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Shipkova M, Butera CD, Flores GD, Kilroy E, Jayashankar A, Harrison L, Cermak SA, Aziz-Zadeh L. Caregiver and youth inter-rater assessment agreement in autism spectrum disorder, developmental coordination disorder, and typical development. Autism Res 2024; 17:610-625. [PMID: 38450955 PMCID: PMC11022856 DOI: 10.1002/aur.3110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/31/2024] [Indexed: 03/08/2024]
Abstract
Youth diagnosed with autism spectrum disorder (ASD) and those with developmental coordination disorder (DCD) are at heightened risk for co-occurring mental health diagnoses, especially anxiety and attention-deficit/hyperactivity disorder (ADHD). However, caregiver-child agreement on presence of related symptoms in populations with neurodevelopmental conditions is not well understood. Here, we examine the extent to which 37 ASD, 26 DCD, and 40 typically developing children and their caregivers agree on the degree of the child's symptoms of anxiety and ADHD. All caregiver-child dyads completed the Screen for Child Anxiety Related Emotional Disorders and Conners 3 ADHD Index. Across groups, intraclass correlations indicated generally poor agreement on anxiety and ADHD symptomatology. Although youth generally reported greater internalizing symptoms (i.e., anxiety), caregivers tended to report more observable externalizing behaviors (i.e., ADHD). Together, the results of this study support the need for a multi-informant approach in assessments of anxiety and ADHD in youth with neurodevelopmental disorders.
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Affiliation(s)
- Michelle Shipkova
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christiana D Butera
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA
| | - Genesis D Flores
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA
| | - Emily Kilroy
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA
| | - Aditya Jayashankar
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA
| | - Laura Harrison
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA
| | - Sharon A Cermak
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Lisa Aziz-Zadeh
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
- Brain and Creativity Institute, Dornsife College of Letters, Arts and Sciences, University of Southern California, Los Angeles, California, USA
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2
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Reaven J, Pickard K, Meyer AT, Hayutin L, Middleton C, Reyes NM, Tanda T, Stahmer A, Blakeley-Smith A, Boles RE. Implementing school-based cognitive behavior therapy for anxiety in students with autism or suspected autism via a train-the-trainer approach: Results from a clustered randomized trial. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:484-497. [PMID: 37208894 DOI: 10.1177/13623613231175951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
LAY ABSTRACT Autistic youth frequently experience anxiety that can negatively affect them at home, with friends, and at school. Autistic youth have difficulty accessing mental health care, and this is particularly true for youth from traditionally underserved backgrounds. Providing mental health programs in schools may increase access to care for autistic youth with anxiety. The purpose of the study was to train interdisciplinary school providers to deliver school-based Facing Your Fears, a cognitive behavior therapy program for anxiety in autistic youth. Seventy-seven interdisciplinary school providers across 25 elementary/middle schools were trained by their colleagues and members of the research (train-the-trainer approach). Eighty-one students with autism or suspected autism, ages 8-14 years, were randomly assigned to either school-based Facing Your Fears or usual care. Students in school-based Facing Your Fears showed significant reductions in anxiety compared to students in usual care according to caregiver and student report. Other measures involved examining change in provider cognitive behavior therapy knowledge after training and determining how well interdisciplinary school providers were able to deliver school-based Facing Your Fears. Results indicated that interdisciplinary school providers showed significant improvements in cognitive behavior therapy knowledge after training. Interdisciplinary school providers were able to deliver most of school-based Facing Your Fears activities and with good quality. The positive outcomes in this study are encouraging. Training interdisciplinary school providers to deliver school-based Facing Your Fears may increase access to care for anxious autistic students. Future directions and limitations are discussed.
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Affiliation(s)
- Judy Reaven
- University of Colorado Anschutz Medical Campus, USA
| | | | | | - Lisa Hayutin
- University of Colorado Anschutz Medical Campus, USA
| | | | - Nuri M Reyes
- University of Colorado Anschutz Medical Campus, USA
| | - Tanea Tanda
- University of Colorado Anschutz Medical Campus, USA
| | - Aubyn Stahmer
- Davis Health Center, University of California, Davis, USA
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3
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DeVries L, Pickard K, Boles R, Blakeley-Smith A, Duncan A, Keefer A, Klinger L, Meyer A, Reaven J. The Role of Maternal Anxiety in Treatment Response for Youth with ASD and Co-occurring Anxiety. Child Psychiatry Hum Dev 2023; 54:1789-1798. [PMID: 35678890 DOI: 10.1007/s10578-022-01381-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/17/2022] [Accepted: 05/21/2022] [Indexed: 11/28/2022]
Abstract
Anxiety disorders occur at higher rates in youth with ASD than in neurotypical youth. Although the efficacy of CBT for anxiety in children with ASD is widely supported, factors that influence treatment outcomes are not well understood. This study examined the role of maternal anxiety in treatment outcomes for youth with ASD. Youth with ASD and anxiety (ages 8 to 14), along with their mothers (n = 87), participated in a group CBT intervention. Results indicated that maternal anxiety did not improve over the course of treatment. However, findings suggest that high levels of maternal anxiety at pre-treatment predicted higher levels of youth anxiety post-treatment. Importantly, the relationship between parent anxiety and youth outcomes was moderated by child age. The findings of the present study may provide initial insight into the role that maternal anxiety plays in treatment outcomes for children with ASD and co-occurring anxiety, particularly when considering child age.
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Affiliation(s)
- Lindsey DeVries
- Division of Developmental and Behavioral Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Center, 13123 East 16th Avenue, 80045, Aurora, CO, USA.
| | - Katherine Pickard
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Richard Boles
- Departments of Pediatrics and Psychiatry, JFK Partners, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Audrey Blakeley-Smith
- Departments of Pediatrics and Psychiatry, JFK Partners, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Amie Duncan
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Amy Keefer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Laura Klinger
- TEACCH Autism Program, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison Meyer
- Departments of Pediatrics and Psychiatry, JFK Partners, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Judy Reaven
- Departments of Pediatrics and Psychiatry, JFK Partners, University of Colorado Anschutz Medical Center, Aurora, CO, USA
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4
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Powell HJ, He JL, Khalil N, Wodka EL, DeRonda A, Edden RAE, Vasa RA, Mostofsky SH, Puts NA. Perceptual alterations in the relationship between sensory reactivity, intolerance of uncertainty, and anxiety in autistic children with and without ADHD. Dev Psychopathol 2023:1-13. [PMID: 37990408 DOI: 10.1017/s0954579423001360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Sensory differences and anxiety disorders are highly prevalent in autistic individuals with and without ADHD. Studies have shown that sensory differences and anxiety are associated and that intolerance of uncertainty (IU) plays an important role in this relationship. However, it is unclear as to how different levels of the sensory processing pathway (i.e., perceptual, affective, or behavioral) contribute. Here, we used psychophysics to assess how alterations in tactile perception contribute to questionnaire measures of sensory reactivity, IU, and anxiety. Thirty-eight autistic children (aged 8-12 years; 27 with co-occurring ADHD) were included. Consistent with previous findings, mediation analyses showed that child-reported IU fully mediated an association between parent-reported sensory reactivity and parent-reported anxiety and that anxiety partially mediated an association between sensory reactivity and IU. Of the vibrotactile thresholds, only simultaneous frequency discrimination (SFD) thresholds correlated with sensory reactivity. Interestingly, we found that sensory reactivity fully mediated an association between SFD threshold and anxiety, and between SFD threshold and IU. Taken together, those findings suggest a mechanistic pathway whereby tactile perceptual alterations contribute to sensory reactivity at the affective level, leading in turn to increased IU and anxiety. This stepwise association can inform potential interventions for IU and anxiety in autism.
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Affiliation(s)
- Helen J Powell
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Jason L He
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Nermin Khalil
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Ericka L Wodka
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioural Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alyssa DeRonda
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Richard A E Edden
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Roma A Vasa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioural Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stewart H Mostofsky
- Department of Psychiatry and Behavioural Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicolaas A Puts
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
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5
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Courreges A, Kouros CD, Ekas NV, Levy S. Remote vs. In-person Schooling during the COVID-19 Pandemic and Internalizing Symptoms among Children on the Autism Spectrum. RESEARCH IN AUTISM SPECTRUM DISORDERS 2023; 109:102284. [PMID: 38009124 PMCID: PMC10673621 DOI: 10.1016/j.rasd.2023.102284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
Background Children on the autism spectrum encountered interruptions to their education due to the COVID-19 pandemic (White et al., 2021). This study examined the extent to which autistic children's anxiety and depressive symptoms during the pandemic were associated with the school format they attended in October 2020 (remote, in-person/hybrid, homeschool), controlling for their pre-pandemic symptoms. Pre-pandemic peer victimization and autism symptom characteristics were tested as moderators. Method Participants were 81 verbally-fluent autistic children (Mage = 14.71 years, 77.8% males), without an intellectual disability, and their mothers; families were part of an ongoing, longitudinal study that began before the pandemic. Results School format did not significantly predict children's anxiety or depressive symptoms. Results indicated that the only significant predictors of children's anxiety and depressive symptoms during the pandemic were their pre-pandemic symptom levels. Conclusions School format did not significantly contribute to variability in children's anxiety and depressive symptoms during the pandemic, over and above their pre-pandemic symptoms. The results contribute quantitative findings to the growing body of research on pandemic-related effects on autistic children, and underscore the need to account for pre-pandemic child functioning when drawing conclusions about pandemic-level effects.
