Can Participation in a Community Organized Football Program Improve Social, Behavioural Functioning and Communication in Children with Autism Spectrum Disorder? A Pilot Study

This pilot research investigated the effects of a community-based organized football program on behavioral, social and communicative outcomes in children with Autism Spectrum Disorder. In a non-randomized design, 19 children completed the football program and were compared pre- and post-intervention with 21 children who received no comparable intervention (ages 5-12 years). Caregiver-report using the child behavior checklist indicated a significant decrease in total, internalizing, DSM-oriented anxiety and social problems for children who participated in the program, with no change in the comparison group. There were no group differences in socialization and communication scores on the Vineland Adaptive Behavior scale. Results provide preliminary evidence in support of the program, justifying the need for further, more rigorous trials in this area.

The Role of Diagnostic Instruments in Dual and Differential Diagnosis in Autism Spectrum Disorder Across the Lifespan

The heterogeneity inherent in autism spectrum disorder (ASD) makes the identification and diagnosis of ASD complex. We survey a large number of diagnostic tools, including screeners and tools designed for in-depth assessment. We also discuss the challenges presented by overlapping symptomatology between ASD and other disorders and the need to determine whether a diagnosis of ASD or another diagnosis best explains the individual's symptoms. We conclude with a call to action for the next steps necessary for meeting the diagnostic challenges presented here to improve the diagnostic process and to help understand each individual's particular ASD profile.

The Role of Diagnostic Instruments in Dual and Differential Diagnosis in Autism Spectrum Disorder Across the Lifespan

The heterogeneity inherent in autism spectrum disorder (ASD) makes the identification and diagnosis of ASD complex. We survey a large number of diagnostic tools, including screeners and tools designed for in-depth assessment. We also discuss the challenges presented by overlapping symptomatology between ASD and other disorders and the need to determine whether a diagnosis of ASD or another diagnosis best explains the individual's symptoms. We conclude with a call to action for the next steps necessary for meeting the diagnostic challenges presented here to improve the diagnostic process and to help understand each individual's particular ASD profile.

Parental criticism and behavior problems in children with autism spectrum disorder

Associations between parent critical attitudes (a component of the Expressed Emotion construct) and behavior problems have been relatively well established in adolescents and young adults with autism spectrum disorder, but use of systems adapted for children with autism spectrum disorder and additional investigations with younger samples are needed. This study examined parental criticism, derived from a population-specific coding system, as related to behavior problems in children with autism spectrum disorder between the ages of 4 and 11 years, and considered parental warmth and children's psychophysiological reactivity as statistical moderators of these associations. In all, 40 children with autism spectrum disorder and their primary caregivers attended a visit involving collection of child electrodermal activity, parent-child interaction, a parent interview from which critical attitudes and warmth were coded, and parent report of child behavior problems. Criticism was directly related to higher child externalizing but not internalizing problems. Parental criticism interacted with warmth in the prediction of internalizing problems such that criticism was only associated with more problems in the context of moderate but not high warmth. Criticism was positively associated with externalizing problems under conditions of moderate and high, but not low, child electrodermal activity reactivity. Implications for conceptualizations of parental criticism in autism spectrum disorder, for understanding comorbid behavior problems in this population, and for intervention are discussed.

Problem Behavior in Autism Spectrum Disorder: Considering Core Symptom Severity and Accompanying Sleep Disturbance

In addition to the core symptoms that define autism spectrum disorder (ASD), many individuals experience broader problem behavior at a level significant enough for families to seek further clinical assessment and intervention. We define "problem behavior" as any significant emotional or behavioral issue captured by the Child Behavior Checklist (CBCL) including anxiety, depression, withdrawal, somatic complaints, problems with socialization, thought or attention, rule-breaking, and aggression. While greater ASD symptom severity and accompanying sleep disturbance have each been linked with more severe problem behavior, there is little understanding about how these two key factors interact; that is, it is unclear whether the severity and type of sleep disturbance an individual experiences differentially influences the relationship between ASD symptom severity and problem behavior. The aim of the current study was, thus, to explore whether the link between greater ASD symptom severity and clinically elevated problem behavior is moderated by the presence/degree of accompanying sleep disturbance. Forty males with ASD, aged 5-12, participated in the study. The Social Responsiveness Scale, CBCL, and Children's Sleep Habits Questionnaire were administered to obtain information about ASD symptom severity, problem behavior, and sleep habits, respectively. Results indicated that the relationship between ASD symptom severity and problem behavior differed among individuals with ASD depending on the degree of sleep disturbance they experienced. Specifically, there was a significant positive relationship between ASD symptom severity and problem behavior for individuals with no sleep disturbance or milder sleep disturbance (i.e., in these cases, individuals with severe ASD symptoms experienced clinically elevated problem behavior, while those with milder ASD symptoms experienced milder problem behavior). In contrast, there was no significant relationship between ASD symptom severity and problem behavior for individuals with moderate-to-severe sleep disturbance; rather, clinically significant problem behavior was apparent across all individuals irrespective of ASD symptom severity. Follow-up analyses indicated that disturbances in sleep duration, disordered breathing, and daytime sleepiness were related to clinically elevated problem behavior even among those with milder ASD symptoms. These findings emphasize the importance of routinely assessing for accompanying sleep disturbance in this population regardless of whether individuals present with mild, moderate, or severe ASD.

