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Brown CE, Borduin CM, Sheerin KM, Kanne SM. Characteristics and correlates of aggressive behavior in autistic youths. Autism Res 2024; 17:1586-1600. [PMID: 39039869 PMCID: PMC11370627 DOI: 10.1002/aur.3199] [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: 12/18/2023] [Accepted: 06/27/2024] [Indexed: 07/24/2024]
Abstract
This study aimed to characterize aggressive behaviors in autistic youths and to identify the social environment variables most strongly linked with aggression in this clinical population. Participants were 2142 caregivers of autistic youths (ages 6.0-17.9) recruited from autism research centers across the United States. Caregivers completed self-report and behavior rating inventories that assessed both verbal and physical aggression as well as characteristics of the individual youths (sleep quality, gastrointestinal [GI] symptoms, and autism characteristics) and their families (caregiver stress, global family functioning, and sibling relations), peers (emotional bonding, number of friends), schools (academic functioning), and neighborhoods (perceived community safety). We used descriptive analyses to identify which aggressive acts were most common among autistic youths, and we performed bivariate correlations and multiple linear regression analyses to determine which characteristics of the youths and their social environments were most strongly linked with youth aggression. Verbally aggressive youth behaviors were endorsed by caregivers most frequently. Youth age and sex were not associated with verbal or physical aggression. A combination of youth and social environment characteristics accounted for 42.6% of the variance in verbal aggression and 26.0% of the variance in physical aggression. Thus, those characteristics most strongly linked with verbal and physical aggression were strained sibling relations, caregiver stress, youth sleep problems, and youth repetitive and restrictive behaviors. Viewed together, the results suggest that aggressive behaviors in autistic youths are associated with multiple characteristics pertaining to the individual youths and their immediate social environments. Implications for treatment and research are discussed.
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Affiliation(s)
- Cynthia E Brown
- School of Graduate Psychology, Pacific University, Hillsboro, Oregon, USA
| | - Charles M Borduin
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Kaitlin M Sheerin
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Stephen M Kanne
- Department of Psychiatry, Center for Autism and the Developing Brain, Weill Cornell Medical College, New York, New York, USA
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2
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Ferguson EF, Barnett ML, Goodwin JW, Vernon TW. "There is No Help:" Caregiver Perspectives on Service Needs for Adolescents and Adults with Profound Autism. J Autism Dev Disord 2024:10.1007/s10803-024-06451-x. [PMID: 38963473 DOI: 10.1007/s10803-024-06451-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 07/05/2024]
Abstract
The underrepresentation of individuals with profound autism (who require 24/7 access to care) in autism research has resulted in limited knowledge about their service needs and a lack of evidence-based practices tailored to those needs. This study explored caregiver perspectives on service needs, barriers to accessing care, and treatment priorities to guide treatment development and improvement of service delivery. A sequential mixed-methods design integrated quantitative survey data (n = 423; Mage = 18.89 years; 26.7% female) with qualitative interviews (n = 20) with caregivers of adolescents and adults with profound autism. Quantitative findings indicated regular socialization opportunities were the most frequently endorsed unmet service need (60.3% of caregivers), followed by primary health care with autism-trained staff (59.3%), social skills instruction (55.8%), life skills instruction (51.3%), and behavioral support (47.3%). Higher likelihood of needing social activity groups was associated with elevated emotional reactivity, higher language level, minoritized ethnicity, and lower household income. Greater need for specialized primary health care was associated with lower income, while the need for social and life skills instruction was associated with increased age and elevated dysphoria. Qualitative analysis identified 10 themes that converged and expanded quantitative findings by highlighting a pervasive shortage of individualized, goal-oriented services, common barriers to care, and the priority of developing centralized treatment settings that coordinate care throughout adulthood. This study identified pressing service needs for adolescents and adults with profound autism in the United States. These insights are crucial for improving the accessibility and quality of clinical care.
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Affiliation(s)
- Emily F Ferguson
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, 401 Quarry Rd, Stanford, CA, 94305-5719, USA.
| | | | | | - Ty W Vernon
- University of California, Santa Barbara, CA, USA
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3
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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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4
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Rosenau KA, Kim J, Cho ACB, Seltzer M, Ugueto AM, Weisz JR, Wood JJ. Meta-analysis of Psychotherapy for Autistic Youth. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01686-2. [PMID: 38580853 DOI: 10.1007/s10578-024-01686-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 04/07/2024]
Abstract
In order to provide more individualized support, it is imperative to further understand the effectiveness of different types of psychotherapy on the clinical areas of need common in autistic youth (Wood et al. in Behav Ther 46:83-95, 2015). Randomized controlled trials of psychotherapy for autistic youth were included if published in English, included random assignment to treatment or control group, required a previous diagnosis of autism, had a mean age of 6-17 years, and provided outcome measure data from both intervention and control groups. A total of 133 measures were coded across 29 studies and included 1464 participants with a mean age of 10.39 years (1.89). A small mean effect size (0.38,95% CI [0.26, 0.47]) was found overall, with the largest effects for cognitive behavioral therapies on autism-related clinical needs (0.81) and overall mental health (0.78). The results show the significant impact of psychotherapy interventions for autistic youth. Additional research should further assess the details of the most effective psychotherapies for each area of clinical need.
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Affiliation(s)
- Kashia A Rosenau
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.
| | - Junok Kim
- School of Education and Information Studies, University of California Los Angeles, Los Angeles, USA
| | - An-Chuen Billy Cho
- School of Education and Information Studies, University of California Los Angeles, Los Angeles, USA
| | - Michael Seltzer
- School of Education and Information Studies, University of California Los Angeles, Los Angeles, USA
| | - Ana M Ugueto
- University of Texas Health Science Center at Houston, Houston, USA
| | | | - Jeffrey J Wood
- School of Education and Information Studies, University of California Los Angeles, Los Angeles, USA
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Eygnor A, Angulo A, Cobian M, Wilson R, Coan E, Reynolds A, Friedman S, Boles RE. Assessing Community Needs for Autism Spectrum Disorder: A Review of Rural/Frontier Needs Through Community Outreach With Developmental Pediatrics. Clin Pediatr (Phila) 2024:99228241233803. [PMID: 38379157 DOI: 10.1177/00099228241233803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Early intervention is known to improve long-term outcomes for individuals with autism spectrum disorder (ASD). Access barriers to care limit timely engagement with supportive services. This report characterized the community needs and supportive services for children and families with suspected or diagnosed ASD. Families and providers participating in outreach clinics identified available services and their attitudes about support for ASD diagnosis. Chart reviews provided referral history, insurance, and current services. Children were nearly 6 years old, 95% of families relied on public health insurance, whereas 50% reported traveling 11 miles or greater for supportive services. Most providers (83%) were medically trained in primary care and placed 1-5 referrals per month to a tertiary referral hospital. Providers reported travel difficulty as the primary reason for referring patients for evaluation. Multiple barriers for supportive services were identified, highlighting the importance to increase the capacity and availability of local ASD supportive services.
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Affiliation(s)
| | - Abigail Angulo
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Maritza Cobian
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rebecca Wilson
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth Coan
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ann Reynolds
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sandra Friedman
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard E Boles
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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6
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Wood JJ, Wood KS, Rosenau KA, Cho AC, Johnson AR, Muscatello VS, Tien IS, Straus J, Wolpe S, Zeldin A, Kazlauskas K, McLeod BD. Practitioner Adherence and Competence in MEYA, a Free Online Self-Instruction Program in Modular Psychotherapy and Counseling for Children's Autism-Related Clinical Needs. J Autism Dev Disord 2024:10.1007/s10803-023-06226-w. [PMID: 38277075 DOI: 10.1007/s10803-023-06226-w] [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: 12/19/2023] [Indexed: 01/27/2024]
Abstract
The quality of care in public schools and other community settings for school-aged youths on the autism spectrum is variable and often not evidence-based. Training practitioners in these settings to deliver evidence-based practices (EBPs) may improve the quality of care. We developed a free internet-based training and clinical guidance system synthesizing multiple EBPs for youth on the autism spectrum addressing a range of mental health needs and autism-related behaviors, entitled Modular EBPs for Youth on the Autism Spectrum (MEYA; meya.ucla.edu). A multiple baseline study was conducted with seven practitioners recruited from mental health practice settings across the United States who were providing services to children on the autism spectrum (aged 6 to 17 years). Practitioners were randomly assigned to undergo baseline conditions of 2 to 8 weeks. Once online training in MEYA commenced, practitioners engaged in algorithm-guided self-instruction in EBPs for autism. Participants video-recorded sessions. Independent coders used the MEYA Fidelity Scale (MEYA-FS) to rate adherence and competence in EBPs for autism. Practitioners also completed measures pertaining to implementation outcomes and parents rated youth outcomes on personalized target behaviors. Five of seven practitioners increased their adherence to MEYA practices (i.e., MEYA-FS scores) following MEYA training. Findings for competence were similar, though somewhat less robust. Practitioners generally viewed MEYA as feasible, understandable, and acceptable. Most youth outcomes improved during MEYA. A randomized, controlled trial of MEYA would be helpful in characterizing its effectiveness for supporting practitioner EBP implementation and youth outcomes in school and community service settings.
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Affiliation(s)
- Jeffrey J Wood
- Department of Education, University of California Los Angeles, Los Angeles, USA.
- Department of Psychiatry, University of California Los Angeles, Los Angeles, USA.
| | - Karen S Wood
- Department of Psychiatry, University of California Los Angeles, Los Angeles, USA
| | - Kashia A Rosenau
- Department of Medicine, University of California Los Angeles, Los Angeles, USA
| | - An Chuen Cho
- Department of Education, University of California Los Angeles, Los Angeles, USA
| | - Amanda R Johnson
- Department of Education, University of California Los Angeles, Los Angeles, USA
| | | | - Ingrid S Tien
- Department of Education, University of California Los Angeles, Los Angeles, USA
| | - Jolie Straus
- Department of Education, University of California Los Angeles, Los Angeles, USA
| | - Samara Wolpe
- Department of Education, University of California Los Angeles, Los Angeles, USA
| | | | | | - Bryce D McLeod
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
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Gerber AH, Kang E, Nahmias AS, Libsack EJ, Simson C, Lerner MD. Predictors of Treatment Response to a Community-Delivered Group Social Skills Intervention for Youth with ASD. J Autism Dev Disord 2023; 53:3741-3754. [PMID: 35904648 DOI: 10.1007/s10803-022-05559-2] [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: 03/25/2022] [Indexed: 10/16/2022]
Abstract
Group social skills interventions (GSSIs) are among the most commonly used treatments for improving social competence in youth with ASD, however, results remain variable. The current study examined predictors of treatment response to an empirically-supported GSSI for youth with ASD delivered in the community (Ntotal=75). Participants completed a computer-based emotion recognition task and their parents completed measures of broad psychopathology, ASD symptomatology, and social skills. We utilized generalized estimating equations in an ANCOVA-of-change framework to account for nesting. Results indicate differential improvements in emotion recognition by sex as well as ADHD-specific improvements in adaptive functioning. Youth with both co-occurring anxiety and ADHD experienced iatrogenic effects, suggesting that SDARI may be most effective for youth with ASD without multiple co-occurring issues. Findings provide important directions for addressing variability in treatment outcomes for youth with ASD.
