Donald P. Oswald

Anxiety in children and adolescents with autism spectrum disorders

Anxiety and poor stress management are common concerns in clinical samples of children with autism spectrum disorders (ASD). Anxiety may worsen during adolescence, as young people face an increasingly complex social milieu and often become more aware of their differences and interpersonal difficulties. This review summarizes the state of research on the prevalence, phenomenology, and treatment of anxiety in youth with autism and related conditions such as Aspergers Disorder. Using search words autism, asperger(s), or pervasive developmental disorder and anxiety or anxious to find reports published between 1990 and 2008, this review identified 40 papers. The results of the review suggest that anxiety, whether measured categorically or dimensionally, is indeed common in children and adolescents with autism spectrum disorders and may be a source of additional morbidity. The assessment of anxiety disorders in ASD should be conducted using multiple informants and modalities, as children with ASD often do not display age-typical symptoms of anxiety. To date, relatively few controlled intervention studies using well-characterized samples have been conducted despite preliminary evidence for efficacy of select pharmacological and psychosocial approaches. Recommendations for future applied research are presented and clinical implications are explored.

Ethnic Representation in Special Education The Influence of School-Related Economic and Demographic Variables

The purpose of this study was to provide current information on the representation of African American students as mildly mentally retarded (MMR) and seriously emotionally disturbed (SED) and to describe the influence of economic, demographic, and educational variables on the identification of minority students for special education. The sample consisted of the districts selected for the Fall 1992 Elementary and Secondary School Civil Rights Compliance Report survey. Odds ratios were constructed for MMR and SED to describe the nature and extent of disproportionate representation. Regression models were tested to investigate the influence of a set of school-related demographic and fiscal variables on disproportionate representation. Results indicated that African American students were about 2.4 times more likely to be identified as MMR and about 1.5 times more likely to be identified as SED than their non-African American peers. Economic and demographic variables were significant predictors of disproportionate representation but influenced identification of students as MMR and SED in different ways. Implications for research are discussed.

Peer-Mediated Interventions To Increase the Social Interaction of Children with Autism: Consideration of Peer Expectancies.

A variety of peer-related strategies to improve the social functioning of children With autism have been developed and empirically tested. Peer-mediated strategies typically involve the use of socially competent peers to model and reinforce appropriate social behavior. Promoting peer effort is an important component of such interventions and can be accomplished by altering peer expectations regarding their classmates With autism. Techniques include arranging situations or contingencies to promote optimal peer effort, teaching peers methods for reinforcing target skills in children With autism, teaching peers strategies for initiating interactions With children With autism, and teaching social skills to the children With autism. Peer-related approaches can be understood in the context of social learning theory. Several studies have shoWn that these strategies lead to substantial improvements in the social interactions of children With autism. Future research should continue to explore various peer-mediated socialization interventions, With an increased focus on the role of peer expectations.

Disproportionate Representation in Special Education: A Synthesis and Recommendations

Disproportionate representation of minority students in special education remains a very controversial, unresolved issue. This synthesis summarizes historical perspectives and current knowledge about disproportionate representation with respect to: (a) definitions of disproportionate representation and related issues of interpretation; (b) national and state-level estimates of disproportionality for four ethnic groups; (c) legal, policy, research and teacher education responses to disproportionality; and (d) hypothesized causes and predictors of disproportionality. Authors stress the need for: coherent and well-articulated conceptual frameworks, responsible use and representation of data, research dialog that is informed by appreciation of the complex sociopolitical history and current context, and the need for effective advocacy to improve the educational success of minority students.

Development of a Cognitive-Behavioral Intervention Program to Treat Anxiety and Social Deficits in Teens with High-Functioning Autism

Anxiety is a common co-occurring problem among young people with autism spectrum disorders (ASD). Characterized by deficits in social interaction, communication problems, and stereotyped behavior and restricted interests, this group of disorders is more prevalent than previously realized. When present, anxiety may compound the social deficits of young people with ASD. Given the additional disability and common co-occurrence of anxiety in ASD, we developed a manual-based cognitive-behavioral treatment program to target anxiety symptoms as well as social skill deficits in adolescents with ASD [Multimodal Anxiety and Social Skills Intervention: MASSI]. In this paper, we describe the foundation, content, and development of MASSI. We also summarize data on treatment feasibility based on a pilot study that implemented the intervention.

