Bio


I am a medically trained researcher focused academic with a background in developmental psychopathology, psychometrics and big data science. My research takes a life-span perspective and is driven by the urgent need to improve outcomes for people with autism and other neuropsychiatric (NPD) disorders and neurodevelopmental conditions (NDD). My primary research interest has focused on combining cutting-edge psychometric procedures and a big data approach to better understand structure of clinical phenotypes across autism and other NPD and NDD and on using this knowledge to improve existing and develop new clinical assessments that are more effective for screening and diagnosis, tracking the natural and treatment-related symptom progression and for use in genetic and neurobiological studies. In addition to my focus on the development of outcome measures, I have collaborated with leading psychopathology researchers and groups in the United States, Europe and Australia on numerous projects spanning a range of topics including genetics, treatment and employment, with a particular focus on understanding risk and resilience factors underpinning poor mental health outcomes in adolescents and adults. Most recently, through several competitively funded projects, I have led the statistical analyses to uncover the latent structure of social and communication and restricted and repetitive behaviors (RRB) clinical phenotypes across NPD and NDD. These findings have enabled us to (i) start capturing and characterizing a highly variable social functioning phenotype across a range of disorders and understanding mechanisms underpinning this variability, (ii) combine phenotypic and genetic units of analyses to advance our understanding of the genetic architecture of RRB, and (iii) focus on identification and characterization of subgroups of individuals that share distinct symptom profiles and demonstrate clinical utility and neurobiological validity. Importantly, this work has provided key information for developing a programmatic line of research aimed at developing novel, comprehensive assessment protocols that combine parent and clinician reports, objective functioning indicators and incorporate state-of-the-art psychometric, mobile and connected technologies and procedures.

Academic Appointments


  • Clinical Assistant Professor, Psychiatry and Behavioral Sciences

All Publications


  • Understanding the heterogeneity of anxiety in autistic youth: A person-centered approach. Autism research : official journal of the International Society for Autism Research Spackman, E., Lerh, J. W., Rodgers, J., Hollocks, M. J., South, M., McConachie, H., Ozsivadjian, A., Vaughan Van Hecke, A., Libove, R., Hardan, A. Y., Leekam, S. R., Simonoff, E., Frazier, T. W., Alvares, G. A., Schwartzman, J. M., Magiati, I., Uljarevic, M. 2022

    Abstract

    The present study aimed to examine anxiety profiles among children and adolescents on the autism spectrum. It further aimed to characterize the association between the identified anxiety profiles and key clinical and developmental variables. The Spence Children's Anxiety Scale-Parent Version (SCAS-P) data from a large international pooled sample of 870 caregivers of autistic children and adolescents (Mage =11.6years, SDage =2.77; 107 females) was used. Latent profile analysis identified a three-anxiety profile solution exhibiting high entropy (0.80) and high latent profile probabilities, with good classification accuracy. Identified profiles fell along the severity spectrum and were named as the mild (n=498), moderate (n=272) and severe (n=100) anxiety profiles. There were no statistically significant differences between the three anxiety profiles in terms of sex distribution. Participants in the mild profile were significantly younger than those in the severe profile, had significantly fewer social communication difficulties than youth in the moderate anxiety profile group and had significantly fewer restricted and repetitive behaviors and lower cognitive functioning scores compared to participants in moderate and severe anxiety profiles. This is the first study to move beyond identifying associations and group-level differences to exploring and identifying characteristics of anxiety-based subgroups at an individual level that differ on key clinical and developmental variables. The subgroups identified in this study are a preliminary, yet important, first step towards informing future assessment and individualized interventions aiming to support young people on the autism spectrum to reduce and manage anxiety. LAY SUMMARY: This study tried to understand if there are subgroups of autistic young people who may have similar anxiety profiles. We found that we could meaningfully group young people into three groups based on how severe the anxiety symptoms their caregivers reported were: a group with low levels of anxiety, those with moderate anxiety, and those with more severe anxiety. We also found that the young people in the mild group were younger, had fewer autism traits and lower levels of intellectual functioning than young people in the other two groups.

    View details for DOI 10.1002/aur.2744

    View details for PubMedID 35642170

  • Big Data Approach to Characterize Restricted and Repetitive Behaviors in Autism JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Uljarevic, M., Frazier, T. W., Jo, B., Billingham, W. D., Cooper, M. N., Youngstrom, E. A., Scahill, L., Hardan, A. Y. 2022; 61 (3): 446-457
  • Characterizing Emotion Recognition and Theory of Mind Performance Profiles in Unaffected Siblings of Autistic Children FRONTIERS IN PSYCHOLOGY Uljarevic, M., Bott, N. T., Libove, R. A., Phillips, J. M., Parker, K. J., Hardan, A. Y. 2022; 12: 736324

    Abstract

    Emotion recognition skills and the ability to understand the mental states of others are crucial for normal social functioning. Conversely, delays and impairments in these processes can have a profound impact on capability to engage in, maintain, and effectively regulate social interactions. Therefore, this study aimed to compare the performance of 42 autistic children (Mage = 8.25 years, SD = 2.22), 45 unaffected siblings (Mage = 8.65 years, SD = 2.40), and 41 typically developing (TD) controls (Mage = 8.56 years, SD = 2.35) on the Affect Recognition (AR) and Theory of Mind (TOM) subtests of the Developmental Neuropsychological Assessment Battery. There were no significant differences between siblings and TD controls. Autistic children showed significantly poorer performance on AR when compared to TD controls and on TOM when compared to both TD controls and unaffected siblings. An additional comparison of ASD, unaffected sibling and TD control subsamples, matched on full-scale IQ, revealed no group differences for either AR or TOM. AR and TOM processes have received less research attention in siblings of autistic children and remain less well characterized. Therefore, despite limitations, findings reported here contribute to our growing understanding of AR and TOM abilities in siblings of autistic children and highlight important future research directions.

    View details for DOI 10.3389/fpsyg.2021.736324

    View details for Web of Science ID 000766850000001

    View details for PubMedID 35283803

    View details for PubMedCentralID PMC8907847

  • Subdomains of restricted and repetitive behaviors within autism: Exploratory structural equation modeling using the diagnostic interview for social and communication disorders. Autism research : official journal of the International Society for Autism Research Uljarevic, M., Carrington, S. J., Hardan, A. Y., Leekam, S. R. 2022

    Abstract

    The current study aimed to explore the factor structure of a broad range of restricted and repetitive behaviors (RRB) within the autism spectrum. Exploratory structural equation modeling was conducted using individual item-level data from the Diagnostic Interview for Social and Communication Disorders (DISCO). DISCO is a comprehensive semi-structured interview used by clinicians to elicit information from caregivers about the individual's profile of development and behavior. Data from a sample of 226 individuals with a clinical diagnosis of autism spectrum disorder (ASD) (189 males; Mage = 11.82years, SDage =7.87) were analyzed. The six-factor structure provided the most optimal and interpretable fit (comparative fit index=0.944, Tucker-Lewis index=0.923, root mean square error of approximation=0.018). Derived factors were interpreted as repetitive motor behaviors (RMB), unusual sensory and object focused interests (USOI), sensory sensitivity (SS), insistence on sameness (IS), circumscribed interests (CI) and stereotyped language (SL). Age was significantly negatively associated with RMB, USOI and SL but not with SS, IS or CI factor scores. None of the factors were associated with sex. ASD individuals with intellectual disability (ID) had the highest RMB, USOI, SS and SL scores while those without ID had the highest IS and CI scores. Our findings provide preliminary evidence for the utility of the DISCO as a comprehensive measure of several distinct RRB domains in both research and clinical contexts. Importantly, the current investigation highlights crucial areas for measurement development.

    View details for DOI 10.1002/aur.2687

    View details for PubMedID 35178885

  • Toward better characterization of restricted and unusual interests in youth with autism. Autism : the international journal of research and practice Uljarevic, M., Alvares, G. A., Steele, M., Edwards, J., Frazier, T. W., Hardan, A. Y., Whitehouse, A. J. 2021: 13623613211056720

    Abstract

    LAY ABSTRACT: Despite being highly prevalent among people with autism, restricted and unusual interests remain under-researched and poorly understood. This article confirms that restricted interests are very frequent and varied among children and adolescents with autism. It also further extends current knowledge in this area by characterizing the relationship between the presence, number, and type of restricted interests with chronological age, sex, cognitive functioning, and social and communication symptoms.

    View details for DOI 10.1177/13623613211056720

    View details for PubMedID 34818937

  • Toward better characterization of restricted and repetitive behaviors in individuals with germline heterozygous PTEN mutations. American journal of medical genetics. Part A Uljarevic, M., Frazier, T. W., Rached, G., Busch, R. M., Klaas, P., Srivastava, S., Martinez-Agosto, J. A., Sahin, M., Eng, C., Hardan, A. Y., Developmental Synaptopathies Consortium 2021

    Abstract

    This study aimed to further our understanding of restricted and repetitive behaviors (RRB) among individuals with germline pathogenic mutations in PTEN by providing multimethod characterization and comparison of key RRB subdomains across individuals with PTEN mutations with autism spectrum disorder (ASD) (PTEN-ASD), with PTEN mutations without ASD (PTEN-No ASD) and with ASD and macrocephaly but without PTEN mutations (Macro-ASD). Of 86 total research participants, 38 had PTEN-ASD (Mage =8.93years, SDage =4.75), 25 Macro-ASD (Mage =11.99years; SDage =5.15), and 23 PTEN-No ASD (Mage =8.94years; SDage =4.85). The Repetitive Behavior Scale-Revised (RBS-R) and the Autism Diagnostic Interview-Revised (ADI-R) were used as measures of distinct RRB domains. There were significant group differences in the RBS-R repetitive motor behaviors (RMB; F=4.52, p=0.014, omega2 =0.08), insistence on sameness (IS; F=4.11, p=0.02, omega2 =0.05), and circumscribed interests (CI; F=7.80, p=0.001, omega2 =0.14) scales. Post hoc comparisons showed that the PTEN-No ASD group had significantly lower RMB, IS, and CI scores compared to both PTEN-ASD and Macro-ASD groups. Importantly, PTEN-No ASD group still showed elevated RRB levels. Furthermore, there was a portion of individuals in PTEN-No ASD group whose Full-Scale Intelligence Quotient (FSIQ) was >70 that did not show floor level scores in the RMB domain. After adjusting for age and FSIQ scores, group differences were no longer statistically significant. RMB, IS, and CI domains showed distinct association patterns with sex, age, and FSIQ. This investigation provides the largest and most comprehensive characterization of distinct RRB domains in individuals with PTEN mutations to date. Despite the limitations, our findings have important assessment and treatment implications.

    View details for DOI 10.1002/ajmg.a.62458

    View details for PubMedID 34423884

  • Big Data Approach to Characterize Restricted and Repetitive Behaviors in Autism. Journal of the American Academy of Child and Adolescent Psychiatry Uljarevic, M., Frazier, T. W., Jo, B., Billingham, W. D., Cooper, M. N., Youngstrom, E. A., Scahill, L., Hardan, A. Y. 2021

    Abstract

    OBJECTIVE: Despite being a core diagnostic feature of autism spectrum disorder (ASD), developmental and clinical correlates of restricted and repetitive behaviors and interests (RRB) remain poorly characterized. This study aimed to utilize the largest available RRB data set to date to provide a comprehensive characterization of how distinct RRB domains vary according to a range of individual characteristics.METHOD: Data were obtained from 17,581 children and adolescents with ASD (Mage= 8.24 years, SDage= 4.06) from the Simons Foundation Powering Autism Research for Knowledge cohort. Caregivers completed the Repetitive Behavior Scale-Revised questionnaire as a measure of repetitive motor behaviors, self-injurious behaviors, compulsions, insistence on sameness and circumscribed interests RRB domains. Caregivers also provided information on children's cognitive functioning, language ability and social and communication impairments.RESULTS: Male sex was associated with higher severity of repetitive motor behaviors and restricted interests and lower severity of compulsions and self-injurious behaviors; no sex differences were found for insistence on sameness domain. While repetitive motor behaviors showed a mostly linear (negative) association with age, other RRB domains showed more complex and non-linear associations. Higher severity of social and communication impairments provided significant independent contribution in predicting higher severity of all RRB domains at the p< .001, however, these effects were small (d< .25). The strongest of these effects was observed for Ritualistic/Sameness (d=.24), followed by Stereotypy (d=.21), Compulsions (d=.17), Restricted Interests (d=.14) and SIB (d=.12).CONCLUSION: Findings reported here provide further evidence that RRB subdomains show a somewhat distinct pattern of associations with demographic, developmental and clinical variables with a key implication that separate consideration of these domains can help to facilitate efforts to understand diverse ASD etiology and inform the design of future interventions.

    View details for DOI 10.1016/j.jaac.2021.08.006

    View details for PubMedID 34391858

  • Brief Report: Emotion Regulation Influences on Internalizing and Externalizing Symptoms Across the Normative-Clinical Continuum FRONTIERS IN PSYCHIATRY Cai, R., Hardan, A. Y., Phillips, J. M., Frazier, T. W., Uljarevi, M. 2021; 12: 693570

    Abstract

    Emotion regulation is theorized to be a transdiagnostic process and has been empirically shown to be associated with various mental health and neurodevelopmental conditions. However, the relationship between emotion regulation and internalizing and externalizing symptoms has yet to be characterized in a sample of individuals spanning normative and atypical development. Therefore, this study aimed to provide initial evidence for emotion regulation as a transdiagnostic process of internalizing and externalizing symptoms in a community sample of adolescents with and without neuropsychiatric and neurodevelopmental conditions. The sample consisted of 1,705 caregivers of adolescents aged between 11 and 17 years (M age = 14.53, SD age = 1.96). Adolescents were typically developing or had a caregiver-reported diagnosis of autism spectrum disorder, attention-deficit hyperactivity disorder, or anxiety. The typically developing adolescents had significantly better caregiver-reported emotion regulation than adolescents with caregiver-reported neuropsychiatric and neurodevelopmental conditions. Additionally, emotion dysregulation significantly and positively correlated with and predicted internalizing and externalizing symptoms within each subgroup. Importantly, emotion dysregulation had a unique contribution to individual differences in the severity of internalizing and externalizing symptoms, above and beyond the diagnostic status. The research and translational implications of the study findings are discussed.

