TL;DR: Individuals who are younger, come from a higher income family, have more parent reported social/communication problems, or engage in repetitive behaviors were more likely to demonstrate aggression.
Abstract: The prevalence of and risk factors for aggression were examined in 1,380 children and adolescents with autism spectrum disorders (ASD). Prevalence was high, with parents reporting that 68% had demonstrated aggression to a caregiver and 49% to non-caregivers. Overall, aggression was not associated with clinician observed severity of ASD symptoms, intellectual functioning, gender, marital status, parental educational level, or aspects of communication. Individuals who are younger, come from a higher income family, have more parent reported social/communication problems, or engage in repetitive behaviors were more likely to demonstrate aggression. Given the significant impact of aggression on individual and family outcomes, it is hoped that this knowledge will inform more targeted intervention efforts.
TL;DR: While the majority of high functioning children with ASD struggle with peer relationships in general education classrooms, a small percentage of them appear to have social success.
Abstract: Self, peer and teacher reports of social relationships were examined for 60 high-functioning children with ASD. Compared to a matched sample of typical children in the same classroom, children with ASD were more often on the periphery of their social networks, reported poorer quality friendships and had fewer reciprocal friendships. On the playground, children with ASD were mostly unengaged but playground engagement was not associated with peer, self, or teacher reports of social behavior. Twenty percent of children with ASD had a reciprocated friendship and also high social network status. Thus, while the majority of high functioning children with ASD struggle with peer relationships in general education classrooms, a small percentage of them appear to have social success.
TL;DR: The results indicate that IQ is a strong predictor of adaptive behavior, the gap betweenIQ and adaptive impairments decreases in lower functioning individuals with ASD, and older individuals have a greater gap between IQ and adaptive skills.
Abstract: The relationship between adaptive functioning and autism symptomatology was examined in 1,089 verbal youths with ASD examining results on Vineland-II, IQ, and measures of ASD severity. Strong positive relationships were found between Vineland subscales and IQ. Vineland Composite was negatively associated with age. IQ accounted a significant amount of the variance in overall adaptive skills (55%) beyond age and ASD severity. Individuals with ASD demonstrated significant adaptive deficits and negligible associations were found between the level of autism symptomatology and adaptive behavior. The results indicate that IQ is a strong predictor of adaptive behavior, the gap between IQ and adaptive impairments decreases in lower functioning individuals with ASD, and older individuals have a greater gap between IQ and adaptive skills.
TL;DR: In this paper, the authors apply diffusion of innovation theory to further understand why efficacious interventions for autism are rarely adopted or successfully implemented in public mental health and education systems, and pose a practical set of questions that administrators face as they decide about the use of interventions.
Abstract: There is growing evidence that efficacious interventions for autism are rarely adopted or successfully implemented in public mental health and education systems. We propose applying diffusion of innovation theory to further our understanding of why this is the case. We pose a practical set of questions that administrators face as they decide about the use of interventions. Using literature from autism intervention and dissemination science, we describe reasons why efficacious interventions for autism are rarely adopted, implemented, and maintained in community settings, all revolving around the perceived fit between the intervention and the needs and capacities of the setting. Finally, we suggest strategies for intervention development that may increase the probability that these interventions will be used in real-world settings.
TL;DR: The development and validation of an abridged version of the 50-item Autism-Spectrum Quotient, a self-report measure of autistic traits, that comprises two higher-order factors assessing ‘social behavioral difficulties’ and ‘a fascination for numbers/patterns’ is reported on.
Abstract: This study reports on the development and validation of an abridged version of the 50-item Autism-Spectrum Quotient (AQ), a self-report measure of autistic traits. We aimed to reduce the number of items whilst retaining high validity and a meaningful factor structure. The item reduction procedure was performed on data from 1,263 Dutch students and general population adults. The resulting 28-item AQ-Short was subsequently validated in 3 independent samples, both clinical and controls, from the Netherlands and the UK. The AQ-Short comprises two higher-order factors assessing ‘social behavioral difficulties’ and ‘a fascination for numbers/patterns’. The clear factor structure of the AQ-Short and its high sensitivity and specificity make the AQ-Short a useful alternative to the full 50-item version.
TL;DR: This randomized controlled study indicates that providing children with low-functioning autism and high functioning autism opportunities to practice attending to eye gaze, discriminating facial expressions and recognizing faces and emotions in FaceSay’s structured environment with interactive, realistic avatar assistants improved their social skills abilities.
