- Email: [email protected]
1.4 SOCIAL INFORMATION PROCESSING IN AUTISM SPECTRUM DISORDER
NEW RESEARCH POSTERS 1. 2. 3. 4. 5. 6.
New New New New New New
Research Research Research Research Research Research
Poster Poster Poster Poster Poster Poster
Session Session Session Session Session Session
1 2 3 4 5 6
NEW RESEARCH POSTER SESSION 1 1.1 UNDERLYING MECHANISMS OF PERCEIVED SOCIAL STATUS AND NEGATIVE AFFECT IN ADOLESCENTS Carolina Vidal, MD, MPH, Psychiatry and Behavioral Sciences, Johns Hopkins University, 1800 Orleans St, Baltimore, MD; Lawrence Wissow, MD, MPH Objectives: Previous research has demonstrated a relationship between higher social status and better health outcomes. This relationship is consistent even at higher levels of socioeconomic status, suggesting that social hierarchy matters even when basic needs are covered. Research suggests that subjective beliefs about one’s social status can be related more strongly to overall health than objective measures, which may not capture subtle aspects of social status. The purpose of this study is to describe the mechanisms of the association between perceived social status and negative affect in adolescents in outpatient settings. Methods: This is a grounded theory qualitative research study. A total of 30 participants were recruited from outpatient centers (day hospital psychiatric program, community mental health clinic, and general pediatrician’s offices), and face-to-face interviews were conducted in English and Spanish. Voice recordings were used, and the transcriptions were analyzed. Results: General themes described include psychological and environmental contributors to the perception of social status and their impact on negative affect. Psychological contributors to the process included the use of different coping styles and locus of control. Learned helplessness is a recurrent theme as teenagers can perceive deprivation but view themselves as limited in their ability to problem solve. Environmental factors include comparisons with school peers, friends in the neighborhood, and the structure of the family. Furthermore, differences in gender were found. Conclusions: These findings have implications on psychotherapy and prevention. Furthermore, the discussion of one’s social status with a provider appears to have benefit for adolescents’ well-being and sense of empowerment.
CBT DDD STRESS Supported by the AACAP Pilot Research Award for Child and Adolescent Psychiatry Residents and Junior Faculty, Supported by AACAP’s Endowment http://dx.doi.org/10.1016/j.jaac.2016.09.002
1.2 SOCIAL MEDIA USE IMPROVES FRIENDSHIP QUALITY IN ADOLESCENTS WITH AUTISM SPECTRUM DISORDER Gerrit Ian van Schalkwyk, MBChB, Child Study Center, Yale University, PO Box 207900, 230 S Frontage Rd, New Haven, CT 06405-7900; Mayra Ortiz-Lopez, BA; Fred R. Volkmar, MD; Wendy K. Silverman, PhD Objectives: The consequences of social media use on peer relationships and other psychosocial outcomes are increasingly recognized to be heterogeneous, and the need to study specific subgroups and outcomes has been highlighted. Youth with ASD likely represent a unique subgroup because of the nature of their social difficulties. This study reports on the social media experience of youth with ASD and its relationship to friendship quality and social anxiety. Methods: Youth with ASD and age-matched clinical control subjects participated in a cross-sectional study involving the administration of the following: Multimodal Anxiety Scale Children (MASC-2, parent and child); the Friendship Questionnaire; and a newly created measure, the Social Media Experience Scale, which was created for this study. Here, we report on participants enrolled in the first wave of recruitment (N ¼ 69).
S100
www.jaacap.org
1.1 – 1.4 Results: In youth with ASD, a significant positive correlation was found between social media use and friendship quality (r ¼ 0.343, P < 0.05), which was consistent with our hypothesis. Furthermore, overall anxiety symptoms were correlated with a degree of anxiety experienced during social media use (r ¼ 0.432, P < 0.05). By contrast, in non–ASD clinical control subjects, there was a significant positive correlation between cell phone use and friendship quality (r ¼ 0.522, P < 0.05). Conclusions: Our preliminary data suggest that social media use may have benefits in improving friendship quality in youth with ASD, although those who experience anxiety in other contexts are likely to experience online anxiety as well.
