1
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Donoso J, Rattray F, de Bildt A, Tillmann J, Williams P, Absoud M, Totsika V. Association of cognitive and adaptive skills with internalizing and externalizing problems in autistic children and adolescents. Autism Res 2024; 17:596-609. [PMID: 38031634 DOI: 10.1002/aur.3056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
The presence of an intellectual disability (ID) alongside autism is considered to increase the risk for mental health and behavior problems in children and adolescents. Existing evidence is restricted by looking at ID as a categorical classification. The study aimed to examine the association of cognitive and adaptive behavior skills with internalizing and externalizing problems in a large sample of autistic children and adolescents, across a wide range of cognitive skills. Participants were 2759 children and adolescents aged between 4 and 18 years recruited as part of the Simons Simplex Collection (SSC), of whom 709 (approximately 25%) had ID. Multiple regression models examined associations of internalizing and externalizing problems with cognitive and adaptive skills (communication, daily living, and socialization skills). Cognitive skills were not associated with externalizing problems but were associated with more internalizing problems in autistic children without ID (Cog β: 0.126). All adaptive skill domains were inversely associated with externalizing (Communication β: -0.145; Daily-Living β: -0.132; Socialization β: -0.289) and internalizing problems (Communication β: -0.074; Daily-Living β: -0.064; Socialization β: -0.213) in those without ID. Daily living (β: -0.158) and socialization skills (β: -0.104) were inversely correlated with externalizing problems in autistic children with ID, while only socialization problems (β: -0.099) were associated with internalizing problems in this group. Socialization skills were systematically associated with internalizing and externalizing problems across all levels of cognitive functioning. Supporting social skills development may benefit all aspects of child mental health, while recognizing that children with higher cognitive skills are more vulnerable to internalizing problems might assist with earlier identification of these problems.
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Affiliation(s)
- Javiera Donoso
- Division of Psychiatry, University College London, London, UK
| | - Fiona Rattray
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Annelies de Bildt
- Department of Child and Adolescent Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Accare Child Study Center, Groningen, The Netherlands
| | - Julian Tillmann
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, Basel, Switzerland
| | - Penny Williams
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michael Absoud
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Vasiliki Totsika
- Division of Psychiatry, University College London, London, UK
- Centre for Research in Intellectual and Developmental Disabilities, University of Warwick, Coventry, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
- Millenium Institute for Care Research (MICARE), Santiago, Chile
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2
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Jodra M, García-Villamisar D. The Impact of the COVID-19 Pandemic Quarantine on Adults with Autism Spectrum Disorders and Intellectual Disability: A Longitudinal Study. J Autism Dev Disord 2024; 54:293-300. [PMID: 36309900 PMCID: PMC9618270 DOI: 10.1007/s10803-022-05792-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 12/26/2022]
Abstract
The impact of the pandemic is being very significant psychologically, especially for people who were already vulnerable in these aspects, such as adults with Autism Spectrum Disorders (ASD) and Intellectual Disability (ID). A longitudinal analysis of motor aspects such as balance and gait, executive functions in daily life, severity of symptoms characteristic of autism, and degree of subjective well-being was performed in 53 adults with ASD and ID. A repeated measures ANOVA was performed and three measures were taken, the first in December 2019, the second in March 2020, and the last in July 2020. The results demonstrated a significant decrease in balance on the latter measure, along with a deterioration in well-being and ASD symptoms in the period of seclusion and an improvement in executive functions after seclusion.
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Affiliation(s)
- Marina Jodra
- Department of Personality, Evaluation and Clinical Psychology, Universidad Complutense de Madrid, Rector Royo Villanova s/n, Ciudad Universitaria, 28040 Madrid, Spain
| | - Domingo García-Villamisar
- Department of Personality, Evaluation and Clinical Psychology, Universidad Complutense de Madrid, Rector Royo Villanova s/n, Ciudad Universitaria, 28040 Madrid, Spain
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3
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You XR, Gong XR, Guo MR, Ma BX. Cognitive behavioural therapy to improve social skills in children and adolescents with autism spectrum disorder: A meta-analysis of randomised controlled trials. J Affect Disord 2024; 344:8-17. [PMID: 37802322 DOI: 10.1016/j.jad.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/30/2023] [Accepted: 10/03/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is effective in treating various neurological and psychiatric diseases. It improves anxiety symptoms in children with autism spectrum disorder, gaining considerable empirical support. However, social skills results are mixed, leading to debate over its effectiveness, highlighting the need for further development. While the Social Responsiveness Scale (SRS) is a secondary indicator to measure anxiety symptoms, it primarily evaluates social skills, which are essential for rehabilitating children with autism. Therefore, evaluating social disorder improvement in children with autism is imperative. Social impairment is a core autism symptom. Therefore, we conducted a systematic review of randomised controlled trials assessing the effects of CBT on social skills in this population. METHODS We reviewed articles published in several databases through October 2022 and relevant reference lists. We used the standardised mean difference (SMD) as the main effect size indicator and focused on SRS metrics from baseline to endpoint. We analysed subgroups, heterogeneity, bias risk, and publication bias. RESULTS Our meta-analysis included 214 children from seven randomised controlled trials with nine datasets. Forest plot analysis shows CBT improved social skills in children with autism compared to controls. Subgroup analysis revealed parents' and teachers' SRS scores for children, SRS scores of CBT versus waitlist controls, and those of CBT versus non-waiting-list controls. LIMITATIONS Most randomised controlled CBT trials for children with autism have explored anxiety symptom improvement. Further, social skill assessment was a secondary outcome or not assessed. Thus, social skills data are insufficient. CONCLUSIONS CBT is effective in improving social impairment in children with autism. REGISTRATION This meta-analysis was registered with the International Prospective Register of Systematic Reviews (CRD42022363423).
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Affiliation(s)
- Xiao-Rui You
- Hebei University of Chinese Medicine, Hebei Province, Shijiazhuang, China
| | - Xing-Ruo Gong
- Hebei University of Chinese Medicine, Hebei Province, Shijiazhuang, China
| | - Mei-Ran Guo
- Hebei University of Chinese Medicine, Hebei Province, Shijiazhuang, China
| | - Bing-Xiang Ma
- The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Henan Province, Zhengzhou, China.
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4
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Adams D, Ambrose K, Simpson K, Malone S, Dargue N. The relationshipbetween anxiety and social outcomes in autistic children and adolescents: A meta-analysis. Clin Child Fam Psychol Rev 2023; 26:706-720. [PMID: 37606793 PMCID: PMC10465686 DOI: 10.1007/s10567-023-00450-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 08/23/2023]
Abstract
Anxiety is one of the most frequently reported co-occurring conditions for autistic children and adolescents. The relationship between anxiety and social outcomes in autistic youth has been the focus of a range of studies, with mixed results. This meta-analysis aimed to identify the strength of the association between anxiety and a frequently researched social outcome (social competence) in autistic young people and whether that association is influenced by individual or research design factors. A previous preregistered systematic review was updated with a search of the same three databases (CINAHL, ERIC, and PsycINFO) as the original review. Through this, 20 studies with sufficient data on a neurotypically-defined measure of social competence and anxiety were identified. Results were synthesised using a mixed effects model. The meta-analysis on 2,321 participants (from 22 samples) highlighted wide heterogeneity in results. The findings show that anxiety has a significant, small negative impact on social competence (d = - 0.48; 95% CI = - 0.71, - 0.26), meaning that as scores on measures of anxiety increase, scores on measures of social competence decrease. This relationship between anxiety and social competence was moderated by age, becoming weaker as age increased. Whilst this is an important finding for supporting mental health and well-being of autistic young people, the large amount of variance left unexplained suggests that multiple factors, including the use of measures designed for neurotypical people and the potential impact of camouflaging on such measures, need to be considered in future designs.
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Affiliation(s)
- Dawn Adams
- Autism Centre of Excellence, Griffith University, Messines Ridge Road, Mt Gravatt, QLD 4122, Brisbane, Australia.
- Griffith Institute for Educational Research, Griffith University, Messines Ridge Road, Mt Gravatt, QLD 4122, Brisbane, Australia.
- Autism CRC, Brisbane, Australia.
| | - Kathryn Ambrose
- Autism Centre of Excellence, Griffith University, Messines Ridge Road, Mt Gravatt, QLD 4122, Brisbane, Australia
- Griffith Institute for Educational Research, Griffith University, Messines Ridge Road, Mt Gravatt, QLD 4122, Brisbane, Australia
- Autism CRC, Brisbane, Australia
| | - Kate Simpson
- Autism Centre of Excellence, Griffith University, Messines Ridge Road, Mt Gravatt, QLD 4122, Brisbane, Australia
- Griffith Institute for Educational Research, Griffith University, Messines Ridge Road, Mt Gravatt, QLD 4122, Brisbane, Australia
- Autism CRC, Brisbane, Australia
| | - Stephanie Malone
- Autism Centre of Excellence, Griffith University, Messines Ridge Road, Mt Gravatt, QLD 4122, Brisbane, Australia
- Griffith Institute for Educational Research, Griffith University, Messines Ridge Road, Mt Gravatt, QLD 4122, Brisbane, Australia
| | - Nicole Dargue
- Autism Centre of Excellence, Griffith University, Messines Ridge Road, Mt Gravatt, QLD 4122, Brisbane, Australia
- Griffith Institute for Educational Research, Griffith University, Messines Ridge Road, Mt Gravatt, QLD 4122, Brisbane, Australia
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5
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Measuring Social Camouflaging in Individuals with High Functioning Autism: A Literature Review. Brain Sci 2023; 13:brainsci13030469. [PMID: 36979279 PMCID: PMC10046375 DOI: 10.3390/brainsci13030469] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
In the recent years, growing attention has been paid to the use of camouflaging strategies by adult populations suffering from autism spectrum disorder (ASD) with milder manifestations and without intellectual impairment, which may lead to a delay in diagnosis or even a misdiagnosis. In fact, high-functioning ASD individuals were reported to be more aware of their communication difficulties and were more likely make considerable efforts to adjust their behavior to conventional rules of non-autistic individuals, learning to imitate other non-ASD individuals. Moreover, females reported a higher frequency of camouflaging strategies, suggesting a role of camouflaging in the gender gap of the ASD diagnosis. Although camouflaging strategies can sometimes grant a better level of adjustment, even resulting in a hyper-adaptive behavior, they are also often correlated with negative mental health consequences due to the long-term stress associated with continuous attempts to adapt in day-to-day life. In this framework, the aim of the present work was to review the available studies that assessed the presence and correlates of camouflaging strategies in individuals with ASD. Although the literature available on the topic is still scarce, some interesting correlations between camouflaging and anxious and depressive symptoms, as well as suicidality, were highlighted. In particular, the controversial and sometime opposite thoughts and results about camouflaging may be clarified and integrated in light of a dimensional approach to psychopathology.
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6
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Rosello R, Martinez-Raga J, Tomas JM, Rosello B, Berenguer C, Cortese S. Exploring developmental trajectories throughout adolescence of children with autism spectrum disorder without intellectual disability. J Neural Transm (Vienna) 2023; 130:299-312. [PMID: 36385316 DOI: 10.1007/s00702-022-02554-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022]
Abstract
Characterizing the developmental trajectories of children with autism spectrum disorder (ASD) throughout adolescence and across different domains of functioning offers opportunities to improve long-term outcomes. This prospective study explored, for the first time, the evolution of children with ASD-without intellectual disability (ID) in terms of socio-adaptative skills, learning behaviors, executive functioning (EF), and internalizing/externalizing problems, compared to typically developing (TD) peers. Forty-five children with ASD-without ID and 37 matched TD children (aged 7-11) were assessed at baseline and after 5 years. Parents and teachers completed measures on theory of mind (ToM), socialization, daily living skills, learning style, EF, and emotional/behavioural difficulties at both time points. On all the domains assessed, the ASD group performed significantly worse than the TD group, both in childhood and adolescence. Specific changes were noted between baseline and follow-up assessment on adaptive skills, prosocial behavior, emotional control, inhibit, working memory and monitoring. Group membership (ASD/TD) was influenced by peer relationships and inhibit EF variables. These findings have implications for clinical and school settings.
