Vineland-3 Structural Validity and Interpretability of Domain Scores: Implications for Practitioners Assessing Adolescents With Developmental Conditions.

The Vineland-3 purports to measure three dimensions of adaptive behavior, but empirical evidence pertaining to its structural validity is lacking. In this study, factor analyses were conducted on the standardization sample data for the comprehensive forms within the 11- to 20-year-old age range. Results did not support the three domain structure of the test and indicated domain scores did not add additional information about an individual's adaptive performance that was not already accounted for by the Adaptive Behavior Composite (ABC) score alone. Practitioners assessing adolescents with developmental conditions should consider using the ABC score within a multimethod assessment protocol for the various purposes of adaptive behavior assessment including the identification of intellectual disability.

Utility of the CBCL DSM-Oriented Scales in Assessing Emotional Disorders in Youth with Autism.

BACKGROUND: Youth with autism spectrum disorder (ASD) are at risk for one or more emotional disorders (ED) including depressive and anxiety conditions. DSM-5 diagnostic guidelines indicate that co-occurring ED must be specified when present (APA, 2013). While ED may be evaluated for during initial diagnostic assessment, routine monitoring and screening is needed to identify emerging ED in later childhood and adolescence, a period of high risk. METHOD: Confirmatory factor analysis, convergent and divergent validity analyses, criterion-related validity, and diagnostic accuracy analyses of the CBCL's Affective Problems and Anxiety Problems DSM Oriented Scales was completed on 93 well-characterized youth, ages 6 to 18 years with ASD (6:1 M:F), with and without intellectual impairment. These youth were from predominately white, middle-class backgrounds. RESULTS: Each scale measured a single construct reliably (depressive and anxiety disorders), neither scale measured symptoms of ASD, and youth with a depressive disorder had other ED co-morbidities. CONCLUSIONS: Findings demonstrate the DSM Oriented Affective and Anxiety Problem Scales can be used to screen for depression and anxiety in youth with ASD. Replication is needed with various subgroups representing gender, age, developmental level, autism, and mental health severity differences, and with groups across a broader set of demographics.

Validity Study of the CBCL 6-18 for the Assessment of Emotional Problems in Youth With ASD.

Youth with autism spectrum disorder (ASD) often present with emotional problems such as anxiety and depression (American Psychiatric Association, 2013). A recent study of the Child Behavior Checklist 6-18 (CBCL; Achenbach & Rescorla, 2001) indicated good sensitivity but relatively low specificity for identifying emotional problems in youth with ASD. The current study examined the extent to which variance in the CBCL's Anxious/Depressed, Withdrawn/Depressed, Internalizing Domain, and Total Problems scales was accounted for by symptoms of emotional problems relative to ASD symptoms. Correlation and multiple regression analyses indicated that these scales measured anxiety and depression but a small statistically significant proportion of variance in Total Problems scores was also accounted for by ASD symptoms. Results contribute to the emerging evidence base for the inclusion of the CBCL in assessment protocols for assessing emotional and behavioral problems in youth with ASD.

High prevalence of sleep disorders and associated comorbidities in a community sample of children with Down syndrome.

STUDY OBJECTIVES: Down syndrome (DS) is a neurodevelopmental disorder characterized by multiple comorbidities. Sleep disorders are common among children with DS and can cause significant distress for families. However, research is limited describing sleep problems and correlates in large population-based samples. Accordingly, we aimed to describe sleep behavior among children with DS and its relationship with medical conditions in this population. METHODS: We conducted a population-based, cross-sectional study (2009-2011) of sleep disturbances in children and adolescents with DS 7 to 17 years of age (N = 107). We assessed sleep problems using caregiver report on two validated screening tools: the Childhood Sleep Habits Questionnaire (CSHQ) and the Pediatric Sleep Questionnaire (PSQ). The prevalence of sleep problems was compared in children with and without important comorbidities using modified Poisson regression with robust standard errors. RESULTS: 65% of children screened positive on the CSHQ for significant sleep problems in the past month, but their parents often did not report sleeping difficulties in their children. On the PSQ, 46% screened positive for sleep related breathing problems and 21% screened positive for sleep related movement disorders. Children with asthma, autism, and a history of enlarged adenoids and tonsils had more current sleep problems than children without these comorbidities. CONCLUSIONS: Our findings suggest that sleep problems may be an important but under-recognized problem in children with DS. Sleep problems appear to be correlated with prevalent comorbidities, which may provide guidance to augment current practice guidelines to evaluate sleep problems in this population.

