Autism Spectrum Diagnosis Research Articles

Factors Associated with a Delayed Autism Spectrum Disorder Diagnosis in Children Previously Assessed on Suspicion of Autism.

This study aimed to investigate factors associated with a delayed autism spectrum (ASD) diagnosis when compared to children with either no or early ASD diagnosis. Among 893 children assessed for ASD before age 8, 39% had no ASD at baseline, of which 21% received a later ASD diagnosis. Autism symptoms, diagnostic history of other developmental disorders, cognitive ability, and socioeconomic factors were associated with delayed ASD. Autism Diagnostic Observation Schedule (ADOS) scores in delayed ASD fell between early and no ASD. Other developmental disorders, time and clinical trends like ADOS use and low parental education distinguished delayed and early ASD, whereas higher frequency of IQ < 70 at baseline and a diagnosis of emotional disorders during follow-up distinguished delayed and no ASD.

Socio-economic and demographic factors associated with adaptive behaviour among children diagnosed with autism spectrum disorder in Egypt

BackgroundAdaptive behaviour among children diagnosed with autism spectrum disorder determines wide range of self-independent and autonomous activities. Adaptive behaviour is a clearly defined measurable variable that can be used as an outcome, hence impacts intervention and training programs. The current study aims to determine the socio-economic and demographic factors that are associated with adaptive behaviour among children diagnosed with autism spectrum disorder in Egypt. In this observational cross sectional study, caregivers’ reports on their children with a confirmed diagnosis of autism spectrum were obtained. Vineland Adaptive Behaviour Scale was used to assess adaptive behaviour among children aged 3–6 years and admitting at the outpatient clinic. Socioeconomic Status Scale was used to assess family socioeconomic status.ResultsParticipants in the current study scored low in domains of adaptive behaviour. Older children scored low in adaptive behaviour compared to younger children. There was significant positive correlation between daily living activities subdomain of adaptive behaviour and education, occupation, family possessions, and home sanitation and health care domains of socioeconomic status scale. There were significant positive correlations between socialization subdomain of adaptive behaviour and education, occupation, family, and family possessions and home sanitation domains of the socioeconomic status scale. The motor functioning subdomain of adaptive behaviour correlates significantly with the following SES domains: education (r = .268), occupation (r = .274), family possessions (r = .232), economic (r = .195) and health care (r = .291). Results of the current study revealed that high socioeconomic status correlates with higher adaptive functioning in daily living skills, socialisation and motor skills domains of adaptive behaviour.ConclusionThe correlations detected in the current study between adaptive behaviour and some social determinants of health can influence stakeholders’ decisions in planning and implementation of autism specific interventions.

Mortality in 787,666 school pupils with and without autism: A cohort study

Studies on children and adults combined suggest higher mortality rates for autistic than other people, but few report mortality rates for autistic children. In addition, past studies may not be representative of the current generation of children diagnosed with autism. We examined mortality in children using data from Scotland’s annual pupil census, linked to National Records of Scotland deaths register, between 2008 and 2015. In total, 9754 (1.2%) of 787,666 pupils had autism. They were more likely to live in neighbourhoods of greater deprivation and receive free school meals. Six autistic pupils died; crude mortality rate 15.8/100,000 person-years (95% CI = 7.1–35.1), compared with 458 other pupils; crude mortality rate 12.5/100,000 person-years (95% CI = 11.4–13.7). The indirectly standardised mortality ratio was 1.1 (95% CI = 0.5–2.5). In the autistic pupils, the most common causes of death were nervous system diseases, for example, epilepsy. Avoidable causes were common. In the comparison group, external causes and cancers were the most common causes of death. We cautiously conclude that mortality in the current generation of autistic children is no higher than for other children, perhaps due to recent widening of criteria for autism spectrum diagnosis, but some deaths could have been avoided by better care.Lay abstractThere are few studies on the deaths of children and young people with autism; some studies on children and adults combined suggest that those with autism may have higher death rates than other people. More children are diagnosed with autism than in the past, suggesting that there are now more children with milder autism who have the diagnosis than in the past, so studies in the past might not apply to the current generation of children and young people diagnosed with autism. We examined the rates of death in children and young people in Scotland using recorded information in Scotland’s annual pupil census, linked to the National Records of Scotland deaths register, between 2008 and 2015. In total, 9754 (1.2%) out of 787,666 pupils had autism. Six pupils with autism died in the study period, compared with 458 other pupils. This was equivalent to 16 per 100,000 for pupils with autism and 13 per 100,000 pupils without autism; hence, the rate of death was very similar. In the pupils with autism, the most common causes of death were diseases of the nervous system, whereas they were from external causes in the comparison pupils. The autism group had some deaths due to epilepsy which might have been prevented by good quality care. We cautiously conclude that the death rate in the current generation of children and young adults with autism is no higher than for other children, but that even in this high-income country, some deaths could be prevented by high quality care.

