Ophthalmological Findings and Their Clinical Correlations in Children With Autism Spectrum Disorder: A Comparative Study.

OP75 – 2431: Mental health and psychiatric symptoms at 11 years among extremely preterm children

BackgroundThe evidence for associations of emotional/behavioral status with sedentary behavior (SB), physical activity (PA) and step counts is scarce in children with autism spectrum disorder (ASD). Also, ASD-related deficiencies may affect actual levels of PA. We aimed to describe accelerometer-measured SB, PA and step counts in children with ASD, and to examine the associations of emotional/behavioral problems with SB, PA and step counts after assessing associations between accelerometer-measured SB, PA and step counts and ASD-related deficiencies.MethodsA total of 93 ASD children, aged 6–9 years, were recruited from the Center for Child and Adolescent Psychology and Behavioral Development of Sun Yat-sen University in Guangzhou, China. Participants wore an accelerometer for seven consecutive days. Of the original 93, 78 participants' accelerometer-measured valid PA were obtained, and the data were shown as time spent in SB, light, moderate, moderate-to-vigorous and vigorous PA, and step counts. Participants' emotional/behavioral problems were assessed via the Strengths and Difficulties Questionnaire (SDQ), and anxiety symptoms were evaluated by the Screen for Child Anxiety Related Emotional Disorders (SCARED). ASD-associated deficiencies include restricted repetitive behaviors (Repetitive Behavior Scale-Revised), poor social competence (Social Responsiveness Scale Second Edition) and motor development restrictions (Developmental Coordination Disorder Questionnaire).ResultsOf the 78 participants, daily vigorous PA (VPA) and moderate-to-vigorous PA (MVPA) averaged 15.62 and 51.95 min, respectively. After adjustment for covariates, SDQ emotional symptoms (β = −0.060, p = 0.028) were inversely associated with the average daily minutes in VPA. Meanwhile, SDQ emotional symptoms (β = −0.033, p = 0.016) were inversely associated with the average daily MVPA minutes in the crude model. After adjustment for covariates, SCARED somatic/panic (β = −0.007, p = 0.040) and generalized anxiety (β = −0.025, p = 0.014) were negatively associated with the average daily VPA minutes; SCARED total anxiety (β = −0.006, p = 0.029) was conversely associated with daily MVPA duration. After adjustment for covariates, no significant associations between accelerometer-measured SB, PA and step counts and ASD-related deficiencies were found (p > 0.05).ConclusionsAccelerometer-measured SB, PA and step counts showed no associations with ASD-related deficiencies. On this basis, we further found that the emotional symptoms were inversely associated with VPA and MVPA. These results emphasize the importance of VPA and MVPA in children with ASD. The longitudinally investigations on the directionality of these associations between emotional symptoms with VPA and MVPA are needed in the future.

The objective of this study was to compare Health-Related Quality of Life (HRQoL) as measured by the 16D instrument with four condition-specific instruments in children and adolescents with significant post-traumatic stress disease (PTSD), to assess the validity of the 16D instrument. In addition, we test for differences in health for the PTSD population compared to a representative sample of Finnish schoolchildren. The study included 156 children and adolescents with trauma-related symptoms in Norway. The condition-specific instruments included were; Child PTDS Symptom Scale (CPSS); Mood and Feelings Questionnaire (MFQ); Screen for Child Anxiety Related Emotional Disorders (SCARED), and; Strengths and Difficulties Questionnaire (SDQ). We found that the 16D HRQoL score was significantly correlated with all condition-specific instruments (CPSS, SCARED, MFQ, and SDQ), where SCARED had the highest correlation with the 16D (-0.659, p < 0.01). Several of the corresponding items (sleep, distress, discomfort and symptoms, mental functioning, and school and hobbies) of the condition-specific instruments were correlated above the threshold (convergent validity, ρ > 0.4). Children and adolescents with symptoms of post-traumatic stress experienced a significant health loss of 0.177 compared to a representative sample of Finnish 12 to 15-years-old schoolchildren with a Cohen’s d of 1.07, and the health difference was significant for all 16 dimensions. These findings support the use of the 16D to measure health outcomes in cost-utility analysis. More studies are needed to examine the responsiveness.
 Published: Online August 2020.