    View details for DOI 10.3389/fpsyt.2021.693570

    View details for Web of Science ID 000681093200001

    View details for PubMedID 34366922

    View details for PubMedCentralID PMC8333703

  • 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

    Abstract

    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

  • Relationship Between Social Motivation in Children With Autism Spectrum Disorder and Their Parents FRONTIERS IN NEUROSCIENCE Uljarevic, M., Frazier, T. W., Jo, B., Phillips, J. M., Billingham, W., Cooper, M. N., Hardan, A. Y. 2021; 15: 660330

    Abstract

    Impairment in social motivation (SM) has been suggested as a key mechanism underlying social communication deficits observed in autism spectrum disorder (ASD). However, the factors accounting for variability in SM remain poorly described and understood. The current study aimed to characterize the relationship between parental and proband SM. Data from 2,759 children with ASD (M age = 9.03 years, SD age = 3.57, 375 females) and their parents from the Simons Simplex Collection (SSC) project was included in this study. Parental and proband SM was assessed using previously identified item sets from the Social Responsiveness Scale (SRS). Children who had parents with low SM scores (less impairments) showed significantly lower impairments in SM compared to children who had either one or both parents with elevated SM scores. No parent-of-origin effect was identified. No significant interactions were found involving proband sex or intellectual disability (ID) status (presence/absence of ID) with paternal or maternal SM. This study establishes that low SM in children with ASD may be driven, in part, by lower SM in one or both parents. Future investigations should utilize larger family pedigrees, including simplex and multiplex families, evaluate other measures of SM, and include other related, yet distinct constructs, such as social inhibition and anhedonia. This will help to gain finer-grained insights into the factors and mechanisms accounting for individual differences in sociability among typically developing children as well as those with, or at risk, for developing ASD.

    View details for DOI 10.3389/fnins.2021.660330

    View details for Web of Science ID 000658890500001

    View details for PubMedID 34121990

    View details for PubMedCentralID PMC8187582

  • Resilience Intervention for Parents of Children with Autism: Findings from a Randomized Controlled Trial of the AMOR Method. Journal of autism and developmental disorders Schwartzman, J. M., Millan, M. E., Uljarevic, M., Gengoux, G. W. 2021

    Abstract

    Parents of children with autism spectrum disorder (ASD) experience elevated stress, yet parent-specific interventions are sparse. Thirty-five parents of children with ASD were randomized to the novel 8-week AMOR (Acceptance, Mindfulness, Optimism, Resilience) Method parent group or waitlist control group. Significant gains in resilience were reported by AMOR parents only (d=1.42, p<0.001, 95% CI [2.152, 10.083]). AMOR parents exhibited significant gains in stress management and reductions in mental health symptoms, along with parent-reported improvements in martial, family, and child functioning. AMOR group follow-up data showed some maintenance of treatment gains. Findings demonstrate promise for resilience interventions in parents of children with ASD. The trial was registered (clinicaltrials.gov; NCT03513419; May 1, 2018) and approved by the Stanford University Institutional Review Board.

    View details for DOI 10.1007/s10803-021-04977-y

    View details for PubMedID 33774741

  • Brief Report: Role of Parent-Reported Executive Functioning and Anxiety in Insistence on Sameness in Individuals with Germline PTEN Mutations. Journal of autism and developmental disorders Uljarevic, M., Frazier, T. W., Rached, G., Busch, R. M., Klaas, P., Srivastava, S., Martinez-Agosto, J. A., Sahin, M., Eng, C., Hardan, A. Y., Developmental Synaptopathies Consortium 2021

    Abstract

    This study aimed to characterize the relationship between insistence on sameness (IS), executive functioning (EF) and anxiety among individuals with PTEN mutations and individuals with macrocephalic ASD. The sample included 38 individuals with PTEN mutation and ASD diagnosis (PTEN-ASD; Mage=8.93years, SDage=4.75), 23 with PTENmutationwithout ASD (PTEN-no ASD; Mage=8.94years; SDage=4.85) and 25 with ASD and macrocephaly but with noPTENmutation (Macro-ASD; Mage=11.99years; SDage=5.15). The final model accounted for 45.7% of variance in IS, with Set-Shifting EF subdomain as a unique independent predictor (t=4.12, p<0.001). This investigation provides the first preliminary evidence for the EF-anxiety-IS interrelationship in individuals with PTEN mutations and with macrocephalic ASD.

    View details for DOI 10.1007/s10803-021-04881-5

    View details for PubMedID 33595755

  • 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

    Abstract

    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

  • Domains of the autism phenotype, cognitive control, and rumination as transdiagnostic predictors of DSM-5 suicide risk. PloS one Hedley, D. n., Uljarević, M. n., Cai, R. Y., Bury, S. M., Stokes, M. A., Evans, D. W. 2021; 16 (1): e0245562

    Abstract

    Suicide is a global health problem affecting both normative and clinical populations. Theoretical models that examine mechanisms underlying suicide risk across heterogeneous samples are needed. The present study explored core characteristics associated with autism spectrum disorder (ASD), a sub-population at high risk of suicide, as well as two dimensional cognitive constructs, as potential transdiagnostic predictors of suicidal ideation in a clinically diverse sample. Participants (n = 1851, 62% female) aged 18 to 89 years completed online questionnaires assessing: social communication difficulties; insistence on sameness; cognitive control; and rumination. Forty-three percent of participants reported the presence of at least one neurodevelopmental or neuropsychiatric disorder. One third of the sample reported some suicidal ideation (SI), and 40 percent met the threshold for concern for depression. All hypothesized constructs were associated with SI and depression and, with the exception of rumination, contributed significantly to SI. Participants reporting SI returned significantly higher social communication difficulties and insistence on sameness, and lower levels of cognitive control than those reporting no-SI. The study was limited by the use of a cross-sectional sample assessed with self-report measures. All diagnoses were self-reported and the study was additionally limited by the use of a single item indicator of suicidal ideation. These findings support a role for constructs associated with the ASD phenotype and associated broad cognitive domains as potential risk factors underlying suicidal ideation in a large clinically diverse sample. Our findings suggest directions for future longitudinal research studies, along with specific targets for suicide prevention and clinical practice.

    View details for DOI 10.1371/journal.pone.0245562

    View details for PubMedID 33482664

  • Using the big data approach to clarify the structure of restricted and repetitive behaviors across the most commonly used autism spectrum disorder measures. Molecular autism Uljarević, M., Jo, B., Frazier, T. W., Scahill, L., Youngstrom, E. A., Hardan, A. Y. 2021; 12 (1): 39

    Abstract

    Restricted and repetitive behaviors (RRB) in autism spectrum disorder (ASD) encompass several distinct domains. However, commonly used general ASD measures provide broad RRB scores rather than assessing separate RRB domains. The main objective of the current investigation was to conduct a psychometric evaluation of the ability of the Social Responsiveness Scale (SRS-2), the Social Communication Questionnaire (SCQ), the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) to capture different RRB constructs.Exploratory Structural Equation Modeling (ESEM) was conducted using individual item-level data from the SRS-2, SCQ, ADI-R and the ADOS. Data were obtained from five existing publicly available databases. For the SRS-2, the final sample consisted of N = 16,761 individuals (Mage = 9.43, SD = 3.73; 18.5% female); for the SCQ, of N = 15,840 (Mage = 7.99, SD = 4.06; 18.1% female); for the ADI-R, of N = 8985 (Mage = 8.86, SD = 4.68; 19.4% female); and for the ADOS, of N = 6314 (Mage = 12.29, SD = 6.79; 17.7% female).The three-factor structure provided the most optimal and interpretable fit to data for all measures (comparative fit index ≥ .983, Tucker Lewis index ≥ .966, root mean square error of approximation ≤ .028). Repetitive-motor behaviors, insistence on sameness and unusual or circumscribed interests factors emerged across all instruments. No acceptable fit was identified for the ADOS.The five datasets used here afforded a large as well as wide distribution of the RRB item scores. However, measures used for establishing convergent and divergent validity were only available for a portion of the sample.Reported findings offer promise for capturing important RRB domains using general ASD measures and highlight the need for measurement development.

    View details for DOI 10.1186/s13229-021-00419-9

    View details for PubMedID 34044873

  • Psychiatric Characteristics Across Individuals With PTEN Mutations. Frontiers in psychiatry Steele, M., Uljarevic, M., Rached, G., Frazier, T. W., Phillips, J. M., Libove, R. A., Busch, R. M., Klaas, P., Martinez-Agosto, J. A., Srivastava, S., Eng, C., Sahin, M., Hardan, A. Y. 2021; 12: 672070

    Abstract

    Germline heterozygous PTEN mutations have been associated with high prevalence of autism spectrum disorder (ASD) and elevated rates and severity of broadly defined behavioral problems. However, limited progress has been made toward understanding whether PTEN mutation is associated with specific psychiatric co-morbidity profiles when compared to idiopathic ASD. The current study aimed to utilize a cross-measure approach to compare concurrent psychiatric characteristics across children and adolescents with PTEN mutation with (PTEN-ASD; n = 38) and without ASD (PTEN-No ASD; n = 23), and ASD with macrocephaly but no PTEN mutation (macro-ASD; n = 25) using the Child Behavior Checklist (CBCL) and the Aberrant Behavior Checklist (ABC). There were significant group effects for the CBCL Internalizing and Externalizing broad symptom score, the majority of specific CBCL syndrome scores, and all ABC subscale scores. Post-hoc comparisons revealed greater behavioral symptoms in the ASD groups (PTEN-ASD and macro-ASD) compared to the PTEN-no ASD group on nearly all subtest scores examined. There were no statistically significant differences between the PTEN-ASD and macro-ASD groups; however, there was a trend for the macro-ASD group showing higher levels of aggressive behaviors. Our findings provide evidence of specific behavior profiles across PTEN-No ASD, PTEN-ASD, and macro-ASD groups and highlight the importance of early identification of behavioral vulnerabilities in individuals with PTEN mutations in order to provide access to appropriate evidence-based interventions.

    View details for DOI 10.3389/fpsyt.2021.672070

    View details for PubMedID 34489750

  • Examining Effectiveness and Predictors of Treatment Response of Pivotal Response Treatment in Autism: An Umbrella Review and a Meta-Analysis. Frontiers in psychiatry Uljarevic, M., Billingham, W., Cooper, M. N., Condron, P., Hardan, A. Y. 2021; 12: 766150

    Abstract

    The current study aimed to provide a comprehensive appraisal of the current evidence on the effectiveness of Pivotal Response Training (PRT) for individuals with autism spectrum disorder (ASD) and to explore predictors of treatment response. We conducted a systematic review of the following electronic databases and registers: PsycINFO, Medline, Embase, Cochrane Central Register of Controlled Trials, ERIC, Linguistics and Language Behavior Abstracts. Six systematic reviews were identified, two with meta-analytic component. Identified reviews varied widely in terms of their aims, outcomes, and designs which precluded a unified and consistent set of conclusions and recommendations. Ten RCTs were identified. Eight of identified RCTs reported at least one language and communication-related outcome. Statistically significant effects of PRT were identified across a majority of identified RCTs for a range of language and communication skills. However, evidence for positive treatment effects of PRT on outcome measures assessing other domains was less robust and/or specific. Overall, both previous systematic reviews and new meta-analysis of the RCTs suggest that PRT shows promise for improving language and communication. Only four RCTs examined the association between baseline child characteristics and treatment outcomes, however, no consistent pattern emerged. This review has identified several key methodological and design improvements that are needed to enable our field to fully capitalize on the potential of RCT designs and characterize detailed profiles of treatment responders. These findings are essential for informing the development of evidence-based guidelines for clinicians on what works for whom and why.

    View details for DOI 10.3389/fpsyt.2021.766150

    View details for PubMedID 35153850

  • 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

    Abstract

    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 autism advantage at work: A critical and systematic review of current evidence. Research in developmental disabilities Bury, S. M., Hedley, D., Uljarevic, M., Gal, E. 2020; 105: 103750

    Abstract

    BACKGROUND: Despite difficulties entering the workforce, people on the autism spectrum are often successful. Furthermore, they are suggested to bring unique abilities (e.g., attention to detail, tolerance for repetitive tasks) related to the repetitive and restrictive behaviours and interests (RRBI) diagnostic domain, that may be advantageous in employment.AIMS: This critical and systematic review examined evidence supporting the superior workplace performance of employees on the autism spectrum, particularly regarding the RRBI domain.METHOD AND PROCEDURES: A systematic review (PRISMA guidelines) evaluated empirical peer-reviewed studies that assess employees on the autism spectrum's performance in the workplace or on work-specific tasks. Nine databases were searched, with additional papers identified from reference lists and consultation.OUTCOMES AND RESULTS: Two quantitative and four qualitative papers met criteria. Results reflect themes; attention to detail, tolerance of repetitive tasks, special/circumscribed interests, other RRBI related advantages/concerns.CONCLUSIONS AND IMPLICATIONS: Due to the nature and quality of the identified studies there is currently no strong evidence supporting or negating a workplace autism advantage. This review highlights the need for more research and urges constraint in utilising stereotypes that may not apply to all on the autism spectrum, arguing an individual differences approach to supporting autism strengths at work.