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Affiliation(s)
- Rocio Rosello
- Division of Psychiatry, Imperial College London, London, UK.
- Division of Psychiatry, University of Valencia, Valencia, Spain.
| | - Jose Martinez-Raga
- Division of Psychiatry, University of Valencia, Valencia, Spain
- Doctor Peset Hospital of Valencia, Valencia, Spain
| | - Jose Manuel Tomas
- Division of Methodology and Behavioural Science, University of Valencia, Valencia, Spain
| | - Belen Rosello
- Division of Developmental and Educational Psychology, University of Valencia, Valencia, Spain
| | - Carmen Berenguer
- Division of Developmental and Educational Psychology, University of Valencia, Valencia, Spain
| | - Samuele Cortese
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
- Centre for Innovation in Mental Health (CIMH), University of Southampton, Southampton, UK
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7
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Palmer M, Tarver J, Carter Leno V, Paris Perez J, Frayne M, Slonims V, Pickles A, Scott S, Charman T, Simonoff E. Parent, Teacher and Observational Reports of Emotional and Behavioral Problems in Young Autistic Children. J Autism Dev Disord 2023; 53:296-309. [PMID: 35028809 PMCID: PMC9889526 DOI: 10.1007/s10803-021-05421-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 02/04/2023]
Abstract
Emotional and behavioral problems (EBPs) frequently occur in young autistic children. Discrepancies between parents and other informants are common but can lead to uncertainty in formulation, diagnosis and care planning. This study aimed to explore child and informant characteristics are associated with reported child EBPs across settings. Participants were 83 4-8-year-old autistic children and their parents and teachers in the Autism Spectrum Treatment and Resilience (ASTAR) study. Questionnaires of child EBPs were completed by parents and teachers, and self-reported parenting stress and wellbeing measures were obtained. An observation of parent-child/researcher-child interaction was also completed. Parents reported more EBPs than teachers and parent-teacher agreement was low, particularly for emotional problems. Greater parenting stress and being verbal was associated with more parent- but not teacher-reported EBPs. More observed behaviors that challenge were displayed by minimally verbal children. More parenting stress could be associated with the presence of more EBPs in the home; alternatively, parenting stress may confound reports. It is essential for assessments of EBPs in autistic children to take a multi-informant approach. Better understanding of the associations between informant characteristics and informant discrepancies of EBPs is needed.
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Affiliation(s)
- Melanie Palmer
- grid.13097.3c0000 0001 2322 6764Department of Child and Adolescent Psychiatry, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Joanne Tarver
- grid.7273.10000 0004 0376 4727Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Virginia Carter Leno
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Juan Paris Perez
- grid.13097.3c0000 0001 2322 6764Department of Child and Adolescent Psychiatry, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Margot Frayne
- grid.13097.3c0000 0001 2322 6764Department of Child and Adolescent Psychiatry, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Vicky Slonims
- grid.420545.20000 0004 0489 3985Newcomen Neurodevelopmental Centre, Evelina Children’s Hospital, Guy’s and St Thomas NHS Foundation Trust, London, UK
| | - Andrew Pickles
- grid.13097.3c0000 0001 2322 6764Department of Biostatistics and Health Informatics, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Stephen Scott
- grid.13097.3c0000 0001 2322 6764Department of Child and Adolescent Psychiatry, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Tony Charman
- grid.37640.360000 0000 9439 0839Service for Complex Autism & Associated Neurodevelopmental Disorders, South London and Maudsley NHS Foundation Trust, London, UK ,grid.13097.3c0000 0001 2322 6764Department of Psychology, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Emily Simonoff
- grid.13097.3c0000 0001 2322 6764Department of Child and Adolescent Psychiatry, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK ,grid.37640.360000 0000 9439 0839Service for Complex Autism & Associated Neurodevelopmental Disorders, South London and Maudsley NHS Foundation Trust, London, UK
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8
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Spackman E, Lerh JW, Rodgers J, Hollocks MJ, South M, McConachie H, Ozsivadjian A, Vaughan Van Hecke A, Libove R, Hardan AY, Leekam SR, Simonoff E, Frazier TW, Alvares GA, Schwartzman JM, Magiati I, Uljarević M. Understanding the heterogeneity of anxiety in autistic youth: A person-centered approach. Autism Res 2022; 15:1742-1754. [PMID: 35642170 DOI: 10.1002/aur.2744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022]
Abstract
The present study aimed to examine anxiety profiles among children and adolescents on the autism spectrum. It further aimed to characterize the association between the identified anxiety profiles and key clinical and developmental variables. The Spence Children's Anxiety Scale-Parent Version (SCAS-P) data from a large international pooled sample of 870 caregivers of autistic children and adolescents (Mage = 11.6 years, SDage = 2.77; 107 females) was used. Latent profile analysis identified a three-anxiety profile solution exhibiting high entropy (0.80) and high latent profile probabilities, with good classification accuracy. Identified profiles fell along the severity spectrum and were named as the mild (n = 498), moderate (n = 272) and severe (n = 100) anxiety profiles. There were no statistically significant differences between the three anxiety profiles in terms of sex distribution. Participants in the mild profile were significantly younger than those in the severe profile, had significantly fewer social communication difficulties than youth in the moderate anxiety profile group and had significantly fewer restricted and repetitive behaviors and lower cognitive functioning scores compared to participants in moderate and severe anxiety profiles. This is the first study to move beyond identifying associations and group-level differences to exploring and identifying characteristics of anxiety-based subgroups at an individual level that differ on key clinical and developmental variables. The subgroups identified in this study are a preliminary, yet important, first step towards informing future assessment and individualized interventions aiming to support young people on the autism spectrum to reduce and manage anxiety. LAY SUMMARY: This study tried to understand if there are subgroups of autistic young people who may have similar anxiety profiles. We found that we could meaningfully group young people into three groups based on how severe the anxiety symptoms their caregivers reported were: a group with low levels of anxiety, those with moderate anxiety, and those with more severe anxiety. We also found that the young people in the mild group were younger, had fewer autism traits and lower levels of intellectual functioning than young people in the other two groups.
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Affiliation(s)
- Emily Spackman
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Jian Wei Lerh
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Jacqui Rodgers
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew J Hollocks
- Department of Child & Adolescent Psychiatry, King's College London, London, UK.,Central and North West London NHS Foundation Trust, London, UK
| | - Mikle South
- Emory University School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Helen McConachie
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Ozsivadjian
- Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
| | | | - Robin Libove
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, California, USA
| | - Antonio Y Hardan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, California, USA
| | - Susan R Leekam
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - Emily Simonoff
- Department of Child & Adolescent Psychiatry, King's College London, London, UK
| | - Thomas W Frazier
- Department of Psychology, John Carroll University, University Heights, Ohio, USA
| | - Gail A Alvares
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Jessica M Schwartzman
- Vanderbilt Child and Adolescent Psychiatry, Vanderbilt University, Nashville, Tennessee, USA
| | - Iliana Magiati
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Mirko Uljarević
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
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9
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Simonoff E, Mowlem F, Pearson O, Anagnostou E, Donnelly C, Hollander E, King BH, McCracken JT, Scahill L, Sikich L, Pickles A. Citalopram Did Not Significantly Improve Anxiety in Children with Autism Spectrum Disorder Undergoing Treatment for Core Symptoms: Secondary Analysis of a Trial to Reduce Repetitive Behaviors. J Child Adolesc Psychopharmacol 2022; 32:233-241. [PMID: 35501967 PMCID: PMC11075077 DOI: 10.1089/cap.2021.0137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective: Anxiety disorders are among the most common co-occurring conditions in autism spectrum disorder (ASD). Despite their prevalence and impact, there are no randomized controlled trials (RCTs) aimed at evaluating the efficacy of selective serotonin reuptake inhibitors (SSRIs) for anxiolysis in this population, who may have a different biological basis for anxiety. Methods: Secondary analyses of the STAART double-blind, placebo-controlled RCT of citalopram in children with ASD examined whether citalopram reduced anxiety measured on the parent-reported Child and Adolescent Symptom Inventory-4 (CASI-4) as the primary outcome. An intention-to-treat analysis involving all 149 participants used multiple imputations for missing data and included baseline stratification factors of age group and site, among others. We prespecified as clinically significant a 33% reduction in anxiety in citalopram versus placebo, coinciding with 80% power. We tested whether communicative ability on the Vineland Communication score moderated treatment effect and explored whether initial anxiety was associated with greater adverse events, which could impact on dose titration and achieving optimal dose. Results: Both groups showed substantial reduction in anxiety. Citalopram was associated with a nonsignificant 16.5% greater reduction (observed coefficient = -0.181, bootstrap standard error = 0.126, p = 0.151, confidence interval = -0.428 to 0.066). Anxiety reports were significantly lower in children with reduced communicative ability, but communicative ability did not moderate the treatment effect (interaction p = 0.294). Initial anxiety levels were not associated with increased adverse effects (interaction ps 0.162-0.954). Conclusion: Citalopram did not statistically significantly improve anxiety in children with ASD. Clinicians should be cautious in their use of SSRIs for this indication. There remains a need for well-powered clinical trials testing the efficacy of SSRIs among autistic children with anxiety disorders.
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Affiliation(s)
- Emily Simonoff
- Department of Child & Adolescent Psychiatry and Institute of Psychiatry, Psychology & Neuroscience and Maudsley Biomedical Research Centre for Mental Health, King's College London, London, United Kingdom
| | - Florence Mowlem
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience and Maudsley Biomedical Research Centre for Mental Health, King's College London, London, United Kingdom
| | - Oliver Pearson
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience and Maudsley Biomedical Research Centre for Mental Health, King's College London, London, United Kingdom
| | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Craig Donnelly
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Eric Hollander
- Autism and Obsessive Compulsive Spectrum Program, Psychiatric Research Institute of Montefiore Einstein, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Bryan H. King
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
| | - James T. McCracken
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Lawrence Scahill
- Department of Pediatrics, Marcus Autism Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Linmarie Sikich
- Department of Psychiatry, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, North Carolina, USA
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience and Maudsley Biomedical Research Centre for Mental Health, King's College London, London, United Kingdom
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10
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Moskowitz LJ, Braconnier M. Assessing anxiety in youth with autism spectrum disorder. PSYCHOLOGY IN THE SCHOOLS 2022. [DOI: 10.1002/pits.22669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Megan Braconnier
- Department of Psychology St. John's University New York City New York USA
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11
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Casper R, Shloim N, Hebron J. Use of non‐directive therapy for adolescents with autism spectrum disorder: A systematic review. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Moore K, Bullard A, Sweetman G, Ahearn WH. Assessing and Treating Anxiety in Individuals with Autism. Behav Modif 2021; 46:1279-1313. [PMID: 34713755 DOI: 10.1177/01454455211051678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anxiety is a cluster of responses that can involve both operant and respondent behavior, which can be both public and/or private in nature, and occurs when an upcoming aversive stimulus is signaled. Despite the reported high comorbidity of autism and anxiety, there has been very limited research on how to directly assess and treat anxiety, especially with individuals who have limited communication skills. In Study 1, anxiety was assessed in five individuals with autism, ranging in age from 10 to 19 years old. Anxiety was assessed by measuring behavior during (1) a baseline (with no putative anxiety-provoking stimuli present), (2) signals for an upcoming aversive event, and (3) exposure to that aversive event. Anxiety presented in several different ways, as both conditioned activation and suppression, and both with and without problem behavior during the aversive event. In Study 2, individualized treatments involving differential reinforcement of alternative responses and stimulus fading were used to successfully reduce anxious responding in all four participants who displayed anxiety. These studies demonstrated a potentially useful means of assessing anxiety in individuals with autism which may not only help to measure anxious behavior and identify anxiety-provoking events, but may also lead to effective treatment.
