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Pemovska T, Loizou S, Appleton R, Spain D, Stefanidou T, Kular A, Cooper R, Greenburgh A, Griffiths J, Barnett P, Foye U, Baldwin H, Minchin M, Brady G, Saunders KRK, Ahmed N, Jackson R, Olive RR, Parker J, Timmerman A, Sapiets S, Driskell E, Chipp B, Parsons B, Totsika V, Mandy W, Pender R, Clery P, Lloyd-Evans B, Simpson A, Johnson S. Approaches to improving mental health care for autistic children and young people: a systematic review and meta-analysis. Psychol Med 2024:1-31. [PMID: 38757186 DOI: 10.1017/s0033291724001089] [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] [Indexed: 05/18/2024]
Abstract
Autistic children and young people (CYP) experience mental health difficulties but face many barriers to accessing and benefiting from mental health care. There is a need to explore strategies in mental health care for autistic CYP to guide clinical practice and future research and support their mental health needs. Our aim was to identify strategies used to improve mental health care for autistic CYP and examine evidence on their acceptability, feasibility, and effectiveness. A systematic review and meta-analysis were carried out. All study designs reporting acceptability/feasibility outcomes and empirical quantitative studies reporting effectiveness outcomes for strategies tested within mental health care were eligible. We conducted a narrative synthesis and separate meta-analyses by informant (self, parent, and clinician). Fifty-seven papers were included, with most investigating cognitive behavioral therapy (CBT)-based interventions for anxiety and several exploring service-level strategies, such as autism screening tools, clinician training, and adaptations regarding organization of services. Most papers described caregiver involvement in therapy and reported adaptations to communication and intervention content; a few reported environmental adjustments. In the meta-analyses, parent- and clinician-reported outcomes, but not self-reported outcomes, showed with moderate certainty that CBT for anxiety was an effective treatment compared to any comparison condition in reducing anxiety symptoms in autistic individuals. The certainty of evidence for effectiveness, synthesized narratively, ranged from low to moderate. Evidence for feasibility and acceptability tended to be positive. Many identified strategies are simple, reasonable adjustments that can be implemented in services to enhance mental health care for autistic individuals. Notable research gaps persist, however.
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Affiliation(s)
- Tamara Pemovska
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Sofia Loizou
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Rebecca Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | | | - Theodora Stefanidou
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Ariana Kular
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Ruth Cooper
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Anna Greenburgh
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Jessica Griffiths
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Una Foye
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Helen Baldwin
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Matilda Minchin
- Division of Psychiatry, University College London, London, UK
| | - Gráinne Brady
- Division of Psychiatry, University College London, London, UK
| | | | - Nafiso Ahmed
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Robin Jackson
- Lancaster and Morecambe Child and Adolescent Mental Health Services, Lancashire and South Cumbria NHS Foundation Trust, Morecambe, UK
- University of Wolverhampton, Wolverhampton, UK
| | - Rachel Rowan Olive
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | - Jennie Parker
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
- School of Health and Psychological Sciences, City, University of London, London, UK
- Berkshire Healthcare NHS Foundation Trust, Reading, UK
| | - Amanda Timmerman
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Suzi Sapiets
- Tizard Centre, University of Kent, Canterbury, UK
| | | | - Beverley Chipp
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, UK
| | | | - Vaso Totsika
- Division of Psychiatry, University College London, London, UK
| | - Will Mandy
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Richard Pender
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Philippa Clery
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Alan Simpson
- NIHR Mental Health Policy Research Unit, King's College London, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Tsai JM, Bhat AN. Demographic differences in access to health/therapeutic services over first year of the pandemic: a SPARK COVID-19 impact survey analysis. FRONTIERS IN HEALTH SERVICES 2024; 4:1343636. [PMID: 38745995 PMCID: PMC11091302 DOI: 10.3389/frhs.2024.1343636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/09/2024] [Indexed: 05/16/2024]
Abstract
Introduction This analysis examined changes in services received and service recovery one-year post-pandemic compared to pre-pandemic levels in children with ASD aged between 19 months and 17 years in various subgroups based on factors such as age, income, race/ethnicity, geographic location, and sex. Methods An online, parent report survey was completed by the parents of children with ASD in the SPARK study cohort (N = 6,393). Descriptive statistics, chi-square analyses, and Spearman correlations were performed to study associations between various factors and service access, pre-pandemic and one-year, post-pandemic. Results One year after pandemic, the lag in service recovery in children with ASD was greatest for PT/OT services followed by SLT. ABA services only recovered in half of the subgroups. In contrast, SES fully recovered and MH and MED services superseded pre-pandemic levels. Across majority of the timepoints, younger children received more SLT, PT/OT, and ABA services whereas older children received more SES, MH, and MED services. Higher income families accessed more SES, SLT, and ABA whereas lower income families received more MH services. White families received less SLT compared to non-white families. Hispanic families received more SLT services compared to non-Hispanic families. Compared to rural families, urban families received more ABA services at baseline which also recovered one year after the pandemic. Certain counterintuitive findings may be attributed to home/remote schooling leading to reduced access to related services. Conclusions Future research and policy changes are needed to address the American healthcare vulnerabilities when serving children with ASD by enhancing the diversity of healthcare formats for continued service access during future pandemics and other similar crises.
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Affiliation(s)
- J.-M. Tsai
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
- Interdisciplinary Neuroscience Graduate Program, University of Delaware, Newark, DE, United States
| | - A. N. Bhat
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
- Interdisciplinary Neuroscience Graduate Program, University of Delaware, Newark, DE, United States
- Biomechanics & Movement Science Program, University of Delaware, Newark, DE, United States
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE, United States
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Keefer A, Perrin J, Singh V, Holingue C, Winchell S, Vasa RA. A pilot, single-arm feasibility study of an integrated cognitive-behavioral treatment for anxiety in young autistic children. J Pediatr Psychol 2024; 49:131-141. [PMID: 38216125 DOI: 10.1093/jpepsy/jsad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE Anxiety is prevalent in young autistic children under 7 years of age. Yet there is a paucity of empirically based interventions for this age group. DINO Strategies for Anxiety and Uncertainty Reduction (DINOSAUR) is an innovative cognitive behavioral intervention that seeks to optimize treatment response in young autistic children by targeting anxiety and the contributing mechanisms of intolerance of uncertainty and parental accommodation using a telehealth delivery model. This pilot, single-arm study examines the preliminary feasibility of DINOSAUR. METHODS Fourteen autistic children ages 4-6 years with average language and cognitive skills and their parents received the intervention. Quantitative and qualitative data pertaining to parent satisfaction and treatment outcomes were collected. RESULTS Attendance, retention, and parent satisfaction ratings offer preliminary support for the feasibility of the treatment model. Change in clinical severity ratings on a semi-structured parent interview of anxiety and parents' qualitative report suggests the potential to benefit young autistic children. CONCLUSIONS Results support future study of the DINOSAUR model in a larger, randomized controlled trial.
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Affiliation(s)
- Amy Keefer
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, United States
| | - Jeremy Perrin
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
| | - Vini Singh
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
| | - Calliope Holingue
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Sarah Winchell
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
| | - Roma A Vasa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, United States
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Failla C, Chilà P, Vetrano N, Doria G, Scarcella I, Minutoli R, Gismondo S, Pioggia G, Marino F. From crisis to opportunity: integrating insights from COVID-19 into the autism research. Front Psychiatry 2024; 15:1341737. [PMID: 38404473 PMCID: PMC10884285 DOI: 10.3389/fpsyt.2024.1341737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024] Open
Affiliation(s)
- Chiara Failla
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
- Classical Linguistic Studies and Education Department, Kore University of Enna, Enna, Italy
| | - Paola Chilà
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
- Faculty of Psychology, International Telematic University Uninettuno, Roma, Italy
| | - Noemi Vetrano
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
- Department of Cognitive, Psychological Science and Cultural Studies, University of Messina, Messina, Italy
| | - Germana Doria
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
- Faculty of Psychology, International Telematic University Uninettuno, Roma, Italy
| | - Ileana Scarcella
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
- Faculty of Psychology, International Telematic University Uninettuno, Roma, Italy
| | - Roberta Minutoli
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
- Faculty of Psychology, International Telematic University Uninettuno, Roma, Italy
| | - Stefania Gismondo
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
| | - Flavia Marino
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
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Su WC, Cleffi C, Srinivasan S, Bhat A. Telehealth Versus Face-to-Face Fine Motor and Social Communication Interventions for Children With Autism Spectrum Disorder: Efficacy, Fidelity, Acceptability, and Feasibility. Am J Occup Ther 2023; 77:7706205130. [PMID: 38048263 PMCID: PMC10846418 DOI: 10.5014/ajot.2023.050282] [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] [Indexed: 12/06/2023] Open
Abstract
IMPORTANCE The efficacy of telehealth (TH) interventions needs to be studied. OBJECTIVE To compare the efficacy, fidelity, acceptability, and feasibility of face-to-face (F2F) versus TH seated play (SP) interventions among children with autism spectrum disorder (ASD). DESIGN As part of a larger randomized controlled trial, children were assigned to the SP group and received TH and F2F interventions over 8 wk using a pretest-posttest study design. SETTING A research lab or through videoconferencing. PARTICIPANTS Fifteen children with ASD (ages 5-14 yr) were randomly assigned to the SP group and received the intervention F2F or through TH. INTERVENTION Children received 16 SP intervention sessions (2 sessions per week for 8 wk). OUTCOMES AND MEASURES Pretests and posttests included standardized fine motor assessments. Video coding compared socially directed verbalization during training sessions. Parents and trainers provided feedback on their experiences. RESULTS Seven children received the intervention F2F, whereas 8 received TH intervention. Children in both subgroups showed similar training improvements in fine motor skills and socially directed verbalizations (ps > .01). Parents rated both interventions as acceptable and feasible; however, they reported longer preparation time and effort during TH interventions (ps < .01). Trainers reported greater parental involvement but more communication and technological issues during TH interventions. Fidelity checks indicated fewer reinforcements during TH versus F2F sessions. CONCLUSIONS AND RELEVANCE TH intervention is feasible and effective in improving fine motor and social communication performance. Clinicians should reduce parental burden and overcome technological issues. What This Article Adds: This study confirmed the efficacy, fidelity, acceptability, and feasibility of delivering seated play, standard of care interventions for children with autism spectrum disorder via telehealth. However, clinicians should work on reducing parental burden and overcoming communication and technological issues related to telehealth.
