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Long EE, Johnson MF, Carpenter LA. Autistic Characteristics, Cognitive Impairment, and Sex as Predictors of Anxiety and Depression among Autistic Youth. J Autism Dev Disord 2024:10.1007/s10803-024-06406-2. [PMID: 39093544 DOI: 10.1007/s10803-024-06406-2] [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] [Accepted: 05/13/2024] [Indexed: 08/04/2024]
Abstract
Although it is well established that autistic youth are at high risk for anxiety and depression, factors associated with heightened risk within this population are poorly understood. The purpose of this study was to evaluate whether autistic characteristics and cognitive impairment interact to predict anxiety and depression symptoms, and whether the impacts of autistic characteristics and cognitive impairment on anxiety and depression differ for male and female children. Participants comprised 7989 youth (M = 11.23 years) enrolled in SPARK, a national cohort of autistic individuals. Autistic characteristics were assessed via the Social Communication Questionnaire. Anxiety and depression were assessed via the Child Behavior Checklist. Linear regressions were conducted to examine associations between autistic characteristics, cognitive impairment, and symptoms and to test for interactions. The effect of parent-reported autistic characteristics on anxiety was stronger for males than for females, while the effect of cognitive impairment on anxiety was stronger for females than for males. A different pattern was observed for depression. The effect of autistic characteristics on depression was the same for males and females, while cognitive impairment was not associated with depression per parent report. Findings indicate that both male and female children with high levels of autistic characteristics are susceptible to experiencing anxiety and depression, and that autistic female children with intact cognitive abilities are uniquely vulnerable to experiencing anxiety based on parent report. Results have implications for the prevention of internalizing problems in autistic youth, and highlight future directions for longitudinal work examining mechanisms of comorbidity.
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Affiliation(s)
- Erin E Long
- Department of Pediatrics, Division of Pediatric Psychology and Developmental Medicine, Medical College of Wisconsin, 8915 W. Connell Ct, Milwaukee, WI, 53226, USA.
| | - Mary F Johnson
- Department of Neuroscience, Neuroscience Administration Research Team, Children's Hospital of Colorado, Aurora, CO, USA
| | - Laura A Carpenter
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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2
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Kim SY, Lecavalier L. Stability and Validity of Self-Reported Depression and Anxiety in Autistic Youth. J Autism Dev Disord 2024:10.1007/s10803-024-06456-6. [PMID: 39001970 DOI: 10.1007/s10803-024-06456-6] [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] [Accepted: 06/24/2024] [Indexed: 07/15/2024]
Abstract
The aim of this study was to assess test-retest reliability and diagnostic validity of self-report instruments of depression and anxiety in autistic youth. Participants were 55 autistic youth aged 8-17 years presenting with depressive or anxiety symptoms. They were interviewed with the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL) and completed the Children's Depression Inventory, Second Edition - Self Report Short (CDI 2:SR[S]) and the Revised Child Anxiety and Depression Scale (RCADS) twice, separated by a two-week interval. Test-retest reliability was measured with intraclass correlation coefficients (ICCs), and diagnostic validity was assessed using receiver operating characteristic (ROC) curves with the summary ratings on the K-SADS-PL as the criterion. The effect of participant characteristics was analyzed through a moderation analysis. Generalized anxiety (GAD) and social anxiety disorder (SOC) were the two most prevalent disorders in the sample. Test-retest reliability for most of the subscales was good (ICC = 0.74 - 0.87), with the exception of the RCADS obsessive-compulsive disorder (OCD) and GAD. The Adaptive Behavior conceptual score was a significant moderator of the reliability of the CDI 2:SR[S]. The ROC analysis suggested the RCADS SOC and the CDI 2:SR[S] to be good screening tools with inadequate specificity when appropriately sensitive cutoff scores are used. Optimal cutoff scores in this sample were lower than originally published. The findings suggest that autistic youth can provide stable reports of anxiety and depressive symptoms over time. Diagnostic validity varied according to the construct and instrument.
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Affiliation(s)
- Soo Youn Kim
- Department of Psychology, The Ohio State University, Columbus, OH, USA
- Nisonger Center, The Ohio State University, Columbus, OH, USA
| | - Luc Lecavalier
- Department of Psychology, The Ohio State University, Columbus, OH, USA.
- Nisonger Center, The Ohio State University, Columbus, OH, USA.
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3
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Fuselier MN, Guzick AG, Bakhshaie J, Wood JJ, Kendall PC, Kerns CM, Small BJ, Goodman WK, Storch EA. Examining the Relationship Between Anxiety Severity and Autism-Related Challenges During Cognitive Behavioral Therapy for Children with Autism. J Autism Dev Disord 2024; 54:1849-1856. [PMID: 36847894 DOI: 10.1007/s10803-023-05912-z] [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: 01/20/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Using data from a randomized clinical trial evaluating cognitive behavioral therapy (CBT) for children with autism and co-occurring anxiety, this study examined the relationship between autism features and anxiety symptoms throughout CBT. METHODS Two multilevel mediation analyses were run which examined the mediating role of changes in anxiety for changes in two core features of autism, (a) repetitive and restrictive behaviors (RRBs) and (b) social communication/interaction impairments, between pre- and post-treatment. RESULTS Indirect effects between time and autism characteristics were significant for both models, indicating that as anxiety changes, so do RRBs and social communication/interaction as the outcomes respectively. CONCLUSION Findings suggest a bidirectional relationship between anxiety and autism features. Implications of these findings are discussed.
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Affiliation(s)
- Madeleine N Fuselier
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX 77030, USA
| | - Andrew G Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX 77030, USA
| | - Jafar Bakhshaie
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey J Wood
- Department of Education, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Connor M Kerns
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Wayne K Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX 77030, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX 77030, USA.
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4
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Guzick AG, Schneider SC, Kook M, Rose Iacono J, Weinzimmer SA, Quast T, Olsen SM, Hughes KR, Jellinek-Russo E, Garcia AP, Candelari A, Berry LN, Goin-Kochel RP, Goodman WK, Storch EA. Parent-Led Cognitive Behavioral Teletherapy for Anxiety in Autistic Youth: A Randomized Trial Comparing Two Levels of Therapist Support. Behav Ther 2024; 55:499-512. [PMID: 38670664 PMCID: PMC11055980 DOI: 10.1016/j.beth.2023.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/24/2023] [Accepted: 08/15/2023] [Indexed: 04/28/2024]
Abstract
Parent-led cognitive behavioral therapy (CBT) is an efficient, promising form of therapy that may be well suited for autistic youth with anxiety disorders, though to date it has been minimally tested. In this study, 87 autistic youth (7 to 13 years old) with anxiety disorders and their parents were randomized to two forms of parent-led CBT in which parents led their child through a guided CBT workbook across 12 weeks: one with low therapist contact (four 30-minute telehealth calls), and one with standard therapist contact (ten 60-minute telehealth calls). Anxiety, functional impairment, and autism features significantly declined across therapy, without differences between groups. High satisfaction was reported in both groups, though significantly higher satisfaction ratings were reported in standard-contact CBT. Responder rates were 69% of completers at posttreatment (70% in standard contact, 68% in low contact) and 86% at 3-month follow-up (86% in standard contact, 87% in low contact). Low-contact CBT was estimated to incur an average cost of $755.70 per family compared with $1,978.34 in standard-contact CBT. Parent-led CBT with minimal or standard therapist contact both appear to be effective CBT delivery formats for autistic youth with anxiety disorders, with significant cost savings for low-contact CBT.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Leandra N Berry
- Baylor College of Medicine, Meyer Center for Developmental Pediatrics and Autism, Texas Children's Hospital
| | - Robin P Goin-Kochel
- Baylor College of Medicine, Meyer Center for Developmental Pediatrics and Autism, Texas Children's Hospital
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5
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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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6
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Baribeau DA, Vigod SN, Pullenayegum E, Kerns CM, Vaillancourt T, Duku E, Smith IM, Volden J, Zwaigenbaum L, Bennett T, Elsabbagh M, Zaidman-Zait A, Richard AE, Szatmari P. Developmental cascades between insistence on sameness behaviour and anxiety symptoms in autism spectrum disorder. Eur Child Adolesc Psychiatry 2023; 32:2109-2118. [PMID: 35871413 DOI: 10.1007/s00787-022-02049-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 07/06/2022] [Indexed: 12/28/2022]
Abstract
Autistic children experience high rates of anxiety. Insistence on sameness behaviour (IS) is a core feature of autism that appears correlated with anxiety severity. The objective of this study was to examine the longitudinal relations between anxiety and IS in autistic children using a developmental cascade model. A longitudinal cohort of 421 autistic children was followed between 4 and 11 years of age. Anxiety was quantified using items from the Anxiety Problems subscale of the Child Behavior Checklist; sameness behaviours were measured using the Repetitive Behavior Scale-Revised, Ritualistic/sameness subscale (both parent-report measures). Structural equation modelling was used to examine the longitudinal and directional associations between anxiety and IS at four time-points, through cross-lagged panel models (CLPM) with and without a random-intercepts component (RI-CLPM). Both the CLPM and the RI-CLPM had good fit. Significant directional associations were detected whereby elevated or increasing IS preceded elevated or increasing anxiety symptoms 1-2 years later, respectively. Stable baseline tendencies towards anxiety and IS as between-person traits (intercepts) were strongly associated (standardized estimate = 0.69, p < 0.001). The magnitude of the cross-sectional associations between anxiety and IS appeared to lessen with age. IS and anxiety symptoms in autism are closely related. They appear to be shared traits that mirror each other particularly in younger children. Increasing IS may be a sign of emerging future anxiety. Interventions that target IS to reduce or prevent anxiety amongst school-aged autistic children merit further study.
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Affiliation(s)
- Danielle A Baribeau
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- The Hospital for Sick Children, Toronto, ON, Canada.
- The Hospital for Sick Children, University of Toronto, 123 Edward Street, 12th floor, Room 1210, Toronto, ON, M5G 1E2, Canada.
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Women's College Hospital and Women's College Research Institute, Toronto, ON, Canada
| | - Eleanor Pullenayegum
- The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Connor M Kerns
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Tracy Vaillancourt
- Counselling Psychology, Faculty of Education, University of Ottawa, Ottawa, ON, Canada
| | - Eric Duku
- Offord Centre for Child Studies, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Isabel M Smith
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
- Autism Research Centre, IWK Health Centre, Halifax, NS, Canada
| | - Joanne Volden
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Teresa Bennett
- Offord Centre for Child Studies, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Mayada Elsabbagh
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Anat Zaidman-Zait
- Department of School Counseling and Special Education at the Constantiner School of Education, Tel Aviv University, Tel Aviv, Israel
- The School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Annie E Richard
- Autism Research Centre, IWK Health Centre, Halifax, NS, Canada
| | - Peter Szatmari
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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7
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Pappagianopoulos J, Rouch E, Mazurek MO. Extracurricular Activity Participation Among Autistic Children and Adolescents: Buffer for Internalizing Conditions and Foundation for Friendship? J Autism Dev Disord 2023:10.1007/s10803-023-06158-5. [PMID: 37898581 DOI: 10.1007/s10803-023-06158-5] [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: 10/10/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE Internalizing conditions, such as anxiety and depression, and difficulties with developing and maintaining friendships are common among autistic children and adolescents. Participation in extracurricular activities may buffer against these challenges as they provide naturalistic opportunities to bring peers with shared interests and skills together. As such, the purpose of the current study was to examine associations between sport and club participation and (1) friendship success and (2) co-occurring anxiety and depression in a large sample of autistic youth. METHODS Secondary analysis was performed using data from the 2018-2019 National Survey of Children's Health. Participants were 562 autistic children (ages 6-11 years) and 818 autistic adolescents (ages 12-17 years). Within each age group, a series of binary logistic regression analyses were conducted. RESULTS Club participation was not associated with friendship or internalizing conditions. However, participation in sports was positively associated with friendship success among both children (OR = 2.07, p = .006) and adolescents (OR = 2.35, p = .001). Results also found that adolescents who participated in sports were 34% less likely to have diagnosis of depression (p = .048). CONCLUSION Findings suggest that participation in sports may play a meaningful role in protecting against depression during adolescence and serve as a context for friendship development across childhood and adolescence. Future research should address barriers to extracurricular activity participation and identify the specific components of sports that are most beneficial to autistic youth to inform activity offerings and the development of interventions targeting friendship formation and mental health outcomes.
