Autism and sexual and gender minority identity in college students: Examination of self-reported rates, functional outcomes, and treatment engagement.

LAY ABSTRACT: Autistic individuals and those who identify with a sexual and/or gender minority are both at risk for various mental health concerns and related impairments. However, the connection between autism and sexual and/or gender minorities and mental health and functional outcomes is not clear. Here, we provide evidence of these connections by analyzing data from a large nationally representative dataset from the American College Health Association-National College Health Assessment III. We found that autistic college students who identify with both sexual and gender minorities reported the highest rates of stress, academic, and mental health concerns including suicidality when compared with autistic college students with or without a sexual and/or gender minority. In addition, college students with at least two identities, such as autism and a sexual minority identity or both a sexual and gender minority identity, reported the next highest rates of concern. These findings affirm the need for mental healthcare providers to consider the intersections of a sexual and gender minority identities in non-autistic and, especially, in autistic college students to develop and provide better support and resources.

Brain Signatures of Early and Late Neural Measures of Auditory Habituation and Discrimination in Autism and Their Relationship to Autistic Traits and Sensory Overresponsivity.

Sensory differences are included in the DSM-5 criteria of autism for the first time, yet it is unclear how they relate to neural indicators of perception. We studied early brain signatures of perception and examined their relationship to sensory behaviors and autistic traits. Thirteen autistic children and 13 Typically Developing (TD) children matched on age and nonverbal IQ participated in a passive oddball task, during which P1 habituation and P1 and MMN discrimination were evoked by pure tones. Autistic children had less neural habituation than the TD comparison group, and the MMN, but not P1, mapped on to sensory overresponsivity. Findings highlight the significance of temporal and contextual factors in neural information processing as it relates to autistic traits and sensory behaviors.

Examining the latent structure and correlates of sensory reactivity in autism: a multi-site integrative data analysis by the autism sensory research consortium.

BACKGROUND: Differences in responding to sensory stimuli, including sensory hyperreactivity (HYPER), hyporeactivity (HYPO), and sensory seeking (SEEK) have been observed in autistic individuals across sensory modalities, but few studies have examined the structure of these "supra-modal" traits in the autistic population. METHODS: Leveraging a combined sample of 3868 autistic youth drawn from 12 distinct data sources (ages 3-18 years and representing the full range of cognitive ability), the current study used modern psychometric and meta-analytic techniques to interrogate the latent structure and correlates of caregiver-reported HYPER, HYPO, and SEEK within and across sensory modalities. Bifactor statistical indices were used to both evaluate the strength of a "general response pattern" factor for each supra-modal construct and determine the added value of "modality-specific response pattern" scores (e.g., Visual HYPER). Bayesian random-effects integrative data analysis models were used to examine the clinical and demographic correlates of all interpretable HYPER, HYPO, and SEEK (sub)constructs. RESULTS: All modality-specific HYPER subconstructs could be reliably and validly measured, whereas certain modality-specific HYPO and SEEK subconstructs were psychometrically inadequate when measured using existing items. Bifactor analyses supported the validity of a supra-modal HYPER construct (ωH = .800) but not a supra-modal HYPO construct (ωH = .653), and supra-modal SEEK models suggested a more limited version of the construct that excluded some sensory modalities (ωH = .800; 4/7 modalities). Modality-specific subscales demonstrated significant added value for all response patterns. Meta-analytic correlations varied by construct, although sensory features tended to correlate most with other domains of core autism features and co-occurring psychiatric symptoms (with general HYPER and speech HYPO demonstrating the largest numbers of practically significant correlations). LIMITATIONS: Conclusions may not be generalizable beyond the specific pool of items used in the current study, which was limited to caregiver report of observable behaviors and excluded multisensory items that reflect many "real-world" sensory experiences. CONCLUSION: Of the three sensory response patterns, only HYPER demonstrated sufficient evidence for valid interpretation at the supra-modal level, whereas supra-modal HYPO/SEEK constructs demonstrated substantial psychometric limitations. For clinicians and researchers seeking to characterize sensory reactivity in autism, modality-specific response pattern scores may represent viable alternatives that overcome many of these limitations.

