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Children with autism spectrum disorder (ASD) are often placed in inclusive mainstream education (ME) or exclusive special education (SE) settings. While ME settings usually offer less-intensive and structured intervention programs than SE settings, they offer more exposure to typically developing peers. A total of 121 children (2-5 years old) with ASD, 85 in SE and 36 in ME, completed two Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) assessments. Repeated-measures analysis of covariance (ANCOVA) analyses were used to assess longitudinal changes in ADOS-2 calibrated severity scores (CSS) and language production (estimated from the ADOS-2), while accounting for baseline cognitive scores, age of diagnosis, and parent-reported intensity of intervention. Longitudinal changes in ADOS CSS did not differ significantly across educational settings but were strongly associated with the age of diagnosis, demonstrating that children diagnosed earlier improved more regardless of educational settings. These findings suggest that children with ASD placed in SE and ME exhibit similar longitudinal changes in core ASD symptoms. Further studies comparing additional outcome measures such as cognitive abilities and adaptive behaviors are highly warranted for establishing placement recommendations and public health policies.

It is widely believed that early diagnosis and treatment of autism spectrum disorder is essential for better outcome. This is demonstrated by the American Academy of Pediatrics recommendation to screen all 1.5-2.5-year-old toddlers for autism spectrum disorder. However, multiple longitudinal studies of children diagnosed with autism spectrum disorder at 1.5-6 years of age and treated in community settings have not reported any associations between earlier diagnosis and improved outcome in core symptoms. Here, we quantified Longitudinal changes in core autism spectrum disorder symptoms of 131 children diagnosed at 1.2-5 years of age using the Autism Diagnostic Observation Schedule--Second Edition Calibrated Severity Scores over a 1-2 year period. We examined the prevalence and magnitude of Calibrated Severity Scores changes across children who were diagnosed at different ages. The results revealed that age of diagnosis was significantly correlated with poorer outcome (r(129) = 0.41, p < 0.001). Approximately 65% of the children diagnosed before 2.5 years of age exhibited improvements in Autism Diagnostic Observation Schedule--Second Edition Calibrated Severity Scores ([greater than or equal to]2 points) in contrast to only 23% of the children diagnosed after this age. Changes in younger children were driven by improvements in social symptoms despite deterioration in restricted and repetitive behaviors. These findings reveal that autism spectrum disorder diagnosis before the age of 2.5 is associated with considerable improvement in social symptoms. We suggest that greater brain plasticity and behavioral flexibility enable younger children to benefit more from autism spectrum disorder interventions even in community settings with heterogeneous services. This motivates further prioritization of early autism spectrum disorder screening as recommended by American Academy of Pediatrics guidelines.

Controlled studies examining canine therapy in autism spectrum disorder are scarce. This study examined the effectiveness of a "Dog Training Intervention" on adaptive skills, autism severity, and anxiety using a controlled crossover design. Seventy-three participants diagnosed with autism spectrum disorder (M[subscript age] = 4:10 ± 1:0) were divided into two groups that received the dog training intervention during half of the school year in addition to standard-of-care interventions. The dog training intervention, in which the children were taught how to interact with and train dogs, was given twice weekly for 4 months within autism spectrum disorder-specific special education school. Those receiving the dog training intervention first showed significantly increased adaptive social and communication skills compared to the controls, and the gains were maintained after the dog training intervention. Belonging to the first dog training intervention group, higher pre-intervention adaptive skills, higher baseline cognitive ability, and less severe autism severity predicted better adaptive social and communication skills. The controls improved in adaptive skills only during their receipt of dog training intervention after crossover. The positive impact on social communication skills suggests that dog training may serve as an effective model for establishing social interaction. Dog training intervention appears to be an effective adjunct treatment to interventions provided in special education schools for children with autism spectrum disorder.

This observational study focuses on prosocial behaviors of children with autism spectrum disorder (ASD) during an interaction with their older, typically developing sibling (TD-Sibs). Twenty-eight sibling dyads, in which the younger sibling was diagnosed with ASD (ASD-Sibs), were video-recorded at home playing a game of their choice. Video recordings were microanalyzed, measuring frame-by-frame observational indices of prosocial behaviors. Siblings' interactions were mostly collaborative. During the interaction, the older TD-Sibs initiated more actions and the younger ASD-Sibs imitated more. The frequency of the prosocial behaviors of the ASD-Sib was associated with the frequency of the TD-Sib's prosocial behaviors. The findings emphasize the importance of sibling interactions as an opportunity for children with ASD to practice prosocial behaviors.

