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Play of younger siblings of children with autism spectrum disorder (ASD) (siblings; n = 44), very preterm children (preterms; n = 44), and children at typical likelihood for ASD (n = 36) was observed at 24 months. Children with ASD and atypical development engaged less in spontaneous (pre-)symbolic play than typically developing children. Total duration of spontaneous and elicited (pre-)symbolic play was associated with later ASD traits in siblings. However, no association between most play variables and ASD traits was found in preterms. This suggests possible different ASD-trajectories between siblings and preterms. Thus, spontaneous (pre-)symbolic play may be indicative of developmental challenges across several populations, and results highlight the need to move beyond studying only siblings in order to broaden our understanding of ASD. [This article was written with the Baby Study Team: Chloè Bontinck, Eva Bruyneel, Marjolein Muès and Liedewij Verhaeghe.]

Satisfaction with the detection process of autism and its determinants was investigated using data from the Autism Spectrum Disorder in the European Union (2015-2018) network. A total of 1342 family members, including 1278 parents, completed an online survey collecting information about their experience and satisfaction with the early detection of autism in their child. Overall, the level of satisfaction varied considerably from one respondent to another. Difficulty in finding information about detection services, lack of professional guidance and support in response to first concerns, finding a diagnostic service on one's own, and a delay of more than 4 months between the confirmation of concerns and the first appointment with a specialist were all experiences individually associated with greater odds of being less satisfied. Using a dominance analysis approach, we further identified professional guidance and support in response to first concerns as the most important predictor of the level of satisfaction. These findings highlight the aspects of the process that need to be improved to enhance the experience of the detection process and are therefore relevant to guide health administrations toward actions to be implemented to this effect.

Children with autism spectrum disorder (ASD) have been shown to exhibit fewer instances of social referencing compared to their typically developing peers. The current study evaluated the effectiveness of multiple-exemplar training, prompting, and social reinforcement to teach social referencing. We used a single-blind randomized control trial with a multiple-baseline design nested within the experimental group to evaluate treatment effects. Twenty-five children with ASD participated. Participants in the treatment group showed significantly higher social referencing scores. However, there were no statistically significant differences between the groups in the posttraining initiating and responding to joint attention scores. The clinical implications of our findings are discussed.

This study estimated ASD prevalence in a cohort of 3-year-old very preterm children (N = 55) and investigated the usefulness of parent-reported ASD screeners and the ADOS-2. 12.7% received an ASD diagnosis by clinical judgment based on DSM-5 criteria. An additional 14.5% were classified as having a broader-autism-phenotype outcome. Sensitivity values for the screeners were poor, whereas specificity values ranged from poor to excellent. The ADOS-2 identified all children with ASD and had a fair specificity. These findings confirm the elevated ASD prevalence made by previous studies with preterm children but also highlight the challenges of successfully identifying ASD in this at-risk group. Caution is warranted when interpreting results of ASD instruments with the currently available cut-off scores and algorithms, especially when developmental challenges are present.

SARS-CoV-2 is the virus causing COVID-19 and is spread through close person-to-person contact. The use of face masks has been described as an important strategy to slow its transmission. We evaluated the effects of coaching caregivers via telehealth technologies to teach face mask wearing to children with autism spectrum disorder. Six participants with a history of challenging behavior associated with mask wearing were recruited from different parts of the world, and trained using graduated exposure, shaping, and contingent reinforcement. By the end of the intervention, all participants wore a face mask for a period of 10 min without exhibiting challenging behavior. The skills generalized to a novel mask or a community setting. Mask wearing did not affect the percentage of oxyhemoglobin saturation of participants, and caregivers found the intervention useful. The findings support previous tolerance training treatment evaluations in children with developmental disorders exhibiting resistance to healthcare routines.

Autism is frequently associated with difficulties with top-down attentional control, which impact on individuals' mental health and quality of life. The developmental processes involved in these attentional difficulties are not well understood. Using a data-driven approach, 2 samples (N = 294 and 412) of infants at elevated and typical likelihood of autism were grouped according to profiles of parent report of attention at 10, 15 and 25 months. In contrast to the normative profile of increases in attentional control scores between infancy and toddlerhood, a minority (7-9%) showed plateauing attentional control scores between 10 and 25 months. Consistent with pre-registered hypotheses, plateaued growth of attentional control was associated with elevated autism and ADHD traits, and lower adaptive functioning at age 3 years. [The Eurosibs Team contributed to the writing of this article.]

Early services for ASD need to canvas the opinions of both parents and professionals. These opinions are seldom compared in the same research study. This study aims to ascertain the views of families and professionals on early detection, diagnosis and intervention services for young children with ASD. An online survey compiled and analysed data from 2032 respondents across 14 European countries (60.9% were parents; 39.1% professionals). Using an ordinal scale from 1 to 7, parents' opinions were more negative (mean = 4.6; SD 2.2) compared to those of professionals (mean = 4.9; SD 1.5) when reporting satisfaction with services. The results suggest services should take into account child's age, delays in accessing services, and active stakeholders' participation when looking to improve services.

