Anxiety and depression in children with HFASDs: symptom levels and source differences

Predicting Self-Esteem and Depressive Symptoms from Social Skills Among Youth Referred for an Autism Evaluation

Social skills are associated with depression and self-esteem in autistic youth. Minimal comparisons between youth and parent-reported social skills to clinically relevant samples limit existing studies. This study compared the relationships between parent and youth-reported social skills, self-esteem, and depressive symptoms between autistic youth and youth referred for but not given an autism diagnosis. Regression analyses of cross-sectional data revealed that youth-reported social skills statistically predicted self-esteem, parent-reported social skills statistically predicted depressive symptoms, and self-esteem statistically predicted depressive symptoms. All relationships were weaker in the autistic group, except parent-reported social skills and depressive symptoms, which was stronger. Results indicate that poor social skills are associated with mental health outcomes among youth referred for autism diagnosis, but that autism-related factors may influence these relationships. Implications for future research and clinical practice are discussed.

Experiences of equine assisted therapy for females with autism spectrum disorders

Purpose

This research indicates females with autism spectrum disorders (ASDs) have a diverse clinical presentation compared to males. Furthermore, females with ASD are often diagnosed later and typically experience greater levels of mental health difficulties. Evidence suggests that clinic-based verbal interventions for ASD have limited efficacy; therefore, alternative therapies, such as equine-assisted therapies (EATs), are gaining recognition. The purpose of this study was to directly explore the experiences of females with an ASD who have undertaken EAT.

Design/methodology/approach

Five female participants with a diagnosis of ASD were recruited from two equine therapy centres. Participants were aged between 15 and 30 years and undertook semi-structured interviews, which were analysed using interpretative phenomenological analysis.

Findings

Three superordinate themes emerged: the difficult experience of the social world, the process of EAT and the emotional impact of horses.

Originality/value

Directly exploring the experiences of females with ASD highlights benefits from engaging therapeutically with horses, building confidence and independence to transferring this into more effective social communication with other people. Offering emotion-focused therapeutic complementary interventions for females with ASD should be forefronted to help remediate the impact of difficult and sometimes traumatic earlier experiences in the social world. This requires increased funding for EAT, combined with larger-scale research projects to evaluate this.

ASD Symptoms, Social Skills, and Comorbidity: Predictors of Bullying Perpetration

Children with ASD are more likely to be involved in bullying compared to typically developing peers; however, studies rarely examine bullying perpetration and the contributing factors among this population. The primary aim of this study was to examine the extent to which parent-reported ASD symptoms, social skills, and comorbid externalizing and internalizing symptoms predicted bullying perpetration in a sample of 390 children with ASD without intellectual disability. Findings from hierarchical regression analyses indicated that social skill deficits, externalizing symptoms (i.e., hyperactivity, aggression, and conduct problems), and depressive symptoms were associated with higher likelihood of bullying perpetration, while severity of ASD symptoms and anxiety were not significant predictors. Further research is needed to better understand bullying perpetration among children with ASD.

Parental Depression Symptoms and Internalizing Mental Health Problems in Autistic Children

Autistic youth are at risk for internalizing mental health problems such as depression and anxiety. Similarly, parents of autistic youth report higher levels of depression than parents of typically developing children. The goal of this study was to examine bidirectional associations between parent depression symptoms and the internalizing problems of autistic youth in 188 families across four time points (T1-T4; spaced 12 months apart). A cross-lagged panel model revealed that mother (T1 and T2) and father (T1) depression symptoms positively predicted the youth's internalizing problems 12 months later. The youth's internalizing problems at T3 positively predicted maternal depression symptoms at T4. Future research should explore genetic and environmental pathways that link parent depression and internalizing problems in autistic youth.

A systematic review of the rates of depression in autistic children and adolescents without intellectual disability

OBJECTIVES

Increasing evidence suggests that major depressive disorder (MDD) is highly prevalent in autism spectrum disorder (ASD). The current study is a systematic review of rates of depression in autistic children and adolescents, without intellectual disability.

DESIGN

Adhering to PRISMA guidelines, a total of 14,557 studies were identified through five databases (MEDLINE, EMBASE, Cinahl, ERIC, PsycINFO, and Web of Science).

METHODS

Articles were screened for inclusion and exclusion criteria and 10% double coded at each stage. Nineteen studies met criteria and were retained in the review.

RESULT

The reported rates of depression in autistic children and adolescents varied from 0% to 83.3%. We discuss these findings in relation to method of report (self/informant, interview/questionnaire), recruitment status (clinical/community recruited), and age (pre-pubertal/adolescent).

CONCLUSION

Rates of depression vary considerably across studies and do not show a particular pattern in relation to methodology, or age. Our research joins a crucial call to action from the research community for future research to improve the identification of depression in autism, which in turn will aid our understanding of the potentially different characterization and manifestation of depression in autism, to ultimately improve assessment and treatment of depression in autistic children and adolescents.

PRACTITIONER POINTS

Rates of depression in autistic children and adolescents vary and do not show a particular pattern in relation to methodology or age. Our research joins the call to action from the research community for future research to improve the identification of depression in autistic children and adolescents, which in turn will aid understanding of depression in autism, and ultimately improve assessment and treatment of depression in autistic children and young people. The development of new measures of depression, specifically designed with, and for, children and adolescents with autism, is warranted.