Brief Report: Sensory Features Associated with Autism After Controlling for ADHD Symptoms.

BACKGROUND: Sensory processing differences are reported both in children with ADHD and in children with autism. Given the substantial overlap between autism and ADHD, the current study examined which sensory features were uniquely predictive of autistic traits after controlling for ADHD symptoms, age, IQ, and sex in a sample of children and adolescents with autism aged 6-17 years. METHODS: The sample included 61 children and adolescents with autism. The Sensory Profile was used to examine Dunn's quadrant model (seeking, sensitivity, avoiding, registration), ADHD symptoms were measured using hyperactivity and attention problems BASC-2 T-scores, and autistic traits were measured using the AQ. RESULTS: After controlling for age, IQ, sex, and ADHD symptoms, Dunn's sensitivity quadrant predicted autistic traits. CONCLUSIONS: Findings provide insight into the phenotype of autism and ADHD. Sensory sensitivity may be unique to autism over and above elevated ADHD symptoms that are commonly seen in this population.

Investigating the Structure of the CESD-R and DASS-21 Across Adults with Low and High Levels of Autistic Traits.

The current study examined factorial invariance of the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) and the Depression Anxiety Stress Scales-21 (DASS-21) using a convenience sample of 434 adults surveyed though Amazon Mechanical Turk. Participants were sorted into two groups based on their score on the Autism-Spectrum Quotient. Results indicated that the CESD-R did not demonstrate configural invariance. The DASS-21 demonstrated evidence of scalar invariance, indicating cross-group equality in factor loadings and factor intercepts. Findings suggest that the DASS-21 measures symptoms of depression, anxiety, and stress consistently across individuals with high and low levels of ASD-related traits, whereas the CESD-R may not be valid when assessing symptoms of depression in those with a high level of ASD-related traits.

Examining the Latent Structure and Correlates of Sensory Reactivity in Autism: A Multi-site Integrative Data Analysis by the Autism Sensory Research Consortium.

Background Differences in responding to sensory stimuli, including sensory hyperreactivity (HYPER), hyporeactivity (HYPO), and sensory seeking (SEEK) have been observed in autistic individuals across sensory modalities, but few studies have examined the structure of these "supra-modal" traits in the autistic population. Methods Leveraging a combined sample of 3,868 autistic youth drawn from 12 distinct data sources (ages 3-18 years and representing the full range of cognitive ability), the current study used modern psychometric and meta-analytic techniques to interrogate the latent structure and correlates of caregiver-reported HYPER, HYPO, and SEEK within and across sensory modalities. Bifactor statistical indices were used to both evaluate the strength of a "general response pattern" factor for each supra-modal construct and determine the added value of "modality-specific response pattern" scores (e.g., Visual HYPER). Bayesian random-effects integrative data analysis models were used to examine the clinical and demographic correlates of all interpretable HYPER, HYPO and SEEK (sub)constructs. Results All modality-specific HYPER subconstructs could be reliably and validly measured, whereas certain modality-specific HYPO and SEEK subconstructs were psychometrically inadequate when measured using existing items. Bifactor analyses unambiguously supported the validity of a supra-modal HYPER construct (ω H = .800), whereas a coherent supra-modal HYPO construct was not supported (ω H = .611), and supra-modal SEEK models suggested a more limited version of the construct that excluded some sensory modalities (ω H = .799; 4/7 modalities). Within each sensory construct, modality-specific subscales demonstrated substantial added value beyond the supra-modal score. Meta-analytic correlations varied by construct, although sensory features tended to correlate most strongly with other domains of core autism features and co-occurring psychiatric symptoms. Certain subconstructs within the HYPO and SEEK domains were also associated with lower adaptive behavior scores. Limitations: Conclusions may not be generalizable beyond the specific pool of items used in the current study, which was limited to parent-report of observable behaviors and excluded multisensory items that reflect many "real-world" sensory experiences. Conclusion Psychometric issues may limit the degree to which some measures of supra-modal HYPO/SEEK can be interpreted. Depending on the research question at hand, modality-specific response pattern scores may represent a valid alternative method of characterizing sensory reactivity in autism.