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Affiliation(s)
- Alan H Gerber
- Department of Psychology, Stony Brook University, 11794-2500, Stony Brook, New York, United States
| | - Erin Kang
- Department of Psychology, Stony Brook University, 11794-2500, Stony Brook, New York, United States
- Department of Psychology, Montclair State University, Little Falls, New Jersey, United States
| | - Allison S Nahmias
- Department of Psychiatry and Behavioral Health, School of Medicine, Stony Brook University, Stony Brook, New York, United States
| | - Erin J Libsack
- Department of Psychology, Stony Brook University, 11794-2500, Stony Brook, New York, United States
| | - Caitlin Simson
- Department of Psychology, Stony Brook University, 11794-2500, Stony Brook, New York, United States
| | - Matthew D Lerner
- Department of Psychology, Stony Brook University, 11794-2500, Stony Brook, New York, United States.
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8
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Drahota A, Sridhar A, Moskowitz LJ, Kerns CM, Soorya L, Wainer A, Cohn E, Lerner MD. Community-based care for autistic youth: community providers' reported use of treatment practices in the United States. Front Psychiatry 2023; 14:1212084. [PMID: 37791130 PMCID: PMC10544899 DOI: 10.3389/fpsyt.2023.1212084] [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] [Received: 04/25/2023] [Accepted: 08/09/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction To illustrate the landscape of community-based care for autistic youth in the United States, we identified transdisciplinary psychosocial intervention practice sets that community providers report utilizing to care for this population, and examined characteristics associated with provider-reported utilization. Methods The Usual Care for Autism Study (UCAS) Survey assessed provider demographics and provider-reported use of transdisciplinary practices for common ASD co-occurring problems: social difficulties, externalizing behaviors, and anxiety. Community practitioners (N = 701) from allied health, behavioral, education, medical, mental health and other disciplines who treat or work with autistic youth (7-22 years) participated. Results Exploratory factor analysis yielded four factors: Consequence-Based Strategies (CBS), Cognitive-Behavioral and Therapy Strategies (CBTS), Antecedent-Based Strategies (ABS), and Teaching Strategies (TS). Providers across disciplines reported utilizing ABS more often than other sets. Providers from behavioral disciplines, with less than 4-year or Master degrees, or with more experience reported the most use of ABS, CBS and CBTS. Medical and behavioral providers reported the most use of TS. Setting and child characteristics were associated with practice set use, indicating variability by disability and client socioeconomic status. Discussion Findings reflect the complexity and inconsistency of the service landscape for autistic youth across the U.S. Only by understanding the service landscape and predictors of practice utilization, can researchers, policymakers, provider groups, and the autistic community facilitate effective implementation strategy development and use to ultimately improve community-based care.
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Affiliation(s)
- Amy Drahota
- Department of Psychology, Michigan State University, East Lansing, MI, United States
| | - Aksheya Sridhar
- Department of Psychology, Michigan State University, East Lansing, MI, United States
| | | | - Connor M. Kerns
- Department of Psychology, University British Columbia, Vancouver, BC, Canada
| | - Latha Soorya
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Allison Wainer
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Elizabeth Cohn
- School of Nursing, Hunter College, CUNY, New York, NY, United States
| | - Matthew D. Lerner
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
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Friedman NR, Watkins L, Barnard-Brak L, Barber A, White SW. De-implementation of Low-Value Practices for Autism Spectrum Disorder. Clin Child Fam Psychol Rev 2023; 26:690-705. [PMID: 37452164 DOI: 10.1007/s10567-023-00447-2] [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: 07/04/2023] [Indexed: 07/18/2023]
Abstract
Due to a variety of factors, Autism Spectrum Disorder (ASD) has long been tethered to use of low-value practice (LVP), arguably moreso than any other psychiatric or neurodevelopmental condition. Although dissemination of empirically supported treatments (EST) for autistic individuals has expanded markedly over the past decade, there has not been concomitant reduction in the use of LVP. It is critical that clinicians and scientists not only promote the implementation of EST, but also facilitate the de-implementation (abandonment and/or divestment) of ineffective or harmful practices. In this review, we describe a data-driven approach that can be used to identify LVP, drawing from established criteria for identification of evidence-based treatments (e.g., APA Division 12, National Clearinghouse on Autism Evidence and Practice; SAMHSA), as well as broader considerations such as social validity, cost, and parsimony. Herein, a data-based approach to LVP identification is proposed with a goal of improving quality of service access. Within an implementation science framework, we identify specific facilitators that sustain LVP use, and recommendations for subsequent de-implementation strategies are offered.
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Affiliation(s)
- Nicole R Friedman
- Center for Youth Development and Intervention, University of Alabama, 101 McMillan Bldg, Box 870348, Tuscaloosa, AL, 35487, USA
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Laci Watkins
- Department of Special Education, University of Alabama, Tuscaloosa, AL, USA
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA
| | - Lucy Barnard-Brak
- Department of Special Education, University of Alabama, Tuscaloosa, AL, USA
| | - Angela Barber
- Department of Communication Sciences and Disorders, Samford University, Birmingham, AL, USA
| | - Susan W White
- Center for Youth Development and Intervention, University of Alabama, 101 McMillan Bldg, Box 870348, Tuscaloosa, AL, 35487, USA.
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA.
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Cho A, Wood JJ, Ferrer E, Rosenau K, Storch EA, Kendall PC. Empirically-identified subgroups of children with autism spectrum disorder and their response to two types of cognitive behavioral therapy. Dev Psychopathol 2023; 35:1188-1202. [PMID: 34866567 DOI: 10.1017/s0954579421001115] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Autism spectrum disorder (ASD) is heterogeneous and likely entails distinct phenotypes with varying etiologies. Identifying these subgroups may contribute to hypotheses about differential treatment responses. The present study aimed to discern subgroups among children with ASD and anxiety in context of the five-factor model of personality (FFM) and evaluate treatment response differences to two cognitive-behavioral therapy treatments. The present study is a secondary data analysis of children with ASD and anxiety (N=202; ages 7-13; 20.8% female) in a cognitive behavioral therapy (CBT) randomized controlled trial (Wood et al., 2020). Subgroups were identified via latent profile analysis of parent-reported FFM data. Treatment groups included standard-of-practice CBT (CC), designed for children with anxiety, and adapted CBT (BIACA), designed for children with ASD and comorbid anxiety. Five subgroups with distinct profiles were extracted. Analysis of covariance revealed CBT response was contingent on subgroup membership. Two subgroups responded better to BIACA on the primary outcome measure and a third responded better to BIACA on a peer-social adaptation measure, while a fourth subgroup responded better to CC on a school-related adaptation measure. These findings suggest that the FFM may be useful in empirically identifying subgroups of children with ASD, which could inform intervention selection decisions for children with ASD and anxiety.
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Affiliation(s)
- Anchuen Cho
- University of California, Los Angeles, 405 Hilgard Ave., 3132A Moore Hall, Los Angeles, CA90095, USA
| | - Jeffrey J Wood
- University of California, Los Angeles, 405 Hilgard Ave., 3132A Moore Hall, Los Angeles, CA90095, USA
| | - Emilio Ferrer
- University of California, Davis, 1 Shields Ave., 135 Young Hall, Davis, CA95616, USA
| | - Kashia Rosenau
- University of California, Los Angeles, 405 Hilgard Ave., 3132A Moore Hall, Los Angeles, CA90095, USA
| | - Eric A Storch
- Baylor College of Medicine, 7200 Cambridge St, Houston, TX77030, USA
| | - Philip C Kendall
- Temple University, 1701 North 13th St., Weiss Hall, Philadelphia, PA19122, USA
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11
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Niu N, Fan W, Ren M, Li M, Zhong Y. The Role of Social Norms and Personal Costs on Pro-Environmental Behavior: The Mediating Role of Personal Norms. Psychol Res Behav Manag 2023; 16:2059-2069. [PMID: 37305222 PMCID: PMC10252934 DOI: 10.2147/prbm.s411640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023] Open
Abstract
Background Pro-environmental behavior necessitates individuals to make personal sacrifices, such as spending more money on environmentally-friendly products to benefit the environment. Realistically, individuals may not be willing to engage in pro-environmental behavior based self-interest. The increase in personal pro-environmental behavior has become an urgent issue in the field of environmental psychology. Purpose The present study adopted green consumption paradigm to explore the internal mechanisms of pro-environmental behavior at different personal costs, the role of social and personal norms on pro-environmental behavior, which can promote individual pro-environmental behavior. Methods In our experiment, participants first were instructed to read texts unrelated and related to social norms in sequence. Participants subsequently completed the product choice task, which involved making choices between buying green (eco-friendly) products or cheaper (self-interested) common products, a method to measure pro-environment behavior. Finally, the participants completed the personal norms scale and social norms check. Results The findings of present study indicated that pro-environmental behavior decreased as personal costs increased. However, social norms effectively promoted individuals' pro-environmental behavior, and personal norms played a mediating role at high personal costs. Conclusion Our findings indicate that individuals tend to choose cheaper common products that are harmful to the natural environment in self-interest. However, we discuss the implications for the use of social norms as a social marketing technique, which extends the Norm Activation Model.
