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.     

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.     

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.     

12-Month peak alpha frequency is a correlate but not a longitudinal predictor of non-verbal cognitive abilities in infants at low and high risk for autism spectrum disorder

Although studies of PAF in individuals with autism spectrum disorder (ASD) report group differences and associations with non-verbal cognitive ability, it is not known how PAF relates to familial risk for ASD, and whether similar associations with cognition in are present in infancy. Using a large multi-site prospective longitudinal dataset of infants with low and high familial risk for ASD, metrics of PAF at 12 months were extracted and growth curves estimated for cognitive development between 12–36 months. Analyses tested whether PAF 1) differs between low and high risk infants, 2) is associated with concurrent non-verbal/verbal cognitive ability and 3) predicts developmental change in non-verbal/verbal ability. Moderation of associations between PAF and cognitive ability by familial risk status was also tested. No differences in 12-month PAF were found between low and high risk infants. PAF was associated with concurrent non-verbal cognitive ability, but did not predict change in non-verbal cognitive over development. No associations were found between PAF and verbal ability, along with no evidence of moderation. PAF is not related to familial risk for ASD, and is a neural marker of concurrent non-verbal cognitive ability, but not verbal ability, in young infants at low and high risk for ASD     

Factors associated with negative co-parenting experiences in families of a child with autism spectrum disorder

Purpose: The purpose of this study was to identify key factors associated with negative co-parenting experiences in parents raising a child with autism spectrum disorder. Methods: Questionnaires were sent to families with one or more children with a diagnosis of autism spectrum disorder. Parents of 142 children with autism spectrum disorder indicated that the diagnosis had a very negative impact on their co-parent relationship. A multivariate logistic regression model was run to analyze the association of these experiences with various demographic, family and community factors. Results: Three factors were associated with negative co-parenting relationships: (1) family stress due to the child’s diagnosis, (2) effects of the diagnosis on parents’ relationship with their other children and (3) distance travelled to the nearest medical facility. Conclusions: Findings highlight the need to further explore family dynamics, particularly the relationships between the co-parenting alliance, other family members and the extra-familial environment.     

The relationship of parental first concerns and autism spectrum disorder in an early intervention sample

Experts in the treatment of children with developmental disabilities emphasize the need to identify at-risk children at an early age. The ability to distinguish children at risk for particular developmental disabilities, such as autism (ASD), can help to target treatment to mitigate core symptoms and the deleterious effects of early delay on developmental trajectory. The present study investigates the relationship between parental first concerns (FC) (communication, social/emotional, cognitive/adaptive/global, behavior problems, motor, hyperactivity, and medical/other concerns) on ASD diagnosis in a sample of 2905 toddlers who presented for early intervention assessment in the state of Louisiana. We also examine whether developmental quotient (DQ) contributes to a diagnosis of ASD. Individuals deemed at-risk for a developmental disability represent a heterogeneous population, and this investigation aims to provide direction for identifying children likely to be diagnosed with an ASD according to parental perceptions of disability. Findings illustrating the differences in ASD diagnosis within each FC category are discussed.     

Impaired disengagement of attention and its relationship to emotional distress in infants at high-risk for autism spectrum disorder

Introduction: We provide data on visual orienting and emotional distress in infants at high and low risk for autism spectrum disorder (ASD). Method: Participants included 83 high-risk (HR) infants with an older sibling with ASD and 53 low-risk (LR) control infants with no family history of ASD. Infants were assessed on the gap-overlap task and a parent-completed temperament questionnaire at 6 and 12 months of age. At 36 months of age, an independent, gold standard diagnostic assessment for ASD was conducted. Results: HR infants subsequently diagnosed with ASD were distinguished at 12 months by an asymmetric disengage impairment (for left- vs. right-sided stimuli) that was associated with an increase in latencies between 6 and 12 months. Across groups, prolonged left-directed disengage latencies at 12 months were associated with emotional distress (high irritability and difficult to soothe). Conclusions: The asymmetry in our findings raises the question of whether the disengage problem in ASD is at base one of orienting or alerting attention. Our findings also raise the question of whether attention training might be a critical ingredient in the early treatment of ASD.     

Atypical attention to voice in toddlers and pre-schoolers with autism spectrum disorder is related to unimpaired cognitive abilities. An ERP study

BackgroundSound perception in autism spectrum disorder (ASD) is usually at typical levels, even when auditory stimuli carry a social value, as it is the case for speech. Nevertheless, orienting to sounds in a speech context might be atypical in some individuals with ASD, which in ERP studies is reflected by a diminished P3a component. As P3 values and cognitive abilities seem to be inversely related under some circumstances, the current study investigates whether diminished attentional orienting to sounds in speech is equally observable in children with ASD with and without developmental delay (DD).MethodChildren with typical development (TD, n = 17) or ASD, with or without comorbid DD (ASD/DD, n = 22, and ASD/noDD, n = 12), aged 1.5 through 4 years took part in a passive auditory oddball task while EEG data were recorded. The paradigm consisted in the presentation of two deviant stimuli (one vowel sound and one complex tone) either in a speech or in a non-speech context.ResultsWe found overall more negative MMN voltages in both ASD groups compared to TD. For P3a mean voltages, we found an attenuated response in children ASD/noDD when deviant tones were presented in speech, but not in other conditions. Children with ASD/DD did not differ from TD in P3a mean voltages.ConclusionAtypical speech sound processing might be more accentuated in children with ASD/noDD than in their peers with comorbid DD. This finding is interpreted within the theoretical framework of neural adaptation.     

