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Taylor JL, Sullivan V, Bishop SL, Zheng S, Adams RE. Associations between Social Experiences and Psychological Health for Autistic Youth with Low IQ. J Autism Dev Disord 2024:10.1007/s10803-024-06378-3. [PMID: 38703252 DOI: 10.1007/s10803-024-06378-3] [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: 04/23/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Social experiences are consistently associated with psychological health among autistic individuals. However, most extant studies on this topic exclude individuals with autism who have lower IQ or are otherwise unable to self-report. The current study addresses this gap by examining associations of negative peer experiences and social participation with psychological health among autistic youth with low IQ. METHODS An online survey was collected from 268 parents of autistic adolescents and adults ages 15-25. Negative peer experiences included measures of peer victimization and being ignored. Social participation was assessed by the amount of participation and parents' perceptions of whether their youth felt the amount of participation was meeting their needs. Psychological health was assessed by parents' report of their youth's psychological quality of life, as well as whether they felt their son/daughter was currently depressed. RESULTS Results suggested low rates of social participation in this sample, with relatively high rates of being ignored. Regression analysis found that lower rates of peer victimization and more activities in which parents perceived that the amount of time was meeting their youth's needs was associated with higher psychological quality of life and lower likelihood that parents felt their son/daughter was depressed. CONCLUSION Though youth with autism and low IQ are often excluded from interventions aimed at improving social experiences, these findings suggest that promoting positive social experiences and ameliorating negative ones might be an avenue to improving psychological health in this group.
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Affiliation(s)
- Julie Lounds Taylor
- Vanderbilt University Medical Center, PMB 40 - 230 Appleton Pl, Nashville, TN, 37203, USA.
| | - Virginia Sullivan
- Vanderbilt University Medical Center, PMB 40 - 230 Appleton Pl, Nashville, TN, 37203, USA
| | | | | | - Ryan E Adams
- Cincinnati Children's Hospital Medical Center, Cincinnati, USA
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2
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Bagnall R, Russell A, Brosnan M, Maras K. Autistic adults' inclination to lie in everyday situations. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:718-731. [PMID: 37572035 PMCID: PMC10913365 DOI: 10.1177/13623613231183911] [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: 08/14/2023]
Abstract
LAY ABSTRACT Differences in social communication and understanding others' mental states may mean that autistic adults are less likely to deceive others than non-autistic individuals. We investigated whether autistic and non-autistic adults differ in their inclination to lie and which psychological factors are involved in the inclination to lie. We found that autistic and non-autistic groups reported a similar inclination to lie, and the extent to which participants viewed lying as acceptable helped to explain their inclination to deceive others. However, the other underlying psychological factors associated with deception inclination differed between autistic and non-autistic groups. Autistic adults' belief about their ability to lie and also how quickly they could lie helped to explain whether they were more or less inclined to lie. For non-autistic adults, their memory and ability to understand others' mental states helped to explain their lie inclination. We discuss these findings and recommend areas for future research.
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3
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Latvala A, Tideman M, Søndenaa E, Larsson H, Butwicka A, Fazel S, Lichtenstein P. Association of intellectual disability with violent and sexual crime and victimization: a population-based cohort study. Psychol Med 2023; 53:3817-3825. [PMID: 35238292 PMCID: PMC10317804 DOI: 10.1017/s0033291722000460] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/20/2021] [Accepted: 02/08/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Intellectual disability (ID) is associated with violent and sexual offending and victimization, but the importance of neuropsychiatric comorbidity and severity of disability remains unclear. METHODS In a register-based cohort study of people born in Sweden 1980-1991 (n = 1 232 564), we investigated associations of mild and moderate/severe ID with any, violent and sexual crimes, and with assault victimization, stratified by comorbid autism and attention deficit hyperactivity disorder (ADHD). We defined ID by attendance at a special school or registered diagnosis and obtained data on criminal convictions and injuries or deaths due to assaults from nationwide registers until end of 2013. RESULTS Compared to people without ID, autism or ADHD, men and women with mild or moderate/severe ID and comorbid ADHD had elevated risks of violent crimes [range of hazard ratios (HRs) 4.4-10.4] and assault victimization (HRs 2.0-7.7). Women with mild ID without comorbidities or with comorbid autism also had elevated risks of violent crimes and victimization (HRs 1.8-4.6) compared to women without ID, autism or ADHD. The relative risks of sexual offending and victimization were elevated in men and women with ID without comorbidities (HRs 2.6-12.7). The highest risks for sexual offending in men (HRs 9.4-11.0) and for sexual assault victimization in women (HRs 11.0-17.1) related to ID and comorbid ADHD. CONCLUSIONS The elevated risk of violent offending and assault victimization in people with ID is largely explained by comorbid ADHD, whereas ID is independently associated with sexual crimes and victimization, even though absolute risks are low.
