Publications by authors named "Andrew Pickles"

235 Publications

Breast may not always be best: moderation of effects of postnatal depression by breastfeeding and infant sex.

Biol Sex Differ 2021 Nov 7;12(1):59. Epub 2021 Nov 7.

Department of Psychology, Faculty of Health and Education, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, Manchester, M15 6GX, UK.

Background: There is good evidence that female infants are particularly vulnerable to poor emotional outcomes following in utero glucocorticoid exposure. It is currently unclear whether such effects might persist into the postnatal period for breastfed infants, as maternal cortisol is expressed in breastmilk and is influenced by maternal psychological distress. We pre-registered hypotheses that maternal postnatal depression would be associated with infant negative emotionality, and that this effect would be moderated by breastfeeding status and infant sex.

Methods: We analysed data from the Wirral Child Health and Development Study (WCHADS), a prospective epidemiological study starting in pregnancy. Nine weeks after birth mothers self-reported depressive symptoms and breastfeeding status, and reported infant negative emotionality using the distress to limits subscale of the infant behaviour questionnaire (IBQ-R) when their infant was aged 9 weeks and 14 months. Maximum likelihood estimations made use of data from 857 mother-infant pairs.

Results: At 9 weeks of age, maternal postnatal depressive symptoms were positively associated with infant distress to limits; however, this effect was not moderated by infant sex or breastfeeding. At age 14 months, the association between postnatal depression symptoms and distress to limits was greatest in the breastfed females, whereas the association was smaller, but still significant, in the non-breastfed females. For males, the association was non-significant in both the breastfed and non-breastfed groups. A test of sex difference between breastfed males and females was significant.

Conclusions: We provide evidence that effects of maternal postnatal depression on child emotional outcomes are moderated by breastfeeding status and differ by infant sex. Female vulnerability to elevated maternal breastmilk glucocorticoids may, at least in part, explain these effects.
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http://dx.doi.org/10.1186/s13293-021-00403-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8573903PMC
November 2021

Exploring the impact of adolescent cognitive inflexibility on emotional and behavioural problems experienced by autistic adults.

Autism 2021 Sep 28:13623613211046160. Epub 2021 Sep 28.

King's College London, UK.

Lay Abstract: Autistic people experience high levels of co-occurring mental health difficulties. To develop more effective treatments, a greater understanding of the thinking processes that may lead to these difficulties is needed. Cognitive inflexibility, defined as a rigid pattern of thoughts and subsequently behaviours, is one possible thinking trait which has previously been associated with both co-occurring mental health difficulties but also other features of autism such as restricted and repetitive behaviours. Restricted and repetitive behaviours include repetitive movements, ritualistic behaviours, and/or highly focused interests. This study investigates the relationship between, cognitive inflexibility, measured using neuropsychological tasks, and emotional and behavioural problems across adolescence and early adulthood. Eighty-one autistic people who were recruited to be representative of the wider autism population were assessed at 16 and 23 years on measures of emotional and behavioural problems, with cognitive inflexibility, restricted and repetitive behaviours and verbal intelligence measured at 16 years. We used statistical modelling to investigate the relationship between cognitive inflexibility and emotional and behavioural symptoms at both timepoints while accounting for the possible relationship with restricted and repetitive behaviours and verbal intelligence quotient. Our results suggest that cognitive inflexibility may be an important factor associated with emotional difficulties across adolescence and early adulthood. This suggests that developing intervention approaches targeting cognitive inflexibility may be an important step in improving the mental health of those with autism.
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http://dx.doi.org/10.1177/13623613211046160DOI Listing
September 2021

Interplay between long-term vulnerability and new risk: Young adolescent and maternal mental health immediately before and during the COVID-19 pandemic.

JCPP Adv 2021 Jan 18;1(1):e12008. Epub 2021 May 18.

Department of Biostatistics & Health Informatics Institute of Psychiatry, Psychology & Neuroscience King's College London London UK.

Background: We examine whether there has been an increase in young adolescent and maternal mental health problems from pre- to post-onset of the COVID-19 pandemic.

Methods: Children aged 11-12 years and their mothers participating in a UK population-based birth cohort (Wirral Child Health and Development Study) provided mental health data between December 2019 and March 2020, and again 3 months after lockdown, 89% ( = 202) of 226 assessed pre-COVID-19. Emotional and behavioural problems were assessed by self- and maternal reports, and long-term vulnerability by maternal report of prior child adjustment, and maternal prenatal depression.

Results: The young adolescents reported a 44% (95% confidence interval [CI: 23%-65%]) increase in symptoms of depression and 26% (95% CI [12%-40%]) for post-traumatic stress disorder, with corresponding maternal reports of child symptoms of 71% (95% CI [44%-99%]) and 43% (95% CI 29%-86%). Disruptive behaviour problem symptoms increased by 76% (95% CI [43%-109%]) particularly in children without previous externalising symptoms. Both female gender and having had high internalising symptoms earlier in childhood were associated with elevated rates of depression pre-pandemic, and with greater absolute increases during COVID-19. Mothers' own depression symptoms increased by 42% (95% CI [20%-65%]), and this change was greater among mothers who had prenatal depression. No change in anxiety was observed among children or mothers. None of these increases were moderated by COVID-19-related experiences such as frontline worker status of a parent. Prior to the pandemic, rates of maternal and child depression were greater in families experiencing higher deprivation, but changed only in less deprived families, raising their rates to those of the high deprivation group.

Conclusions: COVID-19 has led to a marked increase in mental health problems in young adolescents and their mothers with concomitant requirements for mental health services to have the resources to adapt to meet the level and nature of the needs.
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http://dx.doi.org/10.1111/jcv2.12008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206735PMC
January 2021

Two-stage sampling in the estimation of growth parameters and percentile norms: sample weights versus auxiliary variable estimation.

BMC Med Res Methodol 2021 08 17;21(1):173. Epub 2021 Aug 17.

Department of Biostatistics and Health Informatics, Institute of Psychology, Psychiatry and Neuroscience, Kings College London, London, UK.

Background: The use of auxiliary variables with maximum likelihood parameter estimation for surveys that miss data by design is not a widespread approach, despite its documented improved efficiency over traditional approaches that deploy sampling weights. Although efficiency gains from the use of Normally distributed auxiliary variables in a model have been recorded in the literature, little is known about the effects of non-Normal auxiliary variables in the parameter estimation.

Methods: We simulate growth data to mimic SCALES, a two-stage survey of language development with a screening phase (stage one) for which data are observed for the whole sample and an intensive assessments phase (stage two), for which data are observed for a sub-sample, selected using stratified random sampling. In the simulation, we allow a fully observed Poisson distributed stratification criterion to be correlated with the partially observed model responses and develop five generalised structural equation growth models that host the auxiliary information from this criterion. We compare these models with each other and with a weighted growth model in terms of bias, efficiency, and coverage. We finally apply our best performing model to SCALES data and show how to obtain growth parameters and population norms.

