Anxiety, depression, and well-being in autistic adults and adults with other developmental disabilities: A longitudinal cross-lagged analysis.

Autistic people and people with other developmental disabilities (DD) are at high likelihood for anxiety and depression, which can negatively affect adult life. Therefore, this study sought to understand temporal links between anxiety and depression over time in autistic adults and adults with DDs, and how these conditions impact specific aspects of positive well-being. A sample of 130 adults with autism or other DDs and their caregivers were drawn from a longitudinal study. Participants complete measures of anxiety (Adult Manifest Anxiety Scale), depression (Beck Depression Inventory, 2nd Edition), and well-being (Scales of Psychological Well-Being). Cross-lagged panel analyses revealed significant autoregressive effects for anxiety and depressive symptoms over time, based on both caregiver and self-report (all p < 0.01). Additionally, although findings differed across reporter, cross-lagged links between anxiety and depression emerged over time. Based on caregiver-report, anxiety symptoms predicted later depressive symptoms (p = 0.002) but depressive symptoms did not predict later anxiety (p = 0.10); the opposite pattern was identified for self-report. Aspects of positive well-being (purpose in life, self-acceptance, personal growth) demonstrated differential links with anxiety and depression (p = 0.001-0.53). These findings highlight the utility of a transdiagnostic approach to mental health services for autistic adults and adults with DDs, and the need to monitor for anxious or depressive symptoms in autistic adults and adults with DDs presenting with depression or anxiety, respectively.

Marital status over 28 years of parents of individuals with autism and other developmental disabilities.

Longitudinal, prospective analyses of marital status in parents of individuals with autism are needed to better understand the types and timing of supports needed to mitigate the impact of divorce on the family. We describe the timing of divorce and the factors that contribute to divorce in a longitudinal sample of families of individuals with autism and other developmental disabilities. Participants included parents of 219 children initially referred for autism and other developmental delays followed to age 30 years. Approximately 36% of individuals in our sample experienced a parental divorce by age 30. Higher rates of divorce were associated with lower maternal education and families of color and moderately associated with younger maternal age at child's birth, autism symptom severity, and ASD diagnosis. Divorces were most common in children's early years (under age 5) and also in the teenage years and beyond (over age 15). After age 15, higher risk was associated with the child's higher cognitive ability and daily living skills, and being a multiplex family. Results suggest that divorce risk in families of children with autism remains high through childhood into early adulthood. Understanding factors related to changes in marital status may help support families across time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Predictors of Attrition in a Randomized Trial of a Social Communication Intervention for Infant-Toddlers at Risk for Autism.

Addressing factors that make it more likely for families to attrite from early intervention trials will allow researchers to ensure that families reap the full benefits of participation. This study was an analysis of 78 children (Mage = 18.38 months, SD = 5.78) at risk for autism participating in a university-based randomized controlled trial of two 8-week long early intervention programs. Overall, attrition through 8-weeks was low, approximately 13%, however by the one-year follow-up attrition rates were approximately 50%. The most consistent predictor of attrition was the distance that families had to travel to the university. These data highlight the importance of providing services and support (e.g., financial and logistic) during follow-up to families to maximize their participation. Clincaltrials.gov Identifier: NCT01874327, 6/11/2013.

The effect of responsiveness to speech-generating device input on spoken language in children with autism spectrum disorder who are minimally verbal†.

The use of speech-generating devices (SGD) in early interventions for children with autism spectrum disorder (ASD) can improve communication and spoken language outcomes. The purpose of this study was to describe children's responsiveness to SGD input modeled by a social partner during adult-child play interactions over a 24-week intervention trial and explore the effect of that responsiveness on spoken language growth. This secondary analysis consisted of 31 children with less than 20 functional words at study entry who received a blended behavioral intervention (JASPER + EMT) as part of a randomized controlled trial. Significant improvements were seen in rate of responsiveness to both adult SGD models and adult natural speech models; only rate of responsiveness to SGD models at entry was a significant predictor of frequency of commenting and was a more robust predictor of number of different words post-intervention. Lastly, at entry, children with more joint attention and language responded to SGD models at significantly higher rates. Attention and responsiveness to SGD output may be important mechanisms of language growth and children who have more joint attention skills may particularly benefit from use of an SGD.

Extending the Usefulness of the Brief Observation of Social Communication Change (BOSCC): Validating the Phrase Speech and Young Fluent Version.