Siblings of children with autism spectrum disorder (ASD) are at increased risk of psychosocial difficulties due to altered family dynamics and parental stress. However, the mechanisms linking ASD severity, parental psychopathology, and sibling outcomes remain unclear. This study aimed to identify determinants of psychosocial problems among siblings of children with ASD using a family-systems framework and structural equation modeling (SEM). A case-control study was conducted with 67 siblings of children with ASD (ASD-Sibs) and 67 siblings of typically developing children (TD-Sibs), aged 6-18 years. ASD severity was rated using the Childhood Autism Rating Scale (CARS). Sibling depression, anxiety, and emotion regulation were assessed using the Child Depression Inventory (CDI), Screen for Child Anxiety Related Emotional Disorders (SCARED), and Cognitive Emotion Regulation Questionnaire (CERQ). Parents completed the Child Behavior Checklist (CBCL), Beck Depression and Anxiety Inventories (BDI, BAI), and Family Assessment Device (FAD). SEM was used to examine predictors of sibling psychosocial outcomes. ASD-Sibs reported significantly higher depressive and anxiety symptoms than TD-Sibs. SEM revealed that maternal depression and general family functioning were significant predictors of sibling depression, anxiety, and behavioral problems. ASD severity indirectly influenced sibling outcomes through maternal depression and anxiety. Positive reappraisal emerged as a protective factor against anxiety. Maternal psychological well-being and family functioning are key determinants of psychosocial adjustment among ASD-Sibs. Autism severity affects siblings indirectly via maternal psychopathology, underscoring the importance of holistic, family-centered interventions to promote resilience in families of children with ASD.

To describe the prevalence, diagnoses and aetiologies of visual impairment in children with developmental delay (DD) in a Danish county with a population of 618 000 citizens. We carried out a cross-sectional study in Copenhagen County of children aged 4-15 years with profound to borderline DD (IQ <or= 80). Children were located through school psychologists or paediatric clinics. The number of children with DD was estimated using the capture-recapture method. A total of 1126 children fulfilled the inclusion criteria, corresponding to 97.7% of the estimated number of children with DD in the county. Ophthalmological examinations were performed in 923 children. The prevalence of visual impairment was 10.5% in the study group and 22.4% in those with an IQ <or= 50. The diagnoses were predominantly cerebral visual impairment, optic atrophy, retinal dystrophies and congenital nystagmus. The aetiology of visual impairment was prenatal in 54 children, perinatal in 29 children and postnatal in seven children. Visual impairment is highly increased in children with DD and is correlated to low IQ.

Use of the Screen for Child Anxiety Related Emotional Disorders (SCARED) has increased significantly since its publication. Although the validity of the SCARED is well established, most of the samples investigated primarily comprised Caucasian children and, where available, people from Asian cultures such as China. Furthermore, the instrument's utility for screening use in community samples has yet to be validated, although it is commonly advocated for this use. The present study addressed the psychometric properties of the SCARED in a community sample of Malaysian children and adolescents. A total of 386 participants from an urban area, aged between 8 and 17, completed the 41-item SCARED. Confirmatory factor analysis and exploratory factor analysis were performed to investigate the factor structure of the SCARED. Internal consistency ratings for the SCARED's total and subscale scores were good, except for School Avoidance. The validity of the SCARED was further demonstrated through a significant correlation with the Internalizing subscale of the Strength and Difficulties Questionnaire (SDQ). In contrast with the five-factor structure proposed for primarily Caucasian samples, factor analysis revealed a four-factor structure for this Malaysian sample. These research findings support the validity of the SCARED and its utility as a screening tool in a community sample of Malaysian children and adolescents.