ANX ASD COMP Supported by the AACAP Pilot Research Award, Supported by Pfizer and PhRMA http://dx.doi.org/10.1016/j.jaac.2016.09.003
1.3 PHENOTYPE OF TERM VS. PRETERM CHILDREN IN THE AUTISM TREATMENT NETWORK DATABASE Allison Salk, BA, Icahn School of Medicine at Mount Sinai, 50 E 98th St, Apt 11I-4, New York, NY 10029-6552; Alexander Kolevzon, MD; Cristina Farrell, MD Objectives: It is increasingly recognized that children born preterm may have a higher risk of developing ASD and that their presentation may differ from children born full-term with ASD. Premature infants are known to have a higher rate of perceptual and motor differences; therefore, it is plausible that these differences account for their higher risk of adverse neurodevelopmental and behavioral outcomes. However, there is no large-scale analysis of ASD in preterm survivors, including in-depth phenotypic data. This study presents a detailed comparison of the neurobehavioral phenotype of ASD in preterm versus full-term children in the Autism Treatment Network (ATN) database. Methods: The ATN consists of 14 sites in the United States and Canada that collect data on patients with ASD. Patients were included with the absence of a known genetic condition and the presence of recorded gestational age (GA) and phenotypic presentation. We obtained descriptive statistics comparing 1,480 subjects with GA subcategories: <28 weeks (n ¼ 21), 28 to <32 weeks (n ¼ 25), 32 to <37 weeks (n ¼ 226), and 37 weeks (n ¼ 1,208). We conducted a series of ANOVA to identify correlations between GA and parentreported Child Behavioral Checklist (CBCL), Vineland Adaptive Behavior Scales (VABS), and Short Sensory Profile (SSP) scores. Results: There were no significant demographic or socioeconomic differences between GA categories. Patients with GA <28 weeks had significantly worse scores than the other GA categories in the following outcome measures: CBCL (withdrawn, P < 0.001; pervasive developmental problems, P ¼ 0.008), VABS (daily living skills, P ¼ 0.044; socialization, P ¼ 0.007; gross motor skills, P ¼ 0.011; motor skills, P ¼ 0.013; adaptive behavior composite, P ¼ 0.003), and SSP (movement sensitivity, P ¼ 0.017; low energy/weak, P ¼ 0.017; total sensory score, P ¼ 0.04). Conclusions: Our study provides an in-depth phenotypic comparison to create a more complete and accurate picture of ASD in preterm children. This study suggests that those with a history of extreme prematurity may present with a unique neurobehavioral and sensory-motor profile. Further research is needed to create targeted prognostic and diagnostic treatment models for premature patients.
ASD INF ND Supported by the AACAP Summer Medical Student Fellowship, Supported by the Campaign for America’s Kids (CFAK) http://dx.doi.org/10.1016/j.jaac.2016.09.004
1.4 SOCIAL INFORMATION PROCESSING IN AUTISM SPECTRUM DISORDER Diana J. Back, BS, University of Minnesota, 325 Harvard St SE, Minneapolis, MN 55414; Sunday M. Francis, PhD; Emma Skankland, BS; Lucinda H. Wasserburg, BA; Suma Jacob, MD, PhD Objectives: Social information processing encompasses many behaviors, including emotion recognition. For normal social interactions and effective communication, the ability to collect relevant information from faces and correctly interpret facial expressions in real time is crucial. Common errors
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
NEW RESEARCH POSTERS 1.6 – 1.8
include the misinterpretation of anger and disgust or fear and surprise. This study examined differences in identification of facial expressions of individuals with and without ASD. Methods: Two groups of male participants (ages 8–18 years) were recruited to perform the dynamic affect recognition evaluation (DARE; affects: happy, sad, anger, fear, surprise, disgust). Twenty-three individuals with ASD (ages 12.65 2.06 years) and 18 individuals without ASD (ages 11.83 2.41 years) completed the study. Results: To date, in the sample group of patients with ASD, there was a significant difference in the identification of happy and surprise versus anger, disgust, and fear. Happy (anger: P ¼ 0.003; disgust: P < 0.001; fear: P ¼ 0.003) and surprise (anger: P ¼ 0.005; disgust: P < 0.001; fear: P ¼ 0.005) were identified correctly more often than anger, disgust, and fear. ANOVA showed that the group with ASD made significantly less fear/surprise (P ¼ 0.025) errors, and the control group made significantly fewer anger/disgust (P ¼ 0.038) errors. In addition, eye-tracking data on how participants viewed each face were collected. Results from the eye-tracking analysis will be evaluated to examine correlations with accuracy in task performance. Conclusions: When examining performance on the DARE, we found that children and adolescents with ASD were better able to identify several negative affective emotions better than positive ones. These finding may allude to differences in social information processing, specifically emotion recognition. Further understanding of the variation in emotion processing among individuals with and without ASD may prove beneficial in the design of effective and personalized interventions.
