1. Bowden N, Gibb S, Audas R, Clendon S, Dacombe J, Kokaua J, Milne BJ, Mujoo H, Murray SW, Smiler K, Stace H, van der Meer L, Taylor BJ. Association Between High-Need Education-Based Funding and School Suspension Rates for Autistic Students in New Zealand. JAMA Pediatr;2022 (May 16)

IMPORTANCE: Autistic students often experience poor educational outcomes that have implications for later life, including unemployment, interactions with the criminal justice system, increased risk for substance abuse, and low socioeconomic status. Improving educational outcomes is critical for ensuring that autistic young people can reach their potential. OBJECTIVE: To quantify differences in suspension rates between autistic and nonautistic students and to assess whether high-need education-based funding for autistic students is associated with reduced rates of school suspension. DESIGN, SETTING, AND PARTICIPANTS: This national cohort study used linked health and education data from New Zealand’s Integrated Data Infrastructure. Data were obtained for students aged 5 to 16 years from January 1 to December 31, 2018, and analyzed July 7, 2021, to January 1, 2022. A novel case identification method was used to identify autistic students. EXPOSURES: High-need education-based funding (Ongoing Resourcing Scheme [ORS]) obtained before 2019. MAIN OUTCOMES AND MEASURES: Rates of suspension from school. Crude and adjusted analyses of the association between suspension rates and autism among the full population with adjustment made for sociodemographic characteristics (sex, age, ethnicity, deprivation, and urban or rural profile of residence) were conducted using complete-case, 2-level random intercept logistic multivariable regressions. To assess the association between ORS funding and suspension, analysis was restricted to autistic students. RESULTS: Of the 736 911 students in the study population, 9741 (1.3%) were identified as autistic (median [SD] age, 10 [3.2] years; 7710 [79.1%] boys), and 727 170 (98.7%) as nonautistic (median [SD] age, 10 [3.4] years; 369 777 [50.9%] boys). School suspension was experienced by 504 autistic students (5.2%) and 13 845 nonautistic students (1.9%). After adjustment for demographic characteristics, autistic students had significantly higher odds of suspension than their nonautistic peers (adjusted odds ratio, 2.81; 95% CI, 2.55-3.11). Of the 9741 autistic students, 2895 (29.7%) received high-need education-based (ORS) funding. Suspensions were experienced by 57 autistic students (2.0%) with high-need funding and 447 autistic students (6.5%) without high-need funding. After adjustment for demographic characteristics, co-occurring conditions, and level of disability support need, autistic students with high-need funding had significantly lower odds of suspension than autistic students without high-need funding (adjusted odds ratio, 0.29; 95% CI, 0.21-0.40). CONCLUSIONS AND RELEVANCE: In this cohort study, the findings of disparities in suspension rates between autistic and nonautistic students underscore the challenges faced in providing inclusive education for all young people, regardless of disability status. This study found that high-need funding was associated with reduced suspension rates among autistic students, suggesting that if appropriate supports are afforded to autistic students, a more inclusive education can be provided.

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2. Chen Y, Cheng T, Lv F. Sense of Parenting Efficacy, Perceived Family Interactions, and Parenting Stress Among Mothers of Children With Autistic Spectrum Disorders. Front Psychol;2022;13:878158.

This study examined the relationship between maternal sense of parenting efficacy and parental stress in children with autism and the moderating effect of family interaction. A total of 263 mothers of children with autism were investigated with the Parenting Ability Scale, Family Interaction Scale (FIS), and Parental Stress Scale. The results showed that (1) maternal sense of parenting efficacy significantly predicted parental stress in children with autism; and (2) family interaction significantly moderated the relationship between maternal sense of parenting efficacy and parental stress in children with autism, that is, when family interaction was lower than -1.54 standard deviation (SD), the sense of parenting efficacy did not significantly predict parental stress. When family interaction was higher than -1.54 SD, parenting efficacy had a significant negative predictive effect on parenting stress.