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Affiliation(s)
- Audrey Courreges
- Department of Psychology, Southern Methodist University, PO Box 750442, Dallas, TX, 75275, USA
| | - Chrystyna D. Kouros
- Department of Psychology, Southern Methodist University, PO Box 750442, Dallas, TX, 75275, USA
| | - Naomi V. Ekas
- Department of Psychology, Texas Christian University, TCU Box 298920, Fort Worth, TX, 76129, USA
| | - Sam Levy
- Department of Psychology, Southern Methodist University, PO Box 750442, Dallas, TX, 75275, USA
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6
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Khalfe N, Goetz AR, Trent ES, Guzick AG, Smarason O, Kook M, Olsen S, Ramirez AC, Weinzimmer SA, Berry L, Schneider SC, Goodman WK, Storch EA. Psychometric properties of the revised children's anxiety and depression scale (RCADS) for autistic youth without co-occurring intellectual disability. JOURNAL OF MOOD AND ANXIETY DISORDERS 2023; 2:100017. [PMID: 37693105 PMCID: PMC10486182 DOI: 10.1016/j.xjmad.2023.100017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Autistic youth often present with comorbid anxiety and depression yet there is a dearth of validated assessment tools. The Revised Children's Anxiety and Depression Scale (RCADS) assesses internalizing symptoms but there is little psychometric data in autistic youth. Treatment-seeking autistic youth with anxiety or obsessive-compulsive symptoms (N = 74; age 6-14 years), and caregivers, were administered the RCADS-Parent, RCADS-Child, and assessments of internalizing, externalizing symptoms and social impairment indicative of autism. RCADS-Parent and RCADS-Child total anxiety scores demonstrated excellent internal consistency, and the six subscales demonstrated acceptable-to-good internal consistency. The RCADS-Child and Parent total anxiety scores were weakly correlated, and neither child age nor gender altered the strength of this association. Convergent validity was supported by moderate-to-strong correlations with clinician and parent-reported anxiety symptoms. Support for divergent validity was mixed. Results provide support for the RCADS-Parent and RCADS-Child as reliable, valid measures of internalizing symptoms in autistic youth.
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Affiliation(s)
- Nasim Khalfe
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Amy R. Goetz
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Erika S. Trent
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Andrew G. Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Orri Smarason
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Faculty of Psychology, University of Iceland, Reykjavik, Iceland
| | - Minjee Kook
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sean Olsen
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Ana C. Ramirez
- Department of Psychological Science, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Saira A. Weinzimmer
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Leandra Berry
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sophie C. Schneider
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Wayne K. Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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7
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Rozenblat S, Shimshoni Y, Lebowitz ER, Perez M, Koller J. A Pilot Trial of SPACE (Supportive Parenting for Anxious Childhood Emotions) in Autism. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01555-4. [PMID: 37353645 DOI: 10.1007/s10578-023-01555-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2023] [Indexed: 06/25/2023]
Abstract
Family accommodation describes changes parents make to their behavior, intended to alleviate their child's distress, which stems from a psychopathology. In anxiety, studies show that accommodation alleviates distress in the short term but is associated with increased symptom severity, greater functional impairment, poorer treatment outcomes, increased caregiver burden and disruption to family functioning longitudinally. Research shows high prevalence of family accommodation of anxiety in autism. While the most common treatments for anxiety in autism are cognitive-behavior therapy and pharmacology, research is limited and other approaches must be considered. Supportive Parenting for Anxious Childhood Emotions (SPACE) is a parent-based, manualized treatment for anxiety targeting family accommodation, which has been found to be acceptable and efficacious in treating childhood anxiety. This pilot trial examined the feasibility, acceptability, treatment-satisfaction, and preliminary efficacy of SPACE for anxiety in autism. Parents of 15 autistic children (ages 6-10 years) with at least average cognitive abilities exhibiting high levels of anxiety participated in 13 weekly sessions of SPACE. Feasibility and acceptability were assessed through enrollment, attrition rates, and adverse events. Of 26 eligible families, 22 (84.62%) elected to participate, 15 of whom (68.18%) completed treatment. Parents rated the treatment as highly satisfactory. Anxiety symptom severity and family accommodation were significantly reduced following treatment, with 86.66% of participants showing reliable change post-treatment, and this reduction was preserved at 2-month follow-up. This study provides preliminary evidence that SPACE is feasible, acceptable, satisfactory, and produces improvement in anxiety in the autistic population.Trial registration number: NCT04747262 Date of registration: February 10, 2021.
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Affiliation(s)
- Shir Rozenblat
- Seymour Fox School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel.
| | | | | | - Michal Perez
- Seymour Fox School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Judah Koller
- Seymour Fox School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel.
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8
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Kazzi C, Campbell L, Porter M. Psychological therapies for anxiety in autistic individuals with co-occurring intellectual developmental disorder: A systematic review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2023. [DOI: 10.1007/s40489-023-00371-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
AbstractThis systematic review aimed to evaluate the efficacy of psychological therapies for anxiety for people with autism and co-occurring intellectual developmental disorder (AUT + IDD). A systematic search identified 13 studies comprising 49 participants with AUT + IDD, aged between 5 and 41 years. Most studies were single-case experimental designs (n = 7) or case studies or case series (n = 4). Studies implemented cognitive behavioural therapy (n = 4) or exposure therapy techniques (n = 9). All studies reported a reduction in anxiety symptoms, as measured by either quantitative measures or defined as participants meeting end of treatment criterion. However, the conclusions are preliminary due to the methodological limitations of the current literature. The implications of these findings, as well as recommendations for future direction in the field, are discussed.
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Meyer AT, Moody EJ, Keefer A, O'Kelley S, Duncan A, Blakeley-Smith A, Reaven J. Effect of Co-occurring Psychiatric Disorders on Treatment of Children with Autism Spectrum Disorder and Anxiety. J Autism Dev Disord 2023; 53:569-579. [PMID: 32462457 DOI: 10.1007/s10803-020-04540-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Co-occurring psychiatric diagnoses are very common in individuals with ASD. Little is known about the effect that co-occurring psychiatric conditions may have on treatment response to CBT for children with ASD and anxiety. The present study examined the relationship between co-occurring psychiatric diagnoses and response to CBT for anxiety in ninety youth with ASD. Psychiatric complexity did not appear to differentially impact treatment response. A notable portion of youth with anxiety and externalizing disorders such as ADHD, no longer met criteria for those externalizing diagnoses following intervention. Results indicate that youth with ASD and anxiety present with complex psychiatric profiles and CBT for anxiety may positively affect co-occurring diagnoses. In addition, thorough and nuanced assessment of psychiatric symptoms in youth with ASD is needed to ensure the differentiation between diagnoses of anxiety and other co-occurring psychiatric symptoms.
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Affiliation(s)
- Allison T Meyer
- JFK Partners, Department of Pediatrics, University of Colorado School of Medicine, Education 2 South, 13121 E. 17th Ave, Aurora, CO, 80045, USA.
| | - Eric J Moody
- Wyoming Institude for Disabilities, College of Health Sciences, University of Wyoming, Laramie, WY, USA
| | - Amy Keefer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Sarah O'Kelley
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amie Duncan
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Audrey Blakeley-Smith
- JFK Partners, Department of Psychiatry, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Judy Reaven
- JFK Partners, Department of Psychiatry, University of Colorado Anschutz Medical Center, Aurora, CO, USA
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10
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Ng R, Bjornsson HT, Fahrner JA, Harris J. Anxiety in Wiedemann-Steiner syndrome. Am J Med Genet A 2023; 191:437-444. [PMID: 36373844 PMCID: PMC9907226 DOI: 10.1002/ajmg.a.63040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/22/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
This study examined anxiety in Wiedemann-Steiner syndrome (WSS). Eighteen caregivers and participants with WSS completed the parent- and self-report versions of the Screen for Child Anxiety Related Disorder or the adapted version of the Screen for Adult Anxiety Related Disorder. Approximately 33.33% of parents and 65% of participants with WSS rated in the clinical range for overall anxiety. Across anxiety subtypes, parents primarily indicated concerns with Separation Anxiety (72%), which was also endorsed by the majority of participants with WSS (82%). The emergent trend showed Total Anxiety increased with age based on parent-informant ratings. The behavioral phenotype of WSS includes elevated anxiety. Clinical management should include incorporating early behavioral interventions to bolster emotion regulation given the observed risk of anxiety with age.
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Affiliation(s)
- Rowena Ng
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hans Tomas Bjornsson
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Landspitali University Hospital, Reykjavik, Iceland
| | - Jill A. Fahrner
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jacqueline Harris
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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11
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Byrne G, Ghráda ÁN, O’Mahony T. Parent-Led Cognitive Behavioural Therapy for Children with Autism Spectrum Conditions. A Pilot Study. J Autism Dev Disord 2023; 53:263-274. [PMID: 35020117 PMCID: PMC8753322 DOI: 10.1007/s10803-022-05424-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 02/03/2023]
Abstract
This article reports on a pilot study of a parent-only cognitive behavioural therapy (CBT) programme for parents of children with autism spectrum disorders (ASD) and anxiety difficulties. Twenty-one parents of anxious children with ASD (5-11 of age) completed the From Timid to Tiger intervention. Parent outcome measures were assessed at post-intervention and at 3-month follow-up. Analysis indicated significant reductions in both parent and clinician reports of child anxiety symptoms. Specifically, 38% of children were free of their primary diagnosis at treatment end and this increased to 57% when measured at 3-month follow-up. Positive gains were evidenced regarding parents' ability to manage their child's anxiety without accommodating to it. The results provide preliminary evidence of parent-only CBT programs for children with ASD.