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Affiliation(s)
- Wan-Chun Su
- Wan-Chun Su, PhD, MS, PT, is Postdoctoral Fellow, National Institutes of Health, Bethesda, Maryland
| | - Corina Cleffi
- Corina Cleffi, BS, is Graduate Student, Department of Physical Therapy and Biomechanics and Movement Science Program, University of Delaware, Newark
| | - Sudha Srinivasan
- Sudha Srinivasan, PhD, MS, PT, is Assistant Professor, Physical Therapy Program, Department of Kinesiology; Institute for Health, Intervention, and Policy; and Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs
| | - Anjana Bhat
- Anjana Bhat, MS, PhD, PT, is Professor, Department of Physical Therapy, Biomechanics and Movement Science Program, and Department of Psychological and Brain Sciences, University of Delaware, Newark;
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Płatos M, Wojaczek K, Laugeson EA. Effects of Social Skills Training for Adolescents on the Autism Spectrum: a Randomized Controlled Trial of the Polish Adaptation of the PEERS® Intervention via Hybrid and In-Person Delivery. J Autism Dev Disord 2023; 53:4132-4146. [PMID: 36001196 PMCID: PMC9399988 DOI: 10.1007/s10803-022-05714-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2022] [Indexed: 12/19/2022]
Abstract
The study examined the efficacy of the Polish adaptation of the PEERS® curriculum for adolescents on the autism spectrum. Twenty-nine adolescents (aged 11-16) were randomized into a Treatment and a Waitlist Control Group. Due to COVID-19-related restrictions, the Treatment Group received part of the intervention online (in hybrid mode). Results showed large effects of PEERS® increasing the teens' social skills, knowledge about social skills, and the number of get-togethers with peers. Most of the effects were maintained over a six-month follow-up period. There was no impact of the delivery mode on the treatment effects. The study demonstrates the feasibility and efficacy of the Polish adaptation of PEERS® and encourages future research on the online/hybrid delivery of Social Skills Training.
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Affiliation(s)
- Mateusz Płatos
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 01-909, Warsaw, Poland.
- Association for Social Innovation "Mary and Max", Marszałkowska 84/92/201, 00-514, Warsaw, Poland.
| | - Kinga Wojaczek
- Association for Social Innovation "Mary and Max", Marszałkowska 84/92/201, 00-514, Warsaw, Poland
| | - Elizabeth A Laugeson
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, 300 UCLA Medical Plaza, 90095-6967, Los Angeles, CA, USA
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Fell LA, Albright CM, Kryszak EM, Butter E, Kuhlthau KA. Provider Perspectives on Telehealth Services for Children With Autism Spectrum Disorder During the Coronavirus Disease 2019 Pandemic. Acad Pediatr 2023; 23:1196-1203. [PMID: 36871611 PMCID: PMC9985515 DOI: 10.1016/j.acap.2023.02.016] [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: 09/01/2022] [Revised: 02/13/2023] [Accepted: 02/24/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE The purpose of the current study was to explore provider perspectives on the strengths and challenges of telehealth services (e.g., behavioral interventions, physical, speech, and occupational therapy, medication management) for children with autism spectrum disorder during coronavirus disease 2019 related shutdowns. METHODS From September 2020 to May 2021, we conducted qualitative interviews with 35 providers across multiple disciplines from 17 sites in the Autism Care Network. Qualitative data were analyzed using a framework approach and common themes were identified. RESULTS Providers across clinical disciplines identified strengths of the virtual model, such as its flexibility and the opportunity it provided to see children in their home environment. They also indicated that some interventions worked better virtually than others, and that there were several factors that impacted their success. Respondents were generally satisfied providing parent-mediated interventions but expressed mixed satisfaction in using telehealth for direct-to-patient care. CONCLUSIONS Results suggest that telehealth services for children with autism spectrum disorder could be a helpful tool in decreasing barriers and improving service delivery, especially when tailored to the individual needs of the patient. More research is needed on the factors contributing to its success in order to eventually inform clinical guidelines regarding the prioritization of children seen for in-person visits.
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Affiliation(s)
- Lucy A Fell
- Department of Pediatrics (LA Fell, and KA Kuhlthau), Massachusetts General Hospital, Boston.
| | - Charles M Albright
- Nationwide Children...s Hospital (CM Albright, EM Kryszak, and E Butter), Columbus, OH; Department of Pediatrics and Psychology (CM Albright, EM Kryszak, and E Butter), The Ohio State University, Child Development Center, Nationwide Children's Hospital, Westerville
| | - Elizabeth M Kryszak
- Nationwide Children...s Hospital (CM Albright, EM Kryszak, and E Butter), Columbus, OH; Department of Pediatrics and Psychology (CM Albright, EM Kryszak, and E Butter), The Ohio State University, Child Development Center, Nationwide Children's Hospital, Westerville
| | - Eric Butter
- Nationwide Children...s Hospital (CM Albright, EM Kryszak, and E Butter), Columbus, OH; Department of Pediatrics and Psychology (CM Albright, EM Kryszak, and E Butter), The Ohio State University, Child Development Center, Nationwide Children's Hospital, Westerville
| | - Karen A Kuhlthau
- Department of Pediatrics (LA Fell, and KA Kuhlthau), Massachusetts General Hospital, Boston; Department of Pediatrics (KA Kuhlthau), Harvard Medical School, Boston, MA
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Adams L, Adamo N, Hollocks MJ, Watson J, Brewster A, Valmaggia L, Jewitt E, Edwards J, Krisson M, Simonoff E. Autistic young people's experiences of remote psychological interventions during COVID-19. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:1616-1627. [PMID: 36645009 PMCID: PMC9845848 DOI: 10.1177/13623613221142730] [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] [Indexed: 01/17/2023]
Abstract
LAY ABSTRACT Recently, therapy has been delivered at a distance (i.e. remotely) to help control the spread of coronavirus. Clinicians have voiced concerns that remote delivery is unsuitable for certain individuals, including those who are autistic, but they have also highlighted potential benefits for autistic individuals. Benefits include some individuals feeling more comfortable receiving therapy at home. This is the first study to interview autistic individuals about their experience of remote therapy. Participants were six young people aged 15-18 years and eight clinicians. Participants described their experience of remote delivery, including challenges, benefits, and suggestions. Most of these supported previous research findings, but some were new or provided further insight into those already identified. A newly identified challenge was knowing online social etiquette. All participants found aspects of the experience challenging, but all identified benefits and most voiced that remote sessions should be offered to young people. Participants further identified individual characteristics that may make someone less suited to remote delivery (e.g. shyness). They also identified ways of making the experience of remote delivery easier (e.g. sitting with a pet). Young people's and clinicians' views were similar overall, with only subtle differences. For example, young people uniquely voiced that remote delivery was similar to in-person, that benefits were hard to identify, and provided distinct reasons for the social interaction feeling less intense remotely. Findings may be used to improve remote delivery, for guiding future research, and as a case for continuing to offer it to those who may most benefit.
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Affiliation(s)
- Lucy Adams
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | - Nicoletta Adamo
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | - Matthew J Hollocks
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | | | | | - Lucia Valmaggia
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | - Emma Jewitt
- South London and Maudsley NHS Foundation Trust, UK
| | | | | | - Emily Simonoff
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
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Tomeny TS, Hudac CM, Malaia EA, Morett LM, Tomeny KR, Watkins L, Kana RK. Serving Individuals With Autism Spectrum Disorder in the Age of COVID-19: Special Considerations for Rural Families. RURAL SPECIAL EDUCATION QUARTERLY 2023; 42:105-118. [PMID: 38602929 PMCID: PMC10155053 DOI: 10.1177/87568705231167440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
This position paper explores the needs of rural families of children, adolescents, and adults with autism spectrum disorder (ASD) during the COVID-19 pandemic. Prior to COVID-19, literature portrays elevated stress in families of individuals with ASD and health and socioeconomic disparities for rural and underserved populations. These disparities were exacerbated due to COVID-19 and subsequent lockdowns and economic turmoil. Academic and adaptive skills training were particularly impacted due to school closures, with parents tasked with taking some responsibility for training these skills. Our goals for this article focus on special considerations for rural families regarding (a) neurobiological and developmental impacts of stressful experiences like COVID-19, (b) delineation of the impacts on individuals with ASD and other comorbid and related conditions, and (c) education and intervention needs during these times. Finally, we offer suggestions for future care during pandemic events, including recommendations for improving service delivery under such conditions.
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Zhao Y, Luo Y, Zhang R, Zheng X. The impact of COVID-19 pandemic on emotional and behavioral problems of children with autism spectrum disorder and developmental delay aged 1-6 years in China. Front Psychiatry 2023; 14:1134396. [PMID: 36911121 PMCID: PMC9998531 DOI: 10.3389/fpsyt.2023.1134396] [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: 12/30/2022] [Accepted: 02/06/2023] [Indexed: 02/26/2023] Open
Abstract
Introduction The COVID-19 pandemic outbreak have caused increased levels of emotional and behavioral problems, particularly among people with pre-existing mental health conditions. Young individuals with autism spectrum disorders (ASD) and developmental delay (DD) are particularly at risk due to their vulnerability. The purpose of this study was to look into the different effects of the COVID-19 pandemic on 1-6-year-old children with ASD and DD. Methods Parents and guardians of children with ASD completed an online survey that included questions about their children's socio-demographics characteristics, the effects of the COVID-19 outbreak on their health, and what they needed in order to deal with the conditions of the pandemic. Results This study compared 4,138 children with ASD to 711 children with DD. Children with ASD had a higher risk of having more emotional and behavioral problems than children with DD (OR 1.38, 95% CI 1.12-1.70). Compared to parent-oriented rehabilitation at home, discontinuing rehabilitation had a higher likelihood of negative emotional and behavioral change (OR 1.67, 95% CI 1.41-1.98). Having teachers' online support had a higher likelihood of negative emotional and behavioral change for ASD children (OR 1.26, 95% CI 1.03-1.54). Conclusions This article provided evidence that children with developmental disabilities, particularly ASD, were at risk for a variety of challenges to their emotional functioning during the COVID-19 period, and that online support was not an ideal way for children with ASD to receive effective educational intervention in China.
