1. Presented by Peter D. Marle, B.A. Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism Thesis Proposal Presented By Peter D. Marle, B.A.

2. Autism Spectrum Disorder – A Brief History A. Anecdotal Accounts (see Luther, 1652; Wing, 1997) 1. Changeling babies 2. Feral children (e.g., Victor wild boy of Aveyron) people Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

3. Autism Spectrum Disorder – A Brief History A. Anecdotal Accounts (see Luther, 1652; Wing, 1997) 1. Changeling babies 2. Feral children (e.g., Victor wild boy of Aveyron) B. Scientific Investigation 1. Those prior to autism 2. Those who defined Autism a. Leo Kanner b. Hans Asperger 3. Diagnostic and Statistical Manual of Mental Disorders (DSM) Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

4. Autism Spectrum Disorder – DSM History Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism A. DSM (1952) and DSM-II (1968) 1. Schizophrenic reaction, childhood type 2. Autism and schizoid personality disorder? B. DSM-III (1980) 1. Infantile autism a. full presentation b. residual state 2. Autism and schizophrenia? C. DSM-III-R (1987) 1. Social impairments, communicative impairments, and restricted interests D. DSM-IV (1994) 1. Aspergers disorder 2. Childhood disintegrative disorder 3. Pervasive developmental disorder – not otherwise specified E. DSM-IV-TR (2000) F. DSM-5(2011; Press edition due out 2013) American Psychological Association (APA)

5. DSM-5 Proposed Changes and Rationale A. Combine Current PDD diagnoses B. Level of Severity - see APA, 2011 Source: http://themindofanapple.blogspot.com/2011/04/autism-awareness-day.html people Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

6. DSM-5 Proposed Criteria for ASD A. Persistent deficits in social communication and social interaction across contexts B. Restricted, repetitive patterns of behavior, interests, or activities C. Symptoms must be present in early childhood D. Symptoms together limit and impair everyday functioning people -American Psychiatric Association (APA), 2011 Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

7. DSM-5 Proposed Criteria for ASD A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following: 1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction 2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures. 3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people -American Psychiatric Association (APA), 2010 Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

8. DSM-5 Proposed Criteria for ASD A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following: 1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction 2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures. 3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people -American Psychiatric Association (APA), 2010 Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

9. DSM-5 Proposed Criteria for ASD A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following: 1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction 2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures. 3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people -American Psychiatric Association (APA), 2010 Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

10. DSM-5 Proposed Criteria for ASD A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following: 1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction 2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures. 3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people -American Psychiatric Association (APA), 2010 Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

11. DSM-5 Proposed Criteria for ASD A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following: 1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction 2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures. 3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people -American Psychiatric Association (APA), 2010 Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

12. DSM-5 Proposed Criteria for ASD A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following: 1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction 2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures. 3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people -American Psychiatric Association (APA), 2010 Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

13. DSM-5 Proposed Criteria for ASD B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: 1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases). 2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes). 3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects). -APA, 2010 Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

14. DSM-5 Proposed Criteria for ASD B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: 1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases). 2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes). 3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects). -APA, 2010 Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

15. DSM-5 Proposed Criteria for ASD B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: 1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases). 2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes). 3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects). -APA, 2010 Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

16. DSM-5 Proposed Criteria for ASD B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: 1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases). 2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes). 3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects). -APA, 2010 Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

17. DSM-5 Proposed Criteria for ASD B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: 1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases). 2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes). 3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects). -APA, 2010 Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

18. DSM-5 Proposed Criteria for ASD B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: 1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases). 2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes). 3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects). -APA, 2010 Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

19. DSM-5 Proposed Criteria for ASD B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: 1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases). 2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes). 3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects). -APA, 2010 Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

20. DSM-5 Proposed Criteria for ASD B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: 1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases). 2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes). 3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects). -APA, 2010 Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

21. DSM-5 Proposed Criteria for ASD C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities) D. Symptoms together limit and impair everyday functioning -APA, 2010 Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

22. Neurological Sequelae Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism General Findings from the Literature Increased Gray Matter Density White Matter Deficits in Left Hemisphere Disrupted Interconnectivity of Cortical Systems Reduced size of Corpus Callosum see Schmitz et al. (2006), Minshew and Williams (2007), and Verhoeven et al. (2010)

23. Neurological Sequelae Interconnectivity Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism General Aberrations Social-Emotional Reciprocity Communication Peer Relationships StereotypiesFlexibilityPerseveration Sensory Integration Increased Gray Matter Density inDecreased Activation in Disrupted Interconnect- ivity Between Frontal and Parietal Lobes Frontal lobe Dysmaturity in Adolescence Abnormal rostral frontostriatal systems function Disrupted Cortical Connectivity Increased Frontal Lobe Connectedness to Insula Disrupted Interconnect- ivity Between Limbic and Sensory Systems Left Inferior Frontal Gyrus Pregenual Anterior Cingulate Cortex Decreased Mirror Neuron System Thickness Decreased Activation in Possibly linked to emotions Abnormal Left Insula Functioning Abnormal Activation in Parietal Cortex Hyper Pacinian Corpuscle Receptor Pathways Anterior Cingulate Gyrus Anterior Rostral mid Prefrontal Cortex Problems Associated with Auditory Processing Subgenual Anterior Cingulate Cortex Increased Frontal Neuronal Density Abnormal Somatosensory Cortex Functioning Right Superior Frontal Gyrus Fusiform Gyrus Decreased Activation in Anterior Insula Decreased Activation in Middle Frontal Gyrus (bilateral) Right Anterior Insula Brocas Area Ventrolateral Prefrontal Cortex Amygdala White Matter Deficits in Mirror Neuron Sys.Increased Activation in Ventral Striatum Fusiform Gyrus Left Hemisphere Amygdala Wernickes AreaAbnormal Functioning in Disrupted Cortical Interconnectivity Posterior Cingulate Cortex Intraparietal Sulcus Medial Prefrontal Cortex Reduced Size of Corpus Callosum Abnormal Posterior Temporal Sulcus Functioning Inferior Temporal Gyrus Posterior Cingulate/ Precuneus

24. Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism Neurological Sequelae Interconnectivity General Aberrations Social-Emotional Reciprocity Communication Peer Relationships StereotypiesFlexibilityPerseveration Sensory Integration Increased Gray Matter Density inDecreased Activation in Frontal lobe Dysmaturity in Adolescence Abnormal rostral frontostriatal systems function Left Inferior Frontal Gyrus Pregenual Anterior Cingulate Cortex Decreased Mirror Neuron System Thickness Decreased Activation in Possibly linked to emotions Abnormal Left Insula Functioning Abnormal Activation in Parietal Cortex Hyper Pacinian Corpuscle Receptor Pathways Anterior Cingulate Gyrus Anterior Rostral mid Prefrontal Cortex Problems Associated with Auditory Processing Subgenual Anterior Cingulate Cortex Increased Frontal Neuronal Density Abnormal Somatosensory Cortex Functioning Right Superior Frontal Gyrus Fusiform Gyrus Decreased Activation in Anterior Insula Decreased Activation in Middle Frontal Gyrus (bilateral) Right Anterior Insula Brocas Area Ventrolateral Prefrontal Cortex Amygdala White Matter Deficits in Mirror Neuron Sys.Increased Activation in Ventral Striatum Fusiform Gyrus Left Hemisphere Amygdala Wernickes AreaAbnormal Functioning in Posterior Cingulate Cortex Intraparietal Sulcus Medial Prefrontal Cortex Reduced Size of Corpus Callosum Abnormal Posterior Temporal Sulcus Functioning Inferior Temporal Gyrus Posterior Cingulate/ Precuneus Disrupted Cortical Interconnectivity Disrupted Interconnect- ivity Between Frontal and Parietal Lobes Disrupted Cortical Connectivity Increased Frontal Lobe Connectedness to Insula Disrupted Interconnect- ivity Between Limbic and Sensory Systems

25. Autism – Causes and Controversies A. Bettelheim 1. Kanner 2. Refrigerator Mothers 3. Rimland B. Vaccinations 1. Jenny McCarthy a. Autism? C. Genetic Heritability (Hallmayer et al., 2011) 1. 37% Mz 2. 55% Dz D. In Vivo Factors (Hallmayer et al., 2011) 1. Parental age 2. Low birth weight 3. Multiple births 4. Maternal infections Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

26. The Present Study Purpose A. CASS (Coolidge Autistic Symptom Survey) 1. Current alignment 2. Age Range B. DSM-5 changes Hypotheses A. A One-Factor Solution will Best Fit the Data B. Internal Reliability will be Good C. Test-Retest Reliability will be Adequate D. The CASS will Differentiate (1) Severe, (2) Mild Autism, and (3) Group-Matched Control Group Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

27. The Present Study Participants A. Power Analysis based on Marle, Monaghan, Rhoades, and Coolidge (2011) 1. (η 2 =.66 for three groups) a. seven children per group necessary (N = 21) 2. (η 2 =.14; β =.80) a. twenty-two children per group necessary (N = 66) B. Participant characteristics 1. Three groups 2. Parents of children ages 5 to 17 years 3. Collecting data on childrens a. age b. age when diagnosed c. age when parents first noticed differences d. gender e. race and ethnicity f. diagnosis g. medications, h. first behavioral concern 4. Also obtaining information as to who diagnosed the child Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

28. The Present Study Materials A. Informed Consent Form B. 90-Item CASS 1. Forty-five original items a. socialization b. speech and language c. nonverbal communication d. repetitive/stereotyped behavior 2. Forty-five new items a. social communication b. restricted interests and repetitive behaviors c. twenty-one retrospective items C. Demographic Information Sheet Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

29. The Present Study Procedure A. Packets 1. Delivered to parents (via psychology classes, autism resource centers, or participating school district classes) 2. Parents return SASE envelopes B. Packets will take about 30 min to complete C. Participants from psychology classes will be offered SONA credit Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

30. The Present Study Proposed Data Analysis Hypothesis 1. A One-Factor Solution will Best Fit the Data 1. PCA with varimax rotation Hypothesis 2. Internal Reliability will be Good 1. Cronbachs α.80 Hypothesis 3. Test-Retest Reliability will be Adequate 1. Thirty parents will be asked to complete the CASS two times (1 week interval) 2. r.80 Hypothesis 4. The CASS will Differentiate (1) Severe, (2) Mild Autism, and (3) Group- Matched Control Group 1. Oneway ANOVA 2. Tukeys HSD Psychometric Development of a New Inventory to Assess Symptoms across the Spectrum of Autism

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