Friday, 2 June 2023

Psychometric Validation of the ASC-ASD Anxiety Scale in Children with Autism Spectrum Disorder

Psychometric Validation of the ASC-ASD Anxiety Scale inChildren with Autism Spectrum Disorder

Elsa M. Castañeda Mikrukova (PGDip) Autonomous University of Barcelona.

PhD. Manuel Ojea Rúa University of Vigo.


The knowledge, diagnosis and treatment of clinical anxiety in people considered within the autism spectrum is a challenge since most of the instruments are designed based on research variables for people outside the autism spectrum. A total of 91 parents of children between 6 and 18 years of age, diagnosed with ASD in Metropolitan Lima participated in this study. In this sense, the general objective of this study is the validation of the anxiety scale: ANXIETY SCALE FOR CHILDREN WITH ASD (ASC ASD-P) in relation to anxious behaviors in people with ASD. The results show a significant validity of the Scale content; however, there are discrepancies in the allocation of reagents to the corresponding dimensions. The Exploratory Factor Analysis and the Alpha Values of Anxiety present the following data: 1) Anxiety due to Uncertainty (McDonald’s: .86 and Cronbach's Alpha: .85); 2) Performance Anxiety (McDonald’s: .81 and Cronbach's Alpha: .81); 3) Anxious Arousal (0.86 McDonald’s: .86 and Cronbach's Alpha: .8). Separation anxiety is excluded from the analysis due to its low factor value. These data allow us to affirm that the scale to evaluate the presence of ASC-ASD clinical anxiety, parent version, has adequate psychometric properties for the predictive measurement of anxiety in people with Autism Spectrum Disorder (ASD). 

Keywords: Autism Spectrum Disorder, Clinical Anxiety, Anxiety Scale Validation.


[1]. Ali, S., MacConkery, R., & Rodgers, J. (2020). Assessing Anxiety in Iranian Children with Autism Spectrum Disorder. Research in Autism Spectrum Disorder, 79 

[2]. Carmo, J. C., Duarte, E., Souza, C., Pinho, S., & Filipe, C. N. (2017). Brief Report: testing the impairment of initiation processes hypothesis in Autism Spectrum Disorder. J Autism Dev Disord, 47, 1256-1260. DOI 10.1007/s10803-017-3031-6 

[3]. Gara, S., Chhetri, A., Alrjoob, M., Abbasi, S., & Rutkofsky, I. (2020). The Sensory Abnormality and Neuropathology of Autism and Anxiety. Cureus, 12(5), e8071. DOI: 10.7759/cureus.8071 

[4]. Godfrey, K., Espenhahn, S., Stokoe, M., McMorris, C., Murias, K., McCrimmon A., … & Bray S. (2022). Autism interest intensity in early childhood associates with executive functioning but not reward sensitivity or anxiety symptoms. Autism, 26(7), 1723-1736. 

[5]. Golan, O., Haruhi- Lamdan, N., Laor, N., & Horesh D. (2020). The comorbidity between autism spectrum disorder and post-traumatic stress disorder is mediated by brooding rumination. Autism, 26(2), 538- 544. DOI: 10.1177/13623613211035240 

[6]. Gotham, K. O., Siegle, G. J., Han, G. T., Tomarken, A. J., Crist, R. N., Simon, D. M., & Bodfish, J. W. (2018). Pupil response to social-emotional material is associated with rumination and depressive symptoms in adults with autism spectrum disorder. PLOS ONE, 13(8). 

[7]. Hernández, R., Fernández, C., Baptista P. (2014). Research Methodology (6th Ed.). Interamerican: McGrawHill. 

[8]. Hervás, A. (2017). Emotional dysregulation and autism spectrum disorders. Rev Neurol, 64(1), S17-25. DOI: 

[9]. Kerns, C. M., Wood, J. J., Kendall, P. C., Renno, P., Crawford, E. A., Mercado, R. J., … & Storch, E. A. (2016). The Treatment of Anxiety in Autism Spectrum Disorder (TAASD) Study: Rationale, Design and Methods. Journal of child and family studies, 25(6), 1889-1902. 0372-2 

[10]. Kerns, C., Renno, P., Kendall, Ph., Wood, J., & Storch, E. (2017). Anxiety disorders interview scheduleautism addendum: Reliability and validity in children with autism spectrum disorder. Journal of Clinical Child & Adolescent Psychology, 46(1), 88- 100. 

[11]. Lecavalier, L., Wood, J. J., Halladay, A. K., Jones, N. E., Aman, M. G., Cook, E. H., … & Scahill, L. (2014). Measuring anxiety as a treatment endpoint in youth with autism spectrum disorder. Journal of autism and developmental disorders, 44(5), 1128–1143.

[12]. Lei, J., Sukhodolsky, D., Abdullahi, S., Braconnier, M., Ventola, P. (2017). Reduced anxiety following pivotal response treatment in young children with autism spectrum disorder. Research in Autism Spectrum Disorders, 43- 44, 1- 7. ISSN 1750-9467, 

[13]. Maddox, B., Lecavalier L., Miller, J., Pritchett, J., Hollway, J., White, S., … & Scahill, L. (2020). Reliability and validity of the Pediatric Anxiety Rating Scale modified for autism spectrum disorder. Autism, 24(7), 1773-1782. DOI: 10.1177/1362361320922682. Epub PMID: 32476441; PMCID: PMC7541392 

[14]. Magiati, I., Lerh J., Hollocks, M., Uljarevic, M., Rodgers, J., McConachie, H., Ozsivadjian, A., … & Simonoff, E. (2017). 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 Res,1629- 1652. DOI: 10.1002/aur.1809. PMID: 28574646.DOI:10.1002/aur.1809 

[15]. Mandy, W., Midouhas, E., Hosozawa, M, Noriko, C., Sacker, A., & Flouri, E. (2022). Mental health and social difficulties of late-diagnosed autistic children, across childhood and adolescence. J Child Psychol Psychiatry, 63(11), 1405-1414. DOI: 10.1111/jcpp.13587 

[16]. Paula- Pérez, I., Artigas-Pallares, J. (2016). Vulnerability to self-harm in autism. Rev. Neurol, 62(1), S27-S32. DOI: 

[17]. Rodgers, J., S., McConachie, H., Freeston, M., Honey, E., & Parr, J. R. (2016). Development of the anxiety scale for children with autism spectrum disorder (ASC-ASD). Autism Res, 9(11), 1205-1215. DOI: 10.1002/aur.1603 

[18]. Rodgers, J., Wigham, S., McConahie, H., Freeston, M., & Wigham S. (2016). Development of anxiety scale for children with autism spectrum disorder (ASC ASD). Autism Res, 9(11), 1205-1215. DOI: 10.1002/aur.1603 

[19]. Ruggieri, V. L. (2014). The amygdala and its relationship to autism, behavioral disorders, and other neurodevelopmental disorders. Rev. Neurol, 58(1), S137- 48. DOI: 10.33588/rn.58S01.2013571 

[20]. Sayyed, S., McConkey, R., & Rodgers J., (2020). Assessing anxiety in Iranian children with Autism Spectrum Disorder. Research in Autism Spectrum Disorders, 79. ISSN 1750-9467. 