Sympathetic Under-Arousal and Externalizing Behavior Problems in Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) commonly exhibit co-occurring externalizing behavior problems, which can impede learning opportunities and contribute significantly to caregiver stress. Substantial theory and research has linked under-arousal of the sympathetic nervous system to increased externalizing problems in children without ASD, but under-arousal has not been considered as an explanatory mechanism for individual differences among children with ASD. We tested the notion that lower electrodermal activity (EDA) would predict more externalizing problems in children with ASD, and considered the degree to which parent co-regulatory support could buffer this risk. Forty children with ASD between the ages of 4 and 11 years and their primary caregivers participated in a laboratory visit that included various play, compliance, and problem-solving regulatory tasks. EDA was measured through wireless wrist sensors, parental scaffolding was observed during a dyadic problem-solving task, and parents rated their children's externalizing behavior problems. As predicted, low EDA during the compliance-oriented tasks directly predicted higher child externalizing problems. Parental scaffolding moderated the link between under-arousal during the problem-solving regulatory tasks and externalizing problems such that the relation was observed in the context of low, but not high, support. Implications for relevant theories (e.g., fearlessness theory, stimulation-seeking theory) are discussed, and the potential for psychophysiological patterns to inform intervention with these children is considered.

Parent, Teacher, and Self-Report of Problem and Adaptive Behaviors in Children and Adolescents with Asperger Syndrome

The present study examined perceptions of the social problems and adaptive behaviors of children and youth with Asperger Syndrome. Parents and teachers used the Behavior Assessment System for Children (BASC) (Reynolds & Kamphaus, 1992) to evaluate 20 children and youth with Asperger Syndrome. In addition, the 20 students using the BASC self-report instrument evaluated their social problems and adaptive behavior. Findings are discussed relative to better understanding and planning for the needs of children and youth with Asperger Syndrome and their families.

Errorless Compliance Training

Errorless compliance training is a noncoercive, success-focused approach to treatment of problem behavior in children. The intervention involves graduated exposure of a child to increasingly more challenging requests at a slow enough rate to ensure that noncompliance rarely occurs, providing parents with many opportunities to reinforce cooperative responses and rendering punishment unnecessary. The authors evaluated this approach with three boys with characteristics of Asperger syndrome. Mothers first delivered a range of requests to their children and recorded child responses. For each child, the authors calculated compliance probability for all requests and categorized them into four probability levels, from those yielding high compliance (Level 1) to those that commonly led to opposition (Level 4). Treatment began with delivery of Level 1 requests. Requests from Levels 2 through 4 were faded in sequentially over several weeks. All three children demonstrated substantial generalized improvement in compliance.

MMPI-2 Personality Profiles of High-Functioning Adults With Autism Spectrum Disorders

The Minnesota Multiphasic Personality Inventory-Second Edition was administered to 20 adults with autism spectrum disorders (ASD) who fell in the average to above average range of intelligence and 24 age-, intelligence-, and gender-matched college students. Large group differences, with the ASD group scoring higher, were found on the L validity scale, Clinical Scales 2 (D) and 0 (Si), Content scale Social Discomfort (SOD), Supplementary scale Repression (R), and Personality Psychopathology Five (PSY-5) scale INTR (Introversion). The proportion of ASD adults scoring in the clinical range on these scales was between 25% and 35%. High scores on these scales are consistent with the clinical picture of Asperger syndrome and high-functioning autism in adulthood. Future directions and implications for identifying adults in need of a specialized autism assessment are discussed.

Brief Report: The Association of Autistic Traits and Behavioural Patterns in Adolescents Receiving Special Educational Assistance

INTRODUCTION

The study aim was to describe behaviours associated with autistic traits.

