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MacKenzie HM, Flores-Sandoval C, Bateman EA, McIntyre A, Barua U, Mehta S, Bayley M, Teasell R. Evidence-Based Review of Randomized Controlled Trials of Interventions for the Management of Behavioral Issues in Individuals With Moderate to Severe Traumatic Brain Injury. J Head Trauma Rehabil 2024; 39:369-381. [PMID: 39256158 DOI: 10.1097/htr.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
OBJECTIVE To present an evidence-based review of randomized controlled trials (RCTs) evaluating interventions for the management of behavioral issues post moderate to severe traumatic brain injury (MSTBI), as part of an extensive database that has been conceptualized as a living systematic review. METHODS Systematic searches were conducted in MEDLINE, PubMed, Scopus, CINAHL, EMBASE and PsycINFO, up to and including December 2022, for articles published in the English language, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of RCT was assessed using the Physiotherapy Evidence Database (PEDro) scale, and level of evidence was assigned using a modified Sackett scale. RESULTS Forty-six RCTs examining interventions and outcome measures related to behavioral issues post-MSTBI were included. These studies collectively enrolled 3,267 participants. The majority of RCTs were conducted in the United States (n = 27; 58.7%) and 28 (60.9%) were conducted after 2010. Of these, 27 RCTs examined non-pharmacological interventions and 19 examined pharmacological interventions. Effective pharmacological treatments included amantadine and dexmedetomidine. Effective non-pharmacological interventions included sensory stimulation in the acute phase, anger self-management programs, peer mentoring, problem-solving, and emotional regulation. Psychotherapy showed conflicting evidence. CONCLUSION This evidence-based review provides a comprehensive overview of the research landscape of RCTs addressing behavior post-MSTBI. The findings from these RCTs may be valuable for health care professionals, researchers, and policymakers involved in the field of TBI and behavior.
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Affiliation(s)
- Heather M MacKenzie
- Author Affiliations : Parkwood Institute Research, Lawson Health Research Institute (Dr MacKenzie, Dr Flores-Sandoval, Dr Bateman, Barua, Dr Mehta); Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario (Dr MacKenzie, Dr Bateman, Dr Mehta); Parkwood Institute, St. Joseph's Health Care London, London (Dr MacKenzie, Dr Flores-Sandoval, Dr Bateman); Arthur Labatt School of Nursing, Western University, London, Ontario (Dr McIntyre); Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto (Dr Bayley); KITE Research Institute, University Health Network, Toronto (Dr Bayley); and University Health Network, Toronto Rehabilitation Institute, Toronto, Ontario (Dr Bayley)
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LaForme Fiss A, Chiarello LA, Hsu LY, McCoy SW. Adaptive behavior and mastery motivation in children with physical disabilities. Physiother Theory Pract 2024; 40:1616-1627. [PMID: 36847241 DOI: 10.1080/09593985.2023.2181118] [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] [Received: 07/13/2022] [Revised: 11/30/2022] [Accepted: 02/09/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Adaptive behavior consists of conceptual, social, and practical skills and describes the ability of individuals to manage environmental demands, interact with others, and engage in activities to meet ones needs. Mastery motivation is an intrinsic characteristic that enables persistence when attempting to master a skill. Children with physical disabilities often demonstrate less effective adaptive behaviors and lower mastery motivation than their peers without disabilities, which may subsequently impact development and participation in daily activities. Therefore, it may be beneficial for pediatric rehabilitation practitioners to focus intentionally on facilitating effective adaptive behaviors in children with physical disabilities as they aim to support child development and function. OBJECTIVE This perspective paper highlights the importance of adaptive behavior for children with physical disabilities, discusses methods of assessment, and illustrates intervention principles and strategies to support the development of appropriate adaptive behaviors across childhood. Key intervention principles include: 1) engage children and address motivation; 2) collaborate with others; 3) support real-life meaningful experiences; 4) scaffold the just-right challenge; and 5) guide children in discovering solutions.
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Affiliation(s)
| | - Lisa A Chiarello
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA USA
| | - Lin-Ya Hsu
- Department of Rehabilitative Medicine, University of Washington, Seattle, WA USA
| | - Sarah Westcott McCoy
- Department of Rehabilitative Medicine, University of Washington, Seattle, WA USA
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Toby LM, Hustyi KM, Hartley BK, Dubuque ML, Outlaw EE, Logue JJ. Development and Preliminary Validation of the Patient Outcome Planning Calculator (POP-C): A Tool for Determining Treatment Dosage in Applied Behavior Analysis. Behav Anal Pract 2024; 17:601-614. [PMID: 38966276 PMCID: PMC11219665 DOI: 10.1007/s40617-023-00861-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 07/06/2024] Open
Abstract
Board certified behavior analysts (BCBA) are responsible for determining the medically necessary treatment dosage for patients (i.e., the number of hours of therapy a patient should receive per week to optimize progress) during applied behavior analysis (ABA) therapy. However, because there is currently no standard method for making these determinations, BCBAs must rely on their own clinical judgment. Given that clinical judgment may be underdeveloped in some BCBAs, particularly those who are newly certified, more formal strategies are needed to guide decision making as it relates to medical necessity and treatment dosage. In this article we describe the development of the Patient Outcome Planning Calculator (POP-C), a standardized decision-making tool designed to assist novice practitioners in determining the medically necessary ABA treatment intensity and appropriate treatment setting for individuals with autism spectrum disorder (ASD). We present preliminary reliability data as well as construct validity data indicating statistically significant correlations between the POP-C and several norm-referenced and criterion-referenced assessments commonly used to estimate skill level and the corresponding degree of support needed within the ASD population to inform the ABA treatment model and goals. Supplementary Information The online version contains supplementary material available at 10.1007/s40617-023-00861-6.
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Affiliation(s)
- Lauryn M. Toby
- LittleStar ABA Therapy, Congressional Blvd, Carmel, IN 46032 USA
| | | | | | - Molly L. Dubuque
- LittleStar ABA Therapy, Congressional Blvd, Carmel, IN 46032 USA
| | - Erica E. Outlaw
- LittleStar ABA Therapy, Congressional Blvd, Carmel, IN 46032 USA
| | - Jesse J. Logue
- LittleStar ABA Therapy, Congressional Blvd, Carmel, IN 46032 USA
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Ruiz M, Groessing A, Guran A, Koçan AU, Mikus N, Nater UM, Kouwer K, Posserud MB, Salomon-Gimmon M, Todorova B, Wagner IC, Gold C, Silani G, Specht K. Music for autism: a protocol for an international randomized crossover trial on music therapy for children with autism. Front Psychiatry 2023; 14:1256771. [PMID: 37886114 PMCID: PMC10598663 DOI: 10.3389/fpsyt.2023.1256771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/18/2023] [Indexed: 10/28/2023] Open
Abstract
The notion of a connection between autism and music is as old as the first reported cases of autism, and music has been used as a therapeutic tool for many decades. Music therapy holds promise as an intervention for individuals with autism, harnessing their strengths in music processing to enhance communication and expression. While previous randomized controlled trials have demonstrated positive outcomes in terms of global improvement and quality of life, their reliance on psychological outcomes restricts our understanding of underlying mechanisms. This paper introduces the protocol for the Music for Autism study, a randomized crossover trial designed to investigate the effects of a 12-week music therapy intervention on a range of psychometric, neuroimaging, and biological outcomes in school-aged children with autism. The protocol builds upon previous research and aims to both replicate and expand upon findings that demonstrated improvements in social communication and functional brain connectivity following a music intervention. The primary objective of this trial is to determine whether music therapy leads to improvements in social communication and functional brain connectivity as compared to play-based therapy. In addition, secondary aims include exploring various relevant psychometric, neuroimaging, and biological outcomes. To achieve these objectives, we will enroll 80 participants aged 6-12 years in this international, assessor-blinded, crossover randomized controlled trial. Each participant will be randomly assigned to receive either music therapy or play-based therapy for a period of 12 weeks, followed by a 12-week washout period, after which they will receive the alternate intervention. Assessments will be conducted four times, before and after each intervention period. The protocol of the Music for Autism trial provides a comprehensive framework for studying the effects of music therapy on a range of multidimensional outcomes in children with autism. The findings from this trial have the potential to contribute to the development of evidence-based interventions that leverage strengths in music processing to address the complex challenges faced by individuals with autism. Clinical Trial Registration: Clinicaltrials.gov identifier NCT04936048.
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Affiliation(s)
- Marianna Ruiz
- Department of Health and Social Sciences, Norwegian Research Centre (NORCE), Bergen, Norway
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Alexander Groessing
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Alexandrina Guran
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
- Vienna Cognitive Science Hub, University of Vienna, Vienna, Austria
| | - Asena U. Koçan
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Nace Mikus
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
- School of Culture and Society, Interacting Minds Centre, Aarhus University, Aarhus, Denmark
| | - Urs M. Nater
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Karlijn Kouwer
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Maj-Britt Posserud
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Maayan Salomon-Gimmon
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
- The School of Creative Arts Therapies, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Boryana Todorova
- Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Isabella C. Wagner
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
- Vienna Cognitive Science Hub, University of Vienna, Vienna, Austria
- Centre for Microbiology and Environmental Systems Science, University of Vienna, Vienna, Austria
| | - Christian Gold
- Department of Health and Social Sciences, Norwegian Research Centre (NORCE), Bergen, Norway
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Giorgia Silani
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Karsten Specht
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway
- Department of Education, Faculty of Humanities, Social Sciences and Education, UiT-The Arctic University of Norway, Tromsø, Norway
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Eckes T, Buhlmann U, Holling HD, Möllmann A. Comprehensive ABA-based interventions in the treatment of children with autism spectrum disorder - a meta-analysis. BMC Psychiatry 2023; 23:133. [PMID: 36864429 PMCID: PMC9983163 DOI: 10.1186/s12888-022-04412-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/22/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Many studies display promising results for interventions that are based on Applied Behavior Analysis (ABA) in the treatment of autism spectrum disorder (ASD). METHODS This meta-analysis assessed the effects of such treatments on developmental outcomes in children with ASD and on parental stress based on 11 studies with 632 participants. RESULTS Compared to treatment as usual, minimal or no treatment, comprehensive ABA-based interventions showed medium effects for intellectual functioning (standardized mean difference SMD = 0.51, 95% CI [0.09; 0.92]) and adaptive behavior (SMD = 0.37, 95% CI [0.03; 0.70]). Language abilities, symptom severity or parental stress did not improve beyond the improvement in control groups. Moderator analyses indicate that language abilities at intake could influence the effect sizes and the influence of treatment intensity might decrease with older age. CONCLUSIONS Practical implications and limitations are discussed.
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Affiliation(s)
- Theresa Eckes
- Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany
| | - Ulrike Buhlmann
- Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany
| | - Heinz-Dieter Holling
- Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany
| | - Anne Möllmann
- Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Münster, Germany.
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Bremen, Grazer Str. 6, 28359, Bremen, Germany.
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Gitimoghaddam M, Chichkine N, McArthur L, Sangha SS, Symington V. Applied Behavior Analysis in Children and Youth with Autism Spectrum Disorders: A Scoping Review. Perspect Behav Sci 2022; 45:521-557. [PMID: 36249174 PMCID: PMC9458805 DOI: 10.1007/s40614-022-00338-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 12/18/2022] Open
Abstract
This manuscript provides a comprehensive overview of the impact of applied behavior analysis (ABA) on children and youth with autism spectrum disorders (ASD). Seven online databases and identified systematic reviews were searched for published, peer-reviewed, English-language studies examining the impact of ABA on health outcomes. Measured outcomes were classified into eight categories: cognitive, language, social/communication, problem behavior, adaptive behavior, emotional, autism symptoms, and quality of life (QoL) outcomes. Improvements were observed across seven of the eight outcome measures. There were no included studies that measured subject QoL. Moreover, of 770 included study records, only 32 (4%) assessed ABA impact, had a comparison to a control or other intervention, and did not rely on mastery of specific skills to mark improvement. Results reinforce the need for large-scale prospective studies that compare ABA with other non-ABA interventions and include measurements of subject QoL to provide policy makers with valuable information on the impacts of ABA and other existing and emerging interventions. Supplementary Information The online version contains supplementary material available at 10.1007/s40614-022-00338-x.
