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Moore L, Larkin F, Foley S. Mental Health Professionals' Experiences of Adapting Mental Health Interventions for Autistic Adults: A Systematic Review and Thematic Synthesis. J Autism Dev Disord 2024; 54:2484-2501. [PMID: 37179522 DOI: 10.1007/s10803-023-06006-6] [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] [Accepted: 04/23/2023] [Indexed: 05/15/2023]
Abstract
Autistic adults experience high rates of metal health difficulties and face significant barriers to accessing appropriate mental health care. Empirical research and recent professional guidelines emphasise the importance of modifying standard mental health interventions to best meet the needs of autistic adults. This systematic review explored mental health professionals' experiences of adapting mental health interventions for autistic adults. A systematic search was conducted on CINAHL, PsychINFO, PubMed, Scopus, and Web of Science in July 2022. The findings from 13 identified studies were synthesised using thematic synthesis. Three major analytical themes were generated, the unique experience of adapting interventions for autistic clients, factors which facilitate successful adaptations, and challenges to adapting interventions. Each theme contained a number of subsequent sub-themes. Professionals view the process of adapting interventions to be a highly individualised process. A range of personal traits, professional experiences, and systemic, service-based issues were identified in facilitating or challenging this individualised process. Further research regarding adaptations with different intervention models and increased supportive resources are required to enable professionals to successfully adapt interventions for autistic adult clients.
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Affiliation(s)
- Laura Moore
- School of Applied Psychology, University College Cork, Cork, Ireland.
| | - Fionnuala Larkin
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Sarah Foley
- School of Applied Psychology, University College Cork, Cork, Ireland
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2
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Gerber AH, Nahmias A, Schleider JL, Lerner MD. Results from a Pilot Randomized Controlled Trial of a Single-Session Growth-Mindset Intervention for Internalizing Symptoms in Autistic Youth. J Autism Dev Disord 2024:10.1007/s10803-024-06341-2. [PMID: 38833031 DOI: 10.1007/s10803-024-06341-2] [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: 03/29/2024] [Indexed: 06/06/2024]
Abstract
Autistic youth experience elevated rates of co-occurring internalizing symptoms. Interventions to treat internalizing symptoms in autistic youth are almost uniformly costly and time-intensive, blunting dissemination of intervention and highlighting the need for scalable solutions. One promising option is a relatively new class of evidence-based treatments, single-session interventions (SSIs), however, no study has examined SSIs for depression symptoms in autistic youth. Participants included 40 autistic adolescents ranging in age from 11 to 16 (Mage = 14.22, Nmale = 32). Eligible youth who agreed to participate were randomized to either the active intervention (Project Personality), or an active control designed to mimic supportive therapy. Participants and their caregiver completed questionnaires immediately before, after, and three months post intervention. All participants completed the intervention independently and largely reported enjoying it. The intervention was delivered with 100% fidelity. Findings demonstrated improvements in perceived primary control, malleability of personality, and social competence relative to the active control group immediately post-intervention. Further, results revealed improvements in self-reported depression symptoms and parent reported emotional regulation at 3-month follow up. This study was the first to assess a GM-SSI designed to treat depression symptoms in autistic adolescents. Results indicated improvements in perceived control immediately post-intervention and downstream improvements in depression. Nonetheless, we did not find improvements in symptoms of anxiety, suggesting that autistic adolescents may require modifications to the intervention to maximize benefit. Findings demonstrate the utility of GM-SSI for internalizing symptoms for autistic youth and hold considerable promise as a low-intensity and scalable intervention.
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Affiliation(s)
- Alan H Gerber
- Child Study Center, Yale School of Medicine, New Haven, CT, 06519, USA.
| | - Allison Nahmias
- AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
| | - Jessica L Schleider
- Department of Psychology, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Matthew D Lerner
- AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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3
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Stecher C, Pagni BA, Cloonan S, Vink S, Hill E, Ogbeama D, Delaney S, Braden BB. App-based meditation habits maintain reductions in depression symptoms among autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1487-1502. [PMID: 37837362 DOI: 10.1177/13623613231200679] [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] [Indexed: 10/16/2023]
Abstract
LAY ABSTRACT Existing research has identified an increased risk of depression among autistic adults, which can negatively impact their adaptive functioning abilities and socioeconomic outcomes. Mobile app-based meditation is a feasible, accessible, and effective self-care solution for depression among neurotypical adults, but there is limited evidence for the long-term benefits of app-based meditation among autistic adults. Habits are a key behavioral strategy for maintaining behavior change, and anchoring is one effective habit formation intervention that has yet to be tested among autistic adults. This study demonstrates that it is both feasible and effective to integrate the anchoring habit formation strategy into an app-based meditation intervention for establishing meditation habits among autistic adults. In addition, the study shows that app-based meditation habits were successful at maintaining reductions in depressive symptoms over 6 months. These results demonstrate the power of anchoring-based habit formation interventions for establishing healthy habits among autistic adults, which offers a promising behavioral intervention technique for establishing other healthy habits among autistic adults. The study also shows that app-based meditation habits are an effective long-term self-care solution for managing depressive symptoms among autistic adults that should be used by mental health providers and policymakers. Future research should test this combined anchoring and app-based meditation intervention technique among larger samples of autistic adults and over longer durations to better understand the mechanisms underlying the success of this intervention.
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Thiel T, Riedelbauch S, Gaigg S, Roessner V, Ring M. The impact of depressive and anxious symptoms on quality of life in adults on the autism spectrum. Autism Res 2024; 17:1161-1174. [PMID: 38783834 DOI: 10.1002/aur.3144] [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] [Received: 07/24/2022] [Accepted: 04/19/2024] [Indexed: 05/25/2024]
Abstract
Quality of life (QoL) is lower in adults on the autism spectrum (AS) compared with typically developing (TD) adults. In this context, recent studies have examined the role of depression and anxiety in reducing QoL in AS adults. The aim of this study was to (1) replicate these findings of lower QoL and (2) assess the negative influence of depressive and anxious symptoms on QoL in an adult AS (N = 86) and TD (N = 87) German sample with a broad age range (18-70 years). For this, we used questionnaires that have been validated for the AS and TD population: the World Health Organization Quality of Life Brief Version, the Autism-Specific QoL items, and the Hospital Anxiety and Depression Scale. We replicated previous findings and extended them to autism-specific QoL. Our AS sample had lower QoL compared with the TD adults. However, depressive symptoms were the largest contributor to lower QoL in both samples, more so than group membership and anxious symptoms. We conclude that interventions to improve QoL in AS adults should specifically target depressive symptoms and for this, improvements to the diagnostic process and treatment of depression in AS are necessary.
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Affiliation(s)
- Tobias Thiel
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Saskia Riedelbauch
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Sebastian Gaigg
- Autism Research Group, Department of Psychology, City, University of London, London, UK
| | - Veit Roessner
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Medizinische Fakultät, TU Dresden, Dresden, Germany
| | - Melanie Ring
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Medizinische Fakultät, TU Dresden, Dresden, Germany
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5
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Dickson KS, Galligan M, Holt T, Kenworthy L, Anthony L, Roesch S, Brookman-Frazee L. Randomized Feasibility Pilot of an Executive Functioning Intervention Adapted for Children's Mental Health Settings. J Autism Dev Disord 2024:10.1007/s10803-024-06365-8. [PMID: 38678517 DOI: 10.1007/s10803-024-06365-8] [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: 04/18/2024] [Indexed: 05/01/2024]
Abstract
The critical role of executive functioning in autism as well as the co-occurring mental health challenges common among autistic youth support to the immense value of interventions targeting executive functioning for enhancing mental health services for autistic children. The goal of the present study was to conduct a randomized feasibility trial of Unstuck and On Target, an executive functioning intervention, adapted for delivery in children's community mental health setting. Mental health therapists (n = 26) enrolled with participating autistic clients (n = 32) were randomized to receive training in and deliver the adapted Unstuck intervention or to deliver care as usual. We completed masked observational measures of Unstuck strategy use (fidelity) during recorded sessions of participating therapist-client dyads and collected measures of acceptability from participating clients and their caregivers. We also collected measures of pre-post changes in executive functioning and mental health symptoms. Therapists trained in Unstuck demonstrated significantly higher use of Unstuck strategies compared to usual care therapists. Caregivers and autistic clients perceive adapted Unstuck as highly acceptability and helpful. Autistic clients whose therapists were trained in adapted Unstuck demonstrated larger pre-post changes in executive functioning compared to usual care. Across all participating clients, changes in executive functioning were significantly related to changes in mental health symptoms. Finally, clients of therapists trained in adapted Unstuck demonstrated moderate improvements in overall mental health symptoms. The current study provides preliminary evidence of the feasibility and impact of Unstuck and On Target for children's community mental health settings.
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Affiliation(s)
- Kelsey S Dickson
- San Diego State University, San Diego, CA, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
| | - Megan Galligan
- San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Tana Holt
- San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Lauren Kenworthy
- Center for Autism- Children's National Hospital, Washington, DC, USA
- George Washington University Medical School, Washington, DC, USA
| | - Laura Anthony
- University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital of Colorado, Aurora, CO, USA
| | - Scott Roesch
- San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, CA, USA
- Rady Children's Hospital- San Diego, San Diego, CA, USA
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Bal VH, Mournet AM, Glascock T, Shinall J, Gunin G, Jadav N, Zhang H, Brennan E, Istvan E, Kleiman EM. The emotional support plan: Feasibility trials of a brief, telehealth-based mobile intervention to support coping for autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:932-944. [PMID: 37497873 DOI: 10.1177/13623613231186035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
LAY ABSTRACT Autistic adults may have difficulty coping during stressful periods, which could make them more vulnerable to depression and anxiety. We designed the emotional support plan (ESP) to help autistic people find ways to cope in stressful situations. Thirty-six autistic adults created an ESP and answered questions about their opinions of the ESP. Most autistic adults found the ESP to have a positive impact on them and many would recommend the ESP to another person. Feedback from autistic adults suggested ways that we might test the ESP in future studies. Overall, autistic adults in this study found the ESP to be useful and a worthwhile intervention to study more in the future. While more research is clearly needed, we hope that the brief nature of the ESP will make it helpful for autistic people who are trying to handle negative feelings during stressful life events.
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Affiliation(s)
| | | | | | | | | | - Nikita Jadav
- Rutgers, The State University of New Jersey, USA
| | - Henry Zhang
- Rutgers, The State University of New Jersey, USA
| | | | - Emily Istvan
- Rutgers, The State University of New Jersey, USA
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Mohamed Z, Russell A, Palmer M, Simonoff E, Hollocks MJ. Co-designing behavioural activation for depression for autistic adolescents: A case series. Clin Child Psychol Psychiatry 2024; 29:608-623. [PMID: 38286623 PMCID: PMC10945993 DOI: 10.1177/13591045241229583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Autistic youth are at high risk of depression, but there are few psychological interventions that have been specifically designed for use with this population. Behavioural activation (BA) is a particularly promising approach for autistic adolescents, having an established evidence-base for the treatment of depression in non-autistic people, and with a strong focus on behavioural, rather than cognitive change, which is a challenge for some autistic people. In this study, we worked with autistic adolescents and clinicians to co-design a BA-informed intervention to be delivered in an online format. We then conducted a pilot case-series with seven autistic adolescents with depression. Our focus was on establishing the acceptability and feasibility of the intervention but clinical outcomes on both self- and parent-reported symptoms of depression and anxiety are also presented. Our results indicate the intervention to be acceptable and feasible for autistic adolescents, with six out of seven participants being retained to the end of the intervention. Qualitative feedback indicated that all participants found the intervention a positive experience and would recommend it to others. Similarly, all participants found the online format acceptable, with 64% preferring this format to face-to-face therapy. Qualitative feedback and suggestions for refinement will also be discussed.
