- Email: [email protected]
5.27 Evidence for an Infant Construct of Social Motivation and Predictive Validity for Autism Spectrum Disorder
NEW RESEARCH POSTERS 5.25 — 5.28
Conclusions: Irritability and hyperactivity correlated strongly with parenting stress related to parent characteristics (e.g., health, partner relationship). Child irritability explained 40 percent of variance in stress related to parent characteristics. Greater emphasis should be placed on child irritability and hyperactivity as significant factors in parental stress, with implications for early intervention and clinical care.
ASD, CM, STRESS Supported by the Marcus Foundation and PerkinElmer, Inc. http://dx.doi.org/10.1016/j.jaac.2017.09.307
5.25 RETROSPECTIVE CHART REVIEW OF YOUTH WITH AUTISM SPECTRUM DISORDER PRESENTING TO THE EMERGENCY DEPARTMENT Sarah Lytle, MD, University Hospitals Cleveland Medical Center, [email protected]; Grace Pinto-Britton, MD, University Hospitals Cleveland Medical Center, Grace. [email protected]; Andrew Hunt, MD, University Hospitals Cleveland Medical Center, andrew.hunt@ uhhospitals.org; Hongyan Liu, PhD, Case Western Reserve University, [email protected]; Marcie Hall-Mennes, MD, University Hospitals Cleveland Medical Center, mary-hall. [email protected]; Awais Aftab, MD, University Hospitals Cleveland Medical Center, muhammed@ uhhospitals.org; Martha Sajatovic, MD, University Hospitals Cleveland Medical Center, [email protected] Objectives: Youth with autism spectrum disorder (ASD) may present to the emergency department (ED) as a result of behavioral issues. ED evaluation, management, and disposition of youth with ASD can be complicated by a variety of factors. To better understand these complexities, we conducted a retrospective chart review of youth with ASD who presented to the ED. Methods: This single center, three-year retrospective chart review assessed youth with ASD (ages 4–17 years) who presented to the ED with behavioral problems. We evaluated demographics, events leading up to the ED visit, comorbid diagnoses, physical injuries, health resource utilization, use of restraints, and disposition. Results: The sample group comprised 55 patients, with a total of 152 visits in a three-year period. The majority were male, African American (n ¼ 25, 45.5%) or Caucasian (n ¼ 27, 49.1%), and on Medicaid insurance. Mean age was 13.5 SD 2.85 years. The most common comorbid diagnoses were ADHD (n ¼ 30, 54.5%), bipolar/mood disorders (n ¼ 18, 32.7%), and anxiety (n ¼ 16, 29.1%). Illustrating distress burden, patients presented to the ED in handcuffs in at least six percent (n ¼ 9) of visits. Patients (74.5%; n ¼ 41) presented to the ED with a recent history of aggression, agitation, or property destruction during at least one visit. Once in the ED, 39.9 percent (n ¼ 17) demonstrated these externalizing behaviors. A total of 13 patients (23.6%) received psychotropic medications in the ED, and eight (4.5%) were placed in physical restraints. A slight majority (n ¼ 75, 55.5%) of ED visits concluded with the patient being discharged to home, whereas 25.2 percent (n ¼ 34) and 14.1 percent (n ¼ 19) were admitted to a psychiatric hospital or medical floor, respectively. It is noteworthy that 60 percent (n ¼ 9) of medical admissions occurred because of lack of availability of inpatient psychiatry beds. Conclusions: This three-year retrospective chart review demonstrates that ED visits by youth with ASD occur in the context of high distress burden to youth and their families, can result in medical restraint interventions, and often leads to a psychiatric or medical admission and that lack of psychiatric bed availability may result in medical floor admission. Care approaches that include proactive interventions for externalizing behaviors, help to prevent ED visits, and optimize disposition after an ED visit are needed to advance care for youth with ASD.