Developmental pathways to autism: A review of prospective studies of infants at risk

Autism Spectrum Disorders (ASDs) are neurodevelopmental disorders characterized by impairments in social interaction and communication, and the presence of restrictive and repetitive behaviors. Symptoms of ASD likely emerge from a complex interaction between pre-existing neurodevelopmental vulnerabilities and the child's environment, modified by compensatory skills and protective factors. Prospective studies of infants at high familial risk for ASD (who have an older sibling with a diagnosis) are beginning to characterize these developmental pathways to the emergence of clinical symptoms. Here, we review the range of behavioral and neurocognitive markers for later ASD that have been identified in high-risk infants in the first years of life. We discuss theoretical implications of emerging patterns, and identify key directions for future work, including potential resolutions to several methodological challenges for the field. Mapping how ASD unfolds from birth is critical to our understanding of the developmental mechanisms underlying this disorder. A more nuanced understanding of developmental pathways to ASD will help us not only to identify children who need early intervention, but also to improve the range of interventions available to them.     

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.     

Efficacy of cognitive behavior therapy-based social skills intervention for school-aged boys with autism spectrum disorders

School-aged children with Autism Spectrum Disorders (ASD) experience significant difficulty with peer interaction. Research to identify the most effective strategies to address this difficulty has increased but more evidence is needed. Cognitive behavior therapy (CBT), which focuses on changing how a person thinks about social situations as well as how he behaves, is a promising approach. This study evaluated the efficacy of a 15 week CBT-based social skills intervention for boys aged 10–12 years diagnosed with an ASD. Boys with average or better IQ and receptive language skills were randomly assigned to either a control (n = 8) or intervention condition (n = 7). During intervention, boys attended weekly 2 h long group sessions focusing on self-monitoring skills, social perception and affective knowledge, conversation skills, social problem-solving, and friendship management skills. Comparison of the outcomes using repeated measures analyses indicated that boys receiving the intervention scored significantly better on measures of social perception, peer interaction, and social knowledge than boys who had not received intervention. There were no differences on general measures of socialization. The manualized intervention used in this study shows promise but replication with larger samples is needed.     

Adaptive behavior profiles in young children with autism spectrum disorder diagnosed under DSM-5 criteria

BackgroundThis study explored adaptive behavior profiles in a clinical sample of well-characterized children aged one to three years with ASD.MethodProfiles were compared to a sample of children with non-ASD developmental delays. Cluster analyses were performed to determine whether differences in adaptive skills effectively distinguished children with ASD from other young children presenting for assessment due to behavioral or other concerns, but who received other non-ASD diagnoses.ResultsA profile of motor > daily living > socialization > communication skills was found in both children with ASD and children with non-spectrum diagnoses, showing that this profile is not unique to young children with ASD. A two-group cluster solution was found which differentiated children by developmental functioning level rather than by diagnosis.DiscussionThe results of this study provide support for two developmental profiles for adaptive functioning in children with ASD: an average to borderline delayed profile and a borderline to more severely delayed profile that may remain stable or worsen over time. They additionally highlight the importance of delivering early targeted interventions to children with ASD who have greater deficits in adaptive functioning due to their association with poorer long-term outcomes.     

Causal attribution in individuals with subclinical and clinical autism spectrum disorder: An fMRI study

This neuroimaging study compares brain activation during causal attribution to three different attribution loci (i.e., self, another person, and situation) across a typical population without (N = 20) or with subclinical autism spectrum symptoms (N = 18) and a clinical population with autism spectrum disorder (ASD; N = 11). While they underwent fMRI, all participants read short sentences describing positive and negative behaviors and thoughts of another person directed toward the participant (i.e., “you”). Participants were then asked to attribute these behaviors to themselves, the other person, or the situation. Behavioral measures revealed self-serving attributions (i.e., attributing positive events to the self, while attributing negative events externally from the self) in all three participant groups. Neural measures revealed a great deal of shared activation across the three attribution loci and across the three participant groups in the temporo-parietal junction, the posterior superior sulcus, and the precuneus. Comparison between groups revealed more widespread activation in both subclinical and clinical ASD participants, which may be indicative of the extraneural resources these participants invest to compensate their impairments.     

