Autism spectrum disorder (ASD) is a neurodevelopmental disorder that presents many challenges for parents and providers while impacting a child's developmental trajectory across several domains, including disruptive behaviors. Unfortunately, due to limited access and affordability of care, especially during the pandemic or other situations that require people to stay at home, in-person services are not always feasible. Rural or underserved communities may face additional barriers, such as geographic isolation and lack of ASD resources. Accessibility of ASD treatment may be expanded through telehealth supports, such as mobile applications. When implementing these supports for autistic children, decreasing child problem behaviors while improving parent stress, knowledge, and competence is crucial. The current study investigated the feasibility and preliminary efficacy of a behavior consultation mobile application, Treks, to improve telehealth support for 26 parents (male = 2) of autistic children (3-13 years). Participants were randomly assigned to a one-session telehealth consultation with 1) the enhancement of the Treks app over the course of one month (TH) or 2) with access to mobile resources comparable to Treks for one month (CC). They were then administered measures at baseline, pre-Treks, and post-Treks to assess changes in parenting stress, knowledge, competence, and child behaviors as well as feasibility metrics. Results indicated that the mobile app was received positively across groups, showing significant improvement in participants enrolled in the TH group from pre- to post-Treks on parenting and child outcomes, in addition to moderate to high satisfaction. Future directions should examine the use of mobile supports to supplement parent training consultations for caregivers of autistic children who present with a range of behavioral difficulties. / Doctor of Philosophy / Autism spectrum disorder (ASD) presents with many challenges for parents and providers. Unfortunately, due to limited access and affordability of care, especially during the pandemic or other situations that require people to stay at home, in-person services are not always feasible. Rural or underserved communities may face additional barriers, such as geographic isolation and lack of ASD resources. Accessibility of ASD treatment can include telehealth (e.g., mobile applications), and should focus on decreasing child problem behaviors while improving parent stress, knowledge, and competence. The current study investigated the feasibility and preliminary efficacy of a behavior consultation mobile application, known as Treks, to improve telehealth support for 26 parents of autistic children (3-13 years). Participants were randomly assigned to a one-session telehealth consultation with access to 1) Treks for one month (TH) or 2) mobile resources comparable to Treks for one month (CC). They were then administered measures at baseline, pre-Treks, and post-Treks to assess changes in parenting stress, knowledge, competence, and child behaviors as well as feasibility. Results indicated that the mobile app was received positively across groups, showing significant improvement in participants enrolled in the TH group from pre- to post-Treks on parenting and child outcomes, in addition to moderate to high satisfaction. Future research should examine the use of mobile apps to supplement parent training for caregivers of autistic children who present with a range of behavioral difficulties.

The impact of birth order on language development has gained significant traction over the years, with contradictory evidence suggesting that lower birth order may hinder language development in typically-developing children (Nafissi and Vosoughi, 2015). However, results also suggest that when considering measures of social communication, second-born typically-developing children demonstrate a significant advantage (Kheirkhah and Cekaite, 2018). These findings have interesting ramifications when considering autistic children, as language impairments are characteristic of the disorder. The current study investigated the impact of birth order, in particular having an older, typically-developing sibling, on vocabulary and social language development in autistic youth. Participants included 1338 first-borns and 1049 second-borns (M age = 9.03 years, SD = 3.57; 86.4% male) with diagnoses of Autistic disorder, Aspergers, or PDD-NOS from the Simons Simplex Collection (Fischbach and Lord, 2010). Results indicated no significant differences in vocabulary or social language between first-borns and second-borns. Hierarchical linear regressions indicated no significant main effect of birth order; however, significant 2-way interactions with birth order x income and birth order x age predicted expressive vocabulary and inappropriate speech. Post-hoc simple slopes suggested that birth order may have a greater impact on language in younger autistic children, and lower-income families. This is the first work to date to investigate birth order and contextual factors on expressive language outcomes in autistic youth. / Doctor of Philosophy / Families provide an important context for important developmental milestones, such as language development (e.g., first words, firs phrases). Many parents and previous literature suggest that occasionally, older siblings can "speak on behalf" of their younger siblings, which reduces the number of opportunities second-born children have to practice important language skills. Previous literature in the field suggests that first-born siblings demonstrate stronger language skills when considering vocabulary, but that second-born siblings demonstrate stronger social language skills. The current dissertation evaluated these birth order findings in a clinical group of children and adolescents with Autism Spectrum Disorder (ASD), as language differences are key features of the disorder. Using a large, representative data set from the Simon Simplex Collection, nearly 3,000 youth with ASD were evaluated on vocabulary and social language skills, grouped by birth order status. Group comparisons suggested that there were no significant differences between first-borns and second-borns in vocabulary and language. When evaluating what factors predicted vocabulary and language, birth order was also not significant. However, some interaction effects emerged between birth order and income, suggesting that in lower-income families, birth order may make a meaningful difference in vocabulary and social language. This is the first work to evaluate the role of siblings on language in ASD, and has important implications for interventions, especially for lower-income families impacted by ASD.