Abstract: This study assessed the efficacy of FaceSay, a computer-based social skills training program for children with Autism Spectrum Disorders (ASD). This randomized controlled study (N = 49) indicates that providing children with low-functioning autism (LFA) and high functioning autism (HFA) opportunities to practice attending to eye gaze, discriminating facial expressions and recognizing faces and emotions in FaceSay’s structured environment with interactive, realistic avatar assistants improved their social skills abilities. The children with LFA demonstrated improvements in two areas of the intervention: emotion recognition and social interactions. The children with HFA demonstrated improvements in all three areas: facial recognition, emotion recognition, and social interactions. These findings, particularly the measured improvements to social interactions in a natural environment, are encouraging.
TL;DR: The RAADS-R is a useful adjunct diagnostic tool for adults with ASD and its Cronbach alpha coefficients for the subscales and 4 derived factors were good.
Abstract: The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R) is a valid and reliable instrument to assist the diagnosis of adults with Autism Spectrum Disorders (ASD). The 80-question scale was administered to 779 subjects (201 ASD and 578 comparisons). All ASD subjects met inclusion criteria: DSM-IV-TR, ADI/ADOS diagnoses and standardized IQ testing. Mean scores for each of the questions and total mean ASD vs. the comparison groups’ scores were significantly different (p < .0001). Concurrent validity with Constantino Social Responsiveness Scale-Adult = 95.59%. Sensitivity = 97%, specificity = 100%, test–retest reliability r = .987. Cronbach alpha coefficients for the subscales and 4 derived factors were good. We conclude that the RAADS-R is a useful adjunct diagnostic tool for adults with ASD.
TL;DR: The results suggest that among those with low genetic susceptibility, some maternal and obstetric factors may have an independent role in autism etiology whereas among genetically susceptible children, these factors appear to play a lesser role.
Abstract: We conducted a linked database cohort study of infants born between 1990 and 2002 in Nova Scotia, Canada. Diagnoses of autism were identified from administrative databases with relevant diagnostic information to 2005. A factor representing genetic susceptibility was defined as having an affected sibling or a mother with a history of a psychiatric or neurologic condition. Among 129,733 children, there were 924 children with an autism diagnosis. The results suggest that among those with low genetic susceptibility, some maternal and obstetric factors may have an independent role in autism etiology whereas among genetically susceptible children, these factors appear to play a lesser role. The role of pre-pregnancy obesity and excessive weight gain during pregnancy on autism risk require further investigation.
TL;DR: It is suggested that the large majority of higher-functioning children with ASD show discrepancies between actual achievement levels and levels predicted by their intellectual ability, whereas in others, they are achieving lower than expected.
Abstract: Academic achievement patterns and their relationships with intellectual ability, social abilities, and problem behavior are described in a sample of 30 higher-functioning, 9-year-old children with autism spectrum disorder (ASD). Both social abilities and problem behavior have been found to be predictive of academic achievement in typically developing children but this has not been well studied in children with ASD. Participants were tested for academic achievement and intellectual ability at age 9. Problem behaviors were assessed through parent report and social functioning through teacher report at age 6 and 9. Significant discrepancies between children's actual academic achievement and their expected achievement based on their intellectual ability were found in 27 of 30 (90%) children. Both lower than expected and higher than expected achievement was observed. Children with improved social skills at age 6 demonstrated higher levels of academic achievement, specifically word reading, at age 9. No relationship was found between children's level of problem behavior and level of academic achievement. These results suggest that the large majority of higher-functioning children with ASD show discrepancies between actual achievement levels and levels predicted by their intellectual ability. In some cases, children are achieving higher than expected, whereas in others, they are achieving lower than expected. Improved social abilities may contribute to academic achievement. Future studies should further explore factors that can promote strong academic achievement, including studies that examine whether intervention to improve social functioning can support academic achievement in children with ASD.
TL;DR: The ASD group did not differ from the other two groups at 6 months of age in the frequency of gaze, smiles, and vocalizations directed toward the caregiver, nor in their sensitivity to her withdrawal from interaction, but by 12 months, infants in the ASD group exhibited lower rates of joint attention and requesting behaviors.