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Affiliation(s)
- Antti Latvala
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Tideman
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Erik Søndenaa
- Forensic Department, St Olavs University Hospital, Trondheim, Norway
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Agnieszka Butwicka
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Region Stockholm, Sweden
- Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Chien YL, Tsai WC, Chen WH, Yang CL, Gau SSF, Soong WT, Laugeson E, Chiu YN. Effectiveness, durability, and clinical correlates of the PEERS social skills intervention in young adults with autism spectrum disorder: the first evidence outside North America. Psychol Med 2023; 53:966-976. [PMID: 34247667 DOI: 10.1017/s0033291721002385] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite the fact that social deficits among individuals with autism spectrum disorder (ASD) are lifelong and impact many aspects of personal functioning, evidence-based programs for social skills training were not available until recently. The Program for the Education and Enrichment of Relational Skills (PEERS®) has been shown to effectively improve social skills for adolescents on the spectrum across different social cultures. However, the effectiveness for young adults beyond North America has yet to be examined. This study aimed to investigate the effectiveness of the PEERS intervention in Taiwanese young adults with ASD, and examine its durability and clinical correlates. METHODS We recruited 82 cognitively-able young adults with ASD, randomized to the PEERS treatment or treatment-as-usual. RESULTS Following treatment, significant improvement was found in aspects of social deficits, autism severity, social interaction anxiety, empathy, and social skills knowledge either by self-report or coach-report. Additionally, communicative behaviors rated by observers improved throughout the sessions, showing a trend toward more appropriate eye contact, gestures, facial expression during conversation, and appropriate maintenance of conversation and reciprocity. Most effects maintained at 3-month and 6-month follow-ups. The improvement of social deficits was positively correlated with baseline severity, while gains in social skills knowledge were positively correlated with IQ. The improvement of social deficits, autism severity, and empathy were positively correlated with each other. CONCLUSION Overall, the PEERS intervention appears to effectively improve social functioning in Taiwanese young adults with ASD. Improvement of social response and knowledge may be predicted by baseline severity and intelligence respectively.
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Affiliation(s)
- Yi-Ling Chien
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Che Tsai
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Hao Chen
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Liang Yang
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wei-Tsuen Soong
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Elizabeth Laugeson
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
| | - Yen-Nan Chiu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
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Hymas R, Badcock JC, Milne E. Loneliness in Autism and Its Association with Anxiety and Depression: A Systematic Review with Meta-Analyses. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00330-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Abstract
Objectives
This systematic review aimed to quantify differences in loneliness levels between autistic and neurotypical samples and investigate the association between loneliness and mental health in autistic individuals.
Methods
Three meta-analyses were conducted. Studies were methodologically appraised using established tools.
Results
Overall, 39 studies were included. The majority of these achieved moderate methodological quality ratings. The primary meta-analysis (N = 23) found autistic samples reported higher loneliness compared with neurotypical samples (Hedges’ g = .89). The meta-analyses on the associations between loneliness and anxiety (N = 14) and depression (N = 11) in autistic samples found significant pooled correlations (r = .29 and r = .48, respectively).
Conclusions
This review highlights numerous limitations within current autism and loneliness research. Nevertheless, loneliness in autism merits targeted clinical and research attention.
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Riddiford JA, Enticott PG, Lavale A, Gurvich C. Gaze and social functioning associations in autism spectrum disorder: A systematic review and meta-analysis. Autism Res 2022; 15:1380-1446. [PMID: 35593039 PMCID: PMC9543973 DOI: 10.1002/aur.2729] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 03/08/2022] [Accepted: 03/28/2022] [Indexed: 12/11/2022]
Abstract
Autism spectrum disorder (ASD) is characterized by significant social functioning impairments, including (but not limited to) emotion recognition, mentalizing, and joint attention. Despite extensive investigation into the correlates of social functioning in ASD, only recently has there been focus on the role of low‐level sensory input, particularly visual processing. Extensive gaze deficits have been described in ASD, from basic saccadic function through to social attention and the processing of complex biological motion. Given that social functioning often relies on accurately processing visual information, inefficient visual processing may contribute to the emergence and sustainment of social functioning difficulties in ASD. To explore the association between measures of gaze and social functioning in ASD, a systematic review and meta‐analysis was conducted. A total of 95 studies were identified from a search of CINAHL Plus, Embase, OVID Medline, and psycINFO databases in July 2021. Findings support associations between increased gaze to the face/head and eye regions with improved social functioning and reduced autism symptom severity. However, gaze allocation to the mouth appears dependent on social and emotional content of scenes and the cognitive profile of participants. This review supports the investigation of gaze variables as potential biomarkers of ASD, although future longitudinal studies are required to investigate the developmental progression of this relationship and to explore the influence of heterogeneity in ASD clinical characteristics.
