Michael Morrier | Private Practice (original) (raw)

Papers by Michael Morrier

Research paper thumbnail of Integrating Deep Learning with Behavior Imaging to Accelerate Industry’s ‘Learning’ of Autism Core Deficits

INSAR 2018 Annual Meeting, May 11, 2018

Research paper thumbnail of Defining in Detail and Evaluating Reliability of DSM-5 Criteria for Autism Spectrum Disorder (ASD) Among Children

Journal of Autism and Developmental Disorders, 2022

This paper describes a process to define a comprehensive list of exemplars for seven core Diagnos... more This paper describes a process to define a comprehensive list of exemplars for seven core Diagnostic and Statistical Manual (DSM) diagnostic criteria for autism spectrum disorder (ASD), and report on interrater reliability in applying these exemplars to determine ASD case classification. Clinicians completed an iterative process to map specific exemplars from the CDC Autism and Developmental Disabilities Monitoring (ADDM) Network criteria for ASD surveillance, DSM-5 text, and diagnostic assessments to each of the core DSM-5 ASD criteria. Clinicians applied the diagnostic exemplars to child behavioral descriptions in existing evaluation records to establish initial reliability standards and then for blinded clinician review in one site (phase 1) and for two ADDM Network surveillance years (phase 2). Interrater reliability for each of the DSM-5 diagnostic categories and overall ASD classification was high (defined as very good .60-.79 to excellent ≥ .80 Kappa values) across sex, race/ethnicity, and cognitive levels for both phases. Classification of DSM-5 ASD by mapping specific exemplars from evaluation records by a diverse group of clinician raters is feasible and reliable. This framework provides confidence in the consistency of prevalence classifications of ASD and may be further applied to improve consistency of ASD diagnoses in clinical settings.

Research paper thumbnail of Validation of an Enhanced Telehealth Platform for Toddlers at Increased Likelihood for a Diagnosis of Autism Spectrum Disorder (ASD)

Journal of Autism and Developmental Disorders

Research paper thumbnail of Correction to: Defining in Detail and Evaluating Reliability of DSM-5 Criteria for Autism Spectrum Disorder (ASD) Among Children

Journal of Autism and Developmental Disorders, 2022

The supplementary documents was missing in this article and it has been uploaded. The original ar... more The supplementary documents was missing in this article and it has been uploaded. The original article has been revised. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Research paper thumbnail of Integrating de novo and inherited variants in 42,607 autism cases identifies mutations in new moderate-risk genes

Nature Genetics

To capture the full spectrum of genetic risk for autism, we performed a two-stage analysis of rar... more To capture the full spectrum of genetic risk for autism, we performed a two-stage analysis of rare de novo and inherited coding variants in 42,607 autism cases, including 35,130 new cases recruited online by SPARK. We identified 60 genes with exome-wide significance (P < 2.5 × 10−6), including five new risk genes (NAV3,ITSN1,MARK2,SCAF1andHNRNPUL2). The association ofNAV3with autism risk is primarily driven by rare inherited loss-of-function (LoF) variants, with an estimated relative risk of 4, consistent with moderate effect. Autistic individuals with LoF variants in the four moderate-risk genes (NAV3,ITSN1,SCAF1andHNRNPUL2;n = 95) have less cognitive impairment than 129 autistic individuals with LoF variants in highly penetrant genes (CHD8, SCN2A, ADNP, FOXP1andSHANK3) (59% vs 88%,P = 1.9 × 10−6). Power calculations suggest that much larger numbers of autism cases are needed to identify additional moderate-risk genes.

Research paper thumbnail of Buddies: A Structured Outdoor Play Curriculum in an Integrated Preschool

Play is the natural context in which children with neuroptypical development (NTD) hone their com... more Play is the natural context in which children with neuroptypical development (NTD) hone their communication and social interaction skills. It is precisely these key developmental areas in which children with a diagnosis of Autism Spectrum Disorder (ASD) present with deficits (American Psychiatric Association, 2013). Early childhood education centers typically offer daily outdoor recess times in which children are given the opportunity to play outside (Georgia Department of Early Care and Learning, 2016). However, the curriculum during recess is often unstructured and adult staffing is reduced. (Kasari, Rotheram-Fuller, Locke, & Gulsrud, 2012). This lack of a structured activity time, which could otherwise be used for focused treatment, lends to children with ASD experiencing difficulties engaging in play, due to engagement in repetitive and compulsive behaviors, and impulsiveness that may be more motivating (Peeters 1997; Veale 1998). Unstructured periods of time during the school day are missed opportunities for needed social skills treatment for children with ASD. This study, conducted in an integrated preschool setting across four age groups, examines if a structured, cooperative outdoor play curriculum with a focus on natural modeling and imitation, increases the rate that children with ASD are in proximity to typically developing peers, increases the number of social bids from children with ASD to peers with NTD, and increases the number of social bids from children with NTD to peers with ASD, in both outdoor recess and indoor free-play sessions. This study is currently being conducted, however it is hypothesized that children, both with ASD and NTD, will increase these defined behaviors

