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  • Asperger syndrome and clinical heterogeneity: Reflections on the past, present, and future. Developmental medicine and child neurology Uljarević, M., Frazier, T. W., Chetcuti, L. 2023

    View details for DOI 10.1111/dmcn.15741

    View details for PubMedID 37641436

  • Categorical versus dimensional structure of autism spectrum disorder: A multi-method investigation. JCPP advances Frazier, T. W., Chetcuti, L., Al-Shaban, F. A., Haslam, N., Ghazal, I., Klingemier, E. W., Aldosari, M., Whitehouse, A. J., Youngstrom, E. A., Hardan, A. Y., Uljarevic, M. 2023; 3 (2): e12142


    Background: A key question for any psychopathological diagnosis is whether the condition is continuous or discontinuous with typical variation. The primary objective of this study was to use a multi-method approach to examine the broad latent categorical versus dimensional structure of autism spectrum disorder (ASD).Method: Data were aggregated across seven independent samples of participants with ASD, other neurodevelopmental disorders (NDD), and non-ASD/NDD controls (aggregate Ns=512-16,755; ages 1.5-22). Scores from four distinct phenotype measures formed composite "indicators" of the latent ASD construct. The primary indicator set included eye gaze metrics from seven distinct social stimulus paradigms. Logistic regressions were used to combine gaze metrics within/across paradigms, and derived predicted probabilities served as indicator values. Secondary indicator sets were constructed from clinical observation and parent-report measures of ASD symptoms. Indicator sets were submitted to taxometric- and latent class analyses.Results: Across all indicator sets and analytic methods, there was strong support for categorical structure corresponding closely to ASD diagnosis. Consistent with notions of substantial phenotypic heterogeneity, the ASD category had a wide range of symptom severity. Despite the examination of a large sample with a wide range of IQs in both genders, males and children with lower IQ were over-represented in the ASD category, similar to observations in diagnosed cases.Conclusions: Our findings provide strong support for categorical structure corresponding closely to ASD diagnosis. The present results bolster the use of well-diagnosed and representative ASD groups within etiologic and clinical research, motivating the ongoing search for major drivers of the ASD phenotype. Despite the categorical structure of ASD, quantitative symptom measurements appear more useful for examining relationships with other factors.

    View details for DOI 10.1002/jcv2.12142

    View details for PubMedID 37753161

  • Continuity of temperament subgroup classifications from infancy to toddlerhood in the context of early autism traits. Autism research : official journal of the International Society for Autism Research Chetcuti, L., Uljarevic, M., Varcin, K. J., Boutrus, M., Dimov, S., Pillar, S., Barbaro, J., Dissanayake, C., Green, J., Whitehouse, A. J., Hudry, K., AICES Team 2022


    Our previous cross-sectional investigation (Chetcuti et al., 2020) showed that infants with autism traits could be divided into distinct subgroups based on temperament. This longitudinal study builds on this existing work by exploring the continuity of temperament subgroup classifications and their associations with behavioral/clinical phenotypic features from infancy to toddlerhood. 103 infants (68% male) showing early signs of autism were referred to the study by community healthcare professionals and seen for assessments when aged around 12-months (Time 1), 18-months (Time 2), and 24-months (Time 3). Latent profile analysis revealed inhibited/low positive, active/negative reactive, and sociable/well-regulated subgroups at each timepoint, and a unique reactive/regulated subgroup at Time 3. Cross-tabulations indicated a significant likelihood of children having a recurrent subgroup classification from one timepoint to the next, and no apparent patterns to the movement of children who did change from one subgroup to another over time. Temperament subgroups were associated with concurrent child social-emotional functioning and autism traits, but unrelated to child age, sex, or developmental level. These findings suggest that temperament subgroup classifications might represent a reliable and very early indicator of autism characteristics and social-emotional functioning among infants/toddlers with autism traits.

    View details for DOI 10.1002/aur.2874

    View details for PubMedID 36511365

  • Caregiver Psychological Distress Predicts Temperament and Social-Emotional Outcomes in Infants with Autism Traits. Research on child and adolescent psychopathology Chetcuti, L., Uljarevic, M., Varcin, K. J., Boutrus, M., Pillar, S., Dimov, S., Barbaro, J., Dissanayake, C., Green, J., Wan, M. W., Segal, L., Slonims, V., Whitehouse, A. J., Hudry, K., AICES Team, Iacono, T., Maybery, M., Renton, M., Sadka, N., Segal, L., Wakeling, S., Wray, J. 2021


    Child temperament and caregiver psychological distress have been independently associated with social-emotional difficulties among individuals with autism. However, the interrelationship among these risk factors has rarely been investigated. We explored the reciprocal interplay between child temperament (surgency, negative affectivity, and self-regulation) and caregiver psychological distress in the development of child internalizing and externalizing symptoms, in a cohort of 103 infants showing early autism traits. Caregivers completed questionnaires when children were aged around 12-months (Time 1 [T1]), 18-months (Time 2 [T2]), and 24-months (Time 3 [T3]). Cross-lagged path models revealed a significant pathway from T1 caregiver psychological distress through lower T2 child self-regulation to subsequently greater T3 child internalizing symptoms. No such caregiver-driven pathway was evident through T2 child negative affectivity or in the prediction of T3 child externalizing symptoms. Further, no support was found for temperament-driven pathways through caregiver psychological distress to child social-emotional difficulties. Child surgency was mostly unrelated to caregiver psychological distress and social-emotional difficulties. These findings implicate the need to support the mental health of caregivers with an infant with autism traits in order to enhance the emotion regulation and social-emotional development of their infants.

