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Westlake F, Westlake M, Totsika V. A systematic review and meta-analysis of the effectiveness of interventions targeting the parent-child relationship in families of children with an intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13273. [PMID: 39192691 DOI: 10.1111/jar.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND The review aimed to investigate the effectiveness of parent-child relationship interventions for families of children with intellectual disability up to 12 years old. METHODS Quasi-experimental or randomised controlled trials (RCTs) of interventions targeting the parent-child relationship where ≥50% of children had an intellectual disability were included. Meta-analyses of parent-child relationship outcomes and child outcomes used standardised mean difference as the effect size. RESULTS Twenty-seven papers were included (N = 1325). Parent-child relationship outcomes improved significantly (n = 1325; g = 1.08, 95% CI: 0.64, 1.52) with a large effect size that was robust to sensitivity analyses. Child developmental outcomes improved significantly (n = 1082; g = 0.65, 95% CI: 0.23, 1.07), and indicated a large effect size for child socialisation and communication. CONCLUSIONS Findings suggest that interventions targeting parent-child relationship quality are associated with substantial improvements in parent-child relationship and may improve child outcomes related to socialisation and communication.
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Affiliation(s)
- Freya Westlake
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Meryl Westlake
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Child Attachment and Psychological Therapies Research Unit, The Anna Freud National Centre for Children and Families, London, UK
| | - Vaso Totsika
- Division of Psychiatry, University College London, London, UK
- Centre for Research in Intellectual and Developmental Disabilities, University of Warwick, Coventry, UK
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2
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Albright J, Shinall JA, Tomczuk L, Stewart RE, Mandell DS, Stahmer AC, Beidas RS, Pellecchia M. A multi-constituent qualitative examination of facilitators and barriers to caregiver coaching for autistic children in publicly funded early intervention. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241272993. [PMID: 39171756 DOI: 10.1177/13623613241272993] [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: 08/23/2024]
Abstract
LAY ABSTRACT Caregiver coaching is an evidence-based practice for young autistic children, but it is not widely used in community-based early intervention services. Previous research has explored why caregiver coaching is not widespread in early intervention, but only from the perspective of early intervention providers. Caregivers, providers, and administrators are all involved in the decision of whether to use caregiver coaching in early intervention. Therefore, it is important to include all perspectives in research regarding this practice. In this study we interviewed 20 caregivers of autistic children, 36 early intervention providers, and 6 administrators from early intervention agencies and asked questions about their perspectives regarding the use of caregiver coaching in early intervention. We did this to figure out what factors help and hinder the use of caregiver coaching in this setting and to see how caregivers, providers, and administrators agreed or disagreed on these factors. All participants agreed that caregivers' attitudes and expectations can influence whether caregiver coaching is used. In addition, all participants agreed that when caregivers and providers collaborate and have a strong working relationship, it can facilitate the use of caregiver coaching in early intervention. Other factors, such as caregiver stress and provider flexibility were also discussed. Based on these findings, we suggest strategies that can be used to possibly increase the use of caregiver coaching in early intervention for autistic children and their families.
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Affiliation(s)
| | | | | | | | | | | | - Rinad S Beidas
- Northwestern University Feinberg School of Medicine, USA
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3
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Sandbank M, Pustejovsky JE, Bottema-Beutel K, Caldwell N, Feldman JI, Crowley LaPoint S, Woynaroski T. Determining Associations Between Intervention Amount and Outcomes for Young Autistic Children: A Meta-Analysis. JAMA Pediatr 2024; 178:763-773. [PMID: 38913359 PMCID: PMC11197026 DOI: 10.1001/jamapediatrics.2024.1832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/20/2024] [Indexed: 06/25/2024]
Abstract
Importance Health professionals routinely recommend intensive interventions (ie, 20-40 hours per week) for autistic children. However, primary research backing this recommendation is sparse and plagued by methodological flaws. Objective To examine whether different metrics of intervention amount are associated with intervention effects on any developmental domain for young autistic children. Data Sources A large corpus of studies taken from a recent meta-analysis (with a search date of November 2021) of early interventions for autistic children. Study Selection Studies were eligible if they reported a quasi-experimental or randomized clinical trial testing the effects of a nonpharmacological intervention on any outcome in participant samples comprising more than 50% autistic children 8 years or younger. Data Extraction and Synthesis Data were independently extracted by multiple coders. Meta-regression models were constructed to determine whether each index of intervention amount was associated with effect sizes for each intervention type, while controlling for outcome domain, outcome proximity, age of participants, study design, and risk of detection bias. Data were analyzed from June 2023 to February 2024. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Main Outcomes and Measures The primary predictor of interest was intervention amount, quantified using 3 different metrics (daily intensity, duration, and cumulative intensity). The primary outcomes of interest were gains in any developmental domain, quantified by Hedges g effect sizes. Results A total of 144 studies including 9038 children (mean [SD] age, 49.3 [17.2] months; mean [SD] percent males, 82.6% [12.7%]) were included in this analysis. None of the meta-regression models evidenced a significant, positive association between any index of intervention amount and intervention effect size when considered within intervention type. Conclusions and Relevance Findings of this meta-analysis do not support the assertion that intervention effects increase with increasing amounts of intervention. Health professionals recommending interventions should be advised that there is little robust evidence supporting the provision of intensive intervention.
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Affiliation(s)
- Micheal Sandbank
- Department of Health Sciences, The University of North Carolina at Chapel Hill, Chapel Hill
| | | | | | - Nicolette Caldwell
- Department of Curriculum and Instruction, University of Arkansas, Fayetteville
| | - Jacob I. Feldman
- Department of Hearing and Speech Sciences, Frist Center for Autism and Innovation at Vanderbilt University, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shannon Crowley LaPoint
- TEACCH Autism Program, Research Fellow, The University of North Carolina at Chapel Hill, Chapel Hill
| | - Tiffany Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Vanderbilt Kennedy Center, Vanderbilt Brain Institute, Frist Center for Autism and Innovation at Vanderbilt University, Nashville, Tennessee
- Department of Communication Sciences and Disorders, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu
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Tu G, Jiang N, Chen W, Liu L, Hu M, Liao B. The neurobiological mechanisms underlying the effects of exercise interventions in autistic individuals. Rev Neurosci 2024; 0:revneuro-2024-0058. [PMID: 39083671 DOI: 10.1515/revneuro-2024-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/15/2024] [Indexed: 08/02/2024]
Abstract
Autism spectrum disorder is a pervasive and heterogeneous neurodevelopmental condition characterized by social communication difficulties and rigid, repetitive behaviors. Owing to the complex pathogenesis of autism, effective drugs for treating its core features are lacking. Nonpharmacological approaches, including education, social-communication, behavioral and psychological methods, and exercise interventions, play important roles in supporting the needs of autistic individuals. The advantages of exercise intervention, such as its low cost, easy implementation, and high acceptance, have garnered increasing attention. Exercise interventions can effectively improve the core features and co-occurring conditions of autism, but the underlying neurobiological mechanisms are unclear. Abnormal changes in the gut microbiome, neuroinflammation, neurogenesis, and synaptic plasticity may individually or interactively be responsible for atypical brain structure and connectivity, leading to specific autistic experiences and characteristics. Interestingly, exercise can affect these biological processes and reshape brain network connections, which may explain how exercise alleviates core features and co-occurring conditions in autistic individuals. In this review, we describe the definition, diagnostic approach, epidemiology, and current support strategies for autism; highlight the benefits of exercise interventions; and call for individualized programs for different subtypes of autistic individuals. Finally, the possible neurobiological mechanisms by which exercise improves autistic features are comprehensively summarized to inform the development of optimal exercise interventions and specific targets to meet the needs of autistic individuals.
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Affiliation(s)
- Genghong Tu
- Department of Sports Medicine, 47878 Guangzhou Sport University , Guangzhou, Guangdong, 510500, P.R. China
- Guangdong Provincial Key Laboratory of Physical Activity and Health Promotion, 47878 Scientific Research Center, Guangzhou Sport University , Guangzhou, Guangdong, 510500, P.R. China
| | - Nan Jiang
- Graduate School, 47878 Guangzhou Sport University , Guangzhou, Guangdong, 510500, P.R. China
| | - Weizhong Chen
- Graduate School, 47878 Guangzhou Sport University , Guangzhou, Guangdong, 510500, P.R. China
| | - Lining Liu
- Graduate School, 47878 Guangzhou Sport University , Guangzhou, Guangdong, 510500, P.R. China
| | - Min Hu
- Guangdong Provincial Key Laboratory of Physical Activity and Health Promotion, 47878 Scientific Research Center, Guangzhou Sport University , Guangzhou, Guangdong, 510500, P.R. China
| | - Bagen Liao
- Department of Sports Medicine, 47878 Guangzhou Sport University , Guangzhou, Guangdong, 510500, P.R. China
- Guangdong Provincial Key Laboratory of Physical Activity and Health Promotion, 47878 Scientific Research Center, Guangzhou Sport University , Guangzhou, Guangdong, 510500, P.R. China
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Conrad CE, Jørgensen R, Amstrup C, Gottschau TE, Thomsen PH, Lauritsen MB. "It Seems Much More Enjoyable Now": Parental Perception of Relational Change from Participating in Paediatric Autism Communication Therapy (PACT). CHILDREN (BASEL, SWITZERLAND) 2024; 11:838. [PMID: 39062287 PMCID: PMC11276199 DOI: 10.3390/children11070838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/07/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVES This qualitative study aims to examine parental experiences of feasibility and relational changes from participating in the Paediatric Autism Communication Therapy (PACT) intervention. METHODS Thirteen parents of children diagnosed with autism spectrum disorder (mean age 3.89 years) participated in semi-structured interviews. Thematic analysis was performed, inspired by an abductive approach informed by the theories of the attachment system, the caregiving system and mentalisation. RESULTS Three overarching themes were identified: the struggle of fitting PACT into everyday life, the fruit of relational connection and the cascading relational effects of PACT. Parents were challenged regarding finding time for the intervention but adapted PACT to their individual needs and possibilities. All parents experienced relational improvement, and a cycle of positive relational change through PACT was identified. CONCLUSIONS This study has several clinical implications. Therapists and clinics offering PACT interventions should encourage and support parents in their individual journey of implementing PACT into their everyday lives. Some of the parents described improvements in parental mentalisation, child attachment and mutual enjoyment in the parent-child relationship. Children with autism could benefit from parents increasing their sensitivity when caregiving, and clinicians may through interventions such as PACT facilitate this development.
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Affiliation(s)
- Charlotte Engberg Conrad
- Psychiatry, Aalborg University Hospital, 9000 Aalborg, Denmark; (R.J.); (C.A.); (M.B.L.)
- Department of Clinical Medicine, Aalborg University, 9260 Gistrup, Denmark
| | - Rikke Jørgensen
- Psychiatry, Aalborg University Hospital, 9000 Aalborg, Denmark; (R.J.); (C.A.); (M.B.L.)
- Department of Clinical Medicine, Aalborg University, 9260 Gistrup, Denmark
| | - Cecilie Amstrup
- Psychiatry, Aalborg University Hospital, 9000 Aalborg, Denmark; (R.J.); (C.A.); (M.B.L.)
| | - Tine Ellitsgaard Gottschau
- Research Unit, Department of Child and Adolescent Psychiatry, Copenhagen University Hospital—Psychiatry Region Zealand, 4000 Roskilde, Denmark;
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, 8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
| | - Marlene Briciet Lauritsen
- Psychiatry, Aalborg University Hospital, 9000 Aalborg, Denmark; (R.J.); (C.A.); (M.B.L.)
- Department of Clinical Medicine, Aalborg University, 9260 Gistrup, Denmark
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Marret S, Chadie A, Muller JB, Chollat C. [Neurodevelopment and neuroprotection in young children]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:481-489. [PMID: 38492741 DOI: 10.1016/j.gofs.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024]
Abstract
In France, the most pessimistic estimates put the prevalence of neurodevelopmental disorders (NDD) at 15 % of births. The two largest populations of newborns at highest risk of NDD are premature babies and babies born into siblings with one or more infants who already have an autism spectrum disorder or another NDD. The high prevalence of these disorders justifies a health promotion policy, centred on the child and his or her family. Prevention is based on the early identification of high-risk factors, by informing families and training pregnancy and early childhood professionals, and implementing perinatal prevention protocols for high-risk newborns (antenatal corticosteroid therapy and magnesium sulfate for women at risk of preterm delivery before 32 weeks, developmental care, therapeutic hypothermia for full-term infants with early neonatal encephalopathy presumed to be anoxic). Preventing the severity of NDD depends on their early identification, as early as possible in the highest plastic "1000 days" developmental window, a smooth flow of diagnosis and care for mothers and children, and the establishment of an ecosystem that includes multi-modal early intervention, at the best in multi-disciplinary teams such as the early medical and social action centres, support for families through guidance programs and inclusion in the community, first in day-care centers and then in nursery schools.
