Julie A. Worley

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.

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 co-morbid psychopathology on challenging behaviours among infants and toddlers with Autistic Disorder and PDD-NOS as assessed with the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT).

Purpose: To examine whether level of symptoms of co-morbid psychopathology exacerbated challenging behaviours in young children with autism spectrum disorders (ASD). Method: Using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT)–Part 2 which measures co-morbid symptoms and the BISCUIT- Part 3 which examines challenging behaviours, 362 infants and toddlers with ASD were evaluated. Results: Findings showed that participants scoring high on symptoms of Avoidance and Tantrum/Conduct problems had greater rates of aggressive/destructive behaviours, self-injurious behaviours (SIB) and stereotypies compared to those with low scores. Participants with high levels of Inattention/Impulsivity or Eat/Sleep concerns, compared to those with low levels, demonstrated greater aggressive/destructive behaviour and stereotypies. For symptoms of Anxiety/Repetitive Behaviours, participants with high scores displayed greater levels of stereotypies. Conclusions: Symptoms of co-morbid psychopathology are present at a very early age for children with ASD and elevated levels of these symptoms may exacerbate challenging behaviours.

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.

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.

Replacement behaviors for identified functions of challenging behaviors

Functional assessment has become a major feature of learning-based research. A critical element of the majority of these studies includes not only methods and procedures to identify the cause of the challenging behavior, but to establish replacement treatment methods. By far the most common intervention in the 176 studies we reviewed was reinforcement. Noncontingent reinforcement (NCR) was the most common reinforcement method, followed by differential reinforcement of other behavior (DRO). Reinforcement plus extinction was the second most commonly employed treatment followed by functional communication training with or without reinforcement. Researchers proved to be very creative. Forty different treatment methods were employed. The implications of these data are discussed.

The effects of inattention/impulsivity and ASD symptom severity on social skills in toddlers

Objective: The aim of the current study was to examine the effects of symptom severity of ASD and symptom severity of inattention and impulsivity in toddlers to determine the potential impact on social skills. Methods: A total of 240 toddlers diagnosed with ASD, ranging in age from 17–36 months, were included in this study. Parents or legal guardians were administered measures assessing for symptoms of ASD, symptoms of psychopathology and social skills. Results: A significant interaction was found, indicating that toddlers with less severe symptoms of ASD and of inattention/impulsivity had better social skills. In contrast, toddlers with more severe symptoms of ASD and inattention/impulsivity had the most deficits in social skills. Conclusion: These results further confirm that a multidimensional approach to assessment is needed and that comorbid psychopathology symptoms and social skills targets should be a focus of assessment and intervention.

Diagnostic Instruments for the Core Features of ASD

Autism spectrum disorders (ASDs) are a group of lifelong, heterogeneous disorders that share overlapping diagnostic criteria. The broad diagnostic criteria first defined by Kanner (1943) have remained consistent; however, the diagnostic systems classifying these core impairments (i.e., in socialization, communication, and restricted interests/repetitive behavior) have changed over time. Thus, to account for these changes, measures used to assess symptoms of various forms of ASDs have amended and transformed. With the increasing knowledge about the various ASDs, the development of diagnostic measures and screeners that assess for symptoms of ASD continues. Therefore, the focus of this chapter will be on measures specific to ASDs that assist in screening for symptoms and for diagnostic decision making. The standardization of ASD diagnoses remains complicated by research on the symptoms of ASD, differential diagnoses between ASDs, and the promotion of diagnosing ASD in preschoolers (Matson, Nebel-Schwalm, & Matson, 2007). Therefore, measures included in this chapter may cover one or a number of the above (e.g., for younger versus older children, just for autism versus differentiating between ASDs).

Person Characteristics of Individuals in Functional Assessment Research.

This paper is a review of person characteristics that were present in 173 studies that were reviewed on functional assessment. The purpose was to give the reader an idea about the types of individuals for which functional assessment is appropriate and to outline persons and their characteristics which have the best research support. The majority of participants were diagnosed with intellectual disability and/or autism. Additionally more males that females were included and children were frequently studied versus adolescents and older adults. Finally, while the majority of studies employed experimental functional analysis, the number of participants per study was small. Conversely, functional analysis scales were used in far fewer studies, but with much larger sample sizes. Thus, relatively equal numbers of individuals have been studied with both methods.