1. Burrows CA, Usher LV, Becker-Haimes EM, McMahon CM, Mundy PC, Jensen-Doss A, Henderson HA. {{Profiles and Correlates of Parent-Child Agreement on Social Anxiety Symptoms in Youth with Autism Spectrum Disorder}}. {J Autism Dev Disord}. 2018.
This study characterized patterns and correlates of parent-youth agreement on social anxiety in youth with and without autism spectrum disorder (ASD). Participants (279 verbally-fluent youth aged 8-16 years, NASD = 144, NTD = 135) completed the SASC-R. Youth with ASD exhibited higher social anxiety across informants. While TD youth endorsed higher anxiety than did parents, self- and parent-reports did not differ in youth with ASD. For children with ASD, higher parent-youth agreement was associated with lower lifetime ASD symptoms and higher adaptive skills. For TD youth, agreement on high anxiety was associated with lowest adaptive skills. Demographic factors (age, verbal IQ, gender) did not relate to agreement for either group. In ASD, parent-child agreement on youth anxiety, either high or low, was associated with better outcomes.
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2. Cortes HD, Wevrick R. {{Genetic analysis of very obese children with autism spectrum disorder}}. {Molecular genetics and genomics : MGG}. 2018.
Autism spectrum disorder (ASD) is defined by the triad of deficits in social interactions, deficits in communication, and repetitive behaviors. Common co-morbidities in syndromic forms of ASD include intellectual disability, seizures, and obesity. We asked whether very obese children with ASD had different behavioral, physical and genetic characteristics compared to children with ASD who were not obese. We found that very obese children with ASD had significantly poorer scores on standardized behavioral tests. Very obese boys with ASD had lower full scale IQ and increased impairments with respect to stereotypies, communication and social skills. Very obese girls with ASD had increased impairments with respect to irritability and oppositional defiant behavior. We identified genetic lesions in a subset of the children with ASD and obesity and attempted to identify enriched biological pathways. Our study demonstrates the value of identifying co-morbidities in children with ASD as we move forward towards understanding the biological processes that contribute to this complex disorder and prepare to design customized treatments that target the diverse genetic lesions present in individuals with ASD.
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3. Guisso DR, Saadeh FS, Saab D, El Deek J, Chamseddine S, El Hassan HA, Majari G, Boustany RM. {{Association of Autism with Maternal Infections, Perinatal and Other Risk Factors: A Case-Control Study}}. {J Autism Dev Disord}. 2018.
This case-control study explores the association between pregnancy/birth complications and other factors with Autism Spectrum Disorder (ASD) in Lebanese subjects aged 2-18 years. Researchers interviewed 136 ASD cases from the American University of Beirut Medical Center Special Kids Clinic, and 178 controls selected by systematic digit dialing in the Greater-Beirut area. Male gender (Adjusted Odds Ratio [95% CI]: 3.9 [2.2-7.0]); postpartum feeding difficulties (2.5 [1.2-5.4]); maternal infections/complications during pregnancy (2.9 [1.5-5.5], 2.1 [1.1-3.9]); consanguinity (2.5 [1.0-6.0]); family history of psychiatric disorders (2.2 [1.1-4.4]) were risk factors for ASD. Being born first/second (0.52 [0.28-0.95]) and maternal psychological support during pregnancy (0.49 [0.27-0.89]) were negatively associated with ASD. Identifying ASD correlates is crucial for instigating timely screening and subsequent early intervention.
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4. Hall DA, Berry-Kravis E. {{Fragile X syndrome and fragile X-associated tremor ataxia syndrome}}. {Handbook of clinical neurology}. 2018; 147: 377-91.