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Affiliation(s)
- Keira Moore
- The New England Center for Children, Southborough, MA, USA.,Western New England University, Springfield, MA, USA.,Regis College, Weston, MA, USA
| | - Amanda Bullard
- The New England Center for Children, Southborough, MA, USA.,Western New England University, Springfield, MA, USA
| | - Gemma Sweetman
- The New England Center for Children, Southborough, MA, USA.,University of Ulster, Coleraine, Londonderry, UK
| | - William H Ahearn
- The New England Center for Children, Southborough, MA, USA.,Western New England University, Springfield, MA, USA
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13
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Characterizing Sleep Problems in 16p11.2 Deletion and Duplication. J Autism Dev Disord 2021; 53:1462-1475. [PMID: 34633643 DOI: 10.1007/s10803-021-05311-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
Studies of 16p11.2 copy number variants (CNVs) provide an avenue to identify mechanisms of impairment and develop targeted treatments for individuals with neurodevelopmental disorders. 16p11.2 deletion and duplication phenotypes are currently being ascertained; however, sleep disturbances are minimally described. In this study, we examine sleep disturbance in a well-characterized national sample of 16p11.2 CNVs, the Simons Foundation Autism Research Initiative (SFARI) database of youth and adults (n = 692). Factor analyses and multilevel models of derived sleep questionnaires for youth (n = 345) and adults (n = 347) indicate that 16p11.2 carriers show elevated sleep disturbance relative to community controls. Non-carrier family members also show elevated sleep disturbance. However, sleep duration does not differ between carriers and controls. Further studies of sleep in 16p11.2 are needed.
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14
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Ambrose K, Simpson K, Adams D. The relationship between social and academic outcomes and anxiety for children and adolescents on the autism spectrum: A systematic review. Clin Psychol Rev 2021; 90:102086. [PMID: 34598053 DOI: 10.1016/j.cpr.2021.102086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 12/28/2022]
Abstract
Anxiety is the most common co-occurring condition in children on the autism spectrum but the potential impacts of anxiety on social and academic outcomes of children on the autism spectrum have not been systematically examined. In this review, 50 studies were identified that explore the relationship between anxiety and scores on social or academic measures in children on the autism spectrum. Social competence was frequently measured, and the findings of these studies were mixed. While other social constructs have received little attention, associations were found between anxiety and victimisation, and anxiety and social relationships. Only three studies focused on the impact of anxiety on scores on academic measures, highlighting the need for further research in this area. Anxiety was most frequently measured using subscales from broader behavioural instruments, which may not capture the range of anxiety symptoms of children on the autism spectrum. Future studies that include multi-informant methodologies and proportional representation of females and children with intellectual disability will further knowledge of the impact of anxiety in children on the spectrum.
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Affiliation(s)
- Kathryn Ambrose
- Autism Centre of Excellence, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122, Australia; The Co-operative Research Centre for Living with Autism (Autism CRC), PO Box 6068, St Lucia, QLD 4067, Australia.
| | - Kate Simpson
- Autism Centre of Excellence, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122, Australia; Griffith Institute for Educational Research, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122, Australia; The Co-operative Research Centre for Living with Autism (Autism CRC), PO Box 6068, St Lucia, QLD 4067, Australia
| | - Dawn Adams
- Autism Centre of Excellence, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122, Australia; Griffith Institute for Educational Research, Griffith University, Messines Ridge Road, Mt Gravatt, Brisbane, QLD 4122, Australia; The Co-operative Research Centre for Living with Autism (Autism CRC), PO Box 6068, St Lucia, QLD 4067, Australia
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15
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Keary CJ, Mullett JE, Nowinski L, Wagner K, Walsh B, Saro HK, Erhabor G, Thibert RL, McDougle CJ, Ravichandran CT. Parent Description of Anxiety in Angelman Syndrome. J Autism Dev Disord 2021; 52:3612-3625. [PMID: 34417655 DOI: 10.1007/s10803-021-05238-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 01/17/2023]
Abstract
Anxiety is being increasingly identified in Angelman syndrome (AS). Qualitative questions and quantitative assessments were used to evaluate for anxiety in 50 subjects with AS. In-person evaluations assessed behaviors concerning for anxiety and circumstances wherein they occurred. Caregivers completed anxiety and other behavioral rating scales. Caregiver responses were categorized and compared to items from anxiety rating scales. The most common behavioral manifestation of anxiety was "aggression." The most common circumstance was "separation from caregiver/parent." Subjects had elevated scores on anxiety, irritability and hyperactivity scales with lower mean scores among subjects with a maternal deletion. The Pediatric Anxiety Rating Scale best captured behaviors described by caregivers. Existing anxiety scales should be adapted for use in AS.
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Affiliation(s)
- Christopher J Keary
- Angelman Syndrome Program, Massachusetts General Hospital for Children, Boston, MA, USA. .,Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA. .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Jennifer E Mullett
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA
| | - Lisa Nowinski
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Karyn Wagner
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA
| | - Briana Walsh
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA
| | - Hannah K Saro
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA
| | - Gillian Erhabor
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ronald L Thibert
- Angelman Syndrome Program, Massachusetts General Hospital for Children, Boston, MA, USA.,Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Christopher J McDougle
- Angelman Syndrome Program, Massachusetts General Hospital for Children, Boston, MA, USA.,Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Caitlin T Ravichandran
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421, USA.,McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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16
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Brief Report: Caregiver Confidence in Reporting Anxiety Symptoms in Children with Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:3727-3733. [PMID: 34363572 PMCID: PMC8818806 DOI: 10.1007/s10803-021-05210-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
Assessment of anxiety in children with autism spectrum disorder (ASD) most commonly includes parent questionnaires. However, due to the nature of the questions and verbal limitations often present in children with ASD, caregivers may have difficulty completing such measures. Caregivers of 144 children with ASD ages 6 to 12 completed the Child and Adolescent Symptom Inventory-4 ASD Anxiety Scale and rated their level of confidence in responding to each item. Results indicated that parents had a moderate to high level of confidence in rating their children's anxiety symptoms. Parent confidence was not influenced by their child's age, expressive language ability, or intellectual functioning, but was related to their child's anxiety symptom count and ASD severity.
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17
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Tarver J, Vitoratou S, Mastroianni M, Heaney N, Bennett E, Gibbons F, Fiori F, Absoud M, Ramasubramanian L, Simonoff E, Santosh P. Development and Psychometric Properties of a New Questionnaire to Assess Mental Health and Concerning Behaviors in Children and Young People with Autism Spectrum Disorder (ASD): The Assessment of Concerning Behavior (ACB) Scale. J Autism Dev Disord 2021; 51:2812-2828. [PMID: 33051784 PMCID: PMC8254716 DOI: 10.1007/s10803-020-04748-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2020] [Indexed: 01/29/2023]
Abstract
Although 70% of autistic children and young people meet criteria for co-occurring psychiatric conditions, there are few screening measures specifically for autistic individuals. We describe the development and validation of the Assessment of Concerning Behavior (ACB), an instrument co-developed with the autistic community to assess mental health and problematic/risky behaviors. Items include descriptions to facilitate symptom recognition by autistic people, and carers/professionals. The ACB was completed by 255 parents, 149 autistic children and young people and 30 teachers. Internal consistency, stability and validity was assessed. The ACB parent-version fit a two-factor model (internalizing and externalizing problems) and showed adequate test-retest reliability, internal consistency and construct validity. The ACB is a promising new measure for research and clinical use in autism.
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Affiliation(s)
- Joanne Tarver
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Silia Vitoratou
- Department of Biostatistics and Health Informatics, Psychometrics and Measurement Lab, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Mathilde Mastroianni
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - Natalie Heaney
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eleanor Bennett
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Felicity Gibbons
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Federico Fiori
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
- HealthTracker Ltd, Gillingham, Kent, UK
| | - Michael Absoud
- Children's Neurosciences, Evelina London Children' Hospital, St Thomas' Hospital, King's Health Partners Academic Health Science Centre, London, UK
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Lakshmi Ramasubramanian
- Child and Adolescent Mental Health Services, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK.
- HealthTracker Ltd, Gillingham, Kent, UK.
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18
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E Marcondes AA, Gomez TGB, Ravache TT, Batistuzzo A, Lorena FB, de Paula CS, Lowenthal R, Bianco AC, Ribeiro MO. Assessment of children in the autistic spectrum disorder that carry the Thr92Ala-DIO2 polymorphism. J Endocrinol Invest 2021; 44:1775-1782. [PMID: 33449341 PMCID: PMC8693502 DOI: 10.1007/s40618-020-01497-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/31/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION A polymorphism in the type 2 deiodinase (Thr92Ala-DIO2) gene has been associated with behavioral and cognitive dysfunction as well as neurodegeneration and oxidative stress in the central nervous system. OBJECTIVE To test whether the minor allele (Ala92) frequency (MAF) is increased in children in the autism spectrum disorder (ASD), and whether carriers of the minor allele exhibit more severe symptoms and/or worse adaptive behavior. STUDY DESIGN ASD children were evaluated at baseline and yearly throughout the study by psychologists using the following tools: autism behavior checklist, Vineland Adaptative Behaviour Scales II, non-verbal intelligence test SON-R 21/2-7, SON-R 6-40, Weschler scale for intelligence, and autism treatment evaluation checklist. SETTINGS Academic outpatient mental health facility in Sao Paulo, Brazil. PARTICIPANTS ASD boys and girls younger than 18 years of age. 132 consecutive ASD children, mostly boys (~ 80%); ~ 50% was classified as verbal. Exclusion criteria were coexistence of sensory and/or physical impairment, or any associated genetic syndromes. RESULTS Median follow-up was for an uninterrupted period of 937 days (139-1375 days), which did not vary significantly among the genotypes. The MAF was 47% in ASD patients vs. 51% in a local reference population with similar ethnic background; the clinical severity and progression were not affected by the minor allele. Carriers of the minor allele exhibited higher adaptive behavior in the domains "daily living skills" and "communication", which correlated positively with the dose of the minor allele. CONCLUSION The MAF is not different in ASD children, but carriers of the Thr92Ala-DIO2 polymorphism exhibited higher adaptive behavior.
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Affiliation(s)
- A A E Marcondes
- Developmental Disorders Program, CCBS, Center of Biological Science and Health, Mackenzie Presbyterian University, Rua da Consolação, 930 Bld. #28, São Paulo, SP, 01302-907, Brazil
| | - T G B Gomez
- Developmental Disorders Program, CCBS, Center of Biological Science and Health, Mackenzie Presbyterian University, Rua da Consolação, 930 Bld. #28, São Paulo, SP, 01302-907, Brazil
| | - T T Ravache
- Developmental Disorders Program, CCBS, Center of Biological Science and Health, Mackenzie Presbyterian University, Rua da Consolação, 930 Bld. #28, São Paulo, SP, 01302-907, Brazil
| | - A Batistuzzo
- Developmental Disorders Program, CCBS, Center of Biological Science and Health, Mackenzie Presbyterian University, Rua da Consolação, 930 Bld. #28, São Paulo, SP, 01302-907, Brazil
| | - F B Lorena
- Developmental Disorders Program, CCBS, Center of Biological Science and Health, Mackenzie Presbyterian University, Rua da Consolação, 930 Bld. #28, São Paulo, SP, 01302-907, Brazil
- Federal University of Sao Paulo, São Paulo, Brazil
| | - C S de Paula
- Developmental Disorders Program, CCBS, Center of Biological Science and Health, Mackenzie Presbyterian University, Rua da Consolação, 930 Bld. #28, São Paulo, SP, 01302-907, Brazil
| | - R Lowenthal
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - A C Bianco
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - M O Ribeiro
- Developmental Disorders Program, CCBS, Center of Biological Science and Health, Mackenzie Presbyterian University, Rua da Consolação, 930 Bld. #28, São Paulo, SP, 01302-907, Brazil.
