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Lay Abstract: The early detection of autism spectrum disorder can lead to access to autism spectrum disorder-specific services that have been shown to have a large impact on a child's overall development. Although a stable diagnosis of autism spectrum disorder can be made by age 2 years, most children are not diagnosed until much later. To address this issue, this study examined the effectiveness of training Part C Early Intervention providers to use an interactive autism spectrum disorder screening tool, the Screening Tool for Autism in Toddlers. Sixty-nine providers attended a 1-day training workshop on the use of the Screening Tool for Autism in Toddlers. After the workshop, providers reported increased knowledge about recognizing the early signs of autism spectrum disorder, and about 45% of the providers reported using the Screening Tool for Autism in Toddlers with families in their caseloads 18 months after the training. These results suggest that the Screening Tool for Autism in Toddlers is feasible for use within Early Intervention settings. In addition, they suggest that specific providers might serve as a screening "point-person," rather than expecting the Screening Tool for Autism in Toddlers to be used by all providers. Future research should aim to identify specific characteristics of agencies or providers that might be best suited for using the Screening Tool for Autism in Toddlers.

The Screening Tool for Autism in Toddlers (STAT) is a validated stage-2 autism spectrum disorder (ASD) screening measure that takes 20 minutes to administer and comprises 12 play-based items that are scored according to specific criteria. This study examines an expanded version (STAT-E) that includes the examiner's subjective ratings of children's social engagement (SE) and atypical behaviors (AB) in the scoring algorithm. The sample comprised 238 children who were 24-35 months old. The STAT-E assessors had limited ASD experience to mimic its use by community-based non-specialists, and were trained using a scalable web-based platform. A diagnostic evaluation was completed by clinical experts who were blind to the STAT-E results. Logistic regression, ROC curves, and classification matrices and metrics were used to determine the screening properties of STAT-E when scored using the original STAT scoring algorithm versus a new algorithm that included the SE and AB ratings. Inclusion of the SE and AB ratings improved positive risk classification appreciably, while the specificity declined. These results suggest that the STAT-E using the original STAT scoring algorithm optimizes specificity, while the STAT-E scoring algorithm with the two new ratings optimizes the positive risk classification. Using multiple scoring algorithms on the STAT may provide improved screening accuracy for diverse contexts, and a scalable web-based tutorial may be a pathway for increasing the number of community providers who can administer the STAT and contribute toward increased rates of autism screening., (© 2022 International Society for Autism Research and Wiley Periodicals LLC.)

Objective: To determine whether an intervention addressing both logistical and knowledge barriers to early screening for autism spectrum disorder (ASD) increases evidence-based screening during 18-month well-child visits and primary care providers' (PCPs') perceived self-efficacy in caring for children with ASD., Methods: Forty-six PCPs from 10 diverse practices across four counties in Washington State participated. PCPs attended a 2-hour training workshop on early recognition and care for toddlers with ASD and use of a REDCap-based version of the Modified Checklist for Autism in Toddlers-Revised with Follow-up (webM-CHAT-R/F) that provided automated presentation and scoring of follow-up questions. Data were collected at baseline and 6 months following each county's training window. PCPs' screening methods and rates and perceived self-efficacy regarding ASD care were measured by self-report and webM-CHAT-R/F use was measured via REDCap records., Results: At follow-up, 8 of the 10 practices were using the webM-CHAT-R/F routinely at 18-month visits. The proportion of PCPs reporting routine M-CHAT screening increased from 82% at baseline to 98% at follow-up (16% increase, 95% confidence interval [CI] 3%-28%; McNemar exact P = .02). The proportion using the M-CHAT-R/F follow-up interview questions increased from 33% to 82% (49% increase, 95% CI 30%-68%, exact McNemar test, P < .001). Significant increases in self-efficacy were found for all seven areas assessed (Ps ≤ .008)., Conclusions: This brief intervention increased PCPs' self-reported valid use of the M-CHAT-R/F at 18 months and their self-efficacy regarding ASD care. Combining educational information with a web-based ASD screen incorporating the M-CHAT-R/F follow-up questions may increase universal ASD screening with improved fidelity., (Copyright © 2021 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

The COVID-19 pandemic has posed unique challenges for families and caregivers, as well as for autism-focused clinicians, who are faced with providing a thorough and accurate evaluation of children's specific needs and diagnoses in the absence of in-person assessment tools. The shift to telehealth assessments has challenged clinicians to reconsider approaches and assumptions that underlie the diagnostic assessment process, and to adopt new ways of individualizing standard assessments according to family and child needs. Mandates for physical distancing have uncovered deficiencies in diagnostic practices for suspected autism and have illuminated biases that have posed obstacles preventing children and families from receiving the services that they truly need. This Commentary outlines several considerations for improving diagnostic practices as we move forward from the current pandemic and continue to strive to build an adaptable, sustainable, equitable, and family-centered system of care. LAY SUMMARY: Physical distancing and the abrupt end to in-person services for many children on the autism spectrum has forced clinicians to examine the existing challenges with autism spectrum disorder (ASD) diagnostic assessment and consider things they want to keep and things that should be changed in the years ahead. New approaches such as telehealth both alleviated and exacerbated existing disparities, and brought into stark focus the importance of equitable and timely access to family-centered care. This commentary suggests ways of improving clinical practices related to ASD assessment to continue along this path., (© 2021 International Society for Autism Research and Wiley Periodicals LLC.)