Abstract: We investigated whether deficits in social gaze and affect and in joint attention behaviors are evident within the first year of life among siblings of children with autism who go on to be diagnosed with autism or ASD (ASD) and siblings who are non-diagnosed (NoASD-sib) compared to low-risk controls. The ASD group did not differ from the other two groups at 6 months of age in the frequency of gaze, smiles, and vocalizations directed toward the caregiver, nor in their sensitivity to her withdrawal from interaction. However, by 12 months, infants in the ASD group exhibited lower rates of joint attention and requesting behaviors. In contrast, NoASD-sibs did not differ from comparison infants on any variables of interest at 6 and 12 months.
TL;DR: Clinical findings of PDD cases were consistent with previous data, such as, male preponderance, more children diagnosed with PDD-NOS than with autistic disorder, and half of them born from older mothers.
Abstract: This pilot study presents preliminary results concerning the prevalence of Pervasive Developmental Disorder (PDD) in South America. It was a three-phase study conducted in a typical town in Southeast Brazil. Case definition was based in a combination of standardized instruments and clinical evaluations by experts. The prevalence of PDD was 27.2/10,000 (95% CI: 17.6–36.8) and some hypotheses were raised to explain this low frequency. Clinical findings of PDD cases were consistent with previous data, such as, male preponderance, more children diagnosed with PDD-NOS than with autistic disorder, and half of them born from older mothers. Moreover, the study raised concerns about treatment of cases, because identification of PDD had been late and access to services has been very limited.
TL;DR: Results suggest that the ToM tests each utilized differing cognitive mechanisms, and no EF domains accounted for significant variance in RMET scores; only estimated IQ scores were significant predictors of RMET performance.
Abstract: This study examined the relationship between Executive Function (EF) and Theory of Mind (ToM) using the Delis-Kaplan Executive Function System (D-KEFS) and three tests of ToM (Reading the Mind in the Eyes test (RMET), Strange Stories test, and Faux Pas test). Separate regression analyses were conducted, and EF predictors varied by ToM test. No EF domains accounted for significant variance in RMET scores; only estimated IQ scores were significant predictors of RMET performance. Verbal fluency and deductive reasoning were significant predictors of performance on the Strange Stories test, while verbal fluency, problem solving, and gender accounted for a significant variance in the Faux Pas test. Results suggest that the ToM tests each utilized differing cognitive mechanisms.
TL;DR: Melatonin significantly improved sleep latency and total sleep compared to placebo, but not number of night wakenings, and the side effect profile was low and not significantly different between the two arms.
Abstract: Twenty-two children with autism spectrum disorders who had not responded to supported behaviour management strategies for severe dysomnias entered a double blind, randomised, controlled crossover trial involving 3 months of placebo versus 3 months of melatonin to a maximum dose of 10 mg. 17 children completed the study. There were no significant differences between sleep variables at baseline. Melatonin significantly improved sleep latency (by an average of 47 min) and total sleep (by an average of 52 min) compared to placebo, but not number of night wakenings. The side effect profile was low and not significantly different between the two arms.
TL;DR: College students’ openness to peers who demonstrate ASD-characteristic behaviors is explored, and universities should make efforts to prevent social isolation of students with ASD.
Abstract: One probable consequence of rising rates of autism spectrum disorder diagnosis in individuals without co-occurring intellectual disability is that more young adults with diagnoses or traits of ASD will attend college and require appropriate supports. This study sought to explore college students’ openness to peers who demonstrate ASD-characteristic behaviors. Results showed a significant difference in openness between students who had a first-degree relative with an ASD (n = 18) and a gender-matched comparison group of students without such experience (F = 4.85, p = .035). Engineering and physical science majors did not demonstrate more overall openness. Universities should make efforts to prevent social isolation of students with ASD, such as programs to educate students about ASD and supports to ease college transition.
TL;DR: ADOS module 4 proves to be a reliable instrument with good predictive value that can adequately discriminate ASD from psychopathy and typical development, but is less specific with respect to schizophrenia due to behavioral overlap between autistic and negative symptoms.
Abstract: Autism Diagnostic Observation Schedule (ADOS) module 4 was investigated in an independent sample of high-functioning adult males with an autism spectrum disorder (ASD) compared to three specific diagnostic groups: schizophrenia, psychopathy, and typical development. ADOS module 4 proves to be a reliable instrument with good predictive value. It can adequately discriminate ASD from psychopathy and typical development, but is less specific with respect to schizophrenia due to behavioral overlap between autistic and negative symptoms. However, these groups differ on some core items and explorative analyses indicate that a revision of the algorithm in line with Gotham et al. (J Autism Dev Disord 37: 613-627, 2007) could be beneficial for discriminating ASD from schizophrenia.
