Alison M. Kozlowski

DSM-IV vs DSM-5 diagnostic criteria for toddlers with autism.

Purpose: To evaluate prevalence rates of autism and autism symptomatology in toddlers using DSM-IV vs DSM-5 criteria. Method: Two thousand seven hundred and twenty-one toddlers at risk for a developmental disability participated. DSM-IV and DSM-5 criteria were applied and overall prevalence using each set of criteria was established. Groups were also compared on BISCUIT-Part 1 scores to determine if groups differed on autism symptomatology. Results: DSM-5 resulted in 47.79% fewer toddlers being diagnosed with ASD compared to those on the DSM-IV. Toddlers diagnosed according to DSM-5 exhibited greater levels of autism symptomatology than those diagnosed with DSM-IV, but the latter group still exhibited significant levels of autism symptomatology. Conclusion: The proposed DSM-5 will result in far fewer persons being diagnosed with ASD. These results replicate findings from two previous studies, with older children/adolescents and adults. As a result of these new criteria, far fewer people will qualify for needed autism services.

Parents’ first concerns of their child's development in toddlers with autism spectrum disorders

Objective: Investigations about first concerns among parents of toddlers with ASD and comparisons of the same with children diagnosed with other developmental disorders are scarce. Method: The current study utilized a sample of toddlers diagnosed with an ASD or other developmental delay and examined the nature of parents’ first concern and the age of first concern compared to the age of first assessment. Results: The majority of parents of both toddlers diagnosed with ASD and non-ASD related developmental delays indicated that the area of first concern was in communication. However, the age of first concern was significantly younger for toddlers with an ASD diagnosis. In addition, there was a significant positive correlation between the age at which concerns were first noted and the age at which assessment was sought. Conclusion: The implications of these findings are discussed as they relate to early assessment and intervention.

What Is the Evidence for Environmental Causes of Challenging Behaviors in Persons with Intellectual Disabilities and Autism Spectrum Disorders

An extensive literature on the causes of challenging behaviors has been developed, primarily in the applied behavior analysis literature. One hundred and seventy-three empirical studies were reviewed where functional assessment serves as the primary method of identifying these causes. Most of the studies were able to identify a clear function or functions. Most commonly established causes were attention, the efforts to acquire tangibles, negative reinforcement in the form of escape from tasks or environments, and sensory stimulation, also described as an alone condition. Examples are provided regarding how these conditions are investigated across studies. Biological and cognitive causes have also been demonstrated. However, to date the empirical literature is limited with the bulk of studies being correlational. Considerably more research is needed, but some causes and methods to identify them are beginning to emerge.

Developmental milestones in toddlers with autistic disorder, pervasive developmental disorder--not otherwise specified and atypical development.

Objective: To investigate age differences in developmental milestone attainment among toddlers with Autistic Disorder, PDD-NOS and atypical development. Methods: A questionnaire was administered to caregivers of toddlers to obtain ages of onset of developmental milestones. The study included 1044 participants with 442, 112, 498 and 497 participants in first word, first phrase, crawling and walking analyses, respectively. Results: Significant differences were found between groups on the attainment of milestones within normal limits, delayed or not yet attained. Significant differences were also found between groups in age of saying first word and onset of crawling. There were no significant differences between groups for walking or first phrase. Conclusion: Increased severity of autism has been noted to be related to greater deficits in a multitude of areas. With basic human motor behaviours also appearing to follow that trend, motor and speech skills should be targeted in early intervention programmes.

Stability of symptoms of autism spectrum disorders in toddlers: An examination using the Baby and Infant Screen for Children with aUtIsm Traits–Part 1 (BISCUIT)

Objective: The diagnostic stability of Autism Spectrum Disorders (ASD) at very young ages continues to be debated, despite empirical evidence that ASDs can be reliably diagnosed in children under the age of 3 years. This topic is of the upmost importance given that early intervention increases long-term outcomes in this population. Methods: The goal of the current study was to examine the stability of symptoms of ASD between two assessment times for 114 toddlers. The following was compared from the first to second assessment: diagnostic classification stability, correlations between scores and the impact of time between the first and second assessment. Results: Significant correlations were found for toddlers as young as 18 months of age. In addition, even with up to a year between assessment intervals, symptoms of ASD were relatively stable prior to 3 years of age. Conclusions: Implications of the current findings are discussed.

Effects of Symptoms of Comorbid Psychopathology on Challenging Behaviors among Atypically Developing Infants and Toddlers as Assessed with the Baby and Infant Screen for Children with Autism Traits (BISCUIT).

