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Bin Zuair HM, Baird JM, Caldwell AR. Parent-Mediated Occupational Therapy Interventions for Children with Developmental Disabilities: A Scoping Review. Phys Occup Ther Pediatr 2024:1-17. [PMID: 39014870 DOI: 10.1080/01942638.2024.2378063] [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: 03/07/2024] [Accepted: 07/03/2024] [Indexed: 07/18/2024]
Abstract
AIM This scoping review synthesizes literature about occupational therapy parent-mediated interventions (PMIs) that target occupation-based outcomes for children with developmental disabilities (DD). METHODS A search of PubMed, Web of Science, and CINAHL from 2010 through 2023 was performed resulting in 471 publications. Studies were included if they involved PMIs for participants with DD aged 3-12 years and were published in English. Studies were excluded if the outcomes were not occupation-based. A thematic analysis was conducted following an iterative review of charted data. RESULTS Twelve studies met the inclusion criteria reflecting four themes across occupational therapy PMIs, including variation in terminologies, types of PMIs, key components of PMIs, and the overall impact. While the effects of PMIs are difficult to define due to the variability in the samples, interventions, and outcomes, this review suggests general positive impacts of PMIs. CONCLUSION The emerging body of evidence supporting PMIs within the field of occupational therapy suggests they are feasible and have the potential to improve child and parent outcomes when delivered to children with DD. Further research is needed to clarify PMIs' components, unify the identification terminology, and test the efficacy of different types of PMIs for specific populations.
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Affiliation(s)
- Hessah M Bin Zuair
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Joanne M Baird
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, United States of America
| | - Angela R Caldwell
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, United States of America
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A Boyd B, Howard W, W Bodfish J, Lecavalier L, Harrop C, Jones D, Dallman A, Nagabhushan Kalburgi S, Hollway J. Examining Sensitivity to Developmental Changes on the Behavioral Inflexibility Scale. J Autism Dev Disord 2024; 54:1058-1067. [PMID: 36484964 DOI: 10.1007/s10803-022-05837-z] [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: 11/15/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The study objective was to determine if the validated Behavioral Inflexibility Scale (BIS) is sensitive to the detection of developmental changes in inflexibility in a sample of autistic children. METHODS Parents of autistic children (n = 146, 3-17 years) completed the BIS at two time points, one year apart, to examine change. RESULTS The findings indicate the BIS is sensitive to the detection of developmental changes and that child-level variables are not associated with those changes. Children's Time 1 BIS scores predicted children's severity on an independent outcome measure. Finally, a relationship between total services children were receiving and change in BIS scores over time was not found. CONCLUSION The findings suggest the BIS is a reasonable candidate for consideration as an outcome measure.
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Affiliation(s)
- Brian A Boyd
- University of North Carolina at Chapel Hill, School of Education, Chapel Hill, NC, USA.
| | - Waylon Howard
- University of Kansas, Juniper Gardens Children's Project, Kansas City, KS, USA
| | - James W Bodfish
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Luc Lecavalier
- Ohio State University, Nisonger Center, Columbus, OH, USA
- Department of Psychology, Ohio State University, Columbus, OH, USA
| | - Clare Harrop
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Desiree Jones
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aaron Dallman
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Jill Hollway
- Ohio State University, Nisonger Center, Columbus, OH, USA
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Lin W, Chan YH, Kiing JSH, Lim TSH, Chong SC, Kang YQ, Aishworiya R, Mulay KV, Tan MY. Restricted and repetitive behaviors and association with cognition and adaptive functioning in children with autism spectrum disorder in Singapore. Front Psychiatry 2023; 14:1249071. [PMID: 38034929 PMCID: PMC10687550 DOI: 10.3389/fpsyt.2023.1249071] [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: 06/28/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Background One of the core features of autism spectrum disorder (ASD) is restricted, repetitive patterns of behavior, interests and activities (RRBs). RRBs are known to adversely affect cognition and adaptive functioning. We explored the relationship of RRBs with cognition and adaptive functioning in children with ASD in an Asian setting. Methods This cross-sectional study was conducted at a tertiary developmental pediatrics center in Singapore from September 2019 to October 2021. Parent-child dyads (parents and their children ≤7 years old diagnosed with ASD) were recruited. Parents completed the Repetitive Behavior Questionnaire-2 (RBQ-2), which reports total score and two subscales - Motor/Sensory Behaviors (RBQ-2 MS) and Rigidity/Routines/Preoccupation with Restricted Interests (RBQ-2 RRPRI). Standardized assessments included Mullen Scales of Early Learning (MSEL) and Vineland Adaptive Behavior Scales (VABS-II). Data analysis utilized descriptive statistics and Pearson's correlation. Results Parents of 113 children [75.2% male, mean (SD) age 5.0 (1.2) years] participated. Median (IQR) RBQ-2 score was 29.0 (11.0). Significant negative correlations (adjusted for age, gender and family history of ASD) were observed for total RBQ-2 scores with MSEL ELC scores (r = -0.248, n = 101, p = 0.014) and VABS-II ABC scores (r = -0.281, n = 88, p = 0.009). Specifically, these correlations of fair strength were seen only with the RBQ-2 MS subscale for both ELC (r = -0.321, n = 101, p = 0.001) and ABC (r = -0.3478, n = 88, p = 0.001). Conclusion In children with ASD, severity of RRBs correlated with adverse cognition and adaptive functioning measures in our study, consistent with Western literature. While our study does not show causality, it adds to literature serving as a foundation for further research for both clinicians and researchers to target RRBs in improving outcomes with children in ASD.
