Factor analysis of the autism spectrum screening questionnaire in a population-based child sample.

PURPOSE: The aim of this study was to investigate several possible factor structures of the Autism Spectrum Screening Questionnaire (ASSQ). MATERIALS AND METHODS: We used the 27-item screening tool for school-aged children in a general population of 8-year-old children (n = 3,538) and compared the occurring solutions to previously published factor models. RESULTS: A one-factor solution and a four-factor solution were identified in Exploratory Factor Analysis (EFA) and confirmed with Confirmatory Factor Analysis (CFA), while two-, three-, five- and six-factor solutions were rejected. In CFA, our four-factor solution showed the best goodness-of-fit indexes when compared with factor models previously presented by Posserud et al. and Ehlers et al. CONCLUSIONS: The results indicate a strong underlying connection between all ASSQ items which is elicited by the one-factor solution. Although as a screening tool, ASSQ is functioning with the unifactorial solution, the four factors can help to identify certain clusters of autism spectrum traits.

Dynamic lag analysis reveals atypical brain information flow in autism spectrum disorder.

This study investigated whole-brain dynamic lag pattern variations between neurotypical (NT) individuals and individuals with autism spectrum disorder (ASD) by applying a novel technique called dynamic lag analysis (DLA). The use of 3D magnetic resonance encephalography data with repetition time = 100 msec enables highly accurate analysis of the spread of activity between brain networks. Sixteen resting-state networks (RSNs) with the highest spatial correlation between NT individuals (n = 20) and individuals with ASD (n = 20) were analyzed. The dynamic lag pattern variation between each RSN pair was investigated using DLA, which measures time lag variation between each RSN pair combination and statistically defines how these lag patterns are altered between ASD and NT groups. DLA analyses indicated that 10.8% of the 120 RSN pairs had statistically significant (P-value <0.003) dynamic lag pattern differences that survived correction with surrogate data thresholding. Alterations in lag patterns were concentrated in salience, executive, visual, and default-mode networks, supporting earlier findings of impaired brain connectivity in these regions in ASD. 92.3% and 84.6% of the significant RSN pairs revealed shorter mean and median temporal lags in ASD versus NT, respectively. Taken together, these results suggest that altered lag patterns indicating atypical spread of activity between large-scale functional brain networks may contribute to the ASD phenotype. Autism Res 2020, 13: 244-258. © 2019 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. LAY SUMMARY: Autism spectrum disorder (ASD) is characterized by atypical neurodevelopment. Using an ultra-fast neuroimaging procedure, we investigated communication across brain regions in adults with ASD compared with neurotypical (NT) individuals. We found that ASD individuals had altered information flow patterns across brain regions. Atypical patterns were concentrated in salience, executive, visual, and default-mode network areas of the brain that have previously been implicated in the pathophysiology of the disorder.

How are social-emotional and behavioral competences and problems at age 1 year associated with infant motor development? A general population study.

Based on limitations in previous research evidence, we concluded that more research is needed for deeper understanding of how social-emotional and behavioral (SEB) outcomes among infant-toddler-aged children in the general population are associated with early motor development. In this study, we investigated associations between early competencies and problems, as measured by the Brief Infant-Toddler Social and Emotional Assessment (BITSEA), and the timing of achievement of the main gross and fine motor milestones usually attained during the first year of life in a general population context. The study sample consisted of 515 infants (mean age 12.9 [SD 0.9] months) and their parents (514 mothers, 434 fathers), who were recruited in child health centers in Northern Finland. The infants were divided into two groups, based on their BITSEA screen status, and motor milestone achievement ages were compared across BITSEA screen status No Concern and Of-Concern infants. An Of-Concern screen status on the maternal and paternal Competence scale and Autism spectrum disorder (ASD) item cluster was associated with later infant achievement ages for gross motor milestones. By contrast, infants who were screened to be in the Of-Concern range on the maternal Problem scale achieved gross motor milestones earlier than infants with the corresponding No Concern screen status. No significant associations were found between the paternal Problem scale screen status and infant motor development. In further analyses, the strongest associations were found between an Of-Concern screen status on the paternal Competence scale and ASD item cluster and infant motor development. The findings indicate that the inclusion of infant motor developmental information may assist early identification and the clinical interpretation of parental reports of early SEB problems. Clinical implications of the current findings are discussed in the paper.