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Affiliation(s)
- Gary Byrne
- Psychology Department, Primary Care Psychology Services, Churchtown Primary Care Services, Health Service Executive, Churchtown, Dublin 14, Ireland
| | - Áine Ní Ghráda
- Psychology Department, Primary Care Psychology Services, Churchtown Primary Care Services, Health Service Executive, Churchtown, Dublin 14, Ireland
| | - Teresa O’Mahony
- Psychology Department, HSE Community Healthcare East, Vergemount Hall, Clonskeagh, Dublin, Ireland
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12
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Hennessy A, Seguin D, Correa S, Wang J, Martinez-Trujillo JC, Nicolson R, Duerden EG. Anxiety in children and youth with autism spectrum disorder and the association with amygdala subnuclei structure. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:1053-1067. [PMID: 36278283 PMCID: PMC10108338 DOI: 10.1177/13623613221127512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Autism spectrum disorder (ASD) is clinically characterized by social and communication difficulties as well as repetitive behaviors. Many children with ASD also suffer from anxiety, which has been associated with alterations in amygdala structure. In this work, the association between amygdala subnuclei volumes and anxiety was assessed in a cohort of 234 participants (mean age = 11.0 years, SD = 3.9, 95 children with ASD, 139 children were non-autistic). Children underwent magnetic resonance imaging. Amygdala subnuclei volumes were extracted automatically. Anxiety was assessed using the Screen for Child Anxiety Related Disorders, the Child Behavior Checklist, and the Strength and Difficulties Questionnaire. Children with ASD had higher anxiety scores relative to non-autistic children on all anxiety measures (all, p < 0.05). Anxiety levels were significantly predicted in children with ASD by right basal (right: B = 0.235, p = 0.002) and paralaminar (PL) (B = −0.99, p = 0.009) volumes. Basal nuclei receive multisensory information from cortical and subcortical areas and have extensive projections within the limbic system while the PL nuclei are involved in emotional processing. Alterations in basal and PL nuclei in children with ASD and the association with anxiety may reflect morphological changes related to in the neurocircuitry of anxiety in ASD. Lay abstract Autism spectrum disorder (ASD) is clinically characterized by social communication difficulties as well as restricted and repetitive patterns of behavior. In addition, children with ASD are more likely to experience anxiety compared with their peers who do not have ASD. Recent studies suggest that atypical amygdala structure, a brain region involved in emotions, may be related to anxiety in children with ASD. However, the amygdala is a complex structure composed of heterogeneous subnuclei, and few studies to date have focused on how amygdala subnuclei relate to in anxiety in this population. The current sample consisted of 95 children with ASD and 139 non-autistic children, who underwent magnetic resonance imaging (MRI) and assessments for anxiety. The amygdala volumes were automatically segmented. Results indicated that children with ASD had elevated anxiety scores relative to peers without ASD. Larger basal volumes predicted greater anxiety in children with ASD, and this association was not seen in non-autistic children. Findings converge with previous literature suggesting ASD children suffer from higher levels of anxiety than non-autistic children, which may have important implications in treatment and interventions. Our results suggest that volumetric estimation of amygdala’s subregions in MRI may reveal specific anxiety-related associations in children with ASD.
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Affiliation(s)
| | | | | | | | | | | | - Emma G Duerden
- Western University, Canada
- The University of Western Ontario, Canada
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13
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Kalinousky AJ, Rapp T, Hijazi H, Johnson J, Bjornsson HT, Harris JR. Neurobehavioral phenotype of Kabuki syndrome: Anxiety is a common feature. Front Genet 2022; 13:1007046. [PMID: 36276984 PMCID: PMC9582441 DOI: 10.3389/fgene.2022.1007046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
Kabuki syndrome (KS) is a Mendelian Disorder of the Epigenetic Machinery (MDEM) caused by loss of function variants in either of two genes involved in the regulation of histone methylation, KMT2D (34–76%) or KDM6A (9–13%). Previously, representative neurobehavioral deficits of KS were recapitulated in a mouse model, emphasizing the role of KMT2D in brain development, specifically in ongoing hippocampal neurogenesis in the granule cell layer of the dentate gyrus. Interestingly, anxiety, a phenotype that has a known association with decreased hippocampal neurogenesis, has been anecdotally reported in individuals with KS. In this study, anxiety and behavior were assessed in a cohort of 60 individuals with molecularly confirmed KS and 25 unaffected biological siblings, via questionnaires (SCARED/GAS-ID and CBCL/ABCL). Participant age ranged from 4 to 43 years old, with 88.3% of participants having a pathogenic variant in KMT2D, and the rest having variants in KDM6A. In addition, data was collected on adaptive function and positive affect/quality of life in participants with KS using appropriate online surveys including ABAS-III and PROMIS Positive Affect. Survey scores were compared within the KS participants across age groups and between KS participants and their unaffected siblings. We found that children with KS have significantly higher anxiety scores and total behavior problem scores than their unaffected siblings (p = 0.0225, p < 0.0001). Moreover, a large proportion of affected individuals (22.2% of children and 60.0% of adults) surpassed the established threshold for anxiety; this may even be an underestimate given many patients are already treated for anxiety. In this sample, anxiety levels did not correlate with level of cognitive or adaptive function in any KS participants, but negatively correlated with positive affect in children with KS (p = 0.0005). These findings indicate that anxiety is a common neurobehavioral feature of KS. Providers should therefore carefully screen individuals with KS for anxiety as well as other behavioral issues in order to allow for prompt intervention. Neurobehavioral anxiety measures may also prove to be important outcome measures for clinical trials in KS.
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Affiliation(s)
- Allison J. Kalinousky
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Tyler Rapp
- University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Hadia Hijazi
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Hans Tomas Bjornsson
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Landspitali University Hospital, Reykjavík, Iceland
| | - Jacqueline R. Harris
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Kennedy Krieger Institute, Baltimore, MD, United States
- *Correspondence: Jacqueline R. Harris,
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14
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Jolliffe R, Adams D, Simpson K. Trait Anxiety in Individuals on the Autism Spectrum: a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00308-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AbstractAlthough anxiety is commonly researched in autism, the focus has predominantly been on anxiety disorders and not upon general levels of anxiousness or trait anxiety. This review summarises research investigating trait anxiety in autism. Systematic searches yielded 1099 records, with 23 studies meeting inclusion criteria. Study participants were mainly males from Western countries, with no representation of older adults or individuals with intellectual disability. All articles used self-report questionnaire trait anxiety measures. Anxiety measure psychometric details were absent in most studies, with 21 using subjective measures that are not validated for use in autism. Results showed higher trait anxiety scores in autism versus control groups, and correlations between trait anxiety scores and other study outcomes.
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15
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Transdermal Electrical Neuromodulation for Anxiety and Sleep Problems in High-Functioning Autism Spectrum Disorder: Feasibility and Preliminary Findings. J Pers Med 2021; 11:jpm11121307. [PMID: 34945779 PMCID: PMC8704341 DOI: 10.3390/jpm11121307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Autism spectrum disorder (ASD) is associated with anxiety and sleep problems. We investigated transdermal electrical neuromodulation (TEN) of the cervical nerves in the neck as a safe, effective, comfortable and non-pharmacological therapy for decreasing anxiety and enhancing sleep quality in ASD. Methods: In this blinded, sham-controlled study, seven adolescents and young adults with high-functioning ASD underwent five consecutive treatment days, one day of the sham followed by four days of subthreshold TEN for 20 min. Anxiety-provoking cognitive tasks were performed after the sham/TEN. Measures of autonomic nervous system activity, including saliva α-amylase and cortisol, electrodermal activity, and heart rate variability, were collected from six participants. Results: Self-rated and caretaker-rated measures of anxiety were significantly improved with TEN treatment as compared to the sham, with effect sizes ranging from medium to large depending on the rating scale. Sleep scores from caretaker questionnaires also improved, but not significantly. Performance on two of the three anxiety-provoking cognitive tasks and heart rate variability significantly improved with TEN stimulation as compared to the sham. Four of the seven (57%) participants were responders, defined as a ≥ 30% improvement in self-reported anxiety. Salivary α-amylase decreased with more TEN sessions and decreased from the beginning to the end of the session on TEN days for responders. TEN was well-tolerated without significant adverse events. Conclusions: This study provides preliminary evidence that TEN is well-tolerated in individuals with ASD and can improve anxiety.