METHODS

The Childhood Behaviour Checklist (CBCL) and Social Communication Questionnaire (SCQ) were used as measures of behaviour and autistic traits respectively in 331 adolescents receiving educational support. CBCL scores were compared between three groups defined by SCQ score: autism, pervasive developmental disorder (PDD) and non-PDD.

RESULTS

The PDD and autism groups had significantly higher scores on the CBCL than the non-PDD group across all CBCL scales except Delinquent Behaviour. On seven of the eight scales, there was no difference between the autism and PDD groups.

CONCLUSION

Those with PDD or autism display significantly higher levels of withdrawal, somatic complaints, anxiety/depression, social, thought and attention problems, and aggressive behaviour.

The effects of a course of intranasal oxytocin on social behaviors in youth diagnosed with autism spectrum disorders: a randomized controlled trial

BACKGROUND

There is increasing interest in oxytocin as a therapeutic to treat social deficits in autism spectrum disorders (ASD). The aim of this study was to investigate the efficacy of a course of oxytocin nasal spray to improve social behavior in youth with ASD.

METHODS

In a double-blind, placebo-controlled trial across two Australian university sites between February 2009 and January 2012, 50 male participants aged between 12 and 18 years, with Autistic or Asperger's Disorder, were randomized to receive either oxytocin (n = 26) or placebo (n = 24) nasal sprays (either 18 or 24 International Units), administered twice-daily for 8 weeks. Participants were assessed at baseline, after 4- and 8-weeks of treatment, and at 3-month follow-up. Primary outcomes were change in total scores on the caregiver-completed Social Responsiveness Scale and clinician-ratings on the Clinical Global Impressions-Improvement scale. Secondary assessments included caregiver reports of repetitive and other developmental behaviors and social cognition.

CLINICAL TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry www.anzctr.org.au ACTRN12609000513213.

RESULTS

Participants who received oxytocin showed no benefit following treatment on primary or secondary outcomes. However, caregivers who believed their children received oxytocin reported greater improvements compared to caregivers who believed their child received placebo. Nasal sprays were well tolerated and there was no evidence of increased side effects resulting from oxytocin administration.

CONCLUSIONS

This is the first evaluation of the efficacy for a course of oxytocin treatment for youth with ASD. Although results did not suggest clinical efficacy, further research is needed to explore alternative delivery methods, earlier age of intervention, and the influence of caregiver expectation on treatment response.

Coping, daily hassles and behavior and emotional problems in adolescents with high-functioning autism/Asperger's Disorder

Although daily hassles and coping are associated with behavior and emotional problems in non-clinical populations, few studies have investigated these relationships in individuals with high-functioning autism/Asperger's Disorder (HFASD). This study examined the relationships between daily hassles, coping and behavior and emotional problems in adolescents with HFASD. Thirty-one adolescents with HFASD completed questionnaires assessing their coping and behavior and emotional problems, and completed an Ecological Momentary Assessment run via a mobile phone application on their coping and daily hassles. Parents completed questionnaires of the adolescents' daily hassles, coping, and behavior and emotional problems. The disengagement coping style was associated with significantly higher levels of behavior and emotional problems regardless of respondent or methodology, suggesting it may be a valuable target for intervention.

Asperger's disorder will be back

This review focuses on identifying up-to-date number of publications that compared DSM-IV/ICD-10 Asperger's disorder (AspD) to Autistic Disorder/High-functioning Autism (AD/HFA). One hundred and twenty-eight publications were identified through an extensive search of major electronic databases and journals. Based on more than 90 clinical variables been investigated, 94 publications concluded that there were statistically significant or near significant level of quantitative and/or qualitative differences between AspD and AD/HFA groups; 4 publications found both similarities and differences between the two groups; 30 publications concluded with no differences between the two groups. Although DSM-5 ASD will eliminate Asperger's disorder. However, it is plausible to predict that the field of ASD would run full circle during the next decade or two and that AspD will be back in the next edition of DSM.

Mental health services for individuals with high functioning autism spectrum disorder

Adolescents and adults with an autism spectrum disorder (ASD) who do not have an intellectual impairment or disability (ID), described here as individuals with high-functioning autism spectrum disorder (HFASD), represent a complex and underserved psychiatric population. While there is an emerging literature on the mental health needs of children with ASD with normal intelligence, we know less about these issues in adults. Of the few studies of adolescents and adults with HFASD completed to date, findings suggest that they face a multitude of cooccurring psychiatric (e.g., anxiety, depression), psychosocial, and functional issues, all of which occur in addition to their ASD symptomatology. Despite this, traditional mental health services and supports are falling short of meeting the needs of these adults. This review highlights the service needs and the corresponding gaps in care for this population. It also provides an overview of the literature on psychiatric risk factors, identifies areas requiring further study, and makes recommendations for how existing mental health services could include adults with HFASD.

