The baby and infant screen for children with autism traits-part 2: The development of age-based cutoffs.

OBJECTIVE: To create age-based scoring procedures for the BISCUIT-Part 2, an assessment measure of comorbid psychopathology in infants and toddlers aged 17-37 months. METHOD: The standard deviation from the mean method was used to develop separate age-based cutoffs for those with an autism spectrum disorder (ASD) and those with non-ASD related developmental delays, using a sample of 2867 infants and toddlers and their parents. RESULTS: As age increased in those with ASD, higher cutoff scores were indicated. Less variation was seen in the cutoff scores established for those with non-ASD related delays. CONCLUSION: The findings suggest that as children with ASD grow older, symptoms of comorbidity become more prevalent and easier to detect. The implications of these results, as well as possible areas of future research, are discussed.

The relationship between Axis I psychopathology and quality of life in adults with mild to moderate intellectual disability.

Individuals with intellectual disability are at risk for impaired quality of life (QOL) compared to the general population. Little is known, however, about factors that may affect QOL in those with intellectual disability. The current study examined the role that Axis I psychopathology plays in the QOL of 138 adults with moderate to borderline intellectual disability. Scores on the Quality of Life Questionnaire (QOL-Q) were compared between those with a Psychotic Disorder, those with a Mood/Anxiety Disorder, and those with no Axis I diagnosis. Additionally, the effects of number of Axis I diagnoses was explored. Those with no Axis I diagnosis were found to have significantly higher QOL-Q scores than those in either diagnostic group. No significant differences were found between the two diagnostic groups. Additionally, those with no Axis I diagnosis were found to have significantly higher QOL-Q scores than those presenting with two or more Axis I diagnoses. The results and their implications are discussed.

DSM-IV vs DSM-5 diagnostic criteria for toddlers with autism.

PURPOSE: To evaluate prevalence rates of autism and autism symptomatology in toddlers using DSM-IV vs DSM-5 criteria. METHOD: Two thousand seven hundred and twenty-one toddlers at risk for a developmental disability participated. DSM-IV and DSM-5 criteria were applied and overall prevalence using each set of criteria was established. Groups were also compared on BISCUIT-Part 1 scores to determine if groups differed on autism symptomatology. RESULTS: DSM-5 resulted in 47.79% fewer toddlers being diagnosed with ASD compared to those on the DSM-IV. Toddlers diagnosed according to DSM-5 exhibited greater levels of autism symptomatology than those diagnosed with DSM-IV, but the latter group still exhibited significant levels of autism symptomatology. CONCLUSION: The proposed DSM-5 will result in far fewer persons being diagnosed with ASD. These results replicate findings from two previous studies, with older children/adolescents and adults. As a result of these new criteria, far fewer people will qualify for needed autism services.

The relationship between parents' first concerns and symptoms of autism spectrum disorders.

OBJECTIVE: To examine the relationship between parents' first concerns and early Autism Spectrum Disorder (ASD) symptoms. METHODS: Symptoms of ASD were compared in 1393 toddlers with and without a diagnosis of an ASD, based on the area of parents' first concerns. Communication and behaviour problems were examined in the current study, as they are the most frequently reported first concerns in the literature. A series of one-way, between-subjects ANOVAs were conducted on each sub-scale of the BISCUIT Part-1. RESULTS: Symptoms of Autism Spectrum Disorders (ASD) significant differences were found between most groups on all sub-scales. On the Socialization/Non-verbal Communication and Repetitive Behaviour/Restricted Interest sub-scales, those with ASD and behaviour concerns had the highest scores. On the Communication sub-scale, those with ASD and communication concerns had the highest scores. CONCLUSIONS: A significant relationship exists between early ASD symptoms and area of first concern. The implications of these results 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.

The effects of gender and age on repetitive and/or restricted behaviors and interests in adults with autism spectrum disorders and intellectual disability.

Frequency of repetitive and/or restricted behaviors and interests (RRBIs) was assessed in 140 adults with autism spectrum disorders (ASDs) and severe or profound intellectual disability (ID). The associations of gender and age range were analyzed with RRBI frequency which was obtained using the Stereotypies subscale of the Diagnostic Assessment for the Severely Handicapped-II (DASH-II). A significant main effect of gender was found. Male participants had higher frequency of RRBIs than females regardless of age range. There was not a significant main effect of age range or a significant interaction between gender and age range. Results and implications are discussed.

Developmental milestones in toddlers with atypical development.

The attainment of developmental milestones was examined and compared in 162 infants and toddlers with developmental disabilities, including Down Syndrome (n = 26), Cerebral Palsy (n = 19), Global Developmental Delay (n = 22), Premature birth (n = 66), and Seizure Disorder (n = 29). Toddlers in the Seizures Disorder group began crawling at a significantly younger age than toddlers in the Down Syndrome and Cerebral Palsy groups. Additionally, toddlers in the Seizure Disorder group began walking at a younger age than children in the Down Syndrome, Cerebral Palsy, and Global Developmental Delay groups, while toddlers in the Prematurity group began walking at a younger age than children in the Down Syndrome group. No between group differences were found with respect to age at which first words were spoken. Results and their implications are discussed.

