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Menezes M, Burroughs C, Pappagianopoulos J, Sadikova E, Fuhrmann E, Bohac G, Cross R, Witte L, Brinkmann G, Lemley R, Sukhodolsky DG, Mazurek MO. Feasibility and preliminary efficacy of behavioral activation for treatment of depression in autistic adolescents. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241252470. [PMID: 38764234 DOI: 10.1177/13623613241252470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
LAY ABSTRACT Depression is common among autistic youth and has a significant negative impact on quality of life and day-to-day functioning. Despite great need for efficacious treatments, there are currently limited research-supported interventions for depression symptoms in autistic young people. This study tested a novel, behavior-based approach or psychotherapy for treatment of depression symptoms in autistic adolescents without intellectual disability (i.e. Behavioral Activation for Autistic Adolescents, BA-A) with 15 youth (11-16 years old). BA-A is an individually delivered 12-session therapy that was developed for and to meet the needs of autistic youth with depression. Results found that autistic youth and their caregivers were able to participate in BA-A therapy sessions, and clinicians were able to deliver BA-A in accordance with the treatment manual. Notably, results demonstrated that autistic youth depression symptoms significantly improved after participating in BA-A. Furthermore, anxiety symptoms and social skills significantly improved following BA-A.
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Affiliation(s)
| | | | | | - Eleonora Sadikova
- Vanderbilt University Medical Center, USA
- University of Virginia, USA
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Pemovska T, Loizou S, Appleton R, Spain D, Stefanidou T, Kular A, Cooper R, Greenburgh A, Griffiths J, Barnett P, Foye U, Baldwin H, Minchin M, Brady G, Saunders KRK, Ahmed N, Jackson R, Olive RR, Parker J, Timmerman A, Sapiets S, Driskell E, Chipp B, Parsons B, Totsika V, Mandy W, Pender R, Clery P, Lloyd-Evans B, Simpson A, Johnson S. Approaches to improving mental health care for autistic children and young people: a systematic review and meta-analysis. Psychol Med 2024:1-31. [PMID: 38757186 DOI: 10.1017/s0033291724001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Autistic children and young people (CYP) experience mental health difficulties but face many barriers to accessing and benefiting from mental health care. There is a need to explore strategies in mental health care for autistic CYP to guide clinical practice and future research and support their mental health needs. Our aim was to identify strategies used to improve mental health care for autistic CYP and examine evidence on their acceptability, feasibility, and effectiveness. A systematic review and meta-analysis were carried out. All study designs reporting acceptability/feasibility outcomes and empirical quantitative studies reporting effectiveness outcomes for strategies tested within mental health care were eligible. We conducted a narrative synthesis and separate meta-analyses by informant (self, parent, and clinician). Fifty-seven papers were included, with most investigating cognitive behavioral therapy (CBT)-based interventions for anxiety and several exploring service-level strategies, such as autism screening tools, clinician training, and adaptations regarding organization of services. Most papers described caregiver involvement in therapy and reported adaptations to communication and intervention content; a few reported environmental adjustments. In the meta-analyses, parent- and clinician-reported outcomes, but not self-reported outcomes, showed with moderate certainty that CBT for anxiety was an effective treatment compared to any comparison condition in reducing anxiety symptoms in autistic individuals. The certainty of evidence for effectiveness, synthesized narratively, ranged from low to moderate. Evidence for feasibility and acceptability tended to be positive. Many identified strategies are simple, reasonable adjustments that can be implemented in services to enhance mental health care for autistic individuals. Notable research gaps persist, however.
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Affiliation(s)
- Tamara Pemovska
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Sofia Loizou
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Rebecca Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | | | - Theodora Stefanidou
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Ariana Kular
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Ruth Cooper
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Anna Greenburgh
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Jessica Griffiths
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Una Foye
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Helen Baldwin
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Matilda Minchin
- Division of Psychiatry, University College London, London, UK
| | - Gráinne Brady
- Division of Psychiatry, University College London, London, UK
| | | | - Nafiso Ahmed
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Robin Jackson
- Lancaster and Morecambe Child and Adolescent Mental Health Services, Lancashire and South Cumbria NHS Foundation Trust, Morecambe, UK
- University of Wolverhampton, Wolverhampton, UK
| | - Rachel Rowan Olive
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | - Jennie Parker
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
- School of Health and Psychological Sciences, City, University of London, London, UK
- Berkshire Healthcare NHS Foundation Trust, Reading, UK
| | - Amanda Timmerman
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Suzi Sapiets
- Tizard Centre, University of Kent, Canterbury, UK
| | | | - Beverley Chipp
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | | | - Vaso Totsika
- Division of Psychiatry, University College London, London, UK
| | - Will Mandy
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Richard Pender
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Philippa Clery
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Alan Simpson
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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3
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Rosenau KA, Kim J, Cho ACB, Seltzer M, Ugueto AM, Weisz JR, Wood JJ. Meta-analysis of Psychotherapy for Autistic Youth. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01686-2. [PMID: 38580853 DOI: 10.1007/s10578-024-01686-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 04/07/2024]
Abstract
In order to provide more individualized support, it is imperative to further understand the effectiveness of different types of psychotherapy on the clinical areas of need common in autistic youth (Wood et al. in Behav Ther 46:83-95, 2015). Randomized controlled trials of psychotherapy for autistic youth were included if published in English, included random assignment to treatment or control group, required a previous diagnosis of autism, had a mean age of 6-17 years, and provided outcome measure data from both intervention and control groups. A total of 133 measures were coded across 29 studies and included 1464 participants with a mean age of 10.39 years (1.89). A small mean effect size (0.38,95% CI [0.26, 0.47]) was found overall, with the largest effects for cognitive behavioral therapies on autism-related clinical needs (0.81) and overall mental health (0.78). The results show the significant impact of psychotherapy interventions for autistic youth. Additional research should further assess the details of the most effective psychotherapies for each area of clinical need.