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Affiliation(s)
- Wanyun Lin
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jennifer S. H. Kiing
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tammy S. H. Lim
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shang Chee Chong
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ying Qi Kang
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ramkumar Aishworiya
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kalyani Vijayakumar Mulay
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mae Yue Tan
- Child Development Unit, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Montiel-Nava C, Tregnago M, Marshall J, Sohl K, Curran AB, Mahurin M, Warne-Griggs M, Dixon P. Implementing the WHO caregivers skills training program with caregivers of autistic children via telehealth in rural communities. Front Psychiatry 2022; 13:909947. [PMID: 36101706 PMCID: PMC9464274 DOI: 10.3389/fpsyt.2022.909947] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background For families with autistic children living in rural areas, limited access to services partly results from a shortage of providers and extensive travel time. Telehealth brings the possibility of implementing alternative delivery modalities of Parent Mediated Interventions (PMIs) with the potential to decrease barriers to accessing services. This study aimed to evaluate the feasibility and acceptability of implementing the World Health Organization-Caregivers Skills Training program (WHO-CST) via an online, synchronous group format in rural Missouri. Methods We used a mixed methods design to collect qualitative and quantitative data from caregivers and program facilitators at baseline and the end of the program, following the last home visit. Caregivers of 14 autistic children (3-7 years), residents of rural Missouri, completed nine virtual sessions and four virtual home visits. Results Four main themes emerged from the focus groups: changes resulting from the WHO-CST, beneficial aspects of the program, advantages and disadvantages of the online format, and challenges to implementing the WHO-CST via telehealth. The most liked activity was the demonstration (36%), and the least liked was the practice with other caregivers. From baseline to week 12, communication skills improved in both frequency (p < 0.05) and impact (p < 0.01), while atypical behaviors decreased (p < 0.01). For caregivers' outcomes, only confidence in skills (p < 0.05) and parental sense of competence (p < 0.05) showed a positive change. Conclusion Our results support the feasibility of implementing the WHO-CST program via telehealth in a US rural setting. Caregivers found strategies easy to follow, incorporated the program into their family routines, and valued the group meetings that allowed them to connect with other families. A PMI such as the WHO-CST, with cultural and linguistic adaptations and greater accessibility via telehealth-plays an essential role in closing the treatment gap and empowering caregivers of autistic children.
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Affiliation(s)
- Cecilia Montiel-Nava
- Department of Psychological Science, University of Texas Rio Grande Valley-Edinburg, Edinburg, TX, United States
| | | | | | - Kristin Sohl
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, United States
- ECHO Autism Communities, University of Missouri School of Medicine, Columbia, MO, United States
| | - Alicia Brewer Curran
- ECHO Autism Communities, University of Missouri School of Medicine, Columbia, MO, United States
| | - Melissa Mahurin
- ECHO Autism Communities, University of Missouri School of Medicine, Columbia, MO, United States
| | - Melissa Warne-Griggs
- Missouri Telehealth Network, School of Medicine University of Missouri, Columbia, MO, United States
| | - WHO CST Team
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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Deniz E, Francis G, Torgerson C, Toseeb U. Parent-mediated play-based interventions to improve social communication and language skills of preschool autistic children: A systematic review and meta-analysis protocol. PLoS One 2022; 17:e0270153. [PMID: 35969530 PMCID: PMC9377609 DOI: 10.1371/journal.pone.0270153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022] Open
Abstract
Early years interventions have shown to be effective in improving the social communication and language skills of autistic children. Therefore, various play-based interventions have been developed to support those developmental areas of autistic children. Although researchers have previously reported the overall effectiveness of different types of play-based interventions on the social communication and language skills of autistic children, no previous systematic reviews have yet evaluated the effectiveness of parent-mediated play-based interventions in preschool autistic children. The overarching aims of the study will be to (i) report the key characteristics and (ii) synthesise the results of studies evaluating parent-mediated play-based interventions targeting the social communication and language skills of preschool autistic children using experimental designs. A comprehensive search for and screening of the relevant studies published between 2000 and 2021 will be undertaken. To be included, studies will have to (i) use either a randomised control trial or quasi-experimental design, (ii) focus on preschool autistic children aged six years old or younger, (iii) deliver a play-based intervention in non-educational settings, and (iv) include at least one parent as the mediator of the intervention. Data extraction of all included studies will be undertaken using a specially devised template and they will also be assessed for risk of bias using an adapted form from the Cochrane Risk of Bias tool. The overall characteristics of the included studies will be reported and a narrative synthesis of the results of the included studies will be undertaken. A meta-analysis may be performed (if justified) to report the pooled effect size of the parent-mediated play-based interventions on the social communication and language skills of preschool autistic children. Trial registration: The current study protocol was pre-registered with the international prospective register of systematic reviews (PROSPERO: CRD42022302220).
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Affiliation(s)
- Emre Deniz
- Department of Education, University of York, York, United Kingdom
| | - Gill Francis
- Department of Education, University of York, York, United Kingdom
| | - Carole Torgerson
- Department of Education, University of York, York, United Kingdom
| | - Umar Toseeb
- Department of Education, University of York, York, United Kingdom
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Pervin M, Ahmed HU, Hagmayer Y. Effectiveness of interventions for children and adolescents with autism spectrum disorder in high-income vs. lower middle-income countries: An overview of systematic reviews and research papers from LMIC. Front Psychiatry 2022; 13:834783. [PMID: 35990045 PMCID: PMC9386527 DOI: 10.3389/fpsyt.2022.834783] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/11/2022] [Indexed: 12/21/2022] Open
Abstract
Background There is a multitude of systematic reviews of interventions for children and adolescents with autism spectrum disorder (ASD). However, most reviews seem to be based on research conducted in High-Income Countries (HIC). Thus, summary findings may not directly apply to Lower Middle-Income Countries (LMIC). Therefore, we conducted a Meta-Review analyzing systematic reviews on the effectiveness of interventions for target outcomes in children and adolescents with ASD to find out whether there are differences in effectiveness between HIC and LMIC and which interventions can be considered evidence-based in LMIC. Methods Electronic databases (PsycINFO, PubMed, Cochrane database of systematic reviews) were searched for reviews on interventions for ASD in children and adolescents from January 2011 through December 2021, which included studies not coming from HIC. Systematic reviews with qualitative and quantitative syntheses of findings were included. Two investigators independently assessed studies against predetermined inclusion/exclusion criteria and extracted relevant data including quality and evidence assessments. Evidence for different types of interventions in HIC vs. LMIC was planned to be compared, but none of the reviews assessed potential differences. Therefore, a narrative review of the studies from LMIC was conducted including an assessment of quality and evidence. Results Thirty-five reviews fulfilled the inclusion criteria. Eleven considered findings from HIC and LMIC. Sixty-nine percent included studies with various research designs; 63% provided a qualitative synthesis of findings; 77% percent assessed the quality of studies; 43% systematically assessed the level of evidence across studies. No review compared evidence from HIC and LMIC. A review of the studies from LMIC found some promising results, but the evidence was not sufficient due to a small number of studies, sometimes poor quality, and small sample sizes. Conclusion Systematic reviews on interventions for children and adolescents with ASD did not look for potential differences in the effectiveness of interventions in HIC and LMIC. Overall, there is very little evidence from LMIC. None of the interventions can be considered evidence-based in LMIC. Hence, additional research and mutually agreed methodological standards are needed to provide a more secure basis for evidence-based treatments in LMIC trying to establish evidence-based practices.
