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García-Zambrano S, Pinto-Ocampo RH. How Many Autistic Children are there in Colombia? A Nationwide Examination of Autism Through Health System Data. J Autism Dev Disord 2024:10.1007/s10803-024-06534-9. [PMID: 39256294 DOI: 10.1007/s10803-024-06534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2024] [Indexed: 09/12/2024]
Abstract
PURPOSE Accurate healthcare data is indispensable for monitoring the epidemiology of autism spectrum disorders (ASD) and improving the quality of care for individuals on the spectrum. In Colombia, the Ministry of Health has developed the social protection information system (SISPRO) as a comprehensive registry, drawing data from the healthcare system with close to universal coverage (approximately 95%). This study utilizes data gathered by SISPRO to estimate the prevalence and specific characteristics of autistic children registered between January 2020 and December 2022. METHOD A descriptive epidemiological approach was employed, using the International Statistical Classification of Diseases as search terms for ASD within the SISPRO dataset. RESULTS The study revealed a prevalence of 13.788 cases per 10,000 children in 2022 among aged 4 to 14. Regarding healthcare coverage types in 2022, the majority of autistic children served were under the contributory regime (68.28%), followed by the subsidized regime (25.36%). Geographic analysis indicated a non-uniform distribution of ASD prevalence in Colombia. The regions with the highest GDP, such as Antioquia, Atlántico, Bogotá, Cundinamarca, and Valle del Cauca, exhibited the highest prevalence (M = 17.90; SD = 14.3). In contrast, areas with the lowest GDP, including Amazonas, Guainía, Vaupés, Vichada, and Guaviare, showed the lowest prevalence among children (M = 2.6; SD = 2.5). CONCLUSION The estimation of ASD prevalence in Colombia represents an ongoing initiative to inform public policy actions. During the COVID-19 pandemic, there was a decrease in the number of autistic children served by the healthcare sector; however, the prevalence of ASD changed to higher levels in 2022. These findings contribute to strategies aimed at improving the quality of life for autistic individuals and mitigating the economic burden on their families.
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Micai M, Caruso A, Gila L, Campanella F, Colombi C, Funari F, Scordino V, Sogos C, Veronesi C, Zili V, Fulceri F, Scattoni ML. Effectiveness, implementation settings, and research priorities of telemedicine-delivered interventions for children and adolescents with autism spectrum disorder: A systematic review. Neurosci Biobehav Rev 2024; 166:105875. [PMID: 39255913 DOI: 10.1016/j.neubiorev.2024.105875] [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: 02/13/2024] [Revised: 08/09/2024] [Accepted: 09/04/2024] [Indexed: 09/12/2024]
Abstract
This systematic review aims to examine evidence on telemedicine-delivered interventions for autistic children and adolescents, considering diverse approaches, settings, and modalities used to address core symptoms and co-occurring conditions. A comprehensive search strategy consulted PubMed and PsycInfo databases from inception to March 2023. PROSPERO registration: CRD42023404111. Each work was screened, and two blind authors extracted data. Out of 6010 studies, 19 publications with 366 participants (305 carers and 61 autistic children/adolescents) were included. Combined findings from observational and experimental studies indicate telemedicine-delivered interventions are comparable in effectiveness to traditional "in-person" treatments and involve lower costs. Tele-intervention outcomes show promise in facilitating interventions, actively engaging parents, and generalizing the socio-communicative behaviors of children. While the enforced adoption of telemedicine during the COVID-19 pandemic has prompted clinicians to assess its role in the field of autism, a comprehensive understanding of its efficacy, benefits, and associated costs has yet to be fully established. Future studies should prioritize rigorous experimental methodologies, including subgroup analyses based on child/adolescent and family characteristics, aiding intervention implementation.
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Affiliation(s)
- Martina Micai
- Coordination and Promotion of Research, Istituto Superiore di Sanità, Viale Regina Elena, 299, Rome, Italy.
| | - Angela Caruso
- Coordination and Promotion of Research, Istituto Superiore di Sanità, Viale Regina Elena, 299, Rome, Italy.
| | - Letizia Gila
- Coordination and Promotion of Research, Istituto Superiore di Sanità, Viale Regina Elena, 299, Rome, Italy.
| | - Francesco Campanella
- Laboratory of Observation, Diagnosis, and Training, Department of Psychology and Cognitive Sciences, Università di Trento, via Calepina, 14, Trento, Italy; Cooperativa Socio-Sanitaria Albero Blu, Via delle Scuole 7, 38012 Coredo, Predaia, Trento, Italy.
| | - Costanza Colombi
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, viale del Tirreno, 331, Calambrone, Pisa, Italy.
| | - Federica Funari
- CRC - Centro Ricerca e Cura, viale Beethoven, 56, Rome, Italy
| | | | - Carla Sogos
- Department of Human Neurosciences - Sapienza University of Rome, Piazzale Aldo Moro, 5, Rome, Italy.
| | | | - Valeria Zili
- CRC - Centro Ricerca e Cura, viale Beethoven, 56, Rome, Italy.
| | - Francesca Fulceri
- Coordination and Promotion of Research, Istituto Superiore di Sanità, Viale Regina Elena, 299, Rome, Italy.
| | - Maria Luisa Scattoni
- Coordination and Promotion of Research, Istituto Superiore di Sanità, Viale Regina Elena, 299, Rome, Italy.
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Ingersoll B, Frost KM, Straiton D, Ramos AP, Casagrande K. Telehealth coaching in Project ImPACT indirectly affects children's expressive language ability through parent intervention strategy use and child intentional communication: An RCT. Autism Res 2024. [PMID: 39233512 DOI: 10.1002/aur.3230] [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: 06/10/2024] [Accepted: 08/27/2024] [Indexed: 09/06/2024]
Abstract
Parent-mediated, naturalistic developmental behavioral interventions (NDBIs) are a promising approach for supporting social communication development in young autistic children. This study examined the effect of telehealth delivery of a parent-mediated NDBI, Project ImPACT, on children's expressive language ability using a randomized control trial with intent-to-treat analysis. Sixty-four young autistic children and their primary caregiver were matched on age and developmental quotient and randomly assigned to receive 6 months of therapist-assisted Project ImPACT (i.e., telehealth coaching), self-directed Project ImPACT, or an active control. Parent-child interactions were recorded at intake and immediately post-treatment, and the children's expressive language skills were assessed at intake and a 9-month follow-up using standardized measures. Although there was no total effect of treatment group assignment on child outcomes, a serial mediation analysis revealed that therapist-assisted ImPACT had an indirect effect on children's expressive language ability at follow-up through their parents' use of the intervention strategies and their intentional communication immediately post-treatment. Findings support Project ImPACT's program theory and highlight the importance of coaching in achieving positive outcomes when delivered via telehealth.
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Affiliation(s)
- Brooke Ingersoll
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Kyle M Frost
- Department of Pediatrics, University of Massachusetts Chan Medical School/UMass Memorial Children's Medical Center, Worcester, Massachusetts, USA
| | - Diondra Straiton
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Karis Casagrande
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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Chambers N, de Vries PJ, Wetherby AM. Feasibility of the Autism Navigator ® JumpStart to Coaching in Everyday Activities course in South Africa. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:2232-2243. [PMID: 38332664 PMCID: PMC11395170 DOI: 10.1177/13623613231223784] [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] [Indexed: 02/10/2024]
Abstract
LAY ABSTRACT In low-resource settings, non-profit organisations play an essential role in providing services and support for families with young children with autism, including in Africa. However, non-profit organisation service providers may not have access to quality training in proven intervention methods. Web-based or online courses may help to meet this need. In this study, we invited a group of specialist (10) and non-specialist (16) non-profit organisation providers in South Africa to complete a web-based course, Autism Navigator® JumpStart to Coaching in Everyday Activities, a 20-h self-paced course that provides training in an evidence-based parent coaching intervention called Early Social Interaction. We evaluated acceptability, appropriateness, and feasibility of the training. Of the 26 who enrolled, 16 completed the course (7 specialists and 9 non-specialists). All providers found it difficult to find time to do the course until the lockdown restrictions due to COVID-19, when most completed the course. Those whose first language was not English experienced more difficulties with two of six learner assessments and those who were not clinical specialists had more difficulty with the coaching strategies learner assessment. Most providers rated the course highly feasible, acceptable, and appropriate stating that the course content was very valuable and helpful in equipping them to serve their families. They felt the extensive video clips and regular meetings with a local trainer helped them engage with and understand the material. They suggested that including South African video clips would make the course more relatable. The fact that the course was web-based was identified as a strong benefit, especially during COVID-19 restrictions.
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Duncan AL, Keene H, Shepley C. Do Naturalistic Developmental Behavioral Interventions improve family quality of life? A systematic review and meta-analysis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:2152-2165. [PMID: 38318790 DOI: 10.1177/13623613241227516] [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] [Indexed: 02/07/2024]
Abstract
LAY ABSTRACT Naturalistic Developmental Behavioral Interventions have been described as culturally responsive and family-friendly interventions, with research demonstrating improvements in children's development following the receipt of these interventions. Given the child-directed nature of Naturalistic Developmental Behavioral Interventions and the intervention's integration within families' daily routines, many studies have examined the impact of Naturalistic Developmental Behavioral Interventions on family and family member quality of life. We conducted a systematic review and meta-analysis to explore the relationship between Naturalistic Developmental Behavioral Interventions and family quality of life. Results suggest that the provision of a Naturalistic Developmental Behavioral Intervention neither improved nor worsened family or family member quality of life. For those involved in delivering Naturalistic Developmental Behavioral Intervention services, there is an immediate need to convey to families that children's improvements will likely not translate into improvements in family quality of life.
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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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Sandbank M, Bottema-Beutel K, Syu YC, Caldwell N, Feldman JI, Woynaroski T. Evidence-b(i)ased practice: Selective and inadequate reporting in early childhood autism intervention research. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1889-1901. [PMID: 38345030 PMCID: PMC11301951 DOI: 10.1177/13623613241231624] [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: 03/06/2024]
Abstract
LAY ABSTRACT When researchers fail to report their findings or only report some of their findings, it can make it difficult for clinicians to provide effective intervention recommendations. However, no one has examined whether this is a problem in studies of early childhood autism interventions. We studied how researchers that study early childhood autism interventions report their findings. We found that most researchers did not register their studies when they were supposed to (before the start of the study), and that many researchers did not provide all of the needed information in the registration. We also found that researchers frequently did not publish their findings when their studies were complete. When we looked at published reports, we found that many of the studies did not report enough information, and that many studies were reported differently from their registrations, suggesting that researchers were selectively reporting positive outcomes and ignoring or misrepresenting less positive outcomes. Because we found so much evidence that researchers are failing to report their findings quickly and correctly, we suggested some practical changes to make it better.
