Integration of Family Navigation into ECHO Autism for Pediatric Primary Care in Underserved Communities.

Children with autism from underserved communities face complex system-, provider-, and family-level barriers to accessing timely diagnosis and early intervention. The current study evaluated the preliminary effects and feasibility of a new program (ECHO Autism LINKS) that integrated pediatric primary care provider (PCP) training with family navigation (FN) to bridge the gaps between screening, referral, and service access. Three cohorts of PCPs (n = 42) participated in the program, which consisted of 60-minute sessions delivered by Zoom twice per month for 12 months. Each session included didactics, case-based learning, and collaborative discussion with participants and an interdisciplinary team of experts. Family navigators were members of the expert team and provided FN services to families referred by PCP participants. Program attendance and engagement were strong, with 40 cases presented and 258 families referred for FN services, most of whom (83%) needed help accessing and connecting with services, and 13% required ongoing support due to complex needs. PCPs demonstrated significant improvements in self-efficacy in providing best-practice care for children with autism, reported high satisfaction, and observed improved knowledge and practice as a result of the program. The results of this initial pilot provide support for the feasibility, acceptability, and preliminary efficacy of the ECHO Autism LINKS program. The model holds promise in addressing complex barriers to healthcare access by providing both PCPs and families with the knowledge and support they need. Future research is needed to evaluate the efficacy and effectiveness of the program in improving child and family outcomes.

Associations Among Autism Symptom Domains and Facets of Caregiver Strain.

Parents of children with autism spectrum disorder (ASD) often experience elevated levels of caregiver strain (CGS). Few studies have examined the relationship between core ASD symptoms and each facet of CGS: objective, subjective internalized, and subjective externalized strain. The predictive effect of core and associated features of ASD on CGS facets were investigated, while also exploring the moderating effect of age. Atypical behaviors and behavior problems were the strongest predictors of all types of caregiver strain. For younger children, more repetitive behaviors predicted higher externalized strain, yet the opposite was true for parents of adolescents. Given that caregiver strain impacts parents' service utilization patterns, future research should focus on strategies to support parents in reducing caregiver strain.

Snack Talk: Effects of a Naturalistic Visual Communication Support on Increasing Conversation Engagement for Adults with Disabilities.

Adults with intellectual and developmental disabilities frequently experience poor life outcomes, with individuals reporting lower levels of social support, relationships, gainful employment, and satisfaction in their quality of life. To ameliorate these outcomes, social skills and social communication interventions aligned with the needs of adults are warranted. This study examined the efficacy of Snack Talk, a supplemental naturalistic visual communication support, with five adults with intellectual and developmental disabilities. Snack Talk was implemented during the midday mealtime, with the goal of increasing conversation engagement. A withdrawal design across participants was used. Results demonstrated increases in conversation engagement and showed meaningful gains for participants in the intervention and postintervention phase compared to baseline.

A mixed methods study of autistic adults' mental health therapy experiences.

Autistic adults are at high risk for co-occurring mental health problems and need access to effective and appropriate mental health treatment. However, the relative effectiveness or acceptability of specific mental health strategies among autistic adults has not been previously examined. The current study sought to gain a deeper understanding of autistic adults' experiences and preferences regarding mental health strategies using a mixed methods approach. Autistic adults (n = 303, ages 21-77) completed online surveys and open-ended questions about their mental health and therapy experiences. Most (88.8%) had participated in therapy, with cognitive approaches being the most common. Regarding overall therapy experiences, qualitative analyses revealed four primary themes and nine subthemes. Therapist acceptance and understanding were seen as critical for therapy success, and many participants felt that therapy was helpful for personal growth. However, many participants found that talking in session was challenging and noted that aspects of the session format affected their ability to engage in therapy. Regarding specific strategies, four cross-cutting themes and eight strategy-specific subthemes were identified. A variety of strategies were seen as helpful for reducing anxiety and improving mood. However, autistic adults reported trouble generalizing strategies to daily life and found some techniques to be difficult to implement due, in part, to their unique autism-related needs. As the first study of its kind, the results underscore the importance of establishing a safe and accepting therapeutic relationship, providing accommodations to support communication needs, and considering individual differences and preferences when selecting mental health strategies for autistic clients.

Preliminary Validation and Feasibility of the Autism Detection in Early Childhood-Virtual (ADEC-V) for Autism Telehealth Evaluations in a Hospital Setting.