Lay Abstract: Determining whether a young child has an autism spectrum disorder requires direct observation of the child and caregiver report of the child's everyday behaviors. There are few interviews for parents that are specifically designed for children under 3 years of age. The Toddler Autism Symptom Inventory is a new interview that asks caregivers of children age 12-36 months about symptoms of possible autism spectrum disorder. The Toddler Autism Symptom Inventory uses a cutoff score to indicate likelihood for autism spectrum disorder; this cutoff score appears to accurately identify most children who are diagnosed with autism spectrum disorder without identifying too many who do not have autism spectrum disorder. The Toddler Autism Symptom Inventory interview can help clinicians to determine whether a young child shows symptoms suggestive of an autism spectrum disorder.

Lay Abstract: Children with autism show more social-communication symptoms and repetitive behaviors than children with typical development or those diagnosed with other developmental disorders; however, non-autistic children often show some behaviors that are associated with autism. We compared the behavioral reports from caregivers of children in these three groups to identify the behaviors that were specific to autism. Children with autism were found to show more of these behaviors, and behaviors that are particularly indicative of autism were identified. These behaviors included social symptoms (approaching others to interact, showing things, looking back while showing, responding to an approaching child, spontaneous imitation) and repetitive behavior symptoms (specific, inflexible play, unusual body movements, strong specific interest, carrying around an unusual object, sensory seeking, and sensory hyper-reactivity).These findings may aid professionals in determining the most appropriate diagnosis for a child between the ages of 12 and 36 months.

Objective: Most autism spectrum disorder (ASD) screening measures have been developed for use with low-risk (LR) children; however, measures may perform differently in high-risk (HR) younger sibling populations. The current study sought to investigate the performance of an ASD screening measure, the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F), in a sample of HR younger siblings and directly compared its performance with that in an LR sample., Methods: High-risk younger siblings (n = 187) and LR children (n = 15,848) were screened using the M-CHAT-R/F. Screen-positive children completed comprehensive evaluations. The M-CHAT-R/F psychometric properties and clinical characteristics were compared across the samples., Results: The M-CHAT-R/F demonstrated a significantly higher screen-positive rate and ASD detection rate in the HR sample compared with the LR sample. Children with ASD in the HR sample had stronger verbal, nonverbal, and overall cognitive abilities compared with children with ASD in the LR sample despite comparable ASD severity and adaptive functioning. High positive predictive value of the M-CHAT-R at initial screen, with only incremental change after Follow-Up, suggests that Follow-Up is less critical in HR than LR samples. A significantly lower number of changed responses during Follow-Up further supports improved reporting accuracy of parents with ASD experience compared with parents less familiar with ASD., Conclusion: The findings suggest that the M-CHAT-R/F can distinguish between ASD and non-ASD at 18 to 24 months in an HR sibling sample, with performance comparable with or better than its performance in the general population.

Few behavioral indices of risk for autism spectrum disorders (ASD) are present before 12 months, and potential biomarkers remain largely unexamined. This prospective study of infant siblings of children with ASD (n = 16) and low-risk comparison infants (n = 15) examined group differences in event-related potentials (ERPs) indexing processing of facial positive affect (N290/P400, Nc) at 9 months and their relation to joint attention at 15 months. Group differences were most pronounced for subtle facial expressions, in that the low-risk group exhibited relatively longer processing (P400 latency) and greater attention resource allocation (Nc amplitude). Exploratory analyses found associations between ERP responses and later joint attention, suggesting that attention to positive affect cues may support the development of other social competencies.

Most research into the epidemiology, etiology, clinical manifestations, diagnosis and treatment of autism is based on studies in high income countries. Moreover, within high income countries, individuals of high socioeconomic status are disproportionately represented among participants in autism research. Corresponding disparities in access to autism screening, diagnosis, and treatment exist globally. One of the barriers perpetuating this imbalance is the high cost of proprietary tools for diagnosing autism and for delivering evidence-based therapies. Another barrier is the high cost of training of professionals and para-professionals to use the tools. Open-source and open access models provide a way to facilitate global collaboration and training. Using these models and technologies, the autism scientific community and clinicians worldwide should be able to work more effectively and efficiently than they have to date to address the global imbalance in autism knowledge and at the same time advance our understanding of autism and our ability to deliver cost-effective services to everyone in need., (© 2015 The Authors Autism Research published by Wiley Periodicals, Inc. on behalf of International Society for Autism Research.)

