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Gridley N, Blower S, Dunn A, Bywater T, Bryant M. Psychometric Properties of Child (0-5 Years) Outcome Measures as used in Randomized Controlled Trials of Parent Programs: A Systematic Review. Clin Child Fam Psychol Rev 2019; 22:388-405. [PMID: 30806864 PMCID: PMC6669186 DOI: 10.1007/s10567-019-00277-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This systematic review is one of the three which sought to identify measures commonly implemented in parenting program research, and to assess the level of psychometric evidence available for their use with this age group. This review focuses specifically on measures of child social-emotional and behavioral outcomes. Two separate searches of the same databases were conducted; firstly to identify eligible instruments, and secondly to identify studies reporting on the psychometric properties of the identified measures. Five commercial platforms hosting 19 electronic databases were searched from their inception to conducted search dates. Twenty-four measures were identified from Search 1: a systematic search of randomized controlled trial evaluations of parenting programs. For Search 2, inclusion/exclusion criteria were applied to 21,329 articles that described the development and/or validation of the 24 measures identified in Search 1. Thirty articles met the inclusion criteria. resulting in 11 parent report questionnaires and three developmental assessment measures for review. Data were extracted and synthesized to describe the methodological quality of each article using the COSMIN checklist alongside the overall quality rating of the psychometric property reported for each measure. Measure reliability was categorized into four domains (internal consistency, test-re-test, inter-rater, and intra-rater). Measure validity was categorized into four domains (content, structural, convergent/divergent, and discriminant). Results indicated that supporting evidence for included measures is weak. Further work is required to improve the evidence base for those measures designed to assess children's social-emotional and behavioral development in this age group. PROSPERO Registration number: CRD42016039600.
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Affiliation(s)
- Nicole Gridley
- Department of Health Sciences, University of York, York, YO10 5DD, UK
- Carnegie School of Education, Leeds Beckett University, Leeds, UK
| | - Sarah Blower
- Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Abby Dunn
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Tracey Bywater
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Maria Bryant
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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102
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Herbrecht E, Lazari O, Notter M, Schmeck K, Spiegel R. Process research in early intensive intervention in autism spectrum disorder: Sensitivity to change of the autism behavior coding system. Autism Res 2019; 12:1817-1828. [PMID: 31397545 PMCID: PMC6916622 DOI: 10.1002/aur.2188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 05/10/2019] [Accepted: 07/15/2019] [Indexed: 12/17/2022]
Abstract
The development of sensitive measures to capture changes in core autism symptoms is crucial in early intervention research. The study examines the sensitivity to change of the Autism Behavior Coding System (ABCS), a video‐based instrument to assess core autism symptoms during therapist‐child interaction. Video sequences of 40 young children treated in the Frühintervention bei Autistischen Störungen center were analyzed with regard to the question of whether short‐term changes during an 18 day period of early intervention could be captured, and whether these results are reflected in an independent clinical assessment (Developmental Disorders‐Child‐Global Assessment Scale [DD‐C‐GAS]). ABCS results showed statistically significant improvements on behavioral domains such as “expression of wishes” and “social cooperative behavior” (P < 0.01), less pronounced on “eye contact.” Improvements on the DD‐C‐GAS were highly significant on all subdomains. Both scales showed high correlations within their subdomains, yet no significant correlations between the changes in both instruments' scores were found. An additional analysis between the DD‐C‐GAS scores at day 18 and the changes in the ABCS scores showed statistically significant associations in the expected direction between the changes in the variable “eye contact” and all DD‐C‐GAS subdomains. The correspondence of the two levels of assessment is low, but the specifics of this relationship deserve further study. The ABCS may prove useful in addition to standard assessment tools, especially in early intervention research settings, as it allows reliable analysis of core behavioral elements in young children with autism. Autism Res 2019, 12: 1817–1828. © 2019 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. Lay Summary The study examined the sensitivity of an autism‐specific video coding system (ABCS) in assessing changes after an 18 day period of intensive early intervention. Video sequences of therapist‐child‐interaction of 40 young children with autism spectrum disorder (ASD) were analyzed. Children's behavior improved in expression of wishes, social cooperativity and eye contact. A therapist‐based global assessment scale also showed important improvement after 18 days, yet both assessment instruments showed weak correlations between their respective changes. We showed that the ABCS may prove useful in capturing short‐term changes in autism‐related behaviors, especially in early intervention research.
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Affiliation(s)
- Evelyn Herbrecht
- Department of Child and Adolescent Psychiatry, University Hospital for Psychiatry Basel, Basel, Switzerland
| | - Olga Lazari
- Department of Child and Adolescent Psychiatry, University Hospital for Psychiatry Basel, Basel, Switzerland
| | - Marianne Notter
- Department of Child and Adolescent Psychiatry, University Hospital for Psychiatry Basel, Basel, Switzerland
| | - Klaus Schmeck
- Department of Child and Adolescent Psychiatry, University Hospital for Psychiatry Basel, Basel, Switzerland
| | - René Spiegel
- Department of Child and Adolescent Psychiatry, University Hospital for Psychiatry Basel, Basel, Switzerland
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103
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Trembath D, Gurm M, Scheerer NE, Trevisan DA, Paynter J, Bohadana G, Roberts J, Iarocci G. Systematic review of factors that may influence the outcomes and generalizability of parent‐mediated interventions for young children with autism spectrum disorder. Autism Res 2019; 12:1304-1321. [DOI: 10.1002/aur.2168] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 06/10/2019] [Indexed: 12/25/2022]
Affiliation(s)
- David Trembath
- Menzies Health Institute QueenslandGriffith University Southport Queensland Australia
| | - Mandeep Gurm
- Department of PsychologySimon Fraser University Burnaby British Columbia Canada
| | - Nichole E. Scheerer
- Department of PsychologySimon Fraser University Burnaby British Columbia Canada
| | - Dominic A. Trevisan
- Faculty of EducationSimon Fraser University Burnaby British Columbia Canada
- Child Study CenterYale University New Haven Connecticut
| | - Jessica Paynter
- Menzies Health Institute QueenslandGriffith University Southport Queensland Australia
| | - Gal Bohadana
- Menzies Health Institute QueenslandGriffith University Southport Queensland Australia
| | - Jacqueline Roberts
- Griffith Institute for Educational ResearchGriffith University Mount Gravatt, Queensland Australia
| | - Grace Iarocci
- Department of PsychologySimon Fraser University Burnaby British Columbia Canada
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104
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Quantifying individual differences in brain morphometry underlying symptom severity in Autism Spectrum Disorders. Sci Rep 2019; 9:9898. [PMID: 31289283 PMCID: PMC6617442 DOI: 10.1038/s41598-019-45774-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 06/14/2019] [Indexed: 01/12/2023] Open
Abstract
The neurobiology of heterogeneous neurodevelopmental disorders such as autism spectrum disorders (ASD) are still unclear. Despite extensive efforts, most findings are difficult to reproduce due to high levels of individual variance in phenotypic expression. To quantify individual differences in brain morphometry in ASD, we implemented a novel subject-level, distance-based method on subject-specific attributes. In a large multi-cohort sample, each subject with ASD (n = 100; n = 84 males; mean age: 11.43 years; mean IQ: 110.58) was strictly matched to a control participant (n = 100; n = 84 males; mean age: 11.43 years; mean IQ: 110.70). Intrapair Euclidean distance of MRI brain morphometry and symptom severity measures (Social Responsiveness Scale) were entered into a regularised machine learning pipeline for feature selection, with rigorous out-of-sample validation and permutation testing. Subject-specific structural morphometry features significantly predicted individual variation in ASD symptom severity (19 cortical thickness features, p = 0.01, n = 5000 permutations; 10 surface area features, p = 0.006, n = 5000 permutations). Findings remained robust across subjects and were replicated in validation samples. Identified cortical regions implicate key hubs of the salience and default mode networks as neuroanatomical features of social impairment in ASD. Present results highlight the importance of subject-level markers in ASD, and offer an important step forward in understanding the neurobiology of heterogeneous disorders.
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105
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Szatmari P, Offringa M, Butcher NJ, Monga S. Counting What Counts: The Case for Harmonized Outcomes in Child and Youth Mental Health Research. J Am Acad Child Adolesc Psychiatry 2019; 58:656-658. [PMID: 31229181 DOI: 10.1016/j.jaac.2019.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 01/11/2023]
Abstract
Evidence-based mental health care for children and youth critically depends on properly conducted randomized controlled trials (RCTs) and prospective studies that investigate change in mental health outcomes over time. As evidence accumulates, it can be synthesized through systematic reviews and meta-analyses that combine the results of many studies into a single estimate of effect. Clinical practice guidelines incorporate this information along with input from stakeholders and content experts, who fill in evidence gaps to formulate recommendations for best practice. Collectively, this evidence generation and synthesis process, once implemented, supports better long-term outcomes for the population by highlighting the "best available evidence" and reducing variability in clinical care. In addition, this process identifies knowledge gaps that might inform the field's research agenda. The objective of this commentary is to examine the potential of developing and implementing "Core Outcome Sets" (COS) as a means of reducing variability in the measurement and reporting of outcomes across RCTs and cohort studies, and thereby promoting the translation of evidence to practice.
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Affiliation(s)
- Peter Szatmari
- The Hospital for Sick Children and the University of Toronto, Ontario, Canada; Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Suneeta Monga
- The Hospital for Sick Children and the University of Toronto, Ontario, Canada
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106
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Assessing Communication in Children with Autism Spectrum Disorder Who Are Minimally Verbal. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2019. [DOI: 10.1007/s40474-019-00171-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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107
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Gridley N, Blower S, Dunn A, Bywater T, Whittaker K, Bryant M. Psychometric Properties of Parent-Child (0-5 years) Interaction Outcome Measures as Used in Randomized Controlled Trials of Parent Programs: A Systematic Review. Clin Child Fam Psychol Rev 2019; 22:253-271. [PMID: 30734193 PMCID: PMC6478772 DOI: 10.1007/s10567-019-00275-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This systematic review sought to identify observational measures of parent-child interactions commonly implemented in parenting program research, and to assess the level of psychometric evidence available for their use with this age group. Two separate searches of the same databases were conducted; firstly, to identify eligible instruments, and secondly to identify studies reporting on the psychometric properties of the identified measures. Five commercial platforms hosting 19 electronic databases were searched from their inception to conducted search dates. Fourteen measures were identified from Search 1; a systematic search of randomized controlled trial evaluations of parenting programs. For Search 2, inclusion/exclusion criteria were applied to 1327 retrieved papers that described the development and/or validation of the 14 measures identified in Search 1. Seventeen articles met the inclusion criteria, resulting in five observational measures for the final review. Data were extracted and synthesized using the COSMIN rating system to describe the methodological quality of each article alongside the overall quality rating of the psychometric property reported for each measure using the Terwee checklist. Measure reliability was categorized into four domains (internal consistency, test-re-test, inter-rater, and intra-rater). Measure validity was categorized into four domains (content, structural, convergent/divergent, and discriminant). Results indicated that the majority of psychometric evidence related to children aged from birth the three with internal consistency, inter-rater reliability, and structural validity the most commonly reported properties, although this evidence was often weak. The findings suggest further validation of the included measures is required to establish acceptability for the whole target age group.
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Affiliation(s)
- Nicole Gridley
- Department of Health Sciences, University of York, York, UK.
- School of Education, Leeds Beckett University, Leeds, LS6 3QQ, UK.
| | - Sarah Blower
- Department of Health Sciences, University of York, York, UK
| | - Abby Dunn
- Department of Health Sciences, University of York, York, UK
| | - Tracey Bywater
- Department of Health Sciences, University of York, York, UK
| | - Karen Whittaker
- School of Nursing, University of Central Lancashire, Preston, UK
| | - Maria Bryant
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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108
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The Need for a Developmentally Based Measure of Social Communication Skills. J Am Acad Child Adolesc Psychiatry 2019; 58:555-560. [PMID: 31130206 PMCID: PMC6599636 DOI: 10.1016/j.jaac.2018.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/04/2018] [Accepted: 02/15/2019] [Indexed: 12/14/2022]
Abstract
The ability to demonstrate and quantify changes in social communication skills has been hindered by a lack of existing measures with appropriate standardization and psychometric properties. Such a measure would be helpful for research in many populations but would be particularly crucial for detecting incremental changes in youth with neurodevelopmental disorders who might gain skills but still lag substantially behind same-age peers. Although study designs and statistical methods are under development to try to account for slow and/or nonlinear, but potentially meaningful, improvements,1 there is a dearth of measures designed to capture growth and loss of social communication skills. This opinion piece outlines the argument for such a measure and the primary issues to consider in its development.
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109
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McConachie H, Livingstone N, Morris C, Beresford B, Le Couteur A, Gringras P, Garland D, Jones G, Macdonald G, Williams K, Parr JR. Parents Suggest Which Indicators of Progress and Outcomes Should be Measured in Young Children with Autism Spectrum Disorder. J Autism Dev Disord 2019; 48:1041-1051. [PMID: 28861649 PMCID: PMC5861173 DOI: 10.1007/s10803-017-3282-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Evaluation of interventions for children with autism spectrum disorder (ASD) is hampered by the multitude of outcomes measured and tools used. Measurement in research with young children tends to focus on core impairments in ASD. We conducted a systematic review of qualitative studies of what matters to parents. Parent advisory groups completed structured activities to explore their perceptions of the relative importance of a wide range of outcome constructs. Their highest ranked outcomes impacted directly on everyday life and functioning (anxiety, distress, hypersensitivity, sleep problems, happiness, relationships with brothers and sisters, and parent stress). Collaboration between professionals, researchers and parents/carers is required to determine an agreed core set of outcomes to use across evaluation research.