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Affiliation(s)
- Nana Niu
- Department of Psychology, Hunan Normal University, Changsha, People’s Republic of China
- Cognition and Human Behavior Key Laboratory of Hunan Province, Changsha, People’s Republic of China
- Institute of Interdisciplinary Studies, Hunan Normal University, Changsha, People’s Republic of China
| | - Wei Fan
- Department of Psychology, Hunan Normal University, Changsha, People’s Republic of China
- Cognition and Human Behavior Key Laboratory of Hunan Province, Changsha, People’s Republic of China
- Institute of Interdisciplinary Studies, Hunan Normal University, Changsha, People’s Republic of China
| | - Mengmeng Ren
- Department of Psychology, Hunan Normal University, Changsha, People’s Republic of China
- Cognition and Human Behavior Key Laboratory of Hunan Province, Changsha, People’s Republic of China
- Institute of Interdisciplinary Studies, Hunan Normal University, Changsha, People’s Republic of China
| | - Mei Li
- Department of Psychology, Hunan Normal University, Changsha, People’s Republic of China
- Cognition and Human Behavior Key Laboratory of Hunan Province, Changsha, People’s Republic of China
- Institute of Interdisciplinary Studies, Hunan Normal University, Changsha, People’s Republic of China
| | - Yiping Zhong
- Department of Psychology, Hunan Normal University, Changsha, People’s Republic of China
- Cognition and Human Behavior Key Laboratory of Hunan Province, Changsha, People’s Republic of China
- Institute of Interdisciplinary Studies, Hunan Normal University, Changsha, People’s Republic of China
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12
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Tschida JE, Drahota A. Fidelity to the ACT SMART Toolkit: an instrumental case study of implementation strategy fidelity. Implement Sci Commun 2023; 4:52. [PMID: 37194052 DOI: 10.1186/s43058-023-00434-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 05/02/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Evidence-based practices (EBPs) are shown to improve a variety of outcomes for autistic children. However, EBPs often are mis-implemented or not implemented in community-based settings where many autistic children receive usual care services. A blended implementation process and capacity-building implementation strategy, developed to facilitate the adoption and implementation of EBPs for autism spectrum disorder (ASD) in community-based settings, is the Autism Community Toolkit: Systems to Measure and Adopt Research-based Treatments (ACT SMART Toolkit). Based on an adapted Exploration, Adoption decision, Preparation, Implementation, Sustainment (EPIS) Framework, the multi-phased ACT SMART Toolkit is comprised of (a) implementation facilitation, (b) agency-based implementation teams, and (c) a web-based interface. In this instrumental case study, we developed and utilized a method to evaluate fidelity to the ACT SMART Toolkit. This study responds to the need for implementation strategy fidelity evaluation methods and may provide evidence supporting the use of the ACT SMART Toolkit. METHODS We used an instrumental case study approach to assess fidelity to the ACT SMART Toolkit during its pilot study with six ASD community agencies located in southern California. We assessed adherence, dose, and implementation team responsiveness for each phase and activity of the toolkit at both an aggregate and individual agency level. RESULTS Overall, we found that adherence, dose, and implementation team responsiveness to the ACT SMART Toolkit were high, with some variability by EPIS phase and specific activity as well as by ASD community agency. At the aggregate level, adherence and dose were rated notably lowest during the preparation phase of the toolkit, which is a more activity-intensive phase of the toolkit. CONCLUSIONS This evaluation of fidelity to the ACT SMART Toolkit, utilizing an instrumental case study design, demonstrated the potential for the strategy to be used with fidelity in ASD community-based agencies. Findings related to the variability of implementation strategy fidelity in the present study may also inform future adaptations to the toolkit and point to broader trends of how implementation strategy fidelity may vary by content and context.
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Affiliation(s)
- Jessica E Tschida
- Department of Psychology, Michigan State University, 316 Physics Rd, East Lansing, MI, 48824, USA.
| | - Amy Drahota
- Department of Psychology, Michigan State University, 316 Physics Rd, East Lansing, MI, 48824, USA
- Child and Adolescent Services Research Center (CASRC), 3665 Kearny Villa Road, Suite 200N, San Diego, CA, 92123, USA
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13
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Cervantes PE, Conlon GR, Seag DEM, Feder M, Lang Q, Meril S, Baroni A, Li A, Hoagwood KE, Horwitz SM. Mental health service availability for autistic youth in New York City: An examination of the developmental disability and mental health service systems. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:704-713. [PMID: 35893840 PMCID: PMC9880247 DOI: 10.1177/13623613221112202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
LAY ABSTRACT Autistic children and adolescents experience high rates of co-occurring mental health conditions, including depression and suicidality, which are frequently identified by stakeholders as treatment priorities. Unfortunately, accessing community-based mental health care is often difficult for autistic youth and their families. The first obstacle families confront is finding a provider that offers mental health treatment to autistic youth within the many service systems involved in supporting the autism community. The mental health and developmental disability systems are two of the most commonly accessed, and previous work has shown there is often confusion over which of these systems is responsible for providing mental health care to autistic individuals. In this study, we conducted a telephone survey to determine the availability of outpatient mental health services for autistic youth with depressive symptoms or suicidal thoughts or behaviors in New York City across the state's mental health and developmental disability systems. Results showed that while a greater percentage of clinics in the mental health system compared with in the developmental disability system offered outpatient mental health services to autistic youth (47.1% vs 25.0%), many more did not offer care to autistic youth and there were very few options overall. Therefore, it is important that changes to policy are made to increase the availability of services and that mental health care providers' knowledge and confidence in working with autistic youth are improved.
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Affiliation(s)
- Paige E. Cervantes
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Greta R. Conlon
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Dana E. M. Seag
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Michael Feder
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Qortni Lang
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Samantha Meril
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Annie Li
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Kimberly E. Hoagwood
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Sarah M. Horwitz
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
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14
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Paquet A, Dionne C, Joly J, Rousseau M, Rivard M, Lemire C. Competency drivers to support implementation of early intensive behavioral intervention in large-scale community-based services: Perspectives of caseworkers and organization representatives. EVALUATION AND PROGRAM PLANNING 2023; 97:102211. [PMID: 36592543 DOI: 10.1016/j.evalprogplan.2022.102211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/23/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Implementing evidence-based practices in "real-world" settings poses significant challenges. Organizations involved must address this issue by providing supportive infrastructures. Among the elements to consider are competency drivers, which refer to the selection, training, and supervision of caseworkers. The purpose of this study was to describe the perspectives of caseworkers and representatives on competency drivers that organizations put in place to support the implementation of early intensive behavioral intervention (EIBI) in large-scale community-based services. The sample consisted of 109 caseworkers and 23 organization representatives who completed questionnaires. Results demonstrated that respondents consider clinical support and training as key elements in EIBI implementation. However, despite recognizing these factors, respondents reported considerable variability in practices. It appears necessary to better define and plan the implementation of these competency drivers with a view to improving EIBI implementation.
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Affiliation(s)
- Annie Paquet
- Département de psychoéducation, Université du Québec à Trois-Rivières, 3351, boulevard des Forges, Trois-Rivières, Québec G8Z 4M3, Canada.
| | - Carmen Dionne
- Département de psychoéducation, Université du Québec à Trois-Rivières, 3351, boulevard des Forges, Trois-Rivières, Québec G8Z 4M3, Canada.
| | - Jacques Joly
- Département de psychoéducation, Université de Sherbrooke, 2500, boulevard de l'Université, Sherbrooke, Québec J1K 2R1, Canada.
| | - Myriam Rousseau
- CIUSSS Mauricie Centre-du-Québec, 3090, rue Foucher, Trois-Rivières, Québec G8Z 1M3, Canada.
| | - Mélina Rivard
- Département de psychologie, Université du Québec à Montréal, 100 rue Sherbrooke Ouest, Montréal, Québec H2X 3P2, Canada.
| | - Colombe Lemire
- Département de psychoéducation, Université du Québec à Trois-Rivières, 3351, boulevard des Forges, Trois-Rivières, Québec G8Z 4M3, Canada.
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15
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Panganiban JL, Shire SY, Williams J, Kasari C. Supporting peer engagement for low-income preschool students with autism spectrum disorder during academic instruction: A pilot randomized trial. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:2175-2187. [PMID: 35420044 PMCID: PMC9596950 DOI: 10.1177/13623613221085339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Schools are the portal through which many children with autism spectrum disorder access early intervention. Collaborating with teachers can be an effective way to implement evidence-based practices. In this study, teachers learned to embed strategies from the Joint Attention, Symbolic Play, Engagement, and Regulation intervention into the standard preschool curriculum. Twelve schools with special education preschool classrooms for students with moderate to severe disabilities from under-resourced neighborhoods were randomized to augment their curriculum with Joint Attention, Symbolic Play, Engagement, and Regulation strategies or continue the standard curriculum. Teachers’ strategy implementation, children’s time on task, and social communication were examined before and after completing the intervention phase. Teachers in the Joint Attention, Symbolic Play, Engagement, and Regulation group implemented more Joint Attention, Symbolic Play, Engagement, and Regulation strategies than the control group after the intervention phase. Children in both groups increased time on task during teacher-led small group instruction. Children in the Joint Attention, Symbolic Play, Engagement, and Regulation group were more likely to be engaged with peers during small group instruction at the end of the intervention phase. Children from both groups improved in standardized measures of joint attention, requesting, expressive language, and receptive language. Training teachers to embed Joint Attention, Symbolic Play, Engagement, and Regulation strategies into small group instruction can help facilitate peer engagement, providing children more opportunities for peer socialization.
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16
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Liu E, Zhao J, Sofeia N. Students' Entire Deep Learning Personality Model and Perceived Teachers' Emotional Support. Front Psychol 2022; 12:793548. [PMID: 35095678 PMCID: PMC8792743 DOI: 10.3389/fpsyg.2021.793548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/02/2021] [Indexed: 11/29/2022] Open
Abstract
In recent years, deep learning as the requirement of higher education for students has attracted the attention of many scholars, and previous studies focused on defining deep learning as the deep processing of knowledge of the brain, however, in the process of knowledge processing, the brain not only involves the deep processing of information but also participates in learning consciously and emotionally. Therefore, this research proposed a four-factor model hypothesis for deep learning that includes deep learning investment, deep cognitive-emotional experience, deep information processing, and deep learning meta-cognitive. In addition, the research proposed teachers’ emotional support perceived by students has an effect on the four factors of deep learning. Through SPSS 26 and AMOS 24, this research has verified the four-factor model of deep learning applying exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) and verified that the perceived teacher emotional support has an impact on the four factors of students’ deep learning using the SEM.