TL;DR: The current evidence implicates impairments in fine motor control and visual-motor integration as likely contributors to handwriting difficulties in children with ASD, though the role of the latter is not well-understood.
Abstract: Functional handwriting involves complex interactions among physical, cognitive and sensory systems. Impairments in many aspects of these systems are associated with Autism spectrum disorders (ASD), suggesting a heightened risk of handwriting difficulties in children with ASD. This scoping review aimed to: (1) survey the existing evidence about potential contributions to compromised handwriting function in children with ASD, and (2) map out the existing studies documenting handwriting difficulties in children with ASD. The current evidence implicates impairments in fine motor control and visual-motor integration as likely contributors to handwriting difficulties in children with ASD, though the role of the latter is not well-understood. Moreover, diminished overall legibility and compromised letter formation are emerging points of convergence among existing studies of handwriting quality in children with ASD.
TL;DR: It is found that in adults with ASC, autism symptom severity correlated negatively with attention to faces when watching video clips, however, only the degree of alexithymia, and not autism symptoms severity, predicted eye fixation.
Abstract: Eye-tracking studies have demonstrated mixed support for reduced eye fixation when looking at social scenes in individuals with Autism Spectrum Conditions (ASC). We present evidence that these mixed findings are due to a separate condition-alexithymia-that is frequently comorbid with ASC. We find that in adults with ASC, autism symptom severity correlated negatively with attention to faces when watching video clips. However, only the degree of alexithymia, and not autism symptom severity, predicted eye fixation. As well as potentially resolving the contradictory evidence in this area, these findings suggest that individuals with ASC and alexithymia may form a sub-group of individuals with ASC, with emotional impairments in addition to the social impairments characteristic of ASC.
TL;DR: Double dissociations in speech, prosody, and voice impairments in ASD were interpreted as consistent with a speech attunement framework, rather than with the motor speech impairments that define CAS.
Abstract: In a sample of 46 children aged 4–7 years with Autism Spectrum Disorder (ASD) and intelligible speech, there was no statistical support for the hypothesis of concomitant Childhood Apraxia of Speech (CAS). Perceptual and acoustic measures of participants’ speech, prosody, and voice were compared with data from 40 typically-developing children, 13 preschool children with Speech Delay, and 15 participants aged 5–49 years with CAS in neurogenetic disorders. Speech Delay and Speech Errors, respectively, were modestly and substantially more prevalent in participants with ASD than reported population estimates. Double dissociations in speech, prosody, and voice impairments in ASD were interpreted as consistent with a speech attunement framework, rather than with the motor speech impairments that define CAS.
TL;DR: The children with autism exhibited greater exploration and perseverative attention on objects related to circumscribed interests than did typically developing children, suggesting that circumscribed attention may be an early emerging characteristic of autism.
Abstract: School-aged children and adolescents with autism demonstrate circumscribed attentional patterns to nonsocial aspects of complex visual arrays (Sasson et al. 2008). The current study downward extended these findings to a sample of 2–5 year-olds with autism and 2–5 year-old typically developing children. Eye-tracking was used to quantify discrete aspects of visual attention to picture arrays containing combinations of social pictures, pictures of objects frequently involved in circumscribed interests in persons with autism (e.g., trains), and pictures of more commonplace objects (e.g., clothing). The children with autism exhibited greater exploration and perseverative attention on objects related to circumscribed interests than did typically developing children. Results suggest that circumscribed attention may be an early emerging characteristic of autism.
TL;DR: Eye-tracking is used to examine visual attention to faces and objects in adolescents with autism spectrum disorder (ASD) and typical peers and suggest that naturalistic assessments are important for quantifying atypicalities in visual attention.
Abstract: This study used eye-tracking to examine visual attention to faces and objects in adolescents with autism spectrum disorder (ASD) and typical peers Point of gaze was recorded during passive viewing of images of human faces, inverted human faces, monkey faces, three-dimensional curvilinear objects, and two-dimensional geometric patterns Individuals with ASD obtained lower scores on measures of face recognition and social-emotional functioning but exhibited similar patterns of visual attention In individuals with ASD, face recognition performance was associated with social adaptive function Results highlight heterogeneity in manifestation of social deficits in ASD and suggest that naturalistic assessments are important for quantifying atypicalities in visual attention
TL;DR: The reported low prevalence of ASD in Oman is likely due to under-diagnosis and under-reporting.
