Objectives: There has been a significant increase in the incidence rates and public awareness of autism spectrum disorder (ASD) in recent years. The DSM-5’s latest modification of diagnostic criteria for ASD has also stimulated considerable debate. Despite the rising concerns, few studies have been conducted in the Chinese population of Hong Kong, especially among youth and adolescents. This study investigates the clinical profile of ASD in adolescents in Hong Kong. In addition to using screening instruments commonly used to assess specific ASD characteristics, other psychometric measures for internalizing and externalizing problems are employed to examine their associations with the ASD symptoms. It also assesses the extent to which different ASD symptoms and their associated features predict parenting stress. Methods: A total of 143 adolescents aged between 11 and 17 (M = 14.17; SD = 1.76) completed this study with their parents, including 71 adolescents with ASD and 72 typically developing adolescents. Adolescents completed two self-report measures of emotional symptoms: the Spence Children’s Anxiety Scale (SCAS) and Children’s Depression Inventory (CDI). Their parents completed the Autism Spectrum Screening Questionnaire (ASSQ), Child Behaviour Checklist (CBCL), and Spence Children’s Anxiety Scale – Parent version (SCAS-P) for evaluating their child’s characteristics. Parents also completed the Depression, Anxiety, and Stress Scale-21 (DASS-21) and Parenting Stress Index-Short Form (PSI-SF) for measuring their own parenting stress. Results: All measures showed good to excellent internal consistency. They were as reliable and internally consistent as the original English versions. Parent reports in the ASD group were significantly higher than in the control group on all measures. Mean ASSQ scores in the ASD group fell within the clinical range. Optimal ASSQ cutoff scores were estimated using receiver operating characteristics analysis. ASD symptoms, as well as internalizing and externalizing problems, were found to be significant discriminators between the ASD group and the controls. In addition, parents reported that their child’s emotional and behaviour problems were more distressing than the ASD symptoms. Discussion: This study highlights the importance of evaluating specific ASD characteristics and their associated symptoms of emotional and behavioural disturbances. This study suggests an optimal cutoff score of 9 for the ASSQ in Hong Kong. However, there is a need to assess its generalizability using large-scale community samples and other childhood clinical conditions. Although the findings appear to support the revised DSM-5 taxonomy of ASD, they must be interpreted with caution. Future treatments should provide parents with adequate professional support for reducing parenting stress and helping them cope with their child’s social, emotional, and behavioural impairments. Conclusions: This study documents preliminary norms for a broad range of measures for adolescents with ASD in Hong Kong. It also provides a useful empirical basis for future investigations of the interplay between specific ASD characteristics and their associated features. Regarding treatment planning, this study postulates a comprehensive treatment model for adolescents with ASD to guide treatment research. / published_or_final_version / Clinical Psychology / Doctoral / Doctor of Psychology

Background: The Weak Central Coherence (WCC) account of autism spectrum disorder (ASD) proposes a weakness of global integrative processing (i.e. central coherence) resulting in a strength in local, detailed, focused processing in individuals with ASD. However, because of the mixed findings regarding weaknesses in global integrative processing, recent literature had neglected this part of the WCC theory. Mixed findings about global integrative deficits in ASD came about because WCC was operationalized differently in different studies. This research’s primary aim was to delineate the nature of integrative processing that is impaired in ASD more precisely. Integrative processes were demarcated into first order and second order processes. Individuals with ASD were hypothesized to have problems in second order integrative processing only, which refers to the apprehension of inter-elemental relations that exist external to the individual elements. The hypothesis was investigated in both the visual-perceptual domain (Study One) and the verbal-conceptual domain (Study Two). In the visual-perceptual domain, first order and second order integrative processing refer to global processing and gestalt processing respectively. In the verbal-conceptual domain, they refer to the apprehension of taxonomic relations and thematic relations respectively. With better delineation of the construct of integrative processing in WCC, Study Three pursued the secondary aims of this research: to use the clarified constructs to study whether WCC exists as a central mechanism, and to test its predictive value on ASD symptomatology. Methods: Twenty high functioning adolescents with ASD (HFA, aged 12 to 15) and 20 matched typically developing (TD) counterparts (aged 12 to 15) participated in the three studies of this research. In Study One, participants were administered a first order task with hierarchical compound stimuli that aimed to tap their global processing, and a second order task that aimed to tap their apprehension of gestalt principles (gestalt processing). In Study Two, participants were administered a lexical decision priming task with half of the prime-target pairs denoting a taxonomic relation (first order task), and half of the prime-target pairs denoting a thematic relation (second order task). In Study Three, correlation analyses were done among the second order task measures of the two domains as well as HFA symptomatology indexed by the Autism Quotient (AQ). Results: For Study One, there was a trend showing that participants with HFA performed worse than TD peers in a subtask that tapped one gestalt principle (the principle of similarity). Contrary to prediction, in the global processing task, HFA individuals exhibited a reliable local bias. For Study Two, HFA participants were found to be primed to a significantly lesser extent by a thematic prime while exhibiting intact taxonomic priming. In Study Three, cross domain associations of second order processing measures were not significant, which was against the notion of a central mechanism of WCC. The priming extent by a thematic prime and a measure of gestalt processing were found to associate negatively with ASD symptoms in the TD group. Conclusions: All in all, the present research had partial success in clarifying the nature of WCC as a weakness in second order integrative processing. Theoretical and practical significance as well as future research directions were discussed. / published_or_final_version / Educational Psychology / Doctoral / Doctor of Psychology