Fragile X-associated disorders encompass several conditions, which are caused by expansion mutations in the fragile X mental retardation 1 (FMR1) gene. Fragile X syndrome is the most common inherited etiology of intellectual disability and results from a full mutation or >200 CGG repeats in FMR1. It is associated with developmental delay, autism spectrum disorder, and seizures. Fragile X-associated tremor/ataxia syndrome is a progressive neurodegenerative disease that occurs in premutation carriers of 55-200 CGG repeats in FMR1 and is characterized by kinetic tremor, gait ataxia, parkinsonism, executive dysfunction, and neuropathy. Fragile X-associated primary ovarian insufficiency also occurs in premutation carrier women and manifests with infertility and early menopause. The diseases constituting fragile X-associated disorders differ mechanistically, due to the distinct molecular properties of premutation versus full mutations. Fragile X syndrome occurs when there is a lack of fragile X mental retardation protein (FMRP) due to FMR1 methylation and silencing. In fragile X-associated tremor ataxia syndrome, a toxic gain of function is postulated with the production of excess CGG repeat-containing FMR1 mRNA, abnormal translation of the repeat sequence leading to production of polyglycine, polyalanine, and other polypeptides and to outright deficits in translation leading to reduced FMRP at larger premutation sizes. The changes in underlying brain chemistry due to FMR1 mutations have led to therapeutic studies in these disorders, with some progress being made in fragile X syndrome. This paper also summarizes indications for testing, genetic counseling issues, and what the future holds for these disorders.
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5. Halstead E, Ekas N, Hastings RP, Griffith GM. {{Associations Between Resilience and the Well-Being of Mothers of Children with Autism Spectrum Disorder and Other Developmental Disabilities}}. {J Autism Dev Disord}. 2018.
There is variability in the extent to which mothers are affected by the behavior problems of their children with developmental disabilities (DD). We explore whether maternal resilience functions as a protective or compensatory factor. In Studies 1 and 2, using moderated multiple regression models, we found evidence that maternal resilience functioned as a compensatory factor-having a significant independent main effect relationship with well-being outcomes in mothers of children with DD and autism spectrum disorder. However, there was no longitudinal association between resilience and maternal well-being outcomes. There was little evidence of the role of resilience as a protective factor between child behavior problems and maternal well-being in both studies.
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6. Hedgecock JB, Dannemiller LA, Shui A, Rapport MJ, Katz T. {{Associations of Gross Motor Delay, Behavior, and Quality of Life in Young Children With Autism}}. {Physical therapy}. 2018.
Background: Young children with autism spectrum disorder (ASD) often have gross motor delays (GMD) that may accentuate problem daytime behavior (PDB) and health-related quality of life (QoL). Objective: The objective of this study was to describe the degree of GMD in young children with ASD and associations of GMD with PDB and QoL. The primary hypothesis was that GMD significantly modifies the associations between internalizing or externalizing PDB and QoL. Design: This study used a cross-sectional, retrospective analysis. Methods: Data from 3253 children who were 2 to 6 years old and who had ASD were obtained from the Autism Speaks Autism Treatment Network and analyzed using unadjusted and adjusted linear regression. Measures included the Vineland Adaptive Behavior Scales, 2nd edition, gross motor v-scale score (VABS-GM) (for GMD), the Child Behavior Checklist (CBCL) (for PDB), and the Pediatric Quality of Life Inventory (PedsQL) (for QoL). Results: The mean VABS-GM was 12.12 (SD = 2.2), representing performance at or below the 16th percentile. After adjustment for covariates, the internalizing CBCL t score decreased with increasing VABS-GM (beta = -0.64 SE = 0.12). Total and subscale PedsQL scores increased with increasing VABS-GM (for total score: beta = 1.79 SE = 0.17; for subscale score: beta = 0.9-2.66 SE = 0.17-0.25). CBCL internalizing and externalizing t scores decreased with increasing PedsQL total score (beta = -0.39 SE = 0.01; beta = -0.36 SE = 0.01). The associations between CBCL internalizing or externalizing t scores and PedsQL were significantly modified by VABSGM (beta = -0.026 SE = 0.005]; beta = -0.019 SE = 0.007). Limitations: The study lacked ethnic and socioeconomic diversity. Measures were collected via parent report without accompanying clinical assessment. Conclusions: GMD was independently associated with PDB and QoL in children with ASD. GMD modified the association between PDB and QoL. Children with ASD and co-occurring internalizing PDB had greater GMD than children without internalizing PDB; therefore, these children may be most appropriate for early physical therapist evaluation.
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7. Hiraide T, Nakashima M, Yamoto K, Fukuda T, Kato M, Ikeda H, Sugie Y, Aoto K, Kaname T, Nakabayashi K, Ogata T, Matsumoto N, Saitsu H. {{De novo variants in SETD1B are associated with intellectual disability, epilepsy and autism}}. {Human genetics}. 2018.