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Affiliation(s)
- Helen McConachie
- Institute of Health and Society, Newcastle University, Sir James Spence Institute 3rd floor, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.
| | - Nuala Livingstone
- School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK.,Cochrane Editorial Unit, London, UK
| | - Christopher Morris
- PenCRU, Child Health Group, University of Exeter Medical School, Exeter, UK
| | | | - Ann Le Couteur
- Institute of Health and Society, Newcastle University, Sir James Spence Institute 3rd floor, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
| | - Paul Gringras
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Deborah Garland
- National Autistic Society, North East Resource Centre, Newcastle upon Tyne, UK
| | - Glenys Jones
- School of Education, University of Birmingham, Birmingham, UK
| | - Geraldine Macdonald
- School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, Northern Ireland, UK.,University of Bristol, Bristol, UK
| | - Katrina Williams
- Developmental Medicine, Royal Children's Hospital, University of Melbourne and Murdoch Childrens Research Institute, Parkville, Australia
| | - Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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110
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Kitzerow J, Teufel K, Jensen K, Wilker C, Freitag CM. Case-control study of the low intensive autism-specific early behavioral intervention A-FFIP: Outcome after one year. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2019; 48:103-112. [PMID: 30971173 DOI: 10.1024/1422-4917/a000661] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Abstracts: Objective: In current international research, early intervention in children with autism-spectrum disorder (ASD) focuses on naturalistic developmental behavioral interventions (NDBI). The manualized Frankfurt Early Intervention Program for preschool-aged children with ASD (A-FFIP) implements NDBI principles within a low-intensity approach of 2 h intervention/week. The present case-control study established effect sizes of change in autistic symptoms, comorbid behavioral problems as well as IQ after one year. Methodology: An intervention group (N = 20; age: 3.4-7.9 years) and a treatment-as-usual control group (N = 20; age: 3.2-7.3 years) of children with ASD were matched for developmental and chronological age. The outcome measures used were the ADOS severity score, the Child Behavior Checklist, and cognitive development. Results: After one year, the A-FFIP group showed a trend towards greater improvement in autistic symptoms (η2 = .087 [95 %-CI: .000-.159]) and significantly greater improvements in cognitive development (η2 = .206 [CI: .012-.252]) and global psychopathology (η2 = .144 [CI: .001-.205]) compared to the control group. Conclusion: The efficacy of A-FFIP should be established in a larger, sufficiently powered, randomized controlled study.
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Affiliation(s)
- Janina Kitzerow
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Research and Intervention Center of Excellence Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Karoline Teufel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Research and Intervention Center of Excellence Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics, University of Heidelberg, Germany
| | - Christian Wilker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Research and Intervention Center of Excellence Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Research and Intervention Center of Excellence Frankfurt, Goethe University Frankfurt am Main, Germany
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111
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Beresford B, Clarke S, Maddison J. Therapy interventions for children with neurodisabilities: a qualitative scoping study. Health Technol Assess 2019; 22:1-150. [PMID: 29345224 DOI: 10.3310/hta22030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Therapy interventions emerged four times in the top 10 research priorities in a James Lind Alliance research prioritisation exercise for children with neurodisabilities (Morris C, Simkiss D, Busk M, Morris M, Allard A, Denness J, et al. Setting research priorities to improve the health of children and young people with neurodisability: a British Academy of Childhood Disability-James Lind Alliance Research Priority Setting Partnership. BMJ Open 2015;5:e006233). The National Institute for Health Research (NIHR) commissioned this study as part of an information-gathering exercise in response to this. OBJECTIVES The objectives were to (1) describe the current practice, approaches and schools of thought in relation to physiotherapy, occupational therapy and speech and language therapy for children with neurodisability; (2) explore clinical decision-making; (3) investigate views on outcomes and their measurement, particularly participation as an outcome, that is, the child's ability to have the opportunity to be involved in life situations and activities (e.g. communication, mobility, interpersonal interactions, self-care, learning and applying knowledge); (4) seek views on the aspects of therapy interventions that have an impact on outcomes; and (5) elicit stakeholder views on research needs and priorities. DESIGN, SETTING AND PARTICIPANTS More than 70 professionals (therapists, service leads, paediatricians and education staff) and 25 parents participated in a qualitative interview (either individually or as part of a focus group). RESULTS Professional thinking and models of service delivery are in a state of flux and development. There is a move towards goals-focused, family-centred approaches. Work tends to be highly individualised, with few protocols. Parents are certain of the value of therapies, although they may experience difficulties with provision and may seek (additional) private provision. Therapy interventions are conceived as three components: the therapist, the procedures/equipment, etc., and the wider therapeutic environment. They are believed to be highly complex and poorly understood. Although participation is widely endorsed as a core intervention objective of therapy interventions, its suitability, or appropriateness, as an outcome measure was questioned. Other child and/or parent outcomes were identified as more or equally important. Notions of intermediate outcomes - in terms of body structure/function, and the achievement of activities - were regarded as important and not counter to participation-focused approaches. Among therapists, research on intervention effectiveness was (cautiously) welcomed. A number of methodological challenges were identified. A portfolio of study designs - quantitative and qualitative, experimental and observational - was called for, and which included economic evaluation and clear pathways to impact. LIMITATIONS The study was not successful in recruiting children and young people. Further work is required to elucidate the views of this key stakeholder group. CONCLUSIONS Therapy interventions are poorly understood. There was strong support, tempered a little by concerns among some about the feasibility of demonstrating impact, for investment in research. FUTURE WORK The identification of research priorities was a core study objective, and a wide-ranging research agenda was identified. It included 'foundational' research into neurodisability, the active components of therapy interventions and the concept of participation. Three areas of evaluation were identified: overall approaches to therapy, service organisation and delivery issues, and the evaluation of specific techniques. Parents regarded evaluations of approaches to therapy (e.g. goals-focused; supporting family-self management) as priorities, along with evaluations of models of service provision. Professionals' views were broadly similar, with an additional emphasis on methodological research. In terms of specific techniques, there was no shared agreement regarding priorities, with views informed by personal interests and experiences. FUNDING The NIHR Health Technology Assessment programme.
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112
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Bradshaw J, Shic F, Holden AN, Horowitz EJ, Barrett AC, German TC, Vernon TW. The Use of Eye Tracking as a Biomarker of Treatment Outcome in a Pilot Randomized Clinical Trial for Young Children with Autism. Autism Res 2019; 12:779-793. [PMID: 30891960 DOI: 10.1002/aur.2093] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 02/07/2019] [Accepted: 02/22/2019] [Indexed: 11/06/2022]
Abstract
There is a pressing need for objective, quantifiable outcome measures in intervention trials for children with autism spectrum disorder (ASD). The current study investigated the use of eye tracking as a biomarker of treatment response in the context of a pilot randomized clinical trial of treatment for young children with ASD. Participants included 28 children with ASD, aged 18-48 months, who were randomized to one of two conditions: Pivotal Response Intervention for Social Motivation (PRISM) or community treatment as usual (TAU). Eye-tracking and behavioral assessment of developmental functioning were administered at Time 1 (prior to randomization) and at Time 2 (after 6 months of intervention). Two well-established eye-tracking paradigms were used to measure social attention: social preference and face scanning. As a context for understanding relationships between social attention and developmental ability, we first examined how scanning patterns at Time 1 were associated with concurrent developmental functioning and compared to those of 23 age-matched typically developing (TD) children. Changes in scanning patterns from Time 1 to Time 2 were then compared between PRISM and TAU groups and associated with behavioral change over time. Results showed that the social preference paradigm differentiated children with ASD from TD children. In addition, attention during face scanning was associated with language and adaptive communication skills at Time 1 and change in language skills from Time 1 to Time 2. These findings highlight the importance of examining targeted biomarkers that measure unique aspects of child functioning and that are well-matched to proposed mechanisms of change. Autism Research 2019, 12: 779-793. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Biomarkers have the potential to provide important information about how and why early interventions effect positive change for young children with ASD. The current study suggests that eye-tracking measures of social attention can be used to track change in specific areas of development, such as language, and points to the need for targeted eye-tracking paradigms designed to measure specific behavioral changes. Such biomarkers could inform the development of optimal, individualized, and adaptive interventions for young children with ASD.
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Affiliation(s)
- Jessica Bradshaw
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Frederick Shic
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Anahita N Holden
- Department of Counseling, Clinical, and School Psychology, University of California Santa Barbara, Santa Barbara, California
| | - Erin J Horowitz
- Department of Psychological and Brain Sciences, University of California Santa Barbara, Santa Barbara, California
| | - Amy C Barrett
- Department of Counseling, Clinical, and School Psychology, University of California Santa Barbara, Santa Barbara, California
| | - Tamsin C German
- Department of Psychological and Brain Sciences, University of California Santa Barbara, Santa Barbara, California
| | - Ty W Vernon
- Department of Counseling, Clinical, and School Psychology, University of California Santa Barbara, Santa Barbara, California
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113
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Bangerter A, Ness S, Lewin D, Aman MG, Esbensen AJ, Goodwin MS, Dawson G, Hendren R, Leventhal B, Shic F, Opler M, Ho KF, Pandina G. Clinical Validation of the Autism Behavior Inventory: Caregiver-Rated Assessment of Core and Associated Symptoms of Autism Spectrum Disorder. J Autism Dev Disord 2019; 50:2090-2101. [PMID: 30888551 PMCID: PMC7261279 DOI: 10.1007/s10803-019-03965-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
There is a need for measures to track symptom change in autism spectrum disorder (ASD). We conducted a validation study on a revised version of the Autism Behavior Inventory (ABI), and a short form (ABI-S). Caregivers of individuals (6–54 years) with confirmed diagnoses of ASD (N = 144) completed the ABI and other rating scales at 4 time points. Scale consistency for each domain, 3–5 day test–retest reliability, and construct validity, determined by comparison to pre-specified scales, were all good. Change in the ABI was congruent with changes in other instruments. Collectively, results suggest incipient suitability of the ABI as a measure of changes in core and associated symptoms of ASD. Trial Registration NCT02299700.
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Affiliation(s)
- Abigail Bangerter
- Department of Neuroscience, Janssen Research & Development, LLC, Titusville, NJ, USA.
| | - Seth Ness
- Department of Neuroscience, Janssen Research & Development, LLC, Titusville, NJ, USA
| | - David Lewin
- Department of Neuroscience, Janssen Research & Development, LLC, Titusville, NJ, USA
- Statistically Speaking Consulting, LLC, Chicago, IL, USA
| | - Michael G Aman
- Department of Psychology, Ohio State University, 175C McCampbell, 1581 Dodd Drive, Columbus, OH, USA
| | - Anna J Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, 3430 Burnet Avenue, ML 4002, Cincinnati, OH, USA
| | - Matthew S Goodwin
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, 312E Robinson Hall, 360 Huntington Avenue, Boston, MA, USA
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Duke University, 2608 Erwin Road, Suite 300, Durham, NC, USA
| | - Robert Hendren
- Department of Psychiatry and the Weill Institute for Neuroscience, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA, USA
- Benioff Children's Hospital, University of California, San Francisco,, San Francisco, CA, USA
| | - Bennett Leventhal
- Department of Psychiatry and the Weill Institute for Neuroscience, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA, USA
- Benioff Children's Hospital, University of California, San Francisco,, San Francisco, CA, USA
| | - Fred Shic
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Yale Child Study Center, Hartford, CT, USA
| | - Mark Opler
- MedAvante-ProPhase, Inc, NYU School of Medicine, 3 Park Avenue Floors 28, 37, New York, NY, USA
| | | | - Gahan Pandina
- Department of Neuroscience, Janssen Research & Development, LLC, Titusville, NJ, USA
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114
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Trembath D, Westerveld MF, Teppala S, Thirumanickam A, Sulek R, Rose V, Tucker M, Paynter J, Hetzroni O, Keen D, Vivanti G. Profiles of vocalization change in children with autism receiving early intervention. Autism Res 2019; 12:830-842. [PMID: 30676000 DOI: 10.1002/aur.2075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/29/2018] [Accepted: 12/03/2018] [Indexed: 01/28/2023]
Abstract
Children with autism spectrum disorder (ASD) commonly present with comorbid language impairment, negatively impacting their learning and participation across settings. Addressing these needs requires a detailed understanding of their communication trajectories. In this study, we used the language environment and analysis (LENA) system to examine possible changes in children's (a) vocalizations and (b) ratio of speech to nonspeech vocalizations over a 10-month period. Data for 23 children with ASD (17M, 6F; ages 32-67 months) were analyzed, including monthly 3-hr in-class recordings and standardized measures of language, cognition, and ASD characteristics. Using hierarchical generalized linear models, we found significant time-trends for child vocalizations (P ≤ 0.001) and the vocalization ratio (P = 0.02), reflecting a waxing and waning pattern. Children with higher expressive language scores (Mullen scales of early learning, Vineland adaptive behavior scales - 2nd Ed.) and nonverbal cognition (Mullen scales of early learning), and fewer ASD characteristics (social communication questionnaire) demonstrated greater increases in the vocalization ratio over time (P values 0.04-0.01). Children with greater language and cognition difficulties were the most vocal, but produced a higher proportion of nonspeech vocalizations. The results demonstrate that significant fluctuations, as opposed to linear increases, may be observed in children with ASD receiving intervention, highlighting the value of assessment at multiple time-points. In addition, the findings highlight the need to consider both the quantity (vocalization counts) and quality (ratio of speech to nonspeech vocalizations) when interpreting LENA data, with the latter appearing to provide a more robust measure of communication. Autism Research 2019, 12: 830-842. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY ABSTRACT: In this study, we examined possible changes in speech and nonspeech vocalizations in 23 children with autism attending a comprehensive early intervention program over a 10-month period. Contrary to our expectation, we observed a waxing and waning pattern of change in children's vocalizations over time, rather than a steady increase. We also found evidence to suggest that looking at the quality of children's vocalizations (i.e., the ratio of speech to nonspeech vocalizations) provides a more accurate picture of children's development than simply looking at the quantity (i.e., how frequently they vocalize).