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Affiliation(s)
- Maleka Pervin
- Institute of Psychology, Georg August University of Goettingen, Göttingen, Germany
- Department of Psychology, University of Dhaka, Dhaka, Bangladesh
| | - Helal Uddin Ahmed
- Department of Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh
| | - York Hagmayer
- Institute of Psychology, Georg August University of Goettingen, Göttingen, Germany
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Tian J, Gao X, Yang L. Repetitive Restricted Behaviors in Autism Spectrum Disorder: From Mechanism to Development of Therapeutics. Front Neurosci 2022; 16:780407. [PMID: 35310097 PMCID: PMC8924045 DOI: 10.3389/fnins.2022.780407] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/09/2022] [Indexed: 01/28/2023] Open
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by deficits in social communication, social interaction, and repetitive restricted behaviors (RRBs). It is usually detected in early childhood. RRBs are behavioral patterns characterized by repetition, inflexibility, invariance, inappropriateness, and frequent lack of obvious function or specific purpose. To date, the classification of RRBs is contentious. Understanding the potential mechanisms of RRBs in children with ASD, such as neural connectivity disorders and abnormal immune functions, will contribute to finding new therapeutic targets. Although behavioral intervention remains the most effective and safe strategy for RRBs treatment, some promising drugs and new treatment options (e.g., supplementary and cell therapy) have shown positive effects on RRBs in recent studies. In this review, we summarize the latest advances of RRBs from mechanistic to therapeutic approaches and propose potential future directions in research on RRBs.
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Affiliation(s)
| | | | - Li Yang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), NHC Key Laboratory of Mental Health (Peking University), Beijing, China
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Blackwell S, Zylberberg A, Scerif G, Miller S, Woodcock KA. Understanding the psycho-social context for a new early intervention for resistance to change that aims to strike a beneficial balance between structure and flexibility. BMC Psychiatry 2021; 21:621. [PMID: 34895178 PMCID: PMC8665637 DOI: 10.1186/s12888-021-03519-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emotional and behavioural problems linked to changes to expectations - resistance to change - are linked to disability in neurodevelopmental disorders, including autism spectrum disorder (ASD), Prader-Willi (PWS) and fragile X syndromes (FXS). Structuring routines is best practice for minimising current resistance to change. But complete structure is impractical and flexibility in early life may actually reduce later resistance by supporting cognitive development. We aimed to examine the psycho-social context of families with children at risk of developing resistance to change so as to identify design requirements for an intervention that strikes a beneficial balance between structure and flexibility. METHODS Thirty-six caregivers of children aged 4-12 years (17 ASD, 15 PWS, and 4 FXS) took part in an interview designed collaboratively with 12 professional stakeholders. RESULTS Children need to feel like they are in control of flexibility but they also need support in choice making, understanding plans (using individually tailored visuals) and anxiety reduction. Caregivers need an accessible approach that they have full control over, and which they can tailor for their child. Caregivers also need clear guidance, education and support around structure and flexibility. CONCLUSIONS We propose a digital approach which addresses the needs identified. It tackles the most perplexing challenge by presenting flexibility to children in the context of a game that children can feel they have full control over, whilst caregivers can maintain control in reality. Furthermore, individualised support for children and caregivers would be enabled.
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Affiliation(s)
- Siobhan Blackwell
- Centre for Applied Psychology, School of Psychology & Institute for Mental Health, University of Birmingham, 52 Pritchatts Road, Edgbaston, Birmingham, B15 2SA, UK
| | - Alex Zylberberg
- Centre for Applied Psychology, School of Psychology & Institute for Mental Health, University of Birmingham, 52 Pritchatts Road, Edgbaston, Birmingham, B15 2SA, UK
| | - Gaia Scerif
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Sarah Miller
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Kate A Woodcock
- Centre for Applied Psychology, School of Psychology & Institute for Mental Health, University of Birmingham, 52 Pritchatts Road, Edgbaston, Birmingham, B15 2SA, UK.
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Koller J, David T, Bar N, Lebowitz ER. The Role of Family Accommodation of RRBs in Disruptive Behavior Among Children with Autism. J Autism Dev Disord 2021; 52:2505-2511. [PMID: 34185236 DOI: 10.1007/s10803-021-05163-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 12/28/2022]
Abstract
Family accommodation refers to changes in families' behavior aimed at reducing children's psychopathology-related distress (Shimshoni et al. in Indian J ournal of Psychiatry 61(Suppl 1):S93-S103, 2019). Family accommodation of RRBs occurs frequently in families of children with autism, is linked to greater symptom severity (Feldman et al. in J Autism Dev Disord 49(9):3602-3610, 2019), and is unexplored in the context of disruptive behaviors. This study examined child and parent factors associated with disruptive behavior in children with autism. Parents (N = 90; age 2-9 years) reported on children's autism symptomatology, adaptive functioning, and disruptive behavior, alongside parenting stress and family accommodation of RRBs. Such accommodation contributed significantly to predicting disruptive behavior. These findings indicate that parent behavior is associated with the expression of disruptive behavior in this sample, highlighting potential intervention targets for children with autism.
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Affiliation(s)
- Judah Koller
- Seymour Fox School of Education, Hebrew University of Jerusalem, Mt. Scopus, 9190501, Jerusalem, Israel.
| | - Tamar David
- Seymour Fox School of Education, Hebrew University of Jerusalem, Mt. Scopus, 9190501, Jerusalem, Israel
| | - Noa Bar
- Seymour Fox School of Education, Hebrew University of Jerusalem, Mt. Scopus, 9190501, Jerusalem, Israel
| | - Eli R Lebowitz
- Yale Child Study Center, Yale University, New Haven, CT, USA
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TrASDition Training: An online parental training for transition-age youth with autism spectrum disorder. Psychiatry Res 2021; 300:113930. [PMID: 33887518 DOI: 10.1016/j.psychres.2021.113930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 04/05/2021] [Indexed: 01/01/2023]
Abstract
Transition to the adult age represents a rather challenging period of life for youth with Autism Spectrum Disorder (ASD) and for their families. Given the actual lack of integrated healthcare systems for autistic young-adults, enhancing parental skills could represent a feasible program to improve skills preparatory for transition in adult life. The online approach, providing easy access to services which otherwise would burden a daily family organization, already strenuous for a family with an autistic person, can represent an innovative way of delivering intervention. Therefore, we developed an online psychoeducational parental training, named TrASDition Training, with a 6 months duration, addressed to parents of autistic youth with and without Intellectual Disability during the transition age. The aim of this study was to longitudinally evaluate the impact of the online parental training on the adaptive functioning, on the repetitive and problematic behaviors of ASD youth (n = 23) and on parental stress. After 6 months of Training, we found a significant improvement in adaptive functioning of ASD participants and a reduction of parental stress.
