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A study was undertaken to investigate whether a clinical diagnosis of autism can be accurately made in children under the age of three. The results support previous conclusions that a clinical diagnosis can be accurately made. The most prevalent diagnostic factors were deficits in the user of nonverbal social-communicative behaviors, delayed acquisition of spoken language and lack of social or emotional reciprocity.

Although symptoms of autism are present early in life and early diagnosis can lead to better outcomes, there is a dearth of validated caregiver-report interviews designed for children under the age of 3 years. We developed the Toddler Autism Symptom Inventory, a semi-structured interview designed to assess the presence and absence of skills and symptoms in children aged 12–36 months. Reliability and validity of items and a cutoff score for likelihood of autism spectrum disorder were established. Specificity and sensitivity of this cutoff were confirmed with a cross-validation sample. The Toddler Autism Symptom Inventory effectively identified most children with autism without excessive false positives. The Toddler Autism Symptom Inventory is a developmentally appropriate caregiver interview for use in diagnostic evaluations of children under age 3 years that offers clearly operationalized diagnostic criteria and a cutoff for autism likelihood for very young children. Determining whether a young child has an autism spectrum disorder requires direct observation of the child and caregiver report of the child's everyday behaviors. There are few interviews for parents that are specifically designed for children under 3 years of age. The Toddler Autism Symptom Inventory is a new interview that asks caregivers of children age 12–36 months about symptoms of possible autism spectrum disorder. The Toddler Autism Symptom Inventory uses a cutoff score to indicate likelihood for autism spectrum disorder; this cutoff score appears to accurately identify most children who are diagnosed with autism spectrum disorder without identifying too many who do not have autism spectrum disorder. The Toddler Autism Symptom Inventory interview can help clinicians to determine whether a young child shows symptoms suggestive of an autism spectrum disorder. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic has posed unique challenges for families and caregivers, as well as for autism‐focused clinicians, who are faced with providing a thorough and accurate evaluation of children's specific needs and diagnoses in the absence of in‐person assessment tools. The shift to telehealth assessments has challenged clinicians to reconsider approaches and assumptions that underlie the diagnostic assessment process, and to adopt new ways of individualizing standard assessments according to family and child needs. Mandates for physical distancing have uncovered deficiencies in diagnostic practices for suspected autism and have illuminated biases that have posed obstacles preventing children and families from receiving the services that they truly need. This Commentary outlines several considerations for improving diagnostic practices as we move forward from the current pandemic and continue to strive to build an adaptable, sustainable, equitable, and family‐centered system of care. Lay Summary: Physical distancing and the abrupt end to in‐person services for many children on the autism spectrum has forced clinicians to examine the existing challenges with autism spectrum disorder (ASD) diagnostic assessment and consider things they want to keep and things that should be changed in the years ahead. New approaches such as telehealth both alleviated and exacerbated existing disparities, and brought into stark focus the importance of equitable and timely access to family‐centered care. This commentary suggests ways of improving clinical practices related to ASD assessment to continue along this path. [ABSTRACT FROM AUTHOR]

Although the early behaviors associated with autism spectrum disorder have been well characterized, many behaviors are also commonly observed in young children with other developmental delays and even in those with typical development. Therefore, consideration must be given to whether a child demonstrates sufficient autism spectrum disorder symptoms to warrant this diagnosis. Using the Toddler Autism Symptom Inventory, we examined caregiver endorsement of specific behaviors in three groups of toddlers referred for autism spectrum disorder risk: those who received a best-estimate diagnosis of autism spectrum disorder, those with another developmental disorder, and those who showed slight or no developmental delays and did not meet criteria for any disorder. The results revealed significant differences in symptoms among the three diagnostic groups, as well as low frequency of some DSM-5, ASD criteria, especially insistence on sameness, for those with ASD. These findings have important implications for applying the DSM-5, diagnostic criteria to toddlers. Children with autism show more social-communication symptoms and repetitive behaviors than children with typical development or those diagnosed with other developmental disorders; however, non-autistic children often show some behaviors that are associated with autism. We compared the behavioral reports from caregivers of children in these three groups to identify the behaviors that were specific to autism. Children with autism were found to show more of these behaviors, and behaviors that are particularly indicative of autism were identified. These behaviors included social symptoms (approaching others to interact, showing things, looking back while showing, responding to an approaching child, spontaneous imitation) and repetitive behavior symptoms (specific, inflexible play, unusual body movements, strong specific interest, carrying around an unusual object, sensory seeking, and sensory hyper-reactivity). These findings may aid professionals in determining the most appropriate diagnosis for a child between the ages of 12 and 36 months. [ABSTRACT FROM AUTHOR]