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Affiliation(s)
| | | | - Ya-Cing Syu
- The University of North Carolina at Chapel Hill, USA
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Okumura K, Takeda T, Komori T, Toritsuka M, Yamamuro K, Takada R, Ikehara M, Kamikawa K, Noriyama Y, Nishi Y, Ishida R, Kayashima Y, Yamauchi T, Iwata N, Makinodan M. Adverse childhood experiences exacerbate peripheral symptoms of autism spectrum disorder in adults. Psychiatry Clin Neurosci 2024. [PMID: 39037014 DOI: 10.1111/pcn.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/13/2024] [Accepted: 06/18/2024] [Indexed: 07/23/2024]
Abstract
AIM Adverse childhood experiences are potentially traumatic events with long-lasting effects on the health and well-being of patients with autism spectrum disorder (ASD). It is important to clarify which types of long-lasting autism-related symptoms are influenced by childhood experiences to design future intervention studies. However, few studies have examined the association between childhood experiences and autistic symptoms in large samples of adults with ASD and individuals with typical development (TD). In this study, we evaluate the effects of adverse childhood experiences on multiple ASD phenotypes among both individuals with ASD and those with TD. METHOD We combined questionnaire evaluations; Childhood Abuse and Trauma Scale, the Japanese version of the Autism-Spectrum Quotient, Conners' Adult ADHD Rating Scale, the Japanese version of the Impact of Event Scale-Revised, and the Japanese version of the Adolescent/Adult Sensory Profile. RESULTS Individuals with ASD and those with TD (n = 205 and 104, respectively) were included. There were significant correlations between the extent of adverse childhood experiences and severity of attention-deficit/hyperactivity disorder symptoms, posttraumatic stress disorder symptoms, and hypersensitivity in both participants with ASD and those with TD. By contrast, ASD core symptoms showed no significant correlation with adverse childhood experiences in either group. These results remained consistent after adjusting for age, sex, and the estimated intelligence quotient. CONCLUSION These findings suggest the need for a detailed disentanglement of ASD-related core and peripheral symptoms of adverse childhood experiences, which may help to appropriately set outcomes for future early interventions for the childhood experiences of individuals with ASD.
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Affiliation(s)
- Kazuki Okumura
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
- Department of Epidemiology, Nara Medical University School of Medicine, Kashihara, Japan
| | - Tsutomu Takeda
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - Takashi Komori
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Michihiro Toritsuka
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kazuhiko Yamamuro
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Ryohei Takada
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Minobu Ikehara
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Kohei Kamikawa
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Yuki Noriyama
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Yuki Nishi
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Rio Ishida
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yoshinori Kayashima
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Takahira Yamauchi
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - Manabu Makinodan
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
- Osaka Psychiatric Research Center, Osaka, Japan
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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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Battanta NK, Jenni OG, Schaefer C, von Rhein M. Autism spectrum: parents' perspectives reflecting the different needs of different families. BMC Pediatr 2024; 24:439. [PMID: 38982431 PMCID: PMC11232266 DOI: 10.1186/s12887-024-04912-x] [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] [Received: 03/13/2024] [Accepted: 06/26/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Parents of children on the autism spectrum often face great challenges in the care of their child. Early support tailored to families' individual needs is therefore crucial for the development and quality of life of both children on the autism spectrum and their families. However, to date it is unclear whether the support available meets the parents' needs. STUDY AIM To investigate how the system of care, support, and therapies for children on the autism spectrum is perceived by their parents. METHOD A total of 57 parents of Swiss children on the autism spectrum participated in an online survey, and 20 of them participated in additional semi-structured interviews. RESULTS We found that parents of children on the autism spectrum may face substantial challenges and that social support is essential. Two thirds of the participating parents reported a long and difficult diagnostic process as challenging, and 60% expressed their need for closer follow-up after diagnosis and more support. Only one third of the parents stated that they manage their everyday lives well, whereas 17.5% felt exhausted, and more than half of the parents responded that they felt challenged. One fifth indicated that they had poor family support, and half reported substantial financial challenges. At the same time, most families also emphasize how important their neurodivergent children are to the family`s life together. CONCLUSION It is important that primary pediatricians not only initiate the diagnostic process, but also assess the different needs of the different family independent of the diagnosis and, if necessary, initiate adequate measures or guide parents to institutions in charge. Parents who do not actively express their individual needs should nevertheless be advised about support services, including financial counseling. The positive aspects mentioned by families can be emphasized and used as resources to improve their quality of life.
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Affiliation(s)
- Nadja K Battanta
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Oskar G Jenni
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Christina Schaefer
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Michael von Rhein
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland.
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
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11
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Megari K, Frantzezou CK, Polyzopoulou ZA, Tzouni SK. Neurocognitive features in childhood & adulthood in autism spectrum disorder: A neurodiversity approach. Int J Dev Neurosci 2024. [PMID: 38953464 DOI: 10.1002/jdn.10356] [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: 04/20/2024] [Revised: 05/30/2024] [Accepted: 06/10/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVES Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a diverse profile of cognitive functions. Heterogeneity is observed among both baseline and comorbid features concerning the diversity of neuropathology in autism. Symptoms vary depending on the developmental stage, level of severity, or comorbidity with other medical or psychiatric diagnoses such as intellectual disability, epilepsy, and anxiety disorders. METHOD The neurodiversity movement does not face variations in neurological and cognitive development in ASD as deficits but as normal non-pathological human variations. Thus, ASD is not identified as a neurocognitive pathological disorder that deviates from the typical, but as a neuro-individuality, a normal manifestation of a neurobiological variation within the population. RESULTS In this light, neurodiversity is described as equivalent to any other human variation, such as ethnicity, gender, or sexual orientation. This review will provide insights about the neurodiversity approach in children and adults with ASD. Using a neurodiversity approach can be helpful when working with children who have autism spectrum disorder (ASD). DISCUSSION This method acknowledges and values the various ways that people with ASD interact with one another and experience the world in order to embrace the neurodiversity approach when working with children with ASD.
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Affiliation(s)
- Kalliopi Megari
- Department of Psychology, CITY College, University of York, Europe Campus, Thessaloniki, Greece
| | | | - Zoi A Polyzopoulou
- Department of Psychology, University of Western Macedonia, Florina, Greece
| | - Stella K Tzouni
- Department of Psychology, University of Western Macedonia, Florina, Greece
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12
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Mazurek MO, Nevill RE, Orlando K, Page K, Howard M, Davis BE. Integration of Family Navigation into ECHO Autism for Pediatric Primary Care in Underserved Communities. J Autism Dev Disord 2024:10.1007/s10803-024-06445-9. [PMID: 38954361 DOI: 10.1007/s10803-024-06445-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/04/2024]
Abstract
Children with autism from underserved communities face complex system-, provider-, and family-level barriers to accessing timely diagnosis and early intervention. The current study evaluated the preliminary effects and feasibility of a new program (ECHO Autism LINKS) that integrated pediatric primary care provider (PCP) training with family navigation (FN) to bridge the gaps between screening, referral, and service access. Three cohorts of PCPs (n = 42) participated in the program, which consisted of 60-minute sessions delivered by Zoom twice per month for 12 months. Each session included didactics, case-based learning, and collaborative discussion with participants and an interdisciplinary team of experts. Family navigators were members of the expert team and provided FN services to families referred by PCP participants. Program attendance and engagement were strong, with 40 cases presented and 258 families referred for FN services, most of whom (83%) needed help accessing and connecting with services, and 13% required ongoing support due to complex needs. PCPs demonstrated significant improvements in self-efficacy in providing best-practice care for children with autism, reported high satisfaction, and observed improved knowledge and practice as a result of the program. The results of this initial pilot provide support for the feasibility, acceptability, and preliminary efficacy of the ECHO Autism LINKS program. The model holds promise in addressing complex barriers to healthcare access by providing both PCPs and families with the knowledge and support they need. Future research is needed to evaluate the efficacy and effectiveness of the program in improving child and family outcomes.
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Affiliation(s)
- Micah O Mazurek
- Department of Human Services, School of Education and Human Development, University of Virginia, 417 Emmet Street South, PO Box 400267, Charlottesville, VA, 22904, USA.
| | - Rose E Nevill
- Department of Human Services, School of Education and Human Development, University of Virginia, 417 Emmet Street South, PO Box 400267, Charlottesville, VA, 22904, USA
| | - Karen Orlando
- Department of Human Services, School of Education and Human Development, University of Virginia, 417 Emmet Street South, PO Box 400267, Charlottesville, VA, 22904, USA
| | - Keith Page
- Department of Human Services, School of Education and Human Development, University of Virginia, 417 Emmet Street South, PO Box 400267, Charlottesville, VA, 22904, USA
| | - Mya Howard
- Department of Human Services, School of Education and Human Development, University of Virginia, 417 Emmet Street South, PO Box 400267, Charlottesville, VA, 22904, USA
| | - Beth Ellen Davis
- Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
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Swain D, Li Y, Brown HR, Petkova E, Lord C, Rogers SJ, Estes A, Kasari C, Kim SH. Implementing a Uniform Outcome Measurement Approach for Early Interventions of Autism Spectrum Disorders. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)00351-4. [PMID: 38964630 DOI: 10.1016/j.jaac.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/22/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE Naturalistic developmental behavioral interventions for children with autism spectrum disorder show evidence for effectiveness for specific social communication targets such as joint attention or engagement. However, combining evidence from different studies and comparing intervention effects across those studies have not been feasible due to lack of a standardized outcome measure of broader social communication skills that can be applied uniformly across trials. This investigation examined the usefulness of the Brief Observation of Social Communication Change (BOSCC) as a common outcome measure of general social communication skills based on secondary analyses of data obtained from previously conducted randomized controlled trials of 3 intervention models, Early Social Intervention (ESI), Early Start Denver Model (ESDM) and Joint Attention Symbolic Play Engagement and Regulation (JASPER). METHOD The subset of datasets from the 3 randomized controlled trials was created to examine differences in the BOSCC scores between intervention and control groups over the course of the interventions. RESULTS Based on 582 videos from 207 caregiver-child dyads, the BOSCC noted significant differences between intervention vs control groups in broad social communication skills within 2 of the 3 intervention models, which were longer in duration and focused on a broad range of developmental skills. CONCLUSION The BOSCC offers the potential to take a uniform measurement approach across different intervention models to capture the effect of intervention on general social communication skills but may not pick up the effects of some brief interventions targeting proximal outcomes. CLINICAL TRIAL REGISTRATION INFORMATION Comparing Parent-Implemented Interventions for Toddlers With Autism Spectrum Disorders; https://www. CLINICALTRIALS gov/; NCT00760812. Intensive Intervention for Toddlers With Autism (EARLY STEPS); https://www. CLINICALTRIALS gov/; NCT00698997. Social and Communication Outcomes for Young Children With Autism; https://www. CLINICALTRIALS gov/; NCT00953095.
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Affiliation(s)
| | - Yi Li
- New York University Langone Health, New York, New York
| | | | - Eva Petkova
- New York University Langone Health, New York, New York
| | - Catherine Lord
- University of California Los Angeles, Los Angeles, California
| | - Sally J Rogers
- University of California Davis Medical Center, Sacramento, California
| | | | - Connie Kasari
- University of California Los Angeles, Los Angeles, California
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14
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Bent C, Glencross S, McKinnon K, Hudry K, Dissanayake C, Vivanti G. Predictors of Developmental and Adaptive Behaviour Outcomes in Response to Early Intensive Behavioural Intervention and the Early Start Denver Model. J Autism Dev Disord 2024; 54:2668-2681. [PMID: 37171764 PMCID: PMC11286629 DOI: 10.1007/s10803-023-05993-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/13/2023]
Abstract
Many autistic children require support to meet their learning needs. Given the heterogeneity within the autism spectrum it is plausible that different types of support might be better suited to different children. However, knowledge on what interventions work best for which children is limited. We examined the outcomes of autistic preschool-aged children receiving one of two community early intervention approaches. Our main objective was to understand which baseline child characteristics might be associated with the degree of individual response to intervention-whether prognostically (i.e., irrespective of intervention received) or predictively (i.e., specifically in the context of one or other EI approach). Participants comprised two matched groups of preschool-aged autistic children receiving either Group-based Early Start Denver Model (G-ESDM; n = 42) delivered in a 1:3-4 staff:child ratio or an Early Intensive Behavioural Intervention (EIBI; n = 40) delivered in combination of 1:1 and 1:2 staff:child ratio. Over an approximate one-year follow-up period, children in both groups made significant gains in Developmental Quotient (DQ) scores, and trend-level gains in adaptive behaviour composite scores. Higher attention to a playful adult measured via an eye-tracking task was prognostically indicative of better verbal DQ and adaptive behaviour outcomes for the cohort overall. Moderation analyses indicated a single predictive effect-of pre-program sustained attention for subsequent NVDQ outcomes specific to those children receiving G-ESDM. These findings suggest that fine-grained measures of learning skills offer promise towards the selection and tailoring of intervention approaches to meet individual children's learning needs.