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16
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Kim SY, Lecavalier L. Evaluating the Use of Self-reported Measures in Autistic Individuals in the Context of Psychiatric Assessment: A Systematic Review. J Autism Dev Disord 2021; 52:4355-4374. [PMID: 34643862 DOI: 10.1007/s10803-021-05323-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 11/24/2022]
Abstract
The current review examined the use of self-report measures in autistic individuals in the context of psychiatric assessments. It focused on inter-rater agreement, internal consistency, test-retest reliability, and criterion validity with clinical diagnoses. It also gathered information on constructs measured, the nature of the samples, and the quality of the studies. Thirty-six out of 10,557 studies met inclusion criteria. We found that the majority of studies (1) targeted young people with average or above average cognitive abilities, (2) measured anxiety symptoms, and (3) evaluated parent-child agreement. More studies are needed on individuals with lower cognitive abilities, adults, and other constructs. Studies assessing criterion validity and test-retest reliability are also needed.
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Affiliation(s)
- Soo Youn Kim
- Nisonger Center, The Ohio State University, 1581 Dodd Drive, Columbus, OH, 43210, USA
| | - Luc Lecavalier
- Nisonger Center, The Ohio State University, 1581 Dodd Drive, Columbus, OH, 43210, USA.
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17
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Schiltz HK, Magnus BE. Differential Item Functioning Based on Autism Features, IQ, and Age on the Screen for Child Anxiety Related Disorders (SCARED) Among Youth on the Autism Spectrum. Autism Res 2021; 14:1220-1236. [PMID: 33543824 DOI: 10.1002/aur.2481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/04/2021] [Accepted: 01/21/2021] [Indexed: 12/28/2022]
Abstract
Anxiety commonly occurs among youth on the autism spectrum, yet measurement of anxiety in this population is complicated by a number of factors, including potentially overlapping symptomatology, the child's intellectual functioning, and changes in anxiety across development. Moreover, few studies have examined the psychometric properties of anxiety measures in this population, and no study to date has tested whether there are systematic differences in the measurement of anxiety, or differential item functioning (DIF), across the high degree of heterogeneity and the developmental course of autism. To test this possibility, data were combined across multiple studies using the National Database for Autism Research, an NIH-funded data repository. Parent-report on the Screen for Child Anxiety Related Disorders (SCARED) and Social Communication Questionnaire (SCQ) were used as measures of anxiety and autism features, respectively. A confirmatory factor analysis indicated good fit of the literature standard five-factor structure. Moderated nonlinear factor analysis (MNLFA) revealed multiple items with intercept and loading DIF based on level of autism features, IQ, and age, especially for items related to social behavior. Therefore, although the measure's factor structure is consistent with that found in the general population, the SCARED may not capture differences in anxiety equivalently for all children on the spectrum and across their development. Clinicians and researchers need to be especially vigilant in measuring anxiety symptoms in children with autism by removing items flagged for DIF from the SCARED and/or by using multiple measures and informants. LAY ABSTRACT: Autistic youth often experience clinical levels of anxiety. Many tools used to measure anxiety were developed for the general population, but not for use with autistic youth. This study found that the Screen for Child Anxiety Related Disorders (SCARED) measures the same five dimensions of anxiety as in the general population. Parents, however, may respond differently to questions on the SCARED based on their child's autism features, intellectual functioning, and age, which impacts our ability to accurately measure anxiety among autistic youth.
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Affiliation(s)
- Hillary K Schiltz
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA
| | - Brooke E Magnus
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, Massachusetts, USA
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18
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Stephenson KG, Beck JS, South M, Norris M, Butter E. Validity of the WISC-V in Youth with Autism Spectrum Disorder: Factor Structure and Measurement Invariance. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 50:669-681. [PMID: 33448884 DOI: 10.1080/15374416.2020.1846543] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Assessment of intellectual abilities in individuals with autism spectrum disorder (ASD) is a core component of a comprehensive diagnostic evaluation. However, relatively limited information is available regarding the validity of one of the most commonly-used measures of intelligence, the Wechsler Intelligence Scale for Children - 5th Edition (WISC-V) in ASD.Method: We investigated the factor structure and measurement invariance of the WISC-V in a sample of 349 children aged 6-16 diagnosed with ASD using single- and multi-group confirmatory factor analysis. The comparison group was the WISC-V standardization sample.Results: A four-index bifactor solution best fit the ASD group data. Measurement invariance analyses indicated support for configural and metric, but not scalar, invariance of the published 5-index structure, suggesting systematic differences in performance among some subscales in ASD. The 7-subtest FSIQ scale had partial scalar invariance after relaxing equality constraints on the Coding and Digit Span subtest intercepts, suggesting sources other than theorized IQ ability contribute to lower scores on these subtests within ASD. The Cognitive Proficiency Index (CPI) failed to demonstrate appropriate fit in baseline models. The General Ability Index (GAI) had full configural, metric, and scalar invariance.Conclusions: Statistical bias on the WISC-V within ASD in processing speed and working memory subtests creates significant limitations for the use of FSIQ and especially CPI index scores in ASD populations. The GAI showed strong measurement properties and should be considered as the preferred indicator of overall intellectual functioning when assessing children with ASD using the WISC-V.
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Affiliation(s)
- Kevin G Stephenson
- Child Development Center, Nationwide Children's Hospital.,Departments of Pediatrics and Psychology, The Ohio State University
| | - Jonathan S Beck
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center
| | - Mikle South
- Departments of Psychology and Neuroscience, Brigham Young University
| | - Megan Norris
- Child Development Center, Nationwide Children's Hospital.,Departments of Pediatrics and Psychology, The Ohio State University
| | - Eric Butter
- Child Development Center, Nationwide Children's Hospital.,Departments of Pediatrics and Psychology, The Ohio State University
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19
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Sensory over-responsivity is related to GABAergic inhibition in thalamocortical circuits. Transl Psychiatry 2021; 11:39. [PMID: 33436538 PMCID: PMC7804323 DOI: 10.1038/s41398-020-01154-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/17/2020] [Accepted: 11/30/2020] [Indexed: 12/13/2022] Open
Abstract
Sensory over-responsivity (SOR), extreme sensitivity to or avoidance of sensory stimuli (e.g., scratchy fabrics, loud sounds), is a highly prevalent and impairing feature of neurodevelopmental disorders such as autism spectrum disorders (ASD), anxiety, and ADHD. Previous studies have found overactive brain responses and reduced modulation of thalamocortical connectivity in response to mildly aversive sensory stimulation in ASD. These findings suggest altered thalamic sensory gating which could be associated with an excitatory/inhibitory neurochemical imbalance, but such thalamic neurochemistry has never been examined in relation to SOR. Here we utilized magnetic resonance spectroscopy and resting-state functional magnetic resonance imaging to examine the relationship between thalamic and somatosensory cortex inhibitory (gamma-aminobutyric acid, GABA) and excitatory (glutamate) neurochemicals with the intrinsic functional connectivity of those regions in 35 ASD and 35 typically developing pediatric subjects. Although there were no diagnostic group differences in neurochemical concentrations in either region, within the ASD group, SOR severity correlated negatively with thalamic GABA (r = -0.48, p < 0.05) and positively with somatosensory glutamate (r = 0.68, p < 0.01). Further, in the ASD group, thalamic GABA concentration predicted altered connectivity with regions previously implicated in SOR. These variations in GABA and associated network connectivity in the ASD group highlight the potential role of GABA as a mechanism underlying individual differences in SOR, a major source of phenotypic heterogeneity in ASD. In ASD, abnormalities of the thalamic neurochemical balance could interfere with the thalamic role in integrating, relaying, and inhibiting attention to sensory information. These results have implications for future research and GABA-modulating pharmacologic interventions.
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20
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Blakeley-Smith A, Meyer AT, Boles RE, Reaven J. Group Cognitive Behavioural Treatment for Anxiety in Autistic Adolescents with Intellectual Disability: A Pilot and Feasibility Study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:777-788. [PMID: 33410240 DOI: 10.1111/jar.12854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/09/2020] [Accepted: 12/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adolescents with Autism Spectrum Disorder (ASD) and intellectual disability evidence significant anxiety. This study aimed to adapt a group cognitive behaviour therapies (CBT) programme designed for youth with ASD and anxiety to meet the cognitive, communication, and behavioural needs of adolescents with intellectual disability, and assess initial feasibility and efficacy of the intervention. METHODS Structural, content and procedural adaptations were made to a 14-week family-focused CBT intervention. Twenty-three adolescents with ASD, intellectual disability and anxiety were included. Treatment acceptability along with adolescent anxiety symptoms was assessed via parent report measures. RESULTS Of the 23 participants, 19 completed treatment and attended 94% of sessions. Parent acceptability was high. Significant reductions were noted on anxiety symptoms post-intervention. CONCLUSIONS Results indicate that the CBT group was feasible and acceptable. Preliminary outcomes suggest that adolescent anxiety improved, although replication with a larger sample and comparison to a control group is needed.
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Affiliation(s)
- Audrey Blakeley-Smith
- JFK Partners, Psychiatry & Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Allison T Meyer
- JFK Partners, Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard E Boles
- JFK Partners, Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Judy Reaven
- JFK Partners, Psychiatry & Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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21
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Edirisooriya M, Dykiert D, Auyeung B. IQ and Internalising Symptoms in Adolescents with ASD. J Autism Dev Disord 2020; 51:3887-3907. [PMID: 33381856 PMCID: PMC8510967 DOI: 10.1007/s10803-020-04810-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 12/12/2022]
Abstract
Intelligence quotient (IQ), has been found to relate to the presence of internalising symptoms in autism spectrum disorder (ASD). This meta-analysis sought to clarify the direction of the relationship between IQ and two prevalent internalising symptoms, anxiety and depression, in adolescents with ASD. Secondly, this study aimed to highlight methodological factors contributing to inconsistent findings in existing research. Self-reported anxiety was found to be significantly higher in youth with a lower IQ, while depression was positively associated with IQ. Consequently, parents, schools and clinicians should be cautious of underestimating anxiety in youth with a lower IQ. However, care should also be taken to ensure adolescents with ASD without intellectual disabilities are not overlooked with regards to social and emotional support.