A community cross-sectional survey of medical problems in 440 children with Down syndrome in New York State.

OBJECTIVE: To determine the frequency of medical problems in a large population of children with Down syndrome. STUDY DESIGN: Study population included 440 children with Down syndrome (ages 3-14 years) identified primarily through the New York Congenital Malformations Registry. Parents completed questionnaires on medical problems. RESULTS: Our study population was predominately White (92.3%), non-Hispanic (72.3%) with at least 1 college educated parent (72.3%). The prevalence of medical problems was as follows: heart disease (55%), hearing problem (39%), vision problem (39%), thyroid disease (27%), celiac disease (5%), alopecia (5%), seizures (7%), asthma/reactive airway disease (32%), diabetes (1%), and juvenile rheumatoid arthritis (0.2%). Of the children with heart disease, 58% needed surgery at a mean age of 9 months. Of the children with hearing loss, 29% were identified on newborn screening and 13% used an amplification device. Of the children with thyroid disease, 31% were diagnosed in the newborn period. Only 7% of these children with Down syndrome had no medical problem listed. CONCLUSION: Prevalence data of medical illnesses in a large population of children with Down syndrome provide us with data to support implementation of the American Academy of Pediatrics guidelines for health supervision for children with Down syndrome. The long-term health implications of the conditions we surveyed will be important for decreasing morbidity and increasing overall health and wellness into adulthood.

An initial evaluation of the Social Communication Questionnaire for the assessment of autism spectrum disorders in children with Down syndrome.

OBJECTIVE: This study investigated the psychometric properties of the Social Communication Questionnaire (SCQ) in a sample of children with Down syndrome (DS), many of whom had a co-occurring autism spectrum disorder (ASD). The SCQ is a widely used ASD screening measure; however, its measurement properties have not been comprehensively evaluated specifically in children with DS, a group that seems to be at higher risk for an ASD. METHODS: Exploratory and confirmatory factor analyses, scale reliability, convergent and discriminant correlations, significance tests between groups of children with DS and DS + ASD, and diagnostic accuracy analyses were conducted. RESULTS: Factor analyses identified 2 reliable factors that we labeled Social-Communication and Stereotyped Behavior and Unusual Interests. Pearson correlations with Autism Diagnostic Interview-Revised subscales indicated support for the SCQ's convergent validity and some support for the discriminant validity of the factor-based scales. Significance tests and receiver operating characteristic analyses indicated that children with DS + ASD obtained significantly higher SCQ factor-based and total scores than children with DS alone, and that the SCQ Total Score evidenced good sensitivity and adequate specificity. CONCLUSIONS: Results indicated initial psychometric support for the SCQ as an ASD screening measure in children with DS. The SCQ should be considered as part of a multimethod evaluation when screening children with DS.

An Initial Psychometric Evaluation of the CBCL 6-18 in a Sample of Youth with Autism Spectrum Disorders.

Individuals with an autism spectrum disorder (ASD) often present with co-occurring emotional and behavioral disorders (EBD). The Child Behavior Checklist 6-18 (CBCL; Achenbach & Rescorla, 2001) is an EBD measure that contains several norm-referenced scales derived through factor analysis of data from the general pediatric population. The psychometric properties of this widely used and well-researched measure have not been evaluated in samples of youth with ASD. This study evaluated the CBCL's internal structure, scale reliability, criterion-related validity, and diagnostic accuracy using archival data from a well-characterized sample of youth with ASD (N = 122). Confirmatory factor analyses supported the unidimensionality of the CBCL's syndrome scales and its Internalizing-Externalizing factor structure. Significance tests indicated that many scales discriminated between two subgroups: a group of individuals with ASD+EBD and a group with ASD alone. Diagnostic accuracy analyses indicated that the CBCL had good sensitivity but low specificity for detecting co-occurring disorders. Results supported the use of the CBCL in conjunction with other clinical data when assessing for EBD in youth with ASD.