The relationship between race and challenging behaviours in infants and toddlers with autistic disorder and pervasive developmental disorder-not otherwise specified.

OBJECTIVE: To examine the contributions of race and diagnostic category to endorsement rates of challenging behaviours in infants and toddlers with autism, PDD-NOS and atypical development without ASD, using the Baby and Infant Screen for Children with aUtIsm Traits, Part-3 (BISCUIT Part-3). DESIGN: Multivariate analyses of variance (MANOVAs) on each sub-scale of the BISCUIT Part-3. Follow-up univariate analyses and post-hoc tests as needed. METHODS: Scores on the BISCUIT Part-3 were compared for 453 Caucasian and 409 African-American infants and toddlers, grouped by race and diagnosis. RESULTS: Significant differences between races were found on five out of 10 aggressive behaviours, while no significant differences were found on self-injurious or stereotypic behaviours. Significant differences between diagnostic groups were found on all behaviours. CONCLUSION: Cultural factors should be taken into account when examining challenging behaviours in infants and toddlers with ASD.

The occurrence of challenging behaviours in children with autism spectrum disorders and atypical development.

OBJECTIVE: This study examines the occurrence of challenging behaviours in children with ASDs and atypical development. DESIGN: This study is a descriptive non-experimental design that inspects the frequencies of challenging behaviours among two diagnostic groups. This type of methodology is important since research in this area is still in the beginning stages of development. METHODS: The sample consisted of 2131 children, with 633 having an ASD and 1498 having atypical development. The Baby and Infant Screen for Children with aUtIsm Traits-Part 3 (BISCUIT-Part 3) assesses problematic behaviours within this population. The frequencies of challenging behaviours were examined along with an inspection of the co-occurring items. RESULTS: Greater percentages of problematic behaviours were found in the ASD group as compared to the group with atypical development. CONCLUSION: Challenging behaviours are variables affecting the behavioural presentation of those with ASDs and may be considered into the treatment plans for these children.

The relationship among side effects associated with anti-epileptic medications in those with intellectual disability.

Seizures are fairly common in those with intellectual disabilities. In order to treat these seizures, antiepileptic drugs (AEDs) are often used and in many cases are effective. However, these medications often create a variety of associated side effects. In order to monitor these side effects, measures such as the SEIZES-B have been used. While many side effects have been found to occur with the use of AEDs, research has not explored if certain side effects are more likely to co-occur. For the current study, 281 people with intellectual disability were administered the SEIZES-B to monitor side effects associated with AEDs. Correlations between side effect subscales were then computed. Several subscales were found to be significantly correlated: hepatic disturbance with dermatological changes and cognitive disturbance; respiratory disturbance with dermatological changes, sedation, and electrolyte disturbance; and cognitive disturbance with sedation and dermatological disturbance. Possible implications of these findings are discussed.

Cross-cultural differences in comorbid symptoms of children with autism spectrum disorders: an international examination between Israel, South Korea, the United Kingdom and the United States of America.

OBJECTIVE: To examine the relationship between culture and symptoms of comorbid psychopathology in those with autism spectrum disorders (ASD). DESIGN: Multivariate analyses of variance (MANOVAs) for each country and each sub-scale of the Autism Spectrum Disorders-Comorbid for Children (ASD-CC). Follow-up independent univariate analyses and post-hoc tests as needed. METHODS: Separate samples from South Korea, the UK and Israel were compared to a sample from the US in order to examine cultural contributions, using the ASD-CC. RESULTS: Overall, few differences were found. Significantly, the US had significantly higher scores than South Korea on the avoidant sub-scale. Additionally, the US had significantly higher scores than Israel on the over-eating and tantrum sub-scales. No significant differences were found between the US and the UK. CONCLUSION: Cultural factors, such as views of typical behaviour, should be taken into account when examining symptoms of comorbidity in children with ASD.

Parents' first concerns of their child's development in toddlers with autism spectrum disorders.

OBJECTIVE: Investigations about first concerns among parents of toddlers with ASD and comparisons of the same with children diagnosed with other developmental disorders are scarce. METHOD: The current study utilized a sample of toddlers diagnosed with an ASD or other developmental delay and examined the nature of parents' first concern and the age of first concern compared to the age of first assessment. RESULTS: The majority of parents of both toddlers diagnosed with ASD and non-ASD related developmental delays indicated that the area of first concern was in communication. However, the age of first concern was significantly younger for toddlers with an ASD diagnosis. In addition, there was a significant positive correlation between the age at which concerns were first noted and the age at which assessment was sought. CONCLUSION: The implications of these findings are discussed as they relate to early assessment and intervention.

Gender differences in symptoms of comorbidity in toddlers with ASD using the BISCUIT-Part 2.