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Affiliation(s)
- Enyun Liu
- Shandong Women's University, Jinan, China
| | - Jingxian Zhao
- Faculty of Education, Languages and Psychology, SEGi University, Kota Damansara, Malaysia
| | - Noorzareith Sofeia
- Center for Teaching and Learning, SEGi University, Kota Damansara, Malaysia
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17
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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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18
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Dickson KS, Kenworthy L, Anthony L, Brookman-Frazee L. Mental Health Therapist Perspectives on the Role of Executive Functioning in Children's Mental Health Services. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 8:39-54. [PMID: 36950479 PMCID: PMC10027378 DOI: 10.1080/23794925.2021.2013142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Executive functioning is considered a key transdiagnostic factor underlying multiple mental health conditions. Evidence-based interventions targeting executive functioning skills exist and there are ongoing efforts to implement these interventions in routine community-based care. However, there is limited research characterizing therapist perspectives regarding addressing executive functioning within community-based mental health services. The current mixed-methods study aims to characterize mental health therapist perspectives regarding the role of executive functioning in youth clinical presentation and the psychotherapy process and outcomes as well as their experience and training related to executive functioning. Forty-three therapists completed a survey about their perspectives about executive functioning and 14 participated in subsequent focus groups to expand survey results. Results indicated that therapists perceive executive functioning challenges as impacting a large portion of children on their caseload, present across multiple mental health conditions, and that executive functioning is frequently a focus of psychotherapy. Therapists also identified executive functioning challenges as a barrier to therapy engagement and effectiveness. However, therapists reported limited knowledge and training as well as significant motivation for executive functioning training, including executive functioning interventions. Findings confirm the significant role of executive functioning in youth presenting for mental health services and the psychotherapy process and outcomes. Findings also highlight the need for further translation of evidence-based interventions and tools. Challenges as well as potential solutions to inform ongoing and future work seeking to translate and implement evidence-based executive functioning interventions in community mental health services are discussed.
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Affiliation(s)
- Kelsey S. Dickson
- San Diego State University, San Diego, CA
- Child and Adolescent Services Research Center, San Diego,
CA
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorders –
Children’s National Hospital, Washington, DC
| | - Laura Anthony
- University of Colorado School of Medicine, Aurora, CO
- Children’s Hospital of Colorado, Aurora, CO
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego,
CA
- University of California, San Diego, CA
- Rady Children’s Hospital-San Diego, CA
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19
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Larraceleta A, Castejón L, Iglesias-García MT, Núñez JC. Assessment of Public Special Education Teachers Training Needs on Evidence-Based Practice for Students with Autism Spectrum Disorders in Spain. CHILDREN 2022; 9:children9010083. [PMID: 35053708 PMCID: PMC8774119 DOI: 10.3390/children9010083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022]
Abstract
Over decades, the concern for the quality of psychoeducational practices for students with autism spectrum disorders has led to study to what extent are evidence-based educational methods disseminated among teachers. The purpose of this cross-sectional study, taking as reference Hsiao and Sorensen’s previous research, was to identify through a survey to what extent social-communication evidence-based practices for these students were provided in teacher education and in-service training programs, in a sample of 108 special education teachers from Spain, and to compare these results with Hsiao and Sorensen’s. Overall, more than 70% of the teachers reported that evidence-based practices in their teacher education programs (87.6%) and in-service training programs (73.6%) were never taught or mentioned incidentally. Finally, a higher percentage of addressing on each practice (i.e., mentioned and discussed or mentioned and taught through direct instruction) is shown in the sample of American teachers compared to the Spaniards, in both training paths.
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Affiliation(s)
- Aitor Larraceleta
- Equipo Regional ACNEAE, Ministry of Education of the Principality of Asturias, Avenida San Pedro de los Arcos, 18, 33012 Asturias, Spain
- Correspondence:
| | - Luis Castejón
- Department of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Asturias, Spain; (L.C.); (J.C.N.)
| | | | - José Carlos Núñez
- Department of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Asturias, Spain; (L.C.); (J.C.N.)
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20
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Lerner MD, Brown CE, Sridhar A, Tschida JE, Felsman P, Libsack EJ, Kerns CM, Moskowitz LJ, Soorya L, Wainer A, Cohn E, Drahota A. Usual care for youth with autism spectrum disorder: Community-based providers' reported familiarity with treatment practices. Front Psychiatry 2022; 13:923025. [PMID: 35958649 PMCID: PMC9360540 DOI: 10.3389/fpsyt.2022.923025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine patterns and predictors of familiarity with transdisciplinary psychosocial (e.g., non-pharmacologic) practices for practitioners treating youths with autism spectrum disorder (ASD) in the United States. METHOD Practitioners (n = 701) from behavioral, education, medical, and mental health backgrounds who worked with youth (ages 7-22) with ASD completed the Usual Care for Autism Survey, which assessed provider demographics and self-reported familiarity with transdisciplinary treatment practices for the most common referral problems of ASD. We examined relations between provider-, setting-, and client-level characteristics with familiarity of key groups of the treatment practices (practice sets). Practice sets were identified using exploratory factor analysis (EFA), and demographic predictors of practice subsets were examined using generalized estimating equations (GEE). RESULTS The EFA yielded a three-factor solution: (1) environmental modifications/antecedent strategies; (2) behavior analytic strategies; and (3) cognitive strategies, with overall familiarity ranked in this order. Medical providers indicated the least familiarity across disciplines. More experience with ASD and treating those with intellectual disabilities predicted greater familiarity with only environmental modifications/antecedent strategies and behavior analytic, but not cognitive strategies. Experience treating low SES clients predicted familiarity with environmental modification and behavior analytic strategies while experience treating high SES clients predicted familiarity with behavior analytic and cognitive strategies. CONCLUSION This is the first study to identify transdisciplinary, interpretable sets of practices for treating youth with ASD based on community providers' reported familiarity. Results highlight factors associated with familiarity with practice sets, which is essential for mapping practice availability, and optimizing training and dissemination efforts for youth with ASD.
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Affiliation(s)
- Matthew D Lerner
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Cynthia E Brown
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States.,School of Graduate Psychology, Pacific University, Hillsboro, OR, United States
| | - Aksheya Sridhar
- Department of Psychology, Michigan State University, Lansing, MI, United States
| | - Jessica E Tschida
- Department of Psychology, Michigan State University, Lansing, MI, United States
| | - Peter Felsman
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States.,Department of Social Work, Northern Michigan University, Marquette, MI, United States
| | - Erin J Libsack
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Connor M Kerns
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Lauren J Moskowitz
- Department of Psychology, St. John's University, Queens, NY, United States
| | - Latha Soorya
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
| | - Allison Wainer
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, United States
| | - Elizabeth Cohn
- Hunter-Bellevue School of Nursing, City University of New York, New York, NY, United States
| | - Amy Drahota
- Department of Psychology, Michigan State University, Lansing, MI, United States
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21
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Producing Child-Centered Interventions: Social Network Factors Related to the Quality of Professional Development for Teachers of Autistic Students. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10120453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Autistic students benefit from child-centered goals that align with evidence-based practices (EBPs) that meet their individualized needs, however, most teachers are not trained in how to implement autism-specific EBPs. The challenges do not lie with teachers alone. Professional development (PD) providers, such as district or regional autism experts who train and coach teachers on how to implement autism-specific EBPs, face barriers accessing the needed supports to conduct high-quality PD and lack experience with individualizing their methods for training and coaching teachers. When PD providers have networks of professional support, they can potentially gain access to resources to provide successful individualized coaching for teachers. No research has measured the impact of the social networks of PD providers on their performance as coaches in classrooms for teachers of autistic students. To test the hypothesis that social network resources can impact the performance of PD providers who coach teachers how to use EBPs for their autistic students, we conducted social network analysis with PD providers. Findings suggest that network factors were associated with the self-reported performance for PD providers. PD providers who have more people in their networks who were autism EBP experts, as well as more people in their networks who supported them with how to individualize their PD efforts to specific teachers or districts, had higher performance as teacher coaches. We discuss future research about how to support network development for PD providers and policy implications.
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22
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Dickson KS, Lind T, Jobin A, Kinnear M, Lok H, Brookman-Frazee L. A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:857-883. [PMID: 33884535 PMCID: PMC8411365 DOI: 10.1007/s10488-021-01133-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
Youth with autism spectrum disorder (ASD) have high rates of co-occurring mental health needs that necessitate mental health interventions. Given the unique clinical characteristics of youth with ASD, there have been significant efforts to adapt and test mental health interventions for this population. Yet, characterization of the nature and types of interventions adaptations is limited, especially across the wide range of interventions tested for youth with ASD with a focus on implementation factors. Additionally, understanding how these interventions may be implemented in community services is limited. The aims of this systematic review are to characterize the (1) types of interventions tested for co-occurring mental health conditions for youth with ASD; (2) adaptations to mental health interventions for use with youth with ASD; and (3) implementation strategies, outcomes, and determinants of mental health interventions to inform their translation to community service settings. Eighty-three articles testing interventions targeting mental health symptoms in youth with ASD that included implementation factors in analyses were reviewed. The Stirman et al. (2013; 2019) FRAME adaptation, Powell et al. (2012;2015) implementation strategies, and Proctor et al. (2011) implementation outcomes taxonomies were applied to characterize the nature and types of adaptations for use with youth with ASD and types of implementation strategies, outcomes, and determinants used, when available, respectively. Of the interventions examined, the majority (64.1%) were originally designed to target youth mental health concerns and were then adapted to be used with ASD. The most common adaptations included those to the intervention content, particularly adding elements with tailoring or refining aspects of the intervention while maintaining core functions. Half of the articles described at least one implementation strategy used during intervention testing. Fidelity and acceptability were the most frequently examined implementation outcomes, with some examination of appropriateness and feasibility. Nineteen percent of articles described implementation determinants (i.e. barriers/facilitators) of these implementation outcomes. The common adaptations for ASD provide direction for future intervention development and for training community therapists. Further examination, specification, and reporting of implementation strategies and outcomes within ongoing efforts to adapt and interventions to meet the co-occurring mental health needs of youth ASD are needed to facilitate their translation to community settings. Areas for future research as well as clinical implications are discussed.
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Affiliation(s)
- Kelsey S Dickson
- San Diego State University, San Diego, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
| | - Teresa Lind
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
| | - Allison Jobin
- University of California, San Diego, USA
- California State University, San Marcos, USA
| | | | - Ho Lok
- San Diego State University, San Diego, 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, USA
- Rady Children's Hospital-San Diego, San Diego, USA
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23
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Maddox BB, Dickson KS, Stadnick NA, Mandell DS, Brookman-Frazee L. Mental Health Services for Autistic Individuals Across the Lifespan: Recent Advances and Current Gaps. Curr Psychiatry Rep 2021; 23:66. [PMID: 34402984 PMCID: PMC8961310 DOI: 10.1007/s11920-021-01278-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW This synthesis of recent mental health services research with autistic individuals presents significant advances, current gaps, and recommendations for improving mental healthcare for this population. RECENT FINDINGS Recent advances include improved understanding of co-occurring mental health conditions among autistic individuals, a growing evidence base for interventions to address them, the development and implementation of new service models to support mental health for this population, and a substantial increase in mental health services and implementation research focused on autism. Ongoing challenges include a lack of mental health interventions designed for community implementation with autistic individuals, limited workforce capacity, complex and disconnected service systems, and racial, ethnic, and socioeconomic disparities in accessibility and quality of mental health services. Despite the advances in our understanding of mental health needs and mental health services for autistic individuals, several critical gaps remain. We encourage future efforts to develop and test interventions that can be used in community settings, train and incentivize the workforce to provide them, realign policies and funding with best practice, and embrace an equity-focused approach to autism research and care.