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Affiliation(s)
- Jacqueline A Riddiford
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, Victoria
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | - Alex Lavale
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, Victoria
| | - Caroline Gurvich
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, Victoria
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7
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Klang A, Westerberg B, Humble MB, Bejerot S. The impact of schizotypy on quality of life among adults with autism spectrum disorder. BMC Psychiatry 2022; 22:205. [PMID: 35305592 PMCID: PMC8934003 DOI: 10.1186/s12888-022-03841-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) and schizotypal personality disorder can be difficult to distinguish. Deficits in social relationships and social interaction, present in both conditions, are known to impair quality of life. The aim of the present study was to investigate if schizotypal symptoms affect quality of life among adults diagnosed with autism spectrum disorder and to study the association between schizotypy and autistic traits among them. METHODS Participants diagnosed with autism spectrum disorder (n = 110) completed questionnaires exploring schizotypy (Schizotypal Personality Questionnaire - Brief Revised (SPQ-BR)), autistic traits (The Ritvo Autism, Asperger Diagnostic Scale-Revised Screen 14 items), anxiety and depression (The Hospital Anxiety and Depression scale) and quality of life (Brunnsviken Brief Quality of Life Scale and the European quality of life index version 5D). RESULTS Schizotypy was found to be associated with anxiety, depressive and autistic symptoms, and poor quality of life. Although schizotypy was a predictor for impaired quality of life, this relationship was mediated by symptoms of anxiety and depression, plausibly inherent to autism. Autistic traits were positively associated with all higher order constructs of the SPQ-BR, i.e. positive and negative schizotypy, disorganization and social anxiety, as well as with poor quality of life. CONCLUSIONS There is considerable overlap between schizotypy and autism that needs to be considered in research. Prominent schizotypal traits in people with ASD may constitute an endophenotype coinciding with a particularly poor quality of life. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03570372 : Internet-based Treatment for Adults with Autism Spectrum Disorder (MILAS).
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Affiliation(s)
- Albin Klang
- grid.15895.300000 0001 0738 8966School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Britta Westerberg
- grid.15895.300000 0001 0738 8966School of Medical Sciences, Örebro University, Örebro, Sweden ,grid.15895.300000 0001 0738 8966University Health Care Research Centre, Region Örebro County, Faculty of Medicine and Health, Örebro University, P.O. Box 1613, University Hospital, S-701, Örebro, Sweden
| | - Mats B. Humble
- grid.15895.300000 0001 0738 8966School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Susanne Bejerot
- School of Medical Sciences, Örebro University, Örebro, Sweden. .,University Health Care Research Centre, Region Örebro County, Faculty of Medicine and Health, Örebro University, P.O. Box 1613, University Hospital, S-701, Örebro, Sweden.
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8
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Rothman EF, Graham Holmes L, Caplan R, Chiang M, Haberer B, Gallop N, Kadel R, Person M, Sanchez A, Quinn E, Wharmby P. Healthy Relationships on the Autism Spectrum (HEARTS): A feasibility test of an online class co-designed and co-taught with autistic people. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:690-702. [PMID: 35000417 DOI: 10.1177/13623613211069421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT The Healthy Relationships on the Autism Spectrum class is unique because autistic people helped to develop it and co-taught it. It is an online, six-session class. The class was piloted in 2020-2021 with 55 autistic people who were ages 18-44 years old. This feasibility study found that most people who took the class liked it. Surveys filled out by the students before and after the class showed that they became less sensitive to rejection, used more positive thinking skills, and were more interested in being social. However, the class may not have made them feel less lonely. The team that invented the class is using the feedback to improve it. The class holds promise for improving the quality of friendships and dating relationships for autistic adults and should be tested further.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Emily Quinn
- Boston University School of Public Health, USA
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9
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Rothman EF, Graham Holmes L. Using formative research to develop HEARTS: A curriculum-based healthy relationships promoting intervention for individuals on the autism spectrum. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:160-168. [PMID: 34120485 PMCID: PMC8665942 DOI: 10.1177/13623613211024521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
LAY ABSTRACT What is already known about the topic? All people can benefit from education about how to have healthy friendships and dating relationships. But specific interventions on relationship skills-like respecting boundaries, identifying warning signs of abuse, or talking about sexual preferences-are too rare, particularly for autistic individuals. The goal of this study was to collect formative data from autistic emerging adults to help create a new, six-session workshop for autistic young adults to support healthy peer relationships. Twenty-five autistic youth aged 16-22 years old were interviewed.What this paper adds? The participants described a need for more and better information about how to support lasting friendships, deal with their anxiety about relationships, and know when friendships or dating relationships were reciprocal and rewarding versus unhealthy.Implications for practice, research, or policy. The results reveal a need for a new and effective intervention that supports healthy relationship skills for autistic people.