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Affiliation(s)
- David Trembath
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Marleen F Westerveld
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.,Griffith Institute for Educational Research, Griffith University, Brisbane, Queensland, Australia
| | - Srinivas Teppala
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Abirami Thirumanickam
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Rhylee Sulek
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Veronica Rose
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.,Neurodisability and Rehabilitation Research, Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | | | - Jessica Paynter
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | | | - Deb Keen
- Griffith Institute for Educational Research, Griffith University, Brisbane, Queensland, Australia
| | - Giacomo Vivanti
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania
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115
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Frost KM, Koehn GN, Russell KM, Ingersoll B. Measuring child social communication across contexts: Similarities and differences across play and snack routines. Autism Res 2019; 12:636-644. [PMID: 30663859 DOI: 10.1002/aur.2077] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/22/2018] [Accepted: 12/29/2018] [Indexed: 01/31/2023]
Abstract
Improving measurement of outcomes in randomized controlled trials of early interventions for autism spectrum disorder (ASD) has been identified as a priority in the field. In addition, the importance of measurement across contexts has been indicated by researchers and community stakeholders alike [Lord et al., ; McConachie et al., ; Schreibman et al., ]. The Brief Observation of Social Communication Change (BOSCC; Grzadzinski et al., ), an observational rating scheme of brief play interactions, was developed to address a need for measures that are reliable, sensitive to change, and valid for use in research settings. The goal of this study was to examine the feasibility and utility of applying the BOSCC to a new context: a home snack routine. Results suggest that rating the BOSCC on home snack routines is feasible and psychometrically sound, and captures change in child social communication behaviors. However, the utility of the BOSCC for measuring restricted and repetitive behaviors (RRBs) is less clear. Nonetheless, differences in RRBs across play and snack lend support for the claim that measurement across contexts is essential. Application of the BOSCC across contexts may allow researchers to obtain a more accurate estimate of intervention response and help capture context-specific changes in social communication. It may also provide a method for researchers to evaluate the effect of context on child social communication more broadly. Autism Res 2019, 12: 636-644. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Improving measurement of outcomes in studies of early interventions for autism spectrum disorder (ASD) has been identified as a priority in the field. The importance of measurement across contexts has also been indicated by researchers and community stakeholders. The goal of this study was to determine whether an existing observational rating scheme, the Brief Observation of Social Communication Change (BOSCC), could be applied to a new activity: a home snack routine. Results suggest that rating the BOSCC on home snack routines is feasible and promising for capturing change over time. In addition, some child behaviors differed across play and snack, lending further support for the claim that measurement across activities is essential.
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Affiliation(s)
- Kyle M Frost
- Department of Psychology, Michigan State University, East Lansing, Michigan
| | - Genna N Koehn
- Department of Psychology, Michigan State University, East Lansing, Michigan
| | - Kaylin M Russell
- Department of Psychology, Michigan State University, East Lansing, Michigan
| | - Brooke Ingersoll
- Department of Psychology, Michigan State University, East Lansing, Michigan
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116
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Jones RM, Plesa Skwerer D, Pawar R, Hamo A, Carberry C, Ajodan EL, Caulley D, Silverman MR, McAdoo S, Meyer S, Yoder A, Clements M, Lord C, Tager-Flusberg H. How effective is LENA in detecting speech vocalizations and language produced by children and adolescents with ASD in different contexts? Autism Res 2019; 12:628-635. [PMID: 30638310 DOI: 10.1002/aur.2071] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/20/2018] [Accepted: 12/16/2018] [Indexed: 12/20/2022]
Abstract
The LENA system was designed and validated to provide information about the language environment in children 0 to 4 years of age and its use has been expanded to populations with a number of communication profiles. Its utility in children 5 years of age and older is not yet known. The present study used acoustic data from two samples of children with autism spectrum disorders (ASD) to evaluate the reliability of LENA automated analyses for detecting speech utterances in older, school age children, and adolescents with ASD, in clinic and home environments. Participants between 5 and 18 years old who were minimally verbal (study 1) or had a range of verbal abilities (study 2) completed standardized assessments in the clinic (study 1 and 2) and in the home (study 2) while speech was recorded from a LENA device. We compared LENA segment labels with manual ground truth coding by human transcribers using two different methods. We found that the automated LENA algorithms were not successful (<50% reliable) in detecting vocalizations from older children and adolescents with ASD, and that the proportion of speaker misclassifications by the automated system increased significantly with the target-child's age. The findings in children and adolescents with ASD suggest possibly misleading results when expanding the use of LENA beyond the age ranges for which it was developed and highlight the need to develop novel automated methods that are more appropriate for older children. Autism Research 2019, 12: 628-635. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Current commercially available speech detection algorithms (LENA system) were previously validated in toddlers and children up to 48 months of age, and it is not known whether they are reliable in older children and adolescents. Our data suggest that LENA does not adequately capture speech in school age children and adolescents with autism and highlights the need to develop new automated methods for older children.
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Affiliation(s)
- Rebecca M Jones
- Weill Cornell Medicine, Center for Autism and the Developing Brain, White Plains, New York
| | - Daniela Plesa Skwerer
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | | | - Amarelle Hamo
- Weill Cornell Medicine, Center for Autism and the Developing Brain, White Plains, New York
| | - Caroline Carberry
- Weill Cornell Medicine, Center for Autism and the Developing Brain, White Plains, New York
| | - Eliana L Ajodan
- Weill Cornell Medicine, Center for Autism and the Developing Brain, White Plains, New York
| | | | - Melanie R Silverman
- Weill Cornell Medicine, Center for Autism and the Developing Brain, White Plains, New York
| | - Shannon McAdoo
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Steven Meyer
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Anne Yoder
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Mark Clements
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Catherine Lord
- Weill Cornell Medicine, Center for Autism and the Developing Brain, White Plains, New York.,University of California Los Angeles, Semel Institute for Neuroscience and Behavior, Los Angeles, California
| | - Helen Tager-Flusberg
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
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117
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Colombi C, Vivanti G, Rogers S. Evidenced-Based Practices. HANDBOOK OF INTERDISCIPLINARY TREATMENTS FOR AUTISM SPECTRUM DISORDER 2019. [DOI: 10.1007/978-3-030-13027-5_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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118
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Pollock A, Campbell P, Struthers C, Synnot A, Nunn J, Hill S, Goodare H, Morris J, Watts C, Morley R. Stakeholder involvement in systematic reviews: a scoping review. Syst Rev 2018; 7:208. [PMID: 30474560 PMCID: PMC6260873 DOI: 10.1186/s13643-018-0852-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 10/22/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND There is increasing recognition that it is good practice to involve stakeholders (meaning patients, the public, health professionals and others) in systematic reviews, but limited evidence about how best to do this. We aimed to document the evidence-base relating to stakeholder involvement in systematic reviews and to use this evidence to describe how stakeholders have been involved in systematic reviews. METHODS We carried out a scoping review, following a published protocol. We searched multiple electronic databases (2010-2016), using a stepwise searching approach, supplemented with hand searching. Two authors independently screened and discussed the first 500 abstracts and, after clarifying selection criteria, screened a further 500. Agreement on screening decisions was 97%, so screening was done by one reviewer only. Pre-planned data extraction was completed, and the comprehensiveness of the description of methods of involvement judged. Additional data extraction was completed for papers judged to have most comprehensive descriptions. Three stakeholder representatives were co-authors for this systematic review. RESULTS We included 291 papers in which stakeholders were involved in a systematic review. Thirty percent involved patients and/or carers. Thirty-two percent were from the USA, 26% from the UK and 10% from Canada. Ten percent (32 reviews) were judged to provide a comprehensive description of methods of involving stakeholders. Sixty-nine percent (22/32) personally invited people to be involved; 22% (7/32) advertised opportunities to the general population. Eighty-one percent (26/32) had between 1 and 20 face-to-face meetings, with 83% of these holding ≤ 4 meetings. Meetings lasted 1 h to ½ day. Nineteen percent (6/32) used a Delphi method, most often involving three electronic rounds. Details of ethical approval were reported by 10/32. Expenses were reported to be paid to people involved in 8/32 systematic reviews. DISCUSSION/CONCLUSION We identified a relatively large number (291) of papers reporting stakeholder involvement in systematic reviews, but the quality of reporting was generally very poor. Information from a subset of papers judged to provide the best descriptions of stakeholder involvement in systematic reviews provide examples of different ways in which stakeholders have been involved in systematic reviews. These examples arguably currently provide the best available information to inform and guide decisions around the planning of stakeholder involvement within future systematic reviews. This evidence has been used to develop online learning resources. SYSTEMATIC REVIEW REGISTRATION The protocol for this systematic review was published on 21 April 2017. Publication reference: Pollock A, Campbell P, Struthers C, Synnot A, Nunn J, Hill S, Goodare H, Watts C, Morley R: Stakeholder involvement in systematic reviews: a protocol for a systematic review of methods, outcomes and effects. Research Involvement and Engagement 2017, 3:9. https://doi.org/10.1186/s40900-017-0060-4 .
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Affiliation(s)
- Alex Pollock
- Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
| | - Pauline Campbell
- Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Caroline Struthers
- EQUATOR Network, Centre for Statistics in Medicine, NDORMS, University of Oxford, Botnar Research Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - Anneliese Synnot
- Cochrane Consumers and Communication, Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, Victoria, 3086, Australia.,Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, L4, 551 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Jack Nunn
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, Victoria, 3086, Australia
| | - Sophie Hill
- Cochrane Consumers and Communication, Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, Victoria, 3086, Australia
| | | | - Jacqui Morris
- School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ, UK
| | - Chris Watts
- Cochrane Learning and Support Department, Cochrane Central Executive, St Albans House, 57-59 Haymarket, London, SW1Y 4QX, UK
| | - Richard Morley
- Cochrane Consumer Network, St Albans House, 57-59 Haymarket, London, SW1Y 4QX, UK
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119
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Measurement considerations in pediatric research on autism spectrum disorders. PROGRESS IN BRAIN RESEARCH 2018. [PMID: 30447755 DOI: 10.1016/bs.pbr.2018.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Studying Autism Spectrum Disorders (ASD) in genetic syndromes has gained interest in the scientific community as a way to elucidate mechanisms and symptom profiles to understand ASD more broadly. Appropriate and adequate measurement of constructs, symptomatology, and outcomes in clinical research is of vital importance in establishing the prevalence of such symptoms and measuring change in symptoms in the context of clinical trials. As such, we provide an overview of the prevalence of ASD, present current diagnostic guidelines, discuss important comorbidities to consider, describe current assessment strategies in assessing ASD, and discuss these within the context of a specific genetic condition to highlight how ASD can be best evaluated.
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120
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Drozd HP, Karathanasis SF, Molosh AI, Lukkes JL, Clapp DW, Shekhar A. From bedside to bench and back: Translating ASD models. PROGRESS IN BRAIN RESEARCH 2018; 241:113-158. [PMID: 30447753 DOI: 10.1016/bs.pbr.2018.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Autism spectrum disorders (ASD) represent a heterogeneous group of disorders defined by deficits in social interaction/communication and restricted interests, behaviors, or activities. Models of ASD, developed based on clinical data and observations, are used in basic science, the "bench," to better understand the pathophysiology of ASD and provide therapeutic options for patients in the clinic, the "bedside." Translational medicine creates a bridge between the bench and bedside that allows for clinical and basic science discoveries to challenge one another to improve the opportunities to bring novel therapies to patients. From the clinical side, biomarker work is expanding our understanding of possible mechanisms of ASD through measures of behavior, genetics, imaging modalities, and serum markers. These biomarkers could help to subclassify patients with ASD in order to better target treatments to a more homogeneous groups of patients most likely to respond to a candidate therapy. In turn, basic science has been responding to developments in clinical evaluation by improving bench models to mechanistically and phenotypically recapitulate the ASD phenotypes observed in clinic. While genetic models are identifying novel therapeutics targets at the bench, the clinical efforts are making progress by defining better outcome measures that are most representative of meaningful patient responses. In this review, we discuss some of these challenges in translational research in ASD and strategies for the bench and bedside to bridge the gap to achieve better benefits to patients.
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Affiliation(s)
- Hayley P Drozd
- Program in Medical Neurobiology, Stark Neurosciences Institute, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sotirios F Karathanasis
- Program in Medical Neurobiology, Stark Neurosciences Institute, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Andrei I Molosh
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jodi L Lukkes
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - D Wade Clapp
- Department of Pediatrics, Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Anantha Shekhar
- Program in Medical Neurobiology, Stark Neurosciences Institute, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN, United States; Indiana Clinical and Translation Sciences Institute, Indiana University School of Medicine, Indianapolis, IN, United States.
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121
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Bal VH, Hendren RL, Charman T, Abbeduto L, Kasari C, Klinger LG, Ence W, Glavin T, Lyons G, Rosenberg E. Considerations from the 2017 IMFAR Preconference on Measuring Meaningful Outcomes from School-Age to Adulthood. Autism Res 2018; 11:1446-1454. [DOI: 10.1002/aur.2034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/31/2018] [Accepted: 09/18/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Vanessa H. Bal
- Weill Institute for Neurosciences Department of Psychiatry; University of California; San Francisco California
| | - Robert L. Hendren
- Weill Institute for Neurosciences Department of Psychiatry; University of California; San Francisco California
| | - Tony Charman
- King's College London; Institute of Psychiatry, Psychology & Neuroscience (IoPPN); London UK
| | - Leonard Abbeduto
- MIND Institute and Department of Psychiatry and Behavioral Sciences; University of California; Davis California
| | - Connie Kasari
- Center for Autism Research & Treatment; Graduate School of Education & Information Studies, University of California; Los Angles California
| | - Laura Grofer Klinger
- Department of Psychiatry, TEACCH Autism Program; University of North Carolina; Chapel Hill North Carolina
| | - Whitney Ence
- Weill Institute for Neurosciences Department of Psychiatry; University of California; San Francisco California
| | - Tara Glavin
- Weill Institute for Neurosciences Department of Psychiatry; University of California; San Francisco California
| | - Gregory Lyons
- Weill Institute for Neurosciences Department of Psychiatry; University of California; San Francisco California
| | - Erin Rosenberg
- Weill Institute for Neurosciences Department of Psychiatry; University of California; San Francisco California
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Lord C, Elsabbagh M, Baird G, Veenstra-Vanderweele J. Autism spectrum disorder. Lancet 2018; 392:508-520. [PMID: 30078460 PMCID: PMC7398158 DOI: 10.1016/s0140-6736(18)31129-2] [Citation(s) in RCA: 904] [Impact Index Per Article: 150.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 04/19/2018] [Accepted: 05/02/2018] [Indexed: 12/20/2022]
Abstract
Autism spectrum disorder is a term used to describe a constellation of early-appearing social communication deficits and repetitive sensory-motor behaviours associated with a strong genetic component as well as other causes. The outlook for many individuals with autism spectrum disorder today is brighter than it was 50 years ago; more people with the condition are able to speak, read, and live in the community rather than in institutions, and some will be largely free from symptoms of the disorder by adulthood. Nevertheless, most individuals will not work full-time or live independently. Genetics and neuroscience have identified intriguing patterns of risk, but without much practical benefit yet. Considerable work is still needed to understand how and when behavioural and medical treatments can be effective, and for which children, including those with substantial comorbidities. It is also important to implement what we already know and develop services for adults with autism spectrum disorder. Clinicians can make a difference by providing timely and individualised help to families navigating referrals and access to community support systems, by providing accurate information despite often unfiltered media input, and by anticipating transitions such as family changes and school entry and leaving.