Autism spectrum disorder (ASD) is associated with a variety of physical, mental, and behavioral healthcare needs. However, parents of autistic children consistently report difficulty accessing necessary services, and no instrument has been validated to assess and quantify these barriers for autistic children. The current study aims to adapt and validate the Barriers to Care Questionnaire (BCQ), a pre-existing measure of barriers to healthcare for children with specific healthcare needs, for families of autistic children. The BCQ and theoretically related measures were collected from 242 parents (117 parents of autistic children, 125 parents of non-autistic children). Cronbach’s alpha statistics (ranging from 0.87 to 0.96 for BCQ subscales) provide evidence of reliability for the BCQ. The BCQ subscales were correlated with unmet treatment need, treatment experiences, and theoretically related variables at the child, parent, and family level, providing evidence of convergent validity. Correlations were of low magnitude with theoretically unrelated variables (parent personality and socially desirable responding), suggesting preliminary evidence of discriminant validity. Additionally, the BCQ subscales predicted a significant amount of variance in unmet need and treatment experiences over and above other predictors for autistic youth, indicating incremental validity. Parents of autistic children reported significantly more barriers to care across all subscales of the BCQ than parents of non-autistic children, and the highest average item score was on the “skills” subscale, which measures difficulties with navigating the healthcare system. Results support that the BCQ can be used among autistic youth, and suggest the critical need for family-centered supports and provider education in order to ameliorate barriers to healthcare for autistic children. / M.S. / Autism spectrum disorder (ASD) is related to many physical, mental, and behavioral healthcare needs. However, parents of autistic children state that it is often hard to receive healthcare when their child needs it. No questionnaire exists to measure barriers that make getting healthcare harder for autistic children. Our study adapted the Barriers to Care Questionnaire (BCQ) for families of autistic children. The BCQ and related questionnaires were filled out by 242 parents (117 parents of autistic children, 125 parents of non-autistic children). The BCQ reliably and consistently measured barriers to care in these groups. The BCQ subscales were associated with unmet treatment need, treatment experiences, and other related variables at the child, parent, and family level. The questionnaire was less strongly related to variables that we would not expect to be associated with barriers to care, like personality and social desirability. Also, the BCQ subscales predicted healthcare experiences even when accounting for other factors that might impact access to care. Parents of autistic children reported more barriers to care on all subscales of the BCQ than parents of non-autistic children, and the highest average item score was on the “skills” subscale, which measures difficulties with navigating the healthcare system. Results show that the BCQ can be used among autistic youth, and suggest the need for family-centered supports and provider education in order to improve barriers to healthcare for autistic children.

Findings related to the adjustment of typically-developing (TD) siblings of children with Autism Spectrum Disorder (ASD) have been inconsistent, but suggest that most function well over time. The current mixed methods study investigated the relationship between family factors, especially disruptions to family routines, and academic functioning of TD siblings. Measures of family functioning, parenting stress, and parenting daily hassles were collected from parents (n = 20); an additional 19 families also completed semi-structured interviews (total n = 39). Teacher reports on classroom functioning (n = 25) and report cards were also collected. All parent participants (92% Caucasian, 90% married, 79% college-educated) had a child with an ASD diagnosis (80% male, M age = 11.74) and a TD child (62% male, M age = 10.31 years). Seventy-two percent of TD siblings (n = 18) had scores above the mean on the Academic Performance Rating Scale (DuPaul, Rapport, and Perriello, 1991), and 91% (n = 32) had grade averages of B or higher. Ninety-six percent (n = 24) of TD siblings had scores within the normative range on the Learning Problems and School Problems scales of the Behavior Assessment System for Children, Second Edition (BASC-2; Reynolds and Kamphaus, 2004). Daily hassles were not significantly correlated with any school measures for the TD siblings. Families with children with more severe ASD symptoms discussed greater frequencies of emotional outbursts in the child with ASD and missed social opportunities as a family. Families of children with externalizing behaviors may particularly benefit from targeted support. / Ph. D.