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Affiliation(s)
- Catherine Bent
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | | | | | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Giacomo Vivanti
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, USA
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15
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Annunziata S, Santos L, Caglio A, Geminiani A, Brazzoli E, Piazza E, Olivieri I, Pedrocchi A, Cavallini A. Interactive mirrOring Games wIth sOCial rObot (IOGIOCO): a pilot study on the use of intransitive gestures in a sample of Italian preschool children with autism spectrum disorder. Front Psychiatry 2024; 15:1356331. [PMID: 39006819 PMCID: PMC11240845 DOI: 10.3389/fpsyt.2024.1356331] [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: 12/15/2023] [Accepted: 06/06/2024] [Indexed: 07/16/2024] Open
Abstract
Background Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication, social interaction, and restricted behaviors. The importance of early intervention has been widely demonstrated, and developmental trajectories in ASD emphasize the importance of nonverbal communication, such as intransitive gesture production, as a possible positive prognostic factor for language development. The use of technological tools in the therapy of individuals with ASD has also become increasingly important due to their higher engagement and responsiveness to technological objects, such as robots. Materials and methods We developed a training protocol using the humanoid robot NAO, called IOGIOCO (Interactive mirroring Games wIth sOCial rObot), based on the use of intransitive gestures embedded in naturalistic dialogues, stimulating a triadic interaction between child, robot and therapist. The training was divided into six levels; the first 2 levels were called "familiarization levels," and the other 4 were "training levels". The technological setup includes different complexity levels, from mirroring tasks to building spontaneous interactions. We tested the protocol on 10 preschool children with ASD (aged 2-6 years) for 14 weeks. We assessed them at recruitment (T0), at the end of training (T1), and after 6 months (T2). Results We demonstrated the tolerability of the protocol. We found that one group (n=4, males and 2 females) reached the training level, while another and group (n=6 males) remained at a familiarization level (mirroring), we analyzed the results for the two groups. In the group that reached the training levels, we found promising results, such as an improvement in the Social Adaptive Domain of the ABAS-II questionnaire between T0 and T2. Conclusion While current results will need a Randomized Controlled Trial to be confirmed, the present work sets an important milestone in using social robots for ASD treatment, aimed at impacting social and communication skills in everyday life.
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Affiliation(s)
| | - Laura Santos
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- Institute for Systems and Robotics, Instituto Superior Técnico, University of Lisbon, Lisbon, Portugal
| | | | - Alice Geminiani
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | - Elena Piazza
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Ivana Olivieri
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
- Centro Benedetta d’Intino Onlus, Milan, Italy
| | - Alessandra Pedrocchi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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16
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Kosloski EE, Patel SD, Rollins PR. The Role of Pathways Early Autism Intervention in Improving Social Skills and Respeto for Young Hispanic Autistic Children. J Autism Dev Disord 2024:10.1007/s10803-024-06419-x. [PMID: 38842669 DOI: 10.1007/s10803-024-06419-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE We know very little about Hispanic autistic children's response to intervention as, historically, Hispanic children are underrepresented in intervention studies. Pathways parent-mediated early autism intervention is one of the few naturalistic developmental behavioral interventions (NDBIs) that is contextually and linguistically responsive to Hispanic families. However, some child-centered NDBI strategies do not align with the Hispanic caregiving value of respeto. A child exhibiting respeto demonstrates affiliative obedience by displaying deference and respect toward adults. Furthermore, theories of the ontogeny of cultural learning suggest that certain levels of social development may be necessary to learn cultural values. The current study investigates (1) the relationship between Hispanic autistic children's social skills and affiliative obedience and (2) the efficacy of Pathways in improving affiliative obedience in Hispanic children. METHODS This quasi-experimental design study used preexisting standardized test data and video recordings from 26 Hispanic participants who took part in a previous Pathways efficacy study. Recordings were coded for affiliative obedience and social connectedness. Residual change variables were used to measure progress from baseline to post-intervention, and correlation and hierarchical regression analyses were conducted to analyze the data. RESULTS We found significant positive correlations between social skills and children's affiliative obedience for baseline and change variables. In addition, we found Pathways had a significant medium-large magnitude effect on change in affiliative obedience skills. CONCLUSION This study highlights the benefits of NDBI interventions that advance social development in autistic children and support Hispanic parents in enculturating their children in the value of respeto.
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Affiliation(s)
- Erin E Kosloski
- Department of Speech, Language and Hearing, University of Texas, Dallas-Richardson, TX, USA
- Callier Center for Communication Disorders, 1966 Inwood Road, Dallas, TX, 75235, USA
| | - Siddhi D Patel
- Department of Speech, Language and Hearing, University of Texas, Dallas-Richardson, TX, USA
- Callier Center for Communication Disorders, 1966 Inwood Road, Dallas, TX, 75235, USA
| | - Pamela Rosenthal Rollins
- Department of Speech, Language and Hearing, University of Texas, Dallas-Richardson, TX, USA.
- Callier Center for Communication Disorders, 1966 Inwood Road, Dallas, TX, 75235, USA.
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17
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Bloomfield M, Lautarescu A, Heraty S, Douglas S, Violland P, Plas R, Ghosh A, Van den Bosch K, Eaton E, Absoud M, Battini R, Blázquez Hinojosa A, Bolshakova N, Bölte S, Bonanni P, Borg J, Calderoni S, Calvo Escalona R, Castelo-Branco M, Castro-Fornieles J, Caro P, Cliquet F, Danieli A, Delorme R, Elia M, Hempel M, Leblond CS, Madeira N, McAlonan G, Milone R, Molloy CJ, Mouga S, Montiel V, Pina Rodrigues A, Schaaf CP, Serrano M, Tammimies K, Tye C, Vigevano F, Oliveira G, Mazzone B, O'Neill C, Pender J, Romero V, Tillmann J, Oakley B, Murphy DGM, Gallagher L, Bourgeron T, Chatham C, Charman T. European Autism GEnomics Registry (EAGER): protocol for a multicentre cohort study and registry. BMJ Open 2024; 14:e080746. [PMID: 38834317 PMCID: PMC11163653 DOI: 10.1136/bmjopen-2023-080746] [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] [Received: 10/09/2023] [Accepted: 05/10/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION Autism is a common neurodevelopmental condition with a complex genetic aetiology that includes contributions from monogenic and polygenic factors. Many autistic people have unmet healthcare needs that could be served by genomics-informed research and clinical trials. The primary aim of the European Autism GEnomics Registry (EAGER) is to establish a registry of participants with a diagnosis of autism or an associated rare genetic condition who have undergone whole-genome sequencing. The registry can facilitate recruitment for future clinical trials and research studies, based on genetic, clinical and phenotypic profiles, as well as participant preferences. The secondary aim of EAGER is to investigate the association between mental and physical health characteristics and participants' genetic profiles. METHODS AND ANALYSIS EAGER is a European multisite cohort study and registry and is part of the AIMS-2-TRIALS consortium. EAGER was developed with input from the AIMS-2-TRIALS Autism Representatives and representatives from the rare genetic conditions community. 1500 participants with a diagnosis of autism or an associated rare genetic condition will be recruited at 13 sites across 8 countries. Participants will be given a blood or saliva sample for whole-genome sequencing and answer a series of online questionnaires. Participants may also consent to the study to access pre-existing clinical data. Participants will be added to the EAGER registry and data will be shared externally through established AIMS-2-TRIALS mechanisms. ETHICS AND DISSEMINATION To date, EAGER has received full ethical approval for 11 out of the 13 sites in the UK (REC 23/SC/0022), Germany (S-375/2023), Portugal (CE-085/2023), Spain (HCB/2023/0038, PIC-164-22), Sweden (Dnr 2023-06737-01), Ireland (230907) and Italy (CET_62/2023, CEL-IRCCS OASI/24-01-2024/EM01, EM 2024-13/1032 EAGER). Findings will be disseminated via scientific publications and conferences but also beyond to participants and the wider community (eg, the AIMS-2-TRIALS website, stakeholder meetings, newsletters).
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Affiliation(s)
- Madeleine Bloomfield
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexandra Lautarescu
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK
| | - Síofra Heraty
- Department of Psychological Sciences, Birkbeck University of London, London, UK
| | - Sarah Douglas
- AIMS-2-TRIALS A-Reps, Cambridge University, Cambridge, UK
| | | | - Roderik Plas
- AIMS-2-TRIALS A-Reps, Cambridge University, Cambridge, UK
| | - Anjuli Ghosh
- AIMS-2-TRIALS A-Reps, Cambridge University, Cambridge, UK
| | | | - Eliza Eaton
- Autism Research Centre, Cambridge University, Cambridge, UK
| | - Michael Absoud
- Department of Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Roberta Battini
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ana Blázquez Hinojosa
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic Universitari Barcelona, Barcelona, Spain
| | - Nadia Bolshakova
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm, Sweden
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Paolo Bonanni
- Epilepsy Unit, Scientific Institute IRCCS E. Medea Conegliano, Treviso, Italy
| | - Jacqueline Borg
- Centre for Psychiatry Research and Centre for Cognitive and Computational Neuropsychiatry (CCNP), Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
- Department of Neuropsychiatry, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at The University of Gothenburg, Gothenburg, Sweden
| | - Sara Calderoni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rosa Calvo Escalona
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic Universitari Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Miguel Castelo-Branco
- Institute of Physiology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic Universitari Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Pilar Caro
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Freddy Cliquet
- Génétique Humaine et Fonctions Cognitives, UMR3571 CNRS, Institut Pasteur, Paris, France
| | - Alberto Danieli
- Epilepsy Unit, Scientific Institute IRCCS E. Medea Conegliano, Treviso, Italy
| | - Richard Delorme
- Child and Adolescent Psychiatry Department, Robert Debre Hospital, APHP, Paris, France
| | - Maurizio Elia
- Unit of Neurology and Clinical Neurophysiopathology, Oasi Research Institute-IRCCS, Troina, Italy
| | - Maja Hempel
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Claire S Leblond
- Génétique Humaine et Fonctions Cognitives, UMR3571 CNRS, Institut Pasteur, Paris, France
| | - Nuno Madeira
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Psychiatry Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
- Institute of Psychological Medicine, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Grainne McAlonan
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK
- Behavioural and Developmental Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - Roberta Milone
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Ciara J Molloy
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Susana Mouga
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
| | - Virginia Montiel
- Pediatric Neurology Department, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Ana Pina Rodrigues
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
| | - Christian P Schaaf
- Institute of Human Genetics, University Hospital Heidelberg, Heidelberg, Germany
| | - Mercedes Serrano
- Pediatric Neurology Department, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Kristiina Tammimies
- Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Tye
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Federico Vigevano
- Neurological Sciences and Rehabilitation Medicine Scientific Area, Bambino Gesù Children's Hospital, Rome, Italy
- Paediatric Neurorehabilitation Department, IRCCS San Raffaele, Rome, UK
| | - Guiomar Oliveira
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute of Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- University Clinic of Pediatrics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Child Developmental Center and Research and Clinical Training Center, Pediatric Hospital, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Beatrice Mazzone
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Cara O'Neill
- Cure Sanfilippo Foundation, Columbia, South Carolina, USA
| | - Julie Pender
- SYNGAP Research Fund, San Diego, California, USA
| | | | - Julian Tillmann
- Roche Pharma Research and Early Development, Roche Innovation Center, Basel, Switzerland
| | - Bethany Oakley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK
| | - Declan G M Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Louise Gallagher
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
- SickKids Research Institute, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child and Youth Division Centre for Addiction and Mental Health, CAMH, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, Univerisity of Toronto, Toronto, Ontario, Canada
| | - Thomas Bourgeron
- Génétique Humaine et Fonctions Cognitives, UMR3571 CNRS, Institut Pasteur, Paris, France
| | | | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Kushner EH, Hendrix N, Islam N, Pickard K. Addressing disruptive behaviors within naturalistic developmental behavioral interventions: Clinical decision-making, intervention outcomes, and implications for practice. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1441-1456. [PMID: 37840216 DOI: 10.1177/13623613231203308] [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] [Indexed: 10/17/2023]
Abstract
LAY ABSTRACT Naturalistic developmental behavioral interventions are a common and well-researched type of intervention for young autistic children that focus on supporting social communication. These interventions often do not include formal guidelines on how to address disruptive behaviors, even though they are common among autistic children. This study measured how often clinicians delivering a specific naturalistic developmental behavioral intervention, Project ImPACT, adapted how they delivered the program to address disruptive behavior, and how these adaptations related to children's social communication outcomes at the end of their participation in the intervention. We also spoke with clinicians about how they address disruptive behavior and emotion regulation during their sessions. In this study, clinicians adapted Project ImPACT to address disruptive behaviors in about one-third of all sessions. These adaptations did not affect children's social communication outcomes. Clinicians discussed how they felt social communication, disruptive behavior, and emotion regulation are linked to one another and that they often try to integrate intervention strategies to address each of these areas. However, they note that a clinicians' approach to addressing disruptive behavior might vary depending on their level of training and experience. These results indicate several future directions for supporting clinicians in addressing behavior and regulation effectively within these types of interventions.