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Affiliation(s)
- Kashia A Rosenau
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.
| | - Junok Kim
- School of Education and Information Studies, University of California Los Angeles, Los Angeles, USA
| | - An-Chuen Billy Cho
- School of Education and Information Studies, University of California Los Angeles, Los Angeles, USA
| | - Michael Seltzer
- School of Education and Information Studies, University of California Los Angeles, Los Angeles, USA
| | - Ana M Ugueto
- University of Texas Health Science Center at Houston, Houston, USA
| | | | - Jeffrey J Wood
- School of Education and Information Studies, University of California Los Angeles, Los Angeles, USA
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Hammer LA, Springfield CR, Tighe CA, Oswalt S, Bonfils KA. Schizotypy Moderates the Relationship Between Sleep Quality and Social Cognition. J Nerv Ment Dis 2024; 212:133-140. [PMID: 37983373 DOI: 10.1097/nmd.0000000000001744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
ABSTRACT Poor sleep quality has been tied to worse social cognition. Social cognitive deficits have been noted in those with high schizotypy. Yet, no study has assessed whether schizotypy moderates the relationship between sleep quality and social cognition, which may be vital to our understanding of contributors to social functioning. We conducted a cross-sectional analysis of associations of sleep quality and social cognition, with potential moderation by schizotypy. Participants ( n = 906) completed self-report measures of schizotypy, sleep quality, and social cognition. Levels of schizotypy significantly moderated some of the relationships between sleep and social cognition. For participants low in total or interpersonal schizotypy, worse sleep quality was associated with worse theory of mind scores. For participants low in total, disorganized, or cognitive perceptual schizotypy, worse sleep quality was associated with worse self-reported cognitive empathy. For those high in these facets of schizotypy, worse sleep quality was associated with better self-reported cognitive empathy. These results suggest that the individual facets of schizotypy provide additional information and, therefore, are important to assess when examining social cognition and sleep.
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Affiliation(s)
- Lillian A Hammer
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi
| | - Cassi R Springfield
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi
| | - Caitlan A Tighe
- Department of Psychology, Providence College, Providence, Rhode Island
| | - Sophia Oswalt
- Department of Counseling, Educational Psychology, and Foundations, Mississippi State University, Mississippi State, Mississippi
| | - Kelsey A Bonfils
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi
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Schwartzman JM, Roth MC, Paterson AV, Jacobs AX, Williams ZJ. Community-guided, autism-adapted group cognitive behavioral therapy for depression in autistic youth (CBT-DAY): Preliminary feasibility, acceptability, and efficacy. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023:13623613231213543. [PMID: 38009186 PMCID: PMC11128473 DOI: 10.1177/13623613231213543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
LAY ABSTRACT Depression in youth is a significant public health problem worldwide, particularly for autistic youth who are over twice as likely to experience depression than their non-autistic peers. Although pathways to depression are complex, emotional reactivity and negative self-esteem are two risk factors for depression in autistic and non-autistic youth. Although autistic youth are more likely to experience depression than their non-autistic peers, psychotherapy options for autistic youth are very limited; community guidance in the development and testing of psychotherapy programs is a promising approach in autism. Therefore, in this study, we designed an autism-adapted CBT-DAY, in collaboration with autistic community members. Specifically, CBT-DAY combined neurodiversity-affirming and cognitive behavioral approaches to target emotional reactivity and self-esteem in youth to improve depressive symptom severity in a group setting across 12 weeks. We examined the preliminary feasibility, acceptability, and efficacy of CBT-DAY in a pilot non-randomized trial. In addition, we implemented a rigorous protocol for assessing, monitoring, and addressing potential harms in this intervention. Results from 24 autistic youth (11-17 years old) suggest that CBT-DAY may be feasible to use in an outpatient clinical setting and generally acceptable to youth and their caregivers. Participation in CBT-DAY may be associated with significant improvements in youth emotional reactivity and self-esteem, as well as depressive symptom severity per self-report only. Exploratory analyses showed that participation in CBT-DAY may also be associated with significant improvements in internalizing symptoms. Findings demonstrate the potential promise of neurodiversity-affirming and cognitive behavioral approaches to treating depressive symptoms in some autistic youth.
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6
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Wichers RH, van der Wouw LC, Brouwer ME, Lok A, Bockting CLH. Psychotherapy for co-occurring symptoms of depression, anxiety and obsessive-compulsive disorder in children and adults with autism spectrum disorder: a systematic review and meta-analysis. Psychol Med 2023; 53:17-33. [PMID: 36404645 DOI: 10.1017/s0033291722003415] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Individuals with autism spectrum disorder (ASD) struggle accessing psychotherapy services for comorbidities, including anxiety-, depressive- and obsessive-compulsive disorders (OCD). Apart from cognitive behavioural therapy (CBT) for anxiety in children with ASD, it is unclear whether psychotherapy is effective for these comorbid disorders.We therefore systematically reviewed any form of psychotherapy for co-occurring symptoms of anxiety, depression and OCD in individuals with ASD.Database searches were conducted until February 2022 using EMBASE, PsycINFO and PubMed. Randomised controlled trials (RCT) were included investigating any form of psychotherapy for symptoms of anxiety, depression and OCD in individuals with ASD. Summary data were extracted, and random-effects meta-analyses were conducted.For CBT 26 RCTs (n = 1251), and for social skills training (SST) 11 RCTs (n = 475) met criteria for inclusion. Pooled effect sizes indicated a moderate reduction of anxiety in children (g = -0.70) and a small reduction of depressive symptoms in adults (g = -0.39). For SST overall effect sizes were small for reduction of anxiety in children (g = -0.35) and adults (g = -0.34) and moderate for reduction of depressive symptoms in children (g = -0.50). Risk of bias was high in 18, moderate in 16 and low in 3 RCTs.Our results provide new and age-specific evidence that: (1) CBT is effective for reducing anxiety in children and to a lesser extent for depressive symptoms in adults with ASD; and (2) social skills interventions are effective for reducing anxiety in children and adults and for depressive symptoms in children with ASD.
