Caregiver Mental Health,Parenting Practices,and Perceptions of Child Attachment in Children with Autism Spectrum Disorder

This paper investigates the role of caregiver mental health and parenting practices as predictors of attachment in children with intellectual disability/developmental delay, comparing between children with ASD (n?=?29) and children with other developmental disabilities (n?=?20). Parents reported that children with ASD had high levels of anxiety and stress, and attachment insecurity in children (less closeness and more conflict in attachment relationships, and more inhibited attachment behaviours) compared with children with other developmental disabilities. Children’s attachment quality was associated with parenting practices and the presence of an ASD diagnosis. These results highlight the bidirectional nature of the quality of caregiving environments and attachment in children with ASD, and also provide a strong rationale for targeting children’s attachment quality in early interventions.     

Empathic Responding in Toddlers at Risk for an Autism Spectrum Disorder

Empathy deficits represent an important social impairment in autism spectrum disorders (ASD), but little is known about the early development of empathy prior to diagnosis. This study examined empathic responding to parental distress in toddlers at risk for an ASD. Children later diagnosed with an ASD engaged in less empathic responding at 24 and 30 months than children with no later diagnosis. Lower empathic responding was associated with higher autism symptomatology at 30 months. This is the first study to examine empathy deficits in response to parental distress in toddlers prior to ASD diagnosis. Early empathic responding may represent a unique developing social skill that indexes the overall severity of later ASD symptomatology in at-risk children.     

Brief Report: Sex Differences in Parental Concerns for Toddlers with Autism Risk

Research on sex differences in autism spectrum disorder (ASD) suggests both higher prevalence and a more easily observable presentation of core ASD symptomology in males, which may lead to sex differences in parental concerns. The current study examined whether sex and diagnosis relate to the timing, number, and types of pre-diagnosis concerns for 669 (N_male = 468) toddlers who screened at risk for ASD. No sex differences in parents’ concerns emerged for toddlers diagnosed with ASD; however, in the overall at-risk sample, parents of boys endorsed ASD symptoms, including restricted and repetitive behaviors, more than parents of girls. Future research should examine why sex differences in pre-diagnosis concerns emerge and how they might impact early diagnosis for at-risk boys versus girls.     

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

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

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

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

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

Sleep Disturbances in Adults with Autism Spectrum Disorders and Severe Intellectual Impairments

Sleep disturbances are a significant problem for persons with developmental disabilities. These problems occur at a higher rate than what is observed in the typically developing population, and persons with Autism Spectrum Disorders (ASD) appear to be at a higher risk than individuals with other developmental disabilities. However, another major risk is intellectual disability (ID). These two groups of disorders overlap to a substantial degree. Thus, persons with ASD and ID appear to be particularly susceptible to sleep disturbances. These sleep problems can have serious consequences beyond sleep, particularly with respect to increased challenging behaviors and as an impediment to learning. Despite these concerns, adults with ASD and ID have been largely neglected with respect to the study of these nocturnal difficulties. In this report, 168 adults with ASD and ID were compared to 166 adults with ID alone in regard to sleep disturbance and related difficulties. Individuals in the ASD group presented with much higher rates of sleep disturbances, and greater severity of sleep disorder was related to the expression of more serious challenging behaviors. The implications of our results are discussed for future assessment and treatment of these disorders.     

Addressing parental concerns at the initial diagnosis of an autism spectrum disorder

The core deficits in autism spectrum disorders (ASDs) include socialization, communication, and the presence of repetitive, stereotypical interests and behaviors. In addition to these core problems the autism spectrum includes a variety of possible developmental delays, intellectual disabilities, medical issues, and co-morbid psychiatric disorders. As each child may present with a unique set of difficulties, it may be difficult for clinicians to adequately address each families concerns at the time of diagnosis. The object of this study was to assess what problems were of foremost important to parents at the time of their child's ASD diagnosis and to determine how well they felt those concerns were addressed during the diagnostic process. Four-hundred and thirty-eight parents of children with an ASD completed web-based surveys collecting demographic information and assessing areas of concern and how well those concerns were addressed at diagnosis. At the time of diagnosis, core deficits were of most important to respondents but were considered well addressed only about half of the time. Also important was discussing information about treatments options with the diagnosing clinician. Clinicians could better address the core deficits in autism and their treatment options at the time they make an ASD diagnosis.     

Parents’ developmental concerns and age variance at diagnosis of children with autism spectrum disorder

Although early recognition of autism spectrum disorder (ASD) is important, the age of children at diagnosis is variable. Forty-five participants diagnosed with ASD were divided into groups based on age at diagnosis and compared on age when parents first became concerned about various aspects of their development. Results demonstrated no differences between the two groups with regard to most factors except Early Intervention referral. While concerns about atypical behavior and attainment of milestones were similar between the groups, parents in the early diagnosis group noted social development concerns at an earlier age (mean 18.0 vs. 25.3 months), suggesting close surveillance of this particular developmental domain may facilitate earlier ASD referral and diagnosis.     

