Amie Duncan

Application of DSM-5 Criteria for Autism Spectrum Disorder to Three Samples of Children With DSM-IV Diagnoses of Pervasive Developmental Disorders

OBJECTIVE Substantial revisions to the DSM-IV criteria for autism spectrum disorders (ASDs) have been proposed in efforts to increase diagnostic sensitivity and specificity. This study evaluated the proposed DSM-5 criteria for the single diagnostic category of autism spectrum disorder in children with DSM-IV diagnoses of pervasive developmental disorders (PDDs) and non-PDD diagnoses. METHOD Three data sets included 4,453 children with DSM-IV clinical PDD diagnoses and 690 with non-PDD diagnoses (e.g., language disorder). Items from a parent report measure of ASD symptoms (Autism Diagnostic Interview-Revised) and clinical observation instrument (Autism Diagnostic Observation Schedule) were matched to DSM-5 criteria and used to evaluate the sensitivity and specificity of the proposed DSM-5 criteria and current DSM-IV criteria when compared with clinical diagnoses. RESULTS Based on just parent data, the proposed DSM-5 criteria identified 91% of children with clinical DSM-IV PDD diagnoses. Sensitivity remained high in specific subgroups, including girls and children under 4. The specificity of DSM-5 ASD was 0.53 overall, while the specificity of DSM-IV ranged from 0.24, for clinically diagnosed PDD not otherwise specified (PDD-NOS), to 0.53, for autistic disorder. When data were required from both parent and clinical observation, the specificity of the DSM-5 criteria increased to 0.63. CONCLUSIONS These results suggest that most children with DSM-IV PDD diagnoses would remain eligible for an ASD diagnosis under the proposed DSM-5 criteria. Compared with the DSM-IV criteria for Aspergers disorder and PDD-NOS, the DSM-5 ASD criteria have greater specificity, particularly when abnormalities are evident from both parents and clinical observation.

Understanding the gap between cognitive abilities and daily living skills in adolescents with autism spectrum disorders with average intelligence

Daily living skills standard scores on the Vineland Adaptive Behavior Scales–2nd edition were examined in 417 adolescents from the Simons Simplex Collection. All participants had at least average intelligence and a diagnosis of autism spectrum disorder. Descriptive statistics and binary logistic regressions were used to examine the prevalence and predictors of a “daily living skills deficit,” defined as below average daily living skills in the context of average intelligence quotient. Approximately half of the adolescents were identified as having a daily living skills deficit. Autism symptomatology, intelligence quotient, maternal education, age, and sex accounted for only 10% of the variance in predicting a daily living skills deficit. Identifying factors associated with better or worse daily living skills may help shed light on the variability in adult outcome in individuals with autism spectrum disorder with average intelligence.

Using Self- and Parent-Reports to Test the Association Between Peer Victimization and Internalizing Symptoms in Verbally Fluent Adolescents with ASD

The current study tested the associations between peer victimization and internalizing symptoms in 54 verbally fluent adolescent males with a diagnosis of autism spectrum disorder. Adolescent- and parent-reports of multiple types of peer victimization and internalizing symptoms were used. First, the validity and reliability of the adolescent-report measure of peer victimization were successfully tested, with some exceptions. Then, structural equation models showed that adolescent-reports of peer victimization were associated with a latent construct of internalizing symptoms even after controlling for parent-reports of peer victimization. Discussion focuses on the importance of considering adolescent-reports of negative peer experience, such as peer victimization, rather than relying exclusively on parent reports.

Autism Spectrum Disorders: Building Social Skills in Group, School, and Community Settings

Adolescents diagnosed with autism spectrum disorders (ASD) face a variety of social difficulties as they interact with same-aged peers and adults in their schools and communities. Few empirically based interventions have been designed to increase social understanding (e.g., understanding gestures and facial expressions), social interaction abilities (e.g., initiating conversation with peers), and social competence (e.g., distinguishing between teasing and joking). This article reviews the most effective strategies for increasing social skills in adolescents with ASD and also gives examples of how to implement these strategies in group, school, and community settings.