Positive emotional engagement develops in the context of face-to-face interactions during the first 6 months of life. Deficits in emotional engagement are characteristic of autism spectrum disorder (ASD) and may characterize the younger siblings of children with ASD (high-risk siblings). High-risk siblings are likely to exhibit a broad range of positive emotional engagement that may or may not be associated with ASD outcomes. We examined positive emotional engagement (i.e., smiling rate and contingent responsiveness to the partner's smile) during the infant-parent interaction episodes of the face-to-face/still face protocol at 6 months of age. The sample included 43 high-risk infant siblings, 11 of whom went on to an ASD diagnosis, and 25 low-risk siblings with no family history of ASD. Low-risk siblings and high-risk siblings without ASD showed the typical still-face effect (i.e., decreases in smiling rate after period of parental nonresponsiveness), but high-risk siblings with later ASD outcomes did not show this decrease. Although high-risk siblings without an ASD diagnosis were less likely to respond to their parents' smiles than were low-risk siblings, the children with eventual ASD did not differ from the other groups in contingent responsiveness. Findings suggest that subtle differences in positive emotional engagement are present in the early development of high-risk siblings but are not consistently associated with ASD outcomes., ((c) 2015 APA, all rights reserved).)

The increased prevalence of autism spectrum disorder and documented benefits of early intensive intervention have created a need for flexible systems for determining eligibility for autism-specific services. This study evaluated the effectiveness of a training program designed to enhance autism spectrum disorder identification and assessment within community pediatric settings across the state. Twenty-seven pediatric providers participated in regional trainings across a 3.5-year period. Trainings provided clinicians with strategies for conducting relatively brief within-practice interactive assessments following positive autism spectrum disorder screenings. Program evaluation was measured approximately 1.5 years following training through (a) clinician self-reports of practice change and (b) blind diagnostic verification of a subset of children assessed. Pediatric providers participating in the training reported significant changes in screening and consultation practices following training, with a reported 85% increase in diagnostic identification of children with autism spectrum disorder within their own practice setting. In addition, substantial agreement (86%-93%) was found between pediatrician diagnostic judgments and independent, comprehensive blinded diagnostic evaluations. Collaborative training methods that allow autism spectrum disorder identification within broader community pediatric settings may help translate enhanced screening initiatives into more effective and efficient diagnosis and treatment., (© The Author(s) 2013.)

Facilitative linguistic input directly connected to children's interest and focus of attention has become a recommended component of interventions for young children with autism spectrum disorder (ASD). This longitudinal correlational study used two assessment time points and examined the association between parental undemanding topic-continuing talk related to the child's attentional focus (i.e., follow-in comments) and later receptive language for 37 parent-child dyads with their young (mean = 21 months, range 15-24 months) children with autism symptomology. The frequency of parental follow-in comments positively predicted later receptive language after considering children's joint attention skills and previous receptive language abilities.

The study investigated whether infant siblings of children with autism (sibs-ASD) process familiar and novel faces differently from typical infants and whether sensitivity to face familiarity is associated with infants' social and communicative behaviors. Visual event-related potentials (ERPs) were recorded in 35 infants, age 9 months ± 15 days (20 typical infants, 15 sibs-ASD) using an oddball paradigm presenting photographs of infants' mothers (70% of trials) and an unfamiliar female (30% of trials). Eye tracking responses to a different unfamiliar face were recorded to determine whether differences in gaze patterns might account for any ERP differences found. There were no group differences in the distribution, number or duration of fixations. Both infant groups differentiated between mothers and strangers, as reflected in amplitude modulations of posterior N290/P400 and frontal/central Nc responses. Group differences were present in the latency of the P400 response, where a delayed response to the stranger face was observed only in typical infants. Across both groups, shorter Nc latency to mother's face was associated with parental reports of stronger interpersonal skills. Individual differences in the speed of processing for novel vs. familiar faces may be an informative early marker of risk for atypical social development., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Lack of familiarity with early signs of autism by community service providers has resulted in significant delays in children receiving early intervention services necessary to improve long-term outcomes. The Screening Tool for Autism in Toddlers and Young Children (STAT) was specifically developed to identify early behavioral features of autism. Although STAT training has been available for years, access is limited because of few STAT trainers and geographic concerns. This study evaluated the efficacy and acceptability of Web-based training of the STAT as a means of increasing accessibility to this training., Materials and Methods: Thirty professionals from three geographic areas participated. Roughly 1 of 3 had little or no training on autism assessment. The tutorial contains a general overview, administration and scoring conventions, and item-specific content and concepts. Participants completed a pretest and then completed the STAT tutorial at their own pace, followed by a post-test and a user satisfaction questionnaire., Results: Mean scores on STAT concepts significantly improved after taking the tutorial (p<0.001). At pretest, only 1 person (3%) obtained correct scores on at least 80% of the items (a priori cutoff for a "pass"), compared with 22 (73%) at post-test (p<0.001). The majority of trainees enjoyed taking the tutorial, thought it was well organized, relevant, interesting, and useful, and felt it was easy to understand and operate., Discussion: Results support Web-based training as a promising method for promoting early identification of autism and may help overcome problems associated with the critical shortage of autism-screening professionals.