ADOL, ASD, CON http://dx.doi.org/10.1016/j.jaac.2017.09.308
S262
www.jaacap.org
5.27 EVIDENCE FOR AN INFANT CONSTRUCT OF SOCIAL MOTIVATION AND PREDICTIVE VALIDITY FOR AUTISM SPECTRUM DISORDER Natasha Marrus, MD, PhD, Washington University in St. Louis, [email protected]; Kelly N. Botteron, MD, Washington University in St. Louis School of Medicine, [email protected]; Lucille Dai-He, Washington University in St. Louis, [email protected]; Joshua Jackson, PhD, Washington University in St. Louis, [email protected]; Lori Markson, PhD, Washington University in St. Louis, [email protected]; Annette M. Estes, PhD, University of Washington Autism Center, [email protected]; Stephen Dager, MD, University of Washington, [email protected]; Heather Hazlett, PhD, University of North Carolina at Chapel Hill, [email protected]; Robert Schultz, PhD, Children’s Hospital of Pennsylvania, [email protected]. edu; Joseph Piven, MD, University of North Carolina at Chapel Hill, [email protected]; John N. Constantino, MD, Washington University in St. Louis School of Medicine, [email protected] Objectives: According to the social motivation hypothesis, individual differences in social motivation are present in infancy and may predict the emergence of autism spectrum disorder (ASD). We investigated the evidence for a social motivation construct in a large sample group of existing infant data with the following aims: 1) to derive a preliminary index of social motivation in infants and toddlers; and 2) to investigate psychometric properties of this index. Methods: Behavioral data were analyzed from the Autism Center of Excellence Infant Brain Imaging Study, a prospective, longitudinal study of more than 500 infants at high and low familial risk for ASD. Items were selected from multiple assessments based on face validity for social motivation, which was operationalized as the disposition to preferentially orient to social stimuli, seek social interactions, and exert effort to maintain social engagement. Item scores were uniformly weighted and summed to generate a “social motivation score” at ages six, 12, and 24 months. A clinical best estimate procedure (including the Autism Diagnostic Observation Schedule) was used to diagnose ASD at 24 months. Results: Summed items demonstrated a continuous, unimodal score distribution at ages 6, 12, and 24 months. Items showed good internal consistency (6 months: a ¼ 0.587; 12 months: a ¼ 0.714; 24 months: a ¼ 0.869), and significant cross-age correlations (ages 6–12 months: r ¼ 0.400, P < 0.001; ages 12–24 months: r ¼ 0.279, P ¼ 0.010), suggesting some trait-like stability. Scores at all three ages significantly correlated with ASD severity on the Autism Diagnostic Interview-Revised at age 24 months (age 6 months: r ¼ 0.174, P ¼ 0.012; age 12 months: r ¼ 0.259, P < 0.001; age 24 months: r ¼ 0.675, P < 0.001). Lower social motivation scores were observed by age 6 months for infants later diagnosed with ASD [age 6 months: t(328) ¼ 3.66, P < 0.001; age 12 months: t(365) ¼ 2.75, P ¼ 0.006; age 24 months: t(117) ¼ 5.05, P < 0.001]. Conclusions: These findings provide initial evidence for a measurable social motivation construct in infancy, which shows predictive validity for ASD by age six months. ASD-related score differences suggest that further characterization of social motivation in infancy could promote earlier identification of children with ASD who would benefit from intervention.
ASD, INF, DEV Supported by NMH Grant 1 K08 MH112891-01, Eunice Kennedy Shriver National Institute of Child Health and Human Development Grant HD055741, Autism Speaks Grant 6020, and Simons Foundation Grant 140209 http://dx.doi.org/10.1016/j.jaac.2017.09.310
5.28 BREASTFEEDING STATUS IS NOT ASSOCIATED WITH RISK FOR AUTISM SPECTRUM DISORDER: A SYSTEMATIC REVIEW AND META-ANALYSIS Sherief Gozy, MD, Mansoura University, Sherief_ghozy@ yahoo.com; Sadiq Naveed, MD, KVC Hospitals, snaveed@
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
Conclusions: Irritability and hyperactivity correlated strongly with parenting stress related to parent characteristics (e.g., health, partner relationship). Child irritability explained 40 percent of variance in stress related to parent characteristics. Greater emphasis should be placed on child irritability and hyperactivity as significant factors in parental stress, with implications for early intervention and clinical care.
