Sex differences in autism screening: An examination of the Childhood Autism Spectrum Test-Hebrew version.

LAY ABSTRACT: Autism is a neurodevelopmental condition, characterized by social communication alterations and restricted, repetitive behaviors. Typically diagnosed in early childhood, screening and diagnosis at a later age can be challenging, particularly in girls who exhibit a wider range of behaviors and characteristics. Our study set out to examine the effectiveness of the Hebrew translation of the Childhood Autism Spectrum Test, a parent report questionnaire, in identifying these diverse characteristics of autism within an Israeli sample of boys and girls. We examined parent reports on 403 (211 autistic, 192 non-autistic) children, aged 4-12 years. Results revealed the Childhood Autism Spectrum Test-Hebrew version was a valuable tool in differentiating between autistic and typically developing children, correctly identifying 93% of children with autism and 82% of typically developing children. In addition, specific items of the Childhood Autism Spectrum Test-Hebrew version were particularly useful in differentiating between autistic and non-autistic boys and autistic and non-autistic girls. Using these items, in addition to the overall score of the questionnaire, increased the correct identification of children as autistic or typically developing, especially in girls. The Childhood Autism Spectrum Test-Hebrew version test results corresponded well with the Autism Diagnostic Interview-Revised, which relies on parental input, but not with the clinician-administered Autism Diagnostic Observation Schedule-2. Our findings highlight the potential benefits of gender-specific tools to better support correct identification of autism in boys and in girls. More research is recommended to further explore these gender differences and to validate our findings with a larger, diverse group.

Autonomic nervous system responses to social stimuli among autistic individuals: A systematic review and meta-analysis.

Physiological responses to environmental and social stimuli have been studied broadly in relation to psychological states and processes. This may be especially important regarding autistic individuals, who show disparities in social interactions. However, findings from studies assessing autonomic nervous system (ANS) responses of autistic individuals present contradictions, with reports showing both autonomic disparities and intact autonomic functioning. The current study aimed to review the existing literature and to estimate if there is a difference between autistic individuals and neurotypical (NT) individuals in their autonomic responses to social stimuli. Furthermore, the study examined factors that may moderate this difference, including the type of physiological function measured, the level of participation required, as well as the age and intellectual functioning of the participants. The meta-analysis revealed a small and statistically insignificant overall difference between autistic and NT individuals, albeit with high heterogeneity. A further nested moderator analysis revealed a significant difference between autistic and NT individuals in physiological response that reflects mainly a parasympathetic nervous system (PNS) activity. Another difference was found in physiological response that reflects a combined activity of the sympathetic and parasympathetic systems, but only for experimental tasks that demanded active participation in social interactions. These results suggest a distinctiveness in autonomic regulation of autistic individuals in social situations, and point to the PNS as an important study objective for future investigation.

Enhancing emotion recognition in young autistic children with or without attention-deficit/hyperactivity disorder in Hong Kong using a Chinese App version of The Transporters.

TRIAL REGISTRATION: This study was registered with the German Clinical Trials Register - Deutschen Register Klinischer Studien (DRKS) on 23 December 2018. The Trial Registration Number (TRN) is DRKS00016506. LAY ABSTRACT: The Transporters App is an intervention programme with 15 animated episodes that teach emotion recognition skills to autistic children between 4 and 6 years of age. Each episode contains a story depicting social interactions between characters in the form of a vehicle, with human faces grafted on to each of them. Each episode teaches a specific emotion in a story context. Autistic children watched at least three episodes at home for about 15 min daily for a month, with parental guidance. Its automated, home-based format is cost-saving and readily accessible. This study translated The Transporters to a Cantonese-Chinese version. Results showed a significant improvement in emotion recognition following viewing The Transporters in a group of Hong Kong Chinese autistic children, between 4 and 6 years of age, with and without attention-deficit/hyperactivity disorder (n = 48) relative to a control group (n = 24). A non-autistic group (n = 23) showed that the autistic children scored lower in emotion recognition pre-intervention. Post-intervention, the autistic children had improved in emotion recognition to the level of the non-autistic children. The autistic children in the intervention groups also generalized their learning to novel situations/characters not taught within The Transporters. There was no dosage effect, with the standard recommended number of episodes viewed being sufficient to achieve significant improvement. This study confirms the effectiveness of The Transporters for Chinese autistic children and contributes to the literature/practice by expanding the range of applicability of The Transporters to autistic children with attention-deficit/hyperactivity disorder, which is important given the high rate of co-occurrence between autism and attention-deficit/hyperactivity disorder.

