Improving Transition to Adulthood for Students with Autism: A Randomized Controlled Trial of STEPS.

Emerging adulthood is a period of heightened risk for young people with autism spectrum disorder (ASD). Due in part to a lack of evidence-based services and supports during the transition to adulthood, many emerging adults fail to matriculate into postsecondary education or thrive in productive employment. The Stepped Transition in Education Program for Students with ASD (STEPS) was developed to address the psychosocial, transition-related needs of emerging adults with ASD. Adolescents and emerging adults (n = 59) with ASD were randomly assigned to either STEPS or transition as usual (TAU). Results indicate that STEPS is acceptable to young people with ASD and their parents and that it can be implemented with high fidelity. Among secondary school students, those who completed STEPS exhibited significantly greater gains in transition readiness from high school, and these gains were largely sustained after program completion. Among students enrolled in postsecondary education, STEPS resulted in increased levels of student adaptation to college relative to those in TAU. Programming to address ASD-related challenges can promote successful educational transitions.

The Influence of Parent and Parent-Adolescent Relationship Characteristics on Sexual Trajectories into Adulthood.

To examine sexual partner acquisition into young adulthood and to explore what characteristics of the adolescent family context might predict this change, we used growth curve modeling to examine data from a nationally representative sample of adolescents followed longitudinally over 13 years through young adulthood (N = 5385). Growth curve modeling allowed us to treat the outcome as a dynamic variable and to examine 10 potential predictors of change while accounting for the nested nature of the data. Six family characteristics emerged as predictors of mean number of partners and rate of partner acquisition, while accounting for three significant adolescent predictors. Living in a single-parent or blended family and general communication about sex predicted higher lifetime number of sexual partners in young adulthood. Parent religiosity, parent disapproval of adolescent engagement in sex, and parent-adolescent connectedness were predictive of lower lifetime number of sexual partners. By following participants into their late twenties and early thirties, we were able to detect changes in the impact of early family factors that are not apparent in studies restricted to adolescents and emerging adults. For example, parent education, parent disapproval, and parent-adolescent connectedness were associated with higher rates of partner acquisition at age 23, but faster deceleration in partner acquisition as time progressed. Communication about negative consequences of sex was not predictive, regardless of whether it was "on time" (before sexual intercourse) or not. These results reveal that parents have significant, and sometimes unexpected, influence on their children's sexual behavior that persists well into adulthood.

Effects of Verbal Ability and Severity of Autism on Anxiety in Adolescents With ASD: One-Year Follow-Up After Cognitive Behavioral Therapy.

There is evidence supporting the efficacy of cognitive-behavioral therapy for treatment of anxiety in youth with Autism Spectrum Disorders (ASD), but long-term course of anxiety after treatment and individual predictors of treatment response are unknown. To meet the demands for personalized mental health care, information on the fit between patient and treatment as well as treatment durability is needed. We evaluated change in anxiety symptoms during intervention and 1 year after completion of the treatment, and evaluated predictors of response using an advanced analytical design, with follow-up data from a randomized controlled trial of 22 adolescents (12-17 years) with ASD and 1 or more anxiety disorders. Reduction in anxiety was partially maintained during the year following treatment; greater ASD severity predicted better treatment response. Our finding that brief treatment is associated with sustained gains is promising, given the pervasive and chronic nature of ASD. Implications for the treatment of anxiety in higher functioning adolescents with ASD are considered.

Cross-level covariance approach to the disaggregation of between-person effect and within-person effect.

In longitudinal studies, researchers are often interested in investigating relations between variables over time. A well-known issue in such a situation is that naively regressing an outcome on a predictor results in a coefficient that is a weighted average of the between-person and within-person effect, which is difficult to interpret. This article focuses on the cross-level covariance approach to disaggregating the two effects. Unlike the traditional centering/detrending approach, the cross-level covariance approach estimates the within-person effect by correlating the within-level observed variables with the between-level latent factors; thereby, partialing out the between-person association from the within-level predictor. With this key device kept, we develop novel latent growth curve models, which can estimate the between-person effects of the predictor's change rate. The proposed models are compared with an existing cross-level covariance model and a centering/detrending model through a real data analysis and a small simulation. The real data analysis shows that the interpretation of the effect parameters and other between-level parameters depends on how a model deals with the time-varying predictors. The simulation reveals that our proposed models can unbiasedly estimate the between- and within-person effects but tend to be more unstable than the existing models. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Education, Social Engagement, and Cognitive Function: A Cross-Lagged Panel Analysis.