Results: Parameter estimation from a model that incorporates a non-Normal auxiliary variable is unbiased and more efficient than its weighted counterpart. The auxiliary variable method is capable of producing efficient population percentile norms and velocities.

Conclusions: The deployment of a fully observed variable that dominates the selection of the sample and correlates strongly with the incomplete variable of interest appears beneficial for the estimation process.
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http://dx.doi.org/10.1186/s12874-021-01353-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8369688PMC
August 2021

Behavioural and physiological response to frustration in autistic youth: associations with irritability.

J Neurodev Disord 2021 07 19;13(1):27. Epub 2021 Jul 19.

Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.

Background: Irritability is a common and impairing occurrence in autistic youth, yet the underlying mechanisms are not well-known. In typically developing populations, differences in frustration response have been suggested as important driver of the behavioural symptoms of irritability. Research exploring the role of frustration response as a risk factor for irritability in autistic populations is limited and often uses parent report or observer ratings; objective measures of frustration response appropriate for use in autistic populations are required to advance the field.

Methods: In the current study, fifty-two autistic adolescents aged 13-17 years from a population-based longitudinal study completed an experimental task designed to induce frustration through exposure to periods of unexpected delay. Behavioural (number of button presses) and physiological (heart rate; HR) metrics were collected during delay periods. Irritability was measured using the parent-rated Affective Reactivity Index (ARI). Analyses used mixed-level models to test whether irritability was associated with different slopes of behavioural and physiological response to experimentally induced frustration during the task. Age and baseline HR (for the physiological data only) were included as covariates.

Results: Analyses showed a marginal association between irritability and the slope of behavioural response (incident rate ratio (IRR) =.98, p=.06), and a significant association with the slope of physiological response (b=-.10, p=.04); higher levels of irritability were associated with a dampened behavioural and physiological response, as indicated by flatter slopes of change over the course of the task. The pattern of results largely remained in sensitivity analyses, although the association with physiological response became non-significant when adjusting for IQ, autism symptom severity, and medication use (b=-.10, p=.10).

Conclusions: Results suggest that the current experimental task may be a useful objective measure of frustration response for use with autistic populations, and that a non-adaptive response to frustration may be one biological mechanism underpinning irritability in autistic youth. This may represent an important target for future intervention studies.
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http://dx.doi.org/10.1186/s11689-021-09374-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287810PMC
July 2021

Using a pragmatically adapted, low-cost contingency management intervention to promote heroin abstinence in individuals undergoing treatment for heroin use disorder in UK drug services (PRAISE): a cluster randomised trial.

BMJ Open 2021 07 1;11(7):e046371. Epub 2021 Jul 1.

Drug and Alcohol Services, Avon and Wiltshire Mental Health Partnership NHS Trust, Bath, UK.

Introduction: Most individuals treated for heroin use disorder receive opioid agonist treatment (OAT)(methadone or buprenorphine). However, OAT is associated with high attrition and persistent, occasional heroin use. There is some evidence for the effectiveness of contingency management (CM), a behavioural intervention involving modest financial incentives, in encouraging drug abstinence when applied adjunctively with OAT. UK drug services have a minimal track record of applying CM and limited resources to implement it. We assessed a CM intervention pragmatically adapted for ease of implementation in UK drug services to promote heroin abstinence among individuals receiving OAT.

Design: Cluster randomised controlled trial.

Setting And Participants: 552 adults with heroin use disorder (target 660) enrolled from 34 clusters (drug treatment clinics) in England between November 2012 and October 2015.

Interventions: Clusters were randomly allocated 1:1:1 to OAT plus 12× weekly appointments with: (1) CM targeted at opiate abstinence at appointments (CM Abstinence); (2) CM targeted at on-time attendance at appointments (CM Attendance); or (3) no CM (treatment as usual; TAU). Modifications included monitoring behaviour weekly and fixed incentives schedule.

Measurements: Primary outcome: heroin abstinence measured by heroin-free urines (weeks 9-12).

Secondary Outcomes: heroin abstinence 12 weeks after discontinuation of CM (weeks 21-24); attendance; self-reported drug use, physical and mental health.

Results: CM Attendance was superior to TAU in encouraging heroin abstinence. Odds of a heroin-negative urine in weeks 9-12 was statistically significantly greater in CM Attendance compared with TAU (OR=2.1; 95% CI 1.1 to 3.9; p=0.030). CM Abstinence was not superior to TAU (OR=1.6; 95% CI 0.9 to 3.0; p=0.146) or CM Attendance (OR=1.3; 95% CI 0.7 to 2.4; p=0.438) (not statistically significant differences). Reductions in heroin use were not sustained at 21-24 weeks. No differences between groups in self-reported heroin use.

Conclusions: A pragmatically adapted CM intervention for routine use in UK drug services was moderately effective in encouraging heroin abstinence compared with no CM only when targeted at attendance. CM targeted at abstinence was not effective.

Trial Registration Number: ISRCTN 01591254.
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http://dx.doi.org/10.1136/bmjopen-2020-046371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252884PMC
July 2021

The association of adverse life events and parental mental health with emotional and behavioral outcomes in young adults with autism spectrum disorder.

Autism Res 2021 08 2;14(8):1724-1735. Epub 2021 Jun 2.

Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology & Neuroscience, and South London and Maudsley Foundation Trust, London, UK.

People with autism spectrum disorder (ASD) are at increased risk of developing co-occurring mental health difficulties across the lifespan. Exposure to adverse life events and parental mental health difficulties are known risk factors for developing a range of mental health difficulties. This study investigates the association of adverse life events, parental stress and mental health with emotional and behavioral problems in young adults with ASD. One hundred and fifteen young adults with ASD derived from a population-based longitudinal study were assessed at three time-points (12-, 16-, and 23-year) on questionnaire measures of emotional and behavioral problems. Parent-reported exposure to adverse life events and parental stress/mental health were measured at age 23. We used structural equation modeling to investigate the stability of emotional and behavioral problems over time, and the association between adverse life events and parental stress and mental health and emotional and behavioral outcomes at 23-year. Our results indicate that exposure to adverse life events was significantly associated with increased emotional and behavioral problems in young adults with ASD, while controlling for symptoms in childhood and adolescence. Higher reported parental stress and mental health difficulties were associated with a higher frequency of behavioral, but not emotional problems, and did not mediate the impact of adverse life events. These results suggest that child and adolescent emotional and behavioral problems, exposure to life events and parent stress and mental health are independently associated, to differing degrees, with emotional or behavioral outcomes in early adulthood. LAY SUMMARY: People with autism experience high rates of mental health difficulties throughout childhood and into adult life. Adverse life events and parental stress and mental health may contribute to poor mental health in adulthood. We used data at three time points (12-, 16-, and 23-year) to understand how these factors relate to symptoms at 23-year. We found that emotional and behavioral problems in childhood, adverse life events and parent mental health were all associated with increased emotional and behavioral problems in adulthood.
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http://dx.doi.org/10.1002/aur.2548DOI Listing
August 2021

Investigating longitudinal associations between parent reported sleep in early childhood and teacher reported executive functioning in school-aged children with autism.

