1. Babb S, McNaughton D, Light J, Caron J. « Two Friends Spending Time Together »: The Impact of Video Visual Scene Displays on Peer Social Interaction for Adolescents With Autism Spectrum Disorder. Language, speech, and hearing services in schools. 2021; 52(4): 1095-108.

Purpose Social interaction poses many challenges for adolescents with autism spectrum disorder (ASD) and complex communication needs. The purpose of this study was to investigate the impact of video visual scene displays (video VSDs) on communication during interactions between adolescents with ASD and peer partners. Method This study used an across-participant multiple-baseline single-case experimental design. Four adolescents with ASD and complex communication needs were taught to use video VSDs, presented on a tablet-based app, during social interactions with peer partners in a high school setting. The video VSDs used during the interactions were selected (and programmed with vocabulary) based on the interests of the adolescent with ASD and their peer partner. Results Following the introduction of the video VSD intervention, all four adolescents with ASD demonstrated an increase in communicative turns compared to baseline (Tau-U= 1.0, 95% CI [0.56, 1]), and all four increased in modes of communication used. Increased use of speech also was observed for the three participants who made use of speech prior to the intervention. All participants with ASD (and their peer partners) expressed an interest in continued use of the video VSD app to support social interaction. Conclusion The use of video VSDs may be a viable option to increase the participation and communication of adolescents with ASD during social interactions with peer partners. Supplemental Material https://doi.org/10.23641/asha.16734532.

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2. Dijkstra M, Rommes E. Dealing with disability: challenges in Dutch health care of parents with a non-Western migration background and a child with a developmental disability. Disability and rehabilitation. 2021: 1-12.

PURPOSE: Parents of children with developmental disabilities who have a non-western migration background often experience unique challenges in foreign health care systems. This study aimed to describe these experiences to better understand these challenges and thereby improve health care provision. METHOD: Twelve parents were interviewed using in-depth, semi-structured interviews. Our data was analysed, and themes were identified using open, selective, and axial coding. RESULTS: Multiple parents in our study had a different perception of what constitutes a « handicap », may regard it as something that is very severe and highly stigmatized and will be less aware of the complex system of care professionals that aim to support them in the care for their child. Additionally, communication with care professionals may be complicated because of language differences and expectations about the division of roles and responsibilities between parents and professionals. This may result in lower involvement in health care. CONCLUSION: As a result of cultural differences in the meaning, information and interaction about disabilities, non-western migrant parents will have a harder time coping with the diagnosis of their child’s disability and will experience more challenges with their involvement in health care.(1)Implications for RehabilitationTo be aware that non-western parents who are told their child has a disability are likely to experience more shame, fear of stigma and may have other definitions of disability than western parents.To pay specific attention to explain as much as possible about the causes, meaning and medical as well as societal future expectations for children with a disability to parents with another cultural background.To explore which knowledge parents have about their child’s disability and the Dutch health care system, so that information and support can be personalized.To make sure there are translators present who can not only translate in the correct language but who can also explain commonly used terms for disabilities and other medical concepts, diagnostic procedures, and other specificities of the health care system of the host country to migrant parents.To psycho-educate parents with a migrant background that they are expected to be actively involved in the professional care for their child with a disability without this having negative consequences for the care of their child.

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3. Gabbay-Dizdar N, Ilan M, Meiri G, Faroy M, Michaelovski A, Flusser H, Menashe I, Koller J, Zachor DA, Dinstein I. Early diagnosis of autism in the community is associated with marked improvement in social symptoms within 1-2 years. Autism : the international journal of research and practice. 2021: 13623613211049011.

It is widely believed that early diagnosis and treatment of autism spectrum disorder is essential for better outcome. This is demonstrated by the American Academy of Pediatrics recommendation to screen all 1.5-2.5-year-old toddlers for autism spectrum disorder. However, multiple longitudinal studies of children diagnosed with autism spectrum disorder at 1.5-6 years of age and treated in community settings have not reported any associations between earlier diagnosis and improved outcome in core autism spectrum disorder symptoms. In this study, we measured changes in core autism spectrum disorder symptoms over a 1-2-year period in 131 children diagnosed with autism spectrum disorder at 1.2-5 years of age, and treated in the community. The results revealed that children who were diagnosed before 2.5 years of age were three times more likely to exhibit considerable improvements in social autism spectrum disorder symptoms in comparison to children diagnosed at later ages. These results highlight the importance of early diagnosis and treatment of autism spectrum disorder even in community settings with heterogeneous services. In addition, these results motivate further prioritization of universal screening for autism spectrum disorder before 2.5 years of age.