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Abstract
Over the past four decades there have been significant advances in our understanding of autism, yet services for autistic adults continue to lag far behind those for children, and prospects for employment and independent living remain poor. Adult outcomes also vary widely and while cognitive and language abilities are important prognostic indicators, the influence of social, emotional, familial and many other factors remains uncertain. For this special issue marking the 40th anniversary of DSM-III, the present paper describes the changing perspectives of autism in adulthood that have occurred over this period, explores individual and wider environmental factors related to outcome, and suggests ways in which services need to be changed to improve the future for adults living with autism.
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Affiliation(s)
- Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.
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11
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Autistic Input in Social Skills Interventions for Young Adults: a Systematic Review of the Literature. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00280-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Muris P, Ollendick TH. Selective Mutism and Its Relations to Social Anxiety Disorder and Autism Spectrum Disorder. Clin Child Fam Psychol Rev 2021; 24:294-325. [PMID: 33462750 PMCID: PMC8131304 DOI: 10.1007/s10567-020-00342-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 12/24/2022]
Abstract
In current classification systems, selective mutism (SM) is included in the broad anxiety disorders category. Indeed, there is abundant evidence showing that anxiety, and social anxiety in particular, is a prominent feature of SM. In this article, we point out that autism spectrum problems in addition to anxiety problems are sometimes also implicated in SM. To build our case, we summarize evidence showing that SM, social anxiety disorder (SAD), and autism spectrum disorder (ASD) are allied clinical conditions and share communalities in the realm of social difficulties. Following this, we address the role of a prototypical class of ASD symptoms, restricted and repetitive behaviors and interests (RRBIs), which are hypothesized to play a special role in the preservation and exacerbation of social difficulties. We then substantiate our point that SM is sometimes more than an anxiety disorder by addressing its special link with ASD in more detail. Finally, we close by noting that the possible involvement of ASD in SM has a number of consequences for clinical practice with regard to its classification, assessment, and treatment of children with SM and highlight a number of directions for future research.
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Affiliation(s)
- Peter Muris
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
- Stellenbosch University, Stellenbosch, South Africa.
| | - Thomas H Ollendick
- Virginia Polytechnic Institute and State University, Blacksburg, USA
- Roehampton University, London, England
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13
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Script Fading Procedure: a Systematic Review and Meta-analysis. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Bemmer ER, Boulton KA, Thomas EE, Larke B, Lah S, Hickie IB, Guastella AJ. Modified CBT for social anxiety and social functioning in young adults with autism spectrum disorder. Mol Autism 2021; 12:11. [PMID: 33557903 PMCID: PMC7871647 DOI: 10.1186/s13229-021-00418-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/21/2021] [Indexed: 01/15/2023] Open
Abstract
Background There is a strong research imperative to investigate effective treatment options for adolescents and adults with autism spectrum disorder (ASD). Elevated social anxiety, difficulties with social functioning and poor mental health have all been identified as core treatment targets for this group. While theoretical models posit a strong bidirectionality between social anxiety and ASD social functioning deficits, few interventions have targeted both domains concurrently. Of the two group interventions previously conducted with adolescents and adults with ASD, significant results have only been observed in either social anxiety or social functioning, and have not generalised to changes in overall mood. The aim of this study was to evaluate the potential benefit, tolerability and acceptability of a group cognitive-behaviour therapy (CBT) intervention in young adults with ASD. Primary treatment outcomes were social anxiety symptoms and social functioning difficulties; secondary outcomes were self-reported mood and overall distress. Method Ten groups of participants completed an eight-week, modified group CBT intervention targeting both social anxiety and social functioning, that included social skills training, exposure tasks and behavioural experiment components. Seventy-eight adolescents and young adults with ASD, without intellectual impairment, aged between 16 and 38 (M = 22.77; SD = 5.31), were recruited from the community, Headspace centres and the Autism Clinic for Translational Research at the Brain and Mind Centre, University of Sydney. Outcomes (social anxiety, social functioning and mood) were measured pre- and post-intervention via self-report questionnaires (administered either online or through the return of hard-copy booklets), and participants were invited to provide anonymous feedback on the intervention (at the mid-point and end of the intervention). Results Participants demonstrated statistically significant improvements on all outcome measures in response to the intervention. Specifically, social anxiety symptoms decreased (p < .001), and specific subdomains of social functioning improved post-intervention, particularly in social motivation (p = .032) and restricted interests and repetitive behaviours (p = .025). Self-reported symptom improvements also generalised to mood (depression, anxiety and stress; p < .05). All improvements demonstrated small effect sizes. Participant feedback was positive and indicated strong satisfaction with the program. Limitations The absence of a control group and follow-up measures, reliance on self-report instruments as outcome measures and the exclusion of those with intellectual disability represent significant limitations to this study. Conclusions These findings indicate that a group CBT intervention appears to be a beneficial intervention for self-reported social anxiety, social functioning and overall mental health in adolescents and young adults with ASD. The stand-alone nature of the intervention combined with positive participant feedback indicates it was well tolerated, has potential clinical utility and warrants further study in a randomised-controlled, follow-up design.