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11
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Measuring the Emergence of Specific Abilities in Young Children with Autism Spectrum Disorders: The Example of Early Hyperlexic Traits. Brain Sci 2021; 11:brainsci11060692. [PMID: 34070294 PMCID: PMC8225194 DOI: 10.3390/brainsci11060692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 11/28/2022] Open
Abstract
The presence of a restricted interest in written materials, including an early ability to name and recognize letters and numbers, is regularly reported in preschoolers with autism spectrum disorders (ASDs). There is, however, scarce information on this early ability akin to emerging hyperlexic traits in preschoolers with ASD younger than 3 years old. Here, we defined a measure of early naming and recognition of letters and numbers in 155 preschoolers with ASD using a sliding window approach combined with a 90th percentile threshold criterion, and subsequently compared the profiles of children with ASD with and without early hyperlexic traits. Using this measure, we found that 9% of children with ASD showed early hyperlexic traits. The early ability to name and recognize letters and numbers was associated with a higher level of restricted and repetitive behaviors yet more social-oriented behaviors at baseline and with better expressive and written communication at baseline and one year later. This study contributes to a better definition of the profile of children with ASD with an early ability in letters and numbers akin to emerging hyperlexic traits, a skill that is associated with promising social strengths and language abilities in this subgroup of children.
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Nezgovorova V, Ferretti CJ, Taylor BP, Shanahan E, Uzunova G, Hong K, Devinsky O, Hollander E. Potential of cannabinoids as treatments for autism spectrum disorders. J Psychiatr Res 2021; 137:194-201. [PMID: 33689997 DOI: 10.1016/j.jpsychires.2021.02.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/22/2021] [Indexed: 01/04/2023]
Abstract
Current treatments for autism spectrum disorders (ASD) are limited in efficacy and are often associated with substantial side effects. These medications typically ameliorate problem behaviors associated with ASD, but do not target core symptom domains. As a result, there is a significant amount of research underway for development of novel experimental therapeutics. Endocannabinoids are arachidonic acid-derived lipid neuromodulators, which, in combination with their receptors and associated metabolic enzymes, constitute the endocannabinoid (EC) system. Cannabinoid signaling may be involved in the social impairment and repetitive behaviors observed in those with ASD. In this review, we discuss a possible role of the EC system in excitatory-inhibitory (E-I) imbalance and immune dysregulation in ASD. Novel treatments for the core symptom domains of ASD are needed and phytocannabinoids could be useful experimental therapeutics for core symptoms and associated domains.
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Affiliation(s)
- V Nezgovorova
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA
| | - C J Ferretti
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA
| | - B P Taylor
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA
| | - E Shanahan
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA
| | - G Uzunova
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA
| | - K Hong
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA
| | - O Devinsky
- New York University Comprehensive Epilepsy Center, New York, NY, USA
| | - E Hollander
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA.
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Kunze MG, Machalicek W, Wei Q, St. Joseph S. Coaching via Telehealth: Caregiver-Mediated Interventions for Young Children on the Waitlist for an Autism Diagnosis Using Single-Case Design. J Clin Med 2021; 10:1654. [PMID: 33924440 PMCID: PMC8070073 DOI: 10.3390/jcm10081654] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022] Open
Abstract
Years can elapse between parental suspicion of a developmental delay and a diagnostic assessment, ultimately delaying access to medically necessary, autism-specific intervention. Using a single-case, concurrent multiple baseline design, autism spectrum disorder symptomology (i.e., higher-order restrictive and repetitive behaviors and interests; higher-order RRBIs) was targeted in toddlers (21-35 months) waiting for a diagnostic appointment. Caregivers were coached via telehealth to mediate early intervention to decrease interfering, inflexible higher-order RRBIs during play using four evidence-based applied behavior analytic strategies: modeling, prompting, differential reinforcement of appropriate behaviors, and response interruption and redirection. Six mother-child dyads were recruited from pediatrician offices and early intervention service districts in the United States. All families were considered under-served, under-resourced, or living in rural locations. A visual analysis of the data combined with Tau-U revealed a strong basic effect between the intervention package and parent strategy use and child flexible and inflexible behavior. Findings were consistent across participants with one exception demonstrating a moderate effect for flexible behaviors yet a strong effect for inflexible behaviors. Standardized mean difference was beyond zero for all participants. Implications for science and practice include support for early intervention of higher-order RRBIs for young children with and at risk for ASD.
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Affiliation(s)
- Megan G. Kunze
- Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR 97403, USA; (W.M.); (Q.W.); (S.S.J.)
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Grahame V, Dixon L, Fletcher-Watson S, Garland D, Glod M, Goodwin J, Grayson Z, Heron S, Honey E, Iversen R, Kasim AS, Kernohan A, Kharatikoopaei E, Le Couteur A, Mackie L, Mathias A, Probert H, Riby D, Rob P, Rogan L, Thompson S, Vale L, Walls E, Webb EI, Weetman C, Wolstenhulme F, Wood R, Rodgers J. A clinical and cost-effectiveness trial of a parent group intervention to manage challenging restricted and repetitive behaviours in young children with autism spectrum disorder: study protocol for a randomised controlled trial. Trials 2021; 22:240. [PMID: 33794962 PMCID: PMC8012746 DOI: 10.1186/s13063-021-05175-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Restricted and repetitive behaviours vary greatly across the autism spectrum, and although not all are problematic some can cause distress and interfere with learning and social opportunities. We have, alongside parents, developed a parent group based intervention for families of young children with autism, which aims to offer support to parents and carers; helping them to recognise, understand and learn how to respond to their child's challenging restricted repetitive behaviours. METHODS The study is a clinical and cost-effectiveness, multi-site randomised controlled trial of the Managing Repetitive Behaviours (MRB) parent group intervention versus a psychoeducation parent group Learning About Autism (LAA) (n = 250; 125 intervention/125 psychoeducation; ~ 83/site) for parents of young children aged 3-9 years 11 months with a diagnosis of autism. All analyses will be done under intention-to-treat principle. The primary outcome at 24 weeks will use generalised estimating equation (GEE) to compare proportion of children with improved RRB between the MRB group and the LAA group. The GEE model will account for the clustering of children by parent groups using exchangeable working correlation. All secondary outcomes will be analysed in a similar way using appropriate distribution and link function. The economic evaluation will be conducted from the perspective of both NHS costs and family access to local community services. A 'within trial' cost-effectiveness analysis with results reported as the incremental cost per additional child achieving at least the target improvement in CGI-I scale at 24 weeks. DISCUSSION This is an efficacy trial to investigate the clinical and cost-effectiveness of a parent group based intervention designed to help parents understand and manage their child's challenging RRB. If found to be effective, this intervention has the potential to improve the well-being of children and their families, reduce parental stress, greatly enhance community participation and potential for learning, and improve longer-term outcomes. TRIAL REGISTRATION Trial ID: ISRCTN15550611 Date registered: 07/08/2018. Sponsor and Monitor: Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust R&D Manager Lyndsey Dixon, Address: St Nicholas Hospital, Jubliee Road, Gosforth, Newcastle upon Tyne NE3 3XT, lyndsey.dixon@cntw.nhs.uk , Tel: 0191 246 7222.
