Autism spectrum disorder in older people: A scoping review of the screening and diagnostic tools available for diagnosis.

Social phobia in late‐life: is it worth a diagnosis?

This study assessed the relationship of timeliness of autism spectrum disorder (ASD) diagnosis with current use of ASD-related services in a nationally representative sample of U.S. children. The Centers for Disease Control's (CDC's) Survey of Pathways to Diagnosis and Services was used to assess experiences of 722 children ages six to 11 with ASD. Bivariate and multivariate analyses were used to explore associations between age at ASD diagnosis and delay in ASD diagnosis and use of health services. Health services included current use of behavioral intervention (BI) therapy, school-based therapy, complementary and alternative medicine (CAM), and psychotropic medications. Mean age at ASD diagnosis was 4.4 years, and mean diagnostic delay was 2.2 years. In adjusted analysis, older age at diagnosis (≥4 versus <4) was associated with lower likelihood of current BI or school-based therapy use and higher likelihood of current psychotropic medication use. Analyses that treated age at diagnosis as a continuous variable found that likelihood of current psychotropic medication use increased with older age at diagnosis. A delay of two or more years between parents' first discussion of concerns with a provider and ASD diagnosis was associated with higher likelihood of current CAM use. Likelihood of current CAM use increased as delay in diagnosis became longer. Both older age at diagnosis and longer delay in diagnosis were associated with different health services utilization patterns among younger children with ASD. Prompt and early diagnosis may be associated with increased use of evidence-based therapies for ASD.

Assessing Diverse Students With Autism Spectrum Disorders

The objectives of our study were to (a) report how many children met an autism spectrum disorder (ASD) surveillance definition but had no clinical diagnosis of ASD in health or education records and (b) evaluate differences in demographic, individual, and service factors between children with and without a documented ASD diagnosis. ASD surveillance was conducted in selected areas of Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin. Children were defined as having ASD if sufficient social and behavioral deficits and/or an ASD diagnosis were noted in health and/or education records. Among 4,498 children, 1,135 (25%) had ASD indicators without having an ASD diagnosis. Of those 1,135 children without a documented ASD diagnosis, 628 (55%) were not known to receive ASD services in public school. Factors associated with not having a clinical diagnosis of ASD were non-White race, no intellectual disability, older age at first developmental concern, older age at first developmental evaluation, special education eligibility other than ASD, and need for fewer supports. These results highlight the importance of reducing disparities in the diagnosis of children with ASD characteristics so that appropriate interventions can be promoted across communities. Autism Res 2020, 13: 464-473. © 2019 International Society for AutismResearch,Wiley Periodicals, Inc. LAY SUMMARY: Children who did not have a clinical diagnosis of autism spectrum disorder (ASD) documented in health or education records were more likely to be non-White and have fewer developmental problems than children with a clinical diagnosis of ASD. They were brought to the attention of healthcare providers at older ages and needed fewer supports than children with a clinical diagnosis of ASD. All children with ASD symptoms who meet diagnostic criteria should be given a clinical diagnosis so they can receive treatment specific to their needs.