Explaining Age at Autism Spectrum Diagnosis in Children with Migrant and Non-Migrant Background in Austria.

This study explored (i) differences in age at Autism Spectrum Disorder (ASD) diagnosis between children with and without a migrant background in the main diagnostic centre for ASD in Upper Austria (ii) factors related to the age at diagnosis and (iii) whether specific factors differed between the two groups. A retrospective chart analysis included all children who received their first diagnosis before the age of 10 years (n = 211) between 2013 and 2018. Children with a migrant background were diagnosed 13 months earlier than those without (r = 0.278, p < 0.001), and had more severe delays in language, more severe autism, no Asperger’s syndrome, lower parental educational level and more frequent referrals by paediatricians. For the total sample, expressive language delay, severity of restricted and repetitive behaviours, higher nonverbal development, and paediatric referrals explained earlier diagnoses. There was a stronger effect of parental education and weaker effect of language impairment on age at ASD diagnosis in children with a migrant background. In conclusion, no delay in diagnosing ASD in children with a migrant background in a country with universal health care and an established system of paediatric developmental surveillance was found. Awareness of ASD, including Asperger’s syndrome, should be raised among families and healthcare professionals.

Presuming competence: troubling the ideal student

ABSTRACT Using [Canary, D. J., & MacGregor, I. M. (2008). Differences that make a difference in assessing student communication competence. Communication Education, 57(1), 41-63. doi:10.1080/03634520701635133] prototypes of ideal and less-than-ideal student communication behaviors, I rhetorically analyzed participant interview transcripts from young adults with an autism spectrum diagnosis for representative behaviors to determine the implications of such prototypes. Participants revealed that they feel chronically misunderstood by their communication partners. This research offers communication instructors and scholars a better understanding of communication produced by students with an autism spectrum diagnosis. It also challenges use of a normative communication lens to read so-called ideal student communication behaviors such as motivation and participation. It calls for communication experts to expand their own communication competence and to be mindful of the opportunities students have available to represent their interests and skills in the classroom.

‘It’s autism, it’s just a name’: Exploring the impact of autism spectrum diagnosis with adolescent females using Interpretative Phenomenological Analysis

Aim:To explore how adolescent females, who have an autism spectrum diagnosis, make sense of this diagnosis and how autism diagnosis has affected and influenced their sense of self or identity.Rationale:Educational Psychologists often work with children and young people who are diagnosed with autism and they can also be involved in the diagnostic process. Research findings will suggest what educational and health professionals may learn by listening to the voices of adolescent females who have an autism spectrum diagnosis.Method:This was a qualitative study. Interpretative Phenomenological Analysis (IPA) was used as a methodological approach as this offers insight into how a person makes sense of a given phenomenon.Findings/limitations:Research findings indicate that some participants were uncertain about the meaning of autism. Participants accepted, rejected or seemed unsure of their autism diagnoses. Some participants maintained a positive sense of self and achieved separateness from their diagnosis, but some participants experienced low self-esteem and depression which were linked to a sense of being different. This research included six participants, hence findings cannot be generalised.Conclusion:It is suggested that some young people find autism spectrum diagnosis useful, or may find it useful at certain times, but for some young people this label can be unwanted and even at times harmful to personal identity.

