Autism spectrum disorder (ASD) is a heterogeneous disorder with a range of symptoms and challenges. The current sex ratio of ASD is estimated to be four males to every one female. Theories have been proposed to explain this variation in sex ratio across the spectrum, such as the failure of diagnostic measures to correctly identify females and/or females’ ASD behaviors present differently than those of males. The purpose of this study was to further investigate the sex presentation of ASD within a community sample referred to an autism screening center. 195 children, 144 males and 51 females, received and met criteria on the ADOS, and were administered parent-reported instruments. Findings indicated that females with limited to phrase speech who met ASD criteria on ADOS-2 were reported to have more overt social deficits and problem behaviors per caregiver report than males. No others sex differences were found. There were no significant differences in caregiver-reported measures for females who did meet criteria for ASD on the ADOS-2 versus those who not did. Discussion focused on the significance of exploring sex differences in ASD related behaviors in a community sample.

Student-teacher relationship (STR) quality during the early school years has important implications for student adjustment and outcomes. Studies with typically developing (TD) children have identified links between parent behaviors and STRs, but these connections remain unexplored for children with autism spectrum disorder (ASD). The present study investigated relationships between observed parent behaviors during a shared literacy task and STRs one year later for 117 children (ages 4-7) with ASD. Children whose parents displayed more intrusiveness had poorer-quality STRs. Further, parent intrusiveness mediated the predictive relationship between child spoken language skills and STR quality. These results suggest that parent intrusiveness plays an important role in the development of STRs for young children with ASD. Implications for intervention and research are discussed.

Young students on the autism spectrum are at risk for poor social-emotional and behavioral functioning at school. Better quality student-teacher relationships (STRs) have been associated with improved student outcomes across social-emotional, behavioral, and academic domains. Teachers who use more positive reinforcement strategies may promote better student-teacher interactions and closer STRs that could mitigate some of this risk. The present study investigates a path by which teachers’ use of positive reinforcement strategies promotes closer STRs, which in turn lead to improved social-emotional and behavioral functioning in a sample of 145 young (age 4-7 years) autistic students. The model was a close fit (χ2 (18, N = 145) = 18.4, p = .43, TLI = 1.0, CFI = 1.0, RMSEA = .01), with teachers who reported using more positive reinforcement strategies having significantly closer STRs, and closer STRs significantly predicting student academic engagement, social skills, and social integration. Student outcomes in academic engagement and social integration persisted into the following school year. Strategies that teachers reported using most frequently were praising good behavior, commenting on good behavior, and rewarding good behavior with incentives. Factors contributing to teachers’ reported frequency of using positive reinforcement strategies were also explored. Of all teacher variables examined (e.g., years of experience, general education v. special education, perceived preparedness to teach autistic students), teachers’ perceived usefulness of positive reinforcement strategies and regular trainings in autism were the only significant contributors to frequency of positive reinforcement strategy use. Findings underscore the protective role that teachers’ use of positive reinforcement and close STRs plays for young autistic students, and highlight teachers’ perceived usefulness and regular trainings in autism as critical factors for implementation of positive reinforcement strategies.

Adolescents with autism spectrum disorder (ASD) have difficulty initiating and maintaining conversations with peers, affecting their ability to develop friendships (Reichow & Volkmar, 2010). Social skills interventions targeting conversational skills (e.g., the PEERS intervention) have demonstrated effectiveness (Laugeson et al., 2009, 2012), but few studies have utilized objective behavioral outcome measures. The Contextual Assessment of Social Skills (CASS; Ratto et al., 2011) is the most commonly used observational measure of conversational skills following the PEERS social skills program, but its specificity to the skills targeted has been under-examined. This study evaluates the utility of an adapted version of the CASS in measuring changes in conversational skills following a social skills intervention with a diverse sample of adolescents with ASD. Seven adolescents with ASD and their parents attended concurrent weekly 90-minute PEERS sessions over 16 weeks. Preliminary analyses revealed consistent improvements in several conversational domains. Observed improvements were associated with parent-reported gains in social responsiveness and increased adolescent social skills knowledge.