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Affiliation(s)
- Robert H Wichers
- Amsterdam UMC - Locatie AMC: Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Lisa C van der Wouw
- Amsterdam UMC - Locatie AMC: Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Marlies E Brouwer
- Amsterdam UMC - Locatie AMC: Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Anja Lok
- Amsterdam UMC - Locatie AMC: Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Claudi L H Bockting
- Amsterdam UMC - Locatie AMC: Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
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Chancel R, Miot S, Dellapiazza F, Baghdadli A. Group-based educational interventions in adolescents and young adults with ASD without ID: a systematic review focusing on the transition to adulthood. Eur Child Adolesc Psychiatry 2022; 31:1-21. [PMID: 32889578 DOI: 10.1007/s00787-020-01609-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022]
Abstract
There is a growing number of young people, diagnosed with an autism-spectrum disorder (ASD), transitioning to adulthood. Among this number, individuals without an intellectual disability have significant adaptive deficits and need individualized care and support services to better target vocational, social, and educational prospects and outcomes. Group-based interventions, including patient education, social-skills training, and cognitive-behavioral therapy, are widely used in clinical settings to improve the daily life and prospects of ASD individuals facing the challenge of transitioning to adulthood. We performed a systematic review of studies concerning the efficiency of group-based educational interventions with a focus on the transition to adulthood for young, ASD individuals without intellectual disability (ID). As a result of this systematic search, 21 studies out of 163 were found to be eligible for inclusion. We observed considerable heterogeneity across the studies, in terms of effect sizes and intervention design, delivery, and the comparison of controls. Strong evidence was found in favor of social-skills training and cognitive-behavioral therapy interventions. Professionals should consider group-based psychoeducational intervention to be an appropriate and relevant service for young subjects with ASD without ID transitioning to adulthood. Further research is needed on larger samples using multicentric designs to validate efficacy before generalization.
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Affiliation(s)
- Raphael Chancel
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France.,Faculté de Médecine, Université de Montpellier, Montpellier, France
| | - Stephanie Miot
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.,Gerontology Centre, Antonin Balmès, University Hospital of Montpellier, CHU de Montpellier, Université de Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier, France
| | - Florine Dellapiazza
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France
| | - Amaria Baghdadli
- Centre de Ressource Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neurodéveloppementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France. .,Faculté de Médecine, Université de Montpellier, Montpellier, France. .,Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.
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A School-Based Approach to Building Resilience and Mental Health Among Adolescents on the Autism Spectrum: A Longitudinal Mixed Methods Study. SCHOOL MENTAL HEALTH 2022. [DOI: 10.1007/s12310-022-09501-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractTackling mental health difficulties in adolescents on the autism spectrum requires a comprehensive prevention approach. A 3-year multisite proof-of-concept longitudinal study implemented an evidence-based multilevel resilience intervention in schools to promote protective factors at the adolescent, parent, and school level. The intervention, consisting of the adolescent, parent and teacher components of the Resourceful Adolescent Program–Autism Spectrum Disorder (RAP-ASD) augmented with the Index for Inclusion, was implemented in 6 secondary schools with 30 adolescents with an autism diagnosis in Grades 7 and 8, 31 parents of 23 of the adolescents, and school staff. The intervention was implemented with good validity and acceptability. Quantitative data from adolescents and parents were analysed using the Reliable Change Index, and qualitative data were analysed using Consensual Qualitative Research. Triangulated quantitative and qualitative outcomes from the majority of adolescents and their parents showed some evidence for promoting resilience for adolescents with a diagnosis or traits of autism, as reflected in reliable improvements in coping self-efficacy and school connectedness, and a reduction in anxiety symptoms and emotional and behavioural difficulties. A reliable improvement in depressive symptoms was more modest and was only achieved by a small minority of adolescents. This multilevel, strength-focused, resilience-building approach represents a promising and sustainable school-based primary prevention program to improve the quality of life for adolescents on the spectrum by promoting their mental health and providing their families with much needed support.
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Schwartzman JM, Williams ZJ, Corbett BA. Diagnostic- and sex-based differences in depression symptoms in autistic and neurotypical early adolescents. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:256-269. [PMID: 34180264 PMCID: PMC8710183 DOI: 10.1177/13623613211025895] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
LAY ABSTRACT Depression is more common in autistic adolescents than their neurotypical peers, but the effects of diagnosis and sex on the severity and types of depressive symptoms remain unclear. The study explored diagnostic- and sex-based differences in depressive symptoms in 212 autistic and neurotypical early adolescents. Results show that autism spectrum disorder and female may pose elevated risks, and depressive symptoms related to interpersonal problems and negative self-esteem are more frequent in autism spectrum disorder. Autistic males and females endorsed similar severity and type of depressive symptoms, but unique differences emerged when compared to sex-matched neurotypical peers. Exploratory analyses in a clinical subsample of early adolescents with elevated depressive symptoms (Children's Depression Inventory, Second Edition, Total T-score ⩾60) revealed more endorsement of beliefs of worthlessness in autistic early adolescents. Findings suggest initial intervention targets for treating depression in autistic early adolescents.
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Affiliation(s)
- Jessica M. Schwartzman
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Zachary J. Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN
- Department of Hearing & Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Brain Institute, Vanderbilt University School of Medicine, Nashville, TN
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN
| | - Blythe A. Corbett
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, TN
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN
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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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Eadeh HM, Breaux R, Nikolas MA. A Meta-Analytic Review of Emotion Regulation Focused Psychosocial Interventions for Adolescents. Clin Child Fam Psychol Rev 2021; 24:684-706. [PMID: 34275057 PMCID: PMC8600935 DOI: 10.1007/s10567-021-00362-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 01/19/2023]
Abstract
Emotion regulation (ER) is the ability to monitor, evaluate, and modify one's emotional responses to be appropriate for environmental demands. Poor ER has been considered a transdiagnostic risk factor for a range of internalizing and externalizing disorders and overall decreased well-being in adolescents. A range of evidence-based interventions exist which may improve ER. However, much of the intervention research to date does not include a measure of ER to assess change pre and post treatment, with limited information about the efficacy of these interventions in youth across a range of sample types. There is a clear need for a comprehensive review of the literature examining ER-focused interventions in adolescents with a wide range of presenting disorders. A literature search was originally conducted in January 2020 and an updated search was conducted in February 2021 which elicited 1245 articles, of which 605 were duplicates and were removed. Abstracts of the remaining 640 articles were screened with 121 articles being reviewed in full. Of note, 16 additional articles were identified through references and other sources during this process and were also included in the full review. Of the 137 articles reviewed in full, 41 studies were ultimately included in the present review. The present paper provides a descriptive review of intervention approaches and findings from community prevention programs, programs for war-affected youth, programs for clinical populations, and programs for incarcerated and delinquent adolescents. The overall pooled effect was significantly different from zero based on the pre/post effects [Hedge's g = 0.29, 95% CI (0.22, 0.36)] and the intervention/control effects [Hedge's g = 0.19, 95% CI (0.06-0.32)]. Although neither sex nor age significantly accounted for heterogeneity in effect sizes, there were significant findings for population type (clinical vs. community), with community samples having significantly lower effect sizes on average. Impacts of the different ER measures used and significant methodological variability (e.g., use of control groups, length of intervention) across included studies are discussed. Implications and suggestions for future research are reviewed, specifically, that additional understanding of moderators of effects are needed and that measures used to assess change in ER, both dysregulation and adaptive skill use, may need to more directly align with the intervention's focus and the strategies taught as part of the intervention.