[21]. Siegle, G. J., D´Andrea, W., Jones, N., Hallquist, M. N., Stepp, S. D., Fortunato, A., … & Pilkonis, P. A. (2015). Prolonged physiological reactivity and loss: Association of pupillary reactivity with negative thinking and feelings. International Journal of Psychophysiology, 98(2), 310-320. https://doi. org/10.1016/j.ijpsycho.2015.05.009 

[22]. Soh, C., Goh, T., Magiati, I., & Sung, M., (2020). Caregiver- and Child-Reported Anxiety Using an Autism-Specific Measure: Measurement Properties and Correlates of the Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD) in Verbal Young People with ASD. J Autism Dev Disord, 51, 2646-2662

[23]. Thomas, M. S. C., Davis, R., Karmiloff-Smith, A. Knowland, V. C. P., & Charman, T. (2016). The overpruning hypothesis of Autism. Developmental Science, 19(2), 284-305. DOI: 10.1111/desc.12303

Monday, 29 May 2023



Manuel Ojea Rúa
Elsa M. Castañeda Mikrukova


From the behavioural perspective, the specific diagnosis of people with Autism Spectrum Disorder (ASD), was categorized by the Diagnostic and Statistical Manual of Mental Disorders 5th of the DSM-V-TR of American Psychiatric Association (2013) and also the International Classification of Diseases, 11th. from World Health Organization (2018). Both classifications have indicated it specific behavioural construct associated with its diagnosis, defined by a whole of socio- behavioural deficits; however, it is need to have added that cognitive-perceptive symptomatic groups are the direct cause and consequence of the behavioural particularity in people with ASD. For this reason, in this study has raised like general aim to analyse the effectiveness of the application of an integrated cognitive-behavioural systemic program to improve behaviours in people with ASD. The research study has been designed a quasi-experimental analysis of three groups with two pre-test and posttest measures. The groups are made up by: 1) an experimental group of 4 students with ASD (n= 4), which the integrated global systemic program was applied, 2) a control group-1, composed of 4 students with ASD, who have followed an A-B behavioural program (Stimulus-Response), and 3) a third control group-2, also made up of 4 students with ASD, who have followed several usual behaviours of modification programs (N= 12). Results found from means of non-parametric Kruskal Wallis Test (K-W), have showed the effectiveness of global integrated program implemented to experimental group, which has founded highly significant critical differential indices, regarding other two control 1-2 groups. Likewise, the bivariate correlations between behavioural dimension and cognitive-perceptive factors of processing are calculated and shown. 

KEYWORDS: Autism Spectrum Disorder, Global Systemic Intervention, Cognitive- Behavioural Attention. 


 1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th). American Psychiatric Publishing. dsm

2. Becker, S. P., & Barkley, R. A. (2018). Sluggish cognitive tempo. In T. Banaschewski, D. Coghill & A. Zuddas (Eds.), Oxford textbook of attention deficit hyperactivity disorder (pp. 147–153). Oxford University Press. 31_Sluggish_cognitive_tempo/link/5c395ba3a6fd ccd6b5a5e778/download

 3. Blijd-Hoogewys, E. M., Bezemer, M. L., & van Geert, P. L. (2014) Executive functioning in children with ASD: an analysis of the BRIEF. Journal of Autism and Developmental Disorders 44(12): 3089-3100. 

4. Brewe, A. M., Simmons, G. L., Capriola-Hall, N. N., & White, S. W. (2020). Sluggish cognitive tempo: An examination of clinical correlates for adults with autism. Autism, 24(6) 1373–1383. DOI: 10.1177/1362361319900422 

5. Brookman-Frazee, L., Stadnick, N., Chlebowski, C., Baker-Ericzén, M., & Ganger, W. (2018). Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services. Autism, 22(8) 938– 952. DOI: 10.1177/1362361317712650 

6. Cellot, G., & Cherubini, E. (2014). GABAergic signalling as therapeutic target for autism spectrum disorders. Frontiers in Pediatrics, 2. Article 70. DOI:10.3389/fped.2014.00070 

7. De Bruin, E. I., Ferdinand, R. F., Meester, S., de Nijs, F. A., & Verheij, F. (2007) High rates of psychiatric co-morbidity in PDD-NOS. Journal of Autism and Developmental Disorders 37(5), 877- 886. 

8. Duncan, A., Tamm, L., Birnschein, A. M., & Becker, S. P. (2019). Clinical correlates of sluggish cognitive tempo in adolescents with autism spectrum disorder. Autism, 23(6), 1354-1362. DOI: 10.1177/1362361318811329 

9. Fonseca- Pedro, E., Muñiz, J., Lemos- Giráldez, S., Paino, M., & Villazón- García, U. (2010). SchizoQ. Oviedo Questionnaire for the schizotypy evaluation. Madrid: TEA. 

10. Ford, T. C., Crewther, D. P., & Abu-Akel, A. (2020). Psychosocial deficits across autism and schizotypal spectra are interactively modulated by excitatory and inhibitory neurotransmission. Autism, 24(2), 364–373. DOI: 10.1177/1362361319866030 journals.sagep 

11. Foss-Feig, J. H., Adkinson, B. D., Ji, J. L., Yang, G., Srihari, V. H., McPartland, J. C., . . . Anticevic, A. (2017). Searching for cross-diagnostic convergence: Neural mechanisms governing excitation and inhibition balance in schizophrenia and autism spectrum disorders. Biological Psychiatry, 81, 848–861. DOI:10.1016/j.biopsych.2017.03.005 

12. Gengoux, G. W., Abrams, D. A., Schuck, R., Millan, M. E., Libove, R., Ardel, C. M., . . Hardan, A. Y. (2019). A pivotal response treatment package for children with autism spectrum disorder: An RCT. Pediatrics, 144. Article e20190178. 