Comorbid psychopathology and challenging behaviors often occur among persons with developmental disabilities. However, little attention to this issue has been reported in young children. In this study, individuals 17 through 36 months of age with varying diagnoses, such as intellectual disability, developmental delay, and Down syndrome, among others, were evaluated. Greater levels of symptoms of comorbid psychopathology were related to higher rates of challenging behaviors. Additionally, Inattention/Impulsivity, Avoidant Behavior, Anxiety/Repetitive Behaviors, and Tantrum/Conduct Problems were significantly related to high rates of Aggressive and Destructive Behaviors, Stereotypies, and Self-Injurious Behavior. Also, those who displayed greater levels of Eating/Sleep Problems engaged in more Aggressive and Destructive Behaviors and Stereotypies but not Self-Injurious Behavior. Thus, even at young ages, children with atypical development without an autism spectrum disorder diagnosis are at high risk for a variety of problem behaviors and disorders that may be related to one another.

Behaviors and corresponding functions addressed via functional assessment

One-hundred seventy-three studies that employed functional assessment were evaluated with respect to types of challenging behaviors studied and the functions identified that maintained those behaviors. For most studies, two to three behaviors were targeted. Of the 38 different challenging behaviors identified, self-injurious behavior (SIB) and aggression were by far the most studied. Other commonly studied behaviors were tantrums, stereotypies, property destruction, bizarre/inappropriate speech/vocalizations, and disruptive behaviors. The most commonly identified functions for both SIB and aggressions were attention and escape/demands. The implications of these and other data complied on target behaviors and maintaining variables are discussed.

The relationship between race and challenging behaviours in infants and toddlers with autistic disorder and pervasive developmental disorder–not otherwise specified

Objective: To examine the contributions of race and diagnostic category to endorsement rates of challenging behaviours in infants and toddlers with autism, PDD-NOS and atypical development without ASD, using the Baby and Infant Screen for Children with aUtIsm Traits, Part-3 (BISCUIT Part-3). Design: Multivariate analyses of variance (MANOVAs) on each sub-scale of the BISCUIT Part-3. Follow-up univariate analyses and post-hoc tests as needed. Methods: Scores on the BISCUIT Part-3 were compared for 453 Caucasian and 409 African-American infants and toddlers, grouped by race and diagnosis. Results: Significant differences between races were found on five out of 10 aggressive behaviours, while no significant differences were found on self-injurious or stereotypic behaviours. Significant differences between diagnostic groups were found on all behaviours. Conclusion: Cultural factors should be taken into account when examining challenging behaviours in infants and toddlers with ASD.

The relationship between psychopathology symptom clusters and the presence of comorbid psychopathology in individuals with severe to profound intellectual disability.

In the typically developing population, comorbid psychopathology refers to the co-occurrence of two different psychopathologies other than cognitive impairments. With respect to individuals with intellectual disability, comorbidity is often described as cognitive deficits and one additional psychopathology manifesting together. However, just as within the typically developing population, individuals with intellectual disability may also present with symptoms of two or more additional disorders. The presentation of these symptom clusters may similarly correlate. Therefore, the current study used the Diagnostic Assessment for the Severely Handicapped-II in order to examine relationships between psychopathological symptom clusters in adults with severe to profound intellectual disability. Additionally, we assessed comorbid presentation of disorders other than cognitive impairments in these same adults. Several symptom clusters were identified as being related with moderate to strong positive correlations. Furthermore, elevations on the Impulse subscale were noted to be the most prevalent in the current sample, with comorbid elevations most commonly occurring along the Mood, Mania, and Anxiety subscales. The significance of these findings is discussed.

Factor structure of the Matson Evaluation of Social Skills with Youngsters-II (MESSY-II)

The importance of social skills in development is a well studied area of research, and deficits in these skills can have implications long into adulthood. Therefore, assessment tools must be able to aid clinicians in identifying areas of weaknesses to target in treatment. The purpose of the current paper was to investigate the factor structure of a well researched measure of social skills, the Matson Evaluation of Social Skills with Youngsters (MESSY), which has recently been re-normed to update its psychometric properties. As such, this measure has now been dubbed the MESSY-II. This new norm sample was utilized in the current study to determine whether the original two factor structure for the MESSY would remain for the MESSY-II. Based on factor analysis, a three factor model was found to be ideal. Implications of these findings are discussed.