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High comorbidity and diagnostic overlap between autism spectrum disorder and social anxiety disorder have been documented. We examined if differences in adaptive behavior, essential for daily functioning, could differentiate these conditions among young university students. Eighty-eight autistic and 123 non-autistic undergraduates were categorized into four groups: autistic individuals: with low (n = 26)/high (n = 62) social anxiety (SA) symptoms; non-autistic: with low (n = 63)/high (n = 60) SA. The Adaptive Behavior Assessment System (ABAS) was utilized to assess three domains of adaptive skills essential for daily functioning: conceptual (academic and communication abilities), social (relationships and understanding social cues), and practical (everyday tasks such as self-care and work). Autistic students, regardless of SA level, reported ABAS scores within the low average range for the conceptual adaptive behavior domain, while non-autistic students had average scores. In terms of ABAS social adaptive behavior scores, both autistic and non-autistic groups with high levels of SA had low average scores. Conversely, those with low SA, whether autistic or non-autistic, exhibited average scores. These results were supported by the regression analyses outcomes. While autism traits and social anxiety showed medium (β=-0.37) and small (β=-0.27) effects, respectively, on conceptual adaptive scores, only social anxiety exhibited significant (medium) effects on social (β=-0.41) and practical (β=-0.34) adaptive scores. Reduced conceptual skills, previously linked to communication and executive function, may distinguish autism from social anxiety. Implications for research and practice are discussed., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest related to this study. No financial, personal, or professional relationships that could influence the work reported in this manuscript have been disclosed., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Autism spectrum disorder (ASD) involves challenges in communication and social interaction, including challenges in recognizing emotions. Existing technological solutions aim to improve social behaviors in individuals with ASD by providing learning aids. This paper presents a real-time environmental translator designed to enhance social behaviors in individuals with ASD using sensory substitution. Our system utilizes vibrotactile and visual feedback to interpret and convey emotional states through vibration patterns emitted from small vibration motors on the user's temple, complemented by color-coded displays of emotional intensity. It can detect seven emotions: neutral, sad, happy, angry, disgust, surprise, and fear. Testing with adults with ASD showed they could adapt to the system in about 19 min, enabling them to intuitively and immediately recognize others' emotions. This innovative approach presents a promising advancement in emotion recognition technology for individuals with ASD, offering potential benefits in enhancing their social interactions and communication skills., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: This study investigated the impact of dog training intervention (DTI) on verbal, non-verbal, and maladaptive behaviors in autistic preschoolers. Previous research has demonstrated the benefits of animal-assisted interventions, but this study specifically focused on changes during the DTI., Methods: We analyzed video recordings of 37 autistic children (mean age 4:7 years, SD = 1:1) from special education preschools, comparing their behaviors during the initial and final intervention sessions. The intervention, consisting of 17 structured stages, progressively introduced the children to dog interactions, ultimately allowing them to act as dog trainers. Behavioral analysis was divided into two main areas: responses to the therapist's instructions and self-initiated behaviors observed in interactions with the therapist and the dog., Results: Post-intervention results indicated a notable increase in non-verbal communication, with more sustained self-initiated eye contact, gestures, and facial expressions and increased verbal commands directed toward the dog. Improvements were also seen in therapist-prompted gestures and joint attention, and question-answer interactions with the therapist. However, a decrease was observed in self-initiated eye contact, duration of eye contact, and verbal sharing with the therapist. Maladaptive behaviors, such as inappropriate physical contact and repetitive movements, decreased. The study found a moderate negative correlation between autism severity and responsiveness to therapist instructions and a moderate positive correlation between IQ and improvements in therapist responsiveness., Discussion: These findings support the growing evidence for the efficacy of dog-assisted interventions and emphasize the importance of tailoring interventions to individual child characteristics., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Polak-Passy, Ben-Itzchak and Zachor.)

Background: Cognitively able autistic adults demonstrate low rates of employment due to social and vocational challenges. The current study aimed to examine changes in various areas among autistic young adults who participated in the 'Roim Rachok' ('Looking Ahead' in Hebrew) Training Course (RRTC). The course prepares young autistic adults for integration into military service as vocational soldiers., Methods: The study included 49 autistic participants who completed the RRTC in one of three vocational fields: Digital ( n  = 19), Technical ( n  = 9), and Visual ( n  = 21). Evaluations at the beginning and end of the course included adaptive behavior (Adaptive Behavior Assessment Scale 2 nd Edition [ABAS-II]), autism symptom severity (Social Responsiveness Scale 2nd Edition [SRS-II]), and communication skills (Faux Pas; Empathy Quotient [EQ]; Friendship Quality Scale; Conversation task based on Yale in vivo Pragmatic Protocol [YiPP])., Results: The results revealed a significant Time effect for the self-reported ABAS-II conceptual, social, and practical subdomains, EQ empathy quotient subdomain, Faux Pas, and SRS-II social communication interaction scores. Accordingly, participants reported increasing their adaptive skills, emotional empathy, and the ability to detect and interpret awkward statements, and decreased in their social communication interaction symptoms, following the RRTC. No significant Time x Group interaction was found for any of the examined measures, meaning similar trends were observed in all three vocational groups., Conclusion: Following the RRTC, participants reported significant improvements in areas essential for their future integration as soldiers in the military and as employees in the vocational world. Implications of the study findings are discussed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lousky, Selanikyo, Tubul-Lavy and Ben-Itzchak.)