ASD, CM, STRESS Supported by the Marcus Foundation and PerkinElmer, Inc. http://dx.doi.org/10.1016/j.jaac.2017.09.307
5.25 RETROSPECTIVE CHART REVIEW OF YOUTH WITH AUTISM SPECTRUM DISORDER PRESENTING TO THE EMERGENCY DEPARTMENT Sarah Lytle, MD, University Hospitals Cleveland Medical Center, [email protected]; Grace Pinto-Britton, MD, University Hospitals Cleveland Medical Center, Grace. [email protected]; Andrew Hunt, MD, University Hospitals Cleveland Medical Center, andrew.hunt@ uhhospitals.org; Hongyan Liu, PhD, Case Western Reserve University, [email protected]; Marcie Hall-Mennes, MD, University Hospitals Cleveland Medical Center, mary-hall. [email protected]; Awais Aftab, MD, University Hospitals Cleveland Medical Center, muhammed@ uhhospitals.org; Martha Sajatovic, MD, University Hospitals Cleveland Medical Center, [email protected] Objectives: Youth with autism spectrum disorder (ASD) may present to the emergency department (ED) as a result of behavioral issues. ED evaluation, management, and disposition of youth with ASD can be complicated by a variety of factors. To better understand these complexities, we conducted a retrospective chart review of youth with ASD who presented to the ED. Methods: This single center, three-year retrospective chart review assessed youth with ASD (ages 4–17 years) who presented to the ED with behavioral problems. We evaluated demographics, events leading up to the ED visit, comorbid diagnoses, physical injuries, health resource utilization, use of restraints, and disposition. Results: The sample group comprised 55 patients, with a total of 152 visits in a three-year period. The majority were male, African American (n ¼ 25, 45.5%) or Caucasian (n ¼ 27, 49.1%), and on Medicaid insurance. Mean age was 13.5 SD 2.85 years. The most common comorbid diagnoses were ADHD (n ¼ 30, 54.5%), bipolar/mood disorders (n ¼ 18, 32.7%), and anxiety (n ¼ 16, 29.1%). Illustrating distress burden, patients presented to the ED in handcuffs in at least six percent (n ¼ 9) of visits. Patients (74.5%; n ¼ 41) presented to the ED with a recent history of aggression, agitation, or property destruction during at least one visit. Once in the ED, 39.9 percent (n ¼ 17) demonstrated these externalizing behaviors. A total of 13 patients (23.6%) received psychotropic medications in the ED, and eight (4.5%) were placed in physical restraints. A slight majority (n ¼ 75, 55.5%) of ED visits concluded with the patient being discharged to home, whereas 25.2 percent (n ¼ 34) and 14.1 percent (n ¼ 19) were admitted to a psychiatric hospital or medical floor, respectively. It is noteworthy that 60 percent (n ¼ 9) of medical admissions occurred because of lack of availability of inpatient psychiatry beds. Conclusions: This three-year retrospective chart review demonstrates that ED visits by youth with ASD occur in the context of high distress burden to youth and their families, can result in medical restraint interventions, and often leads to a psychiatric or medical admission and that lack of psychiatric bed availability may result in medical floor admission. Care approaches that include proactive interventions for externalizing behaviors, help to prevent ED visits, and optimize disposition after an ED visit are needed to advance care for youth with ASD.