The making of a field: the development of comorbid psychopathology research for persons with intellectual disabilities and autism

Knowledge in the area of developmental disabilities has been expanding rapidly. One area that has received particular attention is the topic of related comorbid conditions. This phenomenon is not exclusive to the field of developmental disabilities. However, research with this population is of recent origin. The purpose of this paper is to review the origins of this field including some of the notable developments and potential future trends.

Psychopathology trajectories of children with autism spectrum disorder: the role of family poverty and parenting

OBJECTIVE

Children with autism spectrum disorder (ASD) are reported to have high rates of co-occurring psychopathology. Little is known about risk factors that might contribute to this psychopathology. This study modeled the effect of family poverty on psychopathology trajectories in young children with ASD, and examined whether home organization and maternal warmth and involvement could buffer the effect of poverty on children's psychopathology.

METHOD

The sample comprised 209 children with ASD who participated in the UK's Millennium Cohort Study, a population birth cohort study. Individual trajectories of psychopathology at ages 3, 5, and 7 years were analyzed using growth curve models. Psychopathology was assessed with the Strengths and Difficulties Questionnaire.

RESULTS

Children with ASD exhibited increasingly high rates of psychopathology over time. Family poverty was associated with broad and specific (emotional and conduct problems) psychopathology, but not with changes in psychopathology over time. Warmth, involvement, and home organization did not buffer the association of family poverty with psychopathology. However, low warmth explained the relationship between poverty and broad psychopathology, and predicted annual changes in broad psychopathology. Warmth was associated with fewer conduct problems and less hyperactivity, and with an annual decrease in peer and conduct problems. Household chaos was a risk factor for conduct problems, as was maternal involvement for peer problems.

CONCLUSIONS

Family poverty, low maternal warmth, and household chaos are risk factors for externalizing problems in children with ASD. Maternal warmth may be a key target for intervention, particularly in poorer families of children with ASD.

Parent–Child Interaction Therapy for the Treatment of Asperger’s Disorder in Early Childhood

Almost half of all children diagnosed with Asperger’s disorder (ASP) present with comorbid behavioral difficulties associated with attention deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, obsessive-compulsive disorder, and generalized anxiety disorders. Children with ASP often are noncompliant, aggressive, and difficult for parents to manage, which may prevent these children from participating in school and community activities, thus contributing to reduced opportunities for development of important skills. Finding effective interventions to treat these behavioral issues remains a clinical priority to improve overall outcomes for these children. This case study presents the treatment of a 5-year-old boy with ASP and severe behavior problems using Parent–Child Interaction Therapy, an empirically supported behavioral parenting intervention developed for young children with disruptive behavior disorders. Findings from this case report documented (a) an improvement in behavioral functioning that was maintained at follow-up and (b) provided support for utilizing this evidenced-based treatment to improve functioning of young children with ASP and comorbid disruptive behavior disorders.

Cognitive Behaviour Therapy for Children and Adults with Asperger's Syndrome

Asperger's syndrome is a relatively newly diagnosed developmental disorder within the autistic spectrum. Children and adults with Asperger's syndrome have an intellectual ability within the normal range but due to their unusual profile of cognitive, social and emotional abilities are vulnerable to the development of a secondary mood disorder. This paper provides an explanation of the abilities associated with Asperger's syndrome, and modifications to cognitive behaviour therapy (CBT) for this very unusual client group. In particular, the paper emphasises the importance of affective education for this clinical population and describes a new strategy used in cognitive restructuring, namely, the emotional toolbox. The paper concludes with a brief description of a current evaluation study of the effectiveness of CBT to treat anxiety and anger in children who have Asperger's syndrome. However, the strategies described in this paper can also be used with adults with Asperger's syndrome and applied to other clinical populations.

Differential olfactory identification in children with autism and Asperger's disorder: a comparative and longitudinal study

Key theories of autism implicate orbitofrontal cortex (OFC) compromise, while olfactory identification (OI) deficits are associated with OFC dysfunction. This study aimed to complete a 5-year follow-up of children with high-functioning autism (HFA) who previously lacked the normal age-OI association; and compare unirhinal-OI in children with HFA, Asperger's disorder (ASP), and controls. While both HFA and controls had improved birhinal-OI at follow-up, reduced OI in some HFA participants suggested OFC deterioration and heterogeneous OFC development. Unirhinal-OI was impaired in HFA but not ASP relative to controls, suggesting orbitofrontal compromise in HFA but integrity in ASP. Differing IQ-OI relationships existed between HFA and ASP. Findings support the hypothesis of separate neurobiological underpinnings in ASP and HFA, specifically differential orbitofrontal functioning.

