Cognitive control processes in behavior therapy for youth with Tourette's disorder.

BACKGROUND: Cognitive control processes are implicated in the behavioral treatment of Tourette's disorder (TD). However, the influence of these processes on treatment outcomes has received minimal attention. This study examined whether cognitive control processes and/or tic suppression predicted reductions in tic severity and treatment response to behavior therapy. METHOD: Fifty-three youth with TD or a pervasive tic disorder participated in a randomized wait list-controlled trial of behavior therapy. Following a baseline assessment to evaluate psychiatric diagnoses, tic severity, and cognitive control processes (e.g., response selection, inhibition, and suppression), youth were randomly assigned to receive eight sessions of behavior therapy (n = 23) or a wait list of equal duration (n = 28). Youth receiving immediate treatment completed a post-treatment assessment to determine improvement in tic severity. Meanwhile, youth in the wait list condition completed another assessment to re-evaluate tic severity and cognitive control processes, and subsequently received 8 sessions of behavior therapy followed by a post-treatment assessment to determine improvement. RESULTS: A multiple linear regression model found that pretreatment inhibition/switching on the Delis-Kaplan Executive Function System Color-Word Interference Test predicted reductions in tic severity after behavior therapy (ß = -.36, t = -2.35, p = .025, ƞ2 = .15). However, other cognitive control processes and tic suppression did not predict treatment response and/or reductions in tic severity. Small nonsignificant effects were observed in cognitive control processes after behavior therapy. CONCLUSION: Cognitive control processes may influence tic severity reductions in behavior therapy. Notably, even when other cognitive control processes are impaired and youth are initially unable to voluntarily suppress their tics, youth with TD can still benefit from behavior therapy. Findings offer implications for clinical practice and research for TD.

The Effect of Neurocognitive Function on Math Computation in Pediatric ADHD: Moderating Influences of Anxious Perfectionism and Gender.

Predictors of math achievement in attention-deficit/hyperactivity disorder (ADHD) are not well-known. To address this gap in the literature, we examined individual differences in neurocognitive functioning domains on math computation in a cross-sectional sample of youth with ADHD. Gender and anxiety symptoms were explored as potential moderators. The sample consisted of 281 youth (aged 8-15 years) diagnosed with ADHD. Neurocognitive tasks assessed auditory-verbal working memory, visuospatial working memory, and processing speed. Auditory-verbal working memory speed significantly predicted math computation. A three-way interaction revealed that at low levels of anxious perfectionism, slower processing speed predicted poorer math computation for boys compared to girls. These findings indicate the uniquely predictive values of auditory-verbal working memory and processing speed on math computation, and their differential moderation. These findings provide preliminary support that gender and anxious perfectionism may influence the relationship between neurocognitive functioning and academic achievement.

Development and validation of an item response theory-based Social Responsiveness Scale short form.

BACKGROUND: Research and practice in autism spectrum disorder (ASD) rely on quantitative measures, such as the Social Responsiveness Scale (SRS), for characterization and diagnosis. Like many ASD diagnostic measures, SRS scores are influenced by factors unrelated to ASD core features. This study further interrogates the psychometric properties of the SRS using item response theory (IRT), and demonstrates a strategy to create a psychometrically sound short form by applying IRT results. METHODS: Social Responsiveness Scale analyses were conducted on a large sample (N = 21,426) of youth from four ASD databases. Items were subjected to item factor analyses and evaluation of item bias by gender, age, expressive language level, behavior problems, and nonverbal IQ. RESULTS: Item selection based on item psychometric properties, DIF analyses, and substantive validity produced a reduced item SRS short form that was unidimensional in structure, highly reliable (α = .96), and free of gender, age, expressive language, behavior problems, and nonverbal IQ influence. The short form also showed strong relationships with established measures of autism symptom severity (ADOS, ADI-R, Vineland). Degree of association between all measures varied as a function of expressive language. CONCLUSIONS: Results identified specific SRS items that are more vulnerable to non-ASD-related traits. The resultant 16-item SRS short form may possess superior psychometric properties compared to the original scale and emerge as a more precise measure of ASD core symptom severity, facilitating research and practice. Future research using IRT is needed to further refine existing measures of autism symptomatology.

Autonomic arousal in anxious and typically developing youth during a stressor involving error feedback.