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Affiliation(s)
| | - Erica Rouch
- University of Virginia, 417 Emmet St. S, Charlottesville, VA, 22903, USA
| | - Micah O Mazurek
- University of Virginia, 417 Emmet St. S, Charlottesville, VA, 22903, USA
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8
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Fynn G, Porter M, Borchard T, Kazzi C, Zhong Q, Campbell L. The effectiveness of cognitive behavioural therapy for individuals with an intellectual disability and anxiety: a systematic review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:816-841. [PMID: 37291991 DOI: 10.1111/jir.13046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 02/16/2023] [Accepted: 05/12/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Individuals with intellectual disability (ID) are at higher risk of experiencing difficulties with anxiety than the general population. However, there are major barriers for individuals to receive appropriate services. There is a growing understanding of the importance of developing appropriate psychological interventions for this group. The objective of the current review was to systematically evaluate the findings of studies investigating the effectiveness of cognitive behavioural therapy (CBT) for individuals with ID and anxiety. Another aim was to explore which adaptions to CBT and treatment components were currently being utilised within the field. METHOD The electronic databases of CINAHL, EMBASE, Medline, PsycINFO, Psychology and Behavioural Sciences Collection and Scopus were searched to identify relevant studies. The methodological quality of these studies was assessed using established quality assessment tools by the National Institutes of Health for pre and post studies and case series. RESULTS Nine studies were included in this systematic review, all of which reported improvements in anxiety severity for some participants (25%-100%; N = 60) following CBT. Only three studies reported moderate effect sizes for CBT interventions on anxiety for individuals with ID. DISCUSSION AND CONCLUSIONS There is emerging literature supporting the effectiveness of CBT for individuals with mild ID. Findings highlight that CBT for individuals with anxiety and mild ID, including cognitive components, may be feasible and tolerable. While the field is gradually receiving more attention, there are significant methodological flaws present, which limit the conclusions that can be drawn regarding the effectiveness of CBT for individuals with ID. However, there is emerging evidence for techniques such as cognitive restructuring and thought replacement and modifications such as visual aids, modelling and smaller groups based on this review. Future research is warranted to investigate whether individuals with more severe ID can benefit from CBT, as well as further exploring what are the necessary components and modifications.
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Affiliation(s)
- G Fynn
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - M Porter
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - T Borchard
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - C Kazzi
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Q Zhong
- School of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - L Campbell
- School of Psychology, University of Newcastle, Newcastle, New South Wales, Australia
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9
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Hatfield MK, Ashcroft E, Maguire S, Kershaw L, Ciccarelli M. "Stop and just breathe for a minute": perspectives of children on the Autism Spectrum and their caregivers on a Mindfulness Group. J Autism Dev Disord 2023; 53:3394-3405. [PMID: 35771338 PMCID: PMC10465386 DOI: 10.1007/s10803-022-05542-x] [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: 03/18/2022] [Indexed: 10/17/2022]
Abstract
Children on the autism spectrum often experience anxiety. Mindfulness is growing in popularity as a method to support children with anxiety; however, there is limited evidence on mindfulness for children on the autism spectrum. This study investigated the feasibility of a 10-week group-based mindfulness intervention for 14 children on the autism spectrum. A one-group pre-post design determined outcomes of anxiety (caregiver and child report), mindful attention, and wellbeing (child report). Interviews explored children's and caregivers' perceptions. There were no significant differences in outcomes post-intervention. Five themes were identified from interviews: (1) Children felt calmer; (2) Parents observed differences in anxiety; (3) Breathing and yoga helped; (4) Parents wanted more; and (5) Challenges and benefits of group intervention.
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Affiliation(s)
- Megan K Hatfield
- Curtin School of Allied Health, Curtin University, GPO Box U1987, 6845, Perth, Western Australia, Australia.
| | - Emma Ashcroft
- Curtin School of Allied Health, Curtin University, GPO Box U1987, 6845, Perth, Western Australia, Australia
| | - Siobhan Maguire
- Curtin School of Allied Health, Curtin University, GPO Box U1987, 6845, Perth, Western Australia, Australia
| | - Lauren Kershaw
- Curtin School of Allied Health, Curtin University, GPO Box U1987, 6845, Perth, Western Australia, Australia
| | - Marina Ciccarelli
- Curtin School of Allied Health, Curtin University, GPO Box U1987, 6845, Perth, Western Australia, Australia
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10
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Kalvin CB, Jordan R, Rowley S, Weis AL, Ibrahim K, Sukhodolsky DG. Aggression Is Associated With Social Adaptive Functioning in Children With ASD and Anxiety. FOCUS ON AUTISM AND OTHER DEVELOPMENTAL DISABILITIES 2023; 38:168-176. [PMID: 38469453 PMCID: PMC10927274 DOI: 10.1177/10883576231165265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Social adaptive functioning is notably compromised and may be further impaired by aggressive behavior in children with autism spectrum disorder (ASD). This study examined the association between aggressive behavior and social adaptive skills in children with ASD and the contribution of aggressive behavior to social adaptive skills in a combined sample of children with and without ASD. Participants consisted of children, ages 8 to 15 years, with ASD (n = 52) and who were typically developing (n = 29). Results indicate that aggressive behavior is negatively associated with social adaptive skills in children with ASD and that it contributes to reduced social adaptive functioning above and beyond ASD diagnosis. Findings underscore the importance of considering the role of aggressive behavior when evaluating and promoting social functioning in children with ASD.
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11
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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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12
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Arnardóttir ÁÁ, Guðmundsdóttir LÁ, Hannesdóttir DK, Halldórsson F, Auðardóttir H, Sveinbjörnsdóttir B. A Pilot Study on the FEST program - Friendship and Emotional Skills Training for Children on the Autism Spectrum. J Autism Dev Disord 2023:10.1007/s10803-023-06099-z. [PMID: 37642875 DOI: 10.1007/s10803-023-06099-z] [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] [Accepted: 08/04/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Social skills difficulties among children on the autism spectrum can impede social, emotional, and academic development, especially with increasing age and social demands. This pilot study examined the efficacy of a 5-week skill-building program for children on the autism spectrum. Although effective social skills programs are available for adolescents with autism spectrum disorder (ASD), very few programs are explicitly intended for 10-12-year-old children. METHODS This pilot study examined the efficacy of the 9-session Friendship and Emotional Skills Training (FEST Program) for children with ASD without intellectual disability. Participants were 22 children randomly assigned to the FEST Program or a delayed intervention control group. Eleven children (boys = 8; girls = 3) received the FEST Program in two separate groups, and 11 were wait-listed for a delayed intervention. Parents, teachers, and the children answered questionnaires at baseline, post-intervention, and a 3-month follow-up. RESULTS Upon completing the FEST Program (post-intervention), parents reported an increase in overall social skills (on the Social Skills Rating System - SSRS) and a reduction on the Autistic Mannerisms factor (on the Social Responsiveness Scale - SRS) compared to the control group. These changes were also maintained at the 3-month follow-up. The children's assessment also showed a significant increase in assertion (on the SSRS) post-intervention. Teachers also reported a significant reduction on the Autistic Mannerisms factor at the 3-month follow-up. CONCLUSION The findings suggest that the FEST Program shows some promising results as one possibility for supporting children with ASD and their families in everyday life.
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Affiliation(s)
- Ágústa Á Arnardóttir
- The National Agency for Children and Families (Barna- og fjölskyldustofa), Reykjavik, Iceland.
| | - Laufey Á Guðmundsdóttir
- Children´s Mental Health Center for the Primary Health Care of the Capital Area (Gedheilsumistod barna Heilsugaeslu hofudborgarsvaedisins), Reykjavik, Iceland
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Dagmar Kr Hannesdóttir
- Children´s Mental Health Center for the Primary Health Care of the Capital Area (Gedheilsumistod barna Heilsugaeslu hofudborgarsvaedisins), Reykjavik, Iceland
- Department of Psychology, University of Iceland, Reykjavik, Iceland
| | - Freyr Halldórsson
- Department of Business Administration, Reykjavik University, Reykjavik, Iceland
| | - Helga Auðardóttir
- SOL clinic - Psychological and medical services for families, Kopavogur, Iceland
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Stankova M, Kamenski T, Ivanov I, Mihova P. Emotional and Behavioral Problems of Children with ASD-The Lessons That We Learned from the Pandemic. CHILDREN (BASEL, SWITZERLAND) 2023; 10:969. [PMID: 37371201 PMCID: PMC10297218 DOI: 10.3390/children10060969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
The data available for changes in the behavior and emotional state of children with ASD (autism spectrum disorder) in lockdown situations are controversial and scarce. In our research, we compare results before the first COVID-19 lockdown of 21 children with ASD and 21 typically developing children, four to five years of age with those obtained immediately after. The study attempts to answer the question of whether there are changes in the levels of emotional and behavioral problems in children with ASD after the lockdown and how these new living conditions affect some aspects of their functioning. The instruments used for data analysis are the Childhood Autism Spectrum Test (CAST); Child Behavior Checklist (CBCL); Survey on the consequences of COVID-19 on the life and development of the participants. No significant differences in the emotional and behavioral state of the participants were found, except for attention deficit/hyperactivity problems where ASD children showed lower levels after the lockdown. ASD group parents' answers to the survey pointed towards more positive consequences of staying at home. Some reported they had more time for learning together, communicating, playing, and assisting the learning process through online therapy. As negatives, the parents of ASD children reported low physical activity, increased time with electronic devices, and time spent with the same people. Caregivers of typically developing children agreed that the lockdown had only negative effects. To conclude, for children with ASD in the study, the lockdown period demonstrated that more time spent with parents in structured everyday activities is an opportunity that can lead to positive results in their behavior.
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Affiliation(s)
- Margarita Stankova
- Department of Health Care and Social Work, New Bulgarian University, 1618 Sofia, Bulgaria; (T.K.); (P.M.)
| | - Tsveta Kamenski
- Department of Health Care and Social Work, New Bulgarian University, 1618 Sofia, Bulgaria; (T.K.); (P.M.)
| | - Ivan Ivanov
- College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA;
| | - Polina Mihova
- Department of Health Care and Social Work, New Bulgarian University, 1618 Sofia, Bulgaria; (T.K.); (P.M.)