This individual participant data meta-analysis is the most intensive possible evaluation of the effectiveness of early intensive applied behaviour analysis-based interventions for pre-school autistic children compared with treatment as usual/eclectic interventions. Data from 491 participants (originally collected in 10 studies) were included. Children receiving early intensive applied behaviour analysis-based interventions improved more on the Vineland adaptive behaviour scale (MD = 7.00; 95% confidence interval = 1.95-12.06) and cognitive ability (intelligence quotient) (MD = 14.13; 95% confidence interval = 9.16-19.10) relative to comparators at 2 years; though effects varied considerably across studies. Evidence for other outcomes was inconclusive due to insufficient evidence and there were few data on longer-term effects. All studies were at risk of bias across several domains, often due to the lack of randomisation or blinding of outcome assessors. Given the emerging evidence of modest, albeit short term, effects of a range of pre-school autism interventions and the limitations of the quality of evaluation studies to date, future research should investigate which supports and interventions are most effective for children and families prioritising outcomes measures that are meaningful for the autism community and longer-term follow-up. Further systematic reviews of the existing evidence are unlikely to add to the findings presented here.

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 [less than] 85; N = 41) and high cognitive (developmental quotient [greater than or equal to] 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.

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.

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.

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.

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.

Challenging behaviors are deemed extremely common within the autism spectrum disorders (ASD) population. Numerous factors and their effects upon the presence and severity of challenging behaviors within this population have been investigated. However, there has been limited research to investigate the effects of cultural differences on challenging behaviors. The aim of the current study was to examine differences between cultures in the reported presence and severity of a multitude of challenging behaviors commonly displayed by children with ASD. The "Autism Spectrum Disorders-Behavior Problems for Children" was used to assess possible differences between the United States and three other countries (South Korea, Israel, and the United Kingdom). Relatively few differences were found between the United States and both South Korea and Israel, with the United States endorsing a higher presence and severity on items that differed. In contrast, the United States and the United Kingdom differed on nearly half of the behavior items assessed with the United Kingdom reporting greater endorsements. The potential implications of these results are discussed. (Contains 4 tables.)

Research in autism spectrum disorders (ASD) described individual differences in response to intervention. This study explored child and parental characteristics at baseline that predict outcomes in adaptive skills and acquisition of cognitive gains. Seventy-eight children aged 15-35 months diagnosed with ASD by standardized diagnostic tools were included. Evaluations of verbal and non-verbal abilities, adaptive skills and autism severity were obtained at pre-intervention (T1) and after one year of intervention (T2). At T2, children improved significantly in their verbal ability and the severity of autism symptoms was reduced. Outcome in adaptive skills was best predicted by baseline verbal ability and maternal age. Better verbal ability especially in those with severe autism symptoms, and older maternal age predicted better adaptive skills outcome. T1 autism severity, child's age and maternal age and educational attainment best predicted cognitive gains. Less severe autism symptoms, younger child's age at start of intervention, older maternal age and higher maternal education predicted greater cognitive gains with intervention. The study suggests biological factors including age, language abilities and autism severity and environmental factors including maternal age and education, impact the ability to benefit from early intervention in ASD. (Contains 3 tables.)

Epidemiologic studies on maternal and pregnancy risk factors for autism spectrum disorder (ASD), including use of assisted reproductive technology (ART), found conflicting results. This study included the following aims: to assess frequencies of ART in a large ASD group; to examine confounding birth and familial risk factors in the ASD with ART group; to examine possible relationships between ART and autism severity, adaptive skills and developmental trajectory. The study included 624 participants, 507 diagnosed with ASD. Autism severity and adaptive skills were assessed using standardized tests. Extensive medical, familial and developmental histories were obtained. The rate of ART in the ASD group was significantly higher (10.7%) than in a large Israeli population (3.06%). Parental age's distribution did not differ in both ASD groups, with and without ART. Although maternal age was more advanced in the ASD group, the frequency of ART in young mothers (less than 29 years) was still significantly high (8.7%). The frequencies of gestational age less than 36 weeks and low birth weight (less than 2500 g) in the ASD with ART singleton group and in the Israeli population were not significantly different. None of the ASD with ART group and 14.7% in the ASD without ART group had a relative with ASD. Autism severity, adaptive skills and developmental regression were not significantly different in the ASD with and without ART groups. This pilot study points to the role of assisted conception as a risk factor for ASD. However, this group of ASD with ART does not represent a separate clinical phenotype in ASD. (Contains 3 tables.)