Anxiety has been proposed to influence psychophysiological reactivity in children and adolescents. However, the extant empirical literature has not always found physiological reactivity to be associated with anxiety in youth. Further, most investigations have not examined psychophysiological reactivity in real time over the course of acute stress. To test the impact of anxiety disorder status on autonomic arousal in youth, we compared youth with primary anxiety disorders (N = 24) to typically developing (TD) youth (N = 22) on heart rate (HR), heart rate variability (HRV), and respiratory sinus arrhythmia (RSA) during an acute stressor in which youth received error-related feedback. We also conducted exploratory analyses on youth performance during the task. Youth ages 9-17 participated in the arithmetic portion of the Trier Social Stress Test for Children (Buske-Kirschbaum et al., Psychosom 59:419-426, 1997), during which time they received consecutive, standardized feedback that they made calculation errors. Results indicated that, compared to their TD counterparts, the anxious group demonstrated elevated HR and suppressed HRV during initial provision of error feedback and during the recovery period. No group differences were found for RSA. Additionally, overall TD youth made a greater proportion of errors than anxious youth. Clinically, these findings may provide preliminary support for anxious youth exhibiting physiological reactivity in response to receipt of error-related feedback, and may have implications for understanding biological processes during stress. This work underscores the need for further study of when and how anxiety may influence autonomic reactivity over the course of stress.

Psychometric exploration of the RAADS-R with autistic adults: Implications for research and clinical practice.

LAY ABSTRACT: Surveys used to screen for autism are being used much more by adults. Adults and clinicians want to be confident that the results from their surveys are accurate. If scores are not accurate, it is not possible to compare the scores of different groups of individuals. There are also concerns that these surveys do not accurately identify autistic individuals. This study explored the accuracy of two commonly used autism screening surveys for adults: the RAADS-R and the RAADS-14. The accuracy of these two screening tools was measured using a sample of 839 adults. Adults in the study were in one of the following categories: (1) diagnosed with autism, (2) adults who considered themselves to be autistic but had not been diagnosed, (3) adults who were unsure whether they were autistic, and (4) adults who did not consider themselves to be autistic and had not been diagnosed. The study found that the RAADS-R and the RAADS-14 are accurate. The study also found that a person's age, gender, autism diagnosis, or whether an individual considered themselves to be autistic did not impact how they understood the survey. Survey accuracy could be improved by changing the number of question responses from four to two. Importantly, individuals with a clinical diagnosis of autism and those who considered themselves to be autistic responded to survey items in a very similar way. Individuals with autism diagnoses and those who were unsure whether they were autistic were more different in their responses. Four specific survey items related to sensory experiences and social interaction identified key differences between autistic and non-autistic adults.

Measurement matters: A commentary on the state of the science on patient reported outcome measures (PROMs) in autism research.

High quality science relies upon psychometrically valid and reliable measurement, yet very few Patient Reported Outcome Measures (PROMs) have been developed or thoroughly validated for use with autistic individuals. The present commentary summarizes the current state of autism PROM science, based on discussion at the Special Interest Group (SIG) at the 2022 International Society for Autism Research (INSAR) Annual Meeting and collective expertise of the authors. First, we identify current issues in autism PROM research including content and construct operationalization, informant-structure, measure accessibility, and measure validation and generalization. We then enumerate barriers to conducting and disseminating this research, such as a lack of guidance, concerns regarding funding and time, lack of accessible training and professionals with psychometric skills, difficulties collecting large representative samples, and challenges with dissemination. Lastly, we offer future priorities and resources to improve PROMs in autism research including a need to continue to evaluate and develop PROMs for autistic people using robust methods, to prioritize diverse and representative samples, to expand the breadth of psychometric properties and techniques, and to consider developing field specific guidelines. We remain extremely optimistic about the future directions of this area of autism research. This work is well positioned to have an immense, positive impact on our scientific understanding of autism and the everyday lives of autistic people and their families.

Predictors of Sexual Victimization Among Autistic and Non-Autistic College Students.