The Modified Checklist for Autism in Toddlers-revised/follow-up (M-CHAT-R/F) was developed to reduce the number of cases requiring telephone verification. The aim of this study was to validate a Spanish version of the M-CHAT-R/F in the Spanish public health system. The M-CHAT-R/F was translated, culturally adapted, and then administered to 6625 children. Of the 39 positive screening cases, 15 children were diagnosed with autism spectrum disorder (ASD) and 24 with non-ASD disorders or delays. The sensitivity was 0.79 and specificity of 0.99. Positive and negative predictive values were 0.39 and 0.99, respectively. These results are similar to the English equivalent, though observed prevalence was lower. This study supports Spanish National Health System policy makers to consider a universal ASD screening program.

The validity of the Language ENvironment Analysis (LENA) System was evaluated for Dutch. 216 5-min samples (six samples per age per child) were selected from daylong recordings at 5, 10 and 14 months of age of native Dutch-speaking younger siblings of children with autism spectrum disorder (N=6) and of typically developing children (N=6). Two native Dutch-speaking coders counted the amount of adult words (AWC), child vocalisations (CVC) and conversational turns (CT). Consequently, correlations between LENA and human estimates were explored. Correlations were high for AWC at all ages (r=0.73 to 0.81). Regarding CVC, estimates were moderately correlated at 5 months (r=0.57) but the correlation decreased at 10 (r=0.37) and 14 months (r=0.14). Correlations for CT were low at all ages (r=0.19 to 0.28). Lastly, correlations were not influenced by the risk status of the children.

This study explored regression patterns in 100 children with ASD (3-11 years) using several approaches to enhance the validity of retrospective parent report. Both early development and outcome were examined in regression groups defined by 36 months age cut-off and two underlying empirical patterns based on type and onset age. Results over regression groups were generally consistent. During early development, children with regression showed a similar amount of social atypicalities and stereotyped behaviour as compared to children without regression. However, parents indicated less communication skills which could be a valuable predictor of regression. Development after regression was characterised by early language delay and more restricted and repetitive behaviour. The findings provide insight into the diagnosis and prognosis of regression in ASD.

Identifying the early signs of developmental disability is important for ensuring timely diagnosis and early intervention. Day-care workers may be in a prime position to notice potential developmental deviations, but it is unclear if they can accurately recognize subtle early signs of atypical development. Sixty day-care workers examined home-videos of very young children with fragile X syndrome and typically developing children. Results indicated that most day-care workers can distinguish typical and atypical development in general and might therefore have an important role in early identification. Special work experience and advanced pedagogical training appeared to boost day-care workers' sensitivity to detect atypical features in early development and to provide effective daily surveillance.

Background: Children with autism spectrum disorder (ASD) show substantial variability in their language development. Language problems are highly prevalent in these children. In addition, the quality of early language abilities contributes to the overall development of these children and is highly predictive of their adult outcome. Yet, little is known about language development in children at risk of ASD during the first years of life. Aims: To compare early receptive language (RL) and expressive language (EL) development in children at risk of ASD and determine predictors of language development. Methods & Procedures: Developmental trajectories of RL and EL were investigated from 10 to 36 months of age in younger siblings of typically developing children (LR-sibs, N = 30) and in younger siblings of children with ASD (HR-sibs, N = 31) using the Mullen Scales of Early Learning. Furthermore, both child and demographic characteristics were examined as possible predictors of language development. Outcomes & Results: Both groups showed similar growth curves for RL and EL and the majority of the children showed average (within ±1.5 SD of the mean) or above-average language abilities. Nevertheless, the mean growth of EL was lower and the variation in growth of both RL and EL was higher in HR-sibs than in LR-sibs. Furthermore, early child characteristics were predictive of language development in both groups. Yet, some child characteristics seemed to be of more importance in HR-sibs than in LR-sibs. Consequently, lower non-verbal abilities at 10 months in both groups and a higher degree of ASD characteristics at 14 months in HR-sibs may be indicative of difficulties in language development. Conclusions & Implications: HR-sibs show more variation in their language development than LR-sibs during the first 3 years of life. The majority of HR-sibs, however, did not present with below-average language abilities. Yet, early characteristics of ASD may be a red flag for difficulties in the language development of HR-sibs.

This study compared sibling interactions between 24-month-old children and their older sibling with ASD (high-risk; n = 24) with 24-month-old children and their typically developing older sibling (low-risk; n = 32). First, high-risk sibling pairs showed lower levels of positive behaviour and younger siblings of children with ASD imitated their older sibling less. Second, in the high-risk group positive interactions were positively associated with the youngest child's language abilities. However, this association was no longer significant after controlling for language abilities at 14 months. Third, more total interactions in the high-risk group, both negative and positive, were associated with more ASD characteristics. Thus, early sibling interactions might reveal interesting information in light of the (atypical) developmental trajectories of younger siblings of children with ASD.

This study examined how 34 senior students and first-year college students with autism spectrum disorder, their mothers (n = 34) and fathers (n = 26) navigate the higher education transition, and how this context impacts on dynamics in the parent-child relationships. Semi-structured interviews were analyzed based on grounded theory and dyadic analysis principles. Both parties were confronted with an abundance of challenges and experienced strong feelings of ambivalence, stress and anxiety. Differences in perspectives occurred regarding the construction of adulthood, the acquisition of autonomy, disclosure and subscribing to support services. These differences caused tensions in the parent-child relationship, hindering the transformation of the relationship into an adult-like mutual relationship. Clinical implications are extrapolated on the basis of these findings.