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Affiliation(s)
- Victoria Grahame
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Complex Neurodevelopmental Disorder Service (CNDS), Walkergate Park, Benfield Road, Newcastle upon Tyne, NE6 4QD UK
| | - Linda Dixon
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Complex Neurodevelopmental Disorder Service (CNDS), Walkergate Park, Benfield Road, Newcastle upon Tyne, NE6 4QD UK
| | - Sue Fletcher-Watson
- Salvesen Mindroom Research Centre, The University of Edinburgh, Kennedy Tower, Morningside Terrace, Edinburgh, EH10 5HF UK
| | - Deborah Garland
- National Autistic Society, North East Resource Centre, Newcastle upon Tyne, NE5 2LW UK
| | - Magdalena Glod
- Population Health Sciences Institute, Newcastle University, Level 3, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
| | - Jane Goodwin
- Population Health Sciences Institute, Newcastle University, Level 3, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
| | - Zoe Grayson
- Salvesen Mindroom Research Centre, Child Life and Health, Royal Hospital for Sick Children, Edinburgh, EH9 1LF UK
| | - Saoirse Heron
- Royal Edinburgh Hospital, Kennedy Tower, Morningside Terrace, Edinburgh, EH10 5HF UK
| | - Emma Honey
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Complex Neurodevelopmental Disorder Service (CNDS), Walkergate Park, Benfield Road, Newcastle upon Tyne, NE6 4QD UK
| | - Rebecca Iversen
- Royal Edinburgh Hospital, Kennedy Tower, Morningside Terrace, Edinburgh, EH10 5HF UK
| | - Adetayo S. Kasim
- Durham Research Methods Centre, Durham University, South Road, Durham, DH1 3LE UK
| | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AA UK
| | | | - Ann Le Couteur
- Population Health Sciences Institute, Newcastle University, Level 3, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
| | - Leila Mackie
- Salvesen Mindroom Research Centre, Child Life and Health, Royal Hospital for Sick Children, Edinburgh, EH9 1LF UK
| | - Ayesha Mathias
- Newcastle Clinical Trials Unit, Newcastle University 1-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE UK
| | - Helen Probert
- Psychology Department, Durham University, Science Laboratories, South Road, Durham, DH1 3LE UK
| | - Deborah Riby
- Psychology Department, Durham University, Science Laboratories, South Road, Durham, DH1 3LE UK
| | - Priyanka Rob
- Population Health Sciences Institute, Newcastle University, Level 3, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
| | - Leanne Rogan
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Complex Neurodevelopmental Disorder Service (CNDS), Walkergate Park, Benfield Road, Newcastle upon Tyne, NE6 4QD UK
| | - Sarah Thompson
- Psychology Department, Durham University, Science Laboratories, South Road, Durham, DH1 3LE UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AA UK
| | - Eamonn Walls
- Royal Edinburgh Hospital, Kennedy Tower, Morningside Terrace, Edinburgh, EH10 5HF UK
| | | | - Christopher Weetman
- Newcastle Clinical Trials Unit, Newcastle University 1-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE UK
| | - Faye Wolstenhulme
- Newcastle Clinical Trials Unit, Newcastle University 1-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE UK
| | - Ruth Wood
- Newcastle Clinical Trials Unit, Newcastle University 1-4 Claremont Terrace, Newcastle upon Tyne, NE2 4AE UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, Level 3, Sir James Spence Institute, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
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The Impact of COVID-19 on the Adaptive Functioning, Behavioral Problems, and Repetitive Behaviors of Italian Children with Autism Spectrum Disorder: An Observational Study. CHILDREN-BASEL 2021; 8:children8020096. [PMID: 33540683 PMCID: PMC7913091 DOI: 10.3390/children8020096] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 11/25/2022]
Abstract
Children with autism spectrum disorder (ASD) and their families have represented a fragile population on which the extreme circumstances of the COVID-19 outbreak may have doubly impaired. Interruption of therapeutical interventions delivered in-person and routine disruption constituted some of the main challenges they had to face. This study investigated the impact of the COVID-19 lockdown on adaptive functioning, behavioral problems, and repetitive behaviors of children with ASD. In a sample of 85 Italian ASD children (mean age 7 years old; 68 males, 17 females), through a comparison with a baseline evaluation performed during the months preceding COVID-19, we evaluated whether after the compulsory home confinement any improvement or worsening was reported by parents of ASD individuals using standardized instruments (Adaptive Behavior Assessment System (Second Edition), Achenbach Child Behavior Checklist, Repetitive Behavior Scale-Revised). No significant worsening in the adaptive functioning, problematic, and repetitive behaviors emerged after the compulsory home confinement. Within the schooler children, clinical stability was found in reference to both adaptive skills and behavioral aspects, whereas within preschoolers, a significant improvement in adaptive skills emerged and was related to the subsistence of web-delivered intervention, parental work continuance, and online support during the lockdown.
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16
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Liu Q, Hsieh WY, Chen G. A systematic review and meta-analysis of parent-mediated intervention for children and adolescents with autism spectrum disorder in mainland China, Hong Kong, and Taiwan. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1960-1979. [PMID: 32720805 DOI: 10.1177/1362361320943380] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
LAY ABSTRACT The ideal dosage for early intensive interventions for autism spectrum disorder has been suggested to be at least 25-hour per week to reach optimal effects. However, insufficient service use and unmet needs among families with children with autism spectrum disorder are frequently reported worldwide. Helping parents to develop strategies for interaction and management of behavior through parent training has been demonstrated to be a prominent way to supplementing service insufficiency for autism spectrum disorder, which is particularly crucial in less-resourced areas. This review included 21 parent-mediated intervention programs conducted in China, the most populated developing country. Among them, we were able to combine outcome information from 12 randomized controlled trials to increase confidence in the results. We also rated the quality of methodology and evidence for all included studies, which was taken into account in making conclusions. The included programs varied in the content, length, and delivery method of trainings. Although targeting different training outcomes, the majority of the studies aimed to help parents be more competent and responsive during interactions with their child in order to decrease symptom severity. Overall, results showed sufficient evidence that parent training did improve child outcomes as intended. However, the quality of more than half (14/21) of the included studies were below satisfactory. Identified programs lack the capacity to be further transported in the Chinese societies due to the lack of solid theoretical foundations, implementation manuals, and appropriate cultural adaptations. This review reinforces the need for promotion and improvement of parent-mediated interventions in low-resource context.