ASD COG NEURODEV Supported by CTSI of the University of Minnesota http://dx.doi.org/10.1016/j.jaac.2016.09.005
1.6 A SYSTEMATIC REVIEW OF SCREENING FOR AUTISM SPECTRUM DISORDER Tomoya Hirota, MD, Psychiatry, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA; Young Shin Kim, MD, MPH, MS, PhD; Ryuhei So, MD; Bennett L. Leventhal, MD; Richard Epstein, MPH, PhD Objectives: No studies have systematically examined the validity of ASDscreening tools compared with the gold standard diagnostic procedures—the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview, Revised (ADI-R). Furthermore, extant reviews mostly focused on young children despite an increased need for reliable and valid tools that clinicians can use to assess school-age children, adolescents, and young adults. To address limitations of existing reviews of the validity of ASD-screening tools and clinical gaps, we conducted a review of ASD-screening tools. Methods: MEDLINE, EMBASE, PsychINFO, Cochrane Library, and CINAHL citations were searched from database inception until March 2016. Eligibility for this systematic review was based on the following inclusion criteria: 1) studies investigating validity of screening tools on ASD against ADI-R and/or ADOS; and 2) at a minimum, sensitivity (Se), specificity (Sp), positive predictive value (PPV), or negative predictive value (NPV) are either published or obtainable from the authors. Our review included studies of both general population sample (GP) groups and sample groups at high risk (HR) for ASD to provide information on the use of these tools in nonclinical and clinical settings. Results: Computerized search yielded 890 references. A total of 32 studies met the inclusion criteria, which included 18 studies conducted with children ages 3 years or younger, 11 studies with children between the ages of 4 and 18 years, and three studies with adults only. Twelve studies examined screening tools in a general population sample, 18 studies were conducted in a high risk population, and two studies had samples that included both general population and high risk persons. Se was low (< 80 percent) in most studies in GP young children, while high in HR samples. Sp was mostly high (> 70 percent) among included studies. PPV was unsatisfactory overall (mostly < 80 percent), even in studies with HR samples. Conclusions: Low Se in studies with GP young children raises a concern over false negative cases. Although their Se and Sp are relatively high, the validity of screening tools in HR samples may be weakened due to unsatisfactory
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
PPV. Scarcity of included studies makes it hard to draw a firm conclusion about the efficacy of each screening tool in these populations.
ASD EPI http://dx.doi.org/10.1016/j.jaac.2016.09.007
1.7 FACIAL AFFECT RECOGNITION IN AUTISM SPECTRUM DISORDER, ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER, AND TYPICAL DEVELOPMENT
€ vlegatan 22, Steve Berggren, MSc, KIND, Karolinska Institutet, Ga Stockholm 11330, Sweden; Ann-Charlotte Engstrom; €lte, PhD Sven Bo Objectives: ASD and ADHD have been associated with explicit facial affect recognition (FAR) alterations, but comparative studies are scarce. This study examined FAR accuracy and response times for overall and specific basic emotions FAR performance in whole-face and eye-region stimuli. Methods: FAR was assessed in matched sample groups of children and adolescents with ASD (n ¼ 35), ADHD (n ¼32), and typical development (TD) (n ¼ 32) aged 8.6–15.9 years (mean age ¼ 11.6 years; SD ¼ 2.0). Results: Compared with TD, the group with ASD showed less accuracy and longer response times for general and specific FAR, mostly driven by problems in neutral and happy face identification. The group with ADHD responded faster than the group with ASD for global FAR. No differences between ADHD and TD were found. Attentional distractibility had a significant effect on FAR performance in ASD and ADHD. Conclusions: Findings confirm FAR alterations in ASD, but not ADHD, and endorse effects of attentional distractibility on FAR in ASD and ADHD. FAR and attention function training is clinically meaningful in ASD, as well as additional attention training in ASD and ADHD to improve FAR. Future studies should include control for visual attention and facial configuration skills, use naturalistic FAR material, and also investigate implicit FAR.