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19
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Simpson K, Adams D, Ambrose K, Keen D. "My cheeks get red and my brain gets scared": A computer assisted interview to explore experiences of anxiety in young children on the autism spectrum. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 113:103940. [PMID: 33765519 DOI: 10.1016/j.ridd.2021.103940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Anxiety symptoms are common in children on the autism spectrum and may be present at an early age. While a multi-informant approach is considered best practice in the assessment of anxiety, self-reports from young children on the autism spectrum are rarely included. AIMS The aim of this study was to utilise a computer-assisted interview procedure incorporating visual prompts to elicit the viewpoints of children about their experiences of anxiety. METHODS AND PROCEDURES Ten children aged 5-8 years who were diagnosed on the autism spectrum completed the interview. Directed content analysis was used to explore the data generated in the interview. OUTCOMES AND RESULTS A wide range of situations that trigger anxiety, and responses to anxiety, were reported across the participant group. These responses may be unrecognised as anxiety by others. The children provided positive feedback on the use of the computer-assisted interview. CONCLUSIONS AND IMPLICATIONS The child's own self-report can inform parents and professionals of the situations which make them more or less anxious and the behaviours that they use to communicate their anxiety in that specific situation. The use of a computer-assisted interview may be an effective method to support self-report of anxiety-related experiences for young children on the autism spectrum.
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Affiliation(s)
- Kate Simpson
- Autism Centre of Excellence, Arts Education and Law, Griffith University, QLD, Australia; Griffith Institute for Educational Research, Griffith University, QLD, Australia.
| | - Dawn Adams
- Autism Centre of Excellence, Arts Education and Law, Griffith University, QLD, Australia; Griffith Institute for Educational Research, Griffith University, QLD, Australia.
| | - Kathryn Ambrose
- Autism Centre of Excellence, Arts Education and Law, Griffith University, QLD, Australia; Griffith Institute for Educational Research, Griffith University, QLD, Australia.
| | - Deb Keen
- Autism Centre of Excellence, Arts Education and Law, Griffith University, QLD, Australia; Griffith Institute for Educational Research, Griffith University, QLD, Australia.
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20
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Kim SY, Kim YA, Song DY, Bong G, Kim JM, Kim JH, Yoo HJ. State and Trait Anxiety of Adolescents with Autism Spectrum Disorders. Psychiatry Investig 2021; 18:257-265. [PMID: 33735545 PMCID: PMC8016686 DOI: 10.30773/pi.2020.0328] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/18/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE This study examined how state and trait anxiety of adolescents with autism spectrum disorders (ASD) are associated with their demographic characteristics, repetitive and restricted behaviors (RRBs), and internalizing and externalizing problem behaviors. METHODS A total of 96 participants with ASD (mean age=14.30 years; 91 males) completed a battery of tests including the State/Trait Anxiety Inventory (STAI), the Autism Diagnostic Interview-Revised, the Social Responsiveness Scale (SRS), and a cognitive test measuring intelligence quotient (IQ). Participants' parents completed the Child Behavior Checklist (CBCL). Pearson's correlations among age, IQ, two subscales of the STAI (i.e., STAIS and STAIT, measuring self-reported state and trait anxiety, respectively), and the Anxiety subscale of CBCL (i.e., CBCL-Anxiety, measuring parent-reported trait anxiety) were computed. Subsequently, Pearson's correlations were computed among the three anxiety measures, RRBs, and problem behaviors, while controlling for participants' age and IQ. RESULTS The STAIS and CBCL-Anxiety were both significantly correlated with higher age, sensory sensitivity, depressive symptoms, somatic complaints, and aggressive behaviors. All three anxiety variables were significantly and positively correlated with total SRS RRB scores. Additionally, the STAIS and STAIT were significantly associated with more severe Compulsion/Adherence behaviors, and the CBCL-Anxiety was also significantly associated with more severe Rule-breaking Behaviors. CONCLUSION Self-reported state anxiety showed association patterns similar to those of parent-reported trait anxiety. Future studies investigating the precise operationalization of different anxiety instruments are needed to accurately measure the anxiety of adolescents with ASD.
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Affiliation(s)
- So Yoon Kim
- Department of Teacher Education, Duksung Women's University, Seoul, Republic of Korea
| | - Young Ah Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Da-Yea Song
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Guiyoung Bong
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jong-Myeong Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joo Hyun Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hee Jeong 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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21
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Romero M, Marín E, Guzmán-Parra J, Navas P, Aguilar JM, Lara JP, Barbancho MÁ. Relationship between parental stress and psychological distress and emotional and behavioural problems in pre-school children with autistic spectrum disorder. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.anpede.2020.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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22
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Jordan R, Kalvin CB, Ibrahim K, Sukhodolsky DG. Parent Emotion Socialization in Children with Autism Spectrum Disorder and Co-Occurring Anxiety. Res Child Adolesc Psychopathol 2021; 49:125-137. [PMID: 33442839 PMCID: PMC7809195 DOI: 10.1007/s10802-020-00731-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 12/14/2022]
Abstract
Although parents' socialization of children's emotional experiences and expression has been widely studied in typically developing (TD) populations, these processes have been largely unexplored in families of children with autism spectrum disorder (ASD). The present study examined parent emotion socialization in a well-characterized sample of verbally fluent children with ASD and comorbid anxiety disorders. Participants included 64 children, aged 8-15 years, who had ASD and co-occurring anxiety and 24 matched TD children without psychiatric disorders. Parents completed ratings of their responses to their children's emotional experiences using the Coping with Children's Negative Emotions Scale (CCNES), and both parents and children completed ratings of child anxiety using the Multidimensional Anxiety Rating Scale (MASC). Parents of children with ASD and anxiety did not differ from parents of TD children without psychiatric disorders in their endorsement of different emotion socialization practices. However, among children with ASD and anxiety, greater anxiety was associated with more emotion-focused responses from parents, and for children with less ASD symptom severity, lower levels of anxiety were associated with more punitive responses from parents. Results suggest that certain types of more directive emotion socialization approaches may be associated with lower anxiety in children with ASD, whereas emotion socialization approaches focused on altering the child's emotional experiences may be associated with greater anxiety in this population. While it is likely that parent emotion socialization practices impact children's emotional experiences of anxiety, it is also likely that children with distinct profiles of anxiety and ASD symptomology elicit specific styles of emotion socialization from parents.
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Affiliation(s)
- Rebecca Jordan
- Child Study Center, Yale University School of Medicine, 230 S. Frontage Road, New Haven, CT, 06520, US.
| | - Carla B Kalvin
- Child Study Center, Yale University School of Medicine, 230 S. Frontage Road, New Haven, CT, 06520, US
| | - Karim Ibrahim
- Child Study Center, Yale University School of Medicine, 230 S. Frontage Road, New Haven, CT, 06520, US
| | - Denis G Sukhodolsky
- Child Study Center, Yale University School of Medicine, 230 S. Frontage Road, New Haven, CT, 06520, US
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23
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Mingins JE, Tarver J, Waite J, Jones C, Surtees ADR. Anxiety and intellectual functioning in autistic children: A systematic review and meta-analysis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 25:18-32. [PMID: 33198481 PMCID: PMC8162138 DOI: 10.1177/1362361320953253] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Autistic children experience higher levels of anxiety than their peers. Making appropriate diagnoses of anxiety disorders and providing effective treatment for these children is particularly difficult. Inconsistent evidence suggests that levels of anxiety in autistic children are related to intellectual functioning. We provide the first meta-analysis of this evidence. A systematic search identified 49 papers for review. These papers included measures of anxiety and intelligence quotient in 18,430 autistic children. Studies employing correlations showed evidence of a significant relationship between intelligence quotient and anxiety in autistic children: children with higher intelligence quotient scored higher on measures of anxiety. Studies directly comparing groups of autistic children with and without intellectual disability also supported this conclusion. Most studies employing other designs also supported this finding. Employing a quality assessment framework identified common threats to validity. Many studies used measures of anxiety that were not validated across the samples they measure. This was most notable for those autistic children with an intellectual disability. It is vital that future research determines whether the identified relationship between intelligence quotient and anxiety reflects something important in the mechanism for anxiety in autistic children, or quantifies the lack of sensitivity of our measures of anxiety across different groups.
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Affiliation(s)
| | | | | | | | - Andrew DR Surtees
- University of Birmingham, UK
- Birmingham Children’s Hospital, UK
- Andrew DR Surtees, School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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24
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Xie S, Karlsson H, Dalman C, Widman L, Rai D, Gardner RM, Magnusson C, Sandin S, Tabb LP, Newschaffer CJ, Lee BK. The Familial Risk of Autism Spectrum Disorder with and without Intellectual Disability. Autism Res 2020; 13:2242-2250. [PMID: 33103358 PMCID: PMC7821228 DOI: 10.1002/aur.2417] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/13/2020] [Accepted: 10/08/2020] [Indexed: 12/22/2022]
Abstract
Autism spectrum disorder (ASD) is highly heritable, yet how its familial risk and heritability may vary by cognitive ability is not well understood. In this population‐based cohort study, we examined the familial risk and heritability of ASD with and without co‐occurring intellectual disability (ID). We estimated odds ratios and heritability of ASD with ID (ASD+ID) and ASD without ID (ASD−ID) using register‐based diagnosis data of 567,436 index persons born in 1984–2009 in Stockholm County, Sweden, and their parents, siblings, cousins, aunts, and uncles. The familial risk profile exhibited differences between ASD−ID and ASD+ID, most notably for index persons with affected parents. For example, for an index person who had at least one parent with ASD, the child's odds of ASD−ID and ASD+ID (95% confidence interval (CI)) increased by 16.2 (14.2–18.6) and 7.4 (5.5–10.0) folds, respectively. The more closely related a family member with ASD was, the greater the observed risk was of ASD in the index person, especially for ASD−ID. The broad‐sense heritability (95% CI) for ASD − ID and ASD+ID were 64.6% (46.0–100.0%) and 33.4% (14.4–58.4%), respectively. Familial risk and heritability of ASD may vary by intellectual ability, which implies that risk factors between these ASD phenotypes may differ. Our findings from the heritability analysis and familial risk analysis suggest that ASD−ID may have a greater genetic basis than ASD+ID, although this should be verified in future studies. Lay Summary Autism spectrum disorder (ASD) is highly heritable, yet how its familial risk and heritability may vary by cognitive ability is not well‐understood. In a population‐based cohort study on families of 567,436 index persons using Swedish registers data, we found that the familial risk profile differed between ASD with and without intellectual disability. Our findings from the heritability analysis and familial risk analysis suggest that ASD−ID may have a greater genetic basis than ASD+ID, although this should be verified in future studies.
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Affiliation(s)
- Sherlly Xie
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Håkan Karlsson
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christina Dalman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Linnea Widman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Dheeraj Rai
- Population Health Sciences, Bristol Medical School, Bristol, UK.,Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - Renee M Gardner
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Sven Sandin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Seaver Autism Center for Research and Treatment at Mount Sinai, New York, New York, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Loni P Tabb
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Craig J Newschaffer
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA.,A. J. Drexel Autism Institute, Philadelphia, Pennsylvania, USA
| | - Brian K Lee
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,A. J. Drexel Autism Institute, Philadelphia, Pennsylvania, USA
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25
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McCauley JB, Elias R, Lord C. Trajectories of co-occurring psychopathology symptoms in autism from late childhood to adulthood. Dev Psychopathol 2020; 32:1287-1302. [PMID: 32677592 PMCID: PMC7655668 DOI: 10.1017/s0954579420000826] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Given high rates of co-occurring conditions in youth and adults with autism spectrum disorder (ASD), it is critical to examine the developmental trajectories of these symptoms of psychopathology. Using data from a cohort of participants (n = 194), most of whom were first assessed for ASD in very early childhood, we investigated the trajectories of co-occurring depressive, anxiety, and attention-deficit hyperactivity disorder (ADHD) symptoms from late childhood to adulthood. Additionally, childhood predictors and adult outcomes associated with these symptom trajectories were examined. Using group-based trajectory modeling, we found two distinct classes of individuals exhibiting each of these co-occurring symptom patterns: one class exhibited fairly low symptoms across time, and one class with elevated symptoms with varied fluctuation across time (ADHD symptoms starting high but decreasing, anxiety symptoms high and stable, and depressive symptoms fluctuating but peaking at clinically significant levels in young adulthood). All high trajectory classes were associated with age 9 adaptive skills; verbal IQ predicted higher anxiety and depressive symptom classes. After accounting for verbal IQ, all high symptom trajectory classes were negative predictors of objective adult outcomes. These findings call for wide-ranging considerations of the needs of individuals across ability levels, autism symptoms, and behavioral and emotional challenges.
