Impaired Social Skills Research Articles

Motor, cognitive, and socio-cognitive mechanisms explaining social skills in autism and typical development.

Challenges in social functioning are considered a core criterion for diagnosing autism. Although motor skills, executive functioning (EF), and theory of mind (ToM) abilities independently affect social challenges and are interconnected, these abilities' shared contribution to the explanation of social functioning in autism remains under-investigated. To address this disparity, we examined the motor, EF, and ToM abilities of 148 autistic and non-autistic youth (ages 6-16 years), evaluating these variables' impact on social ability and their interconnections. Our mediation model exploring the contribution of motor, EF, and ToM skills explained 85% of the variance in social functioning (Social Responsiveness Scale-SRS-2). Analysis yielded a direct path from study group to SRS-2-social (typically developing-TD > autistic) and two main parallel indirect joint paths: (a) Group ➔ motor ➔ EF ➔ SRS-2-social; and (b) Group ➔ motor ➔ ToM ➔ SRS-2-social. In two secondary indirect paths, autistic children showed lower motor skills, which in turn explained their higher EF and/or ToM impairment, which in turn explained their higher social skills impairment. Put differently, our results suggest that better EF and TOM proficiency may compensate for poorer motor skills. Findings also indicated that the collective impact of motor, EF, and ToM skills on social functioning, along with the mediating role played by EF and ToM on the social-motor linkage, may contribute to understanding individual differences in the social functioning of autistic children. These conclusions call for the inclusion of motor, EF, and ToM activities into daily practices to facilitate social functioning.

Unraveling the Role of Neuroligin3 in Autism Spectrum Disorders: Pathophysiological Insights and Targeted Therapies.

Autism Spectrum Disorder is a neurodevelopmental disorder characterized by impaired social and communication skills, repetitive behaviors, and/or restricted interests with a prevalence of as high as 1% of children. Autism spectrum has strongly associated with genetic factors and exhibits wide clinical and heterogeneous genetic architecture. Most genes associated with Autism are involved in neuronal and synaptic development. The neuroligin3, the sex-linked gene on the X chromosome, was the first gene to be associated with a monogenic form of Autism. Neuroligin3 is a postsynaptic cell adhesion protein involved in synapse transmission, brain formation, and neuronal development. In this review, we provide recent findings on different mutations in the Neuroligin3 gene linked to Autism spectrum disorder and their molecular pathway effect. We also give the behavioral, and synaptic alterations reported in the Neuroligin3 animal model of Autism and the potential therapeutic strategies targeting the biological processes and the main symptoms of autism spectrum disorder. In addition, we discuss the use of novel technologies like induced pluripotent stem cells from Autistic patients that have the potential to differentiate in human neurons and therefore have a variety of applications in therapy and biomedical studies to search specific biomarkers, and develop systems for screening chemical molecules in human cells to discover target therapies.

Psychosocial Burden in Parents Having Intellectually Disabled Children: A Hospital-based Study

Abstract Background: Intellectual disability is a non-communicable health disorder that has become a public health concern worldwide, with a marked impairment in communication, academic, and social skills. It is important to identify the level of psychological stress among parents of these children. Hence, this study was designed to assess the level of psychological stress among parents having intellectually disabled children. Materials and Methods: The study was conducted in the Physical Medicine and Rehabilitation outpatient department (OPD) at Kalawati Saran Children’s Hospital, New Delhi. Data were collected to analyze the psychological stress in families. Parental Stress Scale (PSS) was used as the tool to measure stress in parents. Results: A total of 170 mothers were enrolled in the study. In total, 14 different variables were considered plausible contributing factors to the mother’s stress. Four variables demonstrated a clear linear association between variable values and PSS. These variables were a) per-capita monthly family income, b) socioeconomic status, c) study subjects’ occupation, and d) duration of disability. The overall mean PSS for the entire cohort was found to be 47.14 ± 2.93. The reference criteria for low stress was 19–45, and it was 45–90 for high stress. Conclusion: The study suggests that mothers of children with intellectual disability experience high stress. Raising a child with special care needs is overwhelming for mothers. Appropriate clinical services should be provided to support parents of children with disabilities and offer resources to educate and enable mothers to manage their children’s disabilities and needs.