ADOL, ASD, CON http://dx.doi.org/10.1016/j.jaac.2017.09.308
S262
www.jaacap.org
5.27 EVIDENCE FOR AN INFANT CONSTRUCT OF SOCIAL MOTIVATION AND PREDICTIVE VALIDITY FOR AUTISM SPECTRUM DISORDER Natasha Marrus, MD, PhD, Washington University in St. Louis, [email protected]; Kelly N. Botteron, MD, Washington University in St. Louis School of Medicine, [email protected]; Lucille Dai-He, Washington University in St. Louis, [email protected]; Joshua Jackson, PhD, Washington University in St. Louis, [email protected]; Lori Markson, PhD, Washington University in St. Louis, [email protected]; Annette M. Estes, PhD, University of Washington Autism Center, [email protected]; Stephen Dager, MD, University of Washington, [email protected]; Heather Hazlett, PhD, University of North Carolina at Chapel Hill, [email protected]; Robert Schultz, PhD, Children’s Hospital of Pennsylvania, [email protected]. edu; Joseph Piven, MD, University of North Carolina at Chapel Hill, [email protected]; John N. Constantino, MD, Washington University in St. Louis School of Medicine, [email protected] Objectives: According to the social motivation hypothesis, individual differences in social motivation are present in infancy and may predict the emergence of autism spectrum disorder (ASD). We investigated the evidence for a social motivation construct in a large sample group of existing infant data with the following aims: 1) to derive a preliminary index of social motivation in infants and toddlers; and 2) to investigate psychometric properties of this index. Methods: Behavioral data were analyzed from the Autism Center of Excellence Infant Brain Imaging Study, a prospective, longitudinal study of more than 500 infants at high and low familial risk for ASD. Items were selected from multiple assessments based on face validity for social motivation, which was operationalized as the disposition to preferentially orient to social stimuli, seek social interactions, and exert effort to maintain social engagement. Item scores were uniformly weighted and summed to generate a “social motivation score” at ages six, 12, and 24 months. A clinical best estimate procedure (including the Autism Diagnostic Observation Schedule) was used to diagnose ASD at 24 months. Results: Summed items demonstrated a continuous, unimodal score distribution at ages 6, 12, and 24 months. Items showed good internal consistency (6 months: a ¼ 0.587; 12 months: a ¼ 0.714; 24 months: a ¼ 0.869), and significant cross-age correlations (ages 6–12 months: r ¼ 0.400, P < 0.001; ages 12–24 months: r ¼ 0.279, P ¼ 0.010), suggesting some trait-like stability. Scores at all three ages significantly correlated with ASD severity on the Autism Diagnostic Interview-Revised at age 24 months (age 6 months: r ¼ 0.174, P ¼ 0.012; age 12 months: r ¼ 0.259, P < 0.001; age 24 months: r ¼ 0.675, P < 0.001). Lower social motivation scores were observed by age 6 months for infants later diagnosed with ASD [age 6 months: t(328) ¼ 3.66, P < 0.001; age 12 months: t(365) ¼ 2.75, P ¼ 0.006; age 24 months: t(117) ¼ 5.05, P < 0.001]. Conclusions: These findings provide initial evidence for a measurable social motivation construct in infancy, which shows predictive validity for ASD by age six months. ASD-related score differences suggest that further characterization of social motivation in infancy could promote earlier identification of children with ASD who would benefit from intervention.
ASD, INF, DEV Supported by NMH Grant 1 K08 MH112891-01, Eunice Kennedy Shriver National Institute of Child Health and Human Development Grant HD055741, Autism Speaks Grant 6020, and Simons Foundation Grant 140209 http://dx.doi.org/10.1016/j.jaac.2017.09.310
5.28 BREASTFEEDING STATUS IS NOT ASSOCIATED WITH RISK FOR AUTISM SPECTRUM DISORDER: A SYSTEMATIC REVIEW AND META-ANALYSIS Sherief Gozy, MD, Mansoura University, Sherief_ghozy@ yahoo.com; Sadiq Naveed, MD, KVC Hospitals, snaveed@
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017