Early sensory over-responsivity in toddlers with autism spectrum disorders as a predictor of family impairment and parenting stress.

BACKGROUND: Sensory over-responsivity (SOR) affects many individuals with autism spectrum disorders (ASD), often leading to stressful encounters during daily routines. METHODS: This study describes the associations between early SOR symptoms and the longitudinal course of restrictions in family life activities and parenting stress across three time-points in families raising a child with ASD (n = 174). Covariates were child diagnostic severity, emotional problems, and maternal affective symptoms. At time 1 mean chronological age was 28.5 months. Children were administered the Autism Diagnostic Observation Schedule (ADOS) and Mullen Scales of Early Learning (MSEL). Parents completed the Infant Toddler Sensory Profile (ITSP), Infant-Toddler Social Emotional Assessment (ITSEA), Beck Anxiety Index (BAI), and the Center for Epidemiologic Studies Depression Inventory (CES-D) at time 1; and the Parenting Stress Index (PSI) and Family Life Impairment Scale (FLIS) at the three annual time-points. RESULTS: Latent Growth Curve Models indicated that higher SOR scores on the ITSP at time 1 were associated with higher initial levels of family life impairment and parenting stress and with a smaller magnitude of change over time. These associations were independent of severity of ADOS social-communication symptoms, MSEL composite score, ITSEA externalizing and anxiety symptoms, and maternal affective symptoms as measured by the BAI and CES-D. On average FLIS and PSI did not change over time, however, there was significant individual variability. Concurrently, SOR at time 1 explained 39-45% of the variance in family stress and impairment variables. CONCLUSIONS: An evaluation of SOR should be integrated into the assessment of toddlers with ASD considering their role in family life impairment and stress.

Sensory clusters of toddlers with autism spectrum disorders: differences in affective symptoms.

BACKGROUND: Individuals with autism spectrum disorders (ASDs) show variability in their sensory behaviors. In this study we identified clusters of toddlers with ASDs who shared sensory profiles and examined differences in affective symptoms across these clusters. METHOD: Using cluster analysis 170 toddlers with ASDs were grouped based on parent rating of the Infant Toddler Sensory Profile (Dunn, 2002) under-responsivity, over-responsivity, and seeking scales. Affective symptoms were evaluated with the Infant Toddler Social Emotional Assessment (Carter & Briggs-Gowan, 2005). RESULTS: Three clusters were identified: (1) low frequency of sensory symptoms (n = 44); (2) high frequency of symptoms (n = 49); and (3) mixed (n = 77); high frequency of under-and over-responsivity and low frequency of seeking). Relative to the low frequency cluster, parents rated toddlers in the high frequency and mixed clusters (both characterized by high frequencies of sensory under- and over-responsivity) as higher on negative emotionality, depression, and anxiety symptoms. Sensory and affective differences among clusters remained after co-varying severity of ASD symptoms. CONCLUSIONS: Interdisciplinary assessments are recommended for toddlers with ASDs in order to identify the interplay of sensory and affective symptoms.

Anxiety sensitivity and auditory perception of heartbeat.

Anxiety sensitivity (AS) is the fear of sensations associated with autonomic arousal. AS has been associated with the development and maintenance of panic disorder. Given that panic patients often rate cardiac symptoms as the most fear-provoking feature of a panic attack, AS individuals may be especially responsive to cardiac stimuli. Consequently, we developed a signal-in-white-noise detection paradigm to examine the strategies that high and low AS individuals use to detect and discriminate normal and abnormal heartbeat sounds. Compared to low AS individuals, high AS individuals demonstrated a greater propensity to report the presence of normal, but not abnormal, heartbeat sounds. High and low AS individuals did not differ in their ability to perceive normal heartbeat sounds against a background of white noise; however, high AS individuals consistently demonstrated lower ability to discriminate abnormal heartbeats from background noise and between abnormal and normal heartbeats. AS was characterized by an elevated false alarm rate across all tasks. These results suggest that heartbeat sounds may be fear-relevant cues for AS individuals, and may affect their attention and perception in tasks involving threat signals.