Social skills in patients with obsessive-compulsive disorder before and after treatment.

We aim to investigate whether: 1) social skills (SS) are impaired in obsessive-compulsive disorder (OCD); 2) SS would change over the course of treatment; and 3) severity of OCD, age of onset of OCD symptoms and illness duration would be associated with SS impairments. 41 treatment-naive patients with OCD and 34 control participants (CP) were assessed using a SS inventory. Patients were reevaluated 12-weeks after standardized treatment. Group differences, as well as the treatment effect on OCD symptomatology over time, were analyzed with independent and paired tests, respectively. OCD severity, age at illness onset and illness duration were tested as predictors of SS. Patients had lower total SS scores compared to controls (p-value < 0.001). After treatment, although OCD symptomatology (p-value < 0.001) improved, there was no statistical difference in SS performance (p-value = 0.673). Earlier age of onset of OCD symptoms predicted worse SS total score (p-value = 0.016). This study suggests that, despite the amelioration of OCD symptomatology, there was no alteration in Social Skills (SS) performance. Subsequent treatment investigations incorporating larger sample sizes and extended follow-up periods could elucidate whether enhancements in social skills are likely to manifest over time.

Only Child Male and their Perception Towards Romantic Relationship and Gender Roles

Abstract: The purpose of this study is to provide a thorough understanding of the attitudes and experiences of only child men by examining their opinions of romantic relationships and gender roles. Due to the lack of siblings, the historical concept of "only child syndrome" has perpetuated unfavourable perceptions about only children, implying possible social skill impairments or selfish behaviour (Falbo &amp; Polit, 1986). Modern research, however, contradicts these theories, showing that only children frequently perform comparably to siblings and, in specific situations, even outperform them in particular areas (Falbo &amp; Polit, 1986). This study (Braithwaite &amp; Holt-Lunstad, 2017) offers a nuanced perspective among only child guys, who value equality, partnership, and mutual respect in their romantic relationships through qualitative interviews and thematic analysis. They stress how important it is to spend time together, give back to the community, and engage in similar interests in order to promote emotional closeness and fulfilment (Falbo &amp; Polit, 1986). Additionally, participants advocate for flexibility and shared responsibility in partnerships, rejecting established gender norms (Bukowski et al., 1987). Good communication techniques, such having candid conversations and paying attention, become essential instruments for resolving disputes and preserving harmonious relationships (Furman &amp; Shaffer, 2003). These findings contribute to a deeper understanding of contemporary relationship dynamics by challenging stereotypes and providing insights into building fulfilling and healthy partnerships among male only children (Bukowski et al., 1987).

Autism Spectrum Disorders: Etiology, Epidemiology, and Challenges for Public Health.

Autism spectrum disorder (ASD) is a growing public health problem. American psychiatrist Leo Kanner is considered the "father of autism." ASD encompasses a range of neurodevelopmental disorders that last throughout life. Symptoms of ASD include impairments in social skills, including specific repetitive behaviors, as well as abnormal sensory responses. The clinical symptoms of ASD vary among patients. Their severity also differs, both in the area of social communication and cognitive functioning. The etiology of ASD is still unclear, although a role is attributed to both genetic and environmental factors. According to the World Health Organization, 1/100 children have ASD, but these estimates vary depending on the methodology used. Nevertheless, early detection of ASD and initiation of appropriate therapy may be essential in the continued functioning of patients and their families. The purpose of this article is to provide an overview of current knowledge about autism spectrum disorders. We discuss factors associated with autism and the prevalence of ASD in various parts of the world, and identify the most common diseases comorbid with ASD, pointing to limitations in the quality of life of patients with ASD and their families.

Feasibility of Using Magnetic Resonance Spectroscopy Test Biomarkers to Diagnose Alzheimer's Disease: Systematic Evaluation and Meta-Analysis.