Background: Regarding the research on individuals with autism, more focus was on the behavioral and social aspects, whereas relatively limited attention has received in the domain of learning of this population. As the development of assessments in assessing the needs of the population is getting more comprehensive and sophisticated in recent years, there is a trend of increase in the number of children being identified with Autistic Spectrum Disorder (ASD) and were placed in general educational settings and engaged in mainstream academic curricula. 　　To survive in the mainstream education setting, proficiency in reading is essential. However, there are evidences suggested that people with ASD show difficulties in reading, especially in reading comprehension. Therefore, it would be valuable to investigate the potential factors that might hinder the reading performance of people with ASD and develops corresponding strategies to cater their needs. 　　In this paper, the role of executive functioning and metacognitive awareness towards reading performance of adolescents with ASD was examined and compared with their typically developing peers, so as to explore the potential factors affecting the reading performance of the group. 　　 Methods: Forty high functioning adolescents with ASD (HFA, aged 12 to 15) and forty matched typically developing (TD) counterparts (aged 12 to 15) participated in this research. There were one main study and one follow-up study. For the main study (Study One), there were three study focuses of investigation. Firstly, it was aimed at investigating the reading performance profile of the two groups (HFA vs TD) and to explore the pattern of reading deficits of students with HFA. Secondly, the EF profile of the two groups was compared to see whether distinct features of impairments were noted in the HFA group. Thirdly, from the results revealed in the profiles on reading performance and EF of the two groups, the association between the impairment of reading performance and the profile of executive dysfunctions was examined, so as to attest the proposition that deficits in EF skills played a role in reading difficulties of individuals with ASD. For the follow-up study (26 participants for the HFA group and 27 participants for the TD group), it was interested to explore the reading metacognitive awareness of the HFA and TD groups, to see whether there was a differentiated pattern on the aspect, and how it might explain the difference in reading performance of the two groups. Results: For the reading performance, the performance of the two groups was comparable in word reading, reading fluency, word knowledge as well as general knowledge, whereas participants with HFA performed significantly worse than TD peers in reading comprehension and distinct weakness was noted in the ability of inference making and generating novel ideas in the HFA group. For the ability in EF skills, participants with HFA were found to be performed poorer only in the Higher-order EF domain (i.e. self-monitoring and generativity) as compared to the TD group. In which, associations were found between reading comprehension performance and some of the EF skills, suggesting that reading comprehension performance was affected by the proficiency of specific EF skills. Moreover, the follow-up study also highlighted the difference in preferences on repair strategies and reading strategies adopted as well as perceived reading difficulties of the HFA and TD group, which further support the findings of Study One. / published_or_final_version / Educational Psychology / Doctoral / Doctor of Psychology