PURPOSE: This study examined predictors of sexual victimization among autistic and non-autistic college students. Specifically, we aimed to determine whether autistic students are more likely than non-autistic students to experience unwanted sexual contact and sexual assault, controlling for co-occurring diagnoses. We also aimed to determine whether students with other disabilities, specifically ADHD, learning disability (LD), and psychological disorders, are more likely than students without these disabilities to experience unwanted sexual contact and sexual assault. METHODS: Autistic students (n=270) and non-autistic students (n=270) who had participated in a nationwide survey were matched on demographic characteristics and co-occurring diagnoses. Logistic regression analyses were conducted to address the research questions and evaluate predictors of unwanted sexual contact and sexual assault. RESULTS: Autistic students were as likely as non-autistic students to have experienced unwanted sexual contact and sexual assault, controlling for co-occurring diagnoses. Regardless of autism diagnostic status, students with ADHD were more likely than students without ADHD to have experienced unwanted sexual contact and sexual assault. CONCLUSIONS: Although autism diagnostic status was not a significant predictor of unwanted sexual contact or sexual assault, other factors associated with increased risk of sexual victimization, such as co-occurring ADHD, are likely to be found in autistic populations. This study highlights the importance of educational, social, and institutional supports to decrease sexual victimization among college students with neurodevelopmental disabilities.

Dual Identification: Trajectories to English Proficiency for English Learners with Autism Spectrum Disorder.

BACKGROUND: There are an increasing number of English Learners (EL) served in schools, including children with Autism Spectrum Disorder (ASD). However, little is known about students who receive school-based services as EL and under autism eligibility. PURPOSE & METHODS: The present study aimed to examine the sociodemographic characteristics, time to English Language Proficient status by survival analysis, and predictors of English fluency utilizing a logistic regression for dually identified EL and autism eligible students in a large urban school district during the 2011-2019 academic school years. RESULTS: Overall, dually identified students (N = 849) educated in segregated settings (N = 372) became English proficient at lower rates and at older ages than students included in general education (N = 477). CONCLUSION: Students placed in segregated special education classrooms were significantly less likely to achieve English Language Proficient classification. The present study begins to illustrate the time to English proficiency of dually identified students and the potential impact it has on their educational opportunities.

Discrimination and Harassment Experiences of Autistic College Students and Their Neurotypical Peers: Risk and Protective Factors.

This study examines autistic and non-autistic college students' experiences of discrimination and harassment and identifies protective and risk factors. A nationwide survey was used to match autistic students (N = 290) and non-autistic students (N = 290) on co-occurring diagnoses and demographic characteristics. Multiple regression and interaction analysis revealed that faculty support was protective against discrimination and harassment regardless of autism status. Habits of mind was particularly protective for autistic students against harassment. Any student who engaged in school-facilitated events was more likely to experience discrimination and harassment, but the risk was heightened for autistic students. Findings highlight the importance of faculty support in fostering positive interpersonal experiences on campus, and demonstrate the need to address deeper college campus issues with respect to neurodiversity.

Examining indicators of psychosocial risk and resilience in parents of autistic children.

Background: Parents of autistic children experience increased levels of caregiver strain and adverse mental health outcomes, even in comparison to parents of children with other neurodevelopmental disabilities. Previous studies have largely attributed these increased levels of mental health concerns to their child behavioral concerns and autism symptomatology, but less attention has been given to other potential child factors, such as child adaptive functioning. Additionally, little is known about potential protective factors, such as parents' emotion regulation (ER) abilities, that may ameliorate the experience of caregiver strain, anxiety, and depression. Objective: The current study examined the impact of child characteristics (restricted and repetitive behaviors, adaptive functioning and behavioral concerns) on parent mental health outcomes (caregiver strain, anxiety, depression and wellbeing). Additionally, we explore parents' ER abilities as a moderator of the impact of child characteristic on parents' mental health outcomes. Results: Results of linear mixed effect models indicated a significant relationship between parents' ER abilities and all four parent outcomes. Additionally, children's adaptive functioning abilities and repetitive behaviors (RRBs) were significant predictors of caregiving strain. Parents' ER abilities were a significant moderator of the effect of children's repetitive behaviors and adaptive functioning challenges on caregiver strain, such that better ER abilities mitigated the impact of child clinical factors on caregiver strain. Finally, a significant difference was detected for mothers' and fathers' mental health, with mothers reporting higher caregiver strain, and more symptoms of anxiety and depression than did fathers. Conclusion: This study leveraged a large sample of autistic children and their biological parents to examine the relationship between children's clinical characteristics and parents' psychological wellbeing. Results indicate that, although parents of autistic children do experience high rates of internalizing mental health concerns that relate to child adaptive functioning and RRBs, parent ER abilities act as a protective factor against parents' adverse mental health outcomes. Further, mothers in our sample reported significantly higher rates of depression, anxiety, and caregiver strain, as compared with fathers.