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Affiliation(s)
- James B McCauley
- Department of Psychiatry, University of California, Los Angeles, CA, USA
| | - Rebecca Elias
- Department of Psychiatry, University of California, Los Angeles, CA, USA
| | - Catherine Lord
- Department of Psychiatry, University of California, Los Angeles, CA, USA
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26
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Wijnhoven LAMW, Creemers DHM, Vermulst AA, Lindauer RJL, Otten R, Engels RCME, Granic I. Effects of the video game 'Mindlight' on anxiety of children with an autism spectrum disorder: A randomized controlled trial. J Behav Ther Exp Psychiatry 2020; 68:101548. [PMID: 32155470 DOI: 10.1016/j.jbtep.2020.101548] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/09/2020] [Accepted: 01/19/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND OBJECTIVES In the clinical setting, a large proportion of children with an autism spectrum disorder (ASD) experience impairing anxiety symptoms. Recently, an applied videogame called Mindlight has been developed that focuses on decreasing anxiety in children. The present study involved a randomized controlled trial (RCT) investigating the effect of Mindlight on (sub)clinical anxiety symptoms in children with an ASD. METHODS In total, 109 children of 8-16 years old with an ASD and (sub)clinical anxiety symptoms were randomly assigned to the experimental (N = 53) or the control (N = 56) condition. Children in the experimental condition played Mindlight, children in the control condition played a commercial game (Triple Town) for 1 h per week, for six consecutive weeks. All children and parents completed assessments at baseline, post-intervention and 3-months follow-up. RESULTS Results showed no differences in decrease of child-rated anxiety symptoms between both conditions. However, the decrease of parent-rated anxiety symptoms was significantly larger in the experimental condition. LIMITATIONS Mechanisms of change associated with treatment outcomes were not investigated in the present study. Therefore, it remains unclear which specific or non-specific factors contributed to the decrease in anxiety symptoms in both conditions. CONCLUSIONS The present study provided some preliminary evidence that video games are a promising new intervention vehicle for children with an ASD and anxiety, at least according to parents. However, further research on working mechanisms is needed, in order to specify to what extent and for which children with ASD Mindlight could be an effective anxiety treatment.
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Affiliation(s)
- Lieke A M W Wijnhoven
- Mental Health Care Institute GGZ Oost-Brabant, P.O. Box 3, 5427, ZG, Boekel, the Netherlands; Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, the Netherlands.
| | - Daan H M Creemers
- Mental Health Care Institute GGZ Oost-Brabant, P.O. Box 3, 5427, ZG, Boekel, the Netherlands; Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, the Netherlands.
| | - Ad A Vermulst
- Mental Health Care Institute GGZ Oost-Brabant, P.O. Box 3, 5427, ZG, Boekel, the Netherlands.
| | - Ramón J L Lindauer
- Mental Health Care Institute De Bascule, P.O. Box 303, 1115, ZG, Duivendrecht, the Netherlands; Faculty of Medicine, University of Amsterdam, P.O. Box 22660, 1100, DD, Amsterdam, the Netherlands.
| | - Roy Otten
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, the Netherlands; Mental Health Care Institute Pluryn, P.O. Box 53, 6500, AB, Nijmegen, the Netherlands; Arizona State University, REACH Institute, P.O. Box 876005, Tempe, AZ, USA.
| | - Rutger C M E Engels
- Erasmus University, Erasmus School of Social and Behavioral Sciences, P.O. Box 1738, 3000, DR, Rotterdam, the Netherlands.
| | - Isabela Granic
- Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, the Netherlands.
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27
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Alivar A, Carlson C, Suliman A, Warren S, Prakash P, Thompson DE, Natarajan B. Smart bed based daytime behavior prediction in Children with autism spectrum disorder - A Pilot Study. Med Eng Phys 2020; 83:15-25. [PMID: 32807344 DOI: 10.1016/j.medengphy.2020.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 05/30/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Abstract
Monitoring the sleep patterns of children with autism spectrum disorders (ASD) and understanding how sleep quality influences their daytime behavior is an important issue that has received very limited attention. Polysomnography (PSG) is commonly used as a gold standard for evaluating sleep quality in children and adults. However, the intrusive nature of sensors used as part of PSG can themselves affect sleep and is, therefore, not suitable for children with ASD. In this study, we evaluate an unobtrusive and inexpensive bed system for in-home, long-term sleep quality monitoring using ballistocardiogram (BCG) signals. Using the BCG signals from this smart bed system, we define "restlessness" as a surrogate sleep quality estimator. Using this sleep feature, we build predictive models for daytime behavior based on 1-8 previous nights of sleep. Specifically, we use two supervised machine learning algorithms namely support vector machine (SVM) and artificial neural network (ANN). For all daytime behaviors, we achieve more than 78% and 79% accuracy of correctly predicting behavioral issues with both SVM and ANN classifiers, respectively. Our findings indicate the usefulness of our designed bed system and how the restlessness feature can improve the prediction performance.
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Affiliation(s)
- Alaleh Alivar
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
| | - Charles Carlson
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
| | - Ahmad Suliman
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
| | - Steve Warren
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
| | - Punit Prakash
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
| | - David E Thompson
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
| | - Balasubramaniam Natarajan
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
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28
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Characterization and Prediction of Anxiety in Adolescents with Autism Spectrum Disorder: A Longitudinal Study. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1239-1249. [PMID: 32617732 DOI: 10.1007/s10802-020-00673-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Anxiety is one of the most common comorbidities in youth with autism spectrum disorder (ASD). The current study's aims were: To examine the frequency of elevated anxiety symptoms in adolescents diagnosed with ASD in toddlerhood; To explore the impact of comorbid anxiety in adolescents on clinical presentation; To evaluate variables in toddlerhood that associate with anxiety symptom severity in adolescence. The study included 61 adolescents (mean age = 13:8y) diagnosed with ASD in toddlerhood (T1). Participants underwent a comprehensive assessment of cognitive ability, adaptive skills and autism severity at T1 and again as adolescents (T2), and an evaluation of anxiety symptoms at T2. For the first aim, the most prevalent anxiety subtypes noted in adolescence were separation (39.3%), social (27.9%) and generalized anxiety (18.0%). For the second aim, cognitive ability, autism severity and adaptive skills in adolescents with and without elevated anxiety symptoms scores of any type did not differ significantly. For the third aim, younger age at adolescence was associated with more severe separation and generalized anxiety symptoms. Higher cognitive ability and adaptive skills in toddlerhood were associated with elevated generalized anxiety symptoms in adolescence. Lower adaptive behaviors and repetitive behaviors (RRBs) correlated with elevated social anxiety symptoms. Lower cognitive abilities and more severe RRBs in toddlerhood predicted separation anxiety in adolescence. The study sheds light on early characteristics in ASD that associate with anxiety symptom severity in adolescence. The type of elevated anxiety symptoms presented in adolescence associated with the level of cognitive ability, adaptive skills and RRBs in toddlerhood.
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29
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Baribeau DA, Vigod S, Pullenayegum E, Kerns CM, Mirenda P, Smith IM, Vaillancourt T, Volden J, Waddell C, Zwaigenbaum L, Bennett T, Duku E, Elsabbagh M, Georgiades S, Ungar WJ, Zaidman-Zait A, Szatmari P. Repetitive Behavior Severity as an Early Indicator of Risk for Elevated Anxiety Symptoms in Autism Spectrum Disorder. J Am Acad Child Adolesc Psychiatry 2020; 59:890-899.e3. [PMID: 31541676 DOI: 10.1016/j.jaac.2019.08.478] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/15/2019] [Accepted: 09/13/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE A significant proportion of children with autism spectrum disorder (ASD) will develop an anxiety disorder during childhood. Restricted and repetitive behavior severity in ASD positively correlates with anxiety severity in cross-sectional surveys. The longitudinal relationship between restricted/repetitive behavior and future anxiety symptoms is unclear. METHOD In a longitudinal cohort of children with ASD (n = 421), restricted/repetitive behavior severity at enrollment (age 2-5 years) was categorized as "mild," "moderate," or "severe" using the Autism Diagnostic Interview-Revised. Elevated anxiety symptoms were defined by a Child Behavior Checklist (parent report) Anxiety subscale T-score of >65 at ages 8 to 11 years. Multivariable logistic regression with multiple imputation for missing data was used to examine the association between restricted/repetitive behavior severity and elevated anxiety symptoms while adjusting for age, sex, adaptive functioning, baseline anxiety, income, and parenting stress, generating adjusted odds ratios (aORs) and 95% CIs. RESULTS Approximately 58% of children with severe restricted/repetitive behavior at enrollment had elevated anxiety symptoms by age 11, compared to 41% of those with moderate, and 20% of those with mild restricted/repetitive behavior, respectively. Moderate and severe restricted/repetitive behavior were both associated with increased odds of elevated anxiety (moderate aOR: 2.5 [1.2-5.3]; severe aOR: 3.2 (1.4-7.5]). CONCLUSION Restricted/repetitive behavior severity at time of ASD diagnosis indicates risk for future anxiety symptoms. This finding increases our understanding of which children with ASD will develop anxiety disorders and may guide research concerning early interventions and etiological mechanisms.
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Affiliation(s)
| | - Simone Vigod
- University of Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada; Women's College Hospital and Women's College Research Institute, Toronto, Ontario, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | | | - Pat Mirenda
- University of British Columbia, Vancouver, Canada
| | - Isabel M Smith
- Dalhousie University, Halifax, Nova Scotia, Canada; Autism Research Centre, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Tracy Vaillancourt
- Counselling Psychology, Faculty of Education, University of, Ottawa, Ontario, Canada
| | - Joanne Volden
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Charlotte Waddell
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | | | - Teresa Bennett
- Offord Centre for Child Studies, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada
| | - Eric Duku
- Offord Centre for Child Studies, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada
| | - Mayada Elsabbagh
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Stelios Georgiades
- Offord Centre for Child Studies, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada
| | - Wendy J Ungar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Anat Zaidman-Zait
- Constantine School of Education, Tel Aviv University, Israel; The School of Population and Public Health, Faculty of Medicine, University of British Columbia, Canada
| | - Peter Szatmari
- University of Toronto, Ontario, Canada; Centre for Addiction and Mental Health and The Hospital for Sick Children, Toronto, Ontario, Canada.
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30
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A Pilot Study of Cardiovascular Reactivity in Children With Autism Spectrum Disorder. Semin Pediatr Neurol 2020; 34:100807. [PMID: 32446441 DOI: 10.1016/j.spen.2020.100807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In preparation for a larger case-control study of children with autism spectrum disorder (ASD) and anxiety, we conducted a pilot study using a noninvasive electrocardiographic device to measure cardiovascular reactivity in 10 children (age range 9-14) with ASD. The 45-minute procedure included 6 conditions: baseline rest, an interview about school, interim rest, an unfair computerized ball-toss game followed by a fair version of the game, and a final rest. Data were successfully collected for 95% of all conditions. Omnibus Skillings-Mack tests suggested that heart rate variability variables including mean heart rate, mean RR interval, and root mean square of successive differences showed statistically significant variation across conditions. The procedure appears feasible and may be an informative biomarker of anxiety in ASD.