Studies comparing mathematical abilities of children with autism spectrum disorder (ASD) and typically developing children are hitherto scarce, inconclusive, and mainly focusing on elementary school children or adolescents. The present study wants to gain insight into the foundation of mathematics by looking at preschool performances. Five early numerical competencies known to be important for mathematical development were examined: verbal subitizing, counting, magnitude comparison, estimation, and arithmetic operations. These competencies were studied in 20 high-functioning children with ASD and 20 age-matched control children aged 4 and 5 years. Our data revealed similar early number processing in children with and without ASD at preschool age, meaning that both groups did not differ on the foundation of mathematics development. Given the pervasiveness and the family impact of the condition of ASD, this is an important positive message for parents and preschool teachers. Implications and several directions for future research are proposed.

The impact of ASD on parental QOL was evaluated in the EpiTED cohort study at early adulthood. Two-third of parents of young adults with ASD (66.7%) reported that their QoL was at least moderately altered. The perceived impact of ASD on parental QoL was related to the young adults' level of adaptive skills, as well as to symptom severity and the presence of challenging behaviors, which appeared to be the main risk factor. The study of change between adolescence and early adulthood showed that parents whose children had a decrease in challenging behaviors perceived a decreased impact on their QoL. These results argue for the importance to propose specific interventions to target associated challenging behaviors in ASD.

Little is known about use of early interventions for autism spectrum disorder in Europe. Parents of children with autism spectrum disorder aged 7?years or younger (N?=?1680) were recruited through parent organisations in 18 European countries and completed an online survey about the interventions their child received. There was considerable variation in use of interventions, and in some countries more than 20% of children received no intervention at all. The most frequently reported interventions were speech and language therapy (64%) and behavioural, developmental and relationship-based interventions (55%). In some parts of Europe, use of behavioural, developmental and relationship-based interventions was associated with higher parental educational level and time passed since diagnosis, rather than with child characteristics. These findings highlight the need to monitor use of intervention for children with autism spectrum disorder in Europe in order to contrast inequalities.

The transition into higher education constitutes a precarious life stage for students with autism spectrum disorder (ASD). Research on how students with ASD navigate college life is needed for the development of adequate support. This study investigated the challenges and support needs of 23 students with ASD in higher education through semi-structured interviews. Data were analyzed following the principles of Grounded Theory. Students faced difficulties with new situations and unexpected changes, social relationships, problems with information processing and time management and had doubts about disclosure. Facing these challenges simultaneously in the domains of education, student life and daily (independent) living, had a major impact on students' well being. Besides these challenges, students also reported benefits that contributed to success in the three domains. They pointed out to a set of recommendations for support. These findings are linked with previous research and implications for higher education institutions are extrapolated on the basis of these findings.

Research Findings: To date, studies comparing the mathematical abilities of children with autism spectrum disorder (ASD) and typically developing children are scarce, and results remain inconclusive. In general, studies on this topic focus on mathematical abilities learned from elementary school onward, with little attention for possible precursors at younger ages. The current exploratory study focused on the important developmental period of preschool age, investigating 5 early numerical competencies in 30 high-functioning children with ASD and 30 age-matched control children: verbal subitizing, counting, magnitude comparison, estimation, and arithmetic operations. Children were examined at 5 or 6 years of age, attending the 3rd and final year of preschool. Overall, rather similar early number processing was found in children with and without ASD, although marginally significant results indicated a weaker performance of children with ASD on verbal subitizing and conceptual counting. Practice or Policy: Given the pervasiveness and impact of ASD on other domains of functioning, it is important to know that no general deficits in early numerical competencies were found in this study. However, some downward trends in mathematics performance were identified in children with ASD, which can serve as the basis for additional research in this field.

A relationship between motor and mathematical skills has been shown by previous research. However, the question of whether subtypes can be differentiated within developmental coordination disorder (DCD) and/or mathematical learning disability (MLD) remains unresolved. In a sample of children with and without DCD and/or MLD, a data-driven model-based clustering was used to identify subgroups of individuals with relatively homogeneous profiles on measures associated with motor and mathematical skills. One subgroup of children with motor problems was found based on motor variables. Based on mathematical variables, two clinical clusters were found: a subtype with number fact retrieval problems and a subtype with procedural calculation problems. Clustering with motor and mathematical skills revealed two clinical clusters: a cluster with number fact retrieval as well as procedural calculation problems and below average motor and visual-motor integration skills. A second cluster of children had only procedural calculation and visual-motor problems. Our results raise questions about the usefulness of placing children who have below average mathematical skills into a single diagnostic category. Furthermore, we inform ongoing debates about the overlap between DCD and MLD, as below average motor skills were found in both MLD subgroups, although a different motor profile is linked to a different mathematical profile.