Development and Initial Utility of the Autism Clinical Interview for Adults: A New Adult Autism Diagnostic Measure.

Clinicians use diagnostic interviews to help them gather and organize information collected in the assessment of autism. Most instruments are developed for children and few measures have been developed that are reliable, valid, and appropriate for use in adulthood. This is a significant barrier to providing a high-quality, timely service for adults. The aim of this development study was to assess the initial utility of the recently developed Autism Clinical Interview for Adults (ACIA) for use in autism diagnostic clinical services before further large-scale testing and evaluation. We invited adults who had received an autism spectrum diagnosis through a U.K. National Health Service (NHS) multidisciplinary adult autism assessment to participate. Seventeen autistic adults (8 women and 9 men, mean age of 37 years) and four relatives agreed to an interview. The semistructured ACIA interview comprises subject and informant versions, and a self-report preinterview questionnaire. In combination, the ACIA components cover topics relevant to autism and co-occurring condition assessment. We evaluated clinical utility and content validity via comparison with the Diagnostic and Statistical Manual Fifth Edition (DSM-5) and NHS diagnostic reports. Each interview took between 60 and 90 minutes to complete. Comparison with DSM-5 and the NHS autism diagnostic report demonstrated that the ACIA accurately identified information on core autism characteristics needed for a diagnosis, and identified co-occurring conditions. In response to participant suggestions we revised the interview. These initial findings support the potential utility and validity of the ACIA for adult autism diagnostic clinical services. Further investigations of the acceptability, utility, and validity of this interview are planned. Why was this study done?: Clinicians use diagnostic interviews during assessments to help gather and record information both from a person suspected to be on the autism spectrum and from an informant (someone who knows them well). However, most autism diagnostic interviews were originally developed for assessing autism in childhood, and few have been developed for use with adults. The lack of diagnostic interviews developed specifically for use with adults makes it difficult to provide a good-quality, consistent assessment.What was the purpose of this study?: The study tested a new semistructured diagnostic interview called the Autism Clinical Interview for Adults (ACIA). The ACIA includes a questionnaire for people to complete before their interview. This is followed by an interview that can be conducted with the person themselves and a separate version to be used with someone who knows them well (if permitted). The interview covers autism traits, strengths and difficulties, and co-occurring physical and mental health conditions. We wanted to find out if the interview is useful for autism diagnostic services by comparing information collected using the ACIA with clinical diagnostic reports.What did the researchers do?: We invited people who had received a diagnosis of autism from a U.K. National Health Service (NHS) assessment to take part in an interview. We asked them if we could also interview someone who knew them well, and if we could compare their NHS autism diagnostic report with information gathered using the ACIA.What were the results of the study?: Seventeen autistic adults (average age 37 years; 8 women and 9 men) and 4 relatives/supporters (2 parents, a spouse, and a cohabiting partner) agreed to be interviewed. Each interview took 60 to 90 minutes to complete. A comparison with clinical reports showed the ACIA identified autism traits relevant for a diagnosis, as well as co-occurring conditions (e.g., depression). Participants suggested some ways to improve the interview, and revisions were made.What do these findings add to what is already known?: There are few diagnostic interviews designed specifically for use with adults seeking a diagnosis of autism. The findings from this study show that the ACIA is a promising new interview.What are the potential weaknesses of the study?: The study is small. However, it is important to run an initial test study before involving more people and resources in larger studies. Building on these results, we aim to undertake further studies on the acceptability and usefulness of the new interview with a larger number of people, including people from a range of backgrounds.How will these findings help autistic people now or in the future?: The ACIA has potential for use in adult autism clinical assessment services and as a resource for research and training. The semistructured format helps gather important and relevant information, and the interview length supports feasibility in clinical and research settings. The ACIA has the potential to streamline autism assessments and speed up the process for adults who currently wait a long time for their diagnosis.