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Affiliation(s)
- Catherine Lord
- Center for Autism and the Developing Brain, NewYork-Presbyterian Hospital, Weill Cornell Medicine, Cornell University, White Plains, NY, USA.
| | - Mayada Elsabbagh
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Gillian Baird
- Evelina Children's Hospital, King's Health Partners, London, UK
| | - Jeremy Veenstra-Vanderweele
- Division of Child and Adolescent Psychiatry, Center for Autism and the Developing Brain, NewYork-Presbyterian Hospital, Department of Psychiatry, Columbia University, New York State Psychiatric Institute, White Plains, NY, USA
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123
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Abstract
Background Research has shown high rates of suicidality in autism spectrum conditions (ASC), but there is lack of research into why this is the case. Many common experiences of autistic adults, such as depression or unemployment, overlap with known risk markers for suicide in the general population. However, it is unknown whether there are risk markers unique to ASC that require new tailored suicide prevention strategies. Methods Through consultation with a steering group of autistic adults, a survey was developed aiming to identify unique risk markers for suicidality in this group. The survey measured suicidality (SBQ-R), non-suicidal self-injury (NSSI-AT), mental health problems, unmet support needs, employment, satisfaction with living arrangements, self-reported autistic traits (AQ), delay in ASC diagnosis, and 'camouflaging' ASC. One hundred sixty-four autistic adults (65 male, 99 female) and 169 general population adults (54 males, 115 females) completed the survey online. Results A majority of autistic adults (72%) scored above the recommended psychiatric cut-off for suicide risk on the SBQ-R; significantly higher than general population (GP) adults (33%). After statistically controlling for a range of demographics and diagnoses, ASC diagnosis and self-reported autistic traits in the general population significantly predicted suicidality. In autistic adults, non-suicidal self-injury, camouflaging, and number of unmet support needs significantly predicted suicidality. Conclusions Results confirm previously reported high rates of suicidality in ASC, and demonstrate that ASC diagnosis, and self-reported autistic traits in the general population are independent risk markers for suicidality. This suggests there are unique factors associated with autism and autistic traits that increase risk of suicidality. Camouflaging and unmet support needs appear to be risk markers for suicidality unique to ASC. Non-suicidal self-injury, employment, and mental health problems appear to be risk markers shared with the general population that are significantly more prevalent in the autistic community. Implications for understanding and prevention of suicide in ASC are discussed.
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124
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Cassidy S, Bradley L, Shaw R, Baron-Cohen S. Risk markers for suicidality in autistic adults. Mol Autism 2018; 9:42. [PMID: 30083306 DOI: 10.1186/s13229-018-02264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/22/2018] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Research has shown high rates of suicidality in autism spectrum conditions (ASC), but there is lack of research into why this is the case. Many common experiences of autistic adults, such as depression or unemployment, overlap with known risk markers for suicide in the general population. However, it is unknown whether there are risk markers unique to ASC that require new tailored suicide prevention strategies. METHODS Through consultation with a steering group of autistic adults, a survey was developed aiming to identify unique risk markers for suicidality in this group. The survey measured suicidality (SBQ-R), non-suicidal self-injury (NSSI-AT), mental health problems, unmet support needs, employment, satisfaction with living arrangements, self-reported autistic traits (AQ), delay in ASC diagnosis, and 'camouflaging' ASC. One hundred sixty-four autistic adults (65 male, 99 female) and 169 general population adults (54 males, 115 females) completed the survey online. RESULTS A majority of autistic adults (72%) scored above the recommended psychiatric cut-off for suicide risk on the SBQ-R; significantly higher than general population (GP) adults (33%). After statistically controlling for a range of demographics and diagnoses, ASC diagnosis and self-reported autistic traits in the general population significantly predicted suicidality. In autistic adults, non-suicidal self-injury, camouflaging, and number of unmet support needs significantly predicted suicidality. CONCLUSIONS Results confirm previously reported high rates of suicidality in ASC, and demonstrate that ASC diagnosis, and self-reported autistic traits in the general population are independent risk markers for suicidality. This suggests there are unique factors associated with autism and autistic traits that increase risk of suicidality. Camouflaging and unmet support needs appear to be risk markers for suicidality unique to ASC. Non-suicidal self-injury, employment, and mental health problems appear to be risk markers shared with the general population that are significantly more prevalent in the autistic community. Implications for understanding and prevention of suicide in ASC are discussed.
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Affiliation(s)
- Sarah Cassidy
- 1School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD UK
- 2Centre for Innovative Research across the Life Course, Coventry University, Coventry, UK
- 3Autism Research Centre, University of Cambridge, Cambridge, UK
| | - Louise Bradley
- 2Centre for Innovative Research across the Life Course, Coventry University, Coventry, UK
| | - Rebecca Shaw
- 2Centre for Innovative Research across the Life Course, Coventry University, Coventry, UK
- Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Simon Baron-Cohen
- 3Autism Research Centre, University of Cambridge, Cambridge, UK
- 5Cambridge Lifetime Asperger Syndrome Service (CLASS), Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Crawford MJ, Gold C, Odell-Miller H, Thana L, Faber S, Assmus J, Bieleninik Ł, Geretsegger M, Grant C, Maratos A, Sandford S, Claringbold A, McConachie H, Maskey M, Mössler KA, Ramchandani P, Hassiotis A. International multicentre randomised controlled trial of improvisational music therapy for children with autism spectrum disorder: TIME-A study. Health Technol Assess 2018; 21:1-40. [PMID: 29061222 DOI: 10.3310/hta21590] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Preliminary studies have indicated that music therapy may benefit children with autism spectrum disorders (ASD). OBJECTIVES To examine the effects of improvisational music therapy (IMT) on social affect and responsiveness of children with ASD. DESIGN International, multicentre, three-arm, single-masked randomised controlled trial, including a National Institute for Health Research (NIHR)-funded centre that recruited in London and the east of England. Randomisation was via a remote service using permuted blocks, stratified by study site. SETTING Schools and private, voluntary and state-funded health-care services. PARTICIPANTS Children aged between 4 and 7 years with a confirmed diagnosis of ASD and a parent or guardian who provided written informed consent. We excluded children with serious sensory disorder and those who had received music therapy within the past 12 months. INTERVENTIONS All parents and children received enhanced standard care (ESC), which involved three 60-minute sessions of advice and support in addition to treatment as usual. In addition, they were randomised to either one (low-frequency) or three (high-frequency) sessions of IMT per week, or to ESC alone, over 5 months in a ratio of 1 : 1 : 2. MAIN OUTCOME MEASURES The primary outcome was measured using the social affect score derived from the Autism Diagnostic Observation Schedule (ADOS) at 5 months: higher scores indicated greater impairment. Secondary outcomes included social affect at 12 months and parent-rated social responsiveness at 5 and 12 months (higher scores indicated greater impairment). RESULTS A total of 364 participants were randomised between 2011 and 2015. A total of 182 children were allocated to IMT (90 to high-frequency sessions and 92 to low-frequency sessions), and 182 were allocated to ESC alone. A total of 314 (86.3%) of the total sample were followed up at 5 months [165 (90.7%) in the intervention group and 149 (81.9%) in the control group]. Among those randomised to IMT, 171 (94.0%) received it. From baseline to 5 months, mean scores of ADOS social affect decreased from 14.1 to 13.3 in music therapy and from 13.5 to 12.4 in standard care [mean difference: music therapy vs. standard care = 0.06, 95% confidence interval (CI) -0.70 to 0.81], with no significant difference in improvement. There were also no differences in the parent-rated social responsiveness score, which decreased from 96.0 to 89.2 in the music therapy group and from 96.1 to 93.3 in the standard care group over this period (mean difference: music therapy vs. standard care = -3.32, 95% CI -7.56 to 0.91). There were seven admissions to hospital that were unrelated to the study interventions in the two IMT arms compared with 10 unrelated admissions in the ESC group. CONCLUSIONS Adding IMT to the treatment received by children with ASD did not improve social affect or parent-assessed social responsiveness. FUTURE WORK Other methods for delivering music-focused interventions for children with ASD should be explored. TRIAL REGISTRATION Current Controlled Trials ISRCTN78923965. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 59. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Christian Gold
- The Grieg Academy Music Therapy Research Centre, Uni Research Health, Bergen, Norway
| | - Helen Odell-Miller
- Music for Health Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Lavanya Thana
- Centre for Psychiatry, Imperial College London, London, UK
| | - Sarah Faber
- Music for Health Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Jörg Assmus
- The Grieg Academy Music Therapy Research Centre, Uni Research Health, Bergen, Norway
| | - Łucja Bieleninik
- The Grieg Academy Music Therapy Research Centre, Uni Research Health, Bergen, Norway
| | - Monika Geretsegger
- The Grieg Academy Music Therapy Research Centre, Uni Research Health, Bergen, Norway
| | - Claire Grant
- Central and North West London NHS Foundation Trust, London, UK
| | - Anna Maratos
- Central and North West London NHS Foundation Trust, London, UK
| | - Stephan Sandford
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Helen McConachie
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Morag Maskey
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Karin Antonia Mössler
- The Grieg Academy Music Therapy Research Centre, Uni Research Health, Bergen, Norway
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Wong V, Ruble LA, McGrew JH, Yu Y. An empirical study of multidimensional fidelity of COMPASS consultation. SCHOOL PSYCHOLOGY QUARTERLY : THE OFFICIAL JOURNAL OF THE DIVISION OF SCHOOL PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION 2018; 33:251-263. [PMID: 28857590 PMCID: PMC5832494 DOI: 10.1037/spq0000217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Consultation is essential to the daily practice of school psychologists (National Association of School Psychologist, 2010). Successful consultation requires fidelity at both the consultant (implementation) and consultee (intervention) levels. We applied a multidimensional, multilevel conception of fidelity (Dunst, Trivette, & Raab, 2013) to a consultative intervention called the Collaborative Model for Promoting Competence and Success (COMPASS) for students with autism. The study provided 3 main findings. First, multidimensional, multilevel fidelity is a stable construct and increases over time with consultation support. Second, mediation analyses revealed that implementation-level fidelity components had distant, indirect effects on student Individualized Education Program (IEP) outcomes. Third, 3 fidelity components correlated with IEP outcomes: teacher coaching responsiveness at the implementation level, and teacher quality of delivery and student responsiveness at the intervention levels. Implications and future directions are discussed. (PsycINFO Database Record
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Affiliation(s)
- Venus Wong
- Department of Educational, School, and Counseling Psychology
| | - Lisa A Ruble
- Department of Educational, School, and Counseling Psychology
| | - John H McGrew
- Department of Psychology, Indiana University-Purdue University Indianapolis
| | - Yue Yu
- Department of Psychology, Indiana University-Purdue University Indianapolis
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127
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Scott M, Falkmer M, Falkmer T, Girdler S. Evaluating the Effectiveness of an Autism-Specific Workplace Tool for Employers: A Randomised Controlled Trial. J Autism Dev Disord 2018; 48:3377-3392. [DOI: 10.1007/s10803-018-3611-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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128
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Green J, Garg S. Annual Research Review: The state of autism intervention science: progress, target psychological and biological mechanisms and future prospects. J Child Psychol Psychiatry 2018; 59:424-443. [PMID: 29574740 DOI: 10.1111/jcpp.12892] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND There has been recent systematic review of key evidence in psychosocial intervention in autism but little review of biological treatments. METHODS We analyse the current literature from the perspective of intervention and mechanism targets across social and biological development. RESULTS The overall quality of trials evidence in autism intervention remains relatively low, despite some recent progress. Many treatments in common use have little or no evidence base. This is very concerning in such an important disorder. A variety of psychosocial interventions can show effect to improve some short-term effects on children's immediate dyadic social interactions, for instance with caregivers. But showing true effectiveness in this developmental disorder requires generalisation of such effects into wider social contexts, on autism symptoms and in long-term progress in development. Only a few interventions so far have begun to show this. A number of early phase interventions on biological targets have shown real promise, but none has yet progressed to larger scale effectiveness trials on behavioural or symptom outcomes. CONCLUSIONS There has been enough progress in psychosocial intervention research now to be able to begin to identify some evidence-based practice in autism treatment. To consolidate and improve outcomes, the next phase of intervention research needs improved trial design, and an iterative approach building on success. It may also include the testing of potential synergies between promising biological and psychosocial interventions.
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Affiliation(s)
- Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Shruti Garg
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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129
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Leadbitter K, Aldred C, McConachie H, Le Couteur A, Kapadia D, Charman T, Macdonald W, Salomone E, Emsley R, Green J. The Autism Family Experience Questionnaire (AFEQ): An Ecologically-Valid, Parent-Nominated Measure of Family Experience, Quality of Life and Prioritised Outcomes for Early Intervention. J Autism Dev Disord 2018; 48:1052-1062. [PMID: 29150738 PMCID: PMC5861155 DOI: 10.1007/s10803-017-3350-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There is a lack of measures that reflect the intervention priorities of parents of children with autism spectrum disorder (ASD) and that assess the impact of interventions on family experience and quality of life. The Autism Family Experience Questionnaire (AFEQ) was developed through focus groups and online consultation with parents, and reflected parental priorities. It was then administered to the parents of children enrolled in the Pre-school Autism Communication Trial and its 6-year follow-up study. The AFEQ showed good convergent validity with well-established measures of child adaptive functioning, parental mental health and parental wellbeing. It was sensitive to change in response to a parent-mediated intervention for young children with autism, showing treatment effect at treatment endpoint which increased at six-year follow-up.
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Affiliation(s)
- Kathy Leadbitter
- University of Manchester, Manchester, UK.