Although clinical practitioners often express concerns about the mathematical functioning of children with autism spectrum disorder (ASD), the field of mathematics remains a relatively unexplored topic in individuals with ASD. Moreover, research findings are fragmentary and hold inconclusive results. The present study aimed to examine whether grade 1 (aged 6-7?years) to 4 (aged 9-10?years) elementary school children with ASD scored significantly different from age-adequate norms on mathematics. To this end, a multi-componential approach of mathematics was used. Four domains of mathematics were assessed in 121 children with ASD: procedural calculation, number fact retrieval, word/language problems, and time-related competences. All children attended general education classrooms, following the standard curriculum, and were coached by integrated educational services. Children with ASD showed a strength in word/language problems in second and fourth grade. There was evidence of a weakness for procedural calculation in first grade and for time-related competences in first and third grade. In all other cases, average scores were shown. As such, results revealed a profile of strengths, average abilities, and weaknesses in mathematics and highlighted the importance of focusing on different domains of mathematics. Because a high variability in mathematical performance could be observed, we recommend an individual assessment when considering the mathematical trajectory of children with ASD.

Background: The effect of assisted reproduction technology (ART) on language development is still unclear. Moreover, different techniques are introduced at rapid pace and are not always accompanied by extensive follow-up programmes. Aims: To investigate the language development of 3-10-year-old children born following ART using intracytoplasmic sperm injection (ICSI) combined with assisted oocyte activation (AOA), which is a highly specialized technique applied in cases with a history of fertilization failure following conventional ICSI. Secondly, a comparison is made between the language development of singletons and twins. Methods & Procedures: Twenty children, six boys and 14 girls, born following ICSI combined with AOA and older than 3 years were included in the study. The mean age of the children was 5;4 years (range = 3;1--10;4 years; SD = 1;8 years). Expressive and receptive language development were assessed using the Clinical Evaluation of Language Fundamentals (CELF-IV-NL) for children older than 5 years and the Reynell Developmental Language Scales (RTOS) for children younger than or equal to 5 years. Outcomes & Results: The mean total score for language ability (in percentiles) was 56.8 (SD = 33.6), which corresponds to normal language skills. Significantly higher scores were found for AOA singletons compared with twins. For the general language, none of the children scored within the clinical zone for language disability corresponding with a percentile lower than 5. Conclusion & Implications: This study presents the first data concerning language outcome in 3-10-year-old children born following AOA. General language scores of the AOA children in this study are located within the normal ranges. The language development of singletons was significantly better compared with twins. Although the results are reassuring for language development, in future long-term follow-up studies in this population are necessary.

Since imitation and joint attention are both important abilities for young children and since children with autism spectrum disorder show a range of problems in these domains, imitation and joint attention are important targets for intervention. In this study, we examined the possibility of promoting imitation and joint attention by means of a training programme specifically designed for low-intensity, non-residential treatment. Two matched groups of 18 children each participated in the study. The experimental group, receiving the training programme, improved significantly more on joint attention than the group receiving only treatment as usual. Only the experimental group obtained a significantly higher imitation score during the post-test compared to the pre-test. This study shows that it is possible to promote joint attention with a low-intensity treatment programme. The results concerning imitation are more modest. Future replications should involve measures of stability and generalization.

Children with reading disabilities (RD, n = 17), mathematical disabilities (MD, n = 22), combined reading and mathematical disabilities (RD + MD, n = 28) and control peers (n = 45) were tested on behavioral inhibition with a Go/no-go task in a picture, letter and digit-modality. In contrast to children without RD, children with RD made significantly more commission errors on alphanumeric (letter and digit) modalities compared to the non-alphanumeric picture modality. As compared to children without MD, children with MD made as much commission errors on the picture modality as on the letter modality. No significant interaction-effect was found between RD and MD. These results can be considered as evidence for behavioral inhibition deficits related to alphanumeric stimuli in children with RD but not in children with MD. (Contains 3 tables and 2 figures.)

It has been shown that delayed consumable rewards are discounted to a higher degree than money, which has been referred to as the "domain effect". Until now the effects of reward type on temporal discounting (TD) have mainly been studied in adults. Although there is evidence that children with attention-deficit/hyperactivity disorder (ADHD) tend to show steeper TD of money than typically developing peers or children with autism spectrum disorders (ASD), it remains untested whether the domain effect is also seen in children with ADHD and ASD. To explore this we compared TD of children (8-16 year) with ADHD, ASD and typically developing controls with five different reward types. Seventy-two participants with ADHD, 69 with ASD and 130 controls performed two hypothetical TD-tasks: a monetary TD-task and a TD-task with one of four alternative rewards (material rewards, rewarding activities, food, social rewards). TD was seen for all reward types, but the rate of discounting was steeper for food, praise and rewarding activities compared to money, and for food and praise compared to material rewards. For the ADHD and control groups, but not the ASD group, money and material rewards were equally highly discounted. High correlations between TD of money and of activities, food and material rewards were found. In conclusion, a domain effect was observed in typically developing children, as well as in children with ADHD or ASD, although the pattern was somewhat different for ASD children. Despite this domain effect, there is also evidence for a domain-general aspect in TD. (Contains 3 tables and 4 figures.)

Since their discovery in the early 1990s, mirror neurons have been proposed to be related to many social-communicative abilities, such as imitation. However, research into the early manifestations of the putative neural mirroring system and its role in early social development is still inconclusive. In the current EEG study, mu suppression, generally thought to reflect activity in neural mirroring systems was investigated in 18- to 30-month-olds during the observation of object manipulations as well as mimicked actions. EEG power data recorded from frontal, central, and parietal electrodes were analysed. As predicted, based on previous research, mu wave suppression was found over central electrodes during action observation and execution. In addition, a similar suppression was found during the observation of intransitive, mimicked hand movements. To a lesser extent, the results also showed mu suppression at parietal electrode sites, over all three conditions. Mu wave suppression during the observation of hand movements and during the execution of actions was significantly correlated with quality of imitation, but not with age or language level. (Contains 2 figures and 2 tables.)