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Affiliation(s)
- Stéphane Marret
- Service de pédiatrie néonatale et réanimation - neuropédiatrie, hôpital Charles-Nicolle, CHU de Rouen et Unité Inserm 1245, UFR santé de Rouen, université de Normandie, Rouen, France.
| | - Alexandra Chadie
- Service de pédiatrie néonatale et réanimation - neuropédiatrie, hôpital Charles-Nicolle, CHU de Rouen et Unité Inserm 1245, UFR santé de Rouen, université de Normandie, Rouen, France
| | - Jean-Baptiste Muller
- Service de pédiatrie néonatale et réanimation - neuropédiatrie, hôpital Charles-Nicolle, CHU de Rouen et Unité Inserm 1245, UFR santé de Rouen, université de Normandie, Rouen, France
| | - Clément Chollat
- Service de néonatologie, hôpital Armand Trousseau, AP-HP, université Paris Cité, Inserm, NeuroDiderot, Paris, France
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7
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Klein CB, Klinger LG. Aging Well and Autism: A Narrative Review and Recommendations for Future Research. Healthcare (Basel) 2024; 12:1207. [PMID: 38921321 PMCID: PMC11203987 DOI: 10.3390/healthcare12121207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/05/2024] [Accepted: 06/08/2024] [Indexed: 06/27/2024] Open
Abstract
With autism first recognized in the 1940s, the early cohorts of autistic children are beginning to enter older adulthood. Little is known about the experiences and outcomes of autistic older adults. In the general population, "successful aging" is a dominant model among gerontologists and is used to evaluate outcomes in older adulthood. This narrative review aims to provide a framework for understanding and supporting successful aging in older autistic adults. Using Fernández-Ballesteros' four-domain model of "aging well" we review knowledge on aging and autism by examining outcomes in health and functioning, cognitive and physical functioning, positive affect and control, and social participation and engagement. Findings indicate that outcomes in autistic older adults are generally poor, marked by increased medical conditions, low adaptive skills, elevated risk of cognitive decline, limited physical activity, high rates of mental health conditions, low quality of life, and reduced social or community participation. Patterns of challenges are similar across cognitive abilities and profiles of autistic traits. Challenges and next steps in aging and autism research are identified, and future directions for the field are discussed.
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Affiliation(s)
- Claire B. Klein
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- UNC TEACCH Autism Program, Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Laura G. Klinger
- UNC TEACCH Autism Program, Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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8
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Gao P, Zhou C, Ruan Z, Zhang Z, Fang X. Association between caregiver-child interaction and autistic-like behaviors at around three years of age. J Affect Disord 2024; 355:326-332. [PMID: 38556097 DOI: 10.1016/j.jad.2024.03.078] [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: 08/21/2023] [Revised: 02/29/2024] [Accepted: 03/12/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND The prevalence of autistic-like behaviors is increasing worldwide, both in developed and developing countries. With a high disease burden and complex developmental causes, there has been much interest in the etiology of the disease, and there is a lack of evidence on the relationship between caregiver-child interaction and autistic-like behaviors. AIM/OBJECTIVE This study investigated the association between caregiver-child interaction and children's autistic-like behaviors during early childhood. METHOD The subjects of this study were 171 kindergartens selected from the Longhua Child Cohort Study (LCCS), and a total of 40,237 children around the age of three were included. Sociodemographic characteristics, family income, and frequency of interaction between caregivers and children were all filled in by the child's primary caregiver, and the adapted Chinese Autism Behavior Checklist was used to assess children's autism-like behaviors. Tobit Regression and ancovariance analysis (ANCOVA) were used to measure the relationship between caregiver-child interactions (family and social activities) and autism-like behaviors, with a two-tailed p value of <0.05 being significant. RESULTS Tobit regression analyses found that in the 0-1 year age group, different frequencies of singing activities by caregivers with children (<3 times per week, 3-6 times per week, 6 times or more per week) were significantly negatively associated with autistic-like behaviors in a dose-response manner (B values of -0.323, -0.381, -0.544, all p < 0.0001); in the 1-3 year age group, different frequencies of reading interactions by caregivers with children (<3 times per week, 3-6 times per week, 6 times or more per week) were also significantly negatively associated with autistic-like behaviors in a dose-response manner (B values of -0.388, -0.632, -0.956, all p < 0.0001), and similar associations were found in singing and chatting interactions. CONCLUSIONS Our findings suggest that higher frequencies of early caregiver-child interactions are associated with lower levers of autistic-like behaviors in children around the age of three years.
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Affiliation(s)
- Peng Gao
- Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Cheng Zhou
- Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Zhaohui Ruan
- Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Zixing Zhang
- Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Xinyu Fang
- Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei 230032, China.
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9
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Zhang L, Ren T, He H, Huang L, Huang R, Xu Y, Zhou L, Tan H, Chen J, Wu D, Yang H, Zhang H, Yu J, Du X, Dai Y, Pu Y, Li C, Wang X, Shi S, Sahakian BJ, Luo Q, Li F. Protective factors for children with autism spectrum disorder during COVID-19-related strict lockdowns: a Shanghai autism early developmental cohort study. Psychol Med 2024; 54:1102-1112. [PMID: 37997447 DOI: 10.1017/s0033291723002908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
BACKGROUND COVID-19 lockdowns increased the risk of mental health problems, especially for children with autism spectrum disorder (ASD). However, despite its importance, little is known about the protective factors for ASD children during the lockdowns. METHODS Based on the Shanghai Autism Early Developmental Cohort, 188 ASD children with two visits before and after the strict Omicron lockdown were included; 85 children were lockdown-free, while 52 and 51 children were under the longer and the shorter durations of strict lockdown, respectively. We tested the association of the lockdown group with the clinical improvement and also the modulation effects of parent/family-related factors on this association by linear regression/mixed-effect models. Within the social brain structures, we examined the voxel-wise interaction between the grey matter volume and the identified modulation effects. RESULTS Compared with the lockdown-free group, the ASD children experienced the longer duration of strict lockdown had less clinical improvement (β = 0.49, 95% confidence interval (CI) [0.19-0.79], p = 0.001) and this difference was greatest for social cognition (2.62 [0.94-4.30], p = 0.002). We found that this association was modulated by parental agreeableness in a protective way (-0.11 [-0.17 to -0.05], p = 0.002). This protective effect was enhanced in the ASD children with larger grey matter volumes in the brain's mentalizing network, including the temporal pole, the medial superior frontal gyrus, and the superior temporal gyrus. CONCLUSIONS This longitudinal neuroimaging cohort study identified that the parental agreeableness interacting with the ASD children's social brain development reduced the negative impact on clinical symptoms during the strict lockdown.
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Affiliation(s)
- Lingli Zhang
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tai Ren
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hua He
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Like Huang
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Runqi Huang
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yixiang Xu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Zhou
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Hangyu Tan
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingyu Chen
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danping Wu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hanshu Yang
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haotian Zhang
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juehua Yu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Experimental Studies and Research, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiujuan Du
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Dai
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwei Pu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shenxun Shi
- Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Barbara J Sahakian
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Psychiatry and the Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Qiang Luo
- National Clinical Research Center for Aging and Medicine at Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai 200433, China
- MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Institutes of Brain Science and Human Phenome Institute, Fudan University, Shanghai 200032, China
| | - Fei Li
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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10
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Waizbard-Bartov E, Fein D, Lord C, Amaral DG. Autism Severity and its Relationship to Disability. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:252-262. [PMID: 38680979 PMCID: PMC11046712 DOI: 10.1176/appi.focus.24022007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Autism severity is currently defined and measured based exclusively on the severity levels of the two core symptom domains: social-communication and restricted or repetitive patterns of behaviors and interests. Autistic individuals, however, are often diagnosed with other medical, developmental, and psychological co-occurring conditions. These additional challenges such as intellectual disability, limited expressive and/or receptive language, and anxiety disorders, can have a tremendous impact on the day-to-day lives of autistic individuals, for both their adaptive functioning as well as their sense of wellbeing. Furthermore, the initial presentation of core symptoms and their likelihood of changing over time are influenced by the presence of such co-occurring conditions. In order to truly understand how a person's autism impacts their life, both core symptoms as well as other challenges should be considered. This approach was recently taken by The Lancet Commission on the future of care and clinical research in autism, which proposed the term "profound autism" for a subgroup of individuals presenting with high core symptom severity, co-occurring intellectual disability, and little or no language, who require extensive long-term care. Considering other individual factors such as daily living skills, specific support needs and environmental resources would also enhance the evaluation of disability in autistic individuals. As currently employed in the assessment of intellectual disability, a multidimensional approach to autism could provide a more comprehensive system for classification of impairment. At present, however, there is no formal way to designate the combined effect of these different aspects of autism on a person's life. A comprehensive outlook that acknowledges impairments, capabilities, co-occurring conditions, and environmental factors would be useful for identifying subgroups of individuals as well as for determining individual needs and strengths in clinical assessments. Lay Summary: The severity of a person's autism is currently defined based on the severity of their core autism symptoms: impaired social-communication and the presence of restricted or repetitive patterns of behaviors and interests. But autistic people often face additional challenges such as intellectual disability, epilepsy, and anxiety disorder, that considerably impact their everyday life, wellbeing, and the need for support. A more complete view of autism severity, one that includes core symptoms as well as additional challenges, could help identify meaningful sub-groups of autistic individuals and could be useful in clinical care. Appeared originally in Autism Res 2023; 16:685-696.
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Affiliation(s)
- Einat Waizbard-Bartov
- Department of Psychology, University of California Davis, Davis, California, USA (Waizbard-Bartov); The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA (Waizbard-Bartov, Amaral); Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA; Department of Pediatrics, University of Connecticut, Farmington, Connecticut, USA (Fein); Departments of Psychiatry and Human Development and Psychology, University of California, Los Angeles, California, USA (Lord)
| | - Deborah Fein
- Department of Psychology, University of California Davis, Davis, California, USA (Waizbard-Bartov); The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA (Waizbard-Bartov, Amaral); Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA; Department of Pediatrics, University of Connecticut, Farmington, Connecticut, USA (Fein); Departments of Psychiatry and Human Development and Psychology, University of California, Los Angeles, California, USA (Lord)
| | - Catherine Lord
- Department of Psychology, University of California Davis, Davis, California, USA (Waizbard-Bartov); The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA (Waizbard-Bartov, Amaral); Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA; Department of Pediatrics, University of Connecticut, Farmington, Connecticut, USA (Fein); Departments of Psychiatry and Human Development and Psychology, University of California, Los Angeles, California, USA (Lord)
| | - David G Amaral
- Department of Psychology, University of California Davis, Davis, California, USA (Waizbard-Bartov); The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA (Waizbard-Bartov, Amaral); Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA; Department of Pediatrics, University of Connecticut, Farmington, Connecticut, USA (Fein); Departments of Psychiatry and Human Development and Psychology, University of California, Los Angeles, California, USA (Lord)
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11
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Pfeiffer DL, Hess CR, Landa RJ. Seeking Validation and Creating Meaningful Interactions: Perceptions of a Parent-Mediated Infant Intervention. INFANTS AND YOUNG CHILDREN 2024; 37:85-100. [PMID: 39006999 PMCID: PMC11244628 DOI: 10.1097/iyc.0000000000000260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Infancy, a formative period for development, has been identified as an advantageous time to provide family-centered support for children with delays. Families should be included as stakeholders during development of such interventions to ensure social value. We describe a preliminary randomized controlled trial evaluating Infant Achievements (IA), an 8-week (16-session) parent-mediated intervention for parents of infants 8-12 months old with social communication delays. This study reports our qualitative examination of the intervention's social validity. We conducted focus groups with 7 IA parent participants and analyzed their responses using conventional content analysis. Five themes emerged: (a) difficulty identifying resources to address concerns, (b) seeking validation of concerns, (c) seeking support to enhance children's development, (d) experiencing a supportive coaching relationship, and (e) creating meaningful interactions to support children's communication and social skills. Our results emphasize the necessity of partnering with families in the development of evidence-based family-centered interventions for infants with developmental delays to maximize their social value.
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Affiliation(s)
- Danika L Pfeiffer
- School of Communication Sciences and Disorders, Old Dominion University
| | - Christine Reiner Hess
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Johns Hopkins University School of Medicine
| | - Rebecca J Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Johns Hopkins University School of Medicine
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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McDonnell AA, Page A, Bews-Pugh S, Morgalla KA, Kaur-Johal T, Maher M. Families' experiences of the Low Arousal Approach: a qualitative study. Front Psychol 2024; 15:1328825. [PMID: 38596338 PMCID: PMC11002904 DOI: 10.3389/fpsyg.2024.1328825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Background Parents and carers supporting a family member presenting with behaviors of concern experience heightened stress. The Low Arousal Approach is a crisis management strategy which recognizes that stress, or physiological arousal, can be expressed through behaviors of concern. This approach aims to equip parents and carers to manage behaviors in a person-centered and non-confrontational way. There is a paucity of published research exploring the experiences of families applying this approach. Methods Seventeen parents who had received training in the Low Arousal Approach were interviewed to gain their perspectives on supporting their family members using this approach. Results Thematic analysis revealed themes relating to parental stress, which was related to external pressures, isolation, family stress, and challenges in their caring role. They described encountering negative narratives relating to self-criticism and negative judgments from others. Training in the Low Arousal Approach was related to being empowered through access to evidence, increased confidence, and increased ability to advocate for their family member's needs. Low Arousal was described as a "lifestyle" that enabled increased coping for the family unit as a whole. Discussion/conclusion Findings indicate that it is vitally important to recognize the views of parents and carers, and these are equally as important as the views of professionals. We must understand parents' and carers' needs in order to provide adequate support.