Deficits in social functioning in individuals with autism spectrum disorder (ASD) may be explained in part by the limited salience of or reward value associated with the social world, relative to individuals with typical development (e.g., Jones and Klin, 2008; Mundy, 1995; Mundy and Neal, 2005). However, despite many calls for the use of ecologically valid, rich, complex stimuli when investigating deficits in social attention and interest in ASD, few studies have adopted these recommendations. The current study investigated social interest in a non-clinical college student population (n = 78; 72% female; M age = 20.41 years) by analyzing participants' verbal descriptions of dynamic film clips. It was predicted that as level of self-reported ASD characteristics increased, proportions of verbal descriptions devoted to higher-level social information (e.g., relationships, mental or emotional states) would decrease, while holding self-reported social anxiety, autonomic flexibility (i.e., heart rate variability), and verbal ability constant. In other words, self-reported ASD characteristics were hypothesized to impact social interest above and beyond the effects of other predicted covariates. Results, however, did not reveal significant differences in social interest across varying levels of ASD characteristics, and neither social anxiety nor autonomic flexibility served as a moderator of this association. Variations of the current study and the inclusion of a clinical population are discussed as possible future directions to refine the study and better target intervention efforts aimed at ameliorating social deficits in ASD. / Ph. D.

The broad autism phenotype (BAP) has been defined both behaviorally and biologically. There has been little research on the association of the BAP, behaviorally defined, with neural or cognitive biomarkers typically associated with Autism Spectrum Disorder (ASD). People diagnosed with ASD tend to show reduced gaze fixation toward the eye region, but much less eye-tracking research has been done related to the BAP (Boraston & Blakemore, 2007). In this study, we sought to assess eye gaze patterns in people with the behaviorally defined BAP, as defined by a score of 30 or above on the Autism Spectrum Quotient (AQ; Baron-Cohen et al., 2001). It was hypothesized that the BAP group participants would exhibit longer average fixation duration to the eye region during an emotion recognition condition, relative to a free-viewing condition, whereas the comparison group participants (defined as an AQ score of 24 and below) would not show a difference in fixation duration to the eye region between conditions. Nine hundred and thirty-nine undergraduates completed an online survey, and 45 of these students (15 BAP group and 30 comparison group) participated in the eye-tracking session, where they viewed a series of human faces, each presented twice within a condition. Results revealed a significant negative relationship between social anxiety and eye region fixation duration in the free-viewing condition, for both presentations of faces. Contrary to expectation, BAP predicted longer eye region fixation duration in the free-viewing condition, for the second presentation of faces. Possible explanations for these surprising findings are discussed. / Master of Science

In addition to social communication deficits, restricted repetitive behaviors (RRBs) are a key diagnostic feature of autism spectrum disorder (ASD). Two theories regarding the etiology of RRBs in ASD have been proposed: the hyper-arousal theory, and the hypo-arousal theory. Both of these theories posit the autonomic nervous system (ANS) as being dysfunctional in ASD, resulting in the occurrence of RRBs. Many studies investigating ANS activity in ASD have focused solely on its relation to social functioning. The few that have addressed RRBs have had inconclusive findings. Not only do the current theories and studies simplify ANS activity to a measure of baseline arousal levels through vague measures such as heart rate (HR) and skin conductance response (SCR), but the literature has also framed the theories as mutually exclusive. This study used respiratory sinus arrhythmia (RSA) patterns in children with and without an ASD diagnosis as an indicator of ANS functioning to analyze its relationship to the manifestation of RRBs. Baseline RSA and RSA reactivity were found to predict RRB severity and exploratory analyses revealed that these measures were associated with specific subgroups of RRBs. These results are discussed in regards to the current behavioral literature on RRBs and the benefits of finding biomarkers for these behaviors. / Master of Science