During writing, perceptual, motor, and cognitive processes interact. This study explored the predictive value of several factors on handwriting quality as well as on speed in children with Autism Spectrum Disorder (ASD). Our results showed that, in this population, age, gender, and visual-motor integration significantly predicted handwriting quality, whereas age, reading abilities, and fine motor coordination had an impact on handwriting speed. These results indicate that, although reading abilities are often overlooked, handwriting remediation in children with ASD should tackle reading skills as well. (Contains 7 tables.)

Although imitation problems have been associated with autism for many years, the underlying mechanisms of these problems remain subject to debate. In this article, the question whether imitation problems are caused by selection or correspondence problems is explored and discussed. This review revealed that hypotheses on the nature of imitation problems in autism are complicated and inconclusive at the present time. There is some evidence for impaired selection, especially implicating poor preferential attention to biological motion and poor ascription of intention to action. There is also some evidence that both transformations of perspectives and mapping of visual to motor information are impaired, characterized as correspondence problems. However, it is not yet clear how poor selection processes contribute to correspondence problems and vice versa. Insight in this interaction may provide a valuable contribution to our understanding of imitation problems in autism. For further research we recommend that tasks should be constrained to target as few mechanisms as possible in given experiments.

Elementary school children with reading disabilities (RD; "n" = 17), mathematical disabilities (MD; "n" = 22), or combined reading and mathematical disabilities (RD+MD; "n" = 28) were compared to average achieving (AA; "n" = 45) peers on working memory measures. On all working memory components, 2 (RD vs. no RD) × 2 (MD vs. no MD) factorial ANCOVAs revealed clear differences between children with and without RD. Children with MD had lower span scores than the AA children on measures of the phonological loop and the central executive. A significant interaction effect between RD and MD was found only for listening recall and had a small, partial effect size. In addition, analyses showed that the best logistic regression model consisted of a visuospatial and a central executive task. The model significantly distinguished between the AA and clinical groups and between the MD and RD+MD groups. Evidence was found for domain-general working memory problems in children with learning disabilities. Management of working memory loads in structured learning activities in the classroom, at home, or during therapy may help these children to cope with their problems in a more profound manner.

It has been difficult to differentiate attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in terms of some aspects of their cognitive profile. While both show deficits in executive functions, it has been suggested that they may differ in their response to monetary reward. For instance, children with ADHD prefer small immediate over large delayed rewards more than typically developing controls. One explanation for this is that they discount the value of rewards to a higher degree as they are moved into the future. The current study investigated whether children with ADHD can be differentiated from those with ASD in terms of reward discounting. Thirty-nine children (8-16 y) with ADHD, 34 children with ASD and 46 typically developing controls performed a hypothetical monetary temporal discounting task. Participants were instructed to make repeated choices between small variable rewards (0, 5, 10, 20, 30[Euro]) delivered immediately and large rewards delivered after a variable delay. Children with ADHD but not ASD discounted future rewards at a higher rate than typically developing controls. These data confirm steeper discounting of future rewards in ADHD and add to a small but growing literature showing that the psychological profile of ADHD can be distinguished from that of ASD in terms of disrupted motivational processes. (Contains 2 tables and 2 figures.)

In a sample of 39 children with mathematical learning disabilities (MLD) and 106 typically developing controls belonging to three control groups of three different ages, we found that visual perception, motor skills and visual-motor integration explained a substantial proportion of the variance in either number fact retrieval or procedural calculation. Furthermore, children with MLD performed significantly worse on visual perception, motor skills and visual-motor integration in comparison with age-matched control children. A mild developmental delay in visual perception, visual-motor integration and (fine) motor coordination and a severe delay in motor skills were found in children with MLD. However, not all children with MLD have problems on these domains. They seem to be a heterogeneous group, not only with respect to their mathematical profile but also with respect to their visual perceptual, motor and visual-motor integration skills. Diagnostic implications are discussed. (Contains 6 tables.)

Background: Fluctuations in attention-deficit hyperactivity disorder (ADHD) symptoms related to regulatory deficits in arousal states are themselves characterized by circadian rhythms. Although cortisol is an important circadian arousal-related marker, studies focusing on across-the-day cortisol variations in ADHD are scarce. There is no study with multiple measurements to take into account interday and intraday variability. Methods: Salivary cortisol was sampled five times a day (awakening, 30 min after awakening, noon, 4 p.m., 8 p.m.) across five consecutive days in 33 children with ADHD (22 with and 11 without oppositional defiant disorder; ODD) and 33 class- and sex-matched controls (aged 6-12). The cortisol awakening response (increase from awakening to 30 min after awakening) and the diurnal cortisol profile (across-the-day variations) were compared for ADHD with ODD (ADHD + ODD) and without ODD (ADHD) subgroups and the control group. Results: The cortisol awakening response was not significantly different between groups. However, longitudinal analyses to evaluate cortisol profiles across the day revealed a significant Group x Time effect (p less than 0.001). More specifically, compared to each other, the ADHD subgroup showed a flatter slope with relative morning hypo-arousal and evening hyperarousal, whereas the ADHD + ODD subgroup showed a steeper slope with relative morning hyperarousal and evening hypo-arousal (p less than 0.001). Conclusions: Findings support time-related arousal disruptions in children with ADHD associated with the presence or absence of ODD comorbidity. We recommend research on cortisol in larger samples for a better understanding of arousal mechanisms involved in ADHD not only with and without ODD but also with other comorbidities which may have implications for timing of arousal-based treatments.