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3. Davidson D, Morales D. Associations Between Autism Symptomatology, Alexithymia, Trait Emotional Intelligence, and Adjustment to College. Front Psychol;2022;13:813450.

It has been asserted that the socio-emotional challenges associated with autism spectrum disorder (ASD) may be explained, in part, by the higher rates of alexithymia in individuals with autism. Alexithymia refers to difficulties in identifying one’s own emotional states and describing those states to others. Thus, one goal of the present study was to examine levels of alexithymia in relation to ASD symptomatology and trait emotion intelligence (EI). Trait EI is a multifaceted concept that captures emotional competencies and behavioral dispositions A second goal was to assess whether alexithymia, ASD symptomatology and trait EI served as significant predictors of adjustment to college, including academic, social, and personal-emotional adjustment. In addition to keeping with the spectrum nature of autism, our research strategy allowed us to capture those students who may not have received a formal diagnosis of ASD but report symptoms that can be indicative of ASD. This includes women, who are less likely to receive a diagnosis of ASD even when ASD symptomatology is present. The results of the study showed that students reporting higher levels of ASD symptomatology also reported significantly higher levels of alexithymia and lower trait emotional intelligence (trait EI) than those with less or no symptomatology. Alexithymia was also negatively related to trait EI, and both alexithymia and ASD symptomatology were found to be significant predictors of trait EI. However, only trait EI was a significant predictor of adjustment to college and only for social adjustment. These findings suggest that support programs that develop trait EI skills may improve the college experience for students with ASD, regardless of alexithymia or ASD symptomatology.

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4. Elsabbagh M, Yusuf A, Zeidan J, Scorah J, Fombonne E, Durkin MS, Saxena S, Shih A. The time has come for living systematic reviews in autism research. Autism Res;2022 (May 15)

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5. Halls D, Leppanen J, Kerr-Gaffney J, Simic M, Nicholls D, Mandy W, Williams S, Tchanturia K. Examining the relationship between autistic spectrum disorder characteristics and structural brain differences seen in anorexia nervosa. Eur Eat Disord Rev;2022 (May 15)

Cortical differences have been reported in Anorexia Nervosa (AN) compared with healthy controls (HC); however, it is unclear if Autism Spectrum Disorder (ASD) characteristics are related to these cortical differences. The aim of this study was to examine if structural measures were correlated to ASD traits in AN. In total 184 female participants participated in the study; 57 acutely underweight AN participants (AAN), 59 weight-restored participants (WR) and 68 HC. Participants underwent structural magnetic resonance imaging as well as completing the Autism Diagnostic Observation schedule, second edition to examine ASD characteristics. Group differences in curvature, gyrification, surface area, thickness, global grey matter and white matter were measured. Correlation and regression analysis were conducted to examine the relationship between cortical measures and ASD characteristics. Two decreased gyrification clusters in the right post central and supramarginal gyrus and decreased global grey matter were observed in the AAN group compared to HC and WR. No correlations between ASD traits and structural measures existed. Our results suggest structural differences seen in individuals with AN do not appear to be related to ASD characteristics.

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6. Harris LL, Coolidge FL. The psychometric properties of a self-report inventory of autistic symptoms in individuals with autism spectrum disorder. J Clin Psychol;2022 (May 17)

INTRODUCTION AND METHODS: This study examined 85 parental-reports with 85 self-reports of autistic symptoms with the 84-item Coolidge Autistic Symptom Survey (CASS). The CASS covers all of the diagnostic criteria for autism spectrum disorder (ASD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as no studies to date have compared the self-reports of individuals with autism with parent- or significant-other-reports of those individuals using the complete DSM-5. RESULTS: The CASS-Parental-Report and CASS-Self-Report exhibited excellent internal reliability (α = 0.97 and 0.96, respectively). There was support for the hypothesis that parental-reports and self-reports would be similar (r = 0.66, p < 0.001). DISCUSSION: In conclusion, the CASS should be considered a promising tool for assessing autistic symptoms from both parent- and self-perspectives.