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Affiliation(s)
- Yanan Zhao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
- Asia-Pacific Economic Cooperation Health Sciences Academy, Peking University, Beijing, China
| | - Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Rong Zhang
- Neuroscience Research Institute, Peking University, Beijing, China
- Key Laboratory for Neuroscience of the Ministry of Education, Key Laboratory for Neuroscience of the Ministry of National Health Commission, Department of Neurobiology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
- Autism Research Centre, Peking University Health Science Centre, Beijing, China
| | - Xiaoying Zheng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
- Asia-Pacific Economic Cooperation Health Sciences Academy, Peking University, Beijing, China
- Autism Research Centre, Peking University Health Science Centre, Beijing, China
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Ogourtsova T, Boychuck Z, O'Donnell M, Ahmed S, Osman G, Majnemer A. Telerehabilitation for Children and Youth with Developmental Disabilities and Their Families: A Systematic Review. Phys Occup Ther Pediatr 2023; 43:129-175. [PMID: 36042567 DOI: 10.1080/01942638.2022.2106468] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM To determine the level of evidence for the effectiveness of telerehabilitation against comparison interventions in improving child- and parent-related outcomes in children and youth with developmental disabilities. METHOD A systematic approach, comprised of a comprehensive search; transparent study selection, data extraction, quality assessment by independent reviewers; and synthesis of sufficiently similar data (per diagnostic group, health profession, and overall level of evidence for each outcome) was undertaken. RESULTS Fifty-five studies (29 randomized trials) were included across six diagnostic groups and ten health professions. Common telerehabilitation targets varied across diagnostic groups and included motor function, behavior, language, and parental self-efficacy. Telerehabilitation was found to be either more effective or as effective versus comparison intervention in improving 46.9% or 53.1% of outcomes, respectively. It was never found to be detrimental or less effective. Strong to moderate, limited, and insufficient levels of evidence were found for 36.5%, 24.5%, and 38.6% of the outcomes, respectively. CONCLUSION There is sufficient evidence suggesting that telerehabilitation is a promising alternative when face-to-face care is limited. It is comparable to usual care and is more effective than no treatment. Blending in-person and telerehabilitation approaches could be beneficial for the post-pandemic future of rehabilitation in pediatric care.
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Affiliation(s)
- Tatiana Ogourtsova
- Research Center of the Jewish Rehabilitation Hospital, CISSS (Center Intégré de Santé et de Services Sociaux) Laval, Site of CRIR, Quebec, Canada.,Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
| | - Zachary Boychuck
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,CanChild Center for Childhood Disability Research and Department of Pediatrics, McMaster University, Ontario, Canada
| | - Maureen O'Donnell
- Provincial Health Services Authority BC, Vancouver, Canada.,Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Sara Ahmed
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada.,Center for Outcome Research and Evaluation (CORE), Research Institute of the McGill University Health Center, Montreal, Canada
| | - Galil Osman
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Annette Majnemer
- Research Center of the Jewish Rehabilitation Hospital, CISSS (Center Intégré de Santé et de Services Sociaux) Laval, Site of CRIR, Quebec, Canada.,Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Center for Outcome Research and Evaluation (CORE), Research Institute of the McGill University Health Center, Montreal, Canada
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12
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Lamash L, Little L, Hen-Herbst L. Telehealth Interventions to Promote Health and Behavior-Related Outcomes in Adolescents with Autism Spectrum Disorder. J Autism Dev Disord 2023; 53:405-423. [PMID: 35061162 PMCID: PMC8780047 DOI: 10.1007/s10803-022-05440-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 02/03/2023]
Abstract
This systematic review examined the effectiveness in a hybrid telehealth model for adolescents with autism spectrum disorder (ASD), exploring the evidence base, methodology, and outcomes of health and behavior-related interventions for adolescents with ASD. The 11 included studies (a) were quantitative, (b) evaluated interventions delivered through a hybrid telehealth model (i.e., combined remote intervention with minimal in-person procedures), (c) measured health and behavior-related outcomes, and (d) considered adolescence as ages 12 through 25 years. The studies were a mixture of designs, methods, and outcome measures, and participant numbers were extremely low. Results demonstrated an overall lack of empirical evidence on the efficacy of hybrid-delivered interventions for adolescents with ASD, and more studies are needed to explore their effectiveness.
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Affiliation(s)
- Liron Lamash
- Department of Occupational Therapy, University of Haifa, Israel, 199 Aba Khoushy Ave. Mount Carmel, 3498838 Haifa, Israel
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13
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de Nocker YL, Toolan CK. Using Telehealth to Provide Interventions for Children with ASD: a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2023; 10:82-112. [PMID: 34306962 PMCID: PMC8282771 DOI: 10.1007/s40489-021-00278-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/25/2021] [Indexed: 10/27/2022]
Abstract
As the need for accessible interventions for autism spectrum disorder (ASD) grows, empirically supported telehealth interventions become increasingly necessary. With the current COVID-19 public health crisis, in-person interventions have become largely infeasible; therefore, it is crucial that providers have information regarding the effectiveness of telehealth interventions. This systematic review evaluates and synthesizes existing group design research on telehealth ASD interventions. Sixteen articles were evaluated on implementer and child-level intervention outcomes as well as factors that promote equitable access to intervention. Findings suggest that telehealth programs are highly acceptable, comparable to face-to-face interventions, and can be an effective method of training implementers in interventions. Recommendations for future research and for maximizing equitable access to telehealth interventions are presented.
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Affiliation(s)
- Yanicka L. de Nocker
- grid.19006.3e0000 0000 9632 6718Center for Autism Research and Treatment, University of California Los Angeles (UCLA), 300 UCLA Medical Plaza, Box 956967, Los Angeles, CA 90095 USA
| | - Christina K. Toolan
- grid.19006.3e0000 0000 9632 6718Center for Autism Research and Treatment, University of California Los Angeles (UCLA), 300 UCLA Medical Plaza, Box 956967, Los Angeles, CA 90095 USA
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14
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Byrne G, Vickers L, Ni Longphuirt E, Cunningham R. Evaluation of Telehealth Delivery of Group Parent-Led Cognitive-Behavioral Therapy During COVID-19: A Pilot Study. FOCUS ON AUTISM AND OTHER DEVELOPMENTAL DISABILITIES 2022; 37:251-256. [PMID: 36471802 PMCID: PMC9666411 DOI: 10.1177/10883576221121280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic has led to governments around the world imposing varying levels of restrictions and lockdowns leading to home confinement and closure of schools. Children with autism spectrum disorder (ASD) and their families may be particularly susceptible to increased anxiety. A growing evidence base has developed for parent-led cognitive-behavioral therapy (CBT) for child anxiety disorders. The current pilot study aimed to evaluate the preliminary clinical utility (acceptability, feasibility, and efficacy) of a parent-led CBT program in Dublin, Ireland, through an online format. Parents of nine children completed the program. The child did not participate in any part of the online program. Acceptability was strong, and although technical issues were problematic at times, all families completed the program. Preliminary efficacy analysis is mixed, with significant reductions on youth anxiety as measured by clinician-administered questionnaire but no reduction in parent-report measures. Findings suggest that the online program is acceptance, feasible, and effective.
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Affiliation(s)
- Gary Byrne
- Health Service Executive, Dublin,
Ireland
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15
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d'Halluin A, Costa M, Morgiève M, Sebbane D. Attitudes of children, adolescents, and their parents toward digital health interventions: a scoping review (Preprint). J Med Internet Res 2022; 25:e43102. [PMID: 37129931 DOI: 10.2196/43102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/29/2023] [Accepted: 03/08/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND The prevalence of mental health problems in children and adolescents is high. As these problems can impact this population's developmental trajectories, they constitute a public health concern. This situation is accentuated by the fact that children and adolescents infrequently seek help. Digital health interventions (DHIs) offer an opportunity to bridge the treatment gap between health care needs and patient engagement in care. Additional detailed research is needed to identify how children and adolescents can be empowered to access help through DHIs. In this context, an understanding of their attitudes toward digital health appears to be a necessary first step in facilitating the effective implementation of DHIs. OBJECTIVE This study aimed to establish an inventory of children's, adolescents', and their parents' attitudes toward DHIs. METHODS A scoping review following PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) recommendations was performed using the MEDLINE, Embase, and PsycINFO databases. This research was conducted using 3 key concepts: "child and adolescent mental health service users," "digital health interventions," and "attitudes." Data extracted included the name of the publishing journal, the methodology used, the target population, the DHI studied, and the principal results. RESULTS Of 1548 studies found, 30 (1.94%) were included in our analysis. Among these, 13 concerned satisfaction, 24 concerned preferences, 22 concerned the use of DHI, 11 concerned perception, and 10 concerned needs. CONCLUSIONS The results of this study provide a better understanding of the factors influencing children's and adolescents' attitudes toward digital health and DHIs. The continued growth of DHIs can help reduce barriers to mental health care. Future research on these interventions should investigate the needs of the targeted populations to increase their engagement in care.
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Affiliation(s)
- Arnaud d'Halluin
- WHO Collaborating Centre for Research and Training in Mental Health, EPSM Lille Métropole, Lille - Hellemmes, France
| | - Marie Costa
- WHO Collaborating Centre for Research and Training in Mental Health, EPSM Lille Métropole, Lille - Hellemmes, France
- Évaluation clinique épidémiologique-économique appliquée aux populations vulnérables, Inserm, Université Paris Cité, Paris, France
| | - Margot Morgiève
- WHO Collaborating Centre for Research and Training in Mental Health, EPSM Lille Métropole, Lille - Hellemmes, France
- Centre de recherche médecine, sciences, santé, santé mentale, société, Inserm, Université Paris Cité, Paris, France
| | - Déborah Sebbane
- WHO Collaborating Centre for Research and Training in Mental Health, EPSM Lille Métropole, Lille - Hellemmes, France
- Évaluation clinique épidémiologique-économique appliquée aux populations vulnérables, Inserm, Université Paris Cité, Paris, France
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16
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Traube DE, Taylor A, Cederbaum JA, Naish L, Rau A. Strategies for implementation of virtual home visitation in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2118-e2126. [PMID: 34791751 DOI: 10.1111/hsc.13650] [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: 03/15/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 06/13/2023]
Abstract
Utilising telepractice videoconferencing technology to offer home visitation services has the potential to provide access and parenting support through a high-tech and high-touch service delivery option. Families can receive evidence-based, family support intervention from their home via videoconferencing technology, removing the need for the provider to be physically in the home. While the expansion of telehealth and telepractice services for families is essential for meeting the needs of both parents and their children, well-documented engagement barriers to digital health/computer-mediated interventions exist across treatment modalities and technology platforms. Semi-structured interviews with 15 providers were conducted and analysed to identify engagement strategies utilised to sustain families in a home visitation model offered through live videoconferencing technology on a telehealth platform. Analysis revealed four themes that were deemed essential for successfully attracting and maintaining families in a telepractice-based home visitation programme: (a) engagement strategies to encourage families to participate; (b) clinical skills used within sessions; (c) articulation of benefits to the family; and (d) exploration of rationale for ending services. This study was able to identify strategies for engagement and sustained involvement of families in telehealth-based home visitation. Findings include evidence that providers should be able to move between telehealth and on-ground service provision with relative ease.