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Affiliation(s)
- Hana-May Eadeh
- Department of Psychological and Brain Sciences, University of Iowa, 340 Iowa Ave, Iowa City, IA, 52242, USA.
| | - Rosanna Breaux
- Department of Psychology, Virginia Tech, Blacksburg, VA, USA
| | - Molly A Nikolas
- Department of Psychological and Brain Sciences, University of Iowa, 340 Iowa Ave, Iowa City, IA, 52242, USA
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12
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Ventrolateral prefrontal hemodynamic responses in autism spectrum disorder with and without depression. PLoS One 2021; 16:e0256780. [PMID: 34449833 PMCID: PMC8396790 DOI: 10.1371/journal.pone.0256780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 08/14/2021] [Indexed: 11/25/2022] Open
Abstract
In clinical settings, autism spectrum disorder (ASD) with comorbid depression is often difficult to diagnose, and should be considered in treatment. However, to our knowledge, no functional imaging study has examined the difference between ASD adolescents with and without comorbid depression. We aimed to compare the characteristics and prefrontal brain function of ASD with and without depression in order to identify a biological marker that can be used to detect the difference. Twenty-eight drug-naïve adolescents with ASD (14 ASD with and 14 ASD without depression) and 14 age- and gender-matched adolescents with typical development were evaluated using several variables. These included intelligence quotient, autism quotient, depression severity using the Beck Depression Inventory 2nd edition (BDI-II), and level of social functioning using the Social Adaptation Self-evaluation Scale (SASS). In addition, frontotemporal hemodynamic responses during a verbal fluency task (VFT) were measured using functional near-infrared spectroscopy (fNIRS). The ASD group, including both of the ASD with and ASD without depression groups, showed smaller hemodynamic responses than the typical development group in portions of the left dorsolateral prefrontal cortex (DLPFC), bilateral ventrolateral prefrontal cortex (VLPFC) and anterior part of the temporal cortex (aTC) during the VFT. Moreover, the smaller hemodynamic responses in the right VLPFC during the VFT in the ASD group were associated with the worse BDI-II and SASS scores. Furthermore, the ASD with depression group showed smaller hemodynamic responses in the right VLPFC during the VFT than the ASD without depression group in a direct comparison. Adolescents with ASD showed reduced activation in broad frontotemporal regions during a cognitive task compared with those with typical development. More specifically, the right VLPFC activation reflected the level of self-estimated depression and social functioning in the ASD subjects, and could be used to discriminate between ASD adolescents with and without depression.
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Cameron LA, Phillips K, Melvin GA, Hastings RP, Gray KM. Psychological interventions for depression in children and young people with an intellectual disability and/or autism: systematic review. Br J Psychiatry 2021; 218:305-314. [PMID: 33198825 DOI: 10.1192/bjp.2020.226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Children and young people with intellectual disability and/or Autism Spectrum Disorder (autism) experience higher rates of mental health problems, including depression, than their typically developing peers. Although international guidelines suggest psychological therapies as first-line intervention for children and young people, there is limited evidence for psychological therapy for depression in children and young people with intellectual disability and/or autism. AIMS To evaluate the current evidence base for psychological interventions for depression in children and young people with intellectual disability and/or autism, and examine the experiences of children and young people with intellectual disability and/or autism, their families and therapists, in receiving and delivering psychological treatment for depression. METHOD Databases were searched up to 30 April 2020 using pre-defined search terms and criteria. Articles were independently screened and assessed for risk of bias. Data were synthesised and reported in a narrative review format. RESULTS A total of 10 studies met the inclusion criteria. Four identified studies were clinical case reports and six were quasi-experimental or experimental studies. All studies were assessed as being of moderate or high risk of bias. Participants with intellectual disability were included in four studies. There was limited data on the experiences of young people, their families or therapists in receiving or delivering psychological treatment for depression. CONCLUSIONS Well-designed, randomised controlled trials are critical to develop an evidence base for psychological treatment for young people with intellectual disability and/or autism with depression. Future research should evaluate the treatment experiences of young people, their families and therapists.
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Affiliation(s)
- Lauren A Cameron
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - Katelyn Phillips
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University; and Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales Medicine, The University of New South Wales, Australia
| | - Glenn A Melvin
- School of Psychology, Deakin University, Australia; and Centre for Education, Appraisal and Research, University of Warwick, UK
| | - Richard P Hastings
- Centre for Education, Appraisal and Research, University of Warwick, UK; and Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
| | - Kylie M Gray
- Centre for Education, Appraisal and Research, University of Warwick, UK; and Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Australia
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Abstract
Individuals with autism experience substantially higher rates of mood problems compared to the general population, which contribute to reduced quality of life and increased mortality through suicide. Here, we reviewed evidence for the clinical presentation, aetiology and therapeutic approaches for mood problems in autism. We identified a lack of validated tools for accurately identifying mood problems in individuals with autism, who may present with 'atypical' features (e.g. severe irritability). Risk factors for mood problems in autism appear to be largely overlapping with those identified in the general population, including shared genetic, environmental, cognitive, physiological/neurobiological mechanisms. However, these mechanisms are exacerbated directly/indirectly by lived experiences of autism, including increased vulnerability for chronic stress - often related to social-communication difficulties(/bullying) and sensory sensitivities. Lastly, current therapeutic approaches are based on recommendations for primary mood disorders, with little reference to the neurobiological/cognitive differences associated with autism. Thus, we recommend: 1) the development and validation of (objective) tools to identify mood problems in autism and measure therapeutic efficacy; 2) an interactive approach to investigating aetiologies in large-scale longitudinal studies, integrating different levels of analysis (e.g. cognitive, neurobiological) and lived experience; 3) testing potential treatments through high-quality (e.g. sufficiently powered, blinded) clinical trials, specifically for individuals with autism.