Complex segregation analyses of old order Amish families ascertained through bipolar I individuals.

Specific genetic hypotheses about the mode of transmission of bipolar affective disorders were examined by performing complex segregation analyses of Old Order Amish families. The analyses were performed on 1) the total set of 42 families including 689 relatives, 2) a subset of 19 families consisting of those kindreds sharing common ancestors within three generations that contained 333 relatives, and 3) a subset of 23 more distantly related families with 356 relatives. When all 42 families were included in the analyses, the specific mode of transmission that could be distinguished was dependent upon the diagnostic scheme used in the analysis. An autosomal dominant mode of inheritance could be rejected when relatives with bipolar I, atypical bipolar, major depressive disorder, and hypomania were included as affected. When analyses included only the subset of families more closely related, an autosomal dominant inheritance model was found to be consistent with transmission of BP I disorder. It was not possible to distinguish between other transmission models with broader diagnostic schemes in this subset of families. Finally, results of analyses on the subset of more distantly related families suggest that there is a significant proportion of Old Order Amish families in which the genetic factors contributing to the expression of bipolar illness are either polygenic or oligogenic.

Reflections on stillness: mothers' reactions to the still-face situation.

The still-face procedure, in which mothers maintain a neutral face and are noninteractive with their infants, has been used to study the effects of maternal withdrawal on the mother-infant interaction. In this study, 56 mothers' reactions to their own experience during a still-face procedure were explored using an open-ended interview. The associations between the mothers' reported experience, the infants' behavior during the procedure, and the mothers' behavior during subsequent play were examined. Over half of the mothers reported experiencing discomfort during the session and were more likely to report discomfort if their infants protested their affective absence. Mothers reporting discomfort were significantly more likely to pick up their infants and continue to reflect verbally on their own feelings after the still-face ended. These results are discussed in terms of their clinical implications for understanding the early development of the social dialogue between mother and infant.

A prospective longitudinal study of Gilles de la Tourette's syndrome.

OBJECTIVE: The goals of this study were to estimate the frequency of Gilles de la Tourette's syndrome (TS), tics, and other behavioral disorders among children at risk for TS and to examine the association of family functioning with children's diagnostic status and social-emotional functioning. METHOD: A prospective longitudinal design was used. Young children who were not displaying any tic behaviors but who had a first-degree relative with TS were recruited. Children's diagnostic status, social-emotional functioning, and family functioning were assessed with the Schedule for Tourette and Other Behavioral Syndromes, Vineland Adaptive Behavior Scales, Child Behavior Checklist, the Harter Self Perception Profile, and Family Environment Scale. RESULTS: Increased rates of tic disorders, obsessional and anxiety symptoms, and attentional and speech difficulties were observed. Family functioning, independent of parental psychopathology, was associated with attention-deficit and anxiety disorders, decreased adaptive and increased maladaptive behaviors, and lower self-esteem but not tic spectrum or learning disorders. CONCLUSIONS: The observed rates of tic disorders add support for an autosomal dominant mode of transmission. Family functioning appears to play an important role in non-tic disorders as well as adaptive and maladaptive behaviors. Family, cognitive-behavioral, and interpersonal therapies should be considered to address the social-emotional difficulties that often accompany TS.

Prevalence of social-emotional and behavioral problems in a community sample of 1- and 2-year-old children.

