Autism最新文献

Lay summary: Specialists conduct autism evaluations using tools that are expensive and difficult to get trained on. Families often wait a long time and travel far to get a diagnosis for their child. To help with this problem, primary care practitioners can be trained to provide evaluations in local communities. However, usable and accurate tools developed for non-specialists are needed. The Screening Tool for Autism in Toddlers and Young Children (STAT) was created for this purpose, but limited research has been done on accuracy of the tool in community primary care. This study tested the STAT when used by primary care practitioners as part of a diagnostic evaluation in 130, 14- to 48-month-old children. We tested (1) STAT agreement with the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), and diagnosis based on an expert research evaluation, and (2) the relationship between STAT classification, primary care practitioner diagnosis, and expert diagnosis. STAT classification matched the ADOS-2 in 77% of cases and expert diagnosis in 78% of cases. Autistic children incorrectly classified by the STAT were older, had higher developmental and adaptive skills, and fewer autism symptoms. In 86% of cases, the STAT classification agreed with primary care practitioner diagnosis. STAT classification, primary care practitioner diagnosis, and expert diagnosis agreed in 73% of cases. Overall, the STAT shows good accuracy when used by primary care practitioners as part of a community primary care autism evaluation.

Lay abstract: In research, language ability has historically been measured using structured tasks in laboratory settings. In recent years, there has been a growing emphasis on the need to instead capture language ability in an individual's natural setting (i.e. through social interaction or in their home). Considering natural language may be particularly important for the autistic population, as an autistic child's language ability can be very different depending on the setting. One common tool for capturing natural language is the LENA recording system, which takes audio recordings over long periods of time and provides estimates of children's and caregivers' speech. The purpose of this systematic review is to summarize the use of LENA in autism research, to highlight the strengths and limitations of the system as identified by researchers, and to provide recommendations for future research and clinical use. We identified 42 autism studies that used LENA in a variety of ways and settings. Most studies used LENA within the guidelines put forth by its creators, and it was most commonly used to understand speech or speech development for autistic children. LENA is a useful tool for clinicians and caregivers to gain some insights into child speech, but those considering using it should be aware of concerns about its accuracy and limitations about the information it provides. In this review, we supplement the official LENA guidelines with specific suggestions for use with the autistic population.

Lay abstract: Autistic people describe having to mask or 'camouflage' their autistic selves to fit into certain social settings. Many researchers have used the CAT-Q to measure the extent to which autistic people engage in camouflaging. However, some researchers have questioned whether the CAT-Q measures camouflaging or whether it measures other related experiences and behaviours associated with social anxiety, fear of being negatively judged or social autistic traits. In our study, we analysed the CAT-Q to check whether it is indeed similar to or different from these related experiences. To do this, we asked 308 autistic adults to complete the CAT-Q and questionnaires about social anxiety, fear of being negatively judged and autistic social features. Then, we put all the CAT-Q items together with the items from each of the other measures in three separate analyses (called factor analyses) to see how the items would group together. These analyses showed us whether camouflaging behaviours are distinguishable and different from, or cluster together with, these other experiences. We found that most of CAT-Q items grouped together separately from the other measures' items, suggesting that camouflaging differs from these other related experiences. Only some items from one of the CAT-Q subscales clustered together with some social anxiety and autistic items, suggesting these may need to be teased out better in the future. Generally, our findings show that we can use the CAT-Q to measure camouflaging behaviours among autistic people.

Lay abstract: During a conversation, on average, autistic individuals are often more likely than non-autistic people to provide an off-topic comment and/or to pause for longer before providing a response. One possible explanation for this is that autistic individuals prefer, or are more tolerant of, unconventional communication styles. To explore this possibility, we investigated whether autistic and non-autistic 9-13-year-olds find off-topic or delayed responding a deterrent to friendship or interaction. Participants listened to scripted conversations and then rated social desirability statements, such as 'I would enjoy chatting to the [target speaker]'. We also examined the prevalence of these behaviours in children's own conversational responses. We found that autistic children were just as likely as non-autistic children to dis-prefer unconventional conversational responding. Both groups indicated that they were less likely to want to be friends with the speaker, or to chat with them, when they provided off-topic or delayed responses. However, despite their judgements of others, the same autistic children were more likely to provide off-topic responses themselves than their non-autistic peers, as well as giving fewer on-topic responses which facilitate back-and-forth conversation. Overall, this is problematic for autistic children, as our findings suggest that the tendency to exhibit unconventional conversational behaviours will have negative social consequences, even when interacting with other autistic peers.