Emotional Rational Education Training Associated with Mindfulness for Managing Anxiety within Adolescents Affected by High-Functioning Autism: A Descriptive Study

Background: Autism spectrum disorder (ASD) is a chronic and persistent pervasive developmental disorder (PDD) whose characteristic deficit is represented by social difficulties, semantic–pragmatic alterations and a limited, unusual and repetitive pattern of interests and behaviors. Specifically, individuals with high-functioning autism (HFA) frequently exhibit associated internalizing symptoms that are not part of the diagnostic criteria but which, nonetheless, tend to impair daily functioning. In this study, we investigated how some forms of treatment could be useful in subjects with HFA who display internalizing symptoms. Theoretical background relates to standard cognitive therapy (SCT) and rational education training with mindfulness (M-ERE). Methods: In this study, we investigated how some forms of treatment could be useful in subjects with HFA and internalizing symptoms, focusing on standard cognitive therapy (SCT) and mindfulness associated with emotional rational education training (M-ERE). We selected two groups of HFA patients with significant internalizing symptoms and performed two different forms of treatment for six months: SCT and M-ERE. The aim of the study was to verify the effectiveness of an M-ERE protocol with respect to anxious and depressive symptoms in subjects with HFA. Furthermore, we wanted to compare the results obtained with this combined treatment with those obtained in HFA subjects treated with SCT. Results: Our analyses showed an improvement in the internalizing symptoms (especially those related to the anxiety dimension) of the group that followed a treatment based on mindfulness and rational emotional education for 6 months compared to the group that had instead performed a 6-month treatment based on the SCT. Conclusions: Our hypotheses were supported by the results, which highlighted the efficacy of mindfulness-based interventions in the treatment of internalizing symptoms in adolescents with HFA, and specifically showed that an M-ERE intervention appears more effective in managing anxiety compared to treatment with SCT and appears to be equally effective in the management of depressive symptoms. Not only was the M-ERE treatment effective for the management of anxious and depressive symptoms in subjects with HFA, but the efficacy for the management of anxious symptoms was greater than the SCT treatment.

The Utility of the Test of Memory Malingering Trial 1 in Differentiating Neurocognitive, Emotional, and Behavioral Functioning in a Pediatric Concussion Population

OBJECTIVE

In concussion populations, suboptimal task engagement detected by performance validity tests (PVTs) has been associated with poorer neuropsychological scores and greater post-concussive symptoms (PCS). This study examined if Pass/Fail status on the Test of Memory Malingering-TOMM Trial 1-differentiated the neurocognitive, emotional, and behavioral profile of pediatric patients with concussion.

METHOD

This study utilized archival data from 93 patients (mean age = 14.56 and SD = 2.01) with a history of concussion who were assessed at ~5-6 weeks post-injury (mean days = 40.27 and SD = 35.41). Individuals were divided into "Pass" and "Fail" groups based on TOMM Trial 1 performance. The testing battery included ACT, CPT-II and III, HVLT-R, WJ-III and IV ACH, ImPACT, BASC-2, and BRIEF.

RESULTS

The overall pass rate on Trial 1 was 70% (mean = 46.04 and SD = 4.55). Findings suggested that a passing score on Trial 1 may be associated with adequate performance across the remaining two trials of the TOMM. The Fail group scored significantly lower across attention, memory, and processing speed measures when compared with the Pass group. On rating scales, significantly more concerns were endorsed with the Fail group for attention and executive functioning relative to the Pass group. Parents generally endorsed significantly more concerns for executive functioning when compared with their children's self-reported symptoms. There was a trend for the Fail group to report more PCS; however, they did not significantly differ from the Pass group for depression, anxiety, or somatization.

CONCLUSIONS

This study highlights the importance of utilizing PVTs when evaluating concussion recovery.

Sex Differences in Externalizing and Internalizing Symptoms of Children with ASD

This study examined sex differences in externalizing and internalizing symptoms of children with ASD without intellectual disability (ID). The sample (n = 80) included 40 girls and 40 boys, ages 6-12 years, with ASD (without ID) matched on age and IQ. Externalizing and internalizing symptoms were significantly elevated for this sample (girls and boys) relative to normative estimates for all the scales (hyperactivity, aggression, anxiety, and depression) except conduct problems. No significant differences were found between girls and boys for either externalizing symptoms or internalizing symptoms (based on standard score and raw score analyses). Implications for clinical practice and future research are discussed.

Prospective College Students With Autism Spectrum Disorder: Parent Perspectives

Young adults with autism spectrum disorder (ASD) are attending university in increasing numbers. While those with ASD may be very knowledgeable within their chosen field, a range of academic-related and nonacademic challenges may hinder their success including executive functioning challenges and interpersonal issues. The purpose of this study was to conduct a preliminary investigation into the perspective of parents of high schoolers with ASD regarding their son/daughters' transition to college. Qualitative analysis of parent interviews examined the concerns and challenges they anticipated their son/daughter might experience in a university setting, as well as supports they are seeking as they consider postsecondary options. Prominent themes that emerged as areas of concern were social skills, executive functioning, academics, campus living, and support services. These findings highlight some key potential pitfalls for students with ASD which may be useful targets for prevention and remediation, as well as informing policy for colleges and universities as they consider cost-effective interventions to improve the academic success of students with ASD.