Motor proficiency and emotional/behavioural disturbance in autism and Asperger's disorder: another piece of the neurological puzzle?

The relationship of motor proficiency with emotional/behavioural disturbance, autistic symptoms and communication disturbance was investigated in children diagnosed with autism and Asperger's disorder (AD). The Movement Assessment Battery for Children was used as a measure of motor impairment, and the Developmental Behavioural Checklist was used as a measure of emotional/behavioural disturbance in the following groups: AD (n = 22), high functioning autism (HFA) (n = 23), LFA (n = 8) and typically developing children (n = 20). The HFA group had more difficulty with motor items, such as ball skills and balance, than did the AD group. There were significant positive correlations between impairments in motor proficiency (in particular ball skills and balance) and emotional/behavioural disturbance, autistic symptoms and communication disturbance. These findings are consistent with the hypothesis that there are qualitative and quantitative differences in the motor profile between autism and AD. In addition, the association between motor proficiency impairment and emotional/behavioural disturbance in autism and AD emphasizes the importance for screening of co-occurring emotional/behavioural symptoms in individuals with motor difficulties. These findings have implications for the potential use of adjunct motor measures in the diagnosis and definition of autism spectrum disorders.

Confusion and inconsistency in diagnosis of Asperger syndrome: a review of studies from 1981 to 2010

This paper presents a review of past and current research on the diagnosis of Asperger syndrome (AS) in children. It is suggested that the widely used criteria for diagnosing AS in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV are insufficient and invalid for a reliable diagnosis of AS. In addition, when these diagnostic criteria are applied, there is the potential bias of receiving a diagnosis towards the high-functioning end of the autism spectrum. Through a critical review of 69 research studies carried out between 1981 and 2010, this paper shows that six possible criteria for diagnosing AS (specifically, the age at which signs and symptoms related to autism become apparent, language and social communication abilities, intellectual abilities, motor or movement skills, repetitive patterns of behaviour and the nature of social interaction) overlap with the criteria for diagnosing autism. However, there is a possibility that some finer differences exist in the nature of social interaction, motor skills and speech patterns between groups with a diagnosis of AS and autism. These findings are proposed to be of relevance for designing intervention studies aimed at the treatment of specific symptoms in people with an autism spectrum disorder.

Greater disruption to control of voluntary saccades in autistic disorder than Asperger's disorder: evidence for greater cerebellar involvement in autism?

It remains unclear whether autism and Asperger's disorder (AD) exist on a symptom continuum or are separate disorders with discrete neurobiological underpinnings. In addition to impairments in communication and social cognition, motor deficits constitute a significant clinical feature in both disorders. It has been suggested that motor deficits and in particular the integrity of cerebellar modulation of movement may differentiate these disorders. We used a simple volitional saccade task to comprehensively profile the integrity of voluntary ocular motor behaviour in individuals with high functioning autism (HFA) or AD, and included measures sensitive to cerebellar dysfunction. We tested three groups of age-matched young males with normal intelligence (full scale, verbal, and performance IQ estimates >70) aged between 11 and 19 years; nine with AD, eight with HFA, and ten normally developing males as the comparison group. Overall, the metrics and dynamics of the voluntary saccades produced in this task were preserved in the AD group. In contrast, the HFA group demonstrated relatively preserved mean measures of ocular motricity with cerebellar-like deficits demonstrated in increased variability on measures of response time, final eye position, and movement dynamics. These deficits were considered to be consistent with reduced cerebellar online adaptation of movement. The results support the notion that the integrity of cerebellar modulation of movement may be different in AD and HFA, suggesting potentially differential neurobiological substrates may underpin these complex disorders.

Psychiatric disorders in individuals with high-functioning autism and Asperger's disorder: similarities and differences

OBJECTIVES

To investigate and compare the rate and type of psychiatric co-morbidity in individuals with diagnosis of high functioning autism (HFA) and Asperger's disorder (AS).

METHODS

This study includes 30 children and adolescents with diagnosis of HFA and 30 with diagnosis of AS. Diagnoses of HFA and AS were made using strict DSM-IV criteria. Psychiatric co-morbidity was assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL-T).