    View details for DOI 10.1016/j.ridd.2020.103750

    View details for PubMedID 32810716

  • Brief Report: Psychometric Properties of the Patient Health Questionaire-9 (PHQ-9) in Autistic Adults JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS Arnold, S. C., Uljarevic, M., Hwang, Y., Richdale, A. L., Trollor, J. N., Lawson, L. P. 2020; 50 (6): 2217–25
  • Sleep Quality in Autism from Adolescence to Old Age AUTISM IN ADULTHOOD Jovevska, S., Richdale, A. L., Lawson, L. P., Uljarevic, M., Arnold, S. C., Trollor, J. N. 2020; 2 (2): 152-162
  • Interventions for anxiety in mainstream school-aged children with autism spectrum disorder: A systematic review CAMPBELL SYSTEMATIC REVIEWS Hillman, K., Dix, K., Ahmed, K., Lietz, P., Trevitt, J., O'Grady, E., Uljarevic, M., Vivanti, G., Hedley, D. 2020; 16 (2)

    View details for DOI 10.1002/cl2.1086

    View details for Web of Science ID 000632294200005

  • 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

    Abstract

    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

  • How Does Emotion Regulation Strategy Use and Psychological Wellbeing Predict Mood in Adults With and Without Autism Spectrum Disorder? A Naturalistic Assessment JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS Cai, R., Richdale, A. L., Dissanayake, C., Uljarevic, M. 2020; 50 (5): 1786–99
  • Exploring Social Subtypes in Autism Spectrum Disorder: A Preliminary Study. Autism research : official journal of the International Society for Autism Research Uljarevic, M., Phillips, J. M., Schuck, R. K., Schapp, S., Solomon, E. M., Salzman, E., Allerhand, L., Libove, R. A., Frazier, T. W., Hardan, A. Y. 2020

    Abstract

    Impairments in social functioning are considered a hallmark diagnostic feature of autism spectrum disorder (ASD). Yet, individuals diagnosed with ASD vary widely with respect to specific presentation, severity, and course across different dimensions of this complex symptom domain. The aim of this investigation was to utilize the Stanford Social Dimensions Scale (SSDS), a newly developed quantitative measure providing parental perspective on their child's social abilities, in order to explore the existence of homogeneous subgroups of ASD individuals who share unique profiles across specific dimensions of the social domain. Parents of 164 individuals with ASD (35 females, 129 males; meanage = 7.54years, SD = 3.85) completed the SSDS, the Social Responsiveness Scale (SRS-2) and the Child Behavior Checklist (CBCL). Data on children's verbal and nonverbal intellectual functioning (FSIQ) were also collected. The Latent Profile Analysis was used to classify participants according to the pattern of SSDS subscale scores (Social Motivation, Social Affiliation, Expressive Social Communication, Social Recognition, and Unusual Approach). Five profiles were identified. Profiles did not differ in terms of chronological age nor gender distribution but showed distinct patterns of strengths and weaknesses across different social components rather than simply reflecting a severity gradient. Profiles were further differentiated in terms of cognitive ability, as well as ASD and internalizing symptom severity. The implications of current findings and the necessary further steps toward identifying subgroups of individuals with ASD who share particular constellation of strengths and weaknesses across key social domains as a way of informing personalized interventions are discussed. Autism Res 2020. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: People with autism spectrum disorder (ASD) vary greatly in terms of their social abilities and social motivation. However, researchers lack measures that can fully assess different components of social functioning. This paper provides initial evidence for capturing subgroups of individuals with ASD with specific strengths and weakness across different aspects of social functioning.

    View details for DOI 10.1002/aur.2294

    View details for PubMedID 32187854

  • Factor structure and psychometric properties of the brief Connor-Davidson Resilience Scale for adults on the autism spectrum. Autism : the international journal of research and practice Hwang, Y. I., Arnold, S., Trollor, J., Uljarevic, M. 2020: 1362361320908095

    Abstract

    LAY ABSTRACT: Adults on the autism spectrum experience high rates of anxiety and depression, and may be particularly vulnerable to difficult and traumatic life experiences, which may contribute to the development and maintenance of these conditions. Resilience is an increasingly popular concept in research, which describes the ability to 'bounce back' following difficult emotional experiences, and the flexibility to adapt to stressful and demanding situations. The Connor-Davidson Resilience Scale has been used predominantly in studies involving non-autistic adults to measure resilience. While resilience is a potentially important concept for autistic adults, the suitability of the 10-item version of the Connor-Davidson Resilience Scale for use with adults on the spectrum has not yet been studied. In this short report, we investigate whether the Connor-Davidson Resilience Scale 10 is a valid measure to use with this population, and its relationship with other measures of mental well- or ill-being. Participants were 95 autistic adults with a mean age of 44 (63% female) who completed measures of resilience, autism symptoms, depression, anxiety and mental wellbeing. Overall, the findings indicate that the Connor-Davidson Resilience Scale 10 may be reliably used with autistic adults to measure trait resilience, which is associated with positive wellbeing and may serve as a protective factor from negative mental wellbeing. Future studies may use the Connor-Davidson Resilience Scale 10 to investigate resilience as a protective factor from negative mental health outcomes in response to traumatic and adverse emotional events for which autistic individuals may be particularly susceptible.

    View details for DOI 10.1177/1362361320908095

    View details for PubMedID 32168989

  • What Is Important in Measuring Quality of Life? Reflections by Autistic Adults in Four Countries AUTISM IN ADULTHOOD McConachie, H., Wilson, C., Mason, D., Garland, D., Parr, J. R., Rattazzi, A., Rodgers, J., Skevington, S., Uljarevic, M., Magiati, I. 2020; 2 (1): 4-12
  • Deconstructing the repetitive behaviour phenotype in autism spectrum disorder through a large population-based analysis. Journal of child psychology and psychiatry, and allied disciplines Uljarevic, M., Cooper, M. N., Bebbington, K., Glasson, E. J., Maybery, M. T., Varcin, K., Alvares, G. A., Wray, J., Leekam, S. R., Whitehouse, A. J. 2020

    Abstract

    OBJECTIVE: Restricted and repetitive pattern of behaviours and interests (RRB) are a cardinal feature of autism spectrum disorder (ASD), but there remains uncertainty about how these diverse behaviours vary according to individual characteristics. This study provided the largest exploration to date of the relationship between Repetitive Motor Behaviours, Rigidity/Insistence on Sameness and Circumscribed Interests with other individual characteristics in newly diagnosed individuals with ASD.METHOD: Participants (N=3,647; 17.7% females; Mage=6.6years [SD=4.7]) were part of the Western Australian (WA) Register for ASD, an independent, prospective collection of demographic and diagnostic data of newly diagnosed cases of ASD in WA. Diagnosticians rated each of the DSM-IV-TR criteria on a 4-point Likert severity scale, and here we focused on the Repetitive Motor Behaviours, Insistence on Sameness and Circumscribed Interests symptoms.RESULTS: The associations between RRB domains, indexed by Kendall's Tau, were weak, ranging from non-significant for both Circumscribed Interests and Repetitive Motor Behaviours to significant (.20) for Insistence on Sameness and Repetitive Motor Behaviours. Older age at diagnosis was significantly associated with lower Circumscribed Interests and significantly associated with higher Insistence on Sameness and Repetitive Motor Behaviours. Male sex was significantly associated with higher Repetitive Motor Behaviours but not Insistence on Sameness or Circumscribed Interests.CONCLUSIONS: The pattern of associations identified in this study provides suggestive evidence for the distinctiveness of Repetitive Motor Behaviours, Insistence on Sameness and Circumscribed Interests, highlighting the potential utility of RRB domains for stratifying the larger ASD population into smaller, more phenotypically homogeneous subgroups that can help to facilitate efforts to understand diverse ASD aetiology and inform design of future interventions.

    View details for DOI 10.1111/jcpp.13203

    View details for PubMedID 32037582

  • Quantifying Research Domain Criteria Social Communication Subconstructs Using the Social Communication Questionnaire in Youth. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53 Uljarević, M. n., Frazier, T. W., Phillips, J. M., Jo, B. n., Littlefield, S. n., Hardan, A. Y. 2020: 1–11

    Abstract

    Research Domain Criteria (RDoC) has posited a set of social dimensions that could be useful in identifying sources of individual variation in social impairments across neurodevelopmental disorders. The current investigation aimed to derive estimates of the RDoC social constructs from the Social Communication Questionnaire (SCQ) and examine whether RDoC social processes, as captured by the SCQ, are best represented by a dimensional, categorical, or hybrid model. Individual SCQ items from 4 databases were combined resulting in a total of 26,407 individuals (Mage = 8.13 years, SDage = 4.19; 69.1% male). The sample consisted of 60.0% of individuals with autism spectrum disorder (ASD), 6.8% with a range of neurodevelopmental disorders and 33.2% of siblings of individuals with ASD. Comparison of a range of factor solutions through the use of exploratory structural equation modeling and confirmatory factor analysis indicated that a 3-factor structure with separate attachment and affiliation, production of nonfacial and facial communication factors provided excellent fit to the data (comparative fit index = .989, Tucker-Lewis index = .984, root mean square error of approximation = .045). and robustness across clinical groups, age, sex, and verbal status. Comparison between the best-fitting factor analysis, latent class analysis, and factor mixture analysis solutions demonstrated that the RDoC social processes domain is best represented as dimensional. Our findings show promise for capturing some of the important RDoC social constructs using the SCQ but also highlight crucial areas for the development of new, dedicated dimensional measures.

    View details for DOI 10.1080/15374416.2019.1669156

    View details for PubMedID 31922427

  • Setting the research agenda to secure the wellbeing of autistic people. The Lancet. Neurology Hudry, K. n., Pellicano, E. n., Uljarević, M. n., Whitehouse, A. J. 2020

    View details for DOI 10.1016/S1474-4422(20)30031-4

    View details for PubMedID 32142627

  • Anxiety in young people with autism spectrum disorder: Common and autism-related anxiety experiences and their associations with individual characteristics. Autism : the international journal of research and practice Lau, B. Y., Leong, R., Uljarevic, M., Lerh, J. W., Rodgers, J., Hollocks, M. J., South, M., McConachie, H., Ozsivadjian, A., Van Hecke, A., Libove, R., Hardan, A., Leekam, S., Simonoff, E., Magiati, I. 2019: 1362361319886246

    Abstract

    Anxiety is common in autism spectrum disorder. Many anxiety symptoms in autism spectrum disorder are consistent with Diagnostic and Statistical Manual of Mental Disorders (5th ed.) anxiety disorders (termed "common" anxieties), but others may be qualitatively different, likely relating to autism spectrum disorder traits (herein termed "autism-related" anxieties). To date, few studies have examined both "common" and "autism-related" anxiety experiences in autism spectrum disorder. We explored caregiver-reported Spence Children's Anxiety Scale-Parent version data from a multi-site (United Kingdom, Singapore, and United States) pooled database of 870 6- to 18-year-old participants with autism spectrum disorder, of whom 287 provided at least one written response to the optional open-ended Spence Children's Anxiety Scale-Parent item 39 ("Is there anything else your child is afraid of?"). Responses were thematically coded to explore (a) common and autism-related anxiety presentations and (b) their relationship with young people's characteristics. Nearly half of the responses were autism-related anxieties (mostly sensory, uncommon, or idiosyncratic specific phobias and worries about change and unpredictability). The other half described additional common anxieties not covered in the original measure (mostly social, weather and environmental disasters, and animals). Caregivers of participants who were more severely affected by autism spectrum disorder symptoms reported more autism-related, as compared to common, additional anxieties. Implications for the assessment and understanding of anxiety in autism are discussed.

    View details for DOI 10.1177/1362361319886246

    View details for PubMedID 31852214

  • MAPPING THE RESEARCH DOMAIN CRITERIA (RDOC) SOCIAL COMMUNICATION SUB-CONSTRUCTS TO THE SOCIAL RESPONSIVENESS SCALE Hardan, A., Uljarevic, M., Frazier, T., Phillips, J. M., Jo, B., Littlefield, S. ELSEVIER SCIENCE INC. 2019: S311
  • The misnomer of 'high functioning autism': Intelligence is an imprecise predictor of functional abilities at diagnosis. Autism : the international journal of research and practice Alvares, G. A., Bebbington, K., Cleary, D., Evans, K., Glasson, E. J., Maybery, M. T., Pillar, S., Uljarevic, M., Varcin, K., Wray, J., Whitehouse, A. J. 2019: 1362361319852831

    Abstract

    'High functioning autism' is a term often used for individuals with autism spectrum disorder without an intellectual disability. Over time, this term has become synonymous with expectations of greater functional skills and better long-term outcomes, despite contradictory clinical observations. This study investigated the relationship between adaptive behaviour, cognitive estimates (intelligence quotient) and age at diagnosis in autism spectrum disorder. Participants (n=2225, 1-18years of age) were notified at diagnosis to a prospective register and grouped by presence (n=1041) or absence (n=1184) of intellectual disability. Functional abilities were reported using the Vineland Adaptive Behaviour Scales. Regression models suggested that intelligence quotient was a weak predictor of Vineland Adaptive Behaviour Scales after controlling for sex. Whereas the intellectual disability group's adaptive behaviour estimates were close to reported intelligence quotients, Vineland Adaptive Behaviour Scales scores fell significantly below intelligence quotients for children without intellectual disability. The gap between intelligence quotient and Vineland Adaptive Behaviour Scales scores remained large with increasing age at diagnosis for all children. These data indicate that estimates from intelligence quotient alone are an imprecise proxy for functional abilities when diagnosing autism spectrum disorder, particularly for those without intellectual disability. We argue that 'high functioning autism' is an inaccurate clinical descriptor when based solely on intelligence quotient demarcations and this term should be abandoned in research and clinical practice.

    View details for DOI 10.1177/1362361319852831

    View details for PubMedID 31215791

  • Brief Report: Psychometric Properties of the Patient Health Questionaire-9 (PHQ-9) in Autistic Adults. Journal of autism and developmental disorders Arnold, S. R., Uljarevic, M., Hwang, Y. I., Richdale, A. L., Trollor, J. N., Lawson, L. P. 2019

    Abstract

    Despite the high prevalence of depression and other mental illnesses in autistic adults, screening instruments such as the Patient Health Questionnaire (PHQ-9) have not been specifically validated in an autistic sample. Using data from two Autism CRC longitudinal studies (n=581), confirmatory factor analysis supported the two-factor model (somatic and cognitive/affective) in the autistic sample and one-factor model in the community comparison sample. Confirmatory bifactor analysis also supported use of the PHQ-9 total score in autism. Good convergent validity was found with two measures of psychological well-being for PHQ-9 total and subdomain scores. The PHQ-9 is a useful tool for autism research allowing comparison across autistic and non-autistic participants.