Research paper thumbnail of Changes in Educational Placements for Children with Autism Spectrum Disorders (ASDs) in a Population-Based Sample in a US Metropolitan Area

Background: ASDs affect about 1% of children (CDC, 2009) which challenges school systems to meet ... more Background: ASDs affect about 1% of children (CDC, 2009) which challenges school systems to meet these students’ educational needs. Federal mandates require students with disabilities to be educated in the least restrictive environment to the maximum extent possible (IDEA, 2004). Objectives: To document changes in educational placements for students with an ASD over four time periods from a population-based ASD surveillance system. Methods: Children with ASD were identified through record abstraction at multiple health and education sources within a US metropolitan area. Case status based on the DSMIVTR criteria was determined by clinician reviewers. Educational placement was obtained from the child’s Individualized Educational Plan (IEP) at age eight, while intellectual level was based on the most recent IQ score on record. Socioeconomic status was coded from Census 2000 indicators based on the child’s residence. Results: A total of 1,497 8-year-old children with an ASD were identi...

Research paper thumbnail of Assessing Peer-Related Social Interest in Preschool-Aged Children with Autism

Background: Diagnosis of an Autism Spectrum Disorder (ASD) relies on use of the ADOS (Lord et al.... more Background: Diagnosis of an Autism Spectrum Disorder (ASD) relies on use of the ADOS (Lord et al., 2003) and ADI-R (Rutter et al., 2003) to assess behaviors associated with DSMIVTR criteria. Criteria also requires an assessment of a child’s “development of peer relationships” (APA, 2000), yet there are no behavioral observations dedicated to this observation. Most evaluators rely on parental reports of children’s social interest, through the ADI-R and/or Vineland (Sparrow et al., 2005). Although parent report can be reliable for out-of-school settings, gathering behavioral information during peer social interactions is lacking. Wing and Gould (1979) originally classified children with autism by their interest in other people, yielding three classifications (passive, avoidant, active but odd). A modified assessment using Wing and Gould’s classifications targeting peer interest is needed. Objectives: To describe a standard protocol for assessing peer-related interest in children with ...

Research paper thumbnail of Ethnic Differences in Autism Eligibility in the United States Public Schools

The Journal of Special Education, 2010

This study investigates ethnic differences for 295,945 children and youth with an autism eligibil... more This study investigates ethnic differences for 295,945 children and youth with an autism eligibility reported to the U.S. Department of Education (USDOE) by 49 states plus the District of Columbia. Data analyses used relative difference, risk index, and risk ratio (RR). Results indicate that 80% of states report underrepresentation across ethnicities, with Hispanic children underrepresented in 95% of states. Use of developmental delay label was significantly related to disproportionate representation for school-age population ( F = 3.291, p = .046). Region of country yielded significant differences in RR for children classified as Asian ( F = 3.532, p = .014) and Caucasian ( F = 5.219, p = .002), for Black ( F = 4.355, p = .005) and Caucasian ( F = 2.840, p = .038) preschoolers, and for Asian ( F = 5.676, p = .001) and Caucasian ( F =4.906, p = .002) youth. Policy, training, and programming implications of the data are discussed.

Research paper thumbnail of Accelerating autism diagnosis using asynchronous telehealth technology

International Journal Of Community Medicine And Public Health

Background: Early identification and treatment of autism can prevent additional behavioral proble... more Background: Early identification and treatment of autism can prevent additional behavioral problems later in a child’s life. Long wait lists and travel limitations can often make it difficult for parents to obtain timely evaluations. A new telehealth technology has been developed that can provide clinicians with the ability to remotely observe a child’s behavior at home and allows parents to communicate with the clinician directly. The objective of this study was to compare the length of time from referral to the completion of a child’s diagnostic evaluation using asynchronous telehealth (TH) and using the traditional in-person assessment method (IPA). Methods: Three tertiary autism diagnostic centers in the United States conducted this study between 2016 and 2018. All three institutional review boards approved the research. Twenty-eight children were assigned to an IPA group and 29 children were assigned to a TH group. The IPA assessment was based on a standard in-person evaluation...

