Adaptive behavior in autism: Minimal clinically important differences on the Vineland‐II

Chatham, Chris; Taylor, Kirsten I.; Charman, Tony; d’Ardhuy, Xavier Liogier; Eule, Eckhart; Fedele, Angie; Hardan, Antonio Y.; Loth, Eva; Murtagh, Lorraine; Rubido, Marta del Valle; Cáceres, Antonia San José; Sevigny, Jeff; Sikich, Linmarie; Snyder, Lee Anne Green; Tillmann, Julian; Ventola, Pamela; Walton–Bowen, Karen; Wang, P. P.; Willgoss, Tom; Bolognani, Federico

doi:10.1002/aur.1874

Cited by 120 publications

(113 citation statements)

References 63 publications

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“…This may indicate that IQ‐adaptive discrepancies become more pronounced with higher IQ, such that in high‐IQ individuals adaptive skills are less commensurate with cognitive abilities. Although these effects were modest and only significant at trend level, they are in line with another recent study [Chatham et al, ], suggesting that cognitive ability does not fully explain impairments in adaptive functioning in ASD, and particularly in higher‐ability individuals. It is also noteworthy that albeit significant due to the large sample studied, age had only a modest effect on adaptive scores.…”

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

“…In ASD there is wide heterogeneity in the level of functioning across these domains, which is partly linked to development and level of cognitive abilities [Szatmari et al, ; Bal, Kim, Cheong, & Lord, ; Chatham et al, ; Farmer, Swineford, Swedo, & Thurm, ]. Although higher intellectual functioning is typically associated with better adaptive functioning, adaptive behavior tends to be more impaired than what would be expected based on general intellectual and cognitive ability [Bölte & Poustka, ; Klin et al, ; Charman et al, ; Kanne et al, ; Mouga, Almeida, Café, Duque, & Oliveira, ; Chatham et al, ]. The discrepancy between level of adaptive behavior and general intellectual level is particularly pronounced in individuals with ASD who have average or above average levels of cognitive functioning, where adaptive behavior has been found to lag one to two standard deviations behind IQ [Klin et al, ; Charman et al, ; Kanne et al, ; Kraper, Kenworthy, Popal, Martin, & Wallace, ].…”

Section: Introductionmentioning

confidence: 99%

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Investigating the factors underlying adaptive functioning in autism in the EU‐AIMS Longitudinal European Autism Project

et al. 2019

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Scientific Abstract Individuals with autism spectrum disorder (ASD) exhibit significant impairments in adaptive functioning that impact on their ability to meet the demands of everyday life. A recurrent finding is that there is a pronounced discrepancy between level of cognitive ability and adaptive functioning, and this is particularly prominent among higher‐ability individuals. However, the key clinical and demographic associations of these discrepancies remain unclear. This study included a sample of 417 children, adolescents, and adults with ASD as part of the EU‐AIMS LEAP cohort. We examined how age, sex, IQ, levels of ASD symptom and autistic trait severity and psychiatric symptomatology are associated with adaptive functioning as measured by the Vineland Adaptive Behavior Scales‐Second Edition and IQ‐adaptive functioning discrepancies. Older age, lower IQ and higher social‐communication symptoms were associated with lower adaptive functioning. Results also demonstrate that older age, higher IQ and higher social‐communication symptoms are associated with greater IQ‐adaptive functioning discrepancy scores. By contrast, sensory ASD symptoms, repetitive and restricted behaviors, as well as symptoms of attention deficit/hyperactivity disorder (ADHD), anxiety and depression, were not associated with adaptive functioning or IQ‐adaptive functioning discrepancy scores. These findings suggest that it is the core social communication problems that define ASD that contribute to adaptive function impairments that people with ASD experience. They show for the first time that sensory symptoms, repetitive behavior and associated psychiatric symptoms do not independently contribute to adaptive function impairments. Individuals with ASD require supportive interventions across the lifespan that take account of social‐communicative ASD symptom severity. Autism Res 2019, 12: 645–657 . © 2019 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. Lay summary This study investigated key clinical and demographic associations of adaptive functioning impairments in individuals with autism. We found that older age, lower IQ and more severe social‐communicative symptoms, but not sensory or repetitive symptoms or co‐occurring psychiatric symptoms, are associated with lower adaptive functioning and greater ability‐adaptive function discrepancies. This suggests that interventions targeting adaptive skills acquisition should be flexible in their timing and intensity across developmental periods, levels of cognitive ability and take account of social‐communicative ASD symptom severity.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Investigating the factors underlying adaptive functioning in autism in the EU‐AIMS Longitudinal European Autism Project

et al. 2019

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“…They lagged behind typical individuals the most for socialization, then communication, and finally daily living skills. This rank of impairment for the Vineland domains is similar to that reported in the literature [Chatham et al, ; Yang et al, ] and was found at each step of the study. Overall, the entire group improved, but we identified two contrasting adaptive trajectories: ~80% of the sample followed a low‐growth trajectory (LG), whereas the rest followed a high‐growth trajectory (HG).…”

Section: Discussionsupporting

confidence: 88%

“…Similarily, the CARS contains a substantial proportion of “negative” symptoms (abilities for which the absence has a diagnostic value for autism) which is related to the Vineland Social Skills subsubscale. Moreover, this predictive association may not exist to the same extent for autistic people with high verbal IQ and no speech delay [Cederlund et al, ; Howlin et al, ], where it was found only for communication and daily living skills, but not social skills [Chatham et al, ; Freeman et al, ]. Second, the evaluation of IQ (due to possible underestimation), language, and adaptation measurements in autism should be improved.…”