Objective: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairment in social communication and interaction, and restricted, stereotypic, repetitive behaviors. Behavioral problems are common in children with ASD. Herein, we report the effect of N-acetylcysteine (NAC) treatment on repetitive behaviors in 10 children with ASD.Methods: Ten children with ASD were assessed using the Childhood Autism Rating Scale and Aberrant Behavior Checklist (ABC). The clinical follow-up was performed with ABC and Clinical Global Impressions-Improvement (CGI-I). A total of 10 patients were initiated on NAC therapy in addition to their treatment with a stable dose of risperidone to avoid the potential adverse effects of higher doses of risperidone. Two patients discontinued NAC treatment before the third week. Eight patients were treated with an NAC dosage of 1200–2700 mg/day for 6–10 weeks.Results: The mean age of the patients was 8.6 years. Patients received NAC treatment for a mean duration of 8.25 weeks and a mean dosage of 2100 mg/day. Improvement in stereotypic behaviors was statistically significant in addition to the improvement in mean CGI-I score (p = .025 and .006, respectively).Conclusion: NAC adjunction to risperidone treatment may be helpful to reduce repetitive behaviors in children with ASD with limited adverse effects and good tolerability.

Background and aims Males with fragile X syndrome display many behavioral features of autism spectrum disorder. Despite this overlap, our understanding of autism spectrum disorder symptoms and severity in fragile X syndrome is limited due to variation in assessment methods in the literature. Furthermore, the relationship between autism spectrum disorder symptoms and child characteristics, like age, language, and cognitive abilities, are not well understood in individuals with fragile X syndrome. Therefore, the first research aim was to compare the rates of autism spectrum disorder classifications from three commonly reported autism spectrum disorder assessments in the literature. Our second research aim was to examine the relationship between autism spectrum disorder characteristics and other child characteristics. Methods The present study compared autism spectrum disorder classifications and symptoms using the Autism Diagnostic Observation Schedule, Autism Diagnostic Interview, Revised, and Childhood Autism Rating Scale, second edition in a sample of 33 school-age and adolescent boys with fragile X syndrome. In addition, the participants completed nonverbal IQ testing, expressive vocabulary and grammar tests, and a conversation language sample. Results The majority of the participants met criteria for autism spectrum disorder on the Autism Diagnostic Observation Schedule (96.97%) and Autism Diagnostic Interview, Revised (90.91%), while only half met criteria for autism spectrum disorder on the Childhood Autism Rating Scale, second edition. Sixteen boys (48.48%) met criteria for autism spectrum disorder on all three measures, and all participants met criteria for autism spectrum disorder on at least one measure. Expressive vocabulary accounted for a unique amount of variance in Childhood Autism Rating Scale, second edition and Autism Diagnostic Observation Schedule scores. Additionally, grammatical complexity accounted for a unique amount of variance in Childhood Autism Rating Scale, second edition scores. None of the child variables accounted for the variance found in Autism Diagnostic Interview, Revised scores. Although nonverbal IQ scores did not account for a significant amount of variance on the Autism Diagnostic Observation Schedule, Autism Diagnostic Interview, Revised, and Childhood Autism Rating Scale, Second Edition, boys who met criteria for autism spectrum disorder on all three measures had lower nonverbal IQ compared to the boys who did not. Additionally, mean length of utterance and expressive vocabulary scores were lower in the boys who met criteria for autism spectrum disorder on all three measures than those who did not. Conclusions Our findings identify areas of overlap and difference in the Autism Diagnostic Observation Schedule, Autism Diagnostic Interview, Revised, and Childhood Autism Rating Scale, second edition when used with males with fragile X syndrome. Variation in assessments may differentially identify the phenotypic behaviors of boys with fragile X syndrome that lead to a co-diagnosis of autism spectrum disorder, which contributes to the variation in reported co-morbidity of fragile X syndrome and autism spectrum disorder. Also, expressive language abilities, especially expressive vocabulary, are associated with autism spectrum disorder symptomatology. Implications: When interpreting comorbid fragile X syndrome and autism spectrum disorder rates in the literature, it is important to consider the assessment tool that was used. Although the assessments that we used in the present study yielded scores that were highly correlated (i.e. Autism Diagnostic Observation Schedule and Childhood Autism Rating Scale, second edition), their categorical classifications did not align perfectly. Our findings also highlight the importance of considering language skills when assessing autism spectrum disorder severity in fragile X syndrome.

