Terisa Gabrielsen

This book is released at a unique moment in time. Had it been released any earlier, the wealth of research conducted since 2020 would not have been included. The flood of information about nuanced autism and autistic female experiences will undoubtedly continue to grow, so this manuscript is the first step towards changing how we think about autism identification. The change we hope to accomplish is to bridge the gap between autistic people seeking support and understanding and the professional communities who have previously been positioned as gatekeepers for diagnostic decisions.<br> <br>Autism has always been characterized as a spectrum, but that conceptualization has not been an exact fit with existing diagnostic practices. In the medical model (including mental health diagnostic models), the idea of autistic enough based on counts of deficits and dysfunction that have a certain look, exemplars or presentation ignores the reality and complexity of individual autistic traits. Daily experiences in a society that does not expect or accommodate autistic traits very well can be difficult to capture in a set of data particularly for measures based primarily on one subset of the population. This is a problem not unique to autism, but has life-altering consequences just as significant as missed diagnoses of a heart attack in a woman whose symptoms do not match up or appear to be the same as a mans (because females had not been well-represented in research).<br><br> The solution to this problem is probably easier than some may think. Joining the autistic and professional communities together to solve the problem can be as simple as taking more time to listen. Reaching beyond cutoffs and checklist approaches to complicated diagnostic decisions can lead to more informed diagnoses, more individualized approaches for supports, and better advocacy for acceptance and inclusion of neurodiversity as something that is known and expected in the world rather than an aberration from a norm.<br> <br>Data from first-person narratives are included here along with data from scientific research, integrated into a comprehensive approach to assessment. As a group, we represent professionals and stakeholders. We are autistic and parents and grandparents of autistic children across all genders. We are clinicians who diagnose and provide support for autistic people. We teach and train the next generation of professionals in a very different way than we were trained originally, informed by experiences across communities over the years. We first planned this resource based on our own clinical experiences, but in the intervening years, evidence to substantiate our clinical observations is now well established. We are incredibly hopeful about this moment in time.<br><br><i>Checklists are supposed to be succinct descriptions of what is. But in the case of autism, most sounded more like one-dimensional prescriptions for how autistic people were supposed to behave. If it swims like a duck, walks like a duck, follows Mama Duck, it's probably a duck. Unless its the Ugly Duckling - - a.k.a. the swan who's failing at being who/how others say he ought, instead of being a natural at being himself. And let's face it, he's probably going to have a much better explanation for what he was doing all along than would a duck who had watched him struggle with his lack of duckiness. </i><br>-Jennifer OToole (2018), <i>Autism in Heels, </i>Skyhorse, p. 9

Understanding the cognitive and emotional mechanisms that link autism traits and risk for suicide is a vital next step for research and clinical practice. This study included a broad sample of adult women (<i>n</i>=74) who report finding social situations confusing and/or exhausting, and who score high on autism trait measures. Regardless of autism diagnostic status, these women reported high rates of suicidal thoughts and behaviors. Depression symptoms were much more predictive of suicidality than were autism trait measures of social communication. Measures of neurotypical “imagination” and of repetitive behavior likewise predicted suicidality risk. Simultaneously feeling sad and feeling stuck may uniquely increase suicide risk in autism.

Background
Early intervention in autism spectrum disorder (ASD) improves outcomes, but treatment access depends on early identification. Despite reliability of most autism diagnoses by age 24 months, the majority of children with autism do not receive comprehensive evaluations until after age 36 months. Although many possible reasons exist for delayed evaluations, the referral decision process itself is not clearly defined nor understood. In particular, little is known about how perceptions of early childhood symptoms of ASD interact with decision criteria to ultimately refer a child for comprehensive diagnostic assessment.

Method
To better understand pre-referral perceptions and decision factors involved, we provided multiple video clips from early comprehensive autism evaluations as prompts, then asked early childhood clinicians and educators (n=346) to make decisions about autism referral, then to identify factors considered when making decisions.

Results
Decision factors cited most often were play, social interactions/engagement, and verbal behaviors, but none were cited by a clear majority. Some important early signs were infrequently mentioned: absence of joint attention, social reciprocity and gestures. Accuracy of referral decisions was similar across disciplines, indicating a broad range of professionals capable of identifying early signs of autism.

Conclusions
Autism training across early childhood professional disciplines should emphasize importance of early signs involving significant absences of behaviors, such as low joint attention, gestures, and social reciprocity in addition to odd social, verbal, and play behaviors. Such targeted training may encourage earlier referrals when autism is suspected in young children.

Functional neuroimaging research in autism spectrum disorder has reported patterns of decreased long-range, within-network, and interhemispheric connectivity. Research has also reported increased corticostriatal connectivity and between-network connectivity for default and attentional networks. Past studies have excluded individuals with autism and low verbal and cognitive performance (LVCP), so connectivity in individuals more significantly affected with autism has not yet been studied. This represents a critical gap in our understanding of brain function across the autism spectrum.