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Affiliation(s)
| | - Andrea Page
- School of Nursing and Midwifery, Birmingham City University, Birmingham, United Kingdom
| | | | | | | | - Mary Maher
- Studio 3 Clinical Services Limited, Alcester, United Kingdom
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Byrne K, Sterrett K, Holbrook A, Kim SH, Grzadzinski R, Lord C. Extending the Usefulness of the Brief Observation of Social Communication Change (BOSCC): Validating the Phrase Speech and Young Fluent Version. J Autism Dev Disord 2024; 54:1009-1023. [PMID: 36547793 PMCID: PMC9772597 DOI: 10.1007/s10803-022-05877-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
The current study investigated the utility of the Brief Observation of Social Communication Change-Phrase Speech Young Fluent (BOSCC-PSYF) as an outcome measure of treatment response by analyzing the measure's psychometric properties and initial validity. The BOSCC coding scheme was applied to 345 administrations from 160 participants diagnosed with autism. Participants included individuals of any age with phrase speech, or individuals under the age of 8 years with complex sentences. All were receiving behavioral intervention throughout the study. Test-retest and inter-rater reliability were good for the Early Communication and Social Reciprocity/Language domains, and fair for the Restricted and Repetitive Behavior domain. Significant changes occurred over time in the Early Communication and Social Reciprocity/Language domains, and Core Total scores. The BOSCC-PSYF may provide a low-cost, flexible, and user-friendly outcome measure that reliably measures changes in broad social communicative behaviors in a short period of time.
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Affiliation(s)
| | - Kyle Sterrett
- University of California, Los Angeles, California, USA
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Moshe S, Oppenheim D, Slonim M, Hamburger L, Maccabi Y, Yirmiya N. Positive and challenging themes in parents' perceptions of their relationships with their child with autism: Comparison between mothers and fathers. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:744-754. [PMID: 37448108 PMCID: PMC10913294 DOI: 10.1177/13623613231182513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
LAY ABSTRACT Most studies of how parents of children with autism see the parent-child relationship used questionnaires completed by the parents and focused on challenges. This study broadened the lens by interviewing parents using open-ended questions that provide an opportunity to raise challenging but also positive experiences. Seventy-five mother-father dyads were interviewed individually about their own and their spouses' relationships with their preschooler, and we found nine relationship themes. In descending order, the themes mentioned most frequently by mothers were "Security and Closeness," "Love," and "Tenderness and Sensitivity," and by fathers were "Pleasure in Joint Activities," "Security and Closeness," and "Guidance." Positive themes were more common than challenging themes. Finally, more mothers mentioned the themes "Love," "Tenderness and Sensitivity," "High Involvement and Care," and "Difficulties" than did fathers, whereas more fathers mentioned the themes "Guidance" and "Pleasure in Joint Activities" than did mothers. The findings portray a nuanced view of the parenting experience of mothers and fathers of preschoolers with autism.
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Blume J, Miller M, O'Neill D, Mastergeorge AM, Ozonoff S. Utility of the Language Use Inventory in Young Children at Elevated Likelihood of Autism. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:573-585. [PMID: 38215350 PMCID: PMC11000786 DOI: 10.1044/2023_jslhr-23-00442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 01/14/2024]
Abstract
PURPOSE The aims of this study were (a) to evaluate the convergent validity of the Language Use Inventory (LUI) with measures of autism spectrum disorder (ASD) symptoms, language, and social skills and (b) to assess discriminant validity of the LUI with measures of nonlanguage skills, including daily living skills and motor development. METHOD This study sample included participants from a longitudinal study (n = 239) of infant siblings with elevated familial likelihood of ASD and lower familial likelihood. Assessment measures completed at 36 months included the LUI, the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2), the Mullen Scales of Early Learning, and the Vineland Adaptive Behavior Scales-Second Edition. Bivariate Pearson correlations were estimated between ADOS-2 comparison scores and four language and social skills measures. Additional correlations were estimated between LUI total scores and standard scores from nonlanguage measures. A series of Fisher's Z transformations were applied to evaluate whether bivariate correlations were significantly different. RESULTS All four language and social skill measures were moderately to strongly associated with each other and ASD symptom severity scores. The correlation between ADOS-2 comparison scores and LUI total scores was significantly stronger than ADOS-2 correlations with all other measures. CONCLUSIONS Our findings provide support for the LUI as a feasible, pragmatic language-targeted instrument for inclusion in early developmental evaluations prompted by language concerns. Administration of the LUI may accelerate earlier referral for a comprehensive assessment of ASD symptoms. Given the high correlation with ADOS-2 scores, an LUI total score in a clinical range of concern may encourage a clinician to refer families for a full diagnostic evaluation of ASD.
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Affiliation(s)
- Jessica Blume
- Office of Global Health, Texas Tech University Health Sciences Center, Lubbock
| | - Meghan Miller
- Department of Psychiatry and Behavioral Sciences, University of California, Davis
| | - Daniela O'Neill
- Department of Psychology, University of Waterloo, Ontario, Canada
| | - Ann M. Mastergeorge
- Department of Human Development and Family Sciences, Texas Tech University, Lubbock
| | - Sally Ozonoff
- Department of Psychiatry and Behavioral Sciences, University of California, Davis
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Carruthers S, Pickles A, Charman T, McConachie H, Le Couteur A, Slonims V, Howlin P, Collum R, Salomone E, Tobin H, Gammer I, Maxwell J, Aldred C, Parr J, Leadbitter K, Green J. Mediation of 6-year mid-childhood follow-up outcomes after pre-school social communication (PACT) therapy for autistic children: randomised controlled trial. J Child Psychol Psychiatry 2024; 65:233-244. [PMID: 37095645 PMCID: PMC10953331 DOI: 10.1111/jcpp.13798] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND There are very few mechanistic studies of the long-term impact of psychosocial interventions in childhood. The parent-mediated Paediatric Autism Communication Therapy (PACT) RCT showed sustained effects on autistic child outcomes from pre-school to mid-childhood. We investigated the mechanism by which the PACT intervention achieved these effects. METHODS Of 152 children randomised to receive PACT or treatment as usual between 2 and 5 years of age, 121 (79.6%) were followed 5-6 years after the endpoint at a mean age of 10.5 years. Assessors, blind to the intervention group, measured Autism Diagnostic Observation Scale Calibrated Severity Score (ADOS CSS) for child autistic behaviours and Teacher Vineland (TVABS) for adaptive behaviour in school. Hypothesised mediators were child communication initiations with caregivers in a standard play observation (Dyadic Communication Measure for Autism, DCMA). Hypothesised moderators of mediation were baseline child non-verbal age equivalent scores (AE), communication and symbolic development (CSBS) and 'insistence on sameness' (IS). Structural equation modelling was used in a repeated measures mediation design. RESULTS Good model fits were obtained. The treatment effect on child dyadic initiation with the caregiver was sustained through the follow-up period. Increased child initiation at treatment midpoint mediated the majority (73%) of the treatment effect on follow-up ADOS CSS. A combination of partial mediation from midpoint child initiations and the direct effect of treatment also contributed to a near-significant total effect on follow-up TVABS. No moderation of this mediation was found for AE, CSBS or IS. CONCLUSIONS Early sustained increase in an autistic child's communication initiation with their caregiver is largely responsible for the long-term effects from PACT therapy on autistic and adaptive behaviour outcomes. This supports the theoretical logic model of PACT therapy but also illuminates fundamental causal processes of social and adaptive development in autism over time: early social engagement in autism can be improved and this can have long-term generalised outcome effects.
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Affiliation(s)
- Sophie Carruthers
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Andrew Pickles
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Tony Charman
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Helen McConachie
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Ann Le Couteur
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Vicky Slonims
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
- Evelina London Children's HospitalLondonUK
| | - Patricia Howlin
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Rachel Collum
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Erica Salomone
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
- Department of PsychologyUniversity of Milano‐BicoccaMilanItaly
| | | | - Isobel Gammer
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUK
| | - Jessica Maxwell
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - Jeremy Parr
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - Jonathan Green
- Manchester Academic Health Sciences Centre, Royal Manchester Children's HospitalUniversity of ManchesterManchesterUK
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Rouhandeh AA, Honsberger C, Shanok NA, Lozott EB, Levy T, Kolevzon A, Buxbaum JD, Sotelo M, Foss-Feig J, Siper PM. Brief Report: Assessment of a Caregiver-Implemented Intervention for Improving Social Communication Skills in Toddlers and Young Children with Autism. J Autism Dev Disord 2024; 54:794-802. [PMID: 35616818 PMCID: PMC9134715 DOI: 10.1007/s10803-022-05587-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 10/25/2022]
Abstract
As early identification of autism improves, there is a critical need for interventions to support the development of social communication skills in toddlers. Caregiver coaching and parental involvement is crucial for improving outcomes and providing children with adequate hours of planned active engagement. This pilot study assessed a 4-week intervention for individual caregiver-child dyads. Eight toddlers 21- to 45-months of age participated. Standardized assessments were collected at four study visits to assess autism symptomatology, language development, and both caregiver knowledge and engagement. Results demonstrated the feasibility of the intervention. Social communication, receptive and expressive language all improved as measured by direct assessment. Caregiver knowledge and caregivers' subjective feelings of engagement with their toddlers also improved.
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Affiliation(s)
- Audrey A Rouhandeh
- Seaver Autism Center for Research and Treatment at Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA
| | | | | | | | - Tess Levy
- Seaver Autism Center for Research and Treatment at Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA
| | - Alexander Kolevzon
- Seaver Autism Center for Research and Treatment at Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA
| | - Joseph D Buxbaum
- Seaver Autism Center for Research and Treatment at Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA
| | | | - Jennifer Foss-Feig
- Seaver Autism Center for Research and Treatment at Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA
| | - Paige M Siper
- Seaver Autism Center for Research and Treatment at Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY, 10029, USA.
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Gajre MP, Shah M, Pradhan SV, Aseri H. Examining the Impact of Group-Based Social Skills Intervention in Autistic Children Aged Eight to 15 Years. Cureus 2024; 16:e53376. [PMID: 38435203 PMCID: PMC10907971 DOI: 10.7759/cureus.53376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Autism spectrum disorder (ASD) is a neurological and developmental disorder, which poses challenges to social communication and behavior, particularly affecting social functioning. Individuals with ASD face significant social challenges, including difficulty understanding social cues and body language, limited ability to engage in reciprocal social interactions, and challenges with establishing empathy. A preference for routines and repetitive behaviors limits their ability to adapt to new or unexpected social situations. These problems tend to escalate during adolescence. These often cause distress to the individual as well as the caregivers. Group-based social skills interventions (GSSIs) are a widely used and effective modality for addressing core social impairments in children with autism. This study aims to assess the impact of GSSI on the broad age group of eight to 15 years, involving parents to enhance the transferability of children's social skills. Methods This was a single-arm interventional study where 30 verbal autistic children, aged eight to 15 years, with intelligence quotient (IQ) > 70 were enrolled after utilizing the Binet Kamat Test of Intelligence (BKT) to assess IQ and the Indian Scale for Assessment of Autism (ISAA) to grade severity of autism. The children received GSSI from interdisciplinary therapists for 12 sessions, on a weekly basis, lasting 90 minutes each for a period of three months. After each therapy session, parents received summaries of each session and were delegated reinforcing homework assignments to enable generalization and maintenance of the skills taught. Outcome measures were taken at three points in time by utilizing the Social Communication Questionnaire (SCQ) and the parent-rated Social Responsiveness Scale 2 (p-SRS-2): T1: pre-therapy at the time of enrolment; T2: immediately post-therapy at the end of three months of training; and T3: long-term follow-up, three months after the end of training. Results Mean SCQ scores were as follows: T1 = 21.87, T2 = 18.57, and T3 = 18.57 (p = 0.000). This progressive decline at T1, T2, and T3 indicated a decreasing trend in the severity of difficulties in the social communication domain. Mean p-SRS-2 scores were as follows: T1 = 73.00, T2 = 64.57, and T3 = 64.30 (p < 0.0001). This declining trend at T1, T2, and T3 suggested a statistically significant decrease in the severity of difficulties faced in various social aspects tested by the p-SRS-2, i.e., social awareness, social cognition, social communication, and social motivation, along with a reduction in restricted interests and repetitive behaviors (RRBs). Very strong correlation coefficients were obtained for SCQ scores (T1-T2 = 0.921, T1-T3 = 0.921, and T2-T3 = 1.000), as well as for p-SRS-2 scores (T1-T2 = 0.743, T1-T3 = 0.746, and T2-T3 = 0.989), which reinforced the statistical significance of the data. Conclusion GSSI is an effective parent-assisted intervention for adolescents with ASD, with effects lasting up to three months post-intervention.
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Affiliation(s)
- Mona P Gajre
- Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, IND
| | - Mansi Shah
- Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, IND
| | - Shreeya V Pradhan
- Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, IND
| | - Harshna Aseri
- Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, IND
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Nedungadi P, Shah SM, Stokes MA, Kumar Nair V, Moorkoth A, Raman R. Mapping autism's research landscape: trends in autism screening and its alignment with sustainable development goals. Front Psychiatry 2024; 14:1294254. [PMID: 38361829 PMCID: PMC10868528 DOI: 10.3389/fpsyt.2023.1294254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/29/2023] [Indexed: 02/17/2024] Open
Abstract
Introduction Autism Spectrum Disorder is a complex neurodevelopmental syndrome that profoundly affects social interactions, communication, and sensory perception. The research traced the evolution of autism research from 2011-2022, specifically focusing on the screening and diagnosis of children and students. Methods Through an analysis of 12,262 publications using the PRISMA framework, bibliographic coupling, science mapping, and citation analysis, this study illuminates the growth trajectory of ASD research and significant disparities in diagnosis and services. Results The study indicates an increasing trend in autism research, with a strong representation of female authorship. Open Access journals show a higher average citation impact compared to their closed counterparts. A keyword co-occurrence analysis revealed four central research themes: Child Development and Support Systems, Early Identification and Intervention, Prevalence and Etiology, and Mental Health. The pandemic's onset has prioritized research areas like mental health, telehealth, and service accessibility. Discussion Recommendations on a global level stress the importance of developing timely biological markers for ASD, amplifying Disability Inclusion research, and personalizing mental health services to bridge these critical service gaps. These strategies, underpinned by interdisciplinary collaboration and telehealth innovation, particularly in low-resource settings, can offer a roadmap for inclusive, context-sensitive interventions at local levels that directly support SDG3's aim for health and well-being for all.