OBJECTIVES: Although education and social engagement are considered cognitive reserves, the pathway of both reserves on cognitive function has been rarely studied. This study aimed to examine the underlying mechanism between education, social engagement, and cognitive function. METHODS: This study used 2-wave data (2010 and 2014) from Health and Retirement Study in the United States (N = 3,201). Education was measured by years of schooling. Social engagement was evaluated by 20 items including volunteering, physical activities, social activities, and cognitive activities. Cognitive function was assessed by a modified Telephone Interview for Cognitive Status. A cross-lagged panel model was fitted to test the mediating mechanism between education, social engagement, and cognitive function. RESULTS: Controlling for covariates, higher education in early life was associated with better cognitive function in old age (b = 0.211, 95% confidence interval [CI] = [0.163, 0.259], p < .01). Late-life social engagement partially mediated the association between education and cognitive function (indirect effect = 0.021, 95% CI = [0.010, 0.033], p < .01). The indirect path between education and social engagement via cognition also existed (b = 0.009, 95% CI = [0.005, 0.012], p < .001). DISCUSSION: Education in earlier life stage may exert a lifelong effect on cognitive function as well as an indirect effect via enhancing late-life cognitive reserve such as social engagement. The cross-lagged effect of social engagement on cognitive function is significant and vice versa. Future research may explore other cognitive reserves over the life course and its underlying mechanism to achieve healthy cognitive aging.

Moral injury and psychosocial functioning in health care workers during the COVID-19 pandemic.

Studies of moral injury among nonmilitary samples are scarce despite repeated calls to examine the prevalence and outcomes of moral injury among civilian frontline workers. The purpose of this study was to describe the prevalence of moral injury and to examine its association with psychosocial functioning among health care workers during the COVID-19 pandemic. We surveyed health care workers (N = 480), assessing exposure to potentially morally injurious events (PMIEs) and psychosocial functioning. Data were analyzed using latent class analysis (LCA) to explore patterns of PMIE exposure (i.e., classes) and corresponding psychosocial functioning. The minimal exposure class, who denied PMIE exposure, accounted for 22% of health care workers. The moral injury-other class included those who had witnessed PMIEs for which others were responsible and felt betrayed (26%). The moral injury-self class comprised those who felt they transgressed their own values in addition to witnessing others' transgressions and feeling betrayed (11%). The betrayal-only class included those who felt betrayed by government and community members but otherwise denied PMIE exposure (41%). Those assigned to the moral injury-self class were the most impaired on a psychosocial functioning composite, followed by those assigned to the moral injury-other and betrayal-only classes, and finally the minimal exposure class. Moral injury is prevalent and impairing for health care workers, which establishes a need for interventions with health care workers in organized care settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Infant attention and maternal education are associated with childhood receptive vocabulary development.

Receptive vocabulary development was examined in 313 children (151 girls; 78% White) as a function of infant attention and maternal education (66% of mothers held a college degree or higher). Attention was measured at 10 months using a dynamic puppet task and receptive vocabulary was measured at 3-, 4-, 6-, and 9 years of age using the Peabody Picture Vocabulary Test. The best-fitting multilevel growth model was a quadratic model as a function of age. Results indicated that both infant attention and maternal education were predictors of receptive vocabulary initial status, with no differences as a function of child sex. In contrast, infant attention, but not maternal education, predicted growth in receptive language skill, and boys demonstrated a faster rate of receptive language development in comparison to girls. These findings illustrate that even after accounting for child sex and maternal education, infant visual attention predicts children's receptive language development starting from the early preschool period into the elementary school years. These findings demonstrate the importance and nature of the role that infant attention and maternal education play with respect to childhood receptive language development. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Bias for Treatment Effect by Measurement Error in Pretest in ANCOVA Analysis.

This paper investigated consequences of measurement error in the pretest on the estimate of the treatment effect in a pretest-posttest design with the analysis of covariance (ANCOVA) model, focusing on both the direction and magnitude of its bias. Some prior studies have examined the magnitude of the bias due to measurement error and suggested ways to correct it. However, none of them clarified how the direction of bias is affected by measurement error. This study analytically derived a formula for the asymptotic bias for the treatment effect. The derived formula is a function of the reliability of the pretest, the standardized population group mean difference for the pretest, and the correlation between pretest and posttest true scores. It revealed a concerning consequence of ignoring measurement errors in pretest scores: treatment effects could be overestimated or underestimated, and positive treatment effects can be estimated as negative effects in certain conditions. A simulation study was also conducted to verify the derived bias formula.

Integrating Measurement-Based Care into Treatment for Autism Spectrum Disorder: Insights from a Community Clinic.