This interactive, online resource provides a pathway for clinicians seeking information on how to prepare for medical visits with patients who have autism spectrum disorders using a three-tiered system of preparation and responses.

BACKGROUND: Pediatricians, neurologists, and geneticists are important sources for autism surveillance, screening, and referrals, but practical time constraints limit the clinical utility of behavioral observations. We analyzed behaviors under favorable conditions (ie, video of autism evaluations reviewed by experts) to determine what is optimally observable within 10-minute samples, asked for referral impressions, and compared these to formal screening and developmental testing results.

METHODS: Participants (n = 42, aged 15 to 33 months) were typically developing controls and children who screened positive during universal autism screening within a large community pediatric practice. Diagnostic evaluations were performed after screening to determine group status (autism, language delay, or typical). Licensed psychologists with toddler and autism expertise, unaware of diagnostic status, analyzed two 10-minute video samples of participants autism evaluations, measuring 5 behaviors: Responding, Initiating, Vocalizing, Play, and Response to Name. Raters were asked for autism referral impressions based solely on individual 10-minute observations.

RESULTS: Children who had autism showed more typical behavior (89% of the time) than atypical behavior (11%) overall. Expert raters missed 39% of cases in the autism group as needing autism referrals based on brief but highly focused observations. Significant differences in cognitive and adaptive development existed among groups, with receptive language skills differentiating the 3 groups.

CONCLUSIONS: Brief clinical observations may not provide enough information about atypical behaviors to reliably detect autism risk. High prevalence of typical behaviors in brief samples may distort clinical impressions of atypical behaviors. Formal screening tools and general developmental testing provide critical data for accurate referrals.

OBJECTIVE: The goal of this study was to investigate the feasibility and outcome of a systematic autism screening process for all toddlers (aged 1430 months) in a large, community-based pediatric practice.

METHODS: All toddlers who presented to the clinic during the 6-month screening period were eligible. We used 2 screening questionnaires and allowed physicians to refer directly to capture as many children as possible. Receptionists and medical assistants distributed and collected screening questionnaires; research staff did all scoring and follow-up, either by telephone or in person when indicated.

RESULTS: We obtained a high rate of screening (80% of eligible children). Of the 796 children screened, 3 had already been diagnosed with an autism spectrum disorder (ASD); an additional 10 children who showed signs of early ASD that warranted further evaluation or intervention were identified. Formal screening measures identified more children with ASD than did clinical judgment or caregiver concerns; however, no single method (ie, questionnaire, caregiver concerns, provider concerns) identified all children with signs of early ASD. We had excellent participation from racially and ethnically diverse families, including Spanish-speaking families. Thirty-two percent of the children who were screened did not present for a well-child visit during the study period and were screened at a sick visit, follow-up visit, or injection appointment.

CONCLUSIONS: A partnership between pediatricians and autism specialists resulted in effective, systematic autism screening. Future studies should examine how to create effective systems of care.

Core deficits in autism spectrum disorder (ASD) center around social communication and behavior. For individuals with ASD, these deficits complicate the task of learning how to cope with and manage complex social emotional issues. Although individuals with ASD may receive sufficient academic and basic behavioral support in school settings, supports for dealing with complex social emotional issues are more difficult to access, even though these issues significantly impact student learning. When addressing these challenging social- and emotional-based issues, school and professional personnel need more specific instructional skill sets and resources to effectively and compassionately support students with ASD. In this article, we address three challenging areas of social emotional development that are commonly experienced by individuals with ASD: anxiety, social isolation, and grief. We briefly explore the existing research on these three topics, identify evidence-based practices and learning strategies to support social emotional learning in individuals with ASD, and include descriptive lists of practical resources that address anxiety, social isolation, and grief.

The purpose of this case report is to describe the conceptualization and treatment of comorbid anxiety diagnoses, selective mutism, and procedural anxiety in a young female presenting to a pediatric family therapy clinic with common variable immunodeficiency disease (CVID) and behavioral concerns. Treatment included a comprehensive interview assessing domains of functioning. Treatment plans for both selective mutism and procedural anxiety were informed by behavior learning theories. In collaboration with parents and teachers, evidence-based interventions were implemented concurrently across the clinic, home, and school settings to facilitate generalization. Over the course of 8 sessions, coping skills were successfully employed in the home setting to decrease procedural anxiety. Behavioral techniques implemented by clinician, parents, and the patients teacher to reinforce functional communication resulted in the reestablishment of speech in the school setting. Comorbid treatment of anxiety disorders proved successful and was effectively applied within an academic medical setting in a child with CVID. Application of evidence-based interventions informed by behavioral learning theories brought about improvements in both functional communication and procedural anxiety. Close collaboration among pediatric psychologists, school personnel, and parents was critical to achieving positive treatment outcomes across multiple settings. (PsycINFO Database Record (c) 2013 APA, all rights reserved)