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Affiliation(s)
- Emily R Bemmer
- Autism Clinic for Translational Research, Brain and Mind Centre, Child Neurodevelopment and Mental Health Team, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 100 Mallet Street, Camperdown, NSW, 2050, Australia.,School of Psychology, University of Sydney, Sydney, 2050, Australia
| | - Kelsie A Boulton
- Autism Clinic for Translational Research, Brain and Mind Centre, Child Neurodevelopment and Mental Health Team, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 100 Mallet Street, Camperdown, NSW, 2050, Australia.,Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2050, Australia
| | - Emma E Thomas
- Autism Clinic for Translational Research, Brain and Mind Centre, Child Neurodevelopment and Mental Health Team, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 100 Mallet Street, Camperdown, NSW, 2050, Australia
| | - Ben Larke
- Autism Clinic for Translational Research, Brain and Mind Centre, Child Neurodevelopment and Mental Health Team, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 100 Mallet Street, Camperdown, NSW, 2050, Australia
| | - Suncica Lah
- School of Psychology, University of Sydney, Sydney, 2050, Australia
| | - Ian B Hickie
- Autism Clinic for Translational Research, Brain and Mind Centre, Child Neurodevelopment and Mental Health Team, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 100 Mallet Street, Camperdown, NSW, 2050, Australia
| | - Adam J Guastella
- Autism Clinic for Translational Research, Brain and Mind Centre, Child Neurodevelopment and Mental Health Team, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 100 Mallet Street, Camperdown, NSW, 2050, Australia. .,Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, 2050, Australia.
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15
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Brezis RS, Levin A, Oded Y, Zahavi O, Gampel G, Levit-Binnun N. A Contemplative Biofeedback Intervention for Adults with Autism Spectrum Disorder: Feasibility of a Community-Based Treatment. Appl Psychophysiol Biofeedback 2021; 46:141-149. [PMID: 33507458 DOI: 10.1007/s10484-021-09503-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
As the number of diagnosed adults living with autism spectrum disorder (ASD) continues to grow, a lack of resources and lack of available interventions exacerbate their low quality of life, including low levels of education and employment, and high levels of co-morbid anxiety and depression. Here we build upon existing research showing the effectiveness of contemplative interventions on individuals with ASD, to provide a low-cost biofeedback-enhanced training which can be implemented by non-professional staff, and may help autistic individuals grasp abstract contemplative techniques. We hypothesize that the intervention will decrease participants' anxiety and autism symptoms, and increase their self-awareness, self-determination, and empathy. Fourteen adults with ASD, residing in assisted living, were provided with 16 weekly half-hour contemplative-biofeedback sessions with non-professional trainers, in which they learned to reduce their arousal levels through combined biofeedback and contemplative techniques, and apply those to everyday life. Quantitative and qualitative data was collected pre- and post-intervention, to determine changes in participants' self-awareness, self-determination, anxiety, autism symptoms, and empathy. Participants were capable of successfully improving their physiological arousal levels on the biofeedback setup, indicating feasibility of the technique. Further, we found initial indications for reduction in autism symptoms and increased self-determination. Qualitative reports by participants and counselors revealed that participants applied the techniques in many real-life situations, and these had far-ranging effects on their emotional regulation, work and social motivation, and self-determination. The study provides proof-of-concept for a low-cost, community-based intervention which can ameliorate the lives of adults with ASD.