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Affiliation(s)
- Brenna B Maddox
- Department of Psychiatry, TEACCH Autism Program, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
| | - Kelsey S Dickson
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Child and Family Development, San Diego State University, San Diego, CA, USA
| | - Nicole A Stadnick
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, San Diego, CA, USA
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, San Diego, CA, USA
- Rady Children's Hospital, San Diego, CA, USA
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A Systematic Review of Play-Based Interventions Targeting the Social Communication Skills of Children with Autism Spectrum Disorder in Educational Contexts. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractChildren with autism spectrum disorder (ASD) experience social communication difficulties which can be compounded by increased social demands and expectations of the school environment. Play offers a unique context for social communication development in educational settings. This systematic review aimed to synthesize play-based interventions for the social communication skills of children with ASD in educational contexts and identified nine studies. Overall, studies in this review provided a promising evidence base for supporting social communication skills through play in education for children with ASD. The review also highlighted gaps in research on play-based interventions for the social communication skills of children with ASD within naturalistic educational settings.
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Dickson KS, Lind T, Jobin A, Kinnear M, Lok H, Brookman-Frazee L. Correction to: A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:884-908. [PMID: 34196884 DOI: 10.1007/s10488-021-01144-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Due to the errors occurred in the originally published version, this article is being reprinted in its entirety as Correction. All errors have been corrected. It is the correct version.
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Affiliation(s)
- Kelsey S Dickson
- San Diego State University, San Diego, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
| | - Teresa Lind
- San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
| | - Allison Jobin
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
- California State University, San Marcos, USA
| | | | - Ho Lok
- San Diego State University, San Diego, 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, USA
- Rady Children's Hospital-San Diego, San Diego, USA
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Sridhar A, Drahota A, Walsworth K. Facilitators and barriers to the utilization of the ACT SMART Implementation Toolkit in community-based organizations: a qualitative study. Implement Sci Commun 2021; 2:55. [PMID: 34039434 PMCID: PMC8157454 DOI: 10.1186/s43058-021-00158-1] [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] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence-based practices (EBPs) have been shown to improve behavioral and mental health outcomes for children diagnosed with autism spectrum disorder (ASD). Research suggests that the use of these practices in community-based organizations is varied; however, the utilization of implementation guides may bridge the gap between research and practice. The Autism Community Toolkit: Systems to Measure and Adopt Research-Based Treatments (ACT SMART) Implementation Toolkit is a web-based implementation toolkit developed to guide organization-based implementation teams through EBP identification, adoption, implementation, and sustainment in ASD community-based organizations. METHODS This study examined the facilitators and barriers (collectively termed "determinants") to the utilization of this toolkit, based on the perspectives of implementation teams at six ASD community-based organizations. Two independent coders utilized the adapted EPIS framework and the Technology Acceptance Model 3 to guide qualitative thematic analyses of semi-structured interviews with implementation teams. RESULTS Salient facilitators (e.g., facilitation teams, facilitation meetings, phase-specific activities) and barriers (e.g., website issues, perceived lack of ease of use of the website, perceived lack of resources, inner context factors) were identified, highlighting key determinants to the utilization of this toolkit. Additionally, frequent determinants and determinants that differed across adapted EPIS phases of the toolkit were noted. Finally, analyses highlighted two themes: (a) Inner Context Determinants to use of the toolkit (e.g., funding) and (b) Innovation Determinants (e.g., all website-related factors), indicating an interaction between the two models utilized to guide study analyses. CONCLUSIONS Findings highlighted several factors that facilitated the utilization of this implementation guide. Additionally, findings identified key areas for improvement for future iterations of the ACT SMART Implementation Toolkit. Importantly, these results may inform the development, refinement, and utilization of implementation guides with the aim of increasing the uptake of EBPs in community-based organizations providing services to children with ASD and their families. Finally, these findings contribute to the implementation science literature by illustrating the joint use of the EPIS framework and Technology Acceptance Model 3 to evaluate the implementation of a web-based toolkit within community-based organizations.
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Affiliation(s)
- Aksheya Sridhar
- Department of Psychology, Michigan State University, East Lansing, MI, USA.
| | - Amy Drahota
- Department of Psychology, Michigan State University, East Lansing, MI, USA
- Child & Adolescent Services Research Center, San Diego, CA, USA
| | - Kiersten Walsworth
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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Characterizing Shared and Unique Implementation Influences in Two Community Services Systems for Autism: Applying the EPIS Framework to Two Large-Scale Autism Intervention Community Effectiveness Trials. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:176-187. [PMID: 30905009 DOI: 10.1007/s10488-019-00931-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to examine common and unique factors influencing implementation process for two evidence-based interventions for children with autism spectrum disorder (ASD) in mental health and education service contexts. This study prospectively collected qualitative data from intervention developers and research staff on the implementation process within the context of two separate ASD intervention effectiveness trials. Results reveal common and unique factors influencing implementation in both study contexts. Implementation leadership and provider attitudes and motivation emerge as key influences on implementation across systems. These findings provide promising targets for modular implementation interventions that can be leveraged within growing, large-scale translation efforts in usual care.
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Wood JJ, Wood KS, Cho AC, Rosenau KA, Guevara MC, Galán C, Bazzano A, Zeldin AS, Hellemann G. Modular cognitive behavioral therapy for autism-related symptoms in children: A randomized controlled trial. J Consult Clin Psychol 2021; 89:110-125. [PMID: 33705167 PMCID: PMC8284564 DOI: 10.1037/ccp0000621] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To date, no one-on-one psychotherapy protocol for elementary and middle school-aged children with autism spectrum disorder (ASD) has been found to be efficacious for treating autism-related symptoms such as failure to initiate social interactions. This study compared modular cognitive behavioral therapy (CBT) with enhanced standard community treatment (ESCT) in terms of impact on the severity of autism-related symptoms. METHOD Children with ASD (N = 107; aged 6-13 years) were randomly assigned to a treatment condition (CBT or ESCT). Both treatments provided 32 therapy sessions. The CBT condition utilized a modular design, matching specific evidence-based treatment elements to each child's clinical needs (e.g., social-communication symptoms). The ESCT condition provided social skills training and cognitive behavioral training in a structured and linear group therapy format. The primary outcome measure was independent evaluator ratings of peer engagement during school recess using a structured and validated observation system. Parents also made session-by-session ratings on personalized autism-related symptom profiles throughout treatment. RESULTS CBT outperformed ESCT on the primary outcome measure (p < .001; d = .50; 95% CI [.06, .93]) and the secondary outcome measure (p = .003; d = .87; 95% CI [.45, 1.27]). CONCLUSIONS The modular one-on-one CBT program evaluated in this study may be beneficial for reducing the severity of autism-related symptoms in some children with ASD. Further research is needed to clarify the extent of the treatment effect and the feasibility of implementation for therapists in the community. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Jeffrey J. Wood
- Department of Education, Division of Human Development and Psychology, University of California, Los Angeles
- David Geffen School of Medicine, University of California, Los Angeles
| | - Karen Sze Wood
- David Geffen School of Medicine, University of California, Los Angeles
| | - An Chuen Cho
- Department of Education, Division of Human Development and Psychology, University of California, Los Angeles
| | - Kashia A. Rosenau
- Department of Education, Division of Human Development and Psychology, University of California, Los Angeles
| | | | | | - Alicia Bazzano
- David Geffen School of Medicine, University of California, Los Angeles
| | | | - Gerhard Hellemann
- David Geffen School of Medicine, University of California, Los Angeles
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Rojas-Torres LP, Alonso-Esteban Y, Alcantud-Marín F. Early Intervention with Parents of Children with Autism Spectrum Disorders: A Review of Programs. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E294. [PMID: 33333900 PMCID: PMC7765314 DOI: 10.3390/children7120294] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/05/2020] [Accepted: 12/10/2020] [Indexed: 02/05/2023]
Abstract
The aim of this article was to analyze the evidence regarding the effectiveness of intervention programs for children with autism based on the participation of their parents. To obtain the data, a systematic search was carried out in four databases (PsycARTICLES (ProQuest), ERIC (ProQuest), PubMed (ProQuest), and Scopus). The retrieved documents were refined under the inclusion/exclusion criteria, and a total of 51 empirical studies were selected. These studies were first classified according to the function of the intervention objective and, later, by the methodology applied (19 studies were based on comprehensive interventions, 11 focused on the nuclear symptoms of autism spectrum disorder (ASD), 12 focused on the promotion of positive parenting, and nine interactions focused on child play). Once all of the documents had been analyzed, the evidence indicated scientific efficacy in most studies, mainly in those based on child development and the application of behavioral analysis principles. Moreover, the positive influence of parent participation in such programs was demonstrated.