From the moment infants are born, they seem to prefer orienting to social stimuli, over objects and non-social stimuli. This preference lasts throughout adulthood and is believed to play a crucial role in social-communicative development. By following up a group of infants at the age of 6, 8, and 12 months, this study explored the role of social orienting in the early development of joint attention skills. The expected association between social orienting and joint attention was partially confirmed. Social orienting in real-life photographs of everyday situations was not related to later joint attention skills, however fixation to the eyes in a neutral face was related to response to joint attention skills, and fixation to the eyes in a dynamic video clip of a talking person was predictive of initiating joint attention skills. Several alternative interpretations of the results are discussed. (Contains 3 figures and 3 tables.)

Objective: To examine the factor structure of attention-deficit/hyperactivity disorder (ADHD) in a clinical sample of 1,373 children and adolescents with ADHD and their 1,772 unselected siblings recruited from different countries across a large age range. Hierarchical and correlated factor analytic models were compared separately in the ADHD and sibling samples, across three different instruments and across parent and teacher informants. Specific consideration was given to factorial invariance analyses across different ages and different countries in the ADHD sample. Method: A sample of children and adolescents between 5 and 17 years of age with ADHD and their unselected siblings was assessed. Participants were recruited from seven European countries and Israel. ADHD symptom data came from a clinical interview with parents Parental Account of Childhood Symptoms and questionnaires from parents and teachers (Conners Parent and Teacher). Results: A hierarchical general factor model with two specific factors best represented the structure of ADHD in both the ADHD and unselected sibling groups, and across informants and instruments. The model was robust and invariant with regard to age differences in the ADHD sample. The model was not strongly invariant across different national groups in the ADHD sample, likely reflecting severity differences across the different centers and not any substantial difference in the clinical presentation of ADHD. Conclusions: The results replicate previous studies of a model with a unitary ADHD component and separable specific traits of inattention and hyperactivity/impulsivity. The unique contribution of this study was finding support for this model across a large developmental and multinational/multicultural sample and its invariance across ages.

Whilst impairments in joint attention, imitation, and pretend play are well documented in children with autism spectrum disorder (ASD), the developmental trajectories of these symptoms remain unknown. The main objective was to explore these trajectories in a sample of children at risk for ASD between the ages of 2 and 4 years. After screening positive for ASD, 17 children were prospectively followed with 6-monthly assessments of social communicative skills and general development. During this study, 9 children were diagnosed with ASD. Results showed that there was growth in imitation skills and in pretend play ability. Also, a slightly increased amount of initiation of joint attention was noted. However, the quality of joint attention behaviours did not significantly improve and growth rates did not significantly differ between children with ASD and non-ASD cases. There was a great intra-individual variability, especially in the performances on the imitation tasks. Also interindividual variability was apparent: some children with ASD showed a delayed development of imitation or pretend play, whereas others had a more clearly deviant developmental profile. The importance of looking at individual trajectories and variability in the study of social communicative development in children with ASD is discussed. (Contains 2 tables and 3 figures.)

It is generally accepted that joint attention skills are impaired in children with autism spectrum disorder (ASD). In this study, social preference, attention disengagement and intention understanding, assumed to be associated with the development of joint attention, are explored in relation to joint attention skills in children with ASD at the age of 36 months. Response to joint attention was related to intention understanding, whereas the number of joint attention initiations was associated with attention disengagement, and somewhat less stronger with social preference. The level on which children initiated joint attention was related to social preference. Possible interpretations of these findings are discussed. (Contains 3 tables and 2 figures.)

Background: Children with attention deficit/hyperactivity disorder (ADHD) display abnormalities in reward processing. Most reward studies have focused on the effects of material or monetary rewards. Studies with autism spectrum disorder (ASD) have focused on social rewards. In this study we compared the effects of amount and type of reward in children with ADHD and those with ASD. Methods: Two adapted versions of the Monetary Incentive Delay Task were used to study the effects of monetary and social reward anticipation on performance in 40 typically developing (TD) children and adolescents (8-16y), 35 children and adolescents with ADHD and 31 children and adolescents with ASD. Results: Monetary and social reward improved accuracy and response time (RT) in all groups. The higher the anticipated reward, the more accurate and faster were responses. Independent of these effects, there was a differential effect of reward type. Both clinical groups, but not TD, responded faster for monetary than social rewards. Conclusions: The results, while not supporting hyposensitivity to changes in reward amount in ADHD and ASD, do suggest that both groups are generally less motivated in settings where social as opposed to monetary rewards can be earned.