Discrepancies between parent and child ratings of anxiety in children with autism spectrum disorder

Co-occurring anxiety is common in children with autism spectrum disorder (ASD). However, inconsistencies across parent and child reports of anxiety may complicate the assessment of anxiety in this population. The present study examined parent and child anxiety ratings in children with ASD with and without anxiety disorders and tested the association between parent-child anxiety rating discrepancy and ASD symptom severity. Participants included children aged 8-16 years in three diagnostic groups: ASD with co-occurring anxiety disorders (ASD + Anxiety; n = 34), ASD without co-occurring anxiety disorders (ASD; n = 18), and typically developing healthy controls (TD; n = 50). Parents and children completed ratings of child anxiety using the Multidimensional Anxiety Rating Scale. Patterns of parent and child anxiety ratings differed among the three groups, with parent ratings exceeding child ratings only in the ASD + Anxiety group. Parents reported higher levels of child anxiety in the ASD + Anxiety versus ASD group, whereas children reported comparable levels of anxiety in the two groups. Among children with ASD, ASD symptom severity was positively associated with the degree to which parent ratings exceeded child ratings. Results suggest that children with ASD and co-occurring anxiety disorders endorse some anxiety symptoms but may underreport overall levels of anxiety. In addition, ASD symptom severity might increase discrepancies in parent-child anxiety ratings. These findings suggest a unique and valuable role of child anxiety ratings and suggest that both parent and child anxiety ratings should be considered in light of children's ASD symptom severity and used to guide further assessment. Autism Res 2020, 13: 93-103. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Children with autism spectrum disorder (ASD) commonly experience anxiety; yet, their perceptions of their anxiety might differ from their parents' perceptions. This study found that, while children with ASD and anxiety disorders acknowledge some anxiety, their parents report them as having higher levels of anxiety. Also, child and parent perceptions of anxiety may differ more for children with more severe ASD symptoms. How these findings may guide research and clinical practice is discussed.

Course and Predictors of Sleep and Co-occurring Problems in Children with Autism Spectrum Disorder

The chronicity of sleep disturbance and its relation to co-occurring symptoms in children with autism spectrum disorder (ASD) are not well understood. The current study examined longitudinal relations among sleep and co-occurring symptoms in a large well-characterized sample of 437 children with ASD assessed at baseline and follow-up (M = 3.8 years later). Twenty-three percent experienced worsening sleep problems over time, while 31.5% showed improvement. Path analysis indicated that sleep problems at baseline predicted later development of ADHD symptoms in younger children and somatic complaints in older children. For younger children, sensory over-responsivity predicted future sleep problems. Findings suggest that sensory over-reactivity may contribute to sleep problems in some children with ASD, and that sleep problems may result in poor daytime functioning.

A Psychometric Analysis of the Social Anxiety Scale for Adolescents Among Youth With Autism Spectrum Disorder: Caregiver-Adolescent Agreement, Factor Structure, and Validity

Social anxiety is common among adolescents with autism spectrum disorder (ASD). An ongoing challenge for both research and clinical practice in ASD is the assessment of anxious symptomatology. Despite its widespread use in samples of youth with ASD, the Social Anxiety Scale for Adolescents (SAS-A) has not received psychometric evaluation within this population; thus, the validity of its use in research and clinical practice for ASD remains unclear. The present study conducted a psychometric analysis of caregiver and adolescent SAS-A forms in a sample of adolescents with ASD (N = 197). Results revealed (1) poor caregiver-adolescent item-level agreement, (2) a two-factor structure, (3) lack of measurement invariance between reporters, and (4) modest evidence for convergent and discriminant validity. Overall, findings suggest that this measure demonstrates reasonable psychometric properties in an ASD sample. Lack of measurement invariance, however, calls for careful interpretation of research involving the SAS-A in ASD samples, particularly when the primary goal is to compare adolescent and caregiver reports. The implications of these findings for future research and clinical practice are discussed.

Depression, Anxiety, and Hyperactivity in Youth with HFASD: A Replication and Extension of Symptom Level Differences in Self-Report Versus Parent Report

The present study compared parent ratings to self-report ratings of depression, anxiety, hyperactivity, attention problems, and atypical behaviors in youth with high-functioning autism spectrum disorder (HFASD) and typically developing (TD) controls. Measures included parent and self-report forms from the Behavioral Assessment System for Children-Second Edition (BASC-2), and self-report forms from the Children's Depression Inventory (CDI) and the Multidimensional Anxiety Scale for Children (MASC). Results across all five BASC-2 scales indicated parent ratings for the HFASD condition were significantly higher than HFASD self-ratings, and were significantly higher than parent and self-ratings from the TD condition. In addition, average self-report scores did not differ significantly between HFASD and TD conditions on any of the BASC-2 scales, the CDI, or the MASC.