RESULTS

The rate of comorbid psychiatric disorders was very high in both groups (93.3% in HFA and 100% in AS). The most common disorder in both groups was attention deficit hyperactivity disorder. There was no statistically significant difference between groups in the rate of associated psychiatric disorders, except for major depressive disorder (P = 0.029) and ADHD-combined type (P = 0.030). The AS group displayed greater comorbidity with depressive disorders and ADHD-CT.

CONCLUSION

From a clinical perspective, it could be concluded that both disorders involve a high risk for developing psychiatric disorders, with AS patients at greater risk for depression. From a nosological perspective, the substantial similarities in terms of psychiatric comorbidity may support the idea that both disorders are on the same spectrum and differs in some aspects.

Categorical and dimensional structure of autism spectrum disorders: the nosologic validity of Asperger Syndrome

There is an ongoing debate whether a differentiation of autistic subtypes, especially between Asperger Syndrome (AS) and high-functioning-autism (HFA) is possible and if so, whether it is a categorical or dimensional one. The aim of this study was to examine the possible clustering of responses in different symptom domains without making any assumption concerning diagnostic appreciation. About 140 children and adolescents, incorporating 52 with a diagnosis of AS, 44 with HFA, 8 with atypical autism and 36 with other diagnoses, were examined. Our study does not support the thesis that autistic disorders are discrete phenotypes. On the contrary, it provides evidence that e.g. AS and autism are not qualitatively distinct disorders, but rather different quantitative manifestations of the same disorder.

Peer Victimization in Adolescents and Young Adults Diagnosed with Asperger's Syndrome: A Link to Depressive Symptomatology, Anxiety Symptomatology and Suicidal Ideation

The present exploratory study examined the level of peer victimization, depressive symptomatology, anxiety symptomatology, and level of suicidal ideation among adolescents and young adults diagnosed with Asperger's Syndrome (AS). This cross-sectional study used a self-administrated mail questionnaire and a Web-based questionnaire. The study included two samples. The first sample used snowball sampling, beginning with parents of adolescents and young adults diagnosed with AS who participated in a qualitative study conducted in 2002. The second sample consisted of a volunteer sample of parents who accessed Web sites for parents and individuals diagnosed with Autism Spectrum Disorder. A total sample of 10 adolescents and young adults diagnosed with AS was obtained. The high proportion of respondents with scores above the cutoff point on the overt victimization and relational victimization scales suggests that these adolescents and young adults experienced high levels of victimization. Of the sample, 20 percent met criteria for a diagnosis of Major Depressive Disorder, 30 percent met criteria for Generalized Anxiety Disorder and 50 percent had clinically significant level of suicidal ideation.

Anxiety in children and adolescents with autism spectrum disorders

Anxiety and poor stress management are common concerns in clinical samples of children with autism spectrum disorders (ASD). Anxiety may worsen during adolescence, as young people face an increasingly complex social milieu and often become more aware of their differences and interpersonal difficulties. This review summarizes the state of research on the prevalence, phenomenology, and treatment of anxiety in youth with autism and related conditions such as Asperger's Disorder. Using search words autism, asperger(s), or pervasive developmental disorder and anxiety or anxious to find reports published between 1990 and 2008, this review identified 40 papers. The results of the review suggest that anxiety, whether measured categorically or dimensionally, is indeed common in children and adolescents with autism spectrum disorders and may be a source of additional morbidity. The assessment of anxiety disorders in ASD should be conducted using multiple informants and modalities, as children with ASD often do not display age-typical symptoms of anxiety. To date, relatively few controlled intervention studies using well-characterized samples have been conducted despite preliminary evidence for efficacy of select pharmacological and psychosocial approaches. Recommendations for future applied research are presented and clinical implications are explored.

The effectiveness of parent-child interaction therapy for families of children on the autism spectrum

We report the results of a pilot trial of an evidence-based treatment-Parent-Child Interaction Therapy (PCIT; Eyberg et al. Psychopharmacology Bulletin, 31(1), 83-91, 1995) for boys aged 5-12 with high functioning autism spectrum disorders and clinically significant behavioral problems. The study also included an investigation of the role of shared positive affect during the course of therapy on child and parent outcomes. The intervention group showed reductions in parent perceptions of child problem behaviors and child atypicality, as well as an increase in child adaptability. Shared positive affect in parent child dyads and parent positive affect increased between the initial and final phases of the therapy. Parent positive affect after the first phase was related to perceptions of improvement in problem behaviors and adaptive functioning.

