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Early identification of autism spectrum disorder (ASD) is regarded as crucial for swift access to early intervention and, subsequently, better outcomes later in life. However, current instruments miss large proportions of children who later go on to be diagnosed with ASD, raising a question of what these instruments measure. The present study utilized data from the Norwegian Mother, Father, and Child Cohort Study and the Autism Birth Cohort study to explore the subsequent developmental and diagnostic characteristics of children raising developmental concern on the six-critical discriminative item criterion of the M-CHAT (DFA6) at 18 months of age (N = 834). The DFA6 identified 28.8% of children diagnosed with ASD (N = 163), but 4.4% with language disorder (N = 188) and 81.3% with intellectual disability (N = 32) without ASD. Scoring in the «at-risk» range was associated with lower IQ, impaired functional language, and greater severity of autism symptoms whether children had ASD or not.

In this systematic map review, we aimed (1) at identifying studies including the co-occurrence of autism spectrum disorders (ASD) and gender dysphoria (GD) between 1946 and 2018, and (2) to present the papers included in this systematic map review to provide authors in the field of GD, sexuality and ASD with an important database of studies focusing on this very complex topic. The field is of emerging interest, as observed by the large increase of studies over the past decades, especially since 2015. However, future challenges are to be addressed in future studies.

Here we address the earlier published review by Øien et al. (J Autism Dev Disord, 10.1007/s10803-018-3686-7, 2018) and the subsequent comments by Zucker and VanderLaan (J Autism Dev Disord, 10.1007/s10803-018-3748-x, 2018). The current commentary is a response to the corrections put forth by the latter authors where aspects related to diagnostic criteria of Gender Dysphoria and corrections to the existence of a control group were noted. Additionally, to highlight that research on Gender Dysphoria and ASD is becoming a very fast and growing field we also present an update of the original review which show a 13% increase of empirical studies published only in the past few months., Author(s): Anders Nordahl-Hansen [sup.1] , Domenic V. Cicchetti [sup.2] , Roald A. Øien [sup.3] [sup.4] Author Affiliations: (Aff1) grid.446040.2, Faculty of Education, Østfold University College, , P.O. 700, B R [...]

In this systematic map review, we aimed (1) at identifying studies including the co-occurrence of autism spectrum disorders (ASD) and gender dysphoria (GD) between 1946 and 2018, and (2) to present the papers included in this systematic map review to provide authors in the field of GD, sexuality and ASD with an important database of studies focusing on this very complex topic. The field is of emerging interest, as observed by the large increase of studies over the past decades, especially since 2015. However, future challenges are to be addressed in future studies., Author(s): Roald A. Øien [sup.1] [sup.2] , Domenic V. Cicchetti [sup.2] , Anders Nordahl-Hansen [sup.3] Author Affiliations: (Aff1) 0000000122595234, grid.10919.30, Department of Psychology, UiT - The Arctic University of Norway, [...]

In an earlier investigation, the authors assessed the reliability of the ADI-R when multiple clinicians evaluated a single case, here a female 3 year old toddler suspected of having an autism spectrum disorder (Cicchetti et al. in "J Autism Dev Disord" 38:764-770, 2008). Applying the clinical criteria of Cicchetti and Sparrow ("Am J Men Def" 86:127-137, 1981); and those of Cicchetti et al. ("Child Neuropsychol" 126-137, 1995): 74% of the ADI-R items showed 100% agreement; 6% showed excellent agreement; 7% showed good agreement; 3% manifested average agreement; and the remaining 10% evidenced poor agreement. In this follow-up investigation, the authors described and applied a novel method for determining levels of statistical significance of the reliability coefficients obtained in the earlier investigation. It is based upon a modification of the Z test for comparing a given level of inter-examiner reliability with a lower limit value of 70% (Dixon and Massey in "Introduction to statistical analysis." McGraw-Hill, New York, 1957). Results indicated that every item producing a clinically acceptable level of inter-examiner reliability was also statistically significant. However, the reverse was not true, since a number of the items with statistically significant reliability levels did not reach levels of agreement that were clinically meaningful. This indicated that clinical significance was an accurate marker of statistical significance. The generalization of these findings to other areas of diagnostic interest and importance is also examined.