    View details for PubMedID 30847710

  • Predictors of mental health and well-being in employed adults with autism spectrum disorder at 12-month follow-up AUTISM RESEARCH Hedley, D., Uljarevic, M., Bury, S. M., Dissanayake, C. 2019; 12 (3): 482-494

    View details for DOI 10.1002/aur.2064

    View details for Web of Science ID 000461586600010

  • Resting heart rate variability, emotion regulation, psychological wellbeing and autism symptomatology in adults with and without autism INTERNATIONAL JOURNAL OF PSYCHOPHYSIOLOGY Cai, R., Richdale, A. L., Dissanayake, C., Uljarevic, M. 2019; 137: 54-62
  • How Does Emotion Regulation Strategy Use and Psychological Wellbeing Predict Mood in Adults With and Without Autism Spectrum Disorder? A Naturalistic Assessment. Journal of autism and developmental disorders Cai, R. Y., Richdale, A. L., Dissanayake, C., Uljarevic, M. 2019

    Abstract

    The aim of this study was to identify emotion regulation (ER) strategies that most strongly impact momentary mood in a sample of 23 adults with and 19 without autism spectrum disorder (ASD). Participants completed cognitive and behavioural assessments, online questionnaires, and experience sampling methodology questions. In the ASD group, the use of dampening and other-blame reduced mood while savouring and emotional acceptance improved mood. The use of self-blame and avoidance negatively impacted mood only in the non-ASD group, suggesting the use of these two strategies do not reduce mood in individuals with ASD. ER and mental health interventions should capture ER strategy use and aim to decrease maladaptive strategy use and increase adaptive strategy use.

    View details for PubMedID 30790195

  • 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

  • Editorial Perspective: Furthering research on temperament in autism spectrum disorder JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY Chetcuti, L., Uljarevic, M., Hudry, K. 2019; 60 (2): 225-228

    View details for DOI 10.1111/jcpp.12957

    View details for Web of Science ID 000456605900012

  • Predictors of mental health and well-being in employed adults with autism spectrum disorder at 12-month follow-up. Autism research : official journal of the International Society for Autism Research Hedley, D., Uljarevic, M., Bury, S. M., Dissanayake, C. 2019

    Abstract

    People with Autism Spectrum Disorder (ASD) commonly experience poor outcomes in adulthood. Previous research on adult outcomes has focused on negative aspects of health and well-being, while positive well-being remains understudied. The current study charted 12-month change in daily living skills, job satisfaction, depression, anxiety, and positive well-being in 36 (32 male) newly employed adults with ASD aged 18 to 57 years who were participating in a supported employment program. There was a small increase in daily living skills, and a slight decrease in job satisfaction, with all other measures remaining stable over time. Regression analyses revealed that, controlling for baseline depression, positive well-being negatively predicted depression at follow-up. No significant predictors of anxiety were identified. Social support and depression at baseline were associated with positive well-being at follow-up; however, they were no longer significant predictors after the effects of baseline positive well-being were taken into account. The findings provide evidence that positive well-being may buffer against depression in people with ASD. Our finding of stability of mental health and well-being measures over time indicates more research is required to uncover the mechanisms underpinning mental health and well-being outcomes in employed adults with ASD. Autism Research 2019. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: People with autism commonly experience poor outcomes in adulthood. We studied mental health and well-being in newly employed adults with autism who were participating in a supported employment program. Apart from a slight increase in daily living skills and a slight decrease in job satisfaction, other measures of mental health and well-being remained stable over time. Our findings suggest that positive well-being may protect against symptoms of depression in people with autism.

    View details for PubMedID 30675764

  • Development of the Stanford Social Dimensions Scale: initial validation in autism spectrum disorder and in neurotypicals. Molecular autism Phillips, J. M., Uljarević, M. n., Schuck, R. K., Schapp, S. n., Solomon, E. M., Salzman, E. n., Allerhand, L. n., Libove, R. A., Frazier, T. W., Hardan, A. Y. 2019; 10: 48

    Abstract

    The aim of this paper was to provide an initial validation of a newly developed parent questionnaire-the Stanford Social Dimensions Scale (SSDS), designed to capture individual differences across several key social dimensions including social motivation in children and adolescents with and without psychiatric disorders.The initial validation sample was comprised of parents of 175 individuals with autism spectrum disorder (ASD) (35 females, 140 males; Mage = 7.19 years, SDage = 3.96) and the replication sample consisted of 624 parents of children who were either typically developing or presented with a range of neurodevelopmental and neuropsychiatric disorders (302 females, 322 males; Mage = 11.49 years, SDage = 4.48). Parents from both samples completed the SSDS and the Social Responsiveness Scale (SRS-2).Exploratory Structural Equation Modeling indicated that a 5-factor model provided adequate to excellent fit to the data in the initial ASD sample (comparative fit index [CFI] = .940, Tucker-Lewis Index [TLI] = .919, root mean square error of approximation [RMSEA] = .048, standardized root mean square residual [SRMR] = .038). The identified factors were interpreted as Social Motivation, Social Affiliation, Expressive Social Communication, Social Recognition, and Unusual Approach. This factor structure was further confirmed in Sample 2 (CFI = 946, TLI = .930, RMSEA = .044, SRMR = .026). Internal consistency for all subscales was in the good to excellent range across both samples as indicated by Composite Reliability scores of ≥ .72. Convergent and divergent validity was strong as indexed by the pattern of correlations with relevant SRS-2 and Child Behavior Checklist domains and with verbal and non-verbal intellectual functioning scores in Sample 1 and with the Need to Belong Scale and Child Social Preference Scale scores in Sample 2. Across both samples, females had higher social motivation and expressive social communication scores. Discriminant validity was strong given that across all SSDS subscales, the ASD sample had significantly higher impairment than both the typically developing group and the group with other clinical conditions, which in turn, had significantly higher impairment than the typically developing group.Our findings provide initial validation of a new scale designed to comprehensively capture individual differences in social motivation and other key social dimensions in ASD.

    View details for DOI 10.1186/s13229-019-0298-9

    View details for PubMedID 31890146

    View details for PubMedCentralID PMC6921422

  • Cohort profile: the Australian Longitudinal Study of Adults with Autism (ALSAA). BMJ open Arnold, S. n., Foley, K. R., Hwang, Y. I., Richdale, A. L., Uljarevic, M. n., Lawson, L. P., Cai, R. Y., Falkmer, T. n., Falkmer, M. n., Lennox, N. G., Urbanowicz, A. n., Trollor, J. n. 2019; 9 (12): e030798

    Abstract

    ​PURPOSE: There is a significant knowledge gap regarding the lives of adults on the autism spectrum. Some literature suggests significant health and mental health inequalities for autistic adults, yet there is a lack of comprehensive longitudinal studies exploring risk factors. Further, most research does not include the perspective of autistic adults in its conduct or design. Here, we describe the baseline characteristics and inclusive research approach of a nationwide longitudinal study. ​PARTICIPANTS: The Autism Cooperative Research Centre for Living with Autism's Australian Longitudinal Study of Adults with Autism (ALSAA) is a questionnaire-based longitudinal study of autistic adults (25+ years old) with follow-up at 2-year intervals. Autistic advisors were involved in each stage of research apart from data analysis. Three questionnaires were developed: self-report, informant report (ie, proxy report) and carers (ie, carer experiences and characteristics). ​FINDINGS TO DATE: An inclusive research protocol was developed and agreed with autistic advisors. Baseline data were collected from 295 autistic adults (M=41.8 years, SD=12.0) including 42 informant responses, 146 comparison participants and 102 carers. The majority of autistic participants (90%) had been diagnosed in adulthood (M=35.3 years, SD=15.1). When compared with controls, autistic adults scored higher on self-report measures of current depression and anxiety. Participant comments informed ongoing data gathering. Participants commented on questionnaire length, difficulty with literal interpretation of forced response items and expressed gratitude for research in this area. ​FUTURE PLANS: A large comprehensive dataset relating to autistic adults and their carers has been gathered, creating a good platform for longitudinal follow-up repeat surveys and collaborative research. Several outputs are in development, with focus on health service barriers and usage, caregivers, impact of diagnosis in adulthood, further scale validations, longitudinal analyses of loneliness, suicidal ideation, mental illness risk factors and other areas. Baseline data confirm poorer mental health of autistic adults. The ALSAA demonstrates a working approach to inclusive research.

    View details for DOI 10.1136/bmjopen-2019-030798

    View details for PubMedID 31806608

  • Mapping the Research Domain Criteria Social Processes Constructs to the Social Responsiveness Scale. Journal of the American Academy of Child and Adolescent Psychiatry Uljarević, M. n., Frazier, T. W., Phillips, J. M., Jo, B. n., Littlefield, S. n., Hardan, A. Y. 2019

    Abstract

    Research Domain Criteria (RDoC) operationalizes a set of basic social dimensions that can be used to deconstruct sources of variation in social impairments across affected individuals, regardless of their diagnostic status. This is a necessary step toward the development of etiologically based and individualized treatments. The main objective of this investigation was to derive estimations of the RDoC social constructs from the Social Responsiveness Scale (SRS-2).Exploratory structural equation modeling and confirmatory factor analysis were conducted using individual SRS-2 items from six distinct databases ( N = 27,953; mean age = 9.55 years, SD = 3.79; 71.7% male participants) spanning normative (33.8%) and atypical (66.2%) development. The following models were estimated: a one-factor model; a three-factor model with separate Attachment and Affiliation , Social Communication , and Understanding of Mental States factors; and a four-factor model where Social Communication was further split into Production of Facial and Non-Facial Communication.The one-factor solution showed poor fit. The three-factor solution had adequate fit (comparative fit index = 0.952, Tucker Lewis Index = 0.937, root mean square error of approximation = 0.054). However, the four-factor solution had superior fit (comparative fit index = 0.973, Tucker Lewis Index = 0.961, root mean square error of approximation = 0.042) and was robust across age, sex, and clinical status.To our knowledge, this is the first study examining estimations of the RDoC social constructs from an existing measure. Reported findings show promise for capturing important RDoC social constructs using the SRS-2 and highlight crucial areas for the development of novel dimensional social processing measures.

    View details for DOI 10.1016/j.jaac.2019.07.938

    View details for PubMedID 31376500

    View details for PubMedCentralID PMC7470629

  • Anxiety and Depression from Adolescence to Old Age in Autism Spectrum Disorder. Journal of autism and developmental disorders Uljarević, M. n., Hedley, D. n., Rose-Foley, K. n., Magiati, I. n., Cai, R. Y., Dissanayake, C. n., Richdale, A. n., Trollor, J. n. 2019

    Abstract

    This study examined age trends in anxious and depressive symptoms, from older adolescence to old age, and explored the association between anxious and depressive symptoms with gender, ASD severity, and socio-economic factors. Two hundred and fifty-five individuals with ASD (151 males, Mage = 33.52 years, SDage = 14.98) took part. More than one-third of participants reported clinically significant anxiety (38.4%) or depression (38%). A slight trend for an increase in the severity of both anxiety and depression from adolescence to middle adulthood, and then a slight decline in older adulthood was found. Female gender and higher ASD severity predicted more anxiety and depression symptoms. Our findings emphasise the need to provide timely assessment and treatment of anxiety and depression in ASD.

    View details for DOI 10.1007/s10803-019-04084-z

    View details for PubMedID 31190198

  • Emotion regulation in autism: Reappraisal and suppression interactions. Autism : the international journal of research and practice Cai, R. Y., Richdale, A. L., Dissanayake, C. n., Trollor, J. n., Uljarević, M. n. 2019; 23 (3): 737–49

    Abstract

    Emotion regulation has been proposed to be a transdiagnostic factor in the development and maintenance of psychopathology in the general population, yet the nature of the relationships between emotion regulation strategy use and psychological well-being has not been comprehensively explored in individuals with autism spectrum disorder (ASD). The aim of this study was to assess how the individual differences in self-reported emotion regulation strategy use relate to levels of both positive and negative psychological well-being. In total, 56 individuals with ASD aged 14-24 years (Mage = 18.15; SDage = 2.30) completed Emotion Regulation Questionnaire, Diagnostic and Statistical Manual of Mental Disorders-5 Generalized Anxiety Disorder Dimensional Scale, Patient Health Questionnaire-9, Warwick-Edinburgh Mental Well-being Scale and Autism-Spectrum Quotient - Short. Individuals were grouped into four clusters based on their Emotion Regulation Questionnaire subscale scores. Individuals in the high suppression and low reappraisal group expressed higher depressive symptoms and lower positive well-being when compared with the low suppression and high reappraisal group. Interestingly, individuals who self-reported using both high suppression and reappraisal expressed relatively high positive well-being and low depression symptoms. We suggest that the maladaptive effect of habitual suppression usage may be buffered by the habitual use of reappraisal, and this interaction between adaptive and maladaptive emotion regulation strategy use has clinical implications.