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Affiliation(s)
- Monisha Edirisooriya
- University of Edinburgh, School of Philosophy, Psychology and Language Sciences, University of Edinburgh Medical School, Edinburgh, Scotland, UK. .,Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London, England.
| | - Dominika Dykiert
- University of Edinburgh, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Centre for Cognitive Ageing and Cognitive Epidemiology, Edinburgh, Scotland, UK.,Anna Freud Centre for Children and Families, The Kantor Centre of Excellence, 4-8 Rodney Street, London, N1 9JH, England
| | - Bonnie Auyeung
- University of Edinburgh, School of Philosophy, Psychology and Language Sciences, Room S30, Psychology Building, 7 George Square, Edinburgh, EH8 9JZ, Scotland, UK.,Autism Research Centre, University of Cambridge, Cambridge, England
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22
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Robles-Bello MA, Sánchez-Teruel D, Valencia Naranjo N. Adaptation of the Screen for Child Anxiety Related Emotional Disorders in Spanish with Nonspecific Intellectual Disability. Child Psychiatry Hum Dev 2020; 51:742-753. [PMID: 32337661 DOI: 10.1007/s10578-020-00996-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Anxiety continues to be one of the most frequent disorders with typically developing children and youth. However, people with intellectual disability (ID) lack validated diagnostic tests backed by sufficient methodological rigor. Analyze the psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in this clinical population, specifically in children and young Spanish with Nonspecific Intellectual Disability. Descriptive statistics and item analysis (N = 542), exploratory factorial analysis (n = 245) and confirmatory (n = 297) and scale reliability analyses were performed and evaluated the internal consistency with various indices (Cronbach's alpha and omega) and the stability of the measurement (test-retest) of the resulting scale with better goodness-of-adjustment indices. A new scale called SCARED-DI was obtained in this clinical sample with three factors and a smaller number of items (22), offering important goodness-of-fit indices (RMSEA [95% CI] 03[0.01; .04]; CFI = 0.99; TLI = 0.98; GFI = 0.88; AGFI = 0.89) and high internal consistency (α = 0.91; ω = 0.93) and adequate measurement stability (rxx = 0.92). The importance of validating psychopathological anxiety tests for children and youth with ID in order to build good mental health is discussed, emphasizing the need to provide easy, short-duration tests on both cognitive and emotional aspects in this clinical sub-population. In addition, the results are assessed in terms of future research and practical implications. This new version of SCARED-ID represents a valid and reliable tool to evaluate the anxiety in people with intellectual disabilities.
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Affiliation(s)
| | - David Sánchez-Teruel
- Department of Psychology, University of Córdoba, Avda. San Alberto Magno s/n, 14071, Cordoba, Spain.
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23
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Maddox BB, Lecavalier L, Miller JS, Pritchett J, Hollway J, White SW, Gillespie S, Evans AN, Schultz RT, Herrington JD, Bearss K, Scahill L. Reliability and validity of the Pediatric Anxiety Rating Scale modified for autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1773-1782. [PMID: 32476441 PMCID: PMC7541392 DOI: 10.1177/1362361320922682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
LAY ABSTRACT Many youth with autism spectrum disorder have anxiety, but it can be difficult to assess anxiety with existing measures. We modified the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder and tested the new measure in a group of 116 youth (age: 5-17 years) with autism spectrum disorder. The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder is an interview that a clinician usually completes with the child and parent together. We modified the interview questions and scoring instructions based on feedback from parents of children with autism spectrum disorder and from a panel of experts in autism spectrum disorder and anxiety. Unlike many other anxiety measures, the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder relies less on a child's verbal expression of anxiety and more on signs that a parent can easily observe. Training clinicians to administer and score the Pediatric Anxiety Rating Scale for youth with autism spectrum disorder was uncomplicated, and raters showed excellent agreement on video-recorded interviews. Youth who were not currently in treatment for anxiety had stable Pediatric Anxiety Rating Scale for youth with autism spectrum disorder scores with repeat measurement over a 1-month period. The Pediatric Anxiety Rating Scale for youth with autism spectrum disorder is a useful clinician-rated measure of anxiety in youth with autism spectrum disorder and fills a gap for assessing anxiety in this population.
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Affiliation(s)
| | | | - Judith S Miller
- University of Pennsylvania, USA
- Children's Hospital of Philadelphia, USA
| | | | | | | | | | - Andrea N Evans
- Emory University, USA
- University of California, Los Angeles, USA
| | - Robert T Schultz
- University of Pennsylvania, USA
- Children's Hospital of Philadelphia, USA
| | - John D Herrington
- University of Pennsylvania, USA
- Children's Hospital of Philadelphia, USA
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24
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Keith JM, Jamieson JP, Bennetto L. The Importance of Adolescent Self-Report in Autism Spectrum Disorder: Integration of Questionnaire and Autonomic Measures. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:741-754. [PMID: 30073571 DOI: 10.1007/s10802-018-0455-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Anxiety and sensory symptoms are highly prevalent and meaningful in the daily lives of individuals with autism spectrum disorder (ASD). Despite the importance of carefully measuring, researching, and treating these symptoms, current methods in ASD seldom include self-report. This study investigated the consistency of adolescent and parent reports of anxiety and auditory sensitivity in individuals with ASD, and examined their validity via comparisons with sympathetic arousal at baseline and in response to an auditory challenge. Fifty adolescent-parent dyads (n = 26 ASD, n = 24 typically developing; 12-16 years old; IQ>80) completed parallel versions of both anxiety and auditory hypersensitivity scales, which were compared to heart rate collected at rest and during an aversive noise task. Adolescents with ASD exhibited greater anxiety and auditory hypersensitivity than their peers, based on both self and parent report. Across groups, self-report was higher than parent report. In individuals with ASD, a significant relationship was found between self-reported anxiety and autonomic arousal at rest, and between self-reported auditory sensitivity and autonomic reactivity during the noise task. These relationships were not significant for parent-report. These findings extend past work by demonstrating greater self-reported (than parent-reported) anxiety and sensory symptoms. Furthermore, the presence of significant correlations between self-reported symptoms and sympathetic arousal supports the validity of self-report in adolescents with ASD with average or above average cognitive abilities. This indicates that adolescents with ASD have a unique perspective on their internal experience, which can complement parent reports and provide a more comprehensive assessment of symptoms in research and clinical settings.
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Affiliation(s)
- Jessica M Keith
- Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, NY, 14627, USA.
| | - Jeremy P Jamieson
- Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, NY, 14627, USA
| | - Loisa Bennetto
- Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, NY, 14627, USA
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25
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Sánchez-Teruel D, Robles-Bello MA, Camacho-Conde JA. Assessment of emotional intelligence in adults with down syndrome: Psychometric properties of the Emotional Quotient Inventory. PLoS One 2020; 15:e0236087. [PMID: 32697810 PMCID: PMC7375611 DOI: 10.1371/journal.pone.0236087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 06/30/2020] [Indexed: 01/11/2023] Open
Abstract
Introduction The Emotional Quotient Inventory: Youth version-EQ-i:YV was developed by Bar-On & Parker in 2000 and later translated and adapted for the general Spanish adolescent population by Ferrandiz et al. in 2012. The Spanish scale presents similar psychometric properties to the original version (54 items and five subdimensions). The Emotional Quotient Inventory assesses a set of personal, emotional, and social skills that influence adaptation to and coping with environmental demands and pressures. These factors can influence an adolescent’s success later in life, health, and psychological well-being. Traditionally, research in Down syndrome (DS) has focused on identifying cognitive deficits, relatively little is known about emotional intelligence (EI) and there are no scales that measure EI in people with DS adults. Objectives To validate and analyze the psychometric properties of the scale in the clinical population, specifically in Spanish adults with DS (EQ-i: SVDS). Methods A cross-sectional investigation was carried out in several stages. Descriptive, exploratory factorial (n = 345), confirmatory (n = 397), and scale reliability analyses were performed with better goodness-of-adjustment indices. Results A new scale named Emotional Quotient Inventory: Short Version for DS adults was obtained with a structure of four factors called mood, stress management, interpersonal, and intrapersonal. This new scale was reduced to 25 items. Goodness-of-fit indices were excellent (RMSEA [95% CI] = 02[.01; .03]; CFI = .99; TLI = .98; GFI = .87; AGFI = .89). The internal consistency of the four dimensions and the calculated total score (α = .91, ω = .93 and divided halves = .90) yielded high values in this clinical sample. Discussion The results recommend the use of the revised EQ-i: YV, the EQ-i: SVDS, to assess EI in adults with DS. The psychometric properties of this study are satisfactory but have four factors. The findings are discussed in terms of future research and practical implication to gain a more thorough understanding of how this population behaves on both a general and preventive level in order to teach EI properly. Conclusions This new version is a valid and reliable tool to evaluate emotional intelligence in people with intellectual disabilities and specifically in Spanish adults with DS.