Does Having a Sibling Affect Autistic People's Empathy?

This study examined whether autistic people with siblings score higher on measures of empathy than those without siblings. Cohorts of autistic children (n = 939; mean age = 7.35 years (SD = 2.15)) and autistic adults (n = 736; mean age = 37 years (SD = 12.39)) from the Cambridge Autism Research Database (CARD) were each divided into two groups: with or without siblings. Empathy was measured using the children version of the Empathy Quotient (EQ) (parent-report) for children. For adults, the EQ (self-report version) and the Reading the Mind in the Eyes Test (RMET) were used. Contrary to the hypothesis, autistic children without siblings scored higher on EQ than those with siblings (t(283.70) = 4.20, p < .001; d = 0.50). In adults, there was no difference between autistic adults with and without siblings on both measures, but there was an interaction effect between sex and group on the RMET (f(1732) = 4.10, p = 0.04): whilst autistic males without siblings on average scored lower than females, autistic males with siblings on average performed similarly to females. Future research should investigate the possible effect of siblings on autistic males' empathy performance in a larger cohort of autistic individuals. Children's empathic abilities may be underestimated by their parents when they have siblings due to a contrast effect.

The Autism-Spectrum Quotient-Hebrew version: Psychometric properties of a full and a short form, adapted for DSM-5.

LAY ABSTRACT: Despite the attempt to diagnose autism at an early age, there are still many individuals who would only get an autism diagnosis in adulthood. For these adults, a questionnaire that could assist in highlighting their need to seek diagnostic assessment is needed. The Autism-Spectrum Quotient is a self-report scale used to assess autistic traits. It was tested cross-culturally, and a short version was recommended to help identify adults who should be referred for an autism assessment. However, its relevance for the up-to-date diagnostic criteria, according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), has not been tested. This study aimed to examine the psychometric properties of the Hebrew version of the Autism-Spectrum Quotient and to create a short version of the Hebrew Autism-Spectrum Quotient, based on items which map on to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria. Ninety-three autistic adults (24 females), aged 18-51, clinically diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.), and 147 comparable controls (34 females) filled out the Hebrew version of the Autism-Spectrum Quotient. Ten clinicians who specialize in diagnosing autism in adults classified the Autism-Spectrum Quotient's items according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria. The short version of the Hebrew Autism-Spectrum Quotient comprised items that best differentiated between adults with and without autism, five items representing each of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) diagnostic domains. The overall probability for participants to be correctly classified as autistic or neurotypical was 86% for the Hebrew version of the Autism-Spectrum Quotient and 88% for the short version of the Hebrew Autism-Spectrum Quotient. We conclude that both versions are reliable and sensitive instruments that can help referring adults for autism assessment.

A Self-Determination Theory Approach to Work Motivation of Autistic Adults: A Qualitative Exploratory Study.

The study explores work motivation of autistic adults through the lens of Self-Determination Theory (SDT). Twelve autistic employees (ages 28-47; 3 females) participated in semi-structured qualitative interviews about their work experience. Analysis combined inductive and deductive approaches, identifying motivational themes emerging from the interviews, and analyzing them according to SDT concepts. Two major themes emerged: (1) work motivation factors positioned on the self-determination continuum: income and self-reliance; a daily routine; social/familial internalized norms; meaning and contribution; and job interest; and (2) satisfaction of psychological needs at work, postulated by SDT: competence, social-relatedness, and autonomy and structure. Findings are discussed in relation to current literature, and practical applications are suggested for meeting the motivational needs of autistic employees and promoting employment stability.

