Depressive and anxiety symptom trajectories from school age through young adulthood in samples with autism spectrum disorder and developmental delay.

OBJECTIVE: The objectives of this study were to model growth in anxiety and depressive symptoms from late school age through young adulthood in individuals with autism spectrum disorder (ASD) and controls with developmental delay (DD), and to assess relationships among internalizing growth patterns, participant characteristics, baseline predictors, and distal outcomes. METHOD: Data were collected between ages 6 and 24 years in 165 participants (n = 109 with ASD; n = 56 with nonspectrum DD), most of whom received diagnostic evaluations in both childhood and early adulthood. Questionnaires were collected approximately every 3 to 6 months between ages 9 and 24 years. Parent-rated Child Behavior Checklist (CBCL), Adult Behavior Checklist (ABCL), and Developmental Behaviour Checklist anxiety- and depression-related subscale distributions were modeled with mixed-effects Poisson models, covarying diagnosis, age, verbal IQ (VIQ), gender, and significant 2- and 3-way interactions. RESULTS: Anxiety was positively associated with VIQ, and controlling for VIQ, both anxiety and depressive symptoms were greater in ASD than nonspectrum participants. Female gender predicted greater increases over time in anxiety and depressive symptoms for both diagnostic groups. Lower maternal education was associated with increasing internalizing symptoms in a subset of less verbal individuals with ASD. In exploratory post hoc analyses, internalizing symptoms were associated with poorer emotional regulation in school age, and with lower life satisfaction and greater social difficulties in early adulthood. CONCLUSION: Findings support previous claims that individuals with ASD are at particular risk for affect- and anxiety-specific problems. Although symptom levels in females increase at a faster rate throughout adolescence, males with ASD appear to have elevated levels of depressive symptoms in school age that are maintained into young adulthood

Measuring depression in autistic adults : psychometric validation of the Beck Depression Inventory–II

Depressive disorders are common in autistic adults, but few studies have examined the extent to which common depression questionnaires are psychometrically appropriate for use in this population. Using item response theory, this study examined the psychometric properties of the Beck Depression Inventory–II (BDI-II) in a sample of 947 autistic adults. BDI-II latent trait scores exhibited strong reliability, construct validity, and moderate ability to discriminate between depressed and nondepressed adults on the autism spectrum (area under the receiver operating characteristic curve = 0.796 [0.763, 0.826], sensitivity = 0.820 [0.785, 0.852], specificity = 0.653 [0.601, 0.699]). These results collectively indicate that the BDI-II is a valid measure of depressive symptoms in autistic adults, appropriate for quantifying depression severity in research studies or screening for depressive disorders in clinical settings. A free online score calculator has been created to facilitate the use of BDI-II latent trait scores for clinical and research applications (available at https://asdmeasures.shinyapps.io/bdi_score/ )

Commentary: Advancing measurement of ASD severity and social competence: a reply to Constantino and Frazier (2013)

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98257/1/jcpp12065.pd

Factors influencing scores on the social responsiveness scale

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/96433/1/j.1469-7610.2012.02589.x.pd

Defining and Quantifying Severity of Impairment in Autism Spectrum Disorders Across the Lifespan.

Individuals with autism spectrum disorders (ASD) vary considerably in language level, cognitive ability, symptom severity, as well as comorbid psychopathology and behavioral issues. The first study in this three-paper project suggests preliminary means to stratify this diverse population into more homogeneous subgroups by ASD severity. Autism Diagnostic Observation Schedule (ADOS) scores were standardized within a large sample to approximate an autism severity metric. The resulting metric was less associated with verbal IQ than were ADOS raw totals, and resulted in increased comparability across age- and language-specific modules of this instrument. In the second study, standardized ADOS scores were used to plot longitudinal trajectories of ASD severity among children and adolescents. Four latent trajectory classes were identified, including persistent severe and persistent moderate groups, as well as much smaller classes that increased or decreased in ASD severity over time. Comorbid psychopathology is another way to characterize impairment in the autism spectrum. The third paper in this series posits that better understanding of the mechanisms that cause and/or maintain depressive symptoms in ASD will contribute to the ability to prevent and treat them, therefore providing one way to improve quality of life for these individuals. The objectives of this study were (1) to explore the relationship between insight into one’s own core autism symptoms and the level of depressive symptoms as described by the individual and an informant, and (2) to explore the relationship between social motivation, social participation, and level of depressive symptoms. Insight into functional independence impairments significantly predicted higher depression scores on the Beck Depression Inventory in the sample of adolescents and adults with borderline to above average IQ and ASD. This dissertation is thus focused on severity of impairment in autism spectrum disorders, with ‘impairment’ defined in relation to both autism-specific and comorbid factors.Ph.D.PsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/77759/1/kog_1.pd

Trajectories of Autism Severity in Children Using Standardized ADOS Scores

OBJECTIVES: To plot longitudinal trajectories of autism spectrum disorder (ASD) severity from early childhood to early adolescence. In line with reported trajectories in toddlers, we hypothesize that a substantial minority of children will show marked changes in ASD severity over time, with “Improvers” demonstrating the highest mean baseline and rate of growth in verbal IQ (VIQ). METHODS: Patients included 345 clinic referrals and research participants with best-estimate clinical diagnoses of ASD at 1 or more time points, and repeated Autism Diagnostic Observation Schedule (ADOS), VIQ, and nonverbal IQ scores. Standardized ADOS severity scores were applied to 1026 assessments collected longitudinally between the ages of 2 and 15 (VIQ at most recent assessment: mean = 58, SD = 35). Scores were fitted for latent severity trajectory classes with and without covariates. Adaptive behavior and VIQ trajectories over time were modeled within each of the best-fit latent classes. RESULTS: A 4-class model best represented the observed data. Over 80% of participants were assigned to persistent (stable) high or moderately severe classes; 2 small classes respectively increased or decreased in severity over time. Age, gender, race, and nonverbal IQ did not predict class membership; VIQ was a significant predictor. Baseline VIQ was highest in the improving and worsening classes; it increased at the greatest rate in the improving class. Adaptive behavior declined in all but the improving class, with consistent impairment in all classes. CONCLUSIONS: If replicated, identified trajectory classes of ADOS severity may contribute to clinical prognosis and to subtyping samples for neurobiological and genetic research

Standardizing ADOS Scores for a Measure of Severity in Autism Spectrum Disorders

The aim of this study is to standardize Autism Diagnostic Observation Schedule (ADOS) scores within a large sample to approximate an autism severity metric. Using a dataset of 1415 individuals aged 2–16 years with autism spectrum disorders (ASD) or nonspectrum diagnoses, a subset of 1807 assessments from 1118 individuals with ASD were divided into narrow age- and language-cells. Within each cell, severity scores were based on percentiles of raw totals corresponding to each ADOS diagnostic classification. Calibrated severity scores had more uniform distributions across developmental groups and were less influenced by participant demographics than raw totals. This metric should be useful in comparing assessments across modules and time, and identifying trajectories of autism severity for clinical, genetic, and neurobiological research