Abstract: Prevalence of autistic spectrum disorders (ASD) in Oman is unknown. We conducted a cross-sectional study to estimate the prevalence of ASD among 0-14 year old children. Diagnoses were made as per DSM-IV-TR criteria and supplemented with information collected with the standard Childhood Autism Rating Scale (CARS) questionnaire. A total 113 cases of ASD were enumerated nationwide, indicating an overall prevalence of 1.4 (95% CI 1.2, 1.7) cases per 10,000 children aged 0-14 years. More prevalent cases were among boys (75%) and among low-income families. Ritualistic interests were more common among girls as an onset-symptom compared to boys (p = 0.03). The reported low prevalence of ASD in Oman is likely due to under-diagnosis and under-reporting.
TL;DR: Children and adolescents with ASDs showed quick and accurate recognition for most emotions, including pride, a socially complex emotion, and no differences emerged between ASD and TD groups, even though systematizing should promote a speed-accuracy trade-off.
Abstract: Researchers have argued that individuals with autism spectrum disorders (ASDs) use an effortful “systematizing” process to recognize emotion expressions, whereas typically developing (TD) individuals use a more holistic process. If this is the case, individuals with ASDs should show slower and less efficient emotion recognition, particularly for socially complex emotions. We tested this account by assessing the speed and accuracy of emotion recognition while limiting exposure time and response window. Children and adolescents with ASDs showed quick and accurate recognition for most emotions, including pride, a socially complex emotion, and no differences emerged between ASD and TD groups. Furthermore, both groups trended toward higher accuracy when responding quickly, even though systematizing should promote a speed-accuracy trade-off for individuals with ASDs.
TL;DR: Children demonstrating more frequent Sensory Sensitivity and Sensory Avoiding had significantly lower competence scores than children with fewer behaviors in these domains, suggesting that sensory responsiveness may impact the ability to participate successfully.
Abstract: This pilot study explored activity patterns in children with and without ASD and examined the role of sensory responsiveness in determining children’s level of competence in activity performance. Twenty-six children with high functioning ASD and twenty-six typically-developing children 6–12 years old were assessed using the Sensory Profile and the Child Behavior Checklist. Results reflect differences in the types of activities and jobs/chores engaged in by children with ASD compared to children without ASD. Significant differences were seen in overall level of competence in activities, social, and school performance. Children demonstrating more frequent Sensory Sensitivity and Sensory Avoiding had significantly lower competence scores than children with fewer behaviors in these domains, suggesting that sensory responsiveness may impact the ability to participate successfully.
TL;DR: Path analysis showed that sense of coherence, internal locus of control, social support and quality of marriage increase the ability to cope with the stress of parenting an autistic child.
Abstract: The research validates a multivariate model that predicts parental adjustment to coping successfully with an autistic child. The model comprises four elements: parental stress, parental resources, parental adjustment and the child’s autism symptoms. 176 parents of children aged between 6 to 16 diagnosed with PDD answered several questionnaires measuring parental stress, personal resources (sense of coherence, locus of control, social support) adjustment (mental health and marriage quality) and the child’s autism symptoms. Path analysis showed that sense of coherence, internal locus of control, social support and quality of marriage increase the ability to cope with the stress of parenting an autistic child. Directions for further research are suggested.
TL;DR: Findings suggest that child behavior problems and reframing are most strongly associated with family outcomes and clinical implications for working with these families, including the use of strength-based approaches are discussed.
Abstract: In this study, the Double ABCX model of family adaptation was used to explore the impact of severity of autism symptoms, behavior problems, social support, religious coping, and reframing, on outcomes related to family functioning and parental distress. The sample included self-report measures collected from 195 families raising school-age children with autism from racially diverse backgrounds throughout the United States. Hierarchical regression results revealed that the Double ABCX model of family adaptation accounted for a substantial amount of the variance in family functioning (28%) and parental distress (46%). Findings suggest that child behavior problems and reframing are most strongly associated with family outcomes. Clinical implications for working with these families, including the use of strength-based approaches, are discussed.