Objectives: (1) To assess the distribution of parental age and birth weight in a large cohort with autism spectrum disorder (ASD) and to compare them to Israeli national data. (2) To examine possible relationships between these risk factors and functioning. Methods: The study included 529 participants diagnosed with ASD using standardized tests: the Autism Diagnosis Interview-Revised and the Autism Diagnosis Observation Schedule (ADOS). Medical, developmental and familial histories (gender, age, pregnancy and birth information, parental ages) were obtained. Autism severity was assessed using the new ADOS severity scale and adaptive skill using the Vineland Adaptive Behavior Scales. Results: Advanced parental age was associated with ASD. In the older age range the percentages of mothers (35-44 y) and fathers (30-40 y) were significantly higher in the ASD cohort in comparison to the Israeli newborn data. The ASD cohort had significantly higher percentages of low birth weight (less than 2500 g) and very low birth weight (VLBW less than 1500 g) in comparison to the Israeli newborn data. Of these risk factors, only VLBW was associated with lower adaptive functioning. The group with VLBW had lower scores in daily living, socialization and motor skills in comparison to the greater than 1500 g group. Autism severity was not associated with advanced parental age or VLBW. Conclusions: The shift in parental age distribution and birth weight in our ASD cohort suggests that the increase in ASD prevalence in recent years might be associated with novel prenatal insults. An adverse fetal course resulting in VLBW may represent a "second hit" phenomenon, causing a poorer outcome. (Contains 4 tables.)

Purportedly, there is a worldwide acceptance of diagnostic criteria for Autism Spectrum Disorders (ASD); however, cultural differences in regards to what is considered normal development may affect the diagnosis despite the biological basis for the condition. The aim of the current study was to examine the differences in reports of symptoms of ASD across cultures. The "Autism Spectrum Disorders-Diagnostic for Children" (ASD-DC) was utilized to examine symptoms of ASD between children from Israel, South Korea, the United Kingdom, and the United States. Symptom expression differences were found on nonverbal communication/socialization, verbal communication, and insistence of sameness and restricted interests. However, no significant differences emerged between participants on the domain of social relationships. The implications of these results are discussed. (Contains 3 tables.)

The current study examined the relation between autism severity at baseline, type of intervention employed and outcomes in young children with autism spectrum disorder (ASD). Seventy-eight children with ASD, aged 15-35 months (M=25.4, SD=4.2), received either applied behavioral analysis (ABA) or integration of several intervention approaches (Eclectic) in community center-based programs. Outcome was measured after 1 year of intervention using standardized autism diagnostic tests, and cognitive and adaptive skills evaluations. ASD diagnosis was highly stable (99%). Both intervention groups improved significantly in verbal cognitive abilities and in socialization and communication adaptive skills, but no significant difference between the intervention groups was documented. Less severe autism symptoms at baseline were associated with better progress in adaptive skills and in cognitive abilities. Within the group with less severe autism symptoms, those who received Eclectic intervention had a better outcome than those who received ABA in communication and socialization adaptive skills as reported by the parents, but not in the standardized cognitive test results. The child's baseline social abilities and deficits appear to be crucial variables for intervention outcomes and should be considered in treatment approach decision-making. (Contains 3 tables and 2 figures.)

Impaired performance in a range of imitation tasks has been described in children with autism spectrum disorders (ASD) and several underlying mechanism have been suggested. This study examined whether imitation abilities are related to autism severity and to motor skills. Furthermore, the performance of children with ASD in four imitation situations (body movements and "action on objects", using meaningful and non-meaningful tasks) was compared. Twenty-five children aged 32-51 months diagnosed with autism (23) and ASD (2) were evaluated for autism severity using the Autism Diagnosis Observation Schedule and for gross and fine motor skills using the Peabody Developmental Motor Scales. Controlling for cognitive level, imitation abilities in all four situations correlated significantly only with autism severity measures and mostly with socio-communication deficits. Motor abilities were below average and did not correlate with imitation abilities nor with autism severity. Comparison of the four imitation situations revealed that performances of meaningful actions were better than non-meaningful actions and imitation of "action on objects" was better than imitation of body movements. The current research supports the fact that socio-communication deficits and not motor abilities are linked to imitation abilities in young children with autism. (Contains 4 tables and 1 figure.)