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31
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Zachor DA, Ben-Itzchak E. From Toddlerhood to Adolescence, Trajectories and Predictors of Outcome: Long-Term Follow-Up Study in Autism Spectrum Disorder. Autism Res 2020; 13:1130-1143. [PMID: 32450608 DOI: 10.1002/aur.2313] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 12/20/2022]
Abstract
This study is one of a very few prospective long-term studies in autism spectrum disorder (ASD). The study compared outcome trajectories in three adolescent groups (T2): "best outcome" (BO, n = 11) did not meet cut-off points for ASD and IQ scores ≥85; high functioning (HF-ASD, n = 14); and lower functioning (LF-ASD, n = 43). Additionally, the study searched for characteristics at toddlerhood (T1) that may predict belonging to the above groups. The study included 68 adolescents (63 males) diagnosed with ASD at toddlerhood (mean age: 13:10 years), mean follow-up time was 11:7 years. Participants underwent comprehensive assessments at T1 and T2. Different trajectories were found for the three defined groups. The BO group improved significantly in cognitive ability, autism severity, and adaptive skills in comparison to no improvement for the LF-ASD group or partial progress for the HF-ASD group. At toddlerhood, better cognition and less severe autism social affect symptoms were generally associated with a better outcome. Early social behaviors including better "pointing," "facial expression directed to others," "showing," and "response to joint attention" were associated with membership in the BO group. In addition, the BO group had the lowest prevalence of significant T2 inattention and anxiety symptoms. No significant differences between the three outcome groups were noted in the birth and prevalence of medical problems. Higher cognitive ability and better T1 showing and pointing behaviors predicted better outcome. The study points to the change in autism severity over time and to the prognostic value of early developmental abilities, social engagement behaviors, and the existence of comorbidities. Autism Res 2020, 13: 1130-1143. © 2020 International Society for Autism Research and Wiley Periodicals LLC. LAY SUMMARY: This long-term study compared characteristics of toddlers diagnosed with autism spectrum disorder (ASD) in three outcome groups in adolescence: best outcome (BO-average IQ/not meeting criteria for ASD), high-functioning ASD, and low-functioning ASD (LF-ASD). At toddlerhood, the BO group displayed less severe autism symptoms, mostly in sharing interests, compared to the LF-ASD group. The BO group had fewer inattention and anxiety symptoms than the two ASD groups. Additionally, early cognitive level and social engagement behaviors predicted outcome in ASD.
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Affiliation(s)
- Ditza A Zachor
- The Autism Center, Department of Pediatrics, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Esther Ben-Itzchak
- Bruckner Center for Research in Autism Spectrum Disorders, Department of Communication Disorders, Ariel University, Ariel, Israel
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32
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Gara SK, Chhetri AG, Alrjoob M, Abbasi SAA, Rutkofsky IH. The Sensory Abnormalities and Neuropsychopathology of Autism and Anxiety. Cureus 2020; 12:e8071. [PMID: 32542126 PMCID: PMC7290113 DOI: 10.7759/cureus.8071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Autism spectrum disorder (ASD) is a developmental disorder of interpersonal communications and restricted interest and deficits in sensory and social interactions. It co-occurs with anxiety and mostly in 30% of cases related to specific phobia. This review article summarises the sensory association between anxiety and ASD. The role of emotions and neurobiology discussed and sensory over-reactivity (SOR) was related to ASD and anxiety. PubMed database systematically searched for related articles on ASD and anxiety. The keywords used are autism spectrum disorder, autism spectrum disorder and emotion, anxiety disorder, sensory in autism and anxiety, and psychopathology. The results were most significant and related to the sensory association between ASD and anxiety. Out of 19 studies discussed, there were eight systematic reviews with meta-analysis, seven systematic reviews, three traditional reviews, and one included both systematic reviews with randomized controlled trials (RCTs). However, due to possible limitations and considerations, like small sample size and few clinical trials; hence, further recommendations to randomized clinical trials and cohort studies warranted. This review article helps scientists to plan and focus on necessary studies and possible screening for the disease to improve possible clinical outcomes. People gain awareness of the disease. Early recognition, as well as educational, behavioral, and family therapy, might decrease symptoms and support learning and development in children.
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Affiliation(s)
- Sirisha K Gara
- Primary Care, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Ashok G Chhetri
- Primary Care, Department of Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Montaser Alrjoob
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Sassi Ashraf Ali Abbasi
- Primary Care, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Ian H Rutkofsky
- Psychiatry, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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33
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Romero-González M, Marín E, Guzmán-Parra J, Navas P, Aguilar JM, Lara JP, Barbancho MÁ. [Relationship between parental stress and psychological distress and emotional and behavioural problems in pre-school children with autistic spectrum disorder]. An Pediatr (Barc) 2020; 94:99-106. [PMID: 32402776 DOI: 10.1016/j.anpedi.2020.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/08/2020] [Accepted: 03/23/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The Autistic Spectrum Disorders (ASD) are characterised by general deficits in social communication, stereotypes, and restricted interests. The ASD have a high prevalence of additional psychiatric disorders that make their daily functioning worse, and reduces the quality of life of them and their families. MATERIAL AND METHODS In an effort to identify family environmental characteristics that may influence in the course of additional psychiatric disorders, this study has focused on the symptoms of parental stress and psychological distress as possible risk factors. A cross-section study was carried out on the relationship between the stress and psychological distress of the parents and its relationship with co-existing psychopathology in a population of pre-school children with ASD (2-6 years). RESULTS AND CONCLUSIONS High levels of stress and psychological distress of the parents arealready associated, since early childhood, with co-existing psychiatric symptoms, specifically with emotional and behavioural problems (p < 0.05). However, further longitudinal studies are needed for a better understanding of the causal relationship between these variables and their possible bidirectional relationship.
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Affiliation(s)
- Marina Romero-González
- U.G.C Salud Mental, Hospital Regional Universitario de Málaga, IBIMA, Málaga, España; Unidad de Salud Cerebral, CIMES, Facultad de Medicina, Universidad de Málaga, IBIMA, Málaga, España.
| | - Ester Marín
- U.G.C Salud Mental, Hospital Regional Universitario de Málaga, IBIMA, Málaga, España
| | - Jose Guzmán-Parra
- U.G.C Salud Mental, Hospital Regional Universitario de Málaga, IBIMA, Málaga, España
| | - Patricia Navas
- Unidad de Salud Cerebral, CIMES, Facultad de Medicina, Universidad de Málaga, IBIMA, Málaga, España; U.G.C Neurociencias, Servicio de Neurofisiología, Clínica HRU Málaga, Málaga, España
| | - Juan Manuel Aguilar
- U.G.C Salud Mental, Hospital Regional Universitario de Málaga, IBIMA, Málaga, España
| | - J Pablo Lara
- Unidad de Salud Cerebral, CIMES, Facultad de Medicina, Universidad de Málaga, IBIMA, Málaga, España
| | - Miguel Ángel Barbancho
- Unidad de Salud Cerebral, CIMES, Facultad de Medicina, Universidad de Málaga, IBIMA, Málaga, España
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34
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Bangerter A, Chatterjee M, Manyakov NV, Ness S, Lewin D, Skalkin A, Boice M, Goodwin MS, Dawson G, Hendren R, Leventhal B, Shic F, Esbensen A, Pandina G. Relationship Between Sleep and Behavior in Autism Spectrum Disorder: Exploring the Impact of Sleep Variability. Front Neurosci 2020; 14:211. [PMID: 32265629 PMCID: PMC7105870 DOI: 10.3389/fnins.2020.00211] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 02/26/2020] [Indexed: 11/13/2022] Open
Abstract
Objective The relationship between sleep (caregiver-reported and actigraphy-measured) and other caregiver-reported behaviors in children and adults with autism spectrum disorder (ASD) was examined, including the use of machine learning to identify sleep variables important in predicting anxiety in ASD. Methods Caregivers of ASD (n = 144) and typically developing (TD) (n = 41) participants reported on sleep and other behaviors. ASD participants wore an actigraphy device at nighttime during an 8 or 10-week non-interventional study. Mean and variability of actigraphy measures for ASD participants in the week preceding midpoint and endpoint were calculated and compared with caregiver-reported and clinician-reported symptoms using a mixed effects model. An elastic-net model was developed to examine which sleep measures may drive prediction of anxiety. Results Prevalence of caregiver-reported sleep difficulties in ASD was approximately 70% and correlated significantly (p < 0.05) with sleep efficiency measured by actigraphy. Mean and variability of actigraphy measures like sleep efficiency and number of awakenings were related significantly (p < 0.05) to ASD symptom severity, hyperactivity and anxiety. In the elastic net model, caregiver-reported sleep, and variability of sleep efficiency and awakenings were amongst the important predictors of anxiety. Conclusion Caregivers report problems with sleep in the majority of children and adults with ASD. Reported problems and actigraphy measures of sleep, particularly variability, are related to parent reported behaviors. Measuring variability in sleep may prove useful in understanding the relationship between sleep problems and behavior in individuals with ASD. These findings may have implications for both intervention and monitoring outcomes in ASD.
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Affiliation(s)
- Abigail Bangerter
- Neuroscience Therapeutic Area, Janssen Research & Development, Titusville, NJ, United States
| | - Meenakshi Chatterjee
- Computational Biology, Discovery Sciences, Janssen Research & Development, Spring House, PA, United States
| | - Nikolay V Manyakov
- Computational Biology, Discovery Sciences, Janssen Research & Development, Beerse, Belgium
| | - Seth Ness
- Neuroscience Therapeutic Area, Janssen Research & Development, Titusville, NJ, United States
| | - David Lewin
- Statistically Speaking Consulting, LLC, Chicago, IL, United States
| | - Andrew Skalkin
- Computational Biology, Discovery Sciences, Janssen Research & Development, Spring House, PA, United States
| | - Matthew Boice
- Neuroscience Therapeutic Area, Janssen Research & Development, Titusville, NJ, United States
| | - Matthew S Goodwin
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC, United States
| | - Robert Hendren
- Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Bennett Leventhal
- Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Frederick Shic
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Anna Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,University of Cincinnati, College of Medicine, Cincinnati, OH, United States
| | - Gahan Pandina
- Neuroscience Therapeutic Area, Janssen Research & Development, Titusville, NJ, United States
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35
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Lau BY, Leong R, Uljarevic M, Lerh JW, Rodgers J, Hollocks MJ, South M, McConachie H, Ozsivadjian A, Van Hecke A, Libove R, Hardan A, Leekam S, Simonoff E, Magiati I. Anxiety in young people with autism spectrum disorder: Common and autism-related anxiety experiences and their associations with individual characteristics. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 24:1111-1126. [PMID: 31852214 DOI: 10.1177/1362361319886246] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Anxiety is common in autism spectrum disorder. Many anxiety symptoms in autism spectrum disorder are consistent with Diagnostic and Statistical Manual of Mental Disorders (5th ed.) anxiety disorders (termed "common" anxieties), but others may be qualitatively different, likely relating to autism spectrum disorder traits (herein termed "autism-related" anxieties). To date, few studies have examined both "common" and "autism-related" anxiety experiences in autism spectrum disorder. We explored caregiver-reported Spence Children's Anxiety Scale-Parent version data from a multi-site (United Kingdom, Singapore, and United States) pooled database of 870 6- to 18-year-old participants with autism spectrum disorder, of whom 287 provided at least one written response to the optional open-ended Spence Children's Anxiety Scale-Parent item 39 ("Is there anything else your child is afraid of?"). Responses were thematically coded to explore (a) common and autism-related anxiety presentations and (b) their relationship with young people's characteristics. Nearly half of the responses were autism-related anxieties (mostly sensory, uncommon, or idiosyncratic specific phobias and worries about change and unpredictability). The other half described additional common anxieties not covered in the original measure (mostly social, weather and environmental disasters, and animals). Caregivers of participants who were more severely affected by autism spectrum disorder symptoms reported more autism-related, as compared to common, additional anxieties. Implications for the assessment and understanding of anxiety in autism are discussed.