The Influence of Sociodemographics and Gender on the Disproportionate Identification of Minority Students as Having Learning Disabilities

The purpose of this study was to investigate the extent of gender and race/ethnicity disproportionality among students identified as having learning disabilities (LD) and to investigate relationships between disproportionality and sociodemographic factors. Using nationally representative data collected by the U.S. Office for Civil Rights, this study examined the effects of gender, ethnicity, and sociodemographic factors on the proportion of students who are identified as having LD. Results indicated a clear association between ethnicity and gender and the odds of being identified as a student with LD. Sociodemographic factors for a school district were also found to be strongly associated with the proportion of students identified as having LD. A logistic regression model that included the nine sociodemographic variables, gender, and race, was significantly better at predicting LD identification than a model that included sociodemographic predictors alone. Adjusted odds ratios illustrated how the likelihood of identifying LD changes when sociodemographic influences are taken into account. Findings indicated that both individual student characteristics and district sociodemographic characteristics are important in determining the likelihood of LD identification and that the impact of the sociodemographic characteristics is different for each of the gender-ethnicity groups.

State Variation in Gender Disproportionality in Special Education Findings and Recommendations

Gender disproportionality in special education has been apparent for many years, reflected in male-to-female ratios that range from about 1.5:1 to 3.5:1. The purpose of this study was to investigate the extent of disproportionate representation for the disability conditions of learning disability (LD), serious emotional disturbance (SED), and mental retardation (MR) at the state, regional, and national levels. Using data collected by the U.S. Office for Civil Rights, we examined the hypothesis that current variations across states in gender disproportionality should be small, and similar to rates for the nation as a whole. Substantial variations in state rates for students with LD and SED were observed. We also examined the hypothesis that states serving relatively fewer students for a given disability are likely to have greater male overrepresentation. This hypothesis was generally supported for students with LD but not for students with MR or SED. We examined factors related to state policies for students with MR and SED that might help to account for these findings. We conclude with recommendations for research to better understand the basis for gender disproportionality and with several practical implications for policy review and response related to gender disproportionality at the regional, state, and national levels.

The discriminative ability and diagnostic utility of the ADOS-G, ADI-R, and GARS for children in a clinical setting

Recent years have seen a surge of interest in assessment instruments for diagnosing autism in children. Instruments have generally been developed and evaluated from a research perspective. The Autism Diagnostic Observation Schedule-Generic (ADOS-G), Autism Diagnostic Interview-Revised (ADI-R), and Gilliam Autism Rating Scale (GARS) have received considerable attention and are widely used. The objective of this study was to explore the diagnostic utility and discriminative ability of these tools using a clinical population of children referred to a specialty diagnostic clinic over a 3 year time span. The results indicated that the ADOS-G and ADI-R led to approximately 75 percent agreement with team diagnoses, with most inconsistencies being false positive diagnoses based on the measures. The GARS was generally ineffective at discriminating between children with various team diagnoses and consistently underestimated the likelihood of autism. The findings have important implications for the use of these measures in both research and clinical practice.

Trends in the Special Education Identification Rates of Boys and Girls: A Call for Research and Change

Female underrepresentation in special education is now of significant concern to educators. The purpose of this study was to present nationally representative information about the extent of disproportionate representation for the disability conditions of learning disabilities, mental retardation, and emotional disturbance. Using data collected by the U.S. Office for Civil Rights, national trends are reported in gender disproportion between 1980-1997. Recommendations are made for carefully designed empirical research to elucidate the basis for differences, improved data collection and reporting by gender, and changes in practice.

ASD, a Psychiatric Disorder, or Both? Psychiatric Diagnoses in Adolescents with High-Functioning ASD

Varied presentations of emotion dysregulation in autism complicate diagnostic decision making and may lead to inaccurate psychiatric diagnoses or delayed autism diagnosis for high-functioning children. This pilot study aimed to determine the concordance between prior psychiatric diagnoses and the results of an autism-specific psychiatric interview in adolescents with high-functioning autism. Participants included 35 predominantly Caucasian and male verbal 10- to 17-year-olds with a confirmed autism spectrum disorder and without intellectual disability. The average age of autism spectrum diagnosis was 11 years old. Lifetime psychiatric diagnoses were established via the Autism Comorbidity Interview, developed to identify comorbid conditions within the context of autism. Autism Comorbidity Interview results were compared to parent report of prior community psychiatric diagnoses. Approximately 60% of prior psychiatric diagnoses were not supported on the Autism Comorbidity Interview; the lowest diagnostic concordance was for prior bipolar disorder and obsessive-compulsive disorder diagnoses. Although 51% of children met Autism Comorbidity Interview criteria for at least one psychiatric disorder, rates of prior diagnoses were much higher, with 77% having at least one prior psychiatric diagnosis and 60% having two or more. Although many participants met criteria for comorbid psychiatric disorders, the majority of previous psychiatric diagnoses were not supported when autism-related manifestations were systematically taken into account. These findings require replication and may not generalize to lower functioning and earlier diagnosed children with autism spectrum disorder. Results emphasize the importance of increasing awareness of the manifestations of high-functioning autism in order to improve accuracy of diagnosis and appropriateness of interventions.