- Social Development Research Group, University of Manchester, Room 3.312, Jean McFarlane Building, Oxford Rd., Manchester, M13 9PL, UK.
| | | | | | - Ann Le Couteur
- Newcastle University, Newcastle upon Tyne, UK
- Northumberland, Tyne & Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Wendy Macdonald
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Erica Salomone
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- University of Turin, Turin, Italy
| | | | - Jonathan Green
- University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Sciences Centre, Royal Manchester Children's Hospital, Manchester, UK
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130
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Lami F, Egberts K, Ure A, Conroy R, Williams K. Measurement properties of instruments that assess participation in young people with autism spectrum disorder: a systematic review. Dev Med Child Neurol 2018; 60:230-243. [PMID: 29230802 DOI: 10.1111/dmcn.13631] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 01/18/2023]
Abstract
AIM To systematically review the measurement properties of instruments assessing participation in young people with autism spectrum disorder (ASD). METHOD A search was performed in MEDLINE, PsycINFO, and PubMed combining three constructs ('ASD', 'test of participation', 'measurement properties'). Results were restricted to articles including people aged 6 to 29 years. The 2539 identified articles were independently screened by two reviewers. For the included articles, data were extracted using standard forms and their risk of bias was assessed. RESULTS Nine studies (8 cross-sectional) met the inclusion criteria, providing information on seven different instruments. The total sample included 634 participants, with sex available for 600 (males=494; females=106) and age available for 570, with mean age for these participants 140.58 months (SD=9.11; range=36-624). Included instruments were the school function assessment, vocational index, children's assessment of participation and enjoyment/preferences for activities of children, experience sampling method, Pediatric Evaluation of Disability Inventory, Computer Adaptive Test, adolescent and young adult activity card sort, and Patient-Reported Outcomes Measurement Information System parent-proxy peer relationships. Seven studies assessed reliability and validity; good properties were reported for half of the instruments considered. Most studies (n=6) had high risk of bias. Overall the quality of the evidence for each tool was limited. INTERPRETATION Validation of these instruments, or others that comprehensively assess participation, is needed. Future studies should follow recommended methodological standards. WHAT THIS PAPER ADDS Seven instruments have been used to assess participation in young people with autism. One instrument, with excellent measurement properties in one study, does not comprehensively assess participation. Studies of three instruments that incorporate a more comprehensive assessment of participation have methodological limitations. Overall, limited evidence exists regarding measurement properties of participation assessments for young people with autism.
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Affiliation(s)
- Francesca Lami
- Department of Paediatrics, Faculty of MDHS, The University of Melbourne, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Kristine Egberts
- Department of Paediatrics, Faculty of MDHS, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alexandra Ure
- Department of Paediatrics, Faculty of MDHS, The University of Melbourne, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Rowena Conroy
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Victoria, Australia.,School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Katrina Williams
- Department of Paediatrics, Faculty of MDHS, The University of Melbourne, Melbourne, Victoria, Australia.,Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Victoria, Australia
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131
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Chatham CH, Taylor KI, Charman T, Liogier D'ardhuy X, Eule E, Fedele A, Hardan AY, Loth E, Murtagh L, Del Valle Rubido M, San Jose Caceres A, Sevigny J, Sikich L, Snyder L, Tillmann JE, Ventola PE, Walton-Bowen KL, Wang PP, Willgoss T, Bolognani F. Adaptive behavior in autism: Minimal clinically important differences on the Vineland-II. Autism Res 2018; 11:270-283. [PMID: 28941213 PMCID: PMC5997920 DOI: 10.1002/aur.1874] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/09/2017] [Accepted: 08/16/2017] [Indexed: 12/28/2022]
Abstract
Autism Spectrum Disorder (ASD) is associated with persistent impairments in adaptive abilities across multiple domains. These social, personal, and communicative impairments become increasingly pronounced with development, and are present regardless of IQ. The Vineland Adaptive Behavior Scales, Second Edition (Vineland-II) is the most commonly used instrument for quantifying these impairments, but minimal clinically important differences (MCIDs) on Vineland-II scores have not been rigorously established in ASD. We pooled data from several consortia/registries (EU-AIMS LEAP study, ABIDE-I, ABIDE-II, INFOR, Simons Simplex Collection and Autism Treatment Network [ATN]) and clinical investigations and trials (Stanford, Yale, Roche) resulting in a data set of over 9,000 individuals with ASD. Two approaches were used to estimate MCIDs: distribution-based methods and anchor-based methods. Distribution-based MCID [d-MCID] estimates included the standard error of the measurement, as well as one-fifth and one-half of the covariate-adjusted standard deviation (both cross-sectionally and longitudinally). Anchor-based MCID [a-MCID] estimates include the slope of linear regression of clinician ratings of severity on the Vineland-II score, the slope of linear regression of clinician ratings of longitudinal improvement category on Vineland-II change, the Vineland-II change score maximally differentiating clinical impressions of minimal versus no improvement, and equipercentile equating. Across strata, the Vineland-II Adaptive Behavior Composite standardized score MCID estimates range from 2.01 to 3.2 for distribution-based methods, and from 2.42 to 3.75 for sample-size-weighted anchor-based methods. Lower Vineland-II standardized score MCID estimates were observed for younger and more cognitively impaired populations. These MCID estimates enable users of Vineland-II to assess both the statistical and clinical significance of any observed change. Autism Res 2018, 11: 270-283. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY The Vineland Adaptive Behavior Scales (2nd edition; Vineland-II) is the most widely used scale for assessing day-to-day "adaptive" skills. Yet, it is unknown how much Vineland-II scores must change for those changes to be regarded as clinically significant. We pooled data from over 9,000 individuals with ASD to show that changes of 2-3.75 points on the Vineland-II Composite score represent the "minimal clinically-important difference." These estimates will help evaluate the benefits of potential new treatments for ASD.
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Affiliation(s)
- C H Chatham
- F. Hoffmann La Roche, Innovation Center Basel, Hoffmann La Roche, Basel, 4070, Switzerland
| | - K I Taylor
- F. Hoffmann La Roche, Innovation Center Basel, Hoffmann La Roche, Basel, 4070, Switzerland
| | - T Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Camberwell, London, SE5 8AF, UK
| | - X Liogier D'ardhuy
- F. Hoffmann La Roche, Innovation Center Basel, Hoffmann La Roche, Basel, 4070, Switzerland
| | - E Eule
- F. Hoffmann La Roche, Innovation Center Basel, Hoffmann La Roche, Basel, 4070, Switzerland
| | - A Fedele
- Autism Speaks, New York, New York, 10016
| | - A Y Hardan
- Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, 94305-5717
| | - E Loth
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Camberwell, London, SE5 8AF, UK
| | - L Murtagh
- F. Hoffmann La Roche, Innovation Center Basel, Hoffmann La Roche, Basel, 4070, Switzerland
| | - M Del Valle Rubido
- F. Hoffmann La Roche, Innovation Center Basel, Hoffmann La Roche, Basel, 4070, Switzerland
| | - A San Jose Caceres
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Camberwell, London, SE5 8AF, UK
| | - J Sevigny
- F. Hoffmann La Roche, Innovation Center Basel, Hoffmann La Roche, Basel, 4070, Switzerland
| | - L Sikich
- Duke Center for Autism and Brain Development, Pavilion East at Lakeview, Durham, North Carolina, 27705
| | - L Snyder
- Simons Foundation, New York, New York, 10010
| | - J E Tillmann
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Camberwell, London, SE5 8AF, UK
| | - P E Ventola
- Yale Child Study Center, New Haven, CT, 06520
| | | | - P P Wang
- Simons Foundation, New York, New York, 10010
| | - T Willgoss
- F. Hoffmann La Roche, Innovation Center Basel, Hoffmann La Roche, Basel, 4070, Switzerland
| | - F Bolognani
- F. Hoffmann La Roche, Innovation Center Basel, Hoffmann La Roche, Basel, 4070, Switzerland
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132
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Farmer C, Swineford L, Swedo SE, Thurm A. Classifying and characterizing the development of adaptive behavior in a naturalistic longitudinal study of young children with autism. J Neurodev Disord 2018; 10:1. [PMID: 29329511 PMCID: PMC5795287 DOI: 10.1186/s11689-017-9222-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/19/2017] [Indexed: 12/21/2022] Open
Abstract
Background Adaptive behavior, or the ability to function independently in ones’ environment, is a key phenotypic construct in autism spectrum disorder (ASD). Few studies of the development of adaptive behavior during preschool to school-age are available, though existing data demonstrate that the degree of ability and impairment associated with ASD, and how it manifests over time, is heterogeneous. Growth mixture models are a statistical technique that can help parse this heterogeneity in trajectories. Methods Data from an accelerated longitudinal natural history study (n = 105 children with ASD) were subjected to growth mixture model analysis. Children were assessed up to four times between the ages of 3 to 7.99 years. Results The best fitting model comprised two classes of trajectory on the Adaptive Behavior Composite score of the Vineland Adaptive Behavior Scale, Second Edition—a low and decreasing trajectory (73% of the sample) and a moderate and stable class (27%). Conclusions These results partially replicate the classes observed in a previous study of a similarly characterized sample, suggesting that developmental trajectory may indeed serve as a phenotype. Further, the ability to predict which trajectory a child is likely to follow will be useful in planning for clinical trials. Electronic supplementary material The online version of this article (10.1186/s11689-017-9222-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cristan Farmer
- Pediatrics and Developmental Neuroscience Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Lauren Swineford
- Pediatrics and Developmental Neuroscience Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA.,Department of Speech and Hearing Sciences, Washington State University, Spokane, WA, 99202, USA
| | - Susan E Swedo
- Pediatrics and Developmental Neuroscience Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Audrey Thurm
- Pediatrics and Developmental Neuroscience Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA.
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133
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Howes OD, Rogdaki M, Findon JL, Wichers RH, Charman T, King BH, Loth E, McAlonan GM, McCracken JT, Parr JR, Povey C, Santosh P, Wallace S, Simonoff E, Murphy DG. Autism spectrum disorder: Consensus guidelines on assessment, treatment and research from the British Association for Psychopharmacology. J Psychopharmacol 2018; 32:3-29. [PMID: 29237331 PMCID: PMC5805024 DOI: 10.1177/0269881117741766] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An expert review of the aetiology, assessment, and treatment of autism spectrum disorder, and recommendations for diagnosis, management and service provision was coordinated by the British Association for Psychopharmacology, and evidence graded. The aetiology of autism spectrum disorder involves genetic and environmental contributions, and implicates a number of brain systems, in particular the gamma-aminobutyric acid, serotonergic and glutamatergic systems. The presentation of autism spectrum disorder varies widely and co-occurring health problems (in particular epilepsy, sleep disorders, anxiety, depression, attention deficit/hyperactivity disorder and irritability) are common. We did not recommend the routine use of any pharmacological treatment for the core symptoms of autism spectrum disorder. In children, melatonin may be useful to treat sleep problems, dopamine blockers for irritability, and methylphenidate, atomoxetine and guanfacine for attention deficit/hyperactivity disorder. The evidence for use of medication in adults is limited and recommendations are largely based on extrapolations from studies in children and patients without autism spectrum disorder. We discuss the conditions for considering and evaluating a trial of medication treatment, when non-pharmacological interventions should be considered, and make recommendations on service delivery. Finally, we identify key gaps and limitations in the current evidence base and make recommendations for future research and the design of clinical trials.
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Affiliation(s)
- Oliver D Howes
- 1 MRC London Institute of Medical Sciences, London, UK
- 2 Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Maria Rogdaki
- 1 MRC London Institute of Medical Sciences, London, UK
| | - James L Findon
- 3 Sackler Institute for Translational Neurodevelopment, King's College London, London, UK
| | - Robert H Wichers
- 3 Sackler Institute for Translational Neurodevelopment, King's College London, London, UK
| | - Tony Charman
- 4 Department of Psychology, King's College London, London UK
| | - Bryan H King
- 5 Department of Psychiatry, University of California at San Francisco, San Francisco, USA
| | - Eva Loth
- 3 Sackler Institute for Translational Neurodevelopment, King's College London, London, UK
| | - Gráinne M McAlonan
- 6 The Sackler Centre and Forensic and Neurodevelopmental Science Behavioural and Developmental Psychiatry, Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
- 7 NIHR-BRC for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - James T McCracken
- 8 Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, USA
| | - Jeremy R Parr
- 9 Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Carol Povey
- 10 The National Autistic Society, London, UK
| | - Paramala Santosh
- 11 Department of Child Psychiatry, King's College London, London, UK
| | | | - Emily Simonoff
- 13 Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - Declan G Murphy
- 6 The Sackler Centre and Forensic and Neurodevelopmental Science Behavioural and Developmental Psychiatry, Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
- 7 NIHR-BRC for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
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134
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Bangerter A, Ness S, Aman MG, Esbensen AJ, Goodwin MS, Dawson G, Hendren R, Leventhal B, Khan A, Opler M, Harris A, Pandina G. Autism Behavior Inventory: A Novel Tool for Assessing Core and Associated Symptoms of Autism Spectrum Disorder. J Child Adolesc Psychopharmacol 2017; 27:814-822. [PMID: 28498053 PMCID: PMC5689117 DOI: 10.1089/cap.2017.0018] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Autism Behavior Inventory (ABI) is a new measure for assessing changes in core and associated symptoms of autism spectrum disorder (ASD) in participants (ages: 3 years-adulthood) diagnosed with ASD. It is a web-based tool with five domains (two ASD core domains: social communication, restrictive and repetitive behaviors; three associated domains: mental health, self-regulation, and challenging behavior). This study describes design, development, and initial psychometric properties of the ABI. METHODS ABI items were generated following review of existing measures and inputs from expert clinicians. Initial ABI scale contained 161 items that were reduced to fit a factor analytic model, retaining items of adequate reliability. Two versions of the scale, ABI-full (ABI-F; 93 items) and ABI-short version (ABI-S; 36 items), were developed and evaluated for psychometric properties, including validity comparisons with commonly used measures. Both scales were administered to parents and healthcare professionals (HCPs) involved with study participants. RESULTS Test-retest reliability (intraclass correlation coefficient [ICC] = 0.79) for parent ratings on ABI was robust and compared favorably to existing scales. Test-retest correlations for HCP ratings were generally lower versus parent ratings. ABI core domains and comparison measures strongly correlated (r ≥ 0.70), demonstrating good concurrent validity. CONCLUSIONS Overall, ABI demonstrates promise as a tool for measuring change in core symptoms of autism in ASD clinical studies, with further validation required.