Purpose: Follow-up studies of children diagnosed with autism spectrum disorder (ASD) in early childhood that focus on friendship formation during adolescence are scarce. The present study focused on exploring characteristics possibly related to the ability to establish friendships during adolescence among children diagnosed with ASD in toddlerhood., Methods: The cohort included 43 participants who underwent comprehensive assessments during toddlerhood and adolescence. Participants were divided into two groups [Friendship(+)/Friendship(-)] based on (1) adolescent social insight as assessed by professionals and (2) parental and adolescent self-reports regarding having or not having friends. No differences in IQ, ASD symptoms, or adaptive behavior during early childhood were found between the two groups., Results: Different and better changes in social communication, adaptive socialization, and daily living skills were observed for the Friendship(+) group. Adolescents with ASD in the Friendship(+) group exhibited greater social independence. Attention-deficit/hyperactivity disorder incidence, anxiety symptom severity, and placement in mainstream or special education classes did not differ between the two groups., Conclusion: This long-term study highlights that for children with ASD, longitudinal growth in social communication and adaptive functioning is possible, highly important for and related to the development of the complex ability to establish friendship., (© 2024. The Author(s).)

Purpose: Only a few studies examined the longitudinal pattern of parent-teacher reports on autism severity and comorbidities in autism spectrum disorder (ASD) and yielded conflicting results. The study's aims were to compare parents and teachers' perception of autism, attention deficit hyperactivity disorder (ADHD) and anxiety symptoms severity in children with ASD, at the start (T1) and end (T2) of the school year, to assess changes in their perception over time and to examine correlations between their reports., Methods: The study included 73 participants, (M = 61), aged 2:10 - 7:6 years (M = 4:10, SD = 1:0), who attended ASD special education classes and were receiving intensive interventions. Parents and teachers completed measures of autism severity and ADHD and anxiety symptoms at T1 and T2., Results: Teachers, in comparison to parents, rated more severe social-communication impairments and inattention symptoms at T1, but not at T2. A significant improvement in teachers' ratings of autism and inattention symptoms severity was documented at T2. At both time points, parents reported more severe anxiety symptoms. Significant correlations between parents' and teachers' reports were noted for autism severity at T1 and T2, but not for inattention and anxiety symptoms severity., Conclusion: The study emphasizes the contribution of multiple perspectives for better collaboration between home and school environments. Obtaining accurate information from parents and teachers at the start of the school year may help to identify factors needed for better adjustment at school and to better address difficulties at home., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Concerns raised by parents regarding their child's development are compatible with the child's final diagnosis of autism spectrum disorder. A better understanding of the relationship between parental concerns and a final diagnosis of autism spectrum disorder is therefore critical. In the current study, we compared the frequencies of parental concerns related to DSM-5 criteria for autism spectrum disorder between pair-matched groups with and without a final diagnosis of autism spectrum disorder and determined which parental concerns predicted a final diagnosis of autism spectrum disorder. The cohort included 80 participants (48-154 months of age, IQ > 70) assessed for a possible autism spectrum disorder diagnosis. Parental concerns were retrieved from the free-description portion of the introductory questions of the Autism Diagnostic Interview-Revised and analyzed to assess whether they corresponded to any of the seven DSM-5 criteria for ASD. The two groups only differed in the frequency of parental concerns relating to deficits in social-emotional reciprocity. Parents of children diagnosed with autism spectrum disorder were four times as likely to report deficits in social-emotional reciprocity. This finding highlights the significance of parental concerns regarding deficits in social-emotional reciprocity in predicting a final diagnosis of autism spectrum disorder.

Background: Previous research on autistic students enrolled in university support programs has reported moderate improvement in anxiety/depression or adaptive behavior. However, alterations in autistic traits have not been examined., Methods: This longitudinal study evaluated changes in university students' autistic trait and state/trait anxiety levels. Participants were 24 neurotypically developed (ND) students with high levels of social anxiety symptoms (High SA), 30 ND students with low levels of SA symptoms (Low SA), and 41 autistic students (the primary focus of this study) residing with an ND peer student mentor as part of participating in the university's integration support program. Autism spectrum quotient [AQ and State Trait Anxiety Inventory STAI] data were collected during the first semester of two consecutive academic years (T1, T2), as well as baseline (T1) levels of social anxiety, depression, and obsessive-compulsive symptoms., Results: Significant interaction between group and time was observed, denoting a sharp decrease (2.9 SD) from T1 to T2 in the overall autistic trait level among the autistic group (AQ "attention switching" subscale demonstrating the most robust decrease), and a moderate decrease (0.5 SD) among the high SA group. Only for the autistic students were more compulsive symptoms at T1 associated with a lesser decrease in AQ scores (T1-T2), which in turn was negatively correlated with their T1 year-end grade point average., Conclusion: The findings suggest that attending post-secondary education (while partaking in a support/transition program) is followed by a profound change of the individual's subjective experience of autism, characterized by a sharp decline in the level of autistic traits, particularly attention switching. This change is independent of alterations in well-being indices, such as anxiety, that are known to characterize students attending university., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zukerman, Yahav and Ben-Itzchak.)