Barriers to an Autistic Identity: How RRBs may Contribute to the Underdiagnosis of Females.

Background: Autistic females are frequently underdiagnosed, misdiagnosed, and/or diagnosed later in life. Restricted and Repetitive Behaviors (RRBs) are increasingly critical for diagnosis and yet are commonly rated lower in females. Whether this reflects genuinely lower levels of these traits, or if female-typical RRBs have a different phenotypic presentation that may not register on current quantitative measurement tools is unclear. Methods: Twenty-one autistic females and 21 autistic males matched on chronological age and FSIQ completed the AQ, ADOS-2, and ADI-R. Items from the ADOS-2 and ADI-R were selected that were relevant to the four areas of restricted and repetitive behavior in the DSM-5 diagnostic criteria of autism. Using a mixed-methods analytical approach, scores and comments on these measures were compared between sexes to better characterize RRBs in autistic females. Results: There were no sex differences on the AQ, which broadly assesses autistic traits. When analyzed by the four DSM-5 RRB criteria, there were no sex differences on the ADI-R when using traditional algorithm scoring that narrows questions down to those that are more sensitive and specific in capturing autism in research samples with a high proportion of males. When incorporating additional items relevant to the DSM-5 to identify sex changes in a broader pool of items, females scored higher on stereotyped movements and speech. Females also engaged in more sensory behaviors during the ADOS-2. Qualitative analyses indicated that females were more likely to engage in stereotyped body rocking and spinning, stereotyped behaviors when anxious, to show major reactions to changes, repetitive language including listing and counting, and sensory behaviors, especially in the tactile domain. Conclusion: Exploratory findings highlight sex differences in RRBs that may help enhance diagnostic clarity for females. Higher tactile sensory behaviors in females suggests there may be increased diagnostic sensitivity for females with the updated DSM-5 that now includes sensory components as part of the diagnostic criteria.

A Preliminary Study Characterizing Subcortical and Cortical Auditory Processing and Their Relation to Autistic Traits and Sensory Features.

This study characterizes the subcortical auditory brainstem response (speech-ABR) and cortical auditory processing (P1 and Mismatch Negativity; MMN) to speech sounds and their relationship to autistic traits and sensory features within the same group of autistic children (n = 10) matched on age and non-verbal IQ to their typically developing (TD) peers (n = 21). No speech-ABR differences were noted, but autistic individuals had larger P1 and faster MMN responses. Correlations revealed that larger P1 amplitudes and MMN responses were associated with greater autistic traits and more sensory features. These findings highlight the complexity of the auditory system and its relationships to behaviours in autism, while also emphasizing the importance of measurement and developmental matching.

A Randomized Feasibility Trial of a Fundamental Motor Skill Parent-Mediated Intervention for Children with Autism Spectrum Disorders.

The purpose of this pilot study was to examine the feasibility of a fundamental motor skills (FMS) intervention with two groups on the acquisition of FMS of children with autism spectrum disorders (ASD). We randomly assigned families (n = 15) of children with ASD aged 4-11 years into two groups (a workshop or a home-based group) focused on FMS development. Both groups participated in a 10-week intervention and were given the same instructional manual and adapted physical activity equipment. The workshop group also attended four in-person workshops targeting the needs of children with ASD and their parents. Children were tested on their FMS using the third edition of the Test of Gross Motor Development at the start and end of the intervention and then three months following the intervention. The recruitment rate was 50%, and the retention rate was 80% for all participants. The intervention for groups was safe and accepted by the participants as evaluated by post-program interviews. The outcomes of this pilot study suggest that parents can facilitate the acquisition of FMS of their children with ASD. Although these results are positive, there is a need to further identify effective interventions for FMS development in children with ASD.