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Affiliation(s)
- Zameer Mohamed
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ailsa Russell
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, UK
| | - Melanie Palmer
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Emily Simonoff
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Trust, London, UK
| | - Matthew J Hollocks
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Trust, London, UK
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Gu J, Li T, Dong H. Maternal autistic traits and anxiety in children with typical development in Chinese families: a moderated mediation model of mothers' negative emotional expressions and child gender. Front Psychol 2024; 15:1264173. [PMID: 38375119 PMCID: PMC10875098 DOI: 10.3389/fpsyg.2024.1264173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024] Open
Abstract
Background Prior studies have focused on the effects of maternal autistic traits on children with autism, but little attention has been paid to the effects of maternal autistic traits on typically developing children, while the mechanisms of the effects are not clear. Objective Given that, a moderated mediation model was conducted to examine the association between maternal autistic traits and typically developing children's anxiety and the underlying mechanisms. Methods and results Participants were 648 mother-child dyads in which these children had no autistic siblings. Mothers reported their autistic traits and negative emotional expressions in the family and children's anxiety. The results indicated that children's anxiety was predicted by maternal autistic traits. Mediating analysis revealed that mothers' negative emotional expressions partially mediated the association between their autistic traits and children's anxiety. The findings also indicated that child gender moderated the relationship between maternal emotional expressions and children's anxiety. Specifically, anxiety in girls was more strongly predicted by negative emotional expressions from their mothers than in boys. Conclusion These results have important theoretical and practical implications for reducing the adverse effect of maternal autistic traits on children's anxiety, especially for girls. The present study also reveals that maternal negative emotional expression is an important mechanism. Causal conclusions cannot be drawn based on cross-sectional research design, so it is necessary to conduct longitudinal studies in the future.
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Affiliation(s)
| | | | - Huiqin Dong
- Faculty of Education, Shandong Normal University, Jinan, China
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Mournet AM, Gunin G, Shinall J, Brennan E, Jadav N, Istvan E, Kleiman EM, Bal VH. The impact of measurement on clinical trials: Comparison of preliminary outcomes of a brief mobile intervention for autistic adults using multiple measurement approaches. Autism Res 2024; 17:432-442. [PMID: 38321822 DOI: 10.1002/aur.3095] [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] [Received: 08/07/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024]
Abstract
Initial studies of the emotional safety plan (ESP), a new, brief telehealth and mobile intervention to support autistic adults to cope with periods of distress, have reported feasibility and acceptability (Bal et al., 2023, Autism, 1-13). Herein we report the preliminary clinical outcomes of thirty-six autistic adults who developed a personalized ESP, with a specific interest in comparing "outcomes" demonstrated by different instruments and assessment frequencies in order to inform outcome measurement in future clinical trials. Comparison of pre-intervention baseline to post-monitoring outcome (pre-post) anxiety symptoms (Generalized Anxiety Disorder-7 [GAD-7]) and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) revealed medium effect sizes for reduction in symptoms, though, low effect sizes were observed for pre-post Adult Self-report Anxiety and Depressive Problems scales and the Emotion Dysregulation Inventory Reactivity and Dysphoria scales. Weekly assessments showed an initial decrease in GAD-7 anxiety symptoms but no effect on weekly PHQ-9 depressive ratings. Ecological momentary assessment (EMA) data suggested that, when participants reported feeling sad or agitated and used the ESP, reduced negative feelings and increased positive states were reported in subsequent EMA. Perhaps not surprisingly, preliminary outcomes of these feasibility trials differed depending on measure chosen. Implications for the design of clinical trials are discussed.
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Affiliation(s)
- Annabelle M Mournet
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Gabrielle Gunin
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Jacqueline Shinall
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Emily Brennan
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Nikita Jadav
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Emily Istvan
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Evan M Kleiman
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Vanessa H Bal
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
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Maughan AL, Lunsky Y, Lake J, Mills JS, Fung K, Steel L, Weiss JA. Parent, child, and family outcomes following Acceptance And Commitment Therapy for parents of autistic children: A randomized controlled trial. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:367-380. [PMID: 37165863 PMCID: PMC10851654 DOI: 10.1177/13623613231172241] [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] [Indexed: 05/12/2023]
Abstract
LAY ABSTRACT Parents of autistic children commonly experience difficulties with their own mental health. This study looked at the effects of a brief group-based Acceptance and Commitment Therapy program, developed for parents of autistic children, youth, and adults. ACT focuses on increasing psychological flexibility, which is the ability to be mindful and accepting of difficult thoughts and experiences, shown to be important for mental wellness. Participants included 54 parents of autistic people, ages 3-34. Parents were randomly divided into two groups: a Treatment group that received the intervention right away, and a Waitlist group that completed the program after the Treatment group completed the trial. All parents filled out questionnaires right before the program began, and at 3, 7, and 17 weeks after randomization. Compared to the group that was waiting to participate in the program, parents in the Treatment group reported greater improvements in depression and family distress, and these improvements were still present 4 months later. Parents in the Treatment group also reported short-term improvements in their positive feelings and personal goals, compared to those waiting. Results showed that ACT may help improve some aspects of mental health for parents of autistic children, but further research is recommended.
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Affiliation(s)
| | - Yona Lunsky
- Centre for Addiction and Mental Health, Canada
| | | | | | | | - Lee Steel
- Centre for Addiction and Mental Health, Canada
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Agius H, Luoto AK, Backman A, Eriksdotter C, Jayaram-Lindström N, Bölte S, Hirvikoski T. Mindfulness-based stress reduction for autistic adults: A feasibility study in an outpatient context. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:403-414. [PMID: 37190953 PMCID: PMC10851647 DOI: 10.1177/13623613231172809] [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] [Indexed: 05/17/2023]
Abstract
LAY ABSTRACT Autistic adults report high stress levels and difficulties dealing with everyday stressors. Mindfulness-based stress reduction groups aim to help regulate stress responses. We asked 50 autistic adults, without intellectual disability, to participate in a study of mindfulness-based stress reduction. The group program was made accessible through clear group leader communication and good program predictability, as well as reduced exposure to disturbing sensory stimuli. The mindfulness and yoga based exercises from the original mindfulness-based stress reduction program were included. The participants were positive and would even recommend an autistic friend to participate in a mindfulness-based stress reduction group. They reported that mindfulness-based stress reduction could lower symptoms of stress and improved stress coping. We still need to investigate these effects further in larger studies. The findings of this work show that mindfulness-based stress reduction groups can be adapted for autistic adults and that the participants overall were positive to the intervention and the group format.
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Affiliation(s)
- Hanna Agius
- Karolinska Institutet, Stockholm Health Care Services, Sweden
- Stockholm Health Care Services, Sweden
| | | | - Anna Backman
- Karolinska Institutet, Stockholm Health Care Services, Sweden
- Stockholm Health Care Services, Sweden
| | | | | | - Sven Bölte
- Karolinska Institutet, Stockholm Health Care Services, Sweden
- Stockholm Health Care Services, Sweden
- Curtin University, Australia
| | - Tatja Hirvikoski
- Karolinska Institutet, Stockholm Health Care Services, Sweden
- Stockholm Health Care Services, Sweden
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12
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Josyfon E, Spain D, Blackmore C, Murphy D, Oakley B. Alexithymia in Adult Autism Clinic Service-Users: Relationships with Sensory Processing Differences and Mental Health. Healthcare (Basel) 2023; 11:3114. [PMID: 38132004 PMCID: PMC10742835 DOI: 10.3390/healthcare11243114] [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: 10/26/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
Mental health difficulties commonly co-occur with autism, especially in autistic people accessing clinic services, impacting substantially on quality-of-life. Alexithymia (difficulty describing/identifying feelings) and sensory processing differences are prevalent traits in autism that have been associated with depression/anxiety in autistic community samples. However, it is important to better understand interrelationships between these traits in clinical populations to improve identification of service-user needs. In this study, 190 autistic adults (65.3% male), seen in a tertiary autism clinic, completed self-report measures of alexithymia (20-item Toronto Alexithymia Scale), sensory processing differences (Adolescent/Adult Sensory Profile) and depression/anxiety (Hospital Anxiety and Depression Scale). Multiple linear regression models and mediation analyses were used to examine associations between alexithymia, sensory processing differences, and depression/anxiety severity. Across the sample, 66.3% of individuals (N = 126) were classified as alexithymic (score ≥ 61). Total alexithymia and difficulty describing/identifying feelings were significantly associated with depression severity (β = 0.30-0.38, highest p < 0.002), and difficulty identifying feelings was significantly associated with anxiety severity (β = 0.36, p < 0.001). Sensory processing differences were also significantly associated with depression severity (β = 0.29, p = 0.002) and anxiety severity across all models (β = 0.34-0.48, highest p < 0.001) Finally, difficulty describing/identifying feelings partially mediated the relationships between sensory processing differences and both depression/anxiety severity. Overall, these results highlight that interventions adapted for and targeting emotional awareness and sensory-related uncertainty may improve mental health outcomes in autistic service-users.
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Affiliation(s)
- Emily Josyfon
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - Debbie Spain
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - Charlotte Blackmore
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - Declan Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London SE5 8AF, UK
- Sackler Institute for Translational Neurodevelopment, King’s College London, De Crespigny Park, London SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust (SLaM), London SE5 8AZ, UK
| | - Bethany Oakley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London SE5 8AF, UK
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Kois LE, Cox J, Simmons GL, White SW, Scott-Adams V. University-Community Mental Health Training Collaboration: Teaching Criminal Legal Stakeholders About Autism. Psychiatr Serv 2023; 74:1311-1314. [PMID: 37194315 DOI: 10.1176/appi.ps.20220254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Individuals with autism spectrum disorder (ASD) are disproportionately represented in the criminal legal system, yet ASD-specific training is rarely provided to frontline clinical staff or legal professionals. This column describes a collaboration between university researchers and a state mental health department to promote ASD awareness, knowledge, and intervention skills among clinical and legal professionals working with autistic individuals with criminal legal involvement. Descriptions of how specific needs were identified, how tailored educational workshops were developed, and how workshop efficacy was assessed are provided. Lessons learned and recommendations for researchers and health care systems interested in similar collaborations are offered.