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Affiliation(s)
| | - Nicole Hendrix
- Emory University, USA
- Children's Healthcare of Atlanta, USA
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19
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Takeda T, Osada H, Tsuji Y, Kurita H. Validation and determining an optimal cut-off score of the Infant Behavior Checklist for autism spectrum disorder. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e212. [PMID: 38904062 PMCID: PMC11187909 DOI: 10.1002/pcn5.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 05/05/2024] [Accepted: 05/21/2024] [Indexed: 06/22/2024]
Abstract
Aim Given the escalating prevalence of autism spectrum disorder (ASD), the persistent paucity of child psychiatrists in Japan, and the need to prepare for unforeseen situations, such as the COVID-19 pandemic, it is essential to establish a reliable screening tool. This study aims to validate the Infant Behavior Checklist (IBC) developed by Japanese experts and determine its appropriate cut-off score. Methods A total of 354 clinic-referred children, along with their caregivers, participated in this research. Clinical records, including diagnoses established through the sub-structured diagnostic interviews, and the IBC assessments, were subjected to rigorous statistical analysis. Results Among the 24 items, six failed to reach significance to differentiate ASD from non-ASD cases. The Cronbach's alpha coefficient for the IBC was calculated at 0.77. The IBC total score for ASD cases was significantly higher than that of non-ASD cases. With the chosen cut-off score, the IBC demonstrated an area under the ROC curve of 0.803, along with sensitivity, specificity, positive predictive value, and negative predictive value of 8.03, 0.79, 0.69, 0.34, and 0.94, respectively. Conclusion The IBC exhibits satisfactory internal consistency and content and discriminant validity. The high sensitivity and other associated indices for the optimal cut-off score of the IBC affirm its validity as a screening instrument for ASD. Nevertheless, further investigations are warranted to ascertain the clinical utility of the IBC.
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Affiliation(s)
| | | | - Yui Tsuji
- Sapporo Gakuin UniversitySapporoJapan
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20
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Asta L, Di Bella T, La Fauci Belponer F, Bruschetta M, Martines S, Basile E, Boncoddo M, Bellomo F, Cucinotta F, Ricciardello A, Turriziani L, Colombi C, Banchelli F, Cuoghi Costantini R, D’Amico R, Persico AM. Cognitive, behavioral and socio-communication skills as predictors of response to Early Start Denver Model: a prospective study in 32 young children with Autism Spectrum Disorder. Front Psychiatry 2024; 15:1358419. [PMID: 38873535 PMCID: PMC11170145 DOI: 10.3389/fpsyt.2024.1358419] [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: 12/19/2023] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction The effectiveness of early interventions in young autistic children is well established, but there is great interindividual variability in treatment response. Predictors of response to naturalistic developmental behavioral interventions (NDBI), like the Early Start Denver Model (ESDM), are needed. Methods We conducted an exploratory study to prospectively seek predictors of response in 32 young children treated with ESDM after receiving an ASD diagnosis. All children were less than 39 months old (mean age: 29.7 mo), and received individualized ESDM for nine months. Tests were administered at the beginning, after 4 months, and at the end of treatment. Results Four children (12.5%) were "strong responders", 8 children (25.0%) were "moderate responders", and 20 children (62.5%) were "poor responders". A more favorable response to ESDM was significantly predicted by higher PEP-3 Expressive Language, Receptive Language, Cognitive Verbal/Preverbal, Visuo-Motor Imitation scores, higher GMDS-ER Personal/Social, and VABS-II Communication scores, by lower ADI-R C restricted/stereotypic behaviors, and by joint attention level. Discussion Most predictors showed a linear association with increasing response to ESDM, but GMDS-ER Personal-Social and joint attention level predicted strong response, while PEP-3 receptive language equally predicted moderate or strong response. Although larger samples will be necessary to reach definitive conclusions, in conjunction with prior reports our findings begin providing information able to assist clinicians in choosing the most appropriate treatment program for young autistic children.
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Affiliation(s)
- Lisa Asta
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tiziana Di Bella
- Interdepartmental Program “Autism 0–90”, “G. Martino” University Hospital, Messina, Italy
| | | | - Marianna Bruschetta
- Interdepartmental Program “Autism 0–90”, “G. Martino” University Hospital, Messina, Italy
| | - Silvia Martines
- Interdepartmental Program “Autism 0–90”, “G. Martino” University Hospital, Messina, Italy
| | - Enrica Basile
- Interdepartmental Program “Autism 0–90”, “G. Martino” University Hospital, Messina, Italy
| | - Maria Boncoddo
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
| | - Fabiana Bellomo
- Interdepartmental Program “Autism 0–90”, “G. Martino” University Hospital, Messina, Italy
| | | | - Arianna Ricciardello
- Interdepartmental Program “Autism 0–90”, “G. Martino” University Hospital, Messina, Italy
| | - Laura Turriziani
- Center for Autism “Dopo di noi”, Barcellona Pozzo di Gotto, Messina, Italy
| | | | - Federico Banchelli
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Statistical and Methodological Support to Clinical Research, Modena University Hospital, Modena, Italy
| | - Riccardo Cuoghi Costantini
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Statistical and Methodological Support to Clinical Research, Modena University Hospital, Modena, Italy
| | - Roberto D’Amico
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Statistical and Methodological Support to Clinical Research, Modena University Hospital, Modena, Italy
| | - Antonio M. Persico
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Child and Adolescent Neuropsychiatry Program, Modena University Hospital, Modena, Italy
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21
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Hofer J, Blum M, Wiltsche R, Deluggi N, Holzinger D, Fellinger J, Tulzer G, Blum G, Oberhuber R. Research gaps in the neurodevelopmental assessment of children with complex congenital heart defects: a scoping review. Front Pediatr 2024; 12:1340495. [PMID: 38846331 PMCID: PMC11155449 DOI: 10.3389/fped.2024.1340495] [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: 11/21/2023] [Accepted: 04/15/2024] [Indexed: 06/09/2024] Open
Abstract
Background Children with congenital heart defects (CHD) are at risk for a range of developmental disabilities that challenge cognition, executive functioning, self-regulation, communication, social-emotional functioning, and motor skills. Ongoing developmental surveillance is therefore key to maximizing neurodevelopmental outcome opportunities. It is crucial that the measures used cover the spectrum of neurodevelopmental domains relevant to capturing possible predictors and malleable factors of child development. Objectives This work aimed to synthesize the literature on neurodevelopmental measures and the corresponding developmental domains assessed in children aged 1-8 years with complex CHD. Methods PubMed was searched for terms relating to psycho-social, cognitive and linguistic-communicative outcomes in children with CHD. 1,380 papers with a focus on complex CHD that reported neurodevelopmental assessments were identified; ultimately, data from 78 articles that used standardized neurodevelopmental assessment tools were extracted. Results Thirty-nine (50%) of these excluded children with syndromes, and 9 (12%) excluded children with disorders of intellectual development. 10% of the studies were longitudinal. The neurodevelopmental domains addressed by the methods used were: 53% cognition, 16% psychosocial functioning, 18% language/communication/speech production, and 13% motor development-associated constructs. Conclusions Data on social communication, expressive and receptive language, speech motor, and motor function are underrepresented. There is a lack of research into everyday use of language and into measures assessing language and communication early in life. Overall, longitudinal studies are required that include communication measures and their interrelations with other developmental domains.
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Affiliation(s)
- Johannes Hofer
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria
- Institute of Neurology of Senses and Language, Hospital of St. John of God, Linz, Austria
| | - Marina Blum
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria
| | - Regina Wiltsche
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria
| | - Nikoletta Deluggi
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria
| | - Daniel Holzinger
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria
- Institute of Neurology of Senses and Language, Hospital of St. John of God, Linz, Austria
- Institute of Linguistics, University of Graz, Graz, Austria
| | - Johannes Fellinger
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria
- Institute of Neurology of Senses and Language, Hospital of St. John of God, Linz, Austria
- Division of Social Psychiatry, University Clinic for Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Gerald Tulzer
- Department of Pediatric Cardiology, Children’s Heart Center Linz, Kepler University Hospital, Linz, Austria
| | - Gina Blum
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria
| | - Raphael Oberhuber
- Research Institute for Developmental Medicine, Johannes Kepler University of Linz, Linz, Austria
- Department of Pediatric Cardiology, Children’s Heart Center Linz, Kepler University Hospital, Linz, Austria
- Department of Inclusive Education, University of Education Upper Austria, Linz, Austria
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22
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Pye K, Jackson H, Iacono T, Shiell A. Economic Evaluation of Early Interventions for Autistic Children: A Scoping Review. J Autism Dev Disord 2024; 54:1691-1711. [PMID: 36914827 DOI: 10.1007/s10803-023-05938-3] [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] [Accepted: 02/16/2023] [Indexed: 03/16/2023]
Abstract
Many autistic children access some form of early intervention, but little is known about the value for money of different programs. We completed a scoping review of full economic evaluations of early interventions for autistic children and/or their families. We identified nine studies and reviewed their methods and quality. Most studies involved behavioral interventions. Two were trial-based, and the others used various modelling methods. Clinical measures were often used to infer dependency levels and quality-adjusted life-years. No family-based or negative outcomes were included. Authors acknowledged uncertain treatment effects. We conclude that economic evaluations in this field are sparse, methods vary, and quality is sometimes poor. Economic research is needed alongside longer-term clinical trials, and outcome measurement in this population requires further exploration.
