet criteria, and a comparison group of 2399 toddlers referred for evaluation due to atypical development. Though toddlers diagnosed under the DSM-5 exhibited the most challenging behaviors, those who did not meet DSM-5 criteria exhibited significantly more challenging behaviors than the atypically developing toddlers. The effect of the changes in ASD diagnostic criteria on access to early behavioral interventions warrants careful consideration as the new DSM-5 criteria are adopted.     

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.     

The gender of participants in published research involving people with autism spectrum disorders

Research articles involving participants with an autism spectrum disorder and published from 2010 through 2012 in Autism, Journal of Autism and Developmental Disorders, Journal of Child Psychology and Child Psychiatry, and Research in Autism Spectrum Disorders were examined to determine the reported gender of participants. The overall male:female ratio was 4.62, which is similar to that reported in epidemiological studies, but the ratio was 6.07 in intervention studies. These findings suggesting that males were in a statistical sense over-represented in intervention studies, but not in other kinds of research. Most (82.21%) of these studies included both male and female participants, but direct comparisons of males and females with an autism spectrum disorder are scarce. Few of the articles we examined, 0.49% of the total, involved only female participants. Roughly half of the articles included comparison groups without an autism spectrum disorder. The percentage of male participants in these comparison groups was substantially and significantly lower than the percentage of males in groups with an autism spectrum disorder, which may in some cases constitute a methodological confound. We encourage researchers to carefully consider the gender of participants as both an extraneous variable and as an independent variable in future investigations.     

The relationship between symptoms of autism spectrum disorders and psychotropic medication use in infants and toddlers

Little research has been conducted to date on the relationship between psychotropic medication use and autism spectrum disorders (ASDs). Participants in the current study were placed into one of four groups: ASD on psychotropic medications (N = 33), ASD off psychotropic medications (N = 45), atypically developing on psychotropic medications (N = 30) and atypically developing off psychotropic medications (N = 45). Severity of autistic symptoms were compared between the groups based on total scores on the Baby and Infant Screen for Children with aUtIsm Traits, Part 1(BISCUIT Part-1). Toddlers with ASD on psychotropic medications had significantly higher ratings than any other group. No such relationship was found within the atypically developing group. The results suggest a relationship between psychotropic medication use and severity of autistic symptoms in infants and toddlers. Implications of these results are discussed.     

Cognitive flexibility impairments in children with autism spectrum disorders: Links to age,gender and child outcomes

There are still many questions about the cognitive flexibility in autism spectrum disorder (ASD) that remain unanswered. The goal of current study was to evaluate cognitive flexibility patterns and their demographic, clinical and behavioral correlates in large sample of children with ASD. A total of 123 children (94 boys and 29 girls) with ASD aged 7–14 years were assessed on the Wisconsin card sorting test (WCST). Findings showed that gender but not age was associated with the cognitive flexibility performance in ASD. Individuals who had more parent-reported language deficits, lower level of intelligence and education, and showed lower daily sleep time or more engagement in solitary instead of social daily activities were more likely to demonstrate perseveration. Findings provide tentative evidence of a link between cognitive flexibility deficits and sociodemographic or clinical child outcomes in ASD.     

Characterizing difficulties with emotion regulation in toddlers with autism spectrum disorder

BackgroundDifficulties with emotion regulation (ER) underlie emotional/behavioral challenges and co-occurring psychiatric symptoms in autism spectrum disorder (ASD), yet very little is known about the early development of emotion dysregulation. The present study aimed to identify differences in positive and negative emotional reactivity and regulation strategies in toddlers with and without ASD.MethodNine tasks from the Laboratory Temperament Assessment Battery (Lab-TAB) were completed with 37 toddlers with and without ASD (22–28 months). Video-recordings of these tasks were coded by research assistants using a behavioral coding scheme tapping facial, bodily, and vocal affect and the frequency of ER strategies. Mixed model analyses were performed to examine the mean affect and total regulation strategies across each task and t-tests were conducted to assess the types of ER strategies utilized.ResultsToddlers with ASD showed significantly less positive affect and greater frustration compared to non-ASD toddlers; reactivity was comparable between the groups for fear. Both groups used ER strategies in a similar pattern across tasks, with the exception that toddlers with ASD more often engaged in distraction to regulate. Effects of age and developmental level are discussed.ConclusionsToddlers with ASD were robustly characterized by greater frustration and lower joy despite frequent and age appropriate attempts to regulate their emotions. This study provides preliminary evidence that observable indicators of emotion dysregulation are present by two years of age. Clinical implications and future research directions are discussed.     

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.     

Feeding and sleep difficulties in toddlers with autism spectrum disorders

Children with autism spectrum disorders (ASD) present with a variety of comorbid difficulties, some of which relate to seemingly simply activities of daily living. Feeding and sleep difficulties are purportedly common within the ASD population, although the association between these problems and ASD symptomatology has rarely been addressed. The current study examined the feeding and sleep difficulties of 1747 toddlers who had a diagnosis of Autistic Disorder (n = 506), PDD-NOS (n = 522), or atypical development (n = 719) using the Baby and Infant Screen for Children with aUtIsm Traits-Part 2, a screening tool designed to identify comorbid difficulties of toddlers with ASD and/or atypical development. Individuals with Autistic Disorder were found to exhibit significantly more feeding and sleep difficulties than those with PDD-NOS, who in turn presented with more difficulties of this type than those with atypical development. While developmental quotient (DQ) was also related to feeding and sleep difficulties, DQ could not account for the differences between these groups.     

The relationship between race and comorbid symptoms in infants and toddlers with autism spectrum disorder

Researchers have indicated that persons with autism spectrum disorder (ASD) population evince higher rates of comorbid symptoms. While the relationship between comorbid symptoms and factors such as autism symptom severity, IQ level, age, communication abilities, and degree of social impairment were previously examined, there has been limited research on the effect of race in this area. The current study examined the potential role of race in comorbid symptoms in toddlers with ASD and atypically developing toddlers without a diagnosis of ASD using The Baby and Infant Screen for Children with aUtIsm Traits – Part 2 (BISCUIT-Part 2). Based on the current findings, African-American toddlers evinced higher rates of comorbid symptoms than Caucasian toddlers and toddlers of other races. In addition, toddlers with ASD evinced higher rates of comorbid symptoms than atypically developing toddlers without a diagnosis of ASD. Implications regarding these findings are discussed.     

The relationship between sleep and behavior in autism spectrum disorder (ASD): a review

Although there is evidence that significant sleep problems are common in children with autism spectrum disorder (ASD) and that poor sleep exacerbates problematic daytime behavior, such relationships have received very little attention in both research and clinical practice. Treatment guidelines to help manage challenging behaviors in ASD fail to mention sleep at all, or they present a very limited account. Moreover, limited attention is given to children with low-functioning autism, those individuals who often experience the most severe sleep disruption and behavioral problems. This paper describes the nature of sleep difficulties in ASD and highlights the complexities of sleep disruption in individuals with low-functioning autism. It is proposed that profiling ASD children based on the nature of their sleep disruption might help to understand symptom and behavioral profiles (or vice versa) and therefore lead to better-targeted interventions. This paper concludes with a discussion of the limitations of current knowledge and proposes areas that are important for future research. Treating disordered sleep in ASD has great potential to improve daytime behavior and family functioning in this vulnerable population.