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The increased prevalence of autism spectrum disorder and documented benefits of early intensive intervention have created a need for flexible systems for determining eligibility for autism-specific services. This study evaluated the effectiveness of a training program designed to enhance autism spectrum disorder identification and assessment within community pediatric settings across the state. Twenty-seven pediatric providers participated in regional trainings across a 3.5-year period. Trainings provided clinicians with strategies for conducting relatively brief within-practice interactive assessments following positive autism spectrum disorder screenings. Program evaluation was measured approximately 1.5 years following training through (a) clinician self-reports of practice change and (b) blind diagnostic verification of a subset of children assessed. Pediatric providers participating in the training reported significant changes in screening and consultation practices following training, with a reported 85% increase in diagnostic identification of children with autism spectrum disorder within their own practice setting. In addition, substantial agreement (86%-93%) was found between pediatrician diagnostic judgments and independent, comprehensive blinded diagnostic evaluations. Collaborative training methods that allow autism spectrum disorder identification within broader community pediatric settings may help translate enhanced screening initiatives into more effective and efficient diagnosis and treatment.

Given recent advances in science, policy, and practice of early identification in autism spectrum disorder (ASD), questions about the effectiveness of early intervention have far-reaching service and policy implications. However, rigorous research evaluating the efficacy and effectiveness of intervention programs for toddlers with ASD faces a multitude of novel scientific challenges. The Autism Speaks Toddler Treatment Network (ASTTN) was formed in 2007 to provide an infrastructure for ongoing communication between the investigators of eight research projects evaluating parent-mediated interventions for toddlers with ASD. The present article describes and compares the research studies of the ASTTN; highlights specific challenges with regard to research design, participants, recruitment, eligibility criteria, enrollment, and intervention approach; and outlines practical considerations that may guide the next generation of parent-mediated intervention studies involving toddlers with ASD.

Few behavioral indices of risk for autism spectrum disorders (ASD) are present before 12 months, and potential biomarkers remain largely unexamined. This prospective study of infant siblings of children with ASD (n = 16) and low-risk comparison infants (n = 15) examined group differences in event-related potentials (ERPs) indexing processing of facial positive affect (N290/P400, Nc) at 9 months and their relation to joint attention at 15 months. Group differences were most pronounced for subtle facial expressions, in that the low-risk group exhibited relatively longer processing (P400 latency) and greater attention resource allocation (Nc amplitude). Exploratory analyses found associations between ERP responses and later joint attention, suggesting that attention to positive affect cues may support the development of other social competencies., Author(s): Alexandra P. Key[sup.1] , Lisa V. Ibanez[sup.2] , Heather A. Henderson[sup.3] , Zachary Warren[sup.4] , Daniel S. Messinger[sup.5] , Wendy L. Stone[sup.6] Author Affiliations: (1) Vanderbilt Kennedy Center for [...]

Background: This randomized controlled trial compared Hanen's "More than Words" (HMTW), a parent-implemented intervention, to a "business as usual" control group. Methods: Sixty-two children (51 boys and 11 girls; M age = 20 months; SD = 2.6) who met criteria for autism spectrum disorders (ASD) and their parents participated in the study. The HMTW intervention was provided over 3.5 months. There were three measurement periods: prior to randomization (Time 1) and at 5 and 9 months post enrollment (Times 2 and 3). Children's communication and parental responsivity were measured at each time point. Children's object interest, a putative moderator, was measured at Time 1. Results: There were no main effects of the HMTW intervention on either parental responsivity or children's communication. However, the effects on residualized gains in parental responsivity from Time 1 to both Times 2 and 3 yielded noteworthy effect sizes (Glass's delta = 0.71, 0.50 respectively). In contrast, there were treatment effects on child communication gains to Time 3 that were moderated by children's Time 1 object interest. Children with lower levels of Time 1 object interest exhibited facilitated growth in communication; children with higher levels of object interest exhibited growth attenuation. Conclusions: The HMTW intervention showed differential effects on child communication depending on a baseline child factor. HMTW facilitated communication in children with lower levels of Time 1 object interest. Parents of children who evidence higher object interest may require greater support to implement the HMTW strategies, or may require different strategies than those provided by the HMTW curriculum.