Sleep difficulties in children with autism spectrum disorders are common, with poor sleep hygiene a contributing factor. We developed the Family Inventory of Sleep Habits to measure sleep hygiene in this population. Its validity and reliability in 2 groups of children aged 4 to 10 years, those with a clinical diagnosis of autism spectrum disorders, and those who are typically developing are described. In both groups, total and modified (reflecting insomnia subscales) scores on the Children's Sleep Habits Questionnaire showed significant negative correlations with the total score. The Peabody Picture Vocabulary Test-III was significantly correlated with total score in the autism spectrum group but not in the typically developing group. Age and socioeconomic status were not correlated with total score in either group. This preliminary work suggests that the Family Inventory of Sleep Habits is a valid and reliable measure of sleep hygiene in autism spectrum disorders.

The study examined the properties of the Screening Tool for Autism in Two-Year-Olds (STAT) for children under 24 months. The STAT provides a standard context for observing social-communicative behavior in play, imitation, and communication. Seventy-one children received the STAT between 12 and 23 months of age and a follow-up diagnostic evaluation after 24 months. All had an older sibling with an autism spectrum diagnosis (n=59) or had been referred for evaluation for concerns about autism (n=12). Signal detection analysis resulted in a cut score of 2.75 for this sample, which yielded a sensitivity of 0.95, specificity of 0.73, positive predictive value of 0.56, and negative predictive value of 0.97. False positives were highest for the 12- to 13-month-old age group; STAT screening properties were improved when the sample was limited to children 14 months and older. Implications for using the STAT with children under 24 months are discussed.

Background: Few studies have examined the variability in outcomes of children diagnosed with autism spectrum disorder (ASD) at age 2. Research is needed to understand the children whose symptoms - or diagnoses - change over time. The objectives of this study were to examine the behavioral and diagnostic outcomes of a carefully defined sample of 2-year-old children with ASD, and to identify child and environmental factors that contribute to variability in outcomes at age 4., Methods: Forty-eight children diagnosed with autism or pervasive developmental disorder not otherwise specified (PDDNOS) at age 2 were followed to age 4. Diagnostic measures included the Autism Diagnostic Observation Schedule - Generic (ADOS-G) and clinical diagnosis at ages 2 and 4, and the ADI-R at age 4., Results: Diagnostic stability for an ASD diagnosis (autism or PDDNOS) was 63%, and for an autism diagnosis was 68%. Children who failed to meet diagnostic criteria for ASD at follow-up were more likely to: 1) be 30 months or younger at initial evaluation; 2) have milder symptoms of autism, particularly in the social domain; and 3) have higher cognitive scores at age 2. No differences between children with stable and unstable diagnoses were found for amount of intervention services received. Among the children with unstable diagnoses, all but one continued to have developmental disorders, most commonly in the area of language., Conclusions: The stability of ASD was lower in the present study than has been reported previously, a finding largely attributable to children who were diagnosed at 30 months or younger. Implications for clinical practice are discussed.

The validity of the Parental Concerns Questionnaire, a brief screening checklist assessing the presence and severity of 13 developmental and behavioral concerns expressed by parents of children with autism spectrum disorders, was determined in 53 children ages 4 to 10 years with a clinical diagnosis of autism spectrum disorder and 48 age-matched typically developing controls. Parents completed the Parental Concerns Questionnaire, the Child Behavior Checklist, the Child Sleep Habits Questionnaire, and either the Repetitive Behavior Scale or the Compulsive Behavior Checklist. A clinical examiner administered the Peabody Picture Vocabulary Test and the Autism Diagnostic Observation Scale. The Parental Concerns Questionnaire demonstrated high internal consistency in the autism spectrum disorder subgroup. Reliability and stability over time were demonstrated. Analyses showed variability in item responses for each child indicating that parents were not globally answering all items as concerns. Comparison of Parental Concerns Questionnaire item scores to scores for similar multiquestion domains on standardized parent-rated and clinician-administered assessment tools demonstrated external validity with other parent-rated and clinician-rated instruments. The Parental Concerns Questionnaire is a reliable screening instrument to assess parentally reported developmental and behavioral symptoms in children with autism spectrum disorders.