The author examined critically three beliefs of S.S. Stevens pertaining to his quadripartite system of scales of measurement: (1) There are four scales of measurement in common usage (2) These scales and the scientific disciplines that use them can be incrementally graded for levels of reliability and validity or accuracy such that: Nominal scale variables produce the lowest levels of reliability and accuracy; with successively improving levels for Ordinal, Equal Interval, and Equal Ratio scales; and (3) The scale upon which a variable is measured determines the type of statistical test that one is permitted to apply. It was shown that each of the three beliefs is fundamentally flawed.

The objectives of this report are: (a) to trace the theoretical roots of the concept clinical significance that derives from Bayesian thinking, Marginal Utility/Diminishing Returns in Economics, and the "just noticeable difference", in Psychophysics. These concepts then translated into: Effect Size (ES), strength of agreement, clinical significance, and related concepts, and made possible the development of Power Analysis; (b) to differentiate clinical significance from statistical significance; and (c) to demonstrate the utility of measures of ES and related concepts for enhancing the meaning of Autism research findings. These objectives are accomplished by applying criteria for estimating clinical significance, and related concepts, to a number of areas of autism research.

The Prudhoe Cognitive Function Test (PCFT) directly measures the cognitive abilities of people with intellectual impairment. This study examined the relationship between this instrument and the Kaufman Brief Intelligence Test (K-BIT) and two shorter versions of the same scale. High correlations between the verbal and performance sections of the K-BIT and the Long PCFT were found with correlation coefficients of 0.85 and 0.78, respectively. Extremely high correlations between the Short versions of the PCFT and the Long version were obtained at 0.97 for Form A and 0.98 for Form B, illustrating that both Short forms and the Long form are essentially interchangeable. The PCFT is a reliable and robust schedule in the assessment of cognitive function in this population.

A consistent result in the evaluation of group-delivered intervention to promote social reciprocity in children with PDDs is that outcome data are inconclusive. Lack of robust evidence of efficacy confounds understanding of these interventions and their value to the field. It is conceivable that the construct of impaired social reciprocity in PDD presents unique circumstances that require special consideration when evaluating the evidence base. Social reciprocity and impairment in social functioning are complex constructs, which require a multi-dimensional, multi-method approach to intervention and measurement of gains. The existing paradigm for evaluating the evidence base of intervention may need modification to permit a more intricate analysis of the extant research, and increase the sophistication of future research.

Although research in autism has grown more sophisticated, the gap between research knowledge and applicability of research in real world settings has grown. There have been a number of different reviews of evidence-based practices of treatments for young children with autism. Reviews which have critically evaluated the empirical evidence have not found any treatments that can be considered evidence-based. Reasons for this shortcoming are explored, and a new method for the evaluation of empirical evidence is provided. Future uses of this evaluative method are provided as well as a discussion of how this tool might aid in narrowing the research to practice gap.

Background: It is often useful to ascertain whether adults have moderate to profound intellectual disability (approximate IQ less than 50; developmental age less than 108 months) when deciding whether to refer to specialist or mainstream services. The aim of the present study was to develop a simple measure to estimate moderate to profound intellectual disability in adults with a potential need for specialist care. Materials and Methods: Three hundred and twenty-two individuals with information on home interviews from the Leicestershire Learning Disability Register were also assessed using the Vineland Adaptive Behaviour Scales. A variety of variables concerning intelligence, adaptive functioning and dependency were used to predict developmental age (as estimated from the Vineland) using backward stepwise regression. The derived equation formed the Leicestershire Intellectual Disability (LID) tool. A cut-off point was chosen using a receiver operator characteristic (ROC) curve to achieve 95% sensitivity in identifying moderate to profound intellectual disability. Results: Seven variables from the home interviews were found to predict estimated developmental age at the 10% level (P less than or equal to 0.1). When the tool was used to detect adults with moderate to profound intellectual disability, the area under the ROC curve was 0.93. The chosen cut-off point was 95% sensitive and 65% specific. The positive predictive value was 95%, the negative predictive value was 65%, and the overall diagnostic accuracy was 91%. Conclusions: These preliminary findings suggest that the LID tool may help to identify adults with moderate to profound intellectual disability among those with potential need for specialist care. Further evaluation is recommended.