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Affiliation(s)
- Rachel S Brezis
- Sagol Center for Brain and Mind, Baruch Ivcher School of Psychology, Interdisciplinary Center Herzliya, P.O.Box 167, 46150, Herzliya, Israel.
| | - Amitai Levin
- Sagol Center for Brain and Mind, Baruch Ivcher School of Psychology, Interdisciplinary Center Herzliya, P.O.Box 167, 46150, Herzliya, Israel
| | | | - Opher Zahavi
- Beit-Ekstein Organization, Kerem Maharal, Israel
| | - Galit Gampel
- Private Psychotherapy Practice, Tel Aviv, Israel
| | - Nava Levit-Binnun
- Sagol Center for Brain and Mind, Baruch Ivcher School of Psychology, Interdisciplinary Center Herzliya, P.O.Box 167, 46150, Herzliya, Israel
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16
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Beresford B, Mukherjee S, Mayhew E, Heavey E, Park AL, Stuttard L, Allgar V, Knapp M. Evaluating specialist autism teams’ provision of care and support for autistic adults without learning disabilities: the SHAPE mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The National Institute for Health and Care Excellence recommends that every locality has a ‘Specialist Autism Team’: an specialist autism, community-based, multidisciplinary service that is responsible for developing, co-ordinating and delivering care and support. The National Institute for Health and Care Excellence recommended that this novel delivery model was evaluated.
Objectives
The objectives were to identify services fulfilling the National Institute for Health and Care Excellence’s description of a Specialist Autism Team; to describe practitioner and user experiences; to investigate outcomes; to identify factors associated with these outcomes; and to estimate costs and investigate cost-effectiveness of these services.
Design
During stage 1, desk-based research and a survey to identify Specialist Autism Teams were carried out. Stage 2 comprised a mixed-methods observational study of a cohort of Specialist Autism Team users, which was followed for up to 2 years from the assessment appointment. The cohort comprised users of a Specialist Autism Team not previously diagnosed with autism (the ‘Diagnosis and Support’ group) and those already diagnosed (the ‘Support-Only’ group). Stage 2 also involved a nested qualitative study of senior practitioners and an exploratory comparison of the Diagnosis and Support group with a cohort who accessed a service which only provided autism diagnostic assessments (‘Diagnosis-Only’ cohort).
Setting
The setting in stage 2 was nine Specialist Autism Teams; three also provided a regional diagnostic assessment service (used to recruit the Diagnosis-Only cohort).
Participants
There were 252 participants in the Specialist Autism Team cohort (Diagnosis and Support, n = 164; Support Only, n = 88) and 56 participants in the Diagnosis-Only cohort. Thirty-eight participants (across both cohorts) were recruited to the qualitative evaluation and 11 practitioners to the nested qualitative study.
Main outcome measures
The World Health Organization Quality of Life assessment, abbreviated version (psychological domain) and the General Health Questionnaire (12-item version).
Data sources
Self-reported outcomes, qualitative interviews with users and focus groups with practitioners.
Results
A total of 18 Specialist Autism Teams were identified, all for autistic adults without learning disabilities. Services varied in their characteristics. The resources available, commissioner specifications and clinical opinion determined service design. Practitioners working in Specialist Autism Teams recruited to stage 2 reported year-on-year increases in referral rates without commensurate increases in funding. They called for an expansion of Specialist Autism Teams’ consultation/supervision function and resources for low-intensity, ongoing support. For the Specialist Autism Team cohort, there was evidence of prevention of deterioration in outcomes and positive benefit for the Diagnosis and Support group at the 1-year follow-up (T3). Users of services with more professions involved were likely to experience better outcomes; however, such services may not be considered cost-effective. Some service characteristics were not associated with outcomes, suggesting that different structural/organisational models are acceptable. Findings suggest that one-to-one work for mental health problems was cost-effective and an episodic approach to delivering care plans was more cost-effective than managed care. Qualitative findings generally align with quantitative findings; however, users consistently connected a managed-care approach to supporting improvement in outcomes. Among the Diagnosis-Only cohort, no changes in mental health outcomes at T3 were observed. Findings from the interviews with individuals in the Diagnosis and Support group and Diagnosis-Only cohort suggest that extended psychoeducation post diagnosis has an impact on immediate and longer-term adjustment.
Limitations
Sample size prohibited an investigation of the associations between some service characteristics and outcomes. Comparison of the Diagnosis-Only cohort and the Diagnosis and Support group was underpowered. The economic evaluation was limited by incomplete costs data.
Conclusions
The study provides first evidence on the implementation of Specialist Autism Teams. There is some evidence of benefit for this model of care. Service characteristics that may affect outcomes, costs and cost-effectiveness were identified. Finding suggest that extended psychoeducation post diagnosis is a critical element of Specialist Autism Team provision.