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Characterization and Prediction of Anxiety in Adolescents with Autism Spectrum Disorder: A Longitudinal Study. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1239-1249. [PMID: 32617732 DOI: 10.1007/s10802-020-00673-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Anxiety is one of the most common comorbidities in youth with autism spectrum disorder (ASD). The current study's aims were: To examine the frequency of elevated anxiety symptoms in adolescents diagnosed with ASD in toddlerhood; To explore the impact of comorbid anxiety in adolescents on clinical presentation; To evaluate variables in toddlerhood that associate with anxiety symptom severity in adolescence. The study included 61 adolescents (mean age = 13:8y) diagnosed with ASD in toddlerhood (T1). Participants underwent a comprehensive assessment of cognitive ability, adaptive skills and autism severity at T1 and again as adolescents (T2), and an evaluation of anxiety symptoms at T2. For the first aim, the most prevalent anxiety subtypes noted in adolescence were separation (39.3%), social (27.9%) and generalized anxiety (18.0%). For the second aim, cognitive ability, autism severity and adaptive skills in adolescents with and without elevated anxiety symptoms scores of any type did not differ significantly. For the third aim, younger age at adolescence was associated with more severe separation and generalized anxiety symptoms. Higher cognitive ability and adaptive skills in toddlerhood were associated with elevated generalized anxiety symptoms in adolescence. Lower adaptive behaviors and repetitive behaviors (RRBs) correlated with elevated social anxiety symptoms. Lower cognitive abilities and more severe RRBs in toddlerhood predicted separation anxiety in adolescence. The study sheds light on early characteristics in ASD that associate with anxiety symptom severity in adolescence. The type of elevated anxiety symptoms presented in adolescence associated with the level of cognitive ability, adaptive skills and RRBs in toddlerhood.
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Kerns CM, Winder-Patel B, Iosif AM, Nordahl CW, Heath B, Solomon M, Amaral DG. Clinically Significant Anxiety in Children with Autism Spectrum Disorder and Varied Intellectual Functioning. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:780-795. [DOI: 10.1080/15374416.2019.1703712] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | | | - Ana Maria Iosif
- Division of Biostatistics, Department of Public Health Sciences, University of California
- Department of Psychiatry and Behavioral Sciences, UC Davis
| | - Christine Wu Nordahl
- The MIND Institute, UC Davis
- Department of Psychiatry and Behavioral Sciences, UC Davis
| | - Brianna Heath
- The MIND Institute, UC Davis
- Department of Psychiatry and Behavioral Sciences, UC Davis
| | - Marjorie Solomon
- The MIND Institute, UC Davis
- Department of Psychiatry and Behavioral Sciences, UC Davis
| | - David G. Amaral
- The MIND Institute, UC Davis
- Department of Psychiatry and Behavioral Sciences, UC Davis
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Sánchez-Teruel D, Robles-Bello MA. Preliminary Study on Psychometric Properties of an Anxiety Scale in Down Syndrome with Anxiety Symptoms. Int J Psychol Res (Medellin) 2020; 13:50-61. [PMID: 32952963 PMCID: PMC7498123 DOI: 10.21500/20112084.4493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 05/11/2019] [Accepted: 11/29/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND anxiety remains one of the most common disorders in typically developing children and young adults. Adolescents with Down syndrome (DS) lack diagnostic tests for evaluation. METHODS this study evaluated the psychometric properties of the Screen for Child Anxiety Related Emotional Disorders inventory in its self-report version in 63 adolescents with anxiety symptoms with DS. The inclusion criteria for the studies were trisomy 21 and a chronological age between 8 and 17 years. Psychometric properties arestrictly evaluated with the sample exceeding a cutoff point in anxiety symptomatology. A confirmatory factorial analysis tested two models for the new evaluation test. RESULTS both models confirmed a four-factor structure (somatic/panic, social phobia, generalized anxiety, and separation anxiety). Model 2, nevertheless, had fewer items and a better fit, and it also showed a high correlation with other anxiety detection measures and adequate internal consistency. CONCLUSIONS the importance of validating psychopathological anxiety tests for children and young people with DS in order to build good mental health is discussed, emphasizing the need to provide easy and short-term tests on cognitive and emotional aspects in people with intellectual disabilities.
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Affiliation(s)
- David Sánchez-Teruel
- Department of Psychology, Universidad de Córdoba, Córdoba, España. Universidad de Córdoba Universidad de Córdoba Córdoba Spain
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Reaven J, Moody EJ, Grofer Klinger L, Keefer A, Duncan A, O'Kelley S, Meyer A, Hepburn S, Blakeley-Smith A. Training clinicians to deliver group CBT to manage anxiety in youth with ASD: Results of a multisite trial. J Consult Clin Psychol 2019; 86:205-217. [PMID: 29504790 DOI: 10.1037/ccp0000285] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Few guidelines are available regarding optimal training models for practitioners delivering cognitive-behavioral therapy (CBT) for anxiety in youth with autism spectrum disorder (ASD). The present study systematically compared 3 instructional conditions for delivering the Facing Your Fears program (FYF) to children with ASD and anxiety. METHOD Thirty-four clinicians (Mage = 34 years; 94% women, 88% Caucasian) and an intent-to-treat sample of 91 children with ASD and anxiety (Mage = 11; 84% male 53% Caucasian) met eligibility criteria across 4 sites. A 3-group parallel design via a Latin square procedure was used to randomize 9 teams of clinicians to 1 of 3 training conditions: Manual, Workshop, Workshop-Plus. The effectiveness of instructional condition was assessed via implementation (CBT knowledge, treatment fidelity) and treatment outcomes (reductions in anxiety as measured by the Anxiety Disorders Interview Schedule-Parent (ADIS-P). RESULTS Clinicians in both Workshop conditions significantly increased CBT knowledge postworkshop, F(1, 18) = 19.8, p < .001. Excellent treatment fidelity was obtained across conditions (above 89%), although clinicians in the Workshop conditions obtained significantly higher fidelity ratings and delivered FYF with greater quality than the Manual condition. Children with ASD demonstrated significant reductions in anxiety symptoms for three of the four anxiety diagnoses, with no differences noted across instructional condition. Rates of improvement were lower than those obtained in a previous controlled trial. CONCLUSIONS Results suggest that although there may be some advantage to participating in a Workshop, clinicians in all conditions could deliver FYF with excellent fidelity and yield positive treatment outcomes. Lack of a no-treatment comparison group limits interpretation of findings. (PsycINFO Database Record
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Affiliation(s)
- Judy Reaven
- Department of Psychiatry, University of Colorado Anschutz Medical Campus
| | - Eric J Moody
- Department of Psychiatry, University of Colorado Anschutz Medical Campus
| | - Laura Grofer Klinger
- Department of Psychiatry, TEACCH Autism Program, University of North Carolina-Chapel Hill
| | - Amy Keefer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine/Kennedy Krieger Institute
| | - Amie Duncan
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center
| | - Sarah O'Kelley
- Department of Psychology, University of Alabama-Birmingham
| | - Allison Meyer
- Department of Pediatrics, University of Colorado Anschutz Medical Center
| | - Susan Hepburn
- Human Development and Family Studies, Colorado State University
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Keefer A, Kreiser NL, Singh V, Blakeley-Smith A, Reaven J, Vasa RA. Exploring Relationships Between Negative Cognitions and Anxiety Symptoms in Youth With Autism Spectrum Disorder. Behav Ther 2018; 49:730-740. [PMID: 30146140 DOI: 10.1016/j.beth.2017.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 12/22/2022]
Abstract
Although cognitions are central to the conceptualization and treatment of anxiety in typically developing (TD) youth, there is scant research investigating automatic thoughts and their relationship with anxiety in youth with autism spectrum disorder (ASD). We sought to examine the types of automatic thoughts experienced by youth with ASD and co-occurring anxiety as well as the predictive relationship of anxiety to different types of automatic thoughts in 97 children, ages 8-14 years. We also explored the relationship of automatic thoughts and intolerance of uncertainty. Consistent with prior data, there was a strong relationship between anxiety and automatic thoughts pertaining to social and physical threat. Anxiety and IU were independently associated with thoughts pertaining to personal failure which raises the hypothesis that personal failure may serve as a common pathway between anxiety, IU, and depression in ASD youth. These findings highlight the importance of assessing and treating negative cognitions in youth with ASD and anxiety.