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4. Golson ME, Haverkamp CR, McClain MB, Schwartz SE, Ha J, Harris B, Benallie KJ. Influences of student race/ethnicity and gender on autism special education classification considerations. Autism : the international journal of research and practice. 2021: 13623613211050440.

Autism prevalence has continued to rise in recent years. However, females and children from Black, Latinx, and Asian backgrounds are often misidentified or identified less often than White males. These identification disparities make it difficult for children to receive appropriate special education and school intervention services. In this study, school psychologists read a vignette featuring a student with possible autism symptoms. The vignette varied by student race/ethnicity and gender. Afterward, participants rated the likelihood that they would classify the student with autism and their confidence in this rating. Student race/ethnicity and gender influenced both classification likelihood and confidence. These results suggest that school psychologists are influenced by implicit bias and do not fully consider cultural factors in school autism evaluations. This may contribute to identification disparities.

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5. Halstead EJ, Sullivan EC, Dimitriou D. The Impact of COVID-19 on Sleep in Autistic Adults: Longitudinal Comparisons pre and During Lockdown. Frontiers in psychiatry. 2021; 12: 708339.

Background: The longer-term impact of the pandemic on autistic adults’ sleep are yet to be revealed, with studies concentrating on sleep in autistic children or mental health outcomes and coping strategies of autistic adults. Given the prevalence of sleep problems experienced by autistic adults and the changes in routine that have occurred as a result of COVID-19 societal restrictions, this study assessed the impact of the COVID-19 pandemic on sleep problems via a longitudinal subjective assessment method. Methods: Sleep data were gathered at three time points from 95 autistic adults, namely prior to the pandemic, at the start of COVID-19 and several months into COVID-19 to obtain a rich longitudinal dataset ascertaining how/if sleep patterns have changed in autistic adults over these several months. Results: In comparison to pre-lockdown, several sleep components were shown to improve during the lockdown. These improvements included reduced sleep latency (time taken to fall asleep), longer sleep duration, improved sleep efficiency, improved sleep quality, as well as improved daytime functioning. Pre-sleep cognitive arousal scores were found to decrease compared to pre-lockdown, meaning cognitive arousal improved. Approximately 65% of participants reported that they felt their sleep had been impacted since COVID-19 since Time 1, with the most common reasons reported as waking up exhausted (36.92%), not being able to get to sleep (33.85%), waking up in the night (29.23%), having a disrupted sleep pattern (27.69%), and nightmares (18.46%). Conclusions: Improvements in sleep may be related to societal changes (e.g., working from home) during the pandemic. Some of these changes are arguably beneficial for autistic adults in creating a more autism-inclusive society, for example telehealth opportunities for care. Further exploration of the associations between mental health and sleep are warranted.

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6. Healy S, Brewer B, Laxton P, Powers B, Daly J, McGuire J, Patterson F. Brief Report: Perceived Barriers to Physical Activity Among a National Sample of Autistic Adults. Journal of autism and developmental disorders. 2021.

Improving physical activity (PA) levels in autistic adults is an important population health goal. Limiting efforts to achieve this goal is an incomplete understanding of the barriers to PA in this high-risk group. This study utilized cross-sectional data collected via an electronic survey from 253 autistic adults aged 18-50 years to examine their perceived barriers to PA, how PA barriers differed by demographic factors, and the relationship between PA barriers and meeting PA guidelines. The Barriers to Physical Activity scale assessed the independent variable. Lack of motivation to exercise, perceiving exercise as boring, and lack of transportation were the most strongly endorsed barriers to PA. Participants who reported these barriers were significantly less likely (≤ 50%) to meet PA guidelines.

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7. Kaliukhovich DA, Manyakov NV, Bangerter A, Pandina G. Context Modulates Attention to Faces in Dynamic Social Scenes in Children and Adults with Autism Spectrum Disorder. Journal of autism and developmental disorders. 2021.

Individuals with autism spectrum disorder (ASD) have been found to view social scenes differently compared to typically developing (TD) peers, but results can vary depending on context and age. We used eye-tracking in children and adults (age 6-63) to assess allocation of visual attention in a dynamic social orientation paradigm previously used only in younger children. The ASD group (n = 94) looked less at the actor’s face compared to TD (n = 38) when they were engaged in activity (mean percentage of looking time, ASD = 30.7% vs TD = 34.9%; Cohen’s d = 0.56; p value < 0.03) or looking at a moving toy (24.5% vs 33.2%; d = 0.65; p value < 0.001). Findings indicate that there are qualitative differences in allocation of visual attention to social stimuli across ages in ASD.ClinicalTrials.gov identifier: NCT02668991.