Research paper thumbnail of Correlations between ADOS-2, Module 4 Comparison Scores and Standardized Assessment Measures: Preliminary Examination in Adults with Autism Spectrum Disorder

Research paper thumbnail of Psychosocial Correlates of Autistic Traits: Implications for Higher Education Settings

Research paper thumbnail of Increasing Social Interactions of Preschool Children With Autism Through Cooperative Outdoor Play

The Journal of Special Education, 2021

Unstructured activity periods are central components of early childhood education programs. Defic... more Unstructured activity periods are central components of early childhood education programs. Deficits in social communication and social interaction presented by children with autism spectrum disorder (ASD) become apparent in these settings during unstructured activities, such as outdoor recess. Thirty-two preschool-aged children with and without ASD participated in the Buddy Game, a structured, cooperative play curriculum that focused on natural peer–peer modeling and imitation. The Buddy Game used familiar songs to promote peer proximity and discrete social bids between peers during outside time. A multiple baseline design across three classrooms was used to study curriculum effects on discrete social bids of children with ASD. Results demonstrated increased social bids from children with ASD to their peers with neurotypical development (NTD) across classrooms. In one classroom, effects maintained after intervention stopped and generalized to other times of the day. Implications fo...

Research paper thumbnail of Integrating de novo and inherited variants in over 42,607 autism cases identifies mutations in new moderate risk genes

Despite the known heritable nature of autism spectrum disorder (ASD), studies have primarily iden... more Despite the known heritable nature of autism spectrum disorder (ASD), studies have primarily identified risk genes with de novo variants (DNVs). To capture the full spectrum of ASD genetic risk, we performed a two-stage analysis of rare de novo and inherited coding variants in 42,607 ASD cases, including 35,130 new cases recruited online by SPARK. In the first stage, we analyzed 19,843 cases with one or both biological parents and found that known ASD or neurodevelopmental disorder (NDD) risk genes explain nearly 70% of the genetic burden conferred by DNVs. In contrast, less than 20% of genetic risk conferred by rare inherited loss-of-function (LoF) variants are explained by known ASD/NDD genes. We selected 404 genes based on the first stage of analysis and performed a meta-analysis with an additional 22,764 cases and 236,000 population controls. We identified 60 genes with exome-wide significance (p < 2.5e-6), including five new risk genes (NAV3, ITSN1, MARK2, SCAF1, and HNRNPUL...

Research paper thumbnail of Development of an interactive tool of early social responsiveness to track autism risk in infants and toddlers

Developmental Medicine & Child Neurology, 2021

To evaluate the psychometric properties of a 4‐minute assessment designed to identify early autis... more To evaluate the psychometric properties of a 4‐minute assessment designed to identify early autism spectrum disorder (ASD) status through evaluation of early social responsiveness (ESR).

Research paper thumbnail of The Role of Diagnostic Instruments in Dual and Differential Diagnosis in Autism Spectrum Disorder Across the Lifespan

Child and Adolescent Psychiatric Clinics of North America, 2020

BACKGROUND Specifying autism spectrum disorder (ASD) has been the goal of clinicians and research... more BACKGROUND Specifying autism spectrum disorder (ASD) has been the goal of clinicians and researchers alike over the past 40 years, in an attempt to understand the heterogeneity and the chronogeneity 1 in autism. Chronogeneity refers to the study of the heterogeneity of autism in relationship to the dimension of time, which is not always captured in the assessment process. Autism is a label used to describe a constellation of behaviorally identified criteria that cluster together in diverse ways and differing severities to form a definable pattern in a person's developmental progression, and its utility lies in

Research paper thumbnail of Beliefs in vaccine as causes of autism among SPARK cohort caregivers