Sleep 2021 09;44(9)

Montreal Neurological Institute, Azrieli Centre for Autism Research, McGill University, Montreal, Canada.

Up to 80% of children with autism spectrum disorder (ASD) experience sleep disturbance. Poor sleep impairs executive functioning (EF), a lifelong difficulty in ASD. Evidence suggests EF difficulties in ASD are exacerbated by poor sleep. We examine whether early childhood sleep disturbances are associated with worsening EF trajectories in school-aged children with ASD. A subsample (n = 217) from the Pathways in ASD longitudinal study was analyzed. The Children's Sleep Habits Questionnaire captured sleep duration, onset, and night awakenings before age 5 (mean = 3.5 years). Metacognition (MI) and Behavioral Regulation (BRI) indices, on the Teacher Behavior Rating Inventory of Executive Functioning, were used to measure cognitive and affective components of EF respectively at four time-points (7.8-11.8 years). We applied latent growth curve models to examine associations between sleep and EF, accounting for relevant covariates, including school-age sleep (mean = 6.7 years). Sleep traits had different age-related impacts on behavioral regulation, but not metacognition. Longer sleep onset at 3.5 years was associated with a worsening BRI difficulties slope (b = 2.07, p < 0.04), but conversely associated with lower BRI difficulties at 7.7 years (b = -4.14, p = 0.04). A longer sleep onset at 6.7 years was related to higher BRI difficulties at 7.7 years (b = 7.78, p < 0.01). Longer sleep duration at 6.7 years was associated with higher BRI difficulties at age 7.7 (b = 3.15, p = 0.01), but subscale analyses revealed shorter sleep duration at age 6.7 was linked to a worsening inhibition slope (b = -0.60, p = 0.01). Sleep onset is a robust early correlate of behavior regulation in children with ASD, whereas sleep duration is a later childhood correlate.
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http://dx.doi.org/10.1093/sleep/zsab122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8522468PMC
September 2021

A Novel Group Parenting Intervention for Emotional and Behavioral Difficulties in Young Autistic Children: Autism Spectrum Treatment and Resilience (ASTAR): A Randomized Controlled Trial.

J Am Acad Child Adolesc Psychiatry 2021 Nov 6;60(11):1404-1418. Epub 2021 May 6.

Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom.

Objective: To examine the feasibility and preliminary efficacy of a group behavioral parenting intervention for emotional and behavioral problems (EBPs) in young autistic children.

Method: This was a feasibility pilot randomized controlled trial comparing a 12-week group behavioral parenting intervention (Predictive Parenting) to an attention control (Psychoeducation). Parents of 62 autistic children 4 to 8 years of age were randomized to Predictive Parenting (n = 31) or Psychoeducation (n = 31). The primary outcome was a blinded observational measure of child behaviors that challenge. Secondary outcomes were observed child compliance and parenting behaviors; parent- and teacher-reported child EBPs; self-reported parenting practices, stress, self-efficacy, and well-being. Cost-effectiveness was also explored.

Results: Recruitment, retention, completion of measures, treatment fidelity, and parental satisfaction were high for both interventions. There was no group difference in primary outcome: mean log of rate 0.18 lower (d, 90% CI = -0.44 to 0.08) in Predictive Parenting. Differences in rates of child compliance (0.44, 90% CI = 0.11 to 0.77), facilitative parenting (0.63, 90% CI = 0.33 to 0.92) and parent-defined target symptom change (-0.59, 90% CI -0.17 to -1.00) favored Predictive Parenting. There were no differences on other measures. Predictive Parenting was more expensive than Psychoeducation, with a low probability of being more cost-effective.

Conclusion: Feasibility was demonstrated. There was no evidence from this pilot trial that Predictive Parenting resulted in reductions in child EBPs beyond those seen following Psychoeducation; in addition, the effect size was small, and it was more expensive. However, it showed superiority for child compliance and facilitative parenting with moderate effect sizes. Future, definitive studies should evaluate whether augmented or extended intervention would lead to larger improvements.

Clinical Trial Registration Information: Autism Spectrum Treatment and Resilience (ASTAR); https://www.isrctn.com/; 91411078.
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http://dx.doi.org/10.1016/j.jaac.2021.03.024DOI Listing
November 2021

Association between spectral electroencephalography power and autism risk and diagnosis in early development.

Autism Res 2021 07 6;14(7):1390-1403. Epub 2021 May 6.

Montreal Neurological Institute-Hospital, Azrieli Centre for Autism Research, McGill University, Montréal, Canada.

Autism spectrum disorder (ASD) has its origins in the atypical development of brain networks. Infants who are at high familial risk for, and later diagnosed with ASD, show atypical activity in multiple electroencephalography (EEG) oscillatory measures. However, infant-sibling studies are often constrained by small sample sizes. We used the International Infant EEG Data Integration Platform, a multi-site dataset with 432 participants, including 222 at high-risk for ASD, from whom repeated measurements of EEG were collected between the ages of 3-36 months. We applied a latent growth curve model to test whether familial risk status predicts developmental trajectories of spectral power across the first 3 years of life, and whether these trajectories predict ASD outcome. Change in spectral EEG power in all frequency bands occurred during the first 3 years of life. Familial risk, but not a later diagnosis of ASD, was associated with reduced power at 3 months, and a steeper developmental change between 3 and 36 months in nearly all absolute power bands. ASD outcome was not associated with absolute power intercept or slope. No associations were found between risk or outcome and relative power. This study applied an analytic approach not used in previous prospective biomarker studies of ASD, which was modeled to reflect the temporal relationship between genetic susceptibility, brain development, and ASD diagnosis. Trajectories of spectral power appear to be predicted by familial risk; however, spectral power does not predict diagnostic outcome above and beyond familial risk status. Discrepancies between current results and previous studies are discussed. LAY SUMMARY: Infants with an older sibling who is diagnosed with ASD are at increased risk of developing ASD themselves. This article tested whether EEG spectral power in the first year of life can predict whether these infants did or did not develop ASD.
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http://dx.doi.org/10.1002/aur.2518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8360065PMC
July 2021

A psychometric and validity study of callous-unemotional traits in 2.5 year old children.

Sci Rep 2021 04 13;11(1):8065. Epub 2021 Apr 13.

School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.