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Affiliation(s)
- Lauren E Kois
- Department of Clinical Psychology (Kois, Cox, Simmons, White) and Center for Youth Development and Intervention (Simmons, White), University of Alabama, Tuscaloosa; Office of Forensic Mental Health Services, Alabama Department of Mental Health, Tuscaloosa (Scott-Adams)
| | - Jennifer Cox
- Department of Clinical Psychology (Kois, Cox, Simmons, White) and Center for Youth Development and Intervention (Simmons, White), University of Alabama, Tuscaloosa; Office of Forensic Mental Health Services, Alabama Department of Mental Health, Tuscaloosa (Scott-Adams)
| | - Grace Lee Simmons
- Department of Clinical Psychology (Kois, Cox, Simmons, White) and Center for Youth Development and Intervention (Simmons, White), University of Alabama, Tuscaloosa; Office of Forensic Mental Health Services, Alabama Department of Mental Health, Tuscaloosa (Scott-Adams)
| | - Susan W White
- Department of Clinical Psychology (Kois, Cox, Simmons, White) and Center for Youth Development and Intervention (Simmons, White), University of Alabama, Tuscaloosa; Office of Forensic Mental Health Services, Alabama Department of Mental Health, Tuscaloosa (Scott-Adams)
| | - Virginia Scott-Adams
- Department of Clinical Psychology (Kois, Cox, Simmons, White) and Center for Youth Development and Intervention (Simmons, White), University of Alabama, Tuscaloosa; Office of Forensic Mental Health Services, Alabama Department of Mental Health, Tuscaloosa (Scott-Adams)
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Alrehaili RA, ElKady RM, Alrehaili JA, Alreefi RM. Exploring Early Childhood Autism Spectrum Disorders: A Comprehensive Review of Diagnostic Approaches in Young Children. Cureus 2023; 15:e50111. [PMID: 38186518 PMCID: PMC10771115 DOI: 10.7759/cureus.50111] [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: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Autism spectrum disorders (ASD) encompass a diverse range of developmental disabilities characterized by pervasive deficiencies in socialization, communication, and the manifestation of behavioral issues. This review aims to clarify the diagnostic criteria for ASD, explore available diagnostic tools, evaluate biomedical examinations facilitating ASD diagnosis, and discuss the approach to screening assessments for ASD. ASDs are prevalent conditions, with a globally estimated prevalence of 7.6 cases per 100 (one in 132), based on a comprehensive review of epidemiological studies. The precise cause of autism and other ASDs remains unknown; however, genetic and environmental factors likely contribute. Common signs and symptoms shared among individuals with autism include restricted repetitive behaviors and learning disabilities. Standardized methods, such as the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), diagnostic instruments, a thorough medical history, multiple physical examinations, laboratory investigations, neuroimaging, and screening tests, play a pivotal role in early autism diagnosis and intervention. ASD is a lifelong neurodevelopmental condition characterized by multiple deficits. Early detection is anticipated to have a positive impact on outcomes.
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Affiliation(s)
- Ruba A Alrehaili
- Family Medicine, Academy of Family Medicine, Ministry of Health, Al-Madinah, SAU
| | - Reem M ElKady
- Radiology and Medical Imaging, Faculty of Medicine, Taibah University, Al-Madinah, SAU
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15
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Jubenville-Wood T, Nicholas DB, Weiss J, Cairns S. Facilitators and barriers in psychotherapy from the perspective of autistic adults: an enhanced critical incident study. Int J Qual Stud Health Well-being 2023; 18:2278858. [PMID: 37979185 PMCID: PMC11000678 DOI: 10.1080/17482631.2023.2278858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/30/2023] [Indexed: 11/20/2023] Open
Abstract
PURPOSE A significant portion of autistic adults experience mental health challenges. Currently, the literature is incomplete when it comes to understanding the needs and preferences of autistic adults who receive therapy. This study elicited the perspectives of autistic adults, focusing on the facilitators, barriers and ways to enhance psychotherapy based on receiving this care for mental health problems. METHODS Using the qualitative, exploratory approach of the Enhanced Critical Incident Technique, eight autistic adults took part in interviews. RESULTS A total of 147 critical incidents were extracted from participant interviews and categories salient to therapeutic practice. The study identified key factors influencing therapy, such as trust and respect, practical approaches, client factors, structure of sessions, knowledge about autism, support for individualized needs, access to mental health services, and involvement of family/advocate. These factors were categorized into eight main areas relevant to therapeutic practice. CONCLUSIONS Findings from this research reveal that psychotherapy with autistic adults is analogous to performing this work with non-autistic adults, in the sense that this work too entails elements of individually tailored treatment and the reliance on common therapeutic factors. There are also differences in this work that necessitate providers having foundational knowledge about autism. Learning directly from autistic adults' insights may help to improve upon the delivery of mental health care for autistic adults.
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Affiliation(s)
| | - David B. Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan Weiss
- Faculty of Health, York University, Toronto, Ontario, Canada
| | - Sharon Cairns
- Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
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16
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Gallant C, Roudbarani F, Ibrahim A, Maddox BB, Weiss JA. Clinician Knowledge, Confidence, and Treatment Practices in Their Provision of Psychotherapy to Autistic Youth and Youth with ADHD. J Autism Dev Disord 2023; 53:4214-4228. [PMID: 36076117 PMCID: PMC10539421 DOI: 10.1007/s10803-022-05722-9] [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: 08/11/2022] [Indexed: 10/14/2022]
Abstract
Autistic youth have an increased risk of mental health problems. Despite the efficacy of various psychotherapeutic approaches for autistic youth, they often do not receive these interventions. Research is needed to identify patterns of effective treatment for autistic youth and whether they differ from those used for youth with other neurodevelopmental conditions (e.g., attention-deficit hyperactivity disorder; ADHD). We compared clinicians' (N = 557) knowledge, confidence and practices when treating autistic youth and youth with ADHD. Although ratings were moderately high overall and similar interventions were used for both groups, clinicians were significantly less knowledgeable and confident when supporting autistic clients compared to clients with ADHD. Thus, improving clinician perspectives may help facilitate treatment for autistic youth with mental health problems.
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Affiliation(s)
- Caitlyn Gallant
- Department of Psychology, York University, Toronto, ON, M3J 1P3, Canada.
| | - Flora Roudbarani
- Department of Psychology, York University, Toronto, ON, M3J 1P3, Canada
| | - Alaa Ibrahim
- Department of Psychology, York University, Toronto, ON, M3J 1P3, Canada
| | - Brenna B Maddox
- Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Jonathan A Weiss
- Department of Psychology, York University, Toronto, ON, M3J 1P3, Canada
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17
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Bal VH, Wilkinson E, Glascock V, Hastings RP, Jahoda A. Mechanisms of change in Behavioral Activation: Adapting depression treatment for autistic people. COGNITIVE AND BEHAVIORAL PRACTICE 2023; 30:589-596. [PMID: 37899797 PMCID: PMC10611425 DOI: 10.1016/j.cbpra.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Despite high rates of co-occurring depression, few studies have developed or adapted treatments targeting depressive symptoms for autistic adults. Behavioral activation is widely accepted as an empirically-supported approach for treating depression in other populations. Careful attention to the mechanisms targeted by behavioral activation is an essential step toward adapting behavioral activation protocols for use with autistic adults. We consider the mechanisms targeted by behavioral activation and provide a framework for research to explore the facilitators and barriers to the use of behavioral activation to treat depression in autistic adults. Drawing upon clinical experience and extant literature, the suggestions presented are aimed at highlighting considerations for clinicians wanting to use behavioral activation programs in their clinical practices with autistic adults and to promote the research needed to establish behavioral activation as an evidence-based practice for treating depression in adults on the autism spectrum.
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Affiliation(s)
- Vanessa H. Bal
- Graduate School of Applied and Professional Psychology, Rutgers University – New Brunswick
| | - Ellen Wilkinson
- Graduate School of Applied and Professional Psychology, Rutgers University – New Brunswick
| | - Victoria Glascock
- Graduate School of Applied and Professional Psychology, Rutgers University – New Brunswick
| | | | - Andrew Jahoda
- Institute of Health & Well Being, University of Glasgow
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18
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Lai MC. Mental health challenges faced by autistic people. Nat Hum Behav 2023; 7:1620-1637. [PMID: 37864080 DOI: 10.1038/s41562-023-01718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/07/2023] [Indexed: 10/22/2023]
Abstract
Mental health challenges impede the well-being of autistic people. This Review outlines contributing neurodevelopmental and physical health conditions, rates and developmental trajectories of mental health challenges experienced by autistic people, as well as unique clinical presentations. A framework is proposed to consider four contributing themes to aid personalized formulation: social-contextual determinants, adverse life experiences, autistic cognitive features, and shared genetic and early environmental predispositions. Current evidence-based and clinical-knowledge-informed intervention guidance and ongoing development of support are highlighted for specific mental health areas. Tailored mental health support for autistic people should be neurodivergence-informed, which is fundamentally humanistic and compatible with the prevailing bio-psycho-social frameworks. The personalized formulation should be holistic, considering physical health and transdiagnostic neurodevelopmental factors, intellectual and communication abilities, and contextual-experiential determinants and their interplay with autistic cognition and biology, alongside resilience. Supporting family well-being is integral. Mutual empathic understanding is fundamental to creating societies in which people across neurotypes are all empowered to thrive.
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Affiliation(s)
- Meng-Chuan Lai
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychology, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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19
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Huang XC, Zhang YN, Wu XY, Jiang Y, Cai H, Deng YQ, Luo Y, Zhao LP, Liu QL, Luo SY, Wang YY, Zhao L, Jiang MM, Wu YB. A cross-sectional study: family communication, anxiety, and depression in adolescents: the mediating role of family violence and problematic internet use. BMC Public Health 2023; 23:1747. [PMID: 37679728 PMCID: PMC10485963 DOI: 10.1186/s12889-023-16637-0] [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] [Received: 03/16/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE The objective of this study is to explore the relationship between family communication, family violence, problematic internet use, anxiety, and depression and validate their potential mediating role. METHODS The study population consisted of Chinese adolescents aged 12 to 18 years, and a cross-sectional survey was conducted in 2022. Structural equation models were constructed using AMOS 25.0 software to examine the factors that influence adolescent anxiety and depression and the mediating effects of problematic internet use and family violence. RESULTS The results indicate that family communication was significantly and negatively related to family violence (β = -.494, p < 0.001), problematic internet use (β = -.056, p < .05), depression (β = -.076, p < .01), and anxiety (β = -.071, p < .05). And the finds also indicate that family violence mediated the relationships between family communication and depression (β = -.143, CI: -.198 -.080), and between family communication and anxiety (β = -.141; CI: -.198 -.074). Chain indirect effects between family communication and depression (β = -.051; CI: -.081 -.030) or anxiety (β = -.046; CI: -.080 -.043) via family violence and then through problematic internet use were also found in the present study. CONCLUSIONS In conclusion, positive family communication is crucial in reducing anxiety and depression in adolescents. Moreover, problematic internet use and family violence mediate the effects of positive family communication on anxiety and depression. Therefore, improving family communication and promoting interventions aimed at reducing family violence and problematic internet use can help reduce anxiety and depression in adolescents, thus promoting their healthy development.