According to the Center for Disease Control (CDC; 2014), the prevalence rate of autism spectrum disorders (ASD) is now 1 in 68. Among children with ASD, 50-80% meet criteria for ADHD (van der Meer, 2014) and about 40-50% experience clinical levels of anxiety (White et al., 2009). This study examined the prevalence of ADHD and anxiety, the ways in which ADHD and anxiety manifest (as reported by parents and teachers), and the special education placement of a sample of young children on the spectrum transition to school. Participants in this study included 180 children with ASD ages 4 to 7 years old and their parents and teachers. Behavior problems were measured using parent and teacher report on the Child Behavior Checklist – Parent Report and the Teacher Report Form (CBCL and C-TRF; Achenbach & Rescorla, 2001). Clinically significant symptoms of anxiety were reported by parents for 31% for preschool children (ages 4-5) and 50% for school-aged children (ages 6-7). Clinically significant symptoms of ADHD were reported by parents for 22% for preschool children and 45% for school-aged children. There was a disparity between parent- and teacher-reported anxiety and ADHD problems, with teachers reporting fewer problem behaviors overall. Specific behaviors endorsed more and less frequently by parents and teachers are discussed. Finally, this study found that children whose teachers reported clinically elevated ADHD symptoms were less likely to be placed in general education settings. Implications of these findings in the schools are discussed.

The objective of this dissertation is to explore the nature of behavior problems at crucial stages of development. Following a brief overview of autism spectrum disorder (ASD) and intellectual disability (ID), including the expression of co-occurring behaviors in these populations, two related studies are presented. Both studies utilized the instruments of the Achenbach System of Empirically Based Assessments (ASEBA; Achenbach & Rescorla, 2000; 2001) to describe behavior problems, as observed during early childhood to adolescence. Study 1 utilized a sample of young children, ages 5 years and under, deemed at risk of a developmental disorder who were referred to a university-based screening clinic to be assessed for possible ASD. The objective of Study 1 was to empirically identify homogenous classes of emotional and behavioral syndromes during early childhood. Using latent class analysis, results revealed that behaviors clustered into two classes: a highly behavioral class characterized by emotion dysregulation difficulties (56%) and a normative class (44%). Predictors of autism classification and severity were included in the analysis but yielded no significant effects. These findings highlight the need to assess emotional regulation issues prior to formal schooling and to provide emotion-focused interventions that may foster the use of effective coping strategies. Study 2 utilizes a sample of children and adolescents with and without ID from a NICHD-funded longitudinal study (PIs: Bruce L. Baker, Jan Blacher, & Keith Crnic). The aim of Study 2 was (a) to examine the trajectory of behavior problems from ages g to 15 and (b) to explore whether a transactional relationship exists between behavior problems and social skills over these time points. Controlling for disability status, results of a fitted path analysis model revealed that ratings of behavior problems (internalizing and externalizing) and social skills were highly stable over time. A behavior-driven model fit the data best and revealed that behaviors in early adolescence significantly contributed to later social difficulties. Findings illustrate how challenging behaviors may impact emerging social competence during adolescent years. Implications for practice and future research directions are discussed.

Young children with autism spectrum disorder are increasingly placed in general education classrooms, particularly in the early grades (kindergarten through grade 3). Estimates suggest at least 40% of general education teachers have these children in their classrooms, and many report feeling ill-equipped to support them, primarily due to lack of training and professional development. One construct that is key to the success of children with ASD in general education classrooms is their relationship with the teacher. Indeed, previous literature has linked high-quality student-teacher relationships (STRs) to more positive outcomes including fewer behavior problems, better academic performance, and social-emotional adjustment in the early elementary grades. Yet students with autism spectrum disorder are at heightened risk of developing poor-quality STRs. Thus, there is need for socially valid teacher training that, in addition to increasing autism-related knowledge, emphasizes the development of warm and less conflictful STRs. In addition, the evaluation of most teacher training programs has focused exclusively on effectiveness (i.e., randomized-control trials), without a thorough examination of social validity. The purpose of this study was to examine the social validity of the Smooth Sailing program through a concurrent mixed methods approach. Results indicated that (1) teacher knowledge of ASD increased substantially between pre- and post-program, and (2) teachers found the Smooth Sailing program socially valid. The mixed-methods approach provided nuanced information about the acceptability, feasibility, perceived effectiveness, and contextual fit of the program. Implications for educational practice and implementation science, as well as suggestions for future research, are discussed.