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Affiliation(s)
- Bethany Oakley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK
| | - Eva Loth
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK
| | - Declan G Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK.,South London and Maudsley NHS Foundation Trust (SLaM), London, UK.,Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, UK
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15
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A Systematic Review of the Perceived Barriers and Facilitators to Accessing Psychological Treatment for Mental Health Problems in Individuals on the Autism Spectrum. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020. [DOI: 10.1007/s40489-020-00226-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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16
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England-Mason G. Emotion Regulation as a Transdiagnostic Feature in Children with Neurodevelopmental Disorders. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2020. [DOI: 10.1007/s40474-020-00200-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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17
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Hillman K, Dix K, Ahmed K, Lietz P, Trevitt J, O'Grady E, Uljarević M, Vivanti G, Hedley D. Interventions for anxiety in mainstream school-aged children with autism spectrum disorder: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2020; 16:e1086. [PMID: 37131419 PMCID: PMC8356281 DOI: 10.1002/cl2.1086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Kylie Hillman
- Australian Council for Educational ResearchCamberwellVictoriaAustralia
| | - Katherine Dix
- Australian Council for Educational ResearchAdelaideSouth AustraliaAustralia
| | - Kashfee Ahmed
- Australian Council for Educational ResearchAdelaideSouth AustraliaAustralia
| | - Petra Lietz
- Australian Council for Educational ResearchAdelaideSouth AustraliaAustralia
| | - Jenny Trevitt
- Australian Council for Educational ResearchCamberwellVictoriaAustralia
| | - Elizabeth O'Grady
- Australian Council for Educational ResearchCamberwellVictoriaAustralia
| | - Mirko Uljarević
- Division of Child and Adolescent Psychiatry, Stanford Autism Center, Department of Psychiatry and Behavioral Sciences, School of MedicineStanford UniversityPalo AltoCalifornia
| | - Giacomo Vivanti
- A. J. Drexel Autism InstituteDornsife School of Public Health, Drexel UniversityPhiladelphiaPennsylvania
| | - Darren Hedley
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health and EngineeringLaTrobe UniversityBundooraVictoriaAustralia
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18
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Lake JK, Tablon Modica P, Chan V, Weiss JA. Considering efficacy and effectiveness trials of cognitive behavioral therapy among youth with autism: A systematic review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1590-1606. [PMID: 32423224 DOI: 10.1177/1362361320918754] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
LAY ABSTRACT Cognitive behavioral therapy is a common treatment for emotional problems in people with autism. Most studies of cognitive behavioral therapy and autism have focused on efficacy, meaning whether a treatment produces results under "ideal" conditions, like a lab or research setting. Effectiveness trials, by contrast, investigate whether a treatment produces results under "real-world" conditions, like a community setting (e.g. hospital, community mental health center, school). There can be challenges in bringing a cognitive behavioral therapy treatment out of a lab or research setting into the community, and the field of implementation science uses frameworks to help guide researchers in this process. In this study, we reviewed efficacy and effectiveness studies of cognitive behavioral therapy treatments for emotional problems (e.g. anxiety, depression) in children and youth with autism. Our search found 2959 articles, with 33 studies meeting our criteria. In total, 13 studies were labelled as effectiveness and 20 as efficacy. We discuss how the effectiveness studies used characteristics of an implementation science framework, such as studying how individuals learn about the treatment, accept or reject it, how it is used in the community over time, and any changes that happened to the individual or the organization (e.g. hospital, school, community mental health center) because of it. Results help us better understand the use of cognitive behavioral therapy in the community, including how a framework can be used to improve effectiveness studies.
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Affiliation(s)
- Johanna K Lake
- Centre for Addiction and Mental Health, Canada.,University of Toronto, Canada
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19
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Lamash L, Josman N. Full-information factor analysis of the Daily Routine and Autonomy (DRA) questionnaire among adolescents with autism spectrum disorder. J Adolesc 2020; 79:221-231. [PMID: 31986477 DOI: 10.1016/j.adolescence.2020.01.011] [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] [Received: 11/26/2018] [Revised: 12/31/2019] [Accepted: 01/14/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Adolescents with autism spectrum disorder (ASD) show poor independence in daily activities. Unlike existing instruments, the innovative self-report Daily Routine and Autonomy questionnaire (DRA) addresses their level of and desire for independence in activities throughout a full daily routine. This study describes the DRA development, explores its psychometric properties and internal consistency reliability using full-information factor analysis (FIFA), and identifies levels of and desire for independence among adolescents with ASD. METHODS Seventy-two Israeli adolescents with ASD (58 boys and 14 girls) aged 11-19 years (M = 14.59, SD = 1.61) completed the DRA. Statistical analyses were performed using SPSS and R. Internal consistency reliability, FIFA, Spearman's correlations, t-tests, and Wilcoxon signed-rank were conducted to assess relationships and differences between the DRA parts. RESULTS The FIFA revealed three factors with high sum-of-squared loadings (4.09-5.13). Of the 31 DRA items, 28 had factor loadings higher than 0.35 and were retained in the study questionnaire. The DRA had moderate-to-high internal reliability for factors (α = 0.65-0.84) and total scores (α = 0.86-0.90). Participants showed partial independence in most daily activities, with high desire for independence in social and leisure activities. Significant gaps in half of the DRA items indicate the participants' desire for independence was significantly higher than their independence level. CONCLUSION The DRA provides crucial information about levels of and desire for autonomy that can be used to promote participation of adolescents with ASD in setting their own goals for independent living.