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Affiliation(s)
- Mojgan Gitimoghaddam
- University of British Columbia Faculty of Medicine, Vancouver, British Columbia Canada
| | | | - Laura McArthur
- Club Aviva Recreation Ltd., Coquitlam, British Columbia Canada
| | - Sarabjit S Sangha
- Club Aviva Recreation Ltd., Coquitlam, British Columbia Canada
- University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Australia
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Daniolou S, Pandis N, Znoj H. The Efficacy of Early Interventions for Children with Autism Spectrum Disorders: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:5100. [PMID: 36079029 PMCID: PMC9457367 DOI: 10.3390/jcm11175100] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/12/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
The superiority of early interventions for children with autism spectrum disorders (ASDs) compared to treatment as usual (TAU) has recently been questioned. This study was aimed to investigate the efficacy of early interventions in improving the cognitive ability, language, and adaptive behavior of pre-school children with ASDs through a systematic review of randomized controlled trials (RCTs). In total, 33 RCTs were included in the meta-analysis using the random effects model. The total sample consisted of 2581 children (age range: 12-132 months). Early interventions led to positive outcomes for cognitive ability (g = 0.32; 95% CI: 0.05, 0.58; p = 0.02), daily living skills (g = 0.35; 95% CI: 0.08, 0.63; p = 0.01), and motor skills (g = 0.39; 95% CI: 0.16, 0.62; p = 0.001), while no positive outcomes were found for the remaining variables. However, when studies without the blinding of outcome assessment were excluded, positive outcomes of early interventions only remained for daily living skills (g = 0.28; 95% CI: 0.04, 0.52; p = 0.02) and motor skills (g = 0.40; 95% CI: 0.11, 0.69; p = 0.007). Although early intervention might not have positive impacts on children with ASDs for several outcomes compared to controls, these results should be interpreted with caution considering the great variability in participant and intervention characteristics.
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Affiliation(s)
- Sofia Daniolou
- Department of Psychology, University of Bern, 3012 Bern, Switzerland
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, 3010 Bern, Switzerland
| | - Hansjörg Znoj
- Department of Psychology, University of Bern, 3012 Bern, Switzerland
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Golos A, Ben-Zur H, Chapani SI. Participation in preschool activities of children with autistic spectrum disorder and comparison to typically developing children. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 127:104252. [PMID: 35569171 DOI: 10.1016/j.ridd.2022.104252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 03/09/2022] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Participation is essential to children's development and is a major focus of intervention. This study aimed to describe the participation patterns of children with ASD, in comparison to typically developing (TD) children. METHODS 70 preschoolers participated: 33 children with ASD, attending non-inclusive-education settings; and 37 TD children, attending mainstream educational settings. Two occupational therapists assessed their participation through structured observations in self-care activities, play, learning, and social participation areas; demographic and environmental questionnaires were also completed. RESULTS In the ASD group, frequency of participation was found to be significantly higher in ADL and learning than in other areas; level of performance was found to be significantly lower in social participation than in other areas. The TD group scored significantly higher than did the ASD group in most areas and scales. Initial findings tentatively showed that a structured educational environment for children with ASD may increase participation frequency. CONCLUSIONS The findings are consistent with recognized disabilities in play and social participation among children with ASD, and their limitations in participation, compared to their TD peers in most areas. Further studies are needed to evaluate additional psychometric properties of the different scales, and the impact of educational environments on participation.
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Affiliation(s)
- Anat Golos
- OTR, Head of Environment, Culture and Participation in Community Laboratory, School of Occupational Therapy , Hebrew University, Jerusalem, Israel.
| | - Hadas Ben-Zur
- OTR, Ministry of Education and School of Occupational Therapy, Hebrew University, Jerusalem, Israel.
| | - Sophi Itkin Chapani
- OTR, ALUT organization and School of Occupational Therapy, Hebrew University, Jerusalem, Israel.
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9
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Meza N, Rojas V, Escobar Liquitay CM, Pérez I, Aguilera Johnson F, Amarales Osorio C, Irarrázaval M, Madrid E, Franco JVA. Non-pharmacological interventions for autism spectrum disorder in children: an overview of systematic reviews. BMJ Evid Based Med 2022:bmjebm-2021-111811. [PMID: 35217568 DOI: 10.1136/bmjebm-2021-111811] [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: 01/25/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the effectiveness of non-pharmacological interventions for the treatment of autism spectrum disorder (ASD) in children. DESIGN Overview of systematic reviews (SRs). PARTICIPANTS Children aged 12 years and under with ASD. SEARCH METHODS In October 2021, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO and Epistemonikos placing no restrictions on language or date of publication. INTERVENTIONS 17 non-pharmacological interventions compared with placebo, no-treatment (including waiting list) or other interventions (ie, usual care, as defined by the authors of each study). DATA COLLECTION AND ANALYSIS We rated the methodological quality of the included SRs using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). We reported the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) certainty of the evidence (CoE) according to the analysis conducted by the authors of the included SRs. MAIN OUTCOME MEASURES A multidisciplinary group of experts agreed on analysing nine critical outcomes evolving core and non-core ASD symptoms. PUBLIC AND PATIENT INVOLVEMENT STATEMENT Organisations of parents of children with ASD participated in external revision of the final version of the report. RESULTS We identified 52 reports that were within our scope, of which 48 were excluded for various reasons. After excluding less reliable SRs, we included four SRs. Non-pharmacological interventions (ie, Early Intensive Behavioural Intervention, Applied Behaviour Analysis, Picture Exchange Communication System and Naturalistic Developmental Behavioural Interventions) may have favourable effects on some core outcomes including language, social and functioning, play or daily living skills in children with ASD (with either no GRADE assessment, very low or low CoE). In addition, we identified a lack of report for other key outcomes in the included SRs (ie, restricted, repetitive behaviour; play and sensory processing). CONCLUSIONS Synthesised evidence regarding the efficacy of non-pharmacological interventions for children with ASD is scarce. High-quality SRs addressing the variety of both non-pharmacological interventions and relevant outcomes are needed. PROSPERO REGISTRATION NUMBER CRD42020206535.
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Affiliation(s)
- Nicolás Meza
- Interdisciplinary Centre for Health Studies (CIESAL), Cochrane Chile Associate Centre, Universidad de Valparaíso, Viña del Mar, Chile
| | - Valeria Rojas
- School of Medicine, Universidad de Valparaíso, Viña del Mar, Chile
- Autism program, Hospital Dr Gustavo Fricke, Viña del Mar, Chile
| | | | - Ignacio Pérez
- School of Medicine, Universidad de Valparaíso, Viña del Mar, Chile
| | | | - Claudia Amarales Osorio
- School of Medicine, Universidad de Valparaíso, Viña del Mar, Chile
- Pediatric Neurology Unit, Hospital Carlos van Buren, Valparaíso, Chile
| | - Matías Irarrázaval
- Department of Mental Health, Ministry of Health, Santiago, Chile
- Millenium Institute for Research in Depression and Personality, Santiago, Chile
| | - Eva Madrid
- Interdisciplinary Centre for Health Studies (CIESAL), Cochrane Chile Associate Centre, Universidad de Valparaíso, Viña del Mar, Chile
| | - Juan Victor Ariel Franco
- Associate Cochrane Centre - Research Department, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Yazıcı S, Oksev BK, Demirarslan PÇ, Uğurlu M, Nazık A. Parent observations about the impact of COVID-19 on children with autism spectrum disorder in Turkey. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 69:835-844. [PMID: 37885846 PMCID: PMC10599176 DOI: 10.1080/20473869.2021.2023447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/23/2021] [Indexed: 10/28/2023]
Abstract
Objectives: The Covid-19 pandemic has shown that people with disabilities are the most vulnerable, neglected and discriminated individuals at times of emergency. National and international studies are needed to understand the extent to which the general well-being, quality of life, and positive and negative behaviors of children with ASD are affected during the pandemic. Methods: This study explores the impact of Covid-19 on the typical behaviors of children with Autism Spectrum Disorder (ASD) by focusing on quantitative observation findings obtained from their parents and caregivers. In order to explore the effects of three months of pandemic restrictions during the initial period, 103 parents and caregivers were asked to describe significant behavior changes in their children with ASD comparing before and during the pandemic period. Results: The results showed that children were negatively affected in 21 of 32 typical ASD traits. However, a significant number of participants also reported positive changes in several of their children's social and communicative behaviors as shared family time increased during the pandemic. This finding alone was not statistically supported. However, when it was coupled with the variable of access to online education assistance, it was concluded that the two variables together reduced the negative impact on children. Additionally, we found a sex difference in the impact of Covid-19 on children with ASD. The test results and mean scores show that girls were affected either more negatively or more positively than boys. Conclusions: Our results indicate that the negative effects of a natural disaster such as Covid-19 may be decreased when family members cooperatively share their responsibilities, spend more time with their children with ASD, and use distance education support services.Keywords: Autism spectrum disorder, Covid-19, pandemic, parents, sex difference, social distancing.
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Affiliation(s)
- Sedat Yazıcı
- Center for Research and Practice in Special Education, Bartin University, Bartın, Turkey
| | - Birgül Koçak Oksev
- Center for Research and Practice in Special Education, Bartin University, Bartın, Turkey
| | | | - Mahir Uğurlu
- Department of Special Education, Bartin University, Bartın, Turkey
| | - Ayşenur Nazık
- Department of Child Development, Bartin University, Bartın, Turkey
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Gosling CJ, Cartigny A, Mellier BC, Solanes A, Radua J, Delorme R. Efficacy of psychosocial interventions for Autism spectrum disorder: an umbrella review. Mol Psychiatry 2022; 27:3647-3656. [PMID: 35790873 PMCID: PMC9708596 DOI: 10.1038/s41380-022-01670-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The wide range of psychosocial interventions designed to assist people with Autism Spectrum Disorder (ASD) makes it challenging to compile and hierarchize the scientific evidence that supports the efficacy of these interventions. Thus, we performed an umbrella review of published meta-analyses of controlled clinical trials that investigated the efficacy of psychosocial interventions on both core and related ASD symptoms. METHODS Each meta-analysis that was identified was re-estimated using a random-effects model with a restricted maximum likelihood estimator. The methodological quality of included meta-analyses was critically appraised and the credibility of the evidence was assessed algorithmically according to criteria adapted for the purpose of this study. RESULTS We identified a total of 128 meta-analyses derived from 44 reports. More than half of the non-overlapping meta-analyses were nominally statistically significant and/or displayed a moderate-to-large pooled effect size that favored the psychosocial interventions. The assessment of the credibility of evidence pointed out that the efficacy of early intensive behavioral interventions, developmental interventions, naturalistic developmental behavioral interventions, and parent-mediated interventions was supported by suggestive evidence on at least one outcome in preschool children. Possible outcomes included social communication deficits, global cognitive abilities, and adaptive behaviors. Results also revealed highly suggestive indications that parent-mediated interventions improved disruptive behaviors in early school-aged children. The efficacy of social skills groups was supported by suggestive evidence for improving social communication deficits and overall ASD symptoms in school-aged children and adolescents. Only four meta-analyses had a statistically significant pooled effect size in a sensitivity analysis restricted to randomized controlled trials at low risk of detection bias. DISCUSSION This umbrella review confirmed that several psychosocial interventions show promise for improving symptoms related to ASD at different stages of life. However, additional well-designed randomized controlled trials are still required to produce a clearer picture of the efficacy of these interventions. To facilitate the dissemination of scientific knowledge about psychosocial interventions for individuals with ASD, we built an open-access and interactive website that shares the information collected and the results generated during this umbrella review. PRE-REGISTRATION PROSPERO ID CRD42020212630.