The authors assessed the reliability of the Autism Diagnostic Interview (ADI-R). Seven Clinical Examiners evaluated a three and one half year old female toddler suspected of being on the Autism Spectrum. Examiners showed agreement levels of 94-96% across all items, with weighted kappa (K[subscript w]) between 0.80 and 0.88. They were in 100% agreement on 74% of the items; in excellent agreement on 6% of the items (93-96%, with K[subscript w] between 0.78 and 0.85); in good agreement on 7% (89-90%, with K[subscript w] between 0.62 and 0.68); and in fair agreement on 3% (82 - 84%, with K[subscript w] between 0.40 and 0.47). For the remaining 10% of ADI-R items, examiners showed poor agreement (50-81% with K[subscript w] between -0.67 and 0.37).

Objective: To evaluate the impact of risperidone on adaptive behavior in children with autistic disorder who have serious behavior problems and to examine different methods of scoring the Vineland Adaptive Behavior Scales to measure change. Method: Forty-eight children (5 years to 16 years, 5 months) who showed behavioral improvement during acute treatment with risperidone were followed for 6 months and assessed with the Vineland Scales. Results: Raw scores, age-equivalents, and special norm percentile scores all showed significant increases in adaptive behavior in the areas of communication, daily living skills, and socialization (p less than 0.01). During a period of 6 to 8 months, children gained an average of 7.8 age-equivalent months in the area of socialization, a greater than 6% improvement beyond what would be expected based on baseline growth rates. Conclusions: Although limited by the absence of a control group, these results suggest that risperidone may improve adaptive skills in children with autistic disorder accompanied by serious behavioral problems. Vineland age-equivalent scores appear to be most useful in assessing change with treatment over time. (Contains 2 tables.)

In this paper we address the points raised by groups of scientists who were invited to respond to our initial critique of polychlorinated biphenyl (PCB) research in this special issue. In that article, we applied six objective criteria to more than two decades of published PCB research and concluded that much of the research was badly flawed. The PCB researchers responded to our criticisms by stating that our criteria are either irrelevant or require major revision to be applicable to health areas of research. In response, we know of no methodologic criteria or laws of probability that apply solely to toxicology research. Although we support strong environmental regulations, such should be based upon solid scientific evidence rather than upon methodologically flawed research and false belief systems. (Contains 1 table.)

The purpose of this study is to provide a microanalysis of differences in adaptive functioning seen between well-matched groups of school-aged children with autism and those diagnosed as having Pervasive Developmental Disorder-Not Otherwise Specified, all of whom functioned in the mild to moderate range of intellectual impairment. Findings indicate that the major area of difference between children with autism and those with Pervasive Developmental Disorder-Not Otherwise Specified, was expressive communication; specifically, the use of elaborations in syntax and morphology and in pragmatic use of language to convey and to seek information in discourse. Linear discriminant function analysis revealed that scores on just three of these expressive communication item sets correctly identified subjects in the two diagnostic categories with 80% overall accuracy. Implications of these findings for both diagnosis and intervention with children with Autism Spectrum Disorders will be discussed.