Micro-Analyses Reveal Increased Parent-Child Positive Affect in Children with Poorer Adaptive Functioning Receiving the ESDM.

Synchronous positive affect (SPA) is a key element of parent-child interaction quality which is related to favorable developmental outcomes. Children with autism spectrum disorder (ASD) and their parents tend to show less SPA compared to other populations. The current study explored changes in SPA made by parents and their children with ASD following the Preschool-Based Early Start Denver Model (PB-ESDM) intervention. Thirty children receiving PB-ESDM and 23 receiving treatment-as-usual (TAU) were assessed pre- and post- intervention using microanalysis of video-recorded parent-child interactions, in which SPA was quantified. Results showed a significant increase in SPA among children receiving PB-ESDM who had lower pre-treatment adaptive functioning. These findings suggest that SPA may serve as a sensitive treatment outcome measure for children with poorer adaptive functioning, who often struggle to show significant changes on standardized measures. The study's modest sample and non-randomized design are noted as limitations.

Home-quarantine during the initial Covid-19 outbreak in Israel: parent perceived impact on children with ASD.

Background: Studies have reported that Covid-19 home-quarantine periods have had mostly negative psychological impact on children with ASD and their families. Here we examined parent perceived impact of a 6-week quarantine period imposed in Israel at the beginning of the Covid-19 outbreak, in mid-March 2020. Methods: An anonymous online questionnaire was completed by parents of 268 children with ASD. Parents rated deterioration/improvement in their child's behaviors, abilities, mood, sleep, and anxiety along with changes in their own mood, sleep, parenting skills, and family relationships. We performed t-tests and ANOVA analyses to assess the significance of perceived impact on each domain and potential differences in the impact across families with children of different ages, genders, and levels of required support as well as families that experienced different magnitudes of economic hardships. Results: Parents reported significant deterioration in their mood and sleep along with significant improvements in relationships with their spouse and child with ASD, and in their parenting skills. Parents also reported significant increases in the severity of tantrums, anxiety, and restricted and repetitive behavior symptoms along with significant improvements in social and communication abilities of their child with ASD. Ratings were significantly lower in families of ASD children who regularly require more support and in families that experienced economic hardships. Conclusions: While periods of home-quarantine create numerous hardships for families of children with ASD, they may also offer an opportunity for improving parenting skills, family relationships, and children's social communication abilities with potential relevance for improving remote services.

The comorbidity between autism spectrum disorder and post-traumatic stress disorder is mediated by brooding rumination.

LAY ABSTRACT: Autism spectrum disorder is a neurodevelopmental condition characterized by social communication difficulties and restricted repetitive behaviors. Individuals with autism spectrum disorder are often diagnosed with other psychiatric conditions, including attention deficit hyperactivity disorder, anxiety, and depression. However, research on post-traumatic stress disorder among individuals with autism spectrum disorder is scarce. Nonetheless, studies have shown that those with autism spectrum disorder may face an increased risk of exposure to traumatic events. Separate lines of research in autism spectrum disorder and post-traumatic stress disorder have shown that the two may share several vulnerability factors. One of those is ruminative thinking, that is, one's tendency to re-hash thoughts and ideas, in a repetitive manner. This article examined the role of two rumination types as potential factors connecting autism spectrum disorder and post-traumatic stress disorder: brooding (continuously comparing one's current condition to one's desired condition) and reflection (an introspective effort to cognitively solve one's problems). A total of 34 adults with autism spectrum disorder (with no intellectual impairment) and 66 typically developing adults completed questionnaires assessing post-traumatic stress disorder symptoms and rumination. The results showed increased post-traumatic stress disorder symptoms in adults with autism spectrum disorder, compared to typically developing adults. Brooding rumination was also higher among those with autism spectrum disorder. Finally, brooding, but not reflection, served as a mechanism connecting autism spectrum disorder and post-traumatic stress disorder, that is, those with autism spectrum disorder showed increased brooding, which in turn predicted more post-traumatic stress disorder symptoms. This study has potential clinical implications. Rumination and cognitive inflexibility, which are common in autism spectrum disorder, could exacerbate post-traumatic symptoms among individuals with autism spectrum disorder who experience traumatic events. Interventions targeting brooding rumination and cognitive flexibility may assist in alleviating post-traumatic symptoms in individuals with autism spectrum disorder.