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Morales-Hidalgo P, Voltas-Moreso N, Hernández-Martínez C, Canals-Sans J. Emotional problems in preschool and school-aged children with neurodevelopmental disorders in Spain: EPINED epidemiological project. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 135:104454. [PMID: 36804709 DOI: 10.1016/j.ridd.2023.104454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/09/2022] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Children with neurodevelopmental disorders (NDD) are often at risk of developing emotional problems. AIMS AND METHODS The co-occurrence of anxiety and depression with ASD and/or ADHD was determined by exploring the association with children's clinical and neuropsychological functioning and their parent's mental health. To this end, we assessed 295 preschoolers (PRE; 4-5 years old) and 486 school-aged children (SCH; 10-11 years old) in Tarragona, Spain. NDD diagnoses were based on DSM-5. Emotional problems were assessed using Achenbach's scales. RESULTS Emotional problems (PRE: 36%-78%; SCH: 32%-81%) were more common and more severe in participants with NDD than in controls and children in the ASD + ADHD school-aged group were the most affected. In ADHD, emotional problems were associated with more severe symptoms of attention deficit (PRE) and hyperactivity/impulsivity (SCH). In ASD + ADHD, emotional problems showed a trend of association with more severe ASD repetitive behaviours and impaired working memory, whereas in ASD were associated with greater overall ASD severity. CONCLUSIONS AND IMPLICATIONS Children with NDD are vulnerable to emotional problems, which become more prevalent and interfering with age. Early detection and intervention aimed at tackling emotional problems can improve NDD prognosis.
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Affiliation(s)
- Paula Morales-Hidalgo
- Research Group on Nutrition and Mental Health (NUTRISAM), Research Center for Behavioral Assessment (CRAMC), Department of Psychology, University Rovira i Virgili, Tarragona, Spain; Psychology and Education Studies, Universitat Oberta de Catalunya (UOC), Barcelona, Spain; Interdisciplinary Research Network for the PROmotion of Mental Health and Wellness EMocional in Young People (Red PROEM), Spain
| | - Núria Voltas-Moreso
- Research Group on Nutrition and Mental Health (NUTRISAM), Research Center for Behavioral Assessment (CRAMC), Department of Psychology, University Rovira i Virgili, Tarragona, Spain; Interdisciplinary Research Network for the PROmotion of Mental Health and Wellness EMocional in Young People (Red PROEM), Spain; Serra Húnter Fellow, University Rovira i Virgili, Spain
| | - Carmen Hernández-Martínez
- Research Group on Nutrition and Mental Health (NUTRISAM), Research Center for Behavioral Assessment (CRAMC), Department of Psychology, University Rovira i Virgili, Tarragona, Spain
| | - Josefa Canals-Sans
- Research Group on Nutrition and Mental Health (NUTRISAM), Research Center for Behavioral Assessment (CRAMC), Department of Psychology, University Rovira i Virgili, Tarragona, Spain; Interdisciplinary Research Network for the PROmotion of Mental Health and Wellness EMocional in Young People (Red PROEM), Spain.
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Loftus T, Mathersul DC, Ooi M, Yau SH. The efficacy of mindfulness-based therapy for anxiety, social skills, and aggressive behaviors in children and young people with Autism Spectrum Disorder: A systematic review. Front Psychiatry 2023; 14:1079471. [PMID: 36993931 PMCID: PMC10040538 DOI: 10.3389/fpsyt.2023.1079471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/10/2023] [Indexed: 03/16/2023] Open
Abstract
IntroductionThe purpose of this systematic review was to examine the efficacy of mindfulness-based interventions for improving anxiety, social skills, and aggressive behaviors in children and young people (CYP) with Autism Spectrum Disorder (ASD); summarize the results across clinic, home, and school contexts; and evaluate the quality of these interventions for clinical practice.MethodsA search of the PsycINFO, Medline (Ovid), Web of Science, and Scopus databases was conducted in June 2021, and no date restrictions were applied. Inclusion criteria were quantitative or qualitative research implementing a mindfulness-based intervention for CYP aged 6–25 years with a diagnosis of ASD, Pervasive Development Disorder, or Asperger’s Syndrome.ResultsWe identified 23 articles for inclusion including within subject pre- and post-testing, multiple baselines, and randomized control trials, among other research designs. Of these, a quality analysis conducted using an ASD research-specific risk of bias tool found over half (14) were of weak methodological quality, whereas only four and five were found to be of strong and adequate quality, respectively.DiscussionWhile the results of this systematic review suggest promising evidence for the use of mindfulness-based interventions to improve anxiety, social skills, and aggressive behaviors in CYP with ASD, results should be interpreted with caution due to the limitations resulting from the overall weak quality of the studies.The review protocol was pre-registered on PROSPERO (CRD42021259125) and can be viewed at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=259125
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Affiliation(s)
- Tundi Loftus
- School of Psychology, Murdoch University, Murdoch, WA, Australia
- *Correspondence: Tundi Loftus,
| | - Danielle C. Mathersul
- School of Psychology, Murdoch University, Murdoch, WA, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, WA, Australia
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Michelle Ooi
- School of Psychology, Murdoch University, Murdoch, WA, Australia
| | - Shu H. Yau
- School of Psychology, Murdoch University, Murdoch, WA, Australia
- School of Education, University of Bristol, Bristol, United Kingdom
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Tallas-Mahajna N. Social communication problems, social anxiety, and mood problems: kindergarten and primary school teachers' perspective among students with autism spectrum disorder. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2023; 70:935-942. [PMID: 39131766 PMCID: PMC11308970 DOI: 10.1080/20473869.2022.2160413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 08/13/2024]
Abstract
This study examined the level of social communication problems (SCP), social anxiety (SA), and mood problems (MP) among children with ASD (age 4-13 years) enrolled in special classes (n = 74) and regular classes (n = 73) and grade level (kindergarten, 1st-3rd, 4th-6th) from teachers' perspective in schools of Palestinian Arabs in Israel. Teachers responded to three questionnaires about (1) SCP, (2) SA and (3) MP; the teachers' responses to the questionnaires were used to answer the research questions. Results: SCP, SA and MP were of medium rates for students with ASD enrolled in regular and special classes. No significant differences in the level of SCP could be attributed to class type (Regular, Special) or the grade level (kindergarten, 1st-3rd, 4th-6th). There were significant differences in SA levels that could be attributed to grade level in favor of the 4th-6th grades but there were no significant differences according to class type (Regular, Special). There were statistically significant differences in MP levels that could be attributed to the class type in favor of special classes, and the effect of grade level was not significant. There was a direct significant relationship between SCP, SA, and MP. Conclusion: SCP may be an important risk factor for the development of SA and MP among students with ASD, which lead us to incorporating social skills interventions by educational staff to alleviate or even prevent symptoms of SA and MP among students with ASD, which supports the view of inclusion.
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"You Feel Like You Kind of Walk Between the Two Worlds": A Participatory Study Exploring How Technology Can Support Emotion Regulation for Autistic People. J Autism Dev Disord 2023; 53:216-228. [PMID: 35018585 PMCID: PMC9889404 DOI: 10.1007/s10803-021-05392-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 02/04/2023]
Abstract
An increasing amount of technological solutions aiming to support emotion regulation are being developed for Autistic people. However, there remains a lack of understanding of user needs, and design factors which has led to poor usability and varied success. Furthermore, studies assessing the feasibility of emotion regulation technology via physiological signals for autistic people are increasingly showing promise, yet to date there has been no exploration of views from the autistic community on the benefits/challenges such technology may present in practice. Focus groups with autistic people and their allies were conducted to gain insight into experiences and expectations of technological supports aimed at supporting emotion regulation. Reflexive thematic analysis generated three themes: (1) communication challenges (2) views on emotion regulation technology (3) 'how' technology is implemented. Results provide meaningful insight into the socio-emotional communication challenges faced by autistic people, and explore the expectations of technology aimed at supporting emotion regulation.
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18
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O’Connor RA, van den Bedem N, Blijd-Hoogewys EM, Stockmann L, Rieffe C. Friendship quality among autistic and non-autistic (pre-) adolescents: Protective or risk factor for mental health? AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:2041-2051. [PMID: 35068188 PMCID: PMC9597130 DOI: 10.1177/13623613211073448] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Autistic young people are often misunderstood by non-autistic young people, and this can lead to difficulties in their friendships. We know that friendship is very important for our mental health. For non-autistic young people, having good friendships is linked to better mental health and having problems in friendship can cause mental health problems. This study aimed to compare the positive and negative features of friendship that autistic non-autistic young people experience. The study also aimed to understand if having positive or negative friendship features is related to signs of mental health problems (anxiety and depression). 306 young people aged 9-16 took part in this study. These were 86 autistic boys, 18 autistic girls, 91 non-autistic boys and 111 non-autistic girls. The findings of this study showed that autistic young people have less positive friendship features than non-autistic young people. For all young people in the study, having more positive friendship features was related to fewer signs of depression, while having more negative friendship features was related to more signs of depression. Just for autistic girls, having more positive friendship features was related to more signs of anxiety. These findings show that support is needed to help autistic young people have more positive friendships. For example, by teaching non-autistic young people how to be supportive friends to their autistic peers.
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Affiliation(s)
| | | | | | | | - Carolien Rieffe
- Leiden University, The
Netherlands
- University College London, UK
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19
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Hendrix NM, Pickard KE, Binion GE, Kushner E. A systematic review of emotion regulation in parent-mediated interventions for autism spectrum disorder. Front Psychiatry 2022; 13:846286. [PMID: 36213921 PMCID: PMC9544248 DOI: 10.3389/fpsyt.2022.846286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 08/26/2022] [Indexed: 12/03/2022] Open
Abstract
Autistic individuals are at elevated risk for difficulties with emotion regulation (ER) that emerge early in life and are associated with a range of internalizing and externalizing disorders. Existing interventions that support ER have focused on school-age autistic children and adolescents as well as adults. Proactive approaches to improving ER in early childhood are thus needed, as is understanding the approaches by which ER skills can be feasibly supported in this young population. This review summarizes how ER has been measured within parent-mediated interventions for children at or under the age of 6 years and the extent to which ER is measured concurrently with or distinctly from observable behaviors that have been referenced in existing literature as externalizing or challenging behavior. Using PsycInfo, EBSCOhost, and PubMed databases, we searched for peer-reviewed journal articles published through August 2021, that focused on the use of parent-mediated interventions targeting ER and/or challenging behavior. The systematic search resulted in 4,738 publications; following multi-stage screening, the search yielded 20 studies. Eighteen of 20 studies were designed to target challenging behavior using manualized curricula or behavior analytic methodologies and assessed child outcomes through validated caregiver rating scales and/or direct behavioral observation. One study measured changes in ER as secondary to the social communication skills that were targeted in the intervention. Only one study specifically supported ER skill development and measured changes in ER as the primary intervention outcome. Findings highlight the need for better assessment of ER outcomes within the context of parent-mediated interventions for toddlers and young autistic children.
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Affiliation(s)
- Nicole M. Hendrix
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Katherine E. Pickard
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Grace E. Binion
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Elizabeth Kushner
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
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Warner K, Keville S, Hockley J, Ludlow A. Experiences of equine assisted therapy for females with autism spectrum disorders. ADVANCES IN AUTISM 2022. [DOI: 10.1108/aia-10-2021-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This research indicates females with autism spectrum disorders (ASDs) have a diverse clinical presentation compared to males. Furthermore, females with ASD are often diagnosed later and typically experience greater levels of mental health difficulties. Evidence suggests that clinic-based verbal interventions for ASD have limited efficacy; therefore, alternative therapies, such as equine-assisted therapies (EATs), are gaining recognition. The purpose of this study was to directly explore the experiences of females with an ASD who have undertaken EAT.