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Affiliation(s)
| | - Ruth Leong
- National University of Singapore, Singapore
| | | | | | | | - Matthew J Hollocks
- King's College London, UK.,Central and North West London NHS Foundation Trust, UK
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Phillips JM, Uljarević M, Schuck RK, Schapp S, Solomon EM, Salzman E, Allerhand L, Libove RA, Frazier TW, Hardan AY. Development of the Stanford Social Dimensions Scale: initial validation in autism spectrum disorder and in neurotypicals. Mol Autism 2019; 10:48. [PMID: 31890146 PMCID: PMC6921422 DOI: 10.1186/s13229-019-0298-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/15/2019] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this paper was to provide an initial validation of a newly developed parent questionnaire-the Stanford Social Dimensions Scale (SSDS), designed to capture individual differences across several key social dimensions including social motivation in children and adolescents with and without psychiatric disorders. Methods The initial validation sample was comprised of parents of 175 individuals with autism spectrum disorder (ASD) (35 females, 140 males; Mage = 7.19 years, SDage = 3.96) and the replication sample consisted of 624 parents of children who were either typically developing or presented with a range of neurodevelopmental and neuropsychiatric disorders (302 females, 322 males; Mage = 11.49 years, SDage = 4.48). Parents from both samples completed the SSDS and the Social Responsiveness Scale (SRS-2). Results Exploratory Structural Equation Modeling indicated that a 5-factor model provided adequate to excellent fit to the data in the initial ASD sample (comparative fit index [CFI] = .940, Tucker-Lewis Index [TLI] = .919, root mean square error of approximation [RMSEA] = .048, standardized root mean square residual [SRMR] = .038). The identified factors were interpreted as Social Motivation, Social Affiliation, Expressive Social Communication, Social Recognition, and Unusual Approach. This factor structure was further confirmed in Sample 2 (CFI = 946, TLI = .930, RMSEA = .044, SRMR = .026). Internal consistency for all subscales was in the good to excellent range across both samples as indicated by Composite Reliability scores of ≥ .72. Convergent and divergent validity was strong as indexed by the pattern of correlations with relevant SRS-2 and Child Behavior Checklist domains and with verbal and non-verbal intellectual functioning scores in Sample 1 and with the Need to Belong Scale and Child Social Preference Scale scores in Sample 2. Across both samples, females had higher social motivation and expressive social communication scores. Discriminant validity was strong given that across all SSDS subscales, the ASD sample had significantly higher impairment than both the typically developing group and the group with other clinical conditions, which in turn, had significantly higher impairment than the typically developing group. Conclusions Our findings provide initial validation of a new scale designed to comprehensively capture individual differences in social motivation and other key social dimensions in ASD.
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Affiliation(s)
- Jennifer M. Phillips
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
| | - Mirko Uljarević
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
| | - Rachel K. Schuck
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
| | - Salena Schapp
- Department of Psychiatry, Kaiser Permanente, Redwood City, CA USA
| | - Elizabeth M. Solomon
- Department of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center, Sacramento, CA USA
| | - Emma Salzman
- Department of Psychiatry, University of California San Francisco, San Francisco, CA USA
| | - Lauren Allerhand
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
| | - Robin A. Libove
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
| | | | - Antonio Y. Hardan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
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Kalvin CB, Marsh CL, Ibrahim K, Gladstone TR, Woodward D, Grantz H, Ventola P, Sukhodolsky DG. Discrepancies between parent and child ratings of anxiety in children with autism spectrum disorder. Autism Res 2019; 13:93-103. [PMID: 31643143 PMCID: PMC7062240 DOI: 10.1002/aur.2220] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/20/2019] [Indexed: 01/24/2023]
Abstract
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.
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Affiliation(s)
- Carla B Kalvin
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Carolyn L Marsh
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Karim Ibrahim
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Theresa R Gladstone
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Diana Woodward
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Heidi Grantz
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Pamela Ventola
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Denis G Sukhodolsky
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
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Development of the Parent-Rated Anxiety Scale for Youth With Autism Spectrum Disorder. J Am Acad Child Adolesc Psychiatry 2019; 58:887-896.e2. [PMID: 30797036 DOI: 10.1016/j.jaac.2018.10.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/03/2018] [Accepted: 11/06/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Anxiety is common in youth with autism spectrum disorder (ASD). There is no accepted outcome measure for anxiety in this population. METHOD Following a series of focus groups with parents of youth with ASD, we generated 72 items (scored 0-3). Parents of 990 youth with ASD (aged 5-17 years; 80.8% male) completed an online survey. Factor analysis and item response theory analyses reduced the content to a single factor with 25 items. Youth with at least mild anxiety (n = 116; aged 5-17 years; 79.3% male) participated in a comprehensive clinical assessment to evaluate the validity and reliability of the 25-item Parent-Rated Anxiety Scale for ASD (PRAS-ASD). RESULTS In the online sample, the mean PRAS-ASD score was 29.04 ± 14.9 (range, 0-75). The coefficient α was 0.93. The item response theory results indicated excellent reliability across a wide range of scores with low standard errors. In the clinical sample (n = 116), the PRAS-ASD mean was 31.0 ± 15.6 (range, 1-65). Pearson correlations with parent ratings of ASD symptom severity, repetitive behavior, and disruptive behavior ranged 0.33 to 0.66, supporting divergent validity of the PRAS-ASD. Pearson correlation with a parent-rated measure of anxiety used in the general pediatric population of 0.83 supported convergent validity. A total of 40 participants (32 boys, 8 girls; mean age, 11.9 ± 3.4 years) returned at time 2 (mean, 12.2 days) and time 3 (mean, 24.2 days). Intraclass correlation showed test-retest reliabilities of 0.88 and 0.86 at time 2 and time 3, respectively. CONCLUSION The 25-item PRAS-ASD is a reliable and valid scale for measuring anxiety in youth with ASD.
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Sukhodolsky DG, Lecavalier L, Johnson C, Smith T, Swiezy N, Bearss K, Kalvin CB, Scahill L. Anxiety in 3- to 7-year-old children with autism spectrum disorder seeking treatment for disruptive behavior. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 24:400-410. [PMID: 31390873 PMCID: PMC6982590 DOI: 10.1177/1362361319866561] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Anxiety is a common and impairing problem in children with autism spectrum disorder, but little is known about it in preschool children with autism spectrum disorder. This article reports on the characteristics of anxiety symptoms in young children with autism spectrum disorder using a parent-completed rating scale. One hundred and eighty children (age 3-7 years) participated in a clinical trial of parent training for disruptive behaviors. Anxiety was measured as part of pre-treatment subject characterization with 16 items from the Early Childhood Inventory, a parent-completed scale on child psychiatric symptoms. Parents also completed other measures of behavioral problems. Sixty-seven percent of children were rated by their parents as having two or more clinically significant symptoms of anxiety. There were no differences in the Early Childhood Inventory anxiety severity scores of children with IQ < 70 and those with ⩾70. Higher levels of anxiety were associated with severity of oppositional defiant behavior and social disability. Anxiety symptoms are common in preschoolers with autism spectrum disorder. These findings are consistent with earlier work in school-age children with autism spectrum disorder. There were no differences in anxiety between children with IQ below 70 and those with IQ of 70 and above. Social withdrawal and oppositional behavior were associated with anxiety in young children with autism spectrum disorder.
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Carpenter KLH, Baranek GT, Copeland WE, Compton S, Zucker N, Dawson G, Egger HL. Sensory Over-Responsivity: An Early Risk Factor for Anxiety and Behavioral Challenges in Young Children. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 47:1075-1088. [PMID: 30569253 PMCID: PMC6508996 DOI: 10.1007/s10802-018-0502-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Anxiety disorders are prevalent and significantly impact young children and their families. One hypothesized risk factor for anxiety is heightened responses to sensory input. Few studies have explored this hypothesis prospectively. This study had two goals: (1) examine whether sensory over-responsivity is predictive of the development of anxiety in a large prospective sample of children, and (2) identify whether anxiety mediates the relationship between sensory over-responsivity and behavioral challenges. Children's sensory and anxiety symptoms were assessed in a community sample of 917 at 2-5 and again in 191 of these children at 6 years old. Parents also reported on a number of additional behavioral challenges previously found to be associated with both sensory over-responsivity and anxiety separately: irritability, food selectivity, sleep problems, and gastrointestinal problems. Forty three percent of preschool children with sensory over-responsivity also had a concurrent impairing anxiety disorder. Preschool sensory over-responsivity symptoms significantly and positively predicted anxiety symptoms at age six. This relationship was both specific and unidirectional. Finally, school-age anxiety symptoms mediated the relationship between preschool sensory over-responsivity symptoms and both irritability and sleep problems at school-age. These results suggest sensory over-responsivity is a risk factor for anxiety disorders. Furthermore, children who have symptoms of sensory over-responsivity as preschoolers have higher levels of anxiety symptoms at school-age, which in turn is associated with increased levels of school-age behavioral challenges.
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Affiliation(s)
- Kimberly L H Carpenter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA.
| | - Grace T Baranek
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Bondurant Hall, CB #7120, Chapel Hill, NC, 27599-7120, USA
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar Street, CHP 133, Los Angeles, CA, 90089-9003, USA
| | - William E Copeland
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Nancy Zucker
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
| | - Helen L Egger
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 3527 DUMC, Durham, NC, 27710, USA
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, 1 Park Avenue, 7th Floor, New York, NY, 10016, USA
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Priorities for Advancing Research on Youth with Autism Spectrum Disorder and Co-occurring Anxiety. J Autism Dev Disord 2019; 48:925-934. [PMID: 29164436 DOI: 10.1007/s10803-017-3320-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Research on anxiety disorders in youth with autism spectrum disorder (ASD) has burgeoned in the past two decades. Yet, critical gaps exist with respect to measuring and treating anxiety in this population. This study used the nominal group technique to identify the most important research priorities on co-occurring anxiety in ASD. An international group of researchers and clinicians with experience in ASD and anxiety participated in the process. Topics ranked as most important focused on understanding how ASD symptoms affect treatment response, implementing treatments in real world settings, developing methods to disentangle overlapping symptoms between anxiety and ASD, and developing objective measures to assess anxiety. Collectively, these priorities can lead to collaborative studies to accelerate research in the field.
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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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Rosen TE, Spaulding CJ, Gates JA, Lerner MD. Autism severity, co-occurring psychopathology, and intellectual functioning predict supportive school services for youth with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:1805-1816. [DOI: 10.1177/1362361318809690] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supportive school services are a primary service modality for youth with autism spectrum disorder. Autism spectrum disorder, as well as co-occurring psychiatric symptoms and low intellectual abilities, interfere with academic achievement and therefore influence decisions about school services. Therefore, we examined the association of parent, teacher, and clinician ratings of autism spectrum disorder and co-occurring psychiatric symptom severity and intellectual functioning with school services. In total, 283 youth with autism spectrum disorder were assessed with clinical evaluation via the Autism Diagnostic Observation Schedule and parent and teacher versions of the CASI-4R ( Child and Adolescent Symptom Inventory). Full Scale Intelligence Quotient scores were obtained from case records. Clinical and teacher evaluations of autism spectrum disorder severity predicted services and were more strongly associated with school services than parent ratings. Teacher ratings were only associated with common school services (e.g. speech/language therapy, occupational therapy, and/or social skills training) frequency at medium and high levels of clinician-rated autism spectrum disorder severity. Higher IQ and parent-rated externalizing symptoms predicted lower likelihood of receiving school services, whereas internalizing symptoms were not predictive of school services. Autism spectrum disorder symptoms may overshadow externalizing and internalizing symptoms when considering school service supports. Results highlight the importance of evaluating autism spectrum disorder severity via multiple sources, especially in cases of unclear symptom presentation, when examining correlates of school services for youth with autism spectrum disorder.