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Affiliation(s)
- Dorian E Traube
- USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California, USA
| | - Amanda Taylor
- USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California, USA
| | - Julie A Cederbaum
- USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California, USA
| | - Lauren Naish
- USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California, USA
| | - Angela Rau
- Parents as Teachers National Center, St. Louis, Missouri, USA
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17
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Cultural and Telehealth Considerations for Trauma-Focused Treatment Among Latinx Youth: Case Reports and Clinical Recommendations to Enhance Treatment Engagement. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Qu L, Chen H, Miller H, Miller A, Colombi C, Chen W, Ulrich DA. Assessing the Satisfaction and Acceptability of an Online Parent Coaching Intervention: A Mixed-Methods Approach. Front Psychol 2022; 13:859145. [PMID: 35967644 PMCID: PMC9367480 DOI: 10.3389/fpsyg.2022.859145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/26/2022] [Indexed: 11/15/2022] Open
Abstract
Background Parent-mediated intervention (PMI) has been studied in promoting skill acquisition or behavior change in the children with autism spectrum disorder. Most studies emphasize on the improvement of child's core symptoms or maladaptive behaviors, making parental perceived competence and self-efficacy secondary. Yet, the evaluations of intervention implementation are under-reported, especially when translating such interventions into a new population or context. This research investigated the intervention implementation of a 12-week parent coaching intervention which was delivered through telehealth and tailored to Chinese population. The intervention was based on the Parent-mediated Early Start Denver Model with culturally adapted lectures, manuals, and demonstration and commentary videos. This study aimed to evaluate the intervention implementation by assessing parents' satisfaction, acceptability, appropriateness, and feasibility. Method A randomized controlled trial was conducted with two telehealth conditions: self-directed and web+group therapy. Parents in the self-directed condition received intervention individually through the online learning platform. The web+group therapy condition navigated the same program with weekly 1.5-h group coaching sessions via videoconferencing. This mixed-methods study used a concurrent convergent design to evaluate the intervention implementation at post-intervention. The quantitative data was collected from the Program Evaluation Survey and the qualitative data was collected from five focus groups. Results Parents in self-directed group reported significantly lower scores in total perceived competence than parents in web+group therapy condition, while there was no group difference on the total self-efficacy. Tailored feedback, demonstration and commentary videos, peer commenting, live coaching, and guided reflection were the top-five acceptable telehealth strategies that were strongly endorsed by parents. Family centered care, home-based intervention, strategies relative to daily activities, the remote learning platform, and the program-based community were elements that parents considered when evaluating the program's appropriateness. Parent modeling, step-by-step instructions, and tailored feedback were key components in making intervention strategies feasible for parents to implement at home. Conclusion Findings indicate the application of telehealth was acceptable, appropriate, and feasible for Chinese parents. Group-based parent coaching intervention via videoconferencing could be a promising home-based service model to increase parental perceived competence. A large-scale RCT is needed to investigate the effectiveness of group-based PMI via telehealth.
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Affiliation(s)
- Lu Qu
- Institute of AI for Education, East China Normal University, Shanghai, China
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
| | - Huiying Chen
- College of Physical Education, Yangzhou University, Yangzhou, China
| | - Haylie Miller
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
| | - Alison Miller
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | | | - Weiyun Chen
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
| | - Dale A. Ulrich
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
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19
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Chen Y, Zhou Z, Cao M, Liu M, Lin Z, Yang W, Yang X, Dhaidhai D, Xiong P. Extended Reality (XR) and telehealth interventions for children or adolescents with autism spectrum disorder: Systematic review of qualitative and quantitative studies. Neurosci Biobehav Rev 2022; 138:104683. [PMID: 35523302 DOI: 10.1016/j.neubiorev.2022.104683] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/15/2022] [Accepted: 04/29/2022] [Indexed: 12/17/2022]
Abstract
World Health Organization reported that almost one in 100 children is diagnosed with autism spectrum disorder (ASD) worldwide. Extended Reality (XR) and Telehealth interventions are evident to be effective for ASD treatments. While there is no comprehensive systematic review to summarize and evaluate the evidence for promoting the accessibility of different technology-based treatment regiments. This paper aims to verify the efficacy and validity of XR and Telehealth interventions for children and adolescents with ASD. We reviewed 112 studies from databases of PubMed, Web of Science and Cochrane Library, published in English between January 2010 to April 1st, 2022. We found that after interventions, positive improvements for ASD participants were observed in social interaction, acceptance, and engagement, communication and speech, emotion recognition and control, daily living skill, problem behavior reduction, attention, cost reduction, anxiety symptom reduction, pretend play, contextual processing, match to sample skill, and insomnia control. Our findings provide a solid and positive evidence of XR and Telehealth interventions in improving the treatment outcomes for children and adolescents with ASD. In the future, more research with RCTs and standardized outcome measurements are required to establish the therapeutic efficiency of the two interventions independently or combined.
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Affiliation(s)
- Yuhan Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zhuoren Zhou
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Min Cao
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Min Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zhihao Lin
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Weixin Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Xiao Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Denzel Dhaidhai
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Peng Xiong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.
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20
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Dörttepe ZÜ, Duman ZÇ. Examination of Telemental Health Practices in Caregivers of Children and Adolescents with Mental Illnesses: A Systematic Review. Issues Ment Health Nurs 2022; 43:625-637. [PMID: 35021018 DOI: 10.1080/01612840.2021.2013366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this systematic review, effects of telemental health (TMH) practices' on caregivers of children/adolescents with mental illnesses were investigated. The literature review included databases, and reference lists of published studies. All studies published until September 2021 were reviewed. Eleven studies were included. Several services were provided via TMH: education, cognitive behavioral therapy (CBT), parent training, caregiver behavior training, family CBT. The effectiveness of TMH interventions on caregivers varied from low to high. Most reproducible findings were on caregivers' satisfaction, stress, therapeutic alliance and caregiver burden. Studies had a low to high bias risk. Most studies had small samples. Results built on the small but growing literature support TMH interventions' promising role in caregivers of children with mental illness. Future studies should estimate outcomes with medium to low effect size. Other caregiver groups, rarely considered in previous studies, should be included. Bias risk should be minimized. Larger, more methodologically rigorous studies should be conducted.
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Affiliation(s)
- Zümra Ülker Dörttepe
- Medical Services and Techniques Department, Vocational School of Health Sciences, Uşak University, Uşak, Turkey
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21
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Adams L, Adamo N, Hollocks MJ, Valmaggia L, Brewster A, Watson J, Krisson M, Simonoff E. Examining clinicians' concerns delivering telemental health interventions directly to autistic individuals during COVID-19. RESEARCH IN AUTISM SPECTRUM DISORDERS 2022; 94:101956. [PMID: 35369648 PMCID: PMC8963796 DOI: 10.1016/j.rasd.2022.101956] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/16/2022] [Accepted: 03/20/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic necessitated the adoption of telemental health (TMH). Pre-pandemic, clinicians had voiced many TMH concerns, but these had not been investigated with respect to autism spectrum disorder (ASD) even with it being known that there are distinct ASD-associated challenges for in-person mental health interventions. METHOD A convenience sample of (n = 55) clinicians completed an online survey regarding their perspectives of adopting TMH interventions in ASD, with closed- and open-answered questions. Quantitative and qualitative data were analysed descriptively/inferentially and via Content Analysis, respectively. RESULTS Multiple clinicians endorsed each TMH challenges/barrier previously identified as concerns in the non-ASD literature. However, overall levels of concern over challenges/barriers were low, and challenges were more likely to be predicted than experienced and considered to be case/presentation specific. Challenges that were considered ASD-specific included the exacerbation of those associated with in-person delivery in ASD, alongside difficulties with trust and appropriate remote social behaviour. On average, clinicians indicated a preference for 50% TMH interventions post-pandemic. Clinicians' perceived technological competence and extent of professional experience with ASD were not significantly associated with levels of concern, nor number of experienced challenges, with TMH interventions in ASD. CONCLUSION In support of the existing TMH literature, challenges/barriers were more likely to be predicted than experienced and were considered to be case/presentation-specific, though this may be more variable in ASD owing to the well-established marked heterogeneity in this population. Remote provision of interventions exacerbated in-person ASD-associated challenges, as predicted, but clinician-level factors appeared not to impact TMH perceptions.
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Affiliation(s)
- Lucy Adams
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
- Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Nicoletta Adamo
- Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Matthew J Hollocks
- Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Aylana Brewster
- Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Jennifer Watson
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Maisie Krisson
- Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
| | - Emily Simonoff
- Service for Complex Autism and Associated Neurodevelopmental Disorders, Maudsley Hospital, Michael Rutter Centre, De Crespigny Park, London SE5 8AZ, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF, UK
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22
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Estabillo JA, Moody CT, Poulhazan SJ, Adery LH, Denluck EM, Laugeson EA. Efficacy of PEERS® for Adolescents via Telehealth Delivery. J Autism Dev Disord 2022; 52:5232-5242. [PMID: 35624224 PMCID: PMC9137447 DOI: 10.1007/s10803-022-05580-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
Abstract
PEERS® for Adolescents is an evidence-based social skills intervention for autistic youth and adolescents with other social challenges. The efficacy and effectiveness of PEERS® are well established; however, limited data on PEERS® via telehealth delivery exist. The current study aimed to examine the efficacy of PEERS® for Adolescents via telehealth and compare outcomes between telehealth and in-person modalities. Thirty-one adolescents (Mage = 13.77, SD = 2.14) participated in telehealth groups, and outcomes were compared with 212 adolescents (Mage = 14.02, SD = 2.00) from in-person groups. Findings demonstrate PEERS® for Adolescents via telehealth results in significant improvements in social skills knowledge, social responsiveness, overall social skills and problem behaviors, and social engagement. Telehealth outcomes are relatively equivalent to in-person delivery.
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Affiliation(s)
- Jasper A Estabillo
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, 300 UCLA Medical Plaza, Los Angeles, CA, 90095-6967, USA. .,Department of Psychology, University of California, Los Angeles, CA, USA.
| | - Christine T Moody
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, 300 UCLA Medical Plaza, Los Angeles, CA, 90095-6967, USA
| | - Solene J Poulhazan
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, 300 UCLA Medical Plaza, Los Angeles, CA, 90095-6967, USA
| | - Laura H Adery
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, 300 UCLA Medical Plaza, Los Angeles, CA, 90095-6967, USA
| | - Elizabeth M Denluck
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, 300 UCLA Medical Plaza, Los Angeles, CA, 90095-6967, USA.,College of Education School Psychology Program, University of Oregon, Eugene, OR, USA
| | - Elizabeth A Laugeson
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, 300 UCLA Medical Plaza, Los Angeles, CA, 90095-6967, USA
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23
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Georén L, Jansson-Fröjmark M, Nordenstam L, Andersson G, Olsson NC. Internet-delivered Cognitive Behavioral Therapy for insomnia in youth with autism spectrum disorder: A pilot study. Internet Interv 2022; 29:100548. [PMID: 35651733 PMCID: PMC9149190 DOI: 10.1016/j.invent.2022.100548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/05/2022] [Accepted: 05/19/2022] [Indexed: 11/18/2022] Open
Abstract
Adolescents with ASD often suffer from sleep disorders affecting their development and quality of life. Research concerning psychological treatment of insomnia in this population is scarce. The objective of this pilot study was to examine the feasibility of internet-delivered CBT for insomnia (iCBT-I) and the participants' experiences after completing the treatment. Both quantitative and qualitative methods were used. Six adolescents with ASD and insomnia, aged 13 to 17, participated in the study. The results of the qualitative investigation showed general satisfaction with the iCBT-I. The participants experienced both better sleep and insights into their sleep patterns. Thematic analysis revealed five themes: experience of the structure of the treatment, treatment content, experienced outcomes, experienced difficulties, and suggested improvements. The results indicate the need for additional support for some participants and suggest distinct recommendations for further studies. The quantitative investigation showed large reductions in insomnia symptoms indicating the feasibility of the treatment in this population. The findings suggest promising results, but more studies are needed to define the efficacy of iCBT-I for adolescents with ASD.