Design/methodology/approach
Five female participants with a diagnosis of ASD were recruited from two equine therapy centres. Participants were aged between 15 and 30 years and undertook semi-structured interviews, which were analysed using interpretative phenomenological analysis.
Findings
Three superordinate themes emerged: the difficult experience of the social world, the process of EAT and the emotional impact of horses.
Originality/value
Directly exploring the experiences of females with ASD highlights benefits from engaging therapeutically with horses, building confidence and independence to transferring this into more effective social communication with other people. Offering emotion-focused therapeutic complementary interventions for females with ASD should be forefronted to help remediate the impact of difficult and sometimes traumatic earlier experiences in the social world. This requires increased funding for EAT, combined with larger-scale research projects to evaluate this.
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21
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Coulter H, Donnelly M, Mallett J, Kernohan WG. Heart Rate Variability Biofeedback to Treat Anxiety in Young People With Autism Spectrum Disorder: Findings From a Home-Based Pilot Study. JMIR Form Res 2022; 6:e37994. [PMID: 36018712 PMCID: PMC9463620 DOI: 10.2196/37994] [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: 03/15/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 12/04/2022] Open
Abstract
Background People with autism spectrum disorder (ASD) frequently experience high levels of anxiety. Despite this, many clinical settings do not provide specialist ASD mental health services, and demand for professional support frequently outstrips supply. Across many sectors of health, investigators have explored digital health solutions to mitigate demand and extend the reach of professional practice beyond traditional clinical settings. Objective This critical appraisal and pilot feasibility study examines heart rate variability (HRV) biofeedback as an approach to help young people with ASD to manage anxiety symptoms outside of formal settings. The aim is to explore the use of portable biofeedback devices to manage anxiety, while also highlighting the risks and benefits of this approach with this population. Methods We assessed the feasibility of using home-based HRV biofeedback for self-management of anxiety in young people with ASD. We adopted coproduction, involving people with ASD, to facilitate development of the study design. Next, a separate pilot with 20 participants with ASD (n=16, 80% male participants and n=4, 20% female participants, aged 13-24 years; IQ>70) assessed adoption and acceptability of HRV biofeedback devices for home use over a 12-week period. Data were collected from both carers and participants through questionnaires and interviews; participants also provided single-lead electrocardiogram recordings as well as daily reports through smartphone on adoption and use of their device. Results Pre-post participant questionnaires indicated a significant reduction in anxiety in children (t6=2.55; P=.04; Cohen d=0.99) as well as adults (t7=3.95; P=.006; Cohen d=0.54). Participant age was significantly negatively correlated with all HRV variables at baseline, namely high-frequency heart rate variability (HF-HRV: P=.02), the root mean square of successive differences in normal heartbeat contractions (RMSSD: P=.02) and the variability of normal-to-normal interbeat intervals (SDNN: P=.04). At follow-up, only SDNN was significantly negatively correlated with age (P=.05). Levels of ASD symptoms were positively correlated with heart rate both before (P=.04) and after the intervention (P=.01). The majority (311/474, 65.6%) of reports from participants indicated that the devices helped when used. Difficulties with the use of some devices and problems with home testing of HRV were noted. These initial findings are discussed within the context of the strengths and challenges of remotely delivering a biofeedback intervention for people with ASD. Conclusions HRV biofeedback devices have shown promise in this pilot study. There is now a need for larger evaluation of biofeedback to determine which delivery methods achieve the greatest effect for people with ASD. Trial Registration ClinicalTrials.gov NCT04955093; https://clinicaltrials.gov/ct2/show/NCT04955093
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Affiliation(s)
- Helen Coulter
- South Eastern Health and Social Care Trust, County Down, United Kingdom
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22
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Ahlberg R, Garcia-Argibay M, Hirvikoski T, Boman M, Chen Q, Taylor MJ, Frans E, Bölte S, Larsson H. Shared familial risk factors between autism spectrum disorder and obesity - a register-based familial coaggregation cohort study. J Child Psychol Psychiatry 2022; 63:890-899. [PMID: 34881437 DOI: 10.1111/jcpp.13538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Meta-analyses suggest an association between autism spectrum disorder (ASD) and obesity, but the factors underlying this association remain unclear. This study investigated the association between ASD and obesity stratified on intellectual disability (ID). In addition, in order to gain insight into possible shared etiological factors, the potential role of shared familial liability was examined. METHOD We studied a cohort of 3,141,696 individuals by linking several Swedish nationwide registers. We identified 35,461 individuals with ASD and 61,784 individuals with obesity. Logistic regression models were used to estimate the association between ASD and obesity separately by ID and sex and by adjusting for parental education, psychiatric comorbidity, and psychotropic medication. Potential shared familial etiologic factors were examined by comparing the risk of obesity in full siblings, maternal and paternal half-siblings, and full- and half-cousins of individuals with ASD to the risk of obesity in relatives of individuals without ASD. RESULTS Individuals with ASD + ID (OR = 3.76 [95% CI, 3.38-4.19]) and ASD-ID (OR = 3.40 [95% CI, 3.23-3.58]) had an increased risk for obesity compared with individuals without ASD. The associations remained statistically significant when adjusting for parental education, psychiatric comorbidity, and medication. Sex-stratified analyses indicated a higher relative risk for males compared with females, with statistically significant interaction effects for ASD-ID, but not for ASD+ID in the fully adjusted model. First-degree relatives of individuals with ASD+ID and ASD-ID had an increased risk of obesity compared with first-degree relatives of individuals without ASD. The obesity risk was similar in second-degree relatives of individuals with ASD+ID but was lower for and ASD-ID. Full cousins of individuals with ASD+ID had a higher risk compared with half-cousins of individuals with ASD+ID). A similar difference in the obesity risk between full cousins and half-cousins was observed for ASD-ID. CONCLUSIONS Individuals with ASD and their relatives are at increased risk for obesity. The risk might be somewhat higher for males than females. This warrants further studies examining potential common pleiotropic genetic factors and shared family-wide environmental factors for ASD and obesity. Such research might aid in identifying specific risks and underlying mechanisms in common between ASD and obesity.
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Affiliation(s)
- Richard Ahlberg
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | | | - Tatja Hirvikoski
- Division of Neuropsychiatry, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet & Center for Psychiatry Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Habilitation & Health, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Marcus Boman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Qi Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mark J Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Emma Frans
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sven Bölte
- Division of Neuropsychiatry, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet & Center for Psychiatry Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, WA, Australia
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Waldman J, McPaul A, Jahoda A. A comparison of the content and nature of worries of autistic and neurotypical young people as they transition from school. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:667-678. [PMID: 35893767 PMCID: PMC10074755 DOI: 10.1177/13623613221111313] [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: 11/16/2022]
Abstract
LAY ABSTRACT Autistic young people experience higher levels of anxiety than neurotypical young people. Having worries is part of feeling anxious. This makes it surprising that very little research has looked at the kind of worries autistic young people have. Leaving school, in particular, can be a worrying time for young people. Twenty-two autistic young people and 22 neurotypical young people who were at mainstream secondary schools agreed to take part in the study. They were between 16 and 18 years of age. They were asked to sort through a series of pictures, showing the different types of worries that young people might experience. They were then asked to pick out their four main worries and say how much they thought about each worry and how upset the worry made them. They also completed a questionnaire about their level of anxiety. There were similarities and differences between the autistic and neurotypical young people's worries. Both groups worried about failing and how they might get on in further education. The autistic young people were more worried about change and friendships. Work and money were particular concerns for the neurotypical young people. The autistic young people said that they found their worries more upsetting than the neurotypical young people. Having a better understanding of autistic young people's worries at important points in their lives might mean that more timely help and support can be given to them. Simply knowing what to ask young autistic school leavers about may help them to express unspoken concerns.
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Affiliation(s)
- Jack Waldman
- University of Glasgow, Gartnavel Royal Hospital, UK
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Shi T, Feng S, Shi W, Fu Y, Zhou W. A modified mouse model for observational fear learning and the influence of social hierarchy. Front Behav Neurosci 2022; 16:941288. [PMID: 35957923 PMCID: PMC9359141 DOI: 10.3389/fnbeh.2022.941288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/24/2022] [Indexed: 11/20/2022] Open
Abstract
Background Indirectly experiencing traumatic events either by witnessing or learning of a loved one’s suffering is associated with the highest prevalence rates of epidemiological features of PTSD. Social species can develop fear by observing conspecifics in distress. Observational fear learning (OFL) is one of the most widely used paradigms for studying fear contagion in mice. However, the impact of empathic fear behavior and social hierarchy on fear transfer in mice is not well understood. Methods Fear emotions are best characterized in mice by using complementary tests, rather than only freezing behavior, and simultaneously avoiding behavioral variability in different tests across time. In this study, we modified the OFL model by implementing freezing (FZ), open field (OF), and social interaction (SI) tests in a newly designed experimental facility and applied Z-normalization to assess emotionality changes across different behaviors. Results The integrated emotionality scores revealed a robustly increased emotionality of observer mice and, more importantly, contributed to distinguishing susceptible individuals. Interestingly, fos-positive neurons were mainly found in the interoceptive network, and mice of a lower social rank showed more empathy-like behaviors. Conclusion Our findings highlight that combining this experimental model with the Z-scoring method yields robust emotionality measures of individual mice, thus making it easier to screen and differentiate between empathic fear-susceptible mice and resilient mice, and refining the translational applicability of these models.
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Affiliation(s)
- Tianyao Shi
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Shufang Feng
- Department of Medical Psychology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Wenlong Shi
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Yuan Fu
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Wenxia Zhou
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
- *Correspondence: Wenxia Zhou,
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25
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Seguin D, Pac S, Wang J, Nicolson R, Martinez-Trujillo J, Anagnostou E, Lerch JP, Hammill C, Schachar R, Crosbie J, Kelley E, Ayub M, Brian J, Liu X, Arnold PD, Georgiades S, Duerden EG. Amygdala subnuclei volumes and anxiety behaviors in children and adolescents with autism spectrum disorder, attention deficit hyperactivity disorder, and obsessive-compulsive disorder. Hum Brain Mapp 2022; 43:4805-4816. [PMID: 35819018 PMCID: PMC9582362 DOI: 10.1002/hbm.26005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/11/2022] [Accepted: 06/26/2022] [Indexed: 12/14/2022] Open
Abstract
Alterations in the structural maturation of the amygdala subnuclei volumes are associated with anxiety behaviors in adults and children with neurodevelopmental and associated disorders. This study investigated the relationship between amygdala subnuclei volumes and anxiety in 233 children and adolescents (mean age = 11.02 years; standard deviation = 3.17) with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and children with obsessive compulsive disorder (OCD), as well as typically developing (TD) children. Parents completed the Child Behavior Checklist (CBCL), and the children underwent structural MRI at 3 T. FreeSurfer software was used to automatically segment the amygdala subnuclei. A general linear model revealed that children and adolescents with ASD, ADHD, and OCD had higher anxiety scores compared to TD children (p < .001). A subsequent interaction analysis revealed that children with ASD (B = 0.09, p < .0001) and children with OCD (B = 0.1, p < .0001) who had high anxiety had larger right central nuclei volumes compared with TD children. Similar results were obtained for the right anterior amygdaloid area. Amygdala subnuclei volumes may be key to identifying children with neurodevelopmental disorders or those with OCD who are at high risk for anxiety. Findings may inform the development of targeted behavioral interventions to address anxiety behaviors and to assess the downstream effects of such interventions.