Alzheimer's disease (AD) is the leading cause of dementia, resulting in impairments in memory, cognition, decision-making, and social skills. Thus, accurate preclinical diagnosis of Alzheimer's disease is paramount. The identification of biomarkers for Alzheimer's disease through magnetic resonance spectroscopy (MRS) represents a novel adjunctive diagnostic approach. This study conducted a meta-analysis of the diagnostic results of this technology to explore its feasibility and accuracy. PubMed, Cochrane Library, EMBASE, and Web of Science databases were searched without restrictions, with the search period extending up to July 31, 2022. The search strategy employed a combination of subject headings and keywords. All retrieved documents underwent screening by two researchers, who selected them for meta-analysis. The included literature was analyzed using Review Manager 5.4 software, with corresponding bias maps, forest plots, and summary receiver operating characteristic (SROC) curves generated and analyzed. A total of 344 articles were retrieved initially, with 11 articles meeting the criteria for inclusion in the analysis. The analysis encompassed data from approximately 1766 patients. In the forest plot, both sensitivity (95% CI) and specificity (95% CI) approached 1. Examining the true positive rate, false positive rate, true negative rate, and false negative rate, all studies on the summary receiver operating characteristic (SROC) curve clustered in the upper left quadrant, suggesting a very high accuracy of biomarkers detected by MRS for diagnosing Alzheimer's disease. The detection of biomarkers by MRS demonstrates feasibility and high accuracy in diagnosing AD. This technology holds promise for widespread adoption in the clinical diagnosis of AD in the future.

Challenges of Sexuality Expression in Individuals with Autism Spectrum Disorder

IntroductionSexuality, although an essential component of human health, remains a controversial topic shrouded in stigma, particularly in the context of neurodiversity, which includes autism spectrum disorder (ASD), where the expression of sexuality presents unique challenges. Autism and sexuality is a complex and multifaceted topic that involves understanding the unique ways in which individuals on the autism spectrum experience and express their sexuality.ObjectivesThe purpose of this work is to address the complexity of the biopsychosocial sexuality components of people with autism, promoting a shift in the medical perspective, societal attitudes, and supporting greater inclusion of these individuals in current discussions regarding this area of human behavior and experience.MethodsEvidence-based review, through research conducted on PubMed and selection of the most relevant studies on this topic, published in the last decade.ResultsSexuality in autism is now recognized as a normative and integral aspect of development and functioning. Existing research suggests that most individuals with ASD display a clear interest in sexuality and relationships, with a study reviling that 96% of the ASD sample expressed an interest in sexuality. Individuals with high autistic traits tended to identify themselves more times as bisexual or presented a sexuality not definable within the categories of heterosexual. The relationship between autism and gender dysphoria is an area of ongoing research and discussion. Studies have suggested a higher prevalence of gender diverse identities and experiences within the autism community compared to the general population. Various hypotheses have been proposed to explain the increased gender and sexual diversity among individuals with autism. People with ASD may face unique challenges when it comes to their sexuality. The impairments in social skills and communication central to ASD potentially impact an autistic individual’s expression and experience of sexuality by affecting their abilities to understand and interpret social cues, emotions, and nonverbal behaviors of others. Importantly, such individuals may be more vulnerable, as they may have different or even limited understanding of boundaries and consent. To address these challenges, it is important to acknowledge and respect the diversity of sexual experiences and desires among individuals with neuro(bio)logical differences. This can be done by providing accurate and inclusive sex education, creating safe spaces for such individuals to explore and express their sexuality, and working to address discrimination and abuse in intimate contexts.ConclusionsRecognizing and respecting this diversity and fostering inclusive and accepting environments, we can help individuals with neurological differences to fully express and explore their sexuality and have satisfying sexual lives.Disclosure of InterestNone Declared