The rising prevalence of autism spectrum disorder (ASD) has increased awareness of the need for early diagnosis and intervention; however, not all children are diagnosed at preschool age. In the literature, findings regarding factors that may play a role in later diagnosis are inconsistent. Presence or absence of intellectual disability is a possible factor. This study aimed to identify factors associated with later diagnosis of ASD among children grouped according to low and high cognitive levels. Data of children who were previously diagnosed with ASD between 2002 and 2016 at a national autism center were analyzed. Better cognitive ability, having more siblings, and previous diagnosis of attention-deficit/hyperactivity disorder were predictors of later diagnosis among the entire cohort. Children exhibiting lower cognitive levels (LC-ASD; DQ/IQ < 70; n = 209) were diagnosed much earlier. Among this group, later ASD diagnosis was predicted by poorer adaptive behavior, more severe restricted and repetitive behaviors, and previous diagnosis of epilepsy. In the higher cognitive level group (HC-ASD; DQ/IQ ≥ 70; n = 321), familial variables and more severe social impairments were predictors of later ASD diagnosis. Clinicians should be aware of variables that may affect ASD diagnostic age among children with varying cognitive abilities., (Copyright © 2022. Published by Elsevier B.V.)

In recent years, more young adults with ASD are attending post-secondary education, and several support programs have been proposed for this population. However, research regarding the long-term effects of university enrollment on outcomes among students with ASD is scarce. This study examined adaptive behavior and psychiatric symptoms during the first semester of two consecutive academic years (T1, T2) among 39 students with ASD, 29 students without ASD and high levels of social anxiety symptoms (High SA), and 32 students without ASD and low levels of SA symptoms (Low SA). Students with ASD participated in a university support program and resided with a peer mentor student without ASD, which encouraged social interaction. At T1, students with ASD reported lower levels of adaptive behavior and higher levels of social anxiety and obsessive-compulsive symptoms compared to the other groups. However, at follow-up (T2), significantly higher conceptual adaptive skill levels (specifically communication skills) and significantly lower depression symptom levels from T1 were reported only among students with ASD. The levels of social anxiety and obsessive-compulsive symptoms at T1 were negatively associated with adaptive functioning a year later (T2). Implications regarding adults with ASD attending university are discussed., (Copyright © 2022. Published by Elsevier B.V.)

Daily functioning involves identifying emotions in spoken language, a fundamental aspect of social interactions. To date, there is inconsistent evidence in the literature on whether individuals with autism spectrum disorder without intellectual disability (ASD-without-ID) experience difficulties in identification of spoken emotions. We conducted a meta-analysis (literature search following the PRISMA guidelines), with 26 data sets (taken from 23 peer-reviewed journal articles) comparing individuals with ASD-without-ID (N = 614) and typically-developed (TD) controls (N = 640), from nine countries and in seven languages (published until February 2020). In our analyses there was no sufficient evidence to suggest that individuals with HF-ASD differ from matched controls in the identification of simple prosodic emotions (e.g., sadness, happiness). However, individuals with ASD-without-ID were found to perform significantly worse than controls in identification of complex prosodic emotions (e.g., envy and boredom). The level of the semantic content of the stimuli presented (e.g., sentences vs. strings of digits) was not found to have an impact on the results. In conclusion, the difference in findings between simple and complex emotions calls for a new-look on emotion processing in ASD-without-ID. Intervention programs may rely on the intact abilities of individuals with ASD-without-ID to process simple emotions and target improved performance with complex emotions. LAY SUMMARY: Individuals with autism spectrum disorder without intellectual disability (ASD-without-ID) do not differ from matched controls in the identification of simple prosodic emotions (e.g., sadness, happiness). However, they were found to perform significantly worse than controls in the identification of complex prosodic emotions (e.g., envy, boredom). This was found in a meta-analysis of 26 data sets with 1254 participants from nine countries and in seven languages. Intervention programs may rely on the intact abilities of individuals with ASD-without-ID to process simple emotions., (© 2021 International Society for Autism Research and Wiley Periodicals LLC.)

Lay Abstract: There is some evidence that using therapy dogs for children with autism spectrum disorder generally results in improved social communication skills and reduced behavioral problems. However, well-controlled studies that examine its effectiveness are scarce. This study examined the effectiveness of a "Dog Training Intervention." The study included 73 participants diagnosed with autism spectrum disorder (61 males, 12 females) with age range of 2:10-7:6 years ( M = 4:10 ± 1:0) who attend autism spectrum disorder-specific special education schools. The study population was divided into two groups. Each group received the dog training intervention during one part of the school year (first half or second half) in addition to the standard interventions provided by the special education school settings. The dog training intervention was given twice weekly for 4 months within the school setting. The group that received the dog training intervention first showed a significant increase in adaptive social and communication skills in comparison to the second group that did not receive the intervention in this period. This improvement was maintained after the dog training intervention. The second group, which received intervention at the second half of the year, showed improvement in communication and socialization adaptive skills only during the period in which they received the dog training intervention. The positive impact on social communication adaptive skills of the dog training intervention among young children with autism spectrum disorder suggests that dogs may serve as an effective model for establishing social interaction. Dog training intervention appears to be an effective adjunct treatment to the interventions provided in special education schools for young children with autism spectrum disorder.

The gap between cognitive ability and adaptive behavior has been thought to enhance psychopathology among people with autism, particularly among those without intellectual disability. We examined this association by exploring the gap between cognitive understanding of social behavior and socially adaptive behavior, and its impact on social anxiety symptoms, obsessive-compulsive symptoms, and depressive symptoms, among 53 university students with autism (without intellectual disability). A higher cognition-social adaptation discrepancy was associated with more social anxiety, but this effect was moderated by autistic trait (AT) levels; a greater gap was associated with more avoidance symptoms of social anxiety only among students with high AT. Cognitive flexibility and prosocial behavior may mitigate the effects of AT. Potential implications and interventions are discussed.