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Affiliation(s)
- Amy Keefer
- Kennedy Krieger Institute, Center for Autism and Related Disorders; Johns Hopkins University School of Medicine.
| | | | - Vini Singh
- Kennedy Krieger Institute, Center for Autism and Related Disorders
| | | | - Judy Reaven
- University of Colorado Anschutz Medical Campus School of Medicine
| | - Roma A Vasa
- Kennedy Krieger Institute, Center for Autism and Related Disorders; Johns Hopkins University School of Medicine
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Jitlina K, Zumbo B, Mirenda P, Ford L, Bennett T, Georgiades S, Waddell C, Smith IM, Volden J, Duku E, Zwaigenbaum L, Szatmari P, Vaillancourt T, Elsabbagh M. Psychometric Properties of the Spence Children's Anxiety Scale: Parent Report in Children with Autism Spectrum Disorder. J Autism Dev Disord 2018; 47:3847-3856. [PMID: 28409361 DOI: 10.1007/s10803-017-3110-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although anxiety is frequently reported in children with autism spectrum disorder (ASD), existing anxiety scales are often psychometrically inappropriate for this population. This study examined the internal structure, reliability, convergent and discriminant validity of the Spence Children's Anxiety Scale-Parent Report (SCAS-P; Spence 1999) in 238 school-aged children with ASD. While confirmatory factor analysis did not support the original six-correlated-factor structure, structural support as well as acceptable internal consistency and convergent validity was found for Generalized Anxiety, Separation Anxiety, Panic, and Agoraphobia subscales. Use of the SCAS-P in its original form for assessment in children with ASD was not supported. However, four subscales showed viability, and may benefit re-analyses of existing SCAS-P data and future scale adaptations for research and clinical purposes.
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Affiliation(s)
- Katia Jitlina
- University of British Columbia, Vancouver, BC, Canada.
| | - Bruno Zumbo
- University of British Columbia, Vancouver, BC, Canada
| | - Pat Mirenda
- University of British Columbia, Vancouver, BC, Canada
| | - Laurie Ford
- University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Isabel M Smith
- Dalhousie University/IWK Health Centre, Halifax, NS, Canada
| | | | - Eric Duku
- McMaster University, Hamilton, ON, Canada
| | | | - Peter Szatmari
- Centre for Addiction and Mental Health, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Vasa RA, Kreiser NL, Keefer A, Singh V, Mostofsky SH. Relationships between autism spectrum disorder and intolerance of uncertainty. Autism Res 2018; 11:636-644. [PMID: 29316350 PMCID: PMC5903967 DOI: 10.1002/aur.1916] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 11/08/2017] [Accepted: 12/06/2017] [Indexed: 12/21/2022]
Abstract
Intolerance of uncertainty (IU) is a dispositional risk factor involving maladaptive responding under conditions of uncertainty. Recent data indicate that IU is likely elevated in youth with autism spectrum disorder (ASD) and is positively correlated with anxiety. This study examined whether IU may be associated with ASD independent of anxiety. Relationships between anxiety, ASD, and IU were examined in 57 children with ASD without co-occurring intellectual disability and 32 control participants, ages 7-16 years. Hierarchal linear regressions were run to examine whether ASD variables, including emotion dysregulation, were predictive of IU when controlling for anxiety. Severity of social communication deficits, repetitive behaviors, and emotion dysregulation were each related to IU when controlling for the effects of anxiety. When these variables were entered into the regression model together, emotion dysregulation was the only significant predictor of IU. These findings suggest that IU is directly related to features of ASD possibly due to shared genetic, neurological, or psychological underpinnings. Autism Res 2018, 11: 636-644. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY Youth with ASD without co-occurring intellectual disability experience high levels of intolerance of uncertainty (IU), which is related to anxiety. This study found that IU may also have a relationship with certain aspects of ASD, particularly emotion dysregulation.
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Affiliation(s)
- Roma A. Vasa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Avenue, Baltimore, Maryland, 21211
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 707 North Broadway, Baltimore, Maryland, 21205
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, Maryland, 21287
| | - Nicole L. Kreiser
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 710, Norfolk, Virginia, 23507
| | - Amy Keefer
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Avenue, Baltimore, Maryland, 21211
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, Maryland, 21287
| | - Vini Singh
- Center for Autism and Related Disorders, Kennedy Krieger Institute, 3901 Greenspring Avenue, Baltimore, Maryland, 21211
| | - Stewart H. Mostofsky
- Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, 707 North Broadway, Baltimore, Maryland, 21205
- Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 710, Norfolk, Virginia, 23507
- Department of Neurology, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, Maryland, 21205
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Iniesta-Sepúlveda M, Nadeau JM, Ramos A, Kay B, Riemann BC, Storch EA. An Initial Case Series of Intensive Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in Adolescents with Autism Spectrum Disorder. Child Psychiatry Hum Dev 2018; 49:9-19. [PMID: 28389841 DOI: 10.1007/s10578-017-0724-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Obsessive-compulsive disorder (OCD) is prevalent among youth with autism spectrum disorder (ASD). Cognitive-behavioral therapy (CBT) with ASD-specific modifications has support for treating OCD in this population; however, use of intensive CBT in youth with ASD and severe OCD has not been tested. The current study examined the preliminary effectiveness of an individualized intensive CBT protocol for OCD in adolescents with ASD. Nine adolescents (aged 11-17 years) completed a regimen of intensive CBT (range 24-80 daily sessions) incorporating exposure with response prevention (ERP). Treatment materials, language and techniques were modified in accordance with evidence-based findings for this population. Seven of nine participants (78%) were treatment responders, and large treatment effects (d = 1.35-2.58) were obtained on primary outcomes (e.g., obsessive-compulsive symptom severity). Preliminary findings suggest that an intensive CBT approach for OCD is effective among adolescents with ASD.
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Affiliation(s)
- Marina Iniesta-Sepúlveda
- Department of Psychology, Catholic University of Murcia, Murcia, Spain. .,Department of Education, Catholic University of Murcia, 35 Campus de los Jerónimos, 30107, Guadalupe, Spain.
| | - Joshua M Nadeau
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA.,Rogers Memorial Hospital, Oconomowoc, WI, USA
| | - Amaya Ramos
- Rogers Memorial Hospital, Oconomowoc, WI, USA
| | - Brian Kay
- Rogers Memorial Hospital, Oconomowoc, WI, USA
| | | | - Eric A Storch
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA.,Rogers Memorial Hospital, Oconomowoc, WI, USA.,Department of Health Policy and Management, University of South Florida, Tampa, FL, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA.,Department of Psychology, University of South Florida, St. Petersburg, FL, USA.,All Children's Hospital - Johns Hopkins Medicine, St. Petersburg, FL, USA
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The Relationship Between Treatment Acceptability and Youth Outcome in Group CBT for Youth with ASD and Anxiety. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2018. [DOI: 10.1007/s10879-018-9380-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Magiati I, Lerh JW, Hollocks MJ, Uljarevic M, Rodgers J, McConachie H, Ozsivadjian A, South M, Van Hecke A, Hardan A, Libove R, Leekam S, Simonoff E. The measurement properties of the spence children's anxiety scale-parent version in a large international pooled sample of young people with autism spectrum disorder. Autism Res 2017; 10:1629-1652. [DOI: 10.1002/aur.1809] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 02/03/2017] [Accepted: 04/07/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Iliana Magiati
- Department of Psychology; National University of Singapore, 9 Arts Link; Singapore 117570
| | - Jian Wei Lerh
- Department of Psychology; National University of Singapore, 9 Arts Link; Singapore 117570
| | - Matthew J. Hollocks
- Department of Child and Adolescent Psychiatry; Institute of Psychiatry, Psychology & Neuroscience, King's College London, DeCrespigny Park, Denmark Hill; London SE5 8AF UK
- Department of Clinical Psychology; Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia; Norwich UK
| | - Mirko Uljarevic
- Olga Tennison Autism Research Centre; School of Psychological Science, La Trobe University; Victoria 3086 Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket; Brisbane Queensland Australia
| | - Jacqui Rodgers
- Clinical Psychology; Ridley Building, Institute of Neuroscience, Newcastle University; Newcastle NE1 7RU UK
| | - Helen McConachie
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road; Newcastle upon Tyne NE1 4LP UK
| | - Ann Ozsivadjian
- Evelina London Children's Hospital, St Thomas' Hospital; London UK
| | - Mikle South
- Department of Psychology; College of Family, Home and Social Sciences, Brigham Young University; Provo Utah
| | - Amy Van Hecke
- Department of Psychology; College of Arts and Sciences, Marquette University, Cramer Hall; Milwaukee Wisconsin 53201-1881
| | - Antonio Hardan
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine, Stanford University; Stanford California 94305
| | - Robin Libove
- Department of Psychiatry and Behavioral Sciences; Stanford University School of Medicine, Stanford University; Stanford California 94305
| | - Susan Leekam
- Wales Autism Research Centre; School of Psychology, Cardiff University; Cardiff CF10 3AT UK
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Feasibility, Acceptability and Preliminary Treatment Outcomes in a School-Based CBT Intervention Program for Adolescents with ASD and Anxiety in Singapore. J Autism Dev Disord 2017; 47:3909-3929. [DOI: 10.1007/s10803-016-3007-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Lohr WD, Daniels K, Wiemken T, Williams PG, Kelley RR, Kuravackel G, Sears L. The Screen for Child Anxiety-Related Emotional Disorders Is Sensitive but Not Specific in Identifying Anxiety in Children with High-Functioning Autism Spectrum Disorder: A Pilot Comparison to the Achenbach System of Empirically Based Assessment Scales. Front Psychiatry 2017; 8:138. [PMID: 28824469 PMCID: PMC5539181 DOI: 10.3389/fpsyt.2017.00138] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/17/2017] [Indexed: 12/28/2022] Open
Abstract
Validated brief screening instruments are needed to improve the detection of anxiety disorders in autism spectrum disorder (ASD). The Screen for Child Anxiety-Related Emotional Disorders (SCARED), a 41-item parent- and self-reported scale measuring anxiety, was compared to the Achenbach System of Empirically Based Assessment (ASEBA) scales. One hundred participants with a clinical diagnosis of high-functioning ASD, aged 8-18 years, and their parents completed the above scales. We hypothesized that the SCARED would be useful in screening for anxiety and its results for total scores of anxiety would converge with ASEBA syndrome scales for anxiety and internalizing disorders. Significant correlations were shown between the SCARED and the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) across a broad spectrum of scales. The CBCL syndrome scale for anxious/depressed showed the highest correlation and predicted anxiety scores on the SCARED. While many of the YSR scales significantly correlated with child ratings of anxiety, none of the scales predicted the SCARED child scores. Differences in self and parent reports suggest that parents interpret externalizing behaviors as signs of anxiety in ASD, whereas youth may describe internalized symptoms as anxiety. Females were more likely to self-report anxiety than males. Results support the use of the SCARED as a screening tool for anxiety in high-functioning ASD, but it should be supplemented with other tools to increase the specificity of its results.