We compared working memory (WM) for the location of social versus non-social targets in infant siblings of children with Autism Spectrum Disorders (sibs-ASD, n = 25) and of typically developing children (sibs-TD, n = 30) at 6.5 and 9 months of age. There was a significant interaction of risk group and target type on WM, in which the sibs-ASD had better WM for non-social targets as compared with controls. There was no group by stimulus interaction on two non-memory measures. The results suggest that the increased competency of sibs-ASD in WM (creating, updating and using transient representations) for non-social stimuli distinguishes them from sibs-TD by 9 months of age. This early emerging strength is discussed as a developmental pathway that may have implications for social attention and learning in children at risk for ASD.

Few studies have examined vocal expressions of emotion in children with autism. We tested the hypothesis that during social interactions, children diagnosed with autism would exhibit less extreme laugh acoustics than their nonautistic peers. Laughter was recorded during a series of playful interactions with an examiner. Results showed that children with autism exhibited only one type of laughter, whereas comparison participants exhibited two types. No group differences were found for laugh duration, mean fundamental frequency (F[subscript 0]) values, change in F[subscript 0], or number of laughs per bout. Findings are interpreted to suggest that children with autism express laughter primarily in response to positive internal states, rather than using laughter to negotiate social interactions.

Later-born siblings of children with autism spectrum disorder (Sibs-ASD) are at elevated risk for social impairments. Two putative predictors of later social impairment--measures of responding to joint attention and weighted triadic communication--were examined in a sample of 43 Sibs-ASD who were followed from 15 to 34 months of age. Results revealed that initial level of responding to joint attention and growth rate of weighted triadic communication predicted the degree of social impairment at the final measurement period. Additionally, both predictors were associated with later ASD diagnosis. In contrast, unweighted triadic communication, age of entry into the study, and initial language level did not predict later social impairment. The importance of considering social outcome as a continuous variable in prospective studies of Sibs-ASD is discussed.

The study examined whether face-specific perceptual brain mechanisms in 9-month-old infants are differentially sensitive to changes in individual facial features (eyes versus mouth) and whether sensitivity to such changes is related to infants' social and communicative skills. Infants viewed photographs of a smiling unfamiliar female face. On 30% of the trials, either the eyes or the mouth of that face were replaced by corresponding parts from a different female. Visual event-related potentials were recorded to examine face-sensitive brain responses. Results revealed that increased competence in expressive communication and interpersonal relationships was associated with a more mature response to faces, as reflected in a larger occipito-temporal N290 with shorter latency. Both eye- and mouth changes were detected, though infants derived different information from these features. Eye changes had a greater impact on the face perception mechanisms and were not correlated with social or communication development, whereas mouth changes had a minimal impact on face processing but were associated with levels of language and communication understanding. (Contains 4 figures and 1 table.)

The study examined the properties of the Screening Tool for Autism in Two-Year-Olds (STAT) for children under 24 months. The STAT provides a standard context for observing social-communicative behavior in play, imitation, and communication. Seventy-one children received the STAT between 12 and 23 months of age and a follow-up diagnostic evaluation after 24 months. All had an older sibling with an autism spectrum diagnosis (n = 59) or had been referred for evaluation for concerns about autism (n = 12). Signal detection analysis resulted in a cut score of 2.75 for this sample, which yielded a sensitivity of 0.95, specificity of 0.73, positive predictive value of 0.56, and negative predictive value of 0.97. False positives were highest for the 12- to 13-month-old age group; STAT screening properties were improved when the sample was limited to children 14 months and older. Implications for using the STAT with children under 24 months are discussed. (Contains 1 figure and 3 tables.)