This study provided preliminary validation of the Autism Detection in Early Childhood-Virtual (ADEC-V) for telehealth assessment of possible autism. Participants were 121 children (24.79% female) aged 18-47 months who completed telehealth evaluations at a large pediatric hospital in the Midwestern United States between October 2020 and February 2021. The ADEC-V showed good sensitivity (0.82) and specificity (0.78) and was significantly correlated with other ASD symptom measures (i.e., CARS-2, ADI-R). Internal consistency was acceptable (α = 0.77). These results need replication in a larger and broader sample including more children without ASD. This preliminary validation study identifies the ADEC-V as a promising measure for telehealth ASD assessments in young children.

Interobserver agreement: A preliminary investigation into how much is enough?

Interobserver agreement (IOA) is important for research and practice, and supports the consistency of behavioral data (Kahng et al., 2011). Although general parameters for how much IOA is needed have been suggested (Bailey & Burch, 2018), it is unknown if the total number of sessions with IOA might impact the IOA coefficient. In this study, IOA was reanalyzed using functional analysis data at various cutoffs. Obtained IOA from these analyses was then compared to the original IOA. Overall, results suggested that, at least when using highly trained observers in a structured clinical setting, there were no significant differences in IOA across cutoffs. However, IOA was sensitive to overall rate of responding in the functional analysis. These data are encouraging, particularly for practitioners, because they provide preliminary support that the amount of sessions with IOA may not be as important as the consistency of the data.

The Development, Reliability, and Validity of the Social Impact of Repetitive Behavior Scale in Children with Autism Spectrum Disorder.

Introduction: Current measures of restrictive and repetitive behavior (RRB) in people with autism focus on severity and intensity and, to some degree, the global interference of the behavior. In this study we developed the Social Impact of Repetitive Behavior Scale (SIRBS) to capture several different contexts in which repetitive behavior is likely to occur and interfere. Methods: SIRBS items were selected through reviewing the RRB literature, participant chart reviews, and consensus among authors, followed by an initial piloting and further refinement of the tool. Caregivers completed the SIRBS a total of 400 times. Results: Subscales showed high internal consistency and good test-retest reliability, moderate concurrent validity, and average to excellent inter-rater reliability. Conclusion: The SIRBS is a psychometrically reliable and valid measure of the social impact of repetitive behavior with children with autism. Additional research is needed to independently validate it and conduct an initial exploratory factor analysis of subscales.

Brief Report: Replication and Validation of the Brief Autism Detection in Early Childhood (BADEC) in a Clinical Sample.

We investigated the clinical validity of the BADEC, an abbreviated, five-item version of the Autism Detection in Early Childhood, level-2 screening tool for autism. Initially developed by Nah et al. (2019) using a research sample, the present study replicated Nah et al. (2019) procedures in a clinical population. Using a cutoff score of five, five items were identified as most effective in discriminating children who later received an ASD diagnosis by an interdisciplinary team. This algorithm had improved validity compared to the original research algorithm. Results supported the efficacy of a very brief, easy to administer ASD screening tool in identifying children under three who are likely to have ASD.

Language profiles in young children with autism spectrum disorder: A community sample using multiple assessment instruments.

This study investigated language profiles in a community-based sample of 104 children aged 1-3 years who had been diagnosed with autism spectrum disorder using Diagnostic and Statistical Manual of Mental Disorders (5th ed.) diagnostic criteria. Language was assessed with the Mullen scales, Preschool Language Scale, fifth edition, and Vineland-II parent-report. The study aimed to determine whether the receptive-to-expressive language profile is independent from the assessment instrument used, and whether nonverbal cognition, early communicative behaviors, and autism spectrum disorder symptoms predict language scores. Receptive-to-expressive language profiles differed between assessment instruments and reporters, and Preschool Language Scale, fifth edition profiles were also dependent on developmental level. Nonverbal cognition and joint attention significantly predicted receptive language scores, and nonverbal cognition and frequency of vocalizations predicted expressive language scores. These findings support the administration of multiple direct assessment and parent-report instruments when evaluating language in young children with autism spectrum disorder, for both research and in clinical settings. Results also support that joint attention is a useful intervention target for improving receptive language skills in young children with autism spectrum disorder. Future research comparing language profiles of young children with autism spectrum disorder to children with non-autism spectrum disorder developmental delays and typical development will add to our knowledge of early language development in children with autism spectrum disorder.

Brief report: Poor self-regulation as a predictor of individual differences in adaptive functioning in young children with autism spectrum disorder.