Shifts in Behavioral Synchrony in Response to an Interaction Partner's Distress in Adolescents With and Without ASD.

Individuals with Autism spectrum disorder (ASD) show altered behavioral synchrony and empathic behavior. Yet, an ecologically valid examination of these in adolescents is still required. We employed a social interaction sequence comprising a friendly conversation with a confederate, an expression of distress by her, and a return to friendly conversation. 44 male adolescents (22 with ASD) participated. Socio-emotional behaviors, coded by blind raters and through automated analyses of motion, were analyzed. Results indicated reduced synchrony in the ASD group. Moreover, whereas controls displayed a decrease in synchrony when facing another's distress, adolescents with ASD showed no such change. No group differences were found on empathic behavior. Findings imply gaps between verbal and non-verbal responses of adolescents with ASD to a distressed interaction partner.

General mentalizing, emotional theory of mind and interpersonal mistrust in anorexia nervosa: The validation of the Hebrew version of the Cambridge mindreading face-task.

OBJECTIVE: This study had two goals. The first was to validate and examine the potential of the Hebrew version of the Cambridge Mindreading face task (CAMHeb )-an ecological measure of emotional theory of mind (eToM)-to assess eToM in individuals with anorexia nervosa (AN). The second goal was to examine whether interpersonal mistrust would mediate the relation between mentalizing and eToM and the severity of AN. METHOD: The validity of the CAMHeb was examined using well-established measures of mentalizing ability and eToM in 45 young female patients with AN and 53 control participants. Next, the mediation model was assessed using a subsample of 33 AN patients and 34 controls, in which interpersonal mistrust was additionally assessed. RESULTS: The CAMHeb correlated with the measures of mentalizing ability and eToM. The CAMHeb , along with the measure of general mentalizing, significantly differentiated between the AN and control groups. The associations of general mentalizing and CAMHeb with eating disorder (ED) symptoms were mediated by interpersonal mistrust. CONCLUSION: The CAMHeb is a valid measure of deficient eToM in AN. In therapy, an increase in mentalizing ability and accurate eToM may enhance interpersonal trust, which may further contribute to attenuation of AN symptoms.

Implications of Employment Changes Caused by COVID-19 on Mental Health and Work-Related Psychological Need Satisfaction of Autistic Employees: A Mixed-Methods Longitudinal Study.

This mixed-methods study examined longitudinal data, assessing Israeli autistic adults' employment-related changes, resulting from the COVID-19 pandemic. In the quantitative phase, 23 participants answered a survey before and during COVID-19, assessing work-status, mental health, and work-related psychological need satisfaction. The qualitative phase included interviews with ten employed participants. Results indicate a significant decrease in mental health of participants who lost their jobs during COVID-19, while participants who continued to physically attend work, maintained pre-COVID-19 levels on all assessed variables. Participants who transitioned to remote-work from home, showed a marginally significant deterioration in mental health and a significant decrease in satisfaction of work-related psychological needs for competence and autonomy. Qualitative accounts supplement these findings and portray advantages and disadvantages of remote-work.

Keeping in time with social and non-social stimuli: Synchronisation with auditory, visual, and audio-visual cues.