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7. Jiang X, Zhou Y, Zhang Y, Zhang L, Qiao L, De Leone R. Estimating High-Order Brain Functional Networks in Bayesian View for Autism Spectrum Disorder Identification. Front Neurosci;2022;16:872848.

Brain functional network (BFN) has become an increasingly important tool to understand the inherent organization of the brain and explore informative biomarkers of neurological disorders. Pearson’s correlation (PC) is the most widely accepted method for constructing BFNs and provides a basis for designing new BFN estimation schemes. Particularly, a recent study proposes to use two sequential PC operations, namely, correlation’s correlation (CC), for constructing the high-order BFN. Despite its empirical effectiveness in identifying neurological disorders and detecting subtle changes of connections in different subject groups, CC is defined intuitively without a solid and sustainable theoretical foundation. For understanding CC more rigorously and providing a systematic BFN learning framework, in this paper, we reformulate it in the Bayesian view with a prior of matrix-variate normal distribution. As a result, we obtain a probabilistic explanation of CC. In addition, we develop a Bayesian high-order method (BHM) to automatically and simultaneously estimate the high- and low-order BFN based on the probabilistic framework. An efficient optimization algorithm is also proposed. Finally, we evaluate BHM in identifying subjects with autism spectrum disorder (ASD) from typical controls based on the estimated BFNs. Experimental results suggest that the automatically learned high- and low-order BFNs yield a superior performance over the artificially defined BFNs via conventional CC and PC.

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8. Keller R, Ardizzone F, Finardi C, Colella R, Genuario C, Lopez M, Salerno L, Nobile E, Cicinelli G. Real-Life Social-Skills Training and Motor-Skills Training in Adults With Autism Spectrum Disorder: The Con-Tatto Project Walking Down the Francigena Route. Front Psychiatry;2022;13:846619.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with an early onset and a genetic and epigenetic component. ASD is characterized by deficits in socio-emotional reciprocity, impaired verbal and non-verbal communication skills, and specific difficulties in developing and maintaining adequate social relationships with peers. Indeed, restricted, repetitive patterns of behavior, interests, or activities are required by DSM-5 diagnostic criteria. Autistic people usually need an unchanging environment (or in any case predictable and stable) and may have hypo- or hyper-sensitivity to sensory inputs. The onset of clinical symptoms occurs during the early years of life. Social skills competence is a significant therapeutic aim to be pursued when addressing ASD core symptoms. Several considerable motor difficulties (87%) in people with autism spectrum disorder in adulthood have been found. The Con-tatto project developed a project addressing social, physical, and mental health difficulties in real-life walking down the Francigena route for 9 days with 12 autistic people, by (1) Implementing daily sessions of social skills training program whose abilities were addressed to be immediately generalized and used throughout the day. (2) Educational movement and walking activity programs were led by a fitness coach. (3) The creation of walking peers’ social community with a strong and relevant impact on adults with ASD social life respecting every person’s individuality. (4) Provision of social reinforcers to reduce the stigma of people with autism and the experienced perception of low self-esteem, especially when they are bullied.

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9. Kunihiro N, Tsukamoto M, Taura S, Hitosugi T, Miki Y, Yokoyama T. Sevoflurane concentration for cannulation in developmental disabilities. BMC Anesthesiol;2022 (May 16);22(1):148.