Diffusion Tensor Imaging Abnormalities in the Uncinate Fasciculus and Inferior Longitudinal Fasciculus in Phelan-McDermid Syndrome

BackgroundThis cohort study utilized diffusion tensor imaging tractography to compare the uncinate fasciculus and inferior longitudinal fasciculus in children with Phelan-McDermid syndrome with age-matched controls and investigated trends between autism spectrum diagnosis and the integrity of the uncinate fasciculus and inferior longitudinal fasciculus white matter tracts. MethodsThis research was conducted under a longitudinal study that aims to map the genotype, phenotype, and natural history of Phelan-McDermid syndrome and identify biomarkers using neuroimaging (ClinicalTrial NCT02461420). Patients were aged three to 21 years and underwent longitudinal neuropsychologic assessment over 24 months. MRI processing and analyses were completed using previously validated image analysis software distributed as the Computational Radiology Kit (http://crl.med.harvard.edu/). Whole-brain connectivity was generated for each subject using a stochastic streamline tractography algorithm, and automatically defined regions of interest were used to map the uncinate fasciculus and inferior longitudinal fasciculus. ResultsThere were 10 participants (50% male; mean age 11.17 years) with Phelan-McDermid syndrome (n = 8 with autism). Age-matched controls, enrolled in a separate longitudinal study (NIH R01 NS079788), underwent the same neuroimaging protocol. There was a statistically significant decrease in the uncinate fasciculus fractional anisotropy measure and a statistically significant increase in uncinate fasciculus mean diffusivity measure, in the patient group versus controls in both right and left tracts (P ≤ 0.024). ConclusionBecause the uncinate fasciculus plays a critical role in social and emotional interaction, this tract may underlie some deficits seen in the Phelan-McDermid syndrome population. These findings need to be replicated in a larger cohort.

The Emergence of Bidirectional Naming Through Sequential Operant Instruction Following the Establishment of Conditioned Social Reinforcers.

Bidirectional naming (BiN) is the integration of speaker and listener responses, reinforced by social consequences. Unfortunately, these consequences often do not function as reinforcers for behavior in children with autism. Accordingly, the repertoire of BiN is also often limited in these children. Previous research has suggested that so-called multiple-exemplar instruction, a rotation between different speaker and listener operants, may be necessary to establish BiN. The present experiment aimed to investigate whether sequential operant instruction might also work as a successful intervention to improve BiN skills after the establishment of standard social reinforcers. Standard social reinforcers were identified and established through an operant-discrimination training procedure in 4 participating children with an autism spectrum diagnosis. In the present experiment, all participants showed increased BiN after sequential operant instruction with conditioned social reinforcers contingent on relevant operants. Two of 4 participants acquired BiN skills. Moreover, the remaining 2 participants scored within the mastery criterion on listener responses, and 1 of them also met the criterion on the tact probes. Essential characteristics of an intervention, as well as the role of the echoic in the emission of BiN, are discussed.

A cross-sectional examination of the clinical significance of autistic traits in individuals experiencing a first episode of psychosis

Autism traits are found at elevated rates in individuals with schizophrenia spectrum disorders, however, there is a lack of evidence regarding potential clinical impact. The current research aimed to examine potential associations between autism traits and symptoms of psychosis, social and role functioning, and quality of life. 99 individuals experiencing a first episode of psychosis took part in a cross-sectional interview and self-report questionnaire which assessed current symptoms of psychosis, autism traits, functioning, and quality of life. Participants were found to have a high level of autism traits. Higher autism traits were associated with poorer quality of life, functioning, and current psychotic symptoms. Receiver operating characteristic curve (ROC) analyses indicated that optimal AQ cut-off scores to predict severity of psychosis symptoms, functioning, and quality of life were lower than those used to suggest likely autism-spectrum diagnosis. Results suggest that autism traits are associated with poorer clinical presentation in first-episode psychosis populations, even in those whose traits fall below potentially diagnostic thresholds for autism. Psychosis services should be prepared to adequately address the needs of individuals with higher autism traits.

Mental Health Correlates of Autism Spectrum Disorder in Gender Diverse Young People: Evidence from a Specialised Child and Adolescent Gender Clinic in Australia.

