Amy Esler

A Multisite Study of the Clinical Diagnosis of Different Autism Spectrum Disorders

CONTEXT Best-estimate clinical diagnoses of specific autism spectrum disorders (autistic disorder, pervasive developmental disorder-not otherwise specified, and Asperger syndrome) have been used as the diagnostic gold standard, even when information from standardized instruments is available. OBJECTIVE To determine whether the relationships between behavioral phenotypes and clinical diagnoses of different autism spectrum disorders vary across 12 university-based sites. DESIGN Multisite observational study collecting clinical phenotype data (diagnostic, developmental, and demographic) for genetic research. Classification trees were used to identify characteristics that predicted diagnosis across and within sites. SETTING Participants were recruited through 12 university-based autism service providers into a genetic study of autism. PARTICIPANTS A total of 2102 probands (1814 male probands) between 4 and 18 years of age (mean [SD] age, 8.93 [3.5] years) who met autism spectrum criteria on the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule and who had a clinical diagnosis of an autism spectrum disorder. MAIN OUTCOME MEASURE Best-estimate clinical diagnoses predicted by standardized scores from diagnostic, cognitive, and behavioral measures. RESULTS Although distributions of scores on standardized measures were similar across sites, significant site differences emerged in best-estimate clinical diagnoses of specific autism spectrum disorders. Relationships between clinical diagnoses and standardized scores, particularly verbal IQ, language level, and core diagnostic features, varied across sites in weighting of information and cutoffs. CONCLUSIONS Clinical distinctions among categorical diagnostic subtypes of autism spectrum disorders were not reliable even across sites with well-documented fidelity using standardized diagnostic instruments. Results support the move from existing subgroupings of autism spectrum disorders to dimensional descriptions of core features of social affect and fixated, repetitive behaviors, together with characteristics such as language level and cognitive function.

A computer vision approach for the assessment of autism-related behavioral markers

The early detection of developmental disorders is key to child outcome, allowing interventions to be initiated that promote development and improve prognosis. Research on autism spectrum disorder (ASD) suggests behavioral markers can be observed late in the first year of life. Many of these studies involved extensive frame-by-frame video observation and analysis of a childs natural behavior. Although non-intrusive, these methods are extremely time-intensive and require a high level of observer training; thus, they are impractical for clinical purposes. Diagnostic measures for ASD are available for infants but are only accurate when used by specialists experienced in early diagnosis. This work is a first milestone in a long-term multidisciplinary project that aims at helping clinicians and general practitioners accomplish this early detection/measurement task automatically. We focus on providing computer vision tools to measure and identify ASD behavioral markers based on components of the Autism Observation Scale for Infants (AOSI). In particular, we develop algorithms to measure three critical AOSI activities that assess visual attention. We augment these AOSI activities with an additional test that analyzes asymmetrical patterns in unsupported gait. The first set of algorithms involves assessing head motion by facial feature tracking, while the gait analysis relies on joint foreground segmentation and 2D body pose estimation in video. We show results that provide insightful knowledge to augment the clinicians behavioral observations obtained from real in-clinic assessments.

Computer Vision Tools for Low-Cost and Noninvasive Measurement of Autism-Related Behaviors in Infants

The early detection of developmental disorders is key to child outcome, allowing interventions to be initiated which promote development and improve prognosis. Research on autism spectrum disorder (ASD) suggests that behavioral signs can be observed late in the first year of life. Many of these studies involve extensive frame-by-frame video observation and analysis of a childs natural behavior. Although nonintrusive, these methods are extremely time-intensive and require a high level of observer training; thus, they are burdensome for clinical and large population research purposes. This work is a first milestone in a long-term project on non-invasive early observation of children in order to aid in risk detection and research of neurodevelopmental disorders. We focus on providing low-cost computer vision tools to measure and identify ASD behavioral signs based on components of the Autism Observation Scale for Infants (AOSI). In particular, we develop algorithms to measure responses to general ASD risk assessment tasks and activities outlined by the AOSI which assess visual attention by tracking facial features. We show results, including comparisons with expert and nonexpert clinicians, which demonstrate that the proposed computer vision tools can capture critical behavioral observations and potentially augment the clinicians behavioral observations obtained from real in-clinic assessments.

Autism spectrum disorder in fragile X syndrome: Cooccurring conditions and current treatment

BACKGROUND AND OBJECTIVE: Individuals with fragile X syndrome (FXS) are frequently codiagnosed with autism spectrum disorder (ASD). Most of our current knowledge about ASD in FXS comes from family surveys and small studies. The objective of this study was to examine the impact of the ASD diagnosis in a large clinic-based FXS population to better inform the care of people with FXS. METHODS: The study employed a data set populated by data from individuals with FXS seen at specialty clinics across the country. The data were collected by clinicians at the patient visit and by parent report for nonclinical and behavioral outcomes from September 7, 2012 through August 31, 2014. Data analyses were performed by using χ2 tests for association, t tests, and multiple logistic regression to examine the association between clinical and other factors with ASD status. RESULTS: Half of the males and nearly 20% of females met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for current ASD. Relative to the FXS-only group, the FXS with ASD (FXS+ASD) group had a higher prevalence of seizures (20.7% vs 7.6%, P < .001), persistence of sleep problems later in childhood, increased behavior problems, especially aggressive/disruptive behavior, and higher use of α-agonists and antipsychotics. Behavioral services, including applied behavior analysis, appeared to be underused in children with FXS+ASD (only 26% and 16% in prekindergarten and school-age periods, respectively) relative to other populations with idiopathic ASD. CONCLUSIONS: These findings confirm among individuals with FXS an association of an ASD diagnosis with important cooccurring conditions and identify gaps between expected and observed treatments among individuals with FXS+ASD.