Relations Between Executive Functions, Social Impairment, and Friendship Quality on Adjustment Among High Functioning Youth with Autism Spectrum Disorder

High functioning adolescents with Autism Spectrum Disorder (ASD) often have adjustment difficulties, specifically loneliness and depression. To better understand contributing factors, the current study evaluated associations between several Executive Function (EF) domains, social impairment, and friendship quality on depressive symptoms and loneliness in this population. Participants included 127 high functioning ASD adolescents and a parent/caregiver. Results indicated significant levels of parent-reported EF impairment which were positively correlated with increased levels of loneliness and depressive symptoms. Social impairment was identified as a significant mediator between all studied EF domains and adjustment, while friendship quality only partially mediated the relation between emotional control and loneliness. These results have implications for treatments focusing both on social skills and adjustment in adolescents with ASD.

Relations among activity participation, friendship, and internalizing problems in children with autism spectrum disorder

Social interaction difficulties in children with autism spectrum disorder can be challenging, especially during adolescence. In addition, high rates of comorbid internalizing disorders in autism spectrum disorder can lead to social isolation. With limited social activity participation, social deficits and internalizing problems in autism spectrum disorder may be related to participation, exposure, and practice with friends. The purpose of this study was to evaluate the relations among friendship, activity participation, and internalizing problems. Participants included 129 children with autism spectrum disorder between the ages of 6 and 18 years. Measures of friendship, sport, hobby, and club participation, and internalizing problems were assessed. Results showed that activity participation was related to more friendships, even after controlling for intelligence quotient. This study sheds light on the impact of social engagement with peers in developing and maintaining friendships as well as managing internalizing problems.

The Stability of Self-Reported Anxiety in Youth with Autism Versus ADHD or Typical Development

Children with autism spectrum disorder (ASD) are at risk for anxiety symptoms. Few anxiety measures are validated for individuals with ASD, and the nature of ASD raises questions about reliability of self-reported anxiety. This study examined longitudinal stability and change of self-reported anxiety in higher functioning youth with ASD (HFASD) compared to youth with symptoms of attention deficit hyperactivity disorder and typical development (TD) using the Multidimensional Anxiety Scale for Children (March, 2012; March et al. J Am Acad Child Adolesc Psychiatry 36(4):554-565, 1997). Diagnostic groups demonstrated comparable evidence of stability for most dimensions of anxiety. The HFASD group displayed higher anxiety than both comparison groups, especially physical symptoms. These findings have implications for identification and measurement of anxiety in ASD.

Stranger Fear and Early Risk for Social Anxiety in Preschoolers with Fragile X Syndrome Contrasted to Autism Spectrum Disorder

This study investigated behavioral indicators of social fear in preschool boys with fragile X syndrome (FXS) with a low degree of autism spectrum disorder (ASD) symptoms (FXS-Low; n = 29), FXS with elevated ASD symptoms (FXS-High; n = 25), idiopathic ASD (iASD; n = 11), and typical development (TD; n = 36). Gaze avoidance, escape behaviors, and facial fear during a stranger approach were coded. Boys with elevated ASD symptoms displayed more avoidant gaze, looking less at the stranger and parent than those with low ASD symptoms across etiologies. The iASD group displayed more facial fear than the other groups. Results suggest etiologically distinct behavioral patterns of social fear in preschoolers with elevated ASD symptoms.

The Hospital Anxiety and Depression scale: Factor structure and psychometric properties in older adolescents and young adults with autism spectrum disorder

Despite the high frequency of anxiety and depression symptoms in individuals with Autism Spectrum Disorder (ASD) and a significant impact of these comorbidities on both individuals with ASD and their families, research on the validity of anxiety and depression measures in the ASD population is currently lacking. The aim of this study was to explore the psychometric properties of the Hospital Anxiety and Depression Scale [HADS; Zigmond & Snaith, ] in a sample of older adolescents and young adults with ASD. One hundred and fifty one participants (UK Transition longitudinal study: N = 106; 75 males, M_age  = 16.04 years, SD = 1.28; Longitudinal Study of Australian Schools Leavers with ASD: N = 45, 30 males; M_age  = 18.35 years, SD = 2.55) completed the HADS and a range of mental health and well-being measures. Combination of the Principal Component Analysis and Parallel Analysis indicated two factors as an optimal solution in our sample, accounting for 43.77% of variance with factors being identical in terms of content with the structure found in the general population. Internal consistency was good for the HADS anxiety scale (HADS-A; .82-.84) and acceptable for the HADS depression scale (HADS-D; .60-.72). Convergent validity of both HADS-A and HADS-D scales was excellent and divergent validity was acceptable. Our study represents a significant contribution to the literature by providing an initial validation of the HADS in older adolescents and younger adults with ASD. Autism Res 2018, 11: 258-269. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

LAY SUMMARY

Research on the validity of measurement of anxiety and depression in ASD is currently lacking. The aim of this study was to explore the properties of the Hospital Anxiety and Depression Scale (HADS) in a sample of 151 young people with ASD. Participants completed HADS and a range of mental health and well-being measures. Encouragingly, our findings suggest that HADS provides a reliable and valid assessment of anxiety and depression in ASD.