Despite the development of several evidence‐based Naturalistic Developmental Behavioral Interventions (NDBIs), very few have been adapted for use in community‐based settings. This study examines the implementation of Reciprocal Imitation Training (RIT)—an NDBI—by community Early Intervention (EI; IDEA Part C) providers serving toddlers from birth to 3 years. Of the 87 EI providers enrolled from 9 agencies in 4 counties across Washington State, 66 were included in the current sample. A stepped‐wedge design was used to randomly assign counties to the timing of RIT training workshops. Self‐report measures of practice and self‐efficacy regarding ASD care were collected at baseline (T1, T2) and 6‐months and 12‐months post‐training (T3, T4). At T3 and T4, providers reported on RIT adoption and rated items about RIT feasibility and perceived RIT effectiveness; at T4, they also reported on child characteristics that led to RIT use and modifications. From pre‐training to post‐training, there were significant increases in providers' self‐efficacy in providing services to children with ASD or suspected ASD. At T3 and T4, provider ratings indicated high levels of RIT adoption, feasibility, and perceived RIT effectiveness. At T4, providers indicated that they most commonly: (a) initiated RIT when there were social‐communication or motor imitation delays, or an ASD diagnosis; and (b) made modifications to RIT by repeating elements, blending it with other therapies, and loosening its structure. While additional research is needed, RIT may help families get an early start on accessing specialized treatment within an established infrastructure available across the United States. Lay Summary: Reciprocal imitation training (RIT) is an evidence‐based treatment for ASD that might be a good fit for use by intervention providers in widely accessible community‐based settings. After attending an educational workshop on RIT, providers reported feeling more comfortable providing services to families with ASD concerns, used RIT with over 400 families, and believed that RIT improved important social communication behaviors. [ABSTRACT FROM AUTHOR]

• Gardening can provide health and well-being benefits. • Little is known about how housing characteristics may influence people's opportunities to garden. • Opportunities to garden may not be equally available to all people. • A research agenda is proposed focused on housing characteristics, socio-economic status and gardening. There is increasing evidence of the health and wellbeing benefits of gardening. However, such benefits are not shared equally across groups in the community. It is important from a social justice perspective to understand the contextual factors that influence opportunities to garden, and how they are distributed in society, how well, and to whom. Despite being a primary site in which people garden, little is known about how characteristics of housing (e.g., property rights, dwelling type) may influence gardening opportunities. Identifying housing-related barriers or enablers to gardening could suggest potential strategies to increase participation in gardening or provide gardening opportunities for those with less conducive housing situations. Building on the small body of knowledge of housing characteristics relevant to gardening opportunities and participation, we propose a new research agenda aiming to understand the relationships between housing characteristics, socio-economic status, and gardening. Through identifying ways to engage more people from diverse housing situations and socio-economic positions in the act of gardening, we hope that this new research agenda can help to promote health equity. [ABSTRACT FROM AUTHOR]

Autism is a chronic developmental disorder in which social interactions of children are impaired. Early diagnosis is critical, as early intervention programs may result in improved behavior. The average age of onset is 18 months, but often a definite diagnosis cannot be given until the child is around four years old. There are two behavior characteristics that may be used to diagnose autism at an early age: deviant play behaviors and impaired imitation skills. Autistic children play in a less mature and imaginative way and cannot imitate the movements of others. A study was conducted to see if these two criteria could be used to distinguish autism from mental retardation and other communication disorders, such as hearing and language impairment, in 91 children between the ages of three and six years. Twenty-two of the children were autistic, 15 were mentally retarded, 15 hearing-impaired, 19 language-impaired and 20 were not handicapped. Behavior during play and imitation skills were assessed. The children who were autistic played with fewer toys, did not play with toys as long as the other children, and when they did play with toys, less frequently used them in the way they were intended to be used. They did not imitate actions of others as well as the other children. These three measures, but especially the lack of imitation skills, could distinguish autistic children from other children, and can thus be useful in diagnosing autism. (Consumer Summary produced by Reliance Medical Information, Inc.)

Like the rest of the world, African countries are reeling from the health, economic and social effects of COVID-19. The continent's governments have responded by imposing rigorous lockdowns to limit the spread of the virus. The various lockdown measures are undermining food security, because stay at home orders have among others, threatened food production for a continent that relies heavily on agriculture as the bedrock of the economy. This article draws on quantitative data collected by the GeoPoll, and, from these data, assesses the effect of concern about the local spread and economic impact of COVID-19 on food worries. Qualitative data comprising 12 countries south of the Sahara reveal that lockdowns have created anxiety over food security as a health, economic and human rights/well-being issue. By applying a probit model, we find that concern about the local spread of COVID-19 and economic impact of the virus increases the probability of food worries. Governments have responded with various efforts to support the neediest. By evaluating the various policies rolled out we advocate for a feminist economics approach that necessitates greater use of data analytics to predict the likely impacts of intended regulatory relief responses during the recovery process and post-COVID-19. [ABSTRACT FROM AUTHOR]