Constructs assessed by the GARS-2: factor analysis of data from the standardization sample.

The GARS-2 (Gilliam 2006) is widely used for autism screening; however, the validity of its three conceptually-derived subscales has not been evaluated. In this study, exploratory (EFA) and confirmatory (CFA) factor analyses of data from matched subgroups of the standardization sample did not support the GARS-2 subscale structure. EFAs identified four factors in the model development subgroup (n = 496): stereotyped/repetitive behavior, stereotyped/idiosyncratic language, word use problems, and social impairment. CFAs supported this model in the replication subgroup (n = 494). Findings suggest that the GARS-2 subscales have limited clinical utility and that the Autism Index should be interpreted with caution. Although more research is needed, the clinical utility of the four empirically-derived scales may be limited by factors related to item content and test development procedures.

Access to and satisfaction with school and community health services for US children with ASD.

OBJECTIVE: Our objective was to compare access to and satisfaction with school and community health resources among families with a child with an autism spectrum disorder (ASD) and families of other children with special health care needs (CSHCN). METHODS: Parents of 40,256 children aged 0 to 17 were surveyed by the 2005-2006 National Survey of Children With Special Health Care Needs. Autism was defined by the question, "To the best of your knowledge, does (child) currently have autism or autism spectrum disorder, that is, ASD?" We used chi(2) and multivariate regression analyses to compare access to and satisfaction with services for parents of children with ASDs and parents of other CSHCN. RESULTS: Children with ASDs (n = 2123) comprise 5.4% of the CSHCN. More parents of children with ASDs reported difficulty using school and community services (27.6% vs 9.7%) and dissatisfaction (19.8% vs 7.9%) than parents of other CSHCN. Multivariate models determined that parents of children with ASDs were 3.39 times more likely to experience difficulty in obtaining services and 2.65 times more likely to be dissatisfied with services received than parents of other CSHCN, after controlling for household demographics and insurance status. Parents of children with ASDs reported a lack of available services and skilled providers. CONCLUSIONS: Parents of children with ASDs reported less access to and more dissatisfaction with school and community health services than parents of other CSHCN. An increased supply of appropriate services with qualified providers for children with ASDs is needed in the United States.

Confirmatory factor analysis of the child behavior checklist 1.5-5 in a sample of children with autism spectrum disorders.

Validity studies of measures for emotional and behavioral disorders (EBD) for use with preschool children with autism spectrum disorders (ASD) are lacking. The Child Behavior Checklist 1.5-5 (CBCL; Achenbach and Rescorla, Manual for the ASEBA Preschool Forms & Profiles. VT: University of Vermont, Research Center for Children, Youth, and Families, Burlington, 2000), a widely used measure for EBD, contains several norm-referenced scales derived through factor analysis of data from the general pediatric population. In this study, confirmatory factor analysis of archival data evaluated the adequacy of the CBCL factor model in a well characterized sample of preschoolers with ASD (N = 128). Psychometric results supported the model and suggested that practitioners can use the CBCL to assess for EBD in young children with ASD in conjunction with other clinical data. This will increase the likelihood of accurate identification and EBD-specific intervention.

Factor structure evaluation of the childhood autism rating scale.

This study investigated the factor structure of the Childhood Autism Rating Scale (CARS). Principal components analysis (PCA) and principal axis factor analysis (PAF) evaluated archival data from children presenting to a university clinic with suspected autism spectrum disorders (ASDs; N = 164). PCA did not replicate components identified by DiLalla and Rogers (1994, Domains of the Childhood Autism Rating Scale: Relevance for diagnosis and treatment. Journal of Autism and Developmental Disorders, 24(2), 115-128) and Stella, Mundy, and Tuchman (1999, Social and nonsocial factors in the Childhood Autism Rating Scale. Journal of Autism and Developmental Disorders, 29(4), 307-317). PAF identified correlated Social-Communication, Social Interaction, Stereotypies and Sensory Abnormalities, and Emotional Regulation factors. Results differed across studies; however, each identified ASD related constructs conceptually consistent with DSM-IV. Although its development predates the DSM-IV, and many newer measures are available, the CARS' psychometric properties, conceptual relevance, and flexible administration procedures support its continued use as a screening device in the diagnostic decision-making process.