Directing attention based on incidental learning in children with autism spectrum disorder

OBJECTIVE Attention is a complex construct that taps into multiple mechanisms. One type of attention that is underinvestigated in autism is incidentally or implicitly guided attention. The purpose of this study is to characterize how children with autism spectrum disorder (ASD) direct spatial attention based on incidental learning. METHOD Children with high-functioning ASD and typically developing children engaged in a visual search task. For the first half of the study, over multiple trials, the target was more often found in some locations than other locations. For the second half, the target was equally likely to appear in all locations. We measured search performance for targets located in the high-probability and low-probability locations. RESULTS Children with ASD were able to direct spatial attention using incidentally learned information about the targets location probability. Although unaware of the experimental manipulation, children with ASD were faster and more efficient in finding a target in the high-probability locations than low-probability locations, and this bias dissipated after the targets location probability was even. The pace and magnitude of learning, as well as later adjustment to new statistics, were comparable between children with ASD and typically developing children. CONCLUSIONS Incidentally learned attention is preserved in children with ASD.

Autism Spectrum Disorder (ASD) Prevalence in Somali and Non-Somali Children

The current study presents results from an autism spectrum disorder (ASD) public health surveillance project conducted in Minneapolis. The study was designed to compare ASD prevalence in Somali children (ages 7–9) to that of non-Somali children. The study adapted methodology used by the Centers for Disease Control and Prevention’s Autism and Developmental Disabilities Monitoring Network. Results indicated that Somali (1 in 32) and White (1 in 36) children were about equally likely to be identified with ASD, but more likely to be identified with ASD than Black and Hispanic children. Somali children with ASD were significantly more likely to have an intellectual disability than children with ASD in all other racial and ethnic groups.

Addressing Standards and Assessments on the IEP

The purpose of this study was to examine state Individualized Education Program (IEP) forms to determine the extent to which they include documentation of standards and assessments. All 50 states were asked to send their IEP forms and to indicate whether they were required, recommended, or simply sample forms. Out of the 41 states with IEP forms, only 5 specifically addressed educational standards on their forms; 31 addressed the general curriculum on their IEP forms. IEP forms in 30 states listed three or more options for assessment participation, including standard participation in general state or district assessments, accommodated participation, and alternate assessment participation. Because IEP forms may be the only source of information to guide decisions during IEP team meetings, we make several recommendations for IEP forms that will provide decision-making guidance to IEP teams.

Phenotypic Characteristics of Autism Spectrum Disorder in a Diverse Sample of Somali and Other Children

The potential for culture to impact diagnosis of autism spectrum disorder (ASD) is high, yet remains largely unstudied. This study examined differences across racial/ethnic groups in ASD symptoms, cognitive and adaptive skills, and related behaviors in children with ASD that included a unique subgroup, children from the Somali diaspora. Somali children were more likely to have ASD with intellectual disability than children from all other racial/ethnic groups. Few differences were found in the presence of specific symptoms and behaviors across groups once IQ was controlled. Results lend support to previous studies that found higher rates of ASD intellectual disability in children of immigrants from low human resource index countries compared to other groups. Implications for future research are discussed.

DSM-5 Diagnostic Criteria for Autism Spectrum Disorder With Implications for School Psychologists

Changes to the diagnosis of autism spectrum disorder (ASD) within the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; American Psychiatric Association, 2013) have important implications for school psychologists responsible for evaluating children with ASD, interpreting results to caregivers, and informing policy makers of needed revisions to eligibility criteria based on empirical understanding. The primary purpose of this review is to describe changes to the DSM-5 and the empirical evidence behind the modifications. A secondary goal is to describe implications for best practices in school evaluations for ASD. Given the concerns about the DSM-5 expressed by caregivers and individuals with ASD during the revision process, school psychologists who are aware of the rationale for and implications of the changes will be better positioned to assist local policy makers regarding diagnostic evaluations for ASD and address parental concerns regarding the evaluation process and service implications for their child.

National Study of School Psychologists’ Use of Evidence-Based Assessment in Autism Spectrum Disorder

ABSTRACT This study aimed to better understand predictors of evidence-based assessment practices for autism spectrum disorder (ASD). Nationwide, 402 school psychologists were surveyed for their knowledge of and training and experience with ASD on assessment practices, including reported areas of training needs. The majority of school psychologists reported that they did not engage in comprehensive assessment of ASD, which was defined as assessments that consider all areas of development in addition to the use of ASD-specific instruments. Results from logistic regression revealed that experience and training, working with young children with ASD, and geographic location predicted use of evidence-based assessment practices. Experience and training with ASD was the strongest predictor of evidence-based assessment. No differences in training needs were indicated by school psychologists whose practices were consistent with evidence-based assessment and those whose practices were not. Overall, the results identified gaps between best and current practices by school psychologists and highlight areas of need for additional training and professional development.