The current study characterized stability and changes of autism diagnostic classification with intervention in very young children and examined pre-treatment predictors and post-intervention outcome. Sixty-eight children diagnosed with autism, aged 18-35 months (M = 25.4, SD = 4.0) participated in the study. Children underwent comprehensive evaluations at pre-intervention time (T1) and after 1 year of intervention (T2). The evaluation included autism classification based on Autism Diagnosis Observation Schedule (ADOS) original algorithm, cognitive abilities (Mullen) and adaptive skills evaluation (Vineland). At T2, two groups were identified: the Unchanged group (n = 53) remained in the same autism classification and the Improved group (n = 15) changed classification to Autism Spectrum Disorder (ASD) (n = 13) or Off Spectrum (n = 2). The verbal domain scores at T1 was the only significant variable that distinguished the two groups. Specifically, the Improved group had better receptive language scores than the Unchanged group. The Improved group gained significantly more than the Unchanged group in all the outcome measures (cognitive, adaptive and reduction of stereotyped behaviors). Two distinct subtypes of autism were identified, one with stable autism symptomatology, poor verbal abilities and limited cognitive and adaptive gains, and a second type with better baseline verbal abilities and overall better response to intervention. (Contains 3 figures and 2 tables.)

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.

It is still debated what is the best early intervention approach for autism. This study compared two intervention approaches, Eclectic-Developmental (ED) and Applied Behavioral Analysis (ABA) in very young children with autism/autism spectrum disorder (ASD). Nineteen children received ED intervention, using combination of methods. Twenty children received Applied Behavioral Analysis (ABA) intervention which used behavioral principles. Children in both groups were not significantly different in their autism severity, cognitive abilities and in socio-economic background at pre-intervention time. Change in the severity of autism symptoms was assessed by the Autism Diagnosis Observation Schedule (ADOS). The ABA group showed significantly greater improvements than the ED group at post-intervention time. Pre-post intervention differences in language and communication domain were significant only for the ABA group. Both groups showed significant improvement in reciprocal social interaction domain. However, the effect size was greater for the ABA group. Changes in diagnostic classification were noted in both groups but were more pronounced for the ABA group. Pre-treatment IQ scores were positively related to ADOS scores at pre- and post-intervention times, but not to progress over time. Behavioral intervention is more effective than eclectic approach in improving autism core symptoms in young children with autism.

The objective was to assess the effects of long-term psychostimulant medication on growth parameters in children with attention deficit hyperactivity disorder (ADHD). Eighty-nine children diagnosed with ADHD treated by prescribed psychostimulant medications were followed with repeated growth measures over a 3 years duration. Anthropometric measurements were recorded at baseline, 3, 6, 12, 24, and 36 months. Medical records were reviewed for demographic information, medication side effects and appetite suppression. Body mass index (BMI) and z-scores were determined at each follow up visit. Descriptive and analytical analyses by repeated measures analysis of variance were performed. Significant weight loss was documented mostly during the first few months of treatment with stimulants. Although z-scores for weight showed significant changes over the 2 years of treatment, further analysis of the changes did not reach clinical significance. BMI growth was within normal limits throughout the duration of treatment. Baseline weight predicted weight loss for heavier children only. Pre-pubertal children were more subject to weight loss than children during puberty, as well as children for which appetite suppression was reported. No long-term impact on height was noted. Different stimulant medication did not differ in their effects on growth. Generally, parents and providers can be reassured that growth changes with long-term stimulant therapy are not clinically significant for a diverse group of children with ADHD.

The interdisciplinary evaluation has been a well-established process in centers for neurodevelopmental disabilities, but it is costly and may generate long waiting lists that can delay early diagnosis and treatment. An alternative evaluation paradigm was designed, using a specific screening approach, to improve use of staff time without compromising quality of care. An alternative model (AM) was designed, where a pre-designed selection process was used to sort new patients for either a comprehensive evaluation or a screening procedure, addressing medical, developmental and social issues with the additional use of developmental screening tools. A routine clinic (RC) comprehensive evaluation of each referral, was compared to the AM for waiting time, charges for patients, reimbursement to the center, and parents' and professional trainees' satisfaction. Results showed that waiting time for the screening procedure (10.3 weeks) was significantly reduced (RC 20.6 weeks). Charges for the screening procedure were significantly lower, but center revenues were not affected. Caregivers' satisfaction was maintained and trainees' satisfaction was high. The AM identified medical concerns sooner and encouraged collaboration with community resources. This study supports the use of an Alternative Developmental Evaluation paradigm for more effective use of interdisciplinary teams in centers for neurodevelopmental disabilities.