    View details for PubMedID 29792076

  • Poh-tay-toe, Poh-tah-toe: Autism Diagnosis and Conceptualization. Journal of child neurology Leong, D. n., Hedley, D. n., Uljarević, M. n. 2019: 883073819887587

    View details for DOI 10.1177/0883073819887587

    View details for PubMedID 31726922

  • Cognitive reappraisal and psychological wellbeing but not autism spectrum disorder symptomatology is related to resting heart rate variability. International journal of psychophysiology : official journal of the International Organization of Psychophysiology Cai, R. Y., Richdale, A. L., Dissanayake, C., Uljarevic, M. 2018

    Abstract

    Heart rate variability (HRV) has been separately shown to be associated with ASD symptomatology, psychological wellbeing and emotion regulation (ER) in specific samples consisting of either individuals with ASD, those without ASD, or combined. However, no study has examined these constructs together or incorporated habitual ER strategy use. Hence, the aim of this study was to examine the relationships between resting HRV, ASD symptomatology, ER strategy use (reappraisal and suppression), and psychological wellbeing (anxiety, depression and positive wellbeing) in a combined sample of adults with and without ASD. Twenty-four adults with ASD (Mage = 31.36; SDage = 14.84) and twenty without ASD (Mage = 35.45; SDage = 12.19) completed the ER Questionnaire (ERQ), Diagnostic and Statistical Manual of Mental Disorders-5 Cross-cutting Dimensional Scale, Patient Health Questionnaire-9, Warwick-Edinburgh Mental Well-being Scale, and Autism-Spectrum Quotient-Short. Participants' resting HRV data were also collected via short-term electrocardiogram. Self-reported use of reappraisal was associated with higher resting HRV. Additionally, reappraisal predicted variance in all three HRV indices above and beyond ASD symptomatology and medication use. These preliminary findings can inform the design of future studies to determine the extent to which reappraisal impacts autonomic flexibility.

    View details for PubMedID 30578793

  • Assessing subtypes of restricted and repetitive behaviour using the Adult Repetitive Behaviour Questionnaire-2 in autistic adults MOLECULAR AUTISM Barrett, S. L., Uljarevic, M., Jones, C. G., Leekam, S. R. 2018; 9: 58

    Abstract

    The majority of previous research into restricted and repetitive behaviours (RRBs) has focussed on children, partly due to a lack of suitable measures for RRBs in adults. This study aimed to explore the psychometric properties of the Adult Repetitive Behaviour Questionnaire-2 (RBQ-2A) in a large sample of autistic adults using a self-report questionnaire method.The RBQ-2A and Autism-Spectrum Quotient (AQ) were administered online. Data from 275 autistic adults aged 18-66 (M = 36.56, SD = 12.24; 100 men and 171 women) were analysed using polychoric principal components analysis (PCA). Reliability and validity were assessed using Cronbach's alpha and correlation analyses.PCA resulted in two components of the RBQ-2A, interpretable as repetitive sensory and motor behaviours (RSMB) and insistence on sameness (IS). Both components showed acceptable internal consistency (α = .70 and .81 respectively) and were significantly moderately correlated with scores on the AQ (r s  = .25 and .42). Participants' scores on IS were higher than their scores on RSMB. RSMB, but not IS, was negatively associated with age, particularly in older adults (≥ 50 years). There were no gender differences.The RBQ-2A is a reliable and valid self-report measure of RRBs in the present sample of autistic adults. As one of the few measures of RRBs aimed at adults, it is suitable for adults with the ability to read and complete a self-report questionnaire. Results build on previous work with children using the Repetitive Behaviour Questionnaire-2 (RBQ-2).

    View details for PubMedID 30505424

  • Exploring the nature of anxiety in young adults on the autism spectrum: A qualitative study RESEARCH IN AUTISM SPECTRUM DISORDERS Halim, A. T., Richdale, A. L., Uljarevic, M. 2018; 55: 25–37
  • Brief Report: The Impact of Sensory Hypersensitivity and Intolerance of Uncertainty on Anxiety in Williams Syndrome JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS Uljarevic, M., Labuschagne, I., Bobin, R., Atkinson, A., Hocking, D. R. 2018; 48 (11): 3958-3964
  • Brief report: Poor self-regulation as a predictor of individual differences in adaptive functioning in young children with autism spectrum disorder AUTISM RESEARCH Uljarevic, M., Hedley, D., Nevill, R., Evans, D. W., Cai, R., Butter, E., Mulick, J. A. 2018; 11 (8): 1157-1165

    View details for DOI 10.1002/aur.1953

    View details for Web of Science ID 000448802100007

  • Brief Report: The Impact of Sensory Hypersensitivity and Intolerance of Uncertainty on Anxiety in Williams Syndrome. Journal of autism and developmental disorders Uljarevic, M., Labuschagne, I., Bobin, R., Atkinson, A., Hocking, D. R. 2018

    Abstract

    This study explored the interrelationship between intolerance of uncertainty, sensory hyper-sensitivity and anxiety in Williams syndrome (WS). Thirty-two parents or guardians of individuals with WS (M age =24.76years, SD=7.55) were included. Associations between anxiety, intolerance of uncertainty, sensory hyper-sensitivity, and ASD symptoms were assessed. Linear regression analysis revealed that intolerance of uncertainty and sensory hyper-sensitivity were unique independent predictors of anxiety, while social communication score was not. There was evidence of a mediating effect of sensory hyper-sensitivity on the relationship between intolerance of uncertainty and anxiety. These findings bear strong resemblance to the pattern seen in ASD and emphasize the need for development of anxiety interventions that attempt to reduce negative beliefs about unpredictable situations in WS.

    View details for PubMedID 29948532

  • Parental education accounts for variability in the IQs of probands with Down syndrome: A longitudinal study. American journal of medical genetics. Part A Evans, D. W., Uljarević, M. 2018; 176 (1): 29-33

    Abstract

    Recent work has demonstrated that variability in probands' phenotypes, including physical features, cognitive abilities, social functioning, and other developmental domains, is influenced by parental traits. Here we examine the role of parental education as a factor contributing to the variability of intelligence quotient (IQ) of offspring with trisomy 21. Participants were 43 probands with trisomy 21, aged 4-21 years of age, and their parents. Data were collected on parental education, and a bi-parental mean education score (BMES) was calculated. Probands' cognitive abilities were assessed by the Stanford-Binet 4th edition at baseline (T1), and again 24 months later (T2). Probands were placed into one of two age groups: 4-12 years and 13-21 years. Results indicated higher parent-proband correlations in Age Group 2 (mean r = .47) relative to Age Group 1 (mean r = .33) and increasing parent-proband correlations across time, with mean correlations of Age Group 1, T1: r = .26, T2: 39; Age Group 2 T1: r = .49, T2: r = 46. Despite the expected IQ deficits observed in trisomy 21 probands, parental education may still contribute to the variability of probands' cognitive abilities. These findings are consistent with the literature noting increasing heritability of IQ with development.

    View details for DOI 10.1002/ajmg.a.38519

    View details for PubMedID 29159970

  • If you've employed one person with autism …: An individual difference approach to the autism advantage at work. Autism : the international journal of research and practice Bury, S. M., Hedley, D. n., Uljarević, M. n., Dissanayake, C. n., Gal, E. n. 2018: 1362361318794937

    Abstract

    In this letter to the editor, we comment on the 'autism advantage' - the idea that superior skills associated with autism (e.g. attention to detail) present a talent in employment - an example of which is a recent discussion by Austin and Pisano. We welcome advocacy that raises awareness around the strengths and capabilities of people with autism, and also the need to reform human resource management processes that disadvantage them. However, we are concerned that, by highlighting certain stereotypes (e.g. the 'talented nerd lacking social graces'), the heterogeneity of autism may be overlooked and support needs downplayed. Furthermore, not appreciating individual differences might result in a misalignment between work-profile and employment, pressure to outperform peers without autism and a failure to appreciate the diverse interests of people with autism. We argue that an individual differences approach will prove more sustainable for improving long-term employment outcomes.

    View details for PubMedID 30130975

  • Risk and protective factors underlying depression and suicidal ideation in Autism Spectrum Disorder. Depression and anxiety Hedley, D. n., Uljarević, M. n., Foley, K. R., Richdale, A. n., Trollor, J. n. 2018

    Abstract

    People with Autism Spectrum Disorder (ASD) are at significantly increased risk of suicidal thoughts and behavior. Given that social difficulties in ASD often lead to social isolation, which can in turn increase the risk for depression, this study examined loneliness and social support as potential risk and protective factors associated with depression and suicidal ideation.The sample comprised 185 people (92 females) with ASD aged 14 to 80 years who were participating in a national survey.Forty-nine percent of participants returned scores in the clinical range for depression and 36% reported recent suicidal ideation. Females, comprising almost 50% of the sample, returned higher depression scores than males, however no differences were identified between males and females in terms of suicidal ideation. Regression analyses revealed that loneliness, satisfaction with social support, and ASD traits predicted depression scores. Satisfaction with social support predicted suicidal ideation, however, it was no longer a significant predictor after the effects of depression were taken into account. Path analysis showed that ASD trait severity was independently related to depression, that the effect of number of social supports on depression was mediated by loneliness and satisfaction with social support, and that effects of loneliness and satisfaction with social support on suicidal ideation were mediated by depression. The pattern of relationships was nearly identical for males and females.This study supports a model whereby loneliness and social support operate respectively as protective and risk factors for depression and suicidal ideation in ASD.

    View details for PubMedID 29659141

  • Brief report: Poor self-regulation as a predictor of individual differences in adaptive functioning in young children with autism spectrum disorder. Autism research : official journal of the International Society for Autism Research Uljarević, M. n., Hedley, D. n., Nevill, R. n., Evans, D. W., Cai, R. Y., Butter, E. n., Mulick, J. A. 2018

    Abstract

    The present study examined the link between poor self-regulation (measured by the child behavior checklist dysregulated profile [DP]) and core autism symptoms, as well as with developmental level, in a sample of 107 children with autism spectrum disorder (ASD) aged 19-46 months. We further examined the utility of DP in predicting individual differences in adaptive functioning, relative to the influence of ASD severity, chronological age (CA), and developmental level. Poor self-regulation was unrelated to CA, developmental level, and severity of ADOS-2 restricted and repetitive behaviors, but was associated with lower ADOS-2 social affect severity. Hierarchical regression identified poor self-regulation as a unique independent predictor of adaptive behavior, with more severe dysregulation predicting poorer adaptive functioning. Results highlight the importance of early identification of deficits in self-regulation, and more specifically, of the utility of DP, when designing individually tailored treatments for young children with ASD. Autism Res 2018. © 2018 International Society for Autism Research, Wiley Periodicals, Inc.This study explored the relationship between poor self-regulation and age, verbal and non-verbal developmental level, severity of autism symptoms and adaptive functioning in 107 children with autism under 4 years of age. Poor self-regulation was unrelated to age, developmental level, and severity of restricted and repetitive behaviors but was associated with lower social affect severity. Importantly, more severe self-regulation deficits predicted poorer adaptive functioning.

    View details for PubMedID 29624924

  • Brief report: Cross-sectional interactions between expressive suppression and cognitive reappraisal and its relationship with depressive symptoms in autism spectrum disorder Research in Autism Spectrum Disorders Cai, R., Richdale, A. L., Foley, K., Trollor, J., Uljarević, M. 2018; 45: 1-8
  • Understanding depression and thoughts of self-harm in autism: A potential mechanism involving loneliness Research in Autism Spectrum Disorders Hedley, D., Uljarević, M., Wilmot, M., Richdale, A. L., Dissanayake, C. 2018; 46: 1-7
  • Predictors of Mental Health in Chinese Parents of Children with Autism Spectrum Disorder (ASD). Journal of autism and developmental disorders Su, X., Cai, R. Y., Uljarević, M. 2017

    Abstract

    The aim of this study was to explore the influence of parental intolerance of Uncertainty (IU), sensory sensitivity (SS) and Broader Autism Phenotype (BAP), as well as the severity of their children's autism symptoms and co-morbid symptoms, on the mental health of Chinese parents of children with autism spectrum disorder (ASD). One hundred and twenty-two parents (86.9% mothers; M age = 35.64 years, SD = 4.21) of children with ASD took part. Regression and mediation analyses showed that children's internalizing difficulties, parental BAP and IU had a direct effect, and SS had an indirect effect through IU, on parental mental health. We did not find a significant relationship between parental mental health and children's ASD severity. Our findings emphasise the need to focus on parental traits when considering their well-being and mental health, and have implications for the design of evidence-based services to support the needs of parents.

    View details for DOI 10.1007/s10803-017-3364-1

    View details for PubMedID 29127642

  • Language profiles in young children with autism spectrum disorder: A community sample using multiple assessment instruments. Autism : the international journal of research and practice Nevill, R., Hedley, D., Uljarević, M., Sahin, E., Zadek, J., Butter, E., Mulick, J. A. 2017: 1362361317726245

    Abstract

    This study investigated language profiles in a community-based sample of 104 children aged 1-3 years who had been diagnosed with autism spectrum disorder using Diagnostic and Statistical Manual of Mental Disorders (5th ed.) diagnostic criteria. Language was assessed with the Mullen scales, Preschool Language Scale, fifth edition, and Vineland-II parent-report. The study aimed to determine whether the receptive-to-expressive language profile is independent from the assessment instrument used, and whether nonverbal cognition, early communicative behaviors, and autism spectrum disorder symptoms predict language scores. Receptive-to-expressive language profiles differed between assessment instruments and reporters, and Preschool Language Scale, fifth edition profiles were also dependent on developmental level. Nonverbal cognition and joint attention significantly predicted receptive language scores, and nonverbal cognition and frequency of vocalizations predicted expressive language scores. These findings support the administration of multiple direct assessment and parent-report instruments when evaluating language in young children with autism spectrum disorder, for both research and in clinical settings. Results also support that joint attention is a useful intervention target for improving receptive language skills in young children with autism spectrum disorder. Future research comparing language profiles of young children with autism spectrum disorder to children with non-autism spectrum disorder developmental delays and typical development will add to our knowledge of early language development in children with autism spectrum disorder.