Lay Abstract: Early intensive applied behaviour analysis-based interventions are designed to support young autistic children's learning and development. Unfortunately, the available evidence about the effectiveness of these interventions remains unclear. Several reviews have focused on the published findings rather than contacting the authors to collect and analyse data about the individual participants in the original studies. Also, most of the studies were carried out by groups involved in delivering the interventions leading to the potential bias in interpreting the results. Our research team (supported by an international advisory group) carried out an independent individual patient data review by collecting the original participant data from the authors of the studies, to examine the effectiveness of these interventions. The results suggested that early intensive applied behaviour analysis-based interventions might lead to some changes in children's cognitive ability (intelligence quotient) and everyday life skills after 2 years, compared with standard treatments. However, all the studies had problems with the way they were designed. Also, few of the studies looked at outcomes that have been described as most important to autistic people or followed children beyond 2 years. We think that further systematic reviews of the existing evidence are unlikely to add to the findings of our review. Furthermore, we recommend that future research should investigate which types of supports and interventions are most effective for children and families, prioritising outcomes measures that are meaningful for the autism community and include, wherever possible, longer-term follow-up.

Anxiety is one of the most common comorbidities in youth with autism spectrum disorder (ASD). The current study's aims were: To examine the frequency of elevated anxiety symptoms in adolescents diagnosed with ASD in toddlerhood; To explore the impact of comorbid anxiety in adolescents on clinical presentation; To evaluate variables in toddlerhood that associate with anxiety symptom severity in adolescence. The study included 61 adolescents (mean age = 13:8y) diagnosed with ASD in toddlerhood (T1). Participants underwent a comprehensive assessment of cognitive ability, adaptive skills and autism severity at T1 and again as adolescents (T2), and an evaluation of anxiety symptoms at T2. For the first aim, the most prevalent anxiety subtypes noted in adolescence were separation (39.3%), social (27.9%) and generalized anxiety (18.0%). For the second aim, cognitive ability, autism severity and adaptive skills in adolescents with and without elevated anxiety symptoms scores of any type did not differ significantly. For the third aim, younger age at adolescence was associated with more severe separation and generalized anxiety symptoms. Higher cognitive ability and adaptive skills in toddlerhood were associated with elevated generalized anxiety symptoms in adolescence. Lower adaptive behaviors and repetitive behaviors (RRBs) correlated with elevated social anxiety symptoms. Lower cognitive abilities and more severe RRBs in toddlerhood predicted separation anxiety in adolescence. The study sheds light on early characteristics in ASD that associate with anxiety symptom severity in adolescence. The type of elevated anxiety symptoms presented in adolescence associated with the level of cognitive ability, adaptive skills and RRBs in toddlerhood.

This study is one of a very few prospective long-term studies in autism spectrum disorder (ASD). The study compared outcome trajectories in three adolescent groups (T2): "best outcome" (BO, n = 11) did not meet cut-off points for ASD and IQ scores ≥85; high functioning (HF-ASD, n = 14); and lower functioning (LF-ASD, n = 43). Additionally, the study searched for characteristics at toddlerhood (T1) that may predict belonging to the above groups. The study included 68 adolescents (63 males) diagnosed with ASD at toddlerhood (mean age: 13:10 years), mean follow-up time was 11:7 years. Participants underwent comprehensive assessments at T1 and T2. Different trajectories were found for the three defined groups. The BO group improved significantly in cognitive ability, autism severity, and adaptive skills in comparison to no improvement for the LF-ASD group or partial progress for the HF-ASD group. At toddlerhood, better cognition and less severe autism social affect symptoms were generally associated with a better outcome. Early social behaviors including better "pointing," "facial expression directed to others," "showing," and "response to joint attention" were associated with membership in the BO group. In addition, the BO group had the lowest prevalence of significant T2 inattention and anxiety symptoms. No significant differences between the three outcome groups were noted in the birth and prevalence of medical problems. Higher cognitive ability and better T1 showing and pointing behaviors predicted better outcome. The study points to the change in autism severity over time and to the prognostic value of early developmental abilities, social engagement behaviors, and the existence of comorbidities. Autism Res 2020, 13: 1130-1143. © 2020 International Society for Autism Research and Wiley Periodicals LLC. LAY SUMMARY: This long-term study compared characteristics of toddlers diagnosed with autism spectrum disorder (ASD) in three outcome groups in adolescence: best outcome (BO-average IQ/not meeting criteria for ASD), high-functioning ASD, and low-functioning ASD (LF-ASD). At toddlerhood, the BO group displayed less severe autism symptoms, mostly in sharing interests, compared to the LF-ASD group. The BO group had fewer inattention and anxiety symptoms than the two ASD groups. Additionally, early cognitive level and social engagement behaviors predicted outcome in ASD., (© 2020 International Society for Autism Research and Wiley Periodicals LLC.)

Identifying emotions in speech is based on the interaction of lexical content and prosody. This may be disrupted in individuals with High-Functioning Autism Spectrum Disorder (HF-ASD). Undergraduates with HF-ASD (n = 20) and matched typically developed peers (n = 20) were tested using the (Hebrew) Test for Rating of Emotions in Speech. Participants rated the degree to which a target-emotion is present in spoken sentences, in which the emotional-lexical and -prosodic content appear in different combinations from trial to trial. No group differences were found in measures of emotion-identification, selective-attention (focusing on one target-channel) and integration. These preserved abilities can partially explain the high levels of independence and self-control characterizing students with HF-ASD. Support programs may rely on such skills to improve social interactions.