Validated brief screening instruments are needed to improve the detection of anxiety disorders in autism spectrum disorder (ASD). The Screen for Child Anxiety-Related Emotional Disorders (SCARED), a 41-item parent- and self-reported scale measuring anxiety, was compared to the Achenbach System of Empirically Based Assessment (ASEBA) scales. One hundred participants with a clinical diagnosis of high-functioning ASD, aged 8–18 years, and their parents completed the above scales. We hypothesized that the SCARED would be useful in screening for anxiety and its results for total scores of anxiety would converge with ASEBA syndrome scales for anxiety and internalizing disorders. Significant correlations were shown between the SCARED and the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) across a broad spectrum of scales. The CBCL syndrome scale for anxious/depressed showed the highest correlation and predicted anxiety scores on the SCARED. While many of the YSR scales significantly correlated with child ratings of anxiety, none of the scales predicted the SCARED child scores. Differences in self and parent reports suggest that parents interpret externalizing behaviors as signs of anxiety in ASD, whereas youth may describe internalized symptoms as anxiety. Females were more likely to self-report anxiety than males. Results support the use of the SCARED as a screening tool for anxiety in high-functioning ASD, but it should be supplemented with other tools to increase the specificity of its results.

The purpose of the study was to compare the risk of psychiatric disturbance among sighted and vision-impaired children aged 11 years. Scores from the parent and teacher versions of the Strengths and Difficulties Questionnaire (SDQ) were used to compare sighted children with: vision-impaired children; vision-impaired children with no other reported disabilities or special educational needs; and children with vision impairment and additional disabilities or special educational needs. Logistic regression was used to measure the associations between the independent variables and SDQ scores, and to test for significance of the observed differences. Both parents and teachers scored vision-impaired children significantly higher on the SDQ compared with sighted children (p≤0.000) and a significantly higher proportion of the vision-impaired children had SDQ scores in the abnormal range (p≤0.000). Children with vision impairment and other disabilities or special educational needs were rated as being at greatest risk of psychiatric disorder by both parents (30%) and teachers (22%). Vision impairment among children as young as 11 years of age is associated with an increased risk of psychiatric disorder.

Background: Children with Autism Spectrum Disorder (ASD) often experience sleep disturbances, such as difficulty falling asleep and frequent night wakings, which can exacerbate repetitive behaviours like hand-flapping and rocking. These sleep problems may increase the frequency and intensity of repetitive behaviours, affecting the child's overall well-being. This study aims to explore the relationship between sleep issues and repetitive behaviours in children with ASD Study Design: A Correlational study. Aim: To identify the relationship between sleep problem and repetitive behaviour in children with autism spectrum disorder. &nbsp;Objective: To assess sleep problem in children with autism spectrum disorder. To evaluate repetitive behaviour in children with autism spectrum disorder. To find relation between sleep problem and repetitive behaviour in children with autism spectrum disorder Participants: In this study, 73 children with autism spectrum disorder were included after taking Informed consent from the parents. Methods: This study employs a correlational design to examine the relationship between sleep problem and repetitive behaviour in children with autism spectrum disorder. Result: A statistically significant relationship was found between sleep problems and repetitive behaviours in children with autism spectrum disorder (ASD). Using the Sleep Disturbance Scale for Children (SDSC) and the Repetitive Behaviour Questionnaire-3 (RBQ3), a moderate positive correlation of 0.342 was observed. The p-value of 0.003 confirms the statistical significance of this relationship, supporting the alternative hypothesis that sleep disturbances are linked to increased repetitive behaviours in children with ASD. Conclusion- The study concluded that there is a positive correlation between sleep disturbances and repetitive behaviours suggests that improving sleep quality may help reduce these behaviours. These insights underscore the need for targeted interventions addressing sleep issues to enhance well-being in children with ASD.

The association between Visual Impairment (VI) and Autism Spectrum Disorder (ASD) remains an important research topic among children suffering from developmental delays and disabilities. The objective of this mini review was to evaluate previous literature on prevalence and etiology of visual impairment, frequency of visual impairment and types of refractive errors associated with autism in children. Previous researches on ASD found that the visual impairment is one of the major factors in autistic children. Hence measurement of vision screening in autism disorder is necessary for better explanation of the problem. The etiologies of visual impairment in autistic children were associated with refractive error and strabismus. Identification of refractive error in ASD children and providing them suitable corrective lenses may improve their visual functions and help in their daily activities. With these findings in mind, there is an urgent need to investigate further in this area and developed more detailed research. The findings would help optometrist, ophthalmologist in understanding types of visual impairment in autism school children.