Brief Report: Personality Mediates the Relationship between Autism Quotient and Well-Being: A Conceptual Replication using Self-Report

Autism spectrum disorder (ASD) impacts well-being across the lifespan. Individuals with ASD evidence differences in personality traits and self-concept clarity that are predictors of well-being in typically-developing individuals. The current research replicates a growing body of evidence demonstrating differences in well-being and personality between individuals low in ASD characteristics (n = 207) and individuals high in ASD characteristics (n = 46) collected from the general population using an online survey. Results were consistent in a subsample of demographically matched pairs (n = 39 per group) and relative to norms. Further, the current research provides the first evidence that openness, conscientiousness, emotional stability, and self-concept clarity mediate the relationship between ASD characteristics and well-being.

Anxiety Levels in Children with Autism Spectrum Disorder: A Meta-Analysis

The aim of the current study was to meta-analytically examine whether anxiety levels in children with autism spectrum disorders (ASD) are elevated. A total of 83 articles were selected from a systematic literature search and were included in the meta-analyses. Results demonstrated that children with ASD had higher anxiety levels compared to typically developing children, and this difference increased with IQ. Youth with ASD also tended to have higher anxiety levels compared to clinically referred children, and this difference increased with age. Children with ASD had higher anxiety levels compared to youth with externalizing or developmental problems, but not when compared to youth with internalizing problems. The study findings highlight the importance of more research in order to fully understand the nature and development of anxiety in children with ASD. More specifically, the results suggest that especially high-functioning adolescents with ASD may be at risk for developing anxiety disorders. Therefore, it seems important to carefully follow and monitor children with ASD transcending to adolescence.

Social-emotional adjustment and pet ownership among adolescents with autism spectrum disorder

Adolescents with Autism Spectrum Disorder (ASD) often experience poor social-emotional adjustment and interactions with peers, but taking care of a family pet may serve as a buffer. This study utilized 81 parent-adolescent dyads to examine how dimensions of pet ownership (responsibility, comfort, companionship) may be associated with social-emotional adjustment (depression, loneliness, friendship quality) among adolescents with ASD, as well as how social impairments may influence these relations. Results revealed that adolescents who took more responsibility for their pet exhibited fewer depressive symptoms. Additionally, parents of more socially impaired adolescents reported better friendship quality than less socially impaired adolescents. Findings suggest taking care of a pet may facilitate better social-emotional adjustment among adolescents with ASD.

Medical and Behavioral Correlates of Depression History in Children and Adolescents With Autism Spectrum Disorder

BACKGROUND AND OBJECTIVES

Depression is commonly associated with autism spectrum disorder (ASD) across the life span. We sought to identify medical and behavioral problems associated with a history of a parent-reported diagnosis of depression in a large sample of school-aged children and adolescents with ASD.

METHODS

A sample of 1272 participants (aged 6-17 years; mean [SD]: 9.56 [2.79] years) from the Autism Speaks Autism Treatment Network consortium were divided into "ever-depressed" (n = 89) and "nondepressed" (n = 1183) groups on the basis of caregiver endorsement of children's current or previous diagnoses of depression.

RESULTS

In total, 7.0% of children with ASD (4.8% of those aged 6-12 years and 20.2% of those aged 13-17 years) were reported to have a history of a depression diagnosis. Positive depression history was associated with greater chronological age, higher IQ, and Asperger disorder diagnosis. After controlling for age, IQ, and within-spectrum categorical diagnosis, the ever-depressed group exhibited significantly greater rates of seizure disorders (odds ratio = 2.64) and gastrointestinal problems (odds ratio = 2.59) and trend-level differences in aggression, somatic complaints, and social impairments. The groups did not differ in autism severity, repetitive behaviors, sleep problems, eating problems, self-injurious behavior, or current intervention use.

CONCLUSIONS

Co-occurring depression is a particularly common problem in higher-functioning older children within the Autism Treatment Network. Our findings indicate that children with ASD and a history of a depression diagnosis are more likely to also have co-occurring medical problems, although the presence and direction of causality is unclear.

Informant agreement for youth with autism spectrum disorder or intellectual disability: a meta-analysis

This study investigated informant agreement on emotional and behavior problems and social skills in youth with autism spectrum disorder or intellectual disability using meta-analytic methods. Forty-nine studies were included, consisting of 107 effect sizes. The mean weighted effect size across all raters and all behaviors was .36, reflecting moderate agreement. Consistent with meta-analyses in typically developing youth, pairs of similar informants (e.g., parent-parent) demonstrated higher agreement compared to pairs of different raters (e.g., parent-teacher). With all rater pairs combined, agreement was significantly higher for externalizing problems (r = .42) than either internalizing problems (r = .35) or social skills (r = .30). Several factors appear to moderate the level of agreement among informants, including the youth's diagnosis, age, and IQ.

Measuring the plasticity of social approach: a randomized controlled trial of the effects of the PEERS intervention on EEG asymmetry in adolescents with autism spectrum disorders

This study examined whether the Program for the Education and Enrichment of Relational Skills (PEERS: Social skills for teenagers with developmental and autism spectrum disorders: The PEERS treatment manual, Routledge, New York, 2010a) affected neural function, via EEG asymmetry, in a randomized controlled trial of adolescents with Autism spectrum disorders (ASD) and a group of typically developing adolescents. Adolescents with ASD in PEERS shifted from right-hemisphere gamma-band EEG asymmetry before PEERS to left-hemisphere EEG asymmetry after PEERS, versus a waitlist ASD group. Left-hemisphere EEG asymmetry was associated with more social contacts and knowledge, and fewer symptoms of autism. Adolescents with ASD in PEERS no longer differed from typically developing adolescents in left-dominant EEG asymmetry at post-test. These findings are discussed via the Modifier Model of Autism (Mundy et al. in Res Pract Persons Severe Disabl 32(2):124, 2007), with emphasis on remediating isolation/withdrawal in ASD.