Research suggests an overrepresentation of autism spectrum diagnoses (ASD) or autistic traits in gender diverse samples, particularly in children and adolescents. Using data from the GENTLE (GENder identiTy Longitudinal Experience) Cohort at the Gender Diversity Service at the Perth Children’s Hospital, the primary objective of the current retrospective chart review was to explore psychopathology and quality of life in gender diverse children with co-occurring ASD relative to gender diverse children and adolescents without ASD. The Social Responsiveness Scale (Second Edition) generates a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) score indicating a likely clinical ASD diagnosis, which was used to partition participants into two groups (indicated ASD, n = 19) (no ASD indicated, n = 60). Indicated ASD was far higher than would be expected compared to general population estimates. Indicated ASD on the Social Responsiveness Scale 2 (SRS 2) was also a significant predictor of Internalising behaviours (Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Thought Problems subscales) on the Youth Self Report. Indicated ASD was also a significant predictor of scores on all subscales of the Paediatric Quality of Life Inventory. The current findings indicate that gender diverse children and adolescents with indicated ASD comprise an especially vulnerable group that are at marked risk of mental health difficulties, particularly internalising disorders, and poor quality of life outcomes. Services working with gender diverse young people should screen for ASD, and also provide pathways to appropriate care for the commonly associated mental health difficulties.

Transdiagnostic Prediction of Affective, Cognitive, and Social Function Through Brain Reward Anticipation in Schizophrenia, Bipolar Disorder, Major Depression, and Autism Spectrum Diagnoses.

The relationship between transdiagnostic, dimensional, and categorical approaches to psychiatric nosology is under intense debate. To inform this discussion, we studied neural systems linked to reward anticipation across a range of disorders and behavioral dimensions. We assessed brain responses to reward expectancy in a large sample of 221 participants, including patients with schizophrenia (SZ; n = 27), bipolar disorder (BP; n = 28), major depressive disorder (MD; n = 31), autism spectrum disorder (ASD; n = 25), and healthy controls (n = 110). We also characterized all subjects with an extensive test battery from which a cognitive, affective, and social functioning factor was constructed. These factors were subsequently related to functional responses in the ventral striatum (vST) and neural networks linked to it. We found that blunted vST responses were present in SZ, BP, and ASD but not in MD. Activation within the vST predicted individual differences in affective, cognitive, and social functioning across diagnostic boundaries. Network alterations extended beyond the reward network to include regions implicated in executive control. We further confirmed the robustness of our results in various control analyses. Our findings suggest that altered brain responses during reward anticipation show transdiagnostic alterations that can be mapped onto dimensional measures of functioning. They also highlight the role of executive control of reward and salience signaling in the disorders we study and show the power of systems-level neuroscience to account for clinically relevant behaviors.

Girls and women with autism.

Girls and women with autism are often undiagnosed, misdiagnosed or receive a diagnosis of autism at later age. This can result in adverse outcomes in their well-being, mental health, education, employment, and independence. The diagnosis of autism spectrum condition/disorder (hereinafter referred to as autism), with its current features linked with descriptions in the major diagnostic classification systems, is based primarily on observations and research on males. The term 'Autism Spectrum Condition' (ASC), used in this paper, has been coined by Simon Baron-Cohen and used in the professional literature for a decade to respect these individuals on the autism spectrum who feel that the term 'disorder'is stigmatizing, whereas ASC presents both the strengths of these people and difficulties they experience. The research shows that autism in females has unique symptomatology and manifests itself differently, more subtly, especially in high-functioning girls and women, i.e., those with fluent speech, average or above-average intelligence quotient. The research also shows diagnostic stereotypes and lack of required sensitivity to identify autistic females. Additionally they do not reflect the unique presentation of autism in females demonstrated by greater compensatory capacity and an ability to develop sophisticated methods of 'camouflaging'and masquerading. Furthermore, autism in females is associated with high comorbidity during adolescence including anxiety disorder, tic disorder, depression, high incidence of suicide, eating disorders, and high rates of other medical problems. Timely diagnosis, however, can reduce the difficulties that females with autism experience over their lifetime, allowing for the assessment of their needs regarding health, education, leisure, social relationships, and employment.

Autism Mental Status Examination (AMSE): A Valid Instrument in the Evaluation of Pre-school Children with Suspected Autism Spectrum Disorders?