Vaccine, 2020

Background: Fear of autism has led to a decline in childhood-immunization uptake and to a resurge... more Background: Fear of autism has led to a decline in childhood-immunization uptake and to a resurgence of preventable infectious diseases. Identifying characteristics of parents who believe in a causal role of vaccines for autism spectrum disorder (ASD) in their child may help targeting educational activities and improve adherence to the immunization schedule. Objectives: To compare caregivers of children with ASD who agree or disagree that vaccines play an etiological role in autism for 1) socio-demographics characteristics and 2) developmental and clinical profiles of their children. Methods: Data from 16,525 participants with ASD under age 18 were obtained from SPARK, a national research cohort started in 2016. Caregivers completed questionnaires at registration that included questions on beliefs about the etiologic role of childhood immunizations and other factors in ASD. Data were available about family socio-demographic characteristics, first symptoms of autism, developmental regression, co-occurring psychiatric disorders, seizures, and current levels of functioning. Results: Participants with ASD were 80.4% male with a mean age of 8.1 years (SD = 4.1). Overall, 16.5% of caregivers endorsed immunizations as perceived causes of autism. Compared to caregivers who disagreed with vaccines as a cause for ASD, those who believed in vaccine causation came disproportionately from ethnic minority, less educated, and less wealthy backgrounds. More often their children had experienced developmental regression involving language and other skills, were diagnosed earlier, had lost skills during the second year of life, and had worse language, adaptive, and cognitive outcomes. Conclusion: One in six caregivers who participate in a national research cohort believe that child immunizations could be a cause of autism in their child. Parent social background (non-White, less educated) and child developmental features (regression in second year, poorer language skills, and worse adaptive outcomes) index caregivers who are more likely to harbor these beliefs and could benefit from targeted educational activities.

Research paper thumbnail of Disparities in Documented Diagnoses of Autism Spectrum Disorder Based on Demographic, Individual, and Service Factors

Autism Research, 2019

The objectives of our study were to (a) report how many children met an autism spectrum disorder ... more The objectives of our study were to (a) report how many children met an autism spectrum disorder (ASD) surveillance definition but had no clinical diagnosis of ASD in health or education records and (b) evaluate differences in demographic, individual, and service factors between children with and without a documented ASD diagnosis. ASD surveillance was conducted in selected areas of Arizona,

Research paper thumbnail of Exome sequencing of 457 autism families recruited online provides evidence for autism risk genes

npj Genomic Medicine, 2019

Autism spectrum disorder (ASD) is a genetically heterogeneous condition, caused by a combination ... more Autism spectrum disorder (ASD) is a genetically heterogeneous condition, caused by a combination of rare de novo and inherited variants as well as common variants in at least several hundred genes. However, significantly larger sample sizes are needed to identify the complete set of genetic risk factors. We conducted a pilot study for SPARK (SPARKForAutism.org) of 457 families with ASD, all consented online. Whole exome sequencing (WES) and genotyping data were generated for each family using DNA from saliva. We identified variants in genes and loci that are clinically recognized causes or significant contributors to ASD in 10.4% of families without previous genetic findings. In addition, we identified variants that are possibly associated with ASD in an additional 3.4% of families. A meta-analysis using the TADA framework at a false discovery rate (FDR) of 0.1 provides statistical support for 26 ASD risk genes. While most of these genes are already known ASD risk genes, BRSK2 has the strongest statistical support and reaches genome-wide significance as a risk gene for ASD (p-value = 2.3e−06). Future studies leveraging the thousands of individuals with ASD who have enrolled in SPARK are likely to further clarify the genetic risk factors associated with ASD as well as allow accelerate ASD research that incorporates genetic etiology.

Research paper thumbnail of Contributions of university lab schools to behavior analysis

European Journal of Behavior Analysis, 2019

Lab schools provide a means to expand state-of-the-science advances in Applied Behavior Analysis ... more Lab schools provide a means to expand state-of-the-science advances in Applied Behavior Analysis (ABA). As an example, Walden School is showcased as a comprehensive intervention program, which aims to promote optimal language and social growth by children with autism at the youngest ages possible. Building upon earlier contributions by pioneers in the field of ABA, Walden is based on incidental teaching as a planned protocol of instruction that takes place in environments that have been engineered to engage children with autism among typically developing peers. Programmatic research conducted in development of an ABA treatment model is highlighted, along with illustration of the potential benefits of a lab school. In sum, lab schools such as Walden offer: (a) training sites for preparation of behavior analysts, (b) controlled settings in which research can expedite the evolution of an ever-improving science of human behavior, and (c) demonstrations that may promote dissemination of ABA findings from research to practice.