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Affiliation(s)
- Lisa Georén
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Markus Jansson-Fröjmark
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Lisa Nordenstam
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Gerhard Andersson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Nora Choque Olsson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Corresponding author at: Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Liljeholmstorget 7, 117 63 Stockholm, Sweden.
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A Distance-Delivered Social Skills Program for Young Adults with Williams Syndrome: Evaluating Feasibility and Preliminary Efficacy. J Autism Dev Disord 2022; 52:5162-5176. [PMID: 35575839 PMCID: PMC9109668 DOI: 10.1007/s10803-022-05501-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
Abstract
Adults with Williams syndrome (WS) display hypersocial behaviors and experience social skills deficits. To improve social outcomes, we evaluated the feasibility, acceptability, and preliminary efficacy of an 8-week distance-delivered social skills program for adults with WS. Sessions were offered twice a week for 90 min. Twenty-four adults with WS were assigned to an intervention or waitlist control group. Outcomes were assessed through interviews and surveys with adults with WS, parents, and facilitators. The intervention was rated as acceptable and feasible by all. Parents rated adults with WS as displaying significant improvements in social skills; yet ratings by adults with WS did not change. Adults also displayed increased social skills knowledge following participation. Implications for practice and future research are discussed.
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A Virtually Delivered Adapted Cognitive-Behavioral Therapy Group for Adults With Williams Syndrome and Anxiety. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Stavropoulos KK, Heyman M, Salinas G, Baker E, Blacher J. Exploring telehealth during COVID for assessing autism spectrum disorder in a diverse sample. PSYCHOLOGY IN THE SCHOOLS 2022; 59:1319-1334. [PMID: 35572181 PMCID: PMC9088649 DOI: 10.1002/pits.22672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 10/27/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022]
Affiliation(s)
| | - Michelle Heyman
- Graduate School of Education University of California, Riverside Riverside CA USA
| | - Giselle Salinas
- Graduate School of Education University of California, Riverside Riverside CA USA
| | - Elizabeth Baker
- Graduate School of Education University of California, Riverside Riverside CA USA
| | - Jan Blacher
- Graduate School of Education University of California, Riverside Riverside CA USA
- Department of Psychology University of California Los Angeles USA
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Hodge MA, Chan E, Sutherland R, Ong N, Bale G, Cramsie J, Drevensek S, Silove N. Tele-Assessments in Rural and Remote Schools – Perspectives of Support Teachers. JOURNAL OF PSYCHOEDUCATIONAL ASSESSMENT 2022. [DOI: 10.1177/07342829211059640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tele-assessments may enable specialist evaluation of students in schools and their progress following intervention. The aim of this project was to evaluate the feasibility of using videoconferencing technology to assess students with reading difficulties in the school setting and obtain the perspectives of teachers supporting the students during the assessment. Teachers ( n = 57) of 71 primary school age students participated in the study. Teachers provided feedback on the tele-assessment by completing questionnaires about students’ behaviours and the quality of the technology and assessment process. Randomly selected teachers ( n = 24) were invited to participate in a semi-structured interview to provide qualitative feedback. Tele-assessments were completed in 93.4% of the sample. Support teachers reported satisfaction with the audio and visual quality as well as the assessment process. The majority of students completed the tele-assessment with good compliance, engagement and attention. Feedback from support teachers also reflected the strengths of tele-assessments, such as better access to service, cost saving and convenience. Barriers to tele-assessments included technical difficulties, assessment limitations and equipment issues at schools. Tele-assessment is a feasible method of objectively measuring outcomes of students following an intervention. Tele-assessment at school is largely accepted by teachers who supported students in this study. Feedback obtained from this research may be used to offer guidance on undertaking tele-assessments with students in the school setting.
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Affiliation(s)
| | - Esther Chan
- The Children’s Hospital at Westmead, Westmead, Australia
| | - Rebecca Sutherland
- The Children’s Hospital at Westmead, Westmead, Australia
- University of Canberra, Canberra, Australia
| | - Natalie Ong
- The Children’s Hospital at Westmead, Westmead, Australia
- University of Sydney, Sydney, Australia
| | - Gillian Bale
- New South Wales Department of Education, Sydney, Australia
| | - Jane Cramsie
- The Children’s Hospital at Westmead, Westmead, Australia
| | - Suzi Drevensek
- The Children’s Hospital at Westmead, Westmead, Australia
| | - Natalie Silove
- The Children’s Hospital at Westmead, Westmead, Australia
- University of Sydney, Sydney, Australia
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Stavropoulos KKM, Bolourian Y, Blacher J. A scoping review of telehealth diagnosis of autism spectrum disorder. PLoS One 2022; 17:e0263062. [PMID: 35143494 PMCID: PMC8830614 DOI: 10.1371/journal.pone.0263062] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/11/2022] [Indexed: 12/16/2022] Open
Abstract
Background Considering the COVID-19 pandemic, understanding the reliability, validity, social validity, and feasibility of using telehealth to diagnose ASD is a critical public health issue. This paper examines evidence supporting the use of telehealth methods to diagnose ASD and outlines the necessary modifications and adaptations to support telehealth diagnosis. Methods and procedures Studies were identified by searching PubMed and PsychInfo electronic databases and references lists of relevant articles. Only peer reviewed articles published in English with a focus on using telehealth for the purposes of diagnosing ASD were included. Searches were conducted through June 3rd, 2021. Outcomes and results A total of 10 studies were identified as meeting inclusion criteria. Of the eight papers that reported on reliability (e.g., accuracy), telehealth methods to diagnose ASD were between 80–91% accurate when compared with traditional in-person diagnosis. Six studies reported on validity (i.e., sensitivity and/or specificity). All six studies calculated sensitivity, with values ranging from 75% and 100%. Five of the six studies calculated specificity, with values ranging from 68.75% and 100%. The seven papers that reported social validity indicated that caregivers, as well as adult participants and clinicians, were mostly satisfied with telehealth. Feasibility was reported by seven studies and suggests that telehealth methods appear largely viable, though some challenges were reported. Conclusions and implications Although findings reviewed here are promising, more research is needed to verify the accuracy, validity, and feasibility of utilizing telehealth to diagnose ASD. Studies with larger sample sizes and samples across sites will be critical, as these will allow clinicians to identify subjects most likely to benefit from telehealth as well as those more likely to require an in-person assessment. This research is important not only due to the current pandemic, but also due to increased prevalence rates of ASD and an insufficient number of diagnostic providers—particularly in rural and/or otherwise under-served communities.
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Affiliation(s)
| | - Yasamin Bolourian
- School of Education, University of California, Riverside, CA, United States of America
| | - Jan Blacher
- School of Education, University of California, Riverside, CA, United States of America
- Department of Psychology, University of California, Los Angeles, CA, United States of America
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Factor RS, Glass L, Baertschi D, Laugeson EA. Remote PEERS ® for preschoolers: A pilot parent-mediated social skills intervention for young children with social challenges over telehealth. Front Psychiatry 2022; 13:1008485. [PMID: 36523874 PMCID: PMC9745198 DOI: 10.3389/fpsyt.2022.1008485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/09/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Social differences characteristic of autism spectrum disorder (ASD) and other developmental disabilities are evident in early childhood and are associated with later difficulties. Unfortunately, there is a paucity of evidence-based interventions explicitly targeting social skills development for young children, few actively integrate parents and caregivers, and even fewer have remote models. The importance of providing accessible, tailored services for families in the wake of the COVID-19 pandemic, prompted the creation of a parent-mediated telehealth version of Program for the Education and Enrichment of Relational Skills (PEERS®) for Preschoolers (P4P), a pre-existing, evidence-based social skills intervention for children 4-6 years focused on making and keeping friends. METHOD This methodological paper documents the implementation, feasibility, and satisfaction of a novel telehealth group-based delivery of P4P. RESULTS Qualitative results indicate acceptable feasibility and satisfaction. Additionally, following completion there was an increase in parental confidence in social coaching and increased use of child social skills. DISCUSSION Future work will evaluate quantitative outcomes and comparisons between delivery methods (e.g., telehealth vs. in-person).
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Affiliation(s)
- Reina S Factor
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Leila Glass
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Daliah Baertschi
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Elizabeth A Laugeson
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
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Baweja R, Brown SL, Edwards EM, Murray MJ. COVID-19 Pandemic and Impact on Patients with Autism Spectrum Disorder. J Autism Dev Disord 2022; 52:473-482. [PMID: 33689088 PMCID: PMC7943706 DOI: 10.1007/s10803-021-04950-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 12/20/2022]
Abstract
The COVID-19 infectious disease pandemic has caused significant fear and uncertainty around the world and had significant adverse psychological impact. Children, adolescents and adults with autism spectrum disorder (ASD) are a particularly vulnerable population, impacted by stay-at-home orders, closures at nonessential services, and social distancing standards. This commentary describes various challenges faced by individuals with ASD in the United States including disruptions caused by educational and vocational changes, challenges to home and leisure routines, limited access to behavioral health services and changes in health services delivery due to the pandemic. We highlight the need for ongoing skills development for individuals and development within systems to better respond to needs of the ASD population in future emergencies.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry and Behavior Health, Penn State University College of Medicine, 500 University Drive, H073, Hershey, PA, 17033-0850, USA.
| | - Sierra L Brown
- Department of Psychiatry and Behavior Health, Penn State University College of Medicine, 500 University Drive, H073, Hershey, PA, 17033-0850, USA
| | - Erin M Edwards
- Department of Psychiatry and Behavior Health, Penn State University College of Medicine, 500 University Drive, H073, Hershey, PA, 17033-0850, USA
| | - Michael J Murray
- Department of Psychiatry and Behavior Health, Penn State University College of Medicine, 500 University Drive, H073, Hershey, PA, 17033-0850, USA
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Peros OM, Webb L, Fox S, Bernstein A, Hoffman L. Conducting Exposure-Based Groups via Telehealth for Adolescents and Young Adults With Social Anxiety Disorder. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:679-689. [PMID: 34690482 PMCID: PMC8523107 DOI: 10.1016/j.cbpra.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/03/2021] [Indexed: 11/30/2022]
Abstract
The rapid spread of COVID-19 and subsequent social distancing measures posed unprecedented challenges in providing mental health care and a swift transition of services to telehealth platforms. Social distancing measures create unique concerns for young people with social anxiety disorder who already struggle with social connection and isolation; therefore, the continuation of care via telehealth platforms is especially important for this population. To date, there is little literature regarding use of telehealth groups for this population and the current commentary aims to fill in this gap in the literature while also providing general guidelines for telehealth groups. The commentary discusses the delivery of an exposure-based cognitive behavioral therapy group for adolescents and young adults via telehealth and provides considerations, challenges, and benefits of conducting a group through a telehealth platform. In conjunction with clinically relevant examples and in-depth exposure discussions, we aim to provide guidance for youth-focused practitioners who are considering conducting groups in a telehealth format for a range of presentations.