Pathways of perceptual primacy: ERP evidence for relationships between autism traits and enhanced perceptual functioning.

Autistic individuals show enhanced perceptual functioning on many behavioral tasks. Neurophysiological evidence also supports the conclusion that autistic individuals utilize perceptual processes to a greater extent than neurotypical comparisons to support problem solving and reasoning; however, how atypicalities in early perceptual processing influence subsequent cognitive processes remains to be elucidated. The goals of the present study were to test the relationship between early perceptual and subsequent cognitive event related potentials (ERPs) and their relationship to levels of autism traits. 62 neurotypical adults completed the Autism Spectrum Quotient (AQ) and participated in an ERP task. Path models were compared to test predictive relationships among an early perceptual ERP (the P1 component), a subsequent cognitive ERP (the N400 effect), and the Attention to Detail subscale of the AQ. The size of participants' P1 components was positively correlated with the size of their N400 effect and their Attention to Detail score. Model comparisons supported the model specifying that variation in Attention to Detail scores predicted meaningful differences in participants' ERP waveforms. The relationship between Attention to Detail scores and the size of the N400 effect was significantly mediated by the size of the P1 effect. This study revealed that neurotypical adults with higher levels of Attention to Detail show larger P1 differences, which, in turn, correspond to larger N400 effects. Findings support the Enhanced Perceptual Functioning model of autism, suggesting that early perceptual processing differences may cascade forward and result in modifications to later cognitive mechanisms.

Longitudinal stability of salivary microRNA biomarkers in children and adolescents with autism spectrum disorder.

BACKGROUND: Autism spectrum disorder (ASD) is a complex neurological condition with increasing prevalence. Few tools accurately predict the developmental trajectory of children with ASD. Such tools would allow clinicians to provide accurate prognoses and track the efficacy of therapeutic interventions. Salivary RNAs that reflect the genetic-environmental interactions underlying ASD may provide objective measures of symptom severity and developmental outcomes. This study investigated whether salivary RNAs previously identified in childhood ASD remain perturbed in older children. We also explored whether RNA candidates changed with therapeutic intervention. METHOD: A case-control design was used to characterize levels of 78 saliva RNA candidates among 96 children (48 ASD, 48 non-ASD, mean age: 11 years). Thirty-one children (22 ASD, 9 non-ASD developmental delay, mean age: 4 years) were followed longitudinally to explore changes of RNA candidates during early intervention. Saliva RNA and standardized behavioral assessments were collected for each participant. Associations between candidate RNAs and behavioral scores were determined in both groups via Spearman Correlation. Changes in candidate RNAs across two time-points were assessed in the younger cohort via Wilcoxon rank-sum test. RESULTS: Seven RNAs were associated with VABS-II and BASC scores in the older group ([R] >0.25, FDR< 0.15). Within the younger cohort, 12 RNAs displayed significant changes over time (FDR< 0.05). Three microRNAs were associated with behavioral scores and changed over time (miR-182-5p, miR-146b-5p, miR-374a-5p). CONCLUSION: Several salivary RNAs are strongly associated with autistic behaviors in older individuals with ASD and change as early as three months after therapy initiation in younger children. These molecules could be used to track treatment effectiveness and provide prognoses. Further validation is necessary.

The science of humanity and the humanity of science: Perspectives on Ed Zigler's contributions to developmental psychopathology and the study of all children.

We present this article as a testament to Ed Zigler's commitment to science in the service of humanity and to policy based on conceptually compelling theory and methodologically rigorous science. In doing so, we highlight ways that Ed's universal and inclusive developmental world view, early training as a behaviorist, exacting scientific standards, concern for others, and appreciation of his own roots and upbringing all transformed the way that many different groups of people of all ages and backgrounds are studied, viewed, and intervened with by researchers, policy makers, and society at large. Ed's narrative of development rather than defect, universality rather than difference, and holistic rather than reductionist continues to compel us in the quest for a kinder, more inclusive, and enabling society. Conversely, Ed's behaviorist training as a graduate student also influenced him throughout his career and was essential to his career-long commitment to systemic action in the service of improving the lives of others. We cite the lessons that we, as his descendants, learned from Ed and apply them to our own areas of research with populations that Ed did not study, but had considerable interest in - persons with autism spectrum disorder and Indigenous youth.