This prospective study examined the developmental changes over time of adolescents diagnosed in toddlerhood with autism spectrum disorder and searched for child characteristics at toddlerhood that predict outcome at adolescence. The study included 65 participants who were divided into low cognitive (developmental quotient < 85; N = 41) and high cognitive (developmental quotient ⩾ 85; N = 21) groups in adolescence. Participants underwent a comprehensive assessment of cognitive ability, adaptive skills, and autism severity. Significant differences in the current clinical phenotypes and in developmental changes over time were found between the two cognitive groups. At baseline, the high cognitive group had significantly less severe social communication deficits. Only the high cognitive group showed a decrease in social communication deficits over time. Although the two groups did not differ in their adaptive skills at the time of diagnosis, the high cognitive group had better adaptive skills at adolescence. Better adaptive communication skills in toddlerhood were associated with better outcome at adolescence in cognitive ability, adaptive skills, and fewer autism symptoms. Less impaired baseline social affect and better cognitive ability predicted higher cognitive level and adaptive skills at adolescence. Cognitive potential of individuals with autism spectrum disorder plays an important role in long-term outcome and comprehensive evaluations at toddlerhood have strong prognostic value in adolescence.

Narrative impairments are common in autism spectrum disorders (ASDs). The Autism Diagnostic Observation Schedule (ADOS) battery includes a story-telling activity using a picture book called Tuesday . The current study aimed to identify differences between children with ASD and children with typical development (TD) on the production of Tuesday narratives, with a special focus on semantic-pragmatic aspects. Participants were 48 cognitively-able boys, in the age range of 4;10-7;0 years. Twenty-four participants were boys with ASD and 24 participants were TD boys. The semantic-pragmatic analysis included measures of: story details (characters setting, objects, and actions), central ideas, evaluative comments, and unrelated text. Results showed that the narratives produced by children with ASD included fewer central ideas, and fewer settings, characters, and actions, but not objects, as compared with the narratives produced by their TD peers. The number of evaluative comments and utterances that were unrelated to the story did not differ between the groups. A negative correlation was found between the autism severity level and the number of central ideas and number of characters mentioned in the narratives of the ASD participants. Taken together, as a group, these findings point to a semantic-pragmatic impairment in ASD. However, individual analysis revealed heterogeneity within the ASD group in this area. Some of the results may be explained by cognitive deficits in maintaining central coherence (the Weak Central Coherence account). This study has important clinical implications. Defining the specific differentiating measures can maximize the use of the ADOS story-telling activity by clinicians. The association found between the autism severity level and some of the semantic measures can be used in evaluating the severity of the ASD symptoms., (Copyright © 2019 Kenan, Zachor, Watson and Ben-Itzchak.)

Family accommodation occurs frequently among families of children with OCD and anxiety disorders, with higher levels of accommodation repeatedly associated with greater symptom severity, lower functioning, and poorer treatment outcomes for children. This is the first examination of family accommodation of restricted and repetitive behaviors (RRBs) in children with autism spectrum disorder (ASD). Parents of children with ASD (N = 86) completed questionnaires assessing their children's RRBs and parental accommodation of these symptoms. Most participants (80%) reported engaging in accommodation at least once a month and family accommodation was significantly positively correlated with RRB severity. These results suggest accommodation of RRBs follows a pattern similar to that reported in obsessive compulsive and anxiety disorders, and highlight avenues for potential parent-based interventions.

Research findings indicate that anxiety, social anxiety in particular, is the most common experience reported by individuals with autism spectrum disorder (ASD) attending postsecondary education. Among students without ASD, higher levels of social anxiety have been postulated to correlate with impaired academic achievement; restriction of one's social network because of anxiety is thought to lead to reduction of access to resources important for learning such as social/emotional support and collaborative learning. However, despite growing interest in the outcomes of young students with ASD, no research has studied the associations between academic achievement and anxiety among students with ASD. This study examined the association between social anxiety and grade point average (GPA) among university students: 55 diagnosed with ASD, 31 without ASD but high levels of social anxiety, and 25 without ASD and with low levels of social anxiety (controls). GPAs were significantly lower for the ASD group than for the two non-ASD groups. Among students without ASD, a negative correlation between social anxiety and grades was observed whereas the reverse pattern was found for the ASD group, meaning that for students with ASD, higher levels of social anxiety were associated with higher grades. Additionally, in a regression analysis, ASD diagnosis, social anxiety, and the interaction of group × social anxiety significantly predicted GPA. Possible explanations for this finding, as well as implications for interventions among this population of high-functioning students with ASD, are discussed. Autism Res 2019, 12: 1376-1385. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study compared the relationship between levels of social anxiety and grades in students with autism spectrum disorder (ASD) and in students without ASD who had either high social anxiety or low social anxiety (controls). Among the group with ASD, higher levels of social anxiety were associated with higher grades, whereas the reverse pattern was found among the other groups. This finding's implications for interventions among students with ASD are discussed., (© 2019 International Society for Autism Research, Wiley Periodicals, Inc.)

High rates of attention deficit/hyperactivity disorder (ADHD) comorbidity have been described in autism spectrum disorder (ASD). This study searched for predictors at toddlerhood of the severity of ADHD symptoms at adolescence. The study included 65 participants, (mean age = 13:8 year), diagnosed with ASD at toddlerhood. Participants underwent a comprehensive assessment of cognitive ability, adaptive skills and autism severity at toddlerhood and adolescence. More severe restricted and repetitive behaviors (RRB) in toddlerhood predicted the severity of Inattention symptoms. In addition, more severe RRB and lower adaptive skills in the toddler years significantly predicted the severity of Hyperactivity/Impulsivity symptoms. Adolescents with elevated ADHD symptoms diagnosed at toddlerhood with ASD showed lower cognitive and adaptive skills and more severe autism symptoms.