Research paper thumbnail of Integrating Deep Learning with Behavior Imaging to Accelerate Industry’s ‘Learning’ of Autism Core Deficits

INSAR 2018 Annual Meeting, May 11, 2018

Research paper thumbnail of Defining in Detail and Evaluating Reliability of DSM-5 Criteria for Autism Spectrum Disorder (ASD) Among Children

Journal of Autism and Developmental Disorders, 2022

This paper describes a process to define a comprehensive list of exemplars for seven core Diagnos... more This paper describes a process to define a comprehensive list of exemplars for seven core Diagnostic and Statistical Manual (DSM) diagnostic criteria for autism spectrum disorder (ASD), and report on interrater reliability in applying these exemplars to determine ASD case classification. Clinicians completed an iterative process to map specific exemplars from the CDC Autism and Developmental Disabilities Monitoring (ADDM) Network criteria for ASD surveillance, DSM-5 text, and diagnostic assessments to each of the core DSM-5 ASD criteria. Clinicians applied the diagnostic exemplars to child behavioral descriptions in existing evaluation records to establish initial reliability standards and then for blinded clinician review in one site (phase 1) and for two ADDM Network surveillance years (phase 2). Interrater reliability for each of the DSM-5 diagnostic categories and overall ASD classification was high (defined as very good .60-.79 to excellent ≥ .80 Kappa values) across sex, race/ethnicity, and cognitive levels for both phases. Classification of DSM-5 ASD by mapping specific exemplars from evaluation records by a diverse group of clinician raters is feasible and reliable. This framework provides confidence in the consistency of prevalence classifications of ASD and may be further applied to improve consistency of ASD diagnoses in clinical settings.

Research paper thumbnail of Validation of an Enhanced Telehealth Platform for Toddlers at Increased Likelihood for a Diagnosis of Autism Spectrum Disorder (ASD)

Journal of Autism and Developmental Disorders

Research paper thumbnail of Correction to: Defining in Detail and Evaluating Reliability of DSM-5 Criteria for Autism Spectrum Disorder (ASD) Among Children

Journal of Autism and Developmental Disorders, 2022

The supplementary documents was missing in this article and it has been uploaded. The original ar... more The supplementary documents was missing in this article and it has been uploaded. The original article has been revised. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Research paper thumbnail of Integrating de novo and inherited variants in 42,607 autism cases identifies mutations in new moderate-risk genes

Nature Genetics

To capture the full spectrum of genetic risk for autism, we performed a two-stage analysis of rar... more To capture the full spectrum of genetic risk for autism, we performed a two-stage analysis of rare de novo and inherited coding variants in 42,607 autism cases, including 35,130 new cases recruited online by SPARK. We identified 60 genes with exome-wide significance (P < 2.5 × 10−6), including five new risk genes (NAV3,ITSN1,MARK2,SCAF1andHNRNPUL2). The association ofNAV3with autism risk is primarily driven by rare inherited loss-of-function (LoF) variants, with an estimated relative risk of 4, consistent with moderate effect. Autistic individuals with LoF variants in the four moderate-risk genes (NAV3,ITSN1,SCAF1andHNRNPUL2;n = 95) have less cognitive impairment than 129 autistic individuals with LoF variants in highly penetrant genes (CHD8, SCN2A, ADNP, FOXP1andSHANK3) (59% vs 88%,P = 1.9 × 10−6). Power calculations suggest that much larger numbers of autism cases are needed to identify additional moderate-risk genes.

Research paper thumbnail of Buddies: A Structured Outdoor Play Curriculum in an Integrated Preschool

Play is the natural context in which children with neuroptypical development (NTD) hone their com... more Play is the natural context in which children with neuroptypical development (NTD) hone their communication and social interaction skills. It is precisely these key developmental areas in which children with a diagnosis of Autism Spectrum Disorder (ASD) present with deficits (American Psychiatric Association, 2013). Early childhood education centers typically offer daily outdoor recess times in which children are given the opportunity to play outside (Georgia Department of Early Care and Learning, 2016). However, the curriculum during recess is often unstructured and adult staffing is reduced. (Kasari, Rotheram-Fuller, Locke, & Gulsrud, 2012). This lack of a structured activity time, which could otherwise be used for focused treatment, lends to children with ASD experiencing difficulties engaging in play, due to engagement in repetitive and compulsive behaviors, and impulsiveness that may be more motivating (Peeters 1997; Veale 1998). Unstructured periods of time during the school day are missed opportunities for needed social skills treatment for children with ASD. This study, conducted in an integrated preschool setting across four age groups, examines if a structured, cooperative outdoor play curriculum with a focus on natural modeling and imitation, increases the rate that children with ASD are in proximity to typically developing peers, increases the number of social bids from children with ASD to peers with NTD, and increases the number of social bids from children with NTD to peers with ASD, in both outdoor recess and indoor free-play sessions. This study is currently being conducted, however it is hypothesized that children, both with ASD and NTD, will increase these defined behaviors