ASD COG ND http://dx.doi.org/10.1016/j.jaac.2016.09.008
1.8 SOCIAL SKILLS GROUP TRAINING: KONTAKT FOR CHILDREN AND ADOLESCENTS WITH HIGHFUNCTIONING AUTISM SPECTRUM DISORDER: A PRAGMATIC MULTICENTER AND RANDOMIZED CONTROLLED TRIAL €lte, PhD, KIND, Karolinska Institutet, Ga € vlegatan 22, Sven Bo Stockholm 11330, Sweden
Objectives: Social skills group training (SSGT) is a widely applied intervention for high functioning ASD (HFASD). However, rigorous trials of SSGT in clinical settings are lacking. The aim of this study was to examine the efficacy and effectiveness of SSGT in HFASD. Methods: We conducted a pragmatic randomized controlled trial in 13 regular clinical outpatient units. A total of 296 individuals (ages 8–17 years; IQ >70) with HFASD and common psychiatric comorbidity were randomized to SSGT plus treatment as usual or a waiting list control group. Twelve sessions of manualized SSGT (“Kontakt”) lasting 60 (children) or 90 minutes (adolescents) were delivered in a clinical setting (two trainers, 4–8 participants/group) to improve social communication skills. The Social Responsiveness Scale (SRS) ratings from the parent and blinded teacher report were used as primary outcomes. Secondary outcomes included measures for adaptive behaviors, global functioning, clinical severity, and experienced child and caregiver stress. Measures were collected at baseline, post training, and three-month follow-up. Results: Parent ratings showed improvement on the SRS subscale social cognition at follow-up in the SSGT group compared with the control groups (B ¼ 1.33, Z ¼ 1.44, P ¼ 0.02). Blinded teacher ratings yielded no change on the SRS for SSGT. Divided by age-groups, we found behavioral gains for trained adolescents, but not for children, on the SRS total score (B > 8.34, Z > 2.54, P < 0.001) and several subscales at follow-up (e.g., social communication, B ¼ 3.89, Z ¼ 2.59, P ¼ 0.01) for parent ratings post-SSGT
www.jaacap.org
S101
New New New New New New
Research Research Research Research Research Research
Poster Poster Poster Poster Poster Poster
Session Session Session Session Session Session
1 2 3 4 5 6
NEW RESEARCH POSTER SESSION 1 1.1 UNDERLYING MECHANISMS OF PERCEIVED SOCIAL STATUS AND NEGATIVE AFFECT IN ADOLESCENTS Carolina Vidal, MD, MPH, Psychiatry and Behavioral Sciences, Johns Hopkins University, 1800 Orleans St, Baltimore, MD; Lawrence Wissow, MD, MPH Objectives: Previous research has demonstrated a relationship between higher social status and better health outcomes. This relationship is consistent even at higher levels of socioeconomic status, suggesting that social hierarchy matters even when basic needs are covered. Research suggests that subjective beliefs about one’s social status can be related more strongly to overall health than objective measures, which may not capture subtle aspects of social status. The purpose of this study is to describe the mechanisms of the association between perceived social status and negative affect in adolescents in outpatient settings. Methods: This is a grounded theory qualitative research study. A total of 30 participants were recruited from outpatient centers (day hospital psychiatric program, community mental health clinic, and general pediatrician’s offices), and face-to-face interviews were conducted in English and Spanish. Voice recordings were used, and the transcriptions were analyzed. Results: General themes described include psychological and environmental contributors to the perception of social status and their impact on negative affect. Psychological contributors to the process included the use of different coping styles and locus of control. Learned helplessness is a recurrent theme as teenagers can perceive deprivation but view themselves as limited in their ability to problem solve. Environmental factors include comparisons with school peers, friends in the neighborhood, and the structure of the family. Furthermore, differences in gender were found. Conclusions: These findings have implications on psychotherapy and prevention. Furthermore, the discussion of one’s social status with a provider appears to have benefit for adolescents’ well-being and sense of empowerment.