The current study investigated the utility of the Brief Observation of Social Communication Change-Phrase Speech Young Fluent (BOSCC-PSYF) as an outcome measure of treatment response by analyzing the measure's psychometric properties and initial validity. The BOSCC coding scheme was applied to 345 administrations from 160 participants diagnosed with autism. Participants included individuals of any age with phrase speech, or individuals under the age of 8 years with complex sentences. All were receiving behavioral intervention throughout the study. Test-retest and inter-rater reliability were good for the Early Communication and Social Reciprocity/Language domains, and fair for the Restricted and Repetitive Behavior domain. Significant changes occurred over time in the Early Communication and Social Reciprocity/Language domains, and Core Total scores. The BOSCC-PSYF may provide a low-cost, flexible, and user-friendly outcome measure that reliably measures changes in broad social communicative behaviors in a short period of time.

Trajectories of Seizures, Medication Use, and Obesity Status into Early Adulthood in Autistic Individuals and Those with Other Neurodevelopmental Conditions.

Background: Physical and psychiatric health conditions affect the lives of many autistic adults. However, relatively little is known about individual trajectories in autistic individuals' physical and mental health from adolescence to adulthood. Methods: This study uses a well-characterized longitudinal sample (n = 253) to investigate rates of seizures, medication use, and obesity, from early adolescence (age 10 years) into adulthood (age 30 years). Within this sample, 196 participants were diagnosed with autism spectrum disorder (ASD), whereas the remaining 57 participants never received an ASD diagnosis, but, rather, were diagnosed with other neurodevelopmental conditions. Data were collected through parent report questionnaires and in-person interviews and assessments. Results: Seizure onset continued well into adulthood, with two individuals experiencing their first seizure at the age of 25 years. Seizures and neuropsychiatric medication use were both higher for those with lower intelligence quotient (IQs). In addition, medication use increased over time for these individuals, whereas those with higher IQs saw a reduction in medication use with age. Between the ages of 15 to 30 years, the predicted probability of medication use increased from 82% to 88% for those with lower IQs and decreased from 37% to 13% for those with higher IQs. Collectively, almost 70% of all participants in this study were classified as either overweight or obese. Body mass index (BMI) increased throughout adulthood, especially for those with higher IQs. The steepest increase in BMI over time occurred for those with higher IQs who also took antipsychotic medications. Conclusion: Overall, continued risk for developing seizures, high rates of neuropsychiatric medication use, and significant and increasing rates of obesity from adolescence to adulthood underscore the importance of monitoring health issues in autistic individuals and those diagnosed with other neurodevelopmental conditions throughout the lifespan.

Why was this study done?: Autistic individuals and those diagnosed with other neurodevelopmental conditions are at risk for many physical health issues from adolescence to adulthood. This includes, but is not limited to, seizure disorders, high rates of medication use, and obesity. Yet, not much longitudinal research exists measuring these health issues throughout the lifespan and, especially, in adulthood. What did the researchers do?: The researchers analyzed data from a sample of 253 individuals who lived in North Carolina, Michigan, and Illinois. This sample was recruited almost 30 years ago, beginning the study when they were roughly 2 years old. Some participants had an autism spectrum disorder diagnosis, and some did not, but instead had other neurodevelopmental conditions. The researchers measured changes in medication use, height, and weight beginning in early adolescence (age 10 years) into adulthood (age 30 years). The researchers also tracked seizure occurrences across the life span (beginning at age 2 years up until age 30 years). What were the results of the study?: In adulthood, this sample showed high rates of obesity and medication use. For example, almost 70% of this sample was classified as either overweight or obese. In addition, 55% of this sample was taking at least one neuropsychiatric medication in adulthood, and 22% of this sample was taking three different types of medication at the same time. Individuals with higher and lower intelligence quotient (IQs) had different findings over time: obesity increased throughout adulthood for those with higher IQs and medication use increased throughout adulthood for those with lower IQs. Seizures first developed for a group of individuals in adolescence and adulthood. Two individuals experienced their first seizure as late as 25 years of age. What do these findings add to what is already known?: Research, and especially longitudinal research, on physical health in autistic adults is limited. Although we know that autistic individuals generally experience high rates of obesity, seizure disorders, and medication use, less is known about how these physical health issues change over the lifespan. This study has provided useful information regarding how certain physical health issues change over time, and who these physical health issues impact the most in adulthood. How will these findings help autistic adults now or in the future?: The findings in this study identified that, in adulthood, autistic adults experience high rates of physical health issues, including increasing rates of obesity and medication use for certain populations. These findings confirm how important it is for autistic adults to have access to quality health care across the lifespan. We hope that, with these findings in mind, caregivers and health professionals will work to ensure that autistic individuals, from childhood through adolescence and adulthood, will have access and assistance in monitoring these ongoing and persistent health problems.

The Brief Observation of Symptoms of Autism (BOSA): Development of a New Adapted Assessment Measure for Remote Telehealth Administration Through COVID-19 and Beyond.