Objective: To compare the early social-communicative development of younger siblings of children with autism spectrum disorders (ASDs) with that of younger siblings of children with typical development, using parental report and child-based measures., Design: Group comparison., Setting: Vanderbilt University, between July 1, 2003, and July 31, 2006., Participants: Younger siblings of children with ASD (n = 64) and younger siblings of children with typical development (n = 42) between the ages of 12 and 23 months (mean, 16 months). Main Exposure Having a sibling with an ASD., Outcome Measures: Child-based measures included a cognitive assessment; an interactive screening tool assessing play, imitation, and communication; and a rating of autism symptoms. Parental report measures were an interview of social-communicative interactions and a questionnaire assessing language and communication skills., Results: Younger siblings of children with ASD demonstrated weaker performance in nonverbal problem solving (mean difference [MD], 5.91; 95% confidence interval [CI], 2.48-9.34), directing attention (MD, 0.52; 95% CI, 0.07-0.97), understanding words (MD, 33.30; 95% CI, 3.11-63.48), understanding phrases (MD, 4.56; 95% CI, 1.85-7.27), gesture use (MD, 1.49; 95% CI, 0.51-2.47), and social-communicative interactions with parents (MD, 1.32; 95% CI, 0.27-2.37), and had increased autism symptoms (MD, 2.54; 95% CI, 1.05-4.03), relative to control siblings. A substantial minority of the ASD sibling group exhibited lower performance relative to controls. Significant correlations between child-based measures and parental reports assessing similar constructs were found (r = -0.74 to 0.53; P range, .000-.002)., Conclusion: The weaker performance found for children in the ASD sibling group may represent early-emerging features of the broader autism phenotype, thus highlighting the importance of developmental surveillance for younger siblings.

We compared responding to joint attention (RJA) in younger siblings of children with ASD (SIBS-ASD; n = 46) and younger siblings of children developing typically (SIBS-TD; n = 35). Children were tested between 12 and 23 months of age in a situation in which an experimenter directed the child's attention to one of 8 targets. Each child responded to 10 different combinations of verbal and nonverbal cues containing varying levels of attention-specifying information. SIBS-ASD had significantly lower overall RJA scores than SIBS-TD. Moderately redundant cues were most difficult for SIBS-ASD relative to SIBS-TD; adding a point to moderately redundant cues improved RJA for SIBS-ASD, bringing them to a level of RJA commensurate with SIBS-TD.

Study Objectives: To relate parentally reported sleep concerns in autism spectrum disorders (ASD) to polysomnographic (PSG) findings and measures of daytime behavior and autism symptomatology., Design: Cross-sectional study involving validated questionnaires, sleep histories and diaries, 2 nights of PSG, and the Autism Diagnostic Observation Schedule (ADOS)., Setting: Vanderbilt University General Clinical Research Center Sleep Core., Participants: 21 children with ASD and 10 typically developing (TD) children, aged 4-10 years. Children were free of psychotropic medications, with no history of mental retardation or epileptic seizures., Interventions: N/A., Measurements and Results: Children with ASD were defined as "good sleepers" (10 children) and "poor sleepers" (11 children) on the basis of parental report; the age-comparable TD children were all reported by their parents to be good sleepers. Poor sleepers with ASD showed prolonged sleep latency and decreased sleep efficiency on night 1 of PSG and differed on insomnia-related subscales of the Children's Sleep Habits Questionnaire (CSHQ; increased sleep onset delay and decreased sleep duration). The good sleepers with ASD did not differ from the TD children in sleep architecture or on CSHQ domains. As compared with ASD good sleepers, the ASD poor sleepers also had higher scores related to affective problems on the Child Behavior Checklist and more problems with reciprocal social interaction on the ADOS., Conclusions: Parentally reported sleep concerns of insomnia in children with ASD are substantiated by validated sleep questionnaires and by PSG. Furthermore, good sleepers with ASD showed fewer affective problems and better social interactions than ASD poor sleepers.

Purpose: This randomized group experiment compared the efficacy of 2 communication interventions (Responsive Education and Prelinguistic Milieu Teaching [RPMT] and the Picture Exchange Communication System [PECS]) on spoken communication in 36 preschoolers with autism spectrum disorders (ASD)., Method: Each treatment was delivered to children for a maximum total of 24 hr over a 6-month period. Spoken communication was assessed in a rigorous test of generalization at pretreatment, posttreatment, and 6-month follow-up periods., Results: PECS was more successful than RPMT in increasing the number of nonimitative spoken communication acts and the number of different nonimitative words used at the posttreatment period. Considering growth over all 3 measurement periods, an exploratory analysis showed that growth rate of the number of different nonimitative words was faster in the PECS group than in the RPMT group for children who began treatment with relatively high object exploration. In contrast, analogous slopes were steeper in the RPMT group than in the PECS group for children who began treatment with relatively low object exploration.