Developmental Perspectives on the Study of Persons with Intellectual Disability.

Developmental approaches provide inclusive, universal, and methodologically rigorous frameworks for studying persons with intellectual disability (ID). This is an exceptionally heterogeneous group with regard to etiology, genotype, and phenotype that simply shares the traditional diagnostic criteria, typically a score of two standard deviations below the population mean of 100 on standardized IQ tests and deficits in adaptive behavior. We trace the foundational, conceptual, and methodological roots of developmental approaches and highlight ways that these and more recent iterations continue to be central to advances in the increasingly nuanced study of persons with ID. This work is premised on the consideration of specific etiological groupings and subgroupings across and between different domains of functioning within the context of familial and complex environments throughout the life span. We highlight the potential contributions of advances in behavioral methodologies, genomics, and neuroscience when considered within universal and hierarchic frameworks based on development.

Examining the Temporal Limits of Enhanced Visual Feature Detection in Children With Autism.

The enhanced perceptual processing of visual features in children with autism spectrum disorder (ASD) is supported by an abundance of evidence in the spatial domain, with less robust evidence regarding whether this extends to information presented across time. The current study aimed to replicate and extend previous work finding that children with an ASD demonstrated enhanced perceptual accuracy in detecting feature-based (but not categorically defined) targets in time, when these were presented quickly, at a stimulus onset asynchrony (SOA) of 50 ms per item. Specifically, we extend the range of SOAs to examine the temporal boundaries of this enhanced accuracy and examine whether there is a relationship between ASD-related traits and detection accuracy on temporal visual search tasks. Individuals with autism perceived feature-based targets with statistically higher accuracy than their typically developing peers between SOAs of 39 and 65 ms and were numerically faster at all SOAs. No group differences were noted for category-based task accuracy. Our results also demonstrated that ASD-related traits measured by the autism spectrum quotient were positively correlated with accuracy on the feature-based task. Overall, results suggest that accurate visual perception of features (particularly color) is enhanced in children with ASD across time. LAY SUMMARY: Our results suggest that children with autism are able to process visual features, such as color, more accurately than typically developing children, even when these are presented very rapidly. Accuracy was higher in children with higher levels of autism-related traits and symptoms. Our findings suggest that more accurate visual perception exists not only across space in children with autism, as much of the existing literature demonstrates, but also over time. Autism Res 2020, 13: 1561-1572. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.

Forensic Interviewers' Difficulty With Invitations: Faux Invitations and Negative Recasting.

An ongoing challenge for forensic interviewers is to maximize their use of invitations, such as requests that the child "tell me more about" details mentioned by the child. Examining 434 interviews with 4- to 12-year-old children questioned about abuse, this study analyzed (1) faux invitations, in which interviewers prefaced questions with "tell me" but then asked a noninvitation, (2) negative recasts, in which interviewers started to ask an invitation but then recast the question as a wh- or option-posing question, and (3) other aspects of questions that may relate to productivity independent of their status as invitations. About one fourth of "tell me" questions were faux invitations, and over 80% of recasts were negative. The frequency of both faux invitations and negative recasts increased during the substantive phase of the interviews, and these were related to decreased productivity, increased nonresponsiveness, and increased uncertainty. In contrast, use of exhaustive terms (e.g., "tell me everything") and nonstatic questions (e.g., about actions) was related to increased productivity. The results suggest that training should teach interviewers when and how strategic use of invitations and other question types can elicit specific types of forensically relevant information.

Sensory Overresponsivity as a Predictor of Amplitude Discrimination Performance in Youth with ASD.