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Affiliation(s)
- Diane Seguin
- Physiology & Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Sara Pac
- Neuroscience, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Jianan Wang
- Biomedical Engineering, Faculty of Engineering, Western University, London, Canada
| | - Rob Nicolson
- Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Julio Martinez-Trujillo
- Physiology & Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Evdokia Anagnostou
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, Canada
| | - Jason P Lerch
- The Hospital for Sick Children, Toronto, Canada.,Wellcome Centre for Integrative Neuroimaging, University of Oxford, FMRIB, Nuffield Department of Clinical Neurosciences, Oxford, UK.,Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | | | | | | | | | - Muhammad Ayub
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Jessica Brian
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, Canada
| | - Xudong Liu
- Department of Psychiatry, Queen's University, Kingston, Canada.,Queen's Genomics Lab at Ongwanada (QGLO), Ongwanada Resource Center, Kingston, Canada
| | - Paul D Arnold
- Department of Psychiatry Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Stelios Georgiades
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Emma G Duerden
- Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada.,Applied Psychology, Faculty of Education, Western University, London, Canada
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26
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Russo AM, Payet JM, Kent S, Lesku JA, Lowry CA, Hale MW. Acute treatment with 5-hydroxytryptophan increases social approach behaviour but does not activate serotonergic neurons in the dorsal raphe nucleus in juvenile male BALB/c mice: A model of human disorders with deficits of sociability. J Psychopharmacol 2022; 36:806-818. [PMID: 35475390 DOI: 10.1177/02698811221089039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The BALB/c mouse has been proposed as a model of human psychiatric disorders characterised by elevated anxiety and altered sociability. Juvenile BALB/c mice show decreased social exploratory behaviour, increased anxiety, and reduced brain serotonin synthesis compared to other strains including C57BL/6J mice. AIM To determine whether supplementation of brain serotonin synthesis alters social behaviour and activation of serotonergic neurons across subregions of the dorsal raphe nucleus (DR) in BALB/c mice. METHODS Juvenile male BALB/c mice were assigned to one of four treatment conditions: vehicle/vehicle, carbidopa (25 mg/kg)/vehicle, vehicle/5-HTP (10 mg/kg), carbidopa (25 mg/kg)/5-HTP (10 mg/kg). Social behaviour was measured using the three-chamber social approach test, followed by immunohistochemical staining for TPH2 and c-Fos to measure activation of serotonergic neurons across subregions of the DR. RESULTS Mice treated with carbidopa/5-HTP spent more time in the social cage zone and covered more distance in the social approach test compared to other treatment groups. There was no difference between treatment groups in the activation of serotonergic neurons across subregions of the DR. However, the DRD was associated with increased social approach behaviour in carbidopa/5-HTP treated animals. CONCLUSIONS Supplementation of serotonin synthesis can increase social approach behaviour in juvenile BALB/c mice. An increase in locomotor behaviour was also observed suggesting that increasing central serotonin synthesis may have led to a reduction in state anxiety, manifesting in increased exploratory behaviour. As no effect on serotonergic activation within the DR was found, alternative mechanisms are likely important for the effects of 5-HTP on social behaviour.
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Affiliation(s)
- Adrian M Russo
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Jennyfer M Payet
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Stephen Kent
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - John A Lesku
- School of Life Sciences, La Trobe University, Melbourne, VIC, Australia
| | - Christopher A Lowry
- Department of Integrative Physiology and Centre for Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Matthew W Hale
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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27
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Dellapiazza F, Michelon C, Picot MC, Baghdadli A. Early risk factors for anxiety disorders in children with autism spectrum disorders: results from the ELENA Cohort. Sci Rep 2022; 12:10914. [PMID: 35764687 PMCID: PMC9239987 DOI: 10.1038/s41598-022-15165-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 06/20/2022] [Indexed: 11/09/2022] Open
Abstract
Anxiety in children with autism spectrum disorder (ASD) negatively affects their social interactions, and quality of life. It is necessary to identify early risk factors for anxiety to tailor prevention and interventions. We aimed to examine the clinical level of anxiety in children with ASD from 5 to 10 years of age and identify potential early risk factors 3 years earlier. Participants were ASD children included in ELENA, a French prospective cohort. In this study, we used the collection of data at Time 1-T1 (at baseline) and Time 2-T2 (3 years after T1). Two groups were identified at T2 according to the threshold for anxiety on the CBCL: ASD-only group and ASD + anxiety group. Our results showed that half of the children in our sample had a clinical level of anxiety at T2. Regression analysis showed that greater ASD severity and lower sensory processing difficulties predicted lower anxiety, whereas higher levels of restricted and repetitive behaviours tended to predict higher levels of anxiety. The high prevalence of clinical-level anxiety in our sample suggests the need for specific assessment and targeted treatment of anxiety on a routine basis.
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Affiliation(s)
- Florine Dellapiazza
- Centre de Ressources Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-développementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France
| | - Cécile Michelon
- Centre de Ressources Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-développementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France
| | - Marie-Christine Picot
- Centre de Ressources Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-développementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France.,Clinical Research and Epidemiology Unit, Department of Medical Information, University Hospital, CHU Montpellier, Montpellier, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France
| | - Amaria Baghdadli
- Centre de Ressources Autisme Languedoc-Roussillon et Centre d'Excellence sur l'Autisme et les Troubles Neuro-développementaux, CHU Montpellier, 39 Avenue Charles Flahaut, 34295, Montpellier cedex 05, France. .,Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France. .,Faculté de Médecine, Université de Montpellier, Montpellier, France.
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28
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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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29
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Key AP, Jones D, Corbett BA. Sex differences in automatic emotion regulation in adolescents with autism spectrum disorder. Autism Res 2022; 15:712-728. [PMID: 35103402 PMCID: PMC9060299 DOI: 10.1002/aur.2678] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/23/2021] [Accepted: 01/15/2022] [Indexed: 11/11/2022]
Abstract
Autism may be underdiagnosed in females because their social difficulties are often less noticeable. This study explored sex differences in automatic facial emotion processing in 45 adolescents with autism spectrum disorder (22 female, 23 male), age 10-16 years, performing active target detection task and Go/NoGo tasks where faces with positive and negative emotional expressions served as irrelevant distractors. The combined sample demonstrated more accurate performance on the target detection (response initiation) than the Go/NoGo task (response inhibition), replicating findings previously reported in typical participants. Females exhibited greater difficulty than males with response initiation in the target detection task, especially in the context of angry faces, while males found withholding a response in the Go/NoGo block with happy faces more challenging. Electrophysiological data revealed no sex differences or emotion discrimination effects during the early perceptual processing of faces indexed by the occipitotemporal N170. Autistic males demonstrated increased frontal N2 and parietal P3 amplitudes compared to females, suggesting greater neural resource allocation to automatic emotion regulation processes. The associations between standardized behavioral measures (autism severity, theory of mind skills) and brain responses also varied by sex: more adaptive social functioning was related to the speed of perceptual processing (N170 latency) in females and the extent of deliberate attention allocation (P3 amplitudes) in males. Together, these findings suggest that males and females with autism may rely on different strategies for social functioning and highlight the importance of considering sex differences in autism. LAY SUMMARY: Females with autism may exhibit less noticeable social difficulties than males. This study demonstrates that autistic females are more successful than males at inhibiting behavioral responses in emotional contexts, while males are more likely to initiate a response. At the neural level, social functioning in females is related to the speed of automatic perceptual processing of facial cues, and in males, to the extent of active attention allocation to the stimuli. These findings highlight the importance of considering sex differences in autism diagnosis and treatment selection.
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Affiliation(s)
- Alexandra P. Key
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center
| | - Dorita Jones
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center
| | - Blythe A. Corbett
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center
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30
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Utilising Interview Methodology to Inform the Development of New Clinical Assessment Tools for Anxiety in Autistic Individuals Who Speak Few or no Words. J Autism Dev Disord 2022; 53:2328-2348. [PMID: 35304663 PMCID: PMC10229722 DOI: 10.1007/s10803-022-05509-y] [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: 02/26/2022] [Indexed: 10/18/2022]
Abstract
Autistic individuals with intellectual disability who speak few or no words are at high risk of anxiety but are underrepresented in research. This study aimed to describe the presentation of anxiety in this population and discuss implications for the development of assessments. Interviews were conducted with 21 parents/carers of autistic individuals and nine clinicians. Data were analysed using content analysis and interpretative phenomenological analysis. Anxiety behaviours described by parents/carers included increased vocalisation, avoidance and behaviours that challenge. Changes to routine were highlighted as triggering anxiety. Clinicians discussed the importance of identifying an individual's baseline of behaviour, knowing an individual well and ruling out other forms of distress. This study raises considerations for early identification of anxiety and for subsequent support.
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31
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Milosevic S, Brookes-Howell L, Randell E, Williams-Thomas R, Delport S, Busse M, Gillespie D, Ahuja AS, McKigney AM, Glarou E, McNamara R. Understanding the support experiences of families of children with autism and sensory processing difficulties: A qualitative study. Health Expect 2022; 25:1118-1130. [PMID: 35303380 PMCID: PMC9122432 DOI: 10.1111/hex.13465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/13/2022] [Accepted: 02/23/2022] [Indexed: 01/26/2023] Open
Abstract
Background Support, such as information, advice and therapies, can play a vital role in the lives of families of autistic children. However, little is known about the support experiences of UK parents and carers. Aim To explore experiences of and access to support for families of children with autism and sensory processing difficulties, from the perspective of parents and carers. Methods Semi‐structured, timeline‐assisted interviews were conducted with parents/carers of 30 children aged 5–11, exploring experiences of support. Framework analysis was used to identify themes in the interview data. Results Support varied widely and was not accessed equitably. Specialist autism support, together with support from other parents and voluntary organizations, was perceived as more useful than statutory and nonspecialist provision. Unmet support needs included an ongoing point of contact for information and advice for parents, and access to direct therapy and specialist mental health provision for children. Conclusions Findings emphasize the need for a clear pathway of support following autism diagnosis, autism‐specific training for professional service providers and specialist provision tailored to the needs of autistic children. Patient or Public Contribution An advisory group of four parents of children with autism provided feedback on study procedures and materials, including participant information sheets and timeline completion instructions.
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Affiliation(s)
| | | | | | | | - Sue Delport
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Monica Busse
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Alka S Ahuja
- Aneurin Bevan University Health Board, Newport, UK
| | | | - Eleni Glarou
- Centre for Trials Research, Cardiff University, Cardiff, UK.,School of Medicine, Cardiff University, Cardiff, UK
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32
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Jolliffe R, Adams D, Simpson K. Trait Anxiety in Individuals on the Autism Spectrum: a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00308-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AbstractAlthough anxiety is commonly researched in autism, the focus has predominantly been on anxiety disorders and not upon general levels of anxiousness or trait anxiety. This review summarises research investigating trait anxiety in autism. Systematic searches yielded 1099 records, with 23 studies meeting inclusion criteria. Study participants were mainly males from Western countries, with no representation of older adults or individuals with intellectual disability. All articles used self-report questionnaire trait anxiety measures. Anxiety measure psychometric details were absent in most studies, with 21 using subjective measures that are not validated for use in autism. Results showed higher trait anxiety scores in autism versus control groups, and correlations between trait anxiety scores and other study outcomes.