An autism spectrum disorder (ASD) diagnosis in childhood comes with inherent vulnerability to adverse experiences. For some, the developmental process of adolescence overwhelms their altered neural system, exacerbating this vulnerability. Adolescence presents an opportunity to mitigate the negative effects of adverse childhood experiences (ACEs) on the developing brain. However, little is known about children who have both ASD and a history of ACEs. This study, first sought to understand the prevalence of ACEs among adolescents with ASD and whether those who have experienced ACEs are placed at further risk for other social and emotional challenges, impacting their transition into adulthood. With adolescents being highly sensitized to their environment, opportunities for intervention in their environments may mitigate the long-term consequences of ACEs. Due to adolescents spending a great deal of their time in school, developing interventions to support those with ASD that can be implemented within the school would be beneficial. Thus, the second aim of this study was to understand how schools can serve as a place for trauma-informed intervention. The Whole School, Whole Community, Whole Child (WSCC) model served as the conceptual framework for this mixed-methods study. Data from the 2020 National Survey of Children’s Health (NSCH) were examined to determine the prevalence of ACEs and further risk for social-emotional issues in adolescents with ASD. Focus groups and semi-structured interviews were conducted with school personnel in public schools to understand how they respond to typically developing and ASD students who have experienced ACEs. The findings showed that 60% of adolescents with ASD had experienced ACEs. Additionally, significant associations were found between the experience of ACEs and a diagnosis of anxiety, depression and ADHD. Furthermore, the experience of ACEs was associated with being bullied, however, no significant association was found with their ability to make friends. Great variability exists in the way schools respond to ACEs, if at all, and lack consistency and clarity in their SEL practices. Therefore, there is a need to identify the school climate components that are needed to provide trauma-informed interventions and determine how to scale these interventions. Further, with the heterogeneity of the ASD profile, identifying which factors are associated with this risk will be helpful in providing tailored interventions, specifically in the school environment.

Under federal law, students with disabilities have the right to be educated in classrooms with students without disabilities. For students with autism, social, communication, and behavioral deficits make inclusion difficult. The severity of deficits change over time, and therefore, so too do the effects of these deficits upon inclusion. Although most research indicates autism symptoms improve with age, some studies suggest symptoms worsen, thereby affecting classroom placement. Students with autism use a multitude of interventions, most of which are not evidenced-based. Behavioral interventions are among the small number of treatments that can decrease autism severity and foster inclusion. However, behavioral interventions have not been compared to other widely used treatments, and in practice, they are rarely used in isolation. The purpose of the present study was threefold. First, relations between age, and autism severity were examined. Second, the study investigated whether relations between autism severity and time spent in regular education classrooms differed according to age. Third, it investigated types of treatments students used, and whether using behavioral treatments moderated relations between age, autism severity and amount of time in regular education classrooms. Using a national database (Interactive Autism Network), data about the severity of social, communication and behavior deficits, treatment type, and amount of time spent in regular education classrooms were extracted from school-age students (n = 2646) with autism. The results of the study showed that as age increased, social deficits increased. Furthermore, younger students, and students with more severe social impairment spent less time in regular education classrooms. Age also predicted use of behavioral treatment, and students who used behavioral treatment spent more time in special education classrooms. The findings of this study reflect the current climate of autism knowledge, which emphasizes early, intensive intervention. Consequently, students who were younger, and used behavioral treatments, were likely to be in special education classrooms that could maximize individualization, and associated treatment benefits. This is important, as social deficits increase with age, and reduce the amount of time students spend in inclusive classrooms. Additional studies are needed to further understand how behavioral treatment, compared to or used in conjunction with other commonly used treatments, affects inclusion. / Department of Educational Psychology

Autism Spectrum Disorder (ASD) affects one out of every 68 children in the United States. The disorder is characterized by persistent deficits in social communication, social interaction, and restricted, repetitive patterns of behavior, interest, or activities that together limit and impair everyday functioning. Research has shown that the use of visual resources, such as video modeling procedures, can support individuals with ASD to acquire and maintain a variety of daily living skills leading to enhanced levels of independence. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2015. / FAU Electronic Theses and Dissertations Collection

Indiana University-Purdue University Indianapolis (IUPUI) / The empathizing-systemizing (E-S) theory states that individuals with autism spectrum conditions (ASC) can be identified by a deficit in empathy (social skills, communication skills, and theory of mind) and a propensity for systemizing (islets of ability, obsessions with systems, and repetitive behavior). This theory has been tested in various contexts, but never with adolescents between the ages of 12 and 16. The EQ-A (Empathizing Quotient for Adolescents) and the SQ-A (Systemizing Quotient for Adolescents) were administered to 47 adolescents between the ages of 12 and 16 who had been diagnosed with ASC and 97 adolescents with no reported physical or mental disorders to discover differences in empathizing and systemizing. To test the specific elements and predictions of the E-S theory, the EQ-A was divided into a set of three subscales derived by conceptually mapping items to factors corresponding to the concepts theoretically underlying the scale. The SQ-A was divided into subscales using factor analysis. It was found that all four subscales resulting from the factor analysis on the SQ-A were associated with obsessions with systems. A weak positive correlation was found between the SQ-A and the EQ-A. Although the EQ-A was able to differentiate significantly between individuals with an ASC and those without, the SQ-A was not. In addition, although the EQ-A and EQ-A subscales scores correlated with similar subscales scores of the GARS-2 (a well-validated existing autism screening test), the SQ-A and its subscales did not. Implications for the E-S Theory are discussed.