The early development of stereotypy and self-injury: a review of research methods

Background The origin and developmental course of stereotypic and self-injurious behaviour among individuals with developmental disabilities such as intellectual disability (ID) or pervasive development disorders such as autism is not well understood. Method Twelve studies designed to document the prevalence, nature, or development of stereotypic and/or self-injurious behaviour in children under 5 years of age and identified as at risk for developmental delay or disability were reviewed. Comparisons were made with similar studies with typically developing children. Results It appears that the onset of naturally occurring rhythmic motor stereotypies is delayed in young at-risk children, but that the sequencing may be similar. A very small database, differences in samples, measures, and designs limited the degree to which comparisons could be made across studies. Conclusion Future work is needed based on appropriately designed prospective comparison studies and uniform quantitative measures to provide an empirical basis for new knowledge about the early development of one of the most serious behaviour disorders afflicting children with ID and related problems of development.     

Predictors of Developmental Outcome in 4- to 6-Year-Olds With Developmental Disability

Objective Studies on the early trajectories of developmental disability (DD) are limited. This study aimed to evaluate the diagnostic stability and developmental trajectories of autism spectrum disorder (ASD) and intellectual disability (ID), and to determine baseline clinical characteristics that affect future diagnosis. Methods We analyzed 192 children who were referred for possible DD through retrospective chart review. Clinical diagnosis was assessed once at baseline, aged 2–4, and at follow-up, aged 4–6. The participants’ developmental profiles were measured by Psychoeducational Profile-Revised (PEP-R), Vineland Social Maturity Scale (VSMS), Beery-Buktenica Developmental Test of Visual Motor Integration (VMI), and Childhood Autism Rating Scale (CARS). Results On comparing the diagnostic change, 5% of children were no longer diagnosed as ASD, and 13% of children were no longer diagnosed as ID at follow-up. Trajectories of developmental profiles were compared between children with and without ID at follow-up, and significant time-by-group interaction were observed in PEP-R (p<0.001), VSMS (p<0.001), and VMI (p=0.003) scores, indicating that children without ID at follow-up showed significant improvement over time compared to children with ID. ASD diagnosis (p<0.001) and CARS score (p=0.007) at baseline were significantly associated with ASD at follow-up, while VSMS score (p=0.004) and VMI score (p=0.019) at baseline were significantly associated with ID at follow-up. Conclusion A subset of children lost their diagnosis at follow-up, and such diagnostic change was significantly more common in ID compared to ASD. Baseline autism symptomatology was related to ASD at follow-up, and baseline adaptive and visuo-motor function was related to ID at follow-up.     

ADHD symptom prevalence and risk factors in a sample of toddlers with ASD or who are at risk for developmental delay

Individuals with attention deficit/hyperactivity disorder (ADHD) experience difficulties with inattention, hyperactivity, and impulsivity which significantly interfere with their daily functioning. Symptoms of the disorder occur in children, but the developmental trajectory of ADHD symptoms is not known. The present study examines the prevalence of ADHD symptomology in a sample of 2956 children who were determined to be at risk for developmental delay. Prevalence rates for ADHD in the overall sample was 4.50%, and prevalence rates by gender, race, and presence of autism spectrum disorder (ASD) were comparable. The prevalence was not significantly different in children with an ASD diagnosis. No significant effects of gender or ASD diagnosis were observed. ADHD should be considered as a diagnosis among young children who present to clinics for children at risk for developmental delay, and future researchers should further study its developmental trajectory, beginning at an early age.     

Parent-infant interaction in infant siblings at risk of autism

Recent models of the early emergence of autism spectrum disorder (ASD) propose an interaction between risk susceptibility and the infant's social environment, resulting in a progressively atypical developmental trajectory. The infant's early social environmental experience consists mostly of interaction with caregivers, yet there has been little systematic study of early parent-infant interaction in infants at risk of ASD. This study examined the global characteristics of parent-infant interaction in 6- to 10-month-old infants with an older sibling diagnosed with ASD (at-risk sibs), in comparison with a group of infants with no family history of ASD (low-risk sibs). As part of the British Autism Study of Infant Siblings (BASIS), 6-min videotaped unstructured play interactions of mother-infant dyads (45 at-risk sibs and 47 low-risk sibs) were rated on global aspects of parent-infant interaction, blind to participant information. Differences in global characteristics of interaction were observed in both infant and parent contributions in the at-risk group compared to low-risk controls. In analyses adjusted for age and developmental level, at-risk sib infants were less lively, and their parents showed higher directiveness, and lower sensitive responding (as a trend after adjustment). Level of infant liveliness was independent of other interactive behaviour. Consistent with reports in previous literature in older children with autism and in other neurodevelopmental disorders, our findings may suggest that infants at genetic risk are exposed to a more directive interactive style relatively early in infancy. We discuss possible explanations for these findings and implications for further developmental study and intervention.     