Characterizing individual differences in children and adolescents with autism spectrum disorder: a descriptive study.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by a higher prevalence in male than in female participants. Recent studies have hypothesized the presence of different phenotypes in male and female participants with ASD. The present study aims to assess possible sex differences in cognitive and adaptive functioning, symptomatology of ASD, and psychopathological comorbidities in a large sample of children and adolescents with ASD. The study included a total of 2,146 children and adolescents diagnosed with ASD, comprising 1785 boys (mean age 7.12 ± 3.69 years) and 361 girls (mean age 6.25 ± 3.30 years). The age of the participants ranged from 1.35 to 19.05 years (mean age 9.98 ± 3.64). The study sought to include all children and adolescents diagnosed with Autism or ASD. Present results showed that girls with ASD had lower IQs than boys but similar adaptive functioning. The severity of symptoms of ASD was greater in boys than in girls, as were scores on psychopathological measures. With increasing age, boys with ASD showed greater impairment in social communication skills than girls and increased psychopathological comorbidities. Older girls showed fewer restricted and repetitive behaviors. Exploring phenotypic differences in children and adolescents with ASD fosters an understanding of subtle diagnostic facets that may go unrecognized, allowing for increasingly individualized and tailored interventions.

Improvement of autistic-like behaviors in adult rats prenatally exposed to valproic acid through early suppression of orexin receptor.

Autism spectrum disorder (ASD) is a disabling psychiatric disease characterized by impairments in communication and social skills. The pathophysiology of autism is complex and not fully known. Considering the incidence of sleep disorders in individuals with ASD and the important role of orexin in sleep, it is possible to hypothesize that an alteration of the orexinergic system could be implicated in the pathogenesis of autism symptoms. The present study was conducted to investigate the effect of suvorexant [dual orexin receptor antagonists (DORAs)] on autism-like behavior in prenatally valproic acid (VPA)-exposed rats]. Wistar female rats were administered VPA [600 mg/kg, intraperitoneally (i.p.)] or normal saline (10 ml/kg, i.p.; vehicle control) on gestational day 12.5. Thirty-two male offspring were divided into four groups: Control, VPA, Suvorexant+VPA, and VPA+Risperidone. The pups were given suvorexant [20 ml/kg, by mouth/orally (p.o.)] or risperidone (1 ml/kg, p.o.) daily from postnatal day (PND) (40-54). The offspring were tested for repetitive behaviors and cognitive ability with a Y-maze task on PND 55, and social interaction was assessed by play behavior in the open field on PND 56. And anxiety with using the three-chamber social assay on PND 56. In the Y-maze apparatus, spontaneous alteration significantly decreased in the prenatal VPA-treated rats compared to control rats showing autistic-like behavior, and 2-week suvorexant increased the alternation, indicating the beneficial effect of suvorexant. Prenatal treatment with VPA, impaired play behavior (sniffing, grooming, and darting), and increased anxiety-related behavior. Suvorexant treatment attenuated the problems in male offspring's social behavior. Our results showed that suvorexant improved ASD-associated behaviors in the VPA-treated rats, and the orexinergic system may be associated with the pathogenesis of autism symptoms.

An Exploration of a General Social Outcome Measure

The General Social Outcome Measure (GSOM) is a performance-based measurement tool designed to assess the change in social skills performance during and after intervention for students with social skills deficits. In the current study, the psychometric properties of the GSOM, including the total score and social communication domains, were examined in adolescents with social skill deficits. Internal consistency alphas were conducted, which showed promising results. Correlational analyses were conducted using the GSOM and the Children’s Communication Checklist-2 (CCC-2), School Social Behavior Scales (SSBS), and the Autism Diagnostic Observation Schedule–Second Edition (ADOS-2). A small but significant correlation was documented between the GSOM and the ADOS-2, with higher GSOM total scores (higher social skills) associated with lower ADOS-2 scores. Additional analyses revealed that individuals with different levels of symptomology according to the ADOS-2 (low, moderate, or high) differed significantly in the GSOM total score. The implications of these findings are discussed with respect to the utility of the GSOM as a progress-monitoring tool for targeted populations with social skill impairments.