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Affiliation(s)
| | - Yurena Alonso-Esteban
- Department of Developmental and Educational Psychology, Universitat de Valencia, 46010 Valencia, Spain
| | - Francisco Alcantud-Marín
- Department of Developmental and Educational Psychology, Universitat de Valencia, 46010 Valencia, Spain
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Helverschou SB, Bakken TL, Berge H, Bjørgen TG, Botheim H, Hellerud JA, Helseth I, Hove O, Johansen PA, Kildahl AN, Ludvigsen LB, Nygaard S, Rysstad A, Wigaard E, Howlin P. Preliminary Findings From a Nationwide, Multicenter Mental Health Service for Adults and Older Adolescents With Autism Spectrum Disorder and ID. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2020. [DOI: 10.1111/jppi.12366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Sissel Berge Helverschou
- NevSom ‐ Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias Oslo University Hospital Norway
| | - Trine Lise Bakken
- NevSom ‐ Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias Oslo University Hospital Norway
| | - Heidi Berge
- Specialized Habilitation Service, Nordmøre and Romsdal, Møre and Romsdal Hospital Trust Norway
| | | | - Henrik Botheim
- Specialized Habilitation Service, Sunnmøre, Møre and Romsdal Hospital Trust Norway
| | - Jane Askeland Hellerud
- NevSom ‐ Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias Oslo University Hospital Norway
| | - Ingunn Helseth
- Department of Mental Health, Regional Section Autism and Intellectual Disability Mental Health Helse Fonna Hospital Trust Norway
| | - Oddbjørn Hove
- Department of Research and Innovation/Department of Mental Health, Regional Section Autism and Intellectual Disability Mental Health Helse Fonna Hospital Trust Norway
| | | | - Arvid Nikolai Kildahl
- Regional Section Mental Health, Intellectual Disabilities/Autism and NevSom—Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnia Oslo University Hospital Norway
| | - Linn Beate Ludvigsen
- Department of Psychiatry, Section Intellectual Disability and Autism Vestre Viken Hospital Trust Norway
| | - Sissel Nygaard
- Department of Psychiatry, Section Specialized Habilitation Nord‐Trøndelag Hospital Trust Norway
| | - Anne Rysstad
- Department of Psychiatry, Section Intellectual Disability and Autism Vestre Viken Hospital Trust Norway
| | - Elisabeth Wigaard
- Department of Psychiatry Section Intellectual Disability and Autism, Vestre Viken Hospital Trust Norway
| | - Patricia Howlin
- Department of Psychology King's College LondonInstitute of Psychiatry, Psychology and Neuroscience London UK
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Frost KM, Brian J, Gengoux GW, Hardan A, Rieth SR, Stahmer A, Ingersoll B. Identifying and measuring the common elements of naturalistic developmental behavioral interventions for autism spectrum disorder: Development of the NDBI-Fi. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:2285-2297. [PMID: 32731748 PMCID: PMC7541530 DOI: 10.1177/1362361320944011] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Naturalistic developmental behavioral interventions for young children with autism spectrum disorder share key elements. However, the extent of similarity between programs within this class of evidence-based interventions is unknown. There is also currently no tool that can be used to measure the implementation of their common elements. This article presents a multi-stage process which began with defining all intervention elements of naturalistic developmental behavioral interventions. Next, intervention experts identified the common elements of naturalistic developmental behavioral interventions using a survey. An observational rating scheme of those common elements, the eight-item NDBI-Fi, was developed. We evaluated the quality of the NDBI-Fi using videos from completed trials of caregiver-implemented naturalistic developmental behavioral interventions. Results showed that the NDBI-Fi measure has promise; it was sensitive to change, related to other similar measures, and demonstrated adequate agreement between raters. This unique measure has the potential to advance intervention science in autism spectrum disorder by providing a tool to measure the implementation of common elements across naturalistic developmental behavioral intervention models. Given that naturalistic developmental behavioral interventions have numerous shared strategies, this may ease clinicians' uncertainty about choosing the "right" intervention package. It also suggests that there may not be a need for extensive training in more than one naturalistic developmental behavioral intervention. Future research should determine whether these common elements are part of other treatment approaches to better understand the quality of services children and families receive as part of usual care.
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Affiliation(s)
- Kyle M. Frost
- Michigan State University, 316 Physics Road, 69F Psychology, East Lansing, MI
| | - Jessica Brian
- Bloorview Research Institute, 150 Kilgour Road Toronto, Ontario
| | - Grace W. Gengoux
- Stanford University School of Medicine, 401 Quarry Road, Stanford, CA
| | - Antonio Hardan
- Stanford University School of Medicine, 401 Quarry Road, Stanford, CA
| | - Sarah R. Rieth
- San Diego State University, 5500 Campanile Drive, San Diego, CA
| | - Aubyn Stahmer
- University of California-Davis MIND Institute, 2825 50th Street, Sacramento, CA
| | - Brooke Ingersoll
- Michigan State University, 316 Physics Road, 105B Psychology, East Lansing, MI
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Cervantes PE, Matheis M, Estabillo J, Seag DEM, Nelson KL, Peth-Pierce R, Hoagwood KE, Horwitz SM. Trends Over a Decade in NIH Funding for Autism Spectrum Disorder Services Research. J Autism Dev Disord 2020; 51:2751-2763. [PMID: 33040269 DOI: 10.1007/s10803-020-04746-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 12/15/2022]
Abstract
Investments in autism spectrum disorder (ASD) research, guided by the Interagency Autism Coordinating Committee (IACC), have focused disproportionately on etiology over a well-established stakeholder priority area: research to improve accessibility and quality of community-based services. This study analyzed National Institutes of Health ASD services research funding from 2008 to 2018 to examine funding patterns, evaluate the impact of IACC objectives, and identify future directions. Approximately 9% of total funds were allocated to services research. This investment remained relatively stable across time and lacked diversity across domains (e.g., area of focus, ages sampled, implementation strategies used). While advancements were observed, including increased prevalence of projects focused on adult samples and on dissemination/implementation and prevention areas, greater investment in service research is critically needed.
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Affiliation(s)
- Paige E Cervantes
- Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, NY, USA.
| | - Maya Matheis
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Jasper Estabillo
- Tarjan Center, Jane & Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | - Dana E M Seag
- Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, NY, USA
| | - Katherine L Nelson
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | | | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, NY, USA
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Lake JK, Tablon Modica P, Chan V, Weiss JA. Considering efficacy and effectiveness trials of cognitive behavioral therapy among youth with autism: A systematic review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1590-1606. [PMID: 32423224 DOI: 10.1177/1362361320918754] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
LAY ABSTRACT Cognitive behavioral therapy is a common treatment for emotional problems in people with autism. Most studies of cognitive behavioral therapy and autism have focused on efficacy, meaning whether a treatment produces results under "ideal" conditions, like a lab or research setting. Effectiveness trials, by contrast, investigate whether a treatment produces results under "real-world" conditions, like a community setting (e.g. hospital, community mental health center, school). There can be challenges in bringing a cognitive behavioral therapy treatment out of a lab or research setting into the community, and the field of implementation science uses frameworks to help guide researchers in this process. In this study, we reviewed efficacy and effectiveness studies of cognitive behavioral therapy treatments for emotional problems (e.g. anxiety, depression) in children and youth with autism. Our search found 2959 articles, with 33 studies meeting our criteria. In total, 13 studies were labelled as effectiveness and 20 as efficacy. We discuss how the effectiveness studies used characteristics of an implementation science framework, such as studying how individuals learn about the treatment, accept or reject it, how it is used in the community over time, and any changes that happened to the individual or the organization (e.g. hospital, school, community mental health center) because of it. Results help us better understand the use of cognitive behavioral therapy in the community, including how a framework can be used to improve effectiveness studies.
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Affiliation(s)
- Johanna K Lake
- Centre for Addiction and Mental Health, Canada.,University of Toronto, Canada
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Dickson KS, Aarons GA, Anthony LG, Kenworthy L, Crandal BR, Williams K, Brookman-Frazee L. Adaption and pilot implementation of an autism executive functioning intervention in children's mental health services: a mixed-methods study protocol. Pilot Feasibility Stud 2020; 6:55. [PMID: 32699642 PMCID: PMC7371471 DOI: 10.1186/s40814-020-00593-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Youth with autism spectrum disorder (ASD) represent a growing population with significant service needs. Prominent among these needs are high rates of co-occurring psychiatric conditions that contribute to increased functional impairments and often necessitate mental health services. Executive functioning deficits are associated with ASD as well as common co-occurring conditions (e.g., attention-deficit/hyperactivity disorder) and an evidence-based intervention has been developed and tested to address executive functioning within the school context. There is an urgent need to implement indicated evidence-based interventions for youth with ASD receiving care in community mental health settings. Interventions that optimally "fit" the mental health services context as well as the complex and co-occurring mental health needs of these youth have the potential to improve key clinical outcomes for this high priority population. METHODS This mixed-methods developmental study will apply the Exploration, Preparation, Implementation, Sustainment implementation framework and a community-academic partnership approach to systematically adapt and test an evidence-based executive functioning intervention for youth with ASD for delivery in community mental health settings. Specific aims are to (1) conduct a need and context assessment to inform the systematic adaptation an executive functioning evidence-based intervention; (2) systematically adapt the clinical intervention and develop a corresponding implementation plan, together entitled "Executive Functioning for Enhancing Community-based Treatment for ASD," (EFFECT for ASD); and (3) conduct a feasibility pilot test of EFFECT for ASD in community mental health settings. DISCUSSION Tailoring evidence-based interventions for delivery in community-based mental health services for youth with ASD has the potential to increase quality of care and improve child outcomes. Results from the current study will serve as the foundation for large-scale hybrid implementation and effectiveness trials and a generalizable approach for different service systems of care and clinical populations. TRIAL REGISTRATION Clinicaltrials.gov, NCT04295512.
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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
| | - Gregory A. Aarons
- Child and Adolescent Services Research Center, San Diego, CA USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
| | - Laura Gutermuth Anthony
- University of Colorado School of Medicine, Aurora, CO USA
- Children’s Hospital of Colorado, Aurora, CO USA
| | - Lauren Kenworthy
- Center for Autism Spectrum Disorders, Children’s National, Washington, DC USA
| | | | - Katherine Williams
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
- Rady Children’s Hospital-San Diego, San Diego, CA USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA USA
- Autism Disovery Institute at Rady Children’s Hospital, San Diego, CA USA
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Maddox BB, Crabbe S, Beidas RS, Brookman-Frazee L, Cannuscio CC, Miller JS, Nicolaidis C, Mandell DS. "I wouldn't know where to start": Perspectives from clinicians, agency leaders, and autistic adults on improving community mental health services for autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 24:919-930. [PMID: 31674198 DOI: 10.1177/1362361319882227] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
LAY ABSTRACT Most autistic adults struggle with mental health problems, such as anxiety and depression. However, they often have trouble finding effective mental health treatment in their community. The goal of this study was to identify ways to improve community mental health services for autistic adults. We interviewed 22 autistic adults with mental healthcare experience, 44 community mental health clinicians (outpatient therapists, case managers, and intake coordinators), and 11 community mental health agency leaders in the United States. Our participants identified a variety of barriers to providing quality mental healthcare to autistic adults. Across all three groups, most of the reported barriers involved clinicians' limited knowledge, lack of experience, poor competence, and low confidence working with autistic adults. All three groups also discussed the disconnect between the community mental health and developmental disabilities systems and the need to improve communication between these two systems. Further efforts are needed to train clinicians and provide follow-up consultation to work more effectively with autistic adults. A common suggestion from all three groups was to include autistic adults in creating and delivering the clinician training. The autistic participants provided concrete recommendations for clinicians, such as consider sensory issues, slow the pace, incorporate special interests, use direct language, and set clear expectations. Our findings also highlight a need for community education about co-occurring psychiatric conditions with autism and available treatments, in order to increase awareness about treatment options.