Measurement-based care (MBC), an evidence-based approach that has demonstrated efficacy for improving treatment outcomes, has yet to be investigated in clients with Autism Spectrum Disorder. The current paper investigates the use of MBC in autistic (n = 20) and non-autistic (n = 20) clients matched on age, sex, and presenting problem. Results of change score analysis indicated that utilizing routine symptom monitoring can enhance treatment evaluation. Autistic clients participated in significantly more sessions, made significantly less progress, and were less compliant with MBC than non-autistic clients. Though hierarchical linear modeling demonstrated no significant differences in treatment slope, results indicated moderate effect size. These results inform the use of MBC in community clinics, highlighting policy implications and need for targeted measurement.

Identification of county-level health factors associated with COVID-19 mortality in the United States.

Many studies have investigated causes of COVID-19 and explored safety measures for preventing COVID-19 infections. Unfortunately, these studies fell short to address disparities in health status and resources among decentralized communities in the United States. In this study, we utilized an advanced modeling technique to examine complex associations of county-level health factors with COVID-19 mortality for all 3141 counties in the United States. Our results indicated that counties with more uninsured people, more housing problems, more urbanized areas, and longer commute are more likely to have higher COVID-19 mortality. Based on the nationwide population-based data, this study also echoed prior research that used local data, and confirmed that county-level sociodemographic factors, such as more Black, Hispanic, and older subpopulations, are attributed to high risk of COVID-19 mortality. We hope that these findings will help set up priorities on high risk communities and subpopulations in future for fighting the novel virus.

Global DNA hypomethylation suppresses squamous carcinogenesis in the tongue and esophagus.

Genome-wide DNA hypomethylation and concomitant site-specific gene hypermethylation are among the most common molecular alterations in human neoplasia. Previous studies revealed that genetic reduction of the DNA methylation level results in opposing effects on tumor development, depending on the tumor cell type and on the different stages of the tumorigenesis. For instance, reduced levels of DNA methylation in mice strongly inhibited tumor development of the intestine, whereas they induced thymic lymphomas and liver tumors. In the present study, using DNA methyltrasferase 1 (Dnmt1) hypomorphic alleles to reduce genomic methylation, we examined the effects of DNA hypomethylation on a murine squamous carcinogenesis in the tongue and esophagus induced by 4-nitroquinoline 1-oxide. Genetic reduction of DNA methylation level led to the suppression of tumor formation in both tongue and esophagus. Histological analyses revealed that DNA hypomethylation preferentially inhibited the development of squamous cell carcinomas. The results suggest that genomic hypomethylation inhibits squamous carcinogenesis in the tongue and esophagus, and that pharmacological modification of epigenetic status might be useful for the prevention and treatment of cancers in the upper digestive tract.

The effect of neoadjuvant therapy on the 5-fluorouracil metabolic and relative enzymes of oral squamous cell carcinoma.

To assess the effect of neoadjuvant therapy using tegafur/uracil (UFT) and radiation therapy on the 5-fluorouracil (5-FU) metabolic and relative enzymes, thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD), orotate phosphoribosyl transferase (OPRT) and thymidine phosphorylase (TP) in oral squamous cell carcinoma (OSCC), we examined the mRNA expression and immunohistochemical staining status of these enzymes using 17 surgical specimens. Seven patients did not receive any neoadjuvant therapy and 10 were treated with UFT and local irradiation therapy. Our result showed that the mRNA expression of these enzymes in neoadjuvant group was not significantly different from that of non-treated group using real-time quantitative PCR. To confirm the protein expression, we also carried out immunohistological staining of TS and DPD two key enzymes in the 5-FU metabolism, using the same specimens. Immunohistological staining status did not correspond to the results of mRNA analysis completely, though no significant difference between the groups was observed. Furthermore, no significant relationship between the UFT administration period and mRNA expression of the 5-FU metabolic enzymes was observed in neoadjuvant therapy group and also the distribution of the enzyme mRNA expression levels was similar to that of non-treated group. The results suggested that the neoadjuvant therapy of OSCC might not affect the expression status of 5-FU metabolic and relative enzymes in surgical tumor samples and the tumor tissues might serve as a useful specimen source to analyze the expression status of the 5-FU metabolic and relative enzymes and to determine the prospective efficiency of 5-FU-based adjuvant chemotherapy.

Multilevel analysis of BMI growth trajectories of US school children: Features and risk factors.