In an earlier investigation, the authors assessed the reliability of the ADI-R when multiple clinicians evaluated a single case, here a female 3 year old toddler suspected of having an autism spectrum disorder (Cicchetti et al. in J Autism Dev Disord 38: 764-770, 2008). Applying the clinical criteria of Cicchetti and Sparrow (Am J Men Def 86: 127-137, 1981); and those of Cicchetti et al. (Child Neuropsychol 126-137, 1995): 74 % of the ADI-R items showed 100 % agreement; 6 % showed excellent agreement; 7 % showed good agreement; 3 % manifested average agreement; and the remaining 10 % evidenced poor agreement. In this follow-up investigation, the authors described and applied a novel method for determining levels of statistical significance of the reliability coefficients obtained in the earlier investigation. It is based upon a modification of the Z test for comparing a given level of inter-examiner reliability with a lower limit value of 70 % (Dixon and Massey in Introduction to statistical analysis. McGraw-Hill, New York, 1957). Results indicated that every item producing a clinically acceptable level of inter-examiner reliability was also statistically significant. However, the reverse was not true, since a number of the items with statistically significant reliability levels did not reach levels of agreement that were clinically meaningful. This indicated that clinical significance was an accurate marker of statistical significance. The generalization of these findings to other areas of diagnostic interest and importance is also examined. Keywords Autism * Clinical significance * Statistical significance * Inter-rater reliability * Multiple raters, one patient, Introduction In the prototypic research design for assessing the reliability of a given test instrument, two well-trained evaluators independently examine a large clinically representative sample of respondents. A much less [...]

The concurrent validity of the original and revised versions of the Leiter International Performance Scale was examined with 26 children (ages 4-16) with autism. Although the correlation between the two tests was high (.87), there were significant intra-individual discrepancies present in 10 cases, two of which were both large and clinically meaningful. Implications for assessment are drawn. (Contains references.) (DB)

Pilot-tested a developmentally appropriate cancer prevention education curriculum for grades K-6, assessing its feasibility and acceptance. Pretesting and posttesting of students who participated in the program indicated that students made significant gains in conceptual understanding for cancer causality and prevention. They also made significant gains in factual knowledge and decreases in misconceptions about casual contact. (SM)

This study examined the inter-rater reliability of clinician-assigned diagnosis of autism using or not using the criteria specified in the Diagnostic and Statistical Manual IV (DSM-IV). For experienced raters there was little difference in reliability in the two conditions. However, a clinically significant improvement in diagnostic reliability occurred when inexperienced raters used the DSM-IV criteria. (Contains references.) (DB)

This study attempted to replicate previously reported increases in birth rates in March and August for individuals with autism. Statistical analysis of 904 cases revealed no significant seasonal effect. Samples were subcategorized into verbal and mute groups and again results failed to support the seasonal hypothesis. (Author/DB)

This study used a well-normed task of face recognition with 102 young children with autism, pervasive developmental disorder (PDD) not otherwise specified, and non-PDD disorders (mental retardation and language disorders) matched for chronological age and either verbal or nonverbal mental age. Autistic subjects exhibited pronounced deficits in face recognition relative to other verbally and nonverbally matched groups. (Contains extensive references.) (Author/DB)

Author(s): Roald A. Øien [sup.1] [sup.2] , Domenic V. Cicchetti [sup.2] , Anders Nordahl-Hansen [sup.3] , Synnve Schjølberg [sup.4] Author Affiliations: (1) grid.10919.30, 0000000122595234, Department of Education, UiT - The [...]

The author examined critically three beliefs of S.S. Stevens pertaining to his quadripartite system of scales of measurement: (1) There are four scales of measurement in common usage (2) These scales and the scientific disciplines that use them can be incrementally graded for levels of reliability and validity or accuracy such that: Nominal scale variables produce the lowest levels of reliability and accuracy; with successively improving levels for Ordinal, Equal Interval, and Equal Ratio scales; and (3) The scale upon which a variable is measured determines the type of statistical test that one is permitted to apply. It was shown that each of the three beliefs is fundamentally flawed. Keywords Scales * Measurement * ASD, Introduction The objective of this article is to examine critically the quadripartite scales of measurement proposed by Stanley Smith Stevens, known by family and friends as 'Smitty'. As such, the [...]