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33
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Wittwer J. Autismus: Ein Überblick über Lernvoraussetzungen und Fördermaßnahmen. ZEITSCHRIFT FUR PADAGOGISCHE PSYCHOLOGIE 2022. [DOI: 10.1024/1010-0652/a000326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Autistische Schülerinnen und Schüler besitzen häufig geringere schulische Kompetenzen als nicht-autistische Schülerinnen und Schüler. Zugleich bestehen große Unterschiede in den schulischen Kompetenzen zwischen autistischen Schülerinnen und Schülern. Nicht selten weisen sie schulische Kompetenzen auf, die niedriger sind, als es aufgrund ihrer kognitiven Fähigkeiten zu erwarten wäre. Um zu verstehen, welche Faktoren das Lernen autistischer Schülerinnen und Schüler beeinflussen, wird in diesem Artikel ein Überblick über die Lernvoraussetzungen autistischer Schülerinnen und Schüler gegeben. Der Überblick zeigt, dass es autistischen Schülerinnen und Schülern schwerfallen kann, Vorwissen abzurufen und in Lernsituationen aktiv anzuwenden, Lernprozesse aufgrund von Einschränkungen in den exekutiven Funktionen angemessen zu steuern, verbale und visuelle Informationen im Arbeitsgedächtnis zu verarbeiten, kognitive und metakognitive Lernstrategien spontan anzuwenden, sich mit Lerninhalten auseinanderzusetzen, die nicht ihren eigenen Interessen entsprechen, und lernabträgliche Emotionen mittels geeigneter Strategien zu regulieren. Um autistische Schülerinnen und Schüler im Lernen zu unterstützen, werden Fördermaßnahmen zu den einzelnen Lernvoraussetzungen vorgestellt. Implikationen für Forschung und Praxis werden diskutiert.
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Affiliation(s)
- Jörg Wittwer
- Albert-Ludwigs-Universität Freiburg, Deutschland
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34
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Grebe SC, Limon DL, McNeel MM, Guzick A, Peters SU, Tan WH, Sadhwani A, Bacino CA, Bird LM, Samaco RC, Berry LN, Goodman WK, Schneider SC, Storch EA. Anxiety in Angelman Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:1-10. [PMID: 34979033 PMCID: PMC8803540 DOI: 10.1352/1944-7558-127.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/20/2021] [Indexed: 06/14/2023]
Abstract
Angelman Syndrome (AS) is a neurodevelopmental disorder most commonly caused by the impaired expression of the maternal UBE3A gene on chromosome 15. Though anxiety has been identified as a frequently present characteristic in AS, there are limited studies examining anxiety in this population. Studies of anxiety in other neurodevelopmental disorders have found disorder specific symptoms of anxiety and age specific displays of anxiety symptoms. However, there is a consistent challenge in identifying anxiety in people with neurodevelopmental disorders given the lack of measurement instruments specifically designed for this population. Given the limited information about AS and anxiety, the aims of the current project were to (a) examine symptoms of anxiety in children with AS and (b) determine the correlates of anxiety in children with AS. Participants included 42 adult caregivers of youth with AS in the AS Natural History study who completed the Developmental Behavior Checklist (DBC). The results found that 26% of the sample demonstrated elevated symptoms of anxiety and established a relationship between elevated anxiety in youth with AS and higher levels of irritability, hyperactivity, self-absorbed behaviors, and disruptive/antisocial behaviors. Findings from this research provide a foundation for tailoring evidence-based assessments and treatments for youth with AS and anxiety.
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Affiliation(s)
- Stacey C Grebe
- Stacey C. Grebe, Danica L. Limon, Morgan M. McNeel, and Andrew Guzick, Baylor College of Medicine
| | - Danica L Limon
- Stacey C. Grebe, Danica L. Limon, Morgan M. McNeel, and Andrew Guzick, Baylor College of Medicine
| | - Morgan M McNeel
- Stacey C. Grebe, Danica L. Limon, Morgan M. McNeel, and Andrew Guzick, Baylor College of Medicine
| | - Andrew Guzick
- Stacey C. Grebe, Danica L. Limon, Morgan M. McNeel, and Andrew Guzick, Baylor College of Medicine
| | | | - Wen-Hann Tan
- Wen-Hann Tan and Anjali Sadhwani, Boston Children's Hospital
| | - Anjali Sadhwani
- Wen-Hann Tan and Anjali Sadhwani, Boston Children's Hospital
| | - Carlos A Bacino
- Carlos A. Bacino, Baylor College of Medicine and Texas Children's Hospital
| | - Lynne M Bird
- Lynne M. Bird, University of California and Boston Children's Hospital
| | | | - Leandra N Berry
- Leandra N. Berry, Baylor College of Medicine and Texas Children's Hospital
| | | | | | - Eric A Storch
- Sophie C. Schneider and Eric A. Storch, Baylor College of Medicine
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35
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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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Rau S, Whitman ET, Schauder K, Gogate N, Lee NR, Kenworthy L, Raznahan A. Patterns of psychopathology and cognition in sex chromosome aneuploidy. J Neurodev Disord 2021; 13:61. [PMID: 34911436 PMCID: PMC8903493 DOI: 10.1186/s11689-021-09407-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background Sex chromosome aneuploidies (SCAs) are a collectively common family of genetic disorders that increase the risk for neuropsychiatric and cognitive impairment. Beyond being important medical disorders in their own right, SCAs also offer a unique naturally occurring model for studying X- and Y-chromosome influences on the human brain. However, it remains unclear if (i) different SCAs are associated with different profiles of psychopathology and (ii) the notable interindividual variation in psychopathology is related to co-occurring variation in cognitive ability. Methods We examined scores for 11 dimensions of psychopathology [Child/Adult Behavior Checklist (CBCL)] and general cognitive ability [full-scale IQ (FSIQ) from Wechsler tests] in 110 youth with varying SCAs (XXY = 41, XYY = 22, XXX = 27, XXYY = 20) and 131 typically developing controls (XX = 59, XY = 72). Results All SCAs were associated with elevated CBCL scores across several dimensions of psychopathology (two-sample t tests comparing the euploidic and aneuploidic groups [all |T| > 9, and p < 0.001]). Social and attentional functioning were particularly sensitive to the carriage of a supernumerary Y-chromosome. In particular, the XYY group evidenced significantly more social problems than both extra-X groups (Cohen’s d effect size > 0.5, Bonferroni corrected p < .05). There was marked variability in CBCL scores within each SCA group, which generally correlated negatively with IQ, but most strongly so for social and attentional difficulties (standardized β, − 0.3). These correlations showed subtle differences as a function of the SCA group and CBCL scale. Conclusions There is domain-specific variation in psychopathology across SCA groups and domain-specific correlation between psychopathology and IQ within SCAs. These findings (i) help to tailor clinical assessment of this common and impactful family of genetic disorders and (ii) suggest that dosage abnormalities of X- and Y-linked genes impart somewhat distinct profiles of neuropsychiatric risk. Supplementary Information The online version contains supplementary material available at 10.1186/s11689-021-09407-9.
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Affiliation(s)
- Srishti Rau
- Center for Autism Spectrum Disorders and Division of Neuropsychology, Children's National Health System, Washington DC, USA. .,Section on Developmental Neurogenomics, Human Genetics Branch, National Institute of Mental Health, Bethesda, MD, USA.
| | - Ethan T Whitman
- Section on Developmental Neurogenomics, Human Genetics Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Kimberly Schauder
- Center for Autism Spectrum Disorders and Division of Neuropsychology, Children's National Health System, Washington DC, USA.,Section on Developmental Neurogenomics, Human Genetics Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Nikhita Gogate
- The Department of Biochemistry & Molecular Medicine, The George Washington University Medical Center, Washington DC, USA
| | | | - Lauren Kenworthy
- Center for Autism Spectrum Disorders and Division of Neuropsychology, Children's National Health System, Washington DC, USA.,Section on Developmental Neurogenomics, Human Genetics Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Armin Raznahan
- Section on Developmental Neurogenomics, Human Genetics Branch, National Institute of Mental Health, Bethesda, MD, USA
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Kim SK, McKay D, Cepeda SL, Schneider SC, Wood J, Storch EA. Assessment of improvement in anxiety severity for children with autism spectrum disorder: The matched correspondence analysis approach. J Psychiatr Res 2021; 145:175-181. [PMID: 34923358 PMCID: PMC9198104 DOI: 10.1016/j.jpsychires.2021.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/06/2021] [Accepted: 12/10/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Clinical trials typically involve random assignment to treatment conditions. However, random assignment does not guarantee a lack of systematic variation in the outcomes, and application of covariation methods for multiple dependent measures requires complicated assumptions that are often not met. METHODS This study employed matched correspondence analysis (CA) for controlling systematic variation and handling multiple outcomes. One hundred nine children with autism spectrum disorder (ASD) were assessed for anxiety symptom severity across four studies, where participants were randomly assigned to either cognitive behavioral therapy (CBT) or treatment as usual or waitlist (TAU/WT). Matched CA is designed to optimally scale only the differences between baseline and posttreatment, rendering the systematic baseline carryover effects irrelevant. RESULTS Differences in treatment efficacy were observed. CBT showed treatment efficacy on anxiety severity and anxiety-related impairment relative to TAU/WT, after the control of baseline carryover effects. CONCLUSION This study provides a way to control systematic variation between groups at the outset of treatment trials and is expected to provide a novel pathway to more proper assessment of treatment efficacy for children with ASD and anxiety.
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Affiliation(s)
- Se-Kang Kim
- Department of Psychology, Fordham University, USA.
| | - Dean McKay
- Department of Psychology, Fordham University, USA
| | - Sandra L Cepeda
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, USA
| | - Sophie C Schneider
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, USA
| | - Jeffrey Wood
- Department of Education, University of California, Los Angeles, USA
| | - Eric A Storch
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, USA
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Foldes ST, Jensen AR, Jacobson A, Vassall S, Foldes E, Guthery A, Brown D, Levine T, Tyler WJ, Frye RE. Transdermal Electrical Neuromodulation for Anxiety and Sleep Problems in High-Functioning Autism Spectrum Disorder: Feasibility and Preliminary Findings. J Pers Med 2021; 11:1307. [PMID: 34945779 PMCID: PMC8704341 DOI: 10.3390/jpm11121307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is associated with anxiety and sleep problems. We investigated transdermal electrical neuromodulation (TEN) of the cervical nerves in the neck as a safe, effective, comfortable and non-pharmacological therapy for decreasing anxiety and enhancing sleep quality in ASD. METHODS In this blinded, sham-controlled study, seven adolescents and young adults with high-functioning ASD underwent five consecutive treatment days, one day of the sham followed by four days of subthreshold TEN for 20 min. Anxiety-provoking cognitive tasks were performed after the sham/TEN. Measures of autonomic nervous system activity, including saliva α-amylase and cortisol, electrodermal activity, and heart rate variability, were collected from six participants. RESULTS Self-rated and caretaker-rated measures of anxiety were significantly improved with TEN treatment as compared to the sham, with effect sizes ranging from medium to large depending on the rating scale. Sleep scores from caretaker questionnaires also improved, but not significantly. Performance on two of the three anxiety-provoking cognitive tasks and heart rate variability significantly improved with TEN stimulation as compared to the sham. Four of the seven (57%) participants were responders, defined as a ≥ 30% improvement in self-reported anxiety. Salivary α-amylase decreased with more TEN sessions and decreased from the beginning to the end of the session on TEN days for responders. TEN was well-tolerated without significant adverse events. CONCLUSIONS This study provides preliminary evidence that TEN is well-tolerated in individuals with ASD and can improve anxiety.