Sibling relationships play a unique developmental role, especially in emotional and social domains. In autism spectrum disorder (ASD), social-communication skills are often impaired in comparison to typical development. Therefore, studying siblings' effects on social skills of the child with ASD is important. This retrospective study examined how autism severity and functioning were affected by having older and younger sibling/s, the sex of the index child and of the sibling, and the number of siblings. The study population included 150 participants with ASD (mean age = 4:0 ± 1:6), divided into three equal groups (no sibling, older and younger siblings), matched for cognitive level. The evaluation included neurological and standardized behavioral, cognitive, and functional assessments. Children with ASD with older siblings showed less severe social interaction deficits and better social adaptive skills than only children. No significant differences in autism severity and adaptive functioning were noted between the group with younger siblings and the other groups. The more older siblings the affected child had, the better their social functioning. The sex of the participants with ASD and that of the sibling were not associated with social functioning. Social interaction deficits, the presence of older or younger siblings for children with ASD, and higher cognitive ability contributed significantly to the explained variance (48.9%) in social adaptive skills. These findings emphasize that older siblings positively influence the social skills of their younger sibling with ASD. The effect of typically developing younger siblings was modest and seen only in children with ASD and better cognition.

High variability in adaptive behavior in cognitively-able adults with autism spectrum disorder has been previously reported, and may be caused by the high prevalence of psychiatric comorbidity in this population. This study's goals were to examine self-reported psychiatric symptoms in students with ASD, and to identify their relative contribution to the variance in adaptive behaviors. The study population included 95 students: 55 diagnosed with ASD (4 females; age range 18-34) who participated in a university integration program (ASD group), and 40 regularly matriculated students (non-ASD group, 7 females; age range 20-36). The ASD group showed a lower adaptive skill level than the non-ASD group as measured by the Adaptive Behavior Assessment System (GAC-ABAS). Significantly higher scores for the ASD group were found for social anxiety, trait anxiety, obsessive-compulsive symptoms, and depression symptoms. The level of adaptive skills correlated negatively and significantly with the severity of social anxiety symptoms in both groups and with severity of obsessive-compulsive symptoms only in the ASD group. Additionally, in a regression model, significant contributions of having an ASD diagnosis and severity of social anxiety explained 41.7% of the variance in adaptive skills. Adequate evaluation and treatment, if needed, are recommended in this population., (Copyright © 2019 Elsevier B.V. All rights reserved.)

High rates of attention deficit/hyperactivity disorder (ADHD) and anxiety symptoms have been documented in autism spectrum disorder (ASD), and have been associated with social and adaptive impairments. The study examined the frequency of clinically elevated ADHD and anxiety symptoms in an ASD group in comparison to a non-clinical group, compared the clinical presentation in the ASD group with and without ADHD and anxiety, assessed which child and familial variables add to the severity of Inattention, Hyperactivity/Impulsivity (HI), and anxiety symptoms, and evaluated whether having clinically elevated ADHD and/or anxiety symptoms adds to the prediction of adaptive functioning in ASD. The study included 260 participants diagnosed with ASD (mean age: 7.5 ± 1.1), using standardized tests. The rate of clinically elevated ADHD and anxiety symptoms in ASD was 62.7 and 44.6%, respectively, and symptom severity was significantly greater than the non-clinical sample. The entire population was divided into four subgroups: ASD alone, ASD+ADHD, ASD+anxiety, ASD+ADHD+anxiety, based on the parental behavioral questionnaire. The ASD alone group showed less severe autism symptoms in comparison to the other groups. Having ASD+ADHD symptoms was associated with greater impairments in socialization adaptive skills. Only the group with ASD+ADHD+anxiety was associated with poorer daily living adaptive skills. Regression analyses for prediction of ADHD and anxiety symptoms revealed that being a female and having lower adaptive skills scores predicted higher Inattention severity; being older, having better cognition, and more severe Restrictive Repetitive Behavior symptoms predicted more severe HI symptoms; being older and having more severe social impairments predicted higher anxiety scores. A regression analysis for the prediction of adaptive skills revealed that in addition to cognition and autism severity, the severity of Inattention symptoms added to the prediction of overall adaptive skills. In light of these findings, clinicians should diagnose these comorbidities in ASD early on, and provide effective interventions to reduce their negative impact on functioning, thereby improving outcome.

ERP studies have associated posttraumatic stress disorder (PTSD) with enhanced P3 amplitudes in response to trauma-related stimuli, along with reduced amplitudes in the context of neutral (trauma-unrelated) stimuli. Additionally, a bias toward trauma-related stimuli is also observed among trauma-exposed participants not meeting criteria for PTSD, suggesting that trauma exposure itself, and not only the severity of posttraumatic stress (PTS), is a critical factor in information processing changes. However, previous examination of the response of trauma-exposed (PTSD and non-PTSD) participants to novel, neutral stimuli has produced conflicting findings. The current study examined ERPs in response to a novelty oddball paradigm comprised of neutral distractor sounds. Participants were 16 individuals with PTSD, 21 trauma-exposed individuals without PTSD, and 12 nontraumatized controls. Detailed trauma histories and PTS symptoms were collected. A significant effect of group on early ERPs was observed, showing an increase in the N1-P2 complex peak amplitude among the PTSD group, relative to controls. Among the entire sample, significant positive correlations were observed between PTS symptom severity, as well as trauma history, and early N1-P2 complex peak amplitudes, in response to novel stimuli. Furthermore, trauma-exposed participants with no PTS symptoms exhibited larger N1 amplitudes compared to participants with no trauma history. No trauma-related alterations in later ERP components were observed. These results suggest that trauma exposure may lead to hyperarousal at early processing levels, even in response to neutral novel stimuli. The findings concur with the neurocircuitry model that associates PTSD with hyperresponsivity of the amygdala., (© 2018 Society for Psychophysiological Research.)