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Affiliation(s)
- Katherine Pye
- School of Health and Social Development, Deakin University, Geelong, Australia.
| | - Hannah Jackson
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Teresa Iacono
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Alan Shiell
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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23
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Pillay S, Duncan M, de Vries PJ. 'We wait and we wait'-caregiver perspectives on autism spectrum disorder services in the Western Cape Province of South Africa. Child Adolesc Ment Health 2024; 29:145-153. [PMID: 38533770 DOI: 10.1111/camh.12704] [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] [Accepted: 02/19/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Caregivers of children with autism face significant challenges in navigating health, education and other systems of care to ensure appropriate services for their children. In South Africa, for example, many children with autism are reported to be out of schools and waiting long periods for specialist school placements thus adding to the burden of care for caregivers and raising many questions about equity, diversity and inclusion. METHODS Here we performed a qualitative study using focus groups to collect data on the perspectives of caregivers of children with autism waiting for school placement in the Western Cape Province of South Africa. We asked families about their experiences of current autism services and for suggestions to improve service delivery. RESULTS The main theme that emerged was 'We wait and we wait'. Caregivers expressed high levels of frustration with existing autism educational and other services. Perspectives about services were captured under three categories. The first category, 'The costs of waiting' describes the socioemotional, financial and time costs associated with having a child with autism wait for educational services. The second category 'Barriers while waiting' describes the attitudinal, structural, process and communication barriers experienced by caregivers while seeking services for their children. The final category 'Expecting action' describes attitudinal, service and policy expectations that caregivers felt could improve service delivery. Caregivers provided 10 recommendations for autism service improvements. CONCLUSION Caregivers of children with autism waiting for educational services in the Western Cape Province of South Africa expressed dissatisfaction with existing services. Efforts to find solutions to providing services and support to children with autism waiting for educational services and their caregivers should be prioritized.
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Affiliation(s)
- Sarosha Pillay
- Department of Health and Rehabilitation Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Madeleine Duncan
- Department of Health and Rehabilitation Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Petrus J de Vries
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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24
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Ouyang Y, Feng J, Wang T, Xue Y, Mohamed ZA, Jia F. Comparison of the efficacy of parent-mediated NDBIs on developmental skills in children with ASD and fidelity in parents: a systematic review and network meta-analysis. BMC Pediatr 2024; 24:270. [PMID: 38664754 PMCID: PMC11044316 DOI: 10.1186/s12887-024-04752-9] [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: 11/16/2023] [Accepted: 04/10/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Recently, studies on behavioral interventions for autism have gained popularity. Naturalistic Developmental Behavior Interventions (NDBIs) are among the most effective, evidence-based, and widely used behavior interventions for autism. However, no research has been conducted on which of the several NDBI methods is most effective for parents and children with autism spectrum disorders. Therefore, we conducted a network meta-analysis to compare the specific effects of each type of parental-mediated NDBI on children's developmental skills and parent fidelity. METHODS PubMed, Embase, Cochrane Library, Medline, Web of Science, China National Knowledge Infrastructure (CNKI), CINAHL, and Wanfang databases were searched from inception to August 30, 2023. A total of 32 randomized controlled trial studies that examined the efficacy of different NDBIs were included. RESULTS Parents of children with ASD who received Pivotal Response Treatment (PRT) reported significant improvements in their children's social skills (SUCRA, 74.1%), language skills (SUCRA, 88.3%), and parenting fidelity (SUCRA, 99.5%). Moreover, parents who received Early Start Denver Model (ESDM) reported significant improvements in their children's language (SMD = 0.41, 95% CI: 0.04, 0.79) and motor skills (SMD = 0.44, 95% CI: 0.09, 0.79). In terms of the efficacy of improving parent fidelity, the results showed that the Improving Parents as Communication Teachers (ImPACT) intervention significantly improved parent fidelity when compared with the treatment-as-usual group (TAU) (SMD = 0.90, 95% CI: 0.39, 1.42) and the parental education intervention (PEI) (SMD = 1.10, 95% CI:0.28, 1.91).There was a difference in parent fidelity among parents who received PRT(SMD = 3.53, 95% CI: 2.26, 4.79) or ESDM(SMD = 1.42, 95% CI: 0.76, 2.09) training compared with PEI. CONCLUSION In conclusion, this study revealed that parents can achieve high fidelity with the ImPACT intervention, and it can serve as an early first step for children newly diagnosed with ASD. It also showed that parent-mediated ESDM is effective in improving language and motor skills for children with ASD and can be used as part of the second stage of parent training. Parent-mediated PRT can also be used as a third stage of parent training with sufficient training intensity to further improve language, social, and motor skills.
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Affiliation(s)
- Yuling Ouyang
- Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University, Changchun, 130021, China
- School of Nursing, Jilin University, Changchun, 130021, China
| | - Junyan Feng
- Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University, Changchun, 130021, China
| | - Tiantian Wang
- Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University, Changchun, 130021, China
| | - Yang Xue
- Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University, Changchun, 130021, China
| | - Zakaria Ahmed Mohamed
- Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University, Changchun, 130021, China
| | - Feiyong Jia
- Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University, Changchun, 130021, China.
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McMahon CM, McClain MB, Wells S, Thompson S, Shahidullah JD. Autism Knowledge Assessments: A Closer Examination of Validity by Autism Experts. J Autism Dev Disord 2024:10.1007/s10803-024-06293-7. [PMID: 38583097 DOI: 10.1007/s10803-024-06293-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE The goal of the current study was to conduct a substantive validity review of four autism knowledge assessments with prior psychometric support (Gillespie-Lynch in J Autism and Dev Disord 45(8):2553-2566, 2015; Harrison in J Autism and Dev Disord 47(10):3281-3295, 2017; McClain in J Autism and Dev Disord 50(3):998-1006, 2020; McMahon in Res Autism Spectr Disord 71:101499, 2020). 69 autism experts who served on the editorial board of one or more peer-reviewed autism journals evaluated the accuracy and ambiguity of autism knowledge questions. 34% of the questions were flagged as "potentially problematic" for accuracy, and 17% of the questions were flagged as "potentially problematic" for ambiguity. Autism expert feedback revealed three themes across ambiguous questions: (1) an oversimplification of mixed or still-evolving research literature, (2) an insufficient recognition of the heterogeneity of the autism spectrum, and (3) a lack of clarity in the question/answer prompt. Substantive validity of future autism knowledge assessments should be carefully evaluated via feedback from a diverse group of autism experts and/or potential respondents. Potentially problematic questions can be removed or modified to improve the validity of autism knowledge assessments.
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Affiliation(s)
- Camilla M McMahon
- Department of Social and Behavioral Sciences, Miami University, 1601 University Blvd., Hamilton, OH, 45011, USA.
- Department of Psychology, Miami University, 90 North Patterson Avenue, Oxford, OH, 45056, USA.
| | - Maryellen Brunson McClain
- Department of Counseling and Educational Psychology, Indiana University Bloomington, 201 N. Rose Avenue, Bloomington, IN, 47405, USA
| | - Savannah Wells
- Department of Social and Behavioral Sciences, Miami University, 1601 University Blvd., Hamilton, OH, 45011, USA
| | - Sophia Thompson
- Department of Social and Behavioral Sciences, Miami University, 1601 University Blvd., Hamilton, OH, 45011, USA
- Department of Psychology, Miami University, 90 North Patterson Avenue, Oxford, OH, 45056, USA
| | - Jeffrey D Shahidullah
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, 1601 Trinity Blvd, Austin, TX, 76018, USA
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26
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Rosenau KA, Kim J, Cho ACB, Seltzer M, Ugueto AM, Weisz JR, Wood JJ. Meta-analysis of Psychotherapy for Autistic Youth. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01686-2. [PMID: 38580853 DOI: 10.1007/s10578-024-01686-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 04/07/2024]
Abstract
In order to provide more individualized support, it is imperative to further understand the effectiveness of different types of psychotherapy on the clinical areas of need common in autistic youth (Wood et al. in Behav Ther 46:83-95, 2015). Randomized controlled trials of psychotherapy for autistic youth were included if published in English, included random assignment to treatment or control group, required a previous diagnosis of autism, had a mean age of 6-17 years, and provided outcome measure data from both intervention and control groups. A total of 133 measures were coded across 29 studies and included 1464 participants with a mean age of 10.39 years (1.89). A small mean effect size (0.38,95% CI [0.26, 0.47]) was found overall, with the largest effects for cognitive behavioral therapies on autism-related clinical needs (0.81) and overall mental health (0.78). The results show the significant impact of psychotherapy interventions for autistic youth. Additional research should further assess the details of the most effective psychotherapies for each area of clinical need.
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Affiliation(s)
- Kashia A Rosenau
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.
| | - Junok Kim
- School of Education and Information Studies, University of California Los Angeles, Los Angeles, USA
| | - An-Chuen Billy Cho
- School of Education and Information Studies, University of California Los Angeles, Los Angeles, USA
| | - Michael Seltzer
- School of Education and Information Studies, University of California Los Angeles, Los Angeles, USA
| | - Ana M Ugueto
- University of Texas Health Science Center at Houston, Houston, USA
| | | | - Jeffrey J Wood
- School of Education and Information Studies, University of California Los Angeles, Los Angeles, USA
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27
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Kim SY, Song DY, Bottema-Beutel K, Gillespie-Lynch K. Time to level up: A systematic review of interventions aiming to reduce stigma toward autistic people. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:798-815. [PMID: 37886792 DOI: 10.1177/13623613231205915] [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] [Indexed: 10/28/2023]
Abstract
LAY ABSTRACT How non-autistic people think about autistic people impacts autistic people negatively. Many studies developed trainings to reduce autism stigma. The existing trainings vary a lot in terms of study design, content, and reported effectiveness. This means that a review studying how the studies have been conducted is needed. We also looked at the quality of these studies. We collected and studied 26 studies that tried to reduce stigma toward autistic people. The studies often targeted White K-12 students and college students. Most trainings were implemented once. Trainings frequently used video or computer. Especially, recent studies tended to use online platforms. The study quality was poor for most studies. Some studies made inaccurate claims about the intervention effectiveness. Studies did not sufficiently address study limitations. Future trainings should aim to figure out why and how interventions work. How intervention changes people's behavior and thoughts should be studied. Researchers should study whether the training can change the societal stigma. Also, researchers should use a better study design.
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Affiliation(s)
| | - Da-Yea Song
- Seoul National University Bundang Hospital, South Korea
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28
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Walton KM, Borowy AR, Taylor CA. "It just depends": Parent, teacher, and expert conceptualization of social communication in young autistic children. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:920-931. [PMID: 37491973 PMCID: PMC10811291 DOI: 10.1177/13623613231185401] [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: 07/27/2023]
Abstract
LAY ABSTRACT Improving social communication is often one goal during early autism services. However, researchers do not yet know whether their ideas about which social communication skills should be targeted during services for young autistic children are the same as the goals of autism community members, such as parents, teachers, and expert clinicians. This study used focus groups (meetings of small groups of community members) to ask people from these groups about what aspects of social communication are most important to support in young autistic children. A total of 43 people participated in these focus groups. These groups included parents (three groups; 21 people), teachers (two groups; 8 people), and experts in early social communication and autism (two groups; 14 people). Focus group participants talked about several aspects of social communication that were already familiar to the research team, such as problems with expressive communication, language understanding, and social interaction. However, participants also talked about several parts of social communication that were less familiar to the research team and had usually not been mentioned in previous research. These included (1) considering the value of unusual forms of communication, (2) taking context and setting into account when considering social communication, and (3) how communication and emotion regulation impact one another. The information from these focus groups will be helpful to making sure that researchers and clinicians focus their social communication supports on areas that are most important to parents and teachers.
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29
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Wimmer L, Steininger TM, Schmid A, Wittwer J. Category learning in autistic individuals: A meta-analysis. Psychon Bull Rev 2024; 31:460-483. [PMID: 37673843 PMCID: PMC11061057 DOI: 10.3758/s13423-023-02365-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/08/2023]
Abstract
Learning new categories is a fundamental human skill. In the present article, we report the first comprehensive meta-analysis of category learning in autism. Including studies comparing groups of autistic and nonautistic individuals, we investigated whether autistic individuals differ in category learning from nonautistic individuals. In addition, we examined moderator variables accounting for variability between studies. A multilevel meta-analysis of k = 50 studies examining n = 1,220 autistic and n = 1,445 nonautistic individuals based on 112 effect sizes in terms of the standardized mean difference revealed lower-level category learning skills for autistic compared with nonautistic individuals, g = -0.55, 95% CI = [-0.73, -0.38], p < .0001. According to moderator analyses, the significant amount of heterogeneity, Q(111) = 617.88, p < .0001, was explained by only one of the moderator variables under investigation-namely, study language. For the remaining variables-namely, age, year of publication, risk of bias, type of control group, IQ of autistic group, percentage of male autistic participants, type of category, type of task, and type of dependent measure-there were no significant effects. Although hat values and Cook's distance statistics confirmed the robustness of findings, results of Egger's test and a funnel plot suggested the presence of publication bias reflecting an overrepresentation of disadvantageous findings for autistic groups. Objectives for future work include identifying additional moderator variables, examining downstream effects of suboptimal category learning skills, and developing interventions.