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Affiliation(s)
- Corentin J. Gosling
- Paris Nanterre University, DysCo Laboratory, F-92000 Nanterre, France ,grid.508487.60000 0004 7885 7602Université de Paris, Laboratoire de Psychopathologie et Processus de Santé, F-92100 Boulogne-Billancourt, France ,grid.5491.90000 0004 1936 9297Centre for Innovation in Mental Health (CIMH), School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Ariane Cartigny
- grid.508487.60000 0004 7885 7602Université de Paris, Laboratoire de Psychopathologie et Processus de Santé, F-92100 Boulogne-Billancourt, France ,grid.413235.20000 0004 1937 0589Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris, France
| | | | - Aleix Solanes
- grid.10403.360000000091771775Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain
| | - Joaquim Radua
- grid.10403.360000000091771775Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain ,grid.13097.3c0000 0001 2322 6764Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK ,grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Richard Delorme
- grid.413235.20000 0004 1937 0589Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, Paris, France ,grid.428999.70000 0001 2353 6535Human Genetics and Cognitive Functions, Institut Pasteur, Paris, France
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12
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Noda S, Murakami A, Kimura S, Minamiyama M, Katsuno M, Kuru S. Duchenne Muscular Dystrophy Successfully Treated with Aripiprazole in a Patient with Autism Spectrum Disorder Symptoms Including Irritability. Intern Med 2021; 60:3983-3986. [PMID: 34148958 PMCID: PMC8758452 DOI: 10.2169/internalmedicine.7248-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Duchenne muscular dystrophy (DMD) is associated with neuropsychiatric disorders, and patients often present with autism spectrum disorder (ASD). We herein report a case of DMD accompanied by ASD that was successfully treated with aripiprazole, an atypical antipsychotic that has been used for treating irritability in child and early adolescent patients with ASD. The patient was diagnosed as having DMD at 3 years of age. Although he developed severe psychotic symptoms including irritability, insomnia, hallucinations, and delusions at 17 years of age, all the symptoms were successfully treated with aripiprazole without any detectable side effects.
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Affiliation(s)
- Seiya Noda
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
- Department of Neurology, National Hospital Organization Suzuka Hospital, Japan
| | - Ayuka Murakami
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
- Department of Neurology, National Hospital Organization Suzuka Hospital, Japan
| | - Seigo Kimura
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
- Department of Neurology, National Hospital Organization Suzuka Hospital, Japan
| | - Makoto Minamiyama
- Department of Neurology, National Hospital Organization Suzuka Hospital, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Satoshi Kuru
- Department of Neurology, National Hospital Organization Suzuka Hospital, Japan
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13
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London EB, Yoo JH. From Research to Practice: Toward the Examination of Combined Interventions for Autism Spectrum Disorders. Brain Sci 2021; 11:1073. [PMID: 34439691 PMCID: PMC8391105 DOI: 10.3390/brainsci11081073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/25/2021] [Accepted: 08/06/2021] [Indexed: 12/04/2022] Open
Abstract
The use of biological (i.e., medications) in conjunction with applied behavior analysis is relatively common among people with ASD, yet research examining its benefit is scarce. This paper provides a brief overview of the existing literature on the combined interventions, including promising developments, and examines the existing barriers that hinder research in this area, including the heavy reliance on RCTs. Recommendations for possible solutions, including the creation of health homes, are provided in order to move toward a more integrated approach.
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Affiliation(s)
- Eric Bart London
- Department of Psychology, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road Staten Island, New York, NY 10314, USA;
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14
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Nguyen Thanh L, Nguyen H, Duy Ngo M, Bui VA, Dam PT, Thi Phuong Bui H, Van Ngo D, Tran KT, Thi Thanh Dang T, Duc Duong B, Anh Thi Nguyen P, Forstyth N, Heke M. In Reply. Stem Cells Transl Med 2021; 10:827-828. [PMID: 34010520 PMCID: PMC8133348 DOI: 10.1002/sctm.20-0452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/11/2020] [Accepted: 12/07/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Liem Nguyen Thanh
- Vinmec Research Institute of Stem Cell and Gene Technology (VRISG)HanoiVietnam
| | - Hoang‐Phuong Nguyen
- Vinmec Research Institute of Stem Cell and Gene Technology (VRISG)HanoiVietnam
| | - Minh Duy Ngo
- Vinmec Times City International HospitalHanoiVietnam
| | - Viet Anh Bui
- Vinmec Hightech Center, Vinmec Health Care SystemHanoiVietnam
| | - Phuong T.M. Dam
- Vinmec Hightech Center, Vinmec Health Care SystemHanoiVietnam
| | | | - Doan Van Ngo
- Vinmec Times City International HospitalHanoiVietnam
| | - Kien Trung Tran
- Vinmec Research Institute of Stem Cell and Gene Technology (VRISG)HanoiVietnam
| | | | | | | | | | - Michael Heke
- Department of BiologyStanford UniversityStanfordCaliforniaUSA
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15
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Rodgers M, Simmonds M, Marshall D, Hodgson R, Stewart LA, Rai D, Wright K, Ben-Itzchak E, Eikeseth S, Eldevik S, Kovshoff H, Magiati I, Osborne LA, Reed P, Vivanti G, Zachor D, Couteur AL. Intensive behavioural interventions based on applied behaviour analysis for young children with autism: An international collaborative individual participant data meta-analysis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1137-1153. [PMID: 33482692 PMCID: PMC8108110 DOI: 10.1177/1362361320985680] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
LAY ABSTRACT Early intensive applied behaviour analysis-based interventions are designed to support young autistic children's learning and development. Unfortunately, the available evidence about the effectiveness of these interventions remains unclear. Several reviews have focused on the published findings rather than contacting the authors to collect and analyse data about the individual participants in the original studies. Also, most of the studies were carried out by groups involved in delivering the interventions leading to the potential bias in interpreting the results. Our research team (supported by an international advisory group) carried out an independent individual patient data review by collecting the original participant data from the authors of the studies, to examine the effectiveness of these interventions. The results suggested that early intensive applied behaviour analysis-based interventions might lead to some changes in children's cognitive ability (intelligence quotient) and everyday life skills after 2 years, compared with standard treatments. However, all the studies had problems with the way they were designed. Also, few of the studies looked at outcomes that have been described as most important to autistic people or followed children beyond 2 years. We think that further systematic reviews of the existing evidence are unlikely to add to the findings of our review. Furthermore, we recommend that future research should investigate which types of supports and interventions are most effective for children and families, prioritising outcomes measures that are meaningful for the autism community and include, wherever possible, longer-term follow-up.
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Wang X, Zhao J, Huang S, Chen S, Zhou T, Li Q, Luo X, Hao Y. Cognitive Behavioral Therapy for Autism Spectrum Disorders: A Systematic Review. Pediatrics 2021; 147:peds.2020-049880. [PMID: 33888566 DOI: 10.1542/peds.2020-049880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT In several studies, authors have reported on cognitive behavioral therapy (CBT) for children and adolescents with autism spectrum disorders (ASDs), but inconsistent treatment effectiveness was revealed from these studies. OBJECTIVE To evaluate the effectiveness of CBT on the symptoms of ASD and social-emotional problems in children or adolescents with ASD by using a meta-analytic approach. DATA SOURCES Data sources included PubMed, Embase, and the Cochrane Library. STUDY SELECTION We selected randomized controlled trials (RCTs) in which authors reported effectiveness of CBT on the symptoms of ASD and social-emotional problems in children or adolescents with ASD from database inception to May 2019. DATA EXTRACTION For each study, 2 authors extracted data on the first author's surname, publication year, country, sample size, mean age, CBT target, intervention, outcome measurement, follow-up duration, and investigated outcomes. RESULTS Forty-five RCTs and 6 quasi RCTs of 2485 children and adolescents with ASDs were selected for the final meta-analysis. There was no significant difference between CBT and control for symptoms related to ASD based on self-reported outcomes (standard mean difference: -0.09; 95% confidence interval: -0.42 to 0.24; P = .593), whereas CBT significantly improved the symptoms related to ASD based on informant-reported outcomes, clinician-rated outcomes, and task-based outcomes. Moreover, the pooled standard mean differences indicated that CBT has no significant effect on symptoms of social-emotional problems based on self-reported outcomes. LIMITATIONS The quality of included studies was low to modest, significant heterogeneity among the included studies for all investigated outcomes was detected, and publication bias was inevitable. CONCLUSIONS These findings indicate that CBT may significantly improve the symptoms of ASD and social-emotional problems in children or adolescents with ASD.
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Slušná D, Rodríguez A, Salvadó B, Vicente A, Hinzen W. Relations between language, non-verbal cognition, and conceptualization in non- or minimally verbal individuals with ASD across the lifespan. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2021; 6:23969415211053264. [PMID: 36440372 PMCID: PMC9685121 DOI: 10.1177/23969415211053264] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background & aims Individuals with non- or minimally verbal autism (nvASD) are primarily characterized by a severe speech production deficit, with speech limited to no or only a few words by school age. Significant unclarity remains over variability in language profiles across the lifespan, the nature of the language impairment seen, and (dis-) associations between linguistic and nonverbal cognitive measures. Methods To address these questions, we recruited both a school-age and an adult group with nvASD (total N = 49) and investigated relations between expressive and receptive language, and between these and nonverbal intelligence quotient (NVIQ) and sense-making capacities (the ComFor test). Results Results revealed limited variation across this sample in receptive language, which in turn predicted expressive language levels. Importantly, an upward trend in verbal mental age (VMA) across increasing chronological age was seen in the youngsters (only). A radical dissociation between NVIQ and both expressive and receptive language transpired as well, and a subset of individuals with normal NVIQ were comparable in terms of any other cognitive aspect. Sense-making reached symbolic levels in 62.2% of the sample and loaded on both verbal and nonverbal factors. Conclusions These patterns inform theories of nvASD by revealing an impairment that is not conceptualizable as one of expressive language only, sharply limits learning opportunities across the lifespan, and cannot be compensated for by nonverbal cognition. Implications These findings stress the need to seize developmental opportunities that may disappear when youngsters turn into adults, via therapies that specifically target language as a central cognitive system comprising both production and comprehension.