Offspring who encounter biological and psychosocial adversities early in development are vulnerable to lasting physical, mental, emotional, and social deficits across the lifespan, especially autism spectrum disorders (ASD) and socioemotional problems. Numerous individual risk factors have been linked with these problems separately in children of various ages. However, few studies have analyzed the effects of prenatal, perinatal, and early life exposure to cumulative risk factors in predicting socioemotional problems co-occurring with ASD in toddlers. The current study aimed to determine if ASD was associated with internalizing, externalizing, and dysregulation problems in toddlers, and if a novel measure of cumulative risk explained observed deficits above and beyond an ASD diagnosis. 344 participants from an ongoing multisite longitudinal study evaluating optimal timing for repeat ASD screening were divided into 3 groups based on a diagnosis given at a clinical evaluation by trained research staff: ASD (n = 107), developmental delays (DD; n = 145), and typical development (TD; n = 92). The Cumulative Risk Scale was developed from a developmental history questionnaire. The presence of a risk factor (e.g., prenatal SSRI exposure, prematurity, low birth weight, maternal psychiatric diagnosis) was coded as 1 and the absence as 0, and the sum total created each participant's Cumulative Risk Score. After handling significant amounts of missing data with five iterations of multiple imputation, three multiple hierarchical regressions were conducted to determine if an ASD diagnosis was significantly associated with the Externalizing, Internalizing, and Dysregulation domain standard scores of the Infant-Toddler Social-Emotional Assessment (ITSEA). A second block of the hierarchical regression containing the novel Cumulative Risk Scale was added to determine if cumulative risk predicted these outcomes and increased the predictive ability of the model. The "segmented" package of R was then utilized to identify a linear or threshold relationship between cumulative risk and ITSEA outcomes. Results show that an ASD diagnosis was significantly associated with Internalizing problems ([beta] = .143, p = .035, 95% CI [.305, 8.430]), partially supporting the first hypothesis that an ASD diagnosis would be associated with internalizing, externalizing, and dysregulation problems. Further analyses show that both an ASD ([beta] = .278, p &lt; .001, 95% CI [.088, .231]) and DD diagnosis ([beta] = .157, p = .010, 95% CI [.020, .149]) predict Depression/Withdrawal symptoms when controlling for child age. The addition of the Cumulative Risk Scale to the regression model improved prediction of Dysregulation problems only ([beta] = .103, p = .039, 95% CI [.027, 1.010], R2 change = .009, p = .039), partially supporting the second hypothesis that Cumulative Risk would significantly predict socioemotional problems. Further hierarchical multiple linear regressions showed cumulative risk significantly predicted Sleep Problems ([beta] = .101, p = .048) and Eating Problems ([beta] = .102, p = .045). Both hierarchical regressions showed a significant R2 change as well, but should also be interpreted with caution, as both increases were small (0.9% increases). An ASD diagnosis was significantly predictive of only the Negative Emotionality Subscale of the Dysregulation domain ([beta] = .151, p = .047). Results from the "segmented" package of R estimate a break point of 10.27 (p = .04171) for predicting Externalizing problems, but not Internalizing or Dysregulation problems. Toddlers ages 12-60 months with ASD are more likely to experience comorbid internalizing problems, which can have numerous clinical implications in the detection and prevention of internalizing problems early in life. Cumulative risk in early developmental periods overall does not explain socioemotional deficits in toddlers with ASD, DD, or with typical development. However, cumulative risk does predict dysregulation problems across children, regardless of diagnosis. A model depicting the relationship between cumulative risk in early developmental periods, dysregulation or non-disorder-specific socioemotional problems, and later psychopathology was proposed and should be investigated further in future research. A significant threshold of 10 risk factors was identified in predicting externalizing problems but may be possible in predicting internalizing and dysregulation problems as well. A more sensitive measure of cumulative biomedical risk early in life may also improve assessment of cumulative risk.

Background. Many studies have shown a relationship between physical functioning and health status in older people. Aim. The purpose of this study was to analyze the temporal trends of physical activity (PA), ability to walk, weight status, self-perceived health, and disease or chronic health problems in people over 65 years from 2009 to 2017, using the European Health Survey in Spain and the National Health Survey in Spain. Methods. This study included 13,049 older people: 6026 (2330 men and 3696 women; age (mean, SD (Standard Deviation)) = 75.61 ± 7.11 years old) in 2009 and 7023 (2850 men and 4173 women; age (mean, SD) = 76.01 ± 7.57 years old) in 2017. Results. In 2017, older people exhibited lower values of moderate PA (p < 0.001), a lower number of hours of walking per week (p < 0.001), and worse self-perceived health status (p < 0.001) compared to 2009. These differences are maintained when comparing the sexes. Compliance with PA recommendations was 27.9% and 6.1% (chi-squared = 352.991, p < 0.001) in 2009 and 2017, respectively. There were no significant differences in weight status between older people in 2009 and 2017. In 2017, older people had significantly high percentages of disease or chronic health problems (p < 0.05), number of diseases (p < 0.001), severe difficulty walking 500 m without assistance (p < 0.05), and severe difficulty going up or down 12 stairs. Conclusions. From 2009 to 2017, Spanish older people worsened their PA levels and perception of their health status, and they increased their disease levels, which could be associated with the worsening of ability to walk in 2017.