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Affiliation(s)
- Brenna B Maddox
- University of Pennsylvania, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), USA
| | | | - Rinad S Beidas
- University of Pennsylvania, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), USA
| | - Lauren Brookman-Frazee
- University of California, San Diego, USA.,Child and Adolescent Services Research Center, USA.,Rady Children's Hospital, USA
| | | | - Judith S Miller
- University of Pennsylvania, USA.,Children's Hospital of Philadelphia, USA
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Baker-Ericzén MJ, Brookman-Frazee L, Brodkin ES. Accelerating research on treatment and services for transition age youth and adults on the autism spectrum. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 22:2-5. [PMID: 29369717 DOI: 10.1177/1362361317738646] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Discrete electrocortical predictors of anxiety and anxiety-related treatment response in youth with autism spectrum disorder. Biol Psychol 2019; 146:107710. [DOI: 10.1016/j.biopsycho.2019.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 12/28/2022]
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Brown CE, Borduin CM, Dopp AR, Mazurek MO. The social ecology of aggression in youths with autism spectrum disorder. Autism Res 2019; 12:1636-1647. [PMID: 31206256 DOI: 10.1002/aur.2157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/27/2019] [Indexed: 12/28/2022]
Abstract
This study examined the social-ecological correlates of aggressive behavior in 120 youths with autism spectrum disorder. Youths were divided into three groups based on caregiver reports of the youth's aggressive acts: youths who engaged in acts of both physical and verbal aggression, youths who engaged only in acts of physical aggression, and nonaggressive youths. Caregivers and youths completed self-report instruments and behavior rating inventories that assessed youth individual functioning, family relations, and extrafamilial factors (i.e., peer relations, academic performance). Results showed that youths who engaged in both verbal and physical aggression were characterized by poor sleep quality and victimization by peers, and their caregivers evidenced high levels of distress and avoidant coping. In contrast, youths who were physically but not verbally aggressive were distinguished by difficulties in social interaction and communication. In general, each group of youths who were aggressive experienced more problems with repetitive behaviors, family relations, and academic performance than did their nonaggressive counterparts. The implications of these findings for theory, research, and treatment are discussed. Autism Res 2019. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The present study demonstrated that youths with autism spectrum disorder may be classified by the types of aggressive behaviors that they exhibit: youths who are verbally and physically aggressive, physically aggressive only, or not aggressive. Compared to the nonaggressive group, both groups of youths who were aggressive experienced difficulties in their individual, family, peer, and academic functioning. Youths with both verbal and physical aggression showed the most problems in their functioning.
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Affiliation(s)
| | | | - Alex R Dopp
- University of Arkansas, Fayetteville, Arkansas
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Reaven J, Moody EJ, Grofer Klinger L, Keefer A, Duncan A, O'Kelley S, Meyer A, Hepburn S, Blakeley-Smith A. Training clinicians to deliver group CBT to manage anxiety in youth with ASD: Results of a multisite trial. J Consult Clin Psychol 2019; 86:205-217. [PMID: 29504790 DOI: 10.1037/ccp0000285] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Few guidelines are available regarding optimal training models for practitioners delivering cognitive-behavioral therapy (CBT) for anxiety in youth with autism spectrum disorder (ASD). The present study systematically compared 3 instructional conditions for delivering the Facing Your Fears program (FYF) to children with ASD and anxiety. METHOD Thirty-four clinicians (Mage = 34 years; 94% women, 88% Caucasian) and an intent-to-treat sample of 91 children with ASD and anxiety (Mage = 11; 84% male 53% Caucasian) met eligibility criteria across 4 sites. A 3-group parallel design via a Latin square procedure was used to randomize 9 teams of clinicians to 1 of 3 training conditions: Manual, Workshop, Workshop-Plus. The effectiveness of instructional condition was assessed via implementation (CBT knowledge, treatment fidelity) and treatment outcomes (reductions in anxiety as measured by the Anxiety Disorders Interview Schedule-Parent (ADIS-P). RESULTS Clinicians in both Workshop conditions significantly increased CBT knowledge postworkshop, F(1, 18) = 19.8, p < .001. Excellent treatment fidelity was obtained across conditions (above 89%), although clinicians in the Workshop conditions obtained significantly higher fidelity ratings and delivered FYF with greater quality than the Manual condition. Children with ASD demonstrated significant reductions in anxiety symptoms for three of the four anxiety diagnoses, with no differences noted across instructional condition. Rates of improvement were lower than those obtained in a previous controlled trial. CONCLUSIONS Results suggest that although there may be some advantage to participating in a Workshop, clinicians in all conditions could deliver FYF with excellent fidelity and yield positive treatment outcomes. Lack of a no-treatment comparison group limits interpretation of findings. (PsycINFO Database Record
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Affiliation(s)
- Judy Reaven
- Department of Psychiatry, University of Colorado Anschutz Medical Campus
| | - Eric J Moody
- Department of Psychiatry, University of Colorado Anschutz Medical Campus
| | - Laura Grofer Klinger
- Department of Psychiatry, TEACCH Autism Program, University of North Carolina-Chapel Hill
| | - Amy Keefer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine/Kennedy Krieger Institute
| | - Amie Duncan
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center
| | - Sarah O'Kelley
- Department of Psychology, University of Alabama-Birmingham
| | - Allison Meyer
- Department of Pediatrics, University of Colorado Anschutz Medical Center
| | - Susan Hepburn
- Human Development and Family Studies, Colorado State University
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Klebanoff SM, Rosenau KA, Wood JJ. The therapeutic alliance in cognitive-behavioral therapy for school-aged children with autism and clinical anxiety. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:2031-2042. [DOI: 10.1177/1362361319841197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Little is known about the alliance between therapists and children with autism spectrum disorder who are receiving psychological therapies in outpatient treatment settings. This study examined the therapeutic alliance in children with autism spectrum disorder and clinical anxiety, who were receiving cognitive behavioral therapy in a randomized, controlled trial. The Therapeutic Alliance Scale for Children was administered to a sample of children and youth with autism spectrum disorder and anxiety ( N = 64; aged 7–14) as well as to their parents and therapists. A comparison sample of typically developing youth with clinical anxiety ( N = 36; aged 5–12) was included. The child-therapist alliance was more positive among typically developing children than among children with autism spectrum disorder; correspondingly, the parent-therapist alliance was also more positive among parents of typically developing children. Therapist reports of positive child-therapist alliance predicted post-treatment reductions in anxiety among children with autism spectrum disorder, although child reports of this alliance did not. Parent reports of positive parent-therapist alliance also predicted post-treatment reductions in the child’s anxiety in the group with autism spectrum disorder. A strong therapeutic alliance appears to be associated with better treatment outcomes in children with autism spectrum disorder receiving cognitive behavioral therapy, although a thoughtful and diagnostically sensitive approach is advisable to promote a positive alliance with children with autism spectrum disorder.
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Fidelity Assessment in Community Programs: An Approach to Validating Simplified Methodology. Behav Anal Pract 2019; 13:29-39. [PMID: 32231965 DOI: 10.1007/s40617-019-00337-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Fidelity to intervention protocol is linked to best outcomes for individuals with autism spectrum disorder (ASD; see Boyd & Corley [Autism 5(4):430-441, 2001]; Pellecchia et al. [J Autism Dev Disord 45(9):2917-2927, 2015]); however, fidelity measurement tools that are both accurate and feasible for community use are often not available. In this paper we explore methods for validated simplification of fidelity assessment procedures toward the goal of increased use in clinical practice. Video recordings (n = 36) of therapists working with children with ASD were coded using three variations of fidelity assessment methodology (trial-by-trial, 5-point Likert Scale, and 3-point Likert Scale), and the results were compared for exact agreement, mastery criterion agreement, and overall reliability. The results indicated overall a very high percentage of exact agreement (mean 99.44%, range 94.4-100%) and excellent reliability (mean Krippendorff's alpha [Kα] 1.0) between the trial-by-trial and 5-point Likert Scale across all components; however, the 3-point method may be viewed as being the more feasible strategy within community programs.
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42
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Broder-Fingert S, Qin S, Goupil J, Rosenberg J, Augustyn M, Blum N, Bennett A, Weitzman C, Guevara JP, Fenick A, Silverstein M, Feinberg E. A mixed-methods process evaluation of Family Navigation implementation for autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:1288-1299. [PMID: 30404548 DOI: 10.1177/1362361318808460] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
There is growing interest in Family Navigation as an approach to improving access to care for children with autism spectrum disorder, yet little data exist on the implementation of Family Navigation. The aim of this study was to identify potential failures in implementing Family Navigation for children with autism spectrum disorder, using a failure modes and effects analysis. This mixed-methods study was set within a randomized controlled trial testing the effectiveness of Family Navigation in reducing the time from screening to diagnosis and treatment for autism spectrum disorder across three states. Using standard failure modes and effects analysis methodology, experts in Family Navigation for autism spectrum disorder (n = 9) rated potential failures in implementation on a 10-point scale in three categories: likelihood of the failure occurring, likelihood of not detecting the failure, and severity of failure. Ratings were then used to create a risk priority number for each failure. The failure modes and effects analysis detected five areas for potential "high priority" failures in implementation: (1) setting up community-based services, (2) initial family meeting, (3) training, (4) fidelity monitoring, and (5) attending testing appointments. Reasons for failure included families not receptive, scheduling, and insufficient training time. The process with the highest risk profile was "setting up community-based services." Failure in "attending testing appointment" was rated as the most severe potential failure. A number of potential failures in Family Navigation implementation-along with strategies for mitigation-were identified. These data can guide those working to implement Family Navigation for children with autism spectrum disorder.
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Affiliation(s)
| | - Sarah Qin
- 2 The Children's Hospital of Philadelphia, USA
| | | | | | | | | | | | | | | | | | | | - Emily Feinberg
- 1 Boston University School of Medicine, USA.,5 Boston University School of Public Health, USA
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Brookman-Frazee L, Stadnick N, Chlebowski C, Baker-Ericzén M, Ganger W. Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 22:938-952. [PMID: 28914082 PMCID: PMC6491206 DOI: 10.1177/1362361317712650] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Publicly funded mental health programs play a significant role in serving children with autism spectrum disorder. Understanding patterns of psychiatric comorbidity for this population within mental health settings is important to implement appropriately tailored interventions. This study (1) describes patterns of psychiatric comorbidity in children with autism spectrum disorder who present to mental health services with challenging behaviors and (2) identifies child characteristics associated with comorbid conditions. Data are drawn from baseline assessments from 201 children with autism spectrum disorder who participated in a community effectiveness trial across 29 publicly funded mental health programs. Non-autism spectrum disorder diagnoses were assessed using an adapted Mini-International Neuropsychiatric Interview, parent version. Approximately 92% of children met criteria for at least one non-autism spectrum disorder diagnosis (78% attention deficit hyperactivity disorder, 58% oppositional defiant disorder, 56% anxiety, 30% mood). Logistic regression indicated that child gender and clinical characteristics were differentially associated with meeting criteria for attention deficit hyperactivity disorder, oppositional defiant disorder, an anxiety, or a mood disorder. Exploratory analyses supported a link between challenging behaviors and mood disorder symptoms and revealed high prevalence of these symptoms in this autism spectrum disorder population. Findings provide direction for tailoring intervention to address a broad range of clinical issues for youth with autism spectrum disorder served in mental health settings.