TL;DR: Preliminary evidence that CBT may yield increased independence and daily living skills among children with ASD is provided.
Abstract: CBT is a promising treatment for children with autism spectrum disorders (ASD) and focuses, in part, on children’s independence and self-help skills. In a trial of CBT for anxiety in ASD (Wood et al. in J Child Psychol Psychiatry 50:224–234, 2009), children’s daily living skills and related parental intrusiveness were assessed. Forty children with ASD (7–11 years) and their primary caregiver were randomly assigned to an immediate treatment (IT; n = 17) or 3-month waitlist (WL; n = 23) condition. In comparison to WL, IT parents reported increases in children’s total and personal daily living skills, and reduced involvement in their children’s private daily routines. Reductions correlated with reduced anxiety severity. These results provide preliminary evidence that CBT may yield increased independence and daily living skills among children with ASD.
TL;DR: Although this pilot study did not find a statistically significant benefit from omega-3 fatty acids, the small sample size does not rule out small to moderate beneficial effects.
Abstract: We conducted a pilot randomized controlled trial to determine the feasibility and initial safety and efficacy of omega-3 fatty acids (1.3 g/day) for the treatment of hyperactivity in 27 children ages 3–8 with autism spectrum disorder (ASD). After 12 weeks, hyperactivity, as measured by the Aberrant Behavior Checklist, improved 2.7 (±4.8) points in the omega-3 group compared to 0.3 (±7.2) points in the placebo group (p = 0.40; effect size = 0.38). Correlations were found between decreases in five fatty acid levels and decreases in hyperactivity, and the treatment was well tolerated. Although this pilot study did not find a statistically significant benefit from omega-3 fatty acids, the small sample size does not rule out small to moderate beneficial effects.
TL;DR: The aim of this study was to demonstrate that parents can learn Pivotal Response Training (PRT) in group therapy, resulting in correlated gains in children’s language.
Abstract: The number of children diagnosed with autism spectrum disorders is increasing, necessitating the development of efficient treatment models. Research has demonstrated that parent-delivered behavioral interventions are a viable treatment model; however, little research has focused on teaching parents in groups. The aim of this study was to demonstrate that parents can learn Pivotal Response Training (PRT) in group therapy, resulting in correlated gains in children’s language. Baseline and post-treatment data were obtained and examined for changes in (a) parent fidelity of PRT implementation, and (b) child functional verbal utterances. Significant differences were observed for both variables. These findings suggest that parents can learn PRT in a group format, resulting in correlated child language gains, thus future controlled studies are warranted.
TL;DR: Examining the types of treatments in current use by families of children with ASD found that most families adopt multiple treatment approaches, and parents were most likely to discontinue non-evidence based treatments when they did not see improvement in their child’s functioning.
Abstract: Empirically conducted studies of the efficacy of various treatments for autism are limited, which leaves parents with little evidence on which to base their treatment decisions (Kasari, Journal of Autism and Developmental Disorders, 32: 447–461, 2002). The purpose of this study was to examine the types of treatments in current use by families of children with ASD. In addition, parents’ perceptions of improvement in their child’s functioning were explored. Through an online survey, a sample of 970 parents of ASD children reported on the treatments currently in use, those discontinued, and reasons for discontinuation. Results indicate that most families adopt multiple treatment approaches. Parents were most likely to discontinue non-evidence based treatments when they did not see improvement in their child’s functioning.
TL;DR: Model-based cluster analysis of parent-reported sensory functioning (measured using the Short Sensory Profile) confirmed the triad of sensory subtypes reported earlier, and elucidation of two of the subtypes was achieved in this study.
Abstract: Distinct sensory processing (SP) subtypes in autism have been reported previously. This study sought to replicate the previous findings in an independent sample of thirty children diagnosed with an Autism Spectrum Disorder. Model-based cluster analysis of parent-reported sensory functioning (measured using the Short Sensory Profile) confirmed the triad of sensory subtypes reported earlier. Subtypes were differentiated from each other based on degree of SP dysfunction, taste/smell sensitivity and vestibular/proprioceptive processing. Further elucidation of two of the subtypes was also achieved in this study. Children with a primary pattern of sensory-based inattention could be further described as sensory seekers or non-seekers. Children with a primary pattern of vestibular/proprioceptive dysfunction were also differentiated on movement and tactile sensitivity.