    View details for DOI 10.1007/s10802-021-00838-5

    View details for PubMedID 34216330

  • Differential predictors of well-being versus mental health among parents of pre-schoolers with autism. Autism : the international journal of research and practice Green, C. C., Smith, J., Bent, C. A., Chetcuti, L., Sulek, R., Uljarevic, M., Hudry, K. 2021: 1362361320984315


    LAY ABSTRACT: Raising a child with autism has been linked to mental health difficulties. Poor parental mental health is likely influenced by various factors - including child-, parent-, and family/socioeconomic characteristics. However, little is known about what influences and promotes well-being (as opposed to mental health) among parents of young, newly diagnosed autistic children who may be particularly vulnerable. We examined child-, parent-, and family/socioeconomic factors associated with each of mental health and well-being in a sample of 136 parents of pre-school-aged children. Parental mental health was linked to both child- (i.e. autism symptom severity) and parent-related factors (i.e. personality traits reflecting a tendency to experience negative emotions). By contrast, in additional to mental health difficulties, which were linked to well-being, only other parent-related characteristics (and not child characteristics) were related to well-being. These included personality traits reflecting a tendency to be more extraverted/sociable, and also mindfulness. Other child-related and family/socioeconomic context factors (including household income, parental education level) were not linked to parental mental health or well-being in this sample. These results support the idea that poorer mental health and well-being are not simply the opposite of one another. That is, while these two factors were related, they were linked to different personal characteristics. Perhaps most importantly, the link between well-being and mindfulness - a personal characteristic that parents can improve - suggests mindfulness-based interventions may be helpful in directly supporting parental well-being in the context of raising a young child with autism.

    View details for DOI 10.1177/1362361320984315

    View details for PubMedID 33472386

  • Temperament in individuals with Autism Spectrum Disorder: A systematic review. Clinical psychology review Chetcuti, L. n., Uljarević, M. n., Ellis-Davies, K. n., Hardan, A. Y., Whitehouse, A. J., Hedley, D. n., Putnam, S. n., Hudry, K. n., Prior, M. R. 2021; 85: 101984


    The study of temperament in Autism Spectrum Disorder (ASD) has the potential to provide insight regarding variability in the onset, nature, and course of both core and co-morbid symptoms. The aim of this systematic review was to integrate existing findings concerning temperament in the context of ASD. Searches of Medline, PsychInfo and Scopus databases identified 64 relevant studies. As a group, children and adolescents with ASD appear to be temperamentally different from both typically developing and other clinical non-ASD groups, characterized by higher negative affectivity, lower surgency, and lower effortful control at a higher-order level. Consistent with research on typically developing children, correlational findings and emerging longitudinal evidence suggests that lower effortful control and higher negative affect are associated with increased internalizing and externalizing problems in ASD samples. Longitudinal studies suggest there may be temperamental differences between high familial risk infants who do and do not develop ASD from as early as 6-months of age. Limitations of existing research are highlighted, and possible directions for future research to capitalize on the potential afforded through the study of temperament in relation to ASD are discussed.

    View details for DOI 10.1016/j.cpr.2021.101984

    View details for PubMedID 33607568

  • The Role of Negative Affectivity in Concurrent Relations Between Caregiver Psychological Distress and Social-Emotional Difficulties in Infants With Early Signs of Autism. Autism research : official journal of the International Society for Autism Research Chetcuti, L., Uljarevic, M., Varcin, K. J., Boutrus, M., Wan, M. W., Slonims, V., Green, J., Segal, L., Iacono, T., Dissanayake, C., Whitehouse, A. J., Hudry, K., AICES Team 2020


    Recent evidence suggests the link between caregiver psychological distress and offspring social-emotional difficulties may be accounted for by offspring temperament characteristics. However, existing studies have only focused on neurotypical children; thus, the current study sought to provide an initial examination of this process among children with varying levels of early autism features. Participants included 103 infants aged 9-16months (M = 12.39, SD = 1.97; 68% male) and their primary caregiver (96% mothers) referred to a larger study by community healthcare professionals. We utilized caregiver-reported measures of psychological distress (Depression Anxiety Stress Scales), infant temperament (Infant Behavior Questionnaire-Revised) and internalizing and externalizing symptoms (Infant-Toddler Social and Emotional Assessment) and administered the Autism Observation Schedule for Infants (AOSI) at an assessment visit to quantify autism features. Infant negative affectivity was found to mediate positive concurrent relations between caregiver psychological distress and infant internalizing and externalizing symptoms, irrespective of the infants' AOSI score. While preliminary and cross-sectional, these results replicate and extend previous findings suggesting that the pathway from caregiver psychological distress to negative affectivity to social-emotional difficulties might also be apparent among infants with varying levels of autism features. More rigorous tests of causal effects await future longitudinal investigation. LAY SUMMARY: Offspring of caregivers experiencing psychological distress (i.e., symptoms of depression, anxiety, and/or stress) may themselves be at increased risk of poor mental health outcomes. Several previous studies conducted with neurotypical children suggest that this link from caregiver-to-child may be facilitated by children's temperament qualities. This study was a preliminary cross-sectional exploration of these relationships in infants with features of autism. We found that infants' elevated negative emotions were involved in the relation between caregiver heightened psychological distress and children's mental health difficulties, consistent with neurotypical development.

    View details for DOI 10.1002/aur.2296

    View details for PubMedID 32390345

  • Editorial Perspective: Furthering research on temperament in autism spectrum disorder. Journal of child psychology and psychiatry, and allied disciplines Chetcuti, L., Uljarevic, M., Hudry, K. 2019; 60 (2): 225–28

    View details for PubMedID 30673138