Introduction to the Special Issue: Interventions to Reduce Challenging Behavior Among Individuals With Autism Spectrum Disorder

Behavioral Parent Training via Telehealth for Autistic Children: Further Exploration of Feasibility During the COVID-19 Pandemic

Objectives

Many autistic children exhibit challenging and disruptive behaviors that can present challenges for both children and their families by interfering with acquisition of adaptive skills and affecting family and peer relationships. Behavioral parent training (BPT) is an evidence-based approach to reducing autistic children's disruptive behavior, but many families face a number of barriers to accessing BPT, such as availability of BPT in their community, and transportation and scheduling challenges. Therefore, we sought to explore the feasibility and promise of effectiveness of adapting an established BPT program to a telehealth format during the COVID-19 pandemic.

Methods

A feasibility trial of BPT via telehealth was conducted with fourteen parents of autistic children.

Results

Parents and clinicians were able to implement BPT via telehealth with a high degree of fidelity, and parents rated both BPT and the telehealth format favorably. The program also showed promise of effectiveness in reducing autistic children's disruptive behavior, improving their adaptive skills, as well as reducing parents' stress, and improving parents' sense of parenting competence.

Conclusions

The findings replicate and extend findings from previous studies, further demonstrating the promise of telehealth as a viable alternative format for delivering BPT. We also explore implications for future research, including the opportunity for more thorough evaluation of the effectiveness of BPT via telehealth.

Post-evacuation return of psychiatric hospital inpatients evacuated to hospitals outside the Fukushima prefecture after the nuclear accident: A Retrospective Cohort Study

BACKGROUND

Post-evacuation return after mandatory hospital evacuation due to complicated disasters is often overlooked and not well-discussed.

AIMS

In this study, we explored the factors which are related to the ease or difficulty of the post-evacuation return to Fukushima prefecture of psychiatric inpatients who had been evacuated to hospitals outside the prefecture because of the Great East Japan Earthquake (GEJE) and subsequent Fukushima Daiichi Nuclear Power Plant (FDNPP) accident.

METHOD

This retrospective cohort study included evacuated psychiatric hospital inpatients who were registered in the Matching Project for Community Transition (MPCT) and had been traced until July 31, 2019. A total of 531 patients were included for the analyses. Univariable and multivariable analysis were conducted to detect the patients' traits including their psychiatric/physical backgrounds which were associated with their outcome - the time from GEJE to the date of return to Fukushima.

RESULTS

Over half of the patients returned to Fukushima. In the multivariable analysis, the patients' gender (male), age (older), and psychiatric diagnoses of schizophrenia, schizotypal and delusional disorders (ICD-10, F20-29) showed lower hazard ratio (HR) and statistically significant association with the difficulties of post-evacuation return. Meanwhile, disorders of psychological development (F80-89), diseases of the nervous (G00-99, except G40-41) and genitourinary (N00-99) systems showed higher HR and statistically significant association with the ease of return.

CONCLUSIONS

The specific characteristics of the psychiatric inpatients including their psychiatric and physical status are associated with their post-evacuation return to their hometown. These results indicated that the evacuated hospitals' practitioners and staffs from the MPCT understood the necessity of the earlier return of inpatients to their hometown. Moreover, clinicians should pay more attention to some symptoms unique to psychiatric patients which contributed to their difficulties in returning safely or expressing their hope to return.

Treatment Acceptability for Interventions Addressing Challenging Behavior Among Chinese Caregivers of Children with Autism Spectrum Disorder

The present study evaluated treatment acceptability for behavioral interventions addressing challenging behaviors with Chinese caregivers of children with autism spectrum disorder. Factors influencing treatment acceptability (i.e., severity of challenging behavior and Chinese child-rearing values) were investigated. Caregivers of children aged 2-12 years (N = 216) participated in this survey study. Results suggest that caregivers found positive strategies including noncontingent reinforcement and positive reinforcement the most acceptable; punishment-based strategies were rated as the least acceptable. Furthermore, positive punishment was perceived as more acceptable for severe challenging behavior. Caregivers who endorsed training were more likely to find positive strategies acceptable, whereas those who endorsed shaming were more likely to rate punishment-based strategies as more acceptable. Implications for future research and culturally competent behavioral treatments in Chinese context are provided.

ESCAP practice guidance for autism: a summary of evidence-based recommendations for diagnosis and treatment

Across Europe, there is increased awareness of the frequency and importance of autism spectrum disorder (ASD), which is now recognised not only as a childhood disorder but as a heterogeneous, neurodevelopmental condition that persists throughout life. Services for individuals with autism and their families vary widely, but in most European countries, provision is limited. In 2018, European Society of Child and Adolescent Psychiatry (ESCAP) identified the need for a Practice Guidance document that would help to improve knowledge and practice, especially for individuals in underserviced areas. The present document, prepared by the ASD Working Party and endorsed by the ESCAP Board on October 3, 2019, summarises current information on autism and focuses on ways of detecting, diagnosing, and treating this condition.