Lay abstract: Attitudes towards autism vary across countries. Some of this variation could reflect differences in cultural values across countries, or differences in how much people know about autism. Until now, most research on this topic has asked people directly about their attitudes towards interacting with autistic people. As a result, we understand little about why some people unconsciously hold negative attitudes towards autism, and whether these unconscious attitudes vary across countries. We studied explicit attitudes (willingness to interact), implicit attitudes (unconscious beliefs), knowledge about autism, and cultural values in university students from Hong Kong, the United Kingdom and the United States. We found that people were less willing to interact with autistic people if they knew less about autism, aligned with a competitive and hierarchical society ('vertical individualism'), did not see themselves as part of a collective whose members are equal (less 'horizontal collectivism'), and if they unconcsciously associated autism with negative attributes. Students in Hong Kong were less willing to interact with autistic people and had less understanding of autism compared to those in the United Kingdom and the United States. Unconscious biases did not differ across countries. Our findings highlight the need to combat misconceptions about autism to improve attitudes towards autistic people, especially in Hong Kong. Unfortunately, our results suggest that acquiring more accurate knowledge may not be sufficient to alter unconscious biases. Further research is needed to determine the factors underlying unconscious biases.

Lay abstract: Autism spectrum disorder is a neurodevelopmental disorder characterized by a wide range of behavioral alterations, including impaired social interaction and repetitive behaviors. Numerous pharmacological interventions have been developed for autism spectrum disorder, often proving ineffective and accompanied by a multitude of side effects. The gut microbiota is the reservoir of bacteria inhabiting our gastrointestinal tract. The gut microbial alterations observed in individuals with autism spectrum disorder, including elevated levels of Bacteroidetes, Firmicutes, and Proteobacteria, as well as reduced levels of Bifidobacterium, provide a basis for further investigation into the role of the gut microbiota in autism spectrum disorder. Recent preclinical studies have shown favorable outcomes with probiotic therapy, including improvements in oxidative stress, anti-inflammatory effects, regulation of neurotransmitters, and restoration of microbial balance. The aim of this review is to explore the potential of probiotics for the management and treatment of autism spectrum disorder, by investigating insights from recent studies in animals.

Lay abstract: Self-determination encompasses various components, including decision-making and independence, making it a complex process. While the importance of self-determination for individuals with autism spectrum disorder has been explored in previous studies, there is limited research focusing on individuals with moderate to severe autism spectrum disorder. Evidence-based practices such as visual activity schedules and video modeling have shown effectiveness in promoting independence among individuals with autism spectrum disorder. To address the need for independence and choice-making among individuals with moderate to severe autism spectrum disorder, this study developed a visual support package incorporating visual activity schedules, video modeling, preference assessments, and prompt procedures. By investigating the intervention's effectiveness in three participants, this study contributes to the existing literature on the use of a visual activity schedule and video modeling in enhancing choice-making and independent leisure engagement. Following the intervention, all participants were able to select three leisure activities, develop their own visual schedules, and complete them. Notably, this study conducted preference assessments to determine participants' preferred leisure activities and did not provide additional reinforcement. Practical implications of this research include incorporating video prompting as needed and adjusting activity engagement time. Future research should explore the long-term effectiveness of the visual support package and its application in developing novel skills or vocational activities for individuals with moderate to severe autism spectrum disorder. This study fills a critical gap in the literature, providing important insights for practices and research in the field of autism spectrum disorder interventions.

Lay abstract: Later autism diagnosis is associated with risk for mental health problems. Understanding factors related to later autism diagnosis may help reduce mental health risks for autistic people. One characteristic associated with later autism diagnosis is female sex. However, studies often do not distinguish sex assigned at birth and gender identity. Gender diversity may be more common in autistic relative to neurotypical people, and autism is more common in gender-diverse populations. We studied age at autism diagnosis by sex assigned at birth, gender identity, and gender diversity (gender-diverse vs cisgender) status, separately. We studied three separate autistic samples, each of which differed in how they were diagnosed and how they were recruited. The samples included 193 persons (8.0-18.0 years) from a research-recruited academic medical center sample; 1,550 people (1.3-25.4 years) from a clinic-based sample; and 244 people (18.2-30.0 years) from a community-enriched sample. We found significant differences in the clinic-based and community-enriched samples. People assigned female sex at birth were diagnosed with autism significantly later than people assigned male at birth. People of female gender were diagnosed significantly later than people of male gender. Gender-diverse people were diagnosed significantly later than cisgender people. Sex assigned at birth, gender identity, and gender diversity may each show unique relationships with age of autism diagnosis. Differences in how autistic people are diagnosed and recruited are important to consider in studies that examine sex assigned at birth or gender identity. More research into autism diagnosis in adulthood is needed.

Lay abstract: Many autistic people struggle with mental health problems like anxiety, depression, inattention, and aggression, which can be challenging to treat. Executive function challenges, which impact many autistic individuals, may serve as a risk factor for mental health problems or make treating mental health conditions more difficult. While some people respond well to medication or therapy, others do not. This study tried to understand if there are different subgroups of autistic young people who may have similar patterns of executive function strengths and challenges-like flexibility, planning, self-monitoring, and emotion regulation. Then, we investigated whether executive function subgroups were related to mental health problems in autistic youth. We found three different types of executive function subgroups in autistic youth, each with different patterns of mental health problems. This helps us identify specific profiles of executive function strengths and challenges that may be helpful with identifying personalized supports, services, and treatment strategies for mental health conditions.