Many researchers have suggested that temperament information could be useful for understanding the behavioral variability within the autism spectrum. The purpose of this brief report is to examine temperament profiles of 110 children with ASD (ages 3-8 years, 61 with Autistic Disorder, 42 with PDD-NOS; and 7 with Asperger Disorder) via a commonly used parent report measure of child temperament. Internal consistency of temperament dimensions, test-retest reliability, descriptions of means and standard deviations are examined, relative to previously published norms. Internal consistency of the dimensions and test-retest reliability were comparable to published norms; however, children with autism were rated as presenting with more extreme scores than typically-developing children on several dimensions. Limitations and implications for future work are discussed.

This randomized group experiment compared the efficacy of 2 communication interventions (Responsive Education and Prelinguistic Milieu Teaching [RPMT] and the Picture Exchange Communication System [PECS]) in 36 preschoolers with autism spectrum disorders. Each treatment was delivered 3 times per week, in 20-min sessions, for 6 months. The results revealed that the RPMT facilitated the frequency of generalized turn taking and generalized initiating joint attention more than did the PECS. The latter effect occurred only for children who began treatment with at least some initiating joint attention. In contrast, the PECS facilitated generalized requests more than the RPMT in children with very little initiating joint attention prior to treatment. These effect sizes were large., (Copyright 2006 APA, all rights reserved.)

Background: This study describes a new caregiver-report assessment, the Sensory Experiences Questionnaire (SEQ), and explicates the nature of sensory patterns of hyper- and hyporesponsiveness, their prevalence, and developmental correlates in autism relative to comparison groups., Method: Caregivers of 258 children in five diagnostic groups (Autism, PDD, DD/MR, Other DD, Typical) ages 5-80 months completed the SEQ., Results: The SEQ's internal consistency was alpha' = .80. Prevalence of overall sensory symptoms for the Autism group was 69%. Sensory symptoms were inversely related to mental age. The Autism group had significantly higher symptoms than either the Typical or DD groups and presented with a unique pattern of response to sensory stimuli -hyporesponsiveness in both social and nonsocial contexts. A pattern of hyperresponsiveness was similar in the Autism and DD groups, but significantly greater in both clinical groups than in the Typical group., Conclusion: The SEQ was able to characterize sensory features in young children with autism, and differentiate their sensory patterns from comparison groups. These unique sensory patterns have etiological implications, as well as relevance for assessment and intervention practices.

The purpose of the present study was to examine the developmental outcomes of children 7 years after their initial diagnosis. Children diagnosed with autism or PDD-NOS at age 2 received follow-up evaluations at age 9. Diagnostic stability was high, with 88 percent of the sample obtaining autism spectrum diagnoses at age 9. Cognitive scores improved considerably for a large segment of the sample, with over 50 percent obtaining scores in the average range at follow-up. Language outcomes were also positive at follow-up; 88 percent of the sample demonstrated at least some functional language, and 32 percent were able to engage in conversational exchanges. Early characteristics that predicted outcome status were: age of diagnosis, age 2 cognitive and language scores, and total hours of speech-language therapy between ages 2 and 3. These findings highlight the potential long-term benefits of both early identification and early intervention, and provide additional evidence for the importance of promoting public awareness of the early signs of autism.

This study used an intact group comparison to examine attention following in 34 children aged 2 years diagnosed with autism spectrum disorder (ASD) matched pairwise for vocabulary comprehension with a group of typically developing toddlers. For both groups of children, the presence of verbal labels during a referential task increased attention to a novel object over and above the attention-facilitating effect of child-directed talking without labeling. The typically developing children displayed more attention following than comprehension matched children with ASD across experimental conditions and there was no significant difference between the groups in the facilitative effect of hearing verbal labels. Implications for word-learning theory, intervention strategies and future research are considered.

Sleep disorders can affect daytime functioning in a variety of neurologic conditions, including autism spectrum disorder. This report describes improvements in sleep, social communication, attention, repetitive behaviors, and hypersensitivity after adenotonsillectomy for obstructive sleep apnea in a 5-year-old female with an autism spectrum disorder. Improvements were documented via pre- and postsurgical measures of parent report, polysomnography, validated sleep and behavior scales, and the Autism Diagnostic Observation Schedule. Identification and treatment of sleep disorders, including obstructive sleep apnea, may improve daytime behavior in children with autism spectrum disorders.

The STAT is an interactive screening measure for autism that assesses behaviors in the areas of play, communication, and imitation skills. In Study 1, signal detection procedures were employed to identify a cutoff score for the STAT using developmentally matched groups of 2-year-old children with autism and with nonspectrum disorders. The resulting cutoff yielded high sensitivity, specificity, and predictive values for the development sample as well as for an independent validation sample. Study 2 examined psychometric properties of the STAT and revealed acceptable levels of interrater agreement, test-retest reliability, and agreement between STAT risk category and ADOS-G classification. The STAT demonstrates strong psychometric properties and shows promising utility as a Level 2 screening measure for autism.