Interest in telehealth assessment for autism has increased due to COVID-19 and subsequent expansion of remote psychological services, though options that are easy for clinicians to adopt and available through the lifespan are limited. The Brief Observation of Symptoms of Autism (BOSA) provides a social context with standardized materials and activities that can be coded by clinicians trained in the Autism Diagnostic Observation Schedule. The current project examined psychometric properties to determine optimal use for each BOSA version. Three hundred and seven participants with 453 BOSAs were included to determine best performing items for algorithms, validity, sensitivity, specificity, recommended cut-offs, and proposed ranges of concern. While preliminary, the BOSA provides a promising new option for telehealth-administered assessment for autism.

Work and well-being: Vocational activity trajectories in young adults with autism spectrum disorder.

Young adults with autism spectrum disorder (ASD) experience limited social connectedness, difficulty living independently, and other poor outcomes at high rates. Vocational activities, including employment and postsecondary education, are associated with increased positive outcomes and subjective well-being in typical adults. This study identified vocational activity trajectory groups in adults with ASD, examined change in these trajectories from ages 18 to 28, and compared levels of parent- and self-report subjective well-being across trajectory groups. One hundred fifty-one adults with ASD were drawn from an ongoing longitudinal study. Data on psychosocial outcomes and vocational activities were compiled from parent-report demographic forms. Vocational activities were scored using the vocational index (VDI). There was no significant effect of age on the slope of vocational trajectories (p = 0.787). Participants in the Independent Activities group had significantly higher parent-report happiness factor scores than participants in the No Activities group (F [3, 107] = 3.56, p = 0.017) and significantly higher self-report happiness factor scores than participants in the Volunteer Activities group (F [2, 35] = 6.46, p = 0.004). The Independent Activities group was also significantly more likely to have at least one social contact (X2 [3, 118] = 10.54, p = 0.014), however, there was no difference in trajectories groups in the likelihood of living independently (X2 [3, 120] = 1.71, p = 0.634). The results of this study indicate vocational activities in young adults with ASD are stable across time. In the current sample, participation in independent vocational activities was associated with increased levels of subjective well-being.

What are the odds? Predicting the likelihood of a negative episode in a sample of toddlers with autism spectrum disorder.

LAY ABSTRACT: Children with autism spectrum disorder sometimes have challenges with regulating their negative emotions. These difficulties can impact children's social outcomes and how well they respond to intervention. We know that caregivers of children with autism spectrum disorder can help their children regulate negative emotions in a process known as co-regulation, but not much is known about how child and caregiver strategy use impacts children's negativity in real time. In this study, 71 caregivers of toddlers with autism spectrum disorder were asked to encourage their child to unlock a locked toy box, a task which is designed to elicit frustration. Video observations of the participants completing the task were used to examine whether specific child and caregiver behaviors increased or decreased the likelihood that the child will become upset. No child strategies were predictive of a decreased likelihood of a child becoming upset, but when children used high-energy behaviors that did not serve a purpose, such as running back and forth, they were more likely to then show signs of being upset a few seconds later. The way that caregivers responded to their child was a potent caregiver predictor of the likelihood of children's negativity, with caregivers' unresponsiveness and proactiveness both emerging as salient predictor of increased likelihood of the child being upset a few moments later. These findings give insight into how children with autism spectrum disorder and their caregiver navigate challenging and frustrating tasks, and have the potential to influence clinical practice by giving an indication off which parent and child behaviors are most effective in reducing children's negativity while interacting with parents and caregivers.

Short-term trajectories of restricted and repetitive behaviors in minimally verbal children with autism spectrum disorder.

Very little is known about the 30% of children with Autism Spectrum Disorder (ASD) who remain minimally verbal when they enter school. Restricted and repetitive behaviors (RRBs) are well-characterized in younger, preschool, and toddler samples. However, the prevalence and impact of RRBs has not been characterized in older, minimally verbal children. The goal of this study was to characterize this core diagnostic feature in minimally verbal children with ASD ages 5-8 years over a 9-month period to better understand how these behaviors manifest in this crucially understudied population. RRBs were coded from caregiver-child interactions (CCX) at four timepoints. Upon entry into the study, children demonstrated an average of 17 RRBs during a 10-min CCX. The most common category was Verbal. RRBs remained constant over 6 months; however, a slight reduction was observed at the final timepoint. Compared to prior literature on younger samples, minimally verbal children with ASD demonstrated higher rates of RRBs and higher rates of verbal RRBs. Further work is required to understand the function and impact of RRBs in minimally verbal children. LAY ABSTRACT: Approximately one-third of children with autism spectrum disorder (ASD) remain minimally verbal at the time of school entry. In this study, we sought to characterize the presence of restricted and repetitive behaviors (RRBs) in school-aged children (5-8) who were minimally verbal. Compared to prior studies, minimally verbal children with ASD had higher frequencies of RRBs and demonstrated a different profile of behaviors, including more verbal RRBs.