Everyday social interactions require us to closely monitor, predict, and synchronise our movements with those of an interacting partner. Experimental studies of social synchrony typically examine the social-cognitive outcomes associated with synchrony, such as affiliation. On the other hand, research on the sensorimotor aspects of synchronisation generally uses non-social stimuli (e.g. a moving dot). To date, the differences in sensorimotor aspects of synchronisation to social compared to non-social stimuli remain largely unknown. The present study aims to address this gap using a verbal response paradigm where participants were asked to synchronise a 'ba' response in time with social and non-social stimuli, which were presented auditorily, visually, or audio-visually combined. For social stimuli a video/audio recording of an actor performing the same verbal 'ba' response was presented, whereas for non-social stimuli a moving dot, an auditory metronome or both combined were presented. The impact of autistic traits on participants' synchronisation performance was examined using the Autism Spectrum Quotient (AQ). Our results revealed more accurate synchronisation for social compared to non-social stimuli, suggesting that greater familiarity with and motivation in attending to social stimuli may enhance our ability to better predict and synchronise with them. Individuals with fewer autistic traits demonstrated greater social learning, as indexed through an improvement in synchronisation performance to social vs non-social stimuli across the experiment.

Integrating the Early Start Denver Model into Israeli community autism spectrum disorder preschools: Effectiveness and treatment response predictors.

LAY ABSTRACT: Early intensive intervention has been shown to significantly affect the development of children with Autism. However, the costly implementation of such interventions limits their wide dissemination in the community. This study examined an integration of a research-supported early intensive intervention model called the Early Start Denver Model into community preschool programs for children with Autism in Israel. Four community preschools implemented the preschool-based Early Start Denver Model and four implemented the existing multidisciplinary developmental intervention which is widely applied in Israeli community preschools for children with autism. Fifty-one children (aged 33-57 months) participated in the study. Twenty-six attended the preschool-based Early Start Denver Model preschools and twenty-five attended the multidisciplinary developmental intervention preschools. Before the intervention began, groups were comparable on children's age and developmental functioning and on families' socio-economic status. Results showed that, compared to the multidisciplinary developmental intervention group, children in the preschool-based Early Start Denver Model treatment group made greater gains on measures of overall cognitive development, language skills, as well as on parent- and teacher-reported adaptive communication and socialization abilities. Children who had lower autism symptom severity, higher adaptive functioning and better language understanding abilities before taking part in the preschool-based Early Start Denver Model program showed greater improvements following it. This study documents the successful implementation of an intensive early intervention program in pre-existing community preschools, underlining the importance of the integration of research-supported intervention programs into community settings.

Autism Spectrum Disorder and Post-Traumatic Stress Disorder: An unexplored co-occurrence of conditions.

LAY ABSTRACT: People with Autism Spectrum Disorder show an increased risk of experiencing traumatic events, particularly social victimization. However, Autism Spectrum Disorder and Post-Traumatic Stress Disorder co-occurrence was hardly studied. We examined exposure to traumatic life events and Post-Traumatic Stress Disorder symptoms in adults with Autism Spectrum Disorder vs typical adults. Two groups took part in this study: Twenty-five adults with Autism Spectrum Disorder and 25 typical adults of similar age and male to female ratio. Participants completed questionnaires on potentially traumatic life events of social and non-social nature, as well as on Post-Traumatic Stress Disorder symptoms related to their most distressing event. Participants also filled out an autism traits questionnaire. Results showed a higher Post-Traumatic Stress Disorder rate in the Autism Spectrum Disorder group (32%) compared with the typical group (4%). Individuals with Autism Spectrum Disorder reported more Post-Traumatic Stress Disorder symptoms, particularly re-experiencing and increased physiological arousal, compared with typical adults, although the latter was elevated only in females with Autism Spectrum Disorder. Participants with Autism Spectrum Disorder, especially females, reported more negative life events, particularly social events, than typical adults. Sixty percent of Autism Spectrum Disorder participants, but only 20% of typical participants, chose a social event as their most distressing event. Individuals with Autism Spectrum Disorder who were also suspected as having Post-Traumatic Stress Disorder (based on their questionnaires) presented poorer social skills compared with those with Autism Spectrum Disorder alone. Results indicate that individuals with Autism Spectrum Disorder are more susceptible to trauma and Post-Traumatic Stress Disorder, particularly due to social stressors. Females with Autism Spectrum Disorder may be especially vulnerable to Post-Traumatic Stress Disorder.