In this study the Autism Mental Status Exam (AMSE) was validated towards ICD-10 Autism Spectrum Diagnoses (ASD) based on an interview with the Diagnostic Interview for Social and Communication Disorders (DISCO-11) with parent(s)/caregiver(s) in a group of 124 children referred for assessment to a clinical assessment unit for pre-school children. The results from the study indicates a Fair relation across the AMSE score and ICD-10 Autism Spectrum Disorder (ASD). AMSE mean score for children not fulfilling criteria for an ASD at the assessment was significantly lower compared to the AMSE mean score for children who acquired an ASD diagnosis in the study. In addition, Vineland-II Parent/caregiver rating questionnaire GAF standard scores showed a reversed correlation to the AMSE mean scores (i.e. higher AMSE mean scores were related to lower Vineland-II GAF standard scores and vice versa).

Use, costs, and predictors of psychiatric healthcare services following an autism spectrum diagnosis: Population-based cohort study.

A number of cross-sectional studies report extensive use of psychiatric services and high healthcare costs in autistic youths. However, little is known about how the use of these services evolves from the time of diagnosis, as children grow up. Our objectives were to investigate the use, costs, and predictors of psychiatric services following autism spectrum diagnosis. We built a cohort of 1227 newly diagnosed autism spectrum individuals identified in the Quebec (Canada) Régie de l'assurance maladie du Québec administrative database (January 1998 to December 2010). Mean number and cost per individual of psychiatric healthcare use (hospitalizations, medical visits, psychoactive drug use) were calculated yearly for 5 years following autism spectrum diagnosis. Mean number of psychiatric visits decreased over time by more than threefold (7.5 vs 2.1 visits) from year 1 to year 5, whereas psychoactive drug use increased from 16.0 to 25.2 claims. Psychiatric hospitalizations decreased during follow-up, but still represented the greatest costs per individual (CAD9820 for year 1; CAD4628 for year 5). Antipsychotics represented over 50% of drug costs. Mixed-effect model with repeated measures showed that previous psychoactive drug use was the strongest predictor of greater psychiatric healthcare cost during follow-up (odds ratio: 9.96; 95% confidence interval: 7.58-13.10). These trends contrast with guidelines advocating cautious prescribing of antipsychotics with periodical re-assessment of their benefit.

Silent shapes and shapeless sounds: the robustness of the diminished crossmodal correspondences effect in autism spectrum conditions

We performed a registered replication of the Oberman and Ramachandran (Soc Neurosci 3(3–4):348–355, 2008) study on the ‘kiki/bouba’ effect in autism spectrum conditions (ASC). The aim of the study was to test the robustness of the diminished crossmodal correspondences effect in autism, but also to verify whether this effect is not an artifact of differences in intelligence. We tested a Polish-speaking sample of 21 participants with ADOS-confirmed autism spectrum conditions (mean age 15.90) and 21 age- (mean age 15.86), sex- and IQ-matched neurotypical control participants. Procedure closely followed the replicated study. Participants’ task was to match five pairs of unfamiliar words and shapes. Matching words and shapes had similar supramodal characteristics that allowed the match. We report partial replication of the diminished ‘kiki/bouba’ effect in individuals with ASC compared to the neurotypical control group. However, we found that nonverbal intelligence also significantly contributed to task performance, but only in participants with autism, suggesting a compensatory role of intelligence. Finally, the effect of autism severity (measured by ADOS classification) was significant—crossmodal correspondences were weaker in individuals with autism, compared to those with autism spectrum diagnosis.

Microaggression Experiences of Fathers With Children With Autism Spectrum Disorder

Using interpretive phenomenological analysis, we interviewed six fathers to learn about their experiences in acclimating others to their children’s autism spectrum diagnoses. Results indicate a need for counselors to understand and support clients who experience frequent microaggressions and stereotyping related to autism spectrum disorder and its subsequent influence on fathers’ mental health and family wellness. Recommendations for working with families of individuals with autism and additional research are presented.

He said, she said: Autism spectrum diagnosis and gender differentially affect relationships between executive functions and social communication.