CBT DDD STRESS Supported by the AACAP Pilot Research Award for Child and Adolescent Psychiatry Residents and Junior Faculty, Supported by AACAP’s Endowment http://dx.doi.org/10.1016/j.jaac.2016.09.002
1.2 SOCIAL MEDIA USE IMPROVES FRIENDSHIP QUALITY IN ADOLESCENTS WITH AUTISM SPECTRUM DISORDER Gerrit Ian van Schalkwyk, MBChB, Child Study Center, Yale University, PO Box 207900, 230 S Frontage Rd, New Haven, CT 06405-7900; Mayra Ortiz-Lopez, BA; Fred R. Volkmar, MD; Wendy K. Silverman, PhD Objectives: The consequences of social media use on peer relationships and other psychosocial outcomes are increasingly recognized to be heterogeneous, and the need to study specific subgroups and outcomes has been highlighted. Youth with ASD likely represent a unique subgroup because of the nature of their social difficulties. This study reports on the social media experience of youth with ASD and its relationship to friendship quality and social anxiety. Methods: Youth with ASD and age-matched clinical control subjects participated in a cross-sectional study involving the administration of the following: Multimodal Anxiety Scale Children (MASC-2, parent and child); the Friendship Questionnaire; and a newly created measure, the Social Media Experience Scale, which was created for this study. Here, we report on participants enrolled in the first wave of recruitment (N ¼ 69).
S100
www.jaacap.org
1.1 – 1.4 Results: In youth with ASD, a significant positive correlation was found between social media use and friendship quality (r ¼ 0.343, P < 0.05), which was consistent with our hypothesis. Furthermore, overall anxiety symptoms were correlated with a degree of anxiety experienced during social media use (r ¼ 0.432, P < 0.05). By contrast, in non–ASD clinical control subjects, there was a significant positive correlation between cell phone use and friendship quality (r ¼ 0.522, P < 0.05). Conclusions: Our preliminary data suggest that social media use may have benefits in improving friendship quality in youth with ASD, although those who experience anxiety in other contexts are likely to experience online anxiety as well.
ANX ASD COMP Supported by the AACAP Pilot Research Award, Supported by Pfizer and PhRMA http://dx.doi.org/10.1016/j.jaac.2016.09.003
1.3 PHENOTYPE OF TERM VS. PRETERM CHILDREN IN THE AUTISM TREATMENT NETWORK DATABASE Allison Salk, BA, Icahn School of Medicine at Mount Sinai, 50 E 98th St, Apt 11I-4, New York, NY 10029-6552; Alexander Kolevzon, MD; Cristina Farrell, MD Objectives: It is increasingly recognized that children born preterm may have a higher risk of developing ASD and that their presentation may differ from children born full-term with ASD. Premature infants are known to have a higher rate of perceptual and motor differences; therefore, it is plausible that these differences account for their higher risk of adverse neurodevelopmental and behavioral outcomes. However, there is no large-scale analysis of ASD in preterm survivors, including in-depth phenotypic data. This study presents a detailed comparison of the neurobehavioral phenotype of ASD in preterm versus full-term children in the Autism Treatment Network (ATN) database. Methods: The ATN consists of 14 sites in the United States and Canada that collect data on patients with ASD. Patients were included with the absence of a known genetic condition and the presence of recorded gestational age (GA) and phenotypic presentation. We obtained descriptive statistics comparing 1,480 subjects with GA subcategories: <28 weeks (n ¼ 21), 28 to <32 weeks (n ¼ 25), 32 to <37 weeks (n ¼ 226), and 37 weeks (n ¼ 1,208). We conducted a series of ANOVA to identify correlations between GA and parentreported Child Behavioral Checklist (CBCL), Vineland Adaptive Behavior Scales (VABS), and Short Sensory Profile (SSP) scores. Results: There were no significant demographic or socioeconomic differences between GA categories. Patients with GA <28 weeks had significantly worse scores than the other GA categories in the following outcome measures: CBCL (withdrawn, P < 0.001; pervasive developmental problems, P ¼ 0.008), VABS (daily living skills, P ¼ 0.044; socialization, P ¼ 0.007; gross motor skills, P ¼ 0.011; motor skills, P ¼ 0.013; adaptive behavior composite, P ¼ 0.003), and SSP (movement sensitivity, P ¼ 0.017; low energy/weak, P ¼ 0.017; total sensory score, P ¼ 0.04). Conclusions: Our study provides an in-depth phenotypic comparison to create a more complete and accurate picture of ASD in preterm children. This study suggests that those with a history of extreme prematurity may present with a unique neurobehavioral and sensory-motor profile. Further research is needed to create targeted prognostic and diagnostic treatment models for premature patients.