Examining the validity of autism spectrum disorder subtypes

The classification of autism spectrum disorders (ASDs) is a topic of debate among clinicians and researchers with many questioning the validity of the distinction among subtypes. This manuscript examines the validity of three ASD subtypes (Autism, Asperger's, and PDDNOS) by reviewing 22 studies published between 1994 and 2006. We reviewed studies that examined differences between the subtypes in terms of clinical and demographic characteristics, neuropsychological profiles, comorbidity, and prognosis. Results largely did not support differences between autism and Asperger's disorder based on current diagnostic criteria. Overall, the most salient group differences were noted when samples were categorized on IQ. Drawing definitive conclusions is difficult due to the inconsistent application of diagnostic criteria and circularity in methods.

Psychological and neurobehavioral comparisons of children with Asperger's Disorder versus High-Functioning Autism

This study investigated personality and neurobehavioral differences between 16 children with Asperger's Disorder, 15 children with High-Functioning Autism (HFA), and 31 controls, all ranging in age from 5-17 years, M age = 10.7 years, SD = 3.0. Parents rated their children's behaviors on a 44-item autistic symptoms survey and on the 200-item Coolidge Personality and Neuropsychological Inventory (Coolidge, Thede, Stewart, & Segal (2002a). The Coolidge Personality and Neuropsychological Inventory for Children (CPNI): Preliminary psychometric characteristics. Behavior Modification, 26, 550-566). The results indicated that the two clinical samples were significantly elevated on the Executive Function Deficits scale and Attention-Deficit/Hyperactivity Disorder (ADHD) scale compared to controls. There were more similarities than differences between the two clinical samples on the personality scales, although the Asperger's group scored significantly on the two scales with anxiety components.

Social skills and problem behaviours in school aged children with high-functioning autism and Asperger's Disorder

The social skills and problem behaviours of children with high-functioning autism and Asperger's Disorder were compared using parent and teacher reports on the Social Skills Rating System. The participants were 20 children with high-functioning autism, 19 children with Asperger's Disorder, and 17 typically developing children, matched on chronological and overall mental age. The children with autism and Asperger's Disorder were not differentiated on any social skill or problem behaviour based either on teacher or parent report. However, both clinical groups demonstrated significant social skill deficits and problem behaviours relative to the typically developing children, and the original standardization sample. The findings were compatible with the view that autism and Asperger's Disorder belong on a single spectrum of disorder.

Treating anxiety disorders in children with high functioning autism spectrum disorders: a controlled trial

A family-based, cognitive behavioural treatment for anxiety in 47 children with comorbid anxiety disorders and High Functioning Autism Spectrum Disorder (HFA) was evaluated. Treatment involved 12 weekly group sessions and was compared with a waiting list condition. Changes between pre- and post-treatment were examined using clinical interviews as well as child-, parent- and teacher-report measures. Following treatment, 71.4% of the treated participants no longer fulfilled diagnostic criteria for an anxiety disorder. Comparisons between the two conditions indicated significant reductions in anxiety symptoms as measured by self-report, parent report and teacher report. Discussion focuses on the implications for the use of cognitive behaviour therapy with HFA children, for theory of mind research and for further research on the treatment components.

Social attribution processes and comorbid psychiatric symptoms in children with Asperger syndrome

The factors that place children with Asperger syndrome at risk for comorbid psychiatric symptoms, such as anxiety and depression, remain poorly understood. We investigated the possibility that the children's emotional and behavioral difficulties are associated with social information and attribution processing. Participants were children with either Asperger syndrome (n = 31) or typical development (n = 33).To assess social information and attribution processing, children responded to hypothetical social vignettes. They also completed self-report measures of social difficulties and psychological functioning. Their parents provided information on social competence and clinical presentation. Children with Asperger syndrome showed poor psychosocial adjustment, which was related to their social information and attribution processing patterns. Cognitive and social-cognitive abilities were associated with aspects of social information processing tendencies, but not with emotional and behavioral difficulties. Results suggest that the comorbid symptoms of children with Asperger syndrome may be associated with their social perception, understanding, and experience.

Sleep Patterns of School-Age Children with Asperger Syndrome or High-Functioning Autism

Sleep patterns of 32 school-age children with Asperger syndrome (AS) and high-functioning autism (HFA) were compared to those of 32 typically developing age- and gender-matched children, using parent survey and one week of diary and actigraphic monitoring. Parents of children with AS/HFA more commonly reported that their children had difficulty falling asleep. One week of sleep recording with diary and actigraphy confirmed that children in the AS/HFA group spent a longer time awake in bed before falling asleep than children in the control group, possibly because the children in the AS/HFA group had earlier bedtimes. Other essential aspects of sleep patterns coincided between the groups. The sleep patterns of children with AS and HFA did not differ.