Social Motor Synchronization: Insights for Understanding Social Behavior in Autism

Impairments in social interaction and communication are critical features of ASD but the underlying processes are poorly understood. An under-explored area is the social motor synchronization that happens when we coordinate our bodies with others. Here, we explored the relationships between dynamical measures of social motor synchronization and assessments of ASD traits. We found (a) spontaneous social motor synchronization was associated with responding to joint attention, cooperation, and theory of mind while intentional social motor synchronization was associated with initiating joint attention and theory of mind; and (b) social motor synchronization was associated with ASD severity but not fully explained by motor problems. Findings suggest that objective measures of social motor synchronization may provide insights into understanding ASD traits.

The autism symptom interview, school‐age: A brief telephone interview to identify autism spectrum disorders in 5‐to‐12‐year‐old children

This study reports on the initial validation of the Autism Symptom Interview (ASI), School‐Age, a brief (15–20 min) phone interview derived from questions from the Autism Diagnostic Interview‐Revised (ADI‐R). The ASI, School‐Age was administered by interviewers with minimal training to parents of children ages 5 to 12 who had all been previously identified with (or referred for assessment of) ASD or another neurodevelopmental disorder. Children then underwent a comprehensive assessment to determine a best‐estimate clinical diagnosis of ASD (n = 159) or non‐ASD (e.g. language disorder, intellectual disability, ADHD; n = 130). Clinicians who conducted the assessments were blind to ASI results. ROC analyses compared ASI scores to clinical diagnosis. Due to the small number of participants with non‐ASD diagnoses who were classified as nonverbal (i.e. not yet using phrases on a daily basis), it was not possible to assess sensitivity and specificity of the nonverbal algorithm in this sample. The verbal algorithm yielded a sensitivity of 0.87 (95% CI = 0.81–0.92) and a specificity of 0.62 (95% CI = 0.53–0.70). When used in conjunction with the Autism Diagnostic Observation Schedule (ADOS), sensitivity and specificity were 0.82 (95% CI = 0.74–0.88) and 0.92 (95% CI = 0.86–0.96), respectively. Internal consistency and test‐retest reliability were both excellent. Particularly for verbal school age children, the ASI may serve as a useful tool to more quickly ascertain or classify children with ASD for research or clinical triaging purposes. Additional data collection is underway to determine the utility of the ASI in children who are younger and/or nonverbal. Autism Res 2017, 10: 78–88.

Evaluating the importance of social motor synchronization and motor skill for understanding autism

Impairments in social interaction and communicating with others are core features of autism spectrum disorder (ASD), but the specific processes underlying such social competence impairments are not well understood. An important key for increasing our understanding of ASD‐specific social deficits may lie with the social motor synchronization that takes place when we implicitly coordinate our bodies with others. Here, we tested whether dynamical measures of synchronization differentiate children with ASD from controls and further explored the relationships between synchronization ability and motor control problems. We found (a) that children with ASD exhibited different and less stable patterns of social synchronization ability than controls; (b) children with ASD performed motor movements that were slower and more variable in both spacing and timing; and (c) some social synchronization that involved motor timing was related to motor ability but less rhythmic synchronization was not. These findings raise the possibility that objective dynamical measures of synchronization ability and motor skill could provide new insights into understanding the social deficits in ASD that could ultimately aid clinical diagnosis and prognosis. Autism Res 2017, 10: 1687–1699.

Can low-cost motion-tracking systems substitute a Polhemus system when researching social motor coordination in children?