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Affiliation(s)
- Prema Nedungadi
- Amrita School of Computing, Amrita Vishwa Vidyapeetham, Kollam, India
| | | | | | | | - Ajit Moorkoth
- Seed Special Education Center, Dubai, United Arab Emirates
| | - Raghu Raman
- Amrita School of Business Amritapuri, Amrita Vishwa Vidyapeetham University, Coimbatore, Tamil Nadu, India
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Drmic I, Brian J, Roncadin C, Shaver C, Pase M, Rugajs N, Tofano K, Dowds E, Zwaigenbaum L, Smith IM, Bryson SE. Community implementation of a brief parent mediated intervention for toddlers with probable or confirmed autism spectrum disorder: feasibility, acceptability, and drivers of success (IE Drmic et al.). Front Pediatr 2024; 11:1295294. [PMID: 38322245 PMCID: PMC10844426 DOI: 10.3389/fped.2023.1295294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/27/2023] [Indexed: 02/08/2024] Open
Abstract
Background Social ABCs is a caregiver-mediated Naturalistic Developmental Behavioral Intervention for toddlers with confirmed/suspected Autism Spectrum Disorder (ASD), with evidence in controlled research settings. Information is lacking on implementation in community settings. We reported on the treatment effectiveness of this program within a community setting, and the current paper describes the implementation phase of this work. Distinguishing between treatment and implementation effectiveness is critical for transporting interventions from laboratory to community. Objectives Describe the implementation of Social ABCs through a large public autism service, supported by a research-community partnership. Methods We describe this project through the Exploration, Preparation, Implementation, Sustainment (EPIS) framework as it focuses on implementation of evidence-based practices in publicly funded services. We apply this framework to the reporting stage. This project took place in the context of a 3-year government-funded pilot at a hospital-based publicly funded autism service. Participants: Program developers; Autism Service team; toddlers with suspected/confirmed ASD aged 14-34 months (M = 25.18 months) and their caregivers. Training/supervision: Provided by program developers at tapering intensity. Evaluation: Caregivers completed the Caregiver Diary and satisfaction surveys. We explored training processes, intervention uptake, acceptability, adaptations to fit community context, appropriateness, perceived impact, and facilitators/barriers. Results Six coaches were trained to fidelity, and three of these were further trained as Site Trainers. 183 clinically referred families enrolled and 89.4% completed the 12-week program. Caregivers reported increases in adherence and competence, high satisfaction and perceived benefits for their children. Coaches reported high satisfaction. Toddlers were appropriately identified to receive the intervention. Referral processes improved, including decreased referral age, and increased family readiness for diagnostic assessment and subsequent services. Conclusions Social ABCs was successfully implemented in a community service through a research-community partnership. The program was feasible, acceptable, and appropriate within a community context. Drivers of success included funding, institutional support, shared decision-making, adaptations to fit context, leadership support, perceived positive impact, and commitment to evaluation.
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Affiliation(s)
- Irene Drmic
- McMaster Children’s Hospital, Autism Program, Hamilton, ON, Canada
| | - Jessica Brian
- Autism Research Centre, Bloorview Research Institute, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Chantelle Shaver
- McMaster Children’s Hospital, Autism Program, Hamilton, ON, Canada
| | - Marlene Pase
- McMaster Children’s Hospital, Autism Program, Hamilton, ON, Canada
| | - Natalie Rugajs
- McMaster Children’s Hospital, Autism Program, Hamilton, ON, Canada
| | - Kristina Tofano
- McMaster Children’s Hospital, Autism Program, Hamilton, ON, Canada
| | - Erin Dowds
- McMaster Children’s Hospital, Autism Program, Hamilton, ON, Canada
| | | | - Isabel M. Smith
- Department of Pediatrics and Department of Psychology & Neuroscience, Autism Research Centre, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Susan E. Bryson
- Department of Pediatrics and Department of Psychology & Neuroscience, Autism Research Centre, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
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Franz L, Viljoen M, Askew S, Brown M, Dawson G, Di Martino JM, Sapiro G, Sebolai K, Seris N, Shabalala N, Stahmer A, Turner EL, de Vries PJ. Autism Caregiver Coaching in Africa (ACACIA): Protocol for a type 1-hybrid effectiveness-implementation trial. PLoS One 2024; 19:e0291883. [PMID: 38215154 PMCID: PMC10786379 DOI: 10.1371/journal.pone.0291883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND While early autism intervention can significantly improve outcomes, gaps in implementation exist globally. These gaps are clearest in Africa, where forty percent of the world's children will live by 2050. Task-sharing early intervention to non-specialists is a key implementation strategy, given the lack of specialists in Africa. Naturalistic Developmental Behavioral Interventions (NDBI) are a class of early autism intervention that can be delivered by caregivers. As a foundational step to address the early autism intervention gap, we adapted a non-specialist delivered caregiver coaching NDBI for the South African context, and pre-piloted this cascaded task-sharing approach in an existing system of care. OBJECTIVES First, we will test the effectiveness of the caregiver coaching NDBI compared to usual care. Second, we will describe coaching implementation factors within the Western Cape Department of Education in South Africa. METHODS This is a type 1 effectiveness-implementation hybrid design; assessor-blinded, group randomized controlled trial. Participants include 150 autistic children (18-72 months) and their caregivers who live in Cape Town, South Africa, and those involved in intervention implementation. Early Childhood Development practitioners, employed by the Department of Education, will deliver 12, one hour, coaching sessions to the intervention group. The control group will receive usual care. Distal co-primary outcomes include the Communication Domain Standard Score (Vineland Adaptive Behavior Scales, Third Edition) and the Language and Communication Developmental Quotient (Griffiths Scales of Child Development, Third Edition). Proximal secondary outcome include caregiver strategies measured by the sum of five items from the Joint Engagement Rating Inventory. We will describe key implementation determinants. RESULTS Participant enrolment started in April 2023. Estimated primary completion date is March 2027. CONCLUSION The ACACIA trial will determine whether a cascaded task-sharing intervention delivered in an educational setting leads to meaningful improvements in communication abilities of autistic children, and identify implementation barriers and facilitators. TRIAL REGISTRATION NCT05551728 in Clinical Trial Registry (https://clinicaltrials.gov).
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Affiliation(s)
- Lauren Franz
- Duke Center for Autism and Brain Development, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Marisa Viljoen
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Sandy Askew
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Musaddiqah Brown
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, United States of America
| | - J Matias Di Martino
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, United States of America
| | - Guillermo Sapiro
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, United States of America
| | - Katlego Sebolai
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Noleen Seris
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Nokuthula Shabalala
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Aubyn Stahmer
- Center for Excellence in Developmental Disabilities, MIND Institute, University of California, Davis, Davis, California, United States of America
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States of America
| | - Petrus J de Vries
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
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22
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Zavaleta-Ramírez P, Rosetti M, Albores-Gallo L, López ON, González PP. Pediatric and psychiatric models of autism care in Mexico: Differences in diagnostic tools and prescribed interventions. Clin Child Psychol Psychiatry 2024; 29:232-244. [PMID: 37541309 DOI: 10.1177/13591045231193817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
Low- and middle-income countries face heterogeneity in the way clinicians' approach Autism Spectrum Disorder (ASD) diagnosis and treatment. The current study analyzes the diagnostic tools, laboratory tests, pharmacological and psychosocial interventions received by patients during the steps to diagnosis and treatment of two specialized care centers. Researchers interviewed families with a child with ASD receiving services at either a child psychiatric or a pediatric hospital. Of the total sample, 47% reported clinicians not using a diagnostic tool, 20% reported not receiving any psychosocial intervention, and 88% reported receiving a pharmacological prescription. Patients at the pediatric hospital were more likely to receive interventions with some components of Applied Behavioral Analysis, Early Start Denver Model, Treatment and Education of Autistic and Related Communication Handicapped Children, and Sensory integration therapy; while patients at the psychiatric hospital were more likely to undergo learning, daily living skills, and socialization therapies. Patients at the psychiatric hospital received significantly more requests to obtain auditory and vision tests whilst genetic testing and imaging were more common in the pediatric hospital. The range and variability in terms of diagnostic tools, laboratory tests, and treatment options observed for both sites reflect a lack of consensus. Recommendations to improve ASD diagnostic and treatment in Mexico are given.
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Affiliation(s)
- Patricia Zavaleta-Ramírez
- Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Servicios de Atención Psiquiátrica, Mexico City, Mexico
| | - Marcos Rosetti
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Instituto Nacional de Psiquiatría Dr. Ramón de la Fuente Muñiz, México City, México
| | - Lilia Albores-Gallo
- Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Servicios de Atención Psiquiátrica, Mexico City, Mexico
| | - Omar Nafate López
- Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Chiapas, México
| | - Paula Padierna González
- Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Servicios de Atención Psiquiátrica, Mexico City, Mexico
- Fundación Alicia Koplowitz, Madrid, España
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23
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Shire S. The devil is in the details: Advancing our collective understanding of naturalistic developmental behavioral interventions. Autism Res 2024; 17:10-16. [PMID: 37943121 DOI: 10.1002/aur.3048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/15/2023] [Indexed: 11/10/2023]
Abstract
Given the growing body of randomized trials examining various Naturalistic Developmental Behavioral Intervention (NDBI) approaches, a dialog has emerged exploring the overlap in strategies across NDBIs to create single measures that propose to capture core strategies across the interventions. This commentary will ask readers to consider the current state of the science, the potential value of looking not only for similarities but also for differences across approaches, and present five scientific next steps to advance our collective understanding of the NDBIs including: (a) operationalizing intervention strategies and outcomes, (b) expansion of the effectiveness evidence base and begin testing implementation strategies for individual NDBIs, (c) rigorous testing of core intervention components and the mechanism of each intervention, (d) personalization, and (e) supporting transparency with a priori trial registration.
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Affiliation(s)
- Stephanie Shire
- Special Education and Clinical Sciences, College of Education, University of Oregon, Eugene, Oregon, USA
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24
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Brandi Gomes Godoy P, McWilliams L, Rodrigues da Silveira L, de Cesaro Revers Biasão M, Speggiorin Pereira Alarcão F, Seda L, Generoso Campoli R, Liang H, Divan G, Leadbitter K, Green J, Shephard E. Acceptability and feasibility of a parent-mediated social-communication therapy for young autistic children in Brazil: A qualitative implementation study of Paediatric Autism Communication Therapy. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:123-137. [PMID: 36588298 DOI: 10.1177/13623613221144501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
LAY ABSTRACT Parents of autistic children and health professionals who work with autistic children in Brazil had positive views about introducing Paediatric Autism Communication Therapy as a therapy for autistic children in Brazil. The parents and clinicians also mentioned some difficulties about using Paediatric Autism Communication Therapy in Brazil. We made adaptations to Paediatric Autism Communication Therapy to address these difficulties. Paediatric Autism Communication Therapy is a therapy to support the development of social and communication skills for autistic children aged 2-10 years. The therapy is conducted with the autistic child's parent. Paediatric Autism Communication Therapy has not been used in Brazil before. There are few therapy options available for autistic children in Brazil and we believed that Paediatric Autism Communication Therapy may be useful. We asked three groups of people in Brazil about their views of Paediatric Autism Communication Therapy, after explaining how the therapy works. Group 1 included 18 parents of autistic children aged 2-10 years. Group 2 included 20 health professionals such as psychologists who work with autistic children. Group 3 included 15 parents of autistic children aged 2-7 years who received the Paediatric Autism Communication Therapy. We learned that parents and clinicians felt that Paediatric Autism Communication Therapy would be a beneficial therapy for autistic children in Brazil. We also found out about the challenges of using Paediatric Autism Communication Therapy in Brazil. We used these findings to make small cultural adaptations to Paediatric Autism Communication Therapy to make it more suitable for Brazil.