Purpose: To evaluate whether the validity of the Receptive Vocabulary scale of the MacArthur Communicative Development Inventory for Infants (MCDI-I; L. Fenson et al., 1991), a parent-report measure of early vocabulary, could be improved for children with autism spectrum disorders (ASD) by removing items that are biased. Method: Logistic regression was used to identify biased items. Items are considered biased if characteristics other than those being measured by the instrument change the probability that a person will get an item correct. Participants in the current study included 272 typically developing infants younger than 18 months of age and 209 toddlers with ASD older than 18 months of age. The age difference between the 2 groups is a result of matching on total size of the receptive vocabulary. Results: Twenty-five items were identified as showing large bias. Conclusion: Deletion of these items from the test should increase the degree to which the authors are measuring the size of the respondent's mental lexicon with the total score from the MCDI-I.

Background: Few studies have examined the variability in outcomes of children diagnosed with autism spectrum disorder (ASD) at age 2. Research is needed to understand the children whose symptoms--or diagnoses--change over time. The objectives of this study were to examine the behavioral and diagnostic outcomes of a carefully defined sample of 2-year-old children with ASD, and to identify child and environmental factors that contribute to variability in outcomes at age 4. Methods: Forty-eight children diagnosed with autism or pervasive developmental disorder not otherwise specified (PDDNOS) at age 2 were followed to age 4. Diagnostic measures included the Autism Diagnostic Observation Schedule-Generic (ADOS-G) and clinical diagnosis at ages 2 and 4, and the ADI-R at age 4. Results: Diagnostic stability for an ASD diagnosis (autism or PDDNOS) was 63%, and for an autism diagnosis was 68%. Children who failed to meet diagnostic criteria for ASD at follow-up were more likely to: 1) be 30 months or younger at initial evaluation; 2) have milder symptoms of autism, particularly in the social domain; and 3) have higher cognitive scores at age 2. No differences between children with stable and unstable diagnoses were found for amount of intervention services received. Among the children with unstable diagnoses, all but one continued to have developmental disorders, most commonly in the area of language. Conclusions: The stability of ASD was lower in the present study than has been reported previously, a finding largely attributable to children who were diagnosed at 30 months or younger. Implications for clinical practice are discussed.

Detecting early signs of autism is essential for timely diagnosis and initiation of effective interventions. Several research groups have initiated prospective studies of high-risk populations including infant siblings, to systematically collect data on early signs within a longitudinal design. Despite the potential advantages of prospective studies of young children at high-risk for autism, there are also significant methodological, ethical and practical challenges. This paper outlines several of these challenges, including those related to sampling (e.g., defining appropriate comparison groups), measurement and clinical implications (e.g., addressing the needs of infants suspected of having early signs). We suggest possible design and implementation strategies to address these various challenges, based on current research efforts in the field and previous studies involving high-risk populations.

This study used a concurrent correlational design to examine associations between three types of motor imitation with objects and three proposed correlates in 32 two- and three-year-old children diagnosed with ASD. Attention-following and fine motor ability were significant, unique correlates of imitation in an observational learning context. Attention-following was a significant correlate of imitation in a direct elicitation context. Social reciprocity was a significant correlate of imitation in an interactive play context. These associations were observed after controlling for general developmental level. Results support previous findings that motor imitation may not reflect a unitary construct for children with ASD and that different skills may underlie the performance of different types of motor imitation. Implications for interventions targeting motor imitation are discussed.

We compared responding to joint attention (RJA) in younger siblings of children with ASD (SIBS-ASD; n = 46) and younger siblings of children developing typically (SIBS-TD; n = 35). Children were tested between 12 and 23 months of age in a situation in which an experimenter directed the child's attention to one of 8 targets. Each child responded to 10 different combinations of verbal and nonverbal cues containing varying levels of attention-specifying information. SIBS-ASD had significantly lower overall RJA scores than SIBS-TD. Moderately redundant cues were most difficult for SIBS-ASD relative to SIBS-TD; adding a point to moderately redundant cues improved RJA for SIBS-ASD, bringing them to a level of RJA commensurate with SIBS-TD.