Adjustment Across the First College Year: A Matched Comparison of Autistic, Attention-Deficit/Hyperactivity Disorder, and Neurotypical Students.

Background: Although the number of autistic students attending higher education has grown substantially in recent decades, little is known about factors that support their retention and persistence in college. First-year experiences and adaptability to the college environment greatly impact students' decisions to remain enrolled. Despite the importance of first-year adjustment to persistence and retention, few studies have examined the adjustment experiences of first-year autistic students compared to those of matched nonautistic students. Methods: This study used national survey data to compare the first-year college adjustment experiences of 222 freshmen, including 74 self-identified autistic students, 74 students with attention-deficit/hyperactivity disorder (ADHD), and 74 students without diagnoses (referred to as neurotypical; NT), matched on mental health and demographic characteristics. Students were compared on measures of academic, social, emotional, and institutional adjustment at the end of freshman year. Separate general linear models were used to investigate predictors of positive self-reported first-year adjustment. Results: Autistic students reported significantly lower levels of social self-confidence than their NT and ADHD peers at the end of freshman year. On all other adjustment domains, students in the autism, ADHD, and NT groups did not significantly differ. Autistic students were not significantly different from their ADHD and NT peers in terms of satisfaction with their college experience or sense of belonging to their institution. Social factors, including social self-confidence and ease of making friends, emerged as important contributors to positive first-year adjustment outcomes across all groups. Conclusions: When controlling for demographic factors and mental health characteristics entering college, autistic students do not significantly differ from their NT and ADHD peers on several domains of college adjustment. Future studies should further investigate the impact of mental health and student characteristics on college trajectories and outcomes for autistic students.

Why is this an important issue?: Although more autistic young people are enrolling in college, many do not finish their degrees. Adjusting more easily to college life in the first year can encourage students to stay enrolled. Not much is known about adjustment for autistic college students, in particular compared with their nonautistic peers. What was the purpose of this study?: Our goal was to understand whether there were differences in how the three groups of first-year students adjust to college. Those three groups included the following: (1) autistic students, (2) students with attention-deficit/hyperactivity disorder ("ADHD"), and (3) neurotypical ("NT") students (those who do not identify as having a disability). We wanted to see if the groups were similar or different in their first-year experiences. We also wanted to know what factors help autistic students adjust and feel comfortable during their first year. What did the researchers do?: We compared survey responses about first-year adjustment across three groups of students. We know that students' background can affect their experience in college, so we matched each autistic student to one student with ADHD and one NT student so that they had similar background characteristics (e.g., gender and high school test scores). We compared the groups on campus, academic, emotional, and social experiences during the first year of college. Lastly, we determined which factors were most important for the successful first-year adjustment of autistic college students. What were the results of the study?: Autistic students were less confident socially than their ADHD and NT peers but were not significantly different from their peers on many other domains, including satisfaction with their college experience. Having more social self-confidence and making friends more easily were important to the first-year adjustment of all students. What do these findings add to what was already known?: While previous studies looked at academic adjustment, this study adds information about the social, emotional, and institutional adjustment of autistic college students. What are the potential weaknesses of the study?: We used surveys that were not specifically designed for autistic and other neurodivergent people. Students who dropped out during their first year were not included in this study, and so, our findings only apply to students who completed their first year. There were a relatively small number of students in each group, which may have made it harder for us to see the differences in how these groups adjust to college. Lastly, our sample does not include students enrolled in 2-year colleges and is not representative of the racial/ethnic and gender diversity of the autistic community across the United States. How will these findings help autistic adults now or in the future?: These findings can guide colleges in choosing which resources to focus on for first-year students. Our results show that autistic students may benefit from more supports around social self-confidence during their first year of college. Mental health is another area that is important for autistic students and their success in college, and future studies should explore this topic more.

Advancing methodologies to improve RRB outcome measures in autism research: Evaluation of the RBS-R.