Understanding one's own emotions is an important part of social-emotional development in early childhood. Few studies have looked at the ability of children with autism spectrum disorder (ASD) to relate their own emotions to previous life events. Our previous study showed that the description of events that elicited specific emotions is qualitatively and quantitatively different in ASD in comparison to typically developing (TD) pre-adolescents. The current study evaluated differences in coherence and content of responses to questions on emotions in ASD and TD in two age groups. The evaluation was based on the section on Emotions of the Autism Diagnostic Observation Schedule Module 3 test. The study included 96 boys, 48 diagnosed with ASD (IQ≥85) and 48 TD children, divided into younger (6:0-8:0y) and older (8:2-11:0y) groups. Young TD children were able to give coherent responses to questions on experiences that evoked basic emotions. Children with ASD gave fewer coherent responses and more 'no response' and 'odd' responses across the examined age range. Only in the TD group was the level of vocabulary associated with the number of coherent statements. TD children gave more responses with content related to interpersonal relationships, self-awareness and social events than children with ASD. Deficits in coherence and content of responses to questions on emotions related to previous life events derive from the core deficits of ASD. The significant quantitative and qualitative gap that exists between ASD and TD may be useful during the diagnostic process of ASD in childhood.

Aim: Outdoor adventure programmes aim to improve interpersonal relationships using adventurous activities. The current study examined the effectiveness of an outdoor adventure programme in children with autism spectrum disorders (ASD)., Method: The study included 51 participants (40 males, 11 females; age 3y 4mo-7y 4mo) enrolled in ASD special education kindergartens. Only the intervention group (n=30) participated in the outdoor adventure programme for 13 weeks, completing challenging physical activities that required cooperation and communication with peers and instructors. The control group (n=21) was not significantly different from the research group in age, sex, cognitive, and adaptive behaviour measures., Results: Outcomes after the intervention revealed significant improvement in social-communication and different directions in the two groups in the social cognition, social motivation, and autistic mannerisms subdomains of the Social Responsiveness Scale. While the group that received an outdoor adventure programme showed a tendency toward a reduction in severity, the control group showed the opposite (p<0.010)., Interpretation: The outdoor adventure programme required problem-solving skills and forced the child to communicate in exciting situations. This study suggests that an outdoor adventure programme may be an effective intervention in addition to traditional treatments in young children with ASD. Future studies should examine the outcome of outdoor adventure programmes delivered for longer periods of time and maintenance of the achievements over time., (© 2016 Mac Keith Press.)

Among typically developing children, having sibling relationships promotes the development of social skills. This is a retrospective study of the effect of having sibling/s on the severity of the clinical presentation of autism spectrum disorder (ASD). The study included 112 children, 99 males and 15 females, mean age 29.6 ± 9.2 months, diagnosed with ASD. The study population was composed of a group of children with ASD who had older typically developing sibling/s (n = 56) pair-matched for age and cognitive level to a group of children with ASD without sibling/s. Each participant underwent a comprehensive assessment using standardized tests. The group with older sibling/s had less severe observed social deficits (Autism Diagnostic Observation Schedule-Social Affect calibrated severity scales [ADOS-SA-CSS]) and fewer reported non-verbal communication impairments (Autism Diagnostic Interview-Revised [ADI-R]). Regression analyses revealed that, for the ADOS-SA-CSS, higher cognitive level and having older sibling/s were associated with less severe observed social affect deficits. This model explained 32.0 % of the variance. For the ADI-R communication scores, older age, higher cognitive level and having older sibling/s were associated with less severe reported non-verbal communication impairments. This model explained 33.0 % of the variance. The main finding in this study is that a familial factor, specifically having older sibling/s, was associated with better social communication abilities in children with ASD, in addition to age and cognitive ability. Having sibling/s may offer opportunities for the child with ASD to experience social interactions with children and to acquire communication skills.

Autism spectrum disorder (ASD) is a heterogeneous group of disorders which occurs with numerous medical conditions. In previous research, subtyping in ASD has been based mostly on cognitive ability and ASD symptom severity. The aim of the current study was to investigate whether specific medical conditions in ASD are associated with unique behavioral profiles. The medical conditions included in the study were macrocephaly, microcephaly, developmental regression, food selectivity, and sleep problems. The behavioral profile was composed of cognitive ability, adaptive skills, and autism severity, and was examined in each of the aforementioned medical conditions. The study population included 1224 participants, 1043 males and 181 females (M:F ratio = 5.8:1) with a mean age of 49.9 m (SD = 29.4) diagnosed with ASD using standardized tests. Groups with and without the specific medical conditions were compared on the behavioral measures. Developmental regression was present in 19% of the population and showed a more severe clinical presentation, with lower cognitive abilities, more severe ASD symptoms, and more impaired adaptive functioning. Microcephaly was observed in 6.3% of the population and was characterized by a lower cognitive ability and more impaired adaptive functioning in comparison to the normative head circumference (HC) group. Severe food selectivity was found in 9.8% and severe sleep problems in 5.1% of the ASD population. The food selectivity and sleep problem subgroups, both showed more severe autism symptoms only as described by the parents, but not per the professional assessment, and more impaired adaptive skills. Macrocephaly was observed in 7.9% of the ASD population and did not differ from the normative HC group in any of the examined behavioral measures. Based on these findings, two unique medical-behavioral subtypes in ASD that affect inherited traits of cognition and/or autism severity were suggested. The microcephaly phenotype occurred with more impaired cognition and the developmental regression phenotype with widespread, more severe impairments in cognition and autism severity. In contrast, severe food selectivity and sleep problems represent only comorbidities to ASD that affect functioning. Defining specific subgroups in ASD with a unique biological signature and specific behavioral phenotypes may help future genetic and neuroscience research.

