Extreme Demand Avoidance in Children with Autism Spectrum Disorder: Refinement of a Caregiver-Report Measure

Objectives: Extreme/“pathological” demand avoidance (PDA) describes a presentation found in some children on the autism spectrum, characterized by obsessive resistance to everyday demands and requests. Demands often trigger avoidance behavior (e.g., distraction, excuses, withdrawal into role play). Pressure to comply can lead to escalation in emotional reactivity and behavior that challenges. Methods: Previously, the Extreme Demand Avoidance Questionnaire (EDA-Q) was developed to quantify resemblance to clinical accounts of PDA from caregiver reports. The aim of this study was to refine the EDA-Q using principal components analysis (PCA) and item response theory (IRT) analysis on parent/caregiver-report data from 334 children with ASD aged 5–17 years. Results: PCA and IRT analyses identified eight items that are discriminating indices of EDA traits, and behave similarly with respect to quantifying EDA irrespective of child age, gender, reported academic level, or reported independence in daily living activities. The “EDA-8” showed good internal consistency (Cronbach’s alpha =.90) and convergent and divergent validity with other measures (some of which were only available for a subsample of 233 respondents). EDA-8 scores were not related to parental reports of ASD severity. Conclusions: Inspection of the test information function suggests that the EDA-8 may be a useful tool to identify children on the autism spectrum who show an extreme response to demands, as a starting point for more in-depth assessment

Measuring the prevalence of autistic traits in a cohort of adults living with HIV or taking HIV pre-exposure prophylaxis and mapping safer-sex barriers and facilitators:a study protocol

IntroductionAutistic individuals identify with a wider range of sexual orientations than non-autistic individuals, including higher rates of bisexual orientation in autistic men. Gay, bisexual and other men who have sex with men are at greater risk for HIV. Prevalence data of autistic traits in people living with HIV or using Pre-Exposure Prophylaxis (PrEP) for HIV are lacking so far. Such data, combined with insights in barriers and facilitators for safer sex in autistic people living with HIV or using PrEP, are a first step to improve health support for autistic people in HIV clinics. This support is crucial since autistic individuals have worse physical and mental health outcomes. The objective of this research is to determine the prevalence of autistic traits within the group of people living with HIV or using PrEP in Belgium and to describe specific facilitators and barriers for sexual safer behaviour in people living with HIV and PrEP users with autistic traits. Methods and analysisThe research is a cross-sectional, observational and multicentre study with recruitment of individual participants. The research consists of two phases. In phase 1, adults coming for HIV/AIDS care or HIV PrEP in participating Belgian HIV Reference Centres will be invited to fill in the validated Autism Spectrum Quotient questionnaire. In phase 2, participants with a score above the predefined cut-off for autistic traits (&gt;26), who agreed to be informed about this score, will be invited to complete an additional survey, inquiring facilitators and barriers for sexual safer behaviour. Ethics and dissemination of resultsInstitutional Review Board Institute of Tropical Medicine Antwerp, 25 July 2022, REF 1601/22 and University Hospital of Antwerp, 12 September 2022, Project ID 3679: BUN B3002022000111. Study results will be published in peer-reviewed journals and presented to Belgian HIV Reference Centres and at conferences.</p

Parenting Goals: Links with Parenting Strategies in Caregivers of Children with Autism Spectrum Disorder

OBJECTIVES: Parenting goals describe the outcomes that parents aim for when interacting with their child. They have received little attention in research with caregivers of children with autism spectrum disorder (ASD). The present study explored different types (dimensions) of parenting goals reported by caregivers of children with ASD, investigated links between these parenting goals and child characteristics, and explored whether parenting goals were linked to reported use of particular parenting strategies. METHODS: Data from 161 caregivers of children with ASD aged 7–18 years revealed two goal dimensions: “Norm Adherence Goals” (i.e. the perceived importance of the child cooperating with the parent, respecting their authority, and behaving well in public); and “Autonomy Support and Relationship Goals” (i.e. the perceived importance of promoting the child’s resilience, wellbeing, and the quality of the parent-child relationship). RESULTS: Parents who reported that norm adherence goals were particularly important to them were more likely to endorse parenting strategies such as setting rules, using rewards, and giving punishments. These parents also reported using less “Accommodation” (e.g. making allowances for their child, being flexible, avoiding triggers). Autonomy support and relationship goals were very strongly endorsed by nearly all parents, and we therefore could not find strong links between the importance of these goals and parenting strategies. CONCLUSION: These findings suggest that parenting goals might be importantly linked to parenting strategies and could be considered in personalizing interventions in clinical practice. Given that parents’ cognitions about their child’s behaviour and their role as parents likely interact with and influence their parenting goals, we argue that future research should investigate parenting goals, cognitions, and behaviours in parallel

Parenting Strategies Used by Parents of Children with ASD: Differential Links with Child Problem Behaviour