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Affiliation(s)
- Olivia M Peros
- The Columbia University Clinic for Anxiety and Related Disorders and Hofstra University
| | - Lauren Webb
- The Columbia University Clinic for Anxiety and Related Disorders and Hofstra University
| | - Schuyler Fox
- The Columbia University Clinic for Anxiety and Related Disorders
| | - Alyssa Bernstein
- The Columbia University Clinic for Anxiety and Related Disorders
| | - Lauren Hoffman
- The Columbia University Clinic for Anxiety and Related Disorders
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Vasa RA, Singh V, Holingue C, Kalb LG, Jang Y, Keefer A. Psychiatric problems during the COVID-19 pandemic in children with autism spectrum disorder. Autism Res 2021; 14:2113-2119. [PMID: 34231323 PMCID: PMC8420610 DOI: 10.1002/aur.2574] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 01/27/2023]
Abstract
Children with autism spectrum disorder (ASD) are at elevated risk for psychiatric problems in response to the COVID-19 pandemic. This risk is due to their high rates of pre-pandemic psychiatric comorbidities and the pandemic's disruption to routines and access to necessary supports. Prior research has indicated that children with ASD may experience a worsening of specific psychiatric symptoms in response to COVID-19, though this body of work is limited in scope. The present study expands this literature by examining specific types of psychiatric problems that emerged about 2 months after the onset of the pandemic, and risk factors predicting changes in these psychiatric symptoms. Parents of children with a confirmed ASD diagnosis (N = 257), who enrolled in a clinic registry at an outpatient specialty autism center, were included in this study. All data were gathered online via customized and standardized questionnaires. Results showed that 59% of children experienced either a worsening of their pre-pandemic psychiatric diagnoses and/or the development of new psychiatric symptoms during the pandemic. Multivariable regression models indicated that risk factors for increased psychiatric problems included child understanding of COVID-19, COVID-19 illness in the family, low family income, and elevated parental depression and anxiety symptoms (all p < 0.05). Findings from this study emphasize the urgent need to provide effective and accessible psychiatric services for children with ASD and their families during and after the pandemic. LAY SUMMARY: Children with ASD are at high risk for psychiatric problems during the COVID-19 pandemic. We found that 59% of children in our clinical sample are experiencing increased psychiatric problems. The child's understanding of COVID-19, COVID-19 illness in the family, low family income, and depression and anxiety symptoms in the parent increase the risk for poor mental health during the pandemic. These findings indicate the importance of helping children with ASD access mental health treatment during COVID-19.
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Affiliation(s)
- Roma A. Vasa
- Kennedy Krieger InstituteCenter for Autism and Related DisordersBaltimoreMarylandUSA
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Vini Singh
- Kennedy Krieger InstituteCenter for Autism and Related DisordersBaltimoreMarylandUSA
| | - Calliope Holingue
- Kennedy Krieger InstituteCenter for Autism and Related DisordersBaltimoreMarylandUSA
- Department of NeuropsychologyKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Luther G. Kalb
- Kennedy Krieger InstituteCenter for Autism and Related DisordersBaltimoreMarylandUSA
- Department of NeuropsychologyKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Yeon Jang
- Kennedy Krieger InstituteCenter for Autism and Related DisordersBaltimoreMarylandUSA
| | - Amy Keefer
- Kennedy Krieger InstituteCenter for Autism and Related DisordersBaltimoreMarylandUSA
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Dickson KS, Lind T, Jobin A, Kinnear M, Lok H, Brookman-Frazee L. A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:857-883. [PMID: 33884535 PMCID: PMC8411365 DOI: 10.1007/s10488-021-01133-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
Youth with autism spectrum disorder (ASD) have high rates of co-occurring mental health needs that necessitate mental health interventions. Given the unique clinical characteristics of youth with ASD, there have been significant efforts to adapt and test mental health interventions for this population. Yet, characterization of the nature and types of interventions adaptations is limited, especially across the wide range of interventions tested for youth with ASD with a focus on implementation factors. Additionally, understanding how these interventions may be implemented in community services is limited. The aims of this systematic review are to characterize the (1) types of interventions tested for co-occurring mental health conditions for youth with ASD; (2) adaptations to mental health interventions for use with youth with ASD; and (3) implementation strategies, outcomes, and determinants of mental health interventions to inform their translation to community service settings. Eighty-three articles testing interventions targeting mental health symptoms in youth with ASD that included implementation factors in analyses were reviewed. The Stirman et al. (2013; 2019) FRAME adaptation, Powell et al. (2012;2015) implementation strategies, and Proctor et al. (2011) implementation outcomes taxonomies were applied to characterize the nature and types of adaptations for use with youth with ASD and types of implementation strategies, outcomes, and determinants used, when available, respectively. Of the interventions examined, the majority (64.1%) were originally designed to target youth mental health concerns and were then adapted to be used with ASD. The most common adaptations included those to the intervention content, particularly adding elements with tailoring or refining aspects of the intervention while maintaining core functions. Half of the articles described at least one implementation strategy used during intervention testing. Fidelity and acceptability were the most frequently examined implementation outcomes, with some examination of appropriateness and feasibility. Nineteen percent of articles described implementation determinants (i.e. barriers/facilitators) of these implementation outcomes. The common adaptations for ASD provide direction for future intervention development and for training community therapists. Further examination, specification, and reporting of implementation strategies and outcomes within ongoing efforts to adapt and interventions to meet the co-occurring mental health needs of youth ASD are needed to facilitate their translation to community settings. Areas for future research as well as clinical implications are discussed.
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Affiliation(s)
- Kelsey S Dickson
- San Diego State University, San Diego, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
| | - Teresa Lind
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
| | - Allison Jobin
- University of California, San Diego, USA
- California State University, San Marcos, USA
| | | | - Ho Lok
- San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
- Rady Children's Hospital-San Diego, San Diego, USA
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Ellison KS, Guidry J, Picou P, Adenuga P, Davis TE. Telehealth and Autism Prior to and in the Age of COVID-19: A Systematic and Critical Review of the Last Decade. Clin Child Fam Psychol Rev 2021; 24:599-630. [PMID: 34114135 PMCID: PMC8191715 DOI: 10.1007/s10567-021-00358-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 01/20/2023]
Abstract
There has been growing interest in the use of telehealth; however, the COVID-19 pandemic and the subsequent isolation and restrictions placed on in-person services have fast-tracked implementation needs for these services. Individuals with autism spectrum disorder (ASD) have been particularly affected due to the often-intensive service needs required by this population. As a result, the aim of this review was to examine the evidence base, methodology, and outcomes of studies that have used telehealth for assessment and/or intervention with children and adolescents with ASD as well as their families over the last decade. Further, the goal is to highlight the advances in telehealth and its use with this special population. A systematic search of the literature was undertaken, with 55 studies meeting inclusion criteria and quality analysis. Specified details were extracted from each article, including participant characteristics, technology, measures, methodology/study design, and clinical and implementation outcomes. Services provided via telehealth included diagnostic assessments, preference assessments, early intervention, applied behavior analysis (ABA), functional assessment and functional communication training, and parent training. Findings, although still emerging, encouragingly suggested that services via telehealth were equivalent or better to services face-to-face. Results support the benefits to using telehealth with individuals with ASD. Future research should continue to explore the feasibility of both assessments and interventions via telehealth with those having ASD to make access to assessment services and interventions more feasible for families, while acknowledging the digital divide it could create.
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Affiliation(s)
- Kimberly S Ellison
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Jerrica Guidry
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Paige Picou
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Paige Adenuga
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA
| | - Thompson E Davis
- Department of Psychology, Louisiana State University, 236 Audubon Hall, Baton Rouge, LA, 70803, USA.
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McCrae CS, Mazurek MO, Curtis AF, Beversdorf DQ, Deroche CB, Golzy M, Sohl KA, Ner ZH, Davis BE, Stearns MA, Nair N. Protocol for targeting insomnia in school-aged children with autism spectrum disorder without intellectual disability: a randomised control trial. BMJ Open 2021; 11:e045944. [PMID: 34433593 PMCID: PMC8388273 DOI: 10.1136/bmjopen-2020-045944] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 08/07/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Insomnia affects up to 80% of children with autism spectrum disorder (ASD). Negative consequences of insomnia in ASD include decreased quality of life (QOL), impaired learning and cognition, increased stereotypic and challenging behaviours, and increased parental stress. Cognitive behavioural treatment for childhood insomnia (CBT-CI) is a promising treatment for dealing with insomnia and its negative consequences but has not yet been studied in school-aged children with ASD and comorbid insomnia. Access to healthcare is another challenge for children with ASD, particularly in rural and underserved regions. Previous studies indicate that ASD and insomnia share common arousal-based underpinnings, and we hypothesise that CBT-CI will reduce the hyperarousal associated with insomnia and ASD. This trial will be the first to examine CBT-CI adapted for children with ASD and will provide new information about two different modes of delivery across a variety of primary and secondary child and parent sleep and related outcomes. Knowledge obtained from this trial might allow us to develop new or modify current treatments to better target childhood insomnia and ASD. METHODS AND ANALYSIS Children (N=180) 6-12 years of age with ASD and insomnia will be recruited from an established autism database, a paediatric clinic and community outreach in the Columbia, MO and surrounding areas. Participants will be randomised to CBT-CI adapted for children with ASD (in-person or remote using computers with cameras) or Sleep Hygiene and Related Education. Participants will be assessed at baseline, post-treatment, 6-month and 12-month follow-ups. The following assessments will be completed regarding the children: objective and subjective sleep, daytime functioning (adaptive functioning, attention, challenging behaviours, anxiety), QOL and physiological arousal (heart rate variability) and parents: objective and subjective sleep, daytime functioning (anxiety, depression, fatigue), QOL, physiological arousal and parental burden/stress. ETHICS AND DISSEMINATION Ethics approval was obtained in January 2020 from the University of Missouri. Ethics approval was obtained in July 2020 from the US Army Medical Research and Development Command, Office of Research Protections and Human Research Protection Office. All data are expected to be collected by 2024. Full trial results are planned to be published by 2025. Secondary analyses of baseline data will be subsequently published. TRIAL REGISTRATION NUMBER NCT04545606; Pre-results.