Childhood obesity continues to be a major focus of public health efforts in the United States, where nearly 17% of children are obese. In this study, we focused on two significant features that characterize U.S. society-school mobility and a single-parent family structure-and how they relate to childhood obesity/overweight. Using a nationally representative sample from the Early Childhood Longitudinal Study-Kindergarten (ECLS-K) class of 1998, we examined the body mass index (BMI) growth trajectories of children to determine how these two key features interacted with demographic characteristics of gender, race/ethnicity, and socio-economic status (SES), which are known to be associated with BMI. We analyzed five waves of data from kindergarten through fifth grade of 9041 students applying a two-level hierarchical linear model (HLM). Results indicated that children who changed schools more than two times from kindergarten to fifth grade had higher BMI growth trajectories compared to children who changed only once or did not change schools. To our knowledge, no prior studies have examined this association. Results also indicated children in single-parent families were more likely to have higher BMI growth trajectories compared to children in two-parent families. Although both school mobility and family structure had an impact on children's BMI, we found that family structure had a larger impact than school mobility. Being in a two-parent family was a protective factor for children; that is, even if children in two-parent families moved schools twice or more, they still maintained a healthy BMI on average. For children in single-parent families, however, moving schools tended to have a greater, negative impact on their BMI statuses.

The effect of hypoxic microenvironment on matrix metalloproteinase expression in xenografts of human oral squamous cell carcinoma.

Hypoxia is a common environmental stress factor and is associated with physiological and pathological conditions related to cancer invasion and metastasis. The process of cancer cell invasion involves degradation of the extracellular matrix. Here, we examine the effect of hypoxic microenvironment on matrix metalloproteinase expression in human oral squamous cell carcinoma under in vitro and in vivo conditions. At first, the expression levels of HIF-1alpha and matrix metalloproteinase (MMP) proteins in human oral squamous cell carcinoma cell lines, SAS and HSC-2 cultured under hypoxic or normoxic condition, were assessed by Western blotting. Enzyme activity and mRNA of MMP under hypoxic or normoxic condition were also investigated. Then the SAS and HSC-2 cells were transplanted subcutaneously into immunodeficient mice and the correlation between hypoxia and protein expression for MMPs, HIF-1alpha and Ki-67 were assessed. Hypoxic region was detected by in situ hypoxic probe, pimonidazole. MMP proteins and mRNA in both SAS and HSC-2 cells were increased under hypoxic condition. In xenograft, MMP-2 was expressed in tumor tissue, especially in hypoxic region. In contrast, MMP-9 expression was recognized in tumor tissue, especially neighboring stromal tissues containing blood vessels. Our study suggests that the hypoxic microenvironment in human oral squamous cell carcinoma plays important roles in expression for HIF-1alpha and MMPs, and proliferative activity of tumor cells.

Preventive effect of fermented brown rice and rice bran on N-methyl-N'-nitro-N-nitrosoguanidine-induced gastric carcinogenesis in rats.

A number of possible preventive agents for cancers in different organs have been reported, however, little information is available regarding the effective agents for the development of gastric cancers. The rice components are known to be effective for the prevention of the development of cancers. Our group has demonstrated that fermented brown rice by Aspergillus Orzae (FBRA) has chemopreventive potentials in several organs. In this study, we investigated the modifying effects of FBRA exposed during the initiation or post-initiation phase of N-methyl-N'-nitro-N-nitrosoguanidine (MNNG)-induced gastric carcinogenesis in rats. Five-week-old male ACI rats were divided into 7 groups. Groups 1-5 were given oral administration of MNNG (100 mg/l in distilled water) for 24 weeks starting at 6 weeks of age. Groups 2 and 3 were fed a diet containing 5 and 10% FBRA during the initiation phase, respectively, whereas groups 4 and 5 were fed these diets during the post-initiation phase. Group 6 was given a diet containing 10% FBRA throughout the experiment. Group 7 was kept on the basal diet alone and served as an untreated control. Rats were sacrificed at 52 weeks after the start, and the epithelium of the stomach was investigated in detail. Incidence and multiplicity of gastric proliferative lesions of group 1 (MNNG alone) were 61% and 1.67+/-1.57/rat, respectively. Those of group 5 (25%, 0.35+/-0.67) which were given FBRA at a dose of 10% during the post-initiation phase were significantly less than those of group 1. Furthermore, the same group expressed a significantly decreased Ki67-labeling index in the non-lesional gastric epithelium when compared to that of group 1. These results indicate that FBRA inhibits MNNG-induced development of gastric tumors by administration during the post-initiation phase in rats. FBRA is regarded as a promising dietary agent for the prevention of human gastric cancer.

Linking classical test theory and two-level hierarchical linear models.