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Affiliation(s)
- Xin-Cheng Huang
- School of Economics and Management, Beijing Institute of Graphic Communication, Beijing, China
| | - Yue-Ning Zhang
- School of Nursing, North Sichuan Medical College, Nanchong, China
| | - Xiao-Yu Wu
- School of Pharmaceutical Science, Shandong University, Jinan, China
| | - Yang Jiang
- Jitang College of North China University of Science and Technology, Tangshan, China
| | - Hao Cai
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Yu-Qian Deng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yuan Luo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Li-Ping Zhao
- The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qin-Ling Liu
- School of Nursing, North Sichuan Medical College, Nanchong, China
| | - Sheng-Yue Luo
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Yan-Yan Wang
- School of Economics and Management, Beijing Institute of Graphic Communication, Beijing, China
| | - Li Zhao
- Department of Nuring, Affiliated Hospital of North Sichuan Medical Collge, Nanchong, China
| | - Mao-Min Jiang
- School of Public Affairs, Xiamen University, 422 Simingnan Road, Siming District, Xiamen, China.
| | - Yi-Bo Wu
- School of Public Health, Peking University, Beijing, China.
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20
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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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21
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Mazurek MO, Pappagianopoulos J, Brunt S, Sadikova E, Nevill R, Menezes M, Harkins C. A mixed methods study of autistic adults' mental health therapy experiences. Clin Psychol Psychother 2023; 30:767-779. [PMID: 36708045 PMCID: PMC10372197 DOI: 10.1002/cpp.2835] [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] [Received: 10/13/2022] [Revised: 01/11/2023] [Accepted: 01/24/2023] [Indexed: 01/29/2023]
Abstract
Autistic adults are at high risk for co-occurring mental health problems and need access to effective and appropriate mental health treatment. However, the relative effectiveness or acceptability of specific mental health strategies among autistic adults has not been previously examined. The current study sought to gain a deeper understanding of autistic adults' experiences and preferences regarding mental health strategies using a mixed methods approach. Autistic adults (n = 303, ages 21-77) completed online surveys and open-ended questions about their mental health and therapy experiences. Most (88.8%) had participated in therapy, with cognitive approaches being the most common. Regarding overall therapy experiences, qualitative analyses revealed four primary themes and nine subthemes. Therapist acceptance and understanding were seen as critical for therapy success, and many participants felt that therapy was helpful for personal growth. However, many participants found that talking in session was challenging and noted that aspects of the session format affected their ability to engage in therapy. Regarding specific strategies, four cross-cutting themes and eight strategy-specific subthemes were identified. A variety of strategies were seen as helpful for reducing anxiety and improving mood. However, autistic adults reported trouble generalizing strategies to daily life and found some techniques to be difficult to implement due, in part, to their unique autism-related needs. As the first study of its kind, the results underscore the importance of establishing a safe and accepting therapeutic relationship, providing accommodations to support communication needs, and considering individual differences and preferences when selecting mental health strategies for autistic clients.
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Affiliation(s)
- Micah O Mazurek
- Department of Human Services, University of Virginia, Charlottesville, Virginia, USA
| | | | - Sophie Brunt
- Department of Human Services, University of Virginia, Charlottesville, Virginia, USA
| | - Eleonora Sadikova
- Department of Human Services, University of Virginia, Charlottesville, Virginia, USA
| | - Rose Nevill
- Department of Human Services, University of Virginia, Charlottesville, Virginia, USA
| | - Michelle Menezes
- Department of Human Services, University of Virginia, Charlottesville, Virginia, USA
| | - Christina Harkins
- Department of Human Services, University of Virginia, Charlottesville, Virginia, USA
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22
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Malow BA, Qian Y, Ames JL, Alexeeff S, Croen LA. Health conditions in autism: Defining the trajectory from adolescence to early adulthood. Autism Res 2023; 16:1437-1449. [PMID: 37377040 PMCID: PMC10524876 DOI: 10.1002/aur.2960] [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] [Received: 01/23/2023] [Accepted: 05/01/2023] [Indexed: 06/29/2023]
Abstract
Autistic adults, as compared to non-autistic adults, have increased rates of nearly all medical and psychiatric conditions. Many of these conditions begin in childhood, although few longitudinal studies have been conducted to examine prevalence rates of these conditions from adolescence into early adulthood. In this study, we analyze the longitudinal trajectory of health conditions in autistic youth, compared to age and sex-matched non-autistic youth, transitioning from adolescence into early adulthood in a large integrated health care delivery system. The percent and modeled prevalence of common medical and psychiatric conditions increased from age 14 to 22 years, with autistic youth having a higher prevalence of most conditions than non-autistic youth. The most prevalent conditions in autistic youth at all ages were obesity, neurological disorders, anxiety, and ADHD. The prevalence of obesity and dyslipidemia rose at a faster rate in autistic youth compared to non-autistic youth. By age 22, autistic females showed a higher prevalence of all medical and psychiatric conditions compared to autistic males. Our findings emphasize the importance of screening for medical and psychiatric conditions in autistic youth, coupled with health education targeted at this population, to mitigate the development of adverse health outcomes in autistic adults.
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Affiliation(s)
- Beth A. Malow
- Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yinge Qian
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jennifer L. Ames
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Stacey Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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23
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Rozenblat S, Shimshoni Y, Lebowitz ER, Perez M, Koller J. A Pilot Trial of SPACE (Supportive Parenting for Anxious Childhood Emotions) in Autism. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01555-4. [PMID: 37353645 DOI: 10.1007/s10578-023-01555-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 06/25/2023]
Abstract
Family accommodation describes changes parents make to their behavior, intended to alleviate their child's distress, which stems from a psychopathology. In anxiety, studies show that accommodation alleviates distress in the short term but is associated with increased symptom severity, greater functional impairment, poorer treatment outcomes, increased caregiver burden and disruption to family functioning longitudinally. Research shows high prevalence of family accommodation of anxiety in autism. While the most common treatments for anxiety in autism are cognitive-behavior therapy and pharmacology, research is limited and other approaches must be considered. Supportive Parenting for Anxious Childhood Emotions (SPACE) is a parent-based, manualized treatment for anxiety targeting family accommodation, which has been found to be acceptable and efficacious in treating childhood anxiety. This pilot trial examined the feasibility, acceptability, treatment-satisfaction, and preliminary efficacy of SPACE for anxiety in autism. Parents of 15 autistic children (ages 6-10 years) with at least average cognitive abilities exhibiting high levels of anxiety participated in 13 weekly sessions of SPACE. Feasibility and acceptability were assessed through enrollment, attrition rates, and adverse events. Of 26 eligible families, 22 (84.62%) elected to participate, 15 of whom (68.18%) completed treatment. Parents rated the treatment as highly satisfactory. Anxiety symptom severity and family accommodation were significantly reduced following treatment, with 86.66% of participants showing reliable change post-treatment, and this reduction was preserved at 2-month follow-up. This study provides preliminary evidence that SPACE is feasible, acceptable, satisfactory, and produces improvement in anxiety in the autistic population.Trial registration number: NCT04747262 Date of registration: February 10, 2021.
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Affiliation(s)
- Shir Rozenblat
- Seymour Fox School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | | | | | - Michal Perez
- Seymour Fox School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Judah Koller
- Seymour Fox School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel.
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24
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Barzegari A, Mahdirejei HA, Hanani M, Esmaeili MH, Salari AA. Adolescent swimming exercise following maternal valproic acid treatment improves cognition and reduces stress-related symptoms in offspring mice: Role of sex and brain cytokines. Physiol Behav 2023; 269:114264. [PMID: 37295664 DOI: 10.1016/j.physbeh.2023.114264] [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: 12/16/2022] [Revised: 05/20/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023]
Abstract
Valproic acid (VPA) treatment during pregnancy is a risk factor for developing autism spectrum disorder, cognitive deficits, and stress-related disorders in children. No effective therapeutic strategies are currently approved to treat or manage core symptoms of autism. Active lifestyles and physical activity are closely associated with health and quality of life during childhood and adulthood. This study aimed to evaluate whether swimming exercise during adolescence can prevent the development of cognitive dysfunction and stress-related disorders in prenatally VPA-exposed mice offspring. Pregnant mice received VPA, afterwards, offspring were subjected to swimming exercise. We assessed neurobehavioral performances and inflammatory cytokines (interleukin-(IL)6, tumor-necrosis-factor-(TNF)α, interferon-(IFN)γ, and IL-17A) in the hippocampus and prefrontal cortex of offspring. Prenatal VPA treatment increased anxiety-and anhedonia-like behavior and decreased social behavior in male and female offspring. Prenatal VPA exposure also increased behavioral despair and reduced working and recognition memory in male offspring. Although prenatal VPA increased hippocampal IL-6 and IFN-γ, and prefrontal IFN-γ and IL-17 in males, it only increased hippocampal TNF-α and IFN-γ in female offspring. Adolescent exercise made VPA-treated male and female offspring resistant to anxiety-and anhedonia-like behavior in adulthood, whereas it only made VPA-exposed male offspring resistant to behavioral despair, social and cognitive deficits in adulthood. Exercise reduced hippocampal IL-6, TNF-α, IFN-γ, and IL-17, and prefrontal IFN-γ and IL-17 in VPA-treated male offspring, whereas it reduced hippocampal TNF-α and IFN-γ in VPA-treated female offspring. This study suggests that adolescent exercise may prevents the development of stress-related symptoms, cognitive deficits, and neuroinflammation in prenatally VPA-exposed offspring mice.
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Affiliation(s)
- Ali Barzegari
- Department of Exercise Physiology, Payame Noor University (PNU), Tehran, Iran
| | | | - Masoumeh Hanani
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Kish International Campus, University of Tehran, Kish, Iran
| | | | - Ali-Akbar Salari
- Salari Institute of Cognitive and Behavioral Disorders (SICBD), Karaj, Alborz, Iran; Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
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25
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Kazzi C, Campbell L, Porter M. Psychological therapies for anxiety in autistic individuals with co-occurring intellectual developmental disorder: A systematic review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2023. [DOI: 10.1007/s40489-023-00371-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
AbstractThis systematic review aimed to evaluate the efficacy of psychological therapies for anxiety for people with autism and co-occurring intellectual developmental disorder (AUT + IDD). A systematic search identified 13 studies comprising 49 participants with AUT + IDD, aged between 5 and 41 years. Most studies were single-case experimental designs (n = 7) or case studies or case series (n = 4). Studies implemented cognitive behavioural therapy (n = 4) or exposure therapy techniques (n = 9). All studies reported a reduction in anxiety symptoms, as measured by either quantitative measures or defined as participants meeting end of treatment criterion. However, the conclusions are preliminary due to the methodological limitations of the current literature. The implications of these findings, as well as recommendations for future direction in the field, are discussed.