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Affiliation(s)
- Dominika Slušná
- Department of Translation and Language
Sciences, Universitat Pompeu Fabra,
Barcelona, Spain
| | - Andrea Rodríguez
- Centre for Orientation and Assistance of
Infants’ and Youth’s Neurodevelopment (COADI), Barcelona, Spain
| | - Berta Salvadó
- Centre for Orientation and Assistance of
Infants’ and Youth’s Neurodevelopment (COADI), Barcelona, Spain
| | - Agustín Vicente
- Department of Linguistics and Basque Studies,
Universidad del País Vasco,
Vitoria-Gasteiz, Spain
| | - Wolfram Hinzen
- Department of Translation and Language
Sciences, Universitat Pompeu Fabra,
Barcelona, Spain
- Catalan Institution for Research and Advanced
Studies (ICREA), Barcelona, Spain
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18
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Dimian AF, Symons FJ, Wolff JJ. Delay to Early Intensive Behavioral Intervention and Educational Outcomes for a Medicaid-Enrolled Cohort of Children with Autism. J Autism Dev Disord 2020; 51:1054-1066. [DOI: 10.1007/s10803-020-04586-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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19
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Rodgers M, Marshall D, Simmonds M, Le Couteur A, Biswas M, Wright K, Rai D, Palmer S, Stewart L, Hodgson R. Interventions based on early intensive applied behaviour analysis for autistic children: a systematic review and cost-effectiveness analysis. Health Technol Assess 2020; 24:1-306. [PMID: 32686642 PMCID: PMC7397479 DOI: 10.3310/hta24350] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Early intensive applied behaviour analysis-based interventions are intensive interventions for autistic children that are often delivered on a one-to-one basis for 20-50 hours per week. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of early intensive applied behaviour analysis-based interventions for autistic children, based on current evidence. METHODS A systematic review and individual participant data meta-analysis were conducted to evaluate the clinical effectiveness of an early intensive applied behaviour analysis-based intervention for autistic children. An economic analysis included a review of existing analyses and the development of a new model. RESULTS Twenty studies were included in the clinical review. Individual participant data were retrieved from 15 of these studies. Results favoured the interventions when assessing adaptive behaviour after 2 years compared with treatment as usual/eclectic interventions (mean difference 7.00, 95% confidence interval 1.95 to 12.06). In analyses of cognitive ability (intelligence quotient), results favoured the interventions by approximately 10 points after 1 year (mean difference 9.16, 95% confidence interval 4.38 to 13.93) and 2 years (mean difference 14.13, 95% confidence interval 9.16 to 19.10). Evidence for other outcomes was limited and meta-analyses were generally inconclusive. There was no evidence that the effect of the interventions varied with characteristics of the children, but data were limited. Adopting a £30,000 per quality-adjusted life-year threshold, the results of the cost-effectiveness analysis indicate that early intensive applied behaviour analysis-based interventions would need to generate larger benefits or cost savings to be cost-effective. Adopting a public sector perspective and making pessimistic assumptions about long-term effects, the incremental cost-effectiveness ratio for early intensive applied behaviour analysis-based therapy compared with treatment as usual is £189,122 per quality-adjusted life-year. When optimistic assumptions are made, the incremental cost-effectiveness ratio is £46,768 per quality-adjusted life-year. Scenario analyses indicated that these interventions can potentially be cost-effective if long-term improvements persist into adulthood, or if they have significant impact on educational placement. Care should be taken when interpreting these scenarios owing to the limited data. LIMITATIONS All included studies were at risk of bias, there was substantial heterogeneity and effects varied considerably across studies. The effect of intervention on autism symptom severity, language development and school placement remains uncertain because of the limited data. The long-term effects are unclear owing to a lack of follow-up data. CONCLUSIONS This review found limited evidence that early intensive applied behaviour analysis-based interventions may improve cognitive ability and adaptive behaviour, but the long-term impact of the interventions remains unknown. The economic analysis is constrained by the limited effectiveness evidence, but suggests that these interventions are unlikely to be cost-effective unless clear long-term benefits, or a substantial change in which schools children attend, can be identified. FUTURE WORK Further studies into the effectiveness of early intensive applied behaviour analysis-based interventions may be warranted if they include well-defined, alternative interventions as comparators and collect relevant outcomes. Consideration should be given to future studies that not only address whether or not early intensive applied behaviour analysis-based interventions are clinically effective, but also aim to identify which components of early intensive applied behaviour analysis-based interventions might drive effectiveness. STUDY REGISTRATION This study is registered as PROSPERO CRD42017068303. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 35. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Mark Rodgers
- Centre for Reviews and Dissemination, University of York, York, UK
| | - David Marshall
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Mark Simmonds
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Ann Le Couteur
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mousumi Biswas
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Dheeraj Rai
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | - Lesley Stewart
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Robert Hodgson
- Centre for Reviews and Dissemination, University of York, York, UK
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20
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Yu Q, Li E, Li L, Liang W. Efficacy of Interventions Based on Applied Behavior Analysis for Autism Spectrum Disorder: A Meta-Analysis. Psychiatry Investig 2020; 17:432-443. [PMID: 32375461 PMCID: PMC7265021 DOI: 10.30773/pi.2019.0229] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/07/2019] [Accepted: 02/22/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To systematically evaluate evidence for the use of interventions based on appied behavior analysis (ABA) to manage various symptoms of children with autism spectrum disorder (ASD). METHODS Sensitivity analyses were conducted by removing any outlying studies and subgroup analyses were performed to compare the effectiveness of ABA and early start denver model (ESDM), picture exchange communication systems (PECS) and discrete trial training (DTT). RESULTS 14 randomized control trials of 555 participants were included in this meta-analysis. The overall standardized mean difference was d=-0.36 (95% CI -1.31, 0.58; Z=0.75, p=0.45) for autism general symptoms, d=0.11 (95% CI -0.31, 0.54; Z=0.52, p=0.60) for socialization, d=0.30 (95% CI -0.02, 0.61; Z=1.84, p=0.07) for communication and d=-3.52 (95% CI -6.31, -0.72; Z=2.47, p=0.01) for expressive language, d=-0.04 (95% CI -0.44, 0.36; Z=0.20, p=0.84) for receptive language. Those results suggested outcomes of socialization, communication and expressive language may be promising targets for ABA-based interventions involving children with ASD. However, significant effects for the outcomes of autism general symptoms, receptive language, adaptive behavior, daily living skills, IQ, verbal IQ, nenverbal IQ, restricted and repetitive behavior, motor and cognition were not observed. CONCLUSION The small number of studies included in the present study limited the ability to make inferences when comparing ABA, ESDM, PECS and DTT interventions for children with ASD.
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Affiliation(s)
- Qian Yu
- Department of Child Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Enyao Li
- Department of Child Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liguo Li
- Department of Child Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Weiyi Liang
- Department of Rehabilitation, Peking University Shenzhen Hospital, Shenzhen, China
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21
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Kinard JL, Mosner MG, Greene RK, Addicott M, Bizzell J, Petty C, Cernasov P, Walsh E, Eisenlohr-Moul T, Carter RM, McLamb M, Hopper A, Sukhu R, Dichter GS. Neural Mechanisms of Social and Nonsocial Reward Prediction Errors in Adolescents with Autism Spectrum Disorder. Autism Res 2020; 13:715-728. [PMID: 32043748 DOI: 10.1002/aur.2273] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 01/01/2023]
Abstract
Autism spectrum disorder (ASD) is characterized by impaired predictive abilities; however, the neural mechanisms subsuming reward prediction errors in ASD are poorly understood. In the current study, we investigated neural responses during social and nonsocial reward prediction errors in 22 adolescents with ASD (ages 12-17) and 20 typically developing control adolescents (ages 12-18). Participants performed a reward prediction error task using both social (i.e., faces) and nonsocial (i.e., objects) rewards during a functional magnetic resonance imaging scan. Reward prediction errors were defined in two ways: (a) the signed prediction error, the difference between the experienced and expected reward; and (b) the thresholded unsigned prediction error, the difference between expected and unexpected outcomes regardless of magnitude. During social reward prediction errors, the ASD group demonstrated the following differences relative to the TD group: (a) signed prediction error: decreased activation in the right precentral gyrus and increased activation in the right frontal pole; and (b) thresholded unsigned prediction error: increased activation in the right anterior cingulate gyrus and bilateral precentral gyrus. Groups did not differ in brain activation during nonsocial reward prediction errors. Within the ASD group, exploratory analyses revealed that reaction times and social-communication impairments were related to precentral gyrus activation during social prediction errors. These findings elucidate the neural mechanisms of social reward prediction errors in ASD and suggest that ASD is characterized by greater neural atypicalities during social, relative to nonsocial, reward prediction errors in ASD. Autism Res 2020, 13: 715-728. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We used brain imaging to evaluate differences in brain activation in adolescents with autism while they performed tasks that involved learning about social and nonsocial information. We found no differences in brain responses during the nonsocial condition, but differences during the social condition of the learning task. This study provides evidence that autism may involve different patterns of brain activation when learning about social information.
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Affiliation(s)
- Jessica Lynn Kinard
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, Chapel Hill, North Carolina.,Division of Speech and Hearing Sciences, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Maya Gelman Mosner
- Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Rachel Kirsten Greene
- Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Merideth Addicott
- Department of Psychiatry, University of Arkansas for Medical Science, Little Rock, Arkansas
| | - Joshua Bizzell
- Duke-UNC Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina.,Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Chris Petty
- Duke-UNC Brain Imaging and Analysis Center, Duke University Medical Center, Durham, North Carolina
| | - Paul Cernasov
- Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Erin Walsh
- Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Tory Eisenlohr-Moul
- Department of Psychiatry, University of Illinois at Chicago, Neuropsychiatric Institute, Chicago, Illinois
| | - Ronald McKell Carter
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado
| | - Marcy McLamb
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, Chapel Hill, North Carolina
| | - Alissa Hopper
- Division of Speech and Hearing Sciences, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Rebecca Sukhu
- Division of Speech and Hearing Sciences, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
| | - Gabriel Sviatoslav Dichter
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, Chapel Hill, North Carolina.,Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina.,Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
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22
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Yang YH. Review of Early Intervention for Children with Autism Spectrum Disorder: Focused on Randomized Controlled Trials. Soa Chongsonyon Chongsin Uihak 2019; 30:136-144. [PMID: 32595334 PMCID: PMC7298910 DOI: 10.5765/jkacap.180035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 05/07/2019] [Accepted: 08/28/2019] [Indexed: 12/24/2022] Open
Abstract
Early identification and intervention for autism spectrum disorder (ASD) were reported to be important for outcomes or clinical courses. However, there have been a few robust evidences for effectiveness of early intervention until now. This review aims to identify the effectiveness of early intervention by investigating the randomized controlled trial (RCT) of early intervention for autism. There are some RCT studies using behavioral program. Although there are some significant findings, the outcome measurements and small sample size are the limitations. Further studies are needed.
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Affiliation(s)
- Young-Hui Yang
- Department of Child and Adolescent Psychiatry, National Center for Mental Health, Seoul, Korea
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23
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Grey I, Coughlan B, Lydon H, Healy O, Thomas J. Parental satisfaction with early intensive behavioral intervention. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2019; 23:373-384. [PMID: 29157073 DOI: 10.1177/1744629517742813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Research related to parental satisfaction with early intensive behavioral intervention (EIBI) remains limited. A 35-item questionnaire called the parental satisfaction scale-EIBI (PSS-EIBI) was developed with four subdomains (child outcomes, family outcomes, quality of the model, and relationship with the team). Study 1 assessed levels of satisfaction for 48 parents with their child's EIBI program after approximately 1 year of intervention. Study 2 examined the relationship between parental satisfaction, length of child participation in EIBI, and the relationship between parental satisfaction and actual outcomes for their child as assessed by the Verbal Behavior Milestones Assessment and Placement Program after approximately 2 years. Results indicate that parental satisfaction with EIBI was consistently high in all four domains of the PSS-EIBI in both studies. Parental satisfaction was found to be associated with gains in child functioning after 1 year of intervention.
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Affiliation(s)
- Ian Grey
- Zayed University, United Arab Emirates
| | - Barry Coughlan
- Trinity College Dublin, The University of Dublin, Ireland
| | | | - Olive Healy
- Trinity College Dublin, The University of Dublin, Ireland
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Neural Mechanisms of Reward Prediction Error in Autism Spectrum Disorder. AUTISM RESEARCH AND TREATMENT 2019; 2019:5469191. [PMID: 31354993 PMCID: PMC6634058 DOI: 10.1155/2019/5469191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 03/04/2019] [Accepted: 04/23/2019] [Indexed: 01/03/2023]
Abstract
Few studies have explored neural mechanisms of reward learning in ASD despite evidence of behavioral impairments of predictive abilities in ASD. To investigate the neural correlates of reward prediction errors in ASD, 16 adults with ASD and 14 typically developing controls performed a prediction error task during fMRI scanning. Results revealed greater activation in the ASD group in the left paracingulate gyrus during signed prediction errors and the left insula and right frontal pole during thresholded unsigned prediction errors. Findings support atypical neural processing of reward prediction errors in ASD in frontostriatal regions critical for prediction coding and reward learning. Results provide a neural basis for impairments in reward learning that may contribute to traits common in ASD (e.g., intolerance of unpredictability).