An Evaluation of Individually Delivered Secret Agent Society Social Skills Program for Children with High-Functioning Autism Spectrum Disorders: A Pilot Study

High-functioning children with autism spectrum disorders display social skill deficits that can have a debilitating impact on their daily lives. The Secret Agent Society (SAS) program has been shown to be effective in improving the social skills of these children when delivered in a group setting. This pilot study evaluated whether individually delivered SAS would yield similar outcomes. Three participants were recruited for the 9-week intervention. Measures of social competence were administered at four points: pretest 1, pretest 2, post-intervention, and 6-week follow-up. Participants showed significant improvement in half of the measures assessing social competence. On a third of these measures, two participants demonstrated improvements to within the range of their typically developing peers. Follow-up results suggested that improvements were maintained at 6 weeks’ post-intervention. Limitations of this study and directions for future research are discussed.

Parent-Child Agreement Using the Spence Children's Anxiety Scale and a Thermometer in Children with Autism Spectrum Disorder

Children with Autism Spectrum Disorder (ASD) experience high anxiety which often prompts clinical referral and requires intervention. This study aimed to compare parent and child reports on the Spence Children's Anxiety Scale (SCAS) and a child-reported “worry thermometer” in 88 children aged 8–13 years, 44 with ASD and 44 age, gender, and perceptual IQ matched typically developing children. There were no gender differences in child report on the SCAS and worry thermometers. Results indicated generally good correlations between parent and child self-reported SCAS symptoms for typically developing children but poor agreement in parent-child ASD dyads. The worry thermometer child-report did not reflect child or parent reports on the SCAS. Findings suggest 8–13-year-old children with ASD may have difficulties accurately reporting their anxiety levels. The clinical implications were discussed.

Anxiety in youth with and without autism spectrum disorder: examination of factorial equivalence

Although anxiety is frequently reported among children and adolescents with autism spectrum disorder (ASD), it has not been established that the manifest symptoms of anxiety in the context of ASD are the same as those seen in youth without ASD. This study sought to examine the metric and latent factor equivalence of anxiety as measured by the Multidimensional Anxiety Scale for Children, parent-report (MASC-P) and child-report (MASC-C), in youth with anxiety disorders and ASD with intact verbal ability (n=109, M(age)=11.67 years, 99 male) and a gender-matched comparison group of typically developing (TD) children and adolescents with anxiety disorders but without ASD (n=342, M(age)=11.25 years, 246 male). Multigroup factorial invariance (MFI) using structural equation modeling indicated equivalent latent factors in youth with and without ASD on the MASC-C (metric invariance). However, the item means and covariances along with the relations among the factor scores were different for the youth with ASD (i.e., lack of evidence for scalar or structural invariance). The MASC-P data did not fit the measure's established structure for either the ASD or TD group, and post-hoc exploratory factor analysis revealed a different factor structure in the ASD group. Findings suggest that the MASC-C may not measure identical constructs in anxious youth with and without ASD. Further research on the structure of the MASC in clinical samples is warranted.

Capturing Age-group Differences and Developmental Change with the BASC Parent Rating Scales

Estimation of age-group differences and intra-individual change across distinct developmental periods is often challenged by the use of age-appropriate (but non-parallel) measures. We present a short version of the Behavior Assessment System (Reynolds & Kamphaus, 1998), Parent Rating Scales for Children (PRS-C) and Adolescents (PRS-A), which uses only their common-items to derive estimates of the initial constructs optimized for developmental studies. Measurement invariance of a three-factor model (Externalizing, Internalizing, Adaptive Skills) was tested across age-groups (161 mothers using PRS-C; 200 mothers using PRS-A) and over time (115 mothers using PRS-C at baseline and PRS-A five years later) with the original versus short PRS. Results indicated that the short PRS holds a sufficient level of invariance for a robust estimation of age-group differences and intra-individual change, as compared to the original PRS, which held only weak invariance leading to flawed developmental inferences. Importance of test-content parallelism for developmental studies is discussed.

Depression and its measurement in verbal adolescents and adults with autism spectrum disorder

In a sample of 50 verbally fluent adolescents and adults with autism spectrum disorders (age: 16-31 years; verbal IQ: 72-140), we examined the pattern of response and associations between scores on common measures of depressive symptoms, participant characteristics, and clinical diagnosis of depressive disorders. Beck Depression Inventory-Second Edition item descriptives in this autism spectrum disorder sample were compared to previously published data from a large typically developing sample, with results suggesting that cognitive-attributional symptoms of depression may be particularly prevalent in autism spectrum disorder. Scores on a variety of self- and parent-report depression measures were not associated with chronological age or verbal IQ, and were relatively highly correlated with each other and with clinical diagnosis of a mood disorder. The Beck Depression Inventory-Second Edition and the Adult Self-Report "Depressive" scale best identified both depressed and non-depressed participants in this sample, though neither was particularly strong. Validation studies of depression measures in the autism spectrum disorder population are necessary to advance research into this prevalent and impairing comorbidity.