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Affiliation(s)
- Qing Liu
- The University of Hong Kong, Hong Kong
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17
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Evidence-based support for autistic people across the lifespan: maximising potential, minimising barriers, and optimising the person-environment fit. Lancet Neurol 2020; 19:434-451. [PMID: 32142628 DOI: 10.1016/s1474-4422(20)30034-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/01/2019] [Accepted: 11/27/2019] [Indexed: 12/22/2022]
Abstract
Autism is both a medical condition that gives rise to disability and an example of human variation that is characterised by neurological and cognitive differences. The goal of evidence-based intervention and support is to alleviate distress, improve adaptation, and promote wellbeing. Support should be collaborative, with autistic individuals, families, and service providers taking a shared decision-making approach to maximise the individual's potential, minimise barriers, and optimise the person-environment fit. Comprehensive, naturalistic early intervention with active caregiver involvement can facilitate early social communication, adaptive functioning, and cognitive development; targeted intervention can help to enhance social skills and aspects of cognition. Augmentative and alternative communication interventions show preliminary evidence of benefit in minimising communication barriers. Co-occurring health issues, such as epilepsy and other neurodevelopmental disorders, sleep problems, and mental health challenges, should be treated in a timely fashion. The creation of autism-friendly contexts is best achieved by supporting families, reducing stigma, enhancing peer understanding, promoting inclusion in education, the community, and at work, and through advocacy.
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18
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Hyman SL, Levy SE, Myers SM. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics 2020; 145:peds.2019-3447. [PMID: 31843864 DOI: 10.1542/peds.2019-3447] [Citation(s) in RCA: 484] [Impact Index Per Article: 121.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with reported prevalence in the United States of 1 in 59 children (approximately 1.7%). Core deficits are identified in 2 domains: social communication/interaction and restrictive, repetitive patterns of behavior. Children and youth with ASD have service needs in behavioral, educational, health, leisure, family support, and other areas. Standardized screening for ASD at 18 and 24 months of age with ongoing developmental surveillance continues to be recommended in primary care (although it may be performed in other settings), because ASD is common, can be diagnosed as young as 18 months of age, and has evidenced-based interventions that may improve function. More accurate and culturally sensitive screening approaches are needed. Primary care providers should be familiar with the diagnostic criteria for ASD, appropriate etiologic evaluation, and co-occurring medical and behavioral conditions (such as disorders of sleep and feeding, gastrointestinal tract symptoms, obesity, seizures, attention-deficit/hyperactivity disorder, anxiety, and wandering) that affect the child's function and quality of life. There is an increasing evidence base to support behavioral and other interventions to address specific skills and symptoms. Shared decision making calls for collaboration with families in evaluation and choice of interventions. This single clinical report updates the 2007 American Academy of Pediatrics clinical reports on the evaluation and treatment of ASD in one publication with an online table of contents and section view available through the American Academy of Pediatrics Gateway to help the reader identify topic areas within the report.
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Affiliation(s)
- Susan L Hyman
- Golisano Children's Hospital, University of Rochester, Rochester, New York;
| | - Susan E Levy
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Scott M Myers
- Geisinger Autism & Developmental Medicine Institute, Danville, Pennsylvania
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19
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Shiri E, Pouretemad H, Fathabadi J, Narimani M. A pilot study of family-based management of behavioral excesses in young Iranian children with autism spectrum disorder. Asian J Psychiatr 2020; 47:101845. [PMID: 31683193 DOI: 10.1016/j.ajp.2019.101845] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Parent-mediated early behavioral interventions are considered as effective approaches in the treatment of children with Autism Spectrum Disorder (ASD). The majority of these interventions focus on social-communication deficits rather than behavioral excesses which severely irrupt child and family social life as well as the child's appearance behavior and learning processes. The study examines the effectiveness and feasibility of Family-based Management of Behavioral Excesses of Autism Program (FMBEAP) on Iranian families. METHOD This pre-post and follow-up intervention study involved 17 parents of children with DSM-5 diagnosis of ASD recruited from Tehran Autism Center. All parents conducted FMBEAP on their children while receiving 10-weekly group supervision on top of everyday on-line individual coaching. The study's measures were Repetitive Behavior Scale-R, video-monitoring of child-parent Interaction, Clinical Global Impression-Improvement Scale, Parental Self-Efficacy and Parenting Stress Index-short form. The measures were applied to the sample three times: pre and post-intervention and at one-month follow-up. RESULTS The Results showed high and low order behavioral excesses significantly decreased at post-intervention and the follow-up. 15 out of 17 children reached to recovered or highly recovered at post-test. Parents showed significant improvements in self-efficacy and parenting stress scales. The intervention was highly accepted by them. CONCLUSION FMBEAP is shown to be a feasible, acceptable and effective intervention to improve autistic behavioral. The parents should also benefit from the program in terms of self-efficacy and parenting stress. FMBEAP is highly recommended for overcoming behavioral excesses along with those interventions focus on behavioral deficits in ASD.
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Affiliation(s)
- Esmaeil Shiri
- Department of Clinical and Health Psychology, Shahid Beheshti University, Tehran, Iran
| | - Hamidreza Pouretemad
- Department of Clinical and Health Psychology, Shahid Beheshti University, Tehran, Iran; Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran.
| | - Jalil Fathabadi
- Department of Developmental and Educational Psychology, Shahid Beheshti University, Tehran, Iran
| | - Mohammad Narimani
- Department of Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
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20
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The Effects of Parent Training Programs on the Quality of Life and Stress Levels of Parents Raising a Child with Autism Spectrum Disorder: a Systematic Review of the Literature. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2019. [DOI: 10.1007/s40489-019-00190-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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21
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Kapp SK, Steward R, Crane L, Elliott D, Elphick C, Pellicano E, Russell G. 'People should be allowed to do what they like': Autistic adults' views and experiences of stimming. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 23:1782-1792. [PMID: 30818970 PMCID: PMC6728747 DOI: 10.1177/1362361319829628] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
'Stereotyped or repetitive motor movements' are characterised as core features in the diagnosis of autism, yet many autistic adults (and the neurodiversity movement) have reclaimed them as 'stimming'. Supported by a growing body of scientific research, autistic adults argue that these behaviours may serve as useful coping mechanisms, yet little research has examined stimming from the perspective of autistic adults. Through interviews and focus groups, we asked 32 autistic adults to share their perceptions and experiences of stimming, including the reasons they stim, any value doing so may hold for them and their perceptions of others' reactions to stimming. Using thematic analysis, we identified two themes: stimming as (1) a self-regulatory mechanism and (2) lacking in social acceptance, but can become accepted through understanding. Autistic adults highlighted the importance of stimming as an adaptive mechanism that helps them to soothe or communicate intense emotions or thoughts and thus objected to treatment that aims to eliminate the behaviour.