Previous studies have suggested that sensory overresponsivity in youth with autism spectrum disorder (ASD) may be due to a failure to habituate to stimuli. We examined the relationship between performance on three tactile psychophysical tasks and the construct of sensory overresponsivity in children with and without ASD. Sensory overresponsivity predicted amplitude discrimination with an adapting stimulus, as well as the effect of adaptation, for ASD youth. Results replicate previous research that children with ASD are less affected by the presence of an adapting stimulus as compared to typically developing children, and further suggest that sensory overresponsivity may be the mechanism underlying the observed lack of an adaptation effect in children with ASD.

Autism Spectrum Disorders and ADHD: Overlapping Phenomenology, Diagnostic Issues, and Treatment Considerations.

PURPOSE OF REVIEW: Autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) are both increasing in prevalence and commonly co-occur with each other. The goal of this review is to outline what has been published recently on the topics of ASD, ADHD, and the comorbid state (ASD+ADHD) with a particular focus on shared phenomenology, differential diagnosis, and treatment considerations. RECENT FINDINGS: ASD and ADHD have shared genetic heritability and are both associated with shared impairments in social functioning and executive functioning. Quantitative and qualitative differences exist, however, in the phenotypic presentations of the impairments which characterize ASD and ADHD. For ASD interventions to be maximally efficacious, comorbid ADHD needs to be considered (and vice versa). The research on ASD and ADHD suggests some overlap between the two disorders yet enough differences to indicate that these conditions are sufficiently distinct to warrant separate diagnostic categories.

Specific differences in temporal binding aspects of the attentional blink in Chromosome 22q11.2 Deletion Syndrome.

Chromosome 22q11.2 Deletion Syndrome (22q11DS) is a genetic syndrome characterized by a variety of cognitive impairments, including difficulty with attention. 22q11DS is the strongest known genetic risk factor for developing schizophrenia, a disorder characterized by impairments in visual attention and temporal binding processes. Here we examine a specific temporal visual attention phenomenon (the attentional blink; AB) within two rapid serial visual presentation tasks, and compare those with 22q11DS to groups of typically developing individuals matched on chronological (CA) and mental age (MA). Performance of individuals with 22q11DS was sensitive to differing task demands. On a Category Task, individuals with 22q11DS performed similarly to control groups on all measures of the AB, with the exception of lower detection accuracy of the first of two targets. In contrast, on a feature-based Color Task which required temporal binding of stimulus features, individuals with 22q11DS differed from CA and MA matched control groups on all AB performance measures, exhibiting lower target accuracy, more temporal binding errors, and a deeper, more protracted AB. Temporal binding in the visual domain is thought to be dependent on a serial attention mechanism that facilitates simultaneous firing of neurons in multiple areas of the visual cortex, activating short-term working memory for storage of bound features. Given the discrepancy between these two tasks, results suggest that temporal binding processes may be significantly affected in individuals with 22q11DS, a finding that importantly, has been previously demonstrated among individuals with schizophrenia.

Validation of the C.A.R.E. stimulus set of 640 animal pictures: Name agreement and quality ratings.

Stimulus sets are valuable tools that can facilitate the work of researchers designing experiments. Images of faces, and line drawings of objects have been developed and validated, however, pictures of animals, that do not contain backgrounds, have not been made available. Here we present image agreement and quality ratings for a set of 640 color images of animals on a transparent background, across 60 different basic categories (e.g. cat, dog, frog, bird), some with few, and others with many exemplars. These images were normed on 302 participants. Image agreement was measured both with respect to the proportion of participants that provided the same name as well as the H-statistic for each image. Image quality was measured both overall, and with respect to the accuracy of participants' naming of the basic category. Word frequency of each basic and superordinate category based on the English Lexicon Project (Balota, et al., 2007) and the HAL database (Kucera & Francis, 1976) are provided as are Age of Acquisition (Kuperman, Stadthagen-Gonzalez, & Brysbaert, 2012) data.