Future work
We recommend a comparative evaluation of Specialist Autism Teams with diagnosis-only provision, and an evaluation of models of providing consultation/supervision and low-intensity support.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 48. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | | | - Emese Mayhew
- Social Policy Research Unit, University of York, York, UK
| | - Emily Heavey
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Lucy Stuttard
- Social Policy Research Unit, University of York, York, UK
| | | | - Martin Knapp
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
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17
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Morrison KE, DeBrabander KM, Jones DR, Ackerman RA, Sasson NJ. Social Cognition, Social Skill, and Social Motivation Minimally Predict Social Interaction Outcomes for Autistic and Non-Autistic Adults. Front Psychol 2020; 11:591100. [PMID: 33324295 PMCID: PMC7723837 DOI: 10.3389/fpsyg.2020.591100] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/30/2020] [Indexed: 12/22/2022] Open
Abstract
Social cognition, social skill, and social motivation have been extensively researched and characterized as atypical in autistic people, with the assumption that each mechanistically contributes to the broader social interaction difficulties that diagnostically define the condition. Despite this assumption, research has not directly assessed whether or how these three social domains contribute to actual real-world social interaction outcomes for autistic people. The current study administered standardized measures of social cognition, social skill, and social motivation to 67 autistic and 58 non-autistic (NA) adults and assessed whether performance on these measures, both individually and relationally between dyadic partners, predicted outcomes for autistic and NA adults interacting with unfamiliar autistic and NA partners in a 5 minute unstructured "get to know you" conversation. Consistent with previous research, autistic adults scored lower than NA adults on the three social domains and were evaluated less favorably by their conversation partners. However, links between autistic adults' performance on the three social domains and their social interaction outcomes were minimal and, contrary to prediction, only the social abilities of NA adults predicted some interaction outcomes within mixed diagnostic dyads. Collectively, results suggest that reduced performance by autistic adults on standardized measures of social cognition, social skill, and social motivation do not correspond in clear and predictable ways with their real-world social interaction outcomes. They also highlight the need for the development and validation of more ecological assessments of autistic social abilities and the consideration of relational dynamics, not just individual characteristics, when assessing social disability in autism.
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Affiliation(s)
| | | | | | | | - Noah J. Sasson
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
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18
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Air Pollution-Related Brain Metal Dyshomeostasis as a Potential Risk Factor for Neurodevelopmental Disorders and Neurodegenerative Diseases. ATMOSPHERE 2020. [DOI: 10.3390/atmos11101098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Increasing evidence links air pollution (AP) exposure to effects on the central nervous system structure and function. Particulate matter AP, especially the ultrafine (nanoparticle) components, can carry numerous metal and trace element contaminants that can reach the brain in utero and after birth. Excess brain exposure to either essential or non-essential elements can result in brain dyshomeostasis, which has been implicated in both neurodevelopmental disorders (NDDs; autism spectrum disorder, schizophrenia, and attention deficit hyperactivity disorder) and neurodegenerative diseases (NDGDs; Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, and amyotrophic lateral sclerosis). This review summarizes the current understanding of the extent to which the inhalational or intranasal instillation of metals reproduces in vivo the shared features of NDDs and NDGDs, including enlarged lateral ventricles, alterations in myelination, glutamatergic dysfunction, neuronal cell death, inflammation, microglial activation, oxidative stress, mitochondrial dysfunction, altered social behaviors, cognitive dysfunction, and impulsivity. Although evidence is limited to date, neuronal cell death, oxidative stress, and mitochondrial dysfunction are reproduced by numerous metals. Understanding the specific contribution of metals/trace elements to this neurotoxicity can guide the development of more realistic animal exposure models of human AP exposure and consequently lead to a more meaningful approach to mechanistic studies, potential intervention strategies, and regulatory requirements.
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19
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Ferguson EF, Drapalik KN, Liang J, Hua K, Feerst H, Mallory AB, Vernon TW. Social Interaction Skill Intervention for Autistic Adults with Intellectual Disability and Limited Language: A Pilot of the SKILL Program. J Autism Dev Disord 2020; 51:1641-1657. [PMID: 32812191 DOI: 10.1007/s10803-020-04659-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is a dearth of research that focuses on social intervention efforts for adults on the autism spectrum with intellectual disability and limited conversational language. Using a multiple baseline experimental design, this pilot investigation of the Socialization Knowledge for Individuals with Limited Language (SKILL) program evaluated a novel peer-facilitated group program specifically designed to target social interaction skills for this population. Findings from five pilot participants yielded evidence of social improvements across specific verbal skills (on-topic conversational contributions and responses) and nonverbal behaviors (eye-contact, active listening), as evidenced by coded social conversation probes and parent-report measures. These findings demonstrate the promise of a socialization intervention for a population that has historically been neglected in the social intervention research literature.