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22
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Lin CE, Koegel R. Treatment for Higher-Order Restricted Repetitive Behaviors (H-RRB) in Children with Autism Spectrum Disorder. J Autism Dev Disord 2019; 48:3831-3845. [PMID: 29926293 DOI: 10.1007/s10803-018-3637-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Restricted repetitive behaviors (RRB) are one of the core symptoms of autism spectrum disorder (ASD). Evidence suggests that higher-order RRB (H-RRB) are particularly challenging and can negatively impact family functioning (e.g., insistence on sameness, following idiosyncratic routines). The study examined the effects of a parent-implemented behavior intervention using a multiple baseline single case experimental design in three young children with ASD. The intervention involved self-management procedures and included principles of pivotal response treatment during which parents provided bids for children to vary from H-RRB and children obtained points for engaging in these other interests and activities. Results showed improvements in child behavior, parent and child affect and interactions, children's engagement in family activities, and overall parent ratings of RRB.
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Affiliation(s)
- C Enjey Lin
- University of California, San Francisco, 401 Parnassus Ave., LP 132, San Francisco, CA, 94143, USA.
| | - Robert Koegel
- Stanford University School of Medicine, 1520 Page Mill Road, Palo Alto, CA, 94304, USA
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Larkin F, Meins E, Leekam SR. Predisposing Factors for Elevated Restricted and Repetitive Behavior in Typically Developing Toddlers. INFANCY 2019; 24:24-42. [PMID: 32677263 DOI: 10.1111/infa.12264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 07/31/2018] [Accepted: 08/24/2018] [Indexed: 11/30/2022]
Abstract
Little is known about the relation between levels of restricted and repetitive behavior (RRB) in infants and parent factors. The present study investigated maternal and psychosocial factors (depressive symptoms, socio-economic status, social support) and mother-infant engagement factors (mind-mindedness, sensitivity, and infant-mother attachment security) as predictors of children's RRB at age 26 months in a sample of 206 mothers and children. Maternal depressive symptoms predicted levels of sensory and motor repetitive behavior and rigid, routinized, and ritualistic repetitive behavior. Lower socioeconomic status also predicted independent variance in children's sensory and motor repetitive behavior. The relations between maternal depressive symptoms and both types of RRB were not mediated through observational measures of maternal sensitivity or mind-mindedness at 8 months, or attachment security at 15 months. The results are discussed in terms of whether stress regulation, self-stimulation, and genetic susceptibility can help explain the observed link between maternal depressive symptoms and RRB in the child.
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Ameis SH, Kassee C, Corbett-Dick P, Cole L, Dadhwal S, Lai MC, Veenstra-VanderWeele J, Correll CU. Systematic review and guide to management of core and psychiatric symptoms in youth with autism. Acta Psychiatr Scand 2018; 138:379-400. [PMID: 29904907 DOI: 10.1111/acps.12918] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Evidence-based guidance of clinical decision-making for the management of Autism Spectrum Disorder (ASD) is lacking, particularly for co-occurring psychiatric symptoms. This review evaluates treatment evidence for six common symptom targets in children/adolescents with ASD and provides a resource to facilitate application of the evidence to clinical practice. METHOD A systematic search identified randomized controlled trials (RCTs) and high-quality systematic reviews published between 2007 and 2016, focused on: social interaction/communication impairment, stereotypic/repetitive behaviours, irritability/agitation, attention-deficit/hyperactivity disorder symptoms, mood or anxiety symptoms, and sleep difficulties. We then completed qualitative evaluation of high-quality systematic reviews/meta-analyses and quantitative evaluation of recently published RCTs not covered by prior comprehensive systematic reviews. RESULTS Recently published RCTs focused on social interaction and communication impairment (trials = 32) using psychosocial interventions. Interventions for irritability/agitation (trials = 16) were mainly pharmacological. Few RCTs focused on other symptom targets (trials = 2-5/target). Integration of these results with our qualitative review indicated that few established treatment modalities exist, and available evidence is limited by small studies with high risk of bias. CONCLUSION Given the current evidence-base, treatment targets must be clearly defined, and a systematic approach to intervention trials in children/adolescents with ASD must be undertaken with careful consideration of the limitations of safety/efficacy data.
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Affiliation(s)
- S H Ameis
- Child, Youth and Emerging Adult Program, Centre for Addiction and Mental Health (CAMH), Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - C Kassee
- Child, Youth and Emerging Adult Program, Centre for Addiction and Mental Health (CAMH), Campbell Family Mental Health Research Institute, Toronto, ON, Canada
| | - P Corbett-Dick
- Division of Developmental and Behavioural Pediatrics, University of Rochester School of Nursing, University of Rochester Medical Centre, Rochester, NY, USA
| | - L Cole
- Division of Developmental and Behavioural Pediatrics, University of Rochester School of Nursing, University of Rochester Medical Centre, Rochester, NY, USA
| | - S Dadhwal
- Child, Youth and Emerging Adult Program, Centre for Addiction and Mental Health (CAMH), Campbell Family Mental Health Research Institute, Toronto, ON, Canada
| | - M-C Lai
- Child, Youth and Emerging Adult Program, Centre for Addiction and Mental Health (CAMH), Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - J Veenstra-VanderWeele
- New York Presbyterian Hospital Center for Autism and the Developing Brain, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - C U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, NY, USA.,Hofstra Northwell School of Medicine, Hempstead, NY, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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25
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Akbas B, Akca OF. Treatment of a Child with Autism Spectrum Disorder and Food Refusal Due to Restricted and Repetitive Behaviors. J Child Adolesc Psychopharmacol 2018; 28:364-365. [PMID: 29715046 DOI: 10.1089/cap.2017.0168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Betül Akbas
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University , Konya, Turkey
| | - Omer Faruk Akca
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University , Konya, Turkey
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Syriopoulou-Delli CK, Polychronopoulou SA. Organization and management of the ways in which teachers and parents with children with ASD communicate and collaborate with each other. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2017; 65:31-48. [PMID: 34141322 PMCID: PMC8115487 DOI: 10.1080/20473869.2017.1359355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Objectives: This study empirically investigates critical issues relating to prevailing views and perceptions of teachers and parents with children with Autism Spectrum Disorders (ASD) towards the organization and management of approaches to their efficient collaboration and communication. Methods: A total sample of 171 teachers and 50 parents with children with ASD attending primary mainstream or special school units in Greece were randomly selected and were subsequently invited to answer a structured questionnaire. Results: The key empirical results indicate 50.9% of teachers believe teacher-parent meetings for communication and information purposes should be arranged by the schools once a month; 49.1% of teachers once a week; and, the majority of parents (98%) every month. The majority of teachers (90.6%) are seen to contain the view that meetings with children's parents are critical; 90.1% of them feel respect for their students' parents; and, 69.6% of them take parents' views on their children's performance and behavior very seriously. All parents consider it very important to get to know children's teachers; the majority (82%) feel respect for their children's teachers; 76% of them take teachers' views on their children's performance and behavior into serious consideration; 39.2% of teachers and 88.0% of parents recognize their children's special educational needs. Conclusion: The critical factors found to play a fundamental role in teachers' views include: the work unit; previous experience of ASD; and, relevant postgraduate studies.