Callous-unemotional (CU) traits are associated with severe and stable antisocial behaviour in childhood and adolescence. In order to understand the earliest origins of CU traits we need first to know whether measurement is reliable and valid in young children. This study evaluated the psychometric properties and validity of a CU traits measure generated from existing child problem behaviour scales at age 2.5 years. The participants were members of an epidemiological longitudinal study starting in pregnancy. Items from the Antisocial Process Screening Device and other problem behaviour scales were subjected to exploratory and confirmatory factor analysis. Structural equation modelling was used to test whether age 2.5 CU traits showed incremental validity in predicting aggression at age 5. The CU measure showed acceptable psychometric properties, factorial invariance by sex and good stability. Incremental prediction to later aggression was evident in girls, whereas boys showed strong continuity in aggression not found for girls.
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http://dx.doi.org/10.1038/s41598-021-87416-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044146PMC
April 2021

12-Month peak alpha frequency is a correlate but not a longitudinal predictor of non-verbal cognitive abilities in infants at low and high risk for autism spectrum disorder.

Dev Cogn Neurosci 2021 04 3;48:100938. Epub 2021 Mar 3.

Montreal Neurological Institute, Azrieli Centre for Autism Research, McGill University, Montréal, Canada.

Although studies of PAF in individuals with autism spectrum disorder (ASD) report group differences and associations with non-verbal cognitive ability, it is not known how PAF relates to familial risk for ASD, and whether similar associations with cognition in are present in infancy. Using a large multi-site prospective longitudinal dataset of infants with low and high familial risk for ASD, metrics of PAF at 12 months were extracted and growth curves estimated for cognitive development between 12-36 months. Analyses tested whether PAF 1) differs between low and high risk infants, 2) is associated with concurrent non-verbal/verbal cognitive ability and 3) predicts developmental change in non-verbal/verbal ability. Moderation of associations between PAF and cognitive ability by familial risk status was also tested. No differences in 12-month PAF were found between low and high risk infants. PAF was associated with concurrent non-verbal cognitive ability, but did not predict change in non-verbal cognitive over development. No associations were found between PAF and verbal ability, along with no evidence of moderation. PAF is not related to familial risk for ASD, and is a neural marker of concurrent non-verbal cognitive ability, but not verbal ability, in young infants at low and high risk for ASD.
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http://dx.doi.org/10.1016/j.dcn.2021.100938DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966984PMC
April 2021

Predicting Uncertain Multi-Dimensional Adulthood Outcomes From Childhood and Adolescent Data in People Referred to Autism Services.

Front Psychol 2021 9;12:594462. Epub 2021 Feb 9.

Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.

Introduction: Autism spectrum disorder is a highly heterogeneous diagnosis. When a child is referred to autism services or receives a diagnosis of autism spectrum disorder it is not known what their potential adult outcomes could be. We consider the challenge of making predictions of an individual child's long-term multi-facetted adult outcome, focussing on which aspects are predictable and which are not.

Methods: We used data from 123 adults participating in the Autism Early Diagnosis Cohort. Participants were recruited from age 2 and followed up repeatedly through childhood and adolescence to adulthood. We predicted 14 adult outcome measures including cognitive, behavioral and well-being measures. Continuous outcomes were modeled using lasso regression and ordinal outcomes were modeled using proportional odds regression. Optimism corrected predictive performance was calculated using cross-validation or bootstrap. We also illustrated the prediction of an overall composite formed by weighting outcome measures by priorities elicited from parents.

Results: We found good predictive performance from age 9 for verbal and non-verbal IQ, and daily living skills. Predictions for symptom severity, hyperactivity and irritability improved with inclusion of behavioral data collected in adolescence but remained modest. For other outcomes covering well-being, depression, and positive and negative affect we found no ability to predict adult outcomes at any age. Predictions of composites based on parental priorities differed in magnitude and precision depending on which parts of the adult outcome were given more weight.

Conclusion: Verbal and non-verbal IQ, and daily living skills can be predicted well from assessments made in childhood. For other adult outcomes, it is challenging to make meaningful predictions from assessments made in childhood and adolescence using the measures employed in this study. Future work should replicate and validate the present findings in different samples, investigate whether the availability of different measures in childhood and adolescence can improve predictions, and consider systematic differences in priorities.
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http://dx.doi.org/10.3389/fpsyg.2021.594462DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900001PMC
February 2021

Biological responses to COVID-19: Insights from physiological and blood biomarker profiles.

Curr Res Transl Med 2021 05 3;69(2):103276. Epub 2021 Feb 3.

Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK. Electronic address:

Background: Understanding the spectrum and course of biological responses to coronavirus disease 2019 (COVID-19) may have important therapeutic implications. We sought to characterise biological responses among patients hospitalised with severe COVID-19 based on serial, routinely collected, physiological and blood biomarker values.

Methods And Findings: We performed a retrospective cohort study of 1335 patients hospitalised with laboratory-confirmed COVID-19 (median age 70 years, 56 % male), between 1st March and 30th April 2020. Latent profile analysis was performed on serial physiological and blood biomarkers. Patient characteristics, comorbidities and rates of death and admission to intensive care, were compared between the latent classes. A five class solution provided the best fit. Class 1 "Typical response" exhibited a moderately elevated and rising C-reactive protein (CRP), stable lymphopaenia, and the lowest rates of 14-day adverse outcomes. Class 2 "Rapid hyperinflammatory response" comprised older patients, with higher admission white cell and neutrophil counts, which declined over time, accompanied by a very high and rising CRP and platelet count, and exibited the highest mortality risk. Class 3 "Progressive inflammatory response" was similar to the typical response except for a higher and rising CRP, though similar mortality rate. Class 4 "Inflammatory response with kidney injury" had prominent lymphopaenia, moderately elevated (and rising) CRP, and severe renal failure. Class 5 "Hyperinflammatory response with kidney injury" comprised older patients, with a very high and rising CRP, and severe renal failure that attenuated over time. Physiological measures did not substantially vary between classes at baseline or early admission.

Conclusions And Relevance: Our identification of five distinct classes of biomarker profiles provides empirical evidence for heterogeneous biological responses to COVID-19. Early hyperinflammatory responses and kidney injury may signify unique pathophysiology that requires targeted therapy.
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http://dx.doi.org/10.1016/j.retram.2021.103276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857048PMC
May 2021

Evaluation and improvement of the National Early Warning Score (NEWS2) for COVID-19: a multi-hospital study.

BMC Med 2021 01 21;19(1):23. Epub 2021 Jan 21.

Department of Acute Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Background: The National Early Warning Score (NEWS2) is currently recommended in the UK for the risk stratification of COVID-19 patients, but little is known about its ability to detect severe cases. We aimed to evaluate NEWS2 for the prediction of severe COVID-19 outcome and identify and validate a set of blood and physiological parameters routinely collected at hospital admission to improve upon the use of NEWS2 alone for medium-term risk stratification.