This study evaluates the psychometric properties (dimensionality, item bias, reliability) of the Repetitive Behavior Scale-Revised (RBS-R), provides scoring guidelines for the dimensional measure, and makes recommendations for future RRB measure development. Participants included individuals from three large autism data repositories; Simon Foundation Powering Autism Research for Knowledge (SPARK), Simons Simplex Collection (SSC), and National Database for Autism Research (NDAR). The total sample included N = 15,318 autistic individuals ages 3-18. Confirmatory factor analysis was used to evaluate competing theoretical factor structures. Item response theory (IRT) was used to evaluate differential item functioning, estimate the reliability of each RBS-R subdomain, and score the subdomains. A unidimensional factor structure demonstrated clearly inadequate model fit, calling into question the practice of reporting a total score on the RBS-R. A five-dimensional factor structure was supported by the theoretical and empirical evidence, though the fifth factor (restricted interests) was not sufficiently reliable for use. IRT-based scoring tools were generated for use in research. The present study illustrates the promise in the future development of measures for RRBs, particularly in the development of measures to separately and specifically assess RRB constructs using rigorous methodological guidelines. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Personalized autism symptom assessment with the Youth Top Problems Scale: Observational and parent-report formats for clinical trials applications.

Few measures of autism-related symptoms have been established as both psychometrically robust and sensitive to the effects of treatment. In the present study, a personalized measure of autism-related symptoms using the Youth Top Problems (YTP) method (Weisz et al., 2011) was evaluated. Participants included 68 children with diagnoses of autism (ages 6-13 years), and their parents, who were randomized to cognitive behavioral therapy (CBT) or enhanced standard community treatment (ESCT) addressing autism-related symptoms. At pretreatment, parents described their child's top autism-related problems (YTPs) in their own words and rated the severity of these problems on a Likert-type scale. Parents also made daily severity ratings on the child's top three YTPs for 5 days prior to treatment and 5 days following treatment while videorecording their child's behavior at home on each of these days. Trained observers coded these videorecordings, focusing on the same YTPs that the parents rated. Parents also completed standardized checklists of autism-related symptoms and general mental health symptoms. There was evidence of convergent and discriminant validity as well as good test-retest reliability for the YTP measures. YTP severity scores converged with the standardized measure of autism-related symptoms. Parent-reported YTP scores predicted observers' YTP scores at the daily level, and both parent-reported and observers' YTP scores decreased from pre- to post treatment. Observers' ratings of the videorecordings exhibited sensitivity to treatment condition. These applications of the YTP method are promising and may complement standardized symptom checklists for clinical trials focusing on autism-related symptoms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Who gains and who loses? Sociodemographic disparities in access to special education services among autistic students.

Little is known about differences in the allocation of special education services to students with autism compared with students with other primary learning differences (e.g., intellectual disability [ID], specific learning disability [SLD]) and the comparative impact of sociodemographic factors on special education service receipt. The present study aimed to compare allocation of services (i.e., quantity and types) between students eligible for special education services under autism, SLD and ID, and to identify differences in sociodemographic predictors (e.g., race, neighborhood income) of service allocation. Data were culled from special education administrative records from a large urban, primarily Hispanic, Latino, or Spanish-serving school district from academic years 2011-2012 to 2016-2017. Participants included N = 76,428 students (Nautism  = 18,151, NSLD  = 54,001, NID  = 4,276) ages 2-18. Results showed that autistic students received, on average, more services than students with SLD. Services received by students served under autism and SLD eligibility were more congruent with areas of need (e.g., language, occupational therapy) relative to students served under ID. Student-level socioeconomic status (free and reduced lunch) was more positively predictive of the number of special education services received than the neighborhood income of the school the student attended. Finally, the most significant racial disparities in service allocation were observed among students served under autism eligibility. The present study demonstrates the critical role of economic resources in the quantity and types of services received, and the desirability of a public education for well-resourced families who are possibly best situated to navigate special education services. LAY SUMMARY: An eligibility of autism in special education confers a significant advantage in the number of services a student receives. Disparity in the quantity of special education services exists among autistic students across many sociodemographic factors. Most notably, greater allocation of services to non-Hispanic, Latino, or Spanish, White American, European American, or Middle Eastern American students and students who do not receive free and reduced lunch.