Cognitive-behavioral therapy for anxiety in children with high-functioning autism: a meta-analysis

BACKGROUND

Anxiety is a common and impairing problem in children and adolescents with autism spectrum disorder (ASD). There is emerging evidence that cognitive-behavioral therapy (CBT) could reduce anxiety in children with high-functioning ASD.

OBJECTIVE

To systematically review the evidence of using CBT to treat anxiety in children and adolescents with ASD. Methods for this review were registered with PROSPERO (CRD42012002722).

METHODS

We included randomized controlled trials published in English in peer-reviewed journals comparing CBT with another treatment, no treatment control, or waitlist control. Two authors independently screened 396 records obtained from database searches and hand searched relevant journals. Two authors independently extracted and reconciled all data used in analyses from study reports.

RESULTS

Eight studies involving 469 participants (252 treatment, 217 comparison) met our inclusion criteria and were included in meta-analyses. Overall effect sizes for clinician- and parent-rated outcome measures of anxiety across all studies were d = 1.19 and d = 1.21, respectively. Five studies that included child self-report yielded an average d = 0.68 across self-reported anxiety.

CONCLUSIONS

Parent ratings and clinician ratings of anxiety are sensitive to detecting treatment change with CBT for anxiety relative to waitlist and treatment-as-usual control conditions in children with high-functioning ASD. Clinical studies are needed to evaluate CBT for anxiety against attention control conditions in samples of children with ASD that are well characterized with regard to ASD diagnosis and co-occurring anxiety symptoms.

Video game access, parental rules, and problem behavior: A study of boys with autism spectrum disorder

Environmental correlates of problem behavior among individuals with autism spectrum disorder remain relatively understudied. The current study examined the contribution of in-room (i.e. bedroom) access to a video game console as one potential correlate of problem behavior among a sample of 169 boys with autism spectrum disorder (ranging from 8 to 18 years of age). Parents of these children reported on (1) whether they had specific rules regulating their child’s video game use, (2) whether their child had in-room access to a variety of screen-based media devices (television, computer, and video game console), and (3) their child’s oppositional behaviors. Multivariate regression models showed that in-room access to a video game console predicted oppositional behavior while controlling for in-room access to other media devices (computer and television) and relevant variables (e.g. average number of video game hours played per day). Additionally, the association between in-room access to a video game console and oppositional behavior was particularly large when parents reported no rules on their child’s video game use. The current findings indicate that both access and parental rules regarding video games warrant future experimental and longitudinal research as they relate to problem behavior in boys with autism spectrum disorder.

Fear-potentiated startle response is unrelated to social or emotional functioning in adolescents with autism spectrum disorders

It has been suggested that atypical amygdala function contributes to the social impairments characteristic of autism spectrum disorders (ASDs). Previous research has demonstrated that adolescents and adults with ASD generate normal response during a fear-potentiated startle paradigm, suggesting this aspect of amygdala function is intact and may not account for the social dysfunction associated with the condition. The amygdala also plays a crucial role in the expression of anxiety and may contribute to high rates of reported anxiety in individuals with ASD. The present study partially replicates prior work by examining the fear-potentiated startle response in adolescents with ASD, and extends this to investigate the relationship between startle response and anxiety. Eyeblink magnitude and latency (electromyographic activity; EMG) were collected from 20 adolescents with ASD and 19 typically developing (TD) age-matched adolescents during a fear-potentiated startle paradigm. Parent-report and self-report of anxiety and additional psychiatric symptoms were collected. Parental reports indicated higher rates of associated psychopathology in adolescents with ASD compared with TD adolescents. Consistent with previous results, both groups showed normal potentiated startle response, and no group differences in EMG were found. Symptoms of anxiety and level of social impairment were unrelated to startle response. These findings held for all levels of anxiety, suggesting that within the context of the fear-potentiated startle paradigm, amygdala response is not associated with degree of atypical social or emotional functioning in ASD.

Investigating emotional impairments in adults with autism spectrum disorders and the broader autism phenotype

There is an increasing interest in the socio-affective atypicalities observed in adults with autism spectrum disorder (ASD). The aim of this study was to further explore emotional responsiveness in adults with ASD using well-validated self-reports of alexithymia and to determine whether anhedonic features are part of a broader autism phenotype (BAP). Participants comprised 38 adults with ASD, 87 parents of ASD individuals and 47 typical controls. All participants completed the Autism Spectrum Quotient (AQ), the 20-item Toronto Alexithymia Scale, and the Bermond-Vorst Alexithymia Questionnaire, as well as the Chapman Physical and Social Anhedonia Scales. The ASD group differed from controls and parents on most measures, with the exception of physical and social anhedonia, relative to parents. Parents differed from controls on social anhedonia, and a higher proportion of parents were classed as alexithymic, relative to controls. Cluster analysis revealed that some parents share more similarities with ASD participants than with controls. The results suggest that socio-affective impairments characteristic of ASD are part of the BAP.