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Abstract
IMPORTANCE Autism spectrum disorder (ASD), characterized by deficits in social communication and the presence of restricted, repetitive behaviors or interests, is a neurodevelopmental disorder affecting approximately 2.3% children aged 8 years in the US and approximately 2.2% of adults. This review summarizes evidence on the diagnosis and treatment of ASD. OBSERVATIONS The estimated prevalence of ASD has been increasing in the US, from 1.1% in 2008 to 2.3% in 2018, which is likely associated with changes in diagnostic criteria, improved performance of screening and diagnostic tools, and increased public awareness. No biomarkers specific to the diagnosis of ASD have been identified. Common early signs and symptoms of ASD in a child's first 2 years of life include no response to name when called, no or limited use of gestures in communication, and lack of imaginative play. The criterion standard for the diagnosis of ASD is a comprehensive evaluation with a multidisciplinary team of clinicians and is based on semistructured direct observation of the child's behavior and semistructured caregiver interview focused on the individual's development and behaviors using standardized measures, such as the Autism Diagnostic Observation Schedule-Second Edition and the Autism Diagnostic Interview. These diagnostic measures have sensitivity of 91% and 80% and specificity of 76% and 72%, respectively. Compared with people without ASD, individuals with ASD have higher rates of depression (20% vs 7%), anxiety (11% vs 5%), sleep difficulties (13% vs 5%), and epilepsy (21% with co-occurring intellectual disability vs 0.8%). Intensive behavioral interventions, such as the Early Start Denver Model, are beneficial in children 5 years or younger for improvement in language, play, and social communication (small to medium effect size based on standardized mean difference). Pharmacotherapy is indicated for co-occurring psychiatric conditions, such as emotion dysregulation or attention-deficit/hyperactivity disorder. Risperidone and aripiprazole can improve irritability and aggression (standardized mean difference of 1.1, consistent with a large effect size) compared with placebo. Psychostimulants are effective for attention-deficit/hyperactivity disorder (standardized mean difference of 0.6, consistent with a moderate effect size) compared with placebo. These medications are associated with adverse effects including, most commonly, changes in appetite, weight, and sleep. CONCLUSIONS AND RELEVANCE ASD affects approximately 2.3% of children aged 8 years and approximately 2.2% of adults in the US. First-line therapy consists of behavioral interventions, while co-occurring psychiatric conditions, such as anxiety or aggression, may be treated with specific behavioral therapy or medication.
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Affiliation(s)
- Tomoya Hirota
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco
| | - Bryan H King
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco
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Buzzelli V, Carbone E, Manduca A, Schiavi S, Feo A, Perederiy JV, Ambert KH, Hausman M, Trezza V. Psilocybin mitigates the cognitive deficits observed in a rat model of Fragile X syndrome. Psychopharmacology (Berl) 2023; 240:137-147. [PMID: 36469097 DOI: 10.1007/s00213-022-06286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/20/2022] [Indexed: 12/12/2022]
Abstract
RATIONALE Fragile X syndrome (FXS) is the most common form of inherited intellectual disability (ID) and the leading monogenic cause of autism spectrum disorder (ASD). Serotonergic neurotransmission has a key role in the modulation of neuronal activity during development, and therefore, it has been hypothesized to be involved in ASD and co-occurring conditions including FXS. As serotonin is involved in synaptic remodeling and maturation, serotonergic insufficiency during childhood may have a compounding effect on brain patterning in neurodevelopmental disorders, manifesting as behavioral and emotional symptoms. Thus, compounds that stimulate serotonergic signaling such as psilocybin may offer promise as effective early interventions for developmental disorders such as ASD and FXS. OBJECTIVES The aim of the present study was to test whether different protocols of psilocybin administration mitigate cognitive deficits displayed by the recently validated Fmr1-Δexon 8 rat model of ASD, which is also a model of FXS. RESULTS Our results revealed that systemic and oral administration of psilocybin microdoses normalizes the aberrant cognitive performance displayed by adolescent Fmr1-Δexon 8 rats in the short-term version of the novel object recognition test-a measure of exploratory behavior, perception, and recognition. CONCLUSIONS These data support the hypothesis that serotonin-modulating drugs such as psilocybin may be useful to ameliorate ASD-related cognitive deficits. Overall, this study provides evidence of the beneficial effects of different schedules of psilocybin treatment in mitigating the short-term cognitive deficit observed in a rat model of FXS.
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Affiliation(s)
- Valeria Buzzelli
- Department of Science, Section of Biomedical Sciences and Technologies, University "Roma Tre", Viale G. Marconi 446, 00146, Rome, Italy
| | - Emilia Carbone
- Department of Science, Section of Biomedical Sciences and Technologies, University "Roma Tre", Viale G. Marconi 446, 00146, Rome, Italy
| | - Antonia Manduca
- Department of Science, Section of Biomedical Sciences and Technologies, University "Roma Tre", Viale G. Marconi 446, 00146, Rome, Italy.,Neuroendocrinology, Metabolism and Neuropharmacology Unit, IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Sara Schiavi
- Department of Science, Section of Biomedical Sciences and Technologies, University "Roma Tre", Viale G. Marconi 446, 00146, Rome, Italy
| | - Alessandro Feo
- Department of Science, Section of Biomedical Sciences and Technologies, University "Roma Tre", Viale G. Marconi 446, 00146, Rome, Italy
| | | | - Kyle H Ambert
- Nova Mentis Life Science Corp., Vancouver, BC, Canada
| | | | - Viviana Trezza
- Department of Science, Section of Biomedical Sciences and Technologies, University "Roma Tre", Viale G. Marconi 446, 00146, Rome, Italy.
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Linden A, Best L, Elise F, Roberts D, Branagan A, Tay YBE, Crane L, Cusack J, Davidson B, Davidson I, Hearst C, Mandy W, Rai D, Smith E, Gurusamy K. Benefits and harms of interventions to improve anxiety, depression, and other mental health outcomes for autistic people: A systematic review and network meta-analysis of randomised controlled trials. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:7-30. [PMID: 35957523 PMCID: PMC9806485 DOI: 10.1177/13623613221117931] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
LAY ABSTRACT Nearly three out of four autistic people experience mental health problems such as stress, anxiety or depression. The research already done does not guide us on how best to prevent or treat mental health problems for autistic people. Our aim was to look at the benefits and harms of different interventions on mental health outcomes in autistic people. We searched all the published randomised controlled trials (RCTs) about interventions for mental health conditions in autistic people until 17 October 2020. We also searched for RCTs that were not published in peer-reviewed journals. These were obtained from registers of clinical trials online. We then combined the information from all these trials using advanced statistical methods to analyse how good the interventions are. Seventy-one studies (3630 participants) provided information for this research. The studies reported how participants were responding to the intervention for only a short period of time. The trials did not report which interventions worked for people with intellectual disability. In people without intellectual disability, some forms of cognitive behavioural therapy and mindfulness therapy may be helpful. However, further research is necessary. Many trials used medications to target core features of autism rather than targeting mental health conditions, but these medications did not help autistic people. Until we have more evidence, treatment of mental health conditions in autistic people should follow the evidence available for non-autistic people. We plan to widely disseminate the findings to healthcare professionals through medical journals and conferences and contact other groups representing autistic people.
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Affiliation(s)
- Audrey Linden
- University College London, UK,Audrey Linden, Centre for Research in
Autism and Education, University College London, London WC1H 0NU, UK.
| | | | | | | | | | | | | | | | | | - Ian Davidson
- Cheshire and Wirral Partnership NHS
Foundation Trust, UK
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Thapar A, Livingston LA, Eyre O, Riglin L. Practitioner Review: Attention-deficit hyperactivity disorder and autism spectrum disorder - the importance of depression. J Child Psychol Psychiatry 2023; 64:4-15. [PMID: 35972029 PMCID: PMC10087979 DOI: 10.1111/jcpp.13678] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
Abstract
Young people with neurodevelopmental disorders, such as attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), show high rates of mental health problems, of which depression is one of the most common. Given that depression in ASD and ADHD is linked with a range of poor outcomes, knowledge of how clinicians should assess, identify and treat depression in the context of these neurodevelopmental disorders is much needed. Here, we give an overview of the latest research on depression in young people with ADHD and ASD, including possible mechanisms underlying the link between ADHD/ASD and depression, as well as the presentation, assessment and treatment of depression in these neurodevelopmental disorders. We discuss the implications for clinicians and make recommendations for critical future research in this area.
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Affiliation(s)
- Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK.,Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Lucy A Livingston
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Olga Eyre
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK.,Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Lucy Riglin
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK.,Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
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30
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Sánchez-Cueva MS, Alcantud Marín F, Alonso-Esteban Y. Ansiedad y trastornos del espectro del autismo: notas para la intervención psicoeducativa. SIGLO CERO REVISTA ESPAÑOLA SOBRE DISCAPACIDAD INTELECTUAL 2022. [DOI: 10.14201/scero2022534930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Se analizan de forma narrativa las relaciones entre comportamiento sensorial atípico, intolerancia a la incertidumbre y regulación emocional como generadores de los trastornos de ansiedad en niños y niñas autistas. El objetivo es estudiar el origen de la ansiedad en los niños y niñas autistas con la finalidad de determinar cuál o cuáles pueden ser los procedimientos de intervención más adecuados. Se han revisado algunos de los programas de intervención cognitivo-conductuales más utilizados en niños y niñas autistas y las adaptaciones realizadas a los mismos. Se observa un divorcio entre los programas psicoeducativos escolares y los programas clínicos de intervención para el tratamiento de la ansiedad. Como conclusión, se recomienda que en los programas psicoeducativos escolares se incorporen acciones proactivas en forma de programas de intervención cognitivo-conductuales para evitar o aminorar los efectos negativos de la ansiedad en el aprendizaje e inclusión escolar de los niños y las niñas autistas.
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31
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Fisher N, Patel H, van Diest C, Spain D. Using eye movement desensitisation and reprocessing (EMDR) with autistic individuals: A qualitative interview study with EMDR therapists. Psychol Psychother 2022; 95:1071-1089. [PMID: 36334027 PMCID: PMC9804816 DOI: 10.1111/papt.12419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/22/2022] [Accepted: 07/18/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Eye Movement Desensitisation and Reprocessing (EMDR) is an evidence-based psychological therapy that targets distress associated with trauma and affective disturbance. Few studies have examined EMDR for autistic individuals who have co-occurring mental health conditions, but there is preliminary evidence of effectiveness. The current study explored EMDR therapists' experiences of working with autistic individuals, and adaptations incorporated into clinical practice to make this more accessible and effective. DESIGN A qualitative interview design was used. Data were thematically analysed. METHOD Twenty-three UK-based EMDR therapists attended one-off semi-structured qualitative interviews. RESULTS Four main themes emerged: (1) the experience of being autistic; (2) factors around accessing EMDR; (3) adapting EMDR; and (4) supervision and support for EMDR therapists. Participants described offering a nuanced and tailored approach; one that retained the integral components of the eight phases of EMDR, while also being flexible and responsive to each client. CONCLUSIONS Findings reinforce the importance of offering formulation-based psychological therapy that flexes in an evidence-informed way, according to the preferences and needs of autistic individuals. Further research should establish factors influencing accessibility and effectiveness of EMDR for autistic individuals, and the impact of autism-relevant training on the knowledge, skills and confidence of EMDR therapists and clinical supervisors working with this client group.
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Li Y, He X, Zhang J, Zhou Q, Liu X, Zhou G. Medicarpin Improves Depressive-Like Behaviors in a Chronic Unpredictable Mild Stress-Induced Mouse Model of Depression by Upregulating Liver X Receptor β Expression in the Amygdala. Neurotox Res 2022; 40:1937-1947. [PMID: 36445678 DOI: 10.1007/s12640-022-00610-7] [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: 10/02/2022] [Revised: 11/06/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
Presently, the regulatory mechanism underlying depression is indistinct, and almost 50% of depression sufferers undergo no apparent effects during treatment. This study explored the effects of medicarpin on depressive-like behaviors in a chronic unpredictable mild stress (CUMS)-induced mouse model of depression. The results of network pharmacological analysis revealed that liver X receptor β (LXRβ) might be a potential target of medicarpin and depression. The LXRβ level was reduced in the amygdala of mice induced by CUMS; however, this effect was suppressed by co-treatment with medicarpin. Medicarpin treatment ameliorated depressive-like behaviors in CUMS-induced mice by modulating LXRβ level. Moreover, medicarpin treatment reduced M1 polarization and enhanced M2 polarization of amygdala microglia in CUMS-induced mice, as well as increased GFAP level in the amygdala. Medicarpin treatment also suppressed CUMS-induced inflammation and hindered nuclear factor-κ B (NF-κB) signaling activation. These data indicate that medicarpin activated astrocytes and inhibited microglia M1 polarization while promoted M2 polarization by enhancing the expression of LXRβ. Hence, our results suggest that medicarpin could have a positive effect on the treatment of depression, and LXRβ could serve as a novel therapeutic target.