Inhibitory control in youth with Tourette's Disorder, attention-deficit/hyperactivity disorder and their combination and predictors of objective tic suppressibility.

The present study investigated inhibitory control deficits in Tourette's Disorder (TD)-only, Attention Deficit/Hyperactivity Disorder (ADHD)-only, and TD+ADHD and explored the degree to which measures of inhibitory control, and tic and ADHD severity predicted objective tic suppressibility. Participants were youth ages 9 to 14 (M = 11.15) with TD-only (n = 24), TD+ADHD (n = 19), ADHD-only (n = 139), and typically-developing controls (n = 59) drawn from a larger study. Groups were compared on computer-based and paper and pencil neurocognitive inhibitory control tasks. Among youth with TD, neurocognitive measures of inhibitory control, subjective tic-suppressibility (Premonitory Urge for Tics Scale, item 10), and ADHD symptom severity were evaluated as predictors of objective tic suppressibility (i.e., laboratory-based tic suppression task), controlling for total tic severity. There were significant group differences on Color-Word inhibition/switching performance, though post-hoc comparisons yielded no significant pairwise group contrasts. Subjective tic suppressibility was the only significant predictor of objective tic suppressibility. The evident intact neurocognitive inhibitory control among youth with TD suggests that individuals with TD may use compensatory neural mechanisms to support typical speed and accuracy of response. The role of cognitive flexibility in mechanisms of tic suppression should also be further explored.

Academic and psychosocial characteristics of incoming college freshmen with autism spectrum disorder: The role of comorbidity and gender.

There is a pressing need to better characterize the college-bound population of individuals with autism spectrum disorder (ASD), as prior studies have included small samples, consisting of individuals who are either recruited due to diagnosis or are treatment seeking. As postsecondary institutions look to respond to the growing need for support services for individuals with ASD, insights derived from large, population-based samples is a necessity. The current study included a sample of over 2000 incoming postsecondary students who self-identified with ASD as a part of surveys distributed by institutions nationally. The impact of heterogeneity (gender, comorbid attention-deficit/hyperactivity disorder [ADHD], and/or learning disability) on demographic characteristics, and psychosocial (psychological health, interpersonal self-confidence) and academic (self-regulated learning, intellectual self-confidence) domains critical for success in postsecondary education were compared to a matched sample of students with ADHD or no diagnoses. College-bound students with ASD broadly endorsed similar rates of ADHD, LD, and psychological disorder comorbidity to clinic-referred samples, and were more similar than different from their typically developing peers. A comorbid diagnosis of ADHD was associated with greater academic disengagement. Females with ASD and those with any comorbid disorder were more likely to self-report poorer psychological health. Findings revealed that self-reported levels of functioning in critical domains differed by self-reported comorbid disorders and gender. Findings have implications for targeted support service recommendations based on unique sources of heterogeneity (e.g., gender, presenting comorbid disorders) and are detailed in the current study. Autism Res 2019, 12: 931-940. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: College-bound students with ASD feel academically competent; however feel less confident with their peers. Students with ASD and another diagnosis (e.g., ADHD, learning disability) and girls with ASD may be particularly at risk of experiencing poorer psychological health while enrolled in postsecondary education. Using this information, postsecondary institutions can provide more targeted support services to students with ASD enrolled in postsecondary education.

Evaluating the Hierarchical Structure of ADHD Symptoms and Invariance Across Age and Gender.

The bifactor model of attention-deficit/hyperactivity disorder (ADHD) has been extensively explored, yet the tendency of the bifactor model to overfit data necessitates investigation of alternative, more parsimonious models, such as a modified bifactor structure. The present study used item response theory to compare unidimensional, correlated factors, bifactor, and modified bifactor models of ADHD symptoms in a clinical sample of youth ( N = 1,612) and examined differential item functioning (DIF) by age (<11 and ≥11 years) and gender. Results suggested that two restricted bifactor models showed superior fit compared with alternative models, and support strong general and inattention dimensions, with unreliable hyperactivity and impulsivity dimensions. No DIF was found across gender or age. The present study confirms that the general dimension (i.e., inhibition) and one specific dimension (i.e., sustained attention) represent distinct variability in ADHD symptoms that may improve prediction of symptom persistence, treatment response, or functional outcomes.