Purpose: This randomized group experiment compared the efficacy of 2 communication interventions (Responsive Education and Prelinguistic Milieu Teaching [RPMT] and the Picture Exchange Communication System [PECS]) on spoken communication in 36 preschoolers with autism spectrum disorders (ASD). Method: Each treatment was delivered to children for a maximum total of 24 hr over a 6-month period. Spoken communication was assessed in a rigorous test of generalization at pretreatment, posttreatment, and 6-month follow-up periods. Results: PECS was more successful than RPMT in increasing the number of nonimitative spoken communication acts and the number of different nonimitative words used at the posttreatment period. Considering growth over all 3 measurement periods, an exploratory analysis showed that growth rate of the number of different nonimitative words was faster in the PECS group than in the RPMT group for children who began treatment with relatively high object exploration. In contrast, analogous slopes were steeper in the RPMT group than in the PECS group for children who began treatment with relatively low object exploration.

Many researchers have suggested that temperament information could be useful for understanding the behavioral variability within the autism spectrum. The purpose of this brief report is to examine temperament profiles of 110 children with ASD (ages 3-8 years, 61 with Autistic Disorder, 42 with PDD-NOS; and 7 with Asperger Disorder) via a commonly used parent report measure of child temperament. Internal consistency of temperament dimensions, test-retest reliability, descriptions of means and standard deviations are examined, relative to previously published norms. Internal consistency of the dimensions and test-retest reliability were comparable to published norms; however, children with autism were rated as presenting with more extreme scores than typically-developing children on several dimensions. Limitations and implications for future work are discussed.

This randomized group experiment compared the efficacy of 2 communication interventions (Responsive Education and Prelinguistic Milieu Teaching [RPMT] and the Picture Exchange Communication System [PECS]) in 36 preschoolers with autism spectrum disorders. Each treatment was delivered 3 times per week, in 20-min sessions, for 6 months. The results revealed that the RPMT facilitated the frequency of generalized turn taking and generalized initiating joint attention more than did the PECS. The latter effect occurred only for children who began treatment with at least some initiating joint attention. In contrast, the PECS facilitated generalized requests more than the RPMT in children with very little initiating joint attention prior to treatment. These effect sizes were large.

The purpose of the present study was to examine the developmental outcomes of children 7 years after their initial diagnosis. Children diagnosed with autism or PDD-NOS at age 2 received follow-up evaluations at age 9. Diagnostic stability was high, with 88 percent of the sample obtaining autism spectrum diagnoses at age 9. Cognitive scores improved considerably for a large segment of the sample, with over 50 percent obtaining scores in the average range at follow-up. Language outcomes were also positive at follow-up; 88 percent of the sample demonstrated at least some functional language, and 32 percent were able to engage in conversational exchanges. Early characteristics that predicted outcome status were: age of diagnosis, age 2 cognitive and language scores, and total hours of speech-language therapy between ages 2 and 3.These findings highlight the potential long-term benefits of both early identification and early intervention, and provide additional evidence for the importance of promoting public awareness of the early signs of autism. (Contains 3 tables and 4 figures.)

This study used an intact group comparison to examine attention following in 34 children aged 2 years diagnosed with autism spectrum disorder (ASD) matched pairwise for vocabulary comprehension with a group of typically developing toddlers. For both groups of children, the presence of verbal labels during a referential task increased attention to a novel object over and above the attention-facilitating effect of child-directed talking without labeling. The typically developing children displayed more attention following than comprehension matched children with ASD across experimental conditions and there was no significant difference between the groups in the facilitative effect of hearing verbal labels. Implications for word-learning theory, intervention strategies and future research are considered. (Contains 1 table.)