Research paper thumbnail of Changes in Educational Placements for Children with Autism Spectrum Disorders (ASDs) in a Population-Based Sample in a US Metropolitan Area

Background: ASDs affect about 1% of children (CDC, 2009) which challenges school systems to meet ... more Background: ASDs affect about 1% of children (CDC, 2009) which challenges school systems to meet these students’ educational needs. Federal mandates require students with disabilities to be educated in the least restrictive environment to the maximum extent possible (IDEA, 2004). Objectives: To document changes in educational placements for students with an ASD over four time periods from a population-based ASD surveillance system. Methods: Children with ASD were identified through record abstraction at multiple health and education sources within a US metropolitan area. Case status based on the DSMIVTR criteria was determined by clinician reviewers. Educational placement was obtained from the child’s Individualized Educational Plan (IEP) at age eight, while intellectual level was based on the most recent IQ score on record. Socioeconomic status was coded from Census 2000 indicators based on the child’s residence. Results: A total of 1,497 8-year-old children with an ASD were identi...

Research paper thumbnail of Assessing Peer-Related Social Interest in Preschool-Aged Children with Autism

Background: Diagnosis of an Autism Spectrum Disorder (ASD) relies on use of the ADOS (Lord et al.... more Background: Diagnosis of an Autism Spectrum Disorder (ASD) relies on use of the ADOS (Lord et al., 2003) and ADI-R (Rutter et al., 2003) to assess behaviors associated with DSMIVTR criteria. Criteria also requires an assessment of a child’s “development of peer relationships” (APA, 2000), yet there are no behavioral observations dedicated to this observation. Most evaluators rely on parental reports of children’s social interest, through the ADI-R and/or Vineland (Sparrow et al., 2005). Although parent report can be reliable for out-of-school settings, gathering behavioral information during peer social interactions is lacking. Wing and Gould (1979) originally classified children with autism by their interest in other people, yielding three classifications (passive, avoidant, active but odd). A modified assessment using Wing and Gould’s classifications targeting peer interest is needed. Objectives: To describe a standard protocol for assessing peer-related interest in children with ...

Research paper thumbnail of Ethnic Differences in Autism Eligibility in the United States Public Schools

The Journal of Special Education, 2010

This study investigates ethnic differences for 295,945 children and youth with an autism eligibil... more This study investigates ethnic differences for 295,945 children and youth with an autism eligibility reported to the U.S. Department of Education (USDOE) by 49 states plus the District of Columbia. Data analyses used relative difference, risk index, and risk ratio (RR). Results indicate that 80% of states report underrepresentation across ethnicities, with Hispanic children underrepresented in 95% of states. Use of developmental delay label was significantly related to disproportionate representation for school-age population ( F = 3.291, p = .046). Region of country yielded significant differences in RR for children classified as Asian ( F = 3.532, p = .014) and Caucasian ( F = 5.219, p = .002), for Black ( F = 4.355, p = .005) and Caucasian ( F = 2.840, p = .038) preschoolers, and for Asian ( F = 5.676, p = .001) and Caucasian ( F =4.906, p = .002) youth. Policy, training, and programming implications of the data are discussed.

Research paper thumbnail of Accelerating autism diagnosis using asynchronous telehealth technology

International Journal Of Community Medicine And Public Health

Background: Early identification and treatment of autism can prevent additional behavioral proble... more Background: Early identification and treatment of autism can prevent additional behavioral problems later in a child’s life. Long wait lists and travel limitations can often make it difficult for parents to obtain timely evaluations. A new telehealth technology has been developed that can provide clinicians with the ability to remotely observe a child’s behavior at home and allows parents to communicate with the clinician directly. The objective of this study was to compare the length of time from referral to the completion of a child’s diagnostic evaluation using asynchronous telehealth (TH) and using the traditional in-person assessment method (IPA). Methods: Three tertiary autism diagnostic centers in the United States conducted this study between 2016 and 2018. All three institutional review boards approved the research. Twenty-eight children were assigned to an IPA group and 29 children were assigned to a TH group. The IPA assessment was based on a standard in-person evaluation...