There are still no straightforward answers as to whether understanding one's own emotions is impaired in autism spectrum disorder (ASD). This study evaluated the perception of one's own different emotions, based on the relevant section of the Autism Diagnostic Observation Schedule Module 3 test. Forty boys, aged 8-11 years, 20 diagnosed with ASD (IQ ≥ 85) and 20 typically developing children were included. Description of events that elicited specific emotions in ASD was characterized by more 'odd' statements and 'no responses' and less use of content related to 'social situations', 'interpersonal' and 'self-awareness'. More 'no responses' and odd statements were associated with the severity of ASD symptoms. Clinicians should be aware of these differentiating factors during the diagnostic process of ASD.

Variability in clinical expression and in intervention outcome has been described in autism spectrum disorder (ASD). The study examined progress after 1 and 2 years of intervention and compared the impact of baseline cognitive ability on outcome trajectories in 46 children (m = 25.5 months) with ASD. The entire group showed a gradual decrease in autism severity and increase in verbal cognitive scores. Only the low cognitive scores (DQ <70) group significantly improved in fine motor and receptive language scores. Significant gains in adaptive skills were found only for the high cognitive scores (DQ ≥70) group after 2 years of intervention. The entire group progressed with intervention, but only children with higher cognitive levels at baseline transferred their acquired socio-communication skills into daily functioning.

Autism spectrum disorder (ASD) is a heritable disorder occurring predominantly in males. The aim of this study was to compare sex differences in the prevalence of specific neurological phenotypes commonly described in ASD. The study included 663 participants, aged 18 months to 15 years, diagnosed with ASD. Neurological and behavioral assessments were performed using standardized tests, and obtaining medical, developmental, and familial histories from the parents. Phenotypes under investigation were macro- and microcephaly, developmental regression, minor neurological and musculoskeletal deficits (MNMD), and seizures. Male : female ratio in the ASD group was 6.7:1. No sex differences in autism severity, cognitive ability, and adaptive functioning were noted. Mean head circumference percentile for males (50.1 ± 25.6) was significantly larger than females (43.4 ± 30.2). Micro- and macrocephaly were more frequent in ASD than expected (5.9%; 18.1%, respectively). Microcephaly in females (15.1%) was significantly more prevalent than in males (4.5%). The prevalence of macrocephaly in both sexes did not differ significantly. Regression was noted in 30.2% of the females with ASD, significantly higher than in males (18.9%). MNMD was documented in 73.8% of the females, significantly higher than in males (57.1%). M:F ratio decreased in a group with two or more phenotypes (3.6:1), while male predominance was more significant in the group without phenotypes (13.6:1). Neurological phenotypes associated with ASD are more prevalent in females than in males, resulting in more complex clinical and neurological manifestations in females. Therefore, involvement of different etiologies is suggested in ASD in females., (© 2013 International Society for Autism Research, Wiley Periodicals, Inc.)

Unusual responses to sensory stimuli have been described in autism spectrum disorder (ASD).The study examined the frequencies of 'unusual sensory interests' and 'negative sensory responses' and their relation to functioning in a large ASD population (n = 679). Having 'unusual sensory interests' was reported in 70.4 % and 'negative sensory responses' in 66.0 % of the ASD group. Having 'unusual sensory interests' was associated with more severe reported and observed autism symptoms, lower cognitive ability and lower adaptive skills. In contrast, having 'negative sensory responses' was only associated with more severe reported stereotyped behaviors. It is suggested that having 'unusual sensory interests' is a part of a primary more severe type of ASD involving numerous developmental domains that might have a unique neurobiological origin.

Unlabelled: The relations between cognition and autism severity, head size and intervention outcome, were examined. Change in cognitive level with intervention was measured in children with autism and compared to children with developmental disabilities (DD). Eighty-one children (mean age 25.9 months) with autism (n=44) and DD (n=37) were assessed at pre- and post 1 year of intervention. Cognitive abilities and autism severity were measured by standardized tests. Three pre-intervention cognitive level groups: normal (IQ>90), borderline (70

Unlabelled: This study assessed the relation between pre-intervention variables (cognition, socialization and communication) to outcome in young children with autism., Method: Twenty five children with autism (20-32 months) were enrolled in intensive behavior intervention. The children were divided into groups based on their IQ scores and on the severity of their social interaction and communication deficits [per autism diagnostic observation schedule (ADOS) scores]. Six developmental-behavioral domains including, imitation, receptive language, expressive language, nonverbal communication skills, play skills and stereotyped behaviors were assessed at pre- and post-1 year of intervention times., Results: Significant progress was noted in all the six developmental-behavioral domains after 1 year of intervention. Children with higher initial cognitive levels and children with fewer measured early social interaction deficits showed better acquisition of skills in three developmental areas, receptive language, expressive language and play skills. Both groups showed better progress in Receptive language skills. Better progress in expressive language was associated with the child's social abilities, while more significant progress in play skills was related to pre-intervention cognitive level., Conclusions: These findings emphasize the importance of early intensive intervention in autism and the value of pre-intervention cognitive and social interaction levels for predicting outcome.