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Affiliation(s)
- Yujiao Li
- Department of Clinical Pharmacy, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China.
| | - Xiaolu He
- Department of Clinical Pharmacy, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China
| | - Jieyu Zhang
- Department of Clinical Pharmacy, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China
| | - Qing Zhou
- Department of Clinical Pharmacy, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China
| | - Xuejiao Liu
- Department of Clinical Pharmacy, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China
| | - Guohua Zhou
- Department of Clinical Pharmacy, Jinling Hospital, Medical School of Nanjing University, No. 305, Zhongshan East Road, Xuanwu District, Nanjing, 210002, Jiangsu Province, China
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33
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Recommended adaptations to therapy services for autistic adults from specialist clinicians. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-04034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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34
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Kilanko A, Obi-Azuike C, Adaralegbe N, Eze-Njoku C, Urhi A, Agbor C, Ayisire OE, Eche VC, Soomro F, Kaur G, Babalola F, Oyeleye-Adegbite OC, Aladum B, Popoola HA, Anugwom GO. The Correlation Between Autistic Childhood Disorders and the Development of Anxiety and Depression in Adults: A Systematic Review. Cureus 2022; 14:e30093. [PMID: 36381917 PMCID: PMC9642317 DOI: 10.7759/cureus.30093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 06/16/2023] Open
Abstract
Children with autism spectrum disorder significantly suffer from other mental conditions, including anxiety and depression, compared to the general population. This continues to have a significant effect till adulthood. This study aimed at determining if there is a correlation between autism disorder in childhood and the development of anxiety and depression in adulthood and if behavioral therapy for children with this disorder reduces the likelihood of developing anxiety and depression as an adult. Three major databases were searched: EMBASE, Google Scholar, and PubMed, using specific search terms. Studies were selected according to population, exposure, comparison, condition or outcome(s) of interest, study design, and context. Overall, there are five articles relevant to this systematic review synthesis; all were observational studies. Our study shows psychiatric disorders like anxiety and depression could be related to autism spectrum disorder and early behavioral intervention could be beneficial and reduce the need for anxiety and depression medication.
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Affiliation(s)
| | - Crystal Obi-Azuike
- Psychiatry and Behavioral Sciences, University of Medicine and Health Sciences, New York City, USA
| | - Ngozi Adaralegbe
- Psychiatry and Behavioral Sciences, University of Connecticut, Waterbury, USA
| | - Chioma Eze-Njoku
- Pediatrics, Atrium Health Navicient the Medical Center, Macon, USA
| | | | - Chukwudi Agbor
- Psychiatry, Tees, Esk and Wear Valleys NHS Trust, Scarborough, GBR
| | | | - Victor C Eche
- Psychiatry, University of Port Harcourt, Port Harcourt, NGA
| | - Fareena Soomro
- Psychiatry and Behavioral Sciences, Isra University, Sindh, PAK
| | - Garima Kaur
- Psychiatry, All Indian Institute of Medical Sciences Rishikesh, Rishikesh, IND
| | - Funmilola Babalola
- Epidemiology and Public Health, Texas Department of State Health Services, San Antonio, USA
| | | | - Bialo Aladum
- Psychiatry, Ascension Borgess Hospital, Kalamazoo, USA
| | - Hakeem A Popoola
- Internal Medicine, Windsor University School of Medicine, Bassettere, KNA
| | - Gibson O Anugwom
- Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, USA
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35
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Murphy S, Flower RL, Jellett R. Women seeking an autism diagnosis in Australia: A qualitative exploration of factors that help and hinder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:808-821. [PMID: 35978525 DOI: 10.1177/13623613221117911] [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: 11/15/2022]
Abstract
LAY ABSTRACT An autism diagnosis can have a big impact on women and make it possible to access support. This study explored women's experiences of being diagnosed with autism as an adult in Australia, to try to understand what was helpful (facilitators) and unhelpful (barriers) for them during this process. We interviewed 10 autistic women who had been diagnosed in the last 5 years. Framework analysis was used to understand the data. We wanted to understand barriers and facilitators relating to the individual participants, the professionals they saw and the system they went through for their diagnostic assessment. Women reported that being able to recognise they were autistic, being motivated, preparing for the assessment, having social support and unmasking to be themselves were helpful during the diagnostic process. They reported that having a knowledgeable diagnostician who made accommodations for their needs assisted them during the assessment process. When providers dismissed the participants when they first raised the possibility they were autistic, it delayed them in seeking an assessment. At the system level, the women in this study found some aspects of the healthcare system difficult to navigate, particularly costs and long waitlists. Some found the assessment tools used were not well suited to them. The experiences of the women in this study highlight improvements that could be made to accessing an adulthood autism diagnosis in Australia. These include improving provider knowledge of the varied presentation of autism and the development of resources to help autistic women prepare for their diagnostic assessment.
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36
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Schwartzman JM, Corbett BA. Depression and Employment Outcomes in Autistic Adults: A Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00331-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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37
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Hong Y, Zhang Y, Xue P, Fang X, Zhou L, Wei F, Lou X, Zou H. The Influence of Long Working Hours, Occupational Stress, and Well-Being on Depression Among Couriers in Zhejiang, China. Front Psychol 2022; 13:928928. [PMID: 35814051 PMCID: PMC9260285 DOI: 10.3389/fpsyg.2022.928928] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/03/2022] [Indexed: 11/25/2022] Open
Abstract
Objective: This study aimed to examine the association between long working hours, occupational stress, depression, and well-being, and to explore the intermediary effect of occupational stress and well-being between working hours and depression among couriers in Zhejiang, China. Methods: The study used a cluster random sampling method to select 1,200 couriers from mainstream express companies in Zhejiang, China. The data were collected and analyzed using the Core Occupational Stress Scale (COSS) to measure occupational stress, the Patient Health Questionnaire-9 (PHQ-9) scale to evaluate depression, and the World Health Organization five-item Well-Being Index (WHO-5) scale to assess well-being. Structural equation modeling (SEM) was used to test the hypothesized relationship among the variables. Results: The phenomenon of long working hours (75.1%) was quite common among couriers in Zhejiang, China. Working hours had a direct positive effect on depression (β = 0.008, p < 0.001) and on occupational stress (β = 0.009, p < 0.001), and working hours had a negative effect on well-being (β = −0.013, p < 0.001). Occupational stress had a direct positive effect on depression (β = 0.272, p < 0.001), but well-being had no significant direct effect on depression. Working hours had an indirect effect on depression through the mediating effect of occupational stress while the mediating effect of well-being was not found. Conclusion: Long working hours is associated with occupational stress, well-being, and depression. Our results confirmed that working hours, occupational stress, and well-being were strong predicators of depression. Working hours had a significant indirect effect on depression via occupational stress. The result of this study showed that decreasing working hours and reducing occupational stress would be effective for couriers to prevent depression. However, more studies are needed to verify the relationship between working hours and depression.
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Affiliation(s)
- Yu Hong
- Department of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yixin Zhang
- Department of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Panqi Xue
- Occupational Health and Radiation Protection Institute, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xinglin Fang
- Occupational Health and Radiation Protection Institute, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Lifang Zhou
- Occupational Health and Radiation Protection Institute, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Fang Wei
- Occupational Health and Radiation Protection Institute, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xiaoming Lou
- Occupational Health and Radiation Protection Institute, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Hua Zou
- Occupational Health and Radiation Protection Institute, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- *Correspondence: Hua Zou,
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Wu HB, Xiao YG, Chen JS, Qiu ZK. The potential mechanism of Bupleurum against anxiety was predicted by network pharmacology study and molecular docking. Metab Brain Dis 2022; 37:1609-1639. [PMID: 35366129 DOI: 10.1007/s11011-022-00970-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 03/21/2022] [Indexed: 01/20/2023]
Abstract
Bupleurum chinense DC. (Chaihu) is a traditional Chinese medicine (TCM) used in the treatment of anxiety. But the anxiolytic mechanisms of bupleurum are still unclear. Therefore, this unknown is predicted by network pharmacology study with molecular docking in the present study. The components of bupleurum were obtained from the databases. Genes associated with components and disease were also provided by databases. Overlapping genes between components and disease were analyzed. The network of medicine-components-targets-disease was constructed, visualized, and analyzed. Protein-protein interaction (PPI), gene ontology (GO), pathway enrichment (KEGG) and molecular docking were conducted to predict the potential mechanisms of bupleurum on anxiety. A total of 9 bioactive components derived from bupleurum with 80 target genes were involved in anxiety. Neurotransmitter receptor activity, G protein-coupled amine receptor activity, regulation of blood circulation, neuroactive ligand-receptor interaction, calcium signaling pathway and salivary secretion may play significant roles in the anxiolytic of bupleurum. Molecular docking implicated that ACHE and MAOA showed high affinity for stigmasterol. Based on network pharmacology study with molecular docking, multi-component-multi-target-multi-pathway action mode of bupleurum on anxiety was elaborated. Stigmasterol might be the core bioactive component, while ACHE and MAOA might be the core target genes in the pharmacological profile of bupleurum on anxiety.
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Affiliation(s)
- Han-Biao Wu
- Key Specialty of Clinical Pharmacy, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Yu-Gang Xiao
- Key Specialty of Clinical Pharmacy, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Ji-Sheng Chen
- Key Specialty of Clinical Pharmacy, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhi-Kun Qiu
- Key Specialty of Clinical Pharmacy, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China.