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Affiliation(s)
- Lena Wimmer
- Department of Education, University of Freiburg, Rempartstr. 11, D-79098, Freiburg im Breisgau, Germany.
| | - Tim M Steininger
- Department of Education, University of Freiburg, Rempartstr. 11, D-79098, Freiburg im Breisgau, Germany
| | - Annalena Schmid
- Department of Education, University of Freiburg, Rempartstr. 11, D-79098, Freiburg im Breisgau, Germany
- Faculty of Applied Psychology, SRH University Heidelberg, Heidelberg, Germany
| | - Jörg Wittwer
- Department of Education, University of Freiburg, Rempartstr. 11, D-79098, Freiburg im Breisgau, Germany
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30
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Bettencourt C, Garret-Gloanec N, Pellerin H, Péré P, Bertamini G, Squillante M, Roos-Weil F, Ferrand L, Pernel AS, Apter G, Chetouani M, Cortese S, Cohen D. Promoting emotional and behavioral interventions in ASD treatment: Evidence from EPIGRAM, A naturalistic, prospective and longitudinal study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 147:104688. [PMID: 38431998 DOI: 10.1016/j.ridd.2024.104688] [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: 05/30/2023] [Revised: 12/06/2023] [Accepted: 01/22/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Prognostic factors from naturalistic treatment studies of children with Autism Spectrum Disorder (ASD) remain largely unknown. We aimed to identify baseline and treatment-related prognostic predictors at 1-year follow-up after Integrative Care Practices (ICPs). METHODS Eighty-nine preschool children with severe ASD were given ICP combining nine therapeutic workshops based on children's needs. Participants were assessed at baseline and during 12 months follow-up with the Psycho-educational Profile-3-R, Children Autism Rating Scale, Parental Global Impression, and the Autistic Behaviors Scale. We assessed prognostic predictors using multivariable regression models and explored treatment ingredients influencing outcome using Classification and Regression Trees (CART). RESULTS Multivariable models showed that being a child from first generation immigrant parents predicted increased maladaptive behaviors, whereas play activities had an opposite effect; severity of ASD symptoms and impaired cognitive functions predicted worse autism severity at follow-up; and lower play activities predicted worse parent impression. Regarding treatment effects, more emotion/behavioral interventions predicted better outcomes, and more communication interventions predicted lower autism severity, whereas more education and cognitive interventions had an opposite effect. CART confirmed that more hours of intervention in the emotion/behavioral domain helped classifying cases with better outcomes. More parental support was associated with decreased maladaptive behaviors. Sensorimotor and education interventions also significantly contributed to classifying cases according to outcomes but defined subgroups with opposite prognosis. CONCLUSION Children who exhibited the best prognosis following ICPs had less autism severity, better cognition, and non-immigrant parents at baseline. Emotion/behavior interventions appeared key across all outcomes and should be promoted.
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Affiliation(s)
- Carlotta Bettencourt
- Groupe Hospitalo-Universitaire Pitié-Salpêtrière, APHP. SU, Paris, France; Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7222, Institut des Systèmes Intelligents et Robotiques, Sorbonne Université, Paris, France
| | - Nicole Garret-Gloanec
- Centre Nantais de Parentalité, 1 rue Marmontel, Centre Hospitalo-Universitaire, 44000 Nantes, France
| | - Hugues Pellerin
- Groupe Hospitalo-Universitaire Pitié-Salpêtrière, APHP. SU, Paris, France
| | - PereMorgane Péré
- Direction de la recherche, Plateforme de Méthodologie et Biostatistique, Centre Hospitalo-Universitaire de Nantes, Nantes, France
| | - Giulio Bertamini
- Groupe Hospitalo-Universitaire Pitié-Salpêtrière, APHP. SU, Paris, France; Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7222, Institut des Systèmes Intelligents et Robotiques, Sorbonne Université, Paris, France; Laboratory of Observation, Diagnosis and Education (ODF Lab), Department of Psychology and Cognitive Science, University of Trento, Italy
| | - Maria Squillante
- Centre Hopsitalier Universitaire de Brest, 49 rue de Siam, 29200 Brest, France
| | | | - Léa Ferrand
- Direction de la Recherche - Département promotion, Centre Hospitalo-Universitaire de Nantes, Nantes, France
| | | | - Gisèle Apter
- Groupe Hospitalier du Havre, Université de Rouen Normandie, Le Havre, France
| | - Mohamed Chetouani
- Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7222, Institut des Systèmes Intelligents et Robotiques, Sorbonne Université, Paris, France
| | - Samuele Cortese
- New-York University Grossman School of Medicine, New York, USA; School of Psychology, University of Southampton, UK
| | - David Cohen
- Groupe Hospitalo-Universitaire Pitié-Salpêtrière, APHP. SU, Paris, France; Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7222, Institut des Systèmes Intelligents et Robotiques, Sorbonne Université, Paris, France.
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Pino MC, Vagnetti R, Tiberti S, Valenti M, Mazza M. Involving autism stakeholders in identifying priorities for interventions based on augmented reality. Disabil Rehabil Assist Technol 2024; 19:712-720. [PMID: 36074593 DOI: 10.1080/17483107.2022.2120103] [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: 05/06/2022] [Revised: 08/22/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Literature supports the use of technological tools such as augmented reality, 3 D avatars and mobile devices to improve individuals with autism spectrum disorder skills. Possibilities of including these technological tools in intervention and the critical issues related to intervention design are essential research questions. The aim of the current work is to present an interdisciplinary research study on the design of an autism intervention considering these technologies. MATERIALS AND METHODS This study used qualitative evidence and thematic analysis to identify the main design guidelines. A semi-structured interview was administered to a total of twenty participants representing four stakeholder categories: ASD, clinicians, therapists and caregivers. Interviews focussed on three dimensions related to user, technology and environment since they represent a complex system within which the individual using technology is situated. RESULTS Thematic analysis of the interviews identified a total of 10 themes considered central to the design of the technological intervention. CONCLUSIONS Since the application of technology in autism intervention is a relatively new area, the guidelines related to the potential incentives and barriers of the proposed technology are helpful to inform future treatment studies.Implications for RehabilitationThis study highlights the strengths and barriers associated with the use of smartphones and augmented reality in autism spectrum disorder interventions considering the dimensions within which the user using assistive technology is located.Strengths and major concerns that emerged are key points to consider during the development of the technological intervention.Considering these points can foster the use of technology within the intervention and promote its effectiveness.
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Affiliation(s)
- Maria Chiara Pino
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
- Regional Reference Centre for Autism of the Abruzzo Region, Local Health Unit ASL 1, L'Aquila, Italy
| | - Roberto Vagnetti
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Sergio Tiberti
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Marco Valenti
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
- Regional Reference Centre for Autism of the Abruzzo Region, Local Health Unit ASL 1, L'Aquila, Italy
| | - Monica Mazza
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
- Regional Reference Centre for Autism of the Abruzzo Region, Local Health Unit ASL 1, L'Aquila, Italy
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Baiden KMP, Williams ZJ, Schuck RK, Dwyer P, Wang M. The Social Validity of Behavioral Interventions: Seeking Input from Autistic Adults. J Autism Dev Disord 2024:10.1007/s10803-024-06297-3. [PMID: 38470531 DOI: 10.1007/s10803-024-06297-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/14/2024]
Abstract
Many in the autistic community have expressed concerns regarding the use of behavioral interventions with autistic children, suggesting that these interventions may not be socially valid. Though behavioral interventions have evolved to be more naturalistic and child-centered, little structured research has been done to explicitly seek autistic perspectives on the acceptability of specific components of behavioral interventions. Autistic adults (N = 235) were recruited online to take the Autism Intervention Attitudes Scale (AIAS), a questionnaire designed to gather feedback on common intervention goals and practices. Results indicate that participants find goals and practices that highlight quality of life, safety, and autistic interactions acceptable, while those that focus on normalization based on neurotypical standards are not. An exploratory graph analysis revealed three communities of goals ("uncontroversial goals", "controversial goals", and "social goals"). Comparison between naturalistic and structured intervention components additionally showed that autistic participants favored naturalistic strategies. These findings are in line with known criticisms of behavioral intervention from autistic adults, but also provide more information on the specific ways in which behavioral interventions can be reformed. This information can guide professionals in the development of appropriate goals and decisions around intervention planning.
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Affiliation(s)
- Kaitlynn M P Baiden
- Gevirtz Graduate School of Education, University of California, Santa Barbara, USA.
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, USA
| | - Rachel K Schuck
- Gevirtz Graduate School of Education, University of California, Santa Barbara, USA
| | - Patrick Dwyer
- Department of Psychology, University of California, Davis, Davis, USA
- Center for Mind and Brain, University of California, Davis, Davis, USA
- Olga Tennison Autism Research Centre (OTARC), School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Mian Wang
- Gevirtz Graduate School of Education, University of California, Santa Barbara, USA
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Camarata S, Stiles S, Birer S. Naturalistic Developmental Behavioral Interventions for Developmental Language Disorder. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:627-641. [PMID: 38166189 DOI: 10.1044/2023_ajslp-23-00116] [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: 01/04/2024]
Abstract
PURPOSE Naturalistic-developmental-behavioral interventions (NDBIs) are a widely accepted and validated approach for treating language-related symptoms in autism spectrum disorder, including deficits in vocabulary, social skills, and grammar. The purpose of this article is to define the elements naturalistic, developmental, and behavioral as applied to children with developmental language disorder (DLD) and to provide an example of how this type of intervention can be implemented to teach vocabulary and test cross-modal generalization between expressive and receptive modalities. METHOD A vocabulary intervention using hybrid NDBI methods (storybook reading and conversational recast interaction) was provided to three participants with DLD using a single-case design. RESULTS The results indicated that all participants successfully learned receptive and expressive vocabulary targets with extensive cross-modal generalization. However, generalization was limited in some of the participants. CONCLUSIONS This article provided definitions of key elements of NDBI (naturalistic, developmental, and behavioral) including a rationale for extending NDBI procedures to language intervention for children with DLD. In addition, a single-case design demonstrated that NDBI can be implemented in DLD and that broadly defined naturalistic-developmental applied behavior analysis techniques are applicable to language interventions for children with language disorders. Moreover, diverse naturalistic and developmental procedures meet the highest standards for evidence-based practice to treat DLD.