Research paper thumbnail of Correlations between ADOS-2, Module 4 Comparison Scores and Standardized Assessment Measures: Preliminary Examination in Adults with Autism Spectrum Disorder

Research paper thumbnail of Psychosocial Correlates of Autistic Traits: Implications for Higher Education Settings

Research paper thumbnail of Increasing Social Interactions of Preschool Children With Autism Through Cooperative Outdoor Play

The Journal of Special Education, 2021

Unstructured activity periods are central components of early childhood education programs. Defic... more Unstructured activity periods are central components of early childhood education programs. Deficits in social communication and social interaction presented by children with autism spectrum disorder (ASD) become apparent in these settings during unstructured activities, such as outdoor recess. Thirty-two preschool-aged children with and without ASD participated in the Buddy Game, a structured, cooperative play curriculum that focused on natural peer–peer modeling and imitation. The Buddy Game used familiar songs to promote peer proximity and discrete social bids between peers during outside time. A multiple baseline design across three classrooms was used to study curriculum effects on discrete social bids of children with ASD. Results demonstrated increased social bids from children with ASD to their peers with neurotypical development (NTD) across classrooms. In one classroom, effects maintained after intervention stopped and generalized to other times of the day. Implications fo...

Research paper thumbnail of Integrating de novo and inherited variants in over 42,607 autism cases identifies mutations in new moderate risk genes

Despite the known heritable nature of autism spectrum disorder (ASD), studies have primarily iden... more Despite the known heritable nature of autism spectrum disorder (ASD), studies have primarily identified risk genes with de novo variants (DNVs). To capture the full spectrum of ASD genetic risk, we performed a two-stage analysis of rare de novo and inherited coding variants in 42,607 ASD cases, including 35,130 new cases recruited online by SPARK. In the first stage, we analyzed 19,843 cases with one or both biological parents and found that known ASD or neurodevelopmental disorder (NDD) risk genes explain nearly 70% of the genetic burden conferred by DNVs. In contrast, less than 20% of genetic risk conferred by rare inherited loss-of-function (LoF) variants are explained by known ASD/NDD genes. We selected 404 genes based on the first stage of analysis and performed a meta-analysis with an additional 22,764 cases and 236,000 population controls. We identified 60 genes with exome-wide significance (p < 2.5e-6), including five new risk genes (NAV3, ITSN1, MARK2, SCAF1, and HNRNPUL...

Research paper thumbnail of Development of an interactive tool of early social responsiveness to track autism risk in infants and toddlers

Developmental Medicine & Child Neurology, 2021

To evaluate the psychometric properties of a 4‐minute assessment designed to identify early autis... more To evaluate the psychometric properties of a 4‐minute assessment designed to identify early autism spectrum disorder (ASD) status through evaluation of early social responsiveness (ESR).

Research paper thumbnail of The Role of Diagnostic Instruments in Dual and Differential Diagnosis in Autism Spectrum Disorder Across the Lifespan

Child and Adolescent Psychiatric Clinics of North America, 2020

BACKGROUND Specifying autism spectrum disorder (ASD) has been the goal of clinicians and research... more BACKGROUND Specifying autism spectrum disorder (ASD) has been the goal of clinicians and researchers alike over the past 40 years, in an attempt to understand the heterogeneity and the chronogeneity 1 in autism. Chronogeneity refers to the study of the heterogeneity of autism in relationship to the dimension of time, which is not always captured in the assessment process. Autism is a label used to describe a constellation of behaviorally identified criteria that cluster together in diverse ways and differing severities to form a definable pattern in a person's developmental progression, and its utility lies in

Research paper thumbnail of Beliefs in vaccine as causes of autism among SPARK cohort caregivers