Autism spectrum disorder (ASD) and gender dysphoria (GD) frequently cooccur. However, existing research has primarily used smaller samples, limiting generalizability and the ability to assess further demographic variation. The purpose of this study was to (1) examine the prevalence of cooccurring ASD and GD diagnoses among US adolescents aged 9 to 18 and (2) identify demographic differences in the prevalence of cooccurring ASD and GD diagnoses. This secondary analysis used data from the PEDSnet learning health system network of 8 pediatric hospital institutions. Analyses included descriptive statistics and adjusted mixed logistic regression testing for associations between ASD and GD diagnoses and interactions between ASD diagnosis and demographic characteristics in the association with GD diagnosis. Among 919 898 patients, GD diagnosis was more prevalent among youth with an ASD diagnosis compared with youth without an ASD diagnosis (1.1% vs 0.6%), and adjusted regression revealed significantly greater odds of GD diagnosis among youth with an ASD diagnosis (adjusted odds ratio = 3.00, 95% confidence interval: 2.72-3.31). Cooccurring ASD/GD diagnoses were more prevalent among youth whose electronic medical record-reported sex was female and those using private insurance, and less prevalent among youth of color, particularly Black and Asian youth. Results indicate that youth whose electronic medical record-reported sex was female and those using private insurance are more likely, and youth of color are less likely, to have cooccurring ASD/GD diagnoses. This represents an important step toward building services and supports that reduce disparities in access to care and improve outcomes for youth with cooccurring ASD/GD and their families.

Older parental age at birth is associated with increased risk of autism spectrum disorders (ASD) in offspring. Independently, shorter telomere length (TL) has also been shown to be associated with ASD in children. However, older paternal age at birth, with or without controlling for maternal age, has been associated with longer TL, a seemingly contradictory finding. Here, we conducted a retrospective cohort study among participants in the UK Biobank to disentangle associations between leukocyte TL and ASD status in adults, and the potential moderation by parental age on adult offspring's TL. Participants with ASD diagnosis (N = 87) with a mean age of 46.0 (SD 4.4) years were matched to participants without ASD diagnosis (N = 870) based on age, sex, ethnicity, education, household income, and assessment center. No statistically significant differences were seen in TL between participants with and without ASD when parental age at birth was not considered. However, there was a significant interaction between ASD diagnostic status and parental age on participants' TL, such that older paternal or maternal age at birth was more strongly associated with longer TL in participants with ASD. This study suggests that the shortened TL observed in children with ASD in previous research may partially depend on parental age at birth. Future studies tracking TL attrition before ASD diagnosis are warranted to depict temporal associations and the interacting effects of parental age at birth and ASD status on TL across the lifespan.

To perform scoping review of the existing literature available specific to child and adolescent mental health in Tanzania. An extensive literature search of PubMed, Scopus, MEDLINE and EMBASE was undertaken to identify studies that focussed specifically on mental illness in children and young people in Tanzania. This included neurological and functional disorders, affective disorders, psychosis, epidemiological, intervention and treatment-based studies. Qualitative analysis of the studies was then undertaken to assess what is currently known about the subject and how reliable this information is and to identify areas for further research. Of 23 studies were included in the final synthesis, which could be broadly split into studies focussing on the prevalence and incidence of child and adolescent mental illness, hypothesised causes and correlations, identified treatments and interventions and qualitative studies of human experience. There is a dearth of published research regarding child and adolescent mental health in Tanzania. Although some high-quality studies allow us good insight into the epidemiology of mental illness, interventional studies are often small and low-power, and significant correlational relationships are yet to be drawn. There is significant scope for further child and adolescent mental health research in Tanzania.