    View details for DOI 10.1177/1362361317726245

    View details for PubMedID 29126347

  • Prenatal maternal stress events and phenotypic outcomes in Autism Spectrum Disorder. Autism research : official journal of the International Society for Autism Research Varcin, K. J., Alvares, G. A., Uljarević, M., Whitehouse, A. J. 2017; 10 (11): 1866-1877

    Abstract

    There is significant heterogeneity amongst individuals with Autism Spectrum Disorder (ASD) in symptom presentation and severity. An understanding of the factors that contribute to and modulate symptom severity are critical to informing prognosis, stratification, and treatment decisions. Maternal prenatal stress exposure is a nonspecific risk factor for a wide array of neurodevelopmental outcomes in subsequent offspring. Emerging evidence suggests that prenatal maternal stress may increase ASD risk and contribute to variability in autism-like traits in the general population. In the current study, we aimed to determine whether prenatal maternal exposure to stressful life events is associated with symptom severity amongst individuals with ASD. We performed multiple regression analyses to examine associations between retrospectively recalled maternal prenatal stressful life events and the severity of ASD-associated symptoms in 174 children with ASD (Mage = 9.09 years; SD = 3.81). ASD-related symptom severity was measured using the Social Responsiveness Scale and communication abilities were measured using the Children's Communication Checklist. Exposure to prenatal stressful life events was a significant predictor of ASD-related symptom severity (t = 2.014; P = .048) and communication abilities (t = -2.925; P = .004) amongst children with ASD, even after controlling for a range of sociodemographic and obstetric variables. Follow-up analyses demonstrated significant increases in symptom severity only in the context of multiple (two or more) prenatal stressful life events. Together, these findings indicate that ASD, in the context of prenatal maternal stress exposure, may be associated with a more severe phenotype, particularly when there are multiple prenatal exposures. Autism Res 2017, 10: 1866-1877. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.There is emerging evidence that prenatal maternal stress may increase the risk for Autism Spectrum Disorder (ASD) and contribute to variability in autism-like traits in the general population. Here, we found that more stressful life events experienced during pregnancy was associated with more severe ASD-related symptoms and poorer communication abilities amongst children with ASD. The results from this study suggest that prenatal maternal stress exposure and its sequelae may contribute to variability in symptom severity amongst children with ASD.

    View details for DOI 10.1002/aur.1830

    View details for PubMedID 28681538

  • Brief Report: Social Support, Depression and Suicidal Ideation in Adults with Autism Spectrum Disorder. Journal of autism and developmental disorders Hedley, D., Uljarević, M., Wilmot, M., Richdale, A., Dissanayake, C. 2017; 47 (11): 3669-3677

    Abstract

    Adults with autism spectrum disorder (ASD) are at increased risk of suicide compared to the general population. Research has yet to identify the mechanisms underlying this increased risk. This study examined perceived social support as a potential protective factor for depressive symptoms and suicidal ideation in 76 adults with ASD. Twenty-five percent of participants were in the clinical range for depression, and 20% reported recent suicidal ideation. Social support in the form of appraisal and belonging was not associated with depression or ideation; however the perceived availability of tangible (material) support indirectly acted on ideation through depression. The findings suggest that tangible support, but not appraisal or belonging, may act as an indirect protective factor against suicidality in ASD.

    View details for DOI 10.1007/s10803-017-3274-2

    View details for PubMedID 28861661

  • Dimensional assessment of schizotypal, psychotic, and other psychiatric traits in children and their parents: development and validation of the Childhood Oxford-Liverpool Inventory of Feelings and Experiences on a representative US sample. Journal of child psychology and psychiatry, and allied disciplines Evans, D. W., Lusk, L. G., Slane, M. M., Michael, A. M., Myers, S. M., Uljarević, M., Mason, O., Claridge, G., Frazier, T. 2017

    Abstract

    Healthy functioning relies on a variety of perceptual, cognitive, emotional, and behavioral abilities that are distributed throughout the normal population. Variation in these traits define the wide range of neurodevelopmental (NDD) and neuropsychiatric (NPD) disorders. Here, we introduce a new measure for assessing these traits in typically developing children and children at risk for NDD and NPD from age 2 to 18 years.The Childhood Oxford-Liverpool Inventory of Feelings and Experiences (CO-LIFE) was created as a dimensional, parent-report measure of schizotypal and psychotic traits in the general population. Parents of 2,786 children also self-reported on an adapted version of the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE-US).The CO-LIFE resulted in continuous distributions for the total score and for each of three factor analytically-derived subscales. Item response theory (IRT) analyses indicated strong reliability across the score range for the O-LIFE-US and the CO-LIFE. Internal consistency and test-retest reliability were high across all scales. Parent-child intraclass correlations were consistent with high heritability. The scales discriminated participants who reported a lifetime psychiatric diagnosis from those who reported no diagnosis. The O-LIFE-US and CO-LIFE scores correlated positively with the Social Responsiveness Scale 2 (SRS-2) indicating good convergent validity.Like the original O-LIFE, the O-LIFE-US and the CO-LIFE are valid and reliable tools that reflect the spectrum of psychiatric and schizotypal traits in the general population. Such scales are necessary for conducting family studies that aim to examine a range of psychological and behavioral traits in both children and adults and are well-suited for the Research Domain Criteria (RDoC) initiative of the NIMH.

    View details for DOI 10.1111/jcpp.12827

    View details for PubMedID 29083029

  • Brief Report: Inter-Relationship between Emotion Regulation, Intolerance of Uncertainty, Anxiety, and Depression in Youth with Autism Spectrum Disorder. Journal of autism and developmental disorders Cai, R. Y., Richdale, A. L., Dissanayake, C., Uljarević, M. 2017

    Abstract

    The aim of this study was to examine the inter-relationship between emotion regulation (ER), intolerance of uncertainty (IU), and symptoms of anxiety and depression in adolescents and young adults diagnosed with autism spectrum disorder (ASD). Sixty-one individuals aged 14-24 years (M age = 18.19; SD age = 2.19) completed the ER Questionnaire, IU Scale-12, Diagnostic and Statistical Manual of Mental Disorders-5 Dimensional Anxiety Scales, Patient Health Questionnaire-9, and Autism-Spectrum Quotient-Short. Correlation and mediation analyses were conducted. Results indicated all key variables were associated with each other and IU mediated the relationships between ER and symptoms of anxiety and of depression. Findings have implications for the design of future interventions targeting affective disorders in ASD.

    View details for DOI 10.1007/s10803-017-3318-7

    View details for PubMedID 28980172

  • Development of restricted and repetitive behaviors from 15 to 77 months: Stability of two distinct subtypes? Developmental psychology Uljarević, M., Arnott, B., Carrington, S. J., Meins, E., Fernyhough, C., McConachie, H., Le Couteur, A., Leekam, S. R. 2017; 53 (10): 1859-1868

    Abstract

    A community sample of 192 parents reported on their children's restricted and repetitive behaviors (RRBs) at mean ages 15 months (N = 138), 26 months (N = 191), and 77 months (N = 125) using the Repetitive Behavior Questionnaire-2 (RBQ-2). Consistent with previous factor analytic research, 2 factors were found at each age: 1 comprising repetitive sensory and motor behaviors (RSM), and the other comprising insistence on sameness behaviors including rigidity, routines, and restricted interests (IS). Regression analyses indicated that RSM and IS subtypes develop independently. RSM at 77 months was predicted only by RSM behaviors at 26 months and not by IS behaviors at either 15 or 26 months nor by RSM behaviors at 15 months. IS at 77 months was predicted by IS behaviors at both 15 and 26 months, but not by RSM behaviors at either 15 or 26 months. Our findings provide evidence that there is stability of 2 independent subtypes of RRBs, RSM and IS, across early childhood and that these subtypes develop independently of each other. (PsycINFO Database Record

    View details for DOI 10.1037/dev0000324

    View details for PubMedID 28758781

  • The Hospital Anxiety and Depression scale: Factor structure and psychometric properties in older adolescents and young adults with autism spectrum disorder. Autism research : official journal of the International Society for Autism Research Uljarević, M., Richdale, A. L., McConachie, H., Hedley, D., Cai, R. Y., Merrick, H., Parr, J. R., Le Couteur, A. 2017

    Abstract

    Despite the high frequency of anxiety and depression symptoms in individuals with Autism Spectrum Disorder (ASD) and a significant impact of these comorbidities on both individuals with ASD and their families, research on the validity of anxiety and depression measures in the ASD population is currently lacking. The aim of this study was to explore the psychometric properties of the Hospital Anxiety and Depression Scale [HADS; Zigmond & Snaith, ] in a sample of older adolescents and young adults with ASD. One hundred and fifty one participants (UK Transition longitudinal study: N = 106; 75 males, Mage  = 16.04 years, SD = 1.28; Longitudinal Study of Australian Schools Leavers with ASD: N = 45, 30 males; Mage  = 18.35 years, SD = 2.55) completed the HADS and a range of mental health and well-being measures. Combination of the Principal Component Analysis and Parallel Analysis indicated two factors as an optimal solution in our sample, accounting for 43.77% of variance with factors being identical in terms of content with the structure found in the general population. Internal consistency was good for the HADS anxiety scale (HADS-A; .82-.84) and acceptable for the HADS depression scale (HADS-D; .60-.72). Convergent validity of both HADS-A and HADS-D scales was excellent and divergent validity was acceptable. Our study represents a significant contribution to the literature by providing an initial validation of the HADS in older adolescents and younger adults with ASD. Autism Res 2017. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.Research on the validity of measurement of anxiety and depression in ASD is currently lacking. The aim of this study was to explore the properties of the Hospital Anxiety and Depression Scale (HADS) in a sample of 151 young people with ASD. Participants completed HADS and a range of mental health and well-being measures. Encouragingly, our findings suggest that HADS provides a reliable and valid assessment of anxiety and depression in ASD.

    View details for DOI 10.1002/aur.1872

    View details for PubMedID 28922575

  • The measurement properties of the spence children's anxiety scale-parent version in a large international pooled sample of young people with autism spectrum disorder. Autism research Magiati, I., Lerh, J. W., Hollocks, M. J., Uljarevic, M., Rodgers, J., McConachie, H., Ozsivadjian, A., South, M., Van Hecke, A., Hardan, A., Libove, R., Leekam, S., Simonoff, E. 2017

    Abstract

    Anxiety-related difficulties are common in ASD, but measuring anxiety reliably and validly is challenging. Despite an increasing number of studies, there is no clear agreement on which existing anxiety measure is more psychometrically sound and what is the factor structure of anxiety in ASD. The present study examined the internal consistency, convergent, divergent, and discriminant validity, as well as the factor structure of the Spence Children's Anxiety Scale-Parent Version (SCAS-P), in a large international pooled sample of 870 caregivers of youth with ASD from 12 studies in the United Kingdom, United States, and Singapore who completed the SCAS-P. Most were community recruited, while the majority had at least one measure of ASD symptomatology and either cognitive or adaptive functioning measures completed. Existing SCAS-P total scale and subscales had excellent internal consistency and good convergent, divergent and discriminant validity similar to or better than SCAS-P properties reported in typically developing children, except for the poorer internal consistency of the physical injury subscale. Confirmatory Factor Analysis (CFA) of the existing SCAS-P six-correlated factor structure was a poor fit for this pooled database. Principal component analysis using half of the pooled sample identified a 30-item five correlated factor structure, but a CFA of this PCA-derived structure in the second half of this pooled sample revealed a poor fit, although the PCA-derived SCAS-P scale and subscales had stronger validity and better internal consistency than the original SCAS-P. The study's limitations, the use of the SCAS-P to screen for DSM-derived anxiety problems in ASD and future research directions are discussed. Autism Res 2017. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

    View details for DOI 10.1002/aur.1809

    View details for PubMedID 28574646

  • Heterogeneity of sensory features in autism spectrum disorder: Challenges and perspectives for future research. Autism research Uljarevic, M., Baranek, G., Vivanti, G., Hedley, D., Hudry, K., Lane, A. 2017; 10 (5): 703-710

    Abstract

    Pronounced heterogeneity is apparent across every facet of autism spectrum disorder (ASD) and it remains difficult to predict likely future potential among individuals who share a common diagnosis of ASD on the basis of early presentation. In this commentary we argue that a fine-grained understanding of individual differences in sensory features and their influence across the life span can constrain noted clinical heterogeneity in ASD. We organize our discussion around the following three critical themes: (a) considering sensory features as dimensional construct; (b) taking an "individual differences" approach; and (c) adopting a comprehensive, multidimensional and multimodal approach to measurement of sensory features. We conclude that future research will need to investigate individual differences in sensory features via: (1) multidimensional and cross-disciplinary examination, (2) prospective longitudinal designs, and (3) dimensional and developmental frameworks that emphasize the potential value of early individual variability as indicators of later outcomes, not only in relation to the categorical diagnostic outcome status but also the presence of other clinical features. This is a key time for sensory-related research and in this commentary we provide some of the steps that, in our opinion, can shape future research in this area. Autism Res 2017, 10: 703-710. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

    View details for DOI 10.1002/aur.1747

    View details for PubMedID 28266796

  • Relationship between early motor milestones and severity of restricted and repetitive behaviors in children and adolescents with autism spectrum disorder. Autism research Uljarevic, M., Hedley, D., Alvares, G. A., Varcin, K. J., Whitehouse, A. J. 2017

    Abstract

    This study explored the relationships between the later age of achievement of early motor milestones, current motor atypicalities (toe walking), and the severity of restricted and repetitive behaviors (RRBs) in individuals with autism spectrum disorder (ASD). Parents of 147 children and adolescents with ASD (Mage  = 8.09 years, SD = 4.28; 119 males) completed an early developmental milestones questionnaire and the Social Responsiveness Scale as a measure of Insistence on Sameness (IS) and Repetitive Mannerisms (RM). Two hierarchical regression analyses were conducted to test whether RM and IS behaviors were predicted by early motor milestones, or current toe walking. The final model predicting RM accounted for 15% of the variance (F = 3.02, p = .009), with toe walking as a unique and independent predictor of RM scores (t = 3.568, p = .001). The final model predicting IS accounted for 19.1% of variance in IS scores (F = 4.045, p = .001), with chronological age (CA) (t = 2.92, p = .004), age when first standing (t = 2.09, p = .038), and toe walking (t = 2.53, p = .013) as unique independent predictors. Toe walking (t = 2.4, p = .018) and age when first sitting (t = 2.08, p = .04) predicted the severity of RRBs on the Autism Diagnostic Observation Schedule (F = 2.334, p = .036). Our study replicates previous findings on the relationship between concurrent motor impairments and RRBs, and provides the first evidence for the association between RRBs and age of attainment of early motor milestones. Autism Res 2017. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. Autism Res 2017, 10: 1163-1168. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

    View details for DOI 10.1002/aur.1763

    View details for PubMedID 28301081

  • Transition to work: Perspectives from the autism spectrum. Autism Hedley, D., Cai, R., Uljarevic, M., Wilmot, M., Spoor, J. R., Richdale, A., Dissanayake, C. 2017: 1362361316687697-?