The Parent Interview for Autism-Clinical Version (PIA-CV) was developed to measure autism symptom severity across a wide range of behavioral domains. Two studies were conducted to examine the psychometric properties of the PIA-CV for a sample of children under 3 years old. Results of study 1 revealed adequate internal consistency for nine of the 11 PIA-CV dimensions, as well as significant group differences on social-communication domains between 2-year-old children with autism and a developmentally matched sample. Study 2 examined the association between changes in PIA-CV scores and changes in autism symptomatology from age 2 to age 4. Results revealed that changes on PIA-CV dimensions assessing social and communication skills were associated with clinically significant behavioral and diagnostic improvements. These findings support the utility of the PIA-CV for obtaining ecologically valid information from parents and for measuring behavioral change in young children with autism.

Autistic children and typically developing control children were tested on two visual tasks, one involving grouping of small line elements into a global figure and the other involving perception of human activity portrayed in point-light animations. Performance of the two groups was equivalent on the figure task, but autistic children were significantly impaired on the biological motion task. This latter deficit may be related to the impaired social skills characteristic of autism, and we speculate that this deficit may implicate abnormalities in brain areas mediating perception of human movement.

Thirty-five children who received an autism spectrum diagnosis at the age of 2 years (24 with autism, 11 with PDD-NOS) were re-evaluated 2 years later to examine factors related to the development of spoken language. Child variables (play level, motor imitation ability and joint attention) and environmental variables (socioeconomic status and hours of speech/language therapy between ages 2 and 3) were used to predict an aggregate measure of language outcome at age 4. After controlling for age 2 language skills, the only significant predictors were motor imitation and number of hours of speech/language therapy. Implications of these results for understanding the early developmental course of autism spectrum disorders and the effects of intervention are discussed.

Autism is a common disorder of childhood, affecting 1 in 500 children. Yet, it often remains unrecognized and undiagnosed until or after late preschool age because appropriate tools for routine developmental screening and screening specifically for autism have not been available. Early identification of children with autism and intensive, early intervention during the toddler and preschool years improves outcome for most young children with autism. This practice parameter reviews the available empirical evidence and gives specific recommendations for the identification of children with autism. This approach requires a dual process: 1) routine developmental surveillance and screening specifically for autism to be performed on all children to first identify those at risk for any type of atypical development, and to identify those specifically at risk for autism; and 2) to diagnose and evaluate autism, to differentiate autism from other developmental disorders.

The Child Neurology Society and American Academy of Neurology recently proposed to formulate Practice Parameters for the Diagnosis and Evaluation of Autism for their memberships. This endeavor was expanded to include representatives from nine professional organizations and four parent organizations, with liaisons from the National Institutes of Health. This document was written by this multidisciplinary Consensus Panel after systematic analysis of over 2,500 relevant scientific articles in the literature. The Panel concluded that appropriate diagnosis of autism requires a dual-level approach: (a) routine developmental surveillance, and (b) diagnosis and evaluation of autism. Specific detailed recommendations for each level have been established in this document, which are intended to improve the rate of early suspicion and diagnosis of, and therefore early intervention for, autism.

The Vineland Adaptive Behavior Scales were used to investigate patterns of adaptive behavior in children with autism who were under 36 months of age. Subjects were 30 children with autism and 30 children with developmental delay matched on CA and MA. Relative to controls, the autistic group demonstrated weaker socialization and communication skills and greater discrepancies between adaptive behavior and MA. Different patterns of relations between adaptive behavior domains and cognitive and language skills were obtained for the two groups. Preliminary support for the utility of adaptive behavior profiles in identifying subgroups of children with autism is provided. Results are discussed in terms of their implications for early diagnosis of autism.

This study investigated the reliability and stability of an autism diagnosis in children under 3 years of age who received independent diagnostic evaluations from two clinicians during two consecutive yearly evaluations. Strong evidence for the reliability and stability of the diagnosis was obtained. Diagnostic agreement between clinicians was higher for the broader discrimination of autism spectrum vs. no autism spectrum than for the more specific discrimination of autism vs. PDD-NOS. The diagnosis of autism at age 2 was more stable than the diagnosis of PDD-NOS at the same age. Social deficits and delays in spoken language were the most prominent DSM-IV characteristics evidenced by very young children with autism.

The forms, functions, and complexity of nonverbal communication used by very young children with autism were investigated. Fourteen children with autism were matched to 14 children with developmental delays and/or language impairments on the basis of CA, MA, and expressive vocabulary. Subjects participated in a structured communication assessment consisting of 16 situations designed to elicit requesting or commenting behavior. Children with autism requested more often and commented less often than controls. Autistic children were less likely to point, show objects, or use eye gaze to communicate, but were more likely to directly manipulate the examiner's hand. The autistic group also used less complex combinations of behaviors to communicate. Implications for early identification and intervention are discussed.