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26
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Ameis SH, Kassee C, Corbett-Dick P, Cole L, Dadhwal S, Lai MC, Veenstra-VanderWeele J, Correll CU. Systematic review and guide to management of core and psychiatric symptoms in youth with autism. Acta Psychiatr Scand 2018; 138:379-400. [PMID: 29904907 DOI: 10.1111/acps.12918] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Evidence-based guidance of clinical decision-making for the management of Autism Spectrum Disorder (ASD) is lacking, particularly for co-occurring psychiatric symptoms. This review evaluates treatment evidence for six common symptom targets in children/adolescents with ASD and provides a resource to facilitate application of the evidence to clinical practice. METHOD A systematic search identified randomized controlled trials (RCTs) and high-quality systematic reviews published between 2007 and 2016, focused on: social interaction/communication impairment, stereotypic/repetitive behaviours, irritability/agitation, attention-deficit/hyperactivity disorder symptoms, mood or anxiety symptoms, and sleep difficulties. We then completed qualitative evaluation of high-quality systematic reviews/meta-analyses and quantitative evaluation of recently published RCTs not covered by prior comprehensive systematic reviews. RESULTS Recently published RCTs focused on social interaction and communication impairment (trials = 32) using psychosocial interventions. Interventions for irritability/agitation (trials = 16) were mainly pharmacological. Few RCTs focused on other symptom targets (trials = 2-5/target). Integration of these results with our qualitative review indicated that few established treatment modalities exist, and available evidence is limited by small studies with high risk of bias. CONCLUSION Given the current evidence-base, treatment targets must be clearly defined, and a systematic approach to intervention trials in children/adolescents with ASD must be undertaken with careful consideration of the limitations of safety/efficacy data.
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Affiliation(s)
- S H Ameis
- Child, Youth and Emerging Adult Program, Centre for Addiction and Mental Health (CAMH), Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - C Kassee
- Child, Youth and Emerging Adult Program, Centre for Addiction and Mental Health (CAMH), Campbell Family Mental Health Research Institute, Toronto, ON, Canada
| | - P Corbett-Dick
- Division of Developmental and Behavioural Pediatrics, University of Rochester School of Nursing, University of Rochester Medical Centre, Rochester, NY, USA
| | - L Cole
- Division of Developmental and Behavioural Pediatrics, University of Rochester School of Nursing, University of Rochester Medical Centre, Rochester, NY, USA
| | - S Dadhwal
- Child, Youth and Emerging Adult Program, Centre for Addiction and Mental Health (CAMH), Campbell Family Mental Health Research Institute, Toronto, ON, Canada
| | - M-C Lai
- Child, Youth and Emerging Adult Program, Centre for Addiction and Mental Health (CAMH), Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - J Veenstra-VanderWeele
- New York Presbyterian Hospital Center for Autism and the Developing Brain, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - C U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA.,Hofstra Northwell School of Medicine, Hempstead, NY, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Tachibana Y, Miyazaki C, Mikami M, Ota E, Mori R, Hwang Y, Terasaka A, Kobayashi E, Kamio Y. Meta-analyses of individual versus group interventions for pre-school children with autism spectrum disorder (ASD). PLoS One 2018; 13:e0196272. [PMID: 29763417 PMCID: PMC5953451 DOI: 10.1371/journal.pone.0196272] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 04/10/2018] [Indexed: 12/03/2022] Open
Abstract
There is little evidence regarding the effects of individual and group intervention for children with autism spectrum disorder (ASD) on important outcomes. We performed meta-analyses using a random effects model to investigate the effectiveness of the individual and group intervention studies and to compare the effectiveness of these two types if possible. The main analysis which excluded studies at a high risk of bias (Analysis I) included 14 randomised controlled trials targeting children with ASD≤6 years of age (594 children). The results suggested that both individual and group interventions showed significant effects compared to the control condition on "reciprocity of social interaction towards others" (standard mean difference[SMD] [95%confidence interval{CI}] = 0.59[0.25, 0.93], p = 0.16; 0.45[0.02, 0.88], p = 0.39, respectively). Only individual interventions showed significant effects compared to the control condition on "parental synchrony" (SMD [95%CI] = 0.99 [0.70, 1.29], p<0.01). Our results showed no significant differences between individual and group interventions in effects on "autism general symptoms" (no study available for group intervention), "developmental quotient" (no study available for group intervention), "expressive language" (p = 0.56), "receptive language" (p = 0.29), "reciprocity of social interaction towards others" (p = 0.62), or "adaptive behaviour" (p = 0.43). We also performed sensitivity analyses including studies that had been excluded due to being at a high risk of potential bias (Analysis II). The results suggested that "reciprocity of social interactions towards others" showed significant effects for individual intervention compared to the control condition (0.50[0.31,0.69], p<0.001) but not for group intervention (0.23[-0.33, 0.78], p = 0.42). Individual intervention also showed significant effects on "parental synchrony" (0.98[0.30,1.66], p = 0.005) in the sensitivity analysis. The results also suggested no significant difference on all the outcomes between the individual and group interventions. We also reanalysed the data using cluster-robust standard errors as sensitivity analyses (Analysis III). Analysis III showed no significant effects in the intervention condition compared to the control condition on all the outcomes for both individual and group interventions. When Analysis II was reanalysed using cluster-robust standard errors (Analysis IV), individual interventions showed significant effects compared to the control condition on "reciprocity of social interaction towards others" and "parental synchrony" (mean estimate[95%CI], robust standard error, p = 0.50[0.20, 0.81], 0.13, 0.006; and 1.06[0.08, 2.05], 0.42, 0.04, respectively), and none of the outcomes showed significant effects under the intervention condition compared to the control condition for group interventions. The discrepancies in the results between the main analysis (Analysis I) and the sensitivity analyses (Analyses II, III, and IV) may be due to the small number of included studies. Since the outcome of "reciprocity of social interaction towards others" can be a dependent variable that is usually measured in a context-bound setting with the child's parent, we cannot conclude that individual interventions for pre-school children with ASD have significant effects on generalised skills for engaging in reciprocal interactions with others, even if the interventions have significant effects on the outcome. However, the outcomes of "reciprocity of social interaction towards others" may be promising targets for both individual and group interventions involving pre-school children with ASD. "Parental synchrony" may also be a promising target for individual interventions. TRIAL REGISTRATION (CRD42011001349).
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Affiliation(s)
- Yoshiyuki Tachibana
- Division of Infant and Toddler Mental Health, Department of Psychosocial Medicine, National Centre for Child Health and Development, Tokyo, Japan
- Smart Aging International Research Center, IDAC, Tohoku University, Sendai, Japan
- Department of Child and Adolescent Mental Health, National Center for Neurology and Psychiatry, Tokyo, Japan
| | - Celine Miyazaki
- Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Masashi Mikami
- Department of Biostatistics, Clinical Research Centre, National Centre for Child Health and Development, Tokyo, Japan
| | - Erika Ota
- Department of Global Health Nursing, Graduate School of Nursing Science, St. Luke’s International University, Tokyo, Japan
| | - Rintaro Mori
- Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Yeonhee Hwang
- Department of Education, Tohoku Fukushi University, Sendai, Japan
| | - Akiko Terasaka
- Department of Educational Collaboration, Osaka Kyoiku University, Osaka, Japan
| | - Eriko Kobayashi
- Division of Infant and Toddler Mental Health, Department of Psychosocial Medicine, National Centre for Child Health and Development, Tokyo, Japan
| | - Yoko Kamio
- Department of Child and Adolescent Mental Health, National Center for Neurology and Psychiatry, Tokyo, Japan
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Reichow B, Hume K, Barton EE, Boyd BA. Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database Syst Rev 2018; 5:CD009260. [PMID: 29742275 PMCID: PMC6494600 DOI: 10.1002/14651858.cd009260.pub3] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The rising prevalence of autism spectrum disorders (ASD) increases the need for evidence-based behavioral treatments to lessen the impact of symptoms on children's functioning. At present, there are no curative or psychopharmacological therapies to effectively treat all symptoms of the disorders. Early intensive behavioral intervention (EIBI) is a treatment based on the principles of applied behavior analysis. Delivered for multiple years at an intensity of 20 to 40 hours per week, it is one of the more well-established treatments for ASD. This is an update of a Cochrane review last published in 2012. OBJECTIVES To systematically review the evidence for the effectiveness of EIBI in increasing functional behaviors and skills, decreasing autism severity, and improving intelligence and communication skills for young children with ASD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, 12 additional electronic databases and two trials registers in August 2017. We also checked references and contacted study authors to identify additional studies. SELECTION CRITERIA Randomized control trials (RCTs), quasi-RCTs, and controlled clinical trials (CCTs) in which EIBI was compared to a no-treatment or treatment-as-usual control condition. Participants must have been less than six years of age at treatment onset and assigned to their study condition prior to commencing treatment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane.We synthesized the results of the five studies using a random-effects model of meta-analysis, with a mean difference (MD) effect size for outcomes assessed on identical scales, and a standardized mean difference (SMD) effect size (Hedges' g) with small sample correction for outcomes measured on different scales. We rated the quality of the evidence using the GRADE approach. MAIN RESULTS We included five studies (one RCT and four CCTs) with a total of 219 children: 116 children in the EIBI groups and 103 children in the generic, special education services groups. The age of the children ranged between 30.2 months and 42.5 months. Three of the five studies were conducted in the USA and two in the UK, with a treatment duration of 24 months to 36 months. All studies used a treatment-as-usual comparison group.Primary outcomesThere is low quality-evidence at post-treatment that EIBI improves adaptive behaviour (MD 9.58 (assessed using Vineland Adaptive Behavior Scale (VABS) Composite; normative mean = 100, normative SD = 15), 95% confidence interval (CI) 5.57 to 13.60, P < 0.0001; 5 studies, 202 participants), and reduces autism symptom severity (SMD -0.34, 95% CI -0.79 to 0.11, P = 0.14; 2 studies, 81 participants; lower values indicate positive effects) compared to treatment as usual.No adverse effects were reported across studies.Secondary outcomesThere is low-quality evidence at post-treatment that EIBI improves IQ (MD 15.44 (assessed using standardized IQ tests; scale 0 to 100, normative SD = 15), 95% CI 9.29 to 21.59, P < 0.001; 5 studies, 202 participants); expressive (SMD 0.51, 95% CI 0.12 to 0.90, P = 0.01; 4 studies, 165 participants) and receptive (SMD 0.55, 95% CI 0.23 to 0.87, P = 0.001; 4 studies, 164 participants) language skills; and problem behaviour (SMD -0.58, 95% CI -1.24 to 0.07, P = 0.08; 2 studies, 67 participants) compared to treatment as usual. AUTHORS' CONCLUSIONS There is weak evidence that EIBI may be an effective behavioral treatment for some children with ASD; the strength of the evidence in this review is limited because it mostly comes from small studies that are not of the optimum design. Due to the inclusion of non-randomized studies, there is a high risk of bias and we rated the overall quality of evidence as 'low' or 'very low' using the GRADE system, meaning further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.It is important that providers of EIBI are aware of the current evidence and use clinical decision-making guidelines, such as seeking the family's input and drawing upon prior clinical experience, when making recommendations to clients on the use EIBI. Additional studies using rigorous research designs are needed to make stronger conclusions about the effects of EIBI for children with ASD.