Prevalence and Predictors of Psychotropic Use in Children with High-Functioning ASDs

This study examined (1) the prevalence of psychotropic medication use for a sample of children with high-functioning autism spectrum disorders (HFASDs), (2) the extent to which psychotropic agents were linked to targeted symptoms, and (3) predictors of psychotropic use. A total of 115 children, ages 6–13, with HFASDs who were enrolled in psychosocial treatment trials were included in this study. Parents completed extensive background and rating forms prior to treatment that included data on demographic characteristics, child health, child medication use, and child ASD-related symptoms. Results indicated that 33% (n = 38) of the sample was taking psychotropic medication with the most common being stimulants (25%; n = 29), antidepressants (10%; n = 12), and neuroleptics (6%; n = 7). All children taking stimulants had target symptoms that were appropriate for stimulant medication, whereas 57% of those taking neuroleptics and 42% of those taking antidepressants did not have targeted symptoms consistent with the medication. Logistic regression for the major psychotropic drug categories indicated that lower IQ was a significant predictor of increased antidepressant and neuroleptic use. A higher level of ASD-related symptoms was related to the likelihood of stimulant use.

Anxiety, sensory over-responsivity, and gastrointestinal problems in children with autism spectrum disorders

Children with autism spectrum disorders (ASD) experience high rates of anxiety, sensory processing problems, and gastrointestinal (GI) problems; however, the associations among these symptoms in children with ASD have not been previously examined. The current study examined bivariate and multivariate relations among anxiety, sensory over-responsivity, and chronic GI problems in a sample of 2,973 children with ASD enrolled in the Autism Treatment Network (ages 2-17 years, 81.6 % male). Twenty-four percent of the sample experienced at least one type of chronic GI problem (constipation, abdominal pain, bloating, diarrhea, and/or nausea lasting three or more months). Children with each type of GI problem had significantly higher rates of both anxiety and sensory over-responsivity. Sensory over-responsivity and anxiety were highly associated, and each provided unique contributions to the prediction of chronic GI problems in logistic regression analyses. The results indicate that anxiety, sensory over-responsivity and GI problems are possibly interrelated phenomenon for children with ASD, and may have common underlying mechanisms.

Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis

There is considerable evidence that children and adolescents with autistic spectrum disorders (ASD) are at increased risk of anxiety and anxiety disorders. However, it is less clear which of the specific DSM-IV anxiety disorders occur most in this population. The present study used meta-analytic techniques to help clarify this issue. A systematic review of the literature identified 31 studies involving 2,121 young people (aged <18 years) with ASD, and where the presence of anxiety disorder was assessed using standardized questionnaires or diagnostic interviews. Across studies, 39.6% of young people with ASD had at least one comorbid DSM-IV anxiety disorder, the most frequent being specific phobia (29.8%) followed by OCD (17.4%) and social anxiety disorder (16.6%). Associations were found between the specific anxiety disorders and ASD subtype, age, IQ, and assessment method (questionnaire versus interview). Implications for the identification and treatment of anxiety in young people with ASD are discussed.

College students on the autism spectrum

As more young people are identified with autism spectrum diagnoses without co-occurring intellectual disability (i.e. high-functioning autism spectrum disorder; HFASD), it is imperative that we begin to study the needs of this population. We sought to gain a preliminary estimate of the scope of the problem and to examine psychiatric risks associated HFASD symptoms in university students. In a large sample ( n = 667), we examined prevalence of ASD in students at a single university both diagnostically and dimensionally, and surveyed students on other behavioral and psychiatric problems. Dependent upon the ascertainment method, between .7 per cent and 1.9 per cent of college students could meet criteria for HFASD. Of special interest, none of the students who were found to meet diagnostic criteria ( n = 5) formally for HFASD in this study had been previously diagnosed. From a dimensional perspective, those students scoring above the clinical threshold for symptoms of autism ( n = 13) self-reported more problems with social anxiety than a matched comparison group of students with lower autism severity scores. In addition, symptoms of HFASD were significantly correlated with symptoms of social anxiety, as well as depression and aggression. Findings demonstrate the importance of screening for autism-related impairment among university students.

Characterization of depression in children with autism spectrum disorders

Depressive syndromes represent a disabling comorbidity for many children with autism spectrum disorders (ASD); however, the ascertainment of depression can be complicated by phenotypic overlap between the 2 conditions, by ways in which autistic symptomatology can mask cardinal features of depression and by atypical manifestations of depression in children with ASD. These issues have contributed to wide variation in the estimation of prevalence rates of depression in individuals with ASD and invoke the need for new approaches to the specific detection of depression and other neuropsychiatric comorbidities that aggregate in children affected by ASD. The authors review the scientific literature relevant to the occurrence of depression in ASD and consider important parameters of risk, including psychosocial factors such as insight into affectation status, as well as biological factors such as the aggregation of depressive syndromes in certain families affected by autism, which has suggested possible overlap in genetic influences underlying the 2 conditions. Variability in the manifestations of depression across environmental contexts provides important clues to intervention and underscores the potential importance of involving multiple informants in ascertaining depression in children and adolescents with ASD. A practical strategy for evaluating the presence of depression in youth with ASD is synthesized from the available data and discussed.