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8. Khan YS, Khan AW, Tahir ME, Hammoudeh S, Shamlawi MA, Alabdulla M. The impact of COVID-19 pandemic social restrictions on individuals with autism spectrum disorder and their caregivers in the Stateof Qatar: A cross-sectional study. Research in developmental disabilities. 2021; 119: 104090.

INTRODUCTION: Previous research has established an association between changes to the daily routine of individuals with Autism Spectrum Disorder (ASD) and increase in maladaptive behaviours. The relationship between maladaptive behaviours in autistic individuals and increase in care burden among their caregivers is also well established. However, no study has yet examined these associations in the context of the COVID-19 pandemic. The main aim of this study was to explore the impact of COVID-19 restrictions on autistic individuals and their caregivers. METHODS: A questionnaire-based cross-sectional study conducted with the caregivers of 58 autistic individuals across the mental health services at Hamad Medical Corporation, Doha, Qatar. The extent of care burden was measured using the Care Burden Interview, whereas changes in behaviour in autistic individuals was assessed using the Revised Overt Aggression Scale. RESULTS: A total of 58 caregivers participated in the study. Out of these, 24 (41 %) reported a clinically significant increase in their care burden. Among caregivers reporting an increase in care burden, two-third were caring for individuals whose behaviour either remained unchanged or improved during social restrictions. Nine autistic people (15.5 %) were reported to have no aggression prior to the implementation of COVID-19 social restrictions compared to 13 (22.4%) individuals during COVID-19 social restrictions. Minimal, mild and moderate aggression were reported in 27 (46.6 %), 21 (36.2 %), and 1 (1.7 %) patients respectively, before COVID-19 social restrictions compared to 29 (50 %), 15 (25.9), and 1 (1.7 %) during COVID-19 restrictions. Severe aggression was not reported in any patient either before or during COVID-19 social restrictions. CONCLUSION: This study showed reduced levels of aggression in autistic individuals but an increase in care burden among their caregivers during the COVID-19 social restrictions highlighting the need of supporting patients and caregivers alike.

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9. Ku B, Stinson JD, MacDonald M, McIntyre LL. Parental Behavior Influences on Motor Skill Development in Young Children with Developmental Disabilities: A Two-Year Longitudinal Study. Child psychiatry and human development. 2021.

Young children with developmental disabilities (DDs) experience motor skill deficits compared to their peers without disabilities. Even though parents play an important role in developing their children’s motor skills, it has not been widely studied how parental behaviors influence motor skill development in young children with DDs. Therefore, the current study has two main purposes: (a) to examine early motor skill development of preschool aged children (3-5 years) with DDs longitudinally over a two-year period and (b) to longitudinally examine the relationship between parental behaviors and the motor skill development of young children with DDs. Fundamental motor skills (locomotor and object control skills) in 64 young children with DDs and their parent’s behavior was measured at five time points when children were between the ages of three and five years. Multilevel modeling was used to examine motor skill progression in young children with DDs and to evaluate the longitudinal relationship between parenting behaviors and motor skill development in young children with DDs. Findings indicated that young children with DDs develop their motor skills in a non-linear fashion across two years. Young children with DDs who have parents with one standard deviation higher (+ SD) in the positive parental behavior than average showed a statistically significant linear increase in the standard scores of locomotor and object-control skills with age (b = 0.27, p = 0.01; b = 0.22, p < 0.01, respectively). This study highlights the importance of positive parenting behaviors in regard to promoting motor skills in young children with DDs.

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10. Lorenzini L, van Wingen G, Cerliani L. Atypically high influence of subcortical activity on primary sensory regions in autism. NeuroImage Clinical. 2021; 32: 102839.