SETD1B (SET domain containing 1B) is a component of SET1 histone methyltransferase complex, which mediates the methylation of histone H3 on lysine 4 (H3K4). Here, we describe two unrelated individuals with de novo variants in SETD1B identified by trio-based whole exome sequencing: c.5524C>T, p.(Arg1842Trp) and c.5575C>T, p.(Arg1859Cy). The two missense variants occurred at evolutionarily conserved amino acids and are located within the SET domain, which plays a pivotal role in catalyzing histone methylation. Previous studies have suggested that de novo microdeletions in the 12q24.3 region encompassing SETD1B were associated with developmental delays, intellectual disabilities, autism/autistic behavior, large stature and craniofacial anomalies. Comparative mapping of 12q24.3 deletions refined the candidate locus, indicating KDM2B and SETD1B to be the most plausible candidate genes for the pathogenicity of 12q24.3 deletion syndrome. Our cases showed epilepsy, developmental delay, intellectual disabilities, autistic behavior and craniofacial dysmorphic features, which are consistent with those of individuals with de novo 12q24.31 deletions. Therefore, our study suggests that SETD1B aberration is likely to be the core defect in 12q24.3 deletion syndrome.
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8. Little JA. {{Vision in children with autism spectrum disorder: a critical review}}. {Clinical & experimental optometry}. 2018.
Autism spectrum disorder (ASD) is a common neurodevelopmental condition with approximately 1-2 per cent prevalence in the population. The condition has lifelong effects for the individual and family, and early intervention and management helps maximise quality of life and outcomes. Many studies of vision in ASD have attempted to link the behavioural and sensory deficits in ASD with underlying visual processing. From this work, it is clear that individuals with ASD ‘see’ and process the world differently, but there remain gaps in our understanding. This review will summarise our current knowledge of key aspects of visual functions and the optometric profile of ASD. This includes findings regarding visual acuity and contrast sensitivity, refractive error, eye movements, binocular vision, near visual functions and retinal structure in ASD. From this, a pattern of knowledge emerges for children with ASD: we should expect normal visual acuity; there will likely be atypical eye movements and susceptibility for subtle visuo-motor deficits, there is an increased prevalence of strabismus; an increased likelihood of astigmatism and possibly other refractive errors; attention, crowding and task complexity will likely be problematic; and retinal structure and function may be compromised. Bringing this together, these findings highlight that further work is necessary, not only to understand how higher-level functions link to behaviours, but also to ensure there is a sound understanding of the building-blocks of vision to fully grasp the profile of visual processing as a whole in ASD. This review will give a translational viewpoint for clinicians, and underline the benefits of comprehensive vision care in ASD.
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9. Nag HE, Nordgren A, Anderlid BM, Naerland T. {{Reversed gender ratio of autism spectrum disorder in Smith-Magenis syndrome}}. {Mol Autism}. 2018; 9: 1.
Background: A substantial amount of research shows a higher rate of autistic type of problems in males compared to females. The 4:1 male to female ratio is one of the most consistent findings in autism spectrum disorder (ASD).Lately, the interest in studying ASD in genetic disorders has increased, and research has shown a higher prevalence of ASD in some genetic disorders than in the general population.Smith-Magenis syndrome (SMS) is a rare and complex genetic syndrome caused by an interstitial deletion of chromosome 17p11.2 or a mutation on the retinoic acid induced 1 gene. The disorder is characterised by intellectual disability, multiple congenital anomalies, obesity, neurobehavioural abnormalities and a disrupted circadian sleep-wake pattern. Methods: Parents of 28 persons with SMS between 5 and 50 years old participated in this study. A total of 12 of the persons with SMS were above the age of 18 at the time of the study. A total of 11 came from Sweden and 17 were from Norway.We collected information regarding the number of autism spectrum symptoms using the Social Communication Questionnaire (SCQ) and the Social Responsiveness Scale (SRS). Adaptive behaviour was also measured using the Vineland Adaptive Behavior Scale II. The level of intellectual disability was derived from a review of the medical chart. Results: We found significant gender differences in ASD symptomatology using the SCQ and SRS questionnaires. We found approximately three females per male above the SCQ cutoff. The same differences were not found in the intellectual level and adaptive behaviour or for behavioural and emotional problems.Gender had an independent contribution in a regression model predicting the total SCQ score, and neither the Vineland Adaptive Behavior Scale II nor the Developmental Behaviour Checklist had an independent contribution to the SCQ scores. Conclusion: We found a clear reversed gender difference in ASD symptomatology in persons with SMS. This may be relevant in the search for female protective factors assumed to explain the male bias in ASD.