Two studies investigated the nature of motor imitation in young children with autism. Study 1 compared different types of motor imitation in 18 autistic children, 18 children with developmental delay, and 18 normally developing children. Results revealed weaker imitation skills for the autistic group, though all groups demonstrated a similar pattern of performance across different imitation domains. Imitation of body movements was more difficult than imitation of actions with objects, and imitation of nonmeaningful actions was more difficult than imitation of meaningful actions. Study 2 investigated concurrent and predictive relations between imitation and other developmental skills within a sample of 26 two-year-old children with autism. Results suggested that imitation of body movements and imitation of actions with objects represent independent dimensions. Imitation of body movements was concurrently and predictively associated with expressive language skills, and imitation of actions with objects was concurrently associated with play skills. Improvements in both motor imitation domains occurred over a 1-year period.

Objective: To determine which behavioral characteristics of autism are apparent in early childhood and to examine the relative contributions of clinical observation and parental reports to early identification of autism., Design: Blinded comparison of behavioral data obtained through parental reports and clinical observation., Setting: Child development referral center., Patients: Twenty-six children (23 boys and three girls) younger than age 48 months with a clinical diagnosis of autism., Selection Procedures: Consecutive sample., Interventions: None., Measurements and Results: Social interaction, communication, and activities and interests were evaluated using standard diagnostic criteria for autism. Results suggested that deficits in the areas of social interaction, imitation, play, and nonverbal communication are more prominent than insistence on sameness and routines in young children with autism. Also, parental reports and clinical observation appear to detect different aspects of abnormal behavior patterns in this sample., Conclusions: Improved awareness of the early signs of autism should help physicians recognize this disorder in a timely manner. Further research may identify how observation of play and parental reports might be incorporated efficiently into a physician's repertoire of developmental and behavioral screening tools.

This study evaluated the psychometric properties of the Parent Interview for Autism (PIA), a structured interview for gathering diagnostic information from parents of young children with autism. Internal consistency was evaluated in a sample of 165 children under 6 years old, and test-retest reliability and construct validity were evaluated in subsamples of the original group. Results revealed internal consistency and test-retest reliability above .60 for 9 of the 11 dimensions constituting the PIA, as well as significant correlations between the PIA and other measures of autism. Six of the PIA dimensions differentiated a group of young children with autism from a developmentally comparable group with mental retardation. Implications of these findings and suggestions for future research are discussed.

The aim of this study was to identify specific social behaviors that differentiate autistic preschoolers from other children at comparable developmental levels. A parent report measure, the Preschool Social Behavior Checklist (PSBC), was developed for this purpose. The PSBC consists of 22 items representing social milestones usually achieved within the first 4 to 5 years of life. Results obtained from a sample of 20 parents of children with autism and 14 parents of children with mental retardation revealed group differences in specific aspects of imaginative play, peer play, and imitation skills. The importance of examining the specific manifestations of social deficits and implications for the diagnosis of autism are discussed.

Thirty children with autism were observed during their everyday school activities in order to examine patterns of spontaneous communication. The forms, functions, and targets of their communication were recorded by trained observers. The prototypical communicative event consisted of a child directing a motoric form of communication toward the teacher to request something or to attract attention to himself or herself. However, communication patterns were found to vary as a function of the child's cognitive level and severity of autism. Deficits in joint attention functions were observed, and were most striking in the subgroup of children who did not use speech. Results are discussed with reference to Wetherby's (1986) model for the development of communicative functions in autistic children.

Play behaviors and motor imitation skills of 91 children between the ages of 3 and 6 years were investigated to determine their utility in distinguishing autism from mental retardation and other communication disorders. The performance of 22 autistic children was compared with that of 15 mentally retarded, 15 hearing-impaired, 19 language-impaired, and 20 non-handicapped children. Play behaviors were assessed using structured observations of free-play activities, and imitation skills were measured using a set of 12 individually administered tasks. The autistic group spent less total time interacting with toys and using toys appropriately, engaged in fewer functional play acts, and obtained lower imitation scores compared with all other groups. Discriminant function analysis revealed that the latter three variables discriminated the autistic children from the nonautistic handicapped children, with motor imitation emerging as the most important differentiating measure. These results suggest that measuring play and imitation skills may be useful in the clinical diagnosis of autism.

Changing conceptualizations of autism have led to an increased focus on parents and teachers as treatment agents. In order to evaluate the views of autism held by these two groups, 47 teachers of autistic students and 47 parents of autistic children completed a survey assessing beliefs regarding various aspects of the disorder. Parent and teacher responses were compared to those obtained from a group of 22 "specialists" in autism, drawn from across the country. Both parents and teachers were found to harbor misconceptions regarding cognitive, developmental, and emotional features of autism. Furthermore, parents and teachers hold discrepant views in some areas that may have implications for their collaborative efforts.