BACKGROUND: Hypersensitivity, stereotyped behaviors and attentional problems in autism spectrum disorder (ASD) are compatible with inefficient filtering of undesired or irrelevant sensory information at early stages of neural processing. This could stem from the persistent overconnectivity between primary sensory regions and deep brain nuclei in both children and adults with ASD – as reported by several previous studies – which could reflect a decreased or arrested maturation of brain connectivity. However, it has not yet been investigated whether this overconnectivity can be modelled as an excessive directional influence of subcortical brain activity on primary sensory cortical regions in ASD, with respect to age-matched typically developing (TD) individuals. METHODS: To this aim, we used dynamic causal modelling to estimate (1) the directional influence of subcortical activity on cortical processing and (2) the functional segregation of primary sensory cortical regions from subcortical activity in 166 participants with ASD and 193 TD participants from the Autism Brain Imaging Data Exchange (ABIDE). We then specifically tested the hypothesis that the age-related changes of these indicators of brain connectivity would differ between the two groups. RESULTS: We found that in TD participants age was significantly associated with decreased influence of subcortical activity on cortical processing, paralleled by an increased functional segregation of cortical sensory processing from subcortical activity. Instead these effects were highly reduced and mostly absent in ASD participants, suggesting a delayed or arrested development of the segregation between subcortical and cortical sensory processing in ASD. CONCLUSION: This atypical configuration of subcortico-cortical connectivity in ASD can result in an excessive amount of unprocessed sensory input relayed to the cortex, which is likely to impact cognitive functioning in everyday situations where it is beneficial to limit the influence of basic sensory information on cognitive processing, such as activities requiring focused attention or social interactions.

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11. Minichino A, Singh F, Pineda J, Friederich E, Cadenhead KS. Corrigendum to ‘Biological Motion induced mu suppression is reduced in Early Psychosis (EP) patients with active negative symptoms and Autism Spectrum Disorders (ASD)’ [Psychiatry Research 238 (2016) 374-377]. Psychiatry research. 2021; 306: 114177.

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12. Shoaib A, Cepeda MS, Murray G, Ochs-Ross R. Autism: Comorbidities and Treatment Patterns in the Real World, a Retrospective Cohort Study Among Children, Adolescents and Adults Newly Diagnosed with Autism. Journal of autism and developmental disorders. 2021.

We used real world data to summarize comorbidities and interventions among patients newly diagnosed with autism spectrum disorder (ASD). Data were derived from two claims-based US healthcare databases; Medicaid and Optum to construct a retrospective cohort of 36,000 patients. Attention-Deficit-Hyperactivity-Disorder (ADHD) was the most common co-morbidity (Medicaid: 50.09%; Optum: 44.16%), followed by mood disorder (Medicaid: 16.56% and Optum: 17.47%). Most patients received at least one type of treatment. Behavioral therapy was common (74.64% in Medicaid and 71.97% in Optum). More than half the cohorts received at least 1 pharmacotherapy. However, pharmacotherapies were diverse. Combination therapy and therapy switching was common. Understanding the clinical diversity and complexity of patients with ASD is an important first step in understanding unmet therapeutic needs.

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13. Straub L, Bateman BT, Hernandez-Diaz S, York C, Zhu Y, Suarez EA, Lester B, Gonzalez L, Hanson R, Hildebrandt C, Homsi J, Kang D, Lee KWK, Lee Z, Li L, Longacre M, Shah N, Tukan N, Wallace F, Williams C, Zerriny S, Mogun H, Huybrechts KF. Validity of claims-based algorithms to identify neurodevelopmental disorders in children. Pharmacoepidemiology and drug safety. 2021; 30(12): 1635-42.

PURPOSE: To validate healthcare claim-based algorithms for neurodevelopmental disorders (NDD) in children using medical records as the reference. METHODS: Using a clinical data warehouse of patients receiving outpatient or inpatient care at two hospitals in Boston, we identified children (≤14 years between 2010 and 2014) with at least one of the following NDDs according to claims-based algorithms: autism spectrum disorder/pervasive developmental disorder (ASD), attention deficit disorder/other hyperkinetic syndromes of childhood (ADHD), learning disability, speech/language disorder, developmental coordination disorder (DCD), intellectual disability, and behavioral disorder. Fifty cases per outcome were randomly sampled and their medical records were independently reviewed by two physicians to adjudicate the outcome presence. Positive predictive values (PPVs) and 95% confidence intervals (CIs) were calculated. RESULTS: PPVs were 94% (95% CI, 83%-99%) for ASD, 88% (76%-95%) for ADHD, 98% (89%-100%) for learning disability, 98% (89%-100%) for speech/language disorder, 82% (69%-91%) for intellectual disability, and 92% (81%-98%) for behavioral disorder. A total of 19 of the 50 algorithm-based cases of DCD were confirmed as severe coordination disorders with functional impairment, with a PPV of 38% (25%-53%). Among the 31 false-positive cases of DCD were 7 children with coordination deficits that did not persist throughout childhood, 7 with visual-motor integration deficits, 12 with coordination issues due to an underlying medical condition and 5 with ADHD and at least one other severe NDD. CONCLUSIONS: PPVs were generally high (range: 82%-98%), suggesting that claims-based algorithms can be used to study NDDs. For DCD, additional criteria are needed to improve the classification of true cases.

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