Implementation and outcome of child psychotherapy compared with other psychiatric treatments in a naturalistic clinical setting.

BACKGROUND: Mental health problems of children are commonly treated by psychotherapy and other psychosocial treatments. Studies comparing different treatments in naturalistic clinical settings are few, however. AIMS: We assessed the differences: 1) in symptoms and diagnoses; 2) in treatment outcome between psychotherapy and other psychosocial treatments; and 3) evaluated the effect of family background and life circumstances on the outcome. METHODS: The data were collected from the psychiatric hospital records of Oulu University Hospital, Finland. All 118 children (aged < 16 years) referred to psychotherapy from the Department of Child Psychiatry in 1996-2005 and 118 age- and sex-matched children undergoing other psychosocial treatments were included. A lack of later recorded psychiatric problems was used as an indicator of good treatment outcome. RESULTS: On referral, functional ability was severely impaired in almost half of the children (Children's Global Assessment Scale score < 55). Internalizing symptoms were more common in the psychotherapy group, while no difference was found in externalizing symptoms between the groups. In both groups, later psychiatric problems were associated with a child's low functional ability and poor parental coping with their responsibilities. Children with internalizing problems had impaired prognosis if they had psychosocial treatments other than psychotherapy. CONCLUSIONS: Individual psychotherapy should especially be considered for children with internalizing symptoms, but the outcome of psychiatric treatment depends not only on children's own functional abilities, but also on parental abilities.

Validation of the Finnish Autism Spectrum Screening Questionnaire (ASSQ) for clinical settings and total population screening.

We assessed the validity and determined cut-off scores for the Finnish Autism Spectrum Screening Questionnaire (ASSQ). A population sample of 8-year-old children (n = 4,408) was rated via the ASSQ by parents and/or teachers, and a subgroup of 104 children was examined via structured interview, semi-structured observation, IQ measurement, school observation, and medical records. Autism spectrum disorders (ASDs) were diagnosed following DSM-IV-TR criteria. A search for hospital-registered ASDs was performed. For Finnish higher-functioning primary school-aged, 7- to 12-year-olds, the optimal cut-off score was 30 in clinical settings and 28 in total population screening using summed ASSQ scores of parents' and teachers' ratings. Determining appropriate cut-off scores in ASD screening in different languages and in different cultures is of utmost importance.

The association between parental images and satisfaction in intimate relationships in a Northern Finland sample.

OBJECTIVES: Experiences in one's family of origin, especially the relationship to one's parents, supposedly form the basis of relationships in adulthood. The connection between traumatic childhood events and later life has been studied intensively, whereas average childhood growth experiences have been given less attention. The aim of this study was to find out the association between images of the mother and father and the psychosocial well-being of young adults from the perspective of satisfaction in intimate relationships. STUDY DESIGN: Cross-sectional study. METHODS: The research is a part of the Oulu University Hospital Mother-Child Follow-up Study 1971-1972. The follow-up data were collected from the young adults (n=337) in 2000 by way of mailed questionnaires, which included 17 questions about the participants' images of their parents and 18 questions about their intimate relationship satisfaction. In this study we used attachment theory as a theoretical frame of reference. RESULTS: Mental images of dominating parents were associated with quarrelsome intimate relationships, and the image of a dominating father, with repressive/submissive and less balanced relationships. Mental images of diligent and sociable parents were associated with a loving and balanced relationship, and the image of supportive parents, with a balanced relationship. Parental diligence was associated with a less quarrelsome relationship. CONCLUSION: The young adults' mental images of their parents were associated with their intimate relationship satisfaction. Positive mental images of the father, in particular, seemed to protect young adults from a quarrelsome and repressive/submissive intimate relationship.

Comorbid psychiatric disorders associated with Asperger syndrome/high-functioning autism: a community- and clinic-based study.

The present study identifies the prevalence and types of comorbid psychiatric disorders associated with Asperger syndrome (AS)/high-functioning autism (HFA) in a combined community- and clinic-based sample of fifty 9- to 16-year-old subjects using the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime Version. The level of functioning was estimated using the Children's Global Assessment Scale. The results support common (prevalence 74%) and often multiple comorbid psychiatric disorders in AS/HFA; behavioral disorders were shown in 44%, anxiety disorders in 42% and tic disorders in 26%. Oppositional defiant disorder, major depressive disorder and anxiety disorders as comorbid conditions indicated significantly lower levels of functioning. To target interventions, routine evaluation of psychiatric comorbidity in subjects with AS/HFA is emphasized.