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Affiliation(s)
- Brian Reichow
- University of FloridaAnita Zucker Center for Excellence in Early Childhood StudiesGainesvilleFLUSA
| | - Kara Hume
- University of North Carolina at Chapel HillFrank Porter Graham Child Development Institute517 South Greensboro StreetCarrboroNorth CarolinaUSA27510
| | - Erin E Barton
- Vanderbilt UniversityCollege of Education, Department of Special EducationOne Magnolia Cirlce415BNashvilleTNUSA37203
| | - Brian A Boyd
- University of North Carolina at Chapel HillDivision of Occupational Science and Occupational Therapy, Department of Allied Health SciencesCB 7122Chapel HillNorth CarolinaUSA27599‐7122
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Roche L, Zhang D, Bartl-Pokorny KD, Pokorny FB, Schuller BW, Esposito G, Bölte S, Roeyers H, Poustka L, Gugatschka M, Waddington H, Vollmann R, Einspieler C, Marschik PB. Early Vocal Development in Autism Spectrum Disorder, Rett Syndrome, and Fragile X Syndrome: Insights from Studies using Retrospective Video Analysis. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2018; 2:49-61. [PMID: 29774230 PMCID: PMC5951274 DOI: 10.1007/s41252-017-0051-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This article provides an overview of studies assessing the early vocalisations of children with autism spectrum disorder (ASD), Rett syndrome (RTT), and fragile X syndrome (FXS) using retrospective video analysis (RVA) during the first two years of life. Electronic databases were systematically searched and a total of 23 studies were selected. These studies were then categorised according to whether children were later diagnosed with ASD (13 studies), RTT (8 studies), or FXS (2 studies), and then described in terms of (a) participant characteristics, (b) control group characteristics, (c) video footage, (d) behaviours analysed, and (e) main findings. This overview supports the use of RVA in analysing the early development of vocalisations in children later diagnosed with ASD, RTT or FXS, and provides an in-depth analysis of vocalisation presentation, complex vocalisation production, and the rate and/or frequency of vocalisation production across the three disorders. Implications are discussed in terms of extending crude vocal analyses to more precise methods that might provide more powerful means by which to discriminate between disorders during early development. A greater understanding of the early manifestation of these disorders may then lead to improvements in earlier detection.
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Affiliation(s)
- Laura Roche
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Dajie Zhang
- iDN - interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Katrin D Bartl-Pokorny
- iDN - interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Florian B Pokorny
- iDN - interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Graz, Austria
- Machine Intelligence & Signal Processing group, MMK, Technical University of Munich, Munich, Germany
| | - Björn W Schuller
- Chair of Embedded Intelligence for Health Care and Wellbeing, Augsburg University, Augsburg, Germany
- GLAM - Group on Language, Audio & Music, Imperial College London, London, UK
| | - Gianluca Esposito
- Social & Affective Neuroscience Lab, Division of Psychology - HSS, Nanyang Technological University, Singapore, Singapore
- Affiliative Behaviour and Physiology Lab, Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Child and Adolescent Psychiatry, Center of Psychiatry Research, Stockholm County Council, Stockholm, Sweden
| | - Herbert Roeyers
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Markus Gugatschka
- Department of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Hannah Waddington
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Ralf Vollmann
- Department of Linguistics, University of Graz, Graz, Austria
| | - Christa Einspieler
- iDN - interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Peter B Marschik
- iDN - interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Graz, Austria
- Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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The Efficacy and Safety of Acupuncture for the Treatment of Children with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:1057539. [PMID: 29552077 PMCID: PMC5820575 DOI: 10.1155/2018/1057539] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/13/2017] [Accepted: 11/29/2017] [Indexed: 11/18/2022]
Abstract
Objectives. We aimed to summarize and critically evaluate the available evidence regarding the efficacy and safety of acupuncture for children with autism spectrum disorder (ASD). Methods. We searched 13 databases for studies published up to December 2016. Randomized controlled trials (RCTs) evaluating the efficacy of acupuncture for children with ASD were included. Outcome measures were the overall scores on scales evaluating the core symptoms of ASD and the scores for each symptom, such as social communication ability and skills, stereotypies, language ability, and cognitive function. Effect sizes were presented as mean differences (MD). Results. Twenty-seven RCTs with 1736 participants were included. Acupuncture complementary to behavioral and educational intervention significantly decreased the overall scores on the Childhood Autism Rating Scale (CARS) (MD -8.10, 95% CI -12.80 to -3.40) and the Autism Behavior Checklist (MD -8.92, 95% CI -11.29 to -6.54); however, it was unclear which of the ASD symptoms improved. Acupuncture as a monotherapy also reduced the overall CARS score. The reported adverse events were acceptable. Conclusions. This review suggests that acupuncture may be effective and safe for pediatric ASD. However, it is not conclusive due to the heterogeneity of the acupuncture treatment methods used in the studies.
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Howlin P. Evaluating psychological treatments for children with autism-spectrum disorders. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.109.006684] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryThe internet abounds with promises of ‘miracle cures’ for autism and within the published research literature there are numerous claims and counter-claims for the effectiveness of specific therapies. Systematic evaluations, however, indicate that few treatment programmes have a sound evidence base, and even those interventions that do produce positive findings are not successful for all children. To date, the best researched programmes are those involving intensive, early, home-based intervention, and those with a focus on communication and parent–child interaction. This article assesses the evidence base for some of the better evaluated therapies. There is, as yet, no evidence that any one programme is superior to all others. Indeed, large individual differences in response to intervention suggest that the focus of research now needs to shift to the study of which components of therapy work best for which children and under which conditions.
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Maneeton N, Maneeton B, Putthisri S, Woottiluk P, Narkpongphun A, Srisurapanont M. Risperidone for children and adolescents with autism spectrum disorder: a systematic review. Neuropsychiatr Dis Treat 2018; 14:1811-1820. [PMID: 30022830 PMCID: PMC6045903 DOI: 10.2147/ndt.s151802] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Various clinical trials suggested that risperidone was beneficial in the treatment of autism spectrum disorder (ASD) in children and adolescents. OBJECTIVE The aim of this systematic review was to determine the efficacy, acceptability and tolerability of risperidone in the treatment of children and adolescents with ASD. DATA SOURCES The databases of Scopus, PubMed, CINAHL and Cochrane Controlled Trials Register were searched in February 2017. STUDY ELIGIBILITY CRITERIA PARTICIPANTS AND INTERVENTIONS Eligible RCTs of risperidone in the treatment of child and adolescent patients with ASD. Languages were not restricted. STUDY APPRAISAL AND SYNTHESIS METHODS The full-text versions of relevant studies were thoroughly assessed and extracted. The primary efficacy of outcome was the pooled response rate and the pooled mean changed scores of the standardized rating scales for ASD. RESULTS A total of 372 randomized subjects from seven RCTs were included in this review. In acute treatment, the pooled mean change score of the Aberrant Behavior Checklist for irritability subscale (ABC-I) and response rate for the risperidone-treated group had a greater significance than that of the placebo-treated group. In the long-term treatment, the pooled mean change score of the CARS in the risperidone-treated group was significantly greater than that in the placebo-treated group. According to the discontinuation phase, the overall pooled relapse rate of the risperidone-treated group was significantly less than that of the placebo-treated group. The rates of pooled overall discontinuation and discontinuation due to adverse events rates were not different between the two groups in acute and long-term treatments. LIMITATIONS A small study was included in the current review. CONCLUSION In relation to the current systematic review, risperidone is efficacious in the treatment of symptoms in children and adolescents with ASD. Although its acceptability is comparable to placebo, treatment with risperidone is well tolerated in children and adolescents with ASD.
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Affiliation(s)
- Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,
| | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,
| | - Suwannee Putthisri
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pakapan Woottiluk
- Psychiatric Nursing Division, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Assawin Narkpongphun
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,
| | - Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,
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Maneeton N, Maneeton B, Putthisri S, Suttajit S, Likhitsathian S, Srisurapanont M. Aripiprazole in acute treatment of children and adolescents with autism spectrum disorder: a systematic review and meta-analysis. Neuropsychiatr Dis Treat 2018; 14:3063-3072. [PMID: 30519027 PMCID: PMC6237245 DOI: 10.2147/ndt.s174622] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Recent randomized controlled trials indicated that aripiprazole was the effective treatment for children and adolescents with autism spectrum disorder (ASD). OBJECTIVE This study systematically reviewed the efficacy, acceptability and tolerability of aripiprazole in treatment of ASD children and adolescents. DATA SOURCES Electronic search of databases including, Scopus, PubMed, CINAHL and Cochrane Controlled Trials Register was performed in July 2017. METHODS The full-text versions of included trials were meticulously evaluated and extracted. The main efficacious outcomes consisted of pooled mean change scores of the standardized rating scales for ASD and the pooled response rate. RESULTS A total of 408 randomized patients from eligible trials were included for synthesizing in this meta-analysis. The pooled mean change scores in aripiprazole-treated group for the Aberrant Behavior Checklist (ABC)-Irritability, ABC-Hyperactivity/noncompliance, ABC-Inappropriate speech and ABC-Stereotypic behavior were significantly greater than those of the placebo-treated group. Unfortunately, the significant difference between two groups was not found for ABC-Lethargy/social withdrawal. The overall pooled response rate of the aripiprazole-treated group was significantly higher than that of the placebo-treated group. The pooled overall discontinuation rate in aripiprazole-treated group was significantly better than that of placebo-treated group. The pooled discontinuation rates due to adverse events in aripiprazole-treated group significantly differed from the placebo-treated group (RR [95% CI] of 1.43 [0.65, 3.18], I 2=0%). LIMITATION A small number of studies were gathered in this review. CONCLUSION Aripiprazole has efficacy in the treatment of behavioral disturbances, including irritability, hyperactivity/noncompliance, inappropriate speech and stereotypic behavior found in ASD children and adolescents; however, it could not improve the lethargy/social withdrawal in such patients. The present evidence also indicates that it is safe, acceptable and tolerable in such treatment. As a small sample size, further well-defined and large sample size studies should be conducted to warrant those findings.
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Affiliation(s)
- Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,
| | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,
| | - Suwannee Putthisri
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirijit Suttajit
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,
| | | | - Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,
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Tachibana Y, Miyazaki C, Ota E, Mori R, Hwang Y, Kobayashi E, Terasaka A, Tang J, Kamio Y. A systematic review and meta-analysis of comprehensive interventions for pre-school children with autism spectrum disorder (ASD). PLoS One 2017; 12:e0186502. [PMID: 29211740 PMCID: PMC5718481 DOI: 10.1371/journal.pone.0186502] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 10/03/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There has an increasing number of published trials on psychosocial intervention programmes for pre-school children with autism spectrum disorder (ASD). To achieve better quality of unbiased evidence for the effectiveness of ASD interventions, it is necessary to conduct a comprehensive review that covers studies with adequate quality standards, such as randomised controlled trials (RCTs), and different types of intervention In this study, we categorize interventions for ASD as behavioural, social-communication focused, and multimodal developmental based on Howlin's classification of early interventions for children with ASD. The aim of this study was to compare these three models and investigate the strengths and weaknesses of each type of intervention and to identify the approaches that contribute to a successful outcome for children with autism. METHODS We performed a systematic review and meta-analysis. We included RCTs targeting children with ASD 6 years old or younger. A random effects model was used to present the effect estimate for the outcomes. This study also performed combined meta-analyses of all the three models to investigate the overall effectiveness of the intervention programmes. RESULTS 32 randomized controlled studies were found to be eligible for inclusion. The synthesized data included 594 children from 14 RCTs. There was no statistically significant difference in the effects on autism general symptoms between the social-communication-focused model and the multimodal developmental model (p = 0.83). The results suggest that there is evidence of an effect on 'reciprocity of social interaction towards others' (standard mean difference [95% confidential interval] = 0.53[0.29,0.78], p<0.01) and 'parental synchrony' (SMD = 0.99[0.70,1.29], p<0.01). CONCLUSION The small number of studies included in the present study limited the ability to make inferences when comparing the three models and investigating the strengths and weaknesses of each type of intervention with respect to important outcomes. Since the outcome of 'reciprocity of social interaction towards others' could be a dependent variable that might be context-bound to interactions with the child's parent, we cannot conclude the interventions for pre-school children with ASD have significant effects on a generalized skill to engage in reciprocal interactions with others. However, the outcomes of 'reciprocity of social interaction towards others' and 'parental synchrony' may be promising targets for interventions involving pre-school children with ASD. TRIAL REGISTRATION Prospero CRD42011001349.