    Abstract

    To improve employment outcomes for adults with autism spectrum disorder, it is necessary to identify factors associated with successful transition to work from the perspectives of the individual and from those who work with or support them. This study involved focus groups with adults with autism spectrum disorder ( n = 9) participating in a 3-year employment and training programme, as well as focus groups with family members ( n = 6), support staff ( n = 7) and co-workers ( n = 6). The aim was to gain better understanding of the experience of transition to work, barriers and also the factors that promote workplace success. Main themes included factors that facilitated success at work ( Enablers), barriers to success ( Challenges) and programme outcomes ( Outcomes). Organisation support, advice from co-workers, supportive leadership, allowance of environmental modifications and presence of a consultant were identified as enablers that most facilitated success at work. Challenges included task-related difficulties, individual factors, social difficulties and distractibility, not managing work-related stress, and being perceived to be too frank. Outcomes were rated as positive and encompassed work-related outcomes, as well as outcomes related to sense of purpose, achieving personal independence and improvements in social relationships, both with work colleagues and within families.

    View details for DOI 10.1177/1362361316687697

    View details for PubMedID 28387577

  • Relationship between repetitive behaviour and fear across normative development, autism spectrum disorder, and down syndrome. Autism research Uljarevic, M., Evans, D. W. 2017; 10 (3): 502-507

    Abstract

    The present study had two aims: first to compare levels of restricted and repetitive behaviours (RRB) across two groups of typically developing (TD) children, and two disorders: Autism Spectrum Disorder (ASD) and Down syndrome (DS), and second to explore the relationship between fear and repetitive behaviours in these four groups. Parents of 41 offspring with ASD (Mage  = 123.39 months, SDage  = 27.67), 38 offspring with DS (Mage  = 125.37 months, SDage  = 45.71), 45 typically developing children matched to the mental age (MA) of the DS group (TD MA; Mage  = 51.13 months, SDage  = 22.1), and 42 chronological age (TD CA; Mage  = 117.93 months, SDage  = 22.91) matched TD children, completed measures of RRB and fear. ANOVAs revealed differences across the four groups on the RRB subscale scores: "Just Right" F(3,162) = 16.62, P < 0.001; Rigid Routines F(3,162) = 52.76, P < 0.001; Sensory behaviours F(3,162) = 23.26, P < 0.001. Post-hoc comparisons revealed that children with ASD had the highest RRB levels followed by DS, TD MA, and TD CA children. In children with ASD, higher levels of fear were related to higher RRB levels. Similar, albeit less strong, patterns of associations was found among DS and TD MA children but not in older TD CA children. This study provided evidence of a fear-RRB association in children with ASD, DS, and two groups of TD children. Autism Res 2017, 10: 502-507. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

    View details for DOI 10.1002/aur.1674

    View details for PubMedID 27459229

  • Relationship between repetitive behaviour and fear across normative development, autism spectrum disorder, and down syndrome AUTISM RESEARCH Uljarevic, M., Evans, D. W. 2017; 10 (3): 502-507

    View details for DOI 10.1002/aur.1674

    View details for Web of Science ID 000398544600009

  • Attention to novelty versus repetition: Contrasting habituation profiles in Autism and Williams syndrome. Developmental cognitive neuroscience Vivanti, G., Hocking, D. R., Fanning, P. A., Uljarevic, M., Postorino, V., Mazzone, L., Dissanayake, C. 2017

    Abstract

    Abnormalities in habituation have been documented in Autism Spectrum Disorder (ASD) and Williams syndrome (WS). Such abnormalities have been proposed to underlie the distinctive social and non-social difficulties that define ASD, including sensory features and repetitive behaviours, and the distinctive social phenotype characterizing WS.We measured habituation in 39 preschoolers with ASD, 20 peers with WS and 19 typically developing (TD) children using an eye-tracking protocol that measured participants' duration of attention in response to a repeating stimulus and a novel stimulus presented side by side across multiple trials.Participants in the TD group and the WS group decreased their attention toward the repeating stimulus and increased their attention to the novel stimulus over time. Conversely, the ASD group showed a similar attentional response to the novel and repeating stimuli. Habituation was correlated with social functioning in the WS but not in the ASD group. Contrary to predictions, slower habituation in ASD was associated with lower severity of repetitive behaviours.Habituation appears to be intact in WS and impaired in ASD. More research is needed to clarify the nature of the syndrome-specific patterns of correlations between habituation and social and non-social functioning in these neurodevelopmental disorders.

    View details for DOI 10.1016/j.dcn.2017.01.006

    View details for PubMedID 28130077

  • Interrelationship between insistence on sameness, effortful control and anxiety in adolescents and young adults with autism spectrum disorder (ASD) Molecular Autism Uljarević, M., Richdale, A. L., Evans, D. W., Cai, R., Leekam, S. R. 2017; 8: 36
  • Initiatives that diminish the biases of recruiters against people who disclose or demonstrate a diagnosed mental disorder Equality, Diversity and Inclusion: An International Journal Moss, S., Vemuri, S., Hedley, D., Uljarević, M. 2017; 36 (1): 2-16

    View details for DOI 10.1108/EDI-05-2016-0037

  • Development of Two Dimensional Measures of Restricted and Repetitive Behavior in Parents and Children JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Evans, D. W., Uljarevic, M., Lusk, L. G., Loth, E., Frazier, T. 2017; 56 (1): 51-58

    Abstract

    Restricted and repetitive behaviors (RRBs) are a heterogeneous set of behaviors common across a wide range of neurodevelopmental disorders (NDDs) and neuropsychiatric disorders (NPDs) that extend well into the general population. This study introduces 2 dimensional measurements of RRBs for use in typical and clinical populations from infancy to adulthood.The Childhood Routines Inventory-Revised (CRI-R) and the Adult Routines Inventory (ARI) were created and administered online to a nationally representative cohort of 3,108 parents with 3,032 children (range 12 months to 17 years 11 months). Twenty-six percent of children and 36% of adults had at least 1 NDD or NPD.Principal axis factoring exploratory analysis showed a 2-factor structure for the 2 instruments (motor behaviors/compulsions and rigidity/insistence on sameness). Analyses for convergent and discriminant validity, internal consistency (Cronbach α ≥ 0.94), and test-retest reliability (r ≥ 0.87) indicated strong psychometric properties. Item response theory analyses indicated strong reliability across the score range for the 2 instruments. RRB rates varied across development, peaking between the preschool and school years. Children with NDDs or NPDs (particularly those with autism spectrum disorder, schizophrenia/bipolar disorder, or obsessive-compulsive disorder/tic disorders) had increased RRBs compared with those with no diagnosis. Parent-child (0.69-0.84) and sibling-sibling (0.76-0.87) intraclass correlations indicated high heritability. Children of parents with an NDD or an NPD exhibited more RRBs compared with children of parents without NDDs or NPDs.The CRI-R and ARI are open-source instruments with excellent psychometric properties and will be useful for developmental, clinical, and family genetic studies and for the identification of prodromal conditions involving RRBs.

    View details for DOI 10.1016/j.jaac.2016.10.014

    View details for Web of Science ID 000390974600008

    View details for PubMedID 27993229

  • Employment and Living with Autism: Personal, Social and Economic Impact Inclusion, Disability and Culture. Inclusive Learning and Educational Equity Hedley, D., Uljarević, M., Hedley, D. F. Springer. 2017: 295–311
  • Neural substrates of a schizotypal spectrum in typically-developing children: Further evidence of a normal-pathological continuum BEHAVIOURAL BRAIN RESEARCH Evans, D. W., Michael, A. M., Ularevic, M., Lusk, L. G., Buirkle, J. M., Moore, G. J. 2016; 315: 141-146

    Abstract

    Schizophrenia represents the extreme end of a distribution of traits that extends well into the general population. Using a recently developed measure of psychotic-like traits in children, we examined the neural substrates of psychotic (and other psychiatric) symptoms using structural magnetic resonance imaging (MRI). Twenty-eight typically-developing children (14 males) between the ages of 6-17 years underwent a 3T MRI scan. Parents completed the Psychiatric and Schizotypal Inventory for Children. Results revealed that caudate, amygdala, hippocampal and middle temporal gyrus volumes were associated with quantitative dimensions of psychiatric traits. Furthermore, results suggest a differential a sexually-dimorphic pattern of brain-schizotypy associations. These findings highlight brain-behavior continuities between clinical conditions such as schizophrenia and normal trait variation in typical development.

    View details for DOI 10.1016/j.bbr.2016.08.034

    View details for Web of Science ID 000383942000016

    View details for PubMedID 27555534

  • ADOS-2 Toddler and Module 1 standardized severity scores as used by community practitioners RESEARCH IN AUTISM SPECTRUM DISORDERS Hedley, D., Nevill, R., Uljarevic, M., Butter, E., Mulick, J. A. 2016; 32: 84-95
  • Practitioner Review: Multilingualism and neurodevelopmental disorders - an overview of recent research and discussion of clinical implications JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY Uljarevic, M., Katsos, N., Hudry, K., Gibson, J. L. 2016; 57 (11): 1205-1217

    Abstract

    Language and communication skills are essential aspects of child development, which are often disrupted in children with neurodevelopmental disorders. Cutting edge research in psycholinguistics suggests that multilingualism has potential to influence social, linguistic and cognitive development. Thus, multilingualism has implications for clinical assessment, diagnostic formulation, intervention and support offered to families. We present a systematic review and synthesis of the effects of multilingualism for children with neurodevelopmental disorders and discuss clinical implications.We conducted systematic searches for studies on multilingualism in neurodevelopmental disorders. Keywords for neurodevelopmental disorders were based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition categories as follows; Intellectual Disabilities, Communication Disorders, Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder, Specific Learning Disorder, Motor Disorders, Other Neurodevelopmental Disorders. We included only studies based on empirical research and published in peer-reviewed journals.Fifty studies met inclusion criteria. Thirty-eight studies explored multilingualism in Communication Disorders, 10 in ASD and two in Intellectual Disability. No studies on multilingualism in Specific Learning Disorder or Motor Disorders were identified. Studies which found a disadvantage for multilingual children with neurodevelopmental disorders were rare, and there appears little reason to assume that multilingualism has negative effects on various aspects of functioning across a range of conditions. In fact, when considering only those studies which have compared a multilingual group with developmental disorders to a monolingual group with similar disorders, the findings consistently show no adverse effects on language development or other aspects of functioning. In the case of ASD, a positive effect on communication and social functioning has been observed.There is little evidence to support the widely held view that multilingual exposure is detrimental to the linguistic or social development of individuals with neurodevelopmental disorders. However, we also note that the available pool of studies is small and the number of methodologically high quality studies is relatively low. We discuss implications of multilingualism for clinical management of neurodevelopmental disorders, and discuss possible directions for future research.

    View details for DOI 10.1111/jcpp.12596

    View details for Web of Science ID 000387125800002

    View details for PubMedID 27443172

  • Brief Report: Empathic Responsiveness of High Functioning Children with Autism to Expressed and Anticipated Distress JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS Newbigin, A., Uljarevic, M., Vivanti, G., Dissanayake, C. 2016; 46 (10): 3338-3343

    Abstract

    The majority of studies that have investigated empathic responsiveness of individuals with Autism spectrum disorder (ASD) have used heterogeneous groups in terms of age, cognitive level and gender which significantly impact the results. Our aim in this study was to explore responsiveness of a more homogenous sample of 21 children with ASD and 17 typically developing controls, aged 8-12 years to both overt (or expressed) and anticipated distress. In the anticipated distress task, groups were not differentiated in their response towards the experimenter who had her drawing torn. In the expressed distress task, groups were again similar in expressing concern and acting prosocially towards an experimenter who pretended to lose her watch. The theoretical and clinical implications of these findings are discussed.

    View details for DOI 10.1007/s10803-016-2862-x

    View details for Web of Science ID 000386783300013

    View details for PubMedID 27436192

  • Sensory subtypes and anxiety in older children and adolescents with autism spectrum disorder AUTISM RESEARCH Uljarevic, M., Lane, A., Kelly, A., Leekam, S. 2016; 9 (10): 1073-1078

    Abstract

    This study aimed to identify sensory subtypes in older children and adolescents with Autism Spectrum Disorders (ASD) and examine the relationship of sensory subtypes with anxiety levels in this group. Mothers of 57 children and adolescents with ASD aged 11-17 years (Mean age = 14 years. 2.4 months, SD = 1.81) completed the short sensory profile and Spence anxiety scales. Model-based cluster analysis was applied to sensory profile scores to identify sensory subtypes. Three sensory subtypes, sensory adaptive (N = 19), sensory moderate (N = 29) and sensory severe (N = 9) were identified. The results indicated that the differences between the subtypes were well characterised by the severity of sensory symptoms and were not attributable to sensory modality or varying types of sensory-related behaviors. Children and adolescents from the adaptive subtype had significantly lower anxiety scores when compared with other two subtypes. There were no differences between subtypes based on chronological age, expressive language, or severity of autism diagnostic features as measured by the social communication questionnaire (SCQ total score). This is the first study to identify the existence of sensory subtypes among older children and adolescents with ASD and explore their association with anxiety levels. Autism Res 2016, 9: 1073-1078. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

    View details for DOI 10.1002/aur.1602

    View details for Web of Science ID 000386576100005

    View details for PubMedID 26765165

  • Treatment-related changes in children's communication impact on maternal satisfaction and psychological distress RESEARCH IN DEVELOPMENTAL DISABILITIES Ozturk, Y., Vivanti, G., Uljarevic, M., Dissanayake, C. 2016; 56: 128-138

    Abstract

    Parents of children with autism have been found to have reduced psychological well-being that has usually been linked to the stress related to managing their child's symptoms. As children's behavior and cognitive functioning are subject to change when suitable early intervention programs are put in place, it is plausible that positive treatment-related changes in the child will have a positive impact on parental distress.We undertook an individual differences study to investigate whether maternal psychological distress is affected by the outcomes of children receiving intervention.The participants comprised 43 mothers of preschool children with ASD enrolled in an early intervention program for 12 months.Child and family factors were linked to maternal psychological distress. However treatment-related changes in children's communication, as assessed on the Vineland Adaptive Behavior Scales II, and parenting satisfaction uniquely contributed to psychological distress above and beyond other factors. A mediation analysis indicated that mothers whose children make treatment gains in communication skills experience lower levels of psychological distress as a consequence of higher levels of parenting satisfaction.The findings highlight improvements in everyday adaptive communication skills in children with ASD impact on mothers' satisfaction and distress.