13. Gilliam, J. E. (2010). GARS- 2S. Gilliam Rating Scale on Autism (2 th.). México: PRO-ED. _del_desarrollo/gars-2s-escala-de-evaluacion-deautismo-de-gilliam.htm 

14. Joshi G, Petty C, Wozniak J, Henin, A., Fired, R., Galdo, M., … & Biederman, J. (2010). The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: a large comparative study of a psychiatrically referred population. Journal of Autism and Developmental Disorders 40(11), 1361-1370. 

15. Keifer C. K., Mikami, A. Y., Morris, J. P., Libsack, E. J., & Lerner, M. D. (2020). Prediction of social behavior in autism spectrum disorders: Explicit versus implicit social cognition. Autism, 24(7), 1758-1772. DOI: 10.1177/1362361320922058 j 

16. Ketcheson, L., Hauck, J., & Ulrich, D. (2017). The Effects of an Early Motor Skill Intervention on Motor Skills, Levels of Physical Activity, and Socialization in Young Children with Autism Spectrum Disorder: A Pilot Study. Autism: The International Journal of Research and Practice, 21(4),481-492. 

17. Koegel, L. K., Camarata, S. M., ValdezMenchaca, M., & Koegel, R. L. (1998). Setting “Effectiveness of an Integrated Global Systemic Program to Improve Behavioural Development in People with Autism Spectrum Disorder” 299 Manuel Ojea Rúa 1 , RAJAR Volume 09 Issue 05 May 2023 generalization of question asking by children with autism. American Journal on Mental Retardation, 102, 346-357. SBN-13: 978-0939603121/ ISBN10: 0939603128 

18. Koegel, L. K., Koegel, R. L., Green-Hopkins, I., & Barnes, C. C. (2010). Brief report: Question-asking and collateral language acquisition in children with autism. Journal of Autism and Developmental Disorders, 40, 509-515. DOI: 10.1007/s10803-009-0896-z 

19. Koegel, R. L., & Koegel, L. K. (2006). Pivotal response treatments for autism: Communication, social and academic development. Baltimore: Brookes. 

20. Koegel, R. L., & Koegel, L. K. (2012). The PRT Pocket Guide: Pivotal Response Treatment for Autism Spectrum Disorders. Baltimore: Brookes Pub. Co. Koegel-PRT-pocket-guide-intro.pdf 

21. Koegel, R. L., O’ Dell, M. C., & Koegel, L. K. (1987). A natural language teaching paradigm for nonverbal autistic children. Journal of Autism and Developmental Disorders, 17, 187-200. 

22. Koenig, K., De Los Reyes, A., Cicchetti, D., Scahill, L., & Klin, A. (2009). Group intervention to promote social skills in school-age children with pervasive developmental disorders: Reconsidering efficacy. Journal of Autism and Developmental Disorders, 39(8), 1163-1172. https://doi. org/10.1007/s10803-009-0728-1 

23. Lauderdale- Littin, S., & Brennan, M. (2018). Evidence-Based Practices in the Public School: The Role of Preservice Teacher Training. International Electronic Journal of Elementary Education, 10(3), 369-375. rvlet?accno=EJ1172291 

24. Ledford, J. R., Zimmerman, K. N., Harbin, E. R., & Ward, S. E. (2017). Improving the Use of Evidence-Based Instructional Practices for Paraprofessionals. Focus on Autism and Other Developmental Disabilities, 33(4) 206- 216. DOI: 10.1177/1088357617699178 

25. Lerner, M. D., Potthoff, L. M., & Hunter, S. J. (2015). Optimizing cross-sectional prediction of social functioning in youth referred for neuropsychological testing. PLOS ONE, 10(5). Article e0128303. pone.0128303 

26. Leyfer O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J. … & Lainhart, J. E. (2006) Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. Journal of Autism and Developmental Disorders 36(7), 849-861. 

27. Longtin, S. E. (2014). Using the College Infrastructure to Support Students on the Autism Spectrum. Journal of Postsecondary Education and Disability, 27(1), 63-72. rvlet?accno=EJ1029568 

28. Lozano, L., García, E., & Lozano, L. M. (2013). CECAD. Clinical Educational Questionnaire: Anxiety and Depression. Madrid: TEA. xtracto_WEB.pdf 

29. Lyons, G. L. (2017). Cumulative Evidence and Consensus of Pivotal Response Treatment as a Naturalistic Developmental Behavior Intervention for Young Children with Autism. University of Wisconsin: ProQuest LLC. 9.88- 2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertati on&res_dat=xri:pqm&rft_dat=xri:pqdiss:1061845 6 

30. Madden, N. A., Slavin, R. E., & Stivens, R. J. (1986). Cooperative integrated reading and comparison: teacher´s manual. Baltimore. MD: The Johns Hopkins, Center for Research on Elementary and Middley Schools. 

31. McDaniel, J., Yoder, P., Crandall, M., Millan, M. E., Ardel, Ch. M., Gengoux, G. W., & Hardan, A. Y. (2020). Effects of pivotal response treatment on reciprocal vocal contingency in a randomized controlled trial of children with autism spectrum disorder. Autism, 24(6) 1566–1571. DOI:10.1177/1362361320903138 

32. Meadan, H., Angell, M. E., Stoner, J. B., & Daczewitz, M. E. (2014). Parent-Implemented Social-Pragmatic Communication Intervention: A Pilot Study. Focus on Autism and Other Developmental Disabilities, 29(2) 95-110 . DOI: 10.1177/1088357613517504 

33. Moes, D. R., & Frea, W. D. (2002). Contextualized behavioral support in early intervention for children with autism and their families. Journal of Autism and Developmental Disorders, 32(6), 519- 533. “Effectiveness of an Integrated Global Systemic Program to Improve Behavioural Development in People with Autism Spectrum Disorder” 300 Manuel Ojea Rúa 1 , RAJAR Volume 09 Issue 05 May 2023 98729297 

34. Monroy, J. (2014). La resolución de problemas matemáticos y su impacto en el pensamiento crítico del ciudadano. Revista de cooperación, 3. 06r.pdf 

35. Nelson, C., Paul, K., Johnston, S. S., & Kidder, J. E. (2017). Use of a Creative Dance Intervention Package to Increase Social Engagement and Play Complexity of Young Children with Autism Spectrum Disorder. Education and Training in Autism and Developmental Disabilities, 52(2), 170-185. TDDDetailsPage/tabid/80/ArticleID/2320/Use-ofa-Creative-Dance-Intervention-Package-toIncrease-Social-Engagement-and-PlayComplexity-of-Young-Children-with-AutismSpectrum-Disorder.aspx 

36. Ojea, M., & Tellado, F. (2018). Semantic Integration Evaluation Scale (SIS) for children with Autism Spectrum Disorder. Open Access Journal of Addiction and Psychology, 1(3), 1-6. 6j49L1rqup84YRTlZoYJo5qJYk_O1VBYpoCoK M 

37. Ojea, M. (2020). Autism Spectrum Disorder: Integrated Behavioural Intervention Program. Sevilla: Aula Magna, McGraw- Hill Interamericana España, S. L. no-del-espectro-autista-programa-deintervencion-conductual-integrado 

38. Pan, Ch., Chu, Ch., Tsai, Ch., Sung, M., Huang, Ch., & Ma, W. (2017). The Impacts of Physical Activity Intervention on Physical and Cognitive Outcomes in Children with Autism Spectrum Disorder. Autism: The International Journal of Research and Practice, 2(2),190-202. 