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Ness SL, Bangerter A, Manyakov NV, Lewin D, Boice M, Skalkin A, Jagannatha S, Chatterjee M, Dawson G, Goodwin MS, Hendren R, Leventhal B, Shic F, Frazier JA, Janvier Y, King BH, Miller JS, Smith CJ, Tobe RH, Pandina G. An Observational Study With the Janssen Autism Knowledge Engine (JAKE ®) in Individuals With Autism Spectrum Disorder. Front Neurosci 2019; 13:111. [PMID: 30872988 PMCID: PMC6402449 DOI: 10.3389/fnins.2019.00111] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/30/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: The Janssen Autism Knowledge Engine (JAKE®) is a clinical research outcomes assessment system developed to more sensitively measure treatment outcomes and identify subpopulations in autism spectrum disorder (ASD). Here we describe JAKE and present results from its digital phenotyping (My JAKE) and biosensor (JAKE Sense) components. Methods: An observational, non-interventional, prospective study of JAKE in children and adults with ASD was conducted at nine sites in the United States. Feedback on JAKE usability was obtained from caregivers. JAKE Sense included electroencephalography, eye tracking, electrocardiography, electrodermal activity, facial affect analysis, and actigraphy. Caregivers of individuals with ASD reported behaviors using My JAKE. Results from My JAKE and JAKE Sense were compared to traditional ASD symptom measures. Results: Individuals with ASD (N = 144) and a cohort of typically developing (TD) individuals (N = 41) participated in JAKE Sense. Most caregivers reported that overall use and utility of My JAKE was "easy" (69%, 74/108) or "very easy" (74%, 80/108). My JAKE could detect differences in ASD symptoms as measured by traditional methods. The majority of biosensors included in JAKE Sense captured sizable amounts of quality data (i.e., 93-100% of eye tracker, facial affect analysis, and electrocardiogram data was of good quality), demonstrated differences between TD and ASD individuals, and correlated with ASD symptom scales. No significant safety events were reported. Conclusions: My JAKE was viewed as easy or very easy to use by caregivers participating in research outside of a clinical study. My JAKE sensitively measured a broad range of ASD symptoms. JAKE Sense biosensors were well-tolerated. JAKE functioned well when used at clinical sites previously inexperienced with some of the technologies. Lessons from the study will optimize JAKE for use in clinical trials to assess ASD interventions. Additionally, because biosensors were able to detect features differentiating TD and ASD individuals, and also were correlated with standardized symptom scales, these measures could be explored as potential biomarkers for ASD and as endpoints in future clinical studies. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02668991 identifier: NCT02668991.
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Affiliation(s)
- Seth L. Ness
- Neuroscience Therapeutic Area, Janssen Research & Development, Titusville, FL, United States
| | - Abigail Bangerter
- Neuroscience Therapeutic Area, Janssen Research & Development, Titusville, FL, United States
| | - Nikolay V. Manyakov
- Computational Biology, Discovery Sciences, Janssen Research & Development, Beerse, Belgium
| | - David Lewin
- Statistically Speaking Consulting, LLC, Chicago, IL, United States
| | - Matthew Boice
- Neuroscience Therapeutic Area, Janssen Research & Development, Titusville, FL, United States
| | - Andrew Skalkin
- Informatics, Janssen Research & Development, Spring House, PA, United States
| | - Shyla Jagannatha
- Statistical Decision Sciences, Janssen Research & Development, Titusville, NJ, United States
| | - Meenakshi Chatterjee
- Computational Biology, Discovery Sciences, Janssen Research & Development, Spring House, PA, United States
| | - Geraldine Dawson
- Departments of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC, United States
| | - Matthew S. Goodwin
- Department of Health Sciences, Northeastern University, Boston, MA, United States
| | - Robert Hendren
- Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Bennett Leventhal
- Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Frederick Shic
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Jean A. Frazier
- Eunice Kennedy Shriver Center and Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States
| | - Yvette Janvier
- Department of Developmental-Behavioral Pediatrics, Children's Specialized Hospital, Toms River, NJ, United States
| | - Bryan H. King
- Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Judith S. Miller
- Center for Autism Research, Perelman School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Russell H. Tobe
- Department of Outpatient Research, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Gahan Pandina
- Neuroscience Therapeutic Area, Janssen Research & Development, Pennington, NJ, United States
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The Role of Choice and Control in the Impact of Autism Waiver Services on Family Quality of Life and Child Progress. J Autism Dev Disord 2019; 49:2035-2048. [DOI: 10.1007/s10803-019-03886-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lecavalier L, McCracken CE, Aman MG, McDougle CJ, McCracken JT, Tierney E, Smith T, Johnson C, King B, Handen B, Swiezy NB, Eugene Arnold L, Bearss K, Vitiello B, Scahill L. An exploration of concomitant psychiatric disorders in children with autism spectrum disorder. Compr Psychiatry 2019; 88:57-64. [PMID: 30504071 PMCID: PMC6295217 DOI: 10.1016/j.comppsych.2018.10.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 10/04/2018] [Accepted: 10/25/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE We explored patterns of concomitant psychiatric disorders in a large sample of treatment-seeking children and adolescents with autism spectrum disorder (ASD). METHODS Participants were 658 children with ASD (age 3-17 years; mean = 7.2 years) in one of six federally-funded multisite randomized clinical trials (RCT) between 1999 and 2014. All children were referred for hyperactivity or irritability. Study designs varied, but all used the Child and Adolescent Symptom Inventory or Early Childhood Inventory to assess Attention Deficit Hyperactivity Disorder (ADHD), Oppositional-Defiant Disorder (ODD), Conduct Disorder (CD), Anxiety Disorders, and Mood Disorders. In addition, several measures in common were used to assess demographic and clinical characteristics. RESULTS Of the 658 children, 73% were Caucasian and 59% had an IQ >70. The rates of concomitant disorders across studies were: ADHD 81%, ODD 46%, CD 12%, any anxiety disorder 42%, and any mood disorder 8%. Two or more psychiatric disorders were identified in 66% of the sample. Of those who met criteria for ADHD, 50% also met criteria for ODD and 46% for any anxiety disorder. Associations between types of concomitant disorders and a number of demographic and clinical characteristics are presented. CONCLUSION In this well-characterized sample of treatment-seeking children with ASD, rates of concomitant psychiatric disorders were high and the presence of two or more co-occurring disorders was common. Findings highlight the importance of improving diagnostic practice in ASD and understanding possible mechanisms of comorbidity.
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Affiliation(s)
- Luc Lecavalier
- Ohio State University, Nisonger Center, United States of America.
| | - Courtney E McCracken
- Emory University School of Medicine, Department of Pediatrics, United States of America.
| | - Michael G Aman
- Ohio State University, Nisonger Center, United States of America.
| | | | - James T McCracken
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California at Los Angeles, United States of America.
| | - Elaine Tierney
- Johns Hopkins University School of Medicine, United States of America.
| | - Tristram Smith
- University of Rochester Medical Center, United States of America.
| | - Cynthia Johnson
- Cleveland Clinic and Learner College of Medicine, United States of America.
| | - Bryan King
- University of California, San Francisco, Department of Psychiatry, Benioff Children's Hospitals, United States of America.
| | - Benjamin Handen
- University of Pittsburgh School of Medicine, United States of America.
| | - Naomi B Swiezy
- HANDS in Autism Interdisciplinary Training and Resource Center, Indiana University School of Medicine, United States of America.
| | - L Eugene Arnold
- Ohio State University, Nisonger Center, United States of America.
| | - Karen Bearss
- University of Washington, Department of Psychiatry and Behavioral Sciences, United States of America.
| | - Benedetto Vitiello
- Division of Child and Adolescent Neuro-Psychiatry, University of Turin, Italy.
| | - Lawrence Scahill
- Emory University School of Medicine, Department of Pediatrics, United States of America.
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47
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Lerner MD, Mazefsky CA, Weber RJ, Transue E, Siegel M, Gadow KD. Verbal Ability and Psychiatric Symptoms in Clinically Referred Inpatient and Outpatient Youth with ASD. J Autism Dev Disord 2018; 48:3689-3701. [PMID: 29038930 DOI: 10.1007/s10803-017-3344-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Youth with autism spectrum disorder (ASD) experience high rates of psychiatric symptoms, but the relation between verbal ability and psychiatric symptoms is unknown. This study utilized a large sample of clinically referred inpatient and outpatient youth with ASD to compare psychiatric comorbidity between verbal and minimally-verbal youth, adjusting for nonverbal IQ, age, and ASD symptom severity. Results indicated that verbal youth were more likely to present with and meet clinical cutoffs for depression and oppositional defiant disorder symptoms, with greater impairment associated with depression. Youth in inpatient settings had greater symptom severity and impairment across almost all psychiatric comorbidities. These results present the most direct estimate to date of the association between verbal ability and psychiatric comorbidity in ASD.
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Affiliation(s)
- Matthew D Lerner
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA.
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Webster Hall Suite 300, Pittsburgh, PA, 15213, USA.
| | - Rebecca J Weber
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA
| | - Emilie Transue
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Webster Hall Suite 300, Pittsburgh, PA, 15213, USA
| | - Matthew Siegel
- Maine Medical Center Research Institute, Portland, ME, USA
| | - Kenneth D Gadow
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
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48
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Review of interventions for the management of anxiety symptoms in children with ASD. Neurosci Biobehav Rev 2018; 95:449-463. [DOI: 10.1016/j.neubiorev.2018.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 10/07/2018] [Accepted: 10/31/2018] [Indexed: 12/28/2022]
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49
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Roberts JE, Ezell JE, Fairchild AJ, Klusek J, Thurman AJ, McDuffie A, Abbeduto L. Biobehavioral composite of social aspects of anxiety in young adults with fragile X syndrome contrasted to autism spectrum disorder. Am J Med Genet B Neuropsychiatr Genet 2018; 177:665-675. [PMID: 30307687 PMCID: PMC6532983 DOI: 10.1002/ajmg.b.32674] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 04/30/2018] [Accepted: 07/02/2018] [Indexed: 11/08/2022]
Abstract
Social anxiety is a common disorder that has negative impacts across multiple domains of function. Several clinical groups are at elevated risk for social anxiety, including those with fragile X syndrome and those with autism spectrum disorder. Measuring social anxiety in these clinical subgroups is fraught with challenge, however, given the complexity of social anxiety and measurement limitations that are particularly acute in persons with neurodevelopmental disorders. The over-arching aim of this study was to contribute to our understanding of the nature of social anxiety in fragile X syndrome and its association with autism spectrum disorder. To address this aim, we created a multi-faceted composite representing behavioral and biological aspects of social anxiety and examined differences in two adolescent and young adult-aged groups: 59 males with fragile X syndrome and 18 males with autism spectrum disorder. Results indicated a lower score on the multivariate composite for the males with fragile X syndrome relative to autism spectrum disorder but with evidence that traits of autism and social anxiety overlap. We conclude that measuring anxiety and autism traits in fragile X syndrome and autism spectrum disorder is complex with features that overlap and interact in a dynamic manner.
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Affiliation(s)
- Jane E Roberts
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Jordan E Ezell
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Amanda J Fairchild
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Jessica Klusek
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Angela J Thurman
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California
| | - Andrea McDuffie
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California
| | - Leonard Abbeduto
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, California
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50
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Syriopoulou-Delli CK, Polychronopoulou SA, Kolaitis GA, Antoniou ASG. Views of Teachers on Anxiety Symptoms in Students with Autism Spectrum Disorder. J Autism Dev Disord 2018; 49:704-720. [PMID: 30220020 DOI: 10.1007/s10803-018-3752-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
People with autism spectrum disorder (ASD) exhibit comorbidity with anxiety. The aim of this study was the investigation of the perception of teachers on anxiety in school children with ASD. The Scale Teacher Response (SAS-TR) questionnaire was completed by 291 special education and 118 general education teachers, providing data on students in their classes with ASD and of typical development (TD), respectively. According to the total scores on SAS-TR, 46.8% of the children with ASD presented levels of anxiety within the clinical spectrum compared with 15.3% of the children of TD. Gender and age were not associated with the anxiety scores, but in the children with ASD, higher intelligence quotient (IQ) was weakly, and better verbal skills more strongly correlated with a higher anxiety level. Teachers' awareness of anxiety symptoms in children with ASD may contribute to their social inclusion.
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Affiliation(s)
| | | | - Gerasimos A Kolaitis
- Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
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