Part C early intervention (EI) providers are at the front line of service provision for children under 3 years old with developmental delays or disabilities. As such, they can play a key role in both the early detection of autism spectrum disorder (ASD) and the provision of ASD-specialized treatment. Focus groups were conducted with 25 EI providers from three agencies in a Northwestern U.S. county to understand their role in the identification of ASD and communication about ASD concerns to families. Results revealed the tension that providers experience between maintaining a positive and supportive relationship with families and raising the issue of possible ASD. Cultural influences affecting ASD care and suggestions for desired resources were also discussed. [ABSTRACT FROM AUTHOR]

Younger siblings of children with autism spectrum disorders (HR-Sibs) are at elevated risk for social communication deficits and language delays. One way to mitigate this risk early, before these deficits and delays become clear or impairing, may be to equip parents to use the strategies taught through the Im proving P arents a s C ommunication T eachers (ImPACT) intervention. In this randomized control trial, 97 HR-Sibs (mean age 14 months) and their primary caregiver were randomized to either ImPACT or a business-as-usual control group. Our a priori, preregistered hypothesis was that parents' participation in ImPACT training would indirectly attenuate younger siblings' social communication challenges 9 months later by sequentially increasing parents' use of ImPACT strategies immediately after the intervention phase and by improving children's midpoint proximal skills (e.g. motor imitation or intentional communication). Results supported this prediction. Later born siblings of children with autism spectrum disorders (ASD) are at elevated risk for language delay or ASD. One way to manage this risk may be for parents to use techniques taught in Im proving P arents a s C ommunication T eachers (ImPACT) with the younger siblings during the period in which language delay and ASD may be too subtle to be diagnosed. ImPACT targets children's play, imitation, and communication skills. Improvement in these skills may reduce the severity of language delays and social communication deficits associated with ASD. In this study, 97 younger siblings of children with ASD and their primary parents were randomly assigned to ImPACT or a control group. We measured whether parents used ImPACT teaching strategies and whether children used the skills that ImPACT targets. We also measured children's later language ability and social communication skills. The results confirmed our predictions that parents' use of ImPACT strategies improves language ability by improving children's motor imitation and communication skills. Use of ImPACT also had a positive effect on children's language delay and ASD symptoms, supporting the clinical value of the findings. The study's methodological strengths make this one of the most rigorous tests of ImPACT and supports one way to manage the risk of language delay and ASD in younger siblings of children with ASD. [ABSTRACT FROM AUTHOR]

In this second of two primary papers, we examined moderators of treatment effects for younger siblings of children with autism spectrum disorders whose parents were taught to use a parent-implemented intervention called "Improving Parents As Communication Teachers". Investigators randomized 97 high-risk siblings and their primary parent to either the Improving Parents As Communication Teachers or control group, used intent-to-treat analysis, and used assessors and coders who were blinded to group assignment. We hypothesized that a cumulative risk score (incorporating younger siblings' sex, multiplex status, and behavioral risk) would moderate the effect of Improving Parents As Communication Teachers on younger siblings' proximal skills related to their continuously measured communication challenges. Pre-intervention level of parents' depressive symptoms was the proposed moderator of Improving Parents As Communication Teachers on parenting-related stress and parenting efficacy. In high-risk siblings with no additional risk factors (i.e. girls with only one older sibling with autism spectrum disorder and who score at low risk on an autism spectrum disorder screen), parental receipt of Improving Parents As Communication Teachers training had indirect effects on children's expressive language ability or autism spectrum disorder diagnosis through earlier effects on high-risk siblings' intentional communication or expressive vocabulary. "Improving Parents As Communication Teachers" intervention did not show moderated or total effects on parenting-related stress or parenting efficacy. In this second of two primary papers, we examined two pre-intervention characteristics that might describe for whom a parent-implemented intervention, "Improving Parents As Communication Teachers," worked. Investigators randomized 97 high-risk siblings and their primary parent to either the Improving Parents As Communication Teachers or control group, used intent-to-treat analysis, and used assessors and coders who were blinded to group assignment. We predicted that a combined risk score (incorporating young siblings' sex, multiplex status, and behavioral risk) would describe the subgroup for whom Improving Parents As Communication Teachers affected the targeted skills related to reducing communication challenges. We also predicted that pre-intervention level of parents' depressive symptoms would describe the parents whose parenting stress and effectiveness as parents would be improved by learning to use Improving Parents As Communication Teachers. In girls with only one older sibling with autism spectrum disorder and who scored at low risk on an autism spectrum disorder screen, parental receipt of Improving Parents As Communication Teachers training had an indirect effect on children's expressive language ability or autism spectrum disorder diagnosis through earlier effects on high-risk siblings' intentional communication or expressive vocabulary. We did not confirm our prediction regarding Improving Parents As Communication Teachers' effect on parenting-related stress or sense of parenting effectiveness. [ABSTRACT FROM AUTHOR]