Affect Regulation and Temperament in Children with Autism Spectrum Disorder

Affect regulation (AR) and temperament were examined in children with Autism Spectrum Disorder (ASD). To determine AR, children were exposed to a mildly frustrating situation. Temperament was assessed by the Children's Behavior Questionnaire (CBQ). Children with ASD showed greater variability in AR and used less effective AR strategies compared to controls. Lower academic ability was associated with less effective AR strategies for the ASD while for the controls older age predicted more effective AR strategies. Those with ASD were lower than controls in Attention Focusing, Inhibitory Control, and Soothability. Of the three overarching temperament factors of the CBQ, only Effortful Control but not Negative Affectivity and Surgency/Extraversion distinguished those with ASD from controls. For the ASD group, higher academic ability predicted higher Negative Affectivity. Fewer symptoms and older chronological age predicted higher Effortful Control.

Response monitoring, the error-related negativity, and differences in social behavior in autism

Children with autism not only display social impairments but also significant individual differences in social development. Understanding the source of these differences, as well as the nature of social impairments, is important for improved diagnosis and treatments for these children. Current theory and research suggests that individual differences in response monitoring, a specific function of the anterior cingulate cortex (ACC), may contribute to social-emotional and social-cognitive impairments and individual differences in autism. To examine this hypothesis, we used a modified flanker task to assess an ERP index of response monitoring, the error-related negativity (ERN), in a sample of higher function children with autism (HFA) and an IQ-matched control sample. The results revealed a significant Diagnostic group by Verbal IQ interaction on ERN amplitude indicating that the most verbally capable HFA children displayed significantly larger ERN amplitudes than did the control children. Within the HFA sample, greater ERN amplitude was also related to parent reports of fewer symptoms of social interaction impairments, fewer internalizing problems, but more externalizing problems, although these associations were reduced to nonsignificance when medication status was controlled. The latter results complement previous observations from imaging studies of a significant association between ACC activity and social symptoms and impairments in autism. The implications of these results for future research on brain-behavior relations, as well as treatment related research with children with autism are discussed.

Health-related quality of life in parents of school-age children with Asperger Syndrome or High-Functioning Autism

BACKGROUND

The estimated prevalence rate of Pervasive Developmental Disorders (PDD) in children is 6 per 1.000. Parenting children who are intellectually impaired and have PDDs is known to be linked to the impaired well-being of the parents themselves. However, there is still little available data on health-related quality of life (HRQL) in parents of children with Asperger Syndrome (AS) and High-Functioning Autism (HFA), or other PDD diagnoses in children of normal intelligence. The present study aimed to evaluate aspects of HRQL in parents of school-age children with AS/HFA and the correlates with child behaviour characteristics.

METHODS

The sample consisted of 31 mothers and 30 fathers of 32 children with AS/HFA and 30 mothers and 29 fathers of 32 age and gender matched children with typical development. Parental HRQL was surveyed by the use of the 12 Item Short Form Health Survey (SF-12) which measures physical and mental well-being. The child behaviour characteristics were assessed using the structured questionnaires: The High-Functioning Autism Spectrum Screening Questionnaire (ASSQ) and The Strengths and Difficulties Questionnaire (SDQ).

RESULTS

The mothers of children with AS/HFA had lower SF-12 scores than the controls, indicating poorer physical health. The mothers of children with AS/HFA also had lower physical SF-12 scores compared to the fathers. In the AS/HFA group, maternal health was related to behaviour problems such as hyperactivity and conduct problems in the child.

CONCLUSION

Mothers but not fathers of children with AS/HFA reported impaired HRQL, and there was a relationship between maternal well-being and child behaviour characteristics.

Factors associated with functioning style and coping strategies of families with a child with an autism spectrum disorder

A survey of parents/caregivers of a child with an autism spectrum disorder (ASD) was conducted to examine the relationship between ASD characteristics, family functioning and coping strategies. Having a child with ASD places considerable stress on the family. Primary caregivers of a child with ASD from a regional and rural area in Victoria, Australia (N = 53) were surveyed concerning their child with ASD, family functioning (adaptability and cohesion), marital satisfaction, self-esteem and coping strategies. Results suggest that these caregivers had healthy self-esteem, although they reported somewhat lower marital happiness, family cohesion and family adaptability than did norm groups. Coping strategies were not significant predictors of these outcome variables. Results highlight the need for support programmes to target family and relationship variables as well as ASD children and their behaviours, in order to sustain the family unit and improve quality of life for parents and caregivers as well as those children.