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Harrop C, Gulsrud A, Shih W, Hovsepyan L, Kasari C. The impact of caregiver-mediated JASPER on child restricted and repetitive behaviors and caregiver responses. Autism Res 2017; 10:983-992. [PMID: 27910235 PMCID: PMC11385810 DOI: 10.1002/aur.1732] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 10/07/2016] [Accepted: 11/11/2016] [Indexed: 11/11/2022]
Abstract
Restricted and repetitive behaviors (RRBs) are a core feature of autism spectrum disorder (ASD). Compared to the social-communication impairments, we know considerably less about why children engage in RRBs and if and how to intervene with these behaviors. As a result, early intervention has typically focused on social-communication. In this study, we were interested in understanding how child RRBs changed following an intervention targeting social-communication behaviors and if caregiver training changed how they responded to their child's RRBs. Eighty-six toddlers with ASD and their caregivers received one of two interventions: caregivers were either actively coached while playing with their child (JASPER) or attended information sessions about ASD. On three different occasions (when they entered the study, following 10 weeks of intervention and 6-months after) caregivers were filmed playing with their child. From these recordings, we coded child RRBs and caregiver responses to these behaviors. Child RRBs remained relatively stable following intervention in both groups, but increased when the children returned at 6-months. Caregivers who received one-on-one coaching (JASPER) responded to a greater number of their child's RRBs and their responses were rated as more successful. Our study showed that a short-term social-communication intervention delivered through caregivers had "spillover effects" on how they also responded to their child's RRBs. Interventions targeting social-communication behaviors should also examine how these treatments affect child RRBs and how caregiver responses to these behaviors may change following training. Autism Res 2017, 10: 983-992. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Clare Harrop
- Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amanda Gulsrud
- Center for Autism Research and Treatment, UCLA Semel Institute, University of California Los Angeles, Los Angeles, California
| | - Wendy Shih
- Center for Autism Research and Treatment, UCLA Semel Institute, University of California Los Angeles, Los Angeles, California
| | - Lilit Hovsepyan
- School of Behavioral Health - Psychology, Loma Linda University, Loma Linda, California
| | - Connie Kasari
- Center for Autism Research and Treatment, UCLA Semel Institute, University of California Los Angeles, Los Angeles, California
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How Are Child Restricted and Repetitive Behaviors Associated with Caregiver Stress Over Time? A Parallel Process Multilevel Growth Model. J Autism Dev Disord 2016; 46:1773-83. [PMID: 26801776 DOI: 10.1007/s10803-016-2707-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The impact of raising a child with autism spectrum disorder (ASD) is frequently accompanied by elevated caregiver stress. Examining the variables that predict these elevated rates will help us understand how caregiver stress is impacted by and impacts child behaviors. This study explored how restricted and repetitive behaviors (RRBs) contributed concurrently and longitudinally to caregiver stress in a large sample of preschoolers with ASD using parallel process multilevel growth models. Results indicated that initial rates of and change in RRBs predicted fluctuations in caregiver stress over time. When caregivers reported increased child RRBs, this was mirrored by increases in caregiver stress. Our data support the importance of targeted treatments for RRBs as change in this domain may lead to improvements in caregiver wellbeing.
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Earle JF. An Introduction to the Psychopharmacology of Children and Adolescents With Autism Spectrum Disorder. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2016; 29:62-71. [DOI: 10.1111/jcap.12144] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/20/2016] [Accepted: 05/06/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Jason F. Earle
- Armour Academic Center, College of Nursing; Rush University; Chicago IL USA
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Harrop C, Gulsrud A, Shih W, Hovsepyan L, Kasari C. Characterizing caregiver responses to restricted and repetitive behaviors in toddlers with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2016; 20:330-42. [PMID: 25948600 DOI: 10.1177/1362361315580443] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Restricted and repetitive behaviors are a core feature of autism spectrum disorder. This descriptive study documented the presence of restricted and repetitive behaviors in 85 toddlers with autism spectrum disorder as they interacted with their caregiver in a play interaction. For each child restricted and repetitive behavior, a caregiver response/non-response was coded. Caregiver responses were rated as successful or unsuccessful. In all, 83 toddlers demonstrated at least one restricted and repetitive behavior in 10 min. The most common child restricted and repetitive behavior was repetitive object use with 72 children displaying at least one instance of this category of restricted and repetitive behavior. Overall, caregivers responded to fewer than half of their child's restricted and repetitive behaviors, and caregiver response varied by child restricted and repetitive behavior type. The most common response was redirection. Success varied by child restricted and repetitive behavior type and caregiver response--redirections were most successful for child verbal and motor restricted and repetitive behaviors, whereas physical or verbal responses were rated more successful for repetitive object use and visual restricted and repetitive behaviors. This study represents the first attempt to characterize how caregivers respond to restricted and repetitive behaviors. Toddlers with autism spectrum disorder are already demonstrating a variety of restricted and repetitive behaviors within the context of a free play sessions, and caregivers differentially and naturally respond to them.
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Affiliation(s)
- Clare Harrop
- The University of North Carolina at Chapel Hill, USA
| | | | - Wendy Shih
- University of California Los Angeles, USA
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