This paper considers the link between classical test theory (CTT) and two-level hierarchical linear models (HLM). Conceptualizing that items are nested within subjects, we can reformulate the ANOVA classical test model as an HLM. In this HLM framework, item difficulty parameters are represented by the fixed effects, and subject's abilities are represented by the random effects. The population reliability of either the total or the mean score can be represented by a function of the random effects parameters and the number of items. For estimation, taking advantage of the balanced design nature of CTT, we can obtain explicit formulas for parameter estimates of both fixed and random effects in HLM. It reveals that the formula and the estimate derived from HLM exactly match those of CTT reliability, which are equivalent to Cronbach's coefficient alpha under the assumptions of essentially tau equivalent measures. Not only that, we can obtain most of the important quantities in CTT such as estimates of item difficulty, standard error of measurement, true score, and person ability in a single HLM model. Thus, the CTT model formulated by HLM framework provides a systematic approach on measurement analysis by CTT. For illustrative purpose, a small data set was analyzed using HLM software (Raudenbush, Bryk, Cheong, & Congdon, 2000). The results confirmed the theoretical link between CTT and HLM.

Long-Term Effects of CBT on Social Impairment in Adolescents with ASD.

Anxiety interventions involving social skills training and CBT for youth with ASD have shown promise, but few studies have examined the effects on social functioning or the maintenance of treatment gains. This study evaluated change in social skills during a randomized controlled trial of CBT and during the 1-year follow-up for 25 adolescents with ASD and anxiety. We examined the effect of pretreatment social anxiety and loneliness on treatment response. Social impairment improved during treatment and continued to improve through the 3-month follow-up. Although adolescents with higher social anxiety had greater pretreatment social impairment, they showed steeper improvement in social skills during treatment. Loneliness was not a significant predictor of change during treatment. CBT targeting social skills and anxiety can lead to long-term improvements in social functioning.

Curriculum, Practice, and Diet Predict Health Among Experienced Taiji and Qigong Practitioners.

OBJECTIVE: To explore the potential influence of curriculum, frequency of practice, and dietary quality on the health of experienced Taiji and qigong practitioners. DESIGN: Theoretical and cross-sectional study. METHODS: Responses from a volunteer sample of Taiji practitioners from across the United States were collected using an online survey. The instrument was designed to collect data on health-related quality of life, diet, and Taiji practice regimens. All experienced (≥4 years) practitioners (n = 94; mean age, 55.82 years [range, 24-83 years]) were included in the analysis. Relationships among self-reported health, diet, experience, practice frequency, and curricular complexity were analyzed. RESULTS: Practitioners' health status did not show the typical negative association with age and was positively associated with complex curricula, practice, and high-quality diets. Significant interaction effects were seen between (1) curricular complexity and additional practice (p < 0.05) and (2) curricular complexity and diet (p < 0.05). CONCLUSIONS: Intervention designers, Taiji teachers, and practitioners should consider the potential influence of curricula, out-of-class practice, and healthy diets for optimizing health-related gains and minimizing age-related losses in interventions and community-based programs.

Students with autism spectrum disorder in college: Results from a preliminary mixed methods needs analysis.

BACKGROUND: There is a growing call for empirically based programming to support the success of students with autism spectrum disorder (ASD) as they transition to college. AIMS: The purpose of this study was to identify the needs and challenges faced by adolescents and young adults with ASD in postsecondary education. METHODS: A mixed methods approach was taken to explore the needs of college-bound and college-enrolled students with ASD. Primary stakeholders (i.e., parents, educators/support staff from secondary and postsecondary institutions, and students) participated in an online survey (n=67) and focus groups (n=15). RESULTS: Across the stakeholder groups, commonly identified areas of difficulty included limited interpersonal competence, managing competing demands in postsecondary education, and poor emotional regulation. There was a high degree of agreement across stakeholders in the identified needs and challenges. IMPLICATIONS: Findings from this preliminary needs analysis will inform the development of programming to support students with ASD.

Some links between classical and modern test theory via the two-level hierarchical generalized linear model.

This article considers some links between classical test theory (CTT) and modern test theory (MTT) such as item response theory (IRT) and the Rasch model in the context of the two-level hierarchical generalized linear model (HGLM). Conceptualizing items as nested within subjects, both the CTT model and the MTT model can be reformulated as an HGLM where item difficulty parameters are represented by fixed effects and subjects' abilities are represented by random effects. In this HGLM framework, the CTT and MTT models differ only in the level 1 sampling model and the associated link function. This article also contrasts the Rasch and two-parameter IRT models by considering the property of specific objectivity in the context of CTT. It is found that the essentially tau-equivalent model exhibits specific objectivity if the data fit the model, but the congeneric measures model does not. Data from English composition scores on essay writing used by Jöreskog (1971) are reanalyzed for illustration.