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10. Nazar BP, Peynenburg V, Rhind C, Hibbs R, Schmidt U, Gowers S, Macdonald P, Goddard E, Todd G, Micali N, Treasure J. {{An examination of the clinical outcomes of adolescents and young adults with broad autism spectrum traits and autism spectrum disorder and anorexia nervosa: A multi centre study}}. {The International journal of eating disorders}. 2018.
OBJECTIVES: To compare the clinical outcomes of adolescents and young adults with anorexia nervosa (AN) comorbid with broad autism spectrum disorder (ASD) or ASD traits. METHOD: The developmental and well-being assessment and social aptitude scale were used to categorize adolescents and young adults with AN (N = 149) into those with ASD traits (N = 23), and those who also fulfilled diagnostic criteria for a possible/probable ASD (N = 6). We compared both eating disorders specific measures and broader outcome measures at intake and 12 months follow-up. RESULTS: Those with ASD traits had significantly more inpatient/day-patient service use (p = .015), as well as medication use (p < .001) at baseline. Both groups had high social difficulties and poorer global functioning (strengths and difficulties questionnaire) at baseline, which improved over time but remained higher at 12 months in the ASD traits group (p = .002). However, the improvement in eating disorder symptoms at 12 months was similar between groups with or without ASD traits. Treatment completion rates between AN only and ASD traits were similar (80.1 vs. 86.5%). DISCUSSION: Adolescents with AN and ASD traits show similar reductions in their eating disorder symptoms. Nevertheless, their social difficulties remain high suggesting that these are life-long difficulties rather than starvation effects. Lien vers le texte intégral (Open Access ou abonnement)
11. Nguyen AKD, Murphy LE, Kocak M, Tylavsky FA, Pagani LS. {{Prospective Associations Between Infant Sleep at 12 Months and Autism Spectrum Disorder Screening Scores at 24 Months in a Community-Based Birth Cohort}}. {J Clin Psychiatry}. 2018; 79(1).
BACKGROUND: Sleep problems have been associated with autism spectrum disorder (ASD) symptoms and diagnosis. However, past research has studied the simultaneous association of sleep problems with precursor ASD symptoms. Using data from a birth cohort, we estimate prospective associations between infant sleep characteristics at 12 months and later ASD screening scores at 24 months. METHODS: We obtained data from children (N = 1,096) and their mothers as participants in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood longitudinal birth cohort study. Mothers were enrolled between 2006 and 2011, when they were 16-26 weeks pregnant. Using linear regression, we examined the influence of infant sleep characteristics (nighttime and daytime sleep, night wakings, and sleep onset latency) at 12 months on ASD screening scores at 24 months while controlling for other psychosocial characteristics. RESULTS: The number of night wakings was the only sleep characteristic at 12 months to be significantly associated with the development of early ASD symptoms at 24 months (B = 0.097, P = .021; 95% CI, 0.014 to 0.180). However, other competing risks, especially child socioemotional competence at 12 months (B = 0.573, P < .001; 95% CI, 0.361 to 0.785), showed stronger relative contributions in predicting ASD risk. CONCLUSIONS: Infants with more sleep problems by 12 months, especially those waking more often during the night, showed an increased number of early ASD symptoms a year later. This study suggests that infant sleep characteristics could constitute one clinical sign of ASD risk, together with key psychosocial characteristics. Lien vers le texte intégral (Open Access ou abonnement)
12. Ogata H, Ihara H, Gito M, Sayama M, Murakami N, Ayabe T, Oto Y, Nagai T, Shimoda K. {{Aberrant, autistic, and food-related behaviors in adults with Prader-Willi syndrome. The comparison between young adults and adults}}. {Res Dev Disabil}. 2018; 73: 126-34.