Section: Discussionmentioning

confidence: 99%

Adaptive trajectories and early risk factors in the autism spectrum: A 15‐year prospective study

et al. 2018

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Little is known about long‐term outcomes. We investigate the adaptive trajectories and their risk factors in ASD. Data were obtained from 281 children prospectively followed untill adulthood. The final sample consisted of 106 individuals. Vineland scores were collected at baseline (T1), 3 (T2), 10 (T3), and 15 (T4) years later. A group‐based method was used to identify homogeneous patterns of adaptive skills trajectories. Results show that among the children initially categorized as autistic, 82.6% remained over the ADOS diagnostic threshold, 11.9% converted to atypical autism, and 5.4% fell under the ADOS threshold. Most atypical autism diagnoses were unstable. Most (81.7%) autistic participants had an ID at inclusion. At T1, 59.3% were nonverbal, but only 39% at T4. Most changes occurred between 4 and 8 years of age. Approximately 25% of participants exhibited a “high” growth trajectory, in which progress continues throughout adolescence, and 75% a “low” growth trajectory, characterized by greater autistic symptoms, intellectual disability, and lower language abilities reflected by high CARS scores, low apparent DQ, and speech difficulties, which mostly, but not always, predicted low trajectories. Our findings suggest that the adaptive prognosis of autism is mostly poor in this cohort, biased toward intellectual disability. However, changes in diagnostic, speech, and adaptive status are not uncommon, even for indivduals with low measured intelligence or apparent intellectual disability, and are sometimes difficult to predict. Autism Research 2018, 11: 1455–1467. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary Most autism diagnoses given before 5 years of age are stable to adulthood, but one‐fifth of individuals are no longer considered to be autistic, even in a cohort biased toward apparent intellectual disability. Conversely, atypical autism diagnoses are mostly unstable. One‐third of children who are nonverbal at 5 years are verbal within 15 years, mostly before 8 years of age. Concerning adaptive behavior outcomes, only one‐fourth of children exhibit a high‐growth trajectory through at least 15 years.

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Association of Child and Family Attributes With Outcomes in Children With Autism

et al. 2021

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IMPORTANCEThe prevalence and attributes of positive outcomes (or doing well) among children with autism spectrum disorder (ASD) in midchildhood are not well known.OBJECTIVE To estimate the prevalence of doing well according to metrics of proficiency and growth and to investigate the extent to which significant associations exist between child-and family-level variables and doing well. DESIGN, SETTING, AND PARTICIPANTSThis longitudinal cohort study included children with ASD from regional clinics across Canada. Participants were sampled 3 times between ages 2 and 4.9 years (T1) and twice in follow-up into middle childhood (T2). Data were analyzed March 2018 through January 2020.EXPOSURES Language and IQ assessments at first sample; household income, parent coping, and family functioning. MAIN OUTCOMES AND MEASURESKey outcome domains of developmental health included measures of socialization, communication, independent living skills, and measures of internalizing and externalizing behaviors. Thresholds for doing well in these domains by either proficiency or growth were established. The extent to which language, IQ, household income, parent coping, and family functioning were associated with assessed outcomes was determined by logistic regression. The association between outcomes and concurrent Autism Diagnostic Observation Schedule (ADOS) classification scores was also estimated. RESULTS In a total cohort of 272 children (234 [86.0%] boys; mean [SD] age, 10.76 [0.26] years),approximately 78.8% (95% CI, 73.2%-84.4%) of the sample were estimated to be doing well by either metric on at least 1 domain, and 23.6% (95% CI, 17.7%-29.4%) were doing well in 4 or 5 domains. It was possible to be doing well by either proficiency or growth and still meet ADOS criteria for ASD. For the growth metric, between 61.5% (95% CI, 40.7%-79.1%) and 79.6% (95% CI, 66.0%-88.9%) of participants had ADOS scores of 4 or greater; for the proficiency metric, between 63.8% (95% CI, 48.4%-76.9%) and 75.8% (95% CI, 63.0%-85.4%) had scores of 4 or greater. Doing well by either metric for all domains was associated with T1 scores on that outcome domain (eg, T1 daily living skills associated with doing well at T2 daily living by the proficiency metric as measured by the Vineland Adaptive Behavior Scales-Second Edition daily living skills scale [202 participants]: β = 0.07; OR, 1.07; 95% CI, 1.03-1.11; P < .001). Doing well in socialization by the growth metric was also associated with better T1 language skills scores (202 participants) (β = 0.04; OR, 1.04; 95% CI, 1.00-1.07, P = .04). Doing well in externalizing by the growth metric was also associated with higher household income at T1 (178 participants) (β = 0.10; OR, 1.10; 95% CI, 1.06-1.15; P < .001). Better family functioning at T1 was associated with doing well on both socialization and externalizing by proficiency metric and on internalizing by growth metric (socialization by proficiency [202 (continued) Key Points Question How prevalent is "doing well" in 5 developmental domains (communicat...

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Adaptive behavior in autism: Minimal clinically important differences on the Vineland‐II

Cited by 120 publications

References 63 publications

Investigating the factors underlying adaptive functioning in autism in the EU‐AIMS Longitudinal European Autism Project

Investigating the factors underlying adaptive functioning in autism in the EU‐AIMS Longitudinal European Autism Project

Adaptive trajectories and early risk factors in the autism spectrum: A 15‐year prospective study

Association of Child and Family Attributes With Outcomes in Children With Autism

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