Transition to adulthood can be a stressful time for all parents, but particularly so if the young adult has a disability. Young adults with autism spectrum disorder (ASD) and intellectual disability (ID) have less successful outcomes in the education, employment, social, and independence domains compared to their typically developing (TD) peers (e.g., Grigal et al., 2011; Newman et al., 2010; Shattuck et al., 2012). As parents play a crucial role in transition for young adults with ASD and ID, understanding their perspectives and expectations for their young adults is crucial to understanding the factors that affect transition outcomes (Sosnowy et al., 2018). Relatively little research has been devoted to understanding how young adult outcomes are aligned with the priorities of parents, or how parental wellbeing impacts young adult outcomes. This study used qualitative analysis of semi-structured interviews to describe mothers’ (N=109) desired outcomes, challenges, and worries for their young adults ages 20 to 25 with ASD, ID, and TD, participating in a 20-year longitudinal study. Quantitative analyses examined the relationship between mothers’ desired outcomes, maternal wellbeing, and youth transition outcomes. Mothers of young adults with and without disabilities broadly reported common concerns and goals for their young adults, but some themes were unique to mothers of youth with disabilities, reflecting additional challenges for these families. Consistent with previous research, transition outcomes were less positive for young adults with ID or ASD. More successful young adult outcomes were associated with greater maternal wellbeing, more positive outlook, and higher expectations. Discussion provides implications for transition planning and emphasizes how to support parents as facilitators of successful transition.

Despite the high rates of both internalizing and externalizing behavior problems in children with ASD (Simonoff et al., 2008; van der Meer et al., 2012), there are frequently inconsistencies between informants on behavioral rating scales, particularly when rating internalizing behavior (De Los Reyes et al., 2015; Stratis & Lecavalier, 2015). Discrepancies between raters can hinder treatment, as children, parents, and teachers frequently fail to agree on the target problem, making it difficult for all informants participating in treatment to work together to mitigate the problem (De Los Reyes & Kazdin, 2005). The aims of the current study are to examine discrepancies between parent and teacher ratings of behavior over time in a sample of young children with ASD, and to identify parent, child, and teacher characteristics associated with informant discrepancies. Participants in this study included 180 children with ASD ages 4 to 8 years old and their parents and teachers. Internalizing and externalizing behavior problems were measured using parent and teacher report on the Child Behavior Checklist and the corresponding Teacher Report Form (CBCL and TRF; Achenbach & Rescorla, 2001). Latent growth modeling was used to examine developmental trajectories of parent and teacher ratings of child behavior, as well as to examine informant discrepancies across time. The results indicate that, on average, parents tend to rate more problem behaviors, particularly internalizing behaviors. No significant change in parent-teacher discrepancies were found across time. The magnitude of parent-teacher discrepancies in behavior ratings as well as child, parent, and teacher characteristics which predict the discrepancies were also examined. Implications for research and practice are discussed.

In U.S. classrooms, the number of both autistic students and, at the same time, paraprofessionals have been increasing. Though these concurrent increases do not appear to be related, it does imply that there are more autistic students and more paraprofessionals in U.S. classrooms than ever before. The current study sought to understand more about paraprofessionals, the students who receive paraprofessional support, and the relationship between the two of them. It was found that students who had paraprofessional support, had significantly lower cognitive abilities and less internalizing behavior problems compared to those without (though both groups showed similar levels of externalizing behavior and social skills). When comparing the relationships for the same autistic student between teacher-student vs. paraprofessional-student dyads, they were found to be similar across the domains of closeness, conflict, and overall quality, however paraprofessionals reported significantly more dependency than teachers. These findings have implications for future paraprofessional trainings. Though paraprofessionals are not supposed to independently provide instructional support to students, as per federal guidelines, the literature has indicated it is often a role that they do fill. Given the results that autistic students with paraprofessional support tend have lower cognitive abilities and are perceived to be overly dependent on paraprofessionals, paraprofessional training should focus on increasing understanding of autism and teaching skills in order promote independence among autistic students. Due to the small sample size and therefore limited analyses, these findings are viewed as exploratory. They do suggest a need for more research in this area to understand the role, and relationship of paraprofessionals in classrooms with autistic students.