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Background: Heterogeneity in adaptive behavior abilities among people with autism spectrum disorder (ASD) is expressed not only as uneven levels of impairment across domains, but also in the developmental trajectories of adaptive skills. We studied the question of whether, after accounting for global adaptive behavior development, we find evidence of heterogeneity in the trajectories of specific domains of adaptive behavior. Methods: A sample of 504 children with ASD was obtained by combining data from two independent natural history studies conducted in North America. We used a factor of curves model to explain growth between 36 and 138 months in Vineland Adaptive Behavior Scales, Second Edition (VABS) age equivalents as a function of domain‐specific and global growth processes. Results: The domain‐specific trajectories in all three domains (Communication, Daily Living Skills, and Socialization) reflected impairment relative to age expectations as well as slower‐than‐expected growth with age, and the parameters of these trajectories were moderately‐to‐strongly correlated across domains. The global adaptive behavior trajectory had an initial (36–41 months of age) developmental level of about 22 age‐equivalent months, and eventually slowed after initially increasing by about 6 months each year. The global trajectory accounted for the majority of variance in the domain‐level processes; however, additional variance remained (14%–38%) in the domain‐level intercepts, slopes, and quadratic processes. Conclusions: These results extend existing theoretical and empirical support for the hierarchical structure of adaptive behavior to include its development over time in clinical samples of children with ASD. A latent global trajectory may be sufficient to describe the growth of adaptive behavior in children with ASD; however, the remaining domain‐specific variability after accounting for global adaptive behavior development allows for the possibility that differential effects of intervention on specific domains may be possible and detectable. [ABSTRACT FROM AUTHOR]

Objective: It has been suggested that the sequelae of trauma are under‐recognized in youth on the autism spectrum. We aimed to generate expert consensus regarding important trauma indicators, including but not limited to traumatic stress symptoms, in autistic youth. Methods: We recruited 72 experts in autism and/or childhood trauma. Via a 2‐round Delphi survey, experts commented on and rated the importance of 48 potential indicators, drawn from PTSD criteria and a broader literature on traumatic sequelae in autism. A revised list of 51 indicators, 18 clinical guidelines developed from expert comments, and summaries of expert qualifications and ratings from Round 1 were submitted to a second round (n = 66; 92% retention) of expert review and rating. Results: Twenty‐two indicators reached consensus (>75% round 2 endorsement). Many, but not all, reflected PTSD criteria, including intrusions (e.g., trauma re‐enactments in perseverative play/speech), avoidance of trauma‐reminders, and negative alterations in mood/cognition (e.g., diminished interest in activities) and in arousal/reactivity (e.g., exaggerated startle). Experts also identified increased reliance on others, adaptive and language regressions, self‐injurious behavior, and non‐suicidal self‐injury as important indicators. Consensus guidelines emphasized the need for tailored measures, developmentally informed criteria, and multiple informants to increase diagnostic accuracy. Conclusions: Expert consensus emphasizes and informs a need for tailored diagnostic guidelines and measures to more sensitively assess traumatic reactions in autistic youth. [ABSTRACT FROM AUTHOR]

Background: Language regression, broadly defined as the loss of acquired language skills in early childhood, is a distinctive feature of autism. Little is known about the factors underlying regression or the prognosis of children who exhibit regression. We examine potential predictors of language regression and test its association with language development in a prospective longitudinal sample of children with autism spectrum disorder (ASD) from diagnosis to age 10 years. Methods: We analysed data from Pathways in ASD, a prospective longitudinal study of 421 children enrolled around the time of an autism diagnosis between 2 and 5 years. Autism Diagnostic Interview‐Revised data were available for 408 children, of whom 90 (22%) were classified as having language regression. Results: Demographic and other health factors including caregiver education, family income, child sex, reported seizures, and age of enrolment did not differ between children with and without language regression. Children with language regression walked earlier and attained first words sooner than those without regression. However, both groups attained phrase speech at comparable ages. Those with regression exhibited greater delays in expressive and receptive communication over the follow‐up period, although this effect was attenuated when accounting for baseline differences in motor and cognitive ability. Overall, those with language regression continued to exhibit expressive but not receptive communication delay compared to those without regression. Communication trajectories were heterogeneous to age 10 years, irrespective of regression status. Conclusions: Although language regression can be alarming, our findings confirm that its occurrence does not necessarily foreshadow worse developmental outcomes relative to those without regression. Although a discrepancy in age‐equivalent communication skills may persist, this can be expected to be of less practical importance with rising average levels of skills. Future studies need to account for the significant variability in language trajectories by considering factors beyond developmental regression. [ABSTRACT FROM AUTHOR]

Background: Executive functioning (EF) varies in children with autism spectrum disorder (ASD) and is associated with clinical symptoms, academic, and adaptive functioning. Here, we examined whether middle‐childhood EF mediates associations between early‐childhood autism symptoms and adolescent outcomes in children with ASD. Methods: The Pathways in ASD Cohort comprising children recruited at the time of ASD diagnosis (at 2–4 years‐of‐age) and followed prospectively across eight subsequent timepoints over ~10 years was used. A subset of Pathways participants (n = 250) with Behavior Rating Inventory of Executive Function (BRIEF)‐Parent Form data from at least one timepoint when participants were school‐aged was analyzed. A mediation framework was used to examine whether BRIEF‐measured EF across age 7–10 years (middle‐childhood) mediated associations between early‐childhood autism symptoms (measured using the parent‐report Social Responsiveness Scale across age 2–6 years) and clinical, academic, and functional outcomes, indexed at age >10–11.8 years (early‐adolescence) using the Child Behavior Checklist (CBCL)‐Internalizing and Externalizing Scales, Academic Performance from the Teacher's Report Form, and Vineland Adaptive Behavior Scales. Models were rerun substituting clinician‐rated and teacher‐rated measures, where possible. Results: Mediation models indicated a significant indirect effect of middle‐childhood EF on associations between early‐childhood autism symptoms and externalizing behavior, academic performance, or adaptive functioning in early adolescence; kappa squared (κ2) effect sizes ranged from large to small. Model findings were stable across raters. Middle‐childhood EF did not mediate associations between early‐childhood autism symptoms and adolescent internalizing behavior. Conclusions: Among children with an ASD diagnosis, middle‐childhood EF may be one pathway through which early‐childhood autism symptoms influence a variety of outcomes in early‐adolescence. An experimental study targeting middle‐childhood EF to improve adolescent academic, emotional/behavioral, and adaptive functioning is needed to evaluate the clinical meaningfulness of these findings. [ABSTRACT FROM AUTHOR]