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Affiliation(s)
- Emily F Ferguson
- Koegel Autism Center, University of California Santa Barbara, Santa Barbara, CA, USA.
| | - Krista N Drapalik
- Koegel Autism Center, University of California Santa Barbara, Santa Barbara, CA, USA
- Yale Child Study Center, New Haven, CT, USA
| | - Jeffrey Liang
- Koegel Autism Center, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Klaire Hua
- Koegel Autism Center, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Harrison Feerst
- Koegel Autism Center, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Alice B Mallory
- Koegel Autism Center, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Ty W Vernon
- Koegel Autism Center, University of California Santa Barbara, Santa Barbara, CA, USA
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20
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Kerr-Gaffney J, Harrison A, Tchanturia K. Autism spectrum disorder traits are associated with empathic abilities in adults with anorexia nervosa. J Affect Disord 2020; 266:273-281. [PMID: 32056888 DOI: 10.1016/j.jad.2020.01.169] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/10/2019] [Accepted: 01/28/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Social and emotional difficulties have been identified as key factors in the development and maintenance of anorexia nervosa (AN). However, few studies have investigated the influence of comorbid psychopathology on social cognition. The aim of the current study was to examine perception of nonverbal communication and empathy in AN using ecologically valid, performance-based measures, and to explore associations with comorbid psychopathology (anxiety, depression, autism spectrum disorder (ASD) traits, alexithymia, and social anxiety). METHODS In this cross-sectional study, the Multifaceted Empathy Test (MET) and the Mini Profile of Nonverbal Sensitivity (MiniPONS) were administered to 51 adults with AN, 51 recovered AN (REC), and 51 healthy controls (HCs). Comorbid psychopathological traits were assessed using self-report questionnaires and the Autism Diagnostic Observation Schedule - 2nd edition (ADOS-2). RESULTS Individuals with AN showed reduced affective empathy to positive stimuli compared to HCs, and a trend towards lower vocal prosody recognition scores relative to REC. Around a quarter of AN and REC scored above the clinical cut-off for ASD on the ADOS-2, and high ASD symptoms predicted lower cognitive and affective empathy scores. LIMITATIONS The study is cross-sectional, future research would benefit from examining social-cognition performance and comorbid psychopathology longitudinally. CONCLUSIONS The findings highlight the importance of ASD symptoms in empathy dysfunction in those with a lifetime history of AN. Future research should explore whether treatment adaptations to accommodate for differences in social-cognitive abilities may be helpful in the treatment of AN.
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Affiliation(s)
- Jess Kerr-Gaffney
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom.
| | - Amy Harrison
- University College London, Department of Psychology and Human Development, London, United Kingdom; South London and Maudsley NHS Trust, National Eating Disorders Service, Psychological Medicine Clinical Academic Group, London, United Kingdom
| | - Kate Tchanturia
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom; South London and Maudsley NHS Trust, National Eating Disorders Service, Psychological Medicine Clinical Academic Group, London, United Kingdom; Department of Psychology, Ilia State University, Tbilisi, Georgia
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21
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Lord C, Brugha TS, Charman T, Cusack J, Dumas G, Frazier T, Jones EJH, Jones RM, Pickles A, State MW, Taylor JL, Veenstra-VanderWeele J. Autism spectrum disorder. Nat Rev Dis Primers 2020; 6:5. [PMID: 31949163 PMCID: PMC8900942 DOI: 10.1038/s41572-019-0138-4] [Citation(s) in RCA: 574] [Impact Index Per Article: 143.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2019] [Indexed: 12/27/2022]
Abstract
Autism spectrum disorder is a construct used to describe individuals with a specific combination of impairments in social communication and repetitive behaviours, highly restricted interests and/or sensory behaviours beginning early in life. The worldwide prevalence of autism is just under 1%, but estimates are higher in high-income countries. Although gross brain pathology is not characteristic of autism, subtle anatomical and functional differences have been observed in post-mortem, neuroimaging and electrophysiological studies. Initially, it was hoped that accurate measurement of behavioural phenotypes would lead to specific genetic subtypes, but genetic findings have mainly applied to heterogeneous groups that are not specific to autism. Psychosocial interventions in children can improve specific behaviours, such as joint attention, language and social engagement, that may affect further development and could reduce symptom severity. However, further research is necessary to identify the long-term needs of people with autism, and treatments and the mechanisms behind them that could result in improved independence and quality of life over time. Families are often the major source of support for people with autism throughout much of life and need to be considered, along with the perspectives of autistic individuals, in both research and practice.
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Affiliation(s)
- Catherine Lord
- Departments of Psychiatry and School of Education, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Traolach S Brugha
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Guillaume Dumas
- Institut Pasteur, UMR3571 CNRS, Université de Paris, Paris, France
| | | | - Emily J H Jones
- Centre for Brain & Cognitive Development, University of London, London, UK
| | - Rebecca M Jones
- The Sackler Institute for Developmental Psychobiology, New York, NY, USA
- The Center for Autism and the Developing Brain, White Plains, NY, USA
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthew W State
- Department of Psychiatry, Langley Porter Psychiatric Institute and Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Julie Lounds Taylor
- Department of Pediatrics and Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
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