This study aims to explore the differences of age as well as genotype in regards to the severity of behavioral symptoms in Prader-Willi syndrome (PWS), with emphasis on the comparison between youngadults and adults.The Food Related Problem Questionnaire (FRPQ), the Aberrant Behavior Checklist Japanese Version (ABC-J), and the Pervasive Developmental Disorders Autism Society Japan Rating Scale (PARS) were administered to 46 PWS patients, including 33 young adults (ages 18-28) and 13 adults(ages 30-45). To examine the differences between young adults and adults, Mann-Whitney U tests were conducted. Statistically significant differences were found in ABC-J (p=.027) and PARS (p=.046), with higher scores in young adults than adults. Such differences between the two age groups were still true for the subgroups having a paternal chromosome 15q deletion (DEL) for ABC-J (p=.050) and part of PARS (« Problematic behavior »; p=.007). By contrast, there was no significant differences between young adults and adults regarding FRPQ (p=.65).These results suggest that aberrant behaviors decline from around the ages of thirty, in PWS patients in general and in DEL subgroups in particular, while food-related behaviors give no indication of diminishing in spite of developmental growth.
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13. Ramaswami G, Geschwind DH. {{Genetics of autism spectrum disorder}}. {Handbook of clinical neurology}. 2018; 147: 321-9.
Autism spectrum disorder (ASD) is a prevalent neurodevelopmental disorder characterized by impaired social interaction and stereotyped behaviors. ASD has a strong and complex genetic component, with multiple familial inheritance patterns and an estimate of up to 1000 genes potentially implicated. Over the past decade, genomic technologies have enabled rapid progress in the identification of risk genes for ASD. In this chapter, we review the delineation of ASD disease genes starting from traditional genetic studies such as linkage and association, and then focusing on more recent studies utilizing genomic technologies, such as high-throughput genotyping and exome sequencing.
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14. Ray P, Singh A, Dash JK, Sahoo PK, Dash JK. {{Fragile X Syndrome: A Rare Case Report with Unusual Oral Features}}. {Contemporary clinical dentistry}. 2017; 8(4): 650-2.
Fragile X syndrome (FXS) is a rare variant of special health-care need demonstrating delayed developmental milestones and associated with intellectual and emotional disabilities ranging from learning problem to mental retardation. The syndrome is usually not diagnosed until 8-9 years of age since the clinical manifestations of the syndrome are greatly attenuated in childhood. The physical characteristics such as facial features, hyperactivity, attention deficit, autistic behavior, and macroorchidism are quite evident in younger age group. The most typical orofacial characteristics associated with children suffering from FXS are mandibular prominence, ogival, and cleft palate. Till date, very few dental literatures have been reported regarding the association of FXS with orodental anomalies. Here, we report a rare case of 14-year-old boy suffering from FXS with typical orofacial characteristics, multiple supernumerary teeth, and dental caries.
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15. Riquelme I, Hatem SM, Montoya P. {{Reduction of Pain Sensitivity after Somatosensory Therapy in Children with Autism Spectrum Disorders}}. {Journal of abnormal child psychology}. 2018.
Children with autism spectrum disorders (ASD) often present with somatosensory dysfunction including an abnormal reactivity to tactile stimuli and altered pain perception. A therapy based on somatosensory stimuli has shown effectiveness in reducing pain sensitivity among adults with cerebral palsy. The present study aims at exploring the influence of somatosensory therapy on somatosensory parameters in children with ASD. Children with high-functioning ASD were randomly assigned to either the intervention (n = 29) or the control group (n = 30). The intervention group received a somatosensory therapy consisting of four types of exercises (touch, proprioception, vibration, stereognosis). Somatosensory function (pressure pain thresholds, tactile thresholds, stereognosis, proprioception) was assessed before and immediately after the therapy. Children in the intervention group showed a significant reduction of pain sensitivity and increase of tactile sensitivity after treatment, whereas children in the control group displayed increased pain sensitivity in the absence of changes of tactile sensitivity. No changes were observed for proprioception or stereognosis. The repetitive somatosensory stimulation therapy led to a decrease of pain sensitivity and an increase of tactile sensitivity. These findings may have important research and clinical implications, as promoting early tactile interventions in children with ASD may lead to a more adequate development of somatosensory processing and less somatosensory abnormalities upon adult life.
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16. Saeedan AS, Singh I, Ansari MN, Singh M, Rawat JK, Devi U, Gautam S, Yadav RK, Kaithwas G. {{Effect of early natal supplementation of paracetamol on attenuation of exotoxin/endotoxin induced pyrexia and precipitation of autistic like features in albino rats}}. {Inflammopharmacology}. 2018.