The present study examined the link between poor self-regulation (measured by the child behavior checklist dysregulated profile [DP]) and core autism symptoms, as well as with developmental level, in a sample of 107 children with autism spectrum disorder (ASD) aged 19-46 months. We further examined the utility of DP in predicting individual differences in adaptive functioning, relative to the influence of ASD severity, chronological age (CA), and developmental level. Poor self-regulation was unrelated to CA, developmental level, and severity of ADOS-2 restricted and repetitive behaviors, but was associated with lower ADOS-2 social affect severity. Hierarchical regression identified poor self-regulation as a unique independent predictor of adaptive behavior, with more severe dysregulation predicting poorer adaptive functioning. Results highlight the importance of early identification of deficits in self-regulation, and more specifically, of the utility of DP, when designing individually tailored treatments for young children with ASD. Autism Res 2018, 11: 1157-1165. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study explored the relationship between poor self-regulation and age, verbal and non-verbal developmental level, severity of autism symptoms and adaptive functioning in 107 children with autism under 4 years of age. Poor self-regulation was unrelated to age, developmental level, and severity of restricted and repetitive behaviors but was associated with lower social affect severity. Importantly, more severe self-regulation deficits predicted poorer adaptive functioning.

Meta-analysis of parent-mediated interventions for young children with autism spectrum disorder.

A number of studies of parent-mediated interventions in autism spectrum disorder have been published in the last 15 years. We reviewed 19 randomized clinical trials of parent-mediated interventions for children with autism spectrum disorder between the ages of 1 and 6 years and conducted a meta-analysis on their efficacy. Meta-analysis outcomes were autism spectrum disorder symptom severity, socialization, communication-language, and cognition. Quality of evidence was rated as moderate for autism spectrum disorder symptom severity, communication-language, and cognition, and very low for socialization. Weighted Hedges' g varied from 0.18 (communication-language) to 0.27 (socialization) and averaged 0.23 across domains. We also examined the relationship between outcome and dose of parent training, type of control group, and type of informant (parent and clinician). Outcomes were not significantly different based on dose of treatment. Comparing parent training to treatment-as-usual did not result in significantly different treatment effects than when parent training was compared to an active comparison group. Based on parent report only, treatment effects were significant for communication-language and non-significant for socialization, yet the opposite was found based on clinician-rated tools. This meta-analysis suggests that while most outcome domains of parent-delivered intervention are associated with small effects, the quality of research is improving.

The Relationship Between Clinicians' Confidence and Accuracy, and the Influence of Child Characteristics, in the Screening of Autism Spectrum Disorder.

The study examined the confidence accuracy relationship, and the influence of child characteristics on clinician confidence, when predicting a diagnosis of Autism Spectrum Disorder during screening of 125 referred children aged under 3.5 years. The diagnostic process included observation, interview, language and developmental testing. Clinical judgement accuracy was compared against final diagnosis for high and low confidence levels (with confidence assessed on a 0-100 % scale). We identified a significant CA relationship with predictive accuracy highest at confidence levels of 90-100 %. Parent report of unusual behaviors was the only significant independent predictor of confidence. Clinicians' confidence may be important when evaluating decisions to refer, or not to refer, children for further diagnostic assessment.

Efficacy of the ADEC in Identifying Autism Spectrum Disorder in Clinically Referred Toddlers in the US.

The Autism Detection in Early Childhood (ADEC) is a brief, play-based screening tool for the assessment of autism spectrum disorder (ASD) in children aged 12-36 months. We examined the psychometric properties of the ADEC in a clinical sample of toddlers (n = 114) referred to a US pediatric hospital for assessment due to concerns of developmental delay or ASD. The ADEC (cutoff = 11) returned good sensitivity (.93-.94) but poorer specificity (.62-.64) for best estimate clinical diagnosis of ASD, and compared favorably with the ADOS-2. Internal consistency was acceptable, α = .80, and inter-rater reliability was high, ICC = .95. Results support the use of the ADEC as a clinical screen for ASD.

College students' openness toward autism spectrum disorders: improving peer acceptance.

One probable consequence of rising rates of autism spectrum disorder diagnosis in individuals without co-occurring intellectual disability is that more young adults with diagnoses or traits of ASD will attend college and require appropriate supports. This study sought to explore college students' openness to peers who demonstrate ASD-characteristic behaviors. Results showed a significant difference in openness between students who had a first-degree relative with an ASD (n = 18) and a gender-matched comparison group of students without such experience (F = 4.85, p = .035). Engineering and physical science majors did not demonstrate more overall openness. Universities should make efforts to prevent social isolation of students with ASD, such as programs to educate students about ASD and supports to ease college transition.