42 Social Problems in Childhood Epilepsy as it Relates to Overall Intellectual and Adaptive Functioning and Social Skills

Objective:Previous studies have demonstrated a high prevalence of social and emotional problems in young adults with a history of childhood epilepsy, with social skill impairment hypothesized to play a significant role in these outcomes. Few studies have examined social skills within children with epilepsy and very few have examined this within the context of other neuropsychological and neurological variables. This study aims to examine the association between social problems and other relevant neuropsychological variables (IQ, adaptive functioning, social skills) within the pediatric epilepsy population.Participants and Methods:Participants were 86 epilepsy patients between the ages 5 and 18 years of age who were referred for neuropsychological assessment as a part of their surgical candidacy work-up. Pearson correlation analysis was conducted to examine the correlations between performance on objective measures of full-scale IQ, and parent ratings on questionnaires assessing parent perception of the patients’ overall adaptive functioning, social skills, and social problems.Results:As expected, earlier age of onset was associated with lower IQ, which itself was associated with weaker overall daily living skills and social skills. Later age of seizure onset was associated greater social problems. Social skills were not correlated with social problems.Conclusions:The results of this study suggest that children with later age of onset of seizures, are at increased risk of social problems and that these problems may not related to social skill impairment. Implications for clinical practice and future directions are discussed.

Association of ABCA13 Gene Variants with Autism Spectrum Disorder and Other Neuropsychiatric Disorders

Introduction: Autism spectrum disorder (ASD) is a neuropsychiatric disorder characterized by impaired social skills and limited or repetitive behaviors. In this study, we investigated the role of the ABCA13 gene in the etiopathogenesis of ASD. Methods: Single-nucleotide variants were evaluated in 79 ASD patients (59 males +20 females) with no established genetic etiology associated with ASD using whole-exome sequencing/clinical exome sequencing method. Family segregation analysis was performed using Sanger sequencing. We presented the clinical and genetic findings of these cases and their parents in detail. Results: We presented 10 different ABCA13 gene variants in cases with ASD and 10 parents carrying the same ABCA13 gene variant. There of these variants were likely pathogenic and seven variants were classified as variant of uncertain significance. Our cases had a comorbidity rate for attention deficit hyperactivity disorder (ADHD) as 70%. Various types of neuropsychiatric symptoms and diagnoses were detected including ADHD, anxiety disorder, intellectual disability, delay in speech, and febrile convulsion among the parents. Conclusion: To date, very few variants have been reported in the ABCA13 gene. Our findings enrich the role of ABCA13 gene may play a common role in the landscape of neuropsychiatric disorders.

Positive effects of physical activity in autism spectrum disorder: how influences behavior, metabolic disorder and gut microbiota.

Autism spectrum disorder is a neurodevelopmental disorder characterized by social interactions and communication skills impairments that include intellectual disabilities, communication delays and self-injurious behaviors; often are present systemic comorbidities such as gastrointestinal disorders, obesity and cardiovascular disease. Moreover, in recent years has emerged a link between alterations in the intestinal microbiota and neurobehavioral symptoms in children with autism spectrum disorder. Recently, physical activity and exercise interventions are known to be beneficial for improving communication and social interaction and the composition of microbiota. In our review we intend to highlight how different types of sports can help to improve communication and social behaviors in children with autism and also show positive effects on gut microbiota composition.

Genomic architecture of autism spectrum disorder in Qatar: The BARAKA-Qatar Study