The present study was aimed to test the hypothesis that paracetamol (PCM) can precipitate autistic like features when used to counteract vaccine-induced fever using experimental rat pups. The pups were treated with measles mumps rubella (MMR) vaccine, diphtheria tetanus and pertussis (DPT) vaccines and lipopolysaccharide (LPS) with subsequent PCM treatment. The pups were evaluated for postnatal growth (weight gain, eye opening) and behavior alterations (swimming performance, olfactory discrimination, negative geotaxis, nociception, and locomotor activity) by performing battery of neurobehavioral test. Significant correlation was observed between social behavioral domains (nociception, anxiety and motor coordination) and pro-inflammatory load in the pups when treated with MMR/LPS along with PCM. A significant change in pro and anti-inflammatory (IL-4, IL-6, IL-10) markers were observed in rats treated with PCM, MMR, LPS, DPS alone or in combination with MMR, LPS and DPT (5128.6 +/- 0.000, 15,488 +/- 0.000(***), 9661.1 +/- 157.29(***a), 15,312 +/- 249.29 (***) , 10,471 +/- 0.00(***a), 16,789 +/- 273.34 (***) and 12,882 +/- 0.00(***a)). Pups were also scrutinized for the markers of oxidative stress, inflammation and histopathologically. All the treatment groups showed significant alteration in the behavioral changes, oxidative markers (TBARS-in control-4.33 +/- 0.02, PCM-9.42 +/- 0.18(***), MMR-5.27 +/- 0.15(***), MMR + PCM-8.57 +/- 0.18(*** a), LPS-6.84 +/- 0.10(***), LPS + PCM-4.51 +/- 0.30(***a), DPT-5.68 +/- 0.12(***), DPT + PCM-7.26 +/- 0.18(***a)) and inflammatory markers without following any specific treatment. These observation could be accorded to variable phenotypes of autistic spectrum disorders (ASDs).
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17. Thompson GA. {{Long-Term Perspectives of Family Quality of Life Following Music Therapy With Young Children on the Autism Spectrum: A Phenomenological Study}}. {Journal of music therapy}. 2018; 54(4): 432-59.
Background: Parents of children on the autism spectrum have consistently reported feeling uncertain in their parenting role, and desire more practical advice from service providers about how to support their child in the home. There is growing recognition of the need for interventions to provide support to the family as well as fostering child development outcomes. Objective: This study explores mothers’ follow-up perspectives of family-centered music therapy (FCMT) four years after participating in a 16-week home-based program, and therefore provides a unique long-term viewpoint on FCMT outcomes. Methods: Eight mothers who previously participated in FCMT sessions with their young children on the autism spectrum were interviewed to explore their perception of any long-term outcomes. Results: A descriptive phenomenological analysis revealed five global themes, including: improvement in mothers’ confidence to engage their child; rare opportunities for mutual mother-child enjoyment; improved child social communication and quality of life; mothers’ new understanding of the child’s interests and strengths; and more opportunities for continuing the child’s interest in music. Conclusions: Mothers perceived long-term benefits to social relationships within the family, leading to perceived enrichment in child and family quality of life following music therapy sessions.
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18. Zou M, Sun C, Wang J, Kang J, Xu Z, Ma Y, Chen L, Zhang X, Xia W, Wu L. {{Factors influencing the severity of behavioral phenotype in autism spectrum disorders: Implications for research}}. {Psychiatry Res}. 2018; 261: 290-7.
The phenotypic heterogeneity of Autism Spectrum Disorders (ASD) presents particular research challenges in the assessment of symptom severity, while the standardized Autism Diagnostic Observation Schedule (ADOS) scores present a severity metric, namely calibrated severity scores (CSS) that are relatively impervious to individual characteristics. To date, no studies have examined the convergent validity of CSS in Chinese sample populations. The present study investigated the validity of the ADOS-CSS using a sample of 321 children aged 2-18 years with ASD, and developed upon existing literature examining the influence of non-ASD-specific characteristics on other types of measures including Autism Diagnostic Interview-Revised (ADI-R), Social Responsiveness Scale (SRS), and Vineland Adaptive Behavior Scales (VABS). As expected, the findings revealed that the CSS were less influenced than ADOS-RAW scores by the demographic and developmental-level variables. Moreover, compared to the ADOS-CSS, the ADI-R, SRS and VABS were still strongly correlated with confounding factors, such as chronological age, intelligence quotients, and language-level. The results of this study corroborate the utilization of CSS as a more valid indicator of ASD severity than raw scores from ADOS and other instruments.