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Affiliation(s)
- Stephen Camarata
- Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine, Nashville, TN
| | - Suzanne Stiles
- Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine, Nashville, TN
| | - Samara Birer
- Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine, Nashville, TN
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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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Zhuang H, Liang Z, Ma G, Qureshi A, Ran X, Feng C, Liu X, Yan X, Shen L. Autism spectrum disorder: pathogenesis, biomarker, and intervention therapy. MedComm (Beijing) 2024; 5:e497. [PMID: 38434761 PMCID: PMC10908366 DOI: 10.1002/mco2.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
Autism spectrum disorder (ASD) has become a common neurodevelopmental disorder. The heterogeneity of ASD poses great challenges for its research and clinical translation. On the basis of reviewing the heterogeneity of ASD, this review systematically summarized the current status and progress of pathogenesis, diagnostic markers, and interventions for ASD. We provided an overview of the ASD molecular mechanisms identified by multi-omics studies and convergent mechanism in different genetic backgrounds. The comorbidities, mechanisms associated with important physiological and metabolic abnormalities (i.e., inflammation, immunity, oxidative stress, and mitochondrial dysfunction), and gut microbial disorder in ASD were reviewed. The non-targeted omics and targeting studies of diagnostic markers for ASD were also reviewed. Moreover, we summarized the progress and methods of behavioral and educational interventions, intervention methods related to technological devices, and research on medical interventions and potential drug targets. This review highlighted the application of high-throughput omics methods in ASD research and emphasized the importance of seeking homogeneity from heterogeneity and exploring the convergence of disease mechanisms, biomarkers, and intervention approaches, and proposes that taking into account individuality and commonality may be the key to achieve accurate diagnosis and treatment of ASD.
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Affiliation(s)
- Hongbin Zhuang
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Zhiyuan Liang
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Guanwei Ma
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Ayesha Qureshi
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Xiaoqian Ran
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Chengyun Feng
- Maternal and Child Health Hospital of BaoanShenzhenP. R. China
| | - Xukun Liu
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Xi Yan
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
| | - Liming Shen
- College of Life Science and OceanographyShenzhen UniversityShenzhenP. R. China
- Shenzhen‐Hong Kong Institute of Brain Science‐Shenzhen Fundamental Research InstitutionsShenzhenP. R. China
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Paranczak JL, Lambert JM, Ledford JR, Copeland BA, Macdonald MJ. Deriving relations at multiple levels of complexity following minimal instruction: A demonstration. J Appl Behav Anal 2024; 57:408-425. [PMID: 38436116 DOI: 10.1002/jaba.1067] [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: 07/07/2023] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
Recommendations for achieving generalized instructional outcomes often overlook the capacity for generative learning for most verbally competent humans. Four children (ages 5-8) participated in this project. In Study 1, we provided decontextualized discrete trial teaching to establish arbitrary relations between colors, pictures of characters, and researcher motor actions. All participants engaged in derivative responding, providing evidence of relational framing. Subsequently, we demonstrated that, with no additional instruction, these derivatives contributed to effective action within a socially valid context (i.e., Candyland gameplay). Study 2 extended the demonstration by teaching frames of opposition. Following teaching, all participants engaged in novel and contextually appropriate responding that entailed the derivation of both coordination and opposition between untrained stimuli. This outcome demonstrates how teaching simple relations can result in learning that manifests at higher levels of complexity (i.e., relational networking), providing some evidence that there can be socially valid benefits to decontextualized discrete trial instruction.
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Affiliation(s)
| | - Joseph M Lambert
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
| | - Jennifer R Ledford
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
| | - Bailey A Copeland
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
| | - M Janey Macdonald
- Department of Special Education, Vanderbilt University, Nashville, TN, USA
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Skafle I, Gabarron E, Nordahl-Hansen A. Social media shaping autism perception and identity. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241230454. [PMID: 38389125 DOI: 10.1177/13623613241230454] [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: 02/24/2024]
Abstract
LAY ABSTRACT This study suggested that social media can provide important information about autism to autistic people. We interviewed 12 autistic adults (aged 18-49 years) and talked to them about the use of social media to find both general information and content specifically about autism, autism identity and online autistic communities. There is little research exploring how autistic people find information about autism on social media and how that makes them feel. Therefore, it is important to ask autistic people about their experiences with using social media to obtain content about autism. The 12 participants explained that when they searched for information about autism on the official health pages, they often felt that the information they found was insufficient and could not answer their questions. In addition, they searched on social media platforms for information about autism despite that they perceived social media as an unreliable source. On the social media platforms, many found content that was positive in relation to their autistic identities. The participants also found comfort in some of the forums and social media groups and received helpful advice. Nevertheless, some of the discussions were aggressive and the participants felt alienated, which did not provide a sense of community online. The findings from the study may advice on what is missing in the official pages about autism, and highlight the need to involve the autistic community in writing the content on such platforms.
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Affiliation(s)
- Ingjerd Skafle
- Østfold University College, Norway
- University of Oslo, Norway
| | - Elia Gabarron
- Østfold University College, Norway
- Norwegian Centre for E-Health Research, Norway
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Du Plessis CD, Hampton LH, Harty M. Enhanced Milieu Teaching in resource-constrained settings: Stakeholder-informed adaptation guidelines. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2024; 71:e1-e10. [PMID: 38426737 PMCID: PMC10913137 DOI: 10.4102/sajcd.v71i1.989] [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: 04/21/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Enhanced Milieu Teaching (EMT) is an evidence-based naturalistic developmental behavioural intervention (NDBI) for children with developmental disabilities. Little is known about the EMT's fit or what adaptations might be needed to improve its applicability within a resource-constrained setting. OBJECTIVES To explore stakeholders' perceptions of the contextual fit of EMT for young children with developmental disabilities in a resource-constrained context and to identify adaptations to improve EMT's contextual fit. METHOD We conducted a descriptive qualitative study using semi-structured interviews and focus groups. Participants included 5 speech and language therapists and 11 caregivers of children with developmental disabilities who speak English and Afrikaans or isiXhosa. Using thematic analysis, data were coded into 10 subthemes and grouped according to the Adaptome framework components. RESULTS Overall, stakeholders view EMT as an appropriate intervention in the South African context. They indicated that certain intervention components may need to be modified. Specifically, clinicians may need to adapt intervention materials and activities to be sensitive to families' available resources, preferred activity routines and priorities. From these data, we provide guidelines to improve the fit of EMT in South Africa. CONCLUSION Enhanced Milieu Teaching is an appropriate intervention in the South African context, although some adaptations can enhance its fit.Contribution: This article highlights the importance of engaging with stakeholders to determine the fit of NDBIs, like EMT, as they are implemented in new contexts. Based on these insights, stakeholder-informed adaptation guidelines are provided for improving the contextual fit of EMT in resource-constrained settings.
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Affiliation(s)
- Chevonne D Du Plessis
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town.
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Smythe T, Scherer N, Nanyunja C, Tann CJ, Olusanya BO. Strategies for addressing the needs of children with or at risk of developmental disabilities in early childhood by 2030: a systematic umbrella review. BMC Med 2024; 22:51. [PMID: 38302917 PMCID: PMC10835858 DOI: 10.1186/s12916-024-03265-7] [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] [Received: 08/22/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND There are over 53million children worldwide under five with developmental disabilities who require effective interventions to support their health and well-being. However, challenges in delivering interventions persist due to various barriers, particularly in low-income and middle-income countries. METHODS We conducted a global systematic umbrella review to assess the evidence on prevention, early detection and rehabilitation interventions for child functioning outcomes related to developmental disabilities in children under 5 years. We focused on prevalent disabilities worldwide and identified evidence-based interventions. We searched Medline, Embase, PsychINFO, and Cochrane Library for relevant literature from 1st January 2013 to 14th April 2023. A narrative synthesis approach was used to summarise the findings of the included meta-analyses. The results were presented descriptively, including study characteristics, interventions assessed, and outcomes reported. Further, as part of a secondary analysis, we presented the global prevalence of each disability in 2019 from the Global Burden of Disease study, identified the regions with the highest burden and the top ten affected countries. This study is registered with PROSPERO, number CRD42023420099. RESULTS We included 18 reviews from 883 citations, which included 1,273,444 children under five with or at risk of developmental disabilities from 251 studies across 30 countries. The conditions with adequate data were cerebral palsy, hearing loss, cognitive impairment, autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder. ASD was the most prevalent target disability (n = 8 reviews, 44%). Most reviews (n = 12, 67%) evaluated early interventions to support behavioural functioning and motor impairment. Only 33% (n = 10/30) of studies in the reviews were from middle-income countries, with no studies from low-income countries. Regarding quality, half of reviews were scored as high confidence (n = 9/18, 50%), seven as moderate (39%) and two (11%) as low. CONCLUSIONS We identified geographical and disability-related inequities. There is a lack of evidence from outside high-income settings. The study underscores gaps in evidence concerning prevention, identification and intervention, revealing a stark mismatch between the available evidence base and the regions experiencing the highest prevalence rates of developmental disabilities.
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Affiliation(s)
- Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa.
| | - Nathaniel Scherer
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Carol Nanyunja
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Infectious Disease On Epidemiology & International Health, School of Hygiene & Tropical Medicine, London, UK
| | - Cally J Tann
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Infectious Disease On Epidemiology & International Health, School of Hygiene & Tropical Medicine, London, UK
- Neonatal Medicine, University College London NHS Trust, London, UK
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Guevara VLDS, Coêlho RF, Flores EP. Effects of dialogic reading for comprehension (LuDiCa) on the social interaction of autistic adolescents and their peers. PSICOLOGIA-REFLEXAO E CRITICA 2024; 37:4. [PMID: 38305847 PMCID: PMC10837403 DOI: 10.1186/s41155-023-00283-x] [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: 06/12/2023] [Accepted: 12/16/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND In today's contemporary world, relationships take a prominent role in the lives of adolescents. However, challenges related to mutual understanding and a lack of inclusive environments can often lead to autistic teens feeling excluded. OBJECTIVE In order to assess the impact of naturalistic interventions on interpersonal relationships, we conducted an experimental test utilizing Dialogic Reading for Comprehension (LuDiCa) in online reading circles with groups comprising both autistic and neurotypical adolescents. Our focus was on exploring its relevance for enhancing social interaction, particularly in terms of conversational acts, sharing experiences, initiations, and questions. METHODS Five autistic and five neurotypical students between 11 and 15 years old from a public school in Brasilia, Federal District, participated. We paired groups A and B (made up of trios of teenagers) and groups C and D (made up of pairs) in a multiple baseline design per reading group, in which all groups went through the baseline conditions (BL), intervention (LuDiCa) and maintenance. RESULTS LuDiCa increased the frequency of conversational acts of both autistic participants and neurotypical peers. In addition, the intervention favored initiations, questions, and sharing experiences, through the shared activity of reading and talking about a work of fiction. Participants rated the intervention in relation to the platform, the book, the reading facilitator, and interaction with peers. We discuss the potential of the facilitator's role in favoring interactions and the potential of LuDiCa as a joint activity for the engagement of adolescents. We also include suggestions for future research focused on the online context and discuss some limitations of the LuDiCa intervention. CONCLUSION In summary, our study offers initial experimental evidence demonstrating the positive impact of LuDiCa on social interaction behaviors among both autistic and neurotypical adolescents within an inclusive setting.
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Affiliation(s)
- Victor Loyola de Souza Guevara
- Department of Basic Psychological Processes, Institute of Psychology, University of Brasília, ICC SUL-Campus Darcy Ribeiro, Asa Norte, Brasília, Federal District, 70910-900, Brazil.
| | - Raquel Freire Coêlho
- Institute of Psychology, Social Work, Health and Human Communication, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Eileen Pfeiffer Flores
- Department of Basic Psychological Processes, Institute of Psychology, University of Brasília, ICC SUL-Campus Darcy Ribeiro, Asa Norte, Brasília, Federal District, 70910-900, Brazil
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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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Fletcher-Watson S. What's in a name? The costs and benefits of a formal autism diagnosis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:257-262. [PMID: 37997793 DOI: 10.1177/13623613231213300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
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Schuck RK, Dwyer P, Baiden KMP, Williams ZJ, Wang M. Social Validity of Pivotal Response Treatment for Young Autistic Children: Perspectives of Autistic Adults. J Autism Dev Disord 2024; 54:423-441. [PMID: 36427175 PMCID: PMC10821825 DOI: 10.1007/s10803-022-05808-4] [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] [Accepted: 10/25/2022] [Indexed: 11/27/2022]
Abstract
The social validity of autism behavioral intervention has been questioned. Naturalistic Developmental Behavioral Interventions (NDBIs) attempt to address some concerns, but it is unclear whether autistic people consider NDBIs socially valid. Social validity of an NDBI, Pivotal Response Treatment (PRT), was investigated through autistic adults commenting on videos of autistic children receiving PRT. Qualitative coding of responses generated three themes: respect for individuals; assessment of intervention implementation; and socioemotional considerations. Although video brevity limits the scope of the present study's conclusions, participants highlighted PRT components that appeared socially valid (e.g., reinforcing attempts, following the child's lead) and aspects appearing invalid (e.g., overemphasis on spoken language). Therefore, adjustments appear necessary for PRT to be fully acceptable to the autistic community.