OBJECTIVE: The goal of this study was to compare the end-tidal sevoflurane concentration and time for intravenous cannulation at induction of anesthesia using sevoflurane with or without nitrous oxide in healthy children and in those with developmental disabilities. METHODS: Normal and developmentally disabled children were anesthetized by inhalation of sevoflurane with nitrous oxide or with nitrous oxide-free oxygen, and intravenous cannulae were introduced. Nitrous oxide was stopped after loss of consciousness. The following parameters were recorded for each patient: age, gender, height, weight, BMI, duration of intravenous cannulation, end-tidal concentration of sevoflurane at the completion of intravenous cannulation, and use of nitrous oxide. For each parameter except gender, p-value were calculated by one-way analysis of variance (ANOVA). For gender, p-value were calculated using the Fisher method. Two-way ANOVA was performed to evaluate the effect of patient health status and nitrous oxide use on the end-tidal concentrations of sevoflurane and the time required for intravenous cannulation. RESULTS: The end-tidal sevoflurane concentrations at the completion of the intravenous cannulation had received a significant main effect of the factor « the use of nitrous oxide » (F(1,166) = 25.8, p < 0.001, η(2) = 0.13) and a small effect of the factor "the patient health status" (F(1,166) = 0.259, p = 0.611, η(2) = 0.001). However, the time required for intravenous cannulation was not significantly affected by either of the two factors, "the use of nitrous oxide" (F(1,166) = 0.454, p = 0.501, η(2) = 0.003) and "the patient health status" (F(1,166) = 0.308, p = 0.579, η(2) = 0.002). CONCLUSIONS: Between the healthy children and the children with developmental disabilities, no significant differences in the time required for the intravenous cannulation from the beginning of anesthetic induction. However, the end-tidal sevoflurane concentrations at the completion of the intravenous cannulation was significantly different. Sevoflurane in alveoli might be diluted by nitrous oxide.

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10. Lisøy RS, Biegler R, Haghish EF, Veckenstedt R, Moritz S, Pfuhl G. Seeing minds – a signal detection study of agency attribution along the autism-psychosis continuum. Cogn Neuropsychiatry;2022 (May 17):1-17.

INTRODUCTION: Diametrically aberrant mentalising biases, namely hypermentalising in psychosis and hypomentalising in autism, are postulated by some theoretical models. To test this hypothesis, we measured psychotic-like experiences, autistic traits and mentalising biases in a visual chasing paradigm. METHODS: Participants from the general population (N = 300) and psychotic patients (N=26) judged the absence or presence of a chase during five-second long displays of seemingly randomly moving dots. Hypermentalising is seeing a chase where there is none, whereas hypomentalising is missing to see a chase. RESULTS: Psychotic-like experiences were associated with hypermentalising. Autistic traits were not associated with hypomentalising, but with a reduced ability to discriminate chasing from non-chasing trials. Given the high correlation (τ = .41) between autistic traits and psychotic-like experiences, we controlled for concomitant symptom severity on agency detection. We found that all but those with many autistic and psychotic traits showed hypomentalising, suggesting an additive effect of traits on mentalising. In the second study, we found no hypermentalising in patients with psychosis, who performed also similarly to a matched control group. CONCLUSIONS: The results suggest that hypermentalising is a cognitive bias restricted to subclinical psychotic-like experiences. There was no support for a diametrically opposite mentalising bias along the autism-psychosis continuum.

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11. Mac Giolla Phadraig C, Kahatab A, Daly B. Promoting openness to autism amongst student dental care professional Students. Eur J Dent Educ;2022 (May 17)

INTRODUCTION: Autism spectrum disorder (ASD) is a lifelong condition affecting communication and social interaction and characterized by repetitive or repeated patterns of behaviour. People with ASD experience poor systemic and oral health. They face reduced access to dental care related to provider barriers associated with lack of understanding of ASD , lack of training and a consequent reluctance to treat people with ASD. METHODS: The effectiveness of training given by a person with autism to student dental care professionals was evaluated by measuring change in 62 students’ openness to autism scale scores and confidence treating a person with autism. These students included third year dental students and second year dental nursing and hygiene students. This cohort was recruited as part of their curriculum and opted in for inclusion in the study. Data were analysed using SPSS® RESULTS: An increase in openness scale scores of 7.6% (p <0.05), and in confidence of 4.9% (p<0.05) between pre- and post-training was observed. Openness scale score predicted level of confidence at baseline (OR=0.21(95%CI=0.02-0.39). CONCLUSION: An educational intervention delivered by a person with autism promoted modest increases in openness towards autism and confidence amongst dental care pre-service professionals. While the results suggest that peer-led dental care professional teaching by people with autism may be beneficial, more research is needed.