Seeking Team Collaboration, Dialogue and Support: The Perceptions of Multidisciplinary Staff-Members Working in ASD Preschools.

Autism spectrum disorder (ASD) impacts various developmental domains, requiring interventions by professionals from multiple disciplines. In Israel, ASD community preschools' multidisciplinary teams aim to provide each child with an integrative intervention program. The current study focused on the working experience of 21 professionals from multidisciplinary teams in ASD-preschools, with special emphasis on their perceptions of the intra-staff dialogue in their teams. Interviews were transcribed verbatim and analyzed through grounded theory. Arising themes covered: challenges characterizing the delivery of intervention to children with ASD in a community setting; challenges met by professionals when attempting to navigate multidisciplinary teamwork; and factors that facilitate multidisciplinary work. Practices that support multidisciplinary team cohesion at the team, the organizational, and the policy-making levels are discussed.

A Conflict of Interests: A Motivational Perspective on Special Interests and Employment Success of Adults with ASD.

A course of action often suggested in an attempt to improve employment outcomes of adults with autism spectrum disorder, is to match between special interests and job opportunities. In this commentary, we propose that the match may be more complicated than it seems, possibly overseeing more pressing employment needs that should be answered such as: the job's characteristics, labor market demands, and stress resulting from job expectations. Self determination theory of motivation is suggested as a lens through which the association between special interests and a paying job can be examined, highlighting important considerations that hold the potential to increase employment success. Recommendations for new research directions and vocational rehabilitation practice are discussed.

The EU-Emotion Voice Database.

In this study, we report the validation results of the EU-Emotion Voice Database, an emotional voice database available for scientific use, containing a total of 2,159 validated emotional voice stimuli. The EU-Emotion voice stimuli consist of audio-recordings of 54 actors, each uttering sentences with the intention of conveying 20 different emotional states (plus neutral). The database is organized in three separate emotional voice stimulus sets in three different languages (British English, Swedish, and Hebrew). These three sets were independently validated by large pools of participants in the UK, Sweden, and Israel. Participants' validation of the stimuli included emotion categorization accuracy and ratings of emotional valence, intensity, and arousal. Here we report the validation results for the emotional voice stimuli from each site and provide validation data to download as a supplement, so as to make these data available to the scientific community. The EU-Emotion Voice Database is part of the EU-Emotion Stimulus Set, which in addition contains stimuli of emotions expressed in the visual modality (by facial expression, body language, and social scene) and is freely available to use for academic research purposes.

Personal Growth Experiences of Parents to Children with Autism Spectrum Disorder.

Experiences of parenting a child with Autism Spectrum Disorder (ASD) have mostly been studied in relation to hardship. The current study explored personal growth experiences of Israeli parents to children with ASD, specifically in relation to Tedeschi and Calhoun's crisis-related growth model. Nineteen parents were interviewed, and qualitative categorical content analysis was performed. Four major growth themes emerged: Empowerment and personal strength, Existential perspective/spiritual-emotional experience, Interpersonal and Expertise, professional or political involvement. Themes were largely consistent with the crisis-related growth model, with some being unique to the current subject of inquiry. Findings indicated growth might occur differently in different cultures. Clinically, with some parents, the focus regarding the parenting of their child with ASD should be shifted from adjustment to growth.