Purpose: The goal of the current study was to identify a predictive model of vocabulary comprehension and production in a group of young children with autism spectrum disorders. Four prelinguistic behaviors were selected for consideration as predictors based on theoretical and empirical support for the relationship of these behaviors to language development. Method: The study used a longitudinal correlational design. Participants were twenty-nine 2- and 3-year-olds diagnosed with autism spectrum disorders. The prelinguistic behaviors--attention-following, motor imitation, commenting, and requesting--were measured at the initial visit. Vocabulary comprehension and production were measured 6 months later. Results: Commenting was the only unique predictor of comprehension after the degree of cognitive delay was controlled. Both commenting and motor imitation of actions without objects were unique predictors of production over and above the other skills and when the degree of cognitive delay was controlled. Conclusions: The finding that both commenting and motor imitation simultaneously accounted for unique variance in vocabulary production is new to the literature and requires replication. However, results suggest that increasing behaviors that allow children with autism to make their current focus of attention obvious to social partners may be an effective approach for supporting word learning in young children with autism. (Contains 8 tables.)

Wealth and income inequalities are rising globally since the 1970s, with detrimental social, economic and environmental effects. The contribution of housing costs to rising inequality is not well understood. In this paper we examine the intersection of tenure, income, generation and geographical factors compounding after-housing income inequality to understand how housing costs impacted on rising economic inequality in Australia since 1993. Analysing data from the Australian Bureau of Statistics' Household Expenditure Surveys conducted in 1993–4 and 2017–8, the paper shows that rising housing costs disproportionally curtailed real gains from income growth for lower-income households, exacerbating inequality. Between 1993–4 and 2017–8, the incomes of the top 10% of earners rose at a rate twice as high as the bottom 10% of earners in before-housing income, or three times as high after deducting housing costs. The paper examines how this overarching trend was shaped by the intersection of socioeconomic, generational, tenure and geographical factors. [ABSTRACT FROM AUTHOR]

The STAT is an interactive screening measure for autism that assesses behaviors in the areas of play, communication, and imitation skills. In Study 1, signal detection procedures were employed to identify a cutoff score for the STAT using developmentally matched groups of 2-year-old children with autism and with nonspectrum disorders. The resulting cutoff yielded high sensitivity, specificity, and predictive values for the development sample as well as for an independent validation sample. Study 2 examined psychometric properties of the STAT and revealed acceptable levels of interrater agreement, test-retest reliability, and agreement between STAT risk category and ADOS-G classification. The STAT demonstrates strong psychometric properties and shows promising utility as a Level 2 screening measure for autism.

Two studies were conducted to examine the psychometric properties of the Parent Interview for Autism-Clinical Version (PIA-CV) for 58 children (ages 2-5). Results support the utility of the PIA-CV for obtaining ecologically valid information from parents and for measuring behavioral change in young children with autism. (Contains references.) (Author/CR)

Thirty-five children diagnosed with autism or pervasive developmental disorders at age 2 were re-evaluated 2 years later for factors related to spoken language development including child variables and environmental variables. After controlling for age 2 language skills, the only significant predictors of age 4 language skills were motor imitation and number of hours of speech/language therapy. (Contains references.) (Author/DB)

A study examined the validity of the Screening Tool for Autism in Two-Year-Olds (STAT) as a stage 2 screening instrument in a clinic-based sample of two-year-olds with autism (n=12) and with nonautistic developmental disorders (n=21). Results provide preliminary support for the utility of the STAT as an early screening of autism. (Contains references.) (Author/CR)

A study used the Vineland Adaptive Behavior Scales to investigate patterns of adaptive behavior in 30 children with autism who were under 3 years. Relative to controls, participants demonstrated weaker socialization and communication skills and greater discrepancies between adaptive behavior and mental age. The utility of the scales is discussed. (Author/CR)