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Affiliation(s)
| | | | | | | | | | | | | | - Holan Liang
- UCL Great Ormond Street Institute of Child Health, UK
| | | | | | - Jonathan Green
- The University of Manchester, UK
- Royal Manchester Children's Hospital, UK
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25
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Hodge A, Sutherland R, Ong N, Chan E, Barnett D, Bennett B, Boulton K, Francis D, Guastella A, Papanicolaou A, Tomsic G, Williamsz M, Silove N. Telehealth assessment of autism in preschoolers using the TELE-ASD-PEDS: A pilot clinical investigation. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-17. [PMID: 38105699 DOI: 10.1080/17549507.2023.2270187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
PURPOSE Appropriate early intervention is beneficial but dependent on accurate and timely diagnoses. This has been affected by long waiting lists for face-to-face clinical services, in part due to pandemic lockdowns, with telehealth introduced in many services to continue clinical services. This pilot clinical study investigated the feasibility of integrating a specially-designed telepractice autism assessment tool into a tertiary diagnostic service. METHOD Eighteen boys (2;4-5;1) participated in the study. Assessment was undertaken as per standard practice (parent interview, questionnaires, review of reports), with an additional telepractice assessment, included in place of face-to-face assessment, to provide clinicians with an observation of the children's communication, behaviours, and interests. Ten parents provided feedback via semi-structured interviews. RESULT The TELE-ASD-PEDS was a feasible assessment tool in terms of administration, clinical experience, and information gained through the assessment process. Parents reported mostly positive experiences of the TELE-ASD-PEDS and made suggestions for improvements for future use of this tool. CONCLUSION It is possible to obtain useful information about a child's autism-specific behaviours using the activities in the TELE-ASD-PEDS. This information can be combined with clinical history from parents using the DSM-5 framework to provide a gold standard assessment for autism.
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Affiliation(s)
- Antoinette Hodge
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Rebecca Sutherland
- Discipline of Speech Pathology, Faculty of Medicine and Health, Univeristy of Sydney, Sydney, Australia
| | - Natalie Ong
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
- Discipline of Speech Pathology, Faculty of Medicine and Health, Univeristy of Sydney, Sydney, Australia
- The School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Esther Chan
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Diana Barnett
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Beverley Bennett
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Kelsie Boulton
- Discipline of Speech Pathology, Faculty of Medicine and Health, Univeristy of Sydney, Sydney, Australia
| | - Deanna Francis
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
- Black Dog Institute, University of New South Wales, Sydney, Australia, and
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Adam Guastella
- Discipline of Speech Pathology, Faculty of Medicine and Health, Univeristy of Sydney, Sydney, Australia
| | - Angela Papanicolaou
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Gail Tomsic
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Marcia Williamsz
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
| | - Natalie Silove
- Child Development Unit, The Children's Hospital at Westmead, Westmead, Australia
- Discipline of Speech Pathology, Faculty of Medicine and Health, Univeristy of Sydney, Sydney, Australia
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26
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Pickles A, Edwards D, Horvath L, Emsley R. Research Reviews: Advances in methods for evaluating child and adolescent mental health interventions. J Child Psychol Psychiatry 2023; 64:1765-1775. [PMID: 37793673 DOI: 10.1111/jcpp.13892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/06/2023]
Abstract
BACKROUND The evidence base for interventions for child mental health and neurodevelopment is weak and the current capacity for rigorous evaluation limited. We describe some of the challenges that make this field particularly difficult and expensive for evaluation studies. METHODS We describe and review the use of novel study designs and analysis methodology for their potential to improve this situation. RESULTS While several novel designs appeared ill-suited to our field, systematic review found others that offered potential but had yet to be widely adopted, some not at all. CONCLUSIONS While funding is inevitably a constraint, we argue that improvements in the evidence base of both current and new treatments will only be achieved by the adoption of a number of these new technologies and study designs, the consistent application of rigorous constructive but demanding standards, and the engagement of the public, patients, clinical and research services to build a design, recruitment, and analysis infrastructure.
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Affiliation(s)
- Andrew Pickles
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Danielle Edwards
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Levente Horvath
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, King's College London, London, UK
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27
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Roy R, Leadbitter K, Shields G, Taylor C, Aldred C, Juneja M, Gulati S, Vajaratkar V, Davies L, Emsley R, Patel V, Divan G, Green J. A randomised controlled trial of clinical and cost-effectiveness of the PASS Plus intervention for young children with autism spectrum disorder in New Delhi, India: study protocol for the COMPASS trial. Trials 2023; 24:667. [PMID: 37828540 PMCID: PMC10571330 DOI: 10.1186/s13063-023-07621-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 09/04/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Autism Spectrum Disorder (ASD) is a neurodevelopmental disability affecting at least 5 million children in South Asia. Majority of these children are without access to evidence-based care. The UK Pre-school Autism Communication Therapy (PACT) is the only intervention to have shown sustained impact on autism symptoms. It was systematically adapted for non-specialist community delivery in South Asia, as the 'Parent-mediated Autism Social Communication Intervention for non-Specialists (PASS)' and extended 'PASS Plus' interventions. RCTs of both showed feasibility, acceptability and positive effect on parent and child dyadic outcomes. METHODS The Communication-centred Parent-mediated treatment for Autism Spectrum Disorder in South Asia (COMPASS) trial is now a scale-up two-centre, two-arm single (rater) blinded random allocation parallel group study of the PASS Plus intervention in addition to treatment as usual (TAU) compared to TAU alone, plus health economic evaluation embedded in the India health system. Two hundred forty children (approximately 120 intervention/120 TAU) with ASD aged 2-9 years will be recruited from two tertiary care government hospitals in New Delhi, India. Accredited Social Health Activists will be one of the intervention delivery agents. Families will undertake up to 12 communication sessions over 8 months and will be offered the Plus modules which address coexisting problems. The trial's primary endpoint is at 9 months from randomisation, with follow-up at 15 months. The primary outcome is autism symptom severity; secondary outcomes include parent-child communication, child adaptation, quality of life and parental wellbeing. Primary analysis will follow intention-to-treat principles using linear mixed model regressions with group allocation and repeated measures as random effects. The cost-effectiveness analysis will use a societal perspective over the 15-month period of intervention and follow-up. DISCUSSION If clinically and cost-effective, this programme will fill an important gap of scalable interventions delivered by non-specialist health workers within the current care pathways for autistic children and their families in low-resource contexts. The programme has been implemented through the COVID-19 pandemic when restrictions were in place; intervention delivery and evaluation processes have been adapted to address these conditions. TRIAL REGISTRATION ISRCTN; ISRCTN21454676 ; Registered 22 June 2018.
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Affiliation(s)
| | | | | | | | | | - Monica Juneja
- Maulana Azad Medical College and Associated Lok Nayak Hospital, Delhi, India
| | | | | | | | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - Jonathan Green
- University of Manchester, Manchester, UK
- Royal Manchester Children's Hospital, Manchester, UK
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28
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Ingersoll B, Frost KM, Straiton D, Ramos AP, Howard M. Relative Efficacy of Self-directed and Therapist-assisted Telehealth Models of a Parent-mediated Intervention for Autism: Examining Effects on Parent Intervention Fidelity, Well-being, and Program Engagement. J Autism Dev Disord 2023:10.1007/s10803-023-06092-6. [PMID: 37751096 DOI: 10.1007/s10803-023-06092-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE Although there is growing interest in telehealth to deliver parent-mediated intervention for autistic children, empirical evaluations are limited, and little is known regarding the relative benefits of self-directed and therapist-assisted telehealth interventions. This study examined the effect of self-directed and therapist-assisted ImPACT Online on parent learning and well-being, moderators of treatment, and predictors of program engagement. METHOD Sixty-four young autistic children and their primary caregiver participated. Children were matched on age and developmental quotient and randomly assigned to a therapist-assisted, self-directed, or resource support control group. Participants were assessed at intake, after 6 months (post), and at a 3-month follow-up. RESULTS There was a significant treatment effect for parent learning for the therapist-assisted but not self-directed program; when analysis was limited to parents who completed the program, treatment effects were observed for both groups. There were no treatment effects for parent self-efficacy or parenting stress; however, there was an effect on parents' perception of their child's positive impact. Parenting stress did not moderate the effect of group on parent outcomes. Parent age, program satisfaction, and therapist assistance were all significant predictors of parent program engagement. CONCLUSION This study supports the efficacy of therapist-assisted telehealth parent-mediated intervention for teaching parents intervention strategies to support their child's social communication and improving their perceptions of their child's positive impact, and suggests that self-directed programs may be beneficial for parents who fully engage with the program.
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Affiliation(s)
| | - Kyle M Frost
- Michigan State University, East Lansing, MI, USA
| | | | | | - Mya Howard
- Michigan State University, East Lansing, MI, USA
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29
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Tinelli M, Roddy A, Knapp M, Arango C, Mendez MA, Cusack J, Murphy D, Canitano R, Oakley B, Quoidbach V. Economic analysis of early intervention for autistic children: findings from four case studies in England, Ireland, Italy, and Spain. Eur Psychiatry 2023; 66:e76. [PMID: 37732502 PMCID: PMC10594363 DOI: 10.1192/j.eurpsy.2023.2449] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Many autistic children experience difficulties in their communication and language skills development, with consequences for social development into adulthood, often resulting in challenges over the life-course and high economic impacts for individuals, families, and society. The Preschool Autism Communication Trial (PACT) intervention is effective in terms of improved social communication and some secondary outcomes. A previously published within-trial economic analysis found that results at 13 months did not support its cost-effectiveness. We modeled cost-effectiveness over 6 years and across four European countries. METHODS Using simulation modeling, we built on economic analyses in the original trial, exploring longer-term cost-effectiveness at 6 years (in England). We adapted our model to undertake an economic analysis of PACT in Ireland, Italy, and Spain. Data on resource use were taken from the original trial and a more recent Irish observational study. RESULTS PACT is cost-saving over time from a societal perspective, even though we confirmed that, at 13 months post-delivery, PACT is more expensive than usual treatment (across all countries) when given to preschool autistic children. After 6 years, we found that PACT has lower costs than usual treatment in terms of unpaid care provided by parents (in all countries). Also, if we consider only out-of-pocket expenses from an Irish study, PACT costs less than usual treatment. DISCUSSION PACT may be recommended as a cost-saving early intervention for families with an autistic child.
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Affiliation(s)
- Michela Tinelli
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Aine Roddy
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
- Atlantic Technological University, Sligo, Ireland
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
| | - Maria Andreina Mendez
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain
| | | | | | - Roberto Canitano
- University Hospital of Siena – Azienda ospedaliero-universitaria Senese, Siena, Italy
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30
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Franz L, Viljoen M, Askew S, Brown M, Dawson G, Di Martino JM, Sapiro G, Sebolai K, Seris N, Shabalala N, Stahmer A, Turner EL, de Vries PJ. Autism Caregiver Coaching in Africa (ACACIA): Protocol for a type 1-hybrid effectiveness-implementation trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.10.23295331. [PMID: 37745535 PMCID: PMC10516098 DOI: 10.1101/2023.09.10.23295331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Background While early autism intervention can significantly improve outcomes, gaps in implementation exist globally. These gaps are clearest in Africa, where forty percent of the world's children will live by 2050. Task-sharing early intervention to non-specialists is a key implementation strategy, given the lack of specialists in Africa. Naturalistic Developmental Behavioral Interventions (NDBI) are a class of early autism intervention that can be delivered by caregivers. As a foundational step to address the early autism intervention gap, we adapted a non-specialist delivered caregiver coaching NDBI for the South African context, and pre-piloted this cascaded task-sharing approach in an existing system of care. Objectives First, we will test the effectiveness of the caregiver coaching NDBI compared to usual care. Second, we will describe coaching implementation factors within the Western Cape Department of Education in South Africa. Methods This is a type 1 effectiveness-implementation hybrid design; assessor-blinded, group randomized controlled trial. Participants include 150 autistic children (18-72 months) and their caregivers who live in Cape Town, South Africa, and those involved in intervention implementation. Early Childhood Development practitioners, employed by the Department of Education, will deliver 12, one hour, coaching sessions to the intervention group. The control group will receive usual care. Distal co-primary outcomes include the Communication Domain Standard Score (Vineland Adaptive Behavior Scales, Third Edition) and the Language and Communication Developmental Quotient (Griffiths Scales of Child Development, Third Edition). Proximal secondary outcome include caregiver strategies measured by the sum of five items from the Joint Engagement Rating Inventory. We will describe key implementation determinants. Results Participant enrolment started in April 2023. Estimated primary completion date is March 2027. Conclusion The ACACIA trial will determine whether a cascaded task-sharing intervention delivered in an educational setting leads to meaningful improvements in communication abilities of autistic children, and identify implementation barriers and facilitators.
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Affiliation(s)
- Lauren Franz
- Duke Center for Autism and Brain Development, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Marisa Viljoen
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Sandy Askew
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Musaddiqah Brown
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Geraldine Dawson
- Duke Center for Autism and Brain Development, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | - J Matias Di Martino
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
| | - Guillermo Sapiro
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina, USA
| | - Katlego Sebolai
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Noleen Seris
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Nokuthula Shabalala
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Aubyn Stahmer
- Center for Excellence in Developmental Disabilities, MIND Institute, University of California Davis, California, USA
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Petrus J de Vries
- Centre for Autism Research in Africa (CARA), Division of Child & Adolescent Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
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Pacia C, Gunning C, McTiernan A, Holloway J. Developing the Parent-Coaching Assessment, Individualization, and Response to Stressors (PAIRS) Tool for Behavior Analysts. J Autism Dev Disord 2023; 53:3319-3342. [PMID: 35768672 PMCID: PMC10465672 DOI: 10.1007/s10803-022-05637-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/25/2022]
Abstract
Parent engagement in early behavioral intervention is essential to achieving meaningful intervention outcomes. However, parents may experience multiple barriers to engagement. The Parent-coaching Assessment, Individualization, and Response to Stressors (PAIRS) was developed to help practitioners assess families' barriers and facilitators, individualize their intervention, and respond to stressors using a contextual, functional approach. An expert panel of Board Certified Behavior Analysts ® (BCBAs) evaluated the content validity of the PAIRS. Average scale values (S-CVI/Ave) were 0.92 for relevance, 0.85 for effectiveness, and 0.91 for appropriateness. The PAIRS was revised, and a follow-up evaluation was conducted to rate the tool's utility. This led to the final version of the PAIRS. Clinical implications and future directions are discussed.