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Affiliation(s)
- Abi Bangerter
- Janssen Research & Development, LLC, Titusville, New Jersey
| | - Seth Ness
- Janssen Research & Development, LLC, Titusville, New Jersey
| | - Michael G. Aman
- The Nisonger Center University Center for Excellence in Developmental Disabilities (UCEDD), Ohio State University, Columbus, Ohio
| | - Anna J. Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Matthew S. Goodwin
- 312E Robinson Hall, Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Duke University, Durham, North Carolina
| | - Robert Hendren
- Department of Psychiatry, University of California, San Francisco, California
| | | | | | - Mark Opler
- ProPhase, LLC, NYU School of Medicine, Columbia University Medical Center, New York, New York
| | - Adrianne Harris
- Duke Center for Autism and Brain Development, Duke University, Durham, North Carolina
| | - Gahan Pandina
- Janssen Research & Development, LLC, Titusville, New Jersey
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Epstein A, Whitehouse A, Williams K, Murphy N, Leonard H, Davis E, Reddihough D, Downs J. Parent-observed thematic data on quality of life in children with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2017; 23:71-80. [DOI: 10.1177/1362361317722764] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Domains of quality of life in children with autism spectrum disorder have not previously been explored and there has been no quality of life measure developed for this population. Our study investigated parent observations to identify the domains important to children with autism spectrum disorder who also had an intellectual disability. In all, 21 parents (19 mothers, 2 fathers) of children with autism spectrum disorder (aged 6–17 years) participated in a qualitative study to discuss their child’s quality of life. Thematic analysis using a grounded theory framework was conducted and 10 domains emerged in relation to health and well-being, capacity to perform and develop skills in daily life, and connections with the community and environment. Unique aspects of quality of life included varying levels of social desire, consistency of routines, and time spent in nature and the outdoors, which are not comprehensively captured in existing measures. Parent observations provide an initial framework for understanding quality of life in autism spectrum disorder and support the development of a new measure for this population.
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Affiliation(s)
- Amy Epstein
- Telethon Kids Institute, The University of Western Australia, Australia
| | - Andrew Whitehouse
- Telethon Kids Institute, The University of Western Australia, Australia
| | | | - Nada Murphy
- Telethon Kids Institute, The University of Western Australia, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Australia
| | | | | | - Jenny Downs
- Telethon Kids Institute, The University of Western Australia, Australia
- Curtin University, Australia
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136
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Grzadzinski R, Carr T, Colombi C, McGuire K, Dufek S, Pickles A, Lord C. Measuring Changes in Social Communication Behaviors: Preliminary Development of the Brief Observation of Social Communication Change (BOSCC). J Autism Dev Disord 2017; 46:2464-79. [PMID: 27062034 DOI: 10.1007/s10803-016-2782-9] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Psychometric properties and initial validity of the Brief Observation of Social Communication Change (BOSCC), a measure of treatment-response for social-communication behaviors, are described. The BOSCC coding scheme is applied to 177 video observations of 56 young children with ASD and minimal language abilities. The BOSCC has high to excellent inter-rater and test-retest reliability and shows convergent validity with measures of language and communication skills. The BOSCC Core total demonstrates statistically significant amounts of change over time compared to a no change alternative while the ADOS CSS over the same period of time did not. This work is a first step in the development of a novel outcome measure for social-communication behaviors with applications to clinical trials and longitudinal studies.
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Affiliation(s)
- Rebecca Grzadzinski
- Center for Autism and the Developing Brain, Weill Cornell Medical College, New York-Presbyterian Hospital, 21 Bloomingdale Road, Rogers Building, White Plains, NY, 10605, USA
- Teachers College, Columbia University, New York, NY, USA
| | - Themba Carr
- Center for Autism Research and Treatment, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | | | - Kelly McGuire
- Center for Autism and Developmental Disorders, Maine Behavioral Health Care, South Portland, ME, USA
- New York Presbyterian Hospital, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Sarah Dufek
- Center for Autism and the Developing Brain, Weill Cornell Medical College, New York-Presbyterian Hospital, 21 Bloomingdale Road, Rogers Building, White Plains, NY, 10605, USA
| | - Andrew Pickles
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Catherine Lord
- Center for Autism and the Developing Brain, Weill Cornell Medical College, New York-Presbyterian Hospital, 21 Bloomingdale Road, Rogers Building, White Plains, NY, 10605, USA.
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137
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Calder S, Ward R, Jones M, Johnston J, Claessen M. The uses of outcome measures within multidisciplinary early childhood intervention services: a systematic review. Disabil Rehabil 2017; 40:2599-2622. [PMID: 28715915 DOI: 10.1080/09638288.2017.1353144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose of the article: To review the use of outcome measures, across the domains of activity, participation, and environment, within multidisciplinary early childhood intervention services. MATERIALS AND METHODS A systematic literature search was undertaken that included four electronic databases: Medline, CINAHL, EMBASE, and the Cochrane Library and Cochrane Database of Systematic Review. Inclusion criteria were age 0-24 months, having or at risk of a developmental disability, in receipt of multidisciplinary early childhood intervention services, and included outcome measures across all domains of the International Classification of Functioning-Child & Youth (ICF-CY). Only peer-reviewed journal articles were considered. Eligible studies were coded using the Oxford Levels of Evidence. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) Scale for randomised controlled trials and the QualSyst for non-randomised control trials. RESULTS Of the total of 5764 records identified, 10 were considered to meet inclusion criteria. CONCLUSION Fourteen outcome measures were identified, addressing the domains of activity, participation, and environment. Of these, eight have been recommended in the early intervention literature. While the methodological quality of the 10 studies varied, these papers make a contribution to the body of research that acknowledges the role of routine and enriched environments. Implications for Rehabilitation Core practice elements of multidisciplinary early childhood intervention services indicate it is necessary to select outcome measures framed within the International Classification of Functioning-Child & Youth to inform clinical decision-making for measuring intervention effectiveness across the domains of activity, participation and environment. Of the identified measures, three (Canadian Occupational Performance Measure, Pediatric Evaluation of Disability Inventory, and Goal Attainment Scaling) are well-established and identified in the literature as multidisciplinary outcome measures for children with developmental disability. The selection of an appropriate outcome measure depends on the age of the child, individual goals of the family, and the type of intervention. This requires the combination of measures as no one measure alone will capture all components of the International Classification of Functioning-Child & Youth.
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Affiliation(s)
| | - Roslyn Ward
- b Department of Paediatric Rehabilitation , Princess Margaret Hospital for Children , Perth , WA , Australia.,c School of Paediatrics and Child Health , The University of Western Australia , Perth , WA , Australia
| | - Megan Jones
- d School of Psychology and Speech Pathology , Curtin University , Perth , WA , Australia
| | - Jenelle Johnston
- b Department of Paediatric Rehabilitation , Princess Margaret Hospital for Children , Perth , WA , Australia
| | - Mary Claessen
- d School of Psychology and Speech Pathology , Curtin University , Perth , WA , Australia
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138
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Chong LSH, Sautenet B, Tong A, Hanson CS, Samuel S, Zappitelli M, Dart A, Furth S, Eddy AA, Groothoff J, Webb NJA, Yap HK, Bockenhauer D, Sinha A, Alexander SI, Goldstein SL, Gipson DS, Raman G, Craig JC. Range and Heterogeneity of Outcomes in Randomized Trials of Pediatric Chronic Kidney Disease. J Pediatr 2017; 186:110-117.e11. [PMID: 28449820 DOI: 10.1016/j.jpeds.2017.03.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/07/2017] [Accepted: 03/10/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine the range and heterogeneity of outcomes reported in randomized controlled trials of interventions for children with chronic kidney disease (CKD). STUDY DESIGN The Cochrane Kidney and Transplant Specialized Register was searched to March 2016. Randomized trials involving children across all stages of CKD were selected. All outcome domains and measurements were extracted from included trials. The frequency and characteristics of the outcome domains and measures were evaluated. RESULTS From 205 trials included, 6158 different measurements of 100 different outcome domains were reported, with a median of 22 domains per trial (IQR 13-41). Overall, 52 domains (52%) were surrogate, 38 (38%) were clinical, and 10 (10%) were patient-reported. The 5 most commonly reported domains were blood pressure (76 [37%] trials), relapse/remission (70 [34%]), kidney function (66 [32%]), infection (61 [30%]), and height/pubertal development (51 [25%]). Mortality (14%), cardiovascular disease (4%), and quality of life (1%) were reported infrequently. The 2 most frequently reported outcomes, blood pressure and relapse/remission, had 56 and 81 different outcome measures, respectively. CONCLUSIONS The outcomes reported in clinical trials involving children with CKD are extremely heterogeneous and are most often surrogate outcomes, rather than clinical and patient-centered outcomes such as cardiovascular disease and quality of life. Efforts to ensure consistent reporting of outcomes that are important to patients and clinicians will improve the value of trials to guide clinical decision-making. In our study, non-English articles were excluded.
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Affiliation(s)
- Lauren S H Chong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Benedicte Sautenet
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; University Francois Rabelais, Tours, France; Department of Nephrology and Clinical Immunology, Tours Hospital, Tours, France; INSERM (U1153), Paris, France
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Susan Samuel
- Department of Pediatrics, Section of Nephrology, University of Calgary, Calgary, Canada
| | - Michael Zappitelli
- Department of Pediatrics, Division of Pediatric Nephrology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, The Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada
| | - Susan Furth
- Departments of Pediatrics and Epidemiology, Perelman School of Medicine, Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Allison A Eddy
- Department of Pediatrics, University of British Columbia and the British Columbia Children's Hospital, Vancouver, Canada
| | - Jaap Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Nicholas J A Webb
- Department of Pediatric Nephrology and National Institute for Health Research/Wellcome Trust Clinical Research Facility, University of Manchester, Manchester Academic Health Science Centre, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Detlef Bockenhauer
- University College London Centre for Nephrology, Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, India
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Stuart L Goldstein
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Debbie S Gipson
- Department of Pediatrics, School of Medicine, University of Michigan, Ann Arbor, MI
| | - Gayathri Raman
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
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139
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Mottron L. Should we change targets and methods of early intervention in autism, in favor of a strengths-based education? Eur Child Adolesc Psychiatry 2017; 26:815-825. [PMID: 28181042 PMCID: PMC5489637 DOI: 10.1007/s00787-017-0955-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 01/29/2017] [Indexed: 01/10/2023]
Abstract
Early intensive behavioral intervention (EIBI) and its recent variant, naturalist developmental behavioral intervention (NDBI) aim to increase socialization and communication, and to decrease repetitive and challenging behaviors in preschool age autistic children. These behaviorist techniques are based on the precocity and intensity of the intervention, face-to-face interaction, errorless learning, and information fragmentation. Once considered to be "scientifically proven", the efficacy of these approaches has been called into question in the last decade due to poor-quality data, small effects, low cost-efficiency, and the evolution of ethical and societal standards. Grounded on a reappraisal of the genetic and cognitive neuroscience of autism, we question three aspects of EIBI/NDBI: their focus on prerequisites for typical socio-communicative behaviors, their lack of consideration of autistic language development and learning modes, and their negative view of repetitive behaviors and restricted interests. We propose alternative predictions for empirical validation, based on the strengths of prototypical autistic children: (a) their non-verbal intelligence should be normally distributed and within the normal range; (b) improving access to non-communicative verbal and written auditory language material should favor their subsequent speech development and
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140
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Abstract
Autism spectrum disorders (ASDs) are neurodevelopmental disorders whose core features of impaired social communication and atypical repetitive behaviors and/or restrictions in range of interests emerge in toddlerhood and carry significant implications at successive stages of development. The ability to reliably identify most cases of the condition far earlier than the average age of diagnosis presents a novel opportunity for early intervention, but the availability of such an intervention is disparate across US communities, and its impact is imperfectly understood. New research may transform the clinical approach to these conditions in early childhood.
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Affiliation(s)
- John N Constantino
- Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8504, St Louis, MO 63110, USA.
| | - Natasha Marrus
- Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8504, St Louis, MO 63110, USA
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141
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Charman T, Loth E, Tillmann J, Crawley D, Wooldridge C, Goyard D, Ahmad J, Auyeung B, Ambrosino S, Banaschewski T, Baron-Cohen S, Baumeister S, Beckmann C, Bölte S, Bourgeron T, Bours C, Brammer M, Brandeis D, Brogna C, de Bruijn Y, Chakrabarti B, Cornelissen I, Acqua FD, Dumas G, Durston S, Ecker C, Faulkner J, Frouin V, Garcés P, Ham L, Hayward H, Hipp J, Holt RJ, Isaksson J, Johnson MH, Jones EJH, Kundu P, Lai MC, D’ardhuy XL, Lombardo MV, Lythgoe DJ, Mandl R, Mason L, Meyer-Lindenberg A, Moessnang C, Mueller N, O’Dwyer L, Oldehinkel M, Oranje B, Pandina G, Persico AM, Ruggeri B, Ruigrok ANV, Sabet J, Sacco R, Cáceres ASJ, Simonoff E, Toro R, Tost H, Waldman J, Williams SCR, Zwiers MP, Spooren W, Murphy DGM, Buitelaar JK. The EU-AIMS Longitudinal European Autism Project (LEAP): clinical characterisation. Mol Autism 2017; 8:27. [PMID: 28649313 PMCID: PMC5481972 DOI: 10.1186/s13229-017-0145-9] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 05/19/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The EU-AIMS Longitudinal European Autism Project (LEAP) is to date the largest multi-centre, multi-disciplinary observational study on biomarkers for autism spectrum disorder (ASD). The current paper describes the clinical characteristics of the LEAP cohort and examines age, sex and IQ differences in ASD core symptoms and common co-occurring psychiatric symptoms. A companion paper describes the overall design and experimental protocol and outlines the strategy to identify stratification biomarkers. METHODS From six research centres in four European countries, we recruited 437 children and adults with ASD and 300 controls between the ages of 6 and 30 years with IQs varying between 50 and 148. We conducted in-depth clinical characterisation including a wide range of observational, interview and questionnaire measures of the ASD phenotype, as well as co-occurring psychiatric symptoms. RESULTS The cohort showed heterogeneity in ASD symptom presentation, with only minimal to moderate site differences on core clinical and cognitive measures. On both parent-report interview and questionnaire measures, ASD symptom severity was lower in adults compared to children and adolescents. The precise pattern of differences varied across measures, but there was some evidence of both lower social symptoms and lower repetitive behaviour severity in adults. Males had higher ASD symptom scores than females on clinician-rated and parent interview diagnostic measures but not on parent-reported dimensional measures of ASD symptoms. In contrast, self-reported ASD symptom severity was higher in adults compared to adolescents, and in adult females compared to males. Higher scores on ASD symptom measures were moderately associated with lower IQ. Both inattentive and hyperactive/impulsive ADHD symptoms were lower in adults than in children and adolescents, and males with ASD had higher levels of inattentive and hyperactive/impulsive ADHD symptoms than females. CONCLUSIONS The established phenotypic heterogeneity in ASD is well captured in the LEAP cohort. Variation both in core ASD symptom severity and in commonly co-occurring psychiatric symptoms were systematically associated with sex, age and IQ. The pattern of ASD symptom differences with age and sex also varied by whether these were clinician ratings or parent- or self-reported which has important implications for establishing stratification biomarkers and for their potential use as outcome measures in clinical trials.