39. Pathak, M., Bennett, A., & Shui, A. M. (2019). Correlates of adaptive behavior profiles in a large cohort of children with autism: The autism speaks Autism Treatment Network registry data. Autism, 23(1), 87-99. DOI: 10.1177/1362361317733113 

40. Rosenthal, M., Wallace. G. L., Lawson, R. Wills, M. C., Dixon, E., Yerys, B. E., … & Kenworthy, L. (2013) Impairments in real-world executive function increase from childhood to adolescence in autism spectrum disorders. Neuropsychology 27(1), 13- 18. 

41. Volkmar, F. R., Reichow, B., & McPartland, J. C. (2014). Autism Spectrum Disorder in adolescents and adults: an introduction. In: F. R. Volkmar, B. Reichow & J. C. McPartland (Eds.), Adolescents and Adults with Autism Spectrum Disorders (pp. 1- 13). Berlin: Springer. _G_f_Kinder-_und_Jugendpsychiatrie_und_- psychotherapie/028- 018l_S3_Autism_spectrum_disorders_in_childho od__adolescence_and_adulthood_2021- 09_abgelaufen.pdf 

42. World Health Organization. (2018). International statistical classification of diseases and related health problems (11th Revision).

Saturday, 27 May 2023



La Voz de Galicia Ourense, 27-5-2023

"Ourense cuenta desde esta semana con un nuevo recurso de atención a personas con trastorno del espectro autista. El colectivo está impulsado desde el ISIC Tea, un instituto social de investigaciones científicas en el área del autismo que comenzó a funcionar el pasado mes de enero en Ourense bajo la batuta del profesor, psicólogo y psicopedagogo Manuel Ojea. Esa entidad sin ánimo de lucro nació para sumar esfuerzos y fomentar la cooperación de los investigadores que trabajan en ese campo. «Deuse a circunstancia de que había algunha nai dentro do instituto e plantexou por que non facíamos intervención con nenos afectados. Pareceunos boa idea», añade este catedrático que ha publicado más de unta treintena de libros y manuales sobre la materia.
Para ofrecer esa asistencia se crea la asociación, aunque su recorrido dependerá del respaldo que tenga la iniciativa y de las familias que se asocien. La idea es ofrecerles servicios de diagnóstico, intervención psicoeducativa, inserción laboral y actividades de ocio y tiempo libre. «Pensamos ofrecer o de diagnóstico porque realmente hai moi poucos sitios que o dean. Ata agora, que tamén o empezan a facer no CHUO, había que ir a Vigo ou A Coruña. A intervención psicosocial e educativa terá diferentes sesións semanais, dependendo das necesidades dos rapaces e en función dun programa chamado PEP, que é un método psicoeducativo funcional», aclara Manuel Ojea..."



La Escala de Precisión para el Diagnóstico del Autismo se basa en los principios perceptivo- cognitivos relacionados con el proceso de elaboración de redes neuronales entre conceptos y categorías, más allá de los estándares comportamentales recogidos por la Clasificación Internacional DSM-5, con el fin de evitar errores estructurales tan frecuentes en los diagnósticos de base.

Su desarrollo está en proceso de elaboración por Ediciones Barcelona Iberoamericana de Perú (M. A. Pinto).

Wednesday, 10 May 2023

Saturday, 29 April 2023

Protocolo de acceso aos estudos universitarios dos estudantes con Trastorno do Espectro Autista: Novas perspectivas

Protocolo de acceso aos estudos universitarios dos estudantes con Trastorno do Espectro Autista: Novas perspectivas


A investigación psico-social e educativa na área das Persoas con Trastorno do Espectro Autista (TEA) avanzou de forma significativa, na que se refutan empiricamente novos principios nucleares da conceptualización do trastorno e, en consecuencia, é preciso considerar os novos presupostos básicos baseados nos modos do procesamento perceptivo-cognitivo do fenotipo particular das persoas con TEA (Ojea, 2023).

Friday, 7 April 2023


Comparative differential study of comorbid symptomatic groups associated with Autism Spectrum Disorder diagnosis

Manuel Ojea Rúa, University of Vigo

Prof. Dr. Psycho- Pedagogy

(34) 630189639

PhD. Pyschology

Lydia Castro Núñez, University of Vigo

MEd Biology. Doctoral student. of University of Vigo.

Lourdes Rivas Otero, University of Vigo

(MEd Psyco-pedagogy. Doctoral student of University of Vigo)

Tania Justo Román, University of Vigo

MEd Music- therapy. Doctoral student of University of Vigo.


Individuals with autism spectrum disorders (ASD) make up a diagnosis characterized by a multifunctional neurocognitive disorder, based on a limited structure to perform nodal-synaptic interrelationships between the contents of learning. Likewise, this disorder may be associated with a set of comorbid symptom groups, which, regarding their intensity, may border with ASD main diagnosis and lead to basic errors that affect subsequent social- educational treatment. This study analyses most recurrent associated comorbid groups, as well as, if the presence of symptomatic comorbid groups is differential regarding group shape: normotypical and ASD groups. A total of 390 children participated in this study, 128 belonged to normotypical group and 262 did it to experimental group, subdivided into three levels of ASD. Results found through multivariate- test indicate that the whole dimension significantly affects group way intersection, age and sex (sig: .00). The post-hoc test analysis indicates this influence was      differential regarding to the group type for the following dimensions: cognition, behaviour, psychoaffectivity, language and psychomotor disorder, while relative differences were not observed in specific- clinical dimension, where only epilepsy showed a differential result: no differences were found in general- clinic dimension.

