Micah O. Mazurek

A Prospective Study of the Concordance of DSM-IV and DSM-5 Diagnostic Criteria for Autism Spectrum Disorder.

The transition from DSM-IV to DSM-5 criteria for autism spectrum disorder (ASD) sparked considerable concern about the potential implications of these changes. This study was designed to address limitations of prior studies by prospectively examining the concordance of DSM-IV and final DSM-5 criteria on a consecutive sample of 439 children referred for autism diagnostic evaluations. Concordance and discordance were assessed using a consistent diagnostic battery. DSM-5 criteria demonstrated excellent overall specificity and good sensitivity relative to DSM-IV criteria. Sensitivity and specificity were strongest for children meeting DSM-IV criteria for autistic disorder, but poor for those meeting criteria for Asperger’s disorder and pervasive developmental disorder. Higher IQ, older age, female sex, and less pronounced ASD symptoms were associated with greater discordance.

Pathological game use in adults with and without Autism Spectrum Disorder

This study tested whether adults with autism spectrum disorder (ASD) are at higher risk for pathological game use than typically developing (TD) adults. Participants included 119 adults with and without ASD. Participants completed measures assessing daily hours of video game use, percent of free time spent playing video games, and symptoms of pathological game use. The results indicated that adults with ASD endorsed more symptoms of video game pathology than did TD adults. This relationship was strong, enjoying 300,000-to-1 odds in Bayesian model comparison. Results also showed that adults with ASD spent more daily hours playing video games and spent a higher percent of their free time playing video games than did TD adults. Even after adjustment for these differences in daily video game hours and proportion of free time spent on games, model comparisons found evidence for a difference in game pathology scores associated with ASD status. Additionally, escapism motives for playing video games was associated with game pathology scores in both ASD and TD adults, replicating and extending a previous report. In conclusion, the risk for pathological game use appears larger in adults with ASD compared with TD adults. These findings point to pathological game use as a potentially important focus of clinical attention in adults with ASD.

Construct Validity of the Autism Impact Measure (AIM)

The Autism Impact Measure (AIM) was designed to track incremental change in frequency and impact of core ASD symptoms. The current study examined the structural and convergent validity of the AIM in a large sample of children with ASD. The results of a series of exploratory and confirmatory factor analyses yielded a final model with five theoretically and empirically meaningful subdomains: Repetitive Behavior, Atypical Behavior, Communication, Social Reciprocity, and Peer Interaction. The final model showed very good fit both overall and for each of the five factors, indicating excellent structural validity. AIM subdomain scores were significantly correlated with measures of similar constructs across all five domains. The results provide further support for the psychometric properties of the AIM.

ECHO Autism STAT: Accelerating Early Access to Autism Diagnosis

Although early diagnosis of autism is critical for promoting access to early intervention, many children experience significant diagnostic delays. Shortages of healthcare providers, limited capacity at autism centers, and geographic and socioeconomic challenges contribute to these delays. The current pilot study examined the feasibility of a new model for training community-based primary care providers (PCPs) in underserved areas in screening and diagnosis of young children at highest risk for autism. By combining hands-on training in standardized techniques with ongoing virtual mentorship and practice, the program emphasized both timely diagnosis and appropriate referral for more comprehensive assessment when necessary. Results indicated improvements in PCP practice and self-efficacy, and feasibility of the model for enhancing local access to care.

Factors associated with DSM-5 severity level ratings for autism spectrum disorder:

The newest edition of the Diagnostic and Statistical Manual of Mental Disorders (5th ed., DSM-5) introduced substantial changes to the diagnostic criteria for autism spectrum disorder, including new severity level ratings for social communication and restricted and repetitive behavior domains. The purpose of this study was to evaluate the use of these new severity ratings and to examine their relation to other measures of severity and clinical features. Participants included 248 children with autism spectrum disorder who received diagnostic evaluations at one of six Autism Treatment Network sites. Higher severity ratings in both domains were associated with younger age, lower intelligence quotient, and greater Autism Diagnostic Observation Schedule–Second Edition domain-specific symptom severity. Greater restricted and repetitive behavior severity was associated with higher parent-reported stereotyped behaviors. Severity ratings were not associated with emotional or behavioral problems. The new DSM-5 severity ratings in both domains were significantly associated with behavioral observations of autism severity but not with measures of other behavioral or emotional symptoms. However, the strong associations between intelligence quotient and DSM-5 severity ratings in both domains suggest that clinicians may be including cognitive functioning in their overall determination of severity. Further research is needed to examine clinician decision-making and interpretation of these specifiers.

Relations among activity participation, friendship, and internalizing problems in children with autism spectrum disorder:

Social interaction difficulties in children with autism spectrum disorder can be challenging, especially during adolescence. In addition, high rates of comorbid internalizing disorders in autism spectrum disorder can lead to social isolation. With limited social activity participation, social deficits and internalizing problems in autism spectrum disorder may be related to participation, exposure, and practice with friends. The purpose of this study was to evaluate the relations among friendship, activity participation, and internalizing problems. Participants included 129 children with autism spectrum disorder between the ages of 6 and 18 years. Measures of friendship, sport, hobby, and club participation, and internalizing problems were assessed. Results showed that activity participation was related to more friendships, even after controlling for intelligence quotient. This study sheds light on the impact of social engagement with peers in developing and maintaining friendships as well as managing internalizing problems.