Methods: Training cohorts comprised 1276 patients admitted to King's College Hospital National Health Service (NHS) Foundation Trust with COVID-19 disease from 1 March to 30 April 2020. External validation cohorts included 6237 patients from five UK NHS Trusts (Guy's and St Thomas' Hospitals, University Hospitals Southampton, University Hospitals Bristol and Weston NHS Foundation Trust, University College London Hospitals, University Hospitals Birmingham), one hospital in Norway (Oslo University Hospital), and two hospitals in Wuhan, China (Wuhan Sixth Hospital and Taikang Tongji Hospital). The outcome was severe COVID-19 disease (transfer to intensive care unit (ICU) or death) at 14 days after hospital admission. Age, physiological measures, blood biomarkers, sex, ethnicity, and comorbidities (hypertension, diabetes, cardiovascular, respiratory and kidney diseases) measured at hospital admission were considered in the models.

Results: A baseline model of 'NEWS2 + age' had poor-to-moderate discrimination for severe COVID-19 infection at 14 days (area under receiver operating characteristic curve (AUC) in training cohort = 0.700, 95% confidence interval (CI) 0.680, 0.722; Brier score = 0.192, 95% CI 0.186, 0.197). A supplemented model adding eight routinely collected blood and physiological parameters (supplemental oxygen flow rate, urea, age, oxygen saturation, C-reactive protein, estimated glomerular filtration rate, neutrophil count, neutrophil/lymphocyte ratio) improved discrimination (AUC = 0.735; 95% CI 0.715, 0.757), and these improvements were replicated across seven UK and non-UK sites. However, there was evidence of miscalibration with the model tending to underestimate risks in most sites.

Conclusions: NEWS2 score had poor-to-moderate discrimination for medium-term COVID-19 outcome which raises questions about its use as a screening tool at hospital admission. Risk stratification was improved by including readily available blood and physiological parameters measured at hospital admission, but there was evidence of miscalibration in external sites. This highlights the need for a better understanding of the use of early warning scores for COVID.
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http://dx.doi.org/10.1186/s12916-020-01893-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817348PMC
January 2021

Annual Research Review: Anterior Modifiers in the Emergence of Neurodevelopmental Disorders (AMEND)-a systems neuroscience approach to common developmental disorders.

J Child Psychol Psychiatry 2021 05 11;62(5):610-630. Epub 2021 Jan 11.

Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck, University of London, London, UK.

We present the Anterior Modifiers in the Emergence of Neurodevelopmental Disorders (AMEND) framework, designed to reframe the field of prospective studies of neurodevelopmental disorders. In AMEND we propose conceptual, statistical and methodological approaches to separating markers of early-stage perturbations from later developmental modifiers. We describe the evidence for, and features of, these interacting components before outlining analytical approaches to studying how different profiles of early perturbations and later modifiers interact to produce phenotypic outcomes. We suggest this approach could both advance our theoretical understanding and clinical approach to the emergence of developmental psychopathology in early childhood.
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http://dx.doi.org/10.1111/jcpp.13372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8609429PMC
May 2021

Utility of the Autism Diagnostic Observation Schedule and the Brief Observation of Social and Communication Change for Measuring Outcomes for a Parent-Mediated Early Autism Intervention.

Autism Res 2021 02 4;14(2):411-425. Epub 2020 Dec 4.

Department of Biostatistics and Health Informatics, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK.

Measuring outcomes for autistic children following social communication interventions is an ongoing challenge given the heterogeneous changes, which can be subtle. We tested and compared the overall and item-level intervention effects of the Brief Observation of Social Communication Change (BOSCC), Autism Diagnostic Observation Schedule (ADOS-2) algorithm, and ADOS-2 Calibrated Severity Scores (CSS) with autistic children aged 2-5 years from the Preschool Autism Communication Trial (PACT). The BOSCC was applied to Module 1 ADOS assessments (ADOS-BOSCC). Among the 117 children using single or no words (Module 1), the ADOS-BOSCC, ADOS algorithm, and ADOS CSS each detected small non-significant intervention effects. However, on the ADOS algorithm, there was a medium significant intervention effect for children with "few to no words" at baseline, while children with "some words" showed little intervention effect. For the full PACT sample (including ADOS Module 2, total n=152), ADOS metrics evidenced significant small (CSS) and medium (algorithm) overall intervention effects. None of the Module 1 item-level intervention effects reached significance, with largest changes observed for Gesture (ADOS-BOSCC and ADOS), Facial Expressions (ADOS), and Intonation (ADOS). Significant ADOS Module 2 item-level effects were observed for Mannerisms and Repetitive Interests and Stereotyped Behaviors. Despite strong psychometric properties, the ADOS-BOSCC was not more sensitive to behavioral changes than the ADOS among Module 1 children. Our results suggest the ADOS can be a sensitive outcome measure. Item-level intervention effect plots have the potential to indicate intervention "signatures of change," a concept that may be useful in future trials and systematic reviews. LAY SUMMARY: This study compares two outcome measures in a parent-mediated therapy. Neither was clearly better or worse than the other; however, the Autism Diagnostic Observation Schedule produced somewhat clearer evidence than the Brief Observation of Social Communication Change of improvement among children who had use of "few to no" words at the start. We explore which particular behaviors are associated with greater improvement. These findings can inform researchers when they consider how best to explore the impact of their intervention.
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http://dx.doi.org/10.1002/aur.2449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898818PMC
February 2021

Emotion Recognition Performance in Children with Callous Unemotional Traits is Modulated by Co-occurring Autistic Traits.

J Clin Child Adolesc Psychol 2021 Nov-Dec;50(6):811-827. Epub 2020 Nov 30.

School of Psychology and Clinical Language Sciences, University of Reading.

Objective: Atypical emotion recognition (ER) is characteristic of children with high callous unemotional (CU) traits. The current study aims to 1) replicate studies showing ER difficulties for static faces in relation to high CU-traits; 2) test whether ER difficulties remain when more naturalistic dynamic stimuli are used; 3) test whether ER performance for dynamic stimuli is moderated by eye-gaze direction and 4) assess the impact of co-occurring autistic traits on the association between CU and ER.

Methods: Participants were 292 (152 male) 7-year-olds from the Wirral Child Health and Development Study (WCHADS). Children completed a static and dynamic ER eye-tracking task, and accuracy, reaction time and attention to the eyes were recorded.

Results: Higher parent-reported CU-traits were significantly associated with reduced ER for static expressions, with lower accuracy for angry and happy faces. No association was found for dynamic expressions. However, parent-reported autistic traits were associated with ER difficulties for both static and dynamic expressions, and after controlling for autistic traits, the association between CU-traits and ER for static expressions became non-significant. CU-traits and looking to the eyes were not associated in either paradigm.