BackgroundAutism spectrum disorder (ASD) is a neurodevelopmental condition characterized by impaired social and communication skills, restricted interests, and repetitive behaviors. The prevalence of ASD among children in Qatar was recently estimated to be 1.1%, though the genetic architecture underlying ASD both in Qatar and the greater Middle East has been largely unexplored. Here, we describe the first genomic data release from the BARAKA-Qatar Study—a nationwide program building a broadly consented biorepository of individuals with ASD and their families available for sample and data sharing and multi-omics research.MethodsIn this first release, we present a comprehensive analysis of whole-genome sequencing (WGS) data of the first 100 families (372 individuals), investigating the genetic architecture, including single-nucleotide variants (SNVs), copy number variants (CNVs), tandem repeat expansions (TREs), as well as mitochondrial DNA variants (mtDNA) segregating with ASD in local families.ResultsOverall, we identify potentially pathogenic variants in known genes or regions in 27 out of 100 families (27%), of which 11 variants (40.7%) were classified as pathogenic or likely-pathogenic based on American College of Medical Genetics (ACMG) guidelines. Dominant variants, including de novo and inherited, contributed to 15 (55.6%) of these families, consisting of SNVs/indels (66.7%), CNVs (13.3%), TREs (13.3%), and mtDNA variants (6.7%). Moreover, homozygous variants were found in 7 families (25.9%), with a sixfold increase in homozygous burden in consanguineous versus non-consanguineous families (13.6% and 1.8%, respectively). Furthermore, 28 novel ASD candidate genes were identified in 20 families, 23 of which had recurrent hits in MSSNG and SSC cohorts.ConclusionsThis study illustrates the value of ASD studies in under-represented populations and the importance of WGS as a comprehensive tool for establishing a molecular diagnosis for families with ASD. Moreover, it uncovers a significant role for recessive variation in ASD architecture in consanguineous settings and provides a unique resource of Middle Eastern genomes for future research to the global ASD community.

A CRITICAL APPRAISAL OF AUTISM SPECTRUM DISORDER IN TERMS OF AYURVEDA

Introduction: Autism spectrum disorders are conditions characterised by impaired social interaction communication skills and associated stereotypic, restrictive and repetitive behavioural patterns. According to a WHO report, it is estimated that worldwide, about one in 100 children has ASD. In India, according to the calculation of the Rehabilitation Council of India, the prevalence rate is 1 in 500 or 0.2%. Multimodal management approach of Ayurveda comprising herbal supplements, Ayurveda compounds, and panchakarma therapies. In Ayurvedic literature, Acharyas mention three types of chikitsa for the whole body and mind level- daivavyapashraya, yuksivyapashraya and satvavjaya chikitsa. These treatments benefit autistic children by a different mechanism of action and improve their quality of life. It concluded that Ayurveda provides safe, effective, cheap and untoward effect-free management along with enhancing the quality of life for people living with ASD and bringing back smiles on parents' faces.

Life engagement in people living with schizophrenia: predictors and correlates of patient life engagement in a large sample of people living in the community.

Life engagement represents a holistic concept that encompasses outcomes reflecting life-fulfilment, well-being and participation in valued and meaningful activities, which is recently gaining attention and scientific interest. Despite its conceptual importance and its relevance, life engagement represents a largely unexplored domain in schizophrenia. The aims of the present study were to independently assess correlates and predictors of patient life engagement in a large and well-characterized sample of schizophrenia patients. To assess the impact of different demographic, clinical, cognitive and functional parameters on life engagement in a large sample of patients with schizophrenia, data from the social cognition psychometric evaluation project were analyzed. Overall schizophrenia and depressive symptom severity, premorbid IQ, neurocognitive performance, social cognition performance both in the emotion processing and theory of mind domains, functional capacity, social skills performance and real-world functioning in different areas all emerged as correlates of patient life engagement. Greater symptom severity and greater impairment in real-world interpersonal relationships, social skills, functional capacity and work outcomes emerged as individual predictors of greater limitations in life engagement. Life engagement in people living with schizophrenia represents a holistic and complex construct, with several different clinical, cognitive and functional correlates. These features represent potential treatment targets to improve the clinical condition and also facilitate the process of recovery and the overall well-being of people living with schizophrenia.