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12. Martin V, Flanagan TD, Vogus TJ, Chênevert D. Sustainable employment depends on quality relationships between supervisors and their employees on the autism spectrum. Disabil Rehabil;2022 (May 16):1-12.

PURPOSE: Employment outcomes for individuals on the autism spectrum may be contingent upon employers’ knowledge of autism and provision of appropriate workplace supports. We aimed to understand the organizational factors that influenced the organizational socialization of autistic employees. MATERIALS AND METHODS: We wrote nine case histories based on interviews from managers, autistic employees, and job coaches. Intra-case analysis, then cross-case analysis, provided an understanding of organizational factors that lead to sustained employment of autistic employees. RESULTS: The quality of the relationship between managers and autistic employees was consistently seen as the key facilitator of organizational socialization and positive employment outcomes of autistic employees. These relationships, however, relied on the skilled facilitation of the job coach during each stage of the employment cycle (hiring, on-boarding, training, performance management), as they had an important role in building a mutual understanding between supervisors and employees. As such, our study draws upon and contributes to leader-member exchange theory. CONCLUSIONS: Consistent with prior research, our study shows the importance of high-quality relationships between supervisors and supervisees for positive employment outcomes of autistic employees in organization but adds skilled communication facilitation as a novel antecedent to leader-member exchange, as a potentially key factor for autistic employees. Implications for rehabilitationThe relationship between the a manager and their employee is an important factor in effective organizational socialization and workplace outcomes for autistic employees.Job coaches can play a crucial role in building mutual understanding and high-quality relationships between managers and employees.Job coaches can support the inclusion of autistic employees by illustrating the multi-faceted socioemotional performance benefits over the longer term.

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13. McGinley JM, Marsack-Topolewski CN. A Comparative Case Study of Hospice and Hospital End-of-Life Care for Aging Adults With Developmental Disabilities. Glob Qual Nurs Res;2022 (Jan-Dec);9:23333936221087626.

Greater attention is being paid to issues surrounding end-of-life care for aging adults with developmental disabilities. The purpose of this qualitative study was to explore the end-of-life experiences of two aging adults with developmental disabilities and life-limiting serious illnesses who received care in settings in the United States. Using a comparative case study design, data from three sources (records, staff, surrogates) were collected sequentially and triangulated via within and cross-case analyses. Although the setting and design limit the generalizability of these findings, the feasibility of delivering high quality care to adults with developmental disabilities as they age and experience terminal illnesses is supported. Insights are presented regarding how nurses can address barriers by adapting policies and practices to accommodate the distinct needs that arise as people with developmental disabilities age, become seriously ill, and reach life’s end.

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14. Moore HL, Couteur AL, Charman T, Green J, Parr JR, Grahame V. What is the concordance between parent- and education professional-reported adaptive functioning in autistic children using the VABS-II?. J Autism Dev Disord;2022 (May 17)

Adaptive functioning of autistic children is traditionally measured through informant-report, often from parents. Behaviour varies across settings though, and context-specific reports should be considered. Limited and inconsistent results show low parent-education professional concordance, but no research has yet explored item level response variation. We investigated Vineland Adaptive Behaviour Scales-II concordance using 233 lower ability autistic children from the PACT-G sample. Domain and item level agreement was low, but better on objectively measured behaviours. Higher child nonverbal ability improved concordance. Where disagreements occurred, education professionals identified emergent skills more and parents were more likely to rate present/absent. Parents and education professionals view the adaptive abilities of autistic children differently and both should be considered when developing personalised interventions and support.