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Oakley BFM, Jones EJH, Crawley D, Charman T, Buitelaar J, Tillmann J, Murphy DG, Loth E. Alexithymia in autism: cross-sectional and longitudinal associations with social-communication difficulties, anxiety and depression symptoms. Psychol Med 2022; 52:1458-1470. [PMID: 33028432 PMCID: PMC9226426 DOI: 10.1017/s0033291720003244] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Alexithymia (difficulties in identifying and describing emotion) is a transdiagnostic trait implicated in social-emotional and mental health problems in the general population. Many autistic individuals experience significant social-communication difficulties and elevated anxiety/depression and alexithymia. Nevertheless, the role of alexithymia in explaining individual variability in the quality/severity of social-communication difficulties and/or anxiety and depression symptoms in autism remains poorly understood. METHODS In total, 337 adolescents and adults (autism N = 179) were assessed for alexithymia on the Toronto Alexithymia Scale and for social-communication difficulties, anxiety and depression symptoms. A total of 135 individuals (autism N = 76) were followed up 12-24 months later. We used regression models to establish cross-sectional and longitudinal associations between alexithymia, social-communication difficulties, anxiety and depression symptoms. RESULTS Autistic individuals reported significantly higher alexithymia than comparison individuals (p < 0.001, r effect size = 0.48), with 47.3% of autistic females and 21.0% of autistic males meeting cut-off for clinically relevant alexithymia (score ⩾61). Difficulties in describing feelings were particularly associated with current self-reported social-communication difficulties [p < 0.001, β = 0.57, 95% confidence interval (CI) 0.44-0.67] and predicted later social-communication difficulties (p = 0.02, β = 0.43, 95% CI 0.07-0.82). Difficulties in identifying feelings were particularly associated with current anxiety symptom severity (p < 0.001, β = 0.54, 95% CI 0.41-0.77) and predicted later anxiety (p = 0.01; β = 0.31, 95% CI 0.08-0.62). CONCLUSIONS Our findings suggest that difficulties in identifying v. describing emotion are associated with differential clinical outcomes in autism. Psychological therapies targeting emotional awareness may improve social-communication and anxiety symptoms in autism, potentially conferring long-term benefits.
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Affiliation(s)
- Bethany F. M. Oakley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Emily J. H. Jones
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London WC1E 7HX, UK
| | - Daisy Crawley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust (SLaM), London, UK
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behaviour, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Center, Reiner Postlaan 12, Nijmegen, The Netherlands
| | - Julian Tillmann
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Applied Psychology: Health, Development, Enhancement, and Intervention, University of Vienna, Vienna, Austria
| | - Declan G. Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust (SLaM), London, UK
| | - Eva Loth
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
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Carey M, Sheehan D, Healy S, Knott F, Kinsella S. The Effects of a 16-Week School-Based Exercise Program on Anxiety in Children with Autism Spectrum Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095471. [PMID: 35564866 PMCID: PMC9104305 DOI: 10.3390/ijerph19095471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 12/04/2022]
Abstract
Physical activity interventions have been shown to decrease anxiety in children with ASD. There is little known regarding the effects of an exercise program on anxiety in both home and school settings and the optimal dosage to reduce anxiety. Therefore, the aim of this study was to assess the effects of a 16-week exercise program on the anxiety levels of children with moderate to severe symptoms of ASD in home and school settings, and to compare the effects at 8 and 16 weeks. This study was a within-subject, non-controlled design, intervention study. Twenty-four children (5−18 years) with moderate to severe ASD were included. A school-based exercise program was implemented three days a week for 16 weeks. Parents and teachers completed the Anxiety Scale for Children for ASD (ASC-ASD) at baseline, week 8, and week 16. A one-way repeated-measure ANOVA with post hoc analysis using Bonferroni adjustment was used to test for a significant effect for time (p < 0.05), with Cohen’s d used to calculate the effect size. For teacher-reported anxiety, there were significant decreases from baseline to week 16 for total ASC-ASD (p < 0.001), performance anxiety (p < 0.001), anxious arousal (p < 0.001), and uncertainty (p < 0.001). There was no significant decrease in parent-reported anxiety. The findings demonstrate that a 16-week exercise program can reduce anxiety in children with ASD in school settings. Results demonstrate that 16 weeks, as opposed to 8, may be necessary to have a significant effect on in-school anxiety.
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Affiliation(s)
- Marie Carey
- Autism Research Group, Department of Health and Sport Science, Institute of Technology Carlow, R93 V960 Carlow, Ireland; (M.C.); (D.S.)
| | - Damien Sheehan
- Autism Research Group, Department of Health and Sport Science, Institute of Technology Carlow, R93 V960 Carlow, Ireland; (M.C.); (D.S.)
| | - Sean Healy
- School of Nursing, Psychotherapy and Community Health, Dublin City University, D09 Y5N0 Dublin, Ireland;
| | - Fiona Knott
- Department of Psychology, University of Reading, Reading RG6 6EU, UK;
| | - Sharon Kinsella
- Autism Research Group, Department of Health and Sport Science, Institute of Technology Carlow, R93 V960 Carlow, Ireland; (M.C.); (D.S.)
- Correspondence: ; Tel.: +353-599175515
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van Eijndhoven P, Collard R, Vrijsen J, Geurts DEM, Vasquez AA, Schellekens A, van den Munckhof E, Brolsma S, Duyser F, Bergman A, van Oort J, Tendolkar I, Schene A. Measuring Integrated Novel Dimensions in Neurodevelopmental and Stress-Related Mental Disorders (MIND-SET): Protocol for a Cross-sectional Comorbidity Study From a Research Domain Criteria Perspective. JMIRX MED 2022; 3:e31269. [PMID: 37725542 PMCID: PMC10414459 DOI: 10.2196/31269] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/13/2021] [Accepted: 12/06/2021] [Indexed: 09/21/2023]
Abstract
BACKGROUND It is widely acknowledged that comorbidity between psychiatric disorders is common. Shared and diverse underpinnings of psychiatric disorders cannot be systematically understood based on symptom-based categories of mental disorders, which map poorly onto pathophysiological mechanisms. In the Measuring Integrated Novel Dimensions in Neurodevelopmental and Stress-Related Mental Disorders (MIND-SET) study, we make use of current concepts of comorbidity that transcend the current diagnostic categories. We test this approach to psychiatric problems in patients with frequently occurring psychiatric disorders and their comorbidities (excluding psychosis). OBJECTIVE The main aim of the MIND-SET project is to determine the shared and specific mechanisms of neurodevelopmental and stress-related psychiatric disorders at different observational levels. METHODS This is an observational cross-sectional study. Data from different observational levels as defined in the Research Domain Criteria (genetics, physiology, neuropsychology, system-level neuroimaging, behavior, self-report, and experimental neurocognitive paradigms) are collected over four time points. Included are adult (aged ≥18 years), nonpsychotic, psychiatric patients with a clinical diagnosis of a stress-related disorder (mood disorder, anxiety disorder, or substance use disorder) or a neurodevelopmental disorder (autism spectrum disorder or attention-deficit/hyperactivity disorder). Individuals with no current or past psychiatric diagnosis are included as neurotypical controls. Data collection started in June 2016 with the aim to include a total of 650 patients and 150 neurotypical controls by 2021. The data collection procedure includes online questionnaires and three subsequent sessions with (1) standardized clinical examination, physical examination, and blood sampling; (2) psychological constructs, neuropsychological tests, and biological marker sampling; and (3) neuroimaging measures. RESULTS We aim to include a total of 650 patients and 150 neurotypical control participants in the time period between 2016 and 2022. In October 2021, we are at 95% of our target. CONCLUSIONS The MIND-SET study enables us to investigate the mechanistic underpinnings of nonpsychotic psychiatric disorders transdiagnostically. We will identify both shared and disorder-specific markers at different observational levels that can be used as targets for future diagnostic and treatment approaches.
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Affiliation(s)
- Philip van Eijndhoven
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Rose Collard
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Janna Vrijsen
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Pro Persona Mental Health Care, Depression Expertise Centre, Nijmegen, Netherlands
| | - Dirk E M Geurts
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Alejandro Arias Vasquez
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Arnt Schellekens
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- Nijmegen Institute of Scientist-Practitioners in Addiction, Radboud University, Nijmegen, Netherlands
| | - Eva van den Munckhof
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Sophie Brolsma
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Fleur Duyser
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Annemiek Bergman
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Jasper van Oort
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
- LVR-Klinikum Essen, Department of Psychiatry and Psychotherapy, University Hospital Essen, Essen, Germany
| | - Aart Schene
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
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42
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Sorter M, Chua J, Lamy M, Barzman D, Ryes L, Shekhtman JA. Management of Emotion Dysregulation and Outbursts in Children and Adolescents. Curr Psychiatry Rep 2022; 24:213-226. [PMID: 35316849 DOI: 10.1007/s11920-022-01325-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Emotion dysregulation and outbursts are very common reasons for referral to child and adolescent mental health services and a frequent cause of admission to hospitals and residential programs. Symptoms of emotion dysregulation and outburst are transdiagnostic, associated with many disorders, have the potential to cause severe impairment and their management presents a major challenge in clinical practice. RECENT FINDINGS There are an increasing number of psychosocial interventions that demonstrate promise in improving emotion dysregulation and outbursts. Acute care systems to manage the most severely ill patients have limited best practice guidelines but program advancements indicate opportunities to improve care models. Pharmacotherapy may be of assistance to psychosocial interventions but must be used with caution due to potential adverse effects. Much remains to be discovered however evidence informed, targeted treatments for specific populations show potential for future improvements in outcomes.
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Affiliation(s)
- Michael Sorter
- Cincinnati Children's Hospital, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. .,University of Cincinnati College of Medicine, Cincinnati, USA.
| | - Jaclyn Chua
- Children's Hospital of Philadelphia, Philadelphia, USA
| | - Martine Lamy
- Cincinnati Children's Hospital, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.,University of Cincinnati College of Medicine, Cincinnati, USA
| | - Drew Barzman
- Cincinnati Children's Hospital, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.,University of Cincinnati College of Medicine, Cincinnati, USA
| | - Louis Ryes
- Xavier University, Cincinnati, USA.,University of Kentucky College of Medicine, Lexington, USA
| | - Joshua Abraham Shekhtman
- The Ohio State University, Columbus, USA.,University of Cincinnati College of Medicine, Cincinnati, USA
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43
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Brede J, Cage E, Trott J, Palmer L, Smith A, Serpell L, Mandy W, Russell A. “We Have to Try to Find a Way, a Clinical Bridge” - autistic adults' experience of accessing and receiving support for mental health difficulties: A systematic review and thematic meta-synthesis. Clin Psychol Rev 2022; 93:102131. [DOI: 10.1016/j.cpr.2022.102131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 12/04/2021] [Accepted: 01/28/2022] [Indexed: 12/28/2022]
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Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, Carr T, de Vries PJ, Dissanayake C, Divan G, Freitag CM, Gotelli MM, Kasari C, Knapp M, Mundy P, Plank A, Scahill L, Servili C, Shattuck P, Simonoff E, Singer AT, Slonims V, Wang PP, Ysrraelit MC, Jellett R, Pickles A, Cusack J, Howlin P, Szatmari P, Holbrook A, Toolan C, McCauley JB. The Lancet Commission on the future of care and clinical research in autism. Lancet 2022; 399:271-334. [PMID: 34883054 DOI: 10.1016/s0140-6736(21)01541-5] [Citation(s) in RCA: 258] [Impact Index Per Article: 129.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Paul Carbone
- Department of Pediatrics at University of Utah, Salt Lake City, UT, USA
| | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Themba Carr
- Rady Children's Hospital San Diego, Encinitas, CA, USA
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | | | | | | | | | | | - Peter Mundy
- University of California, Davis, Davis, CA, USA
| | | | | | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Vicky Slonims
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul P Wang
- Simons Foundation Autism Research Initiative, Simons Foundation, New York, NY, USA; Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Rachel Jellett
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Patricia Howlin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Peter Szatmari
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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45
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Taylor JL, Adams RE, Pezzimenti F, Zheng S, Bishop SL. Job loss predicts worsening depressive symptoms for young adults with autism: A COVID-19 natural experiment. Autism Res 2022; 15:93-102. [PMID: 34626164 PMCID: PMC8646555 DOI: 10.1002/aur.2621] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/13/2021] [Accepted: 09/26/2021] [Indexed: 01/11/2023]
Abstract
Adults with autism spectrum disorder (ASD) experience high rates of both unemployment and depression. Though job loss predicts increased risk of depression in the general population, studies have yet to directly examine this relationship among individuals with ASD. With the backdrop of rising unemployment due to COVID-19, we used a longitudinal design to examine whether employment changes predicted increasing depressive symptoms among young adults with ASD. Online surveys were collected from young adults with ASD at two times: just before widespread social distancing measures were adopted in the United States, and again 10 weeks later. Both time points included measurement of depressive symptoms (Beck Depression Inventory-2). At Time 2, COVID-related employment changes and the perceived impact of those changes on well-being were collected. Of the young adults who were employed at Time 1 (n = 144), over one-third (37.5%) reported employment changes during the first 2 months of COVID-19. Most of this change was job loss or reductions in hours or pay ("job loss/reduction"). Controlling for Time 1 depressive symptoms, young adults who experienced job loss/reduction had significantly higher depressive symptoms at Time 2 than those without an employment change. Individuals' perceived impact of employment change also predicted depressive symptoms. These findings suggest that losing a job or experiencing reductions in hours or pay leads to worsening depressive symptoms among adults with ASD. Better supporting autistic adults in the workplace may not only decrease the likelihood of job loss, but also combat the exceedingly high rates of depression in this group. LAY SUMMARY: Though unemployment has been linked to mental health problems in the general population, this relationship is seldom considered among adults with autism. In this study, we found that adults on the autism spectrum who lost their jobs or experienced reductions in pay or hours during the first 2 months of COVID-19 had worsening depression compared to adults who did not have job changes. Our findings suggest that increasing access to employment may help alleviate poor mental health among autistic adults.