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Affiliation(s)
- Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Eva Loth
- Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Julian Tillmann
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Daisy Crawley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Caroline Wooldridge
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - David Goyard
- Neurospin Centre CEA, Saclay, 91191 Gif sur Yvette France
| | - Jumana Ahmad
- Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Bonnie Auyeung
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH UK
- The School of Philosophy, Psychology, and Language Sciences, University of Edinburgh, Dugald Stewart Building, 3 Charles Street, Edinburgh, EH8 9AD UK
| | - Sara Ambrosino
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Tobias Banaschewski
- Child and Adolescent Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH UK
| | - Sarah Baumeister
- Child and Adolescent Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Christian Beckmann
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands
| | - Sven Bölte
- Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Stockholm, Sweden
- Child and Adolescent Psychiatry, Center of Psychiatry Research, Stockholm County Council, Stockholm, Sweden
| | - Thomas Bourgeron
- Institut Pasteur, Human Genetics and Cognitive Functions Unit, 25 Rue du Docteur Roux, Paris, Cedex 15 France
| | - Carsten Bours
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands
| | - Michael Brammer
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Daniel Brandeis
- Child and Adolescent Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Claudia Brogna
- University Campus Bio-Medico, Via Álvaro del Portillo, 21, Rome, Italy
| | - Yvette de Bruijn
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands
| | - Bhismadev Chakrabarti
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH UK
- School of Psychology and Clinical Language Sciences, University of Reading, Whiteknights, Reading, RG6 6AL UK
| | - Ineke Cornelissen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands
| | - Flavio Dell’ Acqua
- Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Guillaume Dumas
- Institut Pasteur, Human Genetics and Cognitive Functions Unit, 25 Rue du Docteur Roux, Paris, Cedex 15 France
| | - Sarah Durston
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Christine Ecker
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt am Main, Goethe University, Deutschordenstrasse 50, 60528 Frankfurt, Germany
| | - Jessica Faulkner
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Vincent Frouin
- Neurospin Centre CEA, Saclay, 91191 Gif sur Yvette France
| | - Pilar Garcés
- Roche Pharma Research and Early Development, Neuroscience, Ophthalmology and Rare Diseases, Roche Innovation Center Basel, Grenzacherstrasse 124, B.001 N.667, CH-4070 Basel, Switzerland
| | - Lindsay Ham
- Regulatory Affairs, Pharmaceutical Development, F. Hoffmann-La Roche Pharmaceuticals, Grenzacherstrasse 124, CH-4070 Basel, Switzerland
| | - Hannah Hayward
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Joerg Hipp
- Roche Pharma Research and Early Development, Neuroscience, Ophthalmology and Rare Diseases, Roche Innovation Center Basel, Grenzacherstrasse 124, B.001 N.667, CH-4070 Basel, Switzerland
| | - Rosemary J. Holt
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH UK
| | - Johan Isaksson
- Center for Neurodevelopmental Disorders at Karolinska Institutet (KIND), Stockholm, Sweden
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Mark H. Johnson
- Centre for Brain and Cognitive Development, Birkbeck, University of London, 32 Torrington Square, London, WC1E 7JL UK
| | - Emily J. H. Jones
- Centre for Brain and Cognitive Development, Birkbeck, University of London, 32 Torrington Square, London, WC1E 7JL UK
| | - Prantik Kundu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Meng-Chuan Lai
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH UK
- Child and Youth Mental Health Collaborative, Centre for Addiction and Mental Health and The Hospital for Sick Children, Department of Psychiatry, University of Toronto, 80 Workman Way, Toronto, ON M6J 1H4 Canada
| | - Xavier Liogier D’ardhuy
- Roche Pharma Research and Early Development, Neuroscience, Ophthalmology and Rare Diseases, Roche Innovation Center Basel, Grenzacherstrasse 124, B.001 N.667, CH-4070 Basel, Switzerland
| | - Michael V. Lombardo
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH UK
- Center for Applied Neuroscience, Department of Psychology, University of Cyprus, PO Box 20537, 1678 Nicosia, Cyprus
| | - David J Lythgoe
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - René Mandl
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Luke Mason
- Centre for Brain and Cognitive Development, Birkbeck, University of London, 32 Torrington Square, London, WC1E 7JL UK
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159 Mannheim, Germany
| | - Carolin Moessnang
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159 Mannheim, Germany
| | - Nico Mueller
- Child and Adolescent Psychiatry, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, J5, 68159 Mannheim, Germany
| | - Laurence O’Dwyer
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands
| | - Marianne Oldehinkel
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands
| | - Bob Oranje
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Gahan Pandina
- Janssen Research & Development, 1125 Trenton Harbourton Road, Titusville, NJ 08560 USA
| | - Antonio M. Persico
- University Campus Bio-Medico, Via Álvaro del Portillo, 21, Rome, Italy
- Child and Adolescent Neuropsychiatry Unit, “Gaetano Martino” University Hospital, University of Messina, via Consolare Valeria 1, I-98125 Messina, Italy
| | - Barbara Ruggeri
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Denmark Hill, London, UK
| | - Amber N. V. Ruigrok
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH UK
| | - Jessica Sabet
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Roberto Sacco
- University Campus Bio-Medico, Via Álvaro del Portillo, 21, Rome, Italy
| | - Antonia San Jóse Cáceres
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8LF UK
| | - Roberto Toro
- Institut Pasteur, Human Genetics and Cognitive Functions Unit, 25 Rue du Docteur Roux, Paris, Cedex 15 France
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159 Mannheim, Germany
| | - Jack Waldman
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH UK
| | - Steve C. R. Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Marcel P. Zwiers
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands
| | - Will Spooren
- Roche Pharmaceutical Research and Early Development, NORD Discovery and Translational Area, Roche Innovation Center Basel, Grenzacherstrasse 124, CH-4070 Basel, Switzerland
| | - Declan G. M. Murphy
- Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Jan K. Buitelaar
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands
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142
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Hamdani SU, Akhtar P, Zill-e-Huma, Nazir H, Minhas FA, Sikander S, Wang D, Servilli C, Rahman A. WHO Parents Skills Training (PST) programme for children with developmental disorders and delays delivered by Family Volunteers in rural Pakistan: study protocol for effectiveness implementation hybrid cluster randomized controlled trial. Glob Ment Health (Camb) 2017; 4:e11. [PMID: 29230307 PMCID: PMC5719472 DOI: 10.1017/gmh.2017.7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/28/2017] [Accepted: 04/19/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Development disorders and delays are recognised as a public health priority and included in the WHO mental health gap action programme (mhGAP). Parents Skills Training (PST) is recommended as a key intervention for such conditions under the WHO mhGAP intervention guide. However, sustainable and scalable delivery of such evidence based interventions remains a challenge. This study aims to evaluate the effectiveness and scaled-up implementation of locally adapted WHO PST programme delivered by family volunteers in rural Pakistan. METHODS The study is a two arm single-blind effectiveness implementation-hybrid cluster randomised controlled trial. WHO PST programme will be delivered by 'family volunteers' to the caregivers of children with developmental disorders and delays in community-based settings. The intervention consists of the WHO PST along with the WHO mhGAP intervention for developmental disorders adapted for delivery using the android application on a tablet device. A total of 540 parent-child dyads will be recruited from 30 clusters. The primary outcome is child's functioning, measured by WHO Disability Assessment Schedule - child version (WHODAS-Child) at 6 months post intervention. Secondary outcomes include children's social communication and joint engagement with their caregiver, social emotional well-being, parental health related quality of life, family empowerment and stigmatizing experiences. Mixed method will be used to collect data on implementation outcomes. Trial has been retrospectively registered at ClinicalTrials.gov (NCT02792894). DISCUSSION This study addresses implementation challenges in the real world by incorporating evidence-based intervention strategies with social, technological and business innovations. If proven effective, the study will contribute to scaled-up implementation of evidence-based packages for public mental health in low resource settings. TRIAL REGISTRATION Registered with ClinicalTrials.gov as Family Networks (FaNs) for Children with Developmental Disorders and Delays. Identifier: NCT02792894 Registered on 6 July 2016.
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Affiliation(s)
- S. U. Hamdani
- Human Development Research Foundation, Islamabad, Pakistan
| | - P. Akhtar
- Human Development Research Foundation, Islamabad, Pakistan
| | - Zill-e-Huma
- Human Development Research Foundation, Islamabad, Pakistan
| | - H. Nazir
- Human Development Research Foundation, Islamabad, Pakistan
| | - F. A. Minhas
- Institute of psychiatry, WHO collaborating centre for mental health research and training Rawalpindi, Pakistan
| | - S. Sikander
- Human Development Research Foundation, Islamabad, Pakistan
| | - D. Wang
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - C. Servilli
- Department of Mental Health and Substance Abuse, World Health Organisation, Geneva, Switzerland
| | - A. Rahman
- University of Liverpool, Liverpool, UK
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143
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Budimirovic DB, Berry-Kravis E, Erickson CA, Hall SS, Hessl D, Reiss AL, King MK, Abbeduto L, Kaufmann WE. Updated report on tools to measure outcomes of clinical trials in fragile X syndrome. J Neurodev Disord 2017; 9:14. [PMID: 28616097 PMCID: PMC5467057 DOI: 10.1186/s11689-017-9193-x] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 02/22/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Fragile X syndrome (FXS) has been the neurodevelopmental disorder with the most active translation of preclinical breakthroughs into clinical trials. This process has led to a critical assessment of outcome measures, which resulted in a comprehensive review published in 2013. Nevertheless, the disappointing outcome of several recent phase III drug trials in FXS, and parallel efforts at evaluating behavioral endpoints for trials in autism spectrum disorder (ASD), has emphasized the need for re-assessing outcome measures and revising recommendations for FXS. METHODS After performing an extensive database search (PubMed, Food and Drug Administration (FDA)/National Institutes of Health (NIH)'s www.ClinicalTrials.gov, etc.) to determine progress since 2013, members of the Working Groups who published the 2013 Report evaluated the available outcome measures for FXS and related neurodevelopmental disorders using the COSMIN grading system of levels of evidence. The latter has also been applied to a British survey of endpoints for ASD. In addition, we also generated an informal classification of outcome measures for use in FXS intervention studies as instruments appropriate to detect shorter- or longer-term changes. RESULTS To date, a total of 22 double-blind controlled clinical trials in FXS have been identified through www.ClinicalTrials.gov and an extensive literature search. The vast majority of these FDA/NIH-registered clinical trials has been completed between 2008 and 2015 and has targeted the core excitatory/inhibitory imbalance present in FXS and other neurodevelopmental disorders. Limited data exist on reliability and validity for most tools used to measure cognitive, behavioral, and other problems in FXS in these trials and other studies. Overall, evidence for most tools supports a moderate tool quality grading. Data on sensitivity to treatment, currently under evaluation, could improve ratings for some cognitive and behavioral tools. Some progress has also been made at identifying promising biomarkers, mainly on blood-based and neurophysiological measures. CONCLUSION Despite the tangible progress in implementing clinical trials in FXS, the increasing data on measurement properties of endpoints, and the ongoing process of new tool development, the vast majority of outcome measures are at the moderate quality level with limited information on reliability, validity, and sensitivity to treatment. This situation is not unique to FXS, since reviews of endpoints for ASD have arrived at similar conclusions. These findings, in conjunction with the predominance of parent-based measures particularly in the behavioral domain, indicate that endpoint development in FXS needs to continue with an emphasis on more objective measures (observational, direct testing, biomarkers) that reflect meaningful improvements in quality of life. A major continuous challenge is the development of measurement tools concurrently with testing drug safety and efficacy in clinical trials.