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15. Noel JP, Shivkumar S, Dokka K, Haefner RM, Angelaki DE. Aberrant causal inference and presence of a compensatory mechanism in Autism Spectrum Disorder. Elife;2022 (May 17);11

Autism Spectrum Disorder (ASD) is characterized by a panoply of social, communicative, and sensory anomalies. As such, a central goal of computational psychiatry is to ascribe the heterogenous phenotypes observed in ASD to a limited set of canonical computations that may have gone awry in the disorder. Here, we posit causal inference – the process of inferring a causal structure linking sensory signals to hidden world causes – as one such computation. We show that audio-visual integration is intact in ASD and in line with optimal models of cue combination, yet multisensory behavior is anomalous in ASD because this group operates under an internal model favoring integration (vs. segregation). Paradoxically, during explicit reports of common cause across spatial or temporal disparities, individuals with ASD were less and not more likely to report common cause, particularly at small cue disparities. Formal model fitting revealed differences in both the prior probability for common cause (p-common) and choice biases, which are dissociable in implicit but not explicit causal inference tasks. Together, this pattern of results suggests (i) different internal models in attributing world causes to sensory signals in ASD relative to neurotypical individuals given identical sensory cues, and (ii) the presence of an explicit compensatory mechanism in ASD, with these individuals putatively having learned to compensate for their bias to integrate in explicit reports.

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16. Reisinger DL, Hines E, Raches C, Tang Q, James C, Keehn RM. Provider and Caregiver Satisfaction with Telehealth Evaluation of Autism Spectrum Disorder in Young Children During the COVID-19 Pandemic. J Autism Dev Disord;2022 (May 17)

The present study examines provider and caregiver satisfaction with telehealth evaluation of autism spectrum disorder (ASD) in young children during the coronavirus SARS-CoV-2 (COVID-19) pandemic. A telehealth model of ASD evaluation was implemented with 308 children ages 14 to 78 months between May 2020 to June 2021. Data were gathered from electronic health records, autism-specific telehealth diagnostic tools, and post-evaluation surveys. Overall, the majority of providers and caregivers were satisfied with telehealth ASD evaluation. Multiple variables were associated with ratings of satisfaction, differing by providers and caregivers. Findings have important implications for the feasibility and acceptability of telehealth ASD evaluations, in addition to key factors to consider in optimizing and sustaining telehealth evaluations beyond the COVID-19 pandemic.

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17. Roman-Urrestarazu A, van Kessel R. Inaccurate prevalence estimates impacts autism policy: A letter to the editor in relation to « Global prevalence of autism: A systematic review update » by Zeidan et al. (2022). Autism Res;2022 (May 15)

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18. Safi M, Opoku MP, Alshamsi M, Abu-Shariha AH. Comparative Study of the Perspectives on the Impact of a Culturally Responsive Picture Exchange Communication System for Children With Autism Spectrum Disorder in the United Arab Emirates. Front Pediatr;2022;10:841064.

BACKGROUND: The Picture Exchange Communication System (PECS) is a widely accepted way to develop the communication skills of children with developmental disabilities such as autism spectrum disorder (ASD). However, the efficacy of PECS has been largely studied in Western societies and little research is available regarding its role in the development of children with ASD in a non-Western cultural context. The purpose of this study was to compare the parent and the practitioner perceptions of the use of PECS for children with ASD in the United Arab Emirates. METHOD: A new scale made up of three subscales was used to collect the data from the parents and the practitioners who were either related to or working with a cohort of children with ASD. The data were analyzed using Statistical Package for the Social Sciences (SPSS) and subjected to the computation of means, t-tests, analysis of variance (ANOVA), binary logistical regression, and two-way factorial ANOVA. RESULTS: The results showed uncertainty or neutrality among the parents and the practitioners toward the use of PECS. Variables such as age, years of experience using PECS, and gender were noted to influence perceptions of PECS. CONCLUSION: The need for policymakers to consider developing regular training for parents and practitioners on the use of PECS and other implications are discussed.