Screening infants with social and emotional problems: a pilot study of the brief infant toddler social and emotional assessment (BITSEA) in Northern Finland.

OBJECTIVES: To compare 3 questionnaires used to evaluate early developmental problems, emotional disturbances and competence in 18-month-old infants. STUDY DESIGN: A follow-up study with parents of infants 8 to 36 months of age who responded to a developmental questionnaire. METHODS: Fifty infants (18 months of age) were evaluated through 3 questionnaires: (1) the Brief Infant and Toddler Social and Emotional Assessment (BITSEA), (2) the Child Behavior Checklist (CBCL) and (3) the MacArthur Communicative Development Inventories (MCDI). RESULTS: The BITSEA-questionnaire results (total problem scores) had a strong correlation with the most CBCL subscales and the MCDI (total scores) and gave more precise information concerning the infants' developmental problems. CONCLUSIONS: The BITSEA questionnaire identifies developmental problems in the early stages and screens infants' social-emotional competence.

Multi-informant reports of psychiatric symptoms among high-functioning adolescents with Asperger syndrome or autism.

The aim of the study was to examine psychiatric symptoms in high-functioning adolescents with autism spectrum disorders reported by multiple informants. Forty-three 11- to 17-year-old adolescents with Asperger syndrome (AS) or high-functioning autism (HFA) and 217 typically developed adolescents completed the Youth Self-Report (YSR), while their parents completed the Child Behavior Checklist (CBCL). Teachers of adolescents with AS/HFA completed the Teacher Report Form (TRF). The informants reported significantly more psychiatric symptoms, especially withdrawn, anxious/depressed, social and attention problems, in adolescents with AS/HFA than in controls. In contrast to findings in the general population, the psychiatric problems of adolescents with AS/HFA are well acknowledged by multiple informants, including self-reports. However, anxiety and depressive symptoms were more commonly reported by adolescents with AS/HFA and their teachers than their parents, indicating that some emotional distress may be hidden from their parents.

When does the Autism Spectrum Screening Questionnaire (ASSQ) predict autism spectrum disorders in primary school-aged children?

The aims of this study were, firstly, to study the association between parents' and teachers' ratings for the Finnish version of the Autism Spectrum Screening Questionnaire (ASSQ), secondly, to find out whether the original cut-off scores of the ASSQ identify primary school-aged children with Asperger syndrome (AS) or autism by using the Finnish ASSQ, and thirdly, to evaluate the validity of the ASSQ. Parents and/or teachers of higher-functioning (full-scale intelligence quotient > or = 50) 8-year-old total population school children (n = 4,408) and 7-12-year-old outpatients with AS/autism (n = 47) completed the Finnish version of the ASSQ. Agreement between informants was slight. In the whole total population, low positive correlation was found between parents' and teachers' ratings, while in the sample of high-scoring children the correlation turned out to be negative. A cut-off of 30 for parents' and teacher's summed score and 22 for teachers' single score is recommended. A valid cut-off for parents' single score could not been estimated. The clinicians are reminded that the ASSQ is a screening instrument, not a diagnosing instrument. The importance of using both parents' and teachers' ratings for screening in clinical settings is underlined.

Psychometric evaluation of social phobia and anxiety inventory for children (SPAI-C) and social anxiety scale for children-revised (SASC-R).

The study evaluated the psychometric properties of Finnish versions of the Social Phobia and Anxiety Inventory for Children (SPAI-C) and the Social Anxiety Scale for Children-Revised (SASC-R). 352 students (M = 12.2 years) participated in the study and completed the SPAI-C and SASC-R. In addition, 68 participants (M = 12.2 years) and their parents were interviewed with the Schedule for Affective Disorders and Schizophrenia for School Aged Children (K-SADS-PL). The SPAI-C was more sensitive for identifying youth meeting criteria for social phobia (SP), whereas the SASC-R demonstrated greater specificity. The youth in this sample had lower mean total scores on the self-report questionnaires than did those in the original validitation studies of the SPAI-C and SASC-R conducted in America. These findings question whether cross-cultural differences in the expression of SP influence the clinical cut-off scores used in translated versions of social anxiety questionnaires.