Here, we explored the structure of the ‘Parenting Strategies Questionnaire’, a new scale designed to measure parenting strategies for problem behaviour in ASD. We then examined links between child behaviour and parenting in a sample of 222 predominantly-UK parents of ASD children exhibiting behaviour found difficult or challenging. Analysis revealed three parenting subscales: Accommodation, Reinforcement Approaches and Reducing Uncertainty. Both Accommodation and Reducing Uncertainty were linked to child problem behaviour. Child factors explained up to 29% of the variance in Accommodation, with Socially Inflexible Non-compliance the strongest predictor, and up to 24% of the variance in Reducing Uncertainty, with Intolerance of Uncertainty the strongest predictor. Child factors were not related to Reinforcement Approaches. Longitudinal studies investigating these relationships are needed. Autism Spectrum Disorders (ASD) are neurodevelopmental impairments characterised by difficulties with communication, socialisation, and rigid and repetitive behaviours (Americal Psychiatric Association 2013). Problem behaviour (also referred to as ‘behaviour that challenges’ or, in the past, ‘challenging behaviour’) often occurs in children with ASD, and is more severe in ASD than in other clinical populations (e.g., Brereton et al. 2006; Estes et al. 2009). Forms of problem behaviour include oppositionality, failures to comply, destructiveness and explosiveness (e.g., Gadow et al. 2004). These behaviours are thought to reflect a dysregulated emotional state, resulting in outbursts and prolonged emotional reactions (Mazefsky et al. 2018a, b). Problem behaviour may reflect attempts by the child to reduce anxiety or distress by escaping aversive activities, or reactivity reflecting frustration when things are not on their terms (Brewer et al. 2014; Larson 2006). Demands to comply have been identified as a key trigger of reactivity in ASD (Chowdhury et al. 2016). Some individuals appear more reactive to routine demands (e.g., to wash or get dressed), and others to demands in socially challenging or novel situations (e.g., when visiting friends) (Chowdhury et al. 2016). The former ‘demand-specific’ profile resembles accounts of extreme/‘pathological’ demand avoidance (‘PDA’), which describe avoidance of and reactivity to routine demands in children with ASD (Newson et al. 2003). Some accounts of PDA explicitly attribute these behaviours to elevated anxiety and distress in the context of demands (Newson et al. 2003). In contrast, the latter ‘socially inflexible’ profile, may particularly reflect intolerance of uncertainty: the tendency to “react negatively on an emotional, cognitive, and behavioural level to uncertain situations and events” (Buhr and Dugas 2009, p. 216), which characterizes some children with ASD (Boulter et al. 2014; Larson 2006)

Autism Spectrum Disorders in Gender Dysphoric Children and Adolescents

Only case reports have described the co-occurrence of gender identity disorder (GID) and autism spectrum disorders (ASD). This study examined this co-occurrence using a systematic approach. Children and adolescents (115 boys and 89 girls, mean age 10.8, SD = 3.58) referred to a gender identity clinic received a standardized assessment during which a GID diagnosis was made and ASD suspected cases were identified. The Dutch version of the Diagnostic Interview for Social and Communication Disorders (10th rev., DISCO-10) was administered to ascertain ASD classifications. The incidence of ASD in this sample of children and adolescents was 7.8% (n = 16). Clinicians should be aware of co-occurring ASD and GID and the challenges it generates in clinical management

The Binary Protein Interactome of Treponema pallidum – The Syphilis Spirochete

Protein interaction networks shed light on the global organization of proteomes but can also place individual proteins into a functional context. If we know the function of bacterial proteins we will be able to understand how these species have adapted to diverse environments including many extreme habitats. Here we present the protein interaction network for the syphilis spirochete Treponema pallidum which encodes 1,039 proteins, 726 (or 70%) of which interact via 3,649 interactions as revealed by systematic yeast two-hybrid screens. A high-confidence subset of 991 interactions links 576 proteins. To derive further biological insights from our data, we constructed an integrated network of proteins involved in DNA metabolism. Combining our data with additional evidences, we provide improved annotations for at least 18 proteins (including TP0004, TP0050, and TP0183 which are suggested to be involved in DNA metabolism). We estimate that this “minimal” bacterium contains on the order of 3,000 protein interactions. Profiles of functional interconnections indicate that bacterial proteins interact more promiscuously than eukaryotic proteins, reflecting the non-compartmentalized structure of the bacterial cell. Using our high-confidence interactions, we also predict 417,329 homologous interactions (“interologs”) for 372 completely sequenced genomes and provide evidence that at least one third of them can be experimentally confirmed

Developmental course of conversational behaviour of children with 22q11.2 deletion syndrome and Williams syndrome

This study investigated three conversational subskills in children with 22q11.2 deletion syndrome (22q11.2DS, n = 8, ages 7–13) and Williams syndrome (WS, n = 8, ages 6–12). We re-evaluated these subskills after 18 to 24 months and compared them to those of peers with idiopathic intellectual disability (IID) and IID and comorbid autism spectrum disorders (IID+ASD). Children with 22q11.2DS became less actively involved over time. Lower assertiveness than in children with IID was demonstrated. They seemed less impaired in terms of accounting for listener’s knowledge than children with IID+ASD. Children with WS showed greater difficulties with discourse management compared to children with IID and 22q11.2DS. They had similar levels of conversational impairments to children with IID+ASD but these were caused by different shortcomings. Over time taking account of listener’s knowledge became challenging for them. Findings suggest that children with 22q11.2DS and those with WS would benefit from conversational skills support and that regular re-evaluation is needed to anticipate conversational challenges