Lay abstract

ASD´ diagnosis and treatment shows, to date, many weak points that need to be improved. Previous studies have shown how important is the psycho-educational component regarding ASD treatment, therefore it is necessary to understand the specific characteristics of the nuclear ASD diagnosis, in order to work out a specific therapy according to every single case. 

In the current study, we examined and analysed ASD patients as well as participants showing comorbid symptoms such as epilepsy, in order to show how these comorbidities can reach a very high level, leading to a confused and wrong ASD nuclear diagnosis. 

Therefore, it is essential to gain more insight into the specific diagnosis process, defining the ASD symptoms very precisely in order to develop more accurate and specific educational programs. 

This study contributes to the improvement in ASD diagnosis, providing a large number of participants in order to study the relation between several comorbid symptoms and its reliability as ASD indicative factors or not.


American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders- DSM-5 (5th ed.). American Psychiatric Publishin.

Amiet, C., Gourfinkel-An, I., Laurent, C., Carayol, J. R., Génin, B. R., Leguern, E., Tordjman, S., & Cohen, D. (2013). Epilepsy in simplex autism pedigrees is much lower than the rate in multiplex autism pedigrees. Biological Psychiatry, 74(3). e3-e4. DOI: 10.1016/j.biopsych.2013.01.037

Anukirthiga, B., Mishra, D., Pandey, S., Juneja, M., & Sharma, N. (2019). Prevalence of epilepsy and interictal epileptiform discharges in children with autism and attention-deficit hyperactivity disorder. Indian Journal of Pediatrics, 86, 897- 902.

Bauman, M. L. (2010). Medical comorbidities in autism: Challenges to diagnosis and treatment. Neurotherapeutics, 7(3), 320- 327.

Brookman-Frazee, L., Stadnick, N., Chlebowski, C., Baker- Ericzén, M. J., & Ganger, W. (2017). Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services. Autism, 22(8), 938- 952.

Casseus, M. (2022). Prevalence of co-occurring autism spectrum disorder and attention deficit/hyperactivity disorder among children in the United States. Autism, 26(6) 159-1597. DOI: 10.1177/13623613221083279

Chiarotti, F., & Venerosi, A. (2020). Epidemiology of autism spectrum disorders: A review of worldwide prevalence estimates since 2014. Brain Sciences, 10(5). E274.

Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, S. J. (2018). Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. Journal of Clinical Child and Adolescent Psychology, 47(2), 199- 212.

Danielsson, S., Gillberg, I. C., Billstedt, E., Gillberg, C., & Olsson, I. (2005). Epilepsy in young adults with autism: A prospective population-based follow-up study of 120 individuals diagnosed in childhood. Epilepsia, 46(6), 918- 923.

Dickson, K. S., Galligan, M. L., & Lok, H. (2021). Short report: A quantitative methodological review of participant characteristics in the literature testing mental health interventions for youth with autism spectrum disorder. Autism, 26(4) 995-1000 DOI: 10.1177/13623613211056408

Golan, O., Haruvi-Lamdan, N., Laor, N., & Horesh, D. (2021). The comorbidity between autism spectrum disorder and post-traumatic stress disorder is mediated by brooding rumination. Autism, 26(2) 538-544. DOI: 10.1177/13623613211035240

Hellquist, A., & Tammimies, K. (2021). Access, utilization, and awareness for clinical genetic testing in autism spectrum disorder in Sweden: A survey study. Autism, 26(7) 1795- 1804. DOI: 10.1177/13623613211066130

Holingue, C., Poku, O., Pfeiffer, D., Murray, S., & Fallin, D. (2021). Gastrointestinal concerns in children with autism spectrum disorder: A qualitative study of family experiences. Autism, 26(7) 1698- 1711. DOI: 10.1177/13623613211062667

Kado, Y., Sanada, S., Oono, S., Ogino, T., & Nouno, S. (2020). Children with autism spectrum disorder comorbid with attention-deficit/hyperactivity disorder examined by the Wisconsin card sorting test: Analysis by age-related differences. Brain Development, 42, 113- 120

Kerns, C. M., Berkowitz, S. J., Moskowitz, L. J., Drahota, A., Lerner, M. D., & Newschaffer, C. J. (2020). Screening and treatment of trauma-related symptoms in youth with autism spectrum disorder among community providers in the United States. Autism, 24(2), 515- 525. https://doi. org/10.1177/1362361319847908

Kildahl, A. N., Bakken, T. L., & Iversen, T. E. (2019). Identification of post-traumatic stress disorder in individuals with autism spectrum disorder and intellectual disability: A systematic review identification of post-traumatic stress disorder in individuals with autism spectrum disorder and intellectual. Journal of Mental Health Research in Intellectual Disabilities, 12(1- 2), 1- 25. 080/19315864.2019.1595233

Kohane, I. S., McMurry, A., Weber, G., MacFadden, D., Rappaport, L., Kunkel, L., Bickel, J., Wattanasin, N., Spence, S., & Murphy, S. (2012). The co-morbidity burden of children and young adults with autism spectrum disorders. PLOS ONE, 7(4). e33224. https://doi. org/10.1371/journal.pone.0033224

Lai, M.-C., Kassee, C., Besney, R., Bonato, S., Hull, L., Mandy, W., Szatmari, P., & Ameis, S. H. (2019). Prevalence of co-occurring mental health diagnoses in the autism population: A systematic review and meta-analysis. The Lancet Psychiatry, 6(10), 819- 829.

Liu, X., Sun, X, Sun, C., Zou, M., Chen, Y., Huang, J., Wu, L., & Chen, W. (2021). Prevalence of epilepsy in autism spectrum disorders: A systematic review and meta-analysis. Autism, 26(1) 33- 50. DOI: 10.1177/13623613211045029

Lord, C., Elsabbagh, M., Baird, G., & Veenstra- vanderweele, J. (2018). Autism spectrum disorder. The Lancet, 392, 508- 520.

Miller, D. T., Adam, M. P., Aradhya, S., Biesecker, L. G., Brothman, A. R., Carter, N. … & Ledbetter, D. H. (2010). Consensus statement: Chromosomal microarray is a first-tier clinical diagnostic test for individuals with developmental disabilities or congenital anomalies. American Journal of Human Genetics, 86(5), 749- 764.

Moeschler, J. B., Shevell, M., & Committee on Genetics. (2014). Comprehensive evaluation of the child with intellectual disability or global developmental delays. Pediatrics, 134(3), e903- e918.