ASD INF ND Supported by the AACAP Summer Medical Student Fellowship, Supported by the Campaign for America’s Kids (CFAK) http://dx.doi.org/10.1016/j.jaac.2016.09.004
1.4 SOCIAL INFORMATION PROCESSING IN AUTISM SPECTRUM DISORDER Diana J. Back, BS, University of Minnesota, 325 Harvard St SE, Minneapolis, MN 55414; Sunday M. Francis, PhD; Emma Skankland, BS; Lucinda H. Wasserburg, BA; Suma Jacob, MD, PhD Objectives: Social information processing encompasses many behaviors, including emotion recognition. For normal social interactions and effective communication, the ability to collect relevant information from faces and correctly interpret facial expressions in real time is crucial. Common errors
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
NEW RESEARCH POSTERS 1.6 – 1.8
include the misinterpretation of anger and disgust or fear and surprise. This study examined differences in identification of facial expressions of individuals with and without ASD. Methods: Two groups of male participants (ages 8–18 years) were recruited to perform the dynamic affect recognition evaluation (DARE; affects: happy, sad, anger, fear, surprise, disgust). Twenty-three individuals with ASD (ages 12.65 2.06 years) and 18 individuals without ASD (ages 11.83 2.41 years) completed the study. Results: To date, in the sample group of patients with ASD, there was a significant difference in the identification of happy and surprise versus anger, disgust, and fear. Happy (anger: P ¼ 0.003; disgust: P < 0.001; fear: P ¼ 0.003) and surprise (anger: P ¼ 0.005; disgust: P < 0.001; fear: P ¼ 0.005) were identified correctly more often than anger, disgust, and fear. ANOVA showed that the group with ASD made significantly less fear/surprise (P ¼ 0.025) errors, and the control group made significantly fewer anger/disgust (P ¼ 0.038) errors. In addition, eye-tracking data on how participants viewed each face were collected. Results from the eye-tracking analysis will be evaluated to examine correlations with accuracy in task performance. Conclusions: When examining performance on the DARE, we found that children and adolescents with ASD were better able to identify several negative affective emotions better than positive ones. These finding may allude to differences in social information processing, specifically emotion recognition. Further understanding of the variation in emotion processing among individuals with and without ASD may prove beneficial in the design of effective and personalized interventions.
ASD COG NEURODEV Supported by CTSI of the University of Minnesota http://dx.doi.org/10.1016/j.jaac.2016.09.005
1.6 A SYSTEMATIC REVIEW OF SCREENING FOR AUTISM SPECTRUM DISORDER Tomoya Hirota, MD, Psychiatry, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA; Young Shin Kim, MD, MPH, MS, PhD; Ryuhei So, MD; Bennett L. Leventhal, MD; Richard Epstein, MPH, PhD Objectives: No studies have systematically examined the validity of ASDscreening tools compared with the gold standard diagnostic procedures—the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview, Revised (ADI-R). Furthermore, extant reviews mostly focused on young children despite an increased need for reliable and valid tools that clinicians can use to assess school-age children, adolescents, and young adults. To address limitations of existing reviews of the validity of ASD-screening tools and clinical gaps, we conducted a review of ASD-screening tools. Methods: MEDLINE, EMBASE, PsychINFO, Cochrane Library, and CINAHL citations were searched from database inception until March 2016. Eligibility for this systematic review was based on the following inclusion criteria: 1) studies investigating validity of screening tools on ASD against ADI-R and/or ADOS; and 2) at a minimum, sensitivity (Se), specificity (Sp), positive predictive value (PPV), or negative predictive value (NPV) are either published or obtainable from the authors. Our review included studies of both general population sample (GP) groups and sample groups at high risk (HR) for ASD to provide information on the use of these tools in nonclinical and clinical settings. Results: Computerized search yielded 890 references. A total of 32 studies met the inclusion criteria, which included 18 studies conducted with children ages 3 years or younger, 11 studies with children between the ages of 4 and 18 years, and three studies with adults only. Twelve studies examined screening tools in a general population sample, 18 studies were conducted in a high risk population, and two studies had samples that included both general population and high risk persons. Se was low (< 80 percent) in most studies in GP young children, while high in HR samples. Sp was mostly high (> 70 percent) among included studies. PPV was unsatisfactory overall (mostly < 80 percent), even in studies with HR samples. Conclusions: Low Se in studies with GP young children raises a concern over false negative cases. Although their Se and Sp are relatively high, the validity of screening tools in HR samples may be weakened due to unsatisfactory
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
PPV. Scarcity of included studies makes it hard to draw a firm conclusion about the efficacy of each screening tool in these populations.