Practitioner’s Guide to Assessment of Autism Spectrum Disorders in Infants and Toddlers

Recent advances in clinical research have made it possible to diagnosis autism spectrum disorders (ASD) as early as the second year of life. The diagnostic process early in development is often complex, and thus, familiarity with the most recent findings in clinical assessment instruments, early symptoms, and developmental trajectories of young children with autism is essential. This paper provides an empirically based practitioner's guide to issues and concerns related to early diagnosis of ASD in very young children, documentation of the course and patterns of ASD symptomatology in infants and toddlers, and current understanding in the field of diagnostic outcomes of children identified in the first and second year of life.     

Neurodevelopmental correlates of behavioural and emotional problems in a neuropaediatric sample

Most research does not address the overlap between neurodevelopmental disorders when investigating concomitant mental health problems. The purpose of the present study was to examine the association of intellectual disability (ID), autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD) with the presence of behavioural and emotional problems after controlling for other well-known correlates and risk factors. The sample included 4- to 18-year-old children who attended neuropaediatric clinics (N = 331). After controlling for adversity, age, gender, other developmental/neurological disorders, parental emotional problems, and parenting strategies, the presence of ADHD but not ASD or ID was uniquely associated with behaviour problems. Neither ADHD nor ASD nor ID was significantly associated with emotional problems after controlling for other risk factors. However, ADHD, ASD and behavioural/emotional disorders but not ID were significantly associated with functional impairment in everyday activities after controlling for other risk factors. Because children with neurodevelopmental disorders have complex needs, a holistic approach to diagnosis and interventions is highly warranted, including the assessment and treatment of behavioural and emotional disorders.     

The relationship between parental concerns and final diagnosis in children with developmental delay

Parental concern is a useful screening approach for early detection of children with developmental delay. We investigated the relationships among parental concerns, functional impairment, and final diagnosis of children (n = 273) with developmental delays. Of these, motor, language, and global delay were most common. Parental concerns, especially in language and motor development, were good predictors of children with language or motor delay, and provided reliable information for detection of children with delays in these domains. Parents were less likely to identify children with cognitive problems, global delay, or associated behavioral problems. Co-occurrence of developmental disorders was also recognized, especially in children with global delay. We conclude that parental concerns are useful information for detection of specific developmental problems in children. Because co-occurrence of developmental disorders is common, their early recognition would be helpful for better care of these children.     

Characteristics of adults with autism spectrum disorder who use residential services and supports through adult developmental disability services in the United States

BackgroundMany children and adults with Autism Spectrum Disorder (ASD) need services and support across their lifespans. Currently many residential and community living supports are delivered through state intellectual and developmental disabilities (IDD) service systems.MethodA random sample of 11,947 individual users of adult IDD services from 25 states that included 1,459 individuals with an autism diagnosis was analyzed for this study looking at demographic characteristics and living arrangements. Comparisons were made between adults with and without ASD who receive services through the IDD service system.ResultsOverall, individuals with an ASD diagnosis were younger on average, had a higher percentage of males, and had higher percentages of the No Intellectual Disabilities (ID) and Severe ID categories compared to individuals without an ASD diagnosis. There was a significant association between the type of living arrangement and ASD status with a higher percentage of participants with ASD living in a family member’s home, but a lower percentage of people with ASD living in agency apartments, in their own home or an “other” living arrangement. However, with age, gender, and level of ID and challenging behavior taken into account, people with ASD had 29% higher odds of living in a family member’s home but 42% lower odds of living in their own home when compared to people with other developmental disabilities who received residential services through state IDD service systems.ConclusionsThere are key differences in access and utilization of residential services between people with ASD and people without ASD. While state developmental disabilities systems are serving individuals with ASD there are potential influences of state policies regarding ASD eligibility for various residential services. Implications for future research are discussed.     