Vaccine, 2020

Background: Fear of autism has led to a decline in childhood-immunization uptake and to a resurge... more Background: Fear of autism has led to a decline in childhood-immunization uptake and to a resurgence of preventable infectious diseases. Identifying characteristics of parents who believe in a causal role of vaccines for autism spectrum disorder (ASD) in their child may help targeting educational activities and improve adherence to the immunization schedule. Objectives: To compare caregivers of children with ASD who agree or disagree that vaccines play an etiological role in autism for 1) socio-demographics characteristics and 2) developmental and clinical profiles of their children. Methods: Data from 16,525 participants with ASD under age 18 were obtained from SPARK, a national research cohort started in 2016. Caregivers completed questionnaires at registration that included questions on beliefs about the etiologic role of childhood immunizations and other factors in ASD. Data were available about family socio-demographic characteristics, first symptoms of autism, developmental regression, co-occurring psychiatric disorders, seizures, and current levels of functioning. Results: Participants with ASD were 80.4% male with a mean age of 8.1 years (SD = 4.1). Overall, 16.5% of caregivers endorsed immunizations as perceived causes of autism. Compared to caregivers who disagreed with vaccines as a cause for ASD, those who believed in vaccine causation came disproportionately from ethnic minority, less educated, and less wealthy backgrounds. More often their children had experienced developmental regression involving language and other skills, were diagnosed earlier, had lost skills during the second year of life, and had worse language, adaptive, and cognitive outcomes. Conclusion: One in six caregivers who participate in a national research cohort believe that child immunizations could be a cause of autism in their child. Parent social background (non-White, less educated) and child developmental features (regression in second year, poorer language skills, and worse adaptive outcomes) index caregivers who are more likely to harbor these beliefs and could benefit from targeted educational activities.

Research paper thumbnail of Disparities in Documented Diagnoses of Autism Spectrum Disorder Based on Demographic, Individual, and Service Factors

Autism Research, 2019

The objectives of our study were to (a) report how many children met an autism spectrum disorder ... more The objectives of our study were to (a) report how many children met an autism spectrum disorder (ASD) surveillance definition but had no clinical diagnosis of ASD in health or education records and (b) evaluate differences in demographic, individual, and service factors between children with and without a documented ASD diagnosis. ASD surveillance was conducted in selected areas of Arizona,

Research paper thumbnail of Exome sequencing of 457 autism families recruited online provides evidence for autism risk genes

npj Genomic Medicine, 2019

Autism spectrum disorder (ASD) is a genetically heterogeneous condition, caused by a combination ... more Autism spectrum disorder (ASD) is a genetically heterogeneous condition, caused by a combination of rare de novo and inherited variants as well as common variants in at least several hundred genes. However, significantly larger sample sizes are needed to identify the complete set of genetic risk factors. We conducted a pilot study for SPARK (SPARKForAutism.org) of 457 families with ASD, all consented online. Whole exome sequencing (WES) and genotyping data were generated for each family using DNA from saliva. We identified variants in genes and loci that are clinically recognized causes or significant contributors to ASD in 10.4% of families without previous genetic findings. In addition, we identified variants that are possibly associated with ASD in an additional 3.4% of families. A meta-analysis using the TADA framework at a false discovery rate (FDR) of 0.1 provides statistical support for 26 ASD risk genes. While most of these genes are already known ASD risk genes, BRSK2 has the strongest statistical support and reaches genome-wide significance as a risk gene for ASD (p-value = 2.3e−06). Future studies leveraging the thousands of individuals with ASD who have enrolled in SPARK are likely to further clarify the genetic risk factors associated with ASD as well as allow accelerate ASD research that incorporates genetic etiology.

Research paper thumbnail of Contributions of university lab schools to behavior analysis

European Journal of Behavior Analysis, 2019

Lab schools provide a means to expand state-of-the-science advances in Applied Behavior Analysis ... more Lab schools provide a means to expand state-of-the-science advances in Applied Behavior Analysis (ABA). As an example, Walden School is showcased as a comprehensive intervention program, which aims to promote optimal language and social growth by children with autism at the youngest ages possible. Building upon earlier contributions by pioneers in the field of ABA, Walden is based on incidental teaching as a planned protocol of instruction that takes place in environments that have been engineered to engage children with autism among typically developing peers. Programmatic research conducted in development of an ABA treatment model is highlighted, along with illustration of the potential benefits of a lab school. In sum, lab schools such as Walden offer: (a) training sites for preparation of behavior analysts, (b) controlled settings in which research can expedite the evolution of an ever-improving science of human behavior, and (c) demonstrations that may promote dissemination of ABA findings from research to practice.