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Affiliation(s)
- Dejan B. Budimirovic
- Departments of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute and Child Psychiatry, Johns Hopkins University School of Medicine, 716 N. Broadway, Baltimore, MD 21205 USA
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences, Biochemistry, Rush University Medical Center, 1725 West Harrison, Suite 718, Chicago, IL 60612 USA
| | - Craig A. Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, 3333 Burnet Avenue MLC 4002, Cincinnati, OH 45229 USA
| | - Scott S. Hall
- Division of Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305 USA
| | - David Hessl
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, 2825 50th Street, Sacramento, CA 95817 USA
| | - Allan L. Reiss
- Division of Interdisciplinary Brain Sciences, Departments of Psychiatry and Behavioral Sciences, Radiology and Pediatrics, Stanford University, 401 Quarry Road, Stanford, CA 94305 USA
| | - Margaret K. King
- Autism & Developmental Medicine Institute, Geisinger Health System, Present address: Novartis Pharmaceuticals Corporation, US Medical, One Health Plaza, East Hanover, NJ 07936 USA
| | - Leonard Abbeduto
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, 2825 50th Street, Sacramento, CA 95817 USA
| | - Walter E. Kaufmann
- Center for Translational Research, Greenwood Genetic Center, 113 Gregor Mendel Circle, Greenwood, SC 29646 USA
- Department of Neurology, Boston Children’s Hospital, Boston, MA 02115 USA
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144
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Yun SS, Choi J, Park SK, Bong GY, Yoo H. Social skills training for children with autism spectrum disorder using a robotic behavioral intervention system. Autism Res 2017; 10:1306-1323. [DOI: 10.1002/aur.1778] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 02/14/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Sang-Seok Yun
- Division of Mechanical Convergence Engineering, Silla University; Busan Republic of Korea
| | - JongSuk Choi
- Center for Robotics Research, Korea Institute of Science and Technology (KIST); Seoul Republic of Korea
| | - Sung-Kee Park
- Center for Robotics Research, Korea Institute of Science and Technology (KIST); Seoul Republic of Korea
| | - Gui-Young Bong
- Department of Psychiatry; Seoul National University Bundang Hospital, Seongnam; Republic of Korea
| | - HeeJeong Yoo
- Department of Psychiatry; Seoul National University Bundang Hospital, Seongnam; Republic of Korea
- Department of Psychiatry; Seoul National University College of Medicine; Seoul Republic of Korea
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Touzet S, Occelli P, Schröder C, Manificat S, Gicquel L, Stanciu R, Schaer M, Oreve MJ, Speranza M, Denis A, Zelmar A, Falissard B, Georgieff N, Bahrami S, Geoffray MM. Impact of the Early Start Denver Model on the cognitive level of children with autism spectrum disorder: study protocol for a randomised controlled trial using a two-stage Zelen design. BMJ Open 2017; 7:e014730. [PMID: 28348195 PMCID: PMC5372147 DOI: 10.1136/bmjopen-2016-014730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Early intervention for autism spectrum disorder (ASD) in the European French-speaking countries is heterogeneous and poorly evaluated to date. Early intervention units applying the Early Start Denver Model (ESDM) for toddlers and young children with ASD have been created in France and Belgium to improve this situation. It is essential to evaluate this intervention for the political decision-making process regarding ASD interventions in European French-speaking countries. We will evaluate the effectiveness of 12 hours per week ESDM intervention on the cognitive level of children with ASD, over a 2-year period. METHODS AND ANALYSIS The study will be a multicentre, randomised controlled trial, using a two-stage Zelen design. Children aged 15-36 months, diagnosed with ASD and with a developmental quotient (DQ) of 30 or above on the Mullen Scale of Early Learning (MSEL) will be included. We will use a stratified minimisation randomisation at a ratio 1:2 in favour of the control group. The sample size required is 180 children (120 in the control and 60 in the intervention group). The experimental group will receive 12 hours per week ESDM by trained therapists 10 hours per week in the centre and 2 hours in the toddlers' natural environment (alternatively by the therapist and the parent). The control group will receive care available in the community. The primary outcome will be the change in cognitive level measured with the DQ of the MSEL scored at 2 years. Secondary outcomes will include change in autism symptoms, behavioural adaptation, communicative and productive language level, sensory profile and parents' quality of life. The primary analysis will use the intention-to-treat principle. An economic evaluation will be performed. DISSEMINATION Findings from the study will be disseminated through peer reviewed publications and meetings. TRIAL REGISTRATION NUMBER NCT02608333 (clinicaltrials.gov); Pre-results.
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Affiliation(s)
- Sandrine Touzet
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon F-69003, France
- Laboratoire Health Services and Performance Research, EA 7425 HESPER, Université de Lyon, Lyon F-69008France
| | - Pauline Occelli
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon F-69003, France
- Laboratoire Health Services and Performance Research, EA 7425 HESPER, Université de Lyon, Lyon F-69008France
| | - Carmen Schröder
- Department of Child and Adolescent Psychiatry, Hopitaux universitaires de Strasbourg, Strasbourg F-67000, France
- CNRS UPR 3212—Team 9, Strasbourg University, Strasbourg F-67000, France
| | | | - Ludovic Gicquel
- Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier Spécialisé Henri Laborit, Saint Benoît F-86280, France
- Child and Adolescent Psychiatry Department, Unité de Recherche Clinique, Université de Poitiers, Poitiers F-86000, France
| | - Razvana Stanciu
- Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Bruxelles 1020, Belgium
| | - Marie Schaer
- Office Médico-Pédagogique, University of Geneva, Geneva, Switzerland
| | - Marie-Joelle Oreve
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier de Versailles, Le Chesnay F-78150, France
| | - Mario Speranza
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier de Versailles, Le Chesnay F-78150, France
- EA 4047 HANDIReSP, Université de Versailles Saint-Quentin-en-Yvelines, Versailles F-78000, France
| | - Angelique Denis
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon F-69003, France
- Laboratoire Health Services and Performance Research, EA 7425 HESPER, Université de Lyon, Lyon F-69008France
| | - Amelie Zelmar
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon F-69003, France
- Laboratoire Health Services and Performance Research, EA 7425 HESPER, Université de Lyon, Lyon F-69008France
| | - Bruno Falissard
- Université Paris-Sud, CESP, INSERM, UVSQ, Université Paris-Saclay, U1178, Maison de Solenn, Paris cedex 14, France
- Department of Public Health, AP-HP, Hôpital Paul Brousse, Villejuif F-94800, France
| | - Nicolas Georgieff
- Department of child and adolescent psychiatry, Centre Hospitalier le Vinatiers, Bron F-69500, France
- Université de Lyon, Lyon F-69008, France
| | - Stephane Bahrami
- EA 4047 HANDIReSP, Université de Versailles Saint-Quentin-en-Yvelines, Versailles F-78000, France
- CIC 1429, INSERM, AP-HP, Hôpital Raymond-Poincare, Garches F-92380, France
| | - Marie-Maude Geoffray
- Department of child and adolescent psychiatry, Centre Hospitalier le Vinatiers, Bron F-69500, France
- Université de Lyon, Lyon F-69008, France
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Williams ME, Hastings R, Charles JM, Evans S, Hutchings J. Parenting for Autism, Language, And Communication Evaluation Study (PALACES): protocol for a pilot randomised controlled trial. BMJ Open 2017; 7:e014524. [PMID: 28209607 PMCID: PMC5318566 DOI: 10.1136/bmjopen-2016-014524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/26/2016] [Accepted: 01/17/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Children with autistic spectrum disorder (ASD) often have associated behavioural difficulties that can present a challenge for parents and parenting. There are several effective social learning theory-based parenting programmes for dealing with behavioural difficulties, including the Incredible Years (IY) parent programmes. However, these programmes typically do not specifically target parents of children with ASD. Recently, a new addition to the IY suite of programmes known as the IY Autistic Spectrum and Language Delays (IY-ASLD) parent programme was developed. The main aims of the present study are to examine the feasibility of delivering this programme within child health services and to provide initial evidence for effectiveness and economic costs. METHODS AND ANALYSIS The Parenting for Autism, Language, And Communication Evaluation Study (PALACES) trial is a pragmatic, multicentre, pilot randomised controlled trial comparing the IY-ASLD programme with a wait-list control condition. 72 parents of children with ASD (aged 3-8 years) will be randomly allocated to either the intervention or control condition. Data will be collected prior to randomisation and 6 months postrandomisation for all families. Families in the intervention condition only will also be followed up at 12 and 18 months postrandomisation. This study will provide initial evidence of effectiveness for the newly developed IY-ASLD parenting programme. It will also add to the limited economic evidence for an intervention targeting parents of children with ASD and provide longer term data, an important component for evaluations of parenting programmes. ETHICS AND DISSEMINATION Approval for the study was granted by the Research Ethics Committee at the School of Psychology, Bangor University (reference number: 2016-15768) and the North Wales Research Ethics Committee, UK (reference number: 16/WA/0224). The findings will be disseminated through research conferences and peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN57070414; Pre-results.
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Affiliation(s)
| | - Richard Hastings
- Centre for Educational Development, Appraisal and Research, University of Warwick, Warwick, UK
| | - Joanna Mary Charles
- Centre for Health Economics and Medicines Evaluation, Bangor University, Wales, UK
| | - Sue Evans
- Powys Teaching Health Board, Park Street Clinic, Newtown, Powys, UK
| | - Judy Hutchings
- Centre for Evidence Based Early Intervention, Bangor University, Wales, UK
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147
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Pijl MKJ, Rommelse NNJ, Hendriks M, De Korte MWP, Buitelaar JK, Oosterling IJ. Does the Brief Observation of Social Communication Change help moving forward in measuring change in early autism intervention studies? AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 22:216-226. [DOI: 10.1177/1362361316669235] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The field of early autism research is in dire need of outcome measures that adequately reflect subtle changes in core autistic behaviors. This article compares the ability of a newly developed measure, the Brief Observation of Social Communication Change (BOSCC), and the Autism Diagnostic Observation Schedule (ADOS) to detect changes in core symptoms of autism in 44 toddlers. The results provide encouraging evidence for the Brief Observation of Social Communication Change as a candidate outcome measure, as reflected in sufficient inter- and intra-rater reliability, independency from other child characteristics, and sensitivity to capture change. Although the Brief Observation of Social Communication Change did not evidently outperform the Autism Diagnostic Observation Schedule on any of these quality criteria, the instrument may be better able to capture subtle, individual changes in core autistic symptoms. The promising findings warrant further study of this new instrument.
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Affiliation(s)
- Mirjam KJ Pijl
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Nanda NJ Rommelse
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Monica Hendriks
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Manon WP De Korte
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jan K Buitelaar
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Iris J Oosterling
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
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148
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Green JL, Sciberras E, Anderson V, Efron D, Rinehart N. Association between autism symptoms and functioning in children with ADHD. Arch Dis Child 2016; 101:922-8. [PMID: 27117836 DOI: 10.1136/archdischild-2015-310257] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/16/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine the association between autism spectrum disorder (ASD) symptoms and (a) social functioning, (b) mental health, (c) quality of life and (d) sleep in children with and without attention-deficit hyperactivity disorder (ADHD). METHODS Participants were 6-10-year-old children with ADHD (N=164) and without ADHD (N=198). ADHD was assessed via community-based screening (wave 1) and case confirmation using the Diagnostic Interview Schedule for Children IV (DISC-IV) (wave 2). ASD symptoms were identified using the Social Communication Questionnaire (SCQ). Outcome measures were social functioning (Strengths and Difficulties Questionnaire (SDQ)), mental health (DISC-IV, SDQ), quality of life (QoL, Pediatric Quality of Life Inventory 4.0) and sleep problem severity. RESULTS Greater ASD symptoms were associated with more parent and teacher-reported peer problems and emotional and conduct problems. For every SD increase in SCQ scores, internalising (OR 1.8, 95% CI 1.3 to 2.6, p=0.001) and externalising disorders (OR 1.5, 95% CI 1.1 to 2.1, p=0.02) increased, QoL decreased by 6.7 units (p<0.001), and moderate/severe sleep problems increased (OR 1.5, 95% CI 1.0 to 2.2, p=0.04). Most findings held in analyses adjusting for socio-demographic factors, ADHD symptom severity and comorbidities (when not the outcome), with the exception of externalising disorders and sleep problems. CONCLUSIONS ASD symptoms are associated with poorer functioning in children with ADHD. It is important to identify and potentially manage ASD symptoms in children with ADHD given that they exacerbate functional impairments in this already vulnerable group.
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Affiliation(s)
- Jessica Leigh Green
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia Murdoch Children's Research Institute, Parkville, Victoria, Australia School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Emma Sciberras
- Murdoch Children's Research Institute, Parkville, Victoria, Australia School of Psychology, Deakin University, Burwood, Victoria, Australia The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Parkville, Victoria, Australia The Royal Children's Hospital, Parkville, Victoria, Australia The University of Melbourne, Parkville, Victoria, Australia
| | - Daryl Efron
- Murdoch Children's Research Institute, Parkville, Victoria, Australia The Royal Children's Hospital, Parkville, Victoria, Australia The University of Melbourne, Parkville, Victoria, Australia
| | - Nicole Rinehart
- Murdoch Children's Research Institute, Parkville, Victoria, Australia School of Psychology, Deakin University, Burwood, Victoria, Australia
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Kaufmann WE, Stallworth JL, Everman DB, Skinner SA. Neurobiologically-based treatments in Rett syndrome: opportunities and challenges. Expert Opin Orphan Drugs 2016; 4:1043-1055. [PMID: 28163986 PMCID: PMC5214376 DOI: 10.1080/21678707.2016.1229181] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/23/2016] [Indexed: 12/14/2022]
Abstract
Introduction: Rett syndrome (RTT) is an X-linked neurodevelopmental disorder that primarily affects females, typically resulting in a period of developmental regression in early childhood followed by stabilization and severe chronic cognitive, behavioral, and physical disability. No known treatment exists beyond symptomatic management, and while insights into the genetic cause, pathophysiology, neurobiology, and natural history of RTT have been gained, many challenges remain. Areas covered: Based on a comprehensive survey of the primary literature on RTT, this article describes and comments upon the general and unique features of the disorder, genetic and neurobiological bases of drug development, and the history of clinical trials in RTT, with an emphasis on drug trial design, outcome measures, and implementation. Expert opinion: Neurobiologically based drug trials are the ultimate goal in RTT, and due to the complexity and global nature of the disorder, drugs targeting both general mechanisms (e.g., growth factors) and specific systems (e.g., glutamate modulators) could be effective. Trial design should optimize data on safety and efficacy, but selection of outcome measures with adequate measurement properties, as well as innovative strategies, such as those enhancing synaptic plasticity and use of biomarkers, are essential for progress in RTT and other neurodevelopmental disorders.
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Affiliation(s)
- Walter E Kaufmann
- Center for Translational Research, Greenwood Genetic Center, Greenwood, SC, USA; Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | | | - David B Everman
- Center for Translational Research, Greenwood Genetic Center , Greenwood , SC , USA
| | - Steven A Skinner
- Center for Translational Research, Greenwood Genetic Center , Greenwood , SC , USA
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150
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McGrew JH, Ruble LA, Smith IM. Autism spectrum disorder and evidence‐based practice in psychology. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/cpsp.12160] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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