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Affiliation(s)
- Cressida Pacia
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Ciara Gunning
- School of Psychology, National University of Ireland Galway, Galway, Ireland.
| | - Aoife McTiernan
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Jennifer Holloway
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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Pak NS, Chow JC, Dillehay KM, Kaiser AP. Long-Term Effects of Early Communication Interventions: A Systematic Review and Meta-Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:2884-2899. [PMID: 37418755 DOI: 10.1044/2023_jslhr-22-00711] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
PURPOSE Early language and communication interventions for children with language impairments have been shown to be effective in assessments administered immediately after treatment. The purpose of the current systematic review and meta-analysis was to assess the overall durability of those effects over time and whether durability was related to outcome type, etiology of child language impairments, implementer of intervention, magnitude of posttest effects, time between intervention and follow-up, and study risk of bias. METHOD We conducted a systematic search of online databases and reference lists to identify experimental and quasi-experimental group design studies. All studies tested the effects of early communication interventions at least 3 months post-intervention. Participants were children 0-5 years old with language impairments. Coders identified study features and rated methodological quality indicators for all studies. Effect sizes at long-term timepoints and associations with potential moderators were estimated using multilevel meta-analysis with robust variance estimation. RESULTS Twenty studies with 129 long-term outcome effect sizes met inclusion criteria. Studies included children with developmental language disorders or language impairment associated with autism. The overall average effect size was small and significant (g = .22, p = .002). Effect size estimates were larger for prelinguistic outcomes (g = .36, p < .001) than for linguistic outcomes (g = .14, p = .101). Significant factors were the posttest effect sizes, the risk of bias for randomized trials, and etiology of language impairment for linguistic outcomes. Time post-intervention did not significantly predict long-term effect sizes. CONCLUSIONS Outcomes of early language and communication interventions appear to persist for at least several months post-intervention. More research is needed with collection and evaluation of long-term outcomes, a focus on measurement, and consistency of primary study reporting. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23589648.
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Affiliation(s)
- Natalie S Pak
- Department of Special Education, Peabody College, Vanderbilt University, Nashville, TN
| | | | - Kelsey M Dillehay
- Department of Special Education, Peabody College, Vanderbilt University, Nashville, TN
| | - Ann P Kaiser
- Department of Special Education, Peabody College, Vanderbilt University, Nashville, TN
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Abstract
We are at a time of unparalleled flux in our understanding of what autism is and now to respond to it, including our understanding of the role of clinical services. For any clinician working in the context of child development and child mental health services, the majority experience is probably of overwhelming demand, and then perhaps confusion. Referrals for neurodevelopmental conditions, and particularly autism, have become an increasing proportion of UK CAMHS referrals in recent years-with the consequent lengthening of wait times extending to years, sometimes equivalent to the whole length of a child's life up until that point. Services are struggling to develop response strategies to meet user frustration, a task not helped by the fact that most interventions in current use have no good evidence of effectiveness. Consequently, a plethora of local approaches and initiatives have developed. In this article I address these clinical and related issues. I discuss current different uses of the term autism, the relation to intellectual disability, and introduce a conceptualisation of autism as emergent and transactional, which is consistent with current developmental and intervention science. This could bridge between neurodiversity and clinical perspectives and implies a framing of early intervention support that has strong clinical trials evidence and provides the basis for a rational and pre-emptive evidenced care pathway, which I describe.
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Affiliation(s)
- Jonathan Green
- University of Manchester, Royal Manchester Children's Hospital, and Manchester Academic Health Sciences Centre, Manchester, UK
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Strathearn L, Momany A, Kovács EH, Guiler W, Ladd-Acosta C. The intersection of genome, epigenome and social experience in autism spectrum disorder: Exploring modifiable pathways for intervention. Neurobiol Learn Mem 2023; 202:107761. [PMID: 37121464 PMCID: PMC10330448 DOI: 10.1016/j.nlm.2023.107761] [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: 04/12/2022] [Revised: 02/22/2023] [Accepted: 04/22/2023] [Indexed: 05/02/2023]
Abstract
The number of children diagnosed with autism spectrum disorder (ASD) has increased substantially over the past two decades. Current research suggests that both genetic and environmental risk factors are involved in the etiology of ASD. The goal of this paper is to examine how one specific environmental factor, early social experience, may be correlated with DNA methylation (DNAm) changes in genes associated with ASD. We present an innovative model which proposes that polygenic risk and changes in DNAm due to social experience may both contribute to the symptoms of ASD. Previous research on genetic and environmental factors implicated in the etiology of ASD will be reviewed, with an emphasis on the oxytocin receptor gene, which may be epigenetically altered by early social experience, and which plays a crucial role in social and cognitive development. Identifying an environmental risk factor for ASD (e.g., social experience) that could be modified via early intervention and which results in epigenetic (DNAm) changes, could transform our understanding of this condition, facilitate earlier identification of ASD, and guide early intervention efforts.
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Affiliation(s)
- Lane Strathearn
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; Department of Neuroscience and Pharmacology, Carver College of Medicine, University of Iowa, 51 Newton Road 2-471 Bowen Science Building, Iowa City, IA 52241, USA; Interdisciplinary Graduate Program in Neuroscience, University of Iowa, 356 Medical Research Center, Iowa City, IA 52242, USA; Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, 100 Hawkins Drive, Iowa City, IA 52242, USA; Hawkeye Intellectual and Developmental Disabilities Research Center (Hawk-IDDRC), University of Iowa, 100 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Allison Momany
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; Hawkeye Intellectual and Developmental Disabilities Research Center (Hawk-IDDRC), University of Iowa, 100 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Emese Hc Kovács
- Department of Neuroscience and Pharmacology, Carver College of Medicine, University of Iowa, 51 Newton Road 2-471 Bowen Science Building, Iowa City, IA 52241, USA.
| | - William Guiler
- Interdisciplinary Graduate Program in Neuroscience, University of Iowa, 356 Medical Research Center, Iowa City, IA 52242, USA.
| | - Christine Ladd-Acosta
- Department of Epidemiology and the Wendy Klag Center for Autism and Developmental Disabilities, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
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Matthiesen M, Khlaifia A, Steininger CFD, Dadabhoy M, Mumtaz U, Arruda-Carvalho M. Maturation of nucleus accumbens synaptic transmission signals a critical period for the rescue of social deficits in a mouse model of autism spectrum disorder. Mol Brain 2023; 16:46. [PMID: 37226266 DOI: 10.1186/s13041-023-01028-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/20/2023] [Indexed: 05/26/2023] Open
Abstract
Social behavior emerges early in development, a time marked by the onset of neurodevelopmental disorders featuring social deficits, including autism spectrum disorder (ASD). Although social deficits are at the core of the clinical diagnosis of ASD, very little is known about their neural correlates at the time of clinical onset. The nucleus accumbens (NAc), a brain region extensively implicated in social behavior, undergoes synaptic, cellular and molecular alterations in early life, and is particularly affected in ASD mouse models. To explore a link between the maturation of the NAc and neurodevelopmental deficits in social behavior, we compared spontaneous synaptic transmission in NAc shell medium spiny neurons (MSNs) between the highly social C57BL/6J and the idiopathic ASD mouse model BTBR T+Itpr3tf/J at postnatal day (P) 4, P6, P8, P12, P15, P21 and P30. BTBR NAc MSNs display increased spontaneous excitatory transmission during the first postnatal week, and increased inhibition across the first, second and fourth postnatal weeks, suggesting accelerated maturation of excitatory and inhibitory synaptic inputs compared to C57BL/6J mice. BTBR mice also show increased optically evoked medial prefrontal cortex-NAc paired pulse ratios at P15 and P30. These early changes in synaptic transmission are consistent with a potential critical period, which could maximize the efficacy of rescue interventions. To test this, we treated BTBR mice in either early life (P4-P8) or adulthood (P60-P64) with the mTORC1 antagonist rapamycin, a well-established intervention for ASD-like behavior. Rapamycin treatment rescued social interaction deficits in BTBR mice when injected in infancy, but did not affect social interaction in adulthood.
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Affiliation(s)
- Melina Matthiesen
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, M1C1A4, Canada
| | - Abdessattar Khlaifia
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, M1C1A4, Canada
| | | | - Maryam Dadabhoy
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, M1C1A4, Canada
| | - Unza Mumtaz
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, M1C1A4, Canada
| | - Maithe Arruda-Carvalho
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, M1C1A4, Canada.
- Department of Cell and Systems Biology, University of Toronto, Toronto, ON, M5S3G5, Canada.
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Palmer M, Carter Leno V, Hallett V, Mueller JM, Breese L, Pickles A, Slonims V, Scott S, Charman T, Simonoff E. Effects of a Parenting Intervention for Emotional and Behavioral Problems in Young Autistic Children Under Conditions of Enhanced Uncertainty: Two-Year Follow-up of a Pilot Randomized Controlled Trial Cohort (ASTAR) During the United Kingdom COVID-19 Pandemic. J Am Acad Child Adolesc Psychiatry 2023; 62:558-567. [PMID: 36639313 PMCID: PMC9832423 DOI: 10.1016/j.jaac.2022.09.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 08/25/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Most young autistic children display emotional and behavioral problems (EBPs). There is evidence that behavioral parenting interventions (BPIs) reduce these. The COVID-19 pandemic and associated lockdowns can be seen as a natural experiment to test the longer-term effect of BPIs under conditions of increased uncertainty. METHOD Opportunistic follow-up (n = 49) of a pilot randomized controlled trial (RCT) cohort (n = 62 autistic children aged 6-11 years; originally randomized to a 12-week group BPI [Predictive Parenting; n = 31] or an attention control [Psychoeducation; n = 31]) was conducted during COVID-19-related lockdowns. Measures of parent-reported child irritability and parenting stress were collected at 3 time points (baseline: mean age = 6.7 years; primary endpoint: mean age = 7.1 years, ∼5 months after randomization; and COVID-19 follow-up: mean age = 8.8 years, ∼2 years after randomization). We tested the magnitude of intervention effects using point estimates of differences in child irritability and parenting stress between arms at primary endpoint and COVID-19 follow-up, covarying for baseline scores. We used area under the curve (AUC) analyses to obtain overall estimates of the average intervention effect across all 3 timepoints. Semi-structured qualitative interviews were conducted with a subsample of parents (n = 18). RESULTS A small but significant intervention effect was found from baseline to COVID-19 follow-up in favor of Predictive Parenting on parent-reported child irritability (d = -0.33, 95% CI = -0.65, -0.01) and parenting stress (d = -0.31, 95% CI = -0.59, -0.03). No overall mean intervention effect for these measures as estimated by the AUC analyses (which takes into account the nonsignificant effect at primary endpoint) was found. Interview feedback on the both interventions was positive, and parents reported using strategies from Predictive Parenting during COVID-19-related restrictions. CONCLUSION This opportunistic follow-up study at a time of stress indicates the need for careful consideration of how and when to measure the effects of BPIs in autistic child populations. Future trials should consider both the most appropriate endpoint and in what context effects may be more likely to be seen. CLINICAL TRIAL REGISTRATION INFORMATION Autism Spectrum Treatment and Resilience (ASTAR); https://www.isrctn.com; 91411078.
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Affiliation(s)
- Melanie Palmer
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
| | - Virginia Carter Leno
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Victoria Hallett
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Joanne M Mueller
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Lauren Breese
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Vicky Slonims
- Newcomen Neurodevelopmental Centre, Children's Neurosciences, Evelina Children's Hospital, Guy's and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Stephen Scott
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Chastang J, Bruneau M, Mallick L, Gavet A, Hamidi Y, Roger E, Diaby A, Galvao E, Desportes V, Germanaud D, Desgrez V, Saldanha-Gomes C, Ibanez G. [Use of neurodevelopmental disorder screening tool in primary care : A multicenter observational study]. Rev Epidemiol Sante Publique 2023; 71:101595. [PMID: 37068363 DOI: 10.1016/j.respe.2023.101595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/07/2023] [Accepted: 02/11/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION Neurodevelopmental disorders (NDD) affect 5 to 15% of the population. Improved management largely depends on early detection in primary care. A screening tool was developed by an expert consensus and its use has been recommended since 2019. This tool has never been evaluated to date. The aim of this study was to investigate the prevalence and factors associated with the identification of neurodevelopmental disorders in primary care in children aged 6 months to 5 years. METHOD This work is a multicentric observational study carried out in general practice in two regions of France: Île-de-France and Auvergne-Rhône-Alpes. A multivariate analysis was performed to identify the factors associated with the presence of abnormal signs on the grid. RESULTS Five hundred and sixty-four (564) children aged 6 months to 4 years were included. The prevalence of children identified on the grid was 3.9%. The factors associated with the neurodevelopmental disorders identified in multivariate analysis were: low socio-professional status of the mother, male gender and parental concern about the child's neurodevelopment. Factors associated with identifying a developmental trajectory gap were male gender (OR = 2.10 (1.22-3.62)) and low socio-professional status of the mother (OR = 2.23 [1.05-4.70]). CONCLUSION This original work allowed us to carry out first-line testing of a tool for the identification of NDD in primary care and to evaluate the prevalence of identification of these disorders. A complementary cohort study will be necessary to evaluate the sensitivity and specificity of this identification tool.