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Affiliation(s)
- Liron Lamash
- Department of Occupational Therapy, University of Haifa, Haifa, Israel.
| | - Naomi Josman
- Department of Occupational Therapy, University of Haifa, Haifa, Israel
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20
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Meta-Analysis: 13-Year Follow-up of Psychotherapy Effects on Youth Depression. J Am Acad Child Adolesc Psychiatry 2020; 59:45-63. [PMID: 31004739 DOI: 10.1016/j.jaac.2019.04.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/25/2019] [Accepted: 04/12/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Youth depression is a debilitating condition that constitutes a major public health concern. A 2006 meta-analysis found modest benefits for psychotherapy versus control. Has 13 more years of research improved that picture? We sought to find out. METHOD We searched PubMed, PsychINFO, and Dissertation Abstracts International for 1960 to 2017, identifying 655 randomized, English-language psychotherapy trials for individuals aged 4 to 18 years. Of these, 55 assessed psychotherapy versus control for youth depression with outcome measures administered to both treatment and control conditions at post (κ = 53) and/or follow-up (κ = 32). Twelve study and outcome characteristics were extracted, and effect sizes were calculated for all psychotherapy versus control comparisons. Using a three-level random-effects model, we obtained an overall estimate of the psychotherapy versus control difference while accounting for the dependency among effect sizes. We then fitted a three-level mixed-effects model to identify moderators that might explain variation in effect size within and between studies. RESULTS The overall effect size (g) was 0.36 at posttreatment and 0.21 at follow-up (averaging 42 weeks after posttreatment). Three moderator effects were identified: effects were significantly larger for interpersonal therapy than for cognitive behavioral therapy, for youth self-reported outcomes than parent-reports, and for comparisons with inactive control conditions (eg, waitlist) than active controls (eg, usual care). Effects showed specificity, with significantly smaller effects for anxiety and externalizing behavior outcomes than for depression measures. CONCLUSION Youth depression psychotherapy effects are modest, with no significant change over the past 13 years. The findings highlight the need for treatment development and research to improve both immediate and longer-term benefits.
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21
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Russell A, Gaunt D, Cooper K, Horwood J, Barton S, Ensum I, Ingham B, Parr J, Metcalfe C, Rai D, Kessler D, Wiles N. Guided self-help for depression in autistic adults: the ADEPT feasibility RCT. Health Technol Assess 2019; 23:1-94. [PMID: 31856942 PMCID: PMC6943380 DOI: 10.3310/hta23680] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Co-occurring depression frequently occurs in autism. Evidence-based psychological interventions have been successfully adapted to treat co-occurring anxiety, but there is little evidence about the usefulness of adapted cognitive-behavioural therapy for depression. To the authors' knowledge, to date there have been no randomised trials investigating the usefulness of low-intensity cognitive-behavioural therapy for depression in autism. OBJECTIVES The objectives of the study were to (1) develop a low-intensity psychological intervention for depression adapted for autism, (2) assess the feasibility and patient and therapist acceptability of the intervention, (3) estimate the rates of recruitment and retention for a full-scale randomised controlled trial and (4) identify an appropriate measure of depression to be used in a full-scale randomised controlled trial. DESIGN The study comprised a randomised controlled trial (n = 70) with a nested qualitative evaluation (n = 21). Seventy eligible and consenting participants were randomly allocated to guided self-help or to treatment as usual. SETTING Adult autism services in two NHS regions. PARTICIPANTS Adults with a diagnosis of autism spectrum disorder with depression, that is, a Patient Health Questionnaire-9 items score of ≥ 10. People who had attended more than six sessions of cognitive-behavioural therapy in the previous 6 months were excluded. INTERVENTIONS The low-intensity intervention (guided self-help) comprised materials for nine individual sessions, based on behavioural activation adapted for autism, facilitated by therapist guides (coaches) who were graduate-level psychologists who attended training and regular supervision. Treatment as usual was standard NHS care for depression. MAIN OUTCOME MEASURES Outcomes were measured 10, 16 and 24 weeks post randomisation using self-report and interview measures of depression, anxiety, obsessive-compulsive symptoms, social function and quality of life, and a health-care and service use questionnaire. As this was a feasibility study also designed to identify the most appropriate measure of depression, it was not possible to specify the primary outcome measure or outcome point a priori. RESULTS The aims of the study were met in full. The guided self-help intervention was feasible and well received by participants and coaches. The majority of allocated participants attended the intervention in full. The most practical outcome point was determined to be 16 weeks. There were differential rates of attrition across the treatment groups: 86% of the guided self-help group remained in the study at 24 weeks, compared with 54% of treatment as usual group. The qualitative study suggested that guided self-help had enhanced credibility with participants at the point of randomisation. Inter-rater reliability of the interview measure of depression was less than adequate, limiting the conclusions that can be drawn from the prespecified sensitivity to change analyses. CONCLUSIONS The intervention was feasible and well received. Although this feasibility study was not a fully powered trial, it provided some evidence that the guided self-help intervention was effective in reducing depressive symptoms. A full-scale clinical effectiveness and cost-effectiveness trial of the intervention is warranted. FUTURE WORK Improvements to the intervention materials as a result of qualitative interviews. Stakeholder consultation to consider future trial design, consider strategies to improve retention in a treatment as usual arm and select a self-report measure of depression to serve as the primary outcome measure. TRIAL REGISTRATION Current Controlled Trials ISRCTN54650760. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 68. See the NIHR Journals Library website for further project information. This study was also supported by the NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol.