Prior research has shown that both emotion recognition and expression in children with Autism Spectrum Disorder (ASD) differs from that of typically developing children, and that these differences may contribute to observed social impairment. This study extends prior research in this area with an integrated examination of both expression and recognition of emotion, and evaluation of spontaneous generation of emotional expression in response to another person's emotion, a behavior that is characteristically deficient in ASD. The aim of this study was to assess eye gaze patterns during scripted and spontaneous emotion expression tasks, and to assess quality of emotional expression in relation to gaze patterns. Youth with ASD fixated less to the eye region of stimuli showing surprise (F(1,19.88) = 4.76, p = .04 for spontaneous task; F(1,19.88) = 3.93, p = .06 for the recognition task), and they expressed emotion less clearly than did the typically developing sample (F(1, 35) = 6.38, p = .02) in the spontaneous task, but there was not a significant group difference in the scripted task across the emotions. Results do not, however, suggest altered eye gaze as a candidate mechanism for decreased ability to express an emotion. Findings from this research inform our understanding of the social difficulties associated with emotion recognition and expression deficits. / Master of Science

Emerging adults who have Autism Spectrum Disorder (ASD) often encounter difficulties within the university setting. Despite an increase in the number of students with ASD enrolled in postsecondary educational institutions, there are few reports on the social, academic, and/or other needs of college students with ASD. The purpose of this study was to assess the perspectives of parents of emerging adults with ASD and ADHD, in order to inform efforts to address the poor postsecondary outcomes of students with ASD. Survey data were collected from parents who had a son or daughter in one of three educational placement groups (parents of high school students, parents of postsecondary students, and parents of individuals aged 18-25 not enrolled in education) among two disorders; ASD and ADHD. Participants were recruited nationally to participate in an online survey. Parents of emerging adults with ASD identified social interactions and daily living as primary difficulties for their son or daughter with ASD. Significant differences emerged with respect to difficulties among emerging adults with ADHD, who identified difficulties related to executive functioning and attention. Social interaction training was an identified needed service by parents of emerging adults with ASD. Additionally, independent living training was a common core service requested by parents of individuals with ASD and parents of individuals with ADHD. Results suggest that the postsecondary profile of parent-reported difficulties and needed services remains distinct for the diagnostic groups ASD and ADHD. These difficulties should be considered within the context of intervention for postsecondary students with ASD and ADHD. / Master of Science

Anxiety is an area of documented challenge for people with Autism Spectrum Disorder (ASD). Despite this, some studies state that those with ASD and language deficits have lower reported anxiety than those without language deficits. This effect may be due to the complicated task of appropriately evaluating anxiety in those with compromised language. Using biomarkers of anxiety, such as reduced Heart Rate Variability (HRV) and increased Heart Rate (HR), may improve anxiety assessment but more research is necessary. Specifically, it would be helpful to understand if the relationship between HRV/HR and anxiety is moderated by language abilities in children with ASD, and whether HRV/HR can discriminate between anxiety and other emotions, like anger, in children with ASD. This study examined the relationship between baseline HRV/HR, language ability, and different emotional states (i.e., anxiety and anger) in a sample of 23 children with ASD. It was hypothesized that receptive language would moderate the relationship between decreased HRV/increased HR and increased anxiety but not the relationship between decreased HRV/increased HR and increased anger. Multiple regression analyses indicated that HRV and HR were not significant predictors of anxiety or anger, and language was not a significant moderator. Future studies may wish to take new approaches to determining the role of language in the relationship between HRV/HR and anxiety. / Master of Science / Anxiety is an area of documented challenge for people with Autism Spectrum Disorder (ASD). Despite this, some studies state that those with ASD and language deficits have lower reported anxiety than those without language deficits. This effect may be due to the complicated task of appropriately evaluating anxiety in those with compromised language. Using biomarkers of anxiety, such as reduced Heart Rate Variability (HRV) and increased Heart Rate (HR), may improve anxiety assessment but more research is necessary. Specifically, it would be helpful to understand if the relationship between HRV/HR and anxiety is moderated by language abilities in children with ASD, and whether HRV/HR can discriminate between anxiety and other emotions, like anger, in children with ASD. This study examined the relationship between baseline HRV/HR, language ability, and different emotional states (i.e., anxiety and anger) in a sample of 23 children with ASD. It was hypothesized that receptive language would moderate the relationship between decreased HRV/increased HR and increased anxiety but not the relationship between decreased HRV/increased HR and increased anger. Multiple regression analyses indicated that HRV and HR were not significant predictors of anxiety or anger, and language was not a significant moderator. Future studies may wish to take new approaches to determining the role of language in the relationship between HRV/HR and anxiety.