Background: Although there are many rating scales recording the incidence and intensity of violence there are none that are specifically concerned with the measurement and assessment of severe violence. Aims: To develop a scale sensitive to variation centred on severe violence, establish its normative values, test its feasibility, and assess its reliability and validity in different populations. Method: The Quantification of Violence Scale (QOVS) was developed in two stages. First, a list of 30 commonly experienced violent episodes in clinical psychiatric practice were evaluated and tested by weighting each episode by severity. Second, a numerical scale used to record the severity of the episode according to its degree of planning, intent and consequences. Violent episodes in two clinical populations were compared using the Modified Overt Aggression Scale (ME)AS) and the preliminary version of the QOVS over periods up to 18 months, following which the numerical scale was developed. Results: Good (0.60-0.74) to Excellent (> 0.75) test-retest and inter-rater reliability agreement was obtained with both forms of the scale (intra-class correlations of 0.75 and 0.69 respectively), and similar agreement with MOAS scores was reached (0.67) in clinical populations. The scale was quick and easy to use in practice, and a score defining severe violence (9 on the numerical scale and 16 on the matched scale) was determined. Conclusions: The QOVS, in its two forms, is a useful measure of recording significant violence in clinical and forensic practice. DOI: 10.1177/0020764007083870

Purpose: This study tests the hypothesis that toddlers with autism spectrum disorders (ASD) will show differences from contrast groups in preferences for attending to speech. Method: This study examined auditory [...]

Objective: To develop an assessment of bed need that was as little affected by personal bias as possible. Method: The Bed Requirement Inventory (BRI) is an eight-point scale designed to identify the appropriate use of an acute psychiatric bed. This is completed by a member of the ward staff, usually a nurse, and takes 5 minutes to fill in. The reliability, validity and feasibility of using the scale in normal practice were tested in a one-year study, and variations in inappropriate bed use described. Results: The inter-rater reliability of the scale was good (intra-class correlation coefficient = 0.63) and a comparison of the need for a psychiatric bed (comparing the BRI score with the judgement of an independent multidisciplinary group of professionals) also showed good agreement (k = 0.69), suggesting reasonable validity (although when the assessment was made by the named nurse agreement was less good). Results from a year-long survey in two West London hospitals showed that 17% of admissions were inappropriate and 32% had delayed discharge, black Caribbean patients had a significantly higher proportion (25%) of inappropriate admission than others (11%) and those referred from housing charities and hostels had a higher proportion (50%) of inappropriate bed use at some time than other groups (33%). Conclusions: The Bed Requirement Inventory is a quick and reliable method of determining the appropriate use of a psychiatric bed and could be of use in estimating local bed needs. Delayed discharge remains a serious reason for inappropriate bed use in London.

Background: There are no specific instruments for rating dependent personality, although this may be an important subject in clinical practice, where knowledge of dependent personality features may influence treatment. Aims: To develop a simple self-rating questionnaire for dependent personality features and compare the findings in two groups, one with and one without established dependent personality disorder. Method: An 8-item Dependent Personality Questionnaire (DPQ) was developed and its acceptability and validity tested by administration to 30 psychiatric patients, half of whom had dependent personality disorder using clinical and research data, and the other 15 (pair-matched for age and sex) having other psychiatric diagnoses (including other personality disorders) but no dependent personality features. Results: The mean score on the dependent personality questionnaire (DPQ) was 13.7 in those with dependent personality disorder and 7.5 in those without such a disorder (p < .005). The DPQ was also a good predictor of the diagnosis of dependent personality disorder, with sensitivity, specificity, predicted positive, and predicted negative accuracies of 87%. Conclusions: The results suggest that the DPQ may be a suitable screening instrument for dependent personality characteristics.