OBJECTIVE: To examine the prevalence of infant-toddler social-emotional and behavioral problems and associations with social-emotional competence, interference in family life, and parental worry. METHOD: The sample consisted of 1- and 2-year-old children (mean [MN] age = 24.8 months) from the baseline survey of a representative sample of healthy births (N= 1,280). Parent questionnaires included the Child Behavior Checklist (CBCL/2-3), Parenting Stress Index Short Form (PSI/SF), and Infant-Toddler Social and Emotional Assessment social-emotional competence scales, as well as questions about parental worry and family activities. RESULTS: Approximately 80% of eligible subjects participated. The weighted prevalence of parent-reported subclinical/clinical CBCL/2-3 scores was 11.8% for 2-year-olds. Approximately 6% of parents of 1- and 2-year-olds reported clinical-level scores on the PSI Difficult Child (PSI/DC) scale, which was included as a proxy for behavior problems among 1-year-olds, for whom measures were limited. Sex differences were not observed. CBCL/2-3 and PSI/DC scores were uniquely associated with economic disadvantage (relative risk = 1.89 and 2.24, respectively). Approximately 32% of 2-year-olds with subclinical/clinical CBCL2-3 scores had delayed social-emotional competence. Problems were also associated with parental worry about child behavior and interference in family activities. CONCLUSIONS: A significant need for early identification of emotional/behavioral problems in very young children is highlighted by associations with delayed competence and disruptions in family life that may further contribute to risk for persistent problems.

Maternal depression and comorbidity: predicting early parenting, attachment security, and toddler social-emotional problems and competencies.

OBJECTIVE: To examine relations between maternal depression (in pure and comorbid forms) and mother-infant interactions, infant attachment, and toddler social-emotional problems and competencies. A second objective was to explore sex differences. METHOD: Sixty-nine mother-infant dyads were followed from pregnancy to 30 months postpartum. Depression was measured at multiple times with self-report and interview assessments. Play was assessed at 4 months and attachment status at 14 months postpartum. At 30 months, mothers completed the Child Behavior Checklist and Infant-Toddler Social and Emotional Assessment. RESULTS: Lifetime maternal depression predicted less optimal mother-infant interactions and insecure infant attachment. However, this "depression effect" was accounted for by mothers with comorbid diagnoses, who had less optimal interactions, and infants with higher rates of insecurity than either mothers with depression only or mothers with no psychopathology. Prenatal and postpartum depressive symptoms were associated with problem behaviors and lower competencies for boys. In contrast, quality of early interactions predicted problem behaviors in girls. CONCLUSIONS: It is important to examine the context of maternal depression with respect to additional psychopathology and environmental risks. Maternal depression in the presence of other psychopathology confers risk to the mother-child dyad. Consistent with previous work, risk pathways appear to differ for boys and girls. Early identification and prevention efforts are warranted.

Toward a developmental operational definition of autism.

Traditional approaches to diagnosing autism emphasize delays in communication and socialization. Traditional diagnostic schemes typically list symptoms (e.g., lack of eye contact), but provide little guidance on how to incorporate information about developmental level in making a diagnosis. Because standardized measures of adaptive behavior can provide information about children's communication, socialization, and other behavior relative to their age, they may be useful tools for diagnosing autism. This study investigated the ability of the Vineland Adaptive Behavior Scales to identify children with autism. Vineland scores and measures of intellectual functioning were obtained for children with autism, PDDNOS, and other developmental disorders (DD). Discriminant function analyses indicated that the autism and combined nonautism (PDDNOS and DD) groups could be differentiated on the basis of socialization, daily living skills, and serious maladaptive behaviors. Socialization alone accounted for 48% of the variance in diagnosis. Using regression analyses derived from a large normative sample, adaptive behavior scores were predicted from chronological age (CA) and mental age (MA). Socialization scores in the autism group were substantially below the level predicted from CA or MA. An index derived from the ratio of actual to predicted socialization scores correctly classified 86% of both autism and nonautism cases. Findings suggest that comparison of obtained Vineland socialization scores to those predicted by CA or MA may be useful in clarifying the diagnosis of autism.

The Vineland Adaptive Behavior Scales: supplementary norms for individuals with autism.