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Affiliation(s)
| | - Micah O Mazurek
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | - Ashley F Curtis
- Psychiatry, University of Missouri, Columbia, MO, USA
- Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - David Q Beversdorf
- Departments of Radiology, Neurology, Psychological Sciences, and the Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
| | - Chelsea B Deroche
- Department of Health Management & Informatics, University of Missouri, Columbia, MO, USA
| | - Mojgan Golzy
- Department of Health Management & Informatics, University of Missouri, Columbia, MO, USA
| | - Kristin A Sohl
- Department of Child Health, University of Missouri, Columbia, MO, USA
| | - Zarah H Ner
- Department of Child Health, University of Missouri, Columbia, MO, USA
| | - Beth Ellen Davis
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | | | - Neetu Nair
- Psychiatry, University of Missouri, Columbia, MO, USA
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Dickson KS, Lind T, Jobin A, Kinnear M, Lok H, Brookman-Frazee L. Correction to: A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:884-908. [PMID: 34196884 DOI: 10.1007/s10488-021-01144-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Due to the errors occurred in the originally published version, this article is being reprinted in its entirety as Correction. All errors have been corrected. It is the correct version.
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Affiliation(s)
- Kelsey S Dickson
- San Diego State University, San Diego, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
| | - Teresa Lind
- San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
| | - Allison Jobin
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
- California State University, San Marcos, USA
| | | | - Ho Lok
- San Diego State University, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- University of California, San Diego, USA
- Rady Children's Hospital-San Diego, San Diego, USA
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Technology-Based Assessments and Treatments of Anxiety in Autistic Individuals: Systematic Review and Narrative Synthesis. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00275-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractThis systematic review (Prospero Registration Number: CRD42019142910) aimed to narratively synthesise technology-aided assessments and treatments of anxiety in individuals with autism spectrum disorder (ASD) for the first time. Sixteen studies were identified: 5 assessment studies and 11 treatment studies. Assessment studies targeted state anxiety using ecological momentary assessment, wearables, or computerised tasks. Treatment studies targeted specific fears/phobias using electronic screen media or transdiagnostic anxiety using telemedicine. Broadly, results indicated technology-aided assessments and treatments may be feasible and effective at targeting anxiety in ASD, except treatments involving social scripts or peer modelling. Assessment results further indicated that state anxiety in ASD has a distinct psychophysiological signature and is evoked by idiosyncratic triggers. However, larger scale studies with representative samples are needed.
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Parent-mediated intervention delivered through telehealth for children with autism spectrum disorder. Hippokratia 2021. [DOI: 10.1002/14651858.cd014793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
Pediatric rehabilitation focuses on optimizing function and quality of life of children through a holistic and transdisciplinary patient-centered team approach. This article describes the incorporation of telehealth in pediatric rehabilitation and its growth over the past decade. It also reviews the experience of practitioners using telehealth by necessity during the 2020 COVID-19 pandemic. Evidence suggests many applications where telehealth can appropriately substitute for traditional in-person visits, and there are many potential applications of telehealth to be explored as a means to enhance connectivity of the interdisciplinary rehabilitation team and the outreach to patients in remote and underserved areas.
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Affiliation(s)
- Nancy Hsu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Health Sciences, 1223 E Marshall Street, Richmond, VA 23298, USA
| | - Eugenio Monasterio
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Health Sciences, Children's Hospital of Richmond at VCU, Children's Pavilion, 1000 E Broad Street, Richmond, VA 23219, USA
| | - Olivier Rolin
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Health Sciences, Children's Hospital of Richmond at VCU, Children's Pavilion, 1000 E Broad Street, Richmond, VA 23219, USA.
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Conducting CBT for Anxiety in Children with Autism Spectrum Disorder During COVID-19 Pandemic. J Autism Dev Disord 2021; 51:4239-4247. [PMID: 33385281 PMCID: PMC7775616 DOI: 10.1007/s10803-020-04845-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 02/07/2023]
Abstract
This commentary describes the transition to remote delivery of cognitive-behavioral therapy (CBT) for anxiety in children with autism spectrum disorder (ASD) who participates in a clinical trial during the COVID-19 pandemic. The effects of COVID-19 on children’s anxiety and on the family functioning are discussed. Modifications to CBT necessitated by telehealth delivery were aimed at maximizing engagement of children and their parents while maintaining treatment fidelity and adhering to the research protocol. Treatment targets were updated to address new sources of anxiety and CBT exposure exercises were modified to accommodate the new reality of quarantine restrictions. If the COVID-19 pandemic continues to affect treatment delivery it may require a widespread utilization of telehealth for treating anxiety in children with ASD.
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Telehealth cognitive behavioral therapy for insomnia in children with autism spectrum disorder: A pilot examining feasibility, satisfaction, and preliminary findings. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 25:667-680. [DOI: 10.1177/1362361320949078] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Insomnia is common in children with autism. Cognitive behavioral treatment for childhood insomnia may improve sleep and functioning in children with autism and their parents, but delivery involving multiple office visits limits accessibility. This single-arm pilot study tested telehealth delivery of eight-session cognitive behavioral treatment for childhood insomnia in 17 children (6–12 years) with autism spectrum disorder and insomnia and their parent(s). Treatment integrity was assessed each session ( delivery, by therapist; receipt, participant understanding; and enactment, home practice). Treatment satisfaction was assessed after treatment. Children and parents wore actigraphs and completed electronic diaries for 2 weeks, children completed 5-min Holter Monitoring (assessed heart rate variability, physiological arousal indicator), and parents completed Aberrant Behavior Checklist before and after 1 month. Average integrity scores were high (98%, delivery; 93%, receipt; and 82%, enactment). Parents found cognitive behavioral treatment for childhood insomnia helpful, age-appropriate, and autism-friendly. Paired-samples t-tests (family-wise error controlled) indicated telehealth cognitive behavioral treatment for childhood insomnia improved child and parent sleep ( objective and subjective) and functioning (child—decreased irritability, lethargy, stereotypy, hyperactivity; parent—decreased fatigue). At 1 month, inappropriate speech also decreased, but hyperactivity was no longer decreased. Other gains were maintained. Most children demonstrated reduced arousal following treatment. This pilot shows telehealth cognitive behavioral treatment for childhood insomnia is feasible and may improve child and parent sleep, child behavior and arousal, and parent fatigue. A randomized controlled trial of telehealth cognitive behavioral treatment for childhood insomnia for children with autism is needed. Lay abstract Insomnia is common in children with autism. Cognitive behavioral treatment for childhood insomnia (CBT-CI) may improve sleep and functioning in children with autism and their parents, but typical delivery involving multiple office visits can make it difficult for some children to get this treatment. This pilot study tested telehealth delivery of CBT-CI using computers, which allowed children and their parents to get the treatment at home. This pilot shows therapists that parents and children were able to use telehealth CBT-CI to improve child and parent sleep, child behavior and arousal, and parent fatigue. Parents found telehealth CBT-CI helpful, age-appropriate, and autism-friendly. Telehealth CBT-CI holds promise for treating insomnia in school-aged children with autism and deserves further testing.
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Poba-Nzaou P, Uwizeyemungu S, Liu X. Adoption and Performance of Complementary Clinical Information Technologies: Analysis of a Survey of General Practitioners. J Med Internet Res 2020; 22:e16300. [PMID: 32706715 PMCID: PMC7413273 DOI: 10.2196/16300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 04/12/2020] [Accepted: 05/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background The benefits from the combination of 4 clinical information systems (CISs)—electronic health records (EHRs), health information exchange (HIE), personal health records (PHRs), and telehealth—in primary care depend on the configuration of their functional capabilities available to clinicians. However, our empirical knowledge of these configurations and their associated performance implications is very limited because they have mostly been studied in isolation. Objective This study aims to pursue 3 objectives: (1) characterize general practitioners (GPs) by uncovering the typical profiles of combinations of 4 major CIS capabilities, (2) identify physician and practice characteristics that predict cluster membership, and (3) assess the variation in the levels of performance associated with each configuration. Methods We used data from a survey of GPs conducted throughout the European Union (N=5793). First, 4 factors, that is, EHRs, HIE, PHRs, and Telehealth, were created. Second, a cluster analysis helps uncover clusters of GPs based on the 4 factors. Third, we compared the clusters according to five performance outcomes using an analysis of variance (ANOVA) and a Tamhane T2 post hoc test. Fourth, univariate and multivariate multinomial logistic regressions were used to identify predictors of the clusters. Finally, with a multivariate multinomial logistic regression, among the clusters, we compared performance in terms of the number of patients treated (3 levels) over the last 2 years. Results We unveiled 3 clusters of GPs with different levels of CIS capability profiles: strong (1956/5793, 37.36%), medium (2764/5793, 47.71%), and weak (524/5793, 9.04%). The logistic regression analysis indicates that physicians (younger, female, and less experienced) and practice (solo) characteristics are significantly associated with a weak profile. The ANOVAs revealed a strong cluster associated with significantly high practice performance outcomes in terms of the quality of care, efficiency, productivity, and improvement of working processes, and two noncomprehensive medium and weak profiles associated with medium (equifinal) practice performance outcomes. The logistic regression analysis also revealed that physicians in the weak profile are associated with a decrease in the number of patients treated over the last 2 years. Conclusions Different CIS capability profiles may lead to similar equifinal performance outcomes. This underlines the importance of looking beyond the adoption of 1 CIS capability versus a cluster of capabilities when studying CISs. GPs in the strong cluster exhibit a comprehensive CIS capability profile and outperform the other two clusters with noncomprehensive profiles, leading to significantly high performance in terms of the quality of care provided to patients, efficiency of the practice, productivity of the practice, and improvement of working processes. Our findings indicate that medical practices should develop high capabilities in all 4 CISs if they have to maximize their performance outcomes because efforts to develop high capabilities selectively may only be in vain.