Reliability and validity of the Arabic Screen for Child Anxiety Related Emotional Disorders (SCARED) in a clinical sample

BackgroundA valid screening tool for behavioral and emotional problems in children and adolescents is needed to promote psychological wellbeing and to prevent mental disorders in China's children.AimAssess the use of the Chinese version of the internationally recognized Strengths and Difficulties Questionnaire (SDQ) – which assesses emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems and prosocial behaviors – in a large sample of urban and rural children from different parts of China.MethodsThe Chinese version of the parent-reported SDQ was administered to legal guardians (primarily parents) of a stratified random sample of 22,108 primary school children 5 to 13 years of age from eight provinces in China. The association between SDQ scores and socio-demographic characteristics was assessed and the percentile cutoff scores for ‘abnormal’, ‘borderline’ and ‘normal’ results in China were compared with those for Japan and the United Kingdom.ResultsThe internal consistency of the 4 of the 5 SDQ subscales were satisfactory but that for the ‘peer relationships problems’ subscale was quite poor (alpha=0.22). Guardians reported that boys were more likely than girls to have hyperactivity/inattention problems and that girls were more likely than boys to have problems with emotional symptoms. For both boys and girls hyperactivity/inattention problems decreased with age while peer relationship problems increased with age. Emotional symptoms, conduct problems and peer relationship problems were more common in children from rural areas and in children whose identified guardian was not a parent (i.e., a grandparent or other relative). The 90th percentile cutoff score for abnormal results was higher in Chinese children than the cutoff scores reported for children in Japan and the United Kingdom.ConclusionsThis study suggests that prevention programs for hyperactivity/inattention problems in boys need to start before the age of 10 and that training in methods of reducing the stress associated with peer relationships should start in early adolescence. Further work is needed to improve the cultural validity of the SDQ in China and to determine its sensitivity and specificity for identifying children who are in need of mental health services.

Background: Restricted and repetitive behaviors (RRBs) are a broad class of behaviors characterized by frequent action repetition and intense preference for sameness. Research has predominantly focused on RRBs in diagnosed clinical groups, particularly in autism spectrum disorder and genetic disorders. Using a transdiagnostic approach, the current study examined RRBs in a diverse sample of children in relation to developmental and demographic correlates (age, language, non-verbal ability, child anxiety, sex, and socioeconomic status). Separate analyses examined two RRB subtypes; repetitive sensory and motor behaviors (RSMB) and insistence on sameness (IS).Method: Children (N = 260, age 4–8 years, 174 male, 86 female) in mainstream schools identified by teachers as having behavioral, emotional, and/or cognitive difficulties, were assessed using the Repetitive Behavior Questionnaire-2 (RBQ-2), the British Picture Vocabulary Scale (BPVS), Lucid Ability Scale, the Welsh Index of Multiple Deprivation (WIMD) and the Screen for Child Anxiety Related Emotional Disorders (SCARED). Recruitment excluded diagnosed clinical conditions. The Strengths and Difficulties Questionnaire (SDQ) was used to assess children’s difficulties.Results: RRB scores were of high frequency and the scores for the IS were higher than for RSMB. The severity of anxiety symptoms and male sex were significantly associated with both RRB subtypes, and younger age and SES scores were associated with IS. Elevated RRB total and subtype scores were significantly related to SDQ scores for emotion, conduct, hyperactivity, and peer-relations.Discussion: The study provides the first evidence of RRBs in a diverse sample of young children with emerging difficulties in behavior, cognition, and/or emotion. The results contribute to proposals about psychological development in RRB and indicate that RRBs are best represented on a continuum of severity found across children in the early school years. The results support previous findings of a relation between RRB and anxiety reported in clinical samples and importantly, they indicate that it is time to move beyond the study of categorically defined groups and consider correlates of RRBs that include broad indices of mental health and well-being.