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Affiliation(s)
- Stephen T. Foldes
- Division of Research, Barrow Neurologic Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA; (S.T.F.); (A.J.); (D.B.)
- Division of Neurology, Barrow Neurologic Institute, Phoenix, AZ 85013, USA
- School of Biological and Health Sciences, Arizona State University, Tempe, AZ 85287, USA;
- Department of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, AZ 85004, USA
| | - Amanda R. Jensen
- Section on Neurodevelopmental Disorders, Division of Neurology, Barrow Neurologic Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA;
| | - Austin Jacobson
- Division of Research, Barrow Neurologic Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA; (S.T.F.); (A.J.); (D.B.)
| | - Sarah Vassall
- Division of Psychology, Vanderbilt University, Nashville, TN 37240, USA;
| | - Emily Foldes
- Speech and Hearing Science, Arizona State University, Tempe, AZ 85287, USA;
| | - Ann Guthery
- Division of Psychiatry, Barrow Neurologic Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA; (A.G.); (T.L.)
| | - Danni Brown
- Division of Research, Barrow Neurologic Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA; (S.T.F.); (A.J.); (D.B.)
| | - Todd Levine
- Division of Psychiatry, Barrow Neurologic Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA; (A.G.); (T.L.)
| | - William James Tyler
- School of Biological and Health Sciences, Arizona State University, Tempe, AZ 85287, USA;
| | - Richard E. Frye
- Department of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, AZ 85004, USA
- Section on Neurodevelopmental Disorders, Division of Neurology, Barrow Neurologic Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA;
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Abstract
The search for biomarkers for autism spectrum disorder (henceforth autism) has received a lot of attention due to their potential clinical relevance. The clinical and aetiological heterogeneity of autism suggests the presence of subgroups. The lack of identification of a valid diagnostic biomarker for autism, and the inconsistencies seen in studies assessing differences between autism and typically developing control groups, may be partially explained by the vast heterogeneity observed in autism. The focus now is to better understand the clinical and biological heterogeneity and identify stratification biomarkers, which are measures that describe subgroups of individuals with shared biology. Using stratification approaches to assess treatment within pre-defined subgroups could clarify who may benefit from different treatments and therapies, and ultimately lead to more effective individualised treatment plans.
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40
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Zadok E, Gordon I, Navon R, Rabin SJ, Golan O. Shifts in Behavioral Synchrony in Response to an Interaction Partner's Distress in Adolescents With and Without ASD. J Autism Dev Disord 2021; 52:4261-4273. [PMID: 34611838 DOI: 10.1007/s10803-021-05307-y] [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: 09/24/2021] [Indexed: 11/29/2022]
Abstract
Individuals with Autism spectrum disorder (ASD) show altered behavioral synchrony and empathic behavior. Yet, an ecologically valid examination of these in adolescents is still required. We employed a social interaction sequence comprising a friendly conversation with a confederate, an expression of distress by her, and a return to friendly conversation. 44 male adolescents (22 with ASD) participated. Socio-emotional behaviors, coded by blind raters and through automated analyses of motion, were analyzed. Results indicated reduced synchrony in the ASD group. Moreover, whereas controls displayed a decrease in synchrony when facing another's distress, adolescents with ASD showed no such change. No group differences were found on empathic behavior. Findings imply gaps between verbal and non-verbal responses of adolescents with ASD to a distressed interaction partner.
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Affiliation(s)
- Ester Zadok
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Ilanit Gordon
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel.,Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
| | - Roni Navon
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | | | - Ofer Golan
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel. .,Autism Treatment and Research Center - Association for Children at Risk, Givat Shmuel, Israel.
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McMillion A, Tobiansky B, Wang K, Cronin AJ, Johnson A, Monteiro J, Remington A. UK-based specialist dental professionals' experiences of working with autistic patients. SPECIAL CARE IN DENTISTRY 2021; 42:120-136. [PMID: 34582574 DOI: 10.1111/scd.12653] [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] [Received: 06/10/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 01/02/2023]
Abstract
AIMS Previous research has demonstrated that autistic individuals often experience difficulties accessing dental care, both as a result of autism specific difficulties and practitioners' attitudes towards autism. However, very little research exists that explores dental professionals' experiences of providing care to their autistic patients. The aim of this study was to investigate the strategies UK-based dental professionals' use when working with autistic patients METHODS AND RESULTS: In this study, dental professionals (n = 16) from a variety of specialty roles (special care, paediatrics, orthodontics) were interviewed. We asked participants to talk through, in depth, specific cases they had encountered in their practice, what sorts of accommodations they had provided, and what concerns had arisen during appointments. Thematic analysis was used to analyses the data and revealed four main themes: the unique dental needs associated with being autistic, effective adaptations to practice, the crucial role of the caregiver, and the importance of specialist knowledge CONCLUSION: Recommendations for how dentists can improve the dental experiences of autistic patients can be drawn from the specialist dentists' responses in this study. These include involving autistic patients in decisions about their treatment and being flexible and willing to work with autistic patients and their caregivers.
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Affiliation(s)
- Audrey McMillion
- Deparatment of Psychology and Human Development, UCL Institute of Education, London, UK
| | - Beth Tobiansky
- Deparatment of Psychology and Human Development, UCL Institute of Education, London, UK
| | - Kefei Wang
- Deparatment of Psychology and Human Development, UCL Institute of Education, London, UK
| | - Aaron J Cronin
- Barts Health NHS Trust, The Royal Hospital, The Royal London Hospital, London, UK
| | - Adele Johnson
- Royal National ENT and Eastman Dental Hospital, London, UK
| | | | - Anna Remington
- Deparatment of Psychology and Human Development, UCL Institute of Education, London, UK
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42
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Adams D, Malone S, Simpson K, Tucker M, Rapee RM, Rodgers J, Keen D. Protocol for a longitudinal study investigating the role of anxiety on academic outcomes in children on the autism spectrum. PLoS One 2021; 16:e0257223. [PMID: 34529686 PMCID: PMC8445440 DOI: 10.1371/journal.pone.0257223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 08/19/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Children on the autism spectrum are consistently reported to underachieve compared to ability. In typically developing children, anxiety is a strong predictor of poor school performance. Despite the high prevalence of anxiety disorders among children on the spectrum, the impact of their anxiety on academic achievement is under-researched. The main aim of this project is to determine the moderating role anxiety may have in the development of academic learning behaviours (academic enablers) in children on the spectrum. This project addresses a gap in knowledge about the possible associations between anxiety and academic achievement in children on the spectrum. Understanding these associations opens up the possibility of new intervention pathways to enhance academic outcomes through anxiety reduction/prevention. METHODS This longitudinal study will aim to recruit 64 children on the spectrum aged 4-5 years and their parents. Information will be gathered from children, parents and teachers. Children will be randomly assigned to one of two conditions in order to experimentally manipulate anxiety levels in the sample: experimental (to receive an anxiety reduction/prevention program, N = 32) or control (no intervention/treatment as usual, N = 32). The primary outcome measures are child academic skills and enabling behaviours assessed using the Academic Competence Evaluation Scales and the WIAT-II. Anxiety will be assessed through parent and teacher report. Assessments will be conducted at baseline, post-experimental manipulation of anxiety, and within the first year of formal schooling. It is hypothesised that anxiety will moderate the relationship between autism characteristics and academic enablers. DISSEMINATION Results will be disseminated through peer-reviewed manuscripts and conference presentations. Lay summaries will be provided to all participants and available on the research centre website.
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Affiliation(s)
- Dawn Adams
- Autism Centre of Excellence, Griffith University, Mount Gravatt, Queensland, Australia
| | - Stephanie Malone
- Autism Centre of Excellence, Griffith University, Mount Gravatt, Queensland, Australia
| | - Kate Simpson
- Autism Centre of Excellence, Griffith University, Mount Gravatt, Queensland, Australia
| | | | - Ron M. Rapee
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Deb Keen
- Autism Centre of Excellence, Griffith University, Mount Gravatt, Queensland, Australia
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Anxiety Sensitivity Domains are Differently Affected by Social and Non-social Autistic Traits. J Autism Dev Disord 2021; 52:3486-3495. [PMID: 34374915 PMCID: PMC9296403 DOI: 10.1007/s10803-021-05228-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 12/05/2022]
Abstract
Anxiety sensitivity (AS) is implicated in the development and maintenance of several psychopathological conditions. Non-clinical individuals with high autistic traits may develop anxiety disorders and depressive symptoms. Here, we investigated the relationships of autistic traits with AS dimensions and depression, considering sex. We referred to the two-factor model of the autism spectrum quotient to distinguish social and non-social autistic traits and assessed 345 university students on AS and depression scales. Results showed that only social autistic traits predicted general AS and anxiety-related concerns regarding social and cognitive domains. The present results emphasize the need of assessing multiple domains of anxiety in individuals on the autistic spectrum, differentiating social and non-social traits.
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Developmental Paths to Anxiety in an Autism-Enriched Infant Cohort: The Role of Temperamental Reactivity and Regulation. J Autism Dev Disord 2021; 51:2631-2645. [PMID: 33037563 PMCID: PMC8254725 DOI: 10.1007/s10803-020-04734-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The aim of this study was to explore the associations between temperamental reactivity and regulation and the emergence of anxiety traits in a longitudinal sample of infants enriched for later ASD. Parents of 143 infants who were at high- and low-risk for ASD rated their child’s temperament traits when they were 9, 15 and 24 months old; they rated anxiety and ASD traits when they were 36 months old. The findings suggest that behavioural inhibition may be an early predictor of later anxiety in children with and without ASD and that lower levels of effortful control in children who later develop ASD may contribute to the higher expression of anxiety within this population.
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45
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Sundaresan A, Penchina B, Cheong S, Grace V, Valero-Cabré A, Martel A. Evaluating deep learning EEG-based mental stress classification in adolescents with autism for breathing entrainment BCI. Brain Inform 2021; 8:13. [PMID: 34255197 PMCID: PMC8276906 DOI: 10.1186/s40708-021-00133-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/31/2021] [Indexed: 12/16/2022] Open
Abstract
Mental stress is a major individual and societal burden and one of the main contributing factors that lead to pathologies such as depression, anxiety disorders, heart attacks, and strokes. Given that anxiety disorders are one of the most common comorbidities in youth with autism spectrum disorder (ASD), this population is particularly vulnerable to mental stress, severely limiting overall quality of life. To prevent this, early stress quantification with machine learning (ML) and effective anxiety mitigation with non-pharmacological interventions are essential. This study aims to investigate the feasibility of exploiting electroencephalography (EEG) signals for stress assessment by comparing several ML classifiers, namely support vector machine (SVM) and deep learning methods. We trained a total of eleven subject-dependent models-four with conventional brain-computer interface (BCI) methods and seven with deep learning approaches-on the EEG of neurotypical (n=5) and ASD (n=8) participants performing alternating blocks of mental arithmetic stress induction, guided and unguided breathing. Our results show that a multiclass two-layer LSTM RNN deep learning classifier is capable of identifying mental stress from ongoing EEG with an overall accuracy of 93.27%. Our study is the first to successfully apply an LSTM RNN classifier to identify stress states from EEG in both ASD and neurotypical adolescents, and offers promise for an EEG-based BCI for the real-time assessment and mitigation of mental stress through a closed-loop adaptation of respiration entrainment.