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Affiliation(s)
- Julie Lounds Taylor
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ryan E Adams
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Florencia Pezzimenti
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shuting Zheng
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Somer L Bishop
- Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
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46
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Kemeny B, Burk S, Hutchins D, Gramlich C. Therapeutic Riding or Mindfulness: Comparative Effectiveness of Two Recreational Therapy Interventions for Adolescents with Autism. J Autism Dev Disord 2022; 52:2438-2462. [PMID: 34131850 PMCID: PMC8204925 DOI: 10.1007/s10803-021-05136-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2021] [Indexed: 02/05/2023]
Abstract
Therapeutic riding (THR) and HeartMath (HM) mindfulness-based interventions have promise for reducing stress in adolescents with autism spectrum disorder. In three 10-week periods, this study compared THR, HM, and control on salivary cortisol, self-reported stress, parent-reported social responsiveness, and heart-rate variability. This crossover design included 27 participants (12-21 years) randomly assigned to order of intervention. Findings suggest that HM and THR manualized protocols are equally beneficial in decreasing cortisol levels immediately following a session, but HM sessions had more impact on heart-rate variability. There was no significant effect on follow-up cortisol levels within a week after either intervention, but THR had more impact on decreasing some self-reported stressors.
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Affiliation(s)
- Betsy Kemeny
- Department of Recreational Therapy, Slippery Rock University, 106 Patterson Hall, Slippery Rock, PA 16057 USA
| | - Steffanie Burk
- Department of Equine Science, Otterbein University, Westerville, USA
| | - Deborah Hutchins
- Department of Recreational Therapy, Slippery Rock University, 106 Patterson Hall, Slippery Rock, PA 16057 USA
| | - Courtney Gramlich
- Storm Harbor Equestrian Center, Slippery Rock University, Slippery Rock, USA
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47
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Westerberg B, Bäärnhielm S, Giles C, Hylén U, Holländare F, Bejerot S. An Internet Based Intervention for Adults With Autism Spectrum Disorder-A Qualitative Study of Participants Experiences. Front Psychiatry 2021; 12:789663. [PMID: 35002808 PMCID: PMC8729877 DOI: 10.3389/fpsyt.2021.789663] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/02/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Adults with autism spectrum disorder face several barriers to accessing evidence-based care, including difficulties in communicating needs, social anxiety or in traveling to a health care unit. In recent years, several forms of internet-based treatments have shown to be effective for a variety of psychiatric conditions. Internet-based treatment alternatives allow convenient and flexible formats, and therefore have the potential to increase access to health care for individuals with autism spectrum disorder. However, knowledge about how internet-based treatment features may suit the needs of individuals with autism is limited. The aim of this study was to explore the participant experiences of an internet-based intervention for adults with autism spectrum disorder. The primary focus of the investigation was on autism-specific needs in relation to the features unique to the online format. Methods: In this qualitative study, semi-structured telephone interviews were conducted with 14 participants who had completed a text-based internet-based intervention for adults with autism spectrum disorder. We used an inductive approach and analyzed the data using qualitative content analysis. Results: Five main categories were identified: (1) implications of the online format, (2) the fixed non-individualized model, (3) therapist interaction, (4) interacting with other participants, and (5) making use of the treatment content. Overall, participants appreciated the availability and that they could work on their treatment independent of time or location. Among those participating in group-based chat-sessions with the other participants, it was considered a generally positive experience. Furthermore, most participants felt safe and relaxed in relation to the therapist and appreciated the text-based format. However, several participants felt that the format and content of the treatment was not sufficiently adapted to their individual life situation. Conclusion: In conclusion, this internet-based treatment constitutes an accessible and energy-saving treatment alternative for adults with autism. Further, integrating group-based components seems feasible in an otherwise individual internet-based treatment for individuals with autism. However, group-based components do require a clear purpose and rationale. Future studies should develop and evaluate treatment adaptations tailored to individual needs.
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Affiliation(s)
- Britta Westerberg
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sofie Bäärnhielm
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
| | - Clover Giles
- Center for Lifespan Developmental Research, Örebro University, Örebro, Sweden
| | - Ulrika Hylén
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Fredrik Holländare
- Department of Psychiatry, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Susanne Bejerot
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Beck KB, Northrup JB, Breitenfeldt KE, Porton S, Day TN, MacKenzie KT, Conner CM, Mazefsky CA. Stakeholder informed development of the Emotion Awareness and Skills Enhancement team-based program (EASE-Teams). AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:586-600. [PMID: 34903083 DOI: 10.1177/13623613211061936] [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: 11/15/2022]
Abstract
LAY ABSTRACT Emotion dysregulation (ED) impacts mental health symptoms and well-being in autistic individuals. In prior work, we developed the Emotion Awareness and Skills Enhancement (EASE) to improve emotion dysregulation with autistic adolescents (aged 12-17). The study team partnered with autistic individuals, their caregivers, and expert clinicians to adapt EASE for autistic adolescents and adults with co-occurring intellectual disability and autistic elementary-aged children, groups that often benefit from caregiver support in treatment. In three phases, we (1) gathered caregiver and expert feedback to adapt the original EASE program for autistic adults with intellectual disability, (2) revised the treatment after using it with six autistic adults with intellectual disability, and (3) tested the newly developed caregiver-client team-based treatment, called EASE-Teams, in a small group of 10 autistic individuals with and without intellectual disability (aged 7-25). Families found EASE-Teams to be acceptable and helpful. We found improvements in emotion dysregulation and mental health symptoms for autistic participants. Caregivers reported less stress from their child's dysregulation after participating. These results show that EASE-Teams can be appropriate for different developmental and cognitive needs. Future studies will need to test the benefits of the treatment in community clinics.
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49
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Normansell-Mossa KM, Top DN, Russell N, Freeston M, Rodgers J, South M. Sensory Sensitivity and Intolerance of Uncertainty Influence Anxiety in Autistic Adults. Front Psychol 2021; 12:731753. [PMID: 34867612 PMCID: PMC8635111 DOI: 10.3389/fpsyg.2021.731753] [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: 06/28/2021] [Accepted: 10/15/2021] [Indexed: 01/02/2023] Open
Abstract
Several models of anxiety in autistic adults have focused on the role of intolerance of uncertainty which has biological and evolutionary bases, as a cognitive explanation for the high prevalence of anxiety in autism. This framework suggests that all people are born with a healthy level of intolerance of uncertainty, and as we develop, this intolerance is lessened as we learn when situations are safe and begin to understand and manage the uncertainty. This process of learning about managing uncertainty does not happen in the same way in those who are high in autistic traits, which could be the reason for the high levels of anxiety symptoms commonly seen in this population. We examined archival data of 199 non-autistic and 55 autistic adults from prior studies in which we collected self-report measures of autistic traits, intolerance of uncertainty, sensory processing, and anxiety. We conducted two path analyses to examine the role of intolerance of uncertainty in anxiety in autistic adults. The first model tested the idea that intolerance of uncertainty, an evolutionary phenomenon common for all people, could explain some of the cognitive aspects of anxiety in autism. The second model suggests that primary neurodevelopmental differences associated with autistic traits underlie the sensory sensitivity and sensory seeking behaviors, which in turn increase intolerance of uncertainty and subsequent anxiety. We found that the “neurodevelopmental” model had better model fit than the “evolutionary stress” model, suggesting that the neurodevelopmental impact of higher levels of autistic traits could moderate a non-autistic trajectory of learning to manage uncertainty as children develop and understand that uncertainty is common and acceptable.
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Affiliation(s)
| | - D Nicholas Top
- Student Health Services, Utah Valley University, Orem, UT, United States
| | - Nicholas Russell
- Department of Psychology, Brigham Young University, Provo, UT, United States
| | - Mark Freeston
- School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jacqui Rodgers
- Population Health Sciences Institute, Sir James Spence Institute, Newcastle upon Tyne, United Kingdom
| | - Mikle South
- Department of Psychology, Brigham Young University, Provo, UT, United States.,Neuroscience Center, Brigham Young University, Provo, UT, United States
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50
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Abstract
BACKGROUND Autism spectrum disorder (ASD) is a common and lifelong neurodevelopmental disorder with the hallmark features of social impairment and restricted and repetitive patterns of behaviour. Individuals with ASD often experience co-occurring mental health difficulties, some of which may obfuscate the ASD features themselves. Although there is a high need for mental health services for autistic adults, there are surprisingly few evidence-based treatments (EBTs) available; moreover, many mental health practitioners who are well-trained in EBTs shy away from treating autistic individuals due to lack of training in ASD. AIMS The aim of the current study was to evaluate the feasibility and acceptability of dialectical behaviour therapy skills training (DBT-ST) in a sample of autistic adults without intellectual disability. METHOD Sixteen adults with ASD were recruited from a treatment waiting list to enrol in this study, which included 24 weeks of DBT-ST delivered in a group setting. Feasibility and acceptability were assessed using retention and attendance data and a participant satisfaction questionnaire. RESULTS Retention (81.3%) and attendance data (mean 87.5%) provided support for the feasibility of this intervention. Overall satisfaction ratings were high (mean 4.5 out of 5), and participants reported that they felt that DBT-ST would probably be helpful for others with ASD (mean 4.5 out of 5). CONCLUSIONS The study findings provide preliminary evidence of (1) the feasibility of providing DBT-ST for autistic adults in community-based clinics, and (2) the perceived benefit of DBT-ST for this under-served population. Recommended modifications to the standard DBT-ST materials are discussed.
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