Screening for Autism Spectrum Disorder: Profiles of Children Who Are Missed.

OBJECTIVE: To characterize children presenting with concerns for autism spectrum disorder (ASD) missed by parent-report screeners and to examine benefits of a combined screening approach with the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) and the Ages and Stages Questionnaire, Third Edition (ASQ-3). METHODS: Participants included were 154 children aged 16 to 42 months presenting for an evaluation at an autism center. Caregivers completed the M-CHAT-R, ASQ-3, and a demographic questionnaire. Children participated in an autism diagnostic evaluation consisting of the Mullen Scales of Early Learning (Mullen) and Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). RESULTS: A total of 124 children (81%) were diagnosed with ASD. The M-CHAT-R identified 85% (n = 105) of these children. Children with ASD missed by the M-CHAT-R had significantly higher scores on the Mullen and significantly lower scores on the ADOS-2. Of the ASQ-3 domains, the majority (n = 102, 82%) of children with ASD failed the communication domain; missed cases showed similar patterns of higher Mullen scores and lower ADOS-2 scores. When adopting a combined screening approach, using a failed screen from either the M-CHAT-R or ASQ-3 communication domain, 93% of children were identified. Parent-reported concerns on an open-ended questionnaire revealed ASD red flags for many missed cases. CONCLUSION: Children with ASD missed by screeners had higher scores on developmental testing and lower scores on the ADOS-2; however, children still performed below average on developmental tests. Our findings suggest that a combined screening approach was most effective for identifying children with ASD from a sample group referred for an ASD evaluation.

Sibling Relationships in Adolescence and Early Adulthood With People Who Have Intellectual Disability.

Cross-sectional (N = 106) and longitudinal (N = 35) samples of siblings (ages 11-38) reported on closeness and conflict in their relationships with sisters and brothers with intellectual disability. For closeness, confirmatory factor analysis (CFA) distinguished feelings of emotional closeness from reciprocal sharing behaviors for these siblings. Age effects and changes over time indicated increasing emotional closeness and a general reduction in conflict from adolescence to young adulthood, with stable reciprocal sharing. Cross-sectionally, closeness was greater when siblings were involved in caregiving, and conflict was less when siblings no longer co-resided. Sibling constellation features (sex, birth order, age spacing) had limited effects at this developmental period. Findings support a combination of life-span developmental change and enduring attachment in these sibling relationships.

Sibling relationship quality and social functioning of children and adolescents with intellectual disability.

We examined sibling relationships for children and adolescents with intellectual disability and assessed implications for their social functioning. Targets (total N = 212) had either intellectual disability, a chronic illness/physical disability, or no disability. Nontarget siblings reported on relationship quality, sibling interactions were observed, and teachers reported on social adjustment. Group comparisons highlighted the asymmetrical hierarchy and low conflict unique to siblings and targets with intellectual disability. Sibling relationships characterized by high warmth/closeness, positive affect, and few negative behaviors were predictive of fewer behavior problems for the targets at school. Both high warmth/ closeness and high conflict predicted greater social competence for the targets with intellectual disability, though warmth, conflict, and sibling management had different implications depending on the sibling's gender.