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Affiliation(s)
- Avirath Sundaresan
- The Nueva School, San Mateo, CA, 94033, USA.,Causal Brain Dynamics, Plasticity and Rehabilitation Team, Frontlab, Brain and Spine Institute, ICM, CNRS UMR, Paris, 7225, France
| | - Brian Penchina
- The Nueva School, San Mateo, CA, 94033, USA.,Causal Brain Dynamics, Plasticity and Rehabilitation Team, Frontlab, Brain and Spine Institute, ICM, CNRS UMR, Paris, 7225, France
| | - Sean Cheong
- The Nueva School, San Mateo, CA, 94033, USA.,Causal Brain Dynamics, Plasticity and Rehabilitation Team, Frontlab, Brain and Spine Institute, ICM, CNRS UMR, Paris, 7225, France
| | - Victoria Grace
- Muvik Labs, LLC, Locust Valley, NY, 11560, USA.,Center for Computer Research in Music and Acoustics, Stanford University, Stanford, CA, 94305, USA.,Causal Brain Dynamics, Plasticity and Rehabilitation Team, Frontlab, Brain and Spine Institute, ICM, CNRS UMR, Paris, 7225, France
| | - Antoni Valero-Cabré
- Center for Computer Research in Music and Acoustics, Stanford University, Stanford, CA, 94305, USA.,Department of Anatomy and Neurobiology, Laboratory of Cerebral Dynamics, Boston University School of Medicine, Boston, MA, 02118, USA.,Cognitive Neuroscience and Information Technology Research Program, Open University of Catalonia (UOC), Barcelona, Spain.,Causal Brain Dynamics, Plasticity and Rehabilitation Team, Frontlab, Brain and Spine Institute, ICM, CNRS UMR, Paris, 7225, France
| | - Adrien Martel
- Cognitive Neuroscience and Information Technology Research Program, Open University of Catalonia (UOC), Barcelona, Spain. .,Causal Brain Dynamics, Plasticity and Rehabilitation Team, Frontlab, Brain and Spine Institute, ICM, CNRS UMR, Paris, 7225, France.
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Abstract
The recognition of anxiety as one of the most commonly co-occurring diagnoses for individuals on the autism spectrum has led to increased research on symptomatology and treatment, but there is limited research documenting the impact of this anxiety. To address this, this study reports on the Child Anxiety Life Interference Scale (CALIS, parent version) in a community sample of 121 parents of children on the autism spectrum. Scores indicate that the anxiety is impacting upon the child's engagement in activities both in and outside of home as well as impacting upon parent life. Explanatory variables differed for CALIS subscales. As the child's difficulties with uncertainty and parent level of anxiety were the variables that explained the most variance, these may be important foci for effective interventions.
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Are Mental Health, Family and Childhood Adversity, Substance Use and Conduct Problems Risk Factors for Offending in Autism? J Autism Dev Disord 2021; 51:2057-2067. [PMID: 32915355 PMCID: PMC8124051 DOI: 10.1007/s10803-020-04622-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Mental health difficulties, family and childhood adversity factors, substance use and conduct problems have all been linked to offending behaviour in the general population. However, no large-scale study with comparison groups has investigated these risk factors in relation to autistic offenders. The current research included 40 autistic offenders, 40 autistic non-offenders, 40 typically developed (TD) offenders and 39 TD non-offenders. Conduct problems risk factors differentiated autistic offenders from both non-offender groups (autistic and TD) and mental health risk factors differentiated autistic offenders from both TD groups (offenders and non-offenders). Further research is required to understand more about the role of both conduct problems risk factors in autistic offenders (e.g., age at onset, frequency of behaviours) and the mental health needs of autistic offenders.
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Tanaka M, Tóth F, Polyák H, Szabó Á, Mándi Y, Vécsei L. Immune Influencers in Action: Metabolites and Enzymes of the Tryptophan-Kynurenine Metabolic Pathway. Biomedicines 2021; 9:734. [PMID: 34202246 PMCID: PMC8301407 DOI: 10.3390/biomedicines9070734] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/16/2022] Open
Abstract
The tryptophan (TRP)-kynurenine (KYN) metabolic pathway is a main player of TRP metabolism through which more than 95% of TRP is catabolized. The pathway is activated by acute and chronic immune responses leading to a wide range of illnesses including cancer, immune diseases, neurodegenerative diseases and psychiatric disorders. The presence of positive feedback loops facilitates amplifying the immune responses vice versa. The TRP-KYN pathway synthesizes multifarious metabolites including oxidants, antioxidants, neurotoxins, neuroprotectants and immunomodulators. The immunomodulators are known to facilitate the immune system towards a tolerogenic state, resulting in chronic low-grade inflammation (LGI) that is commonly present in obesity, poor nutrition, exposer to chemicals or allergens, prodromal stage of various illnesses and chronic diseases. KYN, kynurenic acid, xanthurenic acid and cinnabarinic acid are aryl hydrocarbon receptor ligands that serve as immunomodulators. Furthermore, TRP-KYN pathway enzymes are known to be activated by the stress hormone cortisol and inflammatory cytokines, and genotypic variants were observed to contribute to inflammation and thus various diseases. The tryptophan 2,3-dioxygenase, the indoleamine 2,3-dioxygenases and the kynurenine-3-monooxygenase are main enzymes in the pathway. This review article discusses the TRP-KYN pathway with special emphasis on its interaction with the immune system and the tolerogenic shift towards chronic LGI and overviews the major symptoms, pro- and anti-inflammatory cytokines and toxic and protective KYNs to explore the linkage between chronic LGI, KYNs, and major psychiatric disorders, including depressive disorder, bipolar disorder, substance use disorder, post-traumatic stress disorder, schizophrenia and autism spectrum disorder.
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Affiliation(s)
- Masaru Tanaka
- MTA-SZTE—Neuroscience Research Group, H-6725 Szeged, Hungary; (M.T.); (F.T.)
- Interdisciplinary Excellence Centre, Department of Neurology, Faculty of Medicine, University of Szeged, H-6725 Szeged, Hungary; (H.P.); (Á.S.)
| | - Fanni Tóth
- MTA-SZTE—Neuroscience Research Group, H-6725 Szeged, Hungary; (M.T.); (F.T.)
| | - Helga Polyák
- Interdisciplinary Excellence Centre, Department of Neurology, Faculty of Medicine, University of Szeged, H-6725 Szeged, Hungary; (H.P.); (Á.S.)
| | - Ágnes Szabó
- Interdisciplinary Excellence Centre, Department of Neurology, Faculty of Medicine, University of Szeged, H-6725 Szeged, Hungary; (H.P.); (Á.S.)
| | - Yvette Mándi
- Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Szeged, H-6720 Szeged, Hungary;
| | - László Vécsei
- MTA-SZTE—Neuroscience Research Group, H-6725 Szeged, Hungary; (M.T.); (F.T.)
- Interdisciplinary Excellence Centre, Department of Neurology, Faculty of Medicine, University of Szeged, H-6725 Szeged, Hungary; (H.P.); (Á.S.)
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49
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Hosokawa R, Kawabe K, Nakachi K, Yoshino A, Horiuchi F, Ueno SI. Behavioral Affect in Children with Autism Spectrum Disorder during School Closures Due to the COVID-19 Pandemic in Japan: A Case-Controlled Study. Dev Neuropsychol 2021; 46:288-297. [PMID: 34157904 DOI: 10.1080/87565641.2021.1939350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Children with autism spectrum disorder (ASD) could experience more stress due to the changes consequent to school closures because of the coronavirus disease 2019 (COVID-19) pandemic. This study investigated differences in behavioral affect between children with ASD and typically developing children (TD). We conducted an online survey with mothers. The data of 84 children with ASD and 361 TD children aged 6 to 18 years were analyzed. Children with ASD were more frustrated due to the changes in their schedule and engaged more in restricted and repetitive behavior. Children with ASD had different types of behavioral affect compared to TD.
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Affiliation(s)
- Rie Hosokawa
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan.,Center for Child Health, Behavior and Development, Ehime University Hospital, Toon City, Ehime, Japan
| | - Kentaro Kawabe
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan.,Center for Child Health, Behavior and Development, Ehime University Hospital, Toon City, Ehime, Japan
| | - Kiwamu Nakachi
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan.,Center for Child Health, Behavior and Development, Ehime University Hospital, Toon City, Ehime, Japan
| | - Ayumi Yoshino
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan.,Center for Child Health, Behavior and Development, Ehime University Hospital, Toon City, Ehime, Japan
| | - Fumie Horiuchi
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan.,Center for Child Health, Behavior and Development, Ehime University Hospital, Toon City, Ehime, Japan
| | - Shu-Ichi Ueno
- Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan
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50
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Ozsivadjian A, Hollocks MJ, Magiati I, Happé F, Baird G, Absoud M. Is cognitive inflexibility a missing link? The role of cognitive inflexibility, alexithymia and intolerance of uncertainty in externalising and internalising behaviours in young people with autism spectrum disorder. J Child Psychol Psychiatry 2021; 62:715-724. [PMID: 32827150 DOI: 10.1111/jcpp.13295] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Internalising (anxiety and low mood) and externalising (aggressive or outburst behaviours, and irritability) difficulties are very common in autism spectrum disorder (ASD) across the life span, relatively stable over time and often associated with poorer quality of life. Understanding the cognitive mechanisms underlying internalising and externalising difficulties in ASD is essential for developing targeted supports and interventions. In the present study, we investigated established and less-researched cognitive factors hypothesised to contribute to internalising and/or externalising difficulties in ASD, namely cognitive inflexibility (CI), intolerance of uncertainty (IU) and alexithymia. Based on previous models and clinical experience, we hypothesised that IU would lead to internalising symptoms, with alexithymia contributing to this pathway, and that CI would have a direct effect on externalising behaviours and may indirectly contribute to internalising symptoms via increasing IU. METHODS Our sample consisted of 95 5- to 18-year-olds presenting to a specialist neurodevelopmental clinic and receiving a diagnosis of ASD. Parents/caregivers completed questionnaires assessing ASD symptomatology, internalising and externalising difficulties, CI, IU and alexithymia. Structural equation modelling was used to examine the hypothesised pathways and relationships between the main variables of interest. RESULTS Cognitive Inflexibility played a significant direct role in the pathway from ASD symptoms to externalising symptoms in ASD, and indirect role via IU in the pathway to internalising problems. Relationships between alexithymia and both internalising and externalising symptoms were weaker, with alexithymia predicting internalising difficulties via IU only. CONCLUSIONS The finding of a direct pathway from CI to externalising behaviours is novel, as is the indirect role of CI in internalising symptomatology. Of the three cognitive mechanisms examined, only CI significantly predicted externalising symptoms. Possible implications for interventions and supports targeting these cognitive processes in ASD are discussed.
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Affiliation(s)
- Ann Ozsivadjian
- Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Matthew J Hollocks
- Department of Child & Adolescent Psychiatry, Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, UK
| | - Iliana Magiati
- School of Psychological Science, University of Western Australia (UWA), Crawley, WA, Australia
| | - Francesca Happé
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, UK
| | - Gillian Baird
- Newcomen Centre, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Michael Absoud
- Newcomen Centre, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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