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Affiliation(s)
- J Chastang
- Sorbonne Université, Département de médecine générale, Faculté de médecine, Site Saint Antoine, 27 rue Chaligny, 75012 Paris, France; Sorbonne Université, Inserm, Institut Pierre Louis d'épidémiologie et de santé publique, Faculté de médecine, Site Saint Antoine, 27 rue Chaligny, 75012 Paris, France.
| | - M Bruneau
- Sorbonne Université, Département de médecine générale, Faculté de médecine, Site Saint Antoine, 27 rue Chaligny, 75012 Paris, France
| | - L Mallick
- Université Grenoble Alpes, Faculté de médecine de Grenoble, Département de médecine générale, 23, avenue des Maquis du Grésivaudan, 38700 La Tronche, France
| | - A Gavet
- Université Grenoble Alpes, Faculté de médecine de Grenoble, Département de médecine générale, 23, avenue des Maquis du Grésivaudan, 38700 La Tronche, France
| | - Y Hamidi
- Sorbonne Université, Département de médecine générale, Faculté de médecine, Site Saint Antoine, 27 rue Chaligny, 75012 Paris, France
| | - E Roger
- Sorbonne Université, Département de médecine générale, Faculté de médecine, Site Saint Antoine, 27 rue Chaligny, 75012 Paris, France
| | - A Diaby
- Sorbonne Université, Département de médecine générale, Faculté de médecine, Site Saint Antoine, 27 rue Chaligny, 75012 Paris, France
| | - E Galvao
- Sorbonne Université, Département de médecine générale, Faculté de médecine, Site Saint Antoine, 27 rue Chaligny, 75012 Paris, France
| | - V Desportes
- Filière DéfiScience, Hôpital FME, Neurologie pédiatrique, CHU de Lyon HCL-GH Est, 59 boulevard Pinel, 69677 Bron Cedex, France
| | - D Germanaud
- UNIACT Neurospin, CEA_Inserm UMR1129, Université Paris Descartes, Paris, France
| | - V Desgrez
- Université Grenoble Alpes, Faculté de médecine de Grenoble, Département de médecine générale, 23, avenue des Maquis du Grésivaudan, 38700 La Tronche, France
| | - C Saldanha-Gomes
- Sorbonne Université, Département de médecine générale, Faculté de médecine, Site Saint Antoine, 27 rue Chaligny, 75012 Paris, France; Sorbonne Université, Inserm, Institut Pierre Louis d'épidémiologie et de santé publique, Faculté de médecine, Site Saint Antoine, 27 rue Chaligny, 75012 Paris, France
| | - G Ibanez
- Sorbonne Université, Département de médecine générale, Faculté de médecine, Site Saint Antoine, 27 rue Chaligny, 75012 Paris, France; Sorbonne Université, Inserm, Institut Pierre Louis d'épidémiologie et de santé publique, Faculté de médecine, Site Saint Antoine, 27 rue Chaligny, 75012 Paris, France
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Waizbard-Bartov E, Fein D, Lord C, Amaral DG. Autism severity and its relationship to disability. Autism Res 2023; 16:685-696. [PMID: 36786314 PMCID: PMC10500663 DOI: 10.1002/aur.2898] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/19/2023] [Indexed: 02/15/2023]
Abstract
Autism severity is currently defined and measured based exclusively on the severity levels of the two core symptom domains: social-communication and restricted or repetitive patterns of behaviors and interests. Autistic individuals, however, are often diagnosed with other medical, developmental, and psychological co-occurring conditions. These additional challenges such as intellectual disability, limited expressive and/or receptive language, and anxiety disorders, can have a tremendous impact on the day-to-day lives of autistic individuals, for both their adaptive functioning as well as their sense of wellbeing. Furthermore, the initial presentation of core symptoms and their likelihood of changing over time are influenced by the presence of such co-occurring conditions. In order to truly understand how a person's autism impacts their life, both core symptoms as well as other challenges should be considered. This approach was recently taken byThe Lancet Commission on the future of care and clinical research in autism, which proposed the term "profound autism" for a subgroup of individuals presenting with high core symptom severity, co-occurring intellectual disability, and little or no language, who require extensive long-term care. Considering other individual factors such as daily living skills, specific support needs and environmental resources would also enhance the evaluation of disability in autistic individuals. As currently employed in the assessment of intellectual disability, a multidimensional approach to autism could provide a more comprehensive system for classification of impairment. At present, however, there is no formal way to designate the combined effect of these different aspects of autism on a person's life. A comprehensive outlook that acknowledges impairments, capabilities, co-occurring conditions, and environmental factors would be useful for identifying subgroups of individuals as well as for determining individual needs and strengths in clinical assessments.
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Affiliation(s)
- Einat Waizbard-Bartov
- Department of Psychology, University of California Davis, Davis, California, USA
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA
| | - Deborah Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
- Department of Pediatrics, University of Connecticut, Farmington, Connecticut, USA
| | - Catherine Lord
- Departments of Psychiatry and Human Development and Psychology, University of California, Los Angeles, California, USA
| | - David G. Amaral
- The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA
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Oppenheim D, Koren-Karie N, Hamburger L, Maccabi Y, Slonim M, Yirmiya N. Parental insightfulness is associated with mother-father-child interactions among families of preschoolers with an Autism Spectrum Disorder diagnosis. J Child Psychol Psychiatry 2023. [PMID: 36929371 DOI: 10.1111/jcpp.13788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Parental insightfulness underlies parental sensitive behavior and is associated with secure attachment among Typically Developing (TD) children and also among children with Autism Spectrum Disorder (ASD). Moving beyond the parent-child dyad, a study of TD children and their parents linked mothers' and fathers' combined insightfulness to triadic interactions. The goal of the current study was to examine this association in families with children with ASD. The hypothesis was that the interactions in families in which both parents are insightful will be more cooperative than in families in which only one or neither parent was insightful. METHODS Eighty preschooler boys with ASD and both of their parents participated in the study. Parental insightfulness was assessed employing the Insightfulness Assessment (IA) and mother-father-child interactions were observed and coded employing the Lausanne Triadic Play (LTP) procedure. RESULTS As expected, families in which both parents were insightful displayed higher parental coordinated support in the LTP than families in which one or neither parent was insightful, controlling for children's IQ and severity of symptoms. Children's engagement with their parents was associated with their IQ and severity of symptoms but not with parental insightfulness. CONCLUSIONS The importance of considering paternal, in addition to maternal insightfulness as a foundation for parental coordinated support in family interactions, is discussed, as well as the contribution of the LTP in assessing family interactions with children diagnosed with ASD.
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Affiliation(s)
- David Oppenheim
- School of Psychological Sciences and Center for the Study of Child Development, University of Haifa, Haifa, Israel
| | - Nina Koren-Karie
- School of Social Work and Center for the Study of Child Development, University of Haifa, Haifa, Israel
| | - Lior Hamburger
- School of Psychological Sciences and Center for the Study of Child Development, University of Haifa, Haifa, Israel
| | - Yael Maccabi
- School of Psychological Sciences and Center for the Study of Child Development, University of Haifa, Haifa, Israel
| | - Michal Slonim
- School of Psychological Sciences and Center for the Study of Child Development, University of Haifa, Haifa, Israel
| | - Nurit Yirmiya
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
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Guthrie W, Wetherby AM, Woods J, Schatschneider C, Holland RD, Morgan L, Lord CE. The earlier the better: An RCT of treatment timing effects for toddlers on the autism spectrum. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:13623613231159153. [PMID: 36922406 PMCID: PMC10502186 DOI: 10.1177/13623613231159153] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
LAY ABSTRACT Behavioral interventions that incorporate naturalistic, developmental strategies have been shown to improve outcomes for young children who receive an autism spectrum disorder (ASD) diagnosis. Although there is broad consensus that children on the spectrum should begin supports as soon as possible, the empirical evidence for this is relatively limited and little is known about the optimal age to start autism-specific interventions. Our team conducted a randomized controlled trial (RCT) to test the effects of starting intervention at different ages, using the Early Social Interaction (ESI) model, a parent-implemented intervention for toddlers on the spectrum. Participants included 82 autistic toddlers and their caregiver(s) who received 9 months of Individual-ESI and 9 months of Group-ESI, with the timing/order of these two treatment conditions randomized. Thus, families received the more intensive and individualized Individual-ESI at either 18 or 27 months of age. Results revealed that children who received Individual-ESI earlier showed greater treatment gains than those who received this intervention later. Gains were demonstrated in several areas, which included the use and understanding of language, social use of communication skills, and self-help skills. Importantly, these findings were specific to the intensive and individualized parent coaching model compared to group-based treatment, allowing us to rule out the possibility that these timing effects were due to children getting older rather than the treatment itself. Our results suggest that even a narrow window of 18 versus 27 months may have an impact on outcomes and underscore the importance of screening and evaluation as young as possible.
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Affiliation(s)
- Whitney Guthrie
- Children’s Hospital of Philadelphia, USA
- University of Pennsylvania, USA
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41
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Kulasinghe K, Whittingham K, Mitchell AE, Boyd RN. Psychological interventions targeting mental health and the mother-child relationship in autism: Systematic review and meta-analysis. Dev Med Child Neurol 2023; 65:329-345. [PMID: 36208472 PMCID: PMC10953452 DOI: 10.1111/dmcn.15432] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 01/18/2023]
Abstract
AIM To investigate the efficacy of psychological interventions delivered to mothers of young children with autism spectrum disorder (ASD) in improving maternal mental health and the parent-child relationship. METHOD Electronic databases were searched from inception to December 2021. Studies were included if they were randomized controlled trials (RCTs) of psychological interventions that targeted maternal mental health (primary outcome) and/or the parent-child relationship (secondary outcome), delivered to mothers of children (mean age < 60 months) with ASD. Meta-analyses of three parent mental health outcomes (stress, depressive symptomatology, and general mental health) and seven parent-child relationship outcomes (parent responsiveness, affect, directiveness, non-directiveness, child initiation, infant positive affect, and infant attentiveness) were conducted using both mean and standardized mean differences. RESULTS Thirty-two RCTs met the inclusion criteria (2336 participants). Six RCTs showed improved maternal mental health (Cohen's d = 0.41-1.15), with moderate certainty of evidence for improvement in parental stress. There was low and high certainty of evidence of treatment effect on parental depressive symptoms and general mental health respectively, which did not show significant treatment effects post-intervention. Seventeen RCTs showed improved parent-child relationship (d = 0.33-2.28; low certainty of evidence). INTERPRETATION Results demonstrated that parenting interventions promoting responsiveness had the largest positive effect on the parent-child relationship and a moderate effect on overall parenting stress; however, the studies were heterogeneous, making it difficult to identify the intervention components that were responsible for the positive treatment effects. There was no significant treatment effect for studies targeting depression or general mental health, likely due to the lack of an interventional component directly targeting mental health.
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Affiliation(s)
- Kavindri Kulasinghe
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of MedicineUniversity of QueenslandBrisbaneQLDAustralia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of MedicineUniversity of QueenslandBrisbaneQLDAustralia
| | - Amy E. Mitchell
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQLDAustralia
- Menzies Health Institute QueenslandGriffith UniversityBrisbaneQLDAustralia
- Parenting and Family Support Centre, School of PsychologyUniversity of QueenslandBrisbaneQLDAustralia
| | - Roslyn N. Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of MedicineUniversity of QueenslandBrisbaneQLDAustralia
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Chow J, Zhao H, Sandbank M, Bottema-Beutel K, Woynaroski T. Empirically-Derived Effect Size Distributions of Interventions for Young Children on the Autism Spectrum. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:271-283. [PMID: 35076326 PMCID: PMC9309195 DOI: 10.1080/15374416.2021.2007485] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The purpose of this study is to present a set of empirically derived effect size distributions to provide field-based benchmarks for interpreting the observed effects of interventions for young children on the autism spectrum, and for planning future studies. METHOD We generated effect size distributions and reported quartile values for each by outcome domain, and by boundedness, proximity, and assessment approach using 1552 effect sizes from 144 early childhood autism intervention studies gathered for a previously published meta-analysis. RESULTS Quartile values represent considerable heterogeneity in effect size distributions across outcome domains, as well as variability as a function of outcome boundedness, proximity, and assessment approach. CONCLUSIONS Our results serve as field- and outcome-specific benchmarks (e.g., contextual guides for small, medium, and large effects) that will help autism intervention researchers easily incorporate information from relevant prior empirical literature when conducting power analyses to plan for future studies. Benchmarks will also assist researchers seeking to interpret the magnitude of observed effects in clinical trials relative to the broader distribution of intervention effects on similar outcomes. Nuanced discussions that contextualize study findings in light of relevant empirical benchmarks will better assist practitioners in understanding the magnitude and scope of demonstrated change relative to studies with similar outcomes and selecting interventions for clinical practice. We discuss the limitations of these data, our analyses, as well as directions for future work.