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19. Song W, Nonnemacher SL, Miller KK, Anderson K, Shea LL. Living arrangements and satisfaction of current arrangement among autistic adults reported by autistic individuals or their caregivers. J Appl Res Intellect Disabil;2022 (May 15)

BACKGROUND: Living arrangements is an essential component of the social environments for autistic adults. The need to understanding the status and experience of living arrangements has been highlighted. AIM: This study examined living arrangements and satisfaction with current arrangements of autistic adults reported by autistic adults or caregivers of autistic adults. METHODS: This study used data from a statewide survey of autistic adults or caregivers. RESULTS: Older autistic adults and those employed and had higher financial resources were more likely to live alone or with a roommate or spouse than to live with family or in a supervised setting. Correlates of greater satisfaction included being young, either men or women (vs. non-binary adults), public insurance, fewer service needs, no or one mental health diagnosis (vs. two or more), no psychiatric emergency room or hospitalisation history, and living with a roommate or spouse (vs. living with family). CONCLUSION: This cross-sectional study adds to the literature on the status of living arrangements and satisfaction with living arrangements among autistic adults. Future research is needed to investigate contributing factors to the satisfaction of living arrangements and quality of life among autistic adults.

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20. Spain D, Stewart GR, Mason D, Robinson J, Capp SJ, Gillan N, Ensum I, Happé F. Autism Diagnostic Assessments With Children, Adolescents, and Adults Prior to and During the COVID-19 Pandemic: A Cross-Sectional Survey of Professionals. Front Psychiatry;2022;13:789449.

BACKGROUND: Access to timely high quality autism diagnostic assessments has traditionally been patchy; many individuals wait months, if not years, for an appointment. The onset of the COVID-19 pandemic has likely impacted autism diagnostic services. This study investigated professionals’ experiences of, and thoughts about: (1) how autism diagnostic assessments were conducted before the pandemic; (2) adaptations to service provision because of the pandemic; and (3) challenges, risks, advantages and opportunities associated with autism assessments conducted via online platforms (telehealth). METHOD: Fifty-two professionals, based in different autism diagnostic services and working with children, adolescents and/or adults, completed an online cross-sectional survey in August and September 2020. This comprised demographic questions (about professionals’ roles and experiences), and closed and open questions about service provision and telehealth autism assessments. RESULTS: There was substantial variation in how autism assessments were conducted prior to and during the pandemic; for example, in relation to the number of professionals involved in the assessment and types of structured, semi-structured and unstructured measures used to conduct this. Fifty-two percent of participants (n = 27) reported some service disruption (e.g., full closure, substantial reduction in provision, and/or pausing of in person appointments). Waiting times for assessment had become longer for 58% of services (n = 30), due to pandemic-related disruption. Six themes emerged from thematic analysis of open responses: (1) the autism diagnostic pathway, pre-pandemic; (2) initial impact of the pandemic on service delivery; (3) conducting autism assessments during the pandemic; (4) working remotely; (5) improving service design and delivery; and (6) post-diagnostic support. Views about the accessibility, validity, and reliability of conducting telehealth autism assessments were polarized. Some participants considered this efficient, flexible, and adequate; others viewed this as unethical and inappropriate. What constitutes good practice in telehealth autism assessments remains unclear, but there is a general openness to using this method (potentially in a hybrid telehealth-in person model), provided rigor and standardization are enhanced. CONCLUSIONS: The pandemic has potentially compounded existing bottlenecks to the autism diagnostic pathway. Future research should seek to improve timeliness, standardization, accessibility and robustness of this pathway, and the validity and reliability of telehealth autism assessments.