Conclusion: The finding that CU-traits and ER are associated for static but not naturalistic dynamic expressions may be because motion cues in the dynamic stimuli draw attention to emotion-relevant features such as eyes and mouth. Further, results suggest that ER difficulties in CU-traits may be due, in part, to co-occurring autistic traits. Future developmental studies are required to tease apart pathways toward the apparently overlapping cognitive phenotype.
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http://dx.doi.org/10.1080/15374416.2020.1833338DOI Listing
November 2020

Defining Positive Outcomes in More and Less Cognitively Able Autistic Adults.

Autism Res 2020 09 27;13(9):1548-1560. Epub 2020 Aug 27.

Department of Psychiatry, University of California, Los Angeles, Los Angeles, California, USA.

Identifying positive outcomes for a wide range of intellectual abilities in autism spectrum disorder (ASD) remains a challenge. Several past studies of autistic adults have used outcome definitions that do not reflect the experiences of less cognitively able adults. The aim of the current study was to (1) define three domains of outcomes: autonomy, social relationships, and purpose, and (2) examine how these outcomes relate to concurrent aspects of adult functioning. Using data from a longitudinal sample of 126 adults (85% diagnosed with ASD at some point), mean age 26, who first entered the study in early childhood, we generated distinct outcomes for less (daily living skills above an 8-year-old level, having regular activities outside the home, and social contacts outside the family) and more cognitively able adults (living independently, having paid employment, and at least one true friend). Verbal IQ, assessed in adulthood, was a significant predictor of more outcomes achieved for individuals within more and less cognitively able groups. For less cognitively able adults, having ever received a formal ASD diagnosis (in contrast to current Autism Diagnostic Observation Schedule [ADOS] CSS scores) was associated with lower odds of positive outcomes. For more cognitively able adults, living skills and happiness measures were positively associated with number of outcomes met; higher ADOS CSS, internalizing and externalizing symptoms, being racially diverse, and having caregiver education below college graduation were all negatively associated with the number of positive outcomes. Tailoring outcomes to ability levels may lead to better identification of goals and service needs. LAY SUMMARY: This article describes the outcomes of autistic adults who are more and less cognitively able. For less cognitively able individuals, an earlier autism diagnosis was negatively related to outcomes. Several factors that were associated with positive outcomes for more cognitively able individuals, including daily living skills, fewer mental health problems, family demographics, and subjective measures of happiness. Our study identifies several important factors for families, individuals, and service providers to consider and discuss when planning the transition to adulthood. Autism Res 2020, 13: 1548-1560. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/aur.2359DOI Listing
September 2020

Associations between theory of mind and conduct problems in autistic and nonautistic youth.

Autism Res 2021 02 21;14(2):276-288. Epub 2020 Jul 21.

Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.

Many autistic young people exhibit co-occurring behavior difficulties, characterized by conduct problems and oppositional behavior. However, the causes of these co-occurring difficulties are not well understood. Impairments in theory of mind (ToM) are often reported in autistic individuals and have been linked to conduct problems in nonautistic individuals. Whether an association between ToM ability and conduct problems exists in autistic populations, whether this association is similar between individuals who are autistic versus nonautistic, and whether these associations are specific to conduct problems (as opposed to other domains of psychopathology) remains unclear. ToM ability was assessed using the Frith-Happé Triangles task in a pooled sample of autistic (N = 128; mean age 14.78 years) and nonautistic youth (N = 50; mean age 15.48 years), along with parent-rated psychiatric symptoms of conduct problems, hyperactivity/inattention and emotional problems. Analyses tested ToM ability between autistic versus nonautistic participants, and compared associations between ToM performance and conduct problems between the two groups. Where no significant group differences in associations were found, the pooled association between ToM and conduct problems was estimated in the combined sample. Results showed no evidence of moderation in associations by diagnostic status, and an association between poorer ToM ability and higher levels of conduct problems, hyperactivity/inattention and emotional problems across the total sample. However, these associations became nonsignificant when adjusting for verbal IQ. Results provide support for theoretical models of co-occurring psychopathology in autistic populations, and suggest targets for intervention for conduct problems in autistic youth. LAY SUMMARY: Many young people with autism spectrum disorder show co-occurring behavior problems, but the causes of these are not well understood. This paper found an association between difficulties recognizing what others think and intend (so-called "theory of mind") in a simple animated task, and emotional and behavioral problems in autistic and nonautistic young people. However, a substantial part of this association was explained by individual differences in verbal ability. These findings may have implications for intervention efforts to improve young people's mental health.
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http://dx.doi.org/10.1002/aur.2346DOI Listing
February 2021

Callous-unemotional traits in youth with autism spectrum disorder (ASD): replication of prevalence estimates and associations with gaze patterns when viewing fearful faces.

Dev Psychopathol 2021 10;33(4):1220-1228

Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.

Research suggests an increased prevalence of callous-unemotional (CU) traits in children with autism spectrum disorder (ASD), and a similar impairment in fear recognition to that reported in non-ASD populations. However, past work has used measures not specifically designed to measure CU traits and has not examined whether decreased attention to the eyes reported in non-ASD populations is also present in individuals with ASD. The current paper uses a measure specifically designed to measure CU traits to estimate prevalence in a large community-based ASD sample. Parents of 189 adolescents with ASD completed questionnaires assessing CU traits, and emotional and behavioral problems. A subset of participants completed a novel emotion recognition task (n = 46). Accuracy, reaction time, total looking time, and number of fixations to the eyes and mouth were measured. Twenty-two percent of youth with ASD scored above a cut-off expected to identify the top 6% of CU scores. CU traits were associated with longer reaction times to identify fear and fewer fixations to the eyes relative to the mouth during the viewing of fearful faces. No associations were found with accuracy or total looking time. Results suggest the mechanisms that underpin CU traits may be similar between ASD and non-ASD populations.
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http://dx.doi.org/10.1017/S0954579420000449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8564715PMC
October 2021

Play and prosociality are associated with fewer externalizing problems in children with developmental language disorder: The role of early language and communication environment.

Int J Lang Commun Disord 2020 07 4;55(4):583-602. Epub 2020 Jun 4.

School of Health Sciences, University of Manchester, Manchester, UK.

Background: Children with developmental language disorder (DLD) are at higher risk of poorer mental health compared with children without DLD. There are, however, considerable individual differences that need to be interpreted, including the identification of protective factors.

Aims: Pathways from the early language and communication environment (ELCE, 1-2 years) to internalizing (peer and emotional problems) and externalizing (conduct problems and hyperactivity) problems in middle childhood (11 years) were mapped using structural equation modelling. Specifically, the role of indirect pathways via social skills (friendships, play and prosociality) in childhood (7-9 years) was investigated.

Methods & Procedures: Secondary analysis of existing data from the Avon Longitudinal Study of Parents and Children (ALSPAC) was undertaken. The study sample consisted of 6531 children (394 with DLD).