Neumeyer, A. M., Anixt, J., Chan, J., Perrin, J. M., Murray, D., Coury, D. L., Bennett, A., Farmer, J., & Parker, R. A. (2019). Identifying associations among co-occurring medical conditions in children with autism spectrum disorders. Academic Pediatrics, 19(3), 300- 306. https://doi. org/10.1016/j.acap.2018.06.014

Ojea, M. (2021). Classification of the comorbid symptomatic groups on Autism Spectrum Disorder diagnosis. International Journal for Innovation Education and Research, 9(6), 196- 208. ISSN: 2411- 293301.

Ojea, M. (2022). Integrated Scale for Diagnosis of Autism Spectrum Disorder (ISD-ASD). International Journal for Innovation, Education and Research, 10(9), 202-274.

Rosello, R., Martinez-Raga, J., Mira, A., Pastor, J. C., Solmi, M., & Cortese, S. (2021). Cognitive, social, and behavioral manifestations of the co-occurrence of autism spectrum disorder and attention-deficit/hyperactivity disorder: A systematic review. Autism, 26(4) 743- 760. DOI: 10.1177/13623613211065545

Rumball, F., Happé, F., & Grey, N. (2020). Experience of trauma and PTSD symptoms in autistic adults: Risk of PTSD development following DSM-5 and non-DSM-5 traumatic life events. Autism Research, 13(12), 2122- 2132. https://doi. org/10.1002/aur.2306

Schaefer, G. B., Mendelsohn, N. J., & Professional Practice Guidelines Committee. (2013). Clinical genetics evaluation in identifying the etiology of autism spectrum disorders: 2013 guideline revisions. Genetics in Medicine, 15(5), 399- 407.

Srivastava, S., Love-Nichols, J. A., Dies, K. A., Ledbetter, D. H., Martin, C. L., Chung, W. K., Firth, H. V., Frazier, T., Hansen, R. L., Prock, L., Brunner, H., Hoang, N., Scherer, S. W., Sahin, M., Miller, D. T., & NDD Exome Scoping Review Work Group. (2019). Meta-analysis and multidisciplinary consensus statement: Exome sequencing is a firsttier clinical diagnostic test for individuals with neurodevelopmental disorders. Genetics in Medicine, 21(11), 2413- 2421.

Tammimies, K., Marshall, C. R., Walker, S., Kaur, G., Thiruvahindrapuram, B., Lionel, A. C. . . . & Fernandez, B. A. (2015). Molecular diagnostic yield of chromosomal microarray analysis and whole-exome sequencing in children with autism spectrum disorder. JAMA, 314(9), 895- 903.

Monday, 3 April 2023


 Predictive hypotheses of the conceptual category of Autism Spectrum Disorder.

Manuel Ojea Rúa (PhD University of Vigo).
Tania Justo Román (Doctoral Student University of Vigo).
Elsa M. Castañeda Mikrukova (PgDipAutonomousUniversitat of Barcelona).
Alba Pereiras Martínez (PgDip University of Vigo).

Social Institute for Scientific Research (CIF: 44568509). Faculty of Education Sciences, University of Vigo (32004- Ourense). Manuel Ojea Rúa. ORCID-ID:

ISSN : 2321 - 9467 


People with Autism Spectrum Disorder (ASD) are characterized by presenting a neurodevelopmental disorder of fundamentally genetic etiology with consequences in the global cognitive process, affecting the psychoneurological processing of interrelational information processing as a systemic whole. For this reason, the International Classification DSM-5 (American Psychiatric Association (APA), 2013), which includes only behavioral criteria, is very reduced in the face of a disorder that affects the global developmental system, both in the perceptual-cognitive area, as well as in the motor area and other clinical components related to health. In this study, the following general objectives are set out: 1) to analyze the most important predictor variables that make up the explanatory hypotheses for the diagnosis of autism, 2) to analyze whether these predictor variables differ according to the type of ASD group, age and sex of the participants in the sample, and 3) to elaborate the implications of the predictive analysis for the application of adapted programs. A total of 262 children belonging to the three ASD groups (ASD-1: 124, ASD-2: 83, and ASD-3: 84) participated in this study, which have been distributed according to five age intervals and two groups according to the sex of the participants. The results found using linear stepwise regression analysis indicate that there are four predictor variables that accumulate to explain the hypotheses explaining the disorder: 1) SocialCommunication, which represents an explanatory R for autism of .477 (47.7%), R2: .228 (22.8%), adjusted: .225 (22.5%), 2) in the second phase of the model, the Cognition variable is incorporated, whose interaction explains an R: .520, R2: .270, adjusted: .265, 3) the third step is configured sum of the Visual-Motor variable, which justifies an R: .53, R2: .284, adjusted: .275, and 4) the fourth and last step is collected the Rigidity-Motor variable, with a total explanatory sum of R: .54, R2: 29.7% (adjusted: 28.6%).

 Lay abstract

 People with ASD are characterized by presenting a neurodevelopmental disorder of basically genetic etiology with consequences in the global cognitive process, which affects the psycho-neurological processing of interrelational information processing, influencing the global set of the neurocognitive system, both in the perceptual-cognitive, motor, and/or clinical level. This global systemic position requires the application of programs based on the development of processing modes, which can generate holistic development and reduce the cognitive consequences derived from the exposure to stimuli perceived as negative by people with ASD, as they would increase the types and levels of associated comorbidities. For this reason, programs have to design learning contexts that provide for positive responses, elaborated according to previously acquired competencies, which will progressively increase the level of difficulty according to the skills of elaboration of relationships between previous learning and new acquisitions. The subsequent presentation of a wide range of variety of learning contexts will facilitate the processes of generalization of the learned contents to new situations. 


Autism Spectrum Disorder, Perception- Cognition, Semantic- Encoding, Visual- Motor, Behaviour.

Friday, 17 March 2023



Manuel Ojea

La creación de nexos relacionales durante el aprendizaje constituye un elemento clave para favorecer el desarrollo de las personas con trastorno del espectro autista (TEA). En este sentido, el ácido glutámico como tal o en su forma ionizada, denominado L-glutamato (GLU) está involucrado en los aspectos funcionales de los procesos perceptivo- cognitivos y de la memoria; ya que se relaciona con la plasticidad sináptica de la transmisión de la información, especialmente, a través de su interacción con los receptores GABA. Pues bien, el desequilibrio derivado de un incremento del GLU y la reducción del meurotransmisor GABA durante el procesamiento de la información dificulta todavía más las conexiones sinápticas relacionales entre la información nueva percibida y su relación con los contenidos previos, lo cual hace que las personas con TEA vean todavía más limitadas sus capacidades para establecer relaciones significativas y comprensivas entre las conductas y los aprendizajes-objetivo. 