Autism spectrum disorder is characterized by difficulties with social communication, with a preponderance in males. Evidence supports a relationship between metacognitive executive functions (e.g. planning, working memory) and social communication in autism spectrum disorder, yet relationships with specific metacognitive executive functions and how gender alters the expression of these relationships require further study. We used multiple regression to examine relationships between informant-based measures of metacognitive executive function and social communication in intellectually able (IQ ⩾ 85) female (n = 111; mean age = 10.2 ± 2.8; 31 autism spectrum disorder) and male youth (n = 310; mean age = 10.5 ± 1.9; 146 autism spectrum disorder) with and without autism spectrum disorder from the Autism Brain Imaging Data Exchange-II database. Executive function-social communication relationships were different in females and males with autism spectrum disorder. Relationships between the entire metacognitive index and social communication were stronger in males with autism spectrum disorder than without; this pattern was also observed for metacognitive sub-indices 'monitor' and 'working memory'. These patterns were not observed in females. Relationships between executive function and social communication appear different for female and male youth with an autism spectrum disorder diagnosis. To better understand the nature of metacognitive contributions to social communication in autism spectrum disorder, future work should investigate the co-development of monitoring, working memory and social communication, while taking gender into account.

Impact of Psychoactive Drug Use on Developing Obesity among Children and Adolescents with Autism Spectrum Diagnosis: A Nested Case-Control Study.

Obesity in children on the autism spectrum (AS) is becoming a significant health concern. The purpose of this study was to identify the predictors of obesity in a cohort of AS youth and to assess the impact of psychoactive medication use while exploring the second-generation antipsychotics (SGAs) dose-response curve. A nested case-control study was conducted using Quebec public administrative databases. Subjects with AS <18 years [≥2 diagnoses International Classification of Diseases: 9th revision (ICD-9): 299.X] were identified (January 1993 to May 2011). Cases were defined as subjects with an obesity diagnosis (ICD-9: 278.X) during the coverage period and matched to 10 controls for age, gender, and follow-up duration. Potential risk factors for obesity (sociodemographic characteristics, other neuropsychiatric conditions, and psychoactive drug use) were evaluated and analyzed using conditional logistic regression. From a cohort of 5369 AS subjects, we identified 135 obesity cases. Among the different risk factors, only SGAs [rate ratio (RR): 1.04, 95% confidence interval (CI): 1.01-1.07] increased the probability of obesity in multivariate analysis. Exposure for ≥12 months increased significantly the likelihood of obesity (RR: 2.01, 95% CI: 1.18-3.42). Higher risk was observed with chlorpromazine-equivalent daily doses ≥100 mg (RR: 2.20, 95% CI: 1.00-4.84). Among SGA users, concomitant antidepressants (per 30-day exposure) slightly increased the probability (RR: 1.08, 95% CI: 1.01-1.15). Longer and higher SGA exposure increased the risk of obesity, which has to be considered in relation to the paucity of evidence supporting long-term psychoactive medication use in AS children. Results highlight the need to promote optimal use and interventions to mitigate metabolic side effects of SGAs in this population.

Awareness within local authorities in England of autism spectrum diagnoses of looked‐after children

Educational outcomes for looked‐after children on the autism spectrum are significantly poorer than for autistic children not being looked‐after by their local authority (those ‘in care’), and poorer than for most other groups of children with special educational needs who are looked‐after in England. Such poor outcomes have led to calls for specific attention to be paid to the needs of autistic looked‐after children within the care of local authorities. There is also evidence that the numbers of autistic children being looked‐after by local authorities could be under‐represented in official figures. This study sought to find the current numbers of autistic looked‐after children formally recorded across local authorities in England, and whether their needs are given special attention via strategic planning and oversight, using freedom of information (FoI) requests sent to all local authorities in England. From the 147 (97%) local authorities who responded, approximately 3% of looked‐after children in England are recorded as having an autism spectrum diagnosis, although this is still very likely to be an underestimation. The majority of local authorities do not routinely monitor or report on the diagnostic status of autistic looked‐after children at a strategic level. Implications for research and practice are discussed.