Outcomes & Results: The pathways from the ELCE to internalizing and externalizing problems were similar for children with and without DLD. For both groups, a positive ELCE was associated with more competent social play and higher levels of prosociality in childhood, which in turn were associated with fewer externalizing problems in middle childhood. Furthermore, better friendships and higher levels of prosociality in childhood were both associated with fewer internalizing problems in middle childhood.

Conclusions & Implications: A child's ELCE is potentially important not only for the development of language but also for social development. Furthermore, in the absence of adequate language ability, play and prosocial behaviours may allow children with DLD to deploy, practise and learn key social skills, thus protecting against externalizing problems. We suggest that consideration be given to play- and prosociality-based educational and therapeutic services for children with DLD. What this paper adds What is already known on this subject On the whole, children with DLD tend to have poorer mental health compared with their unaffected peers. There are, however, considerable differences and poor outcomes are not inevitable. What this study adds to the existing knowledge We demonstrate that children's ECLE is important for the development of social play behaviours and prosociality. Whilst children with DLD tend to have less competent social play and lower levels of prosociality compared with their unaffected peers, those with more competent social play and higher levels of prosociality are likely to have fewer externalizing problems later in childhood. We speculate that in the absence of adequate structural language ability, play and prosocial behaviours allow children with DLD to deploy, practise and learn key relationship skills, alongside behavioural and emotional regulation skills, thus protecting against externalizing problems. What are the potential or actual clinical implications of this work? Understanding the relationships among play, prosociality and externalizing problems may pave the way for play- and prosociality-based interventions in children with DLD. This may be particularly appealing for practitioners as such interventions capitalize on one of the most intuitive means of learning in childhood: play with friends. The likelihood of acceptability and engagement with such interventions may be higher in children than for traditional adult-led, paper-and-pencil activities.
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http://dx.doi.org/10.1111/1460-6984.12541DOI Listing
July 2020

Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are not associated with severe COVID-19 infection in a multi-site UK acute hospital trust.

Eur J Heart Fail 2020 06 7;22(6):967-974. Epub 2020 Jul 7.

Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.

Aims: The SARS-CoV-2 virus binds to the angiotensin-converting enzyme 2 (ACE2) receptor for cell entry. It has been suggested that angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB), which are commonly used in patients with hypertension or diabetes and may raise tissue ACE2 levels, could increase the risk of severe COVID-19 infection.

Methods And Results: We evaluated this hypothesis in a consecutive cohort of 1200 acute inpatients with COVID-19 at two hospitals with a multi-ethnic catchment population in London (UK). The mean age was 68 ± 17 years (57% male) and 74% of patients had at least one comorbidity. Overall, 415 patients (34.6%) reached the primary endpoint of death or transfer to a critical care unit for organ support within 21 days of symptom onset. A total of 399 patients (33.3%) were taking ACEi or ARB. Patients on ACEi/ARB were significantly older and had more comorbidities. The odds ratio for the primary endpoint in patients on ACEi and ARB, after adjustment for age, sex and co-morbidities, was 0.63 (95% confidence interval 0.47-0.84, P < 0.01).

Conclusions: There was no evidence for increased severity of COVID-19 in hospitalised patients on chronic treatment with ACEi or ARB. A trend towards a beneficial effect of ACEi/ARB requires further evaluation in larger meta-analyses and randomised clinical trials.
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http://dx.doi.org/10.1002/ejhf.1924DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301045PMC
June 2020

Academia Europaea Position Paper on Translational Medicine: The Cycle Model for Translating Scientific Results into Community Benefits.

J Clin Med 2020 May 19;9(5). Epub 2020 May 19.

Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary.

Introduction: Translational science has gained prominence in medicine, but there is still much work to be done before scientific results are used optimally and incorporated into everyday health practice. As the main focus is still on generating new scientific data with financial resources primarily available for that purpose, other activities that are necessary in the transition from research to community benefit are considered less needy. The European Statistical Office of the European Commission has recently reported that 1.7 million people under 75 years of age died in Europe in 2016, with around 1.2 million of those deaths being avoidable through effective primary prevention and public health intervention. Therefore, Academia Europaea, one of the five Pan-European networks that form SAPEA (Science Advice for Policy by European Academies), a key element of the European Commission's Scientific Advice Mechanism (SAM), has launched a project to develop a model to facilitate and accelerate the utilisation of scientific knowledge for public and community benefit.

Methods: During the process, leaders in the field, including prominent basic and clinical researchers, editors-in-chief of high-impact journals publishing translational research articles, translational medicine (TM) centre leaders, media representatives, academics and university leaders, developed the TM cycle, a new model that we believe could significantly advance the development of TM.

Results: This model focuses equally on the acquisition of new scientific results healthcare, understandable and digestible summation of results, and their communication to all participants. We have also renewed the definition in TM, identified challenges and recommended solutions.

Conclusion: The authors, including senior officers of Academia Europaea, produced this document to serve as a basis for revising thinking on TM with the end result of enabling more efficient and cost-effective healthcare.
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http://dx.doi.org/10.3390/jcm9051532DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290380PMC
May 2020

Work, living, and the pursuit of happiness: Vocational and psychosocial outcomes for young adults with autism.

Autism 2020 10 20;24(7):1691-1703. Epub 2020 May 20.

King's College London, UK.

Lay Abstract: It is important to better understand how adults with autism are functioning in adulthood. Studies that have tracked individuals across the lifespan can help identify developmental factors influence differences in adult outcomes. The present study examines the independence, well-being, and functioning of 123 adults that have been closely followed since early childhood. Autism diagnosis and cognitive assessments were given frequently throughout childhood and during adulthood. We examined differences between adults who had received an autism diagnosis at some point with higher cognitive abilities (Ever ASD-High IQ) and lower cognitive abilities (Ever ASD-Low IQ), as well as adults who never received a diagnosis of autism in the course of the study (Never ASD). We found that autistic features specifically related to adaptive skills and friendships, and verbal intelligence related to work outcomes. In many ways, the Never ASD group had similar outcomes compared to the ASD groups. However, adults with ASD tended to have lower well-being and fewer positive emotions. Families played a major role in supporting adults with and without ASD at all intellectual levels. The findings suggest that realistic ways of increasing independence need to be developed by working with adults and their families, while acknowledging the contribution of individual differences in mental health, intelligence and autism symptoms across neurodevelopmental disorders.
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http://dx.doi.org/10.1177/1362361320919246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541415PMC
October 2020

Introducing 'Predictive Parenting': A Feasibility Study of a New Group Parenting Intervention Targeting Emotional and Behavioral Difficulties in Children with Autism Spectrum Disorder.

J Autism Dev Disord 2021 Jan;51(1):323-333

South London and Maudsley NHS Foundation Trust, London, UK.