The present study sought to examine imitation difficulties as a risk factor for autism. Imitation aptitude was examined in 86 preschoolers suspected of autism (1.9-4.5 years) using the Preschool Imitation and Praxis Scale (PIPS). Differences between imitation, language, motor age-equivalents and nonverbal mental age were used to predict the diagnosis of autism. Multidisciplinary team diagnoses and ADOS-G classifications were used to differentiate children with autism spectrum disorders and non-spectrum developmental disorders. Two factors were found to be significantly associated with autism using simple logistic regression analyses: procedural imitation delay and receptive language delay. In a multivariable setting, only procedural imitation delay remained a significant predictor of autism. Results are new to the literature and require replications.

In research on theory of mind (ToM) in individuals with an autism spectrum disorder (ASD) mainly static mind-reading tasks were used. In this study both a static (Eyes Test) and a more naturalistic (empathic accuracy task) ToM measure were used to investigate the perspective taking abilities of adolescents with ASD (n = 13), adolescents with attention-deficit/hyperactivity disorder (ADHD; n = 13) and typically developing adolescents (n = 18). An innovative aspect concerns the standard stimulus tapes of the empathic accuracy task, which showed interactions between dyads of one adolescent with ADHD and one adolescent without ADHD. In this way, we were able to compare the "readability" of the thoughts and feelings of adolescents with and without ADHD. The results clearly demonstrate the impairment in perspective taking abilities of adolescents with ASD, both on the static and naturalistic mind-reading task. Moreover, the empathic accuracy task seems to be a useful and promising method to assess ToM abilities in adolescents, with or without clinical problems. Finally, thoughts and feelings of target persons with ADHD seemed to be less easy to read than the thoughts and feelings of typically developing target persons. (Contains 6 tables.)

The goal of this study was to develop and subsequently evaluate the internal construct and criterion-related validity of the Preschool Imitation and Praxis Scale (PIPS). Different task characteristics were selected considered to be important as unravelled in research in apraxic adults to tap a broad range of possible imitation mechanisms. Participants included 498 children without disabilities (1-4.9 years) and 47 children with autism spectrum disorders (ASD) (1.9-4.5 years). Exploratory factor analysis disclosed 4 dimensions in the scale, labelled: goal directed versus non-goal directed procedural imitation and single versus sequential bodily imitation. Internal consistency for the PIPS scale (alpha = 0.97) and subscales was high (alpha ranged from 0.79 to 0.96). In both samples, the PIPS scale score was strongly related to age (r = 0.78, respectively r = 0.56). Significant relationships between the PIPS score and mental, language, motor ages in the ASD sample supported criterion-related validity (r ranged from 0.59 to 0.74). The PIPS appears to have fundamentally sound psychometric characteristics, although more research is needed. (Contains 3 tables.)

Although imitation problems have been associated with autism for many years, the issue if these problems are a core deficit in autism remains subject of debate. In this review article, the question if autism imitation problems fulfil the criteria of uniqueness, specificity, universality, persistency, precedence and broadness is explored and discussed. Findings of this review suggest that there is only partial evidence for the idea that imitation problems are unique, specific and broad to autism, and that these problems are long-lasting and persistent. In addition, imitation problems seem not to be universal in autism at an early age. Mental and motor impairment may affect imitation performance but they do not seem to explain imitation problems in a sufficient way. Recommendations for clinical practice are formulated.

In this study the social behaviour of young children with autism spectrum disorder (ASD) and their mothers is compared within two different dyads: a dyad consisting of a mother and her own child and a dyad consisting of a mother and an unfamiliar child. Mothers did not change the frequency of their social initiatives and responsiveness with an unfamiliar child, but they became less directive than with their own child. Children with ASD did not show significantly better social behaviour with their own mother than with an unfamiliar mother. The results suggest that the social behaviour of a child with autism is not significantly enhanced by the familiarity of the social partner, but rather by the partner's autism-adapted interaction style. Clinical implications of these findings have been discussed. (Contains 4 tables and 1 note.)

Despite increased interest in the role of effortful control (EC) in developmental disorders, few studies have focused on EC in autism spectrum disorders (ASD) and no study so far has directly compared children with ASD and children with ADHD. A first aim of this study was to investigate whether typically developing (TD) boys, boys with ADHD and boys with ASD can be differentiated based on EC levels. A second aim was to evaluate the relationship between EC and symptoms of ADHD and ASD. We assessed EC in 27 TD boys, 27 boys with ADHD and 27 boys with ASD (age 10-15) using different EC questionnaires. Clinical groups scored lower than the TD group on all EC total scales, but could only be differentiated from each other by means of self-reported persistence, impulsivity and activation control. Our data suggest that although EC is useful in differentiating TD boys from clinical groups, it is less efficient in distinguishing ADHD from ASD. Also, results suggest that EC plays a role in the manifestation of symptoms of both ADHD and ASD and that high levels of EC enable children to function more adequate in daily situations. (Contains 2 tables.)

This study investigated how siblings of children with autism spectrum disorder (ASD) describe and define their quality of life. Using a qualitative research design, the authors collected data through a 4-stage process which included in-depth interviews of 17 children ages 6 to 14 and focus groups. All of the children with ASD were male and between the ages of 5 and 16 with mild to moderate impairments; all of the participating families lived in a Dutch-speaking region of Belgium. Analyzing data according to the principles of grounded theory resulted in the identification of 9 domains of sibling quality of life (SibQol). The apparent invisibility of ASD emerged as an important theme. Results indicate that siblings of children with ASD can define their quality of life, that unique characteristics of ASD give the siblings' experience a highly personal interpretation, and that the SibQol concept can be used to support siblings of children with ASD. (Contains 1 table.)