There is a significant delay between seeking help and a confirmed diagnosis of Autism Spectrum Disorder (ASD). This delay can lead to poor outcomes for both the families and individuals. Telehealth potentially offers a way of improving the diagnostic pathway for ASD. We conducted a scoping review examining which telehealth approaches are used in the diagnosis and assessment of ASD in children and adults, whether they are feasible and acceptable, and how they compare with face-to-face diagnosis and assessment methods. A search for all peer-reviewed articles, combining the terms of autism and telehealth was conducted from 2000 to 2019. A total of 10 studies were identified for inclusion in the review. This review of the literature found there to be two methods of using telehealth: (a) Real-Time method e.g. video conferencing that enables teams in different areas to consult with the families and to assess the child/adult in real time and (b) A Store-and-Forward method as Naturalistic Observation Diagnostic Assessment (NODA) system to upload videos of child’s behaviors to a webportal that enables the clinicians to make an assessment remotely. The findings were positive, finding there to be high agreement in terms of the diagnosis between remote methods and face to face methods and with high levels of satisfaction among the families and clinicians. This field is in the very early stages and so only studies with small sample size using surveys and interviews were identified but the findings suggest that there is potential for telehealth methods to improve access to assessment and diagnosis of ASD used in conjunction with existing methods, especially for those with clear autism traits and adults with ASD. Larger randomised controlled trials of this technology are warranted.

There is limited evidence supporting an association of autism spectrum disorder (ASD) with suicidality and the risk factors for suicide attempt and suicide among people with ASD. Existing research highlights the need for national cohort studies. To analyze whether people with ASD have higher rates of suicide attempt and suicide compared with people without ASD using national register data, identify potential risk factors for suicide attempt and suicide among those with ASD, and examine associations with comorbid disorders. In this cohort study, nationwide register data from January 1, 1995, to December 31, 2016, were gathered on 6 559 266 individuals in Denmark aged 10 years or older. Statistical analysis was performed from November 20, 2018, to November 21, 2020. Rates of suicide attempt and suicide among persons with ASD were compared with rates among persons without ASD, using Poisson regression models to calculate incidence rate ratios adjusted for sex, age, and time period. Of the total study population of 6 559 266 individuals, 35 020 individuals (25 718 male [73.4%]; mean [SD] age at diagnosis, 13.4 [9.3] years) received a diagnosis of ASD. A total of 64 109 incidents of suicide attempts (587 [0.9%] among individuals with ASD) and 14 197 suicides (53 [0.4%] among individuals with ASD) were recorded. Persons with ASD had a more than 3-fold higher rate of suicide attempt (adjusted incidence rate ratio [aIRR], 3.19; 95% CI, 2.93-3.46) and suicide (aIRR, 3.75; 95% CI, 2.85-4.92) than those without ASD. For individuals with ASD, the aIRR for suicide attempt among female individuals was 4.41-fold (95% CI, 3.74-5.19) higher compared with male individuals; for individuals without ASD, the aIRR for female individuals was 1.41-fold (95% CI, 1.39-1.43) higher compared with male individuals. Higher rates of suicide attempt were noted across all age groups for those with ASD. Persons with a diagnosis of ASD only had an aIRR of 1.33 (95% CI, 0.99-1.78) for suicide attempt, whereas those with other comorbid disorders had an aIRR of 9.27 (95% CI, 8.51-10.10) for suicide attempt compared with those without any psychiatric disorders. A total of 542 of 587 individuals with ASD (92.3%) who attempted suicide had at least 1 other comorbid condition and 48 of 53 individuals with ASD (90.6%) who died by suicide had at least 1 other comorbid condition. This nationwide retrospective cohort study found a higher rate of suicide attempt and suicide among persons with ASD. Psychiatric comorbidity was found to be a major risk factor, with more than 90% of those with ASD who attempted or died by suicide having another comorbid condition. Several risk factors are different from the risk factors in the general population, which suggests the need for tailored suicide prevention strategies.

Early detection and early diagnosis of autism spectrum disorder (ASD) are promoted throughout the world. Early detection and early intervention for children with ASD is known to have certain effects. Consistent with global trends, systems to provide children with appropriate environments and educational opportunities in Japan are improving; features of ASD are being detected by the age of approximately 2 years through health checkups for infants and children. However, the early screening of autistic infants and children in Japan, subsequent follow-up, and early intervention methods differ greatly among residential areas and local governments. In this article, we outline well-constructed models of systems that include aspects such as early detection, early diagnosis, early intervention, parent support, and longitudinal follow-up of ASD and are used in some areas in Japan. Furthermore, we note the current efforts of the Early Start Denver Model (ESDM), which the authors are working to apply in Japan. Early detection and diagnosis systems for children with ASD in Japan will continue to develop, and the validation of their effects through randomized controlled trials (RCTs) is desired in research on early intervention for children with ASD. Furthermore, the brain function research that the author of this article is working on may be one approach for objectively evaluating the effects of early intervention from both behavioral and physiological perspectives.