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Affiliation(s)
- Ailsa Russell
- Centre for Applied Autism Research, Department of Psychology, Faculty of Humanities and Social Sciences, University of Bath, Bath, UK
| | - Daisy Gaunt
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Cooper
- Centre for Applied Autism Research, Department of Psychology, Faculty of Humanities and Social Sciences, University of Bath, Bath, UK
| | - Jeremy Horwood
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Stephen Barton
- Newcastle Cognitive and Behavioural Therapies Centre, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ian Ensum
- BASS Adult Autism Service, Avon & Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - Barry Ingham
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jeremy Parr
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Metcalfe
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Dheeraj Rai
- School of Social and Community Medicine, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Kessler
- School of Social and Community Medicine, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicola Wiles
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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22
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Russell A, Gaunt DM, Cooper K, Barton S, Horwood J, Kessler D, Metcalfe C, Ensum I, Ingham B, Parr JR, Rai D, Wiles N. The feasibility of low-intensity psychological therapy for depression co-occurring with autism in adults: The Autism Depression Trial (ADEPT) - a pilot randomised controlled trial. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 24:1360-1372. [PMID: 31782656 PMCID: PMC8645299 DOI: 10.1177/1362361319889272] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low-intensity cognitive behaviour therapy including behavioural activation is an evidence-based treatment for depression, a condition frequently co-occurring with autism. The feasibility of adapting low-intensity cognitive behaviour therapy for depression to meet the needs of autistic adults via a randomised controlled trial was investigated. The adapted intervention (guided self-help) comprised materials for nine individual sessions with a low-intensity psychological therapist. Autistic adults (n = 70) with depression (Patient Health Questionnaire-9 score ⩾10) recruited from National Health Service adult autism services and research cohorts were randomly allocated to guided self-help or treatment as usual. Outcomes at 10-, 16- and 24-weeks post-randomisation were blind to treatment group. Rates of retention in the study differed by treatment group with more participants attending follow-up in the guided self-help group than treatment as usual. The adapted intervention was well-received, 86% (n = 30/35) of participants attended the pre-defined 'dose' of five sessions of treatment and 71% (25/35) attended all treatment sessions. The findings of this pilot randomised controlled trial indicate that low-intensity cognitive behaviour therapy informed by behavioural activation can be successfully adapted to meet the needs of autistic people. Evaluation of the effectiveness of this intervention in a full scale randomised controlled trial is now warranted.
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Affiliation(s)
| | | | | | | | | | | | | | - Ian Ensum
- Avon and Wiltshire Mental Health Partnership NHS Trust, UK
| | - Barry Ingham
- Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Jeremy R Parr
- Northumberland, Tyne and Wear NHS Foundation Trust, UK.,Newcastle University, UK
| | - Dheeraj Rai
- University of Bristol, UK.,Avon and Wiltshire Mental Health Partnership NHS Trust, UK
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23
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Abstract
Depression is both common and impactful in youth with autism spectrum disorder (ASD) and is swiftly growing in recognition as a major public health concern within the autism community. This article is intended to provide a brief overview of the prevalence, impact, presentation, and risk factors associated with cooccurring depression in children and adolescents with ASD. Clinical guidelines for the assessment and treatment of depression in the ASD population are offered in line with the small existing evidence base.
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24
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Outcomes of a Robot-Assisted Social-Emotional Understanding Intervention for Young Children with Autism Spectrum Disorders. J Autism Dev Disord 2019; 50:1973-1987. [DOI: 10.1007/s10803-019-03953-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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25
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Menezes M, Robinson L, Sanchez MJ, Cook B. Depression in Youth with Autism Spectrum Disorders: a Systematic Review of Studies Published Between 2012 and 2016. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2018. [DOI: 10.1007/s40489-018-0146-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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26
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Lord C, Elsabbagh M, Baird G, Veenstra-Vanderweele J. Autism spectrum disorder. Lancet 2018; 392:508-520. [PMID: 30078460 PMCID: PMC7398158 DOI: 10.1016/s0140-6736(18)31129-2] [Citation(s) in RCA: 897] [Impact Index Per Article: 149.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 04/19/2018] [Accepted: 05/02/2018] [Indexed: 12/20/2022]
Abstract
Autism spectrum disorder is a term used to describe a constellation of early-appearing social communication deficits and repetitive sensory-motor behaviours associated with a strong genetic component as well as other causes. The outlook for many individuals with autism spectrum disorder today is brighter than it was 50 years ago; more people with the condition are able to speak, read, and live in the community rather than in institutions, and some will be largely free from symptoms of the disorder by adulthood. Nevertheless, most individuals will not work full-time or live independently. Genetics and neuroscience have identified intriguing patterns of risk, but without much practical benefit yet. Considerable work is still needed to understand how and when behavioural and medical treatments can be effective, and for which children, including those with substantial comorbidities. It is also important to implement what we already know and develop services for adults with autism spectrum disorder. Clinicians can make a difference by providing timely and individualised help to families navigating referrals and access to community support systems, by providing accurate information despite often unfiltered media input, and by anticipating transitions such as family changes and school entry and leaving.
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Affiliation(s)
- Catherine Lord
- Center for Autism and the Developing Brain, NewYork-Presbyterian Hospital, Weill Cornell Medicine, Cornell University, White Plains, NY, USA.
| | - Mayada Elsabbagh
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Gillian Baird
- Evelina Children's Hospital, King's Health Partners, London, UK
| | - Jeremy Veenstra-Vanderweele
- Division of Child and Adolescent Psychiatry, Center for Autism and the Developing Brain, NewYork-Presbyterian Hospital, Department of Psychiatry, Columbia University, New York State Psychiatric Institute, White Plains, NY, USA
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27
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Maughan AL, Weiss JA. Parental Outcomes Following Participation in Cognitive Behavior Therapy for Children with Autism Spectrum Disorder. J Autism Dev Disord 2018; 47:3166-3179. [PMID: 28762160 DOI: 10.1007/s10803-017-3224-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Children with autism spectrum disorder (ASD) benefit from parent involvement in their therapy, and there is evidence that this involvement may improve parent functioning as well. We examined changes in parent mental health, parenting, and expressed emotion, following participation in a randomized controlled trial of cognitive behavior therapy for 57 children with ASD. Post-intervention, improvements occurred in the treatment group in parent depression and emotion regulation, compared to waitlisted parents. Treatment effects also occurred across all parents in depression, emotion regulation, perceptions of their children and mindful parenting. Though preliminary, these results have implications for intervention development and evaluation by focusing on parent outcomes in child treatment.
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Affiliation(s)
- Andrea L Maughan
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Jonathan A Weiss
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
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28
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A Pilot Randomised Controlled Trial of a School-Based Resilience Intervention to Prevent Depressive Symptoms for Young Adolescents with Autism Spectrum Disorder: A Mixed Methods Analysis. J Autism Dev Disord 2018; 47:3458-3478. [PMID: 28770525 DOI: 10.1007/s10803-017-3263-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite increased depression in adolescents with Autism Spectrum Disorder (ASD), effective prevention approaches for this population are limited. A mixed methods pilot randomised controlled trial (N = 29) of the evidence-based Resourceful Adolescent Program-Autism Spectrum Disorder (RAP-A-ASD) designed to prevent depression was conducted in schools with adolescents with ASD in years 6 and 7. Quantitative results showed significant intervention effects on parent reports of adolescent coping self-efficacy (maintained at 6 month follow-up) but no effect on depressive symptoms or mental health. Qualitative outcomes reflected perceived improvements from the intervention for adolescents' coping self-efficacy, self-confidence, social skills, and affect regulation. Converging results remain encouraging given this population's difficulties coping with adversity, managing emotions and interacting socially which strongly influence developmental outcomes.