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21. Stavropoulos KKM, Heyman M, Salinas G, Baker E, Blacher J. Exploring telehealth during COVID for assessing autism spectrum disorder in a diverse sample. Psychol Sch;2022 (Mar 25)

Due to the coronavirus disease 2019 (COVID-19) pandemic, the importance of telehealth has rapidly increased, in particular as many in-person clinics have closed. Early intervention is crucial for improving outcomes in children with autism spectrum disorder (ASD). As such, the need for timely assessments and diagnoses remains despite COVID-19-related closures. This study offers preliminary data collected from 23 children assessed through a no-cost autism clinic in Southern California using a novel telehealth model. This includes an overview of an adapted, telehealth version of in-person observational assessment techniques for diagnosing autism. In addition, preliminary data on social validity assessed at two points are presented. Findings suggest that caregivers found the telehealth assessment procedures acceptable and convenient, and overall were satisfied with both the assessment and the written report/verbal feedback. Implications for future uses of telehealth are discussed, including how telehealth can assist with decision-making around school-based services and/or placement.

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22. Sturner R, Bergmann P, Howard B, Bet K, Stewart-Artz L, Attar S. Do Autism-Specific and General Developmental Screens Have Complementary Clinical Value?. J Autism Dev Disord;2022 (May 17)

Prior studies suggest autism-specific and general developmental screens are complementary for identifying both autism and developmental delay (DD). Parents completed autism and developmental screens before 18-month visits. Children with failed screens for autism (n = 167) and age, gender, and practice-matched children passing screens (n = 241) completed diagnostic evaluations for autism and developmental delay. When referral for autism and/or DD was considered, overall false positives from the autism screens were less frequent than for referral for autism alone. Presence of a failed communication subscale in the developmental screen was a red flag for autism and/or DD. An ordinally-scored autism screen had more favorable characteristics when considering autism and/or DD, yet none of the screens achieved recommended standards at 18 months, reinforcing the need for recurrent screening as autism emerges in early development.

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23. Zhang Y, Zhou Z, Xu Q, Li H, Lv Y, Zhu G, Dong P, Li D, Wang Y, Tang X, Xu X. Screening for Autism Spectrum Disorder in Toddlers During the 18- and 24-Month Well-Child Visits. Front Psychiatry;2022;13:879625.

OBJECTIVE: Early screening contributes to the early detection of children with autism spectrum disorder (ASD). We conducted a longitudinal ASD screening study in a large community setting. The study was designed to investigate the diagnostic rate of ASD screening and determine the effectiveness of ASD screening model in a community-based sample. METHODS: We enrolled children who attended 18- and 24-month well-child care visits in Shanghai Xuhui District. Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) and Binomial Observation Test (BOT) were selected as screening instruments. Screen-positive children were referred to a tertiary diagnostic center for comprehensive ASD diagnostic evaluation. Screen-negative children received well-child checkups and follow-up every 3-6 months until age three and were referred if they were suspected of having ASD. RESULTS: A total of 11,190 toddlers were screened, and 36 screen-positive toddlers were diagnosed with ASD. The mean age at diagnosis for these children was 23.1 ± 4.55 months, diagnosed 20 months earlier than ASD children not screened. The diagnostic rate of ASD was 0.32% (95% CI: 0.23-0.45%) in this community-based sample. In addition, 12 screen-negative children were diagnosed with ASD during subsequent well-child visit and follow-up. The average diagnostic rate of ASD rose to 0.43% (95% CI: 0.32-0.57%) when toddlers were followed up to 3 years old. The positive predictive values (PPVs) of M-CHAT-R/F, M-CHAT-R high risk, and BOT for ASD were 0.31, 0.43, and 0.38 respectively. CONCLUSION: Our findings provide reliable data for estimating the rate of ASD detection and identifying the validity of community-based screening model. M-CHAT-R/F combined with BOT can be an effective tool for early detection of ASD. This community-based screening model is worth replicating.

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