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Affiliation(s)
- Yoshiyuki Tachibana
- Division of Infant and Toddler Mental Health, Department of Psychosocial Medicine, National Centre for Child Health and Development, Tokyo, Japan
- Smart Aging International Research Center, IDAC, Tohoku University, Sendai, Japan
- Department of Child and Adolescent Mental Health, National Center for Neurology and Psychiatry, Tokyo, Japan
| | - Celine Miyazaki
- Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Erika Ota
- Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Rintaro Mori
- Department of Health Policy, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Yeonhee Hwang
- Department of Education, Tohoku Fukushi University, Sendai, Japan
| | - Eriko Kobayashi
- Division of Infant and Toddler Mental Health, Department of Psychosocial Medicine, National Centre for Child Health and Development, Tokyo, Japan
| | - Akiko Terasaka
- Department of Educational Collaboration, Osaka Kyoiku University, Osaka, Japan
| | - Julian Tang
- Department of Education for Clinical Research, National Centre for Child Health and Development, Tokyo, Japan
| | - Yoko Kamio
- Department of Child and Adolescent Mental Health, National Center for Neurology and Psychiatry, Tokyo, Japan
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Tiura M, Kim J, Detmers D, Baldi H. Predictors of longitudinal ABA treatment outcomes for children with autism: A growth curve analysis. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 70:185-197. [PMID: 28963874 DOI: 10.1016/j.ridd.2017.09.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 05/26/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a developmental disorder that causes lifelong disability. Applied Behavior Analysis (ABA) is one of the most empirically studied and validated approaches for treating children diagnosed with ASD. Due to the heterogeneity of ASD, it is important to ascertain who will most benefit from treatment. METHODS In this study, 35 participants, with a mean entry age of 3 years, received ABA therapy. Children were assessed at intake and every 6 months thereafter using the Developmental Profile-3 (DP-3) to measure their communication, social-emotional, adaptive behavior, and physical development (2-6 measures per participant). Using a growth curve analysis, we investigated if age, diagnosis severity, cognitive functioning, treatment hours, gender, parent education level, or primary language spoken at home significantly predicted the growth trajectories of ABA treatment outcomes. RESULTS Our findings indicated that higher cognitive functioning significantly predicted faster growth across all four developmental domains, age at entry predicted initial status, and other variables only predicted growth rates in one or two domains. IMPLICATIONS Knowing the predictors of treatment outcome is important information for customizing treatment and this study demonstrated how longitudinal analyses can illuminate how participant characteristics affect the course of ABA therapy.
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Affiliation(s)
- Michael Tiura
- University of California, Berkeley, 4511 Tolman Hall, Berkeley, CA, 94720, United States.
| | - Jinho Kim
- University of California, Berkeley, 4511 Tolman Hall, Berkeley, CA, 94720, United States
| | - Deanne Detmers
- Behavioral Intervention Association, 2354 Powell Street, Suite A, Emeryville, CA, 94608 United States
| | - Hilary Baldi
- Behavioral Intervention Association, 2354 Powell Street, Suite A, Emeryville, CA, 94608 United States
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Dixon MR, Belisle J, McKeel A, Whiting S, Speelman R, Daar JH, Rowsey K. An Internal and Critical Review of the PEAK Relational Training System for Children with Autism and Related Intellectual Disabilities: 2014-2017. THE BEHAVIOR ANALYST 2017; 40:493-521. [PMID: 31978209 PMCID: PMC6701227 DOI: 10.1007/s40614-017-0119-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The PEAK Relational Training System was designed as an assessment instrument and treatment protocol for addressing language and cognitive deficits in children with autism. PEAK contains four comprehensive training modules: Direct Training and Generalization emphasize a contingency-based framework of language development, and Equivalence and Transformation emphasize an approach to language development consistent with Relational Frame Theory. The present paper provides a comprehensive and critical review of peer-reviewed publications based on the entirety PEAK system through April, 2017. We describe both psychometric and outcome research, and indicate both positive features and limitations of this body of work. Finally, we note several research and practice questions that remain to be answered with the PEAK curriculum as well as other many other autism assessment and treatment protocols that are rooted within the framework of applied behavior analysis.
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Affiliation(s)
- Mark R. Dixon
- Behavior Analysis and Therapy Program, Southern Illinois University, Carbondale, IL 62901 USA
| | - Jordan Belisle
- Behavior Analysis and Therapy Program, Southern Illinois University, Carbondale, IL 62901 USA
| | | | - Seth Whiting
- Central Michigan University, Mt Pleasant, MI USA
| | | | | | - Kyle Rowsey
- University of Southern Mississippi, Hattiesburg, MS USA
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Grzadzinski R, Carr T, Colombi C, McGuire K, Dufek S, Pickles A, Lord C. Measuring Changes in Social Communication Behaviors: Preliminary Development of the Brief Observation of Social Communication Change (BOSCC). J Autism Dev Disord 2017; 46:2464-79. [PMID: 27062034 DOI: 10.1007/s10803-016-2782-9] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Psychometric properties and initial validity of the Brief Observation of Social Communication Change (BOSCC), a measure of treatment-response for social-communication behaviors, are described. The BOSCC coding scheme is applied to 177 video observations of 56 young children with ASD and minimal language abilities. The BOSCC has high to excellent inter-rater and test-retest reliability and shows convergent validity with measures of language and communication skills. The BOSCC Core total demonstrates statistically significant amounts of change over time compared to a no change alternative while the ADOS CSS over the same period of time did not. This work is a first step in the development of a novel outcome measure for social-communication behaviors with applications to clinical trials and longitudinal studies.
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Affiliation(s)
- Rebecca Grzadzinski
- Center for Autism and the Developing Brain, Weill Cornell Medical College, New York-Presbyterian Hospital, 21 Bloomingdale Road, Rogers Building, White Plains, NY, 10605, USA
- Teachers College, Columbia University, New York, NY, USA
| | - Themba Carr
- Center for Autism Research and Treatment, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | | | - Kelly McGuire
- Center for Autism and Developmental Disorders, Maine Behavioral Health Care, South Portland, ME, USA
- New York Presbyterian Hospital, Columbia University Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Sarah Dufek
- Center for Autism and the Developing Brain, Weill Cornell Medical College, New York-Presbyterian Hospital, 21 Bloomingdale Road, Rogers Building, White Plains, NY, 10605, USA
| | - Andrew Pickles
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Catherine Lord
- Center for Autism and the Developing Brain, Weill Cornell Medical College, New York-Presbyterian Hospital, 21 Bloomingdale Road, Rogers Building, White Plains, NY, 10605, USA.
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Kwon HJ, Yoo HJ, Kim JH, Noh DH, Sunwoo HJ, Jeon YS, Lee SY, Jo YU, Bong GY. Re-adjusting the cut-off score of the Korean version of the Childhood Autism Rating Scale for high-functioning individuals with autism spectrum disorder. Psychiatry Clin Neurosci 2017; 71:725-732. [PMID: 28547882 DOI: 10.1111/pcn.12540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 04/12/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022]
Abstract
AIM The current cut-off score of the Korean version of the Childhood Autism Rating Scale (K-CARS) does not seem to be sensitive enough to precisely diagnose high-functioning autism. The aim of this study was to identify the optimal cut-off score of K-CARS for diagnosing high-functioning individuals with autism spectrum disorders (ASD). METHODS A total of 329 participants were assessed by the Korean versions of the Autism Diagnostic Interview - Revised (K-ADI-R), Autism Diagnostic Observation Schedule (K-ADOS), and K-CARS. IQ and Social Maturity Scale scores were also obtained. RESULTS The true positive and false negative rates of K-CARS were 77.2% and 22.8%, respectively. Verbal IQ (VIQ) and Social Quotient (SQ) were significant predictors of misclassification. The false negative rate increased to 36.0% from 19.8% when VIQ was >69.5, and the rate increased to 44.1% for participants with VIQ > 69.5 and SQ > 75.5. In addition, if SQ was >83.5, the false negative rate increased to 46.7%, even if the participant's VIQ was ≤69.5. Optimal cut-off scores were 28.5 (for VIQ ≤ 69.5 and SQ ≤ 75.5), 24.25 (for VIQ > 69.5 and SQ > 75.5), and 24.5 (for SQ > 83.5), respectively. CONCLUSION The likelihood of a false negative error increases when K-CARS is used to diagnose high-functioning autism and Asperger's syndrome. For subjects with ASD and substantial verbal ability, the cut-off score for K-CARS should be re-adjusted and/or supplementary diagnostic tools might be needed to enhance diagnostic accuracy for ASD.
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Affiliation(s)
- Hyuk-Jin Kwon
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hee-Jeong Yoo
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Joo-Hyun Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Dong-Hyun Noh
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun-Jung Sunwoo
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ye Seul Jeon
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Youn Lee
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ye-Ul Jo
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Gui-Young Bong
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Évaluation de la prise en charge institutionnelle d’enfants atteints d’un trouble envahissant du développement. EVOLUTION PSYCHIATRIQUE 2017. [DOI: 10.1016/j.evopsy.2016.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Masi A, DeMayo MM, Glozier N, Guastella AJ. An Overview of Autism Spectrum Disorder, Heterogeneity and Treatment Options. Neurosci Bull 2017; 33:183-193. [PMID: 28213805 PMCID: PMC5360849 DOI: 10.1007/s12264-017-0100-y] [Citation(s) in RCA: 437] [Impact Index Per Article: 62.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 01/10/2017] [Indexed: 01/20/2023] Open
Abstract
Since the documented observations of Kanner in 1943, there has been great debate about the diagnoses, the sub-types, and the diagnostic threshold that relates to what is now known as autism spectrum disorder (ASD). Reflecting this complicated history, there has been continual refinement from DSM-III with 'Infantile Autism' to the current DSM-V diagnosis. The disorder is now widely accepted as a complex, pervasive, heterogeneous condition with multiple etiologies, sub-types, and developmental trajectories. Diagnosis remains based on observation of atypical behaviors, with criteria of persistent deficits in social communication and restricted and repetitive patterns of behavior. This review provides a broad overview of the history, prevalence, etiology, clinical presentation, and heterogeneity of ASD. Factors contributing to heterogeneity, including genetic variability, comorbidity, and gender are reviewed. We then explore current evidence-based pharmacological and behavioral treatments for ASD and highlight the complexities of conducting clinical trials that evaluate therapeutic efficacy in ASD populations. Finally, we discuss the potential of a new wave of research examining objective biomarkers to facilitate the evaluation of sub-typing, diagnosis, and treatment response in ASD.