Our objective was to evaluate pathways between initial concerns of parents regarding atypical development of their children and autism spectrum disorder (ASD) diagnosis in Turkey. The study included 199 children aged 18–97 months and diagnosed with ASD. The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria were used along with information obtained from parents and direct observation of the child. The Childhood Autism Rating Scale (CARS) was used as a diagnostic tool. A 45-minute semi-structured interview was conducted with parents to evaluate the time until their child was diagnosed with ASD. A period longer than 1 year (mean: 13.69 ± 10.80 months) had passed from the first concern of parents until their children were diagnosed with ASD. Further, 53.8% of parents consulted a healthcare professional a few months after their initial concern and 46.2% did not for a longer time (9.34 ± 8.36 months). Maternal education level, socioeconomic status, and higher Autism Behavior Checklist (ABC) relating subscale scores predicted an earlier age for a diagnosis of ASD, while higher ABC language subscale scores predicted ASD diagnosis at older ages. Based on our results, it appears that factors such as spoken language and socioeconomic level may be related to significant delays in ASD diagnoses in Turkey.

The incidence of Autism Spectrum Disorders (ASD) has been increasing over the last two decades. Currently, 1 in 110 children are identified with ASD in the United States (CDC, 2009). ASD refers to a range of neurological disorders that involve some degree of difficulty with communication and interpersonal relationships. The range of the spectrum for autism disorders is wide with those at the higher functioning end often able to lead relatively independent lives and complete academic programs even while demonstrating social awkwardness. Those at the lower functioning end of the autism spectrum often demonstrate physical limitations, may lack speech, and have the inability to relate socially with others. As persons with ASD age, options such as employment become increasingly important as a consideration for long-term personal planning and quality of life. While many challenges exist for persons with ASD in obtaining and maintaining employment, some research is showing that, with effective behavioral and social interventions, employment can occur (Schaller & Yang, 2005). In fact, about 37% of individuals with ASD report having been employed for 12 months or more, four years after exiting high school (Newman, Wagner, Cameto, & Knokey, 2009). However, several studies show that individuals with ASD are more likely to lose their employment for behavioral and social interaction problems rather than their inability to perform assigned work tasks (Dew & Alan, 2007; Hurlbutt & Chalmers, 2004; Unger, 1999). Research has been conducted in the area of autism and employment, but such research has not been reported in a comprehensive evidence review format before. Thus, a systematic review on the effectiveness of adult employment assistance interventions for individuals with ASD would not only demonstrate the extent and magnitude of the interventions’ effects, but also provide ideas for further research that can inform implementation and refinement of related employment-focused programs.

Autism spectrum disorder (ASD) refers to a heterogeneous condition characterized by deficits in social communication and the presence of restricted, repetitive, and stereotypic behaviors, interests, or activities. While some neurodevelopmental disorders have a well-established correlation with ASD, people continue to believe that because individuals with Down syndrome are characteristically perceived as affectionate and engaging, a diagnosis of ASD is contradictory. However, some people with Down syndrome indeed do meet diagnostic criteria for ASD and this chapter examines the research literature regarding Down syndrome and ASD, presenting information regarding the establishment of a diagnosis of ASD in individuals with Down syndrome and research techniques to understand the dual diagnosis of ASD and Down syndrome. Behavioral manifestations of ASD in Down syndrome are presented and research methodologies which address possible underlying mechanisms in Down syndrome and ASD are surveyed. Finally, the need for specification of behavioral profiles for individuals with a dual diagnosis of Down syndrome and ASD, in order to design and implement appropriate therapeutic interventions, is highlighted. Once a person with Down syndrome is diagnosed with ASD, he or she should automatically receive a combined treatment approach incorporating direct instruction, natural environment teaching, and incidental teaching. The manifestation of ASD in individuals with Down syndrome can shed light on our understanding of how ASD and intellectual disability are associated and what impact these diagnoses have on individuals and their families. This knowledge can help shape public policy and our research agenda in the areas of ASD, intellectual impairment, and Down syndrome.