ASD EPI http://dx.doi.org/10.1016/j.jaac.2016.09.007
1.7 FACIAL AFFECT RECOGNITION IN AUTISM SPECTRUM DISORDER, ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER, AND TYPICAL DEVELOPMENT
€ vlegatan 22, Steve Berggren, MSc, KIND, Karolinska Institutet, Ga Stockholm 11330, Sweden; Ann-Charlotte Engstrom; €lte, PhD Sven Bo Objectives: ASD and ADHD have been associated with explicit facial affect recognition (FAR) alterations, but comparative studies are scarce. This study examined FAR accuracy and response times for overall and specific basic emotions FAR performance in whole-face and eye-region stimuli. Methods: FAR was assessed in matched sample groups of children and adolescents with ASD (n ¼ 35), ADHD (n ¼32), and typical development (TD) (n ¼ 32) aged 8.6–15.9 years (mean age ¼ 11.6 years; SD ¼ 2.0). Results: Compared with TD, the group with ASD showed less accuracy and longer response times for general and specific FAR, mostly driven by problems in neutral and happy face identification. The group with ADHD responded faster than the group with ASD for global FAR. No differences between ADHD and TD were found. Attentional distractibility had a significant effect on FAR performance in ASD and ADHD. Conclusions: Findings confirm FAR alterations in ASD, but not ADHD, and endorse effects of attentional distractibility on FAR in ASD and ADHD. FAR and attention function training is clinically meaningful in ASD, as well as additional attention training in ASD and ADHD to improve FAR. Future studies should include control for visual attention and facial configuration skills, use naturalistic FAR material, and also investigate implicit FAR.
ASD COG ND http://dx.doi.org/10.1016/j.jaac.2016.09.008
1.8 SOCIAL SKILLS GROUP TRAINING: KONTAKT FOR CHILDREN AND ADOLESCENTS WITH HIGHFUNCTIONING AUTISM SPECTRUM DISORDER: A PRAGMATIC MULTICENTER AND RANDOMIZED CONTROLLED TRIAL €lte, PhD, KIND, Karolinska Institutet, Ga € vlegatan 22, Sven Bo Stockholm 11330, Sweden
Objectives: Social skills group training (SSGT) is a widely applied intervention for high functioning ASD (HFASD). However, rigorous trials of SSGT in clinical settings are lacking. The aim of this study was to examine the efficacy and effectiveness of SSGT in HFASD. Methods: We conducted a pragmatic randomized controlled trial in 13 regular clinical outpatient units. A total of 296 individuals (ages 8–17 years; IQ >70) with HFASD and common psychiatric comorbidity were randomized to SSGT plus treatment as usual or a waiting list control group. Twelve sessions of manualized SSGT (“Kontakt”) lasting 60 (children) or 90 minutes (adolescents) were delivered in a clinical setting (two trainers, 4–8 participants/group) to improve social communication skills. The Social Responsiveness Scale (SRS) ratings from the parent and blinded teacher report were used as primary outcomes. Secondary outcomes included measures for adaptive behaviors, global functioning, clinical severity, and experienced child and caregiver stress. Measures were collected at baseline, post training, and three-month follow-up. Results: Parent ratings showed improvement on the SRS subscale social cognition at follow-up in the SSGT group compared with the control groups (B ¼ 1.33, Z ¼ 1.44, P ¼ 0.02). Blinded teacher ratings yielded no change on the SRS for SSGT. Divided by age-groups, we found behavioral gains for trained adolescents, but not for children, on the SRS total score (B > 8.34, Z > 2.54, P < 0.001) and several subscales at follow-up (e.g., social communication, B ¼ 3.89, Z ¼ 2.59, P ¼ 0.01) for parent ratings post-SSGT
www.jaacap.org
S101