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Affiliation(s)
- Anne Masi
- Autism Clinic for Translational Research, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Marilena M DeMayo
- Autism Clinic for Translational Research, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Nicholas Glozier
- Autism Clinic for Translational Research, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Adam J Guastella
- Autism Clinic for Translational Research, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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Raines TC, Gordon M, Harrell-Williams L, Diliberto RA, Parke EM. Adaptive Skills and Academic Achievement in Latino Students. JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2017. [DOI: 10.1080/15377903.2017.1292974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Tara C. Raines
- Department of Teaching and Learning Sciences, University of Denver, Denver, Colorado, USA
| | - Melissa Gordon
- Department of Teaching and Learning Sciences, University of Denver, Denver, Colorado, USA
| | - Leigh Harrell-Williams
- Department of Counseling, Educational Psychology, and Research, University of Memphis, Memphis, Tennessee, USA
| | | | - Elyse M. Parke
- Department of Psychology, University of Nevada, Las Vegas, Nevada, USA
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Singh R, Turner RC, Nguyen L, Motwani K, Swatek M, Lucke-Wold BP. Pediatric Traumatic Brain Injury and Autism: Elucidating Shared Mechanisms. Behav Neurol 2016; 2016:8781725. [PMID: 28074078 PMCID: PMC5198096 DOI: 10.1155/2016/8781725] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 11/23/2016] [Indexed: 02/08/2023] Open
Abstract
Pediatric traumatic brain injury (TBI) and autism spectrum disorder (ASD) are two serious conditions that affect youth. Recent data, both preclinical and clinical, show that pediatric TBI and ASD share not only similar symptoms but also some of the same biologic mechanisms that cause these symptoms. Prominent symptoms for both disorders include gastrointestinal problems, learning difficulties, seizures, and sensory processing disruption. In this review, we highlight some of these shared mechanisms in order to discuss potential treatment options that might be applied for each condition. We discuss potential therapeutic and pharmacologic options as well as potential novel drug targets. Furthermore, we highlight advances in understanding of brain circuitry that is being propelled by improved imaging modalities. Going forward, advanced imaging will help in diagnosis and treatment planning strategies for pediatric patients. Lessons from each field can be applied to design better and more rigorous trials that can be used to improve guidelines for pediatric patients suffering from TBI or ASD.
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Affiliation(s)
- Rahul Singh
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26505, USA
| | - Ryan C. Turner
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26505, USA
| | - Linda Nguyen
- Department of Basic Pharmaceutical Sciences, West Virginia University School of Medicine, Morgantown, WV 26505, USA
| | - Kartik Motwani
- Department of Medical Sciences, University of Florida School of Medicine, Gainesville, FL 32611, USA
| | - Michelle Swatek
- Department of Psychology, North Carolina State University, Raleigh, NC 27695, USA
| | - Brandon P. Lucke-Wold
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, WV 26505, USA
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Chericoni N, de Brito Wanderley D, Costanzo V, Diniz-Gonçalves A, Leitgel Gille M, Parlato E, Cohen D, Apicella F, Calderoni S, Muratori F. Pre-linguistic Vocal Trajectories at 6-18 Months of Age As Early Markers of Autism. Front Psychol 2016; 7:1595. [PMID: 27807424 PMCID: PMC5070420 DOI: 10.3389/fpsyg.2016.01595] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 09/30/2016] [Indexed: 11/25/2022] Open
Abstract
This study explores pre-linguistic vocal trajectories in infants with autism spectrum disorder (ASD) during caregiver-infant interaction. Home videos were obtained from 10 infants with ASD and 10 typically developing infants (TD), covering three time periods: 0–6 months (T1, 47 video sequences), 6–12 months (T2, 47 video sequences), and 12–18 months (T3, 48 video sequences). In total 142 video sequences were analyzed. Vocalizations, long reduplicated babbling, 2-syllable babbling, and first words were investigated longitudinally. Face-gazing was also analyzed, to evaluate the social quality of vocal behaviors. Results show a lower rate of vocalizations in the ASD group at T2, and a lower rate of first words at T3, compared to the TD group. However, the prevalence of non-social babbling, appeared higher in the ASD group. The implications of these findings for screening programs are discussed.
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Affiliation(s)
| | | | | | | | | | - Erika Parlato
- School of Medicine, Federal University of Minas Gerais Belo Horizonte, Brazil
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Groupe Hospitalier Pitié-Salpérière, Assistance Publique - Hôpitaux de ParisParis, France; Institut des Systèmes Intelligents et de Robotiques, Université Pierre et Marie CurieParis, France
| | | | - Sara Calderoni
- IRCCS Stella Maris FoundationPisa, Italy; Stella Maris Mediterraneo FoundationChiaromonte, Italy
| | - Filippo Muratori
- IRCCS Stella Maris FoundationPisa, Italy; Department of Clinical and Experimental Medicine, University of PisaPisa, Italy
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Gordon-Lipkin E, Foster J, Peacock G. Whittling Down the Wait Time: Exploring Models to Minimize the Delay from Initial Concern to Diagnosis and Treatment of Autism Spectrum Disorder. Pediatr Clin North Am 2016; 63:851-9. [PMID: 27565363 PMCID: PMC5583718 DOI: 10.1016/j.pcl.2016.06.007] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The process from initial concerns to diagnosis of autism spectrum disorder (ASD) can be a long and complicated process. The traditional model for evaluation and diagnosis of ASD often consists of long wait-lists and evaluations that result in a 2-year difference between the earliest signs of ASD and mean age of diagnosis. Multiple factors contribute to this diagnostic bottleneck, including time-consuming evaluations, cost of care, lack of providers, and lack of comfort of primary care providers to diagnose autism. This article explores innovative clinical models that have been implemented to address this as well as future directions and opportunities.
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Affiliation(s)
- Eliza Gordon-Lipkin
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, 716 North Broadway, Baltimore, MD 21205, USA.
| | - Jessica Foster
- Section of Developmental Pediatrics, Akron Children's Hospital, Neuro Developmental Science Center, Considine Professional Building, 215 West Bowery Street, Suite 4400, Akron, OH 44308, USA
| | - Georgina Peacock
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Hwy MS-E88, Atlanta, GA 30329, USA
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Anand D, Oehlberg KA, Treadway MT, Nusslock R. Effect of failure/success feedback and the moderating influence of personality on reward motivation. Cogn Emot 2016; 30:458-71. [DOI: 10.1080/02699931.2015.1013088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Smith T, Iadarola S. Evidence Base Update for Autism Spectrum Disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 44:897-922. [DOI: 10.1080/15374416.2015.1077448] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Shaheen S. How child's play impacts executive function--related behaviors. APPLIED NEUROPSYCHOLOGY-CHILD 2015; 3:182-7. [PMID: 25010084 DOI: 10.1080/21622965.2013.839612] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Executive functions refer to an array of organizing and self-regulating behaviors often associated with maturation of the prefrontal cortex. In fact, young children with rudimentary neurodevelopment of the prefrontal cortex develop ways to inhibit impulses and regulate behavior from a very early age. Can executive functioning be impacted by intervention, practice, or training? What interventions impact development of executive function in childhood, and how can these be studied? Several programs are reviewed that propose to positively impact executive/self-regulation skills. Evidence-based programs are contrasted with popular programs that have little empirical basis but have apparent wide acceptance by educators and families. As self-regulation has critical implications for later school and life success, interventions may well attenuate the negative consequences of attention-deficit hyperactivity disorder, brain injury, and social stressors. Programs with active play components may be more successful in eliciting improved executive function (defined here as self-regulation) because of the importance of motor learning early on and because of the social motivation aspects of learning. Caution is advised in the recommendation of programs where there is little empirical basis to support program claims. Carefully planned outcome studies can help bring the most effective components of programs to the mainstream.
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Strauss K, Benvenuto A, Battan B, Siracusano M, Terribili M, Curatolo P, Fava L. Promoting Shared Decision Making to strengthen outcome of young children with Autism Spectrum Disorders: the role of staff competence. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 38:48-63. [PMID: 25544428 DOI: 10.1016/j.ridd.2014.11.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/21/2014] [Accepted: 11/25/2014] [Indexed: 06/04/2023]
Abstract
Little is known on how the conceptual description of Shared Decision Making (SDM) accomplishes clinical practice in the context of lifetime disabilities as in particular Autism Spectrum Disorders (ASD), when intervention is long-lasting and requires constant family involvement. This study aimed mainly to investigate to what extent the staff's competence in SDM contributes to positive child and parent improvement when involving parents in Early Intensive Behavior Interventions (EIBI). It was also geared to verify whether SDM staff competence contributes to a child's treatment responsiveness. A total of 25 young children with ASD (23 male, 3 female, age range 34-92 months, mean age 51.4±13.6) were included in the study. Of these, nine children were allocated to a Parent Involvement condition accompanied by SDM Staff Training (PI-SDM), and eight children to a Parent Inclusion in Treatment Delivery Only condition without SDM Staff Training (PI-DO). Nine months treatment outcomes of severity, developmental and adaptive measures were compared to Treatment As Usual (n=8). PI-SDM was associated with improvement of autistic symptoms (p≤.05), adaptive functioning (p≤.01) and developmental outcome (p≤.01), as well as parent (p≤.05) and staff competence (p≤.001). The magnitude of outcome was inferior in the PI-PO and TAU group. A Reliable Change was identified in more than 40% of children included in PI-SDM, while PI-PO (>20%) and TAU (>12%) let to little Reliable Change and partially skill deterioration. Staff's SDM skill competence predicts reduced parental stress (β=-.500, p≤.05) and contributes significantly to a positive treatment responder trajectory (p≤.01), besides lower severity (p≤.05), higher adaptive (p≤.01) and communication skills (p≤.05). The study indicates that parent inclusion should be conceptualized as a collaborative partnership model rather than as adherence in treatment provision, based on a target SDM staff training that may constitute an external contributor to treatment responsiveness and positive child as well as parent outcome.
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Affiliation(s)
- Kristin Strauss
- Association for Treatment and Research in Autism and Related Conditions "Umbrella", Rome, Italy
| | - Arianna Benvenuto
- Department of Neuroscience, Pediatric Neurology Unit, Tor Vergata University of Rome, Rome, Italy
| | - Barbara Battan
- Department of Neuroscience, Pediatric Neurology Unit, Tor Vergata University of Rome, Rome, Italy
| | - Martina Siracusano
- Department of Neuroscience, Pediatric Neurology Unit, Tor Vergata University of Rome, Rome, Italy
| | - Monica Terribili
- Department of Neuroscience, Pediatric Neurology Unit, Tor Vergata University of Rome, Rome, Italy
| | - Paolo Curatolo
- Department of Neuroscience, Pediatric Neurology Unit, Tor Vergata University of Rome, Rome, Italy
| | - Leonardo Fava
- Association for Treatment and Research in Autism and Related Conditions "Umbrella", Rome, Italy.
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Pickles A, Anderson DK, Lord C. Heterogeneity and plasticity in the development of language: a 17-year follow-up of children referred early for possible autism. J Child Psychol Psychiatry 2014; 55:1354-62. [PMID: 24889883 DOI: 10.1111/jcpp.12269] [Citation(s) in RCA: 166] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Delayed, abnormal language is a common feature of autism and language therapy often a significant component of recommended treatment. However, as with other disorders with a language component, we know surprisingly little about the language trajectories and how varied these might be across different children. Thus, we know little about how and when language problems might resolve, whether there are periods of relative stability or lack of change and what periods might offer more favourable circumstances for intervention. METHODS Expressive and receptive language was measured on six occasions between age 2 and 19 on a cohort of 192 children initially referred for autism. Latent class growth models were fitted to characterize the patterns of heterogeneous development. RESULTS Latent class growth analysis identified seven classes. Between age 6 and 19, all classes tracked in parallel. Between ages 2 and 6, development was more heterogeneous with considerable variation in relative progress. In all groups, receptive and expressive language developed very largely in tandem. CONCLUSIONS The results confirmed previous analysis of children with specific language impairment where progress beyond age 6 was remarkably uniform. Greater variation was evident before this age with some groups making clearly better or worse progress compared to others. While this developmental heterogeneity may simply be a reflection of variation in preexisting and unchanging biological disposition, it may also reflect, at least in part, greater sensitivity in the early years to environments that are more or less supportive of language development. These findings contribute to the case for the importance of early intervention.
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Affiliation(s)
- Andrew Pickles
- Department of Biostatistics, King's College London, Institute of Psychiatry, London, UK
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