A review of behavioral interventions for the treatment of aggression in individuals with developmental disabilities

Aggression can present as a significant problem behavior in individuals with a diagnosis of developmental disability. Much research has focused on the prevalence of aggression in individuals with varying degrees of severity of intellectual disability (AD), autism spectrum disorders (ASD) and co-morbidity of ID and ASD. Research has also focused on the impact of aggressive behavior on individuals’ development including cognitive, adaptive and social functioning. The literature on Applied Behavior Analysis provides abundant examples of various interventions that are effective in reducing or eliminating aggressive behavior across a range of ages and degrees of developmental disabilities. Many interventions report success using antecedent alterations, reinforcement-based strategies and consequence manipulations. The current review provides a focused, comprehensive examination of aggressive behavior intervention research for individuals with developmental disabilities aged 3-18 years published between 1980 and 2009.     

Prevalence and characteristics of autistic spectrum disorders in the ALSPAC cohort

The aim of this study was to determine the prevalence of autistic spectrum disorder (ASD) within a large representative population sample: the Avon Longitudinal Study of Parents and Children (ALSPAC). Cases of ASD were identified from the clinical notes of children in the ALSPAC with a suspected developmental disorder and from the Pupil Level Annual Schools Census (PLASC) for England in 2003. Seventy-one cases of ASD diagnosed after a multidisciplinary assessment were identified from health records. There were an additional 15 cases from PLASC data in which ASD was mentioned as a principal difficulty, thus giving a total of 86 children diagnosed by the age of 11 years. Prevalence of ASD per 10,000 population at 11 years was 51.1 for those with a multi-professional diagnosis, and 61.9 if cases from education were included, made up of 21.6 for childhood autism, 10.8 for atypical autism, 16.6 for Asperger syndrome, and 13.0 for unspecified ASD. The male:female ratio was 6.8:1. Median age at diagnosis ranged from 45 months in childhood autism to 116 months in Asperger syndrome. A comorbid developmental disorder was recorded in 33.8% of cases, including learning disability in 14.7%, epilepsy in 10.3%, and mixed developmental disorder in 4.4%. We conclude that the prevalence of ASD diagnosed at 11 years in a UK representative population-based sample is at least 51.1/10,000.     

Parental wellbeing of Iranian families with children who have developmental disabilities

To date, most research with families who have a child with developmental disabilities has been undertaken in English speaking countries. Poorer health, allied with increased levels of stress has been commonly reported for mothers but less is known about the impact on fathers and on overall family functioning. This study aimed to document the correlates of these parental impacts with Iranian mothers and fathers who had children with either intellectual disabilities (ID) or with autism spectrum disorders (ASD). In all 121 parents (69 mothers and 52 fathers from 94 families) who had a child with a diagnosis of ADS, along with 115 parents of children with ID (83 mothers and 32 fathers from 101 families) volunteered to take part in the study. Each participant completed through interview standardised rating scales of parenting stress, emotional well-being, family functioning and satisfaction with caring role along with demographic information and details of informal supports. Structural Equation Modeling identified that family functioning was much poorer in families whose child had ASD and both mothers and fathers reported higher levels of stress. Poorer emotional well-being contributed to higher stress and was more frequent among mothers, single parents and those whose children had behaviour problems. Having other dependents living at home and more sources of informal support improved the emotional wellbeing of parents but not their stress or family functioning. Parents who derived greater satisfaction from their caring role tended to have better emotional health and less stress. Although the impact on Iranian parents of having a child with developmental disabilities is broadly similar to those of parents in other cultures, there are indications that children with ASD present distinct challenges to these families. The model derived in this study is a useful guide both for further research as well as family-centred interventions.     

Early non-social behavioural indicators of autism spectrum disorder (ASD) in siblings at elevated likelihood for ASD: a systematic review

We aimed at identifying early non-social behavioural indicators that predict later ASD. Likewise, we were interested in the moment in which non-social signs discriminate between children at elevated likelihood for ASD with a later diagnosis of ASD, and children at elevated likelihood for ASD with a typical developmental outcome. In addition, we intended to explore the developmental evolution of children’s symptomatology over time. A systematic literature search was conducted for longitudinal studies on early non-social behavioural indicators among siblings at elevated likelihood for ASD. The following databases were searched: PUBMED, Web of Science, PsycINFO, CINAHL and EMBASE. The study identification process was conducted by two reviewers independently. Compared to siblings at elevated likelihood for ASD with a typical developmental outcome, siblings at elevated likelihood for ASD with later ASD show impairments in attention disengagement, in gross and fine motor development and characteristic restricted and repetitive interests and behaviours, starting at 12 months of age. Moreover, early attention disengagement exerts a predictive role towards a later ASD diagnosis, given that from 12 months siblings at elevated likelihood for ASD who will receive an independent ASD diagnosis towards 24–36 months present marked difficulties in disengaging in comparison with siblings at elevated likelihood for ASD that will not satisfy the criteria for an ASD diagnosis. The findings call for a more comprehensive vision on early indicators of ASD. Further research is needed to extend results to other behavioural domains.