Vineland Adaptive Behavior Scales Special Population norms are presented for four groups of individuals with autism: (a) mute children under 10 years of age; (b) children with at least some verbal skills under 10 years of age; (c) mute individuals who are 10 years of age or older; and (d) individuals with at least some verbal skills who are 10 years of age or older. The sample included 684 autistic individuals ascertained from cases referred for the DSM-IV autism/PDD field trial collaborative study and five university sites with expertise in autism. Young children had higher standard scores than older individuals across all Vineland domains. In the Communication domain, younger verbal children were least impaired, older mute individuals most impaired, and younger mute and older verbal individuals in the midrange. Verbal individuals achieved higher scores in Daily Living Skills than mute individuals. The expected profile of a relative weakness in Socialization and relative strength in Daily Living Skills was obtained with age-equivalent but not standard scores. Results high-light the importance of employing Vineland special population norms as well as national norms when evaluating individuals with autism.

A Russian adaptation of the Child Behavior Checklist: psychometric properties and associations with child and maternal affective symptomatology and family function.

The Child Behavior Checklist's (CBCL) applicability to a sample of 105 Russian 9- and 10-year-old children was evaluated by examining the internal consistency of Russian adaptations of parent and teacher report forms. In addition, child behavior scores were correlated with child report of internalizing symptoms and maternal reports of their own internalizing symptoms and general family functioning. Finally, rates of child behavior problems and patterns of interrater agreement were compared with U.S. normative data. The psychometric properties of the adaptations demonstrate the adequacy of these instruments for use in Russia. Internal consistency and interrater agreement were generally comparable to estimates obtained in U.S. normative samples. Further, an exploration of the construct validity of the Russian versions of the CBCL and Teacher Report Form (TRF) lends additional support to the adequacy of these instrument.

Discrepancies among mother, child, and teacher reports: examining the contributions of maternal depression and anxiety.

The relationship between maternal affective symptomatology and discrepancies in maternal reports of child symptoms, relative to teacher and child reports, was evaluated in a community sample of 188 children ages 9-12 years. Mothers, teachers, and children were administered a structured interview about child psychopathology. In general, mothers reported more child behavior problems than children and teachers regardless of maternal symptomatology. However, maternal affective symptoms were associated with discrepancies between mothers' and daughters' reports and between mothers' and teachers' reports of girls' externalizing symptoms. Furthermore, mothers who reported high levels of both anxiety and depressive symptomatology tended to report a large number of symptoms that were not confirmed by either their daughters or teachers. Findings are discussed as possible evidence of the role of maternal affective symptomatology in both actual increases in child symptomatology and maternal reporting distortions. Although maternal depressive and anxiety symptoms shared variance in reporting discrepancies, only anxiety explained unique variance. Consistent with previous studies, cross-informant agreement was modest to moderate (r = .16 to .50) and all informants reported more behavior problems in boys than in girls.

The accuracy of children's reports with anatomically correct dolls.

The accuracy of children's reports of alleged sexual abuse during interviews with anatomically correct dolls is the focus of considerable controversy. This study used an analog experience to measure empirically the accuracy of reports in a relevant, but controlled setting: the forensic medical examination for suspected sexual abuse. Twenty-one 3- to 7-year-old children were interviewed about what occurred during previous examinations with open-ended questions, open-ended questions with anatomically correct dolls, and direct questions with the dolls. Children provided significantly more accurate reports and fewer omissions with direct questions using the dolls compared with either of the two open-ended sections, but there was no significant difference in the number of false reports across the three sections of the interview. These results suggest that anatomically correct dolls may bolster the recall of children's memory in the setting of direct questions without prompting false reports.

The familial and developmental context of obsessive-compulsive disorder.

This article discusses developmental and familial factors in childhood obsessive-compulsive disorder (OCD) highlighting the spectrum of normative to pathologic obsessions and rituals. In addition, it explores the possible role of family functioning in the emergence and maintenance of OCD in childhood and adolescence. Finally, it posits a developmental model that integrates genetic and neurobiologic vulnerability, cognitive models of information processing, behavioral coping strategies, and familial and peer relationships.

The effect of filtering and inter-digit interval on the recognition of dichotic digits.