Por lo tanto, el incremento del neurotransmisor GLU se conforma como un aspecto esencial para mantener cierto equilibrio con el receptor GABA y, en consecuencia, mejorar el desarrollo global del ser humano. Para mejorar este equilibrio, además de los alimentos específicos que contienen monosodio, que pueden favorecer la producción del GLU, los programas psico- socioeducativos también pueden mejorar su equilibrio y la creación de redes o nodos neurales, a través del uso de programas sistémicos, en los cuales interviene el conjunto de los factores neurocerebrales que actúan durante el proceso de aprendizaje, lo cual, además, cuando, se acompaña del éxito en la tarea, genera el incremento de la motivación intrínseca, que potencia el desarrollo integral sistémico. 

En la Figura siguiente puede observarse gráficamente la cadena de participación del conjunto de los aspectos psicológicos del procesamiento de la información sobre un único contenido de aprendizaje, ya que, al hacerlo así, se favorece la elaboración de nodos sinápticos neuronales y, en conclusión, la mejora gradual del desarrollo conductual y del aprendizaje en las personas con TEA.

Figura: Sistemicidad transversal de los contenidos e aprendizaje.


Friday, 3 March 2023



Manuel Ojea

Necesidad observada: Fer, un alumno con TEA que, cuando participaba en un trabajo de grupo en clase de Historia de 3º de ESO, se sintió perdido sobre las cuestiones de contenido que debía realizar dentro del grupo, tanto en relación con la parte conceptual que le correspondía, como con la forma de actuar con sus compañeros y compañeras de grupo, comenzó a moverse con inquietud que iba creciendo en intensidad, a murmurar en voz baja hacia sí mismo, finalmente, se levantaba y sentaba constantemente, que no son comportamientos estereotipados, hasta que el docente le reprendió por ello y le apartó del grupo temporalmente. El docente actúa en función del modelo de refuerzo A-B; en este artículo, por el contrario, se propone un cambio de conducta mediante el aprendizaje en contextos previamente preparados:

Contexto1: Sobre el mismo trabajo anterior de la materia conceptual de Historia, se forma un grupo de trabajo, cuyas partes están previamente y altamente estructuradas en relación con lo que debe hacer cada estudiante dentro del grupo. Fer conoce perfectamente su parte conceptual, la cual ha sido asignada intencionalmente con el fin de que su parte trabajada sea correcta. Además, Fer tiene a su lado una compañera (alumna tutora), la cual le ayuda inmediatamente en caso que se pierda sobre la relación sobre el contexto a nivel de colaboración formal o estructural con su grupo. Cada estudiante realiza su parte en colaboración con el resto del grupo y el trabajo finaliza con éxito.

Contexto2: El mismo proceso se repite en un nuevo contexto, referido a otra categoría conceptual de la misma asignatura o en relación a otra materia. Nuevamente todo está controlado para que el éxito de la tarea se convierta en un éxito para Fer. 

El proceso debe repetirse cuantas veces sea necesario, cuanto mayor sea la variedad de contextos, mejor se facilita su generalización.

El Refuerzo obtenido por el propio éxito percibido y vivido en la acción de ambos contextos1,2 se convierte en el elemento reforzante intrínseco que fortalece la motivación activa sobre el aprendizaje y, en consecuencia, facilita la mejora de la conducta durante el transcurso del tiempo del trabajo en grupo, medida en función de los parámetros de las necesidades iniciales.

Ahora, ya es posible, volver al ensayo real en el contexto original:

Contexto inicial: se repite el proceso de trabajo en el grupo de estudiantes en la misma clase de Historia nuevamente y podrán observarse los cambios de actitud comportamental del alumno. No hace falta reforzar externamente la acción, el refuerzo vivencial y percibido del éxito es el elemento más eficaz de reforzamiento por genera el nexo entre la tarea y sus relaciones en el contexto de participación.

Sunday, 26 February 2023



Manuel Ojea

En relación a las personas con TEA, deben diferenciarse claramente los comportamientos estereotipados y restringidos, los cuales pueden formar parte intrínseca de los criterios del diagnóstico del TEA (APA, 2013), de las alteraciones de conducta, en cuanto constituyen reacciones negativas o alteraciones comportamentales severas ante las exigencias del medio contextual.

En los supuestos de alteraciones conductuales ante el contexto, las intervenciones basadas en los procesos usuales de modificación de conducta A-B, en cualquiera de sus modalidades, no son eficaces, debido a que la relación acción- reacción, sencillamente, no es comprendida y cualquier ligero cambio posterior puede provocar la misma reacción negativa objetivo de la modificación anterior.

Esto es debido a que la causa fundamental de estas alteraciones en las personas con TEA se sitúa en la estrecha asociación existente entre el neurotransmisor L-glutamato con su opuesto, el neurotransmisor GABA, en cuya relación, el L- glutamato puede equilibrar o desequilibrar los efectos del GABA, cuyo desequilibrio afecta de manera importante a la interrelación entre las redes neuronales, que son las que facilitan las conexiones sinápticas entre la información y, por tanto, la significatividad y la coprensividad aportada a las situaciones.

Por este motivo, las intervenciones conductuales han de fundamentarse en la búsqueda de estos equilibrios funcionales, basados en aprendizajes relacionales comprensivos contextos- respuestas- consecuentes, que ayuden a mejorar dichas conductas. 

Thursday, 2 February 2023



Por Manuel Ojea (2023), 11(2), 75-85.

       Diagnostic processes of Autism Spectrum Disorder (ASD) just based over the observation of target- behaviors, regarding to interaction and social communication (social) and restrictive behavior (behavior), seem be most effective for level 2-3 ASD specific diagnosis; however, level 1 ASD diagnosis may be many errors, since the scores sum are within limits corresponding the other specific personality or social communication disorders (American Psychiatric Association (APA), 2013). For this reason, it´s needs complement the analysis of variables that make up the perceptual- cognitive dimension of information processing to specify the diagnosis validity and avoid initial errors that can create important prejudices along educational processes. This study delimits the differential analysis of 3 dimensions on total of 38 participants with level 1 ASD. Indeed, results indicate that, although the constant of diagnostic predictive analysis found through the linear regression analysis shows significant data for diagnosis synthesis, it´s owing to critical influence of cognitive processing dimension: .00, while other 2 dimensions analyzed individually show non-significant influence, being critical significant level for social dimension: .12 and behavior dimension: .35. Therefore, it´s need design diagnostic scales that include the basic principles of perceptual-cognitive processing functioning to avoid errors in autism diagnosis. 
             Autism Spectrum Disorder, Interaction and Communication Social, Behavior, Encoding, Information Processing, Perceptive- Cognitive.

