Piloting a Novel Daily Living Skills Assessment in Autistic Adolescents and Young Adults.

Background: There are a few ecologically valid measurements of Daily Living Skills (DLS)-a critical component of adaptive functioning (AF)-for autistic adolescents and young adults. This is particularly important given that DLS predict outcomes as autistic adolescents transition to adulthood. Methods: We pilot-tested the assessment section of two modules of the Computerized Functional Skills Assessment and Training program (CFSAT) in 25 autistic (n = 4 female) and 25 non-autistic (n = 6 female) adolescents and young adults to evaluate preliminary feasibility in an autistic sample. Tasks involved using an ATM and ticket-buying machine. We also assessed AF and DLS with a well-validated self-report questionnaire. We examined group differences in performance and relationships between performance on CFSAT and an existing measure of AF and DLS. We also conducted regression analyses to investigate the associations between age, IQ, executive functioning (EF), and CFSAT task performance. Results: All but one autistic participant were able to complete the CFSAT tasks. Autistic participants made more errors, but did not take longer to complete the task, than non-autistic participants. Performance correlated strongly with self-reported AF generally and DLS specifically. The regression analyses revealed that task performance was associated with EF in the autistic group, but not the non-autistic group. Conclusions: These results provide preliminary support for the use of a new performance-based ecologically valid assessment of DLS in an autistic population. Two CFSAT modules were well-tolerated and detected differences in DLS ability. Strong correlations with an existing measure of AF suggest evidence of construct validity. The EF was associated with CFSAT task performance in autistic individuals. Such a tool could help identify individuals who would benefit from a DLS intervention.

Why is this an important issue?: For autistic adolescents and young adults, one of the most important predictors of success after high school are daily living skills (DLS), which are a component of adaptive functioning (AF), or the ability to operate independently when engaged in day-to-day tasks. However, most of the measures used to assess these abilities are parent- or child-report questionnaires, which may lack objectivity. What was the purpose of this study?: The Computerized Functional Skills Assessment and Training program (CFSAT) is an innovative software program that was designed to teach people how to perform daily tasks that require the use of technology. This study piloted two CFSAT modules in a sample of autistic adolescents and young adults. The researchers wanted to see whether the program could be completed by the autistic participants and whether their performance related to an existing measure of DLS and other cognitive measures known to be related to AF. What did the researchers do?: This study piloted the assessment portion of two CFSAT modules in 25 autistic and 25 non-autistic adolescents and young adults to investigate whether it might be a useful measure of DLS skills in autistic individuals. The assessment portion of the program gives participants tasks to complete on a virtual ATM and Metro Ticket Kiosk and records time to completion and accuracy. Participants also used a questionnaire to self-report DLS and general AF and performed cognitive tasks. What were the results of the study?: All but one autistic participant were able to complete both tasks. The autistic group made more errors but did not take more time to complete the tasks compared with the non-autistic group. Performance on the CFSAT was related to self-reported DLS scores on a questionnaire and to scores on cognitive tasks. What do these findings add to what was already known?: Previous work recommended computer-based DLS programs for autistic individuals. Since our results suggest the CFSAT is a viable computer-based program of DLS for autistic adults, CFSAT could help fill a need for DLS tools that are more applicable to real life than currently available questionnaires. Findings provide preliminary support that the CFSAT assessment measures DLS and could be a promising program to further study. What are potential weaknesses in the study?: Weaknesses of our work include that the measures used in this study only assessed two specific tasks encountered in daily living. Data on participants' real-life experience were not fully collected, so the association between the amount of real-life experience on these tasks and computer task performance will require further study. No data asking whether the tasks studied are useful for autistic adolescents and adults were collected. The study was small and consisted of relatively fewer women, which means that results will need to be replicated in a larger sample. How will these findings help autistic adults now or in the future?: This work could eventually pave the way for interventions that improve DLS (including the training version of the CFSAT) that may be helpful for teaching autistic individuals technology-related functional skills.

Components of Executive Control in Autism Spectrum Disorder: A Functional Magnetic Resonance Imaging Examination of Dual-Mechanism Accounts.

BACKGROUND: It remains unclear whether executive control (EC) deficits in autism spectrum disorder (ASD) represent a failure in proactive EC (engaged and maintained before a cognitively demanding event) or in reactive EC (engaged transiently as the event occurs). We addressed this question by administering a paradigm investigating components of EC in a sample of individuals with ASD and typically developing individuals during functional magnetic resonance imaging. METHODS: During functional magnetic resonance imaging, 141 participants (64 ASD, 77 typically developing) completed a rapid preparing to overcome prepotency task that required participants to respond to an arrow probe based on the color of an initially presented cue. We examined functional recruitment and connectivity in the frontoparietal task control, cingulo-opercular task control, salience, and default mode networks during cue and probe phases of the task. RESULTS: ASD participants showed evidence of behavioral EC impairment. Analyses of functional recruitment and connectivity revealed that ASD participants showed significantly greater activity during the cue in networks associated with proactive control processes, but on the less cognitively demanding trials. On the more cognitively demanding trials, cue activity was similar across groups. During the probe, connectivity between regions associated with reactive control processes was uniquely enhanced on more-demanding (relative to less-demanding) trials in individuals with ASD but not in typically developing individuals. CONCLUSIONS: The current data suggest that rather than arising from a specific failure to engage proactive or reactive forms of EC, the deficits in EC commonly observed in ASD may be due to reduced proactive EC and a consequent overreliance on reactive EC on more cognitively demanding tasks.

On Defining Irritability and its Relationship to Affective Traits and Social Interpretations.

Irritability has gained recognition as a clinically significant trait in youth and adults that when persistent and severe, predicts poor outcomes throughout life. However, its definition, measurement, and relationship to similar constructs remain poorly understood. In a community sample of adults (N=458; 19-74 years; M=40.5), we sought to identify a unitary irritability factor from independently constructed self-reported measures of irritability distinct from the related constructs of aggression, depression, and anxiety, and whether it was associated with face emotion identification deficits and hostile interpretation biases previously established in clinical pediatric samples. The three measures of irritability generated a common factor characterized by a rapid, angry response to provocation. This irritability factor had unique associations with tendencies to judge ambiguous stimuli as reflecting hostility, but not with face emotion identification performance. These findings clarify the nature of irritability and its associations with neurocognitive phenomenon.

The visual perception of exocentric distance in outdoor settings.

The ability of 20 younger (mean age was 21.8years) and older adults (mean age was 71.5years) to visually perceive exocentric distances outdoors was evaluated. The observers adjusted the extent of in-depth spatial intervals until they appeared identical to fronto-parallel intervals of 4 and 8m. The frontal and in-depth intervals were viewed from a distance of 8m. Almost all of the observers' judgments were inaccurate and most reflected perceptual compressions in depth: e.g., an in-depth interval of 10m would appear to have the same extent as a physically smaller 8m frontal interval. Some observers' judgments, however, were consistent with perceptual expansions of in-depth intervals. No significant effects of age were obtained in the current study: both younger and older adults exhibited perceptual compressions and expansions of in-depth intervals. This outcome differs from that of a recent experiment conducted by our laboratory (Vision Research 109 (2015) 52-58) that found the judgments of younger adults to be less accurate than those of older adults. A comparison of the former and current results revealed that while older adults perform similarly outdoors and indoors, the accuracy of younger adults' exocentric judgements improves substantially in outdoor settings (so that the accuracy becomes similar to that exhibited by older adults).