Functionally stable and robust interpersonal motor coordination has been found to play an integral role in the effectiveness of social interactions. However, the motion-tracking equipment required to record and objectively measure the dynamic limb and body movements during social interaction has been very costly, cumbersome, and impractical within a non-clinical or non-laboratory setting. Here we examined whether three low-cost motion-tracking options (Microsoft Kinect skeletal tracking of either one limb or whole body and a video-based pixel change method) can be employed to investigate social motor coordination. Of particular interest was the degree to which these low-cost methods of motion tracking could be used to capture and index the coordination dynamics that occurred between a child and an experimenter for three simple social motor coordination tasks in comparison to a more expensive, laboratory-grade motion-tracking system (i.e., a Polhemus Latus system). Overall, the results demonstrated that these low-cost systems cannot substitute the Polhemus system in some tasks. However, the lower-cost Microsoft Kinect skeletal tracking and video pixel change methods were successfully able to index differences in social motor coordination in tasks that involved larger-scale, naturalistic whole body movements, which can be cumbersome and expensive to record with a Polhemus. However, we found the Kinect to be particularly vulnerable to occlusion and the pixel change method to movements that cross the video frame midline. Therefore, particular care needs to be taken in choosing the motion-tracking system that is best suited for the particular research.

Training clinicians to deliver group CBT to manage anxiety in youth with ASD: Results of a multisite trial.

Objective: Few guidelines are available regarding optimal training models for practitioners delivering cognitive–behavioral therapy (CBT) for anxiety in youth with autism spectrum disorder (ASD). The present study systematically compared 3 instructional conditions for delivering the Facing Your Fears program (FYF) to children with ASD and anxiety. Method: Thirty-four clinicians (Mage = 34 years; 94% women, 88% Caucasian) and an intent-to-treat sample of 91 children with ASD and anxiety (Mage = 11; 84% male 53% Caucasian) met eligibility criteria across 4 sites. A 3-group parallel design via a Latin square procedure was used to randomize 9 teams of clinicians to 1 of 3 training conditions: Manual, Workshop, Workshop-Plus. The effectiveness of instructional condition was assessed via implementation (CBT knowledge, treatment fidelity) and treatment outcomes (reductions in anxiety as measured by the Anxiety Disorders Interview Schedule-Parent (ADIS-P). Results: Clinicians in both Workshop conditions significantly increased CBT knowledge postworkshop, F(1, 18) = 19.8, p < .001. Excellent treatment fidelity was obtained across conditions (above 89%), although clinicians in the Workshop conditions obtained significantly higher fidelity ratings and delivered FYF with greater quality than the Manual condition. Children with ASD demonstrated significant reductions in anxiety symptoms for three of the four anxiety diagnoses, with no differences noted across instructional condition. Rates of improvement were lower than those obtained in a previous controlled trial. Conclusions: Results suggest that although there may be some advantage to participating in a Workshop, clinicians in all conditions could deliver FYF with excellent fidelity and yield positive treatment outcomes. Lack of a no-treatment comparison group limits interpretation of findings.

Evidence of embodied social competence during conversation in high functioning children with autism spectrum disorder

Even high functioning children with Autism Spectrum Disorder (ASD) exhibit impairments that affect their ability to carry out and maintain effective social interactions in multiple contexts. One aspect of subtle nonverbal communication that might play a role in this impairment is the whole-body motor coordination that naturally arises between people during conversation. The current study aimed to measure the time-dependent, coordinated whole-body movements between children with ASD and a clinician during a conversational exchange using tools of nonlinear dynamics. Given the influence that subtle interpersonal coordination has on social interaction feelings, we expected there to be important associations between the dynamic motor movement measures introduced in the current study and the measures used traditionally to categorize ASD impairment (ADOS-2, joint attention and theory of mind). The study found that children with ASD coordinated their bodily movements with a clinician, that these movements were complex and that the complexity of the children’s movements matched that of the clinician’s movements. Importantly, the degree of this bodily coordination was related to higher social cognitive ability. This suggests children with ASD are embodying some degree of social competence during conversations. This study demonstrates the importance of further investigating the subtle but important bodily movement coordination that occurs during social interaction in children with ASD.