Adams, C., Lloyd,J., Aldred, C., & Baxendale,J. (2006). Exploring the effects of communication intervention for developmental pragmatic language impairments: A signal- generation study. International Journal of Language and Communication Disorders, 41(1), 41-65. American
Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th). 2013. American Psychiatric Publishing.
Bennett, T. A., Szatmari, P., Georgiades, K., Hanna, S., Janus, M., Georgiades, S., ... & Thomson, A. (2015). Do reciprocal associations exist between social and language pathways in preschoolers with Autism Spectrum Disorders? Journal of Child Psychology and Psychiatry, 56(8), 874-883.
Ben-Sasson, A., Gal, E., Fluss, R., Katz-Zetler, N., & Cermak, S. A. (2019). Update of a meta-analysis of sensory symptoms in ASD: A new decade of research. Journal of Autism and Developmental Disorders, 49(12), 4974-4996. DOI: 10.1007/s10803-019-04180-0
Ben-Sasson, A., Gal, E., Fluss, R., Katz-Zetler, N., & Cermak, S. A. (2019). Update of a meta-analysis of sensory symptoms in ASD: A new decade of research. Journal of Autism and Developmental Disorders, 49(12), 4974-4996. DOI: 10.1007/s10803-019-04180-0 
Bijlenga, D., Tjon-Ka-Jie, J. Y. M., Schuijers, F., & Kooij, J. J. S. (2017). Atypical sensory profiles as core features of adult ADHD, irrespective of autistic symptoms. European Psychiatry, 43, 51-57. DOI: 10.1016/j.eurpsy.2017.02.481 
Botting, N., & Adams, C. (2005). Semantic and inferencing abilities in children with communication disorders. International Journal of Language and Communication Disorders, 40(1), 49-66. 
Brignell, A., Williams, K., Jachno, K., Prior, M., Reilly, S., & Morgan, A. T. (2018). Patterns and predictors of language development from 4 to 7 years in verbal children with and without Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 48(10), 3282-3295. 
Coplan, R., & Abreau, K. A. (2009). Peer interactions and play in early childhood. In K. H. Rubin, W. M. Incidence of cognitive processing dimension for the diagnostic reliability of level-1 autism spectrum disorder International Journal for Innovation Education and Research Vol. 11 No. 2 (2023), pg. 84 Bukowski, M. William, & B. Laursen (Eds.), Handbook of peer interactions, relationships, and groups: Social, emotional, and personality development in context (pp. 143-161). New York: Guilford Press.
 Cronin, K. A. (2014). The relationship among oral language, decoding skills, and reading comprehension in children with Autism. Exceptionality, 22(3), 141-157. 
Glod, M., Riby, D. M., Honey, E., & Rodgers, J. (2015). Psychological correlates of sensory processing patterns in individuals with autism spectrum disorder: A systematic review. Review Journal of Autism and Developmental Disorders, 2(2), 199-221. 
Graham, B., Reghr, G., & Wright, J. G. (2003). Delphi as a method to establish consensus for diagnostic criteria. Journal of Clinical Epidemiology 56(12), 1150- 1156. 
Green, S. A., Ben-Sasson, A., Soto, T. W., & Carter, A. S. (2012). Anxiety and sensory over-responsivity in toddlers with autism spectrum disorders: Bidirectional effects across time. Journal of Autism and Developmental Disorders, 42(6), 1112-1119. 
Harris, P. L. (2017). Tell, ask, repair: Early responding to discordant reality. Motivation Science, 3(3), 275- 286. 
Kelley, E., Paul, J. J., Fein, D., & Naigles, L. R. (2006). Residual language deficits in optimal outcome children with a history of Autism. Journal of Autism and Developmental Disorders, 36(6), 807-828. 
Kjellmer, L., Hedvall, A., Holm, A., Fernell, E., Gillberg, C., & Norrelgen, F. (2012). Language comprehension in preschoolers with Autism Spectrum Disorders without Intellectual Disability: Use of the Reynell Developmental Language Scales. Research in Autism Spectrum Disorders, 6(3), 1119-1125. 
Kraper, C. K., Kenworthy, L., Popal, H., Martin, A., & Wallace, G. L. (2017). The gap between adaptive behavior and intelligence in autism persists into young adulthood and is linked to psychiatric comorbidities. Journal of Autism and Developmental Disorders, 47(10), 3007-3017. 
Mayer, J. L. (2017). The relationship between autistic traits and atypical sensory functioning in neurotypical and ASD adults: A spectrum approach. Journal of Autism and Developmental Disorders, 47(2), 316- 327. DOI: 10.1007/s10803-016-2948-5 
Neufeld, J., Eriksson, L. H., Richard Hammarsten, R., Remnélius, K. L., Tillmann, J., Isaksson, J., & Bölte, S. (2021).The impact of atypical sensory processing on adaptive functioning within and beyond autism: The role of familial factors. Autism, 25(8), 2341-2355. DOI: 10.1177/13623613211019852. 
Pellicano, E., Dinsmore, A., & Charman, T. (2014). What should autism research focus upon? Community views and priorities from the United Kingdom. Autism, 18(7), 756-770. DOI: 10.1177/1362361314529627 
Penner, M., Anagnostou, E., Andoni, L. Y., & Ungar, W. J. (2018). Systematic review of clinical guidance Incidence of cognitive processing dimension for the diagnostic reliability of level-1 autism spectrum disorder International Journal for Innovation Education and Research Vol. 11 No. 2 (2023), pg. 85 documents for Autism Spectrum Disorder, diagnostic assessment in select regions. Autism: The International Journal of Research and Practice, 22(5), 517-527. 
Serafini, G., Engel-Yeger, B., Vazquez, G. H., Pompili, M., & Amore, M. (2017). Sensory processing disorders are associated with duration of current episode and severity of side effects. Psychiatry Investigation, 14(1). DOI: 10.4306/pi.2017.14.1.51 
Uljarević, M., Baranek, G., Vivanti, G., Hedley, D., Hudry, K., & Lane, A. (2017). Heterogeneity of sensory features in autism spectrum disorder: Challenges and perspectives for future research. Autism Research, 10(5), 703-710. DOI: 10.1002/aur.1747 
Wigham, S., Rodgers, J., South, M., McConachie, H., & Freeston, M. (2015). The interplay between sensory processing abnormalities, intolerance of uncertainty, anxiety and restricted and repetitive behaviours in autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(4), 943-952