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Affiliation(s)
- Lauren Brookman-Frazee
- University of California, San Diego, USA
- Rady Children’s Hospital, San Diego, USA
- Child and Adolescent Services Research Center, USA
| | - Nicole Stadnick
- University of California, San Diego, USA
- Child and Adolescent Services Research Center, USA
| | - Colby Chlebowski
- University of California, San Diego, USA
- Child and Adolescent Services Research Center, USA
| | - Mary Baker-Ericzén
- Rady Children’s Hospital, San Diego, USA
- Child and Adolescent Services Research Center, USA
| | - William Ganger
- Child and Adolescent Services Research Center, USA
- San Diego State University, USA
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Vivanti G, Stahmer A. Early intervention for autism: Are we prioritizing feasibility at the expenses of effectiveness? A cautionary note. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 22:770-773. [DOI: 10.1177/1362361318803043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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45
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McLeod BD, Cox JR, Jensen-Doss A, Herschell A, Ehrenreich-May J, Wood JJ. Proposing a Mechanistic Model of Clinician Training and Consultation. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018; 25:e12260. [PMID: 30713369 PMCID: PMC6353552 DOI: 10.1111/cpsp.12260] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To make evidence-based treatments deliverable, effective, and scalable in community settings, it is critical to develop a workforce that can deliver evidence-based treatments as designed with skill. However, the science and practice of clinician training and consultation lags behind other areas of implementation science. In this paper, we present the Longitudinal Education for Advancing Practice (LEAP) model designed to help span this gap. The LEAP model is a mechanistic model of clinician training and consultation that details how training inputs, training and consultation strategies, and mechanisms of learning influence training outcomes. We first describe the LEAP model and then discuss how key implications of the model can be used to develop effective training and consultation strategies.
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Affiliation(s)
- Bryce D McLeod
- Virginia Commonwealth University, Department of Psychology
| | - Julia R Cox
- Virginia Commonwealth University, Department of Psychology
| | | | | | | | - Jeffrey J Wood
- Departments of Education and Psychiatry, University of California
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Boudreau AM, Corkum P, Smith IM. Peer-Mediated Pivotal Response Treatment for Children With Autism Spectrum Disorder: Provider Perspectives on Acceptability, Feasibility, and Fit at School. CANADIAN JOURNAL OF SCHOOL PSYCHOLOGY 2018. [DOI: 10.1177/0829573518777417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Few effective school-based interventions that target social-communication skills are available for students with autism spectrum disorder (ASD). The growing gap between interventions designed for use in research settings and the school environment is concerning for researchers and clinicians alike. Research methods that incorporate relevant stakeholders (e.g., educators, early intervention providers [EIPs]) throughout the process from intervention design to implementation help to bridge this gap. This study used content analysis of interview data to evaluate the acceptability and feasibility of a specific peer-mediated intervention (PMI) for school use for young children with ASD. We explored educators’ and EIPs’ perspectives on evidence-based practice (EBP), the components of the proposed intervention (using Pivotal Response Treatment, PRT), and the overall acceptability and feasibility of using the intervention at school, through interviews with 29 participants (24 elementary school educators and five EIPs serving children with ASD). Results indicated that stakeholders had some knowledge of PRT and found the PMI approach to be acceptable and feasible. Several potential challenges were identified with respect to typically developing peers as intervention agents. We discuss educators’ specific recommendations for intervention adaptation and provide a model for researchers and educators to collaborate in promoting optimal use of EBPs at school.
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Affiliation(s)
| | - Penny Corkum
- IWK Health Centre, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Isabel M. Smith
- IWK Health Centre, Halifax, Nova Scotia, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
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47
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Tomlinson M, Hunt X, Rotheram-Borus MJ. Diffusing and scaling evidence-based interventions: eight lessons for early child development from the implementation of perinatal home visiting in South Africa. Ann N Y Acad Sci 2018; 1419:218-229. [DOI: 10.1111/nyas.13650] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Mark Tomlinson
- Department of Psychology; Stellenbosch University; Stellenbosch South Africa
| | - Xanthe Hunt
- Department of Psychology; Stellenbosch University; Stellenbosch South Africa
| | - Mary Jane Rotheram-Borus
- Semel Institute, Department of Psychiatry and Biobehavioral Sciences; University of California Los Angeles; Los Angeles California
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48
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Brookman-Frazee L, Stahmer AC. Effectiveness of a multi-level implementation strategy for ASD interventions: study protocol for two linked cluster randomized trials. Implement Sci 2018; 13:66. [PMID: 29743090 PMCID: PMC5944167 DOI: 10.1186/s13012-018-0757-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Centers for Disease Control (2018) estimates that 1 in 59 children has autism spectrum disorder, and the annual cost of ASD in the U.S. is estimated to be $236 billion. Evidence-based interventions have been developed and demonstrate effectiveness in improving child outcomes. However, research on generalizable methods to scale up these practices in the multiple service systems caring for these children has been limited and is critical to meet this growing public health need. This project includes two, coordinated studies testing the effectiveness of the Translating Evidence-based Interventions (EBI) for ASD: Multi-Level Implementation Strategy (TEAMS) model. TEAMS focuses on improving implementation leadership, organizational climate, and provider attitudes and motivation in order to improve two key implementation outcomes-provider training completion and intervention fidelity and subsequent child outcomes. The TEAMS Leadership Institute applies implementation leadership strategies and TEAMS Individualized Provider Strategies for training applies motivational interviewing strategies to facilitate provider and organizational behavior change. METHODS A cluster randomized implementation/effectiveness Hybrid, type 3, trial with a dismantling design will be used to understand the effectiveness of TEAMS and the mechanisms of change across settings and participants. Study #1 will test the TEAMS model with AIM HI (An Individualized Mental Health Intervention for ASD) in publicly funded mental health services. Study #2 will test TEAMS with CPRT (Classroom Pivotal Response Teaching) in education settings. Thirty-seven mental health programs and 37 school districts will be randomized, stratified by county and study, to one of four groups (Standard Provider Training Only, Standard Provider Training + Leader Training, Enhanced Provider Training, Enhanced Provider Training + Leader Training) to test the effectiveness of combining standard, EBI-specific training with the two TEAMS modules individually and together on multiple implementation outcomes. Implementation outcomes including provider training completion, fidelity (coded by observers blind to group assignment) and child behavior change will be examined for 295 mental health providers, 295 teachers, and 590 children. DISCUSSION This implementation intervention has the potential to increase quality of care for ASD in publicly funded settings by improving effectiveness of intervention implementation. The process and modules will be generalizable to multiple service systems, providers, and interventions, providing broad impact in community services. TRIAL REGISTRATION This study is registered with Clinicaltrials.gov ( NCT03380078 ). Registered 20 December 2017, retrospectively registered.
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Affiliation(s)
- Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0812 USA
- Child and Adolescent Services Research Center, 3020 Children’s Way MC 5033, San Diego, CA 92123 USA
| | - Aubyn C. Stahmer
- Child and Adolescent Services Research Center, 3020 Children’s Way MC 5033, San Diego, CA 92123 USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, UC Davis MIND Institute, 2825 50th Street, Sacramento, CA 95817 USA
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Advancing Evidence-Based Assessment in School Mental Health: Key Priorities for an Applied Research Agenda. Clin Child Fam Psychol Rev 2016; 19:271-284. [PMID: 27730441 DOI: 10.1007/s10567-016-0217-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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50
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Stadnick N, Chlebowski C, Baker-Ericzén M, Dyson M, Garland A, Brookman-Frazee L. Psychiatric comorbidity in autism spectrum disorder: Correspondence between mental health clinician report and structured parent interview. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 21:841-851. [PMID: 27407039 DOI: 10.1177/1362361316654083] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Publicly funded mental health services are critical in caring for children with autism spectrum disorder. Accurate identification of psychiatric comorbidity is necessary for effective mental health treatment. Little is known about psychiatric diagnosis for this population in routine mental health care. This study (1) examined correspondence between psychiatric diagnoses reported by mental health clinicians and those derived from a structured diagnostic interview and (2) identified predictors of agreement between clinician-reported and diagnostic interview-derived diagnoses in a sample of 197 children aged 4-14 years with autism spectrum disorder receiving mental health services. Data were drawn from a randomized effectiveness trial conducted in publicly funded mental health services. Non-autism spectrum disorder diagnoses were assessed using an adapted version of the Mini-International Neuropsychiatric Interview, parent version. Cohen's kappa was calculated to examine agreement between Mini-International Neuropsychiatric Interview, parent version and clinician-reported diagnoses of comorbid conditions. Children met criteria for an average of 2.83 (standard deviation = 1.92) Mini-International Neuropsychiatric Interview, parent version diagnoses. Agreement was poor across all diagnostic categories (κ values: 0.06-0.18). Logistic regression identified child gender and clinical characteristics as significant predictors of agreement for specific diagnoses. Results underscore the need for training mental health clinicians in targeted assessment of specific psychiatric disorders and prioritizing treatment development and testing for specific diagnoses to improve care for children with autism spectrum disorder served in publicly funded mental health settings.
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Affiliation(s)
- Nicole Stadnick
- 1 University of California, San Diego, USA.,2 Child and Adolescent Services Research Center, San Diego, USA
| | - Colby Chlebowski
- 1 University of California, San Diego, USA.,2 Child and Adolescent Services Research Center, San Diego, USA.,3 Autism Discovery Institute at Rady Children's Hospital, San Diego, USA
| | - Mary Baker-Ericzén
- 1 University of California, San Diego, USA.,2 Child and Adolescent Services Research Center, San Diego, USA.,3 Autism Discovery Institute at Rady Children's Hospital, San Diego, USA.,4 Rady Children's Hospital, San Diego, USA
| | - Margaret Dyson
- 1 University of California, San Diego, USA.,2 Child and Adolescent Services Research Center, San Diego, USA.,4 Rady Children's Hospital, San Diego, USA
| | - Ann Garland
- 2 Child and Adolescent Services Research Center, San Diego, USA.,5 University of San Diego, USA
| | - Lauren Brookman-Frazee
- 1 University of California, San Diego, USA.,2 Child and Adolescent Services Research Center, San Diego, USA.,3 Autism Discovery Institute at Rady Children's Hospital, San Diego, USA
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