The new compact disc from the Department of Veterans Affairs, Tonal and Speech Materials for Auditory, Perceptual Assessment, Disc 2.0 (1998), contains two lists of randomly interleaved 1-, 2-, and 3-pair dichotic digits. Two experiments are reported, in which the effects of low-pass filtering and inter-digit interval on dichotic digit recognition were investigated in adult listeners with normal hearing and with mild-to-moderate cochlear hearing loss. Results demonstrated that in the filtered condition, as the low-pass cutoff was increased, there was an increase in recognition performance for 1-, 2-, and 3-pair dichotic digits. When compared to normative data for the materials, findings indicate that the interleaved 1-, 2-, and 3-pair dichotic digit materials were essentially resistant to the effects of hearing loss. There was no significant change in recognition performance as a function of inter-digit interval. The studied 625-ms range of inter-digit intervals studied produced consistent recognition performance with both groups of listeners.

Lexical effects on dichotic word recognition in young and elderly listeners.

Dichotic listening was evaluated using monosyllabic word pairs that differed in lexical difficulty as defined by the Neighborhood Activation Model of spoken word recognition. Four combinations of lexically EASY and lexically HARD words were evaluated (same pair: EASY-EASY, HARD-HARD; or mixed pair: EASY-HARD, HARD-EASY) in young adult listeners with normal hearing and older adult listeners with mild-to-moderate hearing loss. The same-pair data indicated that for all subjects, EASY words were identified correctly more often than HARD words, and recognition performance on words presented to the right ear was better than performance on words presented to the left ear. Overall performance was lower and the right-ear advantage was larger for the older group. The mixed-pair data for the young group revealed that EASY words were recognized more accurately than HARD words, regardless of the ear to which they were presented. For the older adults, the words presented to the right ear were recognized more accurately than were the words presented to the left ear, regardless of the type of word. The efficiency of the processing of stimuli from the left ear is discussed as an explanation of the results for the mixed-pair conditions.

Relation between slopes of word recognition psychometric functions and homogeneity of the stimulus materials.

This tutorial paper examines the relation between the slope of a mean word recognition function and the homogeneity or variability (with respect to recognition) of the individual stimulus items that compose the test materials. This was studied in terms of both the location (Cartesian) and slope of the psychometric functions of the individual words that compose the materials. Word recognition performances were measured for 100 CID W-22 (Hirsh) words and 100 PB-50 (Rush Hughes) words in quiet (0 to 56 dB HL in 8-dB steps) on 12 subjects with normal hearing. The functions for the individual W-22 words were more homogeneous (less variable) than were the functions for the individual PB-50 words. The mean function for the W-22 words was steeper (3.1%/dB) than the function for the PB-50 words (1.9%/dB). This evaluation of the individual words demonstrates the direct relation between variability of the test items and the slope of the mean psychometric function. The more homogeneous performance is on the individual test items with respect to both location and slope, the steeper the slope of the mean psychometric function.

Listeners who prefer monaural to binaural hearing aids.

Four patients who preferred monaural as compared with binaural amplification were evaluated. For these patients, audiometric data, recognition performance on a dichotic digit task, and monaural and binaural hearing aid performance using four amplification strategies (National Acoustic Laboratories-Revised, a speech in noise algorithm, multiple-microphone arrays, and frequency modulated [FM]) are described. The results of dichotic testing using a one-, two-, and three-pair dichotic digit task in free- and directed-recall conditions indicated a left-ear deficit for all subjects that could not be explained by peripheral auditory findings or by a cognitive-based deficit. The results of soundfield testing using a speech in multitalker babble paradigm indicated that when listening in noise, there was little difference between aided and unaided word-recognition performance, suggesting that the binaural hearing aids originally fit for each patient were not providing substantial benefit when listening in a competing babble background. Word-recognition performance when aided monaurally in the right ear was superior to performance when aided monaurally in the left ear and when aided binaurally. The only successful binaural amplification strategy was the FM system. The results indicate that listeners with an auditory-based deficit in dichotic listening may function better with a monaural hearing aid fitting or with an assistive listening device such as an FM system. The findings also suggest that a test of dichotic listening is an important component in the evaluation of patients being considered for amplification.