Investigation of VDR gene polymorphisms in twins with autism spectrum disorder

BackgroundTwin studies to clarify the etiology of autism, copy number variations (CNV), and genome-wide association studies (GWAS) have provided strong evidence that genetic factors play an important role in the etiology of Autism spectrum disorder (ASD). The purpose of this study is to determine the relationship between Vitamin D Receptor (VDR) gene polymorphisms and disease development in ASD twins.MethodThe study included 32 pairs of dizygotic twins (64 patients) with ASD and 100 healthy subjects as the control group. Genomic DNA was isolated from blood samples. It is performed by PCR designed with region-specific primers. After the PCR procedure, RFLP was performed with appropriate enzymes to determine genotypes. The results were statistically evaluated by Chi Square Test and Haplotype analysis.ResultsWhen the results of our study were examined, the frequency of the variant CC genotype of FokI (rs2228570 T/C), the frequency of the variant TT genotype of ApaI (rs7975253 G/T) and the frequency of the variant TT genotype of TaqI(rs731236 T/C) were significantly higher than the control group (p:0,019, p:0,039, p:0,037).ConclusionsIn this study, single nucleotide changes in three different variants of the VDR gene were investigated in dizygotic twins cases with ASD in Turkey. Genotypically, it was found that patients showed statistically significant difference in all three regions compared to controls. In terms of allele frequencies of SNPs, it was observed that ApaI and TaqI allele frequencies were statistically significantly different between dizygotic patients with ASD and healthy controls.     

Assessment of feeding problems in children with autism spectrum disorder

There is growing, but inconsistent, literature on feeding problems for children with Autism Spectrum Disorder. The purposes of this study were to (a) investigate the relation of feeding problems to autism severity, (b) assess the validity of parent-report questionnaires widely used to assess feeding problems in terms of their relation to systematic behavior observations, and (c) determine the relation between child feeding behavior and family mealtime environment. Thirty-eight children and their parents participated in the study. Parents completed questionnaires, and both parents and children participated in mealtime observations. Results indicated that autism severity predicted scores on a measure of feeding problems as well as the duration of negative vocalizations during meal observations. Food Frequency Questionnaires better predicted behavior during meals than the Brief Mealtime Autism Behavior Inventory. Family environment alone did not explain feeding difficulties.     

Shuffling babies and autism spectrum disorder

Background and purposeBottom shuffling is a locomotion strategy that precedes independent walking in some infants. Shuffling babies are generally considered to have favorable outcomes. The aim of the present study was to reveal clinical features and neurodevelopmental outcomes of shuffling babies who visited a child developmental center.MethodsWe studied 48 shuffling babies who visited Toyota Municipal Child Development Center from April 2007 to March 2015. We excluded patients with cerebral palsy, Down syndrome, or congenital disorders. In 2018, we retrospectively reviewed the clinical charts of the enrolled children. We investigated family history, neurological findings, and the developmental outcome during the follow-up period.ResultsDuring the follow-up period, 20 children (42%) were diagnosed with ASD. Gross motor development in infancy was not different between infants with and without ASD. The rate of poor eye contact at the first visit and a delay in the first word speech were significantly higher in infants with ASD than in infants without ASD. A family history of bottom shuffling was significantly less frequent in infants with ASD (10%) than in those without (39%).ConclusionSome of bottom shufflers may represent ASD during follow-up. Paying attention to social and cognitive functions in shuffling babies is important.     

Emotion differentiation in autism spectrum disorder

Autism spectrum disorder (ASD) is commonly associated with reduced ability to recognize emotions in others. It is less clear however, whether ASD is also associated with impaired knowledge of one's own emotions. In the current study we present a first examination of how much knowledge individuals with ASD have about their emotions by investigating their ability to differentiate between emotions. Across two lab tasks that measured to what extent and how people differentiate between their own feeling states and semantic emotion terms, results showed that ASD individuals differentiated less than typically developing individuals. Yet, both groups of participants similarly categorized emotions according to previously established theoretical categories. These findings indicate that while both give similar meaning to emotions, individuals with ASD make less subtle distinctions between emotions. With low levels of emotion differentiation being linked to reduced well-being, these findings may help to better understand the high prevalence of internalizing problems associated with ASD.     

Children with autism spectrum disorder comorbid with attention-deficit/hyperactivity disorder examined by the Wisconsin card sorting test: Analysis by age-related differences

The DSM-5 confirmed that autism spectrum disorder (ASD) might be comorbid with attention-deficit/hyperactivity disorder (ADHD). This study investigated the executive function of ASD comorbid with ADHD (ASD + ADHD), ASD, and typically developed (TD) children using the Keio version of the modified Wisconsin card sorting test (KWCST). Children with ASD + ADHD (n = 43), ASD (n = 69), and TD (n = 69) were examined in two age groups: 5–9 years and 10–15 years. Both of the younger clinical groups showed significantly unfavorable scores for many indices in the second step compared to the TD group. As for the older groups, the ASD children showed significantly unfavorable scores in total errors in the second step, while the ASD + ADHD children did not show significant differences in either step. However, some index scores of the two older clinical groups were comparable to the older TD group in the second step. For the cognitive differences between clinical groups, the younger ASD + ADHD showed unfavorable scores in numbers of response cards until the first category achieved in the second step, while the older ASD showed unfavorable scores in categories achieved and perseverative errors of Nelson in the first step. For the degree of improvements in the second step, the older groups did not show significant group differences, while the younger ASD group showed significantly fewer improvements compared to the TD group. Based on these results, it is presumed that younger ASD + ADHD individuals are not sufficiently able to sustain attention and/or memory, and that the older ASD patients have difficulty in terms of flexibility.