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Affiliation(s)
- Placide Poba-Nzaou
- Department of Organization and Human Resources, University of Quebec in Montreal, Montreal, QC, Canada
| | - Sylvestre Uwizeyemungu
- Accounting Department, University of Quebec in Trois-Rivières, Trois-Rivières, QC, Canada
| | - Xuecheng Liu
- Statistics Department, 12M Statistical Consulting Services, Montreal, QC, Canada
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Phase 2 and Later of COVID-19 Lockdown: Is it Possible to Perform Remote Diagnosis and Intervention for Autism Spectrum Disorder? An Online-Mediated Approach. J Clin Med 2020; 9:jcm9061850. [PMID: 32545809 PMCID: PMC7357157 DOI: 10.3390/jcm9061850] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 01/23/2023] Open
Abstract
COVID-19 is still in phase 2. The lockdown has been significantly reduced compared to phase 1. The centers and institutions that deal with the diagnosis and intervention of children with autism spectrum disorder (ASD) require rapid functional adaptation to respond to patients’ needs. The possibility of using technology to activate and manage diagnostic (preliminary diagnosis) and intervention processes should be explored. Two developed telemedicine working models for diagnosis and intervention, including synchronous and asynchronous transmissions, are presented. They are proposals not yet supported by the data. The diagnosis step is composed by two different and consecutives phases: (A) pre-specialistic consultation (PSC) and (B) specialistic assessment. The intervention step implemented well-recognized evidence-based models for preschoolers, school-aged, and older children in an online format. Parents’ support is also included. The described working models have the purpose of carrying out preliminary specialistic answers to the families without aiming to replace preferable in-person assessment. Based on previous research findings, the telemedicine approach is accepted by parents, increases their sense of competence, increases the parent intervention adhesion, and improves the social communication competencies for children with ASD. In conclusion, the presented working models must be considered partial responses to the current emergency status and at the same time as possible integrations into traditional approaches.
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Hillman K, Dix K, Ahmed K, Lietz P, Trevitt J, O'Grady E, Uljarević M, Vivanti G, Hedley D. Interventions for anxiety in mainstream school-aged children with autism spectrum disorder: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2020; 16:e1086. [PMID: 37131419 PMCID: PMC8356281 DOI: 10.1002/cl2.1086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Kylie Hillman
- Australian Council for Educational ResearchCamberwellVictoriaAustralia
| | - Katherine Dix
- Australian Council for Educational ResearchAdelaideSouth AustraliaAustralia
| | - Kashfee Ahmed
- Australian Council for Educational ResearchAdelaideSouth AustraliaAustralia
| | - Petra Lietz
- Australian Council for Educational ResearchAdelaideSouth AustraliaAustralia
| | - Jenny Trevitt
- Australian Council for Educational ResearchCamberwellVictoriaAustralia
| | - Elizabeth O'Grady
- Australian Council for Educational ResearchCamberwellVictoriaAustralia
| | - Mirko Uljarević
- Division of Child and Adolescent Psychiatry, Stanford Autism Center, Department of Psychiatry and Behavioral Sciences, School of MedicineStanford UniversityPalo AltoCalifornia
| | - Giacomo Vivanti
- A. J. Drexel Autism InstituteDornsife School of Public Health, Drexel UniversityPhiladelphiaPennsylvania
| | - Darren Hedley
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, College of Science, Health and EngineeringLaTrobe UniversityBundooraVictoriaAustralia
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Lake JK, Tablon Modica P, Chan V, Weiss JA. Considering efficacy and effectiveness trials of cognitive behavioral therapy among youth with autism: A systematic review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1590-1606. [PMID: 32423224 DOI: 10.1177/1362361320918754] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
LAY ABSTRACT Cognitive behavioral therapy is a common treatment for emotional problems in people with autism. Most studies of cognitive behavioral therapy and autism have focused on efficacy, meaning whether a treatment produces results under "ideal" conditions, like a lab or research setting. Effectiveness trials, by contrast, investigate whether a treatment produces results under "real-world" conditions, like a community setting (e.g. hospital, community mental health center, school). There can be challenges in bringing a cognitive behavioral therapy treatment out of a lab or research setting into the community, and the field of implementation science uses frameworks to help guide researchers in this process. In this study, we reviewed efficacy and effectiveness studies of cognitive behavioral therapy treatments for emotional problems (e.g. anxiety, depression) in children and youth with autism. Our search found 2959 articles, with 33 studies meeting our criteria. In total, 13 studies were labelled as effectiveness and 20 as efficacy. We discuss how the effectiveness studies used characteristics of an implementation science framework, such as studying how individuals learn about the treatment, accept or reject it, how it is used in the community over time, and any changes that happened to the individual or the organization (e.g. hospital, school, community mental health center) because of it. Results help us better understand the use of cognitive behavioral therapy in the community, including how a framework can be used to improve effectiveness studies.
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Affiliation(s)
- Johanna K Lake
- Centre for Addiction and Mental Health, Canada.,University of Toronto, Canada
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Slaughter AM, McNeel MM, Storch EA, Mire SS. Where should we go from here? Identified gaps in the literature in psychosocial interventions for youth with autism spectrum disorder and comorbid anxiety. CHILDRENS HEALTH CARE 2020. [DOI: 10.1080/02739615.2020.1756818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Alexandra M. Slaughter
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - Morgan M. McNeel
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sarah S. Mire
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
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Telehealth Approaches to Care Coordination in Autism Spectrum Disorder. INTERPROFESSIONAL CARE COORDINATION FOR PEDIATRIC AUTISM SPECTRUM DISORDER 2020. [PMCID: PMC7310994 DOI: 10.1007/978-3-030-46295-6_19] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
This chapter examines the current literature regarding the use of telehealth, and its potential benefits and limitations for diagnosis, treatment, and coordination of care for children diagnosed with Autism Spectrum Disorder (ASD). Barriers to access drive the need to have telehealth as a modality for delivering evidence-based diagnostic and therapeutic processes, which can be impactful in improving developmental trajectories and functional outcomes. The chapter concludes with guidance for clinicians interested in leveraging telehealth, with directions elucidated to further advance the use of telehealth to support families with ASD. More recently, in light of Coronavirus disease 2019 (COVID-19) pandemic and social distancing guidelines and restrictions, this chapter highlights changes in telehealth policy and the use of telehealth for diagnosis and treatment of ASD as well as thoughts about future directions.
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Kaonga NN, Morgan J. Common themes and emerging trends for the use of technology to support mental health and psychosocial well-being in limited resource settings: A review of the literature. Psychiatry Res 2019; 281:112594. [PMID: 31605874 DOI: 10.1016/j.psychres.2019.112594] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 09/29/2019] [Accepted: 09/29/2019] [Indexed: 12/19/2022]
Abstract
There are significant disparities in access to mental health care. With the burgeoning of technologies for health, digital tools have been leveraged within mental health and psychosocial support programming (eMental health). A review of the literature was conducted to understand and identify how eMental health has been used in resource-limited settings in general. PubMed, Ovid Medline and Web of Science were searched. Six-hundred and thirty full-text articles were identified and assessed for eligibility; of those, 67 articles met the inclusion criteria and were analyzed. The most common mental health use cases were for depression (n = 25) and general mental health and well-being (n = 21). Roughly one-third used a website or Internet-enabled intervention (n = 23) and nearly one-third used an SMS intervention (n = 22). Technology was applied to enhance service delivery (n = 32), behavior change communication (n = 26) and data collection (n = 8), and specifically dealt with adherence (n = 7), ecological momentary assessments (n = 7), well-being promotion (n = 5), education (n = 8), telemedicine (n = 28), machine learning (n = 5) and games (n = 2). Emerging trends identified wearables, predictive analytics, robots and virtual reality as promising areas. eMental health interventions that leverage low-tech tools can introduce, strengthen and expand mental health and psychosocial support services and can be a starting point for future, advanced tools.
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Affiliation(s)
- Nadi Nina Kaonga
- HealthEnabled, Cape Town, South Africa; Tufts University School of Medicine, Boston, MA, United States; Maine Medical Center, Portland, ME, United States.
| | - Jonathan Morgan
- Regional Psychosocial Support Initiative (REPSSI), Cape Town, South Africa.
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Qin D, Du W, Sha S, Parkinson A, Glasgow N. Hospital psychosocial interventions for patients with brain functional impairment: A retrospective cohort study. Int J Ment Health Nurs 2019; 28:1152-1161. [PMID: 31257721 DOI: 10.1111/inm.12627] [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: 06/02/2019] [Indexed: 11/30/2022]
Abstract
Psychosocial interventions could improve health and care outcomes, however, little is known about their use for patients with complex needs in the acute hospital care setting. This study aimed to evaluate factors associated with psychosocial intervention use when treating patients with brain functional impairment during their hospital care. The all-inclusive New South Wales (NSW) Admitted Patient Data were employed to identify patients with neurodevelopment disorders, brain degenerative disorders, or traumatic brain injuries admitted to NSW public hospitals for acute care from July 2001 to June 2014. We considered receipt of psychosocial interventions as the primary outcome, and used mixed effect logistic models to quantify factors in relation to outcome. Of important note, psychosocial intervention use was more common in principal hospitals, and amongst those receiving intensive care or having comorbid mental disorders in the study populations. Approximate 70.8% of patients with traumatic brain injuries did not receive psychosocial interventions, despite attempts to target those in need and an overall increasing trend in adoption. Continuing efforts are warranted to improve service delivery and uptake.
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Affiliation(s)
- Danling Qin
- Department of Health Services Research & Policy, Australian National University, Canberra, ACT, Australia
| | - Wei Du
- Department of Health Services Research & Policy, Australian National University, Canberra, ACT, Australia
| | - Sha Sha
- Department of Health Services Research & Policy, Australian National University, Canberra, ACT, Australia
| | - Anne Parkinson
- Department of Health Services Research & Policy, Australian National University, Canberra, ACT, Australia
| | - Nicholas Glasgow
- Department of Health Services Research & Policy, Australian National University, Canberra, ACT, Australia
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50
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Blacher J, Baker BL. Collateral Effects of Youth Disruptive Behavior Disorders on Mothers' Psychological Distress: Adolescents with Autism Spectrum Disorder, Intellectual Disability, or Typical Development. J Autism Dev Disord 2019; 49:2810-2821. [PMID: 29071563 DOI: 10.1007/s10803-017-3347-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Disruptive behavior disorders were assessed in 160 youth aged 13 years, with Autism Spectrum Disorder (ASD, n = 48), intellectual disability (ID, n = 28), or typical development (TD, n = 84). Mothers' reported collateral effects on their psychological adjustment were related to both youth disability status and clinical level behavior disorders. More youth with ASD or ID had clinical level behavior disorders than their TD peers, and their mothers reported significantly higher personal stress and psychological symptoms, as well as lower positive impact of the youth on the family. The youth's clinical level behavior disorders accounted for these differences more than the diagnostic status. Mothers high in dispositional optimism reported the lowest stress and psychological symptoms in relationship to youth behavior challenges.
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Affiliation(s)
- Jan Blacher
- Graduate School of Education, University of California, UCR, Sproul Hall, Riverside, CA, 92521, USA.
| | - Bruce L Baker
- Department of Psychology, University of California, Los Angeles (UCLA), Franz Hall, Los Angeles, CA, 90095, USA
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