    View details for DOI 10.1016/j.ridd.2016.05.021

    View details for Web of Science ID 000379370000012

    View details for PubMedID 27295207

  • Employment programmes and interventions targeting adults with autism spectrum disorder: A systematic review of the literature. Autism Hedley, D., Uljarevic, M., Cameron, L., Halder, S., Richdale, A., Dissanayake, C. 2016

    Abstract

    Individuals with autism spectrum disorder face significant challenges entering the workforce; yet research in this area is limited and the issues are poorly understood. In this systematic review, empirical peer-reviewed studies on employment programmes, interventions and employment-related outcomes in individuals with autism spectrum disorder over 18 years with and without intellectual disability were identified and evaluated. The review was prefaced by a summary of previous systematic reviews in the area. Web of Science, Medline, PsychINFO, ERIC and Scopus databases were systematically searched through to October 2015. From 32,829 records identified in the initial search, 10 review and 50 empirical articles, comprising N = 58,134 individuals with autism spectrum disorder, were included in the review. Selected articles were organised into the following themes: employment experiences, employment as a primary outcome, development of workplace skills, non-employment-related outcomes, assessment instruments, employer-focused and economic impact. Empirical studies were limited by poor participant characterisation, small sample size and/or a lack of randomisation and use of appropriate controls. Poor conceptualisation and measurement of outcomes significantly limited study quality and interpretation. Future research will require a multidisciplinary and multifaceted approach to explore employment outcomes on the individual, the family system, co-workers and the employer, along with the impact of individual differences on outcome.

    View details for PubMedID 27542395

  • The Relationship Between Clinicians' Confidence and Accuracy, and the Influence of Child Characteristics, in the Screening of Autism Spectrum Disorder JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS Hedley, D., Brewer, N., Nevill, R., Uljarevic, M., Butter, E., Mulick, J. A. 2016; 46 (7): 2340-2348

    Abstract

    The study examined the confidence accuracy relationship, and the influence of child characteristics on clinician confidence, when predicting a diagnosis of Autism Spectrum Disorder during screening of 125 referred children aged under 3.5 years. The diagnostic process included observation, interview, language and developmental testing. Clinical judgement accuracy was compared against final diagnosis for high and low confidence levels (with confidence assessed on a 0-100 % scale). We identified a significant CA relationship with predictive accuracy highest at confidence levels of 90-100 %. Parent report of unusual behaviors was the only significant independent predictor of confidence. Clinicians' confidence may be important when evaluating decisions to refer, or not to refer, children for further diagnostic assessment.

    View details for DOI 10.1007/s10803-016-2766-9

    View details for Web of Science ID 000379547700007

    View details for PubMedID 26975451

  • Short report: relationship between restricted and repetitive behaviours in children with autism spectrum disorder and their parents MOLECULAR AUTISM Uljarevic, M., Evans, D. W., Alvares, G. A., Whitehouse, A. J. 2016; 7

    Abstract

    Restricted and repetitive behaviours (RRBs) constitute a core symptom domain of autism spectrum disorder (ASD). However, the nature of RRBs in the context of the Broader Autism Phenotype (BAP) is not well understood. In particular, the relationship between RRBs in ASD probands and their parents remains largely unexplored. The current study explored the link between parental RRBs, measured via Interest in Patterns and Resistance to Changes subscales of the Autism Quotient and their children's RRBs, measured via Autism Diagnostic Observation Schedule RRB standardized domain score.Having both parents within the top 20% of their RRB scores was associated with an increase of RRB scores for their children; however, no parent-of-origin effects were identified. Although the trend was observed for both Interest in Patterns and Resistance to Changes subscale, it was only statistically significant for Interest in Patterns.This paper provides significant contribution to our understanding of association between RRBs in parents and their children with ASD. Future work should also address the BAP in distinct genetic subtypes (whole chromosome aneuploidies, single gene mutations, copy number variations) of neurodevelopmental and neuropsychiatric disorders that involve RRBs.

    View details for DOI 10.1186/s13229-016-0091-y

    View details for Web of Science ID 000380187600001

    View details for PubMedID 27303619

    View details for PubMedCentralID PMC4906972

  • Knowledge acquisition and research evidence in autism: Researcher and practitioner perspectives and engagement RESEARCH IN DEVELOPMENTAL DISABILITIES Carrington, S. J., Uljarevic, M., Roberts, A., White, L. J., Morgan, L., Wimpory, D., Ramsden, C., Leekam, S. R. 2016; 51-52: 126-134

    Abstract

    Government policy and national practice guidelines have created an increasing need for autism services to adopt an evidence-based practice approach. However, a gap continues to exist between research evidence and its application. This study investigated the difference between autism researchers and practitioners in their methods of acquiring knowledge.In a questionnaire study, 261 practitioners and 422 researchers reported on the methods they use and perceive to be beneficial for increasing research access and knowledge. They also reported on their level of engagement with members of the other professional community.Researchers and practitioners reported different methods used to access information. Each group, however, had similar overall priorities regarding access to research information. While researchers endorsed the use of academic journals significantly more often than practitioners, both groups included academic journals in their top three choices. The groups differed in the levels of engagement they reported; researchers indicated they were more engaged with practitioners than vice versa.Comparison of researcher and practitioner preferences led to several recommendations to improve knowledge sharing and translation, including enhancing access to original research publications, facilitating informal networking opportunities and the development of proposals for the inclusion of practitioners throughout the research process.

    View details for DOI 10.1016/j.ridd.2016.01.011

    View details for Web of Science ID 000370465700011

    View details for PubMedID 26826464

  • Anxiety in Autism Spectrum Disorder Psychiatric Symptoms and Comorbidities in Autism Spectrum Disorder Uljarević, M., Nuske, H. J., Vivanti, G. Springer. 2016: 21–38
  • Interventions for anxiety in school-aged children with autism spectrum disorder (ASD) Campbell Collaboration Lietz, P., Kos, J., O'Grady, E., Trevitt, J., Uljarević, M. 2016
  • Brief Report: Effects of Sensory Sensitivity and Intolerance of Uncertainty on Anxiety in Mothers of Children with Autism Spectrum Disorder JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS Uljarevic, M., Carrington, S., Leekam, S. 2016; 46 (1): 315-319

    Abstract

    This study examined the relations between anxiety and individual characteristics of sensory sensitivity (SS) and intolerance of uncertainty (IU) in mothers of children with ASD. The mothers of 50 children completed the Hospital Anxiety and Depression Scale, the Highly Sensitive Person Scale and the IU Scale. Anxiety was associated with both SS and IU and IU was also associated with SS. Mediation analyses showed direct effects between anxiety and both IU and SS but a significant indirect effect was found only in the model in which IU mediated between SS. This is the first study to characterize the nature of the IU and SS interrelation in predicting levels of anxiety.

    View details for DOI 10.1007/s10803-015-2557-8

    View details for Web of Science ID 000367883500028

    View details for PubMedID 26254895

  • The Adult Repetitive Behaviours Questionnaire-2 (RBQ-2A): A Self-Report Measure of Restricted and Repetitive Behaviours JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS Barrett, S. L., Uljarevic, M., Baker, E. K., Richdale, A. L., Jones, C. R., Leekam, S. R. 2015; 45 (11): 3680-3692

    Abstract

    In two studies we developed and tested a new self-report measure of restricted and repetitive behaviours (RRB) suitable for adults. In Study 1, The Repetitive Behaviours Questionnaire-2 for adults (RBQ-2A) was completed by a sample of 163 neurotypical adults. Principal components analysis revealed two components: Repetitive Motor Behaviours and Insistence on Sameness. In Study 2, the mean RBQ-2A scores of a group of adults with autism spectrum disorder (ASD; N = 29) were compared to an adult neurotypical group (N = 37). The ASD sample had significantly higher total and subscale scores. These results indicate that the RBQ-2A has utility as a self-report questionnaire measure of RRBs suitable for adults, with potential clinical application.

    View details for DOI 10.1007/s10803-015-2514-6

    View details for Web of Science ID 000363066900025

    View details for PubMedID 26155763

    View details for PubMedCentralID PMC4608982

  • The effects of bilingual exposure for children with autism spectrum disorders: Current knowledge and future directions Bilingual Landscape of the Contemporary World Hudry, K., Uljarević, M., Rumney, L., Porter, N., Kam, R. Peter Lang. 2015
  • First evidence of sensory atypicality in mothers of children with Autism Spectrum Disorder (ASD) MOLECULAR AUTISM Uljarevic, M., Prior, M. R., Leekam, S. R. 2014; 5

    Abstract

    Atypical reactions to sensory stimuli show heritability in the general population and are a known risk factor for affective disorders. As sensory problems are highly prevalent in individuals with ASD and their siblings, and the occurrence of affective disorders is elevated in parents of children with ASD, investigating sensory symptoms in parents is important both from clinical and theoretical standpoints.Fifty mothers of children and adolescents with ASD completed the Adolescent and Adult Sensory Profile (AASP). The AASP is a norm-referenced questionnaire that provides scores for four types of responses to sensory stimuli (sensory quadrants): hypo-sensitivity, hyper-sensitivity, sensation seeking, and sensory avoiding.Mothers' scores were compared with AASP norms. Ninety eight percent of mothers had sensory scores at least one standard deviation (SD) above the normative mean and 44% were two or more SDs above the mean for at least one sensory quadrant.This study provides the first evidence for sensory atypicality in parents of children with ASD. Further research is needed to elucidate the contribution of genetic and environmental influences on the expression of sensory problems in ASD.

    View details for DOI 10.1186/2040-2392-5-26

    View details for Web of Science ID 000334719600001

    View details for PubMedID 24694290

    View details for PubMedCentralID PMC3975853

  • Relations among restricted and repetitive behaviors, anxiety and sensory features in children with autism spectrum disorders RESEARCH IN AUTISM SPECTRUM DISORDERS Lidstone, J., Uljarevic, M., Sullivan, J., Rodgers, J., McConachie, H., Freeston, M., Le Couteur, A., Prior, M., Leekam, S. 2014; 8 (2): 82-92
  • Imitating the Child with Autism: A Strategy for Early Intervention? Autism Lidstone, J., Uljarević, M., Kanaris, H., Mullis, J., Fasoli, L., Leekam, S. 2014; 4:124
  • Recognition of Emotions in Autism: A Formal Meta-Analysis JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS Uljarevic, M., Hamilton, A. 2013; 43 (7): 1517-1526

    Abstract

    Determining the integrity of emotion recognition in autistic spectrum disorder is important to our theoretical understanding of autism and to teaching social skills. Previous studies have reported both positive and negative results. Here, we take a formal meta-analytic approach, bringing together data from 48 papers testing over 980 participants with autism. Results show there is an emotion recognition difficulty in autism, with a mean effect size of 0.80 which reduces to 0.41 when a correction for publication bias is applied. Recognition of happiness was only marginally impaired in autism, but recognition of fear was marginally worse than recognition of happiness. This meta-analysis provides an opportunity to survey the state of emotion recognition research in autism and to outline potential future directions.

    View details for DOI 10.1007/s10803-012-1695-5

    View details for Web of Science ID 000320507200003

    View details for PubMedID 23114566

  • Restricted and Repetitive Behaviors in Autism Spectrum Disorders: A Review of Research in the Last Decade PSYCHOLOGICAL BULLETIN Leekam, S. R., Prior, M. R., Uljarevic, M. 2011; 137 (4): 562-593

    Abstract

    Restricted and repetitive behaviors (RRBs) are a core feature of autism spectrum disorders. They constitute a major barrier to learning and social adaptation, but research on their definition, cause, and capacity for change has been relatively neglected. The last decade of research has brought new measurement techniques that have improved the description of RRBs. Research has also identified distinctive subtypes of RRBs in autism spectrum disorders. Research on potential causal origins and immediate triggers for RRBs is still at an early stage. However, promising new ideas and evidence are emerging from neurobiology and developmental psychology that identify neural adaptation, lack of environmental stimulation, arousal, and adaptive functions as key factors for the onset and maintenance of RRBs. Further research is needed to understand how these factors interact with each other to create and sustain atypical levels of RRB. The literature indicates that RRBs have the potential to spontaneously reduce across time, and this is enhanced for those with increased age and cognitive and language ability. Research on interventions is sparse. Pharmacological treatments can be helpful in some children but have adverse side effects. Behavioral intervention methods provide the better intervention option with positive effects, but a more systematic and targeted approach is urgently needed. Evidence suggests that we will learn best from the last decade of research by taking a developmental perspective, by directing future research toward subtypes of RRBs, and by implementing early intervention targeted to improve RRBs before these behaviors become entrenched.

    View details for DOI 10.1037/a0023341

    View details for Web of Science ID 000292407700003

    View details for PubMedID 21574682

  • Functions of certain brain structures in the perception and expression of emotions Godišnjak za psihologiju Uljarević, M., Nešić, M. 2008; 5 (6-7): 41-61