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29
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Keefer A, White SW, Vasa RA, Reaven J. Psychosocial interventions for internalizing disorders in youth and adults with ASD. Int Rev Psychiatry 2018. [PMID: 29537895 DOI: 10.1080/09540261.2018.1432575] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Internalizing disorders are common in individuals with ASD. Psychosocial interventions targeting these disorders in the ASD population have burgeoned in the last decade. Cognitive-behavioural therapy, modified for ASD, is the most frequently investigated model, although other interventions, including behaviour therapy, third-wave interventions, models targeting transdiagnostic constructs, and alternative interventions and treatment delivery methods are now emerging. This review provides a summary of the efficacy of these interventions in treating internalizing disorders in youth and adults with ASD. The barriers to accessing these treatments, which are experienced by many individuals with ASD and their families, as well as future research directions, are also discussed.
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Affiliation(s)
- Amy Keefer
- a Center for Autism and Related Disorders , Kennedy Krieger Institute , Baltimore , MD , USA.,b Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Susan W White
- c Department of Psychology , Virginia Tech , Blacksburg , VA , USA
| | - Roma A Vasa
- a Center for Autism and Related Disorders , Kennedy Krieger Institute , Baltimore , MD , USA.,b Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Judy Reaven
- d Department of Psychiatry , University of Colorado Anschutz Medical Campus , Aurora , CO , USA
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30
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Russell A, Cooper K, Barton S, Ensum I, Gaunt D, Horwood J, Ingham B, Kessler D, Metcalfe C, Parr J, Rai D, Wiles N. Protocol for a feasibility study and randomised pilot trial of a low-intensity psychological intervention for depression in adults with autism: the Autism Depression Trial (ADEPT). BMJ Open 2017; 7:e019545. [PMID: 29203509 PMCID: PMC5736092 DOI: 10.1136/bmjopen-2017-019545] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 09/29/2017] [Accepted: 10/05/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION High rates of co-occurring depression are reported in autism spectrum disorder (ASD), a neurodevelopmental condition characterised by social communication impairments and repetitive behaviours. Cognitive-behavioural interventions adapted for ASD have been effective for anxiety problems. There have been evaluation studies of group cognitive-behavioural therapy for co-occurring depression, but no randomised trials investigating low-intensity psychological interventions as recommended in clinical guidelines for mild-moderate depression. METHODS AND ANALYSIS A feasibility study comprising a randomised controlled trial (RCT) and nested qualitative evaluation is under way as preparation for a definitive RCT. Participants (n=70) will be randomised to Guided Self-Help: a low-intensity psychological intervention based on behavioural activation adapted for ASD or treatment as usual. Outcomes including depression symptoms, anxiety, social function and service use will be measured at 10, 16 and 24 weeks postrandomisation and will be blind to group allocation for measures that are not self-administered. The analysis will aim to establish the rates of recruitment and retention for a larger-scale RCT as well as the most appropriate measure of depression to serve as primary outcome. The qualitative study will purposively sample up to 24 participants from each treatment group to consider the acceptability and feasibility of the intervention and the trial design. ETHICS AND DISSEMINATION Ethical approval has been received from WALES REC 3 (IRAS project ID: 191558) and the Health Research Authority with R&D approval from Avon and Wiltshire Mental Health Partnership and Northumberland, Tyne and Wear Foundation NHS Trusts. To our knowledge, this is the first study of a low-intensity intervention for depression in adults with autism. The results will inform the design of a definitive RCT. Dissemination will include peer-reviewed journal publications reporting the quantitative and qualitative research findings of the study and presentations at national and international conferences. TRIAL REGISTRATION NUMBER ISRCTN54650760; Pre-results.
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Affiliation(s)
- Ailsa Russell
- Department of Psychology, University of Bath, Bath, UK
| | - Kate Cooper
- Department of Psychology, University of Bath, Bath, UK
| | - Stephen Barton
- Newcastle Cognitive and Behaviour Therapies (CBT) Centre, Northumberland Tyne & Wear NHS Foundation Trust, Newcastle upon Tyne, UK
- School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingtom
| | - Ian Ensum
- Bristol Adult Autism Services, Avon and Wiltshire Mental Health Partnership NHS Trust, Chippenham, UK
| | - Daisy Gaunt
- Population Health Sciences, Bristol Randomised Trials Collaboration, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- Population Health Sciences, Bristol Randomised Trials Collaboration, Bristol Medical School, University of Bristol, Bristol, UK
| | - Barry Ingham
- Northumberland, Tyne & Wear NHS Foundation Trust, Northumberland, UK
- Institute of Neuroscience, University of Newcastle, Newcastle, UK
| | - David Kessler
- Population Health Sciences, School of Social and Community Medicine, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- Population Health Sciences, Bristol Randomised Trials Collaboration, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jeremy Parr
- Institute of Neuroscience, University of Newcastle, Newcastle, UK
| | - Dheeraj Rai
- Population Health Sciences, School of Social and Community Medicine, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicola Wiles
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Burkhart K, Knox M, Hunter K. Cognitive-Behavioral Therapy in the Treatment of Internalizing Disorders in High-Functioning Youth with Autism Spectrum Disorder. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2017. [DOI: 10.1007/s10879-017-9374-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Brief Report: Social Support, Depression and Suicidal Ideation in Adults with Autism Spectrum Disorder. J Autism Dev Disord 2017; 47:3669-3677. [DOI: 10.1007/s10803-017-3274-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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The Cooperative Research Centre for Living with Autism (Autism CRC) Conceptual Model to Promote Mental Health for Adolescents with ASD. Clin Child Fam Psychol Rev 2016; 19:94-116. [DOI: 10.1007/s10567-016-0203-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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