Double-Blind, Sham-Controlled, Pilot Study of Trigeminal Nerve Stimulation for Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: Trigeminal nerve stimulation (TNS), a minimal-risk noninvasive neuromodulation method, showed potential benefits for attention-deficit/hyperactivity disorder (ADHD) in an unblinded open study. The present blinded sham-controlled trial was conducted to assess the efficacy and safety of TNS for ADHD and potential changes in brain spectral power using resting-state quantitative electroencephalography. METHOD: Sixty-two children 8 to 12 years old, with full-scale IQ of at least 85 and Schedule for Affective Disorders and Schizophrenia-diagnosed ADHD, were randomized to 4 weeks of nightly treatment with active or sham TNS, followed by 1 week without intervention. Assessments included weekly clinician-administered ADHD Rating Scales (ADHD-RS) and Clinical Global Impression (CGI) scales and quantitative electroencephalography at baseline and week 4. RESULTS: ADHD-RS total scores showed significant group-by-time interactions (F1,228 = 8.12, p = .005; week 4 Cohen d = 0.5). CGI-Improvement scores also favored active treatment (χ21,168 = 8.75, p = .003; number needed to treat = 3). Resting-state quantitative electroencephalography showed increased spectral power in the right frontal and frontal midline frequency bands with active TNS. Neither group had clinically meaningful adverse events. CONCLUSION: This study demonstrates TNS efficacy for ADHD in a blinded sham-controlled trial, with estimated treatment effect size similar to non-stimulants. TNS is well tolerated and has minimal risk. Additional research should examine treatment response durability and potential impact on brain development with sustained use. CLINICAL TRIAL REGISTRATION INFORMATION: Trigeminal Nerve Stimulation for ADHD; http://clinicaltrials.gov/; NCT02155608.

An examination of the precision of the Autism Diagnostic Observation Schedule using item response theory.

The current study examined the reliability of the Autism Diagnostic Observation Schedule (ADOS) across the continuum of severity of autism spectrum disorder (ASD) core deficits. Modules 3 and 4 of the ADOS assess the deficits of ASD in 2 core domains (Social Affect and Restrictive and Repetitive Behaviors [RRB]) among verbally fluent children, adolescents, and adults, and ADOS diagnostic classification of ASD is based on a total score that combines the 2 domains. Currently, the total and domain scores are calculated using only a subset of the administered items. This study used an item response theory (IRT) approach to examine whether scores from the ADOS Modules 3 and 4 item sets under the revised scoring algorithm provide adequate reliability around the diagnostic threshold of the total score, as well as across the hypothesized continuum of the Social Affect and RRB domains. Furthermore, the present study examined whether the reliability of the ASD domains measured by the ADOS is improved by incorporating items that are collected but not included in the current diagnostic algorithm. Measurement precision was estimated using IRT models, which allow for an examination of reliability across a continuum of ASD domain severity. Results suggest that although the ADOS Modules 3 and 4 are reliable at the diagnostic threshold using only the scoring algorithm items, adding additional items can improve the reliability of scores at moderately low and moderately high levels of ASD severity. However, even with additional items, the ADOS Modules 3 and 4 do not allow for adequately reliable measurement of restrictive and repetitive behaviors. (PsycINFO Database Record

SMARTer Approach to Personalizing Intervention for Children With Autism Spectrum Disorder.

Purpose: This review article introduces research methods for personalization of intervention. Our goals are to review evidence-based practices for improving social communication impairment in children with autism spectrum disorder generally and then how these practices can be systematized in ways that personalize intervention, especially for children who respond slowly to an initial evidence-based practice. Method: The narrative reflects on the current status of modular and targeted interventions on social communication outcomes in the field of autism research. Questions are introduced regarding personalization of interventions that can be addressed through research methods. These research methods include adaptive treatment designs and the Sequential Multiple Assignment Randomized Trial. Examples of empirical studies using research designs are presented to answer questions of personalization. Conclusion: Bridging the gap between research studies and clinical practice can be advanced by research that attempts to answer questions pertinent to the broad heterogeneity in children with autism spectrum disorder, their response to interventions, and the fact that a single intervention is not effective for all children. Presentation Video: https://doi.org/10.23641/asha.7298021.