Parent-mediated interventions can reduce behavioral and emotional problems in children with ASD. This report discusses the development of the first group parent intervention targeting behaviors and anxiety in children with ASD, across the spectrum of cognitive and language ability. 'Predictive Parenting' was developed from the clinical observation (and emerging evidence base) that children with ASD struggle with 'prediction' and anticipating change. It integrates well-established parenting strategies within an ASD-specific framework. The concept was co-created with patient and public involvement panels of parents and adults with ASD. A feasibility study found the programme is acceptable and accessible. Qualitative feedback from participants was largely positive, and critiques were used to inform a larger, pilot randomized controlled trial of the intervention.
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http://dx.doi.org/10.1007/s10803-020-04442-2DOI Listing
January 2021

Development of the Observation Schedule for Children with Autism-Anxiety, Behaviour and Parenting (OSCA-ABP): A New Measure of Child and Parenting Behavior for Use with Young Autistic Children.

J Autism Dev Disord 2021 Jan;51(1):1-14

Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.

Co-occurring emotional and behavioral problems (EBPs) frequently exist in young autistic children. There is evidence based on parental report that parenting interventions reduce child EBPs. More objective measures of child EBPs should supplement parent reported outcomes in trials. We describe the development of a new measure of child and parenting behavior, the Observation Schedule for Children with Autism-Anxiety, Behaviour and Parenting (OSCA-ABP). Participants were 83 parents/carers and their 4-8-year-old autistic children. The measure demonstrated good variance and potential sensitivity to change. Child and parenting behavior were reliably coded among verbal and minimally verbal children. Associations between reports from other informants and observed behavior showed the measure had sufficient convergent validity. The measure has promise to contribute to research and clinical practice in autism mental health beyond objective measurement in trials.
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http://dx.doi.org/10.1007/s10803-020-04506-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7810641PMC
January 2021

Sex differences in foetal origins of child emotional symptoms: a test of evolutionary hypotheses in a large, general population cohort.

J Child Psychol Psychiatry 2020 11 20;61(11):1194-1202. Epub 2020 Mar 20.

School for Psychology and Clinical Language Sciences, University of Reading, Reading, UK.

Background: Based on previous findings from the Wirral Child Health and Development Study (WCHADS), and on evolutionary hypotheses, we preregistered analyses of data from a large epidemiological sample (https://osf.io/fn5g9/register/564d31db8c5e4a7c9694b2be), to test for sex-dependent moderation by prenatal maternal depressive symptoms of the association between postnatal maternal depressive symptoms and child emotional problems.

Methods: A total of 8,354 mothers and children were followed from pregnancy to 3.5 years in the Avon Longitudinal Study of Parents and Children (ALSPAC). Self-report measures of prenatal and postnatal maternal depressive symptoms, and maternal report of child emotional symptoms were administered.

Results: There was a three-way interaction between maternal prenatal and postnatal depression, and child sex (Coeff .042 95% CI 0.015 to 0.068, p = .002). This arose from moderation by prenatal depression, in opposite directions in boys and in girls. In boys, the association between postnatal depression and child emotional symptoms was weaker following lower prenatal depressive symptoms (interaction term coeff = .030, p = .001), and in girls, to a lesser extent, the association was stronger following lower prenatal depressive symptoms (interaction term coeff = -.012, p = .221).

Conclusions: We replicated the finding from the WCHADS that prenatal depression modifies the association between postnatal depression and children's emotional problems in a sex-dependent fashion. In ALSPAC, the sex difference was explained mainly by a protective effect of low prenatal depression in boys, while in WCHADS, it arose from greater vulnerability of girls to postnatal depression following low prenatal depression. In the light of these findings, in evaluating and implementing early interventions, there is need to consider that risks associated with postnatal depression may vary depending on maternal mood during pregnancy and may differ between boys and girls.
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http://dx.doi.org/10.1111/jcpp.13229DOI Listing
November 2020

Trajectories of emotional and behavioral problems from childhood to early adult life.

Autism 2020 05 19;24(4):1011-1024. Epub 2020 Mar 19.

King's College London, UK.

Lay Abstract: Although mental health problems are common in autism, relatively little is known about their stability and the factors that influence their persistence or change over the life-course. To address this, we use data from the Special Needs and Autism Project (SNAP) cohort studied at three time-points from 12 to 23 years. Using the parent-reported Strengths and Difficulties Questionnaire (SDQ) domains of conduct, emotional, and ADHD symptoms, we evaluated the role of child, family, and contextual characteristics on these three trajectories. Symptoms decreased significantly over time for all three domains, but many participants still scored above the published disorder cutoffs. Individuals showed high levels of persistence. Higher initial adaptive function and language levels predicted a greater decline in conduct and ADHD symptoms. In contrast, higher language functioning was associated with higher levels of emotional symptoms, as was lower levels of autism symptom severity and higher parental education. Those with higher neighborhood deprivation had higher initial conduct problems but a steeper decline over time. Our findings highlight that it may be possible to accurately predict mental health trajectories over this time period, which could help parents and carers in planning and help professionals target resources more efficiently.
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http://dx.doi.org/10.1177/1362361320908972DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7521012PMC
May 2020

Understanding usual care in randomised controlled trials of complex interventions: A multi-method approach.

Palliat Med 2020 05 21;34(5):667-679. Epub 2020 Feb 21.

Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.

Background: Evaluations of complex interventions compared to usual care provided in palliative care are increasing. Not describing usual care may affect the interpretation of an intervention's effectiveness, yet how it can be described remains unclear.

Aim: To demonstrate the feasibility of using multi-methods to describe usual care provided in randomised controlled trials (RCTs) of complex interventions, shown within a feasibility cluster RCT.

Design: Multi-method approach comprising usual care questionnaires, baseline case note review and focus groups with ward staff completed at study end. Thematic analysis of qualitative data, descriptive statistics of quantitative data, followed by methodological triangulation to appraise approach in relation to study aim.

Setting/participants: Four general medical wards chosen from UK hospitals. Purposive sampling of healthcare professionals for usual care questionnaires, and focus groups. Review of 20 patients' notes from each ward who died during admission or within 100 days of discharge.

Results: Twenty-three usual care questionnaires at baseline, two focus groups comprising 20 healthcare professionals and 80 case note reviews. Triangulation of findings resulted in understanding the usual care provided to the targeted population in terms of context, structures, processes and outcomes for patients, families and healthcare professionals. Usual care was described, highlighting (1) similarities and embedded practices, (2) heterogeneity and (3) subtle changes in care during the trial within and across sites.

Conclusions: We provide a feasible approach to defining usual care that can be practically adopted in different settings. Understanding usual care enhances the reliability of tested complex interventions, and informs research and policy priorities.
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http://dx.doi.org/10.1177/0269216320905064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7238505PMC
May 2020
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