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Affiliation(s)
- Jason Chow
- Department of Counseling, Higher Education, and Special Education, University of Maryland at College Park
| | - Hongyang Zhao
- Department of Human Development and Quantitative Methodology, University of Maryland at College Park
| | | | | | - Tiffany Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center
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Trembath D, Varcin K, Waddington H, Sulek R, Bent C, Ashburner J, Eapen V, Goodall E, Hudry K, Roberts J, Silove N, Whitehouse A. Non-pharmacological interventions for autistic children: An umbrella review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:275-295. [PMID: 36081343 DOI: 10.1177/13623613221119368] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT What is already known about the topic?The delivery of evidence-based interventions is an important part of the clinical pathway for many autistic children and their families. However, parents, practitioners, and policymakers face challenges making evidence informed decisions, due to the wide variety of interventions available and the large, and often inconsistent, body of evidence regarding their effectiveness.What this paper adds?This is a comprehensive umbrella review, also known as a 'review of reviews', which examined the range of interventions available, the evidence for their effectiveness, and whether effects were influenced by factors relating to individual children (e.g. chronological age, core autism characteristics, and related skills) or the ways interventions were delivered (by whom and in what setting, format, mode, and amount). There was evidence for positive therapeutic effects for some, but not all, interventions. No single intervention had a positive effect for all child and family outcomes of interest. The influence of child and delivery characteristics on effects was unclear.Implications for practice, research, and policyThe findings provide parents, practitioners, and policymakers with a synthesis of the research evidence to inform decision-making and highlight the importance of individualised approaches in the absence of clear and consistent evidence. The findings also highlight the need to improve consistency and completeness in reporting of research studies, so that the same questions may be answered more comprehensively in the future.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Andrew Whitehouse
- Telethon Kids Institute and The University of Western Australia, Australia
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Waizbard-Bartov E, Miller M. Does the severity of autism symptoms change over time? A review of the evidence, impacts, and gaps in current knowledge. Clin Psychol Rev 2023; 99:102230. [PMID: 36469976 PMCID: PMC10357465 DOI: 10.1016/j.cpr.2022.102230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/10/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
Studies evaluating change in autism symptom severity across the lifespan have yielded inconsistent results, making it difficult to assess the prevalence of meaningful change in autism symptom severity, and what characterizes it. Better understanding the ways in which autism symptoms change over time is crucial, with important implications for intervention. Synthesizing information across past studies, autism symptom severity change (especially decreases) appears common, though stability of symptoms is also frequent. Symptom severity change is characterized by variability in patterns of change between different individuals (between-person), variability in change within a person's trajectory across time (within-person), and variability in change patterns across symptom domains (i.e., social-communication, restricted/repetitive behaviors). Variability in severity change is likely impacted by differences in person-level characteristics (e.g., sex, IQ, sociodemographic factors) as well as developmental processes across time. Numerous methodological issues may impact our ability to understand how common change in symptom severity is, including varying measurement tools, analytic approaches, and change patterns between symptom domains across time. Potential implications of better understanding and characterizing symptom severity change include incorporation of severity change patterns and predictors of change into research on biomarkers, and consideration of such predictors as moderators or mediators of change in clinical practice.
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Affiliation(s)
- Einat Waizbard-Bartov
- Department of Psychology, University of California Davis, Davis, CA, USA; MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA.
| | - Meghan Miller
- MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
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Ouss L, Beauquier Maccotta B, Hervé MJ, Bompard C, Desvignes C, Velasquez P, Rusconi Serpa S, Quirot B. Interventions précoces chez les enfants avec autisme : place du vidéo feedback. Des interventions comportementales, à une approche centrée sur les interactions précoces et la sensibilité parentale. ANNALES MÉDICO-PSYCHOLOGIQUES, REVUE PSYCHIATRIQUE 2023. [DOI: 10.1016/j.amp.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Tsiplova K, Ungar WJ, Szatmari P, Cost K, Pullenayegum E, Duku E, Volden J, Smith IM, Waddell C, Zwaigenbaum L, Bennett TA, Elsabbagh M, Georgiades S, Zaidman-Zait A. Measuring the association between behavioural services and outcomes in young children with autism spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 132:104392. [PMID: 36493738 DOI: 10.1016/j.ridd.2022.104392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Children with autism spectrum disorder (ASD) receive a wide range of services. AIMS To examine the association between behavioural services received by children with ASD between ages 2 and 5 years and outcomes during primary school years. METHODS A total of 414 preschool-aged children diagnosed with ASD were enrolled at five Canadian sites and were assessed within four months of diagnosis (T1), six months later (T2), 12 months later (T3), at school entry (T4), and then annually (T5-T8) to 11 years of age. The association between the receipt of behavioural services during T1 to T3 and T8 outcomes related to adaptive behaviour and behavioural problems was modelled using linear regressions adjusted for immigrant status, family income, child's age at diagnosis, site, sex assigned at birth, and baseline (T1) outcome. RESULTS Children who received behavioural services during at least one time period from T1 to T3 did not have significantly different outcomes at T8 than children who did not receive any behavioural services. IMPLICATIONS Pre-school use of behavioural services was not found to affect outcomes during later childhood. Numerous challenges accompany studies of the association between pre-school service use and later outcomes in a heterogeneous ASD sample. Recommendations for study design are provided.
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Affiliation(s)
- Kate Tsiplova
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 11th floor, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 11th floor, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada.
| | - Peter Szatmari
- Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1×8, Canada
| | - Katherine Cost
- Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1×8, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 11th floor, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
| | - Eric Duku
- Offord Centre for Child Studies, McMaster University, 1280 Main St. W. - MIP 201A, Hamilton, Ontario L8S 4K1, Canada; Department of Psychiatry and Behavioural Neuroscience, McMaster University, St. Joseph's Healthcare Hamilton, West 5th Campus, Administration B3, 100 West 5th Street, Hamilton, Ontario L8N 3K7, Canada
| | - Joanne Volden
- Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 3-48 Corbett Hall, Edmonton, Alberta T6G 2G4, Canada
| | - Isabel M Smith
- Department of Pediatrics, Dalhousie University, IWK Health Centre, 5850 University Avenue, P. O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada; Autism Research Centre, IWK Health Centre, 4th Floor Link Building, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia B3K 6R8, Canada
| | - Charlotte Waddell
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, Room 2435, 515 West Hastings Street Vancouver, British Columbia V6B 5K, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue Edmonton, Alberta T6G 1C9, Canada
| | - Teresa A Bennett
- Offord Centre for Child Studies, McMaster University, 1280 Main St. W. - MIP 201A, Hamilton, Ontario L8S 4K1, Canada; Department of Psychiatry and Behavioural Neuroscience, McMaster University, St. Joseph's Healthcare Hamilton, West 5th Campus, Administration B3, 100 West 5th Street, Hamilton, Ontario L8N 3K7, Canada
| | - Mayada Elsabbagh
- Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, Quebec H3A 2B4, Canada
| | - Stelios Georgiades
- Offord Centre for Child Studies, McMaster University, 1280 Main St. W. - MIP 201A, Hamilton, Ontario L8S 4K1, Canada; Department of Psychiatry and Behavioural Neuroscience, McMaster University, St. Joseph's Healthcare Hamilton, West 5th Campus, Administration B3, 100 West 5th Street, Hamilton, Ontario L8N 3K7, Canada
| | - Anat Zaidman-Zait
- Department of School Counseling and Special Education, Constantiner School of Education, Tel Aviv University, Tel Aviv University, P.O. Box 39040, Tel Aviv 6997801, Israel; The School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
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Amirova A, Rakhymbayeva N, Zhanatkyzy A, Telisheva Z, Sandygulova A. Effects of Parental Involvement in Robot-Assisted Autism Therapy. J Autism Dev Disord 2023; 53:438-455. [PMID: 35088233 PMCID: PMC9889445 DOI: 10.1007/s10803-022-05429-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 02/04/2023]
Abstract
Parental involvement in traditional autism therapy is key to the effective treatment of children with ASD. Little is known about parental involvement in robot-assisted autism therapy (RAAT)-novel therapeutic support for children with ASD. Our study investigates the effect of parental presence on multiple-session RAAT conducted with 16 children with ASD. They interacted with the social robot in the presence or absence of their parents. We measured children's socio-behavioral outcomes and conducted semi-structured interviews with parents. Parents did not necessarily affect the children's outcomes during the interventions. However, children's autism-related symptoms resulted in different socio-behavioral outcomes between sessions with and without parents. Most parents have reported positive changes in their children's behaviors when interacting with the robot.
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Affiliation(s)
- Aida Amirova
- Graduate School of Education, Nazarbayev University, Kabanbay Batyr Avenue, 53, Nur-Sultan, 010000 Kazakhstan
| | - Nazerke Rakhymbayeva
- Department of Robotics and Mechatronics, School of Engineering and Digital Sciences, Nazarbayev University, Kabanbay Batyr Avenue, 53, Nur-Sultan, 010000 Kazakhstan
| | - Aida Zhanatkyzy
- Department of Robotics and Mechatronics, School of Engineering and Digital Sciences, Nazarbayev University, Kabanbay Batyr Avenue, 53, Nur-Sultan, 010000 Kazakhstan
| | - Zhansaule Telisheva
- Department of Robotics and Mechatronics, School of Engineering and Digital Sciences, Nazarbayev University, Kabanbay Batyr Avenue, 53, Nur-Sultan, 010000 Kazakhstan
| | - Anara Sandygulova
- Department of Robotics and Mechatronics, School of Engineering and Digital Sciences, Nazarbayev University, Kabanbay Batyr Avenue, 53, Nur-Sultan, 010000 Kazakhstan
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Colombi C, Chericoni N, Bargagna S, Costanzo V, Devescovi R, Lecciso F, Pierotti C, Prosperi M, Contaldo A. Case report: Preemptive intervention for an infant with early signs of autism spectrum disorder during the first year of life. Front Psychiatry 2023; 14:1105253. [PMID: 37205979 PMCID: PMC10189150 DOI: 10.3389/fpsyt.2023.1105253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/07/2023] [Indexed: 05/21/2023] Open
Abstract
Autism spectrum disorder (ASD) includes neurodevelopmental conditions traditionally considered to bring life long disabilities, severely impacting individuals and their families. Very early identification and intervention during the very first phases of life have shown to significantly diminish symptom severity and disability, and improve developmental trajectories. Here we report the case of a young child showing early behavioral signs of ASD during the first months of life, including diminished eye contact, reduced social reciprocity, repetitive movements. The child received a pre-emptive parent mediated intervention based on the Infant Start, an adaptation of the Early Start Denver Model (ESDM), specifically developed for children with ASD signs during the first year of life. The child here described received intervention from 6 to 32 months of age, in combination with educational services. Diagnostic evaluations performed at several time points (8, 14, 19, and 32 months) showed progressive improvements in his developmental level and ASD symptoms. Our case study supports the possibility of identifying ASD symptoms and providing services as soon as concerns emerge even during the first year of life. Our report, in combination with recent infant identification and intervention studies, suggests the need for very early screening and preemptive intervention to promote optimal outcomes.
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Affiliation(s)
- Costanza Colombi
- Stella Maris Foundation (IRCCS), Calambrone, Italy
- *Correspondence: Costanza Colombi,
| | | | | | | | - Raffaella Devescovi
- Institute for Maternal and Child Health Burlo Garofolo (IRCCS), Trieste, Friuli-Venezia Giulia, Italy
| | - Flavia Lecciso
- Department of History, Society and Human Studies, University of Salento, Lecce, Apulia, Italy
| | | | - Margherita Prosperi
- UFSMIA Valdera-Alta Val di Cecina, Azienda USL Toscana Nord Ovest, Pisa, Tuscany, Italy
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Smith J, Chetcuti L, Kennedy L, Varcin KJ, Slonims V, Bent CA, Green J, Iacono T, Pillar S, Taylor C, Wan MW, Whitehouse AJO, Hudry K. Caregiver sensitivity predicts infant language use, and infant language complexity predicts caregiver language complexity, in the context of possible emerging autism. Autism Res 2022; 16:745-756. [PMID: 36563289 DOI: 10.1002/aur.2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
While theory supports bidirectional effects between caregiver sensitivity and language use, and infant language acquisition-both caregiver-to-infant and also infant-to-caregiver effects-empirical research has chiefly explored the former unidirectional path. In the context of infants showing early signs of autism, we investigated prospective bidirectional associations with 6-min free-play interaction samples collected for 103 caregivers and their infants (mean age 12-months; and followed up 6-months later). We anticipated that measures of caregiver sensitivity/language input and infant language would show within-domain temporal stability/continuity, but also that there would be predictive associations from earlier caregiver input to subsequent child language, and vice versa. Caregiver sensitive responsiveness (from the Manchester Assessment of Caregiver-Infant interaction [MACI]) predicted subsequent infant word tokens (i.e., amount of language, coded following the Systematic Analysis of Language Transcripts [SALT]). Further, earlier infant Mean Length of Utterance (MLU; reflecting language complexity, also derived from SALT coding) predicted later caregiver MLU, even when controlling for variability in infant ages and clear within-domain temporal stability/continuity in key measures (i.e., caregiver sensitive responsiveness and infant word tokens; and infant and caregiver MLU). These data add empirical support to theorization on how caregiver input can be both supportive of, and potentially influenced by, infant capacities, when infants have social-communication differences and/or communication/language delays suggestive of possible emerging autism.
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Affiliation(s)
- Jodie Smith
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Lacey Chetcuti
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Lyndel Kennedy
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kandice J Varcin
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Vicky Slonims
- Children's Neurosciences, Evelina London Children's Hospital, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Catherine A Bent
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Jonathan Green
- School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Teresa Iacono
- Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Sarah Pillar
- School of Biological Sciences, University of Manchester, Manchester, UK
| | - Carol Taylor
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Ming Wai Wan
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Andrew J O Whitehouse
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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