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Affiliation(s)
- W David Lohr
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, United States
| | - Katherine Daniels
- School of Psychology, Spalding University, Louisville, KY, United States
| | - Tim Wiemken
- University of Louisville School of Public Health and Information Sciences, Louisville, KY, United States
| | - P Gail Williams
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, United States
| | - Robert R Kelley
- St. Mary's College of Maryland, St. Mary's City, MD, United States
| | - Grace Kuravackel
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, United States
| | - Lonnie Sears
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, United States
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Kerns CM, Rump K, Worley J, Kratz H, McVey A, Herrington J, Miller J. The Differential Diagnosis of Anxiety Disorders in Cognitively-Able Youth With Autism. COGNITIVE AND BEHAVIORAL PRACTICE 2016. [DOI: 10.1016/j.cbpra.2015.11.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Keefer A, Kreiser NL, Singh V, Blakeley-Smith A, Duncan A, Johnson C, Klinger L, Meyer A, Reaven J, Vasa RA. Intolerance of Uncertainty Predicts Anxiety Outcomes Following CBT in Youth with ASD. J Autism Dev Disord 2016; 47:3949-3958. [DOI: 10.1007/s10803-016-2852-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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40
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Green SA, Hernandez L, Bookheimer SY, Dapretto M. Salience Network Connectivity in Autism Is Related to Brain and Behavioral Markers of Sensory Overresponsivity. J Am Acad Child Adolesc Psychiatry 2016; 55:618-626.e1. [PMID: 27343889 PMCID: PMC4924541 DOI: 10.1016/j.jaac.2016.04.013] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/17/2016] [Accepted: 04/25/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The salience network, an intrinsic brain network thought to modulate attention to internal versus external stimuli, has been consistently found to be atypical in autism spectrum disorders (ASD). However, little is known about how this altered resting-state connectivity relates to brain activity during information processing, which has important implications for understanding sensory overresponsivity (SOR), a common and impairing condition in ASD related to difficulty downregulating brain responses to sensory stimuli. This study examined how SOR in youth with ASD relates to atypical salience network connectivity and whether these atypicalities are associated with abnormal brain response to basic sensory information. METHOD Functional magnetic resonance imaging was used to examine how parent-rated SOR symptoms related to salience network connectivity in 61 youth (aged 8-17 years; 28 with ASD and 33 IQ-matched typically developing youth). Correlations between resting-state salience network connectivity and brain response to mildly aversive tactile and auditory stimuli were examined. RESULTS SOR in youth with ASD was related to increased resting-state functional connectivity between salience network nodes and brain regions implicated in primary sensory processing and attention. Furthermore, the strength of this connectivity at rest was related to the extent of brain activity in response to auditory and tactile stimuli. CONCLUSION Results support an association between intrinsic brain connectivity and specific atypical brain responses during information processing. In addition, findings suggest that basic sensory information is overly salient to individuals with SOR, leading to overattribution of attention to this information. Implications for intervention include incorporating sensory coping strategies into social interventions for individuals with SOR.
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Affiliation(s)
- Shulamite A Green
- Psychiatry and Biobehavioral Sciences, Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles.
| | - Leanna Hernandez
- Psychiatry and Biobehavioral Sciences, Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles
| | - Susan Y Bookheimer
- Psychiatry and Biobehavioral Sciences, Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles
| | - Mirella Dapretto
- Psychiatry and Biobehavioral Sciences, Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles
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Reaven J, Washington L, Moody EJ, Stern JA, Hepburn SL, Blakeley-Smith A. Examining the Relationship Between Parental Anxiety and Treatment Response in Children and Adolescents with Autism Spectrum Disorder and Anxiety. J Autism Dev Disord 2016; 45:2464-73. [PMID: 25778837 DOI: 10.1007/s10803-015-2410-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In response to the high co-occurrence of anxiety symptoms in youth with autism spectrum disorder (ASD), several interventions have been developed for this population. In spite of promising findings, some youth with ASD respond only minimally to such interventions. To understand potential factors that may impact treatment response, the current study explores the role of parental anxiety in youth treatment outcome. Thirty-one youth with ASD, ages 7-18, and their parents participated in the study. Parents completed the State/Trait Anxiety Inventory pre- and post-treatment. Contrary to previous research, there was no correlation between parental anxiety and youth anxiety at baseline or post-treatment. However, parental trait anxiety significantly decreased from pre- to post-treatment for parents of treatment responders. The findings are consistent with previous research and suggest a youth-to-parent influence.
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Affiliation(s)
- Judy Reaven
- JFK Partners, Department of Psychiatry, University of Colorado, Anschutz Medical Campus, School of Medicine, 13121 E. 17th Ave. C-234, Aurora, CO, 80045, USA,
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Hepburn SL, Blakeley-Smith A, Wolff B, Reaven JA. Telehealth delivery of cognitive-behavioral intervention to youth with autism spectrum disorder and anxiety: A pilot study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2015; 20:207-18. [PMID: 25896267 DOI: 10.1177/1362361315575164] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Youth with autism spectrum disorders frequently experience significant symptoms of anxiety. Empirically supported psychosocial interventions exist, yet access is limited, especially for families in rural areas. Telehealth (i.e. videoconferencing) has potential to reduce barriers to access to care; however, little is known about the feasibility or efficacy of directly intervening with youth with autism spectrum disorders through this modality. This study details the pilot testing of a telehealth version of an empirically supported intervention targeting anxiety in youth with autism spectrum disorders. The primary focus of this study is on feasibility, with evaluation of outcomes as a starting point for future randomized trials. In all, 33 families of youth with autism spectrum disorders and significant anxiety symptoms participated in this study (Telehealth Facing Your Fears (FYF) Intervention: n = 17; Wait-list control: n = 16). Youth of all functioning levels were included. Acceptability was strong; however, the usability of the technology was problematic for some families and impeded some sessions significantly. Fidelity of the telehealth version to the critical elements of the original, in vivo version was excellent. More work is needed to improve delivery of exposure practices and parent coaching. Preliminary efficacy analyses are promising, with improvements observed in youth anxiety over time (relative to a comparison group waiting for live intervention) and parent sense of competence (within group). Clearly, stronger designs are necessary to evaluate efficacy sufficiently; however, this study does provide support for further investigation of clinic-to-home videoconferencing as a direct intervention tool for youth with autism spectrum disorders and their parents.
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Reaven J, Blakeley-Smith A, Beattie TL, Sullivan A, Moody EJ, Stern JA, Hepburn SL, Smith IM. Improving transportability of a cognitive-behavioral treatment intervention for anxiety in youth with autism spectrum disorders: results from a US-Canada collaboration. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2014; 19:211-22. [PMID: 24463434 DOI: 10.1177/1362361313518124] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anxiety disorders frequently co-occur in youth with autism spectrum disorders. In addition to developing efficacious treatments for anxiety in children with autism spectrum disorders, it is important to examine the transportability of these treatments to real-world settings. Study aims were to (a) train clinicians to deliver Facing Your Fears: Group Therapy for Managing Anxiety in Children with High-Functioning Autism Spectrum Disorders to fidelity and (b) examine feasibility of the program for novel settings. A secondary aim was to examine preliminary youth treatment outcome. Results indicated that clinicians obtained excellent fidelity following a workshop and ongoing consultation. Acceptability ratings indicated that Facing Your Fears Therapy was viewed favorably, and critiques were incorporated into program revisions. Meaningful reductions in anxiety were reported posttreatment for 53% of children. Results support the initial effectiveness and transportability of Facing Your Fears Therapy in new clinical settings.
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Affiliation(s)
- Judy Reaven
- University of Colorado, Anschutz Medical Campus, School of Medicine, Denver, USA
| | | | | | | | - Eric J Moody
- University of Colorado, Anschutz Medical Campus, School of Medicine, Denver, USA
| | - Jessica A Stern
- University of Colorado, Anschutz Medical Campus, School of Medicine, Denver, USA
| | - Susan L Hepburn
- University of Colorado, Anschutz Medical Campus, School of Medicine, Denver, USA
| | - Isabel M Smith
- IWK Health Centre, Halifax, Nova Scotia, Canada Department of Pediatrics and Psychology & Neuroscience, Dalhousie University, Halifax, Canada
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