A new screening instrument for ASD was developed that can be filled out by child care workers: the Checklist for Early Signs of Developmental Disorders (CESDD). The predictive validity of the CESDD was evaluated in a population of 6,808 children between 3 and 39 months attending day-care centres in Flanders. The CESDD had a sensitivity of 0.80 and a specificity of 0.94. Based on the screening procedure used in this study, 41 children were diagnosed with ASD or got a working diagnosis of ASD. Thus, including child care workers' report on signs of ASD in screening procedures can help to identify cases of ASD at a young age.

Objective: Although twin and family studies have shown attention-deficit/hyperactivity disorder (ADHD) to be highly heritable, genetic variants influencing the trait at a genome-wide significant level have yet to be identified. As prior genome-wide association studies (GWAS) have not yielded significant results, we conducted a meta-analysis of existing studies to boost statistical power. Method: We used data from four projects: a) the Children's Hospital of Philadelphia (CHOP); b) phase I of the International Multicenter ADHD Genetics project (IMAGE); c) phase II of IMAGE (IMAGE II); and d) the Pfizer-funded study from the University of California, Los Angeles, Washington University, and Massachusetts General Hospital (PUWMa). The final sample size consisted of 2,064 trios, 896 cases, and 2,455 controls. For each study, we imputed HapMap single nucleotide polymorphisms, computed association test statistics and transformed them to z-scores, and then combined weighted z-scores in a meta-analysis. Results: No genome-wide significant associations were found, although an analysis of candidate genes suggests that they may be involved in the disorder. Conclusions: Given that ADHD is a highly heritable disorder, our negative results suggest that the effects of common ADHD risk variants must, individually, be very small or that other types of variants, e.g., rare ones, account for much of the disorder's heritability. (Contains 3 figures and 3 tables.)

In a 3-year longitudinal study, 471 children were classified, based on their performances on arithmetic tests in first and second grade, as having persistent arithmetic disabilities (AD), persistent low achieving (LA), persistent typical achieving, inconsistent arithmetic disabilities (DF1), or inconsistent low achieving in arithmetic. Significant differences in the performances on the magnitude comparison in kindergarten (at age 5-6) were found between the AD and LA and between the AD and DF1 groups. Furthermore, the percentage of true-positive AD children (at age 7-8) correctly diagnosed in kindergarten by combination of procedural counting, conceptual counting, and magnitude comparison tasks was 87.50%. When composing clinical samples, researchers should pay attention when stipulating restrictive or lenient cutoffs for arithmetic disabilities and select children based on their scores in 2 consecutive years, because the results of studies on persistent low achievers or children with inconsistent disabilities cannot be generalized to children with persistent arithmetic disabilities. (Contains 7 tables.)

The parenting experiences of mothers in a family with a child with autism spectrum disorder (ASD) and a typically developing (TD) child were studied using a qualitative analysis of mothers' perceptions of the impact of autism on family and personal life. An additional quantitative comparison was performed to evaluate the effect of ASD on mothers' parenting cognitions about their other, TD child. Mothers differentiated clearly in parenting cognitions about their child with ASD and about their TD child. Strong associations were found between mothers' symptoms of stress and depression, and their parenting cognitions about both their children. To maximize intervention outcome, family interventionists should consider parenting experiences and should become aware of interfering maternal feelings and cognitions, such as guilt or low parental self-efficacy beliefs. (Contains 2 tables.)

Counting abilities have been described as determinative precursors for a good development of later arithmetic abilities. Mastery of the stable order, the one-one-correspondence and the cardinality principles can be seen as essential features for the development of counting abilities. Mastery of the counting principles in kindergarten was assessed in a large group of children with a broad range of arithmetic abilities (N = 423). Not all children mastered the counting principles by the end of kindergarten. Mastery of the counting principles in kindergarten was predictive for arithmetic abilities one year later in first grade, especially for scores on arithmetic achievement tests. Children sharing a common educational background tend to have more similar scores on arithmetic tests, yet the importance of mastery of the essential counting principles in the prediction of later arithmetic achievement was the same for all classrooms. (Contains 4 tables.)

The nature of the comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and Reading Disability (RD) was examined using a double dissociation design. Children were between 8 and 12 years of age and entered into four groups: ADHD only (n = 24), ADHD+RD (n = 29), RD only (n = 41) and normal controls (n = 26). In total, 120 children participated in the study; 38 girls and 82 boys. Both ADHD and RD were associated with impairments in inhibition and lexical decision, although inhibition and lexical decision were more severely impaired in RD than in ADHD. Visuospatial working memory deficits were specific to children with only ADHD. It is concluded that there was overlap on lexical decision and to a lesser extent on inhibition between ADHD and RD. In ADHD, impairments were dependent on IQ, which suggest that the overlap in lexical decision and inhibition is different in origin for ADHD and RD. The ADHD only group was specifically characterized by deficits in visuospatial working memory. Hence, no double dissociation between ADHD and RD was found on executive functioning and lexical decision.