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Affiliation(s)
- Rachel K Schuck
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA.
| | - Patrick Dwyer
- Department of Psychology, University of California, Davis, Davis, USA
- Center for Mind and Brain, University of California, Davis, Davis, USA
| | - Kaitlynn M P Baiden
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, USA
| | - Mian Wang
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA
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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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45
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Lee JD, Kang VY, Terol AK, Joo S. Examining the Efficacy of Culturally Responsive Interventions for Autistic Children and Their Families: A Meta-Analysis. J Autism Dev Disord 2024:10.1007/s10803-023-06212-2. [PMID: 38246962 PMCID: PMC11260274 DOI: 10.1007/s10803-023-06212-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/23/2024]
Abstract
Culturally responsive interventions for autistic children and their families have been developed and implemented to address issues related to limited representation, inequities, and disparities in access to care of minoritized families in research. Currently available reviews are relatively limited in scope or do not synthesize interventions specifically. Therefore, we conducted a meta-analysis to synthesize autism intervention literature that specifically targeted autistic individuals and their family members from minoritized backgrounds, such as immigrant families. We used four databases to identify studies that used culturally responsive interventions with minoritized autistic children and their families. An article was included if it included empirical intervention data using an experimental design. A total of 354 studies were initially screened, and 24 studies were included. Effect sizes of these studies were extracted across two levels (i.e., child and family levels). Data from group design studies were extracted manually, and data from single-case design studies were extracted using a web-based tool. We used design-comparable standardized effect sizes to compare across both designs. The analysis revealed a large, positive, and significant overall effect size across culturally responsive interventions. Specifically, social-communication and mental health outcomes yielded significant effects at the child level. Additionally, parents' mental health and fidelity of strategy implementation also yielded significant results. Our results suggest that culturally responsive interventions yield comparable outcomes to unadapted, original interventions. Future research should examine the distinction between the effect of cultural adaptation and the efficacy of the intervention itself.
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Affiliation(s)
- James D Lee
- Department of Psychiatry and Behavioral Sciences, University of Washington, 6901 Sand Point Ave NE, Seattle, WA, 98115, USA.
| | - Veronica Y Kang
- Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park, USA
| | - Adriana Kaori Terol
- Department of Special Education, University of Illinois Urbana-Champaign, Champaign, USA
| | - Sean Joo
- Department of Educational Psychology, University of Kansas, Lawrence, USA
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46
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Fisher AP, Lynch JD. Differences Between Black and White Caregivers in the Association Between Autism Diagnostic Process Satisfaction and Service Use. J Autism Dev Disord 2024:10.1007/s10803-023-06233-x. [PMID: 38231381 DOI: 10.1007/s10803-023-06233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Black families of children with autism spectrum disorder have less access to high quality, culturally responsive care for their children. METHOD We assessed satisfaction and service utilization among fifty (29%) Black caregivers and 124 (71%) White caregivers of children with autism spectrum disorder. We also examined whether race moderated the association between satisfaction and service utilization. RESULTS We did not identify racial differences in satisfaction or service utilization. Race moderated the association between satisfaction and total service use, F(170) = 5.29, p =.02, therapy service use, F(163) = 3.59, p =.046, and community service use, F(169) = 4.76, p =.046. For Black families, there was a positive association between satisfaction and service use. There was no association between satisfaction and service use among White families. DISCUSSION Satisfaction may be particularly important among Black families, who have been mistreated by the healthcare system and frequently face discrimination. Our results suggest the importance of culturally responsive care for Black families.
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Affiliation(s)
- Allison P Fisher
- Department of Psychology, University of Cincinnati, 45 W. Corry Blvd, Cincinnati, OH, USA.
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA.
| | - James D Lynch
- Department of Psychology, University of Cincinnati, 45 W. Corry Blvd, Cincinnati, OH, USA
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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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48
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Song J, Reilly M, Reichow B. Overview of Meta-Analyses on Naturalistic Developmental Behavioral Interventions for Children with Autism Spectrum Disorder. J Autism Dev Disord 2024:10.1007/s10803-023-06198-x. [PMID: 38170431 DOI: 10.1007/s10803-023-06198-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 01/05/2024]
Abstract
We conducted an overview of reviews to determine the effects of naturalistic developmental behavioral interventions (NDBIs; Schreibman et al. (2015) J Autism Dev Disorders 45:2411-2428) on children with autism spectrum disorder under 8 years old. We conducted an electronic database search of Academic Search Premier, CINHAL, ERIC, Medline, and APA PsycINFO in October 2022 and August 2023 and utilized snowball methods to locate relevant reviews of NDBI. We included reviews meeting the following inclusion criteria: (1) review included a meta-analytic synthesis for at least one child outcome; (2) primary studies examined a NDBI; (3) primary studies included children with ASD with a mean pre-treatment age under eight years; (4) primary studies were conducted using a two-group comparison design; and (5) review was published in English. We extracted data on characteristics of the review, participant characteristics from the primary studies, intervention characteristics, and assessed the risk of bias of the included reviews. We conducted a narrative synthesis across outcomes reported in the included reviews. We included five reviews from six reports in this overview. Two reviews included studies that examined the Early Start Denver Model, two reviews included studies that examined the Pivotal Response Treatment, and one review included studies examining NDBIs collectively. We found positive effects of NDBIs on child's communication/language, cognition, and adaptive behavior. We found mixed effects for NDBIs on autism symptomatology and restricted and repetitive behaviors. Examination of moderator analyses reported in the included reviews suggested variables influencing the effects of NDBIs included proximity of outcome to intervention, boundedness of outcome to intervention, and study location. As shown in this overview, positive effects of NDBI for young children with ASD are supported by meta-analytic evidence. While the overall findings for NDBI across reviews are positive, the findings on specific outcomes and influential variables moderating the effects of NDBI are inconsistent. Additional evidence from randomized controlled trials and future meta-analyses are needed to strengthen our knowledge of the effects of NDBI for young children with ASD.Protocol Registration: PROSPERO CRD42022353045.
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Affiliation(s)
- Jinwei Song
- A. J. Pappanikou Center for Excellence in Developmental Disabilities, UConn Health, Farmington, CT, USA
- Neag School of Education, University of Connecticut, Storrs, CT, USA
| | - Molly Reilly
- A. J. Pappanikou Center for Excellence in Developmental Disabilities, UConn Health, Farmington, CT, USA
- Neag School of Education, University of Connecticut, Storrs, CT, USA
| | - Brian Reichow
- A. J. Pappanikou Center for Excellence in Developmental Disabilities, UConn Health, Farmington, CT, USA.
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Martin JC, Clark SR, Hartmann S, Schubert KO. A Tale of Three Spectra: Basic Symptoms in Clinical-High-Risk of Psychosis Vary Across Autism Spectrum Disorder, Schizotypal Personality Disorder, and Borderline Personality Disorder. SCHIZOPHRENIA BULLETIN OPEN 2024; 5:sgae017. [PMID: 39183768 PMCID: PMC11341945 DOI: 10.1093/schizbullopen/sgae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Background and Hypothesis The clinical-high-risk (CHR) approach was developed to prevent psychosis through the detection of psychosis risk. CHR services are transdiagnostic in nature, therefore the appropriate management of comorbidity is a central part of care. Differential diagnosis is particularly challenging across 3 common comorbidities, schizotypal personality disorder (SPD), autism spectrum disorder (ASD), and borderline personality disorder (BPD). Phenomenological research indicates a disturbance of "basic self" may differentiate between these commonly comorbid disorders and can be captured by Huber's basic symptoms (BS) concept. We investigated whether BS vary across these disorders and may inform differential diagnosis in young person's meeting CHR criteria. Study Design A total of 685 participants meeting CHR criteria from the NAPLS-3 cohort completed the COGDIS items of the schizophrenia proneness instrument, a measure of BS, as well as the structured interview for DSM-5 (SCID-5). A logistic regression model was used to investigate the variation of COGDIS across SPD, ASD, and BPD, while controlling for age and SIPs positive severity. Study Results Meeting COGDIS criteria was positively associated with SPD (OR = 1.72, CI = [1.31-2.28], P = .001) but not ASD nor BPD. Conclusions Our results indicate that "basic self-disturbance" as indicated by COGDIS differs across SPD, ASD, and BPD. COGDIS may be useful to inform the management of comorbidities in CHR services, by providing insight into subtle subjective experiences that may benefit from disorder-specific interventions.
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Affiliation(s)
- James C Martin
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia
| | - Scott R Clark
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia
- Discipline of Psychiatry, Basil Hetzel Institute, Woodville, South Australia, Australia
| | - Simon Hartmann
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia
| | - K Oliver Schubert
- Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, North Terrace, Adelaide, South Australia, Australia
- Division of Mental Health, Northern Adelaide Local Health Network, SA Health, South Australia
- Headspace Early Psychosis, Sonder, South Australia
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50
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Chung KM, Chung E, Lee H. Behavioral Interventions for Autism Spectrum Disorder: A Brief Review and Guidelines With a Specific Focus on Applied Behavior Analysis. Soa Chongsonyon Chongsin Uihak 2024; 35:29-38. [PMID: 38204739 PMCID: PMC10774556 DOI: 10.5765/jkacap.230019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/21/2023] [Accepted: 12/03/2023] [Indexed: 01/12/2024] Open
Abstract
We conducted a comprehensive review of behavioral and educational interventions for individuals with autism spectrum disorder (ASD). The most prominent type of intervention, Comprehensive Early Intervention, often referred to as Early Intensive Behavioral Intervention (EIBI), has been found to be particularly effective in improving intelligence and adaptive behaviors. The naturalistic developmental behavioral intervention, designed to enhance social and communication abilities, showed effectiveness in improving language, cognitive function, and social initiation. However, more studies are needed to examine its effectiveness. Intensive individualized intervention, which provides a tailored intervention for a specific target behavior, was effective in improving social skills and communication, as well as reducing sleep, eating, and toileting problems. Cognitive behavioral therapy (CBT) is the most effective method for dealing with emotional difficulties, but it has not been widely used because of the shortage of trained experts. Parent-mediated intervention (PMI) involves parents acquiring knowledge and specific skills to improve their child's functioning or reduce challenging behaviors. Speech and language therapy, sensory integration, Treatment and Education of Autistic and related Communications Handicapped Children, developmental approaches, and social stories are frequently used interventions. However, evidence of their effectiveness has yet to be well established. Based on these findings, intervention recommendations for autism include EIBI, Early Start Denver Model, intensive individualized intervention, CBT, and PMI. The choice of intervention should be tailored to the individual's needs and delivered by qualified professionals with expertise in the specific intervention.
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Affiliation(s)
- Kyong-Mee Chung
- Department of Psychology, College of Arts and Science, Yonsei University, Seoul, Korea
| | - Eunsun Chung
- Department of Psychology, College of Arts and Science, Yonsei University, Seoul, Korea
| | - Hoomyung Lee
- Department of Psychology, College of Arts and Science, Yonsei University, Seoul, Korea
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