Дистанционное обучение учителей технике “Power Cards” в контексте формирования социальных навыков у учащихся с расстройством аутистического спектра

&lt;p style="text-align: justify;"&gt;Impairments in social skills are one of the core characteristics of individuals with autism spectrum disorder. Impairments in social skills in this group of individuals may not naturally decrease or disappear over time. Rather, they become more pronounced unless appropriate interventions to promote social competence are delivered to these individuals. In this study, researchers examined the effects of remote professional development training through behavioral skills training and coaching on teachers&amp;rsquo; (psychologists') use of Power Card method using a one-group pre- and post-test design. Moreover, the effects of Power Card method on teaching social skills &amp;ndash; saying &amp;ldquo;Thank you.&amp;rdquo; (e.g., thanking upon accessing the requested item) &amp;ndash; to their students with autism spectrum disorder were investigated using a multiple probe design across participants. Three psychologists working as a special education teacher and their students with autism spectrum disorder from a special education school participated in the study. The researchers evaluated teachers&amp;rsquo; performance on script and Power Card development and implementation using checklists (e.g., Steps for Developing Scripts and Power Cards). They performed visual analysis to evaluate students&amp;rsquo; performance. Remote behavioral skills training and coaching were effective in the acquisition, maintenance, and generalization of teachers&amp;rsquo; use of Power Card procedure, and the Power Card procedure was effective in teaching social skills to students with autism spectrum disorder. Furthermore, the students maintained the target skills 2 and 4 weeks after the intervention and generalized them across different conditions. Teachers had positive opinions regarding (a) feasibility of the Power Cards, (b) acceptability of remote behavioral skills training and coaching, and (c) social significance of the target skills for the students. Limitations (e.g., narrow focus on social skills and collection of social validity data through participant judgement) and implications for future research are discussed.&lt;/p&gt;

Service Use as a Predictor of Change in Mental Health Problems Among Children: A Prospective Cohort Study.

Psychosocial interventions for children's mental health problems typically differ in several characteristics, such as therapist training, content, motivation for treatment, and extent of comorbid conditions among patients, depending on whether the interventions take place in clinical research studies or in real-life settings. Accordingly, the effects found in research studies may not be generalizable to typical service provision. The authors sought to examine the potential associations between receiving usual care and later psychiatric symptoms, impairment, and potential improvements in social skills. Participants (N=996) drawn from the 2003-2004 birth cohorts in Trondheim, Norway, included children who received usual care and those who did not receive any services (as a control group). The children were assessed with biennial clinical interviews from ages 4 to 14 years. Random intercept, cross-lagged panel models were combined with propensity scoring to adjust for measured time-varying and all unmeasured time-invariant confounders. Usual care was not associated with alterations in social skills or impairment due to mental health problems. Similarly, usual care provided to 7- to 12-year-olds did not predict changes in the number of symptoms of psychiatric disorders. However, usual care received at ages 0-4 and 5-6 predicted a slight increase in the number of psychiatric symptoms 2 years later. No significant associations between usual care and improved outcomes were detected. These observational findings reveal the need to implement existing evidence-based approaches in usual care and to develop evidence-based approaches to the complex cases often seen in specialty and community care systems.

What is specific about employment status, workplace experiences and requirements in individuals with autism in Germany?

The challenge of sustainably integrating highly educated individuals with ASD without intellectual disabilities in the first labor market is repeatedly described in literature. In a retrospective study, a group of 197 clinically late-diagnosed adults with ASD without intellectual disabilities was compared to a closely matched group of 501 individuals who did not meet the criteria for the diagnosis of ASD within a utilization population of the Cologne Autism Outpatient Clinic. Results indicated that the pronounced demand for reduction of social and interpersonal requirements at the workplace (including planned or limited contact with colleagues and customers) as well as the experience of difficulties following unexpected changes in the daily routine were specific for ASD. In addition, individuals with ASD reported greater difficulties in finding a suitable job and being able to live on their wages, taking age and educational qualification into account. Supported employment measures were provided significantly more frequently to individuals in the ASD group. In conclusion, impairments in social skills emerged as one of the main obstacles of workplace performance for individuals with ASD emphasizing the necessity to develop and apply ASD-specific support services.