OBJECTIVE: Examine if gender differences exist with respect to comorbid symptoms in young children with Autistic Disorder (AD), Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) and atypical controls. DESIGN: A factorial MANOVA was conducted for the main analysis and follow-up post-hocs were conducted where significant differences were found. METHODS: The Baby and Infant Screen for Children with aUtIsm Traits, Part 2 was administered to caregivers of 438 young children. RESULTS: The MANOVA was significant, F(10, 858) = 19.38, p < 0.001, Pillai's Trace = 0.37. No gender differences were found; however, diagnostic groups differed significantly on symptoms with AD exhibiting more symptoms than PDD-NOS, followed by atypical controls. No interaction between gender and diagnosis was found. CONCLUSIONS: Those with AD exhibited greater comorbid symptoms which is consistent with previous research. Current finding also support previous literature which state that gender differences are evident only during certain periods in the lifespan.

Behaviors and corresponding functions addressed via functional assessment.

One-hundred seventy-three studies that employed functional assessment were evaluated with respect to types of challenging behaviors studied and the functions identified that maintained those behaviors. For most studies, two to three behaviors were targeted. Of the 38 different challenging behaviors identified, self-injurious behavior (SIB) and aggression were by far the most studied. Other commonly studied behaviors were tantrums, stereotypies, property destruction, bizarre/inappropriate speech/vocalizations, and disruptive behaviors. The most commonly identified functions for both SIB and aggressions were attention and escape/demands. The implications of these and other data complied on target behaviors and maintaining variables are discussed.

Person characteristics of individuals in functional assessment research.

This paper is a review of person characteristics that were present in 173 studies that were reviewed on functional assessment. The purpose was to give the reader an idea about the types of individuals for which functional assessment is appropriate and to outline persons and their characteristics which have the best research support. The majority of participants were diagnosed with intellectual disability and/or autism. Additionally more males that females were included and children were frequently studied versus adolescents and older adults. Finally, while the majority of studies employed experimental functional analysis, the number of participants per study was small. Conversely, functional analysis scales were used in far fewer studies, but with much larger sample sizes. Thus, relatively equal numbers of individuals have been studied with both methods.

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.

Incidence and trends in psychopathology symptoms over time in adults with severe to profound intellectual disability.

Individuals with intellectual disability (ID) have a high risk for developing comorbid psychopathology. While researchers have shown that symptoms of psychopathology remain relatively stable in children with ID over time, little research has been conducted to demonstrate symptom stability for adults with ID. Incidence of psychopathology symptoms was examined in 124 adults with severe to profound ID. Then, trends in symptoms of psychopathology over time were studied in 74 of those individuals who had data collected quarterly over the span of one year. Data from the Diagnostic Assessment for the Severely Handicapped-Second Edition (DASH-II) were evaluated for each of the 13 subscales, as well as the total DASH-II score. For all of the scales except PDD/Autism, symptoms did not fluctuate significantly over the one year period. The PDD/Autism scale revealed a significant change in symptoms from Time 1 to Time 3. The implications of these results are discussed.

What is the evidence for environmental causes of challenging behaviors in persons with intellectual disabilities and autism spectrum disorders?

An extensive literature on the causes of challenging behaviors has been developed, primarily in the applied behavior analysis literature. One hundred and seventy-three empirical studies were reviewed where functional assessment serves as the primary method of identifying these causes. Most of the studies were able to identify a clear function or functions. Most commonly established causes were attention, the efforts to acquire tangibles, negative reinforcement in the form of escape from tasks or environments, and sensory stimulation, also described as an alone condition. Examples are provided regarding how these conditions are investigated across studies. Biological and cognitive causes have also been demonstrated. However, to date the empirical literature is limited with the bulk of studies being correlational. Considerably more research is needed, but some causes and methods to identify them are beginning to emerge.

Replacement behaviors for identified functions of challenging behaviors.

Functional assessment has become a major feature of learning-based research. A critical element of the majority of these studies includes not only methods and procedures to identify the cause of the challenging behavior, but to establish replacement treatment methods. By far the most common intervention in the 176 studies we reviewed was reinforcement. Noncontingent reinforcement (NCR) was the most common reinforcement method, followed by differential reinforcement of other behavior (DRO). Reinforcement plus extinction was the second most commonly employed treatment followed by functional communication training with or without reinforcement. Researchers proved to be very creative. Forty different treatment methods were employed. The implications of these data are discussed.

Communication deficits in babies and infants with autism and pervasive developmental disorder-not otherwise specified (PDD-NOS).

OBJECTIVE: To investigate if, and in what ways, communication impairments are present in toddlers (17-37 months) diagnosed with autism and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). METHODS: Study 1-The scores of 20 toddlers with autism or PDD-NOS (i.e. ASD group) were compared to those of 20 typically-developing infants on the Communication sub-scale of the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT)-Part 1. Study 2-These same scores were compared between 660 toddlers who fell into three groups: autism, PDD-NOS and non-ASD-related developmentally delayed. RESULTS: Infants with an ASD exhibited greater communication impairments than did typically-developing infants overall and on all items. Additionally, significant differences were found in overall communication impairments and the majority of individual items between all three groups in Study 2. CONCLUSIONS: Significant communication impairments are present in toddlers diagnosed with autism and PDD-NOS before 37 months.